GR1010093B - Catheter - Google Patents

Abstract

The present invention refers to a catheter (1) comprising a catheter shaft (2) that extends along a longitudinal axis (500) and comprises a lumen (21) defined by a catheter shaft wall (24), a flexible moving element (3), a surgical tool (3) connected to the flexible moving element (3), a distal piston (8) and a proximal piston (9). The distal piston (8) and the proximal piston (9) are arranged in the lumen (21) and a space between the distal piston (8) and the proximal piston (9) is filled with an incompressible fluid. The distal piston (8) is connected to the flexible moving element (3). The flexible moving element (3) is arranged in the catheter shaft (2) in such a way that the flexible moving element (3) is at least partially circumferentially supported by the catheter shaft wall (24) so that a movement of the proximal piston (9) in a direction from a proximal shaft end (29) of the catheter shaft (2) to a distal shaft end (28) of the catheter shaft (2) causes a movement of the surgical tool (5).

Description

Catheter

Description

The present invention relates to a catheter comprising a surgical tool. The catheter of the present invention can also be characterized as a medical catheter.

Catheters have been used for years in many human and animal medical applications as they provide access to the body in a minimally invasive manner.

For example, catheters are widely used in most endovascular applications. Due to their minimally invasive nature, the treatment of blood vessel diseases can be achieved without significant postoperative pain and the need for general anesthesia during the operation or long hospitalization of the patient. An intravascular catheter is known from WO 2016203277 A1.

It is an object of the present invention to propose a compact catheter with high design flexibility and ease of use and manufacture, which can also be used in various medical applications.

The solution to said object is achieved by a probe having the combination of features of the independent claim. The dependent claims contain advantageous embodiments and forms of the invention.

Specifically, the catheter consists of a catheter sheath, a flexible movable element, a surgical tool connected to the flexible movable element, a distal plunger, and a proximal plunger. The catheter sheath extends along a longitudinal axis and consists of a lumen defined by a catheter sheath wall. The distal piston and the proximal piston are arranged within the lumen, and a space between the distal piston and the proximal piston is filled with an incompressible fluid. The flexible movable member is connected to the distal plunger and is arranged in the catheter sheath such that the flexible movable member is at least partially supported circumferentially by the wall of the catheter sheath such that a movement of the proximal plunger in a direction from a proximal sheath end of the catheter sheath to a distal sheath end of the catheter sheath causes movement of the surgical instrument. It is noted that the terms "distal plunger" and "proximal plunger" mean that the proximal plunger is closer to the proximal sheath end of the catheter sheath than the distal plunger is to the proximal end of the sheath. In other words, the rotary plunger is closer to the distal sheath end of the catheter sheath than the proximal plunger is to the distal sheath end.

In more detail, a movement of the proximal piston in a direction from the proximal sheath end of the catheter sheath to the distal sheath end of the catheter sheath is transferable through the incompressible fluid to the distal piston and from the distal piston to the flexible movable member. Being supported at least partially circumferentially by the wall of the catheter sheath as described above, the flexible movable member is movable from the distal plunger such that its movement causes movement of the surgical instrument. In other words, the flexible movable member is arranged to be supported laterally by the wall of the catheter sheath so that the flexible movable member, while being flexible itself, can push the surgical instrument. Should it not be for the peripheral support of the flexible movable element provided by the wall of the catheter sheath, the flexible movable element will bend, at least partially, when pushed by the distal plunger and thus be unable to move the surgical tool. In other words, the flexible movable member is advantageously constrained by the wall of the catheter sheath so that the flexible movable member acts as a stiffening member when pushed so that the flexible movable member can transmit its motion to the surgical instrument. Thus, the wall of the catheter sheath acts as a restraint and support element for the flexible movable element so that the flexible movable element is supported throughout its movement in the lumen so that its movement results in corresponding movement of surgical instrument. In particular, the wall of the catheter sheath provides the flexible movable element with the stiffness that the flexible movable element inherently lacks and therefore needs to be able to move the surgical tool. It is understood that the flexible movable element functions as a drive and force transmission element configured to transmit a force applied to the flexible movable element and thus a movement to the surgical instrument. However, the flexible movable element is/remains capable of bending when the catheter, specifically the catheter sheath, is advanced through curved paths, e.g. tortuous blood vessels, of a patient's body.

The catheter of the present invention has a compact structure, since due to the proposed configuration it is sufficient for the catheter sheath to consist of only one lumen to receive a means for transmitting a force and thus a movement to the surgical tool. In the present invention, said means correspond to the arrangement of the proximal piston, the distal piston and the flexible movable element as described above.

More specifically, the present invention enables a minimum outer dimension, namely a minimum diameter, of the catheter/catheter sheath to be reduced by about 30% compared to a catheter with a catheter sheath that requires two lumens to receive a medium for transmitting a movement towards the surgical instrument. This in turn has the advantage that the catheter can be used in a wide variety of applications and in particular in applications where the blood vessels, lumens and cavities of small dimensions of a human or animal body need to be accessed. Furthermore, due to the flexible nature of the movable element the catheter can still bend as a whole while the catheter is equipped with a movable surgical tool which is movable relative to the catheter sheath. Thus, the flexible movable element does not alter the flexible nature of the catheter as a whole. It is noted that within the context of the present invention, a catheter is specifically understood to mean a device having a flexible sheath (catheter) for insertion into a body cavity, a duct, a conduit, a blood vessel or passageway of a patient and is configured to deliver or receiving fluids from a patient via the catheter sheath and/or inflating a passageway and/or placing a surgical instrument at a targeted site within the patient's body to cause a modification in the body cavity, duct, channel, vessel, or passageway.

Continuing with the advantages of the catheter of the present invention, the fact that only one lumen is necessary to accommodate the arrangement of the flexible movable element, the distal plunger and the proximal plunger offers great flexibility in spatial arrangement of the lumen relative to any further lumens. that could be formed in the sheath of the catheter, such as a lumen for transporting fluids there and/or receiving a guide. More particularly, the requirement of only one lumen in the catheter sheath of the catheter of the present invention to receive the means for moving the surgical instrument forward is particularly advantageous when further lumen is formed in the catheter sheath for fluid transport, e.g. . bodily fluids, through it, and said further lumen must be of large cross-section to facilitate the transport of large quantities of fluids. This is due to the fact that the single lumen for the operating means of the surgical instrument leaves free space in the catheter sheath so that the further lumen can be formed to the required size.

Further, since the surgical tool can be moved with the arrangement of the flexible movable element, the distal piston and the proximal piston provided in a single lumen, said device can be short in length, in particular compared to a catheter sheath which requires two lumens for receiving a means for transmitting a drive to the surgical tool. In this way, the frictional losses during the movement of the flexible movable element, the distal piston and the proximal piston within the lumen can be reduced and the risk of possible distortion of the catheter sheath can also be reduced or even eliminated.

In addition, the use of an incompressible fluid between two pistons to transmit a motion is advantageous as a controlled transmission of motion between the distal and proximal pistons can be achieved. In addition, a length of the space filled with the incompressible fluid and a length of the flexible movable element in the direction of the longitudinal axis of the catheter sheath can be adapted to the application for which the catheter is intended. For example, the space filled with the incompressible fluid can be chosen so that the flexible movable element has a shorter length if the probe is designed for use in high-torque lumens. On the other hand, the length of the moving flexible element can be chosen to be shorter if the helical lumen is to be approached with the catheter. Furthermore, the force transferred from the proximal piston to the distal piston is independent of the speed of movement of the proximal piston. As an incompressible fluid, water or a water solution may be used to fill the space between the distal piston and the proximal piston.

In addition, the proposed catheter does not require a complex manufacturing process, while also allowing a simple and intuitive handling by the physician. Specifically with respect to the latter aspect, a thrust force, i.e. a force applied by the physician to the proximal plunger toward the distal sheath end of the catheter sheath, translates into movement of the surgical tool in a direction toward the distal sheath end. Further, a pulling force, i.e. a force applied by the physician to the proximal plunger toward the proximal end of the sheath of the catheter sheath translates into a movement of the surgical tool in a direction toward the proximal end of the sheath.

It is noted that a movement of the proximal plunger in a direction from the distal sheath end of the catheter sheath to the proximal sheath end of the catheter sheath affects a corresponding movement of the surgical instrument, since the movement of the proximal plunger results in a build-up of negative pressure in the space between the proximal piston and the distal piston, which in turn causes the fluid and the distal piston to move/pull in the same direction as the proximal piston. The motion of the distal piston is then transferred to the flexible movable element, which in turn pulls the surgical instrument attached thereto.

It is also noted that the term "at least in part" in the expression "at least in part supported regionally" refers to the term "regionally". This means that the flexible movable element rests on at least a portion of its entire circumference at a given cross-section. Specifically, within the scope of the present invention, the flexible movable element rests partially or completely circumferentially within the lumen regardless of the shape/shape of the inner surface of the catheter sheath wall defining the lumen or in other words regardless of the shape/shape of the lumen, when/as long as the flexible movable element moves substantially or only along its longitudinal axis and does not move or bend laterally. Specifically, segmental circumferential support is provided when there is segmental circumferential contact between the flexible movable member and the lumen, while full circumferential support is provided specifically where there is full circumferential contact between the flexible movable member and the lumen.

Preferably, the flexible movable member is fully supported circumferentially by the wall of the catheter sheath. This means that the flexible movable element is supported around its entire circumference at a given cross-section.

Advantageously, the flexible movable element is longitudinally movable arranged within the lumen. More specifically, the flexible movable member is extractably disposed within the lumen. This means that the flexible movable member can be moved outside the lumen due to the at least partial peripheral support by a wall of the catheter sheath so that the flexible movable member can move the surgical tool.

Advantageously, the surgical instrument, the flexible movable element, the distal plunger and the proximal plunger have two end positions. At the first end position (proximal end position), a proximal end of each of these components is at its closest position relative to the proximal sheath end of the catheter sheath, while at the second end of the catheter sheath is the proximal end of each of these components. components. Thus, each of these components is mobile between its respective first extreme position and its second extreme position. The difference between the first extreme position and the second extreme position of the surgical tool corresponds to the range of movement of the surgical tool, in other words the maximum distance that the surgical tool can cover during its movement. Specifically, the flexible movable element is extended to its second end position and retracted to its first end position.

Advantageously, the flexible movable element can be placed partially or fully within the lumen when the flexible movable element is in its first end position corresponding to the first end position of the surgical tool. Preferably, when the flexible movable member is in its second end position corresponding to the position of the second end of the surgical instrument, the flexible movable member may be partially disposed within the lumen. However, it is also possible for the flexible movable element to be arranged completely outside the lumen in its second end position. In other words, it can be said that the flexible movable element is partially arranged within the lumen between its first end position and its second end position, i.e. between the first end position and the second end position of the surgical tool.

The flexible movable element may be substantially disposed within the lumen within and/or between its first end position and/or second end position. "Substantially" specifically means that more than 50%, preferably more than 60%, more preferably more than 70%, even more preferably more than 80% of the total length of the flexible movable element is disposed within the lumen .

The inner surface of the catheter sheath wall defining the lumen may preferably be configured to provide at least partial circumferential support to the flexible movable element over only a portion of its length or its entire length.

Advantageously, the distal piston and the proximal piston are arranged within the lumen for the full range of motion between the respective first and second end positions.

The mobile element is advantageously flexible along its entire length. Additionally, the flexibility of the flexible mobile element may vary along its length. This allows the flexible movable element to be adapted to a corresponding application of the catheter.

According to an advantageous embodiment of the present invention, a distal part and/or a proximal part of the flexible movable element has/has less flexibility than its middle part, i.e. the part between the distal part and the proximal part of the flexible movable element. This is particularly advantageous when the surgical tool is directly connected to the flexible movable element. In this case, the distal portion with less flexibility than the middle portion may correspond to the portion of the flexible movable element that is outside the lumen when the flexible movable element is in its second end position. The distal portion and/or the proximal portion of the flexible movable element preferably correspond to connecting portions of the flexible movable element with other components of the catheter.

Preferably, the flexibility of the flexible movable element is such that the flexibility of the catheter sheath and/or the catheter with the flexible movable element does not exceed 20%, preferably not more than 10%, preferably not more than 5%, different, in particular greater, than the flexibility of the catheter sheath and/or the catheter without the flexible movable element.

Within the context of the present invention, the term "flexible" describing an element, namely the movable element, advantageously means that the corresponding component, namely the movable element, can bend from its own weight when at least one of its purposes is determined. In other words, the term "flexible" means that the corresponding element, namely the movable element, cannot support/carry/carry its weight without bending when at least one of its ends is fixed. It is noted, however, that bending does not mean that the corresponding component collapses due to its weight when at least one of its ends is fixed. In other words, the flexible component can only partially support its own weight.

Advantageously, the surgical tool is connected to the flexible movable element at a distal portion and/or distal end of the flexible movable element.

Additionally, the distal plunger is advantageously connected to the flexible movable element at a proximal portion and/or a proximal end of the flexible movable element.

It is preferred that at least the portion of the flexible movable element that is movably arranged or arranged/movable in the lumen between the first and second end positions of the flexible movable element has a cross-sectional area at least over a portion of its total length, i.e. only over a portion of of its length or along its entire length, i.e. at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably essentially 100%, of a cross-sectional area of the lumen.

Preferably, the flexible movable element has along its entire length a cross-sectional area that is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100 %, of a cross-sectional area of the lumen.

Specifically, when the lumen and at least the flexible movable member portion that is movably arranged or arranged/movable in the lumen between the first and second end positions of the flexible movable member are formed as a circular cylinder, It is preferable that at least said flexible movable portion element to have on at least one part of its length, i.e. only on one part of its length or on its entire length, a diameter that is at least 80%, more preferably at least 85%, even more preferably at least 90%, by even more preferably at least 95%, most preferably substantially 100%, of an egg diameter.

Preferably, when the lumen and the entire flexible movable element is formed as a circular cylinder, it is preferred that the flexible movable element has a diameter over its entire length that is at least 80%, more preferably at least 85%, even more preferably at least 90% , even more preferably at least 95%, most preferably at least 95%, preferably substantially 100%, of a lumen diameter. Advantageously, an arrangement between the flexible movable element and the lumen is a tolerance fit.

It is noted that when referring to the shape of a part or the whole of the flexible movable element, the shape of a main body of the flexible movable element extending in the direction of its longitudinal axis, without taking into account possible protrusions that can act as connecting parts of the flexible movable element with a further component of the catheter, ie when the flexible movable element extends substantially along its longitudinal axis, is specifically understood within the scope of the present invention. Thus, a length of a part or the whole of the flexible movable element specifically means a length of the part or the whole of the flexible movable element in the direction of its longitudinal axis, respectively.

It is further noted that the term "at least the flexible movable member portion" specifically means the portion of the flexible movable member, which is arranged within the lumen during its movement from the first end position to the second end position or vice versa.

By choosing the dimensional relationship of the flexible movable element and the lumen as shown, it can be ensured that the greater part of the force with which the flexible movable element is pushed can be transferred to the surgical tool and cause it to move, namely push. The term "substantially" in relation to the terms "cross-sectional area" and/or "diameter" specifically means that the lumen and the flexible movable element are produced within the technical tolerances thereof or the methods used to manufacture said elements.

Preferably, the catheter sheath is cylindrical in shape, specifically circular in cross-section, ie the catheter sheath is specifically a circular cylinder. However, the cross-section of the cylindrical axis of the probe can also have another shape, e.g. the cross-section may be oval. A cylindrical catheter shaft is easy to manufacture and can be easily advanced through a patient's body lumen.

Preferably, at least the portion of the flexible movable element which is movably arranged or arranged/movable in the lumen between the first and second end positions of the flexible movable element has for at least a portion of its length, i.e. only for a portion of its length or throughout its length, the same shape as the lumen. Preferably, the flexible movable element has the same shape as the lumen throughout its length.

Preferably, the flexible movable element is arranged within the lumen in such a way that the portion of the flexible movable element which is movably arranged or arranged/movable in the lumen between the first and second ends of the positions of the flexible movable element has at least one part of its length, i.e. only in a part of its length or throughout its length, a shape that is complementary to a shape of the lumen. For example, if both the flexible movable member and the lumen have an elliptical cross-section, the flexible movable member is arranged within the lumen such that a major axis and a minor axis of the flexible movable member are aligned with a major axis and a minor axis. axis of the lumen, respectively.

According to an advantageous embodiment, at least the part of the flexible movable element which is movably arranged or arranged/movable in the lumen between the first and the second extreme position of the flexible movable element, namely the entire flexible movable element, is formed as a circular cylinder.

Preferably, the lumen is formed as a circular cylinder.

According to an alternative advantageous embodiment of the present invention, the catheter sheath may include at least one couloroconical region, specifically a plurality of couloroconical regions. In addition to at least one conical region, the catheter sheath may also include at least one cylindrical region. The configuration of the catheter sheath with at least one conical region has the advantage that a sliding friction between the catheter sheath and the wall of a body lumen, into which the catheter can be pushed forward, or between the catheter sheath and a housing arranged in catheter sheath and having a different shape than the catheter sheath, may be reduced due to less contact between the catheter sheath and the lumen or the catheter sheath and the housing respectively.

Advantageously, the catheter sheath comprises a distal sheath wall opening formed in a distal peripheral region of the catheter sheath and communicating with the lumen. In one embodiment of the present invention, the flexible movable member is configured to move the surgical tool outside the catheter sheath through the distal sheath wall opening. In another embodiment of the present invention, a portion of the flexible movable element is always located in the distal sheath wall opening. This means that the flexible movable member is partially disposed in the distal housing wall opening in and between its first end position and its second end position. The distal opening of the sheath wall may advantageously be formed as a recess in the wall of the catheter sheath, in particular as a through recess in a transverse direction of the catheter sheath.

According to an advantageous embodiment of the present invention, the lumen extends from the proximal sheath end of the catheter sheath in a direction toward the distal sheath end of the catheter sheath. This means in other words that a proximal end of the lumen coincides with the proximal sheath end of the catheter sheath. In this case, a control element for controlling the surgical tool can be exited through an opening at the proximal end of the lumen so that it can be manipulated by the physician. It is noted that the phrase "toward the distal sheath end of the catheter sheath" does not mean that the lumen extends, ie reaches the distal sheath end of the catheter sheath, but indicates the direction in which the lumen extends.

According to an alternative advantageous embodiment of the present invention, a proximal end of the lumen is separated from the proximal sheath end of the catheter sheath. In other words, the lumen according to this embodiment does not extend from the proximal sheath end of the catheter sheath in a direction toward the distal sheath end of the catheter sheath.

A proximal sheath wall opening may advantageously be formed in a proximal peripheral region of the catheter sheath, where the proximal sheath wall opening communicates with the lumen. The proximal plunger can thus be controlled through the proximal sheath wall opening. The proximal opening of the sheath wall may advantageously be formed as a recess in the wall of the catheter sheath, in particular by recessing in a transverse direction of the catheter sheath.

According to one embodiment of the present invention, the surgical tool can be directly connected to the flexible movable element. By "direct" is meant that no other component of the catheter (other than any possible connection means required to join the flexible movable element to the surgical instrument) is arranged between the surgical instrument and the flexible movable element at the connection point.

According to one embodiment, the surgical tool can advantageously be connected indirectly to the flexible movable element. By "indirectly" is meant that one or more components, preferably only one component, of the catheter (other than any possible connection means required to join the flexible movable element to the surgical instrument) can be placed between the surgical instrument and the flexible mobile element at the connection point.

The surgical tool can specifically be moved in the longitudinal direction, specifically slidable, arranged in the sheath of the catheter.

In particular, the surgical tool can be movably placed directly in the catheter sheath (catheter sheath wall). When the surgical tool is an inflatable balloon, the inflatable balloon may for example have a shape that partially or completely surrounds the catheter sheath. For example, the inflatable balloon may be shaped as a donut, hollow cylinder, or hollow barrel.

Alternatively, the surgical tool may be longitudinally movable, namely slidably, arranged in the catheter sheath arranged in a further component of the catheter sheath.

In particular, the catheter preferably consists of a tool receiving housing which is movably arranged in the longitudinal direction in the catheter sheath and is connected to the flexible movable member, where the surgical tool is arranged on the tool receiving housing. The tool receiving housing is thus arranged between the flexible movable element and the surgical tool. Specifically, the surgical tool is connected to the tool receiving housing such that there is no relative movement between the surgical tool and the tool receiving housing in the direction of the longitudinal axis of the tool receiving housing. It is noted that the tool receiving housing is advantageously fixed to the flexible movable member so that there is no such relative movement between the flexible movable member and the tool receiving housing at their connection. The described arrangement of the tool receiving housing, the catheter sheath and the flexible movable element in relation to each other is such that a movement of the flexible movable element is transmitted to the tool receiving housing and in turn to the surgical instrument which is arranged, namely fixed in tool holder housing. Thus, the surgical tool can move parallel to the longitudinal axis of the control sheath relative to the control sheath.

According to one embodiment of the present invention, the tool housing is preferably slidably arranged in the catheter sheath.

A longitudinal axis of the tool housing preferably corresponds to or is parallel to the longitudinal axis of the probe sheath.

In one embodiment of the present invention, the tool housing is advantageously connected to the proximal plunger and extends from a proximal portion to a distal portion of the catheter sheath such that the tool housing serves as a control handle for controlling movement of the surgical tool. It will be appreciated that the proximal portion of the catheter sheath from which the tool receiving housing extends is placed outside the patient's body when the catheter is inserted into the patient's body. In other words, a proximal portion including a proximal end of the tool receiving housing is outside the patient's body, while a distal portion including a distal end of the tool receiving housing is inside the patient's body when the catheter is used in a patient. It is noted that although the instrument housing also serves as a control handle, a force on the surgical instrument is advantageously transmitted through the proximal piston, distal piston, and flexible movable element assembly, rather than the instrument housing, when the instrument housing is moved. . Without such an arrangement, the tool housing which is itself flexible would otherwise tend to warp when pushed forward relative to the probe sheath.

The tool receiving housing is advantageously arranged in the catheter sheath such that the tool receiving housing partially or fully covers the rotatable sheath wall opening. Thus, the instrument receiving housing provides further support to the flexible movable element, specifically the portion of the flexible movable element located in the distal opening of the sheath wall at a given location of the surgical instrument. Additionally, the flexible movable member is advantageously connected to the tool receiving housing through the distal housing wall opening. The tool housing may preferably be preferably shaped to provide at least partial circumferential support to the flexible movable element at a given cross-section. Thus, the flexible movable member may be positioned in the lumen and distal opening of the sheath wall such that it is at least partially supported circumferentially by the catheter sheath wall such that a movement of the proximal plunger in a direction from a proximal sheath end of the sheath catheter to a distal sheath end of the catheter sheath causes movement of the surgical instrument.

In general and particularly in the case of the tool receiving housing partially covering the distal opening of the sheath wall, it may be advantageous if the flexibility of a distal portion of the flexible movable member is selected such that the flexible movable member is adequately supported on its distal portion. In particular, the flexibility of the distal portion of the flexible movable element may be of lower flexibility than a middle portion of the flexible movable element.

Similarly to the surgical instrument, the flexible movable element, the distal plunger and the proximal plunger, the instrument housing also has two end positions. At the first end position, the tool receiving housing is at its closest position relative to the proximal sheath end of the catheter sheath, while at the second end the tool receiving housing is at its most distal position relative to the proximal sheath end of the catheter sheath . As the surgical instrument is fixed to the instrument housing, the difference between the first extreme position and the second extreme position of the instrument housing corresponds to the range of movement of the surgical instrument parallel to the longitudinal axis of the catheter sheath, in other words the maximum distance that can cover the surgical instrument during its movement parallel to the longitudinal axis of the catheter sheath.

The dimension of the peripheral sheath wall opening parallel to the longitudinal axis of the catheter sheath advantageously corresponds to the maximum distance that the tool receiving the housing and the surgical instrument can move parallel in the direction of the longitudinal axis of the catheter sheath. The term "substantially" is used herein to mean that a portion of the flexible movable member connected to the tool housing is disposed in the distal housing wall opening. Thus, the distance the instrument housing can move is equal to the dimension of the distal sheath wall opening parallel to the longitudinal axis of the catheter sheath minus the dimension of the distal portion of the flexible movable element disposed in the distal sheath wall opening. in the direction parallel to the longitudinal axis of the catheter sheath.

According to an advantageous embodiment of the present invention, the tool housing can have the same external shape as the (external) shape of the catheter sheath and/or complementary internal shape to the (external) shape of the catheter sheath.

Preferably, an outer and an inner shape of the tool housing are the same.

Preferably, the tool housing has a hollow cylindrical shape, in particular with a circular cross-section, ie the tool housing is in particular a hollow circular cylinder. However, the cross-section of the tool housing can also have another shape, e.g. the cross-section may be oval.

Most preferably, the tool housing is a hollow circular cylinder and the probe sheath is a circular cylinder. In this case, the fit between the tool housing and the probe sheath is advantageously a tolerance fit, meaning that an inner diameter of the tool housing is greater than an outer diameter of the probe sheath.

According to an alternative advantageous embodiment of the present invention, an internal shape of the tool housing and an (external) shape of the catheter sheath are different. This results in less contact between the tool housing and the probe sheath compared to the case where the tool housing and the probe sheath have complementary shapes. With this configuration, frictional losses during movement of the tool housing and the probe sheath relative to each other can be reduced. Preferably, the tool receiving housing is formed as a hollow circular cylinder, while the probe sheath consists of at least one frustoconical region.

According to one embodiment, the surgical tool is an inflatable balloon and the tool receiving housing includes a housing lumen that communicates with the inflatable balloon for inflation of the balloon. In this case, the instrument receiving housing extends from a proximal portion to a distal portion of the catheter sheath so that fluid can be supplied from outside the patient's body into the lumen of the housing. Thus, the sheath lumen extends from a proximal portion to a distal portion of the catheter sheath.

In addition to being longitudinally disposed in the probe sheath, the tool housing is also preferably rotatably disposed in the probe sheath. This allows the surgical tool to be not only movable parallel to but also rotatable about the longitudinal axis of the catheter sheath. This enhances the flexibility of the probe in placing the surgical tool in the desired location and orientation within the patient's body. Additionally, this arrangement of the tool housing facilitates movement of the tool housing and thus the surgical tool through narrow passages in the patient's body. When the surgical instrument is an inflatable balloon and the balloon is inflated and anchored in a body lumen, rotation of the instrument housing and thus the balloon is converted to rotation of the catheter sheath, which can thus be advanced more easily through a narrow passage of the lumen. In order to rotate the tool housing, the flexible element is preferably rotatably arranged within the flexible element receiving lumen. In view of this, the distal opening of the sheath wall is formed so as to allow rotation of the flexible member about the longitudinal axis of the flexible member.

Preferably, the tool housing is rotatably arranged in the catheter sheath such that a rotational range of the tool housing and thus the surgical tool includes (up to) 180 degrees. Accordingly, the flexible element preferably has a range of rotation of (up to) 180 degrees.

In particular, the tool housing and thus the surgical tool can be configured to rotate through 90 degrees in both directions about the longitudinal axis of the tool housing, where the longitudinal axis of the tool housing is in the plane of symmetry of the catheter sheath. . Accordingly, the flexible member can preferably be configured to rotate (up to) 90 degrees in both directions about its longitudinal axis, where the longitudinal axis of the flexible member lies in a plane of symmetry of the catheter sheath. The "0 degrees" position of the tool housing or flexible element corresponds to the plane of symmetry of the probe sheath. To this end, it is preferred that the distal opening of the sheath wall is formed as a recess passing through the wall of the catheter sheath in a transverse axis of the catheter sheath. The transverse axis is perpendicular to the longitudinal axis of the catheter sheath. When the catheter sheath is formed as a circular cylinder, the transverse axis may specifically be a radial axis.

According to an advantageous embodiment of the present invention, the instrument housing and the probe sheath engage in threading with each other. Thus, the tool holder housing can move in the direction of the longitudinal axis of the probe sheath in a controlled manner due to the threaded engagement of the tool holder housing and the probe sheath with each other. More specifically, the tool housing housing is internally threaded, while the probe sheath is externally threaded. Here, the internal (internal) threads of the tool housing are engaged with the external (external) threads of the probe sheath. In the case where the tool housing is formed to also function as a control handle, a distal portion of the tool housing is preferably threaded.

In particular, the internal threads of the tool housing and the external threads of the catheter sheath are formed in such a way that movement of the control handle in the direction of its longitudinal axis causes rotation of the tool housing around the longitudinal axis of the catheter sheath in combination with movement of the tool holder housing in the direction of the longitudinal axis of the probe sheath, i.e. a helical movement of the tool holder housing. This configuration has the advantage that the force with which the control handle moves in the direction of its longitudinal axis is translated into a helical movement of the tool housing. It is understood that, when the threaded tool housing is formed to also function as a control handle, a movement of the tool housing in the direction of the longitudinal axis of the catheter sheath by applying a corresponding force to the proximal end or region thereof will eventually force the user of probe to rotate its arm along with the tool holder housing.

The catheter sheath can be left-handed or right-handed. Accordingly, the tool housing can be left-handed or right-handed.

It is also possible that the catheter sheath consists of at least one left-handed threaded region and at least one right-handed threaded region. Next, the tool housing is formed accordingly. This configuration is advantageous as the surgical tool can be navigated through narrow passages of different morphologies by turning the surgical tool counterclockwise and clockwise to go around/avoid possible obstacles in the path (eg, plaque in a blood vessel, protrusion due to anatomy of the path). When the surgical instrument is an inflatable balloon and the balloon is inflated and anchored in a body lumen, counterclockwise and clockwise rotation of the instrument housing and thus the balloon is converted into corresponding rotation of the catheter sheath, which allows the catheter sheath to compress and to be advanced through a narrow passage of the lumen.

Preferably, at least one part of the tool housing has an open cross-section. This means that the tool housing can preferably have an open cross-section over a portion or its entire length. This is particularly advantageous where the surgical instrument must be moved through narrow passages and tortuous lumens in the patient's body.

Advantageously, the open cross-section is such that the tool housing preferably substantially surrounds the probe sheath. By "substantial" is specifically meant that at least 60%, preferably at least 70%, preferably at least 80%, of a corresponding cross-section of the catheter sheath is surrounded by the corresponding open cross-section of the tool housing. Especially when the open cross-section of the tool housing is circular or oval in shape, "substantially" may additionally or alternatively mean that the cross-section may extend at least 220 degrees, preferably at least 260 degrees, even more preferably at least 290 degrees . This has the advantage that the tool housing cannot be disassembled from the catheter sheath, even if the catheter sheath is advanced through very narrow passages and extreme tortuous lumens of the patient's body.

Alternatively, the tool housing can have a closed cross-section throughout its length.

Preferably, the catheter comprises a control means for controlling the movement of the surgical tool. For this purpose, the control means is connected to the proximal piston. It is obvious that the control means are external to the patient's body when the catheter is inserted into the patient so that the doctor can manipulate the control means.

The control means may preferably comprise a control element which may be formed as a rigid or flexible element.

In the case of the control element formed as a rigid control element, the control element and the proximal piston may be connected together or formed as a single piece. In particular, the rigid control element can be formed as a shaft. Advantageously, the rigid control element and the proximal plunger can be formed as a plunger such as that used in syringes. Within the context of the present invention, the term "rigid" advantageously means that the control element does not bend under its own weight when at least one of its purposes is fixed. In other words, the term "rigid" means that the control can support/carry/carry its own weight without bending.

Specifically, the rigid control element is connected to a distal end of the proximal piston. Additionally, the rigid control element is advantageously movable within the lumen between the first end position and a second end position. The first end position and the second end position of the rigid control correspond to the first end position and the second end position of the surgical instrument, respectively. Specifically, the rigid control element is partially disposed within the lumen throughout its full motion between its first extreme position and its second extreme position.

In the case of the control element formed as a flexible control element, the control element is connected to the proximal piston, in particular to a distal end of the proximal piston, and is such that the flexible control element is at least partially supported circumferentially by the wall thereof catheter sheath so that the proximal plunger is movable toward the distal end of the catheter sheath with the flexible control sheath. In other words, the control element is arranged such that the flexible control element is at least partially supported circumferentially by the catheter sheath wall such that a force applied to the control element in a direction from a proximal sheath end of the catheter sheath toward a distal sheath end of the catheter sheath causes movement of the proximal plunger.

It is noted that the features and details described with respect to the flexible movable element, namely its size, shape and extension in the lumen, also apply, separately or in combination with each other, to the flexible control element. Advantageously, the flexible movable element and the flexible control element may be identical to each other.

The control means may preferably further comprise a control handle connected to the control element, in particular at a proximal end and/or part of the control element. In this case, the doctor can operate the control handle to control the movement of the surgical instrument. For this purpose, the operating indicator can be ergonomically formed.

According to an advantageous embodiment, the control handle is formed as a housing which can be moved in the longitudinal direction, in particular slidable, arranged in the sheath of the catheter. The housing may also describe as a "control housing" within the context of the present invention.

Each of the control means components has a first end position and a second position corresponding to the first end position and the second end position of the surgical instrument, respectively. In the first end position, the respective component of the manipulation means is at its most distant position from the distal end of the housing, while at the second end position the corresponding component is at its closest position to the distal end of the housing.

The control housing is advantageously arranged in the catheter sheath such that the control housing partially or fully covers the proximal sheath wall opening. Thus, the control housing provides further support to the control element when formed as a flexible control, specifically to the portion of the flexible control element located in the proximal sheath wall opening at a given location of the surgical instrument. Further, the control element is advantageously connected to the control housing through the proximal housing wall opening. The control housing may preferably be formed to provide at least partial circumferential support to the flexible control element at a given cross-section. Thus, the flexible control element may be positioned in the lumen and proximal opening of the sheath wall so as to be at least partially supported circumferentially by the catheter sheath wall such that the proximal plunger is movable toward the distal sheath end of the catheter sheath from the flexible control.

A dimension of the proximal sheath wall opening parallel to the longitudinal axis of the catheter sheath advantageously corresponds to the distance the control housing can move parallel to the direction of the longitudinal axis of the catheter sheath. The term "substantially" is used herein to mean that a portion of the control element connected to the housing is disposed in the proximal housing wall opening. Thus, the distance the housing can move is equal to the dimension of the proximal opening of the sheath wall parallel to the longitudinal axis of the catheter sheath minus the dimension of the proximal portion of the control element disposed in the proximal opening of the sheath wall to the direction parallel to the longitudinal axis of the catheter sheath.

Generally and specifically in the case of the control housing partially covering the proximal sheath wall opening, it may be advantageous if flexibility of a proximal portion of the control element, when formed as a flexible control element, is selected so that the control element is sufficiently supported in the proximal part of it. In particular, the flexibility of the proximal portion of the flexible movable element may be of lower flexibility than a medial portion of the flexible movable element.

Advantageously, the manipulation housing may have the same external shape as the (external) shape of the catheter sheath and/or a complementary internal shape to the (external) shape of the catheter sheath. Preferably, an outer and an inner shape of the control housing are the same.

Preferably, the control housing has a hollow cylindrical shape, in particular with a circular cross-section, i.e. the control housing is in particular a hollow circular cylinder. However, the cross-section of the handling housing can also have another shape, e.g. its cross-section may be oval.

According to a preferred embodiment of the present invention, the control housing is a hollow circular cylinder and the probe sheath a circular cylinder. In this case, a fit between the control housing and the probe sheath is advantageously a tolerance fit, meaning that an inner diameter of the housing is greater than an outer diameter of the probe sheath.

According to an alternative advantageous embodiment of the present invention, an internal shape of the control housing and an (external) shape of the catheter sheath are different. This results in less contact between the control housing and the catheter sheath compared to the case where the internal shape of the control housing and the (external) shape of the catheter sheath are the same. Thus, frictional losses during relative movement between the control housing and the probe sheath can be reduced. Preferably, the control housing is formed as a hollow circular cylinder, while the probe sheath consists of at least one frustoconical region.

The flexible movable element and/or the flexible control element are preferably formed as a wire. The term "wire" may also include a wire or any other flexible rod-shaped element. In another advantageous embodiment, the flexible movable element and/or the flexible control element are/are formed as a single sheet. The sheet may in particular be curved. However, the flexible movable member and/or the flexible control member may be any member that can bend so that the catheter can bend as a unit when advanced through lumens and cavities of hollow organs of the patient's body.

The flexible movable element and/or the control element can be made of, for example, metal, plastic or composite material.

According to a preferred embodiment of the present invention, the catheter surgical tool is an inflatable balloon. With the help of the inflatable balloon, the proposed catheter acquires greater propulsion, as the required propulsive force to move the catheter sheath forward can be applied near its tip. The term "propulsion" means the degree to which force transmitted from a proximal catheter sheath end is translated into movement of the peripheral catheter tip (catheter tip), which is dependent on force transmission along the catheter body. In other words, the term "movability" means the ease of advancing the catheter into a lumen, e.g. a blood vessel, and is indicative of the amount of force experienced by the distal end of the catheter sheath when a known force is applied to the proximal end of the catheter sheath. In terms of crossability, i.e. the ability to navigate the tip of the sheath catheter through tight restrictions in the vasculature, the proposed catheter can move through significant stenosis using the propulsive force exerted by the moving balloon by pressing the tip of the sheath catheter with greater force. When a guidewire is further provided to the catheter, the catheter can provide maximum safety backup support to the guidewire and, in addition, the greatest possible pushability, crossability and trackability over the guidewire in narrowed or obstructed lumens and passages of the patient's body. More specifically, the catheter can provide back-up support to the guidewire as it attempts to navigate through anatomically difficult areas of the lumen of the human body, while—at the same time—it can be precisely repositioned, keeping the balloon inflated and anchored within the lumen. In particular, the tracking of the catheter over the guidewire is high, as once again the propulsive force of the balloon moving near the tip of the catheter sheath is much greater. This is particularly advantageous in tortuous lumens, where passage of the catheter is impeded due to the multiplication of friction between the catheter sheath and lumen walls, as well as between the catheter sheath and the guidewire caused by the existing torque.

According to one embodiment of the present invention, the surgical tool is an inflatable balloon and the flexible movable member, the distal plunger and the proximal plunger are hollow. The flexible movable element is in fluid communication with the balloon and a conduit, the conduit arranged between the distal piston and the proximal piston. Thus, the balloon can be inflated by a fluid (gas or liquid) supplied to the balloon through the proximal piston, the conduit, the distal piston and the flexible movable element. In particular, the flexible movable element includes a liquid flexible movable element channel. The distal piston and the proximal piston each form a through aperture. The conduit may specifically be a pipe.

When the probe consists of a tool housing, a through opening is preferably formed in the tool housing. The through opening of the tool housing can be part of the fluid path for supplying fluid to the balloon and/or used as a connection area for the flexible movable element.

Accordingly, when the catheter comprises a control means as described above, the control means may be hollow and in fluid communication with the conduit. Thus, a fluid source may be connected to the control means to supply fluid through the control means to the conduit and from there to a flexible movable element and ultimately to the balloon. In particular, the control means includes a control channel which means liquid channel.

The through opening of the distal piston may be used as part of the fluid path for supplying fluid to the balloon and/or as a connection area for the conduit in its proximal portion and/or for the flexible movable element in its distal portion. Accordingly, the through opening of the proximal piston may be used as part of the fluid path for supplying fluid to the balloon and/or as a connection area for conduit in the proximal portion thereof and/or for the control element in the distal portion thereof.

The control fluid channel means may include a control fluid channel formed in the control element. Where the control is meant to further include a control handle, a control handle is preferably formed. The through opening of the control handle can be part of the control means liquid channel or used as a connection area for the control element.

For example, air, sunlight, water or a water solution preferably containing a contrast agent can be used to inflate the balloon.

In order to assist movement of the distal plunger in a direction from the distal sheath end of the catheter sheath to the proximal sheath end of the catheter sheath, it may be advantageous if the distal plunger and the proximal plunger are connected together by connecting means. This may be particularly advantageous in a catheter in which the negative pressure built up due to movement of the proximal plunger in the direction from the distal sheath end to the proximal sheath end of the catheter sheath is insufficient to controllably move the distal plunger toward the same direction as the proximal piston.

The connection means are preferably configured to exert/transmit only a pulling force. In other words, the connecting link connecting the distal piston to the proximal piston can preferably only be loaded with a tensile load. Thus, the connecting means can only pull the distal plunger toward the proximal sheath end of the catheter sheath when the proximal plunger is pulled toward the proximal sheath end of the catheter sheath. The connecting means may preferably be formed as a wire, thread or the like. However, it is also possible that the connection means are configured so that they can additionally exert/transmit a thrust force/pressure load. In other words, it is also possible that the connection means are configured so that they can additionally be loaded with a pressure load. In this case, a thrust motion of the proximal piston can be transferred to the distal piston through the incompressible fluid and the connecting means.

It is obvious that the connecting means are located in the space between the distal and proximal pistons which are filled with the incompressible fluid.

Such connection means are advantageously provided in catheters, where you do not need to deliver fluid to the surgical instrument. The reason is that in these catheters there is no conduit between the distal plunger and the proximal plunger as described above, which would generally be able to pull or assist in pulling the distal plunger toward the proximal sheath end of the catheter sheath when the proximal plunger is pulled toward the proximal end of the catheter sheath. Nevertheless, connection means can be provided even in these catheters to avoid overloading the conduit, which could potentially lead to disconnection of the conduit from the plungers.

In one embodiment of the present invention, the flexible movable member and the flexible control member may be made as a single flexible member connected to the distal piston and the proximal piston. In this case, the distal piston and the proximal piston are hollow, i.e. each includes a through opening so that the only flexible member can pass through the pistons. In this case, the single flexible element is partially arranged in the space between the pistons which are filled with the incompressible fluid. The incompressible fluid surrounding the single flexible member provides support for the single flexible member in the space between the distal piston and the proximal piston so that a movement of the proximal piston is transmitted to the distal piston through the single flexible member and the incompressible fluid. It may be advantageous if the portion of lumen in which the distal piston and proximal piston are arranged has a larger cross-section than the rest of the lumen, e.g. from the lumen portion in which the flexible movable element and/or the control element is arranged. Thus, a higher amount of incompressible fluid can be provided in the space between the distal piston and the proximal piston. Thus, due to the greater amount of incompressible fluid surrounding the portion of the unitary flexible element arranged in the space between the distal piston and the proximal piston, a force applied to the proximal piston can be more evenly distributed over the unitary flexible element and the incompressible fluid.

Regardless of the embodiment, in which the flexible movable element and the flexible control element are manufactured as a single flexible element, the lumen may generally have an area that is larger in cross section than the rest of the lumen. Preferably, the region with the largest cross-section compared to the rest of the lumen is the region in which the distal piston and the proximal piston are arranged. This means that in this case the distal piston and the proximal piston have piston areas (piston areas) equal to the larger cross-sectional area of the lumen.

Alternatively, the lumen may have the same cross-section throughout its length.

Advantageously, the distal piston and the proximal piston have the same shape.

The distal piston and the proximal piston may also have the same piston area (piston area). A distance between the distal and proximal pistons remains the same throughout the pistons' range of motion.

However, it is also possible that the distal piston and the proximal piston have different piston regions. For example, the distal plunger may have a larger plunger area than the proximal plunger if it is desired to multiply the force applied to the proximal plunger by the physician in the peripheral region of the catheter sheath. This could be particularly beneficial where the catheter is intended to be used to pass through extremely narrow passages in the patient's body, e.g. blocked blood vessels. Of course, the distal piston may have a smaller piston area than the proximal piston when multiplication of the motion of the proximal piston is desired, i.e. when a greater displacement of the surgical instrument than the motion of the proximal piston is desired. If the pistons have different piston areas, the bore must be formed accordingly in order to receive the pistons.

It is further understood that the distal piston and the proximal piston are formed such that leakage of the incompressible fluid cannot occur.

In one embodiment of the present invention, the previously described lumen is a first lumen, wherein the catheter sheath comprises a second lumen and a third lumen, each of which is defined by the wall of the catheter sheath. The actuation means may comprise a further (flexible or rigid) control element partially arranged in the second lumen and connected to the proximal piston. In addition, the catheter consists of a further flexible movable element partially arranged in the third lumen and connected to the distal piston. It is noted that the second lumen and the third lumen are defined so that each communicates with the first lumen, namely the lumen portion of the first lumen, in which the distal piston and the proximal piston are arranged.

As already mentioned above, the surgical tool of the catheter may be an inflatable balloon. Preferably, the inflatable balloon may be shaped so that, when in the inflated state, it allows the patient's body fluids to pass, preferably more easily in one direction than in another direction, preferably only in one direction. This is particularly advantageous when the catheter is used as a nasogastric catheter and placed into the patient's esophagus. To stabilize the catheter in the desired position, the balloon must be inflated so that it is anchored in the esophagus. The balloon formed according to this advantageous embodiment of the present invention would thus allow saliva to pass through the balloon and not accumulate in the esophagus, preferably preventing reflux of gastric contents into the esophagus.

The balloon preferably comprises a proximal balloon end, a distal balloon end, and at least one channel extending from the proximal end of the balloon to the distal end of the balloon to allow fluid to flow in that flow in the inflated state of the balloon.

According to an advantageous embodiment, the at least one channel is formed as a recess in a peripheral region of the balloon. In other words, an outer dimension of a first region of the balloon at a given cross-section is smaller than an outer dimension of a second region of the balloon at the given (same) cross-section. The second region is the region through which the balloon is shaped to contact the wall of a body cavity, passage, lumen, etc., when the balloon is positioned and inflated therein.

The balloon may specifically include a main region and at least one secondary region, which protrudes from the main region in the inflated state of the balloon. Thus, the balloon can be anchored to the wall of a body cavity, passage, lumen, etc. For example, the balloon may have four secondary regions, which protrude from the main region and form the shape of a cross when the balloon is inflated.

According to an alternative advantageous embodiment, the at least one channel extends through an interior space of the balloon.

Regardless of whether the channel is formed as a recess or whether it extends through the interior of the balloon, the channel may preferably be formed so that liquid can flow substantially in one direction or only in one direction through the channel.

For this purpose, a first channel cross-section of at least one channel is preferably larger than a second channel cross-section of at least one channel. In particular, the first channel cross-section is arranged at the end of the first channel, namely at a proximal channel end, and the second channel cross-section is arranged at a second channel end, namely at a distal channel end. Preferably, the at least one channel is tapered between the cross section of the first channel and the cross section of the second channel. In addition or alternatively, a one-way valve is arranged in the first second cross-section or in the second channel cross-section.

The surgical instrument may also be formed as a cutting device, such as a Fallopian tube scraper (scraper wire for uterine scraping) or a blade, e.g. atherotomy blade, stent, or any other instrument that may be used in a surgical procedure, in which a catheter is used, and that may be directly or indirectly connected to the flexible element. Within the scope of the present invention, the surgical tool may also include materials (eg, a cream, a medicinal substance) to be discharged into a lumen or cavity of a hollow organ of the human or animal body.

Preferably, the catheter sheath further comprises at least one further lumen for receiving a guidewire and/or passing fluid therethrough, e.g. for delivering fluid to a point of interest on the patient's body and/or removing body or other fluids from the patient's body. The at least one further lumen may also be characterized as at least one guide wire and/or fluid passage lumen. It is also possible that the at least one more lumen consists of at least one wire guide lumen and at least one fluid passage lumen as a separate lumen.

The at least one guidewire and/or fluid passageway advantageously extends the entire length of the catheter sheath. In other words, a proximal end and a distal end of the at least one guide wire and/or fluid passing through the lumen correspond to a proximal end and a distal sheath end of the catheter sheath, respectively. Alternatively, the at least one guide wire and/or fluid passing lumen may extend a partial length of the catheter sheath.

The lumen(s) and/or the at least one guide wire and/or liquid passageway are preferably parallel to each other.

In addition, the lumen(s) and/or the at least one guide wire and/or fluid passageway may have the same or different shapes and/or sizes.

Preferably, the lumen(s) and/or the at least one guide wire and/or liquid passageway have a cylindrical shape, specifically with a circular cross-section, i.e. the lumen and/or at least one guide wire and/or liquid passageway is specifically a circular cylinder. However, the cross-section of the lumen(s) and/or the at least one guide wire and/or fluid passageway may have another shape, e.g. the cross-section may be oval.

The catheter may also utilize a guide wire arranged in at least one guide wire and/or fluid passage lumen of the catheter sheath. The guidewire may be advantageously used as a guide for the insertion of a further catheter, after the guidewire has reached a point of interest within the body of a human or animal using the catheter of the present invention and the catheter of the present invention has been removed from its body patient. An assembly of the catheter with the guidewire can specifically be characterized as a catheter assembly.

Preferably, the flexibility of the flexible movable element and/or the flexible control element is the same as the flexibility of the guide wire.

The catheter sheath preferably consists of one end with an opening. The catheter tip corresponds to a peripheral end region of the catheter sheath and includes an opening which preferably corresponds to the distal sheath end of the catheter sheath. In addition, the catheter sheath consists of a main part, to which the tip is attached. The tip and a portion of the main portion of the catheter sheath are inside the patient's body when the catheter is in use, while the remaining main portion of the catheter sheath is outside the patient's body. The tip is advantageously tapered.

The catheter sheath may preferably have an inner and/or outer coating of lubricant on an inner surface of the catheter sheath wall defining the lumen(s) and on the outer surface of the catheter sheath wall, respectively. Preferably, the housing receiving tool and/or the handling means housing has/has an internal lubricant coating. The lubricant can for example be Teflon. Thus, the friction between the flexible moving element(s) and/or the flexible control element(s) and the corresponding lumen(s) can be reduced (s) and/or between the pistons and the lumen and/or between the instrument housing and the probe sheath and/or between the control means housing and the probe sheath.

Within the scope of the present invention, the longitudinal axis of the catheter sheath advantageously corresponds to a longitudinal axis of the catheter. Further, the proximal end and the distal sheath end of the catheter sheath advantageously correspond to a distal end and a proximal end of the catheter, respectively.

Within the context of the present invention, the term "proximal sheath end" means the end of the catheter sheath that is external to the patient's body and the term "distal sheath end" the end of the catheter sheath that is inside the patient's body when the catheter to the patient. The term "proximal" describing a feature of the catheter means that said feature is closer to the proximal end of the sheath or to the practitioner than to the distal end of the sheath when the catheter is used in a patient or held in the appropriate orientation corresponding to its intended use, i.e. introduction to the patient. On the other hand, the term "remote" means that the catheter feature is closer to the distal end of the sheath than to the practitioner or the proximal end of the sheath. For example, the term "proximal region/region/portion" of a component of the catheter or the catheter itself specifically means that this region/region/portion is closer to the proximal end of the sheath or to the physician.

It is noted that the composition "defined by the wall of the catheter sheath" referring to the lumen of the catheter sheath described above means that the lumen corresponds to a hollow space of the catheter sheath which is held/confined/bounded/surrounded by the wall of the catheter sheath, specifically an inner portion, preferably an inner surface, of the wall of the catheter sheath.

The catheter may also include at least one more surgical tool that is fixed to the catheter sheath (at least one non-movable surgical tool) and/or at least one more surgical tool that is movable relative to the catheter sheath (at least one more movable surgical tool tool). The features and explanations referred to in the design of the previously described surgical instrument and its movable arrangement in the catheter also advantageously refer to the at least one further movable surgical instrument.

In other words, the catheter of the present invention may include a plurality of surgical tools, at least one of which is a movable surgical tool. A catheter with a plurality of surgical instruments includes in its simplest configuration a first surgical instrument and a second surgical instrument. Here, the previously described surgical tool corresponds to the first surgical tool. The previously described lumen, flexible movable member, distal plunger, and proximal plunger are a first lumen, a first flexible movable member, a first distal plunger, and a first proximal plunger, respectively. The first surgical tool and the second surgical tool are movable relative to each other. The term "multiple surgical instruments" means "two or more surgical instruments".

According to a preferred embodiment, the second surgical tool is attached to the surgical tool.

According to an alternative preferred embodiment, the second surgical tool is movable independently of the first surgical tool. In this embodiment, the catheter sheath comprises a second lumen defined by the wall of the catheter sheath, a second flexible movable element, a second surgical tool connected to the second flexible movable element, a second distal plunger, and a second proximal plunger. The second distal piston and the second proximal piston are arranged in the second lumen, and a space between the second peripheral piston and the proximal piston is filled with an incompressible fluid. The second remote piston is connected to the second flexible movable member. The second flexible movable member is arranged in the catheter sheath such that the second flexible movable member is at least partially supported circumferentially by the wall of the catheter sheath such that a movement of the second proximal plunger in a direction from a proximal sheath end of of the catheter sheath toward a distal sheath end of the catheter sheath causes movement of the second surgical tool.

The catheter may preferably consist of a third surgical tool that is secured to the catheter sheath.

The present invention further relates to a method of using the described catheter in a surgical procedure. The method includes the step of providing a catheter previously described.

These and further details, advantages and features of the present invention will be described based on embodiments of the invention and by reference to the accompanying figures. Appears in:

figure 1 a simplified perspective of a catheter according to the first embodiment of the present invention;

figure 2 a simplified perspective view of a catheter according to a second embodiment of the present invention;

figure 3 a simplified perspective of a part of the catheter according to the second embodiment,

figure 4 a simplified perspective view of a part of the catheter according to the second embodiment of the present invention;

figure 5 a simplified perspective view of a part of the catheter according to a third embodiment of the present invention;

figure 6 a simplified perspective view of a part of the catheter according to the fourth embodiment of the present invention;

Figure 7 is a simplified perspective view of a portion of the catheter of Figure 6;

figure 8 a simplified perspective of a catheter according to the fifth embodiment of the present invention;

figure 9 a simplified perspective view of a part of the catheter of figure 8, figure 10 a simplified perspective view of a part of the catheter according to a sixth embodiment of the present invention,

Figure 11 is a simplified perspective view of a portion of the catheter of Figure 10;

Figure 12 is a simplified perspective view of a portion of the catheter according to the seventh embodiment of the present invention;

figure 13 a simplified perspective view of part of the catheter according to an eighth embodiment of the present invention;

figure 14 a cross section of a part of the catheter according to a ninth embodiment of the present invention;

Figure 15 is a simplified side view of a catheter according to the present invention in a first and a second position within a body lumen;

Figure 16 is a simplified side view of the catheter of Figure 15 in a third and a fourth position within the body lumen, and

Figure 17 is a simplified perspective view of an example of a probe.

Next, embodiments and uses of the present invention are shown in detail with reference to the accompanying Figures 1 through 16. Identical or equivalent features and features acting in the same or equivalent manner are denoted by the same reference numerals. For the sake of brevity, a detailed description of the elements and components is not repeated in each instance of their occurrence. It is also noted that the probe length is not necessarily drawn to scale for illustrative purposes.

Figure 1 shows a perspective view of a catheter 1 according to a first embodiment of the present invention.

As can be seen from figure 1, the catheter 1 comprises a catheter sheath 2, a flexible movable element 3, a surgical tool 5 connected to the flexible movable element 3, a distal plunger 8, a proximal plunger 9 and a control means 7 for the control of the surgical tool 5. In the present embodiment, the surgical tool 5 is an inflatable balloon 50.

The catheter sheath 2 consists of a main portion 200 and an end 201 attached to the main portion 200 and extending in the direction of a longitudinal axis 500 between a distal sheath end 28 and a proximal sheath end 29.

In addition, the catheter sheath 2 comprises a lumen 21 defined by a catheter sheath wall 24 and a distal sheath wall opening 25, which is formed in a distal peripheral region of the catheter sheath 2 and communicates with the lumen 21. The lumen 21 extends from the proximal end 29 of the catheter sheath 2 to the distal opening of the sheath wall 25 and has a constant cross-section over its length. The distal opening of the sheath wall 25 is specifically formed as a through recess in the wall of the catheter sheath 24 in a direction of a transverse axis 502 of the catheter sheath 2.

The distal piston 8 and the proximal piston 9 have the same piston area and are arranged within the lumen 21. However, it is also possible that the distal piston 8 and the proximal piston 9 have different piston areas. In this case, the portion of the lumen 21 must be formed, which the distal piston 8 and the proximal piston 9 are movably arranged.

The distal piston 8 is connected to the flexible movable element 3, specifically to a proximal end 311 of the flexible movable element 3. A distal end 312 of the flexible movable element 3 is directly connected to the balloon 50. A space 11 between the distal piston 8 and the proximal piston 9 is filled with an incompressible fluid so that a movement of the proximal piston 9 can be transferred to the distal piston 8 through the incompressible fluid.

When looking further into the structure of the probe 1, it can be seen that the flexible movable element 3 is formed as a wire 31. The wire 31 is specifically formed as a hollow cylinder and includes a liquid flexible movable element channel 310, which is in fluid communication with the inflatable balloon 50.

Figure 1 shows the balloon 50 in an inflated state protruding from the catheter sheath 2. When the balloon 50 is collapsed, i.e. deflated, the balloon 50 may be completely within the lumen 21 of the catheter sheath 2. Alternatively, the balloon 50 it may be placed in its deflated state partially within the lumen 21 and partially within the distal sheath wall opening 25, or completely within the distal sheath wall opening 25. It is, however, also possible for the balloon 50 to be directly disposed in the catheter sheath 2, specifically in the wall of the catheter sheath 24. For example, the balloon 50 may be formed to completely surround the catheter sheath 2.

The wire 31 is removably arranged in the lumen 21 between a first end position and a second end position. In particular, the wire 31 is arranged in the catheter sheath 2 in such a way that the wire 31 is supported circumferentially by the wall of the catheter sheath 24 so that a movement of the proximal plunger 9 in a direction from the proximal end of the sheath 29 to the distal end sheath 28 of the catheter sheath 2 causes movement of the surgical tool 5. In other words, the wire 31 is configured so that a movement of the distal plunger 8 caused by a movement of the proximal plunger 9 in the direction toward the distal sheath end 28 of the sheath catheter 2 causes the wire 31 to move in such a way that the balloon 50 is also mobile. This is made possible because due to the peripheral/lateral support provided by the sheath wall 24 the rather flexible wire 31 acts as a stiffening element when a pushing force is applied to the distal sheath end 28 of the catheter sheath 2. However, the wire 31 remains capable of bending together with the sheath of the catheter 2 when the catheter 1 is guided through a curved path into the body of a patient.

For this purpose, an outer diameter of the wire 31 is preferably at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, of a diameter of the lumen 21. Advantageously, a fit between the wire 31 and the lumen 21 is a tolerance fit.

In particular, the wire 31 is longitudinally movable, especially slidable, between the first extreme position and the second extreme position.

At the first end position, the wire 31 is pulled fully rearward toward the proximal sheath end 29 of the catheter sheath 2, while at the second end the wire 31 moves fully forward toward the distal sheath end 28 of the catheter sheath 2.

A movement of the wire 31 towards the distal end of the sheath 28 of the catheter sheath 2 results in movement of the balloon 50 towards the distal end of the sheath 28 and eventually outside the catheter sheath 2 through the distal sheath wall 25. Figure 1 shows the second end position of the wire 31. Accordingly, a movement of the wire 31 towards the proximal end 28 results in movement of the balloon 50 towards the proximal end of the sheath 29.

To control the movement of the balloon 50, the catheter 1 further comprises a control means 7.

More specifically, the control means 7 comprises a control element 71 connected to the proximal piston 9. The control element 71 may be formed as a rigid control element, namely a sheath.

To cause movement of the balloon 50, the physician must push or pull the control element 71.

A push movement of the control element 71 indicated by arrow 701 is transferred to the proximal piston 9, from the proximal piston 9 to the distal piston 8 through the incompressible fluid, and from the distal piston 8 through the wire 31 to the balloon 50.

On the other hand, a pulling movement of the control element 71 indicated by the arrow 702 causes a pulling movement of the proximal plunger 9. The movement of the proximal plunger 9 towards the proximal sheath end 29 of the catheter sheath 2 causes a build-up of negative pressure in the space 11 between of the distal piston 8 and the proximal piston 9, which results in the movement of the distal piston 8 towards the proximal end of the sheath 29.

For the purpose of inflating the balloon 50, the liquid channel of flexible movable element 310 is in fluid communication with a liquid channel of control means 75 of the control means 7 by a conduit 10. Specifically, the control means the liquid channel 75 consisting of a liquid control element channel 711 formed in the control element 71. Thus, liquid can be delivered to the balloon 50 through the control element liquid channel 711, the conduit 10 and the flexible moving element channel 310. To this end, the remote piston 8 and the proximal piston 9 is hollow. In the present embodiment, the duct 10 can be connected to the peripheral piston 8 and the proximal piston 9 in their respective hollow parts.

As an alternative to the structure of the control element 71 , it is also possible for the control element 71 to be constructed as a flexible control element. For example, the control element 71 may be formed as a cylindrical hollow wire like the flexible movable element 3. In this case, the flexible control element 71 is arranged within the lumen 21 in such a way that the control element 71 is supported peripherally by the wall of the catheter sheath 24 so that the proximal piston 9 is movable from the control element 71. For this purpose, the outer diameter of the control element 71 is preferably at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, of a diameter of the lumen 21. Advantageously, an arrangement between the control element 71 and the lumen 21 is a tolerance adjustment. Specifically, the control element 71 is longitudinally movable, especially slidable, between a first extreme position and a second extreme position. At the first extreme position, the control element 71 is at its most distant position from the distal end of the sheath 28 of the catheter sheath 2 and preferably partially disposed within the lumen 21, while at the second end the control element 71 is at its closest position to the distal sheath end 28 and preferably partially arranged within the lumen 21. It is noted that a peripheral surface of the control element 71, namely with a length corresponding to the length of the operating element 71, which is arranged outside the lumen 21 at the first extreme position of the operating element 71, may be rigid or equipped with a handle. In this way, a manipulation of the flexible control element 71 by a doctor can be made easier.

The tip 201 and a portion of the main part 200 of the catheter sheath 2 including the distal sheath wall 25 are inside the patient's body during use of the catheter 1, while the remaining main part 200 of the catheter sheath 2 is outside the patient's body. Furthermore, the proximal plunger 9 is preferably located outside the patient's body when the catheter 1 is inserted into the patient. The control element 71 is partially outside the patient's body when the catheter 1 is inserted into the patient, so that the movement of the proximal piston 9 can be controlled and thus that of the inflatable balloon 50.

The catheter sheath 2 also includes a further lumen 22, defined by the catheter sheath wall 24 and into which a guide wire 100 can be placed. The further lumen 22 is specifically parallel to the lumen 21 and extends in a direction parallel to the longitudinal axis 500 of the catheter sheath 2. Both lumens 21, 22 are formed as circular cylinders.

The catheter 1 of the present embodiment can for example be used in a nasogastric application. In such an application, a catheter must typically be placed within the patient's stomach and maintained in place so that it cannot be accidentally withdrawn from the patient's body. In addition, gastric contents must be prevented from refluxing into the esophagus.

To achieve this, the catheter 1 of the present embodiment is first inserted through the patient's nose past the throat and into the esophagus. It is noted that due to the fact that the passages through which the catheter 1 must be advanced until the stomach is accessed are of relatively large size and relatively small torque, the guidewire 100 may be omitted from the catheter 1 of the present embodiment. Catheter 1 is then advanced into the stomach such that the distal sheath end 28 of catheter sheath 2 passes through the gastroesophageal junction and a significant length of catheter sheath 2 is within the stomach. Next, the physician pushes the control element 71 toward the distal sheath end 28 of the catheter sheath 2, whereby the deflated balloon 50 moves toward the distal sheath end 28 and exits the catheter sheath 2 through the distal sheath wall opening 25, as illustrated in Figure 1. Next, the physician may inflate the balloon 50 by supplying fluid to it though the control means fluid channel 75, the conduit 10, and the fluid channel of the flexible movable element 310. By keeping the balloon 50 inflated, the physician draws the control element 71 toward the proximal end 29 of the catheter sheath 2, thereby causing the balloon 50 to also be drawn toward the proximal end 29 of the catheter sheath 2. However, since it is still inflated, the balloon 50 cannot return into the lumen 21 or esophagus and thus, the catheter sheath 2 can be safely placed on the patient's body.

Figures 2 to 5 refer to a catheter 1 according to a second embodiment of the present invention.

Similarly to the catheter 1 of the first embodiment, the catheter 1 of the second embodiment includes a catheter sheath 2, a flexible movable member 3, a surgical tool 5 which is an inflatable balloon 50, a distal plunger 8, a proximal plunger 9 and a control means 7 to control the 50 balloon.

However, in the catheter 1 of the present embodiment, the balloon 50 is not directly connected to the flexible movable member 3, but is fixed to a tool housing housing 6 formed as a hollow circular cylinder extending along a longitudinal axis 600. The longitudinal axis 600 of the housing tool holder 6 coincides with the longitudinal axis 500 of the probe sheath 2.

Specifically, the tool receiving housing 6 is arranged in the probe sheath 2 and can be moved in the direction of the longitudinal axis 500 of the probe sheath 2. This is indicated by arrows 601 and 602. Specifically, the arrow 601 indicates a movement of the receiving housing tool 6 in the direction from the proximal sheath end 29 to the distal sheath end 28, while arrow 602 indicates a movement of the control handle 70 in the opposite direction. The inflatable balloon 50 fixed to the tool housing 6 is thus also movable in the direction of the longitudinal axis 500 of the catheter sheath 2.

As can be seen from figures 2 and 3, the control means 7 for controlling the movement of the balloon 50 includes a control element 71 and a control handle 70, which are connected to each other.

The control handle 70 is formed as a hollow circular cylindrical control housing extending in the direction of a longitudinal axis 700. The longitudinal axis 700 of the control housing coincides with the longitudinal axis 500 of the catheter sheath 2. The control housing is specifically formed in the catheter sheath 2 and can be moved in the direction of the longitudinal axis 500 of the catheter sheath 2. This is indicated by arrows 701 and 702. Specifically, arrow 701 indicates a movement of the control handle 70 in the direction from the proximal sheath end 29 to the distal sheath end 28 , while the arrow 702 indicates a movement of the control handle 70 in the opposite direction.

It is noted that the probe 1 of figure 3 is presented so that more details of the internal structure of the probe 1 are visible.

Specifically, it can be seen that, like the probe 1 of the first embodiment, the flexible movable element 3 of the probe 1 of the second embodiment is formed as a cylindrical wire 31 with a liquid flexible movable element channel 310 and it extends substantially along a longitudinal axis.

The tool housing 6 is fixed to the flexible movable element 3. More specifically, the tool housing 6 is connected to a distal end 312 of the flexible movable element 3, while the proximal end 311 of the flexible movable element 3 is connected to the distal piston 8. As in the catheter 1 of the first embodiment, the wire 31 is arranged within the lumen 21 so that the wire 31 is supported circumferentially by the wall of the catheter sheath 24 so that the balloon 50 can be pushed by the wire 31. Specifically, the diameter of the wire 31 is preferably at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, of a diameter of the lumen 21. Advantageously , a fit between wire 31 and lumen 21 is a tolerance fit.

The control element 71 is connected to the control handle 70 and the proximal piston 9. Due to the proposed device, a movement of the control handle 70 causes movement of the inflatable balloon 50. The control element 71 can be configured as a rigid control element, a partially flexible control element or flexible control element such as the control element 71 of the probe 1 of the previous embodiment.

For the passage of fluid to the control element 71 through the control handle 70 and from the tool housing 6 to the inflatable balloon 50, the control handle 70 includes a through opening 710 and the tool housing 6 a through opening 61, respectively.

Preferably, the flexibility of the wire 31 and/or the control element 71, if the latter is made as a flexible control element, can vary along their length. In particular, a distal portion and a proximal portion of the wire 31 and/or a distal portion and a proximal portion of the control element 71 may have less flexibility than the corresponding middle portions. In other words, the connecting portions of the wire 31 and/or the manipulation element 71 to the tool housing 6 and the manipulation housing 70 may have more stiffness than the rest of the wire 31. More specifically, the parts of the wire 31 that become less flexible from the rest are the parts intended to be placed outside or to come out of the lumen 21 of the catheter sheath 2 during its movement.

As further shown in Figure 3, the catheter sheath 2 includes in addition to the distal sheath wall opening 25 a proximal sheath wall opening 26 formed in a proximal peripheral region of the catheter sheath 2. The proximal sheath wall opening 26 communicates with the lumen 21 .

It is noted that in its first end position, the wire 31 is partially disposed within the lumen 21 and partially in the distal sheath wall opening 25, while in the second end position the wire 31 may be partially or fully disposed in the distal sheath wall opening 25 Accordingly, in the first end position, the control element 71 may be partially or fully seated in the proximal sheath wall opening 26, while in the second end position the control element 71 is arranged partially in the proximal sheath wall opening 26 and partially in the lumen 21.

In addition to being arranged in the probe sheath 2, the tool housing 6 is also rotatably arranged in the probe sheath 2. Specifically, the tool housing 6 and the probe sheath 2 of the probe 1 are threadedly connected to each other .

Figure 4 shows that a right-hand thread 81 is formed in the wall of the catheter sheath 24 of the catheter sheath 2 in the region of the distal sheath wall 25. The right-hand thread 81, which is an external thread, is engaged with a corresponding internal thread of tool holder housing 6.

Specifically, the thread 81 of the probe sheath 2 and the corresponding thread of the tool housing 6 are formed so as to form a movement of the control handle 70 in the direction of the longitudinal axis 500 of the cat. The axis 2 causes the tool housing 6 to rotate around the longitudinal axis of 600 combined with movement of the tool housing 6 in the direction of the longitudinal axis 600. In other words, the tool housing 6 is configured to perform a helical movement. This means that a force with which the control handle 70 moves in the direction of the longitudinal axis 700 is translated into a helical movement of the tool housing 6. It is noted that the rotation of the tool housing 6 causes the wire 31 to twist, as the distal opening 8 cannot be rotated. Therefore, the wire 31 must be configured to allow rotational movement.

Due to the threaded engagement of the tool housing 6 and the probe sheath 2 with each other, the tool housing 6 can move in the direction of the longitudinal axis 500 of the probe sheath 2 in a controlled manner.

To facilitate rotation of the tool housing 6, the distal opening of the sheath wall 25 is formed as a recess extending through the catheter sheath wall 24 in the direction of the transverse axis 502. Specifically, the circumferential opening of the sheath wall 25 is shaped so that to allow rotation of the tool housing by 6 to 90 degrees in each direction with respect to a plane of symmetry 503 of the probe sheath 2.

To simplify the manufacturing process of the catheter sheath 2, the proximal sheath wall opening 26 is also formed as a recess extending through the catheter sheath wall 24 in the direction of the transverse axis 502. However, since the control handle 70 formed as a housing is not needs to be rotatably mounted in the catheter sheath 2, the proximal opening of the sheath wall 26 may also be formed to prevent rotation of the control handle 70.

Such a proximal sheath wall opening 26 is provided in the catheter 1 according to a fourth embodiment of the present invention which will be described later in relation to Figures 6 and 7.

Figure 5 relates to a catheter 1 according to a third embodiment of the present invention.

The catheter 1 according to the third embodiment differs from the catheter 1 of the second embodiment in that the catheter sheath 2 of the catheter 1 of the third embodiment includes a right-handed threaded area 81 and a left-handed threaded area 82. The right-handed thread 81 and the left-handed threads 82, which are formed as an external thread in the catheter sheath 24 and are placed in the region of the distal opening sheath wall 25, are engaged with a right-handed thread and a left-handed thread of the tool holder housing 6, respectively. The left-hand thread and the right-hand thread of the tool holder housing 6 are formed as internal threads on an inner surface of the tool holder housing 6.

The threads 81 , 82 of the probe sheath 2 and the corresponding threads of the tool housing 6 are formed so that the movement of the control housing 70 in the direction of the longitudinal axis 700 causes helical movement of the tool housing 6.

The provision of threads of different directions in the tool housing 6 and the catheter shaft 2 is advantageous as the rotation of the balloon 50 clockwise and counterclockwise makes the movement of the balloon 50 through narrow passages in the patient's body even easier compared to a thread of the same direction . Furthermore, when the balloon 50 is inflated and anchored in a patient's body lumen, the rotation of the tool housing 6 and thus the balloon 50 is converted into a corresponding rotation of the catheter sheath 2, which allows the catheter shaft 2 to be compressed and advanced through narrow passage of the lumen.

Figures 6 and 7 refer to a catheter 1 according to a fourth embodiment of the present invention.

The catheter 1 according to the fourth embodiment differs from the catheter 1 of the second embodiment in the way the distal sheath wall 25 and the proximal sheath wall opening 26 are formed and the arrangement of the control handle 70 relative to the catheter shaft 2.

Fig. 6 shows a perspective view of a part of the catheter 1 according to the fourth embodiment, while Fig. 7 shows a more detailed view of the arrangement of the flexible movable element 3 in the lumen 21 of the catheter 1. As the lumen 21 basically corresponds to a hollow area of the catheter sheath 2 and is defined by the catheter sheath wall 24, the catheter sheath wall 24 is also illustrated in Figure 6. However, to enable clearer view, only a portion of the catheter sheath wall 24 required to define and a graphic representation of lumen 21 is shown in figure 7.

In the catheter 1 according to the present embodiment, both sheath wall openings 25, 26 are formed as elongated openings so that the tool housing 6 and the control handle 70 can only move in the direction of the longitudinal axis 500 of the catheter sheath. 2. In other words, the tool housing 6 and the control handle 70 are not rotationally arranged in the catheter sheath 2 and thus, the balloon 50 loaded in the tool housing 6 can also only move in the direction of the longitudinal axis 500 .

Figures 8 and 9 refer to a catheter 1 according to the fifth embodiment of the present invention.

The basic structure, namely the means for moving the distal plunger 8 towards the distal sheath end 29, of the catheter 1 according to the fifth embodiment generally corresponds to the basic structure, namely the means for moving the plunger booth 8 towards the tip of the axis stand 29, of the probe 1 of the first embodiment, respectively.

In other words, for the movement of the distal piston 8, the probe 1 of the fifth embodiment includes an arrangement of a control element 71, a proximal piston 9, and a space 11 between the proximal piston 9 and the distal piston 8 that is filled with an incompressible fluid like the corresponding probe arrangement 1 of the first embodiment.

The means for transferring a movement of the remote piston 8 to the surgical tool 5 correspond to the means for transferring a movement of the remote piston 8 to the balloon 50 of the catheter 1 according to the second embodiment. In other words, to cause movement of the surgical tool 5 by movement of the distal piston 8, the catheter 1 of the fifth embodiment includes a receiving tool 6 and a flexible movable member 3, which are generally formed as those of the catheter 1 of the second embodiment .

However, a difference between the catheter 1 of the present embodiment and that of the first or second embodiment is that the surgical tool 5 loaded in the tool housing housing 6 of the catheter 1 of the fifth embodiment is a cutting device 51 instead of an inflatable balloon. .

In addition, since there is no need to supply liquid to the cutting device 51 , the control means liquid channel 75 and the liquid channel of the flexible movable element 310 of the flexible movable element 3 are not provided in the probe 1 of the present embodiment. Thus, the control element 71 and the flexible movable element 3 are formed as solid (not hollow) elements. In this context, also the duct 10 and the opening 61 of the tool housing 6 are not provided in the probe 1 of the present embodiment.

For example, the cutting device 51 may be an atherotomy blade. Catheter 1 can then be used as an endovascular catheter to cut an atheroma (atherosclerotic plaque), i.e. an abnormal accumulation in the inner layer of the wall of a blood of an artery.

To achieve this, catheter 1 will be placed close to the atheroma within the affected artery. Next, the physician can move the control element 71 toward the atheroma, thereby causing the atherotomy blade to move toward the atheroma and ultimately cut it.

For more effective movement of the cutting device 51 towards the proximal sheath end 29 of the catheter sheath 2, i.e. for retraction of the cutting device 51, a connecting means 12 can be provided between the distal piston 8 and the proximal piston 9. The connection means that the 12 supports the effect of the negative pressure that accumulates in the space 11, when the proximal piston 9 moves towards the proximal sheath end 29 of the catheter sheath 2 by pulling the control element 71.

The catheter 1 according to the present embodiment can also be used as a urological catheter in a prostatectomy procedure. In this case, the cutter 51 is a prostate cutter.

Figures 10 and 11 refer to a catheter 1 according to the sixth embodiment of the present invention.

The catheter 1 according to the sixth embodiment differs from the catheter 1 according to the second embodiment in that the tool housing 6 also serves as a control handle for controlling the movement of the surgical tool 5, in this case the inflatable balloon 50.

In other words, the tool housing 6 and the control handle 70, namely the control housing in the probe 1 of the second embodiment correspond in functional terms to the tool housing 6 of the probe 1 of the sixth embodiment. By using an alternative composition, the tool housing 6 of the probe 1 of the sixth embodiment can be described as the tool housing 6 and the control handle 70 of the probe 1 of the second embodiment integrated with each other, or in other words, made into one piece only.

To serve the purpose of controlling the movement of the balloon 50, the tool housing 6 extends from a proximal portion to a distal portion of the catheter sheath 2. Specifically, the tool housing 6 has a length that allows it to be partially disposed within and partially outside the patient's body. In particular, the length of the tool receiving housing may exceed 70%, preferably more than 80%, and less than 100% of the length of the catheter sheath 2. Furthermore, the tool receiving housing 6 is connected to the proximal piston 9 by the control 71.

Thus, as specifically shown in Figure 11, the tool housing 6 is distally connected to the flexible movable member 3 and proximally connected to the control element 71. A force applied by the physician to the tool housing 6 in the proximal region 63 is transferred to distal region 62 of the tool housing 6 through the control element 71, the proximal piston 9, the incompressible fluid, the distal piston 8 and the flexible movable element 3;

Figure 12 shows a perspective view of a portion of a catheter 1 according to a seventh embodiment of the present invention.

The probe 1 according to the seventh embodiment generally corresponds to the probe 1 of the sixth embodiment.

However, unlike the probe 1 of the sixth embodiment, the probe 1 according to the seventh embodiment has a probe shaft 2 and a tool housing housing 6 of different shapes.

More specifically, the tool housing housing 6 is formed as a hollow circular cylinder, while the probe sheath 2 preferably includes at least one region with a different cross-section in the direction of the longitudinal axis 500. Thus, an inner surface of the tool housing housing 6 and an outer surface of catheter sheath 2 do not complement each other.

In particular, the catheter sheath 2 includes a plurality of conical regions in the present embodiment. The conical regions are specially extended and arranged in the direction of the longitudinal axis 500 of the catheter sheath 2 so that the catheter sheath 2 and the tool housing 6 contact each other only partially when moving together.

It is noted that it is also possible for the probe sheath 2 to include areas of a different shape and/or with a different arrangement from each other, since the probe sheath 2 and the tool housing 6 do not come into full contact with each other.

What is achieved by the described configuration of the probe 1 is that the sliding friction between the probe sheath 2 and the tool housing 6 can be reduced.

Figure 13 shows a cross-section of a tool housing 6 of a probe 1 according to an eighth embodiment of the present invention.

The catheter 1 according to the eighth embodiment differs from the catheter 1 according to the sixth embodiment in that the balloon 50 is equipped with liquid through a lumen housing 64 formed in the wall of the housing receiving the tool 6, and not through the control means fluid channel 75, the duct 10, the flexible movable element channel 310 and the opening 61 of the instrument housing 6. However, it is possible that both described routes for the supply of fluid to the balloon 50 are provided in the catheter 1.

Since the housing lumen 64 must be accessible from the outside of the patient's body, the housing lumen 64 advantageously extends from the proximal portion 63, namely a proximal end, to a distal portion 62 of the tool receiving housing 6. In this case. , the opening 61 of the tool housing housing 6 is formed so as to create a fluid connection between the housing lumen 64 and the inflatable balloon 50.

Figure 14 shows a cross-sectional view of a tool housing housing 6 of a probe 1 according to a ninth embodiment of the present invention.

The probe 1 of the ninth embodiment generally corresponds to the probe 1 according to the second embodiment.

The only difference is that the tool housing 6 of the probe 1 of the ninth embodiment includes an open cross-section. Preferably, the tool housing 6 is formed with an open cross-section along its entire length.

Due to this design, the flexibility of the tool housing 6 is increased compared to a tool housing 6 with a closed cross-section such as that of the probe 1 of the second embodiment. This allows the catheter 1 to be more easily advanced through narrow passages and tortuous lumens of the patient's body.

Next, a general principle of operation of an inflatable balloon catheter 1 50 according to the present invention will be described with reference to Figures 15 and 16. Figure 15 shows the catheter 1 in first and second states within a body lumen 800, while figure 16 shows the probe 1 in a third and a fourth state within the lumen of the body 800.

In the first state, which is represented by broken lines in figure 15, the probe 1 is positioned at the point of interest within the body lumen 800, while the inflatable balloon 50 is deflated. Next, the physician inflates the balloon 50 and manipulates the catheter 1 so that the catheter sheath 2 is advanced into the body lumen 800. To achieve this, the doctor will push the probe shaft 2 forward. The state in which the catheter sheath 2 has moved forward and the balloon 50 is inflated corresponds to the second state of the catheter 1. The second state of the catheter 1 is represented by solid lines in figure 15.

Next, the doctor deflates the balloon 50 while the catheter sheath 2 remains in place. This state corresponds to the third state and is represented by dashed lines in figure 16.

After the step of deflating the balloon 50, the doctor will manipulate the catheter 1 so that the balloon 50 moves forward and relative to the sheath of the catheter 2. This corresponds to the fourth state of the catheter and is shown in figure 16 with solid lines .

The process can be repeated until the catheter sheath 2 is advanced the desired distance, e.g. distance corresponding to the occlusion length in the lumen 800 of the body.

A more detailed operation of a probe 1 according to the present application will be presented in the following.

First, an intravascular application of a catheter 1 of the present invention will be described in detail. In this case, the catheter 1 can also be characterized as an intravascular catheter. The surgical tool 5 is preferably an inflatable balloon 50.

More specifically, a catheter 1 of the present invention can be used as a support catheter to provide support to the guide wire 100 when pushed through a narrowing of a blood vessel, e.g. artery. Such a blockage can be caused by the build-up of a substance called plaque on the inner walls of the artery. Blood that flows over the top of the plaque tends to clot and thus can cause a further increase in the narrowing of the artery, which can eventually lead to blockage of the artery and consequently total occlusion.

In order to open an artery narrowed by the plaque, a single guide wire may be used. Specifically, the guidewire can be fed to the site of the blockage and pushed through the narrowing of the artery. However, if the occlusion is large and the plaque hardens, the use of a single guidewire proves insufficient, as the guidewire bends at its tip due to its flexibility and therefore cannot be advanced through the occlusion.

This problem can be overcome by using a probe 1 according to the present invention.

First, the catheter 1 is advanced to the point in front of the obstruction and the guide wire 100 is pushed forward so that it exits the end opening of the catheter sheath 2. Due to the support of the guide wires 100 by the catheter sheath 2, the guide wire 100 is able to pass through a first portion of the occlusion. If the surgeon operating the catheter 1 continues to push on the guidewire 100, the guidewire 100 may be pushed a little further through the obstruction, but will eventually reach a point where further pushing by the surgeon will cause the guidewire 100 to begin to bend, which in turn will cause catheter shaft 2 to begin to push against the arterial wall.

Once the surgeon realizes that the catheter sheath 2 tends to push against the arterial wall, the surgeon stops pushing the guide wire 100 further and inflates the balloon 50 until it is anchored to the arterial wall. This provides a further support to the guidewire 100 so that the guidewire 100 can now be pushed further through the occlusion. Again, when the guidewire 100 is pushed to the extent that a certain length is outside the catheter sheath 2, the support of the catheter sheath 2 will no longer be sufficient to prevent the guidewires 100 from bending if the guidewire 100 is pushed further. As this bending would occur within the blockage, this could cause some damage or ever perforate the artery.

At this stage, while the balloon 50 is inflated, the surgeon immobilizes the catheter component 1 provided for controlling the movement of the balloon 50 and pushes the catheter sheath 2 forward. In this way, the force with which the surgeon pushes the catheter sheath 2 is transferred to the balloon 50, which is actually what pushes the catheter shaft 2 through the occlusion. As the catheter sheath 2 has moved forward, the guide wire 100 is again almost completely covered by the catheter shaft 2. The reason for the catheter sheath 2 being able to move forward through the occlusion is that the balloon 50 is very close to the site of the obstruction and thus the force with which the catheter sheath 2 is pushed towards the obstruction is high enough so that the catheter sheath 2 can overcome the resistance through the obstruction.

Next, the surgeon pushes the guidewire 100 forward once more. The guide wire, again supported by the catheter sheath 2, manages to advance further through the occlusion until the guide wire 100 begins to bend again, when the length of the guide wires 100 is no longer covered by the catheter sheath 2 has again reached a certain length.

The surgeon then repeats the process until catheter sheath 2 is able to pass through the obstruction.

If the obstruction is of considerable length, the maximum distance that the catheter sheath 2 and the balloon 50 can move relative to each other may not be large enough for the catheter sheath 2 to cover the entire length of the obstruction by alternately moving the guidewire 100 and probe shaft 2 as described above.

In this case, after the catheter sheath 2 has moved relative to the balloon 50 as far as possible after performing the aforementioned steps, the surgeon will deflate the balloon 50 while stabilizing the catheter sheath 2 and move it toward the forward by advancing the catheter component 1 controlling the balloon 50. After bringing the deflated balloon 50 to the new desired location, the surgeon inflates the balloon 50 so that it is anchored to the arterial wall in the new desired location.

Subsequently, the steps of alternating movements of the guide wire 100 and the catheter sheath 2 as shown above can be repeated, thus allowing the supported guide wire 100 to be pushed further and finally out of the obstruction.

The surgeon can now deflate the balloon 50 and withdraw the catheter 1 of the present invention from the patient, holding the guide wire 100 in place. At this point, only the guidewire 100 is inside the patient's body. Specifically, the tip of the guide wire 100 is located in a healthy portion of the artery after the occlusion. The guidewire 100 can then serve as a guide to bring a stented catheter to the site of the occlusion.

In summary, the process of diffusing an occlusion in an artery using catheter 1 according to the present invention involves alternating forward movements of the guidewire 100 and the catheter sheath 2, while the balloon is in an inflated state, so that the guidewire 100 rests always from probe axis 2 when moving forward. In case the occlusion is of considerable length, the process additionally includes the step of deflating the balloon 50 when the catheter sheath 2 has moved the maximum possible distance relative to the balloon 50, the step of subsequently moving the balloon 50 forward to a new location closer to or even within the occlusion and the balloon anchoring step 50 in the new location in order to again provide support to the guide 1 and 0 the catheter sheath 2.

It is noted that at the beginning of the procedure the balloon 50 will generally be outside, more specifically in front of the obstruction, while gradually it will be placed closer to the point of obstruction or even inside the enlarged portion of the obstruction.

With the balloon 50 inflated and anchored within the artery, a force applied to the balloon 50 that would otherwise cause the balloon 50 to move relative to the catheter sheath 2 is translated into movement of the catheter sheath 2 relative to the balloon 50 and the artery. Thus, the catheter sheath 2 can be moved within the artery precisely and forcefully both forward and backward due to the inflated-anchored balloon 50. In particular, the balloon 50 can have a range of motion of a few centimeters near the tip 201 of the catheter sheath 2. This practically means that the propulsive force moving the catheter sheath 2 is applied close to the tip 201 , achieving a maximum thrust of the tip 201 and thus of the catheter sheath 2 as a whole, since the propulsive force is applied at a distance closer to end 201.

Next, a nasogastric application of a catheter 1 of the present invention will be described. In this case, the catheter 1 can also be characterized as a nasogastric catheter and can be used to gain access to the stomach and its contents, allowing the drainage of gastric contents or preventing reflux of gastric contents into the esophagus, decompression of the stomach, obtaining a sample of gastric contents or inserting a transit into the gastrointestinal tract.

The surgical tool 5 is preferably an inflatable balloon 50.

According to a first technique, the doctor inserts the catheter 1 through the patient's nose, past the throat and down into the stomach and places it in a position where the gastric contents can be drained. At this stage, the balloon 50 is in a deflated state.

When it is ensured that the catheter sheath 2 is placed in the desired position, the physician inflates the balloon 50. Next, the physician moves the inflated balloon 50 toward the proximal end of the catheter sheath 2 by manipulating the catheter component 1 that controls the balloon 50, maintaining at the same time stable the sheath of the probe 2.

When the balloon 50 reaches the region of the gastroesophageal junction and contacts the upper wall of the stomach, it cannot move any further, since due to its inflated state the balloon has a larger cross-sectional area than the esophagus. At this time, the doctor feels in his hand that the catheter sheath 2 tends to move towards the stomach. The doctor immediately stops moving the balloon 50 further and stabilizes it in this position. By following these steps, it can be ensured that the catheter sheath 2, more specifically the distal end of the sheath 28, is securely placed in the desired location within the gastric contents, as the inflated balloon 50 prevents the catheter from being accidentally pulled out of the patient's nose. . Most importantly, the inflated balloon 50 isolates the stomach from the esophagus. In this way, gastric contents cannot enter the esophagus and there is no risk of aspiration pneumonia.

If it is preferred that the balloon 50 be anchored in the esophagus, the physician, after completing the aforementioned steps, deflates the balloon 50 and pulls it toward the esophagus while maintaining the position of the catheter sheath 2. When the balloon 50 is within the esophagus, the doctor can re-inflate the balloon 50 so that it is anchored in the esophagus.

According to a second technique, the doctor feeds the catheter 1 through the nose, past the throat into the patient's esophagus until, depending on the height of the patient, the catheter sheath 2 has entered the stomach but has not yet reached a position, into which the gastric contests may be drained. In other words, the peripheral sheath end 28 of the catheter sheath 2 is positioned so as not to be within the gastric contents. At this stage, the balloon 50 deflates and is in the patient's esophagus.

Next, the doctor inflates the balloon 50, thus anchoring it to the esophagus. Keeping the balloon 50 inflated and the component of the catheter 1 that controls the movement of the balloon 50 fixed so that the balloon 50 cannot move, the doctor pushes the sheath of the catheter 2 further into the patient's stomach. In addition to pushing the catheter sheath 2, the physician can rotate the catheter sheath 2 in order to achieve the desired position in the patient's stomach, i.e. to achieve that the peripheral sheath end 28 of the catheter sheath 2 is positioned within the gastric contents. When the desired position is reached, the doctor stabilizes the balloon 50, thus also stabilizing the catheter 1 in the desired position.

In the event that the inflated balloon 50 needs to remain inside the patient's esophagus for a longer period of time, what may cause complications for the patient, or if complications have already occurred due to the presence of the inflated balloon 50 in the patient's esophagus, the doctor may decide to reinsert the balloon 50 into the esophagus. For this purpose, the doctor will deflate the balloon 50 and move it to a new position, while maintaining the current position of the catheter sheath 2. After that, the doctor will re-inflate the balloon 50, thus fixing it in its new position. position in the esophagus. In this way, already existing complications can be treated or future complications can be avoided, since the balloon 50 will not press the esophagus in the same position for the entire time that the catheter 1 is placed inside the patient. The particular advantage of the catheter 1 of the present invention is that the repositioning of the balloon 50 can be done without having to first remove the catheter 1 from the patient and/or having to use a new catheter of a different length.

According to a third technique, the surgeon inserts the catheter 1 through the nose, past the throat, esophagus and stomach and into the duodenum of the small intestine. At this stage, the balloon 50 is in a deflated state and is within the stomach. The balloon 50 is then inflated and moved proximally while the catheter sheath 2 is stabilized. Similarly to the second technique, when the balloon 50 reaches the region of the gastroesophageal junction and contacts the upper wall of the stomach, it cannot move further as it has a larger cross-sectional area than the esophagus due to its distended state. At this time, the doctor feels in his hand that the catheter sheath 2 tends to move towards the stomach. The surgeon immediately stops moving the balloon 50 further and stabilizes it in this position. In the event that the surgeon wishes to move the balloon to a new location within the esophagus, the balloon 50 must first be deflated and then moved proximally across the gastroesophageal junction. When the new desired position within the esophagus is reached, the balloon 50 is inflated again. Alternatively, the balloon 50 may be repositioned within the esophagus. This is particularly advantageous if the catheter sheath 2 is to be advanced in a subsequent step into the small intestine further than the duodenum.

A further nasogastric application of catheter 1 of the present application is described below.

More specifically, a catheter 1 of the present invention can be used in the case of esophageal stricture, that is, narrowing or tightening of the esophagus that causes swallowing difficulties. The stricture usually occurs at the distal end of the esophagus.

First, the doctor inserts the catheter 1 through the nose and then the throat into the patient's esophagus until the end 201 of the catheter sheath 2 reaches the point of stricture. During this step, the balloon 50 of the catheter 1 is in a deflated state and is inside the esophagus. At this point, the physician inflates the balloon 50, which is thus anchored to the esophagus, thereby providing support to the tip 201 of the catheter sheath 2. If, instead, the physician continued to push the catheter sheath 2 forward with the balloon 50 to deflate, the catheter sheath 2 which was unable to pass through the stricture would begin to bend and coil within the esophagus.

Following the inflated step of the balloon 50, the physician pushes the catheter sheath 2 forward while stabilizing the catheter component 1 that controls the movement of the balloon 50. In this way, the physician transfers the force with which the catheter sheath 2 is pushed into the inflated balloon 50, which is actually what pushes the catheter shaft 2 through the stricture. The fact that the catheter sheath 2 manages to pass through the stricture is based on the fact that the balloon 50 is anchored in the esophagus near the stricture and so the force with which the balloon 50 pushes the catheter sheath 2 is high enough to overcome the resistance of narrowness.

The catheter sheath 2 is pushed into this state until it enters the stomach, more specifically since a significant length of the catheter sheath 2 is inside the stomach. Keeping the catheter sheath 2 stable, the physician now deflates the balloon 50 and pushes it forward by manipulating the component of the catheter 1 that controls its movement.

When the balloon 50 is inside the stomach, the doctor inflates it again. Next, the physician pulls the inflated balloon 50 toward the proximal end of the catheter sheath 2 until the physician feels resistance due to the balloon 50 touching the upper walls of the stomach. Holding the catheter component 1 that controls the movement of the balloon 50 steady, the physician now pushes the catheter shaft 2 forward. Again, the balloon 50 is the component of the catheter 1 that causes the sheath of the catheter 2 to be advanced further into the stomach. When the desired position is achieved, the physician stops pressing on the catheter sheath 2 and stabilizes the balloon 50 in the catheter sheath 2.

Finally, the urological use of catheter 1 of the present invention will now be described. In this case, the catheter 1 can also be characterized as a urological catheter.

More specifically, the catheter 1 of the present invention can be used in the case of urethral stricture. A urethral stricture involves scarring that narrows the lumen that carries urine out of the urethra and thus restricts the flow of urine from the bladder, thereby increasing the risk of a variety of medical problems in the urinary tract, including inflammation or infection. In particular, narrowing of the urethra can occur due to enlargement of the prostate (prostatic hyperplasia).

In order to gain access to the bladder, the doctor can insert the catheter 1 of the present invention into the patient's urethra up to the narrowing in the prostate area.

The procedure to be followed to enter catheter 1 into the bladder is similar to that followed in the case of esophageal stricture. At the end of the procedure, the distal end 28 of the catheter sheath 2 is inside the bladder, while the catheter sheath 2 cannot be accidentally removed from the patient's body due to the inflation of the balloon 50 inside the bladder and in contact with the lower its walls.

Figure 17 shows a portion of the T catheter according to an example.

As can be seen from figure 17, the catheter T includes a catheter sheath 2' with a tip 20T and a main portion 200' attached to each other. Catheter sheath 2' extends along a longitudinal axis 500' between proximal end of sheath 29' and shaft stand 28'.

A first lumen 2T, a second lumen 23' and a third lumen 22' are formed in the catheter sheath 2'. The third lumen 22' is configured to receive a guide wire and/or to pass fluid therethrough. The first lumen 2T and the second lumen 23', which extend parallel to the longitudinal axis 500', are connected to each other by a curved lumen connection 213'. In particular, the first lumen 21' and the second lumen 23' are connected to each other at their respective distal ends. Their proximal ends are not connected to each other. This means that the first lumen 2T, the second lumen 23' and their curved lumen connection 213' together form an open loop lumen.

The catheter T further comprises a tool receiving housing 6', which is movable in the longitudinal direction, namely slidable, arranged in the sheath of the catheter 2' and to which a surgical tool 5', namely an inflatable balloon 50', is fixed. The tool housing 6' extends along a longitudinal axis 600', coinciding with the longitudinal axis 500'.

For the movement of the surgical tool 5', an arrangement of a first flexible element 4T and a second flexible element 42' is provided which are connected to each other. The first flexible element 4T is movably arranged in the first lumen 2T but not in the second lumen 23' and the curved lumen connection 213'. The second flexible member 42' is arranged in the second lumen 23' and the curved lumen connection 213' so as to be movable in the second lumen 23', the curved lumen connection 213' and the first lumen 2T. Thus, the first and second flexible elements 4T, 42' form an open flexible element loop. As can further be seen from Figure 17, both the first and second flexible elements 41', 42' have a much smaller outer dimension, namely diameter, compared to the inner dimension, namely diameter, of the second lumen 23', the curve connection of lumen 213' and the first lumen 21'.

The first flexible element 4T is connected to the tool housing housing 6', so that a movement of the first flexible element 4T causes the movement of the tool housing housing 6'. In particular, in order to move the surgical tool 5' towards the distal end of the sheath 28' of the catheter sheath 2, the second flexible element 42' must be pulled. Therefore, in order to move the surgical tool 5' towards the proximal sheath end 29' of the catheter sheath 2, the first flexible element 41' must be pulled. In other words, it becomes apparent that the movement of the surgical tool 5' in each of the directions towards the distal end of the sheath 28' and the proximal end of the sheath 29' is effected by a pulling force applied to the respective flexible element 41' or 42'. Thus it becomes apparent that the catheter 1' according to the example of figure 17 differs from the catheter 1 of the present invention, since in the catheter 1 of the present invention a movement of the surgical tool 5 towards the distal end of the sheath 28 can be carried out by a pushing force instead of pulling force.

To deliver liquid to the balloon 50', the first flexible element 41' is hollow. For example, the first flexible element 41' can be formed as a (hollow) wire. The first flexible member 4T may communicate with the balloon 50' through a distal sheath wall opening 25' formed in the catheter shaft wall 24'. The second flexible element 42' can, for example, be formed as a solid wire.

If the surgical tool 5' is not an inflatable balloon 50', the first flexible element 4T and the second flexible element 42' can be formed as a single flexible element which is immovably arranged in the first lumen 2T, the curved lumen connection 213' and the second lumen 23'. The single flexible element can then be formed as a solid (not hollow) flexible element such as a wire or thread.

The illustrated and described features and further properties of embodiments of the invention may be arbitrarily isolated and recombined without departing from the essence of the present invention.

In addition to the above description of the present invention, for an additional disclosure, reference is made to the graphical representation of Figures 1 through 16.

List of reference symbols

1 1 catheter

2 2 catheter sheath

3 flexible movable element

5, 5' surgical instrument

6 6 tool holder housing

7 means of control

8 remote piston

9 proximal piston

10 pipeline

11 space

12 binder

20 catheter sheath

21 lumen

21 first lumen

22 additional lumen

22 second lumen

23' third court

24, 24' catheter sheath wall

25, 25' distal sheath wall opening 26 proximal sheath wall opening

27 additional sheath wall opening

28, 28' distal sheath end

29, 29' proximal end of sheath

31 wire

41' first flexible element

42' second flexible element

50, 50' balloon

51 cutting device

61 opening

62 remote area

63 proximal region

64 casing lumen

70 control handle

71 controls

81 thread

2 thread

75 control fluid channel

100 guide wire

200, 200' main section

201, 201’ nose

213' curved shaft connection

310 fluid channel flexible movable element 311 proximal end

312 distal end

410 channel (second channel)

500, 500' longitudinal axis

501 regional direction

502 cross axle

503 plane of symmetry

600, 600' longitudinal axis

601 arrow

602 arrow

700 longitudinal axis

701 arrow

702 arrow

710 opening

711 liquid control element channel

800 body lumen

Claims (15)

Claims 1 .A catheter (1), comprising: • a catheter sheath (2) extending along a longitudinal axis (500) and comprising a lumen (21) defined by a catheter sheath wall (24); • a flexible movable element (3), • a surgical tool (5) connected to the flexible movable element (3), • a distal piston (8) and a proximal piston (9), where: the distal piston (8) and the proximal piston (9) are arranged within the lumen (21) and a space between the distal piston (8) and the proximal piston (9) is filled with an incompressible fluid, the distal piston (8) is connected to the flexible movable element (3), and the flexible movable element (3) is arranged within the catheter sheath (2) in such a way that the flexible movable element (3) is at least partially supported circumferentially by the catheter sheath wall (24), so that a movement of the proximal plunger ( 9) in a direction from a proximal sheath end (29) of the catheter sheath (2) to a distal sheath end (28) of the catheter sheath (2) to cause a movement of the surgical tool (5). The catheter (1) of claim 1, wherein the catheter sheath (2) includes a distal sheath wall opening (25) formed in a distal peripheral region of the catheter sheath (2) and communicating with the lumen (21) and/or or a proximal sheath wall opening (26) formed in a proximal peripheral region of the catheter sheath (2) and communicating with the lumen (21), and/or wherein the lumen (21) extends from the proximal sheath end (29) of the catheter sheath (2) or wherein a proximal end of the lumen (21) is spaced from the proximal sheath end (29) of the catheter sheath (2). 3. The catheter (1) of any of the preceding claims, wherein at least one part of the flexible movable element is movably arranged within the lumen (21) between a first end position and a second end position of the flexible movable element (3). has a bisector surface over at least a portion of its total length that is at least 80%, more preferably at least 85%, even more preferably at least 90%, even more preferably at least 95%, most preferably substantially 100%, of a surface cross-section of the lumen (21), and the wherein at least the part of the flexible movable element which is arranged to be able to move within the lumen (21) between a first end position and a second end position of the flexible movable element (3) has for at least a part of its total length the same shape as the lumen (21), in particular where at least the said part of flexible movable element and the lumen (21) are formed as circular cylinders, specifically where at least said portion of flexible movable element has over at least one portion of its total length a diameter that is at least 80%, more preferably at least 85%, more preferably at least 90%, even more preferably at least 95%, preferably substantially 100%, of a diameter of the lumen (21), and the wherein the flexible movable element (3) is arranged within the lumen (21) in such a way that the part of the flexible movable element which is arranged to be able to move within the lumen (21) between a first end position and a second end position of the flexible movable element (3) to have in at least one part of its total length a shape complementary to a shape of the lumen (21). The catheter (1) of any of the preceding claims, wherein the surgical tool (5) is directly connected to the flexible movable element (3) and/or wherein the surgical tool (5) is arranged to be movable in the longitudinal direction on of the catheter sheath (2), specifically where the surgical tool (5) is directly arranged on the catheter sheath (2). The probe (1) of any one of claims 1 to 3, further comprising a tool receiving housing (6) which is longitudinally movably arranged in the probe sheath (2), wherein the tool receiving housing (6) is connected to the flexible movable element (3) and wherein the surgical tool (5) is arranged on the tool housing (6) The probe (1) of claim 5, wherein the tool receiving housing (6) is rotatably arranged in the probe sheath (2), namely where the tool receiving housing (6) and the probe sheath (2) are threadedly connected between them. The probe (1) of any one of claims 5 or 6, wherein at least a portion of the tool housing (6) comprises an open cross-section. The catheter (1) of any one of claims 5 to 7, wherein the tool housing (6) is connected to the proximal plunger (9) and extends from a proximal portion to a distal portion of the catheter sheath (2), so so that the tool housing (6) serves as a control handle for controlling the movement of the surgical tool (5), namely where the tool housing (6) is connected to the proximal piston (9) via a control element (71 ), wherein the control element (71) is formed as a rigid control element, namely a sheath, connected to or integrally formed with the proximal piston (9); or wherein the control element (71) is formed as a flexible control element and is arranged such that the control element (71) is at least partially supported circumferentially by the wall of the catheter sheath (24) so that the proximal plunger (9 ) to be able to move towards the distal end of the sheath (28) of the catheter sheath (2) via the control element 1. The catheter (1) of claim 8, wherein in the surgical tool (5) is an inflatable balloon (50) and the tool receiving housing (6) includes a housing lumen (64) communicating with the inflatable balloon (50) for the inflation of the balloon (50). The catheter (1) of any one of claims 1 to 7, further comprising a control means (7) for controlling the movement of the surgical tool (5), wherein the control means (7) comprises a control element (71) , where the control element (71) is formed as a rigid control element, namely a sheath, connected to or integrally formed with the proximal piston (9); Pi wherein the control element (71) is formed as a flexible control element, which is connected to the proximal plunger (9) and is arranged in such a way that the control element (71) is at least partially supported circumferentially by the wall of the catheter sheath (24), so that the proximal piston (9) can be moved towards the distal sheath end (28) of the catheter sheath (2) via the control element (71). 11. The probe (1) of claim 10, wherein the control means (7) further comprises a control handle (70) connected to the control element (71), in particular where the control handle (70) is formed as a housing which can moves in the longitudinal direction, specifically sliding, arranged in the probe sheath (2). The catheter (1) of any preceding claim, wherein the distal plunger (8) and the proximal plunger (9) have the same or different plunger surface. The catheter (1) of any of the preceding claims, wherein the surgical tool (5) is an inflatable balloon (50), wherein the flexible movable element (3), the distal plunger (8) and the proximal plunger (9) is hollow and wherein the flexible movable element is in fluid communication with the balloon (50) and a conduit (10) arranged between the distal piston (8) and the proximal piston (9). The catheter (1) of claim 8 to 12, wherein the flexible movable element (3) and the flexible control element (71) are made as a single element connected to the distal piston (8) and the proximal piston (9 ) which are hollow to allow the single element to pass therethrough, particularly where the surgical tool (5) is an inflatable balloon (50) and the single element is hollow and in fluid communication with the balloon (50). 15. The catheter (1) any of the catheters (2) includes at least a receptacle for one of its guide wires. preceding claims, wherein the sheath in an additional lumen (22) for s (100) and/or fluid passage through