US20050004515A1 - Steerable kink resistant sheath - Google Patents

Abstract

A steerable kink resistant access device is provided having an elongated body and a steerable portion. The access sheath has an outside diameter sufficiently small so that it may be inserted into a body cavity or conduit. The access sheath typically has two internal lumen, a first lumen sized and configured as an access to a surgical site and a second lumen sized and configured to contain a tensioning device that, when acted upon, will deflect the steerable portion. The tensioning device may be directly or remotely attached to an actuation device that operates to control the tensioning and loosening of the tensioning device.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application is a continuation-in-part of U.S. patent application Ser. Nos. 10/766,138, filed Jan. 28, 2004, and 10/298,116, filed Nov. 15, 2002, and claims benefit of U.S. Provisional Application No. 60/465,310, filed Apr. 25, 2003, the disclosures of which are hereby incorporated by reference as if set forth in full herein.
BACKGROUND
• The present invention generally relates to surgical access devices and, more specifically, to kink resistant sheaths having steerable sections that enable the sheaths to access hard-to-reach body cavities and conduits.
• Sheaths and catheters have long been used to access body conduits such as the arterial and venous branches of the vascular system, urinary tract, body cavities such as the thorax and abdomen, and hollow viscous organs such as the stomach, intestines and urinary bladder. More specifically, sheaths and catheters have been used for fluid delivery, fluid recovery, implant delivery and for providing an access pathway for an instrument such as an endoscope. However, many endoscopes, for example, are flexible enough to bend but are not steerable or deflectable in a controlled and/or dynamic manner.
• For some instruments, steering has been achieved, for example, by “pre-bending” the distal tip of a surgical device before insertion and then rotating the device once it has been inserted and has reached a branch artery inside the body. If the angle of the bend has to be adjusted, then the device may have to be removed, re-bent and reinserted. This results in greater time spent in the body and thereby increase surgery time. Furthermore, since these sheaths and catheters need to navigate many hard-to-reach areas, it follows that they should be as stiff and yet as flexible as possible. It is also useful that the sheaths and catheters are constructed with thin walls to minimize the diameter of the device and to maximize the radii of the internal lumen.
• In trying to balance the flexibility and stiffness issues, manufacturers have attempted to use a variety of materials such as vinyl, polyurethane, silicone, natural rubber, polyester and nylon. A drawback with these plastics is they only work well when the wall is sufficiently thick. That is, when the access sheath is constructed with a thin wall made of a plastic or rubber material, the sheath may bend or twist during use. This may result in potential damage as the sharp edge of the kinked sheath may allow an endoscope or other device to complicate the surgical procedure. Moreover, a bent or kinked sheath is useless because it cannot communicate and it does not allow the passage of an instrument. As such, there is a desire in the art for a steerable access sheath that is durable enough to provide sufficient strength and stiffness to be guided through a body cavity or tissue and, at the same time, be flexible enough to perform intricate manipulations through the body cavity or tissue. In particular, it would be desirable to have a steerable access sheath having a thin wall section, a large lumen, an atraumatic distal end and a kink resistant construction.
SUMMARY
• A surgical access device or a steerable kink resistant access device, is provided having an elongate body and a steerable portion. The access sheath has an outside diameter sufficiently small so that it may be inserted into a body cavity or conduit. The steerable portion and the elongate body may have variable stiffness depending on the application of the access sheath. The access sheath typically has two internal lumen, a primary lumen and a secondary lumen. The primary lumen is sized and configured as an access to a surgical site or the target of a surgical procedure, and operates to advance diagnostic and therapeutic elements to the surgical site or target. The secondary lumen is sized and configured to contain a tensioning device such as a control or pull wire that, when acted upon, will deflect the steerable portion. The tensioning device may be made of a kink resistant material such as Nitinol, a braided cable or any flexible strand or wire. The tensioning device extends through the secondary lumen and is attached to a handle portion operatively connected to the proximal end of the access sheath. The handle portion may include a control knob to control the tensioning or loosening of the tensioning device.
• In one embodiment of the present invention, a surgical access device is provided comprising an elongated body and an actuator. The elongated body has a proximal end, a distal end, and a steerable region. The body includes a primary lumen and a secondary lumen both extending through the body with the secondary lumen having a tensioning device extending through the secondary lumen and connected to the steerable region of the elongated body. The actuator is connected to the tensioning device distally from the proximal end of the elongated body to control tension of the tensioning device. In one aspect of the present invention, the actuator has a hand-engaging extension, a funnel-shaped entry or entry which is sized and configured to guide an obturator, dilator, ureteroscope and/or other instrumentation into the actuator. The steerable portion may be deflected through the action of the pull wire, which may be connected to an axle in the actuator. That is, as the actuator is manipulated, the pull wire imparts a pulling force on the steerable portion of the sheath, thereby causing the steerable portion to deflect. In another aspect of the invention, passive and/or active directional indicators may be placed on each of the hand-engaging extensions of the hand-piece to indicate the direction of distal deflection or bending of the access sheath.
• In one embodiment, a surgical access device comprises a tube having a proximal end, a distal end, a steerable region, and an enlarged entry, the tube including a primary lumen and a secondary lumen both extending through the tube and means for deflecting the steerable portion of the tube. In another aspect of the present invention, a surgical access device comprises a tube having a substantially rigid portion having a first diameter and a substantially flexible portion having a second diameter and extending from the substantially rigid portion, the first diameter being smaller than the second diameter. The tube also includes a primary lumen and a secondary lumen both extending through the tube, the secondary lumen having a pull wire extending through the secondary lumen and connected to the flexible portion of the elongated body. A connector having a distal end connected to the tube and a proximal end including a funnel-shaped portion is also included with the pull wire extending through the connector from the distal end to the proximal end. A plastic tubing is connected to the connector through which the pull wire extends through and a handle is connected to the plastic tubing and including an axle disposed within the handle and a knob connected to and outside the handle, the axle connected to the pull wire and the knob.
• In another embodiment, a method of using a surgical access device with a dilator and the access device comprising an elongated body having a proximal end, a distal end, and a steerable region, the body including a primary lumen and a secondary lumen both extending through the body, the secondary lumen having a tensioning device extending through the secondary lumen and connected to the steerable region of the elongated body, and an actuator connected to the tensioning device distally from the proximal end of the elongated body to control tension of the tensioning device is provided. The method comprises inserting the dilator through the primary lumen of the access device, removing the dilator from the access device after the access device is inserted into the patient, and manipulating the actuator to a first position to deflect the steerable region to form an arc.
• The access sheath may comprise an extruded multi-lumen plastic tube or a tube molded from a plastic or rubber-like material including polyvinyl chloride, polyester, silicone elastomer, natural or synthetic rubber and polyurethane. The material may range in hardness from around 40 Shore A to 70 Shore D. A structure such as a spring can also be molded into the tube of the access sheath to facilitate kink resistance. More specifically, the access sheath may be formed with an inner plastic body, surrounded by a metal spring coil, which is further covered by an outer plastic body.
• In one aspect of the present invention, a method of manufacturing a surgical access device is provided. The method comprises wrapping a first wire around a mandrel, resting a first tube on the first wire, the first tube extending further in length than the first wire along the mandrel, inserting the mandrel through a second tube, and heating the second tube, the mandrel, the first wire and the first tube. In another embodiment, a method of manufacturing a surgical access device comprises assembling a plurality of first ring-shaped members around a mandrel, resting a first tube on the first connecting member, inserting the mandrel through a second tube, and heating the second tube, the mandrel, the first connecting member and the first tube.
• In one aspect of steerability of the invention, a tightly wound spring may be placed in the secondary lumen of the access sheath to facilitate movement of the tensioning device inserted therethrough. The spring may be bonded or otherwise fixed to the secondary lumen. Among other features, the spring operates to isolate forces applied by the tensioning device such that only the steerable portion is deflected while the elongate body remains relatively firm when the tensioning device is acted upon. The spring may be coated with a lubricious material further facilitating movement of the tensioning device. The spring may line the entire secondary lumen or portions of the secondary lumen and the spring may be stretched in certain sections to facilitate isolation of the tension force. In another embodiment of the present invention, the tensioning device may be a flattened member extending through at least the steerable portion of the access sheath.
• In yet another aspect of the invention, the steerable portion may include a plurality of radially and longitudinally spaced notches and slits disposed on opposite sides of each other facilitating radial deflection of the distal portion in the desired direction or angle. The notches and slits may be of any desired width, length, depth and shape in accordance with the use and flexure requirements of the access sheath. The slits may be narrower and shallower than the notches to provide a “weak-side/strong-side” arrangement of the steerable portion that allows the access sheath to be predisposed to bending in the desired direction.
• Many of the attendant features of this invention will be more readily appreciated as the same becomes better understood by reference to the following detailed description and considered in connection with the accompanying drawings in which like reference symbols designate like parts throughout.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 illustrates a surgical access device or steerable kink resistant access device in accordance with one embodiment of the present invention;
• FIG. 2 is a front view of the distal end of the access device ofFIG. 1;
• FIG. 3 is a rear view of the proximal end of the access device ofFIG. 1;
• FIG. 4 is an enlarged side view of the distal portion of the access sheath ofFIG. 1;
• FIG. 5 is a side-section view of the distal portion of the access sheath ofFIG. 4;
• FIG. 6 illustrates a steerable kink resistant access device of the present invention with its distal portion deflected;
• FIG. 7 is a top view of the distal portion of the access sheath of the present invention;
• FIG. 8 is a bottom view of the distal portion of the access sheath of the present invention;
• FIG. 9 illustrates the atraumatic distal end of the access sheath of the present invention;
• FIG. 10 illustrates an actuator of the access device of the present invention used to control the steerable region or portion of the access sheath;
• FIG. 11 illustrates the access device of the present invention guiding a scope into a kidney pole;
• FIG. 12 illustrates a perspective view of the distal portion of an access sheath having a flattened tensioning member;
• FIG. 13 illustrates a perspective view of an actuator or actuation hand-piece in accordance with another embodiment of the present invention;
• FIG. 14 is a side view of the actuation hand-piece ofFIG. 13;
• FIG. 15 illustrates a perspective view of an actuation hand-piece of the invention including a directional indicator showing the direction of deflection or bending of the access sheath;
• FIG. 16 illustrates another perspective view of an actuation hand-piece of the invention including a directional indicator;
• FIG. 17 illustrates a side-elevation view illustrating a spring embodiment of the tube associated with the sheath of the present invention;
• FIG. 18A illustrates a side view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 18B illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 19 illustrates a cross-sectional view of the actuation hand-piece of FIGS.18A-B;
• FIG. 20 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the invention;
• FIG. 21A illustrates a top view of a disassembled actuation hand-piece ofFIG. 20;
• FIG. 21B illustrates a cross-sectional view of the actuation hand-piece ofFIG. 20;
• FIG. 22 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the invention;
• FIG. 23A illustrates a cross-sectional view of the actuation hand-piece ofFIG. 22;
• FIG. 23A illustrates a perspective view of a disassembled actuation hand-piece ofFIG. 22;
• FIG. 24 illustrates a perspective view of an actuator or actuation hand-piece in accordance with one embodiment of the invention;
• FIG. 25 illustrates a cross-sectional view of the actuation hand-piece ofFIG. 24;
• FIG. 26 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 27 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 28A illustrates a side view of an actuator or actuation hand-piece in accordance with one embodiment of the invention;
• FIG. 28B illustrates another side view of the actuation hand-piece ofFIG. 28A;
• FIG. 29 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 30 illustrates a cross-sectional view of a connector in accordance with one embodiment of the present invention;
• FIG. 31 illustrates a cross-sectional view of the actuation hand-piece ofFIG. 29;
• FIGS.32A-B illustrate perspective views of a disassembled actuation hand-piece in accordance with one embodiment of the present invention;
• FIGS.33A-B illustrate other perspective views of the disassembled actuation hand-piece of FIGS.32 A-B;
• FIG. 34 illustrates a cross-sectional view of the actuation hand-piece ofFIG. 32;
• FIG. 35 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIGS.36A-B illustrate cross-sectional views of the actuation hand-piece ofFIG. 35;
• FIGS. 37-38 illustrate perspective views of embodiments of components of the actuation hand-piece ofFIG. 35;
• FIG. 39 illustrates a view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 40 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 41 illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 42A illustrates a perspective view of an actuation hand-piece in accordance with one embodiment of the present invention;
• FIG. 42B illustrates a perspective view of one embodiment of components of the actuation hand-piece ofFIG. 42A; and
• FIG. 43-46 illustrate cross-sectional views of embodiments of an access sheath in various stages of fabrication in accordance with the present invention.
DETAILED DESCRIPTION
• FIGS. 1-3 illustrate a surgical access device or steerable kinkresistant access device100 in accordance with the one embodiment of the present invention for use in, among other fields, cardiology, urology, radiology, electrophysiology and gastroenterology.Access device100 comprises anaccess sheath102 having alongitudinal axis103 extending from a proximal end to a distal end, and ahandle portion104 operatively connected to the proximal end of theaccess sheath102. Theaccess sheath102 includes anelongated body105 and a steerable region orportion106. It is appreciated that thesteerable portion106 may be formed anywhere along theaccess sheath102. It is further appreciated that thesteerable portion106 and theelongated body105 may have variable stiffness depending on the application of theaccess sheath102. Theaccess sheath102 has an outside diameter sufficiently small so that it may be inserted into a body cavity or conduit. Theaccess sheath102 typically has two internal lumen, aprimary lumen112 and asecondary lumen114, as illustrated inFIG. 2.
• Theprimary lumen112 is sized and configured as an access to a surgical site or the target of a surgical procedure. In particular,primary lumen112 operates to advance diagnostic and therapeutic elements to the surgical site or target. Thesecondary lumen114 is sized and configured to contain atensioning device116 such as a control or pull wire that, when acted upon, will deflect thesteerable portion106 of theaccess sheath102. Thetensioning device116 extends through thesecondary lumen114 and is attached to the actuator or handleportion104 at one end and to adistal portion107 of thesteerable portion106 at the other end. Thehandle portion104 may include a thumb-actuatedknob118 controlling thetensioning device116. For example, theknob118 may be drawn proximally in adirection119 to provide tension to thetensioning device116 or cause the tensioning device to tense or distally in adirection120 to loosen tension or cause thetensioning device116 to loosen.
• In another embodiment of the present invention,FIGS. 13-16 illustrate an actuator or actuation hand-piece500 having a proximally-facingportion502, a distally-facingportion504, hand-engagingextensions506, and at least onethumbwheel member508a,b.The proximally-facingportion502 has a generally flat support surface and includes a funnel-shapedentry portion510. The funnel-shapedentry portion510 is sized and configured to guide an obturator and other instrumentation into a working channel within the hand-piece500. The distally-facingportion504 is connected to theaccess sheath102. The working channel of hand-piece500 is sized and configured to form a transition into theprimary lumen112 of theaccess sheath102. The hand-engagingextensions506 are sized and shaped to accommodate two extended human fingers in a holding position. The at least one thumbwheel508 allows a user to deflect thesteerable portion106 of theaccess sheath102.
• Thesteerable portion106 may be deflected through the action of atensioning device116, such as a pull wire or control wire associated with thesecondary lumen114 within theaccess sheath102. Thetensioning device116 may be connected to an axle positioned between twothumbwheels508aand508bor at least one thumbwheel and an opposing side of hand-piece500. As thethumbwheels508aand508bare rotated, thetensioning device116 imparts a pulling force on thesteerable portion106 ofsheath102, thereby causingportion106 to deflect. In one aspect of the present invention,directional indicators512 may be placed on each of hand-engagingextensions506 of hand-piece500 to indicate the direction of distal deflection or bending ofaccess sheath102.
• It is appreciated that the actuator or actuation hand-piece of the invention may be remotely attached to the associated access sheath to control the tensioning and loosening of the tensioning device. In this case, the hand-piece may be connected to a flexible tubing or body, which is connected to the access sheath. By providing a remote access point or attachment, the thumbwheels of the hand-piece, for example, may be placed away from the surgical site so that they do not prevent or interfere with full insertion of the working length of the access sheath. It is further appreciated that the access sheath may comprise a plurality of pull wires attached to a plurality of thumbwheels of an actuation hand-piece to deflect the steerable portion of the sheath in different directions.
• In one embodiment of the invention, theaccess sheath102 comprises an extruded multi-lumen plastic tube. Alternatively, theaccess sheath102 may be molded from a plastic or rubber-like material. Preferred materials include polyvinyl chloride, polyester, silicone elastomer, natural or synthetic rubber, polyurethane or the like. The materials may range in hardness from around 40 Shore A to 70 Shore D. These materials are generally flexible and durable. In another embodiment of the invention as illustrated inFIG. 17, a structure such as a spring can be molded into the tube of the sheath to facilitate kink resistance. More specifically, theaccess sheath102 may be formed with an innerplastic body610, surrounded by ametal spring coil612, which is further covered by anouter body614. This particular embodiment ofaccess sheath102 provides a high degree of kink resistance. Theinner body610 provides a smooth surface within the sheath, which facilitates passage of instrumentation. Thespring coil612 adds kink resistance to the sheath tube, while theouter body614 provides a suitable covering for the coils of thespring612.
• In one aspect of steerability of the present invention, a tightly wound spring may be placed in thesecondary lumen114 of theaccess sheath102 to facilitate movement of thetensioning device116 inserted there through. The spring may be bonded or otherwise fixed to thesecondary lumen114. Among other features, the spring operates to isolate forces applied by thetensioning device116, which is inserted through the spring and is attached to thedistal portion107 of thesteerable portion106. In particular, the spring adds stability and rigidity to theelongate body105 when thetensioning device116 is acted upon such that only thesteerable portion106 is bent or steered. Furthermore, the spring operates to direct the tension force applied on thedevice116 to thesteerable portion106 so as to allow deflection of only theportion106 and not theelongate body105. That is, the tension force is isolated to thesteerable portion106, which may be formed anywhere along theaccess sheath102. The spring may be coated with a lubricious material further facilitating movement of thetensioning device116. The spring may line or cover the inner surface area of the entiresecondary lumen114 or just portions of thesecondary lumen114 to facilitate isolation of the tension force.
• The spring may be constructed from a 0.005-inch diameter wire that is tightly wound forming a closed wound spring having a 0.02-inch outer diameter. The distal 0.5 to 2 inches of the spring may be stretched to an open wound state such that the windings have an approximately 0.02-inch gap between them. This stretched portion of the spring facilitates isolation of the tension force applied by thetensioning device116. The spring may be coated, for example, in a plastic jacket and bonded to thesecondary lumen114 from the proximal end of the spring to the proximal end of the stretched portion. The stretched portion is then left free to move and/or compress in the plastic jacket. The distal end of the stretched portion may be anchored to the distal end of theaccess sheath102 along with thetensioning device116. The distal end of the plastic jacket may also be bonded to the distal end of theaccess sheath102 along with thetensioning device116 and the spring although these elements do not require a common bonding point or bonding method.
• As discussed above, the proximal end of theaccess sheath102 may be directly or remotely attached to handleportion104 or actuator or hand-piece500, which allows the operator to place tension on thetensioning device116, such as a control or pull wire, while maintaining the position of the catheter. This tension causes the stretched portion of the 0.02-inch diameter spring to collapse and this, in turn, forces the sheath to bend in the region where the stretched portion of the spring is located. It is appreciated that the stretched portion may be formed anywhere along the catheter or surgical access device that may require bending, and is not limited to the distal end of the device. In addition, more than one deflection assembly of spring and tensioning device may be added to the access device to create deflection in different regions or planes. The amount of bending or deflection will in some way be proportional to the amount of force or tension placed on the tensioning device.
• Thetensioning device116 is, in one embodiment, a control or pull wire made of Nitinol, a braided cable or any flexible strand or wire. In one embodiment, the control wire is inserted through the spring such that it runs through thesecondary lumen114 as illustrated inFIG. 5. The proximal end of thetensioning device116, e.g., a control or pull wire, is connected to an actuator such as theknob118 of thehandle portion104. The distal end of the control or pull wire, as previously described, is attached to thedistal portion107 ofsteerable portion106. In another aspect of the invention as illustrated inFIG. 12, thetensioning device416 may be a flattened or flat member extending through at least thesteerable portion106 of theaccess sheath102.
• In another aspect of the present invention as illustrated inFIGS. 1 and 4-5, thesteerable portion106 includes a plurality of radially and longitudinally spacednotches108 andslits110 disposed on opposite sides of each other facilitating radial deflection of thedistal portion107 in a desired direction or angle. Thenotches108 andslits110 are cut into theaccess sheath102 across thelongitudinal axis103. The degree of deflection may vary greatly based on many factors such as the number, size, direction, shape and spacing of thenotches108 and slits110. Thenotches108 are cut deeper and wider at adistal end150 than they are at aproximal end152 ofsteerable portion106. Theslits110 comprise of very shallow cuts to provide a reduction in resistance to stretching as thesteerable portion106 is bent or deflected toward thenotches108.
• As discussed above, thenotches108 and slits110 may be of any desired width, length, depth and shape. The number ofnotches108 andslits110 in thesteerable portion106 can be varied in accordance with the use and flexure requirements of theaccess sheath102. However, in one embodiment, theslits110 are narrower and shallower than thenotches108 to provide a “weak-side/strong-side” arrangement of thesteerable portion106 so as to allow theaccess sheath102 to be predisposed to bending in the desired direction. That is, when the control wire of thetensioning device116 is drawn proximally as illustrated inFIG. 6, the more flexible side of thesteerable portion106, i.e., the side withnotches108, will give first thereby bending in the direction of the notches. Moreover, thedistal end150 of thesteerable portion106 with the deeper andwider notches108 will bend first as the bending progressively moves toward theproximal end152 having shallower and narrower notches. It is appreciated that thenotches108 may extend through the wall of theaccess sheath102.
• Referring now toFIGS. 7 and 8, the opposing series ofnotches108 andslits110 are further illustrated. Thenotches108, as discussed above, provide a “weak-side” or preferred bend path as thenotches108 are closed when bent. It can be seen that thenotches108 are wedge-shaped and have material removed from them. There is, therefore, sufficient room for the material adjacent to each notch to approximate, thereby shortening the length of thesteerable portion106 on the weak-side. In contrast, theslits110 are shallow radial cuts made directly opposite thenotches108 with little or no material removed. Theslits110 provide the mechanical equivalent of increased plastic elasticity. That is, theslits110 allow the material of thesteerable portion106 to stretch beyond the intrinsic properties of the material itself. As a result of this construction, theprimary lumen112 of thesteerable portion106 will not collapse when deformed or bent into a tight circular profile as can be seen inFIG. 6. In other words, theslits110 will only open to provide an elongation of the “strong-side” and will not collapse to provide a shortening of the “strong-side”. The material on either side of thenotches108 and slits110 maintains the general elongate dimension and forms a continuum of theaccess sheath102.
• In another embodiment of the invention as illustrated inFIG. 9, thedistal end200 of thesteerable portion106 has a generally rounded offwall section205 providing an atraumatic insertion tip. With the current construction of the access sheath having a steerable distal portion, less pushing force is required to advance the access sheath since it may be deflected around, under or over anomalies and irregularities in a body cavity or conduit rather than being forced through the tortuous paths. Surgical instruments such as anureteroscope300 may be directed through a steerable access sheath as illustrated inFIGS. 6 and 11. For instance, the steerable access sheath may be used to pass theureteroscope300 into the upper and lower poles of the renal calices as generally illustrated inFIG. 11. It is appreciated that flexible ureteroscopes and other flexible endoluminal scopes, including completely passive scopes, may be accurately positioned with the assistance of the steerable access sheaths of the present invention.
• In another embodiment of the present invention,FIGS. 18-19 illustrate an actuation hand-piece oractuator510 in line with theaccess sheath102. The proximal end of theactuator510 includes a funnel-shapedentry portion516 that is sized and configured to guide an obturator, dilator, ureteroscope and other instrumentation into a workingchannel518 within theactuator510. The workingchannel518 ofactuator510 is sized and configured to form a transition into theprimary lumen112 of theaccess sheath102.
• Thetensioning device116 extending through thesecondary lumen114 is attached to abracket512. A proximal end of thetensioning device116 is balled, crimped, or otherwise sized or deformed to secure thetensioning device116 to thebracket512. Thebracket512 is further connected to aslider514. Alever511 connected to theslider514 allows a user to move theslider514 and thereby controltensioning device116. InFIG. 18B, the hand-piece510 includes apivotable lever519 connected to lever511.Pivotable lever519 provides a counter actuation point relative to lever511. In other words, as thelever519 is moved distally,lever511 moves proximally and vice versa.
• When theslider514 is moved proximally, thetensioning device116 imparts a pulling force on the steerable portion106 (FIG. 1) ofaccess sheath102 thereby deflecting thesteerable portion106. Theslider514 also includes a plurality ofteeth515 that operatively engage correspondingteeth517 along the inside of the hand-piece510. Therefore, as theslider514 is moved proximally and distally, this engagement allows incremental control of the deflection and straightening of the steerable region orportion106 of theaccess sheath102.
• Referring now toFIGS. 20-21, an embodiment of an actuator or actuation hand-piece520 also adapted to be in line with theaccess sheath102 is shown. The proximal end of the hand-piece520 includes a funnel-shapedentry portion522 connected within the hand-piece520 to access a workingchannel524 which forms a transition into theprimary lumen112 of theaccess sheath102.
• Tensioning device116 extending through thesecondary lumen114 is attached to a threadedcylinder526. Aknob527 surrounding thecylinder526 is correspondingly threaded to engage thecylinder526, which allows a user with a twist or turn of theknob527 in one direction, e.g., clockwise, to move thecylinder526 linearly, e.g., proximally. As a result,tensioning device116 also traverses towards the proximal end of the hand-piece520 to impart a pulling force on thesteerable portion106 thereby deflecting thesteerable portion106 of theaccess sheath102. Theknob527 is also allowed to move in the opposite direction moving the threadedcylinder526 distally to straighten thesteerable portion106 of theaccess sheath102. Therefore, the hand-piece520 provides a rotary or scroll type control of the deflection and/or straightening of thesteerable portion106 of theaccess sheath102.
• In another embodiment of the present invention,FIGS. 22-24 illustrate an actuator or actuation hand-piece530 in line with theaccess sheath102, with the hand-piece530 including a funnel-shapedentry portion531. Anaxle532 disposed within the hand-piece530 is connected to a tensioning device from theaccess sheath102 and connected to two thumb-actuated dials orwheels533 and534. In one embodiment, thewheels533 and534 are partially disposed within the hand-piece530. Thewheel533 and/orwheel534 control the tensioning device. For example, thewheel533 turned clockwise causes the tensioning device to be drawn proximally to provide tension to the tensioning device, e.g., one or more a pull or control wires. The control wire(s) being drawn proximally wraps or winds around theaxle532 in the hand-piece530.
• Thewheels533 and534 also include ratchet wheels or a number of radially extendingteeth535 connected to or integrated with thewheels533 and534. Theteeth535 operatively engage with a corresponding lever orpawl536 connected to atrigger537. Thepawl536 engaged with theteeth535 permits rotational movement of thewheels533 and534 in one direction, e.g., a clockwise direction, while preventing rotational movement in the opposite direction. As such, as thewheels533 and534 are turned clockwise, incremental control of the deflection of thesteerable portion106 of theaccess sheath102 is provided as theaxle532 in the hand-piece530 draws thetensioning device116 proximally. Thetrigger537, when actuated, pivotspawl536 causingpawl536 to disengage fromteeth535. As a result, the control wire(s) unwind or move distally from theaxle532 whereby thesteerable portion106 of theaccess sheath102 straightens.
• Referring now toFIGS. 24-25, an actuator or actuation hand-piece610 being connected yet offset from theaccess sheath102 is shown. As such, the offset hand-piece may reduce the working length used in the access sheath or added to the access sheath with the hand-piece being in line with the access sheath. Additionally, the user may operate the hand-piece proximate to the access sheath to provide a tactile or visual feedback or reminder of thesteerable portion106 of theaccess sheath102. The hand-piece610, in one embodiment, includes or is connected to aconnector611 with a funnel-shapedentry portion612 that is sized and configured to receive and guide instruments into/out of theaccess sheath102. Thesecondary lumen114 is separately connected to the hand-piece610. Throughconnector611, in one aspect of the present invention, a conduit connects thesecondary lumen114 andtensioning device116 to the hand-piece610.
• Thetensioning device116 extending through thesecondary lumen114 is attached toslider614. Alever613 connected to theslider614 allows a user to move theslider614 that imparts a pulling force on thesteerable portion106 to deflect thesteerable portion106 or a reduction in tension on thesteerable portion106 allowing thesteerable portion106 of theaccess sheath102 to straighten. Theslider614, in one aspect of the present invention, includes a plurality of teeth that operatively engage corresponding teeth along the inside of hand-piece610 to provide incremental control of the deflection and/or straightening of thesteerable portion106 of theaccess sheath102.
• FIG. 26 illustrates another embodiment of the present invention of an actuator or actuation hand-piece620 offset from theaccess sheath102. The hand-piece620 includes a funnel-shapedentry portion621 providing access to the primary lumen of theaccess sheath102. The secondary lumen and the tensioning device of theaccess sheath102 are also connected to the hand-piece620. Thetensioning device116, for example, is attached to amovable handle member622 that is pivotally connected to astationary handle member623. In one embodiment, the tensioning device is connected to a semi-circular plate or disc that rotates or pivots as the movable handle member is actuated. Manipulation of themovable handle member622 allows a user to pull or release thetensioning device116 to respectively deflect or straighten thesteerable portion106 of theaccess sheath102. In one aspect of the present invention, a ratchet mechanism disposed within the hand-piece620 or between themovable handle member622 and thestationary handle member623 is included to provide incremental control of thetensioning device116 and thus the deflection of thesteerable portion106 of theaccess sheath102.
• Referring now toFIGS. 27-28 illustrate an actuator or actuation hand-piece630 and630′ situated offset from theaccess sheath102. The actuation hand-piece630 and630′ includes a funnel-shapedentry portion631 and is connected to a tensioning device attached to an axle disposed within the hand-piece630 and630′. The axle is connected to two thumb-actuated knobs orwheels632 and633. As shown in FIGS.28A-B, thewheels632 and633 are partially disposed within the hand-piece630′. Thewheels632 and633 control thetensioning device116. For example, thewheel632 and/orwheel633 may be rotated to provide tension to thetensioning device116, e.g., a control wire, or to loosen tension in the control wire. In one embodiment, thewheel632 and633 are connected to separate and independent control wires adapted to deflect the access sheath in an opposing manner and/or to deflect different portions of the access sheath.
• In one aspect of the present invention, atrigger634, when actuated, locks thewheel632 and/orwheel633 thus preventing further movement of thetensioning device116 and the deflection/straightening of thesteerable portion106 of theaccess sheath102. Alternatively, thetrigger634 releases or disengages control of thetensioning device116 fromwheels632 or633 to allow the tensioning device to return to its original position.
• InFIGS. 29-31, one embodiment of an actuator or actuation hand-piece710 of the present invention is remotely attached to an access sheath to control the tensioning and loosening of a tensioning device connected to the access sheath. As such, the actuator may be placed away from the surgical site or operating path or area so that the hand-piece does not prevent or interfere with the insertion of instruments along the working length of the access sheath. Additionally, the remote actuator does not occupy or add additional working space or length to the access sheath. Furthermore, another user may operate the actuator remotely allowing another user to focus on the surgical procedure, e.g., manipulating instruments to be or already inserted in the access sheath. Extended surgery time and confusion caused by switching between the actuator and other devices or simultaneously using the many devices may be reduced.
• Theactuator710, in one embodiment, is connected to a flexible body orconduit711, which is connected to theaccess sheath102 via a Y-connector712. The Y-connector712 includes a funnel-shapedentry portion713 that is sized and arranged to guide instruments into theprimary lumen112 of theaccess sheath102. The Y-connector712 also includes achannel714 for connecting to theflexible conduit711. Thetensioning device116 extends through thesecondary lumen114,channel714, andflexible conduit711 and is attached to anaxle715 disposed within theactuator710. Theaxle715 is connected to a dial orknob716 that partially extends laterally from the hand-piece710 with finger holds disposed radially throughout theknob716. The other end of theaxle715 is rotatably connected to the hand-piece710.
• Theknob716 allows a user to control thetensioning device116. For example, when rotated in one direction, e.g., clockwise, thetensioning device116 is drawn proximally to wrap or wind around theaxle715. A plurality ofteeth717 radially disposed on theknob716 within the hand-piece710 or disposed on a separate or embedded ratchet wheel operatively engages with a corresponding lever orpawl718. Thepawl718 pivoting about a post connected to the hand-piece710 and biased by aleaf spring719 engages with the teeth to permit rotational movement of theknob716 in one direction, e.g., clockwise, while preventing rotational movement in the opposite direction. As such, as theknob716 is rotated, incremental control of the deflection of thesteerable portion106 of theaccess sheath102 is provided as the axle in the hand-piece710 draws thetensioning device116 proximally. Atrigger720 when actuated pivots thepawl718 to disengage thepawl718 from theteeth717. As a result, thetensioning device116 is allowed to unwind or move distally from theaxle715. Thus, thesteerable portion106 of theaccess sheath102 straightens.
• Referring now toFIGS. 32-34, another embodiment of an actuator or actuation hand-piece730 of the present invention remotely attached to anaccess sheath102 is shown. Anaxle731 disposed within the hand-piece730 is attached to thetensioning device116. Theaxle731 is also connected to a rotatable key orwinged lever732 extending laterally from one side of hand-piece730.
• Thelever732 allows a user to control thetensioning device116. For instance, when rotated in one direction, e.g., clockwise, thetensioning device116 is drawn proximally to wrap or wind around theaxle731 in the hand-piece730. A plurality ofteeth733 radially disposed around theaxle731 or disposed on a ratchet wheel surrounding the axle operatively engages with a corresponding pawl orcantilever arm734. Thearm734 mounted on the hand-piece730 and engaged with theteeth733 permit rotational movement of thelever732 andaxle731 in one direction while preventing rotational movement in the opposite direction. This engagement provides incremental control of thetensioning device116 and thus also of thesteerable portion106 of theaccess sheath102.
• The hand-piece730 also includes atrigger lever735 that is pivotally connected to a post in the hand-piece730 and partially extends through a slot in the hand-piece730. Thelever735 when actuated, e.g., pulled proximally, moves thecantilever arm734 to disengage from theteeth733 to allow theaxle731 to freely rotate. Therefore, thetensioning device116 connected to theaxle731 unwinds and/or moves distally from theaxle731 causing thesteerable portion106 of theaccess sheath102 to straighten.
• InFIGS. 35-38, another embodiment of an actuator or actuation hand-piece740 of the present invention that is remotely attached to anaccess sheath102 to control the tensioning and loosening of thetensioning device116 is shown. Disposed within the hand-piece740 is anaxle741, which is attached totensioning device116. Theaxle741 is connected to a slottedwheel742 that is partially rotatable within the hand-piece740. Generally opposingslots743 and744 are disposed in the slotted wheel through which respective dowels orpins745 and746 extend through and connect to distal ends ofrespective button arms747 and748. Proximal ends ofbutton arms747 and748 extend through openings in the hand-piece740.
• Operationally, when thebutton arm748 is lowered, thebutton arm747 rises as the slottedwheel742 rotates clockwise. As a result, thetensioning device116 connected toaxle741 is not drawn to the hand-piece740, such that thesteerable portion106 of theaccess sheath102 is substantially straight. Whenbutton arm747 is lowered, thebutton arm748 rises and the slottedwheel742 rotates causing thetensioning device116 to be pulled by rotatingaxle741 such that thesteerable portion106 ofaccess sheath102 deflects. In one aspect of the present invention, the hand-piece740 includesguides749 for aligning and guiding traversal of thebutton arms747 and748 and slots (not shown) for assisting linear movement of thepins745 and746 as the button arms move. The slottedwheel742 also includes one or more openings along the circumference of the wheel to permit rotation of the wheel without interfering with theguides749. In another aspect of the present invention, theaxle741 is connected to a screw knob for adjusting the tension or pre-winding thetensioning device116 around theaxle741.
• Referring now toFIG. 39, another embodiment of a remotely attached actuator or actuation hand-piece750 is shown. In one aspect of the present invention, the hand-piece750 fits within a user's hand in that a fist closing motion moves a t-bar753 proximally deflecting theaccess sheath102 and an opening motion moves the t-bar753 distally allowing theaccess sheath102 to straighten. For example, the hand-piece750 includes finger-extension members754 to provide one or more fingers on eachmember754 to grasp the t-bar753. A distally flaredend756 of atube751 is also provided for resting in the palm of a hand.
• Extending through a distal end of thetube751 is thetensioning device116 that attaches to plate752 within thetube751. Theplate752 is connected to the t-bar753 that is slidably connected totube751. In one embodiment, an adjustment screw is connected to the t-bar753 to adjust the location of theplate752 relative to the t-bar753 and within thetube751. A set ofteeth755 withintube751 operatively engages with a tooth or detent on t-bar753 as the t-bar753 moves.
• With the t-bar753 moving proximally,plate751 also moves proximally thereby pullingtensioning device116 to cause thesteerable portion106 of theaccess sheath102 to deflect. Similarly, as the t-bar753 andplate751 moves distally, thetensioning device116 loosens and thus thesteerable portion106 straightens. As such, this engagement provides incremental control of the deflection and/or straightening of thesteerable portion106 of theaccess sheath102. A spring-loadedbutton757 on one end of the t-bar753, when actuated, disengages the tooth on t-bar753 from theteeth755 withintube751 allowing the t-bar753 to move freely.
• FIGS. 40-41 illustrate another embodiment of the present invention of an actuator or actuation hand-piece760 and760′ each remotely attachable to theaccess sheath102. The hand-piece760 and760′ are connected to a flexible body ortube761 through which thetensioning device116 extends. Thetensioning device116 is attached to afirst handle member762 that is pivotally connected to asecond handle member763. Actuation of thefirst handle member762 allows a user to pull or release thetensioning device116 to respectively deflect or straighten thesteerable portion106 of theaccess sheath102. In one aspect of the present invention, a ratchet assembly is included to provide incremental control of thetensioning device116 and thus the deflection of thesteerable portion106 of theaccess sheath102.
• It is appreciated that the access sheath may comprise a plurality of pull wires attached to a plurality of thumbwheels, axles, knobs or other types of movable components of an actuation hand-piece to deflect the steerable portion of the sheath in different directions. Also, it is appreciated that the tensioning device may be hydraulic, pneumatic or electronic in nature and the actuation hand-piece may instead be foot, finger or otherwise sensor actuated and may include corresponding foot, finger or otherwise sensor extensions.
• In various embodiments, for example, the embodiments previously described and/or the embodiment of an actuation hand-piece810 shown in FIGS.42A-B, thetensioning device116 is connected to abelt811. Thebelt811 acts as an intermediary between thetensioning device116 and amovable component818 in the hand-piece810. The movable component may also be, for example,slider514 or614 (FIGS. 18B and 24), cylinder526 (FIG. 20), movable handle member622 (FIG. 26),axle715 or731 (FIGS. 31 and 32), and various other movable components fully or partially disposed within or otherwise part of an actuator or hand-piece which is connectable to thetensioning device116. Throughbelt811, stress or forces that may be applied by or result from themovable component818 is displaced from thetensioning device116. Therefore, stress experienced by thetensioning device116 caused by the actuation of the hand-piece may be reduced.
• Thebelt811 includes a number of apertures812 for engagingteeth813 radially disposed on themovable component818 of the hand-piece810. In one embodiment, thebelt811 includes teeth or protrusions for engaging corresponding apertures, teeth or protrusions of themovable component818. With either engagement, incremental control of thetensioning device116 is provided. As such, thebelt811 draws thetensioning device116 proximally as the knob is rotated in one direction and rotating the knob in the opposite direction, allows the tensioning device to withdraw from the hand-piece810.
• A pin orroller814 may also be included to assist in the engagement of thebelt811 with amovable component818 of the hand-piece810. In one aspect of the present invention, thebelt811 is pliable. In another embodiment, a plate, bar, or a less flexible component may be connected to thebelt811 for drawing or releasing thebelt811 in conjunction with or without themovable component818.
• Au-shaped lever815 is connected to aknob816 that is disposed on one or both sides of the hand-piece810 and is connected to themovable component818 in the hand-piece810. Through actuation of theu-shaped lever815, a user can control the movement/tension of thetensioning device116 and thus the deflection and straightening of thesteerable portion106 of theaccess sheath102. In one embodiment, a plate is connected to theu-shaped lever815 and thebelt811 to draw and release thetensioning device116.
• In one aspect of the present invention, atrigger817, when actuated, locks thebelt811, themovable component818 or theu-shaped lever815, thus preventing further movement of thetensioning device116 and the deflection/straightening of thesteerable portion106 of theaccess sheath102. Alternatively, thetrigger817 releases or disengages control of thetensioning device116 from thebelt811, themovable component818 or theu-shaped lever815 to allow thetensioning device116 to return to its original position or state.
• Referring now toFIGS. 43-46, embodiments of an access sheath in various stages of fabrication is shown. Awire801 is wound around a support member ormandrel802 in which the size and shape of mandrel generally defines the size and shape ofprimary lumen112 of theaccess sheath102. The mandrel, in one embodiment, is stainless steel and made of or is coated with a low friction material or surface, e.g., Teflon or various mold releases, allowing for the mandrel to be easily removed from theaccess sheath102. Thewire801 is wound in an over counter fashion by using anchors or starting and stopping points substantially orthogonal of each other and thus winding thewire801 in an oblique line alongmandrel802. As such, thewire801 is wound such that the wire's tendency to unwind is counteracted. In one embodiment, prior to the addition of thewire801, themandrel802 is coated with or inserted into a plastic or PVC material tube to allow instruments and the like to be smoothly inserted into the primary lumen without interference from thewire801.
• Thewire801, in one embodiment, is a plastic coated wire and particularly, a stainless steel co-extruded wire with an approximate diameter of 0.006 inches fused, coated or otherwise included with a plastic material to make the total diameter of thewire801 to be about 0.012 inches. Themandrel802 includingwire801 is placed into or inserted into a control tube. Air, in one embodiment, is supplied, e.g., at 100 PSI, on the opposite end of insertion to assist insertion of themandrel802 by expanding the control tube. The control tube, in one embodiment, may be made of silicon or a material with a higher melting point than the plastic coating ofwire801. This assembly is then heated such that the plastic coating ofwire801 melts and adheres to itself to form a generally continuous tubular structure ormajor tube803. The control tube is then removed.
• Aminor tube804 is placed on or included with themajor tube803. Theminor tube804 is longer than themajor tube803 and thus extends substantially further along themandrel802 than themajor tube803. Extending within a portion of theminor tube804 is a generally tubular structure orinner tube805 that is about as long as themajor tube803. In one embodiment, theinner tube805 is made of polyimide and theminor tube804 is made of carbothane that when heated adheres to theinner tube805, themajor tube803 and other portions of the access sheath, which are described below, that surrounds the outer periphery of theminor tube804.
• Theinner tube805 within theminor tube804 is adapted to receive thesupport wire806. The size and shape of thesupport wire806 along with theinner tube805 generally defines the size and shape of thesecondary lumen114 of theaccess sheath102. In one embodiment, the support wire is a stainless steel wire with a diameter of about 0.12 inches. Thesupport wire806 is secured to a proximal end of themandrel802, threaded through theinner tube805 and theminor tube804 and secured to the distal end of themandrel802. In one embodiment, thesupport wire806 secures theminor tube804 to themajor tube803.
• Theminor tube804 extends along themandrel802 substantially more than theinner tube805. In other words, the length of theminor tube804 is longer than theinner tube805. Theminor tube804 is also more flexible than theinner tube805. As such, the portion from the end point of theinner tube805 and/or themajor tube803 to near the end point of theminor tube804 eventually defines thesteerable portion106 of theaccess sheath102. In one embodiment, theminor tube804 is shorter and less flexible than theinner tube805. Thus, in this embodiment, the portion from the end point of theminor tube804 and/or themajor tube803 to near the end point of theinner tube805 eventually defines thesteerable portion106 of theaccess sheath102.
• In one embodiment, theminor tube804,inner tube805 and themajor tube803 are placed into a final tube to enclose theminor tube804 andinner tube805 between themajor tube803 and the final tube. This assembly is placed into or inserted into a control tube such that the assembly adheres or bonds together and then the control tube is removed.
• In one embodiment, theminor tube804 or theinner tube805, whichever extends further, is rigid, e.g., a stainless steel tube, to assist in the deflection of thesteerable region106. As such, the rigidity of theminor tube804 orinner tube804 prevents the non-steerable portion of theaccess sheath102 from bowing. As such, the tube shifts the force caused by thetensioning device116 to deflect the steerable region directly towards or at thesteerable region106. Also, a rigid secondary lumen formed by the rigid tube may assist in the protection of the tensioning device and instruments inserted or withdrawn from the primary lumen.
• Awire807 is wound around theminor tube804, theinner tube805 and themajor tube803. In one embodiment, where the final tube is utilized, thewire807 is also wound around the final tube. In one embodiment, thewire807 is similar in construction or composition as that ofwire801 and/or extends slightly beyond the distal end of theminor tube804 orinner tube805.
• A support tip, in one embodiment, is placed on a distal end or slightly beyond the distal end of thewire807 to assist in securing thewire807 around theminor tube804 orinner tube805 and/or to provide an atraumatic tip. The support tip may be a 75 Shore D material. Themandrel802 with rest of the assembly is inserted into a control tube. As previously mentioned, air, in one embodiment, is supplied on the opposite end of insertion to assist insertion of themandrel802 by expanding the control tube. In one aspect, a support tube is used to temporarily encompass the control tube when the tube is pressurized in the event the tube breaks down. The control tube with the assembly is heated such that the plastic coating ofwire807 melts and adheres to itself to form a generally continuous tubular structure ortube808. The control tube is then removed. In one embodiment, the control tube and assembly are heated at around 165 degrees plus or minus about five to ten degrees for about ten to fifteen minutes. As such, anaccess sheath102 with a variable flexibility is created.
• Thesupport wire806 is disconnected from themandrel802. For example, thesupport wire806 on the distal end of themandrel802 is cut and then themandrel802 is withdrawn from theaccess sheath803. At or near the tip of the access sheath, a tensioning device, e.g., a pull wire, is attached and threaded to theminor tube804 andinner tube805 out the proximal end of theaccess sheath102 for securing to an actuator. As such, the access sheath is deflectable and controllable.
• In one embodiment, the tensioning device is knotted or looped around an opening or cut in the access sheath, the support tip and/or between loops in thewire807 and back through itself. A catch wire threaded through theinner tube805 and theminor tube804 hooks or otherwise attaches to the tensioning device. The catch wire is removed out the proximal end of the access sheath thereby threading the tensioning device through and out the proximal end of theaccess sheath102. As it is appreciated thesupport wire806 has a diameter sufficiently larger than the diameter of the tensioning device, the catch wire or loops and hooks of the catch wire to permit easy passage of these devices through the secondary lumen of theaccess sheath102. A secondary support tip, in one embodiment, is placed on the distal end of theaccess sheath102 to assist in securing the tensioning device to the access sheath and/or to provide an atraumatic tip.
• As shown in FIGS.46A-C, thedistal end809aof theaccess sheath102 is tapered and thus has a smaller diameter than theproximal end809bof theaccess sheath803. Theprimary lumen112 andsecondary lumen114 diameters, however, remain substantially constant throughout theaccess sheath102. Additionally, the tapering or reduced diameter of the access sheath is a result of the halting or non-extension of theinner tube805 orminor tube804, in one embodiment, and themajor tube803 along the length of themandrel802. As a result, thesteerable portion106 includes a reduced amount of materials and more flexible materials, and thus the steerable portion is easily deflected, bent, shaped or curved in response to the manipulation of the attached tensioning device while the other portion of theaccess sheath102, including more material and less flexible material, remains substantially fixed, e.g., straight and substantially in the same plane, preventing any inadvertent or unintended movement of the access sheath.
• Additionally, since thesteerable region106 of theaccess sheath102 is reinforced bywire807, thesteerable region106 is strengthen such that a flexible, pre-bendable or otherwise not actively controllable instrument may be controllably deflected dynamically as thesteerable region106 is controlled. Additionally, an actively deflectable surgical instrument may have a complicated construction providing components, e.g., optics or clamps, to perform its surgical function and components to perform the active deflection. Therefore, such instruments may be fragile or if broken may be expensive to replace or repair or still usable as a surgical instrument but not actively deflectable. As such, the strengthensteerable region106 may replace the components or use of the components in such surgical instruments or induce an broken instrument to be controllably deflected thereby reducing replacement, repair and/or construction costs, reducing wear and tear of such instruments and increasing the life of such instruments. Also, the reinforcedaccess sheath102 throughwire807 and/orwire801 allows the size and shape of the primary lumen to remain substantially constant throughout theaccess sheath102, thereby reducing forces on instruments placed within the access sheath which may extend the life of these instruments.
• The forces or stress accumulated along the access sheath that may cause kinks in the access sheath are also distributed along the access sheath due to the composite construction of the access sheath described above and are further counteracted by the wire coils, e.g.,wire807 and803. Thus, kinks in the access sheath are reduced. The wire coils also allow the access sheath walls to be very thin without reducing durability or strength in the access sheath. Thus, the overall or outer diameter of the access sheath may be small, which may also reduce the incision or insertion point for the access sheath, without reducing the size or diameter of the primary lumen. As such, the access sheath of various embodiments of the present invention has thin walled portions, a large lumen, an atraumatic end, and a kink resistant construction and is strong, stiff and yet flexible enough to be intricately guided through the body cavity or tissue. In one embodiment, the wire coils are wound in a multifilar fashion with materials having alternating durometers.
• Various other examples of processes that may be used to manufacture theaccess sheath102 or portions of theaccess sheath102 are described in U.S. patent application Ser. Nos. 10/766,138 and 10/298,116, the disclosures of which are hereby incorporated by reference. It is appreciated that these processes or portions of the processes may be varied or combined with the previously described process and vice versa. For example, various ring-shaped elements, such as, plastic rings, metallic rings, un-reinforced plastic rings and metal reinforced plastic rings, and the like may be utilized instead of or in addition to thewires803 and/or807. Additionally, a separate mandrel may be utilized to separately form or define the primary and secondary lumens and combined to make the access sheath.
• In one embodiment of the present invention, various embodiments of access sheaths and actuators previously described, here now referred to as the access sheath, combined with an instrument or device used to stretch or enlarge an opening, e.g., a dilator, allows for gradual and atraumatic dilation of the ureter while being placed. Once the access sheath has been placed at a desired location, the dilator is removed and the access sheath is left in place. The access sheath allows for continued access to the desired area, for example, for the placement of an ureteroscope and other therapeutic instruments, while providing protection of the ureter. For instance, the access sheath may protect the ureter during the placement and removal of devices within the access sheath, during the removal of stone fragments or other tissue, and during the removal of a potentially cancerous biopsy specimen.
• Additionally, with the access sheath being deflectable or steerable, an urologist may effectively and efficiently locate stones and stone fragments within the kidney. When a stone burden is found in one of the calyces of the kidney, especially in the lower pole portion of the kidney; it may be difficult for the urologist to continue to go back to the same calyx or location to remove the burden.
• When there are many fragments within a calyx, many entries and exits may be performed to remove the burden. Also, when a stone or stone fragment is removed, the instruments and tissue, e.g., the scope and stone basket (with the stone or stone fragment) are removed as a single unit. The scope is then passed back through the sheath and manipulated to find the same calyx in order to remove the remaining burden. However, with theaccess sheath102, the access sheath can be left deflected in place looking at the same calyx or location, while the scope and stone basket are removed. As a result, the urologist's procedure time may be reduced, as the urologist may not have to manipulate the ureteroscope to look for the same calyx each time. The amount of time saved may be significant, especially if there is a large stone burden within the kidney. Additionally, the likelihood of doing damage to the kidney due to the additional manipulation that takes place every time the ureteroscope is placed back into the kidney may be reduced. Thus, with the access sheath, one can keep the sheath deflected towards a particular calyx and remove the stone burden without having to find the calyx each and every time a fragment is removed.
• When the urologist manipulates an ureteroscope, the urologist may sometimes use the inside walls of the kidney to help deflect the ureteroscope to enter into a particular difficult locale. With theaccess sheath102, instead of using the inside wall to help deflect the ureteroscope the access sheath may be used. Also, as previously mentioned, this will also help reduce the “wear and tear” on surgical instruments, such as ureteroscopes. The deflecting mechanism with the ureteroscope, if provided, can be damaged often and expensive repair. The use of the access sheath may reduce the damage to the ureteroscope when it is used to help manipulate the ureteroscope to desired locations within the kidney.
• The use of theaccess sheath102 may also help a lesser-experienced urologist perform the same difficult procedure as their more experienced colleagues. In performing this procedure, the urologist may access the lower pole of the kidney in order to remove a stone burden. By performing this procedure in a retrograde fashion, one can reduce a patient's recovery time. If an urologist were neither skilled nor comfortable with using an ureteroscope in a retrograde fashion to remove a stone burden from a kidney's lower pole, the urologist would typically approach the stone burden in an antegrade fashion. This places a sheath percutaneously and thus may add additional recovery time for a patient as well as potentially increasing morbidity. But, with theaccess sheath102 and an ureteroscope, an urologist may efficiently and effectively locate and remove a stone burden within the lower pole of a kidney. The access sheath can also be used in an antegrade fashion and will provide the same or similar features described above, however access in this manner may not be the preferred method.
• Accordingly, the present invention provides a steerable kink resistant access device. Although this invention has been described in certain specific embodiments, many additional modifications and variations would be apparent to those skilled in the art. It is therefore to be understood that this invention may be practiced otherwise than specifically described, including various changes in the size, shape and materials, without departing from the scope and spirit of the present invention. Thus, embodiments of the present invention should be considered in all respects as illustrative and not restrictive, the scope of the present invention to be determined by the appended claims and their equivalents rather than the foregoing description.

Claims (59)

1. A surgical access device comprising:

an elongated body having a proximal end, a distal end, and a steerable region, the body including a primary lumen and a secondary lumen both extending through the body, the secondary lumen having a tensioning device extending through the secondary lumen and connected to the steerable region of the elongated body; and

an actuator connected to the tensioning device distally from the proximal end of the elongated body to control tension of the tensioning device.

2. The surgical access device ofclaim 1 further comprising a flexible body connected to the proximal end of the elongated body with the tensioning device extending through the flexible body and wherein the actuator is connected to the flexible body.

3. The access device ofclaim 1 wherein the tensioning device is at least one pull wire.

4. The access device ofclaim 1 wherein the tensioning device is a flexible flatten member.

5. The access device ofclaim 1 further comprises an enlarged entry at the proximal end of the body and adapted to receive one of a dilator and an ureteroscope.

6. The access device ofclaim 5 wherein the enlarged entry is funnel-shaped.

7. The access device ofclaim 1 wherein the secondary lumen has a diameter smaller than a diameter of the primary lumen.

8. The access device ofclaim 1 wherein the actuator further comprises one of a thumbwheel, a knob, a lever, a button, a handle, a t-bar, and a dial.

9. The access device ofclaim 8 wherein the actuator further comprises a hand engaging extension.

10. The access device ofclaim 9 wherein the actuator further comprises a directional indicator.

11. The access device ofclaim 1 wherein the actuator further comprises means for incrementally controlling tension of the tensioning device.

12. The access device ofclaim 1 wherein the actuator further comprises a movable component disposed within the actuator and connected to the tensioning device.

13. The access device ofclaim 12 wherein the actuator comprises:

a plurality of teeth connected to the movable component; and

a pawl operatively engaged with the first set of teeth.

14. The access device ofclaim 13 wherein the actuator further comprises an extension member connected between the tensioning device and the movable component.

15. The access device ofclaim 14 wherein the extension member operatively engages the plurality of teeth.

16. The access device ofclaim 12 wherein the actuator comprises:

a first set of teeth connected to the movable component;

a second set of teeth operatively engaged with the first set of teeth;

a pawl operatively engaged with the first set of teeth; and

a trigger extending from the actuator and operatively engaged with the pawl.

17. The access device ofclaim 1 wherein the actuator in a first position pulls the tensioning device and in a second position releases the tensioning device.

18. The access device ofclaim 1 further comprising a spring fixed within the secondary lumen and wherein the tensioning device extends through the spring.

19. The access device ofclaim 1 wherein the body further comprises at least one other secondary lumen disposed around the primary lumen.

20. The access device ofclaim 1 wherein the body comprises an inner plastic body, a spring coil and an outer plastic body.

21. The access device ofclaim 20 wherein the inner plastic body is surrounded by the spring coil and covered by the outer plastic body.

22. The access device ofclaim 1 wherein the steerable region includes a weakened portion extending along the steerable region.

23. The access device ofclaim 1 wherein the steerable region includes slots extending along the steerable region and slits extending along the steerable region on a generally opposing side of the slots, the slots being larger than the slits.

24. The access device ofclaim 1 wherein the steerable region includes means for increasing elasticity of the steerable region.

25. The access device ofclaim 1 wherein the tube is adapted to operate in a kidney.

26. The access device ofclaim 1 wherein the steerable region has a length adapted to use in a calyx.

27. A surgical access device comprising:

a tube having a proximal end, a distal end, a steerable region, and an enlarged entry, the tube including a primary lumen and a secondary lumen both extending through the tube; and

means for deflecting the steerable region of the tube.

28. The access device ofclaim 27 wherein the means for deflecting the steerable region of the tube is situated remotely from the tube.

29. The access device ofclaim 27 wherein the means for deflecting the steerable region of the tube is situated offset from the tube.

30. The access device ofclaim 27 wherein the means for deflecting the steerable region further comprises means for transmitting tension extending through the secondary lumen and connected to the steerable region of the tube.

31. The access device ofclaim 30 wherein the means for deflecting the steerable region further comprises means for actuating connected to the means for transmitting tension.

32. The access device ofclaim 31 further comprises a flexible tubing connecting the means for actuating to the proximal end of the tube.

33. The access device ofclaim 31 further comprises means for incrementally controlling the means for transmitting tension and coupled to the means for actuating.

34. The access device ofclaim 27 wherein the tube further comprises means for assisting deflection of the tube.

35. The access device ofclaim 27 wherein the tube further comprises means for increasing elasticity of the tube.

36. The access device ofclaim 27 wherein the tube is adapted to operate in a kidney.

37. The access device ofclaim 27 wherein the means for deflecting is adapted to operate in a calyx.

38. A surgical access device comprising:

a tube having a substantially rigid portion having a first diameter and a substantially flexible portion having a second diameter and extending from the substantially rigid portion, the first diameter being smaller than the second diameter, the tube including a primary lumen and a secondary lumen both extending through the tube, the secondary lumen having a pull wire extending through the secondary lumen and connected to the flexible portion of the elongated body;

a connector having a distal end connected to the tube and a proximal end including a funnel-shaped portion, the pull wire extending through the connector from the distal end to the proximal end;

a plastic tubing connected to the connector through which the pull wire extends through; and

a handle connected to the plastic tubing and including an axle disposed within the handle and a knob connected to and outside the handle, the axle connected to the pull wire and the knob.

39. The access device ofclaim 38 further comprises:

a pawl connected to the handle;

a trigger connected to the handle and the pawl; and

a first set of teeth connected to the axle and operatively engaging with the pawl;

wherein the trigger when actuated causes the pawl to move to disengage the pawl from the first set of teeth.

40. The access device ofclaim 39 further comprising an extension member connected between the axle and the pull wire and having a second set of teeth and operatively engaging the first set of teeth.

41. A method of using a surgical access device with a dilator, the access device comprising an elongated body having a proximal end, a distal end, and a steerable region, the body including a primary lumen and a secondary lumen both extending through the body, the secondary lumen having a tensioning device extending through the secondary lumen and connected to the steerable region of the elongated body, and an actuator connected to the tensioning device distally from the proximal end of the elongated body to control tension of the tensioning device, the method comprising:

inserting the dilator through the primary lumen of the access device;

removing the dilator from the access device after the access device is inserted into the patient; and

manipulating the actuator to a first position to deflect the steerable region to form an arc.

42. The method ofclaim 41 further comprising:

placing the actuator out of a surgical site; and

inserting a surgical instrument into the access device.

43. The method ofclaim 41 further comprising incrementally controlling the deflection of the steerable region.

44. The method ofclaim 41 further comprising:

inserting an ureteroscope into the body;

inserting the body into the kidney; and

manipulating the actuator to a position to deflect the steerable region into a calyx.

45. The method ofclaim 44 further comprising removing the ureteroscope while the steerable region remains deflected in a position substantially identical to a position prior to removal of the ureteroscope.

46. A method of manufacturing an access device, the method comprising:

wrapping a first wire around a mandrel;

resting a first tube on the first wire, the first tube extending further in length than the first wire along the mandrel;

inserting the mandrel through a second tube; and

heating the second tube, the mandrel, the first wire and the first tube.

47. The method ofclaim 46 further comprises wrapping a second wire around the first tube, first wire and mandrel.

48. The method ofclaim 46 further comprises coating the mandrel with a plastic material.

49. The method ofclaim 46 further comprises fusing a tip around the distal end of the second wire.

50. The method ofclaim 46 further comprises attaching a pull wire to a distal end of the second wire.

51. The method ofclaim 50 wherein the second tube comprises of silicon.

52. The method ofclaim 46 further comprising assembling a plurality of ring-shaped members around the first wire and the first tube.

53. The method ofclaim 52 wherein the plurality of ring-shaped members include at least one of plastic rings, metallic rings, un-reinforced plastic rings and metal reinforced plastic rings assembled along the first tube.

54. The method ofclaim 46 wherein the first tube comprises a semi-rigid tube extending partially through the first tube.

55. The method ofclaim 54 wherein the first tube is more flexible than the semi-rigid tube.

56. A method of manufacturing an access device, the method comprising:

assembling a plurality of first ring-shaped members around a mandrel;

resting a first tube on the first connecting member;

inserting the mandrel through a second tube; and

heating the second tube, the mandrel, the first connecting member and the first tube.

57. The method ofclaim 56 further comprising wrapping a wire around the first ring-shaped members and the first tube.

58. The method ofclaim 56 further comprising assembling a plurality of second ring-shaped members around the first ring-shaped members and the first tube.

59. The method ofclaim 58 wherein the plurality of first and second ring-shaped members include at least one of plastic rings, metallic rings, un-reinforced plastic rings and metal reinforced plastic rings assembled along the first tube.

Images