Abstract: Methods and apparatus are provided to facilitate the minimally invasive removal of tissue and to facilitate the direct approach to anesthetizing a body wall of a patient. A pull-type cutting device also is disclosed to introduce an opening into the body wall to provide access for intra-chest surgical interventions, for example a minimally invasive biopsy technique as also described for excising target tissue from within a patient, including a nodule from within the patient's lung.

Abstract: A laparoscopic device includes a flexible insertion part including an imaging optical system and an illumination optical system that are covered with an exterior tube; and an operational part connected to a base end of the insertion part. The insertion part is inserted into a peritoneal dialysis catheter for observation of an abdominal cavity, and the insertion part includes a distal extended part that is extendable from the peritoneal dialysis catheter in the abdominal cavity during use and formed in a shape with a curved part having a cumulative central angle between 180° and 360°.

Abstract: A distal cap apparatus for use with an endoscope, having a proximal end and a distal end and a longitudinal axis extending therebetween, includes a mount configured for mounting to the distal end of the endoscope, and a strap connected to the mount and configured for banding about the distal end of the endoscope when the distal end of the endoscope is received in the mount. The mount defines a strap slot configured to receive an end of the strap to configure the strap in the banded configuration. The strap may be elastic. A tool is provided to facilitate properly seating of the strap within the mount of the cap assembly. The tool includes a window and a swing arm rotatable within the window to cause a portion of the arm to contact a free end of the strap to force the strap into a fully seated position.

Abstract: There is provided herein, a device for treating and/or diagnosing a sinus or an ear condition, the device comprising a housing comprising or functionally connected to: a hollow cannula defining a lumen extending at least partially along the length thereof, the cannula is configured to be at least partially inserted through an ostium into a sinus cavity/ear of a subject; and a flexible grinding wire movable within the cannula's lumen and configured to be inserted into and retrieved out of the sinus cavity through the cannula's lumen, and to rotate along a longitudinal axis thereof and thereby grind, chop and/or stir material present in the sinus cavity and/or inside the hollow cannula, wherein the cannula is in fluid flow communication with an irrigation/aspiration source; and a wire handle functionally connected to the wire, allowing a user to advance and retrieve the wire within the cannula and into and out of the cannula lumen, wherein the device is handheld by a gripping handle.

Abstract: Disclosed are lighting and optical devices, systems, and methods for use in laparoscopic surgical procedures. The disclosed devices, systems, and methods advantageously do not require tethers in order to receive power or transmit data, such as camera images, to and from an external device. In addition, the disclosed devices, systems, and methods utilize improved camera mechanisms and reduce costs and improve accessibility with respect to laparoscopic surgical procedures.

Abstract: The present disclosure provides devices and methods for insufflating abdomens of subjects under direct visualization. Such devices and methods, in some implementations, include features for cleaning the devices, and certain implementations of the methods permit procedures wherein it is not necessary to use a typical obturator to place a cannula, resulting in safer procedures.

Abstract: A sheathed tubular semi-rigid balloon catheter for performing probing, irrigation, dilation, suction and potential intubation of the nasolacrimal system or paranasal sinus system to treat for stenosis or obstruction. The catheter includes a sheathed tubular probe portion through which a tracer fluid can be injected and through which suctioning of blood or other material can be conducted. The sheath portion of the device can have a distal segment that is inflated in order to dilate parts the nasolacrimal or paranasal sinus system. The high axial load accommodating catheter tool includes a more secure and inexpensively manufactured bond between the metallic semi-rigid tube of the probe portion and the plastic hand-manipulable, multi-connector hub using an enlarged bonding collar.

Abstract: Provided is an integrated monitoring and management system for endoscopic surgery, in which the system simultaneously monitors and manages the surgical environment such as pressure, temperature, humidity, smoke, and the like inside the human body, and the type and access of surgical instruments used for surgery throughout the surgical procedure at the time of endoscopic surgery, such that an optimal surgical environment is maintained according to a monitoring result, and when an accident occurrence factor is monitored during the surgical procedure, it is possible to prevent an accident from occurring by informing of the accident occurrence factor, and it is possible to quantify a safe and successful surgical procedure by analyzing accumulated big data.

Abstract: An otoscope provides a disposable speculum sleeve that conducts light to a narrow tip holding an electronic camera. By removing the light source from the tip, the diameter of the tip may be further reduced to allow the space of the ear canal to be shared between the otoscope and a tool such as a curette for removing foreign objects or to permit the tip to navigate around ear obstructions. The sleeve may provide for multidirectional illumination of the ear structure for improved visualization. The tip and sleeve may be flexible for increased patient comfort when using a compact tip design.

Abstract: A minimally invasive medical instrument comprises an elongate flexible body including a proximal portion, a distal portion, an inner sheath defining a central lumen, and an outer sheath. The inner sheath comprises an inner surface and an outer surface. The instrument further comprises a plurality of conduits embedded within the inner sheath. The plurality of conduits extend through the inner sheath and terminate within the inner sheath. Each conduit includes a conduit lumen and a distal end, and the distal end is directly secured to the inner sheath. The instrument further includes at least one tendon extending through the conduit lumen of at least one conduit of the plurality of conduits from the proximal portion and beyond the distal end of the at least one conduit into the distal portion of the elongate flexible body. The at least one tendon is actuatable to steer the distal portion.

Abstract: Cleaning devices disclosed herein provide, for example, an effective and reliable approach for cleaning an exposed surface of an imaging element (e.g., a lens) of an imaging device (e.g., an endoscope). Cleaning devices disclosed herein enable an imaging element to be cleaned while located within a concealed operation site (e.g., an in-vivo surgical site). To enhance imaging device compatibility, cleaning devices disclosed herein have integral therewith a seating adjustor that allows a user to selectively adjust the position of an imaging device seated thereon. Cleaning devices disclosed herein are thus able to accommodate imaging devices that would otherwise be incompatible due to a distance between the imaging element of the imaging device and a position of a cleaning member of the cleaning device being either too big or too small.

Abstract: An endovascular delivery system an elongate outer tubular sheath, an elongate inner tubular member releasably disposed within the elongate outer tubular sheath and an elongate crossover guidewire slidably disposed within the elongate outer tubular sheath.

Abstract: The invention encompasses devices and methods used to keep the objective lens of a viewing or illuminating device, specifically an endoscope, free from obstructive fluid and dirt; specifically a device having a hollow body designed to fit over an endoscope, a transparent lens cover film that is retained within the device and that is threaded in front of the objective lens of an endoscope, thereby maintaining a clear and unobstructed transparent window in front of the endoscope lens, and an endcap configured to engage opposing edges of the lens cover film in a sealing manner.

Abstract: This disclosure concerns systems and methods for removal of material from the body of a patient, and particularly for percutaneous nephrolithotomy. Systems according to the various embodiments of the disclosure include one or more of nested first and second components, for instance a scope nested within a suction or irrigation catheter, guidewires with self-expanding distal tips, and wash-out elements to facilitate rapid removal of stones through an access sheath.

Abstract: A device for preventing air escape and maintaining colonic air distension can include a body, a distal gasket coupled to a distal end of the body, a proximal gasket coupled to a proximal end of the body, and a diaphragm coupled to the proximal gasket. The distal and proximal gaskets can form a fluid-tight seal with a colonoscope positioned within central bores of the distal gasket, the body, and the proximal gasket, and the diaphragm can conform to and form a fluid-tight seal with at least one of an anus and a stoma of a subject.

Abstract: The present invention is premised upon an improved balloon dilator, more particularly to an improved balloon dilator comprising an expandable balloon, a core wire which extends through the expandable balloon, and a single visual marker band positioned at a geometric center within the balloon dilator which may selectively reflect certain wavelengths of light.

Abstract: Maximum hardness of a flexible tube section of an endoscope is set such that substantial maximum hardness at a time when an over-tube is attached is equal to or lower than maximum hardness of a flexible tube section of an endoscope. That is, the maximum hardness of the flexible tube section of the endoscope is set substantially equal to hardness obtained by subtracting hardness of the over-tube itself from the maximum hardness of the flexible tube section of the endoscope. In the endoscopes including a hardness changing mechanism, maximum hardness of the endoscope, to which the over-tube is not attached, and maximum hardness of the endoscope, to which the over-tube is attached, are set substantially equal.

Abstract: An endoscope system includes an endoscope including an insertion section formed in an elongated shape, a flexible tube portion provided at a proximal end side of the insertion section, and a rigidity changing mechanism portion provided inside the flexible tube portion, and configured to change rigidity of the flexible tube portion by an operation performed on a hand side, and a flexible overtube formed in a cylindrical shape extending in an axial direction, into which the insertion section is inserted, where a rigidity change region of the flexible tube portion by the rigidity changing mechanism portion is set to be from an intermediate portion to a proximal end portion of the flexible tube portion, and a total length of the overtube in the axial direction is set to be shorter than a total length of the rigidity change region.

Abstract: Certain aspects relate to manually and robotically controllable medical instruments. A manually and robotically controllable medical instrument can include an elongated shaft articulable by pull wires. The elongated shaft can be connected to an instrument handle that attaches to an instrument drive mechanism. The instrument handle can include a pulley assembly on which the pull wires can be mounted. Rotation of the pulley assembly can actuate the pull wires to cause articulation of the elongated shaft. The medical instrument also includes a manual drive input connected to the pulley assembly such that manual actuation of the manual drive input causes rotation of the first pulley assembly and a robotic drive input configured to engage with a robotic drive output of the instrument drive mechanism such that rotation of the first robotic drive output causes rotation of the pulley assembly.

Abstract: A medical device insertion method includes: inserting an endoscope into an overtube until a distal end of the endoscope protrudes from a distal end of the overtube; grasping a part of the endoscope protruding from the distal end of the overtube and inserting the endoscope into the large intestine until the distal end of the endoscope is between the splenic flexure and the sigmoid colon of the large intestine; and inserting the overtube together with the endoscope into the large intestine until the distal end of the endoscope is beyond the splenic flexure while grasping the overtube from an outer radial direction so as to deform the overtube in an inner radial direction until an inner surface of the overtube is pressed against an outer circumferential surface of the endoscope, and then inserting the overtube into the large intestine until a reinforced region is placed in the splenic flexure.

Abstract: A stiffening assembly comprises a bulkhead including an inner surface defining a central lumen. The bulkhead further includes an outer surface surrounding the inner surface and includes a wall connecting the outer surface to the inner surface. The wall is shaped to form a plurality of holes spaced apart and surrounding the central lumen. The stiffening assembly further comprises a plurality of longitudinal beams. Each beam extends through a corresponding hole of the plurality of holes. The stiffening assembly further comprises a clamping assembly configured to contact the plurality of beams. The stiffening assembly is adjustable between a flexible state in which each beam is movable within the corresponding hole and a stiffened state in which the clamping assembly clamps the plurality of beams against the bulkhead such that a transfer of forces in a radial direction between the plurality of beams and the bulkhead stiffens the stiffening assembly.

Abstract: A single body port or body flange access device and method for performing laparoscopic surgery are disclosed. The device comprises a plurality of crisscrossing conduits through which surgical instruments may be inserted. The instruments are manipulated so that triangulation is obtained using one patient body flange while standard surgical procedures are performed on the patient.

Abstract: A therapeutic endotracheal tube assembly is provided for insertion into a patient's trachea to ventilate, to maintain patency of the patient's airway, and to deliver therapeutic electromagnetic radiation (EMR) to the patient. The therapeutic endotracheal tube assembly has an endotracheal tube and an EMR delivery system. The EMR delivery system has an EMR source for emitting non-ultraviolet, therapeutic EMR having intensity sufficient to activate desired therapeutic properties within the patient and an EMR conduction line conducive to the propagation of EMR from the EMR source along the endotracheal tube. The EMR conduction line is removably insertable into the endotracheal tube. The therapeutic endotracheal tube assembly may be custom made or may be constructed by retrofitting a removably insertable EMR delivery system to an existing endotracheal tube.

Abstract: Various rotatable shafts and linkage mechanisms configured to allow imaging and access to tissue within a body are provided. In an exemplary embodiment, an introducer system has a rotatable sheath and a linkage that can rotatably engage each other. The rotatable sheath has a distal portion extending at a non-zero angle relative to a proximal portion thereof. The linkage has an exit lumen on its distal end and a plurality of entry lumens on its proximal end. The linkage merges the plurality of entry lumens into the exit lumen, and the exit lumen is aligned with the rotatable sheath upon engagement. Fluid and/or surgical instruments can thus be passed from the plurality of entry lumens of the linkage, through the exit lumen of the linkage, and into the rotatable sheath. The linkage and the rotatable sheath can both receive an imaging device therethrough.

Abstract: The invention relates to a trocar system for a minimally invasive work station, comprising an endoscopic instrument (2) having imaging means (3) and a device for transmitting the signals containing the image information to a display unit (6) and, as required, work tools, further comprising a trocar assembly (7 to 16) having a trocar sleeve, which is designed to receive a pin, including imaging means (8, 14), provided with a tip that is permeable to imaging media having different wavelengths, wherein the imaging means are provided to make the work field visible through the distal end of the pin and a device (16) is provided for transmitting the signals containing the image information to a display unit (6). The trocar assembly (7 to 16) and the minimally invasive instrument (3) are provided for separate use and for displaying the respective image information for the same display unit (6). The pin is provided with an on/off switch (13).

Abstract: Certain aspects relate to systems and techniques for manually and robotically driving a medical instrument. For example, a system can include a handle configured to receive an elongated shaft of a medical instrument. The handle can include a gripping mechanism for selectively engaging the elongated shaft, and an articulation input and configured for receiving user inputs of commanded articulation of the elongated shaft. The system can include an instrument drive mechanism configured to engage a base of the medical instrument. The instrument drive mechanism can include at least one robotic drive output configured to engage a robotic drive input of the base to cause articulation of the elongated shaft based on the user inputs received at the articulation input, and a first connector configured to removably couple the instrument drive mechanism to an instrument positioning device.

Abstract: Various methods and devices are provided for allowing multiple surgical instruments to be inserted into sealing elements of a single surgical access device. The sealing elements can be movable along predefined pathways within the device to allow surgical instruments inserted through the sealing elements to be moved laterally, rotationally, angularly, and vertically relative to a central longitudinal axis of the device for ease of manipulation within a patient's body while maintaining insufflation.

Abstract: Inspection assemblies that include one or more sideview cameras for capturing images of an interior surface of a pipe or conduit include an elongate housing, a sideview camera within the housing and arranged to capture an image of a region within a field of view external to the housing, and a viewport element mounted in the housing and located such that light is transmitted through the viewport element and into said sideview camera, wherein the viewport element is diffusion bonded to a metal support.

Abstract: A variably-flexible, locking insertion device includes a hollow body having a proximal end with an entrance for receiving an instrument, a distal end with a tip for protrusion of the instrument, and a handle to be gripped by an operator. A device transitions the hollow body between a relatively flexible condition and a relatively stiff condition. Tendons are disposed within the hollow body for maintaining the hollow body in the relatively flexible and relatively stiff conditions, the tendons being neither in tension nor compression when the hollow body is in the relatively stiff condition.

Abstract: A method for observing the branch portion of the hole comprising, a step of pushing an obstacle in the hole with an elbow portion; a step of rotating a guide member around an axial direction so that a distal portion of the guide member faces the branch portion extending laterally to an extending direction of the hole; a step of projecting an endoscope from the distal portion and inserting into the branch portion, while confirming an image; and a step of rotating the image to match an up-and-down direction of the image recognized by a user with an up-and-down of a vertical direction, after the endoscope is inserted into the branch portion.

Abstract: A method of manufacturing a flexible catheter with a locatable sensor includes non-rotatably coupling a spool with a wire to a first portion of a spool carrier, non-rotatably coupling the spool carrier to a catheter body, and rotating the spool carrier with the catheter body, thereby wrapping a portion of the wire about a distal end portion of the catheter body to form a wrapping layer.

Abstract: To perform a tool exchange in a medical robotic system, tool is retracted back into an entry guide from a deployed position and pose so that an assistant in the operating room may replace it with a different tool. While the tool is being retracted back towards the entry guide by user action, its configuration is changed to an entry pose while avoiding collisions with other objects so that it may fit in the entry guide. After the tool exchange is completed, a new tool is inserted in the entry guide and extended out of the guide by user action to the original position of the old tool prior to its retraction into the entry guide while the tool's controller assists the user by reconfiguring the new tool so as to resemble the original deployed pose of the old tool prior to its retraction into the entry guide.

Abstract: A surgical instrument may include a shaft, a force transmission mechanism, and an end effector. The shaft may have a proximal end and a distal end. The force transmission mechanism may be coupled to the proximal end of the shaft. The end effector may be coupled to the distal end of the shaft. The shaft may include a body having an outer surface and an inner surface. The inner surface may surround a lumen configured to receive a drive member that extends through the lumen. The outer surface of the body may form an outer surface of the shaft. The body may be made of a single material from the inner surface of the body to the outer surface of the body.

Abstract: Certain aspects relate to systems and techniques for driving a medical instrument having an inner body and an outer body. In one aspect, a system includes a medical instrument comprising an outer body and an inner body configured to be driven through a lumen in the outer body. The system may further include a set of one or more instrument manipulators configured to control movement of the outer and inner bodies and a set of one or more processors configured to: receive a change drive mode command, and in response to receiving the change drive mode command, change a drive mode of the medical instrument from a paired drive mode to an unpaired drive mode.

Abstract: Example embodiments relate to devices, systems, and methods for performing a diagnostic and/or therapeutic action. The system may comprise an elongated main body having a first end. The system may further comprise an anchor assembly attached to the main body near the first end of the main body. The anchor assembly may comprise a first expandable member. The first expandable member may be configurable to expand radially away from the main body. The anchor assembly may further comprise a second expandable member provided between the first expandable member and the first end of the main body. The second expandable member may be configurable to expand radially away from the main body. The anchor assembly may be operable to secure the main body with respect to an interior wall forming the cavity of the patient.

Abstract: A mini-invasive device for endourologic treatment includes a tubular conduit, longitudinally flexible, configured to be inserted through and along the operating channel of an endoscope. The tubular conduit internally defines an essentially non-deformable lumen, has a proximal portion having a connector to a suction device, has a distal portion intended to project from the distal tip of the endoscope, and internally delimits a suction conduit, within which at least one tool can be removably inserted to be used in endourologic treatment.

Abstract: Methods for using a surgical device integrating a suction mechanism with a coagulation mechanism for improving lesion creation capabilities. The device comprises an elongate member having an insulative covering attached about means for coagulating soft tissue. Openings through the covering expose regions of the coagulation-causing elements and are coupled to lumens in the elongate member which are routed to a vacuum source and a fluid source to passively transport fluid along the contacted soft tissue surface in order to push the maximum temperature deeper into tissue.

Abstract: An endoscope having a camera and a tubular enclosure. A distal end of the camera may be movable from a first position in line with a longitudinal axis of the tubular enclosure to a second position lateral of the longitudinal axis of the tubular enclosure. Some embodiments are configured such that no portion of the endoscope obstructs a view from the distal end of the camera as the distal end of the camera is moved from the first position to the second position.

Abstract: A dilation introducer for orthopedic surgery is provided for minimally invasive access for insertion of an intervertebral implant. The dilation introducer may be used to provide an access position through Kambin's triangle from a posterolateral approach. A first dilator tube with a first longitudinal axis is provided. A second dilator tube may be introduced over the first, advanced along a second longitudinal axis parallel to but offset from the first. A third dilator tube may be introduced over the second, advanced along a third longitudinal axis parallel to but offset from both the first and the second. An access cannula may be introduced over the third dilator tube. With the first, second, and third dilator tubes removed, surgical instruments may pass through the access cannula to operate on an intervertebral disc and/or insert an intervertebral implant.

Abstract: A dilation introducer for orthopedic surgery is provided for minimally invasive access for insertion of an intervertebral implant. The dilation introducer may be used to provide an access position through Kambin's triangle from a posterolateral approach. A first dilator tube with a first longitudinal axis is provided. A second dilator tube may be introduced over the first, advanced along a second longitudinal axis parallel to but offset from the first. A third dilator tube may be introduced over the second, advanced along a third longitudinal axis parallel to but offset from both the first and the second. An access cannula may be introduced over the third dilator tube. With the first, second, and third dilator tubes removed, surgical instruments may pass through the access cannula to operate on an intervertebral disc and/or insert an intervertebral implant.

Abstract: A surgical stapling device that comprises an end effector that is configured to receive various control motions from a robotic system.

Abstract: Systems, methods, and devices for facilitating insertion of an endotracheal tube and/or for verifying the position of the endotracheal tube within an airway of a patient with respect to an anatomical landmark of a patient are disclosed. Systems, methods, and devices for facilitating removal of debris from the distal airways of a patient under direct visualization are also disclosed.

Abstract: An integrated clot evacuation device having visualization for use in neurosurgical applications, particularly for the evacuation of clots formed as a result of intracranial hemorrhage (ICH). The device may further include an integrated camera and light for visualizing the interior of the brain and the clot itself. Further, the device is configured to evacuate clots through aspiration and irrigation.

Abstract: An operative cannula includes an elongate shaft that includes a wall structure and a channel extending along the wall structure. The wall structure defines an interior pocket sized to receive a tubular member and is configured to grasp the tubular member when the tubular member is disposed within the interior pocket. The channel is configured to allow passage of an instrument from a proximal end region of the elongate shaft through a distal end region of the elongate shaft.

Abstract: A deployable structure is described including a first and a second robotic system (4, 6; 604, 606), each of which includes: a respective distal element (12;22); at least one respective shape-locking element (14;24); and a respective coupling structure (16;26) operable in a first and a second operating mode. When the coupling structure of the first robotic system operates in the first operating mode, it is elastically deformable and operable so as to move the first robotic system; when the coupling structure of the first robotic system operates in the second operating mode, it forms a guide for the movement of the second robotic system. When the coupling structure of the second robotic system operates in the first operating mode, it is elastically deformable and is operable so as to move the second robotic system; when the coupling structure of the second robotic system operates in the second operating mode, it forms a guide for the movement of the shape-locking element of the first robotic system.

Abstract: An overtube, which is punctured into a body wall and guides an endoscope and a treatment tool into a body cavity, includes an interlocking member that interlocks the forward and backward movements of the endoscope and the treatment tool with each other. The interlocking member is constituted of a first sleeve coupled to the endoscope, a second sleeve coupled to the treatment tool, and a coupling member having an elastic body, which couples the first sleeve and the second sleeve together. Accordingly, in a case where the stretching of the coupling member is small, the endoscope interlocks with the forward and backward movement of the treatment tool at a slow response, and in a case where the stretching of the coupling member is large, the endoscope interlock with the forward and backward movement of a treatment tool at a quick response.

Abstract: A pedicle screw mounted retractor has a split tube body that has a central tube longitudinally split into two split halves, a first half portion and a second half portion. The split halves form a central working portal. Each half portion has a cylindrical retractor tube appended on a side along an external surface. Each cylindrical retractor tube has a flange with a post extending at or near a proximal end. The pair of cylindrical retractor tubes is configured to pass onto and over a tower or extended top threaded post of a pedicle screw prepositioned in a pair of vertebrae for retracting the vertebrae. The central working portal has at least a 20 mm diameter in a closed and abutted orientation of the first and second split halves. In one embodiment, the central working portal has a 22 mm diameter in the closed and abutted orientation.

Abstract: A device for operating a surgical manipulator including, at a distal end of an elongate shaft: a rotational joint that is rotatable about a longitudinal axis of the shaft; and a flexing joint that is on a distal-end side of the rotational joint and that can be flexed about an axis that intersects the longitudinal axis. A surgical-manipulator operating device including: a gripping portion that is gripped by an operator; a rotation input portion that is provided with a rotating member attached to the gripping portion in a rotatable manner and with which rotation instructions for the rotational joint are input in accordance with rotational angles of the rotating member; and flexion input portions with which flexion instructions for the flexing joint are input in directions corresponding to fixed circumferential-direction operating positions on the rotating member.

Abstract: This disclosure discusses various methods and devices for providing multiple types of indicators to be used with a sheath set. One type of indicator indicates the linear position and alignment of each of the sheaths within the sheath set, and another type of indicator indicates the rotational position and alignment of the sheaths. Both types of indicators may be included on the ends of the sheath set proximal to the user outside the patient's vasculature, thereby informing the user of the sheath set of the linear and rotational position and alignment of the ends of the inner and outer sheaths within the vasculature.

Abstract: A vein harvesting device is disclosed. The vein harvesting device includes a handle assembly, at least one elongated portion, first and second end effectors, and a tip. Each end effector is disposed adjacent a distal portion of the at least one elongated portion. Each end effector includes a first jaw member and a second jaw member, and at least one jaw member is movable toward the other jaw member. The tip is disposed in mechanical cooperation with the elongated portion. A distal end of the tip extends distally beyond a distal-most end of the first end effector. The first end effector is movable independently of the tip, and the second end effector is movable independently of the tip.