Medical device with pivotable jaws

A medical device with pivotable jaws and method of use thereof are disclosed. The device includes a pair of jaw members which are capable of being rotated independently of one another and spaced apart up to about 360°. Various gear arrangements are provided for enabling rotation of the jaws. The jaw members are disposed within a flexible slotted housing when advanced to a target tissue site, and thereafter rotated out of the housing a predetermined amount to contact target tissue.

BACKGROUND

Medical devices for engaging tissue are used during several types of procedures, including open surgery, laparoscopic surgery, endoscopic surgery, or transluminal surgery. Such devices include graspers, snares, baskets and the like. One common type of tissue engagement medical device that is available for endoluminal engagement of body tissue is forceps. Conventional forceps includes a pair of hinged jaws located at a distal end of a tubular housing. The hinged jaws are commonly activated using a typical actuator such as a push/pull wire mechanism, in which an actuating element such as a wire extends through the tubular housing to connect to the jaws via a mechanical linkage, which in turn drives the jaws between a closed position and a “V” shaped open position. Closing the jaws from the “V” shaped open position causes the jaws to catch on, pinch, or entrap tissue during a procedure. The extent to which the jaws open is typically limited by the mechanical linkage to the “V” shape; usually the jaws are separated by about 90° in their open position.

SUMMARY

The invention may include any of the following aspects in various combinations and may also include any other aspect described below in the written description or in the attached drawings.

In a first aspect, a medical device is provided that improves the effectiveness of the jaws in procedures where a wider angular opening of the jaws is necessary for access and grasping of target tissue. The device comprises a drive gear, a first elongate arm, and a second elongate arm. The first elongate arm comprises a first jaw member and a first gear end. The first gear end is intermeshed with the drive gear. The second elongate arm comprises a second jaw member and a second gear end. The second gear end is intermeshed with the drive gear. The first elongate arm and the second elongate arm are each pivotable about the first gear end and the second gear end, respectively. Each of the first elongate arm and the second elongate arm is pivotable between a first closed position and a second open position. The first jaw member and the second jaw are disposed adjacent each other in the first closed position, while the first jaw member and the second jaw member are spaced apart by an angle of about 360° in the second position.

In a second aspect, a medical device is provided. The medical device comprises a drive gear comprising an elongated rack having a longitudinal length. The drive gear further comprises a first gear surface and a second gear surface being opposed to the first gear surface. A plurality of first ribs laterally protrude away from the first gear surface of the elongate rack along the longitudinal length of the drive gear. The plurality of first ribs define a first plurality of slots therebetween, A plurality of second ribs laterally protrude away from the second gear surface of the elongate rack along the longitudinal length of the drive gear. The plurality of second ribs define a second plurality of slots therebetween. The device also includes a first elongate arm and a second elongate arm. The first elongate arm comprises a first jaw member and a first gear end, the first gear end comprising a first plurality of teeth pivotally connected within the distal end of the housing at a first pivot point, wherein the first plurality of teeth are engaged with the plurality of the first slots of the drive gear. The second elongate member comprises a second jaw member and a second gear end, the second gear end comprising a second plurality of teeth pivotally connected within the distal end of the housing at a second pivot point, the second plurality of teeth engaged with the plurality of the second slots of the drive gear. A housing is also provided. The housing comprises a proximal end, a distal end, and at least one opening extending between the proximal end and the distal end, wherein the housing receives the first and the second elongate arms in a fully open configuration to substantially enclose the arms.

In a third aspect, a method for grasping an object is provided comprising the following steps. A medical device is provided. The device comprises a first elongate arm disposed within a housing and comprises a first jaw member and a first gear end. The first gear end is intermeshed with a drive gear at the distal end of the housing. A second elongate arm is disposed within the housing and comprises a second jaw member and a second gear end intermeshed with the drive gear at the distal end of the housing. The first elongate arm and the second elongate arm are independently pivotable with respect to each other about the first and the second gear ends respectively. Rotation of the first and the second elongate arms controls a spacing between the first jaw member and the second jaw member from about 0° to about 360°. The medical device is advanced to the object, e.g. through a bodily lumen to a target tissue site, with the first jaw member and the second jaw member in a fully open configuration being substantially enclosed within the housing, preferably in a substantially parallel arrangement at about 360° relative to each other. The drive gear is pulled in a proximal direction so as to cause engagement of the drive gear with the first gear end and the second gear end, thereby causing rotation of the first elongate arm in a clockwise direction about the first gear end from a bottom opening of the housing, and rotation of the second elongate arm in a counterclockwise direction about the second gear end from a top opening of the housing. The movement of the arms closes the first and the second jaw members around the object to grasp and retain the object.

DETAILED DESCRIPTION

The terms “proximal” and “distal” as used herein are intended to have a reference point relative to the user. Specifically, throughout the specification, the terms “distal” and “distally” shall denote a position, direction, or orientation that is generally away from the user, and the terms “proximal” and “proximally” shall denote a position, direction, or orientation that is generally towards the user.

An exemplary medical device with pivotable jaws is shown inFIG. 1.FIG. 1shows a perspective view of a medical device100having a first elongate arm110and a second elongate arm120both of which are disposed within a slotted housing130having an opening131sized to substantially enclose the arms110and120. The first elongate arm110and the second elongate arm120are shown substantially parallel to each other in the fully open position, which is shown more clearly inFIG. 2a. As will be explained in greater detail, the device100is designed to allow rotation of the arms110and120and their corresponding jaw members160and170from about 0° to about 180°, thereby enabling a separation angle between the jaw members160and170to range from 0° to about 360°. The terms “about” or “generally” as used herein with reference to relative spacing, generally includes a deviation of plus or minus 15°. For example, in the fully open position of the arms110,120and jaws160,170they may be only spaced apart 300°, yet be substantially or entirely contained within the housing130.

The first elongate arm110in the fully open position is disposed along the bottom portion of opening131of the slotted housing130. The first elongate arm110includes a first gear end111that is pivotally connected by a first pivot pin118along the distal end of the slotted housing130. The first gear end111remains stationary as it intermeshes with a drive gear150, which is disposed between the first gear end111and the second gear end112, as seen more clearly inFIG. 2A. The first elongate arm110further includes a first jaw member160, which is shown disposed within the housing130along the proximal end thereof (FIG. 2a). The jaw member160is shown positioned along an end opposite to the first gear end111.

The second elongate arm120in the fully open position is disposed along the top portion of opening131of the slotted housing130, as can be seen inFIG. 1andFIG. 2a.FIG. 1shows that the second elongate arm120includes a second gear end112, which is pivotally connected by a second pivot pin119along the distal end of the slotted housing130. The second gear end112remains stationary as it intermeshes with the drive gear150. The second elongate arm120includes a second jaw member170, which can be seen inFIG. 1to be disposed within the flexible housing130along the proximal end thereof. The second jaw member170is shown positioned along an end opposite to the second gear end112.

FIG. 2Ashows the first elongate arm110and the second elongate arm120in the fully open position. The fully open position is defined as the elongate arms110and120positioned substantially parallel to each other within a proximal end of the flexible slotted housing130such that the first and second jaw members160and170are spaced apart about 360° relative to each other. Similarly, the fully closed position, as shown inFIG. 2c, is defined as the elongate arms110and120positioned substantially parallel to each other and distally of the distal end of the housing130such that the first and second jaw members160and170are spaced at 0° relative to each other. The mechanism by which the elongate arms110and120rotate from the fully open position (FIG. 2A) to the fully closed position (FIG. 2C) enables a wider range of angular motion of arms110and120relative to conventional medical devices having rotatable members, such as, for example, grasping elements, cutting elements, or biopsy elements. The first elongate arm110and the second elongate arm120are configured to rotate independently of each other. The first elongate arm110is adapted to rotate 180° clockwise relative to a drive gear150(FIG. 2b) and about pivot pin118. The second elongate arm120is adapted to rotate 180 degrees counterclockwise relative to the drive gear150(FIG. 2b) and about pivot pin119. 360° separation relative to each of the arms110and120and their corresponding jaw members160and170is possible with device100(FIG. 2c). The rotation of the arms110and120enables controlled spacing of the jaws160and170from about 0° to about 360° during a procedure that involves grasping tissue.

FIG. 1shows that the slotted housing130contains an opening131that is sufficiently sized to receive the first elongate arm110and the second elongate arm120therewithin. The distal end of the housing130has an opening132which allows the first and the second elongate arms110and120to pivot from the fully open position (FIG. 2a) to the fully closed position (FIG. 2c).

A detailed view of the gear arrangement300used inFIG. 1andFIGS. 2a-2cis shown inFIG. 3. The gear arrangement300includes a drive gear150intermeshed with the first gear end111and the second gear end112. The drive gear150includes an elongated rack151having a first gear surface188and a second gear surface189. A predetermined distal portion of the elongated rack151includes multiple first ribs152which laterally extend or protrude away from the first surface188. A predetermined distal portion of elongate rack151also includes multiple second ribs153which laterally extend or protrude away from a second surface189of the elongate rack151. The spacing between adjacent first ribs152creates multiple first slots192a-ftherebetween, which are sized to receive a corresponding first set of teeth154a-econtained along the outer surface of the first gear end111.192arefers to the most proximal first slot, and192frefers to the most distal first slot. The spacing between adjacent second ribs153creates multiple second slots193a-ftherebetween, which are sized to receive a corresponding second set of teeth155a-econtained along the outer surface of the second gear end112. Note that the second slots193a-fare positioned on the other side of the elongate rack151along back surface189(FIG. 3) and therefore are not visible in the cross sectional views ofFIGS. 2a-2c. Similar designation is used in which193arefers to the most proximal second slot, and193frefers to the most distal second slot. Multiple second slots193a-falong the first surface188of elongate rack151are aligned with multiple first slots192a-falong with second surface189of the elongate rack151.FIG. 3shows that the first set of teeth154a-eextend only along face194of the first gear end111. The second set of teeth155a-eextend only along face195of the second gear end112. Faces194and195are oriented opposite and away from each other to enable drive gear150to sufficiently engage with both the first set of teeth154of first gear end111and the second set of teeth155of the second gear end112. In other words, the teeth154and155may be longer than conventional teeth in gear arrangements to enhance mesh engagement of the teeth154a-eand155a-ewithin their respective slots192a-fand193a-falong the drive gear150. The meshed engagement of teeth154a-eand155a-ewithin their respective slots192a-fand193a-fis designed to be possible even when the overall profile of the device100must be substantially reduced to about 20 Fr or smaller, as is generally required for endoscopic procedures. On the contrary, conventional gear arrangements at such small diameters may need to utilize a drive gear having relatively shallow vertical indentations or grooves that engage with shorter teeth along the gear ends of the elongate arms. Such a gear design may be problematic as slippage between the teeth and the vertical grooves of the drive gear may occur due to the need to reduce the overall profile of the device. Accordingly, the above described gear arrangement300may be significantly less prone to slippage as the overall profile of the device is required to be reduced.

Variations to the above described gear arrangement300are contemplated. The gear arrangement300described above may be modified such that the rack151may only include a single set of laterally extended slots shared by both sets of teeth154a-eand155a-e. In particular, a single set of ribs may extend along one of the surfaces188and189of rack151. Lateral slots would be created between the ribs, and the slots may be sized to receive both sets of teeth154a-eand155a-e.

The mechanism by which the first elongate arm110and the second elongate arm120rotate will be explained in conjunction withFIGS. 2a-2c.FIG. 2ashows that first elongate arm110and the second elongate arm120are in the fully open position within the flexible housing130. In particular, the outermost tooth154aof the first gear end111is shown engaged with corresponding proximal-most slot192a. The outermost tooth155aof second gear end112is shown engaged with corresponding proximal-most slot193aof drive gear150. The configuration of tooth154awith corresponding slot192aand tooth155awith corresponding slot193aenables the first and the second jaw members160and170to be oriented at 360° relative to each other within the proximal end of the flexible housing130(FIG. 2a).

A control handle190as shown inFIG. 1may be used to actuate the drive gear150. In particular, a distal end of a drive wire175connects to a proximal end176of drive gear150(FIG. 2a). Drive wire175is actuated by control handle190. A proximal end of the drive wire175connects to the control handle190. It should be understood that other configurations of control handle190can be employed to actuate drive wire175. For example, the control handle190may be a scissors-type handle, a pin vise, or any other conventional handle suitable for moving a drive wire175relative to a sheath196. Although the term “wire” is used to describe the elongate control member175, the member may be formed from any material (i.e. metals, alloys, plastics, ceramics) and includes any elongate structure capable of longitudinal force transmission over typical endoscope and/or laparoscopic distances, including single filament or multifilament wires, stylets, tubes, catheters, plastic rods or strands, and the like.

The sheath196may be a tubular member. The sheath196has a lumen which houses a drive wire175, the drive wire175connecting at its distal end to the drive gear150and at its proximal end to a control handle190. The sheath196allows connection of the drive wire175from the proximal end of the drive gear150to the spool192, which will be explained in greater detail below. The distal end of sheath196is affixed to the proximal end of housing130, and the proximal end of sheath196is affixed to control handle190. The sheaths196may range in length from about 160 cm to about 220 cm. The sheath196is a flexible tubular member and may be formed from any semi-rigid polymer. For example, the sheath196can be formed from polyurethane, polyethylene, tetrafluoroethylene, polytetrafluoroethylene, perfluoalkoxl, fluorinated ethylene propylene, or the like. Other structures that can house the drive wire175are contemplated. For example, the sheath196may be a wound coiled spring.

Control handle190includes a stem191and a spool192. Stem191includes a lumen through which drive wire175is disposed therewithin. Spool192is slidably engaged with stem191, and spool192is operably connected to the drive wire175. Spool192is provided with a range of slidable motion along stem191. Thus, movement of the spool192in a proximal direction relative to the stem191causes drive wire175to proximally move relative to the sheath196. The movement causes a tensile force to be transmitted to the drive wire175. The drive wire175subsequently exerts a pulling force on the proximal end176of the drive gear150to cause the drive gear150to linearly move in the proximal direction, as indicated by the arrow inFIG. 2a. Linear movement of the drive gear150in the proximal direction causes first gear end111to rotate about pivot pin118in a clockwise direction, as shown by the arrow about first gear end111, thereby causing first elongate member110to rotate in a clockwise direction. The linear movement of the drive gear150in the proximal direction also causes the second gear end112to rotate about pivot pin119in a counterclockwise direction, as shown by the arrow about second gear end112, thereby causing second elongate member120to rotate in a counterclockwise direction.

FIG. 2bshows that the first gear end111has rotated clockwise a sufficient amount to disengage the outermost spoke154aof the first set of teeth154from slot192asuch that first spoke154bengages within corresponding first slot192b. Second gear end112has rotated counterclockwise a sufficient amount to disengage the outermost second spoke155afrom slot193asuch that second spoke155bengages within corresponding slot193b.FIG. 2bshows that during the engagement, the teeth154and155of the first and second gear ends111and112are projected substantially vertically with the corresponding lateral slots192and193of the rack151. The net result is that the first elongate arm110has rotated from the bottom of housing130approximately 45 degrees in a clockwise direction, and the second elongate arm120has rotated from the top of housing130approximately 45 degrees in a counterclockwise direction, as shown inFIG. 2b.

FIG. 2bshows that the drive gear150continues to be pulled in a proximal direction which will cause the first gear end111to further rotate in a clockwise direction such that first spoke154bis disengaged from corresponding first slot192band thereafter first spoke154cof first gear end111engages within corresponding slot192cof drive gear150. Such movement causes the first elongate arm to move an additional 45 degrees in the clockwise direction, thereby creating about 90° total movement from the fully closed position ofFIG. 2a. Similarly, pulling drive gear150in the proximal direction causes the second gear end112to further rotate in a counterclockwise direction such that the second spoke155bis disengaged from corresponding second slot193band thereafter second spoke155cof second gear end112engages within corresponding slot193cof the drive gear150. This movement causes the second elongate arm120to move an additional 45° in the counterclockwise direction, thereby creating about 90° total movement from the fully open position ofFIG. 2a.

The handle190may be pulled in the proximal direction until the first and the second elongate arms110and120have rotated 180° such that jaw members160and170are fully closed, as shown inFIG. 2c. The tip of jaw member160is in contact with the tip of jaw member170.FIG. 2cshows that the first elongate arm110has been rotated 180 degrees in the clockwise direction from the open position ofFIG. 2a. The second elongate arm120has been rotated 180° in the counterclockwise direction from the open position ofFIG. 2a. The gear arrangement300in the fully closed position shows that the first spoke154eis engaged within corresponding first slot192e, and the second spoke155eis engaged within corresponding second slot193e. Such a wider range of movement of the jaw members160and170may enable the jaw members160and170to access and capture target tissue that may not typically be possible with conventional jaw members, which can only undergo a limited range of motion. Additionally, the ability for elongate arms110and120to be extended in the fully open positionFIG. 2cand be separated 360° from each other may enable a larger amount of tissue to be captured compared to conventional medical jaw devices.

In the above described embodiment ofFIGS. 2a-2c, the first set of teeth and the second set of teeth were not required to extend completely around their respective gear ends111and112, as each meshed engagement and subsequent disengagement of a single spoke with a corresponding slot created 45 degrees of rotational movement. As a result, five teeth were required to create about 180° movement of the first and the second elongate members110and120. More than 5 teeth may be used in the gear arrangement300to decrease the incremental rotation created from meshed engagement-disengagement of a spoke and corresponding slot. Alternatively, less than 5 teeth may be used to increase the incremental rotation. The exact number of teeth around each of the gears may depend, in part, on the type of procedure into which device100is being utilized and the size constrains associated with such a procedure. Preferably, a sufficient number of teeth and corresponding slots are provided so as to allow about 180° movement of the first and the second elongate arms110and120.

It should be understood that the above described mechanism for opening and closing jaw members160and170can be used for any type of jaw member, including but not limited to graspers, biopsy cups, scrapers, and scissors. In one example, the jaw mechanism and design as described above may be used for clips having detachable distal ends which may remain in a patient and mechanically maintain compression on a target structure after the particular procedure is completed. Inner surfaces of the jaw members160and170may include serrated features for enhancing the ability to severe tissue. The exact structure of the jaws members160and170may be dependent upon a variety of factors, including the particular application for the device100.

Additional variations to the gear arrangement300(FIG. 3) described in conjunction withFIGS. 2a-2care also contemplated.FIG. 4shows an example of an alternative gear arrangement400. The central drive gear410includes a first set of grooves412a-ewhich engage with corresponding teeth454a-eof a first gear440. The drive gear410also includes a second set of grooves411a-ewhich engage with corresponding teeth455a-eof a second gear450. Unlike the rectangular slots192a-fand193a-fwhich are created along opposing sides of the elongate rack151(FIG. 3), the grooves411a-eare created along a top surface of an elongate member490of the drive gear410, and the grooves412a-eare created along a bottom surface of elongate member490. In the example ofFIG. 4, each of five teeth454a-eengage and subsequently disengage with corresponding grooves412a-e, and each of five teeth455a-eengage and subsequently disengage with corresponding grooves411a-e. Such meshed arrangement allows first elongate arm421to rotate clockwise from the bottom opening of housing130and second elongate arm420to rotate counterclockwise from the top opening of housing130. Each of the elongate arms420and421are capable of rotating 180 degrees from their open position as shown inFIG. 4.

FIG. 5shows that a stopper element510may be disposed along the distal end of the drive gear410to prevent the drive gear410from proximally moving beyond the first gear end111and the second gear end112so as to disengage therefrom. The stopper element510is shown to have a length greater than the spacing between adjacent teeth454a-eof first elongate arm421and adjacent teeth455a-eof second elongate arm420, thereby preventing stopper element510from engaging into the openings defined by the spacing of adjacent teeth454a-eand455a-e. Accordingly, no further rotation of the first gear end440and the second gear end450may be possible when the stopper element510is abutted against the first and the second gear ends440and450. Preferably, the stopper element510is placed distally of the most distal slot or groove of the drive gear150along the distal portion of the elongate member490.

The flexible slotted housing130preferably has a longitudinal length sufficient to house and substantially the first and the second elongate arms110and120in their fully open position as shown inFIGS. 1,2,4, and5. Specifically, the housing130preferably has a top and bottom opening131which is sized to receive elongate members110and120. The distal end of the housing130also contains an opening132to enable a complete range of rotation of the members110and120. The housing130is preferably made from any flexible polymeric material known in the art. As a result, the flexibility of the housing130may allow the device100to be navigated through an accessory channel of an endoscope and tortuous body lumens. Additionally, because the elongate members110and120and corresponding jaw members160and170are completely embedded within a flexible slotted housing130during advancement to a target tissue site, the embodiments described herein may not be limited by a maximum length of elongate members110and120, as may be likely with conventional medical devices having jaws. Such conventional medical devices tend to have elongate members which are too rigid to traverse tortuous bends as well an accessory channel of an endoscope. Accordingly, the length of such conventional elongate members often needs to be shortened to facilitate advancement through tortuous bends. The present embodiments as described herein, however, may enable longer elongate members110and120to be introduced into the accessory channel of the endoscope and subsequent tortuous body lumens. The longitudinal length of elongate members110and120as contemplated herein may be about 0.5 inches (12.7 millimeters) or greater.

One exemplary method of using the device100involves an endoscopic procedure. An endoscope is advanced through an esophagus and into the gastrointestinal tract of a patient. The device100is introduced into an accessory channel of an endoscope in which the elongate members110and120are in their fully open position as shown inFIG. 1, the jaw members160and170being spaced apart about 360°. The orientation ofFIG. 1creates an overall reduced lateral profile of device100during advancement through accessory channel of the endoscope. The proximal end of the handle assembly190is advanced beyond a distal end of the accessory channel towards a target tissue site T (FIG. 2C) so as to advance device100through a bodily lumen to the target tissue site while the first and the second elongate members110and120remain in their open position (FIG. 1). Having reached the target tissue site, the first elongate arm110with jaw member160is rotated from the bottom opening131of housing130in a clockwise direction and the second elongate arm120with jaw member170is rotated from the top opening of housing130in a counterclockwise direction. Such rotational movement is shown inFIG. 2b. The rotational movement is preferably achieved utilizing the gear arrangement300discussed above in conjunction withFIG. 3. Depending on the sizes of the body lumen and the location of target tissue, the arms110and120may be rotated in the fully closed position, as shown inFIG. 2c. In this particular example, the elongate members110and120are rotated about 180° in the configuration ofFIG. 2csuch that corresponding jaw members110and120may close around the tissue to grasp the target tissue. The optional stopper element510(FIG. 5) may be utilized to prevent the drive gear150from being proximally pulled back beyond the first and second gear ends111and112, thereby preventing disengagement of drive gear150from the gear ends111and112.

Having grasped the target tissue, the drive gear150is pushed in the distal direction as shown by the arrow inFIG. 2c. Movement of drive gear150in the distal direction causes meshed engagement of the drive gear150with the first gear end111so as to rotate the first gear end111and the first elongate arm110in the counterclockwise direction, as shown by the arrow about arm110inFIG. 2c. The drive gear150is also in meshed engagement with the second gear end112so as to rotate second gear end112and second elongate arm111in the clockwise direction, as shown by the arrow about arm120inFIG. 2c. The drive gear150may continue to be pushed in the distal direction until first elongate arm110and second elongate arm120are rotated back into the fully open position, as shown inFIG. 2a.

Although not shown, an additional proximal stopper element similar to distal stopper element510(FIG. 5) may be disposed proximal of the most proximal slot or groove of the drive gear150(FIG. 5) along the distal portion of the elongate rack151. The proximal stopper element would have a length greater than the spacing between adjacent teeth454a-eof first elongate arm421and adjacent teeth455a-eof second elongate arm420(FIG. 5) to prevent the proximal stopper element510from engaging into the openings defined by spacing of adjacent teeth454a-eand455a-e. Accordingly, no further rotation of the first gear end111and the second gear end112may be possible when the proximal stopper element is abutted against the first and the second gear ends111and112. Having a pair of stopper elements in such a configuration along elongate rack151of drive gear150reduces the risk of disengagement of the drive gear150from the first and second gear ends111and112during either proximal pulling of drive gear150(i.e., to open the arms110and120out from housing130) or distal pushing of drive gear150(i.e., to close the arms110and120into housing130).

As can be seen, unlike conventional grasping medical devices, the above described method of use involves delivering the device100with the elongate members110and120positioned in a fully open configuration (FIG. 2a) and completely disposed within the housing130during delivery. The sharp jaws160and170in their fully open configuration during delivery remain protected by being encapsulated within housing130. Because conventional devices allow the jaw member to remain exposed, there may be a greater risk of the exposed jaw inadvertently contacting tissue that causes trauma to the patient during a procedure. Such risk is significantly eliminated with the above described device100.

It will be recognized by those skilled in the art that, while the devices and methods described above generally include operating on tissue through an internal bodily lumen, it will be recognized that the systems, devices and methods may be used on any object (e.g. to retrieve small pieces from hard to reach places, such as a lost ring in a drain or other household plumbing) or on any layer of material (e.g. fabrics, cloth, polymers, elastomers, plastics and rubber) that may or may not be associated with a human or animal body and a bodily lumen. For example, the systems, devices and methods can find use in laboratory and industrial settings for manipulating one or more layers of material that may or may not find application to the human or animal body.

While preferred embodiments of the invention have been described, it should be understood that the invention is not so limited, and modifications may be made without departing from the invention. The scope of the invention is defined by the appended claims, and all devices that come within the meaning of the claims, either literally or by equivalence, are intended to be embraced therein. Furthermore, the advantages described above are not necessarily the only advantages of the invention, and it is not necessarily expected that all of the described advantages will be achieved with every embodiment of the invention.