Abstract: Methods, computer program products, and systems are described that include measuring at least one effect of a combined bioactive agent and artificial sensory experience on an individual and/or modifying at least one of the bioactive agent or the artificial sensory experience at least partially based on the at least one effect.

Abstract: The present invention relates to a movement disorder monitor, and a method of measuring the severity of a subject's movement disorder. The present invention additionally relates to a drug delivery system for dosing a subject in response to the increased severity of a subject's symptoms. The present invention provides for a system and method, which can accurately quantify symptoms of movements disorders, accurately quantifies symptoms utilizing both kinetic information and electromyography (EMG) data, that can be worn continuously to provide continuous information to be analyzed as needed by the clinician, that can provide analysis in real-time, that allows for home monitoring of symptoms in subject's with these movement disorders to capture the complex fluctuation patterns of the disease over the course of days, weeks or months, that maximizes subject safety, and that provides remote access to the clinician or physician.

Abstract: An apparatus for estimating a malignant tumor includes: a segmentor configured to segment a first medical image of an object into a first ROI including a mass and a second medical image of the object into a second ROI including a mass; an interest region determiner configured to acquire a first matched ROI and a second matched ROI, which is matched to the first matched ROI based on location information of the first ROI and the second ROI, respectively; a feature extractor configured to extract a similar feature indicating a degree of similarity between the first matched ROI and the second matched ROI, from the first matched ROI and the second matched ROI; and a classifier configured to generate malignant tumor information indicating whether the mass included in the first matched ROI and the second matched ROI is the malignant tumor, based on the extracted similar feature.

Abstract: A headset for detecting brain electrical activity may include a flexible substrate having first and second ends each configured to engage an ear of a subject and dimensioned to fit across the forehead of a subject. The headset may also include a plurality of electrodes disposed on the substrate and configured to contact the subject when the headset is positioned on the subject. First and second electrodes may contact top center and lower center regions of the forehead, respectively, third and fourth electrodes may contact front right and front left regions of the forehead, respectively, fifth and sixth electrodes may contact right side and left side regions of the forehead, respectively, and electrodes included within the securing devices may contact the ear regions. The third and fourth electrodes may be moveable in at least a vertical direction relative to the other electrodes.

Abstract: The invention relates to methods and systems to optically analyze samples such as tissue based on speckle patterns of microscopic motion, such as Brownian motion.

Abstract: The bioinstrumentation apparatus includes a light irradiation unit irradiating a measurement region with light, a light detection unit detecting diffused light from the measurement region, and a computing unit generating a reconstructed image for the interior of the measurement region. The computing unit calculates J coefficients wj set for every pixel of the reconstructed image and more than 0 and not more than 1 (where J is the number of pixels of the reconstructed image) and carries out successive approximation computation by the following iterative formula xj(k+1)=xj(k)+wjdj(k) (where k is an integer from 1 to N, N is the number of times of iterative computation, xj(k) is a pixel value of the jth pixel on the kth iterative computation, and dj(k) is an update amount of the jth pixel on the kth iterative computation) to generate the reconstructed image.

Abstract: Ultrasound data is simulated using magnetic resonance (MR) elastography. MR elastography provides tissue characteristic information, such as elastic modulus, velocity, or stiffness. This tissue characteristic information indicates a density or viscosity of the tissue, allowing simulation of ultrasound data with MR acquired data. The same MR imaging system may be used to acquire the MR elastography and pre-operative anatomy information. The actual ultrasound information may be registered with simulated ultrasound information for registration of the actual ultrasound information with the MR anatomy information.

Abstract: A method of displaying the activity of a brain, the method including the steps of: (i) obtaining an electroencephalogram (EEG) signal from the brain; (ii) segmenting said EEG signal into either contiguous or overlapping segments comprised of a sequential number of samples of said EEG signal; (iii) representing said EEG segments as a fixed order autoregressive moving average (ARMA) signal representation with an autoregressive order between 8 and 13 and a moving average order between 5 and 11; (iv) rewriting in z-domain notation said fixed order ARMA signal representation to obtain a z-domain representation; (v) generating AR coefficient data and MA coefficient data for said segments of said EEG signal for said fixed order ARMA signal representation: (vi) determining the poles and zeros of said z-domain representation for said segments of said EEG signal by substituting said coefficient data for said segments of said EEG signal into said z-domain representation; (vii) calculating the sum of the number of poles

Abstract: An X-ray CT apparatus includes an X-ray tube, an X-ray detector, and a control unit. The X-ray detector includes at least two divided ranges. One range includes a small detection range in which X-ray detection elements of a small size for detecting the X-rays radiated from the X-ray tube are arrayed. The other range includes a large detection range in which the X-ray detection elements of a large size for detecting the X-rays radiated from the X-ray tube are arrayed. The control unit is configured to select the small detection range or the large detection range. The X-ray CT apparatus can efficiently achieve high resolution upon imaging and, further, is capable of fully utilizing X-ray detection elements of a small detector size.

Abstract: According to one embodiment, a support mechanism movably supports the table top. A bed driver generates driving power to be supplied to the support mechanism to move the table top. An imaging mechanism includes a mechanism for acquiring medical image data associated with a subject placed on the table top. An ascending switch receives an ascending instruction for the table top. A descending switch receives a descending instruction for the table top. A storage unit stores the height of the table top at the time of the issuance of an ascending instruction as a target return position. When a descending instruction is issued, a bed controller controls the bed driver to descend the table top to the target return position stored in the storage unit.

Abstract: A couch with a patient-inclining device (10) includes a tabletop (28), a pair of second rails (15) arranged below the tabletop, a second moving section (16) having a pair of second sliders (17) which are movable on the pair of second rails, a pair of block bodies (22A and 22B) which are movable on the pair of second rails, drive mechanisms (23A and 23B) which linearly move the block bodies with respect to the second moving section, a support section (26) provided on the second moving section to support the tabletop, and levers (27A and 27B), each having one end connected to the tabletop and the other end connected to the associated one of the pair of block bodies.

Abstract: A radiolucent patient table top including a first face sheet, a second face sheet, and a honeycomb core is provided. The first face sheet includes carbon fibers in a first radiolucent plastic matrix. The second face sheet includes carbon fibers in a second radiolucent plastic matrix. The honeycomb core is disposed between the first face sheet and the second face sheet, where the first face sheet and the second face sheet sandwich the honeycomb core. The honeycomb core includes carbon fibers embedded in a third radiolucent plastic matrix.

Abstract: A cassette holder of an imaging stand is provided with first and second catch members for catching and holding an electronic cassette from above and below. The first catch member has a multi connector connected to a multi terminal of the electronic cassette. The multi connector is offset with respect to a center line of an imaging surface of the cassette holder. The multi terminal is offset with respect to a center line of an irradiation surface of the electronic cassette in the same direction by the same amount as those of the multi connector. In a state where said electronic cassette mounted on a tray is loaded into the cassette holder, the center line of the irradiation surface coincides with the center line of the imaging surface.

Abstract: A mobile X-ray imaging apparatus includes an X-ray generation unit, a boom member configured to hold and arrange the X-ray generation unit at an arbitrary position, a supporting column unit connected to the boom member and configured to elevate and pivot the X-ray generation unit, a display unit, including a display screen, coupled to the X-ray generation unit through a movable mechanism configured to enable the orientation of the display screen, with respect to the X-ray generating unit, to be altered.

Abstract: A method for imaging with a radiotherapy device is provided. The radiotherapy device includes a movably mounted imaging apparatus with an X-ray source and an oppositely disposed X-ray detector. The method includes preparing a first image with the imaging apparatus from a first imaging direction. The imaging apparatus is moved to a position that permits the preparation of a second image from a second imaging direction extending at an angle to the first imaging direction. The method also includes preparing the second image with the imaging apparatus from the second imaging direction, and verifying the position of an object to be irradiated using the first image and the second image.

Abstract: In this device and the associated method, a connection unit that can be attached to an arm bearing an x-ray source and an x-ray receiver is fashioned such that said connection unit compensates for a pivot movement of the arm so that a compression unit arranged at the connection unit remains stationary during a pivot movement.

Abstract: A radiographic imaging device including: a sensor portion that generates an output signal according to an irradiated amount of irradiated radiation; a detector that based on the output signal detects a radiation irradiation start of radiation irradiated from a radiation source during capture of a radiographic image; a noise data generation means that, based on an output signal from the sensor portion in a non-irradiation state of radiation from the radiation source, generates noise data relating to noise incorporated in the output signal; a controller that controls detection sensitivity to radiation irradiation start in the detector according to a degree of variation in noise level expressed by the noise data; and an imaging unit that captures the radiographic image after radiation irradiation start has been detected by the detector.

Abstract: This invention provides a method for estimating C-arm fluoroscope pose. The method involves introducing a coordinate system into a C-arm image, and applying intensity-based 2D/3D registration without segmentation to the coordinate system C-arm image and an image or known model of the coordinate system, wherein the intensity-based 2D/3D registration yields the C-arm pose. The coordinate system may be provided by introducing one or more markers or a fiducial into an image.

Abstract: A method of calibrating an ultrasound probe includes mounting an ultrasound probe onto a calibration system, transmitting an ultrasound test signal from an element of the probe through a test medium of the calibration system, and receiving the test signal on a matrix of hydrophones such that an element's position relative to other elements and other arrays within the same probe can be computed. Further, the system described herein is configured to detect the acoustic performance of elements of a probe and report the results to an end user or service provider.

Abstract: In one aspect, an ultrasound receive beamformer is configured for one-way only beamforming of transmissive ultrasound using one-way delays. The receive beamforming in some embodiments is used to track, in real time, a catheter, needle or other surgical tool within an image of a region of interest. The tool can have embedded at its tip a small ultrasound transmitter or receiver for transmitting or receiving the transmissive ultrasound. Optionally, additional transducers are fixed along the tool to provide the orientation of the tool.

Abstract: Various embodiments herein provide for imager focusing based on intraoperative data. Ideally, an imaging plane of an ultrasound transducer would be truly planar. That is not the case, though. Instead, ultrasound transducers image a volume that is closer to a rectangular volume, but that has focal depths or areas in the imaged volume that are “thinner” and provide a better resolution. In general, embodiments herein may include determining the pose of an imager, such as an ultrasound transducer, and the pose of a location of interest. Based on those poses, a focal adjustment may be determined in order to, for example, better focus the imager on the object of interest. Then data is generated and the focus of the imager is adjusted. Additionally, imaging data and/or the object of interest may be displayed. In other embodiments, estimated projections of medical devices are displayed to allow for better intraoperative planning.

Abstract: Total core biopsy devices and methods of use are provided for taking a total core biopsy sample and a means for using the devices that provide for an adequate sample size and quality while being light-weight, easy to use, small, inexpensive, and permitting one-handed operation and beveled edges to reduce trauma to the surrounding tissue and organs from which a total core biopsy sample may be taken.

Abstract: A charging station for a battery powered biopsy apparatus includes a charging dock having a housing and a charging unit contained in the housing. The charging unit has a set of electrical contacts. The housing is received in a first cavity of a driver assembly with the electrical contacts being coupled in electrical communication with the driver assembly when the driver assembly is mounted on the charging dock for charging. The charging unit provides a signal to the driver assembly to reset the driver assembly to an initialized state when the driver assembly is mounted to the charging station.

Abstract: A device, a kit, and a method of use thereof, for self-administration and collection of cervical cell tissue samples such as for Pap smear testing. The device comprises an insertion tube, within which is carried a movable cervical aligning tool with an aligning probe, and a cellular sampling tool with a cellular adhesion surface. The aligning probe and cellular adhesion surface can be selectively movable relative to the insertion tube to improve accuracy of the testing and user safety.

Abstract: In an embodiment of the invention, a frictional tissue sampling device with a head designed to be rotated without rotating off the designated site can be used to obtain tissue biopsy samples. A frictional tissue sampling device with a head designed to be rotated without rotating off the designated site can be used to obtain an epithelial tissue biopsy sample from lesions. The device can be otherwise used to sample specific locations. In various embodiments, the head of the device is narrow and pointed with a hybrid pear shaped diamond facet. Abrasive material can be adhered to the facet.

Abstract: An endoscopic vessel harvester includes a vessel keeper for capturing a target vessel within a tunnel that has been dissected along the target vessel. A cutter member cuts and cauterizes side branches while the target vessel is slidably captured in the vessel keeper. A spray nozzle carried by the vessel keeper delivers a preservative fluid via a manual control valve and a conduit. The preservative fluid is sprayed on the target vessel proximate a respective side branch immediately after being cauterized. Thus, a harvested vessel is bathed in preservative fluid prior to being actually removed from the body, enhancing endothelial preservation from cascading events.

Abstract: A vascular closure device includes a main body and an expandable portion that can be selectively expanded and contracted. The vascular closure device may be used to close the hole in a wall of a vessel after a medical procedure. For example, the vascular closure device may be used to close the hole in an artery after a medical procedure that required access to the artery. In one embodiment, the expandable portion may be oriented at an oblique angle relative to the main body. This may be desirable in situations where the vessel puncture is oriented at an angle relative to the vessel. Orienting the expandable portion at an oblique angle relative to the main body may help the expandable portion to cover the hole in the wall of the vessel.

Abstract: A surgical closure device (100) includes (a) a continuous loop (110), which defines an opening (112) therethrough, and which is configured to assume at least an open shape and a closed shape, and (b) four or more tissue anchors (130), coupled to the loop (110). An area of the opening (112) when the loop (110) assumes the closed shape is less than 80% of the area of the opening (112) when the loop (110) assumes the open shape. The loop (110) is configured such that, as the loop (110) transitions from the open shape to the closed shape, all of the anchors (130) move in generally radial directions, and do not move in generally circumferential directions; and a first set of two or more of the anchors (130A) move on average a first distance, and a second set of two or more of the anchors (130B) move on average a second distance that is between 40% and 80% of the first distance.

Abstract: The present disclosure relates generally to methods and devices for closing and/or sealing an opening in a vessel wall and/or an adjacent tissue tract. In one illustrative embodiment, a device is provided for delivering and deploying an anchor, plug, filament, and locking element adjacent to the opening in the vessel wall and/or tissue tract.

Abstract: A medical device and a method for manipulating bodily tissues are described. The medical device includes an elongated portion having a proximal end portion and a distal end portion. The elongated portion has a defined width referred to as first width. The medical device further includes a head portion extending from the distal end portion of the elongated portion. The head portion includes a first flat surface on a first side and a second flat surface on a second side opposite the first side. The head portion has a defined width referred to as second width. The second width is greater than the first width.

Abstract: A novel retractor system can be attached to a table and can be adjusted at desired points in x-y-z axes, and which provides spine surgeries be made in a healthier manner via retractors which are mounted on the retractor carrier wings, and a set, which provides fusion of spines via this system by using an insert.

Abstract: In one embodiment, a method includes securing an implant that includes a pre-formed loop to a vaginal apex. An end of the suture is inserted through a selected portion of a pelvic tissue to dispose at least a portion of the implant within a pelvic region of the patient. The end of the suture is drawn through the loop while simultaneously advancing a uterus to approximate the vaginal apex to the selected portion of pelvic tissue. An apparatus includes an implant and a suture coupled to the implant having a pre-formed loop. configured to receive a portion of a delivery device therethrough. A trocar is coupled to an end of the suture that can be releasably coupled to an end of the delivery device. The trocar can be inserted through a pelvic tissue and drawn through the loop forming a knot to secure the implant to the pelvic tissue.

Abstract: A laparoscopic instrument includes a handle unit by which a user may hold the instrument, an elongated first tube attached to the handle unit, a second tube arranged slidable in relation to the first tube, that the second tube is provided with a thread gripping member capable of gripping suture threads, a locking member arranged to the tubes such that, when the second tube is moved in relation to the first tube, gripped suture threads are locked. The invention is characterized in that the device further includes storage elements for a number of rings, and a ring feeding member capable of, upon activation, moving the ring from the storage elements to a free position in which the suture threads run through the ring.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot of the device can be inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot can carry suturing attachment cuffs with one end of the cuff adapted to receive a needle, while the other end receives suture. A portion of the foot and/or lumen of the shaft can receive a portion of the suture and can include friction reducing structure that aid with movement of the sutured during removal of the cuffs from within the penetration.

Abstract: A surgical device is provided, the surgical device including a first driver for performing a first movement function; a second driver for performing a second movement function; a first rotatable drive shaft configured, upon actuation, to cause selective engagement of one of the first and second drivers with a second rotatable drive shaft, wherein the second rotatable drive shaft is configured to drive the selectively engaged one of the first and second drivers. Third and fourth drivers may also be included. The drivers may function to rotate a shaft portion of the surgical device relative to, and about the longitudinal axis of, a handle; move a jaw portion relative to the shaft portion; move a first jaw relative to a second jaw; and/or move a surgical member within the second jaw.

Abstract: A surgical stapler, or fastening instrument, may generally comprise a layer, such as a tissue thickness compensator, for example, releasably attached to a fastener cartridge and/or anvil by a flowable attachment portion. The flowable attachment portion may be indefinitely flowable. The flowable attachment portion may be flowable from the time that layer is installed to the fastener cartridge to the time in which the layer is implanted to patient tissue. The flowable attachment portion may comprise a pressure sensitive adhesive. The flowable attachment portion may comprise an adhesive laminate comprising a base layer comprising the tissue thickness compensator and an adhesive layer on at least a portion of a surface of the base layer comprising the pressure sensitive adhesive. Articles of manufacture comprising flowable attachment portion and methods of making and using the flowable attachment portion are also described.

Abstract: An adapter assembly for selectively interconnecting a surgical end effector including at least one axially translatable drive member and a powered actuator device including at least one rotatable drive shaft is provided. The adapter assembly includes an actuation shaft configured to convert rotation of a first drive shaft of the powered actuator device into an axial translation of a first drive member of the surgical end effector. The adapter assembly further includes an elongate tube configured to convert rotation of a second drive shaft of the powered actuator device into an axial translation of a second drive member of the surgical end effector. The actuation shaft is disposed within the elongate tube, and the actuation shaft and the elongate tube translate axially independent of each other.

Abstract: Embodiments of invention involve tissue approximation instruments that may be delivered to the body of a patient during minimally invasive or other surgical procedures. In one group of embodiments, the instrument has an elongated configuration with two sets of expandable wings that each have spreadable wings that can be made to expand when located on opposite sides of a distal tissue region and a proximal tissue region and can then be made to move toward one another to bring the two tissue regions into a more proximate position. The instrument is delivered through a needle or catheter and is controlled by relative movement of a push tube and control wire wherein the control wire can be released from the instrument via rotation in a first direction and can cause release of the approximation device from tissue that it is holding by rotation in the opposite direction.

Abstract: An engaging element for engaging tissue is described. The engaging element may include a first member including at least one tissue engaging portion and a second member including at least one tissue engaging portion. The second member may be pivotally connected to the first member. The engaging element includes a locking mechanism operatively associated with the first and second member. The locking mechanism may be configured to inhibit the relative motion of the first and said second member. An engaging system for engaging tissue is described. The engaging system may include an engaging element for engaging tissue, a first member having at least one tissue engaging portion, and/or a second member including at least one tissue engaging portion. A method for engaging tissue is described. The method may include positioning an engaging element relative to an engaging element delivery device and/or to a portion of tissue.

Abstract: A surgical severing and stapling instrument, suitable for laparoscopic and endoscopic clinical procedures, clamps tissue within an end effector of an elongate channel pivotally opposed by an anvil. An E-beam firing bar moves distally through the clamped end effector to sever tissue and to drive staples on each side of the cut. The E-beam firing bar affirmatively spaces the anvil from the elongate channel to assure properly formed closed staples, especially when an amount of tissue is clamped that is inadequate to space the end effector. In particular, an upper pin of the firing bar longitudinally moves through an anvil slot and a channel slot is captured between a lower cap and a middle pin of the firing bar to assure a minimum spacing. Forming the E-beam from a thickened distal portion and a thinned proximal strip enhances manufacturability and facilitates use in such articulating surgical instruments.

Abstract: A method of implanting and securing an implantable flow connector in a body of a patient for providing communication of a first space within the body of the patient with a second space within the body of the patient. The method includes providing a flow connector having a lumen having a first orifice and a second orifice, inserting a retention device into the first space within the body, subsequently inserting the flow connector through an opening in the retention device so the second portion of the flow connector extends into the first space within the body and placing the second space within the body over the retention device.

Abstract: A device for treating biliary disease includes a component configured for deployment to a lumen of a gallbladder or gallbladder duct. The component has a proximal end and a distal end with a lumen extending therethrough and a fluid or gas delivery apparatus at its distal end.

Abstract: A system including an implantable fastener for fastening layers of tissue is disclosed. In one embodiment, the fastener includes a proximal anchor member and a distal anchor member each being movable from a reduced profile position to a deployed position. The anchor members are mesh structures capable of moving to the deployed position by reducing the axial spacing between opposite ends of the anchor members. Methods of treating gastroesophageal reflux disease (GERD) are also disclosed. One of the methods includes placing the distal anchor member through a hole formed in the wall of the esophagus and through a hole formed in the gastric wall. The distal anchor member and the proximal anchor member are then placed in their deployed positions to fasten the wall of the esophagus and the gastric wall together between the anchor members.

Abstract: Bodily implants that can be compacted in a distal-to-proximal direction, and which facilitate repositioning of the implant after compaction. The implants include at least one pull string for expanding the implant in a radial direction while compacting the implant in the longitudinal direction. Where multiple pull strings are provided, they can be secured to the implant at spaced locations along the implant length, and pulled successively to compact the implant in a distal-to-proximal direction. A guide member may also be provided to receive the pull strings and facilitate longitudinal compaction.

Abstract: A device for delivering an implant to a vascular disorder of a patient includes a delivery pusher. A stationary blade may be coupled to the delivery pusher. The stationary blade may include a sharp and stationary cutting component for cutting through a suture coupling the implant to the delivery pusher and for thereby releasing the implant when placed in proximity to the vascular disorder. In some cases, the strength of a junction connecting the suture to the implant is equal to or greater than the tensile strength of the suture itself. Additionally, or alternatively, a detachment handle may be fixedly and permanently attached to the delivery pusher such that a user of the device need not couple the detachment handle to the delivery pusher. The detachment handle may include a user manipulable component for initiating a mechanical release of the implant when placed in proximity to the vascular disorder.

Abstract: A surgical clip includes a pair of opposed arms joined at one end by an integrally formed flexible hinge and a hinge lock. A male locking pin near the free end of one arm is configured to penetrate tissue when the male locking pin is urged towards a mating female aperture near the end of the opposite arm. The clamping side of an arm may include a protruding feature, such as a wedge shape elongated ridge, while the clamping side of the opposite arm includes a corresponding trough or aperture that receives the protruding feature. Clamping surfaces may include non-slip protrusions, such as ribs, ridges, cones or pins. An applicator holding feature, such as a boss, near the hinge prevents the clip from yawing and becoming askew during application.

Abstract: A laparoscopic device comprising: (a) a housing operatively coupled to a first control and a second control; (b) an end effector operatively coupled to the first control, the end effector comprising a first component and a second component selectively repositionable with respect to one another within an X-Y plane, the end effector also including a third component selectively repositionable with respect to the second component within an Y-Z plane; (c) a laparoscopic conduit extending between the housing and the end effector; and, (d) an occlusion clip deployment device operatively coupled to the end effector and the second control.

Abstract: A surgical device for clipping tissue can include a replaceable cartridge comprising a stack of clips contained therein and a firing drive configured to reciprocatingly eject, or deploy, the clips from the cartridge. After the clips have been deployed from the cartridge, a blocking member can be positioned to impede or block the firing drive. In at least one embodiment, the cartridge can include a biasing member configured to bias the blocking member into a firing chamber defined in the cartridge and/or surgical device. The surgical device can also include a crimping drive configured to deform a clip after it has been ejected from the cartridge. The blocking member can also be configured to impede or block the crimping drive after all of the clips from the cartridge have been used.

Abstract: A method of preparing a bone to receive a fixation screw through a fixation device includes providing a drill bit sized and configured to pass through a bore in a fixation device positioned in the bone and drilling a passage into the bone and through the bore. At least a distal portion of the drill bit passes through the bore in the drilling step. At least an outer portion of the distal portion of the drill bit has a hardness that is less than a hardness of the fixation nail.

Abstract: A remote-controlled actuator assembly includes a guide section (3) of an elongated shape, a distal end member (2) fitted to a tip end of the guide section for alteration in attitude, an operating tool (1) in the distal end member, and a restraining tool (6) for aligning the distal end member straight with the guide section. The distal end member is altered in attitude through advancing/retracting attitude altering members (31) in the guide section by attitude altering drive sources (43), which are controlled by an attitude control unit (62). An advance or retraction position detector (45) detects an advance/retraction position of the attitude altering members while the attitude altering members applying a preload to the distal end member restrained by the restraining tool. The attitude control unit uses the detection value as information on the advance/retraction position corresponding to an initial position-attitude of the distal end member.