Abstract: A method for creating a tract in retrograde fashion for nephrostomy tube creation comprising the steps of providing a puncture wire having a tissue penetrating tip shielded in a sheath, inserting the puncture wire and sheath through a channel in an ureteroscope, advancing the puncture wire from the sheath while visualizing under direct vision a position of the puncture wire, advancing the puncture wire through a selected calyx, and inserting antegrade a coaxial catheter over the puncture wire.

Abstract: Endoscopes, endoscopic instruments, and methods for making and using the same. An illustrative endoscopic instrument includes a catheter that can extend through the working channel of an endoscope. The catheter may include an end effector passing region.

Abstract: An exemplary embodiment providing one or more improvements includes a micro endoscope having steering, rotation and tool control function which can be utilized for insertion using a needle and catheter for performing arthroscopy and endoscopic procedures.

Abstract: A diagnostic catheter and method of use for analyzing tissue is provided. A method for analyzing tissue in accordance with one embodiment of the present invention includes inserting a catheter having a sensor at its distal end into the body of a patient, applying suction through the catheter to secure the tissue to the catheter and then analyzing the tissue with the sensor. An apparatus for analyzing tissue within the body of a patient in accordance with an alternative embodiment of the present invention is also provided. This alternative embodiment includes a catheter having a first end and a second end, the first end having an orifice and a sensor, the catheter also having a lumen.

Abstract: An access and positioning arrangement for use during an endoscopic surgical procedure in which a pair of surgical tools are utilized, such as an endoscopic imaging device for providing an image of the surgical site and a surgical instrument for manipulating tissue at the surgical site. The arrangement includes a housing for positioning over a surgical portal defined in the patient through which the surgical site is accessed, which housing defines first and second channels which receive the respective surgical tools so that the tools can be maintained in a fixed orientation relative to one another within the surgical site and so that the tools can be readily positioned in the correct positions relative to one another at the surgical site.

Abstract: Endoscopic surgical operation method includes: a step of lifting a living tissue including an diseased tissue located distally relative to an operation channel of an endoscope inserted through a natural orifice; a step of suturing a proximal region and a distal region of the living tissue positioned basal relative to the diseased tissue lifted by a suturing means section projecting distally from the operation channel of the endoscope after the lifting; and a step of resecting the living tissue between the sutured regions and the diseased tissue endoscopically after suturing the proximal region and the distal region of the living tissue surrounding the diseased tissue.

Abstract: Apparatus and methods are described allow the techniques of endoscopic and laparoscopic surgery to be combined into a minimally invasive hybrid surgical technique called NOTES-assisted laparoscopic surgery. Manual and robotic-controlled versions of a modular laparoscopic tool are described having a small diameter shaft that is delivered laparoscopically to a surgical site. Larger diameter working tips are delivered through a NOTES delivery tube inserted to the surgical site through a natural orifice and joined to the shaft of the modular laparoscopic tool. Larger diameter working tips improve the effectiveness of the modular laparoscopic tools and the number and size of laparoscopic ports used can also be reduced.

Abstract: In an endoscopic system, when an affected area of a biomedical tissue in an image is treated with a scalpel and a holding pair of forceps which movably extend from a distal portion of an endoscope through the endoscope while the image taken by the endoscope in a body cavity in a time-series manner is being observed, a treatment is performed in which the holding pair of forceps holds the affected area detached from the biomedical tissue by the scalpel. When any motion is detected in the distal portion of the endoscope included in the image, a motion direction and a motion amount of the distal portion of the endoscope attributed to the motion are detected, and the distal portion of the endoscope is curved to return the scalpel to an original treatment position.

Abstract: Appropriate stereoscopic images of an affected site are easily acquired. Provided is a stereo-endoscope device that includes an inserted portion that can be inserted into a subject's body; two imaging devices that are disposed on the inserted portion with a space therebetween; driving units that change the relative angle of the optical axes of the imaging devices; a distance sensor for detecting the distance to the imaging devices from a treatment part of a treatment instrument that is inserted into the subject's body and is used to treat the affected site; and a swivel control section that controls the driving units based on insertion information of the treatment instrument, the insertion information including the distance detected by the distance sensor.

Abstract: A medical treatment endoscope includes: an insertion portion which has a lumen formed along a longitudinal axis of the insertion portion and is configured to be inserted into a body cavity, a lateral opening portion which extends in a lateral surface of the insertion portion, from a distal end surface of the insertion portion to a proximal end side of the insertion portion, an elastic member which is provided in an inner wall of the lumen at a position separated from an edge of a proximal end of the insertion portion in a direction toward a distal end side of the insertion portion, and a tubular arm which includes a bendable bending part provided at a distal end side of the tubular arm.

Abstract: An apparatus applicable for the ligation of internal tissue in a created or natural cavity in animals or in the human body, for example varicose veins in the gullet or a duodenal diverticulum, by means of an elastic band (19) while observing the ligations through an endoscope. The apparatus includes an automatic trigger unit (1) mounted firmly on the handle of the endoscope which can release a number of elastic bands (19) with the aid of a single-stranded trigger cord (11). Only a single elastic band (19) is released for each ligation thereby establishing a one-man-operated apparatus.

Abstract: A catheter device is useful in a procedure in which an injectable material or device is injected into a tissue of a patent. In one implementation, for example, the catheter device is useful in injecting a compound into a tissue of the heart, such as the myocardium. The distal tip portion of the catheter may include an extensible and retractable needle in combination with a camera, a balloon, a vacuum port, or any combination thereof.

Abstract: A catheter device is useful in a procedure in which an injectable material or device is injected into a tissue of a patient. In one implementation, for example, the catheter device is useful in injecting a compound into a tissue of the heart, such as the myocardium. The distal tip of the catheter may include an extensible and retractable needle in combination with a camera, a balloon, a vacuum port, or any combination thereof.

Abstract: A surgical device includes a jaw portion and a shaft portion that is pivotably coupled to the jaw portion. The shaft portion defines an interior space having first and second openings on respective radially-opposite sides of the shaft portion. A camera assembly is coupled to the shaft portion and is moveable between a first position, in which the camera assembly is positioned within the interior space of the shaft portion, and, for example, second and third positions, in which the camera assembly extends through a respective one of the first and second radially-opposite openings of the shaft portion. In this manner, the camera assembly may be positionable on, and may provide imaging data of, either side of the surgical device, irrespective of which lateral side the jaw portion is articulated relative to the shaft portion.

Abstract: A medical manipulator which includes: a plurality of arms formed in a cylindrical shape a distal end portion of which is made of a rigid member having a bending portion capable of bending; an insertion portion made of a rigid member having a plurality of channels in which base ends of the plurality of arms are connected to a distal end of the insertion portion so as to connect lumens of the arms to the plurality of channels; a photographic device provided at the distal end of the insertion portion; an operation portion that operates the bending portion; and a transmission member that connects the bending portion and the operation portion, in which the bending portion has: a first bending portion that is capable of bending in a predetermined direction by an operation of the operation portion, and a second bending portion provided in a base end than the first bending portion that is capable of fixing the plurality of arms in a bent state so as to mutually separate, and the transmission portion has: a first regi

Abstract: An endoscope apparatus according to the present invention includes an insertion portion having a distal end portion and at least two channels; an optical observation system provided on one surface of the distal end portion so as to face an axial direction different from a direction of an insertion axis X of the insertion portion; a first channel opening provided on one surface of the distal end portion near the optical observation system; an ultrasound transducer array provided on the one surface of the distal end portion and having a scanning surface Z parallel to the insertion axis; and a second channel opening provided on a proximal end side of the ultrasound transducer array.

Abstract: The various embodiments of the present inventions provide stabilization devices and methods for use of the stabilization devices with minimally invasive gynecological procedures such as methods of preventing pregnancy by inserting intrafallopian contraceptive devices into the fallopian tubes

Abstract: An endoscopic aspiration device is mounted on a manipulating head of an endoscope, from which an elongated insertion rod member is extended forward, the endoscopic aspiration device being composed of a valve casing which is mounted on the manipulation head in communication with an aspiration passage running through the insertion rod member, and a valve assembly unit including a valve member, a valve guide member and a connector member attached to the valve guide member to communicate same with a proximal aspiration passage on the side of a suction source. The valve member is put in a sliding displacement along the valve guide member to bring the aspiration passage into and out of communication with the proximal aspiration passage on the side of a suction source. The valve guide member is coupled with the valve casing through a coupling mechanism which permits to turn the valve assembly unit on and relative to the manipulating head.

Abstract: An endoscope includes an attachment unit detachably attached to an outer peripheral direction side of an insertion section to be rotatable about a longitudinal axis with respect to an insertion main body, and including a gear portion formed over an all-round inner peripheral portion of the attachment unit, a rotary gear meshing with the gear portion to allow the attachment unit to be attached to the insertion section, and a base portion defining a gear arrangement portion where the rotary gear is arranged on an outer peripheral portion of the insertion section. In the endoscope, a channel, extended through an inside of an operation section and an inside of the insertion section from an outer surface of the operation section and opened to an outside of the insertion section in the gear arrangement portion, is defined.

Abstract: An insertion apparatus includes insertion unit, a rotation drive mechanism, a first rotation member which is arranged inside the insertion unit and rotates by the rotation drive mechanism, a second rotation member which is attached to an outer peripheral surface of the insertion unit and is adjacent to the first rotation member, and a helical rotation member which is rotatable in accordance with rotation of the second rotation member. The insertion apparatus include a magnetic force generation mechanism which generates a magnetic force that enables the first rotation member and the second rotation member to be attracted to and coupled and enables the second rotation member to rotate follow rotation of first rotation member. The magnetic force generation mechanism is arranged at a tubular end portion of the first rotation member and a tubular end portion of the second rotation member adjacent to the end portion.

Abstract: Apparatus is described for use with an imaging device (31) that acquires a pre-procedure image of a portion of a subject's body disposed at a pre-procedure position. An input unit receives from a user an indication of two or more lines within the image that correspond to respective branches of a multi-branch luminal structure. A probe (1) moves within the portion along two or more lines in the structure that respectively correspond to the two or more lines within the image. A location sensor (18) coupled to the probe senses location coordinates along the two or more lines, while the portion is at a current position. A control unit (34) registers the image of the portion with the portion's current position by registering (a) the two or more lines within the image, with (b) the location coordinates along the two or more lines. Other embodiments are also described.

Abstract: A medical system including an endoscope having a proximal end, a distal end, and a lumen extending therebetween is disclosed. The endoscope includes a port configured to provide access to the lumen. In addition, the system may include an actuation member slidably disposed through the lumen such that a proximal end of the actuation member extends through the port, and a distal end of the actuation member is operably coupled to an end-effector. The system may further include an actuation handle removably secured to the actuation member. In one embodiment, a portion of the end-effector has dimensions larger than a maximum dimension of the lumen.

Abstract: A catheter for the treatment of tissue, particularly for the treatment of cardiac tissue to alleviate cardiac arrhythmias includes a connector having mechanical use limiter that may be placed in the handle of the catheter or at any point along the electrical connection pathway to an electro-anatomic mapping system and/or ablation system. The mechanical use limiter has a counter wheel and locking pin which when engaged disables the reconnection of the connector to any mated connector after a predetermined number of uses.

Abstract: An endoscope includes an endoscope insertion portion having a bendable bending portion and a bending mechanism configured to bend the bending portion. The bending mechanism includes a pulley, at least one annular member, a pulling member, and a pulling operation member. The pulley is rotatably driven. The annular member is formed into a C-shape with a cut-out, and can be elastically deformed. The annular member is externally fitted to the pulley with a gap. The pulling member has an intermediate portion wound around the annular member. The distal end portion of the pulling member is connected to the bending portion, and the proximal end portion of the pulling member is connected to the pulling operation member which pulls the pulling member. The width direction position at the winding start position of the pulling member wound around the annular member is made different from the width direction position at the winding end position of the pulling member.

Abstract: A medical device such as an endoscope, a laparoscope, or other device including an entry guide uses outriggers or arms that are mounted on the distal end of the entry guide and rotationally deployed to provide separation of instruments when the entry guide reaches a work site. Deployment can be implemented with as few as one cable or actuator to operate the arms. This mechanism may achieve working separation in a short axial length without complicating instrument channels that may be used for other instruments introduced through the entry guide.

Abstract: An automated switch and driver for an open biased spring-based multiple purpose end effector of a medical instrument to be used by a single operator without assistance for biopsy, clipping, clamping, grasping, snaring, cutting, dissecting or other operative functions with electrical connections for cautery or hot biopsy used independently or combined with a rigid or flexible endoscope of any size. The driver mechanism may be a spring(s), gear(s), electrical solenoid or motor, air or hydraulic pressure activated piston or a combination thereof. Automated action may be initiated by voice, hand or foot switch. The switch and driver mechanism may be disposable, attached to or separable from the operative instrument or permanently attached to be reusable. The automated end effector instrument may be combined with or incorporated into an endoscope.

Abstract: An advance and retreat assist tool includes a base unit, a fixing unit and a first tubular member. The advance and retreat assist tool further includes a fixing portion which fixes the treatment instrument to the first tubular member, a rotary portion which provided in the first tubular member and an advance and retreat mechanism which advances and retreats the first tubular member on the basis of the a rotation force of the rotary portion.

Abstract: An endoscope includes a flexible portion extended to a part on a proximal direction side of an insertion main body along a longitudinal axis, and a passive bending portion provided to a distal direction side of the flexible portion in the insertion main body, being more flexible than the flexible portion, and configured to passively bend when external force acts thereon. The endoscope includes an attachment unit which includes a fin portion spirally extended along the longitudinal axis, and through which the insertion section is inserted, and a holding portion provided to the insertion main body, and configured to hold the attachment unit in a state that the attachment unit covers the passive bending portion and that the attachment unit is rotatable about the longitudinal axis with respect to the insertion main body.

Abstract: The present invention is an apparatus, device or tool for performing endoscopic (that is, minimally invasive) surgery. An exemplary embodiment of the invention includes a video endoscope whilst in another embodiment of the invention includes an endoscopic surgical tool which, when equipped with one of a suite of endoscopic surgical instruments, can be used by a surgeon to perform surgical procedures inside a body. Another embodiment of the present invention includes a suite of endoscopic surgical instruments designed to work co-operatively with the endoscopic surgical tool. In another embodiment of the present invention, a video-assisted endoscopic surgical tool system is provided. In one embodiment, the system includes the video-assisted endoscopic surgical tool and a suite of at least one endoscopic surgical instrument.

Abstract: A system for mini-invasive surgery in a body cavity that is easily positioned and hooked including at least one detachable surgical endoclamp (10), assembled with an introduction guide (20) and at an initially open position; and at a naturally closed position when detached from the introduction guide (20) by a detachment mechanism; the endoclamp (10) comprising a portion of ferromagnetic material; a cylindrically-shaped introduction guide (20) assembled with the detachable surgical endoclamp (10), the introduction guide (20) comprising a mechanism to detach the endoclamp (10); and at least one remote traction component (30) for the endoclamp (10), acting through the application of an electromagnetic field over the ferromagnetic portion of the endoclamp (10).

Abstract: An endoscope includes a drive force transmitting section attached to an insertion main body, and configured to transmit rotational drive force that rotates an attachment unit to the attachment unit, and a member inserting portion provided to a proximal direction side of an insertion section. The endoscope includes a first linear member insertable into the insertion section from the member inserting portion and removable from the insertion section through the member inserting portion, and has a distal end connectable to the drive force transmitting section while being inserted into the insertion section. The first linear member is configured to transmit the rotational drive force to the drive force transmitting section when rotated while being connected to the drive force transmitting section.

Abstract: A method for creating a tract for nephrostomy tube creation comprising the steps of providing a puncture wire having a tissue penetrating tip shielded in a sheath, the puncture wire slidable within the sheath and releasably lockingly engaged thereto, inserting the puncture wire and sheath in a first direction through a working channel of an ureteroscope to exit the channel of the ureteroscope, releasing the puncture wire from the sheath and advancing the puncture wire a first distance from the sheath while visualizing via the ureteroscope the position of the puncture wire, advancing the puncture wire and the sheath into a selected calyx and through a flank of a patient, removing the puncture wire from the sheath in a second direction different from the first direction and inserting a guidewire through the sheath.

Abstract: The present invention provides an access device for surgery. The access device includes a guide member and a head member. The guide member and head member define a channel configured to receive and guide a sterile flexible scope with a working channel. The guide member and head member cooperate to extend through a small opening of 2 cm or less to access tissue structures. The head member may include surfaces to separate a pericardium from a surface of the heart, stabilize a beating heart and, with the endoscope, provide visibility for the implantation of a therapeutic such as stem cells to the surface of the heart with improved safety and accuracy. Ranges of other diagnostic, application of therapeutics or biologics, and observational applications may be facilitated by the access device, such as TMR, ablation, echo-probe diagnostics, LAA isolation, observation of the same procedures, etc.

Abstract: A medical instrument system includes an elongated member having an inner space in a direction of a longitudinal axis, an insertion section installed at the inner space and having a bending section capable of being bent, a manipulation section configured to manipulate the bending section, a first manipulation member transmitting a driving force of the bending section in accordance with the manipulation by the manipulation section, a second manipulation member arranged in the direction of a longitudinal axis, a connecting section having a first connecting section and a second connecting section and capable of connecting the first manipulation member and the second manipulation member, and a switching mechanism having a first acting section and a second acting section and switching between a connection state and a release state in accordance with a relative movement between the elongated member and the insertion section.

Abstract: A minimally invasive endoscopic surgical procedure or an endoscopic surgical procedure through natural orifices which includes: introducing a spacial structure in a shrunken state into a body cavity by a spacial structure introduction portion; enlarging the spacial structure in the body cavity; setting the enlarged spacial structure in a predetermined position in the body cavity and supporting the tissues inside of the body cavity with the set spacial structure; inserting a distal end of at least an endoscope or a treatment instrument from at least a part of an opening portion of the spacial structure, and orienting the distal end to a pathological lesion located on the inner side of the tissues inside of the body cavity which is supported by the spacial structure.

Abstract: An adapter for endoscopic treatments has a fiber constraint device that is set at a desired maximum fiber retraction distance, and provides a physical barrier to prevent excessive fiber retraction into the endoscope. The restricted retraction prevents the fiber from firing within the endoscope, thus avoiding expensive damage to both the endoscope and fiber. This benefits the patient with potentially shorter treatment time and less exposure to anesthesia. The adapter also limits maximum extension of fibers. Limiting maximum extension protects the fiber tip and avoids patient complications. The adapter is securely attached to the optical fiber with a connecting means. When using directionally radiating fiber tips, fiber orientation can be defined and the fiber can be rotated relative to the initial angular position of the fiber tip.

Abstract: An object removal tool including a basket device having a basket section; a sheath on the basket device, where the sheath is adapted to longitudinally slide on the basket device; and a control connected to the basket device and the sheath. The control is configured to longitudinally move the sheath on the basket device to close the basket section on an object.

Abstract: An endoscope apparatus comprises an insertion portion having an observation optical system attached onto the distal end portion thereof and having flexibility, a thrust generating portion for generating a thrust by rotation, formed beyond a predetermined length on an outer-peripheral surface of the insertion portion in a longitudinal-axis direction, a rotation device for rotating the thrust generating portion around the longitudinal axis, and a control portion for controlling a rotational speed of the thrust generating portion according to an insertion length of the thrust generating portion inserted in a subject.

Abstract: A probe manipulator which has a grip device that can be held by a user in order to facilitate manipulation of a probe when the latter has been inserted into a channel of an endoscope. Connection devices are provided for releasably connecting the grip device to the probe in such a way that the probe may be rotated or displaced by rotation or displacement of the grip device. The connection device is connectable such that the probe need not be fed through the grip device, but that the grip device may be placed at any point along the length of the probe.

Abstract: An endoscopic delivery system including an endoscope including at least one imaging device and a working channel, and a catheter arranged to pass through the working channel, wherein the catheter is formed with an observation window on a side portion thereof, the window being in a line of sight of the at least one imaging device.

Abstract: The present embodiments provide apparatus and methods suitable for facilitating positioning one or more medical components. In one embodiment, the apparatus comprises a rail member having proximal and distal ends and a generally longitudinal axis. A first connector is adapted to be selectively coupled to the rail member, and a first medical component is adapted to be coupled to the first connector. The first connector is disposed for selective longitudinal movement along the rail member, thereby permitting movement of the first medical component with respect to the rail member. In this manner, one or more components, such as a catheter and a needle, may be inserted into a human or animal body in a controlled fashion with respect to one another.

Abstract: An endoscopic pedicle probe for use during spinal surgery to form a hole in a pedicle for reception of a pedicle screw has an enlarged proximal end for cooperation with the hand of the surgeon and an elongate shaft terminating in a distal tip that may be pushed through the pedicle to form the hole. The tip may be detachable for replacement. An endoscope extends through the shaft and is connected with a monitor to enable the surgeon to visually observe the area being treated. In a preferred form a light means extends through the shaft to illuminate the area being treated, and in a further preferred form a conduit extends through the shaft to convey a fluid to flush the area being treated. In a further embodiment, two endoscopes are associated with the probe.

Abstract: Provided is a medical treatment endoscope including: an endoscope main body which includes an elongated insertion portion having a lumen and an image capturing mechanism disposed in a distal end of the insertion portion; an arm which is able to be inserted into or extracted from the lumen and has a treatment tool lumen for allowing an endoscope treatment tool to be inserted therethrough; and a positioning mechanism which positions a part of the arm inserted through the lumen with respect to the endoscope main body.

Abstract: A medical device such as an endoscope, a laparoscope, or other device including an entry guide uses outriggers or arms that are mounted on the distal end of the entry guide and rotationally deployed to provide separation of instruments when the entry guide reaches a work site. Deployment can be implemented with as few as one cable or actuator to operate the arms. This mechanism may achieve working separation in a short axial length without complicating instrument channels that may be used for other instruments introduced through the entry guide.

Abstract: An instrument for use with an endoscope may include an elongate section configured to move exterior to the endoscope. The elongate section may include a distal end and a proximal end. The instrument may also include an end effector attached to the distal end of the elongate section, and an actuation device attached to the proximal end of the elongate section. The actuation device may be configured to operate the end effector. The instrument may also include a guiding member coupled to the elongate section. The guiding member may be configured to be coupled to an external surface of the endoscope to permit the guiding member to move longitudinally relative to the endoscope. The guiding member may be coupled to the elongate section such that the end effector may extend past a distal end of the endoscope and move in a transverse direction independent of the movement of the distal end of the endoscope.

Abstract: This treatment device for endoscope is used for cutting body tissue while the treatment device is retractably projected from a catheter. The treatment device includes: a control wire inserted into the catheter; and a cutting electrode mounted at the distal end of the control wire with the cutting electrode being imparted a bent configuration in advance. The cutting electrode elastically deforms in a state where the cutting electrode is retracted into the catheter, thereby assuming such a shape as to resemble the configuration of the catheter.

Abstract: Provided is a suturing apparatus for endoscope capable of suturing an opening of a wound, with an endoscope inserted into cavity of a digestive tract, to the same extent as the surgical operation. The suturing apparatus includes a front arm 11, a rear arm 12, arm moving means 13 for causing the front arm 11 and the rear arm 12 to move closer to or away from each other, and rocking means for relatively rocking the front arm 11 and the rear arm 12. The rear arm 12 includes a needle-like member 14 provided on a surface on a side of the front arm 11 so that an axial direction thereof becomes parallel with a direction in which the front arm 11 and the rear arm 12 are moved closer to or away from each other. The front arm 11 is provided with a housing space 16 capable of housing a tip of the needle-like member 14 when the front arm 11 and the rear arm 12 are moved closer to each other. Each of the housing spaces houses an engagement member 21 capable of being engaged with the needle-like member 14.

Abstract: A device for releasable coupling of a first medical tool to a second medical tool. The device may include an elongate member having a first end and a second end. The first end may be configured to be secured to a portion of the first medical tool, and the second end may be secured to a coupling sleeve. The coupling sleeve defines a lumen that may receive a portion of the second medical tool.

Abstract: A valve apparatus device provides surgical instruments with sealable access to an inlet port of an endoscope instrument channel. The valve has a hollow body with a distal end that releasably attaches to the inlet port, and a flexible diaphragm seal dividing the body into a proximal chamber and a distal chamber. An instrument opening extends through the diaphragm seal for the passage of instruments therethrough, and connects the chambers together. The diaphragm seal is configured to seal with a surgical instrument inserted into the instrument opening. At least one fluid transfer member is provided to fluidly interconnect the proximal chamber to the distal chamber when the surgical instrument is sealed within the instrument opening.

Abstract: Systems and methods employing a small gauge steerable catheter (30) including a locatable guide (32) with a sheath (40), particularly as an enhancement to a bronchoscope (14). A typical procedure is as follows. The location of a target in a reference coordinate system is detected or imported. The catheter (30) is navigated to the target which tracking the distal tip (34) of the guide (32) in the reference coordinate system. Insertion of the catheter is typically via a working channel of a convention bronchoscope. Once the tip of the catheter is positioned at the target, the guide (32) is withdrawn, leaving the sheath (40) secured in place. The sheath (40) is then used as a guide channel to direct a medical tool to target.