Apparatus and methods for performing minimally-invasive surgical procedures

• US 8,932,208 B2
• Filed: 10/07/2006
• Issued: 01/13/2015
• Est. Priority Date: 05/26/2005
• Status: Active Grant

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Inventors: Kendale, Amar, Perez, Juan I., Villagomez, Fred, Barrigar, Frederick, Lamberti, Joseph N., Agarwal, Amit, Callas, Peter, Stewart, Michael C., Lin, Arthur, Abbott, Ryan, Cantu R., Alfredo
• Primary Examiner(s): Nia, Alireza
• Application Number:
  US11/544,897
• Publication Number:
  US 20070129719A1
• Time in Patent Office: 3,020 Days
• Field of Search: 600/105, 600/114, 600/127, 600/132, 600/153, 600/170, 600/171, 600/172, 600/175, 600/178, 600/129, 600/157, 600/176
• US Class Current: 600/176
• 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 system for performing minimally invasive surgical procedures, said system comprising:

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving an endoscope therein; and

a lens having a bullet shaped configuration forming an elongated distal tip that extends distally with respect to said distal end portion of said elongated body,

wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough.

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

3. The system of claim 2, further comprising a bell rotatably attached to said handle, wherein said bell is rotatable relative to said handle when said system is in an operative configuration.

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

5. The system of claim 1, wherein the second lumen comprises a service port adapted to receive a tool other than an endoscope.

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

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

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

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

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

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

12. The system 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 system of claim 1, wherein said lens is removably mounted to a portion of said distal tip via mechanical connection.

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

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

16. The system 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 first and second lumens of said elongated body, in fluid communication therewith, to function as at least one service port.

17. The system of claim 1, wherein said distal end comprises a protrusion extending distally from a distal end portion of said distal tip, said distal end portion comprising a curved surface converging toward a longitudinal axis of said distal tip.

18. The system of claim 1, further comprising a snare device extending through said second lumen, said snare device having a snare on a distal end thereof.

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

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

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

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

24. The system 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 system of claim 1, further comprising an insert mounted within said elongated body, wherein said insert and said elongated body cooperate to define said first and second lumens, said first and second lumens each being defined by a surface of said elongated body and a surface of said insert, respectively.

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

27. The system 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 first and second lumens formed in cooperation between said elongated main body and said insert.

28. The system of claim 10, further comprising a second tip that is interchangeable with said distal 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 distal tip.

29. The system of claim 1, wherein said distal tip is axially aligned with said first lumen, and wherein said second lumen is not configured for receiving said endoscope therein and is positioned radially outwardly from said first lumen, such that an implement can be delivered though said second lumen and a distal end portion of said implement is deliverable alongside said distal tip.

30. The system of claim 1, further comprising a suction luer in fluid communication with one of said first and second lumens and extending from said proximal end portion of said elongated body.

31. The system of claim 1, further comprising an introducer tube in fluid communication with one of said first and second lumens and extending from said proximal end portion of said elongated body.

32. The system of claim 30, wherein said elongated body comprises three lumens, said system 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.

33. The system of claim 1, wherein said distal tip is releasably attachable to said elongated body.

34. The system of claim 1, further comprising a suction tube extending through one of said first and second lumens and providing fluid communication between said distal and proximal end portions of said elongated body.

35. The system of claim 1, further comprising a suction tube extending through one of said first and second lumens and providing fluid communication between said distal tip and said proximal end portion of said elongated body.

36. The system of claim 1, wherein said distal tip comprises an inner stop configured to prevent distal advancement of a distal end of said endoscope therepast, to establish an offset between the distal end of said distal tip and a distal end of said endoscope.

37. The system 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.

38. The system 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.

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

40. The system of claim 39, wherein said proximal end portion of said elongated body is circular in cross-section.

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

42. The system of claim 1, further comprising a retrieval hook tool extending through one of said first and second lumens, said retrieval hook tool comprising a hook at a distal end thereof.

43. The system of claim 1, further comprising a perforation tool extending through one of said first and second 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.

44. The system of claim 43, 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.

45. The system of claim 1, further comprising a perforation tool extending through one of said first and second 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.

46. The system of claim 1, further comprising a perforation tool extending through one of said first and second 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.

47. The system of claim 1, further comprising a perforation tool extending through one of said first and second 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.

48. The system of claim 1, further comprising a mapping probe tool extending through one of said first and second 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.

49. The system of claim 48, 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.

50. The system of claim 48, 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.

51. The system of claim 1, further comprising a linear ablating probe tool extending through one of said first and second lumens, said linear ablating probe tool comprising a linear ablation element on a distal end portion thereof.

52. The system of claim 1, further comprising a point ablation probe tool extending through one of said first and second lumens, said point ablation probe tool comprising an ablation probe point on a distal tip thereof.

53. The system of claim 1, further comprising a cautery tool extending through one of said first and second lumens, said cautery tool comprising a cauterizing element on a distal end portion thereof.

54. The system of claim 1, further comprising graspers extending through one of said first and second 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.

55. The system of claim 1, further comprising scissors extending through one of said first and second 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.

56. The system 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 system.

57. The system of claim 56, 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.

58. The system of claim 57, 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.

59. The system of claim 1, wherein said first lumen comprises a positioning feature for positioning the endoscope at more than one predetermined location.

60. The system of claim 59, wherein said positioning feature comprises biased sockets configured to receive protrusions on the endoscope therein.

61. The system 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.

62. The system of claim 2, wherein said handle includes proximal and distal stops so that when said endoscope is inserted in said first lumen, 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.

63. The system of claim 1, wherein the elongated body further comprises a semi-flexible sleeve having distal and proximal sleeve end portions and wherein the elongated distal tip is rigid and attachable to a distal end of the elongated body therethrough.

64. The system of claim 63, 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.

65. The system of claim 63, further comprising an endoscope inserted in said sleeve, said endoscope having a flexible or malleable shaft and being positioned for viewing through said distal tip.

66. The system of claim 63, wherein said distal tip comprises at least one port in fluid communication with said at least one lumen in said elongated body.

67. The system of claim 1, wherein the elongated body further comprises a semi-flexible sleeve having distal and proximal sleeve end portions, and wherein the system further comprises a capturing feature extending distally from a distal end of the elongated body.

68. The system of claim 67, 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.

69. The system of claim 68, wherein said capturing feature comprises a snare threaded through openings in the distal tip to extend distally therefrom.

70. The system of claim 69, wherein the elongated body is slidable proximally with respect to the distal tip to cinch down the snare.

71. The system of claim 67, wherein the capturing feature comprises a pad of either a hook or a loop portion of a hook and loop type fastening mechanism.

72. The system of claim 67, wherein the capturing feature comprises a magnet.

73. The system of claim 1, wherein the second lumen 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.

74. The system of claim 73, wherein the tool comprises a snare catheter.

75. The system of claim 73, wherein the lens that is alignable with one of the first lumen that is configured for receiving an endoscope therein.

76. The system of claim 73, wherein the slot extends over a majority of a length of said elongated body.

77. The system device of claim 73, wherein the slot is formed in an eyelet on the distal end portion of the elongated body.

78. The system device of claim 77, 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.

79. The system of claim 73, wherein the slot is formed by a keyed socket on the distal end portion of the elongated member.

80. The system device of claim 73, wherein the second lumen having the slot is asymmetrical in cross-section and forms a cam surface permitting the tool to be rotated into the second lumen.

81. The system of claim 1, further comprising:

an endoscope having an elongated shaft having distal and proximal end portions, wherein the distal tip is attachable to the distal end portion of the endoscope; and

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

82. The system of claim 81, wherein said ring comprises a releasable locking mechanism.

83. The system of claim 81, wherein said tool comprises a snare catheter.

84. The system of claim 1, wherein the elongated body is configured and dimensioned to apply suction through the elongated distal tip attachable to said distal end portion, wherein the elongated distal tip has a proximal opening having an outside diameter that is greater than an outside diameter of the distal end of the elongated body, such that a gap is formed between the elongated distal tip and the elongated body when the elongated distal tip is attached to the aid elongated body, facilitating diffuse application of suction.

85. The system of claim 84, further comprising struts interconnecting said distal tip and said elongated body.

86. The system of claim 1, further comprising a routing snare tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the routing snare tool comprises

a flexible outer tube having sufficient column strength to advance the tool through the second lumen by pushing on a proximal portion of said outer tube from a location outside of the second 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.

87. The system of claim 86, wherein the routing snare tool further comprises a second snare loop fixed to an opposite end of said snare line via heat shrink tubing.

88. The system of claim 87, wherein both ends of said outer tube are chamfered.

89. The system of claim 87, 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.

90. The system of claim 86, wherein said snare loop comprises a kink extending distally from a remainder of said snare loop.

91. The system of claim 86, 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.

92. The system of claim 86, 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.

93. The system of claim 92, wherein said lock comprises an actuator configured to move a clamp into contact with said snare line.

94. The system of claim 92, wherein said lock comprises a pair of locking clasps that are alternatively lockable and releasable by the same actuating movement by a user.

95. The system of claim 1, further comprising a capture tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the snare capture tool comprises

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

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

a ball fixed at a distal end of said mandrel.

96. The system of claim 95, 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.

97. The system of claim 96, further comprising a compressible spring over said layer, a proximal end portion of said spring abutting said handle, said spring having an outside diameter larger than an inside diameter of said second lumen, thereby being prevented from insertion into said second lumen.

98. The system of claim 97, wherein said snare capture tool is configured and dimensioned, so that when said spring is compressed against a proximal end of the second lumen by advancing said handle distally with respect to said second lumen, said ball and at least a portion of said distal end portion not covered by said polymeric layer extend distally from a distal end of said second 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 end portion not covered by said polymeric layer into said second lumen.

99. The system of claim 1, further comprising a retrieval hook tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the retrieval hook tool comprises

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

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

a hook provided at a distal end of said mandrel.

100. The system of claim 99, wherein the retrieval hook tool further comprises 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.

101. The system of claim 99, wherein the retrieval hook further comprises a compressible spring over said mandrel, a proximal end portion of said spring abutting said handle, said spring having aria outside diameter larger than an inside diameter of said second lumen, thereby being prevented from insertion into said second lumen.

102. The system of claim 101, wherein said retrieval hook tool is configured and dimensioned, so that when said spring is compressed against a proximal end of the second lumen by advancing said handle distally with respect to the second lumen, said hook extends distally from a distal end of the second lumen, and when a driving force is released from said handle, said spring expands, thereby retracting said hook into the second lumen.

103. The system of claim 100, wherein said mandrel is offset in said polymeric layer, such that longitudinal axes of said mandrel and said polymeric layer do not coincide.

104. The system of claim 1, further comprising a bolo tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the bolo tool comprises

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

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

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

105. The system of claim 1, further comprising a trigger snare tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the trigger snare tool comprises

an elongated mandrel configured and dimensioned to be slid through the second 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 second lumen, wherein said snare guide is slidable distally with respect to said mandrel to cinch down said snare.

106. The system of claim 105, wherein the trigger snare tool further comprises

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.

107. The system of claim 105, wherein said snare, when uncinched, is oriented at an acute angle with respect to a longitudinal axis of said mandrel.

108. The system of claim 1, further comprising a perforation tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the perforation tool comprises

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

a sheath configured and dimensioned to be slid through the second lumen of the elongated body and to surround said perforating member and said shaft during sliding within the second 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.

109. The system of claim 108, wherein said perforating member comprises a needle.

110. The system of claim 108, wherein said perforating member comprises a spike.

111. The system of claim 108, wherein the perforation tool further comprises a handle mounted to a proximal portion of the perforation tool, said handle configured to be mated with a connector of a suction assembly.

112. The system of claim 108, wherein the perforation tool further comprises 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.

113. The system of claim 112, wherein the perforation tool further comprises a second actuator, said second actuator being linked to said cutting blade and operable to rotate said cutting blade.

114. The system of claim 112, wherein said perforating member comprises a barbed needle.

115. The system of claim 112, wherein said perforating member comprises a corkscrew.

116. The system of claim 112, wherein said perforating member comprises graspers.

117. The system of claim 116, wherein said actuator is further actuatable to open and close said graspers.

118. The system of claim 1, further comprising a mapping probe tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the mapping probe tool comprises

an elongated member configured and dimensioned to be positioned in the second lumen and having a length sufficient to extend a proximal end portion of said elongated member from the proximal end of the second lumen while a distal end portion extends distally from a distal end of the second 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 the mapping probe tool via at least one electrical wire connected thereto.

119. The system of claim 118, wherein the mapping probe tool further comprises

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

and

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

120. The system of claim 119, wherein said probe mapping tool is configured and dimensioned, so that when said handle is slid distally with respect to the second lumen, thereby biasing the biasing member, said probe mapping elements extend distally from a distal end of the second lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the second lumen, thereby retracting said probe mapping elements into the second lumen.

121. The system of claim 118, 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.

122. The system of claim 118, 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.

123. The system of claim 1, further comprising a ablating probe tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the linear ablating probe tool comprises

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

124. The system of claim 123, wherein the linear ablating probe tool further comprises 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.

125. The system of claim 123, wherein the linear ablating probe tool further comprises

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

and

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

126. The system of claim 125, wherein said linear ablating probe tool is configured and dimensioned, so that when said handle is slid distally with respect to the second lumen, thereby biasing the biasing member, said linear ablation member extends distally from a distal end of the second lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the second lumen, thereby retracting said linear ablation member into the second lumen.

127. The system of claim 1, further comprising a ablation probe tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the point ablation probe tool comprises

an elongated member configured and dimensioned to be positioned in the second lumen and having a length sufficient to extend a proximal end portion of said elongated member from the proximal end of the second lumen while a distal end portion extends distally from a distal end of the second 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 point ablation probe tool.

128. The system of claim 127, wherein the point ablation probe tool further comprises 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.

129. The system of claim 127, wherein the point ablation probe tool further comprises

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

and

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

130. The system of claim 129, wherein said point ablation probe tool is configured and dimensioned, so that when said handle is slid distally with respect to the second lumen, thereby biasing the biasing member, said ablation probe point extends distally from a distal end of the second lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the second lumen, thereby retracting said ablation probe point into the second lumen.

131. The system of claim 1, further comprising a cautery tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the cautery tool comprises

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

132. The system of claim 131, wherein the cautery tool further comprises 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.

133. The system of claim 131, wherein the cautery tool further comprises

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

and

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

134. The system of claim 133, wherein said cautery tool is configured and dimensioned, so that when said handle is slid distally with respect to the second lumen, thereby biasing the biasing member, said cauterizing element extends distally from a distal end of the second lumen, and when a driving force is released from said handle, said biasing member drives said handle proximally with respect to the second lumen, thereby retracting said cauterizing element into the second lumen.

135. The system of claim 1, further comprising a graspers tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the graspers tool comprises

grasping jaws connected to an actuator via an elongated linkage;

a sheath configured and dimensioned to be slid through the second lumen of the elongated body and to surround said grasping jaws and said linkage during sliding within the second 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.

136. The system of claim 135, wherein said actuator is further actuatable to open and close said grasping jaws.

137. The system of claim 1, further comprising a scissors tool configured and dimensioned to be slid through the second lumen of the elongated body, wherein the scissors tool comprises

scissors jaws connected to an actuator via an elongated linkage;

a sheath configured and dimensioned to be slid through the second lumen of the elongated body and to surround said scissors jaws and said linkage during sliding within the second 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.

138. The system of claim 137, wherein said actuator is further actuatable to open and close said scissors jaws.

139. The system of claim 1, wherein the curved and blunt distal end is curved in a direction of the longitudinal axis of the distal tip to allow for blunt dissection.

140. The system of claim 1, wherein the distal tip is configured to provide an endoscopic field of view allowing for visibility of tissue from the distal tip proximal end to a location distal thereto.

141. The system of claim 1, wherein the distal tip is configured to allow for an endoscopic field of view along a length of the distal tip.

142. The system of claim 1, wherein the distal tip has a parabolic profile.

143. The system of claim 1, wherein the distal tip is radially symmetric about its longitudinal axis.

144. The system of claim 1, wherein a length of the distal tip is as least as large as the maximum width of the distal tip.

152. The system of claim 15, wherein said snare device further comprises a snare on a proximal end thereof.

145. A surgical system for performing minimally invasive surgical procedures, said system comprising:

a first elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the exterior body surface, and at least one lumen extending at least partially through said interior region and 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, external to and side-by-side of said first elongated body, said first elongated body also being external to said second 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 lens having a bullet shaped configuration forming an elongated distal tip that is attachable to said distal end portion of said first elongated body, said distal tip comprising a curved and blunt distal end that encloses said distal end portion of said first elongated body when attached thereto for blunt dissection of tissue, and wherein a sidewall of the distal tip extending from a proximal end of the distal tip to the curved and blunt distal allows for visualization of a surgical field therethrough.

146. The system of claim 145, further comprising an endoscope positioned in said lumen that is configured and dimensioned for receiving an endoscope therein.

147. The system of claim 145, further comprising a handle attached to said proximal end portion of said first elongated body.

148. The system of claim 145, wherein said first and second elongated bodies are substantially rigid.

149. The system of claim 145, wherein said second elongated body is fixed externally to said first elongated body.

150. The system of claim 149, wherein said second elongated body is welded to said first elongated body.

151. The system of claim 145, 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.

153. The system of claim 146, 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 positionable within said distal tip.

154. The system of claim 145, wherein said distal tip comprises a notch configured and dimensioned to receive a portion of a snare therein.

155. The system of claim 145, further comprising a tool other than an endoscope extending through one of said at least one lumens of said second elongated body.

156. The system of claim 155, 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.

157. The system of claim 145, wherein the bullet shaped configuration of the elongated distal tip has a parabolic profile.

158. The system of claim 157, wherein when the elongated distal tip is attached to the elongated body, the elongated distal tip is longitudinally offset with respect to a distal opening of the second lumen such that the curved and blunt distal end extends distally beyond the opening.

159. The system of claim 145, wherein when the elongated distal tip is attached to the elongated body, the elongated distal tip is longitudinally offset with respect to a distal opening of the second lumen such that the curved and blunt distal end extends distally beyond the opening.

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

(a) 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, wherein the device comprises a surgical system for performing minimally invasive surgical procedures, wherein the system includes

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving the endoscope therein; and

a lens having a bullet shaped configuration forming an elongated distal tip that extends distally with respect to said distal end portion of said elongated body, wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough;

(b) inserting the flexible member through a service port in the device and extending a distal end portion of the flexible member distally of the second lumen of the elongated body joined by the service port;

(c) visually confirming the distal end portion via the endoscope;

(d) 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;

(e) 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;

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

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

161. The method of claim 160, 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.

162. The method of claim 160, 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.

163. The method of claim 160, 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.

164. The method of claim 160, 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.

165. The method of claim 160, wherein the internal structure comprises a plurality of pulmonary veins.

166. The method of claim 164, further comprising ablating tissue along a pathway defined by the ablation device around the internal structure.

167. The method of claim 160, 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.

168. The method of claim 160, 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.

169. The method of claim 160, 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.

170. The method of claim 160, 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.

171. The method of claim 170, 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 the second lumen that is in fluid communication with the service port and into contact with tissue to be perforated, and perforating the tissue.

172. The method of claim 170, 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 the second 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.

173. The method of claim 166, 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.

174. The method of claim 166, 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.

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

(a) 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, wherein the device comprises a surgical system for performing minimally invasive surgical procedures, wherein the system includes

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving the endoscope therein; and

a lens having a bullet shaped configuration forming an elongated distal tip that extends distally with respect to said distal end portion of said elongated, body, wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough;

(b) inserting the flexible member through a service port in the device and extending a distal end portion of the flexible member distally of the second lumen of the elongated body joined by the service port;

(c) visually confirming the distal end portion via the endoscope;

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

(e) 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;

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

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

176. The method of claim 175, 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.

177. The method of claim 175, 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.

178. The method of claim 177, further comprising ablating tissue along a pathway defined by the ablation device around the internal structure.

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

(a) inserting a device including an endoscope and a semi-flexible sheath slid over the 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, wherein the device comprises a surgical system for performing minimally invasive surgical procedures, wherein the system includes

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving the endoscope therein, and wherein the semi-flexible sheath forms the elongated body; and

a lens having a bullet shaped configuration forming an elongated distal tip at the transparent distal end that extends distally with respect to said distal end portion of said elongated body, wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough;

(b) visually confirming placement of a distal end of the semi-flexible member via the endoscope;

(c) removing the 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;

(d) 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;

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

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

180. The method of claim 179, 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.

181. The method of claim 179, 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.

182. The method of claim 179, further comprising sliding a sleeve having a distal tip over the endoscope prior to said inserting the endoscope through a second small opening.

183. The method of claim 182, 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.

184. The method of claim 183, wherein said connecting comprises cinching the snare loop around the distal end of the semi-flexible member.

185. The method of claim 184, wherein said cinching is performed by sliding the sleeve proximally with respect to the endoscope.

186. The method of claim 179, 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.

187. The method of claim 186, further comprising ablating tissue along a pathway defined by the ablation device around the internal structure.

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

(a) 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, wherein the device comprises a surgical system for performing minimally invasive surgical procedures, wherein the system includes

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving the endoscope therein and the second lumen is configured for receiving the first tool therein; and

a lens having a bullet shaped configuration forming an elongated distal tip that extends distally with respect to said distal end portion of said elongated body, wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough;

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

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

189. The method of claim 188, wherein said removing comprises removing the first tool through a slot opening to an external surface of the device from the second lumen in the device.

190. The method of claim 188, wherein the first tool comprises a snare catheter.

191. The method of claim 188, wherein said removing comprises removing the first tool from an eyelet on a distal end portion of said device.

192. The method of claim 189, wherein the second lumen from which the slot opens is asymmetrical in cross-section and forms a cam surface permitting a second tool to be rotated into the lumen.

193. The method of claim 188, 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.

194. 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:

(a) connecting a distal end of a length of first tubing to a suction assembly of a device to be used to apply suction, wherein the length of first tubing has proximal and distal ends and has a lighter gauge than a gauge of the operating room suction tubing, wherein the device is a surgical system for performing minimally invasive surgical procedures, wherein the system includes

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving the endoscope therein; and

a lens having a bullet shaped configuration forming an elongated distal tip that extends distally with respect to said distal end portion of said elongated body, wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough; and

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

195. The method of claim 194, further comprising clamping the length of first tubing to a support.

196. The method of claim 195, wherein the length of first tubing comprises a tether extending therefrom, and said clamping comprises clamping said tether to the support.

197. A tool for relieving side loading on a device in fluid communication with an operating room suction tube, wherein the device is a surgical system for performing minimally invasive surgical procedures, wherein the system includes

an elongated body having a distal end portion, a proximal end portion, an external body surface, an interior region encompassed by the external body surface, and at least a first lumen and a second lumen extending at least partially through the interior region and generally along a direction of a longitudinal axis of said elongated body, wherein the first lumen is configured for receiving the endoscope therein;

and

a lens having a bullet shaped configuration forming an elongated distal tip that extends distally with respect to said distal end portion of said elongated body, wherein the elongated distal tip comprises a curved and blunt distal end allowing for blunt dissection of tissue and a sidewall extending from a proximal end of the elongated distal tip to the curved and blunt distal end that allows for viewing of the surgical field therethrough, said tool comprising;

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

a first connector at a distal end of said first 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 first tubing;

a second connector at a proximal end of said length of first 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 first tubing; and

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