Patent Description:
The present disclosure relates to medical devices. More particularly, the present disclosure relates to bending sections for endoscope systems.

The duodenoscope is a medical device used in a variety of endoscopic procedures, including endoscopic retrograde cholangiopancreatography ("ERCP"). In an ERCP, a physician inserts the duodenoscope into a patient's mouth, through the patient's gastrointestinal ("GI") tract, and into the duodenum until the distal end of the duodenoscope is positioned near the papilla of Vater, a small mound-like structure that acts as the entrance from the common bile duct and pancreatic duct into the duodenum. The physician then uses a variety of tools and accessories that are passed through a lumen in the duodenoscope to access the common bile duct or pancreatic duct through the papilla of Vater.

However, the duodenoscope suffers from several design issues. For example, due to the location of the papilla of Vater and shape of the duodenoscope, the endoscope tools or accessories must be bent sharply at (or sometimes more than) <NUM> degree angles at the distal end of the duodenoscope, which results in significant friction between the tools and duodenoscope and accompanying force transmission loss. Therefore, the accessories must be durable enough to withstand this sharp bend and the physician must apply a greater force to continue to advance the tools than is desired. Further, the built-in camera system of the duodenoscope is side-facing, making it difficult for novices and even experienced physicians to navigate the duodenoscope through the GI tract. Also, traditional duodenoscopes only have one accessory channel, making the use of multiple accessories time intensive and cumbersome. Additionally, duodenoscopes are difficult to clean, which may result in inadequate cleaning of the device after use and potential bacterial contamination of patients during subsequent use of the duodenoscope.

It is desirable to have an endoscope system that eliminates or lessens the force transmission losses of duodenoscopes. Increased and easier manoeuvrability of an endoscope system through and within the GI tract is desired.

All endoscopes should include a mechanism to bend the distal end so that the physician can steer the endoscope to scan the GI lumen and navigate the GI anatomy. Links of the bending section are intact around the entire circumference of the distal-proximal longitudinal axis of the bending section. However, such bending sections do not allow the accessory channels to bend outwards so that the bending section can advantageously switch between a forward-viewing perspective and a side-viewing perspective. Further, such bending sections may be experimentally inefficient in deflecting with proper degrees of freedom to cannulate a duodenum. Accordingly, for certain practical applications, <NUM>-way deflection of links with "U"-shaped profiles may be preferable. Thus, there remains a need for further contributions in this area of technology. <CIT> describes a bending portion for an endoscope, which has an annular wall portion; a plurality of wire inserting portions in which the wall portion has a first wall thickness; thin wall portions having a second wall thickness thinner than the first wall thickness; and a thick wall portion that is a part of the wall portion different from the thin wall portions between the plurality of wire inserting portions around a longitudinal axis, the thick wall portion formed to have a third wall thickness that is equal to or less than the first wall thickness and is thicker than the second wall thickness. <CIT> describes and articulating torqueable hollow device for use in a medical device, such as an endoscope or a catheter, which includes a series of stacked links disposed adjacent to one another and movable with respect to each other. Each link includes a front face tapered to a pair of pivot points and a rear face defining a wedge shaped recess for receiving the pivot points of the adjacent link. Pull-wires provide tension and hold the staked links together while also allowing for controlled bending of the distal portion by movement of one or more of the pull-wires. <CIT> describes a medical overtube, which includes a long insertion unit having distal and proximal end portions; a bending unit connected to the distal end portion; an operation unit disposed at a proximal end side of the insertion unit; and a linear member having a distal end fixed to a distal end side of the bending unit and disposed movably along a longitudinal axis of the insertion and bending units. The bending unit is bent by the linear member being pulled toward the proximal end portion in response to an operation of the operation unit, the bending unit has a plurality of channels through which medical devices are passed, and the linear member in the insertion unit is disposed at a position shifted in a circumferential direction and inward in a radial direction with respect to a position of the linear member disposed in at least a part of the bending unit. <CIT> describes an endoscope in which an imaging unit at a tip end portion of an insertion section has a board on which the image pickup device is installed, a cable through which a signal is input to and output from the board, and a ground bar which is provided so as to protrude from the surface of the board and is connected to a ground of the board. In a distal portion of the cable on the imaging unit side, a shield part is connected to the ground of the board through the ground bar and a core line is directly assembled on the board. The ground bar supports the cable on the board such that the height of the cable in the vicinity of a board-mounting portion of the cable becomes greater than or equal to a predetermined value.

In one form of the present disclosure, a scope system is provided. The scope system includes an elongate tube including a lumen extending therethrough and a distal portion. The scope system further includes at least one accessory channel including a tubular structure including an accessory lumen extending therethrough, the at least one accessory channel movably disposed at least partially within the lumen, the at least one accessory channel including a distal end section. The scope system further includes a first control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube. The scope system further includes a second control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire. The scope system further includes a third control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire and the second control wire. The scope system further includes a fourth control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire, the second control wire, and the third control wire. Proximal movement of the first control wire bends the distal portion in a first direction. Proximal movement of the second control wire bends the distal portion in a second direction, the second direction opposite to the first direction. Proximal movement of the third control wire bends the distal portion in a third direction, the third direction perpendicular to the first direction and perpendicular to the second direction. Proximal movement of the fourth control wire bends the distal portion in a fourth direction, the fourth direction opposite to the third direction.

According to another aspect of the present disclosure, a scope system is provided. The scope system includes an elongate tube including a lumen extending therethrough and a distal portion, the distal portion including circumferentially uncontinuous ribs, each of the circumferentially uncontinuous ribs including a rib opening, the rib openings of the circumferentially uncontinuous ribs being coaxial. The scope system further includes a tubular structure including a tubular structure including an accessory lumen extending therethrough, each of the circumferentially uncontinuous ribs surrounding the at least one accessory channel, the at least one accessory channel movably disposed at least partially within the lumen, the at least one accessory channel including a distal end section. The scope system further includes a first control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube. The scope system further includes a second control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire. The scope system further includes a third control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire and the second control wire. The scope system further includes a fourth control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire, the second control wire, and the third control wire. Proximal movement of the first control wire bends the distal portion in a first direction. Proximal movement of the second control wire bends the distal portion in a second direction, the second direction opposite to the first direction. Proximal movement of the third control wire bends the distal portion in a third direction, the third direction perpendicular to the first direction and perpendicular to the second direction. Proximal movement of the fourth control wire bends the distal portion in a fourth direction, the fourth direction opposite to the third direction. The at least one accessory channel is reversibly removable from an interior cavity of each of the plurality of circumferentially uncontinuous ribs through the rib openings.

According to yet another aspect of the present disclosure, a method of using a scope system is provided. The method includes the step of inserting an endoscope system into a patient's body, the endoscope system including an elongate tube including a lumen extending therethrough, the elongate tube further including a distal portion; at least one accessory channel including a tubular structure including an accessory lumen extending therethrough, the at least one accessory channel movably disposed at least partially within the lumen, the at least one accessory channel including a distal end section; and parallel control wires, each of the parallel control wires connected to the distal portion of the of the elongate tube and extending proximally along the elongate tube, individual proximal movement of one or more of the parallel control wires bending the distal portion in one of a first direction, a second direction, a third direction, and a fourth direction, the second direction opposite the first direction, the third direction perpendicular to the first direction and perpendicular to the second direction, and the fourth direction opposite the third direction. The method further includes the step of moving one or more of the parallel control wires so as to bend the distal portion in one of the first direction, the second direction, the third direction, and the fourth direction. The method further includes the step of positioning the endoscope system in a forward-viewing configuration, wherein in the forward-viewing configuration the distal end section is substantially parallel to the distal portion. The method further includes the step of moving the endoscope system to a side-viewing configuration wherein in the side-viewing configuration, the distal end section is disposed at an angle of curvature greater than the angle of curvature of the distal portion.

In order that the present disclosure may be well understood, there will now be described various forms thereof, given by way of example, reference being made to the accompanying drawings. The components in the figures are not necessarily to scale. Moreover, in the figures, like-referenced numerals designate corresponding parts throughout the different views.

It should also be understood that various cross-hatching patterns used in the drawings are not intended to limit the specific materials that may be employed in the present disclosure. The cross-hatching patterns are merely exemplary of preferable materials or are used to distinguish between adjacent or mating components illustrated within the drawings for purposes of clarity.

In adding reference denotations to elements of each drawing, although the same elements are displayed on a different drawing, it should be noted that the same elements have the same denotations. In addition, in describing one aspect of the present disclosure, if it is determined that a detailed description of related well-known configurations or functions blurs the gist of one aspect of the present disclosure, it will be omitted.

In the following discussion, the terms "proximal" and "distal" will be used to describe the opposing axial ends of the device, as well as the axial ends of various component features. The term "proximal" is used in its conventional sense to refer to the end of the device (or component) that is closest to the medical professional during use of the assembly. The term "distal" is used in its conventional sense to refer to the end of the device (or component) that is initially inserted into the patient, or that is closest to the patient during use. The term "longitudinal" will be used to refer an axis that aligns with the proximal-distal axis <NUM> of the device (or component), for example, when the device is not bent. The terms "radially" and "radial" will be used to refer to elements, surfaces, or assemblies relative to one another that may extend perpendicularly from a longitudinal axis. The terms "circumference," "circumferentially," and "circumferential" will be used to elements, surfaces, or assemblies relative to one another encircling or substantially encircling a longitudinal axis at a radius.

The uses of the terms "a" and "an" and "the" and similar references in the context of describing the present disclosure (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The use of the term "plurality of" is defined by the Applicant in the broadest sense, superseding any other implied definitions or limitations hereinbefore or hereinafter unless expressly asserted by the Applicant to the contrary, to mean a quantity of more than one.

As used herein, the terms "comprise(s)," "include(s)," "having," "has," "can," "contain(s)," and variants thereof, are intended to be open-ended transitional phrases, terms, or words that do not preclude the possibility of additional acts or structures. The present description also contemplates other examples "comprising," "consisting of," and "consisting essentially of" the elements presented herein, whether explicitly set forth or not.

In describing elements of the present disclosure, the terms <NUM>st, <NUM>nd, first, second, A, B, (a), (b), and the like, may be used herein. These terms are only used to distinguish one element from another element, but do not limit the corresponding elements, irrespective of the nature or order of the corresponding elements.

Unless otherwise defined, all terms used herein, including technical or scientific terms, have the same meanings as those generally understood by those skilled in the art to which the present disclosure pertains. Such terms as those defined in a generally used dictionary are to be interpreted as having meanings equal to the contextual meanings in the relevant field of art.

In the context of the present disclosure, a first piece is said to be integral to a second piece if the first and second pieces are formed as a single piece. For example, if the first and second pieces are cast as a single plastic piece, then the first piece is integral to the second piece.

As used herein, the term "about," when used in the context of a numerical value or range set forth, means a variation of ±<NUM>%, or less, of the numerical value. For example, a value differing by ±<NUM>%, ±<NUM>%, ±<NUM>%, or ±<NUM>%, among others, would satisfy the definition of "about," unless more narrowly defined in particular instances.

Referring to <FIG>, an example of an endoscope system <NUM> is illustrated. The endoscope system <NUM> may be generally shaped as an elongate tube including a distal portion <NUM>, a central portion <NUM>, and a proximal, or handle, portion <NUM>. The central portion <NUM> may be a flexible, elongate tube with at least one lumen <NUM> running throughout the length of the central portion <NUM>. The central portion <NUM> may connect the distal portion <NUM> and proximal portion <NUM> together. The at least one lumen <NUM> of the central portion <NUM> may extend through the distal portion <NUM> and handle portion <NUM> of the endoscope system <NUM> as well. The central portion <NUM> may be made of a braided material, such as a polyether block amide (including, for example, PEBAX) with a polytetrafluoroethylene ("PTFE") liner to provide sufficient torqueability and pushability. Other potential materials for the central portion <NUM> include, but are not limited to, polyethylene, polypropylene, and nylon.

The endoscope system <NUM> may further include two accessory channels <NUM>, <NUM> each with a lumen running therethrough. The accessory channels <NUM>, <NUM> may be designed as individual elongated tubes that may be movable within the at least one lumen <NUM> of the endoscope system <NUM>, thus allowing longitudinal movement of the accessory channels <NUM>, <NUM> with respect to the central portion <NUM>. While this example includes two accessory channels <NUM>, <NUM>, one or even three or more accessory channels may be included. For example, a single, larger accessory channel may be used to accommodate larger endoscopic tools. Further, in lieu of individual accessory channels <NUM>, <NUM>, a single elongate tube may be used with two or more lumens running through it. The accessory channels <NUM>, <NUM> may range in diameter anywhere from <NUM> to <NUM> millimeters. In one example, accessory channel <NUM> may be <NUM> millimeters in diameter while accessory channel <NUM> may be <NUM> millimeters in diameter. The accessory channels <NUM>, <NUM> may extend proximally from or past the handle portion <NUM>, through the at least one lumen <NUM> and into the distal portion <NUM>. Various tools, devices, and cameras may be at least partially inserted into and removably disposed in the accessory channels <NUM>, <NUM>.

Now referring to <FIG>, a detailed view of the distal portion <NUM> of an example of endoscope system <NUM> is illustrated. The endoscope system <NUM> may include an axially rotatable bearing <NUM> disposed between the central portion <NUM> and the distal portion <NUM>, which may allow or permit the distal portion <NUM> to rotate independently of the central portion <NUM>. The distal portion <NUM> may have a flexible rib-like construction with multiple individual ribs <NUM> connected together to create an elongate tube with at least one lumen <NUM>. Ribs <NUM> may be made of a variety of materials, such as polycarbonate, nylon, polyethylene, polypropylene, and polyoxymethylene. The accessory channels <NUM>, <NUM> may travel through the ribs <NUM> to the distal end section <NUM> of the distal portion <NUM>. The distal end section <NUM> may include a pivot arm <NUM> with first and second accessory lumens <NUM>, <NUM> (shown in <FIG>). The distal ends of the accessory channels <NUM>, <NUM> may be fixedly or movably disposed within respective first and second accessory lumens <NUM>, <NUM>. The distal end section <NUM> may also include a side port <NUM> that provides access from the at least one lumen <NUM> to a point external the endoscope system <NUM>.

An example of a distal end section <NUM> of a distal portion <NUM> is illustrated in more detail in <FIG>. For clarity, the accessory channels <NUM>, <NUM> are omitted from <FIG>. The pivot arm <NUM> may be connected or coupled to the distal end section <NUM> via a pin <NUM>. The pin <NUM> may create a pivot point, around which the pivot arm <NUM> may rotate or rotatably pivot with respect to the distal end section <NUM> to the position shown in <FIG>. The pivot arm <NUM> may be moved between a forward-viewing position as shown in <FIG> and a side-viewing position as shown in <FIG>. A light emitting diode ("LED") light <NUM> may be placed on the distal end section <NUM> to assist in navigation through a patient's GI tract. Alternatively, the LED light <NUM> may be placed at other locations on the distal end section <NUM>, such as near the side port <NUM>. Also, multiple LED lights <NUM> may be used at various locations on the endoscope system <NUM>.

As illustrated in <FIG> and <FIG>, the distal ends of the accessory channels <NUM>, <NUM> may be secured to the pivot arm <NUM>. Therefore, the accessory channels <NUM>, <NUM> may rotate with the pivot arm <NUM> when moving the pivot arm <NUM> between the side-viewing and forward-viewing configurations. <FIG> shows the accessory channels <NUM>, <NUM> in the forward-viewing configuration, while <FIG> shows the accessory channels <NUM>, <NUM> in the side-viewing configuration. As can be seen in <FIG>, when in the side-viewing configuration and due to the rotation of the pivot arm <NUM>, distal portions of the accessory channels <NUM>, <NUM> are bent outside of the confines of the ribs <NUM> and then curve back towards and into the pivot arm <NUM>. Thus, in the forward-viewing configuration, the angle of curvature or bending radius of the distal portion <NUM>, or angle of distal portion curvature, is the same as the angle of curvature of the accessory channels <NUM>, <NUM> such that the accessory channels <NUM>, <NUM> and the distal portion <NUM> of the endoscope system <NUM> are substantially parallel; but in the side-viewing configuration, the angle of curvature or bending radius of the accessory channels <NUM>, <NUM> is greater than the angle of curvature of the distal portion <NUM> such that distal portions of the accessory channels <NUM>, <NUM> extend outside the at least one lumen <NUM> of the distal portion <NUM>.

To move the pivot arm <NUM> from the forward-viewing configuration to the side-viewing configuration, the accessory channels <NUM>, <NUM> may be pushed in a distal direction relative to proximal portion <NUM> and central portion <NUM>, which applies a force through the accessory channels <NUM>, <NUM> to the pivot arm <NUM>. The resulting force causes the pivot arm <NUM> to rotate about the pivot point of the pin <NUM>, thereby moving the accessory channels <NUM>, <NUM> and pivot arm <NUM> into the side-viewing configuration. To move back to the forward-viewing configuration, a proximal force may be applied to the accessory channels <NUM>, <NUM> relative to proximal portion <NUM> and central portion <NUM>, thereby transferring the proximal force to the pivot arm <NUM>. The proximal force then causes the pivot arm <NUM> to again rotate around the pivot point of the pin <NUM> in the opposite direction, thereby moving the accessory channels <NUM>, <NUM> and the pivot arm <NUM> back to the forward-viewing configuration. To ensure that the accessory channels <NUM>, <NUM> move in unison during these movements, the accessory channels <NUM>, <NUM> may be secured together at any point along the length of the endoscope system <NUM>, or even along the entire length. In one example, the accessory channels <NUM>, <NUM> may be secured together using plastic tubing throughout the entire length of the central portion. In another example, the accessory channels <NUM>, <NUM> may be secured together at the portions of the accessory channels <NUM>, <NUM> that extend outside the constraints of the distal portion <NUM> when the endoscope system <NUM> is in the side-viewing configuration.

While a pivot arm <NUM> is used to assist in transferring the accessory channels <NUM>, <NUM> between forward-viewing and side-viewing configurations, a variety of other methods and structures may be used. Further, rather than using a pivot arm <NUM>, multiple pivot arms may be used, or one pivot arm may be used for each accessory channel <NUM>, <NUM>. Therefore, each accessory channel <NUM>, <NUM> are moved between the forward-viewing and side-viewing configurations independently of each other. Further, the degree of rotation of the pivot arm <NUM> between the forward-viewing and side-viewing configuration may vary, potential ranging from <NUM> degrees to greater than <NUM> degrees.

<FIG> illustrate views of an example of a rib <NUM> for an example of an endoscope system <NUM> constructed according to the principles of the present disclosure, specifically a ring-shaped rib <NUM>. Each ring-shaped rib <NUM> may be shaped to allow for minimal contact between the individual ring-shaped ribs <NUM>. Endoscope system <NUM> may include one or more ring-shaped ribs <NUM> at the proximal end of the distal portion <NUM>.

<FIG> illustrates a perspective view of an example of a circumferentially continuous, or "ring-shaped," rib <NUM>. Ring-shaped rib <NUM> may be symmetrical about a vertical plane <NUM> including both the longitudinal axis <NUM> and vertical axis <NUM> of endoscope system <NUM>. Vertical axis <NUM> is perpendicular to longitudinal axis <NUM>. Ring-shaped rib <NUM> may include an interior cavity <NUM> in which accessory channels <NUM>, <NUM> may be disposed such that ring-shaped rib <NUM> encircles accessory channels <NUM>, <NUM>. Ring-shaped rib <NUM> may include one or more tab mounts integral to the ring-shaped rib <NUM> projecting toward the interior cavity <NUM> of the ring-shaped rib <NUM>. The one or more tab mounts may extend the proximal-distal width of the ring-shaped rib <NUM>. The one or more tab mounts may include a top tab mount <NUM>. The one or more tab mounts may include a proximal-distal top tab mount lumen <NUM> therethrough. Top tab mount <NUM> may include top tab mount lumen <NUM> extending from the proximal end of the top tab mount <NUM> through to the distal end of the top tab mount <NUM>. The one or more tab mounts may further include one or more side tab mounts <NUM> projecting toward the interior cavity <NUM> of the ring-shaped rib <NUM> from each side of the ring-shaped rib <NUM>. In some examples of a ring-shaped rib <NUM>, the one or more side tab mounts <NUM> are symmetrically positioned about the vertical plane <NUM>. Each of the one or more side tab mounts <NUM> includes a proximal-distal side tab mount lumen <NUM> therethrough. In further examples of a ring-shaped rib <NUM>, each side of the ring-shaped rib <NUM> may have one side tab mount <NUM>. The ring-shaped rib <NUM> may include rib side surface points <NUM> that protrude longitudinally further than the rib top and rib bottom surfaces.

<FIG> illustrates a longitudinal proximal-distal cross-sectional view of an example of a ring-shaped rib <NUM> highlighting the symmetry of the sides of ring-shaped rib <NUM> about the vertical plane <NUM> including the longitudinal axis <NUM>, top tab mount <NUM>, and top tab mount lumen <NUM>.

<FIG> illustrates a bottom view of an example of a ring-shaped rib <NUM> highlighting the symmetry of the sides of ring-shaped rib <NUM> about the vertical plane <NUM> including the longitudinal axis <NUM>, top tab mount <NUM>, and top tab mount lumen <NUM> (not shown in <FIG> illustrates the asymmetry of the longitudinal surfaces of ring-shaped rib <NUM>, one longitudinal surface of which will be the proximal surface, and one longitudinal surface of which will be the distal surface. Because ring-shaped ribs <NUM> will alternate in orientation longitudinally along a distal portion <NUM> of an endoscope system <NUM>, the distal surface of one ring-shaped rib <NUM> will correspond to the proximal surface of the next ring-shaped rib <NUM>. Such proximal surface of the next ring-shaped rib <NUM> will correspond to the distal surface of the subsequent sequential ring-shaped rib <NUM>, and so forth. In a particular ring-shaped rib <NUM>, rib side surface points <NUM> may be on one longitudinal surface, whether such one longitudinal surface faces the proximal end or the distal end of the endoscope system <NUM>, and planar side longitudinal surfaces <NUM>, <NUM> may be on the opposite longitudinal surface. Planar side longitudinal surfaces <NUM>, <NUM> may intersect at intersection surface <NUM>. Planar side longitudinal surface <NUM> may be co-planar to a plane that is at an acute angle (i.e., less than <NUM> degrees) relative to a plane that perpendicularly cross-sects the proximal-distal longitudinal axis <NUM>, perpendicular to vertical plane <NUM>. Planar side longitudinal surface <NUM> may be co-planar to a second plane that is at an acute angle relative to the plane that perpendicularly cross-sects the proximal-distal longitudinal axis <NUM>. A ring-shaped rib <NUM> may generally have a <NUM> degree rotation-reflection symmetry about an axis parallel to, or the same as, the longitudinal axis <NUM>, alternatively referred to by those of ordinary skill as an improper axis of rotation, and more particularly, an S<NUM> symmetry axis. In other words, each ring-shaped rib <NUM> may be generally symmetrical when rotated <NUM> degrees about the longitudinal axis, and reflected through the longitudinal axis <NUM>, such that rib side surface points <NUM> may also be intersection surfaces of two planar longitudinal surfaces, each of which may be co-planar to a plane that is at an acute angle relative to the plane that perpendicularly cross-sects the proximal-distal longitudinal axis <NUM>. Such rotation-reflection symmetry may be without respect to the positions of any tab mounts or tab mount holes, which may not be included in the rotation-reflection symmetry.

<FIG> illustrate views of of a rib <NUM> for an endoscope system <NUM> constructed according to the principles of the present disclosure, specifically a circumferentially uncontinuous rib <NUM>, which may be generally "C-shaped" in some examples. Each circumferentially uncontinuous rib <NUM> may be shaped to allow for minimal contact between the individual circumferentially uncontinuous ribs <NUM>. Endoscope system <NUM> includes one or more circumferentially uncontinuous ribs <NUM> in the distal portion <NUM> between the distal-most ring-shaped rib <NUM> and the distal end section <NUM>.

<FIG> illustrates a perspective view of a circumferentially uncontinuous rib <NUM>. Circumferentially uncontinuous rib <NUM> are symmetrical about a vertical plane <NUM> including the longitudinal axis <NUM> of endoscope system <NUM>. Circumferentially uncontinuous rib <NUM> include an interior cavity <NUM> in which accessory channels <NUM>, <NUM> are disposed such that circumferentially uncontinuous rib <NUM> generally surrounds accessory channels <NUM>, <NUM> and accessory channels <NUM>, <NUM> are reversibly removed from interior cavity <NUM> by passing accessory channels <NUM>, <NUM> through bottom rib opening <NUM>. Bottom rib opening <NUM> interrupts the circumferential continuity of circumferentially uncontinuous rib <NUM>. Circumferentially uncontinuous rib <NUM> may include one or more tab mounts integral to the circumferentially uncontinuous rib <NUM> projecting toward the interior cavity <NUM> of the circumferentially uncontinuous rib <NUM>. The one or more tab mounts may extend the proximal-distal width of the circumferentially uncontinuous rib <NUM>. The one or more tab mounts may include a top tab mount <NUM>. The top tab mount <NUM> may include a proximal-distal top tab mount lumen <NUM> therethrough. Top tab mount lumen <NUM> extends from the proximal end of the top tab mount <NUM> through to the distal end of the top tab mount <NUM>. The one or more tab mounts may further include rib opening-adjacent tab mounts <NUM>, which may be flush with surfaces of the circumferentially uncontinuous rib <NUM> defining bottom rib opening <NUM>. In some examples of a circumferentially uncontinuous rib <NUM>, the rib opening-adjacent tab mounts <NUM> are symmetrically positioned about the vertical plane <NUM>. Each of the rib opening-adjacent tab mounts <NUM> includes a proximal-distal side tab mount lumen <NUM> therethrough. In some examples of a circumferentially uncontinuous rib <NUM>, the circumferentially uncontinuous rib <NUM> may further include one or more side tab mounts <NUM> positioned between each rib opening-adjacent tab mount <NUM> and the top tab mount <NUM>. Each of the one or more side tab mounts <NUM> includes a proximal-distal side tab mount lumen <NUM> therethrough. The circumferentially uncontinuous rib <NUM> may include rib side surface points <NUM> that protrude longitudinally further than the rib top surface.

<FIG> illustrates a longitudinal proximal-distal cross-sectional view of an example of a circumferentially uncontinuous rib <NUM> highlighting the symmetry of the sides of circumferentially uncontinuous rib <NUM> about the vertical plane <NUM> including the longitudinal axis <NUM>, top tab mount <NUM>, and top tab mount lumen <NUM>.

<FIG> illustrates a bottom view of an example of a circumferentially uncontinuous rib <NUM> highlighting the symmetry of the sides of circumferentially uncontinuous rib <NUM> about the vertical plane <NUM> including the longitudinal axis <NUM>, top tab mount <NUM>, and top tab mount lumen <NUM> (not shown in <FIG> illustrates the asymmetry of the longitudinal surfaces of circumferentially uncontinuous rib <NUM>, one longitudinal surface of which will be the proximal surface, and one longitudinal surface of which will be the distal surface. Because circumferentially uncontinuous ribs <NUM> will alternate in orientation longitudinally along a distal portion <NUM> of an endoscope system <NUM>, the distal surface of one circumferentially uncontinuous rib <NUM> will correspond to the proximal surface of the next circumferentially uncontinuous rib <NUM>. Such proximal surface of the next circumferentially uncontinuous rib <NUM> will correspond to the distal surface of the subsequent sequential circumferentially uncontinuous rib <NUM>, and so forth. In a particular circumferentially uncontinuous rib <NUM>, rib side surface points <NUM> may be on one longitudinal surface, whether such one longitudinal surface faces the proximal end or the distal end of the endoscope system <NUM>, and planar side longitudinal surfaces <NUM>, <NUM> may be on the opposite longitudinal surface. Planar side longitudinal surfaces <NUM>, <NUM> may intersect at intersection surface <NUM>. Planar side longitudinal surface <NUM> may be co-planar to a plane that is at an acute angle relative to a cross-sectional plane that perpendicularly cross-sects the proximal-distal longitudinal axis <NUM>. Planar side longitudinal surface <NUM> may be co-planar to a second plane that is at an acute angle relative to the plane that perpendicularly cross-sects the proximal-distal longitudinal axis <NUM>. A circumferentially uncontinuous rib <NUM> may generally have a <NUM> degree rotation-reflection symmetry about an axis parallel to, or the same as, the longitudinal axis <NUM>, alternatively referred to as an improper axis of rotation, and more particularly, an S<NUM> symmetry axis. In other words, each circumferentially uncontinuous rib <NUM> may be generally symmetrical when rotated <NUM> degrees about the longitudinal axis <NUM>, and reflected through the longitudinal axis <NUM>, such that rib side surface points <NUM> may also be intersection surfaces of two planar longitudinal surfaces, each of which may be co-planar to a plane that is at an acute angle relative to the plane that perpendicularly cross-sects the proximal-distal longitudinal axis <NUM>. Such rotation-reflection symmetry may be without respect to the positions of any tab mounts or tab mount holes, or bottom rib opening <NUM>, which may not be included in the rotation-reflection symmetry.

<FIG> illustrate a view of the rotation-reflection symmetry associated with an example of a circumferentially uncontinuous rib <NUM> for an example of an endoscope system <NUM> constructed according to the principles of the present disclosure. <FIG> illustrates a side view of a circumferentially uncontinuous rib <NUM>. As <FIG> demonstrates, rib side surface point <NUM> may be an intersection surface of two planar longitudinal surfaces. <FIG> illustrates a top view of a circumferentially uncontinuous rib <NUM>, which corresponds to a <NUM>-degree rotation-reflection about the longitudinal axis <NUM> of the circumferentially uncontinuous rib <NUM> illustrated in <FIG>. As <FIG> demonstrates, planar side longitudinal surfaces <NUM>, <NUM> may intersect at intersection surfaces <NUM> similarly to two planar longitudinal surfaces intersecting at rib side surface point <NUM> in <FIG>. The <NUM>-degree rotation-reflection symmetry of ring-shaped ribs <NUM> and circumferentially uncontinuous ribs <NUM> advantageously provide for four-way deflection of the bending section of the distal portion <NUM> of the endoscope system <NUM>. The bending section may advantageously move exactly laterally, rather than at an angle. Further, such <NUM>-degree rotation-reflection symmetry advantageously provides for bending of the bending section equally left (i.e., "a first direction") and right (i.e., "a second direction," opposite to the first direction) in the horizontal plane including longitudinal axis <NUM> and up (i.e., "a third direction," perpendicular to the first direction and perpendicular to the second direction) and down (i.e., "a fourth direction," opposite to the third direction) in the vertical plane <NUM>.

<FIG> illustrate detailed views of an example of a distal portion <NUM> of an endoscope system <NUM> constructed in accordance with the principles of the present disclosure. <FIG> illustrates a top view of an example of a distal portion <NUM> of an endoscope system <NUM> constructed in accordance with the principles of the present disclosure. The distal portion <NUM> of endoscope system <NUM> may include one or more ring-shaped ribs <NUM> at the proximal end of the distal portion <NUM>. The one or more ring-shaped ribs <NUM> are arranged sequentially in opposite orientations, with the proximal-most ring-shaped rib <NUM> arranged such that intersection surface <NUM> may be directed distally. The adjacent ring-shaped rib <NUM> to the proximal-most ring-shaped rib <NUM> is arranged such that the intersection surface <NUM> may be directed proximally to confront the intersection surface <NUM> of the proximal-most ring-shaped rib <NUM>. The next distal ring-shaped rib <NUM> in sequence is arranged such that the intersection surface <NUM> may be directed distally. The bending section may include further distal ring-shaped ribs <NUM> in pairs, and such pairs may be arranged such that the intersection surface <NUM> of the distal-most ring-shaped rib <NUM> may be directed distally. Planar side longitudinal surface <NUM> of the proximal-most ring-shaped rib <NUM> and planar side longitudinal surface <NUM> of the adjacent ring-shaped rib <NUM> to the proximal-most ring-shaped rib <NUM> may form an angle. Depending upon left and right movement of the bending section during operation, the angle between a planar side longitudinal surface <NUM> directed proximally and a planar side longitudinal surface <NUM> of an adjacent ring-shaped rib <NUM> directed distally may be an angle from about <NUM> degrees to about <NUM> degrees, preferably from about <NUM> degrees to about <NUM> degrees.

The bending section will include one or more circumferentially uncontinuous ribs <NUM> distal to the distal-most ring-shaped rib <NUM>. The proximal-most circumferentially uncontinuous rib <NUM> may be arranged such that intersection surface <NUM> may be directed proximally to confront the intersection surface <NUM> of the distal-most ring-shaped rib <NUM>. Planar side longitudinal surface <NUM> of the distal-most ring-shaped rib <NUM> and planar side longitudinal surface <NUM> of the proximal-most circumferentially uncontinuous rib <NUM> may form an angle denoted in <FIG> by α. Depending upon left and right movement of the bending section during operation, the angle α may be an angle from about <NUM> degrees to about <NUM> degrees, preferably from about <NUM> degrees to about <NUM> degrees. The bending section may include further circumferentially uncontinuous ribs <NUM> in pairs, and such pairs may be arranged such that the intersection surface <NUM> of the distal-most circumferentially uncontinuous rib <NUM> may be directed proximally. Planar side longitudinal surface <NUM> of a circumferentially uncontinuous rib <NUM> directed distally and planar side longitudinal surface <NUM> of an adjacent circumferentially uncontinuous rib <NUM> directed proximally may form an angle. Depending upon left and right movement of the bending section during operation, the angle between planar side longitudinal surface <NUM> and adjacent planar side longitudinal surface <NUM> may be an angle from about <NUM> degrees to about <NUM> degrees, preferably from about <NUM> degrees to about <NUM> degrees.

<FIG> illustrates a side view of an example of a distal portion <NUM> of an endoscope system <NUM> constructed in accordance with the principles of the present disclosure. While the proximal-most ring-shaped rib <NUM> is arranged such that the intersection surface <NUM> may be directed distally, due to the advantageous <NUM>-degree rotation-reflection symmetry of ring-shaped rib <NUM>, the rib side surface point <NUM> may be directed proximally, as illustrated by <FIG>. The two ring-shaped ribs <NUM> adjacent to the proximal-most ring-shaped rib <NUM> are arranged such that the rib side surface point <NUM> of one ring-shaped rib <NUM> confronts the rib side surface point <NUM> of the adjacent ring-shaped rib <NUM>, as illustrated by <FIG>. Planar side longitudinal surfaces of ring-shaped ribs <NUM> intersect at rib side surface point <NUM> such that adjacent ring-shaped ribs <NUM> that confront each other at their rib side surface points <NUM> may form an angle between planar side longitudinal surfaces of adjacent ring-shaped ribs <NUM>. Depending upon up and down movement of the bending section during operation, the angle between planar side longitudinal surfaces may be an angle from about <NUM> degrees to about <NUM> degrees, preferably from about <NUM> degrees to about <NUM> degrees. Planar side longitudinal surfaces of circumferentially uncontinuous ribs <NUM> intersect at rib side surface points <NUM> such that adjacent circumferentially uncontinuous ribs <NUM> that confront at their rib side surface points <NUM> may form an angle between planar side longitudinal surfaces of adjacent circumferentially uncontinuous ribs <NUM>. Depending upon up and down movement of the bending section during operation, the angle between planar side longitudinal surfaces may be an angle from about <NUM> degrees to about <NUM> degrees, preferably from about <NUM> degrees to about <NUM> degrees.

<FIG> illustrates another example of an assembly of an example of ribs <NUM> of on a series of one or more control wires <NUM>. Control wires <NUM> may be fixedly attached to the distal end section <NUM> and extend in parallel through, or outside of the at least one lumen <NUM> to handle portion <NUM>. Alternatively, the control wires <NUM> may extend through dedicated low friction lumens or catheters along the length of the endoscope system <NUM> to the handle portion <NUM>. A first control wire <NUM> may be fixed on a wall of the distal end section <NUM> such that control wire <NUM> passes through top tab mount lumen <NUM> of one or more circumferentially uncontinuous ribs <NUM> and through top tab mount lumen <NUM> of one or more ring-shaped ribs <NUM>. Additional control wires <NUM> may be fixed in advantageous positions on the wall of the distal end section <NUM> such that a control wire <NUM> passes through a side tab mount lumen <NUM> of the one or more circumferentially uncontinuous ribs <NUM> and through a corresponding side tab mount lumen <NUM> of the one or more ring-shaped ribs <NUM>, as illustrated in <FIG>. An endoscope system <NUM> may include three, four, five, or more control wires <NUM>. In addition to the ability to switch between forward-viewing and side-viewing configurations, the distal portion <NUM> of the endoscope system <NUM> may also bend and rotate as desired advantageously. <FIG> illustrates the distal portion <NUM> in a straight configuration such that the control wires <NUM> are straight and parallel, while <FIG> illustrates the distal portion <NUM> in a bent configuration, such that the control wires <NUM> are parallel but not straight. To move the distal portion <NUM> from the straight configuration illustrated in <FIG> to the bent configuration illustrated in <FIG>, a control wire <NUM> may be pulled in a proximal direction. The proximal movement of the control wire <NUM> may result in a force being applied through the control wire <NUM> and to the distal end section <NUM>. This force may cause the flexible, ribbed body of the distal portion <NUM> to bend as illustrated in <FIG>. To move the distal portion <NUM> back to the straight configuration, second and third control wires <NUM> opposite to the initially-pulled control wire <NUM> may be pulled in a proximal direction. Because the second and third control wires <NUM> are connected to the opposite side of the distal end section <NUM>, a force is applied through the second and third control wires <NUM> and to the distal end section <NUM> that may move the distal portion <NUM> back towards the straight configuration. The side tab mount lumens <NUM> and <NUM> of the ring-shaped rib <NUM> and circumferentially uncontinuous rib <NUM>, respectfully, may be advantageously arranged such that control wires <NUM> may allow for force to be applied through the control wires <NUM> and to the distal end section <NUM>, and reversibly move the distal end section <NUM> up, down, left, or right. The side tab mount lumens <NUM> and <NUM> may be advantageously positioned on the one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> such that the bending section will not be pulled off-plane, which allows for the bending section to move advantageously exactly laterally rather than at an angle and which force transmission is not increased by pulling a ring-shaped rib <NUM> or circumferentially uncontinuous rib <NUM> at a moment. Circumferentially uncontinuous ribs <NUM> may be arranged on control wires <NUM> such that the bottom rib openings <NUM> may be aligned longitudinally, such that the bottom rib openings <NUM> are open to the same direction, or coaxial.

<FIG> illustrates a detailed view of an example of an axially rotatable bearing <NUM> of an example of an endoscope system <NUM> and its functionality. The axially rotatable bearing <NUM> may include a first ring <NUM> and a second ring <NUM>. The axially rotatable bearing <NUM> may further include a first tube <NUM> and a second tube <NUM>. The first tube <NUM> may be fixedly attached to the central portion <NUM> and the first ring <NUM>. The second tube <NUM> may be fixedly attached to the distal portion <NUM> and the second ring <NUM>. The first tube <NUM> and first ring <NUM> may be freely rotatable with respect to the second tube <NUM> and second ring <NUM>, thereby making the distal portion <NUM> freely rotatable with respect to the central portion <NUM>. Because the first ring <NUM> is indirectly secured to the central portion <NUM>, but is located distal to the second ring <NUM>, which is indirectly secured to the distal portion <NUM>, the distal portion <NUM> and central portion <NUM> may remain secured to each other while still remaining freely rotatable with respect to each other. The distal portion <NUM> may be freely rotated when the endoscope system <NUM> is in any one of the configurations described above, including forward-viewing configuration, side-viewing configuration, straight configuration, and bent configuration. The accessory channels <NUM>, <NUM> and the control wires <NUM> may pass freely through lumen <NUM> of the axially rotatable bearing <NUM> while causing no or minimal interference to the axially rotatable bearing <NUM>. This is merely one potential design for the axially rotatable bearing <NUM>, and various other designs that allow free rotation of the distal portion <NUM> with respect to the central portion <NUM> may be used.

Control wires <NUM> may also advantageously secure the one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> of the distal portion <NUM> together. Sufficient tension may be applied to the control wires <NUM>, thereby advantageously securing together the one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> along the control wires <NUM>. Due to this design, the one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> may be advantageously shaped to allow for minimal contact between the individual one or more ring-shaped ribs <NUM> and/or the one or more circumferentially uncontinuous ribs <NUM>. Optionally, one or more control wires <NUM> may include built-in electrical wiring from an electrical power source that allows the one or more control wires <NUM> to function as a circuit for the LED light <NUM> as well. Alternatively, or in addition to the one or more control wires <NUM>, the one or more ring-shaped ribs <NUM> and/or the one or more circumferentially uncontinuous ribs <NUM> may be connected together using a variety of other methods, such as with mechanical hinges, adhesives, and other well-known devices. Further, additional elongate members may extend through the top tab mount lumens <NUM> and <NUM> and/or side tab mount lumens <NUM> and <NUM> similarly to the one or more control wires <NUM> to provide additional support to the distal portion <NUM>.

Additionally, the one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> may be covered by a protective sleeve that may be made up of various biocompatible materials, such as an elastomeric material. The protective sleeve may protect the one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> while also preventing body tissue from accidentally being pinched between the individual one or more ring-shaped ribs <NUM> and the one or more circumferentially uncontinuous ribs <NUM> when the distal portion <NUM> is moved between the bent configuration and the straight configuration. The protective sleeve may also include a slot that corresponds to the bottom rib openings <NUM> in the circumferentially uncontinuous ribs <NUM> that allows the accessory channels <NUM>, <NUM> to move outside of the protective sleeve and between the forward-viewing configuration and the side-viewing configuration. The protective sleeve may also advantageously assist torque transmission when moving the distal portion <NUM> between the bent configuration and the straight configuration. Some natural lag may occur when manipulating the one or more control wires <NUM> that may cause part of the distal portion <NUM> to move initially, while the remainder of the distal portion <NUM> lags behind, but eventually moves as well. The protective sleeve may advantageously ensure that the entire distal portion <NUM> moves together and with minimal lag.

The endoscope system <NUM> may move between a bent configuration and a straight configuration while the endoscope system <NUM> may also be in either the forward-viewing or side-viewing configurations. For example, <FIG> illustrates that the endoscope system <NUM> in a straight and side-viewing configuration. The endoscope system <NUM> may be manipulated and used in any combination of the above-mentioned configurations, and may be repeatedly movable between all configurations.

The accessory channels <NUM>, <NUM> may be used to provide access for a variety of medical tools and accessories through the endoscope system <NUM> and into a patient's body. For example, a camera system may be inserted into one of the accessory channels <NUM>, while a variety of tools including, but not limited to, forceps, sphincterotomes, wires, dilation balloons, extraction balloons, stents, needle knives, hemostasis clips, and any other catheter-based tool may be inserted into the other accessory channel <NUM>. The tools may be advanced past the distal ends of the accessory channels <NUM>, <NUM> where they may be used to operate on a patient.

The endoscope system <NUM>, or any portion thereof, may be designed to be disposable, thus reducing the risk of bacterial infection due to incomplete cleaning between uses.

The present disclosure further contemplates methods of using an endoscope system <NUM>, including the steps of: inserting the endoscope system <NUM> into a patient's body, the endoscope system <NUM> including an elongate tube including at least one lumen <NUM> and one or more accessory channels <NUM>, <NUM> movably disposed at least partially within the at least one lumen <NUM> of the elongate tube, the one or more accessory channels <NUM>, <NUM> including a tubular structure including first and second accessory lumens <NUM>, <NUM> extending therethrough; and moving a control wire <NUM> so as to bend the distal portion <NUM> of the elongate tube in a first direction.

A method of using an endoscope system <NUM> may further include the step of: positioning the endoscope system <NUM> in a forward-viewing configuration, wherein in the forward-viewing configuration the distal end section <NUM> of the one or more accessory channels <NUM>, <NUM> is substantially parallel to the distal portion <NUM> of the elongate tube.

A method of using an endoscope system <NUM> may further include the step of: moving the endoscope system <NUM> to a side-viewing configuration wherein in the side-viewing configuration, the distal end section <NUM> of the one or more accessory channels <NUM>, <NUM> is arced at a radius greater than a radius of the distal portion <NUM> of the elongate tube. The step of moving the endoscope system <NUM> to a side-viewing configuration may further include rotating the distal end section <NUM> of the one or more accessory channels <NUM>, <NUM> about a pivot point of the distal portion <NUM> of the elongate tube.

A method of using an endoscope system <NUM> may further include the step of: moving a second control wire <NUM> so as to bend the distal portion <NUM> of the elongate tube in a second direction, the second direction opposite to the first direction.

A method of using an endoscope system <NUM> may further include the step of: moving a third control wire <NUM> so as to bend the distal portion <NUM> of the elongate tube in a third direction, the third direction perpendicular to the first direction and perpendicular to the second direction.

A method of using an endoscope system <NUM> may further include the step of: moving a fourth control wire <NUM> so as to bend the distal portion <NUM> of the elongate tube in a fourth direction, the fourth direction opposite to the third direction.

A method of using an endoscope system <NUM> may further include the step of: moving the endoscope system <NUM> from the side-viewing configuration back to the forward-viewing configuration.

A method of using an endoscope system <NUM> may further include the step of: removing the one or more accessory channels <NUM>, <NUM> from the interior cavity <NUM> of the one or more circumferentially uncontinuous ribs <NUM>.

Although the present disclosure has been described with reference to examples and the accompanying drawings, the present disclosure is not limited thereto, but may be variously modified and altered by those skilled in the art to which the present disclosure pertains without departing from the spirit and scope of the present disclosure.

The subject-matter of the present disclosure may also relate, among others, to the following aspects:.

A first aspect relates to a scope system, the scope system comprising: an elongate tube comprising a lumen extending therethrough, the elongate tube further comprising a distal portion; at least one accessory channel comprising a tubular structure comprising an accessory lumen extending therethrough, the at least one accessory channel movably disposed at least partially within the lumen, the at least one accessory channel comprising a distal end section; a first control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube; a second control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire; a third control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire and the second control wire; and a fourth control wire, connected to the distal portion of the elongate tube and extending proximally along the elongate tube, parallel to the first control wire, the second control wire, and the third control wire; wherein proximal movement of the first control wire bends the distal portion in a first direction; wherein proximal movement of the second control wire bends the distal portion in a second direction, the second direction opposite to the first direction; wherein proximal movement of the third control wire bends the distal portion in a third direction, the third direction perpendicular to the first direction and perpendicular to the second direction; and wherein proximal movement of the fourth control wire bends the distal portion in a fourth direction, the fourth direction opposite to the third direction.

A second aspect relates to the scope system of aspect <NUM>, wherein the distal portion comprises a plurality of cicumferentially uncontinuous ribs, each of the plurality of circumferentially uncontinuous ribs comprising a rib opening, the rib openings of the plurality of circumferentially uncontinuous ribs being coaxial; wherein each of the plurality of circumferentially uncontinuous ribs surrounds the at least one accessory channel; and wherein the at least one accessory channel is reversibly removable from an interior cavity of each of the plurality of circumferentially uncontinuous ribs through the rib openings.

A third aspect relates to the scope system of any preceding aspect, wherein the distal portion further comprises: a plurality of ring-shaped ribs, each of the plurality of ring-shaped ribs generally <NUM>-degree rotation-reflection symmetrical about a proximal-distal longitudinal axis, each of the plurality of ring-shaped ribs encircling the at least one accessory channel, each of the plurality of ring-shaped ribs comprising a ring-shaped rib proximal surface and a ring-shaped rib distal surface, the ring-shaped rib proximal surface comprising a plurality of ring-shaped rib planar surfaces and the ring-shaped rib distal surface comprising a plurality of ring-shaped rib planar surfaces, each of the plurality of ring-shaped rib planar surfaces at an angle of less than <NUM> degrees relative to a cross-sectional plane, the cross-sectional plane cross-secting the proximal-distal longitudinal axis; each of the plurality of circumferentially uncontinuous ribs generally <NUM>-degree rotation-reflection symmetrical about the proximal-distal longitudinal axis, each of the plurality of circumferentially uncontinuous ribs further comprising a proximal surface and a distal surface, the proximal surface comprising a plurality of planar faces and the distal surface comprising a plurality of planar surfaces, each of the plurality of planar surfaces at an angle of less than <NUM> degrees relative to the cross-sectional plane; and wherein the first control wire, the second control wire, the third control wire, and the fourth control wire connect the plurality of ring-shaped ribs and the plurality of circumferentially uncontinuous ribs.

A fourth aspect relates to the scope system of any preceding aspect, wherein the at least one accessory channel is movable between a forward-viewing configuration and a side-viewing configuration; wherein in the forward-viewing configuration, the distal end section is substantially parallel to the distal portion; and wherein in the side-viewing configuration, the distal end section is disposed at an angle of curvature relative to the distal portion.

A fifth aspect relates to the scope system of any preceding aspect, wherein the distal end section is rotatably coupled to the distal portion.

A sixth aspect relates to the scope system of any preceding aspect, further comprising an axially rotatable bearing disposed between the distal portion and a proximal portion of the elongate tube, the axially rotatable bearing permitting rotation of the distal portion about a proximal-distal longitudinal axis relative to the proximal portion.

A seventh aspect relates to the scope system of any preceding aspect, further comprising a light connected to the distal portion, wherein one of the first control wire, the second control wire, the third control wire, and the fourth control wire further comprises an electrical wiring between the light and a power source.

An eighth aspect relates to the scope system of any preceding aspect, wherein a camera system is at least partially and removably disposed within the at least one accessory lumen.

A ninth aspect relates to the scope system of any preceding aspect, wherein the at least one accessory lumen is configured to receive a tool.

A tenth aspect relates to the scope system of any preceding aspect, wherein the plurality of circumferentially uncontinuous ribs is distal to the plurality of ring-shaped ribs.

An eleventh aspect relates to the scope system of any preceding aspect, wherein the angle between a planar surface of a circumferentially uncontinuous rib and a second planar surface of an adjacent circumferentially uncontinuous rib that faces the planar surface is from about <NUM> degrees to about <NUM> degrees.

A twelfth aspect relates to the scope system of any of aspects <NUM> to <NUM>, wherein the angle between a planar surface of a circumferentially uncontinuous rib and a third planar surface of an adjacent ring-shaped rib that faces the planar surface is from about <NUM> degrees to about <NUM> degrees.

A thirteenth aspect relates to the scope system of any of aspects <NUM> to <NUM>, wherein the angle between a fourth planar surface of a ring-shaped rib and a fifth planar surface of an adjacent ring-shaped rib that faces the fourth planar surface is from about <NUM> degrees to about <NUM> degrees.

A fourteenth aspect relates to the scope system of any of aspects <NUM> to <NUM>, further comprising a fifth control wire; wherein proximal movement of the fourth control wire and the fifth control wire bend the distal portion in the fourth direction; and wherein the fifth control wire connects the plurality of ring-shaped ribs and the plurality of circumferentially uncontinuous ribs.

A fifteenth aspect relates to the scope system of any of aspects <NUM> to <NUM>, wherein in the side-viewing configuration, the angle of curvature is greater than an angle of distal portion curvature.

A sixteenth aspect relates to the scope system of any of aspects <NUM> to <NUM>, wherein in the forward-viewing configuration, the distal end section is substantially disposed within the lumen of the distal portion.

A seventeenth aspect relates to the scope system of any of aspects <NUM> to <NUM>, wherein movement of a proximal portion of the at least one accessory channel in a distal direction relative to the elongate tube moves the at least one accessory channel from the forward-viewing configuration to the side-viewing configuration.

An eighteenth aspect relates to the scope system of any of aspects <NUM> to <NUM>, wherein movement of a proximal portion of the at least one accessory channel in a proximal direction relative to the elongate tube moves the at least one accessory channel from the side-viewing configuration to the forward-viewing configuration.

A nineteenth aspect relates to a method of using a scope system, comprising: inserting an endoscope system into a patient's body, the endoscope system comprising: an elongate tube comprising a lumen therethrough, the elongate tube further comprising a distal portion; at least one accessory channel comprising a tubular structure comprising an accessory lumen extending therethrough, the at least one accessory channel movably disposed at least partially within the lumen, the at least one accessory channel comprising a distal end section; and a plurality of parallel control wires, each of the plurality of parallel control wires connected to the distal portion of the elongate tube and extending proximally along the elongate tube, individual proximal movement of one or more of the plurality of parallel control wires bending the distal portion in one of a first direction, a second direction, a third direction, and a fourth direction, the second direction opposite the first direction, the third direction perpendicular to the first direction and perpendicular to the second direction, and the fourth direction opposite the third direction; moving one or more of the plurality of parallel control wires so as to bend the distal portion in one of the first direction, the second direction, the third direction, and the fourth direction; positioning the endoscope system in a forward-viewing configuration, wherein in the forward-viewing configuration the distal end section is substantially parallel to the distal portion; and moving the endoscope system to a side-viewing configuration wherein in the side-viewing configuration, the distal end section is disposed at an angle of curvature greater than an an angle of distal portion curvature.

Claim 1:
A scope system (<NUM>), comprising:
an elongate tube comprising a lumen extending therethrough, the elongate tube further comprising a distal portion (<NUM>), the distal portion comprising a plurality of circumferentially uncontinuous ribs (<NUM>), each of the plurality of circumferentially uncontinuous ribs generally <NUM>-degree rotation-reflection symmetrical about the proximal-distal longitudinal axis, each of the plurality of circumferentially uncontinuous ribs comprising a rib opening (<NUM>), the rib openings of the plurality of circumferentially uncontinuous ribs being coaxial;
at least one accessory channel (<NUM>, <NUM>) comprising a tubular structure comprising an accessory lumen extending therethrough, each of the plurality of circumferentially uncontinuous ribs surrounding the at least one accessory channel, the at least one accessory channel movably disposed at least partially within the lumen, the at least one accessory channel comprising a distal end section;
a first control wire (<NUM>), connected to the distal portion of the elongate tube and extending proximally along the elongate tube;
a second control wire (<NUM>), connected to the distal portion of the elongate tube and extending proximally along the elongate tube;
a third control wire (<NUM>), connected to the distal portion of the elongate tube and extending proximally along the elongate tube; and
a fourth control wire (<NUM>), connected to the distal portion of the elongate tube and extending proximally along the elongate tube;
wherein proximal movement of the first control wire bends the distal portion in a first direction;
wherein proximal movement of the second control wire bends the distal portion in a second direction, the second direction opposite to the first direction;
wherein proximal movement of the third control wire bends the distal portion in a third direction, the third direction perpendicular to the first direction and perpendicular to the second direction;
wherein proximal movement of the fourth control wire bends the distal portion in a fourth direction, the fourth direction opposite to the third direction;
wherein the first control wire, the second control wire, the third control wire, and the fourth control wire connect the plurality of circumferentially uncontinuous ribs; and
wherein the at least one accessory channel is reversibly removable from an interior cavity (<NUM>) of each of the plurality of circumferentially uncontinuous ribs through the rib openings (<NUM>).