US20070270647A1 - Handle for Multifunction Endoscope - Google Patents

Abstract

A multifunction endoscope handle comprises a body cover, a first body cover extension and a second body cover extension. The body cover comprises distal and proximal ends with a waist of therebetween. The proximal and distal end circumferences part each larger than the waist circumference. The body cover also comprises an outer surface tapering from the distal and proximal ends to the waist. Both of the first and second body cover extensions extend radially outwardly directions from the outer surface of the body cover. In some embodiments the proximal circumference is larger than the distal circumference. The outer surface is preferably a smoothly tapering outer surface. The body cover may comprise a plurality of ports at a proximal portion thereof.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application claims the benefit of Provisional Patent Application No. 60/747,780 filed 19 May 2006, entitled Endoscope for Fiber Optic Procedures, Attorney Docket LSCP 1026-1.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates generally to endoscopes, and in particular the configuration of a handle used for a multifunction endoscope.
• 2. Description of Related Art
• An endoscope is an illuminated medical device used look inside the body and examine organs. An endoscope can be rigid or flexible. Endoscopes designed for particular procedures often have specialized names, such as cystoscope (bladder), nephroscope (kidney), bronchoscope (bronchi), laryngoscope (larynx), otoscope (ear), arthroscope (joint) and laparoscope (abdomen). In addition to being used for viewing and examination, endoscopes are often used with various types of medical instruments for diagnostic and therapeutic procedures. An example of these medical instruments includes a medical laser device using fiber optics to deliver the laser energy to, typically, the distal end of the endoscope. Other medical instruments that can be used with endoscopes include grasping, cutting, tissue sampling and suturing medical instruments as well as medical instruments designed to provide energy other than laser energy such as RF and ultrasonic energy.
• Endoscopic removal of tissue by means of lasers has been realized in procedures such as photoselective vaporization of prostate (PVP) for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Lasers in the visible and invisible spectral range have been utilized for endoscopic procedure of tissue removal. Tissue removal is typically carried out under endoscopic visualization of the operating field through a telescope. Laser light is guided to the operating field by an optical light guide (laser fiber). To steer the light guide to the target tissue an endoscope is often utilized. In some implementations the telescope can be embodied in the endoscope as a fixed or modular component.
• Performing a surgical laser procedure through an endoscope creates several challenges. Vaporization of tissue in a body cavity filled with an irrigant creates vapor bubbles and tissue particles that get released into the irrigant and that can obscure the view of the surgeon.
• Controlling the surgical effect the laser has on tissue requires the surgeon to position the laser fiber with high precision. The surgeon has to consider the characteristics of the laser beam such as its divergence coming out of the laser fiber and control the distance between laser fiber and tissue to achieve the desired effect. In some instances the laser effect can change its nature dependent on the distance between laser fiber and tissue. In some cases vaporization will occur when the fiber is close to tissue but coagulation without vaporization will occur when the fiber is further away from tissue.
• The surgeon has to control the position of the distal tip of the laser fiber relative the distal tip of the endoscope to avoid damage to the endoscope by unintentional exposure of the endoscope to laser light.
• Thus, in some high power laser applications, it is possible to damage an endoscope by inadvertently directing laser radiation into the structure. In addition, it is necessary to provide for an effective irrigation flow in such systems. Finally, is desirable to provide a structural design which is comfortable to hold and utilize by surgeons. An endoscope is described herein that allows surgeons to safely and effectively perform laser surgery, including transurethral laser vaporization of prostate tissue.
SUMMARY OF THE INVENTION
• A simple endoscope used for examination of an organ may have only two ports, one for the light source and one for the optical image. However, endoscopes used for medical procedures such as ablation of tissue using laser energy will typically have many more ports and therefore make the design of the proximal portion of the endoscope more complicated. The increased complexity includes the presence of tubes, lines, wires and other things extending from the proximal portion of the endoscope. One aspect of the invention is the recognition that different individuals using the same endoscope will often hold and manipulate the endoscope by its proximal portion in different ways. This is particularly true for multifunction endoscopes used for both of viewing and for treatment, at least in part because of the increased complexity of the procedure and the number of things extending from the proximal portion, as well as the personal preferences of the operator.
• A handle for a multifunction endoscope comprises a body cover, a first body cover extension and a second body cover extension. The body cover comprises distal and proximal ends with an axis extending therebetween with a waist between the distal and proximal ends. The distal and proximal ends and the waist have distal and proximal circumferences and a waist circumference, respectively. The proximal circumference is larger than the waist circumference and the distal circumference is larger than the waist circumference. The body cover also comprises an outer surface, the outer surface tapering from the distal end to the waist and from the proximal end to the waist. The first body cover extension extends in a first radial direction from the outer surface of the body cover between the proximal end and the waist. The second body cover extension extends in a second radial direction from the outer surface of the body cover between the proximal end and the waist.
• In some embodiments the proximal circumference is larger than the distal circumference. The outer surface is preferably a smoothly tapering outer surface. The body cover may comprise a plurality of ports at a proximal portion thereof. The handle may also comprise a second body cover positioned distally of the distal end of the body cover. The second body cover may comprise additional ports therein.
• A method for manipulating an endoscope comprises selecting an endoscope, the endoscope comprising a handle, an external cannula extending from the handle, and an optical fiber. The optical fiber extends through the handle and through the external cannula with a proximal portion of the optical fiber extending proximally from a port at the second body cover extension. The body cover of the handle is grasped with a first hand using a chosen gripping technique. A user-manipulable knob mounted to the proximal portion of the optical fiber is grasped with a second hand. The optical fiber is selectively moved within the external cannula by at least one of rotating the optical fiber around its own axis and longitudinally sliding the optical fiber through the external cannula using the user-manipulable knob.
• Other features, aspects and advantages of the present invention can be seen on review the Figs., the detailed description, and the claims which follow.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a simplified overall view of a multifunction endoscope including a handle made according to the invention;
• FIG. 1A is a simplified side view of a portion of a laser fiber showing a rotation limiting element, a coupler and a fiber manipulator mounted thereto;
• FIG. 2 is an enlarged view of the handle ofFIG. 1;
• FIGS. 3-6 illustrate four different handle holding techniques accommodated by the handle ofFIGS. 1 and 2; and
• FIGS. 7 and 8 are somewhat simplified overall cross-sectional views with crosshatching omitted for clarity,
• FIG. 9 is a proximal end half-sectional elevational view, and
• FIGS. 10 and 11 are top and bottom half-sectional plan views of the endoscope ofFIG. 1 further illustrating the shape of the outer surface of the handle;
• FIG. 12 a side view of the distal end of the endoscope positioned within a urethra near prostate tissue;
• FIG. 13 is a perspective view of the opening at the distal end of the endoscope, looking from the working region into the opening;
• FIG. 14 is a somewhat simplified cross-sectional view, with crosshatching omitted for clarity, illustrating the cooperation of a travel limiter and a pin within a fiber lumen on the endoscope;
• FIG. 15 illustrates the structure of a travel limiter for use with a fiber adapted for the endoscope described herein;
• FIG. 16 is an end view of the fiber lumen with a travel limiter cam positioned inside in a vertical position; and
• FIG. 17 is an interview of the fiber lumen with a travel limiter cam positioned in a rotated position.
DETAILED DESCRIPTION
• FIG. 1 illustrates a multifunction endoscope10, such as a transurethral cystoscope, including ahandle12 with anexternal cannula14 extending distally from thehandle12. In this embodiment multifunction endoscope10 is designed for use with a medical laser device of the type including anoptical fiber16 having afiber end member19 which extends into a cavity formed by a hood structure (described in more detail below and in Provisional Patent Application No. 60/747,780, the disclosure of which is incorporated by reference) on thedistal tip18 ofexternal cannula14. Theoptical fiber16 has afiber manipulator knob17 attached near thehandle12, that is adapted to be used by a surgeon to manipulate the position of the fiber end member, rotationally and longitudinally.External cannula14 has a number of passageways or lumens formed by an internal structure, not shown, extending generally fromhandle12 todistal tip18 to accommodate, in this disclosed embodiment,optical fiber16 andfiber end element19, a telescope type of visualization device typically coupled to a display monitor (not shown), an inflow irrigation pathway, and an outflow or suction pathway. The endoscope10 in the illustrated embodiment includes an internal cannula which receives thefiber16 in a manner which allows easy movement of thefiber16 at least over a range of motion that allows manipulation of the fiber end member1 longitudinally and rotationally within a working field by a surgeon grasping thefiber manipulator knob17. Other embodiments are adapted for manipulation of thefiber end member19 by a mechanical system under computer control with active feedback based on the video images of the procedure, with or without real time user input.
• Individual lumens may be used for a single purpose, such as delivery of irrigation liquid, or for two or more purposes, such as housing the telescope and a optical fiber.
• As suggested inFIG. 1, alaser beam20 is directed laterally in the illustrated embodiment fromfiber end element19 in a side-firing fashion.Optical fiber16 could also have an end element adapted for forward firing. Visualization in the general direction oflaser beam20 is provided by a telescope with appropriately angled optical elements at its distal end. In addition, other types of medical instruments may be used as a part of endoscope10 instead of, or in addition to, a medical laser device.
• FIG. 1A is a simplified diagram of an optical fiber assembly adapted for use with the endoscope ofFIG. 1. Thefiber16 is connected to a coupler71 adapted to connect the fiber to the output of a laser system. Thefiber end element19 in the illustrated embodiment comprises a fused quartz cap which captures air between abeveled end21 of thefiber16. The air/fiber interface provided by thebeveled end21 causes essentially total internal reflection of thebeam20 in the side firing direction. At a predetermined distance from thefiber end element19, arotation limiting element76, in the form of a cam in this embodiment, is attached to thefiber16. Therotation limiting element76 is adapted to cooperate with a corresponding element within the endoscope, as described in more detail below and in Provisional Patent Application No. 60/747,780, the disclosure of which is incorporated by reference, to prevent the surgeon from withdrawing thefiber end element19 into the cannula so that thebeam20 does not damage the cannula, and to prevent the surgeon from rotating thefiber end element19 toward the hood structure on thedistal tip18 of the external cannula, so that thebeam20 does not damage the hood structure on thedistal tip18. In addition, the fiber is threaded through acoupler70, which is adapted to couple with a fiber port on the endoscope10, as illustrated inFIG. 1, which secures therotation limiting element76 within the endoscope, and provides a seal on the cannula within which thefiber16 is received without interfering with movement of the fiber as described above within the predetermined ranges of longitudinal and rotational motion.
• In a preferred embodiment the longitudinal motion ofoptical fiber16 is directed axially along axis28 (illustrated inFIG. 2) and also rotationally about its own axis to permitlaser beam20 to be directed proximally and distally asoptical fiber16 moves generally alongaxis28 as well as being swept side to side asoptical fiber16 rotates about its own axis.Distal tip18 ofexternal cannula14 is beveled to permit this range of movement oflaser beam20 while providing for proper viewing of workingregion68.
• FIG. 2 shows more detail ofhandle12.Handle12 includes a body cover portion or cover22 having adistal end24 and aproximal end26 and defining acentral axis28. The axial distance between distal and proximal ends24,26 is preferably about 8 to 15 cm, and typically about 9 to 12 cm. This size range is chosen primarily to accommodate different hand grasping techniques, such as shown inFIGS. 3-6, for users with a range of sizes of hands and styles of use for the endoscope.Handle12 also includes a supplemental body cover30 positioned distally of body cover22 with abayonet mount32 therebetween adapted for covering the proximal end of theexternal cannula14 and various fittings used for connecting the internal structures to theexternal cannula14. Theexternal cannula14 is connected with irrigation inflow andoutflow fittings34,36, and secured bybayonet mount32 to internal structures (not shown) which are adapted to receive thetelescope64 and thefiber16.Handle12 has a number of ports opening into the interior of the handle. For example, inflow andoutflow fittings34,36 extend fromsupplemental body cover30 and provide access to inflow andoutflow ports38,40 which open into an inflow irrigation pathway defined by internal structures and an outflow or suction pathway extending alongexternal cannula14. Inflow fitting34 may be connected to a source of an appropriate irrigation liquid, such as saline fed by a gravity feed structure or by a pump, while outflow fitting36 may be connected to an appropriate suction source.
• Body cover22 has a smoothly tapering outer surface48 that tapers radially inwardly from distal and proximal ends24,26 towards a central orwaist portion42. The circumference ofproximal end26 is larger than the circumference ofdistal end24, which is larger than the circumference ofwaist portion42. Outer surface48 has a generally circular, slightly oval cross-sectional shape alongaxis28 with a diameter in a range of about 1.5 to 2 cm, for example. Outer surface48 may have other, preferably smoothly curving, shapes, such as egg-shaped, at various positions alongaxis28 or along the entire length ofaxis28.
• Handle12 also has first and secondbody cover extensions44,46 extending radially outwardly from the outer surface48 of body cover22 adapted to comfortably shield the surgeon's hand from fittings for the telescope and thefiber16.Extensions44,46 are positioned betweenproximal end26 andwaist portion42.Extensions44,46 have smoothly curving, distally-facingouter surfaces50,52 to provide a smooth transition between outer surface of48 ofbody cover22 andextensions44,46. As seen inFIG. 2, firstbody cover extension44 extends generally directly radially outwardly while the secondbody cover extension46 extends both radially outwardly and distally. An illumination fitting54 extends from firstbody cover extension44 and opens into anillumination port56. An optical fiber fitting58 extends from secondbody cover extension46 and opens into anoptical fiber port60.Optical fiber16 passes through fitting58, throughport60, and through an appropriate passageway inhandle12 for entry into and through an appropriate lumen withinexternal cannula14. A valve handle72 is mounted flush with secondbody cover extension46 with a smooth or otherwise comfortable surface transition. The valve handle72 is turned to control a stop cock within thehandle12, to seal offport60 when desired, typically whenoptical fiber16 is removed fromhandle12.
• As shown inFIG. 2, smoothly tapering outer surface48 is provided with a number ofgrooves62 to facilitate grasping by the user. The same or other types of embossing or debossing may also be provided for outer surface48 as well asouter surfaces50,52 to promote a good grip ofhandle12. One or more ofouter surfaces48,50 and52 may be provided with a mat or other suitable surface texture. In the preferredembodiment body cover22 is of a stiff polymer material or metal. In alternative embodiments, theentire body cover22, portions ofbody cover22 and/or a skin on thebody cover22 may comprise a resilient or otherwise yieldable material.
• Endoscope10 also includes atelescope64 extending through atelescope port65 at proximal end of26 and aligned withaxis28.Telescope64 includes a camera fitting66 to permit images of the workingregion68 in the vicinity oflaser beam20 captured by the telescope atdistal tip18 to be recorded and/or monitored during use.Illumination port56 is coupled to the interior oftelescope64 so the light from the illumination source passes distally along the telescope to illuminate workingregion68.
• In a preferred embodiment the motion ofoptical fiber16 is both axially alongaxis28 and also rotationally about its own axis to permitlaser beam20 to be directed proximally and distally asoptical fiber16 moves generally alongaxis28 as well as being swept side to side asoptical fiber16 rotates about its own axis.Distal tip18 ofexternal cannula14 is beveled to permit this range of movement oflaser beam20 while providing for proper viewing of workingregion68. This manipulation ofoptical fiber16, seeFIGS. 1 and 1A, can be aided by the use of acoupler70, afiber manipulator knob17 and arotation limiting element76.Fiber manipulator knob17 androtation limiting element76 are both secured tooptical fiber16 whileoptical fiber16 slides freely throughcoupler70.Coupler70 engages optical fiber fitting58, typically through the use of a luer coupling. The axial movement of the distal tip ofoptical fiber16 at thedistal tip18 ofexternal cannula14 is limited in the distal direction by the engagement offiber manipulator knob17 withcoupler70 and in the proximal direction by the engagement ofrotation limiting element76 withcoupler70. Other structure or methods for limiting this axial movement to fixed or adjustable distances may also be used. By limiting the axial or longitudinal movement ofoptical fiber16 throughcoupler70,laser beam20 is kept within workingregion68.Rotation limiting element76 is designed to engage structure, not shown, withinhandle12 to limit the rotation ofoptical fiber16 about its own axis. It is important, especially whenlaser beam20 is a high-power laser beam, to preventlaser beam20 from impinging againstexternal cannula14, possibly causingexternal cannula14 to be vaporized, by pullingoptical fiber16 too far into the sheath or by over-rotatingoptical fiber16 during lasing operations.
• FIGS. 7-11 are somewhat simplified half-section views of endoscope10 showingbody cover22 andbody cover extensions44,46 from different vantage points.Proximal end26 ofbody cover22 provides anopening80 into the interior ofhandle12 fortelescope64. Firstbody cover extension44 is a generally U-shaped structure having anouter edge82 that partially definesillumination port56.Outer edge82 joins with proximal end of26 for receipt of illumination fitting54 extending fromtelescope64. This configuration facilitates insertion oftelescope64 into and removal of the telescope fromhandle12 andexternal cannula14.
• FIGS. 3-6 illustrate four typical ways a surgeon can comfortably and securely hold or grasphandle12 of endoscope10 by graspingbody cover22 with one hand while leaving the other hand (not shown) free to manipulateoptical fiber16 usingfiber manipulator knob17 to adjust both the axial and rotary positions oflaser beam20. Other grasping techniques may be accommodated by the shape ofhandle12. The different grasping techniques can be based upon different personal preferences as well as the particular procedure being accomplished. For example, an operator may find the grasping technique ofFIG. 6 to be most satisfactory when initially introducing the endoscope to the target site to provide the most sensitivity to this procedure. The provision of the smallercircumference waist portion42 provides an exceptionally secure grasping surface between the user's thumb and opposed fingers. The grasping techniques ofFIGS. 3 and 4 provide extremely stable and secure positioning ofhandle12 due to the provision of the smallercircumference waist portion42 and the larger circumferenceproximal end26, as well as first and secondbody cover extensions44,46 with their smoothly tapering, forward facingouter surfaces50,52. The grasping technique ofFIG. 5 may be chosen by some users when, for example, manipulatingoptical fiber16 extending fromoptical fiber fitting58. In all cases, the smoothly tapering surfaces from the larger circumference distal and proximal ends24,26 to the smallercircumference waist portion42 provide a comfortable and a secure gripping surface for the user.
• FIG. 12 illustrates thedistal end18 of the endoscope positioned within a urethra adjacent prostate tissue. Thefiber end element19 directsradiation20 into the prostate tissue to cause vaporization or other effects in the tissue. Thedistal end18 includes ahood structure101 with a bluntdistal face102 adapted to be inserted into the urethra. Thehood structure101 acts as an obturator which prevents constriction of the urethra onto thefiber end element19, and defines an open area between thetop surface103 and the workingregion68 on the prostate tissue. The internal structure (not shown) within the external cannula at thedistal end18 includes a guide element that is adapted to movably support the optical fiber in a position so that the emission face of theend element19 is spaced away from the workingregion68 on the prostate tissue within the open area defined by thehood structure101. In addition, the external cannula includes a nozzle for directing inflowing irrigant, and regions for suction of outflowing irrigant which together define an irrigation pathway represented by arrows104. The irrigation pathway104 flows across the emission face of thefiber end element19 as thefiber end element19 is moved within the open area, maintaining irrigation flow during the delivery of radiation to facilitate clear visualization through the telescope and to maintain the emission face of thefiber end element19 clear of debris.
• FIG. 13 provides a prospective of the distal end of the endoscope outer cannula from the direction of the workingregion68. As illustrated inFIG. 13, thedistal face102 of the endoscope represents the end of a hood structure. An opening on the end of the external cannula is defined by thedistal face102, and side walls which slope away from the end. The inner cannula110 includes a first lumen having anupper ridge112 which receives the telescope so that the telescope face108 faces the workingregion68, and which supports thefiber end element19. Thus theupper ridge112 has a radius which matches that of the telescope, and thelower ridge113 as a radius which matches that of a bearing surface on thefiber end element19. An irrigant inflow channel is defined by a second lumen which is bonded to the first lumen by welding or otherwise, and having crescent shaped opening106 which acts as an irrigant nozzle directing irrigation flow outwardly over thefiber end element19. In the illustrated embodiment, atube107 is attached to the outside surface of theupper ridge112 of the first lumen acting as a spacer between the inner cannula that defines the first and second lumens, and of the inside wall at the top of the outer cannula. An opening established bytube107 between the inner cannula and the external cannula provides an irrigation outflow channel which is coupled to a suction source tending to cause the irrigant which is forced through the crescent shaped opening106 of the irrigant inflow channel to flow outwardly and an upwardly across thefiber end element19.
• FIG. 14 illustrates the proximal end of the lumen in the endoscope adapted received the fiber and cooperate with thetravel limiter300, which is shown apart from the fiber in the drawing. The fitting58 defines alumen275 into which the fiber with of thetravel limiter300 bonded thereto is received. The fitting58 is coupled to astopcock valve278 which is opened to receive the fiber, and provide a continuous lumen within which thetravel limiter300 is able to move. On the distal side of thestopcock valve278, a tube is bonded which directs the fiber into the internal structure of the endoscope as described above. As shown inFIG. 14, thecover65 includes anextension46 surround thestopcock valve278 and thetube280, while the fitting58 extends outwardly. Apin276 extends into thelumen275 and cooperates with thetravel limiter300 to prevent rotation beyond a predefined arc of the fiber.
• The structure of the travel limiter300 (in the form of a cam in this embodiment) is illustrated inFIG. 15. The travel limiter includes a cylindricalfiber sheath body310 adapted to fit over the sheath of the optical fiber and be bonded thereto.Appendages311,312,313 are formed on thebody310 with arcuate outside surfaces (e.g. surface315 on appendage312) which are adapted to slide rotationally within thelumen275. Aridge314 extends along the major axis of thebody310 having sidewalls with a rear beveled surface320 (and a front beveled surface) set at an angle theta, such as about 60°. The sidewalls are positioned so that in cooperation with thepin276, rotational movement of the fiber is limited to a predefined arc.
• Although not shown inFIG. 14,seal70 when attached to the fitting58 acts to prevent longitudinal motion of thetravel limiter300 in a direction away from the distal end of the endoscope. Longitudinal motion in a direction toward the distal end of the endoscope is not actively limited in this embodiment, but is controlled by the surgeon by observing the fiber end element within the field of view of the telescope. In an alternative embodiment, a structure may be added to limit longitudinal motion toward the distal end. The length of theridge314 is selected so that when the fiber is fully withdrawn against theseal70, the ridge remains in a position to cooperate with thepin276, thereby providing for control of rotational motion of the fiber over a predefined length of longitudinal motion which is the equal to about twice the length of theridge314.
• FIG. 16 illustrates positioning of thetravel limiter300 from an end of view within thelumen275.Appendages311 and312 and theridge314 are adapted to secure thebody310 at a position that is substantially centered within thelumen275, and so that as the fiber is rotated, it remains positioned near the center and does not contact thepin267.
• As illustrated inFIG. 17, when the fiber is rotated in a counterclockwise direction, theridge314 eventually contacts thetin276 to limit the rotational motion. Theridge314 cooperates in a similar manner with thepin276 to limit clockwise motion. In illustrated embodiment, the travel limiter will allow rotational motion of about 270°, with the remaining 90° of the circle being blocked to prevent irradiation of the hood structure on the distal end of the endoscope.
• The above descriptions may have used terms such as above, below, top, bottom, over, under, et cetera. These terms are used to aid understanding of the invention are not used in a limiting sense.
• While the present invention is disclosed by reference to the preferred embodiments and examples detailed above, it is to be understood that these examples are intended in an illustrative rather than in a limiting sense. It is contemplated that modifications and combinations will occur to those skilled in the art, which modifications and combinations will be within the spirit of the invention and the scope of the following claims.
• Any and all patents, patent applications and printed publications referred to above are incorporated by reference.

Claims (20)

1. A handle for a multifunction endoscope comprising:

a body cover comprising:

distal and proximal ends with an axis extending therebetween;

a waist between the distal and proximal ends;

the distal and proximal ends and the waist having distal and proximal circumferences and a waist circumference, respectively;

the proximal circumference being larger than the waist circumference and the distal circumference being larger than the waist circumference; and

an outer surface, the outer surface tapering from the distal end to the waist and from the proximal end to the waist;

a first body cover extension extending in a first radial direction from the outer surface of the body cover between the proximal end and the waist; and

a second body cover extension extending in a second radial direction from the outer surface of the body cover between the proximal end and the waist.

2. The handle according toclaim 1 wherein the proximal circumference is larger than the distal circumference.

3. The handle according toclaim 1 wherein the outer surface is a smoothly tapering outer surface.

4. The handle according toclaim 1 wherein the distance between the distal and proximal ends is 8 to 15 cm.

5. The handle according toclaim 1 wherein the distance between the distal and proximal ends is 9 to 12 cm.

6. The handle according toclaim 1 wherein the first and second body cover extensions comprise forward-facing surfaces, said outer surface and said forward facing surfaces creating a smoothly curving user-grasping surface.

7. The handle according toclaim 1 wherein the second radial direction extends both radially outwardly away from the axis and axially towards the distal end.

8. The handle according toclaim 1 wherein the body cover comprises a proximal portion, the proximal portion comprising a plurality of ports.

9. The handle according toclaim 1 further comprising a first port at the first body cover extension, a second port at the second body cover extension and a third port at the proximal end and along the axis.

10. The handle according toclaim 9 further comprising an illumination fitting at the first port, an optical fiber fitting at the second port and a camera fitting at the third port.

11. The handle according toclaim 10 further comprising a valve at the second body extension associated with the second port.

12. The handle according toclaim 1 further comprising a second body cover positioned distally of the distal end of the body cover.

13. The handle according toclaim 12 farther comprising fourth and fifth ports in the second body cover.

14. The handle according toclaim 13 for the comprising an inflow fitting at the fourth port and an outflow fitting at the fifth port.

15. The handle according toclaim 12 further comprising a coupler between the second body cover and the body cover.

16. A multifunction endoscope comprising:

a handle made according toclaim 1;

an external cannula extending from the handle;

a port at the second body cover extension;

an optical fiber extending through the handle and external cannula with a proximal portion of the optical fiber extending proximally from the port;

a user-manipulable knob mounted to the proximal portion of the optical fiber, so that a user may grasp the body cover of the handle with one hand and manipulate the optical fiber through the user-manipulable knob with the other hand.

17. A method for manipulating an endoscope comprising:

selecting an endoscope comprising a handle made according toclaim 1, an external cannula extending from the handle, and an optical fiber extending through the handle and through the external cannula with a proximal portion of the optical fiber extending proximally from a port at the second body cover extension;

grasping the body cover of the handle with a first hand using a chosen gripping technique;

grasping a user-manipulable knob mounted to the proximal portion of the optical fiber with a second hand; and

selectively moving the optical fiber within the external cannula by at least one of rotating the optical fiber around its own axis and longitudinally sliding the optical fiber through the external cannula using the user-manipulable knob.

18. A handle for a multifunction endoscope comprising:

a body cover comprising:

distal and proximal ends with an axis extending therebetween;

a waist between the distal and proximal ends;

the distal and proximal ends and the waist having distal and proximal circumferences and a waist circumference, respectively;

the proximal circumference being larger than the distal circumference and the distal circumference being larger than the waist circumference; and

an outer surface, the outer surface smoothly tapering from the distal end to the waist and from the proximal end to the waist;

a first body cover extension extending in a first radial direction from the outer surface of the body cover between the proximal end and the waist;

a second body cover extension extending in a second radial direction from the outer surface of the body cover between the proximal end and the waist;

the first and second body cover extensions comprising forward-facing surfaces, said outer surface and said forward facing surfaces creating a smoothly curving user-grasping surface;

a first port at the first body cover extension, a second port at the second body cover extension and a third port at the proximal end and along the axis;

a second body cover positioned distally of the distal end of the body cover;

fourth and fifth ports at the second body cover.

19. The handle according toclaim 18 wherein the second radial direction extends both radially outwardly away from the axis and axially towards the distal end,

20. The handle according toclaim 18 further comprising:

an illumination fitting at the first port;

an optical fiber fitting at the second port;

a camera fitting at the third port;

a valve at the second body extension associated with the second port;

an inflow fitting at the fourth port; and

an outflow fitting at the fifth port.

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