US20150080933A1 - Endoscope with shared working channel - Google Patents

Endoscope with shared working channel Download PDF

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Publication number
US20150080933A1
US20150080933A1 US14/492,297 US201414492297A US2015080933A1 US 20150080933 A1 US20150080933 A1 US 20150080933A1 US 201414492297 A US201414492297 A US 201414492297A US 2015080933 A1 US2015080933 A1 US 2015080933A1
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United States
Prior art keywords
catheter
channel
lumen
tool
optionally
Prior art date
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Abandoned
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US14/492,297
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English (en)
Inventor
Igor IGOV
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MORENA MEDICAL APPLICATIONS Ltd
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MORENA MEDICAL APPLICATIONS Ltd
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Priority to US14/492,297 priority Critical patent/US20150080933A1/en
Assigned to MORENA MEDICAL APPLICATIONS LTD. reassignment MORENA MEDICAL APPLICATIONS LTD. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: IGOV, IGOR
Publication of US20150080933A1 publication Critical patent/US20150080933A1/en
Priority to US15/055,971 priority patent/US20160174814A1/en
Priority to US16/080,017 priority patent/US20190082940A1/en
Priority to US15/482,824 priority patent/US10441144B2/en
Abandoned legal-status Critical Current

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Definitions

  • the present invention in some embodiments thereof, relates to a system for opening a working space in a lumen of a living creature and, more particularly, but not exclusively, to a dissector for unfolding a fold in a lumen of a living creature.
  • U.S. Pat. No. 5,725,545 discloses a balloon dissector in which an elastic balloon is positioned on an exterior portion of a rigid tube. The tube is inserted into the patient and then a medium, such as saline solution, is inserted into the hollow tube.
  • the medium is communicated to an interior portion of the elastic balloon causing the balloon to expand and dissect tissue in the area. This dissection permits a subsequent surgical procedure to be performed at the site.
  • the tube is rigid, one end of the tube is preferably shaped as a dissector.
  • the rigid tube is graspable by the surgeon and is used as an instrument during its insertion into the site.
  • the rigid tube in one embodiment of the invention, is rigidly affixed to a syringe containing the medium so that the syringe/tube form one unit which is manipulated by the surgeon.
  • U.S. Pat. No. 8,246,646 discloses a balloon dissector passed through a tube and expanded. Following dissection by expansion of the balloon, the balloon is contracted, the tube is advanced, and the dissected tissue is spread by moving the blades apart from each other. The balloon dissector is withdrawn and another instrument is then introduced to carry out surgery on the anatomical structure exposed by the dissection and spreading steps.
  • U.S. Pat. No. 7,431,694 discloses a guide system for use with an endoscope, and a method of use.
  • the guide system can include a track, in the form of a rail, and a mating member for engaging the rail.
  • the guide system can also include an accessory, such as an accessory guide tube through which a medical instrument can be carried external of the endoscope.
  • An end cap can be provided to support the track relative to the distal end of the endoscope.
  • Additional background art includes Canadian Patent No. 2552817, U.S. Pat. No. 5,166,787, U.S. Published Patent Application No. 2005/0272976 to Tanaka, U.S. Pat. No. 7,413,543, U.S. Pat. No. 4,796,607, U.S. Pat. No. 8,269,828, U.S. Published Patent Application No. 2013/0131451, U.S. Pat. No. 7,914,448, U.S. Pat. No. 5,166,787.
  • a system for opening a workspace inside a lumen of a living creature comprising: an extender fitting through a channel of a catheter; a tool for performing a function in the lumen; a first anchor mounted proximal to the tool configured for attachment to a wall of the lumen; a second anchor mounted to the extender distal to the tool, the anchor configured for attachment to a wall of the lumen; and wherein the extender is configured for expanding a distance between the first anchor and the second anchor.
  • the tool is mounted to the extender.
  • the first anchor is mounted to the extender.
  • the system further includes a shaft extending through a channel of the a catheter and where the system is mounted on a distal portion of the shaft.
  • the first anchor includes a balloon.
  • the first anchor is mounted on the catheter proximal to a distal opening thereof.
  • the extender includes a stiff shaft extending a distally from the distal opening.
  • the catheter includes a guide and the stiff shaft is conveyed along the guide.
  • the stiff extender extends from a distal end of the catheter.
  • the stiff shaft extends from a fixed point in a cross section of the distal end of the catheter.
  • a distal portion of the stiff shaft is extensible.
  • the stiff shaft has two states: a flexible state and a stiff state, wherein the stiff shaft resists buckling along the longitudinal axis of the catheter.
  • the system further includes a stiffness controller for adjusting a stiffness of a distal portion of the extender from a proximal end of the catheter.
  • the system further includes a sensor for sensing an opening of a fold resulting from the expanding and stopping the expanding in response to the expanding.
  • a method of opening a workspace in a lumen of a living creature comprising: securing a first anchor reversibly to a wall of the lumen at a first location; securing a second anchor reversibly to a wall of the lumen at a second location; and expanding a distance between the first anchor and the second anchor while the first anchor and the second anchor are secured to the first location and the second location thereby stretching the lumen between the first location and the second location.
  • the method further includes inserting a distal end of a catheter into the lumen and wherein the securing of the first anchor is to the first location distal to a distal opening of the catheter and the securing of the second anchor is to the second location proximal to the distal opening of the catheter.
  • the first location is on a first side of a fold of the lumen and the second location is on a second side of said fold and further including: opening the fold by the expanding of the distance between the anchors.
  • the method further includes detecting the unfolding; and stopping the expanding is response to the detecting.
  • a line joining from the first location to the second location is substantially perpendicular to the fold.
  • a frame for a catheter comprising: a series of frame elements arranged along the length of a distal portion of the catheter, the frame elements defining at least one channel passing longitudinally along the catheter; an articulated spine located entirely in a continuous region of less than one eighth a cross section of the catheter, the spine including a series of spacers defining a distance between the frame elements in the continuous region; and a steering element controlled from a proximal end of the catheter for adjusting a longitudinal spacing between the frame elements in the cross section of the catheter outside the continuous region of the spine.
  • a bending axis of the catheter in the distal portion passes through the spine.
  • the frame elements further define at least one more channel passing longitudinally along the catheter from the proximal end to the distal end.
  • the channel and the at least one more channel communicate through a longitudinal slit between the channel and the at least one more channel.
  • the channel has a longitudinal split communicating with an outside of the catheter.
  • a width of the channel is at least one half the width if the catheter.
  • a system for cooling a heat emitting tool in a lumen of a living creature comprising: a fluid flow channel including a distal opening inside a lumen of living creature and a proximal opening outside of the living creature; and a heat exchanger in thermal communication with the tool, the heat exchanger disposed in a flow path of the flow channel.
  • the heat exchanger is located between the proximal opening and the distal opening.
  • the system further includes a housing surrounding the heat emitting tool on at least three sides, the housing including: an inflow opening, an outflow opening and a space for fluid flow between the inflow opening and the outflow opening, the space surrounding the heat emitting tool on at least three sides.
  • a method of cooling a tool using a catheter having a distal opening inside a lumen of a living creature comprising: providing a heat exchanger in a fluid flow path of the catheter and in thermal communication with the tool; selecting a flow rate and temperature of a fluid to achieve a desired cooling of the heat transfer surface and serve a medicinal function; pumping the fluid at the flow rate from a proximal end of the catheter over the heat exchanger at the temperature; and releasing the liquid into the lumen after the transferring.
  • composition of the liquid includes at least 50% of at least one material selected from the group consisting of carbon dioxide, nitrogen, barium sulfate, and water.
  • the lumen is an intestine and the fluid is a gas and the flow rate is between 20 to 100 ml/min.
  • the selecting also includes selecting a concentration to serve the medicinal function at the flow rate.
  • balancing an inflow rate and an outflow rate to achieve the desired cooling rate and net flow rate balancing an inflow rate and an outflow rate to achieve the desired cooling rate and net flow rate.
  • a system for suctioning material through a catheter channel from a lumen in a living creature comprising: a grinder having dimensions smaller than a cross section of the channel for fitting through the channel; a support located proximally to the grinder for conveying the grinder through the channel, the support aligning the grinder with an axis of the channel and supporting the tool near a distal opening of the channel for breaking up lumps entering the distal opening.
  • the support includes a shaft of length greater than the channel and wherein the shaft configured for rotating with respect to the channel and wherein the grinder is operationally connected to a distal portion the shaft for receiving rotational energy therefrom.
  • the system further includes a motor connected to a proximal portion of the shaft for rotating the shaft.
  • the support defines sub-channels for fluid flow from the distal opening to a proximal opening of the channel.
  • FIG. 1 is a flowchart illustrating a method of opening a workspace in a lumen of a living creature in accordance with some embodiments of the current invention
  • FIGS. 2A-D illustrate deploying of a system for opening a workspace in a lumen in accordance with an embodiment of the present invention
  • FIGS. 3A-B illustrate opening a workspace in a lumen in accordance with an embodiment of the present invention
  • FIGS. 4A-C are a schematic illustration of opening a workspace in a lumen in accordance with an embodiment of the present invention.
  • FIGS. 5A-B are perspective views of a tool on a carriage in accordance with an embodiment of the present invention.
  • FIGS. 6A-F are perspective views of various stages of deploying a tool on a carriage with a multi-channel catheter in accordance with an embodiment of the present invention
  • FIGS. 7A-C are perspective views of tools and a multi-lumen catheter in use for removing a growth (for example a polyp) in accordance with an embodiment of the current invention
  • FIG. 8 is a perspective view of an imaging sensor in accordance with an embodiment of the present invention.
  • FIGS. 9A-B are perspective views of a tool cooling system in accordance with some embodiments of the present invention.
  • FIGS. 10A-B are schematic views of a tool cooling systems in accordance with some embodiments of the present invention.
  • FIG. 11 is a schematic view of a tool cooling systems in accordance with an embodiment of the present invention.
  • FIG. 12 is a flow chart illustration of a method of grinding body fluid entering a channel in accordance with an embodiment of the current invention
  • FIGS. 13A-B illustrate a grinder for body fluids suctioned into a catheter in accordance with an embodiment of the present invention
  • FIGS. 14A-D illustrate frames of a catheter in accordance with some embodiment of the present invention
  • FIGS. 15A-B illustrate a magnetic actuator in accordance with an embodiment of the present invention
  • FIG. 15C illustrates a frame steered by magnetic actuators in accordance with an embodiment of the present invention.
  • FIGS. 16A-C illustrate a joint immobilizer for a catheter in accordance with an embodiment of the current invention.
  • the present invention in some embodiments thereof, relates to a system for controlling tools in a lumen of a living creature and, more particularly, but not exclusively, to a catheter for conveying one or more tools through a shared working channel.
  • An aspect of some embodiments of the current invention relates to a method for opening a workspace inside a lumen in a living creature.
  • folds and/or protrusions within a lumen may obscure view and/or access to an object.
  • the tool may include an anchors deployed at two points (for example proximally and/or distally of the work space).
  • two anchors may be anchored to a wall of the lumen and then distanced one from the other stretching the lumen and/or removing folds from the wall of the lumen.
  • a tool to open the workspace is deployed from a catheter.
  • the tool may include a balloon. Expanding the balloon may for example open the lumen laterally.
  • coolant for example a fluid including for example a liquid and/or a gas
  • a tool may include a camera and/or a light source
  • the tool may be inside a catheter inserted into the living creature and/or the tool may be inside a lumen of the living creature.
  • the coolant may come from outside the living creature and/or exit to the lumen inside the living creature.
  • air may be used to cool the tool and/or exit into an intestine.
  • the fluid may serve a function inside the living creature.
  • a gas may serve to inflate the intestine during an endoscopic procedure.
  • fluid drained and/or suctioned from the lumen and/or fluid exiting the lumen may be used for cooling a tool.
  • a heat sink may optionally be provided inside the tool and/or outside the tool.
  • cooling fluid for example water and/or saline solution and/or air
  • cooling fluid may be pumped into the living creature and/or retrieved back outside of the living creature for disposal.
  • cooling fluid may be recycled.
  • cooling fluid may pass through a catheter and/or a carriage supporting the tool.
  • cooling fluid may pass through a guide channel of the catheter and/or a working channel of the catheter.
  • the tool may be inserted through the working channel and/or the fluid may be supplied through a guide channel.
  • a fluid source may be connected to a tool for cooling.
  • the fluid used for cooling the tool may optionally be used for rinsing or cleaning of objects inside the lumen.
  • An aspect of some embodiments of the present invention relates to a grinder.
  • the grinder eliminates potentially clogging materials from fluids suctioned from of a lumen of a living to creature to a catheter.
  • the grinder may include a rotating blade supported by a carriage.
  • the blade and carriage may optionally pass from outside the living creature into a proximal opening of a catheter and/or be conveyed through a channel of the catheter to a distal opening of the catheter.
  • the distal opening of the catheter may be located inside a lumen of the living creature.
  • the blade may be passed out the distal opening of the catheter.
  • the blade may grind material in the flow entering the catheter channel before the material enters the channel.
  • the blade may grind material as it enters and/or after it enters the catheter channel.
  • the carriage may support the rotating blade.
  • the carriage may maintain the rotating blade aligned with the entrance of the channel.
  • the rotating blade is mounted on a shaft that rotates with respect to the carriage.
  • the carriage may rotate with the rotating blade.
  • rotational energy is supplied from outside the proximal end of the catheter (for example by rotating a shaft which passes through the catheter channel to the rotating blade).
  • suctioned material passes from the lumen into a distal opening of the catheter, along a channel of the catheter and/or out a proximal opening of the catheter.
  • the material may pass along the channel through which the carriage and/or rotating blade passed.
  • the carriage remains within the channel while the rotating blade grinds material entering the channel.
  • material may pass through a channel in the carriage.
  • the suctioned material may pass through a sub-channel between the carriage and the walls of the channel.
  • an aspect of some embodiments of present invention relates to a frame and/or skeleton for a catheter.
  • the frame includes a flexible spine connecting a series of elements supporting the cross section of the catheter.
  • the spine may, for example, preserve spacing between the elements along the axis of the spine.
  • the spine runs along one side of the catheter.
  • the spine occupies a small portion of the cross section of the catheter.
  • the catheter includes an open channel and/or a large working channel.
  • the spine is made up of a series of elements.
  • the elements of the spine may, for example, be connected by joints and/or hinges.
  • the joints joining different elements are oriented in different directions.
  • the spine as a whole can optionally be bent in any direction.
  • the elements of the frame optionally support the cross sectional form of the catheter.
  • the distal end of the catheter may be steered from the proximal end.
  • steering may be by a manual means, for example steering cables.
  • the catheter may include a working channel and/or one or more guide channels.
  • actuators may include magnets controlling the angle between elements of the catheter frame.
  • the actuators may interconnect between spinal spacers and/or frame elements and/or ribs of the catheter.
  • the working channel may include a distal opening and/or a proximal opening.
  • the proximal opening is accessible from the outside the living creature and/or the distal opening is exposed to the lumen.
  • the working channel may be wide enough for passing a tool and/or a fluid through the proximal opening, along the length of the working channel to the distal opening and/or into the lumen.
  • Each guide may include, for example, a narrow channel and/or a track running along all and/or part of the length of the working channel.
  • a guide channel and/or a working channel may have a circular cross section.
  • a guide channel and/or a working channel may have a non-circular cross section (for example semi-circular, rectangular, triangular, etc.).
  • a catheter may include one or more working channels.
  • a working channel has a closed perimeter.
  • a working channel may be open over a portion of its length.
  • the working channel may be located in the center of the catheter.
  • a catheter may include multiple working channels and/or guides.
  • catheter may include various kinds of catheters and/or endoscopes for example an encephaloscope, a laryngoscope, an esophagoscope, a thoracoscope, an angioscope, a nephroscope, a colonoscope, a proctoscope, an arthroscope, a rhinoscope, an esophagoscope, a bronchoscope, a mediastinoscope, a gastroscope, a laparoscope, an amnioscope, a cystoscope, and/or a hysteroscope, a urinary catheter, a nephritic catheter, an abdominal catheter, a venous catheter, an arterial catheter, an intracranial catheter, an epidural catheter, a tracheal tube, a central venous catheter, a Swan-Ganz catheter, en embryo transfer catheter, an umbilical line, a Tuohy-Borst adapter,
  • endoscopes for example an encephalo
  • a colonoscope may have a length ranging between 130 to 250 cm and/or longer and/or have a working channel cross sectional area ranging between 3 to 5 mm 2 and/or between 5 to 10 mm 2 and/or between 10 to 15 mm 2 and/or between 15 to 25 mm 2 and/or have a guide channel cross sectional area ranging between 0.1 to 1 mm 2 and/or between 1 to 10 mm 2 and/or between 10 to 15 mm 2 and/or between 15 to 50 mm 2
  • a urinary catheter may for example have a length ranging between 20 to 25 cm and/or 25 to 40 cm and/or have a cross sectional area of a working channel ranging between 1 to 4 mm 2 and/or between 4 to 20 mm 2 and/or between 20 to 40 mm 2 and/or between 40 to 60 mm 2 and/or have a cross sectional area of a guide channel ranging between 0.1 to 1 mm 2 , and/or between 1 to 5 mm 2 , and/or between 5 to 30 mm
  • distal portion of a catheter may mean for example the most distal half of the catheter and/or the most distal quarter of the catheter and/or the most distal 1 ⁇ 8 of the catheter and/or the most distal 1/10 of the catheter and/or the most distal portion of the catheter of length ranging between 1 and 10 cm and/or ranging between 1 mm and 1 cm.
  • the proximal portion of a catheter may be defined for example as the most proximal half of the catheter and/or the most proximal quarter of the catheter and/or the most proximal 1 ⁇ 8 of the catheter and/or the most proximal 1/10 of the catheter and/or the most proximal portion of the catheter of length ranging between 1 and 10 cm and/or ranging between 1 mm and 1 cm.
  • the cross sectional area of a working channel may range between 90% to 1 ⁇ 2 the cross area of the catheter and/or between 1 ⁇ 2 and 1 ⁇ 4 the cross area of the catheter and/or between 1 ⁇ 4 and 1/9 the cross area of the catheter and/or between 1/9 and 1/25 the cross area of the catheter and/or between 1/25 and 1/100 the cross area of the catheter.
  • the ratio of cross section of a working channel to the cross section of the catheter refers to ratio of the minimal cross section of the channel between a proximal and a distal opening of the channel to the minimal cross sectional area of the catheter between the same openings.
  • the ratio of cross sectional area of the working channel to the cross sectional area of the catheter may refer to the minimal local ratio of the cross sectional areas at any location between a proximal opening of the channel and a distal opening of the channel.
  • the ratio of cross section of a working channel to the cross section of the catheter may refer to ratio of the maximum cross section of the channel between a proximal and a distal opening of the channel to the maximum cross sectional area of the catheter between the same openings.
  • the ratio of cross sectional area of the working channel to the cross sectional area of the catheter may refer to the maximum local ratio of the cross sectional areas at any location between a proximal opening of the channel and a distal opening of the channel.
  • one or more guides may run along an inner wall of the working channel.
  • the cross section of the working channel will be greater than the cross section of a guide associated with the working channel.
  • a catheter and/or sleeve may include 1 guide and/or 2 guides and/or 3 guides and/or 4 guides and/or 5 guides and/or 6 guides and/or 7 to 10 guides and/or 10 to 15 guides.
  • one or more guides may run along an outer surface of the catheter.
  • a guide may extend beyond the catheter body.
  • a guide may run along the length of a working channel and/or extend out an opening of the working channel.
  • a carriage may be connected to a guide.
  • the tool may be connected to the carriage.
  • the carriage may extend beyond the guide, for example, the guide may be inside the working channel of the catheter while the carriage and/or the tool may extend out of the working channel.
  • the distance that a tool may extend beyond the distal end of the working may range over many values and/or depend on the kind of catheter.
  • a tool may extend out from an endoscope a distance of less than one outer width of the endoscope and/or between one to five times the outer width of the endoscope and/or between 5 to 20 times the outer width of the endoscope and/or more.
  • a carriage is optionally controlled by a physical manipulation by a user (for example a carriage may have a handle for manipulation by a user outside the lumen and/or a connection to the carriage and/or the tool inside the lumen).
  • a carriage may be self propelled (for example by an actuator).
  • the carriage and/or the guide and/or the tool may include an actuator.
  • the actuator optionally manipulates the tool and/or the carriage.
  • the actuator may be controlled, for example by an on-board processor and/or a remote control unit.
  • a carriage and/or tool may be introduced into the working channel and/or connected to the guide from the proximal end of the catheter.
  • a carriage and/or tool may be introduced into the working channel and/or connected to the guide from the distal end of the catheter.
  • a guide may include a track and/or a guide channel.
  • a guide optionally communicates with the working channel and/or the outer surface of the catheter.
  • a guide and/or guide channel may communicate with the outside of the catheter at its distal and/or proximal end.
  • a guide and/or guide channel may communicate with the outside of the catheter along its length.
  • the guide may include a narrow guide channel with a longitudinal slit communicating with the working channel and/or the outer surface of the catheter.
  • the slit connects to a distal opening and/or to a proximal opening of the guide and/or guide channel and/or working channel.
  • the slit may run along central and/or interior portion of the guide channel and/or guide.
  • a slit runs the entire length of the guide and/or guide channel (for example from a distal end and/or a distal opening to a proximal end and/or a proximal opening).
  • a guide may communicate with the working channel and/or the outside of the catheter along its entire length and/or along a length less than the width of the working channel and/or along a length ranging between the width of the working channel to ten times the width of the working channel and/or along a length ranging between ten times the width of the working channel to one hundred times the width of the working channel and/or over a length less than one tenth the length of the catheter and/or over a length between a tenth to a quarter of the length of the catheter and/or over a length ranging between a quarter to a half the length of the catheter and/or between half the length to the entire length of the catheter.
  • a working channel may communicate with one or more guides and/or the outside of the catheter along its entire length and/or along a length less than the width of the working channel and/or along a length ranging between the width of the working channel to ten times the width of the working channel and/or along a length ranging between ten times the width of the working channel to one hundred times the width of the working channel and/or over a length less than one tenth the length of the catheter and/or over a length between a tenth to a quarter of the length of the catheter and/or over a length ranging between a quarter to a half the length of the catheter and/or over a length ranging between a half to the entire the length of the catheter.
  • the width of a communication slit may range for example between 0.01 to 0.1 mm and/or between 0.1 mm to 0.5 mm and/or between 0.5 mm to 2 mm and/or 2 mm and/or more.
  • the width of a communication slit may range for example between 1/50 to 1/10 the width of the smaller channel and/or between 1/10 to 1 ⁇ 5 the width of the smaller channel and/or between 1 ⁇ 5 to 1 ⁇ 2 the width of the smaller channel and/or from 1 ⁇ 2 to the entire width of the smaller channel.
  • the width of the slit may be variable along the length of the channel.
  • the guide may include a track running along the working channel and/or an outer surface of the catheter.
  • the guide may optionally extend along the entire length of the working channel and/or a portion thereof.
  • the guide may communicate with the working channel along the entire length of the working channel and/or a portion thereof.
  • a plurality of guides may all have similar width and/or form.
  • each guide may have a different width and/or form.
  • a guide may have a cross sectional area ranging between 1 ⁇ 2 to 1 ⁇ 5 the cross sectional area of an associated working channel and/or between 1 ⁇ 5 to 1/20 the cross sectional area of an associated working channel and/or between 1/20 to 1/400 the cross sectional area of an associated working channel.
  • a narrow guide channel may be used as a guide and/or used as an alternative working channel.
  • a narrow tool may be introduced into or out of the lumen through a guide channel and/or materials may be passed into or out of the lumen through a guide channel.
  • a catheter may include and/or not include one or more working channels, internal guides (for example communicating with one or more working channels), external guides (for example communicating with an external surface of the catheter), and/or closed guides.
  • a working channel may include a longitudinal opening and/or may be closed.
  • a guide channel may interconnect two channels (for example working channels and/or guide channels) and/or may connect a channel to an external opening.
  • a tool deployed on the outside of a catheter may be supplied with shielding.
  • a shield may protect internal structures in the patient from damage and/or puncturing by the tool.
  • a balloon may be mounted on the tool.
  • the tool may be conveyed through the catheter with the balloon in a contracted (for example deflated) state and/or the balloon may be expanded (for example) inflated while the tool is located outside the catheter.
  • a working channel is used for transporting tools and/or materials to and/or from the lumen.
  • the working channel may include the access path.
  • the working channel may be included in a catheter.
  • the catheter may be positioned along an access path to the lumen.
  • a guide may be used, for example, to convey one or more tools to the lumen and/or to control the one or more tools in the lumen (for example controlling a tool may include manipulating and/or supporting and/or directing the tool).
  • the tool may be deployed and/or retrieved and/or conveyed through the working channel via the guide.
  • the tool may be controlled in the lumen via the guide.
  • a tool may be deployed in a lumen connected to a distal end of a guide.
  • a tool may be directed along a guide to a location in the lumen where the tool can be supported (permanently or temporarily) by a connection to a body part.
  • the tool may remain connected to the guide and/or the tool may be disconnected from the guide.
  • a tool may be deployed inside the lumen such that an opening of the working channel remains clear. Optionally clearing the opening of the working channel may facilitate use of the working channel to pass further tools and/or materials into and/or out of the lumen.
  • the tool may be reconnected to the guide and/or the tool may be returned to the working channel and/or retrieved from the lumen through the working channel.
  • returning and/or retrieving the tool may include directing the tool via a guide to the working channel and/or conveying the tool along the working channel via the guide.
  • the tool is returned along the same guide that was used to deploy the tool.
  • the tool may be returned using a different guide.
  • one or more tools may be inserted into a working channel and/or conveyed in a working channel and/or deployed from a working channel and/or retrieved from a working channel without the use of a guide.
  • the guide may used to convey and/or guide a tool all the way and/or part of the way to a lumen and/or site of treatment.
  • a tool may arrive to the site of treatment without the guide and/or the guide may be used to retrieve the tool.
  • a tool may arrive to the site of treatment without the guide and/or the guide may be used to control the tool at the site of treatment.
  • a working channel may include a narrowing at one or more locations.
  • the lumen may include a portion of the urinary tract, the digestive tract and/or the pulmonary tract.
  • a plurality of guides may be used to control a plurality of tools.
  • a plurality of guides may be positioned along the access channel and/or a respective tool connected to each guide.
  • each tool is conveyed and/or directed and/or manipulated and/or supported independently.
  • a single guide may be used for multiple tools.
  • a first tool may be disconnected from the guide and/of subsequently a second tool may be connected to the guide.
  • the first tool may be deployed into the lumen and/or disconnected from the guide.
  • the second tool may be connected to the guide.
  • the first tool may be returned from the lumen and/or retrieved from the working channel and/or disconnected from the guide.
  • the guide is optionally used for a second tool.
  • multiple tools may be connected to a single guide and/or a single tool may be connected to multiple guides.
  • a tool may block a channel and/or a path.
  • the tool may be moved to unblock the path and/or channel.
  • blocking a path and/or channel is relative to a context.
  • a first tool blocks a channel when the second tool is prevented from passing through the channel due to the first tool. Unblocking the channel may mean allowing the second tool to pass through the channel.
  • blocking may mean preventing a object from passing along the path when the cross sectional area ranges for example between 10% to 25% of the cross sectional area of the channel and/or path and/or 25% to 50% of the cross sectional area of the channel and/or path and/or 50% to 75% of the cross sectional area of the channel and/or path and/or 75% to 100% of the cross sectional area of the channel and/or path.
  • unblocking a path and/or channel may mean opening 10 to 25% of the blocked cross section of the path and/or channel and/or opening 25 to 50% of the blocked cross section and/or opening 75 to 100% of the blocked cross section.
  • a tool may be inserted into a catheter and/or retrieved from the catheter and/or reinserted into the catheter while the distal end of the catheter remains in a lumen of a patient.
  • inserting, retrieving and/or reinserting may be used to reposition a tool and/or a camera in a lumen.
  • a camera may be relocated to a new position for example with an improved view and/or a tool may be placed in a new position for example with better access to a treatment location.
  • a working channel may include the working channel of a catheter which is positioned along the path to a treatment site.
  • one or more tools are optionally passed sequentially through the working channel into the lumen of a patient.
  • one or more guides may be used to convey one or more tools through the working channel and/or to unblock the working channel.
  • one tool may be passed into the working channel after the previous tool has passed out of the working channel.
  • multiple tools may be passed through the working channel in a line. For example, all of the tools may be attached to a single guide.
  • one or more guides may be used to convey each of a plurality of tools independently through the working channel.
  • the working channel may be too narrow for two tools to pass simultaneously.
  • a first tool may be directed along a guide from a location in the working channel to a site outside the working channel unblocking the working channel.
  • the unblocked working channel may be used for another function.
  • the unblocked working channel may be used for transporting a fluid into or out of the lumen.
  • a second tool may be passed along a second guide through the unblocked working channel and/or past the location vacated by the first tool.
  • the guide may be used to return a tool from the lumen to outside the lumen, for example to the working channel and/or to return the tool to outside the body of the living creature.
  • a tool may be deployed into a lumen and/or later returned to the working channel and/or retrieved.
  • the tool optionally will remain connected to the guide while it is deployed.
  • the tool may be disconnected from the guide while it is deployed and/or reconnected to the guide when it is returned.
  • a tool may be connected to a tether for return and/or retrieval.
  • the tool may be deployed returned and/or retrieved along a single guide.
  • multiple guides may be used for conveying, deploying, returning and/or retrieving a tool.
  • multiple guides may be used sequentially and/or simultaneously.
  • FIG. 1 is a flow chart illustration of a method for opening a workspace inside a lumen of a living creature in accordance with an embodiment of the present invention.
  • a first anchor may be deployed 101 .
  • deployment 101 may include reversibly securing and/or affixing the anchor to a wall of the lumen.
  • the first anchor is optionally deployed 101 proximal to the workspace.
  • a second anchor may be deployed 101 distal to the workspace.
  • the distal opening of the catheter may be within the work area. The distance between the anchors may be expanded 105 thereby stretching the lumen longitudinally.
  • Longitudinal stretching optionally straightens folds in the walls of a lumen.
  • Unfolding may for example expose parts of the wall and/or other structures that were obscured by the folds.
  • a medical procedure for example a diagnostic and/or therapeutic procedure
  • the anchors may optionally be used to laterally expand the lumen and/or to seal the working area.
  • sealing the working area may be used to prevent the transfer of dirt and/or body fluids into the workspace and/or to prevent transfer of drugs, medical materials and/or debris out of the workspace. Sealing may also facilitate inflation of the workspace.
  • the lumen is optionally released from its stretched configuration and/or tools and/or anchors and/or the catheter may be released and/or returned 111 .
  • FIGS. 2A-3B illustrate a tool, for example a dissector, for opening a workspace in a lumen of a living creature in accordance with an embodiment of the present invention.
  • the tool may include a first anchor located proximal to a distal opening of a catheter.
  • the tool may include a second anchor that can be moved distally with respect to the distal opening.
  • the second anchor may be mounted on an extender, for example shaft that moves through and/or out the distal opening.
  • the anchors are optionally secured to the walls of the lumen and then distanced one from the other to longitudinally stretch and/or unfold the lumen.
  • FIG. 2A is a cut away view of a folded lumen 256 containing a dissector catheter 242 in accordance with an embodiment of the current invention.
  • Catheter 242 optionally includes a distal opening 260 inserted into folded lumen 256 .
  • catheter 242 includes an anchor 235 a in a contracted state wrapped around a sleeve of catheter 242 .
  • anchor 235 a may be located proximal to distal opening 260 of the catheter.
  • lumen 256 may include an intestine.
  • a structure 290 of interest may be partially obstructed by a fold 257 in lumen 256 .
  • structure 290 may include a polyp.
  • FIG. 2B illustrates a cutaway perspective view of lumen 256 including catheter 242 in accordance with an embodiment of the present invention.
  • structure 290 is viewed from the perspective of an imaging sensor 234 looking distally from the distal end of catheter 242 .
  • Structure 290 may be partially and/or totally obstructed by a fold 257 in lumen 256 .
  • FIG. 2B only a top portion of structure 290 is within the view of imaging sensor 234 .
  • FIGS. 2C and 2D illustrate deployment of two anchors 235 a, b from catheter 242 inside lumen 256 in accordance with an embodiment of the current invention.
  • catheter 242 is located in lumen 256 with distal opening 260 of the catheter proximal to structure 290 .
  • a first anchor 235 a is optionally located on one side (proximal to) structure 290 .
  • a second anchor 235 b is inserted through catheter 242 and/or through distal opening 260 into lumen 256 .
  • anchors are located on two sides of a fold is in lumen 256 .
  • anchors 235 a, b are located on opposite sides of fold 257 .
  • anchor 235 b is in a collapsed state, as illustrated for example in FIG. 2C .
  • Anchor 235 b is optionally inserted longitudinally along lumen 256 past structure 290 .
  • anchor 235 b is placed on the distal side of structure 290 opposite anchor 235 a.
  • anchors 235 a, b may include one or more balloons. Once anchors 235 a, b are positioned on opposite sides of structure 290 , the balloons are optionally inflated (for example as illustrated in FIG. 2D ). Inflation may secure the anchor to the lumen for example by being pressed against the wall of the lumen. Alternatively or additionally an anchor may be secured to a lumen wall by suction.
  • an anchor may include an opening in communication with a vacuum source. The opening may optionally be placed near the wall of the lumen and suction applied to affix the anchor to the wall.
  • inflating a balloon in lumen 256 may have an effect of opening the workspace laterally and/or of sealing off the workspace.
  • FIGS. 3A and 3B illustrated a workspace in an opened state in accordance with an embodiment of the current invention.
  • the distance between anchors 235 a, b may be expanded.
  • expanding a distance between the anchors may include advancing an extender, for example a carriage 230 , distally from the distal opening of the catheter.
  • carriage 230 may include a shaft extending along a channel and/or a guide of catheter 242 .
  • the shaft may be inserted from a proximal opening of catheter 242 to distal opening 260 and/or out distal opening 260 into lumen 256 .
  • a guide may support the anchor and/or extender at a fixed point at the distal opening of the catheter.
  • expanding distance between anchors 235 a, b optionally stretches lumen 256 longitudinally and/or opens folds between anchors 235 a, b .
  • anchors 235 a, b may be located on opposite sides of fold 257 .
  • a line joining the locations of anchors 235 a, b may be perpendicular to the line of fold 257 .
  • the workspace between anchors 235 a, b is opened by lateral expansion caused by inflation of the balloons.
  • the workspace between anchors 235 a, b is opened by stretching longitudinally and/or opening folds 257 by expanding the longitudinal distance between anchors 235 a, b . Opening folds optionally exposes a previously obscured structure. For example as illustrated in FIG. 3B , longitudinally expanding the workspace unfolds fold 257 in lumen 256 and/or exposes the root 290 ′ of the polyp (structure 290 ) to inspection and/or treatment.
  • an extender may be expandable.
  • an extender may include a spring that is held in a compressed state and released to expand a distance between anchors.
  • an extender may have a limp and/or a stiff configuration.
  • the anchors may be affixed to the lumen with the extender in a limp state and then the extender may be stiffened, expanding the space between the balloons.
  • an extender may be stiffed by inflation, for example by fluid pressure and/or an extender may include a nitinol part that changes properties.
  • an extender may include interlocking parts that are pulled together to stiffen the extender and/or to expand the distance between the anchors.
  • the control mechanism is accessible from outside a proximal opening of a catheter.
  • the stiffening control mechanism may include a syringe for increasing pressure in an extender and/or a drawstring to pull together and/or stiffen a set of links that are flexible when they are loose and become stiff when pulled together and/or an stiffening control may include a release for a spring and/or a mechanism for compressing a spring.
  • a stiff extender may resist buckling and/or compression.
  • a stiff extender may retain between 30% to 60% of its length under compression and/or between 60% to 80% of its length and/or between 80% to 90% of its length and/or between 90% to 95% of its length and/or between 95% to 98% of its length and/or between 98% to 100% of its length under a compression force of for example between 0.01 and 0.1 Newton's and/or between 0.1 and 0.5 Newton's and/or between 0.5 and 1 Newton's and between 1 and 5 Newton's.
  • the distance between anchors 235 a,b may range for example between 2 to 15 cm.
  • distance anchors 235 a,b when distance anchors 235 a,b is expanded it may be extended between for example 1 to 5% and/or 5 to 30% and/or 30 to 70% and/or 70% to 120% and/or 120% to 200%.
  • the distance will be expanded until a fold is sufficiently opened to access an object.
  • the system may include a sensor to sense the opening of a fold and/or a controller responsive to the sensor to continue distancing the anchors until the fold is sufficiently open and/or stop distancing the anchors when the fold is sufficiently open.
  • conveyance of anchor 235 b and/or tools and/or fluids to lumen 256 may be through a working channel of catheter 242 and/or with the assistance of one or more guide channels, for example as explained herein below with regards to FIGS. 6A-D .
  • carriage 230 may be supported by the guide.
  • anchor 235 b may be inserted into catheter 242 through a proximal opening of catheter 242 and/or may be conveyed through the catheter to distal opening 260 .
  • catheter 242 may include one or more guide channels communicating with the working channel. For example, as illustrated in FIGS.
  • carriage 230 may be supported and/or directed by the guide channel.
  • tools and/or fluids may be transported into and/or out of the working space through the catheter while anchors 235 a, b are in deployed and/or while the workspace is open.
  • an anchor may be released (for example by deflation) and/or retrieved from the lumen and/or may be replaced by a different tool and/or anchor.
  • an anchor may be drawn back from the lumen into the distal opening of the catheter and/or conveyed along the catheter to the proximal opening and/or drawn out of the proximal opening.
  • an anchor may be replaced by a larger anchor (that may, for example, be inserted from the proximal opening of the catheter to the distal opening and/or the lumen).
  • a balloon may be used to expand a lumen and then replaced with another balloon as the lumen stretches.
  • Progressively expanding the lumen with larger and larger balloons may be used to open a stricture in the lumen.
  • FIGS. 4A-C illustrate an alternative embodiment of a system for opening a workspace.
  • a system for opening a workspace includes one or more anchors and/or a tool that can be inserted into a lumen through a catheter.
  • FIG. 4A illustrates insertion of a system for opening a workspace into a lumen in accordance with an embodiment of the current invention.
  • two anchors 435 a, b may be mounted on a shaft 430 on either side of a tool 434 .
  • the system may be inserted through a catheter into a lumen 456 near a structure 490 and/or a region of interest.
  • the system is inserted through catheter 442 in a collapsed state.
  • FIG. 4B illustrates deployment of a system for opening a workspace in accordance with an embodiment of the present invention.
  • Anchors 435 a, b may include for example Nitinol rings that expand to affix by friction and/or by pressing themselves onto the pliable walls of the lumen.
  • an anchor may include a friction attachment and/or a vacuum attachment and/or another attachment means.
  • FIG. 4C illustrates a system to open a workspace longitudinally expanding a workspace in accordance with an embodiment of the present invention.
  • the longitudinal distance between anchors 435 a, b is expanded.
  • a cord 431 may be attached to anchor 435 a .
  • An operator outside a proximal opening of catheter 442 may hold shaft 430 steady while pulling cord 431 .
  • Pulling cord 431 optionally slides anchor 435 a proximally along shaft 430 while holding shaft 430 steady keeps anchor 435 b fixed in relation to catheter 442 .
  • opening fold 457 exposes structure 490 to diagnosis and/or treatment using tool 434 .
  • tool 434 may include for example a sensor, an ablation device (for example a radio frequency electrode), a nozzle for applying a stream of cleaning fluid and/or a suction, a pincer, a cutter, a sample collection bag, and/or a medicine application device (for example a micro-needle).
  • anchors 435 a, b may seal off the workspace. For example a medicine and/or a dye may be injected into the sealed workspace for further diagnostic and/or treatment regimes.
  • FIGS. 5A and 5B illustrate two perspective views of a tool 534 for use in a lumen of a patient in accordance with some embodiments of the present invention.
  • tool 534 may include one or more cameras 546 a, b and/or one or more light sources 550 a, b .
  • tool 534 may include an anchor (for example anchor 235 a and/or 235 b ).
  • Tool 534 is optionally mounted on a carriage 230 .
  • carriage 230 may connect to a guide.
  • a guide may direct and/or convey and/or stabilize carriage 230 and/or tool 534 inside a working channel and/or inside a lumen, for example as explained herein below.
  • carriage 230 may include a flexible and/or elastic rod and/or wire.
  • carriage 230 may be used to push and/or pull tool 534 along an access pathway (for example a working channel) to a lumen.
  • carriage 230 may be used to support and/or manipulate tool 534 in the lumen.
  • Carriage 230 is optionally flexible enough to follow curves in the working channel, but stiff enough to retain its length (for example without folding over and/or significantly stretching).
  • a carriage may be torsion resistant. For example, a user may twist a proximal end of the carriage 230 in order to rotate the tool 534 around the axis of carriage 230 .
  • tool 534 may be joined to carriage 230 by a mount 540 .
  • Carriage 230 and/or tool 534 may include an orientor 548 .
  • orientor 548 may orient and/or stabilize tool 534 with respect to a guide and/or with respect to a catheter and/or with respect to another tool (for example as illustrated in FIGS. 6A-F ).
  • tool 534 is permanently connected to mount 540 and/or carriage 230 .
  • a mount may be reversibly connected to the tool.
  • the tool may be connected and/or disconnected and/or reconnected to the carriage and/or guide and/or a manipulator.
  • tool 534 is directly and/or physically attached to carriage 230 and/or mount 540 .
  • a tool may be connected to a carriage by a magnet or other indirect method.
  • FIGS. 6A-F illustrate insertion and deployment of a tool with a catheter in accordance with an embodiment of the current invention.
  • a catheter includes an outer sleeve 642 .
  • Outer sleeve 642 optionally includes one or more large working channels 628 .
  • sleeve 642 includes one or more guides 632 and/or 632 ′.
  • guides 632 may include narrow guide channels.
  • guides 632 , 632 ′ may be oriented parallel to working channel 628 .
  • guides 632 and/or 632 ′ may communicate with working channel 628 and/or with a region on the outside of the catheter.
  • guides 632 and/or 632 ′ may convey carriage 230 and/or tool 534 along working channel 628 and/or outside the catheter.
  • outer sleeve 642 includes a mount 640 .
  • mount 640 may be used to steady and/or support a tool, for example tool 534 .
  • one or more of guides 632 and 632 ′ may be distributed around working channel 628 .
  • a guide 632 runs the entire length of working channel 628 .
  • guide 632 may run along a portion of the length of the working channel 628 .
  • a guide 632 communicates with working channel 628 and/or the outside of the catheter along its entire length and/or along a portion of its length.
  • a guide 632 may include a guide channel.
  • a guide channel may be narrower than the working channel 628 .
  • Communication between guide 632 and working channel 628 is optionally supplied by a longitudinally communication opening 636 for example in the form of a slit between guide 632 and working channel 628 .
  • a guide 632 and/or a working channel 628 may communicate with a space outside the catheter.
  • a guide or guide channel and/or a working channel may communication with the outside of the catheter at one or both of the distal and/or proximal ends.
  • a guide channel (for example guide 632 ) may include a distal opening 658 and/or a proximal opening.
  • working channel 628 may include a distal opening 660 and/or a proximal opening (for example see proximal opening 661 of FIG. 6B ).
  • one or both ends of a guide channel and/or working channel may be closed.
  • a guide and/or a working channel may communicate with the space outside the catheter along all or part of its length.
  • guide 632 ′ communicates with the outside of the catheter along a portion of its length via a communication opening 636 ′.
  • guides 632 and 632 ′ communicate with the working channel 628 along their entire length via openings 636 .
  • openings 636 connect to distal openings 658 at the distal ends of respective guides 632 and 632 ′.
  • working channel 628 communicates with the exterior of the catheter along its length via a slit, for example longitudinal opening 644 .
  • longitudinal opening 644 may allow movement of large objects along working channel (for example while a portion of the object protrudes out of opening 644 ).
  • longitudinal opening 644 may facilitate insertion of outer sleeve 642 around an endoprobe and/or longitudinal opening 644 may facilitate conveyance of a large object.
  • FIGS. 6B and 6C illustrate insertion of a tool into a catheter in accordance with an embodiment of the current invention.
  • tool 534 is inserted into proximal opening 661 of outer sleeve 642 .
  • carriage 230 is inserted into guide 632 ′.
  • mount 540 passes through opening 636 ′ connecting tool 534 to carriage 230 .
  • a guide may be closed (without a slit) and/or a carriage passing through the guide may be connected to the tool via a magnet and/or another means.
  • a guide and/or carriage may be used to manipulate and/or convey a tool inside a working channel.
  • carriage 230 may be used to push and/or convey tool 534 through working channel 628 .
  • FIGS. 6C and 6D carriage 230 has been pushed from proximal opening 659 through guide 632 ′ until carriage 230 reaches and/or extends out of distal opening 658 .
  • carriage 230 pushes tool 534 through working channel 628 from proximal opening 661 until it reaches and/or extends out of distal opening 660 .
  • a carriage and/or guide may be used to deploy and/or steady and/or support a tool outside of a catheter.
  • tool 534 and/or a distal end of carriage 230 and/or mount 540 and/or orientor 548 have been extended and/or deployed out distal openings 658 and 660 of guide 632 ′ and/or opening 636 and/or channel 628 respectively.
  • a clearance is provided between tool 534 and the distal end of the catheter.
  • a center portion of carriage 230 remains inside guide 632 ′ and/or a proximal portion of carriage 230 extends out proximal opening of guide 632 ′.
  • a carriage and/or guide may be used to manipulate a tool outside of a catheter. For example, after extending carriage 230 and/or tool 534 out of the distal end of the catheter, one/or both may be rotated into the configuration of FIG. 6E and/or retracted to the configuration of FIG. 6F .
  • a user for example a doctor performing a medical procedure with the catheter, may optionally twist the proximal end of carriage 230 .
  • twisting carriage 230 while it is supported inside guide 632 ′ and/or while the distal end of carriage 230 and/or tool 534 are extended out of working channel 628 may move tool 534 away from the axis of working channel 628 .
  • working channel 628 is unblocked and/or can be used for a further function.
  • the lenses of tool 534 are above the axis of sleeve 642 .
  • this allows a camera in tool 534 to see backward without being blocked by sleeve 642 .
  • a tool may be supported and/or steadied on an outside surface of a catheter.
  • carriage 230 is used to pull tool 534 onto mount 640 .
  • the distal end of carriage 230 is retracted at least partially back into guide 632 ′ (for example by a user pulling on the proximal end of carriage 230 ).
  • tool 534 is pulled back onto mount 640 .
  • mount 540 and/or orientor 548 are pulled into slit communication opening 636 ′ orienting, supporting and/or steadying tool 534 on the outer surface of outer sleeve 642 .
  • carriage 230 remains inside of guide 532 ′ retaining tool 534 in place on mount 540 .
  • subsequently carriage 230 may be used to push tool 534 back off of mount 540 and/or to return tool 534 back into working channel 628 and/or to retrieve tool 534 out proximal opening 661 of working channel 628 .
  • carriage 230 may be disconnected and/or retracted out of guide 532 ′.
  • carriage 230 may be reconnected to tool 534 for example to return tool 534 to working channel 628 .
  • outer sleeve 642 may be inserted to a location in the subject and then tool 534 may be inserted using working channel 628 as an access channel.
  • tool 534 may be positioned at the distal end of sleeve 642 before inserting sleeve 642 into a subject.
  • a distal end of sleeve 642 may be inserted partially into the subject (for example past a narrowing of the access path) and then tool 534 may be positioned at the distal end of sleeve 642 .
  • FIGS. 7A-C are perspective views of a catheter in use for removing a growth (for example a polyp) in accordance with an embodiment of the current invention.
  • a growth for example a polyp
  • various tools are applied over time to detect a health condition and/or intervene with a treatment.
  • FIG. 7A illustrates a multi-function catheter in a search mode in accordance with some embodiments of the current invention.
  • the search mode may be used for detection of a disease within a lumen 756 (for example an intestine).
  • tool 534 includes a camera and/or is mounted on a catheter sleeve 642 .
  • Tool 534 is mounted off the axis of the catheter with a field of vision 794 a distal to the catheter (looking forward) and a field of vision 794 b looking backward (proximally from the distal end of the catheter).
  • sleeve 642 may be inserted into the lumen in the configuration of FIG. 7A .
  • the camera may be used to search for symptoms.
  • tool 534 may be positioned coaxially with the catheter (for example as illustrated in FIG. 6C ) reducing the profile of the catheter.
  • tool 534 may be located in the distal end of working channel looking ahead (out the distal end of the channel) while the catheter is being inserted.
  • a guide wire and/or camera may first be placed into lumen 756 and then sleeve 642 may be inserted over the guide wire.
  • positioning a tool 534 outside the axis of a catheter may be useful in searching for symptoms in a lumen.
  • a camera that can see in both directions may allow searching the lumen while inserting the catheter and/or while removing the catheter.
  • a camera with a field of vision 794 a, b may allow view both sides of an object (for example as the camera approaches an object the object is viewed from one side with the one field of vision 794 a, b and/or after the catheter passes by the object, the other side of the object is seen with the other field of vision 794 b, a .
  • Tool 534 may optionally include a long focal length camera looking backward and/or proximally (for example field of vision 794 b ).
  • the backwards field of vision 794 b may be used for spotting suspicious objects.
  • the forward field of vision 794 a may be used for spotting suspicious objects from the opposite side. Depending on the location of abnormal structures, obstructions etc. an object may be more easily spotted from one side.
  • the trailing field of vision (for example the forward field of vision 794 a when searching is performed while removing the catheter and/or the rearward field of vision 794 b when searching is being done as the catheter is inserted) may have a smaller focal length than leading field of vision and/or may be used for investing objects closely and/or during an intervention.
  • the forward field of vision 794 a may be used for investigating the suspicious object and/or for directing intervention targeting the object.
  • a camera used for investing objects and/or directing intervention may have a smaller focal length and/or narrower field of view than a camera used for spotting objects.
  • further sensors may be deployed for diagnosing the object.
  • the further sensors may include a camera with specific frequency band sensitivity (for example for spectral analysis) and/or having higher resolution and/or a shorter focal length and/or a temperature sensor and/or a chemical sensor etc.
  • Deployment of further sensors may optionally be made while the catheter and/or the originally camera of tool 534 remains deployed (thus keeping sight of the object and/or avoiding loosing contact with the object while deploying the new sensor).
  • search mode may include opening a workspace, for example as described herein above with respect to FIGS. 1 , 2 A-D, 3 A-B and/or 4 A-C.
  • anchor 235 a may be inserted into the catheter using carriage 230 and/or guide 632 ′ (optionally after a camera and/or associated carriage are removed from guide 632 ′ and/or mount 640 ).
  • Anchor 235 a may optionally be supported on mount 640 and inflated, for example as illustrated in FIG. 3A .
  • anchor 235 b may be inserted into the catheter using carriage 230 and/or guide 632 .
  • Anchor 235 a may optionally be supported on carriage 230 and inflated, for example as illustrated in FIG. 3A .
  • FIG. 7B illustrates a catheter in a treatment mode in accordance with some embodiments of the current invention.
  • a catheter is switched from the search mode to the treatment mode when a condition is found that requires treatment.
  • a catheter may have multiple search and/or treatment modes that may be selected during a medical procedure and/or without removing the catheter from the patient.
  • treatment mode may also include opening a workspace.
  • the workspace may be opened for example as described herein above with respect to FIGS. 1 , 2 A-D, 3 A-B, 4 A-C and/or 7 A.
  • FIG. 7C illustrates an exemplary intervention in accordance with an embodiment of the current invention.
  • a structure 790 including for example a polyp
  • forceps e.g. tool 734 a
  • cutter tool 734 b e.g. cutter tool 734 b
  • Guides for example guide 632
  • carriages for example carriage 230
  • a sample bag may be deployed and/or used to retrieve polyp (e.g. structure 790 ).
  • a tool can be retrieved and/or redeployed in a different guide for improved access to a treatment site.
  • further diagnostic and/or treatment tools may be deployed to while the catheter and/or a sensor remains in place while tracking the suspicious object.
  • tools 734 a and/or 734 b are optionally retrieved and/or new tools are optionally deployed for a further procedure and/or search mode is restarted.
  • Retrieving and/or deploying tools and/or changing modes are optionally carried out while the distal end of sleeve 642 remains in the lumen and/or the site of the procedure.
  • a search for suspicious objects is resumed.
  • further treatment and/or investigative and/or diagnostic tools may be deployed using the same catheter which optionally remains in the lumen.
  • FIG. 8 is a perspective illustration of a sensor array in accordance with an embodiment of the present invention.
  • sensor array 834 includes imaging sensors 846 a - d and/or light sources 850 a - f .
  • Sensor array 834 is optionally mounted on a carriage 230 for deployment and/or manipulation through a working channel and/or in a lumen.
  • sensors may be directed forward, backward and/or towards the sides. Different sensors may have different focal lengths, width of field of view, sensitivity, band sensitivity.
  • Light sources 850 a - f may optionally vary in their intensity, bandwidth and/or focus.
  • Sensor array may optionally be inserted from the proximal opening of a catheter (for example outside a lumen) to a distal opening (for example inside the lumen) and/or deployed away from the axis of a channel.
  • sensor array 834 is optionally moved (for example by rotating around carriage 230 and/or by removing from the catheter and redeploying supported by a different guide and/or by deploying further from and/or closer to the distal opening of the catheter).
  • sensor array 834 may optionally be used to get multiple views and/or multiple spectral images.
  • the multi-view image data may facilitate identification and/or diagnosis of objects and/or conditions.
  • FIGS. 9A-11 illustrate cooling a tool inside a living creature in accordance with some embodiments of the present invention.
  • a tool with a heat emitting part may need cooling inside a lumen of a living creature.
  • a camera and/or a light source may be cooled.
  • a tube may supply cooling fluid flow to tool.
  • the fluid may be directed over a heat exchanger in thermal communication with the tool (for example the heat exchanger may include a heat exchange surface and/or a cooling fin and/or and outer surface of the tool and/or a Peltier element in contact with the tool).
  • the heat exchanger may include a heat exchange surface and/or a cooling fin and/or and outer surface of the tool and/or a Peltier element in contact with the tool.
  • cooling fluid flow 978 may be supplied from outside the living creature and/or be dumped into the living creature.
  • cooling fluid may include sterile saline solution and/or a medicine and/or a diagnostic chemical (for example a barium contrast medium) and/or a gas (for example air or carbon dioxide which may be in use for inflating an intestine during a catheter procedure).
  • the fluid may optionally cool off the tool and then enter a lumen of the living creature.
  • a body fluid may be drawn (for example by suction) from a location in the living creature (for example a location in the lumen in which the catheter is located) and/or cool a tool and/or may exit out of the living creature.
  • fluid may be recirculated. Fluid may be suctioned out of a living creature, pass over a heat exchanger of the tool and/or returned into the creature.
  • cooling fluid may be pumped from outside the living creature to the tool and then back out the creature.
  • used cooling fluid may be discarded.
  • used cooling fluid may be recycled. For example there may be a system for cooling the cooling fluid.
  • a conductive heat sink may be used.
  • the flow rate of the liquid and/or the temperature of the liquid may be selected and/or adjusted to achieve a desired level of cooling of the tool and/or a desired temperature of the liquid entering the lumen and/or a desired level of effect on the living creature. For example, if the tool is hot and the dosage of the material is low, then the flow rate may be raised. Alternatively or additionally, if the tool is heating and the dosage of the substance is already high, than the substance may be cooled before being introduced (improving cooling without increasing flow rate) or the concentration may be reduced and the flow rate increased (for medicaments for which the concentration can be reduced).
  • the flow rate may range between 1 to 10 ml/min and/or between 10 to 50 ml/min and/or between 50 to 200 ml/min and/or between 200 to 1000 ml/min and/or between 1000 to 3000 ml/min.
  • a fluid in order to achieve a cooling effect, a fluid will be pumped into and out of a lumen at a balanced rate.
  • a fluid may be pumped over a heat exchanger at a rate greater than minimal indicated for a medicinal effect. Excess material may be removed, suctioned out and/or vented out to achieve a desired net flow rate.
  • gas in order to achieve a desired cooling, gas may be pumped over a heat exchanger into the intestine at a rate higher that that indicated for desired inflation of the intestine.
  • a vent may be supplied to allow excess gas to be vented from the lumen.
  • gas will be pumped into a lumen.
  • a lumen when the lumen is an intestine, air and/or carbon dioxide may be pumped into a lumen.
  • the gas may keep the lumen inflated.
  • the gas may optionally be passed over a tool needing cooling (for example an LED [light emitting diode]) and/or a cooling fin connected to a tool to cool the tool before being released into the lumen.
  • the gas may be cooled before being pumped into the lumen.
  • a carriage 930 may support tool 934 .
  • carriage 930 is supported by a guide channel 932 a .
  • guides channels 932 a - c communicate with working channel 928 through a longitudinal slit 936 .
  • carriage 930 may be twisted to deploy tool 934 away from an axis of a working channel 928 .
  • cooling tube 964 passes from the proximal end of a sleeve 942 through carriage 930 and/or guide channel 932 a to an inlet of housing 988 a .
  • a heat exchanger 980 of tool 934 may be located in the housing in contact with fluid flow 978 .
  • heat exchanger 980 may include a cooling fin and/or a radiator and/or a cooling coil and/or a thin tube and/or another heat exchanger.
  • cooling fluid may circulate within and/or around tool 934 .
  • tool 934 may be located inside of a housing 988 a .
  • Cooling fluid optionally enters an inlet of housing 988 and/or passes through a space in housing 988 and/or along the outside of tool 934 .
  • the housing may surround the tool on three sides and/or on four sides and/or on five sides and/or on six sides.
  • the fluid may contact the tool on three sides and/or on four sides and/or on five sides and/or on six sides.
  • cooling tubes may pass through working channel 928 .
  • a support carriage may pass through a first channel in an access channel (for example guide channel 932 a and/or working channel 928 ) while coolant (for example a fluid) passes through one or more other channels (for example guide channel 932 b and/or guide channel 932 c and/or working channel 928 ).
  • coolant for example a fluid
  • the heat exchanger may be located on the outside of the channel in a fluid flow zone, for example outside a flow inlet and/or outlet.
  • a flow channel may pass through a tool cooling an inside of the tool.
  • FIG. 10A illustrates an embodiment of a system for cooling a tool using a fluid sucked from a lumen through an inlet 1066 a in accordance with an embodiment of the present invention.
  • a suction tube 1042 a includes a tool 1034 a that requires cooling (for example a LED and/or a camera).
  • a cooling fin 1065 is connected to tool 1034 a .
  • fin 1065 is in the suction flow 1078 .
  • fin 1065 may protrude inside tube 1042 b .
  • a part of tool 1034 a is on the outside of tube 1042 a.
  • FIG. 10B illustrates a tissue washing system wherein irrigation fluid is used to cool a tool.
  • a tube 1042 b is designed for insertion in to a lumen of a living creature.
  • tube 1042 b may be configured for insertion through a catheter channel.
  • Fluid for example air, carbon dioxide, saline solution and/or water
  • in inlet for example including tube 1042 a
  • heat exchanger for example fin 1065 and/or an outer surface of tool 1034 b
  • Flow 1078 from nozzle 1066 b may be focused on a structure needing cleaning.
  • tool 1034 b may include LED's producing light beams 1049 a, b .
  • the heat transfer exchanger may include an outer surface of tool 1034 b and/or a cooling fin.
  • the heat transfer surface may be included in a wall of tube 1042 c.
  • FIG. 11 illustrates a tissue washing system according to an embodiment of the current invention.
  • irrigation, fluid and/or medicine flows 1178 from a channel 1142 into a proximal inlet of a housing 1188 and/or around a tool with a heat emitting part, for example an exothermic tool 1134 .
  • the fluid flow 1178 around the tool on 5 sides (for example around a proximal end, over a top, and/or around two sides).
  • each side of the tool may include a heat exchanger which may be cooled by the fluid flow.
  • the fluid then exits a distal outlet of channel 1142 and/or out a nozzle 1166 .
  • FIG. 12 is a flow chart illustrating a method of grinding fluid suctioned from a lumen in accordance with an embodiment of the current invention.
  • a general purpose sleeve and/or catheter may be inserted into a lumen inside a patient.
  • the catheter may be used for various diagnostic and/or therapeutic procedures.
  • a grinder may be inserted 1291 into the proximal end of a channel of the catheter (for example the proximal opening of the channel may be located outside the patient) and/or conveyed 1292 through a channel of the catheter to a distal opening thereof (for example the distal opening of the channel may be located inside the patient).
  • the grinder may be supported 1293 inside the channel and/or outside the channel.
  • the grinder may be operated 1295 to grind lumps and/or solid matter entering the channel.
  • the grinder may be retrieved 1297 (for example by being conveyed through the channel and back out the proximal end of the catheter).
  • retrieving 1297 the grinder may free up the channel for further uses.
  • the catheter may remain in the lumen and/or may be used for conveying tools and/or materials into and/or out of the lumen and/or for controlling tools in the lumen.
  • FIGS. 13A-B illustrate a grinder in accordance with an embodiment of the present invention.
  • the grinder is configured for insertion into a channel of a catheter.
  • the grinder blades may be inserted into a proximal opening of a catheter.
  • the grinder is optionally conveyed along a channel of the catheter to a distal opening. At the distal opening the grinder breaks up lumps that may clog a lumen channel.
  • the grinder optionally includes a transmission which transmits energy from a proximal end of the catheter to the grinder at a distal end of the catheter.
  • the grinder is optionally supported by a carriage.
  • the grinder may be connected to the distal end of the carriage and/or may be supported distal to the carriage.
  • the carriage may be conveyed through a channel of the catheter.
  • the carriage may optionally remain in the catheter channel while the grinder is in operation.
  • the carriage optionally includes and/or defines sub-channels for conveying suctioned fluid from the distal opening of the catheter to the proximal opening.
  • the sub-channels may run through the carriage and/or the sub-channels may be defined between the carriage and the walls of a channel of the catheter.
  • a grinder may include a blade 1367 (for example blade 1367 may include a propeller) mounted to a carriage 1330 .
  • Carriage 1330 optionally supports blade 1367 .
  • carriage 1330 aligns blade 1367 with the axis of the channel.
  • carriage 1330 limits lateral movement (movement perpendicular to the axis of the channel) of blade 1367 .
  • blade 1367 is rotatable with respect to the catheter.
  • carriage 1330 fixes the location of blade 1367 with respect to the length of the channel.
  • carriage 1330 may fit snugly into a channel (for example preventing for example significant movement perpendicular to the axis of the channel) of a catheter (for example sleeve 1342 ).
  • carriage 1330 may fit a distal portion (for example within 1 cm of the distal end) of sleeve 1342 .
  • carriage 1330 may be fit along all and/or some (for example most) of the channel from a proximal opening (for example outside the lumen) to a distal opening (for example opening inside the lumen).
  • blade 1367 may be mounted rotatably to carriage 1330 via a shaft 1329 .
  • carriage 1330 may rotate the axis of catheter channel.
  • Shaft 1329 and/or carriage 1330 may be rotated by a motor.
  • the motor may be located outside the proximal opening of the catheter.
  • the motor may be located inside the channel of the catheter and/or outside the distal end of the channel.
  • a sub-channel allows fluid flow from the distal opening of sleeve 1342 to the proximal opening thereof.
  • the sub-channel may pass through carriage 1330 .
  • the sub-channel may be sandwiched between carriage 1330 and a wall of the catheter (for example as illustrated in sub-channel 1332 in FIG. 13B ).
  • fluid may flow 1378 a (for example via suction) from a lumen into sleeve 1342 .
  • blade 1367 may include a propeller. Spinning of the propeller may at least partially power flow 1378 a .
  • Flow 1378 b optionally continues along sub-channels 1332 past carriage 1330 .
  • Flow 1378 c optionally continues out the proximal opening of sleeve 1342 .
  • spinning of blade 1367 grinds solid particles and/or gels that flow 1378 a into the distal opening a channel of sleeve 1342 .
  • blade 1367 may be located inside the channel.
  • blade 1367 may be located outside the distal opening of the channel.
  • blade 1367 may be located (inside and/or outside the channel) between 0 to 0.5 mm distant from the distal opening and/or between 0.5 to 1 mm of the proximal opening, and/or between 1 to 5 mm from the distal opening.
  • blade 1367 may have a diameter between 60 to 90% of the width of the channel of the catheter and/or between 90 to 100% of the width of the channel of the catheter.
  • FIGS. 14A-D illustrate frames for a catheter in accordance with some embodiments of the present invention.
  • a frame may include a spine directed along one edge of the catheter.
  • the spine may be made up of joints and/or spacers.
  • Elements of the frame may act a ribs connected to the spinal spacers and/or joints.
  • the spacers may, for example, define the distance between elements in the region of the spacers.
  • Elements of the frame may preserve the shape of the channels of the catheter (for example preventing the channels from collapsing).
  • the spine of the frame may occupy a region along a single edge of the catheter. Limiting the cross section of the spine may allow for a variety of locations for channels along the cross section of the catheter. Channels may communicate with each other and/or with the outside of the catheter. For example a longitudinal slit may join a one channel to another channel and/or a channel to the outside of the catheter.
  • FIG. 14A illustrates a side perspective view of a catheter 1442 including a frame with a single spine in accordance with an embodiment of the present invention.
  • the spine of a frame may be made up of a series spacers 1483 a - h joined by joints 1480 a - d .
  • Elements 1482 b - e are optionally connected to the spacers 1483 a - h and/or the joints 1480 a - d.
  • joints 1480 a - d may include hinges which vary in orientation.
  • the series of element may be bent in any direction by bending a combination of vertically oriented and horizontally oriented joints.
  • joints may be oriented in an alternating pattern.
  • joint 1480 b which is oriented to bend vertically around a horizontal axis intervenes for example between spacers 1483 e and 1483 d .
  • Joint 1480 a which is oriented to bend horizontally around a vertical axis intervenes for example between spacers 1483 b and 1483 c .
  • some joints may bend in one direction (for example right) while others bend in the opposite direction (for example left).
  • the end of the catheter (for example spacer 1483 a ) is raised by bending joints 1480 b and/or 1480 d .
  • the end of the catheter (for example ⁇ 1483 a ) is twisted rightward by bending joints 1480 a and/or 1480 c .
  • joints may include ball and socket joints and/or flexible material and/or other joints.
  • the length of the catheter and/or the spacing between elements 1482 b - e may be fixed by the spine.
  • bending of the catheter may be achieved by rotating elements 1482 b - e around an axis on the spine.
  • the distance between elements 1482 b - e in the region of the spine is optionally defined by the spacers.
  • the distance between elements 1482 b - e in the area not in the region of the spine is optionally adjusted according to steering of the catheter.
  • pulling a lower steering cable may cause the catheter to bend downward.
  • pulling the lower steering cable reduces the distance between elements at the bottom of the catheter while the distance between elements at the top of the catheter is preserved by the spacers of the spine (located at the center top of the catheter).
  • pulling a right steering cable may cause the catheter to bend rightward.
  • pulling the right steering cable reduces the distance between elements at the right side of the catheter while the distance between elements at the center of the catheter is preserved by the spacers of the spine (located at the center top of the catheter).
  • a frame may run the entire length of a catheter.
  • a frame may prevent collapse of channels, prevent twisting and/or limit turning all along the catheter.
  • the frame may be located only near the distal end of the catheter.
  • the frame may be located in distal region of length less than half of the catheter and/or less than 1 ⁇ 8 of the catheter and/or less than 1/16 of the catheter and/or less than 1/32 of the catheter and/or less than 1/64 of the catheter.
  • the length of the framed region of the catheter may be less than 2 cm and/or less than 4 cm and/or less than 8 cm and/or less than 16 cm and/or less than 32 cm and/or less than 64 cm.
  • the frame may assist steering of the endoscope.
  • the frame may prevent collapse of channels, prevent twisting and/or limit turning along all and/or part of the endoscope, for example as the endoscope is maneuvered along a lumen. Maneuvering of the endoscope may be for example by steering cables and/or by actuators for example as described herein below and/or by any means known in the art.
  • FIG. 14B illustrates a cross sectional view of a frame of a catheter in accordance with an embodiment of the current invention.
  • the spine of the frame may run along one edge of a catheter.
  • the spine is made up of joints 1480 a - d which run along top (dorsal) edge of the catheter.
  • the spine may be contained within a continuous convex region 1498 including for example less than 1/10 of the cross sectional area of the catheter.
  • the spine may be contained in a region of less than 1/64 of the cross sectional area of the catheter and/or 1/50 of the cross sectional area of the catheter and/or 1/36 of the cross sectional area of the catheter and/or 1/25 of the cross sectional area of the catheter and/or 1/16 of the cross sectional area of the catheter and/or 1/9 of the cross sectional area of the catheter and/or 1 ⁇ 4 of the cross sectional area of the catheter.
  • the cross section of the catheter includes a working channel 1428 .
  • the working channel may include a longitudinal slit 1436 communicating with the outside of the catheter.
  • a working channel may communicate through a second slit 1436 ′ with a smaller guide channel 1432 a.
  • FIG. 14C illustrates a catheter frame with limiting inserts 1484 a - d intervening between elements 1482 a - e .
  • insert 1484 a limits downward twisting of element 1482 a (for example as element 1482 a twists downward insert 1484 a intervenes between the bottoms of elements 1482 a and 1482 b , preventing joint 1480 e from bending too far).
  • insert 1484 b limits sideways twisting of element 1482 a (for example as element 1482 b twists rightward insert 1484 a intervenes between the right sides of elements 1482 b and 1482 c , preventing joint 1480 a from bending too far).
  • the minimum radius of curvature of bending of the catheter depends on the ratios of the dimensions of the parts of the frame. For example for a longer length of joint 1480 a compared to the width (along the length of the catheter) of elements 1482 a , 1482 b and insert 1484 a , the joint will be able to rotate more sharply.
  • FIG. 14D illustrates an alternative cross section of a catheter with a frame in accordance with an embodiment of the present invention.
  • the frame has a spine running along the top of the catheter including a joint 1480 e .
  • the cross section optionally includes a large working channel 1428 ′ and multiple smaller guide channels 1432 b - f .
  • guide channel 1432 d has longitudinal slits communication with outside the catheter and also with working channel 1428 ′.
  • guide channels 1432 e,c have longitudinal slits communicating with working channel 1428 ′.
  • guide channels 1432 b,f include longitudinal slits communicating with the outer surface of the catheter.
  • FIGS. 15A-C illustrate the use of actuators for steering of an endoscope in accordance with an embodiment of the current invention.
  • Actuators optionally allow independent control of various sections of an endoscope. In some embodiments, independent control may facilitate more precise steering of the endoscope than, for example, steering cables.
  • FIGS. 15A-B illustrate an exemplary magnetic steering actuator 1586 a in a contracted and extended configuration respectively in accordance with an embodiment of the current invention.
  • An operator optionally uses a remote control to contract or extend actuators inside a lumen of a patient.
  • FIG. 15C illustrates an endoscope frame made up of elements 1582 a - c joined by joints 1580 a - d and actuators 1586 a - d in accordance with an embodiment of the present invention.
  • actuators 1586 a - d an endoscope can be steered. For example to steer the end element 1582 a upwards actuator 1586 a would be contracted while actuator 1586 b would be extended.
  • each actuator may be one or more wires running to a power source outside the endoscope.
  • Each actuator may be separately controlled by supplying a current to its respected wire.
  • a single wire may be connected to more than one actuator.
  • a controller may be located inside the endoscope.
  • the controller may control individual actuator according to control signals received from outside the endoscope.
  • Use of a controller optionally reduces the number of wires running all the way through the endoscope.
  • FIGS. 16A-C illustrate an endoscope with immobilizable joints in accordance with an embodiment of the current invention.
  • an endoscope may be inserted into a desired location and/or configuration (for example a guide 1632 and/or a working channel 1628 may be inserted over a guidewire).
  • the endoscope may optionally then be immobilized in place.
  • the guidewire may then be removed with the endoscope remaining in place.
  • the immobile endoscope may be used for access to the location and/or as a stable platform for tools in the location.
  • the immobilization may be reversible. For example, after use, the endoscope may be remobilized and/or removed from the patient.
  • joints 1680 a - c are reversibly immobilized by a collection of different sized balls 1681 .
  • Balls 1681 are optionally packed between frame elements (for example element 1682 ) and/or around joints 1680 a - c and/or are sandwiched between two sleeves 1642 a, b .
  • frame elements for example element 1682
  • balls 1681 can move freely, then as joints 1680 a - c move, balls 1681 are redistributed.
  • joint 1689 a - c are optionally also immobilized.
  • a vacuum may be applied to the area where the balls 1681 are located collapsing the space between sleeves 1642 a, b and/or immobilizing balls 1681 and/or joints 1680 a - c .
  • balls 1681 and/or joints 1680 a - c are remobilized.
  • FIG. 16A illustrates balls 1681 packed between two sleeves 1642 a, b in accordance with an embodiment of the current invention.
  • FIG. 16B illustrates balls 1681 packed around a frame element 1682 in accordance with an embodiment of the current invention.
  • FIG. 16C is a cutaway illustration of balls 1681 packed around joints 1680 a - c in accordance with an embodiment of the current invention.
  • outer sleeve 1642 a is cut away around joints 1680 a - c to illustrate the immobilizing system.
  • Joint 1680 a is illustrated with balls 1681 in place.
  • Joints 1680 b,c are illustrated with balls 1681 removed in order to better illustrate the joint.
  • compositions, method or structure may include additional ingredients, steps and/or parts, but only if the additional ingredients, steps and/or parts do not materially alter the basic and novel characteristics of the claimed composition, method or structure.
  • a compound or “at least one compound” may include a plurality of compounds, including mixtures thereof.
  • range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.
  • a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range.
  • the phrases “ranging/ranges between” a first indicate number and a second indicate number and “ranging/ranges from” a first indicate number “to” a second indicate number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween.

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US15/055,971 US20160174814A1 (en) 2013-08-31 2016-02-29 Endoscope with shared working channel
US16/080,017 US20190082940A1 (en) 2013-08-31 2017-02-27 Endoscope with shared working channel
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US201461988162P 2014-05-03 2014-05-03
US201462015271P 2014-06-20 2014-06-20
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US10441144B2 (en) 2019-10-15
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