Devices, system, and methods for guiding an operative tool into an interior body region
A guide device establishes a guide passage through a guide tube, through which an operative tool can be deployed into an interior body region for use. A steering assembly, in use, deflects or bends the distal end region of the guide tube, so that the operative tool can be placed in a desired orientation with respect to tissue. The steering assembly is desirable configured for single handed operation by the clinician. The steering assembly is also desirably configured to provide a mechanical advantage sufficient to translate relatively small increments of clinician control into relatively larger increments of guide tube deflection. In one arrangement, the steering assembly includes a rack and pinion linkage system. In another arrangement, the steering assembly includes a pivoting lever system.
1. A guide device comprising:
a flexible guide tube comprising a main lumen defining a guide passage and at least one control lumen separate from the main lumen, the guide tube further comprising a tip reinforcing element comprising a uniform ring;
a handle coupled to the guide tube, the handle comprising a proximal opening in communication with the guide passage through which a separate operative tool can be advanced; and
a steering assembly comprising:
a deflecting element at least partially within the control lumen and coupled to a distal end region of the flexible guide tube to apply a deflecting force to bend the distal end region, the deflecting element making a continuous loop completely around the tip reinforcing element,
an actuator configured to rotate about the longitudinal axis of the guide device and rotatable by a single-handed operation, and
a linkage system coupling the actuator to the deflecting element to apply the deflecting force in response to operation of the actuator, the linkage system including a slider and a pivoting lever arm, the slider having a threaded portion adapted to mate with a threaded portion of the actuator, the pivoting lever arm directly coupled to a proximal end of the deflecting element at a first end portion and pivotally attached to the handle at a second end portion and adapted to be contacted by the slider to translate rotation of the actuator into linear movement of the slider into pivotal movement of the lever arm to apply the deflecting force to the deflecting component, wherein the linkage system is positioned within the handle and amplifies the amount of deflecting force.
2. The device according to claim 1 further comprising at least one additional deflecting element.
3. The guide device according to claim 1 further comprising at least two control lumens.
4. The guide device according to claim 3 wherein the control lumens are oriented 180 degrees apart.
5. The guide device according to claim 1 wherein the distal end region of the guide tube comprises radiopaque markers.
6. A system comprising:
a guide device as defined in claim 1 , and
an operative tool that applies one or more fasteners to tissue.
7. A method comprising:
providing a guide device as defined in claim 1 ,
deploying the guide device into an interior tissue region, and
operating the steering assembly to bend the distal end region of the guide tube.
8. A method comprising:
providing a system as defined in claim 6 ,
deploying the guide device into an interior tissue region,
operating the steering assembly to bend the distal end region of the guide tube,
passing the operative tool through the guide device, and
operating the operative tool while residing in the guide device to apply at least one fastener to tissue.