CN116997299A

CN116997299A - System for multidirectional bending

Info

Publication number: CN116997299A
Application number: CN202180088771.9A
Authority: CN
Inventors: J·B·小赖安; C·莉比
Original assignee: INTERSCOPE Inc
Current assignee: INTERSCOPE Inc
Priority date: 2020-11-02
Filing date: 2021-11-02
Publication date: 2023-11-03

Abstract

The present invention includes systems and methods for a surgical instrument capable of multi-directional bending. The present invention includes systems and methods for integrating steerable instruments. The present invention includes systems and methods for manipulating steerable cannula instruments to a treatment site.

Description

System for multidirectional bending

Cross Reference to Related Applications

The present invention claims the benefit of priority from U.S. provisional application No. 63/108,647, filed on month 2 of 11 in 2020, U.S. provisional application No. 63/192,435, filed on month 24 of 2021, U.S. provisional application No. 63/192,449, filed on month 24 of 2021, and U.S. provisional application No. 63/192,468, filed on month 24 of 2021, the contents of which are incorporated herein by reference in their entirety.

Background

The steerable instrument may be inserted into an organ or cavity of the body for examination. The doctor or surgeon may examine or observe the organ or cavity and mark the removed material, such as polyps, necrotic material, or any other material. The steerable instrument may cut a portion of the substance and sever the portion of the substance from the body.

Disclosure of Invention

At least one aspect relates to a surgical instrument. The surgical instrument may include an outer tube extending along an axis from a proximal end to a distal end, the distal end including an articulating member of the outer tube. The surgical instrument may include one or more joint wires extending along the outer tube and coupled to the joint member. The surgical instrument may include a cutting assembly coupled to the distal end of the outer tube, the cutting assembly including an outer component defining a cutting window configured to cut material and an inner component disposed within the outer component coupled to the articular member. The surgical instrument may include a flexible torque member having a portion disposed within the outer tube, the flexible torque member coupled to the inner member and configured to rotate the inner member relative to the outer member to cut material. The surgical instrument may include a handle including a first actuator to rotate the cutting assembly about an axis and a second actuator coupled to one or more articulation wires to bend an articulation member coupled to the cutting assembly away from the axis.

In some embodiments, wherein the axis is a first axis, and wherein the inner component rotates about a second axis relative to the first axis, the second axis is formed by bending of the joint member.

In some embodiments, the surgical instrument further comprises a tension rod disposed along the outer tube, the tension rod configured to maintain tension of one or more articulation wires to control rotation and bending of an articulation member coupled to the cutting assembly.

In some embodiments, the surgical instrument further comprises a flexible torque member disposed partially within the outer tube, the flexible torque member coupled to the inner member and configured to rotate the inner member relative to the outer member to cut material.

In some embodiments, the surgical instrument further comprises a suction channel having a suction port configured to engage with a vacuum source, the suction channel being defined in part by the flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port.

In some embodiments, the first actuator is configured to bend the distal end at a first angle proportional to a second angle of rotation of the first actuator.

In some embodiments, the second actuator is a plurality of actuators, each of the plurality of actuators coupled to a respective wire of the one or more joint wires.

In some embodiments, the surgical instrument further comprises a sheath encasing the one or more joint wires.

In some embodiments, the handle further comprises a locking assembly configured to limit movement of at least one of the one or more articulation wires to set the cutting assembly to a predetermined curvature.

In some embodiments, the one or more joint filaments are a first set of one or more joint filaments. In some embodiments, the surgical instrument further comprises a second set of one or more joint filaments oriented at a first angle relative to the first set of one or more joint filaments. In some embodiments, the third set of one or more joint filaments is oriented at a second angle relative to the first set of one or more joint filaments. In some embodiments, the second actuator is coupled to the first, second, and third sets of one or more joint wires.

At least one aspect relates to a surgical instrument. The surgical instrument may include an overtube extending along an axis from a proximal end to a distal end, the distal end including a plurality of segments. The surgical instrument may include one or more joint wires extending along the overtube and coupled to the plurality of segments. The surgical instrument may include a cutting assembly coupled to the distal end of the outer tube, the cutting assembly configured to cut material from a patient. The surgical instrument may include a handle including a first actuator that rotates a first component of the cutting assembly about an axis and a second actuator coupled to one or more joint wires to selectively bend at least one of a plurality of segments coupled to the cutting assembly away from the axis.

In some embodiments, wherein the first component is an outer component of the cutting assembly, and the cutting assembly further comprises an inner component disposed within the outer component, the outer component defining the cutting window.

In some embodiments, wherein the first actuator is configured to bend the distal end at a first angle proportional to a second angle of rotation of the first actuator.

In some embodiments, the second actuator is a plurality of actuators, each of the plurality of actuators coupled to a corresponding wire of the one or more joint wires.

In some embodiments, wherein the handle further comprises a locking assembly configured to limit movement of the one or more articulation wires to set the cutting assembly to a predetermined curvature.

In some embodiments, wherein the outer tube comprises a plurality of fixation elements extending from the plurality of segments, the plurality of fixation elements configured to fix the one or more joint filaments to the outer tube.

In some embodiments, the surgical instrument further comprises a sheath encasing the one or more joint wires and the plurality of fixation elements.

In some embodiments, one or more of the joint filaments is a first set of one or more joint filaments. The surgical instrument may include a second set of one or more joint filaments oriented at a first angle relative to the first set of one or more joint filaments. The surgical instrument may include a third set of one or more joint filaments oriented at a second angle relative to the first set of one or more joint filaments. The second actuator may be coupled to the first, second, and third sets of one or more joint wires.

At least one aspect relates to a method of retrieving material from a patient. The method may include inserting a surgical instrument into a patient to cut material from the patient, the surgical instrument including an outer tube extending along an axis from a proximal end to a distal end, the distal end connected to a cutting assembly coupled to one or more joint wires extending along the outer tube. The method may include applying a first control input to a first actuator coupled to the handle to rotate the cutting assembly about the axis. The method may include applying a second control input to a second actuator coupled to the one or more joint wires to bend the cutting assembly away from the axis.

In some embodiments, applying the first control input includes rotating the first actuator to rotate the cutting assembly about the axis.

In some embodiments, applying the first control input includes rotating the first actuator a first angle about the axis to rotate the cutting assembly a first angle about the axis.

In some embodiments, inserting the surgical instrument includes inserting the surgical instrument into a patient to cut material from the patient, the surgical instrument including an outer tube extending along an axis from a proximal end to a distal end, the distal end coupled to a cutting assembly coupled to a first set of one or more joint filaments extending along the outer tube and a second set of one or more joint filaments oriented at a first angle relative to the first set of one or more joint filaments.

In some embodiments, applying the second control input includes applying the second control input to a second actuator coupled to the first set of one or more joint wires to bend the cutting assembly away from the axis in the first direction. In some embodiments, applying the second control input includes applying a third control input to a third actuator coupled to the second set of one or more joint wires to bend the cutting assembly away from the axis in a second direction, the second direction being opposite the first direction.

In some embodiments, the method comprises varying the tension of one or more articulation wires to vary the rotation and bending of the cutting assembly.

At least one aspect relates to a surgical instrument. The surgical instrument may include a first bellows having a first diameter that partially encloses a second bellows that extends beyond the first bellows, the second bellows having a second diameter that is smaller than the first diameter, the second bellows configured to retract into the first bellows. The surgical instrument may include a third telescoping tube enclosed in part by and extending out of the second telescoping tube, the third telescoping tube having a third diameter less than the second diameter, the third telescoping tube configured to retract into the second telescoping tube. The surgical instrument may include an actuator coupled to the third telescoping tube, the actuator configured to extend the third telescoping tube from the second telescoping tube. The surgical instrument may include a cutting assembly coupled to the third telescoping tube, the cutting assembly configured to cut material from the patient.

In some embodiments, the first telescoping tube extends along an axis, wherein the second telescoping tube extends along a first arc relative to the axis, and wherein the third telescoping tube extends along a second arc relative to the axis.

In some embodiments, the cutting assembly includes an outer member and an inner member disposed within the outer member, the outer member defining a cutting window.

In some embodiments, the surgical instrument further comprises a flexible torque member, a portion of which is disposed within the first, second, and third telescoping tubes, the flexible torque member coupled to the inner member and configured to rotate the inner member relative to the outer member to cut material.

In some embodiments, the surgical instrument further comprises a suction channel having a suction port configured to engage with a vacuum source, the suction channel being defined in part by the flexible torque member and the first, second, and third telescoping tubes, the suction channel extending from a cutting window defined by the cutting assembly to the suction port.

At least one aspect relates to a method of retrieving material from a patient. The method may include inserting a surgical instrument into a patient to cut material from the patient, the surgical instrument including a first telescoping tube having a proximal end and a distal end, the first telescoping tube having a first diameter, the distal end of the first telescoping tube coupled to a cutting assembly. The method may include applying a first control input to the first actuator to extend a distal end of the first telescoping tube beyond a distal end of a second telescoping tube including a distal end enveloping a proximal end of the first telescoping tube, the second telescoping tube having a second diameter greater than the first diameter. The method may include applying a second control input to the first actuator to extend a distal end of a second telescoping tube beyond a distal end of a third telescoping tube, the third telescoping tube including a distal end enveloping a proximal end of the second telescoping tube, the third telescoping tube having a third diameter greater than the second diameter, the third telescoping tube including a proximal end coupled to the first actuator. The method may include applying a third control input to the second actuator to actuate the cutting assembly to retrieve the material.

At least one aspect relates to a steerable instrument. The steerable instrument may include a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window. The steerable instrument may include a flexible outer tube having an outer diameter of less than 4 millimeters, the flexible outer tube extending from a proximal end of the flexible outer tube to a distal end of the flexible outer tube, the distal end of the flexible outer tube coupled to the outer sheath, the flexible outer tube configured to receive torque at the proximal end of the flexible outer tube and transmit the torque to the outer sheath to rotate the outer sheath. The steerable instrument may include a first connector coupled to the proximal end of the flexible outer tube, the first connector configured to bend the distal end of the flexible outer tube relative to a longitudinal axis extending through the steerable instrument in response to a first control input received at the first connector. The steerable instrument may include a flexible torque member disposed within the flexible outer tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut material. The steerable instrument may include a second connector coupled to the proximal end of the flexible outer tube and configured to rotate the flexible torque component in response to a second control input received at the second connector to cause the inner sheath to rotate relative to the outer sheath to cut material. The steerable instrument may include a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port.

In some embodiments, the first connector is configured to bend the distal end of the flexible outer tube at a first angle relative to the longitudinal axis, the first angle being proportional to a second angle of the first control input at the first connector.

At least one aspect relates to a method of retrieving material from a patient. The method may include inserting a surgical tool into a patient. The method may include disposing a steerable instrument within a working channel of a surgical tool to cut material from a patient, the steerable instrument including a cutting assembly configured to cut the material, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window, the cutting assembly coupled to a flexible outer tube, the flexible outer tube having an outer diameter of less than 4 millimeters. The method may include applying a first control input to a first connector coupled to a proximal end of the flexible outer tube to cause a distal end of the flexible outer tube to bend relative to a longitudinal axis extending through the steerable instrument. The method may include applying a second control input to a second connector coupled to a proximal end of the flexible outer tube to rotate a flexible torque member disposed within the flexible outer tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut material. The method may include actuating a vacuum source coupled to the steerable instrument to provide suction through a suction channel defined by an inner wall of the steerable instrument to cut material from the patient via the suction channel.

At least one aspect relates to a steerable instrument. The steerable instrument may include a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window. The steerable instrument may include a flexible outer tube having an outer diameter of less than 6 millimeters, the flexible outer tube extending from a proximal end of the flexible outer tube to a distal end of the flexible outer tube, the distal end of the flexible outer tube coupled to the outer sheath, the flexible outer tube configured to receive torque at the proximal end of the flexible outer tube and transmit the torque to the outer sheath to rotate the outer sheath. The steerable instrument may include a first connector coupled to the proximal end of the flexible outer tube, the first connector configured to bend the distal end of the flexible outer tube relative to a longitudinal axis extending through the steerable instrument in response to a first control input received at the first connector. The steerable instrument may include a flexible torque member disposed partially within the flexible outer tube, the flexible torque member coupled to the cutting assembly and configured to rotate the inner sheath relative to the outer sheath to cut material. The steerable instrument may include a second connector coupled to the proximal end of the flexible outer tube and configured to rotate the flexible torque component in response to a second control input received at the second connector to cause the inner sheath to rotate relative to the outer sheath to cut material. The steerable instrument may include a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port. The steerable instrument may include at least one attachment member configured to attach the steerable instrument to a surgical tool.

In some embodiments, the at least one attachment member is a first attachment member disposed at a distal end of the surgical tool, and further comprises a second attachment member disposed at a proximal end of the surgical tool.

In some embodiments, the at least one attachment member includes a locking mechanism for securing the at least one attachment member to the surgical tool.

In some embodiments, the at least one attachment member is an elastic band.

In some embodiments, the at least one attachment member includes an opening configured to receive a steerable instrument.

At least one aspect relates to a method of performing a surgical procedure. The method may include positioning a plurality of attachment members along the surgical tool, each attachment member configured to receive a steerable instrument. The method may include manipulating a steerable instrument along the surgical tool through each of a plurality of attachment members to attach the steerable instrument to the surgical tool, the steerable instrument including a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window, the cutting assembly coupled to the flexible outer tube. The method may include inserting a surgical tool and a steerable instrument into a patient. The method may include positioning a distal end of the flexible outer tube to a position in the patient by a control input applied to a first connector coupled to the proximal end of the flexible outer tube where an opening of the cutting window is located at the material and is viewable via a camera of the surgical tool. The method may include applying a second control input to a second connector coupled to a proximal end of the flexible outer tube to rotate a flexible torque member disposed within the flexible outer tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut material. The method may include actuating a vacuum source coupled to the surgical tool to provide suction to a suction channel defined by an inner wall of the steerable instrument to cut material from the patient via the suction channel. The method may include removing the steerable instrument from the patient along the surgical tool via each of the plurality of attachment members.

At least one aspect relates to a steerable instrument. The steerable instrument may comprise a steerable tube having the surgical instrument disposed therein, the steerable tube extending from a proximal end of the steerable tube to a distal end of the steerable tube. The surgical instrument may include a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window. The surgical instrument may include a flexible tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the distal end of the flexible tube being coupled to the outer sheath. The surgical instrument may include a first connector coupled to the proximal end of the steerable tube, the first connector configured to bend the distal end of the steerable tube along a longitudinal axis extending through the steerable instrument in response to a first control input received at the first location. The surgical instrument may include a flexible torque member disposed partially within the flexible tube, the flexible torque member coupled to the inner sheath and configured to rotate the inner sheath relative to the outer sheath to cut material. The surgical instrument may include a second connector coupled to the proximal end of the steerable tube and configured to rotate the flexible torque component to rotate the inner sheath relative to the outer sheath in response to a second control input received at the second connector. The surgical instrument may include a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port.

In some embodiments, the first connector is further configured to rotate the flexible tube.

In some embodiments, the first connector is configured to bend the distal end of the flexible tube along the longitudinal axis at a first angle that is proportional to a second angle of the first control input at the first connector.

In some embodiments, the steerable instrument further comprises a coating disposed between the flexible tube and the steerable tube.

In some embodiments, the steerable tube has a diameter of less than 4.0 millimeters.

In some embodiments, the flexible tube has a diameter of less than 3.1 millimeters.

At least one aspect relates to a method of retrieving material from a patient. The method may include inserting a steerable instrument into a patient to cut material from the patient, the steerable instrument including a steerable tube having a surgical instrument disposed therein, the steerable tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the surgical instrument including a cutting assembly configured to cut material from the patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window, the cutting assembly coupled to a distal end of a flexible tube, the flexible tube extending from the distal end of the steerable tube to the proximal end of the steerable tube. The method may include applying a first control input to a first connector coupled to a proximal end of the steerable tube to bend a distal end of the steerable tube along a longitudinal axis extending through the surgical instrument. The method may include applying a second control input to a second connector coupled to the proximal end of the steerable tube to rotate a flexible torque member disposed within the flexible tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut material. The method may include activating a vacuum source coupled to the surgical instrument to provide suction through a suction channel defined by an inner wall of the steerable instrument to cut material from the patient via the suction channel.

At least one aspect relates to a steerable instrument. The steerable instrument may comprise a steerable tube comprising at least one attachment member configured to attach the steerable tube to the surgical tool, the steerable tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the steerable tube comprising the surgical instrument. The surgical instrument may include a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window. The surgical instrument may include a flexible tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the distal end of the flexible tube being coupled to the outer sheath. The surgical instrument may include a first connector coupled to the proximal end of the steerable tube, the first connector configured to bend the distal end of the steerable tube along a longitudinal axis extending through the steerable tube in response to a first control input received at the first location. The surgical instrument may include a flexible torque member disposed partially within the flexible tube, the flexible torque member coupled to the inner sheath and configured to rotate the inner sheath relative to the outer sheath to cut material. The surgical instrument may include a second connector coupled to the proximal end of the steerable tube and configured to rotate the flexible torque component to rotate the inner sheath relative to the outer sheath in response to a second control input received at the second connector. The surgical instrument may include a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port.

In some embodiments, wherein the at least one attachment member includes a locking mechanism for securing the at least one attachment member to the surgical tool.

In some embodiments, at least one of the attachment members is an elastic band.

In some embodiments, at least one of the attachment members includes an opening configured to receive a steerable instrument.

In some embodiments, wherein the first connector is further configured to rotate the flexible tube.

In some embodiments, wherein the first connector is configured to bend the distal end of the flexible tube along the longitudinal axis at a first angle that is proportional to a second angle of the first control input at the first connector.

In some embodiments, the steerable instrument includes a coating disposed between the flexible tube and the steerable tube.

At least one aspect relates to a method of performing a surgical procedure. The method may include positioning a plurality of attachment members along the surgical tool, each attachment member configured to receive a steerable tube having a steerable instrument disposed therein. The method may include manipulating a steerable tube through each of a plurality of attachment members along a surgical tool to attach the steerable tube to the surgical tool, and the steerable instrument may include a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath defining a cutting window and an inner sheath disposed within the outer sheath, the cutting assembly coupled to a flexible tube extending from a proximal end of the steerable tube to a distal end of the steerable tube. The method may include inserting a surgical tool and a steerable tube into a patient to cut material from the patient. The method may include positioning a distal end of the steerable tube to a position in the patient by a control input applied to a first connector coupled to a proximal end of the steerable tube, where an opening of the cutting window is located at the material and is viewable via a camera of the surgical tool. The method may include applying a second control input to a second connector coupled to the proximal end of the steerable tube to rotate a flexible torque member disposed within the flexible tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut material. The method may include actuating a vacuum source coupled to the surgical tool to provide suction to a suction channel defined by an inner wall of the steerable instrument to cut material from the patient via the suction channel. The method may include removing the steerable instrument from the patient along the surgical tool via each of the plurality of attachment members.

These and other aspects and embodiments are discussed in detail below. The foregoing information and the following detailed description contain illustrative examples of various aspects and embodiments, and provide an overview or framework for understanding the nature and character of the claimed aspects and embodiments. The accompanying drawings provide a description and a further understanding of various aspects and embodiments, and are incorporated in and constitute a part of this specification.

Drawings

The figures are not drawn to scale. Like reference numbers and designations in the various drawings indicate like elements. For purposes of clarity, not every component may be labeled in every drawing. In the figure:

FIGS. 1A-1D are diagrams of steps that can be performed in accordance with embodiments of the present invention;

FIGS. 2A-2D illustrate views of a surgical instrument for maneuvering to a treatment site according to an embodiment of the present invention;

FIGS. 3A-3D illustrate views of a surgical instrument with various sections and fixation elements for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 4 illustrates a perspective view of a surgical instrument with sections for manipulation to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIGS. 5A-5F illustrate perspective views of a surgical instrument for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIGS. 6A-6D illustrate perspective views of a surgical instrument for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIGS. 7A-7E illustrate perspective views of a surgical instrument for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIGS. 8A-8D illustrate perspective views of a surgical instrument for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 9 is a method diagram of performing laparoscopic or hysteroscopic surgery using the surgical instrument;

FIGS. 10A-10D illustrate a surgical instrument with telescoping tubes for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIGS. 11A-11B illustrate perspective views of a surgical instrument having a telescoping configuration for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 12 is a method diagram of performing laparoscopic or hysteroscopic surgery using a steerable instrument;

FIGS. 13A-13D illustrate views of a steerable instrument for steering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 14 illustrates a view of a surgical tool for manipulating a steerable instrument to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 15 illustrates a view of a surgical tool for manipulating a steerable instrument to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 16 illustrates a view of a surgical instrument for manipulating a steerable instrument to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 17 is a method diagram of performing laparoscopic or hysteroscopic surgery using a steerable instrument;

FIG. 18 is a method diagram of performing laparoscopic or hysteroscopic surgery using a steerable instrument;

19A-19D illustrate views of a surgical instrument for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 20 illustrates a view of a surgical tool for manipulating a steerable instrument to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 21 illustrates a view of a surgical tool for manipulating a steerable instrument to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 22 illustrates a view of a surgical tool for manipulating a steerable instrument to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention;

FIG. 23 is a method diagram of performing laparoscopic or hysteroscopic surgery using a steerable instrument;

fig. 24 is a method diagram of performing laparoscopic or hysteroscopic procedures using a steerable instrument with an attachment member.

Detailed Description

The invention will be more fully understood from the following description, which should be taken in conjunction with the accompanying drawings. In this specification, like reference numerals refer to like elements in the various embodiments of the invention. In this description, the claims will be explained with reference to the embodiments. Those skilled in the art will readily appreciate that the methods, apparatus, and systems described herein are merely exemplary and that variations may be made without departing from the spirit and scope of the invention.

The following description of the various portions of the specification and their respective contents may be helpful in understanding the following descriptions of various embodiments:

Section a describes an overview of a material removal scheme that may be used to implement the embodiments described herein.

Section B describes systems and methods for a surgical instrument that can be bent in multiple directions.

Section C describes systems and methods for telescoping surgical instruments.

Section D describes systems and methods for manipulating an integrated steerable instrument to a treatment site in accordance with embodiments of the present invention.

Section E describes systems and methods for steering a steerable cannula instrument to a treatment site in accordance with embodiments of the present invention.

A. Overview of Material removal solutions

The technology provided herein relates to instruments that are capable of effectively and accurately cutting material (e.g., polyps, necrotic material, or other material) from a patient. In particular, the instrument is operable along a tortuous path to provide torque and rotation from a proximal end to a distal end of the instrument that contains the instrument and cutting assembly. Instruments may be inserted into a cavity of a patient to cut, dissect, or penetrate material. The instrument may retrieve a severed sample, such as a polyp, necrotic material, or other material, without cutting the instrument from a treatment site within the patient's body and resorting to, for example, aspiration, drilling, or other laparoscopic or hysteroscopic procedures.

Materials may be referred to and used interchangeably with other descriptive terms, such as an object, substance, or content within a patient. The material may appear to time out in the patient, thereby blocking or occluding the opening of the pathway or conduit. The material may be a liquid or a solid, or a combination of a liquid and a solid substance determined to be cut, extracted, inspected or collected from the patient. The patient may form the material during various surgical procedures. For example, the material may be formed from a lesion or injury to the patient, such as a cut or bruise. The patient's platelets may receive an indication of patient injury. Platelets can fill or occlude the damaged portion of a patient. Platelets can release chemicals to attract additional platelets and other cells in the patient to block the damaged portion. One or more coagulation factors (e.g., proteins) may entangle with platelets to network to capture more platelets and other cells, which may cause a patient to become blocked or clogged. A blockage or occlusion of a patient may refer to a material.

The instruments described herein may be used in a variety of applications using the previously described exemplary surgical procedures. Referring to fig. 1A-1D, a surgical diagram is shown that may be performed using an instrument. Fig. 1A shows a bile duct 102, a reduced duodenum 104, a ampulla of fabry's 106, a common channel 108 and a pancreatic duct 110. Fig. 1B shows a sphincterotomy comprising a guidewire 112, a cutting wire 114, and a ampulla cutter 116. Fig. 1C shows a pre-cut sphincterotomy and fig. 1D shows a combined percutaneous endoscopic procedure. The instrument may be used in percutaneous procedures, such as any medical procedure or method that accomplishes access to internal organs or other materials by needlepunching the skin. The instrument may comprise a 300-600 mm flexible catheter, a 3.0 mm lumen, and provide visualization by Infrared (IR). The instrument may comprise a 30 mm steerable tip. The internal rotator may be maneuvered within the treatment site in conjunction with the cutting assembly. The instrument may be used in endoscopic procedures to examine the interior of a hollow organ or body cavity. The instrument may be used in conjunction with Endoscopic Retrograde Cholangiopancreatography (ERCP) techniques that use endoscopy and fluoroscopy in combination to diagnose and treat certain problems with the biliary or pancreatic systems. The instrument may assist in reaching the treatment site with the catheter. The instrument may contain a 3.0 millimeter lumen or be visualized by IR.

The instrument may be a flexible hysteroscope. The instrument may be used as or with various types of flexible endoscopes including, but not limited to, hysteroscopes, laparoscopes, bronchoscopes, gastroscopes, and laryngoscopes, or other medical devices that may be used to treat patients. The instrument procedure may be performed on various parts or portions of the body, such as the uterus, fallopian tubes, ovaries, ears, esophagus, blood vessels, stomach, small intestine, large intestine, pancreas, or other hollow portion of the patient. Various surgical procedures may be performed using the material removal tool, such as in the diagnosis of female infertility, such as laparoscopy, to examine the exterior of the uterus, ovaries and fallopian tubes. Further, as the cutting assembly is moved to the treatment site, material removal may obtain an image of the treatment site from which material is to be cut and an image of the cutting assembly, allowing for accurate delivery of the instrument to the treatment site.

However, it is difficult to maneuver the cutting assembly to the desired material at the treatment site. For example, it may be difficult to cut a relatively large portion of material adjacent to where the material protrudes from the underlying tissue. In another example, a tortuous path in the colon, pancreas, or duodenum may require multiple large-angle turns to reach a target site. Thus, navigating the distal end of the surgical instrument through a tortuous path (e.g., multiple bends in different directions) while maintaining the ability of the cutting element or other tool at the distal end of the surgical instrument to be properly operated is technically challenging. For example, maneuvering the surgical instrument with the cutting assembly may move the cutting assembly away from the treatment site. Further, attempting to manipulate the cutting assembly with a surgical instrument can squeeze or damage the flexible torque coil, which can limit the ability to actuate (e.g., rotate) the cutting assembly. The instruments described herein address these issues by enabling precise control of the distal end of the instrument to steer the cutting assembly to a particular location (e.g., material) independent of the treatment site and/or the remainder of the instrument at the patient's cavity.

B. Systems and methods for surgical instruments with multi-directional bending

Surgical instruments and methods in accordance with the present invention may include components such as outer tubes, cutting assemblies, articulation wires, handles, rotary actuators, flexible torque members, bending actuators, and aspiration passageways. In general, surgical instruments may be used to provide treatment to a stenosed part of the body, such as the uterus, fallopian tubes, ovaries, or in some cases, to provide non-surgical treatment to a patient. The surgical instrument may be directed to the treatment site to perform laparoscopic or hysteroscopic procedures. For example, an operator may insert a surgical instrument into a cavity of a patient and bend a cutting assembly to reach a material.

After the surgical instrument is at the treatment site, the operator may maneuver the cutting assembly to reach the material. The location of the material may be a treatment site, portion or area that is extracted, inspected or otherwise surgically operated using surgical instruments. The cutting assembly may be configured to cut material and include an outer component and an inner component disposed within the outer component. The surgical instrument may include a bending actuator configured to actuate the articulation wire to bend the tube to extend through the surgical instrument along the longitudinal axis. The surgical instrument may include a flexible torque member configured to rotate the inner member relative to the outer member to cut material. The surgical instrument may include a rotary actuator configured to bend the flexible torque member to cause the cutting assembly to cut material. The surgical instrument may include a suction channel connected to a vacuum source configured to suction material cut by the cutting assembly.

Referring to fig. 2A-2D, a view of a surgical instrument 200 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. The surgical instrument 200 may include an outer tube 202. The outer tube 202 may include a proximal end 204, a longitudinal axis 208, and an articulation member 209. Surgical instrument 200 may include a cutting assembly 210, which may include an outer member 212 and an inner member 214. The outer member 212 may define a cutting window 216. Surgical instrument 200 may include a tube sheath 218, a wire channel 219, an articulation wire 220, a wire coupler 222, a handle 224, a rotary actuator 226, a bending actuator 228, a bending axis 230, a flexible torque member 232, a suction channel 234, and a suction port 236 configured to be coupled to an outer tube 238.

The inclusion of the articulation member 209 is advantageous for allowing the surgical instrument 200 to be properly deployed to the treatment site with concomitant bending of the surgical instrument 200 (e.g., by having a distal end 206 with different flexibility or malleability relative to the remainder of the outer tube 202). In particular, the articulation member 209 may have greater flexibility or ductility relative to the outer tube 202. For example, pulling on the articulation wire 220 coupled to the wire coupler 222 may cause the articulation member 209 to perform more bending while enabling the outer tube 202 to maintain its stiffness or structure in the body, which may allow an operator of the surgical instrument 200 to more easily bend the cutting window 216 to the treatment site. Conversely, the articulation member 209 may have less flexibility or ductility relative to the outer tube 202. For example, pulling on the articulation wire 220 coupled to the wire coupler 222 may cause the articulation member 209 to perform less bending while enabling the outer tube 202 to bend in the body to reach the treatment site, which may enable an operator of the surgical instrument 200 to reach the treatment site and carefully bend the cutting window 216 to a position within the treatment site.

For example, with further reference to fig. 2A, to perform the step of cutting material from the treatment site, an outer tube 202 may be introduced into the cavity of the patient. The cutting assembly 210 may be introduced into the treatment site. The operator may use the rotary actuator 226 to rotate the cutting assembly 210 about the longitudinal axis 208 to the material. The operator may use bending actuator 228 to bend cutting assembly 210 about bending axis 230. A motor, rotary actuator 226, or bending actuator 228 may actuate the cutting assembly 210 to cut material. The material may be extracted, cut, collected, or studied by the surgical instrument 200. In some cases, the cutting assembly 210 may extract, pull, or collect material into the cutting window 216. The vacuum source may draw material into a suction channel 234 extending from the cutting window 216 to a suction port 236.

Referring to fig. 2A and 2B in combination, the outer tube 202 may include a proximal end 204, a distal end 206, and a longitudinal axis 208. The outer tube 202 may extend from a proximal end 204 to a distal end 206. Proximal end 204 may refer to the base, open end, or foundation of outer tube 202. Distal end 206 may refer to the tip or front of outer tube 202. The longitudinal axis 208 may extend through the surgical instrument 200.

The articulation member 209 may be located at the distal end 206 of the outer tube 202. The articulation member 209 may be configured to have additional malleability or flexibility relative to the outer tube 202. For example, the articulation member 209 may be a braided section of the outer tube 202. In another example, the joint member 209 may be a braid or a braided sheath. The additional malleability or flexibility of the articulation member 209 enables the distal end 206 to bend within the patient and along the longitudinal axis 208.

The outer tube 202 may be a guide wire, a motorized wire, or a braid. The outer tube 202 may comprise nickel-titanium alloy, flexible plastic, rubber, cloth, metal, steel, titanium, nickel, or carbon fiber. The outer tube 202 may be a braided sheath. In some embodiments, the outer tube 202 may also include a liner mounted around the outer tube 202. In some embodiments, the liner may prevent air or other fluids from penetrating between the outer tubes 202. The outer tube 202 may be coupled to an outer member 212. In some embodiments, the surgical instrument 200 may be surrounded by a sheath or liner to avoid frictional contact between the outer surface of the outer tube 202 and other surfaces. In some embodiments, the surgical device 200 may be coated with polytetrafluoroethylene ("PFTE") to reduce frictional contact between the outer surface of the surgical device 200 and other surfaces (e.g., the inner wall of a patient).

The outer tube 202 may be maneuvered within a patient. The outer tube 202 may be inserted through an opening or cavity. The outer tube 202 may be rotated, bent, or otherwise navigated through a patient's bend. For example, the outer tube 202 may be maneuvered into a curved portion of a patient. The outer tube 202 may be in contact with the patient such that the outer tube 202 may navigate through the patient's curved portion. The outer tube 202 may bend or rotate in response to reaching or contacting the curved portion such that the outer tube 202 bends past the curved portion as it navigates. For example, the body cavity may contain bends, ridges, or other non-linear paths to the treatment site. The treatment site may be located in the patient at a location that follows a non-linear path. The outer tube 202 may be pushed, bumped or bumped within the body lumen to rotate through the nonlinear path of the lumen. In some cases, the outer tube 202 may navigate through the cavity by rocking, rotating, or adjusting the navigation direction up and down in response to contacting the cavity.

The outer tube 202 may have a diameter of less than 4 millimeters. The outer tube 202 may be composed of higher or lower density, higher or lower ductility, higher or lower flexibility, or other features that facilitate passage through the patient. The flexibility of the outer tube 202 facilitates navigation of the surgical instrument 200 within the patient. The outer tube 202 may be flexible to avoid injury, tearing, wound or other damage in the patient. The outer tube 202 may comprise any width or length. The width may be 1 mm, 2 mm, 3 mm, 4 mm, 5 mm or 1 cm. The length may be 350 mm, 500 mm, 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, or 100 meters.

The outer tube 202 may contain or be coupled to one or more sensors, such as light sensors, electromagnetic sensors, optical stereotactic sensors, pressure sensors, collision sensors, flow sensors, radar sensors, position sensors, or distance sensors. In some embodiments, the outer tube 202 detects the presence of material. The outer tube 202 may be equipped with at least one sensor that may communicate with at least one external device, such as a sensor processing component (not shown), to determine the thickness of the material relative to the rest of the patient indicated by the sensor. The sensor may comprise, for example, a temperature sensor, a pressure sensor, a resistance sensor, a collision sensor, an ultrasonic sensor, or other sensor for medical examination. In some embodiments, the type of material is associated with at least the impedance or density of the tissue. The sensor may collect temperature information and other sensed information and provide signals corresponding to such information to the sensor processing unit. The sensor processing unit may then identify the type of material. In some embodiments, the sensor may be an electrical sensor.

The outer tube 202 may be an extendable and/or retractable wire. Extension of the outer tube 202 may enable the cutting assembly 210 to move toward a treatment site within a patient. The cutting assembly 210 may extend or move past the treatment site where the operator may terminate the extension of the outer tube further into the patient. Upon moving toward the treatment site, the operator may push or apply a force to the proximal end 204 of the outer tube 202. The outer tube 202 may be further moved into the patient and toward the treatment site in response to a force applied to the proximal end 204. The distal end of the outer tube 202 may be positioned a distance from the material, such as 1 millimeter, 1 inch, or 1 meter from the material.

The cutting assembly 210 may be coupled to or located at the distal end 206 of the surgical instrument 200. The cutting assembly 210 may be spaced a distance from the distal end 206 of the outer tube. For example, the distance may be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 millimeters. Cutting assembly 210 may perform actions, in whole or in part, including but not limited to cutting, snare, shredding, slicing, shredding, which are also debridement examples. Thus, the cutting assembly 210 may be a component capable of cutting, snare, shredding, slicing, or comminuting from a body surface of a patient. Thus, the cutting assembly 210 may be implemented as forceps, scissors, a knife, a snare, a chopper, or any other component that may be debrided.

The cutting assembly 210 may include at least one sensor, such as a proximity sensor, light sensor, pressure sensor, radar sensor, flow sensor, bend sensor, collision sensor, distance sensor, or other sensor configured to observe, examine, sense, or navigate through the patient's body. The cutting assembly 210 may include a light source and a recording device or capturing device (e.g., a camera or a scope) to collect visual information from the observation of the patient's body. The light source may comprise a light emitting diode ("LED"), an incandescent lamp, a compact fluorescent lamp, a halogen lamp, a neon lamp, or other type of lighting element. The surgical instrument 200 or cutting assembly may illuminate and initiate recording using the light source and recording device. The cutting assembly 210 may receive at least one visual information from the camera and transmit the at least one visual information to the display device. The display device may generate or display an image based on the received visual information for an operator or doctor to view the interior of the patient's body during surgery. In some embodiments, the cutting assembly 210 may be equipped with an injectable dye composition by which an operator can determine the extent to which it narrows under fluoroscopic guidance or marks a particular region within the patient's body. In other embodiments, the operator may mark a particular area with the cutting assembly 210 without using an injectable dye.

The cutting assembly 210 may include an outer member 212 and an inner member 214 disposed within the outer member 212. The outer member 212 may be configured to pass a fluid. The outer member 212 may be a member, cap, outer tube, housing, or body of the cutting assembly 210. The distal end 206 of the outer tube 202 may be coupled to an outer member 212. The outer member 212 may be shaped or formed, for example, as a cylinder, prism, cone, or other shape. The outer member 212 may be flexible. The outer member 212 may flex and flex to any degree. In some embodiments, the outer member 212 may bend and flex 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, or 180 degrees. The outer member 212 may comprise a thickness. The thickness may be 10 nanometers, 20 nanometers, 1 millimeter, 2 millimeters, 3 millimeters, 4 millimeters, or 5 millimeters. The outer member 212 may comprise a width. The width may be 1 mm, 2 mm, 3 mm, 4 mm, 5 mm or 1 cm. The outer member 212 may comprise a length. The length may be 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, 100 meters, etc. The outer member 212 may comprise a cross-sectional area, such as 0.6 square millimeters, 1 square millimeter, 1.9 square millimeters, and the like. The outer member 212 may be constructed of materials such as metal, steel, plastic, rubber, glass, carbon fiber, titanium, aluminum, or other alloys.

The outer member 212 may at least partially enclose the inner member 214. In some embodiments, the inner member 214 cuts any material that is sucked or otherwise entered into the outer member 212. The outer member 212 may be a member, cap, tube or housing. The inner member 214 may include an opening such that material cut by the cutting assembly 210 enters through the opening. The length of the inner member 214 may be similar to or less than the outer member 212. The length may be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100 cm. The inner member 214 may be designed to facilitate removal of one or more materials and removal of cut material in a single operation. The inner member 214 may be disposed within the outer member 212. The inner member 214 may be coupled with the outer member 212. The inner member 214 may be constructed of a similar material as the outer member 212. The inner member 214 may be flexible similar to the outer member 212.

The outer member 212 may define a cutting window 216. The outer member 212 may define a cutting window 216 at a distal end of the cutting assembly 210. A portion of the radial wall of the outer member 212 may define a cutting window 216 extending around a portion of the radius of the outer member 212. In some embodiments, an operator may receive or retrieve cut material through the cutting window 216.

The cutting window 216 may be configured to enable the cutting assembly 210 to cut, dissect, or debride material. For example, the cutting assembly 210 may initiate a debridement or cutting process by rotating a cut through the material to receive the material in the cutting window 216. The cutting window 216 may be positioned on one side of the cutting assembly 210. The cutting window 216 may be configured to enable tangential or lateral cutting of the material with reference to the movement of the cutting assembly 210. In some embodiments, the outer member 212 may define a cutting window 216. The cutting window 216 may comprise a hollow structure having a shape such as a circle, oval, rectangle, or other geometric shape for exposing the blades of the cutting assembly 210. The cutting window 216 may comprise a diameter. The diameter may be 1 mm, 2 mm, 3 mm, 4 mm or 5 mm. The cutting window 216 may include a cutout, which may be part of the cutting assembly 210. For example, the cutting window 216 may comprise a 0.4 millimeter incision.

The cutting assembly 210 may be configured to cut material from a patient. The cutting assembly 210 may include a blade (or fan blade). The cutting assembly 210 may include one or more cutting members, such as a sector cutter, an axial cutter, a drill bit, a hook, a spade, a reamer, a milling cutter, or other cutting tools or devices. The cutting assembly 210 may be referred to as a debridement member, cutter, removal tool, or extractor. The cutting assembly 210 may include a blade. The cutting member may be composed of one or more materials (e.g., steel, plastic, carbon fiber, titanium, aluminum, metal, or other alloys) for cutting or dissecting materials to perform laparoscopic or hysteroscopic procedures.

The cutting assembly 210 may be actuated such that the cutting assembly 210 may be operated by a conversion of the mechanical force applied by the operator, or automatically actuated using an impeller, a motor (e.g., an electric motor), or any other force that generates a component that actuates the debridement section. The outer tube 202 may be configured to receive torque at the proximal end 204 (e.g., τ -proximal) and transmit the torque to the distal end 206 to the outer member 212 (e.g., as τ -distal) to rotate the outer member 212 to actuate the cutting assembly 210. The cutting assembly 210 may be configured to cut at various speeds, such as 5000 revolutions per minute ("RPM"), 10,000RPM, 20,000RPM, or 50,000RPM. The cutting assembly 210 may be manually operated or may employ any other means of removing material such that the severed material can be retrieved from the treatment site via the outer tube 202. The cutting assembly 210 may cut the material into pieces small enough to be retrieved via the surgical instrument 200 such that the surgical instrument 200 does not need to be cut from the patient to collect the cut material. It should be appreciated that the cutting assembly 210 is capable of rotating a particular angle and at a particular torque that is equal to or matches the rotation and torque of the motor or operator. Accordingly, the cutting assembly 210 may provide cutting accuracy, control, and power consumption. For example, the cutting assembly 210 coupled to the cutting assembly 210 may be rotated by a number of angles at a particular torque that is equal to the angle and torque provided by the operator to the motor. For example, an operator or motor may initiate 30 degrees of rotation. Rotation, force, and torque may be applied from the motor to the cutting assembly 210. The cutting assembly 210 may receive the applied rotation. Accordingly, the cutting assembly 210 may be rotated 30 degrees based on the motor or operator applied rotation, force, and torque.

Referring to fig. 2B and 2C in combination, a tube sheath 218 of the surgical instrument 200 may encapsulate the outer tube 202. The tube jacket 218 may comprise a laminate or heat shrink material. The tube sheath 218 may provide additional shape, texture, grooves, or other features to the outer tube 202. The tube sheath 218 may have any length. For example, the length may be 100, 200, 350, 500, 750, or 900 millimeters. The length of the outer tube 202 may be sized to exceed the length of the tube sheath 218. The outer tube 202 may extend any distance beyond the distal end of the tube sheath 218. For example, the outer tube 202 may extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the tube sheath 218. The size, shape, or configuration of the surgical instrument 200 may be designed such that the diameter is less than the diameter of the channel into which the surgical instrument 200 is to be inserted.

The tube sheath 218 and the outer tube 202 may define a wire channel 219 (e.g., a wire tunnel) configured to receive, retain, or house an articulation wire 220. The tube sheath 218 may be an outer sheath that encases or encapsulates the joint wire 220. The wire passage 219 may extend from the proximal end 204 of the outer tube 202 to the distal end 206 of the outer tube 202. The tube sheath 218 and the joint member 209 may partially define a wire passage 219 such that the wire passage 219 and the joint wire 220 disposed therein may extend along the joint member 209.

The articulation wire 220 may be a woven or metallic wire that extends from the proximal end 204 to the distal end 206 of the outer tube 202. The articulation wire 220 may be made of stainless steel (e.g., 304V hard tempered stainless steel).

Although one joint wire 220 is shown, it is contemplated that the outer tube 202 may contain any number of joint wires 220, such as 1, 2, 3, 4, 5, 8, 10, 24, 30, or 50 wires. It will be appreciated that the desired or optimal number of joint filaments 220 may depend on the material characteristics of the joint filaments 220, the spacing between the joint filaments 220, and other characteristics. In some embodiments, the number of joint filaments 220 may be selected to transmit torque to the outer member 212.

The number of joint filaments 220 can be such that the percent difference between the bending of the proximal end 204 and the distal end 206 (and/or the percent difference between the expected bending of the distal end 206 and the actual bending of the distal end, wherein the expected bending is consistent with a smooth and/or proportional rotational response as described above) is less than a threshold difference. In some embodiments, the threshold difference is less than or equal to thirty percent. In some embodiments, the threshold difference is less than or equal to twenty percent. In some embodiments, the threshold difference is less than or equal to ten percent. In some embodiments, the threshold difference is less than or equal to five percent. In some implementations, a measure of the ratio of τ -proximal to τ -distal as a function of τ -proximal (e.g., within a predetermined range of τ -proximal values) may be used to represent the performance of the outer tube 202; for example, the ratio of the standard deviation of the ratio to the average of the ratios may be less than a threshold ratio (which may indicate how the ratio of τ -proximal to τ -distal remains constant as a function of τ -proximal). The threshold ratio may be less than or equal to 0.3. The threshold ratio may be less than or equal to 0.2. The threshold ratio may be less than or equal to 0.1. The threshold ratio may be less than or equal to 0.05.

Referring to fig. 2B-2D, an articulation wire 220 may be coupled to a wire coupler 222 in the wire channel 219. The wire coupler 222 may be configured to secure the articulation wire 220 under tension. The wire coupler 222 may be coupled to or extend from the outer tube 202. The wire coupler 222 may be located at the distal end 206 of the outer tube 202. One or more articulation wires 220 within the wire channel 219 may be coupled to corresponding wire couplers 222 in the wire channel 219. For example, two joint filaments 220 may be coupled to one filament coupler 222. In some embodiments, the wire couplers 222 may be disposed at different locations along the longitudinal axis 208. For example, the first wire coupler 222 may be disposed closest to the cutting assembly 210, while the second wire coupler 222 may be disposed intermediate the joint members 209 (e.g., closer to the proximal end 204). The articulation wire 220 coupled to the first wire coupler 222 may cause the articulation member 209 to perform a different bending than the articulation wire 220 coupled to the second wire coupler 222.

Referring to fig. 2D, a cross-sectional tunnel view of the articulation member 209, tube sheath 218, wire channel 219, and articulation wire 220 is shown. The articulation member 209 may have a diameter of less than 4 millimeters. The joint member 209 and the tube sheath 218 together may have a diameter of less than 4 millimeters.

The outer tube 202, the joint member 209, or the joint wire 220 may include at least one of an elastomer or a friction reducing additive. In some embodiments, the elastomer comprises a thermoplastic elastomer, such as a polyether block amide (e.g., PEBAX). In some embodiments, the friction reducing additive comprises MOBILIZE manufactured by complex solution company (Compounding Solutions, LLC) of lewis ton, maine. At least one of the elastomer or friction reducing additive may reduce the likelihood that the joint wire 220 will adhere to the outer tube 202, kink, or otherwise suffer frictional losses. Further, at least one of the elastomer or friction reducing additive may reduce friction generated between the outer tube 202 and the outer member 212 when the outer tube 202 and the outer member 212 are in contact with each other (e.g., when the surgical instrument 200 has traversed a tortuous path). In some embodiments, at least one of the elastomer or friction reducing additive may reduce friction generated between the outer wall of the outer tube 202 and the inner wall of the tube jacket 218.

Surgical instrument 200 may include a handle 224. Handle 224 may be configured to be grasped by an operator of surgical instrument 200. Handle 224 may comprise rubber, plastic, or any non-slip material suitable for use in a medical environment. Handle 224 may include a rotary actuator 226 and a bending actuator 228. Handle 224 may be configured to enable an operator of surgical instrument 200 to manipulate surgical instrument 200, rotate rotary actuator 226, and bend bending actuator 228. For example, handle 224 may be configured with a form factor that receives input to rotate rotary actuator 226 and bend bending actuator 208.

The surgical instrument 200 may include a rotary actuator 226 for bending the articulation member 209 of the outer tube 202 about a longitudinal axis 208 extending through the surgical instrument 200 in response to a first control input received at the rotary actuator 226. A rotary actuator 226 may be coupled to the proximal end 204 of the outer tube 202. The rotary actuator 226 may be coupled to the joint filament 220. The rotary actuator 226 may be a knob, tube, handle, grip, or any other surface configured to receive control inputs from an operator. The control input may cause the rotary actuator 226 to rotate the proximal end 204 of the outer tube 202 about the longitudinal axis 208. The control input may cause the rotary actuator 226 to pull the joint wire 202 to rotate the outer tube 202 about the longitudinal axis 208. For example, the control input may rotate the proximal end 204 of the outer tube 202 about the longitudinal axis 208 by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees.

The rotational actuator 226 may be configured to rotate the articulation member 209 about the longitudinal axis 208. The articulation member 209 may rotate at an angle that is proportional to the angle at which the rotational actuator 226 rotates. For example, outer tube 202 may be configured to rotate bending member 209 10 degrees in response to a 10 degree rotation of proximal end 204 by rotary actuator 226. In another example, curved member 209 is configured to rotate according to any other configuration. For example, the joint member 209 may be configured to rotate the joint member 209 10 degrees in response to 10 degrees of rotation of the rotary actuator 226 and rotate the joint member 209 15 degrees in response to 20 degrees of rotation of the rotary actuator 226. In another example, the joint member 209 may be configured to rotate the joint member 209 10 degrees in response to 10 degrees of rotation of the rotary actuator 226 and to rotate the joint member 209 25 degrees in response to 20 degrees of rotation of the rotary actuator 226.

The surgical instrument 200 may include a bending actuator 228 coupled to the proximal end 204 of the outer tube 202 and configured to bend the articulation member 209 away from the longitudinal axis 208. For example, the bending actuator 208 may bend the articulation member 209 along the bending axis 230. The bending axis 230 may be disposed relative to the longitudinal axis 208. For example, the bending axis 230 may be-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis 208.

Bending of the articulation member 209 may allow the cutting assembly 210 to reach the remote sampling site more effectively while reducing the risk of damage to components of the surgical instrument or reduced functionality. The cutting assembly 210 may be operated as the articulation member 209 is flexed (e.g., changes orientation in one or more axes) or at different times. For example, the orientation may be operable along a first axis (e.g., moving the joint member 209 up or down in a frame of reference defined with respect to the longitudinal axis 208) or a second axis (e.g., moving the joint member 209 left or right in a frame of reference defined with respect to the longitudinal axis 208) that is perpendicular to the longitudinal axis 208. The orientation may be manipulated to change the direction of the cutting window 216 of the cutting assembly 210. The bending may enable the cutting assembly to be maneuvered over a wider range of positions to reach the material at the site within the patient.

The bending actuator 228 may be configured to receive control inputs from an operator. The bending actuator 228 may be a slider mechanism, a handle, or any other surface configured to receive a control input. The control input may pull or actuate the bending actuator 228. For example, the control input may pull or push the bending actuator or 228 along the longitudinal axis 208. The control input may pull or push the bending actuator 228 any distance, such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, or 50 millimeters. The distance may be based on the length of handle 224.

The bending actuator 228 may be coupled to the joint filament 220. When the bending actuator 228 pulls or pushes the joint wire 202, the joint wire 202 transmits a force from the bending actuator 228 to bend, buckle, or straighten the joint member 209. In some embodiments, the pushing or pulling force provided by the bending actuator 228 creates tension in the articulation wire 220 to cause the articulation member 209 to perform the bending. In some embodiments, the joint filament 220 has a threshold stiffness that corresponds to a nominal or maximum tension that may be applied to the joint filament 220 such that the joint member 209 conforms (e.g., may be compressed or otherwise change shape) to the tension applied by the joint filament 220. For example, pushing or pulling on the articulation wire 220 by the bending actuator 228 may cause the articulation member 209 to bend about the bending axis 230 at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees. The articulation member 209 may be bent at an angle proportional to the distance the bending actuator 208 moves. For example, the bending actuator 228 may be configured such that the first force causes the joint member 209 to perform a 30 degree bend and the second force causes the joint member 209 to perform a 60 degree bend. The second force may be stronger than the first force. For example, the first force may be 5N and the second force may be 10N.

The bending actuator 228 may couple or control the articulation wire 220 through the use of a control mechanism such as a carbide clamp, guitar mechanism, or tension rod (e.g., truss rod). In some embodiments, a tension rod is disposed along the outer tube 202. The tension rod is configured to maintain tension of the articulation wire 220 to control the articulation member 209 coupled to the cutting assembly 210. The control mechanism may adjust the bending of the articulation member 209. For example, the operator may configure the control mechanism such that the articulation member 209 makes a 10 degree bend in response to a 5 millimeter pull of the bend actuator 228. In another example, the joint member 209 is configured to bend according to any other configuration. For example, the articulation member 209 may be configured to perform a 10 degree bend in response to a 5 millimeter pull of the bend actuator 228 and a 15 degree bend in response to a 10 millimeter pull of the bend actuator 228. In another example, the articulation member 209 may be configured to perform a 10 degree bend in response to a 5 millimeter pull of the bend actuator 228 and a 25 degree bend in response to a 10 millimeter pull of the bend actuator 228.

In some embodiments, the surgical instrument 200, the rotary actuator 226, or the bending actuator 228 may include a locking mechanism. The locking mechanism may limit movement of the articulation member 209 to set the articulation member 209 to a target orientation. In some embodiments, the locking mechanism is a knob, switch, or any other surface configured to receive control input from an operator. In some embodiments, the locking mechanism may be operated to selectively limit movement of the articulation member 209 to a single degree of freedom (e.g., locking movement of the articulation member 209 in a first axis while allowing movement in a second axis). In some embodiments, the locking mechanism is activated in response to actuation or rotation of the rotary actuator 226. In some embodiments, the locking mechanism is activated to cut material in response to actuation of the cutting assembly 210. In some embodiments, the locking mechanism is activated in response to rotation of the flexible torque member 232 to rotate the inner member 214 relative to the outer member 212 to cut material. In some embodiments, the locking mechanism is activated to retrieve the severed material in response to suction provided by the vacuum source. The locking mechanism may include one or more clamps, gears, brakes, or any combination thereof that may selectively contact the one or more joint wires 220 or apply tension to the one or more joint wires 220 to prevent movement of the selected one or more control members. The locking mechanism may be configured to wind or unwind the articulation wire 220.

The surgical instrument 200 may include a flexible torque member 232 disposed within the outer tube 202. The flexible torque member 232 may be coupled to the inner member 214 and disposed within the inner member 214. Further, at least one of the elastomer or friction reducing additive may reduce friction generated between the flexible torque member 232 and the inner member 214 when the flexible torque member 232 and the inner member 214 are in contact with each other (e.g., when the surgical instrument 200 has traversed a tortuous path). The flexible torque member 232 may be configured to rotate the inner member 214 relative to the outer member 212 to cut material. The flexible torque member 232 may be constructed of at least one of metal, steel, plastic, titanium, nickel, carbon fiber, or other alloys. In some embodiments, the inner member 214 may comprise a liner within which the flexible torque member 232 is disposed.

The flexibility of the outer tube 202 may allow the surgical instrument 200 to rotate when bent and bend when rotated. For example, the flexible tube of the surgical instrument 200 may be bent 120 degrees, including components within the surgical instrument 200, such as the flexible torque component 232, and the surgical instrument 200 may maintain rotational performance at the bend of 120 degrees by the flexibility of the flexible tube.

The surgical instrument 200 may include an aspiration channel 234 extending from the cutting window 216 to an aspiration port 236. The suction channel 234 may be defined in part by the flexible torque member 232. The suction channel 234 may be defined in part by an outer wall of the inner member 214. The suction channel 234 may be defined in part by an inner wall of the outer member 212. Material may enter the suction channel 234 via the cutting window 216 and traverse the length of the suction channel 234 to the suction port 236.

The suction port 236 may be an opening or any other connection between the outer tube 202 and the outer tube 238. The suction port 236 may comprise a socket, plug, or any other coupling mechanism configured to couple the outer tube 202 and the outer tube 238. The outer tube 238 may be coupled to a vacuum source configured to aspirate, retrieve, extract, or collect the severed material from the aspiration channel 234. The outer tube 238 may be coupled to a motor configured to rotate the flexible torque member 232 to rotate the inner member 214 relative to the outer member 212. In some embodiments, the outer tube 238 may introduce irrigation fluid, such as saline or water, into the surgical instrument 200, and the irrigation fluid may flow to the treatment site.

The surgical instrument 200 may include a light configured to illuminate the treatment site. The lamp may be a fiber optic lamp, a light emitting diode ("LED"), an incandescent lamp, a compact fluorescent lamp, a halogen lamp, a neon lamp, or other type of lighting element. In some embodiments, actuating the rotary actuator 226 or the bending actuator 228 may actuate the light to turn it on, off, or adjust its intensity.

Referring to fig. 3A-3D, a surgical instrument 300 may be similar to surgical instrument 200 and may contain the same structure and function as surgical instrument 200, but with the difference that surgical instrument 300 may contain segments 302A-302C (collectively referred to as segments 302) in place of joint member 209 and segments 302 may contain fixation elements 304A-304D (collectively referred to as fixation elements 304) configured as fixation wires. The segments 302 have the advantage of being able to flex independently of each other, which enables the operator of the surgical instrument 300 to precisely flex the cutting window 216 to the treatment site. The fixation element 304 has the advantage of fixing the joint filament 220 along the segments 302 to enable more precise control of each individual segment 302. By enabling individual bending of each segment 302, the fixation elements 304 allow manipulation of the cutting assembly 210 coupled to at least one of the segments 302 to a particular location (e.g., material) while maintaining the remainder of the surgical instrument 300 in place at the treatment site and/or within the patient's cavity. For example, a fixation element 304 (e.g., fixation element 304A) near the proximal end 204 may lock or strengthen an adjacent segment 302 (e.g., segment 302A) such that a distal segment (e.g., segment 302C) may bend without bending a proximal segment 302 (e.g., segment 302A), which may enable an operator of the surgical instrument 300 to more precisely bend the cutting window 216 to the treatment site.

A segment 302 (also referred to as a vertebral body) may be located at the distal end 206 of the outer tube 202. The segment 302 may be configured to have additional ductility or flexibility relative to the overtube 202. For example, each segment 302 may be configured to bend independently. The additional malleability or flexibility of the segment 302 enables the distal end 206 to bend within the patient and along the longitudinal axis 208.

Referring to fig. 3D, a cross-sectional tunnel view of outer tube 202, tube sheath 218, wire channel 219, joint wire 220, and segment 302 is shown. The outer tube 202 may have a diameter of less than 4 millimeters. The outer tube 202 and the tube jacket 218 together may have a diameter of less than 4 millimeters.

The fixation element 304 may be configured to fix the joint filament 220 under tension. The tube sheath 218 may encase the fixation element 304. The fixation element 304 may be disposed on the segment 302 or extend from the segment 302. The securing element 304 may be a grommet, ring, or edge strip. The fixing element may be made of metal, plastic or rubber. The fixation element 304 may be flared or looped along the segment 302. The fixation element 304 may be disposed along the longitudinal axis 208 of the outer tube 202. Each fixation element 304 may correspond to a segment 302. For example, the fixation element 304A may be disposed adjacent to the segment 302A. Multiple sets of fixation elements 304 may be disposed on different sides of the outer tube 202. For example, a first set of fixation elements 304A-304D may be disposed on the segments 302A-302C, while a second set of fixation elements 304 may be disposed on a second side of the perimeter of the outer tube 202 that is 180 degrees away from or positioned around the perimeter relative to the first side. Rather, in another example, the surgical instrument 300 may have only a segment 302 and corresponding fixation element 304 disposed on one side. For example, surgical instrument 300 may have only segments 302A-302C and corresponding fixation elements 304A-304D to fix wire 220.

The rotary actuator 226 may be configured to bend the segment 302 about a longitudinal axis 208 extending through the surgical instrument 200 in response to receiving a first control input at the rotary actuator 226. A rotary actuator 226 may be coupled to the proximal end of outer tube 220. The rotary actuator 226 may be coupled to the joint filament 220. The rotary actuator 226 may be a knob, tube, handle, grip, or any other surface configured to receive control inputs from an operator. The control input may cause the rotary actuator 226 to rotate the proximal end 204 of the outer tube 202 about the longitudinal axis 208. The control input may cause the rotary actuator 226 to pull the articulation wire 220 to rotate the outer tube 202 about the longitudinal axis 208. For example, the control input may rotate the proximal end 204 of the outer tube 202 about the longitudinal axis 208 by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees.

The rotary actuator 226 may be configured to rotate the segment 302 about the longitudinal axis 208. The segment 302 may rotate at an angle proportional to the angle rotated by the rotary actuator 226. For example, the rotational actuator 226 may be configured to rotate the segment 302 10 degrees in response to rotating the proximal end 204 10 degrees by the rotational actuator 226. In another example, the segments 302 are configured to rotate according to any other configuration. The fixation element 304 may be configured to stabilize or fix the joint filament 220 along the segment 302 for precise control of rotation. For example, the segment 302 may be configured to rotate the segment 302 10 degrees in response to a 10 degree rotation of the rotary actuator 226 and to rotate the segment 302 15 degrees in response to a 20 degree rotation of the rotary actuator 226. In another example, the rotary actuator 226 may be configured to rotate the segment 302 10 degrees in response to a 10 degree rotation of the rotary actuator 226 and to rotate the segment 302 25 degrees in response to a 20 degree rotation of the rotary actuator 226.

The bending actuator 208 may be configured to bend the segment 302 away from the longitudinal axis 208. For example, the bending actuator 208 may bend the segment 302 along the bending axis 230. The bending axis 230 may be disposed relative to the longitudinal axis 208. For example, the bending axis 230 may be-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis 208.

The bending of the segment 302 may enable the cutting assembly 210 to more effectively reach the distant sampling site while reducing the risk of damage to or reduced functionality of the surgical instrument components. The cutting assembly 210 may be operated as the segment 302 is bent (e.g., changes orientation in one or more axes) or at different times. For example, the orientation may be operable along a first axis (e.g., moving the segment 302 up or down in a frame of reference defined with respect to the longitudinal axis 208) or a second axis (e.g., moving the segment 302 left or right in a frame of reference defined with respect to the longitudinal axis 208) that is perpendicular to the longitudinal axis 208. The orientation may be manipulated to change the orientation of the cutting window 216 of the cutting assembly 210. The bending may enable the cutting assembly 210 to be maneuvered over a wider range of positions to reach the material at the site within the patient.

When the bending actuator 208 pulls or pushes the articulation wire 220, the articulation wire 220 transmits a force from the bending actuator 208 to bend, or straighten the segment 302. In some embodiments, the pushing or pulling force provided by the bending actuator 228 creates tension in the joint filament 220 to cause the segment 302 to perform bending. In some embodiments, the joint filament 220 has a threshold stiffness that corresponds to a nominal or maximum tension that may be applied to the joint filament 220 such that the segment 302 conforms (e.g., may be compressed or otherwise change shape) to the tension applied by the joint filament 220. For example, pushing or pulling on the articulation wire 220 by the bending actuator 228 may cause the segment 302 to bend about the bending axis 230 at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees. The segment 302 may bend at an angle proportional to the distance the bending actuator 228 moves. For example, the bending actuator 228 may be configured such that the first force results in a 30 degree bend of the segment 302 and the second force results in a 60 degree bend of the segment 302. The second force may be stronger than the first force. For example, the first force may be 5N and the second force may be 10N. The number of curved segments 302 may be proportional to the distance the articulated actuator 228 moves. For example, the articulated actuator 228 may be configured such that the first force causes bending of the segment 302C closest to the wire coupler 222 and the second force causes bending of both segments 302C and 302B. The second force is stronger than the first force.

The wire couplers 222 may be disposed at different locations along the longitudinal axis 208 and adjacent the segments 302 to enable selective bending of the segments 302. For example, the first wire coupler 222 may be disposed adjacent to the segment 302C, while the second wire coupler 222 may be disposed adjacent to the segment 302A (e.g., closer to the proximal end 204). The articulation wire 220 connected to the first wire coupler 222 may result in a different bending of the segment 302 than the articulation wire 220 connected to the second wire coupler 222. In some embodiments, a bending actuator 228 coupled to one or more joint wires 220 may selectively bend at least one of the plurality of segments 302 coupled to the cutting assembly away from the longitudinal axis 208. For example, a first force applied to the joint wire 220 connected to the first coupler 222 may result in bending of the segments 302A-302C, but a second force applied to the joint wire 220 connected to the second coupler 222 may result in bending of the segment 302A.

The segments 302 and the fixation elements 304 may comprise at least one of an elastomer or a friction reducing additive. In some embodiments, the elastomer comprises a thermoplastic elastomer, such as a polyether block amide (e.g., PEBAX). In some embodiments, the friction reducing additive comprises MOBILIZE manufactured by complex solution company (Compounding Solutions, LLC) of lewis ton, maine. At least one of the elastomer or friction reducing additive may reduce the likelihood of the segment 302 and the fixation element 304 kinking or otherwise experiencing frictional losses. In some embodiments, at least one of the elastomer or friction reducing additive may reduce friction generated between the segment 302 and the tube jacket 218.

Referring to fig. 4, a surgical instrument 400 may be similar to surgical instrument 300 and may contain the same structure and function as surgical instrument 300, except that surgical instrument 400 does not contain a fixation element 304. The advantage of the surgical instrument 400 is that all segments 302 can be bent by a single control input. The articulation wire 220 may also be compressed and retracted into the wire channel 219. For example, pulling on the articulation wire 220 coupled to the wire coupler 222 closest to the distal segment 302 (e.g., segment 302C) causes all segments 302A-302C to perform some bending (but not necessarily the same), which may enable an operator of the surgical instrument 400 to bend the cutting window 216 to the treatment site.

Referring to fig. 5A-5F, perspective views of a surgical instrument 500 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery are shown, in accordance with an embodiment of the present invention. The surgical instrument 500 may be similar to the surgical instrument 200, 300, or 400 and may contain the same structure and function as the surgical instrument 200, 300, or 400.

Referring to fig. 5A, a perspective view of a surgical instrument 500 according to an embodiment of the invention is shown. An operator may couple the surgical instrument 500 to the outer tube 238 through the aspiration port 236. An operator may receive irrigation fluid or aspirate cut material from the outer tube 238 through the aspiration port 236.

Referring to fig. 5B, a perspective view of a surgical instrument 500 according to an embodiment of the invention is shown. The distal end 206 may be inserted through an opening or lumen, placed in, or reside in the patient. The curved distal end 206 may curve about a bending axis 230.

Referring to fig. 5C, a side view of a surgical instrument 500 is shown according to an embodiment of the present invention. An operator may actuate or rotate the rotary actuator 226 along the rotational axis 502 to rotate the distal end 206 about the longitudinal axis 208. Surgical instrument 500 may include an instrument tube 504, which may be a rigid tube extending from proximal end 204. The operator may actuate the bending actuator 228 to bend the distal end 206 about the bending axis 230. The curved distal end 206A may curve about a bending axis 230.

Referring to fig. 5D, a perspective view of a rotary actuator 226 and a bending actuator 228 of a surgical instrument 500 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. The rotary actuator 226 may be configured to cause the outer tube 202 to rotate. The bending actuator 228 may be coupled to the joint wire 220A. The bending actuator 228 may be configured to slide through the control axis 506. The bending actuator 228 may be configured to pull the joint wire 220 to bend the distal end 206 of the outer tube 202.

Referring to fig. 5E, a cross-sectional side view of a surgical instrument 500 is shown according to an embodiment of the present invention. The curved distal end 206 may curve about a bending axis 230. Aspiration port 236 may connect surgical instrument 200 to aspiration port 236.

Referring to fig. 5F, a cross-sectional view of the cutting assembly 210 of the surgical instrument 200 is shown, in accordance with an embodiment of the present invention. The cutting assembly 210 may include a cutting window 216. The cutting assembly 210 may cut material that is aspirable via the aspiration channel 234.

Referring to fig. 6A-6D, perspective views of a surgical instrument 600 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery are shown, in accordance with an embodiment of the present invention. The surgical instrument 600 may be similar to the surgical instrument 200 or 500 and may contain the same structure and function as the surgical instrument 200 or 500.

Referring to fig. 6A and 6B, a perspective view of the outer tube 202 of the surgical instrument 600 is shown. The articulation member 209 may be coupled to a cutting assembly 210. The cutting assembly 210 may define a cutting window 216. The articulation wire 220A may be configured to bend the articulation member 209 of the outer tube 202.

Referring to fig. 6C and 6D, a perspective view of a cutting assembly 210 of a surgical instrument 600 including articulation wires 220A-220C is shown. The cutting assembly 210 may include a cutting window 216. The cutting assembly 210 may be coupled to the outer tube 202.

The articulation wire 220 may be configured to bend the distal end 206 of the outer tube 202. In certain embodiments, an articulation wire 220 is coupled to the distal end 206 of the outer tube 202. The joint wire 220 may be coupled to a rotary actuator 226, gear, or other linear-to-rotary motion converter such that when the joint wire 220A is pulled, the distal end 206 of the outer tube 202 will bend in a first direction. For example, the joint filament 220A may be configured to receive a force pulling the joint filament 220A. This force may apply tension to the joint filament 220A toward the proximal end 204 of the bending actuator 228. The tensioned joint wire 220A may bend the distal end 206. For example, a pulled joint wire 220A may pull the distal end 206 toward the proximal end 204. Similarly, the joint wire 220B may be coupled to another gear or other transducer of linear motion to rotational motion such that pulling the joint wire 220B may cause the distal end 206 of the outer tube 202 coupled to the gear to bend in a second direction opposite the first direction. The amount of linear force applied to the joint filament 220 may determine the amount by which the outer tube 202 may bend.

The articulation wires 220 may be configured to be disposed at equal distances or angles from one another. For example, the articulation wire 220A may be disposed 90 degrees about the outer tube 202 perimeter about the articulation wire 220C, which itself is disposed 90 degrees about the outer tube 202 perimeter about the articulation wire 220B.

Applying tension to one or more joint filaments 220 can selectively bend joint member 209 in a direction corresponding to how one or more joint filaments 220 are arranged. As such, the articulation wire 220 may be configured to bend the articulation member 209 along multiple axes. Additional bending actuators 228 may be coupled to the articulation wires 220 that correspond to bending in other directions. For example, the first bending actuator 228 may be coupled to a joint wire 220A, the joint wire 220A configured to bend the joint member 209 along an axis of the joint wire 220A, the second bending actuator 208 may be coupled to a joint wire 220B, the joint wire 220B configured to cause the joint member 209 to bend along an axis of the joint wire 220B, and the third bending actuator 228 may be coupled to a joint wire 220C, the joint wire 220C configured to cause the joint member 209 to bend along an axis of the joint wire 220C. In particular, if the articulation wire 220B is disposed on a first side of the outer tube and the articulation wire 220C is disposed on a second side of the outer tube, the first bending actuator 228 may be configured to cause bending of the distal end along the first side and the second bending actuator 228 may be configured to cause bending of the distal end along the second side.

Referring to fig. 7A-7E, there is shown a perspective view of a surgical instrument 700 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery, in accordance with an embodiment of the present invention. The surgical instrument 700 may be similar to the surgical instrument 300 or 500 and may contain the same structure and function as the surgical instrument 300 or 500.

Referring to fig. 7A and 7B, a perspective view of the outer tube 202 of a surgical instrument 700 is shown, in accordance with an embodiment of the present invention. The outer tube 202 may include fixation elements 304A-304D configured to secure the joint wire 220A. The cutting assembly 210 may define a cutting window 216. The articulation wire 220 may be configured to bend the distal end 206 of the outer tube 202. Distal end 206 may include a segment 302 (not shown).

Referring to fig. 7C, a perspective view of the outer tube 202 of a surgical instrument 700 is shown, according to an embodiment of the present invention. The outer tube 202 may include fixation elements 304A-304D configured to secure the joint wire 220A. The outer tube 202 may include fixation elements 304E-304H configured to secure the joint wire 220B.

Referring to fig. 7D and 7E, a perspective view of the cutting assembly 210 of a surgical instrument 700 is shown, in accordance with an embodiment of the present invention. Surgical instrument 700 may include joint filaments 220A-220C. The outer tube 202 may include fixation elements 304D, 304H, and 3041 configured to secure the joint filaments 220A, 220B, and 220C, respectively.

The joint filament 220 may be configured to bend the distal end 206 of the overtube 202 (which includes the segment 302). In certain embodiments, the joint wire 202 is coupled to the distal end 206 of the outer tube 202. The joint wire 202 may be coupled to a rotary actuator 226, gear, or other linear-to-rotary motion converter such that when the joint wire 220A is pulled, the distal end 206 of the outer tube 202 will bend in a first direction. For example, the joint filament 220A may be configured to receive a force pulling the joint filament 220A. The force may apply tension to the joint filament 220A toward the proximal end 204 of the bending actuator 228. The tensioned joint wire 220A may bend the distal end 206. For example, a pulled joint wire 220A may pull the distal end 206 toward the proximal end 204. Similarly, the joint wire 220B may be coupled to another gear or other transducer of linear motion to rotational motion such that pulling the joint wire 220B may cause the distal end 206 of the outer tube 202 coupled to the gear to bend in a second direction opposite the first direction. The amount of linear force applied to the joint wire 220 may determine the amount by which the outer tube 202 may bend.

The joint wires 202 may be configured to be disposed at equal distances or angles from each other. For example, the articulation wire 220A may be disposed 90 degrees about the outer tube 202 circumference with respect to the articulation wire 220C, which itself is disposed 180 degrees about the outer tube 202 circumference with respect to the articulation wire 220B.

Applying tension to one or more joint wires 202 may selectively bend joint member 209 in a direction corresponding to how one or more joint wires 202 are arranged. As such, the articulation wire 220 may be configured to bend the articulation member 209 along multiple axes. Additional bending actuators 228 may be coupled to the articulation wires 220 that correspond to bending in other directions. For example, a first bending actuator 228 may be coupled to a joint wire 220A, the joint wire 220A configured to bend the joint member 209 along an axis of the joint wire 220A, a second bending actuator 228 may be coupled to a joint wire 220B, the joint wire 220B configured to cause the joint member 209 to bend along an axis of the joint wire 220B, and a third bending actuator 228 may be coupled to a joint wire 220C, the joint wire 220C configured to cause the joint member 209 to bend along an axis of the joint wire 220C. In particular, if the articulation wire 220A is disposed on the left side of the outer tube and the articulation wire 220B is disposed on the right side of the outer tube, the first bending actuator 228 may be configured to cause bending of the distal end along the left side and the second bending actuator 228 may be configured to cause bending of the distal end along the right side.

Referring to fig. 8A-8D, a perspective view of a surgical instrument 800 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. The surgical device 800 may be similar to the surgical device 400, 500, or 700 and may contain the same structure and function as the surgical device 400, 500, or 700, but with the difference that the surgical device 800 does not contain the fixation element 304.

Referring now generally to fig. 7 and 8, applying tension to one or more joint filaments 220 may selectively bend segment 302 in a direction corresponding to the placement of one or more joint filaments 220. As such, the joint filament 220 may be configured to bend one or more of the segments 302 along multiple axes. Bending of the segment 302 may enable the cutting assembly 210 to more effectively reach the remote sampling site while reducing the risk of component damage or reduced functionality of the surgical instruments 700 and 800. The cutting assembly 210 may be operated as the segment 302 is bent (e.g., changes direction of one or more axes) or at different times. For example, the orientation may be operable along a first axis (e.g., moving the segment 302 up or down in a frame of reference defined with respect to the longitudinal axis 208) or a second axis (e.g., moving the segment 302 left or right in a frame of reference defined with respect to the longitudinal axis 208) that is perpendicular to the longitudinal axis 208. The orientation may be manipulated to change the orientation of the cutting window 216 of the cutting assembly 210. The bending may enable the cutting assembly 210 to be maneuvered over a wider range of positions to reach the material at the site within the patient.

Additional bending actuators 228 may be coupled to the articulation wires 220 corresponding to bending in other directions. For example, a first bending actuator 228 may be coupled to the joint wire 220A, the joint wire 220A configured to cause the segment 302 to bend along an axis of the joint wire 220A, a second bending actuator 228 may be coupled to the joint wire 220B configured to cause the segment 302 to bend along an axis of the joint wire 220B, and a third bending actuator 228 may be coupled to the joint wire 220C configured to cause the segment 302 to bend along an axis of the joint wire 220C. In particular, if the articulation wire 220A is disposed on the left side of the outer tube and the articulation wire 220B is disposed on the right side of the outer tube, the first bending actuator 228 may be configured to cause bending of the distal end along the left side and the second bending actuator 228 may be configured to cause bending of the distal end along the right side.

Referring to fig. 9, a method 900 of performing laparoscopic or hysteroscopic surgery using a surgical instrument may be shown. The method 900 may be performed using various embodiments of the surgical instruments described herein. The method 900 or steps thereof may be repeated, for example, to treat multiple treatment sites inside and outside of a blood vessel with multiple materials to be cut.

At 910, a surgical instrument (e.g., any of the surgical instruments 200-800) may be inserted into a patient. The cavity may be a body cavity or space within the body, such as the uterus, fallopian tube, ovary, mouth, ear, nose, esophagus, etc. The cavity may be created using at least one surgical procedure, such as cutting, drilling, or dissection. The resulting cavity may be located in various parts of the patient's body, such as uterus, arms, stomach, liver, neck, etc.

The cavity may contain a treatment site with material to be cut from the patient. The material may comprise foreign matter introduced into the patient, coagulated material that blocks the vascular passageway, or other material identified as being severed from the patient. The surgical instrument may include one or more sensors, light sources, or other accessories to facilitate movement or navigation of the surgical instrument toward the treatment site. The accessory may facilitate identification of the material of the treatment site, e.g., receiving visual feedback to indicate the material of the treatment site. The one or more sensors may include, for example, tilt sensors, proximity sensors, light sensors, pressure sensors, flow sensors, collision sensors, ultrasonic sensors, distance sensors, or other sensors that facilitate endoscopic procedures or operations. For example, a physician or operator may use non-invasive imaging techniques (e.g., X-ray, ultrasound, or computed tomography ("CT") scanning) to determine the location of the material. In addition, the material may be identified by navigating the surgical instrument to the treatment site and using one or more sensors (e.g., cameras or light sources) to locate the material. The surgical instrument may reach the treatment site or material based on, for example, sensing an occlusion in a patient's blood vessel using one or more sensors. The camera of the surgical instrument may be used to identify the material and display the image on a display device external to the surgical instrument.

The procedure may include inserting a surgical instrument into a cavity of a patient. For example, the treatment site may be determined within a patient's blood vessel, such as an artery, arteriole, capillary, venule, or vein. The lumen may be identified for access to a blood vessel containing the treatment site. A physician (or operator) may insert a surgical instrument into a cavity leading to a blood vessel. The physician may navigate the surgical instrument to the treatment site of the blood vessel. In response to reaching the treatment site, the surgical instrument may stop or terminate navigation of the surgical instrument. In some cases, the treatment site reached may be based on a camera inserted with or as part of the surgical instrument. In some cases, the treatment site reached may be based on the length of the inserted surgical instrument. The length of the inserted surgical instrument may be determined based on the predetermined location of the treatment site via the use of X-rays, CT scanning, ultrasound, magnetic resonance imaging ("MRI"), or other non-invasive imaging techniques.

The surgical instrument may be navigated within the patient using at least one sensor, determine a location of the material within the patient, and initiate rotation of the cutting assembly in response to positioning a distal tube end of the surgical instrument at or near the treatment site. Positioning of the surgical instrument may refer to, for example, a distance of 0.1 mm, 0.5 mm, 1 mm, or 1.5 mm from contact with the material (or treatment site).

The surgical instrument may be used to navigate or guide the material cutting device within the patient's body along any tortuous path. Thus, the surgical instrument may determine the positioning of the surgical instrument to initiate rotation of the cutting assembly to perform cutting, extraction, or debridement of material within the patient. The determination of the initiation of rotation may be based on, for example, a coupling or engagement between the cutting assembly and the surgical instrument.

The surgical instrument may pass through the treatment site, such as by a material located at the treatment site. Navigation or actuation of the surgical instrument may terminate in response to reaching, contacting, or passing through the material or treatment site. Laparoscopic or hysteroscopic surgery may involve determining the location of the material or treatment site. In some embodiments, an operator may use at least one imaging tool to identify the location of a material, such as an X-ray, MRI, or CT scan. In some embodiments, an operator or physician may use a camera or a viewing mirror to locate material within the patient. The camera or scope may be part of the surgical instrument. For example, an operator may insert a surgical instrument twice to perform a material removal operation or surgery. One for identifying the material and a second for collecting, extracting, debriding or cutting the material. In another example, an operator may insert a surgical instrument into a patient. An operator may navigate the surgical instrument within the patient to find the material. Once the material is found, the operator may initiate rotation of the cutting assembly to debride and cut the material. The process of debriding material may be referred to as removing the material. In this example, the material cutting device may be inserted once to complete a laparoscopic or hysteroscopic procedure or operation.

In some embodiments, the surgical instrument can provide or deliver at least one substance to a treatment site of a patient. The substance may comprise a liquid, gas or other compound. The substance may facilitate the process of debriding the material into a cut material, for example, by applying a gaseous substance to soften, disperse or break down the material. Thus, providing a substance may help perform debridement procedures using a cutting assembly. In another example, the substance may assist in treating the patient, for example, by occluding a damaged portion of the blood vessel or by providing a drug to a treatment area within the blood vessel.

The outer tube may be an extendable and/or retractable wire. Extension of the outer tube may enable movement of the cutting assembly toward a treatment site within the patient. The cutting assembly may extend or move past the treatment site where the operator may terminate further extension of the outer tube into the patient. The operator may push or apply a force to the proximal end of the outer tube as it moves toward the treatment site. In response to a force applied to the proximal end, the outer tube may be moved further within the patient toward the treatment site. The distal end of the outer tube may be positioned a distance from the material, such as 1 millimeter, 1 inch, or 1 meter from the material.

At 920, the distal end of the surgical instrument may be rotated. The operator can grasp the handle while manipulating the surgical instrument. A control input may be applied to the rotary actuator to cause the distal end of the outer tube to rotate about a longitudinal axis extending through the surgical instrument. For example, the control input may rotate the proximal end of the outer tube about the longitudinal axis 208 by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees. The operator may rotate the distal end at an angle proportional to the angle at which the rotary actuator rotates. For example, in response to a 10 degree rotation of the rotary actuator, the operator may rotate the outer tube at the distal end by 10 degrees. In another example, the operator may configure the distal end to rotate according to any other configuration. For example, the operator may rotate the rotary actuator 10 degrees to rotate the distal end 10 degrees, and rotate the rotary actuator 20 degrees to rotate the distal end 15 degrees. In another example, the operator may rotate the rotary actuator 10 degrees to rotate the distal end 10 degrees, and rotate the rotary actuator 25 degrees to rotate the distal end 20 degrees. In some embodiments, upon rotating the distal end, the operator may actuate a locking mechanism, a rotary actuator, or a bending actuator of the surgical instrument to set the distal end to a target orientation.

At 930, the distal end of the surgical instrument may be bent. Control inputs may be applied to the bending actuator to cause the distal end of the outer tube to bend along a bending plane extending through the surgical instrument. The control input may cause the distal end to bend at various angles about the bending plane to steer the cutting assembly to the material. For example, the operator may bend at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis.

The operator may pull or push the bending actuator. For example, the operator may pull or push the bending actuator along the longitudinal axis. The operator may pull or push the bending actuator any distance, for example 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40 or 50 mm. The operator may bend the distal end at an angle proportional to the distance moved by the bending actuator. For example, the operator may apply a first force resulting in a 30 degree bend of the distal end and a second force resulting in a 60 degree bend of the distal end. The second force may be stronger than the first force. For example, the first force may be 5N and the second force may be 10N.

The operator may configure a control mechanism that controls the bending of the bending actuator. The control mechanism may comprise a carbide clamp, guitar mechanism, or tensioning lever (e.g., truss lever). In some embodiments, the tensioning rod is disposed along the outer tube. The tensioning rod may be configured to maintain tension of the articulation wire to control an articulation member coupled to the cutting assembly. For example, the operator may configure the control mechanism such that the distal end makes a 10 degree bend in response to a 5 millimeter pull of the bending actuator. In another example, the distal end 206 is configured to bend according to any other configuration. For example, the operator may configure the distal end to perform a 10 degree bend in response to a 5 millimeter pull on the bending actuator and to perform a 15 degree bend in response to a 10 millimeter pull on the bending actuator 228. In another example, the operator may configure the distal end to perform a 10 degree bend in response to a 5 millimeter pull on the bending actuator and to perform a 25 degree bend in response to a 10 millimeter pull on the bending actuator.

In some embodiments, the operator may bend the plurality of bending actuators. Wherein each bending actuator may correspond to a bending in a particular direction. For example, an operator may actuate a first bending actuator to bend the distal end along a first axis of the joint wire, actuate a second bending actuator to bend the distal end along a second axis, and actuate a third bending actuator to bend the distal end along a third axis. In some embodiments, the operator may actuate a locking mechanism, a rotary actuator, or a bending actuator of the surgical instrument to set the distal end to a target orientation while bending the distal end.

At 940, the cutting assembly may cut material from the treatment site. An operator or motor may rotate a flexible torque member (e.g., flexible torque member 232) disposed within the outer tube. The flexible torque member may be coupled to the inner member. The inner member may rotate in response to receiving a rotational force or torque applied from the bending actuator. The flexible torque member may be configured to rotate the inner member relative to the outer member to cut the material. Removal of material may refer to cutting, debriding, pulling, dissecting, or tearing material from a treatment site. The cutting assembly may cut material in response to rotation of the inner member. The torque may be provided by a bending actuator. The applied rotation may traverse from the proximal end to the distal end of the surgical instrument. As an example, the bending actuator may provide 180 degrees of rotation for the surgical instrument at the proximal end and 180 degrees of rotation at the distal end.

At 950, material may be retrieved from the treatment site. These substances may comprise cutting materials, liquids, gases or other compounds within the patient's body. The surgical instrument may include actuating a vacuum source coupled to the surgical instrument to provide suction through a suction channel (e.g., suction channel 234) defined by an inner wall of the surgical instrument to cut material from a patient via the suction channel. The process of retrieving the cutting material may occur simultaneously with the debridement process of the cutting assembly. For example, the vacuum source may initiate a vacuum to remove the cut material while the cutting assembly debrides the material. The cut material may be stored in a container or reservoir in the vacuum source and/or external to the surgical instrument.

In a further example, the surgical instrument may introduce, withdraw, or pump the cutting material from the patient in response to the cutting assembly debriding the material into the cutting material. The cut material may be withdrawn via the suction channel. The process of providing a substance or withdrawing cut material may be performed by a vacuum source. The vacuum source may be external to the surgical instrument. The vacuum source may be activated by a signal or a mechanical trigger. The pump device may be connected to a suction channel configured to withdraw the cutting material from the patient. The pump device can withdraw the substance from the reservoir and push the chemical substance into the patient. The pump device may withdraw the cut material into a second reservoir for storage.

The surgical instrument may be excised from the patient upon or based on completion of the laparoscopic or hysteroscopic procedure. Completion of laparoscopic or hysteroscopic surgery may require debridement of material (e.g., through the entire treatment site) or collection of debrided material. For example, the treatment site may comprise a length of 3 inches. The surgical instrument may initiate rotation of the cutting assembly and travel 3 inches through the treatment site to debride the material. Upon debriding the material, the surgical instrument may retrieve or aspirate the cutting material into the aspiration channel. For example, once the surgical instrument cuts material through the 3 inch length of the treatment site and retrieves the cut material, laparoscopic or hysteroscopic procedures may be completed.

C. Systems and methods for telescoping surgical instruments.

Surgical instruments and methods thereof according to the present invention may include components such as telescoping tubes, cutting assemblies, actuators, flexible torque components, and aspiration channels. In general, surgical instruments can be used to provide treatment at a stenosed part of the body (e.g., uterus, fallopian tubes, ovaries), or in some cases, to provide non-surgical treatment to a patient. The surgical instrument may be directed to the treatment site to perform laparoscopic or hysteroscopic procedures. For example, an operator may insert a surgical instrument into a patient's cavity, expand or release a telescoping tube, and bend a cutting assembly to reach a material.

After the surgical instrument is at the treatment site, the operator may maneuver the cutting assembly to reach the material. The location of the material may be a treatment site, portion or area that is extracted, inspected or otherwise operated on using a surgical instrument. The cutting assembly may be configured to cut material and include an outer component and an inner component disposed within the outer component. The surgical instrument may include a bending actuator configured to actuate the articulation wire to bend the tube along a longitudinal axis that extends through the surgical instrument. The surgical instrument may include a flexible torque member configured to rotate the inner member relative to the outer member to cut material. The surgical instrument may include a rotary actuator configured to bend the flexible torque member to cause the cutting assembly to cut material. The surgical instrument may include a suction channel connected to a vacuum source configured to suction material cut by the cutting assembly.

Referring to fig. 10A-10D, surgical instrument 1000 may be similar to surgical instruments 200-800 and may include the same structure and function as surgical instruments 200-800, except that surgical instrument 1000 includes telescoping tubes 1002A-1002C (collectively, telescoping tubes 1002). Extension tube 1002 has the advantage of reaching the treatment site by enabling expansion and retraction of surgical instrument 1000. Extension tube 1002 comprises different sized tubes such that smaller sized extension tube 1002 can be retracted or extended from larger extension tube 1002, which enables surgical instrument 1000 to independently bend distal end 206 thereof. Some of the telescoping tubes 1002 are pre-bent, which allows the operator to position the distal end 206 to the treatment site without having to bend the telescoping tubes 1002. In addition, the diameter of telescoping tube 1002 decreases as it approaches distal end 206, which enables surgical instrument 500 to extend into a stenosed region to access a treatment site.

Extension tube 1002 may include the same structure and function as outer tube 202, but with the difference that extension tube 1002 is configured such that extension tube 1002 of each smaller dimension piece fits snugly within larger extension tube 1002. For example, extension tube 1002 may be a nitinol tube. In another example, extension tube 1002A can encase extension tube 1002B, which itself encases extension tube 1002C.

Referring now to FIG. 10B, telescoping tube 1002 can be configured to bend or flex. For example, telescoping tubes 1002 may be configured to bend or flex (e.g., in a straight line as shown in FIG. 10A) to enable telescoping engagement between telescoping tubes 1002. In another example, extension tube 1002 can be configured to bend or flex when released from extension tube 1002. For example, telescoping tube 1002C may be configured to bend or bend when extended from telescoping tube 1002B, and telescoping tube 1002B itself may be configured to bend or bend when released from telescoping tube 1002A. In another example and as shown in FIG. 10B, telescoping tube 1002A extends along longitudinal axis 208, telescoping tube 1002B extends along curve 1003A with respect to longitudinal axis 208, and telescoping tube 1002C extends along curve 1003B with respect to longitudinal axis 208.

Referring generally to fig. 10A-10D, telescoping tube 1002A can include proximal end 204 and distal end 206. The proximal end may be coupled to an outer tube 238 via a suction port 236. In some embodiments, telescoping tube 1002A has a diameter. The diameter may be less than 4 mm. Extension tube 1002A may partially encase extension tube 1002B. Extension tube 1002A may encase extension tube 1002B.

Extension tube 1002B may extend beyond extension tube 1002A. Extension tube 1002B may be configured to extend until the distal end of extension tube 1002A envelopes the proximal end of extension tube 1002B. In some embodiments, the distal end of extension tube 1002A and the proximal end of extension tube 1002B include hooks, anchors, or other limiting mechanisms to prevent extension tube 1002B from sliding out of extension tube 1002A. Extension tube 1002B can be configured to retract into extension tube 1002A until the proximal end of extension tube 1002A envelopes the proximal end of extension tube 1002B. In some embodiments, telescoping tube 1002B has a diameter. Which may be smaller than the diameter of telescoping tube 1002A. Extension tube 1002B may encase extension tube 1002C.

Extension tube 1002C may extend beyond extension tube 1002B. Extension tube 1002C may be configured to extend until the distal end of extension tube 1002B envelopes the proximal end of extension tube 1002C. In some embodiments, the distal end of extension tube 1002B and the proximal end of extension tube 1002C include hooks, anchors, or other limiting mechanisms to prevent extension tube 1002C from sliding out of extension tube 1002B. Extension tube 1002C can be configured to retract into extension tube 1002B until the proximal end of extension tube 1002B envelopes the proximal end of extension tube 1002C. In some embodiments, extension tube 1002C has a diameter. Which may be smaller than the diameter of telescoping tube 1002B. Extension tube 1002B may encase extension tube 1002C.

Extension tube 1002 can be coupled to cutting assembly 210. The cutting assembly 210 may be configured to retrieve material from the treatment site. Material may be drawn through the bellows to the suction port 236 and the outer tube 238.

Referring to FIG. 10C, a cross-sectional tunnel view of telescoping tubes 1002A-1002C having corresponding diameters 1004A-1004C is shown. Diameter 1004A of bellows 1002A may be less than 4 millimeters. Diameter 1004B of telescoping tube 1002B may be smaller than diameter 1004A of telescoping tube 1002A. Diameter 1004C of telescoping tube 1002C may be smaller than diameter 1004B of telescoping tube 1002B.

Referring now generally to fig. 10A-10D, telescoping actuator 1006 can be configured to control extension or retraction of telescoping tube 1002. Telescoping actuator 1006 may incorporate the same structure and function as actuator 226 or 228 (and may be coupled to or incorporate handle 224). Telescoping actuator 1006 may be coupled to telescoping wires 1008A and 1008B (commonly referred to as telescoping wire 1008). An actuator can push or pull telescoping wire 1008 to extend or retract telescoping tube 1002. The telescoping actuator 1006 may include more than one actuator such that each actuator is coupled to a respective telescoping wire 1008.

Telescoping wire 1008 may contain the same structure and function as joint wire 202, but with the difference that telescoping wire 1008 may be configured to cause extension or retraction of telescoping tube 1002. In some embodiments, telescoping wire 1008 may be configured with telescoping functionality like telescoping tube 1002. For example, telescoping wire 1008 may be extended to extend telescoping tube 1002 or retracted to retract telescoping tube 1002. Telescoping wire 1008 may be coupled to at least a distal-most portion of telescoping tube 1002 (e.g., telescoping tube 1002C) or cutting assembly 210.

Telescoping actuator 1006 may be configured to actuate telescoping wire 1008 to cause extension or retraction of telescoping tube 1002. In some embodiments, actuation may be a control input, push, pull, twist, or rotation. For example, pushing on telescoping wire 1008 may cause telescoping tube 1002 to extend, and pulling on telescoping wire 1008 may cause telescoping tube 1002 to retract. In another example, rotating telescoping wire 1008 in a first direction (e.g., clockwise) may cause telescoping tube 1002 to elongate, while rotating telescoping wire 1008 in a second direction (e.g., counterclockwise) may cause telescoping tube 1002 to retract.

Telescoping actuator 1006 can apply a first control input (e.g., push telescoping wire 1008) to extend cutting assembly 210 and telescoping tube 1002C coupled thereto out of telescoping tube 1002B. Telescoping actuator may apply a second control input (e.g., push telescoping wire 1008) to further extend cutting assembly 210 and telescoping tube 1002C coupled thereto, which will cause telescoping tube 1002B to extend out of telescoping tube 1002A. Conversely, a telescoping actuator can apply a third control input (e.g., pull telescoping wire 1008) to retract cutting assembly 210 and the telescoping tube 1002C coupled thereto into telescoping tube 1002B. A second control input (e.g., pulling telescoping wire 1008) may be applied by telescoping actuator to further retract cutting assembly 210 and the telescoping tube 1002C coupled thereto, which will cause telescoping tube 1002B to retract into telescoping tube 1002A.

Telescoping actuator 1006 may be configured to rotate telescoping tube 1002 about longitudinal axis 208 extending through surgical instrument 200 in response to a first control input received at telescoping actuator 1006. Telescoping actuator 1006 may be coupled to the proximal end of telescoping tube 1002. The telescoping actuator 1006 may be coupled to the joint wire 220. The telescoping actuator 1006 may be a knob, tube, handle, grip, or any other surface configured to receive control inputs from an operator. Control inputs may cause telescoping actuator 1006 to rotate proximal end 204 of telescoping tube 1002 about longitudinal axis 208. In another example, control inputs may cause telescoping actuator 1006 to pull on joint wire 202 to rotate telescoping tube 1002 about longitudinal axis 208. For example, control inputs can rotate proximal end 204 of telescoping tube 1002 by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees about longitudinal axis 208.

Referring to fig. 11A and 11B, a perspective view of a surgical instrument 1100 having a telescoping configuration for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery is shown in accordance with an embodiment of the present invention. Surgical instrument 1100 may be similar to surgical instruments 200-800 and 1000 and may include the same structure and function as surgical instruments 200-800 and 1000.

Referring to FIG. 11A, extension tube 1002 can have a telescoping configuration such that a section of extension tube 1002 closer to proximal end 204 envelopes a section closer to distal end 206. For example, extension tube 1002A encloses extension tube 1002B, extension tube 1002B encloses extension tube 1002C coupled to cutting assembly 210.

Referring to FIG. 11B, a perspective view of a telescoping tube 1002 of a pre-curved surgical instrument 1100 for maneuvering to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. For example, telescoping tube 1002A is pre-bent along axis 1003A. Extension tube 1002B extends out of extension tube 1002A along axis 1003B.

Referring to fig. 12, a method 1200 of performing laparoscopic or hysteroscopic surgery using a surgical instrument is shown. Method 1200 may be performed using various embodiments of the surgical instruments described herein. The method 1200, or steps thereof, may be repeated, for example, to treat multiple treatment sites with multiple materials to be cut located inside and outside of a blood vessel.

At 1210, a surgical instrument (e.g., either of surgical instruments 1000 or 1100) can be inserted into a patient. The cavity may be a body cavity or space within the body, such as the uterus, fallopian tube, ovary, mouth, ear, nose, esophagus, etc. The cavity may be created using at least one surgical procedure, such as cutting, drilling, or dissection. The resulting cavity may be located in various parts of the patient's body, such as uterus, arms, stomach, liver, neck, etc.

The procedure may include inserting a surgical instrument into a cavity of a patient. For example, the treatment site may be determined within a patient's blood vessel, such as an artery, arteriole, capillary vessel, venule, or vein. The lumen may be identified for access to a blood vessel containing the treatment site. A physician (or operator) may insert a surgical instrument into a cavity leading to a blood vessel. The physician may navigate the surgical instrument to the treatment site of the blood vessel. In response to reaching the treatment site, the surgical instrument may stop or terminate navigation of the surgical instrument. In some cases, the treatment site reached may be based on a camera inserted with or as part of the surgical instrument. In some cases, the treatment site reached may be based on the length of the inserted surgical instrument. The length of the inserted surgical instrument may be determined based on the predetermined location of the treatment site via the use of x-ray, CT scan, ultrasound, magnetic resonance imaging ("MRI") or other non-invasive imaging techniques.

The surgical instrument may pass through the treatment site, such as by a material located at the treatment site. Navigation or actuation of the surgical instrument may terminate in response to reaching, contacting, or passing through the material or treatment site. Laparoscopic or hysteroscopic surgery may involve determining the location of the material or treatment site. In some embodiments, an operator may identify the location of the material using at least one imaging tool (e.g., an X-ray, MRI, or CT scan). In some embodiments, an operator or physician may use a camera or a viewing mirror to locate material within the patient. The camera or scope may be part of the surgical instrument. For example, an operator may insert a surgical instrument twice to perform a material removal operation or surgery. One for identifying the material and a second for collecting, extracting, debriding or cutting the material. In another example, an operator may insert a surgical instrument into a patient. An operator may navigate the surgical instrument within the patient to find the material. Once the material is found, the operator may initiate rotation of the cutting assembly to debride and cut the material. The process of debriding material may be referred to as removing the material. In this example, the material cutting device may be inserted once to complete a laparoscopic or hysteroscopic procedure or operation.

In some embodiments, the surgical instrument can provide or deliver at least one substance to a treatment site of a patient. The substance may comprise a liquid, gas or other compound. The substance may facilitate the process of debriding the material into a cut material, for example, by applying a gaseous substance to soften, disperse or break down the material. Thus, the provision of the substance may aid in debridement procedures using the cutting assembly. In another example, the substance may assist in treating the patient, for example, by occluding a damaged portion of the blood vessel or by providing a drug to a treatment area within the blood vessel.

The telescoping tubes may be extendable and/or retractable wires. Extension of the telescoping tube may enable the cutting assembly to move toward the treatment site within the patient. The cutting assembly may be extended or moved through the treatment site where the operator may terminate extension of the telescoping tube further into the patient. The operator may push or apply a force to the proximal end of the telescoping tube as it moves toward the treatment site. The bellows is movable further within the patient toward the treatment site in response to a force applied to the proximal end. The distal end of the bellows may be positioned a distance from the material, such as 1 millimeter, 1 inch, or 1 meter from the material.

At 1220, the telescoping tube of the surgical instrument may be released. An operator may apply control inputs to the telescoping actuators to actuate the telescoping wires to cause extension or retraction of the telescoping tubes. In some embodiments, actuation may be a control input, push, pull, twist, or rotation. For example, an operator may push an actuator to push a telescoping wire to cause the telescoping tube to elongate. In another example, the operator may pull on the telescoping wire to cause the telescoping tube to retract. In another example, an operator may rotate the telescoping wire in a first direction (e.g., clockwise) to cause the telescoping tube to extend, and rotating the telescoping wire in a second direction (e.g., counterclockwise) may cause the telescoping tube to retract.

The telescoping actuator may apply a first control input (e.g., push control line) to extend the cutting assembly and the small telescoping tube coupled thereto out of the medium telescoping tube. The telescoping actuator may apply a second control input (e.g., push control line) to further extend the cutting assembly and the small telescoping tube associated therewith, which would result in the medium telescoping tube extending out of the large telescoping tube.

At 1230, the distal end of the surgical instrument may be rotated. The operator can grasp the handle while manipulating the surgical instrument. Control inputs may be applied to the telescoping actuators to cause the distal ends of the telescoping tubes to rotate about a longitudinal axis extending through the surgical instrument. The telescoping actuator may be configured to rotate the telescoping tube about a longitudinal axis extending through the surgical instrument in response to a first control input received at the telescoping actuator. The telescoping actuator may be coupled to the proximal end of the telescoping tube. The telescoping actuator may be coupled to the joint wire. The telescoping actuator may be a knob, tube, handle, grip, or any other surface configured to receive control input from an operator. The control input may cause the telescoping actuator to rotate the proximal end of the telescoping tube about the longitudinal axis. In another example, the control input may cause the telescoping actuator to pull the joint wire to rotate the telescoping tube about the longitudinal axis. For example, the control input may rotate the proximal end of the telescoping tube about the longitudinal axis 208 by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees.

The operator may rotate the distal end at an angle proportional to the angle at which the telescoping actuator rotates. For example, in response to a 10 degree rotation of the telescoping actuator, the operator may rotate the distal end of the telescoping tube 10 degrees. In another example, the operator may configure the distal end to rotate according to any other configuration. For example, the operator may rotate the telescoping actuator 10 degrees to rotate the distal end 10 degrees, and the telescoping actuator 20 degrees to rotate the distal end 15 degrees. In another example, the operator may rotate the telescoping actuator 10 degrees to rotate the distal end 10 degrees, 25 degrees to rotate the distal end 20 degrees.

At 1240, the cutting assembly may cut material from the treatment site. An operator or motor may rotate a flexible torque member (e.g., flexible torque member 232) disposed within the telescoping tube. The flexible torque member may be coupled to the inner member. The inner member may rotate in response to receiving a rotational force or torque applied from the bending actuator. The flexible torque member may be configured to rotate the inner member relative to the outer member to cut the material. Removal of material may refer to cutting, debriding, pulling, dissecting, or tearing material from a treatment site. The cutting assembly may cut material in response to rotation of the inner member. The torque may be provided by a bending actuator. The applied rotation may traverse from the proximal end to the distal end of the surgical instrument. As an example, the bending actuator may provide 180 degrees of rotation for the proximal end of the surgical instrument, and the distal end will rotate 180 degrees.

At 1250, material may be retrieved from the treatment site. These substances may comprise cutting materials, liquids, gases or other compounds within the body of the patient. A vacuum source coupled to the surgical instrument may provide suction through a suction channel (e.g., suction channel 234) defined by an inner wall of the surgical instrument to cut material from the patient via the suction channel. The process of retrieving the cutting material may occur simultaneously with the debridement process of the cutting assembly. For example, the vacuum source may activate a vacuum to remove the cutting material while the cutting assembly debrides the material. The cutting material may be stored in a container or reservoir in the vacuum source and/or external to the surgical instrument.

In a further example, the surgical instrument may introduce, withdraw, or pump the cutting material from the patient in response to the cutting assembly debriding the material into the cutting material. The cut material may be withdrawn via the suction channel. The process of providing a substance or withdrawing cut material may be performed by a vacuum source. The vacuum source may be external to the surgical instrument. The vacuum source may be activated by a signal or a mechanical trigger. The pump device may be connected to a suction channel configured to withdraw the cutting material from the patient. The pump device may withdraw the substance from the reservoir and push the chemical substance into the patient. The pump device may withdraw the cut material into a second reservoir for storage.

The surgical instrument may be excised from the patient upon or based on completion of the laparoscopic or hysteroscopic procedure. The telescoping actuator may apply a third control input (e.g., pulling a control wire) to retract the cutting assembly and the small telescoping tube coupled thereto into the medium telescoping tube. The telescoping actuator may apply a second control input (e.g., pulling a control line) to further retract the cutting assembly and the small telescoping tube coupled thereto, which will cause the middle telescoping tube to retract into the large telescoping tube.

Completion of laparoscopic or hysteroscopic surgery may require debridement of material (e.g., through the entire treatment site) or collection of debrided material. For example, the treatment site may comprise a length of 3 inches. The surgical instrument may initiate rotation of the cutting assembly and travel 3 inches through the treatment site to debride the material. Upon debriding the material, the surgical instrument may retrieve or aspirate the cutting material into the aspiration channel. For example, once the surgical instrument cuts material through the 3 inch length of the treatment site and retrieves the cut material, laparoscopic or hysteroscopic procedures may be completed.

D. Systems and methods for manipulating an integrated steerable instrument to a treatment site.

It is difficult to maneuver the cutting assembly at the distal end of the surgical instrument to the desired material at the treatment site while maintaining the ability of the cutting assembly at the distal end of the surgical instrument to be properly manipulated, and it is even more difficult to use the surgical instrument with other surgical tools in cavities and other narrow or tortuous treatment sites. The steerable instrument and method thereof according to the present invention may address this problem by independently bending the distal end of the steerable instrument while maintaining the ability of the cutting assembly located at the distal end of the steerable instrument to be properly operated. The flexibility and small diameter of the steerable instrument enables the steerable instrument to navigate through the lumen or working channel of the surgical tool. For surgical tools that are unable to receive a steerable instrument through their working channel, the attachment member enables the steerable instrument to navigate or follow the outside of the surgical tool. When the steerable instrument is disposed along the flexible tool in the cavity, working channel, or attachment member, the steerable instrument can then bend the distal end and actuate its cutting assembly without bending the remainder of the steerable instrument to avoid damaging or kinking the cavity, surgical tool, or steerable instrument itself.

The steerable instrument may include components such as a cutting assembly, a flexible outer tube, a first connector, a flexible torque component, a second connector, and a suction channel. Generally, steerable instruments can be used to provide treatment to a stenosed part of the body, such as the uterus, fallopian tubes, ovaries, or in some cases, to provide non-surgical treatment to the patient. The steerable instrument may be directed to a treatment site to perform laparoscopic or hysteroscopic procedures. For example, an operator may insert a steerable instrument into a cavity of a patient and bend the cutting assembly to reach a treatment site. In some embodiments, the operator inserts the steerable instrument into a channel of the surgical tool. In other embodiments, the steerable instrument includes at least one attachment member configured to attach the steerable instrument along the surgical tool.

After the steerable instrument is at the treatment site, the operator may steer the cutting assembly to the material. The location of the material may refer to a treatment site, portion, or area for extracting, inspecting, or performing other procedures using the steerable instrument 1300. The cutting assembly may be configured to cut material and include an outer sheath and an inner sheath disposed within the outer sheath. The steerable instrument may include a first connector configured to bend the flexible outer tube relative to a longitudinal axis extending through the steerable instrument. The steerable instrument may include a flexible torque component configured to rotate the inner sheath relative to the outer sheath to cut material. The steerable instrument may include a second connector configured to rotate the flexible torque member to cause the cutting assembly to cut material. The steerable instrument may include a suction channel connected to a vacuum source configured to suction material cut by the cutting assembly.

13A-13D, a view of a steerable instrument 1300 for steering to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. Steerable instrument 1300 can include a cutting assembly 1302 that can include an outer sheath 1304 and an inner sheath 1306. The outer sheath 1304 may define a cutting window 1308. Steerable instrument 1300 may include steerable tube 1310. Steerable tube 1310 may include a proximal end 1312, a distal end 1314, a base layer 1318, a top layer 1320, an inner diameter 1322, and an outer diameter 1324. Steerable instrument 1300 can include a first connector 1326, a longitudinal axis 1328, a bending axis 1330, a flexible torque member 1332, a second connector 1334, a suction channel 1336, and a suction port 1338 configured to be coupled to a vacuum source 1340.

For example, with further reference to fig. 13A, to perform a procedure to cut material from a treatment site, a steerable tube 1310 may be introduced into a cavity of a patient. The cutting assembly 1302 may be introduced to the treatment site. An operator may use the first connector 1326 to maneuver the cutting assembly 1302 along the bending axis 1330 to reach the material. The operator may actuate the cutting assembly 1302 to cut material using the second connector 1334. The motor may also be rotated to rotate the cutting assembly 1302. The cutting assembly 1302 may rotate in response to rotation initiated by the second connector 1334 or a motor. The material may be extracted, cut, collected, or studied by the steerable instrument 1300. In some cases, the cutting assembly 1302 may extract, pull, or collect material into the cutting window 1308. The vacuum source 1340 may draw material into the suction channel 1336, the suction channel 1336 extending from the cutting window 1308 to the suction port 1338.

Referring to fig. 13A and 13B in combination, the cutting assembly 1302 may be configured to cut material from a patient. The cutting assembly 1302 may be coupled to or located at a distal end of the steerable instrument 1300. The cutting assembly 1302 may be spaced apart from the distal end 1314 of the flexible outer tube. For example, the distance may be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 millimeters. The cutting assembly 1302 may include a blade (or fan blade). The cutting assembly 1302 may include one or more blades, such as the two blades shown in fig. 2B. The cutting assembly 1302 may include a sector cutter, an axial cutter, a drill bit, a hook, a spade, a reamer, a milling cutter, or other cutting tool or device. The cutting assembly 1302 may be referred to as a debridement member, cutter, removal tool, or extractor. The cutting assembly 1302 may include a blade. The blade may be composed of one or more materials for cutting or dissecting materials, such as steel, plastic, carbon fiber, titanium, aluminum, metal, or other alloys, to perform laparoscopic or hysteroscopic procedures. Cutting assembly 1302 may perform actions, in whole or in part, including but not limited to cutting, snare, shredding, slicing, shredding, which are also debridement examples. Thus, the cutting assembly 1302 may be a component capable of cutting, snare, shredding, slicing, or comminuting from a patient's body surface. Thus, the cutting assembly 1302 may be implemented as forceps, scissors, a knife, a snare, a chopper, or any other component that may be debrided.

The cutting assembly 1302 may be actuated such that the cutting assembly 1302 may be operated by conversion of mechanical force applied by an operator or automatically actuated using an impeller, a motor (e.g., an electric motor), or any other force generating component to actuate the debridement component. The cutting assembly 1302 may be configured to cut at various speeds, such as 5000 revolutions per minute ("RPM"), 10,000 RPM, 130,000 RPM, or 50,000 RPM. The cutting assembly 1302 may be manually operated or may employ any other means of debriding the material such that the severed material can be retrieved from the treatment site via the steerable tube 1310. The cutting assembly 1302 may cut the material into pieces small enough that it can be retrieved via the steerable instrument 1300 such that the steerable instrument 1300 does not need to be cut from the patient to collect the cut material. It should be appreciated that the cutting assembly 1302 is capable of rotating a particular angle and at a particular torque that is equal to or matches the rotation and torque of the motor or operator. Thus, the cutting assembly 1302 may provide cutting accuracy, control, and power consumption. For example, the cutting assembly 1302 coupled to the cutting assembly 1302 may be rotated several degrees at a particular torque that is equal to the angle and torque provided by the operator to the motor. For example, the operator or motor may initiate 30 degrees of rotation. Rotation, force, and torque may be applied from the motor to the cutting assembly 1302. The cutting assembly 1302 may receive the applied rotation. Thus, the cutting assembly 1302 may be rotated 30 degrees based on motor or operator applied rotation, force, and torque.

The cutting assembly 1302 may include at least one sensor, such as a proximity sensor, light sensor, pressure sensor, radar sensor, flow sensor, flex sensor, collision sensor, distance sensor, or other sensor configured to observe, examine, sense, or navigate through the patient's body. The cutting assembly 1302 may include a light source and a recording device or capturing device (e.g., a camera or a scope) to collect visual information from the observation of the patient's body. The light source may comprise a light emitting diode ("LED"), an incandescent lamp, a compact fluorescent lamp, a halogen lamp, a neon lamp, or other type of lighting element. The steerable instrument 1300 or cutting assembly can illuminate and initiate recording using the light source and recording device. The cutting assembly 1302 may receive at least one visual information from the camera and transmit the at least one visual information to the display device. The display device may generate or display an image based on the received visual information for an operator or doctor to view the interior of the patient's body during surgery. In some embodiments, the cutting assembly 1302 may be equipped with an injectable dye composition by which an operator can determine the extent to which it narrows under fluoroscopic guidance or marks a particular region within the patient's body. In other embodiments, the operator may mark a particular area with the cutting assembly 1302 without using an injectable dye.

Referring to fig. 13A and 13C in combination, the cutting assembly 1302 may include an outer sheath 1304 and an inner sheath 1306 disposed within the outer sheath 1304. The outer sheath 1304 may be configured to pass a fluid. The outer sheath 1304 may be a component, cap, outer tube, housing, or body of the cutting assembly 1302. The outer sheath 1304 may be shaped or formed, for example, as a cylinder, prism, cone, or other shape. The outer sheath 1304 may be flexible. The outer sheath 1304 may be bent and flexed to any degree. In some embodiments, the outer sheath 1304 may bend and flex 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, or 180 degrees. The outer sheath 1304 may comprise a thickness. The thickness may be 10 nanometers, 20 nanometers, 1 millimeter, 2 millimeters, 3 millimeters, 4 millimeters, or 5 millimeters. The outer sheath 1304 may comprise a width. The width may be 1 mm, 2 mm, 3 mm, 4 mm, 5 mm or 1 cm. The outer sheath 1304 may comprise a length. The length may be 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, 100 meters, etc. The outer sheath 1304 may comprise a cross-sectional area, such as 0.6 square millimeters, 1 square millimeter, 1.9 square millimeters, and the like. The outer sheath 1304 may be constructed of materials such as metal, steel, plastic, rubber, glass, carbon fiber, titanium, aluminum, or other alloys.

The outer sheath 1304 may at least partially surround the inner sheath 1306. In some embodiments, the inner sheath 1306 cuts any material that is sucked or otherwise enters the outer sheath 1304. The outer sheath 1304 may be a component, cap, tube, or housing. The inner sheath 1306 may include an opening such that material cut by the cutting assembly 1302 enters through the opening. The inner sheath 1306 may include a length similar to or less than the outer sheath 1304. The length may be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100 cm. The inner sheath 1306 may be designed to facilitate debriding one or more materials and removing cut materials in a single operation. An inner sheath 1306 may be disposed within the outer sheath 1304. The inner sheath 1306 may be coupled to the outer sheath 1304. The inner sheath 1306 may be constructed of a similar material as the outer sheath 1304. The inner sheath 1306 may be flexible similar to the outer sheath 1304.

The outer sheath 1304 may define a cutting window 1308. The outer sheath 1304 may include a cutting window 1308 at the distal end of the cutting assembly 1302. A portion of the radial wall of the outer sheath 1304 may define a cutting window 1308 that extends around a portion of the radius of the outer sheath 1304. In some embodiments, the operator may receive or retrieve cut material through the cut window 1308.

The cutting window 1308 may be configured to enable the cutting assembly 1302 to cut, dissect, or debride material. For example, the cutting assembly 1302 may initiate a debridement or cutting process by rotating through the cutting of material to receive the material in the cutting window 1308. A cutting window 1308 may be positioned on one side of the cutting assembly 1302. Cutting window 1308 may be configured to enable tangential or side cutting of material with reference to movement of cutting assembly 1302. In some embodiments, the outer sheath 1304 may contain cutting windows 1308. The cutting window 1308 may comprise a hollow structure having a shape, such as a circle, oval, rectangle, or other geometric shape for exposing the blades of the cutting assembly 210. The cutting window 1308 may comprise a diameter. The diameter may be 1 mm, 2 mm, 3 mm, 4 mm or 5 mm. Cutting window 1308 may include a cutout, which may be part of cutting assembly 1302. For example, the cutting window 1308 may comprise a 0.4 millimeter incision.

Steerable tube 1310 may be a navigation wire, a motorized wire, or a braid. Steerable tube 1310 may comprise a nickel titanium alloy or other memory material such that bending of proximal end 1312 will result in bending of distal end 1314. Steerable tube 1310 may comprise rubber, cloth, metal, steel, plastic, titanium, nickel, or carbon fiber. Steerable tube 1310 may be a braided sheath. In some embodiments, steerable tube 1310 may also include a liner that fits around steerable tube 1310. In some embodiments, the liner may prevent air or other fluids from penetrating between the steerable tubes 1310. Steerable tube 1310 may be coupled to outer sheath 1304. In some embodiments, steerable instrument 1300 may be surrounded by a sheath or liner to avoid frictional contact between the outer surface of flexible torque element 1332 and other surfaces. In some embodiments, the steerable instrument 1300 may be coated with polytetrafluoroethylene ("PFTE") to reduce frictional contact between the outer surface of the steerable instrument 1300 and other surfaces (e.g., the inner wall of a patient).

Steerable tube 1310 may be maneuvered within a patient. Steerable tube 1310 may be inserted through an opening or cavity. Steerable tube 1310 may be turned, bent, or otherwise navigated through a curved portion of a patient. For example, steerable tube 1310 may be steered into a bent portion of a patient. Steerable tube 1310 may be in contact with the patient such that steerable tube 1310 may navigate through the patient's bent portion. Steerable tube 1310 may bend or rotate in response to reaching or coming into contact with the bending portion such that steerable tube 1310 bends through the bending portion as it navigates. For example, the body lumen may contain arcs, ridges, or other non-linear paths to the treatment site. The treatment site may be located in the patient at a location that follows a non-linear path. Steerable tube 1310 may be pushed, raised, or bumped within the body lumen to rotate a non-linear path through the lumen. In some cases, steerable tube 1310 may navigate through the cavity by bouncing, rotating, or adjusting the navigation direction in response to at least contact with the cavity.

Steerable tube 1310 may be constructed of higher or lower density, higher or lower ductility, higher or lower flexibility, or other features that facilitate passage through the patient. The flexibility of the steerable tube 1310 facilitates navigation of the steerable instrument 1300 within the patient. Steerable tube 1310 may be flexible so as to avoid injury, tearing, wound, or other damage in the patient. The flexibility of the steerable tube 1310 may allow the steerable instrument 1300 to bend or rotate even when bent. For example, the flexible tube of steerable instrument 100 may be bent 120 degrees, containing components within steerable instrument 100, such as flexible torque component 1332. The curved steerable instrument may maintain rotational performance at a 120 ° bend through the flexibility of the flexible tube. Steerable tube 1310 may comprise any width or length. The width may be 1 mm, 2 mm, 3 mm, 4 mm, 5 mm or 1 cm. The length may be 350 mm, 500 mm, 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, or 100 meters.

In some embodiments, steerable tube 1310 may be inserted into an instrument channel or working channel of a surgical tool. The instrument channel may define a hollow portion or inlet configured for the steerable tube 1310. The instrument channel may provide additional shape, texture, grooves, or other features to the steerable tube 1310, or provide a cover for traversing the patient.

Steerable tube 1310 may contain or be coupled to one or more sensors, such as light sensors, electromagnetic sensors, optical stereotactic sensors, pressure sensors, collision sensors, flow sensors, radar sensors, position sensors, or distance sensors. In some embodiments, steerable tube 1310 detects the presence of material. Steerable tube 1310 may be equipped with at least one sensor that may communicate with at least one external device, such as a sensor processing component (not shown), to determine the thickness of the material relative to the rest of the patient indicated by the sensor. The sensor may comprise, for example, a temperature sensor, a pressure sensor, a resistance sensor, a collision sensor, an ultrasonic sensor, or other sensor for medical examination. In some embodiments, the type of material is associated with at least the impedance or density of the tissue. The sensor may collect temperature information and other sensed information and provide signals corresponding to such information to the sensor processing unit. The sensor processing unit may then identify the type of material. In some embodiments, the sensor may be an electrical sensor.

Referring now to fig. 13A and 13D in combination, a steerable tube 1310 may extend from proximal end 1312 to distal end 1314. Proximal end 1312 may refer to the base, open end, or foundation of steerable tube 1310. The distal end 1314 may refer to the tip or front of the steerable tube 1310. The distal end 1314 may be coupled to the outer sheath 1304. Steerable tube 1310 may be configured to receive torque at proximal end 1312 (e.g., τ -proximal) and transmit torque to distal end 1314 to outer sheath 1304 (e.g., as τ -distal) to rotate outer sheath 1304.

Steerable tube 1310 includes base layer 1318 and top layer 1320. The base layer 1318 and the top layer 1320 may each comprise at least one of an elastomer or a friction reducing additive. In some embodiments, the elastomer comprises a thermoplastic elastomer, such as a polyether block amide (e.g., PEBAX). In some embodiments, the friction reducing additive comprises MOBILIZE manufactured by complex solution company (Compounding Solutions, LLC) of lewis ton, maine. At least one of the elastomer or friction reducing additive may reduce the likelihood of frictional losses during use that may reduce the efficiency of the steerable tube 1310 in transmitting torque from the proximal end 1312 to the distal end 1314. Further, at least one of the elastomer or friction reducing additive may reduce friction generated between the steerable tube 1310 and the outer sheath 1304 when the steerable tube 1310 and the outer sheath 1304 are in contact with each other, for example, when the steerable tube 1300 has been traversing a tortuous path. In some embodiments in which the steerable instrument 1300 may be inserted into a working channel of a surgical instrument, at least one of an elastomer or friction reducing additive may reduce friction generated between the steerable tube 1310 and the inner wall of the working channel of the surgical instrument.

Steerable tube 1310 defines an inner diameter 1322 and an outer diameter 1324. The inner diameter 1322 may be less than 2 millimeters. The inner diameter 1322 may be 1 millimeter. The inner diameter 1322 may be 10 millimeters. The inner diameter 1322 may be less than 0.5 inches. The inner diameter 1322 may be less than 0.25 inches. The inner diameter 1322 may be greater than or equal to 0.05 inches and less than or equal to 0.5 inches. The inner diameter 1322 may be greater than or equal to 0.11 inches and less than or equal to 0.13 inches. The outer diameter 1324 may be less than 4 millimeters. The outer diameter 1324 may be less than 5 millimeters. The outer diameter 1324 may be 10 millimeters. The outer diameter 1324 may be less than 0.5 inches. The outer diameter 1324 may be less than 0.25 inches. The outer diameter 1324 may be greater than or equal to 0.05 inches and less than or equal to 0.5 inches. The outer diameter 1324 may be greater than or equal to 0.11 inches and less than or equal to 0.13 inches. The ratio of the inner diameter 1322 to the outer diameter 1324 may be greater than or equal to 0.5 and less than or equal to 0.95.

The steerable instrument 1300 can include a first connector 1326 for bending the distal end 1314 of the steerable tube 1310 along a longitudinal axis 1328 extending through the steerable instrument 1300 in response to a first control input received at the first connector 1326. The first connector 1326 may be coupled to the proximal end 1312 of the steerable tube 1310. The first connector 1326 may be a knob, tube, handle, grip, or any other surface configured to receive control inputs from an operator. The control input may cause the first connector 1326 to bend the proximal end 1312 of the steerable tube 1310 relative to the longitudinal axis 1328. For example, the control input may bend the proximal end 1312 of the steerable tube 1310-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis 1328.

The first connector 1326 may be configured to bend the distal end 1314 on a bending axis 1330 relative to a longitudinal axis 1328. The bending axis 1330 may be disposed relative to the longitudinal axis 1328. For example, the bending axis 1330 may be at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis 1328. The distal end 1314 may be bent at an angle proportional to the angle at which the proximal end 1312 is bent. For example, steerable tube 1310 may be configured to bend distal end 1314 by 10 degrees in response to a 10 degree bend to proximal end 1312 through first connector 1326. In another example, steerable tube 1310 is configured to bend according to any other configuration. For example, the steerable tube 1310 may be configured to bend the distal end 1314 10 degrees in response to the first connector 1326 bending the proximal end 1312 10 degrees and bend the distal end 1314 15 degrees in response to the first connector 1326 bending the proximal end 1312 20 degrees. In another example, the steerable tube 1310 may be configured to bend the distal end 1314 10 degrees in response to bending the proximal end 1312 10 degrees through the first connector 1326 and bend the distal end 1314 25 degrees in response to bending the proximal end 131 20 degrees through the first connector 1326.

In some embodiments, the first connector 1326 may be configured to input τ -proximal for rotating the steerable tube 1310 and thus the outer sheath 1304 (or applying a control torque corresponding to a desired τ -proximal, for example if the first connector 1326 contains gears and/or motorized actuators to drive rotation of the steerable tube 1310). In some embodiments, the first connector 1326 is coupled to a motor configured to apply torque or control inputs. The distal end 1314 may rotate with a torque equal to the torque provided at the proximal end 1312 via the first connector 1326. It should be appreciated that distal end 1314 may be configured to rotate a particular angle that is equal to or matches the angle of rotation of proximal end 1312. Accordingly, the first connector 1326 may be configured to provide precise control of the steerable tube 1310 and, thus, the outer sheath 1304. For example, the operator may initiate 30 degrees of rotation of the first connector 1326. Rotation, force, and torque may be applied to the distal end 1314 such that the outer sheath 1304 is also rotated 30 degrees.

Steerable instrument 1300 can include a flexible torque component 1332 disposed within steerable tube 1310. Flexible torque member 1332 may be coupled to inner sheath 1306 and disposed within inner sheath 1306. In addition, at least one of the elastomer or friction reducing additive may reduce friction generated between the flexible torque member 1332 and the inner sheath 1306 when the flexible torque member 1332 and the inner sheath 1306 contact each other, for example, when the steerable instrument 1300 has traversed a tortuous path. The flexible torque member 1332 may be configured to rotate the inner sheath 1306 relative to the outer sheath 1304 to cut material. Flexible torque component 1332 may be constructed of at least one of metal, steel, plastic, titanium, nickel, carbon fiber, or other alloys. In some embodiments, the inner sheath 1306 may include a liner within which the flexible torque member 1332 is disposed.

Steerable instrument 1300 can include a second connector 1334, the second connector 1334 coupled to the proximal end 1312 of steerable tube 1310 and configured to rotate flexible torque component 1332. The second connector 1334 may be coupled to the flexible torque member 1332. The second connector 1334 may be configured to receive control inputs from an operator. The second connector 1334 may be a knob, tube, handle, grip, or any other surface configured to receive control inputs.

The control input may rotate the second connector 1334 to rotate the inner sheath 1306 relative to the outer sheath 1304 to cut material. The control input may rotate the second connector 1334 any number of degrees. For example, the control input may rotate the second connector 1334 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, or 360 degrees relative to the longitudinal axis 1328. The inner sheath 1306 may be rotated any number of degrees. For example, the inner sheath 1306 may be rotated 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, or 360 degrees. The inner sheath 1306 may rotate at an angle proportional to the angle of rotation of the second connector 1334. For example, the inner sheath 1306 may be configured to rotate 10 degrees in response to 10 degrees of rotation of the second connector 1334. In another example, the inner sheath 1306 is configured to bend according to any other configuration. For example, the inner sheath 1306 may be configured to rotate 10 degrees in response to 10 degrees of rotation of the second connector 1334, but to rotate 15 degrees in response to 20 degrees of rotation of the second connector 1334. In another example, the inner sheath 1306 may be configured to rotate 10 degrees in response to 10 degrees of rotation of the second connector 1334, but to rotate 25 degrees in response to 20 degrees of rotation of the second connector 1334.

Steerable instrument 1300 may include a suction channel 1336 extending from cutting window 1308 to a suction port 1338. The suction channel 1336 may be defined in part by a flexible torque member 1332. The suction channel 1336 may be defined in part by an outer wall of the inner sheath 1306. The suction channel 1336 may be defined in part by an inner wall of the outer sheath 1304. Material may enter the suction channel 1336 via the cutting window 1308 and traverse the length of the suction channel 1336 to the suction port 1338.

The suction port 1338 may be an opening or any other connection between the steerable tube 1310 and the vacuum source 1340. The suction port 1338 may comprise a socket, plug, or any other coupling mechanism configured to combine the steerable tube 1310 and the vacuum source 1340. In some embodiments, the suction port 1338 may contain additional tubing or hoses to couple the vacuum source 1340 to the steerable tube 1310.

The vacuum source 1340 may retrieve, extract, or collect cut material from the aspiration channel 1336. The vacuum source 1340 may be configured to pull, withdraw, or drag material. The vacuum source 1340 may be configured to activate a suction feature or force to retrieve the cut material. The vacuum source 1340 may be configured to draw liquid, fluid, or gas from the draw channel 1336. The suction channel 1336 may be configured to enable the vacuum source 1340 to maintain suction over the entire length of the suction channel 1336 by preventing air from escaping or entering through the suction channel 1336. Vacuum source 1340 may apply a vacuum pressure of greater than or equal to 200 millimeters of mercury and less than or equal to 750 millimeters of mercury to retrieve the cut material through aspiration channel 1336. Accordingly, the vacuum source 1340 may be configured to aspirate, suck, or pull material into the aspiration channel 1336 for retrieval or extraction of the material. In some embodiments, the vacuum source 1340 may comprise a collection box or reservoir for storing cutting material or any other substance retrieved from the patient using the vacuum source 1340.

Referring to fig. 14, a view of a surgical tool 1402 for manipulating a steerable instrument 1300 to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. The surgical tool 1402 may be inserted, placed, or resident in a patient. The surgical tool 1402 may be inserted into an opening or cavity such as those shown in fig. 1A-1D. The surgical tool 1402 may be inserted through an opening or cavity of a patient. The surgical tool 1402 may be a flexible hysteroscope or laparoscope such that the surgical tool 1402 can be rotated, bent, or otherwise navigated through a curved site of a patient. In some embodiments, the surgical tool 1402 may introduce irrigation fluid. Irrigation fluid may flow along the steerable instrument 1300 to the treatment site.

Although it is difficult to use the surgical device 1300 and the surgical tool 1402 together in a cavity and other narrow or tortuous treatment sites, the flexibility and small diameter of the surgical device 1300 can address this problem by enabling the surgical device 1300 to be inserted into the surgical tool 1402 through the tubing 1404. The instrument 1300 and the surgical tool 1402 can be navigated together to a treatment site where the steerable instrument 1300 can bend its distal end 1314 to steer the cutting assembly 1302 to a material. For example, the surgical instrument 1300 may cut material while the surgical tool 1402 provides a camera or irrigation fluid.

The surgical tool 1402 may include a tube 1404 defining a working channel or instrument channel. The length of the steerable instrument 1300 can be sized to exceed the length of the surgical tool 1402 and/or the tube 1404. For example, the steerable instrument 1300 may be 100, 200, 350, 500, 750, or 900 millimeters longer than the surgical tool 1402 and/or tube 1404. The steerable instrument 1300 can extend any distance beyond the distal end of the surgical tool 1402. For example, the steerable instrument 1300 may extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the surgical tool 1402. The size, shape, or configuration of the steerable instrument 1300 can be designed such that the outer diameter 1324 is less than the diameter of the channel into which the steerable instrument 1300 is to be inserted.

The surgical tool 1402 may include an irrigation inlet 1406. The irrigation inlet 1406 may be configured to introduce irrigation fluid into the surgical tool 1402. The flush inlet 1406 may be configured to engage a flush source such as saline or a water container. In some embodiments, flush inlet 1406 may be a Y-port used in a fluid delivery system that meets medical device industry standards. The surgical tool 1402 may be configured such that irrigation fluid flows between an outer wall of the surgical tool 1402 and an inner wall of a channel within the surgical tool 1402. The irrigant may then be released at the distal end of the surgical tool 1402.

The steerable instrument 1300 may include a controller 1408 coupled to the steerable instrument 1300. The controller 1408 may be an embodiment and/or perform the functions of the first connector 1326 and/or the second connector 1334. In some embodiments, the controller 1408 may be configured to receive a push or pull force to maneuver the steerable instrument 1300 into the tube 1404. In some embodiments, pushing and pulling may cause the steerable instrument 1300 to extend or retract relative to the tube 1404. In some embodiments, the controller 1408 may be configured to receive a pushing or pulling force to provide axial movement of the distal end 1314. Steerable tube 1310 may be configured to receive axial movement at proximal end 1312 such that there is axial movement at the distal end. In some embodiments, the controller 1408 may be configured to receive control inputs to manipulate the proximal end 1312 such that the distal end 1314 of the steerable tube 1310 may be manipulated along the bending axis 1330. For example, the controller 1408 may be configured such that a 60 degree bend relative to the longitudinal axis 1328 results in a 60 degree bend of the distal end 1314. In some embodiments, the controller 1408 may be configured to receive control input to rotate the flexible torque member 1332 to rotate the inner sheath 1306 to cut material by the cutting assembly 1302. For example, the controller 1408 may be configured such that a 60 degree rotation causes the flexible torque component 1332 and the inner sheath 1306 to rotate 60 degrees to cut the material. In some embodiments, the controller 1408 may be configured to receive torque to rotate the proximal end 1312 of the steerable tube 1310 and the outer sheath 1304. For example, the steerable instrument 1300 may be configured such that 360 degree rotation of the controller 1408 results in proximal 1312 and distal 1314 ends of the steerable tube 1310 and thus in 360 degree rotation of the outer sheath 1304.

The surgical tool 1402 can include a light 1410 configured to illuminate a treatment site. The lamp 1410 may be a fiber optic lamp, a light emitting diode ("LED"), an incandescent lamp, a compact fluorescent lamp, a halogen lamp, a neon lamp, or other type of lighting element. In some embodiments, the controller 1408 may actuate the light 1410 to turn it on, off, or adjust its intensity.

Referring to fig. 15, a view of a surgical tool 1502 for manipulating a steerable instrument 1300 to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. Surgical tool 1502 may be inserted, placed, or residing in a patient. Surgical tool 1502 may be inserted into openings or cavities such as those shown in fig. 1A-1D. Surgical tool 1502 may be inserted through an opening or cavity of a patient. The surgical tool 1502 may be flexible hysteroscopic or laparoscopic such that the surgical tool 1502 may be rotated, bent, or otherwise navigated through a curved portion of a patient.

Although it is difficult to use the surgical instrument 1300 and the surgical tool 1502 together in a cavity and other narrow or tortuous treatment sites, the flexibility and small diameter of the surgical instrument 1300 may address this problem by enabling the surgical instrument 1300 to be inserted into the surgical tool 1502. The instrument 1300 and the surgical tool 1502 may be navigated together to a treatment site where the steerable instrument 1300 may bend its distal end 1314 to steer the cutting assembly 1302 to a material. For example, the surgical instrument 1300 may cut material while the surgical tool 1502 provides a camera or irrigation fluid.

Surgical tool 1502 may include a tube 1504 defining a working channel or instrument channel. The length of the steerable instrument 1300 can be sized to exceed the length of the surgical tool 1502. The steerable instrument 1300 can extend any distance beyond the distal end of the surgical tool 1502. For example, the steerable instrument 1300 may extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the surgical tool 1502. The length of the steerable instrument 1300 may exceed the length of the tube 1504. For example, the length may be 100, 200, 350, 500, 750, or 900 millimeters.

Surgical tool 1502 may include a first connector 1506. The first connector 1506 may be coupled to the steerable instrument 1300. The first connector 1506 may be a lever, trigger, or any other mechanism configured to receive control inputs from an operator. The first connector 1506 may be an embodiment and/or perform the function of the first connector 1326. The first connector 1506 and the second connector 1508 may be coupled to the steerable instrument 1300. In some embodiments, the first connector 1506 may be configured to receive a pushing or pulling force from an operator and provide the pushing or pulling force to the steerable instrument 1300. In some embodiments, the pushing or pulling force provided by the first connector 1506 may provide axial movement of the distal end 1314. For example, a pushing or pulling force provided by the first connector 1326 may manipulate the distal end 1314 of the steerable tube 1310 along the bending axis 1330. For example, the first connector 1506 may be configured such that the first force causes the distal end 1314 to bend 30 degrees and the second force causes the distal end 1314 to bend 60 degrees. The second force may be stronger than the first force. For example, the first force may be 5N and the second force may be 10N.

Surgical tool 1502 may include a second connector 1508. The second connector 1508 may be coupled to the steerable instrument 1300. The first connector 1506 may be a wheel, knob, or any other mechanism configured to receive control inputs from an operator. The second connector 1508 may be an embodiment and/or perform the function of the second connector 1334. In some embodiments, the second connector 1508 may be configured to receive a control input to rotate the flexible torque member 1332 to rotate the inner sheath 1306 to cut material through the cutting assembly 1302. For example, the second connector 1508 may be configured such that 60 degrees of rotation causes the flexible torque component 1332 and the inner sheath 1306 to rotate 60 degrees to cut the material. In some embodiments, the second connector 1508 may be configured to receive torque to rotate the proximal end 1312 of the steerable tube 1310 and the outer sheath 1304. For example, the second connector 308 may be configured such that a 360 degree rotation results in a 360 degree rotation of the proximal 1312 and distal 1314 ends of the steerable tube 1310, and thus the outer sheath 1304.

Referring to fig. 16, a view of a surgical tool 1602 for manipulating a steerable instrument 1300 to a treatment site during laparoscopic or hysteroscopic surgery is shown in accordance with an embodiment of the present invention. The surgical tool 1602 may be inserted, placed, or reside in a patient. Surgical tool 1602 may be inserted into an opening or cavity such as those shown in fig. 1A-1D. The tool 1602 may be surgically inserted through an opening or cavity of the patient. The surgical tool 1602 may be a flexible hysteroscope or laparoscope such that the surgical tool 1602 can be rotated, bent, or otherwise navigated through a curved site of a patient.

The surgical tool 1602 and the steerable instrument 1300 may be coupled by one or more attachment members 1604a-1604n (collectively, attachment members 1604). Although it is difficult to use the surgical instrument 1300 and the surgical tool 1602 together in a cavity and other narrow or tortuous treatment sites, the attachment member 1604 may address this problem by enabling the surgical instrument 1300 to be attached and navigated along the outside of the surgical tool 1602. The attachment member 1604 enables the surgical instrument 1300 and the surgical tool 1602 to be navigated together to a treatment site where the steerable instrument 1300 can bend its distal end 1314 to steer the cutting assembly 1302 to a material. For example, the instrument 1300 may cut material while the surgical tool 1602 provides a camera, irrigation, or aspiration. In another example, if the steerable instrument 1300 is employed with the surgical tool 1602, the steerable instrument 1300 does not have or use the suction channel 1336.

The attachment member 1604 may be attached to the surgical tool 1602. The attachment member 1604 may be attached, disposed, or coupled along the length of the steerable tube 1310 and the surgical tool 1602. The attachment member 1604 may comprise a strap or a fishing rod loop. Each of the attachment members 1604 may have an opening configured to receive a steerable instrument 1300. The diameter of the opening diameter may be less than 4 millimeters. The diameter may be 5 mm. The diameter may be 5.8 millimeters. The diameter may be 10 mm. The diameter may be less than 0.5 inches. The diameter may be less than 0.25 inches. The diameter may be greater than or equal to 0.05 inches and less than or equal to 0.5 inches. The diameter may be greater than or equal to 0.11 inches and less than or equal to 0.13 inches.

The length of the steerable instrument 1300 can be designed to exceed the length of the surgical tool 1602. The surgical tool 1602 may have an outer diameter of 5.8 millimeters, an inner diameter of 4.5 millimeters, and a length of 1200 millimeters. The steerable instrument 1300 can extend any distance beyond the distal end of the surgical tool 1602. For example, the steerable instrument 1300 can extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the surgical tool 1602.

The attachment member 1604 may be constructed of one or more materials, such as rubber, cloth, metal, steel, plastic, titanium, nickel, carbon fiber, or other alloys. The attachment member 1604 may include one or more textures or grooves, such as spirals, twists, turns, or other protrusions or engravings. The attachment member 1604 may be coated with at least one chemical compound for insertion into a patient, such as a polymer, hydrophilic, nitinol, fluoropolymer, or a combination of two or more compounds, to increase the durability, lubricity, flexibility, or corrosion resistance of the attachment member 1604. The attachment member 1604 may be flexible without introducing damage, lacerations, wounds, or other damage to the steerable tube 1310 or the surgical tool 1602 in the patient.

The steerable instrument 1300 can pass through and out of the attachment member 1604. For example, the proximal end 1312 of the steerable tube 1310 may be configured to receive a pushing or pulling force from an operator and provide the pushing or pulling force to the distal end 1314. Steerable tube 1310 may rotate within attachment member 1604. For example, the proximal end 1312 of the steerable tube 1310 may be configured to receive control inputs to rotate the steerable tube 1310 and, thus, the steerable tube 1310 to rotate the outer sheath 1304. For example, a 60 degree rotation of the proximal end 1312 may result in a 60 degree rotation of the distal end 1314.

Surgical tool 1602 may be curved along axis 1606. For example, axis 1606 may be an active bending section steerable to a treatment site. The axis 1606 may define an angle. For example, the angle may be-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, 90 degrees relative to the longitudinal axis 1328. The curved portion of the surgical tool 1602 may define a radius. The radius may be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 millimeters. Surgical tool 1602 is steerable along axis 1606 through each attachment member 1604. When the steerable instrument 1300 is secured to the surgical tool 1602 via the attachment member 1604, the first connector 1326 can bend or rotate the distal end 1314 to the outer sheath 1304 and the second connector 1334 can rotate the inner sheath 1306. Regardless of the angle formed by the axes 1606, the first connector 1326 and the second connector 1334 may bend the distal end 1314 and rotate the outer sheath 1304 and the inner sheath 1306.

Referring to fig. 17, a method 1700 of performing laparoscopic or hysteroscopic surgery using a steerable instrument can be illustrated. Method 1700 may be performed using various embodiments of the steerable instrument described herein. Method 1700 or steps thereof may be repeated, for example, to treat multiple treatment sites with multiple materials to be cut located inside and outside of a blood vessel.

At 1710, a steerable instrument (e.g., steerable instrument 1300) can be inserted into the patient. The steerable instrument may be disposed within a working channel of a surgical instrument (e.g., surgical tool 1402, surgical tool 1502). The steerable instrument may include a cutting assembly (e.g., cutting assembly 1302) configured to cut material. The cutting assembly may include an outer sheath (e.g., outer sheath 1304) and an inner sheath (e.g., inner sheath 1306) disposed within the outer sheath, the outer sheath defining a cutting window (e.g., cutting window 1308). The cutting assembly may be coupled to a flexible outer tube (e.g., steerable tube 1310). The flexible outer tube may have an outer diameter (e.g., outer diameter 1324) of less than 4 millimeters.

The cavity may be a body cavity or space within the body, such as the uterus, fallopian tube, ovary, mouth, ear, nose, esophagus, etc. The cavity may be created using at least one surgical procedure, such as cutting, drilling, or dissection. The resulting cavity may be located in various parts of the patient's body, such as uterus, arms, stomach, liver, neck, etc.

The treatment site may comprise material to be cut from the patient. The material may comprise foreign matter introduced into the patient, coagulated material that blocks the vascular passageway, or other material identified as being severed from the patient. The steerable instrument may include one or more sensors, light sources, or other accessories to facilitate movement or navigation of the steerable instrument toward the treatment site. The accessory may facilitate identification of the material at the treatment site, e.g., receiving visual feedback to indicate the material at the treatment site. The one or more sensors may include, for example, tilt sensors, proximity sensors, light sensors, pressure sensors, flow sensors, collision sensors, ultrasonic sensors, distance sensors, or other sensors that facilitate endoscopic procedures or operations. For example, a physician or operator may use non-invasive imaging techniques (e.g., X-ray, ultrasound, or computed tomography ("CT") scanning) to determine the location of the material. In addition, the material may be positioned by navigating the steerable instrument to the treatment site and identifying the material using one or more sensors (e.g., cameras or light sources). The steerable instrument may reach the treatment site or material based on, for example, sensing an occlusion in a patient's blood vessel using one or more sensors. The material may be identified using a camera of the steerable instrument and the image displayed on a display device external to the steerable instrument.

The procedure may include inserting a steerable instrument into a cavity of a patient. For example, the treatment site may be defined within a patient's blood vessel, such as an artery, arteriole, capillary, venule, or vein. The lumen may be identified for access to a blood vessel containing the treatment site. The physician (or operator) may insert the steerable instrument into a lumen leading to a blood vessel. The physician may navigate the steerable instrument to the treatment site of the blood vessel. In response to reaching the treatment site, the steerable instrument may stop or terminate navigation of the steerable instrument. In some cases, the treatment site reached may be based on a camera inserted with or as part of the steerable instrument. In some cases, the treatment site reached may be based on the length of the inserted steerable instrument. The length of the inserted steerable instrument may be determined based on the predetermined location of the treatment site via the use of X-rays, computed tomography ("CT") scanning, ultrasound, magnetic resonance imaging ("MRI"), or other non-invasive methods.

In some embodiments, the steerable instrument may be inserted into the patient in conjunction with a surgical tool. Bonding may refer to being with, for example, a surgical tool, simultaneously or in one example. An operator or physician may insert a surgical tool enveloping the steerable instrument into the patient via the cavity. The steerable instrument may extend from the surgical tool, for example, through a hollow portion of the steerable instrument, and move deeper into the patient. The steerable instrument may be moved along the surgical tool to travel deeper into the patient. For example, at this point, the steerable instrument may be fixed within the patient at a distance from the distal end of the surgical tool. The process may be repeated to reach or pass the steerable instrument to the treatment site to perform other laparoscopic or hysteroscopic procedures.

The steerable instrument may navigate within the patient using at least one sensor, determine a location of the material within the patient, and initiate rotation of the cutting assembly in response to positioning a distal tube end of the steerable instrument at or near the treatment site. Positioning of the steerable instrument may refer to, for example, 0.1 mm, 0.5 mm, 1 mm, or 1.5 mm from contact with the material (or treatment site).

The steerable instrument may be used to navigate or guide the material cutting device along any tortuous path within the patient's body. Thus, the steerable instrument may determine the positioning of the steerable instrument to initiate rotation of the cutting assembly to perform cutting, extraction, or debridement of material within the patient. The determination of the actuation rotation may be based on, for example, a coupling or engagement between the cutting assembly and the steerable instrument.

The steerable instrument may be passed through the treatment site, for example, by a material located at the treatment site. Navigation or actuation of the steerable instrument may be terminated in response to reaching, touching, or passing through the material or treatment site. Laparoscopic or hysteroscopic surgery may involve determining the location of the material or treatment site. In some embodiments, the operator may identify the location of the material using at least one imaging tool, such as an X-ray, MRI, or CT scan. In some embodiments, an operator or physician may use a camera or a viewing mirror to locate material within the patient. The camera or scope may be part of the steerable instrument. For example, an operator may insert a steerable instrument twice to perform a material removal operation or surgery. One for identifying the material and a second for collecting, extracting, debriding or cutting the material. In another example, the operator may insert the steerable instrument into the patient. An operator may navigate the steerable instrument within the patient to find the material. Once the material is found, the operator may initiate rotation of the cutting assembly to debride and cut the cut material. The process of debriding material may be referred to as removing the material. In this example, the material cutting device may be inserted once to complete a laparoscopic or hysteroscopic procedure or operation.

The extension of the steerable instrument can be moved within the patient toward the treatment site. The steerable instrument may extend or move past a treatment site where the operator may terminate further extension of the steerable instrument into the patient. The steerable instrument may be moved toward the treatment site using a surgical tool. The operator may push or apply a force to the proximal end of the steerable instrument as it moves toward the treatment site. The steerable instrument may be moved further toward the treatment site within the patient in response to the force applied to the proximal end.

In some embodiments, the steerable instrument or surgical tool may provide or deliver at least one substance to the treatment site of the patient. The substance may comprise a liquid, gas or other compound. The substance may facilitate the process of debriding the material into a cut material, for example, by applying a gaseous substance to soften, disperse or decompose the material. Thus, providing a substance may aid in debridement procedures using a cutting assembly. In another example, the substance may assist in treating the patient, for example, by occluding a damaged portion of the blood vessel or by providing a drug to a treatment area within the blood vessel.

At 1720, a distal end (e.g., distal end 1314) of the steerable instrument can be bent. A first control input may be applied to a first connector (e.g., first connector 1326) coupled to the proximal end of the flexible outer tube to cause the distal end of the flexible outer tube to bend relative to a longitudinal axis extending through the steerable instrument. For example, the control input may bend the proximal end of the flexible outer tube by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The first control input may cause the distal end to twist and rotate at various angles to steer the cutting assembly to the material.

The first connector may bend the distal end relative to the longitudinal axis on a bending axis. The bending axis may be relative to the longitudinal axis. For example, the bending axis may be at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The distal end may be bent at an angle proportional to the angle at which the proximal end is bent. For example, the flexible outer tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees. In another example, the flexible outer tube may be bent according to any other configuration. For example, the flexible outer tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees and 15 degrees in response to the first connector bending the proximal end 20 degrees. In another example, the flexible outer tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees and 25 degrees in response to the first connector bending the proximal end 20 degrees. The distal end of the steerable instrument may be positioned a distance from the material, such as 1 millimeter, 1 inch, or 1 meter from the material.

In some embodiments, the control input may provide torque at the proximal end of the flexible outer tube to rotate the outer sheath. For example, the control input may rotate the proximal end 60 degrees, resulting in a rotation of the distal end 60 degrees. In some embodiments, the first connector may input a τ -proximal side for rotating the flexible outer tube and thus the outer sheath (or applying a control torque corresponding to a desired τ -proximal side, for example if the first connector contains gears and/or motorized actuators to drive the flexible outer tube into rotation). In some embodiments, the first connector receives torque or control input from the motor. The distal end may rotate with a torque equal to the torque provided at the proximal end via the first connector. It should be appreciated that the distal end may be configured to rotate a particular angle that is equal to or matches the angle of rotation of the proximal end. Thus, the first connector may provide for precise control of the flexible outer tube and thus the outer sheath. For example, the operator may initiate a 30 degree rotation of the first connector. Rotation, force and torque may be applied to the distal end such that the outer sheath is also rotated 30 degrees.

At 1730, the cutting assembly may cut material from the treatment site. A second control input may be applied to a second connector (e.g., second connector 1334) coupled to the proximal end of the flexible outer tube to rotate a flexible torque member (e.g., flexible torque member 1332) disposed within the flexible outer tube. In some cases, the operator may apply a manual or mechanical rotation as the second control input applied to the second connector.

The flexible torque member may be coupled to the inner sheath. The inner sheath may rotate in response to receiving a rotational force or torque applied from the second connector. The flexible torque member may cause the inner sheath to rotate relative to the outer sheath to cut the material. Removal of material may refer to cutting, debriding, pulling, dissecting, or tearing material from a treatment site. The cutting assembly may cut material in response to rotation of the inner sheath. Torque may be provided by the second connector. The applied rotation may traverse from the proximal end to the distal end of the steerable instrument. As an example, the second connector may provide 180 degrees of rotation for the proximal end of the manipulation instrument, and the distal end will be rotated 180 degrees.

At 1740, material may be retrieved from the treatment site. These substances may comprise cutting materials, liquids, gases or other compounds within the body of the patient. The steerable instrument may include actuating a vacuum source (e.g., vacuum source 1340) coupled to the steerable instrument to provide suction through a suction channel (e.g., suction channel 1336) defined by an inner wall of the steerable instrument to cut material from a patient via the suction channel. The process of retrieving the cutting material may be performed simultaneously with the debridement process of the cutting assembly. For example, the vacuum source may activate a vacuum to remove the cutting material while the cutting assembly debrides the material. The cutting material may be stored in a container or reservoir in the vacuum source and/or external to the steerable instrument.

In a further example, the steerable instrument may pull, withdraw, or pump the cut material from the patient in response to the cutting assembly debriding the material into the cut material. The cut material may be removed through the suction channel. The process of providing a substance or withdrawing cut material may be performed by a vacuum source. The vacuum source may be external to the steerable instrument. The vacuum source may be activated by a signal or a mechanical trigger. The pump device may be coupled to a suction channel configured to remove cutting material from the patient. The pump device may pull the substance from the reservoir and push the chemical substance into the patient. The pump device may withdraw the cut material to a second reservoir for storage.

The steerable instrument may be excised from the patient upon or based upon completion of the laparoscopic or hysteroscopic procedure. Completion of laparoscopic or hysteroscopic surgery may require debridement of material (e.g., through the entire treatment site), or collection of debrided material. For example, the treatment site may comprise a length of 3 inches. The steerable instrument may initiate rotation of the cutting assembly and travel 3 inches through the treatment site to debride the material. The steerable instrument may retrieve or introduce the cutting material into the aspiration channel while debriding the material. For example, once the steerable instrument has cut the material through a 3 inch length of the treatment site and retrieved the cut material, laparoscopic or hysteroscopic procedures may be completed.

Referring to fig. 18, a method 1800 of performing laparoscopic or hysteroscopic surgery using a steerable instrument can be illustrated. Method 1800 may be performed using various embodiments of steerable instruments described herein. The method 1800, or steps thereof, may be repeated, for example, to treat multiple treatment sites with multiple materials to be cut, located inside and outside of a blood vessel.

At 1810, a steerable instrument (e.g., steerable instrument 1300) can be attached to a surgical tool (e.g., surgical tool 1602). The surgical tool and attached steerable instrument may be inserted into the patient. The steerable instrument may include a cutting assembly (e.g., cutting assembly 1302) configured to cut material. The cutting assembly may include an outer sheath (e.g., outer sheath 1304) and an inner sheath (e.g., inner sheath 1306) disposed within the outer sheath, the outer sheath defining a cutting window (e.g., cutting window 1308). The cutting assembly may be coupled to a flexible outer tube (e.g., steerable tube 1310). The steerable instrument and surgical tool may be attached with an attachment member (e.g., attachment member 1604). The attachment member may be positioned along the surgical tool. A steerable instrument may be inserted into each attachment member. The steerable instrument can be maneuvered through each attachment member along the surgical tool to attach the steerable instrument to the surgical tool.

The cavity may be a body cavity or space within the body, such as the uterus, fallopian tube, ovary, mouth, ear, nose, esophagus, etc. The cavity may be created using at least one surgical procedure, such as cutting, drilling, or dissection. The resulting cavities are located in various parts of the patient's body, such as uterus, arms, stomach, liver, neck, etc.

The treatment site may comprise material to be cut from the patient. The material may comprise foreign matter introduced into the patient, coagulated material that blocks the vascular passageway, or other material identified as being severed from the patient. The steerable instrument may include one or more sensors, light sources, or other accessories to facilitate movement or navigation of the steerable instrument toward the treatment site. The accessory may facilitate identification of the material of the treatment site, e.g., receiving visual feedback to indicate the material of the treatment site. The one or more sensors may include, for example, tilt sensors, proximity sensors, light sensors, pressure sensors, flow sensors, collision sensors, ultrasonic sensors, distance sensors, or other sensors useful in facilitating endoscopic procedures or operations. For example, a physician or operator may use non-invasive imaging techniques (e.g., X-ray, ultrasound, or computed tomography ("CT") scanning) to determine the location of the material. In addition, the material may be positioned by navigating the steerable instrument to the treatment site and identifying the material using one or more sensors (e.g., cameras or light sources). The steerable instrument may reach the treatment site or material based on, for example, sensing an intravascular occlusion of the patient using one or more sensors. The material may be identified using a camera of the steerable instrument and the image displayed on a display device external to the steerable instrument.

The procedure may include inserting a steerable instrument into a cavity of a patient. For example, the treatment site may be defined within a patient's blood vessel, such as an artery, arteriole, capillary, venule, or vein. The lumen may be identified for access to a blood vessel containing the treatment site. The physician (or operator) may insert the steerable instrument into a lumen leading to a blood vessel. The physician may navigate the steerable instrument to the treatment site of the blood vessel. In response to reaching the treatment site, the steerable instrument may stop or terminate navigation of the steerable instrument. In some cases, the treatment site reached may be based on a camera inserted with or as part of the steerable instrument. In some cases, the treatment site reached may be based on the length of the inserted steerable instrument. The length of the inserted steerable instrument may be determined based on the predetermined location of the treatment site via the use of X-rays, computed tomography ("CT") scanning, ultrasound, magnetic resonance imaging ("MRI"), or other non-invasive imaging techniques.

The steerable instrument may navigate within the patient using at least one sensor, determine a location of the material within the patient, and initiate rotation of the cutting assembly in response to positioning a distal tube end of the steerable instrument at or near the treatment site. Positioning of the steerable instrument may refer to, for example, a distance of 0.1 mm, 0.5 mm, 1 mm, or 1.5 mm from contact with the material (or treatment site).

In some embodiments, the steerable instrument or surgical tool may provide or deliver at least one substance to the treatment site of the patient. The substance may comprise a liquid, gas or other compound. The substance may facilitate the process of debriding the material into a cut material, for example, by applying a gaseous substance to soften, disperse or decompose the material. Thus, the provision of the substance may aid in debridement procedures using the cutting assembly. In another example, the substance may assist in treating the patient, for example, by occluding a damaged portion of the blood vessel or by providing a drug to a treatment area within the blood vessel.

At 1820, a distal end (e.g., distal end 1314) of the steerable instrument may be bent. A first control input may be applied to a first connector (e.g., first connector 1326) coupled to the proximal end of the flexible outer tube to cause the distal end of the flexible outer tube to bend relative to a longitudinal axis extending through the steerable instrument. For example, the control input may bend the proximal end of the flexible outer tube by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The first control input may cause the distal end to twist and rotate at various angles to steer the cutting assembly to the material.

The first connector may bend the distal end relative to the longitudinal axis on a bending axis. The bending axis may be arranged relative to the longitudinal axis. For example, the bending axis may be at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The distal end may be bent at an angle proportional to the angle at which the proximal end is bent. For example, the flexible outer tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees. In another example, the flexible outer tube may be bent according to any other configuration. For example, the flexible outer tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees and 15 degrees in response to the first connector bending the proximal end 20 degrees. In another example, the flexible outer tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees and 25 degrees in response to the first connector bending the proximal end 20 degrees. The distal end of the steerable instrument may be positioned a distance from the material, such as 1 millimeter, 1 inch, or 1 meter from the material.

In some embodiments, the control input may provide torque at the proximal end of the flexible outer tube to rotate the outer sheath. For example, the control input may rotate the proximal end 60 degrees, resulting in a rotation of the distal end 60 degrees. In some embodiments, the first connector may input a τ -proximal side for rotating the flexible outer tube and thus the outer sheath (or applying a control torque corresponding to a desired τ -proximal side, for example if the first connector contains gears and/or electric actuators to drive the flexible outer tube to rotate). In some embodiments, the first connector receives torque or control input from the motor. The distal end may rotate with a torque equal to the torque provided at the proximal end via the first connector. It should be appreciated that the distal end may be configured to rotate a particular angle that is equal to or matches the angle of rotation of the proximal end. Thus, the first connector may provide for precise control of the flexible outer tube and thus the outer sheath. For example, the operator may initiate a 30 degree rotation of the first connector. Rotation, force and torque may be applied to the distal end such that the outer sheath is also rotated 30 degrees.

At 1830, the cutting assembly may cut material from the treatment site. A second control input may be applied to a second connector (e.g., second connector 1334) coupled to the proximal end of the flexible outer tube to rotate a flexible torque member (e.g., flexible torque member 1332) disposed within the flexible outer tube. In some cases, the operator may apply a manual or mechanical rotation as the second control input applied to the second connector.

The flexible torque member may be coupled to the inner sheath. The inner sheath may rotate in response to receiving a rotational force or torque applied from the second connector. The flexible torque member may be configured to rotate the inner sheath relative to the outer sheath to cut material. Removal of material may refer to cutting, debriding, pulling, dissecting, or tearing material from a treatment site. The cutting assembly may cut material in response to rotation of the inner sheath. Torque may be provided by the second connector. The applied rotation may traverse from the proximal end to the distal end of the steerable instrument. As an example, the second connector may provide 180 degrees of rotation for the proximal end of the steerable instrument, and the distal end will be rotated 180 degrees.

At 1840, material may be retrieved from the treatment site. These substances may include cutting materials, liquids, gases or other compounds within the patient's body. The steerable instrument may include actuating a vacuum source (e.g., vacuum source 1340) coupled to the steerable instrument to provide suction through a suction channel (e.g., suction channel 1336) defined by an inner wall of the steerable instrument to cut material from the patient via the suction channel. The process of retrieving the cutting material may be performed simultaneously with the debridement process of the cutting assembly. For example, the vacuum source may activate a vacuum to remove the cutting material while the cutting assembly debrides the material. The cutting material may be stored in a container or reservoir in the vacuum source and/or external to the steerable instrument.

In a further example, the steerable instrument may pull, withdraw, or pump the cut material from the patient in response to the cutting assembly debriding the material into the cut material. The cut material may be removed through the suction channel. The process of removing the cut material may be performed by a vacuum source. The vacuum source may be external to the steerable instrument. The vacuum source may be activated by a signal or a mechanical trigger. The pump device may be connected to a suction channel configured to withdraw the cutting material from the patient. The pump device may pull the substance from the reservoir and push the chemical substance into the patient. The pump device may withdraw the cut material to a second reservoir for storage.

E. Systems and methods for steering an steerable overtube instrument to a treatment site

It is difficult to maintain the ability of the cutting assembly at the distal end of the surgical instrument to be properly manipulated while manipulating the cutting assembly at the distal end of the surgical instrument to the desired material at the treatment site, and it is even more difficult to use the surgical instrument with other surgical tools in cavities and other narrow or tortuous treatment sites. The steerable instrument and method thereof according to the present invention may enable independent bending of the distal end of the steerable instrument while maintaining the ability of the cutting assembly at the distal end of the surgical instrument to be properly operated. The steerable outer tube may encase existing surgical instruments to provide the unique bends described herein. The flexibility and small diameter of the steerable instrument enables the steerable instrument to navigate through the lumen or working channel of the surgical tool. For surgical tools that are unable to receive a steerable instrument through their working channel, the attachment member enables the steerable instrument to navigate or follow the outside of the surgical tool. When the steerable instrument is disposed along the flexible tool in the cavity, working channel, or attachment member, the steerable instrument can then bend the distal end and actuate its cutting assembly without bending the remainder of the steerable instrument to avoid damage or kinking to the cavity, surgical tool, or steerable instrument itself.

The steerable instrument may include components such as a cutting assembly, a flexible tube, a first connector, a flexible torque component, a second connector, and a suction channel. Generally, steerable instruments can be used to provide treatment to a stenosed part of the body, such as the uterus, fallopian tubes, ovaries, or in some cases, to provide non-surgical treatment to the patient. The steerable instrument may be directed to a treatment site to perform laparoscopic or hysteroscopic procedures. For example, an operator may insert a steerable instrument into a cavity of a patient and bend the cutting assembly to reach a treatment site. In some embodiments, the operator inserts the steerable instrument into the channel of the steerable instrument. In other embodiments, the steerable instrument includes at least one attachment member configured to attach the steerable instrument along the steerable instrument.

After the steerable instrument is at the treatment site, the operator may steer the cutting assembly to the material. The location of the material may refer to a treatment site, portion, or area for extraction, examination, or other procedure performed using the steerable instrument. The cutting assembly may be configured to cut material and include an outer sheath and an inner sheath disposed within the outer sheath. The steerable instrument may include a steerable tube that bends at the distal end in response to input from the proximal end. The steerable instrument may include a first connector configured to bend the steerable tube along a longitudinal axis extending through the steerable instrument. The steerable instrument may include a flexible torque component configured to rotate the inner sheath relative to the outer sheath to cut material. The steerable instrument may include a second connector configured to rotate the flexible torque member to cause the cutting assembly to cut material. The steerable instrument may include a suction channel connected to a vacuum source configured to suction material severed by the cutting assembly.

19A-19D, a view of a steerable instrument 1900 for steering a cutting assembly to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. Steerable instrument 1900 may include steerable tube 1902 extending from proximal end 1904 to distal end 1906. Steerable tube 1902 may contain or encase surgical instrument 1908. By enveloping surgical instrument 1908, steerable tube 1902 enables surgical instrument 1908 to have the unique bends described herein, such that distal end 1906 and cutting assembly 1910 can bend to the material while maintaining the ability of cutting assembly 1910 to be properly operated.

Surgical instrument 1908 can include a cutting assembly 1910, and cutting assembly 1910 can include an outer sheath 1912 and an inner sheath 1914. The outer sheath 1912 may define a cutting window 1916. Surgical instrument 1908 may include flexible tube 1918. Steerable tube 1902 may include steerable tube diameter 1920 and flexible tube 1918 may include flexible tube diameter 1922. The surgical instrument 1908 can include a first connector 1924, a longitudinal axis 1926, a bending axis 1928, a flexible torque component 1930, a second connector 1932, a suction channel 1934, and a suction port 1936 configured to couple to a vacuum source 1938.

For example, with further reference to fig. 19A, to perform a procedure to cut material from a treatment site, a steerable instrument 1900 may be introduced into a cavity of a patient. Steerable instrument 1900 may be maneuvered within a patient. An operator may use the first connector 1924 to maneuver the cutting assembly 1910 to a material along the bending axis 1928. The operator may use the second connector 1932 to actuate the cutting assembly 1910 to cut material. The motor may also be rotated to rotate the cutting assembly 1910. The cutting assembly 1910 may rotate in response to rotation initiated by the second connector 1932 or a motor. Steerable instrument 1900 may extract, cut, collect, or study material. In some cases, the cutting assembly 1910 may extract, pull, or collect material into the cutting window 1916. The vacuum source 1938 may draw material into a suction channel 1934 extending from the cutting window 1916 to the suction port 1936.

In some embodiments, steerable instrument 1900 may be inserted into an instrument channel or working channel of a surgical tool. The instrument channel may define a hollow portion or inlet configured for steerable instrument 1900. The instrument channel may provide additional shape, texture, grooves, or other features to the flexible tube 1918, or provide a cover for traversing within the patient.

Steerable tube 1902 may be rotated, bent, or otherwise navigated through a curved portion of a patient. The treatment site may be located in the patient at a location that follows a non-linear path. For example, the body lumen may include an arc, bump, or other non-linear path to the treatment site. Steerable instrument 1900 may be contacted with the patient such that steerable tube 1902 may navigate through the arcuate portion of the patient. The flexible tube 1918 may push, bump or bump within the body lumen to rotate a non-linear path through the lumen. The steerable tube 1902 may bend or rotate in response to reaching or coming into contact with the arcuate portion such that the steerable tube 1902 arcs through the arcuate portion as it navigates. In some cases, the flexible tube 1918 may be navigated through the cavity by bouncing, turning, or adjusting the navigation direction in response to at least contact with the cavity. Steerable tube 1902 may be constructed of higher or lower density, higher or lower ductility, higher or lower flexibility, or other features that facilitate passage through the patient. The flexibility of the steerable tube 1902 facilitates navigation of the steerable instrument 1900 within the patient. Steerable tube 1902 may be flexible to avoid damage, tearing, wounds, or other injuries in the patient. The flexibility of the steerable tube 1902 may allow the steerable tube 1902 to bend or rotate even when the steerable tube 1902 is bent. For example, steerable tube 1902 may be bent 120 degrees, containing components within steerable tube 1902, such as flexible tube 1918. The curved steerable tube 1902 may maintain rotational performance with the flexibility of the flexible tube at 120 degrees of bending.

Steerable tube 1902 may be a navigation wire, a motorized wire, or a braid. Steerable tube 1902 may comprise nickel-titanium alloy or other memory material such that bending of proximal end 1904 will result in bending of distal end 1906. Steerable tube 1902 may comprise rubber, cloth, metal, steel, plastic, titanium, nickel, or carbon fiber. Steerable tube 1902 may be a braided sheath. Steerable tube 1902 may comprise any width or length. The width may be 1 mm, 2 mm, 3 mm, 4 mm, 5 mm or 1 cm. The length may be 350 mm, 500 mm, 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, or 100 meters. Steerable tube 1902 may have a radius of curvature. The bending radius may be 5, 10, 15, 20, 25, 30, 35, 40, 45 or 50 millimeters.

Steerable tube 1902 may extend from proximal end 1904 to distal end 1906. Proximal end 1904 may refer to the base, open end, or foundation of steerable tube 1902. Distal end 1906 may refer to the tip or front of steerable tube 1902. Steerable tube 1902 may be configured to receive torque at proximal end 1904 to cause bending of distal end 1906. Distal end 1906 can be configured to bend in any direction. For example, distal end 1906 may be bent 10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees. Distal end 1906 may support forces during bending. For example, distal end 1906 may support a force of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10N. Steerable tube 1902 may contain surgical instrument 1908.

Referring to fig. 19A and 19B in combination, the cutting assembly 1910 may be configured to cut material from a patient. The cutting assembly 1910 may be coupled to or located at a distal end of the surgical instrument 1908. The cutting assembly 1910 may be a distance from the distal end 1906 of the steerable tube 1902. For example, the distance may be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 millimeters. Cutting assembly 1910 may include a blade (or fan blade). Cutting assembly 1910 may include one or more blades, such as the two blades shown in fig. 19B. Cutting assembly 1910 may include a sector cutter, an axial cutter, a drill bit, a hook, a spade, a reamer, a milling cutter, or other cutting tool or device. Cutting assembly 1910 may be referred to as a debridement member, cutter, removal tool, or extractor. Cutting assembly 1910 may include a blade. The blade may be composed of one or more materials (e.g., steel, plastic, carbon fiber, titanium, aluminum, metal, or other alloys) for cutting or dissecting materials to perform laparoscopic or hysteroscopic procedures. Cutting assembly 1910 may perform actions in whole or in part including, but not limited to, cutting, snare, shredding, slicing, shredding, which are also debridement examples. Thus, cutting assembly 1910 may be a component capable of cutting, snare, shredding, slicing, or shredding from a body surface of a patient. Thus, the cutting assembly 1910 may be implemented as forceps, scissors, a knife, a snare, a chopper, or any other component that may be debrided.

The cutting assembly 1910 may be actuated such that the cutting assembly 1910 may be operated by a conversion of the mechanical force applied by an operator, or automatically actuated using a turbine, a motor (e.g., an electric motor), or any other force that generates a component that actuates the debridement member. The cutting assembly 1910 may be configured to cut at various speeds, such as 5000 revolutions per minute ("RPM"), 10,000 RPM, 20,000 RPM, or 50,000 RPM. The cutting assembly 1910 may be manually operated or may employ any other means of debriding the material such that the cutting material can be retrieved from the treatment site via the surgical instrument 1908. The cutting assembly 1910 may cut the material into pieces small enough that it can be retrieved via the surgical instrument 1908 such that the steerable instrument 1900 does not need to be cut from the patient to collect the cut material. It should be appreciated that a cutting assembly 1910 that is capable of rotating a particular angle with a particular torque that is equal to or matches the rotation and torque of the motor or operator is used. Accordingly, the cutting assembly 1910 may provide cutting accuracy, control, and power consumption. For example, a cutting assembly 1910 coupled to the cutting assembly 1910 may be rotated by a number of angles with a particular torque that is equal to the angle and torque provided by the operator to the motor. For example, an operator or motor may initiate 30 degrees of rotation. Rotation, force, and torque may be applied from the motor to the cutting assembly 1910. The cutting assembly 1910 may receive the applied rotation. Thus, the cutting assembly 1910 may be rotated 30 degrees based on the motor or operator applied rotation, force, and torque.

The cutting assembly 1910 may include at least one sensor, such as a proximity sensor, light sensor, pressure sensor, radar sensor, flow sensor, bend sensor, collision sensor, distance sensor, or other sensor configured to observe, examine, sense, or navigate through the patient's body. The cutting assembly 1910 may include a light source and a recording device or capturing device (e.g., a camera or a scope) to collect visual information from the observation of the patient's body. The light source may comprise a light emitting diode ("LED"), an incandescent lamp, a compact fluorescent lamp, a halogen lamp, a neon lamp, or other type of lighting element. The surgical tool or cutting assembly may emit light and initiate recording using the light source and recording device. The cutting component 1910 can receive at least one visual information from a camera and transmit the at least one visual information to a display device. The display device may generate or display an image based on the received visual information for an operator or doctor to view the interior of the patient's body during surgery. In some embodiments, cutting assembly 1910 may be equipped with an injectable dye composition by which an operator can determine the extent to which it narrows under fluoroscopic guidance or marks a particular area within the patient's body. In other embodiments, the operator may mark a particular area with the cutting assembly 1910 without using an injectable dye.

Referring to fig. 19A in combination with fig. 19C, a cutting assembly 1910 may include an outer sheath 1912 and an inner sheath 1914 disposed within the outer sheath 1912. The outer sheath 1912 may be a cap, outer tube, housing, or body of the cutting assembly 1910. The outer sheath 1912 may be shaped or formed into, for example, a cylinder, prism, cone, or other shape. The outer sheath 1912 may be flexible. The outer sheath 1912 may bend and flex to any degree. In some embodiments, the outer sheath 1912 may bend and flex 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, or 180 degrees. The outer sheath 1912 may comprise a thickness. The thickness may be 10 nanometers, 20 nanometers, 1 millimeter, 2 millimeters, 3 millimeters, 4 millimeters, or 5 millimeters. The outer sheath 1912 may comprise a width. The width may be 1 mm, 2 mm, 3 mm, 4 mm, 5 mm or 1 cm. The outer sheath 1304 may comprise a length. The length may be 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, 100 meters, etc. The outer sheath 1912 may comprise a cross-sectional area such as 0.6 square millimeters, 1 square millimeter, 1.9 square millimeters, etc. The outer sheath 1912 may be constructed of materials such as metal, steel, plastic, rubber, glass, carbon fiber, titanium, aluminum, or other alloys.

The outer sheath 1912 may at least partially surround the inner sheath 1914. In some embodiments, the inner sheath 1914 cuts any material that is sucked or otherwise entered into the outer sheath 1912. The inner sheath 1914 may include an opening such that material cut by the cutting assembly 1910 enters through the opening. The inner sheath 1914 may include a length similar to or less than the outer sheath 1912. The length may be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100 cm. The inner sheath 1914 may be designed to facilitate debriding one or more materials and removing cut materials in a single operation. An inner sheath 1914 may be disposed within the outer sheath 1912. The inner sheath 1914 may be coupled with the outer sheath 1912. The inner sheath 1914 may be composed of a similar material as the outer sheath 1912. The inner sheath 1914 may be flexible similar to the outer sheath 1912.

The outer sheath 1912 may define a cutting window 1916. The outer sheath 1912 may include a cutting window 1916 at a distal end of the cutting assembly 1910. A portion of the radial wall of the outer sheath 1912 may define a cutting window 1916 that extends around a portion of the radius of the outer sheath 1912. In some embodiments, the operator may receive or retrieve the cut material through the cutting window 1916.

The cutting window 1916 may be configured to enable the cutting assembly 1910 to cut, dissect, or debride material. For example, the cutting assembly 1910 may initiate a debridement or cutting process by rotating through the cutting of material to receive the material in the cutting window 1916. A cutting window 1916 may be positioned on one side of the cutting assembly 1910. The cutting window 1916 may be configured to enable tangential or side cutting of the material with reference to movement of the cutting assembly 1910. In some embodiments, the outer sheath 1912 may contain a cutting window 1916. The cutting window 1916 may comprise a hollow structure having a shape such as a circle, oval, rectangle, or other geometric shape for exposing the blades of the cutting assembly 1910. The cutting window 1916 may include a diameter. The diameter may be 1 mm, 2 mm, 3 mm, 4 mm or 5 mm. The cutting window 1916 may include a cutout, which may be part of the cutting assembly 1910. For example, the cutting window 1916 may include a 0.4 millimeter incision.

The flexible tube 1918 may be a tube, motorized wire, or braid. The flexible tube 1918 may comprise rubber, cloth, metal, steel, plastic, titanium, nickel, or carbon fiber. The flexible tube 1918 may be a braided sheath. The flexible tube 1918 may comprise any length. The length may be 350 mm, 500 mm, 1 meter, 2 meters, 3 meters, 4 meters, 5 meters, 6 meters, 7 meters, 8 meters, 9 meters, 10 meters, 50 meters, or 100 meters. The flexibility of the flexible tube 1918 may allow the flexible tube 1918 to bend or rotate even when the flexible tube 1918 is bent. Steerable tube 1902 with flexible tube 1918 disposed therein, as well as components within flexible tube 1918, such as flexible torque component 1930, may also flex with flexible tube 1918. For example, the flexible tube 1918 may bend 120 degrees. The curved flexible tube 1918 may maintain rotational performance through the flexibility of the flexible tube 1918 at 120 degrees of bending.

In some embodiments, the flexible tube 1918 may also include a liner that fits around the flexible tube 1918. In some embodiments, the liner may prevent air or other fluids from penetrating between the flexible tubes 1918. The flexible tube 1918 may be coupled to an outer sheath 1912. In some embodiments, the flexible tube 1918 may be surrounded by a sheath or liner to avoid frictional contact between the outer surface of the steerable tube 1902 and other surfaces. In some embodiments, steerable instrument 1900 may be coated with polytetrafluoroethylene ("PFTE") to reduce frictional contact between the outer surface of steerable instrument 1900 and other surfaces (e.g., the inner wall of a patient).

The flexible tube 1918 may contain or be coupled to one or more sensors, such as light sensors, electromagnetic sensors, optical stereotactic sensors, pressure sensors, collision sensors, flow sensors, radar sensors, position sensors, or distance sensors. In some embodiments, the flexible tube 1918 detects the presence of material. The flexible tube 1918 may be equipped with at least one sensor that may communicate with at least one external device, such as a sensor processing component (not shown), to determine the thickness of the material relative to the rest of the patient indicated by the sensor. The sensor may comprise, for example, a temperature sensor, a pressure sensor, a resistance sensor, a collision sensor, an ultrasonic sensor, or other sensor for medical examination. In some embodiments, the type of material is associated with at least the impedance or density of the tissue. The sensor may collect temperature information and other sensed information and provide signals corresponding to such information to the sensor processing unit. The sensor processing unit may then identify the type of material. In some embodiments, the sensor may be an electrical sensor.

Referring to fig. 19A and 19D in combination, steerable tube 1902 may include steerable tube diameter 1920 and flexible tube 1918 may include flexible tube diameter 1922. Steerable tube diameter 1920 may be less than 4.0 millimeters, for example 3.9 millimeters. Steerable tube diameter 1920 may be 3, 4, 5, 6, 7, 8, 9, or 10 millimeters. The flexible tube diameter 1922 may be smaller than the steerable tube diameter 1920 such that the flexible tube 1918 may fit within the steerable tube 1902. For example, the flexible tube diameter 1922 may be 3.0 millimeters. The flexible tube diameter 1922 may also be 3.9, 3.8, 3.7, 3.6, 3.5, 3.4, 3.3, 3.2, 3.1, 3.0, 2.9, 2.8, 2.7, 2.6, or 2.5 millimeters. In some embodiments, the flexible tube diameter 1922 may be sized such that the flexible tube 1918 fits within the steerable tube 1902 without any gap between the outer wall of the flexible tube 1918 and the inner wall of the steerable tube 1902. The mounting may enable the outer wall of flexible tube 1918 to structurally support steerable tube 1902. In some embodiments, flexible tube 1918 has a gap of 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, or 0.1 millimeters between the outer wall of flexible tube 1918 and the inner wall of steerable tube 1902.

Referring back to fig. 19A and 19C in combination, the steerable instrument 1900 can include a first connector 1924 for bending the distal end 1906 of the steerable tube 1902 along a longitudinal axis 1926 extending through the steerable instrument 1900 in response to a first control input received at the first connector 1924. First connector 1924 may be coupled to proximal end 1904 of steerable tube 1902. The first connector 1924 may be a knob, tube, handle, grip, or any other surface configured to receive control input from an operator. The control input may cause the first connector 1924 to bend the proximal end 1904 of the steerable tube 1902 relative to the longitudinal axis 1926. For example, the control input may bend the proximal end 1904 of the steerable tube 1902-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis 1926. By bending the steerable tube 1902, the first connector 1924 may also bend a flexible tube 1918 disposed within the steerable tube 1902.

The first connector 1924 may be configured to bend the distal end 1906 relative to the longitudinal axis 1926 on a bending axis 1928. The bending axis 1928 may be disposed relative to the longitudinal axis 1926. For example, the bending axis 1928 may be-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis 1926. Distal end 1906 may be bent at an angle proportional to the angle at which proximal end 1904 is bent. For example, steerable tube 1902 may be configured to bend distal end 1906 10 degrees in response to first connector 1924 bending proximal end 1904 10 degrees. Steerable tube 1902 also bends flexible tube 1918 disposed therein. In another example, steerable tube 1902 is configured to bend according to any other configuration. For example, steerable tube 1902 may be configured to bend distal end 1906 10 degrees in response to first connector 1924 bending proximal end 1904 10 degrees and bend distal end 1906 15 degrees in response to first connector 1924 bending proximal end 1904 20 degrees. In another example, the flexible tube 1918 may be configured to bend the distal end 1906 10 degrees in response to the first connector 1924 bending the proximal end 1906 10 degrees and bend the distal end 1906 25 degrees in response to the first connector 1924 bending the proximal end 1904 20 degrees.

In some embodiments, the first connector 1924 may be configured to input a τ -proximal force for rotating the flexible tube 1910 and thus the outer sheath 1912 (or applying a control torque corresponding to a desired τ -proximal force, for example if the first connector 1924 contains gears and/or motorized actuators to drive rotation of the flexible tube 1918 of the steerable tube 1310). In some embodiments, the first connector 1924 is coupled to a motor configured to apply torque or control inputs. The distal end 1906 may rotate with a torque equal to the torque provided at the proximal end 1904 via the first connector 1924. It should be appreciated that employing distal end 1906 may be configured to rotate a particular angle that is equal to or matches the angle of rotation of proximal end 1904. Accordingly, the first connector 1924 may be configured to provide precise control of the flexible tubing 1918 and thus the outer sheath 1912. For example, the operator may actuate 30 degrees of rotation of the first connector 1924. Rotation, force, and torque may be applied to distal end 1906 such that outer sheath 1912 is also rotated 30 degrees.

Steerable instrument 1900 may include a flexible torque component 1930 disposed within flexible tube 1918. Flexible torque member 1930 may be coupled to inner sheath 1914 and disposed within inner sheath 1914. Further, at least one of the elastomer or friction reducing additive may reduce friction generated between the flexible torque member 1930 and the inner sheath 1914 when the flexible torque member 1930 and the inner sheath 1914 are in contact with each other, such as when the steerable instrument 1900 has traversed a tortuous path. The flexible torque member 1930 may be configured to rotate the inner sheath 1914 relative to the outer sheath 1912 to cut material. The flexible torque member 1930 may be composed of at least one of metal, steel, plastic, titanium, nickel, carbon fiber, or other alloys. In some embodiments, the inner sheath 1914 may comprise a liner within which the flexible torque member 1930 is disposed.

Steerable instrument 1900 may include a second connector 1932, the second connector 1932 coupled to the proximal end 1904 of steerable tube 1902 and configured to rotate flexible torque member 1930. The second connector 1932 may be coupled to a flexible torque member 1930. The second connector 1932 may be configured to receive control inputs from an operator. The second connector 1932 may be a knob, tube, handle, grip, or any other surface configured to receive control inputs.

The control input may rotate the second connector 1932 to rotate the inner sheath 1914 relative to the outer sheath 1912 to cut material. The control input may rotate the second connector 1932 any number of degrees. For example, the control input may rotate the second connector 1932 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, or 360 degrees relative to the longitudinal axis 1926. The inner sheath 1914 may be rotated any number of degrees. For example, the inner sheath 1914 may rotate 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 310, 320, 330, 340, 350, or 360 degrees. The inner sheath 1914 may rotate at an angle proportional to the angle of rotation of the second connector 1932. For example, the inner sheath 1914 may be configured to rotate 10 degrees in response to 10 degrees of rotation of the second connector 1932. In another example, the inner sheath 1914 is configured to bend according to any other configuration. For example, the inner sheath 1914 may be configured to rotate 10 degrees in response to 10 degrees of rotation of the second connector 1932, but to rotate 15 degrees in response to 20 degrees of rotation of the second connector 1932. In another example, the inner sheath 1914 may be configured to rotate 10 degrees in response to 10 degrees of rotation of the second connector 1932, but to rotate 25 degrees in response to 20 degrees of rotation of the second connector 1932.

The flexible tube 1918 may include a suction channel 1934 extending from the cutting window 1916 to a suction port 1936. The suction channel 1934 may be defined in part by a flexible torque member 1930. The aspiration channel 1934 may be defined in part by an outer wall of the inner sheath 1914. The aspiration channel 1934 may be defined in part by an inner wall of the outer sheath 1912. Material may enter the suction channel 1934 via the cutting window 1916 and traverse the length of the suction channel 1934 to the suction port 1936.

The suction port 1936 may be an opening or any other connection between the flexible tube 1918 and the vacuum source 1938. The suction port 1936 may comprise a socket, plug, or any other coupling mechanism configured to couple the flexible tube 1918 and the vacuum source 1938. In some embodiments, the suction port 1936 may comprise additional tubing or hoses to couple the vacuum source 1938 to the flexible tube 1918.

The vacuum source 1938 may retrieve, extract, or collect the cut material from the aspiration channel 1934. The vacuum source 1938 may be configured to pull, withdraw, or drag material. The vacuum source 1340 may be configured to activate a suction feature or force to retrieve the cut material. The vacuum source 1938 may be configured to draw liquid, fluid, or gas from the suction channel 1934. The suction channel 1934 may be configured to enable the vacuum source 1938 to maintain suction over the entire length of the suction channel 1934 by preventing air from escaping or entering through the suction channel 1934. The vacuum source 1938 may apply a vacuum pressure greater than or equal to 200 millimeters of mercury and less than or equal to 750 millimeters of mercury to retrieve the cut material through the aspiration channel 1934. Thus, the vacuum source 1938 may be configured to aspirate, suck, or pull material into the aspiration channel 1934 for retrieval or extraction of the material. In some embodiments, the vacuum source 1938 may comprise a collection box or reservoir for storing cutting material or any other substance retrieved from a patient using the vacuum source 1938.

Referring to fig. 20, a view of a surgical tool 2002 for manipulating a steerable instrument 1900 to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. The surgical tool 2002 may be inserted, placed, or reside in a patient. Surgical tool 2002 may be inserted into openings or cavities such as those shown in fig. 1A-1D. Surgical tool 2002 may be inserted through an opening or cavity of a patient. The surgical tool 2002 may be a flexible hysteroscope or laparoscope such that the surgical tool 2002 may be rotated, bent, or otherwise navigated through a curved portion of a patient.

Although it is difficult to use the surgical instrument 1900 and the surgical tool 2002 together in a cavity and other narrow or tortuous treatment sites, the flexibility and small diameter of the surgical instrument 1900 may address this problem by enabling the surgical instrument 1900 to be inserted into the surgical tool 2002. The instrument 1900 and surgical tool 2002 may be navigated together to a treatment site where the steerable instrument 1900 may bend its distal end 1906 to steer the cutting assembly 1902 to a material. For example, the surgical instrument 1900 may cut material while the surgical tool 2002 provides a camera or irrigation fluid.

The surgical tool 2002 may include a tube 2004 defining a working channel or instrument channel. Steerable instrument 1900 may be inserted into surgical instrument 2002 through tube 2004. The length of steerable instrument 1900 may be designed to exceed the length of surgical tool 2002 and/or tube 2004. For example, the length of steerable instrument 1900 may be 100, 200, 350, 500, 750, or 900 millimeters longer than the length of surgical tool 2002 and/or tube 2004. Steerable instrument 1900 may extend any distance beyond the distal end of surgical tool 2002 or tube 2004. For example, the steerable instrument 1900 may extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the surgical tool 1402. Steerable instrument 1900 may be sized, shaped, or configured such that steerable tube diameter 1920 is less than the diameter of the channel into which steerable instrument 1900 is to be inserted. For example, steerable instrument 1900 may be sized such that steerable tube diameter 1920 is 0.1, 0.2, 0.3, 0.4, 0.5, or 1 millimeter smaller than the diameter of the channel of surgical instrument 2002.

The surgical tool 2002 may include an irrigation inlet 2006. The irrigation inlet 2006 may be configured to introduce irrigation fluid into the surgical tool 2002. The flush inlet 2006 may be configured to engage with a flush source such as saline or a water reservoir. In some embodiments, the flush inlet 2006 may be a Y-port used in a fluid delivery system that meets medical device industry standards. The surgical tool 2002 may be configured such that irrigant flows between an outer wall of the surgical tool 1900 and an inner wall of a channel within the surgical tool 2002. The irrigant may then be released at the distal end of the surgical tool 2002.

Steerable instrument 1900 may include a controller 2008 coupled to steerable instrument 1900. The controller 2008 may be an embodiment and/or perform the functions of the first connector 1924 and/or the second connector 1932. In some embodiments, controller 2008 can be configured to receive pushing or pulling forces to steer steerable instrument 1900 into tube 2404. In some embodiments, pushing and pulling may cause steerable instrument 1900 to extend or retract relative to tube 2404. In some embodiments, the controller 2008 may be configured to receive a pushing or pulling force to provide axial movement of the distal end 1906. The flexible tube 1918 may be configured to receive axial movement at the proximal end 1904 such that there is axial movement at the distal end. In some embodiments, the controller 2008 may be configured to receive control inputs to manipulate the proximal end 1904 such that the distal end 1906 of the flexible tube 1918 may be manipulated along the bending axis 1928. For example, the controller 2008 may be configured such that a 60 degree bend relative to the longitudinal axis 1926 results in a 60 degree bend of the distal end 1906. In some embodiments, the controller 2008 may be configured to receive control inputs to rotate the flexible torque member 1930 to rotate the inner sheath 1914 to cut material by the cutting assembly 1910. For example, the controller 2008 may be configured such that 60 degrees of rotation causes the flexible torque member 1930 and the inner sheath 1914 to rotate 60 degrees to cut the material. In some embodiments, the controller 2008 may be configured to receive a torque to rotate the proximal end 1904 of the flexible tube 1918 and the outer sheath 1912. For example, the steerable instrument 1900 may be configured such that 360 degree rotation of the controller 2008 results in 360 degree rotation of the proximal end 1904 and distal end 1906 of the flexible tube 1918 and thus the outer sheath 1912.

The surgical device 2002 may include a light 2010 configured to illuminate a treatment site. The lamp 2010 may be a fiber optic lamp, light emitting diode ("LED"), incandescent lamp, compact fluorescent lamp, halogen lamp, neon lamp, or other type of lighting element. In some embodiments, controller 2008 may actuate lamp 2010 to turn it on, off, or adjust its intensity.

Referring to fig. 21, a view of a surgical tool 2102 for manipulating a steerable instrument 1900 to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the present invention. Surgical tool 2102 may be inserted, placed, or reside in a patient. Surgical tool 2102 may be inserted into an opening or cavity such as those shown in fig. 1A-1D. Surgical tool 2102 may be inserted through an opening or cavity of a patient. The surgical tool 2102 may be flexible hysteroscopic or laparoscopic such that the surgical tool 2102 may be rotated, bent, or otherwise navigated through a curved portion of a patient.

Although it is difficult to use the surgical instrument 1900 and the surgical tool 2102 together in a cavity and other narrow or tortuous treatment sites, the flexibility and small diameter of the surgical instrument 1900 may address this problem by enabling the surgical instrument 1900 to be inserted into the surgical tool 2102. Instrument 1900 and surgical tool 2102 can be navigated together to a treatment site where steerable instrument 1900 can bend its distal end 1906 to steer cutting assembly 1902 to a material. For example, the surgical instrument 1900 may cut material while the surgical tool 2102 provides a camera or irrigation fluid.

The surgical tool 2102 may include a tube 2104 defining a working channel or instrument channel. Steerable instrument 1900 may be inserted into surgical tool 2102 through tube 2104. The length of steerable instrument 1900 may be sized to exceed the length of surgical tool 2102 or tube 2104. For example, the length of steerable instrument 1900 may be 100, 200, 350, 500, 750, or 900 millimeters longer than the length of surgical tool 2102 or tube 2104. Steerable instrument 1900 may extend any distance beyond the distal end of surgical tool 2102. For example, steerable instrument 1900 may extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the surgical tool.

The surgical tool 2102 may include a first connector 2106. The first connector 2106 may be coupled to the steerable tube 1902. The first connector 2106 may be a lever, trigger, or any other mechanism configured to receive control input from an operator. The first connector 2106 may be an embodiment and/or perform the function of the first connector 1924. The first connector 2106 and the second connector 2108 may be coupled to the steerable tube 1902. In some embodiments, the first connector 2106 may be configured to receive a pushing or pulling force from an operator and provide the pushing or pulling force to the steerable instrument 1900. In some embodiments, the pushing or pulling force provided by the first connector 2106 may provide for axial movement of the distal end 1906. For example, a push or pull force provided by the first connector 1924 may manipulate the distal end 1906 of the steerable tube 1902 along the bending axis 1928. For example, the first connector 2106 may be configured such that the first force causes the distal end 1906 to bend 30 degrees and the second force causes the distal end 1906 to bend 60 degrees. The second force may be stronger than the first force. For example, the first force may be 5N and the second force may be 10N.

The surgical tool 2102 may include a second connector 2108. The second connector 2108 may be coupled to the steerable tube 1902. The first connector 2106 may be a wheel, knob, or any other mechanism configured to receive control input from an operator. The second connector 2108 may be an embodiment and/or perform the function of the second connector 1932. In some embodiments, the second connector 2108 may be configured to receive a control input to rotate the flexible torque member 1930 to rotate the inner sheath 1914 to cut material by the cutting assembly 1910. For example, the second connector 2108 may be configured such that 60 degrees of rotation causes the flexible torque element 1930 and the inner sheath 1914 to rotate 60 degrees to cut the material. In some embodiments, the second connector 2108 may be configured to receive torque to rotate the proximal end 1904 of the steerable tube 1902 such that rotation of the flexible tube 1918 causes rotation of the outer sheath 1912. For example, the second connector 2108 may be configured such that a 360 degree rotation results in a 360 degree rotation of the proximal end 1904 and the distal end 1906 of the steerable tube 1902, which rotates the flexible tube 1918 and thus the outer sheath 1912.

Referring to fig. 22, a view of a surgical tool 2202 for manipulating a steerable instrument 1900 to a treatment site during laparoscopic or hysteroscopic surgery is shown, in accordance with an embodiment of the invention. The surgical tool 2002 may be inserted, placed, or reside in a patient. The surgical tool 2202 may be inserted into an opening or cavity such as those shown in fig. 1A-1D. The surgical tool 2202 may be inserted through an opening or cavity of a patient. The surgical tool 2202 may be flexible hysteroscopic or laparoscopic such that the surgical tool 2202 may be rotated, bent, or otherwise navigated through a curved portion of a patient.

The surgical tool 2202 and steerable instrument 1900 may be coupled by one or more attachment members 2204a-2204n (collectively attachment members 2204). Although it is difficult to use the surgical instrument 1900 and the surgical tool 1202 together in a cavity and other narrow or tortuous treatment sites, the attachment member 2204 may address this problem by enabling the surgical instrument 1900 to be attached and navigated along the outside of the surgical tool 2202. The attachment member 2204 enables the surgical instrument 1900 and the surgical tool 2202 to be navigated together to a treatment site where the steerable instrument 1900 may bend its distal end 1914 to steer the cutting assembly 1910 to a material. For example, the instrument 1900 may cut material while the surgical tool 2202 provides a camera, irrigation, or aspiration. In another example, if the steerable instrument 1900 is used with a surgical tool 2202, the steerable instrument 1900 does not have or use the aspiration channel 1936.

The attachment member 2204 may be attached to a surgical tool 2202. The attachment member 2204 may be configured along the length of the flexible tube 1918 and the surgical tool 2202. The attachment member 2204 may include a strap or loop (e.g., a fishing rod loop). Each of the attachment members 2204 may have an opening configured to receive a steerable instrument 1900. In some embodiments, the opening is sized such that steerable instrument 1900 fits snugly within the opening without any gap between the outer wall of steerable instrument 1900 and the inner wall of the opening. The diameter of the opening diameter may be less than 4 millimeters. The diameter may be 5 mm. The diameter may be 5.8 millimeters. The diameter may be 10 mm. The diameter may be less than 0.5 inches. The diameter may be less than 0.25 inches. The diameter may be greater than or equal to 0.05 inches and less than or equal to 0.5 inches. The diameter may be greater than or equal to 0.11 inches and less than or equal to 0.13 inches.

The length of the steerable instrument 1900 may be designed to exceed the length of the surgical tool 2202. For example, the length of the steerable instrument 1900 may be 100, 200, 350, 500, 750, or 900 millimeters longer than the length of the surgical tool 2202. The surgical tool 2202 may have an outer diameter of 5.8 millimeters, an inner diameter of 4.5 millimeters, and a length of 1200 millimeters. Steerable instrument 1900 may extend any distance beyond the distal end of surgical tool 2202. For example, steerable instrument 1900 may extend beyond the distal end 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 millimeters of the surgical tool.

The attachment member 2204 may comprise one or more substances, such as rubber, cloth, metal, steel, plastic, titanium, nickel, carbon fiber, or other alloys. The attachment member 2204 may include one or more textures or grooves, such as spirals, twists, turns, or other protrusions or engravings. The attachment member 2204 may be coated with at least one chemical compound for insertion into a patient, such as a polymer, hydrophilic, nitinol, fluoropolymer, or a combination of two or more compounds to enhance the durability, lubricity, flexibility, or corrosion resistance of the attachment member 2204. The attachment member 2204 may be flexible without introducing damage, lacerations, wounds, or other damage to the flexible tube 1918 or the surgical tool 2202 within the patient.

Steerable instrument 1900 may pass through and out of attachment member 2204. For example, the proximal end 1904 of the steerable tube 1902 may be configured to receive a pushing or pulling force from an operator and provide the pushing or pulling force to the distal end 1906. Steerable tube 1902 may be rotated within attachment member 2204. For example, the proximal end 1904 of the steerable tube 1902 may be configured to receive control input to rotate the steerable tube 1902 and, thus, the flexible tube 1902 to rotate the outer sheath 1304. For example, a 60 degree rotation of the proximal end 1904 may result in a 60 degree rotation of the distal end 1906.

The surgical tool 2202 may include a bend 2206. For example, the curve 2206 may be a curve of the surgical tool 2202 or a section manipulated to reach a treatment site. The curve 2206 may define an angle. For example, the angles may be-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, 90 degrees relative to the longitudinal axis 1926. The curved portion of the surgical tool 2202 may define a radius. The radius may be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 millimeters. Steerable instrument 1900 may be maneuvered through each attachment member 2204 along curve 2206. When the steerable instrument 1900 is secured to the surgical tool 2202 via the attachment member 2204, the first connector 1924 may bend or rotate the outer sheath 1912 and the second connector 1932 may rotate the inner sheath 1914. Regardless of the angle formed by the bend 2206, the first connector 1924 and the second connector 1932 may bend the distal end 1906 and rotate the outer sheath 1912 and the inner sheath 1914.

Referring to fig. 23, a method 2300 of performing laparoscopic or hysteroscopic surgery using a surgical instrument can be illustrated. Method 2300 may be performed using various embodiments of the surgical instruments described herein. Method 2300 or steps thereof may be repeated, for example, to treat multiple treatment sites with multiple materials to be cut located inside and outside of a blood vessel.

At 2310, a steerable instrument (e.g., steerable instrument 1900) can be inserted into the patient. The steerable instrument may be disposed within a working channel of a surgical task (e.g., surgical tool 2002 or surgical tool 2102). The steerable instrument may comprise a steerable tube (e.g., steerable tube 1902). The steerable tube may contain a surgical instrument (e.g., surgical instrument 1908). The steerable instrument may include a cutting assembly (e.g., cutting assembly 1910) configured to cut material. The cutting assembly may include an outer sheath (e.g., outer sheath 1912) and an inner sheath (e.g., inner sheath 1914) disposed within the outer sheath, the outer sheath defining a cutting window (e.g., cutting window 1916). The cutting assembly may be coupled to a distal end of a flexible tube (e.g., flexible tube 1918).

The treatment site may comprise material to be cut from the patient. The material may comprise foreign matter introduced into the patient, coagulated material that blocks the vascular passageway, or other material identified as being severed from the patient. The surgical tool may include one or more sensors, light sources, or other accessories to facilitate movement or navigation of the surgical tool toward the treatment site. The accessory may facilitate identification of the material at the treatment site, e.g., receiving visual feedback to indicate the material at the treatment site. The one or more sensors may include, for example, tilt sensors, proximity sensors, light sensors, pressure sensors, flow sensors, collision sensors, ultrasonic sensors, distance sensors, or other sensors that facilitate endoscopic procedures or operations. For example, a physician or operator may use non-invasive imaging techniques (e.g., X-ray, ultrasound, or computed tomography ("CT") scanning) to determine the location of the material. In addition, the material may be positioned by navigating the surgical tool to the treatment site and identifying the material using one or more sensors (e.g., cameras or light sources). The surgical tool may reach the treatment site or material based on, for example, sensing an occlusion in a patient's blood vessel using one or more sensors. The material may be identified using a camera of the surgical tool and the image displayed on a display device external to the surgical tool.

The procedure may include inserting a surgical tool into a cavity of a patient. For example, the treatment site may be defined within a patient's blood vessel, such as an artery, arteriole, capillary, venule, or vein. The lumen may be identified for access to a blood vessel containing the treatment site. A physician (or operator) may insert a surgical tool into a cavity leading to a blood vessel. The physician may navigate the surgical tool to the treatment site of the blood vessel. In response to reaching the treatment site, the surgical tool may stop or terminate navigation of the surgical tool. In some cases, the treatment site reached may be based on a camera inserted with or as part of the surgical tool. In some cases, the treatment site reached may be based on the length of the inserted surgical tool. The length of the inserted surgical tool may be determined based on the predetermined location of the treatment site via the use of X-rays, computed tomography ("CT") scanning, ultrasound, magnetic resonance imaging ("MRI"), or other non-invasive methods.

In some embodiments, the surgical tool may be inserted into the patient in conjunction with the surgical tool. Bonding may refer to being with, for example, a surgical tool, simultaneously or in one example. An operator or physician may insert a surgical tool enveloping the surgical tool into the patient via the cavity. The surgical tool may extend from the surgical tool, for example, through a hollow portion of the surgical tool, and move deeper into the patient. The surgical tool may be moved along the surgical tool to travel deeper into the patient. For example, at this point, the surgical tool may be secured within the patient at a distance from the distal end of the surgical tool. The process may be repeated to reach or pass the surgical tool through the treatment site to perform other laparoscopic or hysteroscopic procedures.

The surgical tool may be navigated within the patient using at least one sensor, determine a location of the material within the patient, and initiate rotation of the cutting assembly in response to positioning a distal tube end of the surgical tool at or near the treatment site. Positioning of the surgical tool may refer to, for example, 0.1 mm, 0.5 mm, 1 mm, or 1.5 mm from contact with the material (or treatment site).

The surgical tool may be used to navigate or guide the material cutting device along any tortuous path within the patient's body. Thus, the surgical tool may determine the positioning of the surgical tool to initiate rotation of the cutting assembly to perform cutting, extraction, or debridement of material within the patient. The determination of the initiation of rotation may be based on, for example, a coupling or engagement between the cutting assembly and the surgical tool.

The surgical tool may pass through the treatment site, for example, by a material located at the treatment site. Navigation or actuation of the steerable instrument may be terminated in response to reaching, touching, or passing through the material or treatment site. Laparoscopic or hysteroscopic surgery may involve determining the location of the material or treatment site. In some embodiments, the operator may identify the location of the material using at least one imaging tool, such as an X-ray, MRI, or CT scan. In some embodiments, an operator or physician may use a camera or a viewing mirror to locate material within the patient. The camera or scope may be part of the surgical tool. For example, an operator may insert a surgical tool twice to perform a material removal operation or surgery. One for identifying the material and a second for collecting, extracting, debriding or cutting the material. In another example, an operator may insert a surgical tool into a patient. An operator may navigate the surgical tool within the patient to find the material. Once the material is found, the operator may initiate rotation of the cutting assembly to debride and cut the cut material. The process of debriding material may be referred to as removing the material. In this example, the material cutting device may be inserted once to complete a laparoscopic or hysteroscopic procedure or operation.

The extension of the surgical tool may be movable within the patient toward the treatment site. The surgical tool may extend or move past a treatment site where the operator may terminate further extension of the surgical tool into the patient. The surgical tool may be moved toward the treatment site using the surgical tool. The operator may push or apply a force to the proximal end of the surgical tool as it moves toward the treatment site. In response to the force applied to the proximal end, the surgical tool may be moved further within the patient toward the treatment site.

In some embodiments, the surgical tool may provide or deliver at least one substance to a treatment site of a patient. The substance may comprise a liquid, gas or other compound. The substance may facilitate the process of debriding the material into a cut material, for example, by releasing a gaseous substance to soften, disperse, or decompose the material. Thus, the provision of the substance may aid in debridement procedures using the cutting assembly. In another example, the substance may assist in treating the patient, for example, by occluding a damaged portion of the blood vessel or by providing a drug to a treatment area within the blood vessel.

At 2320, a distal end of the steerable tube (e.g., distal end 1906) may be bent. The first control input can be applied to a first connector (e.g., first connector 1924) coupled to the proximal end of the steerable tube to cause the distal end of the steerable tube to bend along a longitudinal axis extending through the surgical tool. For example, the control input may bend the proximal end of the flexible outer tube by-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The first control input may cause the distal end to twist and rotate at various angles to steer the cutting assembly to the material.

The first connector may bend the distal end relative to the longitudinal axis on a bending axis. The bending axis may be arranged relative to the longitudinal axis. For example, the bending axis may be at-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The distal end may be bent at an angle proportional to the angle at which the proximal end is bent. For example, the steerable tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees. In another example, the steerable tube may be curved in accordance with any other configuration. For example, the steerable tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees and bend the distal end 15 degrees in response to the first connector bending the proximal end 20 degrees. In another example, the steerable tube may bend the distal end 10 degrees in response to the first connector bending the proximal end 10 degrees and bend the distal end 25 degrees in response to the first connector bending the proximal end 20 degrees. The distal end of the steerable tube may be positioned a distance from the material, such as 1 millimeter, 1 inch, or 1 meter from the material.

In some embodiments, the control input may provide torque at the proximal end of the steerable tube to rotate the outer sheath. For example, the control input may rotate the proximal end 60 degrees, resulting in a rotation of the distal end 60 degrees. In some embodiments, the first connector may input a τ -proximal side for rotating the steerable tube and thus the outer sheath (or applying a control torque corresponding to a desired τ -proximal side, for example if the first connector contains gears and/or motorized actuators to drive the steerable tube in rotation). In some embodiments, the first connector receives torque or control input from the motor. The distal end may rotate with a torque equal to the torque provided at the proximal end via the first connector. It should be appreciated that the distal end may be configured to rotate a particular angle that is equal to or matches the angle of rotation of the proximal end. Thus, the first connector may provide for precise control of the steerable tube and thus the outer sheath. For example, the operator may initiate a 30 degree rotation of the first connector. Rotation, force and torque may be applied to the distal end such that the outer sheath is also rotated 30 degrees.

At 2330, the cutting assembly may cut material from the treatment site. A second control input may be applied to a second connector (e.g., second connector 1932) coupled to the proximal end of the steerable tube to rotate a flexible torque component (e.g., flexible torque component 1930) disposed within the flexible outer tube. In some cases, the operator may apply a manual or mechanical rotation as the second control input applied to the second connector.

The flexible torque member may be coupled to the inner sheath. The inner sheath may rotate in response to receiving a rotational force or torque applied from the second connector. The flexible torque member may cause the inner sheath to rotate relative to the outer sheath to cut the material. Removal of material may refer to cutting, debriding, pulling, dissecting, or tearing material from a treatment site. The cutting assembly may cut material in response to rotation of the inner sheath. Torque may be provided by the second connector. The applied rotation may traverse from the proximal end to the distal end of the steerable tube. As an example, the second connector may provide 180 degrees of rotation for the proximal end of the steerable tube, and the distal end will be rotated 180 degrees.

At 2340, the material may be retrieved using a surgical tool. These substances may comprise cutting materials, liquids, gases or other compounds within the body of the patient. An operator may actuate a vacuum source (e.g., vacuum source 1938) coupled to the flexible surgical tool to provide suction through a suction channel (e.g., suction channel 1934) defined by an inner wall of the flexible tube to cut material from a patient via the suction channel. The process of retrieving the cutting material may be performed simultaneously with the debridement process of the cutting assembly. For example, the vacuum source may activate a vacuum to remove the cutting material while the cutting assembly debrides the material. The cutting material may be stored in a container or reservoir in the vacuum source and/or external to the flexible surgical tool.

In a further example, the vacuum source may pull, withdraw, or pump the cut material from within the patient in response to the cutting assembly debriding the material into the cut material. The cut material may be removed through the suction channel. The process of removing the cut material may be performed by a vacuum source. The vacuum source may be external to the surgical tool. The vacuum source device may be activated by a signal or a mechanical trigger. The pump device may be coupled to a suction channel configured to remove cutting material from the patient. The pump device may pull the substance from the reservoir and push the chemical substance into the patient. The pump device may withdraw the cut material to a second reservoir for storage.

The surgical tool may be cut from the patient at or based on completion of the laparoscopic or hysteroscopic procedure. Completion of laparoscopic or hysteroscopic surgery may require debridement of material (e.g., through the entire treatment site), or collection of debrided material. For example, the treatment site may comprise a length of 3 inches. The surgical tool may initiate rotation of the cutting assembly and travel 3 inches through the treatment site to debride the material. The surgical tool may retrieve or introduce the cutting material into the aspiration channel while debriding the material. For example, once the surgical tool cuts the material through a 3 inch length of the treatment site and retrieves the cut material, laparoscopic or hysteroscopic procedures may be completed.

Referring to fig. 24, a method 2400 of performing laparoscopic or hysteroscopic surgery using a surgical tool may be shown. Method 2400 may be performed using various embodiments of the surgical tools described herein. Method 2400 or steps thereof can be repeated, for example, with treatment sites having multiple materials to be cut located inside and outside of a blood vessel.

At 2410, a steerable instrument (e.g., steerable instrument 1900) can be attached to a surgical tool (e.g., surgical tool 2202). The steerable instrument may comprise a steerable tube (e.g., steerable tube 1902). The steerable tube may include a surgical instrument (e.g., surgical instrument 1908). The surgical instrument may include a cutting assembly (e.g., cutting assembly 1910) configured to cut material. The cutting assembly may include an outer sheath (e.g., outer sheath 1912) and an inner sheath (e.g., inner sheath 1914) disposed within the outer sheath, the outer sheath defining a cutting window (e.g., cutting window 1916). The cutting assembly may be coupled to a distal end of a flexible tube (e.g., flexible tube 1918). Surgical tools and surgical tools may be attached with an attachment member (e.g., attachment member 2204). The attachment member may be positioned along the surgical tool. A surgical tool may be inserted into each attachment member. A surgical tool may be maneuvered through each attachment member along the surgical tool to attach the surgical tool to the surgical tool. The surgical tool and attached surgical tool may be inserted into a patient.

The treatment site may comprise material to be cut from the patient. The material may comprise foreign matter introduced into the patient, coagulated material that blocks the vascular passageway, or other material identified as being severed from the patient. The surgical tool may include one or more sensors, light sources, or other accessories to facilitate movement or navigation of the surgical tool toward the treatment site. The accessory may facilitate identification of the material of the treatment site, e.g., receiving visual feedback to indicate the material of the treatment site. The one or more sensors may include, for example, tilt sensors, proximity sensors, light sensors, pressure sensors, flow sensors, collision sensors, ultrasonic sensors, distance sensors, or other sensors that facilitate endoscopic surgery or operation. For example, a physician or operator may use non-invasive imaging techniques (e.g., X-ray, ultrasound, or computed tomography ("CT") scanning) to determine the location of the material. In addition, the material may be positioned by navigating the surgical tool to the treatment site and identifying the material using one or more sensors (e.g., cameras or light sources). The surgical tool may reach the treatment site or material based on, for example, sensing an intravascular occlusion of the patient using one or more sensors. The material may be identified using a camera of the surgical tool and the image displayed on a display device external to the surgical tool.

The procedure may include inserting a surgical tool into a cavity of a patient. For example, the treatment site may be defined within a patient's blood vessel, such as an artery, arteriole, capillary, venule, or vein. The lumen may be identified for access to a blood vessel containing the treatment site. A physician (or operator) may insert a surgical tool into a cavity leading to a blood vessel. The physician may navigate the surgical tool to the treatment site of the blood vessel. In response to reaching the treatment site, the surgical tool may stop or terminate navigation of the surgical tool. In some cases, the treatment site reached may be based on a camera inserted with or as part of the surgical tool. In some cases, the treatment site reached may be based on the length of the inserted surgical tool. The length of the inserted surgical tool may be determined based on the predetermined location of the treatment site via the use of X-rays, computed tomography ("CT") scanning, ultrasound, magnetic resonance imaging ("MRI"), or other non-invasive imaging techniques.

The surgical tool may be navigated within the patient using at least one sensor, determine a location of the material within the patient, and initiate rotation of the cutting assembly in response to positioning a distal tube end of the surgical tool at or near the treatment site. Positioning of the surgical tool may refer to, for example, a distance of 0.1 mm, 0.5 mm, 1 mm, or 1.5 mm from contact with the material (or treatment site).

The surgical tool may pass through the treatment site, for example, by a material located at the treatment site. Navigation or actuation of the surgical tool may be terminated in response to reaching, touching, or passing through the material or treatment site. Laparoscopic or hysteroscopic surgery may involve determining the location of the material or treatment site. In some embodiments, the operator may identify the location of the material using at least one imaging tool, such as an X-ray, MRI, or CT scan. In some embodiments, an operator or physician may use a camera or a viewing mirror to locate material within the patient. The camera or scope may be part of the surgical tool. For example, an operator may insert a surgical tool twice to perform a material removal operation or surgery. One for identifying the material and a second for collecting, extracting, debriding or cutting the material. In another example, an operator may insert a surgical tool into a patient. An operator may navigate the surgical tool within the patient to find the material. Once the material is found, the operator may initiate rotation of the cutting assembly to debride and cut the cut material. The process of debriding material may be referred to as removing the material. In this example, the material cutting device may be inserted once to complete a laparoscopic or hysteroscopic procedure or operation.

The extension of the surgical tool may be moved within the patient toward the treatment site. The surgical tool may extend or move past a treatment site where the operator may terminate further extension of the surgical tool into the patient. The surgical tool may be moved toward the treatment site using the surgical tool. The operator may push or apply a force to the proximal end of the surgical tool as it moves toward the treatment site. In response to the force applied to the proximal end, the surgical tool may be moved further within the patient toward the treatment site.

In some embodiments, the surgical tool or tools may provide or deliver at least one substance to the treatment site of the patient. The substance may comprise a liquid, gas or other compound. The substance may facilitate the process of debriding the material into a cut material, for example, by applying a gaseous substance to soften, disperse or decompose the material. Thus, the provision of the substance may aid in debridement procedures using the cutting assembly. In another example, the substance may assist in treating the patient, for example, by occluding a damaged portion of the blood vessel or by providing a drug to a treatment area within the blood vessel.

At 2420, the distal end of the surgical tool (e.g., distal end 1906) may be bent. The first control input can be applied to a first connector (e.g., first connector 1924) coupled to the proximal end of the steerable tube to cause the distal end of the steerable tube to bend along a longitudinal axis extending through the surgical tool. For example, the first control input may cause the distal end to twist and rotate at any angle to steer the cutting assembly to the material. For example, the control input may bend the proximal end of the steerable tube-90, -80, -70, -60, -50, -40, -30, -20, -10, 20, 30, 40, 50, 60, 70, 80, or 90 degrees relative to the longitudinal axis. The first control input may cause the distal end to twist and rotate at various angles to steer the cutting assembly to the material. The distal end of the surgical tool may be positioned a distance from the material, such as 1 millimeter, one inch, or 1 meter.

At 2430, the cutting assembly can cut material from the treatment site. A second control input may be applied to a second connector (e.g., second connector 1932) coupled to the proximal end of the steerable tube to rotate a flexible torque component (e.g., flexible torque component 1930) disposed within the flexible outer tube. In some cases, the operator may apply a manual or mechanical rotation as the second control input applied to the second connector.

The flexible torque member may be coupled to the inner sheath. The inner sheath may rotate in response to receiving a rotational force or torque applied from the second connector. The flexible torque member may rotate the inner sheath relative to the outer sheath to cut the material. Removal of material may refer to cutting, debriding, pulling, dissecting, or tearing material from a treatment site. The cutting assembly may cut material in response to rotation of the inner sheath. Torque may be provided by the second connector. The applied rotation may traverse from the proximal end to the distal end of the steerable tube. As an example, the second connector may provide 180 degrees of rotation for the proximal end of the steerable tube, and the distal end will be rotated 180 degrees.

At 2440, material can be retrieved from the treatment site. These substances may comprise cutting materials, liquids, gases or other compounds within the body of the patient. An operator may actuate a vacuum source (e.g., vacuum source 1938) coupled to the surgical tool to provide suction through a suction channel (e.g., suction channel 1934) defined by an inner wall of the flexible tube to cut material from a patient via the suction channel. The process of retrieving the cutting material may be performed simultaneously with the debridement process of the cutting assembly. For example, the vacuum source may activate a vacuum to remove the cutting material while the cutting assembly debrides the material. The cutting material may be stored in a container or reservoir in the vacuum source and/or external to the surgical tool.

In a further example, the vacuum source may pull, withdraw, or pump the cut material from the patient in response to the cutting assembly debriding the material into the cut material. The cut material may be withdrawn via the suction channel. The process of removing the cut material may be performed by a vacuum source. The vacuum source may be external to the surgical tool. The vacuum source may be activated by a signal or a mechanical trigger. The pump device may be connected to a suction channel configured to withdraw the cutting material from the patient. The pump device may pull the substance from the reservoir and push the chemical substance into the patient. The pump device may withdraw the cut material to a second reservoir for storage.

While the present invention discloses various embodiments of steerable instruments, including but not limited to tools attachable to the tips of steerable instruments, and tools feedable through the length of steerable instruments, the scope of the present invention is not intended to be limited to such embodiments or steerable instruments in general. Rather, the scope of the present invention extends to any device that can debride and cut material and/or necrotic material from a patient or body of a patient using a single tool. Accordingly, the scope of the present invention extends to steerable instruments that may be constructed with some or all of the components of the steerable instruments described herein. Furthermore, it will be appreciated by those skilled in the art that any or all of the components making up the steerable instrument may be built into an existing hysteroscope, laparoscope, endoscope, or into a newly designed material removal tool for debridement and removal of material from within the patient's body.

Having now described a few illustrative embodiments, it should be apparent that the foregoing is illustrative and not limiting and has been presented by way of example. In particular, although many of the examples presented herein involve specific combinations of method acts or system elements, those acts and those elements may be combined in other ways to achieve the same objectives. Acts, elements and features discussed in connection with one implementation are not intended to be excluded from a similar role in other implementations or implementations.

The phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. The use of "including," "comprising," "having," "containing," "involving," "characterized by," and variations thereof herein, is meant to encompass the items listed thereafter and equivalents thereof as well as additional items and alternative embodiments consisting solely of the items listed thereafter. In one embodiment, the systems and methods described herein consist of each combination of one, more than one, or all of the described elements, acts, or components.

Any reference to an embodiment or element or act of a system and method referred to herein in the singular may also encompass embodiments comprising a plurality of such elements, and any reference to any embodiment or element or act referred to herein in the plural may also encompass embodiments comprising only one element. Singular or plural references are not intended to limit the presently disclosed systems or methods, their components, acts, or elements to either a single or plural configuration. Reference to any action or element based on any information, action, or element may encompass embodiments in which the action or element is based at least in part on any information, action, or element.

Any embodiment disclosed herein may be combined with any other embodiment or example, and references to "an embodiment," "some embodiments," "one embodiment," etc., are not necessarily mutually exclusive, and are intended to indicate that a feature, structure, or characteristic described in connection with the embodiment may be included in at least one embodiment or example. These terms are not necessarily all referring to the same embodiment. Any embodiment may be combined with any other embodiment, either inclusive or exclusive, in any manner consistent with aspects and embodiments disclosed herein.

Where technical features in the drawings, the detailed description, or any claim are followed by reference numerals have been included to increase the intelligibility of the drawings, the detailed description, and the claims. Accordingly, no limitation of the scope of any claim element is provided with or without a reference numeral.

The systems and methods described herein may be embodied in other specific forms without departing from the characteristics thereof. Further relative parallel, vertical, or other positioning or orientation descriptions include variations within +/-10% or +/-10 degrees of a purely vertical, parallel, or vertical positioning. Unless explicitly stated otherwise, references to "about," "substantially," or other degree terms include a +/-10% variation from a given measurement, unit, or range. The coupling elements may be electrically, mechanically or physically coupled to each other directly or through intermediate elements. The scope of the systems and methods described herein are, therefore, indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.

The term "coupled" and variants thereof include two members directly or indirectly connected to one another. Such a connection may be stationary (e.g., permanent or fixed) or movable (e.g., removable or releasable). Such connection may be achieved by the two members being directly coupled to each other or to each other, the two members being coupled to each other using a separate intermediate member and any additional intermediate members, or the two members being coupled using an intermediate member integrally formed with one of the two members as a single unitary body. If "coupled" or variants thereof are modified by additional terms (e.g., directly coupled), the generic definition of "coupled" provided above is modified by the plain language meaning of the additional terms (e.g., directly coupled means that two components are not connected by any separate intermediate component), resulting in a definition that is narrower than the generic definition of "coupled" provided above. Such coupling may be mechanical, electrical or fluid.

Reference to "or" may be construed as inclusive such that any term described using "or" may indicate any one of the singular, more than one, and all of the described terms. References to "at least one of a 'and B' may include only" a ", only" B ", and both" a "and" B ". Such references, used in conjunction with "comprising" or other open terms, may include additional items.

Modifications in the elements and acts described, such as variations in the dimensions, sizes, structures, shapes and proportions of the various elements, values of parameters, mounting arrangements, use of materials, colors, orientations, etc., may be made without materially departing from the teachings and advantages of the subject matter disclosed herein. For example, elements shown as integrally formed may be constructed of multiple parts or elements, the position of elements may be reversed or otherwise varied, and the nature or number of discrete elements or positions may be altered or varied. Other substitutions, modifications, changes and omissions may be made in the design, operating conditions and arrangement of the elements and operations disclosed without departing from the scope of the present invention.

References herein to element locations (e.g., "top," "bottom," "above," "below") are used only to describe the orientation of various elements in the drawings. It should be noted that the orientations of the various elements may differ according to other exemplary embodiments, and such variations are intended to be encompassed within the present invention.

Claims

1. A surgical instrument, comprising:

an outer tube extending along an axis from a proximal end to a distal end, the distal end comprising an articulating member of the outer tube;

One or more articulation wires extending along the outer tube and coupled to the articulation member;

a cutting assembly coupled to the distal end of the outer tube, the cutting assembly including an outer component and an inner component disposed within the outer component coupled to the articulating member, the outer component defining a cutting window configured to cut material;

a flexible torque member having a portion disposed within the outer tube, the flexible torque member coupled to the inner member and configured to rotate the inner member relative to the outer member to cut material;

a handle including a first actuator for rotating the outer tube to adjust the position of the cutting window about the axis, the handle including a second actuator coupled to one or more articulation wires to bend an articulation member coupled to the cutting assembly away from the axis.

2. The surgical instrument of claim 1, wherein the axis is a first axis, and wherein the inner component rotates relative to the first axis about a second axis formed by bending of the articular member.

3. The surgical instrument of claim 1, further comprising a tension rod disposed along the outer tube, the tension rod configured to maintain tension of the one or more articulation wires to control rotation and bending of an articulation member coupled to the cutting assembly.

4. The surgical instrument of claim 1, wherein a proximal end of the flexible torque member is coupled to a motor configured to transmit torque to the proximal end of the flexible torque member, the flexible torque member configured to transmit torque from a proximal end to a distal end to rotate the inner member relative to the outer member to cut material.

5. The surgical instrument of claim 4, further comprising a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port.

6. The surgical instrument of claim 1, wherein the first actuator is configured to bend the distal end at a first angle of rotation that is proportional to a second angle of rotation of the first actuator.

7. The surgical instrument of claim 1, wherein the second actuator is designed as a plurality of actuators, each of the plurality of actuators coupled to a corresponding wire of the one or more joint wires.

8. The surgical instrument of claim 1, further comprising a sheath encasing the one or more joint wires.

9. The surgical instrument of claim 1, wherein the handle further comprises a locking assembly configured to limit movement of at least one of the one or more joint wires to set the cutting assembly to a predetermined curvature.

10. The surgical instrument of claim 1, wherein the one or more joint filaments is a first set of one or more joint filaments, and wherein the surgical instrument further comprises:

a second set of one or more joint filaments oriented at a first angle relative to the first set of one or more joint filaments;

a third set of one or more joint filaments oriented at a second angle relative to the first set of one or more joint filaments; and is also provided with

Wherein the second actuator is coupled to the first set of one or more joint wires, a second set of one or more joint wires, and a third set of one or more joint wires.

11. A surgical instrument, comprising:

an outer tube extending along an axis from a proximal end to a distal end, the distal end comprising a plurality of segments;

one or more joint wires extending along the outer tube and coupled to the plurality of segments;

A cutting assembly coupled to the distal end of the outer tube, the cutting assembly configured to cut material from a patient; and

a handle comprising a first actuator that rotates a first component of the cutting assembly about the axis and a second actuator coupled to one or more joint wires to selectively bend at least one of the plurality of segments coupled to the cutting assembly away from the axis.

12. The surgical instrument of claim 11, wherein the first component is an outer component of the cutting assembly, and the cutting assembly further comprises an inner component disposed within the outer component, the outer component defining a cutting window.

13. The surgical instrument of claim 11, further comprising a tension rod disposed along the outer tube, the tension rod configured to maintain tension of one or more articulation wires to control rotation and bending of the articulation member coupled to the cutting assembly.

14. The surgical instrument of claim 12, further comprising a flexible torque member having a portion disposed within the outer tube, the flexible torque member coupled to the inner member and configured to rotate the inner member relative to the outer member to cut material.

15. The surgical instrument of claim 14, further comprising a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from the cutting window defined by the cutting assembly to the suction port.

16. The surgical instrument of claim 11, wherein the first actuator is configured to bend the distal end at a first angle of rotation that is proportional to a second angle of rotation of the first actuator.

17. The surgical instrument of claim 11, wherein the second actuator is configured as a plurality of actuators, each of the plurality of actuators coupled to a corresponding wire of the one or more joint wires.

18. The surgical instrument of claim 11, further comprising a sheath encasing the one or more joint wires.

19. The surgical instrument of claim 11, wherein the handle further comprises a locking assembly configured to limit movement of one or more articulation wires to set the cutting assembly to a predetermined curvature.

20. The surgical instrument of claim 11, wherein the outer tube comprises a plurality of fixation elements extending from the plurality of segments, the plurality of fixation elements configured to fix the one or more joint wires to the outer tube.

21. The surgical instrument of claim 20, further comprising a sheath encasing the one or more joint wires and the plurality of fixation elements.

22. The surgical instrument of claim 11, wherein the one or more joint filaments is a first set of one or more joint filaments, and wherein the surgical instrument further comprises:

23. A method, comprising:

inserting a surgical instrument into a patient to cut material from the patient, the surgical instrument including an outer tube extending along an axis from a proximal end to a distal end, the distal end coupled to a cutting assembly coupled to one or more joint wires extending along the outer tube;

applying a first control input to a first actuator coupled to the handle to rotate the cutting assembly about an axis;

A second control input is applied to a second actuator coupled to the one or more articulation wires to bend the cutting assembly away from the axis.

24. The method of claim 23, wherein applying the first control input comprises rotating the first actuator to rotate the cutting assembly about the axis.

25. The method of claim 23, wherein applying the first control input comprises rotating the first actuator a first angle about an axis to rotate the cutting assembly a first angle about the axis.

26. The method of claim 23, wherein inserting the surgical instrument comprises inserting the surgical instrument into a patient to cut material from the patient, the surgical instrument comprising an outer tube extending along the axis from the proximal end to the distal end, the distal end coupled to the cutting assembly, the cutting assembly coupled to a first set of one or more joint filaments extending along the outer tube and a second set of one or more joint filaments oriented at a first angle relative to the first set of one or more bends.

27. The method of claim 26, wherein applying the second control input comprises:

Applying the second control input to the second actuator coupled to the first set of one or more articulation wires to bend the cutting assembly in a first direction away from the axis;

applying the third control input to the third actuator coupled to the second set of one or more articulation wires to bend the cutting assembly away from the axis in a second direction, the second direction being opposite the first direction.

28. The method of claim 23, further comprising varying the tension of the one or more joint filaments to vary the rotation and bending of the cutting assembly.

29. A surgical instrument, comprising:

a first telescoping tube having a first diameter, the first telescoping tube partially enveloping a second telescoping tube extending beyond the first telescoping tube, the second telescoping tube having a second diameter smaller than the first diameter, the second telescoping tube configured to retract into the first telescoping tube;

a third telescoping tube partially enveloped by and extending out of the second telescoping tube, the third telescoping tube having a third diameter less than the second diameter, the third telescoping tube configured to retract into the second telescoping tube;

An actuator coupled to the third telescoping tube, the actuator configured to extend the third telescoping tube from the second telescoping tube; and

a cutting assembly coupled to the third telescoping tube, the cutting assembly configured to cut material from a patient.

30. The surgical instrument of claim 29, wherein the first telescoping tube extends along an axis, wherein the second telescoping tube extends along a first arc relative to the axis, and wherein the third telescoping tube extends along a second arc relative to the axis.

31. The surgical instrument of claim 29, wherein the cutting assembly includes an outer member defining a cutting window and an inner member disposed within the outer member.

32. The surgical instrument of claim 31, further comprising a flexible torque member disposed in a portion of the first, second, and third telescoping tubes, the flexible torque member coupled to the inner member and configured to rotate the inner member relative to the outer member to cut the material.

33. The surgical instrument of claim 32, further comprising a suction channel having a suction port configured to engage a vacuum source, the suction channel defined in part by the flexible torque member and the first, second, and third telescoping tubes, the suction channel extending from the cutting window defined by the cutting assembly to the suction port.

34. A method of cutting material from a patient, the method comprising:

inserting a surgical instrument into a patient to cut material from the patient, the surgical instrument including a first telescoping tube having a proximal end and a distal end, the first telescoping tube having a first diameter, the distal end of the first telescoping tube coupled to a cutting assembly;

applying a first control input to a first actuator to extend the distal end of the first telescoping tube beyond a distal end of a second telescoping tube, the second telescoping tube including a distal end enveloping the proximal end of the first telescoping tube, the second telescoping tube having a second diameter greater than the first diameter;

applying a second control input to the first actuator to extend the distal end of the second telescoping tube beyond a distal end of a third telescoping tube, the third telescoping tube comprising a distal end enveloping a proximal end of the second telescoping tube, the third telescoping tube having a third diameter greater than the second diameter, the third telescoping tube comprising a proximal end coupled to the first actuator; and

a third control input is applied to a second actuator to actuate the cutting assembly to cut the material.

35. A steerable instrument, comprising:

A cutting assembly configured to cut material from a patient, the cutting assembly comprising an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window;

a flexible outer tube having an outer diameter of less than 4 millimeters, the flexible outer tube extending from a proximal end of the flexible outer tube to a distal end of the flexible outer tube, the distal end of the flexible outer tube coupled to the outer sheath, the flexible outer tube configured to receive torque at the proximal end of the flexible outer tube and transmit the torque to the outer sheath to rotate the outer sheath;

a first connector coupled to a proximal end of the flexible outer tube, the first connector configured to bend the distal end of the flexible outer tube relative to a longitudinal axis extending through the steerable instrument in response to receiving a first control input at the first connector;

a flexible torque member disposed within the flexible outer tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut the material;

a second connector coupled to the proximal end of the flexible outer tube and configured to rotate a flexible torque member in response to receiving a second control input at the second connector to cause the inner sheath to rotate relative to the outer sheath to cut the material;

A suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from the cutting window defined by the cutting assembly to the suction port.

36. The steerable instrument of claim 35, wherein the first connector is configured to bend the distal end of the flexible outer tube at a first angle relative to the longitudinal axis, the first angle being proportional to a second angle of the first control input at the first connector.

37. A method, comprising:

inserting a surgical tool into a patient;

disposing a steerable instrument within a working channel of the surgical tool to cut material from a patient, the steerable instrument comprising a cutting assembly configured to cut the material, the cutting assembly comprising an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window, the cutting assembly coupled to a flexible outer tube, the flexible outer tube having an outer diameter of less than 4 millimeters;

applying a first control input to a first connector coupled to the proximal end of the flexible outer tube to cause the distal end of the flexible outer tube to bend relative to a longitudinal axis extending through the steerable instrument;

Applying a second control input to a second connector coupled to the proximal end of the flexible outer tube to rotate a flexible torque member disposed within the flexible outer tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut material; and

a vacuum source coupled to the steerable instrument is actuated to provide suction through a suction channel defined by an inner wall of the steerable instrument to sever material from a patient via the suction channel.

38. A steerable instrument, comprising:

a flexible outer tube having an outer diameter of less than 6 millimeters, the flexible outer tube extending from a proximal end of the flexible outer tube to a distal end of the flexible outer tube, the distal end of the flexible outer tube coupled to the outer sheath, the flexible outer tube configured to receive torque at the proximal end of the flexible outer tube and transmit the torque to the outer sheath to rotate the outer sheath;

a first connector coupled to the proximal end of the flexible outer tube, the first connector configured to bend the distal end of the flexible outer tube relative to a longitudinal axis extending through the steerable instrument in response to receiving a first control input at the first connector;

A flexible torque member disposed within a flexible outer tube, a portion of the flexible torque member coupled to the cutting assembly and configured to rotate the inner sheath relative to the outer sheath to cut the material;

a second connector coupled to the proximal end of the flexible outer tube and configured to rotate the flexible torque member to rotate the inner sheath relative to the outer sheath to cut the material in response to receiving a second control input at the second connector;

a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by the flexible torque member and extending from the cutting window defined by the cutting assembly to the suction port; and

at least one attachment member configured to attach the steerable instrument to a surgical tool.

39. The steerable instrument of claim 38, wherein the first connector is configured to bend the distal end of the flexible outer tube at a first angle relative to the longitudinal axis, the first angle being proportional to a second angle of a first control input at the first connector.

40. The steerable instrument of claim 38, wherein the at least one attachment member is a first attachment member disposed at a distal end of the surgical tool, and further comprising a second attachment member disposed at a proximal end of the surgical tool.

41. The steerable instrument of claim 38, wherein the at least one attachment member comprises a locking mechanism for securing the at least one attachment member to the surgical tool.

42. The steerable instrument of claim 38, wherein the at least one attachment member is an elastic band.

43. The steerable instrument of claim 38, wherein the at least one attachment member comprises an opening configured to receive the steerable instrument.

44. A method, comprising:

positioning a plurality of attachment members along the surgical tool, each attachment member configured to receive a steerable instrument;

manipulating the steerable instrument through each of the plurality of attachment members along the surgical tool to attach the steerable instrument to the surgical tool, the steerable instrument including a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath and an inner sheath disposed within the outer sheath, the outer sheath defining a cutting window, the cutting assembly coupled to a flexible outer tube;

inserting the surgical tool and the steerable instrument into a patient;

positioning the distal end of the flexible outer tube to a position in the patient where the opening of the cutting window is located at the material and is viewable via a camera of the surgical tool by a control input applied to a first connector coupled to the proximal end of the flexible outer tube;

Applying a second control input to a second connector coupled to the proximal end of the flexible outer tube to rotate a flexible torque member disposed within the flexible outer tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut the material;

actuating a vacuum source coupled to the surgical tool to provide suction to a suction channel defined by an inner wall of a steerable instrument to sever the material from a patient via the suction channel;

a steerable instrument is removed from the patient along the surgical tool through each of the plurality of attachment members.

45. A steerable instrument, comprising:

a steerable tube having a surgical tool disposed therein, the steerable tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the surgical tool comprising:

a flexible tube extending from the proximal end of the steerable tube to the distal end of the steerable tube, the distal end of the flexible tube being coupled to the outer sheath;

A first connector coupled to the proximal end of the steerable tube, the first connector configured to bend the distal end of the steerable tube along a longitudinal axis extending through the surgical tool in response to receiving a first control input at the first connector;

a flexible torque member disposed within the flexible tube, a portion of the flexible torque member coupled to the inner sheath and configured to rotate the inner sheath relative to the outer sheath to cut the material;

a second connector coupled to the proximal end of the steerable tube and configured to rotate the flexible torque component to rotate the inner sheath relative to the outer sheath in response to receiving a second control input at the second connector; and

a suction channel having a suction port configured to engage a vacuum source, the suction channel being defined in part by a flexible torque member and extending from a cutting window defined by the cutting assembly to the suction port.

46. The steerable instrument of claim 45, wherein the first connector is further configured to rotate the flexible tube.

47. The steerable instrument of claim 45, wherein the first connector is configured to bend the distal end of the flexible tube along the longitudinal axis at a first angle that is proportional to a second angle of a first control input at the first connector.

48. The steerable instrument of claim 45, further comprising a coating disposed between the flexible tube and the steerable tube.

49. The steerable instrument of claim 45, wherein the steerable tube has a diameter of less than 4.0 millimeters.

50. The steerable instrument of claim 45, wherein the flexible tube has a diameter of less than 3.1 millimeters.

51. A method, comprising:

inserting a surgical tool into a patient to cut material from the patient, the surgical tool comprising a steerable tube having a steerable instrument disposed therein, the steerable tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the steerable instrument comprising a cutting assembly configured to cut material from the patient, the cutting assembly comprising an outer sheath defining a cutting window and an inner sheath disposed within the outer sheath, the cutting assembly coupled to a distal end of a flexible tube extending from the distal end of the steerable tube to the proximal end of the steerable tube;

applying a first control input to a first connector coupled to the proximal end of the steerable tube to bend the distal end of the steerable tube along a longitudinal axis extending through the surgical tool;

Applying a second control input to a second connector coupled to the proximal end of the steerable tube to rotate a flexible torque member disposed within the flexible tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut the material; and

a vacuum source coupled to the steerable instrument is actuated to provide suction through a suction channel defined by an inner wall of the steerable instrument to cut the material from the patient via the suction channel.

52. A steerable instrument, comprising:

a steerable tube comprising at least one attachment member configured to attach the steerable tube to a surgical tool, the steerable tube extending from a proximal end of the steerable tube to a distal end of the steerable tube, the steerable tube comprising a surgical instrument, the surgical instrument comprising:

a flexible tube extending from the proximal end of the steerable tube to a distal end of the steerable tube, the distal end of the flexible tube coupled to the outer sheath;

A first connector coupled to a proximal end of a steerable tube, the first connector configured to bend the distal end of the steerable tube along a longitudinal axis extending through the steerable tube in response to receiving a first control input at the first connector;

a second connector coupled to the proximal end of the steerable tube and configured to rotate the flexible torque component to rotate the inner sheath relative to the outer sheath in response to receiving a second control input at the second connector;

53. The steerable instrument of claim 52, wherein the at least one attachment member is a first attachment member disposed at a distal end of the surgical tool, and further comprising a second attachment member disposed at a proximal end of the surgical tool.

54. The steerable instrument of claim 52, wherein the at least one attachment member comprises a locking mechanism for securing the at least one attachment member to the surgical tool.

55. The steerable instrument of claim 52, wherein the at least one attachment member is an elastic band.

56. The steerable instrument of claim 52, wherein the at least one attachment member comprises an opening configured to receive the steerable instrument.

57. The steerable instrument of claim 52, wherein the first connector is further configured to rotate the flexible tube.

58. The steerable instrument of claim 52, wherein the first connector is configured to bend the distal end of the flexible tube at a first angle relative to the longitudinal axis, the first angle being proportional to a second angle of the first control input at the first connector.

59. The steerable instrument of claim 52, further comprising a coating disposed between the flexible tube and the steerable tube.

60. The steerable instrument of claim 52, wherein the steerable tube has a diameter less than 4.0 millimeters.

61. The steerable instrument of claim 52, wherein the flexible tube has a diameter less than 3.1 millimeters.

62. A method, comprising:

positioning a plurality of attachment members along the surgical tool, each attachment member configured to receive a steerable tube having a steerable instrument disposed therein;

manipulating the steerable tube along the surgical tool past each of the plurality of attachment members to attach the steerable tube to the surgical tool, the steerable instrument may include a cutting assembly configured to cut material from a patient, the cutting assembly including an outer sheath defining a cutting window and an inner sheath disposed within the outer sheath, the cutting assembly coupled to a flexible tube extending from a proximal end of the steerable tube to a distal end of the steerable tube;

inserting the surgical tool and the steerable tube into a patient to cut the material from the patient;

positioning the distal end of the steerable tube to a position in the patient where the opening of the cutting window is located at the material and is viewable via a camera of the surgical tool by a control input applied to a first connector coupled to the proximal end of the steerable tube;

Applying a second control input to a second connector coupled to the proximal end of the steerable tube to rotate a flexible torque member disposed within the flexible tube, the flexible torque member coupled to the inner sheath, the flexible torque member configured to rotate the inner sheath relative to the outer sheath to cut the material;

actuating a vacuum source coupled to the surgical tool to provide suction to a suction channel defined by an inner wall of the steerable instrument to cut material from a patient via the suction channel;

the steerable instrument is removed from the patient along the surgical tool via each of the plurality of attachment members.