Abstract:
An endoscope ( 1000 ) comprising a flexible elongated solid body ( 110 ) comprising cavities wherein at the distal portion of the body there is a section with greater flexibility than other portions of the body, for enabling an operator to steer the head ( 200 ) along twists and convolutions and a stiffening mechanism ( 480 ) for hardening at least a portion of the body.

Description:
FIELD OF THE INVENTION  
       [0001]     The invention relates to an intra-corpus imaging instrument.  
       BACKGROUND TO THE INVENTION  
       [0002]     Endoscopes are used for a variety of examinations and treatments in lumens in the body. For example, colonoscopes and gastroscopes for the digestive system, bronchoscopes for the respiratory system, etc.  
         [0003]     Endoscope units often comprise two parts: an inserted part, which penetrates into the body lumen, and a handle, which is used by the doctor to hold and control the unit.  
         [0004]     The inserted part comprises a long, flexible trunk coming out of the handle, followed by gimbals topped by the head. The gimbals enable the head to turn in any direction for steering the unit. The head comprises a vision system as well as various ingresses and egresses for operating the unit and for operating various medical systems via the unit. For example, the head can include lenses for viewing, light sources for illuminating the field of view, and apertures for delivering various materials and instruments, such as liquids to clean the lens, liquids to distend the lumen, fluoroscopes, sampling devices, and therapeutic devices. The inserted part comprises several thin canals leading to the apertures, as well as a connection to the lenses and a power connection for the light sources. The connection to the lenses can comprise a fiber optic cable to carry the image or, if the lens is provided with CCD circuitry to convert the image to data, a data link.  
         [0005]     The unit also houses steering cords connected to controls on the handle that enable a user to steer the endoscope by retracting or extending the cords. The steering cords run to the head of the endoscope, where the gimbals enables the head to be steered in any direction, thereby enabling the doctor to steer the unit.  
         [0006]     Insertion and retraction of the unit is usually done manually by the doctor who physically pushes the trunk into the body lumen, steering by means of the handle.  
         [0007]     Ancillary equipment connected to the proximal end of the endoscope unit are collectively referred to as a workstation and can include:  
         [0008]     1. Water pump system.  
         [0009]     2. Compressor for air pressure.  
         [0010]     3. Electrical power supply for light.  
         [0011]     4. Image processing unit.  
         [0012]     5. Vacuum pump.  
         [0013]     The ancillary equipment connects to the endoscope via tubes and cables. Therefore an improved endoscope can be connected to an existing workstation by use of an adaptor that interfaces between the workstation connections and the endoscope connections.  
         [0014]     Existing endoscopes are built for repeated use and therefore must be cleaned and disinfected between uses. This is an expensive time-consuming task. As a corollary, to ensure that a clean endoscope is available at all times, a stock of endoscopes must be maintained, since at any given time some of the endoscopes may not be ready for reuse. It would be preferable to provide a disposable, sterile endoscope. Existing endoscopes are too expensive to be disposable.  
         [0015]     Existing endoscopes also have a high amortization rate caused by bending that breaks interior parts of the endoscope, by chemicals used in the cleaning of the system that attack the lenses, and by liquids that eventually infiltrate the electronic components of the device. Endoscope repair is typically very expensive. On average, an endoscope goes out of service within a thousand uses.  
         [0016]     The present invention provides an economical mass produced design, enabling the endoscope to be disposable. The trunk, gimbals, and head are all mass-produced, for example with extruded plastic.  
         [0017]     In one embodiment, the gimbals comprise a series of links interconnected by cardan joints, perforated for passage of internal tubes and cables and connected to one another by two opposed thin hinges (cardan joint), with the hinges on every other pair of disks situated at 90 degrees to the hinges of the previous disk pair. In this configuration, navigational control wires running from the handle to the head of the device can be pulled and released to steer the head, the gimbals providing freedom of movement in any direction.  
         [0018]     In an alternative embodiment, the gimbals consist of a simple convoluted tube comprising thicker inner rings alternating with thinner outer rings, wherein the outer rings provide the required freedom of movement.  
         [0019]     The typical endoscope is a complex metal device comprising a housing in which each internal cable and tube running from the workstation to the head has its own casing. The need for individual casings is an added expense. A further advantage of using an extruded solid flexible tube for the trunk is that it comprises lumens for the internal cables and tubes, thereby eliminating the need for casings for each individual cable and tube.  
         [0020]     As the endoscope is inserted into the patient, it is desirable to have a means for varying the stiffness of the trunk. For example, when the trunk is starting to go through a sharp curve, it is desirable to increase stiffness (sacrificing flexibility) in order to prevent the trunk from buckling from opposing forces generated by the insertion force on the one hand and the resistance on the head on the other hand.  
         [0021]     It is therefore desirable to have a user-controlled stiffening element for the trunk. The stiffening element could be a cable pulling on the steering cables thereby compressing the trunk, additional separated cable or cables, wires inserted into the trunk to directly impart stiffness, or a fluid (liquid or gas) inserted into the trunk to directly impart stiffness.  
         [0022]     Manual insertion of the endoscope is not always the best method since it can accidentally cause internal punctures in the body. It is therefore desirable to have alternative means of driving the head. There are several possibilities, including pumping a stream of liquid against the inside of the head or mechanically imparting linear motion on the trunk, for example by rollers or other auxiliary propelling device.  
         [0023]     Another problem associated with endoscopes is providing maximum size and number of access channels in the tube. One of the limiting factors is the geometries of the channel cross sections, particularly at the distal end of the endoscope), which are normally circular in shape. A better use of space can be achieved by varying the cross-sectional shape of these elements according to the needs of the particular application. For example, if a larger diameter tool channel is required, the cleaning water channel can be made crescent-shaped to accommodate the area needed for the tool channel. In other words, instead of just circular, the cross sectional shape of the channel can be other geometrical or any other shape—referred to herein as polymorphic.  
         [0024]     Another problem associated with endoscopes is that the viewing lens must be kept a minimum distance from the wall of the lumen to avoid occlusion of the lens. This can be prevented by covering the lens with a cover, which may be a cap incorporated with the lens assembly or a separate cap.  
         [0025]     Another problem associated with endoscopes is that the intensity of the light sources used for illuminating the device&#39;s viewing field and in the fluoroscope is fixed. This can be improved with the addition of an adjustable power control, such as a rheostat to the light sources.  
         [0026]     Accordingly, several objects and advantages of preferred embodiments of the present endoscope invention are (some features are optional): 
        low cost disposable and sterile     mass produced from an inexpensive material     head, gimbals, and/or trunk are produced cheaply enough to justify making the unit disposable.     head, gimbals, and/or trunk are produced employing injection molding or extrusion or other manufacturing method.     head, gimbals, and/or trunk are connected together with simple pressure-fit connector or manufactured as one piece     propelled by manual insertion, liquid pressure, or drive wheel     user-controlled trunk stiffness (complete or partial) by tensioning steering cords, inserting reinforcing fluid, or inserting reinforcing wires     cross-sectional shapes and areas of the channels running through the trunk and their outlets in the head are adjusted as necessary to achieve the most efficient footprint.     lenses are protected by a cap     the intensity of the light sources is user-controlled     CCD (or CMOS or other imaging device) is placed substantially perpendicular to or inclined with respect to the line of sight so that its side faces the head, and a mirror under the lens redirects the viewed image onto the CCD at the correct angle, thereby maintaining minimum CCD footprint.     the drive-control handle is reusable     an adapter connects the endoscope to a workstation (which may be of any existing make).        
 
       BRIEF DESCRIPTION OF THE INVENTION  
       [0040]     There is thus provided, in accordance with some preferred embodiments of the present invention, an endoscope for use in connection and combination with controls and a workstation, the endoscope for inserting into a body lumen to diagnose or treat a medical condition, the endoscope comprising:  
         [0041]     flexible elongated solid body having a proximal portion and a distal portion with a head, the body comprising cavities provided for passing to or from the head materials, data connections, power connections, or instruments, wherein at the distal portion of the body there is a section with greater flexibility than other portions of the body, for enabling an operator to steer the head along twists and convolutions in the lumen; and  
         [0000]     a stiffening mechanism for hardening at least a portion of the body, so as to allow hardening of said at least a portion of the body during navigation of the endoscope within the body lumen.  
         [0042]     Furthermore, in accordance with some preferred embodiments of the present invention, the stiffening mechanism comprises one or more cables, connected to the head or other parts of the body, which when pulled effectively stiffen said at least a portion of the endoscope.  
         [0043]     Furthermore, in accordance with some preferred embodiments of the present invention, the stiffening mechanism comprises at least one elongated insert for insertion into a cavity and provide added stiffness to said at least a portion of the endoscope.  
         [0044]     Furthermore, in accordance with some preferred embodiments of the present invention, the stiffening mechanism comprises at least one cavity for filling with a fluid.  
         [0045]     Furthermore, in accordance with some preferred embodiments of the present invention, the fluid comprises liquid.  
         [0046]     Furthermore, in accordance with some preferred embodiments of the present invention, the fluid comprises gas.  
         [0047]     Furthermore, in accordance with some preferred embodiments of the present invention, the endoscope is further provided with a reservoir for containing the fluid and providing it when desired.  
         [0048]     Furthermore, in accordance with some preferred embodiments of the present invention, the cross-sections of at least some of the cavities are circular.  
         [0049]     Furthermore, in accordance with some preferred embodiments of the present invention, the cross-sections of at least some of the cavities are polygonal.  
         [0050]     Furthermore, in accordance with some preferred embodiments of the present invention, the cross-sections of at least some of the cavities are amorphous.  
         [0051]     Furthermore, in accordance with some preferred embodiments of the present invention, the cross-sections of at least some of the cavities are characterized as lacking symmetry.  
         [0052]     Furthermore, in accordance with some preferred embodiments of the present invention, the section with greater flexibility comprises a plurality of links interconnected by cardan joints.  
         [0053]     Furthermore, in accordance with some preferred embodiments of the present invention, the section with greater flexibility comprises a concatenated section.  
         [0054]     Furthermore, in accordance with some preferred embodiments of the present invention, the endoscope is further provided with an auxiliary propelling unit for coupling with and propelling the endoscope.  
         [0055]     Furthermore, in accordance with some preferred embodiments of the present invention, the auxiliary propelling unit is operable manually.  
         [0056]     Furthermore, in accordance with some preferred embodiments of the present invention, the auxiliary propelling unit is motor-operated.  
         [0057]     Furthermore, in accordance with some preferred embodiments of the present invention, at least some of the cavities with outlets at external surfaces of the distal portion facilitating exit of jets of fluid from the outlets thus providing jet propulsion to the endoscope.  
         [0058]     Furthermore, in accordance with some preferred embodiments of the present invention, the body is made of several separate parts, that are connectable.  
         [0059]     Furthermore, in accordance with some preferred embodiments of the present invention, the parts are provided with snap connectors for fast connection.  
         [0060]     Furthermore, in accordance with some preferred embodiments of the present invention, cords are further provided, inserted through at least some of the cavities, each cord connected to the head, thus enabling manipulating orientation of the head by pulling one or more cords.  
         [0061]     Furthermore, in accordance with some preferred embodiments of the present invention, there is provided an endoscope for use in connection and combination with controls and a workstation, the endoscope for inserting into a body lumen to diagnose or treat a medical condition, the endoscope comprising:  
         [0062]     flexible elongated solid body having a proximal portion and a distal portion with a head, the body comprising cavities provided for passing to or from the head materials, data connections, power connections, or instruments, wherein at the distal portion of the body there is a section with greater flexibility than other portions of the body, for enabling an operator to steer the head along twists and convolutions in the lumen; and  
         [0063]     an orientation control mechanism for controlling the orientation of the head, comprising at least one of a plurality of cords passing through at least one of the cavities and connected to the distal portion, allowing manipulating of the orientation of the head by pulling or releasing some or all of the cords.  
         [0064]     Furthermore, in accordance with some preferred embodiments of the present invention, there is provided an endoscope for use in connection and combination with controls and a workstation, the endoscope for inserting into a body lumen to diagnose or treat a medical condition, the endoscope comprising:  
         [0065]     flexible elongated solid body having a proximal portion and a distal portion with a head, the body comprising a solid body provided with a plurality of cavities for passing to or from the head materials, data connections, power connections, or instruments, wherein at the distal portion of the body there is a section with greater flexibility than other portions of the body, for enabling an operator to steer the head along twists and convolutions in the lumen.  
         [0066]     Furthermore, in accordance with some preferred embodiments of the present invention, there is provided an endoscope for use in connection and combination with controls and a workstation, the endoscope for inserting into a body lumen to diagnose or treat a medical condition, the endoscope comprising:  
         [0067]     flexible elongated solid body having a proximal portion and a distal portion with a head, the body comprising cavities provided for passing to or from the head materials, data connections, power connections, or instruments, wherein at the distal portion of the body there is a section with greater flexibility than other portions of the body, for enabling an operator to steer the head along twists and convolutions in the lumen; and  
         [0068]     an auxiliary propelling device, adapted to be engaged to the flexible elongated solid body, and help in advancing and maneuvering the endoscope in the body lumen.  
         [0069]     Furthermore, in accordance with some preferred embodiments of the present invention, the auxiliary propelling device comprises a mechanical mechanism operable manually.  
         [0070]     Furthermore, in accordance with some preferred embodiments of the present invention, the auxiliary propelling device comprises a motor-operated mechanical mechanism.  
         [0071]     Furthermore, in accordance with some preferred embodiments of the present invention, there is provided an endoscope for use in connection and combination with controls and a workstation, the endoscope for inserting into a body lumen to diagnose or treat a medical condition, the endoscope comprising:  
         [0072]     flexible elongated solid body having a proximal portion and a distal portion with a head, the body comprising cavities provided for passing to or from the head materials, data connections, power connections, or instruments, wherein at the distal portion of the body there is a section with greater flexibility than other portions of the body, for enabling an operator to steer the head along twists and convolutions in the lumen, further provided with cavities with outlets located externally on the flexible elongated solid body, so as to facilitate jets of fluid, when such fluid is pressurized into the cavities, for jet propulsion of the endoscope.  
         [0073]     Furthermore, in accordance with some preferred embodiments of the present invention, there is provided a method for manufacturing an endoscope having a flexible elongated solid body, the body having a proximal portion and a distal portion with a head, the body comprising cavities in the form of a plurality of channels running through it and provided for passing to or from the head materials, data connections, power connections, or instruments, comprising manufacturing the elongated body in extrusion.  
         [0074]     Furthermore, in accordance with some preferred embodiments of the present invention, the method further comprises manufacturing the head employing casting.  
     
    
     BRIEF DESCRIPTION OF THE FIGURES  
       [0075]      FIG. 1  illustrates an endoscope in accordance with a preferred embodiment of the present invention.  
         [0076]      FIG. 2A  illustrates in section view, a connector component for connecting primary components of an endoscope in accordance with a preferred embodiment of the present invention.  
         [0077]      FIG. 2B  illustrates in greater detail the connector of  FIG. 2A .  
         [0078]      FIG. 3  illustrates in side section view the viewing components in the head of an endoscope in accordance with a preferred embodiment of the present invention.  
         [0079]      FIG. 4  illustrates in top view the distal end of an endoscope in accordance with a preferred embodiment of the present invention.  
         [0080]      FIG. 5A  illustrates in isometric view, steering controls and stiffening controls of an endoscope in accordance with a preferred embodiment of the present invention.  
         [0081]      FIG. 5B  illustrates in side section view, components for stiffening the endoscope trunk by tensioning of the steering cords in accordance with a preferred embodiment of the present invention.  
         [0082]      FIG. 6  illustrates in side section view, components for stiffening the endoscope trunk by pumping in fluids in accordance with an alternative preferred embodiment of the present invention.  
         [0083]      FIG. 7  illustrates in side section view, components for stiffening the endoscope trunk by insertion of reinforcing cables in accordance with an alternative preferred embodiment of the present invention.  
         [0084]      FIG. 8  illustrates in side section view a fluid-propulsion mechanism for an endoscope in accordance with a preferred embodiment of the present invention.  
         [0085]      FIG. 9A  illustrates in side view a mechanical propulsion mechanism for an endoscope in accordance with an alternative preferred embodiment of the present invention.  
         [0086]      FIG. 9B  illustrates the propulsion mechanism of  FIG. 8A  in isometric view.  
         [0087]      FIG. 10A  illustrates in isometric view gimbals (with the outer shell removed) of an endoscope in accordance with a preferred embodiment of the present invention.  
         [0088]      FIG. 10B  illustrates in detail the section shown in  FIG. 9A .  
         [0089]      FIG. 10C  illustrates in section view, the gimbals of  FIGS. 9A and 9C .  
         [0090]      FIG. 11  illustrates in isometric view alternative gimbals in accordance with an alternative preferred embodiment of the present invention.  
         [0091]      FIG. 12A  illustrates in top section, the trunk of an endoscope in accordance with a preferred embodiment of the present invention.  
         [0092]      FIG. 12B  illustrates the two side section views indicated in  FIG. 12A . 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0093]     The present invention is an endoscope for working inside lumens of a patient&#39;s body. The proximal end of the endoscope is normally connected to a workstation, which can comprise various ancillary devices, such as water pump, air compressor, electrical power supply etc.  
         [0094]      FIG. 1  is a general view of the endoscope  1000  of the present invention with trunk  100  having a distal end (or head)  200  and proximal end  150 . The length of trunk  100  depends on the desired maximum insertion distance, typically several meters. In  FIG. 1 , omitted portions of trunk  100  are indicated by a dashed curved line. Head  200  is inserted into a patient&#39;s lumen and comprises components for viewing and openings for injecting and withdrawing materials and devices. Head  200  can be steered by an operator by various means as are known in the art. In a preferred embodiment of the present invention, steering is accomplished by retracting and releasing cables passing through trunk  100  and gimbals  700  and attached to head  200 . Head  200  is mounted on gimbals  700 , which enables it to be steered freely in any direction. Trunk  100  is flexible enough to follow head  200  and gimbals  700 .  
         [0095]     In a preferred embodiment of the present invention shown in  FIG. 1 , proximal end  150  is part of a handle  400  with controls whereby an operator controls steering of and insertion/removal of head  200  into/from the patient&#39;s lumen and whereby the operator inserts and removes materials, connections, and instruments (such as a fluoroscope) to/from channels running through trunk  100  and gimbals  700  to head  200 . The materials can be various states of matter (e.g., gas, liquid, solid); the connections can be various types including power supply for a viewing light or data link for receiving viewing data; the instruments can include sampling probes, fluoroscopes, therapeutic devices, and other medical instruments. It will be recognized by one skilled in the art that the user-control interface provided by handle  150  can be implemented in various ways without affecting the primary innovations of the present invention. Thus, for example, the controls could be implemented on a stationary box, rather than a handle. Handle  400  is optional.  
         [0096]     The precise use, location, and existence of these controls and ingress points is not critical to the novelty and innovation of the current patent. They are provided for reference, and can include: 
        Ingress  120  for power for navigation light source, for fluoroscope light source, and for other electrical components.     Egress  130  for vacuuming out liquids     Optional interface to existing workstation  150      Ingress  160  for fluids for cleaning lens at distal end     Conduit  180  for data connections     Conduit  190  for inserting diagnostic and therapeutic instruments.     Control  420  for governing stiffness of trunk  100      Steering controls  440  and  441         
 
         [0105]     In a preferred embodiment of the present invention, the power  120  for the navigation light source and/or the fluoroscope light source can be equipped with a rheostat, so that the operator can control the intensity of the light.  
         [0106]     In a preferred embodiment of the present invention, several components of the invention are separate pieces connected  102  together. These separate pieces include handle  400 , trunk  100 , gimbals  700 , and head  200 . Alternatively, all or some of these pieces can be manufactured as a single unit.  
         [0107]      FIG. 2A  and  FIG. 2B  illustrate a connection point  102  with a connector  810  that can be used for fast, one-time connection of the pieces. Connector  810  comprises a barbed plug inserted into the adjacent ends of each piece.  
         [0108]     One skilled in the art will realize that there are many other types of connectors that can be used to connect the parts. For example, in an alternative preferred embodiment of the present invention, the handle is reusable while the trunk, gimbals and head are disposable. In that embodiment, a reusable lock ring can be used to connect the handle to the trunk, while barbed one-time plugs connect the trunk to the gimbals and the gimbals to the head.  
         [0109]     The present invention can be manufactured using inexpensive mass production, for example extruded plastic, in which case it can affordably used as a one-time, disposable device. Alternatively, it can be adapted to include both disposable and reusable pieces. For example, handle  400  could be reusable and connected to disposable trunk  100 , gimbals  700 , and head  200 .  
         [0110]      FIG. 3  illustrates in side section view, the viewing components in the head  200  of an endoscope  1000  in accordance with a preferred embodiment of the present invention.  
         [0111]     An innovation of the present invention is provided by protective cap  210  covers viewing lens  220 , with a gap between the two. Protective cap  210  ensures that if lens  220  is pushed into contact with another object, such as the wall of the lumen, that the gap between cap  220  and lenses  210  maintains depth of field, keeping the image in focus and preventing occlusion by the object. Protective cap  210  is made of translucent, durable material, such as plastic.  
         [0112]     Another innovation of the present invention is provided by a light-bending component  230 , such as a mirror or prism, which reflects images received through lens  220  at a 90 degree angle to CCD component  231 , thereby enabling CCD  231  and its related electronics to be installed on its side, such that CCD&#39;s  231  longest dimension lies in parallel with the body of trunk  100 , thereby keeping the area of trunk  100  cross-section taken up by CCD  231  to a minimum, thereby leaving the most space possible for other components such as the channels for inserting and removing materials and instruments.  
         [0113]      FIG. 4  is a top view of head  200 . As shown in the figure, another innovation of the present invention is to vary the cross-sectional shapes and areas of the internal channels  370  used to insert/remove materials/instruments to/from head  200  and of fluoroscope channel  350 . Both these channels are shaped for most efficient use of space. For example, if channel  370  were the traditional round shape, it would take up more area of the cross section, thereby limiting the cross-sectional area of channel  350  and of other channels.  
         [0114]     The figure shows lens cap  310  (same as  210  in  FIG. 2A ), light sources  320  (for example, light emitting diodes—LEDs), and lens cap cleanser dispenser  380 . In a preferred embodiment of the present invention, light sources  320  and fluoroscope  350  are equipped with rheostats at handle  400  so that the operator can control the light intensity.  
         [0115]      FIGS. 5A and 5B  illustrate handle  400  in isometric and section view. In accordance with a preferred embodiment of the present invention, an operator steers head  200  by turning co-axially mounted steering controls (for example knobs)  440  and  441 . Each knob is connected (via axis  460  and  450  respectively) to a pulley ( 461  and  460  respectively) around which loop cords  470  and  471  (respectively), which run from the respective knob, through trunk  100  and gimbals  700  to head  200 . When the knob is turned it pulls one end of the cord and plays out the other end, thereby pulling head  200  back in the direction of the cord end that is being pulled. Cords  470  and  471  are at right angles to one another such that combined adjustment of controls  440  and  441  can turn head in any direction.  
         [0116]     In a preferred embodiment of the present invention, a stiffening mechanism is provided to enable the operator to vary the stiffness of trunk  100 . The reason for this is that at some junctures during insertion, for example when turning head  200  to negotiate curve in the patient&#39;s lumen, it is preferable for the trunk to be more pliant. At other junctures, such as when inserting head  200  further into the lumen, it is preferable for the trunk to be stiffer, thereby preventing it from buckling under the insertion force.  
         [0117]     One embodiment of the stiffening mechanism is shown in  FIGS. 5A and 5B . User control (for example, knob)  427  is attached to a pulley to which is attached one end of a cord  430  which runs through pulley  427  to steering axes  450  and  460 . An operator can adjust the tension of cord  430 , thereby adjusting the tension on axes  460  and  461 , thereby adjusting the tension on cords  471  and  470 , thereby compressing or relaxing trunk  200  and gimbals  700 , to achieve greater or lesser stiffness.  
         [0118]     A stiffening mechanism for an alternative preferred embodiment of the present invention is shown in  FIG. 6 . Stiffening channels  480  run inside trunk  100  (see also  FIG. 12A ). Fluid pump  470  can be operated to insert or remove fluid, thereby controlling stiffness of trunk  100 .  
         [0119]     A stiffening mechanism for another alternative preferred embodiment of the present invention is shown in  FIG. 7 . Again, stiffening channels  480  (see also  FIG. 12A ) run inside trunk  100 . This time the stiffening agent is a wire or rod  490  rather than fluid.  
         [0120]     The present invention also provides several optional mechanisms for inserting the endoscope  1000  into the patient in addition to standard automated or manual drive mechanisms.  
         [0121]     With reference to  FIG. 8 , in a preferred embodiment of the present invention, the insertion mechanism comprises a channel  260  through which a propelling fluid (for example, water) is pumped (illustrated by long arrow in  FIG. 5 ), through trunk  100  and gimbals  700  to propulsion plate  240 . There the fluid streams out the sides through exhaust  245  (shown with small arrows in  FIG. 5 ) into the lumen, from where it is removed through exhaust channel  250 , which is at least one of a plurality of tubes running back along on gimbals  700  and trunk  100 . The force of the fluid on plate  240  drives the endoscope forward. If required, the insertion mechanism can be adapted to enable switching to removal mode, where the exhaust force is directed such that endoscope  1000  can be removed.  
         [0122]     With reference to  FIGS. 8A and 8B , another insertion (and in this case, also removal) mechanism  600  for an alternative preferred embodiment of the present invention features inflatable collar  640  which an operator inflates from bladder  650 , to anchor endoscope  1000  in an orifice leading to the patient&#39;s lumen. For example, in the case of a gastrointestinal exam, collar  640  would anchor endoscope  1000  in the patient&#39;s anus. Once endoscope  1000  is anchored, the operator operates a mechanism that applies linear motion control (for example, a roller)  610  moving trunk  100 . In the roller implementation shown, opposition is provided by opposition rollers  630 . Depending on the direction of rotation of motion mechanism  610 , trunk  100  is either inserted into, or retracted from, the patient.  
         [0123]      FIGS. 10A, 10B , and  10 C illustrate a gimbals  700  for an endoscope in accordance with a preferred embodiment of the present invention.  
         [0124]     Gimbals  700  comprises pairs of disks  702  that enable head  200  to pivot in any direction. Each disk  702  has internal spaces for the passage of materials, instruments, power and data, etc. In addition, each disk  702  has holes  710  spaced evenly around its perimeter (for example, at angles of 0, 90, 180 and 270 degrees from center). Each pair of opposing holes provides passage for the two sides of a steering cord  470  or  471 . The cords terminate at the distal end of the device and are used to steer the device as was described earlier. Disks  702  are “hinged” to each other at two points  720 . The members of the hinge pair are located opposite one another on the disk, each at the point where a hole  710  passes. The bridge pair on one face of a disk is oriented at 90 degrees to the bridge pair on the other face of the disk.  
         [0125]     Operation of steering works as follows. When a steering cord  470  or  471  is retracted by control  440  or  441 , it passes back through its series of holes, pulling back on head  200 . The series of hinges  720  located along the path of the retracted cord act as blocks, preventing the adjoining disks from compressing, however the other series of hinges  720  (oriented at 90 degrees to the cord) function as hinges, allowing the adjoining disks to compress together, thereby causing gimbals  700  to turn in the direction of the retracted cord, thereby turning head  200 .  
         [0126]     Another gimbals  700  mechanism is provided in an alternative preferred embodiment of the present invention, as shown in  FIG. 11 . In this arrangement, simple ridged (“convoluted”) plastic tubing is used, the tubing comprising thinner-walled inner rings alternating with thicker-walled outer rings. When the string is retracted, the thinner inner rings compress along the string&#39;s path, thereby turning head  200 .  
         [0127]     The composition of trunk  100  is now described with reference to  FIG. 12A , which is a top section view, and  FIG. 12B , which comprises the two side section views indicated in  FIG. 12A . Trunk  100  comprises a solid core  110  encompassing channels of various cross-sectional shapes running its length. The channels are intrinsic parts of core  110  and are created as part of the manufacturing process.  
         [0128]     The use of the channels depends on the particular application. In most cases, the channels will be used as follows: 
        tensioning channels  480      steering cord channel  104      video link channel  105      instrument (“working”) channel  106      fluid evacuation channel  107         
 
         [0134]     Trunk core  110  is encompassed in mesh  108 , which prevents torsion of trunk  100 . Mesh  108  is covered with sheath  109 , which creates a smooth surface for reduced friction and protects mesh  108 .  
         [0135]     It should be clear that the description of the embodiments and attached Figures set forth in this specification serves only for a better understanding of the invention, without limiting its scope as covered by the following Claims.  
         [0136]     It should also be clear that a person in the art, after reading the present specification could make adjustments or amendments to the attached Figures and above described embodiments that would still be covered by the following Claims.