Abstract: A catheter (1) comprises a jacket (20, 33) and defining a lumen, and extends distally towards a tip (30, 31). The catheter has a helical support (20) within the jacket for at least some of the length of the jacket. The catheter distal end has a plurality of portions of different configurations for different bending and/or pushability characteristics. These may be according to different helical supports and the manner in which they are interwoven, and/or different liners with lap joints. There may be a hydrophilic coating.

Abstract: A direct visualization catheter includes a handle, a balloon, an elongate shaft, and a camera assembly. The elongate shaft has a proximal end and a distal end opposite the proximal end. The proximal end is coupled to the handle. The distal end is coupled to the balloon and defines a longitudinal axis. The camera assembly is coupled to the distal end of the elongate shaft and is disposed within the balloon. The camera assembly includes a camera and an adjustment mechanism for varying a configuration of the camera relative to the distal end of the elongate shaft between a delivery configuration and a deployed configuration. The camera faces primarily in a radial direction in the delivery configuration and the camera faces primarily in an axial direction in the deployed configuration.

Abstract: A drape for covering a robotic surgical system includes a first end portion, a second end portion, and an intermediate portion extending between the first and second end portion. The first end portion defines a cavity therein and has an outer surface and an inner surface and defines an inlet through the outer and inner surfaces. The cavity is dimensioned for receipt of an instrument drive unit and is in fluid communication with the inlet. The second end portion has an outer surface and an inner surface and defines an outlet through the outer and inner surfaces. The second end portion defines a cavity therein that is in fluid communication with the outlet. The intermediate portion defines an elongated conduit therethrough dimensioned for receipt of a surgical robotic arm.

Abstract: A system for automated laser-assisted dermatological treatment is provided, the system comprises a robot arm assembly, comprising a laser head coupled to the robot arm and a controlling unit. The system is configured to remove an undesirable dermatological condition from skin by directing laser energy to a pre-defined skin surface area intended for treatment essentially in an absence of human attendance. A method for real-time controlling an automated laser-assisted removal of undesirable dermatological condition from skin implemented by a system and a computer program product for causing the computer to execute the method are further provided.

Abstract: An endoscope includes: a rigid distal structure portion; a rotational portion; an exterior member; a bearing opposed to the exterior member and recessed from an outer surface of the distal structure portion, the bearing being; and a preventing portion. The bearing is configured to receive and support the rotational shaft and to displace the rotational shaft from the distal structure portion by the exterior member being removed from the distal structure portion. The preventing portion provided on one of the rotational portion and the distal structure portion, and configured to prevent disengagement of the rotational portion by coming in contact with the other of the rotational portion and the distal structure portion when the rotational shaft is displaced from the bearing.

Abstract: An improved system for attaching devices to the distal end of endoscopic instruments is described. An attachment adapter comprises a distal stop, such as a complete or partial loop or cylinder, which limits the penetration of an endoscope into the adapter. The adapter has at least one flange protruding proximally along the endoscope. The adapter is secured on the endoscope by a securing means, which compresses the flange or flanges sufficiently to provide a friction fit. The flexibility of the inventive adapter system allows the adapter to work reliably with endoscopes that are used, damaged or repaired. The adapter may further provide a slit or window allowing viewing of the vessel wall by a lens on an endoscope, thereby improving the operator's ability to understand the location of the endoscope during operation. The adapter may carry any of a variety of devices, including devices for closing a surgical incision, or treating or manipulating tissue.

Abstract: A closed suction system module is provided. In one embodiment, the closed suction system module includes a coupling member configured to couple to a suction port of a multi-port manifold or endotracheal tube adapter (e.g., dual-port or tri-port adapter). In one embodiment, the closed suction system module includes a suction catheter configured to clean the interior surfaces of body-inserted tubes or artificial airways (alone or in addition to suctioning natural airways or portions of the respiratory tract or other body lumens). The suction catheter may include a cleaning portion at a distal portion of the suction catheter (e.g., near the distal end or tip of the suction catheter). In some embodiments, the cleaning portion includes at least one expandable cleaning member (e.g., balloon, sleeve, wiper).

Abstract: The present disclosure relates to the field of endoscopy. Specifically, the present disclosure relates to systems and methods for real-time visualization and sampling of target tissue within body passages. In particular, the present disclosure relates to a system that provides real-time visualization of eccentric pulmonary nodules, and which allows the location/orientation of a biopsy needle to be determined prior to its first actuation.

Abstract: A catheter system comprises an elongate catheter body including a distal end. The catheter system also comprises a cannulation lumen extending through the elongate catheter body and terminating at the distal end of the elongate catheter body. The catheter system also comprises a steering element extending through the elongate catheter body for steering the distal end of the elongate catheter body and an imaging element extending within the elongate catheter body. The imaging element is configured to obtain optical images of an area located distally of the distal end of the elongate catheter body.

Abstract: The invention relates generally to various systems, tools and methods for acquiring diagnostic information, including medical information, for a user, transmitting the information to a remote location, assessing the information, and transmitting resulting diagnosis and treatment information to the user and/or a third party for subsequent action. The present invention provides consumer and user-friendly telemedicine systems and procedures which enable health services and/or diagnosis to be provided at a distance remotely.

Abstract: Devices for joining an endoscope with a system for cleaning a colon or other body lumen are presented. Embodiments include variable placement of distal portions of suction components with respect to the endoscope, multiple suction tubes and/or suction portals, and devices for protecting colon walls from suction damage.

Abstract: An overtube device is disclosed as comprising, in at least one embodiment, a body having a proximal opening and an opposing distal opening in fluid communication with one another via a primary lumen formed within the body, the primary lumen configured for selective receipt and passage therethrough of an endoscope, and a secondary lumen formed within the body so as to intersect and be in fluid communication with the primary lumen and, thus, the distal opening. The secondary lumen is configured for selective engagement with a suction system and defines a suction port. With the distal end of the overtube device attached to the overtube and the suction system engaged with the suction port of the overtube device, suction applied via the suction system through the suction port is, in turn, capable of being applied to the overtube.

Abstract: The multi-section deployable and articulating endoscope is designed with tubing and flat cables that are small enough that the endoscope becomes a thin stick that is minimally invasive and usable with other devices in a common port. The endoscope includes very thin flat cables that are used for electrical connectivity and threaded above and below an articulation and deployment hinge for opening the endoscope passively using an adjustable tension spring, or by pulling on a first cable and closing the endoscope by pulling on a second cable, When in a tubular configuration the endoscope may be inserted into the port and an insufflation membrane inside the port forms an air seal with the endoscope, which aids in insufflation and desufflation. The endoscope includes one or more tubes for creating an air jet stream above the camera to act as a shield for keeping the camera clean.

Abstract: A single use endoscope device which is inserted inside a subject includes: a distal end portion which includes at least an imaging element; an operation unit which operates an operation of the endoscope device; a curved portion which can be curved inside the subject by operating the operation unit; a fractured portion which detaches the distal end portion from the curved portion; and a soft portion which is extended from the operation unit to the curved portion. The distal end portion, the curved portion and the soft portion are inserted in the subject, the operation unit, the curved portion, and the soft portion are discarded after use of the endoscope device, and the distal end portion and at least the imaging element included in the distal end portion are reused.

Abstract: The present disclosure provides systems and methods for deploying a paddle neurostimulation lead within a patient. A delivery tool includes a delivery tube including a first linear segment, a second linear segment, and an arcuate segment coupled between the first and second linear segments, the second linear segment defining an elongated opening. The delivery tool further includes a stylet positioned within an interior of the delivery tube, and a handle coupled to the delivery tube and including a stylet actuation mechanism, the stylet actuation mechanism configured to selectively advance and retract the stylet between a deployed position and a retracted position, wherein the stylet extends across the elongated opening in the deployed position to engage an engagement member of the paddle neurostimulation lead.

Abstract: A cannula assembly can allow an operator to control both an endoscope and a surgical tool with a single hand. In some embodiments, for example, a scope tube may be combined with a tool tube to allow such control. The tool may be manipulated, for example, by causing the tool to rotate, and/or to move forward and backward in relation to the cannula assembly.

Abstract: A sterile drape is provided to cover medical equipment. The drape may include an expandable element to open the open end of the drape. A sheath may also be provided to cover the sheath prior to use. The drape may also be held in a container, which may be coupled to the equipment. Furthermore, the drape may include one or more partially deployed positions in which the drape is partially deployed yet the sterile surface of the drape remains unexposed so that the drape may be partially deployed by non-sterile personnel and stored in a non-sterile area.

Abstract: A protective guide for protecting a cell extraction device during a Pap smear. A camera protective cover encloses a camera and a light emitting device. A thin, flexible transparent sheath encloses the camera cover. A cell extraction device cover encloses the cell extraction device. The location of the cervix is determined by utilizing the camera. The cell extraction device is pushed outward from the cell extraction device cover so that said cell extraction device head contacts the cervix and removes cells from the cervix. The cell extraction device is pulled back into the cell extraction device cover after the cells have been removed from the cervix. In a preferred embodiment the camera and light emitting device is an endoscope and the camera cover is an endoscope cover.

Abstract: Disclosed are systems, apparatus, devices, methods, computer program media and products, and other implementations, including a method that includes capturing an RGB image of a hand of a person, capturing a near infrared (NIR) image of the hand, and determining geometrical features of the hand based on the captured RGB and NIR images. In some embodiments, determining the geometrical features may include determining from extracted image data for the hand one or more values representative of relative spatial features for the hand such as one or more of, for example an angle between a first pair of two fingers in the extracted image data for the hand, and/or a relative distance or length for a second pair of fingers in the extracted image data for the hand. In some embodiments, the method may further include determining identity of the person based on the determined geometrical features of the hand.

Abstract: The present invention relates to comprehensive systems, devices and methods for delivering energy to tissue for a wide variety of applications, including medical procedures (e.g., tissue ablation, resection, cautery, vascular thrombosis, treatment of cardiac arrhythmias and dysrhythmias, electrosurgery, tissue harvest, etc.). In certain embodiments, systems, devices, and methods are provided for delivering energy to difficult to access tissue regions (e.g. peripheral lung tissues), and/or reducing the amount of undesired heat given off during energy delivery.

Abstract: A tissue prosthesis insertion system (80) includes a first assembly (10) comprising a plurality of nested tubes (12), one of the tubes being a carrier tube (14) which, in use, receives a component (16) of a tissue prosthesis at a distal end of the carrier tube (14). A magnetic mount (44) is carried at a proximal end of the first assembly (10). A second assembly (82) is removably attachable to the first assembly (10). An attachment device (92) is carried at a distal end of the second assembly (92), the attachment device (92) being responsive to the magnetic mount (44) of the first assembly (10), the magnetic mount (44) and the attachment device (92) carrying complementary engaging formations to facilitate hermetic sealing between the magnetic mount (44) and the attachment device (92).

Abstract: An exemplary apparatus for imaging at least one anatomical structure can be provided. For example, the apparatus can include an endoscopic first arrangement, a radiation source second arrangement which provides at least one electro-magnetic radiation, and a third arrangement attached to at least one portion of the endoscopic arrangement. The third arrangement can contain an optical arrangement which, upon impact by the at least one electro-magnetic radiation and based thereon, may transmit a first radiation and reflects a second radiation. The first radiation can impact at least one first portion of the anatomical structure(s), and the second radiation can impact at least one second portion of the anatomical structure(s). The first and second portions can be at least partially different from one another. Further, the first and second radiations can have characteristics which are different from one another.

Abstract: Disclosed herein are devices and methods for introducing a plurality of instruments to a target site through a working channel. The working channel can include a surface adapted to guide one or more instruments into select positions. The working channel can be defined by a portion of a guide tube or tip that may be coupled with an endoscope.

Abstract: A tissue prosthesis insertion system includes a first assembly comprising a plurality of nested tubes, one of the tubes being a carrier tube which, in use, receives a component of a tissue prosthesis at a distal end of the carrier tube. A magnetic mount is carried at a proximal end of the first assembly. A second assembly is removably attachable to the first assembly. An attachment device is carried at a distal end of the second assembly, the attachment device being responsive to the magnetic mount of the first assembly, the magnetic mount and the attachment device carrying complementary engaging formations to facilitate hermetic sealing between the magnetic mount and the attachment device.

Abstract: A tissue prosthesis insertion system (80) includes a first assembly (10) comprising a plurality of nested tubes (12), one of the tubes being a carrier tube (14) which, in use, receives a component (16) of a tissue prosthesis at a distal end of the carrier tube (14). A magnetic mount (44) is carried at a proximal end of the first assembly (10). A second assembly (82) is removably attachable to the first assembly (10). An attachment device (92) is carried at a distal end of the second assembly (92), the attachment device (92) being responsive to the magnetic mount (44) of the first assembly (10), the magnetic mount (44) and the attachment device (92) carrying complementary engaging formations to facilitate hermetic sealing between the magnetic mount (44) and the attachment device (92).

Abstract: A system for accessing a patient's body may include an elongate member having a proximal end, a distal end, and two lumens. The elongate member may include two lumens and a thickness of material extending between external and internal surfaces of the elongate member. The system may also include a first illumination device associated with a first of the two lumens such that a portion of the first illumination device may extend into the thickness of material. A second illumination device may be associated with the second of the two lumens such that a portion of the second illumination device may extend into the thickness of material. Further, the system may include an imaging device having a first portion extending into the thickness of material, a second portion protruding into the first of the two lumens, and a third portion protruding into the second of the two lumens.

Abstract: A protective guide for protecting a cell extraction device during a Pap smear. A camera protective cover encloses a camera and a light emitting device. A thin, flexible transparent sheath encloses the camera cover. A cell extraction device cover encloses the cell extraction device. The location of the cervix is determined by utilizing the camera. The cell extraction device is pushed outward from the cell extraction device cover so that said cell extraction device head contacts the cervix and removes cells from the cervix. The cell extraction device is pulled back into the cell extraction device cover after the cells have been removed from the cervix. In a preferred embodiment the camera and light emitting device is an endoscope and the camera cover is an endoscope cover.

Abstract: A tissue prosthesis insertion system (80) includes a first assembly (10) comprising a plurality of nested tubes (12), one of the tubes being a carrier tube (14) which, in use, receives a component (16) of a tissue prosthesis at a distal end of the carrier tube (14). A magnetic mount (44) is carried at a proximal end of the first assembly (10). A second assembly (82) is removably attachable to the first assembly (10). An attachment device (92) is carried at a distal end of the second assembly (92), the attachment device (92) being responsive to the magnetic mount (44) of the first assembly (10), the magnetic mount (44) and the attachment device (92) carrying complementary engaging formations to facilitate hermetic sealing between the magnetic mount (44) and the attachment device (92).

Abstract: Imaging, testing and/or analysis of subjects are facilitated with a capillary-access approach. According to an example embodiment, a capillary is implanted into a specimen and adapted to accept an optical probe to facilitate optical access into the specimen. In some applications, the capillary is implanted for use over time, with one or more different probes being inserted into the capillary at different times, while the capillary is implanted. Certain applications involve capillary implantation over weeks, months or longer. Other applications are directed to the passage of fluid to and/or from a sample via the capillary. Still other applications are directed to the passage of electrical information between the sample and an external arrangement, via an implanted capillary.

Abstract: A treatment tool for an endoscope including: an insertion section inserted from a mouth ring provided at the base-end portion of a channel of the endoscope to the inside of the channel; an operation section provided at the base end of the insertion section; a rigid guide member having a tubular shape, externally fitted around the insertion section at the base end of the insertion section, and fixed to the operation section; and a fixing section that is externally fitted around the guide member, firmly attaches between the inner wall of the mouth ring or the channel and the guide member, and fixes the guide member to the inner wall of the mouth ring or the channel.

Abstract: A reinforced arthroscope comprising external ribs to provide for a number of separate fluid channels, such as inflow, outflow and interstitial tissue drainage, when the arthroscope is slipped into a disposable external sheath. The arthroscope is constructed to be sufficiently rigid so as to penetrate and move within a joint without damaging the rod optics inside. The externality of the arthroscope channels allow for cleaning and sterilizing the scope between uses.

Abstract: An elongated flexible sleeve over the endoscope accessory shaft and secured to the endoscope accessory shaft at the proximal portion protects the shaft of the endoscope accessory from touching the external objects before the endoscope accessory shaft is inserted into endoscope biopsy port and after the endoscope accessory shaft is withdrawn from the endoscope biopsy port. In use, the endoscope accessory cover stays outside of the endoscope biopsy port at all times. The sleeve may be supplied with a handle with a coupling piece at the distal end for removably connect to the endoscope biopsy port cap. The distal end portion of the endoscope accessory cover also may be supplied with an absorbent liner to wipe off secretions during endoscope accessory withdrawal.

Abstract: An endoscope sheath comprising: (a) a tube configured to receive all or a portion of a shaft of an endoscope, the endoscope including a light post in a proximal end region of the endoscope; and (b) an arm attached to and extending from a proximal end region of the sheath; wherein the arm has one or more features that are in communication with the light post to orient the sheath axially and rotationally with respect to the endoscope.

Abstract: A system comprising: (a) a sheath configured to receive all or a portion of an endoscope; (b) an irrigation line connecting the sheath to an irrigation source; (c) a suction line connecting the sheath to a suction source; and (d) a control module located between the sheath, and the irrigation source and the suction source and controls flow of irrigation fluid from the irrigation source to the sheath and movement of suction between the suction source and the sheath; wherein the irrigation source is connected to a resilient reservoir that is located within the control module and movement of the control module compresses the resilient reservoir moving irrigation fluid from the resilient reservoir to the sheath so that the irrigation fluid assists in cleaning the endoscope, and wherein the control module includes a valve and compression of the resilient reservoir initiates movement of the valve so that the valve opens and suction from the suction line is applied to the sheath.

Abstract: The present invention provides a disposable sleeve for covering an instrument. The present invention also provides an instrument embedded in a sleeve. Also provided are a method of covering an instrument with a sleeve, a method of performing a medical procedure, a method of performing sonotubometry, a method of injecting steroids to prevent scarring, and a method of filtering cavities by using the sleeve and instrument combination.

Abstract: Methods and apparatus for treating disorders of the ear, nose, throat or paranasal sinuses, including methods and apparatus for dilating ostia, passageways and other anatomical structures, endoscopic methods and apparatus for endoscopic visualization of structures within the ear, nose, throat or paranasal sinuses, navigation devices for use in conjunction with image guidance or navigation system and hand held devices having pistol type grips and other handpieces.

Abstract: A method of defogging and cleaning a laparoscope includes: (1) inserting a laparoscope into a sheath; (2) inserting the laparoscope and sheath into a body cavity; (3) providing gas to a plurality of gas lumens within a wall of the sheath such that the gas flows through the gas lumens and over a lens of the laparoscope to defog the lens while the laparoscope is in the body cavity; and (4) providing a fluid comprising a surface-active agent to a fluid lumen within the wall of the sheath such that the fluid flows through the fluid lumen and over the lens to clean the lens while the laparoscope is in the body cavity.

Abstract: An improved system for attaching devices to the distal end of endoscopic instruments is described. An attachment adapter comprises a distal stop, such as a complete or partial loop or cylinder, which limits the penetration of an endoscope into the adapter. The adapter has at least one flange protruding proximally along the endoscope. The adapter is secured on the endoscope by a securing means, which compresses the flange or flanges sufficiently to provide a friction fit. The flexibility of the inventive adapter system allows the adapter to work reliably with endoscopes that are used, damaged or repaired. The adapter may further provide a slit or window allowing viewing of the vessel wall by a lens on an endoscope, thereby improving the operator's ability to understand the location of the endoscope during operation. The adapter may carry any of a variety of devices, including devices for closing a surgical incision, or treating or manipulating tissue.

Abstract: The endoscope apparatus of the present invention includes: an insertion portion having a bending portion; an observation device that is provided at the insertion portion; an illumination unit that is provided at the insertion portion, and that illuminates a visual field of the observation device; a main body unit that is formed having a size that enables it to be held and operated by one hand of a user; an operating section that is used to operate the bending portion; a display unit that is connected to the insertion portion, and that displays images acquired by the observation device; a light emitting component that is provided in the main body unit, and that is connected via a light guide to the illumination unit; a heat discharge unit that is provided at the main body unit such that at least a portion thereof is exposed, and that is thermally connected to the light emitting component; and a shielding portion that is provided at the main body unit, and that covers at least a portion of the periphery of the

Abstract: An endoscope includes a substantially rigid shaft having a distal end and a proximal portion, the shaft having a first lumen and a second lumen separate from the first lumen, the second lumen containing one or more objective lenses disposed at the distal end thereof. A housing is mounted on the proximal portion of the shaft, the housing including an eyepiece mount and a light input port. An image fiber bundle is disposed in the second lumen, the image fiber bundle extending proximally from adjacent the one or more objective lenses to the eyepiece mount. An illumination fiber bundle is disposed in the second lumen, the illumination fiber bundle extending proximally from the distal end of the shaft to the light input port.

Abstract: An illuminated suction apparatus including a hand-held surgical device combining a high-performance non-fiber optic optical waveguide with suction. This device is useful in a wide array of surgical procedures including open and minimally invasive orthopedics.

Abstract: An over-tube for use in an endoscopic treatment in an abdominal cavity using an endoscope includes an over-tube main body which is inserted from a distal portion thereof via a natural opening in a patient's body to access the inside of the abdominal cavity from the distal portion through a lumen wall, and an internal cover which is disposed in a passage of the endoscope disposed in an inner cavity of the over-tube main body and which is extractable from a proximal portion of the over-tube main body.

Abstract: An apparatus is disclosed. In some embodiments, the apparatus comprises an endoscope comprising a first distal end portion, and a tube comprising a second distal end portion, wherein the endoscope and the tube are in a side-by-side relationship and are coupled at distal end portions of the endoscope and the tube using a single coupling device.

Abstract: An endoscopic incision system includes: an endoscope; a cylindrical member for covering at least a distal end of an insertion section of the endoscope; and at least an incision section for incising a living tissue, the incision section being provided to a distal end of the cylindrical member and being capable of being exposed from the distal end of the cylindrical member outwardly. In this configuration, the radially expanding incision section will not be twisted or bent, and the incision section prevented from inadvertent fall-off can maintain the desirable shape when it is operated and rotated.

Abstract: An endoscope sheath is provided for advancing medical devices into the anatomy of a patient. The endoscope sheath includes at least one lumen that may be used to advance devices alongside an endoscope. The endoscope sheath may include an endoscope cap configured to mate with the lumen. The endoscope may include one or more coupling members configured to mate with the openings of the lumen.

Abstract: A hysteroscope includes a base and a handle attached to the base. The handle has a first trigger and a second trigger. An outer barrel is attached to the base. The outer barrel has a plurality of channels. An actuatable tool is located within at least one channel. The first trigger is in communication with the actuatable tool for extending the tool from within the at least one channel. The second trigger in communication with the actuatable tool for actuating the tool. The hysteroscope may further include a third trigger to pivot a distal portion of the outer barrel.

Abstract: An endoscope sheath including an elongate flexible hose, which encloses a main lumen, for receiving at least one portion of a shank of a flexible endoscope, and at least one working channel, for receiving at least one portion of a flexible endoscopic working instrument, wherein the endoscope sheath has a transparent distal end portion. Further provided is an endoscope arrangement, and a method for providing an endoscope arrangement.

Abstract: A capsule medical apparatus to be introduced into a subject includes a tissue collecting unit that collects in-vivo tissue; a storage unit that stores therein the in-vivo tissue that is collected by the tissue collecting unit; a liquid storing unit that stores therein liquid for suppressing autolysis of in-vivo tissue; a liquid supplying unit that supplies the liquid in the liquid storing unit to the storage unit; and a control unit that allows, in response to an instruction to start collecting the in-vivo tissue, the tissue collecting unit to collect desired in-vivo tissue and to store the collected in-vivo tissue in the storage unit and that then allows the liquid supplying unit to supply the liquid to the storage unit and makes the storage unit be in a liquid-tight state.

Abstract: A sheath assembly for an endoscope includes an elongate tubular body and a plug. The endoscope has a handle portion and a scope portion extending therefrom to a tip. The body includes first (40) and second (42) wall sections and extends along a longitudinal axis between first and second distal openings located at distal and proximal ends thereof, respectively. The first wall section (40) extends radially about the longitudinal axis to define a scope lumen (44). The scope portion is receivable in the scope lumen with the distal and proximal ends. The second wall section (42) extends radially about a portion of the first wall section (40) and longitudinally between second distal and proximal end openings. The first and second wall sections define an integral suction lumen (50) in fluid communication with a first source of negative pressure. The plug is mated with the distal end opening and includes a lens surface through which energy is transmissible.

Abstract: An apparatus having a tube section and an expanded end. The tube section is flexible while the end section is rigid. The apparatus has a central bore, large enough to loosely receive an endoscope tube, and the end section has two peripheral bores which communicate with the central bore. There is a collar around the central bore which allows formation an air- and water-tight seal with the head of an endoscope. The tube may be fenestrated at its proximal end and may include medial pleats. This apparatus is mainly used by: sliding an endoscope into the central bore until the endoscope head forms an air- and water-tight seal with the central bore; connecting a lavage tube to one peripheral bore and a vacuum tube to the other peripheral bore; inserting the endoscope and the apparatus into a GI tract; and manually controlling the apparatus to apply lavage and vacuum.