Flexible instrument

• US 7,371,210 B2
• Filed: 11/16/2001
• Issued: 05/13/2008
• Est. Priority Date: 02/24/1998
• Status: Expired due to Fees

• Current Assignee: Auris Health, Inc. (Johnson & Johnson)
• Original Assignee: Hansen Medical Incorporated (Johnson & Johnson)
• Inventors: Rogers, Gary, Brock, David L., Weitzner, Barry, Lee, Woojin
• Primary Examiner(s): Philogene; Pedro
• Application Number:
  US10/012,586
• Publication Number:
  US 20020087049A1
• Time in Patent Office: 2,370 Days
• Field of Search: 600/114, 600/101, 600/109, 600/104, 600/146, 600/139, 600/117, 600/118, 606/1, 606/130, 606/159, 606/180, 604/95, 604/159, 128/898
• US Class Current: 600/114
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/0682 for applying U-shaped staples or clamps, e.g. without a forming anvil
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00088 using thermistors
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00331 with preformed bends
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/00986 Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61B 2017/0464 : for soft tissue
• CPC Class Codes: A61B 2017/0645 : being elastically deformed for insertion
• CPC Class Codes: A61B 2017/0648 : threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2017/22069 : Immobilising; Stabilising
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2939 : Details of linkages or pivot points
• CPC Class Codes: A61B 2034/2051 : Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2059 : Mechanical position encoders
• CPC Class Codes: A61B 2034/301 : for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2034/305 : Details of wrist mechanisms at distal ends of robotic arms
• CPC Class Codes: A61B 2034/715 : Cable tensioning mechanisms for removing slack
• CPC Class Codes: A61B 2034/742 : Joysticks
• CPC Class Codes: A61B 2034/744 : Mouse
• CPC Class Codes: A61B 2090/365 : augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/506 : using a parallelogram linkage, e.g. panthograph
• CPC Class Codes: A61B 34/10 : Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 34/35 : for telesurgery
• CPC Class Codes: A61B 34/37 : Master-slave robots A61B34/35 takes precedence
• CPC Class Codes: A61B 34/70 : Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 34/71 : Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 34/72 : Micromanipulators
• CPC Class Codes: A61B 34/77 : Manipulators with motion or force scaling
• CPC Class Codes: A61B 5/0084 : for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/015 : By temperature mapping of body part
• CPC Class Codes: A61B 5/4893 : Nerves
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61F 2/2445 : Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2/2466 : Delivery devices therefor
• CPC Class Codes: B25J 3/04 : involving servo mechanisms servo-actuated heads B25J15/02
• CPC Class Codes: B25J 9/104 : with cables, chains or ribbons

Abstract

A remote control flexible instrument system, employing a shaft which supports a tool, is described in which the has proximal and distal ends with at least a portion thereof extending through a lumen of the human body so as to locate the shaft at an internal target site. A master station including an input device provides control of the instrument situated at a slave station. The master station can control at least one degree-of-freedom of the flexible instrument. A controller intercouples the master and slave stations and is operated in accordance with a computer algorithm that receives a command from the input device for controlling at least one degree-of-freedom of the catheter so as to respond in accordance with action at the input device. The flexible instrument further comprises a controlled flexible segment along the shaft, for controlled bending at the flexible segment to guide the shaft and to dispose the tool at an operative site.

Claims

1. A medical device comprising:

a flexible guide shaft for being disposed through a vascular lumen and having a distal end for being disposed at a predetermined location in a subject;

a single flexible inner shaft having a proximal end and a distal end supporting at its distal end an articulating tool, the inner shaft being insertable into the guide shaft so as to dispose the tool at an operative site; and

a drive unit coupled with the inner shaft for providing controlled actuation of tool, the drive unit being remote controllably drivable by a user via an electrical controller form a manually controllable device.

2. The device of claim 1, wherein the flexible inner shaft includes at its proximal end a mechanically drivable mechanism drivably coupled to the tool via at least a first mechanical cabling and at least a second mechanical cable intercoupling the drive unit and the mechanically drivable mechanism.

10. The device of claim 1, wherein the flexible inner shaft has a controlled flexible segment controlled from the drive unit for controlling a bending action thereat.

18. The device of claim 1, further comprising an input device and an electrical computation system coupled to the drive unit, the computation system capable of receiving commands from the input device thereby operating the drive unit.

3. A medical device comprising:

a flexible guide shaft having a distal end for being disposed at a predetermined location in a subject;

a flexible inner shaft having a proximal end and a distal end supporting at its distal end a tool, the inner shaft being insertable into the guide shaft so as to dispose the tool at an operative site;

a drive unit coupled with the inner shaft for providing controlled actuation of the tool, the drive unit being remote controllably drivable by a user via a manually controllable device;

wherein the flexible inner shaft includes at its proximal end a mechanically drivable mechanism drivably coupled to the tool; and

a mounting mechanism drivably intercoupled with the drive unit, the mechanically drivable mechanism being readily mountable on the mounting mechanism to enable drivable intercoupling from the drive unit through the mounting mechanism to the mechanically drivable mechanism.

4. The device of claim 3, wherein the drive unit is disposed at a first location remote from a second location at which the mounting mechanism is disposed, and further including at least a first tendon intercoupling the drive unit and the mounting mechanism and at least a second tendon intercoupling the mechanically drivable mechanism and the tool.

5. The device of claim 3, wherein the drive unit comprises a plurality of motors, each motor being readily drivably interconnected to and disconnected from the mechanically drivable mechanism.

6. The device of claim 5, wherein the drive unit is readily manually portable.

7. The device of claim 3, wherein the mounting mechanism is readily engageable with the disengageable from the mechanically drivable mechanism.

8. The device of claim 7, wherein the flexible shafts extend to the mechanically drivable mechanism, the flexible shafts and mechanically drivable mechanism being readily manually portable.

9. A medical device comprising:

a flexible guide having a distal end for being disposed at a predetermined location in a subject;

a flexible inner shaft having a proximal end and a distal end supporting at its distal end a tool, the inner shaft being insertable into the guide shaft so as to dispose the tool at an operative site;

a drive unit coupled with the inner shaft for providing controlled actuation of the tool, the drive unit being remote controllably drivable by a user via an electrical controller from a remote manually controllable device;

wherein the guide shaft supports an inflatable balloon, for holding the distal end of the flexible guide shaft at the predetermined location against an anatomic wall of the subject.

11. A medical device comprising:

flexible guide shaft having a distal end for being disposed at a predetermined location in a subject;

a flexible inner shaft having a proximal end and a distal end supporting at its distal end a tool, the inner shaft being insertable into the guide shaft so as to dispose the tool at an operative site; and

a drive unit coupled with the inner shaft for providing controlled actuation of the tool, the drive unit being remote controllably drivable by a user from an electrical controller via a manually controllable device;

wherein the flexible inner shaft has a controlled flexible segment controlled from the drive unit for controlling a bending action thereat;

wherein the flexible guide shaft has a controlled flexible segment controlled from the drive unit for controlling a bending action thereat.

12. The device of claim 11, wherein the inner shaft and the tool is constructed and arranged as a single piece disposable unit, and the controlled bending action is controlled from the manually controllable device via an electrical controller.

13. The device of claim 12, wherein the flexible guide shaft is disposable.

14. A medical device comprising:

a flexible guide shaft having a distal end for being disposed at a predetermined location in a subject;

a flexible inner shaft having a proximal end and a distal end that is connected to a tool used in performing a medical procedure, the inner shaft being insertable into the guide shaft so as to dispose the tool at an operative site; and

a drive unit coupled with the inner shaft for providing controlled movement thereof and actuation of the tool, the drive unit being remote controllably drivable by a user from an electrical controller via a manually controllable device;

wherein the drive unit also intercouples with the flexible guide shaft for controlled movement thereof;

whereby user initiated independent control of movement of both the flexible guide shaft and the flexible inner shaft is a via the drive unit from the remote manually controllable device.

15. The device of claim 14, wherein the flexible guide shaft has at least one controlled flexible segment and the drive unit controls bending at the flexible segment of the flexible guide shaft.

16. The device of claim 15, wherein the flexible inner shaft has at least one controlled flexible segment and the drive unit controls bending at the flexible segment of the flexible inner shaft, and wherein the flexible segments of both shafts are positioned about their distal ends.

17. The device of claim 14, further comprising cabling extending along the inner shaft, controlled from the drive unit, and for actuation of the tool and cabling extending between the drive unit and the proximal end of the flexible inner shaft.

19. A medical device comprising:

a flexible inner shaft inserted within a flexible guide shaft, a tool being disposed at a distal end of the inner shaft for insertion into a subject;

a drive unit coupled with the inner shaft and the guide shaft separately, the drive unit capable of independently effecting movement of each shaft to at least one degree of freedom for the flexible guide shaft and at least two degrees of freedom for the flexible inner shaft; and

a user input interface including an electrical controller remote from the drive unit, for remote controllable manipulating the inner and guide shafts;

wherein at least one of said flexible inner shaft and said flexible guide shaft has a controlled flexible segment controlled from the user input interface via the drive unit for controlling a bending action thereat.

20. A medical device comprising:

a flexible guide shaft having a distal end for being disposed at a predetermined location in a subject;

a flexible disposable inner shaft having a proximal end and a distal end supporting at its distal end a tool, the inner shaft being insertable through the guide shaft so as to dispose the tool at an operative site;

a drive unit coupled with the inner shaft for providing controlled actuation of the tool and controlled deformation of one or more flexible portions of the inner shaft, the drive unit being remote controllable drivable by a user via a manually controllable device;

wherein the proximal end of the inner shaft includes a mechanically drivable mechanism drivably couplable to the drive unit, the mechanically drivable mechanism being disposable together with the tool as a unit; and

a mounting mechanism drivably intercoupled with the drive unit, the mechanically drivable mechanism being removably mountable on the mounting mechanism to enable drivable intercoupling from the drive unit through the mounting mechanism to the mechanically drivable mechanism.

21. The device of claim 20 wherein the drive unit couples with the flexible guide shaft for providing controlled deformation of one or more flexible portions of the flexible guide shaft.

22. The device of claim 20, wherein the drive unit is disposed at a first location remoter from a second location at which the mounting mechanism is disposed and the drive unit is controlled from the manually controllable device via an electrical controller.

23. The device of claim 20, wherein the drive unit comprised couples with the flexible guide shaft for providing controlled deformation of one or more flexible portions of the flexible guide shaft.

24. The device of claim 20, wherein the flexible guide shaft is inserted through a body lumen to reach the operative site.

25. The device of claim 20, wherein the drive unit is disposed in a stationary position.

26. The device of claim 20, wherein the drive unit is disposed remotely from the sterile field.

27. The device of claim 20, wherein at least said flexible guide shaft is constructed and arranged so that its physical properties mat at least some length thereof inherently and sufficiently deformable so as to enable it to readily pass atraumatically into a body lumen.

28. A remotely controllable flexible instrument system for performing a medical procedure on a subject, comprising:

a flexible instrument shaft having proximal and distal ends, carrying a tool at the distal end thereof, and insertable into the subject so as to dispose the tool at an internal target site where the medical procedure is to be performed;

a flexible guide shaft constructed and arranged so that at least some length thereof is inherently and sufficiently deformable so to readily flex and pass atraumatically through an anatomic lumen of the subject;

said flexible instrument shaft nested in a receiving passage of the flexible guide shaft and adapted to pass and be guided therethrough for positioning the tool at the internal target site;

a drive unit coupled with the flexible instrument shaft for providing controlled movement of the flexible instrument shaft with at least two degree of freedom, one of which is tool actuation and coupled with the flexible guide shaft for providing at least one degree of freedom of movement thereof; and

a user input interface controlled by a medical practitioner, remote from the drive unit, and coupled via an electrical controller which receives commands from the interface and transmit signals to the drive unit in accordance with manipulations of the medical practitioner for controlling with movement of the flexible shafts.

29. The system of claim 28 wherein said flexible instrument shaft is controlled with at least three degrees of freedom and has a controllably flexible section that is remotely controlled from said user input interface for selective bending of the flexible instrument shaft.

30. The system of claim 29 wherein said flexible guide shaft is controlled with at least two degrees of freedom and has a controllably flexible section that is remotely controlled from said user input interface for selective bending of the flexible guide shaft.

31. The system of claim 28 including a third shaft nested with the instrument and guide shafts, and remotely controllable from the user input interface.

32. The system of claim 28 wherein the drive unit comprises a plurality of control motors for controlling respective degrees of freedom of movement of the flexible instrument shaft.

33. The system of claim 32 wherein all of the plurality of motors are maintained in a stationary position even as the flexible instrument shaft is moved.

34. The system of claim 28 wherein the flexible instrument shaft is disposable.

35. The system of claim 28 further including a mechanically drivable mechanism at the proximal end of the flexible instrument shaft and drivably coupled to the tool, and a mounting mechanism drivably intercoupled with the drive unit, the mechanically drivable mechanism being removably mountable on the mounting mechanism for drivable intercoupling with the drive unit.

36. The system of claim 35 including a coupling member for enabling ready engagement with and disengagement between the mechanically drivable mechanism and the mounting mechanism.

37. A remotely controllable flexible instrument system for performing a medical procedure on a subject, comprising:

a flexible guide shaft having a distal end for being disposed at a predetermined location in the subject;

a flexible working shaft having a proximal end and a distal end, supporting at its distal end a tool, the flexible working shaft being insertable through the flexible guide shaft so as to be nested therewith and to dispose the tool at an internal operative site of the subject;

an electrically driven drive unit mechanically coupled with the flexible working shaft for providing controlled actuation of the tool; and

a user input interface controlled by a medical practitioner, remote from the drive unit, and coupled via an electrical controller which receives commands from the interface and transmits signals to the drive unit in accordance with manipulations of the medical practitioner for controlling the movement of the flexible working shaft;

said drive unit comprising one or more stationary motors mechanically, removably and drivably interconnected to the proximal end of the flexible working shaft.

38. The system of claim 37 wherein the majority of motors are maintained in a stationary position.

39. The system of claim 37 wherein at least the motor that controls the tool is maintained in a stationary position.

40. The system of claim 37 wherein two or more of said motors are maintained in a stationary position.

41. The system of claim 37 wherein said flexible working shaft has a controllably flexible section that is remotely controlled from said user input interface for selective bending of the flexible working shaft.

42. The system of claim 41 wherein said flexible guide shaft has a controllably flexible section that is remotely controlled from said user input interface for selective bending of the flexible guide shaft.

43. The system of claim 37 including a third shaft nested with the working and guide shafts, and remotely controllable from the user input interface.

44. A method of remotely controlling a flexible instrument system, comprising:

providing a flexible instrument shaft having a distal end that interconnects with a tool, the shaft further including at a proximal end thereof a mechanically drivable mechanism for controlling the tool at an operative site of a patient;

providing a flexible guide shaft having a distal end directed to said operative site;

inserting the flexible guide shaft into an anatomic vascular lumen, the flexible guide shaft adapted to conform to the configuration of the anatomic lumen;

inserting the flexible instrument shaft into and through the flexible guide shaft so as to dispose the tool at the operative site;

mechanically controlling the tool, via a drive unit and an electrical controller, and from an user input interface; and

independently activating the flexible instrument shaft and the flexible guide shaft by operating the drive unit at a location remote from the shaft, so as to thereby effect positioning of the tool at the operative site.

45. The method of claim 44 wherein the flexible instrument shaft carries an articulating tool that can pivot outside of a longitudinal axis of the shaft.

46. The method of claim 44, wherein the step of inserting of the flexible guide shaft comprises providing a percutaneous access.

47. The method of claim 44, wherein said step of inserting the flexible guide shaft comprises providing access through a natural body orifice.

48. The method of claim 44, including providing at least one controlled flexible segment about the distal end of the instrument shaft capable of bending and controlled from the user input device for positioning the tool at the operative site.

49. The method of claim 48, including providing at least one controlled flexible segment about the distal end of the guide shaft capable of bending and controlled from the user input device.

50. A method of remotely controlling a flexible instrument, comprising:

providing a flexible guide shaft;

providing a flexible inner shaft having a working distal end adapted for insertion into a subject to an operative site;

inserting the flexible guide shaft into the subject;

inserting the flexible inner shaft into and through the flexible guide shaft so as to dispose the working end at the operative site;

activating movement of the flexible inner shaft with at least three degrees of freedom including activation of the working distal end;

activating the flexible guide shaft, independently from the flexible inner shaft, and with at least one degree of freedom; and

controlling the activating from a user input interface remote from the shafts, for remote controllably manipulating the flexible inner and guide shafts.

51. The method of claim 50 wherein the step of activating the flexible guide shaft includes operating a tool at the working end whereby the tool can turn to a position outside of a longitudinal axis of the shaft.

52. The method of claim 50 including providing a remote controllable segment of both the flexible guide shaft and the flexible instrument shaft, and the activating step includes remote controlling the segments from the input interface via an electrical computation means.

53. A method of remotely controlling a flexible instrument, comprising:

providing a flexible guide shaft;

providing a flexible inner shaft carrying a tool that is actuable, disposed at a distal end of the flexible inner shaft and adapted for insertion into a subject to an operative site;

inserting the flexible guide shaft into the subject through a vascular lumen;

inserting the flexible inner shaft into and through the flexible guide shaft so as to dispose the tool at the operative site;

controlling operation of said tool;

activating the flexible guide shaft with at least one degree of freedom to, in turn, control disposition of said flexible inner shaft; and

controlling the activating of said flexible guide shaft from a user input interface having a manually operable input device via an electrical interface for remote controllably manipulating the flexible guide shaft.

54. The method of claim 53 wherein the step of activation the flexible guide shaft includes operating a flexible segment of the flexible guide shaft.

55. The method of claim 53 including operating the flexible inner shaft via a remote controllable flexible segment thereof.

56. The method of claim 55 including operating the flexible guide shaft via a remote controllable flexible segment thereof.

57. A remotely controllable flexible instrument, comprising:

a flexible guide shaft; and

a flexible inner shaft having a working distal end adapted for insertion into a subject to an operative site;

said flexible guide shaft being inserted into the subject and receiving therethough the flexible guide shaft so as to dispose the working end at the operative site;

said flexible inner shaft being controlled with at least two degrees of freedom, one of which is activation of the working distal end;

said flexible guide shaft being controlled, independently from the flexible inner shaft, and with at least one degree of freedom;

said shafts being controlled from a user input interface remote from the shaft, for remote controllably manipulating the flexible inner and guide shafts.

58. The instrument of claim 57 wherein said working distal end includes an articulating tool having a pivot for moving the tool away from a longitudinal axis of the inner shaft.

59. The instrument of claim 58 including a wrist coupled between the shaft and tool.

60. The instrument of claim 59 wherein the flexible inner shaft is controlled with at least three degrees of freedom.

61. The instrument of claim 57 wherein said working distal end comprises a medical procedure mechanism that is actuated by at least one cable.

62. The instrument of claim 57 wherein the shafts are controlled via an electrical controller.

63. A method of remotely controlling a flexible instrument, comprising:

providing a flexible guide shaft having at least one remotely controllable bendable segment disposed therealong;

providing a flexible inner shaft carrying a tool disposed at a distal end of the flexible inner shaft and adapted for insertion into a subject to an operative site;

inserting the flexible guide shaft into the subject through a vascular lumen;

inserting the flexible inner shaft into and through the flexible guide shaft so as to dispose the tool at the operative site;

activating the flexible guide shaft with at least one degree of freedom to, in turn, control disposition of said flexible inner shaft; and

controlling the activating of said flexible guide shaft from a user input interface having a manually operable input device via an electrical controller for remote controllably manipulating the flexible guide shaft.

64. The method of claim 63 including controlling the activating of the flexible guide shaft by controlling the bending of a flexible segment of the flexible guide shaft.

65. The method of claim 64 including controlling an activating of the flexible inner shaft by controlling a bending of a flexible segment of the flexible inner shaft.

66. The method of claim 65 including controlling the tool and the flexible segments from the manually operable input device, and via the electrical controller.

67. A medical device for performing a medical procedure at an operative site of a patient, said medical device comprising:

a flexible guide shaft having a proximal end for being disposed outside the patient and a distal end for being disposed adjacent the operative site;

said flexible guide shaft positioned for passage through a vascular lumen to the operative site;

a flexible inner shaft having a proximal end and a distal end, said distal end supporting a tool used in performing the medical procedure;

said flexible inner shaft nested in a receiving passage of the flexible guide shaft and adapted to be received in and threaded through the flexible guide shaft for positioning the tool at the internal target site;

said flexible guide shaft having a flexible segment that is remotely controlled for controlling a bending action thereat so as to direct the location of the flexible inner shaft;

said flexible guide shaft having at its proximal end a mechanically drivable mechanism for controlling said flexible segment.

68. The medical device of claim 67 wherein said inner shaft comprises an inner instrument tube, and further having at least one cable extending through said inner instrument tube for actuating said tool.

69. The medical device of claim 67 including a mounting mechanism drivably intercoupled with a drive unit, the mechanically drivable mechanism being readily mountable on the mounting mechanism to enable drivable intercoupling from the drive unit through the mounting mechanism to the mechanically drivable mechanism.

70. The medical device of claim 69, wherein the drive unit is disposed at a first location remote from a second location at which the mounting mechanism is disposed, and further including at least a first tendon intercoupling the drive unit and the mounting mechanism and at least a second tendon intercoupling the mechanically drivable mechanism and the tool.

71. A medical device for performing a medical procedure at an operative site of a patient, said medical device comprising:

a flexible guide shaft having a proximal end for being disposed outside the patient and a distal end for being disposed adjacent the operative site;

a flexible inner shaft having a proximal end and a distal end supporting at its distal end a tool;

said flexible inner shaft nested in a receiving message passage of the flexible guide shaft and adapted to be received in and threaded through the flexible guide shaft for positioning the tool at the internal target size;

said flexible guide shaft having a flexible segment that is remotely controlled for controlling a bending action thereat so as to direct the location of the flexible inner shaft;

said flexible guide shaft having at its proximal end a mechanically drivable mechanism drivably coupled to said flexible segment;

said mechanically drivable mechanism being removably mountable on a mounting mechanism to enable drivable intercoupling from an external drive through the mounting mechanism to the mechanically drivable mechanism.

72. The medical device of claim 71 including at least one stationary motor for providing mechanical drive to the mechanically drivable mechanism.

73. The medical device of claim 71 wherein said flexible guide shaft is positioned for passage through a vascular lumen to the operative site.

74. A method of remotely controlling a flexible instrument, comprising:

providing a flexible guide shaft;

providing a flexible inner shaft carrying a tool that is cable actuated, disposed at a distal end of the flexible inner shaft and adapted for insertion into a subject to an operative site;

inserting the flexible guide shaft into the subject through a vascular lumen;

threading the flexible inner shaft into and through the flexible guide shaft so as to dispose the tool at the operative site;

activating the flexible guide shaft with at least one degree of freedom to, in turn, control disposition of said flexible inner shaft; and

controlling the operation of said tool.

75. The method of claim 74 wherein the step of activating the flexible guide shaft with at least one degree of freedom includes providing a flexible segment of the flexible guide shaft that is remotely controlled for controlling a bending action thereat so as to direct the location of the flexible inner shaft.

76. The method of claim 75 wherein the activating step include activating said flexible guide shaft from a user input interface having a manually operable input device via an electrical controller for remote controllably manipulating the flexible guide shaft.

77. A remotely controllable flexible instrument system for performing a medical procedure on a subject, comprising:

a flexible instrument shaft having proximal and distal ends, and insertable into the subject so as to dispose the distal end at an internal target site where the medical procedure is to be performed;

a flexible guide shaft constructed and arranged so that at least some length thereof is inherently and sufficiently deformable so to readily flex and pass atraumatically through an anatomic vascular lumen of the subject;

said flexible instrument shaft nested in a receiving passage of the flexible guide shaft and adapted to pass and be threaded therethrough for positioning the distal end at the internal target site;

a drive unit coupled with the flexible guide shaft for providing at least one degree of freedom of movement thereof; and

a user input interface controlled by a medical practitioner, remote from the drive unit, and coupled via an electrical controller which receives commands from the interface and transmits signals to the drive unit in accordance with manipulations of the medical practitioner for controlling the movement of the flexible guide shaft.

78. The system of claim 77 wherein said flexible guide shaft has a controllably flexible section that is remotely controlled from said user input interface for selective bending of the flexible instrument shaft.

79. The system of claim 77 wherein the drive unit comprises at least one stationary motor.

80. The system of claim 78 wherein the flexible guide shaft has at its proximal end a mechanically drivable mechanism for controlling said flexible section.

81. The system of claim 80 including a mounting mechanism drivably intercoupled with the drive unit, the mechanically drivable mechanism being removably mountable on the mounting mechanism to enable drivable intercoupling from the drive unit though the mounting mechanism to the mechanically drivable mechanism.

82. A method of remotely controlling a flexible instrument system, comprising:

providing a flexible instrument shaft having a working distal end;

providing a flexible guide shaft having a distal end directed to said operative site, the flexible guide shaft further including at a proximal end thereof a mechanically drivable mechanism for controlling the position of the flexible guide shaft;

inserting the flexible guide shaft into an anatomic lumen;

threading the flexible instrument shaft into and through the flexible guide shaft so as to dispose the working end at the operative site;

mechanically controlling the working end; and

activating a controllable flexible section of the flexible guide shaft by operating a stationary drive unit form a user interface input device that is remote from the shaft via an electrical controller, so as to thereby effect positioning of the flexible instrument shaft.

83. A medical device of performing a medical procedure at an internal operative site of a patient, said medical device comprising:

a flexible guide shaft having a proximal end for being disposed outside the patient and a distal end for being disposed adjacent the operative site;

said flexible guide shaft positioned for passage through an anatomic lumen to the operative site;

a flexible inner shaft having a proximal end and a working distal end used in performing the medical procedure;

said flexible inner shaft nested in a receiving passage of the flexible guide shaft and adapted to be received in and threaded through the flexible guide shaft for positioning the working distal end at the operative site;

said flexible guide shaft having a flexible segment that is remotely controlled for controlling a bending action thereat so as to direct the location of the flexible inner shaft;

said flexible guide shaft having at its proximal end a mechanically drivable mechanism for controlling said flexible segment;

said mechanically drivable mechanism comprising at least one rotatable body from which a tendon controls said flexible segment.

84. The medical device of claim 83 including an electro-mechanical drive unit coupled with the inner shaft being remote controllably drivable by a user via an electrical controller from a manually controllable user input device.

85. The medical device of claim 84 including at least one interlocking rotatable element engageable with said rotatable body for transferring mechanical motion from the drive unit to the flexible guide shaft.

86. The medical device of claim 85 including a plurality of rotatable bodies and corresponding rotatable elements for controlling multiple degrees of freedom.