Patent Document

CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims priority from U.S. Provisional Patent Application No. 61/287,077, filed Dec. 16, 2009, the disclosure of which is incorporated by reference in its entirety herein. 
     
    
     FIELD OF THE DISCLOSURE 
       [0002]    Exemplary embodiments of the present disclosure relate to arrangements and methods for effecting an endoluminal anatomical structure, and more particularly to arrangements and methods for treatment of gastrointestinal lesions that currently require open abdominal surgery. The exemplary embodiment of at least one of the arrangements can provide an endoluminal colon chamber and a variety of maneuverable operating tools inside that chamber. For example, the exemplary embodiment of such arrangement can function as a miniature operating room inside the colon. 
       BACKGROUND INFORMATION 
       [0003]    Current endoscopic technologies may not facilitate treating colon perforations, large polyps and tumors, and a significant colon bleeding effectively and safely. A gastrointestinal bleeding is a common and potentially life-threatening medical condition, which can complicate any polypectomy (polyp removal), and excision of colonic tumors. A colon perforation can occur when excessive mechanical force or excessive energy is inadvertently applied to a colonic wall. A colon perforation is a life-threatening condition and currently requires major emergency surgery to close the colon perforation and preclude fecal contamination of an abdominal cavity and resulting sepsis. 
         [0004]    Consequently, many patients who develop large polyps, colon perforation, colon bleeding and other significant colon pathology currently have to undergo a major surgery and endure a significant operative trauma and, typically, painful and prolong recovery. Currently there are no effective and safe devices and methods for replacing major abdominal surgery in case of colon perforation or when large wide-based polyps need to be removed. 
         [0005]    Thus, there may be a need to address at least some of the deficiencies described herein above. 
         [0006]    U.S. Provisional Patent Application Ser. No. 61/247,605 filed on Oct. 1, 2009 and entitled “Detachable Balloon Catheter” describes exemplary embodiments of device and method for treatment of a gastrointestinal perforation and/or a gastrointestinal bleeding. The exemplary device can include a balloon catheter that can control bleeding by pressing on a bleeding area or/and prevents the gastrointestinal contents trespassing outside a gastrointestinal lumen into a body cavity by blocking an opening in the luminal wall or blocking the colon distal to the perforation. Such exemplary device can be inserted using an endoscope, and can allow a partial or complete withdrawal of an endoscope, while leaving the balloon at the target area. More specifically, the exemplary device and method can facilitate ceasing a colonic bleeding and blocking a colon perforation. 
         [0007]    The Minos Megachannel is a large bore flexible reinforced tube, which is designed to be inserted over the standard colonoscope. After the colonoscope is removed, the tube can be used as a passage for insertion of different instruments into the colon. 
         [0008]    Further, conventional endoscopes generally have one to two working channels, which likely do not have independent movements from the main body of the endoscope. As a result, when conventional flexible endoscopic instruments are inserted via such channels into the intestinal lumen, an operator can only manipulate these instruments axially (e.g., forward and backward movements), and possibly somewhat rotationally. In addition, since the conventional instruments can only be advanced from the tip of the endoscope towards the target lesion axially and in front of the endoscopic image, the conventional instruments have only limited functionality. 
         [0009]    Accordingly, there may be a need to address at least some of the deficiencies described herein above. 
       SUMMARY OF EXEMPLARY EMBODIMENTS OF THE PRESENT DISCLOSURE 
       [0010]    Exemplary embodiments of the present disclosure can address most if not all of the above-described needs by providing device and method for a treatment of, e.g., a gastrointestinal perforation, bleeding, removal of large polyps, and/or other significant endoluminal pathology, for example, colonic pathology. 
         [0011]    According to one exemplary embodiment of the present disclosure, the device can function as a miniature operating room inside the lumen, for example, colon, and providing an operator with advanced endoluminal functionalities replicating capabilities of a surgical suite. The exemplary device of the present disclosure can provide such miniature endoluminal operating room, chamber or at least partial enclosure, and the ability to utilize a variety of articulating surgical instruments, which can operate within, at or around the chamber. 
         [0012]    According to one exemplary embodiment of the present disclosure, the exemplary arrangement/device can be introduced after a standard diagnostic colonoscopy is performed. An exemplary balloon guide catheter, as described in U.S. Provisional Patent Application Ser. No. 61/247,605, or a large endoluminal channel such as a Minos Megachannel manufactured by, e.g., Minos Inc., can be used to facilitate the insertion of the exemplary device according to the present disclosure. 
         [0013]    In another exemplary embodiment of the present disclosure, the arrangement/device can contain a plurality (e.g., three) primary sections, e.g., a handle, a multi-lumenal tube, and an expandable chamber. 
         [0014]    It is possible to utilize endoluminal channels and associated articulating endoluminal instruments with the exemplary embodiments of the arrangement/device. To that end, the exemplary arrangement/device can include a multi-lumen tube. The multi-lumen tube can include lumens for at least two special tools or tool-channels, or three or more special tools and/or tools-channels. In addition, the multi-lumen tube can include other channels, which can be used for, as an example, air, water, vacuum delivery, etc. The exemplary arrangement/device can also include channel for scope and illumination; and lumens for a chamber activation and lumen for a balloon guide catheter as indicated herein. 
         [0015]    According to still another exemplary embodiment of the present disclosure, the arrangement/device may also contain a chamber located distally, which can be expanded to different sizes within the colon, thus producing a relatively large working space near the targeted luminal lesion. The exemplary arrangement/device can be structured to manipulate the tools and/or tool-channels in such a way that distal ends of one or more of such tools and/or channels can operate within or at the chamber, and approach the lesion from multiple or even all directions, and using numerous angles. In addition, at least one tool-channel can accommodate a large diameter tool, for example, a special endoscopic stapler. 
         [0016]    In a further exemplary embodiment of the present disclosure, the arrangement/device can further contain a control handle, e.g., at or about its proximal end. The handle can be provided in a similar way and/or shape as handles of other endoscopes&#39;, while including further more ports, such as, e.g., tool-channels ports, a balloon guide catheter port, a special lever to control the opening and closing of the device chamber, etc. 
         [0017]    According to a still further exemplary embodiment of the present disclosure, the arrangement/device can include and/or utilize particular tools or tool-channels. For example, the distal ends of the particular tools and/or tool-channels can be operated in all directions and within all degrees of freedom using the actuating mechanisms, which can be controlled at or about the proximal ends of the device. The exemplary instruments/tools (e.g., grasper(s), scissor(s), dissector(s), others), which can be inserted in the special tools or tool-channels, may be manipulated (e.g., rotated, moved axially forward and backward, bent at the distal end at any desired angles) by manipulating the tool-channels. 
         [0018]    In a further exemplary embodiment of the present disclosure, the arrangement/device can facilitate a lateral and/or multi-directional movements of the instruments/tools, in addition to the axial and rotational movements thereof. Since the exemplary tool-channels can be manipulated independently from the main endoscope and other tool-channels, the instruments/tools can approach the lesion from the different and possibly limitless directions. For example, when the endoscopic instruments/tools approach the lesion from the sides in relation to the main longitudinal axis and, hence, without blocking the endoscopic image, a so-called and well-known in laparoscopy “tri-angulation” can be achieved. The tri-angulation can be a preferable technique for achieving the endoscopic arrangement&#39;s/device&#39;s improved functionality and safety. Such exemplary methodology can mimic the functionality of well-established surgical operating room environments. The exemplary tool-channels can be advanced in the lumen from the working ports of the multi-lumen tube and/or be at least partially pre-fixed to the element(s) of the associated expandable chamber. The exemplary tool-channels can also be advanced directly into the body lumen (e.g., an intestinal lumen), into the chamber space, and/or initially advanced along the element(s) of the chamber and then further into the body lumen or into the chamber space. 
         [0019]    As an alternative according to yet another exemplary embodiment of the present disclosure, the arrangement/device, alternatively to the tool-channels or in combination with the tool-channels, can use conventional and/or articulating instruments/tools with at least two degree of freedom. 
         [0020]    In addition, according to a further exemplary embodiment of the present disclosure, a method can be provided for using the exemplary arrangement/device in the body lumen (e.g., colon). For example, using such exemplary method, it is possible to perform a standard colonoscopy and identify a lesion that may not be treated using standard endoscopy and techniques. A balloon guide catheter can be inserted, the balloon inflated and the standard colonoscope (the balloon catheter and inflated balloon are left in place) removed. The balloon guide catheter can be used as a guide-wire to facilitate the insertion of the exemplary arrangement/device. The exemplary arrangement/device can be inserted over the balloon guide catheter, e.g., until the chamber is in the proximity to the lesion. The chamber can be deployed and adjusted to certain dimensions. It is possible to readjust the chamber during the procedure, as needed. Further, an operative area can be cleaned with a provided suction catheter. Further, a proximal balloon, a distal balloon or both proximal and distal balloons can be inflated for the treatment area isolation. Tool-channels can be inserted, followed by or in conjunction with an insertion of the instruments/tools into the tool-channels. It is also possible to manipulate the tool-channels to optimize and facilitate the instruments&#39;/tools&#39; approach to the lesion. Further, a procedure can be performed, for example, closing a colonic perforation, removing a large colon polyp or tumor, stopping a bleeding, closing diverticuli, removing an appendix, treating other body luminal lesions. 
         [0021]    Further, exemplary embodiments of devices and method for affecting at least one anatomical tissue can be provided. A configuration can be provided that includes a structure which is expandable (i) having and/or (ii) forming at least one opening or a working space through which the anatomical tissue(s) is placed in the structure. For example, the structure, prior to being expanding, can have at least one partially rigid portion. In addition, or as an alternative, upon a partial or complete expansion thereof, the structure can be controllable to have a plurality of shapes. Further, the structure can be controllable to provide the working space with multiple shapes and/or multiple sizes. 
         [0022]    According to yet another exemplary embodiment of the present disclosure. prior to the structure being expanded, the structure can have at least one partially rigid portion that is expandable to form a non-cylindrically-shaped working area which can be asymmetrical. Further, an endoscopic arrangement can be included that is structured to be provided in the working area, and that can include a further configuration that facilitates an articulation of a tip portion of the endoscopic arrangement within the working area. The further configuration can include a mechanical bending arm which can facilitate the tip portion to be moved within the working area so as to facilitate a visualization of at least one object in the working area. An arrangement can also be provided which is coupled to the structure, and which can provide (i) at least one lumen and/or (ii) at least one instrument there through to reach the working area. For example, a distance between a tip of the arrangement and a distal portion of the structure that is farthest away from the arrangement can be controllable to adjust a shape and/or a size of the working area. 
         [0023]    In still another exemplary embodiment of the present disclosure, upon a complete or partial expansion of the structure, the structure can be controllable to have a plurality of shapes. In addition, the structure can be controllable to provide the working space with multiple shapes and/or multiple sizes. The structure can have an expanded portion and an unexpanded portion, and form an axes of extension of the device, a first distance to a highest point of the expanded portion can be different than a distance to an non-expanded portion. For example, the first distance can be greater than the second distance. The structure can be controllable to adjust the first distance, while maintaining the second distance approximately the same. Further, in an non-expanded state, the configuration can be controllable to provide an articulation thereof in a plurality of directions. 
         [0024]    According to a further exemplary embodiment of the present disclosure, a first arrangement can be provided at a distance from the configuration and the anatomical structure(s). In addition, a second arrangement can be provided between the first arrangement and the configuration, and can have at least one lumen that is connected to the first arrangement. Further, a third arrangement can be provided which may be structured to move through the lumen at or near the anatomical structure(s), and which can be configured to be provided in the structure. The lumen(s) can comprise a multi-channel tube, and the structure can be structured to be movable through the multi-channel tube and rigidly connected thereto so as to limit or reduce a movement of the structure with respect to the multi-channel tube. At least one movable camera and an illumination arrangement can be provided within or near the configuration, and movable through the multi-channel tube. At least one movable vacuum catheter and/or irrigation catheter can be provided within or near the structure, and movable through the multi-channel tube. 
         [0025]    In one exemplary embodiment, the lumen(s) can comprise a tube channel and/or a tool channel, which is/are movable therein. The tool channel can be axially movable, rotatable, and/or bendable, and can include at least one wire which is configured to bend the tool channel. A distal end of the tool channel can be configured to reach any point inside or near the structure. The tool channel can include at least one wire which can be usable to bend the tube or the tool channel at least in one direction and in at least at one angle which is between 0 and 180 degrees. For example, a distance between the working channel and the structure can be controllable by moving at least one wire in the working channel toward and/or away from the structure. An endoscope can be provided within or near the configuration, and movable through the multi-channel tube to reach the working space. The endoscope can include an image sensor provided on a flexible shaft to visualize at least one portion of the tissue(s). 
         [0026]    According to yet a further exemplary embodiment of the present disclosure, the structure can have at least one flexible strip or at least one wire and/or two or more flexible strips or wires. At least one of the strips or wires can have a pre-formed shape to provide the desired geometry of the working space. In addition, at least one balloon can be provided or two or more balloons. At least one of the balloons can be an asymmetric shape and/or a symmetric shape. The balloon(s) can be positioned proximal to the structure. According to one exemplary variant, a first balloon and a second balloon can be provided, where the first balloon is provided distally in relation to the structure, and the second balloon is provided proximally in relation to the structure. The structure can be composed of wires and/or a mesh. Such wires/mesh, prior to being expanded, can have (i) at least one partially rigid portion, (ii) upon a partial or complete expansion thereof, can be controllable to have a plurality of shapes, and/or (iii) can be controllable to provide the working space multiple shapes and/or multiple sizes. 
         [0027]    These and other objects, features and advantages of the exemplary embodiment of the present disclosure will become apparent upon reading the following detailed description of the exemplary embodiments of the present disclosure, when taken in conjunction with the appended claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0028]    Further objects, features and advantages of the present invention will become apparent from the following detailed description taken in conjunction with the accompanying figures showing illustrative embodiments of the present disclosure, in which: 
           [0029]      FIGS. 1 a  and 1 b   , are schematic cross-sectional illustrations of an exemplary embodiment of an arrangement/device comprising a multi-lumen extrusion tube, and multiple tubes inside one large tube in accordance with the present disclosure; 
           [0030]      FIG. 2 a    is a perspective view of an exemplary embodiment of the arrangement/device according to the present disclosure comprising which includes a nitinol strips chamber in an open position; 
           [0031]      FIG. 2 b    is a perspective illustration of the arrangement/device of  FIG. 2 a    with the chamber formed by flexible strips in a closed position; 
           [0032]      FIG. 2 b    is a side view of the arrangement/device of  FIG. 2 a    with the chamber formed by flexible strips in another position; 
           [0033]      FIG. 2 d    is a side view of the arrangement/device of  FIG. 2 a    with an overtube covering the chamber that is in the closed position according to an exemplary embodiment of the present disclosure; 
           [0034]      FIG. 2 e    is a side view illustration of the arrangement/device of  FIG. 2 a    with a scope that is provided in one of the working channels and facilitating a field of view therefor according to another exemplary embodiment of the present disclosure; 
           [0035]      FIG. 3  is a perspective view of another exemplary embodiment of the arrangement/device according to the present disclosure which includes the chamber made from two metal strips; 
           [0036]      FIG. 4  is a side cross-sectional view of an exemplary embodiment of the arrangement/device according to the present disclosure which includes the chamber made from two asymmetric balloons; 
           [0037]      FIG. 5  is a perspective view of another exemplary of another exemplary embodiment of the arrangement/device according to the present disclosure which includes the chamber made from one asymmetric balloon together with the balloon guide catheter; 
           [0038]      FIG. 6  is a perspective view of another exemplary of still another exemplary embodiment of the arrangement/device according to the present disclosure which includes the chamber made from metal wires braid; 
           [0039]      FIG. 7  is a perspective view of a further exemplary of yet another exemplary embodiment of the arrangement/device according to the present disclosure which includes the nitinol strips chamber with two blocking balloons at both sides; 
           [0040]      FIG. 8  is a side view of another exemplary of yet a further exemplary embodiment of the arrangement/device according to the present disclosure which includes the chamber with cameras; 
           [0041]      FIG. 9 a    is a right side perspective view of another exemplary of a further exemplary embodiment of the arrangement/device according to the present disclosure which includes a particular handle; 
           [0042]      FIG. 9 b    is a left side perspective view the exemplary arrangement/device of  FIG. 9   a;    
           [0043]      FIG. 10  is a perspective view of yet another exemplary of yet another exemplary embodiment of the arrangement/device according to the present disclosure which includes a vacuum catheter; 
           [0044]      FIG. 11  is a perspective view of yet another exemplary of another exemplary embodiment of the arrangement/device according to the present disclosure which includes a tool-channel; 
           [0045]      FIG. 12  are different illustration of a preferred embodiment of still another exemplary of another exemplary embodiment of the arrangement/device according to the present disclosure which includes a tool-channel elevator; and 
           [0046]      FIG. 13  a perspective view of yet another exemplary of another exemplary embodiment of the arrangement/device according to the present disclosure which includes the tool-channels inside the chamber thereof. 
       
    
    
       [0047]    Throughout the figures, the same reference numerals and characters, unless otherwise stated, are used to denote like features, elements, components or portions of the illustrated embodiments. Moreover, while the subject disclosure will now be described in detail with reference to the figures, it is done so in connection with the illustrative embodiments. It is intended that changes and modifications can be made to the described exemplary embodiments without departing from the true scope and spirit of the subject disclosure as defined by the appended claims. 
       DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS 
       [0048]    According to one exemplary embodiment of the present disclosure, a device, an arrangement and a method can be provided for treatment of, e.g., conditions associated with body lumen(s) or/and cavities, for example, gastro-intestinal conditions, including but not limited to a gastrointestinal perforation, bleeding, large polyps or/and tumors, diverticuli, appendix, and others. 
         [0049]    The exemplary embodiments of the arrangement/device according to the present disclosure can provide various functions, which may be the same and/or similar to the surgical functions provided in the surgical operating room, therefore, thus representing a miniature operating room within a lumen (e.g., of a body), such as, e.g., colon and allowing to replace a major surgery, e.g., an open abdominal surgery. 
         [0050]    For example, as shown in  FIGS. 2 a  and 2 b   , the exemplary embodiment of the arrangement/device  1  according to the present disclosure can provide an endoluminal chamber which can also be at least partial enclosure, such as, e.g., an endoluminal colon or an intra-colon chamber/enclosure, and include various maneuverable operating instruments and/or tools  11  within the chamber  10 . The exemplary arrangement/device  1  can be inserted after one or more relevant lesions is/are identified, e.g., during standard colonoscopy. A particular balloon guide catheter  4 , e.g., such as described in U.S. Provisional Patent Application Ser. No. 61/247,605 filed on Oct. 1, 2009, or Mega-channel such as Minos Inc. Mega-channel, can be used to facilitate an insertion of the exemplary arrangement/device  1 . 
         [0051]    According to certain exemplary embodiments of the present disclosure, the arrangement/device  1  can be a particularly-designed endoscope, such as, e.g., a colonoscope. As shown in  FIGS. 9 a  and 9 b   , according to certain exemplary embodiments, the arrangement/device  1  can include, e.g., an exemplary handle  20  (see FIGS. (see  FIGS. 9 a  and 9 b   ), an exemplary multi-lumen tube  30  (see  FIGS. 1 a , 1 b   ,  3 ,  7 ,  8  and  13 ), and an exemplary expandable chamber  10  (see  FIGS. 5, 7, 10 and 13 ). In addition, the arrangement/device  1  can include standard and particular exemplary instruments/tools  11  (see  FIGS. 8, 12 and 13 ) and/or exemplary tool channels (see  FIG. 13 ). 
         [0052]    As indicated herein above, the exemplary arrangement/device  1  can include the multi-lumen tube  30 . Such exemplary multi-lumen tube  30  can be made from a single extrusion polymer tube  31  having multiple lumens {see  FIG. 1 a   }, and/or made in a standard endoscopic equipment configuration using a collection of single or multi-lumen tubes  32  of different sizes that are enclosed by a single, large, flexible tube  33  (see  FIG. 1 b   ). External and internal tubes can be simple polymer tubes and/or reinforced tubes or braided tubes, as known in the art. The external tube  33  can have a diameter that is large enough to contain all inner tubes  32  provided for the exemplary arrangement/device  1 . The exemplary multi-lumen tube  30  can include at least one lumen, and, e.g., possibly 2 to 4 or more lumens for 2 to 4 or more exemplary instruments/tools  11  and/or tool-channels  40 , and possibly additional lumens, for example, for a air insufflation  34 , water irrigation  35 , vacuum  36 , lumen for wiring and/or fibers for cameras and illumination  37 , lumen for a balloon guide catheter  4 , lumen for chamber expansion control  38 , and/or lumen for proximal balloon inflation  39 , as shown in the exemplary embodiment of  FIG. 1   b.    
         [0053]    For example, according to particular exemplary embodiments of the present disclosure, the arrangement/device  1  can contain a distal chamber  10  that can be expanded to different sizes inside the colon, thus likely creating relatively large or sufficient working space near the lesion to be treated. The exemplary chamber  10  can provide a space for manipulations of multiple tools and / or tool-channels in such a way that several tools can approach the lesion from all sides and directions, as shown in, e.g.,  FIGS. 3, 7, 8 and 13 . The exemplary multi-lumen tube  30 , e.g., having a diameter between 10 mm to 40 mm, can accommodate at least one tool-channel, which can in turn accommodate, e.g., a non-standard instrument, for example, an endoscopic stapler, both having a sufficient size for a particular purposes thereof. 
         [0054]    According to one exemplary embodiment of the present disclosure, the exemplary chamber  10  can be constructed from at least one, and possibly two or more flexible metal strips, fibers or wires  12 , which can be made from a flexible material, such as, e.g., Nitinol, as shown in  FIGS. 2 a -2 e    and  3 . These exemplary strips, fibers or wires can be composed of other materials as well, including but not limited to surgical plastic or other materials. The exemplary strips, fibers or wires  12  can be substantially straightened (or slightly-to-moderately bent as needed during steering the device through the lumen) when the chamber  10  (providing a working space) is in non-deployed position (see  FIGS. 2 a  and 2 d   ), and are substantially bent when actuated by a control lever  23  in the handle  20 , hence, enlarging the chamber  10  and creating a larger working space inside the colon, as shown in  FIGS. 2 b , 2 c , 2 e    and  3 . For example, pushing or pulling the exemplary strips, fibers or strips  12  can be performed with a tube  19  that can slide in the lumen  38  by pulling and/or pushing the tube  19  proximal end lever  23  in the handle  20 , as shown in  FIGS. 2 a   - 2   e,    3 ,  9   a  and  9   b.  Further, the guide catheter  4  can be inserted inside the tube  19 . The exemplary strips  12  can be covered by a soft polymer cover to avoid possible inner colon tissue damage. 
         [0055]    According to an exemplary embodiment of the present disclosure, as shown in  FIGS. 2 a -2 e   , the chamber  10  it can be deflected by pulling on the exemplary strips, fibers or wires  12 , or the chamber  10  can be opened when the exemplary strips, fibers or wires  12  are pushed forward from the handle  30 . In thus manner, the exemplary strips, fibers or wires  12  increase working space with in the chamber  30  to facilitate the anatomical structure to be pulled into the chamber  10  by other instruments/tools  11  being manipulated from the handle  30 , as described in further details herein, and shown in, e.g., in  FIG. 8 . 
         [0056]    Further, as shown in  FIGS. 2 c  and 2 e   , the exemplary strips, fibers or wires  12  can be covered with a protective cover portions  70  so as to reduce damage being caused by the exemplary strips, fibers or wires  12  when they are actuated to expand the chamber  10  (i.e., which causes the exemplary strips, fibers or wires  12  to push on the surrounding tissue). As shown in  FIG. 2 d   , the arrangement/device  1  can also include an overtube  65  which can be pushed forward toward the front of the arrangement/device  1  so as to cover the collapsed chamber  10  (e.g., to facilitate insertion and removal and containing the specimen), and pulled back to prepare for the chamber  10  for its expansion.  FIG. 2 e    shows an illustration of the arrangement/device  1  of  FIG. 2 a    with a scope  60  (including a camera and at least one light illuminating source) that is provided in one of the working channels  40  and facilitating a field of view  54  for positioning and propelling the exemplary arrangement/device  1 . 
         [0057]    When the instrument  1  reaches the desired position within the body, the scope  60  can be retracted inside the chamber  10 , e.g., via the working channel  40  to facilitate visualization inside and/or near the chamber  10 . According to another exemplary embodiment of the present disclosure, an articulating scope (which can perform similar functions as that of the scope  60 ) can be provided through one or more of the working channels  40  into the chamber  10 . Such articulating scope can be configured to illuminate and/or provide images of the anatomical structure and tools inside and/or near the chamber  10 . The articulating scope can have a distal portion that can rotate in  360  degrees and bend to provide an end part thereof so as to illuminate and visualize any portion of the anatomical structure and the tools inside and/or near the chamber  10  at any angle. 
         [0058]    In another exemplary embodiment of the present disclosure, as shown in  FIG. 7 , the strips  12  can be proximally connected to a first cap  14 , which can be made from a solid material. The first cap  14  can have multiple holes for most or all lumens  32 . The strips  12  can also be distally connected to a second cap  15  which can be smaller in diameter than the first cap  14 , to facilitate a passage of large specimens, for example, polyps into the area of the chamber  10 . The distal second cap  15  can include a hole for insertion of the balloon guide catheter  4 . Alternatively or in addition, the exemplary chamber  10  can be made from two asymmetrical balloons  5 ,  16 , as shown in the exemplary embodiment of  FIG. 4 . For example, the balloons  5 ,  16  can create space for the chamber  10  and the exemplary instruments/tools  11  when inflated. Alternatively or in addition, the exemplary chamber  10  can be provided using the proximal balloon  16  and the distal balloon  5 , being connected to one another via their attachment to the balloon guide catheter  4 , as shown in  FIG. 5 . Further alternatively or in addition, the exemplary chamber  10  can be provided by a braided metal wire net  17  having an opening  18  at desired location, as shown in  FIG. 6 . 
         [0059]    In another exemplary embodiment of the present disclosure, at least one, and possibly two or more balloons can be used with the chamber  10  that is made from strips  12  made from a bendable material (e.g., metal). The exemplary balloon(s)  5 ,  16  can assist in blocking and/or isolating the chamber  10  from the rest of the colon, hence, minimizing and/or preventing the inflow and outflow of liquids and solids from and/or to the chamber  10 , while the exemplary strips  12  can provide a substantially rigid and stable working space and facilitate treatment of the lesion. For example, as shown in  FIG. 7 , the first symmetric or asymmetric balloon  16  can be provided in proximal to the chamber  10  or the position of the strips  12 . The second balloon  5  can be provided at the position that is distal to the strips  12 . Alternatively, the second balloon  5  that can be connected to the guide catheter  4 . 
         [0060]    According to still another exemplary embodiment of the present disclosure, the arrangement/device  1  can include at least one camera and an illumination apparatus to provide sufficient light to the area of interest. For example, camera or cameras and illuminating component can be movable or fixed in the arrangement/device  1 , for example, to the chamber  10 . In one exemplary embodiment shown in  FIG. 2 e   , the scope/front camera  50  can be used to facilitate the insertion of the arrangement/device  1  into the colon. Referring to  FIG. 8 , e.g., at least one, two or more additional and possibly fixed cameras  51  can be positioned so to facilitate image capture at a location of the lesion. Exemplary field views  54  of the cameras  51  can overlap, and such overlap may facilitate visualization if one or more instruments/tools blocks or adversely affects view of one of the cameras. For example, illumination can be provided by a variety of ways, e.g., by LEDs  52 ,  53 . Exemplary front LEDs  52  can be used for the front camera  50 , and in-chamber LEDs  53  can be used for the illumination in or at the chamber  10 . Alternatively or in addition, a conventional flexible endoscope, having distal bendable section, can be used instead of or together with the fixed camera(s)  51  and illumination via the LEDs  52 ,  53 . 
         [0061]    As shown in  FIGS. 9 a  and 9 b   , the exemplary arrangement/device  1  according to a further exemplary embodiment of the present disclosure can include a control handle  20  at or about its proximal end. The exemplary handle  20  can have similar shape and configuration with respect to other conventional endoscope&#39;s handles, while likely having additional channel ports and actuators than standard endoscope. For example, the ports in the handle  20  can include at least one, and possibly 2-4 or even more ports for the tool-channels  21 , balloon guide catheter port  22  and particular lever  23  to control the opening and closing of the chamber  10 . Additional ports can include, but not limited to, a luer port  24  for a proximal balloon inflation, and a port  26  of a vacuum catheter  25  or an irrigation catheter. The handle  20  can include switches  27 ,  28  for air insufflations, water irrigation and vacuum activation, as well as switch (not shown) for switching camera(s) between frontal and inner locations. 
         [0062]    As illustrated in  FIG. 10 , the exemplary arrangement/device  1  according to a still further exemplary embodiment of the present disclosure can include a vacuum catheter with a bent tip  25 , inserted in a vacuum lumen  36  through a vacuum port  26 . The vacuum catheter can operate as a standalone (as describe herein), and/or may be inserted into tool channel  40  and deflect. Further, the vacuum catheter can be manipulated to reach all or most areas inside and around the chamber  10 , hence, providing an access for elimination of liquids and solids from and around the chamber  10 . In another exemplary embodiment of the present disclosure, the chamber  10  can include bendable and steerable section, which can be actuated at the lever  23 , which when pulled, the instrument  1  is articulated, and when pushed, the chamber  10  is opened (or increased in size). Thus, movements of the exemplary arrangement/device  1  in the colon can be facilitated. According to a further exemplary embodiment, a locking mechanism can be provided which can , e.g., rotate one or more times (e.g., counterclockwise or counter-clockwise) to lock the lever  23 . 
         [0063]    According to still another exemplary embodiment of the present disclosure, the exemplary arrangement/device  1  can include the instruments/tools  11  and/or tool-channels  40 , as shown in  FIG. 11 . When the exemplary instruments/tools  11  are inserted in the tool channels  40 , distal ends  41  thereof change the position(s) and/or shapes of the instruments/tools  11 , for example, rotated, axially moved, bent at desired angles, whenever the position and shape of the associated tools channels  40  are changed, as shown in  FIG. 12 . The tool channels  40  can be actuated and manipulated at or about proximal end of the exemplary arrangement/device of the present disclosure. The described maneuverability of the tool-channels  40 , for example, their distal ends  41  provide and/or facilitate multidirectional and multiangular approach to the target lesion. 
         [0064]    For example, the tool-channels  40  can include at least one, and preferably two, three or more lumen tubes  42 , which can be made of polymer, possibly having high torque-ability, low friction, connected at or about their distal ends to an additional section  41 , which can have “elevators”  43 . The exemplary polymer tube(s)  42  can be reinforced with other materials to change its/their structural or/and functional properties. The elevator  43  can be a flexible bendable section, made, e.g., from a laser cut nitinol tube  44 , and/or actuated, e.g., bent, using one or two metal wires  45 . The instruments/tools  11  can be inserted in the first (e.g., relatively large) lumen of the tube  42 , and the wire  45  can be inserted in the second (e.g., relatively small) lumen of the tube  42 . 
         [0065]    As shown in  FIG. 13 , the ability of the tool-channel tubes  42  to move, independently or simultaneously, axially (e.g., pushing, pulling directions), rotate and bend using the elevator  43 , facilitates the instruments/tools  11  or/and the tool-channels  40  in reaching any point within and around the chamber  10 , and can provide possibly an unlimited range of instrumental freedom within the working space. For example, as shown in  FIG. 11 , the tool channel  40  can include one or more handles  46  connected to the tube  42  at or about a proximal side of the tube  42 , and can be used for a manipulation of the elevator  43 , and utilize a port  47  for an insertion of the exemplary instrument/tool. 
         [0066]      11 . The exemplary tool-channel handle  46  can include a slider or knob  48  which can be used to actuate, e.g., pull and release a wire  45 , as shown in  FIG. 12 . Any standard tool(s) can be used with the exemplary tool-channel(s)  40 . Alternatively or in addition, articulating tools having maneuverable distal ends, e.g., with at least two degrees of freedom, can be used. 
         [0067]    According to yet a further exemplary embodiment of the present disclosure, a method for implementing the exemplary arrangement/device  1  according to the present disclosure can be provided. Such exemplary method can be utilized as follows: 
         [0000]    i. Perform a standard colonoscopy and identifying a lesion that may not be treated using standard endoscopy and techniques.
 
ii. Insert a balloon guide catheter, inflating the balloon and removing the standard colonoscope (the balloon catheter and inflated balloon are left in place). The balloon guide catheter can be used as a guide-wire to facilitate the insertion of the exemplary arrangement/device  1 .
 
iii. Insert the exemplary arrangement/device lover the balloon guide catheter, until the chamber is in the proximity to the lesion.
 
iv. Deploy and adjust the chamber  10  of the exemplary arrangement/device  1  to preferred dimensions. Readjust the chamber  10  during the procedure as needed.
 
v. Clean an operative area with a provided suction catheter. If desired, inflate a proximal balloon, a distal balloon or both proximal and distal balloons for the treatment area isolation.
 
vi. Insert the tool-channels.
 
vii. Insert the instruments/tools into the tool-channels. Manipulate the tool-channels to optimize and facilitate the instruments/tools approach to the lesion.
 
viii. Perform a procedure, e.g., closing a colonic perforation, removing a large colon polyp or tumor, stopping a bleeding, closing diverticuli, removing an appendix, treating other body luminal lesions.
 
         [0068]    The foregoing merely illustrates the principles of the present disclosure. Various modifications and alterations to the described embodiments will be apparent to those skilled in the art in view of the teachings herein. For example, more than one of the described exemplary arrangements, radiations and/or systems can be implemented to implement the exemplary embodiments of the present disclosure. It will thus be appreciated that those skilled in the art will be able to devise numerous systems, arrangements and methods which, although not explicitly shown or described herein, embody the principles of the present disclosure and are thus within the spirit and scope of the present disclosure. In addition, to the extent that the prior art knowledge has not been explicitly incorporated by reference herein above, it is explicitly being incorporated herein in its entirety. All publications referenced herein above are incorporated herein by reference in their entireties.

Technology Category: a