Abstract:
Transparent domes useful for covering at least a lens located on a scope&#39;s distal face, taking the form of a single layer membrane affixed to the distal end of the scope, a solid cap attachable to and detachable from the distal end of the scope, or an inflatable and deflatable balloon having an exterior wall for contacting at least the lens at the scope&#39;s distal face. Methods for performing diagnostic or diagnostic and therapeutic procedures within bodily cavities including collapsed intestines using transparent domes and scopes.

Description:
CROSS REFERENCE TO OTHER APPLICATIONS 
       [0001]    This application claims priority of U.S. Provisional Application No. 61/278,970, filed Oct. 15, 2009, the contents of which are hereby incorporated by reference into this application. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates generally to medical imaging systems and, more particularly, to imaging systems for insertion into a lumen of a patient for viewing the lumen through a transparent dome at the tip of the system, and to methods of use of such systems that take advantage of the transparent dome structure, which systems and methods are particularly useful in performing colonoscopies. 
       BACKGROUND OF THE INVENTION 
       [0003]    Colonoscopy is a very common procedure. In the United States snore than 20 million such procedures are done every year. Colonoscopy is a relatively expansive procedure necessitating intravenous sedation to alleviate pain. The cause of pain may be due to several factors, including dilation and stretching of the colon during air insufflations from the colon&#39;s normal collapsed state resembling a collapsed tortuous hose, and including looping out and stretching fire nerve-laden colonic mesentery when a flexible colonoscope is pushed through multiple S-shaped curves in the colon. Some of these curves resemble, from the interior of the colon, a buckled-down hose. Recent studies show that if instead of air insufflations, water is used to open up the lumen, the colon gets stretched out but not as much as when the colon is opened with air, and the patient has mach less pain. Nonetheless, such use of water results in stretching of the colon and pain to the patient. 
         [0004]    Additionally, traditional scopes used in colonoscopies have blunt edges which can damage or perforate the colon. These scopes also lend to cease transmitting a usable image when their distal ends come too close to the wall of the lumen. 
         [0005]    Accordingly, there is a need for devices and methods useful for performing a colonoscopy that require minimal insufflation of the colon, so as to minimize stretching out of the colon and pain to the patient, while at the same time minimizing the chance of damaging or perforating the colon and maintaining a usable image transmission. 
       SUMMARY OF THE INVENTION 
       [0006]    The present invention provides for the needs identified in the foregoing discussion by providing for a transparent dome useful for covering at least a lens located on a scope&#39;s distal face. In different embodiments of the present invention, the dome may comprise a single-layer membrane affixed to the distal end of the scope such that it also covers an air channel for inflating the transparent dome, or it may comprise a solid cap which is attachable to and detachable from the distal end of the scope, or it may comprise a balloon having an exterior wall for contacting at least the lens at the scope&#39;s distal face. 
         [0007]    The present invention also provides for a transparent dome and a scope having a leas located at its distal face to be used by inserting the scope and the transparent dome into a bodily cavity and viewing, through the lens and the transparent dome, at least a portion of the bodily cavity. The present invention also provides for such a transparent dome and scope to be used by inserting the scope into a bodily cavity; using the lens of the scope, identifying a particular lesion of the bodily cavity; based on the identification of the particular lesion, advancing a catheter comprising a deflated transparent dome and a particular therapeutic tip chosen for its ability to treat the particular lesion, through an operative channel of the scope; inflating the transparent dome; and, under vision through the lens and the transparent dome, treating the particular lesion with the particular therapeutic tip of the catheter. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0008]      FIG. 1  shows a first embodiment of a transparent dome according to the present invention in the form of a balloon at the distal end of a scope, the balloon having a flat bottom. 
           [0009]      FIG. 2  shows an additional embodiment of a transparent dome according to the present invention in the form of a balloon at the distal end of a scope, the balloon having an overhanging portion. 
           [0010]      FIG. 3  shows yet another embodiment of a transparent dome according to the present invention in the form of a balloon at the distal end of a scope, the balloon having a therapeutic tip. 
           [0011]      FIG. 4  shows an additional embodiment of a transparent dome according to the present invention, the balloon being held by a catheter having an operative channel and a separate additional channel for inflating the balloon. 
           [0012]      FIG. 5   a  shows another embodiment of a transparent dome according to the present invention positioned so that it is adjacent or nearly adjacent to the distal face of a scope. 
           [0013]      FIG. 5   b  shows the transparent dome of  FIG. 5   a  positioned as a distance from the distal face of a scope. 
           [0014]      FIGS. 6   a - c  various views of an additional embodiment of a transparent dome with suggested dimensions, with  FIG. 6   a  further showing a catheter. 
           [0015]      FIGS. 7   a - c  shows various views of yet another embodiment of a transparent dome with suggested dimensions, with  FIG. 7   a  further showing a catheter. 
           [0016]      FIG. 8  shows a distal face of a scope such as is known in the art. 
           [0017]      FIG. 9   a  shows a distal face of a scope partially covered by a plastic membrane having a crescent shape. 
           [0018]      FIG. 9   b  shows a different view of the scope and inflated plastic membrane of  FIG. 9   a.    
           [0019]      FIG. 10   a  shows a transparent dome according to the present invention in the form of a solid cap, and a scope to which the transparent dome may be attached. 
           [0020]      FIG. 10   b  shows the transparent dome of  FIG. 10   a  attached to the scope of  FIG. 10   a.    
           [0021]      FIG. 11  shows an additional embodiment of a transparent dome in the form of a balloon along with a catheter, therapeutic device, and scope. 
           [0022]      FIG. 12   a  shows a scope and an embodiment of a transparent dome in the form of a balloon having a therapeutic tip, the balloon being in a hyper-inflated state. 
           [0023]      FIG. 12   b  shows the scope and transparent dome of  FIG. 12   a  in an inflated but not hyper-inflated state. 
           [0024]      FIGS. 13   a - e  show a method for using a transparent dome in the form of a balloon, scope and catheter holding the balloon at the catheter&#39;s side. 
           [0025]      FIG. 14  shows another embodiment of an inflated plastic membrane. 
           [0026]      FIG. 15  shows an embodiment of an uninflated single-layer membrane. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0027]      FIG. 1  shows a transparent dome  110 , in the form of art inflated balloon, covering the distal face  121  of a scope  120 . The distal face  121  of the scope  120  has a lens  122  for transmitting image or video information so the scope&#39;s operator through the visual transmission channel  123 . The transparent dome  110  has an exterior wall ill which contacts the distal face  121  of the scope  120 , at least at the lens  122  of the distal face  121 . In particular, the exterior wall  111  contacts the distal face at a flat region  114  at the proximal end of the transparent dome  110 . The flat region  114  may be a result of the shape of the transparent dome  110 , as opposed to a result of the application of pressure to the proximal end of the transparent dome  110 . Although a slight space appears, for ease of labeling, in  FIG. 1  between the flat region  114  of the exterior wall  111  and distal face  121 , it will be understood that a contacting relationship is shown. The transparent dome  110  has a distal portion  115  which has a rounded shape and is generally convex. The transparent dome  110  also has a distal tip  112 , which may be slightly pointed as shown. The structure of the transparent dome  110  is useful for pushing away a wall of the bodily cavity such as an interior of an organ, and this pushing away may substitute for air or water insufflations of the bodily cavity. 
         [0028]    Because the wall of the bodily cavity is kept away from the lens  122 , the operator avoids seeing only a red blot or similar obstruction, much like the effect when a camera operator touches his or her finger to the camera lens. Blood, clots, fecal material, and mucosa are all kept away from the lens  122  and prevented from obscuring it. The transparent dome  110  also transforms the blunt edge of the scope  120  into a smooth aerodynamic shape, thus decreasing the rate of perforation of the walls of the bodily cavity. As a result of these features, the distal end of the device may be inserted into a pool of blood in such locations as the fundus of the stomach and slid along the wall of the stomach until the point of bleeding is found. The transparent dome  110  may be made of any suitable material, such as a plastic. Preferably, it should be made from a material that is very transparent and which has a thin wall, so as not to distort the image or video received by the lens. 
         [0029]    An air intake portion  113  of the transparent dome  110  connects the dome  110  with an air channel  124  and allows for air to be sent through the air channel  124 , through the air intake portion  113  and into the transparent dome  110 , thereby inflating it. The air channel  113  may be a channel of the scope  120 , or it may be a catheter adapted for insertion into, and proximal and distal movement relative to, the scope  120 . 
         [0030]    The transparent dome  110  may have a color, such that it acts as a color filter for the lens  122 . In particular, the color may be green, the transparent dome  110  acting as a green color filter for the lens  122 . Such a green color filter is particularly helpful in allowing for easier recognition of flat lesions, such as those which may appear in a colon. 
         [0031]      FIG. 2  shows another embodiment of a transparent dome  210 , covering the distal face  121  of a scope  120 . The distal portion of the transparent dome  210  has a convex region  216  at a maximally distal center, and a concave region  217  which is positioned radially outwards from the convex region  216 . This creates an overall aerodynamic shape helpful in safely and easily inserting the device through the bodily cavity. 
         [0032]    The transparent dome  210  also has an overhanging portion  218 . The overhanging portion  218  may comprise a radially-outermost portion of the transparent dome  210  which extends, at a region of fire transparent dome  210  approximately as distal as the distal face  121  of the scope  120 , radially outwards beyond the edge of the distal face of the scope. The overhanging portion  218  also comprises a portion that extends more proximally than the distal face  121  of the scope  120 . Advantageously, when the scope  120  and transparent dome  210  are pulled proximally within a bodily lumen, frictional resistance between the overhanging portion  218  and the inner wall of the bodily lumen consistently slows the speed of the pulling, thereby preventing “slip-off,” inconsistent rates of movement of the transparent dome  210  and scope  120  relative to the bodily cavity, and failing to see lesions through the lens  122  as a result. 
         [0033]    Accordingly, a user may, after inserting the scope  120  and the transparent dome  210  into a bodily cavity, and while viewing, through the lens  122  and the transparent dome  210 , at least a portion of the bodily cavity, pull the scope  120  and transparent dome  210  in a proximal direction through the bodily cavity under frictional resistance between the portion of the transparent dome  210  extending radially outwards beyond the edge of the distal face  121  of the scope  120  and the bodily cavity. Contacting the bodily cavity with the transparent dome  210  may also be used to flatten folds in the bodily cavity. Advantageously, this enlarges the potential field of view of the lens  122  when a fold is present, because in the absence of such a transparent dome  210  it would be necessary to deflect the fold with the distal face  121  of the scope  120  in order to see on the other side of the fold, and in the process there would be obstruction of the lens  122 . The device could also help to visualize polyps on the distal sides of the folds where traditional scopes could not. Additionally, the transparent dome  210  may be pushed against an intestinal wall so as to open up the lumen of the bodily cavity and ease further distal advancement of the scope  120  and transparent dome  210  into the bodily cavity. 
         [0034]    Moreover, a lesion in the bodily cavity may be palpated with the transparent dome  210 , and the result of this palpation may be viewed through the lens  122  and the transparent dome  210 . On the basis of this viewing, the hardness of the lesion may be determined. Alternately, a mucosal defect of the bodily cavity may be contacted with the transparent dome  210 , and the result of this contacting may be viewed through the lens  122  and the transparent dome  210 . On the basis of this viewing, such as by seeing whether the defect blenches, a user may differentiate between the mucosal defect being an abnormal sub-mucosal blood vessel and it being an intra-mucosal inflammation. The transparent dome  210  may also be used to apply direct pressure to a bleeding vessel of the bodily cavity to reduce bleeding. The various viewings may occur while at least the distal tip of the transparent dome  210  is in a pool of blood or is contacting a blood clot, as vision is maintained, unlike a situation where tire lens is directly exposed to the pool of blood or blood clot. 
         [0035]    The bodily cavity may be a generally collapsed small bowel and the insertion and viewing may be accomplished without releasing air or water into the small bowel. This generally collapsed small bowel may belong to an unsedated or comparatively unsedated patient, as pain is greatly reduced by not insufflating (and thereby stretching) the bowel. Accordingly, the present invention is very useful in small bowel enteroscopy, the procedure being performed in a much shorter time and with less technical complexity than with conventional methods involving insufflations of the bowel. 
         [0036]      FIG. 3  shows another embodiment of a transparent dome  310 , covering the distal face  121  of a scope  120 . A catheter  324  has art air channel  327  and an air hole  325  through which air may be sent to inflate the transparent dome  310 . The scope  120  comprises an operative channel  126 , the balloon being held by the catheter  324  which is inserted through the operative channel  126 , the transparent dome  310  being held by the catheter  324  at a side region of the catheter  324 . The transparent dome  310  may connect to the catheter only in the region of the air hole  325 , or it may connect at its distal end to a region of the catheter  324  more distal than the air hole  325 , and at its proximal end to a region of the catheter  324  more proximal than the air hole  325 . 
         [0037]    The catheter  324  further comprises a therapeutic device  326  attached to its distal tip and at least partially located more distal than the transparent dome  310 , The therapeutic device  326  may be, but is not limited to, a sclerotherapy needle, bicap, laser probe, polypectomy device, small biopsy forceps, or the like. 
         [0038]      FIG. 4  shows a cutaway view of another embodiment of a transparent dome  410  covering the distal face  121  of a scope  120 . A catheter  440  comprises an air channel  442  for inflating the transparent dome  410 , and an additional channel  444 , separate from the air channel  442 , opening distally to the distal side of the transparent dome  410 . Advantageously, therapeutic medical devices may be inserted through the additional channel  444  to the distal side of the transparent dome  410 , where they may be used in performing a procedure under direct vision through the lens and the transparent dome  410 . The fiat bottom region may completely cover the entire distal face  121  of the scope  120 , thus lowering the chances of blood getting to the lens. 
         [0039]      FIGS. 5   a  and  5   b  show how a transparent dome  510  may be positioned at different distances from the distal face  121  of the scope  120 .  FIG. 5   a  shows the transparent dome adjacent or nearly adjacent to the distal face  121  of the scope  120 , while  FIG. 5   b  shows the transparent dome at an exemplary distance of 0.5 inches from the distal face  121  of the scope  120 . Movement between these two positions between other relative distal positions can be accomplished through distal or proximal movement of the catheter relative  540  relative to the scope  120 . 
         [0040]      FIG. 6   a  shows an additional embodiment of a transparent dome  610  and a catheter  620 , with particular suggested dimensions. The catheter  620  should be long enough to extend through a scope, and accordingly is shown as 200 cm in length. The length may vary with tire length of the scope. The overhanging portion  613  may extend 1.5 mm proximally beyond the flat region  611 . The transparent dome  610 , from its flat region  611  to its distal tip may be 10 mm. The air intake portion  612  may be positioned 7.5 mm from the center of the transparent dome  610 , as shown in  FIG. 6   c , or as necessary to fit a particular catheter or scope opening.  FIG. 6   b  shows a side view of the transparent dome  616 .  FIG. 6   c  shows an angled view of the transparent dome  610  from below. 
         [0041]      FIG. 7   a  shows an additional embodiment of a transparent dome  710  and a catheter  720 , with particular suggested dimensions. The catheter  720  should be long enough to extend through a scope, and accordingly is shown as 200 cm in length. The length may vary with the length of the scope. The transparent dome  710 , from its flat region  711  to its distal tip may be 10 mm. The air intake portion  712  may be positioned at the center of the transparent dome  710 , as shown in  FIG. 7   c,  or as necessary to fit a particular catheter or scope opening.  FIG. 7   b  shows a side view of the transparent dome  710 . FIG  7   c  shows an angled view of the transparent dome  710  from below. 
         [0042]      FIG. 8  shows a distal face  800  of a scope such as is known in the art. Features of the distal face  800  of the scope include a lens  801 , an operative channel  802  offset from the center of the distal face  800 , a water channel  803 , an air channel  804 , and light sources  805 . 
         [0043]      FIG. 9   a  shows a first view of the scope of  FIG. 8  with an attached transparent dome  910  of the present invention. The transparent dome  910  comprises a single-layer membrane affixed to the distal end of the scope such that it covers the lens  801  as well an air channel  804  for inflating the transparent dome  910 . The single-layer membrane may be, but is not limited to, a saran wrap-like plastic membrane, or any oilier suitable material. The affixation may be by a narrow rim of glue around at least a portion of the perimeter of the operative channel  802  and around the external surface of the scope just beneath a portion of the rim at tire circumference of the distal face  800 . The single-layer membrane may be reusable and built into the scope. Unlike the balloon transparent domes ( 110 ;  210 ;  310 ;  410 ;  510 ;  610 ;  710 ;  1120 ;  1210 ;  1310 ) discussed elsewhere in this description, only a single layer of the transparent dome is distal to the lens  802 . The single-layer membrane is affixed to the distal end of the scope such that it does nor cover the opening of the operative channel  802  through a portion of the distal face  800  of the scope. The single-layer membrane covers an approximately crescent-shaped region of the distal face  800  of the scope, the crescent-shaped region comprising approximately the entire face of the scope other than that portion of the face through which the operative channel  802  opens. The single-layer membrane may be attached to the scope by gluing or otherwise attaching it along the perimeter of the crescent-shaped region of the distal face  800 , or by gluing or otherwise attaching it to the portion of the crescent-shaped region surrounding the operative channel  802  and along the outer circumference of the scope at a region slightly more, or as, proximal relative to the distal face  800 . 
         [0044]      FIG. 9   b  shows a second view of the scope of  FIG. 8  with an attached transparent dome  910  of the present invention. The transparent dome  910  is shown as inflated by the air channel  804 . 
         [0045]      FIG. 14  shows an embodiment similar to that of  FIG. 9   a,  except the transparent dome  1410  comprises a single-layer membrane affixed to the distal end of the scope such that it covers only the lens  801  as well an air channel  804  for inflating the transparent dome  1410 , as well as the intervening region between the lens  801  and the air channel  804 . The transparent dome  1410  may lie flat on the lens  801  when deflated, which advantageously provides for easy washing of the transparent come  1410 . The operative channel  802  is left open for any therapeutic maneuvers. 
         [0046]      FIG. 15  shows an embodiment of an uninflated membrane covering the lens. It is a flat, see-through membrane flush against the lens. An operator can choose not to create a dome-shape structure by not inflating air. It is easy as easy to wash as a regular scope. It is reusable and washable with the scope. 
         [0047]      FIG. 10   a  and  FIG. 10   b  show a transparent dome  1010  according to the present invention in the form of a solid cap, and a scope to which the transparent dome  1010  may be attached to and detached from, at the distal end thereof. The particular shape and size of the solid cap should be configured to attach to a particular manufacturer&#39;s scope.  FIG. 10   a  shows the transparent dome  1010  in the detached state, while  FIG. 10   b  shows the transparent dome  1010  in the attached state. The transparent dome  1010  may be of any suitable solid material, such a solid plastic. When attached, the portion of the distal face  800  through which the operative channel  802  opens is not covered by the transparent dome  1010 . The scope has at least one of an sir channel  804  and a water channel  803  opening out of portions of the distal face  800 . At least one of these portions is not covered by the transparent dome  1010 . Because the transparent dome  1010  is solid, it need not be inflated, and therefore no air channel need be covered by it. However, the lens  801  and light sources  805  are covered by the transparent dome  1010 . When the transparent dome  1010  is attached to the scope, a seal  1011  is formed between the transparent dome  1010  and the scope that is water-tight. However, because file transparent dome  1010  does not need to be inflated, such as by an air channel, the seal  1011  is not air-tight. Alternately, the seal  1011  may be made air-light. 
         [0048]    The transparent dome  1010 , after being inserted along with the scope into a bodily cavity, may be allowed to have its exterior become dirtied by the bodily cavity. After this occurs, but while the scope and transparent dome  1010  are still inserted into the bodily cavity, the exterior of the transparent dome  1010  may be cleaned by water sprayed by the water channel  803  from the distal face  800  of the scope, allowing for easier viewing through the lens  801 . 
         [0049]      FIG. 11  shows an additional embodiment of a transparent dome  1110  in the form of a balloon along with a catheter  1130 , therapeutic device  1140 , and scope  1120 . The transparent dome  1110  is held by a catheter  1130  at the catheter&#39;s side. The catheter comprises a textured portion  1132  and a bar  1133  for limiting distal movement of the transparent dome  1110  relative to the catheter  1130 . The textured portion  1132  and bar  1133  may be made of arty suitable material, such as a plastic. The bar  1133  may clip-on, so as to be separately disposable and inexpensive to manufacture. In addition, either of the textured portion  1132  or the bar  1133  may be used in order to limit distal movement of the transparent dome  1110 , rather than both. A therapeutic device  1140  is inserted through catheter  1130  to the distal side of the transparent dome  1110 . An air channel  1131  is used to inflate and deflate the transparent dome  1110 . The scope  1120  comprises an operative channel  1122  opening out of its distal face  1121 , for passing the catheter  1130 , transparent dome  1110  in its deflated state, and therapeutic device  1140 . The scope  1120  also comprises, at its distal face  1121 , a lens  1123 , and lights  1124 . Advantageously, because the transparent dome  1110  is held by the catheter  1130  and is not directly attached to the scope  1120 , the transparent dome  1110  and/or catheter  1130  can be disposed of while reusing the scope  1120 , saving money. 
         [0050]      FIGS. 12   a  and  12   b  show yet another embodiment of a transparent dome  1210  in the form of a balloon along with a catheter  1224 , therapeutic device  1226 , and scope  120 . The catheter  1224  has an air channel  1227  and an air hole  1225  for inflating the transparent dome  1210 . The catheter  1224  holds she transparent dome  1210  at its side. The scope has an operative channel  126  opening out of its distal face  121  for passing the catheter  1224 , as well as a lens  122  at its distal face and a visual transmission channel  123  for passing the image or video received at the lens  122 . 
         [0051]    This embodiment, like the other embodiments, may be inserted into a bodily cavity. Before inflating the transparent dome  1210 , the catheter  1224  holding the transparent dome  1210  may be inserted through the operative channel  126  of the scope  120 . Initial inflation and/or hyperinflation of the transparent dome  1210  may occur after inserting the scope  120  and the transparent dome  1210  into the bodily cavity, or they may occur beforehand. After inflating the transparent dome  1210 , at least the lens  122  on the distal face  121  of the scope  120  may be contacted with an exterior surface of the inflated transparent dome  1210 . This exterior surface of the inflated transparent dome  1210  that will contact the lens  122  on the distal face  121  of the scope  120  may be generally flat. The contact may occur by pulling the catheter  1224  proximally relative to the scope  120 , after the transparent, dome  1210  has been inflated. 
         [0052]    The transparent dome  1210  is shown in  FIG. 12   a  as being hyper-inflated to a first level of inflation such that the transparent dome  1210  extends to be more distal than, and generally surrounds, the distal tip of the catheter  1224 , and the therapeutic device  1226 . By surrounding die distal tip of the catheter  1224  and the therapeutic device  1226 , the scope  120  and hyper-inflated transparent dome  1210  may be more easily and safely further inserted into a bodily cavity. Thus, after hyper-inflating the transparent dome as shown in  FIG. 12   a,  the user may further insert the scope  120  and hyper-inflated transparent dome  1210  into the bodily cavity. 
         [0053]    Then, as shown in  FIG. 12   b,  the user may deflate the transparent dome  1210  a sufficient amount that the transparent dome  1210  no longer extends to be more distal than, and no longer generally surrounds, the distal tip of tire catheter  1224 , or the therapeutic device  1226 . Then, while viewing, through the visual transmission channel  123 , the lens  122 , and two walls of the transparent dome  1210 , at least a portion of the bodily cavity, the user may use the therapeutic device  1226  at the distal end of the catheter  1224  on the portion of the bodily cavity being viewed. The therapeutic device  1226  being used on the portion of the bodily cavity being viewed extends, by way of the catheter  1224 , from the distal face  121  of the scope  120  and exterior to the transparent dome  1210 . A color filter, such as a green color filter, supplied by a transparent color, such as a green transparent color, of the transparent dome  1210  allows the user to identify, by way of the viewing, a feature of the bodily cavity made more prominent by the color filter or green color filter, such as a flat or other lesion. 
         [0054]    The use of the therapeutic device  1225  may occur while at feast the distal tip of the transparent dome  1210  is to a pool of blood in the bodily cavity, or in direct contact with mucosa. As the transparent dome  1210  separates the lens  122  from the pool of blood or mucosa, vision of the bodily cavity is not greatly impaired by a red-out or like effect of blood or mucosa on the lens  122  itself. 
         [0055]      FIGS. 13   a - e  show a method for using a transparent dome  1310  in the form of a balloon, scope, and catheter  1324  holding the balloon at the catheter&#39;s side. The scope has a lens  1301  for a user to view what is further distal than the scope&#39;s distal face  1300 , and an operative channel  1302  for passing the catheter  1324 . The catheter  1324  holds the transparent dome  1310  at its side. In this embodiment, the transparent dome is held at a hole along the catheter&#39;s side, through which air may flow to inflate the transparent dome  1310 . However the transparent dome may be held in other manners, such as around the circumference of the catheter  1324 . A retractable needle is shown as an example of a therapeutic device  1326  which may be inserted through the catheter. However, other therapeutic devices, either insertable through the catheter, or fixed at the distal tip of the catheter  1324 , may be used. 
         [0056]    In  FIG. 13   a,  the catheter  1324  is shown withdrawn within the operative channel  1302 . the transparent dome  1310  deflated and thereby fitting within the operative channel  1302  along with the catheter  1324 . 
         [0057]    Then, in  FIG. 13   b,  the catheter  1324  is advanced distally relative to the scope such that the distal end of the catheter  1324  and the transparent dome  1310  are more distal than the distal face  1300  of the scope. 
         [0058]    Then, in  FIG. 13   c,  at such a time as when the distal tip of the catheter  1324  comes into view of the lens  1301 , the transparent dome  1310  is inflated. Also, the therapeutic device  1326  is inserted through the catheter  1324  and the operative channel  1302  of the scope by moving it distally relative to the catheter  1324  and the operative channel  1302 . This insertion may occur instead at other times before the therapeutic device  1326  is used on the bodily cavity. 
         [0059]    Then, in  FIG. 13   d,  by pulling the catheter  1324  proximally relative to the scope, at least the lens  1301  on the distal face  1300  of the scope is contacted with an exterior surface of the inflated transparent dome  1310 . The therapeutic device  1326  is withdrawn into the scope during the pulling. The therapeutic device  1326  will therefore not get in the way during movement of the scope within the bodily cavity. 
         [0060]    Then, in  FIG. 13   e,  the transparent dome  1310  is slightly deflated and the catheter  1324  and the withdrawn therapeutic device  1326  are advanced distally relative to the scope such that the therapeutic device  1326  becomes exposed while the transparent dome  1310  continues to contact at least the lens  1301  on the distal face  1300  of the scope. The therapeutic device  1326  is now extending from the distal face  1300  of the scope and exterior to the transparent dome  1310 , available for use, and may be used, on the bodily cavity under direct vision through the lens  1301  and the transparent dome  1310 . After use, the therapeutic device  1326  and catheter  1324  may again be retracted into the scope. 
         [0061]    As the catheter  1324  and therapeutic device  1326  may be chosen on the basis an identification of a particular lesion in a bodily cavity, a diagnostic and therapeutic procedure may be performed without the need to insert a new scope between the diagnostic portion of the procedure and the therapeutic portion of the procedure. In particular, a method of use for a transparent dome  1326  and a scope having a lens  1301  located at its distal face  1310  is presented, involving: inserting the scope into a bodily cavity, such as but not limited to a small intestine; using the lens  1301  of the scope, identifying a particular lesion of the bodily cavity; based on the identification of the particular lesion, advancing a catheter  1324  comprising a deflated transparent dome  1310  and a particular therapeutic device  1326  or tip chosen for its ability to treat the particular lesion, through an operative channel  1302  of the scope; inflating the transparent dome  1310 ; and under vision through the tens  1301  and the transparent dome  1310 , treating the particular lesion with the particular therapeutic device  1326  of the catheter. Of course, a transparent dome that is part of a different catheter or the same catheter  1324  may be used, during the initial diagnostic portion, of the procedure. 
         [0062]    The above specific embodiments are illustrative, and many variations can be introduced on these embodiments without departing from the spirit of the disclosure or from the scope of the appended claims. For example, elements and/or features of different illustrative embodiments may be combined with each other and/or substituted for each other within the scope of this disclosure and appended claims.