US20080146872A1 - Mechanical distension systems for performing a medical procedure in a remote space - Google Patents

Mechanical distension systems for performing a medical procedure in a remote space Download PDF

Info

Publication number
US20080146872A1
US20080146872A1 US11/923,357 US92335707A US2008146872A1 US 20080146872 A1 US20080146872 A1 US 20080146872A1 US 92335707 A US92335707 A US 92335707A US 2008146872 A1 US2008146872 A1 US 2008146872A1
Authority
US
United States
Prior art keywords
uterus
fluid
introducer
lumen
channel
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US11/923,357
Inventor
William H. Gruber
Ronald D. Adams
David L. Foshee
Theodore J. Mosler
Douglas R. Drew
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Gen Probe Inc
Cytyc Corp
Third Wave Technologies Inc
Hologic Inc
Suros Surgical Systems Inc
Biolucent LLC
Cytyc Surgical Products LLC
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to US11/923,357 priority Critical patent/US20080146872A1/en
Priority to EP07864004A priority patent/EP2089091A4/en
Priority to PCT/US2007/083833 priority patent/WO2008058157A2/en
Assigned to INTERLACE MEDICAL, INC. reassignment INTERLACE MEDICAL, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: DREW, DOUGLAS R., FOSHEE, DAVID L., MOSLER, THEODORE J., ADAMS, RONALD D., GRUBER, WILLIAM H.
Publication of US20080146872A1 publication Critical patent/US20080146872A1/en
Assigned to HOLOGIC, INC. reassignment HOLOGIC, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: INTERLACE MEDICAL, INC.
Assigned to GOLDMAN SACHS BANK USA reassignment GOLDMAN SACHS BANK USA SECURITY AGREEMENT Assignors: BIOLUCENT, LLC, CYTYC CORPORATION, CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, GEN-PROBE INCORPORATED, HOLOGIC, INC., SUROS SURGICAL SYSTEMS, INC., THIRD WAVE TECHNOLOGIES, INC.
Assigned to GEN-PROBE INCORPORATED, CYTYC CORPORATION, HOLOGIC, INC., THIRD WAVE TECHNOLOGIES, INC., BIOLUCENT, LLC, CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, SUROS SURGICAL SYSTEMS, INC. reassignment GEN-PROBE INCORPORATED SECURITY INTEREST RELEASE REEL/FRAME 028810/0745 Assignors: GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT
Assigned to GOLDMAN SACHS BANK USA reassignment GOLDMAN SACHS BANK USA CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 028810 FRAME: 0745. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY AGREEMENT. Assignors: BIOLUCENT, LLC, CYTYC CORPORATION, CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, GEN-PROBE INCORPORATED, HOLOGIC, INC., SUROS SURGICAL SYSTEMS, INC., THIRD WAVE TECHNOLOGIES, INC.
Assigned to GEN-PROBE INCORPORATED, CYTYC CORPORATION, HOLOGIC, INC., THIRD WAVE TECHNOLOGIES, INC., SUROS SURGICAL SYSTEMS, INC., BIOLUCENT, LLC, CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP reassignment GEN-PROBE INCORPORATED CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE. Assignors: GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT
Abandoned legal-status Critical Current

Links

Images

Classifications

    • 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
    • A61B1/303Instruments 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 the vagina, i.e. vaginoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0218Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42Gynaecological or obstetrical instruments or methods
    • 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
    • A61M25/0021Catheters; Hollow probes characterised by the form of the tubing
    • A61M25/0023Catheters; Hollow probes characterised by the form of the tubing by the form of the lumen, e.g. cross-section, variable diameter
    • 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
    • A61M25/0097Catheters; Hollow probes characterised by the hub
    • 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
    • A61B1/00131Accessories for endoscopes
    • A61B1/00135Oversleeves mounted on the endoscope prior to insertion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831Material properties
    • A61B2017/00867Material properties shape memory effect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A61B2017/22065Functions of balloons
    • A61B2017/22069Immobilising; Stabilising
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/3205Excision instruments
    • A61B17/3207Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A61B2017/320775Morcellators, impeller or propeller like means
    • 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
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/42Gynaecological or obstetrical instruments or methods
    • A61B2017/4216Operations on uterus, e.g. endometrium
    • 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
    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361Image-producing devices, e.g. surgical cameras
    • A61B2090/3614Image-producing devices, e.g. surgical cameras using optical fibre

Definitions

  • the present invention relates generally to methods and systems for performing medical procedures and relates more particularly to a new method and system for performing a medical procedure.
  • Such a procedure may be diagnostic and/or therapeutic in nature.
  • a procedure may be diagnostic and/or therapeutic in nature.
  • the uterus is a pear-shaped organ made up two distinct anatomical regions: the cervix and the corpus.
  • the cervix is a narrow cylindrical passage (about 1.5-4.0 mm in diameter) which connects at its lower end with the vagina.
  • the corpus which is the portion of the uterus that grows during pregnancy to carry a fetus, is shaped to include two portions: the lower uterine segment and the fundus.
  • the cervix widens at its upper end to form the lower uterine segment of the corpus.
  • the lower uterine segment in turn, widens at its upper end into the fundus of the corpus.
  • the length of the uterus measured from the cervix to the fundus, is approximately 8-10 cm, and the maximum width of the uterus, which is near the fundus, is about 4-5 cm.
  • Extending from the fundus of the uterus on either side are fallopian tubes.
  • the fallopian tubes are continuous with the uterine cavity and allow the passage of an egg from an ovary to the uterus where the egg may implant if fertilized.
  • the conventional technique for creating such a working space within the uterus is to administer a fluid to the uterus, transcervically, under sufficient pressure to cause the uterus to become distended.
  • the fluid used conventionally to distend the uterus include gases like carbon dioxide and liquids like water or certain aqueous solutions (e.g., a saline solution or a sugar-based aqueous solution).
  • a hysteroscope a visualization device that is inserted transcervically into the uterus. If fibroids (i.e., benign tumors), polyps or other abnormalities are detected, such abnormalities may be removed, for example, by resection.
  • Certain devices include the combination of visualization means, such as a hysteroscope, and resection means, such as a morcellator. Examples of such devices are disclosed in U.S. Pat. No. 6,032,673, inventor Savage et al., issued Mar. 7, 2000; U.S. Pat. No. 5,730,752, inventors Alden et al., issued Mar. 24, 1998; and PCT International Publication Number WO 99/11184, published Mar. 11, 1999.
  • the above-described technique of fluid distension suffers from additional shortcomings. For example, throughout the entire period of time that the diagnostic and/or therapeutic procedure is performed, the distension fluid must be continuously administered under pressure to the patient to keep the uterus distended. This requires the availability of an adequate supply of the distending fluid. In addition, suitable equipment must be available to provide the requisite continuous flow of distending fluid to the patient. Furthermore, the above-described fluid distension technique may become messy, particularly when a liquid is used as the distension fluid, as some of the distension fluid within the uterus may escape proper collection and, instead, may leak from the patient to the surrounding environment.
  • the present invention provides a method and system as described below that may be used, for example, in the examination and/or treatment of the uterus.
  • a system for use in performing a medical procedure comprising: an introducer for providing access to an internal site within a body; a mechanical expansion structure, the mechanical expansion structure being deliverable to the internal site using the introducer; a visualization device, the visualization device being deliverable to the internal site using the introducer; and a tissue modifying device, the tissue modifying device being deliverable to the internal site using the introducer.
  • a method of performing a medical procedure comprising the steps of using a mechanical expansion structure to distend a uterus or to maintain a distended uterus in a distended state; and performing at least one of examining and treating tissue located within the distended uterus.
  • a method of performing a medical procedure comprising the steps of inserting an introducer into a body to an internal site, the introducer including a visualization lumen and an instrument lumen; delivering a visualization device to the internal site through the visualization lumen; delivering a mechanical expansion structure to the internal site; deploying the mechanical expansion structure to distend the internal site; observing the distended internal site using the visualization device; delivering a tissue modifying device to the internal site through the instrument lumen; and modifying tissue at the internal site using the tissue modifying device.
  • FIG. 1 is a plan view, partly in section, of a first embodiment of a system for use in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention and being shown in a partially disassembled state;
  • FIG. 2 is a fragmentary, perspective view, shown partly in section, of the introducer sheath shown in FIG. 1 ;
  • FIGS. 3( a ) through 3 ( f ) are fragmentary, schematic views, partly in section, showing one way in which the system of FIG. 1 may be used to perform a medical procedure, such as the removal of a fibroid in a uterus;
  • FIGS. 4( a ) through 4 ( d ) are fragmentary, schematic views, partly in section, showing an alternate way in which the system of FIG. 1 may be used to perform a medical procedure, such as the removal of a fibroid in a uterus;
  • FIG. 5 is a section view of an alternate sheath to the sheath shown in FIG. 1 ;
  • FIG. 6 is a plan view of a second embodiment of a system for use in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention, with the mechanical expansion structure shown in a retracted and non-expanded state;
  • FIG. 7 is a plan view of the system shown in FIG. 6 , with the mechanical expansion structure shown in an advanced and non-expanded state;
  • FIG. 8 is a plan view of the system shown in FIG. 6 , with the mechanical expansion structure shown in an advanced and expanded state;
  • FIG. 9 is a longitudinal section view of the system shown in FIG. 6 , with the mechanical expansion structure shown in a retracted and non-expanded state;
  • FIG. 10 is a transverse section view of the system shown in FIG. 6 , with the hysteroscope, the morcellator and the distension mechanism being shown in simplified form;
  • FIG. 11 is a plan view of a mechanical expansion structure that may be used to maintain a uterus in a distended state, the mechanical expansion structure being constructed according to the teachings of the present invention.
  • FIGS. 12( a ) and 12 ( b ) are fragmentary schematic views, partly in section, illustrating one way in which the mechanical expansion structure of FIG. 11 may be used to maintain a uterus in a distended state.
  • FIG. 1 there is shown a plan view, partly in section, of one embodiment of a system that may be used in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention and being represented generally by reference numeral 11 .
  • System 11 which is shown in a partially disassembled state, is particularly well-suited for use in accessing and examining and/or treating the uterus of a female patient.
  • system 11 is not limited to such a use and may be used in other anatomies that may be apparent to those of ordinary skill in the art.
  • System 11 may comprise an introducer 12 , a visualization device 13 , a distension device 14 and a tissue modifying device 15 .
  • Introducer 12 may include a first port 16 , a second port 17 , a third port 19 , and a flexible sheath 21 .
  • Ports 16 , 17 and 19 are typically not intended for insertion into a patient whereas the distal end of sheath 21 is typically configured for insertion into a patient.
  • a distal zone on sheath 21 configured to extend through and beyond the cervix typically has an OD of less than about 9 mm, typically less than about 8 mm and preferably less than about 7 mm (e.g., less than about 5.5 mm).
  • First port 16 which may be adapted to receive, for example, the distal end of a fluid-containing syringe (not shown) or other fluid source, may be shaped to include a proximal end 25 , a distal end 27 and a longitudinal lumen 29 .
  • a helical thread or luer lock 31 may be provided on the exterior of port 16 near proximal end 25 to matingly engage a complementary thread or luer lock on a syringe or the like.
  • Second port 17 which may be adapted to receive, for example, mechanical distension device 14 , tissue modifying device 15 , or another desired tool, may be shaped to include a proximal end 31 , a distal end 33 and a longitudinal lumen 35 .
  • Third port 19 which may be adapted to receive, for example, visualization device 13 , may be shaped to include a proximal end 37 , a distal end 39 and a longitudinal lumen 41 .
  • Each of first port 16 , second port 17 , and third port 19 may be made of a rigid material, such as a rigid, medical grade plastic.
  • Sheath 21 which is also shown in FIG. 2 , may be an elongated member made of an elastic or compliant or substantially noncompliant material, depending upon the desired radial expansion characteristic. Sheath 21 may be shaped to include a trifurcated proximal end and an unbranched distal end 43 . The trifurcated proximal end of sheath 21 may include a first arm 45 , a second arm 47 and a third arm 49 . First arm 45 may be secured to distal end 27 of first port 16 , second arm 47 may be secured to distal end 33 of second port 17 , and third arm 49 may be secured to distal end 39 of third port 19 .
  • Sheath 21 may include a plurality of longitudinal lumens 51 , 53 and 55 , the proximal end of lumen 51 being aligned with lumen 29 of port 15 , the proximal end of lumen 53 being aligned with lumen 35 of port 17 , and the proximal end of lumen 55 being aligned with lumen 41 of port 19 .
  • sheath 21 is preferably appropriately dimensioned to permit its insertion into a desired anatomy, such as, in the present embodiment, to permit its transcervical insertion into a uterus.
  • sheath 21 is preferably about 22-25 cm in length.
  • sheath 21 is provided with a dedicated fluid lumen 51 , placing the proximal fluid port 16 in communication with a distal opening on fluid lumen 51 .
  • the dedicated fluid lumen 51 permits controllable and optimized fluid infusion rates, compared to a multi-function lumen such as in an alternate embodiment in which fluid is infused in the annular space surrounding another tool such as a visualization element or distension device.
  • the dedicated fluid lumen 51 is preferable in an embodiment in which simultaneous tissue cutting and tissue removal is to be accomplished. Fluid may be introduced through the lumen 51 to the working site, to facilitate aspiration of morcellated or otherwise cut tissue through the tissue removal device and out of the patient.
  • the dedicated fluid lumen 51 may be omitted, in an embodiment in which a grasper or other tool is repeatedly introduced and withdrawn through a working channel in order to remove the desired volume of tissue.
  • Visualization device 13 which may be used for direct visual observation of a uterus, may be, for example, a rod-lens hysteroscope or a flexible hysteroscope and is shaped to include a proximal end 63 and a distal end 65 .
  • Device 13 may be inserted into introducer 12 through third (visualization) port 19 , preferably with proximal end 63 of device 13 not being inserted into introducer 12 and with distal end 65 of device 13 being positioned at or beyond distal end 43 of sheath 21 .
  • the visualization port 19 is in communication with a visualization lumen 55 .
  • Visualization lumen 55 extends throughout the length of the sheath 21 to the distal end.
  • the distal end of the visualization lumen 55 is provided with a transparent barrier such as a window or lens, so that the visualization lumen 55 has a closed distal end. This prevents the introduction of body fluids into the visualization lumen 55 , and thereby avoids contamination of the visualization device 13 .
  • the visualization device 13 may be advanced distally through visualization lumen 55 to a position at or about the location of the distal window, and visualization may be accomplished through the closed end of the visualization lumen 55 without contact between the hysteroscope and body fluids.
  • Distension device 14 which may be particularly well-suited for distending the uterus of a patient, comprises a mechanical expansion structure. Expansion of the expansion structure can be accomplished either actively or passively, depending upon the desired clinical functionality. Active expansion occurs in response to the application of force by the clinician, which may be accomplished in of a variety of ways. For example, rotatable knobs, slider switches, thumb wheels or other controls may be actuated to axially proximally retract or distally advance an actuation wire, or rotate a threaded shaft. An electrical signal can be utilized to activate an electromechanical expansion structure, or any of a variety of inflation media including gas or liquid can be utilized to activate an inflatable component on an active expansion structure.
  • Passive expansion structures include structures which will self expand following the removal of a restraint. When in a constrained configuration, the passive mechanical expansion structures typically exhibit a spring force bias in the direction of the expanded configuration. This may be accomplished using any of a variety of spring constructions, and also through the use of shape memory materials such as various Nitinol or elgiloy alloys, in some instances stainless steel, and shape memory polymeric material which are known in the art.
  • said mechanical expansion structure comprises a self-expanding scaffolding 83 .
  • Scaffolding 83 may include a resiliently-biased foldable weave of filaments 84 made of Nitinol (nickel-titanium alloy) shape-memory alloy, spring steel or a similar shape-memory material. Scaffolding 83 may be constructed so that, when fully expanded within a uterus, it distends the uterus or a portion of the uterus to a desired extent. If desired, scaffolding 83 may be constructed so that its expanded shape mimics the shape of the uterus.
  • scaffolding 83 is constructed to distend the uterus to an extent equivalent to that which would be attained using the above-described conventional fluid distension technique at a pressure of at least 40 mm Hg but not greater than 100 mm Hg and preferably at a pressure of approximately 70 mm Hg.
  • scaffolding 83 may be constructed to provide a uniform radial force in all directions or may be constructed to provide different radial forces in different directions, such as along the coronal and sagittal planes.
  • the woven filaments 84 making up scaffolding 83 may be sized and spaced (e.g., diameter, length, width) to effectively cover a small portion of the contacted surface area, thereby leaving one or two or more large working “windows” between adjacent filaments 84 through which diagnostic and/or therapeutic tool may be advanced and/or procedures may be performed, or the members may be sized and spaced to cover a large portion of the contacted surface area, with comparatively smaller “windows.” It should be noted that, by appropriately sizing and positioning such “windows” over a target tissue, scaffolding 83 may cause a target tissue to avulse through a window and into the interior of scaffolding 83 , where it may then be treated. (As seen in FIGS. 3( d ) and 4 ( c ), scaffolding 83 may additionally be provided with an enlarged window 86 , which may be used to provide facile access to target tissue from within scaffolding 83 .)
  • Distension device 14 may further comprise an outer sheath 85 .
  • Sheath 85 which may be a unitary, tubular member, has a proximal end 87 and a distal end 89 .
  • Sheath 85 may be inserted into introducer 12 through second port 17 , preferably with proximal end 87 remaining external to introducer 12 and with distal end 89 being positioned at or beyond distal end 43 of sheath 21 .
  • scaffolding 83 when scaffolding 83 is positioned within sheath 85 , scaffolding 83 is maintained in a compressed state by sheath 85 .
  • scaffolding 83 may self-expand.
  • Distension device 14 may further comprise a tie-line 91 and an ejector rod 92 .
  • Tie-line 91 may have a proximal end 93 extending proximally from sheath 85 and a distal end fixed to scaffolding 83 .
  • Ejector rod 92 may be slidably and removably mounted within sheath 85 for ejecting scaffolding 83 distally from sheath 85 .
  • Tissue modifying device 15 may comprise a morcellator and/or another tissue modifying device including, for example, a drug delivery device.
  • tissue modifying device 15 is a morcellator, which may be used to remove abnormalities, such as fibroids and polyps, from a uterus.
  • the morcellator may be conventional in size, shape and construction, and may have a proximal end 97 and a distal end 99 .
  • Tissue modifying device 15 may be inserted into introducer 12 through second port 17 , preferably with proximal end 97 not being inserted into introducer 12 and with distal end 99 being positioned at or beyond distal end 43 of sheath 21 .
  • FIGS. 3( a ) through 3 ( f ) there is shown one way in which system 11 may be used to perform a medical procedure.
  • system 11 is shown in FIGS. 3( a ) through 3 ( f ) being used to remove a fibroid F from a uterus; however, it should be understood that system 11 may be used to perform other types of medical procedures, whether in the uterus or otherwise.
  • distal end 43 of sheath 21 is inserted transcervically into the patient up to the os (i.e., the portion of the anatomy where the cervix CE transitions to the corpus CO).
  • distension device 14 is loaded into introducer 12 through second port 17 so that distal end 89 of sheath 85 is positioned at or beyond distal end 43 of sheath 21 . As seen in transverse cross-section in FIG.
  • the insertion of distension device 14 into sheath 21 causes sheath 21 to expand radially to accommodate distension device 14 .
  • the expanded cross-sectional diameter of sheath 21 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • ejector rod 92 is used to eject scaffolding 83 distally from sheath 85 , whereby scaffolding 83 automatically self-expands to distend corpus CO.
  • Ejector rod 92 and sheath 85 are then removed proximally from introducer 12 . As seen in FIG. 3( c ), this leaves scaffolding 83 deployed in the uterus, with the distal end of tie-line 91 connected to scaffolding 83 and proximal end 93 of tie-line 91 passing through introducer 12 and remaining external to the patient. It may be noted that the removal of ejector rod 92 and sheath 85 from introducer 12 causes sheath 21 to return back to its original transverse cross-sectional size.
  • tissue modifying device 15 is loaded into introducer 12 through second port 17 along side of tie-line 91 , tissue modifying device 15 being moved distally until positioned in the area of the fibroid F one wishes to remove.
  • Staffolding 83 is shown in FIG. 3( d ) with an enlarged window 86 to provide facile access to target tissue through scaffolding 83 .
  • the insertion of tissue modifying device 15 into sheath 21 again causes sheath 21 to expand radially.
  • the expanded cross-sectional diameter of sheath 21 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • tissue modifying device 15 With tissue modifying device 15 thus introduced into the patient, device 15 is used to remove fibroid F. When tissue modifying device 15 is no longer needed, device 15 is withdrawn proximally from introducer 12 . The withdrawal of tissue modifying device 15 from introducer 12 causes sheath 21 to return back to its original transverse cross-sectional size. Sheath 85 is then inserted over tie-line 91 and loaded back into introducer 12 , causing sheath 21 again to expand radially. Then, as seen in FIG. 3( f ), tie-line 91 is pulled proximally until scaffolding 83 is drawn back into sheath 85 . The retraction of scaffolding 83 into sheath 85 , in turn, causes corpus CO to return to its relaxed state. Finally, the components of system 11 that still remain in the patient are removed proximally from the patient.
  • system 11 As compared to existing systems for accessing, examining and/or treating fibroids in a uterus, system 11 possesses the benefit of not requiring that a fluid be used to distend the uterus. Instead, as illustrated above, system 11 uses mechanical means to distend the uterus. Fluid may be used, however, for irrigation and aspiration purposes, and to clear the optical field. This may be accomplished by introduction of fluid through fluid lumen 51 , and aspiration through working lumen 53 .
  • FIGS. 4( a ) through 4 ( d ) there is shown another way in which system 11 may be used to perform a medical procedure.
  • system 11 is shown in FIGS. 4( a ) through 4 ( d ) being used to remove a fibroid from a uterus; however, it should be understood that system 11 may be used to perform other types of medical procedures, whether in the uterus or otherwise.
  • FIG. 4( a ) through 4 ( d ) First, as seen in FIG.
  • distension device 14 is inserted transcervically into the patient up to the os.
  • distension device 14 is inserted in the present embodiment parallel to, but outside of, introducer 12 .
  • the combined cross-sectional diameter of sheath 21 and distension device 14 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • ejector rod 92 is used to eject scaffolding 83 distally from sheath 85 , whereby scaffolding 83 automatically self-expands to distend corpus CO.
  • Ejector rod 92 and sheath 85 are then removed proximally from the patient, leaving scaffolding 83 deployed in the uterus, with proximal end 93 of tie-line 91 remaining external to the patient.
  • a visual examination of the uterus may be conducted using visualization device 13 . In the event that a fibroid F or other abnormality is detected that one wishes to remove, then, as seen in FIG.
  • tissue modifying device 15 is loaded into introducer 12 through second port 17 and is inserted into the distended uterus.
  • Staffolding 83 is shown in FIG. 4( c ) with an enlarged window 86 to provide facile access to target tissue through scaffolding 83 .
  • the insertion of the tissue modifying device 15 into sheath 21 causes sheath 21 to expand radially.
  • the combined cross-sectional diameter of sheath 21 and tie-line 91 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • tissue modifying device 15 With tissue modifying device 15 thus introduced into the uterus of the patient, device 15 may then be used to remove fibroid F.
  • tissue modifying device 15 When tissue modifying device 15 is no longer needed, device 15 , introducer 12 and visualization device 13 are withdrawn proximally from the patient.
  • Sheath 85 is then inserted distally over proximal end 93 of tie-line 91 and is re-introduced transcervically into the patient.
  • tie-line 91 is then pulled proximally until scaffolding 83 is retracted into sheath 85 .
  • the retraction of scaffolding 83 into sheath 85 causes corpus CO to return to its relaxed state. Scaffolding 83 and sheath 85 are then removed proximally from the patient.
  • distension device 14 is inserted transcervically into the patient, scaffolding 83 is deployed in the uterus, and ejector rod 92 and sheath 85 are removed from the patient.
  • Introducer 12 and visualization device 13 are then inserted into the patient, with introducer 12 being inserted along side of tie-line 91 .
  • the uterus may then be examined and treated in the manner described above.
  • distension device 14 prior to inserting distension device 14 into the patient, one could insert introducer 12 and visualization device 13 into the patient, use visualization device 13 to take a quick look at the uterus to make sure that there is no reason why distension device 14 should not be used, remove introducer 12 and visualization device 13 from the patient and then, assuming no reason was detected to preclude using distension device 14 , proceed in the fashion described above.
  • FIG. 5 there is shown a section view of an alternate sheath which may be used instead of sheath 21 as part of introducer 12 , the alternate sheath being constructed according to the teachings of the present invention and represented generally by reference numeral 101 .
  • Sheath 101 which preferably is flexible, may comprise an inner member 103 and an outer film 105 .
  • Inner member 103 which may be made of a semi-rigid material, is shaped such as by extrusion to include a first lumen 104 and a second lumen 106 .
  • First lumen 104 may be aligned with longitudinal lumen 29 of first port 16
  • second lumen 106 may be aligned with longitudinal lumen 41 of port 19 .
  • Outer film 105 and inner member 103 jointly define a third lumen 107 , which may be aligned with longitudinal lumen 35 of port 17 .
  • film 105 is an elastic material capable of radial expansion so that third lumen 107 may expand when distension device 14 or tissue modifying device 15 is inserted into lumen 107 and may return to a compact state when neither is inserted into lumen 107 .
  • FIGS. 6 through 10 there are shown various views of a second embodiment of a system for use in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention and being represented generally by reference numeral 111 .
  • System 111 like system 11 , is particularly well-suited for use in accessing and in examining and/or treating the uterus of a female patient. However, it should be understood that system 111 is not limited to such a use and may be used in other anatomies that may be apparent to those of ordinary skill in the art.
  • System 111 may comprise an introducer 112 , a visualization device 113 , a distension device 114 and a tissue modifying device 115 .
  • Introducer 112 may include a first member 116 , a second member 117 , a third member 119 , and a sheath 121 .
  • Members 116 , 117 and 119 are typically not intended for insertion into a patient whereas the distal end of sheath 121 is typically intended for insertion into a patient.
  • First member 116 which may be adapted to receive, for example, the distal end of a fluid-containing syringe (not shown) or another fluid source, may be shaped to include a proximal end 125 , a distal end (not shown) and a longitudinal lumen (not shown).
  • a helical thread or luer lock 131 may be provided on the exterior of member 116 near proximal end 125 to matingly engage a complementary thread or luer lock on a syringe or the like.
  • Second member 117 which may be adapted to receive, for example, distension device 114 and tissue modifying device 115 , may be shaped to include a proximal end 131 , a distal end (not shown) and a pair of longitudinal lumens 135 and 136 .
  • Third member 119 which may be adapted to receive, for example, visualization device 113 , may be shaped to include a proximal end 137 , a distal end (not shown) and a longitudinal lumen (not shown).
  • Each of first member 116 , second member 117 , and third member 119 may be made of a rigid material, such as a rigid, medical grade plastic.
  • Sheath 121 may be an elongated member made of an elastic material capable of radial expansion in one or more places. Sheath 121 may be shaped to include a branched proximal end and an unbranched distal end 143 . The branched proximal end of sheath 121 may include a first arm 145 , a second arm 147 and a third arm 149 . First arm 145 may be secured to the distal end of first member 116 , second arm 147 may be secured to the distal end of second member 117 , and third arm 149 may be secured to the distal end of third member 119 .
  • Sheath 121 may include a plurality of longitudinal lumens 151 , 153 , 154 and 155 , the proximal end of lumen 151 being located in first arm 145 and aligned with the lumen of member 116 , the proximal end of lumen 153 being located in second arm 147 and aligned with lumen 135 of member 117 , the proximal end of lumen 154 being located in second arm 147 and aligned with lumen 136 of member 117 , and the proximal end of lumen 155 being located in third arm 149 and aligned with the lumen of member 119 .
  • Sheath 121 is preferably appropriately dimensioned to permit its insertion into a desired anatomy, such as, in the present embodiment, to permit its transcervical insertion into a uterus.
  • Visualization device 113 which may be used for direct visual observation of a uterus, may be, for example, a rod-lens hysteroscope or a flexible hysteroscope. (For simplicity and clarity, visualization device 113 is shown only in FIG. 10 and is showed therein in simplified form.) Device 113 may be inserted into introducer 112 through third member 119 , preferably with the proximal end of device 113 not being inserted into introducer 112 and with the distal end of device 113 being positioned at or beyond distal end 143 of sheath 121 .
  • Distension mechanism 114 which may be particularly well-suited for distending the uterus of a patient, may comprise an elongated structure slidably disposed in lumens 135 and 153 .
  • the elongated structure may comprise a proximal portion 183 and a distal portion 185 .
  • Proximal portion 183 may be an elongated member having a handle 187 at its proximal end and a plurality of teeth 189 along its top surface.
  • Proximal portion 183 may be made of a rigid material, such as a rigid, medical grade plastic.
  • Distal portion 185 may be an elongated member preferably made of a resilient material, such as Nitinol (nickel-titanium alloy) shape-memory alloy, spring steel, a shape-memory plastic, or a similar shape-memory material.
  • a resilient material such as Nitinol (nickel-titanium alloy) shape-memory alloy, spring steel, a shape-memory plastic, or a similar shape-memory material.
  • Distal portion 185 may be bent at a point 188 , with one end 191 of distal portion 185 being fixed to the distal end 190 of proximal portion 183 and the opposite end 193 of distal portion 185 being fixed to a ring 195 slidably inserted over an intermediate portion of distal portion 185 .
  • ring 195 when ring 195 is distally advanced to a position proximate to point 188 ( FIG. 8 ), distal portion 185 “bows out” to assume an expanded shape.
  • distal portion 185 assumes a non-expanded shape.
  • distal portion 185 may be constructed so that, when fully expanded within a uterus, it distends the uterus or a portion of the uterus to a desired extent. If desired, distal portion 185 may be constructed so that its expanded shape mimics the shape of the uterus. Preferably, distal portion 185 is constructed to distend the uterus to an extent equivalent to that which would be attained using the above-described conventional fluid distension technique at a pressure of at least 40 mm Hg but not greater than 100 mm Hg and preferably at a pressure of approximately 70 mm Hg.
  • Distension mechanism 114 may additionally include a mechanism for selectively positioning ring 195 so that distal portion 185 may assume an expanded shape at any desired point within a working range in between a fully expanded shape and a non-expanded shape.
  • Said ring-positioning mechanism may comprise a biasing mechanism such as coiled spring 197 and a control such as switch 199 .
  • Coiled spring 197 which may be inserted coaxially over adjacent sections of proximal portion 183 and distal portion 185 , may have a proximal end 201 fixed to switch 199 and a distal end 203 fixed to ring 195 .
  • Switch 199 which may be inserted coaxially over proximal portion 183 , is accessible through a transverse slot 205 in second member 117 and is adapted for sliding movement back and forth between the proximal and distal ends of slot 205 .
  • a pawl 207 may be pivotally mounted in switch 199 to engage teeth 189 in a ratchet-like fashion. In this manner, when switch 199 is moved distally within slot 205 , undesired proximal movement of switch 199 is prevented.
  • pawl 207 may be pivoted away from engagement with teeth 189 , thereby allowing spring 197 to decompress, which, in turn, causes switch 199 to be moved back to its proximal position.
  • Tissue modifying device 115 may comprise a morcellator or other mechanical cutting tool, or a transducer or emitter for any of a variety of energy forms such as laser, ultrasound, RF or others known in the art.
  • Another tissue treating device includes, for example, a drug delivery device.
  • tissue modifying device 115 is a side opening or end opening morcellator, which may be used to remove abnormalities, such as fibroids and polyps, from a uterus. (For simplicity and clarity, tissue modifying device 115 is shown only in FIG.
  • Tissue modifying device 115 may be inserted into introducer 112 through lumen 136 of second member 117 , preferably with the proximal end of device 115 not being inserted into introducer 112 and with the distal end of device 115 being positioned at or beyond distal end 143 of sheath 121 .
  • system 111 is prepped by loading visualization device 113 into introducer 112 through third member 119 and by ensuring that distension mechanism 114 is in its retracted and non-expanded state (as in FIGS. 6 and 9 ).
  • a fluid source such as a fluid-containing syringe
  • distal end 143 of sheath 121 is inserted transcervically into the patient up to the os. At this time, it may be desirable to dispense at least some of the fluid contained in the syringe through lumen 151 to wash the distal end of visualization device 113 , as well as to flush the uterus.
  • distension mechanism 114 is placed in its advanced and non-expanded state (as in FIG. 7 ) by moving proximal portion 183 distally until handle 187 abuts proximal end 131 of second member 117 . (Pawl 207 will need to be pivoted out of engagement with teeth 189 as proximal portion 183 is moved distally.)
  • distension mechanism 114 is placed in its advanced and expanded state (as in FIG. 8 ) by moving switch 199 from its proximal position within slot 205 to its distal position within slot 205 . With the uterus thus distended, a visual examination of the uterus may be conducted using visualization device 113 .
  • tissue modifying device 115 is loaded into introducer 112 through lumen 136 of second member 117 and into lumen 154 of sheath 121 . As seen in FIG. 10 , the introduction of tissue modifying device 115 into lumen 154 causes sheath 121 to be distended. Next, tissue modifying device 115 is moved distally until positioned in the area of the fibroid or other abnormality one wishes to remove. Tissue modifying device 115 is then used to remove the fibroid. When tissue modifying device 115 is no longer needed, device 115 is withdrawn proximally from introducer 112 .
  • Distension mechanism 114 is then placed in its advanced and non-expanded state by moving pawl 207 out of engagement with teeth 189 , thereby causing spring 197 to pull ring 195 away from point 188 (and causing switch 199 to be moved back to the proximal end of slot 205 ). Distension mechanism 114 is then placed in its retracted and non-expanded state by pulling handle 187 proximally until distal portion 185 is retracted into sheath 121 . Finally, the components of system 111 that still remain in the patient are removed proximally from the patient.
  • fluid may be used to flush the uterus and/or the distal end of the visualization device
  • non-fluid mechanical means are used to distend the uterus.
  • fluid means are used initially to distend the uterus, and non-fluid mechanical means are thereafter used to maintain the uterus in its distended state.
  • this two-part distension technique is not limited to the particular types of distension devices described above.
  • FIG. 11 there is shown a plan view of a mechanical expansion device suitable for use in practicing the aforementioned two-part distension method, the mechanical expansion device being constructed according to the teachings of the present invention and being represented generally by reference numeral 301 .
  • Device 301 may comprise a pair of arms 303 and 305 .
  • a pressure pad 307 may be mounted on the outer end of arm 303
  • a pressure pad 308 may be mounted on the outer end of arm 305 .
  • the inner ends of arms 303 and 305 may be joined to a spring 309 that biases arms 303 and 305 away from one another.
  • a loop 311 whose purpose will become apparent below, may be positioned adjacent to spring 309 .
  • FIGS. 12( a ) and 12 ( b ) there is shown one way in which device 301 may be used to maintain a uterus in a distended state.
  • a pair of devices 301 are shown loaded into lumen 53 of introducer 13 , introducer device 13 having been inserted transcervically into a patient up to the os.
  • the uterus of the patient is shown distended with a distension fluid, which preferably has previously been delivered to the uterus by means of a fluid-containing syringe (not shown) coupled to lumen 51 .
  • Devices 301 may be ejected from lumen 53 of introducer device 13 into the distended uterus by an ejector rod 315 .
  • devices 301 are shown deployed in the uterus to maintain the uterus in its already distended state. With the uterus thus maintained in its distended state, a morcellator or other desired tool may be inserted through lumen 53 of introducer 13 into the uterus. When distension of the uterus is no longer desired, devices 301 may be removed from the uterus by inserting a hook 319 or similar structure into the uterus through introducer 13 , using hook 319 to grasp devices 301 by their respective loops 311 , and then pulling hook 319 proximally to retract the hooked devices 301 into lumen 53 of introducer 13 .
  • the mechanical distension device is thus any of a wide variety of structures which are capable of translumenal introduction through the working channel in a first, reduced cross sectional profile and transformation to a second, enlarged cross sectional profile once in the vicinity of the treatment site.
  • the second, enlarged cross sectional profile creates a sufficient space at the site to allow manipulation of diagnostic or therapeutic tools necessary for the intended procedure. This may be, for example, equivalent to at least the volume of the cavity created by 70 to 80 mm Hg of fluid distension.
  • the distension provided by a fluid or gas is diffuse in nature. Rather than creating a discrete working space at the desired treatment site, the media expands the associated cavity without preference.
  • a fluid pressure of 35 to 60 mm Hg typically produces a cavity of 10 to 50 cc in total volume. But the volume of the distension media is distributed evenly throughout the entire uterus, so that the effective working space provided in the immediate vicinity of any particular treatment site is relatively small compared to the total volume of the cavity.
  • additional pressure that can reach 100 to 120 mm Hg does provide additional cavity volume but at the risk of fluid intravasation and greater pain for the patient.
  • One particular advantage of the mechanical distension structures in accordance with the present invention is the ability to create a specific working space at a desired site, while leaving other parts of the cavity in its collapsed configuration. By localizing the distension to the desired site, the size of the working cavity at that site can be optimized while minimizing the total volume of the distension and the associated pain for the patient.
  • the infused volume may need to be at least about 40 cc or 50 cc or more.
  • the working space created at the desired site is at least about 50%, often at least about 70% and preferably at least about 85% of the enclosed volume of the expandable portion of the distension device.
  • the working space may be approximately equal to the volume of the expanded device, which may be less than about 50%, often less than about 35% and preferably less than about 25% of the volume of distension media which would be necessary to achieve a similar working volume at the treatment site.
  • the expansion device may be permanently attached to the distal end of an operating shaft, permanently attached to the distal end of a tether, or detachable at the treatment site. Any of a wide variety of detachable expansion structures may be subsequently removed by advancing a grasper down the working channel and grasping the device under endoscopic visualization. The device may be thereafter be proximally retracted into the working channel and reduced in cross section for removal.
  • the tissue distension structure will have at least a first surface for contacting a first tissue zone and a second surface for contacting a second tissue zone. Activation of the distension structure advances the first and second surfaces away from each other, to enlarge the distance between the first and second tissue zones.
  • the tissue distension structure opens such that it resides substantially within a single plane which contains the longitudinal axis of the device.
  • the tissue distension structure may open in two transverse planes having an intersection along the longitudinal axis of the device, or such that the distension structure opens into a more complex three dimensional configuration, including spherical, elliptical, and other geometric forms of rotation about an axis.
  • the tissue distension device preferably includes at least one opening in a side or end wall thereof, to permit access to the target tissue.
  • FIGS. 7 and 8 can be modified such that two or three or four or more axially extending ribs are advanceable from a generally axially extending configuration such as that illustrated in FIG. 7 to a radially outwardly inclined configuration such as that illustrated in FIG. 8 .
  • a plurality of axially extending ribs are connected together at a distal end to a pull wire which extends to the proximal end of the instrument.
  • the proximal ends of the ribs are connected to a tubular column strength support having a central lumen through which the pull wire extends. Proximal retraction of the pull wire axially shortens the distension element while simultaneously radially expanding the ribs to the second, radially enlarged configuration to produce a cage having a three dimensional volume.
  • Both the endoscope and the tissue cutting element may be provided in a steerable configuration, such that they may be distally advanced into the working space created by the distension element and laterally deflected which, in combination with axial rotation, gives access to a wide variety of treatment sites within the distension structure.
  • Any of a wide variety of deflection mechanisms may be utilized, as are well understood in the art, including axially extending pull wires and push wires mechanically linked to a proximal control such as a rotatable knob or slider switch.
  • the expansion structure may be utilized both to accomplish initial expansion as well as retention of the tissue in the expanded configuration.
  • fluid pressure such as water pressure as has been used conventionally may be utilized to achieve tissue expansion, and the expansion structures of the present invention may be utilized to retain the tissue in the expanded configuration. At that point, the fluid pressure may be reduced, such that the risk of intravasation is thereby eliminated.

Abstract

Systems are disclosed, for performing therapeutic or diagnostic procedures at a remote site. According to one embodiment, the system includes an introducer designed for transcervical insertion into the uterus. The introducer is constructed to include a fluid lumen, an instrument lumen, and a visualization lumen. The system may include a fluid source, which is coupled to the fluid lumen and is used to deliver a fluid to the uterus either for washing the uterus or for fluid distension of the uterus. The system additionally includes a tissue modifying device, such as a morcellator, and a distension device for distending the uterus and/or for maintaining the uterus in a distended state. The tissue modifying device and the distension device are alternately deliverable to the uterus through the instrument lumen. The system may further include a hysteroscope deliverable to the uterus through the visualization lumen.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • The present application claims the benefit under 35 U.S.C. 119(e) of U.S. Provisional Patent Application Ser. No. 60/857,440, filed Nov. 7, 2006, U.S. Provisional Patent Application Ser. No. 60/910,618, filed Apr. 6, 2007, and U.S. Provisional Patent Application Ser. No. 60/910,625, filed Apr. 6, 2007, all of which are incorporated herein by reference.
  • BACKGROUND OF THE INVENTION
  • The present invention relates generally to methods and systems for performing medical procedures and relates more particularly to a new method and system for performing a medical procedure.
  • There are many types of situations in which it is desirable for a medical procedure to be performed on a patient. Such a procedure may be diagnostic and/or therapeutic in nature. For example, in the field of gynecology, one may wish to examine and/or treat a uterus for various abnormal conditions including, but not limited to, the presence of fibroids, polyps, tumors, adhesions, or other abnormalities within a uterus; endometriosis or other abnormal bleeding; uterine prolapse; ectopic pregnancy; and fertility issues (both the inability to conceive and the desire to avoid pregnancy).
  • The uterus is a pear-shaped organ made up two distinct anatomical regions: the cervix and the corpus. The cervix is a narrow cylindrical passage (about 1.5-4.0 mm in diameter) which connects at its lower end with the vagina. The corpus, which is the portion of the uterus that grows during pregnancy to carry a fetus, is shaped to include two portions: the lower uterine segment and the fundus. The cervix widens at its upper end to form the lower uterine segment of the corpus. The lower uterine segment, in turn, widens at its upper end into the fundus of the corpus. Dimensionally, the length of the uterus, measured from the cervix to the fundus, is approximately 8-10 cm, and the maximum width of the uterus, which is near the fundus, is about 4-5 cm. Extending from the fundus of the uterus on either side are fallopian tubes. The fallopian tubes are continuous with the uterine cavity and allow the passage of an egg from an ovary to the uterus where the egg may implant if fertilized.
  • To facilitate the examination and/or treatment of the uterus, there should be ample space within the uterus. Unfortunately, however, adequate space typically does not exist naturally in the uterus because the uterus is a flaccid organ. As such, the walls of the uterus are typically in contact with one another when in a relaxed state. Consequently, active steps need to be taken to create a working space within the uterus.
  • The conventional technique for creating such a working space within the uterus is to administer a fluid to the uterus, transcervically, under sufficient pressure to cause the uterus to become distended. Examples of the fluid used conventionally to distend the uterus include gases like carbon dioxide and liquids like water or certain aqueous solutions (e.g., a saline solution or a sugar-based aqueous solution).
  • With the uterus thus distended, examination of the uterus is typically performed using a hysteroscope—a visualization device that is inserted transcervically into the uterus. If fibroids (i.e., benign tumors), polyps or other abnormalities are detected, such abnormalities may be removed, for example, by resection. Certain devices include the combination of visualization means, such as a hysteroscope, and resection means, such as a morcellator. Examples of such devices are disclosed in U.S. Pat. No. 6,032,673, inventor Savage et al., issued Mar. 7, 2000; U.S. Pat. No. 5,730,752, inventors Alden et al., issued Mar. 24, 1998; and PCT International Publication Number WO 99/11184, published Mar. 11, 1999.
  • Although the above-described technique of fluid distension is commonly practiced, there are certain shortcomings associated therewith. For example, because the distending fluid is administered under pressure (which pressure may be as great as 120 mm Hg or greater), there is a risk that such fluids may be taken up by a blood vessel in the uterus, i.e., intravasation, which uptake may be quite harmful to the patient. Because the risk of excess intravasation can lead to death, it is customary to monitor the fluid uptake on a continuous basis using a scale system. This risk of excess intravasation is particularly great when the fluid distension technique is followed by a procedure in which a blood vessel is cut, such as when abnormal or undesired tissue located in the uterus is resected.
  • Moreover, the above-described technique of fluid distension suffers from additional shortcomings. For example, throughout the entire period of time that the diagnostic and/or therapeutic procedure is performed, the distension fluid must be continuously administered under pressure to the patient to keep the uterus distended. This requires the availability of an adequate supply of the distending fluid. In addition, suitable equipment must be available to provide the requisite continuous flow of distending fluid to the patient. Furthermore, the above-described fluid distension technique may become messy, particularly when a liquid is used as the distension fluid, as some of the distension fluid within the uterus may escape proper collection and, instead, may leak from the patient to the surrounding environment.
  • For at least the above reasons, medical procedures involving fluid distension of the uterus are typically performed in a hospital and, as a result, bear a large cost due to the setting and the support personnel required.
  • SUMMARY OF THE INVENTION
  • The present invention provides a method and system as described below that may be used, for example, in the examination and/or treatment of the uterus.
  • Therefore, according to one aspect of the invention, there is provided a system for use in performing a medical procedure, the system comprising: an introducer for providing access to an internal site within a body; a mechanical expansion structure, the mechanical expansion structure being deliverable to the internal site using the introducer; a visualization device, the visualization device being deliverable to the internal site using the introducer; and a tissue modifying device, the tissue modifying device being deliverable to the internal site using the introducer.
  • According to another aspect of the invention, there is provided a method of performing a medical procedure, said method comprising the steps of using a mechanical expansion structure to distend a uterus or to maintain a distended uterus in a distended state; and performing at least one of examining and treating tissue located within the distended uterus.
  • According to yet another aspect of the invention, there is provided a method of performing a medical procedure, said method comprising the steps of inserting an introducer into a body to an internal site, the introducer including a visualization lumen and an instrument lumen; delivering a visualization device to the internal site through the visualization lumen; delivering a mechanical expansion structure to the internal site; deploying the mechanical expansion structure to distend the internal site; observing the distended internal site using the visualization device; delivering a tissue modifying device to the internal site through the instrument lumen; and modifying tissue at the internal site using the tissue modifying device.
  • Additional aspects, features and advantages, of the present invention will be set forth in part in the description which follows, and in part will be apparent from the description or may be learned by practice of the invention. In the description, reference is made to the accompanying drawings which form a part thereof and in which is shown by way of illustration various embodiments for practicing the invention. The embodiments will be described in sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that other embodiments may be utilized and that structural changes may be made without departing from the scope of the invention. The following detailed description is, therefore, not to be taken in a limiting sense, and the scope of the present invention is best defined by the appended claims.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • The accompanying drawings, which are hereby incorporated into and constitute a part of this specification, illustrate various embodiments of the invention and, together with the description, serve to explain the principles of the invention. In the drawings wherein like reference numerals represent like parts:
  • FIG. 1 is a plan view, partly in section, of a first embodiment of a system for use in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention and being shown in a partially disassembled state;
  • FIG. 2 is a fragmentary, perspective view, shown partly in section, of the introducer sheath shown in FIG. 1;
  • FIGS. 3( a) through 3(f) are fragmentary, schematic views, partly in section, showing one way in which the system of FIG. 1 may be used to perform a medical procedure, such as the removal of a fibroid in a uterus;
  • FIGS. 4( a) through 4(d) are fragmentary, schematic views, partly in section, showing an alternate way in which the system of FIG. 1 may be used to perform a medical procedure, such as the removal of a fibroid in a uterus;
  • FIG. 5 is a section view of an alternate sheath to the sheath shown in FIG. 1;
  • FIG. 6 is a plan view of a second embodiment of a system for use in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention, with the mechanical expansion structure shown in a retracted and non-expanded state;
  • FIG. 7 is a plan view of the system shown in FIG. 6, with the mechanical expansion structure shown in an advanced and non-expanded state;
  • FIG. 8 is a plan view of the system shown in FIG. 6, with the mechanical expansion structure shown in an advanced and expanded state;
  • FIG. 9 is a longitudinal section view of the system shown in FIG. 6, with the mechanical expansion structure shown in a retracted and non-expanded state;
  • FIG. 10 is a transverse section view of the system shown in FIG. 6, with the hysteroscope, the morcellator and the distension mechanism being shown in simplified form;
  • FIG. 11 is a plan view of a mechanical expansion structure that may be used to maintain a uterus in a distended state, the mechanical expansion structure being constructed according to the teachings of the present invention; and
  • FIGS. 12( a) and 12(b) are fragmentary schematic views, partly in section, illustrating one way in which the mechanical expansion structure of FIG. 11 may be used to maintain a uterus in a distended state.
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
  • Referring now to FIG. 1, there is shown a plan view, partly in section, of one embodiment of a system that may be used in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention and being represented generally by reference numeral 11.
  • System 11, which is shown in a partially disassembled state, is particularly well-suited for use in accessing and examining and/or treating the uterus of a female patient. However, it should be understood that system 11 is not limited to such a use and may be used in other anatomies that may be apparent to those of ordinary skill in the art.
  • System 11 may comprise an introducer 12, a visualization device 13, a distension device 14 and a tissue modifying device 15. Introducer 12, in turn, may include a first port 16, a second port 17, a third port 19, and a flexible sheath 21. Ports 16, 17 and 19 are typically not intended for insertion into a patient whereas the distal end of sheath 21 is typically configured for insertion into a patient. A distal zone on sheath 21, configured to extend through and beyond the cervix typically has an OD of less than about 9 mm, typically less than about 8 mm and preferably less than about 7 mm (e.g., less than about 5.5 mm).
  • First port 16, which may be adapted to receive, for example, the distal end of a fluid-containing syringe (not shown) or other fluid source, may be shaped to include a proximal end 25, a distal end 27 and a longitudinal lumen 29. A helical thread or luer lock 31 may be provided on the exterior of port 16 near proximal end 25 to matingly engage a complementary thread or luer lock on a syringe or the like. Second port 17, which may be adapted to receive, for example, mechanical distension device 14, tissue modifying device 15, or another desired tool, may be shaped to include a proximal end 31, a distal end 33 and a longitudinal lumen 35. Third port 19, which may be adapted to receive, for example, visualization device 13, may be shaped to include a proximal end 37, a distal end 39 and a longitudinal lumen 41. Each of first port 16, second port 17, and third port 19 may be made of a rigid material, such as a rigid, medical grade plastic.
  • Sheath 21, which is also shown in FIG. 2, may be an elongated member made of an elastic or compliant or substantially noncompliant material, depending upon the desired radial expansion characteristic. Sheath 21 may be shaped to include a trifurcated proximal end and an unbranched distal end 43. The trifurcated proximal end of sheath 21 may include a first arm 45, a second arm 47 and a third arm 49. First arm 45 may be secured to distal end 27 of first port 16, second arm 47 may be secured to distal end 33 of second port 17, and third arm 49 may be secured to distal end 39 of third port 19. Sheath 21 may include a plurality of longitudinal lumens 51, 53 and 55, the proximal end of lumen 51 being aligned with lumen 29 of port 15, the proximal end of lumen 53 being aligned with lumen 35 of port 17, and the proximal end of lumen 55 being aligned with lumen 41 of port 19.
  • As will be discussed further below, sheath 21 is preferably appropriately dimensioned to permit its insertion into a desired anatomy, such as, in the present embodiment, to permit its transcervical insertion into a uterus. For such an application, sheath 21 is preferably about 22-25 cm in length.
  • In the illustrated embodiment, sheath 21 is provided with a dedicated fluid lumen 51, placing the proximal fluid port 16 in communication with a distal opening on fluid lumen 51. The dedicated fluid lumen 51 permits controllable and optimized fluid infusion rates, compared to a multi-function lumen such as in an alternate embodiment in which fluid is infused in the annular space surrounding another tool such as a visualization element or distension device. The dedicated fluid lumen 51 is preferable in an embodiment in which simultaneous tissue cutting and tissue removal is to be accomplished. Fluid may be introduced through the lumen 51 to the working site, to facilitate aspiration of morcellated or otherwise cut tissue through the tissue removal device and out of the patient. The dedicated fluid lumen 51 may be omitted, in an embodiment in which a grasper or other tool is repeatedly introduced and withdrawn through a working channel in order to remove the desired volume of tissue.
  • Visualization device 13, which may be used for direct visual observation of a uterus, may be, for example, a rod-lens hysteroscope or a flexible hysteroscope and is shaped to include a proximal end 63 and a distal end 65. Device 13 may be inserted into introducer 12 through third (visualization) port 19, preferably with proximal end 63 of device 13 not being inserted into introducer 12 and with distal end 65 of device 13 being positioned at or beyond distal end 43 of sheath 21.
  • In the illustrated embodiment, the visualization port 19 is in communication with a visualization lumen 55. Visualization lumen 55 extends throughout the length of the sheath 21 to the distal end. In one embodiment (not illustrated), the distal end of the visualization lumen 55 is provided with a transparent barrier such as a window or lens, so that the visualization lumen 55 has a closed distal end. This prevents the introduction of body fluids into the visualization lumen 55, and thereby avoids contamination of the visualization device 13. In this embodiment, the visualization device 13 may be advanced distally through visualization lumen 55 to a position at or about the location of the distal window, and visualization may be accomplished through the closed end of the visualization lumen 55 without contact between the hysteroscope and body fluids.
  • Distension device 14, which may be particularly well-suited for distending the uterus of a patient, comprises a mechanical expansion structure. Expansion of the expansion structure can be accomplished either actively or passively, depending upon the desired clinical functionality. Active expansion occurs in response to the application of force by the clinician, which may be accomplished in of a variety of ways. For example, rotatable knobs, slider switches, thumb wheels or other controls may be actuated to axially proximally retract or distally advance an actuation wire, or rotate a threaded shaft. An electrical signal can be utilized to activate an electromechanical expansion structure, or any of a variety of inflation media including gas or liquid can be utilized to activate an inflatable component on an active expansion structure. Passive expansion structures include structures which will self expand following the removal of a restraint. When in a constrained configuration, the passive mechanical expansion structures typically exhibit a spring force bias in the direction of the expanded configuration. This may be accomplished using any of a variety of spring constructions, and also through the use of shape memory materials such as various Nitinol or elgiloy alloys, in some instances stainless steel, and shape memory polymeric material which are known in the art.
  • In the present embodiment, said mechanical expansion structure comprises a self-expanding scaffolding 83. Scaffolding 83 may include a resiliently-biased foldable weave of filaments 84 made of Nitinol (nickel-titanium alloy) shape-memory alloy, spring steel or a similar shape-memory material. Scaffolding 83 may be constructed so that, when fully expanded within a uterus, it distends the uterus or a portion of the uterus to a desired extent. If desired, scaffolding 83 may be constructed so that its expanded shape mimics the shape of the uterus. Preferably, scaffolding 83 is constructed to distend the uterus to an extent equivalent to that which would be attained using the above-described conventional fluid distension technique at a pressure of at least 40 mm Hg but not greater than 100 mm Hg and preferably at a pressure of approximately 70 mm Hg. If desired, scaffolding 83 may be constructed to provide a uniform radial force in all directions or may be constructed to provide different radial forces in different directions, such as along the coronal and sagittal planes.
  • The woven filaments 84 making up scaffolding 83 may be sized and spaced (e.g., diameter, length, width) to effectively cover a small portion of the contacted surface area, thereby leaving one or two or more large working “windows” between adjacent filaments 84 through which diagnostic and/or therapeutic tool may be advanced and/or procedures may be performed, or the members may be sized and spaced to cover a large portion of the contacted surface area, with comparatively smaller “windows.” It should be noted that, by appropriately sizing and positioning such “windows” over a target tissue, scaffolding 83 may cause a target tissue to avulse through a window and into the interior of scaffolding 83, where it may then be treated. (As seen in FIGS. 3( d) and 4(c), scaffolding 83 may additionally be provided with an enlarged window 86, which may be used to provide facile access to target tissue from within scaffolding 83.)
  • Distension device 14 may further comprise an outer sheath 85. Sheath 85, which may be a unitary, tubular member, has a proximal end 87 and a distal end 89. Sheath 85 may be inserted into introducer 12 through second port 17, preferably with proximal end 87 remaining external to introducer 12 and with distal end 89 being positioned at or beyond distal end 43 of sheath 21. As will be discussed further below, when scaffolding 83 is positioned within sheath 85, scaffolding 83 is maintained in a compressed state by sheath 85. By contrast, when scaffolding 83 is positioned distally relative to sheath 85, scaffolding 83 may self-expand.
  • Distension device 14 may further comprise a tie-line 91 and an ejector rod 92. Tie-line 91 may have a proximal end 93 extending proximally from sheath 85 and a distal end fixed to scaffolding 83. Ejector rod 92 may be slidably and removably mounted within sheath 85 for ejecting scaffolding 83 distally from sheath 85.
  • Tissue modifying device 15 may comprise a morcellator and/or another tissue modifying device including, for example, a drug delivery device. In the present embodiment, tissue modifying device 15 is a morcellator, which may be used to remove abnormalities, such as fibroids and polyps, from a uterus. The morcellator may be conventional in size, shape and construction, and may have a proximal end 97 and a distal end 99. Tissue modifying device 15 may be inserted into introducer 12 through second port 17, preferably with proximal end 97 not being inserted into introducer 12 and with distal end 99 being positioned at or beyond distal end 43 of sheath 21.
  • Referring now to FIGS. 3( a) through 3(f), there is shown one way in which system 11 may be used to perform a medical procedure. For illustrative purposes, system 11 is shown in FIGS. 3( a) through 3(f) being used to remove a fibroid F from a uterus; however, it should be understood that system 11 may be used to perform other types of medical procedures, whether in the uterus or otherwise. First, as seen in FIG. 3( a), with visualization device 13 loaded into introducer 12 through third port 19, and with a fluid source, such as a fluid-containing syringe 100, coupled to first port 16, distal end 43 of sheath 21 is inserted transcervically into the patient up to the os (i.e., the portion of the anatomy where the cervix CE transitions to the corpus CO). At this time, it may be desirable to dispense at least some of the fluid contained in syringe 100 through lumen 51 to wash distal end 65 of visualization device 13 (as mucus, blood and other debris may have become deposited on distal end 65 of visualization device 13 during the insertion of visualization device 13 into the patient), unless a closed visualization lumen is used as discussed above, as well as to flush the uterus. Next, distension device 14 is loaded into introducer 12 through second port 17 so that distal end 89 of sheath 85 is positioned at or beyond distal end 43 of sheath 21. As seen in transverse cross-section in FIG. 3( b), the insertion of distension device 14 into sheath 21 causes sheath 21 to expand radially to accommodate distension device 14. To minimize discomfort to the patient, such as by obviating the need for administration of anesthetic to the patient, the expanded cross-sectional diameter of sheath 21 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • Next, ejector rod 92 is used to eject scaffolding 83 distally from sheath 85, whereby scaffolding 83 automatically self-expands to distend corpus CO. Ejector rod 92 and sheath 85 are then removed proximally from introducer 12. As seen in FIG. 3( c), this leaves scaffolding 83 deployed in the uterus, with the distal end of tie-line 91 connected to scaffolding 83 and proximal end 93 of tie-line 91 passing through introducer 12 and remaining external to the patient. It may be noted that the removal of ejector rod 92 and sheath 85 from introducer 12 causes sheath 21 to return back to its original transverse cross-sectional size. With the uterus thus distended by scaffolding 83, a visual examination of the uterus may be conducted using visualization device 13. In the event that a fibroid or other abnormality is detected that one wishes to remove, then, as seen in FIG. 3( d), tissue modifying device 15 is loaded into introducer 12 through second port 17 along side of tie-line 91, tissue modifying device 15 being moved distally until positioned in the area of the fibroid F one wishes to remove. (Scaffolding 83 is shown in FIG. 3( d) with an enlarged window 86 to provide facile access to target tissue through scaffolding 83.) As seen in transverse cross-section in FIG. 3( e), the insertion of tissue modifying device 15 into sheath 21 again causes sheath 21 to expand radially. Once again, to minimize discomfort to the patient, such as by obviating the need for administration of an aesthetic to the patient, the expanded cross-sectional diameter of sheath 21 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • With tissue modifying device 15 thus introduced into the patient, device 15 is used to remove fibroid F. When tissue modifying device 15 is no longer needed, device 15 is withdrawn proximally from introducer 12. The withdrawal of tissue modifying device 15 from introducer 12 causes sheath 21 to return back to its original transverse cross-sectional size. Sheath 85 is then inserted over tie-line 91 and loaded back into introducer 12, causing sheath 21 again to expand radially. Then, as seen in FIG. 3( f), tie-line 91 is pulled proximally until scaffolding 83 is drawn back into sheath 85. The retraction of scaffolding 83 into sheath 85, in turn, causes corpus CO to return to its relaxed state. Finally, the components of system 11 that still remain in the patient are removed proximally from the patient.
  • As compared to existing systems for accessing, examining and/or treating fibroids in a uterus, system 11 possesses the benefit of not requiring that a fluid be used to distend the uterus. Instead, as illustrated above, system 11 uses mechanical means to distend the uterus. Fluid may be used, however, for irrigation and aspiration purposes, and to clear the optical field. This may be accomplished by introduction of fluid through fluid lumen 51, and aspiration through working lumen 53.
  • Referring now to FIGS. 4( a) through 4(d), there is shown another way in which system 11 may be used to perform a medical procedure. For illustrative purposes, system 11 is shown in FIGS. 4( a) through 4(d) being used to remove a fibroid from a uterus; however, it should be understood that system 11 may be used to perform other types of medical procedures, whether in the uterus or otherwise. First, as seen in FIG. 4( a), with visualization device 13 loaded into introducer 12 through third port 19, and with a fluid source, such as a fluid-containing syringe 100, coupled to first port 16, distal end 43 of sheath 21 is inserted transcervically into the patient up to the os. At this time, it may be desirable to dispense at least some of the fluid contained in syringe 100 through lumen 51 to wash distal end 65 of visualization device 13, as well as to flush the uterus.
  • Next, distension device 14 is inserted transcervically into the patient up to the os. However, it should be noted that, as compared to the technique discussed above in which distension device 14 is inserted through introducer 12, distension device 14 is inserted in the present embodiment parallel to, but outside of, introducer 12. To minimize discomfort to the patient, such as by obviating the need for administration of an aesthetic to the patient, the combined cross-sectional diameter of sheath 21 and distension device 14 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • Next, as seen in FIG. 4( b), ejector rod 92 is used to eject scaffolding 83 distally from sheath 85, whereby scaffolding 83 automatically self-expands to distend corpus CO. Ejector rod 92 and sheath 85 are then removed proximally from the patient, leaving scaffolding 83 deployed in the uterus, with proximal end 93 of tie-line 91 remaining external to the patient. With the uterus thus distended by scaffolding 83, a visual examination of the uterus may be conducted using visualization device 13. In the event that a fibroid F or other abnormality is detected that one wishes to remove, then, as seen in FIG. 4( c), tissue modifying device 15 is loaded into introducer 12 through second port 17 and is inserted into the distended uterus. (Scaffolding 83 is shown in FIG. 4( c) with an enlarged window 86 to provide facile access to target tissue through scaffolding 83.) The insertion of the tissue modifying device 15 into sheath 21 causes sheath 21 to expand radially. To minimize discomfort to the patient, such as by obviating the need for administration of an aesthetic to the patient, the combined cross-sectional diameter of sheath 21 and tie-line 91 is preferably less than about 5.5 mm, more preferably less than about 5.0 mm.
  • With tissue modifying device 15 thus introduced into the uterus of the patient, device 15 may then be used to remove fibroid F. When tissue modifying device 15 is no longer needed, device 15, introducer 12 and visualization device 13 are withdrawn proximally from the patient. Sheath 85 is then inserted distally over proximal end 93 of tie-line 91 and is re-introduced transcervically into the patient. Then, as seen in FIG. 4( d), tie-line 91 is then pulled proximally until scaffolding 83 is retracted into sheath 85. The retraction of scaffolding 83 into sheath 85, in turn, causes corpus CO to return to its relaxed state. Scaffolding 83 and sheath 85 are then removed proximally from the patient.
  • According to yet another embodiment (not shown), prior to inserting introducer 12 and visualization device 13 into the patient, distension device 14 is inserted transcervically into the patient, scaffolding 83 is deployed in the uterus, and ejector rod 92 and sheath 85 are removed from the patient. Introducer 12 and visualization device 13 are then inserted into the patient, with introducer 12 being inserted along side of tie-line 91. The uterus may then be examined and treated in the manner described above. Alternatively, prior to inserting distension device 14 into the patient, one could insert introducer 12 and visualization device 13 into the patient, use visualization device 13 to take a quick look at the uterus to make sure that there is no reason why distension device 14 should not be used, remove introducer 12 and visualization device 13 from the patient and then, assuming no reason was detected to preclude using distension device 14, proceed in the fashion described above.
  • Referring now to FIG. 5, there is shown a section view of an alternate sheath which may be used instead of sheath 21 as part of introducer 12, the alternate sheath being constructed according to the teachings of the present invention and represented generally by reference numeral 101.
  • Sheath 101, which preferably is flexible, may comprise an inner member 103 and an outer film 105. Inner member 103, which may be made of a semi-rigid material, is shaped such as by extrusion to include a first lumen 104 and a second lumen 106. First lumen 104 may be aligned with longitudinal lumen 29 of first port 16, and second lumen 106 may be aligned with longitudinal lumen 41 of port 19.
  • Outer film 105 and inner member 103 jointly define a third lumen 107, which may be aligned with longitudinal lumen 35 of port 17. Preferably, film 105 is an elastic material capable of radial expansion so that third lumen 107 may expand when distension device 14 or tissue modifying device 15 is inserted into lumen 107 and may return to a compact state when neither is inserted into lumen 107.
  • Referring now to FIGS. 6 through 10, there are shown various views of a second embodiment of a system for use in accessing and in examining and/or treating a body cavity, the system being constructed according to the teachings of the present invention and being represented generally by reference numeral 111.
  • System 111, like system 11, is particularly well-suited for use in accessing and in examining and/or treating the uterus of a female patient. However, it should be understood that system 111 is not limited to such a use and may be used in other anatomies that may be apparent to those of ordinary skill in the art.
  • System 111 may comprise an introducer 112, a visualization device 113, a distension device 114 and a tissue modifying device 115. Introducer 112, in turn, may include a first member 116, a second member 117, a third member 119, and a sheath 121. Members 116, 117 and 119 are typically not intended for insertion into a patient whereas the distal end of sheath 121 is typically intended for insertion into a patient. First member 116, which may be adapted to receive, for example, the distal end of a fluid-containing syringe (not shown) or another fluid source, may be shaped to include a proximal end 125, a distal end (not shown) and a longitudinal lumen (not shown). A helical thread or luer lock 131 may be provided on the exterior of member 116 near proximal end 125 to matingly engage a complementary thread or luer lock on a syringe or the like. Second member 117, which may be adapted to receive, for example, distension device 114 and tissue modifying device 115, may be shaped to include a proximal end 131, a distal end (not shown) and a pair of longitudinal lumens 135 and 136. Third member 119, which may be adapted to receive, for example, visualization device 113, may be shaped to include a proximal end 137, a distal end (not shown) and a longitudinal lumen (not shown). Each of first member 116, second member 117, and third member 119 may be made of a rigid material, such as a rigid, medical grade plastic.
  • Sheath 121 may be an elongated member made of an elastic material capable of radial expansion in one or more places. Sheath 121 may be shaped to include a branched proximal end and an unbranched distal end 143. The branched proximal end of sheath 121 may include a first arm 145, a second arm 147 and a third arm 149. First arm 145 may be secured to the distal end of first member 116, second arm 147 may be secured to the distal end of second member 117, and third arm 149 may be secured to the distal end of third member 119. Sheath 121 may include a plurality of longitudinal lumens 151, 153, 154 and 155, the proximal end of lumen 151 being located in first arm 145 and aligned with the lumen of member 116, the proximal end of lumen 153 being located in second arm 147 and aligned with lumen 135 of member 117, the proximal end of lumen 154 being located in second arm 147 and aligned with lumen 136 of member 117, and the proximal end of lumen 155 being located in third arm 149 and aligned with the lumen of member 119.
  • Sheath 121 is preferably appropriately dimensioned to permit its insertion into a desired anatomy, such as, in the present embodiment, to permit its transcervical insertion into a uterus.
  • Visualization device 113, which may be used for direct visual observation of a uterus, may be, for example, a rod-lens hysteroscope or a flexible hysteroscope. (For simplicity and clarity, visualization device 113 is shown only in FIG. 10 and is showed therein in simplified form.) Device 113 may be inserted into introducer 112 through third member 119, preferably with the proximal end of device 113 not being inserted into introducer 112 and with the distal end of device 113 being positioned at or beyond distal end 143 of sheath 121.
  • Distension mechanism 114, which may be particularly well-suited for distending the uterus of a patient, may comprise an elongated structure slidably disposed in lumens 135 and 153. The elongated structure may comprise a proximal portion 183 and a distal portion 185. Proximal portion 183 may be an elongated member having a handle 187 at its proximal end and a plurality of teeth 189 along its top surface. Proximal portion 183 may be made of a rigid material, such as a rigid, medical grade plastic. Distal portion 185 may be an elongated member preferably made of a resilient material, such as Nitinol (nickel-titanium alloy) shape-memory alloy, spring steel, a shape-memory plastic, or a similar shape-memory material.
  • Distal portion 185 may be bent at a point 188, with one end 191 of distal portion 185 being fixed to the distal end 190 of proximal portion 183 and the opposite end 193 of distal portion 185 being fixed to a ring 195 slidably inserted over an intermediate portion of distal portion 185. As a result, as can be seen by comparing FIGS. 7 and 8, when ring 195 is distally advanced to a position proximate to point 188 (FIG. 8), distal portion 185 “bows out” to assume an expanded shape. Alternatively, when ring 195 is proximally retracted with respect to point 188, distal portion 185 assumes a non-expanded shape.
  • As can be appreciated, distal portion 185 may be constructed so that, when fully expanded within a uterus, it distends the uterus or a portion of the uterus to a desired extent. If desired, distal portion 185 may be constructed so that its expanded shape mimics the shape of the uterus. Preferably, distal portion 185 is constructed to distend the uterus to an extent equivalent to that which would be attained using the above-described conventional fluid distension technique at a pressure of at least 40 mm Hg but not greater than 100 mm Hg and preferably at a pressure of approximately 70 mm Hg.
  • Distension mechanism 114 may additionally include a mechanism for selectively positioning ring 195 so that distal portion 185 may assume an expanded shape at any desired point within a working range in between a fully expanded shape and a non-expanded shape. Said ring-positioning mechanism may comprise a biasing mechanism such as coiled spring 197 and a control such as switch 199. Coiled spring 197, which may be inserted coaxially over adjacent sections of proximal portion 183 and distal portion 185, may have a proximal end 201 fixed to switch 199 and a distal end 203 fixed to ring 195. Switch 199, which may be inserted coaxially over proximal portion 183, is accessible through a transverse slot 205 in second member 117 and is adapted for sliding movement back and forth between the proximal and distal ends of slot 205. A pawl 207 may be pivotally mounted in switch 199 to engage teeth 189 in a ratchet-like fashion. In this manner, when switch 199 is moved distally within slot 205, undesired proximal movement of switch 199 is prevented. However, when one wishes to return switch 199 to its proximal position, pawl 207 may be pivoted away from engagement with teeth 189, thereby allowing spring 197 to decompress, which, in turn, causes switch 199 to be moved back to its proximal position.
  • Tissue modifying device 115 may comprise a morcellator or other mechanical cutting tool, or a transducer or emitter for any of a variety of energy forms such as laser, ultrasound, RF or others known in the art. Another tissue treating device includes, for example, a drug delivery device. In the present embodiment, tissue modifying device 115 is a side opening or end opening morcellator, which may be used to remove abnormalities, such as fibroids and polyps, from a uterus. (For simplicity and clarity, tissue modifying device 115 is shown only in FIG. 10 and is shown therein in simplified form.) Tissue modifying device 115 may be inserted into introducer 112 through lumen 136 of second member 117, preferably with the proximal end of device 115 not being inserted into introducer 112 and with the distal end of device 115 being positioned at or beyond distal end 143 of sheath 121.
  • One way in which system 111 may be used is as follows: First, system 111 is prepped by loading visualization device 113 into introducer 112 through third member 119 and by ensuring that distension mechanism 114 is in its retracted and non-expanded state (as in FIGS. 6 and 9). In addition, a fluid source, such as a fluid-containing syringe, is preferably coupled to first member 116. Next, distal end 143 of sheath 121 is inserted transcervically into the patient up to the os. At this time, it may be desirable to dispense at least some of the fluid contained in the syringe through lumen 151 to wash the distal end of visualization device 113, as well as to flush the uterus. Next, distension mechanism 114 is placed in its advanced and non-expanded state (as in FIG. 7) by moving proximal portion 183 distally until handle 187 abuts proximal end 131 of second member 117. (Pawl 207 will need to be pivoted out of engagement with teeth 189 as proximal portion 183 is moved distally.) Next, distension mechanism 114 is placed in its advanced and expanded state (as in FIG. 8) by moving switch 199 from its proximal position within slot 205 to its distal position within slot 205. With the uterus thus distended, a visual examination of the uterus may be conducted using visualization device 113. In the event that a fibroid or other abnormality is detected that one wishes to remove, then the tissue modifying device 115 is loaded into introducer 112 through lumen 136 of second member 117 and into lumen 154 of sheath 121. As seen in FIG. 10, the introduction of tissue modifying device 115 into lumen 154 causes sheath 121 to be distended. Next, tissue modifying device 115 is moved distally until positioned in the area of the fibroid or other abnormality one wishes to remove. Tissue modifying device 115 is then used to remove the fibroid. When tissue modifying device 115 is no longer needed, device 115 is withdrawn proximally from introducer 112. Distension mechanism 114 is then placed in its advanced and non-expanded state by moving pawl 207 out of engagement with teeth 189, thereby causing spring 197 to pull ring 195 away from point 188 (and causing switch 199 to be moved back to the proximal end of slot 205). Distension mechanism 114 is then placed in its retracted and non-expanded state by pulling handle 187 proximally until distal portion 185 is retracted into sheath 121. Finally, the components of system 111 that still remain in the patient are removed proximally from the patient.
  • In the various embodiments discussed above, although fluid may be used to flush the uterus and/or the distal end of the visualization device, non-fluid mechanical means are used to distend the uterus. However, according to a further aspect of the invention, fluid means are used initially to distend the uterus, and non-fluid mechanical means are thereafter used to maintain the uterus in its distended state. As can be appreciated, this two-part distension technique is not limited to the particular types of distension devices described above.
  • Referring now to FIG. 11, there is shown a plan view of a mechanical expansion device suitable for use in practicing the aforementioned two-part distension method, the mechanical expansion device being constructed according to the teachings of the present invention and being represented generally by reference numeral 301.
  • Device 301 may comprise a pair of arms 303 and 305. A pressure pad 307 may be mounted on the outer end of arm 303, and a pressure pad 308 may be mounted on the outer end of arm 305. The inner ends of arms 303 and 305 may be joined to a spring 309 that biases arms 303 and 305 away from one another. A loop 311, whose purpose will become apparent below, may be positioned adjacent to spring 309.
  • Referring now to FIGS. 12( a) and 12(b), there is shown one way in which device 301 may be used to maintain a uterus in a distended state. In FIG. 12( a), a pair of devices 301 are shown loaded into lumen 53 of introducer 13, introducer device 13 having been inserted transcervically into a patient up to the os. The uterus of the patient is shown distended with a distension fluid, which preferably has previously been delivered to the uterus by means of a fluid-containing syringe (not shown) coupled to lumen 51. Devices 301 may be ejected from lumen 53 of introducer device 13 into the distended uterus by an ejector rod 315. In FIG. 12( b), devices 301 are shown deployed in the uterus to maintain the uterus in its already distended state. With the uterus thus maintained in its distended state, a morcellator or other desired tool may be inserted through lumen 53 of introducer 13 into the uterus. When distension of the uterus is no longer desired, devices 301 may be removed from the uterus by inserting a hook 319 or similar structure into the uterus through introducer 13, using hook 319 to grasp devices 301 by their respective loops 311, and then pulling hook 319 proximally to retract the hooked devices 301 into lumen 53 of introducer 13.
  • In general, the mechanical distension device is thus any of a wide variety of structures which are capable of translumenal introduction through the working channel in a first, reduced cross sectional profile and transformation to a second, enlarged cross sectional profile once in the vicinity of the treatment site. The second, enlarged cross sectional profile creates a sufficient space at the site to allow manipulation of diagnostic or therapeutic tools necessary for the intended procedure. This may be, for example, equivalent to at least the volume of the cavity created by 70 to 80 mm Hg of fluid distension.
  • Typically, the distension provided by a fluid or gas is diffuse in nature. Rather than creating a discrete working space at the desired treatment site, the media expands the associated cavity without preference. In the case of uterine distension, a fluid pressure of 35 to 60 mm Hg typically produces a cavity of 10 to 50 cc in total volume. But the volume of the distension media is distributed evenly throughout the entire uterus, so that the effective working space provided in the immediate vicinity of any particular treatment site is relatively small compared to the total volume of the cavity. The addition of additional pressure that can reach 100 to 120 mm Hg does provide additional cavity volume but at the risk of fluid intravasation and greater pain for the patient.
  • One particular advantage of the mechanical distension structures in accordance with the present invention is the ability to create a specific working space at a desired site, while leaving other parts of the cavity in its collapsed configuration. By localizing the distension to the desired site, the size of the working cavity at that site can be optimized while minimizing the total volume of the distension and the associated pain for the patient.
  • For example, it may be desirable to provide a working space in the immediate vicinity of a treatment site having dimensions that would approximate a 10 cc sphere. To create that same working space by infusion of distension media, the infused volume may need to be at least about 40 cc or 50 cc or more. Thus, in accordance with the present invention, the working space created at the desired site is at least about 50%, often at least about 70% and preferably at least about 85% of the enclosed volume of the expandable portion of the distension device. The working space may be approximately equal to the volume of the expanded device, which may be less than about 50%, often less than about 35% and preferably less than about 25% of the volume of distension media which would be necessary to achieve a similar working volume at the treatment site.
  • The expansion device may be permanently attached to the distal end of an operating shaft, permanently attached to the distal end of a tether, or detachable at the treatment site. Any of a wide variety of detachable expansion structures may be subsequently removed by advancing a grasper down the working channel and grasping the device under endoscopic visualization. The device may be thereafter be proximally retracted into the working channel and reduced in cross section for removal.
  • In general, the tissue distension structure will have at least a first surface for contacting a first tissue zone and a second surface for contacting a second tissue zone. Activation of the distension structure advances the first and second surfaces away from each other, to enlarge the distance between the first and second tissue zones. In the embodiment illustrated in FIGS. 7 and 8, for example, the tissue distension structure opens such that it resides substantially within a single plane which contains the longitudinal axis of the device. In alternative embodiments, the tissue distension structure may open in two transverse planes having an intersection along the longitudinal axis of the device, or such that the distension structure opens into a more complex three dimensional configuration, including spherical, elliptical, and other geometric forms of rotation about an axis. In each instance, the tissue distension device preferably includes at least one opening in a side or end wall thereof, to permit access to the target tissue.
  • Thus, the embodiment of FIGS. 7 and 8 can be modified such that two or three or four or more axially extending ribs are advanceable from a generally axially extending configuration such as that illustrated in FIG. 7 to a radially outwardly inclined configuration such as that illustrated in FIG. 8.
  • In an alternate embodiment (not illustrated), a plurality of axially extending ribs are connected together at a distal end to a pull wire which extends to the proximal end of the instrument. The proximal ends of the ribs are connected to a tubular column strength support having a central lumen through which the pull wire extends. Proximal retraction of the pull wire axially shortens the distension element while simultaneously radially expanding the ribs to the second, radially enlarged configuration to produce a cage having a three dimensional volume.
  • Both the endoscope and the tissue cutting element may be provided in a steerable configuration, such that they may be distally advanced into the working space created by the distension element and laterally deflected which, in combination with axial rotation, gives access to a wide variety of treatment sites within the distension structure. Any of a wide variety of deflection mechanisms may be utilized, as are well understood in the art, including axially extending pull wires and push wires mechanically linked to a proximal control such as a rotatable knob or slider switch.
  • In any of the foregoing embodiments, the expansion structure may be utilized both to accomplish initial expansion as well as retention of the tissue in the expanded configuration. Alternatively, fluid pressure such as water pressure as has been used conventionally may be utilized to achieve tissue expansion, and the expansion structures of the present invention may be utilized to retain the tissue in the expanded configuration. At that point, the fluid pressure may be reduced, such that the risk of intravasation is thereby eliminated.
  • The embodiments of the present invention described above are intended to be merely exemplary and those skilled in the art shall be able to make numerous variations and modifications to it without departing from the spirit of the present invention. All such variations and modifications are intended to be within the scope of the present invention as defined in the appended claims.

Claims (14)

1. A system for use in performing a medical procedure, the system comprising:
a) an introducer for providing access to an internal site within a body;
b) a mechanical expansion structure, the mechanical expansion structure being deliverable to the internal site using the introducer;
c) a visualization device, the visualization device being deliverable to the internal site using the introducer; and
d) a tissue modifying device, the tissue modifying device being deliverable to the internal site using the introducer.
2. The system as claimed in claim 1 wherein the introducer includes a dedicated fluid channel, the system further comprising a fluid source adapted to be coupled to the introducer so that fluid may be dispensed through the fluid channel.
3. The system as claimed in claim 1 wherein the introducer includes a plurality of channels.
4. The system as claimed in claim 3 wherein the plurality of channels includes a first channel, a second channel, and a third channel, the first channel being the dedicated fluid channel, the system further comprising a fluid source adapted to be coupled to the introducer so that fluid may be dispensed through the dedicated fluid channel.
5. The system as claimed in claim 4 wherein the second channel is adapted to receive alternately the mechanical expansion structure and the tissue modifying device.
6. The system as claimed in claim 4 wherein the second channel is radially expandable.
7. The system as claimed in claim 4 wherein the third channel is adapted to receive the visualization device.
8. The system as claimed in claim 1 wherein the mechanical expansion structure is self-expanding.
9. The system as claimed in claim 8 further comprising a tie-line secured at one end to the mechanical expansion structure.
10. The system as claimed in claim 1 wherein the mechanical expansion structure is not self-expanding, the system further comprising an actuator for expanding the mechanical expansion structure.
11. The system as claimed in claim 1 wherein the visualization device includes a hysteroscope.
12. The system as claimed in claim 1 wherein the tissue modifying device includes a morcellator.
13. The system as claimed in claim 1 wherein the introducer includes a first channel, a second channel, a third channel, and a fourth channel, the first channel being a fluid channel, the second channel receiving the mechanical expansion structure, the third channel receiving the visualization device, and the fourth channel receiving the tissue modifying device.
14. The system as claimed in claim 13 further comprising a fluid source coupled to the introducer so that fluid may be dispensed through the fluid channel.
US11/923,357 2006-11-07 2007-10-24 Mechanical distension systems for performing a medical procedure in a remote space Abandoned US20080146872A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US11/923,357 US20080146872A1 (en) 2006-11-07 2007-10-24 Mechanical distension systems for performing a medical procedure in a remote space
EP07864004A EP2089091A4 (en) 2006-11-07 2007-11-06 Mechanical distension systems for performing a medical procedure in a remote space
PCT/US2007/083833 WO2008058157A2 (en) 2006-11-07 2007-11-06 Systems for mechanically expanding, examining and treating a uterus

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US85744006P 2006-11-07 2006-11-07
US91061807P 2007-04-06 2007-04-06
US91062507P 2007-04-06 2007-04-06
US11/923,357 US20080146872A1 (en) 2006-11-07 2007-10-24 Mechanical distension systems for performing a medical procedure in a remote space

Publications (1)

Publication Number Publication Date
US20080146872A1 true US20080146872A1 (en) 2008-06-19

Family

ID=39365329

Family Applications (2)

Application Number Title Priority Date Filing Date
US11/923,482 Active 2035-03-11 US9392935B2 (en) 2006-11-07 2007-10-24 Methods for performing a medical procedure
US11/923,357 Abandoned US20080146872A1 (en) 2006-11-07 2007-10-24 Mechanical distension systems for performing a medical procedure in a remote space

Family Applications Before (1)

Application Number Title Priority Date Filing Date
US11/923,482 Active 2035-03-11 US9392935B2 (en) 2006-11-07 2007-10-24 Methods for performing a medical procedure

Country Status (3)

Country Link
US (2) US9392935B2 (en)
EP (1) EP2089091A4 (en)
WO (1) WO2008058157A2 (en)

Cited By (44)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080245371A1 (en) * 2007-04-06 2008-10-09 William Harwick Gruber Systems, methods and devices for performing gynecological procedures
US20090270812A1 (en) * 2007-04-06 2009-10-29 Interlace Medical , Inc. Access device with enhanced working channel
WO2010014707A1 (en) * 2008-07-30 2010-02-04 Cornell University Method and apparatus for straightening and flattening the side wall of a body lumen or body cavity so as to provide three dimensional exposure of a lesion or abnormality within the body lumen or body cavity, and/or for stabilizing an instrument relative to the same
US8323278B2 (en) 2010-12-06 2012-12-04 Soulor Surgical, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
US8574253B2 (en) 2007-04-06 2013-11-05 Hologic, Inc. Method, system and device for tissue removal
US8834487B2 (en) 2006-10-18 2014-09-16 Hologic, Inc. Systems and methods for preventing intravasation during intrauterine procedures
US8893722B2 (en) 1997-09-04 2014-11-25 Smith & Nephew, Inc. Surgical endoscopic cutting device and method for its use
US9060801B1 (en) 2001-10-26 2015-06-23 Smith & Nephew, Inc. Reciprocating rotary arthroscopic surgical instrument
US9095366B2 (en) 2007-04-06 2015-08-04 Hologic, Inc. Tissue cutter with differential hardness
US9125550B2 (en) 2004-08-27 2015-09-08 Smith & Nephew, Inc. Tissue resecting system
JP2015165865A (en) * 2014-03-04 2015-09-24 株式会社八光 Tissue ablation device for loop endoscope
US9155454B2 (en) 2010-09-28 2015-10-13 Smith & Nephew, Inc. Hysteroscopic system
US10299803B2 (en) 2016-08-04 2019-05-28 Covidien Lp Self-aligning drive coupler
US10299819B2 (en) 2016-07-28 2019-05-28 Covidien Lp Reciprocating rotary surgical cutting device and system for tissue resecting, and method for its use
US10631889B2 (en) 2014-12-16 2020-04-28 Covidien Lp Surgical device with incorporated tissue extraction
US10750931B2 (en) 2015-05-26 2020-08-25 Covidien Lp Systems and methods for generating a fluid bearing for an operative procedure
US10772652B2 (en) 2015-01-28 2020-09-15 Covidien Lp Tissue resection system
US10772654B2 (en) 2017-03-02 2020-09-15 Covidien Lp Fluid-driven tissue resecting instruments, systems, and methods
US10799264B2 (en) 2015-06-18 2020-10-13 Covidien Lp Surgical instrument with suction control
US10804769B2 (en) 2015-06-17 2020-10-13 Covidien Lp Surgical instrument with phase change cooling
US10842350B2 (en) 2015-06-17 2020-11-24 Covidien Lp Endoscopic device with drip flange and methods of use thereof for an operative procedure
US10869684B2 (en) 2018-02-13 2020-12-22 Covidien Lp Powered tissue resecting device
US10898218B2 (en) 2019-02-25 2021-01-26 Covidien Lp Tissue resecting device including a motor cooling assembly
US10945752B2 (en) 2019-03-20 2021-03-16 Covidien Lp Tissue resecting instrument including a rotation lock feature
US10987131B2 (en) 2017-05-25 2021-04-27 Coopersurgical, Inc. Tissue containment systems and related methods
US11065147B2 (en) 2018-10-18 2021-07-20 Covidien Lp Devices, systems, and methods for pre-heating fluid to be introduced into a patient during a surgical procedure
US11083481B2 (en) 2019-02-22 2021-08-10 Covidien Lp Tissue resecting instrument including an outflow control seal
US11154318B2 (en) 2019-02-22 2021-10-26 Covidien Lp Tissue resecting instrument including an outflow control seal
US11179172B2 (en) 2019-12-05 2021-11-23 Covidien Lp Tissue resecting instrument
US11197710B2 (en) 2018-10-26 2021-12-14 Covidien Lp Tissue resecting device including a blade lock and release mechanism
US11317947B2 (en) 2020-02-18 2022-05-03 Covidien Lp Tissue resecting instrument
US11376032B2 (en) 2019-12-05 2022-07-05 Covidien Lp Tissue resecting instrument
US11452806B2 (en) 2019-10-04 2022-09-27 Covidien Lp Outflow collection vessels, systems, and components thereof for hysteroscopic surgical procedures
WO2022255897A1 (en) * 2021-06-04 2022-12-08 Belciu Kerns Roxana Anatomical dilator for passage of medical instruments inside a bodily cavity
US11547782B2 (en) 2020-01-31 2023-01-10 Covidien Lp Fluid collecting sheaths for endoscopic devices and systems
US11547815B2 (en) 2018-05-30 2023-01-10 Covidien Lp Systems and methods for measuring and controlling pressure within an internal body cavity
US11553977B2 (en) 2019-05-29 2023-01-17 Covidien Lp Hysteroscopy systems and methods for managing patient fluid
US11571233B2 (en) 2020-11-19 2023-02-07 Covidien Lp Tissue removal handpiece with integrated suction
US11596429B2 (en) 2020-04-20 2023-03-07 Covidien Lp Tissue resecting instrument
US11737777B2 (en) 2020-02-05 2023-08-29 Covidien Lp Tissue resecting instruments
US11864735B2 (en) 2016-05-26 2024-01-09 Covidien Lp Continuous flow endoscope
US11883058B2 (en) 2019-03-26 2024-01-30 Covidien Lp Jaw members, end effector assemblies, and ultrasonic surgical instruments including the same
US11890237B2 (en) 2019-10-04 2024-02-06 Covidien Lp Outflow collection vessels, systems, and components thereof for hysteroscopic surgical procedures
US11903602B2 (en) 2009-04-29 2024-02-20 Hologic, Inc. Uterine fibroid tissue removal device

Families Citing this family (41)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
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 endoscope
US20100137681A1 (en) * 2008-11-21 2010-06-03 Usgi Medical, Inc. Endoscopic instrument management system
US8460327B2 (en) 2008-12-16 2013-06-11 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
US9655639B2 (en) 2008-12-16 2017-05-23 Nico Corporation Tissue removal device for use with imaging devices in neurosurgical and spinal surgery applications
US10080578B2 (en) 2008-12-16 2018-09-25 Nico Corporation Tissue removal device with adjustable delivery sleeve for neurosurgical and spinal surgery applications
US9931105B2 (en) 2008-12-16 2018-04-03 Nico Corporation System and method of taking and collecting tissue cores for treatment
US9279751B2 (en) 2008-12-16 2016-03-08 Nico Corporation System and method of taking and collecting tissue cores for treatment
US8496599B2 (en) 2008-12-16 2013-07-30 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
US9216031B2 (en) * 2008-12-16 2015-12-22 Nico Corporation Tissue removal device with adjustable fluid supply sleeve for neurosurgical and spinal surgery applications
US8702738B2 (en) 2008-12-16 2014-04-22 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
US8657841B2 (en) 2008-12-16 2014-02-25 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
US10368890B2 (en) 2008-12-16 2019-08-06 Nico Corporation Multi-functional surgical device for neurosurgical and spinal surgery applications
US9820480B2 (en) 2008-12-16 2017-11-21 Nico Corporation System for collecting and preserving tissue cores
US9504247B2 (en) 2008-12-16 2016-11-29 Nico Corporation System for collecting and preserving tissue cores
US8357175B2 (en) 2008-12-16 2013-01-22 Nico Corporation Positioning system for tissue removal device
US8430825B2 (en) 2008-12-16 2013-04-30 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
DE102009015392A1 (en) 2009-03-20 2010-09-23 Karl Storz Gmbh & Co. Kg Medical instrument, in particular hysteroscope
US8388622B2 (en) 2009-09-17 2013-03-05 The Anspach Effort, Inc. Surgical file instrument construction with mechanism to convert rotary motion to reciprocal motion
US8486096B2 (en) * 2010-02-11 2013-07-16 Ethicon Endo-Surgery, Inc. Dual purpose surgical instrument for cutting and coagulating tissue
US20130317390A1 (en) * 2011-01-27 2013-11-28 Mayo Foundation For Medical Education And Research Cytological sample acquisition device and method
US11291351B2 (en) * 2011-08-19 2022-04-05 Harold I. Daily Hysteroscopes with curved tips
US20140121445A1 (en) * 2012-10-28 2014-05-01 PF BioMedical Solutions, LLC Intracavitary Brachytherapy Device for Insertion in a Body Cavity and Methods of Use Thereof
AU2014214538B2 (en) * 2013-02-06 2018-11-15 Mark SILLENDER Embryo transfer catheter and method
SI3003449T1 (en) * 2013-05-29 2018-08-31 SPEISER, Paul Three lumen balloon catheter apparatus
EP3016574B1 (en) * 2013-09-26 2021-03-24 Gyrus ACMI, Inc. (d.b.a.Olympus Surgical Technologies America) Endoscope sheath arm
EP3160528B1 (en) * 2014-06-30 2019-03-27 Stichting Katholieke Universiteit Heart support device
CN104367349A (en) * 2014-11-21 2015-02-25 曾惠清 Automatic radiofrequency ablation negative pressure biopsy system
CN105011971B (en) * 2015-07-29 2018-03-09 上海家宝医学保健科技有限公司 A kind of multifunction combined suction apparatus for uterine cavity tissues
IT201600080030A1 (en) * 2016-07-29 2018-01-29 Medical Swan Italia S A S Di Paolo Valenti & C Disposable hysteroscope sheath
US11253308B2 (en) 2017-05-12 2022-02-22 Covidien Lp Colpotomy systems, devices, and methods with rotational cutting
US11090082B2 (en) 2017-05-12 2021-08-17 Covidien Lp Colpotomy systems, devices, and methods with rotational cutting
US11213320B2 (en) 2017-05-12 2022-01-04 Covidien Lp Uterine manipulator with detachable cup and locking occluder
DE102017117385A1 (en) * 2017-08-01 2019-02-07 Olympus Winter & Ibe Gmbh Endoscope with rotatable working channels
US10980571B2 (en) 2017-08-15 2021-04-20 Covidien Lp Occlusion devices, systems, and methods
US11172815B2 (en) 2017-12-21 2021-11-16 Gyrus Acmi, Inc. Uterine cavity biocompatible seal
US11076982B2 (en) 2017-12-29 2021-08-03 Gyrus Acmi, Inc. Fallopian biocompatible plug with differently expandable portions
US11344292B2 (en) 2018-06-14 2022-05-31 Covidien Lp Trans-vaginal cuff anchor and method of deploying same
AU2019320769A1 (en) 2018-08-17 2021-03-11 Empress Medical, Inc. Devices and methods for compressing tumors
US11419610B2 (en) 2018-08-17 2022-08-23 Empress Medical, Inc. Device and method for passing tension member around tissue mass
US11717656B2 (en) * 2019-03-20 2023-08-08 Gyros ACMI Inc. Delivery of mixed phase media for the treatment of the anatomy
US20220240766A1 (en) * 2021-02-03 2022-08-04 Chin-Piao Chang Endoscope Kit having Functions of Injection, Clamping and Placing Medical Materials or Medicines

Citations (98)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3561429A (en) * 1968-05-23 1971-02-09 Eversharp Inc Instrument for obtaining a biopsy specimen
US4188952A (en) * 1973-12-28 1980-02-19 Loschilov Vladimir I Surgical instrument for ultrasonic separation of biological tissue
US4203444A (en) * 1977-11-07 1980-05-20 Dyonics, Inc. Surgical instrument suitable for closed surgery such as of the knee
US4246902A (en) * 1978-03-10 1981-01-27 Miguel Martinez Surgical cutting instrument
US4261360A (en) * 1979-11-05 1981-04-14 Urethral Devices Research, Inc. Transurethral irrigation pressure controller
US4650462A (en) * 1985-07-29 1987-03-17 Minnesota Mining And Manufacturing Company Irrigation system
US4673393A (en) * 1984-12-28 1987-06-16 Terumo Kabushiki Kaisha Medical instrument
US4729763A (en) * 1986-06-06 1988-03-08 Henrie Rodney A Catheter for removing occlusive material
US4895565A (en) * 1987-09-21 1990-01-23 Cordis Corporation Medical instrument valve
US4998527A (en) * 1989-07-27 1991-03-12 Percutaneous Technologies Inc. Endoscopic abdominal, urological, and gynecological tissue removing device
US5078725A (en) * 1989-11-09 1992-01-07 C. R. Bard, Inc. Balloon catheter and techniques for dilating obstructed lumens and other luminal procedures
US5104377A (en) * 1989-08-10 1992-04-14 C. R. Bard, Inc. Uterine access device with automatic cervical adjustment
US5125903A (en) * 1991-08-01 1992-06-30 Medtronic, Inc. Hemostasis valve
US5183031A (en) * 1991-05-13 1993-02-02 Rossoff Leonard J Fiberoptic intubating laryngoscope
US5195541A (en) * 1991-10-18 1993-03-23 Obenchain Theodore G Method of performing laparoscopic lumbar discectomy
US5201756A (en) * 1990-06-20 1993-04-13 Danforth Biomedical, Inc. Radially-expandable tubular elements for use in the construction of medical devices
US5275609A (en) * 1990-06-22 1994-01-04 Vance Products Incorporated Surgical cutting instrument
US5304115A (en) * 1991-01-11 1994-04-19 Baxter International Inc. Ultrasonic angioplasty device incorporating improved transmission member and ablation probe
US5392765A (en) * 1993-02-11 1995-02-28 Circon Corporation Continuous flow cystoscope
US5402772A (en) * 1991-05-29 1995-04-04 Origin Medsystems, Inc. Endoscopic expandable retraction device
US5458633A (en) * 1994-05-24 1995-10-17 Bailey; Robert W. Irrigating laparoscopic cannula or trocar
US5484401A (en) * 1992-11-04 1996-01-16 Denver Biomaterials, Inc. Treatment method for pleural effusion
US5503626A (en) * 1994-04-14 1996-04-02 Bei Medical Systems Fluid delivery system for hysteroscopic surgery
US5505730A (en) * 1994-06-24 1996-04-09 Stuart D. Edwards Thin layer ablation apparatus
US5514091A (en) * 1988-07-22 1996-05-07 Yoon; Inbae Expandable multifunctional manipulating instruments for various medical procedures
US5602449A (en) * 1992-04-13 1997-02-11 Smith & Nephew Endoscopy, Inc. Motor controlled surgical system and method having positional control
US5601583A (en) * 1995-02-15 1997-02-11 Smith & Nephew Endoscopy Inc. Surgical instrument
US5618296A (en) * 1995-07-24 1997-04-08 Endomedix Corporation/Box 330 Tissue morcellator system and method
US5624395A (en) * 1995-02-23 1997-04-29 Cv Dynamics, Inc. Urinary catheter having palpitatable valve and balloon and method for making same
US5624399A (en) * 1995-09-29 1997-04-29 Ackrad Laboratories, Inc. Catheter having an intracervical/intrauterine balloon made from polyurethane
US5653684A (en) * 1992-06-26 1997-08-05 Schneider (Usa), Inc. Catheter with expandable wire mesh tip
US5725525A (en) * 1993-03-16 1998-03-10 Ep Technologies, Inc. Multiple electrode support structures with integral hub and spline elements
US5738629A (en) * 1991-05-29 1998-04-14 Origin Medsystems, Inc. Self-retracting endoscope
US5741287A (en) * 1996-11-01 1998-04-21 Femrx, Inc. Surgical tubular cutter having a tapering cutting chamber
US5743851A (en) * 1991-05-29 1998-04-28 Origin Medsystems, Inc. Retraction apparatus and methods for endoscopic surgery
US5749845A (en) * 1995-01-25 1998-05-12 Iotek, Inc. Delivering an agent to an organ
US5755731A (en) * 1994-04-15 1998-05-26 Smith & Nephew Dyonics, Inc. Curved surgical instrument with segmented inner member
US5769816A (en) * 1995-11-07 1998-06-23 Embol-X, Inc. Cannula with associated filter
US5857585A (en) * 1996-05-28 1999-01-12 Act Medical, Inc. Ligating band dispenser
US5865728A (en) * 1991-05-29 1999-02-02 Origin Medsystems, Inc. Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space
US5873815A (en) * 1995-10-10 1999-02-23 Conceptus, Inc. Access catheter and method for maintaining separation between a falloposcope and a tubal wall
US5891134A (en) * 1996-09-24 1999-04-06 Goble; Colin System and method for applying thermal energy to tissue
US5902251A (en) * 1996-05-06 1999-05-11 Vanhooydonk; Neil C. Transcervical intrauterine applicator for intrauterine hyperthermia
US5904680A (en) * 1992-09-25 1999-05-18 Ep Technologies, Inc. Multiple electrode support structures having optimal bio-mechanical characteristics
US5904649A (en) * 1998-04-03 1999-05-18 Andrese; Craig A. Organ retractors
US5913814A (en) * 1997-08-26 1999-06-22 Belmont Instrument Corporation Method and apparatus for deflation of an intra-aortic balloon
US6039748A (en) * 1997-08-05 2000-03-21 Femrx, Inc. Disposable laparoscopic morcellator
US6042590A (en) * 1997-06-16 2000-03-28 Novomedics, Llc Apparatus and methods for fallopian tube occlusion
US6068626A (en) * 1997-06-05 2000-05-30 Adiana, Inc. Method and apparatus for tubal occlusion
US6216044B1 (en) * 1993-03-16 2001-04-10 Ep Technologies, Inc. Medical device with three dimensional collapsible basket structure
US6216043B1 (en) * 1994-03-04 2001-04-10 Ep Technologies, Inc. Asymmetric multiple electrode support structures
US6221007B1 (en) * 1996-05-03 2001-04-24 Philip S. Green System and method for endoscopic imaging and endosurgery
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
US6328730B1 (en) * 1999-03-26 2001-12-11 William W. Harkrider, Jr. Endoluminal multi-luminal surgical sheath and method
US20020013601A1 (en) * 2000-01-28 2002-01-31 Nobles Anthony A. Cavity enlarger method and apparatus
US20020020417A1 (en) * 1995-06-07 2002-02-21 Nikolchev Julian N. Contraceptive transcervical fallopian tube occlusion devices and methods
US6378524B1 (en) * 1998-11-06 2002-04-30 Jesse M. Jones Method of sterilizing females
US6387110B1 (en) * 1999-06-23 2002-05-14 Smith & Nephew, Inc. Coating for surgical blades
US6395012B1 (en) * 2000-05-04 2002-05-28 Inbae Yoon Apparatus and method for delivering and deploying an expandable body member in a uterine cavity
US20030050639A1 (en) * 2001-09-12 2003-03-13 Harmonia Medical Technologies Surgical instrument and method of using the same
US6537207B1 (en) * 1999-04-07 2003-03-25 Fovioptics, Inc. Identification of protective covers for medical imaging devices
US6547784B1 (en) * 2000-06-23 2003-04-15 Ethicon, Inc. System and method for placement of a surgical instrument in a body cavity
US20030083684A1 (en) * 2001-10-26 2003-05-01 Cesarini Peter M. Reciprocating rotary arthroscopic surgical instrument
US20040002702A1 (en) * 2002-06-28 2004-01-01 Ethicon, Inc. RF device for treating the uterus
US20040002703A1 (en) * 2002-06-28 2004-01-01 Ethicon, Inc. RF device for treating the uterus
US6682477B2 (en) * 2000-02-25 2004-01-27 Richard Wolf Gmbh Hysteroscope
US20050027245A1 (en) * 1996-02-23 2005-02-03 Memory Medical Systems, Inc. Medical instrument with slotted memory metal tube
US6858024B1 (en) * 1994-02-14 2005-02-22 Scimed Life Systems, Inc. Guide catheter having selected flexural modulus segments
US20050045183A1 (en) * 1996-12-18 2005-03-03 Ovion, Inc. Methods and devices for occluding body lumens and/or for delivering therapeutic agents
US20050080318A1 (en) * 2003-10-09 2005-04-14 Squicciarini John B. Multi-functional video scope
US20050090849A1 (en) * 2003-10-22 2005-04-28 Adams Kenneth M. Angled tissue cutting instruments and method of fabricating angled tissue cutting instrument having flexible inner tubular members of tube and single wrap construction
US20050107663A1 (en) * 2003-01-15 2005-05-19 Usgi Medical Inc. Endoluminal tool deployment system
US20050113836A1 (en) * 2003-11-25 2005-05-26 Lozier Antony J. Expandable reamer
US20050113715A1 (en) * 2000-11-06 2005-05-26 Jeffrey Schwindt Biopsy apparatus
US20050113857A1 (en) * 2000-12-27 2005-05-26 Martin Nohilly Surgical balloon having varying wall thickness
US20060009798A1 (en) * 2004-02-02 2006-01-12 Ams Research Corporation Methods and devices for occluding body lumens and/or enhancing tissue ingrowth
US20060036138A1 (en) * 2004-08-06 2006-02-16 Adam Heller Devices and methods of screening for neoplastic and inflammatory disease
US20060047185A1 (en) * 2004-08-27 2006-03-02 Cemal Shener Tissue resecting system
US20060089658A1 (en) * 2004-10-21 2006-04-27 Harrington Douglas C Method and apparatus for treating abnormal uterine bleeding
US20070010845A1 (en) * 2005-07-08 2007-01-11 Gorman Gong Directionally controlled expandable device and methods for use
US7189206B2 (en) * 2003-02-24 2007-03-13 Senorx, Inc. Biopsy device with inner cutter
US20080015621A1 (en) * 1997-09-04 2008-01-17 Smith & Nephew, Inc. Surgical endoscopic cutting device and method for its use
US20080051758A1 (en) * 2006-07-18 2008-02-28 Boston Scientific Scimed, Inc. Medical devices
US20080058595A1 (en) * 2006-06-14 2008-03-06 Snoke Phillip J Medical device introduction systems and methods
US20080065125A1 (en) * 2000-12-20 2008-03-13 Foxhollow Technologies, Inc. High capacity debulking catheter with distal driven cutting wheel
US20090005739A1 (en) * 2001-11-13 2009-01-01 Applied Medical Resources Corporation Multi-seal trocar system
US7481817B2 (en) * 2003-02-13 2009-01-27 Lsi Soultions, Inc. Instrument for surgically cutting tissue and method of use
US7491212B2 (en) * 2003-02-19 2009-02-17 Smith & Nephew, Inc. Transmitting an actuating force along a curved instrument
US20090048485A1 (en) * 2006-07-19 2009-02-19 Heisler Gary R Endoscopic cutting instruments having improved cutting efficiency and reduced manufacturing costs
US20090054728A1 (en) * 2007-08-21 2009-02-26 Trusty Robert M Manipulatable guide system and methods for natural orifice translumenal endoscopic surgery
US7497833B2 (en) * 2000-11-06 2009-03-03 Suros Surgical Systems, Inc. Biopsy apparatus with vacuum relief
US7510563B2 (en) * 2001-10-26 2009-03-31 Smith & Nephew, Inc. Reciprocating rotary arthroscopic surgical instrument
US20090118699A1 (en) * 1998-02-19 2009-05-07 Respiratory Diagnostic, Inc. Systems and methods for treating obesity and other gastrointestinal conditions
US7666200B2 (en) * 2006-07-19 2010-02-23 Target Medical Innovations Llc Endoscopic cutting instrument with axial and rotary motion
US20100063360A1 (en) * 2006-11-28 2010-03-11 Adiana, Inc. Side-arm Port Introducer
US20110034943A1 (en) * 2007-04-06 2011-02-10 Interlace Medical, Inc. Low advance ratio, high reciprocation rate tissue removal device
US20110077674A1 (en) * 2007-04-06 2011-03-31 Interlace Medical, Inc. Tissue cutter with differential hardness
US7938804B2 (en) * 2009-03-30 2011-05-10 Tyco Healthcare Group Lp Surgical access apparatus with seal and closure valve assembly

Family Cites Families (176)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1080318A (en) 1912-12-19 1913-12-02 John Behringer Non-refillable bottle.
US2849002A (en) 1956-03-12 1958-08-26 Vincent J Oddo Haemostatic catheter
US4198981A (en) * 1978-03-27 1980-04-22 Manfred Sinnreich Intrauterine surgical device
US4207891A (en) 1978-10-10 1980-06-17 Population Research Incorporated Dispensing instrument with supported balloon
EP0044877B1 (en) 1980-07-26 1985-03-13 Kurz, Karl-Heinz, Dr. med. Device for determining the internal dimensions of the uterine cavity
US4598698A (en) 1983-01-20 1986-07-08 Warner-Lambert Technologies, Inc. Diagnostic device
US4552557A (en) 1983-10-21 1985-11-12 Avvari Rangaswamy Inflatable uterine hemostat
US4598710A (en) 1984-01-20 1986-07-08 Urban Engineering Company, Inc. Surgical instrument and method of making same
EP0153190B1 (en) 1984-02-20 1989-05-03 Olympus Optical Co., Ltd. Endoscopic ovum picker instruments
US4750488A (en) 1986-05-19 1988-06-14 Sonomed Technology, Inc. Vibration apparatus preferably for endoscopic ultrasonic aspirator
NL8700329A (en) * 1987-02-11 1988-09-01 Hoed Daniel Stichting DEVICE AND METHOD FOR EXAMINING AND / OR EXPOSING A CAVE IN A BODY.
US5259836A (en) 1987-11-30 1993-11-09 Cook Group, Incorporated Hysterography device and method
US5556376A (en) 1988-07-22 1996-09-17 Yoon; Inbae Multifunctional devices having loop configured portions and collection systems for endoscopic surgical procedures and methods thereof
US4949718B1 (en) 1988-09-09 1998-11-10 Gynelab Products Intrauterine cauterizing apparatus
US5100382A (en) 1988-10-24 1992-03-31 Valtchev Konstantin L Single channel balloon uterine injector
US5163433A (en) 1989-11-01 1992-11-17 Olympus Optical Co., Ltd. Ultrasound type treatment apparatus
US5108414A (en) * 1989-11-09 1992-04-28 C. R. Bard, Inc. Techniques for dilating obstructed lumens and other luminal procedures
US5163949A (en) 1990-03-02 1992-11-17 Bonutti Peter M Fluid operated retractors
CA2039414C (en) 1990-03-29 1995-09-05 Robert W. Bailey Abdominal cavity organ retractor
US5222971A (en) 1990-10-09 1993-06-29 Scimed Life Systems, Inc. Temporary stent and methods for use and manufacture
US5460628A (en) 1991-01-28 1995-10-24 Neuwirth; Robert S. Heated balloon medical apparatus with fluid agitating means
US5199419A (en) 1991-08-05 1993-04-06 United States Surgical Corporation Surgical retractor
AU658932B2 (en) 1991-10-18 1995-05-04 Ethicon Inc. Endoscopic tissue manipulator
US5246016A (en) 1991-11-08 1993-09-21 Baxter International Inc. Transport catheter and multiple probe analysis method
US5269798A (en) 1992-02-19 1993-12-14 Linvatec Corporation Surgical cutting instrument with movable, inner and outer tubular members
US5320091A (en) 1992-04-27 1994-06-14 Circon Corporation Continuous flow hysteroscope
US5443470A (en) 1992-05-01 1995-08-22 Vesta Medical, Inc. Method and apparatus for endometrial ablation
US5331947A (en) * 1992-05-01 1994-07-26 Shturman Cardiology Systems, Inc. Inflatable sheath for introduction of ultrasonic catheter through the lumen of a fiber optic endoscope
US5562720A (en) 1992-05-01 1996-10-08 Vesta Medical, Inc. Bipolar/monopolar endometrial ablation device and method
US5496280A (en) * 1992-07-02 1996-03-05 Applied Medical Resources Corporation Trocar valve assembly
US5356416A (en) 1992-10-09 1994-10-18 Boston Scientific Corporation Combined multiple ligating band dispenser and sclerotherapy needle instrument
US5354302A (en) 1992-11-06 1994-10-11 Ko Sung Tao Medical device and method for facilitating intra-tissue visual observation and manipulation of distensible tissues
US5972000A (en) 1992-11-13 1999-10-26 Influence Medical Technologies, Ltd. Non-linear anchor inserter device and bone anchors
FR2701401A1 (en) 1993-02-10 1994-08-19 Aubry Pascal Angioplasty device
US5377668A (en) 1993-04-12 1995-01-03 Optimed Technologies, Inc. Apparatus and method for endoscopic diagnostics and therapy
US5855549A (en) * 1993-08-18 1999-01-05 Vista Medical Technologies, Inc. Method of using an optical female urethroscope
US5462529A (en) 1993-09-29 1995-10-31 Technology Development Center Adjustable treatment chamber catheter
US5423844A (en) 1993-10-22 1995-06-13 Promex, Inc. Rotary surgical cutting instrument
US5911739A (en) 1994-03-04 1999-06-15 Ep Technologies, Inc. Structures for supporting diagnostic or therapeutic elements in internal body regions
FR2718452B1 (en) 1994-04-06 1996-06-28 Pf Medicament Element of immunogen, immunogenic agent, pharmaceutical composition and method of preparation.
US6002968A (en) 1994-06-24 1999-12-14 Vidacare, Inc. Uterine treatment apparatus
US5575788A (en) 1994-06-24 1996-11-19 Stuart D. Edwards Thin layer ablation apparatus
US5540658A (en) 1994-06-27 1996-07-30 Innerdyne, Inc. Transcervical uterine access and sealing device
US5458112A (en) 1994-08-15 1995-10-17 Arrow Precision Products, Inc. Biliary biopsy device
US6032673A (en) 1994-10-13 2000-03-07 Femrx, Inc. Methods and devices for tissue removal
ES2184780T3 (en) 1994-11-07 2003-04-16 Grieshaber & Co Ag DEVICE FOR FRACTIONING AND ELIMINATION OF THE LENTICULAR NUCLEUS OF THE EYE.
SE508793C2 (en) 1994-11-21 1998-11-09 Wallsten Medical Sa Apparatus for performing heat treatment in a body cavity or duct
US5695511A (en) 1994-11-29 1997-12-09 Metamorphic Surgical Devices Surgical instruments for minimally invasive procedures
US5800493A (en) 1995-04-26 1998-09-01 Gynecare, Inc. Intrauterine ablation system
US6187346B1 (en) * 1995-06-07 2001-02-13 Ablation Products, Inc. Intrauterine chemical cauterizing method and composition
US5749889A (en) * 1996-02-13 1998-05-12 Imagyn Medical, Inc. Method and apparatus for performing biopsy
US5776129A (en) 1996-06-12 1998-07-07 Ethicon Endo-Surgery, Inc. Endometrial ablation apparatus and method
US6053935A (en) 1996-11-08 2000-04-25 Boston Scientific Corporation Transvaginal anchor implantation device
US5954714A (en) 1996-11-20 1999-09-21 Gynecare, Inc. Heated balloon having rotary fluid impeller
US6117070A (en) 1996-11-28 2000-09-12 Fuji Photo Optical Co., Ltd. Plug device for endoscopic instrument channel
US5899915A (en) * 1996-12-02 1999-05-04 Angiotrax, Inc. Apparatus and method for intraoperatively performing surgery
US20010041900A1 (en) 1999-12-21 2001-11-15 Ovion, Inc. Occluding device and method of use
US7073504B2 (en) 1996-12-18 2006-07-11 Ams Research Corporation Contraceptive system and method of use
US6080129A (en) 1996-12-23 2000-06-27 Conceptus, Inc. Method and apparatus for performing hysterosalpingography
US5827269A (en) 1996-12-31 1998-10-27 Gynecare, Inc. Heated balloon having a reciprocating fluid agitator
US6039686A (en) 1997-03-18 2000-03-21 Kovac; S. Robert System and a method for the long term cure of recurrent urinary female incontinence
US5891457A (en) 1997-05-12 1999-04-06 Neuwirth; Robert S. Intrauterine chemical necrosing method, composition, and apparatus
US6139570A (en) 1997-05-19 2000-10-31 Gynelab Products, Inc. Disposable bladder for intrauterine use
US5843046A (en) 1997-05-29 1998-12-01 Paul J. Motisi Catheter apparatus
US6997925B2 (en) * 1997-07-08 2006-02-14 Atrionx, Inc. Tissue ablation device assembly and method for electrically isolating a pulmonary vein ostium from an atrial wall
US6293952B1 (en) 1997-07-31 2001-09-25 Circon Corporation Medical instrument system for piercing through tissue
US5916198A (en) 1997-08-05 1999-06-29 Femrx, Inc. Non-binding surgical valve
US5961532A (en) 1997-08-29 1999-10-05 Stryker Corporation Surgical tool having flexible tubular inner member movable for tissue working
US6436116B1 (en) 1997-10-06 2002-08-20 Smith & Nephew, Inc. Methods and apparatus for removing veins
US5961444A (en) 1997-10-17 1999-10-05 Medworks Corporation In vitro fertilization procedure using direct vision
US5964777A (en) 1997-12-11 1999-10-12 Smith & Nephew, Inc. Surgical cutting instrument
US6428498B2 (en) 1998-04-14 2002-08-06 Renan Uflacker Suction catheter for rapidly debriding abscesses
GB9808140D0 (en) 1998-04-17 1998-06-17 Smiths Industries Plc Self-sealing septa
US6190357B1 (en) * 1998-04-21 2001-02-20 Cardiothoracic Systems, Inc. Expandable cannula for performing cardiopulmonary bypass and method for using same
CA2232726A1 (en) 1998-05-22 1999-11-22 Douglass B. Yackel Endometrial ablation method and apparatus
WO2000000100A1 (en) 1998-06-30 2000-01-06 Ethicon, Inc. Endometrial balloon ablation catheter having heater
WO2000012832A2 (en) 1998-08-26 2000-03-09 Molecular Geodesics, Inc. Radially expandable device
US7105003B2 (en) 1998-09-17 2006-09-12 Karl Storz Gmbh & Co. Kg Surgical instrument
US20010047183A1 (en) 2000-04-05 2001-11-29 Salvatore Privitera Surgical device for the collection of soft tissue
EP1152684B1 (en) 1999-02-18 2003-12-17 Karl Storz GmbH & Co. KG Endoscope
US6179776B1 (en) 1999-03-12 2001-01-30 Scimed Life Systems, Inc. Controllable endoscopic sheath apparatus and related method of use
US6159209A (en) 1999-03-18 2000-12-12 Canox International Ltd. Automatic resectoscope
US6086544A (en) 1999-03-31 2000-07-11 Ethicon Endo-Surgery, Inc. Control apparatus for an automated surgical biopsy device
US6267776B1 (en) 1999-05-03 2001-07-31 O'connell Paul T. Vena cava filter and method for treating pulmonary embolism
US20020068934A1 (en) 1999-06-23 2002-06-06 Edwards Stuart D. Thin layer ablation apparatus
US20050234437A1 (en) 1999-07-14 2005-10-20 Cardiofocus, Inc. Deflectable sheath catheters with out-of-plane bent tip
DE60026313D1 (en) 1999-07-23 2006-04-27 Uutech Ltd SENSITIZATION OF RED BLOOD BODIES AGAINST ULTRASOUND BY IMPACT OF AN ELECTRIC FIELD
WO2001008575A2 (en) 1999-07-30 2001-02-08 Cardiofocus, Inc. Optical fiber basket device for cardiac photoablation
WO2001013832A1 (en) 1999-08-23 2001-03-01 Conceptus, Inc. Insertion/deployment catheter system for intrafallopian contraception
US6709667B1 (en) * 1999-08-23 2004-03-23 Conceptus, Inc. Deployment actuation system for intrafallopian contraception
US6742236B1 (en) 1999-09-20 2004-06-01 Smith & Nephew, Inc. Making closed end tubes for surgical instruments
ES2299447T3 (en) * 1999-11-10 2008-06-01 Cytyc Surgical Products SYSTEM TO DETECT PERFORATIONS IN A BODY CAVITY.
US6827703B1 (en) 1999-11-24 2004-12-07 Coopersurgical, Inc. Single lumen balloon catheter apparatus
JP2001223966A (en) 2000-01-19 2001-08-17 Lg Electronics Inc Video recording and reproducing device, video searching device and its method
US6458076B1 (en) 2000-02-01 2002-10-01 5 Star Medical Multi-lumen medical device
US6673071B2 (en) * 2000-02-24 2004-01-06 Vandusseldorp Gregg A. Partial ablation procedure and device therefor
US6443947B1 (en) 2000-03-01 2002-09-03 Alexei Marko Device for thermal ablation of a cavity
US6428539B1 (en) 2000-03-09 2002-08-06 Origin Medsystems, Inc. Apparatus and method for minimally invasive surgery using rotational cutting tool
US6440061B1 (en) 2000-03-24 2002-08-27 Donald E. Wenner Laparoscopic instrument system for real-time biliary exploration and stone removal
JP4503208B2 (en) * 2000-04-25 2010-07-14 インプレス メディカル, インコーポレイテッド Method and apparatus for generating adhesions in the uterus
US6471644B1 (en) 2000-04-27 2002-10-29 Medtronic, Inc. Endoscopic stabilization device and method of use
US7458940B2 (en) 2000-11-06 2008-12-02 Suros Surgical Systems, Inc. Biopsy apparatus
US6942671B1 (en) 2000-11-06 2005-09-13 Tyco Healthcare Group Lp Surgical sealing apparatus
US6896682B1 (en) 2000-11-14 2005-05-24 Biomedical Engineering Solutions, Inc. Method and system for internal ligation of tubular structures
US6821274B2 (en) 2001-03-07 2004-11-23 Gendel Ltd. Ultrasound therapy for selective cell ablation
US6494909B2 (en) 2000-12-01 2002-12-17 Prodesco, Inc. Endovascular valve
US6607545B2 (en) 2000-12-27 2003-08-19 Ethicon, Inc. Conformal surgical balloon with varying wall expansibility
US6612977B2 (en) 2001-01-23 2003-09-02 American Medical Systems Inc. Sling delivery system and method of use
US6626940B2 (en) 2001-06-15 2003-09-30 Scimed Life Systems, Inc. Medical device activation system
US6802825B2 (en) 2001-07-03 2004-10-12 Coopersurgical, Inc. Access catheter apparatus for use in minimally invasive surgery and diagnostic procedures in the uterus and fallopian tubes
US7485125B2 (en) 2001-12-17 2009-02-03 Smith & Nephew, Inc. Cutting instrument
US7033314B2 (en) 2002-01-11 2006-04-25 Fidelitycorp Limited Endoscopic devices and method of use
US7247161B2 (en) 2002-03-22 2007-07-24 Gyrus Ent L.L.C. Powered surgical apparatus, method of manufacturing powered surgical apparatus, and method of using powered surgical apparatus
AU2003247526A1 (en) * 2002-06-12 2003-12-31 Mitral Interventions, Inc. Method and apparatus for tissue connection
US6960203B2 (en) 2002-06-26 2005-11-01 Ethicon, Inc. Thermal ablation with deployable cage
US7163321B2 (en) 2002-07-25 2007-01-16 Steven Contarino Emergency vehicle grille
US20040127932A1 (en) 2002-09-12 2004-07-01 Shah Tilak M. Dip-molded polymeric medical devices with reverse thickness gradient, and method of making same
US6673101B1 (en) * 2002-10-09 2004-01-06 Endovascular Technologies, Inc. Apparatus and method for deploying self-expanding stents
US20040116955A1 (en) 2002-12-12 2004-06-17 Jonathan Foltz Cervical canal dilator
US20040255957A1 (en) 2003-05-01 2004-12-23 Robert Cafferata Method and system for treating vulnerable plaque
AU2003245593B2 (en) 2003-06-20 2010-06-03 Apollo Endosurgery, Inc. Two-way slit valve
GB0314863D0 (en) 2003-06-26 2003-07-30 Univ Dundee Medical apparatus and method
US7220252B2 (en) 2003-07-18 2007-05-22 Polyzen, Inc. Inflatable dual balloon catheter
US7588545B2 (en) 2003-09-10 2009-09-15 Boston Scientific Scimed, Inc. Forceps and collection assembly with accompanying mechanisms and related methods of use
US8034003B2 (en) 2003-09-11 2011-10-11 Depuy Mitek, Inc. Tissue extraction and collection device
US7150713B2 (en) 2003-10-16 2006-12-19 Smith & Nephew, Inc. Endoscopic device
US6979332B2 (en) 2003-11-04 2005-12-27 Medtronic, Inc. Surgical micro-resecting instrument with electrocautery and continuous aspiration features
EP1684655A2 (en) 2003-11-18 2006-08-02 SciMed Life Systems, Inc. System and method for tissue ablation
US9713549B2 (en) 2004-02-02 2017-07-25 Bayer Healthcare Llc Contraceptive with permeable and impermeable components
US20050182397A1 (en) 2004-02-04 2005-08-18 Thomas Ryan Device and method for ablation of body cavities
US7798960B2 (en) 2004-02-09 2010-09-21 John C. Jaeger Speculum
US7879037B2 (en) 2004-02-11 2011-02-01 Medtronic Xomed, Inc. High speed surgical cutting instrument
US7488322B2 (en) 2004-02-11 2009-02-10 Medtronic, Inc. High speed surgical cutting instrument
US20050222598A1 (en) 2004-04-05 2005-10-06 Manoa Medical, Inc., A Delaware Corporation Tissue cutting device
US7766844B2 (en) 2004-04-21 2010-08-03 Smith & Nephew, Inc. Surgical instrument aspiration valve
EP2559388B8 (en) 2004-04-28 2014-03-12 Bayer Essure Inc. Endoscopic delivery of medical devices
US8764646B2 (en) 2004-04-29 2014-07-01 Umc Utrecht Holding B.V. Surgical expansion device
DE102004021713A1 (en) 2004-04-30 2005-11-17 Karl Storz Gmbh & Co. Kg Arrangement of medical instruments for surgical purposes
US7347853B2 (en) 2004-05-12 2008-03-25 C. R. Bard, Inc. Catheter with removable extension
US8932233B2 (en) 2004-05-21 2015-01-13 Devicor Medical Products, Inc. MRI biopsy device
US8277474B2 (en) 2004-05-26 2012-10-02 Medtronic, Inc. Surgical cutting instrument
US7625353B2 (en) 2004-05-27 2009-12-01 Abbott Laboratories Catheter having first and second guidewire tubes and overlapping stiffening members
US20050277975A1 (en) 2004-06-09 2005-12-15 Usgi Medical Corp. Methods and apparatus for creating a working space within a body lumen or cavity
ATE544423T1 (en) * 2004-07-02 2012-02-15 Cook Medical Technologies Llc STENT WITH ARCH-SHAPED STRUTS
US7226460B2 (en) 2004-08-02 2007-06-05 Karl Storz Endovision, Inc. Surgical instrument attachment system
US8414527B2 (en) * 2004-09-21 2013-04-09 Boston Scientific Scimed, Inc. Rapid exchange catheters having a sealed guidewire lumen and methods of making the same
US20060074345A1 (en) 2004-09-29 2006-04-06 Hibner John A Biopsy apparatus and method
US7611474B2 (en) 2004-12-29 2009-11-03 Ethicon Endo-Surgery, Inc. Core sampling biopsy device with short coupled MRI-compatible driver
US7972354B2 (en) 2005-01-25 2011-07-05 Tyco Healthcare Group Lp Method and apparatus for impeding migration of an implanted occlusive structure
US7918795B2 (en) 2005-02-02 2011-04-05 Gynesonics, Inc. Method and device for uterine fibroid treatment
US20060200041A1 (en) 2005-03-04 2006-09-07 Ethicon Endo-Surgery, Inc. Biopsy device incorporating an adjustable probe sleeve
US20060241344A1 (en) 2005-04-12 2006-10-26 Wilk Patent, Llc Intra-abdominal surgical method and associated apparatus
US20060241586A1 (en) 2005-04-22 2006-10-26 Wilk Patent, Llc Intra-abdominal medical device and associated method
US7918863B2 (en) 2005-06-24 2011-04-05 Conceptus, Inc. Minimally invasive surgical stabilization devices and methods
US7785250B2 (en) 2005-08-11 2010-08-31 Granit Medical Innovation, Llc Endoscopic instrument assembly with separable operative tip and associated medical method
US20070161957A1 (en) 2006-01-06 2007-07-12 Guenther Kevin V Hysteroscope Seal
WO2007092852A2 (en) 2006-02-06 2007-08-16 Mynosys Cellular Devices, Inc. Microsurgical cutting instruments
US8251945B2 (en) 2006-02-24 2012-08-28 U.S. Endoscopy Group, Inc. Endoscopic suction device
US8235047B2 (en) 2006-03-30 2012-08-07 Conceptus, Inc. Methods and devices for deployment into a lumen
US7794393B2 (en) 2006-04-13 2010-09-14 Larsen Dane M Resectoscopic device and method
US8647349B2 (en) 2006-10-18 2014-02-11 Hologic, Inc. Systems for performing gynecological procedures with mechanical distension
US20080221605A1 (en) 2007-01-26 2008-09-11 Laurimed Llc Cutting device positioned via control wire to perform selective discectomy
US9259233B2 (en) 2007-04-06 2016-02-16 Hologic, Inc. Method and device for distending a gynecological cavity
EP2134283B1 (en) 2007-04-06 2014-06-11 Hologic, Inc. System and device for tissue removal
WO2008130582A2 (en) 2007-04-17 2008-10-30 Surgiquest, Incorporated Endoluminal and transluminal surgical methods and devices
US20080280540A1 (en) 2007-05-11 2008-11-13 Johnson Michael E Method for biopsy device needle tip
CN101808691B (en) 2007-09-27 2012-09-19 泰尔茂株式会社 Valve element and medical instrument
JP5283626B2 (en) 2007-09-27 2013-09-04 テルモ株式会社 Valve body and medical device
US7806835B2 (en) 2007-11-20 2010-10-05 Devicor Medical Products, Inc. Biopsy device with sharps reduction feature
EP2265184A1 (en) 2008-03-06 2010-12-29 Trustees of Boston University Low cost disposable medical forceps to enable a hollow central channel for various functionalities
EP2330982A2 (en) 2008-09-24 2011-06-15 Hologic, Inc. Systems, methods and devices for using a flowable medium for distending a hollow organ
US8460327B2 (en) 2008-12-16 2013-06-11 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
US9655639B2 (en) 2008-12-16 2017-05-23 Nico Corporation Tissue removal device for use with imaging devices in neurosurgical and spinal surgery applications
US8496599B2 (en) 2008-12-16 2013-07-30 Nico Corporation Tissue removal device for neurosurgical and spinal surgery applications
US8533360B2 (en) * 2009-10-07 2013-09-10 Wichorus, Inc. Method and apparatus to report resource values in a mobile network
WO2011060192A1 (en) 2009-11-13 2011-05-19 Interlace Medical, Inc. Access system with removable outflow channel

Patent Citations (105)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3561429A (en) * 1968-05-23 1971-02-09 Eversharp Inc Instrument for obtaining a biopsy specimen
US4188952A (en) * 1973-12-28 1980-02-19 Loschilov Vladimir I Surgical instrument for ultrasonic separation of biological tissue
US4203444A (en) * 1977-11-07 1980-05-20 Dyonics, Inc. Surgical instrument suitable for closed surgery such as of the knee
US4203444B1 (en) * 1977-11-07 1987-07-21
US4246902A (en) * 1978-03-10 1981-01-27 Miguel Martinez Surgical cutting instrument
US4261360A (en) * 1979-11-05 1981-04-14 Urethral Devices Research, Inc. Transurethral irrigation pressure controller
US4673393A (en) * 1984-12-28 1987-06-16 Terumo Kabushiki Kaisha Medical instrument
US4650462A (en) * 1985-07-29 1987-03-17 Minnesota Mining And Manufacturing Company Irrigation system
US4729763A (en) * 1986-06-06 1988-03-08 Henrie Rodney A Catheter for removing occlusive material
US4895565A (en) * 1987-09-21 1990-01-23 Cordis Corporation Medical instrument valve
US5730725A (en) * 1988-07-22 1998-03-24 Yoon; Inbae Expandable multifunctional manipulating instruments for various medical procedures and methods therefor
US5514091A (en) * 1988-07-22 1996-05-07 Yoon; Inbae Expandable multifunctional manipulating instruments for various medical procedures
US4998527A (en) * 1989-07-27 1991-03-12 Percutaneous Technologies Inc. Endoscopic abdominal, urological, and gynecological tissue removing device
US5104377A (en) * 1989-08-10 1992-04-14 C. R. Bard, Inc. Uterine access device with automatic cervical adjustment
US5078725A (en) * 1989-11-09 1992-01-07 C. R. Bard, Inc. Balloon catheter and techniques for dilating obstructed lumens and other luminal procedures
US5201756A (en) * 1990-06-20 1993-04-13 Danforth Biomedical, Inc. Radially-expandable tubular elements for use in the construction of medical devices
US5275609A (en) * 1990-06-22 1994-01-04 Vance Products Incorporated Surgical cutting instrument
US5304115A (en) * 1991-01-11 1994-04-19 Baxter International Inc. Ultrasonic angioplasty device incorporating improved transmission member and ablation probe
US5183031A (en) * 1991-05-13 1993-02-02 Rossoff Leonard J Fiberoptic intubating laryngoscope
US5865728A (en) * 1991-05-29 1999-02-02 Origin Medsystems, Inc. Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space
US5738629A (en) * 1991-05-29 1998-04-14 Origin Medsystems, Inc. Self-retracting endoscope
US5743851A (en) * 1991-05-29 1998-04-28 Origin Medsystems, Inc. Retraction apparatus and methods for endoscopic surgery
US5402772A (en) * 1991-05-29 1995-04-04 Origin Medsystems, Inc. Endoscopic expandable retraction device
US5743850A (en) * 1991-05-29 1998-04-28 Origin Medsystems, Inc. Endoscopic inflatable retraction device with additional inflatable chamber
US5125903A (en) * 1991-08-01 1992-06-30 Medtronic, Inc. Hemostasis valve
US5195541A (en) * 1991-10-18 1993-03-23 Obenchain Theodore G Method of performing laparoscopic lumbar discectomy
US5602449A (en) * 1992-04-13 1997-02-11 Smith & Nephew Endoscopy, Inc. Motor controlled surgical system and method having positional control
US5653684A (en) * 1992-06-26 1997-08-05 Schneider (Usa), Inc. Catheter with expandable wire mesh tip
US5904680A (en) * 1992-09-25 1999-05-18 Ep Technologies, Inc. Multiple electrode support structures having optimal bio-mechanical characteristics
US5484401A (en) * 1992-11-04 1996-01-16 Denver Biomaterials, Inc. Treatment method for pleural effusion
US5392765A (en) * 1993-02-11 1995-02-28 Circon Corporation Continuous flow cystoscope
US6216044B1 (en) * 1993-03-16 2001-04-10 Ep Technologies, Inc. Medical device with three dimensional collapsible basket structure
US5725525A (en) * 1993-03-16 1998-03-10 Ep Technologies, Inc. Multiple electrode support structures with integral hub and spline elements
US6858024B1 (en) * 1994-02-14 2005-02-22 Scimed Life Systems, Inc. Guide catheter having selected flexural modulus segments
US6216043B1 (en) * 1994-03-04 2001-04-10 Ep Technologies, Inc. Asymmetric multiple electrode support structures
US5503626A (en) * 1994-04-14 1996-04-02 Bei Medical Systems Fluid delivery system for hysteroscopic surgery
US5755731A (en) * 1994-04-15 1998-05-26 Smith & Nephew Dyonics, Inc. Curved surgical instrument with segmented inner member
US5458633A (en) * 1994-05-24 1995-10-17 Bailey; Robert W. Irrigating laparoscopic cannula or trocar
US5505730A (en) * 1994-06-24 1996-04-09 Stuart D. Edwards Thin layer ablation apparatus
US5749845A (en) * 1995-01-25 1998-05-12 Iotek, Inc. Delivering an agent to an organ
US5601583A (en) * 1995-02-15 1997-02-11 Smith & Nephew Endoscopy Inc. Surgical instrument
US5624395A (en) * 1995-02-23 1997-04-29 Cv Dynamics, Inc. Urinary catheter having palpitatable valve and balloon and method for making same
US20020020417A1 (en) * 1995-06-07 2002-02-21 Nikolchev Julian N. Contraceptive transcervical fallopian tube occlusion devices and methods
US5618296A (en) * 1995-07-24 1997-04-08 Endomedix Corporation/Box 330 Tissue morcellator system and method
US5624399A (en) * 1995-09-29 1997-04-29 Ackrad Laboratories, Inc. Catheter having an intracervical/intrauterine balloon made from polyurethane
US5873815A (en) * 1995-10-10 1999-02-23 Conceptus, Inc. Access catheter and method for maintaining separation between a falloposcope and a tubal wall
US5769816A (en) * 1995-11-07 1998-06-23 Embol-X, Inc. Cannula with associated filter
US7037321B2 (en) * 1996-02-23 2006-05-02 Memory Medical Systems, Inc. Medical device with slotted memory metal tube
US20050027245A1 (en) * 1996-02-23 2005-02-03 Memory Medical Systems, Inc. Medical instrument with slotted memory metal tube
US6221007B1 (en) * 1996-05-03 2001-04-24 Philip S. Green System and method for endoscopic imaging and endosurgery
US5902251A (en) * 1996-05-06 1999-05-11 Vanhooydonk; Neil C. Transcervical intrauterine applicator for intrauterine hyperthermia
US5857585A (en) * 1996-05-28 1999-01-12 Act Medical, Inc. Ligating band dispenser
US5891134A (en) * 1996-09-24 1999-04-06 Goble; Colin System and method for applying thermal energy to tissue
US5741287A (en) * 1996-11-01 1998-04-21 Femrx, Inc. Surgical tubular cutter having a tapering cutting chamber
US20050045183A1 (en) * 1996-12-18 2005-03-03 Ovion, Inc. Methods and devices for occluding body lumens and/or for delivering therapeutic agents
US6068626A (en) * 1997-06-05 2000-05-30 Adiana, Inc. Method and apparatus for tubal occlusion
US6042590A (en) * 1997-06-16 2000-03-28 Novomedics, Llc Apparatus and methods for fallopian tube occlusion
US6565557B1 (en) * 1997-06-16 2003-05-20 Board Of Regents, The University Of Texas System Apparatus and methods for fallopian tube occlusion
US6039748A (en) * 1997-08-05 2000-03-21 Femrx, Inc. Disposable laparoscopic morcellator
US5913814A (en) * 1997-08-26 1999-06-22 Belmont Instrument Corporation Method and apparatus for deflation of an intra-aortic balloon
US20080058588A1 (en) * 1997-09-04 2008-03-06 Smith & Nephew, Inc. Surgical endoscopic cutting device and method for its use
US20080015621A1 (en) * 1997-09-04 2008-01-17 Smith & Nephew, Inc. Surgical endoscopic cutting device and method for its use
US20090118699A1 (en) * 1998-02-19 2009-05-07 Respiratory Diagnostic, Inc. Systems and methods for treating obesity and other gastrointestinal conditions
US5904649A (en) * 1998-04-03 1999-05-18 Andrese; Craig A. Organ retractors
US6378524B1 (en) * 1998-11-06 2002-04-30 Jesse M. Jones Method of sterilizing females
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
US6328730B1 (en) * 1999-03-26 2001-12-11 William W. Harkrider, Jr. Endoluminal multi-luminal surgical sheath and method
US6537207B1 (en) * 1999-04-07 2003-03-25 Fovioptics, Inc. Identification of protective covers for medical imaging devices
US6387110B1 (en) * 1999-06-23 2002-05-14 Smith & Nephew, Inc. Coating for surgical blades
US20020013601A1 (en) * 2000-01-28 2002-01-31 Nobles Anthony A. Cavity enlarger method and apparatus
US6682477B2 (en) * 2000-02-25 2004-01-27 Richard Wolf Gmbh Hysteroscope
US6395012B1 (en) * 2000-05-04 2002-05-28 Inbae Yoon Apparatus and method for delivering and deploying an expandable body member in a uterine cavity
US6547784B1 (en) * 2000-06-23 2003-04-15 Ethicon, Inc. System and method for placement of a surgical instrument in a body cavity
US7497833B2 (en) * 2000-11-06 2009-03-03 Suros Surgical Systems, Inc. Biopsy apparatus with vacuum relief
US20090137927A1 (en) * 2000-11-06 2009-05-28 Miller Michael E Biopsy apparatus with vacuum relief
US20050113715A1 (en) * 2000-11-06 2005-05-26 Jeffrey Schwindt Biopsy apparatus
US20080065125A1 (en) * 2000-12-20 2008-03-13 Foxhollow Technologies, Inc. High capacity debulking catheter with distal driven cutting wheel
US20050113857A1 (en) * 2000-12-27 2005-05-26 Martin Nohilly Surgical balloon having varying wall thickness
US20030050639A1 (en) * 2001-09-12 2003-03-13 Harmonia Medical Technologies Surgical instrument and method of using the same
US20030083684A1 (en) * 2001-10-26 2003-05-01 Cesarini Peter M. Reciprocating rotary arthroscopic surgical instrument
US7510563B2 (en) * 2001-10-26 2009-03-31 Smith & Nephew, Inc. Reciprocating rotary arthroscopic surgical instrument
US20090005739A1 (en) * 2001-11-13 2009-01-01 Applied Medical Resources Corporation Multi-seal trocar system
US20040002702A1 (en) * 2002-06-28 2004-01-01 Ethicon, Inc. RF device for treating the uterus
US20040002703A1 (en) * 2002-06-28 2004-01-01 Ethicon, Inc. RF device for treating the uterus
US20050107663A1 (en) * 2003-01-15 2005-05-19 Usgi Medical Inc. Endoluminal tool deployment system
US7481817B2 (en) * 2003-02-13 2009-01-27 Lsi Soultions, Inc. Instrument for surgically cutting tissue and method of use
US7491212B2 (en) * 2003-02-19 2009-02-17 Smith & Nephew, Inc. Transmitting an actuating force along a curved instrument
US7189206B2 (en) * 2003-02-24 2007-03-13 Senorx, Inc. Biopsy device with inner cutter
US20050080318A1 (en) * 2003-10-09 2005-04-14 Squicciarini John B. Multi-functional video scope
US20050090849A1 (en) * 2003-10-22 2005-04-28 Adams Kenneth M. Angled tissue cutting instruments and method of fabricating angled tissue cutting instrument having flexible inner tubular members of tube and single wrap construction
US20050113836A1 (en) * 2003-11-25 2005-05-26 Lozier Antony J. Expandable reamer
US20060009798A1 (en) * 2004-02-02 2006-01-12 Ams Research Corporation Methods and devices for occluding body lumens and/or enhancing tissue ingrowth
US20060036138A1 (en) * 2004-08-06 2006-02-16 Adam Heller Devices and methods of screening for neoplastic and inflammatory disease
US20060047185A1 (en) * 2004-08-27 2006-03-02 Cemal Shener Tissue resecting system
US20060089658A1 (en) * 2004-10-21 2006-04-27 Harrington Douglas C Method and apparatus for treating abnormal uterine bleeding
US20070010845A1 (en) * 2005-07-08 2007-01-11 Gorman Gong Directionally controlled expandable device and methods for use
US20080058595A1 (en) * 2006-06-14 2008-03-06 Snoke Phillip J Medical device introduction systems and methods
US20080051758A1 (en) * 2006-07-18 2008-02-28 Boston Scientific Scimed, Inc. Medical devices
US20090048485A1 (en) * 2006-07-19 2009-02-19 Heisler Gary R Endoscopic cutting instruments having improved cutting efficiency and reduced manufacturing costs
US7666200B2 (en) * 2006-07-19 2010-02-23 Target Medical Innovations Llc Endoscopic cutting instrument with axial and rotary motion
US20100063360A1 (en) * 2006-11-28 2010-03-11 Adiana, Inc. Side-arm Port Introducer
US20110034943A1 (en) * 2007-04-06 2011-02-10 Interlace Medical, Inc. Low advance ratio, high reciprocation rate tissue removal device
US20110077674A1 (en) * 2007-04-06 2011-03-31 Interlace Medical, Inc. Tissue cutter with differential hardness
US20090054728A1 (en) * 2007-08-21 2009-02-26 Trusty Robert M Manipulatable guide system and methods for natural orifice translumenal endoscopic surgery
US7938804B2 (en) * 2009-03-30 2011-05-10 Tyco Healthcare Group Lp Surgical access apparatus with seal and closure valve assembly

Cited By (83)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9427247B2 (en) 1997-09-04 2016-08-30 Smith & Nephew, Inc. Surgical cutting device and method for its use
US9089358B2 (en) 1997-09-04 2015-07-28 Smith & Nephew, Inc. Surgical cutting device and method for its use
US9226765B2 (en) 1997-09-04 2016-01-05 Smith & Nephew, Inc. Surgical cutting device and method for its use
US8893722B2 (en) 1997-09-04 2014-11-25 Smith & Nephew, Inc. Surgical endoscopic cutting device and method for its use
US9226650B2 (en) 1997-09-04 2016-01-05 Smith & Nephew, Inc. Surgical cutting device and method for its use
US9750520B2 (en) 1997-09-04 2017-09-05 Covidien Lp Surgical endoscopic cutting device and method for its use
US9060801B1 (en) 2001-10-26 2015-06-23 Smith & Nephew, Inc. Reciprocating rotary arthroscopic surgical instrument
US9636130B2 (en) 2001-10-26 2017-05-02 Covidien Lp Reciprocating rotary arthroscopic surgical instrument
US10441306B2 (en) 2001-10-26 2019-10-15 Covidien Lp Reciprocating rotary arthroscopic surgical instrument
US9060800B1 (en) 2001-10-26 2015-06-23 Smith & Nephew, Inc. Reciprocating rotary arthroscopic surgical instrument
US9066745B2 (en) 2001-10-26 2015-06-30 Smith & Nephew, Inc. Reciprocating rotary arthroscopic surgical instrument
US9936861B2 (en) 2004-08-27 2018-04-10 Covidien Lp Tissue resecting system
US10076237B2 (en) 2004-08-27 2018-09-18 Covidien Lp Tissue resecting system
US9125550B2 (en) 2004-08-27 2015-09-08 Smith & Nephew, Inc. Tissue resecting system
US10939810B2 (en) 2004-08-27 2021-03-09 Covidien Lp Tissue resecting system
US8834487B2 (en) 2006-10-18 2014-09-16 Hologic, Inc. Systems and methods for preventing intravasation during intrauterine procedures
US9539019B2 (en) 2007-04-06 2017-01-10 Hologic, Inc. Uterine fibroid tissue removal device
US10130389B2 (en) 2007-04-06 2018-11-20 Hologic, Inc. Uterine fibroid tissue removal device
US20090270812A1 (en) * 2007-04-06 2009-10-29 Interlace Medical , Inc. Access device with enhanced working channel
US20080245371A1 (en) * 2007-04-06 2008-10-09 William Harwick Gruber Systems, methods and devices for performing gynecological procedures
US8951274B2 (en) 2007-04-06 2015-02-10 Hologic, Inc. Methods of high rate, low profile tissue removal
US20090270895A1 (en) * 2007-04-06 2009-10-29 Interlace Medical, Inc. Low advance ratio, high reciprocation rate tissue removal device
US9339288B2 (en) 2007-04-06 2016-05-17 Hologic, Inc. Uterine fibroid tissue removal device
US8574253B2 (en) 2007-04-06 2013-11-05 Hologic, Inc. Method, system and device for tissue removal
US11045217B2 (en) 2007-04-06 2021-06-29 Hologic, Inc. Uterine fibroid tissue removal device
US8528563B2 (en) 2007-04-06 2013-09-10 Hologic, Inc. Systems, methods and devices for performing gynecological procedures
US9095366B2 (en) 2007-04-06 2015-08-04 Hologic, Inc. Tissue cutter with differential hardness
US20100094327A1 (en) * 2008-07-30 2010-04-15 Jeffrey Milsom Method and apparatus for straightening and flattening the side wall of a body lumen or body cavity so as to provide three dimensional exposure of a lesion or abnormality within the body lumen or body cavity, and/or for stabilizing an instrument relative to the same
WO2010014707A1 (en) * 2008-07-30 2010-02-04 Cornell University Method and apparatus for straightening and flattening the side wall of a body lumen or body cavity so as to provide three dimensional exposure of a lesion or abnormality within the body lumen or body cavity, and/or for stabilizing an instrument relative to the same
US9649100B2 (en) 2008-07-30 2017-05-16 Cornell University Method and apparatus for straightening and flattening the side wall of a body lumen or body cavity so as to provide three dimensional exposure of a lesion or abnormality within the body lumen or body cavity, and/or for stabilizing an instrument relative to the same
US11903602B2 (en) 2009-04-29 2024-02-20 Hologic, Inc. Uterine fibroid tissue removal device
US9155454B2 (en) 2010-09-28 2015-10-13 Smith & Nephew, Inc. Hysteroscopic system
US11229354B2 (en) 2010-09-28 2022-01-25 Covidien Lp Hysteroscopic system
US10251539B2 (en) 2010-09-28 2019-04-09 Covidien Lp Hysteroscopic system
US11889993B2 (en) 2010-09-28 2024-02-06 Covidien Lp Hysteroscopic system
US8608738B2 (en) 2010-12-06 2013-12-17 Soulor Surgical, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
US8323278B2 (en) 2010-12-06 2012-12-04 Soulor Surgical, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
US10034687B2 (en) 2010-12-06 2018-07-31 Surgigyn, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
US11627990B2 (en) 2010-12-06 2023-04-18 Gyrus Acmi, Inc. Apparatus for treating a portion of a reproductive system and related methods of use
JP2015165865A (en) * 2014-03-04 2015-09-24 株式会社八光 Tissue ablation device for loop endoscope
US10631889B2 (en) 2014-12-16 2020-04-28 Covidien Lp Surgical device with incorporated tissue extraction
US11871952B2 (en) 2014-12-16 2024-01-16 Covidien Lp Surgical device with incorporated tissue extraction
US10772652B2 (en) 2015-01-28 2020-09-15 Covidien Lp Tissue resection system
US11666354B2 (en) 2015-01-28 2023-06-06 Covidien Lp Tissue resection system
US10750931B2 (en) 2015-05-26 2020-08-25 Covidien Lp Systems and methods for generating a fluid bearing for an operative procedure
US11659977B2 (en) 2015-06-17 2023-05-30 Covidien Lp Endoscopic device with drip flange and methods of use thereof for an operative procedure
US10842350B2 (en) 2015-06-17 2020-11-24 Covidien Lp Endoscopic device with drip flange and methods of use thereof for an operative procedure
US10804769B2 (en) 2015-06-17 2020-10-13 Covidien Lp Surgical instrument with phase change cooling
US10799264B2 (en) 2015-06-18 2020-10-13 Covidien Lp Surgical instrument with suction control
US11712262B2 (en) 2015-06-18 2023-08-01 Covidien Lp Surgical instrument with suction control
US11864735B2 (en) 2016-05-26 2024-01-09 Covidien Lp Continuous flow endoscope
US10299819B2 (en) 2016-07-28 2019-05-28 Covidien Lp Reciprocating rotary surgical cutting device and system for tissue resecting, and method for its use
US11172954B2 (en) 2016-07-28 2021-11-16 Covidien Lp Reciprocating rotary surgical cutting device and system for tissue resecting, and method for its use
US10299803B2 (en) 2016-08-04 2019-05-28 Covidien Lp Self-aligning drive coupler
US11622787B2 (en) 2017-03-02 2023-04-11 Covidien Lp Fluid-driven tissue resecting instruments, systems, and methods
US10772654B2 (en) 2017-03-02 2020-09-15 Covidien Lp Fluid-driven tissue resecting instruments, systems, and methods
US10987131B2 (en) 2017-05-25 2021-04-27 Coopersurgical, Inc. Tissue containment systems and related methods
US11660114B2 (en) 2017-05-25 2023-05-30 Coopersurgical, Inc. Tissue containment systems and related methods
US11806036B2 (en) 2018-02-13 2023-11-07 Covidien Lp Powered tissue resecting device
US10869684B2 (en) 2018-02-13 2020-12-22 Covidien Lp Powered tissue resecting device
US11547815B2 (en) 2018-05-30 2023-01-10 Covidien Lp Systems and methods for measuring and controlling pressure within an internal body cavity
US11065147B2 (en) 2018-10-18 2021-07-20 Covidien Lp Devices, systems, and methods for pre-heating fluid to be introduced into a patient during a surgical procedure
US11197710B2 (en) 2018-10-26 2021-12-14 Covidien Lp Tissue resecting device including a blade lock and release mechanism
US11083481B2 (en) 2019-02-22 2021-08-10 Covidien Lp Tissue resecting instrument including an outflow control seal
US11154318B2 (en) 2019-02-22 2021-10-26 Covidien Lp Tissue resecting instrument including an outflow control seal
US11744606B2 (en) 2019-02-22 2023-09-05 Covidien Lp Tissue resecting instrument including an outflow control seal
US10898218B2 (en) 2019-02-25 2021-01-26 Covidien Lp Tissue resecting device including a motor cooling assembly
US11871950B2 (en) 2019-02-25 2024-01-16 Covidien Lp Tissue resecting device including a motor cooling assembly
US10945752B2 (en) 2019-03-20 2021-03-16 Covidien Lp Tissue resecting instrument including a rotation lock feature
US11819234B2 (en) 2019-03-20 2023-11-21 Covidien Lp Tissue resecting instrument including a rotation lock feature
US11883058B2 (en) 2019-03-26 2024-01-30 Covidien Lp Jaw members, end effector assemblies, and ultrasonic surgical instruments including the same
US11553977B2 (en) 2019-05-29 2023-01-17 Covidien Lp Hysteroscopy systems and methods for managing patient fluid
US11452806B2 (en) 2019-10-04 2022-09-27 Covidien Lp Outflow collection vessels, systems, and components thereof for hysteroscopic surgical procedures
US11890237B2 (en) 2019-10-04 2024-02-06 Covidien Lp Outflow collection vessels, systems, and components thereof for hysteroscopic surgical procedures
US11376032B2 (en) 2019-12-05 2022-07-05 Covidien Lp Tissue resecting instrument
US11179172B2 (en) 2019-12-05 2021-11-23 Covidien Lp Tissue resecting instrument
US11547782B2 (en) 2020-01-31 2023-01-10 Covidien Lp Fluid collecting sheaths for endoscopic devices and systems
US11737777B2 (en) 2020-02-05 2023-08-29 Covidien Lp Tissue resecting instruments
US11317947B2 (en) 2020-02-18 2022-05-03 Covidien Lp Tissue resecting instrument
US11596429B2 (en) 2020-04-20 2023-03-07 Covidien Lp Tissue resecting instrument
US11571233B2 (en) 2020-11-19 2023-02-07 Covidien Lp Tissue removal handpiece with integrated suction
WO2022255897A1 (en) * 2021-06-04 2022-12-08 Belciu Kerns Roxana Anatomical dilator for passage of medical instruments inside a bodily cavity
US11904122B1 (en) 2021-06-04 2024-02-20 Roxana Belciu Kerns Disposable pass through dilator and method of use

Also Published As

Publication number Publication date
WO2008058157A2 (en) 2008-05-15
US9392935B2 (en) 2016-07-19
US20080146873A1 (en) 2008-06-19
WO2008058157A3 (en) 2008-08-28
EP2089091A4 (en) 2010-11-17
EP2089091A2 (en) 2009-08-19

Similar Documents

Publication Publication Date Title
US9392935B2 (en) Methods for performing a medical procedure
US9259233B2 (en) Method and device for distending a gynecological cavity
JP4699380B2 (en) Uterine artery occlusion device with cervical receptor
US8025656B2 (en) Methods, systems and devices for performing gynecological procedures
US7105007B2 (en) Cervical medical device, system and method
CN111658959B (en) Devices and methods for accessing and sealing body vessels and cavities
US5613950A (en) Multifunctional manipulating instrument for various surgical procedures
JP3342021B2 (en) Medical device system that penetrates tissue
US20070162047A1 (en) Apparatus and method for colonoscopic appendectomy
US20090054905A1 (en) Embolization coil delivery systems and methods
CN101511276A (en) Interventional deployment and imaging system
CN102438534A (en) Tissue removal device with high reciprocation rate
JPH11123204A (en) Device and method for sterility treatment
CN111278496B (en) Everting balloon catheter for delivering substances into fallopian tubes
ES2355051T3 (en) DEPLOYMENT PERFORMANCE SYSTEM FOR ANTI-CONCEPTION WITHIN THE FALOPIO TRUMPS.
JP2023166627A (en) Device for fallopian tube diagnostics
KR20190008367A (en) Apparatus and Process for Surgery of Narrow Body Lumen
US9855074B2 (en) Adjustable medical devices and methods for manipulating bodily tissues
US11712237B1 (en) Anatomical tissue anchor and related methods
TW202329866A (en) Delivery and deployment of a prostatic implant
KR20200088075A (en) A catheter for inserted into arm artery so as to be inserted in same direction as blood flow direction and to be easily supported and use method thereof

Legal Events

Date Code Title Description
AS Assignment

Owner name: INTERLACE MEDICAL, INC., MASSACHUSETTS

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:GRUBER, WILLIAM H.;ADAMS, RONALD D.;FOSHEE, DAVID L.;AND OTHERS;REEL/FRAME:020587/0565;SIGNING DATES FROM 20080215 TO 20080226

AS Assignment

Owner name: HOLOGIC, INC., MASSACHUSETTS

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INTERLACE MEDICAL, INC.;REEL/FRAME:025835/0684

Effective date: 20110211

AS Assignment

Owner name: GOLDMAN SACHS BANK USA, NEW YORK

Free format text: SECURITY AGREEMENT;ASSIGNORS:HOLOGIC, INC.;BIOLUCENT, LLC;CYTYC CORPORATION;AND OTHERS;REEL/FRAME:028810/0745

Effective date: 20120801

STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION

AS Assignment

Owner name: CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: CYTYC CORPORATION, MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: BIOLUCENT, LLC, MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: GEN-PROBE INCORPORATED, MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: SUROS SURGICAL SYSTEMS, INC., MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, MASS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: THIRD WAVE TECHNOLOGIES, INC., MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

Owner name: HOLOGIC, INC., MASSACHUSETTS

Free format text: SECURITY INTEREST RELEASE REEL/FRAME 028810/0745;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:035820/0239

Effective date: 20150529

AS Assignment

Owner name: CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: GOLDMAN SACHS BANK USA, NEW YORK

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 028810 FRAME: 0745. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY AGREEMENT;ASSIGNORS:HOLOGIC, INC.;BIOLUCENT, LLC;CYTYC CORPORATION;AND OTHERS;REEL/FRAME:044432/0565

Effective date: 20120801

Owner name: GEN-PROBE INCORPORATED, MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: CYTYC CORPORATION, MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: HOLOGIC, INC., MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: SUROS SURGICAL SYSTEMS, INC., MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: BIOLUCENT, LLC, MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: THIRD WAVE TECHNOLOGIES, INC., MASSACHUSETTS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529

Owner name: CYTYC SURGICAL PRODUCTS, LIMITED PARTNERSHIP, MASS

Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE INCORRECT PATENT NO. 8081301 PREVIOUSLY RECORDED AT REEL: 035820 FRAME: 0239. ASSIGNOR(S) HEREBY CONFIRMS THE SECURITY INTEREST RELEASE;ASSIGNOR:GOLDMAN SACHS BANK USA, AS COLLATERAL AGENT;REEL/FRAME:044727/0529

Effective date: 20150529