Apparatus and methods for performing minimally-invasive surgical procedures

• US 20070129719A1
• Filed: 10/07/2006
• Published: 06/07/2007
• Est. Priority Date: 05/26/2005
• Status: Active Grant

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Inventors: Abbott, Ryan, Agarwal, Amit, Cantu, Alfredo, Callas, Peter, Stewart, Michael, Perez, Juan, Kendale, Amar, Lin, Arthur, Lamberti, Joseph, Barrigar, Frederick, Villagomez, Fred
• Granted Patent: US 8,932,208 B2
• Time in Patent Office: Days
• US Class Current: 606/41
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
• CPC Class Codes: A61B 1/00096 Optical elements
• CPC Class Codes: A61B 1/00101 the distal tip features being detachable
• CPC Class Codes: A61B 1/00135 Oversleeves mounted on the endoscope prior to insertion
• CPC Class Codes: A61B 1/0125 Endoscope within endoscope
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/126 provided with means for cleaning in-use
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3456 blunt

Abstract

Devices, tools and methods for performing minimally invasive surgical procedures. Methods of performing minimally invasive ablation procedures. Methods of performing rapid exchange of tools in a device while the device remains in a reduced-access surgical space.

Claims

1. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an elongated body having distal and proximal end portions and at least two lumens extending generally along a direction of a longitudinal axis of said elongated body; and

a distal tip attachable to said distal end portion of said elongated body, said distal tip including a lens that is viewable therethrough and aligned with one of said at least two lumens that is configured for receiving an endoscope therein.

2. The device of claim 1, further comprising a handle attached to said proximal end portion of said elongated body.

3. The device of claim 2, further comprising a bell rotatably attached to said handle.

4. The device of claim 1, wherein said elongated body is substantially rigid.

5. The device of claim 1, wherein at least one of said at least two lumens other than said lumen configured for receiving an endoscope therein comprises a service port adapted to receive a tool other than an endoscope.

6. The device of claim 5, comprising two of said service ports.

7. The device of claim 5, wherein each said service port comprises a tube received within said elongated body.

8. The device of claim 7, wherein each said tube comprises a stainless steel hypotube.

9. The device of claim 1, further comprising an endoscope positioned in said lumen that is configured for receiving an endoscope therein.

10. The device of claim 7, wherein said tip further comprises at least one lumen therethrough, each said lumen of said tip being configured and dimensioned to receive one of said tubes therein and provide an exit opening for said service port through said tip.

11. The device of claim 1, further comprising a seal between said lens and a portion of said tip proximal to said lens.

12. The device of claim 7, wherein a proximal end portion of each said tube is securely held by a handle attached to said proximal end portion of said elongated body.

13. The device of claim 1, wherein said lens is removably mounted to a remainder of said distal tip via mechanical connection.

14. The device of claim 13, wherein said lens is removably mounted to said remainder of said distal tip via at least one of friction fitting and threads.

15. The device of claim 1, wherein said lens is fixed to a remainder of said distal tip via adhesive.

16. The device of claim 1, wherein said distal tip is fixable to a distal end piece that includes at least one lumen, said distal end piece being mountable to said distal end portion of said elongated body, wherein said at least one lumen of said distal end piece aligns in communication with respective ones of at least one of said at least two lumens of said elongated body, in fluid communication therewith, to function as at least one service port.

17. The device of claim 1, further comprising a protrusion extending distally from a distal end of said distal tip.

18. The device of claim 1, further comprising a snare device extending through one of said at least two lumens, said snare device having a snare on a distal end thereof.

19. The device of claim 18, wherein said snare device further comprises a snare on a proximal end thereof.

20. The device of claim 2, wherein said handle comprises an open proximal end configured to receive an endoscope therethrough.

21. The device of claim 2, wherein said handle captures said proximal end portion of said elongated body, thereby preventing axial movement of said elongated body with respect to said handle.

22. The device of claim 2, wherein said handle allows rotation of said elongated body with respect to said handle.

23. The device of claim 2, wherein said handle prevents rotation of said elongated body with respect to said handle.

24. The device of claim 2, wherein a recess is provided in a portion of said handle, said recess being configured and dimensioned to receive a light cable that extends from an endoscope, when said endoscope is received in said elongated body.

25. The device of claim 1, further comprising an insert mounted within said elongated body, wherein said insert and said elongated body cooperate to define said at least two lumens.

26. The device of claim 25, wherein said insert forms a friction fit with said elongated body within said elongated body.

27. The device of claim 25, further comprising a second insert, interchangeable with said first insert, wherein said second insert and said elongated body cooperate to form lumens having at least one of:

a different size, different relative positioning and different number of lumens relative to size, positioning and number of said at least two lumens formed in cooperation between said elongated main body and said insert.

28. The device of claim 10, further comprising a second tip that is interchangeable with said tip, said second tip comprising at least one of:

a different size, different relative positioning and different number of lumens relative to size, positioning and number of said at least one lumen formed in said tip.

29. The device of claim 1, wherein said distal tip is axially aligned with said lumen that is configured for receiving said endoscope therein, and wherein at least one of said at least two lumens is not configured for receiving said endoscope therein and is positioned radially outwardly from said lumen that is configured to receive said endoscope therein, such that an implement can be delivered though each said lumen positioned radially outward and a distal end portion of said implement is deliverable alongside said tip.

30. The device of claim 1, wherein said distal tip comprises a ball-ended tip.

31. The device of claim 1, wherein said distal tip is bullet shaped.

32. The device of claim 1, wherein said distal tip comprises a notch configured and dimensioned to receive a portion of a snare therein.

33. The device of claim 1, further comprising a suction luer in fluid communication with one of said at least two lumens and extending from said proximal end portion of said elongated body.

34. The device of claim 1, further comprising an introducer tube in fluid communication with one of said at least two lumens and extending from said proximal end portion of said elongated body.

35. The device of claim 33, wherein said elongated body comprises three lumens, said device further including an introducer tube in fluid communication with a lumen other than said lumen configured and adapted to receive an endoscope and said lumen in fluid communication with said suction luer, said introducer extending from said proximal end portion of said elongated body.

36. The device of claim 1, wherein said tip is releasably attachable to said elongated body.

37. The device of claim 36, wherein said tip comprises protrusions on a proximal end portion thereof, and said elongated body comprises openings through the walls of said distal end portion, said openings configured and dimensioned to receive said protrusions.

38. The device of claim 1, further comprising a suction tube extending through one of said at least two lumens and providing fluid communication between said distal and proximal end portions of said elongated body.

39. The device of claim 1, further comprising a suction tube extending through one of said at least two lumens and providing fluid communication between said distal tip and said proximal end portion of said elongated body.

40. The device of claim 1, wherein said tip comprises an inner stop configured to prevents distal advancement of a distal end of said endoscope therepast, to establish an offset between a distal end of said distal tip and said distal end of said endoscope.

41. The device of claim 1, further comprising a cage mounted to said distal tip and extending distally therefrom.

42. The device of claim 1, wherein said lens comprises an outer lens, said distal tip further comprising an inner tapered lens configured to break up reflections when viewing through said endoscope.

43. The device of claim 1, wherein said distal end portion of said elongated body has a first cross-sectional area and said proximal end portion of said elongated body has a second cross-sectional area, said second cross-sectional area being greater than said first cross-sectional area.

44. The device of claim 1, wherein said distal end portion of said elongated body is teardrop-shaped in cross-section.

45. The device of claim 44, wherein said proximal end portion of said elongated body is circular in cross-section.

46. The device of claim 1, wherein said lumens are formed by metal tubes within said elongated tubular body.

47. The device of claim 36, wherein said distal tip comprises at least one inflatable member mounted to a proximal end portion thereof.

48. The device of claim 1, further comprising a snare capture tool extending through one of said at least two lumens, said snare capture tool having a ball-shaped distal end.

49. The device of claim 1, further comprising a retrieval hook tool extending through one of said at least two lumens, said retrieval hook tool comprising a hook at a distal end thereof.

50. The device of claim 1, further comprising a bolo tool extending through one of said at least two lumens, said bolo tool comprising a ball at a distal end thereof.

51. The device of claim 50, wherein said bolo tool further comprises a ball at a proximal end thereof.

52. The device of claim 1, further comprising a trigger snare tool extending through one of said at least two lumens, said trigger snare tool comprising a snare at a distal end thereof that is extendable distally from said distal end portion of said elongated body, and a trigger configured to actuate said snare, said trigger located proximally of said proximal end portion of said elongated body.

53. The device of claim 52, wherein said snare is angled relative to a longitudinal axis of said trigger snare tool.

54. The device of claim 1, further comprising a perforation tool extending through one of said at least two lumens, said perforation tool comprising a needle or barbed needle at a distal end thereof, said needle or barbed needle being extendable distally of said distal end portion of said elongated body.

55. The device of claim 54, wherein said perforation tool further comprises a cutter blade, said barbed needle being retractable proximally to draw tissue engaged by said barb needle into contact with said cutter blade.

56. The device of claim 1, further comprising a perforation tool extending through one of said at least two lumens, said perforation tool comprising graspers adapted to be extended distally to grasp tissue;

and a cutter blade, said graspers being retractable proximally to draw tissue engaged by said graspers into contact with said cutter blade.

57. The device of claim 1, further comprising a perforation tool extending through one of said at least two lumens, said perforation tool comprising a cork screw adapted to be extended distally to engage tissue;

and a cutter blade, said corkscrew being retractable proximally to draw tissue engaged by said corkscrew into contact with said cutter blade.

58. The device of claim 1, further comprising a perforation tool extending through one of said at least two lumens, said perforation tool comprising a spike configured to pierce through tissue upon an impulsive impact;

and a plunger type actuator located on a proximal end portion of said perforation tool.

59. The device of claim 1, further comprising a mapping probe tool extending through one of said at least two lumens, said mapping probe tool comprising at least a pair of mapping elements on a distal end portion thereof, said mapping elements being extendable distally of a distal opening of said lumen.

60. The device of claim 59, wherein said distal end portion of said mapping probe tool is bent at an angle to a longitudinal axis of a remainder of said mapping probe tool when said mapping probe tool is in an unbiased state.

61. The device of claim 59, wherein said distal end portion of said mapping probe tool is formed in a Y-shape when in an unbiased state, one of said mapping elements being located on one arm of the Y-shape and a second of said mapping elements being located on an arm opposite said one arm.

62. The device of claim 1, further comprising a linear ablating probe tool extending through one of said at least two lumens, said linear ablating probe tool comprising a linear ablation element on a distal end portion thereof.

63. The device of claim 1, further comprising a point ablation probe tool extending through one of said at least two lumens, said point ablation probe tool comprising an ablation probe point on a distal tip thereof.

64. The device of claim 1, further comprising a cautery tool extending through one of said at least two lumens, said cautery tool comprising a cauterizing element on a distal end portion thereof.

65. The device of claim 1, further comprising graspers extending through one of said at least two lumens, said graspers comprising a tube having sufficient length to simultaneously extend from both distal and proximal openings of said lumen, grasping jaws provided at a distal end portion of said graspers, and an actuator located at a proximal end portion of said graspers, said actuator linked to said grasping jaws for operation thereof.

66. The device of claim 1, further comprising scissors extending through one of said at least two lumens, said scissors comprising a tube having sufficient length to simultaneously extend from both distal and proximal openings of said lumen, scissor jaws provided at a distal end portion of said scissors, and an actuator located at a proximal end portion of said scissors, said actuator linked to said scissor jaws for operation thereof.

67. The device of claim 1, further comprising an inflatable member that is expandable around a base of said distal tip to achieve a temporary, atraumatic increase in diameter at a distal end portion of said device.

68. The device of claim 67, further comprising a fitting plug positioned over said elongated body and fixed to said inflatable member for holding said inflatable member in position over said base of said distal tip.

69. The device of claim 68, further comprising a tensioning member interconnecting said fitting plug and said inflatable member, said tensioning member being adjustable to draw said inflatable member into a desired position at said base of said distal tip.

70. The device of claim 1, wherein said lumen that is configured for receiving an endoscope therein comprises a positioning feature for positioning the endoscope at more than one predetermined location.

71. The device of claim 70, wherein said positioning feature comprises biased sockets configured to receive protrusions on the endoscope therein.

72. The device of claim 1, wherein said distal tip includes at least one window proximal of a distal end of said distal tip, through which viewing by the endoscope is permitted.

73. The device of claim 2, wherein said handle includes proximal and distal stops so that when said endoscope is inserted in said lumen that is configured for receiving an endoscope therein, a light cable of said endoscope abuts said proximal stop for placing said endoscope in one predetermined location relative to said elongated body, and abuts said distal stop for placing said endoscope in a second location relative to said elongated body.

74. A surgical device for performing minimally invasive surgical procedures, said device comprising:

a first elongated body having distal and proximal end portions and at least one lumen extending generally along a direction of a longitudinal axis of said first elongated body and configured and dimensioned for receiving an endoscope therein;

a second elongated body aligned substantially parallel with said first elongated body, said second elongated body having distal and proximal end portions and at least one lumen extending generally along a direction of a longitudinal axis of said second elongated body and configured and dimensioned for receiving a tool other than said endoscope therein; and

a distal tip attachable to said distal end portion of said first elongated body, said distal tip including a lens that is viewable therethrough and aligned with said lumen that is configured and dimensioned for receiving an endoscope therein.

75. The device of claim 74, further comprising an endoscope positioned in said lumen that is configured and dimensioned for receiving an endoscope therein.

76. The device of claim 74, further comprising a handle attached to said proximal end portion of said first elongated body.

77. The device of claim 74, wherein said first and second elongated bodies are substantially rigid.

78. The device of claim 74, wherein said second elongated body is fixed externally to said first elongated body.

79. The device of claim 78, wherein said second elongated body is welded to said first elongated body.

80. The device of claim 74, further comprising a snare device extending through one of said at least one lumen of said second elongated body, said snare device having a snare on a distal end thereof.

81. The device of claim 80, wherein said snare device further comprises a snare on a proximal end thereof.

82. The device of claim 75, wherein said distal tip is attached to said distal end portion of said first elongated body, and wherein a distal end of said endoscope is positioned within said distal tip.

83. The device of claim 74, wherein said distal tip comprises a ball-ended tip.

84. The device of claim 74, wherein said distal tip is bullet shaped.

85. The device of claim 74, wherein said distal tip comprises a notch configured and dimensioned to receive a portion of a snare therein.

86. The device of claim 74, further comprising a tool other than an endoscope extending through one of said at least one lumens of said second elongated body.

87. The device of claim 86, wherein said tool is selected from the group consisting of:

suction tool, snare capture tool, retrieval hook tool, bolo tool, trigger snare tool, perforation tool, mapping probe tool, linear ablating probe tool, point ablation probe tool, cautery tool, graspers tool, and scissors tool.

88. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an elongated body having distal and proximal end portions and at least two lumens extending generally along a direction of a longitudinal axis of said elongated body; and

an endoscope positioned in one of said at least two lumens that is configured and dimensioned for receiving said endoscope therein;

wherein a distal end of said elongated body extends distally past a distal end of said endoscope to shield said distal end of said endoscope during use.

89. The device of claim 88, wherein said distal end of said elongated body is open.

90. The device of claim 88, wherein one of said at least one lumens comprises an irrigation lumen.

91. The device of claim 90, further comprising a nozzle at a distal end of said irrigation lumen.

92. The device of claim 91, wherein said nozzle is oriented toward said distal end of said endoscope.

93. The device of claim 91, wherein said nozzle is located out of a field of view of said endoscope.

94. The device of claim 88, wherein said distal end portion of said elongated body is transparent to allow visualization therethrough.

95. The device of claim 88, further comprising a snare device extending through one of said at least two lumens of said elongated body, said snare device having a snare on a distal end thereof.

96. The device of claim 95, wherein said snare device further comprises a snare on a proximal end thereof.

97. The device of claim 90, further comprising a snare device extending through one of said at least two lumens of said elongated body, said snare device having a snare on a distal end thereof.

98. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an elongated body comprising a semi-flexible sleeve having distal and proximal end portions and at least one lumen extending generally along a direction of a longitudinal axis of said elongated body; and

a rigid distal tip attached to a distal end of said elongated body, said distal tip being viewable therethrough.

99. The device of claim 98, wherein said sleeve is sufficiently flexible to navigate around pulmonary veins to at least partially encircle the pulmonary veins and said sleeve is sufficiently rigid so that a proximal portion of said sleeve outside of a patient can be pushed on to advance said distal end portion of said sleeve within the patient.

100. The device of claim 98, further comprising an endoscope inserted in said sleeve, said endoscope having a rigid shaft and being positioned for viewing through said distal tip.

101. The device of claim 98, wherein said distal tip comprises a ball at a distal end thereof.

102. The device of claim 98, wherein said distal tip comprises at least one port in fluid communication with said at least one lumen in said elongated body.

103. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an elongated body comprising a semi-flexible sleeve having distal and proximal end portions; and

a capturing feature extending distally from a distal end of the elongated body.

104. The surgical device of claim 103, further comprising an endoscope inserted in said sleeve, the endoscope having a distal tip attached thereto that extends distally of the distal end of the elongated body.

105. The surgical device of claim 104, wherein said capturing feature comprises a snare threaded through openings in the distal tip to extend distally therefrom.

106. The surgical device of claim 105, wherein the elongated body is slidable proximally with respect to the distal tip to cinch down the snare.

107. The surgical device of claim 103, wherein the capturing feature comprises a pad of either a hook or a loop portion of a hook and loop type fastening mechanism.

108. The surgical device of claim 103, wherein the capturing feature comprises a magnet.

109. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an elongated body having distal and proximal end portions and at least two lumens extending generally along a direction of a longitudinal axis of the elongated body, wherein at least one of the lumens comprises a slot opening to an external surface of the elongated body, and wherein the slot is configured and dimensioned to releasably secure a tool therein via friction fit.

110. The surgical device of claim 109, wherein the tool comprises a snare catheter.

111. The surgical device of claim 109, wherein a distal tip is attachable to the distal end portion of the elongated body, the distal tip including a lens that is viewable therethrough and alignable with one of the at least two lumens that is configured for receiving an endoscope therein.

112. The surgical device of claim 109, wherein the slot extends over a majority of a length of said elongated body.

113. The surgical device of claim 109, wherein the slot is formed in an eyelet on the distal end portion of the elongated body.

114. The surgical device of claim 113, wherein the tool includes a distal end portion having a first outside diameter larger than an outside diameter of a portion of the tool immediately proximal of the distal end portion of the tool, wherein the portion immediately proximal is slidable through the slot, and wherein retraction of the tool being positioned through the slot and into the lumen that the slot opens to, secures the distal end portion in the eyelet.

115. The surgical device of claim 109, wherein the slot is formed by a keyed socket on the distal end portion of the elongated member.

116. The surgical device of claim 109, wherein said at least one lumen having a slot is asymmetrical in cross-section and forms a cam surface permitting the tool to be rotated into the at least one lumen having a slot.

117. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an endoscope having an elongated shaft having distal and proximal end portions;

a distal tip attachable to the distal end portion of the endoscope, wherein the distal tip includes a lens that is viewable therethrough; and

a ring provided over the elongated shaft and axially slidable with respect thereto, the ring being configured and dimensioned to releasably fix a distal end portion of a tool thereto.

118. The surgical device of claim 117, wherein said ring comprises a releasable locking mechanism.

119. The surgical device of claim 117, wherein said tool comprises a snare catheter.

120. A surgical device for performing minimally invasive surgical procedures, said device comprising a jig having slots configured and dimensioned to receive and releasably fix an endoscope and at least one tool thereto for rapid exchange procedures.

121. The surgical device of claim 120, wherein a pair of said jigs configured with said slots is provided.

122. The surgical device of claim 120, wherein an endoscope and a snare catheter are each releasably fixed to the jig.

123. A surgical device for performing minimally invasive surgical procedures, said device comprising:

a jig having at least one opening configured and dimensioned to receive and releasably fix a tool thereto for rapid exchange procedures; and

an opening configured and dimensioned to receive an endoscope therethrough, wherein said endoscope is freely slidable with respect to said jig.

124. The device of claim 123, comprising a pair of said jigs each configured with said openings.

125. The device of claim 123, wherein each said jig comprises at least two of said openings for releasably fixing at least two tools.

126. The device of claim 125, further comprising an endoscope slidably received within said jig, and a snare catheter releasably fixed to said jig.

127. The device of claim 125, further comprising an endoscope slidably received within said jig, a snare catheter releasably fixed to said jig, and a second tool releasably fixed to said jig.

128. The device of claim 127, wherein said second tool comprises a suction tube.

129. A surgical device for performing minimally invasive surgical procedures, said device comprising:

an elongated body having distal and proximal end portions and configured and dimensioned to receive an endoscope therethrough and to apply suction therethrough; and

a distal tip attachable to said distal end portion of said elongated body, said distal tip including a lens that is viewable therethrough, said distal tip having a proximal opening having an outside diameter that is greater than an outside diameter of a distal end of said elongated body, such that a gap is formed between said distal tip and said elongated body when said distal tip is attached to said elongated body, facilitating diffuse application of suction.

130. The device of claim 129, further comprising struts interconnecting said distal tip and said elongated body.

131. A routing snare tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

a flexible outer tube having sufficient column strength to advance the tool through the lumen by pushing on a proximal portion of said outer tube from a location outside of said lumen, to advance said tube without buckling;

a snare line having a length greater than a length of said flexible outer tube; and

a snare loop fixed to an end of said snare line via heat shrink tubing.

132. The tool of claim 131, further comprising a second snare loop fixed to an opposite end of said snare line via heat shrink tubing.

133. The tool of claim 132, wherein both ends of said outer tube are chamfered.

134. The tool of claim 132, wherein said heat shrink tubing is color coded differently with respect to each snare loop to facilitate ready visual distinction between the two snare loops.

135. The tool of claim 131, wherein said snare loop comprises a kink extending distally from a remainder of said snare loop.

136. The tool of claim 131, wherein said snare loop is angled, with respect to a longitudinal axis of said snare line, by an angle of less than about thirty degrees.

137. The tool of claim 131, further comprising a lock configured to fix a position of said snare line relative to said outer tube to maintain said snare loop in a cinched configuration.

138. The tool of claim 137, wherein said lock comprises an actuator configured to move a clamp into contact with said snare line.

139. The tool of claim 137, wherein said lock comprises a pair of locking clasps that are alternatively lockable and releasable by the same actuating movement by a user.

140. A snare capture tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated mandrel configured and dimensioned to be slid through the lumen;

a handle fixed to a proximal end of said mandrel; and

a ball fixed at a distal end of said mandrel.

141. The tool of claim 140, further comprising a polymeric layer formed over a majority of said mandrel, wherein a distal end portion of said mandrel extends from a distal end of said polymeric layer and is not covered thereby.

142. The tool of claim 141, further comprising a compressible spring over said layer, a proximal end portion of said spring abutting said handle, said spring having a outside diameter larger than an inside diameter of said lumen, thereby being prevented from insertion into said lumen.

143. The tool of claim 142, wherein said tool is configured and dimensioned, so that when said spring is compressed against a proximal end of the lumen by advancing said handle distally with respect to said lumen, said ball and at least a portion of said distal portion not covered by said polymeric layer extend distally from a distal end of said lumen, and when a driving force is released from said handle, said spring expands, thereby retracting said ball and said at least a portion of said distal portion not covered by said polymeric layer into said lumen.

144. A retrieval hook tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated mandrel configured and dimensioned to be slid through the lumen;

a handle fixed to a proximal end of said mandrel; and

a hook provided at a distal end of said mandrel.

145. The tool of claim 144, further comprising a polymeric layer formed over a majority of said mandrel, wherein a distal end portion of said mandrel extends from a distal end of said polymeric layer and is not covered thereby.

146. The tool of claim 144, further comprising a compressible spring over said mandrel, a proximal end portion of said spring abutting said handle, said spring having a outside diameter larger than an inside diameter of said lumen, thereby being prevented from insertion into said lumen.

147. The tool of claim 146, wherein said tool is configured and dimensioned, so that when said spring is compressed against a proximal end of the lumen by advancing said handle distally with respect to said lumen, said hook extends distally from a distal end of said lumen, and when a driving force is released from said handle, said spring expands, thereby retracting said hook into said lumen.

148. The tool of claim 145, wherein said mandrel is offset in said polymeric layer, such that longitudinal axes of said mandrel and said polymeric layer do not coincide.

149. A bolo tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated mandrel configured and dimensioned to be slid through the lumen;

a first ball provided at a proximal end of said mandrel; and

a second ball provided at a distal end of said mandrel.

150. A trigger snare tool and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated mandrel configured and dimensioned to be slid through the lumen;

a snare provided at a distal end of said mandrel; and

a snare guide into which said elongated mandrel is slidably received, said snare guide being configured and dimensioned to be slid through the lumen, wherein said snare guide is slidable distally with respect to said mandrel to cinch down said snare.

151. The tool of claim 150, further comprising:

a handle provided at a proximal end of said mandrel;

a trigger slidably positioned over said handle and fixed to a proximal end of said snare guide; and

a biasing member that biases said trigger distally from said handle.

152. The tool of claim 150, wherein said snare, when uncinched, is oriented at an acute angle with respect to a longitudinal axis of said mandrel.

153. A perforation tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

a perforating member connected to an actuator via an elongated shaft;

a sheath configured and dimensioned to be slid through the lumen of the device and to surround said perforating member and said shaft during sliding within the lumen;

said actuator being operable to slide said perforating member distally with respect to said sheath to extend said perforating member distally beyond a distal end of said sheath.

154. The tool of claim 153, wherein said perforating member comprises a needle.

155. The tool of claim 153, wherein said perforating member comprises a spike.

156. The tool of claim 153, further comprising a handle mounted to a proximal portion of said tool, said handle configured to be mated with a connector of a suction assembly.

157. The tool of claim 153, further comprising a cutting blade positioned proximally of said perforating member, said perforating member being configured to engage tissue, wherein said actuator is actuatable to retract said perforating member, after engaging tissue, to draw the tissue against said cutting blade, thereby cutting an opening through the tissue.

158. The tool of claim 157, further comprising a second actuator, said second actuator being linked to said cutting blade and operable to rotate said cutting blade.

159. The tool of claim 157, wherein said perforating member comprises a barbed needle.

160. The tool of claim 157, wherein said perforating member comprises a corkscrew.

161. The tool of claim 157, wherein said perforating member comprises graspers.

162. The tool of claim 161, wherein said actuator is further actuatable to open and close said graspers.

163. A mapping probe tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated member configured and dimensioned to be positioned in the lumen and having a length sufficient to extend a proximal end portion of said elongated member from the proximal end of the lumen while a distal end portion extends distally from a distal end of the lumen;

said distal end portion including at least a pair of probe mapping elements, said probe mapping elements being electrically connectable to a power source located proximally of said tool via at least one electrical wire connected thereto.

164. The tool of claim 163, further comprising:

a handle fixed to a proximal end portion of said elongated member; and

a biasing member configured to bias said handle away from the lumen, said biasing member being configured and dimensioned to prevent insertion of said biasing member into the lumen.

165. The tool of claim 164, wherein said tool is configured and dimensioned, so that when said handle is slid distally with respect to the lumen, thereby biasing the biasing member, said probe mapping elements extend distally from a distal end of said lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the lumen, thereby retracting said probe mapping elements into the lumen.

166. The tool of claim 163, wherein said distal end portion is Y-shaped in an unbiased configuration, with one of each said pair of probes being located on opposite ones of open arms of said Y-shape.

167. The tool of claim 163, wherein said distal end portion is angled to a longitudinal axis of a remainder of said elongated member when said elongated member is in an unbiased configuration.

168. A linear ablating probe tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated member configured and dimensioned to be positioned in the lumen and having a length sufficient to extend a proximal end portion of said elongated member from the proximal end of the lumen while a distal end portion extends distally from a distal end of the lumen;

a linear ablation member located at the distal end portion of said elongated member and configured to form a linearly extending lesion in tissue being treated thereby; and

at least one ablation conduit connected to said linear ablation member and extending from said linear ablation member to a proximal end portion of said elongated member, a proximal end of each said ablation conduit being configured to be connected to a source of ablation energy located proximally of said tool.

169. The tool of claim 168, further comprising an actuator located on said proximal end portion of said elongated member, said actuator being operable by a user to deliver ablation energy to said linear ablation member.

170. The tool of claim 168, further comprising:

a handle fixed to a proximal end portion of said elongated member; and

a biasing member configured to bias said handle away from the lumen, said biasing member being configured and dimensioned to prevent insertion of said biasing member into the lumen.

171. The tool of claim 170, wherein said tool is configured and dimensioned, so that when said handle is slid distally with respect to the lumen, thereby biasing the biasing member, said linear ablation member extends distally from a distal end of said lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the lumen, thereby retracting said linear ablation member into the lumen.

172. A point ablation probe tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated member configured and dimensioned to be positioned in the lumen and having a length sufficient to extend a proximal end portion of said elongated member from the proximal end of the lumen while a distal end portion extends distally from a distal end of the lumen;

an ablation probe point provided on a distal end of said elongated member and configured to form a point lesion in tissue being treated thereby; and

an ablation conduit connected to said ablation probe point and extending from said ablation probe point to a proximal end portion of said elongated member, a proximal end of said ablation conduit being configured to be connected to a source of ablation energy located proximally of said tool.

173. The tool of claim 172, further comprising an actuator located on said proximal end portion of said elongated member, said actuator being operable by a user to deliver ablation energy to said ablation probe point.

174. The tool of claim 172, further comprising:

a handle fixed to a proximal end portion of said elongated member; and

a biasing member configured to bias said handle away from the lumen, said biasing member being configured and dimensioned to prevent insertion of said biasing member into the lumen.

175. The tool of claim 174, wherein said tool is configured and dimensioned, so that when said handle is slid distally with respect to the lumen, thereby biasing the biasing member, said ablation probe point extends distally from a distal end of said lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the lumen, thereby retracting said ablation probe point into the lumen.

176. A cautery tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

an elongated member configured and dimensioned to be positioned in the lumen and having a length sufficient to extend a proximal end portion of said elongated member from the proximal end of the lumen while a distal end portion extends distally from a distal end of the lumen;

a cauterizing element provided on a distal end of said elongated member and configured to cauterize tissue; and

an electrical wire connected to said cauterizing element and extending from said cauterizing element to a proximal end portion of said elongated member, a proximal end of said electrical wire being configured to be connected to a power source located proximally of said tool.

177. The tool of claim 176, further comprising an actuator located on said proximal end portion of said elongated member, said actuator being operable by a user to deliver energy to said cauterizing element.

178. The tool of claim 176, further comprising:

a handle fixed to a proximal end portion of said elongated member; and

a biasing member configured to bias said handle away from the lumen, said biasing member being configured and dimensioned to prevent insertion of said biasing member into the lumen.

179. The tool of claim 178, wherein said tool is configured and dimensioned, so that when said handle is slid distally with respect to the lumen, thereby biasing the biasing member, said cauterizing element extends distally from a distal end of said lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the lumen, thereby retracting said cauterizing element into the lumen.

180. A graspers tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

grasping jaws connected to an actuator via an elongated linkage;

a sheath configured and dimensioned to be slid through the lumen of the device and to surround said grasping jaws and said linkage during sliding within the lumen;

said actuator being operable to slide said grasping jaws distally with respect to said sheath to extend said grasping jaws distally beyond a distal end of said sheath.

181. The tool of claim 180, wherein said actuator is further actuatable to open and close said grasping jaws.

182. A scissors tool configured and dimensioned to be slid through a lumen of a device that also receives an endoscope, said tool comprising:

scissors jaws connected to an actuator via an elongated linkage;

a sheath configured and dimensioned to be slid through the lumen of the device and to surround said scissors jaws and said linkage during sliding within the lumen;

said actuator being operable to slide said scissors jaws distally with respect to said sheath to extend said scissors jaws distally beyond a distal end of said sheath.

183. The tool of claim 182, wherein said actuator is further actuatable to open and close said scissors jaws.

184. A minimally invasive method of routing a flexible tool around an internal structure in a patient'"'"'s body, said method comprising the steps of:

inserting a device including an endoscope through a small opening in the patient and advancing the device to position a distal end of the device into a surgical space in which the internal structure resides;

inserting the flexible member through a service port in the device and extending a distal end portion of the flexible member distally of a lumen joined by the service port;

visually confirming the distal end portion via the endoscope;

removing the device from the patient via the small opening while maintaining the flexible member in the patient, substantially in the current position of the flexible member;

inserting the device through a second small opening in the patient and advancing the device to position the distal end of the device into the surgical space in which the internal structure resides, on a side of the internal structure opposite to the side in which the flexible member is placed;

connecting the distal end of the device with the distal end portion of the flexible member; and

removing the device from the patient via the second small opening, thereby drawing the flexible member around the internal structure.

185. The method of claim 184, further comprising advancing the distal end of the flexible member partially around the internal structure after said removing the device from the patient via the small opening while maintaining the flexible member in the patient, substantially in the current position of the flexible member.

186. The method of claim 184, further comprising visualizing the distal end of the flexible member through the endoscope to align the device with the flexible member to perform said connecting step.

187. The method of claim 184, wherein the distal end of the flexible member comprises a snare loop and said connecting comprises cinching the snare loop over a distal end portion of the device.

188. The method of claim 184, further comprising fixing an ablation device to the proximal end of said flexible member and further advancing the flexible member by drawing the flexible member out of the second opening, thereby routing the ablation device around the internal structure.

189. The method of claim 184, wherein the internal structure comprises a plurality of pulmonary veins.

190. The method of claim 188, further comprising ablating tissue along a pathway defined by the ablation device around the internal structure.

191. The method of claim 184, wherein the distal end of the flexible member comprises a ball and said connecting comprises inserting a retrieval hook tool through a service port of the device, extending a hook of the retrieval hook tool distally of a distal end of a lumen that is in fluid communication with the service port, and hooking the distal end portion of the flexible member with the hook.

192. The method of claim 184, wherein the distal end of the flexible member comprises a snare loop and said connecting comprises inserting a retrieval hook tool through a service port of the device, extending a hook of the retrieval hook tool distally of a distal end of a lumen that is in fluid communication with the service port, and hooking the snare loop with the hook.

193. The method of claim 184, wherein the distal end of the flexible member comprises a ball and said connecting comprises inserting a trigger snare tool through a service port of the device, extending a snare of the trigger snare tool distally of a distal end of a lumen that is in fluid communication with the service port, and snaring the distal end portion of the flexible member by cinching down the snare loop after placing the snare loop over the ball.

194. The method of claim 184, further comprising:

after said inserting the through a small opening in the patient and prior to said advancing the device to position a distal end of the device into a surgical space in which the internal structure resides, perforating at least one tissue layer to establish a pathway for said advancing.

195. The method of claim 194, wherein said perforating comprises inserting a perforating tool through a service port of the device, extending a perforating member distally of a distal end of a lumen that is in fluid communication with the service port and into contact with tissue to be perforated, and perforating the tissue.

196. The method of claim 194, wherein said perforating comprises inserting a perforating tool through a service port of the device, extending a perforating member distally of a distal end of a lumen that is in fluid communication with the service port and into contact with tissue to be perforated, grasping the tissue and retracting the grasped tissue against a cutting blade, thereby perforating the tissue.

197. The method of claim 190, further comprising reinserting the device into at least one of said first and second openings, advancing the distal end of the device toward the internal structure, and visually inspecting at least a portion of the lesion formed around the internal structure via the endoscope.

198. The method of claim 190, further comprising reinserting the device into at least one of said first and second openings, advancing the distal end of the device toward the internal structure, inserting a mapping probe tool through a service port in the device, extending mapping probe elements distally of a distal opening of a lumen in fluid connection with said service port, contacting tissue on opposite sides of a lesion formed by said ablating with at least one mapping probe on each side of the lesion, and measuring sufficiency of the lesion formed with the mapping probe tool.

199. A minimally invasive method of routing a flexible tool around an internal structure in a patient'"'"'s body, said method comprising the steps of:

inserting a device including an endoscope through a small opening in the patient and advancing the device to position an distal end of the device into a surgical space in which the internal structure resides;

inserting the flexible member through a service port in the device and extending a distal end portion of the flexible member distally of a lumen joined by the service port;

visually confirming the distal end portion via the endoscope;

retracting the device to remove the flexible member from a distal end of the lumen, while maintaining the flexible member in the patient, substantially in the current position of the flexible member;

distally advancing the device into patient to position the distal end of the device into the surgical space in which the internal structure resides, on a side of the internal structure opposite to the side in which the flexible member is placed;

connecting the distal end of the device with the distal end portion of the flexible member; and

removing the device from the patient via the small opening, thereby drawing the flexible member around the internal structure.

200. The method of claim 199, further comprising advancing the distal end of the flexible member partially around the internal structure after removing the flexible member from the device while maintaining the flexible member in the patient, substantially in the current position of the flexible member.

201. The method of claim 199, further comprising fixing an ablation device to the proximal end of said flexible member and further advancing the flexible member by drawing the flexible member out of the opening, thereby routing the ablation device around the internal structure.

202. The method of claim 201, further comprising ablating tissue along a pathway defined by the ablation device around the internal structure.

203. A minimally invasive method of routing a flexible tool around an internal structure in a patient'"'"'s body, said method comprising the steps of:

inserting a device including a semi-flexible sheath slid over an endoscope through a small opening in the patient and advancing the device to position a distal end of the device into a surgical space in which the internal structure resides, the semi-flexible sheath including a rigid, transparent distal end that allows viewing therethrough via the endoscope;

visually confirming placement of the distal end of the semi-flexible member via the endoscope;

removing the device endoscope from the patient via the small opening while maintaining the semi-flexible member and rigid distal end in the patient, substantially in the current position of the semi-flexible member and rigid distal end;

inserting the endoscope through a second small opening in the patient and advancing the endoscope to position the distal end thereof into the surgical space in which the internal structure resides, on a side of the internal structure opposite to the side in which the semi-flexible member is placed;

connecting the distal end of the endoscope with the distal end of the semi-flexible member; and

removing the endoscope from the patient via the second small opening, thereby drawing the semi-flexible member around the internal structure.

204. The method of claim 203, further comprising advancing the distal end of the semi-flexible member partially around the internal structure after said removing the endoscope from the patient via the small opening while maintaining the semi-flexible member in the patient, substantially in the current position of the flexible member.

205. The method of claim 203, further comprising visualizing the distal end of the flexible member through the endoscope to align the device with the flexible member to perform said connecting step.

206. The method of claim 203, further comprising sliding a sleeve having a distal tip over the endoscope prior to said inserting the endoscope through a second small opening.

207. The method of claim 206, wherein the sleeve comprises a snare loop extending from the distal tip, the snare loop being threaded through a distal tip and the distal tip being mounted to the endoscope.

208. The method of claim 207, wherein said connecting comprises cinching the snare loop around the distal end of the semi-flexible member.

209. The method of claim 208, wherein said cinching is performed by sliding the sleeve proximally with respect to the endoscope.

210. The method of claim 203, further comprising fixing an ablation device to the proximal end of the semi-flexible member and further advancing the semi-flexible member by drawing the semi-flexible member out of the second opening, thereby routing the ablation device around the internal structure.

211. The method of claim 210, further comprising ablating tissue along a pathway defined by the ablation device around the internal structure.

212. A method of performing rapid exchange of tools in a device while performing a minimally invasive surgical procedure, said method comprising the steps of:

inserting a device having at least and an endoscope and a first tool received therein, through a small opening in the patient and advancing the device to position a distal end of the device into a reduced-access surgical space;

removing the first tool from the device, while maintaining the device and the endoscope in the surgical space; and

inserting a second tool into the device, thereby replacing the tool having been removed.

213. The method of claim 212, wherein said removing comprises removing the first tool through a slot opening to an external surface of the device from a lumen in the device.

214. The method of claim 212, wherein the first tool comprises a snare catheter.

215. The method of claim 212, wherein said removing comprises removing the first tool from an eyelet on a distal end portion of said device.

216. The method of claim 213, wherein the lumen from which the slot opens is asymmetrical in cross-section and forms a cam surface permitting the second tool to be rotated into the lumen.

217. The method of claim 212, wherein said device comprises a ring provided over an elongated shaft of the endoscope and axially slidable with respect thereto, and wherein said removing comprises releasing said first tool from said ring.

218. The method of claim 212, wherein said device comprises a jig having slots configured and dimensioned to receive and releasably fix the endoscope and the first tool.

219. The method of claim 218, wherein said device comprises a pair of said jigs.

220. The method of claim 212, wherein said device comprises a jig having an opening configured and dimensioned to receive and releasably fix said first tool thereto for rapid exchange procedures;

and

an opening configured and dimensioned to receive the endoscope therethrough, wherein the endoscope is freely slidable with respect to said jig.

221. A method of relieving side loading by an operating room suction tubing on a device in fluid communication with the operating room suction tubing, said method comprising:

providing a length of tubing having a lighter gauge than a gauge of the operating room suction tubing, said length of tubing having proximal and distal ends;

connecting the distal end of said length of tubing to a suction assembly of a device to be used to apply suction; and

connecting the proximal end of said length of tubing to the operating room suction tubing, thereby putting the suction assembly of the device in fluid communication with the operating room suction tubing.

222. The method of claim 221, further comprising clamping the length of tubing to a support.

223. The method of claim 222, wherein the length of tubing comprises a tether extending therefrom, and said clamping comprises clamping said tether to the support.

224. The method of claim 223, wherein the support is a surgical drape.

225. A tool for relieving side loading on a device in fluid communication with an operating room suction tube, said tool comprising:

a length of tubing having a lighter gauge than a gauge of the operating room suction tubing, said length of tubing having proximal and distal ends;

a first connector at a distal end of said length of tubing configured and dimensioned to be connected to a suction assembly of the device, to establish fluid communication between the suction assembly and the length of tubing;

a second connector at a proximal end of said length of tubing configured and dimensioned to be connected to the operating room suction tube, to establish fluid communication between the operating room suction tube and the length of tubing; and

a tether extending from the length of tubing, said tether adapted to be clamped to a support.