Patent Publication Number: US-2022211252-A1

Title: Disposable endoscopy cannula with integrated grasper

Description:
REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation-in part of International Patent Application PCT/US20/046018 filed on Aug. 12, 2020 and published on Jan. 28, 2021 under publication number WO 202/016626. This application incorporates by reference said International Patent Application and each of the U.S. provisional applications to which it claims priority, and claims priority to the International Patent Application and to the U.S. Provisional Patent Applications, namely,
         U.S. Prov. Ser. No. 63/044,959 filed Jun. 26, 2020;   U.S. Prov. Ser. No. 63/044,358 filed Jun. 26, 2020;   U.S. Prov. Ser. No. 63/001,362 filed Mar. 29, 2020;   U.S. Prov. Ser. No. 62/978,507 filed Feb. 19, 2020;   U.S. Prov. Ser. No. 62/955,859 filed Dec. 31, 2019;   U.S. Prov. Ser. No. 62/933,490 filed Nov. 10, 2019   U.S. Prov. Ser. No. 62/901,393 filed Sep. 17, 2019;   U.S. Prov. Ser. No. 62/897,352 filed Sep. 8, 2019;   U.S. Prov. Ser. No. 62/884,688 filed Aug. 9, 2019;   U.S. Prov. Ser. No. 62/880,677 filed Jul. 31, 2019; and   U.S. Prov. Ser. No. 62/878,384 filed Jul. 25, 2019.       

     This patent application incorporates by reference each of the following provisional, non-provisional patent applications and issued patent(s):
         U.S. Pat. No. 9,895,048 issued Feb. 20, 2018;   U.S. Pat. No. 9,895,858 issued Feb. 20, 2018;   U.S. Pat. No. 10,278,563 issued May 7, 2019;   U.S. Pat. No. 10,292,571 issued May 21, 2019;   U.S. Ser. No. 15/856,077 filed Dec. 28, 2017;   U.S. Ser. No. 16/407,028 filed May 8, 2019;   U.S. Ser. No. 16/413,160 filed May 15, 2019;   U.S. Ser. No. 15/462,331 filed Mar. 17, 2017;   U.S. Ser. No. 14/913,867 filed Feb. 23, 2016;   U.S. Ser. No. 16/664,082 filed Oct. 25, 2019;   Intl. Pat. App. No. PCT/US18/14880 filed Jan. 23, 2018;   Intl. Pat. App. No. PCT/US16/65396 filed Dec. 7, 2016; Intl. Pat. App. No. PCT/US16/18670 filed Feb. 19, 2016;   U.S. Prov. Ser. No. 62/824,324 filed Mar. 27, 2019;   U.S. Prov. Ser. No. 62/821,536 filed Mar. 21, 2019;   U.S. Prov. Ser. No. 62/587,038 filed Nov. 16, 2017;   U.S. Prov. Ser. No. 62/873,861 filed Jul. 13, 2019.   U.S. Prov. Ser. No. 62/870,748 filed Jul. 4, 2019   U.S. Prov. Ser. No. 62/842,297 filed May 2, 2019;   U.S. Prov. Ser. No. 62/825,948 filed Mar. 29, 2019;   U.S. Prov. Ser. No. 62/821,536 filed Mar. 21, 2019;   U.S. Prov. Ser. No. 62/821,430 filed Mar. 20, 2019;   U.S. Prov. Ser. No. 62/797,235 filed Jan. 26, 2019;   U.S. Prov. Ser. No. 62/796,346 filed Jan. 24, 2019;   U.S. Prov. Ser. No. 62/795,042 filed Jan. 22, 2019;   U.S. Prov. Ser. No. 62/791,045 filed Jan. 11, 2019   U.S. Prov. Ser. No. 62/647,454 filed Mar. 23, 2018;   U.S. Prov. Ser. No. 62/634,854 filed Feb. 24, 2018;   U.S. Prov. Ser. No. 62/587,038 filed Nov. 16, 2017;   U.S. Prov. Ser. No. 62/551,264 filed Aug. 29, 2017;   U.S. Prov. Ser. No. 62/452,883 filed Jan. 31, 2017;   U.S. Prov. Ser. No. 62/449,257 filed Jan. 23, 2017;   U.S. Prov. Ser. No. 62/443,769 filed Jan. 8, 2017;   U.S. Prov. Ser. No. 62/416,403 filed Nov. 2, 2016;   U.S. Prov. Ser. No. 62/405,930 filed Oct. 9, 2016;   U.S. Prov. Ser. No. 62/375,814 filed Aug. 16, 2016;   U.S. Prov. Ser. No. 62/362,643 filed Jul. 15, 2016;   U.S. Prov. Ser. No. 62/339,810 filed May 21, 2016;   U.S. Prov. Ser. No. 62/299,453 filed Feb. 24, 2016   U.S. Prov. Ser. No. 62/287,901 filed Jan. 28, 2016;   U.S. Prov. Ser. No. 62/279,784 filed Jan. 17, 2016;   U.S. Prov. Ser. No. 62/275,241 filed Jan. 6, 2016;   U.S. Prov. Ser. No. 62/275,222 filed Jan. 5, 2016;   U.S. Prov. Ser. No. 62/259,991 filed Nov. 25, 2015;   U.S. Prov. Ser. No. 62/254,718 filed Nov. 13, 2015;   U.S. Prov. Ser. No. 62/139,754 filed Mar. 29, 2015;   U.S. Prov. Ser. No. 62/120,316 filed Feb. 24, 2015; and   U.S. Prov. Ser. No. 62/119,521 filed Feb. 23, 2015.       

     All of the above-referenced non-provisional, provisional and international patent applications are collectively referenced herein as “the commonly assigned incorporated applications.” 
    
    
     FIELD 
     This patent specification generally relates to grasping devices for use with endoscopic surgical procedures. More particularly, some embodiments relate to surgical grasping devices and methods configured for use with portable endoscopes having a disposable cannula. 
     BACKGROUND 
     There are many medical procedures which require a tissue or other object in a human cavity to be grasped while under view of an endoscopy device. Examples of procedures include stent removal, foreign body removal, hysteroscopy endometrium biopsy, and removal of polyps. 
     The subject matter described or claimed in this patent specification is not limited to embodiments that solve any specific disadvantages or that operate only in environments such as those described above. Rather, the above background is only provided to illustrate one exemplary technology area where some embodiments described herein may be practiced. 
     SUMMARY 
     According to some embodiments, a disposable, single-use endoscope including a permanently mounted, integrated grasper operated under video control, comprises: a shaft having a manually operated grasper control movable relative to the shaft, a cannula extending distally from the shaft and having a working channel, and a grasper at a distal portion of the working channel; wherein: said grasper is permanently secured to said cannula and to said manually operated grasper control to move relative to the cannula with movement of the control relative to the shaft, between a retracted position at in which the grasper is within the working channel and an extended position at which the grasper protrudes distally from the channel; said grasper comprises a pair of resilient jaw portions with distal portions that are biased to move away from each other toward and to an open position as the grasper moves distally relative to the cannula toward and to its extended position; and said working channel acts on the grasper to move said distal portions of the resilient jaws toward each other and to a closed position as the grasper moves proximally relative to the cannula toward and to its retracted position. 
     According to some embodiments, the endoscope can further comprise one or more of the following: (a) said grasper further includes arch shaped portions from which said jaws extend distally, wherein said arch shaped portions are configured to engage an inside wall of said working channel and move the jaws toward and to said closed position as the grasper moves proximally relative to the cannula; (b) said distal portions of the jaws terminate distally in claw portions that face each other when the grasper is in its extended position and engage each other when the grasper is in its retracted position; (c). a combination with multiple-use handle, wherein the cannula includes an imaging module at a distal portion thereof and the handle includes a video screen and electronics coupled with said imaging module to control the imaging module and to cause said screen to display images taken with said imaging module; (d) in combination with said multiple-use handle of claim, wherein each of the endoscope and the handle comprises respective mechanical and electrical connectors that releasably mate mechanically with each other to form an integral unit of an endoscope and handle and to form an electronic connection between said video screen and electronics and said imaging module; (e) in combination with said multiple-use handle, wherein said mechanical and electrical connectors mate by relative motion in a direction parallel to a length of said shaft; (f) in combination with said multiple-use handle, wherein said mechanical and electrical connectors mate by relative motion in a direction transverse to length of said shaft; (g). said grasper control comprises a manually operated collar movable along a length of said shaft; (h) said grasper control comprises a manually operated tab movable along a length of said shaft; (i) said cannula is configured to rotate relative to a portion of said shaft; (j). further including a first proximal port coupled for fluid flow with a proximal portion of said working channel; (k) said cannula further includes a lumen in addition to said working channel and a second proximal port coupled for fluid flow with a proximal portion of said lumen and distal ports, for two-directional flow along a length of said cannula; (l) further including a mechanism that releasably locks the grasper in at least one of its extended and retracted position, wherein said mechanism comprises a window at a proximal portion of the cannula, a spring tab secured to said shaft and biased to engage said window when aligned therewith and thus lock said grasper against movement relative to the cannula, and a manually operated release button selectively engaging said tab to move it out of engagement with said window and thus release the grasper and cannula for relative movement therebetween; and (m). said mechanism is configured to releasably lock the grasper in its extended position. 
     According to some embodiments, a disposable, single-use endoscope with a canula that includes a permanently mounted, integrated surgical tool operated under video control, comprises: a shaft having a manually operated control movable relative to the shaft, a cannula extending distally from the shaft and having a working channel and a surgical tool at a distal portion of the working channel; wherein: said surgical tool is permanently secured to said manually operated control to move relative to the cannula with movement of the control relative to the shaft, between a retracted position at which the tool is within the working channel and an extended position at which the tool protrudes distally from the channel; and said tool comprises one of: (i) a grasper comprising a pair of resilient jaw portions with distal portions biased to move away from each other and toward and to an open position as the grasper moves distally relative to the cannula toward and to its extended position wherein said working channel acts on the grasper to move said distal portions of the resilient jaws toward each other and to a closed position as the grasper moves proximally relative to the cannula toward and to its retracted position; and (ii) an injection needle for injecting medication into tissue. 
     According to some embodiments, the endoscope described in the immediately preceding paragraph further includes one or more of the following: (a) said tool comprises said grasper; and (b) said tool comprises said injection needle. 
     According to some embodiments, a method comprises: providing a disposable, single-use endoscope with a cannula that includes a permanently mounted, integrated surgical tool; inserting the endoscope in tissue or a tissue cavity or passage while the surgical tool is in a retracted position inside a working channel of the cannula, while observing the insertion path on a video screen mechanically secured releasably to the cannula, which screen receives images sent from an imaging module at a distal end of the cannula; selectively moving manually operated control relative to a shaft forming a proximal portion of the cannula to thereby move the tool toward and to an extended position at which the tool protrudes distally from the channel while observing the motion of the tool out of the working channel; wherein said tool is one of a grasper and an injection needle; and carrying out one of the steps of: (a) grasping tissue with a pair of resilient jaw portions of said grasper that are biased away from each in the extended position of the grasper by manually moving said control relative to the shaft to thereby move the grasper toward and to its retracted position into said working channel to thereby engage the jaws with an inner wall of the working channel and move them toward each into the working channel ( FIG. 6D ); and (b) injecting medication into tissue with said injection needle and thereafter manually moving said control relative to the shaft tot hereby move the needle toward its retracted position in the working channel. 
     The method can carry our step (a) or step (b). 
     As used herein, the grammatical conjunctions “and”, “or” and “and/or” are all intended to indicate that one or more of the cases, object or subjects they connect may occur or be present. In this way, as used herein the term “or” in all cases indicates an “inclusive or” meaning rather than an “exclusive or” meaning. 
     As used herein the terms “surgical” or “surgery” refer to any physical intervention on a patient&#39;s tissues and does not necessarily involve cutting a patient&#39;s tissues or closure of a previously sustained wound. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       To further clarify the above and other advantages and features of the subject matter of this patent specification, specific examples of embodiments thereof are illustrated in the appended drawings. It should be appreciated that these drawings depict only illustrative embodiments, and are therefore not to be considered limiting of the scope of this patent specification or the appended claims. The subject matter hereof will be described and explained with additional specificity and detail through the use of the accompanying drawings in which: 
         FIGS. 1A-1B  are top and side views, respectively, of an endoscopy system having a cannula with an integrated grasper device, according to some embodiments, and  FIG. 1C  is a top view showing further detail of the distal tip of a grasper device integrated into an endoscopy system having a disposable cannula, according to some embodiments; 
         FIG. 2  is a top view of an endoscopy system having a cannula with an integrated grasper device, according to some further embodiments; 
         FIGS. 3A-3C  are perspective views showing further details of an endoscopy system having a cannula with an integrated grasper device, according to some embodiments; 
         FIGS. 4A-4D  are diagrams illustrating further detail of a grasper tool configured for use through the working channel of a cannula of an endoscopy system, according to some embodiments; 
         FIGS. 5A-5E  are diagrams illustrating further detail of a distal tip piece and cannula for an endoscopy system having a disposable cannula with a working channel configured to accept a grasper device, according to some embodiments; 
         FIGS. 6A-6D and 7A-7D  are two sets of diagrams illustrating a process of opening, closing, and retracting a grasper device from an endoscopy system, according to some embodiments; 
         FIG. 8  is a block diagram illustrating the operation of using an endoscopy device with an integrated grasper, according to some embodiments; 
         FIG. 9A  is a perspective view showing an endoscopy system having cannula with an integrated grasper device, according to some further embodiments; 
         FIGS. 9B-9D  are side, top and bottom views, respectively, of a single-use portion of an endoscopy system with an integrated grasper device, according to some further embodiments; 
         FIG. 9E  is an exploded view showing further details of a single-use portion of an endoscopy system with an integrated grasper device, according to some further embodiments; 
         FIGS. 10A-10D  are a set of diagrams illustrating a process of opening, closing, and retracting a grasper device from an endoscopy system, according to some embodiments; and 
         FIGS. 11A-11B  are perspective diagrams of an endoscopy system having a cannula with an integrated needle, according to some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     A detailed description of examples of preferred embodiments is provided below. While several embodiments are described, it should be understood that the new subject matter described in this patent specification is not limited to any one embodiment or combination of embodiments described herein, but instead encompasses numerous alternatives, modifications, and equivalents. In addition, while numerous specific details are set forth in the following description in order to provide a thorough understanding, some embodiments can be practiced without some or all of these details. Moreover, for the purpose of clarity, certain technical material that is known in the related art has not been described in detail in order to avoid unnecessarily obscuring the new subject matter described herein. It should be clear that individual features of one or several of the specific embodiments described herein can be used in combination with features of other described embodiments or with other features. Further, like reference numbers and designations in the various drawings indicate like elements. 
       FIGS. 1A-1B  are top and side views, respectively, of an endoscopy system having a cannula with an integrated grasper device, according to some embodiments. Endoscopy system  100  is configured to be handheld by hand piece  140  and includes a semi-rigid cannula  120  having an integrated grasper device  160  disposed at its distal tip  110 . Imaging and illumination modules are included on distal tip  110 . An electrical cable (not shown) is positioned within cannula  120  and supplies control signals and power to the camera and LED illumination modules on distal tip  110 , and also transmits video image and still image data from the camera module to the hand piece  140  and display  150  for viewing by an operator. In the example shown, hand piece  140  includes control buttons  142  and  144  which can be configured for power on/off and image capture, respectively. 
     According to some embodiments, hand piece  140  includes a third button  148  that is configured as an exposure and/or lighting control button. Button  148  can be configured as a toggle button which circulates through a number of states, for example four states, setting the LED illumination levels and system exposure control parameters. According to some embodiments, hand piece  140  includes a rechargeable battery  146  as well as electronics for video capture, processing and display on display  150 . 
     The cannula  120  is connected proximally to a fluid hub  130  including in this example fluid port  132 . A syringe or other fluid supply device (for example as in  FIG. 9A ) can be used to supply (or withdraw fluid) such as saline through a fluid lumen within canula  120  through port  132 . According to some embodiments, an additional proximal port (for example as in  FIG. 9A ) can be connected to the device lumen and device port for infusing or withdrawing fluid from the organ or tissue into which the distal tip  110  is inserted. According to some embodiments, the outer diameter of cannula  120  is about 4.85 mm. According to some other embodiments, the outer diameter of cannula  120  can be made smaller, for example 4.65 mm. Proximal to the fluid hub  130  is a shaft  168  and a collar  170 . According to some embodiments, the collar  170  is fixed to the proximal portion of grasper  160  such that it can be used to retract and extend the grasper  160  relative to the cannula  120 , as will be shown and described further herein. When the operator moves collar  170  in the proximal direction the grasper  160  moves in a similar or identical proximal direction. A syringe ( FIG. 9A ) can be used to supply fluid, such as saline, through a fluid lumen within cannula  120  via fluid port  132 . According to some embodiments, the working length L of cannula  120  including distal tip  110  is between 250 mm and 300 mm. 
     According to some embodiments, the system  100  is formed of a single use portion  102  and a multiple use portion  104 . The portions  102  and  104  are connectable and separable via a mechanical and electrical connector (shown in  FIG. 3C ). According to some embodiments, the cannula  120  is semi-rigid. The cannula  120  is stiff enough so it does not collapse when actuating the grasper device  160 . On the other hand, cannula  120  is flexible enough such that it can bend while it passes through curved anatomy such as male urethra or female cervix. The distal end of canula  120  can be curved upwards at location  108  as shown in  FIG. 1B . According to some embodiments, the upward bend is at least 15 degrees. According to some further embodiments, the upward bend is about 25 degrees. According to some embodiments, cannula  120  is configured to rotate about its longitudinal axis relative to handle  140 , as indicated by arrow  122 . A suitable rotation mechanism is described below in connection with  FIG. 9E . 
       FIG. 1C  is a top view showing further detail of the distal tip of a grasper device integrated into an endoscopy system having a disposable cannula, according to some embodiments. The distal tip of grasper  160  is shown protruding from distal end of tip  110 . The distal tip of grasper  160  is formed of two opposing jaw portions  162  and  164 . According to some embodiments, the jaw portions  162  and  164  are made of metal. At the distal ends of jaw portions  162  and  164  are opposing claw portions  172  and  174 , respectively. Opposing claw portions  172  and  174  are configured to grasp and securely hold tissue (or other object) when the jaw portions  162  and  164  are actuated towards each other. Jaw portions  162  and  164  also include arch-shaped portions  182  and  184 , respectively, that are shown just protruding distally from device channel (or working channel) opening  116 . According to some embodiments, arch-shaped portions  182  and  184  are shaped such as they are pulled back into the opening  116 , a force is generated to force the claw portions  172  and  714  to close towards each other, as shown by the dotted arrows. According to some embodiments, the grasper  160  is dimensioned such that the distance d from the camera module on the distal tip to the claw portions  172  and  174  allows for clear visualization of tissue or other object being grasped. According to some embodiments, the distance d is 15 mm. According to some embodiments, the grasper jaw portions  162  and  164  are made of a memory-type metal or non-metal material. According to some embodiments, jaw portions  162  and  164  are made of spring steel or nitinol alloy. According to some embodiments, the claw portions  172  and  174  when fully opened (i.e. arch portions are not engaged with opening  116 ) are at least 5 mm apart. According to some embodiments, claw portions  172  and  174  are shaped to “scoop” tissue when grasper  160  is configured to be used as a biopsy device. 
       FIG. 2  is a top view of an endoscopy system having cannula with an integrated grasper device, according to some further embodiments. The endoscopy system  200  is similar or identical to system  100  shown in  FIGS. 1A-C  and elsewhere herein, except that in this case cannula  120  is configured with two separate fluid lumens which are fluidly connected to two separate proximal fluid ports  232  and  234 . One of the lumens is configured as a device lumen where the grasper or needle resides. According to some embodiments, one of the separate fluid lumens can be shared with the electrical cable (not shown) that supplies control signals and power, and transmits image data as described, supra. According to some other embodiments, neither of the two separate fluid lumens is used to carry the electrical cable. 
       FIGS. 3A-3C  are perspective views showing further details of an endoscopy system having cannula with an integrated grasper device, according to some embodiments. In  FIG. 3B , further detail of the distal tip  110  is shown. In particular, the view of  FIG. 3B  shows the camera module  330  and two LEDs  332  and  334  that are positioned below the device opening  116 . According to some embodiments, tip piece  310  of distal tip  110  is arranged such that the device channel opening  116  through which the grasper device  160  (or other built-in device, such as an integrated needle) is above, or on top, of the camera module  330  rather than below the camera module. The location of the device opening  116  is slightly more distal than the surface of camera module  330 , which allows for a better view by the camera module  330  of the grasper claw portions  172  and  174 , or other tool tip components in cases when another type of tool device is used. The slight distal positioning of opening  116  can be achieved by a slight forward (or distal) angle of the upper portion of the front face the tip piece  310 , as can also be seen in  FIGS. 5A, 5B and 5D . 
     According to some embodiments, the grasper  160  is positioned within a lumen or “working channel” formed inside cannula  120 . The device lumen or working channel can be off-center within the cross-section of the cannula  120 , as is shown with working channel  516  in  FIG. 5E . In cases where the cannula has a bend such as shown in  FIGS. 1B and 3A  at location  108 , the grasper  160  (or needle) and working channel can be positioned within the cannula on the concave side of the curved cannula. Positioning an otherwise straight grasper  160  or other tool within the working channel on the concave side of the bend (above center in this case), the natural spring-like stiffness of the grasper or other tool (e.g. a needle as shown in  FIGS. 11A-11B ) will tend to force the grasper or tool back towards the center, or downward in this case, when exiting the device channel opening  116 . The effect is that the grasper  160  or other tool will be pushed slightly toward the camera axis or toward the center of the camera field of view, making for better imaging and viewing of the tool by the operator. In cases where the shaft of the tool has a matching bend (such as shown in  FIG. 4A ), the bending amount can be made less than (i.e. more straight) than the bending of the cannula, which will have the same or similar effect of pushing the distal tip of the tool slightly toward the camera axis or toward the center of the camera field of view. 
     Also visible in  FIG. 3B  are two distal fluid ports  320  and  520  that are positioned on either side of device opening  116 . According to some embodiments, the two distal fluid ports  320  and  520  are fluidly connected to proximal fluid port  132  in  FIG. 1B , or to one of the proximal fluid ports  232  or  234  in  FIG. 2 . 
       FIG. 3C  is a perspective view showing further detail with respect to connecting and separating single use portion  102  and multiple use portion  104 . In particular, connector  340  on multiple use portion  104  and connector  342  on single use portion  102  are configured to make both electrical and mechanical connections between units  104  and  102 . 
       FIGS. 4A-4D  are diagrams illustrating further detail of a grasper tool configured for use through the working channel of a cannula of an endoscopy system, according to some embodiments.  FIG. 4A  is a side view of grasper device  160  showing a main shaft  420  being bent at location  408 . As described supra, the bending amount at location  408  can be made less than (i.e. straighter) than the bending of the cannula  120 , such that the distal tip of the grasper  160  is pushed slightly toward the camera axis or toward the center of the camera field of view. According to some embodiments, the main shaft  20  is not pre-bent at all and is completely straight prior to insertion or after removal from cannula  120 .  FIG. 4B  is a top view of grasper device  160 , while  FIG. 4C  is a more detailed top view of the distal tip of grasper  160 . Various dimensions are shown for this example device.  FIG. 4D  shows a cross section view along A-A′ of  FIG. 4B . The shaft  420  of grasper  160  is shown formed of two layers  422  and  424 . According to some embodiments, the layers  422  and  424  of shaft  420 , arch-shaped portions  182  and  184 , jaw portions  162  and  164 , and claw portions  172  and  174  are made of two pieces of the same material, or a single piece of material folded at the proximal end. According to some embodiments, the two pieces of material can be joined or welded at one or more locations  426  along the shaft  420  as shown in  FIG. 4B . According to some embodiments, the material is a type of memory metal or memory metal alloy or a non-metal material configured to bias the jaws portions  162  and  164  to be spread apart such as shown in  FIG. 4C . This allows for the claw portions  172  and  174  of grasper device  160  to be closed and opened solely by translating its position axially relative to the device channel opening  116  (shown in  FIGS. 10 and 3B ) as is shown in greater detail in  FIGS. 6A-6D . In this way, the grasper device  160  can be relatively simple, low cost, and robust when compared to more complex arrangements such as those that include scissor-like actuation structures. According to some embodiments, each piece  422  and  424  has a cross-sectional dimension of 0.5 mm thick and 1.5 mm wide, such that the overall cross-sectional dimension of the shaft  420  is 1 mm by 1.5 mm. 
       FIGS. 5A-5E  are diagrams illustrating further detail of a distal tip piece and cannula for an endoscopy system having a disposable cannula with a working channel configured to accept a grasper device, according to some embodiments.  FIG. 5A  is perspective view of distal tip piece  310 . According to some embodiments, the distal tip piece  310  is formed as a separate piece and is bonded to the distal end of cannula  120  during assembly. In  FIG. 5A , the camera module and LEDs are not shown for clarity. Visible are camera distal opening  530  and LED distal openings  532  and  534 . Also visible in  FIG. 5A  are distal fluid ports  320  and  520 . According to some embodiments, the device channel  516  and device channel opening  116  can also be used as a fluid channel and fluid port, respectively. 
       FIG. 5B  is a side view of distal tip piece  310 . According to some embodiments, the maximum outer diameter of tip piece  310  and cannula  120  is 6.0 mm. In the example shown, the dimensions of the outer diameter of tip piece  310  can be 5.6 mm in cases where the cannula outer diameter is about 4.85 mm. According to some embodiments, the tip piece  310  can have an outer diameter of 5.1 mm in cases where the cannula outer diameter is about 4.65 mm. Also visible in  FIG. 5B  is the angled upper distal face portion  510  which as described supra, provides for positioning of the device opening to be slightly more distal than the surface of camera module, which allows for a better view by the camera module of the grasper claw portions, or other tool being deployed. According to some embodiments, the face portion  510  is angled distally by about 25 degrees or 30 degrees. 
       FIG. 5C  is a front view of distal tip piece  310 . In this view the camera module  330  and LEDs  332  and  334  are shown inserted in openings  530 ,  532  and  534  (which are shown in  FIG. 5A ), respectively. The diameter of the device channel opening  116  can be 2.0 mm in cases where the outer diameter of piece  310  is 5.6 mmm, and can be 1.6 mm in cases where the outer diameter of piece  310  is 5.1 mm.  FIG. 5D  cross-section view along B-B′ of  FIG. 5C . The proximal opening  512  is dimensioned to accept and be bonded with the distal end of cannula  120 . The inner diameter of opening  512  can be 4.85 mm in cases where the outer diameter of the cannula is 5.6 mm, and can be 4.65 mm in cases where the outer diameter of the cannula is 5.1 mm. 
       FIG. 5E  is a cross section view of canula  120 . The device channel (or working channel)  516  is visible and is used to carry the grasper device  160  or another tool. Also visible are the fluid lumens  522  and  524 , and cable lumen  526 . According to some embodiments, fluid lumens  522  and  524  are fluidly attached to proximal fluid port  132 ,  232  or  234  (shown in  FIGS. 1B and 2 ) and to distal fluid ports  320  and  520 . The cable lumen  526  is used to carry the electrical cable(s) used by the camera module and LEDs. According to some embodiments, device channel  516  having an inner diameter of 2.0 mm provides adequate fluid flow capacity when the grasper shaft  420  (shown in  FIG. 4D ) has a dimension of 1 mm by 1.5 mm. 
       FIGS. 6A-6D and 7A-7D  are two sets of diagrams illustrating a process of opening, closing, and retracting a grasper device from an endoscopy system, according to some embodiments.  FIGS. 6A-6D  illustrate the grasper  160  in different positions relative to the distal tip  110  while  FIGS. 7A-7D  show the relative positions of the collar  170  configured to control grasper  160  and shaft  168 .  FIGS. 6A and 7A  show the grasper and collar positions, respectively, when the grasper jaw portions  162  and  164 , and claw portions  172  and  174  in an “open” position. In this position, the arch shaped portions  182  and  184  protrude distally from the device opening  116  as can be seen in  FIG. 6A . The collar  170  is shown in a distal position relative to shaft  168  as shown in  FIG. 7A . The collar  170  is mounted or otherwise securely directly or indirectly attached to a proximal end of main shaft  420  (shown in dashed outline) of the grasper device. While the grasper  160  is in the distally protruded position from the distal opening  116  as shown in  FIGS. 6A and 7A , the biased shape of the grasper device maintains the jaw portions  162  and  164  and claw portions  172  and  174  apart from each as shown. 
       FIGS. 6B and 7B  show the grasper and collar positions, respectively, when the grasper being moved proximally relative to the distal device opening  116  as indicated by dashed arrow  620  in  FIG. 6B . This is accomplished by the operator manually sliding collar  170  proximally along shaft  168  as shown by dashed arrow  720  in  FIG. 7B . In the position shown in  FIGS. 6B and 7B , the proximal ends of arched shaped portions  182  and  184  are just beginning to engage with edge of distal opening  116 . This engagement will tend for force the claw portions  172  and  174  towards each other, as shown by dashed arrows  622  in  FIG. 6B . Note that due to the distanced between the device opening  116  and claw portions  172  and  174 , the camera module  330  having a wide-field of view (depicted by dotted lines  730 ) has a good view of claw portions  172  and  174  and any tissue (or object) that might be the target of being grasped (not shown). 
       FIGS. 6C and 7C  show the grasper and collar positions, respectively, when the grasper claws securely clamped towards each other. In  FIG. 6C , it can be seen that the arched portions  182  and  184  are shown retracted proximally of distal device opening  116 . In  FIG. 7C  the collar  170  is shown in a more proximal position relative to shaft  168  than in  FIG. 7B . The arched portions  182  and  184  are forced together with the device channel (either within tip piece  310  or working channel  516  of cannula  120  (shown in  FIG. 5E ). Portions  182  and  184  being held together forces the claw portions  172  and  174  to be in a closed position and any tissue (or other object) that might be being grasped (not shown) is securely held by the claw portions. 
       FIGS. 6D and 7D  show the grasper and collar positions, respectively, when the grasper device  160  retracted even more proximally than in  FIG. 6C . In  FIG. 6D , the claw portions  182  and  184  are shown nearly flush with the distal face of opening  116 . In  FIG. 7D  the collar  170  is shown retracted fully proximally along shaft  168 . 
       FIG. 8  is a block diagram illustrating the operation of using an endoscopy device with an integrated grasper, according to some embodiments. In block  810 , the endoscope (e.g. endoscopy device  100  shown in  FIGS. 1A, 1B and 3A ) is inserted into the target cavity while the grasper is retracted (e.g. in the position shown in  FIG. 7D ). Examples of target cavities include the bladder and uterus, although the endoscopy device and integrated grasper can be configured for insertion into and in operation with other cavities in the human body. In block  812  the endoscope is translated or rotated to approach the target. In block  814  the tab or collar (e.g. collar  170  shown in  FIGS. 1A-B ,  2 ,  3 A,  3 C and  7 A- 7 D) at the proximal end of the cannula is pushed distally. Pushing the tab or collar distally causes the grasper or needle to protrude out of the distal tip of the cannula. The grasper jaw opens after emerging from the distal cannula (such as shown in  FIG. 7A ). In block  816 , under direct view of camera images being shown on the integrated display (e.g. display  150  shown in  FIGS. 1A-B ,  2 , and  3 A), the claw portions of the grasper (e.g. portions  172  and  174  shown in  FIGS. 10, 3B, 4C  and  6 A- 6 D) are positioned around the target while advancing the cannula. In block  818  the grasper is retracted back into the cannula which forces the jaw to close and grab the target securely, such as shown in  FIGS. 6C and 6D . According to some embodiments, applications for using the endoscopy device with integrated grasper include, without limitation: stent removal, foreign body removal, hysteroscopy and endometrium biopsy. According to some embodiments, pushing the tab or collar distally can have the opposite effect and cause the grasper or needle to retract and pulling the tab or collar proximally can cause the grasper or need to extent. 
       FIG. 9A  is a perspective view showing an endoscopy system having cannula with an integrated grasper device, according to some further embodiments. In this case the single-use portion  902  is configured to be mounted and unmounted with multiple use portion  904 . According to some embodiments, multiple use portion  904  is similar or identical to the multiple use portions shown and described in the commonly assigned incorporated applications. The single-use portion  902  and reusable portion  904  attach mechanically primarily via mating mechanical connectors  920  and  922 , as shown by the dotted arrow. Electrical connection is made via separate mating electrical connectors  910  and  912 . Instead of collar  170  sliding along shaft  168  of single use portion  102  (shown in  FIGS. 1A, 1B and 3A ), in  FIG. 9A , tab  970  is provided that is configured to slide along shaft  968  as shown by the dashed arrow. Tab  970  is attached to the proximal end of the grasper device  160 . An additional fluid port  932  is provided that is fluidly connected to the device channel (e.g.  516  in  FIG. 5E ) through which grasper  160  is positioned. Also shown in  FIG. 9A  is a fluid line  962  and syringe  960  which can be attached to fluid port  932 . The syringe  960  can be used to draw fluid samples (and tissue particles suspended therein) back through the distal device opening ( 116 ), device channel ( 516 ), port  932  and into syringe  960 . A second syringe  964  and fluid line  966 , or other fluid delivery device, can be attached to fluid port  132  to provide in-flow fluid via ports  320  and  520  at distal tip  110  (shown in  FIG. 3B ). According to some embodiments, the two fluid ports  132  and  932  can provide “continuous inflow/out flow” operation. According to some embodiments, fluid or tissue debris can be withdrawn from the target cavity through port  932  while in-flow fluid (such as saline) is provide via port  132 . In this way, inflow fluid distention and pressure can be controlled during the procedure. According to some embodiments, the in-flow and out-flow can be reversed between ports  132  and  932  such that port  932  is used for fluid in-flow (via device opening  116 ) and port  132  is used for fluid (and tissue) out-flow via distal ports  320  and  520 . 
     The remaining components of the single use portion  902  are similar or identical to single use portion  102  and components thereof shown in  FIGS. 1A, 1B, 3A, 3B, 4A-4D, 5A-5D and 6A-6D . It is understood that single use portion  902  could be substituted for single use portion  102  in any descriptions or depictions of portion  102  herein. It is also understood that multiple use portion  904  could be substituted for multiple use portion  104  in any descriptions or depictions of portion  104  herein. For example, it is understood that hand piece  140  includes two buttons configured for power on/off as well as optionally a third button configured as an exposure and/or lighting control button, as described, supra. 
       FIGS. 9B-9D  are side, top and bottom views, respectively, of a single-use portion of an endoscopy system with an integrated grasper device, according to some further embodiments. According to some embodiments, the working length L of cannula  120  including distal tip  110  is between 250 mm and 300 mm. According to some embodiments, the working length L is 275 mm and the distance d, where the grasper  160  is fully distally protruded, is 15 mm. 
       FIG. 9E  is an exploded view showing further details of a single-use portion of an endoscopy system with an integrated grasper device, according to some further embodiments. At the distal end, distal tip piece  310 , camera module  330  and LEDs  332  and  332  are shown. Electrical cable  972  is shown which is connected at its distal end to camera module  330  and LEDs  332  and  332 . Grasper  160 , including its elongated shaft  420 , is also shown. Grasper  160  and cable  972  are positioned in separate lumens ( 516  and  526 , respectively, shown in  FIG. 5E ) within cannula  120 . At the proximal end of cannula  120 , hub  130  is shown which has an inner cavity in fluid communication with fluid port  932 . According to some embodiments, the device channel  516  of cannula  120  has an opening (e.g. by “skiving”) within hub  130  to provide fluid communication between the device channel and fluid port  932 . A silicone seal  990  is provided to prevent fluid leakage proximally of hub  130 . The seal  990  has two openings through which cable  972  and shaft  420  of grasper  160  pass. The second fluid port  132  is in fluid communication with fluid hub housing  980 . The cavity within housing  980  is in fluid communication with the fluid lumens of cannula  120  (lumen  522  and lumen  524  shown in  FIG. 5E ), for example by an opening (e.g. by “skiving”). The proximal end of hub  980  is sealed with silicone seal  992 , which also has two openings through which cable  972  and shaft  420  of grasper  160  pass. Grasper end piece  994  can be a machined metallic piece that is bonded (e.g. by welding) to the proximal end of shaft  420 . End piece  994 , in turn, is securely mounted to slider piece  974  which includes tab  970 . Slider piece  974  also includes spring tab  1020  which is shown in  FIGS. 10A-10D  and described in further detail, infra. Slider piece  974  is dimensioned to slide within shaft housing  968 . According to some embodiments, elastomer ring  996  is provided to add additional frictional resistance to the sliding actuation of the slider piece  974  and grasper  160 . A rotation socket  984  fits into shaft housing  968  proximal to the slider piece  974 . The socket  984  accepts slotted axle piece  986  to allow for rotation of socket piece  984 , shaft housing  968 , slider piece  974 , and all of the components located distally of axle piece  986  as shown by arrows  122  (and also shown in  FIGS. 1A-1B, 2, 3A, 9A-9D and 11A ) relative to multiple-use portion  140 . According to some embodiments, rotation is confined to, slightly less than 180 degrees in either direction to avoid excessive torsional stress on cable  972 . 
       FIGS. 10A-10D  are a set of diagrams illustrating a process of opening, closing, and retracting a grasper device from an endoscopy system, according to some embodiments.  FIGS. 10A-10D  are similar to  FIGS. 7A-7D  except that tab  970  is actuated instead of collar  170 . In particular, the positions of tab  970  shown in  FIGS. 10A, 10B, 100 and 10D  correspond to the positions of grasper  160  shown in  FIGS. 6A, 6B, 6C and 6D , respectively. Note that in the example shown, single use portion  902  is configured with only one fluid port ( 132 ) instead of two fluid ports (e.g.  132  and  932  as shown in  FIGS. 9A-9E ). In such cases fluid port  132  can be configured as fluidly communicating with the side fluid lumens  522  and  524  and distal fluid ports  320  and  520  (shown in  FIGS. 5E and 5A , respectively). According to some embodiments, device channel ( 516  shown in  FIG. 5E ) is not fluidly attached to any proximal fluid port. According to some other embodiments, an alternative proximal fluid port  934  can be configured to be fluidly attached to the device channel to provide a total of two proximal fluid ports. 
     According to some embodiments, the shaft  968  also includes a releasable locking mechanism as well. In the position shown in  FIG. 10A , a spring tab  1020  protrudes through distal window  1034 . The shape of tab  1020  has a square shaped proximal edge  1040  that engages the square shaped proximal edge of window  1034  which effectively “locks” or prevents retraction or proximal movement of grasper  160  relative to the cannula  120  (shown elsewhere). When the operator wishes to retract the grasper (or needle), the lock release button  1030  is depressed which forces the spring tab  1020  inwards though the window  1034 . In the depressed state, the spring tab  1020  is no longer “locked” by the distal window  1034  and the actuation tab  970  can then be moved rearwards or proximally relative to the housing of shaft  968  which causes the grasper (or needle) to retract. According to some embodiments, the spring tab  1020  can be shaped with square edges on both proximal and distal sides which will allows for the grasper (or needle) to be releasably locked in the both the retracted position (shown in  FIGS. 10D and 6D ) and protruded position (shown in  FIGS. 10A and 6A ). In such cases, the lock release button  1030  is used to unlock the tab  1020  in either position to allow actuation of the grasper (or needle). For further details of a possible configuration of spring tab  1020  and the locking mechanism(s) see, e.g. U.S. Ser. No. 15/462,331, one of the commonly assigned incorporated applications. 
       FIGS. 11A-11B  are perspective diagrams of an endoscopy system having cannula with an integrated needle, according to some embodiments. The needle  1160  could be used, for example, in surgical procedures to inject fluid such as a drug into the patient&#39;s tissues. Shown is single use portion  1102  configured with needle  1160  positioned in the working channel of the canula  120  (e.g. working channel  516  in  FIG. 5E ). In the example shown, fluid port  132  is configured as fluidly communicating with the side fluid lumens  522  and  524  and distal fluid ports  320  and  520  (shown in  FIGS. 5E and 5A , respectively). Proximal fluid port  934  next to sliding tab  970  is configured to be fluidly attached to the central channel  1162  of needle  1160 . 
     Apart from substituting needle  1160  for grasper  160  and the configuration of fluid port  934  described supra, the rest of the single use portion  1102  is the same or similar to single use portions  902  and  102  shown and described elsewhere herein. According to some embodiments, the needle  1160  is positioned within working channel  516  (shown in  FIG. 5E ) which is off-center and on the concave side of the bend portion  108  of the cannula  120 . Positioning an otherwise straight needle  1160  within the working channel on the concave side of the bend (above center in this case) the natural spring-like stiffness of the needle  1160  will tend to force of needle back towards the center, or downward in this case, when exiting the device channel opening  116 . The effect is that the distal tip of needle  1160  will be pushed slightly toward the camera axis or toward the center of the camera field of view, making for better imaging and viewing of the tool by the operator. 
     Although the foregoing has been described in some detail for purposes of clarity, it will be apparent that certain changes and modifications may be made without departing from the principles thereof. It should be noted that there are many alternative ways of implementing both the processes and apparatuses described herein. Accordingly, the present embodiments are to be considered as illustrative and not restrictive, and the body of work described herein is not to be limited to the details given herein, which may be modified within the scope and equivalents of the appended claims.