Abstract: According to an aspect of the present disclosure, an endoscopic surgical device is provided and includes a handle assembly; a tube assembly operatively supported on and extending from the handle assembly, the tube assembly defining a longitudinal axis; an articulation assembly operatively supported on and extending from a distal end of the tube assembly; and a tool assembly operatively supported on and extending from a distal end of the articulation assembly. In use, a rotation of the handle assembly about the longitudinal axis results in a concomitant rotation of the tool assembly; an actuation of the handle assembly in a particular manner results in a concomitant actuation of the tool assembly; and a pivoting of the handle assembly in any off-axis direction relative to the longitudinal axis results in a concomitant articulation of the tool assembly via the articulation assembly.

Abstract: A surgical system according to the present invention comprises: a surgical instrument for medical treatment of an affected portion in the body cavity; an observation device for observing tissue in the body cavity; an image display device for displaying images taken by the observation device; and an indicating-point control device included in at least one of the surgical instrument and the observation device, for controlling the position of an indicating point superimposed on an image displayed on the image display device.

Abstract: The present invention is an integrated and automated irrigation and aspiration system for use in an endoscopic imaging system. The system provides for the automated cleaning of poorly prepared patients during a colonoscopy procedure as well as automated cleaning of an imaging system of an endoscope. The invention analyzes images obtained from an image sensor to detect the presence of an obstructed field of view, whereupon a wash routine is initiated to remove the obstruction. The wash routine may be adjusted in accordance with environmental conditions within the patient that are sensed by one or more sensors within the endoscope. In another embodiment, insufflation is automatically controlled to inflate a patient's colon as a function of one or more sensor readings obtained from one or more environmental sensor(s) on the endoscope.

Abstract: In a gas supply system, a selection unit is configured to send an instruction to select any one of first gas and second gas. In the gas supply system, a controller is operative to control at least one of a first gas supply unit for supplying the first gas and a second gas supply unit for supplying the second gas to selectively insufflate any one of the first gas and second gas into a body based on the instruction sent from the selection unit.

Abstract: A method and apparatus for use during a surgical procedure sealingly isolates a resected specimen to prevent contamination of surrounding tissue as the specimen is removed from the surgical site. The pouch is disposed at the distal end of an endoscope or trocar, and can be used to debulk and dimensionally alter the specimen for removal through a working channel.

Abstract: An access device adapted and configured to be inserted through a natural biological orifice, and related surgical methods are provided. The access device includes a body, a nozzle means and means for delivering a pressurized flow of fluid to the nozzle means. The body is configured and dimensioned to be inserted through a natural bodily orifice and has proximal and distal end portions and defines at least one lumen therethrough to accommodate passage of one or more surgical instruments. The nozzle means is operatively associated with the body for directing pressurized fluid into the lumen to develop a pressure differential in an area within a region within the lumen to form a fluid seal around the one or more surgical instruments passing therethrough.

Abstract: Disclosed herein are various systems and methods for improving the visualization of an optical device, in particular a medical device. The device can include a lens cover that provides an offset between the distal end of an endoscope and the surrounding environment. At least a portion of the lens cover can have an ellipsoidal shape.

Abstract: Systems and methods for removal of bacterial biofilm from a target site of a human patient includes a surgical instrument having an introducer for bodily insertion and maintaining an irrigation duct and a nozzle. A distal portion of the introducer is transitionable between a plurality of bend angles relative to a proximal portion thereof. In particular, the instrument is adapted to independently maintain the distal portion at each of the plurality of bend angles relative to the proximal portion. The nozzle is maintained relative to the distal portion of the introducer and is adapted to dispense pressurized irrigant from the irrigation duct toward a layer of bacterial biofilm.

Abstract: A guide system for use with an endoscope, and a method of use is disclosed. The guide system can include a track, in the form of a rail, and a mating member for engaging the rail. The guide system can also include an accessory, such as an accessory guide tube through which a medical instrument can be carried external of the endoscope. An end cap can be provided to support the track relative to the distal end of the endoscope.

Abstract: An endoscopic imaging system includes a reusable control cabinet having a number of actuators that control the orientation of a lightweight endoscope that is connectable thereto. The endoscope is used with a single patient and is then disposed. The endoscope includes an illumination mechanism, an image sensor, and an elongate shaft having one or more lumens located therein. An articulation joint at the distal end of the endoscope allows the distal end to be oriented by the actuators in the control cabinet. The endoscope is coated with a hydrophilic coating that reduces its coefficient of friction and because it is lightweight, requires less force to advance it to a desired location within a patient.

Abstract: A method for autoclave sterilization of an endoscope 2 of the present invention includes the step of making a space, which is defined by the outer side of a channel and an outer covering member of the endoscope 2, communicate with the outside of the endoscope, while at least one end of the channel communicates with the outside of the endoscope 2 and the channel is inserted through the inside 47 of the endoscope. The space 47 and the outside of the endoscope are once brought into the negative pressure. Thereafter, steam is introduced in the space 47 and the outside of the endoscope, and the endoscope 2 is sterilized.

Abstract: This invention relates to an improved colonoscope and method of removing or adding non-distal fluid from the colon during colonoscopy using a colonoscope, the colonoscope having at least a distal port and a non-distal port or plurality of non-distal ports to remove fluid from a shared channel within the colonoscope. The invention further describes the utilization of multiple ultrasound probes to determine a three dimensional image of anatomy behind the wall of a colon and the usage of microprocessors and/or motors to tighten and release wires of the colonoscope. Finally, a method of using an external joystick and a joystick on a handle of a colonoscope to effect navigation is described.

Abstract: An endoscopic working channel is made of an inner polytetrafluoroethylene tube having a spiral wrap of wire over it with an outer expanded polytetrafluoroethylene tube bonded over the wire to the inner polytetrafluoroethylene tube.

Abstract: An apparatus and method of use thereof for identifying and monitoring women at risk of developing OSE-derived carcinomas is provided. The apparatus includes an introducer needle configured to be capable of insertion into a female such that a terminal end of the needle is positioned adjacent an ovary of the female, a microendoscope having an optic fiber which is operably insertable into the needle in a manner to enable an image of the ovary to be obtained therethrough, and a tissue removing member operably co-insertable into the needle with the optic fiber therein to enable removal of ovarian tissue cells with minimal deleterious effect to the ovary.

Abstract: Apparatus and methods for sealing an aperture in body tissue that extends from an outside surface to an inside surface of the body tissue is described. One embodiment of the apparatus includes an expandable material positioned against at least a portion of an expandable member, the expandable material having a sealing surface adapted to expand against the inside surface of the body tissue surrounding the aperture as the expandable member expands. In an alternative embodiment, tissue is pulled by a retractor mechanism between two biased legs of a deformable clip that is loaded on a trigger. As a base of the trigger is moved away from a base of a housing, the clip is released from the trigger causing the two biased legs of the clip to come together and seal tissue therebetween. Generally, the apparatus of each embodiment is delivered to an aperture site through an endoscope.

Abstract: Mounted internally of a casing of a manipulating head assembly of an endoscope is a branching passage member to connect a base end of a biopsy channel with a biopsy channel entrance way and a suction passage. The branching passage member is retained in position by threaded engagement with a biopsy channel entrance pipe which is fitted in the biopsy channel entrance way. Further, the branching passage member is provided with restrictive members thereby to restrict movements of the branching member except a movement toward the biopsy channel entrance pipe when the branching member is pulled into the biopsy channel entrance way for engagement with the entrance pipe.

Abstract: The holding device of the endoscope allows suspension of the tissue while it is held and fixed securely. Use of holding device with large distal ends will not damage tissue and allows holding and suspension of a large area. A needle pierces at least the proper muscularis, thereby forming a large protrusion including the proper muscularis of the stomach and the esophagus as artificial valve to prevent reflux effectively. The holding device, formed extending out of the distal end of the endoscope, can touch the tissue easily under observation of the endoscope. Treatment is simple, and takes a shorter time.

Abstract: An endoscope shaft comprising a working conduit and a number of supply and/or functional conduits. The supply and/or functional conduits have an excessive length with respect to the endoscope shaft and are arranged in spirals, in serpentine and/or zigzag shape around or along the working conduit, whereby a flexibility and bendability of the endoscope shaft is achieved.

Abstract: A multifunction endoscope handle comprises a body cover, a first body cover extension and a second body cover extension. The body cover comprises distal and proximal ends with a waist of therebetween. The proximal and distal end circumferences part each larger than the waist circumference. The body cover also comprises an outer surface tapering from the distal and proximal ends to the waist. Both of the first and second body cover extensions extend radially outwardly directions from the outer surface of the body cover. In some embodiments the proximal circumference is larger than the distal circumference. The outer surface is preferably a smoothly tapering outer surface. The body cover may comprise a plurality of ports at a proximal portion thereof.

Abstract: A treatment tool insertion channel of an endoscope, which is arranged through an inside of an insertion part that includes a flexible tube and a bendable part, includes a flexible inner tube, a spiral groove formed around the flexible inner tube over an entire length of the bendable part and the flexible tube, at least one coil wound along a bottom of the spiral groove, and at least one type of filler with which the spiral groove is filled. The treatment tool insertion channel includes a first portion that includes a part inside the bendable part and a second portion at a proximal end side of the first portion, the first portion being configured more flexible than the second portion.

Abstract: An insertion portion of an endoscope includes a flexible tubular framework composed of short-cylindrical joint rings coupled in series via rotatable connecting shafts; and flexible internal elements including a treatment tool insertion channel and a optical fiber bundle(s). Each short-cylindrical joint ring is coupled at one end to one adjacent joint ring via two connecting shafts at 180-degree symmetrical positions and is coupled at the other end to another adjacent joint ring via another two connecting shafts at 180-degree symmetrical positions with a 90-degree phase shift with respect to the one adjacent joint ring. Inner end surfaces of one set of connecting shafts at a specific circumferential position are arranged to face the treatment tool insertion channel, and inner end surfaces of another set of the connecting shafts at another specific circumferential direction are arranged to face or substantially face the optical fiber bundle.

Abstract: An apparatus and method for providing a biopsy device at the distal end of a medical device, such as an endoscope, are disclosed. The apparatus can include a device attached to an endoscope to guide the position of the end of the instrument, such as by constraining the instrument to bend in a predetermined manner, or otherwise guide the distal end of the instrument extending from the distal end of the instrument channel.

Abstract: An adapter for an endoscope of the present invention includes: a locking device for attaching and detaching that attaches and locks this adapter for an endoscope onto a predefined position on an endoscope control part; and a first treatment tool locking device that keeps a treatment tool at a first predefined position. Furthermore, at the first predefined position, a guidewire entry aperture of the treatment tool and an entry aperture of a forceps plug are separated in such a way as to face each other along substantially the same line.

Abstract: An operating device is provided which includes an instrument insertion conduit, having a distal end connectable to the operating channel input of a handle of an endoscopic probe, the proximal end of the instrument insertion conduit forming an instrument input for the operating device, a suction assembly comprising a suction conduit communicating with the insertion conduit and a control device for selectively connecting the suction conduit to a pump, to suck out fluids through the operating channel, and a connecting conduit putting the suction conduit into communication with the insertion conduit, and the length of which is such that when the operating device is fixed on the handle, the suction control device is positioned close to the control means located in a proximal part of the handle.

Abstract: An apparatus and method of use thereof for identifying and monitoring women at risk of developing OSE-derived carcinomas is provided. The apparatus includes an introducer needle configured to be capable of insertion into a female such that a terminal end of the needle is positioned adjacent an ovary of the female, a microendoscope having an optic fiber which is operably insertable into the needle in a manner to enable an image of the ovary to be obtained therethrough, and a tissue removing member operably co-insertable into the needle with the optic fiber therein to enable removal of ovarian tissue cells with minimal deleterious effect to the ovary.

Abstract: Apparatus and methods for endoscope assemblies having working channels with reduced bending and stretching resistance are disclosed. In one embodiment, an endoscope assembly includes a sheath having a body portion adapted to at least partially encapsulate an endoscopic insertion tube, and a working channel attached to the body portion and extending along at least a portion of the body portion. The working channel includes a component for reducing the resistance of the assembly to bending and stretching. In alternate aspects, the working channel may include a cut, a gap, a sliding portion, or an expansion section. Endoscope assemblies having a working channel in accordance with the invention advantageously reduce the articulation and stretching resistance of the assembly during articulation of the endoscope assembly.

Abstract: An apparatus including a handle; a first tubular body coupled to the handle and a second tubular body comprising a polymer material coupled to a distal end of the first tubular body and the distal end defining a guide face, wherein the first tubular body and the second tubular body are co-linearly aligned and collectively define a first lumen therethrough extending from an entry port to the guide face; wherein the second tubular body has a dimension adequate for insertion into a uterus of a human subject, and wherein the guide face comprises an outside diameter less than an outside diameter of the second tubular body. Also, a method of using a hysteroscope having a single operating channel.

Abstract: An endoscopic instrument has a portion having an outer surface with a non-circular cross-sectional shape. The non-circular cross-sectional shape may be provided to the instrument by providing peripheral projections or fins along the length of the portion or by providing the periphery of the portion with a polygonal shape. Where fins are used, the fins are preferably quite small and only have a minimal effect on the fluid flow cross sectional area between the interior of the working channel and the endoscopic instrument. The resulting instrument has significantly reduced backlash while maintaining adequate fluid flow in the working channel. According to a second embodiment of the invention, a portion of the interior of the working channel of the endoscope has an interior surface having a non-circular cross sectional shape by the inclusion of a plurality of radially spaced and inwardly directed ribs or by being polygonally shaped.

Abstract: On the side at hand of an optical probe, a whole rotation transfer connector rotates while being supported by a ball bearing and a slide bearing and, therefore, rotation is transferred to a flexible shaft. The relative position between the flexible shaft and an optical sheath is changed in accordance with the amount of screwing of a sheath stopping member on the side at hand into an outer cylinder by an external thread portion and an internal thread portion. When the optical sheath is moved furthermore, the flexible shaft is elongated due to elastic deformation because the length of the flexible shaft is regulated by the interval between a locking part of a locking member at the tip and a shaft stopping member. A tip housing is made to contact with the locking member while tension is applied to the flexible shaft by the rear end surface in the direction of the side at hand.

Abstract: A flexible fiberoptic endoscope has an insertion member with a distal end portion split longitudinally into a plurality of independently operable working segments each provided with at least one longitudinally extending working channel. Visualization optics are provided in the working segments or a separate central segment surrounded by the working segments. A sheath temporarily joins the working segments to one another during an introduction procedure. The sheath is removed upon insertion of the endoscope, so that the working segments may be/separated from one another and independently maneuvered via proximal control heads to facilitate the performance of an endoscopic surgical procedure.

Abstract: The invention relates to an endoscope channel cap that may be used separately with two or more endoscopes each having a cap interface portion with a different configuration. The channel cap also may include one or more seals to maintain insufflation pressure both when an endoscopic instrument is inserted in a working channel of the endoscope and when the instrument is not inserted in the channel.

Abstract: A space through which a cooling fluid flows is provided in the inside of a connection portion between an endoscope and a light source device in order to cool heat generated in the connection portion. For example, a device for performing air supply or air suction (at least either one of air supply and air suction) in the endoscope communicates with the space, and cooling is effected by the flow of air formed by the device. In a preferred example of a cooling method, when neither air supply nor air suction is needed during manipulation of the endoscope, the device and the space are connected to each other to effect cooling, and when air supply or air suction is needed, the flow of air used for cooling is intercepted, and is exclusively directed to an air channel in the endoscope.

Abstract: A sleeve is provided for placing over a flexible endoscope. The sleeve has a port between its distal and proximal openings and the port is connected to a vacuum source. Once the endoscope is retracted proximal to the suction port, the sleeve's proximal opening is sealed off and the entire sleeve is turned into a suction lumen. Devices and methods in accordance with the invention provide improvement in removing materials from body cavities, especially in removing stones from the upper urinary tract.

Abstract: An apparatus for withdrawing a tissue specimen being held by a grasping instrument through an endoscope includes an endoscope having an endoscopic shaft with proximal and distal ends and a lumen extending therebetween. The apparatus also includes first and second hoop-like support members which are selectively slideable within the lumen from a first position to at least one second position. Each of the hoop members includes a diameter which is variable from a first diameter to at least one different diameter. The apparatus also includes a pouch having first and second ends which attach to respective first and second hoop members. The pouch defines a container therein for retaining the tissue specimen. A pair of drawstrings are attached to the first and second ends of the pouch, respectively, and are remotely operable to close the ends about the tissue specimen.

Abstract: A pincerlike instrument for an endoscope, comprising a flexible sheath, a pair of limbs, and a water supply channel. The pair of limbs, being provided at the fore-end of the flexible sheath, opens and closes as a pincers by remote operations from the base-end of the flexible sheath. The water supply channel is formed inside the flexible sheath for ejecting water from the fore-end of the flexible sheath by supplying the water from the base-end of the flexible sheath. A water ejection opening for the water supply channel is disposed at the base portion of the pair of limbs between the two limbs with the water ejection opening facing forward.

Abstract: A locking device for a maintaining an elongated member at a selected place within a body lumen comprises a substantially rigid body including an attachment portion adapted to be coupled to a distal portion of a medical instrument wherein, when in an operative position, the distal portion of the medical instrument is received within the body lumen and an angled head coupled to the substantially rigid body, the angled head being configured to overlie an access port of the medical device when the attachment portion is coupled to the distal portion of the medical device in a predetermined configuration in combination with a plurality of locking features extending from the angled head to immobilize a section of the elongated member relative to the medical device and a locking arm extending from the locking device so that, when the attachment portion is coupled to the medical device, the locking arm extends between the access port and the locking features to guide the elongated member from the access port to the lo

Abstract: An endoscope apparatus comprises an endoscope having a treatment tool passage channel in at least an insertion portion, an adaptor for endoscope forceps opening, which can be detachably attached to a treatment tool insertion opening which is at one end of the treatment tool passage channel, an insertion shape detection probe provided with a plurality of shape detection elements which are to be passed and arranged in the treatment tool passage channel via the adaptor for endoscope forceps opening, an insertion shape detection unit for detecting magnetic field emitted from the shape detection elements of the insertion shape detection probe, an insertion shape detection device which drives the insertion shape detection probe and outputs video signals for visualizing the insertion shape from the signals corresponding to the magnetic field detected by the insertion shape detection unit, and a display device for displaying the insertion shape of the insertion portion based on the video signals output from the inser

Abstract: An electronic endoscope system has a video-scope, a video-processor, and a liquid supply apparatus. The video-scope has a liquid transmitting tube for spouting liquid from a tip of the video-scope, and is detachably and electrically connected to the video-processor. The liquid supply apparatus is electrically connectable to the video-processor, and has a container for storing liquid and a liquid supplier that supplies the liquid in the container to the liquid transmitting tube. A liquid jet performance member for spouting the liquid is provided on the video-scope. A liquid jet performance detector detects operational status of the liquid jet performance member, and a liquid jet performance transmitter feeds a control signal regarding the operational status of the liquid jet performance member to the liquid supply apparatus. The liquid supplier supplies the liquid in the container to the liquid transmitting tube in accordance with the control signal.

Abstract: The invention is directed toward a micro-endoscope assembly for the ablation of tissue in breast ducts comprising a cylindrical guide tube with a distal end defining an internal cylindrical passageway, a first smaller cylindrical tube eccentrically formed in the cylindrical passageway of a smaller diameter than said tube internal cylindrical passageway to receive and guide an endoscope, the smaller cylindrical tube forming together with an inner wall surface of the cylindrical guide tube a second passageway. A energy transmitting probe is mounted in the second passageway and is connected at the distal end of the guide tube with an energy transmitting device. The assembly is inserted into a mammary duct and the interior of the duct is viewed until an abnormality is determined in the duct. The tissue and cells from the abnormality area are ablated, irrigated and aspirated through a suction channel to a collection device.

Abstract: A channel tube coupling structure for an anti-pollution type endoscope which can easily and smoothly couple a multi-lumen type channel tube extending from a base end of an outer sheath with tubes on a side of the endoscope and separate the multi-lumen type channel tube therefrom. At a side surface in a vicinity of the base end of the channel tube, side holes communicate with a plurality of tubes that are formed so as to be shifted from one another in an axial direction. A coupling hole, where the base end portion of the channel tube is loosely inserted thereinto and freely removed therefrom, provides a space in a radial direction between the channel tube and the coupling hole. Annular sealing members are provided which seal portions between the respective side holes, in a state where the base end portion of the channel tube is inserted into the coupling hole.

Abstract: An endoscope has a removable suction tube to facilitate cleaning and reduce the risk of patient infection. The endoscope includes an elongated flexible probe with a housing at its proximal end to control the direction and operation of the probe and for viewing images carried by optical fibers from the distal end of the probe. A recess or slot extending along either the suction tube or probe enables the suction tube to be removably secured to the probe. A suction tube connector at the proximal end of the suction tube allows the suction tube to be removably secured to the housing and also provides a connector for removable attachment to an external suction line. In the preferred embodiment, the suction tube connector includes means for regulating suction through the suction tube, such as a vent opening that can be manually sealed by a healthcare provider.

Abstract: A system, apparatus, and method for viewing a visually obscured portion of a body cavity. The system includes an endoscopic-type instrument, an imaging apparatus, and a human interface apparatus. The endoscopic-type instrument includes a face tip assembly connected to a shaft assembly, the shaft assembly being connected to a handle and viewing assembly. The face tip assembly includes a plurality of input/output ports and a working channel extension to protect an optical image collector. The shaft assembly includes an actively flexible shaft segment and a passively flexible shaft. The method for viewing a visually obscured portion of a cavity includes the steps of providing an instrument having an actively flexible shaft segment and manipulating the actively flexible shaft segment to a desired angular deflection.

Abstract: An endoscope system comprises: an endoscope main body having an insertion portion in which a lumen is formed, the insertion portion having a proximal end and a distal end, a distal end opening of the lumen being provided to the distal end of the insertion portion, and a proximal end opening of the lumen being provided to the proximal end of the insertion portion; a first fixing member provided to the distal end of the insertion portion, capable of selecting between a fixed state for fixing the distal end portion of a linear member inserted into the lumen and a released state thereof in the distal end portion of the insertion portion; a second fixing member provided to the proximal end of the insertion portion, capable of selectively fixing the proximal end portion of the linear member inserted into the lumen in the proximal end of the insertion portion; and a tubular member having a proximal end, a distal end, and a lumen running therebetween, and removably inserted into the lumen, wherein a slit is formed fr

Abstract: A surgical system includes an endoscope, a pair of end effectors provided on the outside of the distal end of a endoscope (“on-scope”), in which one end effector is rotatable or otherwise movable relative to the second end effector and in which such movement is effected via controls elements which do not extend through a lumen of the endoscope, and another instrument extending through the lumen of the endoscope (“through-scope”), and which preferably also has a pair of end effectors. The on-scope device may be clamping jaws, needle passers, clip appliers, cautery devices, staplers, and releasable hemoclips, among other end devices. The through-scope end effectors may be graspers and clip appliers, among other end effectors.

Abstract: An endoscope of the present invention includes a flexible tube section having an outer sheath layer composed of resin for constituting an endoscope insertion section and a slender tube member inserted into the endoscope insertion section, wherein the amount of shrink of the tube member after the completion of a high temperature/high pressure steam sterilization process is set as much as or greater than the amount of shrink of the flexible tube section after the completion of the high temperature/high pressure steam sterilization process.

Abstract: The present invention provides an endoscope apparatus comprising a scope portion in which a flexibly bending portion is provided at an elongated insert portion having a flexibility, the insert portion being inserted into a space which is a target of inspection, and a manipulating device inserting channel is formed, the channel being capable of loading therein a predetermined manipulating device which advances the inside of the insert portion to its distal end side, a remote controller which operates the flexibly bending portion by a joystick, and a connecting device which connects the scope portion and the remote controller to be integrally linked with each other at a position where an operation of the joystick and an operation for inserting the manipulating device through a proximal opening end do not interfere with each other.

Abstract: An apparatus including a handle; a first tubular body coupled to the handle and a second tubular body comprising a polymer material coupled to a distal end of the first tubular body and the distal end defining a guide face, wherein the first tubular body and the second tubular body are co-linearly aligned and collectively define a first lumen therethrough extending from an entry port to the guide face; wherein the second tubular body has a dimension adequate for insertion into a uterus of a human subject, and wherein the guide face comprises an outside diameter less than an outside diameter of the second tubular body. Also, a method of using a hysteroscope having a single operating channel.

Abstract: An endoscope having a tubular stem that, at its distal end, houses a camera and a distally pointing illumination device. The tubular stem defines an empty space extending from the camera in the proximal direction. The empty space receives a camera cable and is used to house implements useful during operation of the endoscope in a surgical procedure.

Abstract: Medical devices and methods for accessing an anatomical space of the body and particularly for penetrating the epicardium to access pericardial space and the epicardial surface of the heart in a minimally invasive manner employing suction are disclosed. The distal end of a tubular access sleeve having a sleeve wall surrounding a sleeve access lumen and extending between a sleeve proximal end and a sleeve distal end having a plurality of suction ports arrayed around the sleeve access lumen distal end opening is applied against an outer tissue layer. Suction is applied through the plurality of suction ports to a plurality of portions of the outer tissue layer. A perforation instrument is introduced through the sleeve access lumen to perforate the outer tissue layer to form an access perforation into the anatomic space while the applied suction stabilizes the outer tissue layer, whereby further treatment drugs and devices can be introduced into the anatomic space.

Abstract: A sheath assembly for a medical instrument such as an endoscope comprises an outer sheath and inner sheath and novel means for providing out-flow of fluids from a surgical site. The outer sheath is disposed about at least a portion of an inner sheath. The assembly has an outflow aperture disposed in an outer wall at the distal end of the assembly. The outflow aperture is the initiation for an outflow conduit that is generally longitudinally disposed in a distal tip portion of the assembly and communicates fluid to a main outflow channel formed between the outer sheath and inner sheath. In a preferred embodiment, the outflow aperture and conduit are disposed wholly or partially in a dielectric tip element. The novel assembly allows improved outflow by disposing the outflow aperture at a more distal end of the instrument than conventional devices such that the outflow aperture is less prone to blockage by surrounding tissue or debris when used in tight anatomical passages.