US20120226227A1 - Coaxial catheter system - Google Patents
Coaxial catheter system Download PDFInfo
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- US20120226227A1 US20120226227A1 US13/470,193 US201213470193A US2012226227A1 US 20120226227 A1 US20120226227 A1 US 20120226227A1 US 201213470193 A US201213470193 A US 201213470193A US 2012226227 A1 US2012226227 A1 US 2012226227A1
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- medical probe
- catheter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1002—Balloon catheters characterised by balloon shape
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/1204—Type of occlusion temporary occlusion
- A61B17/12045—Type of occlusion temporary occlusion double occlusion, e.g. during anastomosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0113—Mechanical advancing means, e.g. catheter dispensers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1011—Multiple balloon catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1018—Balloon inflating or inflation-control devices
- A61M25/10184—Means for controlling or monitoring inflation or deflation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/12127—Double occlusion, e.g. for creating blood-free anastomosis site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements 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
- A61B2017/22072—Implements 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 instrument channel, e.g. for replacing one instrument by the other
- A61B2017/22074—Implements 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 instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
- A61B2017/22075—Implements 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 instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with motorized advancing or retracting means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
- A61B2017/3405—Needle locating or guiding means using mechanical guide means
- A61B2017/3409—Needle locating or guiding means using mechanical guide means including needle or instrument drives
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, 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
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/70—Manipulators specially adapted for use in surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M2025/0004—Catheters; Hollow probes having two or more concentrically arranged tubes for forming a concentric catheter system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M2025/0008—Catheters; Hollow probes having visible markings on its surface, i.e. visible to the naked eye, for any purpose, e.g. insertion depth markers, rotational markers or identification of type
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/0175—Introducing, guiding, advancing, emplacing or holding catheters having telescopic features, interengaging nestable members movable in relations to one another
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M25/1011—Multiple balloon catheters
- A61M2025/1015—Multiple balloon catheters having two or more independently movable balloons where the distance between the balloons can be adjusted, e.g. two balloon catheters concentric to each other forming an adjustable multiple balloon catheter system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1059—Balloon catheters with special features or adapted for special applications having different inflatable sections mainly depending on the response to the inflation pressure, e.g. due to different material properties
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES 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
- A61M25/00—Catheters; Hollow probes
- A61M25/10—Balloon catheters
- A61M2025/1043—Balloon catheters with special features or adapted for special applications
- A61M2025/1072—Balloon catheters with special features or adapted for special applications having balloons with two or more compartments
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Animal Behavior & Ethology (AREA)
- Surgery (AREA)
- Pulmonology (AREA)
- Biophysics (AREA)
- Anesthesiology (AREA)
- Hematology (AREA)
- Child & Adolescent Psychology (AREA)
- Molecular Biology (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Vascular Medicine (AREA)
- Reproductive Health (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
A medical system includes first and second medical probes in an arrangement and configured for insertion into a lumen or vessel of a patient, the first medical probe having indicia, and a detector is fixedly coupled to the second medical probe and configured for insertion into and advancement through the lumen or vessel along with the second medical probe, wherein the detector detects passage of the indicia as the first and second medical probes are moved relative to each other within the lumen or body vessel. An electromechanical driver is coupled to, and operable to move the first and second medical probes. A system controller is configured for directing the electromechanical driver to move the first and second medical probes relative to each other within the lumen or body vessel based on signals received from the detector when the detector is positioned within the lumen or body vessel.
Description
- This application is a continuation of application Ser. No. 11/762,749, filed Jun. 13, 2007, which is a continuation of application Ser. No. 11/467,886, filed Aug. 28, 2006, which is a continuation of application Ser. No. 10/270,740, filed Oct. 11, 2002 (now abandoned), which claims the benefit of Provisional Application No. 60/332,287, filed Nov. 21, 2001, and is a continuation-in-part of application Ser. No. 10/216,069, filed Aug. 8, 2002 (now abandoned), which claims the benefit of Provisional Application No. 60/313,495, filed Aug. 21, 2001, and is a continuation-in-part of application Ser. Nos. 10/023,024 (now abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683, issued Aug. 15, 2006), Ser. No. 10/011,449 (now abandoned), Ser. No. 10/010,150 (now U.S. Pat. No. 7,214,230, issued May 8, 2007), Ser. No. 10/022,038 (now abandoned), and Ser. No. 10/012,586 (now U.S. Pat. No. 7,371,210, issued May 13, 2008), all filed Nov. 16, 2001, and all of which claim the benefit of Provisional Application Nos. 60/269,200, filed Feb. 15, 2001, 60/276,217, filed Mar. 15,2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, and 60/293,346, filed May 24, 2001.
- This application is related in subject matter to application Ser. No. 11/467,886, filed Aug. 28, 2006 (now U.S. Pat. No. 7,766,894, issued Aug. 3, 2010), and application Ser. Nos. 11/762,751 (now U.S. Pat. No. 7,931,586, issued Apr. 26, 2011), and Ser. No. 11/762,748 (now U.S. Pat. No. 7,727,185, issued Jun. 1, 2010), both of which were filed Jun. 13, 2007. The entire disclosures of the above applications are hereby expressly incorporated herein by reference in their entireties.
- Catheters are used extensively in the medical field in various types of medical procedures, as well as other invasive procedures. In general, minimally invasive medical procedures involve operating through a natural body opening or orifice of a body lumen, or through small incisions, typically 5 mm to 10 mm in length, through which instruments are inserted. In general, minimally invasive surgery is less traumatic than conventional surgery, due, in part, because no incision is required in certain minimally invasive procedures, or the significant reduction in the incision size in other procedures. Furthermore, hospitalization is reduced and recovery periods are shortened as compared with conventional surgical techniques.
- Catheters maybe provided in a variety of different shapes and sizes depending upon the particular application. It is typical for a clinician to manipulate the proximal end of the catheter to guide the distal end of the catheter inside the body, for example, through a vein or artery. Because of the small size of the incision or opening and the remote location of the distal end of the catheter, much of the procedure is not directly visible to the clinician. Although clinicians can have visual feedback from the procedure site through the use of a video camera or endoscope inserted into the patient, or through radiological imaging or ultrasonic imaging, the ability to control even relatively simple instruments remains difficult.
- In view of the above, some have proposed using robotic tele-surgery to perform minimally invasive procedures. Typically, these robotic systems use arms that reach over the surgical table and manipulate the surgical instruments inserted into the patient, while the surgeon sits at a master station located a distance from the table and issues commands to the arms.
- In accordance with the present inventions, a medical system comprises a first medical probe (e.g., a flexible catheter) having indicia, and a second medical probe (e.g., a flexible catheter) in a coaxial arrangement with the first medical probe. The second medical probe has a detector (e.g., an optical detector) configured for detecting a passage of the indicia as the first and second medical probes are moved relative to each other. In one embodiment, the first medical probe is an inner medical probe, and the second medical probe is an outer medical probe. The medical system further comprises an electromechanical driver coupled to the first and second medical probes, and a controller configured for directing the electromechanical driver to move the first and second medical probes relative to each other, and for receiving signals from the detector indicating the relative movement between the first and second medical probes. In one embodiment, the first medical probe further includes an articulating tool, in which case, the controller may be configured for directing the electromechanical driver to actuate the articulating tool. In another embodiment, the controller is coupled to the electromechanical driver via external cabling. In still another embodiment, the medical system further comprises a user interface configured for receiving at least one command, in which case, the controller may be configured for directing the electromechanical driver in response to the command(s).
- The controller can control relative movement between the first and second medical probes based on the detected indicia. For example, the controller may be configured for directing the electromechanical driver to linearly translate the first and second medical probes relative to each other. In this case, the indicia may be disposed along a length of the first medical probe, the detector may be configured for detecting a linear passage of the indicia as the first and second medical probes are linearly translated relative to each other, and the controller may be configured for receiving signals from the detector indicating the relative linear translation between the first and second medical probes. As another example, the controller may be configured for directing the electromechanical driver to axially rotate the first and second medical probes relative to each other. In this case, the indicia may be disposed along a circumference of the first medical probe, the detector may be configured for detecting a rotational passage of the indicia as the first and second medical probes are axially rotated relative to each other, and the controller may be configured for receiving signals from the detector indicating the relative axial rotation between the first and second medical probes.
- The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
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FIG. 1 is a schematic perspective view of a coaxial catheter in accordance with the present invention; -
FIG. 2A is a side view of the coaxial catheter system ofFIG. 1 ; -
FIG. 2B is a cross-sectional view of the catheter system illustrated inFIG. 2A ; -
FIG. 3 is a schematic and block diagram of the coaxial catheter system in accordance with the present invention; -
FIG. 4 is a block diagram of another embodiment of the present invention employing controllable balloons for controlled movement of the coaxial catheter system; -
FIG. 5 is a timing diagram associated with the block diagram ofFIG. 4 ; -
FIG. 6 is a schematic diagram illustrating the coaxial catheter arrangement and associated proximal and distal balloons, associated with the block diagram ofFIG. 4 ; -
FIG. 7 is a schematic diagram illustrating another aspect of the present invention employing a detector; -
FIG. 8 is a schematic and block diagram of still another embodiment of the present invention; -
FIG. 9 illustrates another principle of the present invention in a coaxial catheter system illustrated being used in a vein or artery; -
FIG. 9A illustrates a multi-lobed balloon of the system ofFIG. 9 ; -
FIG. 10 illustrates another embodiment of the invention for distal drive of one of the catheters; -
FIG. 11A a block and schematic view a catheter drive system with a fluid delivery system in accordance with the invention; -
FIG. 11B is a close-up view of a manifold of the fluid delivery system ofFIG. 11A ; -
FIG. 12 illustrates a catheter coupled to a catheter drive mechanism in accordance with the invention; -
FIG. 12A is a cross-sectional view of the drive mechanism ofFIG. 12 ; -
FIG. 13 illustrates the catheter ofFIG. 12 and a guide wire coupled to respective drive mechanisms in accordance with the invention; -
FIG. 14 illustrates the linear movement of the drive mechanisms ofFIG. 13 ; -
FIGS. 15A-15C illustrate various devices used to move the drive mechanisms ofFIG. 13 in a linear manner; -
FIG. 16 is a perspective view of the catheter and guide wire ofFIG. 13 shown coupled to respective drive mechanisms of a base unit; -
FIG. 16A is a top view of one of the drive mechanisms shown inFIG. 16 ; -
FIG. 16B is a view of the drive mechanism ofFIG. 16A taken along theline 16B-16B; -
FIGS. 17A-17C illustrate a connector used to couple the catheter and guide wire to their respective drive mechanisms; -
FIGS. 18 and 18A illustrate an alternative embodiment of the connector; and -
FIGS. 19 , 19A and 19B illustrate yet another embodiment of the connector. -
FIGS. 20A and 20B illustrate yet another embodiment of the connector. - A description of preferred embodiments of the invention follows. Referring to
FIG. 1 there is shown acatheter system 5 including threeseparate catheter shafts end effector 12 supported at the distal end of thecatheter shaft 10. Theend effector 12 may be, for example, an articulated tool such a grasper with a pair ofjaws end effector 12 include scissors, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools, and clip appliers. Theend effector 12 can also be a non-articulated tool, such as a cutting blade, probe, irrigator, catheter or suction orifice, and dilation balloon. Further details of catheter systems, particularly those relating to mechanisms for multiple degrees-of-freedom of motion of catheter shafts can be found in application Ser. Nos. 10/023,024 (now abandoned), 10/011,449 (now abandoned), 10/022,038 (now abandoned), 10/012,586 (now U.S. Pat. No. 7,371,210, issued May 13, 2008), Ser. No. 10/011,371 (now U.S. Pat. No. 7,090,683, issued Aug. 15, 2006), and Ser. No. 10/010,150 (now U.S. Pat. No. 7,214,230, issued May 8, 2007), all by Brock et al., and all filed Nov. 16, 2001, and all of which are hereby incorporated herein by reference in their entireties. - Each of the
catheter shafts FIG. 1 are arranged in a coaxial manner with thesmall diameter catheter 10 positioned inside themedium diameter catheter 20 which in turn is positioned inside thelarge catheter 30. The arrangement inFIG. 1 is a coaxial arrangement with thesmall diameter catheter 10 adapted for sliding inside of themedium diameter catheter 20. - As illustrated in
FIG. 1 , as well asFIG. 2A , thecatheter 30 is able to move with a linear translation in thedirection 31, while themedium diameter catheter 20 is able to slide inside thecatheter 30 with a linear translation motion in thedirection 21, and thesmall catheter 10 is able to slide inside the medium catheter with a linear translation motion in thedirection 11. - In addition to the translation motions, each of the
catheter shafts shafts catheters catheters - Referring also to
FIG. 2B , there is shown the coaxial arrangement of thecatheters double arrows FIG. 2A are theoperative segments respective catheters - Turning now to
FIG. 3 , the multiplecoaxial catheters drive system 35. Also shown inFIG. 3 are theoperative sections catheters freedom FIG. 3 but considered to be the location where the catheter enters the anatomic body. The entry of the catheter may, for example, be percutaneously, via an incision, or even through a natural body orifice. Procedures to be described below are particularly adapted for transitioning a multi-shaft catheter constriction through an anatomic body vessel such as through the intestines. Of course, the concepts of the illustrated embodiments may be used in association with the control and transition of the catheters through other body vessels or body cavities as well. - Each
catheter catheters FIG. 3 , these support blocks 40, 50, and 60 are coupled to the respective proximal ends of the catheters identified as 10A, 20A, and 30A. Each of the support blocks controls linear translational movements of the catheters with the use ofwheels support block 40, there is also illustrated control of therotational motion 46 of thecatheter 10. Similarly, support blocks 50 and 60 providerotational control 56 and 66 to therespective catheters - The
drive system 35 also includes anelectromechanical drive member 70 coupled to the support blocks 40, 50, and 60 withmechanical cablings drive member 70 is a under the direction of acontroller 72 that is also coupled to an input device 76 which interfaces thedrive system 35, and hence thecatheter system 5, with a user who is typically a surgeon. - In the illustrated embodiment, the
electromechanical drive member 70 is a motor array with a plurality of drive motors. Themechanical cablings motor array 70, there can be at least one motor for controlling linear translation, and a separate motor for controlling rotational translation relative to each of the support blocks. - Thus, when the
system 35 is in use, the surgeon provides instructions to thecontroller 72 through theinput device 72. In turn, thecontroller 72 directs the operation of themotor array 70 and hence the support blocks 40, 50, and 60 which drive the respective catheters with multiple degrees-of-freedom of movement. - The
motor array 70 also includes separate motors for driving the bending movements S3B1 and S3B2, S2B1 and S2B2 and S1B1 and S1B2 of the catheters as previously indicated inFIG. 1 . InFIG. 3 , in addition to theoperative segments catheters end effector 12 as well. The cabling C1, C2, and C3 can extend through the catheters and through the corresponding support blocks, coupling through the variousmechanical cablings motor array 70 that control the bending movements of the catheters, as well as operation of theend effector 12. Further details of mechanical cabling used for the operation of catheters including bending and flexing thereof may be found in the application Ser. Nos. 10/023,024. 10/011,371, 10/011,449, 10/010,150, 10/022,038, and 10/012,586, mentioned above. - In some embodiments, the
controller 72 is a microprocessor that receives input commands from the input device 76. The input device 76 can be one of various types of controls such as a dial, joystick, wheel, or mouse. A touch-screen can also be employed as the input device 76 to allow the surgeon to input information about the desired location of a particular portion of the catheter by touching the screen. In this regard, reference may also be made to Application No. 10/216,669, filed August 8, 2002 (now abandoned), which application is hereby incorporated herein by reference in its entirety, which describes a catheter tracking system that enables an operator at the input device to select a particular anatomic body site and direct the catheter automatically to that site. - Referring to
FIGS. 4 , 5 and 6, there is shown another implementation of the catheter control. Here, the system employs multiple catheters with multiple balloons in combination with a control mechanism by which the balloons are inflated and deflated to move the catheters in increments through a body vessel. InFIG. 6 , a set ofcatheters body vessel 100. Associated withcatheter 120 is a distal balloon D. and similarly, associated with the distal end ofcatheter 130 is a proximal balloon P. InFIG. 6 there are also shown ports Dl and P1 through which air or other fluid is introduced into each of the balloons to inflate the balloons or removed to deflate the balloons. InFIG. 6 the proximal balloon P is shown inflated and the distal balloon D is shown deflated. Note that although only two balloons are shown, one or more additional balloons can be associated with a third or even a fourth catheter. - In the block diagram of
FIG. 4 there is identified aninner catheter 86 and anouter catheter 87, which may correspond respectively tocatheters FIG. 6 . Also illustrated inFIG. 4 are aninner catheter control 84 and anouter catheter control 85. These controls may be similar to the controls illustrated inFIG. 3 for at least controlling the advancement in a linear manner of the corresponding catheter. Thus, thecatheter control 84 can be considered as controlling the linear movement of theinner catheter 86 while thecatheter control 85 can be considered as controlling the linear translation of theouter catheter 87. - The outputs of a
motor array 90 are coupled to theinner catheter control 84 and theouter catheter control 85, while acontroller 92 is coupled to and controls the motor any 90. Aninput device 96 connected to thecontroller 92 provides an interface for a user such as surgeon to operate the inner andouter catheters - Also illustrated in
FIG. 4 is aballoon controller 94 associated with thecontroller 92 and that has two separate outputs coupled to the proximal, P, and distal, D, balloons. Under the direction of thecontroller 92 the balloon controller controls the inflation and deflation of the proximal balloon P and the distal balloon D. Details about the timing of the inflation and deflation sequence are illustrated inFIG. 5 . - The proximal, P, and distal, D, balloons are inflated and deflated in a sequence in association with advancement of the
different catheter segments controller 92 initiates a sequence by which the catheter creeps or advances in increments through a vessel 100 (FIG. 6 ). - An example of the timing sequence for the advancement of the inner and
other catheters FIG. 4 or 120 or 130 ofFIG. 6 is illustrated inFIG. 5 . Once the advancement sequence is initiated, for example, through theinput device 96, no further control via the input device is necessary. Instead thecontroller 92 simply repeats a predetermined sequence to cause incremental movement of the catheter system through the body. -
FIG. 5 depicts certain timing actions relating primarily to the inflation and deflation of the balloons, P and D, as well as the forward advancement of thecatheters - In step (a), there is an inflation of the proximal balloon P. This causes the
catheter 130 to lock against the side wall of thevessel 100 to create an anchor point for the distal end of thecatheter 130. - Next, in step (b) the
inner catheter 120 is advanced by a certain amount in thevessel 100. Note that, as illustrated inFIG. 6 , the distal balloon D is deflated, and thus is not locked in position but is readily moveable in a forward direction with thecatheters - In step (c), the process inflates the distal balloon D, which locks the distal end of
catheter 120 to the inner wall of thevessel 100. Subsequently, the proximal balloon P is deflated so that it is no longer locked against the inner wall of thevessel 100. Theouter catheter 130 is then free to move. - In step (e) the
outer catheter 130 inFIG. 6 is moved forward carrying the proximal balloon P. which has previously been deflated allowing it to move readily through thevessel 100. - After the
catheter 130 and its associated proximal balloon P has moved a certain distance, then, as illustrated in step (f) the process again inflates the proximal balloon P, and in step (g) deflates the distal balloon D. Once this occurs, the catheter system is then in the position illustrated inFIG. 6 , having advanced by an incremental amount related to the length of movement of the inner andouter catheters - Note that the particular control illustrated in
FIGS. 4-6 does not necessarily require the use of an input device. Alternatively, if an input device is used, it can be of the type that simply initiates a sequence that is stored in the algorithm ofcontroller 92. Hence again, in this way, once the sequence is initiated, then subsequent moves are controlled by thecontroller 92 and not by any specific manipulations at theinput device 96. - Moreover, there may also be provided a force feedback, usually associated with a
distal catheter 110. If the distal end of this catheter, or an end effector supported at the distal end, detects an obstruction or some blockage that provides a force feedback signal to the controller, then the controller may interrupt the sequence of steps depicted in the timing diagram ofFIG. 5 . This enables the surgeon to observe the position of the catheters, for example, through the use of known display techniques including Fluoroscopy, Ultrasound, MRI, CT, or PET. - Referring now to
FIG. 7 , there is shown another embodiment of a catheter system havingseparate catheters detector 240. For illustrative purposes, thecatheter 220 may be considered a proximal catheter, while thecatheter 210 may be considered a distal catheter. A drive system such as that shown inFIG. 3 is used for the linear translation of the catheters. A particular feature of the catheter system shown inFIG. 7 is a feedback signal provided to thedetector 240 to indicate movement of the catheters, as well as relative movement between catheters. To accomplish this, each of thecatheters indicia detector 240 may be or include a counter that counts passing indicia. - As an example, if the
catheter 220 is stationary and thecatheter 210 is being moved forward linearly, then thedetector 240 such as an optical system can simply read theindicia 211 as thecatheter 210 moves coaxially out of thecatheter 220. Each of the indicia is separated by a predetermined length and the optical system simply reads each indicia as it moves relative to an adjacent fixed catheter to determine the overall distance of movement of the catheter system. - The
detection system 240 illustrated inFIG. 7 may be used with the incremental advancement system depicted inFIGS. 4-6 . In connection with the balloons illustrated inFIGS. 4 and 6 , mention has been made of the incremental forward movement of the inner andouter catheters FIG. 7 can be used to measure the distance of movement of either or both of the catheters. - A further embodiment is illustrated in the schematic and block diagram of
FIG. 8 . Unlike the drive arrangement shown inFIG. 3 where coaxial catheters are driven from their proximal ends, thecatheters FIG. 8 are driven from their distal ends. The catheter system also implements the indicia anddetector 240 described with reference toFIG. 7 . - Here, the
catheter 220 is considered the proximal catheter and thecatheter 210 is considered the distal catheter. The operation of thecatheters drive member 160. Thedrive member 160 may be placed at the master station ofFIG. 3 , or controlled from a remote location such as at the master station, usually with surgeon input control. - Each catheter is driven relative to an adjacent coaxial catheter member, such as
catheter 220 relative tocatheter 230, withdrive mechanisms pieces - In
FIG. 8 there are illustrated twodrive blocks respective catheters FIG. 8 may also include the proximal drive arrangement ofFIG. 3 for one or more of the catheters. If both proximal and distal drive is used for any one particular catheter, then the proximal drive may be considered as a “coarse” drive while the more distal drive may be considered as a “fine” drive. - The
drive block 140 includeswheels 142 for controlling linear translation of thecatheter 210, as illustrated byarrow 144. In thedrive block 140 there is also illustrated rotational translation of thecatheter 210, as illustrated by thearrow 146. In a similar manner, the linear translation relating to driveblock 150 is represented bywheels 152 indicated by thearrow 154. Also, with regard to driveblock 150, andcatheter 220, thearrow 156 illustrates rotational movement of thecatheter 220 produced by thedrive block 150. -
FIG. 8 also illustrates the feedback signal to thedetector 240 to sense incremental of movement of the respective catheters. For this purpose, on each of the catheters there is provided indicia that may be of the optical type described earlier. InFIG. 8 these are indicated asindicia 211 oncatheter 210,indicia 221 oncatheter 220, andindicia 231 oncatheter 230. Thedetector 240 may include a counter that counts passing indicia to indicate the liner distance of relative movement between catheters. - Although the drive blocks 140 and 150 are shown in a schematic fashion about each of their respective catheters, it is understood that the drive mechanisms can also be employed within the catheter construction, such as shown in
FIG. 10 , or other drives may be employed between adjacent catheters. Also, theblock 160 illustrated inFIG. 8 as a drive block may in practice be cabling that connects back through the catheters to the motor array, such as themotor array 70 depicted inFIG. 3 . In this way, at an input device, such as the input device 76 inFIG. 3 , the surgeon can control the movement of the catheters in both a proximal manner and in a distal manner, or either manner. - The feedback at
detector 240 may be incorporated with thedrive 160 so that the drive provides for “fine’ movement of catheters in an incremental manner. The movement is fed back by way ofdetector 240 to provide for fine adjustment of the catheters, particularly the smaller diameterdistal catheter 210. - Mention has been made that control of the movement of the catheters can be provided at both the proximal and distal ends of the coaxial catheter system. For certain procedures, it may be advantageous to control the proximal end of the catheters, as well as directly control the movement at the distal end of the catheters. For example,
FIG. 9 depicts a coaxial catheter system extending through theaorta 300 of theheart 304 and used in avascular artery 302 that may be considered as including a main artery and several branches of the artery that are to be negotiated by the catheter system. - In the particular embodiment illustrated in
FIG. 9 the coaxial catheter system includes a largeouter catheter 330, amiddle catheter 320, and a small distal orinner catheter 310. The distal end of thecatheter 310 supports or carries anend effector 312 which may be in the form of a jaw member. For the particular system depicted inFIG. 9 , theouter catheter 330 and themiddle catheter 320 are driven from their respective proximal ends in a manner as illustrated inFIG. 3 with the use of the input device 76,controller 72, andmotor array 70. - To position each of the separate catheters, there is illustrated in
FIG. 9 a fixing or securing means such asballoon 332 located at the distal end of largeouter catheter 330 andballoon 322 located at the distal end of themiddle catheter 320. Each of these balloons may be inflated to hold its corresponding catheter in a relatively fixed position in the body vessel. Alternatively, rather than the use of balloons, other securing devices may be employed such as sonic type of expandable mechanical member. Regardless of the type of securing member employed, it is capable of being operated by the surgeon from a remote location at the master station, and at the appropriate time selected by the surgeon. Theballoons FIG. 9A . Theballoon FIG. 9A has threelobes 305 that when inflated in avessel 306 allows fluid to flow in thespace 307 between the lobes. Theballoon - Initially, both the
middle catheter 320 and the smallinner catheter 310 may be in a withdrawn position, coaxially positioned within theouter catheter 330. When theouter catheter 330 is controlled by the surgeon to be positioned in the manner illustrated inFIG. 9 , the surgeon can then instruct theballoon 332 to inflate to secure theouter catheter 330 in the position illustrated inFIG. 9 . Theballoon 332 expands against the walls of the vessel and essentially locks the outer catheter in position, particularly at its distal end. - Next, under the control of the surgeon through the use of an input device, the
middle catheter 320 is moved forward linearly through the vessel of the anatomy. The control of the forward movement of thecatheter 320 relative to thecatheter 330 may be carried out in a manner illustrated inFIG. 3 from the proximal end of thecatheter 320. - Previously, mention was made that the
balloon 332 is inflated to secure theouter catheter 330. After themiddle catheter 320 is moved forward some distance, then theballoon 322 may also be inflated. This procedure is under the surgeon's control at the master station through the input device to now secure the distal end of themiddle catheter 320 at an appropriate position within a body vessel. - For “fine” control of the small
inner catheter 310, it is intended, in the embodiment ofFIG. 9 , that the control of theinner catheter 310 is implemented in the manner illustrated inFIG. 8 in which the support and drive block 140 can provide direct drive of the inner catheter's 310 forward linear movement out of themiddle catheter 320. Although the drive is located at the distal end of the catheter, the drive is remotely controlled by the surgeon at the master station. Again, this control can be by way of an input device such as an input interface or a joystick moved in a direction to cause a consequent movement of the various catheters depicted inFIG. 9 . - Because of the significant length of the catheters that may be employed in a surgical procedure, it may be desirable to provide direct drive of the
inner catheter 310 at its distal end, rather than drive it at its proximal end. For example, this may be particularly desirable when the length of the entire catheter system is so long that it may have some tendency to deflect or bend even when secured by, for example, theballoons - After the
balloons inner catheter 310. As indicated previously, the drive for theinner catheter 310 is typically of the type illustrated inFIG. 8 , or inFIG. 10 discussed below. - In
FIG. 10 , the small diameterinner catheter 310 is driven relative to themiddle diameter catheter 320. The linear movement of thecatheter 310 is illustrated by thearrow 352 when driven by thewheels 350. The rotation of thecatheter 310 relative to thecatheter 320 is driven theblock 354, as indicated by therotational arrow 356. -
FIG. 10 also illustrates a detector orreader 360. This again may be an optical device that detects the passage of theindicia 311 on theinner catheter 310. Appropriate electrical signal lines coupled from thedetector 360 back to the master station transmit information related to the movement of theinner catheter 310 relative to themiddle catheter 320. - The
detector 360 may also be used for detecting rotation of thecatheter 310 relative to thecatheter 320. For this purpose, in addition to the linear set ofindicia 311 on thecatheter 310, thecatheter 310 is also provided withadditional indicia 315 that extend about the circumference of the catheter. Thereader 360 is able to read not only linear passage ofindicia 311, but also read rotation of theindicia 315 from one linear set ofindicia 311 to the next. - Although a
single detector 360 is shown inFIG. 10 , other detectors may also be employed. For example, one detector could be used for detecting linear translation of thecatheter 310, and a second detector could be used for detecting rotation of thecatheter 310 with the use ofindicia 315. - The catheter drive system described above can be implemented in other configurations as well. For example, there is shown in
FIG. 11A a catheter drive system associated with a fluid or drug delivery system. Note inFIG. 11A , emphasis is placed on the proximal end of acatheter 1070 andguide wire 1072. The more distal portion of the catheter is identified by the dotted lines. Details of the distal portions of thecatheter 1070 andguide wire 1072 may be found in application Ser. No. 10/216,067, filed Aug. 8, 2002 (now abandoned), which application is hereby incorporated herein by reference in its entirety. - At some position along the
catheter 1070, there is a patient interface illustrated at 1074 where the catheter may be considered as entering into the patient's body. The entry of the catheter may, for example, be percutaneously, via an incision, or even through a natural body orifice. - A
support block 1076 supports thecatheter 1070 in a manner to enable at least two degrees-of-freedom of the catheter including axial movement of the catheter to an anatomic body target sit; as well as rotation of the catheter. Thesupport block 1076 controls both the linear translation of thecatheter 1070 by thewheels 1078, as indicated by thearrow 1079, and the rotational translation of the catheter, as illustrated by thearrow 1080. Again, further details of such a catheter support system illustrating multiple degrees-of-freedom can be found in the application Ser. Nos. 10/023,024, 10/011,371, 10/011,449, 10/010,150, 10/022,038, and 10/012,586, mentioned above. - In
FIG. 11 A, there is also ablock 1082 which controls the movement of theguide wire 1072. In particular, thewheels 1084 move theguide wire 1072 in a linear manner in thedirection 1085. Theblock 1082 is also able to rotate theguide wire 1072 in thedirection 1086. Note that theblocks common support structure 1120. Although thesupport 1120 provides a physical connection between theblocks 1076 arid 1082, the blocks are operated independently so that theguide wire 1072 and thecatheter 1070 can be driven independently of each other. - The drive or
support blocks motor array 1090 that controls the movements of both thecatheter 1070 and theguide wire 1072 with at least two degrees-of-freedom. In particular,mechanical cablings motor array 1090 to the support blocks 1076 and 1082, respectively. Themotor array 1090 is also coupled to acontroller 1092 that directs a plurality of motors in the motor array. An input device 1096 provides an interface to the system for use by a surgeon. - The
mechanical cablings motor array 1090 to therespective support blocks catheter 1070 andguide wire 1072. Thus, in themotor array 1090, there may be at least one motor for the linear translation and a separate motor for the rotational translation for theblock 1076. Similarly, there can be motors in themotor array 1090 for both the linear and rotational translations of thesupport block 1082. - The
controller 1092, maybe a microprocessor that receives input commands from the input device 1096. The input device 1096 may include various types of controls such as a dial, joystick, wheel or mouse. A touch screen may also be employed as the input device 1096 to input information about the desired location of a particular portion of the catheter. Details of such a tracking system may be found in application Ser. No. 10/216,669 (now abandoned), mentioned above. Such a tracking system enables an operator, such as a surgeon, through the input device to select a particular anatomic body site and direct the catheter directly and automatically to that site. - Although a
manifold 1100 is shown with a single port, the manifold may include multiple ports. The manifold 1100 provides a delivery conduit to thecatheter 1080 for the delivery of fluids to a site in the patient's body. For example, one of thefluids 1105 employed may be a contrast fluid for purposes of visualization, which is coupled to afeed line 1107 by a valve A. There may also be a drug delivery system indicated generally at 1108 coupled to thefeed line 1107 by way of aline 1109 to a valve B. Alternatively, the manifold 1100 can be provided with two separate ports with a respective valve A and B in each of these ports. - As shown in
FIG. 11 B, themanifold 1100 includes anend piece 1200 sealed to the back end of the manifold 1100 and provided with anopening 1202 through which theguide wire 1072 enters into themanifold 1100, and hence thecatheter 1070. Positioned within the manifold 1110 and adjacent to theend piece 1200 is agasket 1204. Theguide wire 1072 pierces thegasket 1204 such that the gasket forms a seal about the guide wire. Thus, as fluid enters from thefeedline 1107 into themanifold 1100, thegasket 1204 prevents the fluid from leaking out the back end of themanifold 1100. - As indicated previously, the input device 1096 may take on a variety of different forms. If a wheel, dial, or pivoting switch is employed as the input device 1096, then one of these may be used for controlling the two degrees-of-freedom of movement of the
catheter 1070, while another such device is used to control the two degrees-of-freedom of movement of theguide wire 1072. Thus, the operator has independent control of the drive orsupport blocks guide wire 1072 and thecatheter 1070 independently of each other. Typically, the operator advances the guide wire 1072 a certain distance, and then thecatheter 1070, such that theguide wire 1072 can be used to access certain twists or turns in a body lumen such as an artery or vein. - The input device 1096 may also operate means such as buttons, switches, etc. that provide signals through
lines fluid sources controller 1092, thelines - When the system is in operation, the surgeon advances the
catheter 1070 andguide wire 1072 through the patient's body with the drive system. To provide visualization of the end of the catheter, the surgeon can instruct, with the input device 1096, the valve A to open. That is, the surgeon interfaces with the system through the input device 1096 to generate a signal online 1111 that opens the valve A to dispense a contrast fluid through the manifold 1000 and thecatheter 1070 to the target site of interest. Similarly, the surgeon may deliver drugs to the target site by instructing the valve B to open which would allow drugs from thesource 1108 to flow through thecatheter 1070 into the body. - In the following discussion, greater detail will be provided about the drive mechanisms (
FIGS. 12-16 ) and various devices (FIGS. 17-19 ) used to couple the medical instruments to the drive mechanisms. Although the drive mechanisms and connectors are described in reference to thecatheter 1070 andguide wire 1072 discussed above, they can be used in any number of combinations with any of the other medical instruments described earlier. - The
catheter 1070 referred to in these figures is of the type commonly used in angioplasty. Thecatheter 1070 includes afirst leg 1300 joined with asecond leg 1302 at acoupler 1304, and a singleextended leg 1306 that extends from thecoupler 1304. Typically, a part or much of theextended leg 1306 is the portion of thecatheter 1070 that is inserted into the patient. Theleg 1302 is connected to anend piece 1305 through which theguide wire 1072 is inserted such that theguide wire 1072 typically extends from outside theend piece 1305 through thelegs legs leg 1300 is hollow to allow the transmission of a liquid or gas through theleg 1306 to the surgical site. Hence, theleg 1300 would function in much the same way as thefeedline 1107 shown inFIG. 11 . Theleg 1300 is also provided with avalve 1307 that controls the delivery rate of the liquid or gas, and prevents the liquid or gas from escaping once the liquid or gas source is disconnected from theleg 1300. Note that a gasket is typically located in thecoupler 1304 or theend piece 1305 that forms a seal with theguide wire 1072 to prevent the liquid or gas from escaping out the opening of theend piece 1305. - Referring now to
FIGS. 12 and 12A , the drive or support block described earlier is identified asdrive mechanism 1308 a associated with thecatheter 1070. As can be seen inFIG. 12A , which is a view of the drive mechanism along the length of theleg 1306, thedrive mechanism 1308 includes agripping device 1310 in which thecatheter 1070 is secured, and amotor 1312. Abelt 1314 is wrapped aroundpulleys motor 1312 andgripping device 1310, respectively. Hence, as themotor 1312 rotates, this rotary motion is transmitted to thegripping device 1310 through thebelt 1314 as indicated by thedouble arrow 1316, such that thecatheter 1070 rotates accordingly as indicated by the double arrow 1318 (FIG. 12 ). - As shown in
FIG. 13 , a similar type ofdrive mechanism 1308 b can be coupled to guidewire 1072 to provide it with a rotary motion as indicated by thedouble arrow 1318 b. In addition, thedrive mechanisms FIG. 13 also provide thecatheter 1070 andguide wire 1072 with linear motion as indicated by thedouble arrows FIG. 14 , thedrive mechanisms respective rails - To move the
drive mechanisms direction 1319, various configurations can be used as illustrated inFIGS. 15A , 15B, and 15C. Referring in particular toFIG. 15A , there is shown a leadscrew drive arrangement 1360 with a threadedconnector 1362 attached to thedrive mechanism 1308. Alead screw 1364 is threaded through theconnector 1362 and coupled to astationary motor 1366. Accordingly, rotary motion of thelead screw 1364 induced by themotor 1366 in thedirection 1368 results in a linear motion of theconnector 1362. Since theconnector 1362 is attached to thedrive mechanism 1308, linear motion of theconnector 1362 produces a consequent linear motion of thedrive mechanism 1308 in thedirection 1319. - Referring now to
FIG. 15B , there is shown a rack andpinion drive arrangement 1370 for moving thedrive mechanism 1308 in a linear manner. The rack andpinion drive 1370 includes arack 1372 attached to thedrive mechanism 1308, and apinion 1374 coupled to astationary motor 1376. The teeth of thepinion 1374 engage with those of therack 1372 such that as themotor 1376 rotates thepinion 1374 in thedirection 1378, therack 1372 and hence thedrive mechanism 1308 moves linearly back and forth in the direction 1379. - Turning now to
FIG. 15C , there is illustrated yet another configuration for moving thedrive mechanism 1308 linearly. In particular there is shown a belt/pulley drive 1380 that includes a belt, chain orcable 1382 wrapped around apulley 1386 and amotor pulley 1384 coupled to a stationary motor. The belt, chain, orcable 1382 is attached in turn to thedrive mechanism 1308 with aconnector 1388. Hence, rotary motion of themotor pulley 1384 produced by the motor is transformed into a linear motion of theconnector 1388. Thus, as the motor rotates themotor pulley 1384, thedrive mechanism 1308 moves back and forth in thedirection 1319. - Greater detail of the
catheter 1070 andguide wire 1072 arrangement ofFIG. 13 is illustrated inFIG. 16 , and that of thedrive mechanism 1308 is shown inFIGS. 16A and 16B . In particular, thecatheter 1070 andguide wire 1072 are shown as a typical “off-the-shelf” apparatus coupled to abase unit 1400. That is, thebase unit 1400 is meant to be easily coupled to and decoupled from any number of medical instruments, such as thecatheter 1070 andguide wire 1072 combination. In other implementations, such as some of those described earlier, the medical instrument and base unit is considered as a single instrument not to be decoupled from each other. - Referring now in particular to
FIGS. 16A and 16B , in addition to the features illustrated inFIG. 12A , thedrive mechanism 1308 includes ahousing 1401 which encloses much of the moving parts of thedrive mechanism 1308. As described before, rotary motion of themotor 1312 is transferred by thebelt 1314 to theguide wire 1072 or theleg 1306 of thecatheter 1070 via thepulley 1315 b coupled to the gripping device 1310 (FIG. 12A ). Thepulley 1315 b itself is supported in thehousing 1401 with a pair ofbearings 1402. - Turning now to the discussion of the
connector 1310, to facilitate coupling thecatheter 1070 and theguide wire 1072 to theirrespective drive mechanisms 1308, many types of connectors can be used. In some implementations, a Toohy Borst type of fitting may be optimal. Another type ofconnector 1310 is shown inFIG. 17A , in which theleg 1306 orguide wire 1072 would be placed in anenlarged portion 1500 of aslot 1502. A clampingforce 1504 would then be provided to secure theleg 1306 orguide wire 1072 to the drive mechanism. For example, as shown inFIG. 17B , the clamping force could be provided with athumb screw 1506 threaded into ablock 1508 in which theconnector 1310 is mounted. In another type of arrangement shown inFIG. 17C , a slidingring 1510 is fitted over theconnector 1310 in thedirection 1512. The clamping force can also be provided by a vise like device that functions similar to a collet/pin vise. - In another embodiment, as shown in
FIG. 18A , theconnector 1310 and thepulley 1315 b are one and the same device. Here, theleg 1306 orguide wire 1072 snaps into anenlarged portion 1520 of a slot provided in anextended segment 1522 of theconnector device 1310. Since, theenlarged portion 1520 is slightly smaller than the diameter of theleg 1306 or theguide wire 1072, thelegs 1524 of thesegment 1522 provide a sufficient clamping force to theleg 1307 orguide wire 1072. In this arrangement, thebelt 1314 is wrapped around thepulley 1315 a of themotor 1312 and attaches to the twocurved segments 1526 of theconnector 1310. Thus, rotary motion of thepulley 1315 a produces a rotary motion of theconnector 1310, and hence theleg 1306 orguide wire 1072, indicated by thedouble arrow 1318. - Referring now to
FIGS. 19 , 19A and 19B, there is shown another embodiment of theconnector 1310. In this embodiment, theconnector 1310 includes an inner 1550 and an outer 1552 C-shaped rings. To grasp theleg 1306 orguide wire 1072, theouter ring 1552 is slid over theinner ring 1550 in thedirection 1554. Theguide wire 1072 or theleg 1306 of thecatheter 1070 is placed in theinner ring 1550, and theouter ring 1552 is then rotated or twisted in thedirection 1556 around theinner ring 1550, thereby capturing theleg 1306 orguide wire 1072. Alternatively, theleg 1306 orguide wire 1072 can first be placed in the inner 1550 and outer 1554 rings, and then theouter ring 1554 can be rotated about the leg or catheter and subsequently slid over theinner ring 1550. - Yet another embodiment of the
connector 1310 is shown inFIGS. 20A and 20B . In this embodiment, theconnector 1310 includes apin vise 1600 provided withslot 1602 cut along its length, and asleeve 1604 that is threaded onto thepin vise 1600. The pin vise is operated by turning thesleeve 1604 so that as it threads onto thevise 1600 in thedirection 1606 which causes theslot 1602 to narrow. Thus to secure theleg 1306 orguide wire 1072 to thedrive mechanism 1308, the leg or guide wire is first placed into theslot 1602 as shown inFIG. 20B . The operator then rotates thesleeve 1604 to thread it over thepin vise 1600, and hence to close theslot 1602 about the leg or guide wire until the pin vise is sufficiently tightened about theleg 1306 orguide wire 1072. - This invention can be implemented and combined with other applications, systems, and apparatuses, for example, those discussed in greater detail in Provisional Application No. 60/332,287, filed Nov. 21, 2001, the entire contents of which are hereby incorporated herein by reference in their entirety, as well as those discussed in greater detail in each of the following documents, all of which are hereby incorporated herein by reference in their entireties: application Ser. No. 09/783,637, filed Feb. 14, 2001 (now abandoned), which is a continuation of International Application No. PCT/US00/12553, filed May 9, 2000, which claims the benefit of Provisional Application No. 60/133,407, filed May 10, 1999; application Ser. No. 10/208,087, filed Jul. 29, 2002 (now U.S. Pat. No. 6,739,715, issued May 25, 2004), which is a continuation of application Ser. No. 09/827,503, filed Apr. 6, 2001 (now Pat. No. 6,432,112, issued Aug. 13, 2002), which is a continuation of application Ser. No. 09/746,853, filed Dec. 21,2000 (now U.S. Pat. No. 6,692,485, issued Feb. 17, 2004), which is a divisional of application Ser. No. 09/375,666, filed Aug. 17, 1999 (now U.S. Pat. No. 6,197,017, issued Mar. 6, 2001), which is a continuation of application Ser. No. 09/028,550, filed Feb. 24, 1998 (now abandoned); International Application No. PCT/US01/11376, filed Apr. 6, 2001, which claims priority to application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485, issued Feb. 17, 2004), and application No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112, issued Aug. 13, 2002); application Ser. Nos. 10/014,143 (now abandoned), 10/012,845 (now U.S. Pat. No. 7,169,141, issued Jan. 30, 2007), Ser. No. 10/008,964 (now abandoned), Ser. No. 10/013,046 (now abandoned), Ser. No. 10/011,450 (now abandoned), Ser. No. 10/008,457 (now U.S. Pat. No. 6,949,106, issued Sep. 27, 2005), and Ser. No. 10/008,871 (now U.S. Pat. No. 6,843,793, issued Jan. 18, 2005), all filed Nov. 16, 2001, and all of which claim the benefit of Provisional Application No. 60/279,087, filed Mar. 27, 2001; application Ser. No. 10/077,233, filed Feb. 15, 2002 (now U.S. Pat. No. 7,297,142, issued Nov. 20, 2007), which claims the benefit of Provisional Application No. 60/269,203, filed Feb. 15, 2001; application Ser. No. 10/097,923, filed Mar. 15, 2002 (now U.S. Pat. No. 6,860,878, issued Mar. 1, 2005), which claims the benefit of Provisional Application No. 60/276,151, filed Mar. 15.2001; application Ser. No. 10/034,871, filed Dec. 21,2001 (now U.S. Pat. No. 6,810,281, issued Oct. 26, 2004), which claims the benefit of Provisional Application No. 60/257,816, filed Dec. 21,2000; application No. 09/827,643, filed Apr. 6, 2001 (now U.S. Pat. No. 6,554,844, issued Apr. 29, 2003), which claims the benefit of Provisional Application No. 60/257,869, filed Dec. 21, 2000, and Provisional Application No. 60/195,264, filed Apr. 7, 2000.
- While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.
- For example, although a detector for sensing relative movement between adjacent catheters has been described, a detector for sensing movement of any one or more of the catheters relative to a base position that may or may not be a location on a particular one of the catheters can be employed. Also described herein is the use of cabling through the catheters for controlling the movement of the catheters. In certain embodiments a piezo-electric arrangement may be employed in which electrical signal wires would extend through the catheter system for actuation of a mechanical (piezoelectric) member to provide motion of the distal end of the catheter.
Claims (20)
1. A medical system for performing a surgical procedure on a patient, comprising:
a first medical probe having indicia, the first medical probe being configured for insertion into a lumen or vessel of the patient;
a second medical probe positioned in an arrangement with the first medical probe, the second medical probe being configured for insertion into the lumen or vessel;
a detector fixedly coupled to the second medical probe and configured for insertion into and advancement through the lumen or vessel along with the second medical probe, wherein the detector detects passage of the indicia as the first and second medical probes are moved relative to each other within the lumen or body vessel;
an electromechanical driver coupled to the first and second medical probes, the electromechanical driver being operable to move the first and second medical probes; and
a controller configured for directing the electromechanical driver to move the first and second medical probes relative to each other within the lumen or body vessel based on signals received from the detector when the detector is positioned within the lumen or body vessel.
2. The medical system of claim 1 , further comprising a user interface configured for receiving at least one command, wherein the controller is configured for directing the electromechanical driver in response to the at least one command.
3. The medical system of claim 1 , wherein the controller is coupled to the electromechanical driver via external cabling.
4. The medical system of claim 1 , wherein the first and second medical probes are flexible catheters in a coaxial arrangement.
5. The medical system of claim 1 , wherein the detector is an optical detector.
6. The medical system of claim 1 , wherein the controller is configured for directing the electromechanical driver to linearly translate the first and second medical probes relative to each other, the indicia is disposed along a length of the first medical probe, the detector is configured for detecting a linear passage of the indicia as the first and second medical probes are linearly translated relative to each other, and the controller is configured for receiving signals from the detector indicating the relative linear translation between the first and second medical probes.
7. The medical system of claim 1 , wherein the controller is configured for directing the electromechanical driver to axially rotate the first and second medical probes relative to each other, the indicia is disposed along a circumference of the first medical probe, the detector is configured for detecting a rotational passage of the indicia as the first and second medical probes are axially rotated relative to each other, and the controller is configured for receiving signals from the detector indicating the relative axial rotation between the first and second medical probes.
8. The medical system of claim 1 , wherein the first medical probe further includes an articulating tool, and the controller is configured for directing the electromechanical driver to actuate the articulating tool.
9. The medical system of claim 1 , wherein the controller is operable to direct the electromechanical driver to move the second medical probe relative to the first medical probe.
10. The medical system of claim 1 , wherein the controller is operable to direct the electromechanical driver to move the first medical probe and the second medical probe.
11. A method for monitoring relative positions of a first medical probe and a second medical probe inside of a patient, the method comprising:
directing an electromechanical driver coupled to the first medical probe and the second medical probe to move the first medical probe and the second medical probe relative to each other, the first medical probe and the second medical probe being inserted into a lumen or vessel in the patient, the first medical probe having indicia, the second medical probe having a detector for sensing a passage of the indicia as the first medical probe and the second medical probe are moved relative to each other, wherein the detector is inserted into the lumen or vessel, and wherein a position of the detector changes with movement of the second medical probe as the second medical probe is repositioned within the lumen or vessel; and
detecting signals indicating the relative movement between the first medical probe and the second medical probe.
12. The medical system of claim 11 , wherein the first and second medical probes are flexible catheters in a coaxial arrangement.
13. The method of claim 12 , wherein the first medical probe is an inner medical probe and the second medical probe is an outer medical probe.
14. The method of claim 11 , wherein the detector is an optical detector.
15. The method of claim 11 , wherein the first medical probe and the second medical probe are linearly translated relative to each other, and the relative linear movement between the first medical probe and the second medical probe is detected.
16. The method of claim 15 , wherein the first medical probe and the second medical probe are rotationally translated relative to each other, and the relative rotational movement between the first medical probe and the second medical probe is detected.
17. The method of claim 11 , wherein an articulating tool is attached to the first medical probe, the method further comprising directing the electromechanical driver to actuate the articulating tool.
18. The method of claim 11 , wherein the second medical probe is moved relative to the first medical probe.
19. The method of claim 11 , wherein the first medical probe and the second medical probe are independently moved relative to each other.
20. A method for monitoring relative positions of a first medical probe and a second medical probe inside of a patient, comprising:
directing an electromechanical driver coupled to the first medical probe and the second medical probe to controllably bend the first medical probe and the second medical probe and to move the first medical probe and the second medical probe relative to each other, the first medical probe and the second medical probe being inserted into the patient, the first medical probe having indicia, the second medical probe having a detector for sensing a passage of the indicia as the first medical probe and the second medical probe are moved relative to each other, wherein the detector is inserted into the patient, and wherein a position of the detector changes with movement of the second medical probe and as the second medical probe is repositioned within the patient; and
detecting signals indicating the relative movement between the first medical probe and the second medical probe.
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JP2019187995A (en) * | 2018-04-27 | 2019-10-31 | 川崎重工業株式会社 | Surgery system |
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WO2022126101A3 (en) * | 2020-12-07 | 2022-08-25 | Frond Medical Inc. | Methods and systems for body lumen medical device location |
Also Published As
Publication number | Publication date |
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US20070233045A1 (en) | 2007-10-04 |
US20090105639A1 (en) | 2009-04-23 |
US20070239105A1 (en) | 2007-10-11 |
US7766894B2 (en) | 2010-08-03 |
US8603068B2 (en) | 2013-12-10 |
US8187229B2 (en) | 2012-05-29 |
US7955316B2 (en) | 2011-06-07 |
US20070239106A1 (en) | 2007-10-11 |
US20080119824A1 (en) | 2008-05-22 |
US20070060879A1 (en) | 2007-03-15 |
US7727185B2 (en) | 2010-06-01 |
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