Articulating endoscopic accessory channel

Contents of disclosure

[Field of invention] The present invention relates to a method and a device for controlling the movement of the working end of a surgical device in a broad sense.

[Background of invention] Endoscopic surgical instruments are often preferred over traditional open surgical instruments because they use natural openings, resulting in shorter postoperative recovery times and reduced complications. Therefore, the field of endoscopic surgical instruments, which is suitable for accurately locating the working end of the instrument at the desired surgical site through a natural opening, has evolved considerably. These tools can be used to engage and / or treat tissues in a variety of ways to achieve diagnostic and therapeutic effects.

In endoscopic surgery, the shaft of the device is flexible, and at the same time, the working end is jointly moved to orient the working end at an angle to the tissue, and in some cases, the working end. It is necessary to be able to activate the working end to fire the working end or otherwise move the working end. The integration of controls for joint movement of the working end of the endoscopic device, and control for actuation, tends to be complicated by the use of flexible shafts and the size constraints of the endoscopic device. In general, all control movements are transmitted through the shaft by translational movements in the longitudinal direction, which movements can impair the flexibility of the shaft. There is also a desire to reduce the force required to joint and / or actuate the end of action to a level that can be handled by all or the majority of surgeons. One known solution for reducing the force against launch is to use an electric motor. However, surgeons typically prefer to feel feedback from the end of action and be confident of the correct operation of the end effector. The user feedback effect cannot be properly realized by the conventional motor drive device.

Therefore, there is still a need for improved methods and devices for controlling the movement of the working end of endoscopic surgical devices.

[Outline of Invention] In certain embodiments, the surgical device is provided to have an elongated shaft with a proximal end and a distal end, the proximal end having a handle movably coupled to the proximal end. , The distal end has a flexible neck extending from the distal end. The handle and the flexible neck can also be associated operably so that the movement of the handle is effective for the flexible neck to jointly move in multiple planes. In certain exemplary embodiments, the movement of the handle can also be mimicked by the flexible neck. The device can also include an actuator that extends between the handle and the flexible neck and is configured to transmit movement from the handle to the flexible neck.

The handle of the device can have various configurations, but in certain embodiments, the handle can also be configured to articulate with respect to the proximal end of the elongated shaft. For example, the handle is a ball and socket joint, a hinge joint, or a flexing joint. It can also be joined to the proximal end of an elongated shaft by a joint such as joint). The actuator of the device can have various configurations, but in certain embodiments, the actuator can be at least one cable that extends along the length of the elongated shaft. For example, the device can also include multiple cables that extend along the length of the shaft and are evenly spaced from each other around the actuator. The cable is configured to slide relative to the axis of the elongated shaft and to bend and bend at least a portion of the elongated shaft by applying tension to the elongated shaft. The handle and / or cable may optionally include a locking mechanism associated therewith, which locking mechanism is configured to hold the handle and / or cable in place. In an exemplary embodiment, the elongated shaft is configured to passively bend and bend when the elongated shaft is inserted through a meandering lumen.

The elongated shaft can also have various configurations, and in certain embodiments, the device can be in the form of a surgical stapler, the elongated shaft being coupled to the distal end of the flexible neck. The end effector may also include an end effector that engages tissue and is configured to carry at least one fastener to the engaged tissue. The handle and end effector can also be combined so that the movement of the handle is mimicked by the end effector. For example, the handle can be a ball socket joint, a hinge joint, or a flexing joint. It can also be joined to the proximal end of the elongated shaft by a joint such as joint), and the flexible neck can be formed on or joined to the end effector, thereby the end effector. It is possible to imitate the movement of the handle proportionally. The device can also include an actuator that extends between the handle and the end effector and is configured to transmit movement from the handle to the flexible neck. The actuator can also be, for example, a plurality of cables extending along the length of an elongated shaft. The cables can also be evenly spaced from each other around an elongated shaft.

In another embodiment, the device can be in the form of ancillary channels, the elongated shaft can be in the form of a tube with a lumen, which lumen accepts the instrument through this lumen. It is configured as follows. A flexible neck extending from the distal end of the elongated tube can also be configured to bend to orient the instrument extending through the elongated tube. The flexible neck may have a variety of configurations, but in certain embodiments, the flexible neck comprises a plurality of slits formed in the flexible neck to facilitate flexion of the flexible neck. To do. The slits can also be configured to bend the flexible neck in the desired orientation. For example, the flexible neck can also include a distal region of the slit and a proximal region of the slit, where the tension applied to the flexible neck causes the flexible neck to be in the proximal region and far away. It can also be configured to bend in the position region. The handle can also be coupled to the proximal end of an elongated tube, and the handle can also be operably associated with the flexible neck so that the movement of the handle is mimicked by the flexible neck. it can. The handle can also have various configurations, and in certain embodiments, the handle comprises a stationary member and a movable member configured to articulate with respect to the stationary member. You can also. The movable member can also be connected to the stationary member by a joint such as a ball socket joint, a hinge joint, or a bending joint. In use, the accessory channel can also be configured to releasably attach to the endoscope. For example, the meshing element is formed on the outer surface of the accessory channel and along the length of the outer surface so as to mesh with a complementary meshing element formed on a sleeve configured to accept the endoscope. Can be extended. The device can also include an actuator that extends between the handle and the flexible neck. The actuator can also be configured to transmit movement from the handle to the flexible neck. In one exemplary embodiment, an actuator A ta is in the form of at least one cable that extends along the length of an elongated tube. If the actuator includes a plurality of cables, the cables are preferably evenly spaced from each other around an elongated tube. The cable can be extended along an elongated tube using a variety of techniques. For example, an elongated tube may include at least one cavity that is formed on the side wall of the elongated tube and extends along the length of the elongated tube, and the cable is slidably placed inside the cavity. You can also do it. The device also includes a locking mechanism positioned to engage at least one of the handle and cable, allowing the handle and cable to be locked in place.

The present invention also provides an endoscope system having an elongated sleeve configured to be placed around the endoscope and an accessory channel that can be detachably meshed with the elongated sleeve. The accessory channel is formed and attached to the lumen extending between the proximal and distal ends of the accessory channel, the distal portion of the accessory channel, through the accessory channel to receive the device. A flexible portion made flexible by a plurality of slits formed in the channel, and at least one handle coupled to the proximal end of the attached channel, wherein the handle has at least one flexible portion. It is possible to have at least one handle, which is operably associated with the flexible portion so that it is configured to be articulated within one plane. The handle can also be operably associated with the flexible portion by at least one cable, and the handle can also be configured to move the cable axially relative to the attached channel, with the flexible portion The cable can be tensioned on the flexible portion of the attached channel so that it articulates in at least one plane. In certain embodiments, the device may also include a single handle configured to articulate the flexible portions in multiple planes. The single handle can also include a resting portion coupled to the proximal end of the accessory channel and a movable member configured to articulate with respect to the resting member. The single handle and the flexible portion can also be associated operably so that the movement of the single handle is mimicked by the flexible portion. In another embodiment, the handle is configured to have a first member configured to articulate the flexible portion in the first plane and a flexible portion to articulate in the second plane. It can also include a second member. In particular, the handle can also include a stationary member coupled to the proximal end of the accessory channel, and the first and second members can also be rotatably coupled to the stationary member. The device is coupled to and extends from the first member. And a first spool having at least one cable coupled to the flexible portion, and at least one cable coupled to and extending from the second member and coupled to the flexible portion. It is also possible to further include a second spool, which has. The first member and the second member are effective in rotating the first spool and the second spool, whereby the cable can be moved axially and the flexible portion can be articulated.

The surgical instruments disclosed herein can also include a variety of other features. For example, the device can also include an optical image acquisition unit located at the distal end of an elongated shaft. The optical image acquisition unit can also be configured to acquire images during endoscopic procedures. The image display screen may be located in the proximal portion of the device and may be configured to communicate with an optical image acquisition unit to display the acquired image. In another embodiment, the end effector of the device is detachably located within the end effector and houses a plurality of staples for stapling the tissue and a blade for cutting the stapled tissue. , Cartridges can be included.

In other embodiments, surgical methods are provided. This surgical procedure involves inserting an elongated shaft into the body cavity to position the flexible neck attached to the distal end of the elongated shaft near the tissue to be treated, and a handle on the flexible neck. Includes a step of moving a swivelly coupled handle to the proximal end of an elongated shaft to mimic movement. The flexible neck can move plane-symmetrically with the movement of the handle, or the movement of the flexible neck can exactly correspond to the movement of the handle. In one exemplary embodiment, the movement is proportional.

In one exemplary embodiment, the end effector coupled to the distal end of the elongated shaft is located near the tissue to be anchored and has a swivelly coupled handle to the proximal end of the elongated shaft. Moved to cause the end effector to proportionally mimic the movement of the handle. The end effector can move plane-symmetrically with the movement of the steering wheel, or the movement of the end effector can exactly correspond to the movement of the steering wheel. In an exemplary embodiment, the handle is rotatably articulated around the proximal end of an elongated shaft, causing the end effector to mimic the movement of the handle. The method can further include engaging the tissue between the opposing jaws of the end effector and driving at least one fastener from the end effector to the tissue. The tissue can also be engaged by moving the translational movement member formed on the handle from the first position to the second position and closing the opposing jaws, and the clasp is formed on the handle. It can also be fired by rotating the rotatable member, activating a drive mechanism located inside the end effector, and causing the drive mechanism to drive a plurality of fasteners into the tissue. In another embodiment, before moving the translational member from the first position to the second position, the rotatable member is rotated to rotate the end effector with respect to the flexible neck without activating the drive mechanism. You can also let it.

In yet another embodiment, the elongated shaft is in the form of an accessory channel that is slidably meshed with an endoscope placed inside the body cavity and is distal to the attachment channel in the immediate vicinity of the distal end of the endoscope. The end can be positioned. The device is inserted through a lumen within the accessory channel and moves a handle coupled to the proximal end of the accessory channel so that the device extends distally beyond the distal end of the accessory channel. The flexible neck over the distal end of the accessory channel can be articulated, thereby directing the working end of the device to the desired position. The handle can also be moved by rotatably articulating the handle with respect to ancillary channels, or alternative by rotating at least one rotatable member on the handle.

The present invention, along with the accompanying drawings, will be more fully understood from the following detailed description.

[Detailed description of the invention] Here, an exemplary embodiment is described to provide a general understanding of the structure, function, manufacture, and use of the devices disclosed herein, as well as the principles of the method. One or more embodiments of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will appreciate that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and the scope of the invention is defined only by claim. Will understand. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of another embodiment. Such modifications and modifications are intended to be included within the scope of the present invention.

The present invention provides methods and devices for controlling the working end of an endoscopic surgical device. Overall, endoscopic surgical instruments include an elongated shaft with a distal working end with a flexible neck and a handle to control the movement of the flexible neck over the distal working end. Includes the proximal end and. In one exemplary embodiment, this means that, for example, the movement of the handle exerts a force on one or more cables, bending the flexible portion, thereby moving the working end of the device. It can also be achieved by using one or more cables that extend between the flexible necks. Various other features are also provided to make the device easier to use. It is desirable for those skilled in the art to be able to change the particular device to be controlled and the particular configuration of the working end, and that the various control techniques described herein control the movement of the working end. You will understand that it can be used in virtually any surgical device.

1A and 1B are exemplary embodiments of techniques for controlling joint movement of the end effector, in particular techniques for causing the end effector to mimic the movement of the handle and at the same time move the end effector with the handle. Is illustrated. In this embodiment, the device is in the form of a linear staple / cutting device 10 for stapling the tissue in a plurality of linear rows and for cutting the stapled tissue. As shown, the device 10 generally includes an elongated shaft 12 having a proximal end 12a and a distal working end 12a, the proximal end 12a, as further detailed below. It has a handle 14 attached to its proximal end 12a, and the distal action end 12a is an end effector attached to or formed on its distal action end 12a. Has 16. In use, the end effector 16 is configured to mimic the movement of the handle 14. The mimicking behavior between the handle 14 and the end effector 16 generally extends between the handle 14 and the end effector 16 and is effective in transmitting force from the handle 14 to the end effector 16 actuator (non-actuator). It can also be achieved by using (shown). In an exemplary embodiment, the actuator is in the form of several cables that are spaced around the elongated shaft 12 and extend along the length of the elongated shaft 12. The movement of the handle 14 around the proximal end 12a of the shaft 12 exerts a force on one or more cables, causing this cable to exert a force on the end effector 16, thereby causing the end effector 16 to handle. Imitate 14 actions. The mimicking motion can include a corresponding motion in which the end effector 16 moves in the same direction and direction as the handle 14, or a plane-symmetrical motion in which the end effector 16 moves in the opposite direction and direction to the handle 14. The imitation motion can also be proportional to the movement of the steering wheel.

The elongated shaft 12 of the device 10 can have various configurations. For example, the elongated shaft 12 can be solid or hollow, can be formed from a single component, or can be formed from multiple segments. As shown in FIG. 2, the elongated shaft 12 is hollow and is formed from a plurality of connecting segments so that the elongated shaft 12 can be bent. The flexibility of the shaft 12, as well as its relatively small diameter, allows the shaft 12 to be used in endoscopic procedures, whereby the device is translumenally introduced through a natural opening. The length of the shaft can also vary depending on the intended use.

FIG. 2 is an exemplary embodiment of an actuator 22 in the form of several cables 34a, 34b, 34c, 34d that are spaced around the elongated shaft 12 and extend along the length of the elongated shaft 12. Is further illustrated. The number and location of cables can also vary. For example, the three cables can be separated from each other by approximately 120 degrees around the shaft 12. In the embodiment shown in FIG. 2, the four cables 34a, 34b, 34c, 34d are spaced approximately 90 degrees apart from each other around the shaft 12. Each of the cables 34a-34d can also extend through a passage, such as a lumen, formed in or around the elongated shaft 12. FIG. 2 illustrates the respective cables 34a-34d extending through a cutout formed on the outer surface of each segment of the shaft 12. Therefore, each segment contains four equidistant cutouts around the shaft 12 to keep the cables 34a-34d equidistant from each other. The cutout preferably has a size that is effective because the cables 34a-34d can slide freely with respect to the shaft 12 while holding the cables 34a-34d inside.

The distal ends of the cables 34a-34d are engaged with the end effector 16 and can also control the movement of the end effector 16. The end effector 16 can also have a variety of configurations and various end effectors known in the art can be used, although FIG. 3A shows opposing first jaws configured to accept tissue in between. Illustrated is an exemplary embodiment of an end effector 16, generally comprising a portion 18 and a second jaw portion 20. The first jaw 18 is configured to house a staple cartridge with a plurality of staples that is internally located and configured to be driven into the tissue, and the second jaw 20 is configured to accommodate a staple cartridge having a plurality of staples. Form an anvil to deform the staples. The unique configuration and basic operation of the end effector 16 can be varied, and various end effectors 16 known in the art can also be used. As a non-limiting example, US Pat. No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an," incorporated herein in its entirety. E-Beam Firing Mechanism) discloses certain embodiments of end effectors that can be used with the present invention.

The end effector 16 can also be movably coupled to the distal end 12b of the elongated shaft 12 to allow movement of the end effector 16 with respect to the elongated shaft 12. For example, the end effector 16 can also be rotatably coupled to the distal end 12b of the elongated shaft 12 by a pivot joint or rotary joint. Alternatively, the end effector 16 can include a flexible neck 26 formed on the end effector 16 as shown, allowing the end effector 16 to move relative to the elongated shaft 12. The flexible neck 26 can also be formed integrally with the distal end 12b of the elongated shaft 12 and / or the proximal ends of the jaws 18,20, or the flexible neck 26 is the shaft. It can also be a separate member extending between 12 and the jaws 18, 20. As shown in FIG. 3A, the flexible neck 26 includes a first coupler 28 for engaging the flexible neck 26 with the proximal ends of the opposing jaws 18, 20 and a flexible neck 26. Includes a second coupler 30, for engaging with the distal end of the elongated shaft 12. The couplers 28, 30 can also be detachably or fixed and engaged to the flexible neck 26 and / or the jaws 18, 20 and the shaft 12. Couplers 28,30 also serve to accommodate certain components of the end effector 16. For example, the first coupler 28 can function to secure the cable internally, as described below, and also to actuate the jaws 18, 20 (eg, close and fire). It can also function to accommodate the gear drive assembly of.

To facilitate bending of the flexible neck 26, the neck 26 may also include one or more slits 32 formed in the neck. The quantity, position, and size of the slits 32 can also be varied to obtain the desired flexibility. In the embodiment shown in FIG. 3A, the flexible neck 26 comprises a plurality of rows of slits 32, each row extending radially around the flexible neck 26, and each row being a flexible neck. It is axially separated along a length of 26. Each row of slits accommodates two slits extending around the neck 26, and each row of slits 32 is axially offset from each other. As a result, the flexible neck 26 includes alternating slits 32. Those skilled in the art can change the unique pattern of the slit 32, and FIG. 3A merely illustrates one pattern for forming the slit 32 to allow the flexible neck 26 to bend. You will understand that it is nothing more than. Other exemplary slit configurations are described in more detail below.

As described above, the cables 34a to 34d are coupled to the end effector 16 so that the end effector 16 can move in cooperation with the handle 14. The connection position between the cables 34a to 34d and the end effector 16 can also be changed according to the desired movement. In the illustrated embodiment, the distal ends of the cables 34a-34d are connected to the distal ends of the flexible neck 26, in particular the cables 34a-34d extend into the first coupler 28 and the first coupler. It is connected to 28. FIG. 3B illustrates a cross-sectional view of the first coupler 28 showing the four holes 28a, 28b, 28c, 28d for receiving the four cables 34a, 34b, 34c, 34d, respectively. Cables 34a-34d can also be connected to coupler 28 using virtually any technique known in the art, such techniques as, for example, adhesives, clasps, ball socket connections. Includes mechanical meshing techniques such as, threads, etc. In use, when axial force is applied to the cables 34a-34d by the handle 14, the connection of the cables 34a-34d at the distal end of the flexible neck 26 makes the cables 34a-34d flexible in tension. Can be hung on the neck 26. This tension causes the neck 26 to bend in a direction determined by the amount of tension applied to each of the cables 34a-34d, as further detailed below.

The handle 14 of device 10 can be used to control the movement of the end effector 16, in particular the end effector 16 can be articulated, and thus the end with respect to the longitudinal axis A of the elongated shaft 12. The effector 16 can be oriented at an angle. The handle 14 can have a variety of configurations, but in one exemplary embodiment, the handle 14 is located at the proximal end 12a of the elongated shaft 12 so that the movement of the handle 14 can be mimicked by the end effector 16. Is movably connected to. Although various techniques can be used to movably couple the handle 14 to the shaft 12, in the embodiments shown in FIGS. 4A-4C, the ball socket connection is close to the handle 14 and the elongated shaft 12. It is formed between the positions 12a. As best shown in FIG. 4B, the proximal end 12a of the elongated shaft 12 includes a socket 24 formed within the proximal end 12a, and the handle 14 is the distal end of the handle 14. Includes a hemispherical ball 13a formed in the socket 24 and configured to be rotatably seated inside the socket 24. The socket 24 can also be formed integrally with the proximal end 12a of the elongated shaft, or the socket 24 couples the hollow housing 12c to the proximal end 12a of the elongated shaft 12 as shown. It can also be formed by doing. The hemispherical ball 13a can also be formed integrally with the handle 14, or the hemispherical ball 13a can be a separate member coupled to the handle 14. To movably engage the handle 14 with the shaft 12, the hemispherical ball 13a on the handle 14 is held inside the socket 24 using cables 34a-34d attached to the handle 14, as described below. You can also. However, other meshing techniques can also be used to movably engage the handle 14 to the shaft 12. For example, the ball 13a can be spherical, and the ball 13a is an elongated shear. It can also be trapped inside a spherical socket formed at the proximal end 12a of the foot 12. Alternatively, a meshing element such as a pin can extend through the ball 13a to hold the ball 13a inside the socket 24. FIG. 4B illustrates a ball 13a formed on the handle 14 and a socket 24 formed within the shaft 12 with a ball socket connection where the ball is on the shaft 12 and the socket is on the handle 14. You can also reverse it as it is inside. Moreover, one of ordinary skill in the art will appreciate that a variety of other techniques can be used to movably couple the handle 14 to the proximal end 12a of the elongated shaft 12.

In use, the handle 14 can also be swiveled with respect to the joint movement, i.e., the shaft 12, and the end effector 16 can be made to mimic the movement of the handle 14. This can also be achieved by connecting the proximal ends of the cables 34a-34d to the handle 14. The connection position of the cables 34a to 34d and the handle 14 can be changed according to the desired movement. In the illustrated embodiment, the cable (FIG. 4A shows only three cables 34a, 34b, 34c) extends from the elongated shaft 12 through the hollow housing 12c and the proximal end of the hollow housing 12c. It comes out of a slot or opening formed in the portion. Cables 34a-34d then extend around the ball 13a on the handle 14 and connect to the distal surface of the handle 14 surrounding the ball 13a. Cables 34a-34d can be connected to the handle 14 using virtually any technique known in the art, such techniques as, for example, adhesives, clasps, threads, etc. Including mechanical meshing techniques such as. As illustrated in FIG. 4A, the handle 14 includes an opening formed within the handle 14, and a proximal end (not shown) of cables 34a-34d is formed on the proximal end thereof. It can also have a ball or other element that is configured to be trapped inside the opening. Cables (three cables 34a, 34b, as further illustrated in Figure 4A, (Only 34c shown) can be kept apart around the handle 14. This allows the movement of the handle 14 to be moved plane-symmetrically by the end effector 16, as further detailed below. Alternatively, the cables 34a-34d can also be crossed before these cables are connected to the handle 14 in order to move the end effectors 16 in the same direction as the handle 14. For example, the opposing cables 34a and 34c can intersect each other and be connected to the opposing sides of the handle 14. Also, the opposing cables 34b and 34d can similarly intersect each other and be connected to the opposing sides of the handle 14. Cables 34a-34d can be crossed at any location, such as inside a hollow housing 12c on the proximal end 12a of the shaft 12.

As further illustrated in FIGS. 4A and 4B, the handle 14 can also include other features to facilitate the use of the device. For example, the handle 14 has a translational motion member 38 that is effective in closing the jaws 18 and 20 on the end effector 16 and a rotation that is effective in selectively rotating and activating the end effector 16. Member 40, can also be included. The translational motion member 38 and the rotating member 40 include the title "single cable actuator" by Mark Ortiz et al., Filed on the same day as this specification, which is incorporated herein by reference in its entirety. It is explained in more detail in the application for "Surgical Fastener And Cutter With Single Cable Actuator". In other embodiments, the handle 14 may include a trigger, knob, etc. to rotate and / or actuate the end effector 16.

With reference back to FIG. 1B, in use, the handle 14 is swiveled with respect to the proximal end 12a of the elongated shaft 12, i.e. angled and achieved to mimic the movement of the end effector 16. it can. In particular, by turning the handle 14 around the elongated shaft 12 in the first direction, a force is applied to one or more of the cables 34a to 34d, and the cable is pulled in the axial direction. As a result, the actuated cable tensions the flexible neck 26 and bends the neck 26. The flexible neck 26 can have higher flexibility than the elongated shaft 12 because it prevents the elongated shaft 12 from bending in response to the tension applied to the cables 34a-34d by the handle 14. This can be achieved, for example, using the alternating slits 32 described above, or in other embodiments, the materials may be different, or the elongated shaft may extend through the elongated shaft, such as a rod. It also includes a stabilizing element to make the shaft more rigid than the flexible neck.

The direction of movement of the handle 14 is mimicked by the end effector 16 in the same direction (ie, corresponding movement) or in the opposite direction (ie, plane-symmetrical movement). Therefore, the user can accurately control the position of the end effector 16. In an exemplary embodiment, the specific amount of movement of the end effector 16 can be proportional to the amount of movement of the handle 14. That is, the amount of movement of the end effector 16 can be exactly equal to the amount of movement of the handle 14, or the amount of movement of the end effector 16 can be increased or decreased proportionally to the amount of movement of the handle 14. You can also. In certain embodiments, it may be desirable that the amount of movement of the end effector 16 be increased relative to the amount of movement of the handle 14. As a result, only a small movement of the handle 14 is required, and a large movement of the end effector 16 is possible. Although various techniques can be achieved to proportionally double, or increase, the movement of the end effector 16, an exemplary embodiment with a force increasing mechanism is an eccentric cam coupled to a cable. This eccentric cam increases the mechanical advantage of the cables 34a-34d, such as force or dislocation, when tension is applied to the cables 34a-34d by the handle 14.

For those skilled in the art, the movement between the working end of the device and the handle can theoretically be proportional, but in practice some loss of force when the force is transmitted through the elongated shaft. Will understand that will occur. Therefore, the proportional movement used herein is configured so that the handle and the working end move in a proportional amount, but some force loss may occur during the actual operation of the device. Intended to include application, which is sexual.

The various devices disclosed herein can also include various other features that make these devices easier to use. For example, device 10 of FIG. 1A can also include an optical image acquisition unit that is located at the distal end of the elongated shaft 12 and is configured to acquire images during endoscopic procedures. The position of the unit can also be changed, and in some embodiments, the optical image acquisition unit can also be located on the second coupler 30. In particular, FIG. 5 illustrates a tilted housing 42 that projects from the outer surface of the coupler 30 and houses an optical image acquisition unit inside. The observation window 44 is formed on the distal surface of the housing 42 so that the unit can acquire an image of the end effector 16 and an image of the periphery of the surgical site. The image from the optical image acquisition unit is projected on an external image display screen. Alternatively, the device 10 may include an image display screen located in the proximal portion of the device or coupled to the proximal portion of the device. FIG. 6 illustrates an embodiment of the image display screen 46 projecting outward from the handle 14.

As mentioned above, the various techniques disclosed herein for controlling the movement of the working end of an endoscopic surgical device can also be used in combination with various medical devices. FIG. 7 illustrates another embodiment of a medical device having an actuator for controlling the movement of the working end. In this embodiment, the medical device is in the form of ancillary channels 100 for use with an endoscope. The attached channel 100 is an external device that engages with the endoscope and can slide along the endoscope, and other tools such as a grasper and a cutter are introduced through the attached channel, and the observation end of the endoscope is introduced. It becomes possible to be positioned close to the part. The ancillary channel 100 can have substantially any configuration, shape, and size, but in the embodiment illustrated in FIG. 7, the ancillary channel 100 includes an elongated tube or shaft 102, the elongated tube 102. Has an extending lumen between the proximal end 102a and the distal end 102b of this elongated tube, through which the instrument is received. The ancillary channel 100 also includes a meshing element formed on the ancillary channel for directly engaging the ancillary channel 100 with the endoscope, sleeve, or other device located around the endoscope. You can also. Although substantially any meshing technique can be used, in the illustrated embodiment the meshing element on the accessory channel 100 is in the form of a rail 104 extending along the length of the elongated shaft 102. The rail 104 is configured to be accepted by a complementary track formed on the endoscope, or a device placed around the endoscope, such as a sleeve. Those skilled in the art will appreciate that various other techniques can also be used to directly or indirectly engage the accessory channel with the endoscope.

In order to control the movement of the working end of the accessory channel 100, the device 100 can also include features similar to those described above. In particular, the device 100 was formed or coupled on a flexible neck 108 formed or coupled on the distal end 102b of the elongated shaft 102, and on the proximal end 102a of the elongated shaft 102. A handle 106 and an actuator extending between the handle 106 and the flexible neck 108 can be included. In this embodiment, the actuator is configured to transfer force from the handle 106 to the flexible neck 108 so that the movement of the handle 106 is mimicked by the flexible neck 108. Thereby, the tool extending through the attached channel 100 can be positioned in the desired angular orientation.

The flexible neck 108 can have a variety of configurations, the flexible neck 108 can be a separate member coupled to an elongated shaft 102, or as shown in FIG. 7, elongated. It can also be formed integrally with the shaft 102. The neck 108 can also be made flexible using a variety of techniques. For example, the neck 108 can be formed from one or more segments that move relative to each other and / or can be formed from a flexible material. In the exemplary embodiment shown in FIG. 8A, the neck 108 comprises several slits 112 formed in the neck and configured to give the neck 108 maximum flexibility. The size, quantity, and orientation of the slits 112 can be varied to obtain the desired result, but in the illustrated embodiment, the flexible neck 108 has four columns of slits (arrows 112a, 112b, 112c). Includes (only the three struts of the slit shown in are shown). Each strut extends axially along the length of the flexible neck 108, and each strut contains four rows of slits radially spaced around the neck 108. Further, the respective columns of the slit 112 are displaced from each other in the axial direction, and the slits 112 can overlap each other. In use, when tension is applied to the actuator, the slit 112 bends or bends the neck 108 so that the neck 108 articulates with respect to the rest of the elongated shaft 102, as illustrated in FIGS. 8B and 8C. , Can take a curved shape.

In other embodiments, the slits can also be positioned so that the neck can be bent at multiple positions, i.e., at multiple bending points, or the neck can be bent at a predetermined position. .. As a non-limiting example, FIG. 9A illustrates another embodiment of the flexible neck 108'. The flexible neck 108'has two regions of slit 112' formed in the flexible neck 108'. In particular, the flexible neck 108'includes a distal slit region 112a' and a proximal slit region 112b'. Each region 112a'and 112b' can also include any number of slits located in any position to provide the desired degree of flexibility in one or more desired directions. As illustrated in FIG. 9A, each of the proximal slit region 112a'and the distal slit region 112b' is formed on opposite sides of the flexible neck 108'and is flexible neck 108. Includes two rows of slits extending along the length of . In use, when tension is applied to the flexible neck 108', the neck 108'bends in both the proximal region 112a' and the distal region 112b', as detailed below. , Joint movement with respect to the rest of the elongated shaft 102'. As shown in FIG. 9B, flexion can also initially occur in the distal region 112a'of the neck 108'. As shown in FIG. 9C, the proximal region 112b'can also be flexed when further tension is applied to the neck 108'. In other embodiments, the position and / or size of the slit can also be configured to cause flexion in the proximal region 112b'before flexion occurs in the distal region 112a'. Alternatively, the slit can be configured to simultaneously bend the proximal region 112b'and the distal region 112a'. Those skilled in the art will appreciate that the quantity, position, size, and shape of the slits can be adjusted to obtain the desired result. The cut used to form each slit The specific shape of the opening can also be changed. For example, the width and length of the slit can be constant from the outer surface of the elongated shaft to the inner surface of the elongated shaft. Alternatively, the width and length of the slit can be increased or decreased so that the slit is tapered or otherwise varied. As a non-limiting example, the tapered shape can also be formed by forming a slit having a triangular shape, in which case the length and width of the slit is from the outer surface to the inner surface of the elongated shaft. ,Decrease.

As described above, activator Yueta is tensioned flexible neck 108, and a neck 108 is configured to articulate. The actuator can have various configurations, but in one exemplary embodiment, the actuator is similar to the actuator described above, and the handle 106 and flexible neck 108 are operably associated with the handle. Includes one or more cables extending between the 106 and the distal end of the flexible neck 108. Each cable can also be configured to apply tension to the flexible neck 108 to articulate the neck 108 in the working plane. Thus, if the device 100 includes only one cable, the flexible neck 108 can also be articulated within a single motion plane. Each of the additional cables allows the neck 108 to articulate within different planes of motion. Given multiple cables, the neck 108 can also be articulated within multiple planes of motion. In addition, the cable can be tensioned at the same time, potentially allowing 360 degree articulation of the flexible neck 108.

The number of cables can vary, but device 100 can include only one cable, and in the embodiment shown in FIG. 7, device 100 is for four cables (cables 110a, 110b, 110c). Includes (only 3 cables shown). The parts of the cables 110a, 110b, 110c, 110d are shown in detail by FIG. As mentioned above, the cables 110a-110d extend along the length of the elongated shaft 102 between the handle 106 and the flexible neck 108. The specific position of the cables 110a-110d can vary, and in one exemplary embodiment, the cables 110a-110d are radially spaced around the elongated shaft 102, the furthest of the flexible neck 108. It extends between the end and the handle 106. Cables 110a-110d can extend inward through the elongated shaft 102 or outward along the elongated shaft 102. Alternatively, the cables 110a-110d can extend through the cavities and passages formed in the sidewalls of the elongated shaft 102. FIG. 11 illustrates a cross-sectional view of the elongated shaft 102, showing the four cavities 103a, 103b, 103c, 103d formed within the elongated shaft 102. The lumens 103a-103d preferably have a size that allows the cables 116a-116d to slide within the lumen, with the lumens 103a-103d spaced around the elongated shaft 102. The cavities 103a-103d extend between the proximal end 102a and the distal end 102b of the elongated shaft 102, with cables 110a-110d between the handle 106 and the most distal end of the flexible neck 108. It will be possible to extend in between.

The distal ends of the cables 110a-110d can also be engaged with the most distal ends of the flexible neck 108 using a variety of techniques, but in one embodiment, as shown in FIG. , The flexible neck 108 comprises an end cap 114 coupled or formed to the most distal end of the flexible neck 108. The configuration of the end cap 114 may vary depending on the configuration of the actuator, but in the illustrated embodiment, the end cap 114 includes four holes 114a, 114b, 114c, 114d formed in the end cap 114. The holes 114a-114d are spaced around the end cap 114 so as to align with the cavities 103a-103d in the elongated shaft 102. Each of the holes 114a to 114d is configured to accept one of the cables 110a to 110d. Cables 110a-110d can also be held inside holes 114a-114d using a variety of meshing techniques. For example, FIG. 10 illustrates a ball formed at each end of the cables 110a-110d to hold the ends of the cables 110a-110d in the holes 114a-114d in the end cap 114. The end cap 114 also includes a central canal 116 formed within the end cap 114, through which the instrument can be received. The lumen 116 can also function to facilitate positioning of the instrument inserted via the accessory channel 100.

The proximal end of the cables 110a-110d can also be engaged with a handle 106 coupled to the proximal end of the shaft 102. The handle 106 can have various configurations, but in an exemplary embodiment, the handle 106 can also be in the shape of a joystick, as already shown in FIG. 7, which joystick is an elongated shaft. It is movably coupled to the proximal end 102a of the 102 and is specifically configured to articulate with respect to the proximal end 102a of the elongated shaft 102. The joint movement of the handle 106 allows the movement of the handle 106 to be mimicked by the flexible neck 108, as described below.

Joint movement movements can also be achieved using various types of joints, but in an exemplary embodiment, a ball socket connection is formed between the handle 106 and the elongated shaft 102. In particular, as further details are shown in FIGS. 13A and 13B, the proximal end 102a of the elongated shaft 102 includes a housing 103 formed on the proximal end of the elongated shaft 102, wherein the housing 103 is the housing. The socket 118 is defined at the proximal end of the. The handle 106 includes a ball 120 movably located inside the socket 118, the joystick extending proximally from the ball 120, which allows the handle 106 to articulate with respect to the elongated shaft 102. .. A pin or other mechanism can also be used to movably hold the ball 120 inside the socket 118. Those skilled in the art will appreciate that the handle can also have a variety of other shapes and that a variety of other techniques can be used to movably connect the handle 106 to the elongated shaft 102. Let's do it.

As described above, the proximal ends of the cables 110a-110d are configured to engage the handle 106. Therefore, the handle 106 can also include features for engaging the cables 110a-110d. The particular meshing feature can vary depending on the actuator configuration, but in an exemplary embodiment, the joystick 122 on the handle 106 has four legs 124a, 124b, 124c, 124d formed on the joystick. including. The legs 124a-124d are spaced around the joystick 122 so that the legs are substantially in line with the cable and each leg 124a-124d is the end of one of the cables 110a-110d. It is configured to engage the part. As described above for the distal ends of cables 110a-110d, ball socket connections can also be used to engage cables 110a-110d to the legs, or, as an alternative, known in the art. Any other meshing technique can be used.

With reference back to FIG. 7, in use, the handle 106 is swiveled, or angled, with respect to the proximal end 102a of the elongated shaft 102, mimicking the movement of the flexible neck 108. Allows the positioning of the tool to extend through the flexible neck 108. As shown in FIGS. 7 and 13B, the joystick on the handle 106 can also include a lumen 107 formed through the joystick, which is with the lumen 102c within the elongated shaft 102. Aligned in the axial direction, the tool can be introduced through the device 100. In another embodiment, the handle 106 is attached to a cable, but the handle 106 is located at the proximal end 102a of the elongated shaft 102 so as not to interfere with straight access to the lumen 102c within the elongated shaft 102. You can also deviate from it.

To control the movement of the flexible neck 108, and thus the movement of the tool positioned via the flexible neck 108, the handle 106 is swiveled or articulated around the proximal end 102a of the elongated shaft 102. Be done. For example, the movement of the handle 106 in the first direction causes the legs 124a to 124d on the handle 106 to exert a force on one or more of the cables 110a to 110d and pull the cable axially. As a result, the actuated cable applies tension to the flexible neck 108, causing the neck 108 to bend. The flexible neck 108 can also be more flexible than the elongated shaft 102 in order to prevent the elongated shaft 102 from bending in response to the tension applied to the cables 110a-110d by the handle 106. This can also be achieved, for example, by using the slits described above, or in other embodiments, the shaft 102 includes a stabilizing element, such as a rod extending through the shaft, to provide the shaft 102. It can also be made more rigid than the flexible neck 108. The direction of movement of the handle 106 is mimicked by the flexible neck 108 in either the same direction (ie, corresponding movement) or in the opposite direction (ie, plane-symmetrical movement), thus allowing the user to position the flexible neck 108. Can be precisely controlled, thereby controlling the position of the tool extending through the flexible neck 108. In an exemplary embodiment, the particular amount of movement of the flexible neck 108 can also be proportional to the amount of movement of the handle 106. That is, the amount of movement of the flexible neck 108 can be exactly equal to the amount of movement of the handle 106, or it can be reduced or increased proportionally to the amount of movement of the handle 106. In certain embodiments, it may be desirable that the amount of movement of the flexible neck 108 be increased relative to the amount of movement of the handle 106. As a result, only a small movement of the handle 106 is required, allowing a large movement of the flexible neck 108. Flexible using various techniques

As mentioned above, the movement between the working end of the device and the handle can theoretically be proportional, but in practice some force as the force is transmitted through the elongated shaft. Loss will occur. Therefore, the proportional movement used herein is configured so that the handle and the working end move in a proportional amount, but some force loss may occur during the actual operation of the device. There are intended to include applications.

Although FIGS. 1A and 7 illustrate a device in which the working end mimics the movement of the handle, the handle articulates the working end of the device without causing the working end of the device to mimic the movement of the handle. It can also have a variety of other configurations that are effective for exercising. 14A and 14B illustrate another embodiment of the device 200 having a handle 204 that includes a rotatable member, the rotatable member with respect to one or more operating surfaces with respect to the elongated shaft 202 of the device. Within, it is effective for jointing the flexible neck 206. In general, the elongated shaft 202 of the device 200 is very similar to the elongated shaft 102 described above, and the elongated shaft 202 is flexible joined to or formed at the distal end of the elongated shaft 202. Includes neck 206 in general. Four cable actuators (not shown) extend through an elongated shaft between the handle 106 and the flexible neck 206. The shaft 102 and the cable actuator are similar to the shaft 102 and the cable actuators 110a-110d described above for device 100 and are therefore not described in detail.

The handle 204 of the device 200 is shown in more detail in FIGS. 15A and 15B. Overall, the handle 204 includes one or more spools rotatably arranged within the handle 204. Each of the spools is configured to engage and control one of the cable actuators. Thus, the rotation of each spool winds up or unwinds the cable, thereby flexing and articulating the flexible neck 108 in a particular direction. The number of spools can be varied by the number of cable actuators, but in the embodiments shown in FIGS. 15A and 15B, the handle 204 includes four spools 208a, 208b, 210a, 210b. The two first spools 208a and 208b are coupled to each other and the two second spools 210a and 210b are coupled to each other. The first cable 212a is coupled to the first spool 208a and wound around the first spool 208a. The second cable 212b is coupled to the second spool 208b and wound around the second spool 208b. The first cable 212a and the second cable 212b are located on opposite sides of the elongated shaft 202 and extend along the opposite sides. As a result, the tension applied to the first cable 212a causes the flexible neck 206 to articulate in the direction in the first motion plane, and the tension applied to the second cable 212b causes the flexible neck 206 to be the same. The joints are moved in the opposite direction in the motion plane. The first cable 212a and the second cable 212b are wound in opposite directions around the first spool 208a and the second spool 208b to allow tension to be applied to only one of the cables 212a, 212b. Therefore, the rotation of the first spool 208a and the second spool 208b applies tension to one of the cables 212a and 212b to wind them up, and at the same time, the cables 212a, Release the tension of the other of 212b and unwind. Similarly, in the third cable 212c and the fourth cable 212d, the rotation of the third spool 210a and the fourth spool 210b tensions one of the cables 212c and 212d to wind them up, and at the same time, the cables 212c and 212d It is wound around the third spool 210a and the fourth spool 210b so as to release the tension of the other side and unwind the winding. The third cable 212c and the fourth cable 212d are the first cable 212a and the second cable so that the third cable 212c and the fourth cable 212d articulate the flexible neck 206 in the second different operating plane. It can extend along the shaft 102 at a position radially offset from 212b. For example, the third cable 212c and the fourth cable 212d are approximately from the first cable 212a and the second cable 212b such that all of the cables 212a-212d are substantially equidistant around the elongated shaft 202. It can be offset by 90 degrees. Those skilled in the art will appreciate that the handle 204 can include any number of spools and cables to allow joint movement in the desired number of planes. It is wound around the third spool 210a and the fourth spool 210b so as to release the tension of the other 212d and unwind the winding. The third cable 212c and the fourth cable 212d are the first cable 212a and the second cable so that the third cable 212c and the fourth cable 212d articulate the flexible neck 206 in the second different operating plane. It can extend along the shaft 102 at a position radially offset from 212b. For example, the third cable 212c and the fourth cable 212d are approximately from the first cable 212a and the second cable 212b such that all of the cables 212a-212d are substantially equidistant around the elongated shaft 202. It can be offset by 90 degrees. Those skilled in the art will appreciate that the handle 204 can include any number of spools and cables to allow joint movement in the desired number of planes. It is wound around the third spool 210a and the fourth spool 210b so as to release the tension of the other 212d and unwind the winding. The third cable 212c and the fourth cable 212d are the first cable 212a and the second cable so that the third cable 212c and the fourth cable 212d articulate the flexible neck 206 in the second different operating plane. It can extend along the shaft 102 at a position radially offset from 212b. For example, the third cable 212c and the fourth cable 212d are approximately from the first cable 212a and the second cable 212b such that all of the cables 212a-212d are substantially equidistant around the elongated shaft 202. It can be offset by 90 degrees. Those skilled in the art will appreciate that the handle 204 can include any number of spools and cables to allow joint movement in the desired number of planes.

To control the spools 208a, 208b, 210a, 210b, the device may also include one or more gripping members. As shown in FIGS. 15A and 15B, the first rotary knob 214 is coupled to the first spool 208a and the second spool 208b, and the second rotary knob 216 is coupled to the third spool 210a and the fourth spool 210b. There is. The knobs 214,216 can also be integrally formed with the spools 208a, 208b, 210a, 210b, or the knobs 214,216 are spooled 208a, 208b, 210a by a shaft extending through the spools 208a, 208b, 210a, 210b. It can also be combined with, 210b. In the illustrated embodiment, the first knob 214 is formed on or coupled directly to the first spool 208a. The second knob 216 extends from the knob 216 through the first spool 208a and the second spool 208b and is coupled to the third spool 210a and the fourth spool 210b by the shaft 218, the third spool 210a and the fourth spool. It is coupled to spool 210b. In other words, the first spool 208a and the second spool 208b are rotatably arranged around the shaft 218.

In certain exemplary embodiments, the spool and rotary knob may also be of different sizes. In the embodiments shown in FIGS. 15A and 15B, the first spool 208a and the second spool 208b, and the first rotary knob 214 are from the diameters of the third spool 210a and the fourth spool 210b, and the second rotary knob 216. Also has a large diameter. Although not required, such a configuration can also be advantageous to separate the cables 212a-212d and prevent the cables 212a-212d from coming into contact with each other.

In use, the tool can also be positioned through an elongated shaft 202, rotating knobs 214,216 to articulate the flexible neck 206 on the shaft 202, thereby positioning the tool as desired. it can. As shown in FIGS. 14A and 14B, the handle 204 includes a lumen 205 that extends through the handle and aligns with the lumen within the elongated shaft 202, passing the tool through the handle 204 and shaft 202. Can be made to. In another embodiment, the handle 204 is offset from the elongated shaft 202 to provide direct access to the lumen within the elongated shaft 202. When the instrument is positioned via the shaft 202, the knobs 214,216 can also be rotated to articulate the flexible neck 206 on the distal end of the elongated shaft 202. In particular, the first knob 214 is rotated in the first direction, eg clockwise, to apply tension to one of the cables, eg the first cable 212a, and at the same time release the other cable, eg the second cable 212b. That is, the winding can be unwound. As a result, the tension applied to the first cable 212a pulls the most distal end of the flexible neck 206 proximally, flexing the flexible neck 206, thereby causing joint movement in the first direction. .. The rotation of the first knob 214 in the opposite direction, for example counterclockwise, unwinds the first cable 212a and at the same time winds up the second cable 212b. The flexible neck 206 returns to its initial linear shape. Further rotation of the first knob 214 continues to wind up the second cable 212b, while unwinding the first cable 212a, thereby bending the flexible neck 206 in opposite directions along the same plane of motion and jointing. Exercise. Similarly, the second knob 216 can be rotated to articulate the flexible neck within different operating planes. Alternatively, the knobs 214,216 can be rotated and at the same time the flexible neck 206 can be articulated within additional motion planes different from the first and second motion planes.

In other embodiments, the various devices disclosed herein lock the handle and / or actuator in a fixed position to maintain the working end of the device in the desired joint motion orientation or angular orientation. It can also include a locking mechanism. The locking mechanism can have a variety of configurations, but in one exemplary embodiment, the locking mechanism is lowered onto the cable to secure it, thereby impeding the movement of the cable and orienting the working end in the desired orientation. It can also be in the form of a clamp, which is effective for locking. The clamps can have different shapes and sizes and can be positioned at different positions on the device. 16A and 16B illustrate an exemplary embodiment of a clamp 300 placed around a hollow housing 12c on the surgical fixation / cutting device 10 of FIGS. 1A and 1B. The clamp 300 is substantially annular and has cables (in Figure 16B, three cables 34a, 34b, It can also be configured to slidably or rotatably engage the hollow housing 12c in the vicinity of an opening through which (only 34c is shown). In the initial position, the clamp 300 is separated from the opening and allows free movement of cables 34a-34d through the opening. When the working end of the device, eg, the end effector 16, is articulated to the desired position, the clamp 300 extends over the opening and clamps until it engages the cables 34a-34d extending from the opening. The 300 can move axially along the hollow housing 12c. Therefore, the clamp 300 hinders the movement of cables 34a-34d when in the locked position. To move the clamp 300 axially and lock the clamp 300 to the housing 12c, the clamp 300 can also include a meshing element formed on the clamp 300, which meshing element was formed on the housing 12c. It is configured to engage the corresponding mating element. As shown in FIGS. 16A and 16B, the clamp includes a thread 302 formed on the clamp, which thread is configured to mesh with a corresponding thread (not shown) formed on the housing 12c. ing. As a result, the rotation of the clamp 300 around the housing 12c moves the clamp 300 between the initial position and the locked position. Those skilled in the art will appreciate that a variety of other meshing techniques can also be used. In addition, the locking mechanism can also have a variety of other configurations. For example, the handle may include a locking element that is formed on the handle and is configured to lock the handle in a joint motion fixation position. You will understand that you can. In addition, the locking mechanism can also have a variety of other configurations. For example, the handle may include a locking element that is formed on the handle and is configured to lock the handle in a joint motion fixation position. You will understand that you can. In addition, the locking mechanism can also have a variety of other configurations. For example, the handle may include a locking element that is formed on the handle and is configured to lock the handle in a joint motion fixation position.

In other embodiments, cables can be used to passively articulate the elongated shaft through the body cavity, and clamp 300 or other locking mechanisms can be used to, where desired, the working end of the device. Can also be locked in place. In such a configuration, the device can be facilitated by simply utilizing the handle.

In other embodiments, the cable actuators disclosed herein used to achieve joint movement of the working end of the device can also be formed from an electroactive polymer material. Electroactive polymers (EAP), also called artificial muscles, are materials that exhibit piezoelectric, pyroelectric, or electrostrictive properties in response to an electric or mechanical field. In particular, EAP is a series of conductive doped polymers that change shape when a voltage is applied. Conductive polymers are paired with some form of ionic fluid or gel, and ionic electrodes, where the flow of ions from the fluid / gel to the conductive polymer or the flow of ions out of the conductive polymer changes the shape of the polymer. Can also be induced. Voltage potentials, typically in the range of about 1V to 4kV, depending on the particular polymer used and the ionic fluid or gel, can also be applied. It is important to note that EAP does not change volume when voltage is applied, or more precisely, it expands in only one direction and contracts laterally. Thus, the cable actuators previously disclosed herein can also be replaced by EAP actuators, the handle being configured to actuate an energy source to selectively deliver energy to one or more cables. You can also do it. In an exemplary embodiment, the movement of the handle can also be configured to indicate the amount of energy source, as well as the cable that receives the energy source. As a result, the movement of the handle is still mimicked by the working end of the device, allowing the user to have the same precise control over the position of the working end. The energy source can be an internal source such as a battery or an external source. In other embodiments, the EAP cable actuator can also supplement the axial force exerted on the cable by the movement of the handle, thereby increasing the amount of movement of the working end relative to the handle proportionally.

In another aspect, the cable actuator can also be formed from a shape memory material such as nitinol. With such a configuration, tension is applied to the cable to articulate the end effector, and the cable can return to its initial linear shape without the need to operate the handle.

In yet another embodiment, the various devices disclosed herein include parts of those devices and can be designed to be used once and then discarded, or used multiple times. It can also be designed to. In either case, the device can be used at least once and then readjusted for reuse. The readjustment can include any combination of disassembling the device, followed by cleaning or replacing certain parts, and then reassembling. As an example, the surgical staple fastening / fixing device shown in FIGS. 1A and 1B can also be readjusted after being used in a medical procedure. The device can also be disassembled and any number of specific parts can be selectively replaced or removed in any combination. For example, in a surgical staple fastening / cutting device, a cartridge that is located inside the end effector and contains a plurality of fasteners can also be replaced by adding a new fastener cartridge to the end effector. After cleaning and / or replacing certain parts, the device can also be reassembled in readjustment equipment or by the surgical team shortly before the surgical procedure for subsequent use. Those skilled in the art will appreciate that readjustment of equipment can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting readjustment device, are all within the scope of this application.

One of ordinary skill in the art will understand the further features and advantages of the invention based on the embodiments described above. Accordingly, the invention is not limited to what has been specifically shown and described, except as indicated by the appended claims. All publications and references described herein are expressly incorporated herein by reference in their entirety.

[Implementation mode] (1) In the attached channel for releasable attachment to the endoscope An elongated tube having a lumen, the lumen extending through the elongated tube between the proximal and distal ends of the elongated tube and receiving an instrument. When, A flexible neck that extends from the distal end of the elongated tube and is configured to bend to direct an instrument that extends through the elongated tube. A handle coupled to the proximal end of the elongated tube and operably associated with the flexible neck so that the movement of the handle is mimicked by the flexible neck. When, Attached channels, including. (2) In the apparatus according to the first embodiment. The flexible neck portion is a device including a plurality of slits formed in the flexible neck portion in order to facilitate bending of the flexible neck portion. (3) In the apparatus according to the second embodiment. The flexible neck includes a distal slit region and a proximal slit region. The slit is a device configured to bend the flexible neck in the proximal region and the distal region by tension applied to the flexible neck. (4) In the apparatus according to the first embodiment. The handle is a device including a stationary member and a movable member configured to jointly move with respect to the stationary member. (5) In the apparatus according to the fourth embodiment. A device in which the movable member is coupled to the stationary member by a joint selected from the group consisting of a ball socket joint, a hinge joint, and a bending joint. (6) In the apparatus according to the first embodiment. An actuator extending between the handle and the flexible neck, Including The actuator is a device configured to transmit movement from the handle to the flexible neck. (7) In the apparatus according to the sixth embodiment. The actuator comprises at least one cable extending along the length of the elongated tube. (8) In the apparatus according to the seventh embodiment. A locking mechanism, which is positioned to engage at least one of the handle and the at least one cable in order to lock the handle and the at least one cable in a fixed position. Including the device. (9) In the apparatus according to the seventh embodiment. The device, wherein the at least one cable comprises a plurality of cables evenly spaced from each other around the elongated tube. (10) In the apparatus according to the seventh embodiment. The elongated tube comprises at least one cavity formed within the side wall of the elongated tube and extending along the length of the elongated tube. A device in which the at least one actuator is slidably arranged within the at least one lumen. (11) In the apparatus according to the first embodiment. The elongated tube comprises a meshing element formed on the outer surface of the elongated tube and extending along the length of the outer surface. The meshing element is a device that meshes with a complementary meshing element formed on an endoscope or an endoscope sleeve.

(12) In the endoscopic system With an elongated sleeve configured to be placed around the endoscope, An accessory channel that can be detachably engaged with the elongated sleeve. A lumen extending through the accessory channel and between the proximal and distal ends of the accessory channel for receiving equipment, A flexible portion formed on the distal portion of the attached channel, which is made flexible by a plurality of slits formed in the flexible portion, as well as a flexible portion. At least one handle coupled to the proximal end of the accessory channel, such that the at least one handle is configured to articulate the flexible portion in at least one plane. At least one handle, operably associated with said flexible portion, With attached channels, Including endoscopic system. (13) In the system according to embodiment 12, The at least one handle is operably associated with the flexible portion by at least one cable. The at least one handle moves the at least one cable axially with respect to the ancillary channel so that the flexible portion articulates in at least one plane. Is configured to tension the flexible portion of the accessory channel. (14) In the system according to embodiment 12, The system, wherein the at least one handle comprises a single handle configured to articulate the flexible portion in multiple planes. (15) In the system according to embodiment 14, The single handle A resting member coupled to the proximal end of the accessory channel, and A movable member configured to make joint movements with respect to the stationary member, Including the system. (16) In the system according to embodiment 14, A system in which the single handle, and the flexible portion, are operably associated so that the movement of the single handle is mimicked by the flexible portion. (17) In the system according to embodiment 12, The at least one handle A first member configured to articulate the flexible portion in the first plane, and A second member configured to jointly move the flexible portion in the second plane, Including the system. (18) In the system according to embodiment 17, The at least one handle comprises a resting member coupled to the proximal end of the accessory channel. A system in which the first and second members are rotatably coupled to the stationary member. (19) In the system according to embodiment 18. A first spool coupled to the first member, the first spool having at least one cable extending from the first spool and coupled to the flexible portion. A second spool that is coupled to the second member and has at least one cable that extends from the second spool and is coupled to the flexible portion. Including The first and second members are effective in rotating the first and second spools, thereby moving the cable axially and articulating the flexible portion.

(20) In the method for positioning the tool A step of slidingly engaging the accessory channel with an endoscope placed inside the body cavity to position the distal end of the accessory channel in close proximity to the distal end of the endoscope. A step of inserting the device through a lumen in the accessory channel so that the device extends distally beyond the distal end of the accessory channel. The handle coupled to the proximal end of the accessory channel is moved to articulate the flexible neck over the distal end of the accessory channel, thereby bringing the working end of the tool into the desired position. Direction, steps, Including methods. (21) In the method described in embodiment 20, A step of locking the flexible neck to a fixed joint movement position, Including further, methods. (22) In the method described in embodiment 20, The step of moving the handle comprises a step of rotatably articulating the handle with respect to the accessory channel. (23) In the method according to embodiment 22 A method in which the flexible neck mimics the movement of the handle. (24) In the method described in embodiment 20, The method of moving the handle comprises rotating at least one rotatable member on the handle. (25) In the method described in embodiment 20, A method in which when the flexible neck is articulated, the flexible neck bends at a plurality of positions along the length of the flexible neck. (26) In the method described in embodiment 20, The step of slidingly engaging the ancillary channel with the endoscope is a meshing element formed along the length of the ancillary channel along the length of a sleeve placed around the endoscope. A method comprising joining to a formed meshing element.

<figref num="1A">It is a perspective view of an embodiment with a surgical staple / cutting device, showing the working end of the device in its initial position.</figref><figref num="1B">FIG. 1A is a perspective view of the surgical staple / cutting device of FIG. 1A, showing the working end of the device at the articulated position.</figref><figref num="2">FIG. 3 is a perspective view of a portion of the flexible neck of the device shown in FIGS. 1A and 1B.</figref><figref num="3A">It is a perspective view of the distal part of the device shown in FIGS. 1A and 1B, showing the end effector and the flexible neck of FIG. 2 coupled to the end effector.</figref><figref num="3B">It is sectional drawing along the line 3B-3B of the end effector shown in FIG. 3A.</figref><figref num="4A">FIG. 1B is a perspective view of the proximal portion of the device shown in FIGS. 1A and 1B, showing a handle movably coupled to the proximal end of the device shaft.</figref><figref num="4B">It is an assembly exploded view of the proximal part of the apparatus shown in FIG. 4A.</figref><figref num="5">It is a perspective view of the coupling element arranged between the flexible neck part and the elongated shaft of the device shown in FIGS. 1A and 1B, and shows an optical image acquisition device.</figref><figref num="6">It is a perspective view of the handle of the apparatus shown in FIG. 1A and FIG. 1B, and shows an image display screen.</figref><figref num="7">It is a perspective view of an accessory channel for use with an endoscope.</figref><figref num="8A">It is a perspective view of the flexible neck part of the apparatus shown in FIG.</figref><figref num="8B">FIG. 8A is a perspective view of the flexible neck shown in FIG. 8A, showing the neck jointed in the first direction.</figref><figref num="8C">FIG. 8A is a perspective view of the flexible neck shown in FIG. 8A, showing the neck jointed in the second direction.</figref><figref num="9A">FIG. 3 is a perspective view of another embodiment of a flexible neck for use with ancillary channels.</figref><figref num="9B">It is a perspective view of the flexible neck part shown in FIG. 9A, and shows the neck part which articulated in the first direction.</figref><figref num="9C">FIG. 9A is a perspective view of the flexible neck shown in FIG. 9A, showing the neck jointed in the second direction.</figref><figref num="10">FIG. 5 is a perspective view of a plurality of cable actuators for use with the device of FIG.</figref><figref num="11">It is sectional drawing of the shaft of the accessory channel of FIG.</figref><figref num="12">FIG. 5 is a perspective view of an embodiment with an end cap for using the attached channels of FIG. 7 together.</figref><figref num="13A">FIG. 7 is an exploded view of the handle of the device shown in FIG. 7 and the proximal portion of the elongated shaft.</figref><figref num="13B">FIG. 13A is a cross-sectional view of the proximal portion of the elongated shaft of FIG. 13A and the handle in the assembled arrangement.</figref><figref num="14A">It is a perspective view of another embodiment of an attached channel.</figref><figref num="14B">FIG. 6 is a cross-sectional view of the attached channel shown in FIG. 14A.</figref><figref num="15A">It is a side view of the handle assembly of the apparatus shown in FIGS. 14A and 14B.</figref><figref num="15B">It is an assembly exploded view of the handle assembly of FIG. 15A.</figref><figref num="16A">It is a perspective view of an embodiment of a locking mechanism.</figref><figref num="16B">FIG. 6 is a perspective view of the locking mechanism of FIG. 16A coupled to the surgical staple fastening / cutting device of FIGS. 1A and 1B.</figref>