US20040138529A1 - Endoluminal tool deployment system - Google Patents

Endoluminal tool deployment system Download PDF

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Publication number
US20040138529A1
US20040138529A1 US10458060 US45806003A US2004138529A1 US 20040138529 A1 US20040138529 A1 US 20040138529A1 US 10458060 US10458060 US 10458060 US 45806003 A US45806003 A US 45806003A US 2004138529 A1 US2004138529 A1 US 2004138529A1
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end
body
distal
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US10458060
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Brent Wiltshire
Richard Ewers
Rodney Brenneman
Eugene Chen
Vahid Saadat
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USGI Medical Inc
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USGI Medical Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005Flexible endoscopes
    • A61B1/0051Flexible endoscopes with controlled bending of insertion part
    • A61B1/0055Constructional details of insertion parts, e.g. vertebral elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005Flexible endoscopes
    • A61B1/0051Flexible endoscopes with controlled bending of insertion part
    • A61B1/0057Constructional details of force transmission elements, e.g. control wires
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0043Catheters; Hollow probes characterised by structural features
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • A61B2017/00318Steering mechanisms
    • A61B2017/00323Cables or rods
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00349Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2901Details of shaft
    • A61B2017/2906Multiple forceps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3417Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421Cannulas
    • A61B2017/3445Cannulas used as instrument channel for multiple instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A61B2090/306Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50Supports for surgical instruments, e.g. articulated arms
    • A61B2090/508Supports for surgical instruments, e.g. articulated arms with releasable brake mechanisms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/0067Catheters; Hollow probes characterised by the distal end, e.g. tips
    • A61M25/0082Catheter tip comprising a tool
    • A61M2025/0096Catheter tip comprising a tool being laterally outward extensions or tools, e.g. hooks or fibres
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105Steering means as part of the catheter or advancing means; Markers for positioning
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133Tip steering devices
    • A61M25/0147Tip steering devices with movable mechanical means, e.g. pull wires

Abstract

Systems, devices and methods are provided for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Embodiments of the systems include an elongated main body having a scope therethrough. Some embodiments of the systems include an elongated main body which is rigidizable and/or torque transmitting to improve manipulation through passageways in the body.

Description

    CROSS-REFERENCES TO RELATED APPLICATIONS
  • [0001]
    This application is a continuation-in-part of, and claims the benefit of priority from co-pending U.S. patent application Ser. No. 10/346,709, filed Jan. 15, 2003, and also claims the benefit of prior Provisional Application No. 60/______, filed on May 19, 2003, the full disclosures of which are hereby incorporated herein by reference.
  • STATEMENT AS TO RIGHTS TO INVENTIONS MADE UNDER FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
  • [0002]
    NOT APPLICABLE
  • REFERENCE TO A “SEQUENCE LISTING,” A TABLE, OR A COMPUTER PROGRAM LISTING APPENDIX SUBMITTED ON A COMPACT DISK.
  • [0003]
    NOT APPLICABLE
  • BACKGROUND OF THE INVENTION
  • [0004]
    The present invention relates generally to medical devices, systems and methods. More particularly, the present invention relates to devices, systems and methods for use in endoscopic or laparoscopic procedures.
  • [0005]
    Endoscopy is a form of minimally invasive procedure wherein the interior of the body is accessed and visualized through an orifice in the body, such as the esophagus or rectum. Such access allows a surgeon or physician to view and/or treat internal portions of the orifice or internal tissues or organs which are accessible through the orifice. These procedures may be for diagnostic purposes, such as visual inspection or the removal of a tissue sample for biopsy, or the procedure may be used for treatment purposes, such as the removal of a polyp or tumor or the restructuring of tissue. While these procedures can be done using regular open surgery, endoscopy usually involves less pain, less risk, less scarring, and faster recovery of the patient.
  • [0006]
    Endoscopy is typically performed with the use of an endoscope, a small circular tube containing optical components. Traditional endoscopes comprise a small diameter “snake-like” insertion tube having a distal end which is inserted into the orifice to the desired internal location. Fiber optics extend through the insertion tube and terminate at the distal end to allow axial viewing from the distal end. Images of the internal location near the distal end of the endoscope are transmitted to a video monitor for the physician to view. A control handle allows the endoscopist to control the direction of the scope and in some cases, permits the actuation of air, water and suction utilities that may be required for the endoscopy procedure.
  • [0007]
    Since endoscopes may be used to perform a treatment at an internal location, some endoscopes are equipped with a lumen through which a surgical instrument or tool may be passed. Generally, the lumen extends through the length of the insertion tube to the distal end so that the end effector of the inserted instrument protrudes from the distal end in the axial direction. Thus, the instrument is directed in parallel to the fiber optics so that the end effector is positioned along the line of view.
  • [0008]
    Such endoscopes have a number of constraints which limit their usefulness in performing diagnostic and surgical procedures. To begin, surgical instruments and tools are inserted axially through a working lumen in the endoscope. And, most of these endoscopes only allow axial and rotational movement of the tool beyond the distal end. This helps to maintain positioning of the tool within the field of view of the endoscope which is also directed axially. However, this limits the variety and complexity of procedures that may be performed. For example, procedures which involve tissue approximation pose great difficulty since only one portion of tissue may be grasped at a time and lateral, rather than axial, movement may be required. Although steering of an axially inserted tool may be possible near the distal end, such steering typically positions the end effector of the tool out of the field of view of the axially directed scope.
  • [0009]
    A similar minimally invasive procedure which overcomes some of these constraints is laparoscopy. In laparoscopy, the interior of the body is accessed and visualized through a small incision. When accessing the abdomen, the incision is usually made in the navel. Laparoscopy was initially used by gynecologists to diagnose and treat conditions relating to the female reproductive organs: uterus, fallopian tubes, and ovaries. It is now used for a wider range of procedures, including operations that in the past required open surgery, such as removal of the appendix (appendectomy) and gallbladder removal (cholecystectomy). Laparoscopy is performed with a device which allows the surgeon or physician to view and/or treat internal tissues or organs which are accessible through the incision. This device is the same or similar to an endoscope, sometimes referred to as a laparoscope. The device comprises a small diameter insertion tube having a distal end which is inserted into the incision to the desired internal location. Fiber optics extend through the insertion tube and terminate at the distal end to allow axial viewing from the distal end. Images of the internal location near the distal end are transmitted to a video monitor for the physician to view. Sometimes, access through an incision creates a shorter, straighter and more direct access path than through an orifice. Therefore, some laparoscopes may have a shorter and stiffer insertion tube than some endoscopes.
  • [0010]
    Although laparoscopes suffer from many of the same limitations as endoscopes, laparoscopy allows additional surgical instruments and tools to be inserted through separate incisions to perform procedures. Proper location of the incisions can allow instruments to be positioned in various directions. Therefore, movement and viewing is not limited to the axis of the laparoscope and simultaneous viewing of the tissues and the instruments may be more readily achieved during the procedure. However, these additional benefits are achieved at the cost of increased invasiveness. Access paths must be created for the instruments with the use of trocars requiring general anesthesia, risk of complications and infection, and increased overall recovery time for the access paths to heal. In addition, access may be difficult or contraindicated in some patients, particularly in the morbidly obese.
  • [0011]
    Thus, it would be desired to provide an improved methods, devices and systems to perform minimally invasive procedures. Particularly, methods, devices and systems which would provide the benefits of endoscopy, such as lower invasiveness and access to deeply internal locations, with the benefits of laparoscopy, such as the use of multiple instruments with movement and viewing along various axes. The devices and systems would be reliable, convenient and easy to use with improved outcomes for patients due to reduction in invasiveness and therefore risk, cost and recovery time. At least some of these objectives will be met by the invention described hereinafter.
  • [0012]
    In addition, it would be desired to provide improved methods, devices and systems which would provide improve passage and manipulation through endovascular passageways. Typical endoscopes have a length in the range of 130 to 190 cm and may be used to traverse a variety of tortuous paths within the body. For example, endoscopes may be used to access the lower gastrointestinal tract from entry through the anus, sometimes reaching as far as the cecum at the distal end of the colon. The upper gastrointestinal tract may be accessed through the esophagus to the stomach and the upper regions of the small intestine. Achieving access to any of these regions, particularly through the colon, involves tedious manipulation of the endoscope. Much of this manipulation involves torqueing of the endoscope. However, once a substantial length of the endoscope has passed into the body, torqueing becomes increasingly difficult. In addition, accessing such regions usually takes place through minimally supported lumens, such as the colon, which do not provide resistive strength or through open cavities, such as the stomach, which do not provide particular pathways for the endoscope. This also limits the use of endoscopic access to desired treatment locations.
  • [0013]
    Thus, it would be desired to provide improved methods, devices and systems to access desired treatment locations. Particularly, methods, devices and systems which would improve the ability to access desired treatment locations minimally invasively, particularly endoscopically or laparoscopically. The devices and systems would be reliable, convenient and easy to use with improved outcomes for patients due to reduction in invasiveness and therefore risk, cost and recovery time. At least some of these objectives will be met by the invention described hereinafter.
  • BRIEF SUMMARY OF THE INVENTION
  • [0014]
    The present invention provides systems, devices and methods for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Some embodiments of the systems include an elongated main body which is rigidizable and/or torque transmitting to improve manipulation through passageways in the body. And, some embodiments of the systems include an elongated main body having a scope therethrough and at least one steerable tool arm which extends from the distal end of the main body. In these embodiments, the system typically includes two tool arms, each arm steerable to form a curve laterally outward which then bends laterally inward so that the arms form a an angular or boomerang shape. In addition, end effectors extend from the distal ends of each arm for use in manipulation of tissue. The angular shape brings the end effectors together in view of the scope for cooperative movements which are continuously visible by the surgeon through the scope. In addition, the tool arms may be steerable in any additional direction and may be rotateable to allow grasping, pulling, tugging, elevation and more complex manipulation of tissue. Thus, the systems and devices of the present invention provide many of the capabilities of open surgery or laparoscopic surgery with an endoscopic approach. In addition, the systems and devices of the present invention provide improvements in manipulation for accessing desired treatment locations.
  • [0015]
    In a first aspect of the present invention, the tool arm(s) comprise a shaft having a proximal end and a deflectable or steerable distal end. In some embodiments, the steerable distal end will be laterally stabilized so that the distal end may be steered, i.e. bent or manipulated, within a plane but will resist deflection outside of the plane during use. The steering plane will generally be parallel to a central axis of the scope but may be rotated by rotation of the tool arm. In this way, the arm(s) will maintain stable positioning within the field of view of the scope and will resist accidental deflection outside of the field. It may be appreciated that the tool arm may also be translated axially within the stabilized plane while maintaining viewing within the field.
  • [0016]
    A preferred structure for achieving lateral stability comprises a plurality of adjacent links. Usually, the links are pivotally attached by hinged structures. In some embodiments, the hinged structures comprise pivot pins which are disposed parallel to one another and generally transverse to the stabilized plane in which the arm may be steered. In other embodiments, the hinged structures comprise male and female bearing surfaces which define axes, wherein the axes are disposed in parallel to limit deflection of the distal section to within the plane. A variety of other structures are also available to provide lateral stability, such as deployment frames, various shaped linkages connected by reinforcements or pullwires, and slotted tubes, to name a few.
  • [0017]
    Typically, the distal end includes at least two steerable sections, wherein a distal-most steerable section includes a tip section which curves in a first direction and wherein an intermediate steerable section includes a base which curves in the opposite direction, where both curves are in the stabilized plane. In some embodiments, the tip section curve has a radius which is greater than that of the curve of the base. To achieved such curvatures, the adjacent links may be shaped to allow substantially continuous deflection. Or, the adjacent links may be shaped so that the steerable distal end is deflectable to form a predetermined curvature wherein the arm is then restricted from further deflection.
  • [0018]
    Means for selectively deflecting the distal section of the tool arm(s) often comprise at least one pullwire or one pushwire. Such pull or pushwires may be present in any quantity and arrangement. The means for selectively deflecting the distal section can further include at least one spring which is configured to straighten the distal section in opposition to the pullwire or pushwire.
  • [0019]
    In some embodiments, the tool arm includes an end effector disposed at its distal end. A wide variety of end effectors may be used depending on the procedure or tissue manipulations which are desired. For example, end effectors may include but are not limited to knives, needles, sutures, staplers, fasteners, clippers, electrosurgical or hemostatic cutters and coagulators, laser welders, cryosurgery instruments, secondary scopes, forceps, lasers hooks, tongs, graspers, retractors, probes, clamps, scissors, tissue approximation devices and suction applicators. Alternatively, the tool arm may include a tool deployment lumen through which a tool having an end effector may be passed. In these embodiments, the tool arm may include a steering cuff arranged for passage of the tool therethrough so that manipulation of the tool within the steering cuff steers the distal end of the tool arm. Thus, in either case, manipulation of the end effector and the tool arm may be interconnected.
  • [0020]
    In another aspect of the present invention, the elongated main body has a distal end, a proximal end, and an arm guide lumen extending through at least a distal section of the elongated main body. In preferred embodiments, the elongated main body has a viewing or scope lumen extending therethrough and terminating in the distal tip. It may be appreciated that the scope lumen may be used for passage of any viewing element or device or the scope lumen may comprise a viewing element or device fixed or integrated within the main body. Herein, it will be assumed that the term “scope lumen” will be used to refer to either of these embodiments.
  • [0021]
    The arm guide lumens and the viewing scope lumen may be arranged in any suitable fashion within the main body. For example, when the elongated main body has a second arm guide lumen, the distal terminations of the two arm guide lumens and the one viewing scope lumen may be arranged in a generally triangular pattern on the distal tip of the main body. Alternatively, the lumens may be aligned, wherein the viewing scope lumen is disposed between the arm guide lumens.
  • [0022]
    Typically, at least the distal section of the elongated main body is steerable. In some embodiments, the elongated main body comprises a first section and a second section, the first section disposed proximally of the second section, and the first and second sections are independently lockable. Thus, the first section may be lockable while the second section remains steerable. Such steering may be achieved with means for selectively deflecting the second section within at least a single plane. This may include retroflexion wherein the distal end of the main body is directed toward the proximal end. In some embodiments, the distal section of the elongated main body comprises a plurality of adjacent links to allow for such steering.
  • [0023]
    Typically, at least the distal section of the elongated main body has a generally cylindrical exterior wherein the arm guide lumen does not extend out of the cylindrical exterior. And, the arm guide lumen terminates at a distal tip of the elongated main body so that the tool arm advances through the distal tip. Likewise, as mentioned previously, the elongated main body typically has a viewing scope lumen extending therethrough and terminating in the distal tip.
  • [0024]
    In yet another aspect of the present invention, the tool arms may have a distal end which is steerable by a variety of mechanisms. For example, the distal end may be comprised of a flexible tube having at least one pullwire attached thereto so that manipulation of the at least one pullwire deflects the steerable distal end. Or, the tool arm may have a steerable distal end which comprises a flexible tube having shape memory material so that emergence of the steerable distal end from the distal tip of the main body allows deflection of the steerable distal end to a shape memory position. Or, the tool arm may further comprise a deployment frame extending from the distal tip of the main body, the frame comprising at least two supports each attached to one of the at least two tool arms so that manipulation of the deployment frame deflects the attached tool arms.
  • [0025]
    In an additional embodiment of the present invention, the endoluminal tool deployment system may be comprised of an elongated main body having a distal end, a proximal end, and at least two arm guide lumens extending over or through at least a distal section of the elongated main body, wherein said arm guide lumens extend fully to a distal tip of the main body, and at least two tool arms adapted to extend through the arm guide lumens of the elongated main body, said tool arms emerging from the distal tip of the main body.
  • [0026]
    In still another aspect of the present invention, the endoluminal tool deployment system comprises an elongated main body having a distal end, a proximal end, and an arm guide lumen extending through at least a distal section of the elongated main body, wherein at least the distal section comprises a plurality of adjacent links. The system further includes a means for selectively deflecting the distal section within at least a single plane, and at least one tool arm adapted to extend through the arm guide lumen of the elongated main body.
  • [0027]
    In a further aspect of the present invention, a method is provided for deploying one or more tools in an anatomical space. In a preferred embodiment, the method comprises introducing a distal end of a main body to said anatomical space, advancing a tool arm from a tool deployment lumen in said main body into said anatomical space, deflecting and positioning the tool arm to locate a distal tip thereof adjacent to a target location within the anatomical space, wherein a distal section of the arm is curved and laterally stabilized in a single plane, and advancing a tool through a lumen of the tool arm to the target location.
  • [0028]
    In some embodiments, deflecting and positioning comprises tensioning a plurality of adjacent hinged links within the distal section of the tool arm. The adjacent hinged links may be joined by hinge pins which are disposed perpendicularly to the single plane such that the pins stabilize the distal section and inhibit deflection outside of the single plane. The method may further comprise viewing the target location through a viewing scope disposed in the main body, wherein the tool arm extends axially from a distal tip of the main body from a location adjacent to the viewing scope.
  • [0029]
    In some embodiments, an endoluminal system is provided comprising an elongated main body having a proximal end, a distal end sized for passage through a body lumen, and at least one lumen extending between the proximal and distal ends. The system further includes a torque transmitting feature which provides torque transmission between the proximal and distal ends while the main body is unlocked and able to form a desired configuration. In addition, the system includes a locking mechanism which locks the main body in the desired configuration. The at least one lumen may be used for passage of any desired device, including, for example, a viewing scope and optionally one or more tool arms. In addition, the system typically includes a steering mechanism which steers the main body to the desired configuration while the main body is unlocked. In most embodiments, the steering mechanism comprises at least one pullwire extending through the plurality of adjacent links.
  • [0030]
    In preferred embodiments, at least a portion of the elongated main body comprises a plurality of adjacent links. Torque may be transmitted through the adjacent links by a variety of torque transmitting features. For example, in some embodiments, when the plurality of adjacent links comprises at least a first link and an adjacent second link, the torque transmitting feature comprising at least one protrusion or tooth from the first link slidably engageable with at least one groove in the adjacent second link, the torque transmitting feature providing torque transmission through the portion of the main body while the links are rotateable. In some embodiments, the at least one protrusion comprises a pair of protrusions, each protrusion extending outwardly from an outer surface of the first link in a diametrically opposite position from the other protrusion. Correspondingly, the at least one groove may comprise a pair of grooves, each groove configured to accept one or the pair of protrusions passing therein. When the first link comprises a first domed ring having the outer surface and the adjacent second link comprises a second domed ring having an inner surface, the outer surface of the first domed ring is mateable with the inner surface of the second domed ring along a longitudinal axis, and the rings are rotateable away from the longitudinal axis. In some embodiments, each groove comprises a first groove end and a second groove end, the groove ends substantially aligned with the longitudinal axis to allow sliding of the protrusions along the grooves during rotation of the rings away from the longitudinal axis. It may be appreciated that such protrusions may extend inwardly from an inner surface and the grooves may be disposed on the outer surface of an adjacent link to accept such protrusions. Thus, the protrusions and associated grooves may function in a similar manner in an inverse arrangement.
  • [0031]
    In other embodiments, the torque transmitting feature comprises a protrusion or a pin from the first link slidably engageable with a slot in the adjacent second link. This is an example of a torque transmitting feature which provides torque transmission by preventing disengagement of the adjacent links while the main body is unlocked and able to form a desired configuration. In some embodiments, the plurality of adjacent engageable links comprises at least a first link and an adjacent second link and the torque transmitting feature comprising at least one pin from the first link slidably engageable with at least one slot in the adjacent second link. Further, in some embodiments, the at least one pin comprises a pair of pins, each pin extending outwardly from an outer surface of the first link in a diametrically opposite position from the other pin. Similarly, the at least one slot comprises a pair of slots, each slot configured to accept one or the pair of pins passing therethrough.
  • [0032]
    In preferred embodiments, the first link comprises a first domed ring having the outer surface and the adjacent second link comprises a second domed ring having an inner surface, the outer surface of the first domed ring being mateable with the inner surface of the second domed rings along a longitudinal axis, and the rings being rotateable away from the longitudinal axis. Typically, each slot comprises an elongate opening between a first slot end and a second slot end, the slot ends substantially aligned with the longitudinal axis to allow sliding of the pins through the slots during rotation of the rings away from the longitudinal axis. It may be appreciated that such pins may extend inwardly from an inner surface and extend through slots on adjacent links. Thus, the pins and associated slots may function in a similar manner in an inverse arrangement.
  • [0033]
    In yet other embodiments, the torque transmitting feature comprises a torque transmitting covering over the plurality of adjacent engageable links to prevent disengagement of the adjacent links. In some instances, the torque transmitting covering comprises a snuggly fit sheath including reinforcements, such as a braided material. The reinforcements may comprise nylon, polyurethane, polyethylene, Teflon, metal, or polymer, for example. Optionally, the reinforcements may be coated with a polymer or the reinforcements may be covered with a separate polymer component. Alternatively, the torque transmitting covering may comprise a polymer coating over the links themselves.
  • [0034]
    In still further embodiments, an endoluminal device is provided comprising an elongated main body having a proximal end, a distal end, and at least one lumen extending between the proximal and distal ends, at least a portion of the elongated main body comprising at least a first link and an adjacent second link which are rotateable relative to each other when unlocked, one of the at least one lumen extending through the links having at least one partition. An elongated shaft is present passing through one of the at least one lumen in a manner to transmit torque by contacting the least one partition. In addition, a locking mechanism is provided which locks the links upon actuation by preventing rotation of the links relative to each other.
  • [0035]
    In some embodiments, the at least one partition comprises an inward protrusion. And, the at least one lumen extending through the links may have a fluted shape forming the inward protrusions. In other embodiments, the at least one partition comprises a divider spanning across the one of the at least one lumen. The shaft passes through the at least one lumen and is positioned between partitions in each of the links. Torqueing of the plurality of adjacent links is transmitted through the shaft and partitions. For example, by applying torque to a first link, the first link rotates about the longitudinal axis until the shaft contacts a partition. Since the partitions are generally aligned, the shaft will also contact partitions in a second link. Therefore, torque is transmitted from the first link to the second link. This transmission may be repeated through any number of links, transmitting torque through a plurality of adjacent links.
  • [0036]
    In additional embodiments, the torque transmitting feature comprises an oval shape of the plurality of adjacent links. And, in other embodiments, the torque transmitting feature comprises a plurality of wires or rods extending through the adjacent links. In preferred embodiments, the plurality of rods comprises approximately 8 to 64 rods. Torque is transmitted from link to link through these torque transmitting features.
  • [0037]
    Further, a method of accessing is provided comprising providing an elongated main body having a proximal end, a distal end, a visualizing element and a locking mechanism, wherein the main body is capable of forming a desired configuration in an unlocked state and holding the desired configuration in a locked state. The method further includes introducing the main body through a body passageway in the unlocked state forming the desired configuration so that the distal end reaches a target location, actuating the locking mechanism to hold the main body in the desired configuration, and viewing the target location with the use of the visualizing element.
  • [0038]
    Introducing the main body may comprise allowing the main body to assume a shape of the body passageway in the unlocked state forming the desired configuration. Or, introducing the main body may comprise steering the main body through the body passageway in the unlocked state forming the desired configuration. In either situation, in some embodiments, the main body comprises a plurality of adjacent links so that actuating the locking mechanism comprises holding the links in a fixed relation to each other. In particular, the plurality of adjacent links sometimes comprises a plurality of nestable elements so that holding the links comprises wedging the links together to hold them by friction.
  • [0039]
    When the main body includes at least one lumen extending between the proximal and distal ends, the method may further comprise introducing an instrument through the at least one lumen. In some embodiments, the instrument comprises a tool arm. When the elongated main body further includes a visualizing lumen and the visualizing element comprises an endoscope, the method may further comprise positioning the endoscope within the visualizing lumen.
  • [0040]
    Other objects and advantages of the present invention will become apparent from the detailed description to follow, together with the accompanying drawings.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0041]
    [0041]FIG. 1 illustrates an embodiment of a system of the present invention.
  • [0042]
    [0042]FIG. 2 illustrates the system of FIG. 1 in an assembled arrangement.
  • [0043]
    [0043]FIG. 2A depicts the cross-section of the system of FIG. 2, and FIG. 2B depicts an alternative cross-section.
  • [0044]
    FIGS. 3A-3D, 4-6 illustrate possible movements of the steerable distal ends of the tool arms.
  • [0045]
    FIGS. 7A-7B illustrate the use of an embodiment of the system to perform a mucosectomy.
  • [0046]
    FIGS. 8A-8C illustrate an embodiment of the main body in a variety of positions.
  • [0047]
    [0047]FIG. 9A shows an embodiment of the shaft of the main body comprised of a multiplicity of nestable elements, and FIG. 9B provides an exploded view of these elements.
  • [0048]
    FIGS. 9C-9E provide cross-sectional views of various nestable elements.
  • [0049]
    [0049]FIG. 10A provides an exploded view of nestable elements having a pullwire extending through their centers and FIG. 10B provides a cross-sectional view one of the nestable elements.
  • [0050]
    [0050]FIG. 10C illustrates the nestable elements of FIG. 10A with the inclusion of liners and FIG. 10D provides a cross-sectional view of one of the nestable elements.
  • [0051]
    FIGS. 10E-100 illustrate embodiments of the main body.
  • [0052]
    [0052]FIG. 11 illustrates an embodiment of a tool arm.
  • [0053]
    FIGS. 12A-12B, 13A-13B, 14 illustrate embodiments of adjacent links disposed at the distal end of a tool arm.
  • [0054]
    [0054]FIG. 15 illustrates examples of possible deflections or movements of an embodiment of the tool arm.
  • [0055]
    FIGS. 16A-16B illustrate another embodiment of a tool arm comprising a plurality of adjacent links.
  • [0056]
    FIGS. 17, 17A-17C illustrate an embodiment of a tool arm which is steerable to a predetermined arrangement.
  • [0057]
    FIGS. 18A-18B illustrate the creation of distinct curvatures achieved by separate pullwires.
  • [0058]
    [0058]FIG. 19 illustrates two tool arms steered to a predetermined arrangement.
  • [0059]
    [0059]FIG. 20 illustrates an embodiment including both links which are steerable to a predetermined arrangement and links which are unrestrictedly steerable.
  • [0060]
    FIGS. 21A-21B illustrate an embodiment of a tool arm comprised of a slotted tube.
  • [0061]
    FIGS. 21C-21D illustrate an embodiment of a tool arm comprised of a tube wherein a pullwire is positioned on the outside of the tube.
  • [0062]
    FIGS. 21E-21F illustrate an embodiment of a tool arm comprised of a polymer wall co-extruded with shape memory material.
  • [0063]
    FIGS. 21G-21H illustrate a mechanism for steering the tool arms including a deployment frame.
  • [0064]
    FIGS. 22A-22B, 23, 24 illustrate embodiments of the shaft of the main body.
  • [0065]
    FIGS. 25A-25B provide a view of the proximal end of an embodiment of the main body wherein two tool arms are present, each including a steering cuff.
  • [0066]
    FIGS. 26, 27A-27B, 28A-28B illustrate embodiments of a steering cuff.
  • [0067]
    FIGS. 29, 29A-29D illustrate embodiments of a tool having an end effector in the form of various types of scissors.
  • [0068]
    [0068]FIG. 30 illustrates an embodiment of the tool having an end effector in the form of gator toothed graspers.
  • [0069]
    [0069]FIG. 31 illustrates an embodiment of the tool having an end effector in the form of an articulatable grasper.
  • [0070]
    FIGS. 32-36 illustrate embodiments of the tool having end effectors in the form of various shaped retractors.
  • [0071]
    FIGS. 37A-37B illustrate grasping hooks inserted through auxiliary lumens in the main body and FIG. 37C illustrates a fixation device which may be deployed by the tool arms when such grasping hooks are used in a plication procedure.
  • [0072]
    [0072]FIGS. 38, 39, 40A-40B illustrate alternative tools passed through auxiliary lumens in the main body.
  • [0073]
    [0073]FIG. 41 illustrates a tool passed through an arm guide lumen for use in conjunction with a tool arm.
  • [0074]
    [0074]FIG. 42 illustrates an arm used to cleanse a portion of the main body, particularly the scope lens.
  • [0075]
    FIGS. 43A-43F illustrate a torque transmitting feature utilizing a tooth and groove concept to maintain alignment of the plurality of adjacent links at locations along its length.
  • [0076]
    FIGS. 44A-44D illustrate a torque transmitting feature utilizing a pin and slot concept to maintain alignment of the plurality of adjacent links at locations along its length.
  • [0077]
    FIGS. 45A-45C illustrate the use of a torque transmitting covering over the plurality of adjacent links providing torque transmission therethrough while the links are rotateable.
  • [0078]
    FIGS. 46A-46D illustrate cross-sectional views of a link wherein one of the at least one lumen extending through the links has at least one partition.
  • [0079]
    FIGS. 47A-47B illustrate a torque transmitting feature wherein the links have an oval cross-section.
  • [0080]
    FIGS. 48A-48C illustrate a torque transmitting feature comprising a plurality of rods extending through the adjacent links.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0081]
    I. Overview
  • [0082]
    An embodiment of a system 2 of the present invention is illustrated in FIG. 1. The system 2 includes an elongated main body 10 having a proximal end 12 and a distal end 14 terminating in a distal tip 16. The main body 10 is used to access an internal target location within a patient's body. Typically, the distal end 14 is passed through a body orifice and one or more naturally occurring body lumens to the target location, such as in endoscopy, while the proximal end 12 remains outside of the body. Therefore, the main body 10 has a deflectable and/or steerable shaft 20, either due to choice of material or design of the shaft 20 to include links, hinges, coils or other similar structures to allow deflection. Thus, FIG. 1 illustrates the main body 10 in a deflected position wherein the body 10 includes curvatures. Such deflection and/or steering may be useful in traversing body lumens to the target location and is achievable by manipulation of a handle 22 near the proximal end 12. It may be appreciated, however, that the system 2 may be used in laparoscopic procedures wherein such deflection and/or steering may be less utilized for placement of the main body 10. In either case, rigidization of some or all the shaft 20 may be desired, for example to provide a stable visualization platform. Therefore, portions of the shaft 20 of the main body 10 are lockable to maintain a desired shape and provide rigidity, either due to choice of material or design of the shaft 20 to include locking mechanisms, as will be described in later sections.
  • [0083]
    The main body 10 also includes at least one arm guide lumen 26 which extends over or through at least a distal section of the main body 10, typically along the majority of the length of the body 10 as shown. Here in FIG. 1, two arm guide lumens 26 are shown, each extending from a position along the shaft 20 near the proximal end 12 to the distal tip 16. In addition, the main body 10 includes a scope lumen 24 which extends through the shaft 20 to the distal tip 16.
  • [0084]
    The system 2 also includes at least one tool arm 30, two are shown in FIG. 1, each arm 30 of which is insertable through a separate arm guide lumen 26 as indicated by dashed line. Each tool arm 30 has a proximal end 32, a distal end 34 and a shaft 36 therebetween. The distal end 34 is steerable, such as by manipulation of adjacent links as schematically indicated. Such steerability may be controlled by a steering cuff 35 which is part of the proximal end 32. The shaft 36 is typically flexible or deflectable to allow deflection of the surrounding main body shaft 20. Each tool arm 30 additionally includes a tool deployment lumen 38 therethrough.
  • [0085]
    In this embodiment, the system 2 also includes at least one tool 40, two are shown in FIG. 1. Each tool 40 includes a distal end 42, a proximal end 44 and an elongate shaft 46 therebetween to allow passage through the tool deployment lumen 38 of the arm 30. Each tool 40 has an end effector 48 disposed at the distal end 42 and optionally a handle 50 at the proximal end 44 for manipulation of the end effector 48 from outside the body. The tool 40 is advanced so that the end effector 48 emerges from the distal end 34 of the arm 30.
  • [0086]
    [0086]FIG. 2 illustrates the system 2 of FIG. 1 in an assembled arrangement. Here, the tool arms 30 are shown inserted through the arm guide lumens 26 of the main body shaft 20. The steerable distal ends 34 of the arms 30 protrude from the distal end 14 of the main body 10 and the proximal ends 32 of the arms 30 protrude from the proximal end 12 of the main body 10. As shown, the steering cuffs 35 are located at the proximal ends 32 of the arms 30. In addition, the tools 40 are shown inserted through the tool deployment lumens 38 so that the end effectors 48 extend beyond the steerable distal ends 34 of the arms 34. Likewise, the proximal ends 44 of the tools 40 with handles 50 are shown protruding from the steering cuffs 35. Movement of the tools 40 against the steering cuffs 35 will actuate steering of the distal ends 34 of the arms 30, as will be described in later sections.
  • [0087]
    [0087]FIG. 2A provides a cross-sectional view of system 2 of FIG. 2. Since the shaft 20 of the main body 10 has a generally cylindrical exterior in this embodiment, the cross-section of the shaft 20 has a circular shape. It may be appreciated that cylindrical shafts may alternatively have an elliptical, oval or oblong cross-section. The shaft 20 has an outer diameter in the range of about 5 to 25 mm, preferably approximately 14 mm. The shaft 20 has a wall 21 with a thickness in the range of about 0.5 to 5 mm, preferably about 2-3 mm, defining an inner central lumen 23. Within the wall 21 lies various pushwires or pullwires 96, hereinafter referred to as pullwires, for steering the main body 10 which may be present in a variety of quantities and arrangements. Alternatively, the pullwires 96 may be present within the central lumen 23. At least one arm guide lumen 26, two are shown, extend through the central lumen 23. Each arm guide lumen 26 has an inner diameter in the range of about 0.5 to 5 mm, preferably about 4 mm. Positioned within the lumens 26 are the shafts 36 of the tool arms 30. And, likewise, positioned within the shafts 36 are the tools 40. FIG. 2A also illustrates the scope lumen 24 which has an inner diameter in the range of about 2 to 10 mm, preferably about 4 mm. In this embodiment, the two arm guide lumens 26 and the scope lumen 24 are arranged in a generally triangular pattern which is maintained to the distal tip 16, however any suitable arrangement may be used which allows viewing of the tool arms, particularly the end effectors, by the scope. For example, FIG. 2B illustrates a cross-section of an embodiment wherein the shaft 20 has an oval shape and the arm guide lumens 26 and the scope lumen 24 are generally aligned. Here, the scope lumen 24 is disposed between the arm guide lumens 26 to facilitate viewing of the tool arms 30. Also illustrated in FIGS. 2A and 2B are additional lumens which may be used for various needs. For example, an irrigation/suction lumen 60, an insufflation lumen 56 and an auxiliary lumen 58 may be present, each having an inner diameter in the range of about 0.5 to 5 mm, preferably about 2 mm. The auxiliary lumen 58 may be utilized for a variety of uses, such as insertion of additional tools, such as a macerator, a grasping tool, a cutting tool or a light source, to name a few, for use in conjunction with the end effectors present at the distal ends of the arms 30 or the distal ends of the tools 40 inserted through the arms 30.
  • [0088]
    FIGS. 3A-3D illustrate a series of movements of the steerable distal ends 34 of the tool arms 30. This series serves only as an example, as a multitude of movements may be achieved by the distal ends 34 independently or together. FIG. 3A illustrates the distal tip 16 of the main body 10. The scope lumen 24 is shown along with two arm guide lumens 26 terminating at the distal tip 16 and forming a triangular pattern as illustrated in FIG. 2A. FIG. 3B illustrates the advancement of the distal ends 34 of the tool arms 30 through the arm guide lumens 26 so that the arms 30 extend beyond the distal tip 16. FIGS. 3C-3D illustrate deflection of the arms 30 to a preferred arrangement. FIG. 3C illustrates deflection of the arms 30 laterally outward. This is achieved by curvature in the outward direction near the base 64 of the steerable distal end 34. FIG. 3D illustrates deflection of the tip section 66 of the distal end 34 laterally inward achieved by curvature in the inward direction so that each arm 30 forms a hook shape. By facing the tip sections 66 of the arms 30 toward each other as shown, the tip sections 66 are positioned directly in the path of the scope lumen 24. Therefore, when a scope 28 is positioned within the scope lumen 24, the tip sections 66 of the tool arms 30 and any tools 40 advanced therethrough, will be visible through the scope 28. In FIGS. 3C-3D, deflection of the arms 30 is achieved with the use of adjacent links 62 in the areas of desired curvature. Embodiments of such links 62 and other mechanisms of deflection will be discussed in later sections. Further, the deflection of FIGS. 3A-3D are shown to be within a single plane. However, various embodiments include deflection in multiple planes. Likewise, the arms 30 are shown to be deflected simultaneously in FIGS. 3A-3D, however the arms 30 may be deflected selectively or independently.
  • [0089]
    FIGS. 4-6 illustrate additional possible movements of the tool arms 30. For example, FIG. 4 illustrates axial movement of the tool arms 30. Each tool arm 30 can independently move distally or proximally, such as by sliding within the tool deployment lumen 38, as indicated by arrows. Such movement maintains the arms 30 within the same plane yet allows more diversity of movement and therefore surgical manipulations. FIG. 5 illustrates rotational movement of the tool arms 30. Each tool arm 30 can independently rotate, such as by rotation of the arm 30 within the tool deployment lumen 38, as indicated by circular arrow. Such rotation moves the arm 30 through a variety of planes. By combining axial, lateral and rotational movement, the arms 30, and therefore the tools 40 positioned therethrough, may be manipulated through a wide variety of positions in one or more planes.
  • [0090]
    [0090]FIG. 6 illustrates further articulation of the tool arms 30. In some embodiments, the arms 30 are deflectable to form a predetermined arrangement, such as illustrated in FIG. 3D. Typically, when forming the predetermined arrangement, the arms 30 are steerable up until the formation of the predetermined arrangement wherein the arms 30 are then restricted from further deflection. In other embodiments, the arms are deflectable to a variety of positions and are not limited by a predetermined arrangement. Such an embodiment is illustrated in FIG. 6 wherein the arms 30 articulate so that the tip sections 66 curl inwardly toward the distal tip 16 of the main body 10. Again, the tip sections 66 are positioned in front of the scope lumen 24 and scope 28 for viewing. Typically, the tip sections 66 a are positioned on opposite sides of a central axis 31 of the scope 28, wherein the field of view (indicated by arrow 29) spans up to approximately 140 degrees, approximately 70 degrees on each side of the central axis 31. In addition, the depth of field is typically in the range of approximately 1-10 cm.
  • [0091]
    As mentioned previously, the endoluminal tool deployment system 2 of the present invention may be used to access a various internal tissues or organs to perform a wide variety of surgical procedures. FIGS. 7A-7B illustrate the use of an embodiment of the system 2 to perform a mucosectomy, or removal of a portion of the mucosa and/or submucosa of the stomach. FIG. 7A illustrates advancement of the main body 10 through the esophagus E to the stomach S. The main body 10 is then steered to a desired position within the stomach S and the stomach mucosa M is visualized through the scope 28 at the distal tip 16. Referring to FIG. 7B, the tool arms 30 are then advanced through the main body 10 and articulated. As mentioned, tools 40 may be advanced through the tool arms 30 or an end effector 48 may be disposed at the distal end of each arm 30. Here, a grasper 80 is disposed at the distal end of one arm 30 and a cutter 81 is disposed at the distal end of the other arm 30. The grasper 80 is used to grasp a portion of the mucosa M. The grasped portion of mucosa M can then be elevated by rotation or manipulation of the tool arm 30. This allows safe resection of the portion of mucosa M by cutting with the use of the cutter 82, as shown. Manipulation and resection of the tissue is visualized throughout the procedure through the scope 28 which is aligned with the tip sections 66, and therefore end effectors 48.
  • [0092]
    It may be appreciated that the systems, methods and devices of the present invention are applicable to diagnostic and surgical procedures in any location within a body, particularly any natural or artificially created body cavity. Such locations may be disposed within the gastrointestinal tract, urology tract, peritoneal cavity, cardiovascular system, respiratory system, trachea, sinus cavity, female reproductive system and spinal canal, to name a few. Access to these locations may be achieved through any body lumen or through solid tissue. For example, the stomach may be accessed through an esophageal approach, the heart through a port access approach, the rectum through a rectal approach, the uterus through a vaginal approach, the spinal column through a port access approach and the abdomen through a port access approach.
  • [0093]
    A variety of procedures may be performed with the systems and devices of the present invention. The following procedures are intended to provide suggestions for use and are by no means considered to limit such usage: Laryngoscopy, Rhinoscopy, Pharyngoscopy, Bronchoscopy, Sigmoidoscopy (examination of the sigmoid colon, the sigmoid colon is the portion that connects the descending colon to the rectum; primarily for diagnostic purposes, however a biopsy procedure and trans anal micro surgery may be performed for removing tumors), Colonoscopy (examination of colon; for the removal of polyps and tumors or for biopsy), and Esophagogastroduodenoscopy (EGD) which enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain.
  • [0094]
    In addition, endoscopic retrograde cholangiopancreatography (ERCP) may be achieved which enables the surgeon to diagnose disease in the liver, gallbladder, bile ducts, and pancreas. In combination with this process endoscopic sphincterotomy can be done for facilitating ductal stone removal. ERCP may be important for identification of abnormalities in the pancreatic and biliary ductal system. Other treatments include Cholecystectomy (removal of diseased gallbladder), CBD exploration (for common bile duct stones), appendicectomy.(removal of diseased appendix), hernia repair TAP, TEPP and other (all kinds of hernia), fundoplication and HISS procedures (for gastro esophageal reflux disease), repair of duodenal perforation, gastrostomy for palliative management of late stage upper G.I.T. carcinoma), selective vagotomy (for peptic ulcer disease), splenectomy (removal of diseased spleen), gastric restrictive and malabsorbtive procedures (for morbid obesity), upper and lower G.I. endoscopies (diagnostic as well as therapeutic endoscopies), pyloroplastic procedures (for children's congenital deformities), colostomy, colectomy, adrenalectomy (removal of adrenal gland for pheochromocytoma), liver biopsy, gastrojejunostomy, subtotal liver resection, gastrectomy, small intestine partial resections (for infarction or stenosis or obstruction), adhesions removal, treatment of rectum prolaps, Heller's Myotomy, devascularization in portal hypertension, attaching a device to a tissue wall and local drug delivery to name a few.
  • [0095]
    II Main Body
  • [0096]
    As mentioned previously, the system 2 of the present invention includes an elongated main body 10 having a proximal end 12 and a distal end 14 terminating in a distal tip 16. The main body 10 may have a variety of features which are present in a variety of combinations. Generally, the features include deflectability, steerability, torqueability, lockability, lumens for the passage of visualization elements, tool arms, and/or instruments, and integral visualization elements, tool arms, and/or instruments, to name a few. In addition, the main body may have any of these features throughout any portion of the main body, including the entire length of the main body or individual subportions.
  • [0097]
    One embodiment of the main body 10 is illustrated in FIGS. 8A-8C, 9A-9D. In this embodiment, the main body 10 includes deflectability and/or steerability and lumens for the passage of visualization elements, tool arms, and/or instruments, such as scope lumen 24. FIG. 8A illustrates the main body in a straight configuration. Since the main body 10 is used to access an internal target location within a patient's body, the main body 10 has a deflectable and/or steerable shaft 20. Thus, FIG. 8B illustrates the main body 10 having various curvatures in its deflected or steered state. In preferred embodiments, the main body 10 is steerable so that the main body 10 may be advanced through unsupported anatomy and directed to desired locations within hollow body cavities. In some embodiments, the main body 10 includes a first section 90 which is proximal to a second section 92, as indicated in FIG. 8B. Although both sections 90, 92 are steerable, the first section 90 may be locked in place while the second section 92 is further articulated. This is illustrated in FIG. 8C, wherein the first section 90 is shown in a locked position unchanged from FIG. 8B and the second section 92 is shown in various retroflexed positions. In retroflexion, the second section 92 is curved or curled laterally outwardly so that the distal tip 16 is directed toward the proximal end 12 of the main body 10. Optionally, the second section 92 may also be locked, either in retroflexion or in any other position.
  • [0098]
    Steering and locking may be achieved by any suitable mechanisms. In some embodiments, the shaft 20 comprises a multiplicity of nestable elements 260, as illustrated in FIG. 9A. FIG. 9B provides an exploded view of the nestable elements 260 of FIG. 9A. Here it can be seen that the elements 260 are disposed so that a distal surface 262 of one element 260 coacts with a proximal surface 264 of an adjacent element. Each of the nestable elements 260 includes one or more pullwire lumens 98 through which pullwires 96 pass. The pullwires 96 are used to hold the elements 260 in nesting alignment and to provide steering and locking. The pullwires 98 preferably are made from a superelastic material, e.g. nickel titanium alloy, to provide flexibility, kink-resistance and smooth movement of the pullwires 96 through the pullwire lumens 98. Alternatively, the pullwires 96 may be made from braided stainless steel, a single stainless steel wire, poly-para-phenylene terephthalamide (such as Kevlar®), a high tensile strength monofilament thread, combinations thereof or any suitable materials.
  • [0099]
    Generally, the adjacent surfaces 262, 264 are contoured to mate so that when the pullwires 96 are relaxed, surfaces 262, 264 can rotate relative to one another. This allows the shaft 20 to form curvatures throughout its length in any direction. Each pullwire 96 is fixed at its distal end to a specific element 260 along the shaft 20 or to the distal tip 16. When tension is applied to a specific pullwire 96, a curvature forms in the shaft 20 proximal to the fixation point, thus steering the shaft 20. The pullwires 96 may be arranged in various patterns to achieve steering in various directions. For example, FIG. 9C is a cross-sectional view of the shaft 20 in the first section 90 of FIG. 8B. Here, eight pullwires 96 (four pullwires 96 a and four pullwires 96 b) are shown passing through the wall 21. Four pullwires 96 a terminate at the distal end of the first section 90 and are used to steer the first section 90. Since the pullwires 96 a are equidistantly positioned, applying tension to the pullwires 96 a, either individually or in combination, steers the first section 90 in any desired direction. The first section 90 may be locked in place by holding the tension in the pullwires 96 a using any suitable mechanisms. For example, tension may be applied to the pullwires 96 simultaneously until the elements 260 are compressed to a state in which they are locked by friction wherein the tension is held.
  • [0100]
    [0100]FIG. 9D is a cross-sectional view of the shaft 20 in the second section 92 of FIG. 8B. Here, four pullwires 96 b are shown passing through the wall 21. These pullwires 96 b extended through the first section 90, as indicated in FIG. 9C, and terminate near the distal tip 16. Since the pullwires 96 b are equidistantly positioned, applying tension to the pullwires 96 b, either individually or in combination, steers the second section 92 in any desired direction. Since the pullwires 96 b also pass through the first section 90, such steering may also effect the curvature in the first section 90 when the first section is not locked. However, such effects are minimal, may be counteracted or compensated for by steering in the first section 90, and may be avoided by locking. The second section 92 may be also be locked in place by holding the tension in the pullwires 96 b using any suitable mechanisms.
  • [0101]
    In this embodiment, the wall 21 extends continuously from the proximal end 12 to the distal end 14 with the first and second sections 90, 92 determined by the termination points of the pullwires 96 which extend therethrough. Alternatively, the first and second sections 90, 92 may be comprised of separate shafts which are coaxially positioned adjacent to one another.
  • [0102]
    In the embodiment illustrated in FIG. 9B, the nestable elements 260 have a central lumen 23 which passes through the length of the main body 10. Instruments or tools may be passed through this lumen 23, as indicated in FIGS. 9C-9D, or tubes may be present within the lumen 23 through which instruments or tools may be passed. In preferred embodiments, the nestable elements 260 have holes formed therein so that lumens are formed by alignment of the holes when the elements 260 are stacked. For example, FIG. 9E provides a cross-sectional view of a nestable element 260 illustrating the holes formed therein which serve as lumens. As shown, a scope lumen 24, arm guide lumens 26, and auxiliary lumens 58 extend through the center of the element 260 while pullwire lumens 98 are located around the periphery.
  • [0103]
    It may be appreciated that pullwire lumens 98 may also extend through the center of the element 260. For example, FIG. 10A illustrates an embodiment having a pullwire 96 which extends through the center of the stacked nestable elements 260. FIG. 10A provides an exploded view of the nestable elements 260 wherein the elements 260 are disposed so that a distal surface 262 of one element 260 coacts with a proximal surface 264 of an adjacent element. As shown, each of the nestable elements 260 includes a pullwire lumen 98 through its center. FIG. 10B provides a cross-sectional view of a nestable element 260 of FIG. 10A. As shown, the nestable element 260 includes a locking pullwire lumen 98 c having a pullwire 96 c therethrough in the center of the element 260 surrounded by various other lumens, such as a scope lumen 24, arm guide lumens 26, auxiliary lumen 58 and various pullwire lumens 98 used for steering. Once the elements 260 are positioned in a desired arrangement, the shaft 20 may be locked in place by the central pullwire 96 c. Applying tension to the pullwire 96 c compresses the elements 260 to a state in which they are locked by friction wherein the tension is held.
  • [0104]
    In addition, liners 266 may be passed through any of the lumens of the stacked nestable elements 260. Such liners 266 form create a continuous lumen connecting the lumen holes of the nestable elements 260. FIG. 1C illustrates the nestable elements 260 of FIG. 10A with the inclusion of liners 266 passing through, for example, the arm guide lumens 26. Likewise, FIG. 10D provides a cross-sectional view of a nestable element 260 of FIG. 10C. Here, liners 266 are shown positioned through the nestable element 260 forming lumens 24, 26, 58 therethrough. It may also be appreciated that liners 266 may extend through pullwire lumens 98 as well. The liners 266 may be coated on their luminal surface with a hydrophilic coating for reducing friction or the liners 266 may be comprised of a lubricious polymer such as Teflon®, fluoroethylene polymer (FEP) or the like.
  • [0105]
    As mentioned previously, it may be appreciated that the shaft 20 of the main body 10 may have a variety of structures to provide features such as deflectability, steerability, torqueability, lockability, visualization and various tools, etc. Exemplary embodiments of structures which provide deflectability, steerability and or lockability are described above and provided in co-pending U.S. patent application Ser. No. 10/281,462 filed Oct. 25, 2002, which is a continuation in part of U.S. patent application Ser. Nos. 10/173,203, 10/173,227, 10/173,238 and 10/173,220, all of which were filed on Jun. 13, 2002 and herein incorporated by reference for all purposes. Also of interest and incorporated by reference for all purposes are co-pending U.S. patent application Ser. Nos. 10/281,461 and 10/281,426 each filed on Oct. 25, 2002. It is understood that lockablility includes locking the main body in a desired configuration to maintain one or more curvatures along its length. Thus, in these instances the main body is shape lockable. Structures which provide torqueability will be described in later sections, however it is understood that these features are applicable to any of the embodiments described herein.
  • [0106]
    In addition, it may be appreciated that the main body 10 may be comprised of a traditional endoscope or laparoscope. Exemplary embodiments of traditional endoscopes are provided in U.S. Pat. Nos. 3,948,251; 4,036,218; 4,201,198; 4,224,929; 4,988,171; 5,020,539; 5,035,231; 5,068,719; 5,170,775; 5,172,225; 5,187,572; and 5,196,928, all of which are herein incorporated by reference for all purposes. FIG. 10E illustrates the shaft 20 of the main body 10 comprising a traditional endoscope 650, or other endoscope, which includes a visualizing element 652 and at least one light source 654. In this embodiment, the endoscope 650 includes two arm guide lumens 26 for the passage of tool arms 30. The tool arms 30 each have end effectors 48, as shown, or tools 40 which have end effectors 48 may be advanced through a tool deployment lumen 38 in each arm 30. FIG. 10F provides a cross-sectional view of the shaft 20 of FIG. 10E. FIG. 10G illustrates the shaft 20 of the main body 10 comprising a plurality of steerable and/or lockable nestable elements 260 and a traditional endoscope 650, or other endoscope, passing therethrough which includes a visualizing element 652 and at least one light source 654. The endoscope 650 may be advanceable and/or retractable through an endoscope lumen 656 in the shaft 20 of the main body 10 or may be fixed within the shaft 20. The endoscope 650 may be positioned so that a distal end 658 of the endoscope 650 is flush with the distal tip 16 of the shaft 20 or is disposed at any position along the shaft 20 including extending beyond the distal tip 16, as shown. FIG. 10H provides a cross-sectional view of FIG. 10G. Here, the wall 21 of the shaft 20 is more clearly visible including pullwires 96 for steering and/or locking. Further, the shaft 20 of the main body 10 may include one or more arm guide lumens 26 for the passage of tool arms 30, as shown in FIG. 101. The tool arms 30 each have end effectors 48, as shown, or tools 40 which have end effectors 48 may be advanced through a tool deployment lumen 38 in each arm 30. FIG. 10J provides a cross-sectional view of FIG. 10I.
  • [0107]
    [0107]FIG. 10K illustrates the shaft 20 of the main body 10 having an integral or integrated visualizing element 652 and at least one light source 654. Again, the shaft 20 comprising a plurality of nestable elements 260 for steering and/or locking. Optionally, the shaft 10 may also include a lumen 660, illustrated in FIGS. 10M-10N, for passage of a variety of tools, instruments or devices therethrough, including tool arms 30. Or, as shown in FIG. 10O, the shaft 20 having an integral visualizing element and at least one light source 654 may have individual arm guide lumens 26 for the passage of tool arms 30. It may also be appreciated that the tool arms 30 of FIG. 10O may alternatively be fixed or integral with the shaft 20.
  • [0108]
    The visualizing elements 652 of any of the embodiments include elements which transmit and/or detect a visual image. For example, such visualizing elements 652 may include a coherent fiber optic bundle, an ultrasound device, and/or charge coupled devices (CCD) for operation in the visible spectrum of electromagnetic radiation, the infrared spectrum of electromagnetic radiation, the ultraviolet spectrum of electromagnetic radiation, and/or the x-ray spectrum of electromagnetic radiation.
  • [0109]
    III Tool Arms
  • [0110]
    As mentioned previously, system 2 also includes at least one tool arm 30, each arm 30 of which is insertable through a separate arm guide lumen 26 in the main body 10. As shown in FIG. 11, each tool arm 30 has a proximal end 32, a distal end 34 and a shaft 36 therebetween. The distal end 34 is steerable, such as by manipulation of adjacent links 62 as schematically indicated. Such stecrability may optionally be controlled by a steering cuff 35, disposed within the proximal end 32. Each tool arm 30 additionally includes a tool deployment lumen 38 therethrough.
  • [0111]
    A. Distal End
  • [0112]
    FIGS. 12A-12B illustrate an embodiment of adjacent links 62 disposed at the distal end 34 to allow steerability of the arm 30. Here, links 62 are pivotally connected by hinge structures 100. As shown in FIG. 12A, the links 62 are shaped so that connection by the hinge structures 100 creates gaps 102 between the links 62 directly opposite to the hinge structures 100. A pullwire 96 is shown extending through the links 62 and terminating at a fixation point 104. Referring now to FIG. 12B, retraction of the pullwire 96 draws the links 62 together, minimizing the gaps 102 between the links 62. Due to the shape and arrangement of the links 62, this movement creates a curve in the arm 30 as shown. The distal end 34 may be steered to have any curvature between substantially straight and a maximum curvature wherein the gaps 102 are completely closed or another limiting feature is established. In some embodiments, up to 360 degree curvature of the distal end 34 is possible. The distal end 34 may be returned to a straightened position by advancement of the pullwire 96 or by the presence of a spring which will straighten the distal end 34 by recoil force.
  • [0113]
    FIGS. 13A-13B illustrate a similar embodiment of adjacent links 62 disposed at the distal end 34 to allow steerability of the arm 30. Again, links 62 are pivotally connected by hinge structures 100. However, as shown in FIG. 13A, the links 62 are shaped so that connection by the hinge structures 100 creates gaps 102 between the links 62 on both sides of the hinge structures 100. A pullwire 96 is shown extending through the links 62 and terminating at a fixation point 104. Referring now to FIG. 13B, retraction of the pullwire 96 draws the links 62 together, minimizing the gaps 102 between the links 62 along the pullwire 96 and maximizing the gaps 102 on the opposite side of the hinge structures 100. Due to this shape and arrangement of the links 62, this movement creates a curve in the arm 30 as shown. The distal end 34 may also be returned to a straightened position by advancement of the pullwire 96 or by the presence of a spring which will straighten the distal end 34 by recoil force. However, in this embodiment, the distal end 34 may be deflected or curved in the opposite direction by continued advancement of the pullwire 96. Advancement of the pullwire 96 minimizes the gaps 102 on the opposite side of the hinge structures 100 causing a curvature in the opposite direction. Likewise, a spring may be present to straighten the distal end 34 from a curvature in this opposite direction.
  • [0114]
    [0114]FIG. 14 illustrates an embodiment similar to the embodiment illustrated in FIGS. 13A-13B. The links 62 are shown pivotally connected by hinge structures 100. Here the hinge structures 100 comprise pivot pins 106 which are arranged in parallel to limit deflection to a single plane. In some embodiments, the hinge structures comprise male and female bearing surfaces which define axes, wherein the axes are disposed in parallel to limit deflection of the distal section to within the single plane. The links 62 are shaped so that connection by the pivot pins 106 creates gaps 102 between the links 62. Closure of the gaps 102 on one side of the pivot pins 106 simultaneously opens gaps on the other side of the pins 106. FIG. 14 also illustrates an end effector 48 of a tool 40 which has been advanced through the tool deployment lumen 38 of the arm 30.
  • [0115]
    [0115]FIG. 15 illustrates examples of possible deflections or movements of the tool arms 30. Here, two arms 30 are shown emerging from the distal tip 16 of the elongated main body 10. The distal end 34 of each arm 30 is steerable and comprised of a plurality of adjacent links 62. The arm 30 on the left is shown steered to a position wherein the tip section 66 is curled inwardly forming an almost complete circular shape. In contrast, the arm 30 on the right is shown steered to a position wherein the tip section 66 is deflected slightly inwardly forming an arc shape. Thus, the arms 30 may be independently steerable to varying degrees of curvature. Preferably, the arms 30 are steerable inwardly to perform surgical procedures in cooperation and to maintain visibility through the centrally located scope.
  • [0116]
    FIGS. 16A-16B illustrate another embodiment of a tool arm 30 comprising a plurality of adjacent links 62. Here, the links 62 are comprised of disks 110 having faces which are angled to form gaps 102 between the disks 110 when the disks 110 are stacked. The disks 110 are connected by one or more wires or ribbons 112. In this embodiment, illustrated in FIG. 16B, two ribbons 112 are present, each at diametrically opposite positions within the wall of each of the stacked disks 110 so that the angled faces are aligned between the ribbons 112. The ribbons 112 may be embedded in the wall, co-molded with the stacked disks or simply advanced through a lumen in the wall. The ribbons 112 maintain relative position of the disks 110 and stabilize the steerable distal end 34 to be deflectable in only a single plane. Also shown in FIG. 16B, lumens 114 are present between the ribbons 112 for positioning pullwires 96 therethrough. The pullwires 96 pass through the angled portions of the disks 110 so that application of tension to a pullwire 96 draws the angled faces of the disks 110 together to close the gaps 102 therebetween. This in turn widens the diametrically opposite gaps 102 creating curvature in the stack.
  • [0117]
    As mentioned previously, in some embodiments, the arms 30 are deflectable to form a predetermined arrangement, such as previously illustrated in FIG. 3D. Typically, when forming the predetermined arrangement, the arms 30 are steerable up until the formation of the predetermined arrangement wherein the arms 30 are then restricted from further deflection. FIG. 17 illustrates an embodiment of such an arm 30 comprising a plurality of adjacent links 62 wherein the arm 30 is steerable to a predetermined arrangement. As shown, the distal end 34 comprises a base 64 which deflects the distal end 34 outwardly and a tip section 66 which deflects inwardly. Between the base 64 and tip section 66 lies a spacer 68 which is rigid. The spacer 68 may be considered a larger elongate link or simply a straight section. Usage of such spacers 68 is optional and may be used to create specific predetermined arrangements. FIG. 17A is an enlarged view of the tip section 66 which illustrates the shapes of the links 62 which are pivotally connected by hinge structures 100 formed into the links 62. Gaps 102 are present on opposite sides of the structures 100 to allow curvature of the distal end 34. The size of the gaps 102 will vary due to varying sizes and shapes of the links 64 so that closure of the gaps 102 forms a specific curvature. This is most easily seen in FIGS. 17B-17C. FIG. 17B illustrates links 62 of the base 64 having varying shapes to create gaps 102 of varying size. As shown, a pullwire 96 extends through the links 62 along the gaps 102. Applying tension to the pullwire 96 draws the links 62 together to close the gaps 102 and to form a predetermined curve as in FIG. 17C.
  • [0118]
    The predetermined arrangement of FIG. 17 includes curvatures in opposite directions, the base 64 curving laterally outwardly and the tip section 66 curving laterally inwardly. These distinct curvatures may be achieved by separate pullwires 96. For example, as shown in FIG. 18A, a first pullwire 97 a may be positioned along one side of the tool arm 30 terminating at a fixation point 104 a located midway along the distal end 34. The links 62 which lie proximally of this fixation point 104 a form the base 64. A second pullwire 97 b may be positioned along the opposite side of the arm 30 terminating at a fixation point 104 b located at the tip of the distal end 34. Generally, the links 62 which lie between the fixation point 104 a and the fixation point 104 b form the tip section 66. Referring now to FIG. 18B, by applying tension to the first pullwire 97 a, the base curves laterally outwardly, and by applying tension to the second pullwire 97 b, the tip section curves laterally inwardly.
  • [0119]
    [0119]FIG. 19 illustrates two tool arms 30 which are steered to a predetermined arrangement. Such steering is achieved with the use of pullwires 96 as illustrated in FIGS. 18A-18B. Fixation points 104 b are visible while fixation points 104 a are hidden within the arms 30. As shown, the links 62 are varied in size and shape to form this arrangement when tension is applied to the pullwires 96. For example, the links 62 are generally larger thought the bases 64 and smaller through the tip sections 66. Further, this embodiment includes stabilizers 120 which pass through the arms 30 for stability.
  • [0120]
    In some embodiments, the steerable distal end 34 includes both types of links, links which are steerable to a predetermined arrangement and links which are unrestrictedly steerable. For example, FIG. 20 illustrates an embodiment wherein the base 64 is comprised of links 62 which are appropriately shaped and sized to deflect laterally outwardly to form a predetermined arrangement. Such deflection is achieved with a pullwire which is hidden from view and terminates midway along the distal end 34. In this embodiment, the tip section 66 is comprised of links 62 which are appropriately sized and shape to deflect laterally inwardly in an unrestricted fashion. The links 62 of the tip section 66 are hinged together by pivot pins 106 to provide support throughout the unrestricted movement. In addition, a tool 40 having an end effector 48 is shown passed through the tool deployment lumen 38 in the arm 30. Also shown in FIG. 20, the arms 30 are rotated to lie in different planes, a feature which has been described in previous sections.
  • [0121]
    It may be appreciated that the embodiments which include links may have any number of links. For example, the steerable distal end 34 may have two links 62 which are hinged together by a hinge structure 100. In this example, the shaft 36 would direct the first link 62 in a first direction and the hinge structure 100 would turn the distal tip 16 towards a second direction. The addition of more linkages 62 would create a smoother curve and/or allow multiple curves throughout the steerable distal end 34.
  • [0122]
    Although the previous embodiments of the tool arms 30 have been comprised of a plurality of adjacent links, it may be appreciated that the arms 30 may be comprised of material in any suitable form. For example, each arm 30 may be comprised of a polymeric tube which has been pre-shaped, such as by heat setting, to form a desired curvature. The polymeric tube is comprised of a material which is sufficiently flexible to allow straightening of the curve for delivery through the arm guide lumen 26 and adequately flexible to allow recoiling of the arm 30 to form the desired curvature upon emergence from the lumen 30.
  • [0123]
    In another embodiment, each arm 30 is comprised of a slotted tube, as illustrated in FIGS. 21A-21B. Referring to FIG. 21A, a tube 130 has a series of slots 132 along its length. In this embodiment, the slots 132 are present along one side of the tube 130 however, it may be appreciated that the slots 132 may be present on both sides of the tube or along any portion of the tube which is desired to deflect. Referring back to FIG. 21A, the pullwire 96 is positioned within the tube along the slots 132 and fixed to the tube 130 at a fixation point 104. By applying tension to the pullwire 96, the tube 130 is deflected toward the pullwire 96 as shown in FIG. 21B. The presence of the slots 132 allows the tube 130 to be comprised of a relatively rigid or thick material while deflecting and curving with minimal buckling or impedance by the tube 130. It may be appreciated that the tube 130 of FIGS. 21A-21 B may alternatively be a solid-walled tube without slots comprised of a thinner or more flexible material which itself allows deflection and curvature with minimal buckling or impedance. Further, each of the following embodiments illustrating various tool arms 30 may be comprised of solid-walled or slotted tubes, or any other suitable tube construction.
  • [0124]
    FIGS. 21C-21D illustrate an embodiment of the arm 30 comprised of a tube 130 wherein a pullwire 96 is positioned on the outside of the tube 130 and fixed to the tube 130 at a fixation point 104. By applying tension to the pullwire 96, the tube 130 is deflected toward the pullwire 96 as shown in FIG. 21D. Since the pullwire 96 is disposed outside of the tube 130, the pullwire 96 forms a tether to the fixation point 104 and does not follow along the surface of the tube 130.
  • [0125]
    FIGS. 21E-21F illustrate an embodiment of the arm 30 comprised of a polymer wall co-extruded with shape memory material, such as nitinol wire. FIG. 21E illustrates the arm 30 in a straightened position, wherein the arm 30 is passed through the arm guide lumen 26, and a curved position, wherein the arm 30 recoils to a shape-memory curve. FIG. 21F provides a cross-sectional view of the arm 30 of FIG. 21E illustrating shape-memory material 280 distributed within the wall of the arm 30.
  • [0126]
    FIGS. 21G-21H illustrate an alternative mechanism for steering the tool arms 30. Referring to FIG. 21G, the shaft 20 of the main body 10 is illustrated having a pair of tool arms 30 extending therefrom. Surrounding the arms 30 lies a deployment frame 290. The frame 290 is comprised of a semi-rigid or rigid material, such as stainless steel wire, which provides sufficient strength to apply force to the arms 30. The frame 290 comprises at least two supports 292, each extending from the distal tip 16 of the shaft 20 and connecting at a peak 294. Each support 292 attaches to a tool arm 30 at an attachment point 296. The frame 290 also includes an actuation support 298 extending from the distal tip 16 to the peak 294. The arms 30 and supports 292, 298 advance from the distal tip 16 of the main body 10 to a desired location in the body in a straight configuration as illustrated in FIG. 21G. Referring to FIG. 21H, application of tension to the actuation support 298 draws the peak 294 toward the distal tip 16 causing the supports 292 to bow or bend outward drawing the attached arms 30 outward. Likewise, the supports 292 may include hinges wherein the supports 292 would bend at the hinge. Although FIG. 21H illustrates the arms 30 bending at the attachment points 296, it may be appreciated that the arms 30 may bend at any location. Such bending directs the tool deployment lumens 38 toward each other to facilitate coordination of tools passed therethrough. Movement of the peak 294 proximally and distally varies the curvature of the arms 30 and provides steering. The frame 290 also serves to create a working space, restricting surrounding tissue from encroaching on the arms 30 and tools 40.
  • [0127]
    In most embodiments, the distal ends of the tool arms are lockable to maintain a deflected position. Such locking may be achieved by any suitable mechanisms. When the tool arm is steerable by manipulation of pullwires or pushwires, the wires may be held in place to lock the distal end in a desired position. In embodiments comprising a multiplicity of nestable elements through which pullwires pass, the pullwires are typically used to hold the elements in nesting alignment and to provide steering and locking. By applying tension to the pullwires simultaneously, the elements may be compressed to a state in which they are locked by friction wherein the tension is held. Other locking mechanism may also be used. Further, the tool arms may be locked rotationally and axially within the main body to maintain positioning of the tool arm in relation to the main body.
  • [0128]
    B. Shaft
  • [0129]
    As described previously, the shaft 36 of the tool arm 30 passes though the main body 10. In embodiments wherein the main body 10 is deflectable, the shaft 36 is also deflectable. However, although it is desired that the shaft 36 be laterally deflectable, it is also desired that the shaft 36 maintain axial rigidity. Any suitable construction may be used, including a braid reinforced torqueable tube. Additional embodiments are described below.
  • [0130]
    FIGS. 22A-22B illustrate embodiments of the shaft 36 comprising a coil 140. Here, illustrated in FIG. 22A, the turns of the coil 140 lie adjacent to each other to prevent axial movement and maintain axial rigidity. However, the coil configuration allows deflection of the shaft 36 as shown in FIG. 22B.
  • [0131]
    In another embodiment, illustrated in FIG. 23, the shaft 36 comprises a plurality of adjacent linkages 150. Here, each linkage 150 includes a pair of protruding structures 152 on its face and a pair of notches 154 on its base. The protruding structures 152 and notches 154 are both arc shaped so that the protruding structures 152 of one linkage 150 rotateably interfit with the notches 154 of an adjacently stacked linkage 150. By alternating the position of the pairs of protruding structures 152 and notches 154 as shown in FIG. 23, the shaft 36 is flexible in both lateral bending directions while maintaining stiffness axially and in torsion. Also shown are flared lumens 158 which pass through the protruding structures 152 and the wall of the shaft 36. Flaring allows for a rod or wire passed therethrough to move within the lumen 158 as a linkage 150 rotates over the protruding structure 152. Round pullwire lumens 156 pass through the notches 154 and the wall of the shaft 36 as shown. The rod or wire holds the linkages 150 in a stacked configuration and optionally may be used to steer the shaft 36.
  • [0132]
    In another embodiment, illustrated in FIG. 24, the shaft 36 comprises a plurality of adjacent linkages 160 which are also stacked to provide lateral deflection while maintaining axial rigidity. Here, each linkage 160 includes a pair of protruding structures 162 on its face and a pair of notches 164 on its base. The protruding structures 162 and notches 164 are both arc shaped so that the protruding structures 162 of one linkage 160 rotateably interfit with the notches 164 of an adjacently stacked linkage 160. By alternating the position of the pairs of protruding structures 162 and notches 164 as shown in FIG. 24, the shaft 36 is flexible in both lateral bending directions while maintaining stiffness axially and in torsion. In this embodiment, the linkages 150 include a central lumen 166 through which a rod or wire is passed. The rod or wire is used to hold the linkages 60 in the stacked configuration.
  • [0133]
    C. Proximal End
  • [0134]
    The proximal end 32 of the tool arm 30 may simply terminate in an endpiece or connector for passage of a tool 40 through its tool deployment lumen 38. However, the proximal end 32 may optionally include a steering cuff 35 for steering the tool arm 30, particularly for steering its distal end 34.
  • [0135]
    [0135]FIG. 25A illustrates an embodiment of the proximal end 12 of the main body 10 wherein two tool arms 30 are present, each inserted through an arm guide lumen 26 in the shaft 20 of the main body 10. As shown, each tool arm 30 includes a steering cuff 35 which remains outside of the main body 10 and the tool deployment lumen 38 is accessible through the steering cuff 35. FIG. 25B illustrates an alternative embodiment of the proximal end 12 wherein two tool arms 30 are present, each inserted through an arm guide lumen 26 through the handle 22 of the main body 10. Again, each tool arm 30 includes a steering cuff 35 which remains outside of the main body 10 and the tool deployment lumen 38 is accessible through the steering cuff 35. This embodiment also includes a locking mechanism 170 on each arm 30. The locking mechanism 170 can be manipulated, such as by turning a lever 172 shown in FIG. 25B, to lock the distal end 34 or the tool arm 30 in a steered or deflected position.
  • [0136]
    [0136]FIG. 26 illustrates an embodiment of a steering cuff 35 disposed at the proximal end 32 of a tool arm 30 wherein a tool 40 is passed therethrough. In this embodiment, the tool arm 30 includes four pullwires 96 (three are visible in FIG. 26) which are equidistantly positioned around the perimeter of the shaft 36. The pullwires 96 are used to steer the distal end 34 of the arm 30 as previously described. As shown, the tool 40 has a distal end 42 with an end effector 48 which emerges from the distal end 34 of the arm 30. Likewise, the tool 40 has a proximal end 44 which emerges from the steering cuff 35. In this embodiment, the steering cuff 35 has a funnel shape wherein one end is attached to at least the pullwires 96 and typically additionally to the arm 30 itself. Deflection of the proximal end 44 of the tool 40, indicated by angular arrow 180, presses the proximal end 44 against the steering cuff 35 which rotates the steering cuff 35 to a deflected position, indicated by dashed line. Such rotation applies tension to pullwires 96 diametrically opposite to the deflected position as indicated by arrows 182. Such tension steers the distal end 34 of the arm 30. Thus, manipulation of the tool 40 within the steering cuff 35 can be used to steer the distal end 34 of the arm 30.
  • [0137]
    FIGS. 27A-27B and FIGS. 28A-28B illustrate another embodiment of a steering cuff 35. Here, the steering cuff 35 has a sphere shape and is disposed at the proximal end 32 of the tool arm 30. The tool 40 is passed through a lumen 184 in the sphere shaped cuff 35 so that the distal end 42 of the tool emerges from the distal end 34 of the arm 30 and the proximal end 44 remains outside of the cuff 35 as shown. In this embodiment, the tool arm 30 includes four pullwires 96 (three are visible) which are equidistantly positioned around the perimeter of the shaft 36. The pullwires 96 are used to steer the distal end 34 of the arm 30 as previously described. FIG. 27A illustrates the pullwires 96 emerging from the shaft 36 of the arm 30 and attached to the surface of the sphere shaped cuff 35. Likewise, FIG. 27B provides a similar view, however in this case the arm 30 is cutaway to reveal the pullwires 96 extending through lumens in the shaft 36 and the tool 40 extending through the tool deployment lumen 38. FIG. 28A illustrates the embodiment in the straight position. Deflection of the proximal end 44 of the tool 40, indicated by angular arrow 180, presses the proximal end 44 against the steering cuff 35 which rotates the steering cuff 35 to a deflected position, as shown in FIG. 28B. Such rotation applies tension to pullwires 96 diametrically opposite to the deflected position as indicated by arrow 182. Such tension steers the distal end 34 of the arm 30. Thus, manipulation of the tool 40 within the steering cuff 35 can be used to steer the distal end 34 of the arm 30.
  • [0138]
    It may be appreciated that the embodiments of the steering cuff 35 depicted in FIG. 26 and FIGS. 27A-27B, 28A-28B may include any number of pullwires 96 for any desired level of steerability. For example, in each embodiment, two pullwires 96 may be present disposed on opposite sides of the steering cuff 35 for movement of the steerable distal end 34 of an arm 30 in a single plane. This would be the case for laterally stabilized arms 30.
  • [0139]
    IV. Tool
  • [0140]
    As mentioned previously, the system 2 also includes at least one tool 40. In some embodiments, the tool 40 may simply comprises an end effector 48 positioned at the distal end of the tool arm 30 wherein the end effector 48 is operated by manipulation of mechanisms which extend through the arm 30. In other embodiments, each tool 40 includes a distal end 42, a proximal end 44 and an elongate shaft 46 therebetween to allow passage through the tool deployment lumen 38 of the arm 30. The shaft 46 is typically desired to be a torque-stable tube comprised of any suitable material, such as a braid or coil-reinforced extrusion. In these embodiments, each tool 40 has an end effector 48 disposed at the distal end 42 and optionally a handle 50 at the proximal end 44 for manipulation of the end effector 48 from outside the body. Thus, the tool 40 is advanced so that the end effector 48 emerges from the distal end 34 of the arm 30.
  • [0141]
    A wide variety of end effectors 48 may be used depending on the procedure or tissue manipulations which are desired. For example, end effectors 48 may include but are not limited to knives, needles, sutures, staplers, fasteners, clippers, electrosurgical or hemostatic cutters and coagulators, laser welders, cryosurgery instruments, secondary scopes, forceps, lasers hooks, tongs, graspers, retractors, probes, clamps, scissors, tissue approximation devices and suction applicators.
  • [0142]
    [0142]FIG. 29 illustrates an embodiment of a tool 40 having an end effector 48 in the form of scissors 200. Scissors are one of the oldest surgical instruments used by surgeons. Scissors are used to perform many tasks in open surgical procedure but its use in minimal access surgery requires greater skill. As shown, the scissors 200 includes two blades 202, a fulcrum 204 and force applicators 206. The cutting force of the scissors 200 works on the law of lever. The force applied on the blade 202 can be calculated by length of the force applicators 206 and force applied on the applicators 206. The scissors 200 of the tool 40 do not apply the exact law of lever because of the cylinder action of the long shaft 46, but the design of applicators 206 helps in the amplification of force by lever action. When the blades 202 of the scissors 200 close, its sharp edges grind against each other and any tissue which comes between the blades of scissors will be cut.
  • [0143]
    The scissors 200 of FIG. 29 provide an example of straight scissors wherein the blades are straight. This is a widely used instrument for mechanical dissection in laparoscopic surgery. Other types of scissors include curved scissors 214, illustrated in FIG. 29A, wherein the blade 202 of the scissors 214 is slightly curved. In some cases curved scissors 214 are preferred because the curvature of the blade 202 of this scissors creates additional angles of manipulation and may provide a better view through the scope. Other types of scissors include serrated scissors 216 wherein serrated edges 218 prevent the tissue from slipping out of the blades 202. This may be useful in cutting a slippery tissue or ligature. Still other types of scissors include hook scissors 220 which encircle a tissue structure before cutting. Since the tissue is held between its hooked blades, there is minimal chance of slipping. The hook scissor 220 is especially useful for cutting secured ducts or arteries. Likewise, the cutting of nerve bundles in neurectomy becomes may benefit from the use of hook scissors 220. Hook scissors 220 are also helpful in partial cutting of cystic ducts for intra-operative cholangiography. Further, additional types of scissors include microtip scissors 222. One of the main advantages of microtip scissors 222 is to cut ducts partially for facilitating cannulation. Likewise, this scissor 222 may be used for cutting the cystic duct for performing intra-operative cholangiogram. Exploration of small ducts like common bile duct is very helpful with microtip scissors 222 due to its fine small blades. Fine microtip scissors 222 are also available in curved form.
  • [0144]
    [0144]FIG. 30 illustrates an embodiment of a tool 40 having an end effector 48 in the form of gator toothed graspers 230. These graspers 230 have reverse angled teeth 232 which are capable of providing an aggressive grip on tissue. In addition, the graspers 230 are cupped to allow tissue to herniated when the tissue is compressed. Thus, the graspers 230 may be useful for pelviscopy and handling fibrous ovaries and uterine tissue.
  • [0145]
    [0145]FIG. 31 illustrates an embodiment of a tool 40 having an end effector 48 in the form of an articulatable grasper 236. The grasper 236 includes an articulation section 238 between grasper jaws 240 and the shaft 46. This allows the grasper 236 to articulate in an additional degree of freedom relative to tool arm 30.
  • [0146]
    Embodiments of the tool 40 having an end effector 48 may be in the form of various shaped retractors. Examples of such retractors include an angled retractor 242, (FIG. 32), hooked retractors 244 (FIGS. 33-34), a triangular retractor 246 (FIG. 35), and a circular retractor (FIG. 36), to name a few. Each retractor is flexible and allows for manipulation of organs and tissue structures.
  • [0147]
    V. Auxiliary Lumens
  • [0148]
    As mentioned previously, lumens in addition to the scope lumen 24 and arm guide lumens 26 may be present within the main body 10 and may be considered auxiliary lumens 58. Such lumens 58 may be used for any purpose, such as irrigation, suction, insufflation, macerating, illuminating, grasping, or cutting to name a few, and are typically used in conjunction with the arms 30 and/or tools 40 inserted through the arms 30 or positioned at the ends of the arms 30.
  • [0149]
    In one embodiment, illustrated in FIG. 37A, grasping hooks 310 are inserted through a single auxiliary lumen or through separate auxiliary lumens 58 (shown) in the shaft 20. The grasping hooks 310 may be comprised of any suitable material, such as shape-memory wire or shapeable polymer, that allows a hook shape to be formed once the hooks 310 have emerged from the distal tip 16. In addition, the hooks 310 may have a pointed or sharp tip to assist in grasping or piercing tissue. Referring to FIG. 37B, the grasping hooks 310 may be used to grasp a portion of tissue T to create a plication or fold. The tool arms 30 may then be extended on opposite sides of the folded tissue T to deploy a fixation device 312 which will hold the plication in place. FIG. 37C illustrates such a fixation device 312 comprising a tie 314 passing through the tissue T with anchors 316 positioned on either side of the plication. The tie 314 may be comprised of a suture, wire or rod, for example, and the anchors 316 may be comprised of knots, disks or expandable umbrellas, to name a few. Such plication procedures may be used for treating gastroesophageal reflux disease (GERD).
  • [0150]
    Alternatively, other tools may be passed through auxiliary lumens 58 for similar or other purposes. For example, a corkscrew device 320 (FIG. 38) or a grasper claw 322 (FIG. 39) may be passed through an auxiliary lumen 58 for grasping tissue T. Or, tissue T may be grasped with a suction device. FIG. 40A illustrates a suction device 324 in an undeployed configuration. The suction device 324 comprises a deployment sleeve 328 which houses an expandable funnel 326. Withdrawal of the deployment sleeve 328 releases the funnel 326 allowing the funnel 326 to self-expand, as shown in FIG. 40B. The increased surface area of the funnel 326 allows for adequate suction for grasping tissue T and holding the tissue T within the funnel 326.
  • [0151]
    It may be appreciated that tools 40 may alternatively be passed through an arm guide lumen 26 for use in conjunction with a tool arm 30 passed through another arm guide lumen 26. For example, as illustrated in FIG. 41, a macerator 336 may be passed through an arm guide lumen 26 for maceration of tissue T or a blood clot while a tool arm 30 is used for irrigation and aspiration. The macerator 336 macerates the tissue T to form small particles which may be more readily aspirated. Further, irrigation through the arm 30 may be used to cleanse portions of the device. For example, as illustrated in FIG. 42, the arm 30 may be steered to face the scope 28 allowing irrigation to cleanse the scope 28 thus improving viewing.
  • [0152]
    VI Torque Transmission
  • [0153]
    As mentioned previously, the system 2 of the present invention includes an elongated main body 10 having a proximal end 12 and a distal end 14 terminating in a distal tip 16. An embodiment of the main body 10 was illustrated in various configurations in FIGS. 8A-8C utilizing steering and/or locking. Steering and locking may be achieved by any suitable mechanisms. In some embodiments, the shaft 20 comprises a plurality of adjacent links, such as nestable elements 260 illustrated in FIG. 9A. FIG. 9B provided an exploded view of the nestable elements 260 of FIG. 9A, illustrating that the elements 260 are disposed so that a distal surface 262 of one element 260 coacts with a proximal surface 264 of an adjacent element. And, each of the nestable elements 260 includes one or more pullwire lumens 98 through which pullwires 96 pass. The pullwires 96 are used to hold the elements 260 in nesting alignment and to provide steering and locking. Generally, the adjacent surfaces 262, 264 are contoured to mate so that when the pullwires 96 are relaxed, surfaces 262, 264 can rotate relative to one another. This allows the shaft 20 to form curvatures throughout its length in any direction.
  • [0154]
    In addition to steering with the use of pullwires 96, the main body 10 can be manipulated by torqueing. Typically, the distal end 14 of the main body 10 is positioned within the body while the proximal end 12 remains outside of the body. It is often desired to rotate the distal end 14 within the body by manually rotating the proximal end 12. To achieve this effectively, the main body 10 should be capable of effectively transmitting torque. To achieve this, particularly through portions of the main body 10 which include adjacent links, such as nestable elements 260, a torque transmitting feature may be included.
  • [0155]
    One such torque transmitting feature is illustrated in FIGS. 43A-43F. FIGS. 43A-43F illustrate the use of a tooth and groove concept to maintain alignment of the plurality of adjacent links at locations along its length. By maintaining alignment in particular locations, torque may be more easily transmitted while still allowing freedom of rotation of the links for steering.
  • [0156]
    [0156]FIG. 43A is a perspective view of one of the plurality of adjacent links, a first link 500. The first link 500 has a top edge 502, a bottom edge 504, an outer surface 506 and an inner surface 508 forming a domed ring-like structure having a lumen 505 therethrough. Pullwire lumens 98 are shown passing through the inner surface 508 and out through the top edge 502. It may be appreciated that the pullwire lumens 98 may be used for other elements, such as support wires or rigidizing wires, however at least some of the pullwire lumens 98 are used for passing pullwires 96 for steering. The first link 500 also includes a torque transmitting feature comprising at least one protrusion, such as a tooth 510, which protrudes inward from the inner surface 508 in this embodiment. The tooth 510 may have any suitable shape or size and may extend beyond the edges 502, 504. In this embodiment, the tooth 510 has a first tooth end 512 and a second tooth end 514 wherein the first tooth end 512 is flush with the inner surface 508 and the second tooth end 514 protrudes outwardly toward the bottom edge 504 of the link 500 forming a wedge shape. The torque transmitting feature also includes at least one groove 516 in the outer surface 506. The groove 516 is sized, shaped and positioned so that when the first link 500 is engaged with an adjacent link, the groove 516 in the first link 500 accepts a tooth 510 on the adjacent link.
  • [0157]
    In some embodiments, a pair of teeth 510, 510′ are present wherein one tooth 510 is located in a diametrically opposite position from the other tooth 510′. Likewise, a pair of grooves 516, 516′ are also present wherein one groove 516 is located in a diametrically opposite position from the other groove 516′, or 180 degrees apart. Typically, the pair of teeth 510, 510′ and pair of grooves 516, 516′ are located so that each are separated by approximately 90 degrees, as shown in FIG. 43A. FIG. 43B provides a side view and FIG. 43C provides a partial perspective view of the link of FIG. 43A.
  • [0158]
    The first link 500 is engageable with a series or plurality of additional links, each having the same or similar features as the first link 500. Such a plurality of adjacent links is shown in FIG. 43D. Here, the first link 500 is shown mated with a second link 520, a third link 522, a fourth link 524 and a fifth link 526. The links 500, 520, 522, 524, 526 are each individually rotateable by steering, such as with the use of pullwires 96 as described in related earlier sections. FIG. 43E, illustrates four of these links 500, 520, 522, 524 wherein the outer surface 506 of each link is mated with the inner surface 508 of an adjacent link along a longitudinal axis 530. The first link 500 is shown to have a pair of teeth 510, 510′, one tooth 510 disposed in a position along the inner surface 508 which is diametrically opposite to the other tooth 510′. The one tooth 510 is slidably engageable with a groove 516 in the outer surface 506 of the adjacent second link 520 and the other tooth 510′ is slidably engageable with a groove 516′ in a diametrically opposite position in the outer surface 506. In this embodiment, groove 516 has a first groove end 518 and a second groove end 519. The groove ends 518, 519 are substantially aligned with the longitudinal axis 530 to allow sliding of the tooth 510 along the groove 516 during rotation of the link away from the longitudinal axis 530. Likewise, groove 516′ has a first groove end 518′ and a second groove end 519′ in a similar arrangement.
  • [0159]
    The second link 520 also includes a pair of teeth 510, 510′ which are each disposed 90 degrees from the grooves 516, 516′. Therefore, only one tooth 510 is visible in the second link 520 since the teeth 510, 510′ aligned in the view of FIG. 43E, however it may be appreciated that each of the pair of teeth 510, 510′ in the second link 520 are slidably engaged with one of a pair of grooves 516, 516′ in the third link 522. Likewise, the third link 522 is shown to have a pair of teeth 510, 510′, one tooth 510 disposed in a position along the inner surface 508 which is diametrically opposite to the other tooth 510′. The one tooth 510 is slidably engageable with a groove 516 in the outer surface 506 of the adjacent fourth link 524 and the other tooth 510′ is slidably engageable with a groove 516′ in a diametrically opposite position in the outer surface 506.
  • [0160]
    Steering rotates at least some of the links away from the longitudinal axis 530, such as illustrated in FIG. 43F. Here, the first link 500 is shown rotated along another axis 532 which forms an angle with the longitudinal axis 530. Such rotation slides the one tooth 510 on the first link 500 downward along the groove 516 in the second link 520 while the other tooth 510′ slides upward along the groove 516′ in the second link 520. Thus, the first link 500 is free to rotate in this plane. It may be appreciated that each link is free to rotate in at least a plane defined by the alignment of teeth and grooves. When the position of such aligned teeth and grooves are varied along the length of the plurality of adjacent links, the links are able to rotate in various directions.
  • [0161]
    In addition, torqueing of the plurality of adjacent links is transmitted through the aligned teeth and grooves. For example, by applying torque to the fourth link 524, as indicated by arrow 534 in FIG. 43F, the fourth link 524 will rotate about the longitudinal axis 530 until one of the grooves 516′ contacts the slidably engaged tooth 510′ which transmits the torque to the third link 522. This transmission is repeated through each of the links, transmitting torque to the first link 500.
  • [0162]
    Another embodiment of a torque transmitting feature is illustrated in FIGS. 44A-44D. FIGS. 44A-44D illustrate the use of a pin and slot concept to maintain alignment of the plurality of adjacent links at locations along its length. By maintaining alignment in particular locations, torque may be more easily transmitted while still allowing freedom of rotation of the links for steering. In addition, the pin and slot concept prevents disengagement of the adjacent links while the main body is unlocked. This further enhances torque transmission.
  • [0163]
    [0163]FIG. 44A is a perspective view of one of the plurality of adjacent links, a first link 500. The first link 500 has a top edge 502, a bottom edge 504, an outer surface 506 and an inner surface 508 forming a domed ring-like structure having a lumen 505 therethrough. Although pullwire lumens are not shown, it may be appreciated that pullwire lumens may be present, for example passing through the inner surface and out through the top edge. It may also be appreciated that the pullwire lumens may be used for other elements, such as support wires or rigidizing wires, however at least some of the pullwire lumens are used for passing pullwires for steering. The first link 500 also includes a torque transmitting feature comprising at least one protrusion, such as a pin 550, which protrudes outward from the outer surface 506. The torque transmitting feature also includes at least one slot 552, providing an opening between the inner surface 508 and the outer surface 506.
  • [0164]
    In some embodiments, a pair of pins 550, 550′ are present wherein one pin 550 is located in a diametrically opposite position from the other pin 550′. Likewise, a pair of slots 552, 552′ are also present wherein one slot 552 is located in a diametrically opposite position from the other slot 552′, or approximately 180 degrees apart. Typically, the pair of pins 550, 550′ and pair of slots 552, 552′ are located so that each is separated by approximately 90 degrees as illuatrated.
  • [0165]
    [0165]FIG. 44B provides a side view of the first link 500 of FIG. 44A. Dimensions provided are related to an exemplary embodiment are not intended to be limiting. It may be appreciated that the pin 550 may have any suitable shape or size and may be positioned anywhere along the outer surface 506. In this embodiment, the pins 550, 550′ each have a cylindrical shape with a cross-sectional diameter of approximately 0.0325 in. and each is positioned near the top edge 502. Each slot 552 is sized, shaped and positioned so that when the first link 500 is engaged with an adjacent link, a slot 552 in the first link 500 accepts a pin 550 on the adjacent link. Typically, each slot 552 is positioned near the bottom edge 504, preferably 0.010 in. from the bottom edge 504 as illustrated in FIG. 44B. Also illustrated in FIG. 44B, each slot 552 has a first slot end 554 and a second slot end 556, typically approximately 0.090 in. apart. The slot ends 554, 556 are substantially aligned with the longitudinal axis 530 to allow sliding of the pin 550 through the slot during rotation of the link away from the longitudinal axis 530, as will be illustrated in FIGS. 44C-44D.
  • [0166]
    [0166]FIG. 44C illustrates the first link 500 engaged with a second link 520 having the same or similar features as the first link 500. The links 500, 520 are each individually rotateable by steering, such as with the use of pullwires 96 (not shown) as described in related earlier sections. As shown, the outer surface 506 of each link is mated with the inner surface 508 of an adjacent link along a longitudinal axis 530. The first link 500 is shown to have a pair of slots 552, 552′, one slot 552 which is visible in this view. Extending through the one slot 552 is a pin 550 which protrudes from the outer surface 506 of the adjacent second link 520. It may be appreciated that the second link 520 also has an additional pin 550′ which passes through slot 552′.
  • [0167]
    Steering rotates at least some of the links away from the longitudinal axis 530, such as illustrated in FIG. 44D. Here, the first link 500 is shown rotated along another axis 532 which forms an angle with the longitudinal axis 530. Such rotation slides one pin 550 on the second link 520 upward along the slot 552 in the first link 500 while another pin 510′ slides downward along the slot 552′ in the first link 500. Thus, the second link 520 is free to rotate in this plane. It may be appreciated that each link is free to rotate in at least a plane defined by the alignment of pins and slots. When the position of such aligned pins and slots are varied along the length of the plurality of adjacent links, the links are able to rotate in various directions.
  • [0168]
    In addition, torqueing of the plurality of adjacent links is transmitted through the aligned pins and slots. For example, by applying torque to the second link 520, the second link 520 will rotate about the longitudinal axis 530 until one of the slots contacts the slidably engaged pin which transmits the torque to the first link 500. This transmission may be repeated through any number of links, transmitting torque through a plurality of adjacent links.
  • [0169]
    Another torque transmitting feature is illustrated in FIGS. 45A-45C. FIGS. 45A-45C illustrate the use of a torque transmitting covering over the plurality of adjacent links providing torque transmission therethrough while the links are rotateable. FIG. 45A illustrates an embodiment of the torque transmitting covering. In this embodiment, the covering 570 comprises a sheath 576 having reinforcements 578 throughout. Such reinforcements 578 are comprised of nylon, polyurethane, polyethylene, Teflon, metal, polymer or any suitable material and are typically braided or woven, however any arrangement of the reinforcements 578 may be used. The reinforcements 578 may be dipped in a polymer dispersion in a suitable solvent to coat the reinforcements 578. Such coating holds the reinforcements 578 together in a desired arrangement suitable for torque transmission. Alternatively or in addition, the reinforcements 578 may be sprayed, painted or otherwise coated with a polymer. Likewise, other methods of forming the covering 570 may be used. It may also be appreciated that the covering 570 may be formed without reinforcements 578. The coating may also be an independent component that is draped over the reinforcements 578.
  • [0170]
    The covering 570 may have any suitable size or shape, but is typically an elongate tube sized to fit snuggly around the plurality of adjacent links which are rotateable relative to each other when unlocked. Typically the covering 570 has a wall thickness in the range of approximately 0.005 to 0.015 in., typically in the range of approximately 0.010 to 0.015 in. Snug fit of the covering around the adjacent links prevents the links from disengaging while allowing the links to rotate during steering. Thus, the covering 570 may also be formed by dipping the adjacent links in a polymer dispersion to form a coating on the links.
  • [0171]
    [0171]FIG. 45B illustrates the covering 570 fit over a series or plurality of adjacent links (a first link 500, second link 520, third link 522, fourth link 524 and fifth link 526) wherein the outer surface of each link is mated with the inner surface of the adjacent link along a longitudinal axis 530. The links 500, 520, 522, 524, 526 are each individually rotateable by steering, such as with the use of pullwires 96 as described in related earlier sections.
  • [0172]
    Torqueing of the plurality of adjacent links is transmitted with the use of the covering 570. For example, by applying torque to the fifth link 526 and surrounding covering 570, as indicated by arrow 572 in FIG. 45C, the fifth link 526 will rotate about the longitudinal axis 530 along with the surrounding covering 570. The torqueing force applied to the covering 570 will be transmitted along the length of the covering 570 from the fifth link 526 toward the first link 500. Since the covering 570 is snuggly fit around the links, the links will maintain engagement, assisting in the transmission of torque. Thus, the first link 500 will then rotate about the longitudinal axis 530, as indicated by arrow 574, in response to the rotation of the fifth link 526.
  • [0173]
    Another torque transmitting feature is illustrated in FIGS. 46A-46E. As mentioned, embodiments of the main body typically include a proximal end, a distal end and at least one lumen extending between the proximal and distal ends, at least a portion of the elongated main body comprising at least a first link and an adjacent second link which are rotateable relative to each other when unlocked. FIGS. 46A-46D illustrate cross-sectional views of a link wherein one of the at least one lumen extending through the links has at least one partition. For example, referring to FIG. 46A, a first link 500 is shown having lumen 505 extending therethrough. The lumen 505 has two partitions 590, each partition 590 having the form of an inward protrusion. Any number of partitions 590 may be present, such as two, three, four, five, six, seven, eight or more. For example, FIG. 46B illustrates a first link 500 having a lumen 505 with five partitions 590. In this example, the partitions 590 provide the lumen 505 with a fluted shape. The partitions 590 may have any shape, for example, blunt, pointed, rounded, or square, and may extend inwardly any distance. For example, FIG. 46C illustrates a first link 500 having a lumen 505 with partitions 590 which extend further into the lumen 505 than in the embodiments of FIGS. 46A-46B. Further, as illustrated in FIG. 46D, the partitions 590 may comprise at least one divider 592 spanning across the lumen 505 of the link 500 forming sub-lumens 594. In addition, also illustrated in FIGS. 46A-46D, the links 500 may also include other lumens, such as steering or pullwire lumens 98 for the passage of pullwires used in steering.
  • [0174]
    The partitions 590 are used as a torque transmitting feature with the use of an elongated shaft 600 passing through the lumen 505, as illustrated in FIG. 46E. As shown, the first link 500 is engageable with a plurality of adjacent links, such as a second link 520 and third link 522, each having the same or similar features as the first link 500. In addition, the links 500, 520, 522 are arranged so that the partitions 590 within each link are generally aligned. The shaft 600 passes through the lumen 505 and is positioned between partitions 590 in each of the links. Torqueing of the plurality of adjacent links is transmitted through the shaft 600 and partitions 590. For example, by applying torque to the first link 500, the link 500 rotates about the longitudinal axis 530 until the shaft 600 contacts a partition 590. Since the partitions 590 are generally aligned, the shaft 600 will also contact partitions 590 in the second link 520 and third link 522. Therefore, torque is transmitted from the first link 500 to the third link 522. This transmission may be repeated through any number of links, transmitting torque through a plurality of adjacent links.
  • [0175]
    Another torque transmitting feature is illustrated in FIGS. 47A-47B. As mentioned, embodiments of the main body typically include a proximal end, a distal end and at least one lumen extending between the proximal and distal ends, wherein at least a portion of the elongated main body comprises a plurality of adjacent links. FIG. 47A illustrates a section of adjacent links, including a first link 500, a second link 520 and a third link 522, wherein the links have an oval cross-section. As mentioned previously, and illustrated in FIG. 2B, the links may have an oval shape for a variety of purposes, including providing for a desired arrangement of, for example, a scope 28 and optionally tool arms 30 passing through lumen 505. The oval shape may also function as a torque transmitting feature. As shown in FIG. 47B, torqueing of the first link 500 rotates the first link 500 about the longitudinal axis 530, as indicated by arrows 602. The first link 500 will contact the second link 522 due to the oval shape, as shown. This will cause the second link 522 to rotate, as indicated by arrows 604. Thus, torque is transmitted to the second link 522. This transmission may be repeated through any number of links, transmitting torque through a plurality of adjacent links.
  • [0176]
    Another torque transmitting feature is illustrated in FIGS. 48A-48C. As mentioned previously, embodiments of the main body typically include a proximal end, a distal end and at least one lumen extending between the proximal and distal ends, wherein at least a portion of the elongated main body comprises a plurality of adjacent links. A cross-sectional view of one of these adjacent links, such as the first link 500, is shown in FIGS. 48A-48C, wherein each of the links have the same or similar cross-section. The torque transmitting feature comprises a plurality of wires or rods 620 extending through the adjacent links. FIG. 48A shows eight rods 620, symmetrically arranged around lumen 505. It may be appreciated, however, that the rods 620 may be present in any arrangement. When torque is applied to a link which is adjacent to the first link 500, the rods 620 passing through the first link 500 transmit the torque (indicated by arrows 622) to the first link 500 thereby rotating the first link 500. This transmission may be repeated through any number of links, transmitting torque through a plurality of adjacent links. Similarly, FIG. 48B shows sixteen rods 620, symmetrically arrangement around lumen 505. Again, when torque is applied to a link which is adjacent to the first link 500, the rods 620 passing through the first link 500 transmit the torque (indicated by arrows 622) to the first link 500 thereby rotating the first link 500. Thus, the more rods 620 present the higher the torque transmission. FIG. 48C shows thirty-two rods 620, symmetrically arrangement around lumen 505. Any number of rods 620 may be present, typically ranging from eight to sixty-four. It may also be appreciated that the rod 620 may be comprised of any suitable material, such as metal, metal wire, polymer, nitinol, filament or fiber, to name a few. Also, some or all of the rods 620 may be pushwires or pullwires 96.
  • [0177]
    Although the foregoing invention has been described in some detail by way of illustration and example, for purposes of clarity of understanding, it will be obvious that various alternatives, modifications and equivalents may be used and the above description should not be taken as limiting in scope of the invention which is defined by the appended claims.

Claims (54)

    What is claimed is:
  1. 1. An endoluminal system comprising:
    an elongated main body having a proximal end, a distal end sized for passage through a body lumen, and at least one lumen extending between the proximal and distal ends;
    a torque transmitting feature which provides torque transmission between the proximal and distal ends while the main body is unlocked and able to form a desired configuration; and
    a locking mechanism which locks the main body in the desired configuration.
  2. 2. The endoluminal system of claim 1, further comprising a visualizing element.
  3. 3. The endoluminal system of claim 2, wherein the visualizing element is integral with the main body.
  4. 4. The endoluminal system of claim 2, wherein the at least one lumen comprises a visualizing lumen and the visualizing element is configured for passage through the visualizing lumen.
  5. 5. The endoluminal system of claim 4, wherein the visualizing element comprises an endoscope.
  6. 6. The endoluminal system of claim 1, wherein the at least one lumen comprises an arm guide lumen.
  7. 7. The endoluminal system of claim 6, further comprising at least one tool arm being adapted to extend through the arm guide lumen.
  8. 8. The endoluminal system of claim 1, further comprising a steering mechanism which steers the main body to the desired configuration while the main body is unlocked.
  9. 9. The endoluminal system of claim 1, wherein at least a portion of the elongated main body comprises a plurality of adjacent links.
  10. 10. The endoluminal system of claim 9, wherein the plurality of adjacent links comprises at least a first link and an adjacent second link, the torque transmitting feature comprising a tooth from the first link slidably engageable with a groove in the adjacent second link.
  11. 11. The endoluminal system of claim 9, wherein the plurality of adjacent links comprises at least a first link and an adjacent second link, the torque transmitting feature comprising a pin from the first link slidably engageable with a slot in the adjacent second link.
  12. 12. The endoluminal system of claim 9, wherein the torque transmitting feature comprises a fluted shape of the at least one lumen.
  13. 13. The endoluminal system of claim 9, wherein the torque transmitting feature comprises an oval shape of the plurality of adjacent links.
  14. 14. The endoluminal system of claim 13, wherein the torque transmitting feature comprises a plurality of rods extending through the adjacent links.
  15. 15. The endoluminal system of claim 14, wherein the plurality of rods comprises approximately 8 to 64 rods.
  16. 16. The endoluminal system of claim 9, wherein the steering mechanism comprises at least one pullwire extending through the plurality of adjacent links.
  17. 17. The endoluminal system of claim 1, wherein the torque transmitting feature comprises a torque transmitting covering over the main body extending between the proximal and distal ends.
  18. 18. The endoluminal system of claim 17, wherein the torque transmitting covering comprises a sheath having reinforcements.
  19. 19. An endoluminal device comprising:
    an elongated main body having a proximal end, a distal end, and at least one lumen extending between the proximal and distal ends, at least a portion of the elongated main body comprising a plurality of adjacent engageable links; and
    a torque transmitting feature which provides torque transmission by preventing disengagement of the adjacent links while the main body is unlocked and able to form a desired configuration.
  20. 20. The endoluminal device of claim 19, wherein the plurality of adjacent engageable links comprises at least a first link and an adjacent second link, the torque transmitting feature comprising at least one pin from the first link slidably engageable with at least one slot in the adjacent second link.
  21. 21. The endoluminal device of claim 20, wherein the at least one pin comprises a pair of pins, each pin extending outwardly from an outer surface of the first link in a diametrically opposite position from the other pin.
  22. 22. The endoluminal device of claim 21, wherein the at least one slot comprises a pair of slots, each slot configured to accept one or the pair of pins passing therethrough.
  23. 23. The endoluminal device of claim 22, wherein the first link comprises a first domed ring having the outer surface and the adjacent second link comprises a second domed ring having an inner surface, the outer surface of the first domed ring mateable with the inner surface of the second domed ring along a longitudinal axis, and the rings rotateable away from the longitudinal axis.
  24. 24. The endoluminal device of claim 22, wherein each slot comprises an elongate opening between a first slot end and a second slot end, the slot ends substantially aligned with the longitudinal axis to allow sliding of the pins through the slots during rotation of the rings away from the longitudinal axis.
  25. 25. The endoluminal device of claim 19, wherein the torque transmitting feature comprises a torque transmitting covering over the plurality of adjacent engageable links to prevent disengagement of the adjacent links.
  26. 26. The endoluminal device of claim 19, further comprising a locking mechanism which locks the links in the desired configuration.
  27. 27. An endoluminal device comprising:
    an elongated main body having a proximal end, a distal end, and at least one lumen extending between the proximal and distal ends, at least a portion of the elongated main body comprising a at least a first link and an adjacent second link which are rotateable relative to each other when unlocked;
    a torque transmitting feature comprising at least one protrusion from the first link slidably engageable with at least one groove in the adjacent second link, the torque transmitting feature providing torque transmission through the portion of the main body while the links are rotateable; and
    a locking mechanism which locks the links upon actuation by preventing rotation of the links relative to each other.
  28. 28. The endoluminal device of claim 27, wherein the at least one protrusion comprises a pair of protrusions, each protrusion extending outwardly from an outer surface of the first link in a diametrically opposite position from the other protrusion.
  29. 29. The endoluminal device of claim 28, wherein the at least one groove comprises a pair of grooves, each groove configured to accept one or the pair of protrusions passing therein.
  30. 30. The endoluminal device of claim 29, wherein the first link comprises a first domed ring having the outer surface and the adjacent second link comprises a second domed ring having an inner surface, the outer surface of the first domed ring mateable with the inner surface of the second domed ring along a longitudinal axis, and the rings rotateable away from the longitudinal axis.
  31. 31. The endoluminal device of claim 30, wherein each groove comprises a first groove end and a second groove end, the groove ends substantially aligned with the longitudinal axis to allow sliding of the protrusions along the grooves during rotation of the rings away from the longitudinal axis.
  32. 32. An endoluminal device comprising:
    an elongated main body having a proximal end, a distal end, and at least one lumen extending between the proximal and distal ends, at least a portion of the elongated main body comprising a plurality of adjacent links which are rotateable relative to each other when unlocked;
    a torque transmitting covering over the plurality of adjacent links providing torque transmission therethrough while the links are rotateable; and
    a locking mechanism which locks the links upon actuation by preventing rotation of the links relative to each other.
  33. 33. The endoluminal device of claim 32, wherein the torque transmitting covering comprises a snuggly fit sheath.
  34. 34. The endoluminal device of claim 33, wherein the sheath includes reinforcements.
  35. 35. The endoluminal device of claim 34, wherein the reinforcements comprises nylon, polyurethane, polyethylene, Teflon, metal, or polymer.
  36. 36. The endoluminal device of claim 34, wherein the reinforcements have a braided or woven arrangement.
  37. 37. The endoluminal device of claim 34, wherein the reinforcements has been coated with a polymer.
  38. 38. The endoluminal device of claim 32, wherein the torque transmitting covering comprises a polymer coating.
  39. 39. An endoluminal device comprising:
    an elongated main body having a proximal end, a distal end, and at least one lumen extending between the proximal and distal ends, at least a portion of the elongated main body comprising at least a first link and an adjacent second link which are rotateable relative to each other when unlocked, one of the at least one lumen extending through the links having at least one partition;
    an elongated shaft passing through one of the at least one lumen in a manner to transmit torque by contacting the least one partition; and
    a locking mechanism which locks the links upon actuation by preventing rotation of the links relative to each other.
  40. 40. The endoluminal device of claim 39, wherein the at least one partition comprises an inward protrusion.
  41. 41. The endoluminal device of claim 40, wherein the at least one lumen extending through the links has a fluted shape forming the inward protrusions.
  42. 42. The endoluminal device of claim 40, wherein the at least one partition comprises at least one divider spanning across the one of the at least one lumen.
  43. 43. The endoluminal device of claim 39, wherein the at least one lumen includes at least one steering lumen through which a pullwire passes for use in steering the elongated main body.
  44. 44. The endoluminal device of claim 43, wherein the at least one steering lumen comprises a plurality of steering lumens around the one of the at least one lumens.
  45. 45. A method of accessing comprising:
    providing an elongated main body having a proximal end, a distal end, a visualizing element and a locking mechanism, wherein the main body is capable of forming a desired configuration in an unlocked state and holding the desired configuration in a locked state;
    introducing the main body through a body passageway in the unlocked state forming the desired configuration so that the distal end reaches a target location;
    actuating the locking mechanism to hold the main body in the desired configuration; and
    viewing the target location with the use of the visualizing element.
  46. 46. A method as in claim 45, wherein introducing the main body comprises allowing the main body to assume a shape of the body passageway in the unlocked state forming the desired configuration.
  47. 47. A method as in claim 46, wherein the main body comprises a plurality of adjacent links and wherein actuating the locking mechanism comprises holding the links in a fixed relation to each other.
  48. 48. A method as in claim 47, wherein the plurality of adjacent links comprises a plurality of nestable elements and wherein holding the links comprises wedging the links together to hold them by friction.
  49. 49. A method as in claim 45, wherein introducing the main body comprises steering the main body through the body passageway in the unlocked state forming the desired configuration.
  50. 50. A method as in claim 49, wherein the main body comprises a plurality of adjacent links and wherein actuating the locking mechanism comprises holding the links in a fixed relation to each other.
  51. 51. A method as in claim 50, wherein the plurality of adjacent links comprises a plurality of nestable elements and wherein holding the links comprises wedging the links together to hold them by friction.
  52. 52. A method as in claim 45, wherein the main body includes at least one lumen extending between the proximal and distal ends, and further comprising introducing an instrument through the at least one lumen.
  53. 53. A method as in claim 52, wherein the instrument comprises a tool arm.
  54. 54. A method as in claim 45, wherein the elongated main body further includes a visualizing lumen and the visualizing element comprises an endoscope, the method further comprising positioning the endoscope within the visualizing lumen.
US10458060 2003-01-15 2003-06-09 Endoluminal tool deployment system Abandoned US20040138529A1 (en)

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US10346709 US7637905B2 (en) 2003-01-15 2003-01-15 Endoluminal tool deployment system
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US10458060 US20040138529A1 (en) 2003-01-15 2003-06-09 Endoluminal tool deployment system
US10734547 US7744613B2 (en) 1999-06-25 2003-12-12 Apparatus and methods for forming and securing gastrointestinal tissue folds
US10734562 US7955340B2 (en) 1999-06-25 2003-12-12 Apparatus and methods for forming and securing gastrointestinal tissue folds
US10735030 US8574243B2 (en) 1999-06-25 2003-12-12 Apparatus and methods for forming and securing gastrointestinal tissue folds
US10797485 US20040249367A1 (en) 2003-01-15 2004-03-09 Endoluminal tool deployment system
EP20040752537 EP1624790A4 (en) 2003-05-19 2004-05-17 Endoluminal tool deployment system
JP2006533179A JP2007511247A (en) 2003-05-19 2004-05-17 Lumen tool deployment system
PCT/US2004/015539 WO2004103430A3 (en) 2003-05-19 2004-05-17 Endoluminal tool deployment system
US10992306 US7704264B2 (en) 1999-06-25 2004-11-17 Apparatus and methods for forming and securing gastrointestinal tissue folds
US10994101 US20050075653A1 (en) 1999-06-25 2004-11-18 Apparatus and methods for forming and securing gastrointestinal tissue folds
PCT/US2005/008125 WO2005086945A3 (en) 2003-01-15 2005-03-09 Endoluminal tool deployment system
US11400120 US20060178560A1 (en) 2003-01-15 2006-04-07 Endoluminal tool deployment system
US12767731 US8343175B2 (en) 1999-06-25 2010-04-26 Apparatus and methods for forming and securing gastrointestinal tissue folds
US12916325 US20110046441A1 (en) 2003-01-15 2010-10-29 Endoluminal tool deployment system

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US10288619 Continuation-In-Part US7160312B2 (en) 1999-06-25 2002-11-04 Implantable artificial partition and methods of use
US10346709 Continuation-In-Part US7637905B2 (en) 2003-01-15 2003-01-15 Endoluminal tool deployment system
US47189303 Continuation-In-Part 2003-05-19 2003-05-19

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US10173203 Continuation-In-Part US7128708B2 (en) 2002-06-13 2002-06-13 Shape lockable apparatus and method for advancing an instrument through unsupported anatomy
US10639162 Continuation-In-Part US7618426B2 (en) 2002-12-11 2003-08-11 Apparatus and methods for forming gastrointestinal tissue approximations
US10734562 Continuation-In-Part US7955340B2 (en) 1999-06-25 2003-12-12 Apparatus and methods for forming and securing gastrointestinal tissue folds
US10734547 Continuation-In-Part US7744613B2 (en) 1999-06-25 2003-12-12 Apparatus and methods for forming and securing gastrointestinal tissue folds
US10797485 Continuation-In-Part US20040249367A1 (en) 1999-06-25 2004-03-09 Endoluminal tool deployment system

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US20040138529A1 true true US20040138529A1 (en) 2004-07-15

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US10346709 Active US7637905B2 (en) 2003-01-15 2003-01-15 Endoluminal tool deployment system
US10458060 Abandoned US20040138529A1 (en) 2003-01-15 2003-06-09 Endoluminal tool deployment system
US10990406 Abandoned US20050107663A1 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US10990559 Abandoned US20050113640A1 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US10990453 Abandoned US20050065401A1 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US10991118 Active 2024-05-25 US7918845B2 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US12916325 Abandoned US20110046441A1 (en) 2003-01-15 2010-10-29 Endoluminal tool deployment system

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US10990406 Abandoned US20050107663A1 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US10990559 Abandoned US20050113640A1 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US10990453 Abandoned US20050065401A1 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US10991118 Active 2024-05-25 US7918845B2 (en) 2003-01-15 2004-11-16 Endoluminal tool deployment system
US12916325 Abandoned US20110046441A1 (en) 2003-01-15 2010-10-29 Endoluminal tool deployment system

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Cited By (279)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040107004A1 (en) * 2002-12-02 2004-06-03 Seedling Enterprises, Llc Bariatric sleeve
US20040162568A1 (en) * 1999-06-25 2004-08-19 Usgi Medical Apparatus and methods for forming and securing gastrointestinal tissue folds
US20040225595A1 (en) * 2002-12-30 2004-11-11 Fannie Mae System and method for processing data pertaining to financial assets
US20040241768A1 (en) * 2000-05-08 2004-12-02 Whitten David G. Fluorescent polymer-QTL approach to biosensing
US20050085923A1 (en) * 2002-12-02 2005-04-21 Gi Dynamics, Inc. Anti-obesity devices
US20050096694A1 (en) * 2003-10-30 2005-05-05 Woojin Lee Surgical instrument
US20050107667A1 (en) * 2003-05-23 2005-05-19 Novare Surgical Systems, Inc. Hand-actuated device for remote manipulation of a grasping tool
US20050119671A1 (en) * 2003-11-13 2005-06-02 Usgi Medical Inc. Apparatus and methods for endoscopic suturing
US20050192615A1 (en) * 2000-11-03 2005-09-01 Torre Roger D.L. Method and device for use in minimally invasive placement of intragastric devices
US20050201759A1 (en) * 2004-02-12 2005-09-15 Wenshen Wang Photonic RF distribution system
US20050234296A1 (en) * 2004-04-14 2005-10-20 Usgi Medical Inc. Method and apparatus for obtaining endoluminal access
US20050251112A1 (en) * 2003-05-23 2005-11-10 Danitz David J Articulating mechanism for remote manipulation of a surgical or diagnostic tool
US20050273085A1 (en) * 2004-06-07 2005-12-08 Novare Surgical Systems, Inc. Articulating mechanism with flex-hinged links
US20050273084A1 (en) * 2004-06-07 2005-12-08 Novare Surgical Systems, Inc. Link systems and articulation mechanisms for remote manipulation of surgical or diagnostic tools
US20050272977A1 (en) * 2004-04-14 2005-12-08 Usgi Medical Inc. Methods and apparatus for performing endoluminal procedures
US20060020287A1 (en) * 2003-10-30 2006-01-26 Woojin Lee Surgical instrument
US20060025652A1 (en) * 2004-07-27 2006-02-02 Vargas Jaime S Cannula system and method of use
WO2006044797A2 (en) * 2004-10-18 2006-04-27 The Henry M Jackson Foundation For The Advancement Of Military Medicine, Inc. Device for displacement of anterior abdominal wall
US20060111210A1 (en) * 2004-11-23 2006-05-25 Novare Surgical Systems, Inc. Articulating mechanisms and link systems with torque transmission in remote manipulation of instruments and tools
US20060111615A1 (en) * 2004-11-23 2006-05-25 Novare Surgical Systems, Inc. Articulating sheath for flexible instruments
US20060111616A1 (en) * 2004-11-24 2006-05-25 Novare Surgical Systems, Inc. Articulating mechanism components and system for easy assembly and disassembly
US20060116697A1 (en) * 2004-11-30 2006-06-01 Esophyx, Inc. Flexible transoral endoscopic gastroesophageal flap valve restoration device and method
US20060135848A1 (en) * 2004-12-22 2006-06-22 Zutron Medical, L.L.C. Endoscope guiding device
US20060178699A1 (en) * 2005-01-20 2006-08-10 Wilson-Cook Medical Inc. Biopsy forceps
US20060201130A1 (en) * 2005-01-31 2006-09-14 Danitz David J Articulating mechanisms with joint assembly and manual handle for remote manipulation of instruments and tools
US20070032700A1 (en) * 2003-07-15 2007-02-08 Fowler Dennis L Insertable device and system for minimal access procedure
US20070142849A1 (en) * 2005-12-16 2007-06-21 Usgi Medical, Inc. Helical tissue manipulation instruments and methods of use
US20070167680A1 (en) * 2006-01-13 2007-07-19 Olympus Medical Systems Corp. Medical treatment endoscope
US20070167679A1 (en) * 2006-01-13 2007-07-19 Olympus Medical Systems Corp. Medical treatment endoscope
US20070208364A1 (en) * 2006-03-02 2007-09-06 Kms Development, Llc Variably flexible insertion device and method for variably flexing an insertion device
US20070233161A1 (en) * 2004-03-09 2007-10-04 Satiety, Inc. Devices and methods for placement of partitions within a hollow body organ
US20070250113A1 (en) * 2003-05-23 2007-10-25 Hegeman David E Tool with articulation lock
US20070276430A1 (en) * 2006-05-23 2007-11-29 Cambridge Endoscopic Devices, Inc. Surgical instrument
US20070287993A1 (en) * 2006-06-13 2007-12-13 Hinman Cameron D Tool with rotation lock
US20070287933A1 (en) * 2006-06-08 2007-12-13 Chris Phan Tissue debulking device and method of using the same
US20080039691A1 (en) * 2006-08-10 2008-02-14 Kms Development, Llc Torque-transmitting, variably-flexible, corrugated insertion device and method for transmitting torque and variably flexing a corrugated insertion device
US20080046000A1 (en) * 2006-08-16 2008-02-21 Woojin Lee Surgical instrument
US20080051802A1 (en) * 2006-08-10 2008-02-28 Novineon Healthcare Technology Partners Gmbh Medical instrument
US20080051631A1 (en) * 2006-01-13 2008-02-28 Olympus Medical Systems Corp. Medical treatment endoscope
US7338513B2 (en) 2003-10-30 2008-03-04 Cambridge Endoscopic Devices, Inc. Surgical instrument
US20080065105A1 (en) * 2006-06-13 2008-03-13 Intuitive Surgical, Inc. Minimally invasive surgical system
US20080167610A1 (en) * 2006-09-25 2008-07-10 Valentx, Inc. Toposcopic methods and devices for delivering a sleeve having axially compressed and elongate configurations
US20080188868A1 (en) * 2006-12-01 2008-08-07 Barry Weitzner Direct drive endoscopy systems and methods
US20080243064A1 (en) * 2007-02-15 2008-10-02 Hansen Medical, Inc. Support structure for robotic medical instrument
US20080249540A1 (en) * 2007-04-04 2008-10-09 Stokes Michael J Method for plicating and fastening gastric tissue
US20080249560A1 (en) * 2007-04-04 2008-10-09 Stokes Michael J Method for plicating and fastening gastric tissue
US20080249539A1 (en) * 2007-04-04 2008-10-09 Stokes Michael J Device for plicating and fastening gastric tissue
US20080249542A1 (en) * 2007-04-04 2008-10-09 Stokes Michael J Device for plicating and fastening gastric tissue
US20080249561A1 (en) * 2007-04-04 2008-10-09 Stokes Michael J Method for plicating and fastening gastric tissue
US20080255588A1 (en) * 2007-04-16 2008-10-16 Hinman Cameron D Tool with multi-state ratcheted end effector
US20080255608A1 (en) * 2007-04-16 2008-10-16 Hinman Cameron D Tool with end effector force limiter
US20080262492A1 (en) * 2007-04-11 2008-10-23 Cambridge Endoscopic Devices, Inc. Surgical Instrument
US20080262294A1 (en) * 2007-04-20 2008-10-23 Usgi Medical, Inc. Endoscopic system with disposable sheath
US20080262300A1 (en) * 2007-04-20 2008-10-23 Usgi Medical, Inc. Endoscopic system with disposable sheath
US20080269727A1 (en) * 2005-07-20 2008-10-30 Cambridge Endoscopic Devices, Inc. Surgical instrument guide device
US20080287862A1 (en) * 2007-05-18 2008-11-20 Boston Scientific Scimed, Inc. Drive systems and methods of use
US20080287963A1 (en) * 2005-12-30 2008-11-20 Rogers Theodore W Methods and apparatus to shape flexible entry guides for minimally invasive surgery
US20080294191A1 (en) * 2007-05-22 2008-11-27 Woojin Lee Surgical instrument
US20080306339A1 (en) * 2006-01-13 2008-12-11 Olympus Medical Systems Corp. Rotational force transmission mechanism, force-attenuating apparatus, medical device, and medical instrument-operation mechanism
US20090005643A1 (en) * 2007-06-27 2009-01-01 Syntheon Llc Torque-transmitting, variably-flexible, locking insertion device and method for operating the insertion device
WO2006028898A3 (en) * 2004-09-07 2009-01-15 Kenneth Binmoeller Endoscopic device with independently actuated legs
US20090023987A1 (en) * 2005-04-26 2009-01-22 Tsutomu Okada Endoscope apparatus
US20090023985A1 (en) * 2007-06-14 2009-01-22 Usgi Medical, Inc. Endoluminal instrument management system
US20090030273A1 (en) * 2006-01-13 2009-01-29 Olympus Medical Systems Corp. Medical apparatus
US20090036736A1 (en) * 2006-01-13 2009-02-05 Olympus Medical Systems Corp. Treatment endoscope
US20090054734A1 (en) * 2007-08-23 2009-02-26 Tyco Healthcare Group Lp Endoscopic surgical devices
US20090062837A1 (en) * 2007-08-29 2009-03-05 Christoph Gasche Outer tube for natural orifice surgery
US20090069842A1 (en) * 2007-09-11 2009-03-12 Woojin Lee Surgical instrument
US20090171147A1 (en) * 2007-12-31 2009-07-02 Woojin Lee Surgical instrument
US20090171161A1 (en) * 2007-12-10 2009-07-02 Usgi Medical, Inc. Steerable endoscopic instruments
US7615067B2 (en) 2006-06-05 2009-11-10 Cambridge Endoscopic Devices, Inc. Surgical instrument
US20090299344A1 (en) * 2005-07-20 2009-12-03 Woojin Lee Surgical instrument guide device
US7648519B2 (en) 2006-09-13 2010-01-19 Cambridge Endoscopic Devices, Inc. Surgical instrument
US7655004B2 (en) 2007-02-15 2010-02-02 Ethicon Endo-Surgery, Inc. Electroporation ablation apparatus, system, and method
JP2010503460A (en) * 2006-09-13 2010-02-04 バロセンス、インク Endoscopic plication procedure apparatus and method
US20100030018A1 (en) * 2008-08-04 2010-02-04 Richard Fortier Articulating surgical device
US20100041945A1 (en) * 2008-08-18 2010-02-18 Isbell Jr Lewis Instrument with articulation lock
US7678068B2 (en) 2002-12-02 2010-03-16 Gi Dynamics, Inc. Atraumatic delivery devices
US7682330B2 (en) 2003-12-09 2010-03-23 Gi Dynamics, Inc. Intestinal sleeve
US20100081874A1 (en) * 2008-09-02 2010-04-01 Manabu Miyamoto Medical treatment endoscope
US7695446B2 (en) 2002-12-02 2010-04-13 Gi Dynamics, Inc. Methods of treatment using a bariatric sleeve
US7708684B2 (en) 2004-02-27 2010-05-04 Satiety, Inc. Methods and devices for reducing hollow organ volume
EP2190339A1 (en) * 2007-08-29 2010-06-02 Minos Medical Outer tube for natural orifice surgery
US20100160735A1 (en) * 2008-12-18 2010-06-24 Ethicon Endo-Surgery, Inc. Steerable surgical access devices and methods
US7749249B2 (en) * 2006-02-21 2010-07-06 Kardium Inc. Method and device for closing holes in tissue
US7753870B2 (en) 2004-03-26 2010-07-13 Satiety, Inc. Systems and methods for treating obesity
US7757924B2 (en) 2004-02-05 2010-07-20 Satiety, Inc. Single fold system for tissue approximation and fixation
US20100198248A1 (en) * 2009-02-02 2010-08-05 Ethicon Endo-Surgery, Inc. Surgical dissector
US7789848B2 (en) 2002-10-23 2010-09-07 Satiety, Inc. Method and device for use in endoscopic organ procedures
US7794447B2 (en) 2002-11-01 2010-09-14 Valentx, Inc. Gastrointestinal sleeve device and methods for treatment of morbid obesity
US20100249497A1 (en) * 2009-03-30 2010-09-30 Peine William J Surgical instrument
US7815662B2 (en) 2007-03-08 2010-10-19 Ethicon Endo-Surgery, Inc. Surgical suture anchors and deployment device
US7815591B2 (en) 2004-09-17 2010-10-19 Gi Dynamics, Inc. Atraumatic gastrointestinal anchor
US7833156B2 (en) 2006-04-24 2010-11-16 Transenterix, Inc. Procedural cannula and support system for surgical procedures
US7837669B2 (en) 2002-11-01 2010-11-23 Valentx, Inc. Devices and methods for endolumenal gastrointestinal bypass
US7837643B2 (en) 2004-07-09 2010-11-23 Gi Dynamics, Inc. Methods and devices for placing a gastrointestinal sleeve
US7846138B2 (en) 2002-11-01 2010-12-07 Valentx, Inc. Cuff and sleeve system for gastrointestinal bypass
US7862554B2 (en) 2007-04-16 2011-01-04 Intuitive Surgical Operations, Inc. Articulating tool with improved tension member system
US7862574B2 (en) 2001-05-30 2011-01-04 Satiety, Inc. Obesity treatment tools and methods
US20110022078A1 (en) * 2009-07-23 2011-01-27 Cameron Dale Hinman Articulating mechanism
US7881797B2 (en) 2006-04-25 2011-02-01 Valentx, Inc. Methods and devices for gastrointestinal stimulation
US20110046442A1 (en) * 2009-08-18 2011-02-24 Fujifilm Corporation Insertion path securing apparatus and mantle tube
US7914543B2 (en) 2003-10-14 2011-03-29 Satiety, Inc. Single fold device for tissue fixation
US7931661B2 (en) * 2004-06-14 2011-04-26 Usgi Medical, Inc. Apparatus and methods for performing transluminal gastrointestinal procedures
US20110098529A1 (en) * 2009-10-28 2011-04-28 Boston Scientific Scimed, Inc. Method and Apparatus Related to a Flexible Assembly at a Distal End Portion of a Medical Device
US20110112517A1 (en) * 2009-11-06 2011-05-12 Peine Willliam J Surgical instrument
US20110118545A1 (en) * 2006-04-24 2011-05-19 Williams Michael S System and method for multi-instrument surgical access
US7947055B2 (en) 2002-08-30 2011-05-24 Ethicon Endo-Surgery, Inc. Methods and devices for maintaining a space occupying device in a relatively fixed location within a stomach
US7976488B2 (en) 2005-06-08 2011-07-12 Gi Dynamics, Inc. Gastrointestinal anchor compliance
US20110178367A1 (en) * 2008-07-10 2011-07-21 Mcmaster University Endoscopic device with end effector mechanism
US20110184459A1 (en) * 2008-08-04 2011-07-28 Malkowski Jaroslaw T Articulating Surgical Device
US20110179894A1 (en) * 2008-10-08 2011-07-28 Ntn Corporation Remote-controlled actuator
US20110184241A1 (en) * 2008-06-05 2011-07-28 Cardiorobotics, Inc. Extendable articulated probe device
US8007505B2 (en) 2003-10-14 2011-08-30 Ethicon Eado-Surgery, Inc. System for tissue approximation and fixation
US8016755B2 (en) 2000-10-19 2011-09-13 Applied Medical Resources Corporation Surgical access apparatus and method
US20110224684A1 (en) * 2005-12-30 2011-09-15 Intuitive Surgical Operations, Inc. Robotic surgery system including position sensors using fiber bragg gratings
US20110230718A1 (en) * 2009-10-14 2011-09-22 Olympus Medical Systems Corp. Medical flexible section and insertion section of medical apparatus
US20110230723A1 (en) * 2008-12-29 2011-09-22 Salvatore Castro Active Instrument Port System for Minimally-Invasive Surgical Procedures
US8029531B2 (en) 2006-07-11 2011-10-04 Cambridge Endoscopic Devices, Inc. Surgical instrument
US8037591B2 (en) 2009-02-02 2011-10-18 Ethicon Endo-Surgery, Inc. Surgical scissors
US20110257478A1 (en) * 2010-04-20 2011-10-20 Spinewindow Llc Method and apparatus for performing retro peritoneal dissection
US8057420B2 (en) 2003-12-09 2011-11-15 Gi Dynamics, Inc. Gastrointestinal implant with drawstring
US8062207B2 (en) 2002-08-07 2011-11-22 Ethicon Endo-Surgery, Inc. Intra-gastric fastening devices
US8070759B2 (en) 2008-05-30 2011-12-06 Ethicon Endo-Surgery, Inc. Surgical fastening device
US8075572B2 (en) 2007-04-26 2011-12-13 Ethicon Endo-Surgery, Inc. Surgical suturing apparatus
US8092482B2 (en) 2002-08-30 2012-01-10 Ethicon Endo-Surgery, Inc. Stented anchoring of gastric space-occupying devices
US8092378B2 (en) 2004-11-17 2012-01-10 Ethicon Endo-Surgery, Inc. Remote tissue retraction device
US20120010598A1 (en) * 2006-02-28 2012-01-12 Frassica James J Rotate-to-advance catheterization system
US8100922B2 (en) 2007-04-27 2012-01-24 Ethicon Endo-Surgery, Inc. Curved needle suturing tool
US8109873B2 (en) 2007-05-11 2012-02-07 Applied Medical Resources Corporation Surgical retractor with gel pad
US8114119B2 (en) 2008-09-09 2012-02-14 Ethicon Endo-Surgery, Inc. Surgical grasping device
US8114072B2 (en) 2008-05-30 2012-02-14 Ethicon Endo-Surgery, Inc. Electrical ablation device
US8137301B2 (en) 2002-12-02 2012-03-20 Gi Dynamics, Inc. Bariatric sleeve
US20120067604A1 (en) * 2009-05-29 2012-03-22 Hiroshi Isobe Remote-controlled actuator
US20120088964A1 (en) * 2010-10-11 2012-04-12 Epicardial Technologies, Inc. Methods and devices for pericardial access
US8157835B2 (en) 2001-08-14 2012-04-17 Applied Medical Resouces Corporation Access sealing apparatus and method
US8157834B2 (en) 2008-11-25 2012-04-17 Ethicon Endo-Surgery, Inc. Rotational coupling device for surgical instrument with flexible actuators
US8172772B2 (en) 2008-12-11 2012-05-08 Ethicon Endo-Surgery, Inc. Specimen retrieval device
US8182441B2 (en) 2007-06-08 2012-05-22 Valentx, Inc. Methods and devices for intragastric support of functional or prosthetic gastrointestinal devices
US8187177B2 (en) 2003-09-17 2012-05-29 Applied Medical Resources Corporation Surgical instrument access device
US8211125B2 (en) 2008-08-15 2012-07-03 Ethicon Endo-Surgery, Inc. Sterile appliance delivery device for endoscopic procedures
US8226552B2 (en) 2007-05-11 2012-07-24 Applied Medical Resources Corporation Surgical retractor
US8231641B2 (en) 2003-04-16 2012-07-31 Ethicon Endo-Surgery, Inc. Method and devices for modifying the function of a body organ
US8235054B2 (en) 2002-06-05 2012-08-07 Applied Medical Resources Corporation Wound retractor
US8241204B2 (en) 2008-08-29 2012-08-14 Ethicon Endo-Surgery, Inc. Articulating end cap
US8252057B2 (en) 2009-01-30 2012-08-28 Ethicon Endo-Surgery, Inc. Surgical access device
US8257394B2 (en) 2004-05-07 2012-09-04 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US8257365B2 (en) 2004-02-13 2012-09-04 Ethicon Endo-Surgery, Inc. Methods and devices for reducing hollow organ volume
US8262680B2 (en) 2008-03-10 2012-09-11 Ethicon Endo-Surgery, Inc. Anastomotic device
US8262563B2 (en) 2008-07-14 2012-09-11 Ethicon Endo-Surgery, Inc. Endoscopic translumenal articulatable steerable overtube
US8262655B2 (en) 2007-11-21 2012-09-11 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8262568B2 (en) 2008-10-13 2012-09-11 Applied Medical Resources Corporation Single port access system
US8267858B2 (en) 2005-10-14 2012-09-18 Applied Medical Resources Corporation Wound retractor with gel cap
US8277373B2 (en) 2004-04-14 2012-10-02 Usgi Medical, Inc. Methods and apparaus for off-axis visualization
US8317690B2 (en) 2009-03-31 2012-11-27 Covidien Lp Foam port and introducer assembly
US8317806B2 (en) 2008-05-30 2012-11-27 Ethicon Endo-Surgery, Inc. Endoscopic suturing tension controlling and indication devices
US20120302852A1 (en) * 2011-04-25 2012-11-29 Matos Jeffrey A Implantable medical device removal/insertion tool
US8323184B2 (en) 2009-03-31 2012-12-04 Covidien Lp Surgical access port and associated introducer mechanism
US8337394B2 (en) 2008-10-01 2012-12-25 Ethicon Endo-Surgery, Inc. Overtube with expandable tip
US8343047B2 (en) 2008-01-22 2013-01-01 Applied Medical Resources Corporation Surgical instrument access device
US8353487B2 (en) 2009-12-17 2013-01-15 Ethicon Endo-Surgery, Inc. User interface support devices for endoscopic surgical instruments
US8361066B2 (en) 2009-01-12 2013-01-29 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8361112B2 (en) 2008-06-27 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical suture arrangement
US20130041392A1 (en) * 2011-08-08 2013-02-14 Gyrus Ent, L.L.C. Locking flexible surgical instruments
US8388526B2 (en) 2001-10-20 2013-03-05 Applied Medical Resources Corporation Wound retraction apparatus and method
WO2013039999A2 (en) * 2011-09-13 2013-03-21 Medrobotics Corporation Highly articulated probes with anti-twist link arrangement, methods of formation thereof, and methods of performing medical procedures
US8403926B2 (en) 2008-06-05 2013-03-26 Ethicon Endo-Surgery, Inc. Manually articulating devices
US8409200B2 (en) 2008-09-03 2013-04-02 Ethicon Endo-Surgery, Inc. Surgical grasping device
US8444657B2 (en) 2004-05-07 2013-05-21 Usgi Medical, Inc. Apparatus and methods for rapid deployment of tissue anchors
US8449605B2 (en) 2006-06-28 2013-05-28 Kardium Inc. Method for anchoring a mitral valve
US8449560B2 (en) 2004-03-09 2013-05-28 Satiety, Inc. Devices and methods for placement of partitions within a hollow body organ
WO2013082310A1 (en) * 2011-12-02 2013-06-06 Barosense, Inc. Positioning device and articulation assembly for remote positioning of a tool
US20130144401A1 (en) * 2005-11-15 2013-06-06 Endogastric Solutions, Inc. Apparatus including multiple invaginators for restoring a gastroesophageal flap valve and method
US8480683B2 (en) 2009-11-24 2013-07-09 Covidien Lp Foam introduction system including modified port geometry
US8480657B2 (en) 2007-10-31 2013-07-09 Ethicon Endo-Surgery, Inc. Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US8480689B2 (en) 2008-09-02 2013-07-09 Ethicon Endo-Surgery, Inc. Suturing device
US8496574B2 (en) 2009-12-17 2013-07-30 Ethicon Endo-Surgery, Inc. Selectively positionable camera for surgical guide tube assembly
US8506564B2 (en) 2009-12-18 2013-08-13 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US20130205937A1 (en) * 2011-07-15 2013-08-15 Olympus Medical Systems Corp. Insertion apparatus
US8529563B2 (en) 2008-08-25 2013-09-10 Ethicon Endo-Surgery, Inc. Electrical ablation devices
CN103315781A (en) * 2013-07-10 2013-09-25 上海交通大学 Endoscope noninvasive surgery system
US8562516B2 (en) 2004-04-14 2013-10-22 Usgi Medical Inc. Methods and apparatus for obtaining endoluminal access
US8568410B2 (en) 2007-08-31 2013-10-29 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
US8579897B2 (en) 2007-11-21 2013-11-12 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8608652B2 (en) 2009-11-05 2013-12-17 Ethicon Endo-Surgery, Inc. Vaginal entry surgical devices, kit, system, and method
US8628547B2 (en) 2004-03-09 2014-01-14 Ethicon Endo-Surgery, Inc. Devices and methods for placement of partitions within a hollow body organ
US20140046305A1 (en) * 2011-04-06 2014-02-13 Medrobotics Corporation Articulating surgical tools and tool sheaths, and methods of deploying the same
US8652150B2 (en) 2008-05-30 2014-02-18 Ethicon Endo-Surgery, Inc. Multifunction surgical device
US8679003B2 (en) 2008-05-30 2014-03-25 Ethicon Endo-Surgery, Inc. Surgical device and endoscope including same
US8703034B2 (en) 2001-08-14 2014-04-22 Applied Medical Resources Corporation Method of making a tack-free gel
US8726909B2 (en) 2006-01-27 2014-05-20 Usgi Medical, Inc. Methods and apparatus for revision of obesity procedures
US8740904B2 (en) 2009-11-24 2014-06-03 Covidien Lp Seal anchor introducer including biasing member
US8753267B2 (en) 2011-01-24 2014-06-17 Covidien Lp Access assembly insertion device
US8758236B2 (en) 2011-05-10 2014-06-24 Applied Medical Resources Corporation Wound retractor
US8771260B2 (en) 2008-05-30 2014-07-08 Ethicon Endo-Surgery, Inc. Actuating and articulating surgical device
US8801647B2 (en) 2007-02-22 2014-08-12 Gi Dynamics, Inc. Use of a gastrointestinal sleeve to treat bariatric surgery fistulas and leaks
USD712034S1 (en) 2007-10-05 2014-08-26 Covidien Lp Seal anchor for use in surgical procedures
US8828031B2 (en) 2009-01-12 2014-09-09 Ethicon Endo-Surgery, Inc. Apparatus for forming an anastomosis
EP2774547A1 (en) 2013-03-08 2014-09-10 EndoGastric Solutions, Inc. Device for manipulating and fastening tissue
US20140296632A1 (en) * 2011-02-16 2014-10-02 Olympus Medical Systems Corp. Endoscope, and treatment instrument for endoscope
US20140309493A1 (en) * 2013-04-11 2014-10-16 Lumenis Ltd. Adjustable probe
US8870916B2 (en) 2006-07-07 2014-10-28 USGI Medical, Inc Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use
US8888792B2 (en) 2008-07-14 2014-11-18 Ethicon Endo-Surgery, Inc. Tissue apposition clip application devices and methods
US20140350335A1 (en) * 2010-04-08 2014-11-27 Eric James Kezirian Endoscopic device and system
US8906035B2 (en) 2008-06-04 2014-12-09 Ethicon Endo-Surgery, Inc. Endoscopic drop off bag
US8926634B2 (en) 2004-05-07 2015-01-06 Usgi Medical, Inc. Apparatus and methods for manipulating and securing tissue
US8932214B2 (en) 2003-02-25 2015-01-13 Applied Medical Resources Corporation Surgical access system
US8932213B2 (en) 2009-10-01 2015-01-13 Covidien Lp Seal anchor with non-parallel lumens
US8939897B2 (en) 2007-10-31 2015-01-27 Ethicon Endo-Surgery, Inc. Methods for closing a gastrotomy
US8940002B2 (en) 2010-09-30 2015-01-27 Kardium Inc. Tissue anchor system
US20150038792A1 (en) * 2012-03-13 2015-02-05 Thomas Gaiselmann Instrument System For Minimally Invasive Surgery In Single Port Technology
US8956318B2 (en) 2012-05-31 2015-02-17 Valentx, Inc. Devices and methods for gastrointestinal bypass
US20150080907A1 (en) * 2013-09-13 2015-03-19 Vanderbilt University System and method for endoscopic deployment of robotic concentric tube manipulators for performing surgery
US8986199B2 (en) 2012-02-17 2015-03-24 Ethicon Endo-Surgery, Inc. Apparatus and methods for cleaning the lens of an endoscope
US8992421B2 (en) 2010-10-22 2015-03-31 Medrobotics Corporation Highly articulated robotic probes and methods of production and use of such probes
US8992547B2 (en) 2012-03-21 2015-03-31 Ethicon Endo-Surgery, Inc. Methods and devices for creating tissue plications
US9005198B2 (en) 2010-01-29 2015-04-14 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
WO2014179683A3 (en) * 2013-05-02 2015-04-23 Gabriel Johnston A robotic system including a cable interface assembly
US9017252B2 (en) 2010-04-12 2015-04-28 Covidien Lp Access assembly with flexible cannulas
US9028483B2 (en) 2009-12-18 2015-05-12 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US9028511B2 (en) 2004-03-09 2015-05-12 Ethicon Endo-Surgery, Inc. Devices and methods for placement of partitions within a hollow body organ
US20150150634A1 (en) * 2012-08-30 2015-06-04 Olympus Corporation Medical system and operation method
US9050066B2 (en) 2010-06-07 2015-06-09 Kardium Inc. Closing openings in anatomical tissue
US9049987B2 (en) 2011-03-17 2015-06-09 Ethicon Endo-Surgery, Inc. Hand held surgical device for manipulating an internal magnet assembly within a patient
US9060844B2 (en) 2002-11-01 2015-06-23 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US9066655B2 (en) 2007-12-07 2015-06-30 Ethicon Endo-Surgery, Inc. Selective stiffening devices and methods
US9072511B2 (en) 2011-03-25 2015-07-07 Kardium Inc. Medical kit for constricting tissue or a bodily orifice, for example, a mitral valve
US9078662B2 (en) 2012-07-03 2015-07-14 Ethicon Endo-Surgery, Inc. Endoscopic cap electrode and method for using the same
US9113867B2 (en) 2011-12-15 2015-08-25 Ethicon Endo-Surgery, Inc. Devices and methods for endoluminal plication
US9113879B2 (en) 2011-12-15 2015-08-25 Ethicon Endo-Surgery, Inc. Devices and methods for endoluminal plication
USD738500S1 (en) 2008-10-02 2015-09-08 Covidien Lp Seal anchor for use in surgical procedures
US20150257776A1 (en) * 2014-03-13 2015-09-17 Lsi Solutions, Inc. Surgical clamp and clamp jaw
US9155451B2 (en) 2006-03-02 2015-10-13 Syntheon, Llc Variably flexible insertion device and method for variably flexing an insertion device
US9161771B2 (en) 2011-05-13 2015-10-20 Intuitive Surgical Operations Inc. Medical instrument with snake wrist structure
US20150297346A1 (en) * 2014-04-17 2015-10-22 Medtronic Vascular Galway Hinged transcatheter prosthetic heart valve delivery system
US9168050B1 (en) 2011-03-24 2015-10-27 Cambridge Endoscopic Devices, Inc. End effector construction
US9204964B2 (en) 2009-10-01 2015-12-08 Kardium Inc. Medical device, kit and method for constricting tissue or a bodily orifice, for example, a mitral valve
US9226772B2 (en) 2009-01-30 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical device
US9233241B2 (en) 2011-02-28 2016-01-12 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9254169B2 (en) 2011-02-28 2016-02-09 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9271639B2 (en) 2012-02-29 2016-03-01 Covidien Lp Surgical introducer and access port assembly
US9277957B2 (en) 2012-08-15 2016-03-08 Ethicon Endo-Surgery, Inc. Electrosurgical devices and methods
US9289200B2 (en) 2010-10-01 2016-03-22 Applied Medical Resources Corporation Natural orifice surgery system
US9289115B2 (en) 2010-10-01 2016-03-22 Applied Medical Resources Corporation Natural orifice surgery system
US9289112B2 (en) 2006-01-13 2016-03-22 Olympus Corporation Medical treatment endoscope having an operation stick formed to allow a procedure instrument to pass
US9308049B2 (en) 2006-01-13 2016-04-12 Olympus Corporation Medical treatment endoscope
US9314620B2 (en) 2011-02-28 2016-04-19 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9357984B2 (en) 2013-04-23 2016-06-07 Covidien Lp Constant value gap stabilizer for articulating links
US9358007B2 (en) 2005-01-25 2016-06-07 Endogastric Solutions, Inc. Slitted tissue fixation devices and assemblies for deploying the same
US9364955B2 (en) 2011-12-21 2016-06-14 Medrobotics Corporation Stabilizing apparatus for highly articulated probes with link arrangement, methods of formation thereof, and methods of use thereof
US9387048B2 (en) 2011-10-14 2016-07-12 Intuitive Surgical Operations, Inc. Catheter sensor systems
US9414832B2 (en) 2005-08-12 2016-08-16 Endogastric Solutions, Inc. Apparatus and method for securing the stomach to the diaphragm for use, for example, in treating hiatal hernias and gastroesophageal reflux disease
US9421006B2 (en) 2007-01-08 2016-08-23 Endogastric Solutions, Inc. Connected fasteners, delivery device and method
US9427255B2 (en) 2012-05-14 2016-08-30 Ethicon Endo-Surgery, Inc. Apparatus for introducing a steerable camera assembly into a patient
US9446456B2 (en) 2008-09-11 2016-09-20 Ntn Corporation Remote-controlled actuator
US9451960B2 (en) 2012-05-31 2016-09-27 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9452276B2 (en) 2011-10-14 2016-09-27 Intuitive Surgical Operations, Inc. Catheter with removable vision probe
WO2016204954A1 (en) * 2015-06-19 2016-12-22 Evalve, Inc. Catheter guiding system
US9526648B2 (en) 2010-06-13 2016-12-27 Synerz Medical, Inc. Intragastric device for treating obesity
US9545290B2 (en) 2012-07-30 2017-01-17 Ethicon Endo-Surgery, Inc. Needle probe guide
US9572623B2 (en) 2012-08-02 2017-02-21 Ethicon Endo-Surgery, Inc. Reusable electrode and disposable sheath
US9642608B2 (en) 2014-07-18 2017-05-09 Applied Medical Resources Corporation Gels having permanent tack free coatings and method of manufacture
US9649163B2 (en) 2010-11-11 2017-05-16 Medrobotics Corporation Introduction devices for highly articulated robotic probes and methods of production and use of such probes
US9675489B2 (en) 2012-05-31 2017-06-13 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9675360B2 (en) 2005-10-18 2017-06-13 Endogastric Solutions, Inc. Invaginator for gastroesophageal flap valve restoration device
US9700308B2 (en) 2004-02-20 2017-07-11 Endogastric Solutions, Inc. Tissue fixation devices and assemblies for deploying the same
US9707011B2 (en) 2014-11-12 2017-07-18 Covidien Lp Attachments for use with a surgical access device
US9717403B2 (en) 2008-12-05 2017-08-01 Jeffrey B. Kleiner Method and apparatus for performing retro peritoneal dissection
US9717524B2 (en) 2013-03-14 2017-08-01 Gyrus Acmi, Inc. Vaginal cuff closure tool and method
US9737365B2 (en) 2003-05-23 2017-08-22 Intuitive Surgical Operations, Inc. Tool with articulation lock
US9744038B2 (en) 2008-05-13 2017-08-29 Kardium Inc. Medical device for constricting tissue or a bodily orifice, for example a mitral valve
US9757149B2 (en) 2006-06-13 2017-09-12 Intuitive Surgical Operations, Inc. Surgical system entry guide
US9757264B2 (en) 2013-03-13 2017-09-12 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9861360B2 (en) 2011-09-09 2018-01-09 Endogastric Solutions, Inc. Methods and devices for manipulating and fastening tissue
US9901410B2 (en) 2010-07-28 2018-02-27 Medrobotics Corporation Surgical positioning and support system
US9949730B2 (en) 2014-11-25 2018-04-24 Applied Medical Resources Corporation Circumferential wound retraction with support and guidance structures
US9955957B2 (en) 2011-09-09 2018-05-01 Endogastric Solutions, Inc. Methods and devices for manipulating and fastening tissue
US9987118B2 (en) 2005-12-01 2018-06-05 Endogastric Solutions, Inc. Apparatus and method for concurrently forming a gastroesophageal valve and tightening the lower esophageal sphincter
US10004558B2 (en) 2015-03-30 2018-06-26 Ethicon Endo-Surgery, Inc. Electrical ablation devices

Families Citing this family (379)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8944070B2 (en) 1999-04-07 2015-02-03 Intuitive Surgical Operations, Inc. Non-force reflecting method for providing tool force information to a user of a telesurgical system
US7955340B2 (en) 1999-06-25 2011-06-07 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US7744613B2 (en) 1999-06-25 2010-06-29 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
EP1303221A2 (en) * 2000-07-21 2003-04-23 Atropos Limited A surgical instrument
US7037344B2 (en) * 2002-11-01 2006-05-02 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US20050182298A1 (en) * 2002-12-06 2005-08-18 Intuitive Surgical Inc. Cardiac tissue ablation instrument with flexible wrist
US20040122456A1 (en) * 2002-12-11 2004-06-24 Saadat Vahid C. Methods and apparatus for gastric reduction
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
US7942898B2 (en) * 2002-12-11 2011-05-17 Usgi Medical, Inc. Delivery systems and methods for gastric reduction
US7942884B2 (en) * 2002-12-11 2011-05-17 Usgi Medical, Inc. Methods for reduction of a gastric lumen
US7637905B2 (en) 2003-01-15 2009-12-29 Usgi Medical, Inc. Endoluminal tool deployment system
DE602004018903D1 (en) 2003-02-14 2009-02-26 Depuy Spine Inc intervertebral fusion device prepared in situ
US20040199052A1 (en) * 2003-04-01 2004-10-07 Scimed Life Systems, Inc. Endoscopic imaging system
US8118732B2 (en) 2003-04-01 2012-02-21 Boston Scientific Scimed, Inc. Force feedback control system for video endoscope
US7578786B2 (en) * 2003-04-01 2009-08-25 Boston Scientific Scimed, Inc. Video endoscope
US7591783B2 (en) 2003-04-01 2009-09-22 Boston Scientific Scimed, Inc. Articulation joint for video endoscope
US20050245789A1 (en) 2003-04-01 2005-11-03 Boston Scientific Scimed, Inc. Fluid manifold for endoscope system
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
US7960935B2 (en) 2003-07-08 2011-06-14 The Board Of Regents Of The University Of Nebraska Robotic devices with agent delivery components and related methods
DE10334100A1 (en) * 2003-07-25 2005-03-03 Viktor Josef Wimmer Flexible endoscope with longitudinal axial channels
DE112004001398T5 (en) * 2003-07-29 2006-06-29 National Cancer Center Device for internal treatment of a patient and system for internal treatment of a patient
US7216255B2 (en) * 2004-01-23 2007-05-08 Microsoft Corporation Adaptive recovery from system failure for application instances that govern message transactions
GB0402796D0 (en) * 2004-02-09 2004-03-10 Anson Medical Ltd An endoluminal surgical delivery system
US7452351B2 (en) 2004-04-16 2008-11-18 Kyphon Sarl Spinal diagnostic methods and apparatus
US7824390B2 (en) 2004-04-16 2010-11-02 Kyphon SÀRL Spinal diagnostic methods and apparatus
WO2005112555A3 (en) * 2004-04-27 2006-12-28 Intersurgical Inc Ventilator breathing tube support arm
US7390329B2 (en) * 2004-05-07 2008-06-24 Usgi Medical, Inc. Methods for grasping and cinching tissue anchors
US8308765B2 (en) * 2004-05-07 2012-11-13 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US20050251159A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. Methods and apparatus for grasping and cinching tissue anchors
US8057511B2 (en) * 2004-05-07 2011-11-15 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US20050251208A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. Linear anchors for anchoring to tissue
US20060015125A1 (en) * 2004-05-07 2006-01-19 Paul Swain Devices and methods for gastric surgery
EP1607036A1 (en) * 2004-06-18 2005-12-21 Universite Libre De Bruxelles Toolholder mountable on an endoscope and comprising a ring
US8215531B2 (en) 2004-07-28 2012-07-10 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a medical substance dispenser
JP4592007B2 (en) * 2005-02-15 2010-12-01 Hoya株式会社 Within the object treating device and the object inside the treatment system
JP4763307B2 (en) * 2005-02-18 2011-08-31 オリンパス株式会社 Endoscopic treatment tool
US8197472B2 (en) 2005-03-25 2012-06-12 Maquet Cardiovascular, Llc Tissue welding and cutting apparatus and method
US7918848B2 (en) 2005-03-25 2011-04-05 Maquet Cardiovascular, Llc Tissue welding and cutting apparatus and method
US7393320B2 (en) * 2005-04-29 2008-07-01 Ams Research Corporation Pelvic floor health articles and procedures
US8298291B2 (en) 2005-05-26 2012-10-30 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US9585651B2 (en) 2005-05-26 2017-03-07 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US7618413B2 (en) * 2005-06-22 2009-11-17 Boston Scientific Scimed, Inc. Medical device control system
EP1925188B1 (en) * 2005-08-08 2016-10-05 Smart Medical Systems Ltd. Balloon guided endoscopy
US9271720B2 (en) * 2005-08-11 2016-03-01 Biomet Sports Medicine, Llc Steerable suture passing device
US8366773B2 (en) 2005-08-16 2013-02-05 Benvenue Medical, Inc. Apparatus and method for treating bone
US7785368B2 (en) 2005-08-16 2010-08-31 Benvenue Medical, Inc. Spinal tissue distraction devices
US20070194082A1 (en) 2005-08-31 2007-08-23 Morgan Jerome R Surgical stapling device with anvil having staple forming pockets of varying depths
US9237891B2 (en) 2005-08-31 2016-01-19 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US7934630B2 (en) 2005-08-31 2011-05-03 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US20130334284A1 (en) 2005-08-31 2013-12-19 Ethicon Endo-Surgery, Inc. Fastener cartridge assembly comprising a fixed anvil and different staple heights
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US8231524B2 (en) * 2005-09-20 2012-07-31 Ai Medical Devices, Inc. Endotracheal intubation device
US8758375B2 (en) * 2005-09-28 2014-06-24 Olympus Medical Systems Corp Method for suturing perforation
US20070106317A1 (en) 2005-11-09 2007-05-10 Shelton Frederick E Iv Hydraulically and electrically actuated articulation joints for surgical instruments
US9962168B2 (en) 2005-12-20 2018-05-08 CroJor, LLC Method and apparatus for performing minimally invasive arthroscopic procedures
US8679097B2 (en) * 2005-12-20 2014-03-25 Orthodynamix Llc Method and devices for minimally invasive arthroscopic procedures
US20070179340A1 (en) * 2005-12-20 2007-08-02 Medicept, Inc. Method and devices for minimally invasive arthroscopic procedures
US20080255422A1 (en) * 2006-01-13 2008-10-16 Olympus Medical Systems Corp. Medical device
US8728121B2 (en) * 2006-01-13 2014-05-20 Olympus Medical Systems Corp. Puncture needle and medical procedure using puncture needle that is performed via natural orifice
US20070167675A1 (en) * 2006-01-13 2007-07-19 Olympus Medical Systems Corp. Overtube and medical procedure via natural orifice using the same
US20070167676A1 (en) * 2006-01-13 2007-07-19 Olympus Medical Systems Corp. Overtube and medical procedure via natural orifice using the same
US8721657B2 (en) * 2006-01-13 2014-05-13 Olympus Medical Systems Corp. Medical instrument
US20070219411A1 (en) * 2006-01-13 2007-09-20 Olympus Medical Systems Corp. Overtube and endoscopic treatment system
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US9861359B2 (en) 2006-01-31 2018-01-09 Ethicon Llc Powered surgical instruments with firing system lockout arrangements
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US8708213B2 (en) 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US8820603B2 (en) 2006-01-31 2014-09-02 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US7785333B2 (en) 2006-02-21 2010-08-31 Olympus Medical Systems Corp. Overtube and operative procedure via bodily orifice
US8241279B2 (en) 2006-02-23 2012-08-14 Olympus Medical Systems Corp. Overtube and natural opening medical procedures using the same
JP5449653B2 (en) * 2006-03-23 2014-03-19 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. The endoscope accessory channel articulating
US20070225562A1 (en) 2006-03-23 2007-09-27 Ethicon Endo-Surgery, Inc. Articulating endoscopic accessory channel
US8992422B2 (en) 2006-03-23 2015-03-31 Ethicon Endo-Surgery, Inc. Robotically-controlled endoscopic accessory channel
US7976554B2 (en) 2006-04-19 2011-07-12 Vibrynt, Inc. Devices, tools and methods for performing minimally invasive abdominal surgical procedures
US20090281563A1 (en) * 2006-04-19 2009-11-12 Newell Matthew B Devices, tools and methods for performing minimally invasive abdominal surgical procedures
US8585733B2 (en) 2006-04-19 2013-11-19 Vibrynt, Inc Devices, tools and methods for performing minimally invasive abdominal surgical procedures
US20090281500A1 (en) * 2006-04-19 2009-11-12 Acosta Pablo G Devices, system and methods for minimally invasive abdominal surgical procedures
EP2023793B1 (en) * 2006-05-17 2015-11-18 TransEnterix, Inc. Multi-instrument surgical access using a single access port
US20070265494A1 (en) * 2006-05-10 2007-11-15 Boston Scientific Scimed Inc. Flexible and retractable endoscope elevator
US9770230B2 (en) * 2006-06-01 2017-09-26 Maquet Cardiovascular Llc Endoscopic vessel harvesting system components
US8377045B2 (en) * 2006-06-13 2013-02-19 Intuitive Surgical Operations, Inc. Extendable suction surface for bracing medial devices during robotically assisted medical procedures
US8551076B2 (en) * 2006-06-13 2013-10-08 Intuitive Surgical Operations, Inc. Retrograde instrument
US9469034B2 (en) 2007-06-13 2016-10-18 Intuitive Surgical Operations, Inc. Method and system for switching modes of a robotic system
US8620473B2 (en) 2007-06-13 2013-12-31 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US20090192523A1 (en) 2006-06-29 2009-07-30 Intuitive Surgical, Inc. Synthetic representation of a surgical instrument
US9138129B2 (en) 2007-06-13 2015-09-22 Intuitive Surgical Operations, Inc. Method and system for moving a plurality of articulated instruments in tandem back towards an entry guide
KR101376374B1 (en) * 2006-06-14 2014-03-20 옵티비아 메디칼 엘엘씨 Medical Devices introduced a system and method
US8376865B2 (en) 2006-06-20 2013-02-19 Cardiacmd, Inc. Torque shaft and torque shaft drive
EP2397101B1 (en) 2006-06-22 2018-06-13 Board of Regents of the University of Nebraska Magnetically coupleable robotic devices
US8679096B2 (en) * 2007-06-21 2014-03-25 Board Of Regents Of The University Of Nebraska Multifunctional operational component for robotic devices
US9718190B2 (en) 2006-06-29 2017-08-01 Intuitive Surgical Operations, Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US9789608B2 (en) * 2006-06-29 2017-10-17 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US7665647B2 (en) 2006-09-29 2010-02-23 Ethicon Endo-Surgery, Inc. Surgical cutting and stapling device with closure apparatus for limiting maximum tissue compression force
US8647349B2 (en) * 2006-10-18 2014-02-11 Hologic, Inc. Systems for performing gynecological procedures with mechanical distension
US20080172037A1 (en) * 2006-11-01 2008-07-17 Percutaneous Systems, Inc. Catheter with adjustable column stability and methods for its use
US9392935B2 (en) 2006-11-07 2016-07-19 Hologic, Inc. Methods for performing a medical procedure
US8025656B2 (en) 2006-11-07 2011-09-27 Hologic, Inc. Methods, systems and devices for performing gynecological procedures
US8292801B2 (en) * 2006-12-22 2012-10-23 Olympus Medical Systems Corp. Surgical treatment apparatus
US8652120B2 (en) 2007-01-10 2014-02-18 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US20080169332A1 (en) 2007-01-11 2008-07-17 Shelton Frederick E Surgical stapling device with a curved cutting member
JP2010516325A (en) 2007-01-17 2010-05-20 ジー・アイ・ヴュー・リミテッド Diagnostic or therapeutic tool for colonoscopy
JP4914735B2 (en) * 2007-02-14 2012-04-11 オリンパスメディカルシステムズ株式会社 The endoscope system controlling the position of the surgical instrument
US9579088B2 (en) 2007-02-20 2017-02-28 Board Of Regents Of The University Of Nebraska Methods, systems, and devices for surgical visualization and device manipulation
EP2124777A4 (en) 2007-02-21 2013-06-05 Benvenue Medical Inc Devices for treating the spine
EP2124778A4 (en) 2007-02-21 2013-03-20 Benvenue Medical Inc Devices for treating the spine
US8500777B2 (en) 2007-03-13 2013-08-06 Longevity Surgical, Inc. Methods for approximation and fastening of soft tissue
EP2129301A4 (en) * 2007-03-13 2015-03-25 Peter S Harris Methods and devices for reducing gastric volume
US8979872B2 (en) * 2007-03-13 2015-03-17 Longevity Surgical, Inc. Devices for engaging, approximating and fastening tissue
JP5030639B2 (en) * 2007-03-29 2012-09-19 オリンパスメディカルシステムズ株式会社 Surgical instrument position control apparatus of the endoscope apparatus
US8574253B2 (en) 2007-04-06 2013-11-05 Hologic, Inc. Method, system and device for tissue removal
US20090270895A1 (en) 2007-04-06 2009-10-29 Interlace Medical, Inc. Low advance ratio, high reciprocation rate tissue removal device
US9095366B2 (en) 2007-04-06 2015-08-04 Hologic, Inc. Tissue cutter with differential hardness
US9259233B2 (en) 2007-04-06 2016-02-16 Hologic, Inc. Method and device for distending a gynecological cavity
US8591399B2 (en) 2007-04-25 2013-11-26 Karl Storz Endovision, Inc. Surgical method utilizing transluminal endoscope and instruments
US9596980B2 (en) * 2007-04-25 2017-03-21 Karl Storz Endovision, Inc. Endoscope system with pivotable arms
WO2008144401A1 (en) 2007-05-18 2008-11-27 Boston Scientific Scimed, Inc. Articulating torqueable hollow device
JP5019108B2 (en) * 2007-05-22 2012-09-05 オリンパス株式会社 Treatment tool
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
CN101686838A (en) * 2007-06-05 2010-03-31 马塞拉·卡德纳斯;拉斐尔·阿朗戈;海梅·冈萨雷斯 Medical device for exploring and operating on the abdominal cavity and the pelvic cavity
US20090012544A1 (en) * 2007-06-08 2009-01-08 Valen Tx, Inc. Gastrointestinal bypass sleeve as an adjunct to bariatric surgery
US20090012356A1 (en) * 2007-06-11 2009-01-08 Valen Tx, Inc. Endoscopic delivery devices and methods
US8408439B2 (en) 2007-06-22 2013-04-02 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an articulatable end effector
DE102007029162A1 (en) * 2007-06-25 2009-01-08 Tahar Benhidjeb Surgical instrument
US8590762B2 (en) 2007-06-29 2013-11-26 Ethicon Endo-Surgery, Inc. Staple cartridge cavity configurations
WO2009014917A3 (en) * 2007-07-12 2009-12-30 Board Of Regents Of The University Of Nebraska Methods and systems of actuation in robotic devices
US20090030284A1 (en) * 2007-07-18 2009-01-29 David Cole Overtube introducer for use in endoscopic bariatric surgery
US9125552B2 (en) * 2007-07-31 2015-09-08 Ethicon Endo-Surgery, Inc. Optical scanning module and means for attaching the module to medical instruments for introducing the module into the anatomy
JP5475662B2 (en) 2007-08-15 2014-04-16 ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ Modular and segmenting the medical device and associated system
US8137263B2 (en) * 2007-08-24 2012-03-20 Karl Storz Endovision, Inc. Articulating endoscope instrument
US20090062606A1 (en) * 2007-08-31 2009-03-05 Hoya Corporation Endoscope guiding tube device
US20110184231A1 (en) * 2009-07-28 2011-07-28 Page Brett M Deflectable instrument ports
US20110060183A1 (en) * 2007-09-12 2011-03-10 Salvatore Castro Multi-instrument access devices and systems
US20090227843A1 (en) * 2007-09-12 2009-09-10 Smith Jeffrey A Multi-instrument access devices and systems
US8512362B2 (en) * 2007-11-05 2013-08-20 Usgi Medical Inc. Endoscopic ligation
GB0725095D0 (en) * 2007-12-21 2008-01-30 Oliver Crispin Robotics Ltd Robotic arm for use with a rotary machine
JP5325416B2 (en) * 2007-12-27 2013-10-23 オリンパスメディカルシステムズ株式会社 Endoscope body and the endoscope
KR101707924B1 (en) * 2008-02-06 2017-02-17 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 A segmented instrument having braking capabilities
US8561870B2 (en) 2008-02-13 2013-10-22 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
US8752749B2 (en) 2008-02-14 2014-06-17 Ethicon Endo-Surgery, Inc. Robotically-controlled disposable motor-driven loading unit
US7866527B2 (en) 2008-02-14 2011-01-11 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with interlockable firing system
US7819298B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with control features operable with one hand
US8657174B2 (en) 2008-02-14 2014-02-25 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument having handle based power source
US9770245B2 (en) 2008-02-15 2017-09-26 Ethicon Llc Layer arrangements for surgical staple cartridges
US20090206131A1 (en) 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. End effector coupling arrangements for a surgical cutting and stapling instrument
JP5651021B2 (en) 2008-03-06 2015-01-07 クック メディカル テクノロジーズ エルエルシーCook Medical Technologies Llc Medical device for access into the body of a hole
EP2257227A4 (en) * 2008-03-14 2014-03-26 Safestitch Medical Inc Hernia stapler with integrated mesh manipulator
US8870049B2 (en) 2008-03-14 2014-10-28 Transenterix, Inc. Hernia stapler
US20090240699A1 (en) * 2008-03-18 2009-09-24 Morgan Christopher B Integration for intelligence data systems
US8727966B2 (en) * 2008-03-31 2014-05-20 Intuitive Surgical Operations, Inc. Endoscope with rotationally deployed arms
US20120238952A1 (en) 2008-04-02 2012-09-20 Usgi Medical, Inc. Endoluminal surgical tool with small bend radius steering section
ES2652417T3 (en) * 2008-04-18 2018-02-02 Fortimedix Surgical B.V. Instrument for endoscopic applications or the like
US20090270893A1 (en) * 2008-04-25 2009-10-29 Greg Arcenio Medical device for tissue disruption with serrated expandable portion
JP5336760B2 (en) * 2008-05-01 2013-11-06 オリンパスメディカルシステムズ株式会社 The endoscope system
US8834361B2 (en) 2009-05-15 2014-09-16 Cook Medical Technologies Llc Systems, devices and methods for accessing a bodily opening
EP2323569B1 (en) 2008-05-15 2017-10-04 Cook Medical Technologies LLC Device for accessing a bodily opening
US20090287044A1 (en) * 2008-05-15 2009-11-19 Olympus Medical Systems Corp. Endoscopic apparatus
US20090287236A1 (en) * 2008-05-16 2009-11-19 Ethicon Endo-Surgery, Inc. Endoscopic rotary access needle
US9968396B2 (en) 2008-05-27 2018-05-15 Maquet Cardiovascular Llc Surgical instrument and method
US9402679B2 (en) 2008-05-27 2016-08-02 Maquet Cardiovascular Llc Surgical instrument and method
US20090312645A1 (en) * 2008-06-16 2009-12-17 Boston Scientific Scimed, Inc. Methods and Devices for Accessing Anatomic Structures
US20120271327A1 (en) * 2008-06-17 2012-10-25 Stephen West Endoscopic Tissue Grasping Systems and Methods
US8679136B2 (en) 2008-06-17 2014-03-25 Apollo Endosurgery, Inc. Needle capture device
US8287556B2 (en) 2008-06-17 2012-10-16 Apollo Endosurgery, Inc. Endoscopic suturing system
US20090326553A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide
US8864652B2 (en) 2008-06-27 2014-10-21 Intuitive Surgical Operations, Inc. Medical robotic system providing computer generated auxiliary views of a camera instrument for controlling the positioning and orienting of its tip
US9179832B2 (en) * 2008-06-27 2015-11-10 Intuitive Surgical Operations, Inc. Medical robotic system with image referenced camera control using partitionable orientational and translational modes
US9089256B2 (en) 2008-06-27 2015-07-28 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxiliary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US20100010294A1 (en) * 2008-07-10 2010-01-14 Ethicon Endo-Surgery, Inc. Temporarily positionable medical devices
EP2337488B1 (en) * 2008-07-18 2016-05-25 Boston Scientific Scimed, Inc. Endoscope with guide
ES2375880T3 (en) * 2008-07-30 2012-03-07 Ipg Photonics Corporation Welding tool l? L be with? Be fiber.
US8863748B2 (en) * 2008-07-31 2014-10-21 Olympus Medical Systems Corp. Endoscopic surgical operation method
WO2010013059A1 (en) 2008-07-31 2010-02-04 Surgical Innovations Limited Endoscopic surgical instrument
US8777839B2 (en) 2008-09-02 2014-07-15 Olympus Medical Systems Corp. Shock absorbing mechanism and medical instrument
US8303581B2 (en) 2008-09-02 2012-11-06 Covidien Lp Catheter with remotely extendible instruments
US8460276B2 (en) * 2008-09-02 2013-06-11 Olympus Medical Systems Corp. Manipulation mechanism and medical device instrument
JP5297732B2 (en) * 2008-09-12 2013-09-25 オリンパスメディカルシステムズ株式会社 Parent-child type of endoscope
US7905381B2 (en) 2008-09-19 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with cutting member arrangement
US9386983B2 (en) 2008-09-23 2016-07-12 Ethicon Endo-Surgery, Llc Robotically-controlled motorized surgical instrument
US8092722B2 (en) * 2008-09-30 2012-01-10 Sabic Innovative Plastics Ip B.V. Varnish compositions for electrical insulation and method of using the same
CA2776320C (en) * 2008-10-07 2017-08-29 The Trustees Of Columbia University In The City Of New York Systems, devices, and method for providing insertable robotic sensory and manipulation platforms for single port surgery
US8608045B2 (en) 2008-10-10 2013-12-17 Ethicon Endo-Sugery, Inc. Powered surgical cutting and stapling apparatus with manually retractable firing system
US20100116080A1 (en) 2008-11-11 2010-05-13 Intuitive Surgical, Inc. Robotic linkage
US20100137681A1 (en) * 2008-11-21 2010-06-03 Usgi Medical, Inc. Endoscopic instrument management system
FR2939512B1 (en) * 2008-12-04 2012-07-27 Echosens Device and Elastography METHOD
EP2480165B1 (en) * 2009-09-21 2017-08-23 Claret Medical, Inc. Intravascular blood filters
US9326843B2 (en) * 2009-01-16 2016-05-03 Claret Medical, Inc. Intravascular blood filters and methods of use
US20110006101A1 (en) 2009-02-06 2011-01-13 EthiconEndo-Surgery, Inc. Motor driven surgical fastener device with cutting member lockout arrangements
US8444036B2 (en) 2009-02-06 2013-05-21 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
US7918376B1 (en) * 2009-03-09 2011-04-05 Cardica, Inc. Articulated surgical instrument
DE102009013312A1 (en) * 2009-03-18 2010-09-23 Richard Wolf Gmbh Ureterorenoscope
JP5087035B2 (en) * 2009-03-25 2012-11-28 オリンパス株式会社 Cover type treatment endoscope and an endoscope cover
US20100286478A1 (en) * 2009-04-23 2010-11-11 Usgi Medical, Inc. Flexible surgery access systems
WO2010132560A1 (en) * 2009-05-14 2010-11-18 Vance Products Incorporated, D/B/A/ Cook Urological Incorporated Access sheath with active deflection
US20100292535A1 (en) * 2009-05-18 2010-11-18 Larry Paskar Endoscope with multiple fields of view
US8827134B2 (en) 2009-06-19 2014-09-09 Covidien Lp Flexible surgical stapler with motor in the head
JP5582561B2 (en) * 2009-07-03 2014-09-03 国立大学法人九州大学 Forceps support device
US9114226B1 (en) 2009-07-08 2015-08-25 Vioptix, Inc. Devices and monitoring systems for locating a blood vessel
US8753370B2 (en) 2009-07-27 2014-06-17 Claret Medical, Inc. Dual endovascular filter and methods of use
US8459524B2 (en) * 2009-08-14 2013-06-11 Covidien Lp Tissue fastening system for a medical device
US9084623B2 (en) 2009-08-15 2015-07-21 Intuitive Surgical Operations, Inc. Controller assisted reconfiguration of an articulated instrument during movement into and out of an entry guide
US9492927B2 (en) 2009-08-15 2016-11-15 Intuitive Surgical Operations, Inc. Application of force feedback on an input device to urge its operator to command an articulated instrument to a preferred pose
US9955858B2 (en) * 2009-08-21 2018-05-01 Maquet Cardiovascular Llc Surgical instrument and method for use
KR101116867B1 (en) * 2009-08-28 2012-03-06 김준홍 The device for delivering optimal tension safaely and effectively in cerclage annuloplasty procedure
CA2772954A1 (en) * 2009-09-02 2011-03-10 Laszlo Csiky Surgical device and accessories
US9474540B2 (en) * 2009-10-08 2016-10-25 Ethicon-Endo-Surgery, Inc. Laparoscopic device with compound angulation
US20120312103A1 (en) * 2009-11-10 2012-12-13 Kerstin Hannott Inspection device and method for positioning an inspection device
US8986201B2 (en) 2009-11-14 2015-03-24 Spiway Llc Surgical tissue protection sheath
US9451981B2 (en) 2009-11-14 2016-09-27 Spiway Llc Surgical tissue protection sheath
US20110118551A1 (en) * 2009-11-14 2011-05-19 SPI Surgical, Inc. Collateral soft tissue protection surgical device
US9011326B2 (en) 2009-11-14 2015-04-21 Spiway Llc Soft tissue shield for trans-orbital surgery
US9775640B2 (en) * 2009-11-14 2017-10-03 SPI Surgical, Inc. Surgical device
JP4862105B2 (en) 2009-12-10 2012-01-25 オリンパスメディカルシステムズ株式会社 Medical manipulator
CA2784883A1 (en) 2009-12-17 2011-06-23 Board Of Regents Of The University Of Nebraska Modular and cooperative medical devices and related systems and methods
US8851354B2 (en) 2009-12-24 2014-10-07 Ethicon Endo-Surgery, Inc. Surgical cutting instrument that analyzes tissue thickness
US8608046B2 (en) 2010-01-07 2013-12-17 Ethicon Endo-Surgery, Inc. Test device for a surgical tool
US8918211B2 (en) 2010-02-12 2014-12-23 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
JP2011172766A (en) * 2010-02-24 2011-09-08 Fujifilm Corp Torque transmission device
WO2011112340A1 (en) * 2010-03-11 2011-09-15 Boston Scientific Scimed, Inc. Medical immobilization device and related methods of use
US8562592B2 (en) * 2010-05-07 2013-10-22 Ethicon Endo-Surgery, Inc. Compound angle laparoscopic methods and devices
US9226760B2 (en) 2010-05-07 2016-01-05 Ethicon Endo-Surgery, Inc. Laparoscopic devices with flexible actuation mechanisms
US9033998B1 (en) 2010-05-13 2015-05-19 Titan Medical Inc. Independent roll wrist mechanism
US20120116362A1 (en) 2010-06-25 2012-05-10 Kieturakis Maciej J Single port laparoscopic access with laterally spaced virtual insertion points
US9486296B2 (en) * 2010-07-08 2016-11-08 Warsaw Orthopedic, Inc. Surgical assembly with flexible arm
US8783543B2 (en) 2010-07-30 2014-07-22 Ethicon Endo-Surgery, Inc. Tissue acquisition arrangements and methods for surgical stapling devices
JP2014529414A (en) 2010-08-06 2014-11-13 ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ Method and system for handling or delivery of natural orifice surgical material
CN101889853B (en) * 2010-08-06 2013-01-16 上海交通大学 Three-dimensional endoscope system capable of rotating freely for angles
US8360296B2 (en) 2010-09-09 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical stapling head assembly with firing lockout for a surgical stapler
US9289212B2 (en) 2010-09-17 2016-03-22 Ethicon Endo-Surgery, Inc. Surgical instruments and batteries for surgical instruments
US9314246B2 (en) 2010-09-30 2016-04-19 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent
US9629814B2 (en) 2010-09-30 2017-04-25 Ethicon Endo-Surgery, Llc Tissue thickness compensator configured to redistribute compressive forces
US9301753B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Expandable tissue thickness compensator
US9332974B2 (en) 2010-09-30 2016-05-10 Ethicon Endo-Surgery, Llc Layered tissue thickness compensator
US9232941B2 (en) 2010-09-30 2016-01-12 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a reservoir
US9386984B2 (en) 2013-02-08 2016-07-12 Ethicon Endo-Surgery, Llc Staple cartridge comprising a releasable cover
RU2606493C2 (en) 2011-04-29 2017-01-10 Этикон Эндо-Серджери, Инк. Staple cartridge, containing staples, located inside its compressible part
US9414838B2 (en) 2012-03-28 2016-08-16 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprised of a plurality of materials
US9211120B2 (en) 2011-04-29 2015-12-15 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a plurality of medicaments
US9386988B2 (en) 2010-09-30 2016-07-12 Ethicon End-Surgery, LLC Retainer assembly including a tissue thickness compensator
US20120080498A1 (en) 2010-09-30 2012-04-05 Ethicon Endo-Surgery, Inc. Curved end effector for a stapling instrument
JP6224070B2 (en) 2012-03-28 2017-11-01 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. Retainer assembly including a tissue thickness compensator
US9016542B2 (en) 2010-09-30 2015-04-28 Ethicon Endo-Surgery, Inc. Staple cartridge comprising compressible distortion resistant components
US9615826B2 (en) 2010-09-30 2017-04-11 Ethicon Endo-Surgery, Llc Multiple thickness implantable layers for surgical stapling devices
US9433419B2 (en) 2010-09-30 2016-09-06 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a plurality of layers
US9700317B2 (en) 2010-09-30 2017-07-11 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a releasable tissue thickness compensator
RU2013119928A (en) 2010-09-30 2014-11-10 Этикон Эндо-Серджери, Инк. Crosslinking system comprising a retaining matrix and an alignment matrix
US9220501B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensators
US9364233B2 (en) 2010-09-30 2016-06-14 Ethicon Endo-Surgery, Llc Tissue thickness compensators for circular surgical staplers
US8695866B2 (en) 2010-10-01 2014-04-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a power control circuit
WO2012051292A1 (en) * 2010-10-13 2012-04-19 Ethicon Endo-Surgery, Inc. Methods and devices for mechanical space creation at a surgical site
US8603078B2 (en) 2010-10-13 2013-12-10 Ethicon Endo-Surgery, Inc. Methods and devices for guiding and supporting surgical instruments
US20120095498A1 (en) * 2010-10-13 2012-04-19 Ethicon Endo-Surgery, Inc. Methods and devices for mechanical space creation at a surgical site
WO2012064817A1 (en) 2010-11-09 2012-05-18 Benvenue Medical, Inc. Devices and methods for treatment of a bone fracture
US8864659B2 (en) 2010-11-23 2014-10-21 Covidien Lp Seal anchor for use in surgical procedures
US20120165842A1 (en) * 2010-12-22 2012-06-28 Ethicon Endo-Surgery, Inc. Endoluminal fold creation
US9055997B2 (en) 2010-12-30 2015-06-16 Claret Medical, Inc. Method of isolating the cerebral circulation during a cardiac procedure
US20120209375A1 (en) * 2011-02-11 2012-08-16 Gilbert Madrid Stability device for use with percutaneous delivery systems
US8578810B2 (en) * 2011-02-14 2013-11-12 Intuitive Surgical Operations, Inc. Jointed link structures exhibiting preferential bending, and related methods
US9668909B1 (en) * 2011-02-27 2017-06-06 Ann M. Lormand-Koch Method of using gastrojejunostomy drainage bag
KR101184983B1 (en) 2011-03-11 2012-10-02 한양대학교 에리카산학협력단 Bendable medical device for operation
US8632462B2 (en) 2011-03-14 2014-01-21 Ethicon Endo-Surgery, Inc. Trans-rectum universal ports
JP5838311B2 (en) * 2011-03-29 2016-01-06 パナソニックIpマネジメント株式会社 Endoscope apparatus
US9259240B2 (en) 2011-03-29 2016-02-16 Covidien Lp Articulating surgical access system for laparoscopic surgery
US9198662B2 (en) 2012-03-28 2015-12-01 Ethicon Endo-Surgery, Inc. Tissue thickness compensator having improved visibility
US9072535B2 (en) 2011-05-27 2015-07-07 Ethicon Endo-Surgery, Inc. Surgical stapling instruments with rotatable staple deployment arrangements
JP6174017B2 (en) 2011-06-10 2017-08-02 ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ Vivo vessel sealing end effector and in vivo robotic device
US8814873B2 (en) 2011-06-24 2014-08-26 Benvenue Medical, Inc. Devices and methods for treating bone tissue
CA2841459A1 (en) 2011-07-11 2013-01-17 Board Of Regents Of The University Of Nebraska Robotic surgical devices, systems and related methods
CN103717121B (en) 2011-08-03 2016-05-25 爱尔康研究有限公司 Rocker ophthalmic surgical probe
US8668727B2 (en) * 2011-08-23 2014-03-11 Anthony Natale Systems and methods for treating pathogenic infection
US9050084B2 (en) 2011-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Staple cartridge including collapsible deck arrangement
US20140249369A1 (en) * 2011-10-03 2014-09-04 Serendipity Co., Ltd Imaging apparatus and rigid endoscope
JP6162710B2 (en) * 2011-11-16 2017-07-12 コロプラスト アクティーゼルスカブ In particular it intended operating device to advance into the body of the manipulation of the organism
US9504604B2 (en) 2011-12-16 2016-11-29 Auris Surgical Robotics, Inc. Lithotripsy eye treatment
EP2606838B1 (en) * 2011-12-20 2015-06-03 University of Dundee Medical tubular shaft instrument
US9307893B2 (en) 2011-12-29 2016-04-12 Cook Medical Technologies Llc Space-optimized visualization catheter with camera train holder in a catheter with off-centered lumens
US9668643B2 (en) * 2011-12-29 2017-06-06 Cook Medical Technologies Llc Space-optimized visualization catheter with oblong shape
US8382775B1 (en) 2012-01-08 2013-02-26 Vibrynt, Inc. Methods, instruments and devices for extragastric reduction of stomach volume
US9314362B2 (en) 2012-01-08 2016-04-19 Vibrynt, Inc. Methods, instruments and devices for extragastric reduction of stomach volume
US9226741B2 (en) * 2012-01-09 2016-01-05 Covidien Lp Triangulation methods with hollow segments
US9808317B2 (en) * 2012-01-09 2017-11-07 Covidien Lp Pneumatic system for deployment of articulating arms for an access port
KR101833347B1 (en) * 2012-02-06 2018-02-28 삼성전자주식회사 Link unit, arm module and apparatus for surgery having the same
WO2013119592A1 (en) 2012-02-07 2013-08-15 Arthrocare Corporation Surgical instrument for manipulating and passing suture
US8419720B1 (en) * 2012-02-07 2013-04-16 National Advanced Endoscopy Devices, Incorporated Flexible laparoscopic device
US9044230B2 (en) 2012-02-13 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
WO2013140426A1 (en) 2012-02-21 2013-09-26 Calabrian High Tech Srl Twin forceps for single access laparoscopy
US20130225997A1 (en) * 2012-02-28 2013-08-29 Spiration, Inc. Lung biopsy needle
EP2819603A1 (en) * 2012-02-29 2015-01-07 Boston Scientific Scimed, Inc. Electrosurgical device and system
US9078653B2 (en) 2012-03-26 2015-07-14 Ethicon Endo-Surgery, Inc. Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge
US9307989B2 (en) 2012-03-28 2016-04-12 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorportating a hydrophobic agent
RU2014143245A (en) 2012-03-28 2016-05-27 Этикон Эндо-Серджери, Инк. Compensator tissue thickness, comprising a capsule for a medium with a low pressure
US9265514B2 (en) 2012-04-17 2016-02-23 Miteas Ltd. Manipulator for grasping tissue
KR101405087B1 (en) * 2012-04-27 2014-06-10 한양대학교 에리카산학협력단 An articulation for surgical instrument
US9498292B2 (en) 2012-05-01 2016-11-22 Board Of Regents Of The University Of Nebraska Single site robotic device and related systems and methods
US9277990B2 (en) 2012-05-04 2016-03-08 St. Jude Medical, Cardiology Division, Inc. Hypotube shaft with articulation mechanism
US9532871B2 (en) 2012-05-04 2017-01-03 St. Jude Medical, Cardiology Division, Inc. Delivery system deflection mechanism
US8777844B1 (en) * 2012-05-08 2014-07-15 Siddharth Sadanand Modifiable endoscope device
EP2674109A1 (en) * 2012-06-15 2013-12-18 Endo Tools Therapeutics S.A. Endoscopic surgical apparatus
US9101358B2 (en) 2012-06-15 2015-08-11 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising a firing drive
WO2013191773A1 (en) 2012-06-22 2013-12-27 Board Of Regents Of The University Of Nebraska Local Control Robotic Surgical Devices and Related Methods
US9101385B2 (en) 2012-06-28 2015-08-11 Ethicon Endo-Surgery, Inc. Electrode connections for rotary driven surgical tools
US9561038B2 (en) 2012-06-28 2017-02-07 Ethicon Endo-Surgery, Llc Interchangeable clip applier
US9289256B2 (en) 2012-06-28 2016-03-22 Ethicon Endo-Surgery, Llc Surgical end effectors having angled tissue-contacting surfaces
US9364230B2 (en) 2012-06-28 2016-06-14 Ethicon Endo-Surgery, Llc Surgical stapling instruments with rotary joint assemblies
US9226751B2 (en) 2012-06-28 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical instrument system including replaceable end effectors
US9119657B2 (en) 2012-06-28 2015-09-01 Ethicon Endo-Surgery, Inc. Rotary actuatable closure arrangement for surgical end effector
US9125662B2 (en) 2012-06-28 2015-09-08 Ethicon Endo-Surgery, Inc. Multi-axis articulating and rotating surgical tools
US9408606B2 (en) 2012-06-28 2016-08-09 Ethicon Endo-Surgery, Llc Robotically powered surgical device with manually-actuatable reversing system
US9072536B2 (en) 2012-06-28 2015-07-07 Ethicon Endo-Surgery, Inc. Differential locking arrangements for rotary powered surgical instruments
US9282974B2 (en) 2012-06-28 2016-03-15 Ethicon Endo-Surgery, Llc Empty clip cartridge lockout
US9204879B2 (en) 2012-06-28 2015-12-08 Ethicon Endo-Surgery, Inc. Flexible drive member
US9028494B2 (en) 2012-06-28 2015-05-12 Ethicon Endo-Surgery, Inc. Interchangeable end effector coupling arrangement
US9770305B2 (en) 2012-08-08 2017-09-26 Board Of Regents Of The University Of Nebraska Robotic surgical devices, systems, and related methods
US9386985B2 (en) 2012-10-15 2016-07-12 Ethicon Endo-Surgery, Llc Surgical cutting instrument
US9463022B2 (en) * 2012-12-17 2016-10-11 Ethicon Endo-Surgery, Llc Motor driven rotary input circular stapler with lockable flexible shaft
EP2945525A2 (en) 2013-01-21 2015-11-25 G.I. View Ltd. Integrated steering device
US9144370B2 (en) 2013-02-28 2015-09-29 Canon Usa Inc. Mechanical structure of articulated sheath
US9307986B2 (en) 2013-03-01 2016-04-12 Ethicon Endo-Surgery, Llc Surgical instrument soft stop
WO2016037133A1 (en) * 2014-09-05 2016-03-10 Auris Surgical Robotics, Inc. Method, apparatus, and a system for facilitating bending of an instrument in a surgical or medical robotic environment
US9867635B2 (en) 2013-03-08 2018-01-16 Auris Surgical Robotics, Inc. Method, apparatus and system for a water jet
US20150101442A1 (en) * 2013-03-08 2015-04-16 Auris Surgical Robotics, Inc. Method, apparatus, and a system for facilitating bending of an instrument in a surgical or medical robotic environment
US20140263552A1 (en) 2013-03-13 2014-09-18 Ethicon Endo-Surgery, Inc. Staple cartridge tissue thickness sensor system
US9888966B2 (en) 2013-03-14 2018-02-13 Board Of Regents Of The University Of Nebraska Methods, systems, and devices relating to force control surgical systems
US9629629B2 (en) 2013-03-14 2017-04-25 Ethicon Endo-Surgey, LLC Control systems for surgical instruments
WO2014160086A3 (en) 2013-03-14 2014-12-04 Board Of Regents Of The University Of Nebraska Methods, systems, and devices relating to robotic surgical devices, end effectors, and controllers
US9888919B2 (en) 2013-03-14 2018-02-13 Ethicon Llc Method and system for operating a surgical instrument
US20140263541A1 (en) 2013-03-14 2014-09-18 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising an articulation lock
US9572577B2 (en) 2013-03-27 2017-02-21 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a tissue thickness compensator including openings therein
US9795384B2 (en) 2013-03-27 2017-10-24 Ethicon Llc Fastener cartridge comprising a tissue thickness compensator and a gap setting element
US9332984B2 (en) 2013-03-27 2016-05-10 Ethicon Endo-Surgery, Llc Fastener cartridge assemblies
US9826976B2 (en) 2013-04-16 2017-11-28 Ethicon Llc Motor driven surgical instruments with lockable dual drive shafts
US9844368B2 (en) 2013-04-16 2017-12-19 Ethicon Llc Surgical system comprising first and second drive systems
US9801626B2 (en) 2013-04-16 2017-10-31 Ethicon Llc Modular motor driven surgical instruments with alignment features for aligning rotary drive shafts with surgical end effector shafts
US9574644B2 (en) 2013-05-30 2017-02-21 Ethicon Endo-Surgery, Llc Power module for use with a surgical instrument
US9358004B2 (en) * 2013-06-28 2016-06-07 Covidien Lp Articulating apparatus for endoscopic procedures
US20150018940A1 (en) * 2013-07-10 2015-01-15 Medtronic, Inc. Helical coil mitral valve annuloplasty systems and methods
US9924942B2 (en) 2013-08-23 2018-03-27 Ethicon Llc Motor-powered articulatable surgical instruments
US20150073538A1 (en) 2013-09-12 2015-03-12 St. Jude Medical, Cardiology Division, Inc. Alignment of an implantable medical device
US9788910B2 (en) 2014-07-01 2017-10-17 Auris Surgical Robotics, Inc. Instrument-mounted tension sensing mechanism for robotically-driven medical instruments
US9993313B2 (en) 2013-10-24 2018-06-12 Auris Health, Inc. Instrument device manipulator with roll mechanism
KR20160105773A (en) 2013-10-24 2016-09-07 아우리스 서지컬 로보틱스, 인크. System for Robotic-Assisted Endolumenal Surgery and Related Methods
US9918863B2 (en) * 2013-11-13 2018-03-20 Covidien Lp Steerable gastric calibration tube
US9642620B2 (en) 2013-12-23 2017-05-09 Ethicon Endo-Surgery, Llc Surgical cutting and stapling instruments with articulatable end effectors
US9839428B2 (en) 2013-12-23 2017-12-12 Ethicon Llc Surgical cutting and stapling instruments with independent jaw control features
US9724092B2 (en) 2013-12-23 2017-08-08 Ethicon Llc Modular surgical instruments
US20150173749A1 (en) 2013-12-23 2015-06-25 Ethicon Endo-Surgery, Inc. Surgical staples and staple cartridges
US9681870B2 (en) 2013-12-23 2017-06-20 Ethicon Llc Articulatable surgical instruments with separate and distinct closing and firing systems
JP2015128534A (en) * 2014-01-08 2015-07-16 国立大学法人九州大学 Hinge member for bent treatment instrument, and bent treatment instrument with the built-in hinge member
US9962161B2 (en) 2014-02-12 2018-05-08 Ethicon Llc Deliverable surgical instrument
US9693777B2 (en) 2014-02-24 2017-07-04 Ethicon Llc Implantable layers comprising a pressed region
US9937323B2 (en) * 2014-02-28 2018-04-10 Cook Medical Technologies Llc Deflectable catheters, systems, and methods for the visualization and treatment of bodily passages
US20150272574A1 (en) 2014-03-26 2015-10-01 Ethicon Endo-Surgery, Inc. Power management through sleep options of segmented circuit and wake up control
US9913642B2 (en) 2014-03-26 2018-03-13 Ethicon Llc Surgical instrument comprising a sensor system
US9750499B2 (en) 2014-03-26 2017-09-05 Ethicon Llc Surgical stapling instrument system
JP2017513567A (en) 2014-03-26 2017-06-01 エシコン・エンド−サージェリィ・エルエルシーEthicon Endo−Surgery, LLC Power management with segmentation circuit and variable voltage protection
US9820738B2 (en) 2014-03-26 2017-11-21 Ethicon Llc Surgical instrument comprising interactive systems
US20150297232A1 (en) 2014-04-16 2015-10-22 Ethicon Endo-Surgery, Inc. Fastener cartridge comprising non-uniform fasteners
WO2016004355A1 (en) * 2014-07-03 2016-01-07 The Trustees Of Columbia University In The City Of New York Introducer for accessing coronary sinus via right parasternal mediastinotomy
US9980737B2 (en) 2014-08-04 2018-05-29 Medos International Sarl Flexible transport auger
WO2016035084A3 (en) * 2014-09-04 2016-04-21 Memic Innovative Surgery Ltd. Control of device including mechanical arms
US20160066915A1 (en) 2014-09-05 2016-03-10 Ethicon Endo-Surgery, Inc. Polarity of hall magnet to detect misloaded cartridge
US9924979B2 (en) 2014-09-09 2018-03-27 Medos International Sarl Proximal-end securement of a minimally invasive working channel
US9801627B2 (en) 2014-09-26 2017-10-31 Ethicon Llc Fastener cartridge for creating a flexible staple line
US9943310B2 (en) 2014-09-26 2018-04-17 Ethicon Llc Surgical stapling buttresses and adjunct materials
US9924944B2 (en) 2014-10-16 2018-03-27 Ethicon Llc Staple cartridge comprising an adjunct material
US9844376B2 (en) 2014-11-06 2017-12-19 Ethicon Llc Staple cartridge comprising a releasable adjunct material
US9987000B2 (en) 2014-12-18 2018-06-05 Ethicon Llc Surgical instrument assembly comprising a flexible articulation system
US9844374B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member
US20160174972A1 (en) 2014-12-18 2016-06-23 Ethicon Endo-Surgery, Inc. Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge
US9844375B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Drive arrangements for articulatable surgical instruments
US9993258B2 (en) 2015-02-27 2018-06-12 Ethicon Llc Adaptable surgical instrument handle
US20160249916A1 (en) 2015-02-27 2016-09-01 Ethicon Endo-Surgery, Llc System for monitoring whether a surgical instrument needs to be serviced
US9808246B2 (en) 2015-03-06 2017-11-07 Ethicon Endo-Surgery, Llc Method of operating a powered surgical instrument
US9924961B2 (en) 2015-03-06 2018-03-27 Ethicon Endo-Surgery, Llc Interactive feedback system for powered surgical instruments
US9895148B2 (en) 2015-03-06 2018-02-20 Ethicon Endo-Surgery, Llc Monitoring speed control and precision incrementing of motor for powered surgical instruments
US9901342B2 (en) 2015-03-06 2018-02-27 Ethicon Endo-Surgery, Llc Signal and power communication system positioned on a rotatable shaft
US9993248B2 (en) 2015-03-06 2018-06-12 Ethicon Endo-Surgery, Llc Smart sensors with local signal processing
US9566144B2 (en) 2015-04-22 2017-02-14 Claret Medical, Inc. Vascular filters, deflectors, and methods
WO2017008820A3 (en) * 2015-07-15 2017-05-11 Seleem Mohamed Youssef A 2-part system for endoluminal suturing: "a flexible needle holder and a flexible conduit"
USD798443S1 (en) 2016-05-03 2017-09-26 Coloplast A/S Videoscope handle

Citations (94)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6171235B2 (en) *
US2510198A (en) * 1947-10-17 1950-06-06 Earl B Tesmer Flexible positioner
US3060972A (en) * 1957-08-22 1962-10-30 Bausch & Lomb Flexible tube structures
US3096962A (en) * 1960-02-04 1963-07-09 Meijs Pieter Johannes Locking device for a measuring apparatus or the like
US3168274A (en) * 1962-09-18 1965-02-02 Polymathic Engineering Company Supporting stand for instruments, tools and the like
US3266059A (en) * 1963-06-19 1966-08-16 North American Aviation Inc Prestressed flexible joint for mechanical arms and the like
US3430662A (en) * 1964-09-21 1969-03-04 Stephen Guarnaschelli Flexible segmented tube
US3583393A (en) * 1967-12-26 1971-06-08 Olympus Optical Co Bendable tube assembly
US3643653A (en) * 1968-12-24 1972-02-22 Olympus Optical Co Endoscopic apparatus
US3858578A (en) * 1974-01-21 1975-01-07 Pravel Wilson & Matthews Surgical retaining device
US3913565A (en) * 1973-05-18 1975-10-21 Olympus Optical Co Guide tube for a treating instrument to be inserted into body cavity
US3948251A (en) * 1972-10-25 1976-04-06 Olympus Optical Co., Ltd. Flexible tube endoscope
US4036218A (en) * 1974-12-19 1977-07-19 Olympus Optical Co., Ltd. Endoscope
US4201198A (en) * 1976-12-27 1980-05-06 Olympus Optical Co., Ltd. Endoscope having a separable connection to a photographing device
US4224929A (en) * 1977-11-08 1980-09-30 Olympus Optical Co., Ltd. Endoscope with expansible cuff member and operation section
US4245624A (en) * 1977-01-20 1981-01-20 Olympus Optical Co., Ltd. Endoscope with flexible tip control
US4366810A (en) * 1980-08-28 1983-01-04 Slanetz Jr Charles A Tactile control device for a remote sensing device
US4648733A (en) * 1984-07-14 1987-03-10 Robert Merkt Device for producing an installation template for conduits, especially conduits for hydraulic or pneumatic control or process circuits
US4655257A (en) * 1985-03-25 1987-04-07 Kabushiki Kaisha Machida Seisakusho Guide tube assembly for industrial endoscope
US4745908A (en) * 1987-05-08 1988-05-24 Circon Corporation Inspection instrument fexible shaft having deflection compensation means
US4748959A (en) * 1987-05-04 1988-06-07 Ford Motor Company Regulation of engine parameters in response to vapor recovery purge systems
US4869238A (en) * 1988-04-22 1989-09-26 Opielab, Inc. Endoscope for use with a disposable sheath
US4949927A (en) * 1989-10-17 1990-08-21 John Madocks Articulable column
US4988171A (en) * 1987-05-25 1991-01-29 Olympus Optical Co., Ltd. Imaging device and endoscope system provided with the same
US5000683A (en) * 1990-05-10 1991-03-19 Brock David L Periodontal probe
US5015249A (en) * 1989-12-26 1991-05-14 Nakao Naomi L Endoscopic stapling device and method
US5020539A (en) * 1988-03-30 1991-06-04 Olympus Optical Co., Ltd. Ultrasonic endoscope apparatus
US5035231A (en) * 1987-04-27 1991-07-30 Olympus Optical Co., Ltd. Endoscope apparatus
US5088979A (en) * 1990-10-11 1992-02-18 Wilson-Cook Medical Inc. Method for esophageal invagination and devices useful therein
US5187572A (en) * 1990-10-31 1993-02-16 Olympus Optical Co., Ltd. Endoscope system with a plurality of synchronized light source apparatuses
US5196928A (en) * 1991-04-02 1993-03-23 Olympus Optical Co., Ltd. Endoscope system for simultaneously displaying two endoscopic images on a shared monitor
US5275608A (en) * 1991-10-16 1994-01-04 Implemed, Inc. Generic endoscopic instrument
US5318528A (en) * 1993-04-13 1994-06-07 Advanced Surgical Inc. Steerable surgical devices
US5325845A (en) * 1992-06-08 1994-07-05 Adair Edwin Lloyd Steerable sheath for use with selected removable optical catheter
US5337732A (en) * 1992-09-16 1994-08-16 Cedars-Sinai Medical Center Robotic endoscopy
US5337733A (en) * 1989-10-23 1994-08-16 Peter Bauerfeind Tubular inserting device with variable rigidity
US5348259A (en) * 1992-02-10 1994-09-20 Massachusetts Institute Of Technology Flexible, articulable column
US5397304A (en) * 1992-04-10 1995-03-14 Medtronic Cardiorhythm Shapable handle for steerable electrode catheter
US5403326A (en) * 1993-02-01 1995-04-04 The Regents Of The University Of California Method for performing a gastric wrap of the esophagus for use in the treatment of esophageal reflux
US5441499A (en) * 1993-07-14 1995-08-15 Dekna Elektro-U. Medizinische Apparatebau Gesellschaft Mbh Bipolar radio-frequency surgical instrument
US5448989A (en) * 1993-02-22 1995-09-12 Richard Wolf Gmbh Medical instrument shaft capable of positive and non-positive linking of segments
US5558665A (en) * 1994-06-24 1996-09-24 Archimedes Surgical, Inc. Surgical instrument and method for intraluminal retraction of an anatomic structure
US5624381A (en) * 1994-08-09 1997-04-29 Kieturakis; Maciej J. Surgical instrument and method for retraction of an anatomic structure defining an interior lumen
US5662587A (en) * 1992-09-16 1997-09-02 Cedars Sinai Medical Center Robotic endoscopy
US5704898A (en) * 1995-11-17 1998-01-06 Circon Corporation Articulation mechanism for an endoscope
US5741429A (en) * 1991-09-05 1998-04-21 Cardia Catheter Company Flexible tubular device for use in medical applications
US5749828A (en) * 1995-12-22 1998-05-12 Hewlett-Packard Company Bending neck for use with invasive medical devices
US5759151A (en) * 1995-06-07 1998-06-02 Carnegie Mellon University Flexible steerable device for conducting exploratory procedures
US5766169A (en) * 1994-06-13 1998-06-16 Delma Elektro-Und Medizinische Apparatebau Gesellschaft Mbh Medical multifunctional instrument for performing endoscopic operations
US5772597A (en) * 1992-09-14 1998-06-30 Sextant Medical Corporation Surgical tool end effector
US5897417A (en) * 1995-12-11 1999-04-27 Primordial, Llc Construction system
US5902254A (en) * 1996-07-29 1999-05-11 The Nemours Foundation Cathether guidewire
US5908381A (en) * 1997-04-30 1999-06-01 C. R. Bard Inc. Directional surgical device for use with endoscope, gastroscope, colonoscope or the like
US5916147A (en) * 1997-09-22 1999-06-29 Boury; Harb N. Selectively manipulable catheter
US5921915A (en) * 1997-04-30 1999-07-13 C.R. Bard, Inc. Directional surgical device for use with endoscope, gastroscope, colonoscope or the like
US5928264A (en) * 1995-11-08 1999-07-27 Sugar Surgical Technologies, Inc. Tissue grasping device
US5954733A (en) * 1996-11-27 1999-09-21 Yoon; Inbae Suturing instrument with rotatably mounted needle driver and catcher
US5957937A (en) * 1996-11-27 1999-09-28 Yoon; Inbae Suturing instrument with spreadable needle holder mounted for arcuate movement
US6017358A (en) * 1997-05-01 2000-01-25 Inbae Yoon Surgical instrument with multiple rotatably mounted offset end effectors
US6027460A (en) * 1995-09-14 2000-02-22 Shturman Cardiology Systems, Inc. Rotatable intravascular apparatus
US6042155A (en) * 1994-01-04 2000-03-28 Lockwood Products, Inc. Ball and socket joint with internal stop
US6086601A (en) * 1998-04-29 2000-07-11 Yoon; Inbae Instrument and method for suturing anatomical tissue and tying suture material
US6171235B1 (en) * 1998-05-29 2001-01-09 Circon Corporation Flexible pressure resistant cover for the articulation system of a medical instrument
US6174280B1 (en) * 1998-11-19 2001-01-16 Vision Sciences, Inc. Sheath for protecting and altering the bending characteristics of a flexible endoscope
US6179776B1 (en) * 1999-03-12 2001-01-30 Scimed Life Systems, Inc. Controllable endoscopic sheath apparatus and related method of use
US6197017B1 (en) * 1998-02-24 2001-03-06 Brock Rogers Surgical, Inc. Articulated apparatus for telemanipulator system
US6277064B1 (en) * 1997-12-30 2001-08-21 Inbae Yoon Surgical instrument with rotatably mounted offset endoscope
US6352503B1 (en) * 1998-07-17 2002-03-05 Olympus Optical Co., Ltd. Endoscopic surgery apparatus
US20020062062A1 (en) * 2000-04-03 2002-05-23 Amir Belson Steerable segmented endoscope and method of insertion
US6408889B1 (en) * 1999-10-08 2002-06-25 Machida Endoscope Co., Ltd. Bendable tube and method for manufacturing the same
US20020087048A1 (en) * 1998-02-24 2002-07-04 Brock David L. Flexible instrument
US6425859B1 (en) * 1996-03-22 2002-07-30 Sdgi Holdings, Inc. Cannula and a retractor for percutaneous surgery
US6428468B1 (en) * 1995-12-11 2002-08-06 Cardiothoracic Systems, Inc. Apparatus and method for vein removal
US6432112B2 (en) * 1998-02-24 2002-08-13 Brock Rogers Surgical, Inc. Articulated apparatus for telemanipulator system
US20020120253A1 (en) * 2001-02-26 2002-08-29 Asahi Kogaku Kogyo Kabushiki Kaisha Treatment tools for endoscope
US20020120178A1 (en) * 2000-04-03 2002-08-29 Tartaglia Joseph M. Endoscope with guiding apparatus
US6443944B1 (en) * 2000-05-19 2002-09-03 Rajiv Doshi Surgical devices comprising articulated members and methods for using the same
US6506196B1 (en) * 1999-06-22 2003-01-14 Ndo Surgical, Inc. Device and method for correction of a painful body defect
US20030045778A1 (en) * 2000-04-03 2003-03-06 Ohline Robert M. Tendon-driven endoscope and methods of insertion
US6554793B1 (en) * 1998-04-07 2003-04-29 Stm Medizintechnik Starnberg Gmbh Flexible trocar with an upturning tube system
US20030181924A1 (en) * 2002-01-30 2003-09-25 Olympus Optical Co., Ltd. Endoscopic suturing system
US20040010271A1 (en) * 1997-11-03 2004-01-15 Symbiosis Corporation Flexible endoscopic surgical instrument for invagination and fundoplication
US20040024386A1 (en) * 2001-05-30 2004-02-05 Deem Mark E. Obesity treatment tools and methods
US20040059350A1 (en) * 1992-09-04 2004-03-25 Scimed Life Systems, Inc. Suturing instruments and methods of use
US6743240B2 (en) * 2001-06-25 2004-06-01 Ethicon Endo-Surgery, Inc. Flexible surgical device having a rotatable end effector assembly
US6773441B1 (en) * 1999-06-22 2004-08-10 Ndo Surgical, Inc. Methods and devices for tissue reconfiguration
US20040193194A1 (en) * 1999-06-22 2004-09-30 Ndo Surgical, Inc., A Massachusetts Corporation Tissue reconfiguration
US20040193008A1 (en) * 2000-04-03 2004-09-30 Neoguide Systems, Inc. Endoscope having a guide tube
US6837849B2 (en) * 2000-10-02 2005-01-04 Olympus Corporation Endoscope
US20050020901A1 (en) * 2000-04-03 2005-01-27 Neoguide Systems, Inc., A Delaware Corporation Apparatus and methods for facilitating treatment of tissue via improved delivery of energy based and non-energy based modalities
US20050043758A1 (en) * 2003-08-18 2005-02-24 Scimed Life Systems, Inc. Endoscopic medical instrument and related methods of use
US20050049617A1 (en) * 2003-08-25 2005-03-03 Ethicon, Inc. Deployment apparatus for suture anchoring device
US6899673B2 (en) * 2000-10-02 2005-05-31 Olympus Corporation Endoscope
US20050119524A1 (en) * 2002-08-07 2005-06-02 Olympus Optical Co., Ltd. Endoscopic treatment system

Family Cites Families (488)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US533733A (en) * 1895-02-05 Tack-driving machine
US616672A (en) 1898-12-27 kelling
US2899673A (en) * 1959-08-11 Code wheel shaft position encoder
US2201610A (en) 1938-05-20 1940-05-21 Jr James C Dawson Wound clip
US2413142A (en) 1945-06-11 1946-12-24 Edwin M Jones Suturing assembly and method
US2533494A (en) 1949-02-18 1950-12-12 Jr Iverson O Mitchell Adjustable article support
US3190286A (en) 1961-10-31 1965-06-22 Bausch & Lomb Flexible viewing probe for endoscopic use
US3150379A (en) 1962-03-01 1964-09-29 Ernest C Wood Single clip disposable applicator
US3166072A (en) * 1962-10-22 1965-01-19 Jr John T Sullivan Barbed clips
US3162214A (en) 1963-01-16 1964-12-22 American Optical Corp Flexible tubular structures
US3546961A (en) 1967-12-22 1970-12-15 Gen Electric Variable flexibility tether
US3494006A (en) * 1968-01-12 1970-02-10 George C Brumlik Self-gripping fastening device
US3551987A (en) * 1968-09-12 1971-01-05 Jack E Wilkinson Stapling clamp for gastrointestinal surgery
US3646615A (en) * 1970-01-26 1972-03-07 Richard A Ness Reinforcing element for muscles
US3664345A (en) 1970-07-06 1972-05-23 Clyde Harwell Dabbs Surgical buttons
US3753438A (en) 1972-04-25 1973-08-21 E Wood Suture clip
US3897775A (en) 1973-09-07 1975-08-05 Olympus Optical Co Endoscope with facile bending operation
US3867944A (en) * 1972-10-27 1975-02-25 Wood Ernest C Hemostatic clip and applicator therefor
US3874388A (en) 1973-02-12 1975-04-01 Ochsner Med Found Alton Shunt defect closure system
US3835841A (en) 1973-05-31 1974-09-17 Olympus Optical Co Oblique view type endoscope
JPS574963Y2 (en) 1973-06-21 1982-01-29
US3910281A (en) 1973-10-09 1975-10-07 Bio Medicus Inc Suture anchor
US3976079A (en) 1974-08-01 1976-08-24 Samuels Peter B Securing devices for sutures
US4006747A (en) * 1975-04-23 1977-02-08 Ethicon, Inc. Surgical method
US3974834A (en) 1975-04-23 1976-08-17 Medtronic, Inc. Body-implantable lead
US4060089A (en) 1975-09-03 1977-11-29 United States Surgical Corporation Surgical fastening method and device therefor
US4007743A (en) * 1975-10-20 1977-02-15 American Hospital Supply Corporation Opening mechanism for umbrella-like intravascular shunt defect closure device
US4069825A (en) * 1976-01-28 1978-01-24 Taichiro Akiyama Surgical thread and cutting apparatus for the same
US4054128A (en) 1976-09-28 1977-10-18 Universite De Sherbrooke Device for carrying observation and/or manipulation instruments
US4235238A (en) 1978-05-11 1980-11-25 Olympus Optical Co., Ltd. Apparatus for suturing coeliac tissues
DE3044186A1 (en) * 1979-12-11 1981-08-27 Victor Eduardo Derechinsky Klammerhaltegeraet to disconnect from blutgefaessen
US4724840A (en) * 1982-02-03 1988-02-16 Ethicon, Inc. Surgical fastener applier with rotatable front housing and laterally extending curved needle for guiding a flexible pusher
DE3206381C2 (en) * 1982-02-22 1986-07-10 Olympus Winter & Ibe Gmbh, 2000 Hamburg, De
US5417691A (en) 1982-05-20 1995-05-23 Hayhurst; John O. Apparatus and method for manipulating and anchoring tissue
US5601557A (en) * 1982-05-20 1997-02-11 Hayhurst; John O. Anchoring and manipulating tissue
US4414720A (en) 1982-07-22 1983-11-15 Clarence Crooms Cranial closure
US4462402A (en) 1982-11-15 1984-07-31 Minnesota Mining And Manufacturing Company Method and anchor for anchoring
US4494531A (en) * 1982-12-06 1985-01-22 Cook, Incorporated Expandable blood clot filter
US4595007A (en) 1983-03-14 1986-06-17 Ethicon, Inc. Split ring type tissue fastener
US4532926A (en) 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with ratchet leg staple and sealable latching receiver
US4548202A (en) 1983-06-20 1985-10-22 Ethicon, Inc. Mesh tissue fasteners
US4534350A (en) 1983-06-20 1985-08-13 Ethicon, Inc. Two-piece tissue fastener with compressible leg staple and retaining receiver
US4651718A (en) * 1984-06-29 1987-03-24 Warner-Lambert Technologies Inc. Vertebra for articulatable shaft
US4929240A (en) 1983-12-01 1990-05-29 University Of New Mexico Surgical clip and applier
US4586503A (en) 1983-12-01 1986-05-06 University Of New Mexico Surgical microclip
US4873976A (en) 1984-02-28 1989-10-17 Schreiber Saul N Surgical fasteners and method
US4872579A (en) 1984-07-23 1989-10-10 Ballard Medical Products Aspirating/ventilating apparatus and method
GB8422863D0 (en) 1984-09-11 1984-10-17 Univ London Sewing machine
US4592356A (en) 1984-09-28 1986-06-03 Pedro Gutierrez Localizing device
DE3504824A1 (en) * 1985-02-13 1986-08-14 Schoelly Fiberoptic Gmbh Endoscope
US4750492A (en) 1985-02-27 1988-06-14 Richards Medical Company Absorbable suture apparatus, method and installer
US4592339A (en) 1985-06-12 1986-06-03 Mentor Corporation Gastric banding device
US4669473A (en) 1985-09-06 1987-06-02 Acufex Microsurgical, Inc. Surgical fastener
US4610250A (en) 1985-10-08 1986-09-09 United States Surgical Corporation Two-part surgical fastener for fascia wound approximation
US4705040A (en) 1985-11-18 1987-11-10 Medi-Tech, Incorporated Percutaneous fixation of hollow organs
USRE34021E (en) 1985-11-18 1992-08-04 Abbott Laboratories Percutaneous fixation of hollow organs
US4700693A (en) * 1985-12-09 1987-10-20 Welch Allyn, Inc. Endoscope steering section
US5123914A (en) 1986-05-19 1992-06-23 Cook Incorporated Visceral anchor for visceral wall mobilization
US4711002A (en) 1987-01-14 1987-12-08 Pinckney Molded Plastics, Inc. Bag tie with press release lever
US4765335A (en) 1987-03-16 1988-08-23 Intermar, Inc. Aneurysm clip
US5100418A (en) * 1987-05-14 1992-03-31 Inbae Yoon Suture tie device system and applicator therefor
US5366459A (en) 1987-05-14 1994-11-22 Inbae Yoon Surgical clip and clip application procedures
US5437680A (en) * 1987-05-14 1995-08-01 Yoon; Inbae Suturing method, apparatus and system for use in endoscopic procedures
US4790294A (en) 1987-07-28 1988-12-13 Welch Allyn, Inc. Ball-and-socket bead endoscope steering section
US4890615B1 (en) 1987-11-05 1993-11-16 Linvatec Corporation Arthroscopic suturing instrument
US4957498A (en) 1987-11-05 1990-09-18 Concept, Inc. Suturing instrument
US5172225A (en) 1987-11-25 1992-12-15 Olympus Optical Co., Ltd. Endoscope system
US5005558A (en) 1988-05-16 1991-04-09 Kabushiki Kaisha Toshiba Endoscope
US4832055A (en) 1988-07-08 1989-05-23 Palestrant Aubrey M Mechanically locking blood clot filter
GB8826986D0 (en) 1988-11-18 1988-12-21 Crockard A Surgical device
US5053047A (en) 1989-05-16 1991-10-01 Inbae Yoon Suture devices particularly useful in endoscopic surgery and methods of suturing
US5068719A (en) 1989-06-07 1991-11-26 Olympus Optical Co., Ltd. Endoscope photometric apparatus
US5531788A (en) 1989-10-09 1996-07-02 Foundation Pour L'avenir Pour La Recherche Medicale Appliquee Anti-Pulmonary embolism filter
US5059201A (en) 1989-11-03 1991-10-22 Asnis Stanley E Suture threading, stitching and wrapping device for use in open and closed surgical procedures
US5217473A (en) 1989-12-05 1993-06-08 Inbae Yoon Multi-functional instruments and stretchable ligating and occluding devices
DE3941108C1 (en) * 1989-12-13 1991-06-27 Richard Wolf Gmbh, 7134 Knittlingen, De
US5222961A (en) 1989-12-26 1993-06-29 Naomi Nakao Endoscopic stapling device and related staple
US5035692A (en) 1990-02-13 1991-07-30 Nicholas Herbert Hemostasis clip applicator
US5032127A (en) 1990-03-07 1991-07-16 Frazee John G Hemostatic clip and applicator therefor
US5122136A (en) 1990-03-13 1992-06-16 The Regents Of The University Of California Endovascular electrolytically detachable guidewire tip for the electroformation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
US5025778A (en) 1990-03-26 1991-06-25 Opielab, Inc. Endoscope with potential channels and method of using the same
US5037433A (en) 1990-05-17 1991-08-06 Wilk Peter J Endoscopic suturing device and related method and suture
JP2987452B2 (en) * 1990-05-17 1999-12-06 オリンパス光学工業株式会社 Endoscope
JPH0452614A (en) 1990-06-20 1992-02-20 Olympus Optical Co Ltd Endoscope
US5224946A (en) 1990-07-02 1993-07-06 American Cyanamid Company Bone anchor and method of anchoring a suture to a bone
US5041129A (en) 1990-07-02 1991-08-20 Acufex Microsurgical, Inc. Slotted suture anchor and method of anchoring a suture
US5176691A (en) * 1990-09-11 1993-01-05 Pierce Instruments, Inc. Knot pusher
US5268001A (en) 1990-09-25 1993-12-07 Innovasive Devices, Inc. Bone fastener
US5108422A (en) 1990-10-22 1992-04-28 United States Surgical Corporation Skin fastener
US5372146A (en) 1990-11-06 1994-12-13 Branch; Thomas P. Method and apparatus for re-approximating tissue
US5316543A (en) 1990-11-27 1994-05-31 Cook Incorporated Medical apparatus and methods for treating sliding hiatal hernias
US5222963A (en) 1991-01-17 1993-06-29 Ethicon, Inc. Pull-through circular anastomosic intraluminal stapler with absorbable fastener means
US5108420A (en) 1991-02-01 1992-04-28 Temple University Aperture occlusion device
DE4104755A1 (en) 1991-02-15 1992-08-20 Heidmueller Harald The surgical instrument
US5354298A (en) 1991-03-22 1994-10-11 United States Surgical Corporation Suture anchor installation system
CA2063159C (en) * 1991-03-22 1999-06-15 Thomas W. Sander Orthopedic fastener
US5203864A (en) 1991-04-05 1993-04-20 Phillips Edward H Surgical fastener system
US5251611A (en) 1991-05-07 1993-10-12 Zehel Wendell E Method and apparatus for conducting exploratory procedures
US5217471A (en) 1991-05-30 1993-06-08 Burkhart Stephen S Endoscopic suture knotting instrument
US5289817A (en) * 1991-08-20 1994-03-01 Linvatec Corporation Endoscopic surgical retractor
US5201746A (en) 1991-10-16 1993-04-13 United States Surgical Corporation Surgical hemostatic clip
US5289963A (en) 1991-10-18 1994-03-01 United States Surgical Corporation Apparatus and method for applying surgical staples to attach an object to body tissue
CA2082090C (en) 1991-11-05 2004-04-27 Jack Fagan Improved occluder for repair of cardiac and vascular defects
US5282827A (en) * 1991-11-08 1994-02-01 Kensey Nash Corporation Hemostatic puncture closure system and method of use
US5271381A (en) 1991-11-18 1993-12-21 Vision Sciences, Inc. Vertebrae for a bending section of an endoscope
US5643317A (en) 1992-11-25 1997-07-01 William Cook Europe S.A. Closure prosthesis for transcatheter placement
CA2084524C (en) 1991-12-12 1996-07-23 Robert H. Twyford, Jr. Detachable pusher-vasoocclusive coil assembly with interlocking coupling
US5261916A (en) 1991-12-12 1993-11-16 Target Therapeutics Detachable pusher-vasoocclusive coil assembly with interlocking ball and keyway coupling
US5234430A (en) 1991-12-18 1993-08-10 Huebner Randall J Orthopedic fixation screw and method
US5433721A (en) 1992-01-17 1995-07-18 Ethicon, Inc. Endoscopic instrument having a torsionally stiff drive shaft for applying fasteners to tissue
JP3393383B2 (en) 1992-01-21 2003-04-07 リージェンツ オブ ザ ユニバーシティ オブ ミネソタ Septal defect closure device
US5514157A (en) 1992-02-12 1996-05-07 United States Surgical Corporation Articulating endoscopic surgical apparatus
US5624380A (en) * 1992-03-12 1997-04-29 Olympus Optical Co., Ltd. Multi-degree of freedom manipulator
US5403328A (en) 1992-04-22 1995-04-04 United States Surgical Corporation Surgical apparatus and method for suturing body tissue
US5368601A (en) 1992-04-30 1994-11-29 Lasersurge, Inc. Trocar wound closure device
US5250053A (en) 1992-05-29 1993-10-05 Linvatec Corporation Suture shuttle device
JPH0647050A (en) * 1992-06-04 1994-02-22 Olympus Optical Co Ltd Tissue suture and ligature device
US5238002A (en) 1992-06-08 1993-08-24 C. R. Bard, Inc. Disposable biopsy forceps
US5254126A (en) 1992-06-24 1993-10-19 Ethicon, Inc. Endoscopic suture punch
US5437266A (en) 1992-07-02 1995-08-01 Mcpherson; William Coil screw surgical retractor
US5395367A (en) * 1992-07-29 1995-03-07 Wilk; Peter J. Laparoscopic instrument with bendable shaft and removable actuator
US5449989A (en) * 1992-07-31 1995-09-12 Correa; Paulo N. Energy conversion system
US5345949A (en) 1992-09-02 1994-09-13 Shlain Leonard M Methods for use in surgical gastroplastic procedure
US5327914A (en) 1992-09-02 1994-07-12 Shlain Leonard M Method and devices for use in surgical gastroplastic procedure
US5458609A (en) 1992-09-04 1995-10-17 Laurus Medical Corporation Surgical needle and retainer system
US5540704A (en) 1992-09-04 1996-07-30 Laurus Medical Corporation Endoscopic suture system
US5234445A (en) 1992-09-18 1993-08-10 Ethicon, Inc. Endoscopic suturing device
USRE37117E1 (en) 1992-09-22 2001-03-27 Target Therapeutics, Inc. Detachable embolic coil assembly using interlocking clasps and method of use
CA2106127A1 (en) 1992-09-23 1994-03-24 Peter W.J. Hinchliffe Instrument for closing trocar puncture wounds
US5222508A (en) 1992-10-09 1993-06-29 Osvaldo Contarini Method for suturing punctures of the human body
US5662662A (en) 1992-10-09 1997-09-02 Ethicon Endo-Surgery, Inc. Surgical instrument and method
US5304184A (en) 1992-10-19 1994-04-19 Indiana University Foundation Apparatus and method for positive closure of an internal tissue membrane opening
US5693060A (en) 1992-11-17 1997-12-02 Smith & Nephew, Inc. Suture securing device and method
US6036699A (en) 1992-12-10 2000-03-14 Perclose, Inc. Device and method for suturing tissue
US5417699A (en) * 1992-12-10 1995-05-23 Perclose Incorporated Device and method for the percutaneous suturing of a vascular puncture site
US5284488A (en) * 1992-12-23 1994-02-08 Sideris Eleftherios B Adjustable devices for the occlusion of cardiac defects
US5382231A (en) * 1993-02-02 1995-01-17 Shlain; Leonard M. Method for transesophageal retraction of the stomach
US5304204A (en) 1993-02-09 1994-04-19 Ethicon, Inc. Receiverless surgical fasteners
US5380334A (en) * 1993-02-17 1995-01-10 Smith & Nephew Dyonics, Inc. Soft tissue anchors and systems for implantation
US5569274A (en) 1993-02-22 1996-10-29 Heartport, Inc. Endoscopic vascular clamping system and method
US6346074B1 (en) * 1993-02-22 2002-02-12 Heartport, Inc. Devices for less invasive intracardiac interventions
US5797960A (en) 1993-02-22 1998-08-25 Stevens; John H. Method and apparatus for thoracoscopic intracardiac procedures
US5425705A (en) 1993-02-22 1995-06-20 Stanford Surgical Technologies, Inc. Thoracoscopic devices and methods for arresting the heart
US5501691A (en) * 1993-03-23 1996-03-26 Goldrath; Milton H. Verres needle suturing device
US5374275A (en) 1993-03-25 1994-12-20 Synvasive Technology, Inc. Surgical suturing device and method of use
DE4310555C1 (en) * 1993-03-31 1993-12-09 Strobel & Soehne Gmbh & Co J Surgical machine stitching tissue edges together - has forceps opening and shutting in synchronism with needle to hold edges together before puncturing
US5925059A (en) 1993-04-19 1999-07-20 Target Therapeutics, Inc. Detachable embolic coil assembly
US5613975A (en) * 1993-04-28 1997-03-25 Christy; William J. Endoscopic suturing device and method
JP3559561B2 (en) 1993-04-30 2004-09-02 ユナイテッド・ステイツ・サージカル・コーポレイション Surgical instrument with a joint jaw structure and a removable knife
US6716232B1 (en) 1993-04-30 2004-04-06 United States Surgical Corporation Surgical instrument having an articulated jaw structure and a detachable knife
US5342376A (en) 1993-05-03 1994-08-30 Dermagraphics, Inc. Inserting device for a barbed tissue connector
US5549621A (en) 1993-05-14 1996-08-27 Byron C. Sutherland Apparatus and method for performing vertical banded gastroplasty
DE4319829C1 (en) 1993-06-16 1994-08-25 Lerch Karl Dieter Set for treating vascular deformities
US5372604A (en) 1993-06-18 1994-12-13 Linvatec Corporation Suture anchor for soft tissue fixation
CA2124996C (en) 1993-06-21 2006-01-31 Thomas W. Sander Orthopedic fastener applicator
US5824011A (en) 1993-06-23 1998-10-20 Kevin R. Stone Suture anchor assembly
US5527321A (en) 1993-07-14 1996-06-18 United States Surgical Corporation Instrument for closing trocar puncture wounds
US5478354A (en) 1993-07-14 1995-12-26 United States Surgical Corporation Wound closing apparatus and method
US5462561A (en) 1993-08-05 1995-10-31 Voda; Jan K. Suture device
US5470338A (en) 1993-10-08 1995-11-28 United States Surgical Corporation Instrument for closing trocar puncture wounds
US5462560A (en) 1993-10-08 1995-10-31 Tahoe Surgical Instruments Double needle ligature device
US5584859A (en) 1993-10-12 1996-12-17 Brotz; Gregory R. Suture assembly
US5632752A (en) 1993-10-12 1997-05-27 Urohealth Systems, Inc. Surgical suturing device
US5584835A (en) 1993-10-18 1996-12-17 Greenfield; Jon B. Soft tissue to bone fixation device and method
WO1995011630A1 (en) 1993-10-25 1995-05-04 Children's Medical Center Corporation Retractable suture needle with self-contained driver
US5527322A (en) 1993-11-08 1996-06-18 Perclose, Inc. Device and method for suturing of internal puncture sites
JP3185906B2 (en) 1993-11-26 2001-07-11 ニプロ株式会社 The prosthetic material of an atrial septal defect
US5465894A (en) 1993-12-06 1995-11-14 Ethicon, Inc. Surgical stapling instrument with articulated stapling head assembly on rotatable and flexible support shaft
US5527342A (en) 1993-12-14 1996-06-18 Pietrzak; William S. Method and apparatus for securing soft tissues, tendons and ligaments to bone
US5437681A (en) 1994-01-13 1995-08-01 Suturtek Inc. Suturing instrument with thread management
US5549618A (en) 1994-01-18 1996-08-27 Coral Medical Knot tying method and apparatus
US5466243A (en) 1994-02-17 1995-11-14 Arthrex, Inc. Method and apparatus for installing a suture anchor through a hollow cannulated grasper
US5522843A (en) 1994-02-23 1996-06-04 Orthopaedic Biosystems Limited, Inc. Apparatus for attaching soft tissue to bone
US5431666A (en) 1994-02-24 1995-07-11 Lasersurge, Inc. Surgical suture instrument
GB9405790D0 (en) 1994-03-23 1994-05-11 Univ London Sewing device
US5562688A (en) 1994-03-25 1996-10-08 Riza; Erol D. Apparatus facilitating suturing in laparoscopic surgery
JP3526609B2 (en) * 1994-03-31 2004-05-17 テルモ株式会社 Suturing device
US5476470A (en) 1994-04-15 1995-12-19 Fitzgibbons, Jr.; Robert J. Trocar site suturing device
US5429598A (en) 1994-04-19 1995-07-04 Applied Medical Resources Corporation Surgical access device and procedure
US5531759A (en) 1994-04-29 1996-07-02 Kensey Nash Corporation System for closing a percutaneous puncture formed by a trocar to prevent tissue at the puncture from herniating
CA2189366A1 (en) * 1994-05-03 1995-11-09 Kenneth J. Widder Composition for ultrasonically quantitating myocardial perfusion
US5470337A (en) 1994-05-17 1995-11-28 Moss; Gerald Surgical fastener
WO1995032669A1 (en) 1994-06-01 1995-12-07 Perclose, Inc. Apparatus and method for advancing surgical knots
WO1995032671A1 (en) 1994-06-01 1995-12-07 Perclose, Inc. Method and device for providing vascular hemostasis
US5573548A (en) 1994-06-09 1996-11-12 Zimmer, Inc. Suture anchor
US5725552A (en) * 1994-07-08 1998-03-10 Aga Medical Corporation Percutaneous catheter directed intravascular occlusion devices
US5846261A (en) 1994-07-08 1998-12-08 Aga Medical Corp. Percutaneous catheter directed occlusion devices
US6123715A (en) 1994-07-08 2000-09-26 Amplatz; Curtis Method of forming medical devices; intravascular occlusion devices
US5573540A (en) 1994-07-18 1996-11-12 Yoon; Inbae Apparatus and method for suturing an opening in anatomical tissue
US5582616A (en) 1994-08-05 1996-12-10 Origin Medsystems, Inc. Surgical helical fastener with applicator
US5433727A (en) 1994-08-16 1995-07-18 Sideris; Eleftherios B. Centering buttoned device for the occlusion of large defects for occluding
US5702421A (en) 1995-01-11 1997-12-30 Schneidt; Bernhard Closure device for closing a vascular opening, such as patent ductus arteriosus
WO1996009797A1 (en) 1994-09-28 1996-04-04 Innovasive Devices, Inc. Suture tensioning device
US5571116A (en) 1994-10-02 1996-11-05 United States Surgical Corporation Non-invasive treatment of gastroesophageal reflux disease
US5901895A (en) 1994-10-05 1999-05-11 United States Surgical Corporation Articulating apparatus for applying surgical fasteners to body tissue
US5562684A (en) 1994-10-11 1996-10-08 Ethicon, Inc. Surgical knot pusher device and improved method of forming knots
US5496332A (en) * 1994-10-20 1996-03-05 Cordis Corporation Wound closure apparatus and method for its use
US5868760A (en) * 1994-12-07 1999-02-09 Mcguckin, Jr.; James F. Method and apparatus for endolumenally resectioning tissue
US5499991A (en) * 1994-12-19 1996-03-19 Linvatec Corporation Endoscopic needle with suture retriever
JP3331273B2 (en) * 1994-12-26 2002-10-07 富士写真光機株式会社 Endoscope
US5665109A (en) 1994-12-29 1997-09-09 Yoon; Inbae Methods and apparatus for suturing tissue
US5643295A (en) 1994-12-29 1997-07-01 Yoon; Inbae Methods and apparatus for suturing tissue
US5634936A (en) 1995-02-06 1997-06-03 Scimed Life Systems, Inc. Device for closing a septal defect
US5976159A (en) 1995-02-24 1999-11-02 Heartport, Inc. Surgical clips and methods for tissue approximation
US5840078A (en) 1995-03-01 1998-11-24 Yerys; Paul Method and apparatus for mechanical attachment of soft tissue to bone tissue
US5643320A (en) 1995-03-13 1997-07-01 Depuy Inc. Soft tissue anchor and method
US5888247A (en) * 1995-04-10 1999-03-30 Cardiothoracic Systems, Inc Method for coronary artery bypass
US5562686A (en) 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
US5679005A (en) 1995-04-24 1997-10-21 Einstein; Peter Model of corrected transposition of the great arteries
US5630540A (en) 1995-05-24 1997-05-20 United States Surgical Corporation Surgical staple and staple drive member
US5569306A (en) 1995-06-06 1996-10-29 Thal; Raymond Knotless suture anchor assembly
US6132438A (en) * 1995-06-07 2000-10-17 Ep Technologies, Inc. Devices for installing stasis reducing means in body tissue
US5667513A (en) 1995-06-07 1997-09-16 Smith & Nephew Dyonics Inc. Soft tissue anchor delivery apparatus
US5662654A (en) 1995-06-14 1997-09-02 Incont, Inc. Bone anchor, insertion tool and surgical kit employing same
US5700273A (en) 1995-07-14 1997-12-23 C.R. Bard, Inc. Wound closure apparatus and method
US5846253A (en) 1995-07-14 1998-12-08 C. R. Bard, Inc. Wound closure apparatus and method
US6117144A (en) 1995-08-24 2000-09-12 Sutura, Inc. Suturing device and method for sealing an opening in a blood vessel or other biological structure
WO1997007743A1 (en) 1995-08-25 1997-03-06 Grotz R Thomas Stabilizer for human joints
US5746752A (en) 1995-11-08 1998-05-05 Arthrex, Inc. Double-diameter knot pusher
US5827298A (en) 1995-11-17 1998-10-27 Innovasive Devices, Inc. Surgical fastening system and method for using the same
US5843084A (en) 1995-11-17 1998-12-01 Innovasive Devices, Inc. Surgical fastening system and method for using the same
US5626614A (en) 1995-12-22 1997-05-06 Applied Medical Resources Corporation T-anchor suturing device and method for using same
US5817107A (en) 1995-12-28 1998-10-06 Schaller; Guenter Grasping instrument with a guided-on, attachable modified knot pusher
US5810853A (en) 1996-01-16 1998-09-22 Yoon; Inbae Knotting element for use in suturing anatomical tissue and methods therefor
US5707394A (en) * 1996-02-07 1998-01-13 Bristol-Myers Squibb Company Pre-loaded suture anchor with rigid extension
DE19604817C2 (en) 1996-02-09 2003-06-12 Pfm Prod Fuer Die Med Ag Device for closure of defect openings in the human or animal body
DE69729789T2 (en) * 1996-02-16 2005-07-14 Smith & Nephew, Inc., Memphis The graft anchor
US5702397A (en) 1996-02-20 1997-12-30 Medicinelodge, Inc. Ligament bone anchor and method for its use
US5814070A (en) 1996-02-20 1998-09-29 Howmedica Inc. Suture anchor and driver
JP3776529B2 (en) 1996-02-29 2006-05-17 オリンパス株式会社 Clipping device
US5810851A (en) 1996-03-05 1998-09-22 Yoon; Inbae Suture spring device
US5813976A (en) * 1996-04-02 1998-09-29 Filipi; Charles J. Stabilizing instrumentation for the performing of endoscopic surgical procedures
US5938587A (en) 1996-04-25 1999-08-17 Modified Polymer Components, Inc. Flexible inner liner for the working channel of an endoscope
US5746694A (en) 1996-05-16 1998-05-05 Wilk; Peter J. Endoscope biopsy channel liner and associated method
US5776150A (en) 1996-06-10 1998-07-07 Ethicon Endo Surgery, Inc. Suture assist device
US5893856A (en) 1996-06-12 1999-04-13 Mitek Surgical Products, Inc. Apparatus and method for binding a first layer of material to a second layer of material
US6119913A (en) 1996-06-14 2000-09-19 Boston Scientific Corporation Endoscopic stapler
US5683417A (en) 1996-08-14 1997-11-04 Cooper; William I. Suture and method for endoscopic surgery
US5752963A (en) 1996-08-19 1998-05-19 Bristol-Myers Squibb Company Suture anchor driver
US5741297A (en) 1996-08-28 1998-04-21 Simon; Morris Daisy occluder and method for septal defect repair
US6096009A (en) 1996-09-13 2000-08-01 Boston Scientific Corporation Guidewire and catheter locking device and method
US5724978A (en) * 1996-09-20 1998-03-10 Cardiovascular Imaging Systems, Inc. Enhanced accuracy of three-dimensional intraluminal ultrasound (ILUS) image reconstruction
US5948001A (en) 1996-10-03 1999-09-07 United States Surgical Corporation System for suture anchor placement
US5904647A (en) * 1996-10-08 1999-05-18 Asahi Kogyo Kabushiki Kaisha Treatment accessories for an endoscope
US5861003A (en) * 1996-10-23 1999-01-19 The Cleveland Clinic Foundation Apparatus and method for occluding a defect or aperture within body surface
US6053935A (en) 1996-11-08 2000-04-25 Boston Scientific Corporation Transvaginal anchor implantation device
US5948002A (en) 1996-11-15 1999-09-07 Bonutti; Peter M. Apparatus and method for use in positioning a suture anchor
US6331165B1 (en) 1996-11-25 2001-12-18 Scimed Life Systems, Inc. Biopsy instrument having irrigation and aspiration capabilities
US5993467A (en) 1996-11-27 1999-11-30 Yoon; Inbae Suturing instrument with rotatably mounted spreadable needle holder
US5984932A (en) 1996-11-27 1999-11-16 Yoon; Inbae Suturing instrument with one or more spreadable needle holders mounted for arcuate movement
US6159224A (en) 1996-11-27 2000-12-12 Yoon; Inbae Multiple needle suturing instrument and method
US5947999A (en) 1996-12-03 1999-09-07 Groiso; Jorge A. Surgical clip and method
US5779624A (en) 1996-12-05 1998-07-14 Boston Scientific Corporation Sigmoid splint device for endoscopy
CA2224366C (en) 1996-12-11 2006-10-31 Ethicon, Inc. Meniscal repair device
EP1009293B1 (en) * 1996-12-25 2009-03-18 Niti Surgical Solutions Ltd. Surgical clip
US6045497A (en) 1997-01-02 2000-04-04 Myocor, Inc. Heart wall tension reduction apparatus and method
US6050936A (en) 1997-01-02 2000-04-18 Myocor, Inc. Heart wall tension reduction apparatus
US5961440A (en) 1997-01-02 1999-10-05 Myocor, Inc. Heart wall tension reduction apparatus and method
US6406420B1 (en) 1997-01-02 2002-06-18 Myocor, Inc. Methods and devices for improving cardiac function in hearts
US5879371A (en) 1997-01-09 1999-03-09 Elective Vascular Interventions, Inc. Ferruled loop surgical fasteners, instruments, and methods for minimally invasive vascular and endoscopic surgery
US6074401A (en) 1997-01-09 2000-06-13 Coalescent Surgical, Inc. Pinned retainer surgical fasteners, instruments and methods for minimally invasive vascular and endoscopic surgery
US6149658A (en) 1997-01-09 2000-11-21 Coalescent Surgical, Inc. Sutured staple surgical fasteners, instruments and methods for minimally invasive vascular and endoscopic surgery
US6013024A (en) * 1997-01-20 2000-01-11 Suzuki Motor Corporation Hybrid operation system
US5709708A (en) 1997-01-31 1998-01-20 Thal; Raymond Captured-loop knotless suture anchor assembly
US5899920A (en) 1997-02-11 1999-05-04 Wright Medical Technology, Inc. Suture anchor assembly and kit
US6013083A (en) * 1997-05-02 2000-01-11 Bennett; William F. Arthroscopic rotator cuff repair apparatus and method
US5817110A (en) 1997-05-06 1998-10-06 Kronner; Richard F. Abdominal incision suturing apparatus
USH2037H1 (en) 1997-05-14 2002-07-02 David C. Yates Electrosurgical hemostatic device including an anvil
US5976158A (en) 1997-06-02 1999-11-02 Boston Scientific Corporation Method of using a textured ligating band
US5810849A (en) 1997-06-09 1998-09-22 Cardiologics, L.L.C. Device and method for suturing blood vessels and the like
US5993466A (en) 1997-06-17 1999-11-30 Yoon; Inbae Suturing instrument with multiple rotatably mounted spreadable needle holders
US6066090A (en) * 1997-06-19 2000-05-23 Yoon; Inbae Branched endoscope system
DE19727419C2 (en) 1997-06-27 2000-07-13 Wolf Gmbh Richard endoscope
US5916224A (en) 1997-07-09 1999-06-29 The United States Of America As Represented By The Secretary Of The Army Tendon repair clip implant
US5928260A (en) 1997-07-10 1999-07-27 Scimed Life Systems, Inc. Removable occlusion system for aneurysm neck
US5902321A (en) 1997-07-25 1999-05-11 Innovasive Devices, Inc. Device and method for delivering a connector for surgically joining and securing flexible tissue repair members
US5954731A (en) * 1997-07-29 1999-09-21 Yoon; Inbae Surgical instrument with multiple rotatably mounted spreadable end effectors
US6010525A (en) 1997-08-01 2000-01-04 Peter M. Bonutti Method and apparatus for securing a suture
US6059719A (en) 1997-08-06 2000-05-09 Olympus Optical Co., Ltd. Endoscope system
US5843126A (en) 1997-08-15 1998-12-01 Jameel; Irfan M. Multiple surgical suture application
US5957920A (en) 1997-08-28 1999-09-28 Isothermix, Inc. Medical instruments and techniques for treatment of urinary incontinence
US5954732A (en) 1997-09-10 1999-09-21 Hart; Charles C. Suturing apparatus and method
US5964782A (en) 1997-09-18 1999-10-12 Scimed Life Systems, Inc. Closure device and method
US5887594A (en) 1997-09-22 1999-03-30 Beth Israel Deaconess Medical Center Inc. Methods and devices for gastroesophageal reflux reduction
US5868762A (en) * 1997-09-25 1999-02-09 Sub-Q, Inc. Percutaneous hemostatic suturing device and method
US5895404A (en) 1997-09-29 1999-04-20 Ruiz; Carlos E. Apparatus and methods for percutaneously forming a passageway between adjacent vessels or portions of a vessel
US5980558A (en) 1997-09-30 1999-11-09 Biomet Inc. Suture anchor system
US6027523A (en) * 1997-10-06 2000-02-22 Arthrex, Inc. Suture anchor with attached disk
US5964783A (en) 1997-11-07 1999-10-12 Arthrex, Inc. Suture anchor with insert-molded suture
US6332893B1 (en) 1997-12-17 2001-12-25 Myocor, Inc. Valve to myocardium tension members device and method
US5976127A (en) 1998-01-14 1999-11-02 Lax; Ronald Soft tissue fixation devices
US5944738A (en) 1998-02-06 1999-08-31 Aga Medical Corporation Percutaneous catheter directed constricting occlusion device
US5947983A (en) 1998-03-16 1999-09-07 Boston Scientific Corporation Tissue cutting and stitching device and method
US6893450B2 (en) * 1999-03-26 2005-05-17 Cook Urological Incorporated Minimally-invasive medical retrieval device
US5964765A (en) 1998-04-16 1999-10-12 Axya Medical, Inc. Soft tissue fixation device
US6740098B2 (en) 1998-05-11 2004-05-25 Surgical Connections, Inc. Surgical stabilizer devices and methods
US6113609A (en) 1998-05-26 2000-09-05 Scimed Life Systems, Inc. Implantable tissue fastener and system for treating gastroesophageal reflux disease
US6113611A (en) 1998-05-28 2000-09-05 Advanced Vascular Technologies, Llc Surgical fastener and delivery system
US6174323B1 (en) * 1998-06-05 2001-01-16 Broncus Technologies, Inc. Method and assembly for lung volume reduction
US6126058A (en) * 1998-06-19 2000-10-03 Scimed Life Systems, Inc. Method and device for full thickness resectioning of an organ
US6044847A (en) 1998-06-23 2000-04-04 Surx, Inc. Tuck and fold fascia shortening for incontinence
JP4053147B2 (en) * 1998-07-22 2008-02-27 オリンパス株式会社 Endoscopic treatment device
US6260552B1 (en) 1998-07-29 2001-07-17 Myocor, Inc. Transventricular implant tools and devices
US6077214A (en) 1998-07-29 2000-06-20 Myocor, Inc. Stress reduction apparatus and method
US6183411B1 (en) * 1998-09-21 2001-02-06 Myocor, Inc. External stress reduction device and method
US20050004576A1 (en) * 1998-11-23 2005-01-06 Benderev Theodore V. System for securing sutures, grafts and soft tissue to bone and periosteum
US6234958B1 (en) 1998-11-30 2001-05-22 Medical Access Systems, Llc Medical device introduction system including medical introducer having a plurality of access ports and methods of performing medical procedures with same
JP4242491B2 (en) * 1998-12-09 2009-03-25 オリンパス株式会社 Endoscopic treatment device
US6363938B2 (en) 1998-12-22 2002-04-02 Angiotrax, Inc. Methods and apparatus for perfusing tissue and/or stimulating revascularization and tissue growth
US6110183A (en) 1998-12-22 2000-08-29 Cook Incorporated Suture anchor device
US6306159B1 (en) 1998-12-23 2001-10-23 Depuy Orthopaedics, Inc. Meniscal repair device
US6283973B1 (en) 1998-12-30 2001-09-04 Depuy Orthopaedics, Inc. Strength fixation device
US6045573A (en) 1999-01-21 2000-04-04 Ethicon, Inc. Suture anchor having multiple sutures
US6315789B1 (en) 1999-02-08 2001-11-13 Andrew H. Cragg Medical device anchoring system and method
US6228023B1 (en) 1999-02-17 2001-05-08 Abiomed, Inc. Tissue pick and method for use in minimally invasive surgical procedures
US6613059B2 (en) * 1999-03-01 2003-09-02 Coalescent Surgical, Inc. Tissue connector apparatus and methods
US6368338B1 (en) 1999-03-05 2002-04-09 Board Of Regents, The University Of Texas Occlusion method and apparatus
US6159146A (en) 1999-03-12 2000-12-12 El Gazayerli; Mohamed Mounir Method and apparatus for minimally-invasive fundoplication
US6328730B1 (en) * 1999-03-26 2001-12-11 William W. Harkrider, Jr. Endoluminal multi-luminal surgical sheath and method
US6214007B1 (en) 1999-06-01 2001-04-10 David G. Anderson Surgical fastener for fixation of a soft tissue graft to a bone tunnel
US6835200B2 (en) 1999-06-22 2004-12-28 Ndo Surgical. Inc. Method and devices for tissue reconfiguration
US6494888B1 (en) 1999-06-22 2002-12-17 Ndo Surgical, Inc. Tissue reconfiguration
US7846180B2 (en) 1999-06-22 2010-12-07 Ethicon Endo-Surgery, Inc. Tissue fixation devices and methods of fixing tissue
US20050192629A1 (en) 1999-06-25 2005-09-01 Usgi Medical Inc. Methods and apparatus for creating and regulating a gastric stoma
US7744613B2 (en) 1999-06-25 2010-06-29 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US20040249367A1 (en) 2003-01-15 2004-12-09 Usgi Medical Corp. Endoluminal tool deployment system
US7160312B2 (en) * 1999-06-25 2007-01-09 Usgi Medical, Inc. Implantable artificial partition and methods of use
US8574243B2 (en) 1999-06-25 2013-11-05 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US7955340B2 (en) 1999-06-25 2011-06-07 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
DE19932022A1 (en) * 1999-07-09 2001-02-08 Etm Endoskopische Technik Gmbh Endoscope-type device, particularly for emergency intubation
JP4108882B2 (en) 1999-08-04 2008-06-25 オリンパス株式会社 Endoscopic wall fixture
US6358197B1 (en) * 1999-08-13 2002-03-19 Enteric Medical Technologies, Inc. Apparatus for forming implants in gastrointestinal tract and kit for use therewith
US7163801B2 (en) 1999-09-01 2007-01-16 The Burnham Institute Methods for determining the prognosis for cancer patients using tucan
US6322563B1 (en) 1999-09-17 2001-11-27 Genzyme Corporation Small tissue and membrane fixation apparatus and methods for use thereof
US20010041914A1 (en) * 1999-11-22 2001-11-15 Frazier Andrew G.C. Tissue patch deployment catheter
US6231561B1 (en) 1999-09-20 2001-05-15 Appriva Medical, Inc. Method and apparatus for closing a body lumen
US6387104B1 (en) 1999-11-12 2002-05-14 Scimed Life Systems, Inc. Method and apparatus for endoscopic repair of the lower esophageal sphincter
US6641592B1 (en) 1999-11-19 2003-11-04 Lsi Solutions, Inc. System for wound closure
US7153312B1 (en) * 1999-12-02 2006-12-26 Smith & Nephew Inc. Closure device and method for tissue repair
WO2001043649A9 (en) 1999-12-17 2002-07-18 Thomas J Fogarty Method and device for use in minimally invasive approximation of muscle and other tissue
US6293956B1 (en) 2000-01-26 2001-09-25 Designs Standards Corporation Ligating clips
JP3679674B2 (en) 2000-02-03 2005-08-03 オリンパス株式会社 Endoscope
US6537285B1 (en) 2000-02-04 2003-03-25 University Of Utah Spiral cervical retractor apparatus
US6527753B2 (en) * 2000-02-29 2003-03-04 Olympus Optical Co., Ltd. Endoscopic treatment system
ES2435094T3 (en) 2000-05-19 2013-12-18 C.R. Bard, Inc. Device and method for capturing and suture tissue
US7399304B2 (en) 2000-03-03 2008-07-15 C.R. Bard, Inc. Endoscopic tissue apposition device with multiple suction ports
US6712830B2 (en) 2000-03-15 2004-03-30 Esplin Medical Inventions, L.L.C. Soft tissue anchor
DE60110761T2 (en) 2000-03-16 2006-05-04 Medigus Ltd. Device for fundoplication
WO2001070097A1 (en) 2000-03-23 2001-09-27 Atropos Limited An insertion device for an endoscope
US6440061B1 (en) 2000-03-24 2002-08-27 Donald E. Wenner Laparoscopic instrument system for real-time biliary exploration and stone removal
US6984203B2 (en) * 2000-04-03 2006-01-10 Neoguide Systems, Inc. Endoscope with adjacently positioned guiding apparatus
US6468203B2 (en) 2000-04-03 2002-10-22 Neoguide Systems, Inc. Steerable endoscope and improved method of insertion
US6485411B1 (en) 2000-04-12 2002-11-26 Circon Corporation Endoscope shaft with superelastic alloy spiral frame and braid
US6592596B1 (en) 2000-05-10 2003-07-15 Scimed Life Systems, Inc. Devices and related methods for securing a tissue fold
DE60115020D1 (en) 2000-05-15 2005-12-22 Bard Inc C R Endoscopic accessory devices coupling mechanism
US6743239B1 (en) * 2000-05-25 2004-06-01 St. Jude Medical, Inc. Devices with a bendable tip for medical procedures
US6589208B2 (en) 2000-06-20 2003-07-08 Applied Medical Resources Corporation Self-deploying catheter assembly
WO2001097677A3 (en) * 2000-06-22 2002-04-18 Arthrex Inc Graft fixation using a screw or plug against suture or tissue
DE60132005D1 (en) 2000-06-23 2008-01-31 Viacor Inc Automatic circular convolution for Mitral Valve Repair
US6544271B1 (en) 2000-07-18 2003-04-08 Scimed Life Systems, Inc. Device for full-thickness resectioning of an organ
WO2002007618A1 (en) * 2000-07-21 2002-01-31 Atropos Limited A cannula
EP1303221A2 (en) * 2000-07-21 2003-04-23 Atropos Limited A surgical instrument
US6921361B2 (en) 2000-07-24 2005-07-26 Olympus Corporation Endoscopic instrument for forming an artificial valve
US6572629B2 (en) * 2000-08-17 2003-06-03 Johns Hopkins University Gastric reduction endoscopy
US6716224B2 (en) 2000-08-28 2004-04-06 Linvatec Corporation Intracorporeal knot tier
JP2004511275A (en) * 2000-09-01 2004-04-15 アンジオリンク・コーポレイション Management and wound closure device of the wound site
US7037324B2 (en) 2000-09-15 2006-05-02 United States Surgical Corporation Knotless tissue anchor
US6554845B1 (en) 2000-09-15 2003-04-29 PARÉ Surgical, Inc. Suturing apparatus and method
US20020082621A1 (en) 2000-09-22 2002-06-27 Schurr Marc O. Methods and devices for folding and securing tissue
US6755843B2 (en) 2000-09-29 2004-06-29 Olympus Optical Co., Ltd. Endoscopic suturing device
US6736828B1 (en) 2000-09-29 2004-05-18 Scimed Life Systems, Inc. Method for performing endoluminal fundoplication and apparatus for use in the method
US6719763B2 (en) 2000-09-29 2004-04-13 Olympus Optical Co., Ltd. Endoscopic suturing device
JP2002177199A (en) 2000-10-02 2002-06-25 Olympus Optical Co Ltd Endoscope
US6533796B1 (en) 2000-10-11 2003-03-18 Lsi Solutions, Inc. Loader for surgical suturing instrument
US6585639B1 (en) * 2000-10-27 2003-07-01 Pulmonx Sheath and method for reconfiguring lung viewing scope
US6508828B1 (en) * 2000-11-03 2003-01-21 Radi Medical Systems Ab Sealing device and wound closure device
US7033373B2 (en) 2000-11-03 2006-04-25 Satiety, Inc. Method and device for use in minimally invasive placement of space-occupying intragastric devices
US20020082622A1 (en) 2000-11-24 2002-06-27 Kane David Lee Collapsed deployable soft tissue anchor for repairing soft tissue to bone
US20020068945A1 (en) 2000-12-06 2002-06-06 Robert Sixto Surgical clips particularly useful in the endoluminal treatment of gastroesophageal reflux disease (GERD)
US7727246B2 (en) 2000-12-06 2010-06-01 Ethicon Endo-Surgery, Inc. Methods for endoluminal treatment
EP1359851B1 (en) * 2001-01-31 2010-09-22 Rex Medical, Inc. Apparatus for stapling and resectioning gastro-edophageal tissue
US6997931B2 (en) 2001-02-02 2006-02-14 Lsi Solutions, Inc. System for endoscopic suturing
US7235086B2 (en) 2001-02-02 2007-06-26 Lsi Solutions, Inc. Crimping instrument with motion limiting feature
US6884249B2 (en) 2001-02-16 2005-04-26 Depuy Mitek, Inc. Surgical knot pusher and method of use
JP2004524903A (en) 2001-03-08 2004-08-19 アトロポス・リミテッド Colon overtube
US6793621B2 (en) 2001-03-08 2004-09-21 Atropos Limited Colonic overtube
DE60104667T2 (en) 2001-05-09 2005-01-05 Radi Medical Systems Ab An apparatus for sealing an arterial perforation
US7083629B2 (en) 2001-05-30 2006-08-01 Satiety, Inc. Overtube apparatus for insertion into a body
JP3722729B2 (en) * 2001-06-04 2005-11-30 オリンパス株式会社 Endoscopic treatment equipment
US6817974B2 (en) 2001-06-29 2004-11-16 Intuitive Surgical, Inc. Surgical tool having positively positionable tendon-actuated multi-disk wrist joint
US6719764B1 (en) 2001-08-24 2004-04-13 Scimed Life Systems, Inc. Forward deploying suturing device and methods of use
US6986781B2 (en) * 2001-11-08 2006-01-17 Smith & Nephew, Inc. Tissue repair system
US8142448B2 (en) 2001-11-26 2012-03-27 Olympus Corporation Endoscopic instruments for suturing tissues in a body cavity
US7261722B2 (en) 2001-12-20 2007-08-28 Rex Medical, L.P. Apparatus and method for treating gastroesophageal reflux disease
US7344545B2 (en) 2002-01-30 2008-03-18 Olympus Corporation Endoscopic suturing system
WO2003066127A3 (en) 2002-02-04 2003-12-11 Damage Control Surgical Techno Method and apparatus for solid organ tissue approximation
JP4351458B2 (en) 2002-03-18 2009-10-28 アンソニー・ニコラス・カルー The endoscope insertion system
US6988987B2 (en) 2002-03-18 2006-01-24 Olympus Corporation Guide tube
US7527590B2 (en) 2002-03-19 2009-05-05 Olympus Corporation Anastomosis system
US7077850B2 (en) 2002-05-01 2006-07-18 Scimed Life Systems, Inc. Tissue fastening devices and related insertion tools and methods
JP4488280B2 (en) 2002-06-07 2010-06-23 オリンパス株式会社 Instrument for an endoscope and endoscopic device
US6783491B2 (en) * 2002-06-13 2004-08-31 Vahid Saadat Shape lockable apparatus and method for advancing an instrument through unsupported anatomy
FR2840804B1 (en) 2002-06-13 2004-09-17 Richard Cancel System for the treatment of obesity and to implant such a system
US7125413B2 (en) 2002-06-20 2006-10-24 Scimed Life Systems, Inc. Endoscopic fundoplication devices and methods for treatment of gastroesophageal reflux disease
US6932834B2 (en) 2002-06-27 2005-08-23 Ethicon, Inc. Suture anchor
US6773440B2 (en) 2002-07-02 2004-08-10 Satiety, Inc. Method and device for use in tissue approximation and fixation
JP4373146B2 (en) 2002-07-11 2009-11-25 オリンパス株式会社 Endoscopic suturing device
US7591781B2 (en) * 2002-07-15 2009-09-22 Olympus Corporation Endoscope system with insertion direction changing guides
JP4109030B2 (en) 2002-07-19 2008-06-25 オリンパス株式会社 Clip apparatus of living tissue
US6746460B2 (en) 2002-08-07 2004-06-08 Satiety, Inc. Intra-gastric fastening devices
US7083630B2 (en) 2002-08-29 2006-08-01 Scimed Life Systems, Inc. Devices and methods for fastening tissue layers
WO2004021872A3 (en) * 2002-09-06 2004-12-02 Bard Inc C R Tissue capturing devices
US7220237B2 (en) 2002-10-23 2007-05-22 Satiety, Inc. Method and device for use in endoscopic organ procedures
US7229428B2 (en) 2002-10-23 2007-06-12 Satiety, Inc. Method and device for use in endoscopic organ procedures
US6656194B1 (en) 2002-11-05 2003-12-02 Satiety, Inc. Magnetic anchoring devices
US20040122456A1 (en) 2002-12-11 2004-06-24 Saadat Vahid C. Methods and apparatus for gastric reduction
US7942884B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Methods for reduction of a gastric lumen
US7618426B2 (en) 2002-12-11 2009-11-17 Usgi Medical, Inc. Apparatus and methods for forming gastrointestinal tissue approximations
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
US7942898B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Delivery systems and methods for gastric reduction
US8562646B2 (en) 2002-12-19 2013-10-22 Boston Scientific Scimed, Inc. Anchoring to soft tissue
US7637905B2 (en) 2003-01-15 2009-12-29 Usgi Medical, Inc. Endoluminal tool deployment system
EP1593337B1 (en) 2003-02-11 2008-08-13 Olympus Corporation Overtube
US7993368B2 (en) 2003-03-13 2011-08-09 C.R. Bard, Inc. Suture clips, delivery devices and methods
EP1610719B1 (en) 2003-03-28 2010-01-13 GI Dynamics, Inc. Sleeve for delayed introduction of enzymes into the intestine
US20040199052A1 (en) 2003-04-01 2004-10-07 Scimed Life Systems, Inc. Endoscopic imaging system
CA2525275C (en) 2003-05-16 2012-02-07 C.R. Bard, Inc. Single intubation, multi-stitch endoscopic suturing system
US7731757B2 (en) 2003-06-01 2010-06-08 Reflux Corporation Obesity treatment
JP4166632B2 (en) 2003-06-06 2008-10-15 オリンパス株式会社 Suturing device
JP4145200B2 (en) 2003-06-06 2008-09-03 オリンパス株式会社 Suturing device
DE10349825B3 (en) 2003-10-24 2005-07-14 Karl Storz Gmbh & Co. Kg medical instrument
US7736372B2 (en) 2003-11-13 2010-06-15 Usgi Medical, Inc. Apparatus and methods for endoscopic suturing
JP4675241B2 (en) 2003-12-01 2011-04-20 オリンパス株式会社 The endoscope system
US7871419B2 (en) 2004-03-03 2011-01-18 Nmt Medical, Inc. Delivery/recovery system for septal occluder
US7703459B2 (en) 2004-03-09 2010-04-27 Usgi Medical, Inc. Apparatus and methods for mapping out endoluminal gastrointestinal surgery
US20050203488A1 (en) 2004-03-09 2005-09-15 Usgi Medical Inc. Apparatus and methods for mapping out endoluminal gastrointestinal surgery
US8512229B2 (en) 2004-04-14 2013-08-20 Usgi Medical Inc. Method and apparatus for obtaining endoluminal access
US8562516B2 (en) 2004-04-14 2013-10-22 Usgi Medical Inc. Methods and apparatus for obtaining endoluminal access
US8277373B2 (en) 2004-04-14 2012-10-02 Usgi Medical, Inc. Methods and apparaus for off-axis visualization
US20050272977A1 (en) 2004-04-14 2005-12-08 Usgi Medical Inc. Methods and apparatus for performing endoluminal procedures
CA2563298A1 (en) 2004-05-07 2005-11-24 Nmt Medical, Inc. Catching mechanisms for tubular septal occluder
US20050251205A1 (en) 2004-05-07 2005-11-10 Usgi Medical Inc. Apparatus and methods for positioning and securing anchors
US8308765B2 (en) 2004-05-07 2012-11-13 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US7918869B2 (en) 2004-05-07 2011-04-05 Usgi Medical, Inc. Methods and apparatus for performing endoluminal gastroplasty
US7736374B2 (en) 2004-05-07 2010-06-15 Usgi Medical, Inc. Tissue manipulation and securement system
US8216252B2 (en) 2004-05-07 2012-07-10 Usgi Medical, Inc. Tissue manipulation and securement system
US20050250987A1 (en) 2004-05-07 2005-11-10 Usgi Medical Inc. Removable apparatus and methods for manipulating and securing tissue
US20050251176A1 (en) 2004-05-07 2005-11-10 Usgi Medical Inc. System for treating gastroesophageal reflux disease
US7390329B2 (en) 2004-05-07 2008-06-24 Usgi Medical, Inc. Methods for grasping and cinching tissue anchors
US20060135971A1 (en) 2004-05-07 2006-06-22 Usgi Medical Inc. System for treating gastroesophageal reflux disease
US8257394B2 (en) 2004-05-07 2012-09-04 Usgi Medical, I