Patent Description:
In some instances, endoluminal procedures may be complex, and may involve many hands of operators or technicians working conjunctively. Thus, such procedures may require a high cognitive load. Furthermore, accessory devices commonly used may have certain deficiencies, thereby failing to alleviate the complexity and cognitive burden of such procedures. Some of the deficiencies include accessory devices lacking any independent articulation at a distal end of the devices, or devices having only a two-wire articulation in a single plane thereby failing to create enough articulating force due to limitations such as steering wire diameter and frictional losses in a tortuous anatomy. Moreover, other deficiencies may stem from the end effector features of accessory devices. For example, jaws of biopsy forceps/graspers may lack a closing force to sufficiently grab tissue, as the common <NUM>-bar mechanism to close jaws may have a reduced mechanical advantage. Thus, current accessory devices may be complex, ineffective, and expensive.

<CIT> discloses an endoscopic or laparoscopic instrument with a distal tool, a rigid or flexible elongated shaft that supports the distal tool, and a proximal handle or control member, where the tool and the handle are coupled to the respective distal and proximal ends of the elongated shaft via bendable motion members. The tool and the tool motion member are coupled to the handle and the handle motion member via cables and a push rod in such a way that the movement of the handle with respect to the elongated shaft in any direction is replicated by the tool at the distal end of the shaft. The magnitude of the tool motion with respect to the handle motion may be scaled depending on the size of the handle motion member with respect to that of the tool motion member.

<CIT> discloses an apparatus for performing a minimally-invasive procedure. The apparatus comprises a shaft having a distal end and a proximal end. A monopolar knife assembly is attached to the distal end of the shaft. The monopolar knife assembly comprises a knife. A handle is attached to the proximal end of the shaft. The shaft comprises a flexible portion and an articulating portion, wherein the flexible portion extends distally from the handle and the articulating portion extends distally from the flexible portion. At least one articulation cable extends from the handle to the articulating portion, such that when tension is applied to the at least one articulation cable, the articulating portion deflects. An actuation element extends through the shaft from the handle to the knife, such that when the actuation element is moved, the knife is moved. The actuation element transmits electrical power from the handle to the knife.

<CIT> discloses a medical treatment tool comprising a treatment part capable of treating a lesion, an operating part for operating the treatment part, and a guide sheath disposed between the treatment part and the operating part. The tool also comprises a first bending part and a second bending part in which the guide sheath is caused to bend. The first bending part and the second bending part are disposed between the operating part and the treatment part so as to be spaced apart from each other in the longitudinal direction. The tool comprises two or more power transmission members for transmitting motive power applied to the operating part to the treatment part. The power transmission members are inserted through the first bending part and the second bending part of the guide sheath. The first bending part and the second bending part are bent in a direction in which the change in the path length of the power transmission member in the guide sheath due to bending of the first bending part is canceled out by the change in the path length of the power transmission member in the guide sheath due to bending of the second bending part.

Aspects of the disclosure relate to, among other things, medical systems and devices for endoluminal procedures, among other aspects. Each of the aspects disclosed herein may include one or more of the features described in connection with any of the other disclosed aspects.

According to an example, a medical device may comprise a handle extending between a first end and a second end, a first actuator coupled to the first end of the handle, a first shaft coupled to the second end of the handle, and a second shaft extending from the first shaft, the second shaft including a first articulation section and a second articulation section, wherein an articulation of the first actuator relative to the handle is configured to articulate the first articulation section, an articulation of the handle relative to the first shaft is configured to articulate the second articulation section, and the first articulation section and the second articulation section are restricted to articulating only in a first plane.

In another example, the first actuator is configured to articulate relative to the handle within only the first plane and the handle is configured to articulate relative to the first shaft within only the first plane. The handle, the first actuator, the first shaft, and the second shaft are configured so that they must rotate together about a longitudinal axis of the medical device in unison. The first actuator is pivotably coupled to the first end of the handle so that the first actuator is configured to pivot relative to the handle within only the first plane. The second end of the handle is pivotably coupled to the first shaft so that the handle is configured to pivot relative to the first shaft within only the first plane. The second articulation section is proximal to the first articulation section.

In another example, the second shaft further includes a non-articulating section adjacent to the second articulating section, a first articulation coupler coupled to a first end of the first articulation section, and a second articulation coupler coupling a second end of the first articulation section to a first end of the second articulation section. The medical device may further comprise a first wire, a second wire, a third wire, and a fourth wire, wherein each of the first wire and the second wire includes a first end fixed within the first actuator, and each of the third wire and the fourth wire includes a first end fixed within a portion of the handle, and wherein the first wire and the second wire are configured to articulate the first articulation section, and the third wire and the fourth wire are configured to articulate the second articulation section. Each of the first wire and the second wire further includes a second end fixed within the first articulation coupler, and each of the third wire and the fourth wire further includes a second end fixed within the second articulation ring. Longitudinally-extending portions of the second ends of the first wire, the second wire, the third wire, and the fourth wire extend along a shared plane.

In another example, the medical device may further comprise an end effector and a second actuator configured to actuate the end effector, wherein the second actuator is coupled to a portion of the handle between the first end and the second end, and the second actuator is slideably coupled to the handle so that the second actuator may translate along the portion of the handle between the first end and the second end. The first shaft is coupled to the second end of the handle via a ball and socket connection. The first actuator is coupled to the first end of the handle via a ball and socket connection.

In another example, the medical device may further comprise a second actuator, wherein the first actuator and the second actuator are positioned relative to each other so that the first actuator is accessible by a first finger of a hand and the second actuator is accessible by a second finger of the hand without changing a position of the hand relative to the medical device. Tthe handle is configured to be articulated via a flexion of the hand.

According to another example, a medical device may further comprise a handle extending between a first end and a second end, a first actuator pivotably coupled to the first end of the handle, a first shaft pivotably coupled to the second end of the handle, a second shaft extending from the first shaft, the second shaft including a first articulation section and a second articulation section, a first set of connectors between the first actuator and the first end of the handle, wherein said first set restricts a pivoting of the first actuator to a first pivot axis, and a second set of connectors between the first shaft and the second end of handle, wherein said second set restricts a pivoting of the first shaft to a second pivot axis, wherein the pivoting of the first actuator relative to the handle is configured to articulate the first articulation section and the pivoting of the handle relative to the first shaft is configured to articulate the second articulation section. The first pivot axis and the second pivot axis are co-planar. The first set of connectors includes slots and tabs received by the slots. The second set of connectors includes slots and tabs received by the slots.

According to another example, a method of positioning a shaft of a medical device may comprise inserting a distal end of a shaft of the medical device into a body of a subject, articulating a first actuator of the medical device relative to a handle of the medical device to articulate the shaft in a first direction, wherein said articulation is restricted by configuration of the medical device to a single plane, and articulating the handle relative to an intermediary shaft of the medical device to articulate the shaft in a second direction, wherein said articulation is restricted by the medical device to the single plane.

Reference will now be made in detail to aspects of the disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or similar reference numbers will be used through the drawings to refer to the same or like parts. The term "distal" refers to a location or portion of a medical device farthest away from a user of the device, e.g., when introducing a device into a subject (e.g., patient). By contrast, the term "proximal" refers to a location or portion closest to the user, e.g., when placing the device into the subject.

Both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the features, as claimed. As used herein, the terms "comprises," "comprising," "having," "including," or other variations thereof, are intended to cover a non-exclusive inclusion such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements, but may include other elements not expressly listed or inherent to such a process, method, article, or apparatus. In this disclosure, relative terms, such as, for example, "about," "substantially," "generally," and "approximately" are used to indicate a possible variation of ±<NUM>% in a stated value or characteristic.

Embodiments of this disclosure include systems, devices, and methods for performing endoluminal procedures. Exemplary systems may include a medical scope, e.g., an endoscope, a coupling device, and a medical device. The scope is not particularly limited and may be any suitable medical scope. Said medical scope may include a port configured to receive said medical device, e.g., an accessory device, via the coupling device.

The coupling device is also not particularly limited and may be any suitable tube, channel, railing, or guide including a first end and a second end, the first end configured to couple onto a port of the scope. The manner in which the first end couples onto the port is not particularly limited. The second end may include an opening or a passage leading to a lumen or a channel configured to guide the medical device towards an opening of said port. The coupling device may provide stability to the connection between the medical device and the scope. The coupling device may further include a locking mechanism to further secure the connection to the medical device. The coupling device may also provide a surface that a shaft portion of the medical device may press against, when the handle portion is pivoted relative to the shaft, thereby actuating a secondary articulation mechanism of the medical device (discussed in further detail below). Thus, the coupling device may serve as a fulcrum for said secondary articulation. The length of the coupling device may be any suitable length accommodating the medical device. The shape of the coupling device may be any suitable shape assisting with the ergonomics of the medical system.

The medical device may be an accessory device configured to be utilized in conjunction with a medical scope. The medical device may be inserted into a port of the scope, via the coupling device discussed above. The medical device may extend longitudinally from a first, proximal end to a second, distal end. The medical device may include a handle, a first actuator pivtoably coupled to a proximal end of the handle, a second actuator coupled to a body of the handle, an intermediary shaft pivotably coupled to a distal end of the handle, a main shaft extending distally from said intermediary shaft, the main shaft including a non-articulating portion, first articulating portion and a second articulating portion, and an end effector coupled to a distal end of the main shaft. The medical device may further include a first pair of primary steering wires, a second pair of secondary steering wires, and a pull wire configured to actuate the end effector.

It is noted that the main shaft is not particularly limited, and may be any suitable multi-lumen shaft. For example, the main shaft, e.g., the non-articulating portion, first articulating portion, and second articulating portion, may comprise at least a PTFE body defining a plurality of lumens. The number of lumens may vary in each portion of the shaft. In other examples, the shaft may further comprise a braiding and/or a coil over said PTFE body configured to provide stiffness and torquebility. The braiding/coil is not particularly limited and may be round or flat. Said coil may be a dual layer or a triple layer wire wounded in any direction. The braiding may be of a diamond, regular or herculas pattern. An outer covering of portion of the shaft is also not particularly limited, and may be any suitable material, e.g., a FEP reflow, configured to maintain said multi-lumen shaft and braiding. It is noted that a secondary reflow may be included beneath said braiding for improved torque of the shaft. Moreover, said main shaft may be compatible with typical working channels, e.g., <NUM>, of medical scopes.

The steering wires of the medical device are also not particularly limited, and may be any suitable steering wire. In some examples, the steering wires made include stainless steel with a silicon coating, e.g., MDX coating. The steering wires may be of a single strand or a multi strand wire. Furthermore, the steering wires may be coated with any suitable material, e.g., silicon, PTFE, a lubricant, etc. Likewise, the pull wire is not particularly limited as well. The pull wire may include SS, Nitinol with MDX, PTFE, or a silicon coating. The pull wire may also be a single or multi strand wire.

The aforementioned features of the medical device are discussed in further detail when referring to the figures.

Said medical device may be a single hand held device having a number of degrees of freedom, all of which are operable via a single hand. For example, a first degree of freedom may be the articulation of the main shaft at a first articulating portion via actuation of the first actuator of the device (e.g., the primary articulation mechanism). The primary articulation mechanism may be performed via a movement of the thumb of the hand. A second degree of freedom may be the articulation of the main shaft at a second articulating portion via the pivoting of the handle relative to the intermediary shaft (e.g., the secondary articulation mechanism). The secondary articulation mechanism may be performed via a movement of the wrist of the hand. In some examples, the first articulating portion and the second articulating portion may articulate in the same direction along the same plane. This may provide an extra lift and a tighter articulating radius of the main shaft. This double-articulation may be achieved by two different pairs of steering wires lying on a shared plane at the first articulating portion and the second articulating portion of the shaft. Such a wire arrangement is described in further detail below.

A third degree of freedom may be the rotation of the shaft in a clockwise or a counterclockwise direction. As discussed in further detail below, each of the aforementioned aspects of the device may be coupled to one another so that they rotate simultaneously relative to the other aspects of the device. In other words, a rotation of a single feature, e.g., the handle, simultaneously rotates with certain other features of the device. Thus, said rotation of the shaft may be performed via a rotation of the wrist and/or forearm of the hand holding the handle. A fourth degree of freedom may be the actuation of the end effector via actuation of the second actuator. Said actuation may be performed via the movement of at least one finger of the hand holding the device. A fifth degree of freedom may be the proximal-distal translation of the medical device within a bodily lumen, which may be effectuated via a translation of the hand while holding the handle of the device.

It is noted that each of the degrees of freedom discussed above may be performed with minimal movement of the single hand along or relative to the handle of the device (relatively short/simple movements of the fingers and/or the wrist of the hand operate the medical device). Thus, the exemplary medical device discussed above may alleviate cognitive load by being fully operational via a single hand. Moreover, the device may be easy to use as it offers an intuitive interface for operating the various degrees of freedoms of the device, all of which are accessible via the movement of the fingers and/or the wrist of the single hand. The handle of the medical device may be able to be grasped by a wide range of hand sizes (small, medium, large). Furthermore, the medical device may be of low cost and disposable after use.

Referring to <FIG>, an exemplary medical system <NUM> includes a scope <NUM>, e.g., an endoscope, a coupling device <NUM>, and a medical device <NUM>. Scope <NUM> includes a flexible shaft <NUM> (e.g., a catheter) and a handle <NUM> connected at a proximal end of flexible shaft <NUM>. Handle <NUM> may be configured for actuating or otherwise controlling features of medical system <NUM> and/or one or more tools or devices associated with medical system <NUM>. The handle <NUM> as shown includes first and second actuators <NUM>, <NUM>, which control articulation of shaft <NUM>, e.g., an articulation joint at or proximate a distal end of shaft <NUM>. For example, the actuators <NUM>, <NUM> may control movement of the shaft <NUM> in multiple directions, e.g., movement along different planes. Actuators <NUM>, <NUM>, may include, for example, rotatable knobs that rotate to push/pull cables or wires coupled to the shaft <NUM>. For example, one or more cables or wires may comprise medical grade plastic or metal, and may extend distally from a respective actuator <NUM>, <NUM> to connect to flexible shaft <NUM> to control movement thereof. Distal ends of the cables or wires may extend through shaft <NUM> and terminate at an articulation joint and/or a distal tip of shaft <NUM>. For example, one or more cables or wires may be connected to an articulation joint, and rotation of actuators <NUM>, <NUM> may control the cables or wires to move the articulation joint and/or the distal end of shaft <NUM>, e.g., along multiple directions. According to some aspects of the present disclosure, one or more electrical cables (not shown) may extend from the proximal end of system <NUM> to the distal end of shaft <NUM> and may provide electrical controls to imaging, lighting, and/or other electronics at the distal end of shaft <NUM>. Electrical cables may carry imaging signals received at the distal end of shaft <NUM> to be processed and/or displayed on a display. The endoscope may also include at least one port, e.g., port <NUM>, being shown in the example of <FIG>, for introducing a device <NUM> via a coupling device <NUM>.

As shown in <FIG>, coupling device <NUM> is a device that is tubular, but not limited thereto, extending between a first end <NUM> and a second end <NUM>. First end <NUM> includes an opening (not shown) configured to engage or couple with port <NUM> so that an entrance of port <NUM> (not shown) and said opening of first <NUM> are in fluid communication and otherwise permit materials to travel between scope <NUM> and coupling device <NUM>. The manner in which first end <NUM> couples to port <NUM> is not particularly limited, and may be via any suitable manner or mechanism, e.g., adhesive, engageable threading, locking component, etc. Second end <NUM> may include an opening <NUM> (shown in <FIG>) configured to receive a distal portion of device <NUM>. Thus, device <NUM> may traverse a channel (not shown) extending between opening <NUM> and said opening of first end <NUM> to enter port <NUM>, and extend distally along a working channel of shaft <NUM> of scope <NUM>. As shown in <FIG>, coupling device <NUM> may be a curved, S-shape structure, which may provide an ergonomic benefit to an operator when using system <NUM>. However, it is noted that the shape and length of device <NUM> is not particularly limited, and may be any suitable length and/or shape. Device <NUM> may be flexible enough to permit changes to the configuration, but may be configured with sufficient rigidity to maintain the new shapes.

<FIG> illustrate medical device <NUM>, shown in <FIG>. Medical device <NUM> includes a handle <NUM>, a first actuator <NUM> that is pivotably coupled to a proximal end of handle <NUM>, a second actuator <NUM> slidably coupled to a body <NUM> of handle <NUM>, an intermediary shaft <NUM> that is pivotably coupled to a distal end of handle <NUM>, a main shaft <NUM> extending distally through and from within said intermediary shaft <NUM>, the main shaft including a first articulating portion <NUM> and a second articulating portion <NUM> that is proximal to portion <NUM>, and an end effector <NUM> coupled to a distal end of main shaft <NUM>. Further detail with respect to each of the aforementioned features of device <NUM> is discussed in further detail below.

Referring to <FIG>, a handle <NUM> is shown. As can be seen, handle <NUM> is a tubular-shaped structure. However, the shape of handle <NUM> is not particularly limited, and in some embodiments, may have a more defined, edged structure. Handle <NUM> includes a proximal end <NUM>, a body <NUM>, and a distal end <NUM>. Proximal end <NUM> includes a proximal coupling portion <NUM> configured to engage with first actuator <NUM> (shown in <FIG>). Body <NUM> includes a longitudinally extending recess <NUM> facing radially outward and configured to receive a portion of second actuator <NUM> (shown in <FIG>), and further includes a corrugated portion <NUM>. Distal end <NUM> includes a distal coupling portion <NUM> configured to engage with intermediary shaft <NUM> (shown in <FIG>).

A more detailed description of proximal end <NUM> of handle <NUM> and proximal coupling portion <NUM> is provided below. As shown in <FIG>, proximal coupling portion <NUM> is centrally located on proximal end <NUM>. Proximal coupling portion <NUM> includes protrusions <NUM> and <NUM>, slots <NUM> and <NUM>, both of which are between protrusions <NUM> and <NUM>, and wire openings 1215a which reside within slots <NUM> and <NUM>. Each of protrusions <NUM> and <NUM> are C-shaped, half-moon, or partial-ring like protrusions having two ends. Protrusions <NUM> and <NUM> mirror each other so that the ends of protrusion <NUM> face the ends of protrusion <NUM>. Protrusions <NUM> and <NUM> protrude proximally relative to the surface of proximal end <NUM>. Thus, protrusion <NUM> and protrusion <NUM> form a partial ball/sphere like structure, configured to mate with a spherical cavity <NUM> of actuator <NUM> (shown in <FIG>). Excluding protrusions <NUM> and <NUM>, the remaining proximally-facing surface of proximal end <NUM> may otherwise be flat so it may be placed flush against the flat portions of a distal facing surface of first actuator <NUM>, as discussed in further detail below.

Slots <NUM> and <NUM> are partially-defined by the surface of proximal end <NUM> in between the respective ends of protrusions <NUM> and <NUM>. Slots <NUM> and <NUM> may be dimensional to receive tabs <NUM> and <NUM> of first actuator <NUM> (shown in <FIG>). Slots <NUM> and <NUM> each including a wire opening 1215a, configured to receive primary steering wires <NUM>/<NUM>, as shown in <FIG>. Wire openings 1215a are co-planar. The positioning of openings 1215a within slots <NUM> and <NUM> is such that openings 1215a may align with wire openings <NUM> of first actuator <NUM> (shown in <FIG>), as discussed in further detail below.

A more detailed description of body <NUM> of handle <NUM> is provided below. As shown in <FIG>, body <NUM> extends between proximal end <NUM> and distal end <NUM>. Body <NUM> includes a proximal portion <NUM>, a mid portion <NUM> including recess <NUM>, and a distal portion <NUM> including a corrugated outer surface <NUM>. In addition, it is noted that body <NUM> includes a plurality of openings and channels configured to provide passage for primary steering wires, e.g., steering wires <NUM>, <NUM>, and a pull wire, e.g., wire <NUM>, to extend throughout the length of body <NUM>.

Referring to <FIG>, a sectional view of the proximal portion <NUM> of body <NUM> is shown. In addition to proximal coupling portion <NUM>, proximal portion <NUM> includes a wire channel <NUM>, a wire channel <NUM>, and wire openings 1215b. As shown, wire openings 1215a of proximal coupling portion <NUM> lead to wire channels <NUM> and <NUM>, which are configured to receive and house steering wires <NUM>, <NUM> (discussed in further detail below). Wire channels <NUM> and <NUM> extend distally within proximal portion <NUM> of body <NUM>. Each of wire channels <NUM> and <NUM> respectively include a proximal, first section <NUM>, <NUM> and a distal, second section <NUM>, <NUM>. First sections <NUM> and <NUM> extend distally from openings 1215a in a straight-line, linear fashion, as indicated by the directional arrow. As they extend, first sections <NUM> and <NUM> transition to second sections <NUM> and <NUM>. As shown in <FIG>, second sections <NUM> and <NUM> curve at an angle (as indicated by the directional arrow), relative to first sections <NUM>, <NUM>, towards distal wire openings 1215b. Distal wire openings 1215b are oriented <NUM>°, or approximately <NUM>°, relative to the orientation of openings 1215a. It is noted that first section <NUM> and second section <NUM> and first section <NUM> and second section <NUM> may be of single, unitary channels, or may be two individual channel sections joined together as shown in <FIG>. Thus, channels <NUM> and <NUM> define a path for primary steering wires <NUM>, <NUM> to extend through openings 1215a of coupling portion <NUM> to openings 1215b which lead to recess <NUM> of mid portion <NUM> as shown in <FIG>.

Referring to <FIG>, <FIG>, mid portion <NUM> is further discussed. Mid portion <NUM> refers to the portion of body <NUM> including recess <NUM>. Recess <NUM> extends between a proximal surface <NUM> and a distal surface <NUM>. Recess <NUM> defines a longitudinal slot configured to receive a portion of second actuator <NUM>. Moreover, recess <NUM> is shaped and sized so as to allow said portion of second actuator <NUM> to slidably translate within recess <NUM>, while also frictionally engaging said portion so that second actuator <NUM> may maintain its position along body <NUM>. The engagement between second actuator <NUM> and recess <NUM> is further discussed below, when referring to <FIG>. As shown in <FIG>, surface <NUM> includes two wire openings 1215b, and surface <NUM> includes two wire openings 1215c (only one is shown) and a central opening 1230a. Each wire opening 1215b may be aligned with a wire opening 1215c so that each primary steering wire <NUM>, <NUM> may extend through an opening 1215b to an opening 1215c, in a straight, linear manner. Thus, steering wires <NUM>, <NUM> may extend distally from wire openings 1215b, throughout recess <NUM>, into openings 1215c, which transition to primary steering wire channels <NUM> (shown in <FIG>). It is noted that steering wires <NUM>, <NUM> may pass through second actuator <NUM> via through holes (not shown) extending throughout second actuator <NUM>. Central opening 1230a leads to a central lumen <NUM> of distal portion <NUM>, and is configured to receive a pull wire, e.g., a wire <NUM>, that extends between second actuator <NUM> and end effector <NUM>, as discussed further below. Central opening 1230a is configured to accommodate for the longitudinal translation of said pull wire, e.g., wire <NUM>, through opening 1230a.

As shown in <FIG>, mid portion <NUM> may further include two openings 1240a along an outer circumferential surface of mid portion <NUM>. Openings 1240a may lie along a distal portion of portion <NUM>, and may extend in a plane that is perpendicular to the plane on which openings 1215c extend. Openings 1240a transition to channels <NUM> which extend distally towards a distal end of body <NUM>. Thus, openings 1240a may be configured to receive a second set of steering wires, e.g., steering wires <NUM> and <NUM> (shown in <FIG>), which may extend distally through distal portion <NUM> of body <NUM> via channels <NUM>. It is noted that, in some embodiments, body <NUM> may be without openings 1240a, and that during the manufacturing process of device <NUM>, steering wires <NUM> and <NUM> may be installed and fixed within distal portion <NUM> of body <NUM> without requiring openings 1240a.

Referring to <FIG> and <FIG>, distal portion <NUM> of body <NUM> is discussed in further detail. As shown in <FIG>, an outer surface of distal portion <NUM> includes corrugated portion <NUM>, which may provide better handling and grip of distal portion <NUM> of handle <NUM>. However, it is noted that distal portion <NUM> may be without corrugation portion <NUM>, or may substitute corrugated portion <NUM> for a different feature that may assist with the handling and grip of handle <NUM>. As shown in <FIG>, distal portion <NUM> further includes two wire channels <NUM> for secondary steering wires <NUM>, <NUM> (shown in <FIG>), two wire channels <NUM> (shown in <FIG>) for primary steering wires <NUM>, <NUM> (shown in <FIG>), a central lumen <NUM> for wire <NUM>, and a winding mechanism <NUM>, e.g., a pulley, fixed within lumen <NUM>.

Wire channels <NUM>, for secondary steering wires <NUM>, <NUM>, extend distally from openings 1240a towards distal end <NUM>. More specifically, channels <NUM> curve radially inwards, before extending longitudinally along and substantially parallel to central lumen <NUM>. Wire channels <NUM>, for primary steering wires <NUM>, <NUM>, also extend distally from openings 1215c towards distal end <NUM> (shown in <FIG>). Channels <NUM> may extend in a straight, linear manner throughout their lengths, so that channels <NUM> run parallel (or about parallel) to central lumen <NUM>.

Central lumen <NUM> is centrally located within distal portion <NUM>, around the longitudinal axis of handle <NUM>. Lumen <NUM> extends distally from opening 1230a of surface <NUM> to distal end <NUM>. The dimensions of lumen <NUM> are not particularly limited, so long as lumen <NUM> may accommodate for the translation of pull wire <NUM>. Central lumen <NUM> may also house winding mechanism <NUM>, as shown in <FIG>. Winding mechanism <NUM> is not particularly limited, and may be any suitable pulley-like device. Winding mechanism <NUM> may be fixedly coupled within lumen <NUM>. The manner by which winding mechanism <NUM> is fixed to body <NUM> within lumen <NUM> is not particularly limited. As shown, winding mechanism <NUM> may receive wire <NUM>. Wire <NUM> may wrap around winding mechanism <NUM> as wire <NUM> enters lumen <NUM>, and continue to extend distally towards distal end <NUM>. In some examples, wire <NUM> may be lubricated to more smoothly engage with winding mechanism <NUM>. By such configuration, winding mechanism <NUM> may provide an increased mechanical advantage at a proximal portion of wire <NUM>, so that more force may be transferred to a distal portion of wire <NUM>, which is coupled to end effector <NUM>. For example, said increased mechanical advantage may improve the grasping force of a grasping end effector <NUM>, e.g., forceps. It is noted that mechanism <NUM> is not particularly limited to a pulley, but may be other suitable mechanisms configured to increase the mechanical advantage of a proximal portion of wire <NUM>.

Referring to <FIG>, a more detailed description of distal end <NUM> of handle <NUM> and distal coupling portion <NUM> is provided below. Distal end <NUM> includes a distal coupling portion <NUM> centrally located on distal end <NUM>, and two tabs <NUM> at the outer periphery of coupling portion <NUM>. Excluding distal coupling portion <NUM> and tabs <NUM>, the surface of distal end <NUM> may otherwise be flat, as shown in <FIG>. Distal coupling portion <NUM> includes a protrusion <NUM>, an opening 1230b, two wire openings 1215d, and two wire openings 1240b. Protrusion <NUM> is a circular/annular shaped protrusion that protrudes distally relative to a flat surface of distal end <NUM>. Thus, protrusion <NUM> may define a partial ball/sphere like structure, configured to mate with a receiving end of intermediary shaft <NUM>. However, it is noted that protrusion is not limited to a particular shape, and may be any suitable protrusion configured to engage with a receiving end of intermediary shaft <NUM>.

Protrusion <NUM> includes an opening 1230b centrally located on protrusion <NUM>. Opening 1230b is in fluid/material communication with central lumen <NUM> and opening 1230a of handle <NUM>, thereby permitting materials to travel through opening 1230a and 1230b. Thus, opening 1230b may be configured to accommodate for the translation of wire <NUM> through opening 1230b. Protrusion <NUM> further includes two openings 1215d, through which primary steering wires, <NUM>, <NUM>, may extend distally, and two openings 1240b, through which second steering wires, <NUM>, <NUM>, may extend distally. Openings 1215d and 1240b are disposed on protrusion <NUM>, surrounding central opening 1230b. It is noted that openings 1215d are positioned diametrically across from each another, and likewise, openings 1240b are positioned diametrically across from each other. Openings 1215d and openings 1240b alternate circumferentially on protrusion <NUM>. Thus, openings 1215d and openings 1240b, while surrounding central opening 1230b, may be arranged so that each of the distances between an opening 1215d and an opening 1240b are equal. Moreover, it is noted that opening 1215d and openings 1240b are disposed in the same plane - a plane perpendicular to a longitudinal axis of handle <NUM>.

As noted above, distal end <NUM> further includes two tabs <NUM> positioned radially outward of coupling portion <NUM>. However, it is noted that the number of tabs surrounding coupling portion <NUM> is not particularly limited. Tabs <NUM> protrude distally relative the flat surface of distal end <NUM>, and are configured to engage with a receiving end of intermediary shaft <NUM>. As shown, tabs <NUM> may be positioned diametrically across from one another. It is noted that tabs <NUM> may be positioned along the same plane as slots <NUM> and <NUM> of proximal end <NUM>. This is so that first actuator <NUM> coupled to proximal end <NUM> and intermediary shaft <NUM> coupled to distal end <NUM> may also pivot, relative to handle <NUM>, along the same plane.

Referring to <FIG>, a first actuator <NUM> is shown. First actuator <NUM> includes a body <NUM>, a ring <NUM> coupled to body <NUM>, thereby defining an opening <NUM>. Body <NUM> is spherical or partially spherical (as shown in <FIG>), but not limited thereto. As shown in <FIG>, body <NUM> includes a distal surface <NUM> that includes a coupling portion <NUM> configured to engage a proximal end <NUM> of handle <NUM>. Besides coupling portion <NUM>, distal surface <NUM> may otherwise be flat so it may be placed flush against the flat portions of proximal end <NUM>.

Coupling portion <NUM> includes a distally protruding fencing or outline <NUM> that defines at least a portion and a circumference of partially spherical cavity <NUM>, and further includes a first tab <NUM> and a second tab <NUM>. As noted, at least a portion of cavity <NUM> may be defined by fencing <NUM>. Cavity <NUM> may also extend proximally within body <NUM>, relative to distal surface <NUM>. Thus, cavity <NUM> may extend from fencing <NUM> to a portion of body <NUM> that is proximal to distal surface <NUM>. Cavity <NUM> is not particularly limited and may be of any suitable dimension to receive the proximally protruding protrusions <NUM>, <NUM> of proximal end <NUM> of handle <NUM>.

Both first tab <NUM> and second tab <NUM> protrude radially inwards from an inner surface of fencing <NUM>. First tab <NUM> and second tab <NUM> may be diametrically across from one another. As shown, tabs <NUM> and <NUM> are rectangular in shape. However, the dimensions and shape of tabs <NUM> and <NUM> are not particularly limited, so long as said tabs may engage with or otherwise received in slots <NUM>, <NUM> of the proximal end of handle <NUM>. Tabs <NUM> and <NUM> each comprise a proximally facing surface including a wire opening <NUM>, which is configured to accommodate steering wire <NUM>/<NUM>. The positioning of openings <NUM> along the proximally facing surfaces of tabs <NUM> and <NUM> is such that openings <NUM> align with wire openings 1215a of proximal end <NUM> of handle <NUM>.

Ring <NUM> is coupled to a surface of body <NUM>. Ring <NUM> may include a first end coupled to body <NUM>, a second end also coupled to body <NUM>, and a loop/curved structure extending between said first and second ends. Thus, ring <NUM> may define an opening <NUM> between an outer surface of body <NUM> and an inner surface of said loop/curved structure of ring <NUM>. Opening <NUM> may be configured to receive a finger of a hand, e.g., a thumb. Ring <NUM> may be engageable by a finger of a hand, e.g., the thumb, and provides a surface against which the finger may rest. Ring <NUM> may also provide a surface for the finger to press against or pull on, thereby pulling on steering wires <NUM> and <NUM> and actuating the primary articulation mechanism, as discussed in further detail below. However, it is noted that first actuator <NUM> may be with or without ring <NUM>, and that a structure of any other suitable shape may take the place of ring <NUM>, e.g., a tab, ball, etc..

A proximal portion of device <NUM> including first actuator <NUM> coupled to proximal end <NUM> of handle <NUM>, and steering wires <NUM>, <NUM> is shown in <FIG>. First actuator <NUM> is pivotably coupled to proximal end <NUM> of handle <NUM> (as indicated by the directional arrow shown in <FIG>). This is done by coupling portion <NUM> of actuator <NUM> engaging proximal coupling portion <NUM> of handle <NUM>. More specifically, cavity <NUM> of coupling portion <NUM> may receive protrusions <NUM>, <NUM> of coupling portion <NUM>. For example, cavity <NUM> and protrusions <NUM>, <NUM> may be snap-fitted to one another like that of a ball-socket connection, but not limited thereto. Furthermore, tabs <NUM>, <NUM> of coupling portion <NUM> may be fitted within slots <NUM>, <NUM> of coupling portion <NUM>, and wire openings <NUM> of actuator <NUM> may be aligned with wire openings 1215a of handle <NUM>. Given that first actuator <NUM> is pivotably coupled to handle <NUM>, it is noted that tabs <NUM>, <NUM> may be movable within slots <NUM>, <NUM>. Said coupling of tabs <NUM>, <NUM> within slots <NUM>, <NUM> may position and secure actuator <NUM> to articulate or pivot only along a single plane/trajectory/axis extending through and bisecting slots <NUM> and <NUM>. It is noted that this plane may be the same plane within which intermediary shaft <NUM> may articulate or pivot relative to handle <NUM>, as discussed in further detail below. Articulation or pivoting of actuator <NUM> may be performed by a finger of a hand, e.g., the thumb pushing or pulling ring <NUM>. Moreover, the engagement of tabs of <NUM>, <NUM> with slots <NUM>, <NUM> may allow for the simultaneous rotation of handle <NUM> and secondary actuator <NUM> (and also intermediary shaft <NUM>, main shaft <NUM>, and end effector <NUM> as discussed below) when actuator <NUM> is rotated by an operator of device <NUM>.

Steering wires <NUM> and <NUM> are not particularly limited, and may be any suitable wires. Steering wires <NUM>, <NUM> may each include a proximal end, as shown in <FIG> and <FIG>, and a distal end (as shown in <FIG>). As shown in <FIG> and <FIG>, said proximal ends of wires <NUM>, <NUM> may each be crimped via a sleeve <NUM>, <NUM>, e.g., an aluminum sleeve, and housed within channels of body <NUM>. Moreover, sleeves <NUM>, <NUM> may be immovably fixed within said channels of body <NUM>. Proximal portions of wires <NUM> and <NUM> may extend distally from sleeves <NUM>, <NUM>, through said channels, through wire openings <NUM> of actutator <NUM>, and through openings 1215a of proximal end <NUM> of handle <NUM>. Thus, as actuator <NUM> articulates or pivots in one direction relative to handle <NUM>, steering wire <NUM> or <NUM> may be pulled proximally, which in turn may articulate a portion of shaft <NUM> as discussed further below.

Referring to <FIG>, a second actuator <NUM> is shown. Second actuator <NUM> is a spool-like actuator that surrounds/sheaths a portion of body <NUM>, and is configured to slidably translate along body <NUM>, via recess <NUM> of handle <NUM>. Actuator <NUM> includes a distal end <NUM>, a middle portion <NUM>, and a proximal end <NUM>. Distal end <NUM> and proximal end <NUM> may protrude radially outwards relative to middle portion <NUM>, thereby defining a recessed groove within which at least one finger or at least two fingers, e.g., an index finger and a middle finger, may rest. Moreover, protruding ends <NUM> and <NUM> may provide a surface against which said at least one finger may press against, to translate actuator <NUM> in a proximal/distal direction.

It is further noted that actuator <NUM> may be an assembled structure including two halves. For example, actuator <NUM> may include a first half 130a as shown in <FIG>, and first half 130a may include a plurality of coupling means <NUM>, <NUM>, <NUM>, <NUM> configured to mate with corresponding coupling means present on the other half of actuator <NUM>. Alternatively, device <NUM> may be assembled so that actuator <NUM> is a single unitary spool-like structure surrounding body <NUM>.

<FIG> illustrates the coupling between first half 130a and handle <NUM>, and pull wire <NUM>. As shown, first half 130a further includes a first cavity <NUM> and coupling portion <NUM>, which includes a second cavity <NUM>. First cavity <NUM> receives the portion of body <NUM> defining recess <NUM>, so that actuator <NUM> (when assembled by coupling the two halves) encompasses said portion of body <NUM>. While cavity <NUM> receives a portion of body <NUM>, coupling portion <NUM> is fitted within recess <NUM>. Coupling portion <NUM> is fitted so that portion <NUM> may translate within the slot/channel defined by recess <NUM>. The manner by which this is done is not particularly limited. For example, portion <NUM> may be shaped and sized so as to allow said portion <NUM> of second actuator <NUM> to slidably translate within recess <NUM>, while also frictionally engaging the surfaces of body <NUM> around recess <NUM>. As a result, second actuator <NUM> may maintain a position along body <NUM> in the absence of a force applied on second actuator <NUM>. Other means, such as a track, rail, etc. may be implemented to assist with the slidable translation of actuator <NUM> relative to body <NUM>.

Cavity <NUM>, within coupling portion <NUM>, is configured to receive a proximal portion of pull wire <NUM>. Moreover, said proximal portion of wire <NUM> may be crimped to a sleeve <NUM>, which may be immovably fixed or locked within cavity <NUM>. Therefore, the translation of actuator <NUM> in proximal direction may translate wire <NUM>, which in turn may actuate end effector <NUM>. The distal translation of actuator <NUM>, which would translate wire <NUM> distally, may also actuate end effector <NUM>. For example, translating wire <NUM> proximally and distally, via actuator <NUM>, may actuate the opening and closing of a grasping end effector, e.g., forceps. It is noted that the length of recess <NUM> defines a stroke/translation length for the actuation of end effector <NUM>.

Referring to FIG. 6A, an intermediary shaft <NUM> is shown. Shaft <NUM> includes a proximal end <NUM>, a distal end <NUM>, and a lumen <NUM>. Proximal end <NUM> includes a proximal opening <NUM> and two slots <NUM> (only one of which is shown in FIG. Proximal opening <NUM> is not particularly limited, and may be an opening configured to receive protrusion <NUM> of distal coupling portion <NUM>. Slots <NUM> are formed along a proximal edge of shaft <NUM>. Slots <NUM> are diametrically across from one another (shown in <FIG>), and are configured to receive tabs <NUM> of handle <NUM>. Thus, proximal end <NUM> of shaft <NUM> is configured to engage and couple with distal end <NUM> of handle <NUM>. Distal end <NUM> includes a distal opening <NUM>, through which main shaft <NUM> may extend distally.

Lumen <NUM> extends throughout a length of shaft <NUM>, from proximal opening <NUM> to distal opening <NUM>. Lumen <NUM> comprises two sections, a proximal cavity <NUM> and channel <NUM>. Proximal cavity <NUM> is configured to receive and house protrusion <NUM> of distal end <NUM>. Furthermore, cavity <NUM> may also serve as transitional space for steering wires <NUM>, <NUM>, <NUM>, <NUM> to flex towards channel <NUM>, as they extend distally through wire openings 1215d and 1240b of distal end <NUM> and to their respective openings on a proximal end of main shaft <NUM>. Thus, cavity <NUM> may be shaped and sized accordingly. The diameter of cavity <NUM> gradually decreases as it transitions into channel <NUM>. Channel <NUM> is configured to receive and sheath a proximal portion of main shaft <NUM>. Channel <NUM> may be of a shape and diameter configured to frictionally engage the outer surface of shaft <NUM>, and inhibit, but not prevent, movement of main shaft <NUM> relative to intermediary shaft <NUM>.

Referring to <FIG>, a portion of device <NUM> including intermediary shaft <NUM> coupled to distal end <NUM> of handle <NUM>, steering wires <NUM>, <NUM>, <NUM>, <NUM>, and pull wire <NUM> is shown. Intermediary shaft <NUM> is pivotably coupled to distal end <NUM> of handle <NUM> (as shown in <FIG>). This is done by proximal end <NUM> of shaft <NUM> engaging distal coupling portion <NUM> of handle <NUM>. More specifically, proximal opening <NUM> and cavity <NUM> of shaft <NUM> may receive partial ball/sphere-like protrusion <NUM> of coupling portion <NUM>. For example, cavity <NUM> and protrusions <NUM> may be snap-fitted to one another like that of a ball-socket connection, but not limited thereto. Furthermore, tabs <NUM> of coupling portion <NUM> may be fitted, e.g., frictionally, within slots <NUM> of shaft <NUM>. Given that intermediary shaft <NUM> is pivotably coupled to distal end <NUM> of handle <NUM> (as shown in <FIG>), it is noted that tabs <NUM> may be movable within slots <NUM>. Said coupling of tabs <NUM> within slots <NUM> may position and secure shaft <NUM> to articulate or pivot within a single plane/trajectory/axis defined by slots <NUM>. It is noted that this plane may be the same plane within which first actuator <NUM> may articulate or pivot relative to handle <NUM>, as discussed previously. Articulation or pivoting of shaft <NUM> may be performed by a flexion of the wrist of the hand grasping device <NUM>. Thus, an operator may actuate the primary articulation mechanism (pivoting first actuator <NUM> via a finger), as well as the second articulation mechanism (pivoting shaft <NUM> via wrist flexion), with a single hand.

It is further noted that such locking may allow for the simultaneous rotation of intermediary shaft <NUM> (and shaft <NUM>) along with handle <NUM>. Thus, the locking between actuator <NUM> and handle <NUM>, the locking between intermediary shaft <NUM> and handle <NUM>, and the coupling, e.g., frictional, heat shrink, etc., between main shaft <NUM> and intermediary shaft <NUM> may ensure that portions of device <NUM> rotate in unison when any of the aforementioned portions of device <NUM> is rotated, as shown in <FIG>.

As shown in <FIG>, primary steering wires <NUM>, <NUM> may extend distally through distal portion <NUM> of body <NUM> and through openings 1215d (shown in <FIG>) on distal end <NUM>. Primary steering wires <NUM>, <NUM> may continue to extend distally throughout cavity <NUM> of shaft <NUM>, and flex at an angle as cavity 1431decreases in diameter and transitions into channel <NUM>. Wires <NUM>, <NUM> may flex into their respective openings <NUM>, <NUM> on a proximal end of main shaft <NUM> (shown in <FIG>). Proximal portions of secondary steering wires <NUM>, <NUM> may be crimped, via sleeves <NUM>, <NUM>, to counterbores <NUM> located at distal portions of channel <NUM>. Such crimping may fix said proximal portions of wires <NUM>, <NUM> within channels <NUM> of handle <NUM>. Similar to wires <NUM>, <NUM>, secondary steering wires <NUM>, <NUM> may extend distally through body <NUM> and through openings 1240b on distal end <NUM>. Secondary steering wires <NUM>, <NUM> may continue to extend distally throughout cavity <NUM> of shaft <NUM>, and flex at an angle as cavity <NUM> transitions into channel <NUM>. Wires <NUM>, <NUM> may flex into their respective openings <NUM>, <NUM> on a proximal end of main shaft <NUM> (shown in <FIG>).

Referring to <FIG>, a main shaft <NUM> is shown. Shaft <NUM> includes a non-articulating portion <NUM>, secondary articulation portion <NUM>, a secondary articulation ring <NUM>, a primary articulation portion <NUM>, a primary articulation ring <NUM>, and end effector <NUM>. Portion <NUM> is not particularly limited, and may be, as discussed above, any suitable multi-lumen shaft.

Non-articulating portion <NUM> extends distally between a proximal end of main shaft <NUM> to secondary articulation portion <NUM>. Thus, a proximal end <NUM> of non-articulating portion <NUM>, shown in <FIG>, is fixed within channel <NUM>, e.g., via frictional fit, heat shrink, etc., as shown in <FIG>. A proximal end <NUM> of portion <NUM> includes steering wire openings <NUM>, <NUM>, <NUM>, <NUM>, and a pull wire opening <NUM>. Opening <NUM> is configured to receive pull wire <NUM> and accommodate for the proximal/distal translation of wire <NUM> through opening <NUM>. Opening <NUM> is centrally located on a proximal surface of proximal end <NUM>.

Primary steering wire openings <NUM>, <NUM> are respectively configured to receive primary steering wires, <NUM>, <NUM>, and second steering wire openings <NUM>, <NUM> are respectively configured to receive second steering wires, <NUM>, <NUM>. Openings <NUM>, <NUM>, <NUM>, <NUM> lie on the proximal surface of proximal end <NUM>, surrounding central opening <NUM>. It is noted that openings <NUM> and <NUM> are positioned diametrically across from each another, and likewise, openings <NUM> and <NUM> are positioned diametrically across from each other. Thus, openings <NUM>, <NUM>, <NUM>, <NUM>, while surrounding opening <NUM>, may be arranged so that each of the distances between an opening 1215d and an opening 1240b are the equal. The arrangement of the aforementioned openings on proximal end <NUM> may mirror the arrangement of openings on distal end <NUM> of handle <NUM>, to ease the transition of wires <NUM>, <NUM>, <NUM>, <NUM>, and <NUM> into shaft <NUM>.

<FIG> illustrates a cross-section of secondary articulation portion <NUM>. As can be seen, the arrangement of wires <NUM>, <NUM>, <NUM>, <NUM>, and <NUM> is consistent with that of non-articulating portion <NUM>, as shown in <FIG>.

As shown in <FIG>, secondary articulation portion <NUM> transitions into secondary articulation ring <NUM>. Ring <NUM> includes a proximal opening <NUM>, a distal opening <NUM>, and a cavity <NUM> in between. Proximal opening <NUM> (and cavity <NUM>) is configured to receive a distal end/portion of secondary articulating portion <NUM>, including wires <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>. The manner by which proximal opening <NUM> of ring <NUM> couples to the distal end/portion of articulating portion <NUM> is not particularly limited, and may be, for example, via a frictional fit. Cavity <NUM> of ring <NUM> is configured to receive and house wires <NUM>, <NUM>, <NUM>, <NUM>, and <NUM>. Distal opening <NUM> of ring <NUM> is configured to receive a proximal end <NUM> of articulating portion <NUM> via any suitable means, e.g., a frictional fit.

Pull wire <NUM> extends distally via a straight, linear manner into an opening <NUM> (shown in <FIG>) on a proximal end <NUM> of primary articulating portion <NUM>. Secondary steering wires <NUM>, <NUM> may extend distally within cavity <NUM> of ring <NUM>, up until a point between the distal end of portion <NUM> and a proximal end <NUM> of portion <NUM>, e.g., a midpoint or other point of said cavity <NUM>. The distal ends <NUM>, <NUM> of wires <NUM>, <NUM> may be affixed or welded within ring <NUM>, thereby providing leverage for secondary steering wires <NUM>, <NUM> to articulate both ring <NUM> and secondary articulating portion <NUM> as wire <NUM> or <NUM> is pulled proximally. For example, distal ends <NUM>, <NUM> may be welded to an inner surface of ring <NUM> or a partially solid portion of cavity <NUM>. As discussed above, such articulation, e.g., the secondary articulation mechanism, may be actuated via the pivoting of handle <NUM> relative to intermediary shaft <NUM> (or vice versa).

Primary steering wires <NUM>, <NUM> may extend distally throughout cavity <NUM> of ring <NUM> towards primary articulating portion <NUM>. As shown in <FIG>, wires <NUM>, <NUM> respectively have a curved portion <NUM>, <NUM> that curves at an angle while extending towards a proximal end <NUM> of primary articulating portion <NUM>. Wires <NUM>, <NUM> extend, via portions <NUM>, <NUM>, toward wire openings <NUM>, <NUM> (shown in <FIG>) of proximal end <NUM>, which are oriented <NUM>°, or approximately <NUM>°, about a longitudinal axis of shaft <NUM>, relative to the orientation of openings <NUM>, <NUM>. Therefore, primary steering wires <NUM>, <NUM> re-orient, while extending into primary articulating portion <NUM>, so that wires <NUM>, <NUM>, <NUM>, and <NUM> extend along a shared plane, as shown in <FIG>. Wires <NUM>, <NUM>, <NUM>, and <NUM> may extend along a shared plane throughout a length of the portion of wires <NUM>, <NUM> distal to curved portions <NUM>, <NUM>, e.g., greater than <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, etc. Furthermore, it is noted that the portions of wires <NUM>, <NUM> proximal to curved portions <NUM>, <NUM> and the portions of wires distal to curved portions <NUM> travel in offset but parallel lumens.

<FIG> illustrates a section view of proximal end <NUM> of primary articulation portion <NUM>. As can be seen, proximal end <NUM> includes steering wire openings <NUM>, <NUM>, and a pull wire opening <NUM>. As noted above, opening <NUM> is configured to receive pull wire <NUM> and accommodate for the proximal/distal translation of wire <NUM> through opening <NUM>. Opening <NUM> is centrally located on a proximal surface of proximal end <NUM>. Thus, opening <NUM> maintains alignment with opening <NUM> (shown in <FIG>) of non-articulating portion <NUM>. Primary steering wire openings <NUM>, <NUM> are respectively configured to receive primary steering wires, <NUM>, <NUM>. Openings <NUM>, <NUM>, lie on a proximal surface of proximal end <NUM>, around central opening <NUM>. It is noted that openings <NUM> and <NUM> are positioned diametrically across from each another. Furthermore, as previously noted, openings <NUM> and <NUM> guide wires <NUM>, <NUM> along the same plane as secondary steering wires <NUM>, <NUM>.

As shown in <FIG>, primary articulation portion <NUM> transitions into primary articulation ring <NUM>. Ring <NUM> includes a proximal opening <NUM>, a distal opening <NUM>, and a cavity <NUM> in between. Proximal opening <NUM> (and cavity <NUM>) is configured to receive a distal end/portion of primary articulating portion <NUM>, including wires <NUM>, <NUM>, and <NUM>. The manner by which proximal opening <NUM> of ring <NUM> couples to the distal end/portion of articulating portion <NUM> is not particularly limited, and may be, for example, via a frictional fit. Cavity <NUM> of ring <NUM> is configured to receive and house wires <NUM>, <NUM>, and <NUM>. Distal opening <NUM> of ring <NUM> is configured to receive a proximal end/portion of end effector <NUM> via any suitable means, e.g., a frictional fit.

Pull wire <NUM> extends distally via a straight, linear manner towards end effector <NUM>. Primary steering wires <NUM>, <NUM> may extend distally within cavity <NUM> of ring <NUM>, up until a point between the distal end of articulating portion <NUM> and a proximal end of end effector <NUM>, e.g., a midpoint of said cavity. The distal ends <NUM>, <NUM> of wires <NUM>, <NUM> may be affixed or welded within ring <NUM>, thereby providing leverage for primary steering wires <NUM>, <NUM> to articulate both ring <NUM> and primary articulating portion <NUM> as wire <NUM> or <NUM> is pulled proximally. For example, distal ends <NUM>, <NUM> may be welded to an inner surface of ring <NUM> or a partially solid portion of cavity <NUM>. As discussed above, such articulation, e.g., the primary articulation mechanism, may be actuated via the pivoting of first actuator <NUM> relative to handle <NUM> (or vice versa).

Thus, in view of the above, it is noted that the pivoting of first actuator <NUM> relative to handle <NUM>, the pivoting of handle <NUM> relative to intermediary shaft <NUM>, the articulation of secondary articulation portion <NUM>, and the direction of primary articulation portion <NUM> all are restricted to the same plane. This is shown in <FIG>. As shown in <FIG>, pivoting first action <NUM> in a distal direction (indicated by directional arrow A) articulates primary articulating portion <NUM> in a downward direction, in which the pivoting direction and the articulation direction are along the same plane. Likewise, as shown in <FIG>, pivoting handle <NUM> in a downward direction (indicated by directional arrow B) articulates secondary articulating portion <NUM> in a downward direction, in which the pivoting direction and the articulation direction, again, are along the same plane. The same is shown in <FIG> when pivoting actuator <NUM> and handle <NUM> in the opposite direction. As shown in <FIG>, pivoting first action <NUM> in a proximal direction (indicated by directional arrow C) articulates primary articulating portion <NUM> in an upward direction, in which the pivoting direction and the articulation direction are along the same plane. Likewise, as shown in <FIG>, pivoting handle <NUM> in a upward direction (indicated by directional arrow D) articulates secondary articulating portion <NUM> in an upward direction, in which the pivoting direction and the articulation direction, again, are along the same plane.

End effector <NUM> is not particularly limited. For example, end effector <NUM> may be any one of a cautery knife, biopsy forceps, tissue grasper jaws, cautery snare, hemostatis clip, suturing wire, or any other suitable end effector. End effector <NUM> may include a proximal end that may be removably coupled to the distal opening of primary articulation ring <NUM>. For example, end effector <NUM> may be frictionally fitted to said distal opening, so that it end effector <NUM> may be removed and substituted with other end effectors that may be preferred. End effector <NUM> may also be coupled to a distal end <NUM> of pull wire <NUM>. Wire <NUM> may couple to end effector <NUM> via any suitable manner, so that the translation of wire <NUM> in either a proximal or distal direction triggers an actuation of end effector <NUM>, e.g., opening/closing of foreceps.

Referring to <FIG>, an example of how medical system <NUM> and device <NUM> may be used is further discussed below. A user may deliver a distal end of tube <NUM> of scope <NUM> into the body of a subject, e.g., via a natural orifice (such as a mouth or anus) and through a tortuous natural body lumen of the subject, such as an esophagus, stomach, colon, etc., towards a targeted site. The user may couple device <NUM>, via first end <NUM>, to port <NUM>, before or after tube <NUM> is delivered to the targeted site. While grasping device <NUM> via a single hand (or two hands in other examples), the distal end of device <NUM> may be inserted into a second end <NUM> of device <NUM>, and guided through port <NUM>, and delivered to the targeted site, for example, through a working channel of scope <NUM>. Once delivered, the user may further adjust the position of end effector <NUM> relative to the targeted site by any one of the following manners: <NUM>) a user may rotate end effector <NUM> by rotating first actuator <NUM>, via the single hand, in a clockwise or counterclockwise direction; <NUM>) a user may proximally/distally translate end effector <NUM> by a translation of the single hand while holding device <NUM>; <NUM>) a user may articulate end effector <NUM> in one direction by pivoting first actuator <NUM> relative to handle <NUM> using the thumb of the single hand; and <NUM>) a user may further articulate end effector <NUM> in the same direction by pivoting handle <NUM> relative to intermediary shaft <NUM> by flexion of the wrist of the single hand. After adjusting the position of end effector <NUM>, the user may actuate end effector <NUM> by slidably translating second actuator <NUM> relative to handle <NUM> via at least one finger, e.g., index and middle fingers, of the single hand.

While medical device <NUM>, as described above, offers articulation at two different sections of shaft <NUM>, e.g., articulation portions <NUM>, <NUM>, via two different joints, e.g., first actuator <NUM>-handle <NUM> and handle <NUM>-intermediary shaft <NUM>, other exemplary embodiments may be single articulation devices.

<FIG> illustrates an exemplary single articulation device <NUM>'. Device <NUM>' is similar to device <NUM> in some respects, and like reference numerals refer to like parts. Unlike device <NUM>, device <NUM>' is without a pivotable first actuator <NUM>, and includes a ring <NUM>', which may be unitary with a proximal end of handle <NUM>'. Thus, device <NUM>' may only include a single joint between intermediary shaft <NUM> and a distal end of handle <NUM>'. Furthermore, device <NUM>' may include a single articulation portion <NUM> along shaft <NUM>. The manner by which portion <NUM> may be articulated via the pivoting between shaft <NUM> and handle <NUM>' may be the same as (or similar to) device <NUM>.

<FIG> illustrates an exemplary single articulation device <NUM>". Device <NUM>" is similar to device <NUM> in some respects, and like reference numerals refer to like parts. Unlike device <NUM>, device <NUM>" is without a pivotable connection between intermediary shaft <NUM>" and handle <NUM>". Thus, device <NUM>" may only include a single joint between first actuator <NUM>" and a proximal end of handle <NUM>". As shown, actuator <NUM>" may be without a ball/sphere shaped body, like actuator <NUM> of device <NUM>, and may simply be a ring that is pivotably coupled to a proximal end of handle <NUM>". Device <NUM>" may also include a single articulation portion <NUM> along shaft <NUM>. The manner by which portion <NUM> may be articulated via the pivoting between actuator <NUM>" and handle <NUM>" may be the same as (or similar to) device <NUM>.

Claim 1:
A medical device (<NUM>), comprising:
a handle (<NUM>) extending between a first end and a second end;
a first actuator (<NUM>) coupled to the first end of the handle (<NUM>);
a first shaft (<NUM>) coupled to the second end of the handle (<NUM>); and
a second shaft (<NUM>) extending from the first shaft (<NUM>), the second shaft (<NUM>) including a first articulation section (<NUM>) and a second articulation section (<NUM>),
wherein an articulation of the first actuator (<NUM>) relative to the handle (<NUM>) is configured to articulate the first articulation section (<NUM>), an articulation of the handle (<NUM>) relative to the first shaft (<NUM>) is configured to articulate the second articulation section (<NUM>), and the first articulation section (<NUM>) and the second articulation section (<NUM>) are restricted to articulating only in a first plane.