US20090030274A1 - Endoscopic methods and devices for transnasal procedures - Google Patents

Endoscopic methods and devices for transnasal procedures Download PDF

Info

Publication number
US20090030274A1
US20090030274A1 US12/184,166 US18416608A US2009030274A1 US 20090030274 A1 US20090030274 A1 US 20090030274A1 US 18416608 A US18416608 A US 18416608A US 2009030274 A1 US2009030274 A1 US 2009030274A1
Authority
US
United States
Prior art keywords
endoscope
distal end
channel
guidewire
sinus
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US12/184,166
Inventor
Eric Goldfarb
Thomas R. Jenkins
Isaac J. Kim
Tom T. Vo
Thomas J. Wisted
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Acclarent Inc
Original Assignee
Acclarent Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US11/522,497 external-priority patent/US7559925B2/en
Application filed by Acclarent Inc filed Critical Acclarent Inc
Priority to US12/184,166 priority Critical patent/US20090030274A1/en
Publication of US20090030274A1 publication Critical patent/US20090030274A1/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005Flexible endoscopes
    • A61B1/0051Flexible endoscopes with controlled bending of insertion part
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131Accessories for endoscopes
    • A61B1/0014Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147Holding or positioning arrangements
    • A61B1/00154Holding or positioning arrangements using guiding arrangements for insertion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005Flexible endoscopes
    • A61B1/01Guiding arrangements therefore
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/233Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the nose, i.e. nasoscopes, e.g. testing of patency of Eustachian tubes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/24Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/24Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers
    • A61B2017/246Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers for cleaning of the nose
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/0059Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
    • A61B5/0082Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
    • A61B5/0084Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00Measuring for diagnostic purposes; Identification of persons
    • A61B5/06Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09Guide wires
    • A61M2025/09058Basic structures of guide wires
    • A61M2025/09083Basic structures of guide wires having a coil around a core

Definitions

  • the present invention relates generally to medical apparatus and methods and more particularly to devices and methods that are useable to facilitate transnasal insertion and positioning of guidewires and various other apparatus at desired locations within the ear, nose, throat, paranasal sinuses or cranium.
  • FESS Functional endoscopic sinus surgery
  • an endoscope is inserted into the nostril along with one or more surgical instruments. The surgical instruments are then used to cut tissue and/or bone, cauterize, suction, etc.
  • the natural ostium e.g., opening
  • the endoscope provides a direct line-of-sight view whereby the surgeon is typically able to visualize some but not all anatomical structures within the surgical field.
  • the surgeon may remove diseased or hypertrophic tissue or bone and may enlarge the ostia of the sinuses to restore normal drainage of the sinuses.
  • FESS procedures can be effective in the treatment of sinusitis and for the removal of tumors, polyps and other aberrant growths from the nose.
  • the surgical instruments used in the prior art FESS procedures have included; applicators, chisels, curettes, elevators, forceps, gouges, hooks, knives, saws, mallets, morselizers, needle holders, osteotomes, ostium seekers, probes, punches, backbiters, rasps, retractors, rongeurs, scissors, snares, specula, suction cannulae and trocars.
  • applicators chisels, curettes, elevators, forceps, gouges, hooks, knives, saws, mallets, morselizers, needle holders, osteotomes, ostium seekers, probes, punches, backbiters, rasps, retractors, rongeurs, scissors, snares, specula, suction cannulae and trocars.
  • applicators chisels, curettes, elevators, forceps, gouges, hooks, knives, saws, mallets, morseliz
  • FESS procedures of the prior art have included the surgical removal or modification of normal anatomical structures.
  • a total uncinectomy e.g., removal of the uncinate process
  • a total uncinectomy is performed at the beginning of the procedure to allow visualization of and access to the maxillary sinus ostium and/or ethmoid bulla and to permit the subsequent insertion of the rigid surgical instruments.
  • the uncinate process is allowed to remain, such can interfere with endoscopic visualization of the maxillary sinus ostium and ethmoid bulla, as well as subsequent dissection of deep structures using the available rigid instrumentation.
  • new devices, systems and methods have been devised to enable the performance of FESS procedures and other ENT surgeries with minimal or no removal or modification of normal anatomical structures.
  • Such new methods include, but are not limited to, uncinate-sparing procedures using Balloon SinuplastyTM tools and uncinate-sparing ethmoidectomy procedures using catheters, non-rigid instruments and advanced imaging techniques (Acclarent, Inc., Menlo Park, Calif.). Examples of these new devices, systems and methods are described in incorporated U.S. patent application Ser. Nos.
  • 10/829,917 entitled Devices, Systems and Methods for Diagnosing and Treating Sinusitis and Other Disorders of the Ears, Nose and/or Throat; 10/944,270 entitled Apparatus and Methods for Dilating and Modifying Ostia of Paranasal Sinuses and Other Intranasal or Paranasal Structures; 11/116,118 entitled Methods and Devices for Performing Procedures Within the Ear, Nose, Throat and Paranasal Sinuses filed Apr. 26, 2005 and 11/150,847 filed Jun. 10, 2005, each of which is hereby incorporated herein, in its entirety.
  • Procedures using Balloon SinuplastyTM tools such as those described in the above-noted applications, for example, are performable using various types of guidance including but not limited to C-arm fluoroscopy, transnasal endoscopy, optical image guidance and/or electromagnetic image guidance.
  • a beneficial aspect of the present invention is to allow a user to be able to see an adjustable view, with an endoscope, that is generally aligned with the same axis of movement of the user's working device. This is particularly useful when the axis of movement is at an angle with respect to the axis of entry into the patient.
  • This aspect allows the user to see “around the corner” of anatomy that ordinarily would block his/her view and which would therefore require removal in a traditional FESS procedure to allow visualization.
  • This aspect of the invention allows the user to also verify the location of his/her Balloon SinuplastyTM tools without having to use fluoroscopy or image guidance systems, so that the procedure does not have to be performed in an operating room.
  • Another beneficial aspect of the present invention is that it enables a reduction in the amount of fluoroscopy that needs to be performed by the user doing the procedure, resulting in a reduction in radiation exposure to the user and the patient.
  • Another beneficial aspect of the present invention is that it allows a user to hold a tool with an endoscope attached or incorporated therein, such that both can be held with one hand while allowing the user to manipulate another tool with the other hand, thereby eliminating the need for an assistant.
  • a method for positioning a guide device useful for delivering at least one working device therethrough to deliver a working end portion thereof to a desired location within the ear, nose, throat or cranium of a human or animal patient including the steps of: inserting an endoscope into or through an endoscope channel of the guide device that includes an elongated shaft; inserting the guide device into an internal space of the patient; and viewing through the endoscope to guide positioning and delivery of the guide device to an intended location in the patient.
  • a method for locating a sinus ostium including the steps of: inserting an endoscope through a nostril of a patient and advancing the endoscope toward a location of the sinus ostium; inserting a guidewire through the nostril and advancing a distal end portion of the guidewire distally of a distal end of the endoscope; and viewing, through the endoscope, the advancement of the distal end portion of the guidewire to facilitate guidance of the advancement of the guidewire along a desired path.
  • a method for treating a patient including the steps of: inserting an endoscope into or through an endoscope channel of a guide device that includes an elongated shaft; inserting the guide device through a nostril of the patient; advancing a distal end portion of the guide device toward a sinus ostium of the patient; advancing a distal end portion of the endoscope distally of the distal end portion of the guide device, and navigating the distal end portion of the endoscope through the sinus ostium, said navigating being assisted by visualization through the endoscope.
  • a method of visually inspecting a sinus cavity including the steps of: inserting an endoscope through a lumen of a working device having previously been inserted through a nostril of a patient, through a sinus ostium and into the sinus cavity; and viewing the sinus cavity through the endoscope.
  • a method of directing a guidewire to a target location within the ear, nose, throat or cranium of a patient including the steps of: inserting an illuminating guidewire internally of the patient; emitting light from a distal end portion of the guidewire; and tracking movements of the distal end portion of the guidewire by tracking movements of an illumination spot visible externally of the patient, wherein movements of the illumination spot correspond to movements of the distal end portion of the guidewire internally of the patient.
  • a guide device useable to position a working device at a desired location within the ear, nose, throat or cranium of a human or animal subject including: a transnasally insertable elongate shaft having a proximal end and a distal end; a first channel into which an endoscope may be inserted so that the endoscope may be used to view at least an area beyond the distal end of the shaft; and a second channel through which the working device may be advanced, wherein the first channel is statically located relative to the second channel.
  • a flexible microendoscope including: an elongated shaft; a plurality of image fibers; a lens attached at distal end of said image fibers; and a plurality of light transmitting fibers; wherein the microendoscope has a cross-sectional area permitting insertion into a nasal cavity of a patient.
  • An illuminating guidewire device including: a flexible distal end portion; at least one light emitting element in the distal end portion; at least one structure extending from a proximal end of the device through a proximal end portion of the device and at least part of the distal end portion to connect the at least one light emitting element with a power source; a coil; and at least one coil support within the coil, with at least a portion of each coil support fixed to the coil.
  • a method of making an illuminating guidewire including the steps of: providing a coil having a predetermined length and diameter; inserting mandrels through an annulus of the coil; inserting a first core support into the coil and fixing a portion of the first core support at a predetermined length from a distal end of the coil; removing a mandrel and inserting a second core support; fixing said second core support at predetermined locations along a length thereof, to the coil and fixing the first core support at additional locations along the length thereof to the coil; and inserting illumination fibers.
  • a transnasally insertable guide system for positioning an endoscope at a desired location within the ear, nose, throat or cranium of a human or animal subject including: a tubular guide having an elongate shaft and a lumen, at least a portion of the elongate shaft having a predetermined shape; a sheath sized to be inserted into the lumen of the tubular guide, the sheath comprising an elongate flexible body having a distal end and a scope lumen; and an endoscope that is advanceable through the scope lumen of the sheath, wherein the endoscope is useable to view the anatomy when advanced through the scope lumen of the sheath having been inserted into the guide and the guide having been inserted into an internal space within the patient; and wherein the sheath and endoscope are thereafter removable leaving the tubular guide in place.
  • a guide device useable to position a working device at a desired location within the ear, nose, throat or cranium of a human or animal subject including: a transnasally insertable elongate shaft having a proximal end and a distal end; a channel through which the working device may be advanced, wherein the shaft comprises a scooped distal tip.
  • FIG. 1 is a perspective view of one embodiment of a guide system of the present invention.
  • FIG. 2 is a perspective view of the guide system of the present invention in use on a human subject.
  • FIG. 3A is a side view of the guide catheter of the system of FIG. 1 .
  • FIG. 3B is a cross sectional view through line 3 B- 3 B of FIG. 3A .
  • FIG. 3C is a cross sectional view through line 3 C- 3 C of FIG. 3A .
  • FIG. 3D is a side view of the endoscope of the system of FIG. 1 .
  • FIG. 3E is a cross sectional view through line 3 D- 3 D of FIG. 3C .
  • FIG. 3F is a cross-sectional view of a low profile endoscope.
  • FIG. 3G is a cross-sectional view of another embodiment of a low profile endoscope.
  • FIG. 3H illustrates a steering mechanism provided in an endoscope that can be operated from a proximal end portion of the endoscope.
  • FIG. 3I illustrates a guide device according to one embodiment of the present invention.
  • FIG. 3J illustrates a distal portion of a guide device having a removably attached endoscope channel.
  • FIG. 3K illustrates a snap fitting that may be used to releasably attach an endoscope channel to a main tube of a sinus guide.
  • FIG. 3L is a side view of the connector/camera/light cable assembly of the system of FIG. 1 .
  • FIG. 4A shows a distal portion of a guide device configured with a static channel, for accessing a sphenoid sinus.
  • FIG. 4B shows a distal portion of a guide device 12 configured with a static channel, for accessing a frontal sinus.
  • FIG. 5A illustrates a partial plan view of guide device showing one embodiment of a handle.
  • FIG. 5B illustrates a longitudinal sectional view of FIG. 5A .
  • FIG. 6A illustrates another embodiment of a guide device.
  • FIG. 6B illustrates another embodiment of a guide device.
  • FIGS. 7A-7C illustrate distal end portions of guide devices having curved sections with each with a different radius of curvature.
  • FIGS. 8A-8D are cross-sectional illustrations showing various placement locations of an endoscope channel within a main tube of a guide device.
  • FIG. 9A illustrates a guide device having a distal end with a circular tip.
  • FIG. 9B illustrates a guide device having a distal end with a scooped-tip.
  • FIG. 9C illustrates an end view of the device of FIG. 9A .
  • FIG. 9D illustrates an end view of the device of FIG. 9B .
  • FIG. 10A illustrates the reduced profile of a scooped-tip device relative to the profile of the device having a circular end in FIG. 10B .
  • FIGS. 10C-10D shown reduced profiles of scooped-tip devices including a set back endoscope channel.
  • FIG. 11 is a partial perspective view of a guide device of the present invention with an optional linking apparatus for linking the endoscope to a working device to deter divergence of the endoscope away from the path of the working device.
  • FIG. 12 is a side view of a guidewire having an angled distal tip.
  • FIG. 13A shows a step in a method for using a guide system of the present invention in conjunction with the guidewire of FIG. 10 .
  • FIG. 13B shows another step in a method for using a guide system of the present invention in conjunction with the guidewire of FIG. 10 .
  • FIG. 14 illustrates an example of a procedure in which a guide device has been introduced through a nostril and an endoscope has been delivered through a sinus ostium.
  • FIG. 15 illustrates a working device having been inserted through the guide device of FIG. 14 and into a sinus cavity.
  • FIG. 16 illustrates a method in which an endoscope has been inserted through a lumen of a working device to enter a sinus cavity.
  • FIGS. 17A-17D are illustrations of partial sagittal sectional views through a human head showing various steps of one embodiment of a method of gaining access to a paranasal sinus using a sinus guide.
  • FIG. 18 illustrate use of an endoscope inserted through the guide device for visualization.
  • FIG. 19 shows an illuminating guidewire according to one embodiment of the present invention.
  • FIG. 20 illustrates an end view of a semi-cylindrical illumination fiber.
  • FIG. 21A shows a core support that may be used to support an illuminating guidewire.
  • FIG. 21B shows a core support that may be used to support an illuminating guidewire.
  • FIG. 22A shows an example of a core support formed from an oval wire.
  • FIG. 22B illustrates a proximal end view of the core support of FIG. 22A .
  • FIG. 23A shows a distal portion of a coil having been stretched to break tension between adjacent coils and to form an open-pitch portion.
  • FIG. 23B illustrates insertion of mandrels and a first core support into a coil.
  • FIG. 23C shows a cross-sectional view taken along line 23 C- 23 C of FIG. 23B .
  • FIGS. 24A-24B illustrate the sliding ability of core supports relative to one another during bending of the coil.
  • FIG. 25 illustrates a step of melting a polymer tube into the open-pitched portion of the coil.
  • FIGS. 26A-26B illustrate steps for mounting a connector to a proximal end of the illuminating guidewire.
  • FIG. 27 illustrates insertion of illumination fibers and formation of a distal lens.
  • FIG. 28 illustrate finishing steps at a proximal end of the illuminating guidewire.
  • FIGS. 29A-29B illustrate formation of a preset bend in a core support.
  • FIG. 30 illustrates a resulting bend in an illumination guidewire employing a core support having a preset bend.
  • FIG. 31 illustrates etching the coil.
  • FIG. 32 illustrates connection of a light cable to an illuminating guidewire according to one embodiment.
  • FIG. 33 illustrates a light cable having another connector embodiment.
  • FIG. 34 illustrates a light cable having another connector embodiment.
  • FIG. 35 illustrates connection of a light cable to an illuminating guidewire according to another embodiment.
  • FIG. 36 shows an illuminating guidewire according to another embodiment of the present invention.
  • FIG. 37 illustrates an alternative transparent portion that may be included in a device shown in FIG. 37 .
  • FIG. 38 illustrates another alternative transparent portion that may be included in a device shown in FIG. 37 .
  • FIGS. 39A-39C are illustrations of partial coronal sectional views through a human head showing various steps of a method for inserting an illuminating guidewire into an ostium that opens to a frontal sinus.
  • FIG. 40 illustrates a situation where a scope has been inserted as far as possible without causing significant trauma to the patient.
  • FIGS. 41-43 show additional embodiments of transnasally insertable guide systems useable to position an endoscope.
  • FIG. 1 shows one embodiment of a sinus guide system 10 of the present invention.
  • This sinus guide system 10 comprises a sinus guide 12 and a camera/transmission/endoscope assembly 14 .
  • This embodiment of the sinus guide 12 is shown in more detail in FIGS. 3A-3C .
  • this sinus guide 12 comprises a sinus guide body 26 and an endoscope channel 28 in generally side-by-side arrangement.
  • the sinus guide body 26 comprises a tube 44 having a lumen 45 (e.g., see FIG. 3B ), such as a polymer tube made of biocompatible polymeric material.
  • a distal end portion 44 d e.g. a length of about 2 mm may be made of stainless steel, for example, to increase durability, as illustrated in FIG. 3I .
  • a distal end portion 28 d of channel 28 can be formed of stainless steel.
  • channel 28 and/or tube 44 can be formed of stainless steel along the entire length thereof.
  • tube 44 and/or channel 28 may be formed over an entire length thereof of stainless steel or other biocompatible metal, except for a polymer distal tip.
  • a liner 46 FIG. 3B
  • Such liner may be formed of lubricious or smooth material such as polytetrafluoroethylene (PTFE).
  • a proximal portion of the tube 44 may be surrounded by an outer tube member 42 formed of material such as stainless steel hypotube.
  • a distal portion of tube 44 extends out of and beyond the distal end of outer tube 42 .
  • This protruding distal portion of tube 44 may be straight or curved. Also, it may be pre-formed at the time of manufacture or malleable to a desired shape at the time of use.
  • the distal portion of tube 44 When intended for use in accessing the ostium of a paranasal sinus, the distal portion of tube 44 may be curved to form an angle A from about 0 degrees to about 120 degrees.
  • a series of sinus guides 12 having angles A of 0, 30, 70, 90 and 110 degrees may be provided thereby allowing the physician to select the sinus guide angle A that is most appropriate for the particular paranasal sinus ostium to be accessed.
  • a rotation grip 60 may be positioned about a proximal portion of the sinus guide 10 , as seen in FIGS. 1 , 3 A and 3 B.
  • This rotation grip 60 may have a smooth or textured round outer surface (e.g., it may be a cylindrical tube), or it may have a contoured shape, raised at a distal end portion thereof (as well as, optionally, raised at a proximal end thereof), e.g., see FIG. 3I , to prevent slipping of an operator's hand during pushing (or pulling) on the handle 60 .
  • handle 60 may be grasped between the fingers of the operator's hand and easily rotated, thereby facilitating rotation (e.g., rolling) of the sinus guide 12 as it is being used.
  • Such rotation of the sinus guide 12 may be desirable for a number of reasons including but not limited to positioning of the distal end of the sinus guide 12 at a desired location and/or maneuvering the location of an endoscope 30 that is inserted through the endoscope channel 28 .
  • the endoscope channel 28 may comprise any structure (e.g., tube, track, groove, rail, etc.) capable of guiding the advancement of a flexible endoscope.
  • the endoscope channel 28 comprises a tube (e.g., a polymer tube or stainless steel tube or combination of polymer and metal, as noted above) having a lumen 29 extending therethrough.
  • the endoscope channel 28 is attached to and extends along substantially the entire length of the sinus guide body 26 .
  • the endoscope channel 28 can be inside the sinus guide body 26 .
  • FIGS. 4A-4C in application Ser. No.
  • the endoscope channel 28 may be interrupted, non-continuous or may extend over less than the entire length of the sinus guide body 26 .
  • the channel 28 extends along the majority of the length of guide body tube 44 and has a distal end portion that conforms to and hugs the curvature of the curved distal end portion of tube 44 .
  • the distal end of channel 28 ends proximally of the distal end of tube 44 .
  • An outer skin 40 may be heat shrunk or otherwise disposed around the sinus guide body 26 and endoscope channel 28 to hold the endoscope channel 28 at a desired position on the outer surface of the sinus guide body 26 .
  • heat shrink tube or overlamination 40 surrounds the tubes 44 , 28 over a majority of the length of the straight portions of the tubes.
  • all or a portion of the curved distal end portions of tubes 44 , 28 may be surrounded by heat shrink tubing or overlamination 40 d .
  • Proximal end portions of tubes 44 , 28 are routed through separate channels in handle 60 that angles the tubes apart as they travel proximally through handle 60 , so that luer fittings 45 , at the proximal ends of tubes 40 , 28 are spread apart further to make it easier to insert tools into the tubes 28 , 40 and connect to the luers 45 with less interference from the other channel 28 , 40 /luer 45 .
  • the luer 45 for tube 28 can be connected to an irrigation source (saline-filled syringe or other irrigation source) to input irrigation fluid through the lumen of tube 28 to deliver fluid across the viewing tip of endoscope 30 having been inserted in the tube 28 , in order to clean the viewing lens.
  • Luer 45 can then be connected to a vacuum source to withdraw the fluid from the lens.
  • irrigation or vacuum may be applied separately, to rinse debris off of the lens or the suction debris off of the lens, respectively.
  • a suction/irrigation catheter may be inserted through tube 44 to perform these same functions. This may be advantageous when the distal tip of the endoscope 30 has been extended distally of the end of tube 28 and optionally, distally of tube 44 .
  • the endoscope channel 28 may be attached to the sinus guide body 26 at one or more locations by any other suitable attachment substance, apparatus or technique, including but not limited to adhesive, soldering, welding, heat fusion, coextrusion, banding, clipping, etc.
  • the particular circumferential location of the endoscope channel 28 can be important in some applications, particularly when the sinus guide body 26 includes a curve formed in its distal portion 44 .
  • the endoscope channel 28 may be affixed at a particular circumferential location on the sinus guide body 26 to allow a flexible fiber endoscope 30 inserted through the endoscope channel 28 to provide a view from a desired or optimal vantage point, without obstruction from adjacent anatomical structures. This is described in more detail in application Ser.
  • channel 28 may be located interiorly of the lumen of tube 44 , and may be positioned at various locations circumferentially about the inner wall of the tube 44 .
  • FIGS. 8A-8D show channel 28 mounted to the inner wall of tube 44 at 6 o'clock, 3 o'clock, 12 o'clock and 9 o'clock positions, respectively with regard to tube 44 . It is noted that placement is not limited to the four relative locations shown, as channel may be positioned intermediate of any two of the adjacent locations shown.
  • an endoscope channel 28 having an inside lumen diameter of about 0.045′′ can accommodate a rigid distal tip length of about 0.125′′ on a flexible endoscope 30 having an outside diameter of about 0.0375′′ with the curved portion of the channel 28 having a radius of curvature as low as about 0.28′′. In one particular example, the radius of curvature is about 0.40′′.
  • channel 28 having an inside lumen diameter of about 0.045′′ can have a curved portion having a radius of curvature as low as about 0.40′′ when the outside diameter of the endoscope is about 0.0375′′.
  • the radius of curvature is about 0.58′′ for the rigid distal tip length of about 0.150′′.
  • a camera/cable/endoscope assembly 14 is attachable to arm 43 a or the lower luer fitting 45 shown in FIG. 3I . In the particular embodiment shown in FIGS.
  • the camera/cable/endoscope assembly 14 comprises an adjustable scope/lock extension 16 , an endoscope 18 having an elongate flexible scope body 30 and integrated light cable 50 , a camera 20 and a monitor cable 24 .
  • the scope body 30 is advanced through the scope/lock extension 16 and through the lumen 29 of the endoscope channel 28 .
  • the light cable 50 and monitor cable 24 may be connected to console 34 that houses a monitor 36 , light source 38 and video recorder 40 .
  • FIGS. 3D and 3E show a flexible endoscope 30 attached to a proximal body member 52 that engages and attaches to the adjustable scope/lock extension 16 .
  • the scope 30 comprises a flexible shaft having an image fiber bundle 54 that extends coaxially through the center with light transmitting fibers 56 disposed about the periphery.
  • the flexible shaft is a braided polyimide sheathing that has a maximum outer diameter of 0.0375 inches and a length of two feet.
  • the image fiber bundle may be made up of about 10,000 thin image fibers and the light transmitting fibers may be illumination fibers with a diameter of between about 0.008 and 0.020 inches, with a minimum lux of about 10,000.
  • FIG. 3F is a cross-sectional illustration of a flexible endoscope 30 having a low profile configuration.
  • the flexible shaft has an image fiber bundle 54 that extends coaxially through the center of the shaft with light transmitting fibers 56 disposed laterally of the image fiber bundle.
  • light transmitting fibers are shown disposed laterally on both sides of image fiber bundle 54 , light transmitting fibers 56 may alternatively be located all on one side of optical fiber bundle 54 , as illustrated n FIG. 3G .
  • the height profile of the endoscope shaft 30 is reduced which allows channel 28 to, in turn be lower profile, thereby reducing the cross-sectional size of the device 12 allowing for it to be more easily advanced through the patient anatomy.
  • the cross-sectional shape of such a low profile endoscope 30 may be substantially oval, as shown in FIGS. 3F-3G , or elliptical Additionally this lowered profile makes the shat of endoscope 30 easier to bend/more flexible when bending in the direction of the arrows shown, and this may allow for a smaller radius of curvature in the curved portion of channel 28 when channel 28 is provided with a curve in a distal portion thereof.
  • FIG. 3H illustrates a steering mechanism provided in endoscope 30 that can be operated from a proximal end portion of endoscope 30 , outside the patient's body, to steer a distal tip 30 d or portion thereof (e.g., lens barrel 30 e ) to allow directional control of the visual field provided by endoscope 30 .
  • steering mechanism 30 s includes a wire extending through endoscope shaft 30 and attached to a side of lens barrel 30 e , so that when tension is applied via a user pulling on a proximal end portion of wire 30 s , lens barrel 30 e is deflected or angularly directed in the direction shown by the arrow in FIG. 3H .
  • lens barrel 30 e Upon release of tension on wire 30 s , lens barrel 30 e resiliently returns to its unbiased orientation and direction.
  • the unbiased orientation and direction of lens barrel 30 e may be axially aligned with the longitudinal axis of the endoscope 30 shaft.
  • lens barrel may be oriented to point angularly away (downward, in FIG. 3H ) from the direction that it is biased toward when tension is applied via steering mechanism 30 e .
  • an intermediate amount of tension may be applied to align the lens barrel 30 e with the longitudinal axis of endoscope 30 shaft, and a greater amount of tension can be applied to steer the lens barrel 30 e still further in that direction (e.g., pointing angularly upwardly in FIG. 3H ).
  • more than one wire or other steering actuators 30 s may be attached to lens barrel 30 e for directionally pointing the lens barrel 30 e .
  • a second wire 30 s can be mounted on an opposite side of lens barrel 30 e to the side in which the first wire 30 s is shown mounted in FIG. 3H .
  • four wires 30 s can be mounted at ninety degree intervals around the circumference of barrel 30 e . Further arrangements for controlling along different directions may also be provided, as would be apparent to one of ordinary skill in the art, after reading the above description.
  • FIG. 3J is a partial view of a sinus guide 12 in which channel 28 is detachable from tube 44 .
  • channel 28 may be attachable to and detachable from tube 44 via snap fit, such as by assembling one or more snap fittings 51 on tube 44 .
  • Snap fitting 51 includes an enclosed lumen 441 through which tube 44 is received, and which forms a friction fit with tube 44 , and a lumen 281 with an opening that allows channel 28 to be inserted therethrough.
  • the width of the opening 280 is less than the outside diameter of channel 28 , so that when channel 28 is pushed therethrough, the legs on opposite sides of the opening 28 o are deformed outwardly to allow tube to pass therethrough.
  • channel 28 When channel 28 has seated in lumen 281 , the legs resiliently snap back into the configuration shown in FIG. 3K , thereby retaining tube in lumen 281 by a snap fit.
  • lumen 281 can be enclosed and lumen 441 provided with an opening, in which case snap fitting 51 would be slid longitudinally over channel 28 to form a friction fit therewith and tube 44 would be inserted through an opening to perform the snap fit.
  • channel 28 may be provided as attachable and detachable to and from tube 44 via hook and loop type fasteners, adhesives that remain sticky and are thus reusable, or other quick release mechanical fasteners.
  • attachable/detachable tube 48 makes it easier to match the curve of the distal end portion of channel 28 to the rigidity characteristics of the endoscope 30 to be inserted therethrough, particularly the length of the rigid distal tip portion.
  • a kit of tubes 28 having distal end portions of varying curvatures (and, optionally, having varying lumen diameters) may be provided so that an appropriate channel 28 can be selected by a surgeon to accommodate the rigidity characteristics of the particular endoscope to be inserted therethrough, and then the selected tube can be attached to tube 44 .
  • channel 28 may be inserted independently of tube 44 , which may make it easier to locate the distal end portion of channel 28 in a target cavity. However, when used separately, this requires use of a second hand, one to manipulate tube 44 and a second to manipulate channel 28 .
  • the distal end of channel 28 can end proximally of the location of the distal end of tube 44 , so that the distal end of channel 28 is located proximally of the distal end of tube 44 by a setback distance 53 .
  • Setback distance 53 may be about one mm to about four mm, typically about two mm, for sinus guides having statically placed tubes 28 .
  • placement of channel 28 on a relative location about the circumference of tube 44 may vary, for example for various uses in the frontal, maxillary and/or sphenoid sinuses.
  • Setback 53 allows the distal end of endoscope 30 to be advanced distally beyond the distal end of channel 28 without extending distally beyond the distal end of guide body tube 44 , thereby adding protection to the distal end of the endoscope 30 while allowing better visualization when the tip is distally extended from the distal end of channel 28 . This can be particularly advantageous during advancement of the device 12 , for example.
  • setback 53 also reduces the distal profile of the guide device 12 , facilitating entry and passage through smaller openings than allowable by a device that has a distal tip cross sectional area formed by the combined cross sectional areas of tube 44 and channel 28 .
  • Setback 53 also provides a tapering effect, reducing the physical impact from endoscope channel 28 as it is traversed through the patient's anatomy.
  • a distal end portion of channel 28 may be colored with a color that contrasts with a color of the remainder of the channel. This provides visible notice to the user, during traversal of endoscope 30 over or through channel 28 , when the viewing (distal) tip of endoscope 30 has reached the portion having the contrasting color, as the contrasting color can be visualized on the inner wall surface of the channel (e.g., lumen), so that the user is aware that the tip of the endoscope is about to be delivered distally of the distal end of channel 28 . This is possible even when channel 28 is a stainless steel tube.
  • a distal tip portion of tube 44 can be colored with a contrasting color so that this can be visualized as the distal tip of endoscope is exiting the distal end of channel 28 , especially in situations where the distal end of channel 28 is proximally set back from the distal end of tube 44 .
  • the distal tip of channel 28 d is preferably formed as an atraumatic tip, having a rounded distal edge.
  • tip 28 d may be formed of stainless steel or other hard material. In this case the rounded edge makes the tip more atraumatic.
  • tip 28 d may be formed of a softer material such as PEBAXTM, SANOPRENETM (synthetic rubber), silicone, PELLETHANETM (thermoplastic polyurethane elastomers), or other soft plastic, which, when formed with a rounded distal edge, even further increases atraumaticity.
  • FIG. 4A shows a distal portion of device 12 configured with a static channel 28 , for accessing a sphenoid sinus, for example, having tube 44 and channel 28 provided with atraumatic, rounded tips, and wherein a distal tip portion 28 d of channel 28 is colored with a color that contrasts with a portion of channel 28 immediately proximal of tip 28 d .
  • FIG. 4A shows a distal portion of device 12 configured with a static channel 28 , for accessing a sphenoid sinus, for example, having tube 44 and channel 28 provided with atraumatic, rounded tips, and wherein a distal tip portion 28 d of channel 28 is colored with a color that contrasts with a portion of channel 28 immediately proximal of tip 28 d .
  • FIG. 4B shows a distal portion of device 12 configured with a static channel 28 , for accessing a frontal sinus, for example, having tube 44 and channel 28 provided with atraumatic, rounded tips, and wherein a distal tip portion 28 d of channel 28 is colored with a color that contrasts with a portion of channel 28 immediately proximal of tip 28 d.
  • FIG. 5A illustrates a partial plan view of device 12 showing one embodiment of handle 60 .
  • FIG. 5B illustrates a longitudinal sectional view of FIG. 5A .
  • Handle 60 accommodates channel 28 and tube 44 to pass therethrough and extend proximally thereof to join with connectors 45 .
  • Handle 60 may be molded over tube 44 and channel 28 in the configuration shown, or may be molded separately with channels configured and dimensioned to receive channel 28 and tube 44 therethrough (e.g., molded in halves and then assembled over the tube 44 and channel 28 , using screws, clamps, adhesives, press fitting, and/or other connectors).
  • handle 60 can be molded or machined as one piece and the lumens can then be slid into place and fixed with adhesive and/or threaded connection, etc.
  • Handle 60 is shaped to fit a user's hand, and to be easily rotated by the user. Accordingly, handle 60 may be substantially barrel-shaped, cylindrical, or other shape that lends itself to rotation about its longitudinal axis (e.g., rounded about the longitudinal axis, or octagonal or other extruded polygonal cross-section).
  • the outer surface of handle 60 can be smooth for easy sliding within the hand, or can be provided with a roughened surface to enhance the grip, for pushing on the handle 60 and/or torquing it.
  • the distal end portion is formed with an uplift, “bump” or increased cross-sectional area 60 b , relative to the mid portion of the handle, to act as a stop against the hand of the user, thereby preventing the hand from sliding distally off of the handle 60 during use.
  • Channel 28 is guided away from tube 44 at the proximal end portions thereof, such as by an angled or curved channel 60 c that directs the proximal end portion of channel 28 away from tube 44 as channel 28 passes through the channel 60 c .
  • This provides greater separation between the connectors 45 , facilitating easier insertion of endoscope into channel 28 and tools or devices (e.g., balloon catheter, or any of the other devices or tools described herein or in application Ser. Nos. 11/647,530; 11/522,497; 11/193,020; 10/829,917; 11/116,118; and/or 11 / 150 , 847 ; without interference from the other connector 45 .
  • Bend or curve 60 c also creates force feedback and acts as a frictional braking system as endoscope 30 is advanced through channel 28 at the location of the bend or curve in channel 60 c , facilitating greater control of the advancement of the endoscope 30 by the user, with less risk of inserting too quickly or impulsively, or overshooting the amount of insertion. Additionally, this helps maintain the endoscope in longitudinal position relative to channel 28 even when an additional locking mechanism or valve is not provided.
  • Both tube 44 and channel 28 may be provided with a luer connector 45 on proximal ends thereof, to allow for attachment of a syringe for flushing, or attachment of other tools.
  • a Touhy valve or other valve can be alternatively fitted on the proximal end of channel 28 to facilitate locking of the endoscope 30 in a position relative to channel 28 .
  • a Y-adapter may be fitted to the proximal end of channel 28 to permit fixation of luer 45 to one arm of the Y and a valve to the other arm. Numerous other accessories can be attached to either channel 28 or tube 44 , including drip systems, pop-off valves, etc.
  • FIG. 6A illustrates an embodiment of sinus guide device 12 wherein endoscope channel 28 is fixed relative to handle 60 and tube 44 is rotatable about its longitudinal axis within handle 60 . Accordingly, the location of channel 28 relative to tube 44 can be varied by rotating handle 60 and holding the luer connector 45 that connects to tube 44 stationary as the handle 60 is rotated. This causes channel 28 to revolve about the longitudinal axis of tube 44 , thereby repositioning the radial position of channel 28 relative to tube 44 . For example, with channel 28 in a radial position at the top of tube 44 as illustrated in FIG. 6A , luer 45 connected to tube 44 can be grasped and prevented from rotating while rotating handle 60 .
  • FIG. 6A also shows channel 28 having a distal tip positioned proximally of the curved section of tube 44 .
  • FIG. 6B illustrates a variation of a rotatable device 12 .
  • a second handle 61 is provided proximally of handle 60 .
  • Handle 61 is fixed relative to tube 44 , so that the user can hold handle 61 to prevent it and the tube 44 from rotating as the user rotates handle 60 to revolve channel 28 about tube 44 .
  • handle 61 may be spring-biased into contact with handle 60 to act as a brake to prevent handle 60 from rotating relative to handle 61 .
  • the user pulls handle 61 proximally out of contact with handle 60 to relieve the braking force and allow the user to rotate handle 60 while holding handle 61 stationary.
  • the frictional force imposed by handle 61 against handle 60 may be great enough to prevent relative rotation during use of device 12 , but can be overcome by the user twisting on handle 60 and holding handle 61 stationary, without the need to retract or reposition handle 61 relative to handle 60 .
  • the embodiments of the rotational features described with regard to FIG. 6B can be employed in other guide device 12 embodiments, and are not limited to a device having a channel 12 that ends proximally of a bend in tube 44 .
  • the radius of curvature can be designed to readily allow the endoscope 30 (and particularly the distal tip portion that includes the lens, which may be rigid) to move through the lumen of tube 28 and around the curve without the need to increase the inside diameter of the lumen, so that the lumen can be designed with a inside diameter having only a small tolerance around the outside diameter of endoscope 30 .
  • standard 18 gauge hypotube is used having an outside diameter of about 0.050′′.
  • the wall thickness selected is as thin as possible, to maximize the inside diameter of the tube without risking buckling of the tube. Typically the wall thickness is about 0.003′′.
  • the tube is 18 Gauge UTS with an outside diameter of 0.050′′+0.001′′/ ⁇ 0.0005′′, with an inside diameter of about 0.044′′ and therefore a tolerance of about +0.0015/ ⁇ 0.001′′.
  • the inside diameter of tube 28 can be increased if the curvature of the distal end portion is required to have a radius of curvature that would not allow endoscope to pass otherwise.
  • the amount of curvature that can be successfully used with a lumen of normal tolerance relative to the outside diameter of endoscope 30 will also vary with the degree of flexibility of the endoscope 30 and the length of the lens barrel 30 e .
  • FIGS. 7A-7C illustrate exemplary distal end portions of devices 12 in which the curvatures of tubes 28 , 40 are varied, wherein the larger the radius of curvature, the easier it is to pass endoscope therethrough, with all other variables being constant.
  • the radius of curvature is about 0.25 inches
  • the radius of curvature is about 0.5 inches
  • the radius of curvature is about 0.75 inches.
  • the insider diameters of the tubes 28 in these examples are 0.044′′+0.0015′′/ ⁇ 0.001′′.
  • tube 44 may be provided with a non-circular cross-section at the distal end thereof.
  • this facilitates entry and passage through smaller openings or relatively more constrained spaces, such a may be encountered in the passages leading to the frontal or maxillary sinuses, or other spaces relatively constrained by the patient's anatomy, as the reduced cross-sectional profile of the distal end of tube 44 is more readily able to be introduced into and smaller or partially obstructed spaces, compared to tubes having a full circular distal end cross-section.
  • FIG. 9A illustrates tube 44 having a standard, circular cross-section at its distal end.
  • FIGS. 9B and 9D illustrate the distal end profiles of the tube 44 in FIGS. 9A and 9B , respectively.
  • the cross-sectional profile of the scooped tip 44 t tapers down from that of a circular profile, at a proximal end of the scooped tip 44 t , to a semi-circle or less at the distal end of the scooped tip 44 t .
  • a tube 44 having reduced-profile tip such as a scooped-tip 44 t , for example, may facilitate entry into, or closer position to ostia by the distal end of a guide device 12 .
  • the scooped tip 44 t design may also facilitate balloon retraction (of a balloon catheter), back into tube 44 after performing an ostial dilatation procedure, for example.
  • the tapered cross-section provided by scooped tip 44 t allows the distal end of tube 12 to be easily passed behind the uncinate process. In the frontal recess, the scooped tip 44 t may provide additional freedom of movement of device 12 .
  • scooped tip 44 t of FIG. 9B also provides a larger opening than the circular opening of the standard tube end, like shown in FIG. 9A , for tubes 44 having the same inside diameter. Accordingly, as mentioned above, this may make it easier to retract a balloon portion of a balloon catheter back into the lumen of tube 44 , e.g., after performing a dilatation procedure and deflating the balloon. Additionally, the curvature of the sides of the scope shape, tapering down to the proximal end of the scoop shape can facilitate folding of the balloon as it is retracted into the lumen of tube 44 .
  • the scooped tip 44 t can be provided on a guide device 12 that does not include an endoscope channel, as illustrated above with regard to FIG. 9B . Further the advantages discussed above can also be provided to a guide device 12 that does include a channel 28 integrated therewith.
  • the channel 28 may be fixed relative to tube 44 and may be removably fixed, as described previously.
  • FIG. 10A illustrates an example of guide device 12 having a fixed channel 28 that extends so that the distal end of channel 28 is substantially flush with the distal end of scooped tip 44 t .
  • the reduced cross-sectional profile at the end of scooped tip 44 t compensates, or helps to compensate for the additional cross-section profile of the end of channel 28 . That is, the cross sectional dimension 12 ⁇ 1 is less than the cross-sectional dimension 12 ⁇ 2 measured across the distal ends of tubes 44 and 28 when tube 44 has a circular profile distal end as shown in FIG. 10B .
  • the endoscope 30 may sometimes be advanced along side a working device, such as a guidewire 110 , so as to view the advancement, positioning and/or use of the working device.
  • a working device such as a guidewire 110
  • an optional linkage device 62 may be used to link (e.g., couple, connect or attach) the endoscope 30 to the guidewire 110 or other working device.
  • Other working devices that may be inserted through tube 44 , and optionally linked to endoscope 30 via linkage device 62 , include, but are not limited to: graspers, catheters, instrument or other device useable to perform or facilitate a therapeutic or diagnostic task such as local or regional drug delivery, biopsy, suction, irrigation, polyp removal, fungal ball removal or other mass removal.
  • the flexible fiber endoscope 30 may be freely advanced to or beyond the end of the sinus guide 12 and retracted during use, in order to facilitate endoscopic viewing of the desired anatomical structures and/or to view, guide and/or verify the positioning of the sinus guide device 12 or a working device that has been inserted through the sinus guide.
  • the ability to advance the tip of the flexible fiber endoscope 30 beyond the end of the sinus guide allows the tip to be positioned closer to anatomy or to reach spaces in the paranasal sinuses that the sinus guide tip cannot travel to due to size constraints.
  • FIGS. 13A and 13B show an example of such a procedure, wherein the guide device 12 is advanced to a position where its distal end is a spaced distance D from the opening O into which the guidewire 110 is to be inserted.
  • the user may use fluoroscopy and/or a surgical navigation system to position the guide device as described in previous applications to which this application claims priority and which have been incorporated herein by reference.
  • an endoscope inserted through the endoscope channel 28 may be used to view the distal end DE of the guidewire 110 as it advances out of the distal end of the sinus guide body tube 44 .
  • the flexible endoscope 30 With the flexible endoscope 30 so positioned, the user has a view generally along the same axis as the distal opening of the guide device, rather than the proximal axis of the guide device. Furthermore the view can be from behind anatomy that normally would block a conventional endoscope view. In FIG.
  • the view provided by the endoscope allows the operator to see that the distal end of the guidewire 110 is not directed into the opening O.
  • the operator may rotate the guidewire 110 causing its distal end DE to be directed into the opening O as verified by the view provided from the endoscope.
  • the guidewire can be an illuminating guidewire as described in co-pending application Ser. Nos. 11/522,497 and 11/647,530, or as described herein.
  • the current invention provides flexible endoscopes 30 as small as about one mm outside diameter and may be semi-rigid. This small outside diameter of endoscope 30 permits it to be inserted through an ostium either pre- or post-dilation of the ostium to provide direct visualization inside the sinus cavity. This visualization capability may therefore facilitate direct viewing of intra-sinus therapies, treatments and procedures.
  • FIG. 14 illustrates an example of a procedure in which sinus guide device 12 has been introduced through a nostril 2 of a patient 1 and through a nasal cavity to a location close to an ostium 1014 of a sinus 1016 .
  • Endoscope 30 may be used in a position where the distal tip of the endoscope is flush with the opening 28 d of channel 28 , extends distally beyond distal end 28 d , but not distally beyond the distal end of tube 44 , or slightly distally beyond the distal end of tube 44 to provide direct visualization of a procedure to dilate the ostium 1014 , for example. In some cases, intra-sinus procedures may be commenced without dilating the ostium 1014 .
  • endoscope 30 is further distally advanced through the ostium to position the distal viewing tip of the endoscope within the sinus 1016 , as shown in FIG. 14 .
  • a variety of therapies may be delivered into the sinus with direct visualization thereof provided by endoscope 30 positioned in the sinus 1016 , including, but not limited to: local or regional drug delivery, biopsy, suction, irrigation, polyp removal, fungal ball removal and/or removal of other mass.
  • Endoscope 30 when positioned in a sinus 1016 may also be useful for intra-sinus diagnosis to assess an underlying disease, to evaluate ciliary function by viewing transport of a dyed fluid, or other diagnostic procedure. These therapeutic and diagnostic procedures may additionally be facilitated by insertion of one or more tools, instrument or devices through the lumen of tube 44 to deliver a working end portion of the tool, device or instrument through the ostium 1014 and into the sinus 1016 .
  • a variety of tools, instruments or devices may be inserted through tube 44 , including, but not limited to: graspers, cutters, punches, flexible microdebriders, dissectors, electrodes for energy delivery (RF, heat, cryotherapy, ultrasound, or microwave), lasers, suction catheters, irrigation catheters, balloon catheters, etc.
  • graspers including, but not limited to: graspers, cutters, punches, flexible microdebriders, dissectors, electrodes for energy delivery (RF, heat, cryotherapy, ultrasound, or microwave), lasers, suction catheters, irrigation catheters, balloon catheters, etc.
  • FIG. 15 illustrates an intra-sinus procedural step in which endoscope 30 has been positioned intra-sinuously, in sinus 1016 in a manner as described above with regard to FIG. 12 . Additionally a flexible graspers instrument 1007 has been inserted through a lumen of tube 44 and advanced to deliver the distal, working end into the sinus 1016 . By viewing the working end of the graspers 1007 through endoscope 30 , and operator can advance the working end and operate the grasping jaws 1007 j to approach a mass 1016 m in the sinus that is desired to be removed position the jaws 1007 around the mass 1016 m or a portion thereof and clamp the jaws to capture the mass 1016 m or a portion thereof.
  • the mass 1016 m or a portion thereof that has been captured by jaws 1007 j can be withdrawn through ostium 1014 , with visualization of all of these steps being facilitated through endoscope 30 .
  • the mass 1007 j or a portion thereof having been captured and torn away or otherwise removed from the sinus 1016 and through ostium 1014 is then withdrawn through tube 44 .
  • viewing of retraction of the mass into the tube 44 can be performed by retracting the distal end of endoscope 30 to a location just proximal of ostium 1014 or just proximal of the distal end of tube 44 .
  • device 12 can be removed simultaneously with the removal of tool 1007 and the mass 1016 m.
  • FIG. 15 is only one example of procedures that can be performed intra-sinuously and that the present invention is by no means limited to this procedure, as many other procedures can be performed, some examples of which were listed above.
  • FIG. 16 illustrates an alternative procedure in which endoscope 30 is inserted through a lumen of a tool, device or instrument having been inserted through tube 44 of guide device 12 and into a sinus cavity 1016 .
  • endoscope 30 has been inserted through the lumen of an irrigation catheter 330 .
  • device 12 may include an integrated endoscope channel 28 , but need not, since endoscope is delivered through the same lumen in tube 44 that the working tool is delivered through.
  • device 12 does not include an endoscope channel 28 .
  • endoscope 30 may be similarly inserted through any other tool, instrument or device having been inserted through tube 44 and which has a lumen with a sufficient inside diameter to allow endoscope 30 to pass therethrough.
  • endoscope 30 may be used similarly to view locations outside of an ostium 1014 , when the distal end of the tool, instrument or device ahs not been inserted through the ostium, or to view some other cavity or space, for example.
  • irrigation catheter has a lumen having a diameter of about 0.050′′ and endoscope 30 has an outside diameter of about 0.0375′′. Accordingly, after performing irrigation with the distal end of irrigation catheter 330 in the sinus 16 , endoscope 30 is inserted through the lumen of the irrigation catheter 330 and advanced to deliver the distal (viewing) tip into the sinus cavity 1016 , as shown. The user can then view through endoscope 30 to confirm whether the sinus 1016 has been cleaned out sufficiently by the irrigation process, and/or to inspect the sinus for other potential issues or ailments that might be addressed.
  • FIGS. 17A through 17D are illustrations of partial sagittal sectional views through a human head showing various steps of one embodiment of a method of gaining access to a paranasal sinus using a sinus guide 12 .
  • a first introducing device in the form of a sinus guide 12 is introduced through a nostril and through a nasal cavity 1012 to a location close to an ostium 1014 of a sphenoid sinus 1016 .
  • Sinus guide 12 may be straight, malleable, or it may incorporate one or more preformed curves or bends as further described above, as well as in U.S. Patent Publication Nos.
  • the deflection angle of the curve or bend may be in the range of up to about 135 degrees.
  • a second introduction device comprising a guidewire 110 is introduced through the first introduction device (i.e., sinus guide 12 ) and advanced so that the distal end portion of guidewire 110 enters the sphenoid sinus 1016 through the ostium 1014 .
  • a working device 1006 for example a balloon catheter 100
  • a balloon catheter 100 is introduced over guidewire 110 and advanced to extend the distal end portion of device 1006 , 100 into the sphenoid sinus 1016 .
  • working device 1006 , 100 is used to perform a diagnostic or therapeutic procedure.
  • the procedure is dilatation of the sphenoid sinus ostium 1014 , as is illustrated in FIG. 17D , where the balloon of device 1006 is expanded to enlarge the opening of the ostium 1014 .
  • sinus guide 12 , guidewire 110 and working device 1006 , 100 are withdrawn and removed.
  • the present invention may also be used to dilate or modify any sinus ostium or other man-made or naturally occurring anatomical opening or passageway within the nose, paranasal sinuses, nasopharynx or adjacent areas.
  • the operator may additionally advance other types of catheters, and that guidewire 110 may be steerable (e.g. torquable, actively deformable) or shapeable or malleable.
  • FIGS. 17B-17D show endoscope 30 having been inserted through channel 28 to provide visualization of advancement of sinus guide 12 and/or inserted alongside sinus guide 12 to provide visualization of all or at least a portion of working tool 1006 , 100 .
  • scope 30 may comprise any suitable types of rigid or flexible endoscope and such optional scope may be separate from or incorporated into the working devices and/or introduction devices of the present invention, as further described herein.
  • endoscope 30 is a flexible fiber endoscope 30 as described herein.
  • an illumination guidewire 110 may be utilized to enhance visualization.
  • FIG. 18 illustrates a situation where scope 30 has been inserted as far as possible without causing significant trauma to the patient.
  • the range of adequately illuminated visibility in this case does not extend all the way to ostium 1020 , as indicated schematically by the rays 1009 shown extending distally from scope 30 . In this case, adequately illuminated visualization of guidewire 110 into ostium 1020 would not be possible via scope 30 .
  • sinus guide 12 is physically capable of being extended further distally to place the distal end thereof at the approach to ostium 1020 , scope 30 would also not be capable of adequately visualizing this.
  • fluoroscopic or other x-ray visualization of these procedures was required, in order to ensure that the devices approach (and extend through) the appropriate ostium 1020 and not another adjacent opening, such as opening 1024 .
  • the guidewire devices 110 of the present invention include their own light emitting capability.
  • transillumination refers to the passing of light through the walls of a body part or organ.
  • the light emitted from guidewire 110 passes through the facial structures and appears as a glowing region on the skin (e.g., face) of the patient. It is noted that the light emitted from scope 30 , such as positioned in FIG.
  • the transillumination effect becomes brighter and more focused (i.e., smaller in area).
  • the movements of the guidewire 110 can be tracked by following the movements of the transillumination spot produced on the skin of the patient.
  • the light emission portion of illumination guidewire can cause transillumination as guidewire 110 is being manipulated to gain access to an ostium and sinus.
  • transillumination By tracking movements of a transillumination spot that moves as the illuminating portion of the guidewire 110 is moved during the manipulation, this can provide feedback to the user about steering an positioning and whether or not they are successful in entering through the ostium and into the sinus of interest. For example, transillumination may be visible on the bridge of the nose when gaining access to the frontal sinus. If the user positions the illuminating guidewire 110 medially, transillumination may show in the medial aspect. As the user looks for the frontal recess, he may then move the illuminating guidewire 110 laterally. Transillumination can then confirm that the distal end portion of the guidewire has indeed been moved laterally, as the user tracks the lateral movement of the illumination spot.
  • FIG. 19 shows an illuminating guidewire 110 according to one embodiment of the present invention.
  • Device 110 includes a flexible distal end portion 110 d that provides a similar degree of flexibility to a standard, non-illuminating type of guidewire.
  • Distal end portion 110 d may include a coil 110 c as an exterior portion thereof, to help provide the desired flexibility to this portion.
  • the proximal end portion 110 p of device 110 extends the device to provide a sufficient length so that device 110 extends proximally out of the patient (and, when inserted through another device, such as a sinus guide 12 , proximally out of the device into which guidewire 110 is inserted), at all times, including the deepest location into which the distal end of device 110 is placed.
  • the proximal end portion 110 p can have visible markings, preferably spaced at equal intervals, that can be observed by the user to confirm how far the guidewire 110 has been placed in the patient. Proximal end portion 110 p also provides the necessary mechanical properties required to make the guidewire function properly.
  • torquability i.e., the ability to torque the proximal end portion 110 p from a location outside of the patient and have that torque transmitted to the distal end portion 110 p
  • pushability i.e., sufficient rigidity, so that when an operator pushes on the proximal end portion 110 p from a location outside of the patient, the pushing force transmits to the distal portion 110 d to advance the distal portion 110 p without buckling the device 10
  • tensile strength so that an operator can pull on the proximal end portion 110 p from a location outside of the patient and withdraw device 10 from the patient without significant plastic deformation or any disintegration of the device.
  • Coil 110 c may be formed from a stainless steel wire, for example.
  • the diameter of the coil wire can be between about 0.004 and about 0.008 inches, typically about 0.006 inches.
  • coil 110 c is made of stainless steel wire having a diameter of about 0.006 inches, coiled into a coil having an outside diameter of about 0.033 inches.
  • Use of wire having a larger diameter provides added strength to the coil, but at the same time requires a larger outside diameter coil, which makes the overall device 10 more difficult to advance through small openings, but also allows more space in the inside diameter of the coil.
  • coil 110 c may be formed from any of the aforementioned materials in lieu of a coil.
  • materials from which coil 110 c may be formed include, but are not limited to: ELGILOY®, CONICHROME® or other biocompatible cobalt-chromium-nickel alloy; nickel-titanium alloys, or other known biocompatible metal alloys having similar characteristics.
  • distal end portion may comprise a braided metallic construction of any of the aforementioned materials in lieu of a coil.
  • the external casing of the proximal portion 110 p can be made from a polyimide sheath, a continuous coil (optionally embedded in polymer or having polymer laminated thereon), a hypotube (e.g., stainless steel hypotube), a laser-cut hypotube, a cable tube, or a tube made from PEBAX® (nylon resin) or other medical grade resin. In any of these cases the construction needs to meet the required torquability, pushability and tensile requirements of the device.
  • coil 110 c is joined to proximal portion 110 p by solder, epoxy or other adhesive or mechanical joint.
  • One or more illumination channels 110 i are provided in device 110 and extend the length thereof. Illumination channels 110 i are configured to transport light from the proximal end of device 110 to and out of the distal end of device 110 .
  • two illumination channels are provided, each comprising a plastic illumination fiber. The plastic used to make the illumination fibers is compounded for light transmission properties according to techniques known and available in the art.
  • ESKATM Mitsubishi Rayon
  • a high performance plastic optical fiber may be used, which has a concentric double-layer structure with high-purity polymethyl methacrylate (PMMA) core and a thin layer of specially selected transparent fluorine polymer cladding.
  • illumination fibers each have an outside diameter of about 0.010′′.
  • two acrylic light fibers each having an outside diameter of about 0.10′′ are used.
  • the illumination fibers can have an outside diameter in the range of about 0.005 inches to about 0.010 inches.
  • a single plastic illumination fiber 110 i may be used that has an outside diameter of about 0.020′′.
  • a single light fiber having an outside diameter of about 0.010′′ can be used.
  • FIG. 20 illustrates another alternative, in which a single, semi-cylindrical light (illumination) fiber is used, wherein the diameter 109 is about 0.020′′.
  • This half-round or semi-cylindrical fiber frees up additional internal space in the device, relative to use of two cylindrical fibers of 0.010′′ each, and provide about the same illumination output.
  • these fibers are expensive and time consuming to manufacture.
  • Other illumination fibers 10 having custom-shaped cross sections may be alternatively used, but again may be expensive and difficult to manufacture.
  • glass illumination fibers may be substituted which are much smaller in outside diameter, e.g., about 0.002′′. In this case, more illumination fibers may be provided in a bundle, e.g., about six to fifty glass fibers 110 i may be provided.
  • the distal end of device 110 is sealed by a transparent (or translucent) seal 110 s which may be in the form of epoxy or other transparent or translucent adhesive or sealing material, which may also function as a lens.
  • seal 110 s may be formed of a translucent, ultra-violet curing adhesive to form a distal lens of the guidewire 110 .
  • other translucent or transparent and biocompatible adhesives or epoxies may be substituted.
  • Seal 110 s maintains the distal ends of illumination fibers 110 i coincident with the distal end of device 110 and also provides an atraumatic tip of the device 110 . Further, seal 110 s prevents entrance of foreign materials into the device.
  • the distal end can be designed to either focus or distribute the light as it emanates therefrom, to achieve maximum transillumination effects.
  • the distal end can include a lens, prism or diffracting element.
  • the proximal end of device 110 is also sealed by a transparent (or translucent) seal 110 ps which may be in the form of epoxy or other transparent or translucent adhesive or sealing material. Seal 110 ps maintains the proximal ends of illumination fibers 110 i coincident with the proximal end of device 110 .
  • the proximal end of device 110 may be further prepared by grinding and polishing to improve the optical properties at the interface of the proximal end of device 110 with a light source.
  • the illumination fibers 110 i at locations intermediate of the proximal and distal ends need not be, and typically are not fixed, since no mapping of these fibers is required, as device 110 provides only illumination, not a visualization function like that provided by an endoscope. Further, by leaving illumination fibers free to move at locations between the proximal and distal ends, this increases the overall flexibility and bendability of device 110 relative to a similar arrangement, but where the illumination fibers 110 i are internally fixed.
  • the outside diameter of device 110 may be in the range of about 0.025 inches to about 0.040 inches, typically about 0.030 to 0.038 inches, and in at least one embodiment, is about 0.035′′ ⁇ 0.005′′.
  • At least the distal portion 110 p of device 110 is provided with a core support 110 cw that is contained therein.
  • core support 110 cw is a wire that is fixed to proximal section 110 p such as by laser welding, epoxy or other adhesive or mechanical fixture. Core support 110 cw may extend substantially the full length of device 110 .
  • core support 110 cw is typically formed from stainless steel NITINOL (nickel-titanium alloy) or other biocompatible nickel-titanium alloys, cobalt-chromium alloys, or other metal alloys that are biocompatible and provide the necessary rigidity and torquability.
  • Core support 110 cw may be formed as a wire, as in the example shown in FIG. 19 , or alternatively, may be braided from any of the same materials or combination of materials mentioned above.
  • Core support 110 cw when formed as a wire can be ground to different diameters to provide varying amounts of rigidity and torquability. When formed as a braid, the braid can be formed to have varying amounts of rigidity and torquability along the length thereof.
  • core wire 110 cw has a larger outside diameter at the proximal end portion than at the distal end portion so that it is more rigid and transfers more torque from the proximal portion of device 110 , whereas at the distal end portion, core 110 cw is relatively more flexible and twistable.
  • core supports 110 cw that extend through proximal portion 110 p the portion of core support near the proximal end of device 110 may have an even larger outside diameter.
  • FIGS. 21A-21B illustrate an embodiment of the first and second core supports, respectively.
  • core support 110 cw may be formed from a nickel titanium alloy core wire having a diameter of about 0.008′′, although a similar configuration can be made starting with a core wire of different material and/or different diameter.
  • a proximal portion 1130 p of core support 110 cw is maintained as the full wire profile having the diameter of 0.008′′.
  • An intermediate section 1130 i is ground down to a 0.006′′ diameter for greater flexibility in a distal end portion of the guidewire 110 .
  • the distal end portion 1130 d is flattened, which facilitates soldering core support 110 cw to coil 110 c .
  • the length of flattened section 1130 d is maintained small, e.g., about 0.8 cm to prevent guidewire whipping.
  • flattened section 1130 d may be eliminated altogether with the reduced diameter round cross section 1130 i extending to the distal end of core support 110 cw .
  • the length of the section 1130 i (whether or not flattened section 1130 d is employed) may be varied to customize the length of a flexible distal end portion of guidewire 110 .
  • core support 110 cw that may be formed from a nickel titanium alloy core wire having a diameter of about 0.006′′, although a similar configuration can be made starting with a core wire of different material and/or different diameter.
  • Proximal portion 1130 p of core support 110 cw is maintained as the full wire profile having the diameter of 0.006′′.
  • a distal end portion 1130 d is flattened, which facilitates soldering core support 110 cw to coil 110 c and provides flexibility at the tip of the guidewire 110 for atraumatic interaction with tissue.
  • the length of flattened section 1130 d can be about two centimeters, for example.
  • FIG. 22A shows an example of a core support 110 cw formed from an oval wire
  • FIG. 22B illustrates a proximal end view of core support 110 cw , showing the oval profile at the proximal end of core support 110 cw .
  • Proximal portion 1130 p of core support 110 cw is maintained as the full wire profile having the oval-shaped cross-section, wherein the height 1130 h of the wire is about 0.015′′ and the width 1130 w of the wire is about 0.010′′, see FIG. 22B .
  • Intermediate section 1130 i is ground down to a round cross-section having a diameter of about 0.010′′ for greater flexibility in a distal end portion of the guidewire 110 .
  • Distal end portion 1130 d is flattened, and may have a length of about 0.8 cm to about 1.2 cm, for example, typically about 1 cm, which facilitates soldering core support 110 cw to coil 110 c .
  • the length of flattened section 1130 d is maintained small, e.g., about 0.8 cm to prevent guidewire whipping.
  • flattened section 1130 d may be eliminated altogether with the reduced diameter round cross section 1130 i extending to the distal end of core support 110 cw .
  • the length of the section 1130 i (whether or not flattened section 1130 d is employed) may be varied to customize the length of a flexible distal end portion of guidewire 110 .
  • the dimensions of the oval or elliptical cross section may be varied depending upon the amount of space available inside coil 110 c , accounting for all other components to be contained therein, as well as performance characteristics (e.g., flexibility, stiffness, torquability, etc) desired.
  • Coil 110 c may be overlaminated, such as by melting nylon (or other polymer, such as PEBAX, GRILLAMID (nylon resin), or other medical grade resin) into open-pitched areas of the coil 110 c to fill in these areas.
  • the overlamination material increases the steerability of guidewire 110 , increases torquability of guidewire 110 and provides an area that can be easily gripped by the user.
  • FIGS. 23A-31 are now referred to in describing manufacturing steps that may be carried out during the manufacture of certain embodiments of illuminating guidewire 110 .
  • coil 110 c extends over substantially the entire length of guidewire 110 and at least one of core supports 10 cw extends into a proximal portion of guidewire 110 .
  • a distal portion of coil 110 c is stretched to break tension between adjacent coils and to form an open-pitch portion 110 co of coil 110 c .
  • two mandrels 1132 (which may be coated with a lubricious material such as polytetrafluoroethylene, or the like), having dimensions about the same as illumination fibers 110 i that will later replace them, are inserted into coil 110 c , as illustrated in the longitudinal sectional schematic of FIG. 23B .
  • the core support 10 cw having the smaller cross-sectional proximal portion dimension e.g., core support 10 cw formed from a 0.006′′ core wire, as described with regard to FIG.
  • first core support 10 cw is inserted into the coil 110 c such that a distal end of distal portion 1130 d is set back proximally from a distal end of coil 10 c by a predetermined distance.
  • this predetermined distance is about seven cm. In another example this predetermined distance is about nine cm.
  • this predetermined distance may be varied depending upon the desired performance characteristics of the distal end portion of illuminating guidewire 110 . By decreasing the predetermined distance, this increases the stiffness, or moves the stiff section more distal on the distal end portion of the guidewire 110 . Increasing the predetermined distance moves the stiff section more proximal and leaves a greater flexible length at the distal end portion of the guidewire 110 .
  • a third mandrel 1132 which may be made the same as the above-described mandrels 1132 , but which has dimensions to occupy a space that will later be occupied by the second core support 10 cw , is inserted, which appears as the bottom mandrel 1132 shown in FIG. 23B .
  • FIG. 23C shows a cross-sectional view of this arrangement, with the bottom mandrel 1132 being the mandrel that occupies the space that will be later filled by the second core support 10 cw , and the other two mandrels 1132 occupying the spaces that will be later filled by illumination fibers 110 i .
  • the distal end 1130 d of the core support 10 cw may then be soldered to coil 110 c.
  • oxide on the nickel-titanium material, in regions to be soldered can be removed, prior to soldering, to improve solder joint strength.
  • This removal can be accomplished using a highly acidic flux.
  • a phosphoric acid-based flux (about 65% to about 75%, by weight, phosphoric acid) was found to achieve satisfactory removal of the oxide.
  • the regions on the nickel-titanium material that are to be soldered can be manually cleared of oxide, such as by removal using sandpaper or grinding. Further alternatively, or additionally, a chemical etch may be used.
  • solder used to form the solder joints is a tin/silver eutectic solder (96.5% Sn, 3.5% Ag, 0.5% Cu).
  • This eutectic alloy works well as the solder in this case because strength is desired, and the eutectic alloy has no liquidus/solidus transition range, so the solder joint solidifies all at once, which greatly reduces the chances, making it almost impossible for the joint to be disrupted as it is solidifying.
  • the mandrel 112 occupying the space for the second core support 10 cw is removed and the second core support 10 cw (e.g., core support 10 cw formed from a 0.008′′ core wire, as described with regard to FIG. 21A above, referred to here as the “second core support” 10 cw ) is inserted into the coil 110 c in the opening left by removal of the mandrel 1132 .
  • the first and second core supports 10 cw are then soldered to coil 10 c at multiple locations over the length of the core supports.
  • soldering of the second core support 10 cw includes a distal-most solder joint made about two to about five coils back from a distal end of coil 110 c , a second solder joint is made about two cm distal of the location along coil 10 c where the distal solder joint for the first core support 10 cw was made, a third solder joint is made proximal of the distal solder joint of the first core support, but distal of the transition between the open-pitch coil section 110 co and the remainder of the coil 110 c (closed-pitch section), a fourth solder joint is made proximal of the open-pitch coil section 110 co , and a fifth solder joint is made at the proximal end of coil 110 c .
  • the third, fourth and fifth solder joint locations join both of the core supports 10 cw to the coil 10 c for added strength and rigidity.
  • solder joint for the distal end of the first core support 10 cw and the second solder joint of the second core support 10 cw at locations on coil 10 c that are at unequal locations along the longitudinal dimension of coil 110 c , this allows the core supports 10 cw to slide independently of each other during bending of the distal end portion of the illumination guidewire 110 .
  • FIGS. 24A and 24B illustrate this independent sliding capability.
  • FIG. 24A shows the relative positions of the solder joints when coil is in a straight configuration.
  • FIG. 24B shows coil 110 c in a bent configuration, and illustrates the ability of the core supports 10 cw to slide independently of one another, as it can be observed that the solder joints 1134 and 1136 have moved closer together, as compared to the space between these joints shown in FIG. 24A when coil 110 c is straight.
  • the first core support 10 cw is allowed to slide distally I relation to the second core support 10 cw at the bend, because the cores are located together (same longitudinal fix point) at solder joints 1138 , and the first core support 10 cw does not extend all the way to the distal end of the coil 110 c . If the solder joints 1134 and 1136 of the two core supports 10 cw were soldered at the same longitudinal location, this would make the arrangement much stiffer and less flexible in this region. This would also result in greater amounts of “whip” upon torquing the device.
  • the coils of coil 110 c are prevented from substantial separation even when coil 110 c is bent. This greatly increases the stiffness of guidewire 110 /coil 110 c in a segment between the solder joints 1134 and 1138 , but still allows a distal section (distal of joint 1134 to the distal solder joint of the second core support 110 cw ) to remain floppy.
  • the coils between joints 1134 and 1138 or between 1136 and 1138 , or between 1134 and 1136 can be placed under compression during the soldering of the joints.
  • soldering arrangements include, but are not limited to: soldering both core supports 10 cw at the distal end of coil 110 c . This increases the distal stiffness of the coil 110 c /guidewire 110 and thus also reduced distal flexibility. This may also greatly increase whipping of the distal end when torquing the illuminating guidewire 110 .
  • solder locations locations longitudinally along the coil 110 c
  • the solder locations can be varied. For example, by moving joints 1134 and 1136 distally with respect to coil 110 c , but keeping the same separation distance between coils 1134 and 1136 , this moves the stiff section between the joints 1134 and 1136 closer to the distal end of guidewire 110 , reducing the flexible section at the distal end portion of guidewire 110 .
  • the open-pitch coil section 110 co of coil 110 c can next be laminated.
  • a nylon (or other meltable polymer) tube 1140 is slid over the open-pitched coil section 110 co , as illustrated in FIG. 25 , and then a FEP (fluorinated ethylene propylene) heat shrink tube 1142 is slid over the meltable polymer tube 1140 .
  • Tubing 1142 is heated until it shrinks down around the coils of the open coil section 110 co and melts the polymer tubing into the spaces between the coils. After cooling, the shrink tubing 1142 is removed.
  • FIGS. 26A-26B illustrate steps that may be performed to install connector 1120 to the proximal end of guidewire 110 . These steps may be performed while at least the mandrels 1132 that are to be replaced by illumination fibers 110 i are still inserted through coil 110 c .
  • a heat shrink tube (e.g., FEP heat shrink material) 1140 is shrunk down around a proximal end portion of coil 110 c as illustrated in FIG. 26A which shows a longitudinal sectional view of the heat shrink tubing, and a plan view of coil 110 c and mandrels 1132 .
  • the tubing 1142 extends proximally beyond the proximal end of coil 110 c by a predetermined distance, e.g. about two mm.
  • Mandrels 112 act to keep the proximal end of tubing 1142 from shrinking closed during heating.
  • connector 1120 is slid over tubing 1142 so as to substantially align the proximal end of connector 1120 with the proximal end of tubing 1142 , as illustrated.
  • Tubing 1142 help to center coil 110 c within the connector 1120 and also functions as a strain relief.
  • Adhesive 1144 can be applied to adhere connector 1120 to tubing 1142 .
  • Another shrink tubing 1146 e.g., polyolefin shrink tubing
  • Connector 1120 may include a rotatable (relative to coil 110 ) or non-rotatable female luer connector, or rotatable (relative to coil 110 ) or non-rotatable male luer connector, for example.
  • the remaining mandrels 1132 can be removed from coil 110 c in preparation for installation of the light (illumination) fibers 110 i .
  • two light fibers 110 i are installed in their place and extended distally beyond the distal end of coil 110 c .
  • the illumination fibers 110 i are then cut to extend a predetermined distance distally of the distal end of coil 110 c . In one example, this predetermined distance is about 0.5 mm, although this predetermined distance may vary.
  • An adhesive lens 110 s is the formed by applying ultra-violet curable adhesive (or other transparent or translucent adhesive) over the portions of illumination fibers extending distally from the distal end of coil 110 c to completely encapsulate these fiber portions, as shown in FIG. 27 .
  • Adhesive lens 110 s will typically be formed to have a hemispherical distal surface, as shown, although the curvature and shape of this distal surface can be varied, depending upon the characteristics of light patterns desired to be emitted therefrom. Note that adhesive is also applied so as to spread over at least one coil of the coil 110 c and at least one space between coils. Adhesive lens 110 s is then cured to complete the formation of the adhesive lens 110 s.
  • the same or a similar adhesive can be used to apply to the proximal end portion of coil 110 c and portions of the illumination fibers 110 i in the proximal end 110 ps vicinity, as illustrated in FIG. 28 .
  • Adhesive can be applied in amounts enough attach/encapsulate up to about one-half of the proximally exposed portions of illuminating fibers 110 i that extend proximally from the proximal end of coil 110 c .
  • the illumination fibers are then cut substantially flush with the proximal end of connector 1120 , as shown in FIG. 28 .
  • the portion of shrink tubing 1142 extending proximally from the proximal end of coil 110 c may next be shrunk down around the proximally extending portions of illumination fibers 110 i , for example, to an outside diameter of about 0.022′′, to lower the light input into device 110 and allow light input substantially only through the illumination fibers 110 i .
  • a grommet 1148 shown in phantom can be inserted over illumination fibers and inside of shrink tubing 1142 , with or without subsequent further shrinking of the shrink tubing, to accomplish the same function.
  • proximally extending portions of light fibers 110 i may be completely encapsulated in adhesive or epoxy, in the same manner as described above with regard to adhesive lens 110 s .
  • This proximal adhesive lens can be configured to function as a lens to direct light into light fibers 110 i , for example, but the adhesive or epoxy used in this instance must be able to withstand heat generated by the light cable when connected to connector 1120 during use.
  • illuminating guidewire may be manufacture to have a preset curve or bend in a distal end portion thereof.
  • the larger core support 110 cw in the process described above can be set with a curve or bend to form a resulting bend in the distal end portion of guidewire 110 once constructed.
  • FIG. 29A is a partial view of the core support 110 cw described with regard to FIG. 21A , while still in a straight configuration.
  • FIG. 29B illustrates one method of forming a preset curve in core support 110 cw in which the flatted distal end section 1130 d is bent at an angle of about ninety degrees by bending it around a mandrel 1150 .
  • mandrel 50 had a outside diameter of about 0.05′′.
  • the distal portion 1130 d can be bent in the same manner as shown in FIG. 29B , but rather than cold working, the distal end portion can be heated to it annealing temperature and then bent around the mandrel 1150 and quenched.
  • FIG. 30 illustrates a distal portion of an illuminating guidewire 110 manufactured with a core support have a preset bend from either of the techniques described above with regard to FIGS. 29A-29B .
  • the bend in the distal end portion makes it more steerable, as discussed above and in application Ser. No. 11/647,530.
  • FIG. 31 is a partial view of coil 110 c illustrating two portions of coil 110 c that have been etched 110 e . Etching may be performed over all, or one or more select portions of coil 110 c to lower reflectance of the coil where etched, such as when viewed by endoscopy, for example, and/or to act as a marker band to identify a particular location along the coil 110 c.
  • Illumination guidewire 110 may be externally coated with a silicone coating to reduce friction (add lubricity) between guidewire 110 and the tissues, guides and/or other instruments that it is slid against during use.
  • Other lubricious coatings may be substituted, including, but not limited to: polytetrafluoroethylene, parylene, hydrophilic coatings, any of which may be spray coated or dipped, for example, or may be pre-coated on the wire from which the coil is made by the wire manufacturer, or may be pre-coated on the coil 10 c if the coil is manufactured by an outside source.
  • the illumination fibers 110 i can be free to move about radially within the device 110 . Further, there is no need to center the illumination fibers 110 i with respect to device 110 even at the distal and proximal ends of the device.
  • the plastic or glass illumination fibers 110 i are typically used to transmit light from a light source such as one provided in an operating room for use by endoscopes, e.g., xenon light source, halogen light source, metal halide light source, etc.
  • device 110 may be configured to transmit light from other light sources, such as a laser light source, wherein laser fibers would be substituted for the illumination fibers described above, and extend through device 110 in a fiber optic bundle.
  • the fiber optic bundle like the illumination fibers 110 i , contributes to stiffness (in both bending and torquing motions) of device 110 , thereby enhancing trackability, steering and other torquing.
  • device 110 may employ one or more light emitting diodes used to emit light, as described in more detail in application Ser. No. 11/647,530.
  • a light cable 1032 optically connects connector 1120 with light source 1030 to deliver light from the light source 1030 through connector 1120 and illumination fibers 110 i .
  • the light cable 1032 must transmit enough light to allow the illuminating guidewire 110 to transilluminate the sinuses, but at the same time, not transmit so much light that the light fibers become damaged.
  • very bright light sources 1030 e.g., 300 Watt Xenon, new bulb
  • taper 1126 may taper the diameter of the incoming light from about 2 mm down to about 1 mm. While the taper 1032 can concentrate or focus the light down, as noted, there are light losses that result in heat generation at the location of the taper 1126 .
  • a light cable 1032 in this embodiment, has a connector 1320 at the distal end of light cable 1032 which is provided with a male luer 1322 , for connection to the connector 1020 of illumination guidewire 110 .
  • the provision of a male luer is non-standard, as most operating room light cables are provided connectors specific to the manufacturer of the light cable, which are often proprietary to that manufacturer and which do not include a luer connector. Accordingly, when the connector 1020 of illuminating guidewire 110 is configured to mate with this male luer 1322 , this prevents a standard operating room light cable from accidentally being connected to the guidewire 110 .
  • the light fiber bundle in light cable 1032 is sized to provide sufficient illumination through illuminating guidewire 110 to transilluminated the sinuses, but an insufficient amount of light to damage the illumination fibers 110 i . Also, a taper 1026 is not required since the light cable 1032 is sized to substantially match the illumination fibers 110 i , and therefore the heat generation problem caused by tapering does not arise with this embodiment.
  • the light fiber bundle 1324 has a diameter of about 1 mm.
  • the embodiment shown in FIG. 33 may also be provided with a taper 1126 to further funnel the light from light bundle 1324 down to a smaller diameter, as illustrated in FIG. 34 .
  • FIG. 35 shows connector 1320 of light cable 1302 provided with a female luer mated with a male luer of connector 1020 of the illuminating guidewire 110 .
  • This arrangement allows the proximal ends of illumination fibers 110 i to be placed flush in abutment with the light bundle 1324 or taper 1126 (as shown) when connector 120 is screwed or snapped onto connector 1320 .
  • any of the devices 110 described herein may optionally include one or more radiopaque markers and/or electromagnetic coils on the tip of the device 110 and/or elsewhere along the device for enhancing visibility by fluoroscopy systems, image guided surgery (IGS) systems, or other visualization systems.
  • IGS image guided surgery
  • FIG. 36 shows an alternative design of device 110 in which light is emitted proximally of the distal end of the device.
  • This configuration may employ any of the various light transmission means described above (e.g., illumination fibers, laser fibers, LED).
  • the proximal portion 110 p may be constructed in any of the manners described above with regard to other embodiments of device 110 .
  • the distal portion 110 d includes a transparent proximal end portion 110 dp that mounts over the distal end of proximal end portion 110 p of the device 110 .
  • the transparent portion 110 dp permits the illumination emitted from illumination member 110 i or 110 id to pass out of the device 110 at the location of transparent portion 110 dp .
  • the illumination member(s) 110 i or 110 id thus terminate at the proximal end portion 110 dp of the distal end portion of device 110 .
  • the distal portion 110 dd of distal end portion 110 d of device 110 extends as a floppy guidewire leader or tip.
  • This floppy guidewire leader or tip 110 dd may include a coiled section 110 c and may optionally include a core support 110 cw .
  • the light emitted from illumination fibers will disperse naturally through the transparent portion 110 dp .
  • a deflector 111 such as a convex mirror (e.g., parabolic or other convex) shape or other reflective surface may be provided distally of illumination fibers/light emitting portion 110 i , 110 d of device 110 to deflect light rays out of the transparent portion.
  • illumination fibers 110 i may be angled at the distal end portions thereof to direct the emitted light out through the transparent portion.
  • This configuration may be beneficial in further protecting the illumination emitter(s) 110 i from foreign materials inside the body, as well as from trauma that may be induced by bumping the illumination emitter up against structures within the body. Further, a floppy guidewire leader 110 dd of this type may provide more flexibility and maneuverability than a device in which the illumination emitter is located on the distal tip of the device.
  • Transparent portion 110 dp may be provided as a clear plastic or glass integral tube, or may have openings or windows 110 t provided therein (see the partial view of FIG. 37 ). Further alternatively, transparent portion may be formed by a plurality of struts 110 st circumferentially arranged to interconnect the distal floppy tip 110 dd with the proximal end portion 110 p of device 110 as shown in the partial illustration of FIG. 38 . Alternatively members 110 st may be intersecting in a criss-crossing cage like configuration or other cage configuration. In any of these alternative configurations, members 110 st may be transparent, but need not be and could be formed of non-transparent materials, such as metals or opaque plastics, for example.
  • FIGS. 39A-39C illustrations of partial coronal sectional views through a human head showing various steps of a method for inserting an illuminating guidewire 110 into an ostium that opens to a frontal sinus are shown.
  • the methods described here, and all other methods disclosed herein may also comprise a step of cleaning or lavaging anatomy within the nose, paranasal sinus, nasopharynx or nearby structures including but not limited to irrigating and suctioning.
  • the step of cleaning the target anatomy can be performed before and/or after a diagnostic or therapeutic procedure.
  • the methods of the present invention may also include one or more preparatory steps for preparing the nose, paranasal sinus, nasopharynx or nearby structures for the procedure, such as spraying or ravaging with a vasoconstricting agent (e.g., 0.025-0.5% phenylephyrine or Oxymetazoline hydrochloride (Neosynephrine or Afrin) to cause shrinkage of the nasal tissues, an antibacterial agent (e.g., provodine iodine (Betadine), etc. to cleanse the tissues, etc.
  • a vasoconstricting agent e.g., 0.025-0.5% phenylephyrine or Oxymetazoline hydrochloride (Neosynephrine or Afrin)
  • an antibacterial agent e.g., provodine iodine (Betadine), etc.
  • a first introducing device in the form of a sinus guide 12 is introduced through a nostril and through a nasal cavity 1012 to a location close to an ostium 1034 of a frontal sinus 1036 .
  • Sinus guide 12 may be as described previously herein, or as described in the applications incorporated herein by reference.
  • the advancement of sinus guide 12 can be visualized with a scope inserted into the nasal cavity 1012 (e.g., through channel 28 , not shown in FIG. 39A ) and advanced as close to the ostium 1034 as possible without causing significant trauma to the tissues therein.
  • illuminating guidewire 110 is inserted through sinus guide 12 and advanced therethrough, see FIG. 39B .
  • transillumination effects are produced when the tip of guidewire 110 exits the distal end of guide 12 and especially when the light emitting portion of guidewire 110 touches or approximates an intended target surface, such as an inner wall of a sinus, for example.
  • transillumination on the face of the patient can be observed as a glowing spot that moves as the distal end portion of device 110 moves, thereby making it possible to visibly track the location of the light emitting portion of device 110 without the need to use radiographic imaging, such as by fluoroscopy, for example.
  • the glow on the forehead becomes brighter and smaller in dimension (more focused) as the light emitting portion passes through the ostium 1034 and enters the frontal sinus 1036 , FIG. 39C .
  • the glowing spot becomes most defined and brightest as the light emitting portion approaches and contacts a wall of the frontal sinus 1036 .
  • the movement of the transilluminated spot can be visibly followed to confirm that the guidewire 110 is indeed moving within the location of the frontal sinus, as can be confirmed by the surgeon's knowledge of the particular anatomy of the patient being treated.
  • a CAT scan or other image of the sinus anatomy can be performed prior to this procedure and studied by the surgeon, to apprise the surgeon of any distinctive or unusual patterns in the individual patient's sinus anatomy which might be useful in tracking and confirmation of where the guidewire is located, as indicated by the transillumination.
  • Illuminating guidewire device 110 can also be used to facilitate visualization and placement of the sinus guide 12 in the procedure described above with regard to FIGS. 39A-39C , or in another procedure in which a sinus guide, sinus guide or guide tube is placed in the sinus pathways.
  • FIG. 40 illustrates a situation where scope 30 has been inserted as far as possible without causing significant trauma to the patient. The range of visibility in this case does not extend all the way to ostium 1034 , as indicated schematically by the rays 1009 shown extending distally from scope 30 .
  • illuminating guidewire 110 By inserting illuminating guidewire 110 through sinus guide 12 (tube 44 ) as shown in FIG. 30 , additional illumination can be provided distally of the illuminating range of scope 30 .
  • This additional illumination can be received by scope 30 to enable visualization up to the illumination portion of device 110 and potentially even extending to illumination range of device 110 , as long as there is a straight pathway of the field of view.
  • placement of the guidewire 110 can be visualized up to and into the desired ostium 1034 via scope 30 in this case.
  • this can be carried out without the sinus guide 12 , wherein the guidewire 110 is inserted and the scope 30 can be used to visualize placement of guidewire 110 into the target ostium with the assistance of the light emitted by the scope 30 in addition to the light emitted by guidewire 110 .
  • the light emitted from the guidewire 110 will produce a moving transillumination spot as guidewire 110 is advanced, which also helps distinguish the location of the distal portion of the guidewire 110 , relative to any diffuse transillumination produced by the scope light.
  • the guidewire 110 is advanced into an ostium other than the target ostium (e.g., ostium 1035 shown in FIG. 40 ), this may be possible to be viewed by scope 30 , depending upon the line of sight. However, even if it is not, the transillumination resulting from entrance into a different sinus than the target sinus will be evident by the different location on the patient's face. Also, in the example shown, guidewire 110 would not be able to be advanced very far through ostium 135 before it was diverted and curled by the relatively small sinus space that ostium 135 leads into. Thus, by tracking the movement of the illumination spot produced by guidewire 110 , the surgeon could confirm that guidewire 110 was misplaced as the guidewire would be diverted by a much smaller space then that characterized by the target frontal sinus 1036 .
  • an illuminating guidewire device 110 in the methods as described above, the use of fluoroscopy or other X-ray visualization can be reduced as it is not required to confirm proper placement of the guidewire in some cases.
  • FIGS. 41-43 show additional embodiments of transnasally insertable guide systems useable to position an endoscope 30 at a desired location within the ear, nose, throat or cranium of a human or animal subject, to view anatomy for diagnostic purposes or for confirmation that a procedure has been successfully accomplished.
  • guide device 12 includes a single tube 28 having a lumen sized to receive endoscope 30 .
  • Guide 12 may be preshaped to be straight or curved, or may be configured to be deflectable or steerable.
  • FIGS. 42-43 illustrate a guide system comprising a straight or curved transnasal sinus guide 12 and a sheath 90 that is insertable through the sinus guide 12 .
  • the sheath 90 has a single lumen sized and configured to receive endoscope 30 therethrough.
  • endoscope 30 may be inserted through sheath 90 to extend distally of the distal end of guide 12 , as illustrated in the partial view of FIG. 43 , to view anatomy or visually verify the results of a procedure, for example.
  • Examples of transnasal sinus guides 12 useable in this system include those described in U.S. patent application Ser. No. 11/193,020 and herein, as well as those currently available commercially as RelievaTM Sinus Guide Catheters from Acclarent, Inc., Menlo Park, Calif.
  • Sheath 90 illustrated in FIG. 42 , an elongate flexible shaft 92 through which the endoscope lumen 85 extends.
  • a proximal hub 94 may be provided with having two arms 96 , 98 , and is mounted on the proximal end of the flexible shaft 92 .
  • Arm 96 leads into the endoscope lumen 85 and arm 98 also leads to the endoscope lumen 85 and can be used, for example to attach a suction or irrigation source thereto.
  • hub 94 may be provide with only a single arm 96 .

Abstract

Medical devices, systems and methods that are useable to facilitate transnasal insertion and positioning of guidewires and various other devices and instruments at desired locations within the ear, nose, throat, paranasal sinuses or cranium. Direct viewing of such placements via an endoscope.

Description

    CROSS-REFERENCE
  • This application claims benefit of Provisional Application No. 61/124,818 dated Jul. 31, 2007 and this application is a divisional of U.S. Ser. No. 11/725,151, filed Mar. 15, 2007.
  • FIELD OF THE INVENTION
  • The present invention relates generally to medical apparatus and methods and more particularly to devices and methods that are useable to facilitate transnasal insertion and positioning of guidewires and various other apparatus at desired locations within the ear, nose, throat, paranasal sinuses or cranium.
  • BACKGROUND OF THE INVENTION
  • Functional endoscopic sinus surgery (FESS) is currently the most common type of surgery used to treat chronic sinusitis. In a typical FESS procedure, an endoscope is inserted into the nostril along with one or more surgical instruments. The surgical instruments are then used to cut tissue and/or bone, cauterize, suction, etc. In most FESS procedures, the natural ostium (e.g., opening) of at least one paranasal sinus is surgically enlarged to improve drainage from the sinus cavity. The endoscope provides a direct line-of-sight view whereby the surgeon is typically able to visualize some but not all anatomical structures within the surgical field. Under visualization through the endoscope, the surgeon may remove diseased or hypertrophic tissue or bone and may enlarge the ostia of the sinuses to restore normal drainage of the sinuses. FESS procedures can be effective in the treatment of sinusitis and for the removal of tumors, polyps and other aberrant growths from the nose. The surgical instruments used in the prior art FESS procedures have included; applicators, chisels, curettes, elevators, forceps, gouges, hooks, knives, saws, mallets, morselizers, needle holders, osteotomes, ostium seekers, probes, punches, backbiters, rasps, retractors, rongeurs, scissors, snares, specula, suction cannulae and trocars. The majority of such instruments are of substantially rigid design.
  • In order to adequately view the operative field through the endoscope and/or to allow insertion and use of rigid instruments, many FESS procedures of the prior art have included the surgical removal or modification of normal anatomical structures. For example, in many prior art FESS procedures, a total uncinectomy (e.g., removal of the uncinate process) is performed at the beginning of the procedure to allow visualization of and access to the maxillary sinus ostium and/or ethmoid bulla and to permit the subsequent insertion of the rigid surgical instruments. Indeed, in most traditional FESS procedures, if the uncinate process is allowed to remain, such can interfere with endoscopic visualization of the maxillary sinus ostium and ethmoid bulla, as well as subsequent dissection of deep structures using the available rigid instrumentation.
  • More recently, new devices, systems and methods have been devised to enable the performance of FESS procedures and other ENT surgeries with minimal or no removal or modification of normal anatomical structures. Such new methods include, but are not limited to, uncinate-sparing procedures using Balloon Sinuplasty™ tools and uncinate-sparing ethmoidectomy procedures using catheters, non-rigid instruments and advanced imaging techniques (Acclarent, Inc., Menlo Park, Calif.). Examples of these new devices, systems and methods are described in incorporated U.S. patent application Ser. Nos. 10/829,917 entitled Devices, Systems and Methods for Diagnosing and Treating Sinusitis and Other Disorders of the Ears, Nose and/or Throat; 10/944,270 entitled Apparatus and Methods for Dilating and Modifying Ostia of Paranasal Sinuses and Other Intranasal or Paranasal Structures; 11/116,118 entitled Methods and Devices for Performing Procedures Within the Ear, Nose, Throat and Paranasal Sinuses filed Apr. 26, 2005 and 11/150,847 filed Jun. 10, 2005, each of which is hereby incorporated herein, in its entirety. Procedures using Balloon Sinuplasty™ tools such as those described in the above-noted applications, for example, are performable using various types of guidance including but not limited to C-arm fluoroscopy, transnasal endoscopy, optical image guidance and/or electromagnetic image guidance.
  • In FESS procedures, the surgeon typically holds or navigates the endoscope with one hand while using the other hand to handle the surgical instruments. Recognizing the desirability of integrating an endoscope with an operative device so that both could be moved with a single hand, application Ser. No. 11/234,395 filed Sep. 23, 2005 describes a number of transnasally insertable sinus guides that have endoscopes attached thereto or integrated therewith.
  • There remains a need for further development of new devices and methodology to facilitate the integration of endoscopes with sinus guides and/or other instruments to facilitate endoscopic viewing of guidewires and/or other devices/instruments as they are transnasally inserted, positioned and used to treat disorders of the ear, nose, throat, paranasal sinuses or other intracranial disorders that are transnasally accessible.
  • SUMMARY OF THE INVENTION
  • A beneficial aspect of the present invention is to allow a user to be able to see an adjustable view, with an endoscope, that is generally aligned with the same axis of movement of the user's working device. This is particularly useful when the axis of movement is at an angle with respect to the axis of entry into the patient. This aspect allows the user to see “around the corner” of anatomy that ordinarily would block his/her view and which would therefore require removal in a traditional FESS procedure to allow visualization. This aspect of the invention allows the user to also verify the location of his/her Balloon Sinuplasty™ tools without having to use fluoroscopy or image guidance systems, so that the procedure does not have to be performed in an operating room. Another beneficial aspect of the present invention is that it enables a reduction in the amount of fluoroscopy that needs to be performed by the user doing the procedure, resulting in a reduction in radiation exposure to the user and the patient.
  • Another beneficial aspect of the present invention is that it allows a user to hold a tool with an endoscope attached or incorporated therein, such that both can be held with one hand while allowing the user to manipulate another tool with the other hand, thereby eliminating the need for an assistant.
  • A method for positioning a guide device useful for delivering at least one working device therethrough to deliver a working end portion thereof to a desired location within the ear, nose, throat or cranium of a human or animal patient is provided, including the steps of: inserting an endoscope into or through an endoscope channel of the guide device that includes an elongated shaft; inserting the guide device into an internal space of the patient; and viewing through the endoscope to guide positioning and delivery of the guide device to an intended location in the patient.
  • A method for locating a sinus ostium is provided, including the steps of: inserting an endoscope through a nostril of a patient and advancing the endoscope toward a location of the sinus ostium; inserting a guidewire through the nostril and advancing a distal end portion of the guidewire distally of a distal end of the endoscope; and viewing, through the endoscope, the advancement of the distal end portion of the guidewire to facilitate guidance of the advancement of the guidewire along a desired path.
  • A method for treating a patient is provided, including the steps of: inserting an endoscope into or through an endoscope channel of a guide device that includes an elongated shaft; inserting the guide device through a nostril of the patient; advancing a distal end portion of the guide device toward a sinus ostium of the patient; advancing a distal end portion of the endoscope distally of the distal end portion of the guide device, and navigating the distal end portion of the endoscope through the sinus ostium, said navigating being assisted by visualization through the endoscope.
  • A method of visually inspecting a sinus cavity is provided, including the steps of: inserting an endoscope through a lumen of a working device having previously been inserted through a nostril of a patient, through a sinus ostium and into the sinus cavity; and viewing the sinus cavity through the endoscope. A method of directing a guidewire to a target location within the ear, nose, throat or cranium of a patient is provided, including the steps of: inserting an illuminating guidewire internally of the patient; emitting light from a distal end portion of the guidewire; and tracking movements of the distal end portion of the guidewire by tracking movements of an illumination spot visible externally of the patient, wherein movements of the illumination spot correspond to movements of the distal end portion of the guidewire internally of the patient. A guide device useable to position a working device at a desired location within the ear, nose, throat or cranium of a human or animal subject is provided, including: a transnasally insertable elongate shaft having a proximal end and a distal end; a first channel into which an endoscope may be inserted so that the endoscope may be used to view at least an area beyond the distal end of the shaft; and a second channel through which the working device may be advanced, wherein the first channel is statically located relative to the second channel. A flexible microendoscope is provided, including: an elongated shaft; a plurality of image fibers; a lens attached at distal end of said image fibers; and a plurality of light transmitting fibers; wherein the microendoscope has a cross-sectional area permitting insertion into a nasal cavity of a patient.
  • An illuminating guidewire device is provided, including: a flexible distal end portion; at least one light emitting element in the distal end portion; at least one structure extending from a proximal end of the device through a proximal end portion of the device and at least part of the distal end portion to connect the at least one light emitting element with a power source; a coil; and at least one coil support within the coil, with at least a portion of each coil support fixed to the coil.
  • A method of making an illuminating guidewire is provided, including the steps of: providing a coil having a predetermined length and diameter; inserting mandrels through an annulus of the coil; inserting a first core support into the coil and fixing a portion of the first core support at a predetermined length from a distal end of the coil; removing a mandrel and inserting a second core support; fixing said second core support at predetermined locations along a length thereof, to the coil and fixing the first core support at additional locations along the length thereof to the coil; and inserting illumination fibers.
  • A transnasally insertable guide system for positioning an endoscope at a desired location within the ear, nose, throat or cranium of a human or animal subject is provided, including: a tubular guide having an elongate shaft and a lumen, at least a portion of the elongate shaft having a predetermined shape; a sheath sized to be inserted into the lumen of the tubular guide, the sheath comprising an elongate flexible body having a distal end and a scope lumen; and an endoscope that is advanceable through the scope lumen of the sheath, wherein the endoscope is useable to view the anatomy when advanced through the scope lumen of the sheath having been inserted into the guide and the guide having been inserted into an internal space within the patient; and wherein the sheath and endoscope are thereafter removable leaving the tubular guide in place. A guide device useable to position a working device at a desired location within the ear, nose, throat or cranium of a human or animal subject is provided, including: a transnasally insertable elongate shaft having a proximal end and a distal end; a channel through which the working device may be advanced, wherein the shaft comprises a scooped distal tip.
  • These and other features of the invention will become apparent to those persons skilled in the art upon reading the details of the devices, methods and systems as more fully described below.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 is a perspective view of one embodiment of a guide system of the present invention.
  • FIG. 2 is a perspective view of the guide system of the present invention in use on a human subject.
  • FIG. 3A is a side view of the guide catheter of the system of FIG. 1.
  • FIG. 3B is a cross sectional view through line 3B-3B of FIG. 3A.
  • FIG. 3C is a cross sectional view through line 3C-3C of FIG. 3A.
  • FIG. 3D is a side view of the endoscope of the system of FIG. 1.
  • FIG. 3E is a cross sectional view through line 3D-3D of FIG. 3C.
  • FIG. 3F is a cross-sectional view of a low profile endoscope.
  • FIG. 3G is a cross-sectional view of another embodiment of a low profile endoscope.
  • FIG. 3H illustrates a steering mechanism provided in an endoscope that can be operated from a proximal end portion of the endoscope.
  • FIG. 3I illustrates a guide device according to one embodiment of the present invention.
  • FIG. 3J illustrates a distal portion of a guide device having a removably attached endoscope channel.
  • FIG. 3K illustrates a snap fitting that may be used to releasably attach an endoscope channel to a main tube of a sinus guide.
  • FIG. 3L is a side view of the connector/camera/light cable assembly of the system of FIG. 1.
  • FIG. 4A shows a distal portion of a guide device configured with a static channel, for accessing a sphenoid sinus.
  • FIG. 4B shows a distal portion of a guide device 12 configured with a static channel, for accessing a frontal sinus.
  • FIG. 5A illustrates a partial plan view of guide device showing one embodiment of a handle.
  • FIG. 5B illustrates a longitudinal sectional view of FIG. 5A.
  • FIG. 6A illustrates another embodiment of a guide device.
  • FIG. 6B illustrates another embodiment of a guide device.
  • FIGS. 7A-7C illustrate distal end portions of guide devices having curved sections with each with a different radius of curvature.
  • FIGS. 8A-8D are cross-sectional illustrations showing various placement locations of an endoscope channel within a main tube of a guide device.
  • FIG. 9A illustrates a guide device having a distal end with a circular tip.
  • FIG. 9B illustrates a guide device having a distal end with a scooped-tip.
  • FIG. 9C illustrates an end view of the device of FIG. 9A.
  • FIG. 9D illustrates an end view of the device of FIG. 9B.
  • FIG. 10A illustrates the reduced profile of a scooped-tip device relative to the profile of the device having a circular end in FIG. 10B.
  • FIGS. 10C-10D shown reduced profiles of scooped-tip devices including a set back endoscope channel.
  • FIG. 11 is a partial perspective view of a guide device of the present invention with an optional linking apparatus for linking the endoscope to a working device to deter divergence of the endoscope away from the path of the working device.
  • FIG. 12 is a side view of a guidewire having an angled distal tip.
  • FIG. 13A shows a step in a method for using a guide system of the present invention in conjunction with the guidewire of FIG. 10.
  • FIG. 13B shows another step in a method for using a guide system of the present invention in conjunction with the guidewire of FIG. 10.
  • FIG. 14 illustrates an example of a procedure in which a guide device has been introduced through a nostril and an endoscope has been delivered through a sinus ostium.
  • FIG. 15 illustrates a working device having been inserted through the guide device of FIG. 14 and into a sinus cavity.
  • FIG. 16 illustrates a method in which an endoscope has been inserted through a lumen of a working device to enter a sinus cavity.
  • FIGS. 17A-17D are illustrations of partial sagittal sectional views through a human head showing various steps of one embodiment of a method of gaining access to a paranasal sinus using a sinus guide.
  • FIG. 18 illustrate use of an endoscope inserted through the guide device for visualization.
  • FIG. 19 shows an illuminating guidewire according to one embodiment of the present invention.
  • FIG. 20 illustrates an end view of a semi-cylindrical illumination fiber.
  • FIG. 21A shows a core support that may be used to support an illuminating guidewire.
  • FIG. 21B shows a core support that may be used to support an illuminating guidewire.
  • FIG. 22A shows an example of a core support formed from an oval wire.
  • FIG. 22B illustrates a proximal end view of the core support of FIG. 22A.
  • FIG. 23A shows a distal portion of a coil having been stretched to break tension between adjacent coils and to form an open-pitch portion.
  • FIG. 23B illustrates insertion of mandrels and a first core support into a coil.
  • FIG. 23C shows a cross-sectional view taken along line 23C-23C of FIG. 23B.
  • FIGS. 24A-24B illustrate the sliding ability of core supports relative to one another during bending of the coil.
  • FIG. 25 illustrates a step of melting a polymer tube into the open-pitched portion of the coil.
  • FIGS. 26A-26B illustrate steps for mounting a connector to a proximal end of the illuminating guidewire.
  • FIG. 27 illustrates insertion of illumination fibers and formation of a distal lens.
  • FIG. 28 illustrate finishing steps at a proximal end of the illuminating guidewire.
  • FIGS. 29A-29B illustrate formation of a preset bend in a core support.
  • FIG. 30 illustrates a resulting bend in an illumination guidewire employing a core support having a preset bend.
  • FIG. 31 illustrates etching the coil.
  • FIG. 32 illustrates connection of a light cable to an illuminating guidewire according to one embodiment.
  • FIG. 33 illustrates a light cable having another connector embodiment.
  • FIG. 34 illustrates a light cable having another connector embodiment.
  • FIG. 35 illustrates connection of a light cable to an illuminating guidewire according to another embodiment.
  • FIG. 36 shows an illuminating guidewire according to another embodiment of the present invention.
  • FIG. 37 illustrates an alternative transparent portion that may be included in a device shown in FIG. 37.
  • FIG. 38 illustrates another alternative transparent portion that may be included in a device shown in FIG. 37.
  • FIGS. 39A-39C are illustrations of partial coronal sectional views through a human head showing various steps of a method for inserting an illuminating guidewire into an ostium that opens to a frontal sinus.
  • FIG. 40 illustrates a situation where a scope has been inserted as far as possible without causing significant trauma to the patient.
  • FIGS. 41-43 show additional embodiments of transnasally insertable guide systems useable to position an endoscope.
  • DETAILED DESCRIPTION OF THE INVENTION
  • Before the present devices and methods are described, it is to be understood that this invention is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.
  • Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limits of that range is also specifically disclosed. Each smaller range between any stated value or intervening value in a stated range and any other stated or intervening value in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included or excluded in the range, and each range where either, neither or both limits are included in the smaller ranges is also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention.
  • Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods and materials are now described. All publications mentioned herein are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited.
  • It must be noted that as used herein and in the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to “a channel” includes a plurality of such channels and reference to “the endoscope” includes reference to one or more endoscopes and equivalents thereof known to those skilled in the art, and so forth.
  • The publications discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed.
  • Sinus Guide with Continuous Endoscope Channel
  • FIG. 1 shows one embodiment of a sinus guide system 10 of the present invention. This sinus guide system 10 comprises a sinus guide 12 and a camera/transmission/endoscope assembly 14. This embodiment of the sinus guide 12 is shown in more detail in FIGS. 3A-3C. As shown, this sinus guide 12 comprises a sinus guide body 26 and an endoscope channel 28 in generally side-by-side arrangement. The sinus guide body 26 comprises a tube 44 having a lumen 45 (e.g., see FIG. 3B), such as a polymer tube made of biocompatible polymeric material. A distal end portion 44 d, e.g. a length of about 2 mm may be made of stainless steel, for example, to increase durability, as illustrated in FIG. 3I. Similarly, a distal end portion 28 d of channel 28 can be formed of stainless steel. Alternatively, channel 28 and/or tube 44 can be formed of stainless steel along the entire length thereof. Further alternatively, tube 44 and/or channel 28 may be formed over an entire length thereof of stainless steel or other biocompatible metal, except for a polymer distal tip. Optionally, a liner 46 (FIG. 3B) may be disposed within the lumen 45 of the tube 44. Such liner may be formed of lubricious or smooth material such as polytetrafluoroethylene (PTFE). Also, optionally, a proximal portion of the tube 44 may be surrounded by an outer tube member 42 formed of material such as stainless steel hypotube. In the embodiment shown, a distal portion of tube 44 extends out of and beyond the distal end of outer tube 42. This protruding distal portion of tube 44 may be straight or curved. Also, it may be pre-formed at the time of manufacture or malleable to a desired shape at the time of use. When intended for use in accessing the ostium of a paranasal sinus, the distal portion of tube 44 may be curved to form an angle A from about 0 degrees to about 120 degrees. For example, a series of sinus guides 12 having angles A of 0, 30, 70, 90 and 110 degrees may be provided thereby allowing the physician to select the sinus guide angle A that is most appropriate for the particular paranasal sinus ostium to be accessed. Additionally, in some embodiments, a rotation grip 60 may be positioned about a proximal portion of the sinus guide 10, as seen in FIGS. 1, 3A and 3B. This rotation grip 60 may have a smooth or textured round outer surface (e.g., it may be a cylindrical tube), or it may have a contoured shape, raised at a distal end portion thereof (as well as, optionally, raised at a proximal end thereof), e.g., see FIG. 3I, to prevent slipping of an operator's hand during pushing (or pulling) on the handle 60. In any case, handle 60 may be grasped between the fingers of the operator's hand and easily rotated, thereby facilitating rotation (e.g., rolling) of the sinus guide 12 as it is being used. Such rotation of the sinus guide 12 may be desirable for a number of reasons including but not limited to positioning of the distal end of the sinus guide 12 at a desired location and/or maneuvering the location of an endoscope 30 that is inserted through the endoscope channel 28.
  • The endoscope channel 28 may comprise any structure (e.g., tube, track, groove, rail, etc.) capable of guiding the advancement of a flexible endoscope. In the particular examples shown in these figures, the endoscope channel 28 comprises a tube (e.g., a polymer tube or stainless steel tube or combination of polymer and metal, as noted above) having a lumen 29 extending therethrough. In the embodiment seen in FIGS. 1-3C, the endoscope channel 28 is attached to and extends along substantially the entire length of the sinus guide body 26. In another embodiment, the endoscope channel 28 can be inside the sinus guide body 26. In other embodiments, such as described with regard to FIGS. 4A-4C in application Ser. No. 11/647,530, the endoscope channel 28 may be interrupted, non-continuous or may extend over less than the entire length of the sinus guide body 26. In the embodiment of FIG. 3I, the channel 28 extends along the majority of the length of guide body tube 44 and has a distal end portion that conforms to and hugs the curvature of the curved distal end portion of tube 44. However, the distal end of channel 28 ends proximally of the distal end of tube 44. This setback provides multiple advantages that are described in more detail below. An outer skin 40 may be heat shrunk or otherwise disposed around the sinus guide body 26 and endoscope channel 28 to hold the endoscope channel 28 at a desired position on the outer surface of the sinus guide body 26. In FIG. 3I, heat shrink tube or overlamination 40 surrounds the tubes 44,28 over a majority of the length of the straight portions of the tubes. Optionally, all or a portion of the curved distal end portions of tubes 44,28 may be surrounded by heat shrink tubing or overlamination 40 d. Proximal end portions of tubes 44,28 are routed through separate channels in handle 60 that angles the tubes apart as they travel proximally through handle 60, so that luer fittings 45, at the proximal ends of tubes 40, 28 are spread apart further to make it easier to insert tools into the tubes 28, 40 and connect to the luers 45 with less interference from the other channel 28,40/luer 45. Additionally, the luer 45 for tube 28 can be connected to an irrigation source (saline-filled syringe or other irrigation source) to input irrigation fluid through the lumen of tube 28 to deliver fluid across the viewing tip of endoscope 30 having been inserted in the tube 28, in order to clean the viewing lens. Luer 45 can then be connected to a vacuum source to withdraw the fluid from the lens. Alternatively, irrigation or vacuum may be applied separately, to rinse debris off of the lens or the suction debris off of the lens, respectively. Further alternatively, a suction/irrigation catheter may be inserted through tube 44 to perform these same functions. This may be advantageous when the distal tip of the endoscope 30 has been extended distally of the end of tube 28 and optionally, distally of tube 44.
  • Alternatively, the endoscope channel 28 may be attached to the sinus guide body 26 at one or more locations by any other suitable attachment substance, apparatus or technique, including but not limited to adhesive, soldering, welding, heat fusion, coextrusion, banding, clipping, etc. The particular circumferential location of the endoscope channel 28 can be important in some applications, particularly when the sinus guide body 26 includes a curve formed in its distal portion 44. In this regard, for some applications, the endoscope channel 28 may be affixed at a particular circumferential location on the sinus guide body 26 to allow a flexible fiber endoscope 30 inserted through the endoscope channel 28 to provide a view from a desired or optimal vantage point, without obstruction from adjacent anatomical structures. This is described in more detail in application Ser. No. 11/647,530. Alternatively, channel 28 may be located interiorly of the lumen of tube 44, and may be positioned at various locations circumferentially about the inner wall of the tube 44. FIGS. 8A-8D show channel 28 mounted to the inner wall of tube 44 at 6 o'clock, 3 o'clock, 12 o'clock and 9 o'clock positions, respectively with regard to tube 44. It is noted that placement is not limited to the four relative locations shown, as channel may be positioned intermediate of any two of the adjacent locations shown.
  • The curve in the distal end portion of channel 28 d, when fixed/static with regard to tube 44, must accommodate the rigidity of a distal tip portion of an endoscope as it is passed therethrough, as the endoscope 30, although flexible over the majority of its length, is rigid over a small length extending from the distal tip that contains a lens. In one example, an endoscope channel 28 having an inside lumen diameter of about 0.045″ can accommodate a rigid distal tip length of about 0.125″ on a flexible endoscope 30 having an outside diameter of about 0.0375″ with the curved portion of the channel 28 having a radius of curvature as low as about 0.28″. In one particular example, the radius of curvature is about 0.40″. For an endoscope having a rigid distal tip length of about 0.150″, channel 28 having an inside lumen diameter of about 0.045″ can have a curved portion having a radius of curvature as low as about 0.40″ when the outside diameter of the endoscope is about 0.0375″. In one particular example, the radius of curvature is about 0.58″ for the rigid distal tip length of about 0.150″. A camera/cable/endoscope assembly 14 is attachable to arm 43 a or the lower luer fitting 45 shown in FIG. 3I. In the particular embodiment shown in FIGS. 1 and 3L, the camera/cable/endoscope assembly 14 comprises an adjustable scope/lock extension 16, an endoscope 18 having an elongate flexible scope body 30 and integrated light cable 50, a camera 20 and a monitor cable 24. The scope body 30 is advanced through the scope/lock extension 16 and through the lumen 29 of the endoscope channel 28. As shown in FIG. 2, the light cable 50 and monitor cable 24 may be connected to console 34 that houses a monitor 36, light source 38 and video recorder 40.
  • FIGS. 3D and 3E show a flexible endoscope 30 attached to a proximal body member 52 that engages and attaches to the adjustable scope/lock extension 16. As seen in the cross section of FIG. 3E, the scope 30 comprises a flexible shaft having an image fiber bundle 54 that extends coaxially through the center with light transmitting fibers 56 disposed about the periphery. In one embodiment, the flexible shaft is a braided polyimide sheathing that has a maximum outer diameter of 0.0375 inches and a length of two feet. The image fiber bundle may be made up of about 10,000 thin image fibers and the light transmitting fibers may be illumination fibers with a diameter of between about 0.008 and 0.020 inches, with a minimum lux of about 10,000. Preferably, the distal end of the flexible shaft has a lens with a minimum field of view of about seventy degrees. FIG. 3F is a cross-sectional illustration of a flexible endoscope 30 having a low profile configuration. In this arrangement, the flexible shaft has an image fiber bundle 54 that extends coaxially through the center of the shaft with light transmitting fibers 56 disposed laterally of the image fiber bundle. Although light transmitting fibers are shown disposed laterally on both sides of image fiber bundle 54, light transmitting fibers 56 may alternatively be located all on one side of optical fiber bundle 54, as illustrated n FIG. 3G. With either of these arrangements, the height profile of the endoscope shaft 30 is reduced which allows channel 28 to, in turn be lower profile, thereby reducing the cross-sectional size of the device 12 allowing for it to be more easily advanced through the patient anatomy. For example, the cross-sectional shape of such a low profile endoscope 30 may be substantially oval, as shown in FIGS. 3F-3G, or elliptical Additionally this lowered profile makes the shat of endoscope 30 easier to bend/more flexible when bending in the direction of the arrows shown, and this may allow for a smaller radius of curvature in the curved portion of channel 28 when channel 28 is provided with a curve in a distal portion thereof.
  • FIG. 3H illustrates a steering mechanism provided in endoscope 30 that can be operated from a proximal end portion of endoscope 30, outside the patient's body, to steer a distal tip 30 d or portion thereof (e.g., lens barrel 30 e) to allow directional control of the visual field provided by endoscope 30. As shown, steering mechanism 30 s includes a wire extending through endoscope shaft 30 and attached to a side of lens barrel 30 e, so that when tension is applied via a user pulling on a proximal end portion of wire 30 s, lens barrel 30 e is deflected or angularly directed in the direction shown by the arrow in FIG. 3H. Upon release of tension on wire 30 s, lens barrel 30 e resiliently returns to its unbiased orientation and direction. The unbiased orientation and direction of lens barrel 30 e may be axially aligned with the longitudinal axis of the endoscope 30 shaft. Alternatively, lens barrel may be oriented to point angularly away (downward, in FIG. 3H) from the direction that it is biased toward when tension is applied via steering mechanism 30 e. In this way, an intermediate amount of tension may be applied to align the lens barrel 30 e with the longitudinal axis of endoscope 30 shaft, and a greater amount of tension can be applied to steer the lens barrel 30 e still further in that direction (e.g., pointing angularly upwardly in FIG. 3H). Further alternatively, more than one wire or other steering actuators 30 s may be attached to lens barrel 30 e for directionally pointing the lens barrel 30 e. In different directions. As one non-limiting example, a second wire 30 s can be mounted on an opposite side of lens barrel 30 e to the side in which the first wire 30 s is shown mounted in FIG. 3H. As another example, four wires 30 s can be mounted at ninety degree intervals around the circumference of barrel 30 e. Further arrangements for controlling along different directions may also be provided, as would be apparent to one of ordinary skill in the art, after reading the above description.
  • FIG. 3J is a partial view of a sinus guide 12 in which channel 28 is detachable from tube 44. For example, channel 28 may be attachable to and detachable from tube 44 via snap fit, such as by assembling one or more snap fittings 51 on tube 44. Snap fitting 51 includes an enclosed lumen 441 through which tube 44 is received, and which forms a friction fit with tube 44, and a lumen 281 with an opening that allows channel 28 to be inserted therethrough. The width of the opening 280 is less than the outside diameter of channel 28, so that when channel 28 is pushed therethrough, the legs on opposite sides of the opening 28 o are deformed outwardly to allow tube to pass therethrough. When channel 28 has seated in lumen 281, the legs resiliently snap back into the configuration shown in FIG. 3K, thereby retaining tube in lumen 281 by a snap fit. Alternatively, lumen 281 can be enclosed and lumen 441 provided with an opening, in which case snap fitting 51 would be slid longitudinally over channel 28 to form a friction fit therewith and tube 44 would be inserted through an opening to perform the snap fit. Further alternatively, channel 28 may be provided as attachable and detachable to and from tube 44 via hook and loop type fasteners, adhesives that remain sticky and are thus reusable, or other quick release mechanical fasteners.
  • The provision of attachable/detachable tube 48 makes it easier to match the curve of the distal end portion of channel 28 to the rigidity characteristics of the endoscope 30 to be inserted therethrough, particularly the length of the rigid distal tip portion. Thus, for example, a kit of tubes 28 having distal end portions of varying curvatures (and, optionally, having varying lumen diameters) may be provided so that an appropriate channel 28 can be selected by a surgeon to accommodate the rigidity characteristics of the particular endoscope to be inserted therethrough, and then the selected tube can be attached to tube 44.
  • Alternatively, channel 28 may be inserted independently of tube 44, which may make it easier to locate the distal end portion of channel 28 in a target cavity. However, when used separately, this requires use of a second hand, one to manipulate tube 44 and a second to manipulate channel 28.
  • As noted above, the distal end of channel 28 can end proximally of the location of the distal end of tube 44, so that the distal end of channel 28 is located proximally of the distal end of tube 44 by a setback distance 53. Setback distance 53 may be about one mm to about four mm, typically about two mm, for sinus guides having statically placed tubes 28. As noted above, placement of channel 28 on a relative location about the circumference of tube 44 may vary, for example for various uses in the frontal, maxillary and/or sphenoid sinuses. Setback 53 allows the distal end of endoscope 30 to be advanced distally beyond the distal end of channel 28 without extending distally beyond the distal end of guide body tube 44, thereby adding protection to the distal end of the endoscope 30 while allowing better visualization when the tip is distally extended from the distal end of channel 28. This can be particularly advantageous during advancement of the device 12, for example.
  • Additionally, setback 53 also reduces the distal profile of the guide device 12, facilitating entry and passage through smaller openings than allowable by a device that has a distal tip cross sectional area formed by the combined cross sectional areas of tube 44 and channel 28. Setback 53 also provides a tapering effect, reducing the physical impact from endoscope channel 28 as it is traversed through the patient's anatomy.
  • A distal end portion of channel 28 (including at least distal tip portion 28 d, but which may extend proximally thereof) may be colored with a color that contrasts with a color of the remainder of the channel. This provides visible notice to the user, during traversal of endoscope 30 over or through channel 28, when the viewing (distal) tip of endoscope 30 has reached the portion having the contrasting color, as the contrasting color can be visualized on the inner wall surface of the channel (e.g., lumen), so that the user is aware that the tip of the endoscope is about to be delivered distally of the distal end of channel 28. This is possible even when channel 28 is a stainless steel tube. As the scope 30 travel through the steel tube 28, even abrasions in the steel on the inner surface (lumen) are visible. When the endoscope transitions from the steel tube 28 to the polymer atraumatic tip that is colored with a contrasting color, a colored ring is visible, which is the inner wall surface of the colored polymer distal tip 28 d. Additionally, or alternatively, a distal tip portion of tube 44 can be colored with a contrasting color so that this can be visualized as the distal tip of endoscope is exiting the distal end of channel 28, especially in situations where the distal end of channel 28 is proximally set back from the distal end of tube 44.
  • The distal tip of channel 28 d is preferably formed as an atraumatic tip, having a rounded distal edge. As noted, tip 28 d may be formed of stainless steel or other hard material. In this case the rounded edge makes the tip more atraumatic. Alternatively, tip 28 d may be formed of a softer material such as PEBAX™, SANOPRENE™ (synthetic rubber), silicone, PELLETHANE™ (thermoplastic polyurethane elastomers), or other soft plastic, which, when formed with a rounded distal edge, even further increases atraumaticity. By providing the atraumatic distal edge, the helps prevent cutting and other damage to tissues as guide device 12 is advanced through the patient's anatomy, which may include pushing through tissue, where the atraumatic tip(s) act more like blunt dissectors than cutting instruments. The distal tip of tube 44 can be formed similarly to any of the embodiments of the atraumatic distal tip of channel 28 described above. FIG. 4A shows a distal portion of device 12 configured with a static channel 28, for accessing a sphenoid sinus, for example, having tube 44 and channel 28 provided with atraumatic, rounded tips, and wherein a distal tip portion 28 d of channel 28 is colored with a color that contrasts with a portion of channel 28 immediately proximal of tip 28 d. FIG. 4B shows a distal portion of device 12 configured with a static channel 28, for accessing a frontal sinus, for example, having tube 44 and channel 28 provided with atraumatic, rounded tips, and wherein a distal tip portion 28 d of channel 28 is colored with a color that contrasts with a portion of channel 28 immediately proximal of tip 28 d.
  • FIG. 5A illustrates a partial plan view of device 12 showing one embodiment of handle 60. FIG. 5B illustrates a longitudinal sectional view of FIG. 5A. Handle 60 accommodates channel 28 and tube 44 to pass therethrough and extend proximally thereof to join with connectors 45. Handle 60 may be molded over tube 44 and channel 28 in the configuration shown, or may be molded separately with channels configured and dimensioned to receive channel 28 and tube 44 therethrough (e.g., molded in halves and then assembled over the tube 44 and channel 28, using screws, clamps, adhesives, press fitting, and/or other connectors). Alternatively, the handle can be molded or machined as one piece and the lumens can then be slid into place and fixed with adhesive and/or threaded connection, etc. Handle 60 is shaped to fit a user's hand, and to be easily rotated by the user. Accordingly, handle 60 may be substantially barrel-shaped, cylindrical, or other shape that lends itself to rotation about its longitudinal axis (e.g., rounded about the longitudinal axis, or octagonal or other extruded polygonal cross-section).
  • The outer surface of handle 60 can be smooth for easy sliding within the hand, or can be provided with a roughened surface to enhance the grip, for pushing on the handle 60 and/or torquing it. The distal end portion is formed with an uplift, “bump” or increased cross-sectional area 60 b, relative to the mid portion of the handle, to act as a stop against the hand of the user, thereby preventing the hand from sliding distally off of the handle 60 during use.
  • Channel 28 is guided away from tube 44 at the proximal end portions thereof, such as by an angled or curved channel 60 c that directs the proximal end portion of channel 28 away from tube 44 as channel 28 passes through the channel 60 c. This provides greater separation between the connectors 45, facilitating easier insertion of endoscope into channel 28 and tools or devices (e.g., balloon catheter, or any of the other devices or tools described herein or in application Ser. Nos. 11/647,530; 11/522,497; 11/193,020; 10/829,917; 11/116,118; and/or 11/150,847; without interference from the other connector 45. Bend or curve 60 c also creates force feedback and acts as a frictional braking system as endoscope 30 is advanced through channel 28 at the location of the bend or curve in channel 60 c, facilitating greater control of the advancement of the endoscope 30 by the user, with less risk of inserting too quickly or impulsively, or overshooting the amount of insertion. Additionally, this helps maintain the endoscope in longitudinal position relative to channel 28 even when an additional locking mechanism or valve is not provided.
  • Both tube 44 and channel 28 may be provided with a luer connector 45 on proximal ends thereof, to allow for attachment of a syringe for flushing, or attachment of other tools. A Touhy valve or other valve can be alternatively fitted on the proximal end of channel 28 to facilitate locking of the endoscope 30 in a position relative to channel 28. Further alternatively, a Y-adapter may be fitted to the proximal end of channel 28 to permit fixation of luer 45 to one arm of the Y and a valve to the other arm. Numerous other accessories can be attached to either channel 28 or tube 44, including drip systems, pop-off valves, etc.
  • FIG. 6A illustrates an embodiment of sinus guide device 12 wherein endoscope channel 28 is fixed relative to handle 60 and tube 44 is rotatable about its longitudinal axis within handle 60. Accordingly, the location of channel 28 relative to tube 44 can be varied by rotating handle 60 and holding the luer connector 45 that connects to tube 44 stationary as the handle 60 is rotated. This causes channel 28 to revolve about the longitudinal axis of tube 44, thereby repositioning the radial position of channel 28 relative to tube 44. For example, with channel 28 in a radial position at the top of tube 44 as illustrated in FIG. 6A, luer 45 connected to tube 44 can be grasped and prevented from rotating while rotating handle 60. By rotating handle 60 by 180 degrees, this results in channel 28 being positioned at the bottom side of tube 44. This rotatability to reposition channel 28 provides re-orientation of the view provided through endoscope 30 that is positioned through or over channel 28. The channel in handle 60 receiving tube 44 provides some frictional resistance to rotation of tube 44 relative thereto, so that tube 44 will not rotate relative to handle 60 during use of device 12, except when the user deliberately holds the connector 45 or tube 44 to prevent it from rotating and then rotates handle 60. FIG. 6A also shows channel 28 having a distal tip positioned proximally of the curved section of tube 44. This may be advantageous for example, for use in the maxillary sinus, to provide a larger, or wider angle view of the maxillary sinus by setting the distal tip of channel 28 proximally away from the curve. It is noted that the rotatability functions and features described with regard to FIG. 6A are not limited to this embodiment with a shortened channel 28, For example, this rotatability can also be provided with a device 12 like that shown in FIG. 4A.
  • FIG. 6B illustrates a variation of a rotatable device 12. In this arrangement, a second handle 61 is provided proximally of handle 60. Handle 61 is fixed relative to tube 44, so that the user can hold handle 61 to prevent it and the tube 44 from rotating as the user rotates handle 60 to revolve channel 28 about tube 44. Optionally, handle 61 may be spring-biased into contact with handle 60 to act as a brake to prevent handle 60 from rotating relative to handle 61. In order to perform a rotation in this case, the user pulls handle 61 proximally out of contact with handle 60 to relieve the braking force and allow the user to rotate handle 60 while holding handle 61 stationary. Further optionally, the frictional force imposed by handle 61 against handle 60 may be great enough to prevent relative rotation during use of device 12, but can be overcome by the user twisting on handle 60 and holding handle 61 stationary, without the need to retract or reposition handle 61 relative to handle 60. As with the embodiment of FIG. 6A, the embodiments of the rotational features described with regard to FIG. 6B can be employed in other guide device 12 embodiments, and are not limited to a device having a channel 12 that ends proximally of a bend in tube 44.
  • For devices 12 in which distal end portions of tube 44 and channel 28 are curved, and channel 28 comprises a tube, the radius of curvature can be designed to readily allow the endoscope 30 (and particularly the distal tip portion that includes the lens, which may be rigid) to move through the lumen of tube 28 and around the curve without the need to increase the inside diameter of the lumen, so that the lumen can be designed with a inside diameter having only a small tolerance around the outside diameter of endoscope 30. Typically, standard 18 gauge hypotube is used having an outside diameter of about 0.050″. The wall thickness selected is as thin as possible, to maximize the inside diameter of the tube without risking buckling of the tube. Typically the wall thickness is about 0.003″. In one particular example, the tube is 18 Gauge UTS with an outside diameter of 0.050″+0.001″/−0.0005″, with an inside diameter of about 0.044″ and therefore a tolerance of about +0.0015/−0.001″. Alternatively, the inside diameter of tube 28 can be increased if the curvature of the distal end portion is required to have a radius of curvature that would not allow endoscope to pass otherwise. The amount of curvature that can be successfully used with a lumen of normal tolerance relative to the outside diameter of endoscope 30 will also vary with the degree of flexibility of the endoscope 30 and the length of the lens barrel 30 e. In other words, the longer that the stiff section (lens barrel and adhesive) is, the bigger is the required inside diameter of tube 28 and/or the bigger the required radius of curvature of a bend in a tube 28 to allow easy passage of the stiff section. FIGS. 7A-7C illustrate exemplary distal end portions of devices 12 in which the curvatures of tubes 28,40 are varied, wherein the larger the radius of curvature, the easier it is to pass endoscope therethrough, with all other variables being constant. In FIG. 7A, the radius of curvature is about 0.25 inches, in FIG. 7B, the radius of curvature is about 0.5 inches, and in FIG. 7C, the radius of curvature is about 0.75 inches. The insider diameters of the tubes 28 in these examples are 0.044″+0.0015″/−0.001″.
  • In order to reduce the distal end profile of the guide device 12, tube 44 may be provided with a non-circular cross-section at the distal end thereof. By reducing the distal end profile, this facilitates entry and passage through smaller openings or relatively more constrained spaces, such a may be encountered in the passages leading to the frontal or maxillary sinuses, or other spaces relatively constrained by the patient's anatomy, as the reduced cross-sectional profile of the distal end of tube 44 is more readily able to be introduced into and smaller or partially obstructed spaces, compared to tubes having a full circular distal end cross-section. FIG. 9A illustrates tube 44 having a standard, circular cross-section at its distal end. FIG. 9B illustrates tube 44 having a reduced cross-sectional area at its distal end, in this case formed by a scooped-tip 44 t. Because a portion of the distal end of tube 44 is cut away to form the scooped tip, the profile of the distal end of tip 44 t is significantly less than that of the tube 44, as illustrated by comparing FIGS. 9C and 9D, which illustrate the distal end profiles of the tube 44 in FIGS. 9A and 9B, respectively. Accordingly, the cross-sectional profile of the scooped tip 44 t tapers down from that of a circular profile, at a proximal end of the scooped tip 44 t, to a semi-circle or less at the distal end of the scooped tip 44 t. In addition to the advantages noted above, a tube 44 having reduced-profile tip, such as a scooped-tip 44 t, for example, may facilitate entry into, or closer position to ostia by the distal end of a guide device 12. The scooped tip 44 t design may also facilitate balloon retraction (of a balloon catheter), back into tube 44 after performing an ostial dilatation procedure, for example.
  • In particular, with regard to the maxillary sinus, the tapered cross-section provided by scooped tip 44 t allows the distal end of tube 12 to be easily passed behind the uncinate process. In the frontal recess, the scooped tip 44 t may provide additional freedom of movement of device 12.
  • In addition to providing a significantly reduced cross-sectional area at the distal end, scooped tip 44 t of FIG. 9B also provides a larger opening than the circular opening of the standard tube end, like shown in FIG. 9A, for tubes 44 having the same inside diameter. Accordingly, as mentioned above, this may make it easier to retract a balloon portion of a balloon catheter back into the lumen of tube 44, e.g., after performing a dilatation procedure and deflating the balloon. Additionally, the curvature of the sides of the scope shape, tapering down to the proximal end of the scoop shape can facilitate folding of the balloon as it is retracted into the lumen of tube 44.
  • The scooped tip 44 t can be provided on a guide device 12 that does not include an endoscope channel, as illustrated above with regard to FIG. 9B. Further the advantages discussed above can also be provided to a guide device 12 that does include a channel 28 integrated therewith. The channel 28 may be fixed relative to tube 44 and may be removably fixed, as described previously. FIG. 10A illustrates an example of guide device 12 having a fixed channel 28 that extends so that the distal end of channel 28 is substantially flush with the distal end of scooped tip 44 t. Although this arrangement is not preferred as it is preferred to provide a setback, even with this arrangement, the reduced cross-sectional profile at the end of scooped tip 44 t compensates, or helps to compensate for the additional cross-section profile of the end of channel 28. That is, the cross sectional dimension 12×1 is less than the cross-sectional dimension 12×2 measured across the distal ends of tubes 44 and 28 when tube 44 has a circular profile distal end as shown in FIG. 10B.
  • An even greater advantage in reducing the distal end profile of a device 12 having both tube 44 and channel 28 can be obtained by orienting the distal end of channel 28 with a setback 53 as described above and as illustrated in FIGS. 10C and 10D. Regardless of whether the bend in the tube 44 and channel 28 is an acute angle or an obtuse angle (or right angle), the distal end cross-sectional dimension 12×1 is greatly reduced relative to 12×2 in FIG. 10B, and even the cross-sectional dimension 12×3 that includes the profile of channel 28, but is set back from the distal end of device 12, is reduced relative to 12×2.
  • Optional Linkage of Endoscope to Working Device
  • In some applications, it may be desirable to advance the flexible endoscope 30 out of and beyond the distal end of the endoscope channel 28, 28 d, and even beyond the distal end of tube 44. For example, as shown in FIG. 11, the endoscope 30 may sometimes be advanced along side a working device, such as a guidewire 110, so as to view the advancement, positioning and/or use of the working device. In such instances, it is desirable to prevent the endoscope from diverging away from the working device and/or to maintain the endoscope 30 at a specific spaced distance away from the working device. To accomplish this, an optional linkage device 62 may be used to link (e.g., couple, connect or attach) the endoscope 30 to the guidewire 110 or other working device. Other working devices that may be inserted through tube 44, and optionally linked to endoscope 30 via linkage device 62, include, but are not limited to: graspers, catheters, instrument or other device useable to perform or facilitate a therapeutic or diagnostic task such as local or regional drug delivery, biopsy, suction, irrigation, polyp removal, fungal ball removal or other mass removal.
  • Operation and Positioning of the Endoscope and Working Device
  • As noted, the flexible fiber endoscope 30 may be freely advanced to or beyond the end of the sinus guide 12 and retracted during use, in order to facilitate endoscopic viewing of the desired anatomical structures and/or to view, guide and/or verify the positioning of the sinus guide device 12 or a working device that has been inserted through the sinus guide. The ability to advance the tip of the flexible fiber endoscope 30 beyond the end of the sinus guide allows the tip to be positioned closer to anatomy or to reach spaces in the paranasal sinuses that the sinus guide tip cannot travel to due to size constraints.
  • In some instances, it may be desired to advance a guidewire 110 into or through a specific body opening, such as an opening of a paranasal sinus. In such applications, as shown in FIG. 12, it is sometimes desirable to form a bend in the guidewire 110 near its distal end DE so that rotation of the guidewire in situ will redirect its distal end DE. The guidewire may be maneuvered into the opening by simply rotating the guidewire 110. FIGS. 13A and 13B show an example of such a procedure, wherein the guide device 12 is advanced to a position where its distal end is a spaced distance D from the opening O into which the guidewire 110 is to be inserted. In some instances, the user may use fluoroscopy and/or a surgical navigation system to position the guide device as described in previous applications to which this application claims priority and which have been incorporated herein by reference. With the guide device 12 so positioned, an endoscope inserted through the endoscope channel 28 may be used to view the distal end DE of the guidewire 110 as it advances out of the distal end of the sinus guide body tube 44. With the flexible endoscope 30 so positioned, the user has a view generally along the same axis as the distal opening of the guide device, rather than the proximal axis of the guide device. Furthermore the view can be from behind anatomy that normally would block a conventional endoscope view. In FIG. 13A, the view provided by the endoscope allows the operator to see that the distal end of the guidewire 110 is not directed into the opening O. As a result, the operator may rotate the guidewire 110 causing its distal end DE to be directed into the opening O as verified by the view provided from the endoscope. Thus, in these sorts of applications, it is desirable to place the distal end of the sinus guide device 12 at a spaced distance D back from the opening O rather than advancing it to a point where the distal end of the sinus guide body is immediately adjacent to or within the opening O. In an alternative embodiment, the guidewire can be an illuminating guidewire as described in co-pending application Ser. Nos. 11/522,497 and 11/647,530, or as described herein.
  • Use of Flexible Endoscope with Intra-Sinus Procedures
  • Many current FESS procedures are performed to open sinus ostia. Also, balloon dilatation of sinus ostia can be performed in a balloon sinuplasty procedure, embodiments of which have been discussed previously in co-pending applications incorporated by reference herein. The flexible endoscopes described herein can be utilized, with or without guide device 12 to facilitate direct visualization of such procedures.
  • However, until now, the number of procedures performed inside a sinus cavity have been limited, due to challenges with visualizing such procedures, since direct visualization was not possible, due to the prohibitive profile sizes and rigidity of endoscopes conventionally used in the procedures. The current invention provides flexible endoscopes 30 as small as about one mm outside diameter and may be semi-rigid. This small outside diameter of endoscope 30 permits it to be inserted through an ostium either pre- or post-dilation of the ostium to provide direct visualization inside the sinus cavity. This visualization capability may therefore facilitate direct viewing of intra-sinus therapies, treatments and procedures.
  • FIG. 14 illustrates an example of a procedure in which sinus guide device 12 has been introduced through a nostril 2 of a patient 1 and through a nasal cavity to a location close to an ostium 1014 of a sinus 1016. Endoscope 30 may be used in a position where the distal tip of the endoscope is flush with the opening 28 d of channel 28, extends distally beyond distal end 28 d, but not distally beyond the distal end of tube 44, or slightly distally beyond the distal end of tube 44 to provide direct visualization of a procedure to dilate the ostium 1014, for example. In some cases, intra-sinus procedures may be commenced without dilating the ostium 1014. Accordingly, either without dilatation of the ostium 1014, or before of after dilatation of ostium 1014, endoscope 30 is further distally advanced through the ostium to position the distal viewing tip of the endoscope within the sinus 1016, as shown in FIG. 14. A variety of therapies may be delivered into the sinus with direct visualization thereof provided by endoscope 30 positioned in the sinus 1016, including, but not limited to: local or regional drug delivery, biopsy, suction, irrigation, polyp removal, fungal ball removal and/or removal of other mass. Endoscope 30, when positioned in a sinus 1016 may also be useful for intra-sinus diagnosis to assess an underlying disease, to evaluate ciliary function by viewing transport of a dyed fluid, or other diagnostic procedure. These therapeutic and diagnostic procedures may additionally be facilitated by insertion of one or more tools, instrument or devices through the lumen of tube 44 to deliver a working end portion of the tool, device or instrument through the ostium 1014 and into the sinus 1016. A variety of tools, instruments or devices may be inserted through tube 44, including, but not limited to: graspers, cutters, punches, flexible microdebriders, dissectors, electrodes for energy delivery (RF, heat, cryotherapy, ultrasound, or microwave), lasers, suction catheters, irrigation catheters, balloon catheters, etc.
  • FIG. 15 illustrates an intra-sinus procedural step in which endoscope 30 has been positioned intra-sinuously, in sinus 1016 in a manner as described above with regard to FIG. 12. Additionally a flexible graspers instrument 1007 has been inserted through a lumen of tube 44 and advanced to deliver the distal, working end into the sinus 1016. By viewing the working end of the graspers 1007 through endoscope 30, and operator can advance the working end and operate the grasping jaws 1007 j to approach a mass 1016 m in the sinus that is desired to be removed position the jaws 1007 around the mass 1016 m or a portion thereof and clamp the jaws to capture the mass 1016 m or a portion thereof. By then retracting tool 1007, the mass 1016 m or a portion thereof that has been captured by jaws 1007 j can be withdrawn through ostium 1014, with visualization of all of these steps being facilitated through endoscope 30. The mass 1007 j or a portion thereof having been captured and torn away or otherwise removed from the sinus 1016 and through ostium 1014 is then withdrawn through tube 44. Alternatively, viewing of retraction of the mass into the tube 44 can be performed by retracting the distal end of endoscope 30 to a location just proximal of ostium 1014 or just proximal of the distal end of tube 44. Further alternatively, if the mass 1016 m is too large to be retracted through tube 44, device 12 can be removed simultaneously with the removal of tool 1007 and the mass 1016 m.
  • It is noted that FIG. 15 is only one example of procedures that can be performed intra-sinuously and that the present invention is by no means limited to this procedure, as many other procedures can be performed, some examples of which were listed above.
  • FIG. 16 illustrates an alternative procedure in which endoscope 30 is inserted through a lumen of a tool, device or instrument having been inserted through tube 44 of guide device 12 and into a sinus cavity 1016. In the example shown, endoscope 30 has been inserted through the lumen of an irrigation catheter 330. Note also that device 12 may include an integrated endoscope channel 28, but need not, since endoscope is delivered through the same lumen in tube 44 that the working tool is delivered through. In the example shown in FIG. 16, device 12 does not include an endoscope channel 28. It is further noted that this technique is not limited to insertion of endoscope 30 through an irrigation catheter, as endoscope 30 may be similarly inserted through any other tool, instrument or device having been inserted through tube 44 and which has a lumen with a sufficient inside diameter to allow endoscope 30 to pass therethrough. Also, although reference here is made to the tool, instrument or device having a distal end portion inserted into a sinus cavity 1016, endoscope 30 may be used similarly to view locations outside of an ostium 1014, when the distal end of the tool, instrument or device ahs not been inserted through the ostium, or to view some other cavity or space, for example.
  • In the example shown, an irrigation procedure is first performed in the sinus 1016 prior to insertion of endoscope 30 into the lumen of the irrigation catheter 330. In this particular example, irrigation catheter has a lumen having a diameter of about 0.050″ and endoscope 30 has an outside diameter of about 0.0375″. Accordingly, after performing irrigation with the distal end of irrigation catheter 330 in the sinus 16, endoscope 30 is inserted through the lumen of the irrigation catheter 330 and advanced to deliver the distal (viewing) tip into the sinus cavity 1016, as shown. The user can then view through endoscope 30 to confirm whether the sinus 1016 has been cleaned out sufficiently by the irrigation process, and/or to inspect the sinus for other potential issues or ailments that might be addressed.
  • Illuminating Guidewire
  • FIGS. 17A through 17D are illustrations of partial sagittal sectional views through a human head showing various steps of one embodiment of a method of gaining access to a paranasal sinus using a sinus guide 12. In FIG. 17A, a first introducing device in the form of a sinus guide 12 is introduced through a nostril and through a nasal cavity 1012 to a location close to an ostium 1014 of a sphenoid sinus 1016. Sinus guide 12 may be straight, malleable, or it may incorporate one or more preformed curves or bends as further described above, as well as in U.S. Patent Publication Nos. 2006/004323; 2006/0063973; and 2006/0095066, for example, each of which are incorporated herein, in their entireties, by reference thereto. In embodiments where sinus guide 12 is curved or bent, the deflection angle of the curve or bend may be in the range of up to about 135 degrees.
  • In FIG. 17B, a second introduction device comprising a guidewire 110 is introduced through the first introduction device (i.e., sinus guide 12) and advanced so that the distal end portion of guidewire 110 enters the sphenoid sinus 1016 through the ostium 1014.
  • In FIG. 17C, a working device 1006, for example a balloon catheter 100, is introduced over guidewire 110 and advanced to extend the distal end portion of device 1006, 100 into the sphenoid sinus 1016. Thereafter, in FIG. 17D, working device 1006, 100 is used to perform a diagnostic or therapeutic procedure. In this particular example, the procedure is dilatation of the sphenoid sinus ostium 1014, as is illustrated in FIG. 17D, where the balloon of device 1006 is expanded to enlarge the opening of the ostium 1014. After completion of the procedure, sinus guide 12, guidewire 110 and working device 1006, 100 are withdrawn and removed. It will be appreciated that the present invention may also be used to dilate or modify any sinus ostium or other man-made or naturally occurring anatomical opening or passageway within the nose, paranasal sinuses, nasopharynx or adjacent areas. As will also be appreciated by those of ordinary skill in the art, in this or any of the procedures described in this patent application, the operator may additionally advance other types of catheters, and that guidewire 110 may be steerable (e.g. torquable, actively deformable) or shapeable or malleable.
  • FIGS. 17B-17D show endoscope 30 having been inserted through channel 28 to provide visualization of advancement of sinus guide 12 and/or inserted alongside sinus guide 12 to provide visualization of all or at least a portion of working tool 1006, 100. It is to be appreciated that scope 30 may comprise any suitable types of rigid or flexible endoscope and such optional scope may be separate from or incorporated into the working devices and/or introduction devices of the present invention, as further described herein. In one preferred embodiment, endoscope 30 is a flexible fiber endoscope 30 as described herein.
  • In cases where a scope 30 provided is not capable of being inserted into a particular sinus cavity of interest, or to extend the view of endoscope or otherwise assist visualization through the endoscope, and/or to provide visualization for guiding guidewire 110 into the sinus cavity either prior to insertion of endoscope in the cavity or where endoscope 30 is incapable of being inserted into that particular cavity, an illumination guidewire 110 may be utilized to enhance visualization.
  • Further, depending upon the particular configuration of the sinus passageways to be traversed to gain access to a target ostium, the scope 30, due to physical limitations (e.g., outside diameter, degree of rigidity, etc.) may be unable to visualize as deep as the location of the ostium of interest. For example, FIG. 18 illustrates a situation where scope 30 has been inserted as far as possible without causing significant trauma to the patient. The range of adequately illuminated visibility in this case does not extend all the way to ostium 1020, as indicated schematically by the rays 1009 shown extending distally from scope 30. In this case, adequately illuminated visualization of guidewire 110 into ostium 1020 would not be possible via scope 30. Additionally, if sinus guide 12 is physically capable of being extended further distally to place the distal end thereof at the approach to ostium 1020, scope 30 would also not be capable of adequately visualizing this. Thus, prior to the provision of an illuminated guidewire 110 as described herein, fluoroscopic or other x-ray visualization of these procedures was required, in order to ensure that the devices approach (and extend through) the appropriate ostium 1020 and not another adjacent opening, such as opening 1024.
  • In order to overcome these and other problems, the guidewire devices 110 of the present invention include their own light emitting capability. By illuminating a distal end portion of guidewire 110, a process known as transillumination occurs as guidewire 110 traverses through the sinus passageways, passes through an ostium and enters a sinus cavity. Transillumination refers to the passing of light through the walls of a body part or organ. Thus, when guidewire 110 is located in a sinus, the light emitted from guidewire 110 passes through the facial structures and appears as a glowing region on the skin (e.g., face) of the patient. It is noted that the light emitted from scope 30, such as positioned in FIG. 18, for example, results in transillumination as well, but the resultant glow is much more diffuse and larger in area. As the light source in guidewire 110 gets closer to the surface of the structure that it is inserted into (e.g., the surface of the sinus), the transillumination effect becomes brighter and more focused (i.e., smaller in area). Additionally, the movements of the guidewire 110 can be tracked by following the movements of the transillumination spot produced on the skin of the patient. For example, the light emission portion of illumination guidewire can cause transillumination as guidewire 110 is being manipulated to gain access to an ostium and sinus. By tracking movements of a transillumination spot that moves as the illuminating portion of the guidewire 110 is moved during the manipulation, this can provide feedback to the user about steering an positioning and whether or not they are successful in entering through the ostium and into the sinus of interest. For example, transillumination may be visible on the bridge of the nose when gaining access to the frontal sinus. If the user positions the illuminating guidewire 110 medially, transillumination may show in the medial aspect. As the user looks for the frontal recess, he may then move the illuminating guidewire 110 laterally. Transillumination can then confirm that the distal end portion of the guidewire has indeed been moved laterally, as the user tracks the lateral movement of the illumination spot.
  • FIG. 19 shows an illuminating guidewire 110 according to one embodiment of the present invention. Device 110 includes a flexible distal end portion 110 d that provides a similar degree of flexibility to a standard, non-illuminating type of guidewire. Distal end portion 110 d may include a coil 110 c as an exterior portion thereof, to help provide the desired flexibility to this portion. The proximal end portion 110 p of device 110 extends the device to provide a sufficient length so that device 110 extends proximally out of the patient (and, when inserted through another device, such as a sinus guide 12, proximally out of the device into which guidewire 110 is inserted), at all times, including the deepest location into which the distal end of device 110 is placed. The proximal end portion 110 p can have visible markings, preferably spaced at equal intervals, that can be observed by the user to confirm how far the guidewire 110 has been placed in the patient. Proximal end portion 110 p also provides the necessary mechanical properties required to make the guidewire function properly. These mechanical properties include torquability, i.e., the ability to torque the proximal end portion 110 p from a location outside of the patient and have that torque transmitted to the distal end portion 110 p; pushability, i.e., sufficient rigidity, so that when an operator pushes on the proximal end portion 110 p from a location outside of the patient, the pushing force transmits to the distal portion 110 d to advance the distal portion 110 p without buckling the device 10; and tensile strength so that an operator can pull on the proximal end portion 110 p from a location outside of the patient and withdraw device 10 from the patient without significant plastic deformation or any disintegration of the device.
  • Coil 110 c may be formed from a stainless steel wire, for example. The diameter of the coil wire can be between about 0.004 and about 0.008 inches, typically about 0.006 inches. In one particular embodiment, coil 110 c is made of stainless steel wire having a diameter of about 0.006 inches, coiled into a coil having an outside diameter of about 0.033 inches. Use of wire having a larger diameter provides added strength to the coil, but at the same time requires a larger outside diameter coil, which makes the overall device 10 more difficult to advance through small openings, but also allows more space in the inside diameter of the coil. Alternative materials from which coil 110 c may be formed include, but are not limited to: ELGILOY®, CONICHROME® or other biocompatible cobalt-chromium-nickel alloy; nickel-titanium alloys, or other known biocompatible metal alloys having similar characteristics. Further alternatively, distal end portion may comprise a braided metallic construction of any of the aforementioned materials in lieu of a coil.
  • The external casing of the proximal portion 110 p can be made from a polyimide sheath, a continuous coil (optionally embedded in polymer or having polymer laminated thereon), a hypotube (e.g., stainless steel hypotube), a laser-cut hypotube, a cable tube, or a tube made from PEBAX® (nylon resin) or other medical grade resin. In any of these cases the construction needs to meet the required torquability, pushability and tensile requirements of the device.
  • In the example shown, coil 110 c is joined to proximal portion 110 p by solder, epoxy or other adhesive or mechanical joint. One or more illumination channels 110 i are provided in device 110 and extend the length thereof. Illumination channels 110 i are configured to transport light from the proximal end of device 110 to and out of the distal end of device 110. In the example shown, two illumination channels are provided, each comprising a plastic illumination fiber. The plastic used to make the illumination fibers is compounded for light transmission properties according to techniques known and available in the art. As one example, ESKA™ (Mitsubishi Rayon), a high performance plastic optical fiber may be used, which has a concentric double-layer structure with high-purity polymethyl methacrylate (PMMA) core and a thin layer of specially selected transparent fluorine polymer cladding. In one example, illumination fibers each have an outside diameter of about 0.010″. In one example, two acrylic light fibers each having an outside diameter of about 0.10″ are used. The illumination fibers can have an outside diameter in the range of about 0.005 inches to about 0.010 inches. Alternatively, a single plastic illumination fiber 110 i may be used that has an outside diameter of about 0.020″. As another alternative, a single light fiber having an outside diameter of about 0.010″ can be used. This provides additional internal space for other components, but halves the light output compared to embodiments using two 0.010″ fibers. FIG. 20 illustrates another alternative, in which a single, semi-cylindrical light (illumination) fiber is used, wherein the diameter 109 is about 0.020″. This half-round or semi-cylindrical fiber frees up additional internal space in the device, relative to use of two cylindrical fibers of 0.010″ each, and provide about the same illumination output. However, these fibers are expensive and time consuming to manufacture. Other illumination fibers 10 having custom-shaped cross sections may be alternatively used, but again may be expensive and difficult to manufacture. Further alternatively, glass illumination fibers may be substituted which are much smaller in outside diameter, e.g., about 0.002″. In this case, more illumination fibers may be provided in a bundle, e.g., about six to fifty glass fibers 110 i may be provided.
  • The distal end of device 110 is sealed by a transparent (or translucent) seal 110 s which may be in the form of epoxy or other transparent or translucent adhesive or sealing material, which may also function as a lens. For example, seal 110 s may be formed of a translucent, ultra-violet curing adhesive to form a distal lens of the guidewire 110. Alternatively, other translucent or transparent and biocompatible adhesives or epoxies may be substituted. Seal 110 s maintains the distal ends of illumination fibers 110 i coincident with the distal end of device 110 and also provides an atraumatic tip of the device 110. Further, seal 110 s prevents entrance of foreign materials into the device. The distal end can be designed to either focus or distribute the light as it emanates therefrom, to achieve maximum transillumination effects. In this regard, the distal end can include a lens, prism or diffracting element.
  • The proximal end of device 110 is also sealed by a transparent (or translucent) seal 110 ps which may be in the form of epoxy or other transparent or translucent adhesive or sealing material. Seal 110 ps maintains the proximal ends of illumination fibers 110 i coincident with the proximal end of device 110. The proximal end of device 110 may be further prepared by grinding and polishing to improve the optical properties at the interface of the proximal end of device 110 with a light source. The illumination fibers 110 i at locations intermediate of the proximal and distal ends need not be, and typically are not fixed, since no mapping of these fibers is required, as device 110 provides only illumination, not a visualization function like that provided by an endoscope. Further, by leaving illumination fibers free to move at locations between the proximal and distal ends, this increases the overall flexibility and bendability of device 110 relative to a similar arrangement, but where the illumination fibers 110 i are internally fixed.
  • The outside diameter of device 110 may be in the range of about 0.025 inches to about 0.040 inches, typically about 0.030 to 0.038 inches, and in at least one embodiment, is about 0.035″±0.005″. At least the distal portion 110 p of device 110 is provided with a core support 110 cw that is contained therein. In the example shown in FIG. 19, core support 110 cw is a wire that is fixed to proximal section 110 p such as by laser welding, epoxy or other adhesive or mechanical fixture. Core support 110 cw may extend substantially the full length of device 110. In any case, core support 110 cw is typically formed from stainless steel NITINOL (nickel-titanium alloy) or other biocompatible nickel-titanium alloys, cobalt-chromium alloys, or other metal alloys that are biocompatible and provide the necessary rigidity and torquability. Core support 110 cw may be formed as a wire, as in the example shown in FIG. 19, or alternatively, may be braided from any of the same materials or combination of materials mentioned above. Core support 110 cw, when formed as a wire can be ground to different diameters to provide varying amounts of rigidity and torquability. When formed as a braid, the braid can be formed to have varying amounts of rigidity and torquability along the length thereof. For example, core wire 110 cw has a larger outside diameter at the proximal end portion than at the distal end portion so that it is more rigid and transfers more torque from the proximal portion of device 110, whereas at the distal end portion, core 110 cw is relatively more flexible and twistable. For core supports 110 cw that extend through proximal portion 110 p, the portion of core support near the proximal end of device 110 may have an even larger outside diameter.
  • In at least one embodiment, two core supports 110 cw are provided in guidewire 110. FIGS. 21A-21B illustrate an embodiment of the first and second core supports, respectively. In FIG. 21A, core support 110 cw may be formed from a nickel titanium alloy core wire having a diameter of about 0.008″, although a similar configuration can be made starting with a core wire of different material and/or different diameter. A proximal portion 1130 p of core support 110 cw is maintained as the full wire profile having the diameter of 0.008″. An intermediate section 1130 i is ground down to a 0.006″ diameter for greater flexibility in a distal end portion of the guidewire 110. The distal end portion 1130 d is flattened, which facilitates soldering core support 110 cw to coil 110 c. The length of flattened section 1130 d is maintained small, e.g., about 0.8 cm to prevent guidewire whipping. Alternatively, flattened section 1130 d may be eliminated altogether with the reduced diameter round cross section 1130 i extending to the distal end of core support 110 cw. The length of the section 1130 i (whether or not flattened section 1130 d is employed) may be varied to customize the length of a flexible distal end portion of guidewire 110.
  • In FIG. 21B, core support 110 cw that may be formed from a nickel titanium alloy core wire having a diameter of about 0.006″, although a similar configuration can be made starting with a core wire of different material and/or different diameter. Proximal portion 1130 p of core support 110 cw is maintained as the full wire profile having the diameter of 0.006″. A distal end portion 1130 d is flattened, which facilitates soldering core support 110 cw to coil 110 c and provides flexibility at the tip of the guidewire 110 for atraumatic interaction with tissue. The length of flattened section 1130 d can be about two centimeters, for example.
  • Alternative to the use of two core supports 110 cw, a single core support may be used, as already noted above with regard to FIG. 19. Further alternatively, such a single core support 110 cw can be made from an oval-shaped or elliptical-shaped (in cross-section) core wire if enough space is available, which may be made available by eliminating one of the illumination fibers 110 i, for example. FIG. 22A shows an example of a core support 110 cw formed from an oval wire and FIG. 22B illustrates a proximal end view of core support 110 cw, showing the oval profile at the proximal end of core support 110 cw. Proximal portion 1130 p of core support 110 cw is maintained as the full wire profile having the oval-shaped cross-section, wherein the height 1130 h of the wire is about 0.015″ and the width 1130 w of the wire is about 0.010″, see FIG. 22B. Intermediate section 1130 i is ground down to a round cross-section having a diameter of about 0.010″ for greater flexibility in a distal end portion of the guidewire 110. Distal end portion 1130 d is flattened, and may have a length of about 0.8 cm to about 1.2 cm, for example, typically about 1 cm, which facilitates soldering core support 110 cw to coil 110 c. The length of flattened section 1130 d is maintained small, e.g., about 0.8 cm to prevent guidewire whipping. Alternatively, flattened section 1130 d may be eliminated altogether with the reduced diameter round cross section 1130 i extending to the distal end of core support 110 cw. The length of the section 1130 i (whether or not flattened section 1130 d is employed) may be varied to customize the length of a flexible distal end portion of guidewire 110. The dimensions of the oval or elliptical cross section may be varied depending upon the amount of space available inside coil 110 c, accounting for all other components to be contained therein, as well as performance characteristics (e.g., flexibility, stiffness, torquability, etc) desired.
  • Coil 110 c may be overlaminated, such as by melting nylon (or other polymer, such as PEBAX, GRILLAMID (nylon resin), or other medical grade resin) into open-pitched areas of the coil 110 c to fill in these areas. The overlamination material increases the steerability of guidewire 110, increases torquability of guidewire 110 and provides an area that can be easily gripped by the user.
  • FIGS. 23A-31 are now referred to in describing manufacturing steps that may be carried out during the manufacture of certain embodiments of illuminating guidewire 110. In these embodiments, coil 110 c extends over substantially the entire length of guidewire 110 and at least one of core supports 10 cw extends into a proximal portion of guidewire 110. In FIG. 23A, a distal portion of coil 110 c is stretched to break tension between adjacent coils and to form an open-pitch portion 110 co of coil 110 c. Next, two mandrels 1132 (which may be coated with a lubricious material such as polytetrafluoroethylene, or the like), having dimensions about the same as illumination fibers 110 i that will later replace them, are inserted into coil 110 c, as illustrated in the longitudinal sectional schematic of FIG. 23B. The core support 10 cw having the smaller cross-sectional proximal portion dimension (e.g., core support 10 cw formed from a 0.006″ core wire, as described with regard to FIG. 21B above), referred to here as the “first core support” 10 cw, is inserted into the coil 110 c such that a distal end of distal portion 1130 d is set back proximally from a distal end of coil 10 c by a predetermined distance. In one example, this predetermined distance is about seven cm. In another example this predetermined distance is about nine cm. However, this predetermined distance may be varied depending upon the desired performance characteristics of the distal end portion of illuminating guidewire 110. By decreasing the predetermined distance, this increases the stiffness, or moves the stiff section more distal on the distal end portion of the guidewire 110. Increasing the predetermined distance moves the stiff section more proximal and leaves a greater flexible length at the distal end portion of the guidewire 110.
  • A third mandrel 1132, which may be made the same as the above-described mandrels 1132, but which has dimensions to occupy a space that will later be occupied by the second core support 10 cw, is inserted, which appears as the bottom mandrel 1132 shown in FIG. 23B. FIG. 23C shows a cross-sectional view of this arrangement, with the bottom mandrel 1132 being the mandrel that occupies the space that will be later filled by the second core support 10 cw, and the other two mandrels 1132 occupying the spaces that will be later filled by illumination fibers 110 i. The distal end 1130 d of the core support 10 cw may then be soldered to coil 110 c.
  • In cases such as this, where coil 110 c is stainless steel and core support is made of a nickel-titanium alloy, oxide on the nickel-titanium material, in regions to be soldered can be removed, prior to soldering, to improve solder joint strength. This removal can be accomplished using a highly acidic flux. For example, a phosphoric acid-based flux (about 65% to about 75%, by weight, phosphoric acid) was found to achieve satisfactory removal of the oxide. To further improve the solder joint strength, the regions on the nickel-titanium material that are to be soldered can be manually cleared of oxide, such as by removal using sandpaper or grinding. Further alternatively, or additionally, a chemical etch may be used.
  • One example of a solder used to form the solder joints is a tin/silver eutectic solder (96.5% Sn, 3.5% Ag, 0.5% Cu). This eutectic alloy works well as the solder in this case because strength is desired, and the eutectic alloy has no liquidus/solidus transition range, so the solder joint solidifies all at once, which greatly reduces the chances, making it almost impossible for the joint to be disrupted as it is solidifying.
  • Next, the mandrel 112 occupying the space for the second core support 10 cw is removed and the second core support 10 cw (e.g., core support 10 cw formed from a 0.008″ core wire, as described with regard to FIG. 21A above, referred to here as the “second core support” 10 cw) is inserted into the coil 110 c in the opening left by removal of the mandrel 1132. The first and second core supports 10 cw are then soldered to coil 10 c at multiple locations over the length of the core supports. In one particular example, soldering of the second core support 10 cw includes a distal-most solder joint made about two to about five coils back from a distal end of coil 110 c, a second solder joint is made about two cm distal of the location along coil 10 c where the distal solder joint for the first core support 10 cw was made, a third solder joint is made proximal of the distal solder joint of the first core support, but distal of the transition between the open-pitch coil section 110 co and the remainder of the coil 110 c (closed-pitch section), a fourth solder joint is made proximal of the open-pitch coil section 110 co, and a fifth solder joint is made at the proximal end of coil 110 c. The third, fourth and fifth solder joint locations join both of the core supports 10 cw to the coil 10 c for added strength and rigidity.
  • By making solder joint for the distal end of the first core support 10 cw and the second solder joint of the second core support 10 cw at locations on coil 10 c that are at unequal locations along the longitudinal dimension of coil 110 c, this allows the core supports 10 cw to slide independently of each other during bending of the distal end portion of the illumination guidewire 110. For example, FIGS. 24A and 24B illustrate this independent sliding capability. As shown, the distal end solder joint 1136 of the smaller core support 10 cw (core support 10 cw formed from the 0.006″ wire described in the example above) is illustrated at the bottom of coil 110 c, the solder joint 1134 just distal of solder joint 1136 made between the second core support 10 cw and coil 110 c is shown at the top side of the illustration, and both core supports 10 cw are soldered to coil 10 c at a location distal of the transition between the open-pitch coil section 110 co and the closed-pitch section, in this case, about sixteen cm from the distal end of coil 110 c. FIG. 24A shows the relative positions of the solder joints when coil is in a straight configuration. FIG. 24B shows coil 110 c in a bent configuration, and illustrates the ability of the core supports 10 cw to slide independently of one another, as it can be observed that the solder joints 1134 and 1136 have moved closer together, as compared to the space between these joints shown in FIG. 24A when coil 110 c is straight. Thus, when bending toward the first core support 10 cw, the first core support 10 cw is allowed to slide distally I relation to the second core support 10 cw at the bend, because the cores are located together (same longitudinal fix point) at solder joints 1138, and the first core support 10 cw does not extend all the way to the distal end of the coil 110 c. If the solder joints 1134 and 1136 of the two core supports 10 cw were soldered at the same longitudinal location, this would make the arrangement much stiffer and less flexible in this region. This would also result in greater amounts of “whip” upon torquing the device.
  • By soldering the core supports 10 cw at locations 1134 and 1136 as shown in FIGS. 24A-24B and described above, the coils of coil 110 c are prevented from substantial separation even when coil 110 c is bent. This greatly increases the stiffness of guidewire 110/coil 110 c in a segment between the solder joints 1134 and 1138, but still allows a distal section (distal of joint 1134 to the distal solder joint of the second core support 110 cw) to remain floppy. Alternatively, to further increase the stiffness of the region between joints 1134 and 1138, the coils between joints 1134 and 1138 or between 1136 and 1138, or between 1134 and 1136 can be placed under compression during the soldering of the joints.
  • Further alternative soldering arrangements include, but are not limited to: soldering both core supports 10 cw at the distal end of coil 110 c. This increases the distal stiffness of the coil 110 c/guidewire 110 and thus also reduced distal flexibility. This may also greatly increase whipping of the distal end when torquing the illuminating guidewire 110.
  • Further alternatively, the solder locations (locations longitudinally along the coil 110 c) can be varied. For example, by moving joints 1134 and 1136 distally with respect to coil 110 c, but keeping the same separation distance between coils 1134 and 1136, this moves the stiff section between the joints 1134 and 1136 closer to the distal end of guidewire 110, reducing the flexible section at the distal end portion of guidewire 110. Conversely, moving joints 1134 and 1136 proximally with respect to coil 110 c, but keeping the same separation distance between coils 1134 and 1136, moves the stiff section between the joints 1134 and 1136 further from the distal end of guidewire 110, increasing the length of the flexible section at the distal end portion of guidewire 110 and reducing the length of the stiff section.
  • Once core supports 10 cw have been soldered to coil 110 c according to any of the techniques described above, the open-pitch coil section 110 co of coil 110 c can next be laminated. A nylon (or other meltable polymer) tube 1140 is slid over the open-pitched coil section 110 co, as illustrated in FIG. 25, and then a FEP (fluorinated ethylene propylene) heat shrink tube 1142 is slid over the meltable polymer tube 1140. Tubing 1142 is heated until it shrinks down around the coils of the open coil section 110 co and melts the polymer tubing into the spaces between the coils. After cooling, the shrink tubing 1142 is removed.
  • FIGS. 26A-26B illustrate steps that may be performed to install connector 1120 to the proximal end of guidewire 110. These steps may be performed while at least the mandrels 1132 that are to be replaced by illumination fibers 110 i are still inserted through coil 110 c. A heat shrink tube (e.g., FEP heat shrink material) 1140 is shrunk down around a proximal end portion of coil 110 c as illustrated in FIG. 26A which shows a longitudinal sectional view of the heat shrink tubing, and a plan view of coil 110 c and mandrels 1132. The tubing 1142 extends proximally beyond the proximal end of coil 110 c by a predetermined distance, e.g. about two mm. Mandrels 112 act to keep the proximal end of tubing 1142 from shrinking closed during heating.
  • Next, connector 1120 is slid over tubing 1142 so as to substantially align the proximal end of connector 1120 with the proximal end of tubing 1142, as illustrated. Tubing 1142 help to center coil 110 c within the connector 1120 and also functions as a strain relief. Adhesive 1144 can be applied to adhere connector 1120 to tubing 1142. Another shrink tubing 1146 (e.g., polyolefin shrink tubing) is slid over the distal end portion 1120 d of connector 1120 and shrunk down around the distal end portion 1120 d, tubing 1142 and coil 110 c, thereby securing connector 1120 to coil 110 c and also functioning as a strain relief. Connector 1120 may include a rotatable (relative to coil 110) or non-rotatable female luer connector, or rotatable (relative to coil 110) or non-rotatable male luer connector, for example.
  • At this time, the remaining mandrels 1132 can be removed from coil 110 c in preparation for installation of the light (illumination) fibers 110 i. After removal of the mandrels 1132, two light fibers 110 i are installed in their place and extended distally beyond the distal end of coil 110 c. The illumination fibers 110 i are then cut to extend a predetermined distance distally of the distal end of coil 110 c. In one example, this predetermined distance is about 0.5 mm, although this predetermined distance may vary. An adhesive lens 110 s is the formed by applying ultra-violet curable adhesive (or other transparent or translucent adhesive) over the portions of illumination fibers extending distally from the distal end of coil 110 c to completely encapsulate these fiber portions, as shown in FIG. 27. Note that, for simplicity of illustration, core supports have not been shown in the illustration of FIG. 27, however, these would, of course, also be contained within the coil 110 c. Adhesive lens 110 s will typically be formed to have a hemispherical distal surface, as shown, although the curvature and shape of this distal surface can be varied, depending upon the characteristics of light patterns desired to be emitted therefrom. Note that adhesive is also applied so as to spread over at least one coil of the coil 110 c and at least one space between coils. Adhesive lens 110 s is then cured to complete the formation of the adhesive lens 110 s.
  • The same or a similar adhesive can be used to apply to the proximal end portion of coil 110 c and portions of the illumination fibers 110 i in the proximal end 110 ps vicinity, as illustrated in FIG. 28. Adhesive can be applied in amounts enough attach/encapsulate up to about one-half of the proximally exposed portions of illuminating fibers 110 i that extend proximally from the proximal end of coil 110 c. The illumination fibers are then cut substantially flush with the proximal end of connector 1120, as shown in FIG. 28. Optionally, after curing the adhesive, the portion of shrink tubing 1142 extending proximally from the proximal end of coil 110 c, may next be shrunk down around the proximally extending portions of illumination fibers 110 i, for example, to an outside diameter of about 0.022″, to lower the light input into device 110 and allow light input substantially only through the illumination fibers 110 i. Alternatively, and also optionally, a grommet 1148 (shown in phantom) can be inserted over illumination fibers and inside of shrink tubing 1142, with or without subsequent further shrinking of the shrink tubing, to accomplish the same function.
  • Further optionally, the proximally extending portions of light fibers 110 i may be completely encapsulated in adhesive or epoxy, in the same manner as described above with regard to adhesive lens 110 s. This proximal adhesive lens can be configured to function as a lens to direct light into light fibers 110 i, for example, but the adhesive or epoxy used in this instance must be able to withstand heat generated by the light cable when connected to connector 1120 during use.
  • Optionally, illuminating guidewire may be manufacture to have a preset curve or bend in a distal end portion thereof. For example, the larger core support 110 cw in the process described above can be set with a curve or bend to form a resulting bend in the distal end portion of guidewire 110 once constructed. FIG. 29A is a partial view of the core support 110 cw described with regard to FIG. 21A, while still in a straight configuration. FIG. 29B illustrates one method of forming a preset curve in core support 110 cw in which the flatted distal end section 1130 d is bent at an angle of about ninety degrees by bending it around a mandrel 1150. In one example, mandrel 50 had a outside diameter of about 0.05″. By cold working (i.e., plastically deforming) the distal portion about the mandrel 1150 and setting it a about ninety degrees, a curve of about twenty degrees will result in the finished illuminating guidewire device 110 employing this core support in a manner as described above. Alternatively, the nickel-titanium distal end portion 1130 d can be bent in the same manner as shown in FIG. 29B, but rather than cold working, the distal end portion can be heated to it annealing temperature and then bent around the mandrel 1150 and quenched.
  • FIG. 30 illustrates a distal portion of an illuminating guidewire 110 manufactured with a core support have a preset bend from either of the techniques described above with regard to FIGS. 29A-29B. The bend in the distal end portion makes it more steerable, as discussed above and in application Ser. No. 11/647,530.
  • FIG. 31 is a partial view of coil 110 c illustrating two portions of coil 110 c that have been etched 110 e. Etching may be performed over all, or one or more select portions of coil 110 c to lower reflectance of the coil where etched, such as when viewed by endoscopy, for example, and/or to act as a marker band to identify a particular location along the coil 110 c.
  • Illumination guidewire 110 may be externally coated with a silicone coating to reduce friction (add lubricity) between guidewire 110 and the tissues, guides and/or other instruments that it is slid against during use. Other lubricious coatings may be substituted, including, but not limited to: polytetrafluoroethylene, parylene, hydrophilic coatings, any of which may be spray coated or dipped, for example, or may be pre-coated on the wire from which the coil is made by the wire manufacturer, or may be pre-coated on the coil 10 c if the coil is manufactured by an outside source.
  • The illumination fibers 110 i, as noted previously, can be free to move about radially within the device 110. Further, there is no need to center the illumination fibers 110 i with respect to device 110 even at the distal and proximal ends of the device. The plastic or glass illumination fibers 110 i are typically used to transmit light from a light source such as one provided in an operating room for use by endoscopes, e.g., xenon light source, halogen light source, metal halide light source, etc. Alternatively, device 110 may be configured to transmit light from other light sources, such as a laser light source, wherein laser fibers would be substituted for the illumination fibers described above, and extend through device 110 in a fiber optic bundle. The fiber optic bundle, like the illumination fibers 110 i, contributes to stiffness (in both bending and torquing motions) of device 110, thereby enhancing trackability, steering and other torquing. Alternatively, device 110 may employ one or more light emitting diodes used to emit light, as described in more detail in application Ser. No. 11/647,530.
  • A light cable 1032 optically connects connector 1120 with light source 1030 to deliver light from the light source 1030 through connector 1120 and illumination fibers 110 i. The light cable 1032 must transmit enough light to allow the illuminating guidewire 110 to transilluminate the sinuses, but at the same time, not transmit so much light that the light fibers become damaged. Research has shown that very bright light sources 1030 (e.g., 300 Watt Xenon, new bulb) can damage the light fibers 110 i with a light cable surrounding a glass illumination fiber bundle wherein the light cable has a diameter of greater than about 2 mm. One way to concentrate the light coming from light cable 1032 down to a size more nearly matching that needed for the illumination fibers 110 i is to provide a taper (which may be made of glass, for example) 1126 as illustrated in phantom in FIG. 32. For example, taper 1126 may taper the diameter of the incoming light from about 2 mm down to about 1 mm. While the taper 1032 can concentrate or focus the light down, as noted, there are light losses that result in heat generation at the location of the taper 1126.
  • Alternatively, a light cable 1032, in this embodiment, has a connector 1320 at the distal end of light cable 1032 which is provided with a male luer 1322, for connection to the connector 1020 of illumination guidewire 110. The provision of a male luer is non-standard, as most operating room light cables are provided connectors specific to the manufacturer of the light cable, which are often proprietary to that manufacturer and which do not include a luer connector. Accordingly, when the connector 1020 of illuminating guidewire 110 is configured to mate with this male luer 1322, this prevents a standard operating room light cable from accidentally being connected to the guidewire 110. The light fiber bundle in light cable 1032 is sized to provide sufficient illumination through illuminating guidewire 110 to transilluminated the sinuses, but an insufficient amount of light to damage the illumination fibers 110 i. Also, a taper 1026 is not required since the light cable 1032 is sized to substantially match the illumination fibers 110 i, and therefore the heat generation problem caused by tapering does not arise with this embodiment. In one example, the light fiber bundle 1324 has a diameter of about 1 mm.
  • Alternatively, the embodiment shown in FIG. 33 may also be provided with a taper 1126 to further funnel the light from light bundle 1324 down to a smaller diameter, as illustrated in FIG. 34.
  • FIG. 35 shows connector 1320 of light cable 1302 provided with a female luer mated with a male luer of connector 1020 of the illuminating guidewire 110. This arrangement allows the proximal ends of illumination fibers 110 i to be placed flush in abutment with the light bundle 1324 or taper 1126 (as shown) when connector 120 is screwed or snapped onto connector 1320.
  • Any of the devices 110 described herein may optionally include one or more radiopaque markers and/or electromagnetic coils on the tip of the device 110 and/or elsewhere along the device for enhancing visibility by fluoroscopy systems, image guided surgery (IGS) systems, or other visualization systems.
  • FIG. 36 shows an alternative design of device 110 in which light is emitted proximally of the distal end of the device. This configuration may employ any of the various light transmission means described above (e.g., illumination fibers, laser fibers, LED). The proximal portion 110 p may be constructed in any of the manners described above with regard to other embodiments of device 110. The distal portion 110 d includes a transparent proximal end portion 110 dp that mounts over the distal end of proximal end portion 110 p of the device 110. The transparent portion 110 dp permits the illumination emitted from illumination member 110 i or 110 id to pass out of the device 110 at the location of transparent portion 110 dp. The illumination member(s) 110 i or 110 id thus terminate at the proximal end portion 110 dp of the distal end portion of device 110. Distally of this transparent portion 110 dp, the distal portion 110 dd of distal end portion 110 d of device 110 extends as a floppy guidewire leader or tip. This floppy guidewire leader or tip 110 dd may include a coiled section 110 c and may optionally include a core support 110 cw. The light emitted from illumination fibers will disperse naturally through the transparent portion 110 dp. Optionally, a deflector 111, such as a convex mirror (e.g., parabolic or other convex) shape or other reflective surface may be provided distally of illumination fibers/ light emitting portion 110 i, 110 d of device 110 to deflect light rays out of the transparent portion. Additionally, or further alternatively, illumination fibers 110 i may be angled at the distal end portions thereof to direct the emitted light out through the transparent portion.
  • This configuration may be beneficial in further protecting the illumination emitter(s) 110 i from foreign materials inside the body, as well as from trauma that may be induced by bumping the illumination emitter up against structures within the body. Further, a floppy guidewire leader 110 dd of this type may provide more flexibility and maneuverability than a device in which the illumination emitter is located on the distal tip of the device.
  • Transparent portion 110 dp may be provided as a clear plastic or glass integral tube, or may have openings or windows 110 t provided therein (see the partial view of FIG. 37). Further alternatively, transparent portion may be formed by a plurality of struts 110 st circumferentially arranged to interconnect the distal floppy tip 110 dd with the proximal end portion 110 p of device 110 as shown in the partial illustration of FIG. 38. Alternatively members 110 st may be intersecting in a criss-crossing cage like configuration or other cage configuration. In any of these alternative configurations, members 110 st may be transparent, but need not be and could be formed of non-transparent materials, such as metals or opaque plastics, for example.
  • Turning now to FIGS. 39A-39C, illustrations of partial coronal sectional views through a human head showing various steps of a method for inserting an illuminating guidewire 110 into an ostium that opens to a frontal sinus are shown. The methods described here, and all other methods disclosed herein may also comprise a step of cleaning or lavaging anatomy within the nose, paranasal sinus, nasopharynx or nearby structures including but not limited to irrigating and suctioning. The step of cleaning the target anatomy can be performed before and/or after a diagnostic or therapeutic procedure. The methods of the present invention may also include one or more preparatory steps for preparing the nose, paranasal sinus, nasopharynx or nearby structures for the procedure, such as spraying or ravaging with a vasoconstricting agent (e.g., 0.025-0.5% phenylephyrine or Oxymetazoline hydrochloride (Neosynephrine or Afrin) to cause shrinkage of the nasal tissues, an antibacterial agent (e.g., provodine iodine (Betadine), etc. to cleanse the tissues, etc.
  • In FIG. 39A, a first introducing device in the form of a sinus guide 12 is introduced through a nostril and through a nasal cavity 1012 to a location close to an ostium 1034 of a frontal sinus 1036. Sinus guide 12 may be as described previously herein, or as described in the applications incorporated herein by reference. The advancement of sinus guide 12 can be visualized with a scope inserted into the nasal cavity 1012 (e.g., through channel 28, not shown in FIG. 39A) and advanced as close to the ostium 1034 as possible without causing significant trauma to the tissues therein.
  • Once the surgeon is satisfied that the distal end of the sinus guide 12 is positioned close enough to the appropriate ostium 1034, illuminating guidewire 110, connected to a light source as described by any of the techniques mentioned above, is inserted through sinus guide 12 and advanced therethrough, see FIG. 39B. There may be some transillumination from the light emitted from the scope which can be used to confirm that the sinus guide 12 is positioned in the correct general area, which confirmation can be made even before the distal tip of guidewire 110 exits the distal end of sinus guide 12. However, much more specific transillumination effects are produced when the tip of guidewire 110 exits the distal end of guide 12 and especially when the light emitting portion of guidewire 110 touches or approximates an intended target surface, such as an inner wall of a sinus, for example. As the guidewire 110 is advanced, transillumination on the face of the patient can be observed as a glowing spot that moves as the distal end portion of device 110 moves, thereby making it possible to visibly track the location of the light emitting portion of device 110 without the need to use radiographic imaging, such as by fluoroscopy, for example.
  • While there may be some diffuse transillumination on the forehead of the patient overlying the frontal sinus 1036 as the light emitting portion of device 110 approaches the ostium 1034, the glow on the forehead becomes brighter and smaller in dimension (more focused) as the light emitting portion passes through the ostium 1034 and enters the frontal sinus 1036, FIG. 39C. As device 110 is further advanced, the glowing spot becomes most defined and brightest as the light emitting portion approaches and contacts a wall of the frontal sinus 1036. Further, as noted, the movement of the transilluminated spot can be visibly followed to confirm that the guidewire 110 is indeed moving within the location of the frontal sinus, as can be confirmed by the surgeon's knowledge of the particular anatomy of the patient being treated. In this regard, a CAT scan or other image of the sinus anatomy can be performed prior to this procedure and studied by the surgeon, to apprise the surgeon of any distinctive or unusual patterns in the individual patient's sinus anatomy which might be useful in tracking and confirmation of where the guidewire is located, as indicated by the transillumination.
  • Illuminating guidewire device 110 can also be used to facilitate visualization and placement of the sinus guide 12 in the procedure described above with regard to FIGS. 39A-39C, or in another procedure in which a sinus guide, sinus guide or guide tube is placed in the sinus pathways. FIG. 40 illustrates a situation where scope 30 has been inserted as far as possible without causing significant trauma to the patient. The range of visibility in this case does not extend all the way to ostium 1034, as indicated schematically by the rays 1009 shown extending distally from scope 30. By inserting illuminating guidewire 110 through sinus guide 12 (tube 44) as shown in FIG. 30, additional illumination can be provided distally of the illuminating range of scope 30. This additional illumination can be received by scope 30 to enable visualization up to the illumination portion of device 110 and potentially even extending to illumination range of device 110, as long as there is a straight pathway of the field of view. Thus, placement of the guidewire 110 can be visualized up to and into the desired ostium 1034 via scope 30 in this case. Alternatively, this can be carried out without the sinus guide 12, wherein the guidewire 110 is inserted and the scope 30 can be used to visualize placement of guidewire 110 into the target ostium with the assistance of the light emitted by the scope 30 in addition to the light emitted by guidewire 110.
  • In any of these procedures where a scope 30 is used for visualization and an illuminating guidewire 110 is inserted, some transillumination of the target sinus may occur from the light emitted by the scope 30 alone. However, this transillumination will be diffuse and show a rather dim, large area of transillumination on the patient's skin. When the illumination guidewire 110 is inserted and advanced, as noted earlier, a smaller, brighter transillumination spot will be visible when the illuminating portion of the guidewire has entered the sinus. Additionally, even before entering the sinus, the light emitted from the guidewire 110 will produce a moving transillumination spot as guidewire 110 is advanced, which also helps distinguish the location of the distal portion of the guidewire 110, relative to any diffuse transillumination produced by the scope light.
  • If the guidewire 110 is advanced into an ostium other than the target ostium (e.g., ostium 1035 shown in FIG. 40), this may be possible to be viewed by scope 30, depending upon the line of sight. However, even if it is not, the transillumination resulting from entrance into a different sinus than the target sinus will be evident by the different location on the patient's face. Also, in the example shown, guidewire 110 would not be able to be advanced very far through ostium 135 before it was diverted and curled by the relatively small sinus space that ostium 135 leads into. Thus, by tracking the movement of the illumination spot produced by guidewire 110, the surgeon could confirm that guidewire 110 was misplaced as the guidewire would be diverted by a much smaller space then that characterized by the target frontal sinus 1036.
  • Thus, by using an illuminating guidewire device 110 in the methods as described above, the use of fluoroscopy or other X-ray visualization can be reduced as it is not required to confirm proper placement of the guidewire in some cases.
  • Guide Systems with Removable Endoscope/Guidewire Sheaths
  • FIGS. 41-43 show additional embodiments of transnasally insertable guide systems useable to position an endoscope 30 at a desired location within the ear, nose, throat or cranium of a human or animal subject, to view anatomy for diagnostic purposes or for confirmation that a procedure has been successfully accomplished. In FIG. 41, guide device 12 includes a single tube 28 having a lumen sized to receive endoscope 30. Guide 12 may be preshaped to be straight or curved, or may be configured to be deflectable or steerable.
  • FIGS. 42-43 illustrate a guide system comprising a straight or curved transnasal sinus guide 12 and a sheath 90 that is insertable through the sinus guide 12. The sheath 90 has a single lumen sized and configured to receive endoscope 30 therethrough. Thus, endoscope 30 may be inserted through sheath 90 to extend distally of the distal end of guide 12, as illustrated in the partial view of FIG. 43, to view anatomy or visually verify the results of a procedure, for example. Examples of transnasal sinus guides 12 useable in this system include those described in U.S. patent application Ser. No. 11/193,020 and herein, as well as those currently available commercially as Relieva™ Sinus Guide Catheters from Acclarent, Inc., Menlo Park, Calif.
  • Sheath 90, illustrated in FIG. 42, an elongate flexible shaft 92 through which the endoscope lumen 85 extends. A proximal hub 94 may be provided with having two arms 96, 98, and is mounted on the proximal end of the flexible shaft 92. Arm 96 leads into the endoscope lumen 85 and arm 98 also leads to the endoscope lumen 85 and can be used, for example to attach a suction or irrigation source thereto. Alternatively, hub 94 may be provide with only a single arm 96.
  • It is to be appreciated that the invention has been described hereabove with reference to certain examples or embodiments of the invention but that various additions, deletions, alterations and modifications may be made to these examples and embodiments and or equivalents may be substituted without departing from the intended spirit and scope of the invention. For example, any element or attribute of one embodiment or example may be incorporated into or used with another embodiment or example, unless to do so would render the embodiment or example unsuitable for its intended use. In addition, many modifications may be made to adapt a particular situation, material, composition of matter, process, process step or steps, to the objective, spirit and scope of the present invention. All such modifications are intended to be within the scope of the claims appended hereto.

Claims (50)

1: A method for positioning a guide device useful for delivering at least one working device therethrough to deliver a working end portion of the at least one working device to a desired location within the ear, nose, throat or cranium of a human or animal patient, said method comprising the steps of:
inserting an endoscope into or through an endoscope channel of the guide device that includes an elongated shaft;
inserting the guide device into an internal space of the patient; and
viewing through the endoscope to guide positioning and delivery of the guide device to an intended location in the patient.
2: The method of claim 2, wherein the guide device is inserted through a nostril of the patient.
3: The method of claim 1, wherein the endoscope has a rigid shaft.
4: The method of claim 1, wherein the endoscope has a flexible shaft.
5: The method of claim 1, wherein the endoscope is semi-rigid.
6: The method of claim 1, further comprising cleaning a lens of the endoscope using at least one of irrigation and suction, while the lens is located in the internal space of the patient.
7: The method of claim 1, further comprising:
inserting a guidewire through a working device lumen of the guide device;
advancing a distal end portion of the guidewire distally of a distal end of the working device lumen; and
viewing, via the endoscope, advancement of the guidewire distally of the guide device.
8: The method of claim 7, further comprising viewing, via the endoscope, entry of the distal end portion of the guidewire into a sinus ostium.
9: The method of claim 8, further comprising identifying the sinus ostium as a sinus ostium other than a target sinus ostium, retracting the distal end of the guidewire out of the sinus ostium, and redirecting the guidewire, wherein said identifying, retracting and redirecting steps are visualized via the endoscope.
10: The method of claim 9, further comprising viewing, via the endoscope, entry of the distal end portion of the guidewire into the target sinus ostium upon said redirecting and advancing the distal end portion of the guidewire into the target ostium facilitated by visualization through the endoscope.
11: The method of claim 7, wherein the guidewire is an illuminating guidewire.
12: The method of claim 11, wherein visualization through the endoscope is enhanced by light emitted by the illuminating guidewire.
13: The method of claim 8, further comprising advancing a working device over the guidewire and visualizing, via the endoscope, advancement of a working end portion of the working device distally of the guide device.
14: The method of claim 13 further comprising viewing, via the endoscope, entry of the working end portion of the working device into a sinus ostium.
15: The method of claim 14 wherein the working device comprises a balloon catheter and the working end portion comprises a balloon, said method further comprising visualizing, via the endoscope, inflation of the balloon to dilate the sinus ostium.
16: The method of claim 15 further comprising visualizing, via the endoscope, deflation of the balloon and retraction of the balloon from the sinus ostium.
17: The method of claim 16 further comprising visualizing, via the endoscope, the sinus ostium having been dilated by the balloon.
18: The method of claim 17 further comprising determining, after said visualizing the sinus ostium having been dilated, whether the sinus ostium has been dilated sufficiently, or whether the balloon needs to be reinserted and inflated to perform additional dilation.
19: A method for locating a sinus ostium, said method comprising the steps of:
inserting an endoscope through a nostril of a patient and advancing the endoscope toward a location of the sinus ostium;
inserting a guidewire through the nostril and advancing a distal end portion of the guidewire distally of a distal end of the endoscope; and
viewing, through the endoscope, the advancement of the distal end portion of the guidewire to facilitate guidance of the advancement of the guidewire along a desired path.
20: The method of claim 19 further comprising directing the distal end portion of the guidewire, under guidance facilitated by visualization of the distal end portion via the endoscope, into the sinus ostium.
21: The method of claim 20, wherein the guidewire is an illuminating guidewire, and visualization through the endoscope is enhanced by light emitted by the illuminating guidewire.
22: The method of claim 21, further comprising confirming that the distal end portion of the guidewire has been inserted into a desired sinus by observing transillumination effects produced by the illumination from the distal end portion of the guidewire having been inserted through the sinus ostium and into the sinus.
23: The method of claim 20, further comprising advancing a working device over the guidewire and performing a diagnostic or therapeutic step with regard to at least one of the sinus ostium and a sinus that the sinus ostium opens to.
24: A method for treating a patient; said method comprising the steps of:
inserting an endoscope into or through an endoscope channel of a guide device that includes an elongated shaft;
inserting the guide device through a nostril of the patient;
advancing a distal end portion of the guide device toward a sinus ostium of the patient;
advancing a distal end portion of the endoscope distally of the distal end portion of the guide device, and navigating the distal end portion of the endoscope through the sinus ostium, said navigating being assisted by visualization through the endoscope.
25: The method of claim 24, wherein said advancing a distal end portion of the guide device is assisted by visualization of the distal end portion through the endoscope.
26: The method of claim 24, wherein the distal end portion of the endoscope is navigated through the sinus ostium after dilation of the sinus ostium, and wherein a procedure to dilate the ostium is visualized via the endoscope.
27: The method of claim 24, wherein the distal end portion of the endoscope is navigated through the sinus ostium without first dilating the sinus ostium.
28: The method of claim 24, further comprising viewing the sinus cavity that the sinus ostium opens to, via the endoscope, to assess efficacy of a previously preformed therapy or perform a diagnosis.
29: The method of claim 24, further comprising:
inserting a working device through a working device channel of the guide device;
advancing a working end portion of the working device distally of a distal end of the guide device and into the sinus ostium; and
performing at least one therapeutic step in the sinus cavity that the sinus ostium opens to.
30: The method of claim 29, wherein the at least one therapeutic step is selected from one or more of: local during delivery, regional drug delivery, suction, irrigation, biopsy, polyp removal, fungal ball removal, or removal of mass.
31: The method of claim 29, wherein said advancing a working end portion is visualized via the endoscope, prior to navigating the distal end of the endoscope into the sinus ostium.
32: The method of claim 29, wherein the working device is selected from at least one of: guidewires, graspers, cutters, punches, flexible microdebriders, dissectors, electrodes, lasers, suction catheters, irrigation catheters and balloon catheters.
33-37. (canceled)
38: A guide device useable to position a working device at a desired location within the ear, nose, throat or cranium of a human or animal subject, said device comprising:
a transnasally insertable elongate shaft having a proximal end and a distal end;
a first channel into which an endoscope may be inserted so that the endoscope may be used to view at least an area beyond the distal end of the shaft; and
a second channel through which the working device may be advanced, wherein said first channel is statically located relative to said second channel.
39: The device of claim 38, wherein said first channel is removably fixed to said second channel.
40: The device of claim 38, further comprising a proximally located handle, wherein proximal end portions of said first and second channels extend through said handle.
41: The device of claim 40, wherein said proximal end portions diverge away from one another in a direction from a distal end of said handle to a proximal end of said handle.
42: The device of claim 40, wherein said second channel is rotatable within said handle and said first channel is fixed to said handle, prevent rotation of said first channel relative to said handle.
43: The device of claim 40, further comprising a second handle mounted on one of said first and second channels, proximal of said first handle.
44: The device of claim 43, wherein said second handle is mounted on said second channel.
45: The device of claim 42, further comprising a second handle mounted on said second channel, proximal of said first handle, wherein said second handle is fixed to said second channel to prevent rotation of said second channel relative to said second handle.
46: The device of claim 38, further comprising an overlamination or heat shrink tube surrounding said first and second channels.
47: The device of claim 38, wherein a distal end of said first channel is set back proximally of a distal end of said second channel by a predetermined distance.
48: The device of claim 38, where a distal tip portion of said first channel is colored with a color that contrasts with a color of a portion of said first channel proximally adjacent said distal tip portion.
49: The device of claim 38, where a distal tip portion of said second channel is colored with a color that contrasts with a color of a portion of said second channel proximally adjacent said distal tip portion.
50: The device of claim 38, wherein said first channel comprises a scooped distal tip.
51: The device of claim 38, wherein a proximal end of at least one of said first and second channels is fitted with a luer connector.
52: The device of claim 41, wherein a channel in said handle directing said proximal end portion of said first channel away from said second channel comprises a bend, said bend creating frictional resistance on an endoscope inserted in said first channel as the endoscope passes through said bend.
53: The device of claim 47, wherein said distal end of said first channel comprises a scooped distal tip.
54-64. (canceled)
US12/184,166 2006-09-15 2008-07-31 Endoscopic methods and devices for transnasal procedures Abandoned US20090030274A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US12/184,166 US20090030274A1 (en) 2006-09-15 2008-07-31 Endoscopic methods and devices for transnasal procedures

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US84487406P 2006-09-15 2006-09-15
US11/522,497 US7559925B2 (en) 2006-09-15 2006-09-15 Methods and devices for facilitating visualization in a surgical environment
US11/725,151 US9089258B2 (en) 2004-04-21 2007-03-15 Endoscopic methods and devices for transnasal procedures
US12481807P 2007-07-31 2007-07-31
US12/184,166 US20090030274A1 (en) 2006-09-15 2008-07-31 Endoscopic methods and devices for transnasal procedures

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US11/725,151 Division US9089258B2 (en) 2004-04-21 2007-03-15 Endoscopic methods and devices for transnasal procedures

Publications (1)

Publication Number Publication Date
US20090030274A1 true US20090030274A1 (en) 2009-01-29

Family

ID=39201029

Family Applications (3)

Application Number Title Priority Date Filing Date
US11/725,151 Active 2031-02-05 US9089258B2 (en) 2004-04-21 2007-03-15 Endoscopic methods and devices for transnasal procedures
US11/888,273 Pending US20070270644A1 (en) 2004-04-21 2007-07-31 Endoscopic methods and devices for transnasal procedures
US12/184,166 Abandoned US20090030274A1 (en) 2006-09-15 2008-07-31 Endoscopic methods and devices for transnasal procedures

Family Applications Before (2)

Application Number Title Priority Date Filing Date
US11/725,151 Active 2031-02-05 US9089258B2 (en) 2004-04-21 2007-03-15 Endoscopic methods and devices for transnasal procedures
US11/888,273 Pending US20070270644A1 (en) 2004-04-21 2007-07-31 Endoscopic methods and devices for transnasal procedures

Country Status (3)

Country Link
US (3) US9089258B2 (en)
EP (2) EP2068997A4 (en)
WO (1) WO2008036148A2 (en)

Cited By (97)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040116958A1 (en) * 2001-02-06 2004-06-17 Achim Gopferich Spacing device for releasing active substances in the paranasal sinus
US20060063973A1 (en) * 2004-04-21 2006-03-23 Acclarent, Inc. Methods and apparatus for treating disorders of the ear, nose and throat
US20060164680A1 (en) * 2005-01-25 2006-07-27 Hyuck Kim Printing system and method of printing data on a designated paper
US20070005094A1 (en) * 2005-04-04 2007-01-04 Eaton Donald J Device and methods for treating paranasal sinus conditions
US20070073269A1 (en) * 2005-09-23 2007-03-29 Becker Bruce B Multi-conduit balloon catheter
US20070129751A1 (en) * 2004-04-21 2007-06-07 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US20070135789A1 (en) * 2004-04-21 2007-06-14 Acclarent, Inc. Use of mechanical dilator devices to enlarge ostia of paranasal sinuses and other passages in the ear, nose, throat and paranasal sinuses
US20070179518A1 (en) * 2006-02-02 2007-08-02 Becker Bruce B Balloon Catheters and Methods for Treating Paranasal Sinuses
US20070208252A1 (en) * 2004-04-21 2007-09-06 Acclarent, Inc. Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses
US20070208301A1 (en) * 2005-06-10 2007-09-06 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US20070249896A1 (en) * 2004-04-21 2007-10-25 Eric Goldfarb Endoscopic methods and devices for transnasal procedures
US20070282305A1 (en) * 2004-04-21 2007-12-06 Eric Goldfarb Endoscopic methods and devices for transnasal procedures
US20080097514A1 (en) * 2004-04-21 2008-04-24 Acclarent, Inc. Devices, Systems and Methods for Treating Disorders of the Ear, Nose and Throat
US20080125720A1 (en) * 2006-05-17 2008-05-29 Acclarent, Inc. Adapter for attaching electromagnetic image guidance components to a medical device
US20080195041A1 (en) * 2004-04-21 2008-08-14 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose and throat
US20080275483A1 (en) * 2004-04-21 2008-11-06 Acclarent, Inc. Methods and Apparatus for Treating Disorders of the Ear Nose and Throat
US20090017090A1 (en) * 2006-07-10 2009-01-15 Arensdorf Patrick A Devices and methods for delivering active agents to the osteomeatal complex
US20090021818A1 (en) * 2007-07-20 2009-01-22 Ethicon Endo-Surgery, Inc. Medical scanning assembly with variable image capture and display
US20090028923A1 (en) * 2005-01-18 2009-01-29 Acclarent, Inc. Implantable Devices and Methods for Treating Sinusitis and Other Disorders
US20090030409A1 (en) * 2007-07-27 2009-01-29 Eric Goldfarb Methods and devices for facilitating visualization in a surgical environment
US20090187098A1 (en) * 2004-04-21 2009-07-23 Acclarent, Inc. Devices, Systems and Methods for Diagnosing and Treating Sinusitis and Other Disorders of the Ears, Nose, and/or Throat
US20090198216A1 (en) * 2004-04-21 2009-08-06 Acclarent, Inc. Frontal sinus spacer
US20090198179A1 (en) * 2007-12-18 2009-08-06 Abbate Anthony J Delivery devices and methods
US20090240112A1 (en) * 2006-09-15 2009-09-24 Acclarent, Inc. Methods and Devices for Facilitating Visualization In a Surgical Environment
US20090312745A1 (en) * 2004-04-21 2009-12-17 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US20100099946A1 (en) * 2004-04-21 2010-04-22 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US20100114066A1 (en) * 2004-08-04 2010-05-06 Acclarent, Inc. Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders
US20100305697A1 (en) * 2009-03-31 2010-12-02 Acclarent, Inc. System and Method For Treatment of Non-Ventilating Middle Ear by Providing a Gas Pathway Through the Nasopharynx
US20100312101A1 (en) * 2009-06-05 2010-12-09 Entellus Medical, Inc. Frontal sinus dilation catheter
US20110015612A1 (en) * 2009-07-15 2011-01-20 Regents Of The University Of Minnesota Implantable devices for treatment of sinusitis
US20110015734A1 (en) * 2009-06-05 2011-01-20 Entrigue Surgical, Inc. Methods for Providing Therapy to an Anatomical Structure
US20110125091A1 (en) * 2009-05-15 2011-05-26 Abbate Anthony J Expandable devices and methods therefor
US20110137178A1 (en) * 2009-10-06 2011-06-09 The General Hospital Corporation Devices and methods for imaging particular cells including eosinophils
US20110160740A1 (en) * 2009-12-28 2011-06-30 Acclarent, Inc. Tissue Removal in The Paranasal Sinus and Nasal Cavity
US20110202037A1 (en) * 2008-08-18 2011-08-18 Bolger William E Fluid delivery catheter apparatus
US20110201996A1 (en) * 2008-08-27 2011-08-18 Melder Patrick C Nasal ventilation system and method of using same
US20110251457A1 (en) * 2010-04-08 2011-10-13 Eric James Kezirian Endoscopic device and system
US8100933B2 (en) 2002-09-30 2012-01-24 Acclarent, Inc. Method for treating obstructed paranasal frontal sinuses
US8114062B2 (en) 2004-04-21 2012-02-14 Acclarent, Inc. Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders
US8118757B2 (en) 2007-04-30 2012-02-21 Acclarent, Inc. Methods and devices for ostium measurement
US20120071856A1 (en) * 2010-09-22 2012-03-22 Goldfarb Eric A Medical Device and Method for Treatment of a Sinus Opening
US8146400B2 (en) 2004-04-21 2012-04-03 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8172828B2 (en) 2004-04-21 2012-05-08 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US8182432B2 (en) 2008-03-10 2012-05-22 Acclarent, Inc. Corewire design and construction for medical devices
US8435261B2 (en) 2009-07-15 2013-05-07 Regents Of The University Of Minnesota Treatment and placement device for sinusitis applications
US8439687B1 (en) 2006-12-29 2013-05-14 Acclarent, Inc. Apparatus and method for simulated insertion and positioning of guidewares and other interventional devices
US8485199B2 (en) 2007-05-08 2013-07-16 Acclarent, Inc. Methods and devices for protecting nasal turbinate during surgery
US20130265798A1 (en) * 2011-10-27 2013-10-10 Olympus Medical Systems Corp. Endoscope
US20140051928A1 (en) * 2012-08-15 2014-02-20 Brian FOUTS Cannula arrangement for minimally invasive surgery
US8702626B1 (en) 2004-04-21 2014-04-22 Acclarent, Inc. Guidewires for performing image guided procedures
US8763222B2 (en) 2008-08-01 2014-07-01 Intersect Ent, Inc. Methods and devices for crimping self-expanding devices
US8834513B2 (en) 2009-06-05 2014-09-16 Entellus Medical, Inc. Method and articles for treating the sinus system
US8864787B2 (en) 2004-04-21 2014-10-21 Acclarent, Inc. Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis
US8932276B1 (en) 2004-04-21 2015-01-13 Acclarent, Inc. Shapeable guide catheters and related methods
US8945142B2 (en) 2008-08-27 2015-02-03 Cook Medical Technologies Llc Delivery system for implanting nasal ventilation tube
US8979888B2 (en) 2008-07-30 2015-03-17 Acclarent, Inc. Paranasal ostium finder devices and methods
US20150100042A1 (en) * 2013-10-07 2015-04-09 Impel Neuropharma Inc. Muroid Family Nasal Device
US9022967B2 (en) 2010-10-08 2015-05-05 Sinopsys Surgical, Inc. Implant device, tool, and methods relating to treatment of paranasal sinuses
US9044581B2 (en) 2012-03-19 2015-06-02 Cook Medical Technologies Llc Medical devices, methods, and kits for delivering medication to a bodily passage
US9072626B2 (en) 2009-03-31 2015-07-07 Acclarent, Inc. System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx
US9089631B2 (en) 2011-07-22 2015-07-28 Cook Medical Technologies Llc Irrigation devices adapted to be used with a light source for the identification and treatment of bodily passages
US9155492B2 (en) 2010-09-24 2015-10-13 Acclarent, Inc. Sinus illumination lightwire device
US9248266B2 (en) 2013-12-17 2016-02-02 Biovision Technologies, Llc Method of performing a sphenopalatine ganglion block procedure
US9265407B2 (en) 2004-04-21 2016-02-23 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US9283360B2 (en) 2011-11-10 2016-03-15 Entellus Medical, Inc. Methods and devices for treating sinusitis
US9314593B2 (en) 2012-09-24 2016-04-19 Cook Medical Technologies Llc Medical devices for the identification and treatment of bodily passages
US9351750B2 (en) 2004-04-21 2016-05-31 Acclarent, Inc. Devices and methods for treating maxillary sinus disease
US9375138B2 (en) 2011-11-25 2016-06-28 Cook Medical Technologies Llc Steerable guide member and catheter
US9433437B2 (en) 2013-03-15 2016-09-06 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US9457173B2 (en) 2011-09-10 2016-10-04 Cook Medical Technologies Llc Methods of providing access to a salivary duct
US9516995B2 (en) 2013-12-17 2016-12-13 Biovision Technologies, Llc Surgical device for performing a sphenopalatine ganglion block procedure
US9549748B2 (en) 2013-08-01 2017-01-24 Cook Medical Technologies Llc Methods of locating and treating tissue in a wall defining a bodily passage
US9561350B2 (en) 2013-01-25 2017-02-07 Sinopsys Surgical, Inc. Paranasal sinus access implant devices and related tools, methods and kits
US9572964B2 (en) 2012-04-11 2017-02-21 Sinapsys Surgical, Inc. Implantation tools, tool assemblies, kits and methods
US9597179B2 (en) 2011-07-25 2017-03-21 Rainbow Medical Ltd. Sinus stent
US9629684B2 (en) 2013-03-15 2017-04-25 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US9694163B2 (en) 2013-12-17 2017-07-04 Biovision Technologies, Llc Surgical device for performing a sphenopalatine ganglion block procedure
US9700459B2 (en) 2013-10-16 2017-07-11 Sinopsys Surgical, Inc. Apparatuses, tools and kits relating to fluid manipulation treatments of paranasal sinuses
US9820688B2 (en) 2006-09-15 2017-11-21 Acclarent, Inc. Sinus illumination lightwire device
US9895055B2 (en) 2013-02-28 2018-02-20 Cook Medical Technologies Llc Medical devices, systems, and methods for the visualization and treatment of bodily passages
US9937323B2 (en) 2014-02-28 2018-04-10 Cook Medical Technologies Llc Deflectable catheters, systems, and methods for the visualization and treatment of bodily passages
US9956383B2 (en) 2013-03-15 2018-05-01 Cook Medical Technologies Llc Medical devices and methods for providing access to a bodily passage during dilation
US9956384B2 (en) 2014-01-24 2018-05-01 Cook Medical Technologies Llc Articulating balloon catheter and method for using the same
US10016580B2 (en) 2013-12-17 2018-07-10 Biovision Technologies, Llc Methods for treating sinus diseases
EP3200705A4 (en) * 2014-09-29 2018-07-11 Clearmind Biomedical, Inc. Surgical tool
US10188413B1 (en) 2004-04-21 2019-01-29 Acclarent, Inc. Deflectable guide catheters and related methods
US10195398B2 (en) 2014-08-13 2019-02-05 Cook Medical Technologies Llc Tension member seal and securing mechanism for medical devices
US10206821B2 (en) 2007-12-20 2019-02-19 Acclarent, Inc. Eustachian tube dilation balloon with ventilation path
US10232152B2 (en) 2013-03-14 2019-03-19 Intersect Ent, Inc. Systems, devices, and method for treating a sinus condition
USD843596S1 (en) 2014-01-09 2019-03-19 Axiosonic, Llc Ultrasound applicator
US10525240B1 (en) 2018-06-28 2020-01-07 Sandler Scientific LLC Sino-nasal rinse delivery device with agitation, flow-control and integrated medication management system
US10524814B2 (en) 2009-03-20 2020-01-07 Acclarent, Inc. Guide system with suction
WO2020051468A1 (en) * 2018-09-07 2020-03-12 Merit Medical Systems, Inc. Thrombosis macerating and aspiration devices for blood vessels
US10898375B2 (en) 2014-07-24 2021-01-26 Sinopsys Surgical, Inc. Paranasal sinus access implant devices and related products and methods
US11129972B2 (en) 2017-09-20 2021-09-28 Sinopsys Surgical, Inc. Paranasal sinus fluid access implantation tools, assemblies, kits and methods
US11291812B2 (en) 2003-03-14 2022-04-05 Intersect Ent, Inc. Sinus delivery of sustained release therapeutics
US11529502B2 (en) 2004-04-21 2022-12-20 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures

Families Citing this family (54)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20040199052A1 (en) 2003-04-01 2004-10-07 Scimed Life Systems, Inc. Endoscopic imaging system
US7618413B2 (en) * 2005-06-22 2009-11-17 Boston Scientific Scimed, Inc. Medical device control system
WO2007033206A2 (en) 2005-09-13 2007-03-22 Veran Medical Technologies, Inc. Apparatus and method for image guided accuracy verification
US20070066881A1 (en) 2005-09-13 2007-03-22 Edwards Jerome R Apparatus and method for image guided accuracy verification
US8231524B2 (en) * 2005-09-20 2012-07-31 Ai Medical Devices, Inc. Endotracheal intubation device
US9456877B2 (en) 2006-12-01 2016-10-04 Boston Scientific Scimed, Inc. Direct drive instruments and methods of use
EP4233962A3 (en) 2007-05-18 2023-09-06 Boston Scientific Scimed, Inc. Medical drive systems
US9125552B2 (en) * 2007-07-31 2015-09-08 Ethicon Endo-Surgery, Inc. Optical scanning module and means for attaching the module to medical instruments for introducing the module into the anatomy
US20100198191A1 (en) * 2007-12-20 2010-08-05 Acclarent, Inc. Method and system for treating target tissue within the eustachian tube
US7862548B2 (en) * 2008-02-13 2011-01-04 Bekan Rhinologics Inc. Nasal irrigation device
WO2009120622A1 (en) * 2008-03-24 2009-10-01 Boston Scientific Scimed, Inc. Flexible endoscope with core member
US20100057048A1 (en) * 2008-09-04 2010-03-04 Stephen Eldredge Apparatus, System, and Method for Treating Atypical Headaches
US9402686B2 (en) * 2009-03-03 2016-08-02 Valam Corporation Dual access sinus surgery methods
US20110105824A1 (en) * 2009-09-22 2011-05-05 Yosef Krespi Parasympathetically induced vasodilatation method and apparatus
US20120203069A1 (en) * 2009-11-14 2012-08-09 Blake Hannaford Surgical shield for soft tissue protection
WO2011140535A1 (en) 2010-05-07 2011-11-10 Entellus Medical, Inc. Sinus balloon dilation catheters and sinus surgury tools
EP3659490A1 (en) 2010-08-20 2020-06-03 Veran Medical Technologies, Inc. Apparatus and method for four dimensional soft tissue navigation
US9055960B2 (en) * 2010-11-15 2015-06-16 Intuitive Surgical Operations, Inc. Flexible surgical devices
US10758262B2 (en) * 2011-06-20 2020-09-01 Medtronic, Inc. Medical assemblies and methods for implantation of multiple medical leads through a single entry
US9486614B2 (en) 2011-06-29 2016-11-08 Entellus Medical, Inc. Sinus dilation catheter
EP2766084B1 (en) * 2011-10-14 2019-06-19 Volcano Corporation Medical tubing and associated devices, systems, and methods
US9972082B2 (en) 2012-02-22 2018-05-15 Veran Medical Technologies, Inc. Steerable surgical catheter having biopsy devices and related systems and methods for four dimensional soft tissue navigation
US20130281778A1 (en) * 2012-04-19 2013-10-24 Terumo Kabushiki Kaisha Treatment instrument for medical use and method
EP2916748B1 (en) 2012-11-07 2020-07-15 3NT Medical Ltd. Paranasal sinus access system
US9451875B2 (en) * 2012-12-07 2016-09-27 Cook Medical Technologies Llc Flexible lens
ES2768351T3 (en) 2013-01-07 2020-06-22 Ambu As An articulated tip piece for an endoscope
US20150031946A1 (en) * 2013-07-24 2015-01-29 Nidus Medical, Llc Direct vision cryosurgical probe and methods of use
IN2014CH00316A (en) * 2014-01-26 2015-09-04 Chaturvedi Jagdish
US20150305650A1 (en) 2014-04-23 2015-10-29 Mark Hunter Apparatuses and methods for endobronchial navigation to and confirmation of the location of a target tissue and percutaneous interception of the target tissue
US20150305612A1 (en) 2014-04-23 2015-10-29 Mark Hunter Apparatuses and methods for registering a real-time image feed from an imaging device to a steerable catheter
US10322269B1 (en) 2015-01-19 2019-06-18 Dalent, LLC Dilator device
JP6138385B2 (en) * 2015-01-20 2017-05-31 オリンパス株式会社 Insertion aids and medical devices
US10362965B2 (en) * 2015-04-22 2019-07-30 Acclarent, Inc. System and method to map structures of nasal cavity
EP3313325B1 (en) 2015-06-29 2023-09-06 Lyra Therapeutics, Inc. Implantable scaffolds for treatment of sinusitis
US10232082B2 (en) 2015-06-29 2019-03-19 480 Biomedical, Inc. Implantable scaffolds for treatment of sinusitis
CA3209217A1 (en) 2015-06-29 2017-01-05 Lyra Therapeutics, Inc. Scaffold loading and delivery systems
US10973664B2 (en) 2015-12-30 2021-04-13 Lyra Therapeutics, Inc. Scaffold loading and delivery systems
JP6171239B1 (en) * 2016-08-02 2017-08-02 株式会社エフエムディ Medical guide wire and method for manufacturing medical guide wire
WO2018039672A1 (en) * 2016-08-26 2018-03-01 Musc Foundation For Research Development Metal clip detectors and methods of detection
US20180085174A1 (en) * 2016-09-23 2018-03-29 Acclarent, Inc. Suction device for use in image-guided sinus medical procedure
WO2018172565A1 (en) 2017-03-24 2018-09-27 Ambu A/S Articulated tip part for an endoscope
ES2900583T3 (en) * 2017-04-20 2022-03-17 Resnent Llc Hybrid Flexible-Rigid Endoscope and Instrument Fixations
US10201639B2 (en) 2017-05-01 2019-02-12 480 Biomedical, Inc. Drug-eluting medical implants
US11357392B2 (en) 2017-06-26 2022-06-14 Ambu A/S Bending section for an endoscope
US11413050B2 (en) 2018-01-05 2022-08-16 Theragi, LLC Surgical clip and deployment system
WO2019190918A1 (en) 2018-03-29 2019-10-03 Boston Scientific Scimed, Inc. Systems and methods for performing endoscopic procedures
US11229447B2 (en) * 2018-04-25 2022-01-25 excelENT LLC Systems, instruments and methods for treating sinuses
US11883048B2 (en) * 2018-12-07 2024-01-30 Acclarent, Inc. Instrument with integral imaging and irrigation features
EP3797671A1 (en) 2019-09-26 2021-03-31 Ambu A/S A tip part for an endoscope and the manufacture thereof
DE102020106509B3 (en) * 2020-03-10 2021-06-24 Lufthansa Technik Aktiengesellschaft Device and method for the borescope inspection of technical devices
US11324394B2 (en) 2020-09-15 2022-05-10 Ambu A/S Endoscope
EP4228493A1 (en) * 2020-10-13 2023-08-23 Theragi LLC Systems and methods for endoscopic surgery
EP3988006B1 (en) 2020-10-20 2023-08-09 Ambu A/S An endoscope
WO2023122425A1 (en) 2021-12-23 2023-06-29 Excelent, Inc. Systems, instruments and methods for treating a subject

Citations (109)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US446173A (en) * 1891-02-10 Hasp and staple
US513667A (en) * 1894-01-30 Sliding staple for hasps
US2493326A (en) * 1949-03-01 1950-01-03 John H Trinder Tampon for control of intractable nasal hemorrhages
US3552384A (en) * 1967-07-03 1971-01-05 American Hospital Supply Corp Controllable tip guide body and catheter
US3792391A (en) * 1972-12-18 1974-02-12 L Ewing Electrically operated two position electromechanical mechanism
US3859993A (en) * 1973-08-27 1975-01-14 Daniel G Bitner Operating table accessory
US4069307A (en) * 1970-10-01 1978-01-17 Alza Corporation Drug-delivery device comprising certain polymeric materials for controlled release of drug
US4138151A (en) * 1976-07-30 1979-02-06 Olympus Optical Company Limited Detent device for locking the lid of a cassette receiving compartment of a tape recorder
US4184497A (en) * 1977-08-26 1980-01-22 University Of Utah Peritoneal dialysis catheter
US4312353A (en) * 1980-05-09 1982-01-26 Mayfield Education And Research Fund Method of creating and enlarging an opening in the brain
US4499899A (en) * 1983-01-21 1985-02-19 Brimfield Precision, Inc. Fiber-optic illuminated microsurgical scissors
US4564364A (en) * 1983-05-26 1986-01-14 Alza Corporation Active agent dispenser
US4571240A (en) * 1983-08-12 1986-02-18 Advanced Cardiovascular Systems, Inc. Catheter having encapsulated tip marker
US4571239A (en) * 1982-03-01 1986-02-18 Heyman Arnold M Catheter-stylet assembly for slipover urethral instruments
US4637389A (en) * 1985-04-08 1987-01-20 Heyden Eugene L Tubular device for intubation
US4639244A (en) * 1983-05-03 1987-01-27 Nabil I. Rizk Implantable electrophoretic pump for ionic drugs and associated methods
US4645495A (en) * 1985-06-26 1987-02-24 Vaillancourt Vincent L Vascular access implant needle patch
US4726772A (en) * 1986-12-01 1988-02-23 Kurt Amplatz Medical simulator
US4795439A (en) * 1986-06-06 1989-01-03 Edward Weck Incorporated Spiral multi-lumen catheter
US4796629A (en) * 1987-06-03 1989-01-10 Joseph Grayzel Stiffened dilation balloon catheter device
US4803076A (en) * 1986-09-04 1989-02-07 Pfizer Inc. Controlled release device for an active substance
US4897651A (en) * 1985-10-15 1990-01-30 Ing. C. Olivetti & C., S.P.A. Key with selective symbol display and keyboard using such key
US4898577A (en) * 1988-09-28 1990-02-06 Advanced Cardiovascular Systems, Inc. Guiding cathether with controllable distal tip
US4984581A (en) * 1988-10-12 1991-01-15 Flexmedics Corporation Flexible guide having two-way shape memory alloy
US4994033A (en) * 1989-05-25 1991-02-19 Schneider (Usa) Inc. Intravascular drug delivery dilatation catheter
US5020514A (en) * 1989-07-19 1991-06-04 Richard Wolf Gmbh Endoscope for nasal surgery
US5087246A (en) * 1988-12-29 1992-02-11 C. R. Bard, Inc. Dilation catheter with fluted balloon
US5087244A (en) * 1989-01-31 1992-02-11 C. R. Bard, Inc. Catheter and method for locally applying medication to the wall of a blood vessel or other body lumen
US5090910A (en) * 1988-10-14 1992-02-25 Narlo Jeanie R Multiple three dimensional facial display system
US5090595A (en) * 1988-06-29 1992-02-25 Jaico C.V., Cooperatieve Venootschap Pressure capsule for spray can, and spray can which utilizes such a capsule
US5180368A (en) * 1989-09-08 1993-01-19 Advanced Cardiovascular Systems, Inc. Rapidly exchangeable and expandable cage catheter for repairing damaged blood vessels
US5183470A (en) * 1991-03-04 1993-02-02 International Medical, Inc. Laparoscopic cholangiogram catheter and method of using same
US5189110A (en) * 1988-12-23 1993-02-23 Asahi Kasei Kogyo Kabushiki Kaisha Shape memory polymer resin, composition and the shape memorizing molded product thereof
US5275593A (en) * 1992-04-30 1994-01-04 Surgical Technologies, Inc. Ophthalmic surgery probe assembly
US5286254A (en) * 1990-06-15 1994-02-15 Cortrak Medical, Inc. Drug delivery apparatus and method
US5334167A (en) * 1993-11-19 1994-08-02 Cocanower David A Modified nasogastric tube for use in enteral feeding
USD355031S (en) * 1992-04-20 1995-01-31 Terumo Kabushiki Kaisha Catheter
US5386817A (en) * 1991-06-10 1995-02-07 Endomedical Technologies, Inc. Endoscope sheath and valve system
US5391179A (en) * 1992-09-04 1995-02-21 Mezzoli; Giorgio Nasal and/or rhinopharyngeal tampon
US5391147A (en) * 1992-12-01 1995-02-21 Cardiac Pathways Corporation Steerable catheter with adjustable bend location and/or radius and method
US5486181A (en) * 1994-08-04 1996-01-23 Implex Corporation Acetabular cup, method and tool and installing the same
US5591194A (en) * 1994-02-18 1997-01-07 C. R. Bard, Inc. Telescoping balloon catheter and method of use
US5599284A (en) * 1995-02-08 1997-02-04 Shea; John P. Pre-operative nasal splint for endoscopic sinus surgery and method
US5599576A (en) * 1995-02-06 1997-02-04 Surface Solutions Laboratories, Inc. Medical apparatus with scratch-resistant coating and method of making same
US5599304A (en) * 1994-05-10 1997-02-04 Mount Sinai School Of Medicine Of The City University Of New York Sinonasal suction apparatus
US5601594A (en) * 1995-09-14 1997-02-11 Best; Barry D. Nasal stent
US5601087A (en) * 1992-11-18 1997-02-11 Spectrascience, Inc. System for diagnosing tissue with guidewire
US5681262A (en) * 1994-10-05 1997-10-28 Very Inventive Physicians Inc. Endoscope and tool therefore
US5707389A (en) * 1995-06-07 1998-01-13 Baxter International Inc. Side branch occlusion catheter device having integrated endoscope for performing endoscopically visualized occlusion of the side branches of an anatomical passageway
US5707376A (en) * 1992-08-06 1998-01-13 William Cook Europe A/S Stent introducer and method of use
US5708175A (en) * 1995-05-26 1998-01-13 Ishihara Sangyo Kaisha Ltd. Process for producing 4-trifluoromethylnicotinic acid
US5711315A (en) * 1996-02-15 1998-01-27 Jerusalmy; Israel Sinus lift method
US5713946A (en) * 1993-07-20 1998-02-03 Biosense, Inc. Apparatus and method for intrabody mapping
US5718702A (en) * 1992-08-12 1998-02-17 Somnus Medical Technologies, Inc. Uvula, tonsil, adenoid and sinus tissue treatment device and method
US5720300A (en) * 1993-11-10 1998-02-24 C. R. Bard, Inc. High performance wires for use in medical devices and alloys therefor
US5857998A (en) * 1994-06-30 1999-01-12 Boston Scientific Corporation Stent and therapeutic delivery system
US5862693A (en) * 1997-05-02 1999-01-26 Fort Lock Corporation Electronically controlled security lock
US5865767A (en) * 1996-07-10 1999-02-02 Cordis Corporation Guidewire having compound taper
US5872879A (en) * 1996-11-25 1999-02-16 Boston Scientific Corporation Rotatable connecting optical fibers
US6183433B1 (en) * 1995-06-30 2001-02-06 Xomed Surgical Products, Inc. Surgical suction cutting instrument with internal irrigation
US20020002349A1 (en) * 1996-10-11 2002-01-03 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
US20020006961A1 (en) * 1999-05-14 2002-01-17 Katz Stanley E. Method and composition for treating mammalian nasal and sinus diseases caused by inflammatory response
US20020010384A1 (en) * 2000-03-30 2002-01-24 Ramin Shahidi Apparatus and method for calibrating an endoscope
US20020010426A1 (en) * 1999-04-30 2002-01-24 Applied Medical Resources Corporation Guidewire
US20020016564A1 (en) * 2000-05-31 2002-02-07 Courtney Brian K. Embolization protection sytem for vascular procedures
US20020026155A1 (en) * 1998-08-11 2002-02-28 Lorraine Mangosong Slideable cannula and method of use
US20020068851A1 (en) * 1996-10-04 2002-06-06 Dietrich Gravenstein Imaging scope
US20030014036A1 (en) * 2001-06-12 2003-01-16 Varner Signe Erickson Reservoir device for intraocular drug delivery
US20030013985A1 (en) * 2001-07-12 2003-01-16 Vahid Saadat Method for sensing temperature profile of a hollow body organ
US20030014008A1 (en) * 2000-02-04 2003-01-16 Jacques Steven L Triple lumen stone balloon catheter and method
US20030017111A1 (en) * 2000-07-19 2003-01-23 Carlos Rabito Fluorescent agents for real-time measurement of organ function
US20030018291A1 (en) * 1999-12-08 2003-01-23 Hill Frank C. Ear tube and method of insertion
US20030032942A1 (en) * 2001-07-26 2003-02-13 Felix Theeuwes Local concentration management system
US20030040697A1 (en) * 2001-08-17 2003-02-27 Antares Pharma, Inc. Administration of insulin by jet injection
US20030114732A1 (en) * 2001-12-18 2003-06-19 Advanced Cardiovascular Systems, Inc. Sheath for guiding imaging instruments
US6589164B1 (en) * 2000-02-15 2003-07-08 Transvascular, Inc. Sterility barriers for insertion of non-sterile apparatus into catheters or other medical devices
US20030212446A1 (en) * 2002-05-10 2003-11-13 Kaplan Aaron V. Methods and apparatus for lead placement on a surface of the heart
US6673025B1 (en) * 1993-12-01 2004-01-06 Advanced Cardiovascular Systems, Inc. Polymer coated guidewire
US6672773B1 (en) * 2000-12-29 2004-01-06 Amkor Technology, Inc. Optical fiber having tapered end and optical connector with reciprocal opening
US20040015150A1 (en) * 1996-05-20 2004-01-22 Gholam-Reza Zadno-Azizi Method and apparatus for emboli containment
US20040018980A1 (en) * 1998-04-24 2004-01-29 Genentech, Inc. Novel FIZZ proteins
US6878106B1 (en) * 1999-02-15 2005-04-12 Ingo F. Herrmann Deformable fiberscope with a displaceable supplementary device
US20050240147A1 (en) * 2004-04-21 2005-10-27 Exploramed Ii, Inc. Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat
US20050267335A1 (en) * 2004-05-26 2005-12-01 Olympus Corporation Endoscope apparatus
US20060004323A1 (en) * 2004-04-21 2006-01-05 Exploramed Nc1, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US20060004286A1 (en) * 2004-04-21 2006-01-05 Acclarent, Inc. Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses
US6991597B2 (en) * 2001-03-09 2006-01-31 Boston Scientific Scimed, Inc. System for implanting an implant and method thereof
US7108706B2 (en) * 2003-05-28 2006-09-19 Rose Biomedical Development Corporation Inflatable nasal packing device with two non-elastic, flexible bags oversized relative to nasal cavities
US20070005094A1 (en) * 2005-04-04 2007-01-04 Eaton Donald J Device and methods for treating paranasal sinus conditions
US7160255B2 (en) * 2001-07-12 2007-01-09 Vahid Saadat Method and device for sensing and mapping temperature profile of a hollow body organ
US20070020196A1 (en) * 2003-12-31 2007-01-25 Pipkin James D Inhalant formulation containing sulfoalkyl ether cyclodextrin and corticosteroid prepared from a unit dose suspension
US7169163B2 (en) * 2002-09-30 2007-01-30 Bruce Becker Transnasal method and catheter for lacrimal system
US7169140B1 (en) * 1994-02-22 2007-01-30 Boston Scientific Scimed, Inc. Methods of using an intravascular balloon catheter in combination with an angioscope
US20070073269A1 (en) * 2005-09-23 2007-03-29 Becker Bruce B Multi-conduit balloon catheter
US7316168B2 (en) * 2002-11-23 2008-01-08 Fag Kugelfischer Ag Force-sensing bearing
US7318831B2 (en) * 2002-07-13 2008-01-15 Stryker Corporation System and method for performing irrigated nose and throat surgery
US20080015540A1 (en) * 2004-04-21 2008-01-17 Acclarent, Inc. Implantable devices and methods for treating sinusitis and other disorders
US20080015544A1 (en) * 2006-04-21 2008-01-17 Entellus Medical, Inc. Method for accessing a sinus cavity and related anatomical features
US7322934B2 (en) * 2003-06-24 2008-01-29 Olympus Corporation Endoscope
US20080125625A1 (en) * 2005-01-18 2008-05-29 The Regents Of The University Of California Endoscopic Tube Delivery System
US20080172033A1 (en) * 2007-01-16 2008-07-17 Entellus Medical, Inc. Apparatus and method for treatment of sinusitis
US20090017090A1 (en) * 2006-07-10 2009-01-15 Arensdorf Patrick A Devices and methods for delivering active agents to the osteomeatal complex
US7641668B2 (en) * 2003-05-16 2010-01-05 Scimed Life Systems, Inc. Fluid delivery system and related methods of use
US7645272B2 (en) * 2004-04-21 2010-01-12 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US7648367B1 (en) * 2005-09-23 2010-01-19 Acclarent, Inc. Anatomical models and methods for training and demonstration of medical procedures
USD630321S1 (en) * 2009-05-08 2011-01-04 Angio Dynamics, Inc. Probe handle
US20110004057A1 (en) * 2004-04-21 2011-01-06 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US20110015482A1 (en) * 2003-02-19 2011-01-20 Boston Scientific Scimed, Inc. Guidewire Locking Device and Method
US8088063B2 (en) * 2003-12-05 2012-01-03 Fujifilm Corporation Insertion assisting tool for endoscope

Family Cites Families (753)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2899227A (en) 1959-08-11 Charles-louis gschwend
US504424A (en) 1893-09-05 Oscar de pezzer
US705346A (en) 1901-11-02 1902-07-22 Jonathan R Hamilton Dilator.
US816792A (en) 1904-09-06 1906-04-03 Oliver H P Green Lock.
US798775A (en) 1905-04-13 1905-09-05 Valorus A Bradbury Dispensing-bottle.
US1080934A (en) 1912-08-19 1913-12-09 Walter L Shackleford Rectal tube.
US1200267A (en) 1915-02-04 1916-10-03 Motors Lock Company Of America Lock for automobile-hoods.
US1650959A (en) 1926-04-08 1927-11-29 Louis K Pitman Surgical instrument
US1735519A (en) 1926-07-17 1929-11-12 Arlyn T Vance Physician's dilator
US1878671A (en) 1929-07-02 1932-09-20 John Murray Dilator
US1828986A (en) 1929-09-26 1931-10-27 Golder E Stevens Dilating irrigator
US2201749A (en) 1939-02-15 1940-05-21 Vandegrift Middleton Expanding vein tube
US2525183A (en) 1947-03-20 1950-10-10 Jehu M Robison Antral pressure device
US2847997A (en) 1956-01-13 1958-08-19 James J Tibone Catheter
US3037286A (en) 1957-01-28 1962-06-05 North American Aviation Inc Vector gage
US2906179A (en) 1957-01-28 1959-09-29 North American Aviation Inc Vector gage
US3009265A (en) 1960-05-09 1961-11-21 Superior Plastics Inc Anatomical device
US2995832A (en) 1960-08-01 1961-08-15 Alderson Res Lab Inc Training aid for intravenous therapy
US3173418A (en) 1961-01-10 1965-03-16 Ostap E Baran Double-wall endotracheal cuff
US3435826A (en) 1964-05-27 1969-04-01 Edwards Lab Inc Embolectomy catheter
US3347061A (en) 1965-01-11 1967-10-17 Eaton Yale & Towne Flexible drive mechanism
US3393073A (en) 1965-04-16 1968-07-16 Eastman Kodak Co High contrast photographic emulsions
US3376659A (en) 1965-06-09 1968-04-09 Bard Inc C R Demonstration device
US3447061A (en) 1965-07-12 1969-05-27 Basic Inc Multi-phase rectifier with inherent phase balance
US3384970A (en) 1965-09-22 1968-05-28 Boice Gages Inc Precision coordinates measurement apparatus for gaging and layout operations
US3486539A (en) 1965-09-28 1969-12-30 Jacuzzi Bros Inc Liquid dispensing and metering assembly
US3469578A (en) 1965-10-12 1969-09-30 Howard R Bierman Infusion device for ambulatory patients with flow control means
US3509638A (en) 1966-08-04 1970-05-05 Midland Ross Corp Treating apparatus
US3506005A (en) 1967-02-23 1970-04-14 Arthur S Gilio Pressure infusion device for medical use
US3515888A (en) 1967-10-27 1970-06-02 California Computer Products Manual optical digitizer
US3481043A (en) 1967-12-12 1969-12-02 Bendix Corp Gaging machine
US3531868A (en) 1968-04-18 1970-10-06 Ford Motor Co Surface scanner for measuring the coordinates of points on a three-dimensional surface
US3527220A (en) 1968-06-28 1970-09-08 Fairchild Hiller Corp Implantable drug administrator
US3993073A (en) 1969-04-01 1976-11-23 Alza Corporation Novel drug delivery device
US3967618A (en) 1969-04-01 1976-07-06 Alza Corporation Drug delivery device
US3948262A (en) 1969-04-01 1976-04-06 Alza Corporation Novel drug delivery device
US3624661A (en) 1969-05-14 1971-11-30 Honeywell Inc Electrographic printing system with plural staggered electrode rows
US3834394A (en) 1969-11-21 1974-09-10 R Sessions Occlusion device and method and apparatus for inserting the same
US3903893A (en) 1970-05-04 1975-09-09 Alexander L Scheer Nasal hemostatic device
GB1340788A (en) 1971-02-04 1974-01-30 Matburn Holdings Ltd Nasal tampons
US3731963A (en) 1971-04-20 1973-05-08 R Pond Electrically actuated lock mechanism
US3804081A (en) 1971-07-29 1974-04-16 Olympus Optical Co Endoscope
US3802096A (en) 1971-08-09 1974-04-09 H Matern Composite model for medical study
US3948254A (en) 1971-11-08 1976-04-06 Alza Corporation Novel drug delivery device
US3850176A (en) 1972-02-07 1974-11-26 G Gottschalk Nasal tampon
US3910617A (en) 1972-02-20 1975-10-07 Square D Co Solenoid operated electric strike
JPS4920979A (en) 1972-06-19 1974-02-23
JPS4932484U (en) 1972-06-19 1974-03-20
US3800788A (en) 1972-07-12 1974-04-02 N White Antral catheter for reduction of fractures
CH557178A (en) 1972-08-10 1974-12-31 Siemens Ag DEVICE FOR DISPENSING DRUGS.
US4016251A (en) 1972-08-17 1977-04-05 Alza Corporation Vaginal drug dispensing device
US3921636A (en) 1973-01-15 1975-11-25 Alza Corp Novel drug delivery device
US3993069A (en) 1973-03-26 1976-11-23 Alza Corporation Liquid delivery device bladder
US3847145A (en) 1973-04-13 1974-11-12 M Grossan Nasal irrigation system
US4450150A (en) 1973-05-17 1984-05-22 Arthur D. Little, Inc. Biodegradable, implantable drug delivery depots, and method for preparing and using the same
US3993072A (en) 1974-08-28 1976-11-23 Alza Corporation Microporous drug delivery device
US4052505A (en) 1975-05-30 1977-10-04 Alza Corporation Ocular therapeutic system manufactured from copolymer
DE2541084C3 (en) 1975-09-15 1978-12-07 Siemens Ag, 1000 Berlin Und 8000 Muenchen Method for producing a self-supporting coil in the winding area
US4102342A (en) 1975-12-29 1978-07-25 Taichiro Akiyama Valved device
US4471779A (en) 1976-08-25 1984-09-18 Becton, Dickinson And Company Miniature balloon catheter
US4207890A (en) 1977-01-04 1980-06-17 Mcneilab, Inc. Drug-dispensing device and method
JPS567971Y2 (en) 1977-07-23 1981-02-21
US4198766A (en) 1978-06-21 1980-04-22 Baxter Travenol Laboratories, Inc. Intravenous training/demonstration aid
US4213095A (en) 1978-08-04 1980-07-15 Bell Telephone Laboratories, Incorporated Feedforward nonlinear equalization of modulated data signals
USRE31351E (en) 1978-08-04 1983-08-16 Bell Telephone Laboratories, Incorporated Feedback nonlinear equalization of modulated data signals
US4217898A (en) 1978-10-23 1980-08-19 Alza Corporation System with microporous reservoir having surface for diffusional delivery of agent
US4268115A (en) 1979-06-01 1981-05-19 Tetra-Tech, Inc. Quick-release fiber-optic connector
US4299226A (en) 1979-08-08 1981-11-10 Banka Vidya S Coronary dilation method
JPS5628334A (en) 1979-08-14 1981-03-19 Nissan Motor Co Ltd Automatic change gear
US4299227A (en) 1979-10-19 1981-11-10 Lincoff Harvey A Ophthalmological appliance
US4338941A (en) 1980-09-10 1982-07-13 Payton Hugh W Apparatus for arresting posterior nosebleeds
DE3041873C2 (en) 1980-11-06 1982-12-23 Danfoss A/S, 6430 Nordborg Device for generating a speed-dependent control pressure
USD269204S (en) 1981-02-05 1983-05-31 Trepp Charles A Dental hygiene device
US4437856A (en) 1981-02-09 1984-03-20 Alberto Valli Peritoneal catheter device for dialysis
FR2502499B1 (en) 1981-03-27 1987-01-23 Farcot Jean Christian APPARATUS FOR BLOOD RETROPERFUSION, IN PARTICULAR FOR THE TREATMENT OF INFARCTUS BY INJECTION OF ARTERIAL BLOOD INTO THE CORONARY SINUS
CH653400A5 (en) 1981-06-17 1985-12-31 Bauer Kaba Ag LOCK CYLINDER.
US4435716A (en) 1981-09-14 1984-03-06 Adrian Zandbergen Method of making a conical spiral antenna
US5370675A (en) 1992-08-12 1994-12-06 Vidamed, Inc. Medical probe device and method
GB2125874B (en) 1982-08-17 1985-08-14 Michael David Dunn Solenoid operated locks
US4464175A (en) 1982-08-25 1984-08-07 Altman Alan R Multipurpose tamponade and thrombosclerotherapy tube
US4581017B1 (en) 1983-03-07 1994-05-17 Bard Inc C R Catheter systems
USD283921S (en) 1983-06-27 1986-05-20 Difco Laboratories Incorporated Blood collector
DE3376468D1 (en) 1983-06-27 1988-06-09 Borje Drettner An instrument for the treatment of sinusitis
US4554929A (en) 1983-07-13 1985-11-26 Advanced Cardiovascular Systems, Inc. Catheter guide wire with short spring tip and method of using the same
NL8302648A (en) 1983-07-26 1985-02-18 Fundatech Sa APPARATUS FOR SUPPLY AND EXTRACTION OF A LIQUID SUBSTANCE TO RESP. FROM THE JAWS.
US4675613A (en) 1983-08-11 1987-06-23 Hewlett-Packard Company Noise compensated synchronous detector system
CA1232814A (en) 1983-09-16 1988-02-16 Hidetoshi Sakamoto Guide wire for catheter
US4585000A (en) 1983-09-28 1986-04-29 Cordis Corporation Expandable device for treating intravascular stenosis
USD284892S (en) 1983-09-29 1986-07-29 Glassman Jacob A Biliary exploratory balloon catheter with replaceable lead-tip
SE442164B (en) 1984-01-11 1985-12-09 Olle Berg DEVICE FOR NAVIGATION WALL OPERATIONS
US4589868A (en) 1984-03-12 1986-05-20 Dretler Stephen P Expandable dilator-catheter
JPS60253428A (en) 1984-05-30 1985-12-14 住友電気工業株式会社 Fiberscope with bending mechanism
US4851228A (en) 1984-06-20 1989-07-25 Merck & Co., Inc. Multiparticulate controlled porosity osmotic
US4596528A (en) 1984-07-02 1986-06-24 Lewis Leonard A Simulated skin and method
US4705801A (en) 1984-10-16 1987-11-10 Ciba-Geigy Corporation Production for producing 3-cyano-4-phenyl indoles and intermediates
US5019075A (en) 1984-10-24 1991-05-28 The Beth Israel Hospital Method and apparatus for angioplasty
US4607622A (en) 1985-04-11 1986-08-26 Charles D. Fritch Fiber optic ocular endoscope
US4619274A (en) 1985-04-18 1986-10-28 Advanced Cardiovascular Systems, Inc. Torsional guide wire with attenuated diameter
US4748986A (en) 1985-11-26 1988-06-07 Advanced Cardiovascular Systems, Inc. Floppy guide wire with opaque tip
US4691948A (en) 1985-11-27 1987-09-08 A-Dec, Inc. Fail-secure lock system
US4669469A (en) 1986-02-28 1987-06-02 Devices For Vascular Intervention Single lumen atherectomy catheter device
US5350395A (en) 1986-04-15 1994-09-27 Yock Paul G Angioplasty apparatus facilitating rapid exchanges
US4708834A (en) 1986-05-01 1987-11-24 Pharmacaps, Inc. Preparation of gelatin-encapsulated controlled release composition
US4672961A (en) 1986-05-19 1987-06-16 Davies David H Retrolasing catheter and method
CH668188A5 (en) 1986-06-09 1988-12-15 Franz Rappai Corticosteroid ointment compsns. - comprise e.g. dexamethasone in poly:alkylene glycol base, and are used esp. for treating rhinitis
US5019372A (en) 1986-06-27 1991-05-28 The Children's Medical Center Corporation Magnetically modulated polymeric drug release system
US4854330A (en) 1986-07-10 1989-08-08 Medrad, Inc. Formed core catheter guide wire assembly
US4920967A (en) 1986-07-18 1990-05-01 Pfizer Hospital Products Group, Inc. Doppler tip wire guide
US5283004A (en) * 1986-07-18 1994-02-01 Dow Corning Corporation Method for the preparation of a silicone defoamer composition
US4847258A (en) 1986-08-26 1989-07-11 Ciba-Geigy Corporation Substituted benzoylphenylureas compounds useful as pesticides
US5030227A (en) 1988-06-02 1991-07-09 Advanced Surgical Intervention, Inc. Balloon dilation catheter
US5312430A (en) 1986-12-09 1994-05-17 Rosenbluth Robert F Balloon dilation catheter
US4771776A (en) 1987-01-06 1988-09-20 Advanced Cardiovascular Systems, Inc. Dilatation catheter with angled balloon and method
US4819619A (en) 1987-01-16 1989-04-11 Augustine Scott D Device for inserting a nasal tube
US4815478A (en) 1987-02-17 1989-03-28 Medtronic Versaflex, Inc. Steerable guidewire with deflectable tip
US4736970A (en) 1987-03-09 1988-04-12 Mcgourty Thomas K Electrically controlled door lock
US4811743A (en) 1987-04-21 1989-03-14 Cordis Corporation Catheter guidewire
US4793359A (en) 1987-04-24 1988-12-27 Gv Medical, Inc. Centering balloon structure for transluminal angioplasty catheter
US4748969A (en) 1987-05-07 1988-06-07 Circon Corporation Multi-lumen core deflecting endoscope
US4867138A (en) 1987-05-13 1989-09-19 Olympus Optical Co., Ltd. Rigid electronic endoscope
US4755171A (en) 1987-05-29 1988-07-05 Tennant Jerald L Tubular surgical device
DE3719250A1 (en) 1987-06-10 1988-12-22 Kellner Hans Joerg Dr Med ENDOSCOPE
SE8704767L (en) 1987-11-30 1989-05-31 Sigmund Johannes Loefstedt NEW METHOD FOR ADMINISTRATION OF MEDICINAL PRODUCTS
US5041089A (en) 1987-12-11 1991-08-20 Devices For Vascular Intervention, Inc. Vascular dilation catheter construction
US4846186A (en) 1988-01-12 1989-07-11 Cordis Corporation Flexible guidewire
US4917667A (en) 1988-02-11 1990-04-17 Retroperfusion Systems, Inc. Retroperfusion balloon catheter and method
US5372138A (en) 1988-03-21 1994-12-13 Boston Scientific Corporation Acousting imaging catheters and the like
US4883465A (en) 1988-05-24 1989-11-28 Brennan H George Nasal tampon and method for using
US4998917A (en) 1988-05-26 1991-03-12 Advanced Cardiovascular Systems, Inc. High torque steerable dilatation catheter
US4940062A (en) 1988-05-26 1990-07-10 Advanced Cardiovascular Systems, Inc. Guiding member with deflectable tip
AU618613B2 (en) 1988-06-13 1992-01-02 Yaroslavsky Mezhotraslevoi Nauchno-Tekhnichesky Tsentr Device for diagnosing and treating nasal diseases
US5267965A (en) 1988-07-06 1993-12-07 Ethicon, Inc. Safety trocar
EP0355996A3 (en) 1988-07-21 1990-05-02 Advanced Interventional Systems, Inc. Guidance and delivery system for high-energy pulsed laser light and endoscope
US5067489A (en) 1988-08-16 1991-11-26 Flexmedics Corporation Flexible guide with safety tip
US4917419A (en) 1988-08-22 1990-04-17 Mora Jr Saturnino F Electromechanical door lock system
JPH0296072A (en) 1988-09-30 1990-04-06 Aisin Seiki Co Ltd Lid lock device
US4943275A (en) 1988-10-14 1990-07-24 Abiomed Limited Partnership Insertable balloon with curved support
JPH066342B2 (en) 1988-10-14 1994-01-26 三菱重工業株式会社 Shape memory film and its use
US4961433A (en) 1988-11-02 1990-10-09 Cardiometrics, Inc. Guide wire assembly with electrical functions and male and female connectors for use therewith
US5001825A (en) 1988-11-03 1991-03-26 Cordis Corporation Catheter guidewire fabrication method
US4998916A (en) 1989-01-09 1991-03-12 Hammerslag Julius G Steerable medical device
US5221260A (en) 1989-01-13 1993-06-22 Scimed Life Systems, Inc. Innerless dilatation balloon catheter
US5662674A (en) 1989-02-03 1997-09-02 Debbas; Elie Apparatus for locating a breast mass
US4966163A (en) 1989-02-14 1990-10-30 Advanced Cardiovascular Systems, Inc. Extendable guidewire for vascular procedures
US5024650A (en) 1989-02-15 1991-06-18 Matsushita Electric Works, Ltd. Stress dissolving refreshment system
SU1662571A1 (en) 1989-03-01 1991-07-15 Курский Государственный Медицинский Институт Process for preparing x-ray contrast agent for investigating sinuses
US4946466A (en) 1989-03-03 1990-08-07 Cordis Corporation Transluminal angioplasty apparatus
RU1768142C (en) 1989-03-29 1992-10-15 Ярославский Межотраслевой Научно-Технический Центр Device for therapy of sinuitis
US4919112B1 (en) 1989-04-07 1993-12-28 Low-cost semi-disposable endoscope
US5069226A (en) 1989-04-28 1991-12-03 Tokin Corporation Catheter guidewire with pseudo elastic shape memory alloy
US5009655A (en) 1989-05-24 1991-04-23 C. R. Bard, Inc. Hot tip device with optical diagnostic capability
KR0141688B1 (en) 1989-05-24 1998-06-15 스까다 쇼오에이 Balloon-carrying instrument for use in continuously injecting medical fluid
AU5721990A (en) 1989-06-07 1991-01-07 Ultra-Klean Ltd. Exercise and toning apparatus
US5207695A (en) 1989-06-19 1993-05-04 Trout Iii Hugh H Aortic graft, implantation device, and method for repairing aortic aneurysm
ES2081372T3 (en) 1989-06-28 1996-03-01 David S Zimmon STOPPING BALL DEVICES.
DE3927001A1 (en) 1989-08-16 1991-02-21 Lucien C Dr Med Olivier CATHETER SYSTEM
US5169386A (en) 1989-09-11 1992-12-08 Bruce B. Becker Method and catheter for dilatation of the lacrimal system
US5021043A (en) 1989-09-11 1991-06-04 C. R. Bard, Inc. Method and catheter for dilatation of the lacrimal system
DK0420488T3 (en) 1989-09-25 1993-08-30 Schneider Usa Inc Multilayer extrusion as a method for preparing angioplasty balloons
US5256144A (en) 1989-11-02 1993-10-26 Danforth Biomedical, Inc. Low profile, high performance interventional catheters
US5335671A (en) 1989-11-06 1994-08-09 Mectra Labs, Inc. Tissue removal assembly with provision for an electro-cautery device
US5026384A (en) 1989-11-07 1991-06-25 Interventional Technologies, Inc. Atherectomy systems and methods
US5112228A (en) 1989-11-13 1992-05-12 Advanced Cardiovascular Systems, Inc. Vascular model
US5215105A (en) 1989-11-14 1993-06-01 Custom Medical Concepts, Inc. Method of treating epidural lesions
US5137517A (en) 1989-11-28 1992-08-11 Scimed Life Systems, Inc. Device and method for gripping medical shaft
US5053007A (en) 1989-12-14 1991-10-01 Scimed Life Systems, Inc. Compression balloon protector for a balloon dilatation catheter and method of use thereof
US5439446A (en) 1994-06-30 1995-08-08 Boston Scientific Corporation Stent and therapeutic delivery system
US5843089A (en) 1990-12-28 1998-12-01 Boston Scientific Corporation Stent lining
US5209730A (en) * 1989-12-19 1993-05-11 Scimed Life Systems, Inc. Method for placement of a balloon dilatation catheter across a stenosis and apparatus therefor
US5156595A (en) 1989-12-28 1992-10-20 Scimed Life Systems, Inc. Dilatation balloon catheter and method of manufacturing
USD329496S (en) 1990-02-20 1992-09-15 Celia Clarke Needle depth gauge
US5060660A (en) 1990-02-28 1991-10-29 C. R. Bard, Inc. Steerable extendable guidewire with adjustable tip
US5125915A (en) 1990-03-02 1992-06-30 Cardiopulmonics, Inc. Locking y-connector for selective attachment to exterior of medical tubing
AU113882S (en) 1990-03-07 1992-05-08 Terumo Corp Catheter
US5478565A (en) 1990-03-27 1995-12-26 Warner-Lambert Company Treatment of sinus headache
US5147315A (en) 1990-04-06 1992-09-15 C. R. Bard, Inc. Access catheter and system for use in the female reproductive system
US5238004A (en) 1990-04-10 1993-08-24 Boston Scientific Corporation High elongation linear elastic guidewire
US5171233A (en) 1990-04-25 1992-12-15 Microvena Corporation Snare-type probe
WO1991017788A1 (en) 1990-05-11 1991-11-28 Saab Mark A High-strength, thin-walled single piece catheters
SE502055C2 (en) 1990-05-23 1995-07-31 Atos Medical Ab Device for applying a drainage duct
US5044678A (en) 1990-07-25 1991-09-03 Lectron Products, Inc. Solenoid operated latch device with movable pole piece
US5055051A (en) 1990-08-03 1991-10-08 Dornier Medical Systems, Inc. Semi-anthropomorphic biliary/renal training phantom for medical imaging and lithotripsy training
US5167220A (en) 1990-08-09 1992-12-01 Brown Cathy K Systems and methods for maintaining a clear visual field during endoscopic procedures
US5163989A (en) 1990-08-27 1992-11-17 Advanced Cardiovascular Systems, Inc. Method for forming a balloon mold and the use of such mold
US5345945A (en) 1990-08-29 1994-09-13 Baxter International Inc. Dual coil guidewire with radiopaque distal tip
US5197457A (en) 1990-09-12 1993-03-30 Adair Edwin Lloyd Deformable and removable sheath for optical catheter
JP2699641B2 (en) 1990-10-11 1998-01-19 日本電気株式会社 Phase jitter suppression circuit
JPH0683726B2 (en) 1990-10-12 1994-10-26 日本精線株式会社 Guide wire for catheter
US5169043A (en) 1990-12-12 1992-12-08 Catania Claude L Versatile carrying bag
US5341818A (en) 1992-12-22 1994-08-30 Advanced Cardiovascular Systems, Inc. Guidewire with superelastic distal portion
EP0491349B1 (en) 1990-12-18 1998-03-18 Advanced Cardiovascular Systems, Inc. Method of manufacturing a Superelastic guiding member
US5102402A (en) 1991-01-04 1992-04-07 Medtronic, Inc. Releasable coatings on balloon catheters
US5368558A (en) 1991-01-11 1994-11-29 Baxter International Inc. Ultrasonic ablation catheter device having endoscopic component and method of using same
US6006126A (en) 1991-01-28 1999-12-21 Cosman; Eric R. System and method for stereotactic registration of image scan data
US5465717A (en) 1991-02-15 1995-11-14 Cardiac Pathways Corporation Apparatus and Method for ventricular mapping and ablation
US5139510A (en) 1991-02-22 1992-08-18 Xomed-Treace Inc. Nasal packing device
AU1579092A (en) 1991-02-27 1992-10-06 Nova Pharmaceutical Corporation Anti-infective and anti-inflammatory releasing systems for medical devices
US5195168A (en) 1991-03-15 1993-03-16 Codex Corporation Speech coder and method having spectral interpolation and fast codebook search
US6733473B1 (en) 1991-04-05 2004-05-11 Boston Scientific Corporation Adjustably stiffenable convertible catheter assembly
US5211952A (en) 1991-04-12 1993-05-18 University Of Southern California Contraceptive methods and formulations for use therein
US5226302A (en) 1991-04-15 1993-07-13 Loctec Corporation Six-way self-adjusting lock for use on truck storage boxes and the like
CA2069052A1 (en) 1991-05-21 1992-11-22 L. Venkata Raman Superelastic formable guidewire
US5127393A (en) 1991-05-28 1992-07-07 Medilase, Inc. Flexible endoscope with rigid introducer
US5429582A (en) 1991-06-14 1995-07-04 Williams; Jeffery A. Tumor treatment
CA2068584C (en) 1991-06-18 1997-04-22 Paul H. Burmeister Intravascular guide wire and method for manufacture thereof
US5264260A (en) 1991-06-20 1993-11-23 Saab Mark A Dilatation balloon fabricated from low molecular weight polymers
US5236422A (en) 1991-06-24 1993-08-17 Eplett Jr James D Antiseptic urinary catheter cuff
US5766151A (en) 1991-07-16 1998-06-16 Heartport, Inc. Endovascular system for arresting the heart
US5269752A (en) 1991-09-12 1993-12-14 Bennett Laurence M Method of extracorporeal treatment using a kink resistant catheter
US5252183A (en) 1991-09-13 1993-10-12 Abb Lummus Crest Inc. Process of pulping and bleaching fibrous plant material with tert-butyl alcohol and tert-butyl peroxide
US5168864A (en) 1991-09-26 1992-12-08 Clarus Medical Systems, Inc. Deflectable endoscope
US5304123A (en) 1991-10-24 1994-04-19 Children's Medical Center Corporation Detachable balloon catheter for endoscopic treatment of vesicoureteral reflux
US5333620A (en) 1991-10-30 1994-08-02 C. R. Bard, Inc. High performance plastic coated medical guidewire
US5290310A (en) 1991-10-30 1994-03-01 Howmedica, Inc. Hemostatic implant introducer
US5246016A (en) 1991-11-08 1993-09-21 Baxter International Inc. Transport catheter and multiple probe analysis method
US5251092A (en) 1991-11-27 1993-10-05 Protek Devices, Lp Receptacle assembly with both insulation displacement connector bussing and friction connector coupling of power conductors to surge suppressor circuit
US5286524A (en) * 1991-12-13 1994-02-15 General Electric Company Method for producing CVD diamond film substantially free of thermal stress-induced cracks
US5243996A (en) 1992-01-03 1993-09-14 Cook, Incorporated Small-diameter superelastic wire guide
US6109268A (en) 1995-06-07 2000-08-29 Arthrocare Corporation Systems and methods for electrosurgical endoscopic sinus surgery
US6190381B1 (en) 1995-06-07 2001-02-20 Arthrocare Corporation Methods for tissue resection, ablation and aspiration
US6063079A (en) 1995-06-07 2000-05-16 Arthrocare Corporation Methods for electrosurgical treatment of turbinates
US6086585A (en) 1995-06-07 2000-07-11 Arthrocare Corporation System and methods for electrosurgical treatment of sleep obstructive disorders
US6053172A (en) 1995-06-07 2000-04-25 Arthrocare Corporation Systems and methods for electrosurgical sinus surgery
US5273052A (en) 1992-01-08 1993-12-28 Danforth Biomedical, Incorporated Guidewire with reversible contact seal for releasable securement to catheter
CA2117386A1 (en) 1992-01-09 1993-07-22 Motasim M. Sirhan Guidewire replacement device
US5250059A (en) 1992-01-22 1993-10-05 Devices For Vascular Intervention, Inc. Atherectomy catheter having flexible nose cone
US5699796A (en) 1993-01-29 1997-12-23 Cardima, Inc. High resolution intravascular signal detection
US5341240A (en) 1992-02-06 1994-08-23 Linvatec Corporation Disposable endoscope
JPH05211985A (en) 1992-02-07 1993-08-24 Olympus Optical Co Ltd Endoscope guide apparatus for cerebral ventricle
US5263926A (en) 1992-02-18 1993-11-23 Wilk Peter J Device and related method for reducing swelling of hemorrhoidal tissues
US5409444A (en) 1992-03-04 1995-04-25 Kensey Nash Corporation Method and apparatus to reduce injury to the vascular system
DE69326631T2 (en) 1992-03-19 2000-06-08 Medtronic Inc Intraluminal expansion device
US5346075A (en) 1992-04-17 1994-09-13 Johnson & Johnson Medical, Inc. Apparatus and method for holding a medical instrument
US5368566A (en) 1992-04-29 1994-11-29 Cardiovascular Dynamics, Inc. Delivery and temporary stent catheter having a reinforced perfusion lumen
US5817102A (en) 1992-05-08 1998-10-06 Schneider (Usa) Inc. Apparatus for delivering and deploying a stent
US5584827A (en) 1992-05-18 1996-12-17 Ultracell Medical Technologies, Inc Nasal-packing article
US5713848A (en) 1993-05-19 1998-02-03 Dubrul; Will R. Vibrating catheter
US5772680A (en) 1992-06-02 1998-06-30 General Surgical Innovations, Inc. Apparatus and method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization
US5255679A (en) 1992-06-02 1993-10-26 Cardiac Pathways Corporation Endocardial catheter for mapping and/or ablation with an expandable basket structure having means for providing selective reinforcement and pressure sensing mechanism for use therewith, and method
US5324284A (en) 1992-06-05 1994-06-28 Cardiac Pathways, Inc. Endocardial mapping and ablation system utilizing a separately controlled ablation catheter and method
US5348537A (en) 1992-07-15 1994-09-20 Advanced Cardiovascular Systems, Inc. Catheter with intraluminal sealing element
US5313967A (en) 1992-07-24 1994-05-24 Medtronic, Inc. Helical guidewire
ATE182273T1 (en) 1992-08-18 1999-08-15 Spectranetics Corp GUIDE WIRE WITH FIBER OPTICS
US5647361A (en) 1992-09-28 1997-07-15 Fonar Corporation Magnetic resonance imaging method and apparatus for guiding invasive therapy
ATE198159T1 (en) 1992-10-15 2001-01-15 Gen Hospital Corp INFUSION PUMP WITH ELECTRONICALLY LOADABLE MEDICATION LIBRARY
US5356418A (en) 1992-10-28 1994-10-18 Shturman Cardiology Systems, Inc. Apparatus and method for rotational atherectomy
US5295694A (en) 1992-10-27 1994-03-22 Levin John M Laparoscopic surgery simulating game
US5336178A (en) 1992-11-02 1994-08-09 Localmed, Inc. Intravascular catheter with infusion array
US5314408A (en) 1992-11-13 1994-05-24 Cardiovascular Imaging Systems, Inc. Expandable member for a catheter system
US5549542A (en) 1992-11-17 1996-08-27 Life Medical Technologies, Inc. Deflectable endoscope
US5314417A (en) 1992-12-22 1994-05-24 Ethicon, Inc. Safety trocar
US5368564A (en) 1992-12-23 1994-11-29 Angeion Corporation Steerable catheter
US5336163A (en) 1993-01-06 1994-08-09 Smith & Nephew Richards, Inc. Expandable nasal stent
CN2151720Y (en) 1993-01-08 1994-01-05 陈吉峰 Hemostat for nasal cavity and nasopharynx cavity
WO1994015533A2 (en) 1993-01-18 1994-07-21 John Crowe Endoscope forceps
JP3345147B2 (en) 1993-01-26 2002-11-18 テルモ株式会社 Vasodilators and catheters
US5407433A (en) 1993-02-10 1995-04-18 Origin Medsystems, Inc. Gas-tight seal accommodating surgical instruments with a wide range of diameters
US5329927A (en) 1993-02-25 1994-07-19 Echo Cath, Inc. Apparatus and method for locating an interventional medical device with a ultrasound color imaging system
WO1994021320A1 (en) 1993-03-15 1994-09-29 Advanced Cardiovascular Systems, Inc. Fluid delivery catheter
US5318528A (en) 1993-04-13 1994-06-07 Advanced Surgical Inc. Steerable surgical devices
JP3553067B2 (en) 1993-04-13 2004-08-11 ボストン・サイエンティフィック・リミテッド Prosthesis introduction device with extended tip
US5985307A (en) 1993-04-14 1999-11-16 Emory University Device and method for non-occlusive localized drug delivery
US5350396A (en) 1993-04-15 1994-09-27 Hood Laboratories Nasal splint
US5464650A (en) 1993-04-26 1995-11-07 Medtronic, Inc. Intravascular stent and method
US5824048A (en) 1993-04-26 1998-10-20 Medtronic, Inc. Method for delivering a therapeutic substance to a body lumen
ATE161819T1 (en) 1993-04-27 1998-01-15 Solvay Fluor & Derivate METHOD FOR PRODUCING CARBOXYLIC ACID ESTERS FROM CARBOXYLIC ACID HALIDES AND ALCOHOLS
US5346508A (en) 1993-04-29 1994-09-13 Scimed Life Systems, Inc. Apparatus and method for performing diagnostics and intravascular therapies
US5617870A (en) 1993-04-29 1997-04-08 Scimed Life Systems, Inc. Intravascular flow measurement system
US5450853A (en) 1993-10-22 1995-09-19 Scimed Life Systems, Inc. Pressure sensor
US5873835A (en) 1993-04-29 1999-02-23 Scimed Life Systems, Inc. Intravascular pressure and flow sensor
US6832996B2 (en) 1995-06-07 2004-12-21 Arthrocare Corporation Electrosurgical systems and methods for treating tissue
DE4315821A1 (en) 1993-05-12 1994-11-17 Christian Dr Med Milewski Device for tamponade and for keeping open bone-restricted body cavities and passages after surgical manipulation
US5334187A (en) 1993-05-21 1994-08-02 Cathco, Inc. Balloon catheter system with slit opening handle
US5372584A (en) 1993-06-24 1994-12-13 Ovamed Corporation Hysterosalpingography and selective salpingography
JP3337272B2 (en) 1993-06-29 2002-10-21 株式会社町田製作所 Medical equipment
US5402799A (en) 1993-06-29 1995-04-04 Cordis Corporation Guidewire having flexible floppy tip
US5964745A (en) * 1993-07-02 1999-10-12 Med Usa Implantable system for cell growth control
WO1995002430A1 (en) 1993-07-15 1995-01-26 Advanced Cardiovascular Systems, Inc. Rapid exchange type intraluminal catheter with guiding element
US5472449A (en) 1993-07-26 1995-12-05 Chou; Kuei C. Permanent pigment applicator having a detachable needle coupler
US5415633A (en) 1993-07-28 1995-05-16 Active Control Experts, Inc. Remotely steered catheterization device
US5441494A (en) 1993-07-29 1995-08-15 Ethicon, Inc. Manipulable hand for laparoscopy
US6277107B1 (en) 1993-08-13 2001-08-21 Daig Corporation Guiding introducer for introducing medical devices into the coronary sinus and process for using same
US5562619A (en) 1993-08-19 1996-10-08 Boston Scientific Corporation Deflectable catheter
US5578048A (en) 1993-09-15 1996-11-26 United States Surgical Corporation Manipulator apparatus
EP0722286B1 (en) 1993-09-20 2002-08-21 Boston Scientific Corporation Multiple biopsy sampling device
US5607386A (en) 1993-09-21 1997-03-04 Flam; Gary H. Malleable fiberoptic intubating stylet and method
US5558091A (en) 1993-10-06 1996-09-24 Biosense, Inc. Magnetic determination of position and orientation
US5400783A (en) 1993-10-12 1995-03-28 Cardiac Pathways Corporation Endocardial mapping apparatus with rotatable arm and method
US5465733A (en) 1993-10-14 1995-11-14 Hinohara; Tomoaki Guide wire for catheters and method for its use
US5445646A (en) 1993-10-22 1995-08-29 Scimed Lifesystems, Inc. Single layer hydraulic sheath stent delivery apparatus and method
US5437282A (en) 1993-10-29 1995-08-01 Boston Scientific Corporation Drive shaft for acoustic imaging catheters and flexible catheters
US5507301A (en) 1993-11-19 1996-04-16 Advanced Cardiovascular Systems, Inc. Catheter and guidewire system with flexible distal portions
US5459700A (en) 1993-11-22 1995-10-17 Advanced Cardiovascular Systems, Inc. Manual timer control for inflation device
US5451221A (en) 1993-12-27 1995-09-19 Cynosure, Inc. Endoscopic light delivery system
US6716216B1 (en) 1998-08-14 2004-04-06 Kyphon Inc. Systems and methods for treating vertebral bodies
US5538510A (en) 1994-01-31 1996-07-23 Cordis Corporation Catheter having coextruded tubing
SE9400364D0 (en) 1994-02-02 1994-02-02 Sven Eric Stangerup Nasal catheter and procedure for the treatment of nasal bleeding
US5904701A (en) 1994-02-14 1999-05-18 Daneshvar; Yousef Device for aiding procedural and therapeutic interventions of the gastrointestinal tract
DE4405720C1 (en) 1994-02-23 1995-10-19 Wolf Gmbh Richard Instrument for endoscopic therapy of carpal tunnel syndrome
AUPM409094A0 (en) 1994-02-25 1994-03-24 Trimec Securities Pty. Limited Improvements in electromagnetic locks
US5582167A (en) 1994-03-02 1996-12-10 Thomas Jefferson University Methods and apparatus for reducing tracheal infection using subglottic irrigation, drainage and servoregulation of endotracheal tube cuff pressure
US5425370A (en) 1994-03-23 1995-06-20 Echocath, Inc. Method and apparatus for locating vibrating devices
US5887467A (en) 1994-03-30 1999-03-30 U-Code, Inc. Pawl & solenoid locking mechanism
US5454817A (en) 1994-04-11 1995-10-03 Katz; David L. Oto-nasal foreign body extractor
US5533985A (en) 1994-04-20 1996-07-09 Wang; James C. Tubing
US5507795A (en) 1994-04-29 1996-04-16 Devices For Vascular Intervention, Inc. Catheter with perfusion system
US6139510A (en) 1994-05-11 2000-10-31 Target Therapeutics Inc. Super elastic alloy guidewire
US5824044A (en) 1994-05-12 1998-10-20 Endovascular Technologies, Inc. Bifurcated multicapsule intraluminal grafting system
US5551946A (en) 1994-05-17 1996-09-03 Bullard; James R. Multifunctional intubating guide stylet and laryngoscope
US5497783A (en) 1994-05-18 1996-03-12 Scimed Life Systems, Inc. Guidewire having radioscopic tip
US5569183A (en) 1994-06-01 1996-10-29 Archimedes Surgical, Inc. Method for performing surgery around a viewing space in the interior of the body
JPH07327916A (en) 1994-06-02 1995-12-19 Olympus Optical Co Ltd Visual field direction varying type endoscope
DE69532503T2 (en) 1994-06-17 2004-11-04 Hisamitsu Pharmaceutical Co., Inc., Tosu ELECTRODE FOR IONTOPHORESIS AND DEVICE THEREFOR
US5633000A (en) 1994-06-23 1997-05-27 Axxia Technologies Subcutaneous implant
US5458572A (en) 1994-07-01 1995-10-17 Boston Scientific Corp. Catheter with balloon folding into predetermined configurations and method of manufacture
US5441497A (en) 1994-07-14 1995-08-15 Pdt Cardiovascular, Inc. Light diffusing guidewire
US6579285B2 (en) 1994-09-09 2003-06-17 Cardiofocus, Inc. Photoablation with infrared radiation
US5803089A (en) 1994-09-15 1998-09-08 Visualization Technology, Inc. Position tracking and imaging system for use in medical applications
US5673707A (en) 1994-09-23 1997-10-07 Boston Scientific Corporation Enhanced performance guidewire
US5558652A (en) 1994-10-06 1996-09-24 B. Braun Medical, Inc. Introducer with radiopaque marked tip and method of manufacture therefor
US5722401A (en) 1994-10-19 1998-03-03 Cardiac Pathways Corporation Endocardial mapping and/or ablation catheter probe
US6458070B1 (en) * 1994-10-27 2002-10-01 Novoste Corporation Method and apparatus for treating a desired area in the vascular system of a patient
US5814029A (en) 1994-11-03 1998-09-29 Daig Corporation Guiding introducer system for use in ablation and mapping procedures in the left ventricle
CA2204789C (en) 1994-11-10 2002-11-12 Paul Ashton Implantable refillable controlled release device to deliver drugs directly to an internal portion of the body
US6059752A (en) 1994-12-09 2000-05-09 Segal; Jerome Mechanical apparatus and method for dilating and irradiating a site of treatment
US5637113A (en) 1994-12-13 1997-06-10 Advanced Cardiovascular Systems, Inc. Polymer film for wrapping a stent structure
US5664580A (en) 1995-01-31 1997-09-09 Microvena Corporation Guidewire having bimetallic coil
US6830785B1 (en) 1995-03-20 2004-12-14 Toto Ltd. Method for photocatalytically rendering a surface of a substrate superhydrophilic, a substrate with a superhydrophilic photocatalytic surface, and method of making thereof
WO1996029071A1 (en) 1995-03-21 1996-09-26 Ramot University Authority For Applied Research & Industrial Development Ltd. Uses of antibacterial compounds
DE820258T1 (en) 1995-03-23 1998-04-30 Advanced Animal Technology Ltd SUBSTANCE DELIVERY DEVICE
DE69626105T2 (en) 1995-03-30 2003-10-23 Heartport Inc ENDOVASCULAR CATHETER FOR LEADING FROM THE HEART
KR960032597U (en) 1995-03-31 1996-10-24 Tape recorder reservation recording switch
US5685838A (en) 1995-04-17 1997-11-11 Xomed-Treace, Inc. Sinus debrider apparatus
US5837313A (en) 1995-04-19 1998-11-17 Schneider (Usa) Inc Drug release stent coating process
US6638291B1 (en) 1995-04-20 2003-10-28 Micrus Corporation Three dimensional, low friction vasoocclusive coil, and method of manufacture
US5752522A (en) * 1995-05-04 1998-05-19 Cardiovascular Concepts, Inc. Lesion diameter measurement catheter and method
US6122541A (en) 1995-05-04 2000-09-19 Radionics, Inc. Head band for frameless stereotactic registration
US5735817A (en) 1995-05-19 1998-04-07 Shantha; T. R. Apparatus for transsphenoidal stimulation of the pituitary gland and adjoining brain structures
US5656030A (en) 1995-05-22 1997-08-12 Boston Scientific Corporation Bidirectional steerable catheter with deflectable distal tip
JPH08317989A (en) 1995-05-24 1996-12-03 Piolax Inc Guide wire for medical care
US5833650A (en) 1995-06-05 1998-11-10 Percusurge, Inc. Catheter apparatus and method for treating occluded vessels
US5729129A (en) 1995-06-07 1998-03-17 Biosense, Inc. Magnetic location system with feedback adjustment of magnetic field generator
US5752513A (en) 1995-06-07 1998-05-19 Biosense, Inc. Method and apparatus for determining position of object
US6238391B1 (en) 1995-06-07 2001-05-29 Arthrocare Corporation Systems for tissue resection, ablation and aspiration
WO1996040342A1 (en) 1995-06-07 1996-12-19 Cardima, Inc. Guiding catheter for coronary sinus
US6258046B1 (en) 1995-07-06 2001-07-10 Institute Of Critical Care Medicine Method and device for assessing perfusion failure in a patient by measurement of blood flow
US5645789A (en) 1995-07-20 1997-07-08 Navius Corporation Distensible pet balloon and method of manufacture
US5638819A (en) 1995-08-29 1997-06-17 Manwaring; Kim H. Method and apparatus for guiding an instrument to a target
US5669388A (en) 1995-09-06 1997-09-23 Echocath, Inc. Apparatus and method for automatic placement of transducer
GB2305174A (en) 1995-09-15 1997-04-02 Zeneca Ltd Chemical process
US6027461A (en) 1995-10-11 2000-02-22 Micro Therapeutics, Inc. Infusion guidewire having fixed core wire and flexible radiopaque marker
US6302875B1 (en) 1996-10-11 2001-10-16 Transvascular, Inc. Catheters and related devices for forming passageways between blood vessels or other anatomical structures
US6375615B1 (en) 1995-10-13 2002-04-23 Transvascular, Inc. Tissue penetrating catheters having integral imaging transducers and their methods of use
DE69633411T2 (en) 1995-10-13 2005-10-20 Transvascular, Inc., Menlo Park METHOD AND DEVICE FOR PREVENTING ARTERIAL ATTRACTIONS AND / OR FOR CARRYING OUT OTHER TRANSVASCULAR INTERVENTIONS
US5916149A (en) 1995-10-25 1999-06-29 Ryan, Jr.; Edwin H. Shielded illumination device for ophthalmic surgery and the like
US6113567A (en) 1995-10-25 2000-09-05 Becker; Bruce B. Lacrimal silicone tube with reduced friction
US6287315B1 (en) 1995-10-30 2001-09-11 World Medical Manufacturing Corporation Apparatus for delivering an endoluminal prosthesis
US6019736A (en) 1995-11-06 2000-02-01 Francisco J. Avellanet Guidewire for catheter
US5749848A (en) 1995-11-13 1998-05-12 Cardiovascular Imaging Systems, Inc. Catheter system having imaging, balloon angioplasty, and stent deployment capabilities, and method of use for guided stent deployment
US5843050A (en) 1995-11-13 1998-12-01 Micro Therapeutics, Inc. Microcatheter
US5827224A (en) 1995-11-22 1998-10-27 Shippert; Ronald D. Pressure applying fluid transfer medical device
FI100318B (en) 1995-11-23 1997-11-14 Fiskars Consumer Oy Ab Articulated hand tools
US5733248A (en) 1995-11-29 1998-03-31 Scimed Life Systems, Inc. Universal guide catheter
AU712539B2 (en) * 1996-01-08 1999-11-11 Biosense, Inc. Methods and apparatus for myocardial revascularization
US5722984A (en) 1996-01-16 1998-03-03 Iso Stent, Inc. Antithrombogenic radioactive coating for an intravascular stent
US6039699A (en) 1996-01-22 2000-03-21 Cordis Corporation Stiff catheter guidewire with flexible distal portion
CA2246287C (en) 1996-02-15 2006-10-24 Biosense, Inc. Medical procedures and apparatus using intrabody probes
US6860264B2 (en) 1996-02-26 2005-03-01 Evergreen Medical Incorporated Method and apparatus for endotracheal intubation using a light wand and curved guide
US5817013A (en) 1996-03-19 1998-10-06 Enable Medical Corporation Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like
US5682199A (en) 1996-03-28 1997-10-28 Jedmed Instrument Company Video endoscope with interchangeable endoscope heads
US5779699A (en) 1996-03-29 1998-07-14 Medtronic, Inc. Slip resistant field focusing ablation catheter electrode
US5980503A (en) 1996-04-08 1999-11-09 Guidant Corporation Endoscopic cardioplegia infusion cannula and method of use
EP0892625B1 (en) 1996-04-10 2000-06-21 Curaden Ag Apparatus of determining the approximal passability of an interdental space
US6171298B1 (en) * 1996-05-03 2001-01-09 Situs Corporation Intravesical infuser
US7022105B1 (en) 1996-05-06 2006-04-04 Novasys Medical Inc. Treatment of tissue in sphincters, sinuses and orifices
US6503087B1 (en) * 1996-05-08 2003-01-07 Gaumard Scientific, Inc. Interactive education system for teaching patient care
US6050972A (en) 1996-05-20 2000-04-18 Percusurge, Inc. Guidewire inflation system
US6652480B1 (en) 1997-03-06 2003-11-25 Medtronic Ave., Inc. Methods for reducing distal embolization
US5693065A (en) 1996-06-25 1997-12-02 Rains, Iii; B. Manrin Frontal sinus stent
US6167296A (en) 1996-06-28 2000-12-26 The Board Of Trustees Of The Leland Stanford Junior University Method for volumetric image navigation
US5789391A (en) 1996-07-03 1998-08-04 Inspire Pharmaceuticals, Inc. Method of treating sinusitis with uridine triphosphates and related compounds
JPH1024098A (en) 1996-07-10 1998-01-27 Terumo Corp Balloon and balloon catheter
US5664567A (en) 1996-07-16 1997-09-09 Linder; Gerald S. Fenestrated nasopharyngeal airway for drainage
US6569147B1 (en) 1996-07-26 2003-05-27 Kensey Nash Corporation Systems and methods of use for delivering beneficial agents for revascularizing stenotic bypass grafts and other occluded blood vessels and for other purposes
US6126682A (en) 1996-08-13 2000-10-03 Oratec Interventions, Inc. Method for treating annular fissures in intervertebral discs
US5797878A (en) 1996-08-15 1998-08-25 Guidant Corporation Catheter having optimized balloon taper angle
US5833682A (en) 1996-08-26 1998-11-10 Illumenex Corporation Light delivery system with blood flushing capability
US5843113A (en) 1996-10-08 1998-12-01 High; Kenneth Endocystotomy tool
US5971975A (en) 1996-10-09 1999-10-26 Target Therapeutics, Inc. Guide catheter with enhanced guidewire tracking
US6016439A (en) * 1996-10-15 2000-01-18 Biosense, Inc. Method and apparatus for synthetic viewpoint imaging
US5820568A (en) 1996-10-15 1998-10-13 Cardiac Pathways Corporation Apparatus and method for aiding in the positioning of a catheter
US5779669A (en) 1996-10-28 1998-07-14 C. R. Bard, Inc. Steerable catheter with fixed curve
US6913763B2 (en) 1996-11-19 2005-07-05 Intrabrain International Nv Method and device for enhanced delivery of a biologically active agent through the spinal spaces into the central nervous system of a mammal
US5836638A (en) 1996-12-09 1998-11-17 Illinois Tool Works Inc. Fuel door assembly
US5830188A (en) 1996-12-11 1998-11-03 Board Of Regents, The University Of Texas System Curved cannula for continuous spinal anesthesia
US5766194A (en) 1996-12-23 1998-06-16 Georgia Skin And Cancer Clinic, Pc Surgical apparatus for tissue removal
US5935061A (en) 1997-01-03 1999-08-10 Biosense, Inc. Obstetrical instrument system and method
US6007516A (en) 1997-01-21 1999-12-28 Vasca, Inc. Valve port and method for vascular access
US5980551A (en) 1997-02-07 1999-11-09 Endovasc Ltd., Inc. Composition and method for making a biodegradable drug delivery stent
US6669689B2 (en) 1997-02-27 2003-12-30 Cryocath Technologies Inc. Cryosurgical catheter
US5879324A (en) 1997-03-06 1999-03-09 Von Hoffmann; Gerard Low profile catheter shaft
AU6688398A (en) 1997-03-06 1998-09-22 Percusurge, Inc. Intravascular aspiration system
US6190332B1 (en) 1998-02-19 2001-02-20 Percusurge, Inc. Core wire with shapeable tip
US6159170A (en) 1997-03-13 2000-12-12 Borodulin; German Universal mechanical dilator combined with massaging action
US6007991A (en) 1997-03-28 1999-12-28 The Research Foundation Of Suny Antisense oligonucleotides for mitogen-activated protein kinases as therapy for cancer
US6524299B1 (en) 1997-04-09 2003-02-25 Target Therapeutics, Inc. Flow-directed catheter
US5941816A (en) 1997-04-15 1999-08-24 Clarus Medical Systems, Inc. Viewing system with adapter handle for medical breathing tubes
US6019777A (en) 1997-04-21 2000-02-01 Advanced Cardiovascular Systems, Inc. Catheter and method for a stent delivery system
US6016429A (en) * 1997-05-28 2000-01-18 Northern Telecom Limited Method and apparatus for minimizing cellular network costs when upgrading the electronics in an existing cellular system
EP0988081A1 (en) 1997-06-04 2000-03-29 Advanced Cardiovascular Systems, Inc. Steerable guidewire with enhanced distal support
US5997562A (en) 1997-06-13 1999-12-07 Percusurge, Inc. Medical wire introducer and balloon protective sheath
US5938660A (en) 1997-06-27 1999-08-17 Daig Corporation Process and device for the treatment of atrial arrhythmia
DE19728273C1 (en) 1997-07-02 1998-12-10 Fuss Fritz Gmbh & Co Locking device for furniture
US6514249B1 (en) 1997-07-08 2003-02-04 Atrionix, Inc. Positioning system and method for orienting an ablation element within a pulmonary vein ostium
US6432986B2 (en) 1997-07-21 2002-08-13 Bruce H. Levin Compositions, kits, and methods for inhibiting cerebral neurovascular disorders and muscular headaches
US20010004644A1 (en) 1997-07-21 2001-06-21 Levin Bruce H. Compositions, kits, apparatus, and methods for inhibiting cephalic inflammation
US7799337B2 (en) 1997-07-21 2010-09-21 Levin Bruce H Method for directed intranasal administration of a composition
US5928192A (en) 1997-07-24 1999-07-27 Embol-X, Inc. Arterial aspiration
US5908407A (en) 1997-07-25 1999-06-01 Neuroperfusion, Inc. Retroperfusion catheter apparatus and method
DE19732031C1 (en) 1997-07-25 1999-04-22 Solvay Fluor & Derivate 2-phase production of carboxylic acid esters
US6015414A (en) * 1997-08-29 2000-01-18 Stereotaxis, Inc. Method and apparatus for magnetically controlling motion direction of a mechanically pushed catheter
US5902247A (en) 1997-09-09 1999-05-11 Bioenterics Corporation Transilluminating catheter
US6066149A (en) * 1997-09-30 2000-05-23 Target Therapeutics, Inc. Mechanical clot treatment device with distal filter
JP2001518328A (en) 1997-10-01 2001-10-16 ボストン サイエンティフィック リミテッド Expansion system and related methods
US6027478A (en) 1997-10-09 2000-02-22 Medical Purchasing Group, Inc. Nasal cavity drainage and stoppage system
US6042561A (en) 1997-10-22 2000-03-28 Ash Medical Systems, Inc. Non-intravascular infusion access device
US6056702A (en) 1998-10-02 2000-05-02 Cordis Corporation Guidewire with outer sheath
JP4121615B2 (en) 1997-10-31 2008-07-23 オリンパス株式会社 Endoscope
FR2770409B1 (en) 1997-10-31 2000-06-23 Soprane Sa UNIVERSAL CATHETER
US6048299A (en) 1997-11-07 2000-04-11 Radiance Medical Systems, Inc. Radiation delivery catheter
US6179811B1 (en) * 1997-11-25 2001-01-30 Medtronic, Inc. Imbedded marker and flexible guide wire shaft
EP0920882A3 (en) 1997-12-04 2000-01-05 Schneider Inc. Balloon dilatation-drug delivery catheter and stent deployment-drug delivery catheter in rapid exchange configuration
WO1999029363A1 (en) 1997-12-08 1999-06-17 Cardeon Corporation Aortic catheter and methods for inducing cardioplegic arrest and for selective aortic perfusion
WO1999030655A1 (en) 1997-12-15 1999-06-24 Arthrocare Corporation Systems and methods for electrosurgical treatment of the head and neck
AU1720199A (en) 1997-12-23 1999-07-12 Somnus Medical Technologies, Inc. Apparatus for reducing tissue volumes by the use of energy
US6093150A (en) 1997-12-31 2000-07-25 Acuson Corporation Ultrasound otoscope
US7008412B2 (en) 1998-01-06 2006-03-07 Cathlogic, Inc. Subcutaneous port catheter system and associated method
US5989231A (en) 1998-01-15 1999-11-23 Scimed Life Systems, Inc. Optical gastrostomy and jejunostomy
US6159178A (en) 1998-01-23 2000-12-12 Heartport, Inc. Methods and devices for occluding the ascending aorta and maintaining circulation of oxygenated blood in the patient when the patient's heart is arrested
US6295990B1 (en) 1998-02-03 2001-10-02 Salient Interventional Systems, Inc. Methods and systems for treating ischemia
US6083188A (en) 1998-02-04 2000-07-04 Becker; Bruce B. Lacrimal silicone stent with very large diameter segment insertable transnasally
US7371210B2 (en) 1998-02-24 2008-05-13 Hansen Medical, Inc. Flexible instrument
US6176829B1 (en) * 1998-02-26 2001-01-23 Echocath, Inc. Multi-beam diffraction grating imager apparatus and method
US6183461B1 (en) 1998-03-11 2001-02-06 Situs Corporation Method for delivering a medication
JPH11265567A (en) 1998-03-17 1999-09-28 Mitsumi Electric Co Ltd Disk drive
DE19813383A1 (en) 1998-03-26 1999-10-07 Storz Karl Gmbh & Co Device with a transmitter unit, via which the position of a medical instrument can be detected in the context of a CAS system
WO1999049910A2 (en) 1998-03-31 1999-10-07 Transvascular, Inc. Transvascular catheters having imaging transducers
US6013019A (en) * 1998-04-06 2000-01-11 Isostent, Inc. Temporary radioisotope stent
US6364856B1 (en) 1998-04-14 2002-04-02 Boston Scientific Corporation Medical device with sponge coating for controlled drug release
US5968085A (en) 1998-04-20 1999-10-19 Medtronic, Inc. Pacing lead with integral guidance using ultrasound
US6450989B2 (en) 1998-04-27 2002-09-17 Artemis Medical, Inc. Dilating and support apparatus with disease inhibitors and methods for use
US6175752B1 (en) 1998-04-30 2001-01-16 Therasense, Inc. Analyte monitoring device and methods of use
US6306105B1 (en) 1998-05-14 2001-10-23 Scimed Life Systems, Inc. High performance coil wire
US6280411B1 (en) 1998-05-18 2001-08-28 Scimed Life Systems, Inc. Localized delivery of drug agents
US6183464B1 (en) 1998-06-01 2001-02-06 Inviro Medical Devices Ltd. Safety syringe with retractable needle and universal luer coupling
US6048358A (en) 1998-07-13 2000-04-11 Barak; Shlomo Method and apparatus for hemostasis following arterial catheterization
US6290689B1 (en) 1999-10-22 2001-09-18 Corazón Technologies, Inc. Catheter devices and methods for their use in the treatment of calcified vascular occlusions
US6352503B1 (en) 1998-07-17 2002-03-05 Olympus Optical Co., Ltd. Endoscopic surgery apparatus
US5979290A (en) 1998-07-20 1999-11-09 Simeone; Salvatore Mine clearing device
US6226542B1 (en) 1998-07-24 2001-05-01 Biosense, Inc. Three-dimensional reconstruction of intrabody organs
NL1009738C2 (en) 1998-07-24 2000-01-25 Cordis Europ Balloon catheter with filler for stent delivery.
US20040064105A1 (en) 2002-09-27 2004-04-01 Capes David Francis Single-use syringe
US5954694A (en) 1998-08-07 1999-09-21 Embol-X, Inc. Nested tubing sections and methods for making same
US6168586B1 (en) 1998-08-07 2001-01-02 Embol-X, Inc. Inflatable cannula and method of using same
CN2352818Y (en) 1998-08-12 1999-12-08 李平 Medical use light guide
US6152943A (en) 1998-08-14 2000-11-28 Incept Llc Methods and apparatus for intraluminal deposition of hydrogels
JP3244660B2 (en) 1998-08-17 2002-01-07 旭光学工業株式会社 Endoscope treatment tool
WO2000009192A1 (en) 1998-08-17 2000-02-24 Kazuhiro Noda Operation balloon
USD413629S (en) 1998-08-18 1999-09-07 HA-LO Industries, Inc. Nasal tract model
KR100618932B1 (en) 1998-08-19 2006-09-04 쿡 인코포레이티드 Preformed wire guide
US6149213A (en) 1998-10-01 2000-11-21 Southco, Inc. Blind latch keeper
US6613066B1 (en) 1998-10-05 2003-09-02 Kaneka Corporation Balloon catheter and production method therefor
EP1123068A1 (en) 1998-10-21 2001-08-16 John T. Frauens Apparatus for percutaneous interposition balloon arthroplasty
WO2000027461A1 (en) 1998-11-09 2000-05-18 Datascope Investment Corp. Intra-aortic balloon catheter having an ultra-thin stretch blow molded balloon membrane
US6174280B1 (en) * 1998-11-19 2001-01-16 Vision Sciences, Inc. Sheath for protecting and altering the bending characteristics of a flexible endoscope
US6234958B1 (en) 1998-11-30 2001-05-22 Medical Access Systems, Llc Medical device introduction system including medical introducer having a plurality of access ports and methods of performing medical procedures with same
US6464650B2 (en) 1998-12-31 2002-10-15 Advanced Cardiovascular Systems, Inc. Guidewire with smoothly tapered segment
US6206870B1 (en) 1999-01-21 2001-03-27 Quest Medical, Inc. Catheter stylet handle
AU2862200A (en) 1999-01-27 2000-08-18 Bruce H. Levin Compositions, kits, apparatus, and methods for inhibiting cerebral neurovasculardisorders and muscular headaches
US6398758B1 (en) 1999-02-16 2002-06-04 Stephen C. Jacobsen Medicament delivery system
US6332891B1 (en) 1999-02-16 2001-12-25 Stryker Corporation System and method for performing image guided surgery
US6468297B1 (en) 1999-02-24 2002-10-22 Cryovascular Systems, Inc. Cryogenically enhanced intravascular interventions
US10973397B2 (en) 1999-03-01 2021-04-13 West View Research, Llc Computerized information collection and processing apparatus
PL203959B1 (en) 1999-03-03 2009-11-30 Optinose As Nasal delivery device
AU2876200A (en) 1999-03-08 2000-09-28 University Of Virginia Patent Foundation Device and method for delivering a material into the paranasal sinus cavities
US6148823A (en) 1999-03-17 2000-11-21 Stereotaxis, Inc. Method of and system for controlling magnetic elements in the body using a gapped toroid magnet
US6200257B1 (en) 1999-03-24 2001-03-13 Proxima Therapeutics, Inc. Catheter with permeable hydrogel membrane
US6389313B1 (en) 1999-03-26 2002-05-14 Kevin S. Marchitto Laser probes for drug permeation
US6258065B1 (en) 1999-03-26 2001-07-10 Core Dynamics, Inc. Surgical instrument seal assembly
DK1040843T3 (en) 1999-03-29 2006-01-30 William Cook Europe As A guidewire
EP1040842B1 (en) 1999-03-29 2004-05-12 William Cook Europe ApS A guidewire
US6425877B1 (en) 1999-04-02 2002-07-30 Novasys Medical, Inc. Treatment of tissue in the digestive circulatory respiratory urinary and reproductive systems
US6328564B1 (en) 1999-04-06 2001-12-11 Raymond C. Thurow Deep ear canal locating and head orienting device
US6319275B1 (en) 1999-04-07 2001-11-20 Medtronic Ave, Inc. Endolumenal prosthesis delivery assembly and method of use
US6231543B1 (en) 1999-04-15 2001-05-15 Intella Interventional Systems, Inc. Single lumen balloon catheter
WO2000062672A1 (en) 1999-04-15 2000-10-26 Surgi-Vision Methods for in vivo magnetic resonance imaging
US6268574B1 (en) 1999-04-29 2001-07-31 Rudolph R. Edens Electrical and pneumatic lock-out device
DE59900101D1 (en) 1999-04-29 2001-06-28 Storz Karl Gmbh & Co Kg Medical instrument for tissue preparation
US6689146B1 (en) 1999-04-29 2004-02-10 Stryker Corporation Powered surgical handpiece with integrated irrigator and suction application
US6146415A (en) 1999-05-07 2000-11-14 Advanced Cardiovascular Systems, Inc. Stent delivery system
AU4606400A (en) 1999-05-07 2000-11-21 Salviac Limited Improved filter element for embolic protection device
US6758830B1 (en) 1999-05-11 2004-07-06 Atrionix, Inc. Catheter positioning system
US6394093B1 (en) 1999-05-13 2002-05-28 Scott Lethi Nasopharyngeal airway with inflatable cuff
DE19924440A1 (en) 1999-05-28 2000-12-07 Storz Karl Gmbh & Co Kg Shaft for a flexible endoscope
US6079755A (en) 1999-06-07 2000-06-27 Chang; Chih Chung Electromagnetic lock device
US6206900B1 (en) 1999-06-11 2001-03-27 The General Hospital Corporation Clot evacuation catheter
US6890329B2 (en) 1999-06-15 2005-05-10 Cryocath Technologies Inc. Defined deflection structure
US6585717B1 (en) 1999-06-15 2003-07-01 Cryocath Technologies Inc. Deflection structure
DE29923582U1 (en) 1999-07-08 2000-12-14 Hintersdorf Steffen Device for use within the area of the nose, in particular for insertion into the nasal cavities
US6364900B1 (en) 1999-07-14 2002-04-02 Richard R. Heuser Embolism prevention device
JP3447984B2 (en) 1999-07-21 2003-09-16 朝日インテック株式会社 Medical guidewire
US6596009B1 (en) 1999-07-28 2003-07-22 Jeffrey Jelic Retrievable endoscopic orbital floor splint
US6445939B1 (en) 1999-08-09 2002-09-03 Lightlab Imaging, Llc Ultra-small optical probes, imaging optics, and methods for using same
AU760700B2 (en) 1999-08-12 2003-05-22 Wilson-Cook Medical Inc. Dilation balloon having multiple diameters
US6638233B2 (en) 1999-08-19 2003-10-28 Fox Hollow Technologies, Inc. Apparatus and methods for material capture and removal
EP1207931A2 (en) 1999-08-24 2002-05-29 Neuron Therapeutics, Inc. Lumbar drainage catheter
US6249180B1 (en) 1999-09-08 2001-06-19 Atmel Corporation Phase noise and additive noise estimation in a QAM demodulator
US6221042B1 (en) 1999-09-17 2001-04-24 Scimed Life Systems, Inc. Balloon with reversed cones
US6939361B1 (en) 1999-09-22 2005-09-06 Nmt Medical, Inc. Guidewire for a free standing intervascular device having an integral stop mechanism
EP1244392A1 (en) 1999-09-28 2002-10-02 Novasys Medical, Inc. Treatment of tissue by application of energy and drugs
JP2001095815A (en) 1999-09-28 2001-04-10 Olympus Optical Co Ltd Microwave coagulation applicator
US6398775B1 (en) 1999-10-21 2002-06-04 Pulmonx Apparatus and method for isolated lung access
US7366562B2 (en) 2003-10-17 2008-04-29 Medtronic Navigation, Inc. Method and apparatus for surgical navigation
US6536437B1 (en) 1999-10-29 2003-03-25 Branislav M. Dragisic Cuffed nasal airway and anesthetic wand system
US6529756B1 (en) 1999-11-22 2003-03-04 Scimed Life Systems, Inc. Apparatus for mapping and coagulating soft tissue in or around body orifices
US6533754B1 (en) 1999-11-26 2003-03-18 Terumo Kabushiki Kaisha Catheter
US6156294A (en) 1999-11-28 2000-12-05 Scientific Development And Research, Inc. Composition and method for treatment of otitis media
DE60034146T2 (en) 1999-12-22 2007-12-13 Boston Scientific Ltd., St. Michael ENDOLUMINAL OCCLUSION SPÜLKATHETER
DE10042330A1 (en) 1999-12-22 2002-03-14 Hans Sachse Small intestine probe, wall-reinforced
US6450975B1 (en) 1999-12-30 2002-09-17 Advanced Cardiovascular Systems, Inc. Ultrasonic transmission guide wire
DE10102433B4 (en) 2000-01-21 2008-07-10 Pentax Corp. Flexible tube for an endoscope
US7184827B1 (en) 2000-01-24 2007-02-27 Stuart D. Edwards Shrinkage of dilatations in the body
US20010034530A1 (en) 2000-01-27 2001-10-25 Malackowski Donald W. Surgery system
US6386197B1 (en) 2000-01-27 2002-05-14 Brook D. Miller Nasal air passageway opening device
US6312438B1 (en) 2000-02-01 2001-11-06 Medtronic Xomed, Inc. Rotary bur instruments having bur tips with aspiration passages
US6527753B2 (en) 2000-02-29 2003-03-04 Olympus Optical Co., Ltd. Endoscopic treatment system
US6443947B1 (en) 2000-03-01 2002-09-03 Alexei Marko Device for thermal ablation of a cavity
US6485475B1 (en) 2000-03-01 2002-11-26 The Board Of Regents Of The University Texas System Introducer needle for continuous perineural catheter placement
US6494894B2 (en) 2000-03-16 2002-12-17 Scimed Life Systems, Inc. Coated wire
AU143359S (en) 2000-03-17 2001-03-28 Astrazeneca Ab Connector for a catheter
US6485500B1 (en) 2000-03-21 2002-11-26 Advanced Cardiovascular Systems, Inc. Emboli protection system
US6440061B1 (en) 2000-03-24 2002-08-27 Donald E. Wenner Laparoscopic instrument system for real-time biliary exploration and stone removal
US6517478B2 (en) 2000-03-30 2003-02-11 Cbyon, Inc. Apparatus and method for calibrating an endoscope
US6984203B2 (en) 2000-04-03 2006-01-10 Neoguide Systems, Inc. Endoscope with adjacently positioned guiding apparatus
US6478776B1 (en) 2000-04-05 2002-11-12 Biocardia, Inc. Implant delivery catheter system and methods for its use
US6638268B2 (en) 2000-04-07 2003-10-28 Imran K. Niazi Catheter to cannulate the coronary sinus
US6860849B2 (en) 2000-05-08 2005-03-01 Pentax Corporation Flexible tube for an endoscope
GB0011053D0 (en) 2000-05-09 2000-06-28 Hudson John O Medical device and use thereof
US20040034311A1 (en) 2000-05-19 2004-02-19 Albert Mihalcik Guidewire with viewing capability
US6719749B1 (en) 2000-06-01 2004-04-13 Medical Components, Inc. Multilumen catheter assembly and methods for making and inserting the same
US6409863B1 (en) 2000-06-12 2002-06-25 Scimed Life Systems, Inc. Methods of fabricating a catheter shaft having one or more guidewire ports
FR2810458B1 (en) 2000-06-16 2004-04-09 Entrelec Sa ELECTRIC INTERCONNECTION COMB
US6663589B1 (en) 2000-06-20 2003-12-16 Haim Halevy Catheter system
JP3345645B2 (en) 2000-06-20 2002-11-18 東京大学長 Body cavity observation device
US6572590B1 (en) 2000-07-13 2003-06-03 Merit Medical Systems, Inc. Adjustable quick-release valve with toggle capability
JP2002028166A (en) 2000-07-18 2002-01-29 Olympus Optical Co Ltd Treatment device for nasal cavity
US20050107738A1 (en) 2000-07-21 2005-05-19 Slater Charles R. Occludable intravascular catheter for drug delivery and method of using the same
WO2002007794A2 (en) 2000-07-24 2002-01-31 Stereotaxis, Inc. Magnetically navigated pacing leads, and methods for delivering medical devices
RU2213530C2 (en) 2000-07-26 2003-10-10 Сунцов Виктор Владимирович Method and device for treating the cases of paranasal sinusitis
JP4429495B2 (en) 2000-07-28 2010-03-10 オリンパス株式会社 Endoscope
DE10038376C2 (en) 2000-08-07 2003-04-30 Zangenstein Elektro Door lock for the door of an electrical household appliance
US6569146B1 (en) 2000-08-18 2003-05-27 Scimed Life Systems, Inc. Method and apparatus for treating saphenous vein graft lesions
US7625335B2 (en) 2000-08-25 2009-12-01 3Shape Aps Method and apparatus for three-dimensional optical scanning of interior surfaces
US6607546B1 (en) 2000-09-01 2003-08-19 Roger E. Murken Nasal catheter
US6503263B2 (en) * 2000-09-24 2003-01-07 Medtronic, Inc. Surgical micro-shaving instrument with elevator tip
US6719763B2 (en) 2000-09-29 2004-04-13 Olympus Optical Co., Ltd. Endoscopic suturing device
US7052474B2 (en) 2000-10-02 2006-05-30 Sandhill Scientific, Inc. Pharyngoesophageal monitoring systems
US6537294B1 (en) 2000-10-17 2003-03-25 Advanced Cardiovascular Systems, Inc. Delivery systems for embolic filter devices
US6702735B2 (en) 2000-10-17 2004-03-09 Charlotte Margaret Kelly Device for movement along a passage
US6585639B1 (en) 2000-10-27 2003-07-01 Pulmonx Sheath and method for reconfiguring lung viewing scope
US20020055746A1 (en) 2000-11-03 2002-05-09 Alan Burke Method and apparatus for extracting foreign bodies from nasal passages and the like
JP2002146659A (en) 2000-11-07 2002-05-22 Sumitomo Electric Ind Ltd Metallic nonwoven fabric and method for producing the same
US6571131B1 (en) 2000-11-10 2003-05-27 Biosense Webster, Inc. Deflectable catheter with modifiable handle
US6543452B1 (en) 2000-11-16 2003-04-08 Medilyfe, Inc. Nasal intubation device and system for intubation
US6716813B2 (en) 2000-11-28 2004-04-06 House Ear Institute Use of antimicrobial proteins and peptides for the treatment of otitis media and paranasal sinusitis
EP1341476A2 (en) 2000-12-01 2003-09-10 Nephros Therapeutics, Inc. Intrasvascular drug delivery device and use therefor
WO2002045598A2 (en) 2000-12-05 2002-06-13 Lumend, Inc. Catheter system for vascular re-entry from a sub-intimal space
US6500130B2 (en) 2000-12-21 2002-12-31 Scimed Life Systems, Inc. Steerable guidewire
US6544223B1 (en) 2001-01-05 2003-04-08 Advanced Cardiovascular Systems, Inc. Balloon catheter for delivering therapeutic agents
KR100731007B1 (en) 2001-01-15 2007-06-22 앰코 테크놀로지 코리아 주식회사 stack-type semiconductor package
US7043961B2 (en) 2001-01-30 2006-05-16 Z-Kat, Inc. Tool calibrator and tracker system
US6997931B2 (en) 2001-02-02 2006-02-14 Lsi Solutions, Inc. System for endoscopic suturing
DE10104663A1 (en) 2001-02-02 2002-08-08 Solvay Fluor & Derivate Production of fluorine compounds
DE10105592A1 (en) 2001-02-06 2002-08-08 Achim Goepferich Placeholder for drug release in the frontal sinus
JP3939158B2 (en) 2001-02-06 2007-07-04 オリンパス株式会社 Endoscope device
US6585718B2 (en) 2001-05-02 2003-07-01 Cardiac Pacemakers, Inc. Steerable catheter with shaft support system for resisting axial compressive loads
US6796960B2 (en) 2001-05-04 2004-09-28 Wit Ip Corporation Low thermal resistance elastic sleeves for medical device balloons
US7018371B2 (en) 2001-05-07 2006-03-28 Xoft, Inc. Combination ionizing radiation and radiosensitizer delivery devices and methods for inhibiting hyperplasia
US6712757B2 (en) 2001-05-16 2004-03-30 Stephen Becker Endoscope sleeve and irrigation device
US8403954B2 (en) 2001-05-22 2013-03-26 Sanostec Corp. Nasal congestion, obstruction relief, and drug delivery
US7532920B1 (en) 2001-05-31 2009-05-12 Advanced Cardiovascular Systems, Inc. Guidewire with optical fiber
US7140480B2 (en) 2001-06-07 2006-11-28 Drussel Wilfley Design, Llc Centrifugal clutch and cover mount assembly therefor
US6966906B2 (en) 2001-06-08 2005-11-22 Joe Denton Brown Deflection mechanism for a surgical instrument, such as a laser delivery device and/or endoscope, and method of use
AU2002322520A1 (en) 2001-07-17 2003-03-03 Kerberos Proximal Solutions Fluid exchange system for controlled and localized irrigation and aspiration
AUPR649601A0 (en) 2001-07-20 2001-08-09 Redfern Polymer Optics Pty Ltd Casting preforms for optical fibres
US6616659B1 (en) 2001-07-27 2003-09-09 Starion Instruments Corporation Polypectomy device and method
JP4761671B2 (en) 2001-08-29 2011-08-31 テルモ株式会社 Shape memory balloon, manufacturing method thereof, and balloon catheter
US20040127820A1 (en) 2001-09-05 2004-07-01 Clayman Ralph V. Guidewire
US20070112358A1 (en) 2001-09-06 2007-05-17 Ryan Abbott Systems and Methods for Treating Septal Defects
AUPR785001A0 (en) 2001-09-21 2001-10-18 Kleiner, Daniel E. Tamponade apparatus and method of using same
US6918882B2 (en) 2001-10-05 2005-07-19 Scimed Life Systems, Inc. Guidewire with stiffness blending connection
US20030073900A1 (en) 2001-10-12 2003-04-17 Pranitha Senarith System and method for monitoring the movement of an interventional device within an anatomical site
JP3772107B2 (en) 2001-10-12 2006-05-10 オリンパス株式会社 Endoscope system
FR2832516B1 (en) 2001-11-19 2004-01-23 Tokendo Sarl ROTARY ENDOSCOPES WITH A DEVIED DISTAL VIEW
US7488313B2 (en) 2001-11-29 2009-02-10 Boston Scientific Scimed, Inc. Mechanical apparatus and method for dilating and delivering a therapeutic agent to a site of treatment
US6832715B2 (en) 2001-12-03 2004-12-21 Scimed Life Systems, Inc. Guidewire distal tip soldering method
US6612999B2 (en) 2001-12-06 2003-09-02 Cardiac Pacemakers, Inc. Balloon actuated guide catheter
US6755812B2 (en) 2001-12-11 2004-06-29 Cardiac Pacemakers, Inc. Deflectable telescoping guide catheter
US20030144683A1 (en) 2001-12-13 2003-07-31 Avantec Vascular Corporation Inflatable members having concentrated force regions
EP1319366A1 (en) 2001-12-14 2003-06-18 BrainLAB AG Magnetic navigation for a catheter
US6939374B2 (en) 2001-12-21 2005-09-06 Scimed Life Systems, Inc. Stents, stenting systems, and related methods for agent delivery
US6955657B1 (en) 2001-12-31 2005-10-18 Advanced Cardiovascular Systems, Inc. Intra-ventricular substance delivery catheter system
US6740030B2 (en) 2002-01-04 2004-05-25 Vision Sciences, Inc. Endoscope assemblies having working channels with reduced bending and stretching resistance
US7493156B2 (en) 2002-01-07 2009-02-17 Cardiac Pacemakers, Inc. Steerable guide catheter with pre-shaped rotatable shaft
US20040158229A1 (en) 2002-01-24 2004-08-12 Quinn David G. Catheter assembly and method of catheter insertion
SE0200300D0 (en) 2002-02-01 2002-02-01 Aerocrine Ab Diagnostic device and method
CN100372582C (en) 2002-02-07 2008-03-05 卡拉格股份公司 Displacement device for catheter
US6610059B1 (en) 2002-02-25 2003-08-26 Hs West Investments Llc Endoscopic instruments and methods for improved bubble aspiration at a surgical site
JP2003320031A (en) 2002-02-26 2003-11-11 Buaayu:Kk Balloon catheter
US7128718B2 (en) 2002-03-22 2006-10-31 Cordis Corporation Guidewire with deflectable tip
US7074426B2 (en) 2002-03-27 2006-07-11 Frank Kochinke Methods and drug delivery systems for the treatment of orofacial diseases
US6942635B2 (en) 2002-04-04 2005-09-13 Angiodynamics, Inc. Blood treatment catheter and method
AU2003223085A1 (en) 2002-04-17 2003-10-27 Super Dimension Ltd. Endoscope structures and techniques for navigating to a target in branched structure
DE10217559B4 (en) 2002-04-19 2004-02-19 Universitätsklinikum Freiburg Device for minimally invasive, intravascular aortic valve extraction
US20040020492A1 (en) 2002-05-02 2004-02-05 Dubrul William R. Upper airway device and method
EP1509256B1 (en) 2002-05-24 2009-07-22 Angiotech International Ag Compositions and methods for coating medical implants
EP1513440A2 (en) 2002-05-30 2005-03-16 The Board of Trustees of The Leland Stanford Junior University Apparatus and method for coronary sinus access
US7993353B2 (en) 2002-06-04 2011-08-09 Brainlab Ag Medical tracking system with universal interface
US20030229332A1 (en) 2002-06-11 2003-12-11 Scimed Life Systems, Inc. Adjustable double balloon catheter with a through lumen for stone management
IL150189A0 (en) 2002-06-12 2002-12-01 Acoustitech Ltd Acoustic diagnosis of sinusitis
GB0215270D0 (en) 2002-07-02 2002-08-14 Optinose As Nasal devices
AU2003259941A1 (en) 2002-08-20 2004-03-11 The Regents Of The University Of California Optical waveguide vibration sensor for use in hearing aid
US7174774B2 (en) 2002-08-30 2007-02-13 Kimberly-Clark Worldwide, Inc. Method and apparatus of detecting pooling of fluid in disposable or non-disposable absorbent articles
US6783522B2 (en) 2002-09-09 2004-08-31 Angel Medical Systems, Inc. Implantable catheter having an improved check valve
US6619085B1 (en) 2002-09-12 2003-09-16 Hui-Hua Hsieh Remote-controlled lock
MXPA05003044A (en) 2002-09-18 2006-01-27 Asap Breathe Assist Pty Ltd A nasal cavity dilator.
ITVR20020094A1 (en) 2002-09-25 2002-12-24 Vittorio Marinello APPARATUS FOR THE PROCESSING OF THE NEW SYSTEM OF TREATMENT OF THE MAXILLARY SINUSITIES, OF THE FRONTAL AND OF THE TRIGE NEVRITES AND NEVRALGIES
US8317816B2 (en) 2002-09-30 2012-11-27 Acclarent, Inc. Balloon catheters and methods for treating paranasal sinuses
US7488337B2 (en) 2002-09-30 2009-02-10 Saab Mark A Apparatus and methods for bone, tissue and duct dilatation
DE50202566D1 (en) 2002-10-25 2005-04-28 Brainlab Ag Apparatus and method for calibrating an element
US20040220516A1 (en) 2002-11-04 2004-11-04 Stephen Solomon Food extraction apparatus and method
US6899672B2 (en) 2002-11-08 2005-05-31 Scimed Life Systems, Inc. Endoscopic imaging system including removable deflection device
US7881769B2 (en) 2002-11-18 2011-02-01 Mediguide Ltd. Method and system for mounting an MPS sensor on a catheter
US7172562B2 (en) 2002-11-22 2007-02-06 Mckinley Laurence M System, method and apparatus for locating, measuring and evaluating the enlargement of a foramen
US7184067B2 (en) 2003-03-13 2007-02-27 Eastman Kodak Company Color OLED display system
US7343920B2 (en) 2002-12-20 2008-03-18 Toby E Bruce Connective tissue repair system
TW589170B (en) 2002-12-25 2004-06-01 De-Yang Tian Endoscopic device
EP1435757A1 (en) 2002-12-30 2004-07-07 Andrzej Zarowski Device implantable in a bony wall of the inner ear
US20060047261A1 (en) 2004-06-28 2006-03-02 Shailendra Joshi Intra-arterial catheter for drug delivery
EP1438942A1 (en) 2003-01-17 2004-07-21 Schering Oy An otorhinological drug delivery device
US8016752B2 (en) 2003-01-17 2011-09-13 Gore Enterprise Holdings, Inc. Puncturable catheter
US20040230156A1 (en) 2003-02-13 2004-11-18 Schreck Stefan Georg Methods and devices for in-situ crosslinking of vascular tissue
EP1599232B1 (en) 2003-02-21 2013-08-14 Electro-Cat, LLC System for measuring cross-sectional areas and pressure gradients in luminal organs
US8167821B2 (en) 2003-02-26 2012-05-01 Boston Scientific Scimed, Inc. Multiple diameter guidewire
US7182735B2 (en) 2003-02-26 2007-02-27 Scimed Life Systems, Inc. Elongated intracorporal medical device
US10376711B2 (en) 2003-03-14 2019-08-13 Light Sciences Oncology Inc. Light generating guide wire for intravascular use
EP1610865A4 (en) 2003-03-14 2007-11-28 Light Sciences Oncology Inc Light generating device to intravascular use
WO2004082525A2 (en) 2003-03-14 2004-09-30 Sinexus, Inc. Sinus delivery of sustained release therapeutics
US20040193073A1 (en) 2003-03-31 2004-09-30 Demello Richard M. Composite guidewire with a linear elastic distal portion
US7303533B2 (en) 2003-04-10 2007-12-04 Intraluminal Therapeutics, Inc. Shapeable intraluminal device and method therefor
US20040267347A1 (en) 2003-05-01 2004-12-30 Cervantes Marvin John Protective elongated sleeve for stent systems
US7615005B2 (en) 2003-05-16 2009-11-10 Ethicon Endo-Surgery, Inc. Medical apparatus for use with an endoscope
US20040236231A1 (en) 2003-05-23 2004-11-25 Embro Corporation Light catheter for illuminating tissue structures
JP4323221B2 (en) 2003-05-30 2009-09-02 テルモ株式会社 Catheter assembly
US20050234431A1 (en) 2004-02-10 2005-10-20 Williams Michael S Intravascular delivery system for therapeutic agents
US7632291B2 (en) 2003-06-13 2009-12-15 Trivascular2, Inc. Inflatable implant
US8002740B2 (en) 2003-07-18 2011-08-23 Broncus Technologies, Inc. Devices for maintaining patency of surgically created channels in tissue
WO2005011476A2 (en) 2003-07-29 2005-02-10 Endoscopic Technologies, Inc. Tissue positioner
US7359755B2 (en) 2003-08-08 2008-04-15 Advanced Neuromodulation Systems, Inc. Method and apparatus for implanting an electrical stimulation lead using a flexible introducer
US6851290B1 (en) 2003-08-11 2005-02-08 Absolute Access & Security Products, Inc. Door lock assembly and locking system for hinged double-acting impact-traffic doors
US8740844B2 (en) 2003-08-20 2014-06-03 Boston Scientific Scimed, Inc. Medical device with drug delivery member
US7179225B2 (en) 2003-08-26 2007-02-20 Shluzas Alan E Access systems and methods for minimally invasive surgery
US7313430B2 (en) 2003-08-28 2007-12-25 Medtronic Navigation, Inc. Method and apparatus for performing stereotactic surgery
US20050055077A1 (en) 2003-09-05 2005-03-10 Doron Marco Very low profile medical device system having an adjustable balloon
US20050113687A1 (en) 2003-09-15 2005-05-26 Atrium Medical Corporation Application of a therapeutic substance to a tissue location using a porous medical device
US20050059930A1 (en) 2003-09-16 2005-03-17 Michi Garrison Method and apparatus for localized drug delivery
US20050059931A1 (en) 2003-09-16 2005-03-17 Venomatrix Methods and apparatus for localized and semi-localized drug delivery
US20050113850A1 (en) 2003-10-08 2005-05-26 Tagge Bryan C. Apparatus, system, and method for middle turbinate medializer
US7004176B2 (en) 2003-10-17 2006-02-28 Edwards Lifesciences Ag Heart valve leaflet locator
US8014849B2 (en) 2003-11-21 2011-09-06 Stryker Corporation Rotational markers
US7237313B2 (en) 2003-12-05 2007-07-03 Boston Scientific Scimed, Inc. Elongated medical device for intracorporal use
USD501677S1 (en) 2003-12-11 2005-02-08 Bruce B. Becker Dilatation balloon catheter
US20050131316A1 (en) 2003-12-15 2005-06-16 Cook Incorporated Guidewire with flexible tip
ATE523141T1 (en) 2004-02-17 2011-09-15 Philips Electronics Ltd METHOD AND DEVICE FOR REGISTRATION, VERIFICATION OF AND REFERENCE TO BODY ORGANS
US7988705B2 (en) 2004-03-06 2011-08-02 Lumen Biomedical, Inc. Steerable device having a corewire within a tube and combination with a functional medical component
EP1729676A1 (en) 2004-03-15 2006-12-13 Durect Corporation Pharmaceutical compositions for administration to a sinus
US20060211752A1 (en) 2004-03-16 2006-09-21 Kohn Leonard D Use of phenylmethimazoles, methimazole derivatives, and tautomeric cyclic thiones for the treatment of autoimmune/inflammatory diseases associated with toll-like receptor overexpression
US7282057B2 (en) 2004-03-30 2007-10-16 Wilson-Cook Medical, Inc. Pediatric atresia magnets
US20050234507A1 (en) 2004-04-16 2005-10-20 Jeff Geske Medical tool for access to internal tissue
US7452351B2 (en) 2004-04-16 2008-11-18 Kyphon Sarl Spinal diagnostic methods and apparatus
US20060063973A1 (en) 2004-04-21 2006-03-23 Acclarent, Inc. Methods and apparatus for treating disorders of the ear, nose and throat
US20070167682A1 (en) 2004-04-21 2007-07-19 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US7559925B2 (en) 2006-09-15 2009-07-14 Acclarent Inc. Methods and devices for facilitating visualization in a surgical environment
US9089258B2 (en) * 2004-04-21 2015-07-28 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8894614B2 (en) 2004-04-21 2014-11-25 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US20070208252A1 (en) 2004-04-21 2007-09-06 Acclarent, Inc. Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses
US8864787B2 (en) 2004-04-21 2014-10-21 Acclarent, Inc. Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis
US20060284428A1 (en) 2005-06-13 2006-12-21 Darryl Beadle High reliability gate lock for exterior use
US9399121B2 (en) 2004-04-21 2016-07-26 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US8747389B2 (en) 2004-04-21 2014-06-10 Acclarent, Inc. Systems for treating disorders of the ear, nose and throat
US9351750B2 (en) 2004-04-21 2016-05-31 Acclarent, Inc. Devices and methods for treating maxillary sinus disease
US7803150B2 (en) 2004-04-21 2010-09-28 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US9101384B2 (en) 2004-04-21 2015-08-11 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat
US8146400B2 (en) 2004-04-21 2012-04-03 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US7361168B2 (en) 2004-04-21 2008-04-22 Acclarent, Inc. Implantable device and methods for delivering drugs and other substances to treat sinusitis and other disorders
US9554691B2 (en) 2004-04-21 2017-01-31 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US7410480B2 (en) 2004-04-21 2008-08-12 Acclarent, Inc. Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders
WO2005110374A1 (en) 2004-04-30 2005-11-24 Allergan, Inc. Intraocular drug delivery systems containing a therapeutic component, a cyclodextrin, and a polymeric component
US7775968B2 (en) 2004-06-14 2010-08-17 Pneumrx, Inc. Guided access to lung tissues
US9289576B2 (en) 2004-06-17 2016-03-22 W. L. Gore & Associates, Inc. Catheter assembly
US7207981B2 (en) 2004-06-28 2007-04-24 Medtronic Vascular, Inc. Multi-exchange catheter guide member with improved seal
JP2008506447A (en) 2004-07-14 2008-03-06 バイ−パス, インコーポレイテッド Material delivery system
US8277386B2 (en) 2004-09-27 2012-10-02 Volcano Corporation Combination sensor guidewire and methods of use
FR2859377B1 (en) 2004-10-22 2006-05-12 Bertrand Lombard THREE DIMENSIONAL LOCATION DEVICE
US7347868B2 (en) 2004-10-26 2008-03-25 Baronova, Inc. Medical device delivery catheter
US7235099B1 (en) 2004-12-14 2007-06-26 Micromedics, Inc. Sphenoid sinus stent
EP1838215B1 (en) 2005-01-18 2012-08-01 Philips Electronics LTD Electromagnetically tracked k-wire device
US8109981B2 (en) 2005-01-25 2012-02-07 Valam Corporation Optical therapies and devices
US20060173382A1 (en) 2005-01-31 2006-08-03 John Schreiner Guidewire with superelastic core
US20080188803A1 (en) 2005-02-03 2008-08-07 Jang G David Triple-profile balloon catheter
US7195612B2 (en) 2005-03-31 2007-03-27 Gordis Corporation Esophageal balloon catheter with visual marker
US7896891B2 (en) 2005-05-20 2011-03-01 Neotract, Inc. Apparatus and method for manipulating or retracting tissue and anatomical structure
US8951225B2 (en) 2005-06-10 2015-02-10 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
CA2612933C (en) 2005-06-20 2014-08-19 Otomedics Advanced Medical Technologies Ltd. Ear tubes
DE602006017093D1 (en) 2005-09-20 2010-11-04 Medsys S A DEVICE AND METHOD FOR CHECKING A REMOTE DEVICE
USD534216S1 (en) 2005-09-23 2006-12-26 Acclarent, Inc. Anatomical model and demonstration/training device
EP1988850B1 (en) 2006-02-27 2016-10-12 AHM Technologies, Inc. Eustachian tube device
US8585753B2 (en) 2006-03-04 2013-11-19 John James Scanlon Fibrillated biodegradable prosthesis
AU2007249293C1 (en) 2006-05-12 2013-06-27 Arthrocare Corporation Middle turbinate medializer
US20070269385A1 (en) 2006-05-18 2007-11-22 Mercator Medsystems, Inc Devices, methods, and systems for delivering therapeutic agents for the treatment of sinusitis, rhinitis, and other disorders
US9820688B2 (en) 2006-09-15 2017-11-21 Acclarent, Inc. Sinus illumination lightwire device
WO2008036368A2 (en) 2006-09-20 2008-03-27 University Of Virginia Patent Foundation Tube, stent and collar insertion device
US7535991B2 (en) 2006-10-16 2009-05-19 Oraya Therapeutics, Inc. Portable orthovoltage radiotherapy
WO2008051918A2 (en) 2006-10-23 2008-05-02 Allux Medical, Inc. Methods, devices and kits for phototherapy and photodynamic therapy treatment of body cavities
US7634233B2 (en) 2006-11-27 2009-12-15 Chung Shan Institute Of Science And Technology Transmission system with interference avoidance capability and method thereof
US8104483B2 (en) 2006-12-26 2012-01-31 The Spectranetics Corporation Multi-port light delivery catheter and methods for the use thereof
JP2008161491A (en) 2006-12-28 2008-07-17 Asahi Intecc Co Ltd Medical guide wire
US9387124B2 (en) 2007-04-19 2016-07-12 Tusker Medical, Inc. Disposable iontophoresis system and tympanic membrane pain inhibition method
FR2916144A1 (en) 2007-05-14 2008-11-21 Olivier Pascal Bruno Rollet Endotracheal catheter for use during surgery, has tube including distal end connected to collar and another end connected to circular pusher, where pusher is actuated outside buccal cavity by user after endotracheal intubation
EP2160140B1 (en) 2007-06-26 2014-11-05 Galit Avior Eustachian tube device
EP2190520A4 (en) 2007-09-20 2011-01-26 Estimme Ltd Electrical stimulation in the middle ear for treatment of hearing related disorders
US20090088728A1 (en) 2007-09-28 2009-04-02 Dollar Michael L Malleable sleeve for balloon catheter and endoscopic surgical method
USD590502S1 (en) 2007-11-13 2009-04-14 Karl Storz Gmbh & Co. Kg Grip for laparoscope
US20090163890A1 (en) 2007-12-20 2009-06-25 Acclarent, Inc. Method and System for Accessing, Diagnosing and Treating Target Tissue Regions Within the Middle Ear and the Eustachian Tube
US20100198191A1 (en) 2007-12-20 2010-08-05 Acclarent, Inc. Method and system for treating target tissue within the eustachian tube
US20100274188A1 (en) 2007-12-20 2010-10-28 Acclarent, Inc. Method and System for Treating Target Tissue Within the Eustachian Tube
USD586916S1 (en) 2008-05-09 2009-02-17 Lifescan Scotland, Ltd. Handheld lancing device
USD586465S1 (en) 2008-05-09 2009-02-10 Lifescan Scotland Limited Handheld lancing device
EA022565B1 (en) 2008-05-27 2016-01-29 Дзе Юниверсити Оф Мельбурн Methods of treating mammals with eustachian tube dysfunctions
AU2009293312B2 (en) 2008-09-18 2015-07-09 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US20100087811A1 (en) 2008-10-06 2010-04-08 Coaptus Medical Corporation Systems and Methods for Controlling Patient Catheters
US8608360B2 (en) 2009-05-18 2013-12-17 Günther Nath Liquid light guide having position retaining function
USD633208S1 (en) 2009-09-11 2011-02-22 Stryker Trauma Ag External fixation clamp

Patent Citations (112)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US446173A (en) * 1891-02-10 Hasp and staple
US513667A (en) * 1894-01-30 Sliding staple for hasps
US2493326A (en) * 1949-03-01 1950-01-03 John H Trinder Tampon for control of intractable nasal hemorrhages
US3552384A (en) * 1967-07-03 1971-01-05 American Hospital Supply Corp Controllable tip guide body and catheter
US4069307A (en) * 1970-10-01 1978-01-17 Alza Corporation Drug-delivery device comprising certain polymeric materials for controlled release of drug
US3792391A (en) * 1972-12-18 1974-02-12 L Ewing Electrically operated two position electromechanical mechanism
US3859993A (en) * 1973-08-27 1975-01-14 Daniel G Bitner Operating table accessory
US4138151A (en) * 1976-07-30 1979-02-06 Olympus Optical Company Limited Detent device for locking the lid of a cassette receiving compartment of a tape recorder
US4184497A (en) * 1977-08-26 1980-01-22 University Of Utah Peritoneal dialysis catheter
US4312353A (en) * 1980-05-09 1982-01-26 Mayfield Education And Research Fund Method of creating and enlarging an opening in the brain
US4571239A (en) * 1982-03-01 1986-02-18 Heyman Arnold M Catheter-stylet assembly for slipover urethral instruments
US4499899A (en) * 1983-01-21 1985-02-19 Brimfield Precision, Inc. Fiber-optic illuminated microsurgical scissors
US4639244A (en) * 1983-05-03 1987-01-27 Nabil I. Rizk Implantable electrophoretic pump for ionic drugs and associated methods
US4564364A (en) * 1983-05-26 1986-01-14 Alza Corporation Active agent dispenser
US4571240A (en) * 1983-08-12 1986-02-18 Advanced Cardiovascular Systems, Inc. Catheter having encapsulated tip marker
US4637389A (en) * 1985-04-08 1987-01-20 Heyden Eugene L Tubular device for intubation
US4645495A (en) * 1985-06-26 1987-02-24 Vaillancourt Vincent L Vascular access implant needle patch
US4897651A (en) * 1985-10-15 1990-01-30 Ing. C. Olivetti & C., S.P.A. Key with selective symbol display and keyboard using such key
US4795439A (en) * 1986-06-06 1989-01-03 Edward Weck Incorporated Spiral multi-lumen catheter
US4803076A (en) * 1986-09-04 1989-02-07 Pfizer Inc. Controlled release device for an active substance
US4726772A (en) * 1986-12-01 1988-02-23 Kurt Amplatz Medical simulator
US4796629A (en) * 1987-06-03 1989-01-10 Joseph Grayzel Stiffened dilation balloon catheter device
US5090595A (en) * 1988-06-29 1992-02-25 Jaico C.V., Cooperatieve Venootschap Pressure capsule for spray can, and spray can which utilizes such a capsule
US4898577A (en) * 1988-09-28 1990-02-06 Advanced Cardiovascular Systems, Inc. Guiding cathether with controllable distal tip
US4984581A (en) * 1988-10-12 1991-01-15 Flexmedics Corporation Flexible guide having two-way shape memory alloy
US5090910A (en) * 1988-10-14 1992-02-25 Narlo Jeanie R Multiple three dimensional facial display system
US5189110A (en) * 1988-12-23 1993-02-23 Asahi Kasei Kogyo Kabushiki Kaisha Shape memory polymer resin, composition and the shape memorizing molded product thereof
US5087246A (en) * 1988-12-29 1992-02-11 C. R. Bard, Inc. Dilation catheter with fluted balloon
US5087244A (en) * 1989-01-31 1992-02-11 C. R. Bard, Inc. Catheter and method for locally applying medication to the wall of a blood vessel or other body lumen
US4994033A (en) * 1989-05-25 1991-02-19 Schneider (Usa) Inc. Intravascular drug delivery dilatation catheter
US5020514A (en) * 1989-07-19 1991-06-04 Richard Wolf Gmbh Endoscope for nasal surgery
US5180368A (en) * 1989-09-08 1993-01-19 Advanced Cardiovascular Systems, Inc. Rapidly exchangeable and expandable cage catheter for repairing damaged blood vessels
US5286254A (en) * 1990-06-15 1994-02-15 Cortrak Medical, Inc. Drug delivery apparatus and method
US5183470A (en) * 1991-03-04 1993-02-02 International Medical, Inc. Laparoscopic cholangiogram catheter and method of using same
US5386817A (en) * 1991-06-10 1995-02-07 Endomedical Technologies, Inc. Endoscope sheath and valve system
USD355031S (en) * 1992-04-20 1995-01-31 Terumo Kabushiki Kaisha Catheter
US5275593A (en) * 1992-04-30 1994-01-04 Surgical Technologies, Inc. Ophthalmic surgery probe assembly
US5707376A (en) * 1992-08-06 1998-01-13 William Cook Europe A/S Stent introducer and method of use
US5718702A (en) * 1992-08-12 1998-02-17 Somnus Medical Technologies, Inc. Uvula, tonsil, adenoid and sinus tissue treatment device and method
US5391179A (en) * 1992-09-04 1995-02-21 Mezzoli; Giorgio Nasal and/or rhinopharyngeal tampon
US5601087A (en) * 1992-11-18 1997-02-11 Spectrascience, Inc. System for diagnosing tissue with guidewire
US5391147A (en) * 1992-12-01 1995-02-21 Cardiac Pathways Corporation Steerable catheter with adjustable bend location and/or radius and method
US5713946A (en) * 1993-07-20 1998-02-03 Biosense, Inc. Apparatus and method for intrabody mapping
US5720300A (en) * 1993-11-10 1998-02-24 C. R. Bard, Inc. High performance wires for use in medical devices and alloys therefor
US5334167A (en) * 1993-11-19 1994-08-02 Cocanower David A Modified nasogastric tube for use in enteral feeding
US6673025B1 (en) * 1993-12-01 2004-01-06 Advanced Cardiovascular Systems, Inc. Polymer coated guidewire
US5591194A (en) * 1994-02-18 1997-01-07 C. R. Bard, Inc. Telescoping balloon catheter and method of use
US7169140B1 (en) * 1994-02-22 2007-01-30 Boston Scientific Scimed, Inc. Methods of using an intravascular balloon catheter in combination with an angioscope
US5599304A (en) * 1994-05-10 1997-02-04 Mount Sinai School Of Medicine Of The City University Of New York Sinonasal suction apparatus
US5857998A (en) * 1994-06-30 1999-01-12 Boston Scientific Corporation Stent and therapeutic delivery system
US6344028B1 (en) * 1994-06-30 2002-02-05 Boston Scientific Corporation Replenishable stent and delivery system
US5486181A (en) * 1994-08-04 1996-01-23 Implex Corporation Acetabular cup, method and tool and installing the same
US5681262A (en) * 1994-10-05 1997-10-28 Very Inventive Physicians Inc. Endoscope and tool therefore
US5599576A (en) * 1995-02-06 1997-02-04 Surface Solutions Laboratories, Inc. Medical apparatus with scratch-resistant coating and method of making same
US5599284A (en) * 1995-02-08 1997-02-04 Shea; John P. Pre-operative nasal splint for endoscopic sinus surgery and method
US5713839A (en) * 1995-02-08 1998-02-03 Shea; John P. Pre-operative nasal splint for endoscopic sinus surgery
US5708175A (en) * 1995-05-26 1998-01-13 Ishihara Sangyo Kaisha Ltd. Process for producing 4-trifluoromethylnicotinic acid
US5707389A (en) * 1995-06-07 1998-01-13 Baxter International Inc. Side branch occlusion catheter device having integrated endoscope for performing endoscopically visualized occlusion of the side branches of an anatomical passageway
US6183433B1 (en) * 1995-06-30 2001-02-06 Xomed Surgical Products, Inc. Surgical suction cutting instrument with internal irrigation
US5601594A (en) * 1995-09-14 1997-02-11 Best; Barry D. Nasal stent
US5711315A (en) * 1996-02-15 1998-01-27 Jerusalmy; Israel Sinus lift method
US20040015150A1 (en) * 1996-05-20 2004-01-22 Gholam-Reza Zadno-Azizi Method and apparatus for emboli containment
US5865767A (en) * 1996-07-10 1999-02-02 Cordis Corporation Guidewire having compound taper
US20020068851A1 (en) * 1996-10-04 2002-06-06 Dietrich Gravenstein Imaging scope
US20020002349A1 (en) * 1996-10-11 2002-01-03 Transvascular, Inc. Systems and methods for delivering drugs to selected locations within the body
US5872879A (en) * 1996-11-25 1999-02-16 Boston Scientific Corporation Rotatable connecting optical fibers
US5862693A (en) * 1997-05-02 1999-01-26 Fort Lock Corporation Electronically controlled security lock
US20040018980A1 (en) * 1998-04-24 2004-01-29 Genentech, Inc. Novel FIZZ proteins
US20020026155A1 (en) * 1998-08-11 2002-02-28 Lorraine Mangosong Slideable cannula and method of use
US6878106B1 (en) * 1999-02-15 2005-04-12 Ingo F. Herrmann Deformable fiberscope with a displaceable supplementary device
US20020010426A1 (en) * 1999-04-30 2002-01-24 Applied Medical Resources Corporation Guidewire
US20020006961A1 (en) * 1999-05-14 2002-01-17 Katz Stanley E. Method and composition for treating mammalian nasal and sinus diseases caused by inflammatory response
US20030018291A1 (en) * 1999-12-08 2003-01-23 Hill Frank C. Ear tube and method of insertion
US20030014008A1 (en) * 2000-02-04 2003-01-16 Jacques Steven L Triple lumen stone balloon catheter and method
US6589164B1 (en) * 2000-02-15 2003-07-08 Transvascular, Inc. Sterility barriers for insertion of non-sterile apparatus into catheters or other medical devices
US20020010384A1 (en) * 2000-03-30 2002-01-24 Ramin Shahidi Apparatus and method for calibrating an endoscope
US20020016564A1 (en) * 2000-05-31 2002-02-07 Courtney Brian K. Embolization protection sytem for vascular procedures
US20030017111A1 (en) * 2000-07-19 2003-01-23 Carlos Rabito Fluorescent agents for real-time measurement of organ function
US6672773B1 (en) * 2000-12-29 2004-01-06 Amkor Technology, Inc. Optical fiber having tapered end and optical connector with reciprocal opening
US6991597B2 (en) * 2001-03-09 2006-01-31 Boston Scientific Scimed, Inc. System for implanting an implant and method thereof
US20030014036A1 (en) * 2001-06-12 2003-01-16 Varner Signe Erickson Reservoir device for intraocular drug delivery
US7160255B2 (en) * 2001-07-12 2007-01-09 Vahid Saadat Method and device for sensing and mapping temperature profile of a hollow body organ
US20030013985A1 (en) * 2001-07-12 2003-01-16 Vahid Saadat Method for sensing temperature profile of a hollow body organ
US20030032942A1 (en) * 2001-07-26 2003-02-13 Felix Theeuwes Local concentration management system
US20030040697A1 (en) * 2001-08-17 2003-02-27 Antares Pharma, Inc. Administration of insulin by jet injection
US20030114732A1 (en) * 2001-12-18 2003-06-19 Advanced Cardiovascular Systems, Inc. Sheath for guiding imaging instruments
US20030212446A1 (en) * 2002-05-10 2003-11-13 Kaplan Aaron V. Methods and apparatus for lead placement on a surface of the heart
US7318831B2 (en) * 2002-07-13 2008-01-15 Stryker Corporation System and method for performing irrigated nose and throat surgery
US7169163B2 (en) * 2002-09-30 2007-01-30 Bruce Becker Transnasal method and catheter for lacrimal system
US7316168B2 (en) * 2002-11-23 2008-01-08 Fag Kugelfischer Ag Force-sensing bearing
US20110015482A1 (en) * 2003-02-19 2011-01-20 Boston Scientific Scimed, Inc. Guidewire Locking Device and Method
US7641668B2 (en) * 2003-05-16 2010-01-05 Scimed Life Systems, Inc. Fluid delivery system and related methods of use
US7108706B2 (en) * 2003-05-28 2006-09-19 Rose Biomedical Development Corporation Inflatable nasal packing device with two non-elastic, flexible bags oversized relative to nasal cavities
US7322934B2 (en) * 2003-06-24 2008-01-29 Olympus Corporation Endoscope
US8088063B2 (en) * 2003-12-05 2012-01-03 Fujifilm Corporation Insertion assisting tool for endoscope
US20070020196A1 (en) * 2003-12-31 2007-01-25 Pipkin James D Inhalant formulation containing sulfoalkyl ether cyclodextrin and corticosteroid prepared from a unit dose suspension
US20050240147A1 (en) * 2004-04-21 2005-10-27 Exploramed Ii, Inc. Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat
US20060004286A1 (en) * 2004-04-21 2006-01-05 Acclarent, Inc. Methods and devices for performing procedures within the ear, nose, throat and paranasal sinuses
US20060004323A1 (en) * 2004-04-21 2006-01-05 Exploramed Nc1, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US20080015540A1 (en) * 2004-04-21 2008-01-17 Acclarent, Inc. Implantable devices and methods for treating sinusitis and other disorders
US20110004057A1 (en) * 2004-04-21 2011-01-06 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US7645272B2 (en) * 2004-04-21 2010-01-12 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US20050267335A1 (en) * 2004-05-26 2005-12-01 Olympus Corporation Endoscope apparatus
US20090028923A1 (en) * 2005-01-18 2009-01-29 Acclarent, Inc. Implantable Devices and Methods for Treating Sinusitis and Other Disorders
US20080125625A1 (en) * 2005-01-18 2008-05-29 The Regents Of The University Of California Endoscopic Tube Delivery System
US20070005094A1 (en) * 2005-04-04 2007-01-04 Eaton Donald J Device and methods for treating paranasal sinus conditions
US7648367B1 (en) * 2005-09-23 2010-01-19 Acclarent, Inc. Anatomical models and methods for training and demonstration of medical procedures
US20070073269A1 (en) * 2005-09-23 2007-03-29 Becker Bruce B Multi-conduit balloon catheter
US20080015544A1 (en) * 2006-04-21 2008-01-17 Entellus Medical, Inc. Method for accessing a sinus cavity and related anatomical features
US20090017090A1 (en) * 2006-07-10 2009-01-15 Arensdorf Patrick A Devices and methods for delivering active agents to the osteomeatal complex
US20080172033A1 (en) * 2007-01-16 2008-07-17 Entellus Medical, Inc. Apparatus and method for treatment of sinusitis
USD630321S1 (en) * 2009-05-08 2011-01-04 Angio Dynamics, Inc. Probe handle

Cited By (275)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8740929B2 (en) 2001-02-06 2014-06-03 Acclarent, Inc. Spacing device for releasing active substances in the paranasal sinus
US20040116958A1 (en) * 2001-02-06 2004-06-17 Achim Gopferich Spacing device for releasing active substances in the paranasal sinus
US8764786B2 (en) 2002-09-30 2014-07-01 Acclarent, Inc. Balloon catheters and methods for treating paranasal sinuses
US8317816B2 (en) 2002-09-30 2012-11-27 Acclarent, Inc. Balloon catheters and methods for treating paranasal sinuses
US8100933B2 (en) 2002-09-30 2012-01-24 Acclarent, Inc. Method for treating obstructed paranasal frontal sinuses
US9457175B2 (en) 2002-09-30 2016-10-04 Acclarent, Inc. Balloon catheters and methods for treating paranasal sinuses
US11291812B2 (en) 2003-03-14 2022-04-05 Intersect Ent, Inc. Sinus delivery of sustained release therapeutics
US9554691B2 (en) 2004-04-21 2017-01-31 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US10806477B2 (en) 2004-04-21 2020-10-20 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US11511090B2 (en) 2004-04-21 2022-11-29 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US20070249896A1 (en) * 2004-04-21 2007-10-25 Eric Goldfarb Endoscopic methods and devices for transnasal procedures
US20070282305A1 (en) * 2004-04-21 2007-12-06 Eric Goldfarb Endoscopic methods and devices for transnasal procedures
US20080097514A1 (en) * 2004-04-21 2008-04-24 Acclarent, Inc. Devices, Systems and Methods for Treating Disorders of the Ear, Nose and Throat
US20080103521A1 (en) * 2004-04-21 2008-05-01 Acclarent, Inc. Methods and Apparatus for Treating Disorders of the Ear Nose and Throat
US20080119693A1 (en) * 2004-04-21 2008-05-22 Acclarent, Inc. Methods and Apparatus for Treating Disorders of the Ear, Nose and Throat
US11529502B2 (en) 2004-04-21 2022-12-20 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US20080195041A1 (en) * 2004-04-21 2008-08-14 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose and throat
US20080234720A1 (en) * 2004-04-21 2008-09-25 Acclarent, Inc. Devices, Systems and Methods for Treating Disorders of the Ear, Nose and Throat
US20080275483A1 (en) * 2004-04-21 2008-11-06 Acclarent, Inc. Methods and Apparatus for Treating Disorders of the Ear Nose and Throat
US11202644B2 (en) 2004-04-21 2021-12-21 Acclarent, Inc. Shapeable guide catheters and related methods
US11065061B2 (en) 2004-04-21 2021-07-20 Acclarent, Inc. Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses
US8858586B2 (en) 2004-04-21 2014-10-14 Acclarent, Inc. Methods for enlarging ostia of paranasal sinuses
US8088101B2 (en) 2004-04-21 2012-01-03 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US11019989B2 (en) 2004-04-21 2021-06-01 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US10874838B2 (en) 2004-04-21 2020-12-29 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US20090187098A1 (en) * 2004-04-21 2009-07-23 Acclarent, Inc. Devices, Systems and Methods for Diagnosing and Treating Sinusitis and Other Disorders of the Ears, Nose, and/or Throat
US20090198216A1 (en) * 2004-04-21 2009-08-06 Acclarent, Inc. Frontal sinus spacer
US10856727B2 (en) 2004-04-21 2020-12-08 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8080000B2 (en) 2004-04-21 2011-12-20 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US10779752B2 (en) 2004-04-21 2020-09-22 Acclarent, Inc. Guidewires for performing image guided procedures
US10702295B2 (en) 2004-04-21 2020-07-07 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US10695080B2 (en) 2004-04-21 2020-06-30 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat
US10631756B2 (en) 2004-04-21 2020-04-28 Acclarent, Inc. Guidewires for performing image guided procedures
US20090312745A1 (en) * 2004-04-21 2009-12-17 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US20100100181A1 (en) * 2004-04-21 2010-04-22 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitus andother disorders of the ears, nose and/or throat
US20100099946A1 (en) * 2004-04-21 2010-04-22 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US8828041B2 (en) 2004-04-21 2014-09-09 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US20100174308A1 (en) * 2004-04-21 2010-07-08 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US9370649B2 (en) 2004-04-21 2016-06-21 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US10492810B2 (en) 2004-04-21 2019-12-03 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat
US10441758B2 (en) 2004-04-21 2019-10-15 Acclarent, Inc. Frontal sinus spacer
US10188413B1 (en) 2004-04-21 2019-01-29 Acclarent, Inc. Deflectable guide catheters and related methods
US10098652B2 (en) 2004-04-21 2018-10-16 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US10034682B2 (en) 2004-04-21 2018-07-31 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US9826999B2 (en) 2004-04-21 2017-11-28 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US9649477B2 (en) 2004-04-21 2017-05-16 Acclarent, Inc. Frontal sinus spacer
US9610428B2 (en) 2004-04-21 2017-04-04 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US8852143B2 (en) 2004-04-21 2014-10-07 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US9468362B2 (en) 2004-04-21 2016-10-18 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US20070135789A1 (en) * 2004-04-21 2007-06-14 Acclarent, Inc. Use of mechanical dilator devices to enlarge ostia of paranasal sinuses and other passages in the ear, nose, throat and paranasal sinuses
US9399121B2 (en) 2004-04-21 2016-07-26 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US10500380B2 (en) 2004-04-21 2019-12-10 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US20070208252A1 (en) * 2004-04-21 2007-09-06 Acclarent, Inc. Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses
US11020136B2 (en) 2004-04-21 2021-06-01 Acclarent, Inc. Deflectable guide catheters and related methods
US8090433B2 (en) 2004-04-21 2012-01-03 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US20070129751A1 (en) * 2004-04-21 2007-06-07 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US8114062B2 (en) 2004-04-21 2012-02-14 Acclarent, Inc. Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders
US9351750B2 (en) 2004-04-21 2016-05-31 Acclarent, Inc. Devices and methods for treating maxillary sinus disease
US8864787B2 (en) 2004-04-21 2014-10-21 Acclarent, Inc. Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis
US8123722B2 (en) 2004-04-21 2012-02-28 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US9265407B2 (en) 2004-04-21 2016-02-23 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8142422B2 (en) 2004-04-21 2012-03-27 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat
US8146400B2 (en) 2004-04-21 2012-04-03 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8172828B2 (en) 2004-04-21 2012-05-08 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US9241834B2 (en) 2004-04-21 2016-01-26 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US9220879B2 (en) 2004-04-21 2015-12-29 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US9167961B2 (en) 2004-04-21 2015-10-27 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US9107574B2 (en) 2004-04-21 2015-08-18 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US11589742B2 (en) 2004-04-21 2023-02-28 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US11864725B2 (en) 2004-04-21 2024-01-09 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat
US8870893B2 (en) 2004-04-21 2014-10-28 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat
US8414473B2 (en) 2004-04-21 2013-04-09 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
US8425457B2 (en) 2004-04-21 2013-04-23 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitus and other disorder of the ears, nose and/or throat
US9101384B2 (en) 2004-04-21 2015-08-11 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat
US9089258B2 (en) 2004-04-21 2015-07-28 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8777926B2 (en) 2004-04-21 2014-07-15 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasel or paranasal structures
US9055965B2 (en) 2004-04-21 2015-06-16 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US8894614B2 (en) 2004-04-21 2014-11-25 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US20060063973A1 (en) * 2004-04-21 2006-03-23 Acclarent, Inc. Methods and apparatus for treating disorders of the ear, nose and throat
US8961398B2 (en) 2004-04-21 2015-02-24 Acclarent, Inc. Methods and apparatus for treating disorders of the ear, nose and throat
US8961495B2 (en) 2004-04-21 2015-02-24 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US8945088B2 (en) 2004-04-21 2015-02-03 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US8702626B1 (en) 2004-04-21 2014-04-22 Acclarent, Inc. Guidewires for performing image guided procedures
US8715169B2 (en) 2004-04-21 2014-05-06 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US8721591B2 (en) 2004-04-21 2014-05-13 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US8932276B1 (en) 2004-04-21 2015-01-13 Acclarent, Inc. Shapeable guide catheters and related methods
US8764726B2 (en) 2004-04-21 2014-07-01 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US8747389B2 (en) 2004-04-21 2014-06-10 Acclarent, Inc. Systems for treating disorders of the ear, nose and throat
US8764709B2 (en) 2004-04-21 2014-07-01 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US8764729B2 (en) 2004-04-21 2014-07-01 Acclarent, Inc. Frontal sinus spacer
US8905922B2 (en) 2004-04-21 2014-12-09 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, nose and/or throat
US9039657B2 (en) 2004-08-04 2015-05-26 Acclarent, Inc. Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders
US9039680B2 (en) 2004-08-04 2015-05-26 Acclarent, Inc. Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders
US9084876B2 (en) 2004-08-04 2015-07-21 Acclarent, Inc. Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders
US20100114066A1 (en) * 2004-08-04 2010-05-06 Acclarent, Inc. Implantable devices and methods for delivering drugs and other substances to treat sinusitis and other disorders
US8388642B2 (en) 2005-01-18 2013-03-05 Acclarent, Inc. Implantable devices and methods for treating sinusitis and other disorders
US9308361B2 (en) 2005-01-18 2016-04-12 Acclarent, Inc. Implantable devices and methods for treating sinusitis and other disorders
US20090028923A1 (en) * 2005-01-18 2009-01-29 Acclarent, Inc. Implantable Devices and Methods for Treating Sinusitis and Other Disorders
US20060164680A1 (en) * 2005-01-25 2006-07-27 Hyuck Kim Printing system and method of printing data on a designated paper
US8337454B2 (en) 2005-04-04 2012-12-25 Intersect Ent, Inc. Device and methods for treating paranasal sinus conditions
US8740839B2 (en) 2005-04-04 2014-06-03 Intersect Ent, Inc. Device and methods for treating paranasal sinus conditions
US8858974B2 (en) 2005-04-04 2014-10-14 Intersect Ent, Inc. Device and methods for treating paranasal sinus conditions
US20070005094A1 (en) * 2005-04-04 2007-01-04 Eaton Donald J Device and methods for treating paranasal sinus conditions
US11123091B2 (en) 2005-04-04 2021-09-21 Intersect Ent, Inc. Device and methods for treating paranasal sinus conditions
US20090156980A1 (en) * 2005-04-04 2009-06-18 Sinexus, Inc. Device and methods for treating paranasal sinus conditions
US20090227945A1 (en) * 2005-04-04 2009-09-10 Eaton Donald J Device and methods for treating paranasal sinus conditions
US8025635B2 (en) 2005-04-04 2011-09-27 Intersect Ent, Inc. Device and methods for treating paranasal sinus conditions
US9585681B2 (en) 2005-04-04 2017-03-07 Intersect Ent, Inc. Device and methods for treating paranasal sinus conditions
US10124154B2 (en) 2005-06-10 2018-11-13 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US8951225B2 (en) 2005-06-10 2015-02-10 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US10842978B2 (en) 2005-06-10 2020-11-24 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US20070208301A1 (en) * 2005-06-10 2007-09-06 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US20070073269A1 (en) * 2005-09-23 2007-03-29 Becker Bruce B Multi-conduit balloon catheter
US10639457B2 (en) 2005-09-23 2020-05-05 Acclarent, Inc. Multi-conduit balloon catheter
US8968269B2 (en) 2005-09-23 2015-03-03 Acclarent, Inc. Multi-conduit balloon catheter
US9050440B2 (en) 2005-09-23 2015-06-09 Acclarent, Inc. Multi-conduit balloon catheter
US20090171301A1 (en) * 2005-09-23 2009-07-02 Becker Bruce B Multi-conduit balloon catheter
US8114113B2 (en) 2005-09-23 2012-02-14 Acclarent, Inc. Multi-conduit balloon catheter
US9999752B2 (en) 2005-09-23 2018-06-19 Acclarent, Inc. Multi-conduit balloon catheter
US20070179518A1 (en) * 2006-02-02 2007-08-02 Becker Bruce B Balloon Catheters and Methods for Treating Paranasal Sinuses
US9629656B2 (en) 2006-05-17 2017-04-25 Acclarent, Inc. Adapter for attaching electromagnetic image guidance components to a medical device
US8190389B2 (en) 2006-05-17 2012-05-29 Acclarent, Inc. Adapter for attaching electromagnetic image guidance components to a medical device
US9198736B2 (en) 2006-05-17 2015-12-01 Acclarent, Inc. Adapter for attaching electromagnetic image guidance components to a medical device
US20080125720A1 (en) * 2006-05-17 2008-05-29 Acclarent, Inc. Adapter for attaching electromagnetic image guidance components to a medical device
US20090017090A1 (en) * 2006-07-10 2009-01-15 Arensdorf Patrick A Devices and methods for delivering active agents to the osteomeatal complex
US20090306624A1 (en) * 2006-07-10 2009-12-10 Sinexus, Inc. Devices and methods for delivering active agents to the osteomeatal complex
US8535707B2 (en) 2006-07-10 2013-09-17 Intersect Ent, Inc. Devices and methods for delivering active agents to the osteomeatal complex
US8802131B2 (en) 2006-07-10 2014-08-12 Intersect Ent, Inc. Devices and methods for delivering active agents to the osteomeatal complex
US9603506B2 (en) 2006-09-15 2017-03-28 Acclarent, Inc. Methods and devices for facilitating visualization in a surgical environment
US20090240237A1 (en) * 2006-09-15 2009-09-24 Acclarent Inc. Methods and Devices for Facilitating Visualization In a Surgical Environment
US9572480B2 (en) 2006-09-15 2017-02-21 Acclarent, Inc. Methods and devices for facilitating visualization in a surgical environment
US20090240112A1 (en) * 2006-09-15 2009-09-24 Acclarent, Inc. Methods and Devices for Facilitating Visualization In a Surgical Environment
US10716629B2 (en) 2006-09-15 2020-07-21 Acclarent, Inc. Methods and devices for facilitating visualization in a surgical environment
US9179823B2 (en) 2006-09-15 2015-11-10 Acclarent, Inc. Methods and devices for facilitating visualization in a surgical environment
US9820688B2 (en) 2006-09-15 2017-11-21 Acclarent, Inc. Sinus illumination lightwire device
US8439687B1 (en) 2006-12-29 2013-05-14 Acclarent, Inc. Apparatus and method for simulated insertion and positioning of guidewares and other interventional devices
US9615775B2 (en) 2007-04-30 2017-04-11 Acclarent, Inc. Methods and devices for ostium measurements
US8118757B2 (en) 2007-04-30 2012-02-21 Acclarent, Inc. Methods and devices for ostium measurement
US8485199B2 (en) 2007-05-08 2013-07-16 Acclarent, Inc. Methods and devices for protecting nasal turbinate during surgery
US9463068B2 (en) 2007-05-08 2016-10-11 Acclarent, Inc. Methods and devices for protecting nasal turbinates
US20090021818A1 (en) * 2007-07-20 2009-01-22 Ethicon Endo-Surgery, Inc. Medical scanning assembly with variable image capture and display
US20090030409A1 (en) * 2007-07-27 2009-01-29 Eric Goldfarb Methods and devices for facilitating visualization in a surgical environment
US8585730B2 (en) 2007-12-18 2013-11-19 Intersect Ent, Inc. Self-expanding devices and methods therefor
US11497835B2 (en) 2007-12-18 2022-11-15 Intersect Ent, Inc. Self-expanding devices and methods therefor
US8986341B2 (en) 2007-12-18 2015-03-24 Intersect Ent, Inc. Self-expanding devices and methods therefor
US20090220571A1 (en) * 2007-12-18 2009-09-03 Eaton Donald J Self-expanding devices and methods therefor
US11654216B2 (en) 2007-12-18 2023-05-23 Intersect Ent, Inc. Self-expanding devices and methods therefor
US11110210B2 (en) 2007-12-18 2021-09-07 Intersect Ent, Inc. Self-expanding devices and methods therefor
US10010651B2 (en) 2007-12-18 2018-07-03 Intersect Ent, Inc. Self-expanding devices and methods therefor
US10471185B2 (en) 2007-12-18 2019-11-12 Intersect Ent, Inc. Self-expanding devices and methods therefor
US20090198179A1 (en) * 2007-12-18 2009-08-06 Abbate Anthony J Delivery devices and methods
US11826494B2 (en) 2007-12-18 2023-11-28 Intersect Ent, Inc. Self-expanding devices and methods therefor
US8585731B2 (en) 2007-12-18 2013-11-19 Intersect Ent, Inc. Self-expanding devices and methods therefor
US10206821B2 (en) 2007-12-20 2019-02-19 Acclarent, Inc. Eustachian tube dilation balloon with ventilation path
US11850120B2 (en) 2007-12-20 2023-12-26 Acclarent, Inc. Eustachian tube dilation balloon with ventilation path
US11311419B2 (en) 2007-12-20 2022-04-26 Acclarent, Inc. Eustachian tube dilation balloon with ventilation path
US9861793B2 (en) 2008-03-10 2018-01-09 Acclarent, Inc. Corewire design and construction for medical devices
US8182432B2 (en) 2008-03-10 2012-05-22 Acclarent, Inc. Corewire design and construction for medical devices
US9750401B2 (en) 2008-07-30 2017-09-05 Acclarent, Inc. Paranasal ostium finder devices and methods
US10271719B2 (en) 2008-07-30 2019-04-30 Acclarent, Inc. Paranasal ostium finder devices and methods
US8979888B2 (en) 2008-07-30 2015-03-17 Acclarent, Inc. Paranasal ostium finder devices and methods
US11116392B2 (en) 2008-07-30 2021-09-14 Acclarent, Inc. Paranasal ostium finder devices and methods
US8763222B2 (en) 2008-08-01 2014-07-01 Intersect Ent, Inc. Methods and devices for crimping self-expanding devices
US9782283B2 (en) 2008-08-01 2017-10-10 Intersect Ent, Inc. Methods and devices for crimping self-expanding devices
US20110202037A1 (en) * 2008-08-18 2011-08-18 Bolger William E Fluid delivery catheter apparatus
US20110201996A1 (en) * 2008-08-27 2011-08-18 Melder Patrick C Nasal ventilation system and method of using same
US8945142B2 (en) 2008-08-27 2015-02-03 Cook Medical Technologies Llc Delivery system for implanting nasal ventilation tube
US11207087B2 (en) 2009-03-20 2021-12-28 Acclarent, Inc. Guide system with suction
US10524814B2 (en) 2009-03-20 2020-01-07 Acclarent, Inc. Guide system with suction
US10376416B2 (en) 2009-03-31 2019-08-13 Acclarent, Inc. System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx
US20100305697A1 (en) * 2009-03-31 2010-12-02 Acclarent, Inc. System and Method For Treatment of Non-Ventilating Middle Ear by Providing a Gas Pathway Through the Nasopharynx
US8435290B2 (en) 2009-03-31 2013-05-07 Acclarent, Inc. System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx
US9636258B2 (en) 2009-03-31 2017-05-02 Acclarent, Inc. System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx
US9072626B2 (en) 2009-03-31 2015-07-07 Acclarent, Inc. System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx
US10357640B2 (en) 2009-05-15 2019-07-23 Intersect Ent, Inc. Expandable devices and methods for treating a nasal or sinus condition
US11484693B2 (en) 2009-05-15 2022-11-01 Intersect Ent, Inc. Expandable devices and methods for treating a nasal or sinus condition
US20110125091A1 (en) * 2009-05-15 2011-05-26 Abbate Anthony J Expandable devices and methods therefor
US9370650B2 (en) 2009-06-05 2016-06-21 Entellus Medical, Inc. Method and articles for treating the sinus system
US8986340B2 (en) 2009-06-05 2015-03-24 Entellus Medical, Inc. Frontal sinus dilation catheter
US20110224652A1 (en) * 2009-06-05 2011-09-15 Entellus Medical, Inc. Frontal sinus dilation catheter
US11090472B2 (en) 2009-06-05 2021-08-17 Entellus Medical, Inc. Method and articles for treating the sinus system
US11541214B2 (en) 2009-06-05 2023-01-03 Entellus Medical, Inc. Balloon dilation catheter for use in sinus passageways
US10369337B2 (en) 2009-06-05 2019-08-06 Entellus Medical, Inc. Balloon dilation catheter for use in sinus passageways
US10835723B2 (en) 2009-06-05 2020-11-17 Entellus Medical, Inc. Method and articles for treating the sinus system
US10363402B2 (en) 2009-06-05 2019-07-30 Entellus Medical, Inc. Sinus dilation catheter
US8834513B2 (en) 2009-06-05 2014-09-16 Entellus Medical, Inc. Method and articles for treating the sinus system
US8282667B2 (en) 2009-06-05 2012-10-09 Entellus Medical, Inc. Sinus dilation catheter
US10561829B2 (en) 2009-06-05 2020-02-18 Entellus Medical, Inc. Method and articles for treating the sinus system
US9550049B2 (en) 2009-06-05 2017-01-24 Entellus Medical, Inc. Method and articles for treating the sinus system
US9282986B2 (en) 2009-06-05 2016-03-15 Entellus Medical, Inc. Method and articles for treating the sinus system
US8277478B2 (en) 2009-06-05 2012-10-02 Entellus Medical, Inc. Frontal sinus dilation catheter
US20110015734A1 (en) * 2009-06-05 2011-01-20 Entrigue Surgical, Inc. Methods for Providing Therapy to an Anatomical Structure
US9339637B2 (en) 2009-06-05 2016-05-17 Entellus Medical, Inc. Method for treating outflow tracts
US20110015667A1 (en) * 2009-06-05 2011-01-20 Entrigue Surgical, Inc. Systems, Devices and Methods for Providing Therapy to an Anatomical Structure
US8882795B2 (en) 2009-06-05 2014-11-11 Entellus Medical, Inc. Frontal sinus dilation catheter
US10022525B2 (en) 2009-06-05 2018-07-17 Entellus Medical, Inc. Method and articles for treating the sinus system
US20110022172A1 (en) * 2009-06-05 2011-01-27 Entrigue Surgical, Inc. Disposable Medical Device for Engaging with Reusable Medical Instrument and Methods of Use
US20100312101A1 (en) * 2009-06-05 2010-12-09 Entellus Medical, Inc. Frontal sinus dilation catheter
US11083878B2 (en) 2009-06-05 2021-08-10 Entellus Medical, Inc. Method and articles for treating the sinus system
US8435261B2 (en) 2009-07-15 2013-05-07 Regents Of The University Of Minnesota Treatment and placement device for sinusitis applications
US20110015612A1 (en) * 2009-07-15 2011-01-20 Regents Of The University Of Minnesota Implantable devices for treatment of sinusitis
US20110137178A1 (en) * 2009-10-06 2011-06-09 The General Hospital Corporation Devices and methods for imaging particular cells including eosinophils
US20110160740A1 (en) * 2009-12-28 2011-06-30 Acclarent, Inc. Tissue Removal in The Paranasal Sinus and Nasal Cavity
US20140350335A1 (en) * 2010-04-08 2014-11-27 Eric James Kezirian Endoscopic device and system
US20110251457A1 (en) * 2010-04-08 2011-10-13 Eric James Kezirian Endoscopic device and system
US10064683B2 (en) 2010-04-08 2018-09-04 Eric James Kezirian Endoscopic device and system
US8764632B2 (en) * 2010-04-08 2014-07-01 Eric James Kezirian Endoscopic device and system
US20120071856A1 (en) * 2010-09-22 2012-03-22 Goldfarb Eric A Medical Device and Method for Treatment of a Sinus Opening
US11123479B2 (en) 2010-09-22 2021-09-21 Acclarent, Inc. Medical device and method for treatment of a sinus opening
US9554817B2 (en) * 2010-09-22 2017-01-31 Acclarent, Inc. Medical device and method for treatment of a sinus opening
US10383992B2 (en) 2010-09-22 2019-08-20 Acclarent, Inc. Medical device and method for treatment of a sinus opening
US9155492B2 (en) 2010-09-24 2015-10-13 Acclarent, Inc. Sinus illumination lightwire device
US9022967B2 (en) 2010-10-08 2015-05-05 Sinopsys Surgical, Inc. Implant device, tool, and methods relating to treatment of paranasal sinuses
US9308358B2 (en) 2010-10-08 2016-04-12 Sinopsys Surgical, Inc. Implant device, tool, and methods relating to treatment of paranasal sinuses
US10940297B2 (en) 2010-10-08 2021-03-09 Sinopsys Surgical, Inc. Method for providing access to a paranasal sinus
US11110256B2 (en) 2010-10-08 2021-09-07 Sinopsys Surgical, Inc. Kit for treatment of sinusitis
US9901721B2 (en) 2010-10-08 2018-02-27 Sinopsys Surgical, Inc. Method for delivery of treatment formulation to paranasal sinus
US10035004B2 (en) 2010-10-08 2018-07-31 Sinopsys Surgical, Inc. Implant device, tool, and methods relating to treatment of paranasal sinuses
US9980631B2 (en) 2011-07-22 2018-05-29 Cook Medical Technologies Llc Irrigation devices adapted to be used with a light source for the identification and treatment of bodily passages
US9833130B2 (en) 2011-07-22 2017-12-05 Cook Medical Technologies Llc Irrigation devices adapted to be used with a light source for the identification and treatment of bodily passages
US9089631B2 (en) 2011-07-22 2015-07-28 Cook Medical Technologies Llc Irrigation devices adapted to be used with a light source for the identification and treatment of bodily passages
US9597179B2 (en) 2011-07-25 2017-03-21 Rainbow Medical Ltd. Sinus stent
US9457173B2 (en) 2011-09-10 2016-10-04 Cook Medical Technologies Llc Methods of providing access to a salivary duct
US20130265798A1 (en) * 2011-10-27 2013-10-10 Olympus Medical Systems Corp. Endoscope
US8801255B2 (en) * 2011-10-27 2014-08-12 Olympus Medical Systems Corp. Endoscope
US10881843B2 (en) 2011-11-10 2021-01-05 Entellus Medical, Inc. Methods and devices for treating sinusitis
US11806491B2 (en) 2011-11-10 2023-11-07 Entellus Medical, Inc. Methods and devices for treating sinusitis
US10086181B2 (en) 2011-11-10 2018-10-02 Entellus Medical, Inc. Methods and devices for treating sinusitis
US9283360B2 (en) 2011-11-10 2016-03-15 Entellus Medical, Inc. Methods and devices for treating sinusitis
US10342414B2 (en) 2011-11-25 2019-07-09 Cook Medical Technologies Llc Steerable guide member and catheter
US9375138B2 (en) 2011-11-25 2016-06-28 Cook Medical Technologies Llc Steerable guide member and catheter
US9592370B2 (en) 2012-03-19 2017-03-14 Cook Medical Technologies Llc Medical devices, methods, and kits for delivering medication to a bodily passage
US9586034B2 (en) 2012-03-19 2017-03-07 Cook Medical Technologies Llc Medical devices, methods, and kits for delivering medication to a bodily passage
US11045625B2 (en) 2012-03-19 2021-06-29 Cook Medical Technologies Llc Medical devices, methods, and kits for delivering medication to a bodily passage
US9044581B2 (en) 2012-03-19 2015-06-02 Cook Medical Technologies Llc Medical devices, methods, and kits for delivering medication to a bodily passage
US10188828B2 (en) 2012-03-19 2019-01-29 Cook Medical Technologies Llc Medical devices, methods, and kits for delivering medication to a bodily passage
US9572964B2 (en) 2012-04-11 2017-02-21 Sinapsys Surgical, Inc. Implantation tools, tool assemblies, kits and methods
US20140051928A1 (en) * 2012-08-15 2014-02-20 Brian FOUTS Cannula arrangement for minimally invasive surgery
US9131832B2 (en) * 2012-08-15 2015-09-15 Stryker Corporation Cannula arrangement for minimally invasive surgery
US9314593B2 (en) 2012-09-24 2016-04-19 Cook Medical Technologies Llc Medical devices for the identification and treatment of bodily passages
US10426925B2 (en) 2012-09-24 2019-10-01 Cook Medical Technologies Llc Medical devices for the identification and treatment of bodily passages
US9561350B2 (en) 2013-01-25 2017-02-07 Sinopsys Surgical, Inc. Paranasal sinus access implant devices and related tools, methods and kits
US9895055B2 (en) 2013-02-28 2018-02-20 Cook Medical Technologies Llc Medical devices, systems, and methods for the visualization and treatment of bodily passages
US10406332B2 (en) 2013-03-14 2019-09-10 Intersect Ent, Inc. Systems, devices, and method for treating a sinus condition
US11672960B2 (en) 2013-03-14 2023-06-13 Intersect Ent, Inc. Systems, devices, and method for treating a sinus condition
US10232152B2 (en) 2013-03-14 2019-03-19 Intersect Ent, Inc. Systems, devices, and method for treating a sinus condition
US9629684B2 (en) 2013-03-15 2017-04-25 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US9433437B2 (en) 2013-03-15 2016-09-06 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US10524869B2 (en) 2013-03-15 2020-01-07 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US9956383B2 (en) 2013-03-15 2018-05-01 Cook Medical Technologies Llc Medical devices and methods for providing access to a bodily passage during dilation
US10136907B2 (en) 2013-08-01 2018-11-27 Cook Medical Technologies Llc Methods of locating and treating tissue in a wall defining a bodily passage
US9549748B2 (en) 2013-08-01 2017-01-24 Cook Medical Technologies Llc Methods of locating and treating tissue in a wall defining a bodily passage
US20150100042A1 (en) * 2013-10-07 2015-04-09 Impel Neuropharma Inc. Muroid Family Nasal Device
US9700459B2 (en) 2013-10-16 2017-07-11 Sinopsys Surgical, Inc. Apparatuses, tools and kits relating to fluid manipulation treatments of paranasal sinuses
US10420459B2 (en) 2013-12-17 2019-09-24 Biovision Technologies, Llc Method of performing a sphenopalatine ganglion block procedure
US9694163B2 (en) 2013-12-17 2017-07-04 Biovision Technologies, Llc Surgical device for performing a sphenopalatine ganglion block procedure
US10046143B2 (en) 2013-12-17 2018-08-14 Biovision Technologies Llc Surgical device for performing a sphenopalatine ganglion block procedure
US10589072B2 (en) 2013-12-17 2020-03-17 Biovision Technologies, Llc Methods for treating sinus diseases
US10016580B2 (en) 2013-12-17 2018-07-10 Biovision Technologies, Llc Methods for treating sinus diseases
US11058855B2 (en) 2013-12-17 2021-07-13 Biovision Technologies, Llc Surgical device for performing a sphenopalatine ganglion block procedure
US9248266B2 (en) 2013-12-17 2016-02-02 Biovision Technologies, Llc Method of performing a sphenopalatine ganglion block procedure
US9510743B2 (en) 2013-12-17 2016-12-06 Biovision Technologies, Llc Stabilized surgical device for performing a sphenopalatine ganglion block procedure
US9839347B2 (en) 2013-12-17 2017-12-12 Biovision Technologies Llc Method of performing a sphenopalatine ganglion block procedure
US9516995B2 (en) 2013-12-17 2016-12-13 Biovision Technologies, Llc Surgical device for performing a sphenopalatine ganglion block procedure
USD843596S1 (en) 2014-01-09 2019-03-19 Axiosonic, Llc Ultrasound applicator
US9956384B2 (en) 2014-01-24 2018-05-01 Cook Medical Technologies Llc Articulating balloon catheter and method for using the same
US10814098B2 (en) 2014-02-28 2020-10-27 Cook Medical Technologies Llc Deflectable catheters, systems, and methods for the visualization and treatment of bodily passages
US9937323B2 (en) 2014-02-28 2018-04-10 Cook Medical Technologies Llc Deflectable catheters, systems, and methods for the visualization and treatment of bodily passages
US10898375B2 (en) 2014-07-24 2021-01-26 Sinopsys Surgical, Inc. Paranasal sinus access implant devices and related products and methods
US10195398B2 (en) 2014-08-13 2019-02-05 Cook Medical Technologies Llc Tension member seal and securing mechanism for medical devices
EP3200705A4 (en) * 2014-09-29 2018-07-11 Clearmind Biomedical, Inc. Surgical tool
US11129972B2 (en) 2017-09-20 2021-09-28 Sinopsys Surgical, Inc. Paranasal sinus fluid access implantation tools, assemblies, kits and methods
US10525240B1 (en) 2018-06-28 2020-01-07 Sandler Scientific LLC Sino-nasal rinse delivery device with agitation, flow-control and integrated medication management system
US11304713B2 (en) 2018-09-07 2022-04-19 Merit Medical Systems, Inc. Thrombosis macerating and aspiration devices for blood vessels
WO2020051468A1 (en) * 2018-09-07 2020-03-12 Merit Medical Systems, Inc. Thrombosis macerating and aspiration devices for blood vessels

Also Published As

Publication number Publication date
US20070270644A1 (en) 2007-11-22
EP2068997A4 (en) 2010-04-21
US20070249896A1 (en) 2007-10-25
EP2068997A2 (en) 2009-06-17
WO2008036148A2 (en) 2008-03-27
US9089258B2 (en) 2015-07-28
EP2522272A1 (en) 2012-11-14
WO2008036148A3 (en) 2008-11-13

Similar Documents

Publication Publication Date Title
US9089258B2 (en) Endoscopic methods and devices for transnasal procedures
US9468362B2 (en) Endoscopic methods and devices for transnasal procedures
US8146400B2 (en) Endoscopic methods and devices for transnasal procedures
US10856727B2 (en) Endoscopic methods and devices for transnasal procedures
US9107574B2 (en) Endoscopic methods and devices for transnasal procedures
US9820688B2 (en) Sinus illumination lightwire device
EP2618713B1 (en) Sinus illumination lightwire device
US20090030409A1 (en) Methods and devices for facilitating visualization in a surgical environment

Legal Events

Date Code Title Description
STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION