USRE41475E1 - Flexible ureteropyeloscope - Google Patents

Abstract

A flexible ureteropyeloscope having a control section and a shaft extending from the control section. The shaft has a front end with a first active deflection section connected in series with a second active deflection section. The control section is adapted to independently deflect the first and second defection sections. The first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope can be placed in a calyx of a lower pole of a kidney without the need to passively deflect the front end of the shaft against kidney tissue of a patient to reach the calyx of the lower pole.

Description

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part application of U.S. application Ser. No. 09/427,164 filed Oct. 26, 1999 which is hereby incorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to medical instruments and, more particularly, to an endoscope.

2. Brief Description of Prior Developments

U.S. Pat. No. 4,873,965 discloses a flexible endoscope with two articulated lengths. U.K. patent application No. 2130885 discloses a flexible distal end portion for an endoscope. The end portion is made from plastic material with vertebrae connected by an elongate member or spine. U.S. Pat. No. 5,938,588 discloses an endoscope with wire sheaths made as solid tubes from a superelastic alloy material. Endoscopes are also known in the art which comprise an active deflection section and a passive deflection section.

SUMMARY OF THE INVENTION

In accordance with one aspect of the present invention, a flexible ureteropyeloscope is provided having a control section and a shaft extending from the control section. The shaft has a front end with a first active deflection section connected in series with a second active deflection section. The control section is adapted to independently deflect the first and second deflection sections. The first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope can be placed in a calyx of a lower pole of a kidney without passively deflecting the front end of the shaft against tissue in the kidney of a patient to reach the calyx of the lower pole.

In accordance with another aspect of the present invention, a flexible ureteropyeloscope is provided comprising a control section; and a shaft extending from the control section. The shaft comprises a front end with two superelastic tube frame pieces connected in series. A first one of the frame pieces forms a first active deflection section adapted to deflect in a first direction about 155°-190° with a radius of curvature of about 9-12 mm. A second one of the frame pieces forms a second active deflection section adapted to deflect in the first direction about 125°-165° with a radius of curvature of about 9.5-13 mm.

In accordance with one method of the present invention, a method of positioning a distal tip of a flexible ureteropyeloscope in a calyx of a lower pole of a kidney is provided comprising steps of bending a first active deflection section of a front end of the flexible ureteropyeloscope; and bending a second active deflection section of the front end. The second active deflection section is located behind the first active deflection section. The first and second active deflection sections are independently controllably deflectable to locate the distal tip in the calyx of the lower pole without passively deflecting the front end against kidney tissue of the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing aspects and other features of the present invention are explained in the following description, taken in connection with the accompanying drawings, wherein:

FIG. 1 is a side elevational view of an endoscope incorporating features of the present invention;

FIG. 2 is a cross sectional view of a kidney having the front end of the endoscope shown inFIG. 1 located therein;

FIGS. 3A-3D show a fitting used to couple two frame members of the front end of the endoscope shown inFIG. 1;

FIG. 4A is a side elevational view of a first one of the frame members located at the front end of the endoscope shown inFIG. 1;

FIG. 4B is a cross sectional view of the first frame member shown inFIG. 4A taken alongline4B—4B;

FIG. 5A is a side elevational view of a second one of the frame members located at the front end of the endoscope shown inFIG. 1;

FIG. 5B is a cross sectional view of the second frame member shown inFIG. 5A taken alongline5B—5B;

FIG. 6 is a partial cross sectional view of some of the components in the shaft of the endoscope shown inFIG. 1 at a junction between the first and second frame members shown inFIGS. 4A-5B;

FIG. 7 is a schematic diagram showing possible shapes of the front end of the endoscope shown inFIG. 1;

FIG. 8 is a schematic view of portions of frame sections and control wires of an alternate construction of the first and second active deflection sections incorporating features of the present invention; and

FIG. 9 is an elevational side view of the front end of an alternate embodiment of a shaft incorporating features of the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring toFIG. 1, there is shown a side elevational view of anendoscope10 incorporating features of the present invention. Although the present invention will be described with reference to the embodiments shown in the drawings, it should be understood that the present invention can be embodied in many alternate forms of embodiments. Features of the present invention can be embodied in various different types of flexible, deflectable endoscopes. In addition, any suitable size, shape or type of elements or materials could be used.

Theendoscope10, in this embodiment, is a flexible ureteropyeloscope. Theendoscope10 generally comprises ahandle12, aflexible shaft14 connected to thehandle12, and afront end18 of the shaft which has an active deflection capability.

Thehandle12 is part of a control system to control the active deflection capability of thefront end18. The control system generally comprises thehandle12, twoactuators16,17, abrake actuator22, and threecontrol wires24,25,26 (see FIG.6). However, in alternate embodiment, the control system could comprise additional or alternative components. The threeactuators16,17,22 are movably attached to thehandle12. Proximal ends of thewires24,25,26 are connected to the twocontrol actuators16,17. Thebrake actuator22 is connected to a braking mechanism for locking thesecond control actuator17 at a fixed position. However, in an alternate embodiment, any suitable type of brake or locking mechanism could be provided. In one type of alternate embodiment, the endoscope might not comprise a control actuator brake. In the embodiment shown, thefirst control actuator16 does not comprise a brake.

Thehandle12 also comprises alight source post28, an eyepiece30, and working instrument/irrigation inlets32. However, in alternate embodiments, thehandle12 could comprise additional or alternative components. The instrument includes a fiber-optic illumination bundle which extends through theshaft14 between thelight post28 and thedistal end20. A fiber optic image bundle extends through theshaft14 between the eyepiece30 and thedistal end20. A working channel extends through theshaft14 between the workinginstrument inlet32 and thedistal end20.

Theflexible shaft14 behind thefront end18 could comprise any suitable type of flexible shaft, such as the shaft disclosed in U.S. patent application Ser. No. 09/547,686 which is hereby incorporated by reference in its entirety. Thefront end18 comprises a firstactive deflection section34 and a secondactive deflection section36. Referring also toFIG. 2, a cross sectional view of a kidney K is shown with thefront end18 located therein. The twoactive deflection sections34,36 are adapted to allow thedistal end20 of the endoscope to project into a calyx LPC of the kidney in the lower lobe or lower pole LP. More specifically, the twoactive deflection sections34,36 are adapted to allow thedistal end20 to project into the calyx LPC in the lower lobe LP without passively deflecting thefront end18 off of kidney tissue of the patient. Thefront end18 does not comprise a passive deflection section. Instead, thefront end18 comprises the two active deflection sections as described herein.

Referring now toFIGS. 3A-3D,4A-4B,5A-5B and6, components of thefront end18 will be described. Thefront end18 generally comprises adistal end member38, afirst frame member40, asecond frame member42 and a fitting44. Thefront end18 also comprises anelastomeric cover45 which is attached at a sealed joint47 to acover46 which extends the entire length of theshaft14. Thedistal end member38 is connected to a front end of thefirst frame member40. The front ends of the second andthird control wires25,26 are fixedly attached to thedistal end member38.

Thefirst frame member40 generally comprises a single one-piece generally tubular shaped member. However, in alternate embodiments, thefirst frame member40 could be comprised of more than one tube, such as multiple tubes connected in series, and could comprise additional members. Thefirst frame member40 is preferably comprised of a shape memory alloy material, such as Tinel or Nitinol. However, any suitable type of shape memory alloy material could be used. The shape memory alloy material is used for its superelastic properties exhibited by the material's ability to deflect and resiliently return to its natural or predetermined position even when material strains approach 4%, or an order of magnitude greater than the typical yield strain of 0.4% giving rise to plastic deformation in common metals. Thus, the term “superelastic material” is used to denote this type of material.

Thefirst frame member40 has acenter channel49 with open front andrear ends48,50, andslots52 therein. Thefirst frame member40 forms the frame for the firstactive deflection section34. Theslots52, in the embodiment shown, extend into thefirst frame member40 in two opposite directions. However, in alternate embodiments, theslots52 could extend into the first frame member in more or less than two directions. Theslots52 extend into thefirst frame member40 along a majority of the length of the first frame member, and also extend into the first frame member a distance more than half the diameter. However, in alternate embodiments, theslots52 could be arranged in any suitable type of array or shape. A similar superelastic frame member is described in U.S. patent application Ser. No. 09/427,164 which is hereby incorporated by reference in its entirety.

Therear end50 of thefirst frame member40 is fixedly attached to the fitting44. The fitting44 is comprised of a one-piece member made of a suitable material, such as metal. However, in alternate embodiments, the fitting44 could be comprised of more than one member, or could be incorporated into one or both of the frame members, and could be comprised of any suitable type of material(s). The fitting44 generally comprises acenter section54 and twoend sections56,58. Therear end50 of thefirst frame member40 is fixedly attached to the exterior of thefirst end section56.

Thecenter section54 forms a raised annular ring around the fitting44. This raised annular ring forms stop surfaces for theends50,70 of the two frame members. In alternate embodiments, any suitable type of positioning system for positioning the frame members on the fitting could be provided.

The inside of the fitting44 generally comprises two pass-throughholes60,62 and a mountingsection64 for mounting an end of thefirst control cable24 thereto. The two pass-throughholes60,62 are sized and shaped to allow the second andthird control cables25,26 to slidably pass therethrough. The mountingsection64 comprises anaperture66. Theaperture66 is sized and shaped to receive thefront end24a of thecable24, such that thefront end24a can the fixedly mounted therein. However, in alternate embodiments, any suitable means could be used to attach the front end of thecable24 to the fitting44. In addition, in an alternate embodiment, the fitting44 could be adapted to have more than one control cable fixedly mounted thereto. In addition, in another alternate embodiment, the fitting44 could be adapted to have more or less than two control cables pass therethrough.

Thesecond frame member42 generally comprises a single one-piece generally tubular shaped member. However, in alternate embodiments, thesecond frame member42 could be comprised of more than one tube, such as multiple tubes connected in series, and could comprise additional members. Thesecond frame member42 could also be comprised of a front portion of a member which extends along the length of theshaft14, similar to that disclosed in U.S. patent application Ser. No. 09/427,164. Thesecond frame member42 is preferably comprised of a shape memory alloy material, similar to that described above with reference to thefirst frame member40.

Thesecond frame member42 has acenter channel68 with open front andrear ends70,72, andslots74 therein. Thesecond frame member42 forms the frame for the secondactive deflection section36. Theslots74, in the embodiment shown, extend into thesecond frame member42 is only one direction. However, in alternate embodiments, theslots74 could extend into the second frame member in more than one direction. Theslots74 extend into thesecond frame member42 along a majority of the length of the second frame member, and also extend into the second frame member a distance of about three-quarters of the diameter. However, in alternate embodiments, theslots74 could be arranged in any suitable type of array, or shape, or depth of extension into the lateral side of the frame member.

In the embodiment shown, thesecond frame member42 comprises a curved pre-shaped home position as shown in FIG.5A. However, in an alternate embodiment, thesecond frame member42 could comprise any suitable type of pre-shaped home position, including a straight home position similar to thefirst frame member40 shown in FIG.4A. In an alternate embodiment, thefirst frame member40 could comprise a curved pre-shaped home position. Thefront end70 of thesecond frame member42 is fixedly attached to therear section58 of the fitting44. Therear end72 of thesecond frame member42 is fixedly attached to the frame of theshaft14 located behind thefront end18.

In alternate embodiments, thefirst frame member40 and/or thesecond frame member42 could be comprised of any suitable material(s) and/or members. For example, the members could be comprised of metal rings connected by flexible members (such as rods of superelastic material or other flexible material), or could merely comprise metal rings pivotably connected to each other. Features of the present invention are not necessarily limited to use of only two tube shaped frame members comprised only of superelastic material. For example, one type of alternate embodiment is shown in FIG.8. In this alternate embodiment the first and second active deflection sections comprisering members80. Thering members80 are pivotably connected to each other in series at joints82.First control wire24 has its distal end connected to one of thering members84. Theother control wires25,26 pass through the ring members. The metal rings could be comprised of stainless steel. Various different types of flexible, deflectable endoscope shaft constructions are known in the art which could be adapted or modified to practice the present invention.

In the embodiment shown, thelateral side76 of thesecond frame member42, which theslots74 extend into, is aligned with the mountingsection64 of the fitting44. Thefirst control cable24, when set by theactuator16 to a predetermined position, applies tension to the fitting44 such that thesecond frame member42 is maintained in a substantially straight configuration. When thefirst control cable24 is pulled rearward by theactuator16, thesecond frame member42 is adapted to bend inward along thelateral side76. When thefirst control cable24 is released, internal stresses from the curved pre-shaped of thesecond frame member42 cause the secondactive deflection section36 to return to its home straight position.

Referring now also toFIG. 7, certain features provided by the present invention will be described.FIG. 7 shows thefront end18 in three possible positions. The first position A shows thefront end18 in a straight configuration. Thefront end18 has a length L1. In a preferred embodiment, the length L1 is about 7 cm. In alternate embodiments, the length L1 could comprise any suitable length. The firstactive deflection section34 preferably has a length of about 3.6 cm. The secondactive deflection section36 preferably has a length of about 2.8 cm. However, in alternate embodiments, the lengths of the first and second active deflection sections could have any suitable type of length. Thefront end18 also comprises twonon-bendable sections33,35 formed by thefront end member38 and the fitting44, respectively.

The positions B and C show thefront end18 at two different maximum deflected positions. In both of these two deflected positions B, C the secondactive deflection section36, because it is deflectable in only one direction, has the samecurved shape36′. The curved deflection of the secondactive deflection section36 preferably has a maximum curvature of about 125°-165° with a radius of curvature R2 of about 9.5-13 mm. In a preferred embodiment, the maximum curvature is about 135°, and the radius of curvature R2 is about 10.6 mm.

However, in alternate embodiments, any suitable type of maximum curvature or radius of curvature could be provided.

The first active deflection section, in the embodiment shown, is two-way deflectable such that it can be deflected into either one of the configurations B, C. In the first deflected configuration B, the firstactive deflection section34 has thecurved shape34′ with a maximum curvature of about 155°-190°, with a radius of curvature R1′ of about 9-12 mm. In a preferred embodiment, the maximum curvature is about 180° each way and the radius of curvature R1′ is about 10.6 mm. However, in alternate embodiments, any suitable type of maximum curvature and radius of curvature as could be provided.

In the second deflected configuration C, theactive deflection section34 has thecurved shape34″, thecurved shape34″ has a maximum curvature of about 155°-190°, with a radius of curvature R1″ of about 9-12 mm. In a preferred embodiment, the maximum curvature is the about 175° and the radius of curvature R1″ is about 11.3 mm. However, in alternate embodiments, any suitable type of maximum curvature and radius of curvature could be provided. Because of the construction of the instrument, all of these deflections can be limited to a same plane. However, in alternate embodiments, the front end of the instrument might be adapted to deflect in more than one plane.

In the embodiment shown, thefirst control wire24 is slightly offset from the plane having the second andthird control wires25,26. Therefore, the secondactive deflection section36 deflects in a plane slightly offset from the plane of deflection of the firstactive deflection section34. The difference in the two planes should be less than 45° and preferably closer to 0°, such as only about 5°-10° for example. In an alternate embodiment, the two active deflection sections could be limited to deflection in a same plane.

Referring toFIGS. 1,2 and7 the control section of theendoscope10 is adapted to independently deflect the first and second active deflection sections. The first and second active deflection sections are adapted to deflect such that thedistal end20 of the ureteropyeloscope can be placed in the calyx LPC of the lower pole LP of the kidney K without passively deflecting thefront end18 of the shaft against tissue of the kidney to reach the calyx.

For a normal shape and size kidney, a ureteropyeloscope having a front end with an active deflection section and a passive deflection section might be able to reach the calyx of the lower pole of the kidney. However, with kidneys that are unusually large or otherwise misshaped, a ureteropyeloscope having a passive deflection section at its front end is not able to use its passive deflection section effectively in order to place the distal end of the shaft at an operable position in the kidney. The distal end of the prior art ureteropyeloscope simply can't go down low enough because the location where passive deflection is occurring is to far up relative to the lower pole calyx. The present invention overcomes this problem. By providing the front end of the ureteropyeloscope with two active deflection sections, which are independently deflectable, the front end of the ureteropyeloscope is able to locate thedistal end20 in the calyx of a lower pole of a kidney regardless of the size or shape of the kidney.

Theureteropyeloscope10 is not dependent upon use of passive deflection against tissue of the kidney in order to properly position thedistal end20 at a desired position. The amount of space or real estate and the small radius turn into the calyx in the lower pole (from the Ureter U) inside the kidney for manipulating the front end of theureteropyeloscope10 is very limited. The present invention, by using two separate shapememory frame members40,42 provides the ability to manipulate thefront end18 in this limited space and sharp turn path environment. The shapememory frame members40,42 provide superelastic properties to allow the frame members to deflect in this limited space and sharp turn path environment and be able to resiliently return to their home positions. The ability to independently deflect the twoactive deflection sections34,36 combined with the superelastic properties of the shape memory frame members allow the frame members to navigate a path through this limited space and sharp turn path environment. If only a single active deflection section was provided, it would be too long in length in order to operate properly to reach the calyx in the lower pole. Such a single active deflection section would still be in the ureter U and, thus, be prevented from being properly manipulated by the kidney K itself; prevented from shaping the end section such that the distal end can reach its desired position in the calyx of the lower pole. Thus, this is why thefront end18 in theendoscope10 has two independently deflectable active deflection sections.

The firstactive deflection section34 can be deflected before the secondactive deflection section36, and the secondactive deflection section36 can be deflected as it is exiting the ureter U. This ability to provide a sequential deflecting of theactive deflection sections34,36 as they exit the ureter U allows access to the lower pole calyx LPC without the use of passive deflection. The present invention provides the ability to reach previously unavailable areas in a kidney.

In alternate embodiments of the present invention, thefront end18 could comprise more than two active deflections sections. The firstactive deflection section34 has been described above as being two-way deflectable in a same plane. In another alternate embodiment, the firstactive deflection section34 could be deflectable in more or less than two ways. In such an alternate embodiment, the control system could comprise more or less than two control cables for the first active deflection section. The secondactive deflection section36 has been described above as being one way deflectable. In another alternate embodiment, the secondactive deflection section36 could be deflectable in more than one way in a substantially same plane. In such an alternate embodiment, the control system could comprise more than one control cable for the second active deflection section.

Referring now toFIG. 9, another alternate embodiment of the front end of the shaft is shown. In this embodiment the shaft comprises a distalobjective head92, a firstactive deflection section94, a secondactive deflection section96, and anon-active deflection section98. Thenon-active deflection section98 is preferably located between the first and secondactive deflection sections94,96. Thenon-active deflection section98 is preferably a passive deflection section similar to that disclosed in U.S. patent application Ser. No. 09/427,164. However, in alternate embodiments, any suitable type of construction of the passive deflection section could be provided. With this type of construction, the front end of the shaft can be passively deflected off of tissue of the patient at thesection98 if desired. However, the shaft does not need to be passively deflected off of tissue because of the two separate active deflections at thesections94,96. In another type of alternate embodiment, thesection98 might not be a passive deflection section.

It should be understood that the foregoing description is only illustrative of the invention. Various alternatives and modifications can be devised by those skilled in the art without departing from the invention. Accordingly, the present invention is intended to embrace all such alternatives, modifications and variances which fall within the scope of the appended claims.

Claims (34)

1. In a flexible ureteropyeloscope having a control section and a shaft extending from the control section, the improvement comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, the control section being adapted to independently deflect the first and second deflection sections, wherein the first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope can be placed in a calyx of a lower pole of a kidney without the need to passively deflecting the front end of the shaft against tissue of the kidney of a patient to reach the calyx of the lower pole, wherein the a first frame member of the first active deflection section has a first array of slots therein and the a second frame member of the second active deflection section has a second different array of slots therein.

2. A flexible ureteropyeloscope as inclaim 1 wherein the slots of the first array extend into the first frame member in two opposite directions.

3. In a flexible ureteropyeloscope having a control section and a shaft extending from the control section, the improvement comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, the control section being adapted to independently deflect the first and second deflection sections, wherein the first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope can be placed in a calyx of a lower pole of a kidney without the need to passively deflecting the front end of the shaft against tissue of the kidney of a patient to reach the calyx of the lower pole, wherein the first active deflection section comprises a first shape-memory frame member having a general tubular shape comprised of superelastic material, and wherein the second active deflection section comprises a second shape-memory frame member having a general tubular shape comprised of superelastic material, and wherein the first and second frame members are connected to each other by a fitting, and an end of the control wire from the control section is fixedly connected to the fitting.

4. In a flexible ureteropyeloscope having a control section and a shaft extending from the control section, the improvement comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, the control section being adapted to independently deflect the first and second deflection sections, wherein the first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope can be placed in a calyx of a lower pole of a kidney without the need to passively deflecting the front end of the shaft against tissue of the kidney of a patient to reach the calyx of the lower pole, wherein the first active deflection section comprises a first shape-memory frame member having a general tubular shape comprised of superelastic material, and wherein the second active deflection section comprises a second shape-memory frame member having a general tubular shape comprised of superelastic material, and wherein the second frame member has a curved preshaped home position.

5. A flexible ureteropyeloscope as inclaim 4 wherein the second frame member is maintained in a straight position by tension from a control wire from the control section.

6. A flexible ureteropyeloscope having a control section and a shaft extending from the control section, comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, the control section being adapted to independently deflect the first and second deflection sections, wherein the first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope is sized and shaped to be placed in a calyx of a lower pole of a kidney without passively deflecting the front end of the shaft against tissue of the kidney of a patient to reach the calyx of the lower pole,

wherein the first active deflection section is adapted to deflect in at least two opposite directions about 155°-190° with a radius of curvature of about 9-12 mm, and wherein a frame piece of the shaft which forms the second active deflection section is adapted to deflect in at least one direction about 125°-165° with a radius of curvature of about 9.5-13 mm.

7. A flexible ureteropyeloscope as inclaim 6 wherein the first active deflection section is adapted to deflect in a first one of the at least two opposite directions a maximum of about 185° with a radius of curvature of about 10.6 mm, and is adapted to deflect in a second one of the at least two opposite directions a maximum of about 175° with a radius of curvature of about 11.3 mm.

8. A flexible ureteropyeloscope as inclaim 7 wherein the second active deflection section is adapted to deflect a maximum of about 135° with a radius of curvature of about 10.6 mm.

9. A flexible ureteropyeloscope as inclaim 8 wherein the first active deflection section has a length of about 3.6 cm and the second active deflection section has a length of about 2.8 cm.

10. A flexible ureteropyeloscope comprising:

a control section; and

a shaft extending from the control section, the shaft comprising a front end with two superelastic tube frame pieces connected in series, wherein a first one of the frame pieces forms a first active deflection section adapted to deflect in a first direction about 155°-190° with a radius of curvature of about 9-12 mm, and wherein a second one of the frame pieces forms a second active deflection section adapted to deflect in a direction substantially the same as the first direction about 125°-165° with a radius of curvature of about 9.5-13 mm.

11. A flexible ureteropyeloscope as inclaim 10 wherein the first active deflection section is adapted to deflect in an opposite second direction about 90°-190°.

12. A flexible ureteropyeloscope as inclaim 10 wherein the first active deflection section is adapted to deflect in a first one of the at least two opposite directions about 185° with a radius of curvature of about 10.6 mm, and is adapted to deflect in a second one of the at least two opposite directions about 175° with a radius of curvature of about 11.3 mm.

13. A flexible ureteropyeloscope as inclaim 12 wherein the second active deflection section is adapted to deflect about 135° with a radius of curvature of about 10.6 mm.

14. A flexible ureteropyeloscope as inclaim 13 wherein the first active deflection section has a length of about 3.6 cm and the second active deflection section has a length of about 2.8 cm.

15. A flexible ureteropyeloscope as inclaim 10 wherein the first frame member has a first array of slots therein and the second frame member has a second different array of slots therein.

16. A flexible ureteropyeloscope as inclaim 15 wherein the slots of the first array of slots extend into the first frame member in two opposite directions.

17. A flexible ureteropyeloscope comprising:

a control section; and

a shaft extending from the control section, the shaft comprising a front end with two superelastic tube frame pieces connected in series, wherein a first one of the frame pieces forms a first active deflection section adapted to deflect in a first direction about 155°-190° with a radius of curvature of about 9-12 mm, and wherein a second one of the frame pieces forms a second active deflection section adapted to deflect in a direction substantially the same as the first direction about 125°-165° with a radius of curvature of about 9.5-13 mm, wherein the first and second frame members are connected to each other by a fitting, an end of a control wire from the control section being fixedly connected to the fitting.

18. A flexible ureteropyeloscope comprising:

a control section; and

a shaft extending from the control section, the shaft comprising a front end with two superelastic tube frame pieces connected in series, wherein a first one of the frame pieces forms a first active deflection section adapted to deflect in a first direction about 155°-190° with a radius of curvature of about 9-12 mm, and wherein a second one of the frame pieces forms a second active deflection section adapted to deflect in a direction substantially the same as the first direction about 125°-165° with a radius of curvature of about 9.5-13 mm,

wherein the second frame member has a curved pre-shaped home position.

19. A flexible ureteropyeloscope as inclaim 18 wherein the second frame member is maintained in a straight position by tension from a control wire from the control section.

20. A method of positioning a distal tip of a flexible ureteropyeloscope in a calyx of a lower pole of a kidney comprising steps of:

bending a first active deflection section of a front end of a shaft of the flexible ureteropyeloscope; and

bending a second active deflection section of the front end of the shaft, the second active deflection section being located behind the first active deflection section,

wherein the first and second active deflection sections are independently, controllably deflectable to locate the distal tip in the calyx of the lower pole without the need to passively deflect the front end against kidney tissue of the patient.

21. A method as inclaim 20 wherein the first active deflection section comprises a first frame member having a general tube shape comprised of superelastic material, the second active deflection section comprises a second frame member having a general tube shape comprised of superelastic material, wherein the steps of bending the first and second active deflection sections comprise moving different control wires of a control section of the flexible ureteropyeloscope.

22. A method as inclaim 20 wherein the step of bending the first active deflection section comprises bending the first active deflection section about 155°-190° with a radius of curvature of about 9-12 mm, and wherein the step of bending the second active deflection section comprises bending the second active deflection section about 125°-155° with a radius of curvature of about 9.5-13 mm.

23. In a flexible ureteropyeloscope having a control section and a shaft extending from the control section, the improvement comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, the control section being adapted to independently deflect the if first and second deflection sections, wherein the first and second active deflection sections are adapted to deflect such that a distal end of the ureteropyeloscope is adapted to be placed in a calyx of a lower pole of a kidney without passively deflecting the front end of the shaft against tissue of the kidney of a patient to reach the calyx of the lower pole, wherein the first active deflection section comprises a shape-memory frame member having a general tubular shape comprised of superelastic material, and wherein the shape-memory frame member is connected to another frame member in the second active deflection section by a fatting, and an end of a control wire from the control section is fixedly connected to the fitting.

24. A flexible ureteropyeloscope comprising:

a control section; and

a shaft extending from the control section, the shaft comprising a front end with at least one deflectable superelastic tube frame piece forming a first active deflection section connected in series to a second active deflectable section, wherein the frame piece forms the first active deflection section adapted to deflect in a first direction about 155°-190° with a radius of curvature of about 9-12 mm, and wherein the second active deflection section is adapted to deflect in a direction substantially the same as the first direction about 125°-165° with a radius of curvature of about9.5-13 mm or less , wherein the first and second active deflection sections are connected to each other by a fitting, an end of a control wire from the control section being fixedly connected to the fitting for controlling deflection of the second active deflection section.

25. A flexible ureteropyeloscope having a control section and a shaft extending from the control section, comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, wherein the control section is adapted to independently deflect the first and second deflection sections, and wherein, when the shaft is at least partially located in a ureter of a patient, the first and second active deflection sections are adapted to deflect with at least a portion of the front end of the shaft being sized and shaped to be placed at a calyx of a lower pole of a kidney of the patient,

wherein the first active deflection section is adapted to deflect in at least two opposite directions with a radius of curvature of about9-12 mm, and wherein the second active deflection section is adapted to deflect in at least one direction with a radius of curvature of about9.5-13 mm.

26. A flexible ureteropyeloscope as inclaim 25 wherein the first active deflection section is adapted to deflect in a first one of the two opposite directions with a radius of curvature of about9 mm.

27. A flexible ureteropyeloscope as inclaim 26 wherein the first active deflection section is adapted to deflect in a second one of the two opposite directions with a radius of curvature of about9 mm.

28. A flexible ureteropyeloscope as inclaim 26 wherein the first active deflection section is adapted to deflect in a first one of the two opposite directions about155°-190°.

29. A flexible ureteropyeloscope as inclaim 28 wherein the second active deflection section is adapted to deflect at least90° in a third direction.

30. A flexible ureteropyeloscope as inclaim 25 wherein the first active deflection section is adapted to deflect in a first one of the two opposite directions about155°-190°.

31. A flexible ureteropyeloscope as inclaim 25 wherein the second active deflection section is adapted to deflect at least90° in a third direction.

32. A flexible ureteropyeloscope as inclaim 31 wherein the third direction is the same direction as one of the two opposite directions.

33. A flexible ureteropyeloscope as inclaim 25 wherein the shaft comprises a fitting connecting the first active deflection section to the second active deflection section.

34. A flexible ureteropyeloscope having a control section and a shaft extending from the control section, comprising:

the shaft comprising a front end with a first active deflection section connected in series with a second active deflection section, wherein the control section is adapted to independently deflect the first and second deflection sections, wherein the shaft comprises means to deflect such that at least a portion of the front end of the shaft is placed at a calyx of a lower pole of a kidney of a patient when the shaft is at least partially located in a ureter of the patient,

wherein the means to deflect comprises the first active deflection section being adapted to deflect in at least two opposite directions with a radius of curvature of about9-12 mm.

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