[go: up one dir, main page]

WO2025019206A1 - Endoscope avec une paroi de canal de travail mobile - Google Patents

Endoscope avec une paroi de canal de travail mobile Download PDF

Info

Publication number
WO2025019206A1
WO2025019206A1 PCT/US2024/037175 US2024037175W WO2025019206A1 WO 2025019206 A1 WO2025019206 A1 WO 2025019206A1 US 2024037175 W US2024037175 W US 2024037175W WO 2025019206 A1 WO2025019206 A1 WO 2025019206A1
Authority
WO
WIPO (PCT)
Prior art keywords
endoscope
working channel
wall
imaging
face
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
PCT/US2024/037175
Other languages
English (en)
Inventor
Kester Julian Batchelor
Yoichiro Sakanoue
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Gyrus ACMI Inc
Original Assignee
Gyrus ACMI Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Gyrus ACMI Inc filed Critical Gyrus ACMI Inc
Publication of WO2025019206A1 publication Critical patent/WO2025019206A1/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/0034—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means adapted to be inserted through a working channel of an endoscope

Definitions

  • the present disclosure relates generally 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 having working channels through which other instruments, such as tissue retrieval devices for biopsies, can be inserted to perform a biological matter removal and collection process.
  • Endoscopes can be used for one or more of 1) providing passage of other devices, e.g., therapeutic devices or tissue collection devices, toward various anatomical portions, and 2) obtaining imaging of such anatomical portions.
  • Such anatomical portions can include gastrointestinal tract (e.g., esophagus, stomach, duodenum, pancreaticobiliary duct, intestines, colon), renal area (e.g., kidney(s), ureter, bladder, urethra) and other internal organs (e.g., reproductive systems, sinus cavities, submucosal regions, respiratory tract), and the like.
  • 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.
  • fluid delivery e.g., saline or other preparations via a fluid channel
  • passage e.g., via a working channel
  • suction passageways for collecting fluids (e.g., saline or other preparations) and the like.
  • the distal portion of the endoscope can be configured for supporting and orienting a therapeutic device.
  • 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 to anatomic locations within the body that are difficult to reach. For example, some anatomic locations can only be accessed with an endoscope after insertion through a circuitous path.
  • endoscopes are described in: JP2016140574A to Matsuda, titled “Endoscope” and JP2017006313A to Matsuda et al., titled “Endoscope and Endoscope System.”
  • problems to be solved with conventional medical devices, and in particular endoscopes and duodenoscopes used to retrieve sample biological matter from target tissue include, among other things, 1) the difficulty in navigating endoscopes, and instruments inserted therein, to locations in anatomical regions deep within a patient, 2) the disadvantage of only being able to obtain small tissue sample sizes, 3) the potential for obtaining the wrong sample tissue if the target tissue is not adequately engaged, 4) the increased time and associated cost of having to repeatedly remove and reinsert medical devices to obtain a sufficient quantity of sample material, and 5) restriction on the size of instruments that can be used within the working channel of an endoscope.
  • ERCP Endoscopic Retrograde Cholangio-Pancreatography
  • a auxiliary scope also referred to as daughter scope or cholangioscope
  • a main scope also referred to as mother scope or duodenoscope
  • another device e.g., a treatment or therapeutic device
  • a tissue retrieval device used for biopsies can be inserted into the auxiliary scope.
  • the duodenoscope, auxiliary scope and tissue retrieval device become progressively smaller and more difficult to maneuver and perform interventions and treatments.
  • imaging devices which can include camera sensors and illumination units, can have cross- sectional areas that are larger than wires and cables used to connect the imaging device to the controller or handpiece of the endoscope.
  • the working channel of the endoscope can be sized proximally of the imaging device based on the imaging device wiring and then stepped down in size at the imaging device, with the corresponding imaging channel for the wires and cables stepped up in size when at the axial position of the imaging device itself.
  • the working channel can be truncated by being recessed proximally from the imaging device to provide an exit point from the endoscope where the working channel is at the maximum size or diameter.
  • the present disclosure also recognizes that when an instrument is extended from a truncated working channel, the instrument is unsupported underneath the imaging device, which can lead to undesirable drooping of the instrument out of the field of view of the imaging device. Furthermore, the instrument can be less responsive to movements of the endoscope due to the truncated working channel.
  • the present application provides solutions to these problems and other problems by providing a moveable working channel wall that can opened to increase the size of an exit for the working channel to allow an instrument to exit the working channel proximally of the imaging device, and that can be closed to provide support for the instrument.
  • the moveable working channel wall can be a pivotable panel, a flexible panel, a slidable panel and the like.
  • an endoscope can comprise an elongate shaft comprising a distal end portion comprising a distal end face located at a distal-most end of the elongate shaft and a recessed end face located proximally of the distal end face, a working channel extending at least partially through the elongate shaft to the recessed end face, an imaging device located in the distal end portion proximate the distal end face, and an extension wall for the working channel extending from the recessed end face, the extension wall being movable between a closed position and an open position.
  • a method of collecting biological matter using a biopsy device extending from an endoscope can comprise inserting the endoscope into anatomy of a patient, extending the biopsy device into a working channel of the endoscope to extend from the endoscope, adjusting a moveable working channel wall of the endoscope to support the biopsy device, and collecting biological matter from the anatomy with the biopsy device.
  • an endoscope can comprise an elongate shaft comprising a distal end portion comprising a distal end face located at a distal-most end of the elongate shaft, a working channel extending through the elongate shaft to the distal end portion, a moveable wall configured to expose a portion of the working channel proximal of the distal end face, an imaging channel extending through the elongate shaft to the distal end portion, and an imaging device lumen extending from the imaging channel to the distal end face, wherein the imaging device lumen is larger than the imaging channel, an imaging device located in the imaging device lumen and an imaging cable extending from the imaging device through the imaging channel.
  • FIG. 1 is a schematic diagram of an endoscopy system comprising an imaging and control system and an endoscope, such as duodenoscope, with which the moveable working channel walls of the present disclosure can be used.
  • an endoscope such as duodenoscope
  • FIG. 2 is a schematic diagram of the imaging and control system of FIG. 1 showing the imaging and control system connected to the endoscope.
  • FIG. 3 A is a schematic top view of a distal portion of the endoscope of FIG. 2 comprising a camera module including optical components for a side-viewing endoscope and an elevator mechanism.
  • FIG. 3B is a cross-sectional view taken along the plane 3B - 3B of FIG. 3 A showing the optical components.
  • FIG. 3C is a cross-sectional view taken along the plane 3C - 3C of FIG. 3 A showing the elevator mechanism.
  • 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 FIGS. 1 and 2.
  • 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.
  • FIG. 5 is a schematic illustration of a distal portion of an endoscope being used to position an auxiliary scope proximate a duodenum, the auxiliary scope being configured to receive a biopsy device.
  • FIG. 6 is a schematic illustration of a surgical instrument comprising forceps extended from an endoscope proximate target tissue.
  • FIG. 7 is a schematic side view of an endoscope having a truncated working channel and a slidable working channel wall.
  • FIG. 8 is an end view of the endoscope of FIG. 7 showing an arcuate shape of the slidable working channel wall.
  • FIG. 9A is a schematic side view of the endoscope of FIG. 7 having an instrument inserted therein and slidable a working channel wall in an open position.
  • FIG. 9B is a schematic side view of the endoscope of FIG. 9 A having an instrument inserted therein and the slidable working channel wall in a closed position.
  • FIG. 10A is a schematic side view of an endoscope having a slidable working channel wall in a closed position.
  • FIG. 10B is a schematic side view of the endoscope of FIG. 10A with the slidable working channel wall in an open position
  • FIG. 11 is a schematic side view of an endoscope having a truncated working channel and a pivotable working channel wall.
  • FIG. 12 is an end view of the endoscope of FIG. 11 showing an arcuate shape of the pivotable working channel wall.
  • FIG. 13 A is a schematic side view of the endoscope of FIG. 11 having an instrument inserted therein and the pivotable working channel wall in an open position.
  • FIG. 13B is a schematic side view of the endoscope of FIG. 13 A having an instrument inserted therein and the pivotable working channel wall in a closed position.
  • FIG. 14A is a schematic side view of an endoscope having a pivotable working channel wall in a closed position.
  • FIG. 14B is a schematic side view of the endoscope of FIG. 14A with the pivotable working channel wall in an open position.
  • FIG. 15A is a schematic side cross-sectional view of an endoscope having a biasing element and a steering wire with a moveable working channel wall in an advanced position.
  • FIG. 15B is a schematic side cross-sectional view of the endoscope of FIG. 15A having a biasing element and a steering wire with a moveable working channel wall in a retracted position.
  • FIG. 16A is a schematic side cross-sectional view of an endoscope having a moveable working channel wall with a catch configured to interact with an instrument.
  • FIG. 16B is a schematic side cross-sectional view of the endoscope of FIG. 16A with the moveable working channel wall in an actuated state.
  • FIG. 17 is a schematic perspective view of an endoscope having a pivotable working channel wall retractable via resilient members.
  • FIG. 18 is a front view of a restraining clip for use with a pivotable working channel wall of the present disclosure.
  • FIG. 19 a side schematic view of an endoscope having a pivotable working channel wall with an angled reentry portion.
  • FIG. 20 is block diagram illustrating methods of extending and supporting an instrument from an endoscope having a truncated working channel and a two-stage imaging channel using a moveable working channel wall.
  • FIG. 1 is a schematic diagram of endoscopy system 10 comprising imaging and control system 12 and endoscope 14.
  • 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 having a truncated working channel and a two-stage imaging channel for use with a moveable working channel wall.
  • endoscope 14 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 14 can, in advantageous aspects, interface with and connect to imaging and control system 12.
  • endoscope 14 comprises a duodenoscope, though other types of endoscopes can be used with the features and teachings of the present disclosure.
  • Imaging and control system 12 can comprise control unit 16, output unit 18, input unit 20, light source unit 22, fluid source 24 and suction pump 26.
  • Imaging and control system 12 can include various ports for coupling with endoscopy system 10.
  • control unit 16 can include a data input/output port for receiving data from and communicating data to endoscope 14.
  • Light source unit 22 can include an output port for transmitting light to endoscope 14, such as via a fiber optic link.
  • Fluid source 24 can include a port for transmitting fluid to endoscope 14.
  • Fluid source 24 can comprise a pump and a tank of fluid or can be connected to an external tank, vessel or storage unit.
  • Suction pump 26 can comprise a port used to draw a vacuum from endoscope 14 to generate suction, such as for withdrawing fluid from the anatomical region into which endoscope 14 is inserted.
  • Output unit 18 and input unit 20 can be used by an operator of endoscopy system 10 to control functions of endoscopy system 10 and view output of endoscope 14.
  • Control unit 16 can additionally be used to generate signals or other outputs from treating the anatomical region into which endoscope 14 is inserted.
  • control unit 16 can generate electrical output, acoustic output, a fluid output and the like for treating the anatomical region with, for example, cauterizing, cutting, freezing and the like.
  • Endoscope 14 can comprise insertion section 28, functional section 30 and handle section 32, which can be coupled to cable section 34 and coupler section 36.
  • Insertion section 28 can extend distally from handle section 32 and cable section 34 can extend proximally from handle section 32. Insertion section 28 can be elongate and include a bending section, and a distal end to which functional section 30 can be attached. The bending section can be controllable (e.g., by control knob 38 on handle section 32) to maneuver the distal end through tortuous anatomical passageways (e.g., stomach, duodenum, kidney, ureter, etc.). Insertion section 28 can also 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 30, such as auxiliary scope 134 of FIG. 5.
  • working channels e.g., an internal lumen
  • the working channel can extend between handle section 32 and functional section 30.
  • the working channel can be truncated at functional section 30 as discussed herein. Additional functionalities, such as fluid passages, guide wires, and pull wires can also be provided by insertion section 28 (e.g., via suction or irrigation passageways, and the like).
  • Insertion section 28 can additionally include an imaging channel to allow for the positioning of wires and cables from imaging components and illumination components within functional section 30.
  • the imaging channel can be divided into a proximal imaging channel and a distal imaging component lumen.
  • Handle section 32 can comprise control knob 38 as well as port 40A and port 40B (FIG. 2).
  • Control knob 38 can be coupled to a pull wire, or other actuation mechanisms, extending through insertion section 28.
  • Port 40 A, as well as other ports such as port 40B (FIG. 2), 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 32 for coupling with insertion section 28.
  • port 40 A can be used to feed an auxiliary scope, cholangioscope or ductal sampling device into insertion section 28.
  • instrument 350 of FIGS. 9A and 9B and instrument 556 of FIGS. 16A and 16B of the present disclosure can be directly inserted into port 40A or can be inserted into a cholangioscope inserted into port 40A.
  • Imaging and control system 12 can be provided on a mobile platform (e.g., cart 41) with shelves for housing light source unit 22, suction pump 26, image processing unit 42 (FIG. 2), etc.
  • a mobile platform e.g., cart 41
  • suction pump 26 suction pump 26, image processing unit 42 (FIG. 2), etc.
  • FIGS. 1 and 2 can be provided directly on endoscope 14 so as to make the endoscope “self-contained.”
  • Functional section 30 can comprise components for treating and diagnosing anatomy of a patient.
  • Functional section 30 can comprise an imaging device, an illumination device and an elevator, such as is described further with reference to elevator 54 of FIGS. 3 A - 3C.
  • Functional section 30 can further comprise or be used with biological matter and tissue collection and retrieval devices, such as a biopsy device. Operation of some or all features of functional section 30 is typically performed at imaging and control system 12.
  • FIG. 2 is a schematic diagram of endoscopy system 10 of FIG. 1 comprising imaging and control system 12 and endoscope 14.
  • FIG. 2 schematically illustrates components of imaging and control system 12 coupled to endoscope 14, which in the illustrated example comprises a duodenoscope.
  • Imaging and control system 12 can comprise control unit 16, which can include or be coupled to image processing unit 42, treatment generator 44 and drive unit 46, as well as light source unit 22, input unit 20 and output unit 18.
  • control unit 16 be in communication with or coupled to auxiliary scope 134 (FIG. 5), which can receive a device configured to engage tissue and collect and store a portion of that tissue.
  • Coupler section 36 can be connected to control unit 16 via cable 49 (shown schematically in FIG.
  • control unit 16 can be used to insert another instrument or device, such as a daughter scope, auxiliary scope and/or a ductal sampling device, into endoscope 14. Such instruments and devices can be independently connected to control unit 16 via cable 47.
  • port 40B can be used to connect coupler section 36 to various inputs and outputs, such as video, air, light and electric.
  • Control unit 16 can be configured to activate a camera to view target tissue distal of functional section 30, such as when a biopsy device is positioned to extend from insertion section 28.
  • control unit 16 can be configured to activate light source unit 22 to shine light on surgical instrument 200 (FIG. 6).
  • Image processing unit 42 and light source unit 22 can each interface with endoscope 14 (e.g., at functional section 30) by wired or wireless electrical connections.
  • Imaging and control system 12 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 18.
  • Imaging and control system 12 can include light source unit 22 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 12 can connect (e.g., via an endoscope connector) to endoscope 14 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).
  • 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.
  • Fluid source 24 can be in communication with control unit 16 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). Fluid source 24 can be utilized as an activation energy for an actuation device or biasing device of the present disclosure.
  • Imaging and control system 12 can also include drive unit 46, which can be an optional component.
  • Drive unit 46 can comprise a motorized drive for advancing a distal section of endoscope 14, as described in at least PCT Pub. No. WO 2011/140118 Al to Frassica et al., titled “Rotate-to- Advance Catheterization System,” which is hereby incorporated in its entirety by this reference.
  • FIGS. 3A - 3C illustrate a first example of functional section 30 of endoscope 14 of FIG. 2.
  • FIG. 3 A illustrates a top view of functional section 30.
  • FIG. 3B illustrates a cross- sectional view of functional section 30 taken along section plane 3B - 3B of FIG. 3A.
  • FIG. 3C illustrates a cross-sectional view of functional section 30 taken along section plane 3C - 3C of FIG. 3A.
  • FIGS. 3A - 3C illustrate side-viewing endoscope camera module 50, such as can be used with a duodenoscope.
  • side-viewing endoscope camera module 50 can comprise housing 52, elevator 54, fluid outlet 56, illumination lens 58 and objective lens 60.
  • Housing 52 can form a fluid tight coupling with insertion section 28.
  • Housing 52 can comprise opening for elevator 54.
  • Elevator 54 can comprise a mechanism for moving a device inserted through insertion section 28, such as auxiliary scope 134 of FIG. 5.
  • elevator 54 can comprise a device that can bend an elongate device extended through insertion section 28 along axis Al, as is discussed in greater detail with reference to FIG. 3C.
  • Elevator 54 can be used to bend the elongate device at an angle to axis Al to thereby treat or access the anatomical region adjacent side-viewing endoscope camera module 50. Elevator 54 is located alongside, e.g., radially outward of axis Al, illumination lens 58 and objective lens 60.
  • FIG. 3C a schematic cross-sectional view taken along section plane 3C - 3C of FIG. 3C showing elevator 54.
  • Elevator 54 can comprise deflector 55 that can be disposed in accommodation space 53 of housing 52.
  • Deflector 55 can be connected to wire 57, which can extend through tube 59 to connect to handle section 32.
  • Wire 57 can be actuated, such as by rotating a knob, pulling a lever, or pushing a button on handle section 32. Movement of wire 57 can cause rotation, e.g., clockwise, from a first position of deflector 55 about pin 61 to a second position of deflector 55, indicated by deflector 55’.
  • Deflector 55 can be actuated by wire 57 to move the distal portion of instrument 63 extending through window 65 in housing 52.
  • Housing 52 can comprise accommodation space 53 that houses deflector 55.
  • Instrument 63 can comprise forceps, a guide wire, a catheter, or the like that extends through central lumen 62. Instrument 63 can additionally comprise auxiliary scope 134 of FIG. 5, or instrument 350 of FIGS. 9 A and 9B and instrument 556 of FIGS. 16A and 16B, as well as other instruments including other biopsy instruments or ductal sampling devices described herein.
  • a proximal end of deflector 55 can be attached to housing 52 at pin 61 provided to side-viewing endoscope camera module 50.
  • a distal end of deflector 55 can be located below window 65 within housing 52 when deflector 55 is in the lowered, or un-actuated, state.
  • the distal end of deflector 55 can at least partially extend out of window 65 when deflector 55 is raised, or actuated, by wire 57.
  • Instrument 63 can slide on angled ramp surface 51 of deflector 55 to initially deflect the distal end of instrument 63 toward window 65.
  • Angled ramp surface 51 can facilitate extension of the distal portion of instrument 63 extending from window 65 at a first angle relative to the axis of central lumen 62.
  • Angled ramp surface 51 can include groove 69, e.g., a v-notch, to receive and guide instrument 63.
  • Deflector 55 can be actuated to bend instrument 63 at a second angle relative to the axis of central lumen 62, which is closer to perpendicular that the first angle.
  • instrument 63 can comprise a cholangioscope or auxiliary scope 134 (FIG. 5).
  • Side-viewing endoscope camera module 50 of FIGS. 3A - 3C can include optical components (e.g., objective lens 60, prism 66, image processing unit 67, wiring 68) for collection of image signals, lighting components (e.g., illumination lens 58, light transmitter 64) for transmission or generation of light.
  • Side-viewing endoscope camera module 50 can also include a photosensitive element, such as a charge-coupled device (“CCD” sensor) or a complementary metal-oxide semiconductor (“CMOS”) sensor.
  • CCD charge-coupled device
  • CMOS complementary metal-oxide semiconductor
  • image processing unit 67 can be coupled (e.g., via wired or wireless connections) to image processing unit 42 (FIG.
  • imaging and control system 12 and image processing unit 67 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.
  • desired resolution e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.
  • additional devices can be used, e.g., instrument 63 in the form of auxiliary scope 134 (FIG.
  • the cross- sectional area, e.g., diameter, of subsequently nested devices becomes smaller, thereby requiring even smaller devices that can be difficult to manufacture and manipulate, or satisfactorily produce results without repeated interventions (e.g., interactions with the patient).
  • FIG. 4A illustrates an end view of end-viewing endoscope camera module 70
  • FIG. 4B illustrates a cross-sectional view of end-viewing endoscope camera module 70 taken along section plane 4B - 4B of FIG. 4 A.
  • FIGS. 4 A and 4B each illustrate end-viewing endoscope camera module 70, such as for use as a gastroscope, colonoscope, cholangioscope, and the like.
  • 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 14 and in line with a central longitudinal axis of endoscope 14.
  • End-viewing endoscope camera module 70 of FIGS. 4A and 4B can be used as an alternative example of functional section 30 of endoscope 14 of FIGS. 1 and 2. Additionally, end-viewing endoscope camera module 70 can be used in a cholangioscope, such as auxiliary scope 134 of FIG. 5.
  • end-viewing endoscope camera module 70 can comprise housing 72, therapy unit 74, fluid outlets 76, illumination lens 78 and objective lens 80.
  • Housing 72 can comprise and endcap for insertion section 28, thereby providing a seal to lumen 82.
  • insertion section 28 can comprise lumen 82 through which various components can be extended to connect end-viewing endoscope camera module 70 with handle section 32 (FIG. 2), for example.
  • illumination lens 78 can be connected to light transmitter 84, which can comprise a fiber optic cable or cable bundle extending to light source unit 22 (FIG. 1).
  • objective lens 80 can be coupled to imaging unit 87, which can be coupled to wiring 88.
  • light transmitter 84 can be located in the same lumen within housing 72, but light transmitter 84 and wiring 88 can be located within separate lumens within housing 72.
  • objective lens 80 and imaging unit 87 can be wider or have a larger diameter than wiring 88.
  • lumen 82 can be constructed to be wide to accept objective lens 80 and imaging unit 87, such as in imaging device lumen 314 (FIG. 7), and can be necked down to receive wiring 88, such as in imaging channel 310 (FIG. 7).
  • fluid outlets 76 can be coupled to fluid lines 89, which can comprise a tube extending to fluid source 24 (FIG. 1).
  • one of fluid outlets 76 can comprise an inlet connected to a fluid line 89 configured for suction, such as being connected to a vacuum, for recovery of lavage and irrigation fluid.
  • therapy unit 74 can comprise a wide-diameter lumen for receiving other treatment components, such as cutting devices and therapeutic devices including tissue separator devices.
  • End-viewing endoscope camera module 70 can also include a photosensitive element, such as a charge-coupled device (“CCD” sensor) or a complementary metal -oxide semiconductor (“CMOS”) sensor.
  • imaging unit 87 can be coupled (e.g., via wired or wireless connections) to image processing unit 42 (FIG. 1) to transmit signals from the photosensitive element representing images (e.g., video signals) to image processing unit 42, in turn to be displayed on a display such as output unit 18.
  • imaging and control system 12 and imaging unit 87 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.
  • desired resolution e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.
  • FIG. 5 is a schematic illustration of distal portion of endoscope 100 according to the present disclosure positioned in duodenum D.
  • Endoscope 100 can comprise functional module 102, insertion section module 104, and control module 106.
  • Control module 106 can include controller 108.
  • Control module 106 can include other components, such as those described with reference to endoscopy system 10 (FIG. 1) and control unit 16 (FIG. 2). Additionally, control module 106 can comprise components for controlling a camera and a light source connected to auxiliary scope 134, such as imaging unit 110, lighting unit 112 and power unit 114.
  • Endoscope 100 can be configured similarly as endoscope 14 of FIGS. 1 and 2.
  • Duodenum D can comprise duct wall 120, sphincter of Oddi 122, common bile duct 124 and main pancreatic duct 126.
  • Duodenum D comprises an upper part of the small intestine.
  • Common bile duct 124 carries bile from the gallbladder and liver (not illustrated) and empties the bile into the duodenum D through sphincter of Oddi 122.
  • Main pancreatic duct 126 carries pancreatic juice from the exocrine pancreas (not illustrated) to common bile duct 124.
  • tissue e.g., tissue
  • Functional module 102 can comprise elevator portion 130.
  • Endoscope 100 can further comprise lumen 132 and auxiliary scope 134.
  • Auxiliary scope 134 can comprise lumen 136.
  • Auxiliary scope 134 can itself include functional components, such as camera lens 137 and a light lens (not illustrated) coupled to control module 106, to facilitate navigation of auxiliary scope 134 from endoscope 100 through the anatomy and to facilitate viewing of components extending from lumen 132.
  • auxiliary scope also referred to as daughter scope, or cholangioscope
  • auxiliary scope 134 can be attached and advanced through lumen 132 (or central lumen 62 of insertion section 28 of endoscope 14 in FIG. 3B) of the “main scope” (also referred to as mother scope, or duodenoscope), such as endoscope 100.
  • main scope also referred to as mother scope, or duodenoscope
  • auxiliary scope 134 can be guided into sphincter of Oddi 122.
  • a surgeon operating auxiliary scope 134 can navigate auxiliary scope 134 through lumen 132 toward the gall bladder, liver or other locations in the gastrointestinal system to perform various procedures.
  • the surgeon can navigate auxiliary scope 134 past entry 128 of main pancreatic duct 126 and into passage 129 of common bile duct 124, or into entry 128.
  • Auxiliary scope 134 can be used to guide an additional device to the anatomy to obtain biological matter, such as by passage through or attachment to lumen 136.
  • the additional device can have its own functional devices, such as a light source, camera, tissue separators, accessories, and biopsy channel, for therapeutic procedures.
  • endoscope 100 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.
  • cancerous or pre-cancerous matter e.g., carcinoma, sarcoma, myeloma, leukemia, lymphoma and the like
  • endometriosis evaluation e.g., biliary ductal biopsies, and the like.
  • the size of the additional device is typically small due to the progressively smaller sizes of endoscope 100, auxiliary scope 134 and the additional device.
  • lumen 132 of endoscope 100 can typically be on the order of approximately 4.0 mm in diameter
  • lumen 136 of auxiliary scope 134 can typically be on the order of approximately 1.2 mm.
  • FIG. 6 is a schematic illustration of surgical instrument 200 comprising forceps 202 positioned proximate target tissue 254.
  • Surgical instrument 200 can comprise shaft 206 to which forceps 202 can be mounted.
  • Surgical instrument 200 can be positioned to extend from endoscope 230.
  • Forceps 202 can comprise jaws 212A and 212B that can be connected by hinge 214. Jaws 212A and 212B can include teeth 213.
  • Endoscope 230 can comprise shaft 232, working channel 234, passage 236 and lens 238.
  • Field of view 240 can project from lens 238.
  • Endoscope 230 can additionally include lens 239 for the projection of light into field of view 240.
  • Lens 238 and lens 239 can be packaged together in an imaging device located in passage 236. The components and items shown in FIG. 6 are not necessarily drawn to scale.
  • forceps 202 can be positioned in anatomic duct 255 where target tissue 254 is located.
  • Shaft 206 can be used to guide jaws 212A and 212B into anatomic duct 255 from shaft 232 to engage target tissue 254.
  • Target tissue 254 can comprise a protrusion, such as a growth of cancerous or pre-cancerous material.
  • Endoscope 230 can be positioned such that lens 238 faces target tissue 254. As such, target tissue 254 can be within field of view 240 of lens 238.
  • Field of view 240 is illustrated as having a particular viewing angle. However, lens 238 can be configured to have field of view 240 with different angles, up to and including one-hundred-eight degrees.
  • tissue collection device 204 can be moved in the axial direction toward target tissue 254. Jaws 212A and 212B can be rotated toward each other to engage target tissue 254. Tissue collection device 204 can be reciprocated back-and-forth along the axis of shaft 206 to collect target tissue 254. Teeth 213 can be used to cut, saw, tear or rip portions of target tissue 254 away from the anatomy of the patient. In examples, only one of jaws 212A and 212B can be configured to rotate.
  • forceps 202 can extended from shaft 232 to expose jaws 212A and 212B to target tissue 254.
  • jaws 212A and 212B can be located within field of view 240.
  • Jaws 212A and 212B can be supported by portions of shaft 232 forming working channel 234.
  • shaft 232 can support shaft 206 so that jaws 212A and 212B are within field of view 240 so that a surgeon can visualize jaws 212A and 212B alongside target tissue 254 in video imaging.
  • working channel 234 can be configured as a truncated working channel wherein working channel 234 stops short of the distal end face of shaft 232, such as by the formation of a cutout on the bottom or inferior side of shaft 232 as is shown in FIGS. 7 and 11, for example.
  • Working channel 234 can be extended by use of a sliding or pivoting working channel wall element to facilitate ingress and egress from working channel 234, as shown in FIGS. 7 and 11, for example.
  • passage 236 can be configured as a two-stage imaging channel wherein portions of passage 236 extending alongside cables for lens 238 and lens 239 are smaller than portions of passage 236 that receive hardware for lens 238 and lens 239, e.g., imaging chips and illumination elements, as shown in FIGS. 7 and 11, for example.
  • the size, e.g., height Hl, of jaws 212A and 212B can be increased relative to conventional biopsy forceps used with conventional cholangioscopes due to the increase in size of working channels described herein.
  • height Hl can be greater than the height of working channel 234, whereas conventional forceps have a height smaller than the height of working channel 234.
  • Jaws 212A and 212B can be elongated in the radial directions (e.g., up and down with respect to the orientations of FIG. 6) so as to form a container for the storage of collected matter.
  • forceps 202 can be configured as oversized forceps to obtain larger sample tissue volumes, thereby reducing procedure times and reducing the likelihood that a follow-on procedure is needed.
  • FIG. 7 is a schematic side view of endoscope 300 having slidable working channel wall 302.
  • Endoscope 300 can comprise elongate shaft 304 having cutout 306, in which can be located slidable working channel wall 302.
  • Elongate shaft 304 can include working channel 308 and imaging channel 310.
  • Working channel 308 can comprise truncated portion 312 and imaging channel 310 can be connected to imaging device lumen 314.
  • Internal wall structure 316 can be provided within elongate shaft 304 to separate and/or form working channel 308, imaging channel 310, truncated portion 312 and imaging device lumen 314.
  • Elongate shaft 304 can extend to distal end face 318.
  • Cutout 306 can comprise recessed end wall 320 and connecting wall 322.
  • Internal wall structure 316 can comprise lumen wall 324, posterior wall 326 and channel wall 328.
  • Imaging system 330 can comprise imaging device 332 and imaging cable 334.
  • Slidable working channel wall 302 can be connected to actuator 336
  • Imaging device 332 can be positioned in imaging device lumen 314 and imaging cable 334 can extend from imaging device 332 proximally through imaging channel 310. As discussed in greater detail below with reference to FIG. 10A and FIG. 10B, imaging device 332 can be larger in height than imaging cable 334. As such, for the majority of the length of elongate shaft 304, it is not necessary for imaging channel 310 to be as large as imaging device lumen 314. Thus, imaging channel 310 can be reduced in diameter as compared to imaging device lumen 314. However, posterior wall 326 of imaging device lumen 314 can interfere with working channel 308 to form truncated portion 312.
  • truncated portion 312 can include cutout 306.
  • Slidable working channel wall 302 can be configured to close-off and open up cutout 306.
  • Slidable working channel wall 302 can be configured to extend elongate shaft 304 from recessed end wall 320 to distal end face 318.
  • slidable working channel wall 302 can stop short of distal end face 318 and/or can extend beyond recessed end wall 320 in a fully retracted state.
  • slidable working channel wall 302 can extend beyond distal end face 318 and can be longer than the distance between recessed end wall 320 and distal end face 318.
  • Slidable working channel wall 302 can comprise a moveable piece, panel or door configured to move proximally to open cutout 306 and provide direct access to working channel 308 without having to pass through truncated portion 312, or at least pass fully or axially through truncated portion 312. Thereafter, an instrument can be freely extended from working channel 308 without interference from, or at least with less interference from, posterior wall 326. Subsequently, slidable working channel wall 302 can be moved distally to close cutout 306 and provide support to the instrument. As such, in examples, slidable working channel wall 302 can be fabricated from a rigid material, such as a hard plastic or metal.
  • slidable working channel wall 302 can be configured to have some flexibility to facilitate navigation through anatomy and angulation of instruments.
  • slidable working channel wall 302 can be fabricated from Fluoropolymers, such as polytetrafluoroethylene.
  • Slidable working channel wall 302 can be coupled to elongate shaft 304 via means that permit axial displacement. In examples, the coupling means can prevent circumferential displacement and radial displacement. In examples, slidable working channel wall 302 can be mounted to elongate shaft 304 via rials, bracket, rollers and the like. In the example of FIG. 7, slidable working channel wall 302 can be coupled to elongate shaft 304 with brackets 329. As shown in FIG. 8, slidable working channel wall 302 can be slidably attached to elongate shaft 304 via a tongue and groove system. Bracket 329 can be used with our without a tongue and groove system.
  • Slidable working channel wall 302 can be operated by actuator 336.
  • actuator 336 can comprise a wire extending through working channel 308 to reach a controller or handpiece.
  • a wire comprising actuator 336 can be wrapped around a pulley that can be rotated by a user to retract slidable working channel wall 302.
  • actuator 336 can comprise a steering wire incorporated into elongate shaft 304.
  • a biasing system can be used to return slidable working channel wall 302 to the extended position, as discussed with reference to FIGS. 15A and 15B.
  • slidable working channel wall 302 can be advanced and retracted using engagement with a medical device extended through working channel 308, as discussed with reference to FIGS. 16A and 16B.
  • FIG. 8 is an end view of endoscope 300 of FIG. 7 showing an arcuate shape of slidable working channel wall 302.
  • Endoscope 300 can comprise elongate shaft 304, distal end face 318, lumen wall 324 and imaging device 332.
  • Imaging device 332 can comprise objective lens 337 and illumination lens 338.
  • slidable working channel wall 302 can be curved to match the curvature of elongate shaft 304 and can thus comprise an extension of elongate shaft 304.
  • objective lens 337 and illumination lens 338 can be integrated into a single device comprising imaging device 332 so that imaging unit can occupy all the space within imaging device lumen 314.
  • imaging device 332 can comprise only objective lens 337 such that a separate illumination unit can be utilized to share space within imaging device lumen 314.
  • Slidable working channel wall 302 can be attached to elongate shaft 304 via attachment mechanism 340.
  • attachment mechanism 340 can comprise a tongue and groove system comprising rails or tongues 342 extending radially outward from elongate shaft 304 proximally from recessed end wall 320, and tracks or grooves 344 extending radially inward from slidable working channel wall 302.
  • the positions of tongues 342 and grooves 344 can be switched.
  • Attachment mechanism 340 can be configured to allow for axial movement of slidable working channel wall 302, but prevent rotational or pivoting movement of slidable working channel wall 302.
  • Slidable working channel wall 302 can comprise an arcuate body that mates with connecting wall 322 on elongate shaft 304 thereby forming a continuous three-hundred- sixty degree body surrounding working channel 308 and imaging device lumen 314.
  • slidable working channel wall 302 is positioned inside working channel 308.
  • slidable working channel wall 302 can be positioned outside of working channel 308 on the exterior of elongate shaft 304.
  • slidable working channel wall 302 can be configured to extend from within a pocket or channel located within a distal surface of elongate shaft 304.
  • FIG. 9A is a schematic side view of endoscope 300 of FIG. 7 having instrument 350 inserted therein and slidable working channel wall 302 in an open position.
  • FIG. 9B is a schematic side view of endoscope 300 of FIG. 9A having instrument 350 inserted therein and slidable working channel wall 302 in a closed position.
  • Instrument 350 can comprise shaft 352 and intervention device 354.
  • FIGS. 9A and 9B are discussed concurrently.
  • slidable working channel wall 302 can be retracted into working channel 308, such as by actuator 336 and/or a biasing system.
  • slidable working channel wall 302 can minimize the size of the distal end of endoscope 300 to facilitate insertion through anatomy.
  • the space between recessed end wall 320 and lumen wall 324 can be opened up to allow intervention device 354 to pass out of working channel 308.
  • the dimensions of instrument 350 can be correlated to the dimensions of cutout 306, working channel 308, imaging channel 310, truncated portion 312 and imaging device lumen 314.
  • intervention device 354 can be sized to occupy the maximum amount of space within the cross-section of working channel 308 while still being able to pass through cutout 306, which can result in intervention device 354 being blocked by lumen wall 324 but for the fact that slidable working channel wall 302 can be moved out of the way of intervention device 354 to open cutout 306.
  • slidable working channel wall 302 can be advanced from working channel 308, such as by actuator 336 and/or a biasing system. As such, slidable working channel wall 302 can be positioned underneath shaft 352 to provide support to instrument 350 all the way to the end of slidable working channel wall 302. Slidable working channel wall 302 can thus facilitate positioning of intervention device 354 within the field of view of imaging device 332. Furthermore, support of instrument 350 by slidable working channel wall 302 can facilitate better movement of intervention device 354 with the movements of elongate shaft 304, such as by preventing shaft 352 from slipping out of cutout 306.
  • FIG. 10A is a schematic side view of endoscope 300 having slidable working channel wall 302 in a closed position.
  • FIG. 10B is a schematic side view of endoscope 300 of FIG. 10A with slidable working channel wall 302 in an open position.
  • FIGS. 10A and 10B illustrate a distal end portion of elongate shaft 304, which can have a proximal end portion connected to a controller or handpiece as discussed herein. FIGS. 10A and 10B are discussed concurrently.
  • Working channel 308 can have a distance DI and imaging channel 310 can have distance D2. Truncated portion 312 can have distance D3 and imaging device lumen 314 can have distance D4.
  • Distance DI is the inner diameter of working channel 308 of FIGS. 7 and 8 proximally of slidable working channel wall 302 and imaging device lumen 314.
  • inner diameter working channel 308 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance DI can be the maximum height of working channel 308.
  • Distance D2 is the inner diameter of imaging channel 310 of FIGS. 7 and 8 proximally of imaging device lumen 314.
  • imaging channel 310 can comprise a circular channel but can have other cross- sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance D2 can comprise the maximum height of imaging channel 310.
  • Distance D3 is the distance between the bottom of slidable working channel wall 302 and the bottom of lumen wall 324 (FIG. 7) when slidable working channel wall 302 is extended.
  • the shape between the bottom of slidable working channel wall 302 and the bottom of lumen wall 324 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance D3 can be the minimum height between the bottom of slidable working channel wall 302 and the bottom of lumen wall 324.
  • Distance D4 is the inner diameter of imaging device lumen 314 opposite slidable working channel wall 302.
  • imaging device lumen 314 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance D3 can be the maximum height of imaging device lumen 314.
  • Working channel 308 can have distance DI that is greater than distance D2 of imaging channel 310.
  • Imaging device lumen 314 can have distance D4 that is greater than distance D2 of imaging channel 310.
  • Truncated portion 312 of working channel 308 can have distance D3 that is smaller than distance DI of working channel 308 due to, for example, the increase in size of imaging device lumen 314 over imaging channel 310.
  • slidable working channel wall 302 can be advanced forward to extend the bottom portion of working channel 308 from recessed end wall 320 forward to distal end face 318.
  • An instrument inserted into working channel 308 can have a height less than the distance DI.
  • height Hl of FIG. 6, which can also be the outer diameter of intervention device 354 o of FIGS. 9A and 9B, can be less than distance DI.
  • an instrument located within working channel 308 having a height greater than distance D3 of truncated portion 312 would be blocked by rear or posterior wall 326 of imaging device lumen 314.
  • Instruments can be configured to operate with endoscope 300 to maximize the size of the instrument to improve the performance thereof.
  • the size, e.g., height or diameter, of intervention device 354, for example, can be increased to the size of working channel 308.
  • lumen wall 324 can interfere with egress of an instrument positioned within working channel 308.
  • slidable working channel wall 302 can be retracted, or moved backward or proximally, to expose working channel 308 to the exterior of elongate shaft 304 at recessed end wall 320 to form an opening between posterior wall 326 and recessed end wall 320 having distance D3.
  • Distance D5 can be the distance between the forward or distal end of elongate shaft 304 at recessed end wall 320 and the rearward or proximal end of imaging device lumen 314.
  • Distance D5 can be approximately as large as distance DI so that any instrument located within working channel 308 can exit endoscope 300 at the distal end portion.
  • Distance D5 can be the minimum height of for the exit of working channel 308 when slidable working channel wall 302 is retracted.
  • Distance D5 can be greater than distance D3.
  • Imaging device lumen 314 can extend length LI proximally from distal end face 318.
  • Recessed end wall 320 can be located length L2 proximally from distal end face 318.
  • Length L2 can be greater than length LI .
  • Slidable working channel wall 302 can have a length equal to length L2, but can also be longer than length L2 or shorter than length L2 in other examples.
  • FIG. 11 is a schematic side view of endoscope 400 having pivotable working channel wall 402.
  • Endoscope 400 can comprise elongate shaft 404 having cutout 406, in which can be located pivotable working channel wall 402.
  • Elongate shaft 404 can include working channel 408 and imaging channel 410.
  • Working channel 408 can comprise truncated portion 412 and imaging channel 410 can be connected to imaging device lumen 414.
  • Internal wall structure 416 can be provided within elongate shaft 404 to separate and/or form working channel 408, imaging channel 410, truncated portion 412 and imaging device lumen 414.
  • Elongate shaft 404 can extend to distal end face 418.
  • Cutout 406 can comprise recessed end wall 420 and connecting wall 422.
  • Internal wall structure 416 can comprise lumen wall 424, posterior wall 426 and channel wall 428.
  • Imaging system 430 can comprise imaging device 432 and imaging cable 434.
  • Pivotable working channel wall 402 can be connected to actuator 436 and pivot
  • Imaging device 432 can be positioned in imaging device lumen 414 and imaging cable 434 can extend from imaging device 432 proximally through imaging channel 410. As discussed in greater detail below with reference to FIGS. 14A and 14B, imaging device 432 can be larger in height than imaging cable 434. As such, for the majority of the length of elongate shaft 404, it is not necessary for imaging channel 410 to be as large as imaging device lumen 414. Thus, imaging channel 410 can be reduced in diameter as compared to imaging device lumen 414. However, posterior wall 426 of imaging device lumen 414 can interfere with working channel 408 to form truncated portion 412.
  • truncated portion 412 can include cutout 406.
  • Pivotable working channel wall 402 can be configured to close-off and open up cutout 406.
  • Pivotable working channel wall 402 can be configured to extend elongate shaft 404 beyond recessed end wall 420 to distal end face 418.
  • pivotable working channel wall 402 can stop short of distal end face 418 or can extend beyond distal end face 418 so as to be longer than the distance between recessed end wall 420 and distal end face 418.
  • Pivotable working channel wall 402 can comprise a moveable piece, panel or door configured to rotate outward away from endoscope 400 to open cutout 406 and provide direct access to working channel 408 without having to pass through truncated portion 412, or at least pass fully or axially through truncated portion 412. Thereafter, an instrument can be freely extended from working channel 408 without interference from, or at least with less interference from, posterior wall 426. Subsequently, pivotable working channel wall 402 can be rotated toward endoscope 400 to close cutout 406 and provide support to the instrument. As such, in examples, pivotable working channel wall 402 can be fabricated from a rigid material, such as a hard plastic or metal.
  • pivotable working channel wall 402 can be configured to have some flexibility to facilitate navigation through anatomy and angulation of instruments.
  • pivotable working channel wall 402 can be fabricated from Fluoropolymers, such as polytetrafluoroethylene.
  • Pivotable working channel wall 402 can be coupled to elongate shaft 404 via means that permit rotational displacement.
  • the coupling means can prevent circumferential displacement, radial displacement and axial displacement.
  • pivotable working channel wall 402 can be coupled to elongate shaft 404 with pivots 440.
  • pivots 440 can comprise pivot pins, hinges, springs, torsion springs and the like.
  • pivotable working channel wall 402 can additionally be connected to elongate shaft 404 by a flexible panel.
  • Pivotable working channel wall 402 can be operated by actuator 436.
  • actuator 436 can comprise a wire extending through working channel 408 to reach a controller or handpiece.
  • a wire comprising actuator 436 can be wrapped around a pulley that can be rotated by a user to close or open pivotable working channel wall 402, depending on the configuration of pivots 440.
  • actuator 436 can comprise a steering wire incorporated into elongate shaft 404.
  • a biasing system can be used to return pivotable working channel wall 402 to the opened or closed position, as discussed with reference to FIGS. 15A and 15B.
  • FIG. 12 is an end view of the endoscope 400 of FIG. 11 showing an arcuate shape of pivotable working channel wall 402.
  • Endoscope 400 can comprise elongate shaft 404, distal end face 418, lumen wall 424 and imaging device 432.
  • Imaging device 432 can comprise objective lens 437 and illumination lens 438.
  • pivotable working channel wall 402 can be curved to match the curvature of elongate shaft 304 and can thus comprise an extension of elongate shaft 404.
  • objective lens 437 and illumination lens 438 can be integrated into a single device comprising imaging device 432 so that imaging unit can occupy all the space within imaging device lumen 414.
  • imaging device 432 can comprise only objective lens 437 such that a separate illumination unit can be utilized to share space within imaging device lumen 414.
  • Pivotable working channel wall 402 can comprise an arcuate body that mates with connecting wall 422 on elongate shaft 404 thereby forming a continuous three-hundred- sixty degree body surrounding working channel 408 and imaging device lumen 414.
  • pivotable working channel wall 402 can be axially aligned with elongate shaft 404.
  • pivotable working channel wall 402 can be positioned inside working channel 408 on the interior of elongate shaft 404 or outside working channel 408 on the exterior of elongate shaft 404.
  • FIG. 13 A is a schematic side view of the endoscope 400 of FIG. 11 having instrument 450 inserted therein and pivotable working channel wall 402 opened.
  • FIG. 13B is a schematic side view of endoscope 400 of FIG. 13 A having instrument 450 inserted therein and pivotable working channel wall 402 closed.
  • Instrument 450 can comprise shaft 452 and intervention device 454.
  • FIGS. 13A and 13B are discussed concurrently.
  • pivotable working channel wall 402 can be rotated away from working channel 408, such as by actuator 436 and/or a biasing system. As such, the space between recessed end wall 420 and lumen wall 424 can be opened up to allow intervention device 454 to pass out of working channel 408. As discussed below with reference to FIGS. 14A and 14B, the dimensions of instrument 450 can be correlated to the dimensions of cutout 406, working channel 408, imaging channel 410, truncated portion 412 and imaging device lumen 414.
  • intervention device 454 can be sized to occupy the maximum amount of space within the cross-section of working channel 408 while still being able to pass through cutout 406, which can result in intervention device 454 being blocked by lumen wall 424 but for the fact that pivotable working channel wall 402 can be moved out of the way of intervention device 454 to open cutout 406.
  • pivotable working channel wall 402 can be rotated toward working channel 408, such as by actuator 436 and/or a biasing system. In such a position, pivotable working channel wall 402 can minimize the size of the distal end of endoscope 400 to facilitate insertion through anatomy.
  • pivotable working channel wall 402 can be positioned underneath shaft 452 to provide support to instrument 450 all the way to the end of pivotable working channel wall 402. Pivotable working channel wall 402 can thus facilitate positioning of intervention device 454 within the field of view of imaging device 432. Furthermore, support of instrument 450 by pivotable working channel wall 402 can facilitate better movement of intervention device 454 with the movements of elongate shaft 404, such as by preventing shaft 452 from slipping out of cutout 406.
  • FIG. 14A is a schematic side view of endoscope 400 having pivotable working channel wall 402 in a closed position.
  • FIG. 14B is a schematic side view of endoscope 400 of FIG. 14 A with pivotable working channel wall 402 in an open position.
  • FIGS. 14A and 14B illustrate a distal end portion of elongate shaft 404, which can have a proximal end portion connected to a controller or handpiece as discussed herein. FIGS. 14A and 14B are discussed concurrently.
  • Working channel 408 can have a distance DI and imaging channel 410 can have distance D2. Truncated portion 412 can have distance D3 and imaging device lumen 414 can have distance D4.
  • Distance DI is the inner diameter of working channel 408 of FIGS. 1 land 12 proximally of pivotable working channel wall 402 and imaging device lumen 414.
  • inner diameter working channel 408 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance DI can be the maximum height of working channel 408.
  • Distance D2 is the inner diameter of imaging channel 410 of FIGS. 11 and 12 proximally of imaging device lumen 414.
  • imaging channel 410 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance D2 can comprise the maximum height of imaging channel 410.
  • Distance D3 is the distance between the bottom of pivotable working channel wall 402 and the bottom of lumen wall 424 (FIG. 11) when pivotable working channel wall 402 is closed.
  • the shape between the bottom of pivotable working channel wall 402 and the bottom of lumen wall 424 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance D3 can be the minimum height between the bottom of pivotable working channel wall 402 and the bottom of lumen wall 424.
  • Distance D4 is the inner diameter of imaging device lumen 414 opposite slidable working channel wall 402.
  • imaging device lumen 414 can comprise a circular channel but can have other cross-sectional shapes, such as half-circle, elliptical, oval, arcuate and the like.
  • Distance D3 can be the maximum height of imaging device lumen 414.
  • Working channel 408 can have distance DI that is greater than distance D2 of imaging channel 410.
  • Imaging device lumen 414 can have distance D4 that is greater than distance D2 of imaging channel 410.
  • Truncated portion 412 of working channel 408 can have distance D3 that is smaller than distance DI of working channel 408 due to, for example, the increase in size of imaging device lumen 414 over imaging channel 410.
  • pivotable working channel wall 402 can be rotated toward elongate shaft 404.
  • An instrument inserted into working channel 408 can have a height less than the distance DI.
  • height Hl of FIG. 6, which can also be the outer diameter of intervention device 454 o of FIGS. 13 A and 13B, can be less than distance DI.
  • an instrument located within working channel 408 having a height greater than distance D3 of truncated portion 412 would be blocked by rear or posterior wall 426 of imaging device lumen 414.
  • Instruments can be configured to operate with endoscope 400 to maximize the size of the instrument to improve the performance thereof.
  • the size, e.g., height or diameter, of intervention device 454, for example, can be increased to the size of working channel 408.
  • lumen wall 424 can interfere with egress of an instrument positioned within working channel 408.
  • pivotable working channel wall 402 can be rotated away from elongate shaft 404 to expose working channel 408 to the exterior of elongate shaft 404 at recessed end wall 420 to form an opening between posterior wall 426 and recessed end wall 420 having distance D3.
  • Distance D5 can be the distance between the forward or distal end of elongate shaft 404 at recessed end wall 420 and the rearward or proximal end of imaging device lumen 414.
  • Distance D5 can be approximately as large as distance DI so that any instrument located within working channel 408 can exit endoscope 400 at the distal end portion.
  • Distance D5 can be the minimum height of for the exit of working channel 408 when pivotable working channel wall 402 is opened.
  • Distance D5 can be greater than distance D3.
  • Imaging device lumen 414 can extend length LI proximally from distal end face 418.
  • Recessed end wall 420 can be located length L2 proximally from distal end face 418.
  • Length L2 can be greater than length LI .
  • Pivotable working channel wall 402 can have a length equal to length L2, but can also be longer than length L2 or shorter than length L2 in other examples.
  • FIG. 15A is a schematic side cross-sectional view of endoscope 500 having moveable working channel wall 502 attached to biasing system 504 and steering wire 506.
  • FIG. 15A shows moveable working channel wall 502 in an advanced state.
  • FIG. 15B shows moveable working channel wall 502 in a retracted state.
  • FIGS. 15A and 15B are discussed concurrently.
  • Endoscope 500 can comprise elongate shaft 508 and cutout 510.
  • Biasing system 504 can comprise biasing element 512 and stop 514.
  • Endoscope 500 can be configured similarly to endoscope 300 of FIG. 7 - FIG. 10B with the addition of biasing system 504 and the replacement of the pull wire of actuator 336 with steering wire 506.
  • biasing system 504 can be configured to push moveable working channel wall 502 distally to the advanced state and steering wire 506 can be configured to pull moveable working channel wall 502 to the retracted state.
  • biasing system 504 can be configured to pull moveable working channel wall 502 proximally, and an actuator can be used to push moveable working channel wall 502 distally, such as a rigid rod or wire.
  • biasing element 512 can comprise a spring.
  • biasing element 512 can comprise a leaf spring, a coil spring, a flexible element or the like.
  • biasing element 512 can have a length at rest approximately equal to the distance between stop 514 and moveable working channel wall 502 to push moveable working channel wall 502 away from stop 514.
  • steering wire 506 can be configured to be pulled proximally (to the left in FIGS. 15A and 15B) to translate moveable working channel wall 502 proximally and push biasing element 512 against stop 514.
  • Stop 514 can comprise a flange or projection of material extending from elongate shaft 508 to extend into working channel 516.
  • FIGS. 15A and 15B illustrate biasing system 504 in operation with a slidable working channel wall.
  • biasing system 504 can be configured for use with a pivotable working channel wall, such as by the use of a torsion spring or the like.
  • Steering wire 506 can be configured to induce bending of elongate shaft 508 to facilitate insertion of endoscope 500 through anatomy.
  • steering wire 506 can be connected at a proximal end to a pulley that can be rotated by a crank or handle via user interaction to impart tension to steering wire 506.
  • the distal end of steering wire 506 can be attached to elongate shaft 508, such as through moveable working channel wall 502.
  • Steering wire 506 can be positioned loosely within a channel, lumen or passage extending through the interior of elongate shaft 508.
  • pulling of steering wire 506 can induce bending of elongate shaft 508 as is known in the art.
  • the distal end of steering wire 506 is attached to moveable working channel wall 502.
  • the spring force of biasing element 512 can be configured to be stiff to first allow bending of elongate shaft 508 and subsequently permit retraction of moveable working channel wall 502.
  • the spring force of biasing element 512 can be configured to be weak to first allow retraction of moveable working channel wall 502 and subsequently permit bending of elongate shaft 508.
  • Bending of elongate shaft 508 can cause engagement with anatomy, such as a duct wall.
  • engagement of elongate shaft 508 with anatomy can result in further pulling of steering wire 506 not producing additional bending of elongate shaft 508, thereby resulting in the spring force of biasing element 512 being overcome and moveable working channel wall 502 be actuated. Additionally, the spring force of biasing element 512 can be overcome by reaching the end or limit of steering wire 506 actuation.
  • FIG. 16A is a schematic side cross-sectional view of endoscope 550 having moveable working channel wall 552 with catch system 554 configured to interact with instrument 556.
  • FIG. 16A shows moveable working channel wall 552 in a retracted state.
  • FIG. 16B shows moveable working channel wall 552 in an advanced state.
  • FIGS. 16A and 16B are discussed concurrently.
  • Endoscope 550 can comprise elongate shaft 558 and cutout 560.
  • Catch system 554 can comprise catch 562 and catch 564.
  • Endoscope 550 can be configured similarly to endoscope 300 of FIGS. 7 - 10B with the addition of catch system 554.
  • Endoscope 550 can include an actuation system, such as the pull wire of actuator 336 (FIG. 7) steering wire 506 (FIGS. 15A and 15B).
  • Instrument 556 can comprise shaft 566 and intervention device 568.
  • Catch system 554 can be configured to allow for actuation of moveable working channel wall 552 without the use of a specific actuation system, such as a pull wire or steering wire, though and actuation system can be provided for redundancy or for additional control options.
  • Catch system 554 can utilize the movement of instrument 556 to push and pull moveable working channel wall 552.
  • catch 562 can comprise a projection on instrument 556 to engage with catch 564 as instrument 556 is being moved past moveable working channel wall 552.
  • Catch system 554 can be configured for one-way actuation of moveable working channel wall 552 or two-way actuation of moveable working channel wall 552. That is, catch system 554 can be configured to only engage during distal movement of instrument 556 out of endoscope 550 or proximal movement of instrument 556 into endoscope 550, or catch system 554 can be configured to engage during distal movement of instrument 556 out of endoscope 550 and proximal movement of instrument 556 into endoscope.
  • Catch system 554 can be used with a biasing mechanism, e.g., biasing system 504 of FIGS. 15A and 15B.
  • catch 562 can comprise a forward-facing hook and catch 564 can comprise a backward-facing hook.
  • catch 562 can comprise a forward-facing hook and catch 564 can comprise a wire extending laterally across moveable working channel wall 552.
  • catch 564 can be deformable such that once moveable working channel wall 552 reaches the axial limit that it can be moved, such as by constraints placed by bracket 329 or attachment mechanism 340, catch 564 can deform and release catch 562.
  • intervention device 568 can continue to move past moveable working channel wall 552.
  • catch system 554 can be configured for use with pivotable working channel wall 402 of FIG. 11, such as by catch 564 being located on a proximal side of pivot 440 so that forward (distal) movement of catch 562 causes clockwise rotation of pivotable working channel wall 402 (relative to the orientation of FIG. 11) and backward (proximal) movement of catch 562 causes counterclockwise rotation of pivotable working channel wall 402.
  • FIG. 17 is a schematic perspective view of endoscope 600 having pivotable working channel wall 602 retractable via resilient members 604.
  • Endoscope 600 can comprise elongate shaft 606 having main portion 608 from which imaging extension 610 extends. Imaging extension 610 can be formed by cutout 612 as discussed herein.
  • Instrument 614 comprising shaft 616 and intervention device 618, can extend from within endoscope 600.
  • Endoscope 600 can be configured similarly to endoscope 300 of FIG. 11 - FIG. 14B with the addition of resilient member 604 and hinge mechanism 620.
  • Pivotable working channel wall 602 can comprise an arcuate or semi-circular body configured to pivot or bend near main portion 608 of elongate shaft 606. Pivotable working channel wall 602 can be connected to main portion 608 via a hinge mechanism 620. Hinge mechanism 620 can comprise resilient material that allows pivotable working channel wall 602 to deflect from a closed position to an open position. Hinge mechanism 620 can comprise a section of main portion 608 or a separate portion of material connecting main portion 608 and pivotable working channel wall 602. Hinge mechanism 620 can comprise elastic material or a flexible polymer material.
  • Resilient members 604 can comprise straps or bodies of material that can extend between imaging extension 610 and pivotable working channel wall 602. Resilient members 604 can be stretchable so that when pivotable working channel wall 602 is closed to contact imaging extension 610, resilient members 604 can contract to a small size or can be recessed into one of pivotable working channel wall 602 or imaging extension 610.
  • Instrument 614 can be moved distally so that intervention device 618 pushes pivotable working channel wall 602 open as shown in FIG. 17. However, after intervention device 618 moves past pivotable working channel wall 602, resilient members 604 can pull pivotable working channel wall 602 back to the closed position to provide support to shaft 616. In order to facilitate movement of intervention device 618 back into endoscope 600, pivotable working channel wall 602 can be angled or include a ramped surface to allow intervention device 618 to push pivotable working channel all 602 away from imaging extension 610 and cause resilient members 604 to stretch, as shown in FIG. 19.
  • FIG. 18 is a front view of restraining clip 640 for use with pivotable working channel wall 602 of FIG. 17 and other examples of the present disclosure.
  • Restraining clip 640 can comprise a split ring having arcuate body 642 having ends 644A and 644B. Ends 644A and 644B can be spaced apart by arc length A.
  • Arcuate body 642 can be sized to fit around imaging extension 610 and pivotable working channel wall 602 of FIG. 17. As such, the inner diameter of arcuate body 642 can be slightly larger than the outer diameter of elongate shaft 606.
  • Restraining clip 640 can be positioned around imaging extension 610 such that ends 644A and 644B are positioned at pivotable working channel wall 602.
  • Restraining clip 640 can be held in place by attachment to imaging extension by any suitable means. As pivotable working channel wall 602 is forced open by intervention device 618, restraining clip 640 can flex such that ends 644A and 644B become farther apart, e.g., arc length A increases, and arcuate body 642 can become displaced from imaging extension 610 as the diameter of restraining clip 640 increases.
  • the initial length of arc length A can be set such that when pivotable working channel wall 602 is fully open, restraining clip 640 will not become dislodged from imaging extension 610, such as by being popped off.
  • ends 644A and 644B can continue to present inward force against pivotable working channel wall 602 such that when intervention device 618 is moved away from pivotable working channel wall 602, pivotable working channel wall 602 will be pushed back against imaging extension 610 and arcuate body 642 can engage flush with endoscope 600 as the diameter of restraining clip 640 decreases.
  • FIG. 19 a side schematic view of endoscope 600 having pivotable working channel wall 602 with angled reentry portion 650.
  • Endoscope 600 can be configured similarly as endoscope 400 of FIG. 11 or endoscope 600 of FIG. 17.
  • Angled reentry portion 650 can form an angled entryway having variable height D6. The angled entryway can increase in height moving toward the distal end of endoscope 600.
  • pivotable working channel wall 602 is closed, a gap can be provided between pivotable working channel wall 602 and imaging extension 610.
  • the gap can allow an instrument, such as intervention device 618, to gain partial entry into endoscope 600 before pivotable working channel wall 602 begins to open, thereby facilitating reentry of the instrument and preventing pivotable working channel wall 602 becoming pinned closed by an instrument attempting reentry.
  • the illustrated example shows angled reentry portion 650 comprising an angled portion of pivotable working channel wall 602 that is positioned on an upper (relative to the orientation of FIG. 19) side of pivotable working channel wall 602.
  • the lower side of pivotable working channel wall 602 can remain generally cylindrical in shape to not extend beyond the outer perimeter of endoscope 600, thus facilitating movement of endoscope 600 through anatomy when pivotable working channel wall 602 is closed.
  • pivotable working channel wall 602 can be angled outward such that angled reentry portion 650 comprises a flange or lip of pivotable working channel wall 602 angled away form the lower side of pivotable working channel wall 602.
  • FIG. 20 is block diagram illustrating examples of method 900 of inserting an oversized biopsy device through an endoscope.
  • Method 900 can comprise operation 902 - operation 924 that can encompass the use of surgical instrument 200 of FIG. 6, as well as other instruments.
  • Method 900 can additionally be used with the devices and systems of FIGS. 7 - 19.
  • additional operations consistent with the devices, systems methods and operations described herein can be included.
  • some of operation 902 - operation 926 can be omitted.
  • operations 902 - operation 924 can be performed in other sequences.
  • an endoscope such as a duodenoscope
  • endoscope 14 can utilize native imaging capabilities to guide insertion section 28 through anatomic ducts of the patient. Insertion section 28 can be bent or curved using control knob 38 and associated pull wires or steering wires to facilitate turning of endoscope 14.
  • an auxiliary scope can be inserted into the endoscope to access anatomy located further in the duct.
  • auxiliary scope 134 FIG. 5
  • Elevator 54 FIG. 3C
  • a tissue retrieval device or an over-sized biopsy forceps can be inserted into the auxiliary scope to reach target tissue.
  • the target tissue can comprise tissue that is potentially diseased or otherwise indicative of a diseased condition of the patient.
  • surgical instrument 200 FIG. 6) can be inserted into auxiliary scope 134 so that tissue collection device 204 remains within the auxiliary scope.
  • the endoscope having the tissue collection device inserted therein can be navigated to the location of target tissue within the patient.
  • endoscope 300 of FIG. 7 or endoscope 400 of FIG. 11 can be navigated through an anatomic duct to target tissue.
  • a surgeon can advance the auxiliary scope axially forward using an elevator as needed to position the target tissue within the view of an imaging device of the auxiliary scope.
  • a viewing or imaging device on the auxiliary scope can be activated in order to view biological matter of the patient.
  • imaging unit 110 FIG. 5
  • camera lens 137 FIG. 5
  • target tissue can be viewed using an imaging unit and a video display monitor.
  • imaging unit 110 can use objective lens 80 to display target tissue on output unit 18.
  • Objective lens 80 can view the target tissue and surgical instrument 200 at the same time or simultaneously.
  • Light from a light source can be used to illuminate the target tissue.
  • illumination lens 78 as generated by lighting unit 112, can be directed upon the target tissue.
  • the moveable working channel walls of the present disclosure can be opened to allow the over-sized biopsy forceps to exit the endoscope.
  • the endoscope can be prepared to allow the tissue retrieval device to exit the endoscope to engage the target tissue.
  • the moveable working channel wall can comprise a slidable working channel wall as shown in FIG. 7 or a pivotable working channel wall as shown in FIG. 11.
  • the moveable working channel wall can be moved or displaced to open or increase in size the distal most portion of the working channel of the endoscope.
  • the tissue collection device within the endoscope can move around an obstruction at the distal end of the working channel, such as an obstruction produced by the imaging device and in particular posterior wall 326 (FIG. 7) or posterior wall 426 (FIG. 11).
  • the over-sized biopsy forceps can be extended from the endoscope to engage target tissue.
  • the tissue retrieval device With the distal end portion of the working channel opened, the tissue retrieval device can be extended from the endoscope, circumventing the obstruction.
  • the tissue retrieval device can circumvent the obstruction by moving underneath or below the obstruction out of a cutout produced in the working channel wall opened up by the displacement of the moveable working channel wall.
  • the moveable working channel walls of the present disclosure can be closed to support the over-sized biopsy forceps.
  • the functional portion of the tissue retrieval device e.g., tissue collection device 204
  • the moveable working channel wall can be closed or advanced to support the shaft of the tissue retrieval device.
  • the shaft of the tissue retrieval device can be smaller in size, e.g., height, than the functional portion such that the obstruction within the working channel does not present an obstacle to the free movement of the shaft, e.g., shaft 206, such that the moveable working channel wall can be brought closer to the endoscope to support the tissue retrieval device.
  • the tissue retrieval device can be pushed into view of, or better view of, the imaging or viewing device, e.g., the camera, of the endoscope.
  • the moveable working channel wall can allow the tissue retrieval device to better follow movements of the endoscope, particularly up and down movements.
  • a tissue collection device can be pushed, pressed or otherwise brought into pressurized contact with the target tissue.
  • the over-sized biopsy forceps can be reciprocated axially, or rotated, to cause teeth 213 to slice, punch or shave, etc. one or more pieces of tissue away from the anatomy of the patient.
  • Sample tissue or biological matter separated or collected from the patient at operation 916 can be stored within a space inside the tissue collection device.
  • surgical instrument 200 is manipulated back-and-forth, or rotated, separated sample tissue can be positioned within internal pockets of jaws 212A and 212B.
  • the moveable working channel walls of the present disclosure can be opened to allow the over-sized biopsy forceps to be retrieved back into the endoscope.
  • the moveable working channel wall can be moved away from the endoscope or the obstruction within the working channel to again open up the distal end portion of the working channel to allow the tissue retrieval device to pulled proximally to reenter the endoscope.
  • the tissue collection device can be removed from the patient, such as by removal from the auxiliary scope, which can be left in place inside the anatomy. Additionally, the collected sample tissue can be removed from the tissue collection device to be transferred or transported to a laboratory for analysis or disposal.
  • the auxiliary scope can be removed from the endoscope.
  • auxiliary scope 134 (FIG. 5) can be withdrawn from endoscope 14 (FIG. 1).
  • the endoscope can be removed from the patient.
  • endoscope 100 (FIG. 5) can be withdrawn from duodenum D. The patient can thereafter be appropriately closed up or prepared for completion of the procedure.
  • method 900 illustrates examples of a method of collecting biological matter from internal passages of a patient in large enough quantities, e.g., by using an over-sized forceps of the present disclosure in conjunction with an endoscope having a truncated working channel and a two-stage imaging channel using a moveable working channel wall.
  • Example 1 is an endoscope comprising: an elongate shaft comprising: a distal end portion comprising: a distal end face located at a distal-most end of the elongate shaft; and a recessed end face located proximally of the distal end face; a working channel extending at least partially through the elongate shaft to the recessed end face; an imaging device located in the distal end portion proximate the distal end face; and an extension wall for the working channel extending from the recessed end face, the extension wall being movable between a closed position and an open position.
  • Example 2 the subject matter of Example 1 optionally includes wherein the extension wall has an arcuate shape to match with a curvature of the elongate shaft.
  • Example 3 the subject matter of any one or more of Examples 1-2 optionally include an actuation device to move the extension wall between the closed position and the open position.
  • Example 4 the subject matter of Example 3 optionally includes wherein the actuation device comprises a pull wire connected to the extension wall and extending at least partially through the working channel.
  • Example 5 the subject matter of any one or more of Examples 3-4 optionally include wherein the actuation device comprises a steering wire extending within a wall of the elongate shaft, the steering wire configured to induce deflection of the elongate shaft.
  • the actuation device comprises a steering wire extending within a wall of the elongate shaft, the steering wire configured to induce deflection of the elongate shaft.
  • Example 6 the subject matter of any one or more of Examples 1-5 optionally include wherein the extension wall comprises a pivoting panel connected to the elongate shaft proximate the recessed end face.
  • Example 7 the subject matter of Example 6 optionally includes an elastic member configured to pull the extension wall to the closed position.
  • Example 8 the subject matter of Example 7 optionally includes wherein the pivoting panel is connected to the elongate shaft by a flexible hinge.
  • Example 9 the subject matter of any one or more of Examples 6-8 optionally include a split ring disposed about the elongate shaft at the extension wall, the split ring configured to allow the pivoting panel to open and then return the pivoting panel to the closed position.
  • Example 10 the subject matter of any one or more of Examples 1-9 optionally include wherein the extension wall comprises a sliding panel configured to extend beyond and retract toward the recessed end face.
  • Example 11 the subject matter of Example 10 optionally includes wherein the sliding panel is attached to the elongate shaft via a rail system or brackets.
  • Example 12 the subject matter of any one or more of Examples 10-11 optionally include wherein the sliding panel is configured to retract into the elongate shaft to be within an outer perimeter of the elongate shaft.
  • Example 13 the subject matter of any one or more of Examples 10-12 optionally include a catch connected to the sliding panel to allow an instrument extending through the working channel to actuate the sliding panel.
  • Example 14 the subject matter of any one or more of Examples 1-13 optionally include wherein the extension wall includes a ramped distal portion, the ramped distal portion angled relative to an axis of the elongate shaft to form an pathway having an increasing cross- sectional area moving in a distal direction.
  • Example 15 the subject matter of any one or more of Examples 1-14 optionally include a biasing element to bias the extension wall to either the closed position or the open position.
  • Example 16 the subject matter of Example 15 optionally includes wherein the biasing element comprises a spring.
  • Example 17 the subject matter of any one or more of Examples 1-16 optionally include an imaging channel extending through the elongate shaft; and an imaging sensor lumen extending from the imaging channel to the distal end face; wherein the imaging device is positioned within the imaging sensor lumen and the imaging sensor lumen has a greater cross-sectional area than the imaging channel.
  • Example 18 is a method of collecting biological matter using a biopsy device extending from an endoscope, the method comprising: inserting the endoscope into anatomy of a patient; extending the biopsy device into a working channel of the endoscope to extend from the endoscope; adjusting a moveable working channel wall of the endoscope to support the biopsy device; and collecting biological matter from the anatomy with the biopsy device.
  • the subject matter of Example 18 optionally includes wherein extending the biopsy device into the working channel of the endoscope to extend from the endoscope comprises opening the moveable working channel wall to increase a size of an exit from the working channel.
  • Example 20 the subject matter of Example 19 optionally includes wherein the working channel of the endoscope has a recessed face located proximally of a distal end face of the endoscope.
  • Example 21 the subject matter of Example 20 optionally includes wherein the endoscope has an imaging channel with an imaging device lumen that truncates the working channel in a radially direction distally of the recessed face.
  • Example 22 the subject matter of Example 21 optionally includes wherein opening the moveable working channel wall comprises retracting a slidable working channel wall toward the endoscope.
  • Example 23 the subject matter of Example 22 optionally includes wherein retracting the slidable working channel wall toward the endoscope further comprises overcoming a biasing force.
  • Example 24 the subject matter of any one or more of Examples 21-23 optionally include wherein opening the moveable working channel wall comprises rotating a pivotable working channel wall away from the endoscope.
  • Example 25 the subject matter of Example 24 optionally includes wherein rotating the pivotable working channel wall away from the endoscope further comprises overcoming a biasing force.
  • Example 26 the subject matter of any one or more of Examples 20-25 optionally include wherein inserting the endoscope into anatomy of the patient comprises closing the moveable working channel wall to minimize a size of a distal tip of the endoscope.
  • Example 27 the subject matter of Example 26 optionally includes wherein minimizing the size of the distal tip of the endoscope comprises translating a slidable working channel wall proximally to open the exit of the working channel.
  • Example 28 the subject matter of any one or more of Examples 26-27 optionally include wherein adjusting the moveable working channel wall of the endoscope to support the biopsy device comprises operating an actuator to extend the moveable working channel wall.
  • Example 29 the subject matter of Example 28 optionally includes wherein operating the actuator to extend the moveable working channel wall comprises overcoming a biasing force that biases the moveable working channel wall to a closed position.
  • Example 30 the subject matter of any one or more of Examples 18-29 optionally include wherein adjusting the moveable working channel wall from the endoscope to support the biopsy device comprises operating a pull wire to adjust the moveable working channel wall.
  • Example 31 the subject matter of any one or more of Examples 18-30 optionally include wherein adjusting the moveable working channel wall from the endoscope to support the biopsy device comprises operating a steering wire to adjust the moveable working channel wall.
  • Example 32 the subject matter of any one or more of Examples 19-31 optionally include adjusting a moveable working channel wall from the endoscope to open the exit of the working channel; and retracting the biopsy device into the working channel.
  • Example 33 is an endoscope comprising: an elongate shaft comprising: a distal end portion comprising a distal end face located at a distal-most end of the elongate shaft; a working channel extending through the elongate shaft to the distal end portion; a moveable wall configured to expose a portion of the working channel proximal of the distal end face; an imaging channel extending through the elongate shaft to the distal end portion; and an imaging device lumen extending from the imaging channel to the distal end face, wherein the imaging device lumen is larger than the imaging channel; an imaging device located in the imaging device lumen; and an imaging cable extending from the imaging device through the imaging channel.
  • Example 34 the subject matter of Example 33 optionally includes wherein the distal end portion further comprises: a recessed end face located proximally of the distal end face; wherein the working channel extends to the recessed end face.
  • Example 35 the subject matter of Example 34 optionally includes wherein a distance between the recessed end face and a rear portion of the imaging device lumen is at least as long as a height of the working channel.
  • Example 36 the subject matter of any one or more of Examples 34-35 optionally include wherein the moveable wall comprises an extension wall for the working channel extending from the recessed end face, wherein the extension wall is moveable between an open position and a closed position.
  • the moveable wall comprises an extension wall for the working channel extending from the recessed end face, wherein the extension wall is moveable between an open position and a closed position.
  • Example 37 the subject matter of Example 36 optionally includes wherein a distance between the recessed end face and a rear portion of the imaging device lumen is longer than a height between the extension wall and the imaging device lumen.
  • Example 38 the subject matter of any one or more of Examples 36-37 optionally include wherein the extension wall comprises an arcuately shaped pivoting door.
  • Example 39 the subject matter of any one or more of Examples 36-38 optionally include wherein the extension wall comprises an arcuately shaped sliding door.
  • Example 40 the subject matter of any one or more of Examples 36-39 optionally include a biopsy forceps configured to move through the working channel, wherein a height of the biopsy forceps is larger than a radial distance between the extension wall and the imaging device lumen.
  • Example 41 the subject matter of any one or more of Examples 34-40 optionally include wherein the recessed end face is located proximally of the imaging device lumen.
  • Example 42 the subject matter of any one or more of Examples 34-41 optionally include wherein an axial distance between the recessed end face and the distal end face is greater than an axial length of the imaging device lumen.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Biophysics (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Endoscopes (AREA)

Abstract

Un endoscope comprend un arbre allongé avec une partie d'extrémité distale comportant une face d'extrémité distale située au niveau d'une extrémité la plus distale de l'arbre allongé et une face d'extrémité évidée située de manière proximale par rapport à la face d'extrémité distale, un canal de travail s'étendant au moins partiellement à travers l'arbre allongé jusqu'à la face d'extrémité évidée, un dispositif d'imagerie situé dans la partie d'extrémité distale, et une paroi d'extension pour le canal de travail s'étendant à partir de la face d'extrémité évidée, la paroi d'extension étant mobile entre une position fermée et une position ouverte. Un procédé de collecte de tissu à l'aide d'un dispositif s'étendant à partir d'un endoscope comprend l'insertion de l'endoscope dans l'anatomie d'un patient, l'extension du dispositif dans un canal de travail de l'endoscope pour s'étendre à partir de l'endoscope, le réglage d'une paroi mobile de l'endoscope pour supporter le dispositif, et la collecte de tissu à partir de l'anatomie avec le dispositif.
PCT/US2024/037175 2023-07-14 2024-07-09 Endoscope avec une paroi de canal de travail mobile Pending WO2025019206A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US202363513661P 2023-07-14 2023-07-14
US63/513,661 2023-07-14

Publications (1)

Publication Number Publication Date
WO2025019206A1 true WO2025019206A1 (fr) 2025-01-23

Family

ID=92895722

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2024/037175 Pending WO2025019206A1 (fr) 2023-07-14 2024-07-09 Endoscope avec une paroi de canal de travail mobile

Country Status (1)

Country Link
WO (1) WO2025019206A1 (fr)

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS508784U (fr) * 1973-05-23 1975-01-29
JPH0741019B2 (ja) * 1985-05-24 1995-05-10 オリンパス光学工業株式会社 内視鏡用処置具の補助具
WO2011140118A1 (fr) 2010-05-03 2011-11-10 Spirus Medical, Inc. Système de cathétérisme à avancement par rotation
JP2016140574A (ja) 2015-02-02 2016-08-08 オリンパス株式会社 内視鏡
JP2017006313A (ja) 2015-06-19 2017-01-12 オリンパス株式会社 内視鏡、内視鏡システム
US20220386991A1 (en) * 2020-03-04 2022-12-08 Micro-Tech (Nanjing) Co., Ltd. Imaging catheter, tip, tube body and medical device

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS508784U (fr) * 1973-05-23 1975-01-29
JPH0741019B2 (ja) * 1985-05-24 1995-05-10 オリンパス光学工業株式会社 内視鏡用処置具の補助具
WO2011140118A1 (fr) 2010-05-03 2011-11-10 Spirus Medical, Inc. Système de cathétérisme à avancement par rotation
JP2016140574A (ja) 2015-02-02 2016-08-08 オリンパス株式会社 内視鏡
JP2017006313A (ja) 2015-06-19 2017-01-12 オリンパス株式会社 内視鏡、内視鏡システム
US20220386991A1 (en) * 2020-03-04 2022-12-08 Micro-Tech (Nanjing) Co., Ltd. Imaging catheter, tip, tube body and medical device

Similar Documents

Publication Publication Date Title
WO2021127055A1 (fr) Accessoire d'endoscope et kit de dispositif médical
US11723523B2 (en) One-piece elevator for a duodenoscope
WO2004089195A1 (fr) Endoscope autoguide
US20250235085A1 (en) Modular endoscope imaging guidewire systems and methods
AU2007223890A1 (en) Endoscopic catheter apparatus having a radial groove
JP2023521171A (ja) ロッキング要素を有する内視鏡併用デバイス
US20240115116A1 (en) Ergonomic controls for endoscope
WO2025019206A1 (fr) Endoscope avec une paroi de canal de travail mobile
US20240016482A1 (en) Compact biological matter collection systems
US20240049949A1 (en) Direct peroral cholangioscope system with guide sheath
US20240285268A1 (en) Tissue collector with shuttle and expandable shaft
US20240407636A1 (en) Endoscope fluid turbulence control device
US20250098940A1 (en) Rotary articulating cholangioscope with stabilizing overtube
US20240325003A1 (en) Ductal sampling device
US20240277323A1 (en) Biopsy device with loose light conductor
US20240415375A1 (en) Endoscope with integrated stabilizer and cannulation elements
US20250387018A1 (en) Medical devices and systems with articulating shafts
US20240016483A1 (en) Optically enhanced instrument with laser fluorescing capabilities
WO2025172858A1 (fr) Dispositifs, systèmes et procédés de collecte de biopsie multiple
WO2025096282A1 (fr) Revêtement de voûte à rampe de sortie latérale
CN118119326A (zh) 模块化内窥镜成像导丝系统和方法
WO2024258823A1 (fr) Butée coulissante pour poulie de fil de traction d'endoscope
WO2022251797A1 (fr) Dispositif de suture à engrenage électrique ou manuel
WO2025006516A1 (fr) Systèmes médicaux, dispositifs et procédés associés
CN118717186A (zh) 管式采样装置

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 24776666

Country of ref document: EP

Kind code of ref document: A1