Tracheal intubination

• US 6,820,614 B2
• Filed: 12/02/2000
• Issued: 11/23/2004
• Est. Priority Date: 12/02/2000
• Status: Expired due to Term

• Current Assignee: P TECH, LLC
• Original Assignee: The Bonutti 2003 Trust A
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Lewis, Aaron J.
• Application Number:
  US09/728,553
• Publication Number:
  US 20020066450A1
• Time in Patent Office: 1,452 Days
• Field of Search: 128/200.26, 128/205.23, 128/207.14, 128/207.15, 128/207.29, 600/109, 600/409, 600/410, 600/424, 604/93.01
• US Class Current: 128/200.26
• CPC Class Codes: A61B 1/00082 Balloons
• CPC Class Codes: A61B 1/00124 electrical, e.g. electrical plug-and-socket connection
• CPC Class Codes: A61B 1/005 Flexible endoscopes
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/0676 at distal tip of an endoscope
• CPC Class Codes: A61B 1/0684 using light emitting diodes [LED]
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• CPC Class Codes: A61B 5/065 Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• CPC Class Codes: A61B 8/0841 for locating instruments
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/4254 using sensors mounted on the probe
• CPC Class Codes: A61B 8/4263 using sensors not mounted on the probe, e.g. mounted on an external reference frame
• CPC Class Codes: A61B 8/445 Details of catheter construction
• CPC Class Codes: A61B 8/461 Displaying means of special interest
• CPC Class Codes: A61M 16/0411 with means for differentiating between oesophageal and tracheal intubation
• CPC Class Codes: A61M 16/0434 Cuffs
• CPC Class Codes: A61M 16/0488 Mouthpieces; Means for guiding, securing or introducing the tubes guiding or introducing with laryngoscopes A61B1/267; holding devices on the body A61M25/02
• CPC Class Codes: A61M 16/0495 with tongue depressors
• CPC Class Codes: A61M 16/0497 Tube stabilizer
• CPC Class Codes: A61M 2025/0008 having visible markings on its surface, i.e. visible to the naked eye, for any purpose, e.g. insertion depth markers, rotational markers or identification of type
• CPC Class Codes: A61M 2025/022 : specifically adapted for the mouth
• CPC Class Codes: A61M 2025/09008 : having a balloon
• CPC Class Codes: A61M 2025/091 : having a lumen for drug delivery or suction
• CPC Class Codes: A61M 2205/0272 : Electro-active or magneto-active materials
• CPC Class Codes: A61M 2205/587 : Lighting arrangements
• CPC Class Codes: A61M 25/0102 : Insertion or introduction using an inner stiffening member, e.g. stylet or push-rod
• CPC Class Codes: A61M 25/0108 : using radio-opaque or ultrasound markers
• CPC Class Codes: A61M 25/09 : Guide wires

Abstract

A tracheal tube positioning apparatus is located relative to a patient'"'"'s trachea by engaging the patient'"'"'s Adam'"'"'s apple. Indicia on relatively movable sections of the positioning apparatus provides an indication of the distance between the patient'"'"'s mouth and the patient'"'"'s larynx. A flexible guide rod is moved through a distance corresponding to the distance between the patient'"'"'s mouth and larynx, as determined by the positioning apparatus. A magnet is utilized to attract a leading end portion of the guide rod. A plurality of emitters may be disposed in an array around the patient'"'"'s Adam'"'"'s apple. Outputs from the emitters are detected by a detector connected with the guide rod and by a detector connected with the tracheal tube. Alternatively, a plurality of detectors may be disposed in an array around the patient'"'"'s Adam'"'"'s apple to detect the output from an emitter connected with the guide rod and by an emitter connected with the tracheal tube. Expandable elements may be connected with the guide rod and/or tracheal tube to steer movement along an insertion path.

Claims

1. A method of tracheal intubination, said method comprising the steps of positioning a plurality of detectors in an array adjacent to an outer surface of a patient'"'"'s neck, locating a positioning apparatus relative to the patient'"'"'s trachea, moving a guide rod relative to the patient'"'"'s respiratory system along an insertion path which extends from the patient'"'"'s pharynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, emitting an output at a leading end portion of the guide rod as the guide rod moves along the insertion path, detecting the output emitted at the leading end portion of the guide rod with detectors of the plurality of detectors, determining the position of the leading end portion of the guide rod along the insertion path as a function of the relationship of the emitted output detected by one of the plurality of detectors to the emitted output detected by another detector of the plurality of detectors, moving a tracheal tube relative to the patient'"'"'s respiratory system along the insertion path by moving the tracheal tube along the guide rod, emitting an output at a leading end portion of the tracheal tube as the tracheal tube moves along the insertion path, detecting the output emitted at the leading end portion of the tracheal tube with detectors of the plurality of detectors, and determining the position of the leading end portion of the tracheal tube along the insertion path as a function of the relationship of the emitted output detected by one detector of the plurality of detectors to the emitted output detected by another detector of the plurality of detectors.

2. A method as set forth in claim 1 wherein said step of locating the positioning apparatus relative to the patient'"'"'s trachea includes engaging the patient'"'"'s Adam'"'"'s apple with the positioning apparatus.

3. A method as set forth in claim 2 wherein said step of positioning a plurality of detectors in an array adjacent to an outer surface of the patient'"'"'s neck includes positioning the detectors abjacent to the patient'"'"'s Adam'"'"'s apple.

4. A method as set forth in claim 1 further including the steps of providing a display illustrating a position of the leading end portion of the guide rod relative to the patient'"'"'s trachea and a position of a leading end portion of the tracheal tube relative to the patient'"'"'s trachea during at least a portion of said step of moving the tracheal tube along the guide rod.

5. A method as set forth in claim 1 further including the step of providing a display illustrating a position of the leading end portion of the guide rod relative to the patient'"'"'s trachea during at least a portion of said step of moving the guide rod relative to the patient'"'"'s respiratory system.

6. A method of tracheal intubination, said method comprising the steps of positioning a plurality of detectors in an array adjacent to an outer surface of a patient'"'"'s neck, moving a tracheal tube relative to the patient'"'"'s respiratory system along an insertion path which extends from the patient'"'"'s pharynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, emitting an output at a leading end portion of the tracheal tube as the tracheal tube moves along the insertion path, detecting the output emitted at the leading end portion of the tracheal rube with detectors of the plurality of detectors, and determining the position of the leading end portion of the tracheal tube along the insertion path as a function of the relationship of the emitted output detected by one detector of the plurality of detectors to the emitted output detected by another detector of the plurality of detectors,

wherein said step of emitting an output at a leading end portion of the tracheal tube includes emitting light at the leading end portion of the tracheal tube.

7. A method of tracheal intubination, said method comprising the steps of positioning a plurality of detectors in an array adjacent to an outer surface of a patient'"'"'s neck, moving a tracheal tube relative to the patient'"'"'s respiratory system along an insertion path which extends from the patient'"'"'s pharynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, emitting an output at a leading end portion of the tracheal tube as the tracheal tube moves along the insertion path, detecting the output emitted at the leading end portion of the tracheal tube with detectors of the plurality of detectors, and determining the position of the leading end portion of the tracheal tube along the insertion path as a function of the relationship of the emitted output detected by one detector of the plurality of detectors to the emitted output detected by another detector of the plurality of detectors,

wherein said step of moving the tracheal tube relative to the patient'"'"'s respiratory system along an insertion path includes determining when the leading end portion of the tracheal tube approaches a junction between the patient'"'"'s respiratory system and the patient'"'"'s esophagus, and steering the leading end portion of the tracheal tube away from the patient'"'"'s esophagus by applying force against the leading end portion of the tracheal tube.

8. A method as set forth in claim 7 wherein said step of steering the leading end portion of the tracheal tube includes expanding an expandable element to urge the leading end portion of the tracheal tube in direction away from an entrance to the patient'"'"'s esophagus.

9. A method of tracheal intubination, said method comprising the steps of positioning a plurality of emitters in an array adjacent to an outer surface of a patient'"'"'s neck, moving a tracheal tube relative to the patient'"'"'s respiratory system along an insertion path which extends from the patient'"'"'s pharynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, emitting an output from the emitters of the plurality of emitters as the tracheal tube moves along the insertion path, detecting the output emitted by at least some of the emitters with a detector connected with a leading end portion of the tracheal tube as the tracheal tube moves along the insertion path, and determining the position of the leading end portion of the tracheal tube along the insertion path as a function of the output from the plurality of emitters detected by the detector.

10. A method as set forth in claim 9 wherein said step of positioning a plurality of emitters in an array adjacent to an outer surface of the patient'"'"'s neck includes positioning a plurality of magnets which emit magnetic fields adjacent to the outer surface of the patient'"'"'s neck.

11. A method as set forth in claim 9 further including the steps of locating a positioning apparatus relative to the patient'"'"'s trachea, moving a guide rod relative to the patient'"'"'s respiratory system along an insertion path which extends from the patient'"'"'s pharynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, detecting the output emitted by at least some of the emitters with a detector connected with a leading end portion of the guide rod as the guide rod moves along the insertion path, and determining the position of the leading end portion of the guide rod along the insertion path as a function of the output emitted from the plurality of emitters detected by the detector, said step of moving the tracheal tube relative to the patient'"'"'s respiratory system along the insertion path includes moving the tracheal tube along the guide rod.

12. A method as set forth in claim 11 wherein said step of locating the positioning apparatus relative to the patient'"'"'s trachea includes engaging the patient'"'"'s Adam'"'"'s apple with the positioning apparatus.

13. A method as set forth in claim 12 wherein said step positioning a plurality of emitters in an array adjacent to an outer surface of the patient'"'"'s neck includes positioning the emitters adjacent to the patient'"'"'s Adam'"'"'s apple.

14. A method as set forth in claim 11 further including the steps of providing a display illustrating a position of the leading end portion of the guide rod relative to the patient'"'"'s trachea and a position of a leading end portion of the tracheal tube relative to the patient'"'"'s trachea during at least a portion of said step of moving the tracheal tube along the guide rod.

15. A method as set forth in claim 11 further including the step of providing a display illustrating a position of the leading end portion of the guide rod relative to the patient'"'"'s trachea during at least a portion of said step of moving the guide rod relative to the patient'"'"'s respiratory system.

16. A method as set forth in claim 9 further including the step of providing a display illustrating a position of a leading end portion of the tracheal tube relative to the patient'"'"'s trachea during at least a portion of said step of moving the tracheal tube relative to the patient'"'"'s respiratory system.

17. A method of tracheal intubination, said method comprising the steps of positioning an emitter which provides an output adjacent to an outer surface of a patient'"'"'s neck, moving a guide rod relative to a patient'"'"'s respiratory system along an insertion path which extends into the patient'"'"'s trachea, said step of moving the guide rod along the insertion path being performed with a detector connected with a leading end portion of the guide rod, detecting the output emitted from the emitter with the detector as the guide rod moves along the insertion path, interrupting movement of the guide rod along the insertion path in response to the detector detecting that the leading end portion of the guide rod is in a desired position relative to the patient'"'"'s trachea, moving a tracheal tube along the guide rod, said step of moving the tracheal tube along the guide rod being performed with a detector connected with a leading end portion of the tracheal tube, detecting the output emitted from the emitter with the detector connected with the leading end portion of the tracheal tube as the tracheal tube moves along the guide rod, and interrupting movement of the tracheal tube along the guide rod in response to the detector connected with the leading end portion of the tracheal tube detecting that the leading end portion of the tracheal tube is in a desired position relative to the patient'"'"'s trachea.

18. A method as set forth in claim 17 further including the step of engaging the patient'"'"'s Adam'"'"'s apple with a positioning apparatus, said step of moving the guide rod along the insertion path being performed while positioning a portion of the guide rod relative to the insertion path with the positioning apparatus.

19. A method as set forth in claim 18 further including the step of separating the guide rod from the positioning apparatus prior to performing the step of moving the tracheal tube along the guide rod.

20. A method of tracheal intubination, said method comprising the steps of positioning a detector adjacent to an outer surface of a patient'"'"'s neck, moving a guide rod relative to a patient'"'"'s respiratory system along an insertion path which extends into the patient'"'"'s trachea, said step of moving the guide rod along the insertion path being performed with an emitter which provides an output connected with a leading end portion of the guide rod, detecting the output emitted from the emitter with the detector as the guide rod moves along the insertion path, interrupting movement of the guide rod along the insertion path in response to the detector detecting that the leading end portion of the guide rod is in a desired position relative to the patient'"'"'s trachea, moving a tracheal tube along the guide rod, said step of moving the tracheal tube along the guide rod being performed with an emitter which provides an output connected with a leading end portion of the tracheal tube, detecting the output emitted from the emitter with the detector as the tracheal tube moves along the guide rod, and interrupting movement of the tracheal tube along the guide rod in response to the detector detecting that the leading end portion of the tracheal tube is in a desired position relative to the patient'"'"'s trachea.

21. A method as set forth in claim 20 further including the step of engaging the patient'"'"'s Adam'"'"'s apple with a positioning apparatus, said step of moving the guide rod along the insertion path being performed while positioning a portion of the guide rod relative to the insertion path with the positioning apparatus.

22. A method as set forth in claim 21 further including the step of separating the guide rod from the positioning apparatus prior to performing the step of moving the tracheal tube along the guide rod.

23. An apparatus for use in tracheal intubination, said apparatus comprising a tracheal tube, sensor means connected with said tracheal tube for determining the position of a leading end portion of said tracheal tube during movement of said tracheal tube along an insertion path which extends from a patient'"'"'s pharynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, steering means connected with a leading end portion of said tracheal tube for applying force against the leading end portion of said tracheal tube during movement of said tracheal tube along the insertion path, a positioning assembly which is engagable with the patient'"'"'s Adam'"'"'s apple to locate said positioning assembly relative to the patient'"'"'s body, and a guide surface connected with said positioning assembly to guide movement of said tracheal tube relative to the patient'"'"'s body.

24. An apparatus for use in tracheal intubination, said apparatus comprising a tracheal tube, sensor means connected with said tracheal tube for determining the position of a leading end portion of said tracheal tube during movement of said tracheal tube along an insertion path which extends from a patient'"'"'s phaxynx, through the patient'"'"'s larynx and into the patient'"'"'s trachea, and steering means connected with a leading end portion of said tracheal tube for applying force against the leading end portion of said tracheal tube during movement of said tracheal tube along the insertion path, wherein said sensor means includes an emitter which provides an output and a detector which responds to the output from said emitter, one of said emitter and detector being connected with the leading end portion of said tracheal tube for movement therewith along the insertion path, the outer of said emitter and detector being disposed adjacent to an outer surface of the neck of the patient during movement of said tracheal tube along the insertion path.

25. An apparatus for use in tracheal intubination of a patient, said apparatus comprising a tracheal tube which is moveable along an insertion path into a patient'"'"'s trachea, an emitter which provides an output, and a detector which responds to the output from said emitter, a first one of said emitter and said detector being connected with said tracheal tube for movement therewith along the inserting path, a second one of said emitter and said detector being disposed adjacent to an outer surface of the patient'"'"'s neck during movement of said tracheal tube along the insertion path, wherein said detector is connected with a leading end portion of said tracheal tube for movement therewith along the insertion path.

26. An apparatus for use in tracheal intubination of a patient, said apparatus comprising a tracheal tube which is moveable along an insertion path into a patient'"'"'s trachea, an emitter which provides an output, a detector which responds to the output from said emitter, a first one of said emitter and said detector being connected with said tracheal tube for movement therewith along the inserting path, a second one of said emitter and said detector being disposed adjacent to an outer surface of the patient'"'"'s neck during movement of said tracheal tube along the insertion path, and a positioning assembly which is engagable with the patient'"'"'s Adam'"'"'s apple to locate said positioning assembly relative to the patient'"'"'s body, and a guide surface connected with said positioning assembly to guide movement of said tracheal tube relative to the patient'"'"'s body.

27. An apparatus for use in tracheal intubination of a patient, said apparatus comprising a tracheal tube which is movable along an insertion path into a patient'"'"'s trachea;

an emitter connected with a leading and portion of said tracheal tube, said emitter being effective to provide an output during movement of said tracheal tube along the insertion path;

a plurality of detectors disposed in an array adjacent to the patient'"'"'s Adam'"'"'s apple, each detector of said plurality of detectors being responsive to the output from said emitter and means connected with said plurality of detectors for determining the position of the leading end portion of said tracheal tube along the insertion path as a function of outputs from said plurality of detectors during movement of said tracheal tube along the insertion path; and

steering means connected with the leading end portion of said tracheal tube for applying force against the leading end portion of said tracheal tube during movement of said tracheal tube along the insertion path.

28. An apparatus for use in tracheal intubination of a patient, said apparatus comprising a tracheal tube which is movable along an insertion path into a patient'"'"'s trachea;

an emitter connected with a leading end portion of said tracheal tube, said emitter being effective to provide an output during movement of said tracheal tube along the insertion path;

a plurality of detectors disposed in an array adjacent to the patient'"'"'s Adam'"'"'s apple, each detector of said plurality of detectors being responsive to the output from said emitter and means connected with said plurality of detectors for determining the position of the leading end portion of said tracheal tube along the insertion path as a function of outputs from said plurality of detectors during movement of said tracheal tube along the insertion path;

a plurality of expandable elements connected with the leading end portion of said tracheal tube; and

means for conducting fluid pressure along said tracheal tube to said expandable elements to effect expansion of said expandable elements.

29. An apparatus for use in tracheal intubination of a patient, said apparatus comprising a tracheal tube which is movable along an insertion path into a patient'"'"'s trachea, an emitter connected with a leading end portion of said tracheal tube, said emitter being effective to provide an output during movement of said tracheal tube along the insertion path, a plurality of detectors disposed in an array adjacent to the patient'"'"'s Adam'"'"'s apple, each detector of said plurality of detectors being responsive to the output from said emitter and means connected with said plurality of detectors for determining the position of the leading end portion of said tracheal tube along the insertion path as a function of outputs from said plurality of detectors during movement of said tracheal tube along the insertion path, and a positioning assembly which is engagable with the patient'"'"'s Adam'"'"'s apple to locate said positioning assembly, and a guide surface connected with said positioning assembly to guide movement of said tracheal tube relative to the patient'"'"'s body.

30. An apparatus for use in tracheal intubination of a patient, said apparatus comprising a tracheal tube which is movable along an insertion path into a patient'"'"'s trachea, a detector connected with a leading end portion of said tracheal tube for movement therewith along the insertion path, and a plurality of emitters disposed in an array adjacent to the patient'"'"'s Adam'"'"'s apple, each emitter of said plurality of emitters being effective to provide an output which is detectable by said detector, and means connected with said detector for determining the position of the leading end portion of said tracheal tube as a function of the output from said plurality of emitters detected by said detector during movement of said tracheal tube along the insertion path.

31. An apparatus as set forth in claim 30 further including steering means connected with the leading end portion of said tracheal tube for applying force against the leading end portion of said tracheal tube during movement of said tracheal tube along the insertion path.

32. An apparatus as set forth in claim 30 further including a plurality of expandable elements connected with the leading end portion of said tracheal tube and means for conducting fluid pressure along said tracheal tube to said expandable elements to effect expansion of said expandable elements.

33. An apparatus as set forth in claim 30 further including a positioning assembly which is engagable with the patient'"'"'s Adam'"'"'s apple to locate said positioning assembly, and a guide surface connected with said positioning assembly to guide movement of said tracheal tube relative to the patient'"'"'s body.

34. An apparatus as set forth in claim 30 wherein each emitter of said plurality of emitters includes a magnet which emits a magnetic field, said detectors being responsive to the magnetic field emitted by said magnet of each of said emitters of said plurality of emitters.

35. A method of tracheal intubination, said method comprising the steps of locating a positioning apparatus relative to a patient'"'"'s trachea by engaging the patient'"'"'s Adam'"'"'s apple with the positioning apparatus, providing a sensor system having a first portion, a second portion and a third portion, positioning the first portion of the sensor system adjacent to the patient'"'"'s Adam'"'"'s apple, moving a guide rod relative to the positioning apparatus into the patient'"'"'s respiratory system along an insertion path with the second portion of the sensor system connected with a leading end portion of the guide rod, said step of moving the guide rod relative to the positioning apparatus being performed with the positioning apparatus in engagement with the patient'"'"'s Adam'"'"'s apple, determining when the leading end portion of the guide rod is in a desired position relative to the patient'"'"'s trachea as a function of cooperation between the first portion of the sensor system positioned adjacent to the patient'"'"'s Adam'"'"'s apple and the second portion of the sensor system connected with the leading end portion of the guide rod, interrupting movement of the guide rod relative to the positioning apparatus in response to determining that the leading end portion of the guide rod is in the desired position relative to the patient'"'"'s trachea, thereafter, disengaging the positioning apparatus from the guide rod, moving a tracheal tube along the guide rod into the patient'"'"'s trachea with the third portion of the sensor system connected with a leading end portion of the tracheal tube, determining when the leading end portion of the tracheal tube is in a desired position relative to the patient'"'"'s trachea as a function of cooperation between the first portion of the sensor system positioned adjacent to the patient'"'"'s Adam'"'"'s apple and the third portion of the sensor system connected with the leading end portion of the tracheal tube, and interrupting movement of the tracheal tube relative to the guide rod in response to determining that the leading end portion of the tracheal tube is in the desired position relative to the patient'"'"'s trachea.

36. A method as set forth in claim 35 further including the step of steering the leading end portion of the guide rod as the leading end portion of the guide rod moves along the insertion path by expanding an expandable element connected with the leading end portion of the guide rod.

37. A method of treating a patient, said method comprising the steps of locating a positioning apparatus relative to a portion of the patient'"'"'s body by engaging the patient'"'"'s body with the positioning apparatus, wherein a portion of the positioning apparatus is positioned adjacent to an Adam'"'"'s apple of the patient, determining a position to which a elongated member is to be moved relative to the positioning apparatus, moving the elongated member into the patient'"'"'s body while the positioning apparatus is in engagement with the patient'"'"'s body, interrupting movement of the elongated member into the patient'"'"'s body when the elongated member has moved to the previously determined position relative to the positioning apparatus, and performing a procedure in the patient'"'"'s body while the elongated member is in the previously determined position relative to the patient'"'"'s body.

38. A method as set forth in claim 37 wherein said step of moving an elongated member into the patient'"'"'s body includes moving at least a portion of the elongated member though a portion of the positioning apparatus which is aligned with an opening in the patient'"'"'s body.

39. A method as set forth in claim 37 wherein said step of locating the positioning apparatus relative to a portion of the patient'"'"'s body includes varying the spatial relationship between first and second portions of the positioning apparatus, said step of determining a position to which the elongated member is to be moved relative to the patient'"'"'s body includes determining the position as a function of the spatial relationship between the first and second portions of the positioning apparatus after the positioning apparatus has been located relative to the patient'"'"'s body and when the positioning apparatus is disposed in engagement the with the patient'"'"'s body.

40. A method as set forth in claim 37 further including the step of disengaging the positioning apparatus from the elongated member prior to performance of said step of performing a procedure in the patient'"'"'s body, said step of disengaging the positioning apparatus from the elongated member is performed with a portion of the elongated member in the patient'"'"'s body.

41. A method as set forth in claim 37 wherein said step of moving a guide rod relative to the positioning apparatus includes sliding the elongated member along a guide surface connected with the positioning apparatus, said method further including separating the positioning apparatus from the elongated member while the elongated member extends into the patient'"'"'s body, and, thereafter, performing said procedure in the patient'"'"'s body.

42. A method as set forth in claim 37 wherein said step of engaging a portion of the patient'"'"'s body with the positioning apparatus includes engaging spaced apart location on the patient'"'"'s body with the positioning apparatus.

43. A method as set forth in claim 37 wherein said step of moving the elongated member into the patient'"'"'s body includes detecting when a leading end portion of the elongated member is in a position other than a desired position and applying force against the leading end portion of the elongated member to move the leading end portion of the elongated member toward the desired position.

44. A method as set forth in claim 37 further including the step of transmitting an image from a leading end portion of the elongated member to a location outside of the patient to facilitate visualization of tissue disposed in the patient'"'"'s body adjacent to the leading end portion of the elongated member.

45. A method set forth in claim 37 further including the steps of providing a sensor assembly having an emitter portion which provides an output and a detector portion which responds to the output from the emitter portion, moving one of the emitter and detector portions of the sensor assembly into the patient'"'"'s body with a leading end portion of the elongated member as the elongated member moves into the patient'"'"'s body, positioning one of the emitter and detector portions of the sensor assembly adjacent to the portion of the patient'"'"'s body engaged by the positioning apparatus, and determining when the leading end portion of the elongated member is in a desired position relative to the patient'"'"'s body as a function of a response from the detector portion of the sensor assembly during movement of the elongated member into the patient'"'"'s body.

46. A method as set forth in claim 45 wherein said step of moving one of the emitter and detector portions of the sensor assembly into the patient'"'"'s body with the leading end portion of the elongated member includes moving the emitter portion of the sensor assembly into the patient'"'"'s body with the leading end portion of the elongated member, said step of positioning one of the emitter and detector portions of the sensor assembly adjacent to the portion of the patient'"'"'s body engaged by the positioning apparatus includes positioning the detector portion of the sensor assembly adjacent to the portion of the patient'"'"'s body engaged by the positioning apparatus.

47. A method as set forth in claim 46 wherein said step of moving the emitter portion of the sensor assembly into the patient'"'"'s body with the leading end portion of the elongated member includes moving a magnet into the patient'"'"'s body with the leading end portion of the elongated member, said step of positioning the detector portion of the sensor assembly adjacent to the portion of the patient'"'"'s body engaged by the positioning apparatus includes positioning a device which responds to a magnetic field adjacent to the patient'"'"'s Adam'"'"'s apple.

48. A method as set forth in claim 45 wherein said step of moving one of the emitter and detector portions of the sensor assembly into the patient'"'"'s body with the leading end portion of the elongated member includes moving the detector portion of the sensor assembly into the patient'"'"'s body with the leading end portion of the elongated member, said step of positioning one of the emitter and detector portions of the sensor assembly adjacent to the portion of the patient'"'"'s body engaged by the positioning apparatus includes positioning the emitter portion of the sensor assembly adjacent to the portion of the patient'"'"'s body engaged by the positioning apparatus.

49. A method as set forth in claim 48 wherein said step of moving the detector portion of the sensor assembly into the patient'"'"'s body with the leading end portion of the elongated member includes moving a device which responds to magnetic fields into the patient'"'"'s body with the leading end portion of the elongated member, said step of positioning the emitter portion of the sensor assembly adjacent to the portion of the patient'"'"'s body includes positioning a magnet abjacent to the portion of the patient'"'"'s body.

50. A method as set fort in claim 37 wherein said step of moving an elongated member into the patient'"'"'s body includes moving a plurality of expandable elements into the patient'"'"'s body with the elongated member and expanding at least one of the plurality of expandable elements as the leading end portion of the elongated member is moved relative to the patient'"'"'s body.

51. A method as set forth in claim 37 wherein said step of moving the elongated member into the patient'"'"'s body includes steering the leading end portion of the elongated member by expanding an expandable element connected with the leading end portion of the elongated member.

52. A method of treating a patient, said method comprising the steps of locating a positioning apparatus relative to a portion of the patient'"'"'s body by engaging the patient'"'"'s body with the positioning apparatus, determining a position to which a elongated member is to be moved relative to the positioning apparatus, moving the elongated member into the patient'"'"'s body while the positioning apparatus is in engagement with the patient'"'"'s body, magnetically attracting a leading end portion of the elongated member with a magnet disposed outside of the patient'"'"'s body during performance of said step of moving the elongated member into the patient'"'"'s body, interrupting movement of the elongated member into the patient'"'"'s body when the elongated member has moved to the previously determined position relative to the positioning apparatus, and performing a procedure in the patient'"'"'s body while the elongated member is in the previously determined position relative to the patient'"'"'s body.

53. A method of treating a patient, said method comprising the steps of locating a positioning apparatus relative to a portion of the patient'"'"'s body by engaging the patient'"'"'s body with the positioning apparatus, determining a position to which a elongated member is to be moved relative to the positioning apparatus, moving the elongated member into the patient'"'"'s body while the positioning apparatus is in engagement with the patient'"'"'s body, positioning a magnet adjacent to a portion of the patient'"'"'s body and promoting movement of a leading end portion of the elongated member into the patient'"'"'s body under the influence of a magnetic field emanating from the magnet during movement of the elongated member into the patient'"'"'s body, interrupting movement of the elongated member into the patient'"'"'s body when the elongated member has moved to the previously determined position relative to the positioning apparatus, and performing a procedure in the patient'"'"'s body while the elongated member is in the previously determined position relative to the patient'"'"'s body.

54. A method of treating a patient, said method comprising the steps of locating a positioning apparatus relative to a portion of the patient'"'"'s body by engaging the patient'"'"'s body with the positioning apparatus, determining a position to which a elongated member is to be moved relative to the positioning apparatus, moving the elongated member into the patient'"'"'s body while the positioning apparatus is in engagement with the patient'"'"'s body, interrupting movement of the elongated member into the patient'"'"'s body when the elongated member has moved to the previously determined position relative to the positioning apparatus, and performing a procedure in the patient'"'"'s body while the elongated member is in the previously determined position relative to the patient'"'"'s body, wherein said step of moving an elongated member into the patient'"'"'s trachea includes moving a light source with the leading end portion of the elongated member and detecting when the light source is in a position corresponding to a desired position of the leading end portion of the elongated member by observing light emitted from the light source from outside of the patient'"'"'s body.