Patent Publication Number: US-2023136733-A1

Title: Physician-controlled handle for medical devices

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of priority to U.S. Provisional Application No. 63/273,724, filed Oct. 29, 2021. The contents of U.S. Provisional Application No. 63/273,724 are incorporated by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     The present invention relates generally to medical devices, and more particularly to handles for endoscopic medical devices. 
     BACKGROUND 
     Endoscopic medical devices often include an elongate tubular outer member and an elongate inner member movably disposed within the elongate tubular member. The distal end of the inner member includes a distal element (such as, a clip, forceps, or a snare) for performance of a surgical procedure within a patient. A handle is connected to proximal ends of the outer and inner members to control longitudinal and axial rotational movement of one member relative to the other, as well as operation of the distal element. 
     To perform a surgical procedure, the outer and inner members are advanced through a working channel of an endoscope until a distal end of the medical device is at a target treatment site within a patient. Once the distal end at the treatment site, the distal element is manipulated with the handle to perform a desired action on tissue at the treatment site. 
     The surgical procedure is typically performed with two people. One person, usually a physician, holds the endoscope with one hand and longitudinally advances and retracts the inner and outer members through the working channel by grasping the outer member with his/her other hand. A second person, usually a nurse technician, holds and controls the handle in order to control the relative movement of the inner and outer members and operation of the distal element. The second person controls the handle in accordance with instructions given orally by the first person. 
     More and more, physicians desire to control the movement of the inner and outer members and the distal element at the treatment site, rather than issue instructions to the nurse technician. However, when the distal end is at the treatment site, a length of the inner and outer members extending from the proximal opening of the endoscope to the handle is usually too great, such that the physician cannot effectively operate the handle while also holding the endoscope. As such, ways to provide the physician with control of the outer and inner members while also being able to hold the endoscope may be desirable. 
     BRIEF SUMMARY 
     The present description describes medical devices that include a handle that an operator can hold and control with one hand. The handle may be operatively coupled to elongate inner and outer members that are configured to move relative to each other. In addition, the handle may be configured to allow an operator to hold the handle sufficiently close to an endoscope during a medical operation, including during times that the inner and outer members are extending within the endoscope to a treatment site within the patient, which in turn may allow the operator to simultaneously hold and control both the medical device and the endoscope. Accordingly, the handle embodiments described herein may provide an operator holding an endoscope with enhanced control of the medical device extending through the endoscope during an operation, compared to other handles that necessitate two operators to handle and control the medical device handle and the endoscope. 
     In one embodiment, a handle for a medical device includes: a first member from which an inner elongate member and an outer elongate member extend; and a second member configured to move toward and away from the first member, wherein movement of the second member toward and away from the first member controls relative longitudinal movement of the inner and outer elongate members. 
     In another embodiment, a medical device includes: an outer elongate member, an inner elongate member, a distal end effector coupled to a distal end of the elongate inner member, and a handle. The inner member is movably disposed within the outer elongate member, where each of the outer elongate member and the inner elongate member longitudinally extend from a proximal portion to a distal portion. The handle is coupled to the proximal portion, and includes a first member and a second member. The outer and inner elongate members project from a distal end of the first member. Additionally, the first and second members are configured to pivot relative to each other to longitudinally move the outer and inner elongate members relative to each other. 
     In another embodiment a method of operating a medical device includes: positioning a handle in an open state, wherein the handle comprises a first member and a second member pivotably connected to each other, wherein outer and inner elongate members of the medical device distally extend from a distal end of the first member, wherein, in the open state, the first and second members form an angle less than 90 degrees; rotating the second member toward the first member; and proximally moving the inner elongate member relative to the outer elongate member in response to rotating the second member toward the first member. 
     Other embodiments are possible, and each of the embodiments can be used alone or together in combination. Accordingly, various embodiments will now be described with reference to the attached drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1 A  shows a perspective view of a medical device including a handle in an open state. 
         FIG.  1 B  shows a perspective view of the medical device of  FIG.  1 A , with the handle in a closed state. 
         FIG.  2    shows a cross-sectional side view of the medical device of  FIGS.  1 A,  1 B . 
         FIG.  3 A  shows a perspective view of the medical device of  FIG.  1 A -2 being operated by a hand of an operator, with the handle in an open state, and with a distal end effector configured as a clip assembly. 
         FIG.  3 B  shows a perspective view of the medical device of  FIG.  3   , but with the hand configuring the handle in a closed state. 
         FIG.  4    shows a perspective view of a medical system including an endoscope and the medical device of  FIGS.  1 A- 3 B . 
     
    
    
     DETAILED DESCRIPTION 
     The present description describes various embodiments of a handle for a medical device, medical devices and medical systems that include a handle, and related methods that include operating a handle for controlling movement, including relative longitudinal movement and/or axial rotational movement, of inner and outer elongate members of a medical device and/or a distal end effector coupled to one or both of the elongate members. During an endoscopic medical procedure, the handle may be positioned relatively close to a proximal opening of a working channel of an endoscope after distal ends of the outer and inner members have reached a treatment site within a patient, such that an operator is able to handle both the endoscope and the handle. 
     Though use of the handle of the present description, an operator handling the endoscope, which is often a physician, can simultaneously control relative longitudinal and/or rotational movement of the outer and inner members and a distal member of the medical device used to perform an operation on tissue at a treatment site within the patient. In turn, the control of the movement of the outer and inner members does not have to depend on communication between a first operator controlling the endoscope and combined longitudinal movement of the outer and inner members and a second operator controlling relative longitudinal and rotational movement of the outer and inner members. This, in turn, may allow for quicker and more precise and accurate placement, movement, and/or deployment of the distal member at the treatment site. Various example embodiments of the handle are now described. 
       FIGS.  1 A and  1 B  show a perspective view of an example embodiment of a medical device  100  extending from a proximal portion  102  to a distal portion  104 . The medical device  100  includes an outer elongate member  106  and an inner elongate member  108 , each extending from the proximal portion  102  to the distal portion  104 . The inner elongate member  108  is movably disposed within (e.g., within a lumen of) the elongate outer member  106 . The outer and inner elongate members  106 ,  108  may be configured to longitudinally move relative to each other. Such relative longitudinal movement is used or leveraged to perform a medical procedure. For example, the medical device  100  may further include a distal element  110  that is configured to perform an action on tissue at a treatment site within a patient associated with the medical procedure. Non-limiting examples of the distal element include a clip or clip assembly (e.g., a hemostatic clip or clip assembly used to achieve hemostasis at a bleeding site), forceps, an electrode or electrode assembly, a snare, a distal end of a needle knife, or a cutting edge (e.g., of a sphincterotome). The distal element  110  may be attached or connected to the inner member  108 , such that longitudinal and rotational movement of the inner member  108  correspondingly controls longitudinal and rotational movement of the distal element  110 . Accordingly, relative longitudinal movement of the outer and inner members  106 ,  108  may be used to extend the distal element  110  distally past a distal end  112  of the outer member  108  in order to expose the distal element  110  to the tissue at the treatment ( FIG.  1 A ), and to proximally retract the distal element  110  to within the outer member  108  ( FIG.  1 B ). 
     The medical device  100  may further include a handle  114  at the proximal portion  102  coupled to the outer and inner elongate members  106 ,  108 , and that is configured to control relative longitudinal and/or axial rotational movement of the outer and inner members  106 ,  108 . The handle  114  generally includes a pair of members movable relative to each other, including a first member  116  and a second member  118 . As shown in  FIGS.  1 A,  1 B , the outer and inner elongate members  106 ,  108  distally project or extend from the first member  116 . For example, the first member  116  may include an elongate portion or body  117  that extends from a proximal end  120  to a distal end  122 , and the outer and inner elongate members  106 ,  108  may project or extend from the distal end  122 . The movement of the second member  118  may include movement toward and away from an elongate side  119  of the elongate body  117 . 
     The relative movement between the first and second members  116 ,  118  may include two relative directions. In a first relative direction, the first and second members  116 ,  118  move toward or closer to each other. In a second relative direction, the first and second members  116 ,  118  move away from each other. 
     In addition, the relative movement between the first and second members  116 ,  118  may include or be characterized by the second member  118  being movable toward and away from the first member  116 . For example, during a medical procedure, the first member  116 , from which the outer and inner elongate members  106 ,  108  extend, is generally stable or static while the second member  118  moves toward and away from the first member  116 . Correspondingly, movement of the first and second members  116 ,  118  toward each other may include the second member  118  moving toward the first member  116 , and movement of the first and second members  116 ,  118  away from each other may include the second member  118  moving away from the first member  116 . 
     In addition, for at least some embodiments such as shown in  FIGS.  1 A and  1 B , the relative movement between the first and second members  116 ,  118  is a rotational or pivotable movement, as denoted by double-arrow  124  in  FIG.  1 A . The first and second members  116 ,  118  may be connected via a hinge  126  or other similar connection that provides a point, such as a pivot point, about which the first and second members  116 ,  118  rotationally and/or pivotably move relative to each other. For example, as shown in  FIGS.  1 A and  1 B , the hinge  126  may be formed by a pin extending or projecting from the first member  116  perpendicular to the direction of the relative movement of the first and second members  116 ,  118 , and one or more holes integrated with the second member  118  through which the pin extends. The pin and holes define a pivot point about which the first and second members relatively pivot or rotate. Ways for the first and second members  116 ,  118  to relatively pivot or rotate other than through use of a hinge may be possible. 
     Also, the relative movement of the first and second members  116 ,  118  may control relative longitudinal movement of the outer and inner elongate members  106 ,  108 . The relative longitudinal movement may be performed in two opposing relative directions. In a first relative direction, the inner elongate member  108  distally moves relative to the outer elongate member  106 , or the outer elongate member  106  moves proximally relative to the inner elongate member  108 . In a second relative direction, the inner elongate member  108  moves proximally relative to the outer elongate member  106 , or the outer elongate member  106  moves distally relative to the inner elongate member  108 . 
     Further, relative movement of the first and second members  116 ,  118  in each of the relative directions may correspond to a respective one of the relative directions in which the outer and inner elongate members  106 ,  108  longitudinally move. In at least some embodiments such as shown in  FIGS.  1 A and  1 B , relative movement of the first and second members  116 ,  118  toward each other may control or cause the inner elongate member  108  to proximally move relative to the outer elongate member  106 , and relative movement of the first and second members  116 ,  118  away from each other may cause or control the inner elongate member  108  to distally move relative to the outer elongate member  106 . 
     In addition, the handle  114  may be configurable in, and/or the first and second members  116 ,  118  may be configured to be in and to relatively move between, an open state or position and a closed state or position.  FIG.  1 A  shows the handle  114  in the open state.  FIG.  1 B  shows the handle  114  in the closed state. In the open state ( FIG.  1 A ), the first and second members  116 ,  118  are positioned or disposed furthest apart from each other (e.g., they are unable to move further apart from each other). In the closed state ( FIG.  1 B ), the first and second members  116 ,  118  are positioned or disposed closest to each other (e.g., they are unable to move closer to each other). The first and second members  116 ,  118  may also be configured in, positioned in, and/or moved to any of various intermediate states or positions, where the first and second members  116 ,  118  are capable of moving closer to each other or farther apart from each other. 
     As shown in  FIG.  1 A , in the open state, the first and second members  116 ,  118  may form an angle θ that is less than 90 degrees.  FIG.  1 A  shows the angle θ as being defined by geometric rays  127   a ,  127   b  longitudinally extending over generally elongate profiles of the first and second members  116 ,  118 , respectively. Additionally, the rays  127   a ,  127   b  generally extend away from the hinge  126  where the first and second members  116 ,  118  are connected, and toward the unconnected or free ends of the first and second members  116 ,  118 , with the free end of the first member  116  being its distal end  122 . 
     Additionally, as described in further detail below with respect to  FIGS.  3 A,  3 B , the angle θ may be sufficiently small enough to allow an operator to grasp the first and second members  116 ,  118  with a generally open hand, and move the first and second members  116 ,  118  to the closed state ( FIG.  1 B ) by generally closing the hand. At the same time, the angle θ may be sufficiently large to effect sufficient relative longitudinal movement between the outer and inner elongate members  106 ,  108 . A 
     The second member  118  may include a finger-securing portion  128  that provides or defines an area through which an operator may insert and retain at least one finger of the hand used to operate the handle  114 . In at least some embodiments as shown in  FIGS.  1 A,  1 B , the finger-securing portion  128  may be in the form at least one finger ring, such as two finger rings, although other configurations, including those that define an area through which at least one finger may be inserted and/or retained though not in the shape of a ring, may be possible. Additionally, in at least some embodiments, the finger-securing portion  128  may project or extend from, and/or be disposed on, a surface of the second member  118  that faces in a direction that the second member  118  moves away from the first member  116 . Accordingly, when secured by or retained within the finger-securing portion  128 , the at least one finger may bias the second member  118  in a direction that moves the second member  118  toward the first member  116  to the closed state, and may bias the finger-securing portion  128  in a direction that moves the second member  118  away from the first member  116  to the open state. 
       FIG.  2    shows cross-sectional side view of the handle  114 , showing further structural and functional features of the handle  114  in more detail. As best shown in  FIG.  2   , for at least some embodiments, the second member  118  may include and/or be configured as a bell crank  130  that includes a pair of arms  132 ,  134  integrated with the hinge  126 . The pair of arms  132 ,  134  may generally extend from and form or define an angle relative to the pivot point of the hinge  126 .  FIG.  2    shows the angle defined by the arms  132 ,  134  as being greater than 90 degrees and less than 180 degrees, although other angles may be possible. 
     As shown in  FIG.  2   , the first arm  132  includes the finger-securing portion  128 . Also, the first arm  132  may be configured to move, such as pivot or rotate, toward and away from the elongate side  119  of the first member  116  as the handle  114  moves between closed and open states, respectively. For example, the first arm  132  may move toward the elongate side  119  as the handle  114  moves from the open state to the closed state, and may move away from the elongate side  119  as the handle moves from the closed state to the open state. 
     Additionally, the second arm  134  may be configured to engage and/or be positioned adjacent to the proximal end  120  of the first member  116  of the handle  114  when the handle  114  is in the open state, as shown in  FIG.  1 A . In addition, the second arm  134  may be configured to move, such as pivot or rotate, toward and away from the proximal end  120  of the first member  116  movement as the handle  114  moves between open and closed states, respectively. For example, the second arm  134  may move toward the proximal end  120  when the handle  114  moves from the closed state to the open state, and may move away from the proximal end  120  when the handle  114  moves from the open state to the closed state. 
     In addition, the second arm  134  may be connected and operably coupled to the inner elongate member  108 . As shown in  FIG.  1 A -2, the inner elongate member  108  may proximally extend through and be movably disposed within the elongate body  117  of the first member. Through its connection to the inner elongate member  108 , the second arm  134  may be configured to translate its movement, including pivotable movement about the pivot point of the hinge  126 , to longitudinal movement of the inner elongate member  108  relative to the outer elongate member  108 . For example, movement of the second arm  134  away from the proximal end  120  may proximally move the inner elongate member  108  relative to the outer elongate member  106 , and movement of the second arm  134  toward the proximal end  120  may distally move the inner elongate member  108  relative to the outer elongate member  106 . 
     In particular example embodiments, such as shown in  FIG.  1 A -2, the second arm  134  may include an inner member connecting portion  136  that fixedly attaches or connects to a proximal end  138  of the inner elongate member  108 . Various way of fixedly attaching the distal end  138  of the inner elongate member  108  to the inner member connecting portion  136  may be possible. As one non-limiting example, the distal end  138  may extend at least partially through the inner member connecting portion  136 , and a set screw may be positioned within and engaged with a threaded bore extending within the inner member connecting portion  136  in a direction perpendicular to a direction that the distal end  138  partially extends. The set screw may bias the distal end  138  against the inner member connecting portion  136  to fixedly attach the distal end  138  to the inner member connecting portion  136 . Various other ways to fixedly attach the distal end  138  to the inner member connecting portion  136  may be possible. 
     Also, by being configured as a bell crank  130 , the rotational or pivotable movement of the first and second arms  132 ,  134  relative to the first member  116  of the handle  114  may be opposite from each other. That is, when the handle  114  is in the open state such that the first arm  132  is in a position furthest away from the first member  116 , the second arm  134  may be in a closest position to the proximal end  120  of the first member  116 , as shown in  FIG.  1 A . In addition, when the handle  114  is in the closed state such that the second arm  134  is in a position closest to the first member  116 , the second arm  134  may be in a position furthest away from the proximal end  120  of the first member  116 , as shown in  FIGS.  1 A and  2   . Correspondingly, when the first arm  132  moves toward the first member  116 , the second arm  134  moves away from the proximal end  120 , and when the first arm  132  moves away from the first member  116 , the second arm moves toward the proximal end  120 . 
     In sum, movement of the handle  114  from the open state to the closed state moves the second member  118  toward the first member  116 , which includes movement of the first arm  132  pivoting toward the first member  116  and the second arm  134  pivoting away from the first member  116 , causing proximal movement of the inner elongate member  108  relative to the outer elongate member  106 . In addition, movement of the handle  114  from the closed state to the open state moves the second member  118  away from the first member  116 , which includes movement of the first arm  132  pivoting away from the first member  116  and the second arm  134  pivoting ward the first member  116 , causing distal movement of the inner elongate member  108  relative to the outer elongate member  106 . 
     Additionally, for at least some embodiments such as shown in  FIG.  1 A -2, the second member  116  and/or the bell crank  134 , may include an arm connection element  140  connected to the first and second arms  132 ,  134  that may provide structural support for the bell crank  130  and/or facilitate the pivotable movement of the first and second arms  132 ,  134 . As shown in  FIG.  2   , the arm connection element  140  may circumferentially extend about the pivot point of the hinge  126  between the first and second arms  132 ,  134 , and have a first end  142  that connects to the first arm  132  and a second end  144  that connects to the second arm  134 . In particular embodiments such as in  FIG.  2   , the second end  144  connects to the inner member connection portion  138  of the second arm  134 . Also, as shown in  FIG.  2   , the arm connection element  140  may extend through an area of the angle defined by the arms  132 ,  134  that is greater than 90 degrees and less than 180 degrees. 
     Through its connections to the arms  132 ,  134 , the arm connection element  140  may move or pivot about the pivot point of the hinge  126  in the same direction as the movement of the arms  132 ,  134 . For example, the first end  142  may follow movement of the first arm  132  toward and away from the first member  116 , and the second end  144  may follow movement of the second arm  134  toward and away from the proximal end  120  of the first member  116 . 
     Additionally, through its connections to the arms  132 ,  134 , the arm connection element  140  may be configured to translate at least some force or bias on the first arm  132  to the second arm  134  to the corresponding rotational or pivotable movement of the arms  132 ,  134 . For example, when an operator exerts a force on the first arm  132  to move the first arm  132  toward the first member  116 , the arm connection element  140  may translate at least a portion of the force to the second arm  134  to facilitate movement of, such as by pushing, the second arm  134  away from the proximal end  120 . Similarly, when an operator exerts a force on the first arm  132  to move the first arm  132  away from the first member  116 , the arm connection element may translate at least a portion of the force to the second arm  134  to facilitate movement of, such as by pulling, the second arm  134  toward the proximal end  120 . As shown in  FIG.  2   , the ends  142 ,  144  are connected to their respective arms  132 ,  134  at connection points each about half the lengths of the arms  132 ,  134 , providing sufficient distances away from the pivot point to, in turn, provide an amount of torque that enhances the rotational or pivotable movement of the arms  132 ,  134 . 
     In addition, for at least some embodiments as shown in  FIG.  2   , the arm connection element  140  may extend through and be configured to move through the first member  116 . The first member  116  may include a groove or track  146  through which the arm connection element  140  extends. The track  146  may guide movement of the arm connection element  140  through the first member  116  and/or reduce friction between the arm connection element  140  and the first member  116  as the arm connection element  140  moves through the first member  116 . For at least some embodiments as shown in  FIG.  2   , the first member  116  may be in the form of an L-shape or other similar shape formed by the elongate portion  117  and a second portion  148  that includes an arm or projection that extends or projects from, and is connected to, the elongate portion  117  at the proximal end  120 . The hinge  126 , which provides the pivot point for the bell crank  130 , may be integrated with the second portion  148 . For example, the hole for the hinge  126  may extend through the second portion  148 . As shown in  FIG.  2   , the track  146  and the arm connection element  140  may extend through the second portion  146  between the hinge  126  and where the second portion and the elongate portion  117  connect. 
       FIGS.  3 A and  3 B  show a method of operation of the handle  114  of the medical device  100  of  FIG.  1 A -2. The handle  114  may be sized and shaped such that an operator can grasp and optimally operate the handle with a single hand  302 .  FIG.  3 A  shows the operator’s hand  302  engaging with the handle  114  in the open state, and  FIG.  3 B  shows the operator’s hand  302  engaging with the handle  114  in the closed state. 
     As a non-limiting example to illustrate the method, the device  100  is configured as a clip device, such as a hemostatic clip device, where the distal end effector  110  shown in  FIG.  1 A -2 is configured as a clip or clip assembly  304  that is deployed at a treatment site  306  to bind or join together tissue  308  at the treatment site  304  to stop bleeding, such as bleeding caused by removal of a polyp or a bleeding ulcer in the gastrointestinal (GI) tract, as non-limiting examples. However, the handle  114  may be generally used for any of various medical device embodiments to effect relative longitudinal movement of two elongate members  106 ,  108  and/or use any of various configurations of an end effector  110 , as previously described. 
     As shown  FIGS.  3 A and  3 B , the operator operates the handle  114  by simultaneously engaging with or contacting the first and second members  116 ,  118 . In particular, when the operator has at least one of his/her fingers  310  inserted through or in the finger securing portion  128 , the first member  116 , including the elongate body  117 , is positioned against the palm  312  of the operator’s hand  302 . In some embodiments, the handle  114  is self-biased in the open state and/or configure or position itself in the open state absent external forces acting on it, such as by including a spring or other elastic member integrated with the first and/or second members  116 ,  118  that is configured to bias the first and second members  116 ,  118  away from each other in order to move or pivot the first and second members  116 ,  118  away from each other. Accordingly, the operator can open his/her hand  302  and/or uncurl his/her fingers  310  as shown in  FIG.  3 A , and the second member  118  will follow the movement of the fingers  304  and move away from the first member  116  due to the biasing from spring member. In other embodiments, the handle  114  does not have any self-biasing components, and configuring or positioning the handle  114  in the open state may be caused by external forces such as from the operator’s hand  302 . In such latter embodiments, for example, movement of the first and second members  116 ,  118  away from each other may be caused, including solely caused, by the operator’s fingers  310  biasing the finger securing portion  128  when opening the hand  302 . Additionally, to move the handle  114  from the open state ( FIG.  3 A ) to the closed state ( FIG.  3 B ), the operator may close his/her hand  302 , such as if the operator is trying to form a fist while holding the handle  114  by curling or otherwise moving his/her fingers  310  toward the palm  312 , which exerts a bias on the second member  118  that moves the second member  118  toward the first member  116 . 
     Accordingly, when the operator wants to distally move the inner elongate member  108  relative to the outer elongate member  106 , the operator can open his/her hand  302  to cause the second member  118  to move or pivot away from the first member  116  until the handle  114  is in the open state. The operator may distally move the inner elongate member  106  to effect a certain configuration of the distal end effector  110 . For example,  FIG.  3 A  shows that the operator opening his/her hand to move the handle  114  into the open state causes the clip assembly  304  to distally advance past a distal end of the outer elongate member  106  and the legs or jaws of the clip assembly  304  to open. 
     Additionally, when the operator wants so proximally move the inner elongate member  108  relative to the outer elongate member  106 , the operator can close his/her hand  302  to cause the second member  118  to move or pivot toward the first member  116  until the handle  114  is in the closed state. Similarly, the operator may proximally move the inner elongate member  106  to effect a certain configuration of the distal end effector  110 . For example,  FIG.  3 B  shows that the operator closing his/her hand to move the handle  114  toward the closed state causes the legs or jaws of the clip assembly  306  to close to grasp the tissue  308 , which in turn joins portions of the tissue  308  together to stop bleeding. Further closing his/her hand to move the handle  114  to the closed state may cause further proximal movement of the inner elongate member  108  relative to the outer elongate member  106 , which in turn may cause the clip assembly  304  to separate from the inner elongate member  108  (and from the rest of the clip device), fully deploying the clip assembly  304  at the treatment site. 
       FIG.  4    shows a medical system  400  that includes the medical device  100  with the handle  114  in combination and used with an endoscope  402 . In general, the endoscope  402  is used, among other things, to guide or facilitate the movement of the distal portion  104  ( FIG.  1 A -2) of the medical device  100  to a treatment site within a patient. The endoscope  402  includes a handle  404  and an insertion tube  406  that is inserted into a patient. The insertion tube  406  extends from a proximal end connected to the handle  404  to a distal end (not shown). The insertion tube  406  has a longitudinal length sufficient to reach the treatment site within the patient. The endoscope  402  further includes a working channel longitudinally extending through the insertion tube  406  and that proximally extends to a proximal opening  408  at a portion of the handle  404 . 
     An operator, such as a physician, may insert the insertion tube  406  into an opening of a patient and distally advance the insertion tube  406  within the patient until a distal end of the insertion tube  406  reaches a desired location at or near the treatment site. The operator may then insert the distal portion  104  of the medical device  100  into the working channel proximal opening  408 , and distally advance the outer and inner elongate members  106 ,  108  through the working channel until the distal portion  104  reaches the treatment site. The operator may do so by grasping and distally pushing the outer elongate member  106  through the working channel. While the operator is distally advancing the outer elongate member  106  with one hand, the operator may be simultaneously holding the endoscope handle  402  with his/her other hand. 
     For at least some operations using the medical system  400 , while the operator is holding the endoscope  402  and distally advancing the distal portion  104  to the treatment site, a second operator, such as an assistant or nurse of the physician, may be holding the handle  114  of the medical device  100 . As shown in  FIG.  4   , when the first operator has finished distally advancing the distal portion  104  to the treatment site, the handle  114  may be positioned or held a distance D from the working channel proximal opening  408  that is short enough that the first operator can simultaneously hold and control both the endoscope handle  404  and the device handle  114 . As shown in  FIG.  4   , the device handle  114  may be held a sufficiently short distance D from the working channel opening  408  without the portions of the outer and inner elongate members  106 ,  108  between the first member  116  and the working channel opening  408  being too long so as to be kinked, too coiled or twisted or otherwise too tortuous so as to impeded or hinder their unison and/or relative longitudinal movement and operation of the handle  114 . 
     Accordingly, when the first operator has finished advancing the distal portion  104  to the treatment site, the first operator may obtain the handle  114  from the second operator, such that the first operator is simultaneously holding the endoscope handle  404  and the medical device handle  114 . At this time, the first operator has simultaneous control of the endoscope  402 , including operation of the endoscope handle  404 , and the medical device  100 , including operation of the device handle  114 . As a result of the simultaneous control, the first operator can control operation of the medical device  100  as desired while holding and controlling the endoscope  402 . For example, while holding the endoscope  402 , the operator, through control of the device handle  114 , can control relative longitudinal movement of the outer and inner elongate members  106 ,  108 , and/or can control operation of the distal end effector  110 , such as operation and deployment of the clip assembly  304  shown in  FIG.  3   , as a non-limiting example. 
     Additionally, when the distal portion  104  has reached the treatment site and the operator is holding the endoscope  402  with one hand and holding the device handle  114  with his/her other hand the distance D from the working channel opening  408 , a length of portions of the outer and inner elongate members  106 ,  108  between device handle  114  and the working channel opening  408  is short enough such that the first operator can effect unison longitudinal movement of the outer and inner elongate members  106 ,  108  and the distal end effector  110 , through movement of the handle  114  toward and away from the working channel opening  408 , without kinking or other similar undesirable interference of the outer and inner elongate members  106 ,  108  that may otherwise occur if the length of the outer and inner elongate members  106 ,  108  between the opening  408  and the handle  114  is too long. 
     The first operator can also move, such as by rotating, the handle  114  to effect axial rotational movement of the outer elongate member  106 , the inner elongate member  108 , and/or the distal end effector  110 . In various embodiments, such movement of the handle  114  to effect axial rotational movement of the distal end effector  110  may include greater than 90 degrees of rotation of the distal end effector  110 . The operator may effect the rotation, including greater than 90 degrees rotation, of the distal end effector  110  while operating the handle  114  with only one hand. Also, the first operator may move the handle  114  to effect simultaneous unison longitudinal movement of the outer and inner members  106 ,  108  and/or the distal end effector  110 , and axial rotation of the outer and inner members  106 ,  108  and/or the distal end effector  110 . 
     In addition, the operator may move the first and second members  116 ,  118  relative to each other to effect relative longitudinal movement of the outer and inner members  106 ,  108 , while also moving the handle  114  as a whole to effect unison longitudinal movement of the outer and inner elongate members  106 ,  108  and/or to effect axial rotational movement of the outer elongate member  106 , the inner elongate member  108 , and/or the distal end effector  110 . As a particular example, for embodiments where the distal end effector  110  is configured as a clip assembly  304  ( FIGS.  3 A,  3 B ), the operator may move the first and second members  116 ,  118  relative to each other while moving the handle  114  as a whole to effect simultaneous opening or closing of the jaws or legs of the clip assembly  304  while axially rotating the clip assembly  304 . 
     For at least some embodiments such as shown in  FIGS.  1 A,  1 B,  3 A- 4 B , the first member  116  may include a holder  150 , such as a clip, that can hold, retain, and/or attach to a portion  152  of the outer elongate member  106  distal the distal end  122  of the first member  116 . Correspondingly, proximal portions of the outer and inner elongate members  106 ,  108  may extend from the distal end  122  of the first member  116  to the holder  150 , such as in the form of a loop  154  for example, as shown in  FIG.  4   . The outer and inner elongate members  106 ,  108  may then extend from the holder  150  to the endoscope opening  408  and down through the working channel of the endoscope  400 . 
     By attaching to the portion  152  of outer elongate member  106  at the holder  150 , the handle  114  exerts distally transferred forces on the outer and inner elongate members  106 ,  108  at the holder  150  instead of at the distal end  122 . Such distally transferred forces may include longitudinal forces that longitudinally move the outer and inner elongate members  106 ,  108  and the distal end effector  110  in unison with each other, and/or axial rotational forces that axially rotate the outer elongate member  106 , the inner elongate member  108 , and/or the distal end effector  110 . In various embodiments and/or circumstances, the axial rotation may include relative axial rotation where the outer elongate member  106  axially rotates (clockwise or counter-clockwise) corresponding to movement of the first member  116 , relative to the inner elongate member  108  and/or the distal end effector  110 . In other embodiments, the axial rotation may include unison axial rotation of the outer and inner elongate members  106 ,  108  and the distal end effector  110 . 
     Accordingly, the holder  150  effectively shortens the length of the outer and inner elongate members  106 ,  108  between the working channel opening  408  and the device handle  114  compared to the length of the outer and inner elongate members  106 ,  108  between the working channel opening  408  and the distal end  122 . The shortening of the length may enhance the ability of the device handle  114  to effect longitudinal and/or rotational movement of the outer and inner elongate members  106 ,  108  and/or the distal end effector  110 . Accordingly, the holder  150  attaching to the portion  152  of the outer elongate member  106  distal the distal end  122  of the first member  116  may make easier the operator’s control of longitudinal and/or axial rotational movement of the outer and/or inner elongate members  106 ,  108  and/or the end effector  110  through movement of the handle  114 , compared to if the handle  114  instead exerted such longitudinal and/or axial rotational forces on the outer and/or inner elongate members  106 ,  108  at the distal end  122  of the first member  116 . 
     Handles different than the handle  114  of the present description may similarly be able to effect relative or unison longitudinal movement and/or axial rotational movement of the outer and inner members  106 ,  108  and/or manipulate the distal end effector  110 . However, such handles may require use of two operators, a first operator to hold and operate the endoscope  402  and a second operator to hold and operate the device handle  114 . If the first operator tried to hold these other handles while also holding the endoscope  402 , the portions of the outer and inner elongate members between the handle and the working channel opening  408  would be too long for effective movement of the outer and inner members  106 ,  108 , and/or the way that the first operator would have to grasp the handle to properly use it while also holding the endoscope  402  would be uncomfortable. In contrast, the handle  114  described herein allows a single operator to comfortably hold and control both the endoscope handle  404  and the device handle  114  while also allowing for relatively unhindered movement of the outer and inner elongate members  106 ,  108  for performance of the medical procedure for which the medical device  100  is intended. 
     Additionally, the ability of one operator to simultaneously hold and control the endoscope handle  404  and the device handle  114  may be desirable to the operator since the operator does not have to rely on a second operator to hold and control the device handle  114  during operation of the medical procedure. For these other procedures where the second operator is operating the device handle  114 , the first operator holding the endoscope  400  may issue audible commands or instructions to the second operator to carry out the medical procedure. The ability of the first operator operating the endoscope  400  to also hold and operate the device handle  114  may allow for more accurate placement and operation of the distal end effector  110  at the treatment site, compared to other procedures where the second operator is operating the handle  114  in response to audible instructions, resulting in an overall improvement in performance of the medical procedure. 
     The subject matter of the present description may also relate, among others, to the following aspects: 
     A first aspect includes a handle for a medical device comprising: a first member from which an inner elongate member and an outer elongate member extend; and a second member configured to move toward and away from the first member, wherein movement of the second member toward and away from the first member controls relative longitudinal movement of the inner and outer elongate members. 
     A second aspect includes the first aspect, and further includes: wherein the movement of the second member toward and away from the first member comprises rotational movement. 
     A third aspect includes any of the first or second aspects, and further includes that the first member and the second member are connected to each other via a hinge about which the first member and the second member pivotably move relative to each other. 
     A fourth aspect includes any of the first through third aspects, and further includes that the second member comprises a bell crank comprising a pair of arms configured to move opposite from each other toward and away from the first member. 
     A fifth aspect includes the fourth aspect, and further includes that one of the pair of arms is configured to move toward and away from a proximal end of the first member. 
     A sixth aspect includes the fifth aspect, and further includes that the one of the arms is configured to translate movement toward and away from the proximal end of the first member to longitudinal movement of the inner elongate member. 
     A seventh aspect includes any of the fourth through sixth aspects, and further includes that one of the pair of arms is configured to move toward and away from an elongate side of the first member. 
     An eighth aspect includes any of the fourth through seventh aspects, and further includes that the bell crank further comprises an arm connection element connected to each of the pair of arms and circumferentially extending about a pivot point of the bell crank. 
     A ninth aspect includes the eighth aspect, and further includes that the arm connection element extends and is configured to move through the first member. 
     A tenth aspect includes the ninth aspect, and further includes that the arm connection element extends through the first member between a pivot point of the bell crank and a proximal end of an elongate body of the first member. 
     An eleventh aspect includes any of the fourth through tenth aspects, and further includes that the pair of arms forms an angle greater than 90 degrees and less than 180 degrees. 
     A twelfth aspect includes any of the first through eleventh aspects, and further includes that the second member is configured to move toward the first member to configure the handle in a closed state and move away from the first member to configure the handle in an open state. 
     A thirteenth aspect includes the twelfth aspect, and further includes that the first member and the second member form an angle that is less than 90 degrees in the open state. 
     A fourteenth aspect includes any of the first through thirteenth aspects, and further includes that the second member comprises a finger-securing portion disposed on a surface of the second member that faces in a direction that the second member moves away from the first member. 
     A fifteenth aspect includes any of the first through fourteenth aspects, and further includes that the first member comprises a holder configured to hold a portion of the outer elongate member. 
     A sixteenth aspect includes a medical device comprising: an outer elongate member; an inner elongate member movably disposed within the outer elongate member, each of the outer elongate member and the inner elongate member longitudinally extending from a proximal portion to a distal portion; a distal end effector coupled to a distal end of the elongate inner member; and a handle coupled to the proximal portion, the handle comprising a first member and a second member, wherein the outer and inner elongate members project from a distal end of the first member, and wherein the first and second members are configured to pivot relative to each other to longitudinally move the outer and inner elongate members relative to each other. 
     A seventeenth aspect includes the sixteenth aspect, and further includes that the first member and the second member are connected to each other via a hinge about which the first member and the second member pivot relative to each other. 
     An eighteenth aspect includes the seventeenth aspect, and further includes that the second member comprises a bell crank integrated with the hinge. 
     A nineteenth aspect includes any of the sixteenth through eighteenth aspects, and further includes that the first member comprises an elongate body, and a holder configured to hold a portion of the outer elongate member, wherein the outer and inner elongate members form a loop between a distal end of the elongate body and the holder. 
     A twentieth aspect includes any of the sixteenth through nineteenth aspects, and further includes that the distal end effector comprises a clip assembly. 
     A twenty-first aspect includes method of operating a medical device, the method comprising: positioning a handle in an open state, wherein the handle comprises a first member and a second member pivotably connected to each other, wherein outer and inner elongate members of the medical device distally extend from a distal end of the first member, wherein, in the open state, the first and second members form an angle less than 90 degrees; rotating the second member toward the first member; and proximally moving the inner elongate member relative to the outer elongate member in response to rotating the second member toward the first member. 
     A twenty-second aspect includes the twenty-first aspect, and further includes that the second member comprises a bell crank comprising a first arm and a second arm, and wherein rotating the second member toward the first member comprises: rotating the first arm toward an elongate side of the first member and rotating the second arm away from a proximal end of the first member. 
     A twenty-third aspect includes any of the twenty-first or twenty-second aspects, and further includes: deploying a clip assembly at a treatment site in response to moving the handle from the open state to a closed state. 
     A twenty-fourth aspect includes any of the twenty-first through twenty-third aspects, and further includes: rotating the second member away from the first member; and distally moving the inner elongate member relative to the outer elongate member in response to rotating the second member away from the first member. 
     A twenty-fifth aspect includes any of the twenty-first through twenty-fourth aspects, and further includes: with a holder of the first member, exerting an axial rotational force on the outer elongate member to effect axial rotation of at least one of the outer elongate member, the inner elongate member, or a distal end effector. 
     A twenty-sixth aspect includes the twenty-fifth aspect, and further includes: axially rotating the distal end effector more than 90 degrees in response to exerting the axial rotational force. 
     A twenty-seventh aspect includes any of the twenty-first through twenty-sixth aspects, and further includes: simultaneously exerting the axial rotational force on the outer elongate member and rotating the second member toward or away from the first member. 
     A twenty-eighth aspect includes any of the twenty-first through twenty-seventh aspects, and further includes: simultaneously moving the handle toward or away from a proximal working channel opening and rotating the second member toward or away from the first member. 
     The foregoing description of various embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise embodiments disclosed. Numerous modifications or variations are possible in light of the above teachings. The embodiments discussed were chosen and described to provide the best illustration of the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly, legally, and equitably entitled.