Abstract:
A handheld surgical endoscope has a disposable, single-use portion that includes a fluid hub, cannula, distal tip and an integrated needle and a re-usable portion that includes a handle and display module. The distal tip includes LED illumination and an imaging module that feeds live video to the display module that is rotatable to allow viewing by the operator and others. The single-use and re-usable portions mate and un-mate with each other via physically separated mechanical and electrical connectors. The needle is actuatable to allow for both recessed and extended positions. The needle delivers liquid from a attached syringe that can be attached to the handle to move therewith or only connected to the endoscope by a flexible conduit. The surgical endoscope is configured for operation by a single clinician in many procedures.

Description:
REFERENCE TO RELATED APPLICATIONS 
       [0001]    This patent application claims the benefit of and incorporates by reference each of the following provisional applications:
       U.S. Prov. Ser. No. 62/339,810 filed May 21, 2016;   U.S. Prov. Ser. No. 62/362,643 filed Jul. 15, 2016;   U.S. Prov. Ser. No. 62/375,814 filed Aug. 16, 2016;   U.S. Prov. Ser. No. 62/405,930 filed Oct. 9, 2016;   U.S. Prov. Ser. No. 62/416,403 filed Nov. 2, 2016;   U.S. Prov. Ser. No. 62/443,769 filed Jan. 8, 2017;   U.S. Prov. Ser. No. 62/449,257 filed Jan. 23, 2017; and   U.S. Prov. Ser. No. 62/452,883 filed Jan. 31, 2017.       
 
         [0010]    This patent application is a continuation-in-part of and incorporates by reference each of the following applications:
       U.S. Ser. No. 14/913,867 filed Feb. 23, 2016;   U.S. Ser. No. 15/371,858 filed Dec. 7, 2016;   International Patent Application No. PCT/US16/18670 filed Feb. 19, 2016; and   International Patent Application No. PCT/US16/65396 filed Dec. 7, 2016.       
 
         [0015]    This patent application relates to the following provisional and non-provisional applications that are each incorporated by reference:
       U.S. Prov. Ser. No. 62/119,521 filed Feb. 23, 2015;   U.S. Prov. Ser. No. 62/120,316 filed Feb. 24, 2015;   U.S. Prov. Ser. No. 62/139,754 filed Mar. 29, 2015;   U.S. Prov. Ser. No. 62/254,718 filed Nov. 13, 2015;   U.S. Prov. Ser. No. 62/259,991 filed Nov. 25, 2015;   U.S. Prov. Ser. No. 62/275,222 filed Jan. 5, 2016;   U.S. Prov. Ser. No. 62/275,241 filed Jan. 6, 2016;   U.S. Prov. Ser. No. 62/279,784 filed Jan. 17, 2016;   U.S. Prov. Ser. No. 62/287,901 filed Jan. 28, 2016; and   U.S. Prov. Ser. No. 62/299,453 filed Feb. 24, 2016.       
 
     
    
     FIELD 
       [0026]    This patent specification generally relates mainly to a medical device for use in tissue examinations and endoscopic surgery such as in urology. More particularly, some embodiments relate to an integrated, handheld, low-cost surgical endoscope device having a single-use portion and a multiple-use portion. 
       BACKGROUND 
       [0027]    Conventional endoscopy, or direct vision used to examine the interior of a hollow organ or cavity of the body, uses a complex lens system for transmitting the image from the distal tip of the endoscope to a viewer. The lens system is typically a relay lens system in the case of rigid endoscopes or a bundle of fiber optics or an objective lens system in the case of flexible endoscopes. In the case of both rigid and flexible conventional endoscopes, the lens or fiber optic system is relatively expensive and is intended to be re-used many times. Therefore, stringent decontamination and disinfection procedures need to be carried out after each use. 
         [0028]    In surgical procedures where a needle is used to inject fluid such as a drug into the patient&#39;s tissues, a long injection needle is inserted into the working channel of the endoscope. In such procedures, it is common to use two or more operators to carry out the surgical procedure: one to operate the endoscope and another to operate the needle assembly and syringe. It is common for there to be a physical separation between display screen (e.g. mounted overhead), the endoscope (into the patient), and/or the syringe used to administer the drug. In such cases an operator or clinician has to look up the display screen and cannot simultaneously view the scope handle and the syringe. Furthermore, the separate needle assembly which is often long and somewhat cumbersome needs to be threaded through the working channel of the endoscope and substantial manual dexterity may be required to control the jabbing and injection process. 
         [0029]    Disposable endoscopy is an emerging category of endoscopic instruments. In some cases the manufacture of endoscopes can be made inexpensive enough to be used on a single patient only. Disposable or single-use endoscopy lessens the risk of cross-contamination and hospital acquired diseases. Partially disposable endoscopy systems for hysteroscopy are discussed in U.S. Pat. No. 8,460,182, incorporated by reference herein. A hysteroscope having a disposable probe was offered by Endosee Corporation of Los Altos, Calif., and is now offered by CooperSurgical, Inc. of Trumbull, Conn., a company that acquired EndoSee Corporation. 
         [0030]    The subject matter described or claimed in this patent specification is not limited to embodiments that solve any specific disadvantages or that operate only in environments such as those described above. Rather, the above background is only provided to illustrate one exemplary technology area where some embodiments described herein may be practiced. 
       SUMMARY 
       [0031]    According to some embodiments that are particularly suitable for fields such as urology and endoscopic surgery rather than hysteroscopy, a low-cost surgical instrument for examining and injecting a desired fluid into a patient&#39;s tissue comprises an endoscope with a disposable distal portion and a reusable proximal portion, configured to enable a single user to operate the endoscope both (i) to visualize an internal region of the patient and (ii) to concurrently inject fluid in or adjacent said region through an injection needle permanently mounted at a distal part of the endoscope by jabbing with both portions. In this example, the endoscope comprises a handle configured to be grasped by the user&#39;s hand and having at least one button controlling endoscope functions, and an integral video display screen, wherein both the handle and the screen form a part of the reusable portion of the endoscope; a cannula forming a part of the disposable portion of the endoscope and configured with internal lumena and an injection needle permanently mounted at a distal part of the cannula for motion between a retracted position at which it is entirely within the cannula and a releasably locked protruding position in which it extends distally from the cannula; a connector at a proximal part of the disposable portion of the endoscope, configured to releasably mate tool-free with a connector at the reusable portion of the endoscope thereby releasably integrating the reusable and disposable portions; a needle actuation hub at the disposable portion of the endoscope, intermediate the connector of the disposable portion and the cannula; an actuation tab mounted to the hub and configured to be moved by the user&#39;s hand between a first position and a second position; said tab being coupled to the needle to drive it between its retracted and protruding positions as the user moves the tab between its first and second positions; an injection fluid port at the hub, said port being in fluid communication with the injection needle through the cannula so that fluid introduced in the port can be injected through the needle; and a light source and an imaging module with a video camera at a distal portion of the cannula, coupled with the screen to illuminate the region in the patient and provide images of the region to the screen under the control of said buttons on the handle. This configuration enables a single user holding the handle to use one hand to insert and retract the cannula in and from the patient, operate said buttons, move the needle from its retracted position to its protruded position, jab the needle into tissue, and retract the needle, and to use the same or the other hand to selectively force fluid into said fluid port. 
         [0032]    In some embodiments, the endoscope further includes a source of fluid and a flexible conduit from the source to the injection fluid port, wherein the flexible conduit is the sole connection between the source of fluid and the endoscope, thereby helping to keep motion of the source of fluid from being mechanically transmitted to the reusable portion and/or the disposable portion of the endoscope at least while the needle is in its protruding position. 
         [0033]    In some embodiments, the endoscope further includies a fluid source coupled with the fluid port via a conduit, and an attachment releasably securing the syringe to the handle to thereby enable the operator to use a single hand to operate the endoscope to visualize a region of the patient, to jab the needle into tissue, and to inject fluid into the tissue. 
         [0034]    In some embodiments, the endoscope&#39;s video camera has a field of view (FOV) and the distal tip of the needle is at a central region of the FOV when the needle is in its protruding position. 
         [0035]    In some embodiments, the endoscope&#39;s tab has a projection moving with the tab relative to the hub and the hub has stops configured to releasably engage the projection when the tab is in its first and second positions and thereby releasably lock the tab at least at the second tab position and thus the needle at its protruding position, and the hub further includes a hand-operated release button acting on said projection to thereby selectively release the tab and thus the needle from a locked position. 
         [0036]    In some embodiments, the endoscope&#39;s hub is coupled to the mechanical connector of the disposable portion of the endoscope through an angularly sliding coupling enabling rotation of the cannula relative to the handle when the disposable and reusable portions are integrated. 
         [0037]    In some embodiments, the endoscope&#39;s needle is no longer than the distance from the fluid port to the distal end of the cannula. 
         [0038]    In some embodiments, the endoscope is free of openings at a distal part of the disposable portion for insertion of an injection needle. 
         [0039]    In some embodiments, the connector of the disposable portion of the endoscope comprises a mechanical connector and an electrical connector spaced proximally from the mechanical connector, and said connector of the reusable portion comprises a mechanical connector configured to releasably mate tool-free with the mechanical connector of the disposable portion and an electrical connector spaced proximally from the distal end of the reusable portion and configured to releasably mate tool-free with the electrical connector of the disposable portion. 
         [0040]    In some embodiments, the mechanical and electrical connectors of the disposable portion of the endoscope are male connectors and the electrical and mechanical connectors of the reusable portion and female connectors. 
         [0041]    In some embodiments, the surgical instruments comprises: a disposable portion for a single use on a patient, comprising a cannula with an injection needle that is permanently mounted in the cannula for motion between a retracted position and a releasably locked protruded position; a reusable portion comprising a handle configured to be grasped by a user&#39;s hand; an electrical connector and a mechanical connector on each of the disposable portion and the reusable portion, said connectors releasably mating with each other to integrate the disposable portion and the reusable portion and to establish electrical connection between them; wherein each of electrical connectors is spaced in a proximal direction from each of the mechanical connectors thereby facilitating prevention of contamination of the electrical connectors from material in or on the disposable portion; a needle actuator tab mounted to the disposable portion and movable by hand between a retracted position and an extended position, said actuator being coupled with the needle to move the needle between its retracted and protruded positions as the tab moves between its retracted and extended position; an injection fluid port at the disposable portion, coupled with the injection needle for conveying thereto via the cannula fluid introduced into the port; an illumination source and an imaging module including a video camera mounted to a distal part of the cannula, a video screen mounted to the reusable part to move therewith and to rotate and/or tilt relative to the reusable part, and controls on the reusable portion to control video camera; and electrical connections between the reusable portion and the camera and illumination source to control the illumination source and the camera and to convey images from the camera for display on the screen. In this configuration, the endoscope, when integrated, is configured for selective operation with one hand to move the tab and the needle between their positions, to control the illumination source and camera, and to push the needle into tissue by jabbing at least the disposable portion when the needle is in its protruded position. 
         [0042]    The endoscope can include a source of fluid and a flexible conduit connecting the fluid source to said fluid port in the disposable portion of the endoscope. The fluid source can be configured to be out of a mechanical connection with the reusable portions except through said flexible conduit, and can be located sufficiently close to the reusable portion for a single operator to operate the reusable portion with one hand and the fluid source with the other hand. In an alternative, the endoscope can be provided with an attachment mounting the fluid source to at least one of the reusable portion and the disposable portion for operation with a single hand of the endoscope enabling the user to utilize a single hand (i) to move the tab to thereby move the needle between its retracted and protruding positions, (ii) to operate said controls controlling the video camera, and (iii) to operate the fluid source to inject fluid therefrom through the needle. The fluid source can comprise a syringe, and the attachment can be secured to the handle and can include a syringe band into which the syringe can be slipped in and from which it can be slipped out. The attachment can further comprise a handle band secured to the handle, and projections on one of the band and depressions on the other for a releasable snap-fit of the bands to each other. As an alternative, the attachment can comprise hook-and-loop patches or bands secured to each of the fluid source and the handle and adapted to releasably couple with each other thereby attaching the fluid source to the handle. 
         [0043]    In some embodiments, the video screen is mounted to the handle for rotation or tilting about two axes that are transverse to each other so it can be rotated or tilted relative to the handle to facilitate selection of the screen orientation relative to the user before or during a patient procedure. The endoscope can further include a flushing fluid port that is spaced in the distal direction from the injection fluid port, and the cannula can include at least one flushing fluid opening at a distal part of the camera and at least one lumen connecting the flushing fluid port with the at least one flushing fluid opening. The video camera can have a field of view and the needle, when in its protruding position, can have a tip that is at a central position in said field of view. The needle actuator tab can be mounted to the hub for back-and-forth motion in the proximal-distal direction. The needle when in its retracted position can be entirely within the cannula. 
         [0044]    A method of using the surgical instrument can comprise: removing a disposable distal portion of an endoscope from sterile packaging and releasably attaching it tool-free to a reusable portion of the endoscope to thereby assemble the endoscope; introducing a cannula that is a part of the distal portion of the endoscope into a patient until a tip of the cannula reaches a selected region in the patient; illuminating the selected region with a light source mounted in the tip of the cannula and visualizing the region with a video camera mounted in the cannula tip and supplying images to a video screen mounted to the reusable portion of the endoscope; operating a tab movably mounted to the reusable portion of the endoscope to thereby move an injection needle that is permanently mounted to the cannula tip from a retracted position in which the needle is entirely within the cannula to a releasably locked protruding position in which the needle protrudes from the cannula; jabbing the needle into tissue by moving the reusable and disposable portions as a unit while the needle is in its protruding position; and injecting fluid through the needle from a fluid source that is connected to the endoscope; retracting the needle to its retracted position by operating the tab and withdrawing the cannula from the patient. A single user can operates the endoscope to introduce the cannula into the patient, visualize the region, jab the needle, inject fluid through the needle, and retract the needle and withdraw the cannula from the patient, using one or both hands. The method can include detaching the disposable portion from the reusable portion by hand, tool-free, and disposing of the disposable portion. 
         [0045]    In some embodiments of the method, the user can use a single hand to operate the endoscope to visualize the region, jab the needle, inject fluid through the needle, and retract the needle. In some embodiments, the method further includes attaching a syringe to the handle in a position in which the same user&#39;s hand operating controls of the camera on the handle reaches the syringe plunger to inject fluid from the syringe through the needle and into the patient. 
         [0046]    As used herein, the grammatical conjunctions “and”, “or” and “and/or” are all intended to indicate that one or more of the cases, object or subjects they connect may occur or be present. In this way, as used herein the term “or” in all cases indicates an “inclusive or” meaning rather than an “exclusive or” meaning. 
         [0047]    As used herein the terms “surgical” or “surgery” refer to any physical intervention on a patient&#39;s tissues, and does not necessarily involve cutting a patient&#39;s tissues or closure of a previously sustained wound. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0048]    To further clarify the above and other advantages and features of the subject matter of this patent specification, specific examples of embodiments thereof are illustrated in the appended drawings. It should be appreciated that these drawings depict only illustrative embodiments and are therefore not to be considered limiting of the scope of this patent specification or the appended claims. The subject matter hereof will be described and explained with additional specificity and detail through the use of the accompanying drawings in which: 
           [0049]      FIGS. 1 and 2  are a right side view and a top view, respectively, of a handheld surgical endoscope, according to some embodiments; 
           [0050]      FIG. 3  is perspective view showing aspects of attachment and detachment of single-use and reusable portions of a handheld surgical endoscope, according to some embodiments; 
           [0051]      FIGS. 4A, 4B and 4C  are a side view, perspective view and cross section of a cannula used on a handheld surgical endoscope, according to some embodiments; 
           [0052]      FIGS. 5A and 5B  are perspective views showing aspects of needle actuation for a handheld surgical endoscope, according to some embodiments; 
           [0053]      FIGS. 6A and 6B  are perspective views of distal tip  112  and show aspects of the needle actuation, according to some embodiments; 
           [0054]      FIGS. 7A and 7B  are perspective views of parts of the single use portion of handheld surgical endoscope, according to some embodiments; 
           [0055]      FIGS. 8A and 8B  are side and cross section views of the distal tip of a handheld surgical endoscope, according to some embodiments; 
           [0056]      FIG. 9  is a perspective view of a handheld surgical endoscope being used to perform a surgical procedure by a single operator, according to some embodiments; 
           [0057]      FIGS. 10A and 10B  are further perspective views of a handheld surgical endoscope being used to perform a surgical procedure by a single operator, according to some embodiments; 
           [0058]      FIG. 11  is a perspective view of a handheld surgical endoscope, according to some embodiments; 
           [0059]      FIG. 12  is a block diagram showing aspects of single operator carrying out a surgical procedure with a handheld surgical endoscope, according to some embodiments; and 
           [0060]      FIGS. 13 and 14  are perspective views of a handheld surgical endoscope having a clip for attaching the syringe to the handle, according to some embodiments. 
       
    
    
     DETAILED DESCRIPTION 
       [0061]    A detailed description of examples of preferred embodiments is provided below. While several embodiments are described, it should be understood that the new subject matter described in this patent specification is not limited to any one embodiment or combination of embodiments described herein, but instead encompasses numerous alternatives, modifications, and equivalents. In addition, while numerous specific details are set forth in the following description in order to provide a thorough understanding, some embodiments can be practiced without some or all of these details. Moreover, for the purpose of clarity, certain technical material that is known in the related art has not been described in detail in order to avoid unnecessarily obscuring the new subject matter described herein. It should be clear that individual features of one or several of the specific embodiments described herein can be used in combination with features of other described embodiments or with other features. Further, like reference numbers and designations in the various drawings indicate like elements. 
         [0062]      FIGS. 1 and 2  are a right side view and a top view, respectively, of a handheld surgical endoscope, according to some embodiments. The surgical endoscope  100  includes an elongated cannula  120  with a distal tip  112  for inserting into a hollow organ or cavity of the body. A needle  114  passes trough a dedicated lumen in cannula  120 . The tip of needle  114  can be extended to protrude distally from distal tip  112  as shown. The needle  114  is hollow and at needle actuation hub  170  is in fluid communication with fluid line  172 , which in turn is connected to syringe  180  (or other fluid dispensing device). 
         [0063]    According to some embodiments, a separate tip sub-assembly  110  is attached to the cannula  120  which can be made from an extruded material. For further details relating to a separate tip sub-assembly for a handheld endoscope, see co-pending U.S. patent application Ser. No. 15/371,858 filed Dec. 7, 2016, referred to hereinafter as “the co-pending &#39;859 application.” Sub-assembly  110  includes an imaging module and one or more LED light sources for viewing the organ or cavity into which it is inserted. The tip assembly  110  also includes one or more fluid ports. The distal end of the cannula  120  can also be slightly bent as shown in bent region  122 . According to some embodiments, a bend of about 15 degrees in region  122  has been found to be suitable for many applications, but using other angles in alternative embodiments is not excluded. 
         [0064]    According to some embodiments, the cannula  120  includes one or more fluid channels which are fluidly connected to distal fluid port  132  at fluid hub and connection assembly  130 . Port  132  includes a Luer fitting to facilitate leak-free connection of port  132  with various medical fluid components. The fluid channels or lumens in cannula  120  are also connected to a distal facing fluid ports (orifice or ports  616  and  618  shown in  FIGS. 6A, and 6B ) of tip assembly  110 . According to some embodiments, wires running from the LED light sources and camera module in tip assembly  110  pass through a separate channel in cannula  120 . 
         [0065]    The endoscope  100  includes a handle portion  140  that is sized and shaped in a pistol-like fashion for easy grasping by the endoscope operator (e.g. doctor or other medical professional). A display module  150  is rotatably mounted on handle  140  via a bearing which can be a plain bearing made of plastic, and a rubber coated hinge. Also visible on handle  140  are image capture button  160  and power button  162 . According to some embodiments handle  140  and display module  150  are configured to be re-usable and make up reusable portion  102 . According to some embodiments, handle  140  is similar or identical to handle  140  shown and described in the co-pending &#39;859 application. 
         [0066]    Single-use portion  104  includes the needle actuation hub  170 , fluid hub and connection assembly  130 , cannula  120  and tip assembly  110 . Single-use portion  104  is made at a relatively low-cost and is intended to be disposed of after a single-use. By making the tip, cannula, fluid hub all single-use, stringent decontamination and disinfection procedures as well as the risk of cross-contamination and hospital acquired diseases can be significantly lessened or avoided. According to some embodiments the disposable, single-use portion (portion  104  shown in  FIGS. 1 and 3 ) is sterilized, for example, during production and is provided to the user in a sealed sterilized pouch, for ease of storage and handling. The camera module in the tip assembly can have a wide angle of view, such as 140 degrees in this example. According to some embodiments, the fluid line  172  is also included in single use portion  104  and can be attached to hub  170  and included in the same sterilized pouch. 
         [0067]    According to some embodiments, the length of needle  114 , including the fluid pathway within needle actuation hub  170  (i.e. from the distal tip of needle  114  to the needle fluid port  174  is less than 50 cm, and according to some embodiments is about 37 cm. This is is contrast to surgical procedures carried out with a conventional endoscope having a working channel through which is passed a separate needle assembly. In those cases the separate needle assembly is operated by a second clinician which necessitates a longer needle (e.g. between 70 cm to 100 cm) to allow for enough working space for each clinician. Using a much shorter needle, according to the embodiments described herein, allows for less wasted drug fluid remaining within the needle. 
         [0068]    According to some embodiments, the surgical endoscope is configured to allow cannula  120  to rotate about its longitudinal axis as shown by the dotted arrow in  FIG. 1 . For further details of how to configure the hub  130  to allow rotation of the cannula, see the co-pending &#39;859 application. According to some embodiments, the cannula rotation can include a certain amount of friction (e.g. friction overcome by torque in the range of 0.04 N·m to 0.2 N·m). This allows for a “rotate and hold” of the cannula that is desirable for some procedures. For further details of how to configure such a “frictional fit,” see the co-pending &#39;859 application. According to some embodiments, the endoscope can be configured to detect the rotational position of the cannula  120  relative to the handle  140 . The detected rotational position is then input to a software algorithm configured to reorient the image displayed on display module  150  such that a correctly oriented image is displayed to the operator. For further details of such rotational position detection, see the co-pending &#39;859 application. 
         [0069]      FIG. 3  is perspective view showing aspects of attachment and detachment of single-use and reusable portions of a handheld surgical endoscope, according to some embodiments. The single-use portion  104  and reusable portion  102  attach mechanically primarily via mating mechanical connectors  320  and  322 . Electrical connection is made via separate mating electrical connectors  310  and  312 . In this example the two portions  102  and  104  are attached via translation vertically towards each other. Note that the electrical connector  310  and mechanical connector  320  are both separated from the fluid hub  130  and from needle actuation hub  170 . This separation allows for easy and effective fluid sealing to prevent fluid from hubs  170  and  130  from penetrating internally towards connectors  310  and  320  and also allows some protection against any exterior fluid, for example from fluid port  132  from reaching and possibly compromising electrical connectors  310  and  312 . Also, the separation between mechanical connector  320  and hub  130  allows for a sleeve bearing to allow for rotating of cannula  120  relative to the proximal portion of hub  130 . For further details of this rotation mechanism, see the co-pending &#39;859 application, for example  FIGS. 8A-8C and 9A-9B  and associated text of the co-pending &#39;859 application. The physical separation of the fluid hub  130  and the mechanical and electrical connectors  320  and  310  also provide additional assurance against accidental contamination from fluid hub  130  to the re-usable portion  102 . For further details regarding the physical separation and associated benefits, see the co-pending &#39;859 application. 
         [0070]      FIGS. 4A .  4 B and  4 C are a side view, perspective view and cross section of a cannula used on a handheld surgical endoscope, according to some embodiments. The cannula  120  can be extruded and made of a nylon material such as nylon  12  (e.g. Grilamid® L25). The distal end of cannula  120  can include a bent region  122  which is beneficial for certain applications and can effectively increase the field of view of the camera fixed to the distal tip when the endoscope is rotated about its central longitudinal axis.  FIGS. 4B and 4C  show a further detail of the internal lumina of cannula  120 . An insulated electrical cable (not shown) is run though the upper lumen  430 . For further details of the insulated cable, which includes conductors used for sending power to the camera and LEDs in the distal tip and signals back to electronics in the handle, see the co-pending &#39;859 application. Fluid lumina  416  and  418  are used to carry fluid between fluid port  132  (shown in  FIGS. 1-3 ) and the distal fluid ports (see ports  616  and  618  shown in  FIG. 6A ). In this example, lumina  416  and  418  each have a cross sectional area of about 1.33 mm 2 . The needle  114  (shown in  FIGS. 1-3, 6A -B and  8 A-B) passes through lumen  470 . Dimensions are shown in  FIG. 4C  for an example device. In general, the lumen  470  should be dimensioned to allow passage of the needle  114  which according to some embodiments is between 26 gauge (0.4636 mm) and 21 gauge (0.8192 mm). According to some embodiments the needle  114  is 23 gauge (0.6414 mm) or 22 gauge (0.7176 mm). According to some embodiments, the cannula  120  can be made such that its stiffness is not constant along its length. For example, it may be useful in some clinical applications to provide a cannula that is more flexible towards the distal tip and stiffer towards the handle. In such cases the cannula  120  can be made from a multi-durometer tubing such as a multi-duro Pebax® or Grilamid®. 
         [0071]    According to some embodiments, cannula  120  is rotatable relative to the handle. The rotation mechanism can be provided in hub  130  and further details are shown and described in the co-pending &#39;859 application. 
         [0072]      FIGS. 5A and 5B  are perspective views showing aspects of needle actuation for a handheld surgical endoscope, according to some embodiments.  FIG. 5A  shows the needle actuation hub  170  when the needle is in the retracted position while  FIG. 5B  shows the hub  170  when the needle is in the extended position. Hub  170  includes an outer housing  500  through which are formed two windows, proximal window  532  and distal window  534 . A lock release button  530  extends from the housing  500  and includes a inwardly protruding tab that aligns with distal window  534 . Actuation tab  510  is moveable relative to the hub housing  500 . Moving with tab  510  is fluid port  512  that is in fluid communication with fluid line  172  (not shown), spring tab  520  and needle  114  (not shown). Further detail of the movable portions of hub  170  is shown in  FIG. 7B . 
         [0073]      FIGS. 6A and 6B  are perspective views of distal tip  112  and show aspects of the needle actuation, according to some embodiments.  FIG. 6A  shows tip  112  when the needle  114  in the retracted position while  FIG. 6B  shows tip  112  when the needle  114  is in the extended position. Note that while in the retracted position, the sharp tip of needle  114  is fully recessed within needle port  614  of tip assembly  110  and there is no risk a sharps injury from the tip of needle  114 . Also visible in  FIGS. 6A and 6B  are camera lens dust cover  612 , two light-guide lenses  662  and  664  (for LED light sources) and distal fluid ports  616  and  618 . The distal fluid ports  616  and  618  are provided to allow for fluid communication with fluid lumina  410  and  412  of cannula  120  (shown in  FIGS. 4B and 4C ). In this example, each of the fluid ports  616  and  618  have a cross sectional area of about 1.6 mm 2 . Note that port  132 , lumina  410  and  412  and distal fluid ports  616  and  618  can be configured to provide fluid in-flow (i.e. flowing fluid out of the endoscope and into the patient&#39;s organ or cavity and/or fluid out-flow (i.e. flowing fluid out of the patient&#39;s organ or cavity and into the endoscope). 
         [0074]      FIG. 7A and 7B  are perspective views of parts of the single use portion of handheld surgical endoscope, according to some embodiments.  FIG. 7A  shows the needle actuation hub  170  from another perspective in which the needle extension markings  710  and  712  are visible. In this example, marking  710  is a “0” indicating to the operator that the needle is fully retracted when spring tab  520  protrudes through proximal window  532 , and marking  712  is a “15” indicating that the needle is extended by 15 mm when tab  520  protrudes through distal window  534 . According to some embodiments, the full extension of the needle can be amounts other than 15 mm (such as values between 10 and 20 mm) and the marking  712  will reflect that value.  FIG. 7B  shows carrier  720  which is fixedly attached to actuation tab  510 , spring tab  510  and needle  114 . According to some embodiments carrier  720 , spring tab  520  and/or actuation tab  510  are molded from a single piece of polymer material. As shown, spring tab  520  has ramp shaped distal edge and square shaped proximal edge. This shape allows for it move freely distally but will “lock” when it reaches full extension and protrudes through the distal window of housing  500 . Needle  114  is glued or bonded into an opening of carrier  720 . A fluid-tight pathway is provided through carrier  720  between fluid port  512  and the inner lumen of needle  114 . 
         [0075]    Referring to  FIG. 5A , the actuation tab  510  is shown in the retracted position where tab  510  it is in its most rearward or proximal position relative to the hub housing  500 . In this position, spring tab  520  protrudes through proximal window  532  of housing  500  and the tip of needle  114  is recessed within the needle port  614  as shown in  FIG. 6A . In order to extend the tip of needle  114  so as to penetrate a patient&#39;s tissue, the operator moves actuation tab  510  forward (distally) relative to the housing  500  as shown by the dotted arrow in  FIG. 5A . This causes the carrier  720  (shown in  FIG. 7B ) to move distally relative to the housing  500 , and needle  114  to translate distally within lumen  470  (shown in  FIGS. 4B and 4   c ) of cannula  120  and distally relative to tip assembly  110 . As shown in  FIG. 7B , spring tab  520  is movable radially and has ramp shape distal edge and square shaped proximal edge. Therefore the spring tab  520  is pushed inwards radially by the proximal edge of the proximal window  532 . As the actuation tab  510  is pushed further distally, the top surface of tab  520  moves across the inner surface of housing  500  and towards distal window  534 . When the spring tab  520  reaches the distal window  534  the radial spring force pushes the tip of tab  520  through the distal window  534 . The square shaped proximal edge of spring tab  520  engages the square shaped proximal edge of window  534  which effectively “locks” or prevents retraction or proximal movement of needle  114 , carrier  720  and actuation tab  510 . This locking mechanism is useful when using the needle to inject the desired fluid (such as a drug) into the patient&#39;s tissue since the entire endoscope can be used to push the needle without the needle retracting back into the cannula. The surgical endoscope with its needle in a fully extended state is depicted in  FIGS. 5B and 6B . 
         [0076]    When the operator wishes to retract the needle, the lock release button  530  is depressed which forces the spring tab  520  inwards though the window  534 . In the depressed state, the spring tab  520  is no longer “locked” by the distal window  534  and the actuation tab  510  can then be moved rearwards or proximally relative to the housing  500  which caused the needle to retract back within the tip assembly  110  such as shown in  FIG. 6A . According to some embodiments, the spring tab  520  can be shaped with square edges on both proximal and distal sides which will allow for the needle to be releasably locked in both the retracted and protruding positions. In such cases the lock release button  530  is used to unlock the tab  520  in either position to allow actuation of the needle. 
         [0077]      FIGS. 8A and 8B  are side and cross section views of the distal tip of a handheld surgical endoscope, according to some embodiments. The cannula  120  and housing  811  of cannula tip  110  are held together using a sleeve  820  that is dimensioned to fit around both the outer surface of the distal end of cannula  120  and the proximal end  816  of tip housing  811 . Tip housing  811  includes an upper cavity  830  which houses the camera assembly  854  and LEDs  860 . As separate needle cavity  870  is included in tip housing  811  to allow passage of the needle  114 . In the example shown the needle  114  protrudes 15 mm when fully extended, which has been found to be suitable extension amount for many surgical urology applications. According to some other embodiments, other extension amounts such as between 10 and 20 mm can be implemented. According to some embodiments, the needle  114  is not parallel to the center axis of the distal tip assembly  110  and housing  811 . Rather the needle  114  is angled at about 2-5 degrees upwards (towards the camera), so that when the needle  114  is in fully protruded position (by 10-20 mm, preferably by 15 mm), its distal tip will roughly reach the center of the FOV of the camera. This can be accomplished by appropriate shaping of the needle cavity  870  in housing  811 . According to some embodiments, sleeve  820  is made of stainless steel, although other material can be used. The three pieces, cannula  120 , sleeve  820  and tip housing  811  can be glued together using, for example, a U-V cured bonding glue. For further details of the tip assembly  110  including suitable sensor, lens and LED components, as well as suitable assembly and bonding techniques, see the co-pending &#39;859 application. According to some embodiments, the field of view (FOV) of the camera is configured such that when extended the tip of needle  114  is plainly and clearly visible by the sensor and can be displayed as such to the operator. According to some embodiments, the maximum outer diameter of the tip housing  811  is about 15 fr (or 5 mm) or less, and the other diameter of the cannula  120  is about 4.8 mm or less. This is in contrast to conventional rigid endoscopes which often have a outer diameter of about 7 mm. According to some embodiments, the distal outer edge of tip housing  811  is rounded to facilitate insertion in/though tissue passages and alleviate tissue contact issues. For further details of suitable rounding dimensions and criteria see the co-pending &#39;859 application. 
         [0078]      FIG. 9  is a perspective view of a handheld surgical endoscope being used to perform a surgical procedure by a single operator, according to some embodiments. Unlike conventional endoscopic surgical procedures that are performed using at least two skilled operators or clinicians, according to some embodiments, the surgical endoscope  100  with an integrated needle are configured for a single operator to perform many surgical procedures. Shown in  FIG. 9  is a single operator, with his/her left hand  910  grasping the handle  140  (and optionally press the image capture button  160 ) and his/her right hand  912  operating the syringe  180  to dispense the drug (or other fluid) via the extended needle  114 . Note that the patient and patient&#39;s tissues are not shown for purposes of clarity. By integrating the needle assembly with the handheld endoscope with attached display as shown and described herein, it has been found that a single operator can both control endoscope and perform the jabbing with the needle (using the entire endoscope) and administer the drug fluid in the syringe. Although the  FIG. 9  is shown with the left hand operating handle of endoscope  100  and right hand operating the syringe, the operator could easily perform the procedure with his/her hands switched if desired (i.e. right hand operating the handle and left hand operating the syringe. 
         [0079]      FIGS. 10A and 10B  are further perspective views of a handheld surgical endoscope being used to perform a surgical procedure by a single operator, according to some embodiments. It has been found that for some procedures, an operator may prefer to manipulate the cannula  120  with one hand while using the other hand to grasp the handle.  FIGS. 10A and 10B  illustrate how this can be performed by a single operator to both manipulate the endoscope and control the syringe for administering the drug. In particular, the operator uses his/her left hand  910  to grasp the handle and optionally press the capture button  160 , and his/her right hand  912  to manipulate the cannula  120  (shown in  FIG. 10A ) and administer the drug from syringe  180  (shown in  FIG. 10B ). 
         [0080]      FIG. 11  is a perspective view of a handheld surgical endoscope, according to some embodiments. As shown, when needle  114  is in the extended position, the camera sensor captures the needle tip and the display  150  show the needle tip  1115  clearly in the central portion of the display screen. As is also apparent in  FIG. 11 , the handheld surgical endoscope  100  is ergonomically configured to a single operator to view the endoscope, the display screen and the syringe, which further facilitates carrying out surgical procedures with a single operator. 
         [0081]      FIG. 12  is a block diagram showing aspects of single operator carrying out a surgical procedure with a handheld surgical endoscope, according to some embodiments. In block  1210 , the sterilized packaging containing the single use portion of the endoscope is opened. As shown in  FIGS. 1-3 , the single use portion  104  includes the fluid hub  130 , cannula  120 , tip assembly  110 , the needle actuation hub  170  and fluid line  172 . The needle  114  is pre-installed in a dedicated lumen in cannula  120  in the recessed (not-extended) position so as to reduce risk of a sharps injury. In block  1212 , the single use portion from the sterilized package is mated with the multiple use portion. As shown in  FIGS. 1-3 , the multiple use portion  102  includes the handle  140  and the display module  150 . In block  1214  a saline solution supply, such as from a syringe is attached to fluid port  132 , and the syringe  180  containing the pharmaceutical is connected to fluid line  172 . 
         [0082]    In block  1216 , a single operator inserts the distal tip  112  and cannula  120  through the patient&#39;s urethra such that the distal tip  112  is deployed in the patient&#39;s bladder. Note that the saline (or other fluid) supply attached to fluid port  132  can be used in facilitating insertion of the distal tip as is known. Once in the bladder, the operator can view the bladder cavity and associated tissue on the display module  150  using the camera and LED light sources in the tip  112 . In  1218  the needle is actuated from “retracted” to the “extended” position by manipulating the actuation tab  510  (shown in  FIGS. 5A and 5B ) until the sliding mechanism is distally locked. The extended distal tip of the needle  114  is in or near the center of the field of view of the camera module and the operator has a good view of the needle tip on the display module as shown in  FIG. 11 . In block  1220 , the distal end of needle  114  is inserted or jabbed into the bladder tissue by a distal motion or jabbing of the entire endoscope  100 . This is in contrast to procedures using a conventional rigid or flexible endoscope wherein the needle assembly is moved relative to the scope for each jab. The pharmaceutical liquid in syringe  180  is dispensed into the tissue. According to some embodiments, the pharmaceutical liquid is or contains botulinum toxin (botox). In block  1222  the process of jabbing and dispensing is repeated to treat as much of the bladder tissue as desired by the operator. In block  1224 , the needle is retracted by depressing the lock release button  530  and moving the actuation tab  510  proximally. The needle is thereby retracted back into a recessed position within the tip assembly  110  of tip  112 . In block  1226 , the cannula and distal tip are withdrawn from the patient&#39;s bladder and urethra. In block  1228  single use and multiple use portions of the endoscope  100  are separated from each other. The single use portion can be disposed of and the multiple use portion can be disinfected. 
         [0083]    According to some embodiments, the portions of the endoscope that may be come in contact with a patient&#39;s tissue, such as the distal portion of cannula  120  and the tip assembly  110 , are hydrophilic. For further detail relating to hydrophilic treatments, see the co-pending &#39;859 application. 
         [0084]      FIGS. 13 and 14  are perspective views of a handheld surgical endoscope having a clip or similar arrangement for attaching the syringe to the handle, according to some embodiments. In these examples, the syringe  180  can be temporarily attached to the handle  140  using a clip or band, which has been found to facilitate performance of the surgical procedure by a single operator in some applications. In the case of  FIG. 13 , a clip system  1300  is provided that includes a band  1310  to hold syringe  180  and a band  1312  which attaches to the body of handle  140 . The two bands  1310  and  1312  can be fixed to each other in the orientation shown such that the syringe  180  is firmly affixed to the handle. With the clip system  1300  installed, the operator can easily use a single hand  912  to grasp the handle  140  and operate its controls (such as image capture button  160 ) as well as push a plunger of syringe  180 . According to some embodiments, the bands  1310  and  1312  are made of a plastic material and according to other embodiments, one or both are made of elastic or rubber-like material. In the case one or both  1310  and  1312  are made of a hard or semi-hard plastic, one or both of the clips can have an opening to facilitate attachment to the handle and/or syringe. Bands  1310  and  1312  can be attached to handle  140  as a unit so that syringe  180  can be slipped in band  1310  and coupled with fluid port  174  via conduit  172  (see  FIG. 1 ). As an alternative, band  1312  can be wrapped around or otherwise attached to handle  140 , band  1310  can be wrapped around or otherwise attached to syringe  180 , or syringe  180  can be slipped into band  1310 , and bands  1310  and  1312  can then be secured to each other, for example by one or more buttons on one that snap-fit into depressions in the other, or by matching hook-and-loop (e.g., Velcro) patches secured, for example by gluing, to each band at appropriate positions. As yet another alternative, a hook-and-loop band can be wrapped around each of syringe  180  and handle  140 , and the two bands can then be pressed to each other for a hook-and-loop connection. In this manner, a new syringe can be used for each new patient, or two or more syringes can be used in succession for a single patient, and the syringe can be securely attached to the handle such that the user can operate the syringe and the handle with a single hand (and still has the option to push the syringe plunger with the other hand as needed or desired). Syringe  180  can be attached to the left or the right side of handle  140 , and can be tilted at a desired angle relative to the long axis of cannula  120 . 
         [0085]      FIG. 14  shows another example of a clip system or a similar arrangement for attaching syringe  180  to handle  140 . In this case attachment system  1400  includes bands  1410  and  1412  (similar to bands  1310  and  1312 ) to attach the syringe  180  to handle  140 . In the illustrated example, system  1400  is configured to locate the syringe  180  on the right side of handle  140  and also such that the plunger of syringe  180  is tilted slightly upwards as shown. Various other configurations and relative orientations of the positioning of the syringe  180  and the handle  140  are possible and should be implemented depending upon operator ergonomics and preferences for facilitating the particular surgical procedure by a single operator. 
         [0086]    Although the foregoing has been described in some detail for purposes of clarity, it will be apparent that certain changes and modifications may be made without departing from the principles thereof. It should be noted that there are many alternative ways of implementing both the processes and apparatuses described herein. Accordingly, the present embodiments are to be considered as illustrative and not restrictive, and the body of work described herein is not to be limited to the details given herein, which may be modified within the scope and equivalents of the appended claims.