Endoscopies with electro-adhesion capabilities

Abstract

An endoscope comprises an elongate shaft comprising a proximal end portion and a distal end portion comprising a distal end tip, a working channel extending at least partially through the elongate shaft and including an opening proximate the distal end tip, an imaging device located proximate the distal end portion proximate the distal end tip, and an electro-adhesion system located on the elongate shaft. A method of operating an endoscope comprises inserting an elongate shaft of the endoscope into anatomy of a patient, activating an electroadhesion system to cause a portion of the endoscope to adhere to tissue of the anatomy, and performing an endoscopy procedure within the anatomy.

Description

ENDOSCOPES WITH ELECTRO-ADHESION CAPABILITIESPRIORITY CLAIM

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 63 / 744,048 filed January 10, 2025 and U.S. Provisional Patent Application Serial No. 63 / 896,266 filed October 9, 2025; the contents of which are incorporated herein by reference.TECHNICAL FIELD

[0002] The present disclosure relates to medical devices comprising elongate bodies configured to be inserted into incisions or openings in anatomy of a patient to provide diagnostic or treatment operations. More specifically, the present disclosure relates to endoscopes with electro-adhesion capabilities.BACKGROUND

[0003] Endoscopes can be used for a plurality of reasons including obtaining imaging of internal anatomical locations and providing passage of other devices, e.g., therapeutic devices or tissue collection devices, toward such internal anatomic locations. Such anatomical locations can include locations within the gastrointestinal tract, such as the esophagus, stomach, duodenum, pancreaticobiliary duct, intestines and colon; the renal area, such as the kidneys, ureter, bladder and urethra; and other internal locations, such as locations within the reproductive system, sinus cavity, submucosal regions, respiratory tract and the like.

[0004] Conventional endoscopes can be involved in a variety of clinical procedures, including, for example, illuminating, imaging, detecting and diagnosing one or more disease states, providing fluid delivery (e.g., saline or other preparations via a fluid channel) toward an anatomical region, providing passage (e.g., via a working channel) of one or more therapeutic devices for sampling or treating an anatomical region, and providing suction passageways for collecting fluids (e.g., saline or other preparations) and the like.

[0005] In conventional endoscopy, the distal portion of the endoscope can be configured for supporting and orienting a therapeutic device. In some systems, two endoscopes can be configured to work together with a first endoscope guiding a second endoscope inserted therein with the aid of an elevator. Such systems can be helpful in guiding endoscopes toanatomic locations within the body that are difficult to reach. For example, some anatomic locations can be accessed with an endoscope after insertion through a long, circuitous path.OVERVIEW AND SUMMARY

[0006] Endoscopes and duodenoscopes can be used to access anatomic locations deep within the body. It can be difficult to navigate an endoscope to these deep anatomic locations. It can be difficult to insert an instrument through an endoscope that is positioned within a deep anatomic location. For examples, issues relating to binding and stability can arise.

[0007] In duodenoscopy procedures (e.g., Endoscopic Retrograde Cholangiopancreatography, hereinafter “ERCP” procedures), an auxiliary scope (also referred to as a child scope or cholangioscope) can be attached and advanced through the working channel of a main scope (also referred to as a parent scope or duodenoscope). Another device, such as a treatment device, a therapeutic device, or a tissue retrieval device, can be inserted into the auxiliary scope. The duodenoscope, auxiliary scope and tissue retrieval device are progressively smaller. The smaller the device, the more difficult it can be to maneuver and perform diagnostics, imaging, interventions and treatments with the device. For example, it can be difficult to perform auxiliary procedures with an auxiliary scope inserted through a main scope due to, for example, the smaller diameter of the scope shaft compared to the surrounding anatomic duct. It can be difficult to insert a scope shaft deep into an anatomic duct, such as the small intestine, because of both the distance traversed to reach the small intestine and the winding pathway through the small intestine that produces friction and binding of the scope shaft.

[0008] The present disclosure provides endoscopes, auxiliary devices and other devices with electro-adhesion systems. The electro-adhesion systems can be used to add a variety of functionalities to the devices to improve the ability to image, diagnose and treat target tissue. In examples, target tissue can comprise tissue from human anatomy, animal anatomy, synthetic substances configured to mimic human or animal anatomy, cadaver anatomy and the like. The electro-adhesion systems can be configured to facilitate insertion of endoscopes through long, circuitous pathways and stabilize the endoscopes so that deployment of auxiliary scopes is more readily accomplished. The electro-adhesion systems can be used to rigidify an endoscope shaft to enhance pushability and provide a stable structure for auxiliary scopes. The electro-adhesion systems can be configured to anchor or attach a scope shaft to a surrounding anatomic structure to immobilize the scope shaft in axial and radial positions. Anchoring of the scope shaft can stabilize the endoscope to facilitate the performance ofvarious operations, such a medical intervention or an imaging operation. The electroadhesion systems can be used to provide propulsion to the scope shaft, such as through peristalsis action.

[0009] The present disclosure provides electro-adhesive systems that utilize electrical phenomena to cause coupling or attaching, e.g., attraction or adhesion, of one mass to another mass, as well as the reversal of such coupling or attaching. In particular, the electrical phenomena can be used to cause tissue to couple to an endoscope or instrument, such as to provide rigidification, anchoring and propulsion.

[0010] Although described with reference to particular procedures, e.g., ERCP, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), the present disclosure can be used in conjunction with other types of medical procedures, such as other procedures that can be used to perform interventional or diagnostic capabilities, particularly those that can benefit from medication or another substance being held in place against target tissue.

[0011] In an application of an electrical phenomenon, a principle of electrostatic attraction (“electro-attraction”) can be used to cause target tissue to attach to a medication applicator of the present disclosure. Electrostatic attraction can utilize the attraction between oppositely charged items, the forces of which are governed by Coulomb’s law (F=kQlQ2 / r2). The application of an electric field can induce electron transfer between two items to induce electrostatic attraction. This can be similar to the phenomena that occurs when a piece of paper clings to a glass surface in the presence of electrical surface charges. The electrostatic effect of astriction between two surfaces subjected to an electric field can be used to attract tissue to a medication applicator described herein.

[0012] In another application of an electrical phenomenon, a principle of electrostatic adhesion (at times referred to herein as “electro-adhesion” or “electroadhesion”) can be used to cause target tissue to attach to a charged plate in a medication applicator of the present disclosure. Electrostatic adhesion can utilize chemical bonds that are established between items when atoms are shared in a molecule, the forces of which can be described. The application of an electric field can induce atom sharing between two items to induce electrostatic adhesion. This can be similar to the phenomena that has recently been discussed in literature with respect to the attachment of gel to metal bodies via chemical bond induced by an electric field. The electrostatic effect of astriction between two surfaces subjected to an electric polarity can be used to adhere tissue to a medication applicator.

[0013] In the present application, the electrical phenomena of electro-attraction and / or electro-adhesion can be used to couple or attach tissue, at least temporarily, to an instrument that facilitates rigidification, anchoring or propulsion of a device to facilitate such device performing a medical procedure, diagnostic procedure or interventional procedure. In examples, the electro-adhesive system can be used to provide stabilization of a medical device to, for example, facilitate aiming of the device, as discussed with reference to FIG. 5 through FIG. 10. In examples, the electro-adhesive system can be used to provide engagement of a medical device with tissue to, for example, facilitate obtaining images, as discussed with reference to FIG. 11 through FIG. 13B. In examples, the electro-adhesive system can be used to provide propulsion to, for example, provide advancement into anatomic ducts, as discussed with reference to FIG. 14 through FIG. 16F.

[0014] Though described with particular reference to electro-adhesion, the present application may alternatively be used with electro-attraction, in select implementations. In additional implementations electro-adhesion and electro-attraction may be used together.

[0015] With regard to electro-adhesion, it can be demonstrated that electricity can be used to adhere gels, or gel -like objects such as tissue, to objects, particularly hard objects, such as metals and graphite. Salt content in soft materials can play a role in the electro-adhesive effect. Further, metals that are more likely to release free electrons demonstrate a higher likelihood of adhering to the soft tissue under an applied electro-adhesive field. Metals like copper, lead, and tin readily release electrons and exhibit better electro-adhesion compared to metals like nickel, iron, zinc, and titanium, which hold onto their electrons more strongly. Research indicates that electro-adhesion may occur due to chemical bonds formed between the electrode and soft material after electron exchange. Electro-adhesion can occur at different electrodes (e.g., anode or cathode) depending on the materials involved, and increasing voltage strength and duration can enhance adhesion strength. In some circumstances, application of an electric field in a first polarity can induce adhesion and application of an electric field in the opposite polarity can remove the adhesion.

[0016] The present disclosure recognizes that such electro-adhesion can be applied to biological tissue in medical procedures. In examples, the present disclosure relates to electroadhesive components that can utilize electro-adhesion to attach an instrument to tissue in order to facilitate performance of a treatment plan or for other purposes. Such electroadhesive components can be useful in a wide variety of applications, such as ERCP procedures, ultrasound imaging procedures, endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and other medical procedures and operations.

[0017] The electro-adhesive systems can use a gel, such as acrylamide gel, as the electroadhesive material, applying it to biological tissue through electrodes to facilitate attachment to target tissue. However, in alternative examples, gel may not be used, and tissue is directly adhered to the electrode, e.g., electro-adhesive component. A first polarity can be applied to the tissue (and gel, if present) to cause the tissue to attach to the electro-adhesive component. By switching the electrical polarity, the tissue (and gel, if present) can be detached from the electrode, allowing for safe and efficient tissue removal of the electro-adhesive component at a later time after the medication has been exhausted or otherwise utilized. Without wishing to be bound by theory, it is thought that the gel may be able to facilitate sharing of electrons in atoms of the tissue to promote electro-adhesion.

[0018] In an example, an endoscope comprises an elongate shaft comprising a proximal end portion and a distal end portion comprising a distal end tip, a working channel extending at least partially through the elongate shaft and including an opening proximate the distal end tip, an imaging device located proximate the distal end portion proximate the distal end tip, and an electro-adhesion system located on the elongate shaft.

[0019] In an example, a method of operating an endoscope comprises inserting an elongate shaft of the endoscope into anatomy of a patient, activating an electro-adhesion system to cause a portion of the endoscope to adhere to tissue of the anatomy, and performing an endoscopy procedure within the anatomy.

[0020] In an example, a method of controlling an endoscope system comprises activating an expansion device to expand with an electrode to engage the electrode to a target, applying voltage of a first polarity to the electrode to form an electro-adhesive bond between the target and the electrode, and applying voltage of a second polarity opposite the first polarity to the electrode to break the electro-adhesive bond between the target and the electrode.BRIEF DESCRIPTION OF DRAWINGS

[0021] FIG. l is a schematic diagram of an endoscopy system comprising an imaging and control system and an endoscope, such as duodenoscope, with which the electro-adhesion systems of the present disclosure can be used.

[0022] FIG. 2A is a schematic diagram of the imaging and control system of FIG. 1 showing the imaging and control system connected to the endoscope.

[0023] FIG. 2B is a schematic diagram of an electro-adhesion system including an electrical generator system suitable for use with the endoscopy system of FIG.2A to apply electroadhesion energy to medical devices of the present disclosure.

[0024] FIG. 3 A is a schematic top view of a distal portion of the endoscope of FIG. 2A comprising a camera module including optical components for a side-viewing endoscope and an elevator mechanism.

[0025] FIG. 3B is a cross-sectional view taken along the plane 3B - 3B of FIG. 3 A showing the optical components.

[0026] FIG. 3C is a cross-sectional view taken along the plane 3C - 3C of FIG. 3A showing the elevator mechanism.

[0027] FIG. 4A is an end view of a camera module including optical and functional components suitable for use as an auxiliary scope that can be used with the endoscope of FIG. 1 and FIG. 2 A or other scopes.

[0028] FIG. 4B is a cross-sectional view taken along section 4B - 4B of FIG. 4A showing components of the camera module arranged in an end-viewing configuration.

[0029] FIG. 5 is a schematic illustration of distal portion of endoscope 100 according to the present disclosure positioned in duodenum D.

[0030] FIG. 6 is a schematic illustration of an endoscope that includes a shaft with an electroadhesion stabilization system.

[0031] FIG. 7 is a schematic perspective view of an endoscope that includes a shaft with an electro-adhesion positioning system.

[0032] FIG. 8 A is a cross-sectional view of the shaft of FIG. 7 showing the electro-adhesion positioning system in a first radial state relative to an anatomic duct.

[0033] FIG. 8B is a cross-sectional view of the shaft of FIG. 7 showing the electro-adhesion positioning system in a second radial state relative to an anatomic duct.

[0034] FIG. 9 is a schematic view of a controller for the electro-adhesion positioning system of FIG. 7.

[0035] FIG. 10 is a schematic illustration of an electro-adhesion positioning system being used to hold a duodenoscope within a duodenum.

[0036] FIG. 11 is a schematic illustration of an electro-adhesion positioning system being used to hold an endoscopic ultrasound device within an anatomic duct to stabilize an imaging sensor.

[0037] FIG. 12A is a schematic side view of an endoscope with an electro-adhesion positioning system for a first type of imaging sensor, wherein the electro-adhesion positioning system is in a retracted and deactivated state.

[0038] FIG. 12B is schematic side view of the endoscope of FIG. 12A with the electroadhesion positioning system in an extended and activated state to adhere to tissue.

[0039] FIG. 12C is a cross-sectional view through the endoscope of FIG. 12A showing an actuation mechanism for the electro-adhesion positioning system.

[0040] FIG. 13 A is a schematic side view of an endoscope with an electro-adhesion positioning system for a second type of imaging sensor, wherein the electro-adhesion positioning system is in a retracted and deactivated state.

[0041] FIG. 13B is schematic side view of the endoscope of FIG. 13 A with the electroadhesion positioning system in an extended and activated state to adhere to tissue.

[0042] FIG. 13C is a cross-sectional view through the endoscope of FIG. 13A showing an actuation mechanism for the electro-adhesion positioning system.

[0043] FIG. 14 is a perspective view of an endoscope with an electro-adhesion propulsion system of the present disclosure.

[0044] FIG. 15A is schematic side view of the electro-adhesion propulsion system of FIG. 14 shown in cross-section to illustrate components thereof.

[0045] FIG. 15B is a close-up view of a dynamic seal suitable for use with the electroadhesion propulsion system of FIG. 14.

[0046] FIG. 16A through FIG. 16F illustrate operations of a method of deploying an endoscope using the electro-adhesion propulsion system of FIG. 14 through FIG. 15B.

[0047] FIG. 17 is a block diagram illustrating operations in methods of anchoring and / or stabilizing a medical instrument using electro-adhesion systems of the present disclosure.

[0048] FIG. 18 is a block diagram illustrating operations in methods of advancing a medical instrument using electro-adhesion systems of the present disclosure.DETAILED DESCRIPTION

[0049] FIG. 1 is a schematic diagram of endoscopy system 110 comprising imaging and control system 112 and endoscope 114. The system of FIG. 1 is an illustrative example of an endoscopy system suitable for use with the systems, devices and methods described herein, such as endoscopes with electro-adhesion capabilities, such as can be used to provide stabilizing, anchoring and propulsion systems. According to some examples, at least a distal portion of endoscope 114 can be insertable into an anatomical region for imaging and / or to provide passage of one or more sampling devices for biopsies, or one or more therapeutic devices for treatment of a disease state associated with the anatomical region. Endoscope 114 can, in advantageous aspects, interface with and connect to imaging and control system112. In the illustrated example, endoscope 114 comprises a duodenoscope, though other types of endoscopes can be used with the features and teachings of the present disclosure.

[0050] Imaging and control system 112 can comprise control unit 116, output unit 118, input unit 120, light source unit 122, fluid source 124, suction pump 126 and electro-adhesion system 127.

[0051] Imaging and control system 112 can include various ports for coupling with endoscopy system 110. For example, control unit 116 can include a data input / output port for receiving data from and communicating data to endoscope 114. Light source unit 122 can include an output port for transmitting light to endoscope 114, such as via a fiber optic link. Fluid source 124 can include a port for transmitting fluid to endoscope 114. Fluid source 124 can comprise a pump and a tank of fluid or can be connected to an external tank, vessel or storage unit. Suction pump 126 can comprise a port used to draw a vacuum from endoscope 114 to generate suction, such as for withdrawing fluid from the anatomical region into which endoscope 114 is inserted. Output unit 118 and input unit 120 can be used by an operator of endoscopy system 110 to control functions of endoscopy system 110 and view output of endoscope 114. Control unit 116 can be used to generate signals or other outputs from treating the anatomical region into which endoscope 114 is inserted. In examples, suction pump 126 can be configured to provide pressurized fluid to a surgical site. In examples, fluid source 124 and suction pump 126 can be configured to provide gel to the surgical site to facilitate electro-adhesion.

[0052] Output unit 118 and input unit 120 can be used by an operator of endoscopy system 110 to control functions of endoscopy system 110 and view output of endoscope 114.Control unit 116 can be used to generate signals or other outputs from treating the anatomical region into which endoscope 114 is inserted. In examples, control unit 116 can generate electrical output, acoustic output, a fluid output, a gas output, and the like for treating the anatomical region with, for example, cauterizing, cutting, freezing and the like. Control unit 116 can be used to operate electro-adhesion system 127 and various instruments, components and sub -systems thereof.

[0053] Endoscope 114 can comprise insertion section 128, functional section 130 and handle section 132, which can be coupled to cable section 134 and coupler section 136.

[0054] Insertion section 128 can extend distally from handle section 132 and cable section 134 can extend proximally from handle section 132. Insertion section 128 can be elongate and include a bending section, and a distal end to which functional section 130 can be attached. The bending section can be controllable (e.g., by control knob 138 on handlesection 132) to maneuver the distal end through tortuous anatomical passageways (e.g., stomach, duodenum, kidney, ureter, etc.). Insertion section 128 can include one or more working channels (e.g., an internal lumen) that can be elongate and support insertion of one or more therapeutic tools of functional section 130, such as auxiliary scope 234 of FIG. 5. The working channel can extend between handle section 132 and functional section 130. The working channel can be truncated at functional section 130 as discussed herein. Additional functionalities, such as fluid passages, guide wires, and pull wires can be provided by insertion section 128 (e.g., via suction or irrigation passageways, and the like). Insertion section 128 can include an imaging channel to allow for the positioning of wires and cables from imaging components and illumination components within functional section 130. The imaging channel can be divided into a proximal imaging channel and a distal imaging component lumen.

[0055] As described herein, insertion section 128 can be provided with one or more different electro-adhesion systems.

[0056] In examples, insertion section 128 can include or can be inserted into a sheath including a plurality of elongate wires that can extend along all or some of the length of insertion section 128. The elongate wires can be electrically activated to cause insertion section 128 to adhere to surrounding anatomy, thereby stiffening insertion section 128, as discussed with reference to FIG. 6.

[0057] In examples, insertion section 128 can include or can be inserted into a sheath including one or more radially distributed balloons that can direct or push insertion section 128 radially toward anatomy. The one or more balloons can include elongate wires or strips that can be electrically activated to cause the balloons to adhere to surrounding anatomy, thereby stabilizing insertion section 128 to facilitate operation of an auxiliary scope or imaging operations, as discussed with reference to FIG. 7 through FIG. 13B. In particular, the one or more balloons can be inflated and activated to influence the radial position of insertion section 128 within an anatomic duct, as shown in FIG. 7 through FIG. 10. In particular, the one or more balloons can be inflated and activated to hold an imaging device in a fixed position, as shown in FIG. 11 through FIG. 13B.

[0058] In examples, insertion section 128 can include or can be inserted into a sheath including a plurality of axially distributed balloons that can hold insertion section 128 in radial engagement with surrounding anatomy. The one or more balloons can include elongate wires or strips that can be electrically activated to cause the balloons to adhere to surrounding anatomy. The one or more balloons can be axially advanced and / or retractedrelative to insertion section 128 to cause insertion section 128 to move distally or proximally through anatomy, such as via a pushing and pulling or peristalsis action, as discussed with reference to FIG. 14 through FIG. 16F.

[0059] Handle section 132 can comprise control knob 138 as well as port 140A and port 140B (FIG. 2 A). Control knob 138 can be coupled to a pull wire, or other actuation mechanisms, extending through insertion section 128. Port 140A, as well as other ports such as port 140B (FIG. 2 A), can be configured to couple various electrical cables, guide wires, auxiliary scopes, tissue collection or biopsy devices, fluid tubes and the like to handle section 132 for coupling with insertion section 128. In examples, port 140A can be used to feed an auxiliary scope, cholangioscope or ductal sampling device into insertion section 128. For example, electro-adhesion device 306 (FIG. 2B) can be fed into endoscope 114 via port 140 A, or into another endoscope inserted into port 140 A.

[0060] Imaging and control system 112, according to examples, can be provided on a mobile platform (e.g., cart 141) with shelves for the housing or storage of light source unit 122, suction pump 126, image processing unit 142 (FIG. 2 A), etc. Alternatively, several components of imaging and control system 112 shown in FIG. 1 and FIG. 2 A can be provided directly on endoscope 114 so as to make the endoscope “self-contained.”

[0061] Functional section 130 can comprise components for treating and diagnosing anatomy of a patient. Functional section 130 can comprise an imaging device, an illumination device and an elevator, such as is described further with reference to elevator 154 of FIGS. 3A - 3C. Functional section 130 can comprise one or more passages for receiving other instruments, such as auxiliary scope 234 of FIG. 5. Operation of some or all features of functional section 130 can be performed at imaging and control system 112.

[0062] FIG. 2A is a schematic diagram of endoscopy system 110 of FIG. 1 comprising imaging and control system 112 and endoscope 114. FIG. 2A schematically illustrates components of imaging and control system 112 coupled to endoscope 114, which in the illustrated example comprises a duodenoscope. Imaging and control system 112 can comprise control unit 116, which can include or be coupled to image processing unit 142, treatment generator 144, drive unit 146 and electro-adhesion system 127, as well as light source unit 122, input unit 120 and output unit 118. In examples, control unit 116 be in communication with or coupled to auxiliary scope 234 (FIG. 5).

[0063] Coupler section 136 can be connected to control unit 116 via cable 149 (shown schematically in FIG. 2 A) to connect to endoscope 114 to multiple features of control unit 116, such as image processing unit 142 and treatment generator 144. In examples, port 140Acan be used to insert another instrument or device, such as a daughter scope, auxiliary scope or electro-adhesion device 306 of FIG. 2B, into endoscope 114. Such instruments and devices can be independently connected to control unit 116 via cable 147. In examples, port MOB can be used to connect coupler section 136 to various inputs and outputs, such as video, air, light and electric. Such instruments and devices can be independently connected to control unit 116 via cable 147. In examples, port MOB can be used to connect coupler section 136 to various inputs and outputs, such as video, air, light and electric. As is discussed below in greater detail with reference to FIG. 2B, control unit 116 can comprise, or can be in communication with, electro-adhesion system 127. Electro-adhesion system 127 can comprise various components for applying various forms of electrical energy, e.g., one or both of alternating current (AC) and direct current (DC) electricity for producing electroadhesion and the like. In examples, electro-adhesion system 127 can be part of or integrated into treatment generator 144. Control unit 116 can be configured to activate a camera to view target tissue distal of functional section 130, such as when a biopsy device is positioned to extend from insertion section 128. Likewise, control unit 116 can be configured to activate light source unit 122 to shine light on a surgical instrument.

[0064] Image processing unit 142 and light source unit 122 can each interface with endoscope 114 (e.g., at functional section 130) by wired or wireless electrical connections. Imaging and control system 112 can accordingly illuminate an anatomical region, collect signals representing the anatomical region, process signals representing the anatomical region, and display images representing the anatomical region on output unit 118. Imaging and control system 112 can include light source unit 122 to illuminate the anatomical region using light of desired spectrum (e.g., broadband white light, narrow-band imaging using preferred electromagnetic wavelengths, and the like). Imaging and control system 112 can connect (e.g., via an endoscope connector) to endoscope 114 for signal transmission (e.g., light output from light source, video signals from imaging system in the distal end, diagnostic and sensor signals from a diagnostic device, and the like).

[0065] Fluid source 124 (FIG. 1) can be in communication with control unit 116 and can comprise one or more sources of air, saline or other fluids, as well as associated fluid pathways (e.g., air channels, irrigation channels, suction channels) and connectors (barb fittings, fluid seals, valves and the like). In examples, fluid source 124 can be used to deliver gel to a surgical site to facilitate electro-adhesion processes. Fluid source 124 can be utilized as an activation energy for an actuation device or biasing device of the present disclosure. Imaging and control system 112 can include drive unit 146, which can be an optionalcomponent. Drive unit 146 can comprise a system for advancing a distal section of endoscope 114.

[0066] In examples, imaging and control system 112 can include electro-adhesion system 127. Electro-adhesion system 127 can be configured to deliver electrical energy, e.g., current and voltage, to electrodes that can thereby be selectively adhered to and released from tissue via the electro-adhesion effect. In examples, electro-adhesion system 127 can comprise an energy source or electrical generator. In examples, electro-adhesion system 127 can be connected to a user interface, such as a button or lever on handle section 132 or a foot switch, e.g., a pedal shown in FIG. 9, that can selectively apply voltage to the electrodes described herein in multiple polarities.

[0067] FIG. 2B is a schematic diagram of components of electro-adhesion system 300 suitable for use in applying electro-adhesion energy, such as direct current energy, to one or more electrodes of a medical instrument of the present disclosure. In examples, electroadhesion system 300 can be configured to apply various types of electrical energy, such as high-frequency (RF) energy for cutting and ablating. Electro-adhesion system 300 can comprise control unit 302 and treatment generator 304, which can be connected to electroadhesion device 306, electrode 308 and / or other devices, components and electrodes.Treatment generator 304 can comprise an alternating current generator, e.g., AC generator 310, and an electro-adhesion generator, e.g., EA generator 312. Treatment generator 304 can further comprise first connector 314 and second connector 316. First connector 314 can connect to electro-adhesion device 306, which can comprise an active electrode, through cable section 318 and second connector 316 can connect to electrode 308, which can comprise a neutral electrode or an opposing electrode for electro-adhesion device 306, through cable section 320. Electro-adhesion device 306 can comprise endoscope 322 and electrode system 324, which can include electrode 326A and electrode 326B. As discussed in greater detail below, endoscope 322 can be connected to electrode system 324 to allow endoscope 322 to receive electro-adhesive energy.

[0068] Electro-adhesion system 300 can comprise part of or be configured to work with endoscopy system 110. For example, treatment generator 304 can comprise or be part of treatment generator 144, and control unit 302 can comprise or be part of control unit 116.

[0069] AC generator 310 can be used to apply electrical energy to tissue 328, such as at electrode 308, electro-adhesion device 306, or another device that can be used during a surgical procedure that electro-adhesion device 306 is being used with, such as a forceps or cutting instrument. The electrical energy can be used to modify, e.g., cut, coagulate or ablate,tissue 328. AC generator 310 can be used to generate monopolar, bipolar and RF energy, as described herein. In examples, AC generator 310 can be used to generate and apply electroadhesion energy to electro-adhesion device 306 and electrode 308, such as by producing a voltage or electric potential between two of the electrodes, where the polarity is reversible.

[0070] EA generator 312 can be used to apply electrical energy to tissue 328, such as at electrode 308 and electro-adhesion device 306, which can comprise an endoscope or instrument including a tissue-engaging surface. The electrical energy can be used to induce the formation of a bond with surrounding gel and / or tissue, such as via electro-adhesion. EA generator 312 can provide alternating current (AC) and / or direct current (DC) to electroadhesion device 306 and electrode 308. In examples, EA generator 312 can be used to generate and apply electro-adhesion energy to electro-adhesion device 306 and electrode 308, such as by producing a voltage or electric potential between two of the electrodes that include reversible polarities.

[0071] Electrode 308 can comprise a pad that can be disposed relative to electro-adhesion device 306 to form an opposite pole for generating an electrical field. In examples, electrode 308 can comprise a pad disposed outside of the body of a patient in the vicinity of the internal surgical site. Electrode 308 can be positioned proximate the exterior of the chest, abdomen or waist for procedures performed inside the chest cavity, the abdominal cavity or the pelvic cavity. In examples, electrode 308 can be located on an instrument inserted into the anatomy, such as on a retractor, a stand for a retractor, an arm for a retractor, an access portal, an endoscope, a forceps or a cutting instrument. In examples, electrode 308 can comprise a release plate made of materials that are less conducting, and therefore less conducive to electro-adhesion. For example, because it can be in particular configuration desirable to not adhere tissue to electrode 308, electrode 308 can be fabricated from nickel, titanium or ironbased metals that exhibit less electro-adhesion capability than other materials, such as graphite, tin, copper and lead. Materials advantageous for electro-adhesion can exhibit a standard reduction potential of approximately -0.2 Volts. Correspondingly, electrodes of electro-adhesion device 306 can be made of high conducting materials, such as graphite, tin, copper and lead or other materials that enhance the electro-adhesion. Such differentiation in the materials of the electrodes for generating the electro-adhesion voltage polarities can comprise a smart polarity control system.

[0072] Electrode system 324 of electro-adhesion device 306 can comprise an opposite electrode for electrode 308 between which voltage potentials can be generated. As discussed herein, application of one voltage polarity between electro-adhesion device 306 and electrode308 can cause tissue to adhere to electrode system 324 and application of the opposite voltage polarity between electro-adhesion device 306 and electrode 308 can cause the tissue adherence to release from electro-adhesion device 306. Effects at electrode 308 can be the opposite as at electro-adhesion device 306.

[0073] The electro-adhesion energy can be used to intentionally adhere tissue to electrode system 324 for the purposes of enhancing grip, traction or purchase on the tissue to allow endoscope 322 to engage with the tissue to, for example, push off or gain leverage from the tissue to allow endoscope 322 or an instrument used therewith to better achieve a desired result. This is to be distinguished from ablated or coagulated tissue that can undesirably stick to instrumentation due to the tissue becoming sticky in the modified state. As discussed herein, electro-adhesion can be used to cause attaching of desirable tissue portions to electrode system 324. That is, intact tissue that is not ablated or cauterized where the natural characteristic of the tissue is unaltered can be adhered to electrode system 324. Cutting or ablation of tissue can destroy tissue that is not intended to be destroyed or altered via electricity. Voltages for inducing electro-adhesion can be low compared to electro- surgical levels. For example, electro- surgical cutting can use voltages of about two-hundred volts and higher, with alternating current in the range of one-hundred kilohertz to five megahertz. Coagulation can be achieved using cutting voltages at lower duty cycles. For electroadhesion, voltages in the range of approximately five volts to approximately ten volts DC can be used. Though higher voltages below two-hundred volts may be used, depending on desired tissue effect. In examples, the electro-adhesion can be applied in the range of approximately five second to approximately thirty seconds, though other shorter or longer periods of time can be used. For comparison, electro- surgical cutting is applied in bursts of less than five seconds to avoid various issues, such as interference with pacemakers and the like. In examples, the electro-adhesion energy can be applied for approximately three minutes or more, depending on application.

[0074] With the present disclosure, high frequency (HF) AC generator 310 can be used to apply high frequency (HF), AC voltage, in kHz ranges used for electrosurgical coagulation, cutting and cauterizing, in addition to EA generator 312 that can be used to apply DC voltage over the HF energy or at a different time as the HF energy to produce an electro-adhesion effect. Although, as mentioned, in examples, AC generator 310 can be used to generate electro-adhesion electric fields if desired. In examples, EA generator 312 can be configured to provide a voltage level of zero to approximately twenty volts (V). Electro-adhesion can occur in the range of approximately five volts to approximately ten volts. Current levels canbe in the range of approximately zero milliamps (mA) to approximately two-hundred mA. Electro-adhesion can occur in the range of approximately two mA to approximately ninety mA. The DC electro-adhesion voltage can be high enough to produce the desired effect of adhesion, but low enough to fulfil safety standards, such as the IEC 60601-1 standards for patient leakage currents. The DC electro-adhesion voltage can be modulated over the HF, AC voltage or can be generated separate from the HF, AC voltage. The DC electro-adhesion voltage can be switchable, e.g., on / off and polarity switching. In examples, stand-alone AC and DC generators can be used as opposed to being integrated into a single unit, such as treatment generator 304. In examples, one of an AC generator and a DC generator can be used as part of or separate from treatment generator 304. Alternatively, the electro-adhesion voltage (DC) can be applied intermittently alongside the HF Mode. The electro-adhesion voltage (DC) can be controlled via a microcomputer or micro-controller, central processing unit or field programable gate array (pC / CPU / FPGA), such as those included in control unit 302.

[0075] As discussed herein, electro-adhesion device 306 can be configured to adhere to tissue using electro-adhesion in order to accomplish instrument stabilization, positioning and / or advancement. Endoscope 322 of electro-adhesion device 306 can be mechanically engaged with the tissue of an anatomic structure to be traversed, navigated, etc., and electrode system 330 can be chemically bonded to the tissue and anatomic structure to allow endoscope 322 to gain leverage from the tissue.

[0076] FIG. 3A - FIG. 3C illustrate a first example of functional section 130 of endoscope 114 of FIG. 2A. FIG. 3A illustrates a top view of functional section 130. FIG. 3B illustrates a cross-sectional view of functional section 130 taken along section plane 3B - 3B of FIG.3A. FIG. 3C illustrates a cross-sectional view of functional section 130 taken along section plane 3C - 3C of FIG. 3A. FIG. 3A - FIG. 3C illustrate side-viewing endoscope camera module 150, such as can be used with a duodenoscope. In side-viewing endoscope camera module 150, illumination and imaging systems are positioned such that the viewing angle of the imaging system corresponds to a target anatomy lateral to central longitudinal axis Al of endoscope 114.

[0077] In the example of FIG. 3 A and FIG. 3B, side-viewing endoscope camera module 150 can comprise housing 152, elevator 154, fluid outlet 156, illumination lens 158 and objective lens 160. Housing 152 can form a fluid tight coupling with insertion section 128. Housing 152 can comprise opening for elevator 154. Elevator 154 can comprise a mechanism for moving a device inserted through insertion section 128, such as auxiliary scope 234 of FIG.5. In particular, elevator 154 can comprise a device that can bend an elongate device extended through insertion section 128 along axis Al, as is discussed in greater detail with reference to FIG. 3C. Elevator 154 can be used to bend the elongate device at an angle to axis Al to thereby treat or access the anatomical region adjacent to side-viewing endoscope camera module 150. Elevator 154 is located alongside, e.g., radially outward of axis Al, illumination lens 158 and objective lens 160.

[0078] As can be seen in FIG. 3B, insertion section 128 can comprise central lumen 162 through which various components (e.g., auxiliary scope 234 (FIG. 5) can be extended to connect functional section 130 with handle section 132 (FIG. 2A). For example, illumination lens 158 can be connected to light transmitter 164, which can comprise a fiber optic cable or cable bundle extending to light source unit 122 (FIG. 1). Likewise, objective lens 160 can be coupled to prism 166 and image processing unit 167, which can be coupled to wiring 168. Fluid outlet 156A can be coupled to fluid line 156B, which can comprise a tube extending to fluid source 124 (FIG. 1). Other elongate elements, e.g., tubes, wires, cables, can extend through central lumen 162 to connect functional section 130 with components of endoscopy system 110, such as suction pump 126 (FIG. 1) and treatment generator 144 (FIG. 2 A).

[0079] FIG. 3C a schematic cross-sectional view taken along section plane 3C - 3C of FIG.3C showing elevator 154. Elevator 154 can comprise deflector 155 that can be disposed in accommodation space 153 of housing 152. Deflector 155 can be connected to wire 157, which can extend through tube 159 to connect to handle section 132. Wire 157 can be actuated, such as by rotating a knob, pulling a lever, or pushing a button on handle section 132. Movement of wire 157 can cause rotation, e.g., clockwise, from a first position of deflector 155 about pin 161 to a second position of deflector 155, indicated by deflector 155’. Deflector 155 can be actuated by wire 157 to move the distal portion of instrument 163 extending through window 165 in housing 152.

[0080] Housing 152 can comprise accommodation space 153 that houses deflector 155. Instrument 163 can comprise forceps, a guide wire, a catheter, or the like that extends through central lumen 162. Instrument 163 can comprise an electro-adhesion device described herein (e.g., electro-adhesion device 306 of FIG. 2B) or another device, such as an endoscope that can receive an electro-adhesion device described herein. Instrument 163 can comprise auxiliary scope 234 of FIG. 5, as well as other instruments including other biopsy instruments or ductal sampling devices. A proximal end of deflector 155 can be attached to housing 152 at pin 161 provided to side-viewing endoscope camera module 150. A distal end of deflector 155 can be located below window 165 within housing 152 when deflector 155 is in thelowered, or un-actuated, state. The distal end of deflector 155 can at least partially extend out of window 165 when deflector 155 is raised, or actuated, by wire 157. Instrument 163 can slide on angled ramp surface 151 of deflector 155 to initially deflect the distal end of instrument 163 toward window 165. Angled ramp surface 151 can facilitate extension of the distal portion of instrument 163 extending from window 165 at a first angle relative to the axis of central lumen 162. Angled ramp surface 151 can include groove 169, e.g., a v-notch, to receive and guide instrument 163. Deflector 155 can be actuated to bend instrument 163 at a second angle relative to the axis of central lumen 162, which is closer to perpendicular that the first angle. When wire 157 is released, deflector 155 can be rotated, e.g., counterclockwise, back to the lowered position, either by pushing or relaxing of wire 157. In examples, instrument 163 can comprise a cholangioscope or auxiliary scope 234 (FIG. 5).

[0081] Side-viewing endoscope camera module 150 of FIGS. 3A - 3C can include optical components (e.g., objective lens 160, prism 166, image processing unit 167, wiring 168) for collection of image signals, lighting components (e.g., illumination lens 158, light transmitter 164) for transmission or generation of light. Side-viewing endoscope camera module 150 can include a photosensitive element, such as a charge-coupled device (“CCD” sensor) or a complementary metal-oxide semiconductor (“CMOS”) sensor. In either example, image processing unit 167 can be coupled (e.g., via wired or wireless connections) to image processing unit 142 (FIG. 2A) to transmit signals from the photosensitive element representing images (e.g., video signals) to image processing unit 142, in turn to be displayed on a display such as output unit 118. In various examples, imaging and control system 112 and image processing unit 167 can be configured to provide outputs at desired resolution (e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.) suitable for endoscopy procedures.

[0082] FIG. 4A illustrates an end view of end-viewing endoscope camera module 170 and FIG. 4B illustrates a cross-sectional view of end-viewing endoscope camera module 170 taken along section plane 4B - 4B of FIG. 4 A. FIG. 4 A and FIG. 4B each illustrate endviewing endoscope camera module 170, such as for use as a gastroscope, colonoscope, cholangioscope, and the like. In end-viewing endoscope camera module 170, illumination and imaging systems are positioned such that the viewing angle of the imaging system corresponds to a target anatomy located adjacent (e.g., distal of) an end of endoscope 114 and in line with a central longitudinal axis of endoscope 114.

[0083] End-viewing endoscope camera module 170 of FIG. 4A and FIG. 4B can be used as an alternative example of functional section 130 of endoscope 114 of FIG. 1 and FIG. 2A.End-viewing endoscope camera module 170 can be used in a cholangioscope, such as auxiliary scope 234 of FIG. 5.

[0084] In the example of FIGS. 4A and 4B, end-viewing endoscope camera module 170 can comprise housing 172, therapy unit 174, fluid outlets 176, illumination lens 178 and objective lens 180. Housing 172 can comprise and endcap for insertion section 128, thereby providing a seal to lumen 182.

[0085] As can be seen in FIG. 4B, insertion section 128 can comprise lumen 182 through which various components can be extended to connect end-viewing endoscope camera module 170 with handle section 132 (FIG. 2A), for example. For example, illumination lens 178 can be connected to light transmitter 184, which can comprise a fiber optic cable or cable bundle extending to light source unit 122 (FIG. 1). Likewise, objective lens 180 can be coupled to imaging unit 187, which can be coupled to wiring 188. In examples, light transmitter 184 can be located in the same lumen within housing 172, but light transmitter 184 and wiring 188 can be located within separate lumens within housing 172. As can be seen, objective lens 180 and imaging unit 187 can be wider or be of a larger diameter than wiring 188. Fluid outlets 176 can be coupled to fluid line 189, which can comprise a tube extending to fluid source 124 (FIG. 1). In examples, one of fluid outlets 176 can comprise an inlet connected to a fluid line 189 configured for suction, such as being connected to a vacuum, for recovery of lavage and irrigation fluid. In examples, one of fluid outlets 176 can comprise a fluid passage for receiving gel or a gel delivery instrument to facilitate electroadhesion as discussed herein. Other elongate elements, e.g., tubes, wires, cables, can extend through lumen 182 to connect functional section 130 with components of endoscopy system 110, such as suction pump 126 (FIG. 1) and treatment generator 144 (FIG. 2 A). For example, therapy unit 174 can comprise a wide-diameter lumen for receiving other treatment components, such as cutting devices, sampling devices, therapeutic devices, tissue separator devices and the like.

[0086] End-viewing endoscope camera module 170 can include a photosensitive element, such as a charge-coupled device (“CCD” sensor) or a complementary metal -oxide semiconductor (“CMOS”) sensor. In either example, imaging unit 187 can be coupled (e.g., via wired or wireless connections) to image processing unit 142 (FIG. 1) to transmit signals from the photosensitive element representing images (e.g., video signals) to image processing unit 142, in turn to be displayed on a display such as output unit 118. In various examples, imaging and control system 112 and imaging unit 187 can be configured to provide outputs atdesired resolution (e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.) suitable for endoscopy procedures.

[0087] As an endoscope is inserted further into the anatomy, the complexity with which it is maneuvered and contorted increases, as described with reference to FIG. 5. Furthermore, in order to reach locations even further in the anatomy, additional devices can be used, e.g., instrument 163 in the form of auxiliary scope 234 (FIG. 5). As such, the cross-sectional area, e.g., diameter, of nested devices is smaller, accommodating smaller devices that can be difficult to manipulate and stabilize to obtain satisfactory results, such as due to the main scope being unsupported in place. The scopes of the present disclosure can be provided with electro-adhesion systems. The electro-adhesion systems can be used to facilitate axial displacement, maneuvering, contorting, anchoring and controlling of a scope shaft within constricted or confined passages over large lengths.

[0088] FIG. 5 is a schematic illustration of distal portion of endoscope 200 according to the present disclosure positioned in duodenum D. Endoscope 200 can comprise functional module 202, insertion section module 204, and control module 206, as well as an electroadhesion system. Control module 206 can include controller 208. Control module 206 can include other components, such as those described with reference to endoscopy system 110 (FIG. 1) and control module 206 (FIG. 2A). Control module 206 can comprise components for controlling a camera and a light source connected to auxiliary scope 234, such as imaging unit 210, lighting unit 212 and power unit 214. Endoscope 200 can be configured similarly as endoscope 114 of FIG. 1 and FIG. 2 A. Power unit 214 can be used to provide electrical properties, e.g., current and voltage, to various electrodes, e.g., wires, strips and the like described herein, to provide electro-adhesion activation and deactivation.

[0089] Duodenum D can comprise duct wall 220, sphincter of Oddi 222, common bile duct 224 and main pancreatic duct 226. Duodenum D comprises an upper part of the small intestine. Common bile duct 224 carries bile from the gallbladder and liver (not illustrated) and empties the bile into the duodenum D through sphincter of Oddi 222. Main pancreatic duct 226 carries pancreatic juice from the exocrine pancreas (not illustrated) to common bile duct 224. Sometimes it can be desirable to remove biological matter, e.g., tissue, from common bile duct 224 or main pancreatic duct 226 to analyze the tissue to, for example, diagnose diseases or maladies of the patient such as cancer.

[0090] Functional module 202 can comprise elevator portion 230. Endoscope 200 can further comprise lumen 232 and auxiliary scope 234. Auxiliary scope 234 can comprise lumen 236. Auxiliary scope 234 can itself include functional components, such as cameralens 237 and a light lens (not illustrated) coupled to control module 206, to facilitate navigation of auxiliary scope 234 from endoscope 200 through the anatomy and to facilitate viewing of components extending from lumen 232.

[0091] In certain duodenoscopy procedures (e.g., Endoscopic Retrograde Cholangiopancreatography, hereinafter “ERCP” procedures) an auxiliary scope (also referred to as daughter scope, or cholangioscope), such as auxiliary scope 234, can be attached and advanced through lumen 232 (or central lumen 162 of insertion section 128 of endoscope 114 in FIG. 3B) of the “main scope” (also referred to as mother scope, or duodenoscope), such as endoscope 200. As discussed in greater detail below, auxiliary scope 234 can be guided into sphincter of Oddi 222. Therefrom, a surgeon operating auxiliary scope 234 can navigate auxiliary scope 234 through lumen 232 toward the gall bladder, liver or other locations in the gastrointestinal system to perform various procedures. The surgeon can navigate auxiliary scope 234 past entry 228 of main pancreatic duct 226 and into passage 229 of common bile duct 224, or into entry 228. Auxiliary scope 234 can be used to guide an additional device to the anatomy to obtain biological matter, such as by passage through or attachment to lumen 236. The additional device can include its own functional devices, such as a light source, camera, tissue separators, accessories, and biopsy channel, for therapeutic procedures. The biological matter can then be removed from the patient, such as by removal of the additional device from the auxiliary device, so that the removed biological matter can be analyzed to diagnose one or more conditions of the patient. According to several examples, endoscope 200 can be suitable for the removal of cancerous or pre-cancerous matter (e.g., carcinoma, sarcoma, myeloma, leukemia, lymphoma and the like), endometriosis evaluation, biliary ductal biopsies, and the like.

[0092] However, as mentioned above, the size of the additional device can be small due to the progressively smaller sizes of endoscope 200, auxiliary scope 234 and the additional device. In examples, lumen 232 of endoscope 200 can be on the order of approximately 4.0 mm in diameter, and lumen 236 of auxiliary scope 234 can be on the order of approximately 1.2 mm. As such, it can be difficult to hold an endoscope stable within surrounding anatomy. Furthermore, in some procedures, it can be difficult to reach certain anatomic locations due to looping of the endoscope produced by navigating the endoscope through tight turns, such as the pyloric sphincter of the stomach and the sphincter of the common bile duct (Sphincter of Oddi). This looping of the endoscope can potentially result in inoperability of the endoscope due to binding, e.g., the endoscope is too tightly curved to allow for additional articulation. This looping can make it difficult to axially advance an endoscope through anatomy.

[0093] Endoscopic retrograde cholangiopancreatography (ERCP) procedures can benefit from instruments that can be held steady and easily advanced forward. Other procedures can benefit from surgical devices, such as endoscopes and instruments extended therefrom, being held steady and being able to be readily advanced, such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and other endoscopic diagnostic applications. EMR / ESD is a minimally invasive procedure used to remove precancerous and cancerous areas in the gastrointestinal tract. Such a procedure involves using an endoscope to dissect and remove tumors located under the lining of the GI tract. The endoscope location may be stabilized to perform the resection process. Examples of ESD procedures are described in Pub. No. US 2015 / 0105769 Al to Igarashi et al., titled “Method for endoscopic treatment,” the entire contents of which are hereby incorporated herein by this reference.

[0094] Current designs in the market comprise traditional scopes with an insertion tube, a passive and active articulation section, and a front or side facing distal end design for the appropriate procedure it will be used. These designs rely on the experience and technique of the user in order to locate and position the scope before any secondary step for the procedure can be performed. These secondary steps can include deploying a guidewire, cannula, knife or an aspiration needle. An example of a stabilization technology that adds rigidity to the scope during procedure comprises a sheath that can be positioned over an endoscope shaft that can toggle between flexible and the rigidity of the scope. Examples of such technology are mentioned in Pat. No. US 11,135,398 B2 to Tilson et al., titled “Dynamically rigidizing composite medical structures.” However, such systems are bulky and undesirably add some level of rigidity at times when rigidity is not desired.

[0095] With the systems and devices of the present disclosure, it is possible to provide stability to the endoscope with electro-adhesion systems to facilitate the performance of endoscopy procedures. Electro-adhesion stabilization system 404 (FIG. 6), electro-adhesion positioning system 454 (FIG. 7), electro-adhesion positioning system 506 (FIG. 11), electroadhesion positioning system 602 (FIG. 12A), and electro-adhesion positioning system 652 (FIG. 13A) can comprise electro-adhesive anchoring systems of the present disclosure. Furthermore, the electro-adhesion systems of the present disclosure can be used to provide axial advancement of the endoscope even when the endoscope is advanced far into anatomy or looped into tight configurations. Electro-adhesion propulsion system 704 (FIG. 14) can comprise an electro-adhesion propulsion system of the present disclosure. The proposed devices and systems of the present disclosure provide scope stability and traction capabilitiesby fixing a specific position of the scope in relation to an annular area and axial location at the intraluminal tissue via application of electro-adhesion technology. The stability and traction capabilities can be activated while performing a secondary procedure after the surgical site is reached. The general concept of the electro-adhesion phenomenon is discussed in Reversibly Sticking Metals and Graphite to Hydrogels and Tissues by W. Xu et al., ACS Cent. Sci. 2024, 10, 3, 695-707, the entire contents of which are hereby incorporated by this reference.

[0096] FIG. 6 is a schematic illustration of endoscope 400 comprising shaft 402 and electroadhesion stabilization system 404. In examples, electro-adhesion stabilization system 404 can be configured for use with a front facing scope used for ESD, as illustrated in FIG. 6. Electro-adhesion stabilization system 404 can be used with side facing scopes and other procedures. Shaft 402 can comprise distal face 406. Working channel 408 can extend into distal face 406 to a proximal portion of endoscope 400. Distal face 406 can include light emitter 410 and imaging device 412. Irrigation channel 414 can extend into distal face 406 to connect to a fluid or suction source, such as fluid source 124 suction pump 126 (FIG. 1). Electro-adhesion stabilization system 404 can comprise sheath 415, electrode 416A, electrode 416B and electrode 416C. Endoscope 400 can include taper features to guide the electrodes out of and into sheath 415. For example, electrode 416A can include inlet taper 418A and outlet taper 420 A, electrode 416B can include inlet taper 418B and outlet taper 420B, and electrode 416C can include inlet taper 418C and outlet taper 420C. Electrode 416A, electrode 416B and electrode 416C can be connected to wire 422 A, wire 422B and wire 422C, respectively.

[0097] In examples, electro-adhesion stabilization system 404 can be disposed over an existing scope, such as for use with a single-use or disposable device. Sheath 415 can be slid onto shaft 402, and wire 422A, wire 422B and wire 422C can extend along the exterior of shaft 402. An example of an add-on system is shown in FIG. 6. In examples, electroadhesion stabilization system 404 can be embedded to an insertion tube or shaft of a reusable scope. Sheath 415 can comprise the exterior of shaft 402, and wire 422A, wire 422B and wire 422C can extend within shaft 402. Electro-adhesion stabilization system 404 can be lightweight and not substantially increase the diameter and rigidity of shaft 402 when not in use, e.g., electro-adhesively activated.

[0098] In examples, three electrodes are provided: electrode 416A, electrode 416B and electrode 416C. In examples, electro-adhesion stabilization system 404 can comprise more or fewer than electrode 416A, electrode 416B and electrode 416C. The electrodes can be1circumferentially spaced to provide electro-adhesion in multiple, different radial directions relative to the central axis of shaft 402. The electrodes can be equally spaced around the circumference of shaft 402. The electrodes can be unevenly spaced around the circumference of shaft 402. The electrodes can be positioned along an entirety or substantial entirety of the length of shaft 402, or along less than the entire length of shaft 402. The electrodes can be positioned in one or more specific axial and / or circumferential locations where rigidity is desired. Each electrode can comprise a graphite flexible braided wire. However, other types of materials can be used, such as tin, copper or lead wire or other materials listed herein that facilitate electro-adhesion. Electrode 416A, electrode 416B and electrode 416C can be prevented from separating from sheath 415. Electrode 416A, electrode 416B and electrode 416C can be attached to sheath 415 via mechanical fixation, adhesive, metallurgical fixation and the like. Electrode 416A, electrode 416B and electrode 416C can be attached along their entire lengths or along various portions of their lengths. Sheath 415 can be made of a flexible material to reduce interference with the operation, e.g., flexing, of shaft 402 and to facilitate positioning of sheath 415 over shaft 402. Sheath 415 can be fabricated from an insulating material, such as rubber. The taper features, e.g., inlet taper 418A, outlet taper 420A, inlet taper 418B, outlet taper 420B, inlet taper 418C and outlet taper 420C, can be positioned over openings or holes in sheath 415 that allow electrode 416A, electrode 416B and electrode 416C and / or wire 422A, wire 422B and wire 422C to pass through sheath 415. The taper features can comprise rigid bodies that allow are angled to allow tissue to more readily slide over endoscope 400 without snagging or catching on tissue.

[0099] Wire 422A, wire 422B and wire 422C can be extended or connected to other wiring to connect to a voltage source, such as treatment generator 304 (FIG. 2B), treatment generator 144 (FIG. 2 A) or power unit 214 (FIG. 5). Wire 422 A, wire 422B and wire 422C can be individually connected to the voltage source, or can be bundled together in a cable. Each one of wire 422A, wire 422B and wire 422C can be individually activated as an electrode for electro-adhesion with another one of wire 422 A, wire 422B and wire 422C and electrode 308 acting as the opposite electrode. All or most of wire 422A, wire 422B and wire 422C can be connected to the voltage source to collectively be activated for electro-adhesion with electrode 308 acting as the opposite electrode.

[0100] A charge can be applied to electrode 416A, electrode 416B and electrode 416C to cause electro-adhesion. A 5-volt DC positive charge, such as from treatment generator 144 (FIG. 2A) or power unit 214 (FIG. 5), can be applied to electrode 416A, electrode 416B and electrode 416C via wire 422 A, wire 422B and wire 422C, respectively, to cause the electro-adhesion. In examples, electrode 308 (FIG. 2B) can form an opposing electrode for electrode 416A, electrode 416B and electrode 416C. A polarity can be controlled between one or more of electrode 416A, electrode 416B and electrode 416C and electrode 308. The application of voltage to electrode 416A, electrode 416B and electrode 416C can cause the electrodes to adhere to surrounding tissue to hold and stabilize endoscope 400. The electro-adhesion can be released or turned off via switching the polarity between electrode 416A, electrode 416B and electrode 416C and electrode 308. A negative charge can be applied to electrode 416A, electrode 416B and electrode 416C release the electro-adhesion. A 5-volt negative charge can be applied to electrode 416A, electrode 416B and electrode 416C to release the electroadhesion. In examples, other voltages and currents can be used to cause and release the electro-adhesion.

[0101] Electro-adhesion of one or more of electrode 416A, electrode 416B and electrode 416C to tissue of an anatomical duct can temporarily rigidify shaft 402 and immobilize shaft 402 relative to the anatomic duct. The rigidification of shaft 402 can make it easier to pass instruments through working channel 408. The immobilization of shaft 402 can make it easier to control instruments extending from working channel 408, such as by making it easier to aim an instrument to reach a desired tissue location, such as an opening for another duct or target tissue to be sampled.

[0102] FIG. 7 is a schematic perspective view of endoscope 450 comprising shaft 452 with electro-adhesion positioning system 454. In examples, electro-adhesion positioning system 454 can be configured for a side-facing or side-viewing duodenoscope in ERCP applications. In examples, electro-adhesion positioning system 454 can be used with end facing scopes and with other procedures. Endoscope 450 can comprise sheath 456, sheath 457 and functional element 458. Functional element 458 can comprise housing 460, elevator 462, imaging unit 464 and light emitter 466. Electro-adhesion positioning system 454 can comprise power supply system 468, electrode section 470 and balloon system 472. Electro-adhesion positioning system 454 can comprise power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D. Electrode section 470 can comprise electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D and ring 478. Balloon system 472 can comprise balloon 480A (a first balloon), balloon 480B (a second balloon), balloon 480C (a third balloon) and balloon 480D (a fourth balloon).

[0103] Electro-adhesion positioning system 454 can be used to selectively push shaft 452 of endoscope 450 in one or more desired radial directions. One or more of balloon 480A, balloon 480B, balloon 480C and balloon 480D can be partially or fully inflated to positionshaft 452 within an anatomic duct or lumen to influence the location of functional element 458, thereby allowing functional element 458 to better view or interact with tissue, such as by being more stable, closer to a desired target of more firmly engaged with a desired target.

[0104] In examples, electro-adhesion positioning system 454 can be disposed over an existing scope, such as for use with a single-use or disposable device. Sheath 457 can be slid onto shaft 452, and power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D can extend along the exterior of shaft 452. An example of an add-on system is shown in FIG. 7. In examples, electro-adhesion positioning system 454 can be embedded to an insertion tube or shaft of a reusable scope, such as by being incorporated directly onto shaft 452 or insertion section 128 (FIG. 1). Sheath 457 can be disposed along the exterior of shaft 452, and power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D can extend within shaft 452. Electro-adhesion positioning system 454 can be lightweight and not substantially increase the diameter and rigidity of shaft 452 when not in use, e.g., electro-adhesively activated.

[0105] FIG. 7 illustrates four power supply cables (power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D) and four electrodes (electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D). Electro-adhesion positioning system 454 can include greater than or less than four power supply cables and electrodes. The electrodes can be circumferentially spaced to provide electro-adhesion in multiple, different radial directions relative to the central axis of shaft 452. The electrodes can be equally spaced around the circumference of shaft 452. The electrodes can be unevenly spaced around the circumference of shaft 452. In the illustrated example, four electrodes are spaced ninety degrees apart to provide pushing in four radial directions. The electrodes can be positioned along an entirety or substantial entirety of the length of shaft 452, or along less than the entire length of shaft 452. The electrodes can be positioned in one or more specific axial and / or circumferential locations where positioning is desired. For example, the electrodes can be positioned in close proximity to functional element 458 and elevator 462, or can be positioned more proximally from functional element 458 at a specific location along shaft 452.

[0106] Each electrode can comprise a graphite flexible braided wire or a strip of graphite material, such as a ribbon or the like. However, other types of materials can be used, such as tin, copper or lead wire or other materials listed herein that facilitate electro-adhesion.Electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D can be allowed to separate from sheath 457. Electrode strip 476A, electrode strip 476B, electrodestrip 476C, electrode strip 476D can be held in place along shaft 452 via sheath 456 and sheath 457. Sheath 457 can be made of a flexible material to reduce interference with the operation, e.g., flexing, of shaft 452 and to facilitate positioning of sheath 457 over shaft 452. Sheath 457 can be fabricated from an insulating material, such as rubber or a polymer.

[0107] Power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D can be connected to electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D, respectively. In examples, connections can be made using sliding couplers. The sliding couplers can comprise sockets on distal ends of power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D that receive mating plug on proximal ends of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D, similar to female and male spade connectors used in electrical wire. The spade connectors can be loosely fit together to allow electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D to slide relative to power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D to accommodate expansion of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D due to inflation of balloon 480A, balloon 480B, balloon 480C and balloon 480D.

[0108] Distal ends of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D can be connected to ring 478. Ring 478 can be disposed about sheath 457. Ring 478 can be slidable along sheath 457. Ring 478 can slide on sheath 457 to accommodate expansion of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D due to inflation of balloon 480A, balloon 480B, balloon 480C and balloon 480D.

[0109] Power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D can extend proximally to a voltage source, such as treatment generator 304 (FIG. 2B), treatment generator 144 (FIG. 2A) or power unit 214 (FIG. 5).

[0110] Power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D can be individually connected to the voltage source, or can be bundled together in a cable. Each one of power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D can be individually activated as an electrode for electro-adhesion with another one of power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D and electrode 308 acting as the opposite electrode. Each of power supply cable 474 A, power supply cable 474B, power supply cable 474C and power supply cable 474D can be connected to thevoltage source to collectively be activated for electro-adhesion with electrode 308 acting as the opposite electrode.[oni] A charge can be applied to electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D to cause electro-adhesion. A 5-volt DC positive charge, such as from treatment generator 144 (FIG. 2 A) or power unit 214 (FIG. 5), can be applied to electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D via power supply cable 474A, power supply cable 474B, power supply cable 474C and power supply cable 474D, respectively, to cause the electro-adhesion. In examples, electrode 308 (FIG. 2B) can form an opposing electrode for electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D. A polarity can be controlled between one or more of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D and electrode 308. The application of voltage to electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D can cause the electrodes to adhere to surrounding tissue to position and stabilize endoscope 450. The electro-adhesion can be released or turned off via switching the polarity between electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D and electrode 308. A negative charge can be applied to electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D to release the electro-adhesion. A 5-volt negative charge can be applied to electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D to release the electro-adhesion. In examples, other voltages and currents can be used to cause and release the electro-adhesion.

[0112] Electro-adhesion of one or more of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D to tissue of an anatomical duct can temporarily rigidify shaft 452 and immobilize shaft 452 relative to the anatomic duct. The rigidification of shaft 452 can make it easier to pass instruments extending from the working channel of elevator 462. The immobilization of shaft 452 can make it easier to control instruments extending from shaft 452, such as by making it easier to aim an instrument to reach a desired tissue location, such as an opening for another duct or target tissue to be sampled.

[0113] Inflation of balloon 480 A, balloon 480B, balloon 480C and balloon 480D can be accomplished with pressurized fluid, e.g., air, carbon dioxide, a gas, a liquid, saline, from a pump or compressor such as fluid source 124 (FIG. 1). Expansion of one or more of balloon 480A, balloon 480B, balloon 480C and balloon 480D can position shaft 452 relative to a center of an anatomic duct to facilitate engagement with desired tissue and the like, as explained with reference to FIG. 8 A and FIG. 8B.

[0114] FIG. 8 A is a cross-sectional view of shaft 452 of FIG. 7 showing electro-adhesion positioning system 454 in a first radial state relative to anatomic duct 482. In FIG. 8A balloon 480A and balloon 480D can be inflated and balloon 480C and balloon 480B can be deflated to push shaft 452 down and to the right relative to centerline CL2 and the orientation of FIG. 8 A.

[0115] FIG. 8B is a cross-sectional view of shaft 452 of FIG. 7 showing electro-adhesion positioning system 454 in a second radial state relative to anatomic duct 482. In FIG. 8B balloon 480C and balloon 480B can be inflated and balloon 480A and balloon 480D can be deflated to push shaft 452 up and to the left relative to centerline CL2 and the orientation of FIG. 8B.

[0116] Balloon 480A through balloon 480D can be inflated to any partially inflated state between empty and full. The inflation state of each of balloon 480 A through balloon 480D can be individually controlled to position functional element 458 in any radial direction relative to anatomic duct 482. In FIG. 8A, functional element 458 is positioned at the one-hundred-thirty -five-degree location in anatomic duct 482 relative to the orientation of FIG.8A. Balloon 480A could be fully inflated, balloon 480B could be halfway inflate, balloon 480D could be halfway inflated and balloon 480C could be deflated to position functional element 458 in the one-hundred-eighty-degree location in anatomic duct 482. In FIG. 8B, functional element 458 is positioned at the three-hundred-fifteen-degree location in anatomic duct 482 relative to the orientation of FIG. 8B. Balloon 480A could be deflated, balloon 480B could be halfway inflate, balloon 480D could be halfway inflated and balloon 480C could be fully inflated to position functional element 458 in the zero or three-hundred-sixty-degree location in anatomic duct 482. The inflation amount of each of balloon 480A through balloon 480D can be coordinated to achieve different radial positioning of functional element 458.

[0117] For either the position of FIG. 8 A or the position of FIG. 8B, or any other radial position, one or more of electrode strip 476A, electrode strip 476B, electrode strip 476C, electrode strip 476D can be electro-adhesively activated to stick to anatomic duct 482, resulting in shaft 452 being immobilized. Shaft 452 can be axially immobilized in anatomic duct 482. Shaft 452 can be radially immobilized in anatomic duct 482.

[0118] FIG. 9 is a schematic view of controller 490 for electro-adhesion positioning system 454 of FIG. 7. Controller 490 can comprise housing 492 and button 494. Button 494 can extend from opening 496 in housing 492 and can be in mechanical and / or electrical communication with electronics under button 494 within housing 492. Electronics withinhousing 492 can be connected to a pump or compressor, as well as valves, to control flow of compressed fluid to balloon 480A through balloon 480D and retention of compressed fluid therein. Button 494 can comprise first lever 498A, second lever 498B, third lever 498C, fourth lever 498D and center portion 499.

[0119] Button 494 can comprise a joystick or thumb pad to control inflation of balloon 480A through balloon 480D. First lever 498A, second lever 498B, third lever 498C, fourth lever 498D can be used to inflate balloon 480A, balloon 480B, balloon 480C and balloon 480D, respectively. Button 494 can be pushed upward at first lever 498A to inflate balloon 480A. Button 494 can be pushed rightward at second lever 498B to inflate balloon 480B. Button 494 can be pushed downward to inflate balloon 480C. Button 494 can be pushed leftward to inflate balloon 480D. The orientation of first lever 498 A through fourth lever 498D can correspond to the orientation of balloon 480 A through balloon 480D such that operation can be intuitive to a user. Center portion 499 can be depressed to cause deflation of each of balloon 480A, balloon 480B, balloon 480C and balloon 480D. Operation of any of first lever 498A through fourth lever 498D can cause deflation of a balloon to prevent overinflation of any balloon and to achieve the desired radial positioning of functional element 458.

[0120] Controller 490 can comprise a portion of handle section 132 (FIG. 1) or can comprise a standalone controller. Controller 490 can be incorporated into handle section 132 for reusable scope configurations. Controller 490 can comprise a standalone device in examples where electro-adhesion positioning system 454 is configured to be attached to single-use or disposable scopes. Controller 490 can comprise a foot pedal system configured to be positioned on a floor for actuation with a foot of a user.

[0121] FIG. 10 is a schematic illustration of electro-adhesion positioning system 454 of FIG.7 being used to hold endoscope 450 within duodenum D. As discussed herein, inflation of one or more of balloon 480 A, balloon 480B, balloon 480C and balloon 480D can cause engagement with duodenum D, thereby wedging or bracing endoscope 450 within duodenum D. Inflation levels of one or more of balloon 480A, balloon 480B, balloon 480C and balloon 480D can be controlled to move shaft 452 relative to sphincter of Oddi 222. With shaft 452 stabilized, it can be easier to move auxiliary scope 234 into sphincter of Oddi 222.

[0122] The process of locating the papilla surrounding sphincter of Oddi 222 can be challenging for a user of endoscope 450 due to obstruction and / or folding or shaping of the tissue. Keeping the axial position and holding the annular location of shaft 452 anchored in relation to the intraluminal tissue of duodenum D can be helpful so that secondary procedural steps, e.g., insertion of auxiliary scope 234 int sphincter of Oddi 222, can be more easilyperformed. Anchoring and positioning provided by electro-adhesion positioning system 454 can hold endoscope 450 steady while instruments are introduced in the working channel of endoscope 450, such as auxiliary scope 234, guidewires, cannulas, CHF scopes, and aspiration needles, etc. The present disclosure provides ergonomic benefits that can relieve a user of exerting extra effort in keeping endoscope 450 steady in a desired position so that the user can focus on the secondary procedural steps at hand, e.g., introducing another instrument from endoscope 450 into sphincter of Oddi 222.

[0123] FIG. 11 is a schematic illustration of endoscope 500 comprising shaft 502, functional section 504 and electro-adhesion positioning system 506. Electro-adhesion positioning system 506 can be used to hold endoscope 500 in engagement with duodenum D. In examples, endoscope 500 can comprise an endoscopic ultrasound (EUS) device in which functional section 504 comprises ultrasound imaging sensor 508. Functional section 504 can comprise other functional components as described herein, such as video imaging sensors, light emitters and irrigation and / or suction capabilities. Electro-adhesion positioning system 506 can comprise balloon 510 and electrode strip 512.

[0124] Endoscope 500 can be guided through duodenum D using video imaging capabilities. Ultrasound imaging sensor 508 can be used to identify tissue within or behind a wall structure of duodenum D, such as cyst C. In examples, cyst C can comprise cancerous or pre-cancerous cells that are to be diagnosed and potentially removed from the anatomy. The effectiveness of ultrasound imaging sensor 508 can be improved by ensuring flush engagement with tissue of duodenum D to, for example, facilitate efficient transmission and reception of ultrasound waves.

[0125] As described herein, a user can manipulate endoscope 500, such as by using pull wires and the like, to position ultrasound imaging sensor 508 into engagement with the duct wall of duodenum D to facilitate obtaining imaging, such as ultrasound images. In examples, gel can be applied to the duct wall of duodenum to facilitate transmission of sound waves from ultrasound imaging sensor 508 to cyst C, such as by eliminating or reducing air gaps between ultrasound imaging sensor 508 and duodenum D. In examples, gel can be introduced into duodenum D via an injector positioned through the working channel of endoscope 500. In examples, the gel can comprise a water-based gel formulated to exhibit an acoustic impedance similar to skin and tissue, minimizing reflections and allowing clearer imaging. As such, images of cyst C can be displayed on output unit 118 (FIG. 1) of imaging and control system 112 to facilitate positioning of endoscope 500.

[0126] It can be difficult to achieve engagement of ultrasound imaging sensor 508 with the duct wall of duodenum D due to one or more reasons, such as lack of rigidity of endoscope 500 and inability to manipulate endoscope 500 to position ultrasound imaging sensor 508 near cyst C. Electro-adhesion positioning system 506 can be used with an EUS scope, such as endoscope 500, where it is desirable to engage an imaging sensor, e.g., ultrasound imaging sensor 508, in close contact with the tissue to allow for better clarity on the ultrasound, CT or MRI return signal. In examples, an electrode, such as electrode strip 512, can be located on the opposite side of ultrasound imaging sensor 508 and can be activated, e.g., pushed, by a positioning device, such as balloon 510, a piezoelectric actuator, a solenoid or a jack, to cause the electrode to expand or bend from an initially straight position. Electro-adhesion positioning system 506 can be configured similarly as electro-adhesion positioning system 454 of FIG. 7, but with fewer than all the balloons and electrodes of FIG. 7 can be used so as to not obstruct or interfere with ultrasound imaging sensor 508. The expansion or bending of electrode strip 512 can push ultrasound imaging sensor 508 into firm engagement with tissue of duodenum D. Electrode strip 512 can be electro-adhesively activated to produce an anchoring effect to the adjacent tissue of the wall of duodenum D.

[0127] FIG. 12A is a schematic side view of endoscope 600 with electro-adhesion positioning system 602 in a mechanically retracted and electrically deactivated state. FIG. 12B is schematic side view of endoscope 600 of FIG. 12A with electro-adhesion positioning system 602 in a mechanically extended and electrically activated state to adhere to tissue. FIG. 12C is a top cross-sectional view through endoscope 600 of FIG. 12A showing an actuation mechanism including pull wire 620 for electro-adhesion positioning system 602. FIG. 12A, FIG. 12B and FIG. 12C are discussed concurrently.

[0128] Endoscope 600 can comprise shaft 604 and functional section 606. Functional section 606 can comprise housing 608 and imaging sensor 610. Housing 608 can include passage 612 to facilitate coupling to electro-adhesion positioning system 602. Electro-adhesion positioning system 602 can comprise electrode 614, distal pin 616, proximal pin 618, pull wire 620 and conductor wire 630. Passage 612 can comprise first track 622A and second track 622B for receiving distal pin 616 and proximal pin 618. Endoscope 600 can be positioned within anatomic duct 624 comprising first wall 624A and second wall 624B. FIG.12A, FIG. 12B and FIG. 12C illustrate an embodiment where electrode 614 is disposed on the exterior of housing 608.

[0129] Imaging sensor 610 can be located on a front side of endoscope 600 relative to centerline CL3 to face toward first wall 624 A. In examples, imaging sensor 610 cancomprise an ultrasound sensor. Electro-adhesion positioning system 602 can be located on the opposite side, e.g., the back side, of endoscope 600 relative to imaging sensor 610 to face toward second wall 624B. Electro-adhesion positioning system 602 can expand radially outward from centerline CL3 to contact second wall 624B, thereby producing a force that can push imaging sensor 610 into engagement with tissue of first wall 624A.

[0130] Electrode 614 can be located on the exterior of housing 608 of functional section 606. Electrode 614 can comprise a sheet of conducting material that is bent or folded around sides of functional section 606. In examples, electrode 614 can be made of graphite material, but can be made of other conducting materials as described herein. Electrode 614 can comprise a plurality of sheets or panels joined together to implement a geometry that wraps around sides of functional section 606. Electrode 614 can comprise panel 626 that extends across the back side of housing 608 of functional section 606 and two shorter sides, e.g., side panel 628A and side panel 628B, extending from panel 626 along the sides of housing 608 of functional section 606. Electrode 614 can be flexible so as to allow for bowing outward from housing 608.

[0131] Electrode 614 can be connected to functional section 606 is a sliding manner.Electrode 614 can be attached to housing 608 of functional section 606 via distal pin 616 and proximal pin 618. Housing 608 of functional section 606 can include passage 612 that allows distal pin 616 and proximal pin 618 to pass through functional section 606. One side of distal pin 616 and proximal pin 618 can be connected to side panel 628 A and one side of distal pin 616 and proximal pin 618 can be connected to side panel 628B. Pull wire 620 can be connected to distal pin 616 and can extend proximally. Pull wire 620 can extend into and at least partially through shaft 604. The proximal end of pull wire 620 can be connected to an actuator to apply tension to pull wire 620. For example, pull wire 620 can be connected to a lever, thumb wheel and the like that can be attached to handle section 132 (FIG. 1).Electrode 614 can be connected to conductor wire 630 to connect electrode 614 to a source of electrical energy, such as treatment generator 304 (FIG. 2B), treatment generator 144 (FIG.2A) or power unit 214 (FIG. 5). Conductor wire 630 can extend proximally through shaft 604 to connect to appropriate controllers, etc. In examples, pull wire 620 can be configured to deliver electrical energy to electrode 614 by being configured as the conductor wire.

[0132] Pull wire 620 can be pulled proximally to cause distal pin 616 to move closer to proximal pin 618. Movement of distal pin 616 closer to proximal pin 618 can cause electrode 614 to bow outward away from centerline CL3. As shown in FIG. 12B, electrode 614 can remain attached to housing 608 of functional section 606 while portions of electrode 614therebetween can flex radially outward due to distal pin 616 being urged closer to proximal pin 618. The effective thickness of functional section 606 can be increased to occupy additional space within anatomic duct 624. Functional section 606 can become wedged or levered between first wall 624A and second wall 624B, ensuring positive engagement between imaging sensor 610 and first wall 624A. Tension can be continuously applied to pull wire 620 to maintain electrode 614 in the bowed or flexed shape. A lock can be used on an actuator for pull wire 620 to maintain tension. The electro-adhesion of electrode 614, discussed below, can help maintain electrode 614 in the bowed or flexed shape by inhibiting unbending of electrode 614.

[0133] Conductor wire 630 can activated as an electrode for electro-adhesion with another electrode acting as the opposite electrode, such as electrode 308 of FIG. 2B. A charge can be applied to electrode 614 to cause electro-adhesion. A 5-volt DC positive charge, such as from treatment generator 144 (FIG. 2 A) or power unit 214 (FIG. 5), can be applied to electrode 614 via conductor wire 630 to cause the electro-adhesion. In examples, electrode 308 (FIG. 2B) can form an opposing electrode for electrode 614. A polarity can be controlled between electrode 614 and electrode 308. The application of voltage to electrode 614 can cause electrode 614 to adhere to surrounding tissue, e.g., second wall 624B, to hold and stabilize endoscope 600. The electro-adhesion can be released or turned off via switching the polarity between electrode 614 and electrode 308. A negative charge can be applied to electrode 614 release the electro-adhesion. A 5-volt negative charge can be applied to electrode 614 to release the electro-adhesion. In examples, other voltages and currents can be used to cause and release the electro-adhesion.

[0134] Electro-adhesion of electrode 614 to tissue of anatomic duct 624 can anchor endoscope 600 to anatomic duct 624, thereby immobilizing endoscope 600 axially and radially within anatomic duct 624 with imaging sensor 610 engaged with first wall 624 A. The anchoring of endoscope 600 can make it easier to obtain imaging with imaging sensor 610, as discussed herein.

[0135] FIG. 13 A is a schematic side view of endoscope 650 with electro-adhesion positioning system 652 in a mechanically retracted and electrically deactivated state. FIG.13B is schematic side view of endoscope 650 of FIG. 13 A with electro-adhesion positioning system 652 in a mechanically extended and electrically activated state to adhere to tissue. FIG. 13C is a top cross-sectional view through endoscope 650 of FIG. 13A showing an actuation mechanism including pull wire 670 for electro-adhesion positioning system 652. FIG. 13A, FIG. 13B and FIG. 13C are discussed concurrently.

[0136] Endoscope 600 can comprise shaft 654 and functional section 656. Functional section 656 can comprise housing 658 and imaging sensor 660. Housing 658 can include pocket 662 to facilitate coupling to electro-adhesion positioning system 652. Electroadhesion positioning system 652 can comprise electrode 664, distal pin 666, proximal pin 668, pull wire 670 and conductor wire 680. Pocket 662 can comprise first track 672A and second track 672B for receiving distal pin 666 and proximal pin 668. Endoscope 600 can be positioned within anatomic duct 674 comprising first wall 674A and second wall 674B. FIG.13A, FIG. 13B and FIG. 13C illustrate an embodiment where electrode 664 is disposed in the interior of housing 658.

[0137] Imaging sensor 660 can be located on a front side of endoscope 650 relative to centerline CL4 to face toward first wall 674A. In examples, imaging sensor 660 can comprise an ultrasound sensor. Electro-adhesion positioning system 652 can be located on the opposite side, e.g., the back side, of endoscope 650 relative to imaging sensor 660 to face toward second wall 674B. Electro-adhesion positioning system 652 can expand radially outward from centerline CL4 to contact second wall 674B, thereby producing a force that can push imaging sensor 660 into engagement with tissue of first wall 674A.

[0138] Electrode 664 can be located on the exterior of housing 658 of functional section 656. Electrode 664 can comprise a sheet of conducting material that is laid out flat or nearly flat within pocket 662 of housing 658 of functional section 656. In examples, electrode 664 can be made of graphite material, but can be made of other conducting materials as described herein. Electrode 664 can comprise panel 686 that extends across the back side of housing 658 of functional section 656. Electrode 664 can be flexible so as to allow for bowing outward from housing 658.

[0139] Electrode 664 can be connected to functional section 656 is a sliding manner.Electrode 664 can be attached to housing 658 of functional section 656 via distal pin 666 and proximal pin 668. Housing 658 of functional section 656 can include pocket 662 that allows distal pin 666 and proximal pin 668 to pass through functional section 656. A distal side of panel 686 can be connected to distal pin 666 and a proximal side of panel 686 can be connected to proximal pin 668. Pull wire 670 can be connected to distal pin 666 and can extend proximally. Pull wire 670 can extend into and at least partially through shaft 654. The proximal end of pull wire 670 can be connected to an actuator to apply tension to pull wire 670. For example, pull wire 670 can be connected to a lever, thumb wheel and the like that can be attached to handle section 132 (FIG. 1). Electrode 664 can be connected to conductor wire 680 to connect electrode 664 to a source of electrical energy, such astreatment generator 304 (FIG. 2B), treatment generator 144 (FIG. 2 A) or power unit 214 (FIG. 5). Conductor wire 680 can extend proximally through shaft 654 to connect to appropriate controllers, etc. In examples, pull wire 670 can be configured to deliver electrical energy to electrode 664 by being configured as the conductor wire.

[0140] Pull wire 670 can be pulled proximally to cause distal pin 666 to move closer to proximal pin 668. Movement of distal pin 666 closer to proximal pin 668 can cause electrode 664 to bow outward away from centerline CL4. As shown in FIG. 13B, electrode 664 can remain attached to housing 658 of functional section 656 while portions of electrode 664 therebetween can flex radially outward due to distal pin 666 being urged closer to proximal pin 668. The effective thickness of functional section 656 can be increased to occupy additional space within anatomic duct 674. Functional section 656 can become wedged or levered between first wall 674A and second wall 674B, ensuring positive engagement between imaging sensor 660 and first wall 674A. Tension can be continuously applied to pull wire 670 to maintain electrode 664 in the bowed or flexed shape. A lock can be used on an actuator for pull wire 670 to maintain tension. The electro-adhesion of electrode 664 can help maintain electrode 664 in the bowed or flexed shape by inhibiting unbending of electrode 664.

[0141] Conductor wire 680 can activated as an electrode for electro-adhesion with another electrode acting as the opposite electrode, such as electrode 308 of FIG. 2B. A charge can be applied to electrode 664 to cause electro-adhesion. A 5-volt DC positive charge, such as from treatment generator 144 (FIG. 2 A) or power unit 214 (FIG. 5), can be applied to electrode 664 via conductor wire 680 to cause the electro-adhesion. In examples, electrode 308 (FIG. 2B) can form an opposing electrode for electrode 664. A polarity can be controlled between electrode 664 and electrode 308. The application of voltage to electrode 664 can cause electrode 664 to adhere to surrounding tissue, e.g., second wall 674B, to hold and stabilize endoscope 650. The electro-adhesion can be released or turned off via switching the polarity between electrode 664 and electrode 308. A negative charge can be applied to electrode 664 release the electro-adhesion. A 5-volt negative charge can be applied to electrode 664 to release the electro-adhesion. In examples, other voltages and currents can be used to cause and release the electro-adhesion.

[0142] Electro-adhesion of electrode 664 to tissue of anatomic duct 674 can anchor endoscope 650 to anatomic duct 674, thereby immobilizing endoscope 650 axially and radially within anatomic duct 674 with imaging sensor 660 engaged with first wall 674A.The anchoring of endoscope 650 can make it easier to obtain imaging with imaging sensor 660, as discussed herein.

[0143] The systems, devices and methods of the present disclosure provide electro-adhesive stabilizing and positioning capabilities. Electro-adhesive stabilizing and positioning systems of the present can include electrodes that can attach or bond to surrounding tissue to temporarily immobilize a medical device to which they are attached. The electrodes can be expanded, bent, protruded or otherwise shaped to push the medical device in a desired direction before or after the electro-adhesion is applied. As such, the immobilization provided by the electro-adhesion can be applied after moving the medical instrument to a desired orientation or position. The electrodes can comprise thin, elongate strips extending along an axis of the medical device. The electrodes can flex with the shaft of the medical device. The electrodes can be attached to the shaft of the medical device along their length to provide anchoring. The electrodes can be separated from the shaft of the medical device, such as with an actuator comprising an inflatable balloon, a piezoelectric actuator, a solenoid or jack, to provide directionality to the medical device. Electro-adhesive stabilizing and positioning systems of the present disclosure provide rigidification of an endoscope shaft that can enhance pushability and provide stable structure for auxiliary scopes, anchoring to anatomy that can provide immobilization of the endoscope shaft in both axial and radial positions within anatomic structures, and improved instrument control by making it easier to aim instruments extending from the working channel of the endoscope to reach desired tissue locations.

[0144] Electro-adhesive stabilizing and positioning systems of the present disclosure can be useful in ERCP procedures to facilitate navigation through tortuous pathways and stabilize positioning for auxiliary scope deployment into the sphincter of Oddi. Electro-adhesive stabilizing and positioning systems of the present disclosure can be useful in EUS procedures to enable firm engagement of ultrasound sensors with tissue walls for better imaging clarity by eliminating or reducing air gaps. Electro-adhesive stabilizing and positioning systems of the present disclosure can be useful in EMR / ESD procedures to provide stabilization while performing dissection procedures.

[0145] Advancement

[0146] Systems have been developed to assist endoscopes in advancing through anatomic structures, such as powered spiral technology, capsule endoscopy systems and balloon-assisted endoscopy systems.

[0147] It can be difficult to obtain visualization or imaging of small intestines. The small intestine comprises a long tortuous anatomy and can be beyond the reach of a regular endoscope. That is, the path to the small intestine through the mouth, esophagus and stomach can be longer than an endoscope. Procedures to visualize the small intestine with balloon enteroscopy systems can be time consuming. Steps in deploying a balloon enteroscopy system include extending a balloon catheter distally, inflating the balloon and using the balloon as an anchor to pull the endoscope distally. This can cause the small intestine to crumple or compress along its own axis. The later version of this is the two-balloon endoscopy, which uses a push-pull action performance to advance the scope into the small intestine. The push-pull action is an improvement over the single balloon action, as it works like pulling on a sock one portion at a time and advancing each portion incrementally as the whole is advanced. Description of a push-pull, two balloon endoscopy system is described in Pub. No. US 2019 / 0191983 Al to Terliuc, titled “Balloon guided endoscopy.”

[0148] The present disclosure provides devices and systems as alternatives to these aforementioned advancement systems. The present disclosure provides devices and systems that provide forward propulsion using electro-adhesion technology. The electro-adhesion technology can be used to provide backward propulsion. The electro-adhesion propulsion systems of the present disclosure can be simpler to manufacture and can be made with smaller profiles than some of the aforementioned systems.

[0149] With the present disclosure, electro-adhesion can be used to mimic the locomotion of an earthworm. An earthworm moves through a process called “peristalsis” that involves using alternating contractions of circular and longitudinal muscles along a segmented body of the earthworm, combined with tiny bristles called setae to grip soil. These allow the earthworm to extend the front part of its body, anchor it with the setae, then contract to pull the rear part forward, repeating this wave-like motion to move through the ground. In summary, the earthworm propels itself forward by extending and anchoring the front portion of its body, and then pulling the back portion of the body toward the front portion.

[0150] The present disclosure includes a dual-balloon-assisted electro-adhesion assembly that can mimic the peristaltic movement of an earthworm to generate a pull-over action that can be used to advance an endoscope in a small intestine or other anatomic duct. The present disclosure can include electrodes, e.g., biocompatible, radially-patterned, flexible, flat graphite foil strips, that can act as an anode or cathode during electro-adhesion. The aforementioned article to W. Xu et al. describes electro-adhesion phenomena. Beneath the electrodes can be located one or more balloons to radially expand the electrodes to contactthe intestine walls. There can be a distal balloon-electrode assembly and a proximal balloonelectrode assembly. The balloon-electrode assemblies can ride on a flexible rail tube feature that can be disposed along the body of an insertion portion of an endoscope shaft. The balloon-electrode assemblies can be slidably mounted on the rail tube feature of the endoscope between forward and rearward rings for each balloon-electrode assembly. The balloon-electrode assemblies and rings can form seals against the scope or sheath. Assembly and component description of an example electro-adhesion propulsion system of the present disclosure are provided with reference to FIG. 14, FIG. 15A and FIG. 15B.

[0151] FIG. 14 is a perspective view of endoscope 700 comprising shaft 702 and electroadhesion propulsion system 704 of the present disclosure. FIG. 15A is schematic side view of endoscope 700 of FIG. 14 shown in cross-section to illustrate components thereof. FIG.15B is a close-up view of dynamic seal 705 suitable for use with electro-adhesion propulsion system 704 of FIG. 14. FIG. 14, FIG. 15A and FIG. 15B are discussed concurrently.

[0152] Endoscope 700 can comprise functional section 706 located at the end of shaft 702. Functional section 706 can comprise working channel 708, light emitter 710, imaging device 712 and irrigation channel 714. Electro-adhesion propulsion system 704 can comprise tube 716 and propulsor system 718. Tube 716 can comprise proximal end stop 720 and distal end stop 722. Electro-adhesion propulsion system 704 can comprise proximal propulsor 724A, distal propulsor 724B, connector 726 and balloon system 728.

[0153] Proximal propulsor 724A can comprise first ring 730A, second ring 732A and electrodes 734A. Distal propulsor 724B can comprise first ring 730B, second ring 732B and electrodes 734B.

[0154] Connector 726 can comprise insulation ring 736, to which electrodes 734A and electrodes 734B can extend. For example, electrodes 734A can extend distally through second ring 732A and electrodes 734B can extend proximally through first ring 730B. First spring 737A can be located between second ring 732A and insulation ring 736 and second spring 737B can be located between insulation ring 736 and first ring 730B.

[0155] Balloon system 728 can comprise first balloon 738 A and second balloon 738B.

[0156] As shown in FIG. 15B, dynamic seal 705 can comprise housing 750 and ring 752. Housing 750 can include groove 754 for engaging ring 752 and notch 756 for receiving second balloon 738B. Electrodes 734B can connect to housing 750. Ring 752 can be mounted on tube 716. FIG. 15B illustrates dynamic seal 705 as used with second ring 732B. Dynamic seal 705 can be used with first ring 730A, second ring 732A, first ring 730B and second ring 732B.

[0157] Electro-adhesion propulsion system 704 can include one or more conductors or wires, such as wire 758, to connect electrodes 734A and electrodes 734B to an energy source, such as treatment generator 304 (FIG. 2B), treatment generator 144 (FIG. 2 A) or power unit 214 (FIG. 5). Although only a single wire 758 is illustrated, separate wires can be provided for electrodes 734A and electrodes 734B. Electro-adhesion propulsion system 704 can include one or more tubes, such as tube 760, to deliver pressurized air to first balloon 738 A and second balloon 738B, such as from fluid source 124. Although only a single tube 760 is illustrated, separate tubes can be provided for first balloon 738 A and second balloon 738B.

[0158] Each of first balloon 738 A and second balloon 738B can be configured to slide on tube 716. First ring 730A and second ring 732A to which first balloon 738A are connected can slide along a proximal portion of tube 716. First ring 730B and second ring 732B to which second balloon 738B are connected can slide along a distal portion of tube 716. In examples, second ring 732B can be axially fixed on tube 716 using dynamic seal 705.Dynamic seal 705 can prevent the escape of pressurization fluid out the distal end of electroadhesion propulsion system 704, such as by engagement of ring 752 with groove 754. Ring 752 can comprise a protrusion or point that rides in groove 754. Ring 752 can rotate within groove 754 as housing 750 tube 716 rotates about centerline CL5, but prevents or inhibits fluid from escaping axially. However, in examples, first ring 730A, second ring 732A and first ring 730B can be free to slide along tube 716 to facilitate execution of the peristalsis effect. Fluid can be introduced into first balloon 738 A and second balloon 738B to cause radial expansion that causes first ring 730A to be drawn toward second ring 732B.Specifically, second balloon 738B can be radially expanded to cause electrodes 734B to be drawn through first ring 730B and insulation ring 736 to be drawn toward first ring 730B, and first balloon 738 A can be radially expanded to cause electrodes 734A to be drawn through second ring 732A and insulation ring 736 to be drawn toward second ring 732A.

[0159] First spring 737A and second spring 737B can be used to stretch or elongate propulsor system 718 in a default state when first balloon 738 A and second balloon 738B are not inflated. For example, spring 737A can push second ring 732A away from insulation ring 736 and spring 737B can push first ring730B away from insulation ring 736.

[0160] FIG. 16A through FIG. 16F illustrate operations of a method of deploying an endoscope using an electro-adhesion propulsion system of the present disclosure, such as the example described with reference to FIG. 14 through FIG. 15B. FIG. 16A through FIG. 16F show reference arrow R on duct wall 770. FIG. 16A through FIG. 16F illustrate how the distal tip of endoscope 700 can be pushed past reference arrow R on duct wall 770.

[0161] FIG. 16A illustrates endoscope 700 inserted into a patient adjacent to duct wall 770. FIG. 16A can illustrate the first step of a gastrointestinal procedure. Endoscope 500 can extend along center axis CL5. Endoscope 700 can be implemented with three-hundred-sixty-degree symmetry about center line CL5. In examples of a gastrointestinal procedure, endoscope 700 can be advanced until the entrance of the small intestine is reached. First balloon 738 A and second balloon 738B can be deflated to reduce or minimize the diameter of endoscope 700 so as to be better able to traverse an anatomic duct. Endoscope 700 can be positioned so that proximal propulsor 724A and distal propulsor 724B are adjacent to duct wall 770. Duct wall 770 can form part of an endoluminal duct that encircles or surrounds endoscope 700 along center axis CL5 such that portions of duct wall 770 engage with all or some of the outer perimeter of proximal propulsor 724A and distal propulsor 724B. In the state of FIG. 16A first balloon 738 A and second balloon 738B can be flat or mostly flat between first ring 730A and second ring 732A and first ring 730B and second ring 732B. First ring 730A and second ring 732A can be spaced at a first distance D1A from each other and first ring 730B and second ring 732B can be spaced at a first distance DIB from each other. First ring 730A can be engaged with or in close proximity to proximal end stop 720. Second ring 732B can be engaged with or in close proximity to distal end stop 722.Insulation ring 736 can be positioned between second ring 732A and first ring 730B.Insulation ring 736 can be positioned away from, e.g., not engaged with, second ring 732A and first ring 730B. In examples, insulation ring 736 can be positioned equidistant between second ring 732A and first ring 730B. In FIG. 16A, the distal end of endoscope 400 can be approximately aligned with reference arrow R.

[0162] FIG. 16B illustrates endoscope 700 inserted into a patient adjacent to duct wall 770 with second balloon 738B inflated. FIG. 16B can illustrate a second step of a gastrointestinal procedure. Compressed air or another pressurized gas can be introduced into second balloon 738B, such as via tube 760 (FIG. 14) to cause second balloon 738B to increase in volume. First ring 730B and second ring 732B can include appropriate seals as described herein in or other seals such as O-rings and the like to prevent pressurized air from escaping second balloon 738B. Second balloon 738B can push electrodes 734B radially outward to engage or engage more firmly with duct wall 770. In examples, electrodes 734B can push against duct wall 770 to locally increase the diameter of the endoluminal duct of duct wall 770.Electrodes 734B can be electrically charged to generate an electro-adhesion effect with duct wall 770 as described herein. In examples, electrodes 734B can be energized with a positive direct current (DC) charge to cause some or all of electrodes 734B to bond or adhere to thetissue of duct wall 770. Electrical energy can be supplied from wire 758 (FIG. 14).Insulation ring 736 can prevent electrical energy applied to electrodes 734B from spreading to electrodes 734A. The expansion of second balloon 738B can cause first ring 730B to be drawn closer to second ring 732B by the material of second balloon 738B and electrodes 734B. First ring 730B can be spaced second distance D2B away from second ring 732B. Second distance D2B can be less than first distance DIB. Because second ring 732B is engaged with distal end stop 722, distal advancement of second balloon 738B is prevented. The distal advancement of first ring 730B by second balloon 738B causes first balloon 738A to be drawn distally to the right in FIG. 16B. First ring 730A and second ring 732A can slide along tube 716. Likewise, insulation ring 736 can be drawn toward first ring 730B due to electrodes 734B being drawn through first ring 730B. In FIG. 16B, the distal end of endoscope 400 remains approximately aligned with reference arrow R.

[0163] FIG. 16C illustrates endoscope 700 inserted into a patient adjacent to duct wall 770 with second balloon 738B inflated and first balloon 738 A beginning to inflate. FIG. 16C can illustrate a third step of a gastrointestinal procedure. Compressed air or another pressurized gas can be introduced into first balloon 738A, such as via tube 760 (FIG. 14) to cause first balloon 738A to increase in volume. First ring 730A and second ring 732A can include appropriate seals as described herein in or other seals such as O-rings and the like to prevent pressurized air from escaping first balloon 738 A. First balloon 738 A can push electrodes 734A radially outward. First ring 730A can be drawn toward second ring 732A by foreshortening of electrodes 734A. Insulation ring 736 can be drawn closer to second ring 732A due to electrodes 734A being drawn through second ring 732A. In FIG. 16C, the distal end of endoscope 400 remains approximately aligned with reference arrow R.

[0164] FIG. 16D illustrates endoscope 700 inserted into a patient adjacent to duct wall 770 with second balloon 738B inflated and first balloon 738 A fully inflated. FIG. 16D can illustrate a fourth step of a gastrointestinal procedure. Compressed air or another pressurized gas can be introduced into first balloon 738 A, such as via tube 760 (FIG. 14) to cause first balloon 738 A to increase in volume. First balloon 738 A can push electrodes 734A radially outward to engage or engage more firmly with duct wall 770. In examples, electrodes 734A can push against duct wall 770 to locally increase the diameter of the endoluminal duct of duct wall 770. Electrodes 734A can be electrically charged to generate an electro-adhesion effect with duct wall 770 as described herein. In examples, electrodes 734A can be energized with a positive direct current (DC) charge to cause some or all of electrodes 734A to bond or adhere to the tissue of duct wall 770. Electrical energy can be supplied from wire 758 (FIG.14). Insulation ring 736 can prevent electrical energy applied to electrodes 734B from spreading to electrodes 734A. The expansion of first balloon 738A can cause first ring 730A to be drawn closer to second ring 732A by the material of first balloon 738 A and electrodes 734A. First ring 730A can be spaced second distance D2A away from second ring 732A. Second distance D2A can be less than first distance DI A. First ring 730A can be pulled away from proximal end stop 720. Second balloon 738B can remain in place axially within duct wall 770 as first balloon 738 A expands due to electrodes 734B being electro-adhesively engaged with duct wall 770. First ring 730A and second ring 732A can slide along tube 716. Likewise, insulation ring 736 can be drawn toward second ring 732A due to electrodes 734A being drawn through second ring 732A. With first balloon 738 A and second balloon 738B fully inflated, first balloon 738 A and second balloon 738B can be symmetrical relative to insulation ring 736, with insulation ring 736 being positioned centrally between second ring 732A and first ring 730B. However, electro-adhesion propulsion system 704 can be configured without symmetry. In FIG. 16E, the distal end of endoscope 400 remains approximately aligned with reference arrow R.

[0165] FIG. 16E illustrates endoscope 700 inserted into a patient adjacent to duct wall 770 with first balloon 738 A anchored to duct wall 770 via electro-adhesion and the electroadhesion of second balloon 738B being released, simultaneously with first balloon 738 A and second balloon 738B being deflated. FIG. 16E can illustrate a fifth step of a gastrointestinal procedure. Deflation of second balloon 738B can cause electrodes 734B to move away from duct wall 770. Electrodes 734B can no longer be electro-adhesively attached to duct wall 770. Deflation of first balloon 738 A can cause electrodes 734A to pull on tissue of duct wall 770, thereby possibly causing a temporary constriction of the endoluminal duct of duct wall 770. Electrodes 734A can remain electro-adhesively attached to duct wall 770. Relaxing of first balloon 738 A and second balloon 738B can cause electrodes 734A and electrodes 734B to straighten out as the distances between first ring 730A and second ring 732A and first ring 730B and second ring 732B increase. Because electrodes 734A are attached to duct wall 770, the straightening of electrodes 734A and electrodes 734B can push endoscope 700 forward. In particular, second ring 732B can push against distal end stop 722 to move tube 716 and endoscope 700 distally. In FIG. 16E, the distal end of endoscope 400 can be pushed past reference arrow R.

[0166] FIG. 16F illustrates endoscope 700 with first balloon 738 A and second balloon 738B completely or nearly completely deflated. FIG. 16F can illustrate a sixth step of a gastrointestinal procedure. Electrodes 734A can remain electro-adhesively attached to ductwall 770 and electrodes 734B can be released from electro-adhesive attachment to duct wall 770. First balloon 738 A and second balloon 738B can be completely or nearly completely deflated to return to the state of FIG. 16A. However, in FIG. 16F the distal tip of endoscope 400 is moved distally past reference arrow R. the distal tip of endoscope 400 is moved further past reference arrow R compared to what is shown in FIG. 16E as electrodes 734A and electrodes 734B return to their flattened or nearly flattened state. Thereafter, the electroadhesion of electrodes 734 A can be released.

[0167] The steps of FIG. 16A through FIG. 16F can be repeated to incrementally advance endoscope 700 distally to a desired position along duct wall 770, such as until a surgical site or target anatomy is reached, thereby moving endoscope 400 further past reference arrow R.

[0168] The steps of FIG. 16A through FIG. 16F can be executed in reverse order to advance endoscope 700 in the proximal direction, with proximal end stop 720 acting as the surface against which the force of electro-adhesion propulsion system 704 acts. When performing the steps in reverse order, the polarities applied to electrodes 734A and electrodes 734B can be reversed from what is performed when moving from FIG. 16A to FIG. 16B.

[0169] The direction of the tissue pullover action, e.g., the peristaltic advancement of electroadhesion propulsion system 704, can be controlled by a control device attached to endoscope 400 or another control device. In examples, the control device can be attached to a controller of endoscope 400 at the proximal end of shaft 702. In examples, foot pedal or footswitch can be used. In examples, a 2-pedal footswitch including forward (FWD) and rearward (RWD) pedals can be used. The speed of advancement can be variably controlled by the amount of pedal depression though the function of inflation and deflation. Depression of the pedals can automatically coordinate operation of the electro-adhesive effects on electrodes 734A and electrodes 734B to achieve the desired propulsion. Depression of the FWD pedal can result in inflation and positive charging being initiated at the distal and proximal balloons to adhere to the tissue walls to pull over distally endoscope 400 via distal peristaltic advancement. Continued depression of the FWD pedal can cause the cycle to continue with deflation and negative charging once a cycle of FIG. 16A through FIG. 16F is completed. Depression of the RWD pedal can execute the reverse or opposite sequence of steps to cause proximal pull over, e.g., proximal peristaltic advancement. In examples, a footswitch for controlling electro-adhesive, peristaltic advancement can be configured similarly to the device described with reference to FIG. 9.

[0170] FIG. 17 is a block diagram illustrating operations in method 800 of anchoring and / or stabilizing a medical instrument using electro-adhesion systems of the present disclosure.Though discussed with reference to FIG. 5 through FIG. 13C and particular medical devices and systems, method 800 can encompass the use of any medical device including anchoring and / or stabilizing capabilities using electro-adhesion energy consistent with the methods and systems described herein. Method 800 can include fewer or greater operations other than operation 802 to operation 816. In other examples, operation 802 through operation 816 can be performed in other sequences.

[0171] At operation 802, target tissue can be approached with an electrode device of the present disclosure including electro-adhesive anchoring and / or stabilizing capabilities. For example, endoscope 400 (FIG. 6), endoscope 450 (FIG. 7), endoscope 500 (FIG. 11), endoscope 600 (FIG. 12A) or endoscope 650 (FIG. 13A) can be positioned within an anatomic duct, such as to approach target tissue to be treated to be imaged, another anatomic structure, such as a sphincter, to be accessed, or the like. Once positioned proximate to the target tissue, an anchoring an / or stabilizing device can be activated.

[0172] At operation 804, an expansion device can be activated. In examples, use of an expansion device and operation 804 can be omitted. In examples, an expansion device can comprise one or more of balloon 480A through balloon 480D. In examples, an expansion device can comprise a jack, a screw, a solenoid, a piezoelectric actuator and the like.

[0173] At operation 806, biopsy gel can be introduced proximate the target tissue. In examples, use of biopsy gel and operation 806 can be omitted. In examples, an injector can be connected to a port on the medical instrument to move gel through the medical instrument or another injector device can be inserted through the medical instrument to reach the target tissue. The gel can exit a cannulation of the medical device and can be penetrated into the tissue using a needle.

[0174] At operation 808, a voltage of a first polarity can be applied at the target tissue. For example, low voltage, direct current energy from therapy unit 174 (FIG. 2 A) or treatment generator 304 (FIG. 2B) can be applied to one or more of electrode 416A through electrode 416C of endoscope 400 (FIG. 6), one or more of electrode strip 476A - electrode strip 476D of endoscope 450 (FIG. 7), electrode strip 512 of endoscope 500 (FIG. 11), electrode 614 of endoscope 600 (FIG. 12A) or electrode 664 endoscope 650 (FIG. 13A). An electric field can be generated between the electrodes and the target tissue.

[0175] At operation 810, an electro-adhesion bond can be formed between the target tissue and the one or more electrodes. Atoms of the gel and target tissue can be shared with atoms of the electrodes. The electric field can cause atoms of the target tissue or adjacent tissue to form a bond with the atoms of the electrodes, thereby adhering tissue to the electrodes. Inexamples, the gel introduced at operation 806 can facilitate the transfer of atoms between the tissue and the electrodes. Tissue can become bonded to the electrodes.

[0176] At operation 812, a procedure can be performed with the electro-adhesion device. For example, imaging can be obtained using endoscope 400, endoscope 450, endoscope 500, endoscope 600, or endoscope 650. In examples, imaging unit 464 (FIG. 7), ultrasound imaging sensor 508 (FIG. 11), imaging sensor 610 (FIG. 12A) or imaging sensor 660 (FIG.13 A) can be pushed into tissue via operation of the expansion device to improve imaging quality, such as by eliminating or reducing space or gaps between the imaging device and tissue that can reduce the ability to transmit imaging signals such as ultrasound.

[0177] At operation 814, voltage of a second polarity, opposite the first polarity, can be applied at the target tissue. For example, low voltage, direct current energy from therapy unit 174 (FIG. 2 A) or treatment generator 304 (FIG. 2B) can be applied to the aforementioned electrodes.

[0178] At operation 816, the electro-adhesion bond between the target tissue and the electrodes can be broken. An electric field can be generated between the electrodes and the target tissue that is of the opposite polarity that is generated at operation 808. The electric field can cause atoms of the target tissue to release from the atoms of the electrodes, thereby allowing the medical instrument to be freely moved relative to the surrounding anatomy.

[0179] FIG. 18 is a block diagram illustrating operations in methods of advancing a medical instrument using electro-adhesion systems of the present disclosure. Though discussed with reference to FIG. 14 through FIG. 16F and particular medical devices and systems, method 900 can encompass the use of any medical device including propulsion capabilities using electro-adhesion energy consistent with the methods and systems described herein. Method 900 can include fewer or greater operations other than operation 902 to operation 916. In other examples, operation 902 through operation 916 can be performed in other sequences.

[0180] At operation 902, target tissue can be approached with an electro-adhesive propulsion device, such as can be connected to a medical instrument, such as an endoscope. In examples, some or all of operation 902 can be performed as described with reference to FIG.16 A.

[0181] At operation 904, a distal expansion device can be activated, such as by inflating a balloon. In examples, some or all of operation 904 can be performed as described with reference to FIG. 16B.

[0182] At operation 906, an electro-adhesion force can be generated at the distal expansion device, such as to adhere the distal expansion device to tissue. In examples, some or all of operation 906 can be performed as described with reference to FIG. 16B.

[0183] At operation 908, a proximal expansion device can be activated, such as by inflating a balloon. In examples, some or all of operation 908 can be performed as described with reference to FIG. 16C andFIG. 16D.

[0184] At operation 910, an electro-adhesion force can be generated at a proximal expansion device, such as to adhere the proximal expansion device to tissue. In examples, some or all of operation 910 can be performed as described with reference to FIG. 16D.

[0185] At operation 912, the electro-adhesion at the distal expansion device can be released, such as by applying a voltage of opposite polarity as applied at operation 906. In examples, some or all of operation 912 can be performed as described with reference to FIG. 16E.

[0186] At operation 914, the proximal and distal expansion devices, can be deactivated, such as by deflating balloons. In examples, some or all of operation 914 can be performed as described with reference to FIG. 16E and FIG. 16F.

[0187] At operation 916, the electro-adhesion at the proximal expansion device can be released, such as by applying a voltage of opposite polarity as applied at operation 910. In examples, some or all of operation 912 can be performed as described with reference to FIG.16F.

[0188] Method 900 can return to operation 902 to generate additional peristaltic propulsion in a first direction. In order to generate peristaltic propulsion in a direction opposite the first direction, operation 902 to operation 916 can be performed in reverse order and to apply opposite polarities.

[0189] This disclosure describes medical devices including endoscopes with electro-adhesion capabilities that can utilize electrical phenomena to temporarily bond tissue to the endoscope for improved functionality. Example features of the present disclosure include electroadhesion systems that use low-voltage DC current (approximately 5-10 volts) to produce reversible chemical bonds between electrodes and tissue, and reversible polarity control to produce and release the electro-adhesion. In examples, the electro-adhesion capabilities can include a stabilization system, such as shown in FIG. 6. The stabilization system can include elongate flexible wires that can act as electrodes that extend along the endoscope shaft. The elongate flexible wires can provide rigidification capability by adhering to surrounding anatomy to stiffen the shaft and enhance pushability. The improved stability can improve auxiliary scope deployment by providing stable platform. In examples, the electro-adhesioncapabilities can include a positioning system, such as shown in FIG. 7 through FIG. 13. The positioning system can include circumferentially distributed balloons with electrode strips for directional control. The balloons can be activated to provide radial positioning within anatomic ducts via individual balloon inflation. The positioning system can provide anchoring capabilities for both axial and radial immobilization during procedures, which can be used to enhance imaging by pushing ultrasound sensors into firm tissue contact. The electro-adhesion capabilities can include a propulsion system, such as shown in FIG. 14 through FIG. 16). The propulsion system can include a dual balloon-electrode assembly that mimic earthworm peristalsis. The propulsion system can be automated between providing advancement through tortuous anatomy via sequential balloon inflation / deflation and electroadhesion cycling and rearward movement. The electro-adhesion capabilities can be useful in ERCP procedures to provide stabilization for auxiliary scope insertion into the sphincter of Oddi, EUS procedures to provide firm sensor engagement with tissue walls for better imaging, EMR / ESD procedures to provide stabilization during tissue dissection, small intestine visualization procedures to provide propulsion through long, circuitous pathways. The electro-adhesion capabilities can be implemented as add-on devices for existing scopes or integrated into new endoscope designs, providing enhanced maneuverability, stability, and advancement capabilities for challenging anatomic locations.

[0190] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments that may be implemented. These embodiments are referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present disclosure recognizes examples in which only those elements shown or described are provided. Moreover, the present disclosure recognizes examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0191] In the event of inconsistent usages between this document and any documents so incorporated by reference, the usage in this document controls.

[0192] In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” In the following aspects or claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that aspect or claim. Moreover, in the following aspects or claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

[0193] The term “about,” as used herein, means approximately, in the region of, roughly, or around. When the term “about” or “approximately” is used in conjunction with a numerical range, it modifies that range by extending the boundaries above and below the numerical values set forth. In general, the term “about” or “approximately” is used herein to modify a numerical value above and below the stated value by a variance of 10%. In one aspect, the term “about” or “approximately” means plus or minus 10% of the numerical value of the number with which it is being used. Therefore, “about 50%” or “approximately 50%” means in the range of 45% - 55%. Numerical ranges recited herein by endpoints include all numbers and fractions subsumed within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.90, 4, 4.24, and 5). Similarly, numerical ranges recited herein by endpoints include subranges subsumed within that range (e.g., 1 to 5 includes 1 - 1.5, 1.5 - 2, 2 - 2.75, 2.75 -3, 3 - 3.90, 3.90 - 4, 4 - 4.24, 4.24 - 5, 2 - 5, 3 - 5, 1 - 4, and 2 - 4). It is to be understood that all numbers and fractions thereof are presumed to be modified by the term “about” or “approximately.”

[0194] Method examples described herein can be machine or computer-implemented at least in part. Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include code, such as microcode, assembly language code, a higher-level language code, or the like. Such code can include computer readable instructions for performing various methods. The code may form portions of computer program products. Further, in an example, the code can be tangibly stored on one or more volatile, non-transitory, or nonvolatile tangible computer-readable media, such as during execution or at other times.Examples of these tangible computer-readable media can include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memories (RAMs), read only memories (ROMs), and the like.

[0195] The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. The Abstract is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the aspects or claims. In the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. The following aspects or claims are hereby incorporated into the Detailed Description as examples or embodiments, with each aspect or claim standing on its own as a separate embodiment, and it is understood that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended aspects or claims, along with the full scope of equivalents to which such aspects or claims are entitled.

Claims

AMENDED CLAIMSreceived by the International Bureau on 08 May 2026 (08.05.2026)1. An endoscope comprising:an elongate shaft comprising a proximal end portion and a distal end portion comprising a distal end tip;a working channel extending at least partially through the elongate shaft and including an opening proximate the distal end tip;an imaging device located proximate the distal end portion proximate the distal end tip; andan electro-adhesion system located on the elongate shaft, the electro-adhesion system comprising:at least one electrode configured to contact tissue; andan energy source configured to apply a DC voltage of a first polarity to the at least one electrode to cause the at least one electrode to adhere to tissue and to apply a DC voltage of a second polarity opposite the first polarity to the at least one electrode to cause the at least one electrode to release from the tissue.

2. The endoscope of claim 1, wherein the electro-adhesion system comprises an energy source to selectively provide voltage to the electro-adhesion system, wherein the energy source comprises an electrical generator configured to provide a voltage level in a range of approximately five volts to approximately ten volts and a current level at or below two-hundred milliamps to generate an electro-adhesive effect, and the voltage is applied in the range of approximately five seconds to approximately thirty seconds.

3. The endoscope of claim 2, wherein the electro-adhesion system comprises an electroadhesion anchoring system.

4. The endoscope of claim 3, wherein the energy source is controlled to provide the voltage with a first polarity or a second polarity opposite to the first polarity to the electroadhesion anchoring system, wherein the electro-adhesion anchoring system is configured to be adhered to a target tissue in a first state when the voltage is provided with the first polarity, and the electro-adhesion anchoring system is configured to not adhere to the target tissue in a second state when the voltage is provided with the second polarity.

5. The endoscope of claim 4, wherein, in the first state, the electro-adhesion system is configured to stabilize the endoscope by affixing an electrode to the target tissue.

6. The endoscope of claim 3, wherein the electro-adhesion anchoring system comprises a plurality of elongate flexible wires extending along the elongate shaft.

7. The endoscope of claim 6, wherein each the plurality of elongate flexible wires is attached to the elongate shaft along their lengths.

8. The endoscope of claim 7, wherein each the plurality of elongate flexible wires extends from the distal end portion toward the proximal end portion.

9. The endoscope of claim 6, wherein each the plurality of elongate flexible wires comprises a proximal and distal end attached to a proximal and distal ring, respectively, that is slidably positioned over the elongate shaft.

10. The endoscope of claim 9, further comprising an actuator configured to cause deflection of one or more of the plurality of elongate flexible wires.

11. The endoscope of claim 10, wherein the actuator comprises a balloon positioned between the plurality of elongate flexible wires and the elongate shaft.

12. The endoscope of claim 11, wherein:the imaging device comprises a side-viewing device; andthe balloon is positioned on the elongate shaft opposite the imaging device.

13. The endoscope of claim 11, whereimthe balloon is one of a plurality of balloons positioned at different circumferential positions between the plurality of elongate flexible wires and the elongate shaft; andeach of the plurality of balloons can be individually inflated to expand a subset of the plurality of elongate flexible wires.

14. (Cancelled)15. The endoscope of claim 13, wherein inflation of each of the plurality of balloons can change a radial position of the elongate shaft within an anatomic duct.

16. The endoscope of claim 11, wherein the electro-adhesion system is configured to generate axial peristaltic propulsion of the endoscope.

17. The endoscope of claim 16, wherein;the balloon is one of a plurality of balloons positioned at different axial locations between the plurality of elongate flexible wires and the elongate shaft; and inflation of the plurality of balloons can be orchestrated to change an axial position of the elongate shaft relative to the electro-adhesion system within an anatomic duct.

18. (Cancelled)19. The endoscope of claim 17, wherein the electro-adhesion system comprises a sheath disposed over the elongate shaft, wherein the plurality of elongate flexible wires are mounted to the sheath.

20. The endoscope of claim 19, wherein:the plurality of balloons comprises:a first balloon connected to first and second rings that slide along the sheath;anda second balloon connected to third and fourth rings that slide along the sheath; andthe plurality of elongate flexible wires comprises:a first set of electrode strips extending over the first balloon and connecting the first ring and the second ring; anda second set of electrode strips extending over the second balloon and connecting the third ring and the fourth ring.

21. The endoscope of claim 20, further comprising:a proximal end stop against which the first ring can be pushed; anda distal end stop against which the fourth ring can be pushed.

22. The endoscope of claim 21, further comprising an insulator ring disposed between the second ring and the third ring to electrically isolate the first set of electrodes and the second set of electrodes.

23. A method of operating an endoscope, the method comprising:inserting an elongate shaft of the endoscope into anatomy of a patient; activating an electro-adhesion system to cause a portion of the endoscope to adhere to tissue of the anatomy; andperforming an endoscopy procedure within the anatomy.

24. The method of claim 23, wherein activating an electro-adhesion system to cause a portion of the endoscope to adhere to tissue of the anatomy comprises manipulating a position of the endoscope within the anatomy.

25. The method of claim 24, wherein manipulating a position of the endoscope within the anatomy comprises causing the elongate shaft to adhere to the anatomy along a length of the elongate shaft to stiffen the elongate shaft via axial adhesion to the anatomy.

26. The method of claim 24, wherein manipulating a position of the endoscope within the anatomy comprises causing the elongate shaft to adhere to the anatomy at one or more circumferential positions.

27. The method of claim 26, wherein causing the elongate shaft to adhere to the anatomy at one or more circumferential positions comprises adjusting a radial position of the elongate shaft within an anatomic duct.

28. The method of claim 26, wherein causing the elongate shaft to adhere to the anatomy at one or more circumferential positions comprises anchoring the elongate shaft to provide stabilization for performing a medical intervention or an imaging operation.

29. The method of claim 26, further comprising actuating an expansion device to push an electro-adhesion electrode into engagement with the anatomy, wherein actuating the expansion device comprises expanding a balloon to bring an electrode into engagement with the anatomy.

30. (Cancelled)31. The method of claim 24, whereimmanipulating a position of the endoscope within the anatomy comprises generating peristaltic motion of the endoscope with the electro-adhesion system. generating the peristaltic motion of the endoscope comprises inflating and deflating a plurality of axially spaced balloons to cause the elongate shaft to adhere to the anatomy at a plurality of locations along a length of the elongate shaft.

32. (Cancelled)33. A method of controlling an endoscope system, the method comprising:activating an expansion device to expand with an electrode to engage the electrode to a target;applying voltage of a first polarity to the electrode to form an electro-adhesive bond between the target and the electrode; andapplying voltage of a second polarity opposite the first polarity to the electrode to break the electro-adhesive bond between the target and the electrode.

34. The method of claim 33, wherein applying voltage of a first polarity to the electrode to form an electro-adhesive bond between the target and the electrode comprises causing an elongate shaft of an endoscope to adhere to the target along a length of the elongate shaft to stiffen the elongate shaft via axial adhesion to the target.

35. The method of claim 34, wherein applying voltage of a first polarity to the electrode to form an electro-adhesive bond between the target and the electrode comprises causing the elongate shaft to adhere to the target at one or more circumferential positions.

36. The method of claim 35, wherein causing the elongate shaft to adhere to the target at one or more circumferential positions comprises adjusting a circumferential shape of the endoscope.

37. The method of claim 36, further comprising actuating an expansion device to push an electro-adhesion electrode into engagement with the target, wherein actuating the expansion device comprises expanding a balloon to bring an electrode into engagement with the target.

38. (Cancelled)39. The method of claim 34, further comprising generating peristaltic motion of an endoscope with the electro-adhesion system, wherein generating the peristaltic motion of the endoscope comprises inflating and deflating a plurality of axially spaced balloons to cause the elongate shaft to adhere to the target at a plurality of locations along a length of the elongate shaft.

40. (Cancelled)41. The endoscope of claim 2, wherein:the electro-adhesion system comprises a first electrode and a second electrode; and the first electrode comprises a material selected to promote electro-adhesion with tissue and the second electrode comprises a material selected to resist electroadhesion with tissue.

42. The endoscope of claim 41, wherein the first electrode comprises a material selected from the group consisting of graphite, tin, copper, and lead, and the second electrode comprises a material selected from the group consisting of nickel, titanium, iron, and zinc.

43. The endoscope of claim 41, wherein the first electrode comprises a material having a standard reduction potential more positive than the standard reduction potential of the material of the second electrode.

44. The endoscope of claim 41, wherein generation of the electro-adhesive effect comprises forming chemical bonds between atoms of the at least one electrode and atoms of the tissue.

45. The endoscope of claim 44, further comprising a gel positioned on the at least one electrode to facilitate sharing of atoms with the tissue.

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