Patent Publication Number: US-2023157523-A1

Title: Endoscope Comprising Geared Elevator Mechanics

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority from and the benefit of European Patent Application No. 21209850.3, filed Nov. 23, 2021, which is incorporated by reference herein in its entirety. 
     TECHNICAL FIELD 
     The present disclosure relates to an endoscope including a manually operable element linked via elevator mechanics to an elevator element at the tip of the endoscope to raise and lower the elevator element. 
     BACKGROUND 
     Endoscopes, including specialized versions thereof such as bronchoscopes, arthroscopes, colonoscopes, laparoscopes, gastroscopes and duodenoscopes are well known from the state of the art and are used for visual examination and diagnosis of hollow organs and body cavities, as well as to assist in surgery, e.g. for a targeted tissue sampling. Basically, a distal tip unit of an endoscope, which is usually connected to a proximal endoscope handle via a bending section and an insertion tube, can be inserted into a hollow organ or body cavity to be investigated with the endoscope. Both reusable and disposable, i.e. single-use, endoscopes are known from the state of the art. 
     Some endoscopes, in particular duodenoscopes, comprise a distal tip unit having a shovel-like elevator element, a so-called Albarran lever, via which a direction of a tool or an instrument inserted into a patient&#39;s body cavity via a working channel of the endoscope can be changed. The elevator element can be raised and lowered in order to set an angle with respect to a longitudinal axis of the distal tip unit at which the tool or instrument exits the distal tip unit into the patient&#39;s body cavity. In a raised position of the elevator element, the tool or instrument may e.g. point in a direction perpendicular or approximately perpendicular to the longitudinal axis of the distal tip unit. It is known to control the elevator element via a manually operable element like a control lever provided at the endoscope handle. Elevator mechanics are usually provided via which the manually operable element is connected to a (pull) wire which extends through the insertion cord of the endoscope and which is connected to the elevator element in the distal tip unit. 
     In related art endoscopes, it is known to invert a motion of the manually operable element by the elevator mechanics such that a downward-movement of the manually operable element results in an upward-movement of the elevator element and that an upward-movement of the manually operable element results in a downward-movement of the elevator element. An operator of related art endoscopes is used to said described motion inversion. 
     In order to reach the motion inversion it is known from related art endoscopes to connect a slider rod to an operation wheel connected to the manually operable element at a portion of the operation wheel which is approximately diametrically opposed to a portion of the operation wheel where the manually operable element is connected to the operation wheel. Said differently, the slider rod is not connected to the operation wheel at a side of the same where the manually operable element is provided, but is connected to the operation wheel at an opposed side. Thusly, approximately diametrically opposed includes a range of positions on the opposite side, the range including a diametrically opposed position. Therefore, the slider rod moves around inside a handle housing of the endoscope handle, in particular in a central portion of an accommodation space defined by the handle housing or even in a portion of the handle housing which is close to a surface/wall which is opposed to a surface/wall at which the manually operable element is provided. 
     Due to the moving slider rod inside the handle housing, much installation/accommodation space provided inside the handle housing cannot be used for other parts/components like valves, which are intended to be accommodated inside the handle housing. 
     U.S. Pat. No. 5,507,717 discloses an endoscope with an elevator at its distal end, wherein the elevator is controlled by a control lever, which is connected to an elevator rod and a slider. 
     Further, U.S. Pat. No. 5,460,168 discloses an endoscope with an elevator at the distal tip. The elevator is controlled by a lever. The lever is connected to a control lever gear wheel. The control lever gear wheel has teeth that are in engaging contact with a toothed portion of a connecting member formed as a rack that is movable in an axial direction. The connecting member is connected to a wire that runs to the elevator at the distal tip. 
     JP 3 349 804 B2 discloses an endoscope with an elevator, which is controlled by a lever. In an embodiment, the lever is connected to a larger gear wheel that is in meshing contact with a smaller gear wheel. A wire is sandwiched between the two gear wheels. A wire end is not connected to any component/part. 
     Moreover, CN 111012287 A discloses a single-use endoscope with a forceps lifter at its distal tip. The lifter is activated by a lever. The lever is connected to a first gear wheel that meshes with a second gear wheel. The second gear wheel meshes with a third gear wheel. The third gear wheel is in contact with a rack that moves in an axial direction. The movement of the rack drives a wire that is connected to the forceps lifter. The elevator mechanics provided in CN 111012287 A have the disadvantage that they need much installation space. Moreover, the plurality of meshing engagements provided between the plurality of gear wheels and the toothed rack leads an increased play in the elevator mechanics, which is also disadvantageous. 
     SUMMARY 
     In view of the above-described problems, it is an object of the present disclosure to avoid or at least to mitigate the problems of the related art, in particular to provide an endoscope having an endoscope handle comprising a handle housing, which is compact and in which an available installation space is appropriately used, and comprising a manually operable element which is connected to an elevator element provided in the distal tip unit of the endoscope via simple elevator mechanics having in particular a low number of parts, wherein the elevator mechanics are configured such that when the manually operable element is moved in a downward or distal direction, the elevator element is moved to a raised elevator position, and when the manually operable element is moved in an upward or proximal direction, the elevator element is moved to a lowered elevator position. 
     This object is solved by an endoscope in accordance with claim  1  and by a visualization system comprising an endoscope and a monitor in accordance with claim  17 . Advantageous aspects of the present disclosure are claimed in the dependent claims and/or are described herein below. 
     The present disclosure relates to an endoscope comprising: an endoscope handle comprising a handle housing and at least one manually operable element; and an insertion cord configured to be inserted into a patient&#39;s body cavity and comprising a distal tip unit, the distal tip unit comprising an elevator element movable between a first lowered elevator position and a second, raised, elevator position for changing a direction of a tool or an instrument inserted into the patient&#39;s body cavity via a working channel of the endoscope; wherein the manually operable element is connected to the elevator element via elevator mechanics provided inside the handle housing and a wire, and a manual operation of the manually operable element is transmitted via the elevator mechanics and the wire to the elevator element such that a first operation position of the manually operable element corresponds to the first lowered elevator position and a second operation position of the manually operable element corresponds to the second, raised, elevator position; and wherein the elevator mechanics comprise: an operation wheel connected to the manually operable element and comprising an operation wheel gear portion; and a wire wheel comprising a wire wheel gear portion; wherein the operation wheel gear portion is in meshing engagement with the wire wheel gear portion; and wherein the wire is connected to the wire wheel. 
     Summarized, according to the present disclosure an endoscope is provided, which comprises an endoscope handle. The endoscope handle comprises a handle housing and a manually operable element. The endoscope further comprises an insertion cord comprising a distal tip unit. The distal tip unit comprises an elevator element, which is movable between a first elevator position and a second elevator position. The manually operable element is connected to the elevator element via (geared) elevator mechanics and a wire. A manual operation of the manually operable element is transmitted via the elevator mechanics and the wire to the elevator element such that a first operation position of the manually operable element corresponds to the first elevator position and a second operation position of the manually operable element corresponds to the second elevator position. The elevator mechanics comprise an operation wheel connected to the manually operable element and comprising an operation wheel gear portion. The elevator mechanics further comprise a wire wheel comprising a wire wheel gear portion. The operation wheel gear portion is in meshing engagement with the wire wheel gear portion. The wire is connected to the wire wheel. 
     The present disclosure thus provides geared elevator mechanics, which use/comprise (exactly) two gear wheels (the operation wheel having the operation wheel gear portion and the wire wheel having the wire wheel gear portion) for inverting a motion of the manually operable element, instead of the slider rod and the slider as known from the related art. The elevator mechanics in accordance with the present disclosure comprise few parts and thus do not need much installation space inside the handle housing. In other words, the installation space inside the handle housing is appropriately used and the handle housing may be formed compactly. As the elevator mechanics according to the present disclosure do not provide a slider rod moving around in a proximal end portion of the handle housing, the available space can be used for other components/parts like valves and in addition, a risk of affecting a tubing or control wires by such a moving slider rod is excluded. Diameters of the gear wheels may be suitably set so as to provide a desired gearing and to occupy little installation space. Torques and forces for raising the elevator element may be set by appropriately defining the diameters of the gear wheels, a lever arm defined by a distance of the manually operable element to a rotational center of the operation wheel and a lever arm defined by a connection point of the wire to the wire wheel. The provision of (only) two gear wheels makes it possible that a play of the elevator mechanics is not unnecessarily increased. 
     The endoscope according to the present disclosure is preferably a single-use endoscope, i.e. is intended and designed for single-use only. 
     Further, the endoscope according to the present disclosure is preferably a duodenoscope, i.e. is especially designed for examining the duodenum. 
     The endoscope handle may comprise a working channel access port, and the working channel may extend from the working channel access port of the endoscope handle to the distal tip unit of the insertion cord. Further, the insertion cord may comprise an insertion tube and an actively bendable bending section in addition to the distal tip unit. There may be provided at least one, preferably two, operation unit like a control wheel at the endoscope handle for actively bending the bending section in at least one bending plane i.e. two directions, preferably in two bending planes i.e. four directions. The operation unit may be connected to a shaft, which again may be connected to a wire drum, in which steering/control wires for controlling a bending movement of the bending section run. It is to be understood however that the present disclosure is not limited to a flexible endoscope having an insertion cord with an actively bendable bending section. I.e. the endoscope according to the present disclosure may also be a stiff endoscope, an insertion cord of which cannot be actively bent. 
     The elevator element of the present disclosure is preferably a shovel-like elevator element, in particular a so-called Albarran lever. In the first lowered elevator position, the elevator element is preferably arranged such that the instrument or tool may be inserted into the patient&#39;s body cavity in a direction, which is preferably only slightly angled with respect to the longitudinal axis direction of the distal tip unit. There is thus preferably only a slight change of direction (or even no change of direction) of the instrument or tool, which is inserted into the patient&#39;s body cavity via the working channel when the elevator element is in the first lowered elevator position. In the second, raised, elevator position, the elevator element is preferably arranged/angled such that the instrument or tool is inserted into the patient&#39;s body cavity in a direction approximately perpendicular to the longitudinal axis direction of the distal tip unit. The (pull) wire preferably extends from the endoscope handle to the distal tip unit, preferably via the insertion tube and the bending section, and may be fixed/attached to the elevator element in the distal tip unit. 
     Preferably, the manually operable element, via which the elevator element may be actuated/operated, is moved or rotated in a distal direction, which an operator of the endoscope may perceive as downward-movement, in order to transfer the manually operable element from the first operation position to the second operation position and thus the elevator element form the first lowered elevator position to the second, raised, elevator position. Further, preferred, the manually operable element is moved or rotated in a proximal direction, which an operator of the endoscope may perceive as upward-movement, in order to transfer the manually operable element from the second operation position to the first operation position and thus the elevator element from the second, raised, elevator position to the first lowered elevator position. It is to be understood that in the context of the present disclosure “proximal” means away from a patient, towards a user/operator and “distal” means towards the patient, away from the user/operator. Moreover, it is to be understood that the manually operable element may be moved/rotated in any position between the first operation position and the second operation position in order to adjust an angle with respect to the longitudinal axis of the distal tip unit, in which the instrument or tool is inserted into the patient&#39;s body cavity. 
     The manually operable element is preferably a control lever. The control lever may have a gripping surface adapted to and provided for being actuated/operated by the user/operator. The gripping surface may e.g. be ribbed, corrugated, grooved, serrated, recessed, etc., in other words may have a haptic structure so that the user can haptically perceive the manually operable element without looking at the same. Preferably, the gripping surface may be (convexly or concavely) curved, and may e.g. be adapted to a finger like a thumb of the user/operator. 
     Preferably, the manually operable element is fixedly connected to the operation wheel, so that the manually operable element and the operation wheel rotate integrally with each other. I.e. a rotational input provided on the manually operable element by the user/operator preferably results directly in a rotation of the operation wheel due to the fixed connection between the manually operable element and the operation wheel. 
     Further preferred, the manually operable element extends through an opening, which is in particular formed as a slot-shaped opening, provided in the handle housing so as to be accessible by the user/operator. The manually operable element may be movable/displaceable/rotatable along the (slot-shaped) opening. The opening may define the first operation position and the second operation position of the manually operable element. In particular, when the manually operable element hits a proximal-most end of the opening, the manually operable element may be in the first operation position, and when the manually operable element hits a distal-most end of the opening, the manually operable element may be in the second operation position. 
     Preferably, the operation wheel is rotatably mounted in the handle housing of the endoscope handle, e.g. on a (cylindrical) protrusion provided inside the handle housing, and may thus rotate around its rotational center. 
     The operation wheel gear portion of the operation wheel may be an external gear/may comprise external teeth. Basically, the operation wheel gear portion may be provided/may extend over an entire outer circumference of the operation wheel, which according to an embodiment may be disc-shaped, i.e. may have a round/circular outer circumference. Alternatively, the operation wheel gear portion may be provided only in a subarea, in particular in an angular range smaller 180°, preferably between 45° and 180°, on the outer circumference of the operation wheel. In particular, the subarea or angular range in which the operation wheel gear portion having the external teeth/gear is provided may be adjusted to an angular range in which the manually operable element may be rotated inside the (slot-shaped) opening provided in the handle housing of the endoscope handle. The operation wheel may in this light advantageously have a shape corresponding to a portion or part of a disc, comprising at least the rotational center and the operation wheel gear portion in a subarea/angular range, with portions of a hypothetical/imaginary full disc removed. E.g. the operation wheel, which preferably has a flat shape, may not be circular/round but may only have a round/circular portion and two, preferably straight, edges, which are in particular angled with respect to each other. According to said preferred embodiment, less assembly space is occupied by the operation wheel inside the handle housing of the endoscope handle. 
     Further, the wire wheel may be rotatably mounted in the handle housing of the endoscope handle, e.g. on a (cylindrical) protrusion provided inside the handle housing, and may thus rotate around its rotational center. 
     The wire wheel gear portion of the wire wheel may be an external gear/may comprise external teeth. Basically, the wire wheel gear portion may be provided/may extend over an entire outer circumference of the wire wheel, which according to an embodiment may be disc-shaped, i.e. may have a round/circular outer circumference. Alternatively, the wire wheel gear portion may be provided only in a subarea, in particular in an angular range smaller 270°, preferably between 45° and 270°, on the outer circumference of the wire wheel. In particular, the subarea or angular range in which the wire wheel gear portion having the external teeth/gear is provided may be adjusted to the angular range of the operation wheel gear portion of the operation wheel. The wire wheel may in this light advantageously have a shape corresponding to a portion or part of a disc, comprising at least the rotational center and the wire wheel gear portion in a subarea/angular range, with portions of a hypothetical/imaginary full disc removed. E.g. the wire wheel, which preferably has a flat shape, may not be circular/round but may only have a round/circular portion and two, preferably straight, edges, which are in particular angled with respect to each other. According to said preferred embodiment, less assembly space is occupied by the wire wheel inside the handle housing of the endoscope handle. 
     The wire wheel is preferably arranged distally with respect to the operation wheel inside the handle housing of the endoscope handle. Therefore, more installation space is available in a proximal part/portion of the endoscope handle for other components/parts like valves. 
     Preferably, the operation wheel and the wire wheel have a flat shape, in particular a flat disc-shape. A flat shape of both the operation wheel and the wire wheel has the advantage that not much assembly space is occupied by the operation wheel and the wire wheel. 
     The operation wheel may rotate around an axis defined by its rotational center which may correspond to an axis around which the operation unit, the shaft and the wire drum (for bending the bending section of the insertion cord) can be rotated. Said differently, the operation wheel may be arranged concentrically and coaxially to the operation unit, the shaft and the wire drum. This embodiment in combination with the flat shape of the operation wheel makes it possible to suitably use an assembly space in a proximal portion of the handle housing. E.g. the operation wheel may have an annular/ring-shape and may be supported by an outer shell surface of a (hollow) cylindrical protrusion provided in the handle housing, wherein on the inner shell surface of the (hollow) cylindrical protrusion the operation unit(s), the shaft(s) and the wire drum(s) may be suitably supported. 
     According to a preferred embodiment, a radius of the operation wheel gear portion (a distance between the gear portion of the operation wheel having external teeth and the rotational center of the operation wheel) may be greater than a radius of the wire wheel gear portion (a distance between the gear portion of the wire wheel having external teeth and the rotational center of the wire wheel). Said differently, a diameter of the operation wheel may be greater than a diameter of the wire wheel. I.e. the large gear wheel (operation wheel) may in a way serve as a lever for the (power transmission) system, and the small gear wheel (wire wheel) may serve for inverting the motion. This embodiment has further the advantage that in particular the wire wheel does not occupy much assembly space. A radius of the wire wheel gear portion and a radial position on the wire wheel where the wire is connected to the wire wheel may be adjusted such that an appropriate gearing may be provided and that the force introduced into the operation wheel of the elevator mechanics via the manually operable element is suitably transmitted to the wire for actuating the elevator element. E.g. when the radius of the operation wheel gear portion is greater than the radius of the wire wheel gear portion, a torque applied on the wire wheel is smaller than a torque applied to the operation wheel. The torque applied to the operation wheel is dependent on the force applied by the user/operator and the lever arm, which is rather big for the operation wheel since the manually operable element preferably extends to the outside of the handle housing in order to be accessible to the user/operator. Although the torque applied on the wire wheel is reduced, the radial position where the wire is connected to the wire wheel and thus the lever arm may be set appropriately (smaller than the lever arm of the manually operable element) so that the force which is applied to the wire may e.g. correspond to the force which is applied to the wire in a related art endoscope. Therefore, the user/operator may perceive the operation of the elevator element as he is accustomed in related art systems. Said differently, the actuation of the elevator element preferably does not feel unusual or unfamiliar to the user/operator. In some instances it may be advantageous to provide a construction wherein the radius of the operation wheel gear portion is smaller than the radius of the wire wheel gear portion, e.g. to increase the torque applied on the wire wheel to increase the force on the wire. The most simple solution is to have meshing wheels of circular or semi-circular shape, but if considered advantageous meshing wheels of non-circular shape can be used, e.g. to tailor the motion or torque development over the range of motion. 
     Preferably, a wire pipe is provided, which is fixed to the handle housing of the endoscope handle, wherein the wire runs into the wire pipe. I.e. the wire is preferably guided into the wire pipe in order to prevent that the wire arbitrarily moves around inside the endoscope handle. The wire pipe may be fixed in position by gluing the same to the handle housing of the endoscope handle. The wire pipe preferably extends approximately in the proximal-distal direction so as to suitably guide the wire from the endoscope handle into the insertion cord, where it is further guided to the distal tip unit and connected to the elevator element. 
     According to the present disclosure the wire is connected to the wire wheel. According to a preferred embodiment the wire may be directly attached/fixed to a (radial outer) portion of the wire wheel, e.g. by gluing, tying a knot, crimping, a screwed connection, a soldered connection, etc., potentially in combination with looping a portion of the wire through an opening, a passage, a channel, a wire accommodating portion like a groove, etc. provided in the wire wheel. A direct attachment/connection of the wire to a portion of the wire wheel has the advantage that the number of components/parts used for the transmission of the manual operation a user/operator applies to the manually operable element to the elevator element remains quite small, going along with an easy assembly, reduced costs, a reduced required assembly space, etc. A small disadvantage of said embodiment may however be seen in the fact that the wire might move around excessively inside the handle housing, when the wire wheel rotates, the wire having in particular a movement component which is perpendicular to a proximal-distal direction, i.e. horizontally, so that the wire may extend/be directed in a direction which is angled with respect to the orientation/direction of the wire pipe when entering the wire pipe. This may lead to a friction acting on the wire, which is disadvantageous, and may also lead to a force applied to the wire pipe which may lead to a disconnection of the wire pipe from the handle housing or even to a kinking of the wire pipe. 
     Therefore, according to another preferred embodiment a connector element/part is provided, which is rotatably mounted on the wire wheel, wherein the wire is fixed/fixedly attached to the connector element. According to said embodiment, the wire is in a way indirectly connected to the wire wheel via the connector element. According to the present disclosure a connection between the wire and the wire wheel therefore is to be understood as a direct or indirect connection (via another part/component), as long as a movement of the wire wheel directly results in a movement of the wire, which is the case when the wire is fixedly attached to the mentioned connector element/part and the connector element/part (at least a portion mounted to the wire wheel) moves in accordance with a movement of the wire wheel, i.e. in a circle (i.e. both in the proximal-distal direction and perpendicular to the same/horizontally), wherein a radius of the circle is defined by a distance of a mounting position of the connector element/part to the rotational center of the wire wheel. 
     The elevator mechanics preferably comprise only two gear wheels, namely the elevator wheel and the wire wheel. Preferably, no further wheel having a gear portion is in meshing engagement with the operation wheel and/or the wire wheel. I.e. there is e.g. not provided a third wheel having a gear portion which is in meshing engagement with (gear portions of) the operation wheel and/or the wire wheel. 
     According to the embodiment, which provides the connector element/part, the wire wheel may have a protruding, (hollow) cylindrically formed (bearing) portion, which is provided radially away from the rotational center of the wire wheel, in a radially outer portion of the wire wheel, in particular close to the outer circumference of the wire wheel. The connector element/part may be rotatably mounted on said (bearing) portion of the wire wheel. 
     According to said preferred embodiment, the wire wheel may have the wire wheel gear portion, the rotational center defining a rotation axis around which the wire wheel is rotatable, and the protruding, (hollow) cylindrically formed (bearing) portion. The rotation axis of the wire wheel may be parallel to an axis of said (bearing) portion. 
     Preferably, a guide rail element/part may be provided which is rotatably mounted in the handle housing of the endoscope handle, wherein the connector element/part is slidingly accommodated in the guide rail element/part. According to an embodiment the wire pipe is fixedly attached to the guide rail element, e.g. by gluing. Attaching the wire pipe to the guide rail element will reduce the risk of the wire kinking outside the wire pipe, and could also reduce friction in the construction as there will be a relatively short portion of the wire not being protected by the wire pipe. 
     More specifically the connector element/part may comprise a (disc-shaped) connector mounting portion configured to be rotatably mounted on the wire wheel, in particular on the bearing portion of the wire wheel, and a (rod-like) slide portion. The guide rail element/part may comprise a rail mounting portion configured to be rotatably mounted on the handle housing and a guide rail portion (having a guide rail). The slide portion of the connector element may be slidingly accommodated in the guide rail portion of the guide rail element/part. The rail mounting portion of the guide rail element/part may be a distal portion of the guide rail element/part and the guide rail portion may extend from the rail mounting portion in a proximal direction towards the wire wheel, in particular to the (bearing) portion of the wire wheel. The wire may be fixed, in particular by gluing, crimping, a screwed connection, a soldered connection, etc., to a portion of the connector part/element. Especially preferred the wire is looped through, i.e. forms a loop in, the connector mounting portion of the connector element/part, is fixed to the connector element/part, in particular to the connector mounting portion of the connector element/part, and extends through the slide portion of the connector element/part. 
     Although a provision of the connector element/part and of the guide rail element/part may increase a number of components, it is to be understood that these additional components are preferably arranged distally with respect to the wire wheel, i.e. in a portion of the endoscope handle where it is easier to provide additional installation space. Therefore, the preferred embodiment having the connector element/part and the guide rail element/part in an advantageous way does not have moving parts in a proximal-most portion of the endoscope handle, so the installation space in the proximal-most portion of the endoscope handle is available for valves, the operation unit(s), shaft(s), wire drum(s), brake(s), etc. 
     The connector element/part is preferably a plastic component/part, especially preferred manufactured in an injection molding process. The same applies preferably for the guide rail element/part. 
     A proximal end portion of the wire pipe may be arranged adjacent/close to a distal end portion of the guide rail element/part. Since the rail mounting portion of the guide rail element/part is preferably provided at the distal end portion of the guide rail element, in particular adjacent a wire outlet opening of the guide rail element/part, the wire outlet opening remains at an substantially stationary/fixed position throughout an operation range of the manually operable element. In other words, the wire outlet opening preferably only experiences a slight rotational displacement. The proximal end portion of the wire pipe is especially preferred arranged adjacent/close to the wire outlet opening of the guide rail element/part. 
     An extension direction of the proximal end portion of the wire pipe may approximately correspond to an axis of the (guide rail portion of the) guide rail element and thus to an axis of the (rod-like) slide portion of the connector element/part, at least in any position of the manually operable element between the first operation position and the second operation position. 
     The wire preferably runs from the wire pipe directly into the connector element/part where it is attached/fixed. The guide rail element/part preferably serves for suitably orienting the connector element/part, so that the wire runs directly and straightly into the wire pipe. 
     The handle housing of the endoscope handle may comprise two half-shell parts attached, in particular glued, to each other. 
     In a mounted state of the handle housing, the handle housing may be defined so as to have a proximal handle housing portion and a distal handle housing portion, the proximal handle housing portion and the distal handle housing portion merging integrally into each other. The elevator mechanics, in particular the operation wheel and the wire wheel, are preferably arranged at least partially in the proximal handle housing portion. The proximal handle housing portion may thus form a receiving space for the elevator mechanics and may be defined, in particular when looking at a proximal end of the endoscope handle, so as to have a top surface/wall (portion), a bottom surface/wall (portion), a first side surface/wall (portion), a second side surface/wall (portion) and a front surface/wall (portion), wherein the top surface is opposite the bottom surface, the first side surface is opposite the second side surface, and the front surface is connected to the top surface, the bottom surface, the first side surface and the second side surface, and wherein the manually operable element may be provided/may be displaceable/rotatable in a rounded transition area between the bottom surface and the front surface. The top surface is preferably connected to the first and second side surfaces. The bottom surface is preferably connected to the first and second side surfaces. The front surface may be defined as proximal-most surface/wall of the handle housing of the endoscope handle. Preferably rounded transition areas are provided between all surfaces so that the endoscope handle receives a modern design and lies comfortably in a hand of the user/operator. 
     The manually operable element is preferably close to the front surface and distant from the bottom surface in the first operation position which corresponds to the first lowered elevator position. The manually operable element is preferably close to the bottom surface and distant from the front surface in the second operation position which corresponds to the second, raised, elevator position. 
     Preferably, the wire wheel is rotatably mounted in the handle housing, in particular on the first side surface or the second side surface, at a portion on the first side surface or the second side surface which is closer to the bottom surface than to the top surface. 
     Further, the connector part/element is preferably mounted on the wire wheel at a portion of the wire wheel which is between the rotational center of the wire wheel and the bottom surface of the proximal handle housing portion. 
     Moreover, the operation unit(s), in particular control wheel(s), which may be provided as further manually operable element(s), and which are preferably provided for actively bending a bending section of the insertion cord, may be provided on the first side surface or the second side surface of the proximal handle housing portion. When the operation unit(s) is/are provided on one of the side surfaces and the manually operable element for operating the elevator element is provided in a transition area between the front surface and the bottom surface, a risk of accidentally affecting the operation unit(s) is reduced when the manually operable element (the control lever) is operated. Therefore, according to the present disclosure the operation unit(s) and the manually operable element are preferably arranged on different surfaces of the proximal handle housing portion, so as to not accidentally influence each other. 
     Preferably, the connector part/element and the guide rail part/element are at least partially arranged distally with respect to the proximal handle housing portion, i.e. in the distal handle housing portion. 
     According to a preferred embodiment a valve assembly comprising a gas/water injection valve and a suction valve is provided. The valve assembly is preferably arranged adjacent the elevator mechanics, i.e. adjacent the operation wheel and the wire wheel in the handle housing. The valve assembly is preferably arranged in the proximal handle housing portion of the endoscope handle. Especially preferred the valve assembly is attached/provided on the top surface of the proximal handle housing portion. 
     Each of the valves may comprise a valve cylinder extending into the handle housing towards the elevator mechanics (the operation wheel and the wire wheel). Each of the valves may in addition comprise a plurality of tube ports extending (radially) away from the valve cylinders. 
     To sum up/Said in different words, the present disclosure relates to an endoscope, which is preferably a duodensocope, wherein the endoscope comprises a distal tip (unit) with an elevator (element) being movable from a lowered position to a raised positon via elevator mechanics (provided) at a proximal end of the endoscope, in particular the endoscope handle, wherein the elevator mechanics comprise an operation wheel/a control lever gear wheel connected to a manually operable element/a control lever and being in engaging contact with a (toothed) wire wheel, which in turn is connected to an elevator wire running through the endoscope to the distal tip (unit) and connected to the elevator element. 
     The present disclosure further relates to a system comprising an endoscope as described above and a monitor. 
    
    
     
       BRIEF DESCRIPTION OF FIGURES 
       The disclosure is explained in more detail below using preferred embodiments and referring to the accompanying figures. 
         FIG.  1    shows a side view of elevator mechanics provided in an endoscope handle in a related art endoscope. 
         FIG.  2    shows a functional principle of the elevator mechanics of the related art endoscope. 
         FIG.  3    shows an explanatory view of a power transmission chain between a manually operable element provided in the endoscope handle and an elevator element provided in a distal tip unit in the related art endoscope. 
         FIG.  4    shows a side view of elevator mechanics provided in an endoscope handle according to a first preferred embodiment of the present disclosure, in which a manually operable element is in a first operation position. 
         FIG.  5    shows a side view of the elevator mechanics according to the first preferred embodiment of the present disclosure, in which the manually operable element is in a second operation position. 
         FIG.  6    shows a side view of the elevator mechanics according to the first preferred embodiment of the present disclosure, with operational parts not forming part of the elevator mechanics being removed. 
         FIG.  7    shows a perspective view of the elevator mechanics according to the first preferred embodiment. 
         FIG.  8    shows a side view of elevator mechanics provided in an endoscope handle according to a second preferred embodiment of the present disclosure. 
         FIG.  9    shows a perspective view of the elevator mechanics provided in the endoscope handle according to the second preferred embodiment of the present disclosure. 
         FIG.  10    shows another perspective view of the elevator mechanics provided in the endoscope handle according to the second preferred embodiment of the present disclosure. 
         FIG.  11    shows a perspective view of the elevator mechanics provided in the endoscope handle according to the second preferred embodiment of the present disclosure, in which a manually operable element is in a first operation position. 
         FIG.  12    shows a perspective view of the elevator mechanics provided in the endoscope handle according to the second preferred embodiment of the present disclosure, in which the manually operable element is in a second operation position. 
         FIG.  13    shows a perspective view of an endoscope according to the second preferred embodiment, comprising an endoscope handle and an insertion cord, with an elevator element provided in a distal tip unit of the insertion cord, wherein a manually operable element provided at the endoscope handle is in the first operation position. 
         FIG.  14    shows a perspective view of the endoscope according to the second preferred embodiment, comprising the endoscope handle and the insertion cord, with the elevator element provided in the distal tip unit of the insertion cord, wherein the manually operable element provided at the endoscope handle is in the second operation position. 
         FIG.  15    shows a side view of a distal tip unit of the endoscope according to the present disclosure with an elevator element in a lowered elevator position. 
         FIG.  16    shows a side view of a distal tip unit of the endoscope according to the present disclosure with the elevator element in a raised elevator position. 
     
    
    
     The figures are schematic in nature and serve only to understand the disclosure. The features of the different embodiments can be interchanged among each other. 
     DETAILED DESCRIPTION 
     In  FIG.  1   ,  FIG.  2    and  FIG.  3    a related art endoscope  2  is shown, which has an endoscope handle  4  having a handle housing  6  (only a half shell of the handle housing  6  is shown in  FIG.  1   ) and a manually operable element  8  formed as an elevator control lever, which can be rotated in order to move a shovel-like elevator element, or object elevator,  10  (Albarran lever) provided in the distal tip unit  12  of the endoscope  2  between a lowered position and a raised position. A rotational input applied to the manually operable element  8  leads to a rotation of an operation wheel  14 , which is connected to the manually operable element  8 . A slider rod  16  is connected to the operation wheel  14  and is also connected to a slider  18 . The slider  18  is slidingly arranged in the handle housing  6  of the endoscope handle  4 . A wire  20  is fixed to the slider  18 . The wire  20  runs into a wire pipe  22  attached to the handle housing  6  and further into an insertion cord  24  of the endoscope  2 , in particular to the distal tip unit  12 , where the wire  20  is fixed to the elevator element  10 . A manual operation of the manually operable element  8  is thus transmitted via elevator mechanics  26 —comprising the operation wheel  14 , the slider rod  16  and the slider  18 —and the wire  20  to the elevator element  10 . 
       FIG.  2    schematically shows a functional principle of the elevator mechanics  26  of the related art endoscope  2 . In solid lines a first operation position  28  of the manually operable element  8  is shown, which corresponds to a first, lowered, elevator position  29  of the elevator element  10  as seen in  FIG.  3   . In dashed lines a second operation position  30  of the manually operable element  8  is shown, which corresponds to a second, raised, elevator position  31  of the elevator element  10 .  FIG.  2    shows a rotational center  32  of the operation wheel  14 , a first slider rod connection point  34 , where the slider rod  16  is connected to the operation wheel  14 , and a second slider rod connection point  36  where the slider rod  16  is connected to the slider  18 . The manually operable element  8  may rotate around an angle α in order to move between the first operation position  28  and the second operation position  30 . In particular, the manually operable element  8  is rotated in a distal direction, which an operator of the endoscope  2  perceives as downward-movement, in order to transfer the manually operable element  8  from the first operation position  28  to the second operation position  30  and thus the elevator element  10  form the first, lowered, elevator position  29  to the second, raised, elevator position  31 . The manually operable element  8  is rotated in a proximal direction, which an operator of the endoscope  2  perceives as upward-movement, in order to transfer the manually operable element  8  from the second operation position  30  to the first operation position  28  and thus the elevator element  10  from the second, raised, elevator position  31  to the first, lowered, elevator position  29 . Therefore, in the endoscope  2  a motion of the manually operable element  8  is basically inverted by the elevator mechanics  26  such that a downward-movement of the manually operable element  8  results in an upward movement of the elevator element  10  and that an upward-movement of the manually operable element  8  results in a downward-movement of the elevator element  10 . This is even better illustrated in the explanatory view shown in  FIG.  3   . An operator of the endoscope  2  is used to said described motion inversion. 
     In order to reach the motion inversion in the related art endoscope  2  it is necessary to connect the slider rod  16  to the operation wheel  14  at a portion of the operation wheel  14  which is approximately diametrically opposed to a portion of the operation wheel  14  where the manually operable element  8  is connected to the operation wheel  14 . Said differently, the slider rod  16  may not be connected to the operation wheel  14  at a side of the same where the manually operable element  8  is provided, but has to be connected to the operation wheel  14  at an opposed side. Therefore, the slider rod  16  moves around inside the handle housing  6  of the endoscope handle, in particular in a central portion of an accommodation space defined by the handle housing  6  or even in a portion of the handle housing  6  which is close to a surface/wall which is opposed to a surface/wall at which the manually operable element  8  is provided. 
     Due to the moving slider rod  16  inside the handle housing  6 , much installation/accommodation space provided inside the handle housing  6  cannot be used for other parts/components like valves which are intended to be accommodated inside the handle housing  6 . 
     In  FIGS.  4  to  7    a first preferred embodiment of the present disclosure is shown, including an endoscope handle  100  of an endoscope  102 . The endoscope handle  100  comprises a handle housing  104 . The handle housing  104  is formed by two half shells  106 , which are attached to each other, e.g. by gluing. Only one of the half shells  106  is shown in the figures, with the other half shell  106  removed for showing parts/components provided inside the handle housing  104 .  FIGS.  4  to  7    each only show a proximal handle housing portion  108  in its entirety. A distal handle housing portion  110  which is integrally formed with the proximal handle housing portion  108  is only partially shown in the figures. As best seen in  FIGS.  13  and  14   , the endoscope  102  comprises an insertion cord  112  connected to the endoscope handle  100  and configured to be inserted into a patient&#39;s body cavity, wherein the insertion cord  112  comprises an insertion tube  114 , an actively bendable bending section  116  and a distal tip unit  118 . 
     The proximal handle housing portion  108  forms a receiving space  120  for components/parts which are provided for operating the endoscope  102 . In particular, the proximal handle housing portion  108  comprises a top surface/wall  122 , a bottom surface/wall  124 , first and second side surfaces/walls  126  and a front surface/wall  128 . In the figures only one of the first and second side surfaces/walls  126  is shown since one of the half shells  106  of the handle housing  104  has been removed. The top surface/wall  122  is arranged opposite the bottom surface/wall  124 . The first and second side surfaces/walls  126  are arranged opposite with respect to each other. The front surface/wall  128  is connected to the top surface/wall  122 , the bottom surface/wall  124  and the first and second side surfaces  126 . A rounded transition area  130  is provided between the front surface/wall  128  and the bottom surface/wall  124 . Preferably, the proximal handle housing portion  108  transitions to the distal handle housing portion  110  in a transition region  132  in which a cross-section of the handle housing  104  significantly changes. 
     In the rounded transition area  130  between the front surface/wall  128  and the bottom surface/wall  124  a manually operable element  134  is provided. The manually operable element  134  has a control lever  134   a  and a convexly curved knob  134   b  with a gripping surface  136 , which is ribbed and is provided outside the handle housing  104  in order to be accessible to a user/operator. The control lever of the manually operable element  134  extends through a slot-shaped opening  138  provided in the handle housing  104  into the receiving space  120  defined by the proximal handle housing portion  108 . The control lever of the manually operable element  134  is fixedly connected to an operation wheel  140  provided inside the handle housing  104 . The operation wheel  140  is rotatably mounted in the handle housing  104 . A rotational input provided on the manually operable element  134  by the user/operator results directly in a rotation of the operation, or elevator, wheel  140 . More generally, the gripping surface can be any surface outside the handle which an operator can manually move to control the object elevator. The gripping surface can be connected to the elevator wheel via the knob and control lever, as shown. The gripping surface can be part of the elevator wheel if a portion of the elevator wheel is sized to extend outwardly through the slot or can be part of the control lever without the knob. The knob enables use of a thin control lever while providing a comfortably wide control surface and facilitating use of a narrow/small slot in the housing. 
     The operation wheel  140  comprises an operation wheel gear portion  142  having external teeth. As can be seen in particular in  FIG.  6   , the operation wheel  140  has an annular/ring-like disc-shape. The operation wheel gear portion  142  having the external teeth is only provided in an angular range of around 130° to 140° on an outer circumference of the operation wheel  140 . The operation wheel gear portion  142  of the operation wheel  140  is in meshing engagement with a wire wheel gear portion  144  of a wire wheel  146 . Said differently the external teeth of the operation wheel gear portion  142  are in meshing engagement with external teeth of the wire wheel gear portion  144 . The wire wheel  146  has an approximately disc shape and is rotatably mounted in the handle housing  104 , in particular around a cylindrical protrusion  148  provided in the handle housing  104 . The wire wheel gear portion  144  having the external teeth is only provided in an angular range of around 180° to 190° on an outer circumference of the wire wheel  146 . The wire wheel  146  is arranged distally with respect to the operation wheel  140 , in particular partially inside the proximal handle housing portion  108  and inside the transition region  132  between the proximal handle housing portion  108  and the distal handle housing portion  110 . A radius/diameter of the operation wheel gear portion  142  is greater than a radius/diameter of the wire wheel gear portion  144 . As can be best seen in  FIG.  7   , the operation wheel  140  and the wire wheel  146  both have a flat shape. The radius extends from a rotational center or axis to the end of the external teeth of the respective wheel and may be referred to as the “outer” radius. 
     The manually operable element  134  can be rotated between a first operation position  150  shown in  FIG.  4    and a second operation position  152  shown in  FIG.  5   . The first operation position  150  and the second operation position  152  are defined by the slot-shaped opening  138 , through which the manually operable element  134  extends. When the manually operable element  134  hits a proximal-most end of the slot-shaped opening  138  (close to the front surface/wall  128 ), the manually operable element  138  is in the first operation position  150 , and when the manually operable element  134  hits a distal-most end of the slot-shaped opening  138  (close to the bottom surface/wall  124 ), the manually operable element  134  is in the second operation position  152 . 
     As can be in particular seen in  FIG.  4    and  FIG.  5   , a wire  154  is directly connected to a (radial outer) wire attachment portion  156  of the wire wheel  146 . The wire  154  runs into a wire pipe  158 , which is attached to, e.g. glued to, the handle housing  104  and which guides the wire  154  in a proximal-distal direction out of the endoscope handle  100  into the (not shown) insertion cord  112 , where it is guided towards the distal tip unit  118 . In the distal tip unit  118  the wire  154  is fixed to an elevator element  160  formed as an Albarran lever, as e.g. shown in the explanatory view of  FIG.  3    relating to the related art endoscope  2 . The elevator element  160  can be brought in a first, lowered, elevator position  162  and a second, raised, elevator position  164  as schematically illustrated in  FIGS.  13  and  14   . When the manually operable element  134  is rotated from the first operation position  150  shown in  FIG.  4    to the second operation position  152  shown in  FIG.  5    by a user/operator, said manual operation is transmitted via elevator mechanics  166 —consisting of the operation wheel  140  and the wire wheel  146 —and the wire  154  to the elevator element  160  such that the first operation position  150  of the manually operable element  134  corresponds to the first, lowered, elevator position  162  and the second operation position  152  of the manually operable element  134  corresponds to the second, raised, elevator position  164 . Said differently, a distal or downward rotation of the manually operable element  134  leads to an upward movement of the elevator element  160 , and a proximal or upward rotation of the manually operable element  134  leads to a downward movement of the elevator element  160 . This is reached since the operation wheel  140  and the wire wheel  146  rotate in different directions, or said differently since a motion inversion is provided by the elevator mechanics  166  according to the present disclosure. By moving the elevator element  160  between the first, lowered, elevator position  162  and the second, raised, elevator position  164 , it is possible set an angle with respect to a longitudinal axis (proximal-distal-direction) of the distal tip unit  118  at which a tool or instrument coming from a (not shown) working channel  168  of the endoscope  102  is inserted into the patient&#39;s body cavity. 
     In  FIG.  7    a first operation unit  170  and a second operation unit  172  are shown, which are both formed as control wheels. The operation units  170 ,  172  are arranged concentrically and coaxially with respect to each other and are both provided outside the handle housing  104  so as to be accessible to a user/operator, in particular on one of the first and second side surfaces/walls  126 . Each of the operation units  170 ,  172  is connected to a (not shown) shaft, and each of the shafts is connected to a wire drum  174 , in which a steering wire/steering wires for bending the bending section  116  of the insertion cord  112  run. It is evident from  FIG.  4   ,  FIG.  5   ,  FIG.  6    and  FIG.  7    that the operation wheel  140  is coaxially and concentrically arranged to the operation units  170 ,  172 , the shafts and the wire drums  174 . In particular, there is provided an opening in the respective side surface/wall  126  in combination with a hollow cylindrical protrusion  176  extending into the handle housing  104 , wherein the operation wheel  140  is arranged/provided/supported on an outer side of the hollow cylindrical protrusion  176  inside the handle housing  104  and the shafts are supported on an inner side of the opening/the hollow cylindrical protrusion  176 . As is evident from  FIG.  7   , the manually operable element  134  and the operation units  170 ,  172  are preferably spaced apart, as the operation units  170 ,  172  are provided on the respective side surface/wall  126  and the manually operable element  134  is provided in the rounded transition area  130  between the front surface/wall  128  and the bottom surface/wall  124 , such that the manually operable element  134  and the operation units  170 ,  172  do not mutually affect each other. It is added that the operation units  170 ,  172 , the wire drum  174  and further operation parts are not shown in  FIG.  6    in order to better illustrate the elevator mechanics  166 . 
     Due to the concentric and coaxial arrangement of the operations units  170 ,  172 , the shafts, the wire drums  174  and the operation wheel  140 , and due to the arrangement of the wire wheel  146  distally with respect to the operation wheel  140  and in close proximity to the bottom surface/wall  124 , there is much space in the proximal handle housing portion  108 , in particular above the operation wheel  140  and the wire wheel  146  for other components like a valve assembly  178  having a gas/water injection valve  180  and a suction valve  182  as illustrated in  FIG.  8   . As can be in particular seen in  FIG.  7   , the handle housing  104  comprises valve accommodation openings  184 , which are provided for accommodating the gas/water injection valve  180  and the suction valve  182 . 
     The handle  100  is an example of a positioning interface, or interface. A positioning interface functions to control the position of the insertion cord. A handle is an example of a positioning interface and, unless stated otherwise, the terms are used interchangeably. The positioning interface also functions to provide the steering controls, e.g. knobs, levers, buttons, and the like, to steer the field of view of the camera and the elevator controls. Alternatively, a different positioning interface can be provided that is connected to the insertion cord and is detachably connected to a robotic arm. The insertion cord thus extends from the robotic arm, and the intrusive medical device is detachable from the robotic arm. The robotic arm responds to signals, including voice commands from an operator, to rotate, translate, and otherwise position the proximal end of the insertion cord, as an operator would do manually. The positioning interface can include control actuators, including manual control actuators. Alternatively or additionally, control actuators can be provided in or on the robotic arm or by the robotic system including the robotic arm, thereby potentially reducing the cost of the intrusive medical device. Example control actuators include single axis actuators, including linear motion actuators. A linear motion actuator may comprise a threaded rod coupled to a threaded nut portion, in which a motor rotates the rod to translate the nut portion. The elevator wheel may be actuated remotely instead of manually via the knob  134   b.    
     As is evident when looking at  FIG.  4    and  FIG.  5    the wire  154  moves quite around inside the handle housing  104  when the wire wheel  146  rotates, which leads to the wire  154  being angled with respect to an orientation/direction of the wire pipe  158 , in particular when the manually operable element  134  is in the second operation position  152 . In this light, a second preferred embodiment according to the present disclosure, which is shown in  FIGS.  8  to  14   , has been designed to overcome a problem of the wire  154  moving excessively around, potentially leading to a disconnection of the wire pipe  158  from the handle housing  104  or even to a kinking of the wire pipe  158 . 
     With respect to the second preferred embodiment according to the present disclosure, only differences compared to the first preferred embodiment are described. Apart from that, the explanations provided for the first preferred embodiment apply mutatis mutandis for the second preferred embodiment. 
     According to the second preferred embodiment it also applies that a manual operation/rotation of the manually operable element  134  is transmitted via elevator mechanics  166  comprising an operation wheel  140  having an operation wheel gear portion  142  and a wire wheel  146  having a wire wheel gear portion  144  and a wire  154  to an elevator element  160  provided in the distal tip unit  118  of the insertion cord  112 . 
     The manually operable element  134  has a concavely curved, ribbed gripping surface  136  according to the second preferred embodiment. 
     The wire wheel  146  of the second preferred embodiment has a circular, or arcuate, portion  186  and two edges, namely a first edge  188  and a second edge  190 , which are angled with respect to each other, in particular between 90° and 180°. The wire wheel  146  has thus a shape which corresponds to a cut-out portion or part of a disc and thus not a full disc as it is the case in the first preferred embodiment. The wire wheel  146  according to the second preferred embodiment comprises a rotational center  192  defined by an accommodation opening for the protrusion  148 , the wire wheel gear portion  144  which is provided in the circular portion  186 , and a hollow cylindrically formed bearing portion  194 . The bearing portion  194  is provided radially away from the rotational center  192  of the wire wheel  146 , in particular in a radially outer portion of the wire wheel  146 . A rotation axis of the wire wheel  146  is parallel to an axis of the bearing portion  194 . The arcuate portion may comprise an arc of between 80 and 120 degrees, or between 90 and 100 degrees. Although not shown, the elevator wheel may also comprise part of a disc with an arcuate portion comprise an arc of between 80 and 120 degrees, or between 90 and 100 degrees. The portion of the wheel devoid of teeth may be omitted to save space for other components. 
     According to the second preferred embodiment and as can be seen in particular in  FIGS.  8  and  11  to  14   , a connector part  196  is provided which is rotatably mounted on/around the bearing portion  194  of the wire wheel  146 . Further a guide rail part  198  is provided which is rotatably mounted in the handle housing  104  of the endoscope handle  100 . The connector part  196  is slidingly accommodated in the guide rail part  198 . In particular, the connector part  196  comprises a disc-shaped connector mounting portion  200  which is rotatably mounted on the bearing portion  194  of the wire wheel  146 , and a rod-like slide portion  202 . The guide rail part  198  comprises a rail mounting portion  204  rotatably mounted on (a protrusion of) the handle housing  104  and a guide rail portion  206  having a guide rail  208 . The rod-like slide portion  202  of the connector part  196  is slidingly accommodated in the guide rail portion  206  of the guide rail part  198 . The rail mounting portion  204  of the guide rail part  198  is provided at a distal portion of the guide rail part  198  and the guide rail portion  206  extends from the rail mounting portion  204  in a proximal direction towards the wire wheel  146 . The wire  154  is fixed, e.g. by gluing, crimping, a screwed connection, a soldered connection, etc., to a fixation portion  210  of the connector mounting portion  200  of the connector part  196 . The wire  154  is fixed to the connector mounting portion  200  of the connector part  196 , forms a loop  212  in the connector mounting portion  200  of the connector part  196 , and extends through the slide portion  202  of the connector part  196  and through a wire outlet opening  214  provided in the guide rail part  198 . Since the rail mounting portion  204  of the guide rail part  198  is provided at the distal portion/end of the guide rail part  198  adjacent the wire outlet opening  214 , the wire outlet opening  214  remains at an approximately stationary/fixed position throughout an operation range of the manually operable element  134 , in other words experiences only little rotational displacement. A proximal end portion of the wire pipe  158  is arranged adjacent the wire outlet opening  214  of the guide rail part  198 . An extension direction of the proximal end portion of the wire pipe  158  substantially corresponds to an axis of the guide rail portion  206  of the guide rail part  198  and thus to an axis of the rod-like slide portion  202  of the connector part  196 , at least in any position of the manually operable element  134  between the first operation position  150  and the second operation position  152 . 
     A formation of the wire wheel  146  according to the second preferred embodiment can best be seen in the perspective views of  FIG.  9    and  FIG.  10   , in particular as the connector part  196  and the guide rail part  198  are not shown in  FIG.  9    and  FIG.  10   .  FIG.  9    shows valve accommodation openings  184  and  FIG.  10    shows the valve assembly  178  comprising the gas/water injection valve  180  and the suction valve  182  being assembled in the valve accommodation openings  184 .  FIG.  8    shows the connector part  196  being rotatably mounted to the wire wheel  146 . It becomes clear that when the wire  154  is fixed to the connector part  196  and when the guide rail part  198  orients the connector part  196  as shown in  FIG.  8   , the wire  154  runs through the connector part  196  and directly into the wire pipe  158 . 
       FIG.  11    shows the manually operable element  134  in its first operation positon  150 , and  FIG.  12    shows the manually operable element  134  in its second operation position  152 . It becomes clear, that when moving the manually operable element  134  from the first operation position  150  to the second operation position  152 , the connector part  196  is retracted in the guide rail part  198 , so as to apply a pulling force on a wire  154  fixed to the connector part  196 , which pulling force may serve to transfer an elevator element  160  provided in the distal tip unit  118  of the insertion cord  112  to a second, raised, elevator position  164 . Moving in the other direction applies a pushing force on the wire. 
       FIG.  13    and  FIG.  14    show an entire endoscope  102 , with a half shell  106  of the handle housing  104  removed. In particular, also the working channel  168  of the endoscope  102  is shown, as well as the insertion tube  114 , the bending section  116  and the distal tip unit  118  of the insertion cord  112 . It becomes clear that when the manually operable element  134  is in its first operation position  150  shown in  FIG.  13   , an elevator element  160  formed as Albarran lever is in its first, lowered, elevator position  162 , and when the manually operable element  134  is in its second operation position  152  shown in  FIG.  14   , the elevator element  160  is in its second, raised, elevator position  164 . In  FIG.  13    and  FIG.  14    a monitor M is shown which may be connected to the endoscope  102 . The monitor M includes video processing circuits operable to receive image data, present a graphical user interface to allow a user to manipulate image data with a touch screen, and, optionally, output a video signal to allow remote viewing of the images presented with the touch screen. Variations of the monitor M can be provided with various features of the monitor M but including other features. For example, it might not be desirable to provide a display module with a touch screen, or it might be desirable to omit a display module altogether. Omission of the display module might be beneficial to take advantage of evolving video display technologies which improve resolution and reduce cost. Provision of exchangeable medical device interfaces allows for adoption of evolving image sensor and endoscope technologies, thus use of existing or future-developed external video displays could allow presentation of higher resolution or otherwise improved video. Use of external video displays could also leverage existing capital investments. 
     Video processing circuits of the monitor may include the display module supported by a housing, medical device interfaces to connect endoscopes, a processor to process instructions to present images with a graphical user interface (GUI), a field-programmable gate array (FPGA) to receive the images from the endoscope and output variations thereof to the processor for combining with the GUI, and a video output board to output video. User interfaces may comprise a wireless interface operable to receive user inputs via a mouse, keyboard, or other physical user input devices. Example wireless interfaces include Bluetooth and Zigbee controllers. User interfaces may also comprise a USB port to receive a USB connector including the wireless interface or a USB connector of a wired user input device. Thus, the monitor M provides for flexibility in receiving user inputs via various user input devices, regardless whether a display module is integrated therewith. 
     The FPGA is optionally provided because it is capable of rapid power-up (i.e. short boot-up time) and thus is useful in emergency situations. FPGAs may also be provided in the medical device interfaces for the same reasons. FPGAs process data very fast compared to other memory/instruction combinations and are re-programmable. Therefore FPGAs facilitate presentation of a live view of the images captured by the endoscope in real-time with minimal latency so that the physician observing the live view can take immediate actions even in emergency situations. As technology evolves, the functionality of the FPGA may be combined with the processor. The monitor M is therefore not limited to the precise packaged integrated circuits described above but can be constructed to take advantage of design and cost targets and future video processing technologies. For example, faster/more costly memory may be used to increase graphics processing speed. Graphics processing may be provided in the FPGA or a processor that incorporates graphics processing logic may be used instead. 
       FIG.  15    shows a side view of the distal tip unit  118  of the endoscope  102  according to the present disclosure with the elevator element  160  formed as Albarran lever in the first, lowered, elevator position  162 .  FIG.  16    shows a side view of a distal tip unit  118  of the endoscope  102  according to the present disclosure with the elevator element  160  formed as Albarran lever in the second, raised, elevator position  164 . 
     The following items are examples of various embodiments and variations thereof disclosed above, and others: 
     1. An endoscope ( 102 ) comprising: an endoscope handle ( 100 ) comprising a handle housing ( 104 ) and at least one manually operable element ( 134 ); and an insertion cord ( 112 ) configured to be inserted into a patient&#39;s body cavity and comprising a distal tip unit ( 118 ), the distal tip unit ( 118 ) comprising an elevator element ( 160 ) movable between a first, lowered, elevator position ( 162 ) and a second, raised, elevator position ( 164 ) for changing a direction of a tool or an instrument inserted into the patient&#39;s body cavity via a working channel ( 168 ) of the endoscope ( 102 ); wherein the manually operable element ( 134 ) is connected to the elevator element ( 160 ) via elevator mechanics ( 166 ) provided inside the handle housing ( 104 ) and a wire ( 154 ), and a manual operation of the manually operable element ( 134 ) is transmitted via the elevator mechanics ( 166 ) and the wire ( 154 ) to the elevator element ( 160 ) such that a first operation position ( 150 ) of the manually operable element ( 134 ) corresponds to the first, lowered, elevator position ( 162 ) and a second operation position ( 152 ) of the manually operable element ( 134 ) corresponds to the second, raised, elevator position ( 164 ); and wherein the elevator mechanics ( 166 ) comprise: an operation wheel ( 140 ) connected to the manually operable element ( 134 ) and comprising an operation wheel gear portion ( 142 ); and a wire wheel ( 146 ) comprising a wire wheel gear portion ( 144 ); wherein the operation wheel gear portion ( 142 ) is in meshing engagement with the wire wheel gear portion ( 144 ); and wherein the wire ( 154 ) is connected to the wire wheel ( 146 ). 
     2. Endoscope ( 102 ) according to item 1, wherein the elevator mechanics ( 166 ) are configured such that when the manually operable element ( 134 ) is moved or rotated in a distal direction from the first operation position ( 150 ) to the second operation position ( 152 ), the elevator element ( 160 ) is transferred from the first, lowered, elevator position ( 162 ) to the second, raised, elevator position ( 164 ); and when the manually operable element ( 134 ) is moved or rotated in a proximal direction from the second operation position ( 152 ) to the first operation position ( 150 ), the elevator element ( 160 ) is transferred from the second, raised, elevator position ( 164 ) to the first, lowered, elevator position ( 162 ). 
     3. Endoscope ( 102 ) according to item 1 or 2, wherein the operation wheel gear portion ( 142 ) of the operation wheel ( 140 ) and the wire wheel gear portion ( 144 ) of the wire wheel ( 146 ) are external gears comprising external teeth. 
     4. Endoscope ( 102 ) according to any one of items 1 to 3, wherein a radius of the operation wheel gear portion ( 142 ) is greater than a radius of the wire wheel gear portion ( 144 ). 
     5. Endoscope ( 102 ) according to any one of claims  1  to  4 , wherein the wire wheel ( 146 ) is arranged distally with respect to the operation wheel ( 140 ) inside the handle housing ( 104 ) of the endoscope handle ( 100 ). 
     6. Endoscope ( 102 ) according to any one of claims  1  to  5 , wherein a wire pipe ( 158 ) is fixed to the handle housing ( 104 ), and the wire ( 154 ) runs into and is guided in the wire pipe ( 158 ). 
     7. Endoscope ( 102 ) according to any one of items 1 to 6, wherein the operation wheel ( 140 ) is arranged coaxially with respect to an operation unit ( 170 ,  172 ) and a wire drum ( 174 ) provided for actively bending a bending section ( 116 ) of the insertion cord ( 112 ). 
     8. Endoscope ( 102 ) according to any one of items 1 to 7, wherein the wire wheel ( 146 ) has a circular portion ( 186 ) and two edges ( 188 ,  190 ) angled with respect to each other such that the wire wheel ( 146 ) has a shape corresponding to a cut-out portion or part of a disc, the wire wheel ( 146 ) comprising at least a rotational center ( 192 ) and the wire wheel gear portion ( 144 ) provided in the circular portion ( 186 ). 
     9. Endoscope ( 102 ) according to any one of items 1 to 8, wherein a connector part ( 196 ) is rotatably mounted on the wire wheel ( 146 ), and the wire ( 154 ) is fixedly attached to the connector part ( 196 ). 
     10. Endoscope ( 102 ) according to item 9, wherein a guide rail part ( 198 ) is rotatably mounted in the handle housing ( 104 ), and the connector part ( 196 ) is slidingly accommodated in the guide rail part ( 198 ). 
     11. Endoscope ( 102 ) according to item 10, wherein the connector part ( 196 ) and the guide rail part ( 198 ) are arranged distally with respect to the operation wheel ( 140 ) and the wire wheel ( 146 ). 
     12. Endoscope ( 102 ) according to item 10 or 11, wherein the connector part ( 196 ) comprises a disc-shaped connector mounting portion ( 200 ) configured to be rotatably mounted on the wire wheel ( 146 ), and a rod-like slide portion ( 202 ); the guide rail part ( 198 ) comprises a distal rail mounting portion ( 204 ) configured to be rotatably mounted on the handle housing ( 104 ) and a guide rail portion ( 206 ) having a guide rail ( 208 ); and the rod-like slide portion ( 202 ) of the connector part ( 196 ) is slidingly accommodated in the guide rail portion ( 206 ) of the guide rail part ( 198 ). 
     13. Endoscope ( 102 ) according to item 12, wherein the wire ( 154 ) is looped through and fixed to the disc-shaped connector mounting portion ( 200 ) and extends through the rod-like slide portion ( 202 ). 
     14. Endoscope ( 102 ) according to any of items 10 to 13, wherein a proximal end portion of a wire pipe ( 158 ) fixed to the handle housing ( 104 ) is arranged adjacent a distal end portion of the guide rail part ( 198 ). 
     15. System comprising: an endoscope ( 102 ) according to any one of the preceding items 1 to 14; and a monitor (M). 
     LIST OF REFERENCE SIGNS 
     
         
         
           
               2  endoscope 
               4  endoscope handle 
               6  handle housing 
               8  manually operable element 
               10  elevator element 
               12  distal tip unit 
               14  operation wheel 
               16  slider rod 
               18  slider 
               20  wire 
               22  wire pipe 
               24  insertion cord 
               26  elevator mechanics 
               28  first operation position 
               29  first, lowered, elevator position 
               30  second operation position 
               31  second, raised, elevator position 
               32  rotational center 
               34  first slider rod connection point 
               36  second slider rod connection point 
               100  endoscope handle 
               102  endoscope 
               104  handle housing 
               106  half shell 
               108  proximal handle housing portion 
               110  distal handle housing portion 
               112  insertion cord 
               114  insertion tube 
               116  bending section 
               118  distal tip unit 
               120  receiving space 
               122  top surface/wall 
               124  bottom surface/wall 
               126  first/second side surface/wall 
               128  front surface/wall 
               130  rounded transition area 
               132  transition region 
               134  manually operable element 
               136  gripping surface 
               138  slot-shaped opening 
               140  operation wheel 
               142  operation wheel gear portion 
               144  wire wheel gear portion 
               146  wire wheel 
               148  protrusion 
               150  first operation position 
               152  second operation position 
               154  wire 
               156  wire attachment portion 
               158  wire pipe 
               160  elevator element 
               162  first, lowered, elevator position 
               164  second, raised, elevator position 
               166  elevator mechanics 
               168  working channel 
               170  first operation unit 
               172  second operation unit 
               174  wire drum 
               176  hollow cylindrical protrusion 
               178  valve assembly 
               180  gas/water injection valve 
               182  suction valve 
               184  valve accommodation opening 
               186  circular portion 
               188  first edge 
               190  second edge 
               192  rotational center 
               194  bearing portion 
               196  connector part 
               198  guide rail part 
               200  connector mounting portion 
               202  slide portion 
               204  rail mounting portion 
               206  guide rail portion 
               208  guide rail 
               210  fixation portion 
               212  loop 
               214  wire outlet opening