DEVICE TIP

Abstract

In one aspect of the present disclosure, a device may include a shaft having a distal end, and a tip at the distal end of the shaft. The tip may include an opening defined by a surface of the tip. An instrument inserted through the shaft may extend distally out of the opening. The device also may include an elevator for engaging the instrument. The elevator may include a proximal end fixed relative to the surface of the tip, a proximal portion extending distally from the proximal end, and a distal portion extending distally from the proximal portion. A force exerted on the elevator bends the proximal portion to deflect the distal portion without bending of the distal portion.

Description

TECHNICAL FIELD

Various aspects of the present disclosure relate generally to tips for devices. More specifically, the present disclosure relates to endoscope tips for positioning endoscopic instruments.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique to treat patients with pancreatico-biliary disorders. In some instances, ERCP is performed using a side viewing endoscope. A tip of the side viewing endoscope may include side viewing optics, an optics lens wash, a side viewing light source, a side exit working channel, and an elevator assembly for elevating an instrument extending out of the side exit working channel. These features may aid a user in cannulating a subject's papilla, and accessing a target site in the subject's pancreas, with instruments for diagnostic and/or therapeutic procedures. However, elevator assemblies may have complex designs with a multitude of components, making them expensive to manufacture and maintain (e.g., clean and/or repair). Reducing the complexity of an elevator assembly may reduce overall costs associated with using an endoscope. Moreover, when overall costs fall to a certain threshold, it may be practical for the endoscope to be used as a single-use endoscope. By using the endoscope only once before discarding it, cost and time burdens associated with maintaining the endoscope may be eliminated, and the risk of exposing a subject to infection through inadequate cleaning of the endoscope also may be eliminated, leading to improved outcomes.

SUMMARY

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

In one aspect of the present disclosure, a device may include a shaft having a distal end, and a tip at the distal end of the shaft. The tip may include an opening defined by a surface of the tip. An instrument inserted through the shaft may extend distally out of the opening. The device also may include an elevator for engaging the instrument. The elevator may include a proximal end fixed relative to the surface of the tip, a proximal portion extending distally from the proximal end, and a distal portion extending distally from the proximal portion. A force exerted on the elevator bends the proximal portion to deflect the distal portion without bending of the distal portion.

According to another aspect of the present disclosure, the device may include one or more of the features below. The distal portion may have a greater cross-sectional area than the proximal portion. The distal portion may be thicker than the proximal portion along an anterior-posterior direction, the anterior-posterior direction being perpendicular to a proximal-distal direction. The tip may be comprised of a single material. The elevator may be comprised of a single material. An outer surface of the elevator and the surface of the tip may be portions of a continuous surface. An outer surface of the distal portion of the elevator may be continuous with the outer surface of the proximal portion of the elevator. The proximal portion may have a substantially straight rest configuration and a bent configuration. The proximal portion may move the distal portion through an arcuate path in an anterior direction and a proximal direction as the proximal portion moves from the rest configuration to the bent configuration.

In another aspect of the present disclosure, a device may include a shaft having a distal end. The device also may include a tip at the distal end of the shaft. The tip may include an instrument opening. An instrument inserted through the shaft may extend distally out of the instrument opening. The tip also may include an elevator for engaging the instrument as the instrument extends distally out of the instrument opening. The elevator may include a passage extending therethrough. The device also may include a control wire coupled to the elevator. A proximal pulling force exerted on the control wire may deflect the elevator. The device also may include a first control wire opening and a second control wire opening. A first portion of the control wire may extend from the first control wire opening to the passage. A second portion of the control wire may extend from the second control wire opening to the passage. A third portion of the control wire may extend through the passage to link the first portion of the control wire to the second portion of the control wire.

According to another aspect of the present disclosure, the device may include one or more of the features below. A handle at a proximal end of the shaft. The handle may include an actuation mechanism for exerting the proximal pulling force on the control wire. The actuation mechanism may be operatively coupled to the first portion of the control wire and the second portion of the control wire to exert the proximal pulling force simultaneously on the first portion of the control wire and the second portion of the control wire. The elevator may include opposing side surfaces. At least one of the side surfaces may include a channel for receiving at least a portion of the control wire. An opening into the passage may be in the channel. The tip may include sidewalls on opposing sides of the elevator. At least one of the sidewalls may include a channel for receiving at least a portion of the control wire. The tip may be a one-piece, monolithic, polymer component.

In another aspect of the present disclosure, a device may include a shaft having a distal end. The device also may include a tip at the distal end of the shaft. The tip may include an elevator. An instrument inserted through the shaft may extend distally to engage the elevator. The device also may include an actuator to deflect the elevator. The elevator may include a proximal portion having a proximal end fixed relative to the shaft. The elevator also may include a distal portion extending distally from the proximal portion. The proximal portion may have a smaller cross-sectional area than the distal portion, such that a force exerted on the elevator may bend the proximal portion to deflect the distal portion. The elevator may be made of a single, continuous piece of material.

According to another aspect of the present disclosure, the device may include one or more of the features below. The single, continuous piece of material may be a single, continuous piece of injection-molded polymer. The proximal portion may include one or more indentations, such that the proximal portion may have one or more thin regions and one or more thick regions, to facilitate bending of the proximal portion along the one or more thin regions. The tip may further include at least one portion coupled to the single, continuous piece of material. The at least one portion may be made of a more rigid material than the single, continuous piece of material. The actuator may include a control wire coupled to the elevator.

It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of any claimed inventions.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate aspects of the present disclosure and together with the description, serve to explain the principles of the disclosure.

FIG. 1 shows an endoscope, in accordance with aspects of the present disclosure.

FIG. 2 shows a perspective view of a tip of the endoscope of FIG. 1, in accordance with aspects of the present disclosure.

FIG. 3 shows a front view of the tip of the endoscope of FIG. 1, in accordance with aspects of the present disclosure.

FIG. 4 shows a side view of the tip of the endoscope of FIG. 1 in a first configuration, in accordance with aspects of the present disclosure.

FIG. 5 shows a side view of the tip of the endoscope of FIG. 1 in a second configuration, in accordance with aspects of the present disclosure.

FIG. 6 shows a front view of an alternative endoscope tip, in accordance with aspects of the present disclosure.

FIGS. 7A and 7B show top and side views of a living hinge of an endoscope tip, in accordance with aspects of the present disclosure.

FIGS. 8A and 8B show top and front views of an elevator, in accordance with aspects of the present disclosure.

DETAILED DESCRIPTION

The present disclosure is drawn generally to tips for devices, and more specifically to endoscope tips for positioning endoscopic instruments. Reference now will be made in detail to aspects of the present disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. The term “distal” refers to a portion farthest away from a user when introducing an instrument into a subject. By contrast, the term “proximal” refers to a portion closest to the user when placing the instrument into the subject. The terms “anterior” and “posterior” refer to directions and/or regions extending perpendicular to proximal and distal directions. Though the following description refers to “endoscope” or “endoscopy,” the principles/aspects described herein may be used with any suitable introduction sheath or device, even if such sheath or device fails to include one or more features typically associated with “endoscopes.” It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the features claimed. Further, as used herein, the terms “comprises,” “comprising,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not necessarily include only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. The term “exemplary” is used in the sense of “example,” rather than “ideal.”

FIG. 1 shows a device 100 for positioning an instrument 102. Device 100 may be any type of endoscope, such as a duodenoscope. Instrument 102 may include, for example, a guidewire, cutting or grasping forceps, a biopsy device, a snare loop, an injection needle, a cutting blade, scissors, a retractable basket, a retrieval device, an ablation and/or electrophysiology catheter, a stent placement device, a surgical stapling device, a balloon catheter, a laser-emitting device, and/or any other suitable instrument. In one example, device 100 may to facilitate cannulation of a subject's papilla, and placement of instrument 102 therein, during an ERCP procedure.

Device 100 may include a shaft 104. Shaft 104 may include a tube 106 that may be sufficiently flexible so as to have the ability to bend, rotate, and/or twist while being inserted into and/or through a subject's tortuous anatomy to a target site in the subject's body. Shaft 104 may have one or more lumens (not shown) extending therethrough. The lumens may include, for example, control wire lumens for receiving one or more control wires, a working lumen for receiving instrument 102, a fluid lumen for delivering a fluid, an illumination lumen for receiving at least a portion of an illumination assembly (not shown), and/or an imaging lumen for receiving at least a portion of an imaging assembly (not shown).

Device 100 also may include a tip 108 at a distal end of shaft 104. Tip 108 may be attached to the distal end of shaft 104. For example, tip 108 may be a cap configured to receive the distal end of shaft 104. Tip 108 may include one or more openings that communication with the lumens of shaft 104. For example, tip 108 may include control wire openings 110 and 112 through which one or more control wires may exit from the control wire lumens of shaft 104, a working opening 114 through which instrument 102 may exit from the working lumen of shaft 104, a fluid opening or nozzle 116 through which fluid may be emitted from the fluid lumen of shaft 104, an illumination opening or window 118 through which light may be emitted, and/or an imaging opening or window 120 for receiving light used by the imaging device to generate an image. While not depicted in FIG. 1, it should be understood that illumination opening 118 may include a light emitter (e.g., a light-emitting diode, or the like) coupled to a cable or wire running through the illumination lumen of shaft 104, and/or imaging opening 120 may include an imager (e.g., a charge-coupled device image sensor, a complementary metal-oxide image semiconductor, or the like) coupled to a cable or wire running through the imaging lumen of shaft 104.

Control wire openings 110 and 112 may be on a distal-facing surface 124 of tip 108. Working opening 114 may be on a distal-facing surface 126 of tip 108. Distal-facing surface 126 may be recessed from distal-facing surface 124 in a proximal direction. Illumination opening 118 and imaging opening 120 may be on an anterior-facing surface 128. Fluid opening 116 may be on distal-facing surface 124, and may open toward illumination opening 118 and imaging opening 120 to, for example, direct a stream of rinsing fluid across illumination opening 118 and/or imaging opening 120 to wash off bodily fluids or debris.

Working opening 114 may open into a cavity 130 of tip 108. Cavity 130 may be defined by distal-facing surface 126, lateral-facing sidewalls 132 and 134, a posterior-facing surface 136, and an anterior-facing surface 138 of an elevator 140. Instrument 102 may extend distally out of working opening 114 and into cavity 130, where instrument 102 may be positioned for engagement with anterior-facing surface 138 of elevator 140. Anterior-facing surface 138 of elevator 140 may include, for example, an indentation 168 (e.g., a slot, groove, cavity, or the like) formed therein. Indentation 168 may receive at least a portion of instrument 102 to exert a holding or gripping force on instrument 102.

Elevator 140 may be cantilevered, having a fixed proximal end 142 at distal-facing surface 126, and a free distal end 144. Elevator 140 may include a proximal portion 146 and a distal portion 148. Proximal portion 146 may be thinner than distal portion 148 to facilitate bending of proximal portion 146. This is because distal portion 148, due to its thickness, may be more rigid than proximal portion 146. In some examples, proximal portion 146 may bend while distal portion 148 may remain unbent.

Proximal portion 146 may have a rectangular cross-sectional shape to facilitate bending along the anterior-posterior direction. Additionally or alternatively, a length of proximal portion 146 (along the proximal-distal direction) may be greater than a width of proximal portion 146 (along a lateral direction perpendicular to the proximal-distal direction), and the width of proximal portion 146 may be greater than a height/thickness of proximal portion 146 (along the anterior-posterior direction). Additionally or alternatively, proximal portion 146 may have a substantially constant thickness all the way from distal-facing surface 126 to a proximal end of distal portion 148, where elevator 140 may undergo an abrupt increase in thickness. Anterior-facing surface 138 may be angled (e.g., inclined) relative to proximal portion 146 to facilitate engagement between anterior-facing surface 138 and instrument 102. Additionally or alternatively, one or more of a posterior-facing surface of proximal portion 146 and an anterior-facing surface of proximal portion 146 may be substantially planar and/or substantially perpendicular to one or more of lateral-facing sidewalls 132 and 134.

Proximal portion 146 may act as a living hinge to allow distal portion 148 of elevator 140 to move relative to the rest of tip 108. Proximal portion 146 may bend such that distal portion 148 may travel along an arcuate path that may cover a distance in a proximal-distal direction and an anterior-posterior direction. In some examples, elevator 140 may be integral with the rest of tip 108. For example, tip 108, as shown in FIG. 2, may be a single, monolithic, injection-molded component. Tip 108 may be made of a polymeric material, such as polyethylene, polypropylene, and/or any other suitable polymer. Tip 108 may be made by any other suitable process, and with any other suitable material, for forming tip 108 as a single piece of the same material throughout.

Distal portion 148 may be thicker than proximal portion 146 to provide space for a passage 150. The thickness of distal portion 148 may ensure that distal portion 148 does not bend, and that bending of elevator 140 is limited to proximal portion 146. Passage 150 may be a through-hole extending between opposing lateral-facing surfaces 152 and 154 of elevator 140. Passage 150 may receive control wire 122. For example, a first portion 156 of control wire 122 may extend distally from control wire opening 110 to lateral-facing surface 152 and passage 150 (see FIG. 3). A second portion 158 of control wire 122 may extend distally from control wire opening 112 to lateral-facing surface 154 and passage 150. A third portion (not shown) of control wire 122 may extend through passage 150. First portion 156, second portion 158, and the third portion of control wire 122 may form a U-shaped extent of control wire 122.

Channels 160, 162, 164, and 166 may be provided in sidewall 132, lateral-facing surface 152, lateral-facing surface 154, and sidewall 134 for receiving portions of control wire 122. The received portions of control wire 122 may slide along channels 160 and 166 as control wire 122 is retracted into and/or extended out of control wire openings 110 and 112. In the depicted example, passage 150 may open into channels 162 and 164. Control wire 122 may be strung through passage 150 by deflecting elevator 140 in a posterior direction to expose passage 150 from behind sidewalls 132 and 134, inserting control wire 122 through passage 150, aligning control wire 122 with channels 160, 162, 164, and 166, inserting control wire 122 into control wire openings 110 and 112.

By pulling one or both of first portion 156 and second portion 158 of control wire 122 in a proximal direction, the user may retract control wire 122 into control wire openings 110 and 112. This retraction may cause proximal portion 146 of elevator 140 to bend as distal portion 148 of elevator 140 is drawn toward distal-facing surface 124. FIGS. 3 and 4 show views of tip 108 where elevator 140 is at rest, while FIG. 5 shows a view of tip 108 where proximal portion 146 of elevator 140 is bent due to forces exerted on distal portion 148 of elevator 140 by control wire 122. Pulling both of first portion 156 and second portion 158, which are on opposite sides of elevator 140, may ensure that elevator 140 may be drawn toward distal-facing surface 124 with little or no twisting or torqueing, to ensure that instrument 102 is brought into a desired position.

Instrument 102 may be held in indentation 168 of distal portion 148 as distal portion 148 is drawn toward distal-facing surface 124. As distal portion 148 is deflected, distal portion 148 may deflect instrument 102, thereby adjusting the position of instrument 102. Instrument 102 may be extended out of, retracted into, and/or rotated (e.g., twisted) in the working lumen of shaft 104 and working opening 114 before, during, and/or after instrument 102 is deflected by distal portion 148. Continued pulling of control wire 122 may cause distal portion 148 to pin instrument 102 against a protrusion 170 on distal-facing surface 124. This may lock instrument 102 in place relative to tip 108. When locked, the ability to extend, retract, and/or rotate instrument 102 may be hindered or eliminated. In one example, protrusion 170 may have a shape complementary to a shape of indentation 168 to facilitate holding or locking of instrument 102 between protrusion 170 and distal portion 148. For example, protrusion 170 may have a wedge-like shape. When the user ceases to pull control wire 122, and/or extends control wire 122 distally, proximal portion 146 may inherently seek to move to its unbent state, thereby moving distal portion 148 away from distal-facing surface 124 and back toward its orientation as shown in FIGS. 2-4. This may unlock instrument 102.

Device 100 also may include a handle 172 coupled to a proximal end of shaft 104. Handle 172 may include one or more lumens (not shown) that communicate with the lumen(s) of shaft 104. Handle 172 also may include one or more ports 174 that open into the one or more lumens of handle 172. For example, instrument 102 may be inserted into port 174 on its way to the working lumen of shaft 104. In one example, handle 172 may include a cable 176. Cable 176 may couple one or more external systems (not shown) to device 100. Cable 176 may, for example, couple handle 172 to a fluid supply, an illumination source, and/or an imaging processor or display.

Handle 172 also may include an actuation mechanism 178. Actuation mechanism 178 may include one or more knobs, buttons, levers, switches, and/or any other suitable actuators, for controlling at least one of deflection of shaft 104, the delivery of fluid, the emission of illumination, and/or imaging functions. In one example, actuation mechanism 178 may be operatively coupled to proximal portions (not shown) of control wire 122 that extend proximally from control wire openings 110 and 112 into handle 172. The user may manipulate actuation mechanism 178 to selectively exert at least one of a pulling force and a pushing force on control wire 122 to control the position of elevator 140, and thereby control the position of instrument 102.

FIG. 6 shows an alternative embodiment of a tip 108′. Tip 108′ may be similar to tip 108, except tip 108′ may be made of separate components coupled together at a joint 109′. In one example, portions of tip 108′ on a first side of joint 109′ may be a single, monolithic component, while portions of tip 108′ on a second side of joint 109′ may be another single, monolithic component. By producing the components separately and then joining them together, one material may be used for one of the components, while another material (with different properties) may be used for the other component. For example, the component to the left of joint 109′ may be made of a material that is more flexible than the material used to make the component to the right of joint 109′, to facilitate bending of the elevator.

In the example shown in FIG. 6, the component to the left of joint 109′ may include an elevator, a working opening, control wire openings, a distal-facing surface, a lateral-facing sidewall, and/or a posterior-facing surface, similar to those of tip 108. The component to the right of joint 109′ may include a fluid opening, a lateral-facing sidewall, an anterior-facing surface, an imaging opening, and/or an illumination opening, similar to those of tip 108. It should be understood, however, that joint 109′ may divide tip 108′ in any other suitable manner. It also is contemplated that joint 109′ may follow a straight line across tip 108′, or may include one or more bends and/or corners, as it crosses tip 108′. It also is contemplated that joint 109′ may divide tip 108′ into more than two components.

FIGS. 7A and 7B show views of an alternative embodiment of a proximal portion 146′ of an elevator. Proximal portion 146′ may have one or more elements thereon for precisely controlling bending of proximal portion 146′. In one example, proximal portion 146′ may include cutouts or indentations 147′ (e.g., notches, grooves, slots, holes, and the like) to facilitate bending by creating thinner portions of proximal portion 146′. Additionally or alternatively, proximal portion 146′ may include protrusions (e.g., ridges, spines, and the like) (not shown) to limit bending by creating thicker portions of proximal portion 146′. The cutouts, indentations, and/or protrusions may be on a posterior-facing surface of proximal portion 146′, an anterior-facing surface of proximal portion 146′, and/or one or more lateral-facing surfaces of proximal portion 146′.

FIGS. 8A and 8B show views of an alternative embodiment of an elevator 140′ including a plurality of indentations 168′ and 169′. Indentations 168′ and 169′ may have different characteristics. For example, one of indentations 168′ and 169′ may be wider, deeper, and/or longer than the other. Indentation 168′ may be sized to hold larger instruments, and indentation 169′ may be sized to hold smaller instruments.

It will be apparent to those skilled in the art that various modifications and variations can be made in the disclosed systems and methods without departing from the scope of the disclosure. Other aspects of the disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the features disclosed herein. It is intended that the specification and examples be considered as exemplary only.

Claims

1.-20. (canceled)

21. A device, comprising: a shaft; anda distal tip including: a first channel positioned on an inner sidewall of the distal tip; andan elevator configured to move between a first position and a second position, the elevator including: a second channel positioned on an outer sidewall of the elevator; anda third channel positioned inside the elevator;wherein each of the first channel, the second channel, and third channel are configured to receive at least a portion of a control wire when the elevator is in the first position, and the control wire is configured to move out of the first channel and remain within the second channel and the third channel when the elevator moves to the second position.

22. The device of claim 21, wherein the distal tip includes an opening configured to receive an instrument inserted through the shaft such that the instrument extends distally out of the distal tip via the opening; wherein the elevator is configured to deflect the instrument relative to the distal tip when the control wire exits the first channel as the elevator moves to the second position.

23. The device of claim 21, wherein the elevator includes: a proximal portion that is fixed relative to the inner sidewall;a distal portion that is movable relative to the proximal portion, the distal portion including a width defined between the inner sidewall and an opposing sidewall of the elevator; andan intermediate portion positioned between the proximal portion and the distal portion.

24. The device of claim 23, wherein the third channel has a longitudinal length that is less than the width of the distal portion, and the third channel is enclosed within the distal portion.

25. The device of claim 23, wherein the elevator is configured to bend at the intermediate portion without bending the proximal portion and the distal portion when moving from the first position to the second position.

26. The device of claim 21, wherein the elevator includes an opening positioned on the outer sidewall and within the second channel, and the third channel opens into the second channel at the opening such that the opening provides access to the third channel from the outer sidewall.

27. The device of claim 26, wherein the elevator includes a second opening positioned on a second outer sidewall that is opposite of the outer sidewall, and the third channel opens into the second opening such that the second opening provides access to the third channel from the second outer sidewall.

28. The device of claim 27, wherein the control wire received within the second channel extends through the third channel via the opening and exits the third channel at the second opening.

29. A device, comprising: a shaft; anda distal tip including: a first channel extending along an inner surface of the distal tip;an elevator configured to move between a lowered position and a raised position, the elevator including: a second channel extending along an outer surface of the elevator; anda third channel extending through the elevator;wherein, in the lowered position of the elevator, the first channel is configured to receive a first portion of a control wire, the second channel is configured to receive a second portion of the control wire, and the third channel is configured to receive a third portion of the control wire; andwherein, in the raised position of the elevator, the first channel is configured such that the first portion of the control wire is guided out of the first channel, the second channel is configured such that the second portion of the control wire is retained within the second channel, and the third channel is configured such that the third portion of the control wire is retained within the third channel.

30. The device of claim 29, wherein the first channel is open to the inner surface of the distal tip, the second channel is open to the outer surface of the elevator, and the third channel is enclosed within the elevator.

31. The device of claim 29, wherein the elevator is configured to move in response to the control wire moving proximally relative to the shaft, such that an instrument inserted through the shaft and received on the elevator is deflected when the elevator moves from the lowered position to the raised position.

32. The device of claim 31, wherein the distal tip includes a first opening and a second opening, wherein each of the first opening and the second opening is positioned on an outer surface of the tip, and a size of the first opening is greater than the second opening.

33. The device of claim 32, wherein the first opening is configured to receive the instrument from the shaft, and the second opening is configured to receive the first portion of the control wire from the shaft.

34. The device of claim 29, wherein the first channel is configured such that the first portion of the control wire is moved radially outward from the first channel when the elevator moves from the lowered position to the raised position.

35. The device of claim 34, wherein the first channel is configured such that the first portion of the control wire is moved radially inward into the first channel when the elevator moves from the raised position to the lowered position.

36. A device, comprising: a shaft; anda distal tip, wherein the shaft is configured to receive a control wire that extends distally outward from the distal tip, the distal tip including: a first channel positioned on each opposing inner surface of the distal tip; andan elevator positioned between the pair of opposing inner surfaces, the elevator including a second channel positioned on each opposing outer surface of the elevator;wherein the first channels and the second channels are configured to receive the control wire when the elevator is undeflected relative to the opposing inner surfaces, and the first channels are configured to release the control wire when the elevator is deflected relative to the opposing inner surfaces such that the control wire is removed from the first channels and maintained within the second channels.

37. The device of claim 36, wherein the first channels are configured such that the control wire exits the first channels when the control wire translates proximally relative to the shaft to deflect the elevator.

38. The device of claim 36, wherein each of the first channels has an arc length defining a semicircular configuration along the opposing inner surfaces of the distal tip.

39. The device of claim 36, wherein each of the second channels has an arc length defining a semicircular configuration along the opposing outer surfaces of the elevator.

40. The device of claim 36, wherein the opposing inner surfaces of the distal tip at least partially define an opening of the shaft at the distal tip, such that the opening is positioned between the opposing inner surfaces; wherein the elevator is positioned distally from the opening such that the opposing outer surfaces of the elevator are not positioned between the opposing inner surfaces.