Abstract: There is provided a medical support device for holding and positioning a needle. This device is particularly useful for positioning needles in a less invasive puncture treatment. This device comprises two rotational elements and at least one needle guide attached to a rotational element and. The needle guide guides the direction of insertion of a needle-like instrument and includes a guide portion that guides a needle or other needle-like instrument where the puncture point of the needle in a first position is different from the puncture point when the needle guide guides the needle in a second position.

Abstract: One aspect of the present disclosure relates to a system that can facilitate delivery of a medical device in proximity to a target region within a patient's body. Data representing an image of a portion of the patient's body can be received. Based on the data representing the image, a first three dimensional (3D) model of the medical device can be generated. A second 3D model of the medical device can be fitted within the first 3D model at a location in proximity to the target region to create a combined 3D model. A two dimensional (2D) projection of the combined 3D model can be created. In some instances, the 2D projection can be used to facilitate delivery of a medical device in proximity to the target region within a patient's body.

Abstract: A medical facility includes an imaging medical device and at least one portable control/display unit. The imaging medical device includes a number of docking stations, each with a closed surface and designed to establish a wireless data link to the control/display unit, and designed to simultaneously hold the unit on the imaging medical device in a defined position.

Abstract: A method and system are provided for preparing an interspinous space to receive an implantable device. The system may comprise a cutting tool guide having a guiding surface for directing a cutting tool therethrough and a holder for positioning the cutting tool guide relative to the interspinous space. The holder may be configured to adjustably attach to at least one of a pair of spinous processes defining the interspinous space.

Abstract: A method for evaluating the placement of a prosthetic heart valve in a structure of interest. The method comprises acquiring one or more depictions of an anatomical region of interest that includes the structure of interest, wherein each depiction shows the structure of interest and/or the blood pool volume of the left ventricular outflow tract (LVOT) of the patient's heart. The method further comprises designating one or more positions in at least one of the one or more depictions wherein each position corresponds to a respective position in the structure of interest at which the prosthetic valve may be placed. The method still further comprises predicting, for each of the one or more designated positions, an amount of blood flow obstruction through the LVOT of the patient's heart that would occur if the prosthetic valve was to be placed at a corresponding position in the structure of interest.

Abstract: An instrument carriage provides control of a surgical instrument coupled to the instrument carriage. The instrument carriage includes a control surface that is coupled to the surgical instrument to provide the control. A detection pin having a first proximal end that extends from the control surface is coupled to the instrument carriage. A magnet is fixed to a distal end of the detection pin. A carriage controller provides an indication that the surgical instrument is coupled to the instrument carriage when movement of the detection pin causes an output signal from a Hall effect sensor to exceed a threshold value that is stored in the carriage controller as part of a calibration procedure during the assembly of the instrument carriage. Surgical instrument removal may be indicated when detection pin movement causes the output signal to be less than an instrument removal threshold value of less than the instrument threshold value.

Abstract: An apparatus for subcutaneous lead guidance includes a flexible guide strap, a navigation catheter and a tunneling tool. The guide strap includes an upper layer having a plurality of retainer formations and a substrate attachable on a patient's skin extending between an incision and a target site. The navigation catheter is coupled to the upper layer via the retainer formations from a first end to a second end of the guide strap. The navigation catheter includes a plurality of position sensors for generating a subcutaneous navigation volume between the incision and the target site when the navigation catheter is coupled to a navigation system. The tunneling tool has a distal portion with a leading end and at least one position sensor on the distal portion for viewing digital representation of the distal portion in relation to the navigation volume on a display coupled to the navigation system.

Abstract: A system for determining the dimensional coordinates of a point of interest in a work space, includes a plurality of fixed-position ranging radios, located at known positions in the work space, and a wand having a first end configured for indicating a point of interest. A pair of ranging radios are mounted on the wand. A measurement circuit, responsive to the pair of ranging radios, determines the position of each of the pair of ranging radios with respect to the plurality of fixed-position ranging radios, and determines the position of the first end of the wand with respect to the plurality of fixed position ranging radios. A robotic total station may be used in lieu of the fixed-position ranging radios to monitor the positions of retroreflective elements on the wand.

Abstract: The present disclosure is directed to a planning and navigation method. The planning and method includes obtaining and rendering a plurality of images. The plurality of images are segmented to demarcate a target area. A treatment plan is determined based on the target area. The navigation method includes obtaining an ultrasound image of a scan plane including the target and obtaining a fiducial image of a fiducial pattern disposed on an ultrasound device. The obtained fiducial image is corrected and a correspondence between the fiducial image and a model image is found. A position of the surgical device is transformed to model coordinates. Then the ultrasound image and a virtual image of the surgical device is displayed to allow a surgeon to navigate the surgical device to the target using the displayed ultrasound image and the virtual image. The target is treated based on the treatment plan.

Abstract: A medical system including a catheter or other flexible structure uses a combination of two different sensor systems to measure a pose of a section or tip of the catheter or flexible structure. The first sensor system, which may include an electromagnetic sensor, can measure a pose of a first section of the catheter, and the second sensor system can measure a pose of the second section relative to the first section. The second sensor system may employ a technology such as fiber shape sensing that permits the second section to be smaller than the first section, so that a distal tip of the catheter or flexible structure can fit within smaller natural lumens.

Abstract: Presented is a preoperatively designed guidance tool for intraoperative use during bone or joint surgery wherein the guidance tool is specific to the anatomy of the patient being treated. The guidance tool comprises a body portion, a mating surface provided on the body portion for positioning the guidance tool on a corresponding registration surface of a patient's anatomy. The guidance tool further comprises at least one guide mechanism provided on the body portion for guiding a medical instrument at one or more preoperatively defined trajectories relative to a patient's anatomy. In the event of misalignment, the at least one guide mechanism is adjustable to alter the one or more preoperatively defined trajectories if necessary during intraoperative use. Also presented is a preoperative process for designing the guidance tool.

Abstract: Radiosurgical treatments of tissues of the heart mitigate arrhythmias and treat other tumerous and non-tumerous disease using an implanted fiducial positioned in or near the heart using cardiac catheterization techniques. The fiducials may be implanted after diagnostic and planning images of the target tissues have been acquired. Fiducial implantation may take place the day of a scheduled radiosurgical treatment. Techniques to accommodate post-planning fiducial implantation may include registration of the implanted fiducial location with the treatment plan, and active fiducials may limit collateral imaging radiation exposure while enhancing tracking accuracy.

Abstract: A navigation system includes a display monitor, a CPU, and a camera, wherein the camera is mounted to a back side of the display monitor to form a monitor unit. One or more reference units are placed on a body while acquiring an image data set, and are tracked during a surgical operation by the monitor unit to register and correlate a position of a visual image of an exterior surface of the body with the image data set including information concerning internal structures of the body. The image data set is displayed on the display monitor superimposed in registration over the visible image of the exterior of the body with an angle of view and aperture in accordance with the actual position of the camera, whereby the display monitor displays the internal structures corresponding to the line-of-sight of the camera and the observer.

Abstract: Integrated surgical systems and methods for using same are provided that can receive scanned images and produce a three dimensional model from the images. Based at least in part on the three dimensional model, a processor generates code defining an optimized tool path, which is sent to a surgical machining system that can machine the desired portion of the patient. In one exemplary aspect, the integrated system operates in a clearly defined and pre-programmed manner with no necessity for in-situ sensory or guidance feedback.

Abstract: A surgical instrument comprises a first member including an inner surface that defines a cavity and an outer surface configured to space tissue. The first member includes a first locking surface. A second member is configured for disposal within the cavity and extends between a first end configured to penetrate tissue and a second end configured to generate a signal representative of a position of the second member. The second member includes a second locking surface. The members are disposable between a first orientation such that the locking surfaces are engaged to resist relative axial translation of the members and a second orientation such that the locking surfaces are disengaged and the second member is axially translatable relative to the first member. Systems and methods are disclosed.

Abstract: A computer navigation system may be used with the robot to guide movement of a cutting tool. A robot may perform cutting and/or implant placement operations on a portion of a patient. A robot may have computer controls that could be utilized to form the cuts without using guide members.

Abstract: A trackable medical instrument for use in a computer assisted image guided surgery system having a digitizer for tracking the position of the instrument in three dimensional space and a display providing an indication of the position of the instrument with respect to images of a body part taken preoperatively, wherein the instrument comprises a tracking array located distally of a rotatable, axially fixed drive handle.

Abstract: A mapping system (200) including: (a) at least one external marker (210,212,214,216) adapted for positioning outside a target (520) to define a target context; (b) at least one target marker (230) adapted for positioning with the target; (c) a data acquisition tool (221) configured to provide position coordinates for at least one data point (220) at the target (520); and (d) a registration module (300) adapted to output position coordinates of said at least one data point relative to at least a portion of the target context.

Abstract: A medical robotic system has a joint coupled to medical device or a slave manipulator or robotic arm adapted to hold and/or move the medical device for performing a medical procedure, and a control system for controlling movement of the joint according to user manipulation of a master manipulator. The control system includes at least one joint controller having a sliding mode control for reducing stick-slip behavior on its controlled joint during fine motions of the joint. The sliding mode control computes a distance to a sliding surface, computes a reaching law gain, and processes the distance and reaching law gain to generate a sliding mode control action that is in absolute value less that a maximum desired feedback control action. The sliding mode control action is then further processed to generate a feedback torque command for the joint motor.

Abstract: An inventive medical imaging marker includes a base (2) composed of a non-imageable material, three spherical members (10, 11, 12) provided in a predetermined positional relationship in the base (2) and each composed of an imageable material, and auxiliary marker members (20, 21, 22) provided in the base (2) and composed of the imageable material. The auxiliary marker members (20, 21, 22) respectively have linear portions (20L, 21L, 22L) which are disposed parallel to straight lines extending through center points of the three spherical members (10, 11, 12) and each have a predetermined length sufficient to serve as a mark. The center points of the three spherical members (10, 11, 12) can be correctly identified in a captured image with reference to the linear portions (20L, 21L, 22L) of the auxiliary marker members (20, 21, 22) of the inventive medical imaging marker. Thus, reference axes can be correctly defined in the image.

Abstract: An OCT probe for imaging patient tissue may include an actuation system arranged to displace an optical fiber within a cannula. The actuation system may include a driver actuatable to displace a portion of the optical fiber, with the driver acting in an angled direction relative to the axis of the cannula. The actuation system also may include a pivot feature operably engaged with the optical fiber in a manner permitting the optical fiber to pivot on the pivot feature when the driver actuates to displace the portion of the optical fiber.

Abstract: An OCT probe includes a cannula and includes a selectively displaceable light-carrying optical fiber disposed within the cannula. The optical fiber may be arranged to emit light from a distal end thereof. A flexor may be bent to divide the flexor into a first segment and a second segment extending along a lumen of the cannula. The first segment may be coupled to the optical fiber. A driver may be configured to push or pull the second segment in the axial direction to elastically bow the second segment and laterally displace the optical fiber to perform an OCT scan.

Abstract: An image-guided system and method for performing needle biopsy on a moving lung nodule of a body is provided. CT images of the lung nodule are obtained to generate a motion model, based on which an optimal needle advancing path is determined. The motion of the lung nodule and the motion of a fiducial marker attached to the body are correlated. The motion of the fiducial marker is tracked and monitored by a camera to determine a position of the lung nodule based on the correlation. A time for advancing the needle is determined based on a motion attribute of the reference. The needle is advanced by a robotic needle manipulator at the predetermined time along the path to accomplish the needle placement.

Abstract: A method of assessing stenosis severity for a patient includes obtaining patient information relevant to assessing severity of a stenosis, including anatomical imaging data of the patient. Based on the anatomical imaging data, the existence of any lesions of concerns may be identified. A three dimensional image can be generated of any irregular shaped lesion of concern and a surrounding area from the patient anatomical imaging data. A plurality of comparative two dimensional lesion specific models may be created that have conditions that correspond to the three dimensional model. The comparative two dimensional models may represent vessels having regular shaped lesions with each of the comparative two dimensional models represents a different stenosis severity. The three dimensional model can then be mapped to one of the plurality of comparative two dimensional models. After this mapping, a diagnosis of whether the patient has coronary artery disease may be made.

Abstract: The present invention relates to a data processing method of determining at least one operating parameter of a medical imaging device, the method being executed by a computer and comprising the following steps: a) acquiring entity geometry data comprising entity geometry information describing a geometry of a corporeal entity to be considered in a medical procedure; b) acquiring imaging device operability data comprising imaging device operability information describing a mode of operation of the medical imaging device; c) determining, based on the entity geometry data and the imaging device operability data, operating parameter data comprising operating parameter information describing a value of at least one operating parameter of the medical imaging device.

Abstract: Integrated surgical systems and methods for using same are provided that can receive scanned images and produce a three dimensional model from the images. Based at least in pan on the three dimensional model, a processor generates code defining an optimized tool path, which is sent to a surgical machining system that can machine the desired portion of the patient. In one exemplary aspect, the integrated system operates in a clearly defined and pre-programmed manner with no necessity for in-situ sensory or guidance feedback.

Abstract: An optical potentiometer includes a metal pipe having one end closed, a metal pipe that has a relationship of a nested structure with respect to the metal pipe and guides the metal pipe movably in a longitudinal direction, a light source and an optical fiber which supply light into the metal pipe, and an optical power meter that detects a change in the amount of reflected light from inside the metal pipe. The metal pipe has a slit along the longitudinal direction. The optical power meter detects a change in the amount of reflected light from inside the metal pipe caused by a change in the opening amount of the slit caused in accordance with the movement of the metal pipe in the longitudinal direction.

Abstract: A supporting apparatus used for medical treatment includes a support arm in which a leading end side is coupled to a supporting unit supporting an endoscope, and a moving arm that is coupled to a base end side of the support arm, the moving arm moving the supporting unit and supporting the supporting unit in a moved position of the supporting unit. The support arm includes a leading-end-side coupling unit that is turnably coupled to the supporting unit, a base-end-side coupling unit that is disposed in coaxial with the leading-end-side coupling unit and turnably coupled to the moving arm, and an offset unit laterally offset with respect to an axis line R passing through the leading-end-side and the base-end-side coupling units. The offset unit is freely rotatable about the axis line R with respect to the supporting unit and the moving arm.

Abstract: Apparatus and methods are described including, while an endoluminal data-acquisition device is being moved through a subject's lumen, acquiring a plurality of endoluminal data points of the lumen using the endoluminal data-acquisition device. It is determined that respective endoluminal data points correspond to respective locations along the lumen. A display is driven to display at least some of the plurality of endoluminal data points in a stack. While a second endoluminal device is inside the lumen, a current location of at least a portion of the second endoluminal device with respect to the lumen is determined. In response thereto, an image of the second endoluminal device is displayed within the stack, at a location within the stack corresponding to the current location of the second endoluminal device. Other applications are also described.

Abstract: A system is provided to align a surgical guide instrument over a burr hole in a patient's body. Adjustments of a surgical instrument can be made in x, y, z, and angular directions using the system. An instrument guide unit can include an instrument guide for guiding a surgical instrument into the body of a patient and a base unit operative to be secured to the body near an area in which surgery is to occur. The base unit is coupled to the instrument guide. An adjustment mechanism, coupled to the base unit and the instrument guide, is operative to adjust the instrument guide in lateral directions with respect the surface of the area.

Abstract: Tree structures corresponding to a first linear structure and a second linear structure are constructed from medical image data including the first linear structure and the second linear structure, each repeatedly branching from an origin and extending in directions away from the origin in such a manner to become wider. Each of a first root node corresponding to a root node in the first tree structure and a second root node corresponding to a root node in the second tree structure is connected to each node, based on the characteristic that each of the first and second linear structures repeatedly branches from the origin and extends in directions away from the origin in such a manner to become wider, by using, with respect to each node, a cost function that weights a cost representing a probability of connection of each of a plurality of edges connectable to each node.

Abstract: A method and apparatus for allowing determination of patient position change relative to an imaging device and/or allowing digital subtraction in an operative position. The system can include devices for determining a position of a patient at various times and comparing the various positions of the patient. Further, a digital subtraction may be performed if the patient change is not above a threshold value and/or if motion correction can occur.

Abstract: A system and method for localizing a catheter is provided. Distance values are determined between a plurality of reference electrodes and a catheter electrode. At least two circles are identified based on the distance values. The catheter electrode is located at a position where the at least two circles substantially coincide or within a minimum distance between the at least two circles. A transformation is applied to the at least two circles to express the at least two circles in a global coordinate system. An image is displayed as a function of the catheter electrode position.

Abstract: The present invention includes a method of pre-planning a spherical fixed point stereotactic radiosurgery by obtaining an image from a patient having a target, the image comprising coordinates of the actual patient target in 3 dimensions on a first day; planning an optimal stereotactic radiosurgery using the patient's actual target using actual coordinates in 3 dimensions prior to the day of surgery by creating virtual radiosurgical coordinates and plans to maximize target exposure and minimize the patient's waiting time in radiosurgery, thereby allowing evaluation of several plans to maximize plan conformality and safety; and treating the patient based on the virtual stereotactic radiosurgery plans on a second day.

Abstract: The present invention provides methods and compositions for modulating x-ray attenuation, where the x-ray attenuation compound can comprise a molecule having at least two conformational states, a first k-edge atom attached to the molecule at a first position, and a second k-edge atom attached to the molecule at a second position, where the molecule changes from a first conformational state to a second conformational state in response to an external stimulus. Additionally, a first interatom distance between the first k-edge atom and the second k-edge atom in the first conformational state can be within a first harmonic error of 0 to about 0.2, and a second interatom distance between the first k-edge atom and the second k-edge atom in the second conformational state can be within a second harmonic error of about 0.8 to 1.0.

Abstract: The invention provides a non-invasive system and method for treatment of the heart. In a first aspect, a method for treatment of an anatomical site related to arrhythmogenesis of a heart of a patient comprises creating a target shape encompassing the anatomical site, directing particle beam radiation or x-ray radiation from outside the patient toward the target shape wherein one or more doses of radiation ablates the target shape and disregarding at least one orientation of cardiac motion while creating the target shape or directing the particle beam or both.

Abstract: A system and apparatus allows the tracking of a selected body portion, instrument, or both. A tracking device can be interconnected to a body portion at a mounting site. A procedure can be performed at a location remote from the mounting site of the tracking device. The tracking device can be interconnected with the body in a low invasive manner.

Abstract: The present invention provides a surgical tracking system for assisting an operator to perform a laparoscopic surgery of a human body, said surgical tracking system comprising: a. at least one endoscope adapted to acquire real-time images of a surgical environment within said human body; b. a maneuvering subsystem adapted to control the spatial position of said endoscope during said laparoscopic surgery; and, c. a tracking subsystem in communication with said maneuvering subsystem, adapted to control the maneuvering system so as to direct and modify the spatial position of said endoscope to a region of interest.

Abstract: A trajectory guide for providing access to a target site of a living subject along a desired path comprises a baseplate including a clamp lock, a guide member at least partially contained within the baseplate and having a channel therein, a plurality of adjustable legs each including a first end and a second end, wherein the first end is coupled to the baseplate, and a leg lock coupled to each adjustable leg and moveable between an unlocked position and a locked position in order to set a desired length of the adjustable leg, wherein the adjustable legs and the guide member are structured to be adjusted to provide an infinite number of trajectories in three-dimensional space extending through the channel in the guide member toward a target.

Abstract: A model-based method is described which defines a rigid transformation between two co-ordinate systems that reduces the accuracy requirements on the quality of the data-set (including, but not restricted to, the error in the acquisition process, and the number and spread of the points) measured in one of the two co-ordinate systems by identifying a set of remote correspondences that are used to bind the convergence process. The method can be used in minimal-access orthopaedic surgery to improve the accuracy of limb registration. Specific instances include femoral registration, by estimating the functional center of the hip joint in both co-ordinate systems to be co-registered, and tibial registration, using the ankle center as a distant set of paired correspondences. Accuracy can be measured in a variety of ways, including, but not restricted to, evaluating the mis-alignment between the two co-registered objects.

Abstract: A fiducial marker system (210a-c) comprises a first unit and a second unit. The first unit is patient affixable and comprises a partly spherical inner surface having a first center point that is adapted to receive a touch probe measurement head for measuring the spatial position of the center point. The second unit is releasably attachable to an outer surface of the first unit, and has a second center point, wherein the first center point and the second center point are substantially identical when the second unit is attached to the first unit. For stereotactic therapy, a patient is imaged with the first and second unit assembled. Then the second unit is detached. A stereotactic frame (300) is attached to the first units via arms. Thus frameless imaging is provided in a frame based stereotactic surgery system with high precision. Repeated assembly of the frame (300) to the first units, remaining in the patient, provides advantageous fractionized stereotactic radiotherapy.

Abstract: A method and system for identifying a portion of an image data is disclosed. The image data can include image data of an anatomy, such as a brain of a patient. The identified portion can be used for planning a procedure. The identified portions can include anatomical landmarks that can be used to determine anatomical targets of the patient. The plan can include a path or trajectory to reach the anatomical target.

Abstract: A device for registering in a medical navigation system a position and/or orientation of a patient's pelvis includes a pelvic registration frame. A plurality of positioning elements are arranged on the pelvic registration frame so as to define a plane, wherein the plurality of positioning elements are movable with respect to each other to enable placement of the positioning elements at defined pelvic points of the patient's pelvis. At least one position transmitter is arranged in an unambiguously defined position and/or orientation relative to the frame.

Abstract: A navigation system for use during a surgical procedure is provided. The navigation system is configured to use electromagnetic tracking data produced by electromagnetic tracking devices and 2D image data produced by a fluoroscope to intra-operatively register 2D images of a patient to a pre-operative 3D image of the patient. In some implementations, a surgeon may be able to perform an interventional or surgical procedure guided by the navigation system.

Abstract: A method generates a three dimensional (3D) model of a tubular organ having an occluded segment. The occluded segment adjoins a proximal segment at a proximal end thereof, and a distal segment at a distal end thereof. The procedures included injecting a first dye injection into the tubular organ, the first dye approaching a first end of the occluded segment. Multiple first-injection two-dimensional (2D) images of the tubular organ are acquired, each acquired from a different perspective, the first-injection 2D images further acquired with a respective organ timing signal reading. A second dye is injected into the tubular organ, the second dye approaching a second end of the occluded segment. Multiple second-injection 2D images are acquired of the tubular organ, each acquired from a different perspective, the second-injection 2D images further acquired with a respective organ timing signal reading.

Abstract: A reference frame is described for use in a radiographic procedure. The reference frame is positionable relative to a joint or bone to be imaged, and is radio-transparent. The frame has embedded or affixed thereto a plurality of computer recognizable radio opaque markers. A method of obtaining three dimensional images of bones and joints using the frame is described.

Abstract: The system comprises at least three anchors (2,2?,2?) intended to be attached to the patient and equipped with markers (5,5?,5?), an insertion guide device (6) with an insertion guide (7) intended to be attached to said anchors (2,2?,2?), an external calibration device (8) with at least three calibration markers (10,10?,10?) corresponding to said markers (5,5?,5?) and a planning and imaging software. The planning and imaging software is used to determine the position of a target point in the patient with respect to the markers (5,5?,5?), the calibration device is used to calibrate and orient the insertion guide (7) of the insertion guide device (6) mounted on said calibration markers (10,10?,10?) using the determination of the software before the insertion guide device is mounted on said markers (5,5?,5?) attached to the patient.

Abstract: A method is disclosed for assisting in determination of the suitability of a patient for a scan of the heart of the patient using an X-ray computer tomograph. In at least one embodiment of the method, a) an electrocardiogram of the patient is recorded; b) the electrocardiogram is evaluated by predicting the occurrence time of at least the immediately following R wave on the basis of at least four immediately consecutive R waves of the electrocardiogram which were measured last, and comparing this with the actual measured occurrence time of the next R wave; and c) wherein the quality of the prediction is visualized qualitatively. Further, in at least one embodiment, a device is disclosed including an ECG instrument and a computation device for carrying out the method. At least one embodiment of the invention furthermore relates to a method and a device for scanning the heart of a patient on the basis of a prediction of R waves.

Abstract: The present invention relates to a system for positioning with respect to a patient's body an observation and/or intervention device having a portion penetrating into the patient's body comprising a base laid on the patient's body; a means for supporting the device formed of a first portion movably assembled on the base according to a connection with one degree of freedom, and of a second portion movably assembled on the first portion according to a connection with one degree of freedom and connected to the device; and means for actuating the first portion with respect to the base, and the second portion with respect to the first portion, in which the base surrounds at a distance at least partially the device, said device being detachably connected to the second portion to enable removal of the positioning system while leaving in place the device.

Abstract: A trackable medical instrument for use in a computer assisted image guided medical and surgical navigation systems that generate images during medical and surgical procedures, includes a guide member having an emitter array for being tracked by the system and a drive shaft contained within the guide member having a proximal and a distal end, the drive shaft being rotatable within the guide member while being fixable axially inside the guide member, the proximal end of the drive shaft having a first connector for interchangeably receiving at least one drive source, and the distal end having a second connector for interchangeably receiving at least one instrument tip.