Intuitive Surgical Operations, Inc.

Usgi Medical, Inc.

Voyage Medical, Inc.

Children's National Medical Center

Chris A Rothe

Vahid Saadat

Ruey-Feng Peh

Edmund A Tam

Richard Christian Ewers

Cang C Lam

Zachary John Malchano

Kenneth J Michlitsch

David John Miller

Robert A Vaughan

Rodney A Brenneman

Antony Jonathan Fields

Jason Paul Watson

Tracy D Maahs

Veerappan Swaminathan

Eugene C Chen

Bryan Wylie

Amir Abolfathi

Eugene G Chen

N Parker Willis

Arvin T Chang

Kevin H Van Bladel

Gilbert Madrid

Marvin C Elmer

Kabir Gambhir

Kenneth H Michlitsch

Isidro Matias Gandionco

Jules P Sherman

John A Cox

Douglas Frank Schwandt

Aseem K Thakur

David Miller

Rich C Ewers

Juan Diego Perea

Desmond Birkett

Veerappan Swanimathan

Cang C Laduca

Rodney C Brenneman

In vivo visualization systems are described which facilitate tissue treatment by a user in utilizing real time visualized tissue images with generated three-dimensional models of the tissue region of interest, such as the left atrial chamber of a subject's heart. Directional indicators on the visualized tissue as well as the imaging systems may be utilized while other variations may utilize image rotation or manipulation of visualized tissue regions to facilitate catheter control. Moreover, visualized tissue regions may be combined with imaged tissue regions as well as navigational information to further facilitate tissue treatments.

In-vivo visualization systems

A medical manipulation assembly comprises a sheath steerable in response to rotational movement of a sheath steering mechanism. The assembly also comprises a catheter extendable through the sheath. The catheter is steerable in response to rotational movement of a catheter steering mechanism. The sheath and catheter are independently steerable. The assembly also comprises a set of control wires. At least one of the sheath or the catheter includes a plurality of lumens with at least two of the plurality of lumens each sized for passage of one of the control wires of the set of control wires. The steerable catheter includes a working channel sized to receive a visualization instrument therethrough.

Complex shape steerable tissue visualization and manipulation catheter

A system for visualizing a tissue region of interest includes an imaging element, a sheath, and a dilator. The imaging element is configured to visualize tissue. The sheath includes a channel configured to receive the imaging element. The imaging element is positionable along a central longitudinal axis of the sheath and positionable in an off-axis position relative to the central longitudinal axis. The sheath comprises a flexible section defining at least a portion of the channel. The dilator is configured to advance through the channel to force the imaging element into the off-axis position. The dilator is configured to cause the imaging element to bulge the flexible section as the dilator is advanced through the channel.

Off-axis visualization systems

A computer implemented method comprises receiving a model of a tissue region, steering a distal end of a catheter within a body to a first area of a tissue region, and obtaining a first image from the distal end of the catheter of the first area of the tissue region. The method further comprises mapping the first image of the first area of the tissue region to the model of the tissue region and displaying the first image of the first area of the tissue region on the model of the tissue region.

A system for visualizing a tissue region of interest comprises a deployment catheter defining a lumen and a hood coupled to and extending distally from the deployment catheter. The hood has a low-profile configuration within a delivery sheath and a deployed configuration when extended distally of the delivery sheath. The hood in the deployed configuration defines an open area in fluid communication with the lumen. A distal portion of the deployment catheter extends into the open area. An imaging element is coupled to an imager support member. When in the deployed configuration, the imaging element is configured to extend distally of the distal portion while the imager support member extends within the deployment catheter. The imaging element comprises a tapered surface and the deployment catheter comprises a complementary tapered surface. Retraction of the imaging element causes the imaging element to shift radially outward from a longitudinal axis.

A manipulation assembly includes a delivery catheter having a lumen extending therethrough and a deployment catheter positioned within the delivery catheter. The deployment catheter is independently manipulatable with respect to the delivery catheter. The assembly further includes a visualization element extendable distally beyond the deployment catheter and an ablation probe comprising an energy transmitting surface positionable to ablate tissue adjacent to a distal end of the ablation probe. The ablation probe is extendable distally beyond the deployment catheter.

Methods and apparatus for treatment of atrial fibrillation

A delayed cord-clamping surface is provided that includes a newborn platform having a recessed surface configured to receive a chemical warming mattress, where the chemical warming mattress includes a conformable surface, where the newborn platform includes a detachable platform support that is configured to position the newborn platform proximal to a surgical region of a C-section patient, where the newborn platform is configured to support a newborn baby while an umbilical cord remains connected between the newborn and the C-section patient for draining from a placenta, where the newborn platform is configured to fitably mount with a warming table when the newborn platform is in a detached state from the detachable platform support.

Delayed cord clamping system

Apparatus for manipulating and securing tissue are described herein. In creating tissue folds within the body of a patient, a tissue manipulation assembly may generally have an elongate tubular member, an engagement member slidably disposed through the tubular member and a distal end adapted to engage tissue via a helical member, tissue stabilizing members positioned at the tubular member distal end which are adapted to stabilize tissue therebetween, and a delivery tube pivotable about the tissue stabilizer. The stabilizing members can be adapted to become angled relative to a longitudinal axis of the elongate tubular member. Moreover, one or all the articulation controls and functions can be integrated into a singular handle assembly connectable to the tissue manipulation assembly via a rigid or flexible tubular body.

Apparatus for manipulating and securing tissue

A method of ablating a tissue region within a blood-filled environment comprises restraining a fluid within a visualization field in a portion of the blood-filled environment and visualizing the tissue region through the fluid within the visualization field. The method also includes transmitting ablating electrical energy from the fluid into the visualized tissue region.

Visual electrode ablation systems

A computer implemented method comprises activating a control mechanism on a catheter handle in a first direction with respect to a user to steer a distal end of a catheter within a body in a second direction while the catheter handle is in a first rotational position. The control mechanism includes a first indicator associated with the first direction. The computer implemented method also includes obtaining an image from the distal end of the catheter of a tissue region of interest within the body and calibrating a first rotational motion of the catheter handle with a rotational motion of the image. With the catheter handle in a second rotational position that is different than the first rotational position, the control mechanism activated in the first direction with respect to the user moves the distal end of the catheter in the second direction.

A method of treatment comprises intravascularly securing an anchor extending from an anchor member at least partially within a vessel lumen such that blood flows unobstructed through or past the anchor. While the anchor is secured, a distance of the anchor member, between the anchor and a barrier or membrane projecting distally from a deployment catheter, is adjusted such that an open area defined by the barrier or membrane is placed against or adjacent to a portion of a patient tissue. Adjusting the distance of the anchor member comprises moving the deployment catheter distally with respect to the anchor member. The method also comprises displacing blood with a transparent fluid from the open area, and while the anchor is secured, articulating the barrier or membrane circumferentially around the anchor. The method also includes treating the tissue while visualizing through the transparent fluid.

Systems and methods for unobstructed visualization and ablation

A system comprises a deployment catheter defining at least one lumen and a hood projecting distally from the deployment catheter and defining an open area. The open area is in direct fluid communication with the at least one lumen. The system also comprises an elongate channel directly coupled to the hood such that the elongate channel terminates distally into the open area. The elongate channel extends proximally from an outer surface of the hood and is bounded proximally at a proximal pocket surface. The system also comprises an imaging element. The imaging element is sized to pass into the elongated channel at a distal end of the elongate channel. Proximal movement within the elongated channel is restricted by the proximal pocket surface. The system also comprises a control member extending within the elongate channel and through the proximal pocket surface for moving the imaging element through the elongate channel.

A method of inhibiting tissue migration comprises positioning an open area of a hood against or adjacent to a tissue region. The method also comprises displacing an opaque fluid with a transparent fluid from the open area. The method includes engaging a portion of the tissue region within the open area via an end effector advanced through the open area and which grasps onto the portion. The end effector includes a tapered section, tapered along its entire length, through which a lumen extends. The tapered section includes threads extending from a surface of the tapered section in a direction orthogonal to the longitudinal axis. The tissue region is pierced while displacing the opaque fluid with the transparent fluid through the distal opening of the hood and while maintaining engagement of the portion of the tissue region such that distal movement of the tissue is inhibited.

Methods for preventing tissue migration

Visualization apparatus and methods for transseptal access are described herein where intravascular access across a septal wall is facilitated via devices which provide for direct visual viewing of tissue area. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration. In use, the imaging hood is placed against or adjacent to the tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid can be pumped into the imaging hood until the fluid displaces any blood leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. Any number of therapeutic tools or a guidewire can be passed through the catheter and into the imaging hood for crossing the septal wall and passing the guidewire or instruments therethrough.

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San Mateo, CA, United States of America

Chris A Rothe