WO2021113195A1

WO2021113195A1 - Medical devices and related methods

Info

Publication number: WO2021113195A1
Application number: PCT/US2020/062635
Authority: WO
Inventors: Brian Gaffney; Derek BANKER; Rachel Marie WILLIAMS
Original assignee: Boston Scientific Scimed, Inc.
Priority date: 2019-12-03
Filing date: 2020-12-01
Publication date: 2021-06-10

Abstract

A medical device includes a handle portion and an insertion portion. The handle portion includes a handle base, a gripping portion extending from one side of the handle base, and first and second actuators. The insertion portion includes at least one end effector and a sheath. The first and second actuators are coupled to respective portions of the at least one end effector, and the first and second actuators are moveable relative to the handle base to move the at least one end effector relative to the sheath.

Description

MEDICAL DEVICES AND RELATED METHODS

TECHNICAL FIELD

[0001] Various aspects of the present disclosure generally relate to medical devices for grasping, cutting, or otherwise manipulating or treating tissue or other material within a body. In particular, aspects of the present disclosure relate to medical devices and methods for performing a medical procedure using, in some embodiments, a medical device handle capable of multiple degrees of freedom.

BACKGROUND

[0002] A wide variety of medical techniques and instruments have been developed for diagnosis and/or treatment within a patient’s body, such as within a patient’s Gastrointestinal (Gl) tract. Endoscopic mucosal resection (EMR), endoscopic sub-mucosal resection (ESR), polypectomy, mucosectomy, etc., are minimally invasive treatment methods for both malignant and non-malignant lesions. Endoscopic medical procedures, such as, for example, EMR, may be used to excise sessile adenomas or other unwanted tissue (i.e., tumors attached to a bodily surface) from the surface of an anatomical lumen. Such procedures often require the resection of one tissue plane while leaving an underlying tissue plane intact. Commonly, snares are used during such medical procedures, for resecting tissue from a target site. However, many conventional snares operate in only one degree of freedom, and manipulation of the snare is dependent on the tip deflection of an endoscope or other device used for insertion into the patient. Further, the pre formed shape of the wire typically determines the shape of the snare within the patient. Thus, the ability to form a variety of different shapes, and the control and functionality of conventional snares, may be limited. [0003] Further, gripping, handling, and/or manipulating a proximal handle may be difficult when performing a medical procedure. Additionally, the user may be required to hold the medical device handle with one hand, and manipulate the medical device handle or another portion of the medical device with another handle. Alternatively, the user may be required to hold and/or manipulate the medical device with one hand, and hold and/or manipulate one or more other medical devices with another hand. In another aspect, additional medical professionals may be required to assist the user with holding and/or manipulating the insertion device and the one or more medical devices. These concerns may increase the duration, costs, and risks of the medical procedure.

[0004] The devices and methods of the current disclosure may rectify some of the deficiencies described above or address other aspects of the art.

SUMMARY

[0005] Examples of the present disclosure relate to, among other things, medical devices and methods for performing one or more medical procedures with the medical devices. Each of the examples disclosed herein may include one or more of the features described in connection with any of the other disclosed examples.

[0006] In one example, a medical device may include a handle portion and an insertion portion. The handle portion may include a handle base, a gripping portion extending from one side of the handle base, and first and second actuators. The insertion portion may include at least one end effector and a sheath. The first and second actuators may be coupled to respective portions of the at least one end effector, and the first and second actuators may be moveable relative to the handle base to move the at least one end effector relative to the sheath. [0007] The medical device may include one or more of the following aspects.

The handle base may include first and second actuator slots, each defining an opening for receiving the first and second actuators respectively. The handle portion may further include a thumb actuator, and the thumb actuator may be coupled a proximal end of the sheath. The thumb actuator may be coupled to the sheath via a peg, and the handle may include a longitudinally extending slot. The peg may be slideably positioned within the longitudinally extending slot. The thumb actuator may be moveable relative to the handle portion to move the sheath relative to the at least one end effector.

[0008] The at least one end effector may be a snare device. The snare device may include a snare wire. The snare wire may include a first wire end, a second wire end, and a distal loop, and the first wire end may be coupled to the first actuator and the second wire end may be coupled to the second actuator. Movement of the first actuator and the second actuator may control a steering of the distal loop. The first wire end may be coupled to a distal end of the first actuator, and the second wire end may be coupled to a distal end of the second actuator. The first actuator may include a first actuator extension, and the second actuator may include a second actuator extension. The first actuator extension and the second actuator extension may be slidably enclosed within a portion of the handle portion.

[0009] The handle portion may include a handle block and a handle cover coupled to the handle base. The first actuator extension and the second actuator extension may be slidably enclosed between the handle base, the handle block, and the handle cover. The handle portion may be configured to be held in either a right hand or a left hand of a user. The gripping portion may extend from the one side of the handle base at approximately a 45 degree angle. The gripping portion may include two finger openings positioned within the gripping portion, and an axis may extend through a center of the two finger openings and may be transverse to a longitudinal axis of the handle base. The finger opening that is closer to the first and second actuators may be larger than the finger opening that is farther away from the first and second actuators.

[0010] In another aspect, a medical device handle may include a handle base with first and second actuator slots and a gripping portion extending from one of the actuator slots, and the gripping portion may include at least one opening laterally offset from each of the first and second actuator slots. The medical device handle may also include first and second actuators, and the first and second actuators may be movable relative to the handle base. The first and second actuators may move along the first and second actuator slots respectively. The medical device handle may also include a third actuator coupled to a proximal portion of the handle base and movable longitudinally relative to the handle base.

[0011] The medical device handle may include one or more of the following aspects. The first actuator and the second actuator may be configured to be coupled to ends of a snare wire, and the thumb actuator may be configured to be coupled to a proximal portion of a sheath. The at least one opening may include two finger openings positioned within the gripping portion and spaced along the gripping portion from one of the actuator slots, and an axis may extend through a center of the two finger openings and may be transverse to a longitudinal axis of the handle base.

[0012] In yet another aspect, a medical device may include a handle portion and an insertion portion. The handle portion may include a handle base with first and second actuator slots and a gripping portion extending laterally from one of the actuator slots. The handle portion may also include first and second actuators, and the first and second actuators may be movable relative to the handle base. The first and second actuators may move along the first and second actuator slots respectively. The handle portion may also include a third actuator coupled to a proximal portion of the handle base at a longitudinally extending slot in the handle base. The insertion portion may include at least one end effector and a sheath. The at least one end effector may be coupled to the first and second actuators. The sheath may coupled to the third actuator. The handle portion may be configured to be held by either a left hand or a right hand, with ring and pinky fingers of either hand being received within portions of the gripping portion, with pointer and middle fingers of either hand being received within the first actuator or the second actuator, and with the thumb of either hand being received within the third actuator.

[0013] The medical device may include one or more of the following aspects.

The at least one end effector may be a snare device with a snare wire forming a loop. A first end of a snare wire may be coupled to the first actuator, and a second end of the snare wire may be coupled to the second actuator. Movement of the first actuator or the second actuator may be configured to steer a distal end of the loop of the snare wire. The gripping portion may include two finger openings positioned within the gripping portion and spaced along the gripping portion from one of the actuator slots. The finger opening that is closer to the one of the actuator slots may be larger than the finger opening that is farther away from the one of the actuator slots.

[0014] It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the disclosure, as claimed. BRIEF DESCRIPTION OF THE DRAWINGS

[0015] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary aspects of the present disclosure and together with the description, serve to explain the principles of the disclosure.

[0016] FIG. 1 illustrates an exemplary medical device, according to aspects of this disclosure.

[0017] FIG. 2 illustrates an exploded view of a proximal portion of the medical device of FIG. 1.

[0018] FIGs. 3A-3D illustrate various configurations of the medical device of FIG.

1.

[0019] FIG. 4 illustrates another configuration of the medical device of FIG. 1 , according to aspects of the present disclosure.

DETAILED DESCRIPTION

[0020] The terms “proximal” and “distal” are used herein to refer to the relative positions of the components of an exemplary medical system and exemplary medical devices. When used herein, “proximal” refers to a position relatively closer to the exterior of the body or closer to a medical professional using the medical system or medical device. In contrast, “distal” refers to a position relatively further away from the medical professional using the medical system or medical device, or closer to the interior of the body. As used herein, the terms “comprises,” “comprising,” “having,” “including,” or other variations thereof, are intended to cover a non-exclusive inclusion, such that a system, device, or method that comprises a list of elements does not include only those elements, but may include other elements not expressly listed or inherent thereto. Unless stated otherwise, the term “exemplary” is used in the sense of “example” rather than “ideal.” As used herein, the terms “about,” “substantially,” and “approximately,” indicate a range of values within +/- 10% of a stated value.

[0021 ] Examples of the present disclosure include devices and methods for facilitating and/or improving the efficacy, efficiency, and/or safety of a medical procedure. Embodiments of the present disclosure may relate to devices and methods for performing various medical procedures and/or treating portions of the large intestine (colon), small intestine, cecum, esophagus, any other portion of the gastrointestinal tract, and/or any other suitable patient anatomy. Various embodiments described herein include single-use or disposable medical devices. Some aspects of the present disclosure may be used in performing an endoscopic, arthroscopic, bronchoscopic, ureteroscopic, colonoscopic, or other type of procedure. For example, the disclosed aspects may be used with duodenoscopes, bronchoscopes, ureteroscopes, colonoscopes, catheters, diagnostic or therapeutic tools or devices, or other types of medical devices. One or more of the elements discussed herein could be metallic, plastic, or include a shape memory metal (such as nitinol), a shape memory polymer, a polymer, or any combination of biocompatible materials.

[0022] Reference will now be made in detail to examples of the present disclosure described above and illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.

[0023] FIG. 1 depicts a medical device 10 that includes a handle 12 and an insertion portion 14. Handle 12 includes a handle base 16, a first finger actuator 18 (hereinafter, first actuator 18), a second finger actuator 20 (hereinafter, second actuator 20), and a third actuator, or thumb actuator 22. Handle 12 may also include actuator slots 24A, 24B and a gripping portion 26, which may be part of or fixed to handle base 16. First actuator 18, second actuator 20, and thumb actuator 22 may each be movable relative to handle base 16. Insertion portion 14 includes an end effector (e.g., snare device 30) and a sheath 32. Snare device 30 may be formed of a wire 34, and, as shown in FIG. 2, ends 36A and 36B of wire 34 couple to first actuator 18 and second actuator 20, respectively. Sheath 32 may be coupled to thumb actuator 22. Accordingly, movement of first actuator 18, second actuator 20, and thumb actuator 22 may control the movement of snare device 30 and sheath 32. For example, first actuator 18 and second actuator 20 may be moveable to deflect snare device relative to a longitudinal axis A of medical device 10.

[0024] As shown in FIG. 2, which is an exploded view of portions of handle 12, handle base 16 includes a central post 40, for example, a rectangular post. Actuator slots 24A, 24B may be positioned on opposing sides of central post 40. Actuator slots 24A, 24B may each be ovular, for example, with straight longitudinal side(s) and curved proximal and distal ends. In one aspect, the curved proximal and distal ends of actuator slots 24A, 24B may correspond in shape to proximal and distal portions of first actuator 18 and second actuator 20. Furthermore, gripping portion 26 may extend from one of actuator slots 24A, 24B. Gripping portion 26 may include at least one opening laterally offset from each of the first and second actuator slots 24A, 24B. For example, gripping portion 26 includes a first finger hole, for example, a ring finger hole 42, and second finger hole, for example, a pinky finger hole 44. In one aspect, ring finger hole 42 may be slightly larger than pinky finger hole 44. Furthermore, in one aspect, ring finger hole 42 may partially overlap with actuator slots 24A, 24B in the longitudinal direction. For example, a proximal portion of ring finger hole 42 may overlap longitudinally with a distal portion of actuator slots 24A, 24B. Additionally, pinky finger hole 44 may be positioned further proximally than ring finger hole 42 and actuator slots 24A, 24B.

[0025] Moreover, gripping portion 26 may extend at an angle to longitudinal axis A and/or to a longitudinal axis of actuator slot 24A, for example, at approximately a 45 degree angle from a proximal portion of actuator slot 24A. Although FIG. 2 shows gripping portion 26 extending from actuator slot 24A, this disclosure is not so limited, as gripping portion 26 may extend from actuator slot 24B. In either aspect, actuator slots 24A, 24B and gripping portion 26 are fixed to or integrally formed with handle base 16, and as discussed below, handle 12 may be held and/or manipulated by a user’s right or left hand. Moreover, gripping portion 26 may include a gripping portion axis, and the gripping portion axis may extend through respective centers of ring finger hole 42 and pinky finger hole 44. The gripping portion axis may be transverse to a longitudinal axis of slot 24A and post 40, and/or may be transverse to longitudinal axis A.

[0026] Handle base 16 may also include a handle block 46 and a handle cover 48. Handle block 46 and handle cover 48 may be coupled to central post 40, which may help movably secure first actuator 18 and second actuator 20 to handle base 16 (e.g., enclose portions of first actuator 18 and second actuator 20, form tracks for portions or first actuator 18 and second actuator 20 to slide, etc.). For example, handle block 46, handle cover 48, and central post 40 may form longitudinally extending openings through which first actuator 18 and second actuator 20 may move longitudinally. Handle block 46 may include a divider 45 separating grooves 47A, 47B, and grooves 47A, 47B may slidably receive portions of first actuator 18 and second actuator 20. In one aspect, although not shown, the longitudinal openings may include one or more distal stops which may help to limit the distal movement of first actuator 18 or second actuator 20, for example, to help control the movement of wire 34. Central post 40, handle block 46, and handle cover 48 may be coupled via a press-fit, one or more fasteners (e.g., screws, nuts and bolts, etc.) extending through respective through holes, adhesive, etc. In one aspect, a portion of first actuator 18 may be positioned within actuator slot 24A, and a portion of second actuator 20 may be positioned within actuator slot 24B. Additionally or alternatively, proximal and distal ends of actuator slots 24A, 24B may help a user to recognize, (tactilely, visually, etc.) proximal and distal extension limits of movement of actuators 18, 20.

[0027] Handle base 16 may also include an end block 50 and a shaft 51. Shaft 51 may be movable within end block 50 and may be movably coupled to central post 40, for example, via a peg 52. As shown, shaft 51 may include a distal post 54 and a proximal post 56. Proximal post 54 may be coupled to thumb actuator 22, for example, via another peg 53. Although not shown, a distal end of distal post 56 may be coupled to a proximal end of sheath 32. Accordingly, in some aspects, movement of thumb actuator 22 controls the longitudinal movement of sheath 32 relative to snare device 30. In one aspect, peg 52 may be coupled to distal post 56, for example, via hole 58, and peg 52 may be movably coupled to central post 40, for example, via a longitudinally extending slot 60. For example, slot 60 may include a distal stop 60A and a proximal stop 60B. Additionally, handle cover 48 may also include a cover slot 49, which may also include a distal top 49A and a proximal stop 49B that may align with distal top 60A and proximal stop 60B. In this aspect, movement of peg 52 within slot 60 may help to limit the movement of shaft 51 , and thus help to limit the movement of sheath 32 proximally and distally. Although not shown, sheath 32 may include side slits extending longitudinally from a proximal end of sheath 32, and ends 36A and 36B of wire 34 may extend through the side slits in order for wire 34 to be coupled to first actuator 18 and second actuator 20.

[0028] Furthermore, as shown in FIG. 2, first actuator 18 may include a first actuator extension 70, and second actuator 20 may include a second actuator extension 72. A distal end 70A of first actuator extension 70 may be coupled to first end 36A of wire 34, and a distal end 72A of second actuator extension 72 may be coupled to second end 36B of wire 34. Distal ends 70A, 72A may be coupled to ends 36A, 36B of wire 36 via crimping, adhesive, screws, or any other appropriate coupling mechanism. First actuator extension 70 and second actuator extension 72 may extend into handle 12. For example, first actuator extension 70 and second actuator extension 72 may extend between central post 40, handle block 46, and handle cover 48. In one aspect, first actuator extension 70 may be slidably received within groove 47A, and second actuator extension 72 may be slidably received within groove 47B. As discussed in detail below, movement of first actuator 18 and second actuator 20 may control movement of respective ends 36A, 36B to control the movement of a distal end of wire 34.

[0029] Although not shown, insertion portion 14 may be inserted through an insertion device (e.g., an ureteroscope (e.g., LithoVue™ Single-Use Digital Flexible Ureteroscope by Boston Scientific Corp.), a hysteroscope, a bronchoscope, a cystoscope, an endoscope, a colonoscope, a sheath, a catheter, or any similar device) to a lumen within a patient. Alternatively, insertion portion 14 may be separately delivered directly to the lumen within the patient. A user may then control the position of and movement of snare device 30 and sheath 32 via handle 12

[0030] FIGs. 3A-3D illustrate various configurations of medical device 10. For example, FIGs. 3A-3D illustrate handle 12 in various configurations, along with the resulting configuration of insertion portion 14 based on the configurations of handle 12.

[0031 ] FIG. 3A illustrates first actuator 18 and second actuator 20 in proximal, or retracted, positions. As shown, first actuator 18 and second actuator 20 are substantially aligned with proximal portions of actuator slots 24A, 24B. Accordingly, wire 14 is in a non-extended or non-steered configuration. Moreover, thumb actuator 22 is in a distal, or extended, position. As a result, sheath 32 may cover a substantial portion or, although not shown, all of wire 34.

[0032] FIG. 3B also illustrates first actuator 18 and second actuator 20 in the same positions as in FIG. 3A, but illustrates thumb actuator 22 in a retracted, or proximal, position. As shown, a user may retract his or her thumb proximally to retract thumb actuator 22 and shaft 51 , and, thus, sheath 32. As a result, sheath 32 may expose a greater portion of wire 34. Wire 34 may include a self-expanding distal loop (e.g., formed of shape-memory material), that expands as the distal portion of wire 34 is exposed from sheath 32.

[0033] FIGs. 3C and 3D illustrate thumb actuator 22 in the retracted, or proximal, position, similar to as discussed with respect to FIG. 3B in order to expose wire 34 from sheath 32. FIG. 3C illustrates first actuator 18 in an extended, or distal, position within slot 24A, and second actuator 20 in the retracted or proximal position within slot 24B. As a result, the distal end of wire 34 may be steered to the left relative to longitudinal axis A. FIG. 3D illustrates first actuator 18 in the retracted, or proximal position within slot 24A, and second actuator 20 in an extended, or distal, position within slot 24B. As a result, the distal end of wire 34 may be steered to the right relative to longitudinal axis A. In the extended, or distal, positions, first actuator 18 and second actuator 20 may substantially align with distal portions of actuator slots 24A, 24B. It is noted, however, that the steering direction (e.g., right and left) depends on the orientation of medical device 10 relative to the treatment site, as rotating medical device 10 may reorient insertion portion 14 such that wire 34 may be steered, for example, up and down. Moreover, in one aspect, both first actuator 18 and second actuator 20 may be positioned in distal positions to expose wire 34. For example, first actuator 18 and second actuator 20 may be positioned in distal positions, and thumb actuator 22 may be retracted, and wire 34 may be exposed to a greater extent than if only one of first actuator 18 or second actuator 20 are positioned in a distal position with thumb actuator 22 retracted.

[0034] In any of the above configurations, in addition to controlling the extension of wire 34 relative to sheath 32, the user may also rotate his or her wrist in order to rotate sheath 32 and wire 34 along their axes. Moreover, the user may move handle 12 proximally or distally relative to the patient’s lumen in order to control the position of sheath 32 and wire 34 within the patient.

[0035] As shown in FIG. 4, handle 12 may allow for ambidextrous control. For example, FIGs. 3A-3D illustrate a user holding handle 12 with the user’s right hand. Although blocked by the user’s hand in FIGs. 3A-3D, ring and pinky fingers of the user’s right hand may be positioned within ring finger hole 42 and pinky finger hole 44. The user’s middle finger may be positioned within first actuator 18, and the user’s pointer finger may be positioned within second actuator 20. Lastly, the thumb of the user’s right hand may be positioned within thumb actuator 22. FIG. 4 illustrates a user holding handle 12 with the user’s left hand. As shown, ring and pinky fingers of the user’s left hand may be positioned within ring finger hole 42 and pinky finger hole 44, respectively. The user’s middle finger may be positioned within first actuator 18, and the user’s pointer finger may be positioned within second actuator 20. Lastly, the thumb of the user’s left hand may be positioned within thumb actuator 22. Accordingly, handle 12 allows for ambidextrous holding and manipulation. In one aspect, a user may deliver medical device 10 to a treatment site and may switch hands (passing medical device 10 from right hand to left hand, and vice versa) during the procedure.

[0036] Moreover, gripping portion 26 may allow for the user to further grip handle 12. For example, gripping portion 26 may help the user securely hold handle 12 when the user is moving one or more of first actuator 18, second actuator 20, or thumb actuator 22. Furthermore, gripping portion 26 may help the user manipulate, position, and/or rotate handle 12, which may help position or rotate sheath 32 and/or wire 34, for example, to position or rotate sheath 32 and/or wire 34 relative to tissue or other material in a lumen of the patient. Although not shown, it is contemplated that the openings in first actuator 18, second actuator 20, and gripping portion 26 (i.e. , ring finger opening and pinky finger opening) may be adjustable. For example, the openings may include a ratcheting mechanism to narrow or widen the size of the respective openings.

[0037] Additionally, as discussed above, first actuator 18 and second actuator 20 may be manipulated (e.g., advanced distally or retracted proximally) to control the position of wire 34. First actuator 18 and second actuator 20 may be manipulated together, for example, to extend wire 34 from sheath 32. Alternatively, as discussed with respect to FIGs. 3A-3D, first actuator 18 and second actuator 20 may be separately manipulated, for example, to steer wire 34 left or right (or up or down, depending on orientation). Moreover, in one aspect, first actuator 18 and second actuator 20 may be advanced distally different distances, for example, to partially extend wire 34 relative to sheath 32, and also to steer wire 34 in one direction. [0038] Thumb actuator 36 may be manipulated to control the position of sheath 32, for example, relative to wire 34. As discussed above, the user may rotate or extend/retract his or her hand holding handle 12 to rotate and extend/retract insertion portion 14, including sheath 32 and wire 34, for example, to orient and/or position sheath 32 and/or wire 34. Accordingly, handle 12 may allow for steering, actuation of an end effector, rotation, and forward/aft movement of device 10 and the end effector, all with a single hand. As discussed, the single hand may be the user’s left or right hand.

[0039] While much of this disclosure is directed to a snare wire with ends of the snare wire coupled to first actuator 18 and second actuator 20, this disclosure is not so limited. For example, handle 12 may be coupled to other end effectors, for example, a grasper, a clip, a cutting knife, scissors, tomes, etc. In one example, handle 12 may be coupled to two different end effectors, with first actuator 18 controlling the movement of the first end effector and second actuator 20 controlling the movement of the second end effector. Alternatively, one or more of first actuator 18 or second actuator 20 may be coupled to one or more visualization devices, illumination devices, etc., which may be extended or retracted based on the movement of one or more of first actuator 18 or second actuator 20. Moreover, in these aspects, handle 12 and a coupled end effector(s) may be used to perform various medical procedures, not just medical procedures listed herein. These aspects and methods may be used to perform any medical procedure, and may help to reduce the overall procedure time, component costs, reduce the risks to the subject, etc.

[0040] While principles of the present disclosure are described herein with reference to illustrative aspects for particular applications, it should be understood that the disclosure is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, aspects, and substitution of equivalents all fall within the scope of the aspects described herein. Accordingly, the disclosure is not to be considered as limited by the foregoing description.

Claims

CLAIMS We claim:

1. A medical device comprising: a handle portion, wherein the handle portion includes: a handle base; a gripping portion extending from one side of the handle base; and first and second actuators; an insertion portion, wherein the insertion portion includes at least one end effector and a sheath, wherein the first and second actuators are coupled to respective portions of the at least one end effector, and wherein the first and second actuators are moveable relative to the handle base to move the at least one end effector relative to the sheath.

2. The medical device of claim 1 , wherein the handle base includes first and second actuator slots, each defining an opening for receiving the first and second actuators respectively.

3. The medical device of claim 1 , wherein the handle portion further includes a thumb actuator, wherein the thumb actuator is coupled a proximal end of the sheath.

4. The medical device of claim 3, wherein the thumb actuator is coupled to the sheath via a peg, the handle includes a longitudinally extending slot, and the peg is slideably positioned within the longitudinally extending slot.

5. The medical device of any one of claims 3 and 4, wherein the thumb actuator is moveable relative to the handle portion to move the sheath relative to the at least one end effector.

6. The medical device of any one of the preceding claims, wherein the at least one end effector is a snare device.

7. The medical device of claim 6, wherein the snare device includes a snare wire, wherein the snare wire includes a first wire end, a second wire end, and a distal loop, and wherein the first wire end is coupled to the first actuator and the second wire end is coupled to the second actuator.

8. The medical device of claim 7, wherein movement of the first actuator and the second actuator controls a steering of the distal loop.

9. The medical device of any one of claims 7 or 8, wherein the first wire end is coupled to a distal end of the first actuator, and wherein the second wire end is coupled to a distal end of the second actuator.

10. The medical device of any one preceding claim, wherein the first actuator includes a first actuator extension, wherein the second actuator includes a second actuator extension, and wherein the first actuator extension and the second actuator extension are slidably enclosed within a portion of the handle portion.

11. The medical device of claim 10, wherein the handle portion includes a handle block and a handle cover coupled to the handle base, and wherein the first actuator extension and the second actuator extension are slidably enclosed between the handle base, the handle block, and the handle cover.

12. The medical device of any one of the preceding claims, wherein the handle portion is configured to be held in either a right hand or a left hand of a user.

13. The medical device of any one of the preceding claims, wherein the gripping portion extends from the one side of the handle base at approximately a 45 degree angle.

14. The medical device of any one of the preceding claims, wherein the gripping portion includes two finger openings positioned within the gripping portion, wherein an axis extends through a center of the two finger openings and is transverse to a longitudinal axis of the handle base.

15. The medical device of claim 14, wherein the finger opening that is closer to the first and second actuators is larger than the finger opening that is farther away from the first and second actuators.