Intuitive Surgical Operations, Inc.

Usgi Medical, Inc.

Voyage Medical, Inc.

Nidus Medical, LLC

Ruey-Feng Peh

Vahid Saadat

Edmund A Tam

Chris A Rothe

David John Miller

Zachary John Malchano

Christopher A Rothe

Richard Christian Ewers

Aseem K Thakur

N Parker Willis

Tracy D Maahs

Jesus Flores

Amir Abolfathi

Cang C Lam

Ted J Cooper

Alex Khairkhahan

Veerappan Swaminathan

Alexander K Khairkhahan

Eugene G Chen

Marvin C Elmer

Juan Diego Perea

David Miller

Marvin C Elmers

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 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 robotic assembly comprises a deployment catheter including a steerable distal region and further comprises a balloon assembly coupled to the steerable distal region.

Precision control systems for tissue visualization and manipulation assemblies

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 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.

Off-axis visualization systems

Electrophysiology mapping and visualization systems are described herein where such devices may be used to visualize tissue regions as well as map the electrophysiological activity of the tissue. Such a system may include a deployment catheter and an attached 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. A position of the catheter and/or hood may be tracked and the hood may also be used to detect the electrophysiological activity of the visualized tissue for mapping.

Electrophysiology mapping and visualization system

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

An apparatus for inhibiting tissue migration during a procedure comprises a deployment catheter defining at least one lumen therethrough and a non-inflatable hood projecting distally from the deployment catheter and defining an open area. The open area is in fluid communication with the at least one lumen. The apparatus also comprises a visualization element disposed within or along the non-inflatable hood for visualizing tissue adjacent to the open area. The apparatus also comprises a tissue grasping end effector positioned within the open area and configured to temporarily engage the tissue adjacent to the open area such that distal migration of the tissue relative to the barrier or membrane is inhibited.

Methods and apparatus for preventing tissue migration

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 method of cannulating a coronary sinus within a heart chamber includes deploying, from a catheter, an imaging hood to a deployed configuration by extending the imaging hood from a distal end of the catheter and radially expanding the imaging hood to define a constant deployed volume within an open area of the imaging hood. The method further includes positioning a contact edge of the imaging hood and the open area of the imaging hood in the deployed configuration over or upon an ostium of the coronary sinus, displacing an opaque fluid with a transparent fluid from the open area defined by the imaging hood and tissue surrounding the ostium, visualizing the ostium through the transparent fluid by viewing the ostium via an imaging element attached to an inner surface of the imaging hood, and introducing a guidewire through the imaging hood and into the ostium while under visual guidance.

Coronary sinus cannulation

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 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.

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Mountain View, CA, United States of America

Ruey-Feng Peh