Intuitive Surgical Operations, Inc.

Leland Stanford Junior University

Endovx, Inc.

Conformis, Inc.

Kyphon Sarl

Voyage Medical, Inc.

Usgi Medical, Inc.

Baxano, Inc.

David John Miller

Vahid Saadat

Ruey-Feng Peh

Zachary John Malchano

Edmund A Tam

Chris A Rothe

Stephen Arie Leeflang

Christian Scott Eversull

William N Aldrich

Nicholas J Mourlas

Asha Shrinivas Nayak

Philipp K Lang

Daniel Steines

Hacene Bouadi

Christopher A Rothe

Aseem K Thakur

Michael R Smith

N Parker Willis

Veerappan Swaminathan

Erika I Palmer

Steve Mouw

Richard Christian Ewers

Eugene G Chen

Ted J Cooper

Juan Diego Perea

Wolfgang Fitz

Edwin J Hlavka

Jeffery Lee Bleich

Rene Vargas-Voracek

Konstantinos Tsougarakis

Isidro Matias Gandionco

Albert G Burdulis, Jr

Barry Jonathan Linder

James Yurchenco

Steven A Spisak

Cecily Anne Snyder

A tissue visualization system comprises a flexible elongate shaft through which a lumen extends. The system also comprises a pliable visualization device coupled to a distal portion of the flexible elongate shaft. The pliable visualization device includes a chamber configured to receive a fluid. The system also comprises a piercing instrument configured to extend through the lumen and to penetrate a surface of the pliable visualization device.

Methods and apparatus for efficient purging

A method of imaging a tissue region may comprise visualizing lesions over a tissue region via an imaging catheter by viewing the tissue region through a viewing region purged by a fluid and identifying, with a computer, a location of each of the lesions relative to one another over the tissue region. The method may also include registering, with the computer, a unique set of ablation parameters received from a treatment device for lesion generation for each of the lesions and generating, with the computer, a map of the lesions based on the identified locations of the lesions. The method may also include visually displaying the map of the lesions in a common display with a real-time field of view image of a first lesion; and visually displaying the registered unique set of ablation parameters for the first lesion with the real-time field of view image of the first lesion.

Mapping and real-time imaging a plurality of ablation lesions with registered ablation parameters received from treatment device

A medical manipulation assembly comprises a catheter including distal and proximal steerable portions with working channels. The assembly further comprises a steerable sheath through which the steerable portions extend. A distal steering mechanism, including a first lumen extending along a longitudinal axis of the catheter, bends the distal steerable portion. A proximal steering mechanism, including a second lumen extending along the axis and defined by a wall, bends the proximal steerable portion by rotational movement of the proximal steering mechanism independently of the distal steerable portion. The wall is rotatable about the axis. Distal pullwires extend between the distal steerable portion and the distal steering mechanism. Proximal pullwires extend between the proximal steerable portion and the proximal steering mechanism. The second lumen is axially aligned with an access lumen extending proximally from the proximal steering mechanism through which the distal and proximal working channels may receive a visualization instrument.

Catheter control systems

A tissue manipulation system comprises a reconfigurable hood structure. The hood structure is asymmetric and has a low profile delivery configuration and an expanded deployed configuration which defines an open area bounded at least in part by the hood structure and by an interface surface extending across the hood structure distal end and configured to engage against a tissue region. The open area is in fluid communication with an environment external to the hood structure. The system also includes a catheter in communication with the open area such that introduction of a fluid through the catheter purges the open area of bodily fluid. The interface surface is slanted relative to the catheter longitudinal axis when the hood structure is fully expanded in the expanded deployed configuration. The system also includes an imaging element positioned on the hood structure such that the open area is visualized through the fluid.

Stent delivery under direct visualization

A method of inhibiting flow of a purging fluid from a device comprises positioning an imaging hood in proximity to a tissue region to be visualized. The imaging hood includes a distal membrane which defines a main aperture. The imaging hood and the distal membrane define an open area. The method also comprises introducing the purging fluid into a proximal portion of the open area. The proximal portion is bounded by a proximal membrane including a plurality of apertures. The method also comprises pressurizing the proximal membrane with the purging fluid to a partially extended state in which the purging fluid flows through the plurality of apertures and through the main aperture. The method also comprises pressurizing the proximal membrane with the purging fluid to a blocking extended state in which the proximal membrane obstructs the main aperture to block the flow of the purging fluid through the main aperture.

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 method of inhibiting a flow of a purging fluid from a tissue visualization device comprises positioning an imaging hood attached to a distal end of a flexible elongate shaft in proximity to a tissue region to be visualized The method also comprises introducing the purging fluid into an inflation member suspended within an open area of the imaging hood. The inflation member includes at least one aperture on a proximal portion of the inflation member. The method also comprises inflating the inflation member to a partially inflated state in which the inflation member is circumferentially separated from an inner surface of the hood to form an annular flow path for the purging fluid from the at least one aperture, between the inner surface of the hood and the inflation member, and into fluid communication with an environment external to the hood. The method also comprising inflating the inflation member to a blocking inflated state in which the inflation member expands into contact with the imaging hood to block the flow from the at least one aperture to the annular flow path.

A tissue manipulation system comprises a reconfigurable hood structure with a distal end. The hood structure has a membrane extending across the hood structure distal end. The membrane includes an aperture with an aperture diameter smaller than an outer lip diameter of the hood structure in the expanded deployed configuration. The system also includes a fluid lumen in communication with the open area and an inflatable balloon member translatable through the aperture in the membrane and distal to the open area. The system also comprises an expandable stent positioned upon the balloon member. The stent has an unexpanded configuration sized to pass through the aperture in the membrane.

This invention is directed to orthopedic implants and systems. The invention also relates to methods of implant design, manufacture, modeling and implantation as well as to surgical tools and kits used therewith. The implants are designed by analyzing the articular surface to be corrected and creating a device with an anatomic or near anatomic fit; or selecting a pre-designed implant having characteristics that give the implant the best fit to the existing defect.

Standard or customized tibial implant with multiple convexities and concavities, and variable slope

Apparatus and methods are provided for accessing body lumens and/or for delivering instruments into body lumens, e.g., vessels within a patient's vasculature. A flexible sheath is provided that is expandable from a contracted condition to an enlarged condition wherein the sheath at least partially defines a lumen therein. The sheath is lubricious and has a relatively thin wall, thereby providing a collapsible/expandable guide for delivering fluids and/or instruments through tortuous anatomy and/or into relatively narrow passages. The sheath is advanced from an entry site to a body lumen in the contracted condition. Once the sheath reaches a target body lumen, the sheath is expanded to the enlarged condition, thereby defining a lumen within the sheath, and fluids and/or instruments are introduced into the body lumen via the sheath lumen. Upon completing the procedure, the sheath is removed from the body lumen.

Expandable guide sheath and apparatus and methods for using such sheaths

Flow reduction hood systems are described which facilitate the visualization of tissue regions through a clear fluid. Such a system may include an imaging hood having one or more layers covering the distal opening and defines one or more apertures which control the infusion and controlled retention of the clearing fluid into the hood. In this manner, the amount of clearing fluid may be limited and the clarity of the imaging of the underlying tissue through the fluid within the hood may be maintained for relatively longer periods of time by inhibiting, delaying, or preventing the infusion of surrounding blood into the viewing field. The aperture size may be controlled to decrease or increase through selective inflation of the membrane or other mechanisms.

Flow reduction hood systems

Methods and apparatus for efficient purging from an imaging hood are described which facilitate the visualization of tissue regions through a clear fluid. Such a system may include an imaging hood having one or more layers covering the distal opening and defines one or more apertures which control the infusion and controlled retention of the clearing fluid into the hood. In this manner, the amount of clearing fluid may be limited and the clarity of the imaging of the underlying tissue through the fluid within the hood may be maintained for relatively longer periods of time by inhibiting, delaying, or preventing the infusion of surrounding blood into the viewing field. The aperture size may be controlled to decrease or increase through selective inflation of the membrane or other mechanisms.

Image processing systems are described which utilize various methods and processing algorithms for enhancing or facilitating visual detection and/or sensing modalities for images captured in vivo by an intravascular visualization and treatment catheter. Such assemblies are configured to deliver energy, such as RF ablation, to an underlying target tissue for treatment in a controlled manner while directly visualizing the tissue during the ablation process.

Intravascular catheter with hood and image processing systems

Complex shape steerable tissue visualization and manipulation catheters and their methods of use of disclosed herein. The deployment catheter may be articulated utilizing various steering mechanisms to adjust a position of a visualization hood or membrane through which underlying tissue may be visualized.

Complex shape steerable tissue visualization and manipulation catheter

Visual electrode ablation systems are described herein which 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 a region of 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, such as saline, can be pumped into the imaging hood until the fluid displaces any blood, thereby leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. An electric current may be passed through the fluid such that it passes directly to the tissue region being imaged and the electrical energy is conducted through the fluid without the need for a separate ablation probe or instrument to ablate the tissue being viewed.

Growing community of inventors

Palo Alto, CA, United States of America

David John Miller