Patent Publication Number: US-2022225859-A1

Title: Steerable endoscope system and method

Description:
CROSS-REFERENCE TO RELATED APPLICATION PAPERS 
     This application claims benefit of U.S. Patent Application No. 63/139,591, filed 20 Jan. 2021 and which application is incorporated herein by reference. To the extent appropriate, a claim of priority is made to the above-disclosed application. 
    
    
     BACKGROUND 
     The present disclosure relates generally to medical devices and, more particularly, to steerable endoscopes with deflection-based steering, and related methods and systems. 
     Medical endoscopes are long, flexible instruments that can be introduced into a cavity of a patient during a medical procedure in a variety of situations to facilitate visualization and/or medical procedures within the cavity. For example, one type of scope is an endoscope with a camera at its distal end. The endoscope can be inserted into a patient&#39;s mouth, throat, or other cavity to help visualize anatomical structures, or to facilitate procedures such as biopsies or ablations. The endoscope may include a steerable distal tip that can be actively controlled to bend or turn the distal tip in a desired direction, to obtain a desired view or to navigate through anatomy. However, these steerable scopes can be difficult to maneuver into the desired location and orientation within a patient&#39;s anatomy. 
     SUMMARY 
     Certain embodiments commensurate in scope with the originally claimed subject matter are summarized below. These embodiments are not intended to limit the scope of the disclosure. Indeed, the present disclosure may encompass a variety of forms that may be similar to or different from the embodiments set forth below. 
     In an embodiment, a steerable endoscope system includes an endoscope and a controller. The endoscope has a tubular body and a plurality of wires disposed within the tubular body. Each wire of the plurality of wires is coupled to an endoscope distal end such that, upon deflection of one or more wires of the plurality of wires in a non-axial direction, the endoscope distal end changes orientation. The controller is in communication with the endoscope and has a display screen responsive to a user command to steer the endoscope; and a processor that receives the user command and generates instructions to change the orientation of the endoscope distal end. The system also includes at least one clamp, wherein the instructions activate the at least one clamp to clamp the one or more wires, wherein the one or more wires, when clamped, are deflected in the non-axial direction to conform to a contoured surface of the at least one clamp to cause the change the orientation of the endoscope distal end. 
     In an embodiment, an endoscope system includes an endoscope and a controller. The endoscope has a tubular body and a plurality of wires. Each wire of the plurality of wires is coupled to an endoscope distal end and an endoscope proximal end, wherein the endoscope distal end is at a first orientation when the plurality of wires are not deflected. The controller is in communication with the endoscope and receives a user steering input and generates instructions to cause coordinated deflection of the plurality of wires in a non-axial direction to transition the endoscope distal end from the first orientation to a second orientation according to the user steering input. 
     In an embodiment, a method for steering of an endoscope is provided that includes the steps of receiving, via a touch screen display, a user input to change an orientation of an endoscope distal end; and in response to the user input, activate a wire deflector to apply a non-axial deflection force to deflect one or more wires of a plurality of wires disposed within an endoscope, wherein the non-axial deflection force applied to the one or more wires is transferred to the endoscope distal end to change the orientation of the endoscope distal end, and wherein the non-axial deflection force is in a direction that is outside of a plane extending through the one or more wires. 
     In an embodiment, an endoscope includes a tubular body comprising a proximal end and a distal end a plurality of wires within a central passage of the tubular body and extending from the distal end and the proximal end, and one or more wire deflectors that, when activated, apply a non-axial force to at least one wire of the plurality of wires to deflect the at least wire and cause a change in orientation of the distal end. 
     Features in one aspect or embodiment may be applied as features in any other aspect or embodiment, in any appropriate combination. For example, any one of system, laryngoscope, handle, controller, endoscope, or method features may be applied as any one or more other of system, laryngoscope, controller, endoscope, or method features. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Advantages of the disclosed techniques may become apparent upon reading the following detailed description and upon reference to the drawings in which: 
         FIG. 1  is a schematic illustration of a steerable endoscope, according to embodiments of the present disclosure. 
         FIG. 2  is a schematic illustration of a steerable endoscope having a multi-wire arrangement, according to embodiments of the present disclosure. 
         FIG. 3A  is a schematic illustration of a clamp-type wire deflector with the wire in an undeflected configuration, according to embodiments of the present disclosure. 
         FIG. 3B  is a schematic illustration of the clamp-type wire deflector of  FIG. 3A  with the wire in a deflected configuration, according to embodiments of the present disclosure. 
         FIG. 4  is a schematic illustration of an activated surface wire deflector, according to embodiments of the present disclosure. 
         FIG. 5  is a schematic illustration of an activated surface wire deflector that activates to cause proximal or distal wire displacement, according to embodiments of the present disclosure. 
         FIG. 6A  is a schematic illustration of a connector of a controller device that includes a magnet-based wire deflector, according to embodiments of the present disclosure. 
         FIG. 6B  is a schematic illustration of the magnet-based wire deflector of  FIG. 6A  in an activated state to deflect a wire of an endoscope. 
         FIG. 6C  is a schematic illustration of the magnet-based wire deflector of  FIG. 6A  in an activated state to deflect a wire of an endoscope. 
         FIG. 7  is a schematic illustration of a connector of a controller device that includes a wire deflector, according to embodiments of the present disclosure. 
         FIG. 8A  is a schematic illustration of a connector of a controller device that includes a clamp-based wire deflector, according to embodiments of the present disclosure. 
         FIG. 8B  is a schematic illustration of the clamp-based wire deflector of  FIG. 8A  in an activated state to deflect a wire of an endoscope. 
         FIG. 9  is a perspective view of a controller and endoscope, according to embodiments of the present disclosure. 
         FIG. 10  is a block diagram of a controller and endoscope, according to embodiments of the present disclosure. 
         FIG. 11  is a flowchart depicting a method for steering of an endoscope via a wire deflector, according to embodiments of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS 
     A medical scope or endoscope as provided herein is a thin, elongated, flexible instrument that can be inserted into a body cavity for exploration, imaging, biopsy, or other clinical treatments, including catheters, narrow tubular instruments, or other types of scopes or probes. Endoscopes may be navigated into the body cavity (such as a patient&#39;s airway, gastrointestinal tract, oral or nasal cavity, or other cavities or openings) and be steered into by the user via advancement of the distal end to a desired position and, in certain embodiments, biomimetic motion of the endoscope. Endoscopes may be tubular in shape. 
     Advancement of long, flexible medical devices into patient cavities is typically via force transferred from a proximal portion of the device (outside of the patient cavity), that results in advancement of the distal tip within the patient cavity. For example, a doctor or other caregiver holding a proximal portion (such as a handle) of the medical device outside of the patient cavity pushes downward or forward, and the resulting motion is transferred to the distal tip, causing the tip to move forward within the cavity. Similarly, a pulling force applied by the caregiver at the proximal portion may result in retreat of the distal tip or movement in an opposing direction out of the patient cavity. However, because patient cavities are not regularly shaped or sized, the endoscope moves through a tortuous path, and the transferred force in a pushing or pulling motion from the proximal end may not result in predictable motion at the distal tip. 
     Provided herein is a steerable endoscope with controlled steering in three dimensions that facilitates fine steering within curving paths of a patient passageway. The endoscope includes wires that extend along a length of the endoscope and translate steering inputs into desired movement at the endoscope distal tip via deflection of one or more of the wires in a non-axial direction, e.g., in a direction non-axial to the length axis of the steerable endoscope. Applying force an axial direction along the length axis of an endoscope, as in a conventional arrangement, requires more applied force, and power, than deflection-based steering that applies force a non-axial direction to steer the endoscope distal tip in three dimensions. Thus, a lower total force can power the disclosed deflection-based steering relative to conventional axial force application. The steering inputs and control can be provided via a coupled controller that is located outside of the patient and that receives steering inputs from an operator. In some embodiments, the steering inputs cause the controller to activate mechanical or pneumatic elements, magnetic elements, and/or electromagnetic elements that deflect one or more wires of the steerable endoscope in a direction and by a distance consistent with the desired steering outcome. 
       FIG. 1  is a schematic illustration of wire-based deflection to steer an endoscope  12 . The endoscope  12 , e.g., a steerable endoscope, includes one or more wires  16  (e.g., two, three, four, or more) that run along a length of the endoscope  12  in a proximal-distal direction and that are deflected to steer the endoscope  12 . While the illustrated embodiment shows a single wire  16 , it should be understood that coordinated deflection forces applied to multiple wires  16  of the endoscope  12  results in 360 degree steering capabilities of the endoscope distal end  20 . The wires  16  of the steerable endoscope are fixed to a distal coupling point  22  at or near the endoscope distal end such that internal deflection at a more proximal position, e.g., near the endoscope proximal end  24 , causes corresponding movement of the endoscope distal end  20 . In an embodiment, the wire  16  runs along an axis  30  extending through the endoscope proximal end  24  and distal end  20 . 
     Deflection of the wire  16  at a proximal location by an applied deflecting force, illustrated by example deflecting force arrows  40  is translated to the wire distal end  22  to change an orientation of the endoscope distal end  20 . The wire  16  can be deflected in any non-axial direction (e.g., not along the axis  30  or out of plane from a plane that includes that wire  16 ) in the x, y, or z direction such that the direction of deflecting force is transverse or non-axial to the wire  16  and according to the desired steering. A non-axial applied force is the most efficient to result in axial displacement of the wire  16 . The amount of applied force may depend on the angle of non-axial force relative to the wire  16 . In an embodiment, an orthogonal (e.g., perpendicular) force may be more efficient than force directions that are non-axial and also non-orthogonal. The resultant change in orientation of the distal end  20  is related to the direction of the applied force  40 , the amount of applied force  40 , and the position of the wire  16  relative to the tubular body  42 , e.g., the circumferential position of the distal coupling point  22 . In the illustrated embodiment, an applied orthogonal (e.g., perpendicular relative to the axis of the wire  16 ) force  40  causes movement (shown in dashed lines of the distal end  20 ) of the distal end  20  in an opposite direction to the force arrow  40 . In multi-wire embodiments, the orientation change is a function of the combined deflections of each deflected wire  16 . Further, the orientation change may be a result of simultaneous deflection forces or sequential application of deflection forces applied to each deflected wire  16 . Accordingly, the wire deflectors disclosed herein may be activated sequentially to cause incremental orientation changes applied within a particular time window (e.g., 1-30 seconds) that, in total, result in the desired orientation change. 
     The applied non-axial force may be, as illustrated, (perpendicular) to the wire  16  or may be applied at a nonorthogonal angle (e.g., at an angle of 5-85 degrees) relative to the wire  16 . In an embodiment, the non-axial force is not aligned with the axis  30  of the wire  16 . That is, in an embodiment, the non-axial force is not a push/pull force in a direction along the axis  30  and/or is not parallel to the axis  30 . Further, the non-axial force may be applied from one or more directions relative to the wire  16  (e.g., emanating from different possible 360 degree locations). While the wire or wires  16  may be generally axial between the endoscope proximal end  24  and endoscope distal end  20 , portions of the wire or wires  16  may also curve, bend, or extend at an angle within the endoscope  12 . Thus, as provided herein, the non-axial or non-axial force may be non-axial or non-axial relative to a portion of wire  16  corresponding to the location of deflecting force application and/or non-axial or non-axial relative to the axis  30  running through endoscope proximal end  24  and distal end  20 . 
     Force application in a non-axial direction to deflect the wire  16  provides a mechanical advantage over applied axial forces, i.e., pulling or pushing on the wire  16 . A lower applied non-axial force can achieve a desired orientation change of the distal end  20  relative to a required force in a pulling or pushing-type arrangement. Thus, overall power levels are reduced to steer the endoscope. 
     The wire or wires  16  run within or along a tubular body  42  of the endoscope  12 . Each wire  16  may run through a dedicated internal lumen or may be routed through a central bore  43  of the endoscope  12 . The body  42  is at least partially flexible to the endoscope distal end  20  to change orientation in response to wire deflection. In an embodiment, the endoscope proximal end  24  is coupled to a controller in operation and, thus, only the distal end  20  is free to move or change orientation in response to wire deflection. Each wire  16  of the endoscope can be pulled taut (with little to no slack) with preset tension or load when not deflected between the wire distal end  22  and a proximal end  34 . At least the wire distal end  22  is fixed (adhered to, bonded to, tied to, coupled to, clamped, integrally coupled to, etc.) relative to the endoscope distal end  20  such that the deflecting force transfers to the endoscope distal end  20 . In an embodiment, the wire  16  has substantially no slack and no load or with zero tension between the wire distal end  22  and the proximal end  34  when in an undeflected configuration. When deflected, tension in the wire  16  is increased. The wire  16  may be a relatively inelastic but conformable or flexible material (metal, memory metal, polymer), and removal of the deflecting force causes the wire or wires  16  to return to the undeflected configuration or a neutral configuration. In an embodiment, the undeflected configuration is a generally axial configuration while the deflected configuration causes the wire  16  to deviate from the generally axial configuration by bending or curving at one or more locations according to the applied non-axial force. 
     The wire distal end  22  may be coupled to a distal support structure  44 , such as a resilient ring, bridge, or strut that holds the wire distal end  22  distally in place and facilitates transfer of the deflecting force of the wire  16  to the endoscope distal end  20 . As provided herein, each wire  16  may be coupled to a dedicated distal support structure  44  or may share the distal support structure  44  with another wire or wires  16 . Each wire  16  may additionally or alternatively be coupled to one or more proximal support structures  46 . The wire proximal end  34  may be within the endoscope  12  or may extend beyond the endoscope proximal end  24  to couple to a controller. 
     The endoscope distal end  20  can be steered in 360 degrees based on controlled non-axial deflection forces applied to a selected wire or wires  16 , independently or in combination.  FIG. 2  shows an example three wire arrangement in which the wires  16   a ,  16   b ,  16   c  extend along the endoscope  12 , and the respective wire distal ends  22   a ,  22   b ,  22   c  are circumferentially distributed about the endoscope distal end  20  (e.g., spaced approximately 120 degrees apart from one another). Other arrangements including more or fewer wires  16  and/or with different spacing are also contemplated. Depending on the desired orientation change, deflecting forces  40   a ,  40   b ,  40   c  applied at a more proximal location are translated down the length of the endoscope  12 . A deflecting force  40  applied to the wire or wires  16  causes a desired orientation change of the endoscope distal end  20  through force translated to a particular location or region of the endoscope distal end  20  corresponding to the wire distal end  22 . 
     While the wire distal ends  22   a ,  22   b ,  22   c  are spaced apart about the circumference of the endoscope distal end  20  to facilitate the endoscope steering, it may be beneficial to guide the wires  16  in a side-by-side or planar arrangement at more proximal locations in the endoscope via a structural support, such as spacer  50  that includes passages  52  or grooves that correspond to the desired spacing  56  between the wires  16 . In one example, the side-by-side arrangement permits the wires  16  to align with deflecting structures or surfaces of the endoscope  12  or a coupled controller. Further, the planar arrangement may conserve interior space of the endoscope or may permit less complex manufacturing by permitting portions of the wires  16  to run through the central passage  43  of the endoscope  12  rather than through separate dedicated lumens running through an outer wall of the endoscope  12 . In an embodiment, the spacer  50  is shaped to accommodate any other channels or lumens of the endoscope  12  and can maintain a relatively narrow spacing of the wires  16  in cases where working channels are also present. An arrangement in which the wires  16  are in a side-by-side arrangement also allows for single direction actuation (on multiple wires) to be transformed into 360 degree motion via selective deflection of one wire  16 , a subset of the wires  16 , or all of the wires  16  simultaneously. Depending on the selective activation, e.g., which wire  16  or wires  16  are deflected, different orientation changes are possible, with the range of possibilities facilitating 360 degree steering. 
     In another example, the spacer  50  is positioned past a midpoint of the endoscope  12 , e.g., closer to the endoscope distal end  20 , to reduce curvature bias during steering. In operation, the endoscope  12 , when inserted in the patient, follows a curve of the patient airway such that the endoscope has an interior curve and an exterior curve. Wires  16  that are positioned closer to the interior curve of the endoscope  12  would be more curved than those that follow the exterior curve. The different levels of curvature between individual wires  16  in such a case would lead to different responsiveness to applied deflection forces. In an embodiment, the use of the spacer  50   a  to space the wires  16  closer together along at least a portion of a length of the endoscope  12  (e.g., at least 50% or at least 75% of a proximal-distal length dimension) reduces the effects of curvature bias between the wires  16  by reducing differences in curvature between the wires  16 . Multiple spacers  50  may be used to hold the wires  16  in a desired side-by-side arrangement in more proximal regions of the endoscope  12 . 
     The wires  16  can extend distally away from the spacer  50   a  and at an angle corresponding to the desired spacing at the wire distal ends  22 . Additional spacers  50  can be incorporated to maintain or change the spacing of the wires  16  within the endoscope  12 . The endoscope  12  can include a spacer  50   b  with passages  58  having spacing  60  that generally aligns with the larger spacing at the wire distal ends  22 . Thus, a first spacer  50   a  includes passages  52  having a smaller spacing relative to passages  50  of a second spacer  50   b  located distally of the first spacer  50   b.    
     An individual wire  16  can be deflected by mechanical, pneumatic, magnetic, and/or electromagnetic deflection arrangements that apply non-axial force in a non-axial direction to deflect the wire  16 .  FIG. 3-7  illustrate examples of wire deflection arrangements that may be incorporated into or coupled to the endoscope  12  to deflect one or more of the wires  16  and, as a result, change an orientation of the endoscope distal end  20 . Each individual wire  16  may be coupled to a dedicated wire deflector, or a wire deflector may operate simultaneously on multiple wires  16 . The depicted wire deflector arrangements may be used in combination with one another in the endoscope  12 . Further, it should be understood that the depicted wire deflection arrangements may be incorporated into the endoscope  12  at proximal, intermediate, and/or distal positions. In certain embodiments, activation of the wire deflectors provided herein may be controlled by a coupled device, such as a controller (see  FIG. 8 ). The wire deflectors as provided herein are capable of reversibly deflecting the wire  16  such that the wire  16  can return to an undeflected state or configuration when the wire deflector is inactive or is moved away from (e.g., out of direct contact with) or retracted from the wire  16 . Activation of the wire deflector or movement of the wire deflector to contact the wire  16  bends the wire  16  within the endoscope  12 , causing an area of local tension, that in turn is transferred to the endoscope distal end  20 . 
       FIGS. 3A-3B  show an example of a wire deflector clamp  100 . The wire  16  passes through a top section  102  and a bottom section  104  of the clamp  100 . When the top section  102  and the bottom section  104  are not in contact with one another and with the wire  16 , the wire  16  is undeflected as shown in  FIG. 3A . When the top section  102  and the bottom section clamp the wire  16 , as shown in  FIG. 3B , the wire  16  conforms to the respective contoured surfaces  106 ,  108  of the clamp  100 . This effectively shortens the axial length of the wire  16  by displacing wire length along the various contours of the contoured surfaces  106 ,  108  of the clamp  100 . Thus, the total length displacement, and associated axial decrease in length of the wire  16  along a proximal-distal axis, is related to a surface area of the contoured surfaces  106 ,  108 . Increased surface area causes more length displacement of the wire  16  and axial shortening, which in turn results in a greater change in orientation of the endoscope distal end  20 . Thus, in an embodiment, the endoscope  12  can include different clamps  100  along the length of the wire  16  and/or distributed about a circumference of the wire  16 , each with different length displacement capabilities depending on the arrangement and surface area encompassed by the contours of the associated contoured surface. 
     A controller can activate one or more selected clamps  100  from the available clamps  100 , depending on the steering input and the desired magnitude of the orientation change of the distal end  20 . For example, individual clamps  100  may be activated to cause incremental orientation changes applied sequentially, e.g., to cause an inchworm-like motion of the endoscope distal end  20 . These incremental changes are controlled to result in a desired total orientation change of the distal end  20 . The contoured surface or surfaces (e.g., contoured surfaces  106 , 108 ) of the clamp  100  can include peaks and valleys or sinusoidal curves. The contoured surface may include regular or irregular contours. 
     When the clamp  100  is activated or closed around the wire  16 , the wire  16  is deflected. The clamping motion of one or both of the clamp sections  102 ,  104  is generally orthogonal/perpendicular to the axis of the wire  16 . However, the contoured surfaces  106 ,  108  act to apply deflecting forces to the wire  16  at various angles and distances based on their shapes. 
     In an embodiment, the top section  102  or the bottom section  104  are stationary, and only one clamp section moves relative to the wire  16 . The other, stationary, an interior contoured surface of the clamp  100  (e.g., the bottom surface  104 ) may be formed in an interior wall, lumen, or surface of the tubular body  42  ( FIG. 1 ). The wire  16  is positioned within the endoscope to align with the interior surface. In one embodiment, the wire  16  is proximate to an interior contoured surface that extends along at least a portion of the length of the endoscope  16 . One or more movable clamp sections (e.g., the top section  102 ) can be activated to move toward the interior contoured surface. The clamp  100  may be a clamp array with multiple movable clamp sections that clamp the wire  16  against the interior contoured surface. 
     A low compression force applied by orthogonal motion of the clamp  100  yields a relatively high tension in the wire  16  compared to a similar force applied instead in an axial direction, thus providing a mechanical force advantage for endoscope steering. That is, less force applied in a non-axial is required to achieve a desired orientation change of the endoscope distal end  20 . The tension in the wire  16  is related to the length displacement, and the contoured surfaces  102 ,  104  may be shaped to displace a particular length when mated or clamped together. In one embodiment, one section (e.g., the top section  102 ) of the clamp  100  is movable, and the contoured surface of the mating section (e.g., the bottom section  104 ) is stationary and is formed in a wall or surface of the tubular body or incorporated into the spacer  50 . In an embodiment, the top section  102  and/or the bottom section  104  of the clamp  100  may rotate into and out of the clamped position to avoid reduce friction of movement. 
     Other mechanical wire deflectors are also contemplated. In an embodiment, the shortening of the wire  16  may be achieved by activating a pin, paddle, or other structure to directly apply non-axial force to the wire  16 . The contact surface of such a structure may be contoured or shaped to promote bending of the wire  16  around the contact surface during deflection. Retraction of the structure causes the wire  16  to return to the undeflected configuration. 
       FIG. 4  is an example of a magnet-based wire deflector  120  that deflects the wire  16  using at least one activated contoured surface, illustrated as a top contoured surface  122  and a bottom contoured surface  124 . Magnetic, electromagnetic, or electrostatic wire deflection may be used for low power steering, e.g., relatively lower power relative to mechanical movement. Rather than moving the surfaces  122 , 124  to clamp the wire  16 , individual addressable magnets  130  on or in the surfaces  122 ,  124  are selectively activated to attract the wire  16  (e.g., a steel wire) to displace a wire length associated with a desired steering outcome. In the illustrated example, the deflection can be towards portions of the top contoured surface  122  as well as portions of the bottom contoured surface  124  depending on the set of activated magnets  130 . Activation of different sets of magnets  130  creates different displacement lengths of the wire  16  and, thus, introduces the potential for tuning different deflection forces to achieve a desired steering at a more granular level and with improved resolution relative to those associated with axial pulling or pushing. The number and position of magnets  130  relative to each wire  16  can be set to a desired steering resolution, and user steering inputs are translated to a magnet activation pattern associated with a particular orientation change of the user steering input. 
     The wire  16  is positioned within a space  132  that is sized and shaped to permit wire deflection. In an embodiment, the magnet-based wire deflector  120  is integrated into a lumen of the endoscope or into a spacer (e.g., spacer  50 ,  FIG. 2 ) or other structural component (e.g., bridge or strut) through which the wire or wires  16  pass. 
       FIG. 5  is an example showing a wire deflector  150  with a one-sided activated surface  152  that deflects the wire  16  and, additionally or alternatively, applies axial force to the wire  16 . The one-sided activated surface  152  may be incorporated into an interior surface or lumen of the tubular body  42 . Magnets  156 , labeled by way of example as 1, 2, and 3, on or in the activated surface  152  can be selectively activated in a particular combination and order to deflect the wire  16 . While the illustrated arrangement includes three magnets, other combinations are also contemplated that include one, two, four, or more magnets that act on one or more wires  16 . In an embodiment, activation of the magnets in a particular order and combination causes localized wire tension or slack. A spool  158 , located proximally and/or distally of the magnets  156 , can rotate to release more wire  16  or wind up any temporary slack as a result of the magnet deflection. Thus, in an embodiment, the length displacement caused by non-axial force of the magnets may be used to move the wire  16  in a proximal or distal direction to steer the endoscope  12 . 
     A workflow  160  shows a magnet activation pattern in a three-magnet arrangement that results in displacement of the wire  16  in a proximal direction. First, magnet  1  is activated to provide an anchor point so that wire movement is limited to a single direction during the subsequent step. Next, magnets  1  and  2  are simultaneously active (e.g., activation of magnet  2  is added to the already-active magnet  1 ) to attract and pull down the wire  16  to the right and while magnet  3  is not activated. This results in a bending of the wire  16  and an area of local slack near magnet  3 . Magnet  3  is then activated while maintaining activation of magnets  1  and  2  to hold the local slack in place relative to the activated surface  152 . Finally, magnets  1  and  2  are released while magnet  3  is still active, becoming the new anchor point, which pushes the local slack in the wire  16  in a proximal direction as the wire straightens and slides to the left. Another workflow  162  shows the activation pattern of magnets to displace the wire  16  in a distal direction. First, magnet  3  is activated to provide an anchor point so that wire movement is limited to a single direction during the subsequent step. Next, magnets  2  and  3  are simultaneously active (e.g., activation of magnet  2  is added to the already-active magnet  3 ) to attract and pull down the wire  16  and while magnet  1  is not activated. This results in a bending of the wire  16  and an area of local slack near magnet  1 . Magnet  1  is then activated while maintaining activation of magnets  2  and  3  to hold the local slack in place relative to the activated surface  152 . Finally, magnets  2  and  3  are released while magnet  1  is still active, becoming the new anchor point, which pushes the local slack in the wire  16  in a distal direction as the wire straightens and slides to the right. During the workflows  160 ,  162 , to anchor movement in a desired direction, at least magnet  1  or magnet  3 , or both, are active until the completion of the incremental wire movement to provide an anchor point. At the completion of each workflow  160 ,  162 , the wire can return to neutral while all magnets are inactive. 
     The workflows  160 ,  162  can be combined and performed in series a desired number of times to translate the wire  16  in proximal and distal directions using non-axial deflection forces generated by magnet activation. Each iteration of the workflow  160 ,  162  causes an incremental movement on the proximal or distal direction. Multiple iterations of the workflow  160  causes proximal movement of the wire  16 , and multiple iterations of the workflow  162  causes distal movement of the wire  16 . The repetition of the workflow  160  and/or the workflow  162  can be controlled based on user input indicative of a desired steering change. 
     In addition selective activation of clamp  100   s  ( FIGS. 3A-B ) can create loose proximal regions of wire  16  that can be sequentially coiled (e.g., into spool  158 ), pinched, and released in a manner similar to the sequential magnet activation of  FIG. 5 . That is, individual clamps  100  can be activated in different patterns to translate the wire  16  in proximal and distal directions using transverse deflection forces generated by clamp activation. Accordingly, one or more of the magnets  1 ,  2 ,  3  can be replaced with selectively activated clamps  100  to achieve a similar effect. 
     Portions of a magnet-based wire deflector may be resident in a controller  200  that reversibly couples to the proximal end  24  of the endoscope  12 , as shown in  FIGS. 6-7 .  FIGS. 6A-C  show the endoscope proximal end  24  inserted into a connector  201  of the controller  200 . The connector  201  may be port that is formed within a body of the controller  200 . For example, the controller  200  can be a handheld wand or device, and the connector  201  can be configured as a recess or opening formed in the body of the handheld wand. In an embodiment, the controller is a multifunctional visualization instrument that includes an integral display screen, and the connector is formed on or in a rear surface of the display screen. 
     The connector  201  may be relatively smooth and free of or with limited electrical contacts to facilitate cleaning. Accordingly, in certain embodiments, the connector  201  includes integral wire deflector components that apply force through a smooth and resilient surface of the connector  201  to cause the wire  16  to deflect into conformable or contoured regions of the endoscope  12 . Additionally or alternatively, wire deflectors resident on the endoscope  12  may deflect the wire  12  info conformable or contoured regions of the connector  201 . 
     The connector  201  is sized and shaped to accommodate the proximal end  24 , e.g., via an interference or threaded fitting. In the illustrated embodiment, the connector  201  includes an array of magnets  202  that, when active, activate the contact surface  210  of the connector  201 . In  FIG. 6A , the contact surface is not activated, and the wire  16  is in a generally undeflected state. The tubular body  42  is coupled to the contact surface  210 , e.g., in direct contact with the contact surface  210 . 
     The wires  16  are arranged towards the tubular body to be close enough to experience the magnetic forces of the magnets  202 . The applied deflecting force on the wire  16  is based on the subset of activated magnets  202  in the array. The connector  201  can be shaped in a bore that is sized to fit the endoscope proximal end  24 , and the magnets  202  can be located circumferentially around the bore or at particular locations aligned with individual wires  16 . 
     The magnets  202 , when activated, attract the wire  16 , which is pulled towards the tubular body  12  to create local tension in the wire  16 . As shown in  FIG. 6B , the contact surface, when activated, can bend the wire  16 , causing axial shortening, and also compress or bend an interior wall  212  of the tubular body  42  towards the activated magnets  202 . Thus, the endoscope  12  may include compressible or conformable regions that, in response to wire deflection, also change shape to accommodate wire deflection. 
     In another example, shown in  FIG. 6C , the interior surface  212  may include a contoured surface  214 , e.g., a resilient contoured surface. Activation of one or more of the magnets  202  draws the wire into the valleys of the contoured surface  214  to cause local tension and axial shortening of the wire. 
     Turning to  FIG. 6A , other electrical connectors, such as leads  220 ,  224  to a camera, orientation sensor, light source, etc., may be routed in available interior space  43 . In contrast to the wires  16 , the leads may be relatively slack. The connector  201  may include pins  226 ,  228  that electrically couple to the camera, orientation sensor, and/or light source. In an embodiment, the rotational orientation of the endoscope  12  is achieved through electrical coupling of endoscope elements to their respective pins  226   228 . In an embodiment, the endoscope  12  includes an alignment key  230  that mates with a lock  232  of the connector  201  to align the endoscope  12  in a rotational orientation to position the wires  16  proximate to locations on the connector  201  corresponding to the magnets  202 . 
       FIG. 7  is an arrangement that includes a controller  250  having a curved connector  252 . An interior surface  252  of the connector  252  can be activated by activating one or more magnets of a magnet array  256  that is curved to conform to the connector  252 . The coupled endoscope  12  may include wires  16  in a side-by-side arrangement that are deflected based on the subset of activated magnets of the magnet array  256 . 
     While certain features of the controller  200  and the connector  201  are illustrated in the context of magnet-based wire deflectors, the connector  201  may additionally or alternatively include one or more clamps.  FIG. 8A  shows an example of the connector  201  in which a connector clamp  256 , in an inactive state, is generally aligned with an interior surface  262  of the connector  201  and applies no or minimal force to a conformable wall  264  of the tubular body  42 . When active (e.g., when translated by a motor) as in  FIG. 8B , the connector clamp  260  moves towards the conformable wall to cause both the conformable wall  264  and the wire  16  to conformed to a contoured surface of the connector clamp  260 . 
     The disclosed steerable endoscopes in  FIGS. 1-8  may be part of a steerable endoscope system when coupled to a controller that receives steering inputs and that generates instructions to cause wire deflection based on the steering inputs.  FIG. 9  is a view of a steerable endoscope system  900 . The controller  910  is shown as a hand-held wand  930 , and an endoscope  912  is removably connected directly to the wand  930 , for passage of control signals from the wand to the endoscope and, when present, video signals from the endoscope  912  to the wand  930 . In other embodiments the controller  910  may have other forms or structures. For example, the controller  930  may be a video laryngoscope that couples to a laryngoscope blade, table-top display screen, tablet, laptop, puck, or other form factor. 
     The controller  910  with the endoscope  912  operates as a two-part endoscope, where the controller  910  serves as the handle, display, and user input to steer a distal end  920  of the endoscope  912 . In an embodiment, the controller  910  is reusable and the endoscope  912  is single-use and disposable, to prevent cross-contamination between patients or caregivers. 
     The proximal end  924  of the endoscope is connected to the controller, and images from a camera at the distal end  920  are displayed on the screen  940 . With one hand (such as the left hand), the user taps on the screen  940  to steer the distal end  920 , and the endoscope camera, and with the other hand (such as the right hand), the user pushes the endoscope  912  forward into the patient cavity. The endoscope  912  may be passed through an endoscope, in an embodiment, for visualization during intubation. 
     In an embodiment, the display screen  940  includes a touch screen that is responsive to user steering inputs such as taps, touches, or proximity gestures from the user. For example, the user may enter a touch gesture (such as a tap, double-tap, tap-and-hold, slide, highlight, or swipe) to identify a target point or direction within the image on the screen. This gesture identifies where the user desires to steer the endoscope, and the controller translates this into corresponding instructions for deflecting one or more wires of the endoscope  912  by, in an example, activating magnets, closing a clamp, or applying a non-axial force to a wire. In an embodiment, the steering input may additionally or alternatively be provided via user selection from a menu, selection of soft keys, pressing of buttons, operating of a j oy stick, etc. 
     A block diagram is shown in  FIG. 10 , including an endoscope  1012  and a controller  1010 . The connection between them may be wired (in which case they each have an electrical connector) or wireless (in which case they each include a wireless transceiver). The endoscope  1012  includes a camera  1030  and, in an embodiment, an orientation sensor  1056  at the distal end of the endoscope  1012 . The orientation sensor  1056  may be an inertial measurement unit (INIU), accelerometer, gyroscope, or other suitable sensor. The endoscope  1012  also includes a light source  1062  and a wire deflector  1058  that is coupled to the controller  1010  and receives instructions that cause wire deflection in the endoscope  1012  to change the orientation of the distal end, and camera, of the endoscope  1012 . 
     The orientation sensor  1056  is an electronic component that senses the orientation (such as orientation relative to gravity) and/or movement (acceleration) of the distal end of the endoscope and provides a signal indicating a change in the endoscope&#39;s orientation and/or a motion of the endoscope  1012  in response to steering. 
     The controller  1010  includes a processor  1066  or chip (such as a chip, a processing chip, a processing board, a chipset, a microprocessor, or similar devices), a hardware memory  1068 , a display screen  1020  (such as a touch screen), and a wire deflector controller  1070 , which may include a controller to activate any wire deflector components, such as magnets, that are resident on the controller. The controller  1010  includes a display  1080  and may also include some other type of user input (buttons, switches), and a power source (such as an on-board removable and/or rechargeable battery). 
     The controller  1010  may also include a power source (e.g., an integral or removable battery) that provides power to one or more components of the endoscope as well as communications circuitry to facilitate wired or wireless communication with other devices. In one embodiment, the communications circuitry may include a transceiver that facilitates handshake communications with remote medical devices or full-screen monitors. The communications circuitry may provide the received images to additional monitors in real time. 
     The processor  1066  may include one or more application specific integrated circuits (ASICs), one or more general purpose processors, one or more controllers, FPGA, GPU, TPU, one or more programmable circuits, or any combination thereof. For example, the processor may also include or refer to control circuitry for the display screen  1080 . The memory may include volatile memory, such as random access memory (RAM), and/or non-volatile memory, such as read-only memory (ROM). The memory may include stored instructions, code, logic, and/or algorithms that may be read and executed by the processor to perform the techniques disclosed herein and drive the wire deflector controller  1070 . 
     The wire deflector  1058  of the endoscope  1012  and/or the wire deflector  1050  controller  1010  may include the wire deflectors (clamps, magnets) as provided in the disclosed embodiments and associated drivers of movable wire deflector components, such as actuators or servo motors (e.g., motor  1072  of the wire deflector  1050  and/or motor  1074  of the wire deflector  1058 ). In an embodiment, the motor drives back and forth type translation motions (e.g., not spinning motions) to drive movement of a clamp or other wire deflection components. Accordingly, a relatively fast and efficient motor (e.g., operating at 200 Hz or greater) for linear motion control may be used to drive such motion. In an embodiment, the motor drives pinching or spooling/coiling of the wire  16 . 
       FIG. 11  is a process flow diagram of a computer-controlled method  1100  of steering an steerable endoscope and with reference to features discussed in  FIGS. 1-10 , in accordance with an embodiment of the present disclosure. The method  1100  disclosed herein includes various steps represented by blocks. It should be noted that at least some steps of the method  1100  may be performed as an automated procedure by a system, such as the system  1000 . Although the flow chart illustrates the steps in a certain sequence, it should be understood that the steps may be performed in any suitable order and certain steps may be carried out simultaneously, where appropriate. Additionally, steps may be added to or omitted from of the method  1100 . Further, certain steps or portions of the method  1100  may be performed by separate devices. For example, a portion of a method  1100  may be performed by the controller, while other portions of the method  1100  may be performed by the endoscope. 
     The method  1100  initiates with the step of receiving a user steering input at a controller to change an orientation of a distal end of the endoscope (block  1102 ). The controller receives the user steering input and, based on the user steering input, generates instructions at the controller (block  1104 ). Such instructions may include activation of one or more wire deflectors, and may include activating a magnet, activating a clamp to clamp a wire, and/or deploying a retractable pin or paddle. The location of the activated element may be selected based on the steering input. For example, steering in particular x-y-z directions may involve coordinated deflection of two or more wires of the endoscopes in a particular direction and with a particular force. The generated instructions are used to activate the appropriate wire deflectors to deflect one or more wires to cause a change in the orientation of the endoscope distal end (block  1106 ) by causing the one or more wires to conform to a contoured surface. The contoured surface may be an integral or interior surface of the endoscope, a clamp surface, and/or a surface of a port of a controller. The wire deflector can cause the wire to conform to the contoured surface by directly contacting the wire and applying a mechanical force to bend the wire around contours of the contoured surface. The wire deflector, when active, can activate a magnet or set of magnets that attract the wire (e.g., a metal wire) towards the magnets and, in turn, towards the contoured surfaces that include the magnets. Changing the orientation of the distal end causes a camera at the distal end to change orientation. Thus, the user can change the camera view via endoscope steering as provided herein and navigate within the patient airway by combinations of changing orientation at the distal end and forward/backward movement of the endoscope by the user. 
     In an embodiment, the controller may receive feedback from an orientation sensor of the endoscope that is also used to generate the instructions. The rotational or absolute sensor orientation may be used by the controller to determine which wire or wires, distributed circumferentially about the distal end, should be deflected to steer the endoscope in the direction indicated by the user steering input. 
     The disclosed techniques are discussed in the context of steering an endoscope, such as those used for endotracheal intubation. It should be understood that the disclosed techniques may also be useful for steering devices used in other types of airway management or clinical procedures. For example, the disclosed techniques may be used in conjunction with placement of other devices within the airway, secretion removal from an airway, arthroscopic surgery, bronchial visualization past the vocal cords (bronchoscopy), tube exchange, lung biopsy, nasal or nasotracheal intubation, etc. In certain embodiments, the disclosed devices may be used for steering and navigation within the anatomy (such as the pharynx, larynx, trachea, bronchial tubes, stomach, esophagus, upper and lower airway, ear-nose-throat, vocal cords). The disclosed devices may also be used for or in conjunction with suctioning, drug delivery, ablation, or other treatments of tissue and may also be used in conjunction with endoscopes, bougies, blind introducers, scopes, or probes. 
     While the disclosure may be susceptible to various modifications and alternative forms, specific embodiments have been shown by way of example in the drawings and have been described in detail herein. However, it should be understood that the embodiments provided herein are not intended to be limited to the particular forms disclosed. Rather, the various embodiments may cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure as defined by the following appended claims.