Elevator for directing medical tool

There is provided herein an endoscope assembly comprising at least one front-pointing viewing element on a front end of a distal section of the endoscope assembly, at least one side-looking viewing element on at least one side wall of the distal section of the endoscope assembly, a working channel configured for insertion of a medical tool towards the distal section, and a system for regulating the direction of exit of medical device wherein said system enables the medical device to exit at multiple angles to the long dimension of the endoscope device either from the front end or through side walls of the distal section of the device.

FIELD

The present specification generally relates to multiple viewing element endoscopes and, in particular, describes a multiple viewing element endoscope assembly comprising an elevator mechanism that enables a medical tool to exit from one of a plurality of openings, or working channels, present in the fields of view of at least one of the multiple viewing elements.

BACKGROUND

Endoscopes have attained great acceptance within the medical community, since they provide a means for performing procedures with minimal patient trauma, while enabling the physician to view the internal anatomy of the patient. Over the years, numerous endoscopes have been developed and categorized according to specific applications, such as cystoscopy, colonoscopy, laparoscopy, upper GI endoscopy and others. Endoscopes may be inserted into the body's natural orifices or through an incision in the skin.

An endoscope is usually an elongated tubular shaft, rigid or flexible, having one or more video cameras or fiber optic lens assemblies at its distal end. The shaft is connected to a handle, which sometimes includes an ocular for direct viewing. Viewing is also usually possible via an external screen. Various surgical tools may be inserted through a working channel in the endoscope to perform different surgical procedures.

Endoscopes generally have at least a front viewing element and optionally a side viewing element to view the internal organ, such as the colon, illuminators associated with each viewing element, one or more fluid injectors to clean the lens assembly of the viewing element(s), and a working channel to insert surgical tools, for example, to remove polyps found in the colon. Typically, endoscopes also have fluid injectors (“jet”) to clean a body cavity, such as the colon, into which they are inserted. The illuminators commonly used are fiber optics which transmit light, generated remotely, to the endoscope tip section. The use of light-emitting diodes (LEDs) for illumination is also known.

Often surgical tools inserted through a working channel exit from a working channel opening at the front of the distal end of the endoscope tip. The front viewing element allows for the operator to view the tool within the patient's body. In other configurations, surgical tools inserted through a working channel exit from a working channel opening positioned on a side, near the distal end, of the endoscope tip.

Currently available endoscope assemblies do not adequately address the need to exit a surgical tool inserted through the working channel, from either the front opening or one or more side openings located on the distal end of the endoscope tip. Hence there are limitations on the visibility of the body cavity as well as on the ability to reach the cavity and operate on polyps or lesions on the cavity's walls.

U.S. Pat. No. 7,537,561 titled “Endoscope Apparatus” invented by Yamaya et al. describes “an endoscope apparatus comprising: an insertion portion having first and second channels arranged therein and terminating at first and second openings, respectively, at a distal portion of the insertion portion; an observation optical system for capturing an observation image, which is arranged to the insertion portion; a first treatment-tool oscillating base which guides, in a first direction and centering around a first rotating shaft, a first treatment-tool inserted via the first channel arranged to the insertion portion, a range of oscillation of the first treatment-tool by the first treatment-tool oscillating base being set so as to cause a distal end of the first treatment-tool to be selectively positioned inside or outside the observation image; and a second treatment-tool oscillating base which guides, in a second direction which is different from the first direction and centering around a second rotating shaft, a second treatment-tool inserted via the second channel arranged in the insertion portion, the second rotating shaft being positioned closer to the distal portion side of the insertion portion than the first rotating shaft.” However, such assemblies with a front-pointing camera with front working channel openings to treat (removing/biopsying) polyps or lesions found on the side walls of the colon need to be refracted and repositioned with their front facing the polyp or lesion. This repositioning of the tip may result in “losing” the polyp/lesion and further effort and time must be invested in re-locating it.

Thus there is a need in the art for an endoscope assembly that allows a medical tool to exit the working channel from the front as well as the side of an endoscope tip, and which may be viewed by corresponding front and side viewing elements.

SUMMARY

The present specification discloses an endoscope assembly, the assembly comprising: at least one front-pointing viewing element on a front end of a distal section of the endoscope assembly; at least one side-looking viewing element on at least one side wall of the distal section of the endoscope assembly; a working channel configured for insertion of a medical tool towards the distal section; and an elevator for directing the medical tool to exit from the working channel in a direction that can be viewed by one of the at least one front-pointing viewing element and the at least one side-looking viewing element.

Optionally, the working channel comprises: a front channel opening on the front end; and a side channel opening on each of the at least one side wall, wherein the front channel opening and the side channel opening allow the medical tool to exit the working channel.

Optionally, the elevator further comprises: a first curvilinear section and a second curvilinear section wherein an edge of the first section is connected to an edge of the second section forming a substantially V-shaped groove for receiving and guiding a medical tool to either the front channel opening or side channel opening; and, a pivot, wherein the pivot enables controlling of the elevator.

The assembly may comprise one side-looking viewing element.

The assembly may comprise two side-looking viewing elements. The side-looking viewing elements may be directed to opposing sides. An optical axis of each side-looking viewing element may be perpendicular to an optical axis of the front-pointing viewing element. An optical axis of each side-looking viewing element may form an obtuse angle with an optical axis of the front-pointing viewing element. An optical axis of each side-looking viewing element may form an acute angle with an optical axis of the front-pointing viewing element.

The present specification also discloses an endoscope assembly having a distal tip section, the assembly comprising: at least one front-pointing viewing element on a front wall of the distal tip section; at least one side-pointing viewing element on at least one side wall of the distal tip section; a working channel configured for insertion of a medical tool into and through the distal tip section, wherein said working channel provides a first exit for said medical tool, said first exit comprising a first opening in the front wall of the distal tip section, and a second exit for said medical tool, said second exit comprising a second opening in the at least one side wall of the distal tip section; a ramp structure, wherein a portion of said ramp structure is positioned proximal to said second exit within said working channel, thereby positioning said second exit between the first exit and the portion of the ramp structure, wherein said ramp structure is coupled to an internal wall of the distal tip section via a pivot and wherein a position of the ramp structure may be modified to regulate a direction of exit of the medical tool; and a control system coupled to said pivot, wherein said control system is configured to modify a position of said ramp structure to regulate the direction of exit of the said medical device.

The ramp may be adapted to be positioned in at least two different angles relative to the internal wall of the distal tip section.

Optionally, the ramp structure comprises partially raised walls on side edges which are configured to hold and guide an elongated surface of the medical tool.

The pivot may comprise at least one of pivot hinge joint, pivot ball and socket joint, pivot pin and hole joint.

Optionally, the control system comprises a control wire coupled to the pivot at a first end and to a control knob positioned on a handle section of the endoscope assembly at a second end.

The control system may comprise an electronic controller.

When said pivot is in a first position, the ramp structure may be positioned to enable the medical tool to exit from the first exit of the distal tip section. Additionally, when said pivot direction is in a first position, said medical tool may exit from the front wall of the distal tip section at an angle of substantially zero degrees relative to the long dimension towards the front portion of the endoscope device.

When said pivot direction is in a second position, the ramp structure may be configured to receive and bend the medical tool to enable it to exit from the second exit. Additionally, when said pivot direction is in a second position, said medical tool may exit from the second exit at an angle of approximately 90 degrees relative to the long dimension towards the front portion of the endoscope device.

Optionally, said ramp structure further comprises a first curvilinear section and a second curvilinear section wherein an edge of the first section is connected to an edge of the second section forming a groove for receiving and guiding a medical tool to either the first exit or the second exit.

The present specification also discloses an endoscope assembly having a distal tip section, the assembly comprising: at least one front-pointing viewing element on a front wall of the distal tip section; at least one side-pointing viewing element on a side wall of the distal tip section; a working channel configured for insertion of a medical tool into and through the distal tip section, wherein said working channel provides a first exit for said medical tool, said first exit comprising a first opening in the front wall of the distal tip section, and a second exit for said medical tool, said second exit comprising a second opening in the at least one side wall of the distal tip section, wherein said first exit and second exit are separated by a distance of 7 mm to 11 mm; a ramp structure, wherein said ramp structure is coupled to an internal wall of the distal tip section via a pivot, wherein a position of the ramp structure may be modified to regulate a direction of exit of the medical tool, and wherein said pivot is positioned at least 0.3 mm proximal to the second exit within said working channel, thereby placing said second exit between the first exit and the pivot; and a control system configured to modify a position of said ramp structure to regulate the direction of exit of the said medical device, wherein said control system comprises a control wire coupled to the pivot at a first end and to a control knob positioned on a handle section of the endoscope assembly at a second end.

The ramp may be adapted to be positioned in at least two different angles relative to the internal wall of the distal tip section.

Optionally, the ramp structure comprises partially raised walls on side edges which are configured to hold and guide an elongated surface of the medical tool.

When said pivot is in a first position, the ramp structure may be positioned to enable the medical tool to exit from the first exit of the distal tip section. Additionally, when said pivot direction is in a first position, said medical tool may exit from the front wall of the distal tip section parallel to the long dimension towards the front portion of the endoscope device.

When said pivot direction is in a second position, the ramp structure may be configured to receive and bend the medical tool to enable it to exit from the second exit. Additionally, when said pivot direction is in a second position, said medical tool may exit from the second exit at an angle of approximately 90 degrees relative to a long dimension towards the front portion of the endoscope device.

Optionally, said ramp structure further comprises a first curvilinear section and a second curvilinear section wherein an edge of the first section is connected to an edge of the second section forming a groove for receiving and guiding a medical tool to either the first exit or the second exit.

The present specification also discloses an endoscope assembly having a distal tip section, the assembly comprising: at least one front-pointing viewing element on a front wall of the distal tip section; at least one side-pointing viewing element on a side wall of the distal tip section; a working channel configured for insertion of a medical tool into and through the distal tip section, wherein said working channel provides a first exit for said medical tool, said first exit comprising a first opening in the front wall of the distal tip section, and a second exit for said medical tool, said second exit comprising a second opening in the at least one side wall of the distal tip section, wherein said first exit and second exit are separated by a distance of 7 mm to 11 mm; a ramp structure having a distal end and a proximal end with a pivot point, wherein said ramp structure is coupled to an internal wall of the distal tip section via the pivot point, wherein a position of the ramp structure may be modified to regulate a direction of exit of the medical tool, and wherein said distal end of the ramp structure is positioned at least 0.3 mm proximal to the second exit within said working channel, thereby placing said second exit between the first exit and the distal end of the ramp structure; and a control system configured to modify a position of said ramp structure to regulate the direction of exit of the said medical device, wherein said control system comprises a control wire coupled to the pivot at a first end and to a control knob positioned on a handle section of the endoscope assembly at a second end.

The aforementioned and other embodiments of the present invention shall be described in greater depth in the drawings and detailed description provided below.

DETAILED DESCRIPTION OF THE INVENTION

Reference is now made toFIG. 1, which shows an exploded view of a tip section200of an endoscope assembly100. It is noted that the term “endoscope” as mentioned to herein may refer particularly to a duodenoscope or colonoscope, according to some embodiments, but is not limited only to duodenoscopes or colonoscopes. The term “endoscope” may refer to any instrument used to capture images of, and visualize, the interior of a hollow organ or cavity of the body.

As shown inFIG. 1, the tip section200is turnable by way of flexible shaft (not shown), which may also be referred to as a bending section, for example a vertebra mechanism. According to an embodiment, tip section200of an endoscope includes a tip cover300, an electronic circuit board assembly400and a fluid channeling component600.

The electronic circuit board assembly400is configured to carry a front pointing viewing element116and two side looking viewing elements such as viewing element116bon one side and another viewing element on the side opposite to one carrying the viewing element116b, which may be similar to front pointing viewing element116and may include a Charge Coupled Device (CCD) or a Complementary Metal Oxide Semiconductor (CMOS) image sensor.

The electronic circuit board assembly400is also configured to carry front illuminators240a,240b,240c, which are associated with front pointing viewing element116, and are positioned to illuminate its field of view. In addition, the electronic circuit board assembly400is configured to carry side illuminators250aand250b, which are associated with side looking viewing element116b, and are positioned to illuminate its field of view. Electronic circuit board assembly400is also configured to carry side illuminators associated with side looking viewing element opposing side looking viewing element (116b), which may be similar to side illuminators250aand250b.

In an embodiment, the front illuminators240a,240b,240cand side illuminators250aand250bare discrete illuminators and include a light-emitting diode (LED), which may be a white light LED, an infrared light LED, a near infrared light LED, an ultraviolet light LED or any other LED. The term “discrete”, concerning discrete illuminator, refers to an illumination source, which generates light internally—in contrast to a non-discrete illuminator, which may be, for example, a fiber optic merely transmitting light generated remotely.

Reference is now made toFIG. 1along withFIGS. 2A and 2B, which shows alternate views of the tip section200. According to some embodiments, fluid channeling component600includes a proximal fluid channeling section602(or base) which has an cylindrical shape and a unitary distal channeling section604(or elongated housing). Distal fluid channeling section604partially continues the cylindrical shape of proximal fluid channeling section602and has a shape of a partial cylinder (optionally elongated partial cylinder).

In an embodiment, the fluid channeling component600comprises a front working channel640having an entry point640a(ReferFIG. 2B) and a side working channel650having an entry point650a(ReferFIG. 2B). The entry points640aand650aare located on the rear side of the fluid channeling component600of the tip section200as illustrated inFIG. 2B.

The tip cover300is configured to fit over the inner modules of tip section200including electronic circuit board assembly400and fluid channeling component600and to provide protection to the internal components housed within the inner modules. The opening340on the tip cover300provides an exit point for the front working channel640and the opening350on the tip cover300provides an exit point for the side working channel650. Further, the tip cover300includes a front panel320having a front optical assembly256, of front looking viewing element116. Front optical assembly256includes a plurality of lenses, static or movable, which provide a field of view of 90 degrees or more, 120 degrees or more or up to essentially 180 degrees.

Optical axis of front looking viewing element116is essentially directed along the long dimension of the endoscope. However, in embodiments, since front looking viewing element116is a wide angle camera, its field of view may include viewing directions at large angles to its optical axis. Additionally, in an embodiment, the front panel320includes optical windows242a,242b, and242cwhich cover the illuminators240a,240band240c, respectively. It should be noted that number of illumination sources used for illumination of the field of view might vary.

In addition, the front panel320includes a working channel opening340of a working channel640, which is further discussed below.

In another configuration, a jet channel opening344of jet channel644is located on front panel320of tip cover300. Jet channel644is configured to provide high-pressure jet of fluid such as water or saline for cleaning the walls of the body cavity in an embodiment.

Also located on front panel320of tip cover300is injector opening346of injector channel646having a nozzle348aimed at front optical assembly256. Injector channel646is configured for injecting fluid (liquid and/or gas) to wash contaminants such as blood, feces and other debris from front optical assembly256of front looking viewing element116. Optionally, injector channel646may be configured for cleaning front optical assembly256and one, two, or all of optical windows242a,242b, and242c. Visible on sidewall362of tip cover300is side optical assembly256bfor side looking viewing element116b, which may be similar to front optical assembly256and optical windows252aand252bof illuminators250aand250b. Also on sidewall362of tip cover300, on the opposing side to side optical assembly256b, is an optical assembly (not shown) for side looking viewing element, and optical windows of the illuminators corresponding to side looking viewing element. In an embodiment, the optical axis of side looking viewing element116bis directed perpendicular to the long dimension of the endoscope. However, in embodiments, since side looking viewing element116bis a wide angle camera, its field of view includes viewing directions at large angles to its optical axis. In accordance with some embodiments, the side looking viewing element116bhas a field of view of 90 degrees or more, 120 degrees or more or up to essentially 180 degrees.

In embodiments, optical axis of each side-looking viewing element (116band the opposing viewing element) is perpendicular to optical axis of front-pointing viewing element116. In alternative embodiments, optical axis of each side-looking viewing element forms an obtuse angle with optical axis of front-pointing viewing element116. In other embodiments, optical axis of each side-looking viewing element forms an acute angle with optical axis of front-pointing viewing element116.

In addition, in an embodiment, the side injector opening266of side injector channel666is located at distal end of sidewall362. A nozzle cover267is configured to fit side injector opening266.

Additionally, in an embodiment, nozzle cover267includes a nozzle268which is aimed at side optical assembly256band is configured to inject fluid to wash contaminants such as blood, feces, and other debris from side optical assembly256bof side looking viewing element116b. The fluid may include gas that is used for inflating a body cavity. Optionally, nozzle268is configured to clean both side optical assembly256band optical windows252aand/or252b.

According to some embodiments, side injector channel666is configured to supply fluids to clean any of the tip elements (such as any optical assembly, windows, illuminators, and other elements).

Although the tip section200is presented herein showing one side thereof, it is noted that according to some embodiments, the opposing side may include elements similar to the side elements described herein (for example, side looking viewing element, side optical assembly, injector(s), nozzle(s), illuminator(s), window(s), opening(s) and other elements).

It is noted that according to some embodiments, tip section200includes more than one side looking viewing elements. In this case, the side looking viewing elements are installed such that their field of views are substantially opposing. Front-pointing viewing element116is able to detect objects of interest (such as a polyp or another pathology) which are directly in its field of view, while side looking viewing elements are configured to detect additional objects of interest that are normally hidden from front-pointing viewing element116. Once an object of interest is detected, endoscope operator can insert a surgical tool and remove, treat and/or extract a sample of the polyp or its entirety for biopsy.

In some cases, objects of interest may only be visible through side looking viewing elements such as116b. In this case, it is beneficial for the endoscope's operator to be able to use surgical tools, which can access the object of interest and perform surgical operations while the object of interest is visible by such side looking viewing elements.

According to some embodiments, fluid channeling component600is configured as a separate component from electronic circuit board assembly400. This configuration is adapted to separate the fluid channels and working channel640, which are located in fluid channeling component600from the sensitive electronic and optical parts that are present in electronic circuit board assembly400.

In an embodiment, the tip cover300of the tip section200includes a side working channel opening350for the side working channel650as mentioned earlier. Side working channel opening350is configured to improve the performance of the endoscope (particularly, the colonoscope). Typically colonoscopes have only one working channel opening such as the opening340provided for front working channel640, which opens at the front distal section of the colonoscope. Such front working channel is adapted for insertion of a surgical tool. The physician is required to perform all necessary medical procedures, such as biopsy, polyp removal and other procedures, through the front opening.

In addition, for treating (removing/biopsying) polyps or lesions found on the side walls of the colon, tip sections that only have one or more front working channels need to be retracted and repositioned with their front facing the polyp or lesion. This repositioning of the tip may result in “losing” the polyp/lesion and further effort and time must be invested in relocating it. However, the configuration shown inFIG. 1describes an endoscope (such as colonoscope) having a front viewing element and one or more side viewing elements which comprises, in addition to the front working channel opening340, a side working channel opening350. The front working channel640is configured for the insertion of medical tools that can exit from front working channel opening340. Similarly the side working channel650is configured such that the medical tools inserted through it can exit from the side working channel opening350.

While some objects of interest may be visible and/or accessible via the endoscope's front panel320(FIG. 1), some objects of interest may be more visible via side looking viewing element116band/or accessible via endoscope side working channel opening350of the side working channel650. Allowing an exit from side working channel opening350enables medical procedures to be performed from (or in proximity to) the side of tip section200, while at the same time viewing the procedure by side looking viewing element116b. This substantially increases the performance and accessibility of the endoscope. In an embodiment, the tip section of the endoscope assembly200comprises another working channel opening on the side opposite to that shown inFIG. 2A, which allows the physicians to operate on polyps or lesions detected by side viewing element present on the side opposite to side having the sidewall362.

As discussed in the configurations shown inFIGS. 1, 2A and 2B, the endoscope assemblies described here comprise multiple separate working channels to provide operational access to both the front portion and side portions of the device. It includes separate entry and exit points for the front working channel640and the side working channel650.

The present specification describes a novel system for providing operational access to both the front portion and side portion of device from a single working channel. In an embodiment, the present specification describes a system wherein the medical tools inserted through a single working channel can be diverted to exit through both the front opening and side wall openings at multiple angles relative to the long dimension of the device. In an embodiment, the present specification describes a system wherein the exit angle of the medical tool is regulated with the help of an elevator/ramp mechanism which in an embodiment, is controlled by the physician.

Reference is now made toFIG. 3AandFIG. 3Bwhich illustrate a cross-sectional view of the tip section800of an endoscope device in accordance with an embodiment of the present specification. In an embodiment, the tip section800comprises a fluid channeling component810that includes a proximal fluid channeling section802(or base) and a distal channeling section804(or elongated housing). In an embodiment, the distal fluid channeling section804partially continues the shape of proximal fluid channeling section802and in an embodiment has a shape of a truncated partial cylinder.

In an embodiment of the present specification, the tip section800comprises an electronic circuit board850coupled to the fluid channeling component810. The electronic circuit board assembly850is configured to carry a front pointing viewing element816and two side looking viewing elements such as viewing element816bon one side and another viewing element on the side opposite to one carrying the viewing element816b, which may be similar to front pointing viewing element816and may include a Charge Coupled Device (CCD) or a Complementary Metal Oxide Semiconductor (CMOS) image sensor.

The electronic circuit board assembly850is also configured to carry front illuminators840a,840b,840c, which are associated with front pointing viewing element816, and are positioned to illuminate its field of view. In addition, the electronic circuit board assembly850is configured to carry side illuminators850aand850b, which are associated with side looking viewing element816b, and are positioned to illuminate its field of view. Electronic circuit board assembly850is also configured to carry side illuminators associated with side looking viewing element opposing side looking viewing element (816b), which may be similar to side illuminators850aand850b.

In an embodiment, the front illuminators840a,840b,840cand side illuminators850aand850bare discrete illuminators and include a light-emitting diode (LED), which may be a white light LED, an infrared light LED, a near infrared light LED, an ultraviolet light LED or any other LED. The term “discrete”, concerning discrete illuminator, refers to an illumination source, which generates light internally—in contrast to a non-discrete illuminator, which may be, for example, a fiber optic merely transmitting light generated remotely.

According to some embodiments, the proximal fluid channeling section802comprises a working channel840. Medical tools inserted in the working channel840from the rear portion (facing the physician) of the fluid channeling component810, can exit from opening841located within the fluid channeling section802. As the medical tool exits from opening841, in an embodiment, the medical tool is subsequently allowed to either travel in a straight line direction or the direction of medical tool is diverted with help of an elevator/ramp structure801.

In an embodiment, the ramp structure801comprises a first section801aand a second section801bwherein an edge of the first section801ais connected to an edge of the second section801bforming a substantially angled structure, or V-shaped groove,801cfor receiving and guiding a medical tool to the appropriate working channel opening. In embodiments, the shape of the groove may not be limited to a V-shape; and any other shape such as a hyperbola, square, or any other suitable shape, may be used to handle and guide the medical tool.

In an embodiment, the first section801aof the ramp structure801comprises a planar structure that is positioned substantially parallel to the inside wall804aof the fluid channeling component810and defines a plane that intersects with the plane defining the base817of the electronic circuit board850at a right angle. In another embodiment, the plane defined by the first section801abisects the base817of the electronic circuit board850at a right angle.

In an embodiment, the second section801bcomprises a planar structure that is substantially parallel to the plane defined by the base817of the electronic circuit board850and is positioned at a right angle to the first section801aand inside wall804aof the fluid channeling component810.

One of ordinary skill in the art would appreciate that the above described configuration and positioning of the ramp structure801only defines its initial configuration in an embodiment and the position and relative angular orientation of ramp801changes as the ramp is moved with the help of a pivot to regulate the direction of medical tool which is discussed in subsequent sections of the specification.

In an embodiment, the first section801aand second section801bhave substantially curvilinear structures. In an embodiment, the ramp structure801is pivotally connected to the internal side804aof the fluid channeling component810. In an embodiment, a pivot is connected to ramp801such that by controlling the position of pivot, one can control the angle at which ramp801aligns with inner wall804aof fluid channeling component810, which in turn controls the direction in which the medical tool exits the endoscope assembly.

In an embodiment, the system is configured such that ramp structure801can be positioned among seven different positions to provide seven different exit directions to the medical tool inserted through the working channel840. In these seven positions, the ramp is inclined at an angle of 0 degree, 15 degree, 30 degree, 45 degree, 60 degree, 75 degree and 90 degree to the long dimension of the endoscope, where each degree covers a range of +/−five degrees. Accordingly the medical tool exits at angles of zero degree, 15 degree, 30 degree, 45 degree, 60 degree, 75 degree and 90 degree to the long dimension of the endoscope in these respective positions.

In an embodiment, slightly raised walls on the side edges of ramp801are configured to hold and guide the elongated surface of the medical tool passing over it in position during an endoscopic procedure. In an embodiment, the ramp801is positioned between front section808of the distal channeling section804and the opening841of the working channel840, such that changing the position of the ramp guides the medical tool to exit either through the front panel or through an exit in a sidewall of the endoscope device. In embodiments, the ramp position can be regulated to enable the medical tool to exit at multiple angles from both the front panel and sidewall of the device. In an embodiment, the equipment manufacturer provides openings for exit of working channel on the front panel and on sidewalls of the endoscope device and the ramp position is allowed to shift between a predefined positions such that the medical tool can exit from these existing openings on the device.

In embodiments, front-pointing viewing element816, aided by illuminators840a,840band840c, is configured to provide a view of the medical tool exiting through a front channel opening located on a front portion of the distal tip of the endoscope. Similarly, in embodiments, side-looking viewing element816b, aided by illuminators850aand850b, is configured to provide a view of the medical tool when it exits through a side wall of the endoscope device.

InFIG. 3A, the pivot is in a first position such that the first section801aof ramp801is in a plane parallel to the inner wall804aof fluid channeling component810. In an embodiment, a medical tool inserted through working channel840exits at zero degrees relative to the long dimension towards the front portion of the device (illustrated inFIG. 4) through a front channel opening provided on the front panel of the device. In an another embodiment, the pivot is turned to raise the ramp such that it guides the medical tool passing over in a way that the said medical tool bends and exits from one of the side channel openings provided on the device. In an embodiment, the position of pivot is controlled such that the medical tool bends at 90 degrees (illustrated and described in context ofFIGS. 5a, b, and6) or less when it exits a side channel opening provided on a side wall of the endoscope device. In embodiments, the pivot coupled to the ramp801is controlled by adding a control component such as a lever to a handle of endoscope assembly. In an embodiment, the lever is placed between knobs on the handle and the handle's body.

One of ordinary skill in the art would appreciate thatFIG. 3Adescribes a tip section of the endoscope assembly without the external tip cover. In an embodiment, the tip section is covered by a tip cover such as the tip cover300described for endoscope assembly ofFIG. 1. In an embodiment, the tip cover of the endoscope assembly described inFIG. 3Ahas at least one side channel opening positioned at an appropriate position to provide an exit to the medical tool which is maneuvered with the help of ramp structure801towards a side wall of the endoscope tip section (as described in theFIG. 6). One of ordinary skill in the art would appreciate that the side working channel opening on such tip cover can be positioned at any convenient location as per the system requirement. In an embodiment, the side working channel opening is located closer to the front portion of the tip section compared to the position of viewing element816bon the side wall. In another embodiment, the side working channel opening and the viewing element816bare located at same horizontal distance from the front portion of the distal tip. In an embodiment, the viewing element816bis located closer to the front portion of the tip section compared to the position of side working channel opening.

In an embodiment, in order to ensure that the medical tools operated through the side working channel are viewed properly, the side working channel opening is positioned such that the medical tools operated through the side working channel opening are within the field of view of a side viewing element such as the viewing element816bon the sidewall of endoscope.

In an embodiment, the side working channel opening is positioned on the circumference of the endoscope at a distance of 7 to 11 millimeters, preferably 8.5 mm to 9.5 mm, and more preferably at 9 mm to 9.1 millimeters, and any increments therein, from the surface of the tip, where the front working channel opening is located. Accordingly, the ramp structure is positioned within the working channel proximal to the side channel exit at a distance of at least 7 mm from the front working channel exit, and more preferably 8 mm to 10 mm, or at least 0.3 mm proximal to the side working channel exit (i.e. closer to the endoscope handle than the tip). In another embodiment comprising a slim endoscope having a smaller diameter, the side working channel is preferably positioned on the circumference of the endoscope at a distance of 8.7-8.9 mm from the surface of the tip. In all such cases, the working channel may have an inner diameter of 2.8 mm to 6.5 mm.

In other embodiments, the distal end of the ramp is located in the working channel at least 0.3 mm proximal (closer to the handle) relative to the side channel exit. In other embodiments, the pivot point of the ramp is located in the working channel at least 0.3 mm proximal (closer to the handle) relative to the side channel exit. In other embodiments, the distal end of the ramp is located in the working channel a distance of 0.3 mm to 10 mm proximal (closer to the handle) relative to the side channel exit. In other embodiments, the pivot point of the ramp is located in the working channel a distance of 0.3 mm to 10 mm proximal (closer to the handle) relative to the side channel exit.

In embodiments, an operating wire is used to operate ramp801remotely by rotating it in a desired direction. In an embodiment, the operating wire extends from the ramp to the handle of endoscope assembly. In embodiments, an additional knob or a button on the handle provides a control interface to a physician to control ramp801. In various embodiments, the control interface can be located on the handle, on a main control unit connected to the endoscope assembly, on a computer connected to the endoscope assembly, or on any other external control unit that may communicate with the operating wire.

FIG. 7illustrates a control system to regulate the position of ramp/elevator section in accordance with an embodiment of the present specification. As shown inFIG. 7, a ramp801comprises a vertical section801acoupled to a pivot820. In an embodiment, the pivot820is coupled to a control knob890through a control wire880. In an embodiment, the control knob890is located on the control handle portion of the endoscope assembly such that the user/physician can operate the control knob890to regulate the position of ramp801. One of ordinary skill in the art would appreciate that there could be multiple ways to couple the control wire880with the pivot820such that on user instruction, the position of pivot can be changed which in turn can change the position of ramp801. In embodiment, the endoscope assembly comprises any of the conventional pivot joint systems to couple the control wire880to the pivot220. Pivot structures comprises any one of a pivot hinge joint, a pivot ball and socket joint, or a pivot pin and hole joint. In some embodiments the control wire880is coupled to the pivot820through hinges located at position860shown in theFIG. 7. In an embodiment of the present specification, the ramp801is placed between the working channel exit point841positioned on the proximal fluid channeling section802of the fluid channeling component810and a front section808of the distal fluid channeling section804as illustrated inFIG. 3A. Medical tools inserted into the working channel840from the rear portion of the fluid channeling component810exit from the opening841and thereafter pass through the ramp/elevator801in an embodiment.

In an embodiment, the control wire can be operated to regulate the position of pivot820and ramp801in both the forward and sideway directions. In another embodiment, the pivot820is coupled to the ramp801such that the angular position of ramp can be modified to enable the medical tools to exit at multiple angles to the long dimension of the endoscope device. According to some embodiments, the ramp801comprises slightly raised structures referred as side anchoring support830provided along an upper edge of walls of ramp801which guide the medical tool801to bend at an angle and exit the tip section through a side wall of the device. In an embodiment, the ramp801is in a retracted position wherein the pivot820is positioned substantially inside the wall804aof distal channeling section804of the fluid channeling component810shown inFIG. 3A,FIG. 3BandFIG. 4. In this position the medical tool870exiting from the opening841of the working channel840does not come in contact of the ramp801and is enabled to travel in a straight direction and exit from the front portion of the distal tip. In an embodiment, the ramp801is in an extended or raised position wherein the pivot820is positioned substantially outside the wall804aof distal channeling section804of the fluid channeling component810as shown inFIG. 5A, 5BandFIG. 6. In this position, the ramp801and the anchoring supports830are positioned such that the medical tool bends at substantially 90 degree angle and exit the endoscope device from a side wall. While only two positions of the ramp are discussed in detail here, the control system described for pivot820and ramp801is configured such that the movement of ramp801can be controlled in multiple ways, including forward, backward, sideways, or in incremental angular shifts, to enable the medical tool to exit at a variety of angles from either the front portion or through a side portion/wall of the tip section of the endoscope device.

In some embodiments, movement of ramp801is automatically controlled by a computer program, or a pre-defined electronic signal. In embodiments, ramp801is adapted to operate with working channels of different dimensions, such as and not limited to working channel diameters ranging from 2.3 millimeters (mm) to 7 mm. Dimensions may vary on the basis of an application of the scope.

One of ordinary skill in the art would appreciate that the ramp801and the corresponding pivot can be manufactured with any known materials or alloys which are acceptable for use in medical applications. In an embodiment the ramp and the pivot section are manufactured with stainless steel.

FIG. 4illustrates a medical tool870guided by ramp801to exit the front channel opening through working channel840in accordance with some embodiments. As shown in theFIG. 4, the position of ramp801is adjusted such that a pivot coupled to the ramp801is largely positioned on the inside of fluid channeling component810; as a result, ramp801is in a position that allows the medical tool870to extend into the forward direction without bending. Thus, in this position, the ramp allows for the medical tool to exit at an angle of substantially zero degrees relative to the long dimension towards the front portion of the device. In this embodiment, the medical tool exits from the front end of the distal section of the endoscope assembly. In an embodiment, the position of ramp is adjusted by the physician through a control mechanism coupled to the handle section of the endoscope assembly as described inFIG. 7. In embodiments, the angle of exit of the medical tool870from the front end of the distal section is not exactly zero degrees relative to the long dimension towards the front portion of the device and the ramp is enabled to exit the front end of the distal tip at an acute angle relative to the long dimension of the device depending on the positioning and structure of working channel opening on the front portion of the distal tip.

FIGS. 5A and 5Billustrate two different views of an alternative position of ramp801, in accordance with an embodiment. In this embodiment, the pivot820is configured in a raised position below ramp801. When pivot820is activated, it emerges from the inside wall804aof distal channeling section804of the fluid channeling component810such that ramp801is raised and repositioned in a way that it guides medical tool801(referring toFIG. 6) to exit the distal portion of tip section800through a side wall of the device. A side anchoring support830provided along an upper edge of walls of ramp801guides the medical tool801to bend at an angle and exit the tip section through a side wall of the device. In an embodiment, the ramp801and the side anchoring support830are adjusted such that the medical tool bends at substantially a 90 degree angle and exits the side wall of the of tip section800in a direction perpendicular to the long dimension of the endoscope. In alternate embodiments, the positions of ramp801and side anchoring support830can be adjusted to enable the medical device to exit at any other angle to the long dimension of the endoscope device. In an embodiment, the side anchoring support830is configured such that it also provides stability to medical tool870during a procedure. Side anchoring support830holds medical tool870in place and provides support to its sides while it is inserted through working channel840and is guided towards different directions.

Ramp801is controlled, in an embodiment, via pivot820which is used to guide or direct the exit of a medical tool870inserted through working channel840of endoscope assembly. The direction of medical tool870can be altered such that it may exit from either front panel820, or through a side wall of the tip section800of endoscope assembly. The direction of medical tool870may be varied between angles from zero degrees to 90 degrees or more, to exit from working channel openings in the front or the side of tip section800. Viewing elements, such as viewing element816on the front and viewing element816bon the side, provide a view of medical tool870exiting in either direction.

FIG. 6illustrates medical tool870guided by ramp801to exit from a side wall, according to some embodiments. As shown inFIG. 6, the pivot820is activated to raise ramp801such that medical tool870, after exiting from the working channel840, is bent and guided to exit distal part of tip section800from a side wall of the endoscope device. It should be appreciated that, typically, a tip cover such as the tip cover300shown inFIG. 1covers the fluid channeling component810and the circuit board850. The medical tool870exits from openings provided on the front panel or side walls of such a tip cover.

In various embodiments described inFIG. 3AtoFIG. 6, the endoscope comprises a ramp structure that is coupled to an internal wall and can maneuver the medical tools towards the front portion or towards a side wall of the device. In an alternate embodiment of the present specification, the endoscope assembly is structured such that it comprises two working channels similar to the working channel840described inFIG. 3Awherein each working channel has at least one opening on the front portion of the distal tip section and at least one opening on the sidewall of the endoscope device. In addition, the system comprises a separate ramp structure for each working channel such that a first ramp structure enables operational access through the first working channel to the front portion and to one sidewall portion of the endoscope and the second ramp structure enables operational access through the second ramp structure to the front portion and to the opposite sidewall portion of the endoscope device.

In another embodiment, the endoscope assembly is structured such that the tip section comprises a fluid channeling component comprising a working channel with at least three exit openings. The working channel comprises at least one opening on the front portion and at least two openings on the opposite sidewalls. In an embodiment, the fluid channeling component is coupled to a ramp structure which is configured such that it can be positioned in the direction of either of the sidewalls of the endoscope device and in an embodiment, it can direct the medical device inserted through the working channel to either exit from the front portion or exit from either of the two openings on the opposite sidewalls of the device.