Abstract: Systems and methods for creating autologous monocuspid and bicuspid valves can include a catheter having a single expandable element or a double expandable element. Once the leaflets of the valve are created, various techniques can be used to fix the leaflets to the vessel wall or to each other, including clips, tissue anchors, adhesives, and heat.

Abstract: A retrieval device may include a sheath including a distal end and a proximal end, and an end effector at the distal end. At least a portion of the end effector may be movable relative to the sheath between extended and retracted states. The end effector may include a support member extending from the distal end of the sheath, and a movable member extending from the distal end of the support member. The device may include a handle assembly at the proximal end of the sheath, having an actuation member for transitioning the end effector between the extended and retracted states. The device may include a biasing member coupled to at least one of the actuation member and the sheath that may control a force, exerted by one of the movable members and the support member on the other, generated by relative movement between the movable and support members.

Abstract: A method of laparoscopically implanting an electrically stimulating lead proximate the lower esophageal sphincter (LES) of a patient includes delivering the lead through a port of a laparoscope inserted into the abdominal cavity of the patient through an incision in the abdominal wall. The stimulating electrode is implanted in or proximate the muscularis layer of the lower esophageal wall to treat esophageal reflux disease (GERD). The lead includes a needle and suture at its distal end for pulling the electrode into the muscular wall of the LES. Clips are applied to the suture attached to the distal end of the lead to prevent retrograde movement of the electrode. The lead also includes an anchoring member for anchoring the portion of the lead proximal to the electrode. The method and lead used with the method allow the surgeon to work within the confined anatomy present at the gastroesophageal junction and prevents backwards movement and dislodgment of the electrode.

Abstract: A single-use electronic endoscope has a hub, a shaft extending from the hub, flexible or rigid as desired, and an expandable distal tip extending from the shaft. Within the distal tip, an image sensor provides a field of view external from the endoscope. Illuminating elements or light guides within the distal tip emit light to illuminate the field of view. The distal tip also has a variable profile working channel that permits tools to be passed from the hub and into the field of view. The expandable working channel changes cross-sectional shape from a generally noncircular shape to a shape to accommodate the cross-sectional shape of the tool when expanded.

Abstract: In a puncture needle for an endoscope, in a state in which a distal end of an outer sheath is located in an observation field of an observation optical system of an endoscope and a needle slider is retracted to abut a needle slider engaging section, a distal end of an inner sheath is located closer to a distal side than a proximal end of a raising base in the outer sheath, and a proximal end of the inner sheath is located closer to a proximal side than a needle tip of a needle tube in the outer sheath.

Abstract: A tissue clipping apparatus comprises a clip including a proximal end received within a capsule. The clip includes a clip locking member biased to engage a first locking structure of the capsule to lock the clip in the capsule in a closed configuration. The apparatus also comprises a tension member releasably coupling the clip to a proximal end of the device which, during use, remains accessible to a user. The tension member is coupled to the clip by a joint designed to release when subject to a predetermined load to separate the clip from the device, release of the joint releasing the locking member to engage the first locking structure.

Abstract: An elongate probe (204) including a probe head (214) with a transducer array (216), a shaft (210) and an articulating member (212). The articulating member is located between the probe head and the shaft. The articulating member is configured to articulate between a position in which the probe head extends along a longitudinal axis of the probe and at least one articulated position in which the probe head extends at a non-zero angle from the longitudinal axis of the probe. The probe further includes a stiffener (224) configured to controllably move from a retracted position to an extended position at which the stiffener inhibits articulation of the articulating member.

Abstract: Presented here are manufacturing techniques to create an irregularly shaped electronic display, including a hollow within which a sensor, such as a camera, can be placed. The manufacturing techniques enable the creation of the hollow anytime during the manufacturing process. The resulting electronic display occupies the full side of the mobile device, with the sensors placed within and surrounded by the display.

Abstract: A handle for longitudinal movement of a first tubular member over a second tubular member includes a handle body, a nose cone, a locking mechanism, and a retraction control. The nose cone has a sleeve and an outer wall that define a control channel therebetween. The nose cone is moveable over the handle body between extended and retracted positions. The locking mechanism has locked and unlocked positions for selectively fixing the nose cone in the extended and retracted positions. A finger of the retraction control is positioned within the control channel of the nose cone. The retraction control has first and second positions relative to the nose cone for transitioning the locking mechanism between the locked and unlocked position and for moving the nose cone between the extended and retracted positions.

Abstract: A method for performing a surgical procedure within lungs of a patient. The method comprising the steps of providing a plurality of surgical instruments and providing a housing. Attaching a flexible, elongated shaft with distal and proximal ends to the housing. Engaging at least one working end to the distal end of the housing, the working end including a plurality of tubes disposed therein that define a corresponding plurality of working channels for housing a corresponding plurality of surgical instruments. Controlling an actuator to engage at least one of the corresponding plurality of surgical instruments, wherein rotation of the working end with respect to a longitudinal axis of the elongated shaft engages at least one of the plurality of surgical instrument with the actuator to deploy the at least one surgical instrument to the lung as needed during a surgical procedure.

Abstract: A display device configured to display an endoscopic image obtained by an endoscope for observing an object is provided. The display device includes a projecting unit configured to project coordinate axes set to the object onto the endoscopic image, and a display unit configured to display thereon the endoscopic image and the coordinate axes projected onto the endoscopic image.

Abstract: A surgical instrument is inserted through a guide tube. A telemanipulation system moves the distal end of the surgical instrument in all six Cartesian degrees of freedom independently of any guide tube movements.

Abstract: A system and apparatus taught to determine the identification and selected information relating to surgical instruments near a reader. The information can be stored on a member operable to transmit the information to a reader at a selected time. The information can be used in a navigation system to assist in navigation of the instrument relative to a patient.

Abstract: An endoscopic treatment device includes an insertion unit, a manipulation unit provided at a proximal end portion of the insertion unit, and a manipulation unit attachment mechanism attaching the manipulation unit to an insertion port of a channel of an endoscope. The manipulation unit attachment mechanism has: a connection slider engaged with the insertion port by sliding in a first direction intersecting an axis of the insertion unit and disengaged from the insertion port by sliding in a second direction intersecting the axis; an insertion-port abutment part moving toward a proximal end by contacting with the insertion port; and a slider abutment part preventing sliding of the connection slider in the first direction when the insertion-port abutment part is located at a distal end side and permitting the sliding of the connection slider in the first direction when the insertion-port abutment part is located at a proximal end side.

Abstract: An in vivo capsule has a cauterization element that may be deployed by physician while in vivo for cauterizing a lesion, such as bleeding. Energy is transferred from outside of the patient's body to the capsule and specifically to the ablating element, such as via a resonance circuit. Accordingly, it is the object of the present invention to provide a method and apparatus for precisely cauterizing or ablating tissue in-vivo. Embodiments of the invention may provide an in-vivo device having a cauterization or ablation element incorporated therein and a system and method for controlled navigation of the in-vivo cauterization device through a body lumen.

Abstract: A computer-assisted surgery system comprises a first surgical device with a tracking unit tracked during a surgical procedure and adapted to perform a first function associated to the surgical procedure. A second surgical device is adapted to perform a second function associated to the surgical procedure. A triggered unit is triggered when the first surgical device and the second surgical device reach a predetermined proximity relation. A surgical procedure processing unit tracks the first surgical device. A trigger detector detects a triggering of the triggered unit. A CAS application operates steps of a surgical procedure. A controller commands the CAS application to activate a selected step associated with the second function in the surgical procedure when the trigger detector signals a detection. An interface displays information about the selected step in the surgical procedure.

Abstract: The disclosure includes systems and methods for performing surgery. In a first aspect, the system includes a trocar having in a nested configuration, an outer cannula, an inner cannula disposed within the outer cannula, the inner cannula defining the central longitudinal lumen at least in part to provide access through the trocar, a tube center component disposed within the outer cannula, and a ring jet assembly disposed within the outer cannula. In a further aspect, the system includes an instrument guide disposed in the central longitudinal lumen of the trocar. The instrument guide has a proximal end, a distal end, and a plurality of channels defined through the instrument guide from the proximal end to the distal end, each channel being adapted and configured to receive a surgical instrument.

Abstract: A medical device sheath that includes a relatively inelastic body having a proximal end longitudinally separated from a distal end and defining a first lumen, an aperture located at the proximal end in fluid communication with the lumen and configured to admit an elongate endoscope body into the first lumen, and a transparent tip located longitudinally adjacent to an endoscope lens when the elongate endoscope body is located within the first lumen. The endoscope sheath may also include an elongate secondary tube defining a secondary lumen. A method of using the medical device sheath is also described.

Abstract: This invention is directed to a medical device having a longitudinal axis, and including a handle and a catheter. The handle can include a body having a proximal end and a distal end, an actuator moveably coupled to the body, and a handle control member coupled to the actuator, wherein the actuator can be configured to move relative to the body to move the handle control member. The catheter can include a shaft having a proximal end and a distal end, wherein the proximal end of the shaft and the distal end of the body can be configured for releasable coupling. The catheter can also include a steering section located along the shaft and a catheter control member coupled to the steering section, wherein the catheter control member can be configured to move relative to the shaft to move the steering section relative to the longitudinal axis.

Abstract: Presented here are manufacturing techniques to create an irregularly shaped electronic display, including a hollow within which a sensor, such as a camera, can be placed. The manufacturing techniques enable the creation of the hollow anytime during the manufacturing process. The resulting electronic display occupies the full side of the mobile device, with the sensors placed within and surrounded by the display.

Abstract: The present invention relates to an improved cannula that enables a plurality of applications to such as tools to be utilized through a single cannula. According to the present invention there is a cannula having a distal end for insertion into a body, the distal end defining an opening to a primary conduit extending along the longitudinal axis of the cannula. The cannula further comprises a tool element for providing a tool function at or adjacent the distal end of the cannula. At least a portion of the tool element is arranged to be moveable outwardly relative to the longitudinal axis of the cannula. Accordingly, it is beneficial that more than one function can be provided at the distal end of the cannula reducing the trauma to the patient and improving access for the surgeon.

Abstract: In a multi-electrode ablation system, method, and controller, the controller is configured to measure a first current through a common return path when a first voltage is applied by a power supply to a first electrode of a plurality of electrodes, measure a second current through the common return path when a second voltage is applied by the power supply to a second electrode of the plurality of electrodes, measure a third current through the common return path when a third voltage is applied by the power supply concurrently to the first electrode and the second electrode, and determine a common path impedance based at least in part on the first voltage and the first current, the second voltage and the second current, and the third voltage and the third current.

Abstract: A peripheral intravascular catheter assembly comprising a tubular introducer needle and an adapter connected to the proximal end of the light guide. An introducer needle comprises a connection hub and a needle member. The needle member has a lumen, a distal end and a proximal end. The assembly can include a cannula tubing surrounding at least a portion of the needle member, with at least one light source and with an electronic module, configured to power the light source. The light guide has a distal end and a proximal end and extends along the lumen of the needle member. The adapter may be connected to the electronic module to the connection hub of the introducer needle so that light emitted by the light source is capable of entering the light guide, but blood flowing through the lumen of the needle member is prevented from contacting the light source.

Abstract: In one embodiment, a ligator adapted for use with an endoscope includes a ligator body adapted to mount to a body of the endoscope, a barrel adapted to mount to a distal tip of a shaft of the endoscope, the barrel supporting multiple elastic bands that can be sequentially deployed onto internal tissue, and an activation mechanism supported by the ligator body, the activation mechanism including a rotatable activation knob, a rotatable cord winding ring, an activation cord, and a stop element that limits rotation of the activation knob to rotation between a start position and an end position beyond which no further rotation is possible.

Abstract: A surgical apparatus providing access to an underlying body cavity through a tissue tract articulates a flexible surgical object inserted therein. The surgical apparatus includes a tube member defining a longitudinal axis and a lumen therethrough to receive the flexible surgical object. The tube member includes a proximal member, a middle member connected to the proximal member at a first joint, and a distal member connected to the middle member at a second joint. The surgical apparatus also includes articulation mechanisms to articulate the tube member.

Abstract: A visual inspection device includes a body having a support portion and a grip portion extending from the support portion. The device also includes a flexible cable having a first end portion coupled to the body and a second end portion, and a camera assembly coupled to the second end portion of the flexible cable. The camera assembly includes an image sensor operable to transmit image data through the flexible cable. The device further includes a display supported by the support portion of the body. The display is electrically connected to the flexible cable to display image date from the image sensor. The device is powered by a rechargeable battery pack removably coupled to the body.

Abstract: An instrument system for minimally invasive surgery in single port technology, having a trocar and at least one instrument channel which runs at the trocar from proximal to distal and a proximal end remaining extra-corporally when the trocar is inserted into the body of a patient, and a distal end located intra-corporally, wherein a semi-flexible instrument can be inserted through the instrument channel in such a manner that the operating handle thereof remains extra-corporal and the distal working element thereof emerges distally from the instrument channel. The instrument channel is flexibly pliant, stable in the longitudinal direction thereof and arranged outside on the trocar. The distal end of the instrument channel is fixed to the trocar.

Abstract: A device comprising: a handpiece having one or more attachment ports; a tubeset having one or more attachment features for connecting the tubeset to the one or more attachment ports in the handpiece; a removable tip having an attachment arm for attaching to the one or more attachment ports in the handpiece; wherein the device comprises one or more of the following: the handpiece includes an attachment port that attaches the handpiece to an active lead and a return lead and the device is adapted to use only the active lead or both leads so that the device can switch between bi-polar energy and mono-polar energy; the tubeset has one or more fluid conduits that are in fluid communication with the removable tip, wherein the removable tip is located at a distal end of the device; and the handpiece connects to one or more electrical input lines; the tubeset connects to one or more fluid lines, and the removable tip is free of direct connection to both the one or more electrical input lines and the one or more fluid

Abstract: The specification describes a white balance enclosure for use with a tip of a multi-viewing elements endoscope. The white balance enclosure is used to provide a reference white background to the plurality of viewing elements when the tip is positioned within the white balance enclosure and a white balance circuit is used to calculate and store reference white balance values based on white field/test feed signals generated by the plurality of viewing elements exposed to the reference white background.

Abstract: A surgical instrument includes a hollow member having a sidewall provided with a window and a closure member movably connected to the hollow member for alternately covering and uncovering the window. The hollow member has a first clamping surface along an edge of the window, while the closure member has a second clamping surface opposing the first clamping surface and disposable substantially adjacent thereto in a clamping or closure configuration of the instrument. The instrument additionally comprises a tissue occlusion component mounted to at least one of the hollow member and the closure member for acting on tissues gripped between the first clamping surface and the second clamping surface, to couple the tissues to each other.

Abstract: A device comprising: a handpiece having one or more attachment ports; a tubeset having one or more attachment features for connecting the tubeset to the one or more attachment ports in the handpiece; a removable tip having an attachment arm for attaching to the one or more attachment ports in the handpiece; wherein the device comprises one or more of the following: the handpiece includes an attachment port that attaches the handpiece to an active lead and a return lead and the device is adapted to use only the active lead or both leads so that the device can switch between bi-polar energy and mono-polar energy; the tubeset has one or more fluid conduits that are in fluid communication with the removable tip, wherein the removable tip is located at a distal end of the device; and the handpiece connects to one or more electrical input lines; the tubeset connects to one or more fluid lines, and the removable tip is free of direct connection to both the one or more electrical input lines and the one or more fluid

Abstract: An endoscope apparatus includes: an endoscope including at least an elongated insertion section having flexibility and an image pickup device, the insertion section including, at a distal end portion, an observation window forming an observation optical system and an illumination window forming an illumination optical system and the image pickup device including an image pickup surface on which an optical image passing through the observation window is formed; and an apparatus body incorporating a display section that displays an image picked up by the image pickup device, the apparatus body including the display section on one surface having a largest area of the apparatus body and including a holding member that holds the insertion section on a rear surface of the one surface in a wound state.

Abstract: A miniaturized scanning system to generate movement of a flexible device positioned at a distal part of a medical tool. The miniaturized scanning system includes an inner shaft with a longitudinal axis, adapted to guide said flexible device along the longitudinal axis, an abutment comprising an external surface and adapted to maintain said device, and a pusher mechanism adapted to engage with said abutment. The miniaturized scanning system includes at least one end portion adapted to contact said external surface of the abutment at a contact point, wherein said end portion is configured to translate along said longitudinal axis of the inner shaft and wherein the translation of said end portion results in a bending of the device in a bending plane defined by the longitudinal axis of the inner shaft and said contact point.

Abstract: A method and system for diagnosing and treating infection or disease, in which an individual takes a photograph of an infected or diseased area of a body using a camera connected to a microprocessor. The photograph is sent to a diagnosing center having a server with a second microprocessor and a database of photographs correlated with different diseases and infections. The second microprocessor scans the image received from the camera and compares it to the photographs in the database. If a match is found, the second microprocessor then notes the disease or bacteria corresponding to the matching photograph. The second microprocessor then searches an additional database correlated to the match, to further refine the diagnosis. The second microprocessor then searches the second database for a treatment corresponding to the identified disease or bacteria. Once a treatment is identified, information regarding this treatment is automatically sent to the individual's microprocessor.

Abstract: A resection device for resecting tissue from a body. The device includes an elongate member having a proximal end, a distal end, and a lumen extending from the proximal end to the distal end. The device further includes a cap assembly configured to be coupled to the distal end of the elongate member. The cap assembly may include a first cap defining a resection loop channel and a distal end having a first opening. The assembly may further include a second cap configured to receive a portion of the first cap. The second cap includes a distal end having a second opening. A distal portion of the first cap and a distal portion of the second cap may cooperate to define a resection loop track for receiving a resection loop.

Abstract: A system for treating disease involving branching vessels of a mammal system can include a main graft assembly (i) having a lumen permitting fluid flow therethrough, and (ii) configured to expand within a first vessel of a mammal; and a branch graft assembly including a branch cover (i) having a cover lumen permitting fluid flow therethrough; and (ii) configured to expand within a branch vessel that branches from the first vessel. The branch graft assembly may also include an expandable branch stent extending within the cover lumen. The branch graft assembly may further include a branch sheath (i) extending between the branch stent and the cover lumen, and (ii) constraining radial expansion of the branch stent within the cover lumen.

Abstract: Methods and devices that displace bone or other hard tissue to create a cavity in the tissue. Where such methods and devices rely on a driving mechanism for providing moving of the device to form a profile that improves displacement of the tissue. These methods and devices also allow for creating a path or cavity in bone for insertion of bone cement or other filler to treat a fracture or other condition in the bone. The features relating to the methods and devices described herein can be applied in any region of bone or hard tissue where the tissue or bone is displaced to define a bore or cavity instead of being extracted from the body such as during a drilling or ablation procedure.

Abstract: The present invention relates to a surgical apparatus that includes a surgical instrument including an elongated shaft extending along a longitudinal axis from a proximal end to a distal end, a working element coupled to the distal end of the elongated shaft for manipulating tissue; an endoscope having a tubular body including an image fiber, an endoscopic lens coupled to a distal end of the tubular body and operably coupled to the image fiber, the endoscopic lens defining a viewing field about a central axis; and the endoscope mounted to the elongated shaft of the surgical instrument, the endoscopic lens protruding from an outer longitudinal surface of the elongated shaft, the central axis of the viewing field being oblique to the longitudinal axis of the elongated shaft and intersecting the outer longitudinal surface, the working element located within the viewing field and separated from the central axis by a distance.

Abstract: A tool for a medical instrument includes a coupling member on the proximal end of the tool, for releasable mechanical coupling with a distal end of a shaft of a medical instrument, wherein the coupling member is in the form of a helical cutout of a circular cylinder barrel.

Abstract: There is provided a method of treating gastroesophageal reflux disease, which includes dissecting one of a mucosal layer and a submucosal layer of at least one of an esophagogastric junction and a stomach in a range less than an entire circumference of a circumferential direction so that moderate stenosis occurs due to cicatrization in an area in which one of the mucosal layer and the submucosal layer is dissected.

Abstract: A view point is set inside a hollow organ, a clip plane crossing an internal cavity of the hollow organ is set in a position spaced apart in a visual line direction from the view point, a field of view from the view point is divided into a first field-of-view range in which the inside of the hollow organ is viewed and a second field-of-view range other than the first field-of-view range, a projection image is acquired using a template which is defined so that an inner wall surface of a large intestine is able to be drawn in the first field-of-view range, a projection image is acquired using a template which is defined so that a contact surface with the inner wall surface of the air region of the large intestine is able to be drawn in the second field-of-view range, and the projection images are connected.

Abstract: An orthopedic infra-red laser medical device and methods of use for applying infra-red energy to an anatomic region of interest located within the body of a patient. The device includes a hollow needle and a housing on which the needle is releasably mounted. The housing includes an infra-red laser source for producing a laser beam and directing the beam through the needle to exit out of the open distal end of the needle. The distal end of the needle is sharp to pierce through the skin of the patient to a position closely adjacent the anatomic region of interest to deliver the infra-red laser beam thereto without any intervening skin and tissue attenuating the infra-red laser beam. The device can be used for various orthopedic purposes and can also be used on fat in a patient to release activated stem cells.

Abstract: Described herein is an improved device and method for acquiring, and optionally, fastening a tissue fold. The device has an improved configuration for forming a single, two-layer tissue fold.

Abstract: Apparatus, method, computing devices, and computer programs related to photodiagnosis and photodynamic therapy, methods of use thereof, and a method for detecting abnormal tissue, are provided.

Abstract: A medical system including an endoscope having a proximal end, a distal end, and a lumen extending therebetween is disclosed. The endoscope includes a port configured to provide access to the lumen. In addition, the system may include an actuation member slidably disposed through the lumen such that a proximal end of the actuation member extends through the port, and a distal end of the actuation member is operably coupled to an end-effector. The system may further include an actuation handle removably secured to the actuation member. In one embodiment, a portion of the end-effector has dimensions larger than a maximum dimension of the lumen.

Abstract: A technique for deploying an intraluminal device, such as a bariatric device, in a mammalian lumen, such as the gastrointestinal tract, includes positioning a visualization device through an orifice, such as a natural orifice, into the mammalian lumen. A deployment device having the intraluminal device mounted thereto is guided to the mammalian lumen. The intraluminal device, which has a lumen wall that is configured to the size and shape of a portion of the mammalian lumen, is at least partially deployed from the deployment device in the mammalian lumen. The at least partially deployed intraluminal device is positioned with the deployment device while a position of said intraluminal device is visualized with the visualization device.

Abstract: An articulate probe device includes a first mechanism, a second mechanism, and an overtube mechanism. The first mechanism includes a proximal link which is movable coupled to a first intermediate link, a plurality of intermediate links, and a distal link which is moveably coupled to a second one of the intermediate links. The second mechanism includes a proximal link which is movable coupled to a first intermediate link, a plurality of intermediate links, and a distal link which is moveably coupled to a second one of the intermediate links. The overtube mechanism includes a proximal link which is movable coupled to a first intermediate link, a plurality of intermediate links, and a proximal link which is moveably coupled to a second one of the intermediate links. Further, at least one of the first mechanism, second mechanism, and overtube mechanism is steerable and extendable beyond the other mechanisms.

Abstract: A disposable sheath device for use with an endoscope is disclosed. The endoscope has a body with an insertion tube having optics at its distal end. The disposable sheath device has a primary lumen and at least one secondary lumen attached to the primary lumen along a length of the lumen. The primary lumen is for covering and protecting the insertion tube from bodily contamination. The secondary lumen is for accommodating a desired tool. The secondary lumen has an insert substantially commensurate in length to the secondary lumen and has a slit longitudinally along its length. The slit permits radial expansion to accommodate tools having a radius larger than that of the secondary lumen, which preferably is made of a flexible material that expands. A connector is attached to the proximal end of the primary lumen and connects to the body of the endoscope. The connector extends longitudinally to accommodate different length insertion tubes.

Abstract: An apparatus comprises an arm including a flexible portion and an actuation mechanism to bend and straighten the flexible portion of the arm. The apparatus also includes a sensor apparatus that generates bend information about at least one bend in the flexible portion and an electronic data processor. The electronic data processor determines external force information and/or internal force information from the bend information and information representing at least one mechanical property of the flexible portion.

Abstract: Systems, methods, and devices allow intravascular or percutaneous mapping, orientation and/or ablation, in bodily cavities or lumens. A device includes elongate members, moveable between an unexpanded configuration and an expanded or fanned configuration. The elongate members form a stack in the unexpanded configuration to fit through a catheter sheath. The elongate members follow respective arcuate or curvilinear paths as advanced from the sheath into the bent or coiled stack configuration, adopting volute, scroll or rho shapes, and may be nested. The elongated members are fanned or radially spaced circumferentially with respect to one another into the expanded or fanned configuration. Transducer elements carried by elongate members sense various physiological characteristics of or proximate tissue, and/or may apply energy to or proximate tissue. The elongate members are rotatable in groups or as a group in the expanded configuration. The device is retractable.