阅读说明：本技术 动态刚性化复合医疗结构 (Dynamic rigidized composite medical structure ) 是由 A·Q·蒂尔森 S·J·莫里斯 G·J·戈梅斯 A·S·威金顿 M·C·谢弗 C·S·洛夫 于 2019-07-19 设计创作，主要内容包括：一种刚性化装置,其包括细长柔性管、位于细长柔性管之上的编织层、位于柔性管和编织层之上的外层、以及位于细长柔性管和外层之间且能够附接到真空源或压力源的入口。编织层具有编织在一起的多股股线,其编织角相对于细长柔性管为直的时的纵轴线呈5-40度。所述刚性化装置被构造为：当通过入口施加真空或压力时具有刚性构型,并且当不通过入口施加真空或压力时具有柔性构型。所述编织角构造为当刚性化装置处于柔性构型时随着刚性化装置弯曲而变化。(A rigidizing apparatus includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and an inlet positioned between the elongated flexible tube and the outer layer and capable of being attached to a vacuum or pressure source. The braid has a plurality of strands braided together at braiding angles of 5-40 degrees relative to the longitudinal axis of the elongate flexible tube when straight. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet. The braid angle is configured to vary as the rigidizer bends when the rigidizer is in a flexible configuration.)

1. A rigidizing apparatus, comprising:

an elongated flexible tube;

a braid positioned over the elongate flexible tube, the braid having a plurality of strands braided together at a braid angle of 5-40 degrees relative to a longitudinal axis of the elongate flexible tube when straight;

an outer layer over the flexible tube and the braid; and

an inlet between the elongated flexible tube and the outer layer configured to attach to a vacuum or pressure source;

wherein the rigidizer is configured to: a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet; and

wherein the braid angle is configured to change as the rigidizer bends when the rigidizer is in a flexible configuration.

2. The rigidizing device of claim 1, wherein the braid angle is between 10 degrees and 35 degrees.

3. The rigidizing device of claim 1, wherein the braid angle is between 15 degrees and 25 degrees.

4. The rigidizing device of claim 1, wherein the rigidizing device has a stiffness in a rigid configuration that is at least twice its stiffness in a flexible configuration.

5. The rigidizing device of claim 1, wherein the rigidizing device has a stiffness in a rigid configuration that is at least 5 times its stiffness in a flexible configuration.

6. The rigidizing apparatus of claim 1, further comprising a sliding layer adjacent to the woven layer and having a lower coefficient of friction than the woven layer.

7. The rigidizing device of claim 1, wherein the elongated flexible tube includes a stiffening element extending therein.

8. The rigidizing device of claim 1, wherein the reinforcing element comprises a coil or a plurality of loop elements.

9. The rigidizing device of claim 1, wherein the plurality of strands are braided together at 4-60 strands per inch.

10. The rigidizing device of claim 1, wherein the strands comprise polyethylene terephthalate or stainless steel.

11. The rigidizing device of claim 1, wherein the braided layer provides 30-70% coverage relative to the elongated flexible tube.

12. The rigidizing device of claim 1, wherein the plurality of strands comprises 96 strands or more.

13. The rigidizing device of claim 1, wherein the inlet is configured to be attached to a pressure source, and wherein the rigidizing device further comprises a bladder layer therein configured to be pushed toward the braid layer when pressure is supplied through the inlet.

14. The rigidizing device of claim 13, wherein the outer layer further comprises a plurality of stiffening elements therein.

15. The rigidizing device of claim 1, wherein the inlet is configured to attach to a vacuum source, and wherein the outer layer is a thin flexible sheath.

16. The rigidizing device of claim 1, further comprising a radial gap between the woven layer and the outer layer, the gap having a thickness of 0.00002-0.04 inches.

17. The rigidizing device of claim 1, further comprising a steerable distal end.

18. The rigidizing device of claim 1, further comprising a sealing channel between the elongated flexible tube and the outer layer, the sealing channel comprising a working channel, a cable guide, or an inflation lumen.

19. A method of advancing a rigidizing device through a body lumen, comprising:

inserting the stiffening device into the body lumen while the stiffening device is in the flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer, the braid having a plurality of strands braided together at a braid angle of 5-40 degrees relative to a longitudinal axis of the elongated flexible tube when straight, and wherein the braid angle varies as the stiffening device bends in the flexible configuration; and

When the stiffening device has reached a desired location in the body lumen, a vacuum or pressure between the flexible tube and the outer layer is activated to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration.

20. The method of claim 19, further comprising releasing the vacuum or pressure after activating the vacuum or pressure to transition the rigidizer back to the flexible configuration.

21. The method of claim 19, wherein the braid angle is between 10 and 35 degrees.

22. The method of claim 19, wherein the braid angle is between 15 and 25 degrees.

23. The method of claim 19, further comprising passing a mirror through the rigidizing device when the rigidizing device is in a rigid configuration.

24. The method of claim 19, further comprising steering a steerable distal end of the rigidizing device through the body lumen.

25. The method of claim 19, wherein the body lumen is in the gastrointestinal tract.

26. The method of claim 19, wherein the body cavity is located in a heart.

27. The method of claim 19, wherein the body lumen is in a kidney.

28. The method of claim 19, wherein the body cavity is in a lung.

29. The method of claim 19, wherein the body cavity is in the brain.

30. A rigidizing apparatus, comprising:

an elongated flexible tube;

a braided layer positioned over the elongated flexible tube;

an outer layer over the flexible tube and the braid; and

an inlet between the elongated flexible tube and the outer layer configured to attach to a vacuum or pressure source;

wherein the rigidizer is configured to: a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet; and wherein the ratio of the stiffness of the rigidizing means in the rigid configuration to the stiffness of the rigidizing means in the flexible configuration is greater than 5.

31. The rigidizing device of claim 30, wherein the ratio is greater than 6.

32. The rigidizing device of claim 30, wherein the ratio is greater than 10.

33. The rigidizing device of claim 30, wherein the braided layer has a plurality of strands braided together at a braid angle of 5-40 degrees with respect to a longitudinal axis of the elongated flexible tube when straight.

34. The rigidizing device of claim 33, wherein the braid angle is between 10 and 35 degrees.

35. The rigidizing device of claim 30, further comprising a sliding layer adjacent to the woven layer, the sliding layer having a lower coefficient of friction than the woven layer.

36. The rigidizing device of claim 30, wherein the elongated flexible tube includes a stiffening element extending therein.

37. The rigidizing device of claim 36, wherein the reinforcing element comprises a coil or a plurality of loop elements.

38. The rigidizing device of claim 30, wherein the braided layer comprises a plurality of strands braided together at 4-60 strands per inch.

39. The rigidizing device of claim 30, wherein the braided layer comprises a plurality of strands braided together, the strands comprising polyethylene terephthalate or stainless steel.

40. The rigidizing device of claim 30, wherein the braided layer provides 30-70% coverage relative to the elongated flexible tube.

41. The rigidizing device of claim 30, wherein the braided layer comprises 96 or more strands braided together.

42. The rigidizing device of claim 30, wherein the inlet is configured to attach to a pressure source, and wherein the rigidizing device further comprises a bladder layer configured to be pushed toward the braid layer when pressure is supplied through the inlet.

43. The rigidizing device of claim 42, wherein the outer layer further comprises a plurality of reinforcing elements therein.

44. The rigidizing device of claim 30, wherein the inlet is configured to attach to a vacuum source, and wherein the outer layer is a thin flexible sheath.

45. The rigidizing device of claim 30, further comprising a radial gap between the braid and the outer layer, the gap having a thickness of 0.00002 to 0.04 inches.

46. The rigidizing device of claim 30, further comprising a steerable distal end.

47. The rigidizing device of claim 30, further comprising a sealing channel between the elongated flexible tube and the outer layer, the sealing channel comprising a working channel, a cable guide, or an inflation lumen.

48. A method of advancing a rigidizing device through a body lumen, comprising:

inserting the stiffening device into a body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; and

When the stiffening device has reached a desired location in the body lumen, activating a vacuum or pressure between the flexible tube and the outer layer to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration, wherein a ratio of a stiffness of the stiffening device in the rigid configuration to a stiffness in the flexible configuration is greater than 5.

49. The method of claim 48, further comprising releasing the vacuum or pressure after activating the vacuum or pressure to transition the rigidizer back to the flexible configuration.

50. The method of claim 48, wherein the ratio is greater than 6.

51. The method of claim 48, wherein the ratio is greater than 10.

52. The method of claim 48, further comprising passing a mirror through the rigidizing device when the rigidizing device is in a rigid configuration.

53. The method of claim 48, further comprising steering the steerable distal end of the rigidizing device to pass through the body lumen.

54. The method of claim 48, wherein the body lumen is in the gastrointestinal tract.

55. The method of claim 48, wherein the body cavity is located in a heart.

56. The method of claim 48, wherein the body lumen is in a kidney.

57. The method of claim 48, wherein the body cavity is in a lung.

58. The method of claim 48, wherein the body cavity is in the brain.

59. A rigidizing apparatus, comprising:

an elongated flexible tube;

a braid located radially outward of the elongated flexible tube;

a sliding layer adjacent to the woven layer;

an outer layer over the flexible tube, the braid and the sliding layer; and

an inlet between the elongated flexible tube and the outer layer configured to attach to a vacuum or pressure source;

wherein the rigidizer is configured to: a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet;

wherein the sliding layer is configured to reduce friction between the woven layer and the elongate flexible tube or the outer layer when the rigidizing apparatus is in a flexible configuration.

60. The rigidizing device of claim 59, wherein the sliding layer has a lower coefficient of friction than the woven layer.

61. The rigidizing device of claim 59, wherein the sliding layer comprises a powder.

62. The rigidizing device of claim 59, wherein the rigidity of the rigidizing device in a rigid configuration is at least 2 times the rigidity of the rigidizing device in a flexible configuration.

63. The rigidizing device of claim 59, wherein the rigidity of the rigidizing device in a rigid configuration is at least 5 times the rigidity of the rigidizing device in a flexible configuration.

64. The rigidizing device of claim 59, wherein the braid has a plurality of strands braided together at braid angles of 5-40 degrees relative to a longitudinal axis of the elongated flexible tube when straight.

65. The rigidizing device of claim 64, wherein the braid angle is between 10 degrees and 35 degrees.

66. The rigidizing device of claim 59, wherein the elongated flexible tube includes a stiffening element extending therein.

67. The rigidizing device of claim 66, wherein the reinforcing element comprises a coil or a plurality of loop elements.

68. The rigidizing device of claim 59, wherein the braided layer comprises a plurality of strands braided together at 4-60 strands per inch.

69. The rigidizing device of claim 59, wherein the braided layer comprises a plurality of strands braided together, the strands comprising polyethylene terephthalate or stainless steel.

70. The rigidizing device of claim 59, wherein the braided layer provides 30-70% coverage relative to the elongated flexible tube.

71. The rigidizing device of claim 59, wherein the braided layer comprises 96 or more strands braided together.

72. The rigidizing device of claim 59, wherein the inlet is configured to attach to a pressure source, and wherein the rigidizing device further comprises a bladder layer configured to be pushed toward the braid layer when pressure is supplied through the inlet.

73. The rigidizing device of claim 71, wherein the outer layer further comprises a plurality of reinforcing elements therein.

74. The rigidizing device of claim 59, wherein the inlet is configured to attach to a vacuum source, and wherein the outer layer is a thin flexible sheath.

75. The rigidizing device of claim 59, further comprising a radial gap between the braided layer and the outer layer, the gap having a thickness of 0.00002-0.04 inches.

76. The rigidizing device of claim 59, further comprising a steerable distal end.

77. The rigidizing device of claim 59, further comprising a sealing channel between the elongated flexible tube and the outer layer, the sealing channel comprising a working channel, a cable guide, or an inflation lumen.

78. A method of advancing a rigidizing device through a body lumen, comprising:

inserting the stiffening device into a body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a woven layer, a sliding layer adjacent to the woven layer, and an outer layer, wherein the sliding layer reduces friction between the woven layer and the elongated flexible tube or the outer layer while the stiffening device is in the flexible configuration; and

when the rigidizing device has reached a desired location in a body lumen, a vacuum or pressure between the flexible tube and the sheath is activated to transition the rigidizing device to a rigid configuration that is stiffer than the flexible configuration.

79. The method of claim 78, further comprising releasing the vacuum or pressure after activating the vacuum or pressure to transition the rigidizer back to the flexible configuration.

80. The method of claim 78, wherein said sliding layer has a lower coefficient of friction than said woven layer.

81. The method of claim 78, wherein the sliding layer comprises a powder.

82. The method of claim 78, further comprising passing a mirror through the rigidizing device when the rigidizing device is in a rigid configuration.

83. The method of claim 78, further comprising steering a steerable distal end of the rigidizing device through the body lumen.

84. The method of claim 78, wherein the body lumen is in the gastrointestinal tract.

85. The method of claim 78, wherein the body cavity is in a heart.

86. The method of claim 78, wherein the body lumen is in a kidney.

87. The method of claim 78, wherein the body cavity is in a lung.

88. The method of claim 78, wherein the body cavity is in the brain.

Background

During medical procedures, an interventional medical device may bend or loop through the anatomy, making advancement of the medical device difficult.

One well-known clinical challenge faced by endoscopy is when the endoscope can no longer advance due to excessive bending or looping of the gastrointestinal tract, resulting in a gastrointestinal tract loop. In fact, one study found that 91 patients had a loop in 100 patients who had undergone Colonoscopy [ Shah et al, "Magnetic Imaging of Colonocopy: An Audio of Looping, acquisition and annular maneuvers." gastroenterest Endosc 2000; 52:1-8]. The gastrointestinal tract circuit prolongs the procedure time and may cause pain to the patient because it stretches the vessel wall and mesentery. In addition, the gastrointestinal circuits lead to an increased incidence of gastrointestinal perforation. In severe gastrointestinal circuits, complete colonoscopy is not possible because the gastrointestinal circuits stretch the length of the colon, resulting in a colonoscope that is not long enough to reach the extremities. The gastrointestinal tract loop prevents precise control of the tip (tip), thereby preventing the user from obtaining the desired one-to-one motion relationship between the handle and the endoscope tip. Such problems typically occur in a wide range of endoscopic procedures including colonoscopy, Esophagogastroduodenoscopy (EGD), enteroscopy, Endoscopic Retrograde Cholangiopancreatography (ERCP), interventional endoscopy (including ESD (endoscopic submucosal dissection and EMR (endoscopic mucosal resection)), robotic flexible endoscopy, transoral robotic surgery (TORS), cases of anatomical alteration (including Roux-en-Y), and NOTES (natural orifice endoscopic surgery) procedures. Accordingly, there is a need for a device that helps prevent the gastrointestinal tract loop to provide a more successful approach to the gastrointestinal tract.

Similar difficulties arise in advancing medical devices, such as during interventional procedures in the lungs, kidneys, brain, cardiac space, and other anatomical locations. Accordingly, there is a need for a device that can safely, efficiently, and accurately access difficult to reach anatomical locations.

Disclosure of Invention

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and an inlet positioned between the flexible tube and the outer layer and attached to a vacuum or pressure source. The braid has a plurality of strands braided together at braiding angles of 5-40 degrees relative to the longitudinal axis of the elongate flexible tube when straight. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is applied through the inlet. The braid angle is configured to vary as the rigidizer bends when the rigidizer is in a flexible state.

This and other embodiments of the invention can include one or more of the following features. The braid angle may be between 10 and 35 degrees. The braid angle may be between 15 and 25 degrees. The rigidizing device in the rigid configuration may have a stiffness at least twice that of the rigidizing device in the flexible configuration. The rigidizing means in the rigid configuration may have a stiffness at least 5 times greater than the rigidizing means in the flexible configuration. The rigidizer may also include a sliding layer adjacent to the braid, and the sliding layer has a lower coefficient of friction than the braid. The elongate flexible tube may include a stiffening element extending therein. The reinforcing element may comprise a coil or a plurality of annular elements. The multiple strands may be braided together at 4-60 strands per inch. The strands may comprise polyethylene terephthalate or stainless steel. The braid may provide 30-70% coverage relative to the elongate flexible tube. The plurality of strands may comprise 96 strands or more. The inlet may be configured to be connected to a pressure source, and the rigidizing device may further include a bladder therein. The bladder layer may be configured to be pushed toward the woven layer when pressure is provided through the inlet. The outer layer may further include a plurality of reinforcing elements therein. The inlet may be configured to be connected to a vacuum source and the outer layer may be a thin flexible sheath. The stiffening means may further comprise a radial gap between the woven layer and the outer layer, and the gap may have a thickness of 0.00002 to 0.04 inches. The stiffening device may further comprise a steerable distal end. The rigidizer may include a sealed channel between the elongated flexible tube and the outer layer. The sealed channel may include a working channel, a cable guide, or an inflation lumen.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into a body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer, the braid having a plurality of strands braided together at a braid angle of 5-40 degrees relative to a longitudinal axis of the elongated flexible tube when straight, wherein the braid angle is configured to vary as the stiffening device bends when the stiffening device is in the flexible configuration; and (2) when the stiffening device has reached the desired location in the body lumen, transitioning the stiffening device to a stiffer rigid configuration than the flexible configuration by activating a vacuum or pressure between the flexible tube and the outer layer.

This and other embodiments of the invention can include one or more of the following features. The method may further comprise releasing the vacuum or pressure after activating the vacuum or pressure to transition the rigid configuration back to the flexible configuration. The braid angle may be between 10 and 35 degrees. The braid angle may be between 15 and 25 degrees. The method may further include passing the mirror through the rigidizer while the rigidizer is in the rigid configuration. The method may further include steering the steerable distal end of the rigidizing device through the body lumen. The body cavity may be in the gastrointestinal tract. The body cavity may be in the heart. The body cavity may be in a kidney. The body cavity may be in the lung. The body cavity may be in the brain.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and an inlet positioned between the elongated flexible tube and the outer layer and configured to be attached to a vacuum or pressure source. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet. The ratio of the stiffness of the stiffening means in the rigid configuration to the stiffness of the stiffening means in the flexible configuration is greater than 5.

This and other embodiments of the invention can include one or more of the following features. The above ratio may be greater than 6. The ratio may be greater than 10. The braid may have a plurality of strands braided together at braiding angles of 5 to 40 degrees relative to the longitudinal axis of the elongate flexible tube when straight. The braid angle may be between 10 and 35 degrees. The rigidizer may also include a sliding layer adjacent to the braid, and the sliding layer has a lower coefficient of friction than the braid. The elongate flexible tube may include a stiffening element extending therein. The reinforcing element may comprise a coil or a plurality of annular elements. The braid may comprise a plurality of strands braided together at 4-60 strands per inch. The braid may comprise a plurality of strands braided together, and the strands may comprise polyethylene terephthalate or stainless steel. The braid may provide 30-70% coverage relative to the elongate flexible tube. The braided layer may include 96 or more strands braided together. The inlet may be configured to be connected to a pressure source. The stiffening device may further include a bladder therein, and the bladder may be configured to be pushed toward the braid when pressure is provided through the inlet. The outer layer may further include a plurality of reinforcing elements therein. The inlet may be configured to attach to a vacuum source. The outer layer may be a thin flexible sheath. The stiffening means may further comprise a radial gap between the woven layer and the outer layer. The thickness of the gap may be 0.00002-0.04 inches. The rigidizing device may further include a steerable distal end. The rigidizing device may further include a sealing channel between the elongated flexible tube and the outer layer. The sealed channel may comprise a working channel, a cable guide or an inflation lumen.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into a body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; and (2) when the stiffening device has reached the desired location in the body lumen, transitioning the stiffening device to a rigid configuration that is stiffer than the flexible configuration by activating a vacuum or pressure between the flexible tube and the outer layer. The ratio of the stiffness of the rigidizing means in the rigid configuration to the stiffness of the rigidizing means in the flexible configuration is greater than 5.

This and other embodiments of the invention can include one or more of the following features. The method may further comprise converting the rigid configuration back to the flexible configuration by releasing the vacuum or pressure after activating the vacuum or pressure. The ratio may be greater than 6. The ratio may be greater than 10. The method may further include passing the mirror through the rigidizer while the rigidizer is in the rigid configuration. The method may further include steering the steerable distal end of the rigidizing device through the body lumen. The body cavity may be in the gastrointestinal tract. The body cavity may be in the heart. The body cavity may be in a kidney. The body cavity may be in a lung. The body cavity may be in the brain.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a braid positioned radially outward of the elongated flexible tube, a sliding layer adjacent the braid, an outer layer, and a vacuum or pressure inlet between the elongated flexible tube and the outer layer. The outer layer is positioned over the flexible tube, the braid and the slip layer. The inlet is configured to attach to a vacuum source or a pressure source. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet. The sliding layer is configured to reduce friction between the braid and the elongated flexible tube or the braid and the outer layer when the stiffening device is in the flexible configuration.

This and other embodiments of the invention can include one or more of the following features. The sliding layer may have a lower coefficient of friction than the woven layer. The sliding layer may comprise a powder. The rigidizing device has a stiffness in a rigid configuration that is at least 2 times greater than a stiffness in a flexible configuration thereof. The rigidizing device has a stiffness in a rigid configuration that is at least 5 times greater than its stiffness in a flexible configuration. The braid may have a plurality of strands braided together at braiding angles of 5 to 40 degrees relative to the longitudinal axis of the elongate flexible tube when straight. The braid angle may be between 10 and 35 degrees. The elongate flexible tube may include a stiffening element extending therein. The reinforcing element may comprise a coil or a plurality of annular elements. The braid may comprise a plurality of strands braided together at 4-60 strands per inch. The braid may comprise a plurality of strands braided together, and the strands may comprise polyethylene terephthalate or stainless steel. The braid may provide 30-70% coverage relative to the elongate flexible tube. The braided layer may include 96 or more strands braided together. The inlet may be configured to attach to a pressure source. The rigidizing device may further include a bladder layer therein. The bladder layer may be configured to be pushed toward the woven layer when pressure is provided through the inlet. The outer layer may further include a plurality of reinforcing elements therein. The inlet may be configured to attach to a vacuum source. The outer layer may be a thin flexible sheath. The stiffening means may further comprise a radial gap between the woven layer and the outer layer. The thickness of the gap may be 0.00002-0.04 inches. The stiffening device may further comprise a steerable distal end. The rigidizing device may further include a sealing channel between the elongated flexible tube and the outer layer. The sealed channel may include a working channel, a cable guide, or an inflation lumen.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, a sliding layer adjacent to the braid, and an outer layer, wherein the sliding layer reduces friction between the braid and the elongated flexible tube or the braid and the outer layer when the stiffening device is in the flexible configuration; and (2) activating a vacuum or pressure between the flexible tube and the sheath when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration state.

This and other embodiments of the invention can include one or more of the following features. The method may further include releasing the vacuum or pressure after activating the vacuum or pressure to convert the rigid configuration back to the flexible configuration. The sliding layer may have a lower coefficient of friction than the woven layer. The sliding layer may comprise a powder. The method may further include passing the mirror through the rigidizer while the rigidizer is in the rigid configuration. The method may further include steering the steerable distal end of the rigidizing device through the body lumen. The body cavity may be in the gastrointestinal tract. The body cavity may be in the heart. The body cavity may be in a kidney. The body cavity may be in a lung. The body cavity may be in the brain.

Generally, in one embodiment, a rigidizer includes an inner elongated flexible tube having a reinforcing element and a matrix, a braid positioned radially outward of the elongated flexible tube, an outer layer positioned over the braid, and a vacuum or pressure inlet positioned between the elongated flexible tube and the outer layer, the vacuum or pressure inlet configured to be attached to a source of vacuum or pressure. The width to thickness aspect ratio of the reinforcing element exceeds 5: 1. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

This and other embodiments of the invention can include one or more of the following features. The reinforcing element may be a coil. The stiffening element may comprise a plurality of closed loops. The closure loop may include a plurality of pockets or notches. The reinforcing element may comprise a wavy line. The reinforcing elements may be fibres or wires. The aspect ratio of the reinforcing elements may exceed 10: 1. The aspect ratio may exceed 11: 1. There may be a plurality of stiffening elements in the elongate flexible tube, and the spacing between each stiffening element may be 0.0006 inches or less. The elongate flexible tube may further comprise a matrix in which the reinforcing elements are embedded. The matrix may comprise TPU or TPE.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body cavity while the stiffening device is in the flexible configuration, the stiffening device comprising: an elongate flexible tube having a reinforcing element and a matrix, a braid and an outer layer, and the reinforcing element having an aspect ratio of width to thickness in excess of 10: 1; and (2) activating a vacuum or pressure between the flexible tube and the outer layer when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is harder than the flexible configuration.

This and other embodiments of the invention can include one or more of the following features. The elongate flexible tube may resist compression when a vacuum or pressure is applied.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and an inlet positioned between the elongated flexible tube and the outer layer and configured to be attached to a vacuum or pressure source. The braid has a plurality of strands braided together. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet. The ends of the strands are embedded in or surrounded by an annular ring, allowing relative movement of the ends when the rigidizing device is in a flexible configuration.

This and other embodiments of the invention can include one or more of the following features. The annular ring may include a coating of material. The annular ring may comprise silicone or urethane. The annular ring has a thickness of about 0.005-0.250 inches.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid having a plurality of strands braided together, and an outer layer; and (2) activating a vacuum or pressure between the flexible tube and the sheath when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration. The ends of the strands are embedded in or surrounded by the annular ring such that the ends move relative to each other when the rigidizing device is in the flexible configuration. The ends are substantially fixed relative to each other when the rigidizing device is in a rigid configuration.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer sealed over the flexible tube and the braid, and an inlet positioned between the elongated flexible tube and the outer layer and configured to be attached to a vacuum or pressure source. The braided layer has a plurality of strands braided together and a plurality of hoop fibers braided in the braided layer. The rigidizer is configured to have a rigid configuration when a vacuum or pressure is applied through the inlet and a flexible configuration when no vacuum or pressure is applied through the inlet.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; and (2) activating a vacuum between the flexible tube and the outer layer when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration. The braided layer includes a plurality of strands braided together and a plurality of hoop fibers braided in the braided layer.

Generally, in one embodiment, a stiffening device includes an elongated flexible tube, a balloon layer positioned over the elongated flexible tube, a braid layer positioned over the balloon layer, an outer layer positioned over the flexible tube and the braid layer, a pressure inlet positioned between the balloon layer and the elongated flexible tube, and a vent outlet positioned between the balloon layer and the outer layer. The pressure inlet is configured to be connected to a pressure source. The braid comprises a plurality of strands braided together. The rigidizer is configured to: a rigid configuration is achieved when vacuum or pressure is applied through the inlet and a flexible configuration is achieved when no vacuum or pressure is applied through the inlet. When the rigidizing device transitions from a flexible configuration to a rigid configuration, fluid or gas surrounding the strands is expelled through the vent outlets.

This and other embodiments of the invention can include one or more of the following features. The rigidizer may also include a handle connected to the elongated flexible tube. The handle may include a vent port in communication with the vent outlet.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a balloon layer, a braid layer having a plurality of strands braided together, and an outer layer; and (2) when the stiffening device has reached the desired location in the body lumen, providing pressure through the inlet between the elongate flexible tube and the balloon layer and venting gas or fluid surrounding the strands through the vent outlet to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, a passageway extending between the outer layer and the elongated flexible tube, and an inlet. The inlet is located between the elongated flexible tube and the outer layer and is configured to be attached to a vacuum or pressure source. The channel includes a working channel, a steering cable channel, or an inflation lumen. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; (2) activating a vacuum or pressure between the flexible tube and the outer layer when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration; and (3) passing the medical tool through the sealed working channel between the elongate flexible tube and the outer layer.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; (2) activating a vacuum or pressure between the flexible tube and the outer layer when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration; and (3) activating at least one cable positioned between the elongate flexible tube and the outer layer to orient the distal end of the stiffening device.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; (2) activating a vacuum or pressure between the flexible tube and the outer layer when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration; and (3) inflating a balloon on the rigidizer by passing an inflation medium through a sealed inflation lumen located between the elongate flexible tube and the outer layer.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube having a central lumen, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, a plurality of sealed working channels extending in the central lumen, and an inlet positioned between the elongated flexible tube and the outer layer and configured to be attached to a vacuum or pressure source. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting a stiffening device into the body lumen while the stiffening device is in a flexible configuration, wherein the stiffening device comprises an elongated flexible tube, a braid, and an outer layer; (2) activating a vacuum or pressure between the flexible tube and the outer layer when the stiffening device has reached a desired location in the body lumen to transition the stiffening device to a rigid configuration that is stiffer than the flexible configuration; (3) passing a first medical tool through a first sealed working channel of a rigidizing device; and (4) passing a second medical tool through a second sealed working channel of the rigidizing apparatus.

Generally, in one embodiment, an overtube comprises an elongate tube and a distal tip attached to the elongate tube. The distal tip has an annular distal end face with one or more vacuum holes extending therethrough. The one or more vacuum holes are configured to draw tissue toward the annular distal face when a vacuum is applied therethrough.

This and other embodiments of the invention can include one or more of the following features. The elongated tube may be a rigidizing device, and the rigidizing device may be configured to have a rigid configuration when a vacuum or pressure is applied to its wall and a flexible configuration when no vacuum or pressure is applied to its wall. The elongated tube may include a woven layer and an outer layer positioned over the woven layer. The annular distal end surface may be angled relative to a longitudinal axis of the elongate tube.

Generally, in one embodiment, a stiffening device includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and a distal tip coupled to the elongated flexible tube. The braid has a plurality of strands braided together at a first braid angle with respect to a longitudinal axis of the elongate flexible tube when straight. The distal tip includes a second braid having a plurality of strands braided together at a second braid angle, the second braid angle being different from the first braid angle. An inlet between the elongated flexible tube and the outer layer is configured to attach to a vacuum or pressure source. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

This and other embodiments of the invention can include one or more of the following features. The second braid angle may be greater than the first braid angle. The first woven layer and the second woven layer may be bonded to each other.

Generally, in one embodiment, a rigidizer comprises an elongated flexible tube including a plurality of stiffening elements therein. The elongated flexible tube includes a proximal portion and a distal portion. The braid is located on the proximal portion rather than the distal portion. The braid has a plurality of strands braided together at a first braid angle with respect to a longitudinal axis of the elongate flexible tube when the elongate flexible tube is straight. Located above the woven layer is an outer layer. A plurality of steerable linkages extend over the distal portion but not the proximal portion. An inlet between the elongated flexible tube and the outer layer is configured to attach to a vacuum or pressure source. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

This and other embodiments of the invention can include one or more of the following features. The rigidizer may further include a plurality of cables connected to the steerable linkage. A cable may extend between the elongate flexible tube and the outer layer.

Generally, in one embodiment, a rigidizer includes a rigidizer assembly and a plurality of linkages. The rigidizing assembly includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and an inlet. The inlet is located between the elongated flexible tube and the outer layer and is configured to be attached to a vacuum or pressure source. A plurality of steering linkages are mounted on the distal portion of the rigidizing assembly. The rigidizing assembly is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

This and other embodiments of the invention can include one or more of the following features. The rigidizer may further include a plurality of cables connected to the steerable linkage. A cable may extend between the elongate flexible tube and the outer layer.

Generally, in one embodiment, a rigidizer includes an elongated flexible tube, a plurality of steerable linkages, and an outlet. The elongated flexible tube includes a proximal portion and a distal portion. The elongate flexible tube comprises: a plurality of reinforcing elements, a braid over the distal and proximal portions, and an outer layer having a plurality of reinforcing elements. A plurality of steerable linkages extend on the distal portion rather than the proximal portion. The inlet is located between the elongated flexible tube and the outer layer and is configured to be attached to a vacuum or pressure source. The braid has a plurality of strands braided together at a first braid angle with respect to a longitudinal axis of the elongate flexible tube when straight. The outer layer is positioned over the proximal portion but not the distal portion. The rigidizer is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

This and other embodiments of the invention can include one or more of the following features. The rigidizer may further include a plurality of cables connected to the steerable linkage. A cable may extend between the elongate flexible tube and the outer layer.

Generally, in one embodiment, a rigidizer includes a rigidizer assembly and a plurality of linkages. The stiffening assembly includes an elongated flexible tube, a braid positioned over the elongated flexible tube, an outer layer positioned over the flexible tube and the braid, and an inlet positioned between the elongated flexible tube and the outer layer and configured to be attached to a vacuum or pressure source. The ridges extend through the distal portion of the rigidizing assembly. The ridges are configured to bend the rigidizing assembly in a set direction. A plurality of steering linkages are located distal of the rigidizing assembly. The rigidizing assembly is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet.

This and other embodiments of the invention can include one or more of the following features. The rigidizer may also include a pull wire configured to bend the device at the ridge when activated. The rigidizer may further include a plurality of cables connected to the steerable linkage. A cable may extend between the elongate flexible tube and the outer layer.

Generally, in one embodiment, a stiffening device includes a stiffening assembly and a distal tip. The rigidizing assembly includes: an elongated flexible tube; a braided layer positioned over the elongated flexible tube; an outer layer over the flexible tube and the braid; and an inlet located between the elongated flexible tube and the outer layer and configured to be attached to a vacuum or pressure source. The distal tip is attached to the elongated flexible tube. The distal tip includes a plurality of linkages connected together at pivot points. The stiffening assembly and the distal tip are configured to: the rigid configuration is assumed when vacuum or pressure is applied through the inlet and the flexible configuration is assumed when no vacuum or pressure is applied through the inlet.

Generally, in one embodiment, a handle for use with a rigidizing device includes: a handle body configured to attach to a rigidizing device; a vacuum feed line attached to the handle body configured to connect with a vacuum source; a vacuum port in communication with a wall of the rigidizer; and an activation element on the handle body. The activation element is configured to move between a first position and a second position. The activation element in the first position connects the vacuum feed line to the vacuum port to provide vacuum to the wall of the stiffening device, and the activation element in the second position disconnects the vacuum feed line from the vacuum port to vent the wall of the stiffening device.

This and other embodiments of the invention can include one or more of the following features. The activation element may include a magnetic element thereon. The magnetic element may be configured to hold the activation element in either the first position or the second position. The vacuum feed line may be coiled within the handle.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) a handle for holding the rigidizing device; (2) inserting an elongated body of a stiffening device into a body cavity while the stiffening device is in a flexible configuration; (3) when the stiffening device has reached the desired location in the body lumen, moving the activation element in a first direction to connect the vacuum feed line and the vacuum port of the handle to the wall of the elongate body such that a vacuum flows into the wall of the elongate body, thereby transitioning the elongate body to a rigid configuration; and (4) moving the activation element in a second direction to disconnect the vacuum feed line from the vacuum port, venting the elongate body to transition it to the flexible configuration.

Generally, in one embodiment, a handle for use with a rigidizing device includes: a handle body configured to attach to a rigidizing device; a fluid chamber located within the handle body; an outlet in fluid communication with the fluid chamber and the wall of the stiffening means; and an activation element configured to move between a first position and a second position. The activation element is configured to transfer fluid from the fluid chamber to a wall of the rigidizing device when moved from the first position to the second position, and to transfer fluid back to the fluid chamber when moved from the second position to the first position.

This and other embodiments of the invention can include one or more of the following features. The handle may further include an overflow chamber within the handle body and a pressure relief valve located between the fluid chamber and the overflow chamber. The pressure relief valve may be configured to open when the pressure in the fluid chamber reaches a predetermined maximum pressure to allow fluid to flow into the overflow chamber. The handle may further include a piston and rolling diaphragm within the handle body. The piston may be configured to push the rolling diaphragm when the activation element moves between the first position and the second position.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) a handle for holding the rigidizing device; (2) inserting an elongated body of a stiffening device into a body cavity while the stiffening device is in a flexible configuration; (3) moving the activation element in a first direction to move fluid from the fluid chamber of the handle into a wall of the rigidizing element when the rigidizing device has reached a desired location in the body cavity, thereby transforming the rigidizing device into a rigid configuration; and (4) moving the activation element in a second direction to move fluid from the wall of the rigidizing element back into the handle, thereby transitioning the rigidizing device to a flexible configuration.

Generally, in one embodiment, a nesting system includes a first rigidizing device and a second rigidizing device located radially inward of the first rigidizing device. The second rigidifying means are axially slidable with respect to the first rigidifying means. The first and second rigidifying means are configured to be alternately rigidified by vacuum or pressure.

This and other embodiments of the invention can include one or more of the following features. The pressure may be greater than 1 atmosphere. The first rigidizing device may be configured to be rigidized by vacuum and the second rigidizing device may be configured to be rigidized by a pressure greater than 1 atmosphere. The first and second rigidizing means may each comprise multiple layers. The vacuum or pressure may be configured to be supplied between the multiple layers. At least one of the plurality of layers may be a woven layer.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) inserting the first rigidizer into the body cavity while the first rigidizer is in the flexible configuration; (2) providing a vacuum or pressure to the first rigidizing device to convert it to a rigid configuration that is stiffer than the flexible configuration; (3) inserting a second rigidizing device in a flexible configuration through the first rigidizing device while the first rigidizing device is in a rigid configuration such that the second rigidizing device assumes a shape of the first rigidizing device in the rigid configuration; and (4) providing a vacuum or pressure to the second rigidizing device to transition the second rigidizing device from the flexible configuration to the rigid configuration.

This and other embodiments of the invention can include one or more of the following features. Each rigidizing device may include an elongated flexible tube and a braid. The braid may be compressed by providing vacuum or pressure to transition the rigidizer into a rigid configuration.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) moving the first rigidizing device in a flexible configuration until the first rigidizing device reaches a desired position; (2) after the first rigidizer has reached the desired location, converting it to a rigid configuration by providing vacuum or pressure to the first rigidizer; (3) moving a second rigidizing device in a flexible configuration over the first rigidizing device in a rigid configuration after the first rigidizing device is rigidized; (4) transforming the second rigidizer into a rigid configuration by providing vacuum or pressure to the second rigidizer; (5) transforming the first rigidizer into a flexible configuration by removing the vacuum or pressure; and (6) passing the first stiffening means in a flexible configuration through the second elongate stiffening means until the first stiffening means reaches the desired position.

This and other embodiments of the invention can include one or more of the following features. The method may further include periodically changing the first and second rigidizing devices to a flexible configuration to increase the curvature of the first and second rigidizing devices to match the surrounding anatomy.

Generally, in one embodiment, a rigidizing rod includes: an inner capsule layer; a braided layer over the inner bladder layer; an outer sheath sealed over the inner balloon layer and the braid layer; and an inlet between the outer sheath and the inner bladder layer, the inlet configured to attach to a vacuum source. The rigidizing rod is configured to: has a rigid configuration when vacuum or pressure is applied through the inlet and a flexible configuration when vacuum or pressure is not applied through the inlet. The rigidizing rod does not have a through-lumen extending therethrough.

Generally, in one embodiment, a method of advancing a rigidizing device through a body lumen comprises: (1) advancing a rigidizing device through a body lumen; (2) inserting a shaft of flexible configuration into a lumen of a rigidizing device, the shaft comprising an elongated flexible tube, a braid, and a balloon; (3) providing a pressure of greater than 1 atmosphere to the central sealed lumen of the rod to force the braid against the elongated flexible tube when the rod reaches a desired location in the lumen of the stiffening device, thereby transforming the stiffening device into a rigid configuration that is stiffer than the flexible configuration; and (4) further advancing the rigidizer on the rod when the rod is in the rigid configuration.

Generally, in one embodiment, a method of performing a cholangioscopy includes: (1) inserting an outer sleeve into the colon while the outer sleeve is in a flexible configuration, wherein the outer sleeve comprises an elongated flexible tube, a braid having a plurality of strands braided together, and an outer layer; (2) steering the distal end of the overtube toward the mastoid; (3) activating a vacuum or pressure between the flexible tube and the outer layer to transition the outer sleeve to a rigid configuration that is stiffer than the flexible configuration; (4) advancing a guidewire through the outer cannula into the bile or pancreatic duct when the outer cannula is in the rigid configuration; and (5) advancing the scope over the guidewire to the bile or pancreatic duct.

Generally, in one embodiment, a method of accessing cardiac anatomy comprises: (1) inserting a sheath into the cardiac anatomy when the sheath is in a flexible configuration, wherein the sheath comprises an elongate flexible tube, a braid having a plurality of strands braided together, and an outer layer; (2) steering the distal end of the sheath towards a desired final position; (3) activating a vacuum or pressure between the flexible tube and the outer layer to transition the outer sleeve to a rigid configuration that is stiffer than the flexible configuration; and (4) passing the cardiac device through the rigid sheath.

This and other embodiments of the invention can include one or more of the following features. The desired final position may be the aortic valve. The cardiac device may be a transcatheter aortic valve replacement. The desired end position may also be the mitral valve. The cardiac device may also be a mitral valve replacement or mitral valve repair element.

Any of the devices described herein may include one or more of the following: the stiffening means may further comprise a sliding layer adjacent the braid. The sliding layer may have a lower coefficient of friction than the woven layer. The rigidizing device in the rigid configuration may be at least 2 times stiffer than the rigidizing device in the flexible configuration. The rigidizing device in the rigid configuration may be at least 5 times stiffer than the rigidizing device in the flexible configuration. The braid has a plurality of strands braided together at braiding angles of 5-40 degrees relative to the longitudinal axis of the elongate flexible tube when straight. The braid angle may be between 10 and 35 degrees. The elongate flexible tube may include a stiffening element extending therein. The reinforcing element may comprise a coil or a plurality of annular elements. The braid may comprise a plurality of strands braided together at 4-60 strands per inch. The braided layer may comprise a plurality of strands braided together. The strands may comprise polyethylene terephthalate or stainless steel. The braid may provide 30-70% coverage relative to the elongate flexible tube. The braided layer may include 96 or more strands braided together. The inlet may be configured to attach to a pressure source. The rigidizing device may further include a bladder layer positioned therein. The bladder layer may be configured to be pushed toward the woven layer when pressure is provided through the inlet. The outer layer may further comprise a plurality of reinforcing elements. The inlet may be configured to attach to a vacuum source. The outer layer may be a thin flexible sheath. The stiffening means may further comprise a radial gap between the braided layer and the outer layer. The thickness of the gap may be 0.00002-0.04 inches. The rigidizer may also include a steerable distal end. The rigidizer may also include a sealed channel between the elongated flexible tube and the outer layer. The sealed channel may include a working channel, a cable guide, or an inflation lumen.

Any of the methods described herein can include one or more of the following: the method may further comprise releasing the vacuum or pressure after activating the vacuum or pressure to transition the rigidizer back to the flexible configuration. The method may be carried out in the gastrointestinal tract. The method may be performed in the heart. The method may be performed in the kidney. The method may be performed in the lung. The method may be performed in the brain.

Drawings

The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:

figure 1 shows a rigidizing apparatus.

Fig. 2A-2B illustrate a partial braid of the stiffening device.

FIG. 3 is a graph of the bending force vs weave angle for a rigidizer when placed in a vacuum.

Fig. 4A-4D illustrate exemplary braid morphologies (formats).

Fig. 5A-5B illustrate exemplary braid morphologies.

Fig. 6A-6D illustrate various designs of braid termination for a rigidizer.

Figure 7 shows the inner layer of the rigidizer.

Fig. 8A-8F show different coil designs for a layer in a rigidizer.

Figures 9A-9B illustrate a corrugated reinforcing element for a layer in a rigidizer.

Figures 10A-10E illustrate a notch and pocket reinforcement element for a layer in a rigidizer.

Fig. 11A-11B illustrate a cut tube reinforcing element for a layer in a rigidizer.

Fig. 12A-12B illustrate exemplary rigidized shapes of the rigidizer.

Fig. 13A-13D illustrate an exemplary vacuum rigidizer.

Fig. 14A-14B illustrate an exemplary pressure rigidizer.

Fig. 15 is a graph showing the relationship between the bending strength vs. pressure of the rigidizer.

Figures 16A-16O illustrate various examples of pressure rigidizing devices.

Figures 17A-17D illustrate a rigidizing apparatus including an incorporated working channel.

Fig. 18A-18B illustrate a rigidizing device that includes a helical working channel.

Fig. 19A-19B illustrate a rigidizing device including a plurality of helical working channels.

Fig. 20A-20B illustrate a rigidizing device including a plurality of working channels extending down a central lumen.

Figure 21 shows a rigidizer with working channel extending to its side.

FIG. 22 shows a tool that may be used with a working channel of a device, such as a rigidizer.

Fig. 23 shows a rigidizing apparatus having a distal portion.

Fig. 24 shows a rigidizing device having a distal portion with a weave pattern (pattern) that is independent of a proximal portion of the device.

FIG. 25 shows a rigidizing device having a distal portion with a plurality of passive linkages.

FIG. 26 shows a rigidizing device having a distal portion with a plurality of actively controlled linkages.

27A-27E illustrate a plurality of actively controlled linkages.

Fig. 28 illustrates an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 29 illustrates an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 30 illustrates an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 31 shows an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 32 illustrates an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 33 illustrates an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 34 illustrates an embodiment of a rigidizer that includes a cable extending within a layered wall.

Fig. 35 illustrates a rigidizing device that includes a cable extending down a central lumen.

Fig. 36 illustrates an embodiment of a rigidizer that includes a cable helically wound therearound.

Fig. 37 shows an embodiment of a rigidizer that includes a cable helically wound therearound.

Fig. 38A-38B illustrate an embodiment of a rigidizer that includes a cable helically wound therearound.

39A-39B illustrate a rigidizing device that includes a cable helically wound therein

40A-40D illustrate an exemplary linkage of the distal portion.

41A-41B illustrate a rigidizing device having a distal portion including a linkage positioned over a rigidizing portion.

FIG. 42A illustrates a rigidizing device having a distal portion including a linkage within the rigidizing portion.

Fig. 42B shows a rigidizer with a steering cable attached to the wall near the distal end.

Fig. 43A-43C illustrate a rigidizing device having an actively deflectable distal portion.

Figures 44A-44C illustrate a rigidizer having separate rigidizing chambers along its length.

45A-45D illustrate a rigidizing device having a balloon and an inflation lumen.

FIGS. 46A-46B illustrate an embodiment of an aspiration tip for a device such as a rigidizer.

FIGS. 47A-47B illustrate an embodiment of an aspiration tip for a device such as a rigidizing device.

Fig. 48A-48B illustrate an embodiment of an aspiration tip for a device such as a rigidizing device.

Fig. 49A-49D illustrate an embodiment of a handle for use with a rigidizer.

FIGS. 50A-50B illustrate an embodiment of an actuating member for use with a handle of a rigidizer.

Fig. 51A-51C illustrate an embodiment of an actuating member for use with a handle of a rigidizer.

Fig. 52A-52C illustrate an embodiment of an actuating member with a connector for use with a handle of a rigidizer.

Figures 53A-53D illustrate an embodiment of a handle for use with a rigidizer.

Fig. 54A-54B illustrate an embodiment of a handle for use with a rigidizer.

Fig. 55A-55C illustrate an embodiment of an actuating member for use with a handle of a rigidizer.

Fig. 56A-56G illustrate an embodiment of a handle for use with a vacuum rigidizer.

57A-57C illustrate an embodiment of a handle for use with a pressure rigidizer.

Figures 58A-58E illustrate an embodiment of a pre-filled handle for use with a pressure rigidizer.

Fig. 59 shows a rigidizing apparatus having an imaging element mounted on a side thereof.

Fig. 60 illustrates a rigidizing introducer.

Figures 61A-61B illustrate a rigidizer having a side channel mechanism.

Fig. 62 illustrates a nested rigidizing system.

Fig. 63 shows a nested rigidizing system with a cover between the inside and outside of the rigidizing apparatus.

Fig. 64A-64B illustrate a nested rigidizing system in which the external rigidizing device includes steering and imaging functionality.

Fig. 65A-65H illustrate an exemplary use of a nested rigidizing system.

Fig. 66 shows a rigidizing rod.

FIG. 67 shows a rigidizing rod for use with a colonoscope.

68A-68B illustrate an exemplary rigidizer with a mirror therein.

Figures 69A-69B illustrate the use of the rigidizing device in the gastrointestinal tract.

FIGS. 70A-70B illustrate a method of using a rigidizer for an ERCP.

FIGS. 71A-71B illustrate a method of using a rigidizer for ERCP.

FIGS. 72A-72D illustrate a method of using a rigidizer for ERCP.

Fig. 73A-73B illustrate a method of using a rigidizing device in a heart to create a passageway to the left atrium.

Figures 74A-74B illustrate a method of performing a vessel branch treatment in a heart using a rigidizing device.

Figures 75A-75C illustrate a method of using a rigidizing device to perform mitral valve repair in a heart.

Fig. 76A-76B illustrate a method of using a dual rigidizing apparatus in a heart.

Figure 77 shows a rigidizing device used as a trocar.

FIG. 78 illustrates a rigidizing device for use at an aortic bifurcation.

Fig. 79 illustrates a rigidizing device for mitral valve repair.

Fig. 80 illustrates a rigidizing device having a distal payload for mitral valve repair.

81A-81F illustrate a method of controlling a work tool using a rigidizer.

Detailed description of the preferred embodiments

In general, described herein are rigidizing devices (e.g., overtube) configured to assist in transporting a scope (e.g., endoscope) or other medical instrument through a curved or looped portion of a body (e.g., a blood vessel). The rigidizer may be long, thin, and hollow, and may be quickly transitioned from a flexible configuration (i.e., relaxed, soft, or flaccid) to a rigid configuration (i.e., is stiff and/or retains its shape when rigidized). Multiple layers (e.g., a coiled or reinforced layer, a sliding layer, a braided layer, a bladder layer, and/or a sealing sheath) may collectively form a wall of the stiffening device. The rigidizing means may be transformed from a flexible configuration to a rigid configuration by, for example, applying a vacuum or pressure to or within its walls. With the vacuum or pressure removed, the layers can easily shear or move relative to each other. Upon application of vacuum or pressure, the layers may transform into a state in which they exhibit significantly enhanced resistance to shear, movement, bending and twisting (buckling), thereby providing rigidity to the system.

The rigidizing devices of the present invention may provide rigidity for a variety of medical applications, including catheters, sheaths, scopes (e.g., endoscopes), wires (wires), or laparoscopic instruments. The rigidizing device may be used as a separate attachment or may be integrated into the body of a catheter, sheath, scope, wire, or laparoscopic instrument. The devices described herein may also provide stiffening to non-medical structures.

Fig. 1 illustrates an exemplary rigidizer system. The system includes a rigidizer 300 having a wall with a plurality of layers including a woven layer, an outer layer (a portion of which is cut away to show the woven layer thereunder), and an inner layer. The system also includes a handle 342 having a vacuum or pressure inlet 344 to provide vacuum or pressure to the rigidizer 300. The actuation element 346 may be used to turn on and off the vacuum or pressure, thereby transitioning the rigidizing apparatus 300 between the flexible and rigid configurations. The distal tip (tip)339 of the rigidizing device 300 may be smooth, flexible, and atraumatic to facilitate distal movement of the rigidizing device 300 through the body. Further, the tip 339 may be tapered from a distal end to a proximal end to further facilitate distal movement of the stiffening device 300 through the body.

Fig. 2A-2B illustrate a portion of an exemplary braid 209 for a rigidizing apparatus like apparatus 300. The braid 209 may include braided strands (strand) 233. The braid 209 may be, for example, a tubular braid.

The braid angle a of the strands 233 relative to the longitudinal axis 235 of the stiffening device can be less than 45 degrees, such as less than or equal to 40 degrees, less than or equal to 35 degrees, or less than or equal to 25 degrees, when the stiffening device (e.g., device 300) is in a straight (unbent) configuration. Referring to fig. 3, the bending strength of the rigidizer decreases as the braid angle α increases (when the rigidizer is straight or unbent). That is, the bending strength under vacuum of a stiffening device with a braid angle of 45 degrees (typical minimum angle for torque or torsional braids. larger angles are commonly used for catheter shaft reinforcement) is 27% of the bending strength under vacuum of a stiffening device with a braid angle of 25 degrees. Thus, having a smaller braid angle (e.g., less than 45 degrees, such as 40 degrees or less or 35 degrees or less) advantageously ensures that the rigidizing device (e.g., device 300) remains rigid (resists changes in configuration) in bending under vacuum (and similarly under pressure). Additionally, the braid angle α can be greater than 5 degrees, such as greater than 8 degrees, such as greater than 10 degrees, such as 15 degrees or greater, when the rigidizing device is in a straight (unbent) configuration. Having a braid angle α within this range ensures that the braid remains sufficiently flexible to facilitate bending when in a flexible configuration (i.e., when not rigidized under vacuum or pressure). Thus, the braid angle α of the strands 233 relative to the longitudinal axis 235 of the stiffening device can be 5 to 40 degrees, such as 10-35 degrees, 15-25 degrees, such as about 5, 10, 15, 20, 25, 30, 35, or 40 degrees, when the stiffening device is in the straight configuration. A braid angle a of 5-40 degrees of the strands 233 relative to the longitudinal axis 235 of the stiffening device when the stiffening device is in a straight (unbent) configuration ensures that the stiffening device is sufficiently flexible to bend in a flexible configuration (e.g., when not under vacuum/pressure) and sufficiently stiff in a rigid configuration (e.g., when under vacuum or pressure). Further, it should be understood that the strands 233 are configured to slide over each other, and thus the braid angle α will change as the rigidizer flexes and bends. Having a braiding angle a between 5 and 40 degrees also advantageously ensures that the strands 233 are able to move freely relative to each other without causing fibers to collide with each other and preventing further variation in angle.

Further, the braid of braid 209 may be between 4-60 threads per inch (pick), such as 8, 10, 12, 14, 16, 18, 20, or 25 threads per inch. In one embodiment, the tube formed by layer 209 has a diameter of 0.578 inches and has 12-14 braids per inch.

In some embodiments, the braided layer 209 (or any braided layer described herein) may be configured such that the rigidizing apparatus described herein has a high stiffness ratio (i.e., the ratio between the stiffness in a rigid configuration (e.g., when vacuum or pressure is applied) and the stiffness in a flexible configuration (e.g., when vacuum or pressure is not applied)). For example, the stiffness ratio may be greater than 5, such as greater than 6, greater than 9, or greater than 10. Referring to table 1 below, six vacuum rigidizing apparatuses (samples a-F) were fabricated and tested for cantilever bending stiffness at atmospheric pressure (flexible configuration) and vacuum (rigid configuration) at a length of 4 inches and a deflection of 1/2 inches, respectively. As shown, reducing the braid angle increases the stiffness of the rigidizer. Samples E and F show in particular the stiffness difference between the braid at a typical torque angle (sample E, 47.7 degrees, stiffness of 0.529lbf) and the braid with a smaller angle (sample F, 27.2 degrees, stiffness of 1.455 lbf). Also as shown in table 1, rigidizing devices with smaller angles (e.g., angles less than 45 degrees or 35 degrees, such as samples a-D and sample F) can have a much higher stiffness ratio (e.g., a ratio greater than 5, greater than 6, greater than 9, or greater than 10) than rigidizing devices with larger angles (e.g., angles of 45 degrees or greater, such as sample F), which can have a stiffness ratio less than 5. It can also be seen from table 1 that the stiffness ratios for samples a and B are both greater than 5. The braid angle for sample B was 14.9 degrees, which is a lower stiffness ratio than sample a, but a higher absolute stiffness due to the strand orientation of sample B near the longitudinal axis (and thus sample B has a higher stiffness in a flexible configuration).

TABLE 1 vacuum rigidizer

Referring to table 2 below, three pressure rigidizing devices were fabricated (samples G-I) and tested for cantilever bending stiffness at atmospheric pressure (flexible configuration) and 4 atmospheres (rigid configuration) at a length of 4 inches and a deflection of 1/2 inches, respectively. All samples included 35-45% coverage and a braid with 96 strands and one filament per strand. As shown, reducing the braid angle increases the stiffness of the rigidizer. As shown in table 2, the less angled rigidizer had a higher stiffness ratio than the more angled rigidizer. In some embodiments, the pressure rigidizer described herein has a stiffness ratio of greater than 10, such as greater than 15, such as greater than 20.

TABLE 2 pressure rigidizer

Further, in some embodiments, the braid of braid 209 may have a coverage of 30% -70%, such as 40% -60%, e.g., 30%, 40%, 50%, 60%, or 70%, where coverage refers to the percentage of the lower surface that is covered or obscured by the braid.

In some embodiments, braid 209 may be formed by coiling each individual strand around an inner tube or rigidizer and/or a separate helical mandrel such that strands 233 are interwoven with one another. In one embodiment, the braid 209 may be thermoformed over a 0.50-0.60 inch, e.g., 0.56 inch mandrel. Further, in some embodiments, the braid may be mounted over a tube or mandrel to a diameter less than the core diameter (i.e., less than the diameter of the originally manufactured braid) during manufacture. Radially compressing the braid in this manner may reduce braid angle (while also reducing PPI, increasing overall length of tubular braid, and increasing braid coverage) within a range that provides high rigidification factor.

The strands 233 can be rectangular/flat (e.g., 0.001-0.060 inches, such as 0.005 inches, 0.007 inches, 0.010 inches, or 0.012 inches on the long side and 0.0003-0.030 inches, such as 0.001 inches, 0.002 inches, or 0.003 inches on the short side), round (e.g., 0.001-0.020 inches, such as 0.005 inches, 0.01 inches, or 0.012 inches in diameter), or oval. In some embodiments, some of the strands 233 may be flat and some of the strands 233 may be round.

In some embodiments, the strands 233 may be made of metal filaments (filaments) (e.g., stainless steel, aluminum, nitinol, tungsten, or titanium), plastic (nylon, polyethylene terephthalate, PEEK, polyetherimide), or high strength fibers (e.g., aramid, ultra-high molecular weight UHMW polyethylene, or liquid crystal polymers such as Vectran). In some embodiments, the strands 233 may be made of a multi-layer composite material, such as a metal core with a thin elastic coating. In one particular example, the strands 233 may comprise round nylon having a diameter of 0.010 inches (or metal filaments having a diameter of 0.003 inches) that is intertwined with aluminized PET having cross-sectional dimensions of 0.002 inches by 0.002 inches. In some embodiments, the material of the strands 233 of the braid may be a material having a known high coefficient of friction. For example, the strands 233 may be of unitary construction or have a coating such that the strands include an aluminum coating on an aluminum core, a copper coating on a copper core, a silver coating on a silver core, or a gold coating on a gold core. As another example, the strands 233 may be coated with a highly elastic material (e.g., a lower durometer elastomer may be coated on top of a higher modulus substrate). As another example, the strands 233 may be made of styrene copolymer, polycarbonate, or acrylic.

Within the woven layer 209, there may extend 12-800 strands 233, for example 24, 48, 96, 120, 144 or more strands 233. In some embodiments, there are 96 strands or more, 120 strands or more, 200 strands or more, or 240 strands or more. More strands may advantageously help rigidify the braid due to increased interaction between the strands.

Referring to fig. 4A-4D, the braid of any of the rigidizing devices described herein may have a variety of different braid patterns (patterns). For example, referring to fig. 4A, the braid of layer 1709 may be a diamond-shaped loading pattern in which two adjacent strands 1733a, b extend first over and then under two strands. Referring to fig. 4B, the weave of layer 1709 may be a full load pattern with each strand 1733a extending above and below two strands in a manner opposite to its adjacent strand 1733B. Referring to fig. 4C, the braid of layer 1709 may be a diamond half-load pattern with each strand 1733a extending above and below one strand, as opposed to adjacent strands 1733 b. Referring to fig. 4D, the braid of layer 1709 may include one or more longitudinal strands 1733c passing through crossing strands 1733a, 1733 b.

Referring to fig. 5A-5B, each strand 1833 may include a single filament 1818 (fig. 5A) or a plurality of filaments 1818a-c (in fig. 5B, three filaments 1818a-c are shown in each strand 1833). The filaments 1818 may be selected (i.e., their diameter, spacing, and modulus may be specifically tailored) to reduce crimping (rippling or bending of the filaments). Reducing curl can help the system provide increased compressive buckling resistance, which translates into increased system stiffness.

Exemplary specific braid embodiments J-N are shown in table 3.

Table 3-exemplary braid

In use, a vacuum or pressure may be provided between the walls of the rigidizing apparatus of the present invention, causing the braid and adjacent layers to contract and/or separate to transition between the flexible and rigid configurations. Thus, the rigidizing apparatus of the present invention may advantageously transition from being very flexible to very rigid when activated by a user. When vacuum or pressure is applied, the braid or strand may contract or expand radially to mechanically fix or lock in place relative to each other. Thus, when vacuum or pressure is applied, the rigidizer may change from a flexible configuration to a rigid configuration (thereby securing the rigidizer in the shape it was in before the vacuum or pressure was applied).

Referring to fig. 6A-6D, in some embodiments, one or both ends of braid 5609 of rigidizing device 5600 as described herein may be bonded to another layer of device 5600 to prevent strands 5633 of the braid from unraveling. Additionally, the ends of the strands 5633 may be joined in a manner that allows relative motion of the strands 5633 during buckling of the rigidizer 5600 when the rigidizer 5600 is in a flexible configuration (i.e., to prevent rigidizer 5600 from rigidizing or twisting, which in turn may cause drag at the tip 5629, which may occur when the strands 5633 are constrained).

For example, as shown in fig. 6A, the tip 5629 of the braid 5609 can include a coating 5634 of a low durometer material thereon, such as silicone or polyurethane, which is stretchable and/or flexible. Thus, the ends of strands 5633 may be encapsulated by coating 5634 (thereby preventing unraveling), while the strands still move with coating 5634 as coating 5634 stretches and/or contracts (flex). Coating 5634 can be thin, such as between 0.005-0.250 inches thick (e.g., about 1/32 inches thick).

As another example, as shown in fig. 6B, the tip 5629 of the braid 5609 can include an annular ring 5601z therearound. In some embodiments, loops 5601z may be formed by melting the tips of strands 5633. In other embodiments, loops 5601z may be separate elements bonded to strands 5633 (e.g., bonded to less than 20%, less than 10%, or less than 5% of strands 5633). In some embodiments, there may be two bond sites spaced about 180 degrees apart from each other. The turns 5601z can advantageously ensure that the strands 5633 do not unravel, and can also allow for significant movement of the strands relative to each other under the turns 5601 z. The ring 5601z can be made of, for example, rubber, polyimide, polytetrafluoroethylene, silicone, polyurethane, latex, or ePTFE.

As another example, as shown in fig. 6C, the tips 5629 of the braid 5609 may have a varying warp and weft density (pick count) along the tips 5629, with a greater warp and weft density at the tips, and a lesser warp and weft density towards the center. Thus, the angle of strands 5633 at tips 5629 relative to the longitudinal axis may be greater than at the remaining portions of layer 5609. For example, while the strands 5633 at the central portion of the device 5600 may have an angle of 45 degrees or less (e.g., 40 degrees or less, 35 degrees or less, 25 degrees or less, or 20 degrees or less) relative to the longitudinal axis of the device 5600, the strands 5633 at the tip 5629 may have an angle of greater than 45 degrees, such as between 45 degrees and 60 degrees (e.g., 35 degrees, 45 degrees, or 55 degrees), relative to the longitudinal axis. The change in braid angle may be a continuous change at the tip 5629 and/or may be created by joining two separate braids together. The higher angle strands 5633 may be glued to the innermost layer at the tips 5629. By providing a larger angle at the tip 5629 of the braid, the tip 5629 can remain flexible when curved or bent, even when the strands 5633 are secured to the inner layer 5615. In some embodiments, the increased braid angle at the tip 5629 can be created by varying the speed at which the core inside the tubular braid is pulled during the manufacturing process.

As another example, as shown in fig. 6D, the tip 5629 of the braid 5609 can be flipped over and bonded with the innermost layer 5615 (and/or other layers radially inward of the braid 5609). Such a tip 5629 may be more flexible than a non-inverting tip 5629 because it includes an additional (inverted) length within which the strands 5633 may move.

In some embodiments, the proximal and distal ends of the braid 5609 can have different treatments (e.g., the distal end can have a first treatment as shown in fig. 6A-6D, while the proximal end can have a second treatment as shown in fig. 6A-6D).

In some embodiments, a stiffening device (e.g., stiffening device 300) of the present invention may include one or more sliding layers adjacent to a woven layer (e.g., woven layer 209). The sliding layer may be configured to reduce friction between the braid and the adjacent layer to allow the adjacent layers (and particularly the braid) to more easily shear or move relative to each other, particularly when no vacuum or pressure is applied to the rigidizing apparatus, to maximize flexibility in the flexible configuration. The sliding layer may advantageously enhance the baseline flexibility of the rigidizer to allow the layers to move relative to each other. In one embodiment, the sliding layer may comprise a powder, such as talc or corn starch. In particular, the powder slip layer may advantageously reduce friction without significantly increasing the thickness of the device, thereby enhancing flexibility of the rigidized device in a flexible configuration. The sliding layer may be made of a low coefficient of friction material, such as thin film fluoropolymer (FEP, chemical film, PTFE, thickness 2-50 microns). In one embodiment, the sliding layer may be a coating. In one embodiment, the slip layer may be a slip additive added to the elastomer. In one embodiment, the sliding layer may be a sleeve of thin plastic film with inherent lubricating properties, such as Low Density Polyethylene (LDPE). In one embodiment, the sliding layer may be made of a thin spiral wrap film, such as 0.0005 inch FEP or 0.00025 inch chemical film (st. In one embodiment, the sliding layer may be made of grease, oil, or other liquid.

The rigidizing device of the present invention may include an innermost layer configured to provide an inner surface against which an additional layer (e.g., a woven layer) may be reinforced, for example, when a vacuum or pressure is applied within the wall of the rigidizing device. The layer may further provide a seal for the wall (i.e., may be leak-proof) and may be sufficiently strong to provide resistance to radial collapse even during flexing and/or compression of the rigidizer during the rigidizer process. Referring to fig. 7, in some embodiments, the innermost layer 8815 may include reinforcing elements 8850z or coils within a matrix (matrix)8851 z. The reinforcing element 8850z may be a continuous helical coil or a closed loop with a gap therebetween (which exhibits greater resistance to collapse than the helical coil). Additionally, inner layer 8801 can include an inner film 8852z and an outer film 8853z on one or both sides thereof. In some embodiments, each of the elements 8853z, 8852z, 8850z/8851z can have a thickness of 0.0002-0.015 inches.

Stiffening element 8850z may be, for example, a wire, such as a wire made of stainless steel, nitinol, or tungsten. The reinforcing elements 8850z may be, for example, high strength fibers (e.g., kevlar, dynamic, vickland, taclo, or carbon fibers). The reinforcing element 8850z may be, for example, a stent, a structure cut from a tube, or a braid. In some embodiments, stiffening element 8850z can be a round wire (e.g., 0.0005-0.030 inches in diameter, such as 0.001 inches, 0.003 inches, 0.005 inches, 0.007 inches, or 0.009 inches). In some embodiments, the reinforcing elements 8850z can be rectangular wires (e.g., having a width of 0.001-0.100 inches, such as a width of 0.010 inches, 0.020 inches, 0.030 inches, 0.040 inches, 0.050 inches, 0.060 inches, 0.070 inches, 0.080 inches, 0.090 inches, or 0.100 inches, and/or the rectangular wires can have a thickness of 0.0003-0.020 inches, such as a thickness of 0.001 inches, 0.003 inches, 0.005 inches, 0.007 inches, or 0.010 inches). In other embodiments, the stiffening elements 8850z may have an elliptical cross-section and/or may comprise a plurality of individual strands and/or may have a rectangular cross-section rounded with four sharp corners. In some embodiments, the stiffening element 8850z can be cut from a single tube using, for example, a laser to create the gap. In some embodiments, no reinforcing element is used.

In some embodiments, the stiffening elements 8850z can be elements having a high aspect ratio (e.g., having a high RE width relative to the RE height, e.g., an aspect ratio in excess of 5: 1, e.g., in excess of 10: 1, e.g., in excess of 11: 1, e.g., about 12: 1). Note that in fig. 7, the RE width is the width of the stiffening elements 8850z, the RE height is the height or thickness of the stiffening elements 8850z, and the RE gap is the distance of the stiffening elements 8850z from each other. The high aspect ratio of the reinforcing elements 8850z can advantageously assist in preventing external pressure caused by the parallelogram-type collapse of the reinforcing elements 8850z within the innermost layer 8815. A parallelogram-type collapse occurs when the helix of the coil moves from approximately perpendicular to the central axis of the coil toward being parallel to the central axis of the coil (the helix essentially "flips"). Furthermore, it may be advantageous in preventing parallelograms if the RE gap between the reinforcement elements 8850z is no more than 3 times the RE height, such as no more than 2 times the RE height, such as no more than 1.5 times the RE height. In addition, the ratio of the inner diameter of the hollow tube with the innermost layer 8815 to the width of the reinforcing layer 8850z in the innermost layer 8815 is less than 5, such as less than 4.5, such as about 4.3, also helping to prevent parallelogram-type collapse.

The matrix 8851z may be a very low durometer, such as TPU or TPE having a durometer equal to or less than 60A, 50A, 40A, 30A, 20A, or 10A. In some embodiments, the matrix 8851z may be TPU, TPE, PET, PEEK, mylar, polyurethane, or silicone. The inner and outer membranes 8852z, 8853z may similarly comprise TPU, TPE, PET, PEEK, Mylar, polyurethane, or silicone. In some embodiments, the inner and outer membranes 8852z, 8853z can be applied by spraying, dipping, wrapping into a sheet or tube, pulling through a pool of solvent, melting, and/or consolidation. In some embodiments, layer 8815 does not include an inner and/or outer film 8852z, 8853z, and/or may include additional films. The inner and/or outer membranes 8852z, 8853z can produce smooth inner and outer surfaces.

In the specific example of the innermost layer 8815 for a pressure system, the layer is made as a hollow tube with an inner diameter of 0.260 inches and a RE width of 0.050 inches, a RE height of 0.008 inches, and a RE gap of 0.010 inches. The film 8853z is omitted on both sides. The membrane 8852z (on both sides of the base 8851z and the stiffening element 8850 z) is made of polyurethane (100% strain versus 600psi pressure). The base 8851z and each membrane 8852z have a thickness of about 0.006 inches and a total wall thickness of 0.018 inches. Such a structure may resist collapsing under external pressures in excess of 10 atmospheres.

In a second specific example of an innermost layer 8815 for a pressure system, the film 8853z is omitted on both sides. The RE width was 0.050 inches, the RE height was 0.008 inches, and the RE gap was 0.010 inches. The membrane 8852z is a higher durometer elastomer, such as an elastomer having a stress of 2000psi at 100% strain, and is approximately 0.001 inches thick. The matrix 8851z may be 50A polyurethane. The matrix 8851z may be deposited as a thermoplastic elastomer cord stock (cord stock), for example, a 0.008 inch rectangular cross-section or a 0.010 inch round cross-section. Such cord stock may also be deposited with increased axial modulus (but not transverse modulus) by co-extruding it with filaments (e.g., 0.001 inch diameter) or fibers at its core.

In a third specific example of an innermost layer 8815 for a pressure system, the reinforcing elements 8850z may be wires having a high aspect ratio. For example, in a square stainless steel wire, layer 8815 may have a RE height of 0.005 inches, a RE width of 0.060 inches, and a RE gap of 0.006 inches. The tube formed with the innermost layer 8815 has an inner diameter of 0.26 inches. Elements 8852z and 8851z may be 80A polyurethane and are approximately 0.002 inches thick. In addition, layer 8851z may be 50A polyurethane (e.g., deposited from a heated tank that includes melted polyurethane and holes for precise dispensing by pressure). The structure of this exemplary innermost layer 8815 can resist collapse at an external pressure of over 10 atmospheres, such as a pressure of over 12 atmospheres, such as a pressure of over 13 atmospheres.

In the specific example of the innermost layer 8815 for a vacuum system, the outer membrane 8853z on one side (e.g., the outside or top side) is omitted, the membrane 8852z above (outside) the stiffener/base includes 0.005 inch of 50A polyurethane, the base 8851z is made of 0.005 inch thick 50A polyurethane, the stiffener element 8850z is stainless steel wire, the membrane 8852z below (inside) the stiffener/base includes 0.0025 inch thick 50A polyurethane, and the bottom outer membrane 8853z is 0.004 inch thick 80A polyurethane. The RE width is 0.020 inches, the RE height is 0.005 inches, and the RE gap is 0.010 inches. The bottom outer membrane 8853z is a hydrophilic coating. The inner diameter of the tube formed from layer 8815 was 0.551 inches.

Although shown as symmetrical in fig. 7, it should be understood that the innermost layer 8815 need not have symmetrically disposed films 8852z, 8853 z. For example, neither layer is at the bottom (inside the matrix/reinforcement) and both layers are at the top. Further, it should be understood that the material of the two innermost films 8852z need not be the same, nor need the material of the two outermost films 8853z be the same.

The innermost reinforcing element may have a variety of configurations. As shown in fig. 8D-8F, the stiffening element 9205z may be a multi-start line winding (e.g., 2 starts as shown in fig. 8F, 3 starts as shown in fig. 8E, or 4 starts as shown in fig. 8D). When a multi-start coil winding is used, the gap between the reinforcing elements along the longitudinal axis may be the same as a single coil, but the number of starts may be 2, 3, 4, 5, 6, 7, 8, 9 or more. A single origin may produce a near-vertical filament angle (e.g., 2 degrees from vertical), while a multi-origin method may produce a filament angle that biases the coil to be tilted in one direction, away from vertical (e.g., 4, 6, 10, 15, or even 20 degrees). This larger angle may be used to make the innermost layer less prone to tilt or structural collapse under pressure, as coils with larger inclinations tend to support each other for stability. Fig. 8A-8C show the various starting points (coils) of the multi-start stiffening element 9205Z. Fig. 8C shows one coil of fig. 8F, fig. 8B shows one coil of fig. 8E, and fig. 8A shows one coil of fig. 8D.

In some embodiments, referring to fig. 9A-9B, the reinforcing elements 8950z may be a series of wavy or undulating lines (or coiled undulating lines as described herein). As shown in fig. 9B, when the device is loaded, the undulating reinforcing element 8950Z moves toward collision with itself, compressing the matrix 8851Z between the wires and resisting parallelogram-type collapse. In a particular embodiment, the innermost layer having such wavy lines may have a RE height of 0.005 inches, a RE width of 0.060 inches, and a RE gap of only 0.006 inches. The wavy wave may vary +/-0.03 inches from the centerline (i.e., a wave amplitude of 0.060 inches). The wave may repeat every 0.3 inches (i.e., a wavelength of 0.3 inches).

In some embodiments, referring to fig. 10A-10C, the stiffening element 9050z may include alternating pocket wires 9052z and notched wires 9053 z. When unloaded, the pockets and notches of each respective component can be separated (as shown in fig. 10D). However, when loaded, the notch of the wire 9053z moves toward collision with the pocket of the wire 9052z (as shown in fig. 10E) to compress the matrix 8851z between the wires and resist parallelogram-type collapse.

In some embodiments, referring to fig. 11A-11B, the stiffening elements 9150z may be a flexure design, e.g., cut from a laser tube.

In some cases, the reinforcing element may be separate from the inner layer. For example, the reinforcing element may be positioned radially inside or outside the inner layer. The innermost layer may have a hardness of, for example, 30A to 80A. Further, the innermost layer may have a wall thickness of between 0.0005 and 0.060 inches. In some embodiments, the innermost layer may include a lubricant or coating (e.g., a hydrophilic coating) on its inner surface to improve sliding of an endoscope or other instrument therethrough. The coating may be hydrophilic (e.g.Coating orCoating) or hydrophobic (e.g., fluoropolymer). The coating may be applied by, for example, dipping, painting or spraying methods thereon. The innermost layer may be a laminate layer having a low coefficient of friction.

Fig. 12A and 12B illustrate an exemplary rigidizing apparatus in a rigidized configuration. When the rigidizer is rigidized, it is rigidized in the shape it was in prior to application of vacuum or pressure, i.e., it does not straighten, bend, or otherwise significantly change its shape (e.g., it may stiffen in a ring configuration as shown in fig. 12A or a serpentine shape as shown in fig. 12B). This may be because the air hardening effect on the inner or outer layer (e.g., made of a bobbin) may be only a small percentage (e.g., 5%) of the maximum load capacity of the stiffening device when bent, allowing the stiffening device to resist straightening. Once the vacuum or pressure is released, the braids or strands may unlock and move again relative to one another, allowing the rigidizing device to bend. Further, as the rigidizing device becomes more flexible by releasing the vacuum or pressure, it will remain in its shape prior to the release of the vacuum or pressure to become flexible, i.e., it will not straighten, bend, or otherwise significantly change its shape. Thus, the rigidizing device of the present invention can be converted from a flexible, less rigid configuration to a more rigid configuration by restricting movement between the strands of the braid (e.g., by applying a vacuum or pressure).

The rigidizing apparatus described herein can be rapidly switched between rigid and flexible configurations, and in some embodiments has an infinite number of switching cycles. As interventional medical devices are made longer and inserted deeper into the human body, and as they are expected to undergo more rigorous therapeutic procedures, the need for accuracy and control increases. A selectively rigidizing device (e.g., an outer sleeve) as described herein may advantageously provide both the benefits of flexibility (when desired) and stiffness (when desired). Furthermore, the rigidizer of the present invention may be used, FOR example, in a classical endoscope, colonoscope, robotic system and/or navigation system, such as described in International patent application PCT/US2016/050290 entitled "DEVICE FOR ENDOSCOPIC ANDANCEMENT THROUGH THE SMALL INTESTINE," filed 2016, 9, 2, 2016, the entire contents of which are hereby incorporated by reference.

The rigidizing devices of the present invention may be provided in a variety of configurations, including different lengths and diameters. In some embodiments, the stiffening device may include a working channel (e.g., for passage of a typical endoscopic tool within the body of the stiffening device), a balloon, a nesting element, and/or a side-loading feature.

Referring to fig. 13A-13D, in one embodiment, a tubular rigidizing apparatus 100 may include a wall having multiple layers positioned about a lumen 120 (e.g., for placement of instruments or endoscopes therethrough). A vacuum may be provided between the layers to rigidize the rigidizer 100.

The innermost layer 115 may be configured to provide an inner surface against which the remaining layers may be reinforced, for example, when a vacuum is applied within the wall of the rigidizing apparatus 100. The structure may be configured to minimize bending forces/maximize flexibility under non-vacuum conditions. In some embodiments, innermost layer 115 may comprise a reinforcing element 150z or coil within the matrix, as described above.

Layer 113 above (i.e., radially outward of) innermost layer 115 may be a sliding layer.

Layer 111 may be a radial gap (i.e., space). The interstitial layer 111 may provide space for the braid thereon to move therein (when no vacuum is applied) and space for the braid to move radially inward (when vacuum is applied).

Layer 109 may be a first braided layer including braided strands 133, similar to that described elsewhere herein. The woven layer may be, for example, 0.001-0.040 inches thick. For example, the braid may be 0.001 inch, 0.003 inch, 0.005 inch, 0.010 inch, 0.015 inch, 0.020 inch, 0.025 inch, or 0.030 inch thick.

In some embodiments, as shown in fig. 13B, the braid may have a tensile or hoop fiber (hop fiber) 137. The hoop fibers 137 may be spiraled and/or woven into the woven layer. Further, the hoop fibers 137 may be positioned at 2-50 rings per inch, such as 20-40 rings per inch. The hoop fibers 137 may advantageously impart a high compressive stiffness in the radial direction (to resist twisting or outward bending), but may remain compliant in the direction of the longitudinal axis of the rigidizing device 100. That is, if compression is applied to rigidizer 100, braid 109 will attempt to expand in diameter upon compression. The hoop fibers 137 may resist this radial expansion and thus resist compression. Thus, the hoop fibers 137 may provide a system that is flexible when bent, yet resists stretching and compression.

Layer 107 can be another radial gap layer similar to layer 111.

In some embodiments, the rigidizing apparatus of the present invention may have more than one woven layer. For example, the rigidizer may include two, three, or four braided layers. Referring to fig. 13C, layer 105 may be second knit layer 105. Second knit layer 105 may have any of the features described with respect to first knit layer 109. In some embodiments, the braid of second braid 105 may be the same as the braid of first braid 109. In other embodiments, the braid of second braid 105 may be different than the braid of first braid 109. For example, the braid of second braid 105 may include fewer strands and have a greater braid angle α than the braid of first braid 109. Having fewer strands may help increase the flexibility of stiffening device 100 (relative to a case where the second braid has the same or more strands), and a greater braid angle α may help shrink the diameter of first braid 109 (e.g., if the first braid is compressed) while increasing/maintaining the flexibility of stiffening device 100. As another example, the braid of second braid 105 may include more strands and have a greater braid angle α than the braid of first braid 109. Having more strands may produce a relatively strong and smooth layer, while having a larger braid angle α may help shrink the diameter of first braid 109.

Layer 103 can be another radial gap layer similar to layer 111. The gap layer 103 can have a thickness of 0.0002-0.04 inches, for example about 0.03 inches. A thickness within this range may ensure that braided strands 133 may easily slide and/or bulge relative to one another to ensure flexibility during bending of rigidizing apparatus 100.

The outermost layer 101 is configured such that when a vacuum is applied to pull it in a direction towards the layers 105, 109, the outermost layer 101 will move radially inwardly and conform to the surface of the braid. The outermost layer 101 may be flexible and atraumatic and may be sealed at both ends to form a vacuum tight chamber with layer 115. The outermost layer 101 may be elastic, for example made of polyurethane. The outermost layer 101 may have a hardness of 30A-80A, for example. Further, the outermost layer 101 may have a thickness of 0.0001-0.01 inches, such as about 0.001 inches, 0.002 inches, 0.003 inches, or 0.004 inches. Alternatively, the outermost layer may be a plastic, including, for example, LDPE, nylon, or PEEK.

In some embodiments, the outermost layer 101 may have stretched or hoop fibers 137 extending therethrough, for example. The hoop fibers 137 may be made of, for example, aramid (e.g., Technora, nylon, Kelvar), polyarylate fibers, polyethylene fibers, carbon fibers, glass fibers, or plastic. In addition, the hoop fibers 137 may be provided in the range of 2-50 rings per inch, such as 20-40 rings per inch. In some embodiments, the hoop fibers 137 may be laminated within an elastic sheath. The hoop fibers may advantageously provide a higher stiffness in one direction than in the other direction (e.g., may be very stiff in the hoop direction, but very compliant in the direction of the longitudinal axis of the rigidizing device). Additionally, the hoop fibers may advantageously provide a low hoop stiffness until the fibers are placed under a tensile load, at which point the hoop fibers may suddenly exhibit a high hoop stiffness.

In some embodiments, the outermost layer 101 may include a lubricant, coating, and/or powder (e.g., talc) on its outer surface to improve sliding of the rigidizing device in the anatomy. The coating may be hydrophilic (e.g.Coating orCoating) or hydrophobic (e.g., fluoropolymer). The coating may be applied, for example, by dipping, painting or spraying the coating thereon.

Innermost layer 115 may similarly include a lubricant, coating (e.g., a hydrophilic or hydrophobic coating), and/or powder (e.g., talc) on its inner surface configured to allow easier mutual shearing between adjacent layers, particularly when no vacuum is applied to rigidizer 100, to maximize flexibility.

In some embodiments, the outermost layer 101 may relax on the radially inward layer. For example, the layer 101 may have a diametrical clearance of 0-0.200 inches between its inner diameter (assuming it constitutes a tube) and the next layer radially inward (e.g., from the braid). This can make the vacuum rigidizing system more flexible when not under vacuum, while still maintaining a high rigidizing factor. In other embodiments, the outermost layer 101 may be stretched some over the next layer radially inward (e.g., the woven layer). For example, the zero strain diameter of the tube comprising layer 101 may be 0-0.200 inches smaller than the diameter of the next layer radially inward and stretched thereover. When not under vacuum, the system may be less flexible than a system in which the outer layer 101 is looser. However, it may also have a smoother appearance and is less likely to tear during use.

In some embodiments, the outermost layer 101 may relax on the radially inward layer. A small positive pressure may be applied under the layer 101 to gently expand the layer 101 and allow the rigidizing apparatus to bend more freely in a flexible configuration. In this embodiment, the outermost layer 101 may be elastic and may maintain a compressive force on the braid, thereby imparting rigidity thereto. Once positive pressure is provided (sufficient to nominally deploy the sheath from the braid, e.g., 2 pounds), the outermost layer 101 no longer contributes stiffness, which may enhance baseline flexibility. Once stiffening is required, negative pressure (vacuum) can be used instead of positive pressure to provide stiffness.

The vacuum may be delivered within the stiffening apparatus 100 in a range from a minimum vacuum to a full atmospheric vacuum (e.g., about 14.7 psi). In some embodiments, there may be a bleed valve, regulator, or pump controller such that vacuum is bled to any intermediate level to provide variable stiffness capability. The vacuum pressure may advantageously stiffen the rigidizer structure by pressing the braided sleeve layer against the adjacent layer. The braid is naturally flexible when bent (i.e., when bent perpendicular to its longitudinal axis) and when the sleeve is bent, the lattice structure formed by the interwoven strands deforms such that the braid conforms to the curved shape when placed over the inner layer. This results in the corners of each mesh element in the geometry of the mesh varying as the braided sleeve bends. When compressed between conformal materials (e.g., layers as described herein), the mesh elements are locked at their current angle and have an enhanced resistance to deformation when a vacuum is applied, thereby enabling the entire structure to be rigidized in bending when a vacuum is applied. Furthermore, in some embodiments, hoop fibers passing through the braid or on the braid may carry tensile loads, which helps prevent local twisting of the braid when high bending loads are applied.

The stiffness of the rigidizing apparatus 100 may be increased from 2 times (fold) to more than 30 times, such as 10 times, 15 times, or 20 times, when transitioning from the flexible configuration to the rigid configuration. In one particular example, the stiffness of a rigidizer similar to rigidizer 100 was tested. The rigidizer tested a wall thickness of 1.0 mm and an outer diameter of 17 mm, and a force was applied to the end of the 9.5 cm long cantilever portion of the rigidizer until the rigidizer deflected 10 degrees. The force required to do this is only 30 grams in the flexible mode, whereas 350 grams in the rigid (vacuum) mode.

In some embodiments of the vacuum stiffening apparatus 100, there may be only one braided layer. In other embodiments of the vacuum stiffening apparatus 100, there may be two, three, or more braided layers. In some embodiments, one or more radial gap layers or sliding layers of the stiffening apparatus 100 may be removed. In some embodiments, some or all of the sliding layer of the rigidizing apparatus 100 may be removed.

The woven layer of the present invention may be used as a variable stiffness layer. The variable stiffness layer may include one or more variable stiffness elements or structures that, when activated (e.g., when a vacuum is applied), increase in bending stiffness and/or shear resistance, resulting in higher stiffness. Other variable stiffness elements may be used in addition to or in place of the braid. In some embodiments, a joint may be used as the variable stiffness element, as described in international patent application PCT/US2018/042946 entitled "DYNAMICALLY RIGIDIZING OVERTUBE" filed 2018, 7, 19, the entire contents of which are incorporated herein by reference. Alternatively or additionally, the variable stiffness element may comprise particles or granules, an occlusion layer, a sheet, a rigidizing axial member, a rigidizer, a longitudinal member, or a substantially longitudinal member.

In some embodiments, the rigidizing apparatus of the present invention may be rigidized by the application of pressure rather than by the application of vacuum. For example, referring to fig. 14A-14B, the rigidizing device 2100 may be similar to the rigidizing device 100, except that it may be configured to maintain a pressure (e.g., greater than 1 atmosphere) therein for rigidization instead of a vacuum. Accordingly, the rigidizer 2100 may include multiple layers positioned about the cavity 2120 (e.g., for placement of an instrument or endoscope therethrough). The stiffening device 2100 may include an innermost layer 2115 (similar to innermost layer 115), a sliding layer 2113 (similar to sliding layer 113), a pressure gap 2112, a balloon layer 2121, a interstitial layer 2111 (similar to interstitial layer 111), a braided layer 2109 (similar to braided layer 109) or other variable stiffness layer described herein, an interstitial layer 2107 (similar to layer 107), and an outermost containment layer 2101.

The pressure gap 2112 may be a sealed chamber that provides a gap for applying pressure to the layers of the rigidizing device 2100. Fluid or gas expansion/pressure media may be used to provide pressure to the pressure gap 2112. The expansion/pressure medium may be water or saline, or a lubricating fluid such as oil or glycerol, for example. The lubricating fluid may, for example, help the layers of rigidizer 2100 slide over one another in a flexible configuration. During the rigidization of the rigidizing device 2100, inflation/pressure medium may be supplied to the gap 2112 and may be partially or completely evacuated from the gap 2112 to convert the rigidizing device 2100 back to the flexible configuration. In some embodiments, the pressure gap 2112 of the stiffening device 2100 may be connected to a pre-filled pressure source, such as a pre-filled syringe or a pre-filled insufflator, thereby reducing the setup time required by the physician.

The bladder layer 2121 may be made of, for example, a low durometer elastomer (e.g., shore 20A to 70A) or a thin plastic sheet. The pocket 2121 may be formed from a plastic or rubber sheet that has been longitudinally sealed to form a tube. For example, the longitudinal seal may use a butt or lap joint. For example, the lap joint may be formed in a longitudinal manner in the rubber sheet by melting the rubber at the lap joint or by using an adhesive. In some embodiments, the thickness of the pocket layer 2121 can be 0.0002-0.020 inches, e.g., about 0.005 inches thick. The pocket layer 2121 may be soft, high-friction, resilient, and/or capable of being easily wrinkled. In some embodiments, the pocket layer 2121 is a polyolefin or polyester. The pocket 2121 may be formed, for example, by using a method for forming a heat shrinkable tube, such as extruding a base material, and then thinning the wall using heat, pressure, and/or radiation. When pressure is provided through the pressure gap 2112, the pocket layer 2121 can expand through the gap layer 2111 to push the braided layer 2109 toward the outermost containment layer 2101 such that relative motion of the braided strands is reduced.

The outermost containment layer 2101 may be a tube, such as an extruded tube. Alternatively, the outermost containment layer 2101 may be a tube with a reinforcing member (e.g., a wire, including round or rectangular cross-section wires) encapsulated in an elastomeric matrix, similar to the innermost layers described in other embodiments of the present invention. In some embodiments, the outermost containment layer 2101 may include a coil spring (e.g., made of round or flat wire), and/or a tubular braid (e.g., made of round or flat wire) and a thin resilient sheet that is not bonded to the other elements in the layer. The outermost containment layer 2101 may be a tubular structure with a continuous and smooth surface. This facilitates sliding of the outer member against it and under locally high contact loads (e.g., nested configurations as further described herein). Further, the outer layer 2101 may be configured to support a compressive load, such as compression. Further, the outer layer 2101 (e.g., with the stiffening element therein) may be configured to prevent the rigidizing apparatus 2100 from changing diameter even when pressure is applied.

Because both the outer layer 2101 and the inner layer 2115 include reinforcing elements, the braid 2109 may be reasonably constrained both in diameter contraction (under tensile load) and diameter increase (under compressive load).

The rigidity of the rigidizer 2100 may be increased by using pressure instead of vacuum to convert the flexible state to the rigid state. For example, in some embodiments, the pressure supplied to the pressure gap 2112 can be between 1 and 40 atmospheres, such as between 2 and 40 atmospheres, such as between 4 and 20 atmospheres, such as between 5 and 10 atmospheres. In some embodiments, the pressure supplied is about 2 atmospheres, about 4 atmospheres, about 5 atmospheres, about 10 atmospheres, about 20 atmospheres. In some embodiments, the rigidizer 2100 may exhibit a 2-100 fold change in relative bending stiffness (measured in a simple cantilever configuration) from a flexible configuration to a rigid configuration, such as 10-80 fold, for example 20-50 fold. For example, the rigidizing device 2100 may have a relative bending stiffness change of about 10, 15, 20, or 25, 30, 40, 50, or more than 100 times from a flexible configuration to a rigid configuration. FIG. 15 shows a graph of the bending strength versus pressure for a rigidizer according to the present invention. As shown, the bending strength of the rigidizer increases as the pressure provided to the wall increases.

Simplified versions of the walls of various pressurized rigidizing devices similar to rigidizing device 2100 are shown in fig. 16A-16O. For example, the stiffening device 2200a of fig. 16A includes an innermost layer 2215a, a pressure gap 2212a, a bladder layer 2221a sealed to the outermost layer 2201a, a woven layer 2209a, and an outer containment layer 2201a (similar to that described in the stiffening device 2100). Rigidizer 2200a also includes end caps 2292a at its proximal and distal ends to seal the pressure therein. When pressure is supplied to pressure gap 2212a via inlet 2293a, bladder layer 2221a is pressed against braid layer 2209a, which in turn is pressed against outermost layer 2201a to prevent the strands of the braid from moving relative to each other.

Referring to fig. 16J, rigidizer 2200J is similar to rigidizer 2200a, except for the addition of a sliding layer 2213J and a stiffening layer 2298J. Layer 2213j may be a sliding layer as described in the present invention, including, for example, a coated film or powder. Layer 2298j may be a stiffening layer and, like layers 2201j and 2215j, may include stiffening elements 2250z as described elsewhere herein. An additional reinforcement layer 2298j may be used in conjunction with the inner layer 2215 j. For example, in a flexible configuration, the two layers 2215j and 2298j may easily slide over each other (via the sliding layer 2213j) and adhere to each other in a rigid configuration (i.e., when pressure is applied) to form a hard composite structure. Layer 2298j may be a high hardness elastomeric rubber, such as TPU (thermoplastic polyurethane) or TPE (thermoplastic elastomer) having a hardness greater than or equal to 60A, 70A, 80A, or 90A. When the tube is in a flexible state, layers 2215j and 2298j can easily shear or move relative to each other (e.g., due to sliding layers 2213j), making the flexibility of the system lower than when the layers are bonded together. When the tube is in a rigid state (e.g., when pressure is applied), layers 2215j, 2298j, and 2213j may lock to each other and act like a single bonded layer to resist wall collapse of rigidizer 2200 j. Similar to other embodiments, when pressure is provided to the gap 2212j to rigidize the device 2200j, the braid 2205j may push against the outer layer 2201 j.

Referring to fig. 16B, the rigidizing apparatus 2200B is similar to rigidizing apparatus 2200a except that the pressure gap 2212B is surrounded by an inverted bladder layer 2221B (or double bladder), i.e., such that bladder layer 2221B includes a side adjacent to the braid 2205B and a side adjacent to the innermost layer 2215B. When pressure is supplied to the pressure gap 2212b (within both sides of the bladder layer 2221 b), the bladder layer 2221b may expand toward the innermost layer 2215b and the braided layer 2209b (the braid 2209b may in turn be pushed toward the outermost layer 2201 b).

Referring to fig. 16C, rigidizer 2200C is similar to rigidizer 2200a except that bladder layer 2221C is sealed to innermost layer 2215C instead of outermost layer 2201C. When pressure is supplied to the pressure gap 2212c via the inlet 2293c, the bladder layer 2221c is pressed against the braid layer 2209c, which in turn is pressed against the outermost layer 2201 c.

Referring to fig. 16D, rigidizer 2200D is similar to rigidizer 2200b, except that innermost layer 2215D is a spring element instead of a bobbin. Because the pressure is in the inverted bladder layer 2221d, the inner layer 2215d itself does not need to be sealed.

Referring to fig. 16E, rigidizer 2200E is similar to rigidizer 2200a, except that innermost layer 2215a is replaced by an internal payload 2294E that is sealed at both the proximal and distal ends and may include a plurality of lumens therein (e.g., working channel 2291E, pressure channel 2292E, and irrigation channel 2293E).

Referring to fig. 16F, rigidizer 2200F is similar to rigidizer 2200a except that the braid 2209F is inside the pressure gap 2212F and the plies 2221F such that the pressure provided to the pressure gap 2212F causes the plies 2221F to push the braid 2209F inward, which in turn pushes the braid 2209F against the innermost layer 2215F.

In some embodiments, the pressure rigidizer may include two braided layers (e.g., having the same or different braid characteristics). For example, an exemplary rigidizer 2200M is shown in fig. 16M having two braided layers 2209M and 2205M. The two braided layers 2209m and 2205m sandwich the two balloons 2221m and 2217m (and/or a single annular balloon) therebetween. When pressure is applied to the pressure gap 2212m between the two balloons, the outer braid 2205m will be pushed radially outward toward the outer layer 2201m while the inner braid 2209m will be pushed radially inward toward the inner braid 2215m to rigidize the device 2200 m.

Fig. 16N illustrates another example rigidizer 2200N having two braided layers 2209N, 2205N. Two braided layers 2209n, 2205n are positioned adjacent to one another between balloon layer 2221n (not labeled in this figure) and outer tube 2201 n. When pressure is supplied to the pressure gap 2212n, the balloon 2221n forces the two braided layers 2209n, 2205n together and against the outer tube 2201 n. When pressurized, the braided layers 2209n, 2205n may be interlaced with one another, thereby enhancing the rigidity of the device 2200 n.

Referring to fig. 16K, rigidizer 2200K is similar to rigidizer 2200a except that an annular ring 2219K (e.g., comprising fibers and adhesive) is located around each end of braid 2209K and balloon layer 2221K to attach balloon layer 2221K to innermost layer 2215K (thereby maintaining pressure within pressure gap 2212K when pressure is supplied through inlet 2293K). For example, the annular ring 2219k may include high strength fibers, such as Kevlar or Dyneema. Further, the adhesive may be, for example, cyanoacrylate. In some embodiments, adhesive may also be placed at the end between the innermost layer 2215k and the bladder layer 2221k, and also surround the inlet tube.

Figure 16G shows a rigidizing device 2200G having a gap inlet 2293G and a vent inlet 2223G. The inlet 2293g is connected to the pressure gap 2212g (connected by a pressure line 2294 g). The inlet ports 2223g are connected to the gaps 2206g around the braided layer 2209g (between the balloon 2221g and the outermost layer 2201 g). The device 2200g can be rigidized in one or more different configurations. In the first rigid configuration, pressure may be applied to inlet 2293g, while vent inlet 2223g may be opened or vented to atmospheric pressure. Thus, pressure supplied to the pressure gap 2212g through inlet 2293g may push the braid 2209g toward the outermost layer 2201g, which in turn may force any air in the gap 2206g out through vent inlet 2223 g. Allowing air to escape through vent inlet 2223g may result in a tighter mechanical fit between braided layer 2209g and outer layer 2201g, thereby stiffening device 2200 g. In the second, rigid configuration, pressure may be applied to inlet 2293g and vacuum may be applied to vent inlet 2223 g. This may cause the stiffening device 2200g to become stiffer than in the first configuration because the vacuum helps move the braid 2209g toward the outer layer 2201 g. The device 2200g can likewise have one or more different flexible configurations. In the first, flexible configuration, inlet 2293g and vent inlet 2223g may both be open to atmospheric pressure. This will cause the braid 2209g to become loose relative to the outer layer 2201g and, as the braid 2209g is free to move relative to the outer layer 2201g, cause the rigidizing apparatus 2200g to assume a flexible state. In the second, flexible configuration, low pressure (e.g., 5-10% above atmospheric pressure) may be provided to inlet 2293g and vent inlet 2223 g. This may result in slight separation of outermost layer 2201g and innermost layer 2215g, which may provide additional area for braid 2209g to move freely. Thus, this may result in the rigidizing device 2200g becoming more flexible than in the first rigidized configuration. Further, providing a lower pressure above atmospheric pressure in a flexible configuration may allow the rigidizer 2200g to be introduced into the body at a very small diameter (e.g., such that the pressure gap 2212g is substantially zero), and then the lower pressure may be provided to the inlet 2293g and vent inlet 2223g to slightly enlarge the pressure gap 2212g, thereby providing more room for the braid 2209g to freely move.

Fig. 16H shows a rigidizer 2200H with a bellows 2243H connected to a pressure line 2294H. The pressure gap 2212h, pressure line 2294h, and bellows 2243h may all be configured to be filled with a sealed pressure transmission medium, such as distilled water or saline solution or oil. The pressure transmission medium may be a radiopaque fluid, which advantageously will more clearly show the rigidizing apparatus during a procedure using fluoroscopy. The pressure transmission medium may be added to the rigidizing apparatus just prior to use and/or at the time of manufacture of the apparatus. In use, activating the actuator 2288h may compress the bellows 2243h, thereby reducing the volume of pressure medium in the bellows 2243h that flows through the pressure line 2294h to the pressure gap 2212h, causing the pressure in the pressure gap 2212h to rise and initiate movement of the braid 2209h toward the outer layer 2201 h. Vent ports 2223h may be open to the atmosphere to allow gases to escape from space 2206h around braid 2209 h. Furthermore, reversing the action of the actuator 2288h may cause the pressure in the pressure gap 2212h to drop, as the pressure medium moves back to the bellows 2243 h. The actuator 2288h may be, for example, a solenoid, voice coil, lead screw, valve, or rotary cam. In some embodiments, instead of using bellows 2243h, pressure line 2294h may be clamped or flattened to increase the pressure in pressure gap 2212 h.

Fig. 16I shows a rigidifying means 2200I comprising two water collecting means 2230I and 2228I, respectively. The water collection devices 2230i and 2228i may include a fluid medium, such as water and a gaseous medium, such as air. Pressure or vacuum, or a combination thereof, may be applied to inlets 2293i, 2223 i. Using the illustrated water collection device configuration may mean that there is no air or gas in the rigidizer, regardless of the pressurized state (increased pressure, vacuum, or atmospheric pressure) of each gap 2206i or 2212 i. If the gap should leak during surgery, this means that only the fluid medium enters the patient, and the patient can be protected from gas (e.g. air) embolisms.

In some embodiments, the rigidizing devices of the present invention may include a plurality of individual balloons that extend longitudinally along the length of the device. For example, referring to fig. 16O, the apparatus 2200O includes four different circumferential bladders 2221O distributed around the pressure gap 2212O. In this embodiment, the braid is again divided into four longitudinal flattened braids 2209o, each positioned radially outward of the balloon 2221 o. In other embodiments, the braided layer may comprise a tubular braid (similar to that described below with reference to fig. 67) wrapped around the balloon 2221 o. Further, outer layer 2201o and inner layer 2215o are connected by partition 2236 o. In some embodiments, the partitions 2236o may be formed from elements of the outer or inner layers 2201o, 2215o (e.g., continuous elements that may be one or both of 2201o, 2215 o). In some embodiments, the dividers 2230o may be configured to help maintain the thickness of the walls. When pressure is provided to the pressure gap 2212o, the balloon 2221o expands to push the flat braid 2209o toward the outer layer 2201 o.

In some embodiments, referring to fig. 16L, the pressure rigidizer described herein does not include an innermost layer (e.g., does not include an innermost layer having reinforcing elements therein). In contrast, the rigidizing device 2200l may include an outer layer 2201l, a gap layer 2206l, a braided layer 2209l, and an everting or tubular balloon 2221l (with a pressure gap 2212l therein). The tubular balloon 2221l may be configured to be positioned around an internal device (e.g., a scope 2291). When the pressure gap 2212l is filled with a pressurized medium, the balloon 2221l may expand toward the scope 2291 and the braid 2209 l. It should be understood that any of the features described herein with respect to the vacuum stiffening means may be replaced or substituted with any of the features described with respect to the pressure stiffening means.

In some embodiments, the rigidizer of the present invention may incorporate a tool or working channel therein. The working channel may be designed so as not to significantly increase the bending stiffness of the rigidizer. Referring to fig. 17A-17C, in one embodiment, the stiffening device 500 may include a working channel 555 extending therethrough. The working channel 555 can include a central cavity 571z (e.g., for passage of a working element therethrough) formed by alternating telescoping tubular portions that locally neck or taper from a larger diameter end 569z to a smaller diameter end 570 z. Each section may be connected to a lower layer of the wall (e.g., sliding layer 513 on innermost layer 515) at a discrete location or anchor point 568z and may otherwise be free to move. When rigidizer 500 is bent, smaller diameter end 570z may move within larger diameter end 559z of the adjacent section to allow working channel 555 to bend. The working channel 555 may be located within the wall of the stiffening device 500, such as in the radial gap 511 between the sliding layer 513 and the first braid 509 (and thus may also be located below the radial gap layer 507, the second braid 505, the radial gap layer 503, and the outermost layer 501). The working channel 555 can thus be positioned within a sealed vacuum (or pressure chamber) of the rigidizer 500. In some embodiments, the working channel 555 itself may be located within a sealed bag or layer 572 to ensure that there is no vacuum or pressure leak path. In other embodiments, the portions may include a sliding seal therebetween to ensure that there is no vacuum or pressure leak path. In some embodiments, as shown in fig. 17D, there may be an alternative large diameter portion 525a and small diameter portion 525b, rather than having tapered portions. The smaller diameter portion 525b may move within the larger diameter portion 525a during bending on the rigidizer 500. The working channel may be placed within the sealed volume formed by layers 501 and 515, or may be placed outside the sealed volume, for example on top of layer 501.

Referring to fig. 18A-18B, in some embodiments, the rigidizing device 7800 can include a working channel 7855 that spirals around a portion of the elongate body 7803z of the rigidizing device 7800. For example, working channel 7855 can be threaded at an angle of 40-50 degrees, such as an angle of about 45 degrees, relative to the longitudinal axis of device 7800. When rigidizer 7800 is bent, helical working channel 7855 can advantageously be deformed into a curvilinear path without resisting bending and/or forcing the path length to adjust along its length. Working channel 7855 can include a proximal port 7840z integral to handle 7831 and a distal port 7841z (through which the working tool can be withdrawn) formed to the end of tip 7833z of rigidizing apparatus 7800. Spiral working channel 7855 may be located above outermost layer 7801, below outer layer 7801 (outer layer 7801 has been removed for clarity as shown in fig. 18A-18B), or further within the layers of the wall (e.g., below the woven layer).

Referring to fig. 19A-19B, in some embodiments, rigidizer 4500 can include a plurality of working channels 4555 spiraling around the outside thereof. As shown in fig. 19A-19B, working channel 4555 can, for example, form a spiral shroud around stiffening device 4500. In some embodiments, working channels 4555 may be co-configured to form a second stiffening element that may be stiffened separately from internal stiffening device 4500. The second rigidizing element may advantageously be highly flexible due to the relative movement of the respective helical working channels 4555. In some embodiments, working channel 4555 may include a thin flexible loop and/or a thin flexible sheath to contain working channel 4555 in a circular cross-section. In some embodiments, device 4500 can further include a steerable distal tip 4547, e.g., to aid in the placement of a tool extending through working channel 4555.

Referring to fig. 20A-20B, in some embodiments, the rigidizer 8000 can include a rigidized elongate body 8003z having a plurality of working channels 8055a-d (e.g., 1-10, 3-5, or 4-5 working channels) extending along its central lumen 8020 to a tip 8033 z. Throughout the procedure, working channels 8055a-d can be used with a variety of different tools. For example, one of working channels 8055a-d can be used for catheters with cameras and illumination, another can be used for traction, another can be used for cutting, another can be used for suction, and the like. Elements extending along working channels 8055a-d can be interchanged throughout the procedure. In some embodiments, the rigidizing elongate body 8003z may be disposable, while the tool may be cleanable and/or sterilizable. In some embodiments, the rigidizer 8000 may further include a passive or active linkage (linkage)8004 z.

Referring to fig. 21, in some embodiments, a rigidizer 8100 can include a first working channel 8155a and a second working channel 8155 b. The first working channel 8155b can extend along the central lumen 8120 (or within the wall of the elongate body 8103 z) all the way to the distal end 8133 z. The second working channel may similarly extend along the central lumen 8120 or within the wall of the elongate body 8103z, but may exit from a side of the elongate body 8103z proximate the distal portion 8102z (e.g., prior to the linkage 8104 z). Exiting the tool passage 8155b near the distal portion may advantageously limit its interference with the steering or bending of the linkage 8104 z.

Referring to FIG. 22, in some embodiments, tool 7942z may be specifically designed for use with a working channel of a rigidizer as described herein. The tool 7942z may include a flexible shaft 7943z and an expandable atraumatic tip 7944 z. Atraumatic tip 7944z may be an inflatable balloon or a nickel titanium alloy shell with foam around it. In some embodiments, the expandable tip 7944z may be configured to contract (e.g., sheathed) to be delivered via the working channel and self-expand after withdrawal of the sheath and placement through the working channel. The atraumatic tip 7944z may be sized, for example, to not fill the lumen of the gastrointestinal tract, and thus so as not to contact the wall of the gastrointestinal tract. The tool 7942z may also have a flexible ring 7945z connected to a tip 7944z or axis 7943 z. In some embodiments, ring 7945z may be connected to an endoscopic clip (typically used to close various defects in the gastrointestinal tract) to provide traction during an ESD procedure. By sliding the shaft 7943z longitudinally, the user can provide traction for the clip. The inflatable atraumatic tip 7944z may advantageously allow the tool 7942z to be freely advanced prior to rigidizing the device without fear that it may cause trauma or become stuck in the gastrointestinal tract. By hooking the flexible loop 7945z onto the clip, the tool 7942z can achieve good traction with a simple back and forth movement of the flexible shaft 7943 z.

Any of the rigidizing devices described herein may have one or more distal portions having a different design than the main elongated body of the rigidizing device. For example, as shown in fig. 23, the rigidizing device 5500 may have a main elongated body 5503z and a distal portion 5502 z. Only the distal portion 5502z, only the main elongate body 5503z, or both the distal portion 5502z and the main elongate body 5503z may be rigidized (e.g., by vacuum and/or pressure) as described herein. In some embodiments, one portion of 5502z, 5503z is activated by pressure while the other portion is activated by vacuum. In other embodiments, the two portions 5502z, 5503z are activated by pressure or vacuum, respectively.

Referring to fig. 24, in some embodiments, the distal portion 5702z can include a rigidizing braid that is different from the braid of the primary elongate portion 5703 z. For example, in one embodiment, the braid angle relative to the longitudinal axis in the distal portion 5702z can be greater than the braid angle of the main elongate body 5703 z. For example, the braid angle in the distal portion may be 40 degrees, while the braid angle in the main elongate body may be 20 degrees. The braids may be slightly overlapped and joined with a flexible adhesive. These designs can impart greater bending flexibility to the distal portion 5702z than the main elongated portion 5703z in a non-stiffened state. For example, having a more flexible distal tip may advantageously prevent twisting and dragging at the tip (caused by securing the braid end), and/or may advantageously provide flexibility during navigation through a body lumen to prevent damage to anatomical structures. In another embodiment, the braid angle relative to the longitudinal axis in the distal portion 5702z can be less than the braid angle of the main elongate body 5703 z. This can make the distal portion 5702z stiffer in a stiffened state relative to the main elongate body 5703 z. For example, greater stiffness in the distal portion 5702z may advantageously provide a stable platform for moving or delivering a medical device through the central lumen and out of the distal end of the rigidizer 5700.

Referring to fig. 25, in some embodiments, distal portion 5802z may include a plurality of linkages 5804z that are passively activated. The linkages 5804z may be connected together at one or more pivot points, and may advantageously provide deterministic bending (i.e., bending in a particular and predetermined direction). Additionally, linkage 5804z may advantageously provide torsional rigidity to distal portion 5802z while providing high flexibility for bending. Linkage 5804z may be activated passively, e.g., by flexing, as device 5800 moves in the anatomy. Distal portion 5802z may include, for example, 1-100 linkages 5804z, such as 1, 2, 4, 6, 8, 10, 16, 20, 30, or 40 linkages 5504 z. In some embodiments, linkage 5804z may be formed from a passively cut bend (flex), such as a laser cut tube or stent.

Referring to fig. 26, in other embodiments, the distal portion 7602z can include a plurality of linkages 7604z, these linkages 7604z actively controlled by, for example, a cable 7624 for effecting steering of the rigidizer 7600. The device 7600 is similar to the device 5800 except that it includes a cable 7624 configured to control movement of the device. Although the cable 7624 is not shown in fig. 26 as passing through the rigidizing elongate body 7603z (i.e., having an outer wall 7601, a braid 7609, and an inner layer 7615), the cable 7624 can extend therethrough in any manner as described elsewhere herein. In some embodiments, one or more layers of the rigidizing elongate body 7603z can continue into the distal portion 7602 z. For example, as shown in fig. 26, the inner layer 7615 can continue into the distal portion 7602z, e.g., can be radially inward of the linkage 7604 z. Similarly, any additional layers from the stiffened proximal portion (e.g., braid 7609 or outer layer 7601) can continue into the distal portion 7602z and/or be radially inward of the linkage 7604 z. In other embodiments, none of the layers in the rigidized elongate body 7603z continue into the distal portion 2702 z. Linkage 7604z (and any linkage described herein) can include a cover 7627z thereon. The cap 7627z can advantageously render the distal portion 7602z atraumatic and/or lubricious. The cover 7627z can be a membrane, such as expanded PTFE. Expanded PTFE advantageously provides a smooth, low friction surface that is less resistant to bending but more resistant to distortion.

Fig. 27A-E illustrate another exemplary distal portion 4302z including a plurality of linkages 4304z actively controlled, for example, by cables 4324, for effecting steering of the rigidizer. In some embodiments, as shown in fig. 27A-27E, the pivot of the linkage 4304z may be involute, similar to teeth of a gear, to reduce local contact resistance. The cable 4324 may be positioned within a cable guide (e.g., a sleeve or coiled tubing) that extends the length of the rigidizer. In some embodiments, the cable 4324 (and cable guide) may extend within a wall of the rigidizer. The cable guide may advantageously ensure that tensile loads are carried by the cable guide rather than by the wall of the rigidizer, so that the structure of the wall does not deflect adversely when a load is applied to the linkage 4304 z. In some embodiments, the cable guide and cable 4324 may have excess length to account for (account for) bending of the rigidizer. For example, such excess length may be interwoven (woven) or crimped within the wall of the rigidizer. Further, cable 4324 can pass through a hole and/or groove in linkage 4304z (see, e.g., fig. 27C) while remaining otherwise free floating within the wall (thereby accounting for the flexing of the rigidizer). When cable 4324 is activated, linkages 4304z pivot relative to each other, providing steering for the distal portion of the rigidizer. Activation of the linkage 4304z for steering and the cable 4324 may be accomplished by an actuator (e.g., an electric motor in the field, a current activated (hot) nitinol wire, a proximal actuator (typically stainless steel, tungsten, or composite), hydraulics, and/or an EAP (electro-active polymer)). Such a steering mechanism may advantageously improve clinical utility. Moreover, such steering allows devices positioned through a central lumen (e.g., endoscope or guidewire) to be steered toward and more easily reach a desired anatomical location.

When a cable is used to steer the distal portion, the cable (which may or may not be in the cable guide) may be threaded through the wall of the rigidizer of the present disclosure in a number of different ways. Fig. 28-39B illustrate an exemplary configuration of a rigidizer with a cable guide (with some wall layers omitted from fig. 28-39B for clarity). For example, fig. 28 shows a stiffening device 6200 having a cable 6224 extending in a cable guide 6299 within an outer radial gap layer 6207 (and thus between the braided layer 6209 and the outer layer 6201). In some embodiments, each of the cables 6224 and the cable guide 6299 may be positioned substantially equidistantly around the circumference (i.e., about 90 degrees apart between adjacent cables when four cables are used). In other embodiments, one or more of the cable 6224 and the cable guide 6299 may be closely grouped together (e.g., within the same quadrant), rather than separated from one another. Further, in some embodiments, the cables 6224 and/or guides 6299 may be asymmetrically distributed about the circumference of the stiffening device 6200.

Fig. 29 illustrates a stiffening device 6300 in which the cable 6324 and cable guide 6399 are located within the inner radial gap layer 6311 (and thus between the braid 6309 and the inner layers of the stiffening device, such as the balloon 6321). For example, when pressure is provided to the pressure gap 6312, the bladder 6321 may push against the braid 6309, and the braid correspondingly pushes against the outer layer 6301, while the braid 6309 does not crush or otherwise impact the cable 6234. Likewise, the cables 6324 and cable guides may be positioned equidistantly or asymmetrically around the circumference of the rigidizer 6300.

Referring to fig. 30, in some embodiments, a rigidizing device 6400 may have a cable 6424 and a cable guide 6499 at least partially separated from a pressurized or vacuum region. For example, as shown in fig. 30, a tubular bladder layer 6421 may surround the pressure gap 6412. Some or all of the cable 6424 and cable guide 6499 may be located in the gap 6407 between the inner layer 6415 and braid 6409, and circumferentially adjacent to the tubular pocket 6421. Advantageously, in such a configuration, both the cable 6424 and the cable guide 6499 may be minimally affected by pressurization of the pocket 6421 and provide substantially no additional stack height or thickness to the wall.

Referring to fig. 31, in some embodiments, the rigidizer 6500 may include a plurality of circumferentially spaced tubular bladders 6521 such that each cable 6524 and cable guide 6599 may fit in a gap 6507 between adjacent tubular bladders 6521.

Referring to fig. 32, a rigidizing device 6600 is similar to device 6500, except that the cables 6624 and guides 6699 are grouped in pairs to reduce the number of tubular bladders 6621 required (e.g., there may be two tubular bladders 6621 and two pairs of cables 6624 and guides 6699 located therebetween).

Referring to fig. 33, a rigidizing device 6700 is similar to device 6500 except that each tubular bladder 6721 includes a tubular braid 6709 therearound (i.e., having a single braid 6509 as opposed to device 6500). When pressurized medium is provided to the pressure gap 6712, the bladder 6721 may expand to compress each individual tubular braid 6709, and the tubular braid 6709 may expand to compress the inner layer 6715 and the outer layer 6701. Alternatively, not all of the bladders may be pressurized simultaneously (e.g., only 1 or 2) such that the device is only partially stiffened about the circumference. This may create stiffness along only one portion of the device while still being able to have flexibility at other portions, which may allow preferential movement of the device in the event of a deflection load being applied.

Referring to fig. 34, in some embodiments, the rigidizer 6800 can comprise a strip of braid 6809 (i.e., a flat braid rather than a tubular braid). Each strip of braid 6809 and each cable 6824 and cable guide 6899 can be positioned in radial gap 6807. Furthermore, strips of braid 6809 may be alternated with cables 6824/6899 to minimize the wall thickness of rigidizer 6800. The bladder 6821 may be located radially outward of the braid 6809 strips and the cables 6824/guides 6899. When pressure medium is supplied to pressure gap 6812, bladder 6821 may urge strips of braid 6809 radially inward toward innermost layer 6815 to rigidize device 6800. In other embodiments, the bladder 6821 can be located radially inward of the strips of braid 6809 (and cable 6824/guide 6899) and configured to push the strips of braid 6809 toward the outer layer 6801.

In some embodiments, referring to fig. 35, a cable 6924 and a cable guide 6999 may be positioned to extend along a central lumen 6920 of a rigidizing device 6900.

In some embodiments, referring to fig. 36, the cable 7024 and the cable guide 7099 may be located radially outward of the outer layer 7001. The cable 7024 and guide 7099 may be located, for example, in the sheath 7009z, which sheath 7009z may extend only over the cable 7024 or may completely surround the outer layer 7001. The guide 7099 may be only minimally constrained within the sheath 7009z so as to be free to bend during movement of the device 7000 (e.g., to curl or extend to full length depending on whether the guide 7099 is located inside or outside the center of the rigidizer 7000 when the rigidizer 7000 is bent).

Referring to fig. 37, in some embodiments, a cable guide 7199 (having one or more cables therein) can be coiled outside of the outer layer 7101 of the rigidizer 7100. Additional cable guides may also be coiled therearound. In some embodiments, the cable guide 7199 can be coiled around other layers of the rigidizer 7100, such as around an inner layer.

Referring to fig. 38A-38B, in some embodiments, the cable guide 7299 (having one or more cables therein) and the tubular elements 7210z can be alternately coiled around the inner layer 7215 (i.e., such that the cable guide 7299 and the tubular elements 7210z form a substantially single layer along the length of the rigidizer 7200). Tubular element 7210z can comprise an outer tubular braid 7209 with an inner tubular bladder 7221. When pressurized medium is provided to the pressure gap 7212, the bladder 7221 can expand to press the tubular braid 7209 outward, which can push the outer layer outward (not shown for clarity).

With reference to fig. 39A-39B, rigidizing device 7300 may be similar to device 7200 except that only cable guide 7399 and tubular balloon 7321 may be coiled around inner layer 7315 within gap 7311 (note that, for clarity, cable guide 7399 and tubular balloon 7321 are not shown in fig. 39B). The braid 7309 may be radially wound around the gap 7311. When pressure medium is supplied to tubular bladder 7321, bladder 7321 may expand to push braided layer 7309 toward outer layer 7301 (not shown in fig. 39A for clarity).

It should be understood that the cable configurations described in fig. 28-39B may be used with any number of cables (e.g., 1, 2, 3, 4, 5, 6, 8, 12, or 16 cables). Further, the cable may be used to steer any tip or rigidizing device and/or to steer any distal portion (e.g., portions having linkages and different braid angles). Furthermore, the cable guide according to the invention may be round (for round cables), flat, rectangular (for flat ribbon-like tensile elements) or a combination of the above. Furthermore, in some embodiments, other steering elements may be used in place of the cable (e.g., pneumatic elements, hydraulic elements, shape memory alloys, EAPs (electroactive polymers), or motors). Even if the forces available for steering are significantly lower than those required for rigidization of nested systems, purposely separating the elements required for steering from those required for rigidization enables the structure to exhibit continuously high rigidizing performance as a function of length.

Further, it should be understood that the cable configurations and arrangements described in fig. 28-39B may be similarly used for arrangements of working channels or other lumens within a rigidizing device (e.g., inflation lumens for a balloon).

Referring to fig. 40A-40D, in some embodiments, the distal portion 5902z may include a series of linkages 5904z (active or passive) specifically designed to be rigidized by the application of pressure or vacuum. For example, linkages 5904z may be connected to each other by pivot point 5928z (e.g., may be a line pivot point). Each pivot point 5928z may allow bending between linkages in one degree of freedom. Further, linkages 5904z may be arranged in an alternating manner with every other linkage connected to pivot point 5928z, with pivot point 5928z positioned 90 degrees from the previous linkage. Each linkage 5904z may have a cut-out 5975z extending from a pivot point 5928z at its proximal and distal ends to allow linkages 5904z to flex relative to each other. Further, each linkage 5904z may be connected to an adjacent linkage 5904z by a respective tensile member 5930 z. Tensile member 5930z may be fixed relative to one linkage and may be movable at least partially within track 5931z of an adjacent linkage (e.g., within track 5931z of linkage 3203 b). The movement of linkage 5904z allows tension member 5930z to elongate when outside the curve and shorten when inside the curve during bending of the rigidizer. Further, proximal portion 5902z may include two sliding clamps 5932z attached to tensile member 5930z along opposing axes (i.e., 90 degrees from each other). Two tensile members 5930z extend from each slide clamp 5932z to the distal-most end of distal portion 5902 z. As the distal portion 5902z bends, one cable element of each slide clamp 5932z shortens and one cable element of each slide clamp 5932z lengthens, resulting in circumferential movement of the slide clamp 5932 z. An outer sleeve (sleeve) may compress the sliding clamp 5932z to the rail 5931z surface when vacuum or pressure is applied. The sliding clamp 5932Z and rail 5931Z surfaces may be smooth, rough, or toothed. This compressive force may lock sliding clamp 5932Z in a position relative to linkage 5904Z, thereby fixing the position of tensile member 5930Z and making the distal portion stiffer in its current shape. Additional rigidizing linkages and/or joints are described in international patent application PCT/US2018/042946, entitled "DYNAMICALLY RIGIDIZING OVERTUBE," filed 2018, 7, 19, and having PCT publication number WO2019/018682, the entire contents of which are incorporated herein by reference.

Referring to fig. 41A-41B, in some embodiments, the distal portion 6002z may include a linkage 6004z (active or passive) that rests on a portion 6007z, which portion 6007z is rigidized by vacuum or pressure, as otherwise described herein (i.e., located over a rigidized wall having an inner layer 6015, a pressure gap 6012, a bladder 6021, a knit layer 6009, and an outer layer 6001). Placing the linkage 6004z above the rigidized portion can provide the advantages of a linkage system (e.g., bending flexibility and torsional rigidity), as well as a steering or deterministic curved tip that can be rigidized when the remaining structure is rigidized. Alternatively, the linkage may be located radially inward of the rigidized portion. As shown in fig. 41B, cable 6024 in cable guide 6099 may extend through linkage 6004z to provide selectable active steering of linkage 6004 z.

Referring to fig. 42A, in some embodiments, the distal portion 6102z may include a series of linkages 6104z (active or passive) sealed within a thin layer of material 6108z (e.g., made of elastomer, PVC, or PEEK). Linkage 6104z and sheet material 6108z may be located, for example, above braid 6109 (i.e., radially outward from braid 6109) and may remain continuous with coil wound tube 6101 of main elongate body 6103 z. In this embodiment, when pressure or vacuum is provided to the gap 6112, the braid 6109 may be pressed by the balloon 6121 against the coil winding tube 6101 in the main elongate body 6103z and against the linkage sheath 6108z in the distal portion 6102z to rigidize. Linkage 6108z is supported by linkage 6104z so that it can resist the pressure of braid expansion. This design advantageously provides stiffening and linkage while maintaining low wall thickness and/or diameter. The distal portion 6102z can include a cable 6124 extending within a cable guide, for example, to activate the linkage 6104 z.

In some embodiments, the rigidizing structure may be diverted from within the wall of the rigidizing structure, and optionally without any connectors. Fig. 42B shows a cross-section of a pressure rigidizing structure 2500 in which a cable guide 2599 is placed in the pressure gap 2512 and may be connected to the inner layer 2515. A cable 2524 extends from the cable guide 2499 into the distal portion 2502z and is anchored to the inner layer 2515 at anchor point 2568. Pulling on cable 2524 will cause distal portion 2502z (distal to the end of cable guide 2599) to deflect. In some embodiments, cable guide 2599 may be omitted, and when cable 2524 is pulled, rigidizer 2500 will bend along its entire length. In some embodiments, the device 2500 can be configured to have a distal portion 2502z with a lower bending stiffness than the proximal elongate body 2503z (e.g., by changing the braid angle or using more flexible stiffening elements in the inner or outer layers, as described herein) such that the distal portion 2502z bends more than the body 2503 z. Cable guide 2599 and cable 2524 may be located between balloon 2521 and braid 2509 or between braid 2509 and outer layer 2501. Cable guide 2599 and/or cable 2524 may be attached to outer wall 2501. Alternatively, in a vacuum-stiffened structure, cable guide 2599 and cable 2524 may be located between the inner and braided layers or between the braided and outer layers. In some embodiments, in portions of cable 2524 that are not within cable guide 2599, the braid in balloon 2521 and braid 2509 may be omitted, leaving only the inner and outer layers 2515, 2501, or only the outer or inner layers.

Referring to fig. 43A-43C, in some embodiments, the distal portion 4602z may include an active deflection segment 4646. The deflecting segments 4646 may include strips or ridges extending therethrough that, when activated, provide bending only in one or more predetermined directions. The active deflecting segment 4646 may be deflected into a predetermined shape, for example, by using one or more cables, balloons, pull wires, and/or lead-in wires. The active deflecting segment 4646 may thus provide bending of the rigidizer 4600 in a fixed position and fixed direction. In some embodiments, a marker (e.g., a radiopaque marker) may be positioned within or proximal to the active deflection section 4646 to indicate where bending will occur and/or in which direction the active deflection section 4646 will bend. It may be advantageous to use the active deflecting segments 4646 to bend the rigidizing device 4600, for example, when bending is desired without assistance from the anatomy (i.e., when the anatomical path of the rigidizing device 4600 is not pre-set or constrained by the anatomy). For example, during a transseptal procedure of the mitral valve, such bending may help create bending in the open or relatively unconstrained space between the Inferior Vena Cava (IVC) and the atrial septum. The active bend section 4646 may be configured to be rigidized (i.e., by pressure or vacuum) as described herein, thereby securing or locking the active deflection section 4646 in the bent configuration. Further, in addition to the active deflection section 4646, the rigidizing device 4600 may include a steerable distal portion 4647 (e.g., with a linkage). As discussed elsewhere herein, steerable distal portion 4647 may be used to point or orient the distal end of rigidizer 4646 in a desired direction (e.g., via a cable and/or along four axes).

Any of the rigidizer apparatuses described herein may include one or more separate rigidizer portions. For example, referring to fig. 44A-44C, in some embodiments, rigidizer 900 can have individual vacuum/pressure chambers 975a-d (e.g., four vacuum or pressure chambers) along its length. Each chamber 975a, b, c, d may have its own vacuum/pressure line 927a-d extending to it for individual rigidization of the chambers 975a, b, c, d. The compression seals 929 may extend between each chamber and/or at the distal end. In some embodiments, a stiffening device 900 having individual stiffening chambers 975a, b, c, d may include a steerable distal portion 902z (e.g., having linkages as described elsewhere in the present disclosure). The cables 924a-d controlling steerable distal portion 902z can be managed using cable guides 999 (e.g., there can be at least one, such as 1-4 cable guides 999 in each vacuum chamber 975). In some embodiments, as shown in FIG. 44B, the cables 924a-d, cable guides 999a-d, and/or vacuum/pressure lines 927a-d may extend within the radial gap 911 between the innermost layer 915 and the braid 909 (and thus also beneath the outermost layer 901). In other embodiments shown in FIG. 44C, cables 924a-d, cable guides 999a-d, and/or vacuum/pressure lines 927a-d may extend within the central lumen 920 of the stiffening device 900. In use of the stiffening device 900, any chambers 975a-d that are in a flexible state may be deflected or deflected in the direction of cable tension, while the stiffened chambers 975a-d will remain in their position and not deflect. Advantageously, this design allows chambers 975a-d to be alternately placed in vacuum/pressure and/or steering directions to form various complex shapes and provide navigation through the anatomy with minimal looping.

In some embodiments, the distal portion of the rigidizing device of the present invention may include an element for local tissue stabilization, such as a suction element, a balloon element, or a cage element. For example, referring to fig. 45A-45D, in one embodiment, the stiffening device 600 may include a balloon 666 and a balloon inflation lumen or tube 667 extending into the balloon 666. As shown in fig. 45B-45D (the outer layer has been removed in fig. 6B-6C for clarity), a balloon inflation tube 667 can extend alongside working channel 655 (and thus within radial gap 611 between sliding layer 613 and first braided layer 609). As shown in FIGS. 45B-45C, the fill tube 667 can be configured to include an auxiliary tube bundle loop 668 (i.e., straightened as shown in FIG. 45B or more curved as shown in FIG. 45C) that can vary in length to accommodate bending of the stiffening device 600. In some embodiments, the balloon inflation tube may be helically coiled about its axis to accommodate bending. In some embodiments, the vacuum rigidizer may include a balloon inflation tube located between the innermost layer and the braid, between the braid and the outer layer, radially inward of the inner layer, or radially outward of the outer layer. In some embodiments, the pressure rigidizer may include an inflation lumen in the pressure gap, between the bladder and the braid, between the braid and the outer layer, radially inward of the inner layer, or radially outward of the outer layer. For example, the inflation lumen may be positioned similar to that described in the present disclosure with respect to the working channel and/or cable.

As another example, FIGS. 46A-46B illustrate an exemplary vacuum tip (tip)5354 for use with a rigidizer. The vacuum tips 5354 may include a circumferential array of vacuum holes 5358 on a distal-most end surface 5359. Further, the array of vacuum holes 5358 can be connected to a vacuum line 5356 that extends along the rigidizer (e.g., within or alongside a layered wall of the rigidizer). The vacuum line 5356 can be connected to a vacuum source such that, when activated, a vacuum is provided to each of the apertures 5358 of the array through the vacuum line 5356 (e.g., through the annular inlet 5319 z). Thus, suction can be provided on the distal-most face 5359 of the tip 5354 (i.e., the distal-most face of the rigidizer). Such suction may be used, for example, to aspirate tissue (e.g., for stabilization of interventional procedures, such as for papillary intubation, such as for accessing the pancreatic duct or bile duct). Such suction may also be applied, for example, to Endoscopic Submucosal Dissection (ESD), or endoscopic full-thickness resection (EFTR).

In some embodiments, the vacuum tip 5354 can be located just distal to the steering portion of the rigidizer, which can be advantageously used to orient the vacuum tip 5354 in a desired direction. Further, in some embodiments, a tool (e.g., a guidewire or scope) can be passed through the central lumen 5320z of the tip 5354 and between the array of vacuum holes 5358 to allow for procedures to be performed upon suction activation.

Referring to fig. 47A-47B, in some embodiments, the vacuum tip 5254 can comprise a semi-annular array of apertures 5238 at the distal-most face 5259, rather than a circumferential array of apertures.

Referring to fig. 48A-48B, in some embodiments, the vacuum tip 5454 can have a distal end surface 5459 with an angle of inclination (e.g., at an angle of 30-80 degrees, such as 30, 45, 60, 70, or 80 degrees, relative to a longitudinal axis of the tip 5454). The angled distal surface may advantageously assist in accessing an angled anatomy for easier attachment to a local surface.

The vacuum tip described herein may advantageously provide suction without causing the endoscope lens to "look-out" because suction may occur locally (e.g., at aperture 5358) rather than at the lens of the endoscope. Thus, the endoscope can provide visualization of tissue even when suction is applied.

In some embodiments, the vacuum tip of the present invention may include metalized portions and/or wires having a common joint so that the vacuum tip may conduct current. Such an electrical current may be used, for example, to cut or coagulate aspirated tissue.

In some embodiments, the vacuum tip of the present invention may be used with standard endoscopic or endoscopic-type devices that do not include rigidization.

Any of the rigidizing devices described herein may be used with a handle configured to allow manual manipulation and/or activation of the device.

Fig. 49A-49D illustrate an exemplary handle 1031. The handle 1031 includes an activation element 1048 in the form of a button configured to activate vacuum or pressure (the button is shown closed in fig. 49A and 49C and open in fig. 49B and 49D). In addition, the flow path within the handle 1031 may include a vacuum or pressure inlet port 1049 configured to connect to a source of vacuum or pressure, a rigidizer port 1050 connected to a rigidizer by an outlet 1073z, and a vent port 1051 connected to atmosphere. As shown in fig. 49A, when the activation element 1048 is in the distal "closed" position (i.e., such that the stiffening vacuum or pressure of the stiffening device is closed), the vent port 1051 and the stiffening device port 1050 communicate with each other, thereby venting any stiffening pressure or vacuum to the atmosphere and placing the stiffening device in a flexible configuration. As shown in fig. 49B, when the activation element 1048 is in a proximal "on" position (i.e., such that the vacuum or pressure to the stiffening device is on), the stiffening device port 1050 and the vacuum or pressure inlet port 1049 communicate with each other, thereby providing pressure or vacuum to the stiffening device to allow the device to be stiffened. In some embodiments, the handle 1031 may be configured to be bonded to a rigidizing device (e.g., an internal coil wound tube bonded to a rigidizing device) at a bonding region 1053. As shown in fig. 49C-D, the handle includes a status indicator element 1067z to indicate whether the rigidizing apparatus is in a flexible or rigid configuration. In this embodiment, status indicator 1067z is configured to: the word "on" is displayed when the button is placed in the "on" position and the word "off is displayed when the button is placed in the" off "position. In other embodiments, the status indicator may be a symbol, color, light, or movement indicator.

The activation element of the handle of the rigidifying apparatus described in the present invention may be a button, switch, toggle switch, slider, threaded joint, squeeze handle or tap. Furthermore, the activation elements may be planar, fan-shaped, or omni-directional. The indicator element may comprise text, a light or an element that rotates with the flow of vacuum or pressure. For example, referring to fig. 50A-50B, in some embodiments, the activation element 1548 may be a slider element. Activation element 1548 may include a connecting element 1574z (e.g., a hollow tube or snap element) configured to slide over the handle. The indicator element 1567z may be built into the slider (e.g., indicating "rigid" when the slider is in one position and "flexible" when the slider is in another position). A similar slider activation element 1648 (this is orthogonal) can be seen in fig. 51A-51C.

In some embodiments, one or both of the activation element and the indicator element may be disposed on a separate element rather than on the handle. For example, the activation element may be located along a vacuum or pressure line between the handle and a vacuum or pressure pump, may be actuated by a foot pedal, may be on the scope tube, on the scope shaft, or may be clipped onto the patient's bed. In some embodiments, the actuating member may be separate from the handle, but may be clipped to the handle during part of the procedure. For example, fig. 52A-52C illustrate an activation element 1448 that includes a connection mechanism 1452 (e.g., a C-clip) for removable connection to the handle 1431. Separating the indicator element and/or the activation element from the handle may advantageously allow the actuator and the indicator to be seen more clearly (i.e., unobstructed by the anatomy of the person) and/or may allow the actuator and the indicator to be more easily controlled/used by another person (e.g., a surgical assistant).

Fig. 53A-53D illustrate a handle 1131 that is designed to allow manipulation of the rigidizing apparatus, but which does not include an activation element or an indicator element. The handle 1131 includes a large stop or flange 1161 at its distal end, which large stop or flange 1161 can serve as an insertion stop for the handle 1131 (i.e., to prevent the handle 1131 from moving into the anatomy) and as a surface against which the operator can push during use. The rigidizing means may be attached at a bonding region 1153. In addition, the handle 1131 may include an input 1165 from the remote activation element that is connected to an output 1173z of the rigidizing device.

In some embodiments, a handle for use with a vacuum rigidizer may include a vent port to vent the rigidizer when no vacuum is supplied (i.e., when the rigidizer is in a flexible configuration). For example, fig. 54A-54B illustrate a handle 1231 having a slide valve activation element 1248 that reciprocates in one direction to activate vacuum in the rigidizer, and can reciprocate in the opposite direction to deactivate vacuum or pressure. When the vacuum or pressure of the rigidizer is deactivated, the activation element 1248 may be vented through the vent port 1251. The activation element 1248 may be positioned on a vacuum or pressure line 1232 leading to the handle, e.g., 4-8 inches, such as 6 inches, away from the handle. As shown in fig. 54A, a spool valve with an end button indicator element 1267z can indicate that the rigidizing device is in a flexible configuration (as shown) or a rigid configuration (when pushed in the opposite direction).

Referring to fig. 55A-55C, the activation member 1348 can be a rotary valve (e.g., attached to a handle or elsewhere as described herein), and a sliding indicator 1367z on the rotary valve activation member 1348 can indicate that vacuum or pressure is on (as shown in fig. 55A and 55C) or off and vented (as shown in fig. 55B).

In some embodiments, a handle for use with a vacuum rigidizer may include a mechanism configured to automatically lock the handle in a vacuum or vent configuration. For example, fig. 56A-56G illustrate a handle 7531 for use with a vacuum rigidizer 7500. The handle 7531 includes a handle body 7515z configured to be attached to a rigidizer 7500. The handle 7531 also includes an activation member 7548 in the form of a switch ring for providing a vacuum to the rigidizer 7500. The switch ring activation element 7548 can include a magnet 7522z configured to mate with either the proximal magnet 7523z (as shown in fig. 56D) or the distal magnet 7524z (as shown in fig. 56E). When the switch ring magnet 7522z is mated with the proximal magnet 7523z, the vacuum feed line 7532 in the handle 7531 is disconnected from the vacuum port 7550 of the rigidizer, and both the rigidizer and the vacuum are vented or opened to atmosphere (as shown in fig. 56F). When the switch ring magnet 7522z is mated with the distal magnet 7523z, the vacuum feed line 7532 in the handle 7531 is connected to the vacuum port 7550 of the rigidizer so that a vacuum is provided thereto (as shown in fig. 56G). Advantageously, the magnets 7522z, 7523z, 7524z can lock the switch ring 7548 in the vacuum or vent configuration, thereby preventing injury to the patient that may result in an unintended configuration (e.g., attempting to move the device through the anatomy while in a rigid configuration, the device 7500 may damage the anatomy). In some embodiments, the magnets 7522z can be ferrous materials and the magnets 7523z, 7524z can be magnets, or vice versa. As shown in fig. 56A-56B, the handle 7531 can also include a user grip 7521z for a user's hand grip, with a grip cover 7525z configured to cover the vacuum feed line 7532 in the handle 7531. Furthermore, the vacuum feed line 7532 may be directly connected to the switch ring activation element 7548. The vacuum feed line 7532 can have a helical or coiled shape below the handle cover 7525, which can allow the switch ring activation member 7548 to move proximally and distally without being restricted in its movement by the vacuum feed line 7532. The helix of the vacuum feed line 7532 may be from 30 degrees to about 1440 degrees. For example, 90 degrees (as shown in fig. 56C, with the handle cover removed for clarity) 180 degrees, 360 degrees, and 720 degrees. The handle cover 7525z can be designed such that it covers the entire vacuum feed line 7532, even when the helix completely surrounds the handle 7531. The handle 7531 can also include a stop flange 7561 to prevent the handle 7531 from moving into the anatomy (e.g., the stop flange can prevent the device from passing through the anus or through the oral bite guard); a proximal handle port 7526z for insertion of a scope or other working tool therethrough; and/or indicator elements 7567 z. The indicator element 7567z is a band that is only visible when the switch ring activation element 7548 is in the distal position. The indicator element 7567z may have a different color and/or lightness value than the rest of the handle, preferably a color that contrasts sharply and is also visible with a reduction in lightness. For example, the handle 7531 can be white and the indicator elements 7567z can be medium to dark blue. The indicator element 7567z strip can also have a different texture than the rest of the handle 7531. For example, it may have raised bumps or cross-hatching. This allows the doctor to easily feel the state of the handle 7531.

In some embodiments, a handle for use with a pressure rigidizer may include a pressure gap inlet and a vent gap inlet. 57A-57C illustrate an exemplary handle 6231 attached to a pressure rigidizing device 6200. The handle includes a gap entrance 6293 and a vent gap entrance 6223. Pressure gap inlet 6293 is connected to pressure gap 6212 (via pressure line 6294). A vent gap entrance 6223 (which may extend all the way through the handle to exit on both sides thereof) is attached to the gap 6206 around the braided layer 2209 (between the bladder 6221 and the outermost layer 6201). The vent inlet 6223 may be open to the atmosphere, while the gap inlet 6293 may be connected to a pressure source (e.g., activated with an activation element). Handle 6231 may be used, for example, to operate device 2200G depicted in fig. 16G. In some embodiments, a fitting can be added to gap entrance 6293 such that handle 6231 can be used to operate device 2200I, as described with reference to fig. 16I.

In some embodiments, a handle for use with a pressure rigidizer may include a pre-filled pressure medium therein. For example, an exemplary handle 7431 is shown in fig. 58A-58E connected to a pressure rigidizer 7400. The handle 7431 includes a handle body 7415z and a grip/lever 7411z, the grip/lever 7411z being activatable to provide a pressure medium to the rigidifying device 7400, for example a pressure medium pre-filled or stored in a fluid chamber 7412z of the handle 7431. Fluid chamber 7412z may be bounded by, for example, rolling diaphragm 7416 z. The handle/stick 7411z may include teeth 7476z that cooperate with a rack 7414z of the piston 7413 z. As the grip/joystick 7411z moves toward the handle body 7415z, the piston 7413z may move distally toward the rolling diaphragm 7416z of the fluid chamber 7412 z. As the rolling diaphragm 7416z is pushed distally, it forces pressure media from the chamber 7412z through the gap entrance 7493 to the pressure gap 7412 outside of the bladder 7421 for stiffening (and air or other fluid may likewise escape from around the braid 7409 via the vent 7423). In some embodiments, the handle 7431 may include a locking mechanism (e.g., by a click on/click off mechanism, such as that in a ballpoint pen) having a spring 7477z and a probe (feeler)7778z configured to lock the handle/lever 7411z on the body 7415z, thereby locking the rigidifying device 7400 in a rigid configuration. Similarly, when the handle/stick 7411z is again pushed toward the body, the handle/stick 7411 may be released and fluid may be moved back into the fluid chamber 7412z via the inlet 7493.

In some embodiments, the handle 7431 may further include a pressure relief valve 7417z located between the chamber 7412z and the overflow chamber 7418 z. When the pressure in the fluid chamber 7412z reaches a preset maximum pressure (e.g., 5 atmospheres), the pressure relief valve 7417z may open to allow fluid to be introduced into the overflow chamber 7418 z. The fluid chamber 7412z may be overfilled during manufacture so that the valve 7417 is always open upon initial activation of the knob/lever 7411z, which may ensure that the handle 7431 is calibrated to a desired pressure. One exemplary method of filling fluid chamber 7412z may include (1) connecting handle 7431 to a fill fitting connected to a tube leading to a pressure system; (2) drawing a vacuum on the handle to remove air through the fill fitting; (3) introducing water, deionized water (DI), saline, oil, or other incompressible fluid into the system through a fill fitting while maintaining the vacuum; and (4) crimping and sealing the tube distal to the pressure fitting (by mechanical crimping, or melting the tube, etc.), and then removing the pressure fitting, leaving the crimped/sealed tube in the handle.

Any handle described in the present invention may incorporate a pressure indicating feature. For example, the handle may have a pressure gauge. The handle may include a feature, such as a piston, that may be displaced to give a visual indication that the device is pressurized. The handle may have a flip or swivel feature to display different colors; for example, it may display green dots at atmospheric pressure, and red dots when rigidized. In some embodiments, the visual indication may be seen in a fluoroscopy.

Any of the pressure rigidized handles described above may have an emergency vent feature if the handle passageway is blocked for some reason. The emergency venting feature may allow, for example, cutting of the device, thereby destroying its pressure chamber. For example, the emergency vent feature may be a valve (e.g., a swabable valve) distal to the handle, such that if the valve is actuated, the device will vent pressure and thus de-rigidify.

Any of the rigidizing means described herein may include built-in cameras, lighting, etc. to provide onboard imaging. In some embodiments (as shown in fig. 63 below), the camera and illumination may be located at the distal tip of the device. In other embodiments, as shown in fig. 59, a rigidizing device 8200 can include a linkage camera 8234z and a lighting device 8235z mounted on the elongate body 8203z proximal to the distal end 8202z of the device (e.g., proximal to the steering linkage 8204 z).

In some embodiments, the rigidizing device of the present invention may be configured as an introducer (i.e., an instrument for introducing a flexible device, such as an introducer sheath for interventional cardiology). For example, referring to fig. 60, a rigidizing device 8700 can include a rigidizing elongate body 8703 having a tapered distal tip 8733 z. The device 8700 can further include a hemostasis valve 8749z and/or a flush line 8748 z.

The woven fabric of the present invention may comprise or be replaced by a mesh, woven material, tape or cloth. In some embodiments, the braid may be non-woven (i.e., the different angled fibers may not be above or below each other, but rather on separate layers that do not cross each other). Similarly, the braid may be replaced by a stent or a structure (e.g., a metal structure) cut from a hypodermic tube.

In some embodiments, the stiffening device of the present invention may be configured to be loaded onto the side of a scope or other instrument (e.g., rather than requiring the scope/instrument to be inserted into the proximal end of the stiffening device). For example, as shown in fig. 61A-61B, the rigidizing device 400 may be split along its length (i.e., longitudinally through the wall from proximal to distal). Further, the connection features 444 may connect the partition walls together. In some embodiments, the connection feature 444 may be reusable. For example, the connection feature 444 may be a series of magnets that may be engaged (fig. 61A) to hold the rigidizer 400 together and disengaged (fig. 61B) to provide a side channel for the scope/instrument. Other exemplary reusable connection features include zippers, interlocking zipper male and female structures, or reusable straps. In some embodiments, the attachment feature 444 may be permanent and non-reusable, such as a permanent tape or adhesive.

In some embodiments, the vacuum and pressure multilayer systems described herein can be used to provide stiffness to non-cylindrical or non-tubular structures. For example, the system of the present invention may be used to manufacture balloons that assume a desired shape when pressurized and/or rigidized. Such a structure may be a flexible structure, however simultaneously comprising elements exhibiting a high hoop stiffness, such as filaments (tensile or compressive) or thin fiber strands (tensile).

In some embodiments, the stiffening means of the present invention may include proximal and distal seals within the innermost layer to create a space between the scope or instrument and the innermost layer to maintain lubrication.

In some embodiments, the rigidizer described herein may be used in conjunction with other versions of a product. For example, the endoscope may include the stiffening mechanism described herein, and the stiffening device may include the stiffening mechanism described herein. They can be used together to create a nested system that can be advanced one after the other so that there is always one element that remains rigid, thereby reducing or eliminating loops (i.e., they can create a nested system that advances in sequence).

An exemplary nesting system 2300z is shown in fig. 62. The system 2300z can include an outer stiffening device 2300 and an inner stiffening device 2310 (here, configured as a stiffening mirror) that are capable of concentric or non-concentric axial movement relative to each other. The outer stiffening device 2300 and the inner stiffening device 2310 may include any of the stiffening features described herein. For example, the outer rigidizing device 2300 may include an outermost layer 2301a, a braided layer 2309a, and an inner layer 2315a, the inner layer 2315a including a coil wound thereon. The outer stiffening device 2300 may be configured to, for example, receive a vacuum between the outermost layer 2301a and the inner layer 2315a to provide stiffening. Similarly, the endoscope 2310 can include an outer layer 2301b (e.g., wrapped with a coil), a braid 2309b, a balloon layer 2321b, and an inner layer 2315b (e.g., wrapped with a coil). For example, the endoscope 2310 can be configured to receive pressure between the balloon 2321b and the inner layer 2315b to provide stiffening. In addition, the air/water channel 2336z and working channel 2355 can extend through the inner rigidizer 2310. Additionally, inner rigidizing mirror 2310 may include a distal portion 2302z with a camera 2334z, a lighting 2335z, and a steerable linkage 2304 z. Cap 2327z may extend over distal end portion 2302 z. In another embodiment, the camera and/or the lighting device may be delivered in separate assemblies (e.g., the camera and the lighting device may be bundled together in a catheter and delivered to the distal-most 2333z along working channel 2355 and/or additional working channels).

An interface 2337z may be provided between the inner stiffening apparatus 2310 and the outer stiffening apparatus 2300. Interface 2337z can be a gap, e.g., having a dimension d (see fig. 62) of 0.001-0.050 inches, such as 0.0020 inches, 0.005 inches, or 0.020 inches thick. In some embodiments, interface 2337z can be low friction and have, for example, a powder, coating, or lamination to reduce friction. In some embodiments, there may be a seal between the inner rigidizer 2310 and the outer rigidizer 2300, and the intervening space may be pressurized with, for example, fluid or water to create a hydrostatic bearing. In other embodiments, there may be a seal between the inner rigidizer 2310 and the outer rigidizer 2300, and the intervening space may be filled with pellets to reduce friction.

The inner rigidizer 2310 and the outer rigidizer 2300 are capable of moving relative to each other and alternately rigidizing so as to impart a bend or shape along the length of the nesting system 2300 z. For example, an inner device 2310 may be inserted into a cavity and bent or turned into a desired shape. Pressure may be applied to the inner rigidizer 2310 to engage the knit elements and lock the inner rigidizer 2310 in this configuration. The stiffening device 2300 (e.g., in a flexible state) may then be advanced over the inner device 2310. When the outer stiffening device 2300 reaches the tip of the inner device 2310, a vacuum may be applied to the stiffening device 2300 to engage and lock the layers, thereby fixing the shape of the stiffening device. The inner device 2310 may transition to a flexible state, advance, and repeat the process. Although the system 2300z is described as including a rigidizing device and an internal device configured as a mirror, it should be understood that other configurations are possible. For example, the system may include two outer sleeves, two catheters, or a combination of an outer sleeve, a catheter, and a scope.

Fig. 63 shows another exemplary nesting system 2700 z. The system 2700z is similar to the system 2300z except that it includes a cap 2738z connected to the inner and outer rigidizing devices 2710, 2700. Cover 2738z may be, for example, low durometer and thin walled to ensure elasticity and stretch. Cover 2738z may be rubber, such as polyurethane, latex, or silicone. The cover 2728z can protect the interface/radial gap 2337z between the inner and outer devices 2710, 2700. Cover 2738z can prevent contaminants from entering the space between the inner and outer tubes. Cap 2738z can further prevent tissue and other materials from being trapped in the space between the inner and outer tubes. Cover 2738z may stretch to allow inner device 2710 and outer device 2700 to travel independently of each other within the elastic limits of the material. Cover 2738z can be bonded or attached to rigidizer 2710, 2700 in such a way that it is always at a minimum of slight stretching. This embodiment can be wiped from the outside for cleaning. In some embodiments, the cover 2738z may be configured as a "rolling" seal, such as disclosed in US6447491, the entire disclosure of which is incorporated herein by reference.

Fig. 64A-64B illustrate another exemplary nesting system 9400 z. In this system 9400z, the outer stiffening device 9400 includes steering and imaging (e.g., similar to a mirror), while the inner device includes only stiffening (although it may include additional steering elements as described elsewhere herein). Thus, the external device 9400 includes a linkage or other steering device 9404z, a camera 9434z, and a lighting device 9435z as disclosed herein. The outer device 9400 may further include a central passage 9439 (e.g., a lumen such as a working channel therein) for accessing the inner device 9410. In some embodiments, a bellows or tubing loop may connect the channel 9439z to the lumen of the inner device 9410. Similar to other nested systems, at least one of the devices 9410, 9400 can be rigidized at a time while the other can conform to the rigidization and/or move through the anatomy. Here, the outer device 9400 may guide an inner device 9410 (inner device 9410 is shown retracted relative to outer device 9400 in fig. 64A, and extends generally flush with outer device 9400 in fig. 64B). Advantageously, the system 9400z can provide a smooth outer surface to avoid pinching of anatomical structures and/or fluid access between the inner and outer devices 9410, 9400. Providing a turn on the outer device 9400 can also provide additional leverage for turning the tip. In addition, the external device 9400 can contribute to better imaging capabilities due to its larger diameter and ability to accommodate larger cameras.

Fig. 65A-65H illustrate an exemplary use of nesting system 2400z in accordance with the present invention. In fig. 65A, the inner stiffening device 2410 is positioned within the outer stiffening device 2400, and the distal end of the inner stiffening device 2410 extends outside of the outer stiffening device 2400. In fig. 65B, the distal end of the inner rigidizer 2410 is bent in the desired direction/orientation and then rigidized (e.g., using vacuum or pressure as described herein). In fig. 65C, the outer stiffening device 2400 (in a flexible configuration) is advanced over the stiffened inner stiffening device 2410 (including over the curved distal portion). Once the distal end of the outer stiffening device 2400 is sufficiently advanced over the distal end of the inner stiffening device 2410, the outer stiffening device 2400 may then be stiffened (e.g., using a vacuum or pressure as described herein). In fig. 65D, the inner rigidizer 2410 can then be converted to a flexible state (e.g., by removing vacuum or pressure as described herein, and by letting the steering cables slack so that the tip can be easily moved), and can be advanced and pointed/oriented/steered as desired. Alternatively, in fig. 65D, the inner stiffening device 2410 may be actively steered (manually or through computational control) as it is exposed, such that the load on the stiffening outer tube is minimized. Minimizing the load on the outer stiffening device 2400 makes it easier for the tube to maintain a stiffened shape. Once the inner stiffening device 2410 is stiffened, the outer stiffening device 2400 may be transitioned to a flexible state and advanced thereover (as shown in fig. 65E). The process may then be repeated as shown in FIGS. 65F-H.

In some embodiments, upon completion of the sequence shown in fig. 65A-H, the third stiffening device may be slid over the first two stiffening devices (2400, 2410) and stiffened. The rigidizers 2400 and 2410 may then be withdrawn. Finally, a fourth stiffening means may be inserted through the lumen of the third tube. The fourth stiffening means may have a larger diameter and more features than the stiffening means 2410. For example, it may have a larger working channel, more working channels, a better camera, or a combination of the above. This technique allows two smaller tubes (which tend to be more flexible and steerable) to be advanced into the body while still allowing the larger tube to be ultimately delivered for therapeutic purposes. Alternatively, in the above example, the fourth rigidizing device may be a conventional endoscope known in the art.

In some embodiments, upon completion of the sequence shown in fig. 65A-H, the outer rigidizer 2400 may be rigidized, after which the inner rigidizer 2410 may be removed. For example, the rigidizing device 2410 may be a "navigation" device that includes a camera, lighting, and a distal steering section. The "navigation" device 2410 may be well sealed so that it is easily cleaned between procedures. A second internal device may then be placed within rigidized external device 2400 and advanced beyond the distal end of external device 2400. The second internal device may be a "treatment" tube, including elements such as a camera, lighting, water, suction, and various tools. The "treatment" device may not have the ability to steer or rigidize, thereby providing additional space in the body of the treatment tube for including other features, such as tools for performing the treatment. Once in place, the tool on the "treatment" tube can be used to perform a treatment in vivo, such as a mucoresection or dissection in the human gastrointestinal tract.

In another embodiment, a third device may be inserted inside the inner tube 2410 after or during completion of the sequence shown in fig. 65A-H. The third device may be rigidized and/or endoscopic.

While the outer rigidizing device of the nested system of the present invention is generally considered to be rigidized by vacuum and the inner rigidizing device is considered to be rigidized by pressure, the situation may be reversed (i.e., the outer rigidizing device may be rigidized by pressure and the inner rigidizing device may be rigidized by vacuum) and/or both may have the same source of rigidization (pressure and/or vacuum).

Although the inner and outer elements of the nested system are generally described as including integrated rigidizing elements, the rigidizing elements may be separate (e.g., to allow relative sliding between the imaging mirror element and the rigidizing elements).

The rigidizers of the nested systems described herein may be designed such that when they are assembled, the inner rigidizer is substantially unable to rotate within the outer rigidizer. For example, the outer surface of the inner rigidizer may have longitudinal ridges and grooves that form keys. The inner surface of the outer rigidizer may have corresponding ridges and grooves that match the same features in the outer and inner rigidizers.

One or both of the rigidizers of the nesting system described herein may be steerable. If both rigidizers are steerable, an algorithm may be implemented to steer either flexible and longitudinally moving rigidizer. The algorithm may steer the flexible rigidizer to its intended shape, thereby minimizing the tendency of the moving flexible rigidizer to straighten the rigidizer.

If one rigidizer of the nested system described herein requires vacuum and another rigidizer requires pressure, a user control can be constructed in which movement of one relative to the other (outer or inner) involves toggling a switch that switches between a first state, in which, for example, one is pressurized for rigidization and the other is vented for flexibility, and a second state, in which one is vented for flexibility and the other is evacuated for rigidization. The switch may be, for example, a foot pedal or a manual switch.

In some embodiments, the alternating movement of the nested system described herein can be controlled manually. In other embodiments, the alternating motion may be automatically controlled by a computer and/or an electric motion control system.

The nesting system described herein may advantageously have similar stiffness. This ensures that the overall stiffness of the nested system is relatively continuous. The nesting system described herein can be small to fit a variety of different anatomical structures. For example, for neurological applications, the outer diameter of the system may be between 0.05-0.15 inches, such as about 0.1 inches. For cardiology applications, the outer diameter of the system can be between 0.1-0.3 inches, such as about 0.2 inches. For gastrointestinal applications, the outer diameter of the system may be between 0.3-1.0 inches, such as 0.8 inches. Furthermore, the nesting system of the present invention maintains high stiffness even in small profiles. For example, the change in relative stiffness from a flexible configuration to a rigid configuration may be 10 times, 20 times, 30 times or even more. In addition, the nesting systems described herein may advantageously move smoothly relative to one another.

The nesting system described herein can advantageously navigate arbitrary paths, or open, complex, or tortuous spaces, and create a series of independent complex shapes. The nested system may further advantageously provide shape propagation such that shape memory may be transferred from one element to another. In some embodiments, the two tubes may be periodically placed in a partially or fully flexible state such that, for example, the radius or curvature of the system is increased and the surrounding anatomy provides support for the system. The pressure or vacuum used to rigidify the tube may be reduced or stopped to place the tube in a partially or fully flexible state. This momentary relaxation (e.g., 1-10 seconds) may allow the system to find a shape that more closely matches the anatomy through which it passes. For example, in the colon, this relaxation may gently open sharp turns in the anatomy.

In some embodiments, the stiffness capability of the inner or outer rigidizing devices may be designed such that the sharp turn formed by the inner rigidizing device at its tip gradually opens (is configured to have a larger radius) when replicated by the outer rigidizing device as the shape propagates proximally along the outer tube. For example, the outer rigidizer may be designed to have a larger minimum radius of curvature when rigidized.

Nested systems are continuous (i.e., non-segmented), thus providing smooth and continuous motion through the body (e.g., the bowel). The nesting system can be disposable and low cost.

In some embodiments, the outer rigidizer may be a dynamically rigidized outer sleeve (e.g., as described in PCT/US18/42946, which is incorporated herein by reference in its entirety). In some embodiments, the internal rigidizing device may be a rigidizing system or a commercially available scope, such as a 5 mm diameter rhinoscope. Utilizing a rigidizing and nesting system can allow the use of a smaller scope that can provide greater flexibility (if desired), greater rigidity (if desired), greater maneuverability, and the ability to articulate with a much smaller radius of curvature than a duodenoscope.

In some embodiments, once the target location is reached, the internal rigidizer of the nesting system may be retracted. The outer rigidizer may remain rigidized and may inject a contrast agent through the space of the inner element for fluoroscopic imaging.

The radio frequency coil may be used in any of the nested systems described herein to provide a three-dimensional representation of any shape presented by the nested system. The representation may be used to recreate a shape or return to a given point (e.g., for review by a physician after an automated colonoscopy).

In some embodiments, the nested system described herein can be used as a complete endoscope, with its internal structure carrying the working channel, pressurized lines, vacuum lines, tip washing, and payload for electronics for illumination and imaging (vision system, ultrasound, X-ray, magnetic resonance imaging).

The nesting system of the present invention can be used, for example, in colonoscopy. Such a colonoscope nesting system can reduce or eliminate loops. It may eliminate the need for endoscopic reduction. Without the loop, the procedure can combine the speed and low cost of sigmoidoscopy with the efficacy of colonoscopy. In addition, the colonoscope nesting system can eliminate conscious sedation and its associated cost, time, risk, and facility requirements. Furthermore, by using the nesting system of the present invention, the surgical skill for such colonoscopy procedures can be significantly reduced. Further, in some embodiments, the nesting system described herein may provide for automated colonoscopy, in which the vision system automatically drives the nesting system along the center of the colon while finding polyps. Such automated systems advantageously require neither sedation nor a physician to perform a basic examination, while allowing the physician to perform subsequent examinations if necessary.

In some embodiments, the rigidizing devices described herein may be configured as rigidizing rods. Referring to fig. 66, the stem 4900 may include an outer layer 4901, a braided layer 4909, and an inner balloon layer 4921. Further, the gap 4912 within the pocket may be sealed and filled with, for example, air or water (e.g., to push the pocket 4921 radially outward). The outer layer 4901 may be a wire reinforced layer, such as a coil reinforced polyurethane tube. Braided layer 4901 may include braided strands 4933, and may have any of the features of other braided layers described herein. The inner bladder layer 4921 may be made of a low durometer elastomer. Stem 4900 can also include a soft and/or tapered atraumatic tip.

In some embodiments, the distal end of inner bladder layer 4921 may be sealed to outer layer 4901, and stem 4900 may include an inlet located between outer layer 4901 and inner bladder layer 4921 to provide a vacuum for stiffening. In other embodiments, the distal end of inner balloon layer 4921 may be sealed to itself or to an atraumatic distal tip, and the proximal end may be configured with an entrance to the inside of inner balloon layer 4921 (i.e., radially inside of inner balloon layer 4921) to provide pressure stiffening. When pressure stiffening is used, the stem 4900 can further include vents on the distal and/or proximal ends to allow air to vent from between the inner bladder layer 4921 and the outer layer 4901 (thereby allowing the bladder 4921 to push the braid 4909 fully toward the outer layer 4901).

In some embodiments, the outer surface of the outer layer 4901 may be coated to provide a low friction surface including a hydrophilic coating. In some embodiments, the outer diameter of stem 4900 can be less than 5 millimeters, less than 4 millimeters, or less than 3 millimeters. For example, the outer diameter may be between 2mm and 5mm, such as between 2.5mm and 3mm, such as about 2.8 mm. In some embodiments, the angle of the braid of braid 4909 may be less than 25 degrees, such as about 5-15 degrees, relative to the longitudinal axis of the tube. In some embodiments, there may be 10 to 50 strands, for example 20-40 strands, extending therein within the woven layer 4909.

Referring to fig. 67, a rod 4900 may be used as a stiffening wire for colonoscopy, for example. In such use, the colonoscope 5091 may be inserted into the patient's colon. If a loop is created (thereby impeding advancement of the colonoscope), the scope 5091 may be left in place, the working channel 5055 of the scope 5091 may be flushed, water may be applied to the outer surface of the shaft 4900 to activate the hydrophilic coating, and the shaft 4900 may be inserted through the working channel 5055 in a flexible (i.e., non-stiffened) state. Once shaft 4900 is fully inserted into the endoscope such that the distal end of shaft 4900 is flush with the distal end of colonoscope 5091, vacuum or pressure may be applied to shaft 4900 (e.g., via pressure inlet and/or connector 5063z) to stiffen the shaft. In some embodiments, pressure or vacuum may be provided to the stem 4900 by a syringe or a locking insufflator. Colonoscope 5091 may be advanced relative to the patient on rod 4900 while keeping rod 4900 stationary relative to the patient. Vacuum or pressure may be removed to advance or remove rigidizing stem 4900.

Advantageously, the stem 4900 can thus be inserted into the scope 5091 in a flexible configuration for easy navigation at turns as compared to standard stiffening wires (i.e., as compared to a fixed rigid stiffening wire). Further, rod 4900 can conform to the shape of the circular colon in a flexible configuration while providing a rigid track for the scope to follow in a rigid configuration. The dynamic transition of stem 4900 between the flexible and rigid configurations may prevent undesirable straightening of mirror 5091 (which may occur in standard stiffening wires). In addition, the atraumatic tip of stem 4900 may prevent damage to working channel 5055. Rigidizing stem 4900 can also be relatively long (e.g., longer than the mirror) without interfering with the navigation of the mirror, because the mirror moves along rigidizing stem 4900 on rigidizing stem 4900, so stem 4900 can work with a variety of mirrors regardless of the length of the mirror. Similarly, shaft 4900 can have a diameter of 3.2 millimeters or less, and thus can work with a variety of endoscopes regardless of their diameter (as most endoscopes have working channels of 3.2 millimeters or more).

The rigidizing systems and devices of the present invention may be used to treat or approximate many different anatomical locations.

In one method of use, the rigidizing apparatus of the present invention may be introduced into a patient in a flexible configuration during a surgical procedure. Once the distal end of the stiffening device is positioned past the challenging anatomical structure (e.g., a portion of the anatomical structure would cause a loop or otherwise be difficult to pass using standard instruments), the stiffening device may be transformed into a rigid configuration. The instrument (e.g., scope) may then be passed over or through the rigid device.

For example, the device of the present invention may be used to navigate the gastrointestinal tract to an anatomical location in the stomach, for accessing an anatomical location through the abdomen that is otherwise occluded by other organs for interventional endoscopic procedures (including ESD (endoscopic mucosectomy) and EMR (endoscopic mucosectomy)), for direct cholangioscopy, for endoscopic retrograde cholangiopancreatography, for cardiology applications, for resecting or capturing lesions in the gastrointestinal tract, for enteroscopy, for EUS, for accessing the lung, for accessing the kidney, for neurology applications, for treatment of chronic total occlusions, for laparoscopic hand tools, for contralateral access, for otorhinolaryngology applications, for esophagogastric duodenoscopy, for transoral robotic surgery, for flexible robotic endoscopy, for natural orifice transluminal endoscopic procedures, or for altered anatomical conditions. Specific examples are described further below.

Further, the rigidizing means of the present invention may have different dimensions depending on the desired application. For example, when designed for use in, for example, the gastrointestinal tract, the rigidizing device may have an inner diameter of about 0.3-0.8 inches (e.g., 0.5 inches), an outer diameter of 0.4-1.0 inches (e.g., 0.6 inches), and a length of 50-200 centimeters, such as 75-150 centimeters. For example, when designed for use in a cardiovascular vessel, the rigidizing device may have an inner diameter of, for example, 0.04-0.3 inches (e.g., 0.2 inches), an outer diameter of 0.06-0.4 inches, and a length of 30-130 centimeters.

The rigidizing apparatus of the present invention can be used as an outer sleeve for a scope in at least three different ways (i) placing the outer sleeve after the scope has reached its destination; (II) the outer cannula follows the scope but remains proximal to the tip of the scope until the scope reaches the destination; or (III) a spot-beam method. Exemplary rigidizer 2000 and mirror 2091 are shown in fig. 68A-68B

For procedure I, mirror 2091 may be placed at a desired location within the body using standard techniques, and then stiffening device 2000 may be advanced proximally until stiffening device 2000 adequately supports mirror 2091. For example, to perform a resection in the colon, the physician may advance the colonoscope to the target site and then advance the stiffening device almost or completely to the tip of the endoscope. Rigidizer 2000 may then be rigidized. For example, by providing a stable surgical platform, rigidizer 2000 may advantageously enhance control during a colectomy. The rigidizer 2000 may also advantageously facilitate a good connection between the movement of the physician's hand outside the patient's body to the shaft of the mirror 2091 and to the movement of the tip of the mirror 2091 (so-called "1 to 1" movement).

For method ii, the mirror 2091 may be guided to the rigidizer 2000 (e.g., the distal end of mirror 2091 and the distal end of rigidizer 2000 may never be approximately aligned) while the rigidizer repeatedly switches between flexible and rigid states to facilitate mirror advancement. For example, the stiffening device 2000 may be rigid when advancing the mirror 2091, thereby helping to prevent mirror looping and facilitating the transfer of mirror force. Once the scope 2091 has been advanced, the stiffening device may again become flexible and advanced distally over the scope. This process may be repeated.

Method III can include the steps of (1) rigidizing device 2000 can be in a flexible state with its distal end generally aligned with the distal end of mirror 2091; (2) mirror 2091 may be steered with the distal end of rigidizer 2000 positioned over the mirror, and thus steered by mirror 2091; (3) rigidizer 2000 may be placed in a rigid state reflecting the steered position of mirror 2091; (4) the distal end of the scope 2091 may be advanced. Such spot firing may advantageously advance the scope 2091 in the direction in which its tip is pointed. In some embodiments, these steps may be repeated to advance rigidizer 2000 and mirror 2091 within a body cavity or lumens.

It should be understood that methods I-III can be used in combination with each other. Further, in some embodiments, the rigidizer may be steerable to further provide orientation to the mirror.

Three different control regimes are available for the digestive tract. For example, as shown in fig. 69A, these techniques can allow an endoscope 2691a to be positioned in the upper alimentary tract 2646z using the rigidizing device 2600 a. As another example, as shown in fig. 69B, the rigidizer 2600B can be used to position an endoscope 2691B in the lower alimentary tract 2647 z. The described control scheme may make the positioning shown in fig. 69A and 69B easier and faster to achieve, while minimizing the risk of complications, such as gastrointestinal perforation, and reducing or eliminating patient discomfort to the endoscopic circuit.

The rigidizing devices and systems of the present invention may be used for Endoscopic Retrograde Cholangiopancreatography (ERCP) and/or Direct Cholangioscopy (DC). Endoscopic retrograde cholangiopancreatography is aimed at diagnosing and treating biliary and pancreatic duct diseases. The most common method is examination with a side-looking duodenoscope, by navigating a guide wire into the bile and pancreatic ducts, injecting contrast into these ducts, viewing under fluoroscopy, and passing various tools through these ducts over the guide wire. It is desirable to visualize the tract directly using the camera rather than using radiation and contrast agent injections. By placing a small endoscope into the bile duct, one can directly view the duct without radiation. However, it is difficult to guide such a small endoscope through the stomach and into the bile duct because the endoscope can form a loop.

Bile or pancreatic duct intubation is difficult for two reasons. First, the endoscope must be small in order to fit into a small duct, which means that it is very flexible and therefore can twist in the stomach when trying to exit the stomach. Secondly, the duct entrance (mastoid) is on the side of the duodenal wall, which means that the endoscope must bend and advance at an angle relative to the long axis of the endoscope, which is not possible without deflecting the surfaces against. The rigidizing devices described herein may be used to provide a more optimal path and stability during ERCP and DC, including the kinematically and clinically challenging mastoid intubation task. For example, the device of the present invention can be used to reach the papilla (typically with a duodenoscope) and to cannulate the bile duct and pancreatic tree.

Referring to fig. 70A-72D, the rigidizing apparatus of the present invention may be used in a variety of ways for direct visualization of ERCP and pancreas/bile duct (cholangioscopy). For example, as shown in fig. 70A-70B, a rigidizing device 8300 having a steerable distal end 8302z (which may be similar to the rigidizing device of fig. 25) may be used on the cholangioscope 8391. The cholangioscope 8391 may be a flexible endoscope with a camera, illumination device, and optionally a tool channel designed to have the bend radius and diameter required to enter the bile duct. The radius of curvature of the cholangioscope 8391 may be 0.5 inches, with a distal end and insertion tube diameter of 2-6 mm. The cholangioscope 8391 may be placed inside the rigidizing device 8300, and the rigidizing device 8300 may begin in a flexible state. The two devices 8300, 8391 may be navigated together through the upper gastrointestinal tract to the duodenum 8354 (or the cholangioscope 8391 may be advanced before the rigidizing device 8300 with the rigidizing device 8300 following when the operator deems it necessary). Once in the duodenum 8354z, the rigidizing device 8300 may be rigidized and steered to tilt the cholangioscope 8391 towards the entrance of the tract (papilla 8355 z). The steering of the rigidizer 8300 may be locked in place and the cholangioscope 8391 may be advanced toward the mastoid 8355. A guide wire 8385 may be pushed through the cholangioscope 8391 and aimed at the entrance of the mastoid 8355z, and pushed through the bile duct 8357z or the pancreatic duct 8356z (which is positioned in the bile duct 8355z as shown in fig. 70A). As shown in fig. 70B, a cholangioscope 8391 may be advanced over a guidewire 8385 into the bile duct 8357 to enable direct cannulation. In this method, the rigidizing device 8300 may advantageously support the small choledochoscope 8391 to prevent it from twisting in the stomach, and the deflecting portion 8302z of the rigidizing device 8300 may advantageously deflect and direct the choledochoscope 8391 toward the papilla. Thus, direct visualization may be achieved, reducing the amount of radiation required during ERCP.

Another exemplary ERCP method is shown in FIGS. 71A-71B. In this embodiment, a rigidizer 8400 without a steerable distal end may be used. The cholangioscope 8491 may be used to steer the rigidizer 8400 when the rigidizer 8400 is in a flexible configuration to direct the rigidizer 8400 toward the mastoid 8455 z. Once pointed in the correct direction, the rigidizer 8400 can be rigidized. The cholangioscope 8491 may then be advanced in the same manner as described above with reference to fig. 70A-70B. This method may be referred to as the "spot-fire" method of direct cholangioscopy.

Another exemplary ERCP method is shown in FIGS. 72A-72D. In this embodiment, the rigidizer 8500 includes at least two working channels therein (e.g., similar to the devices shown in FIGS. 20A-20B and 21A-21B). A cholangioscope 8591 is initially placed along the first tool channel for navigation and cannulation of the mastoid 8555 z. Once the guidewire 8585 has passed through the bile duct 8557z (as shown in fig. 72B) or the pancreatic duct (8556z), the cholangioscope 8591 may be removed from the first tool channel while the guidewire 8585 remains in place within the duct 8557z (as shown in fig. 72C). The cholangioscope 8591 may then be placed into the second tool channel (e.g., as shown in fig. 81, which may extend laterally beyond the wall of the device 8500) so that the duodenal-side papilla 8555z may be seen (as shown in fig. 72D). The first tool passage may be used to place a larger tool therethrough, such as a carriage 8558z to be placed in a conduit 8557 z. In some embodiments, it may be useful to have an external (duodenal) visualization function of the mastoid 8555z during stent placement since the stent 8558z occupies a majority of the diameter of the conduit 8557z, and a portion of the stent 8558z remains within the duodenum 8554 z.

In another exemplary ERCP method, a rigidizing device similar to the device shown in fig. 59 includes a single tool channel running the entire length of the device. The rigidizer includes a camera coupled to an outer side of the rigidizer just proximal of the steering section. Intubation, ERCP, and direct cholangioscopy may be performed similarly to the methods described above. The cholangioscope may be removed from the tool channel when using the stent or larger tool, and the exterior of the papilla may be viewed with the camera of the rigidizing device when using the larger instrument or stent.

In another exemplary ERCP method, as shown in fig. 46A-46B, the rigidizing device includes an aspiration tip at its distal end. The suction tip may surround the mastoid and suction may be applied to the tip. This procedure stabilizes the mastoid, making it easier to target the cholangioscope at the appropriate location to pass through the guide wire. The surrounding tissue holding the mastoid may also provide some back tension when the mastoid is pushed with a silk or a cholangioscope. Providing counter tension to the compressive force of the choledochoscope or other tool may reduce the number of sphincterotomies (mastotomies) required.

Advantageously, the rigidifying means for ERCP according to the present invention may be disposable and sterile, thereby reducing the risk of infection or cross-contamination between patients. Further, the method may reduce radiation and may be easily directed to the mastoid by steering function via the rigidizing means and/or the mirror.

The rigidizing devices and systems of the present invention may be used in cardiology and cardiac surgery, including aortic and mitral valves.

Typically, in transcatheter, percutaneous procedures, the clinician may affect movement of an access site (e.g., an artery or vein of the groin, arm, etc.) using some flexible rod or shaft that is sufficiently rigid to advance the catheter to the treatment site, but sufficiently flexible to conform to the anatomy. This means that all forces or leverage are generated at the distal access site and react in the more localized anatomy to (a) bend the flexible shaft or shaft to navigate to the surgical site; and (b) providing local forces (linear forces and torques) at the surgical site. In contrast, the dynamic rigidizer of the present invention effectively moves the access site to the treatment site by providing a method that both traverses tortuous anatomy to the treatment site and rigidizes and forms a stable port at the treatment site independent of anatomical reflexes.

One of the advantages of the rigidizing apparatus of the present invention is the ability to conform to surrounding anatomical structures, such as the vasculature. Devices such as guide catheters need to be somewhat rigid to advance through anatomical structures (e.g., vasculature) and perform desired functions. However, the stiff system can impede advancement of the device to the target anatomy, at least in part because of the highly tortuous path, forcing the anatomy to conform to the device, which can result in damage to surrounding tissue and blood vessels. In contrast, the rigidizing devices of the present invention may be sufficiently flexible to be able to move within a vessel, conforming to the vasculature rather than remodeling the vasculature. The inch creep allowed by the rigidizer or nesting system allows for this flexible forward motion. Once the device has been advanced to the target site, the rigidization allows the created path through the vasculature to be preserved and utilized. For example, the stiffening device of the present invention may have a stiffness that is 1/10 for a typical guide catheter in the flexible state and 5 times that of a typical guide catheter in the rigid state.

In some embodiments, the rigidizing devices of the present invention may be used in percutaneous procedures in the heart or vasculature. The rigidizing device is capable of both conforming to the anatomy of the heart and providing a local distal fulcrum for instrument manipulation. Currently, when percutaneous surgery is performed, mechanical fixation and stabilization occurs at the access site (e.g., femoral vein, radial artery, iliac vein, etc.). As described above, the fixation point creates a long moment arm that extends from the access site to the surgical site. In addition, as described in further detail below, the mechanical coupling created by typical hard catheter systems between the access site and the target anatomy relies on anatomical reflexes to guide the catheter tip and transfer forces to the tools used. When the stiff catheter system is bent to conform to the anatomy, it creates potential energy along the approach path. This energy may be released when the operator intentionally or unintentionally moves the patient at the access site. In contrast, the rigidizing device of the present invention conforms to the anatomical path prior to rigidization, thereby eliminating the stored energy associated with hard catheter systems. Once rigidized, mechanical fixation can be achieved independently of the anatomical reflexes, greatly reducing the moment arm and enhancing the surgeon's control of the surgical tool, resulting in more predictable results. In some embodiments, the rigidizer may include an integrated hemostasis valve, eliminating the need for a separate access sheath.

In some embodiments, the rigidizer described herein may be used to stiffen an introducer sheath in interventional cardiology or structural heart cases. For example, a rigidizer may be used to provide a "guide" for a Transcatheter Aortic Valve Replacement (TAVR) device, thereby preventing the tip of the TAVR catheter from scraping and scraping the top of the aortic arch, which is often burdened with thrombus (current systems tend to straddle the outside of the arch, rub against plaque, creating embolic debris). The rigidizer facilitates superior alignment and placement, reduced paravalvular leakage, and more optimal placement compared to a pacing node.

In some embodiments, the rigidizing devices of the present invention may be used as a delivery system that may circulate from the veins, through the right atrium and interatrial septum, through the mitral valve, into the left atrium, and antegrade into the left ventricular outflow tract and the aortic valve. This approach facilitates Transcatheter Aortic Valve Implantation (TAVI) and avoids contact with the aortic arch and the ascending aorta, which is usually retrograde in distribution

In some embodiments, the rigidizer apparatus described herein may be used to deliver a mitral valve replacement. That is, crossing the septal wall during mitral valve replacement can be particularly difficult due to the involvement of multiple blood vessels, the beating heart, and the need for precisely aligned access and stabilization prior to delivery of the implant. Current valve delivery platforms can be quite rigid, which can be dangerous for their straightened anatomy (e.g., femoral arteries, which can be highly calcified and fragile). The rigidizer described herein may advantageously create a flexible entry catheter that is then rigidized in the shape of any particular human anatomy, such that the rigidizer conforms to the entire anatomical path. Thus, the rigidizing device of the present invention may allow a clinician to create a stable mechanical lumen directly to the anatomy, position it without significant local anatomical loading, and then rigidly stabilize in that shape as the device is delivered therethrough.

Fig. 73A depicts an embodiment of a rigidizer 3700, the rigidizer 3700 being advanced through the right atrium RA of the heart to the left atrium. A guidewire or other piercing member and dilator may be used to pierce the septum 3704 to create a passage to the left atrium LA. The rigidizer 3700 can be advanced to a treatment site using the methods described herein. Cardiac tool 3787 (which may or may not be rigidized) may be advanced with it within rigidizer 3700. For example, the cardiac tool 3787 and rigidizer 3700 can be advanced as a nested system according to the present invention, such as that shown in fig. 65A-65H. The rigidized dynamic properties allow the device 3700 and tool 3787 to be advanced in tortuous anatomy. The rigidizer 3700 can be rigidized once at the treatment site to provide a stable foundation for treatment. Optionally, the stiffening device 3700 may include an anchoring balloon 3778 near its distal tip to anchor the stiffening device 3700 into the chamber of the heart, e.g., to the septum 3704 of the atrium, to retain the tip of the tube 3700 in the left atrium LA. The detail view of fig. 73B shows balloon 3778. Balloon 3778 may be located anywhere around the circumference of tube 3700. In some embodiments, the balloon is annular and surrounds the circumference of the tube 3700. The rigidizer 3700 may include an echogenic tip. Other tips that satisfy real-time visualization functions are also possible (e.g., X-ray shooting tips, mirrors in saline bags, etc.).

Figures 74A-74B illustrate an exemplary method of using a dynamic stiffening device in the treatment of small branch vessels, such as coronary arteries. When navigating to these smaller vessels, it is often the case that application of force in these areas causes a guide catheter or other advancing device to be pushed out of the area. Access sheaths are sometimes used in this case to provide some mechanical advantage. However, with such an access sheath, the entire device may still be pushed out of the area upon application of force, such as by pushing through the stopper. Figures 74A-74B compare the use of a standard guide catheter with the use of a rigidizing apparatus as described herein. In fig. 74A, a standard guide catheter 3886 is used to navigate to the ostia 3845 of one of the main coronary arteries 3842. A guidewire 3885 extends from the tip of the guide catheter 3886 and may be used to perform a procedure (e.g., place a stent). In some embodiments, the guide catheter 3886 may reflect the adjacent anatomical structure 3873 to achieve a mechanical advantage, prevent the catheter from being pushed back and/or provide a more localized force. In contrast, fig. 74B shows a rigidizer 3800 of the present invention advanced through a small hole 3845 and into a coronary artery 3842. Due to the rigidizing capabilities of device 3800, it does not require a reflex topography, but rather may provide inherent stability at the treatment site. Additionally, due to the dynamic stiffening ability of the stiffening device, it may be advanced through the ostia 3845 and into the coronary arteries 3842.

Fig. 75A illustrates an exemplary method of mitral valve repair using a dynamically rigidized outer cannula system. The method illustrates how the rigidizing device 3900 is positioned in the left atrium LA such that it remains independently axially aligned with the treatment site (the mitral valve in this example). As shown in fig. 75A, rigidizing device 3900 is advanced through the vasculature to the right atrium RA and then through the atrial septum into the left atrium LA. The end of the stiffening device may be turned such that the longitudinal axis 3983 extending through the end of tube 3969 is aligned with the desired treatment area (e.g., a portion of a valve). Steering, dynamic rigidization, and tip visualization capabilities may enable precise positioning of the rigidized device. For example, axis 3983 extends through mitral valve MV into left ventricle LV. Another location 3964 of the stiffening device 3900 is shown in phantom with its axis extending through the leaflets of the mitral valve MV. Current methods of mitral valve repair utilize a guide catheter to navigate to the left atrium LA and often fail to provide reliable axial alignment. The method of using the rigidizer 3900 to achieve axial alignment in a flexible state prior to rigidization disclosed in the present invention provides significant advantages over positioning methods currently used, such as in mitral valve repair procedures. Such precise alignment may also be beneficial in other areas of the anatomy (e.g., through other valves, at transseptal access sites, within a vessel lumen, etc.). ) Including the ability to place sutures, clips, and other devices within the heart with an accuracy comparable to that typically used for open heart surgery.

Referring to fig. 75B, a rigidizer 3900 used in a procedure such as that shown in fig. 75A may comprise a variety of configurations. In some embodiments, the rigidizing device 3900 may use a guidewire 3985 for steering and positioning. In some embodiments, rigidizer 3900 may comprise a nested system comprising an inner rigidizer 3910.

As shown in fig. 75C, in one embodiment, a needle-tip catheter 3958z may be advanced through the rigidizing device 3900 and positioned within the cardiac anatomy, for example, over the mitral valve leaflets. In some embodiments, the needle-tip catheter 3958z may include an anchoring device 3962z (gauze, stainless steel strips, etc.) attached to a length of suture 3959z, which anchoring device 3962z may be passed through tissue to form an anchoring structure for the suture. The suture and anchoring structure delivered by the rigidizer may be used to suture tissue structures together, such as for leaflet plications for mitral valve repair.

It should be understood that a system including one or more of the rigidizing devices of the present invention may be used in cardiac procedures other than mitral valve repair. For example, the system may be used for complex mitral valve procedures, where the goal may be to achieve leaflet repair and mitral valve annuloplasty during the same procedure. The system may be used to perform transseptal delivery of an aortic prosthesis (e.g., TAVI). In some embodiments, the system is used for aortic valve repair via a transseptal access. The combination of dynamically rigidized outer sleeves may be used simultaneously to deliver sutures or other instruments from one ventricle to another. In any of these procedures, the dynamic stiffening system of the present invention may advantageously provide a catheter or access sheath to provide universal access to the various chambers of the heart.

FIG. 76A shows an exemplary dual rigidized catheter system that may be placed in multiple chambers of the heart simultaneously. The two rigidized catheters 4000a, 4000b may be axially aligned and allow the clinician to transfer instruments from one catheter to the other. In use, first rigidizing catheter 4000a may be navigated to the left atrium LA through right atrium RA with tip 4004 of the catheter facing mitral valve 4081. Rigidizing catheter 4000a may be rigidized at this location. The conduit 4004a may include a curved portion near the tip 4004 to properly position the tip and turn the device. The second catheter 4000b may be navigated retrograde into the left ventricle LV through the aorta 4066 z. The catheter 4000b may be steered and positioned such that the tip 4039 is positioned below the mitral valve and facing the tip 4004 of the first catheter 4000 a. The catheter 4000b may be rigidized at this location. An axis 4014 extending between the tip 4004 of the first catheter and the tip 4039 of the second catheter may be aligned with the area to be treated. Such dual passages may allow, for example, for suture to pass from one catheter to another and/or for tools to pass therebetween. The use of two catheters also allows the procedure to be performed with greater precision and accuracy (e.g., the treatment site may be accessed from the top or bottom or both). Examples of procedures that can be performed with two such rigidized catheters 4000a, 4000b include leaflet folding using standard suturing techniques and annuloplasty using a conventional ring. Each catheter 4000a, 4000b may include multiple working channels and provide a fixed access site within the heart. The provision of these dual fixation points may allow standard open heart surgery to be replicated through a much less invasive pathway.

FIG. 76B shows the dual rigidized catheter system of FIG. 76A being used to pass sutures through tissue. The first rigidizer 4000a is positioned on a first side of the tissue 4061z to be stapled. The second rigidizing device 4000b is positioned on the opposite side of the tissue 4061 z. A needle catheter 4058z positioned by the first apparatus 4000a can be used in conjunction with a tool 4065z (e.g., grasper, snare, etc.) positioned by the second tube 4026 to pass a suture through tissue 4061 z.

Referring to fig. 77, in some embodiments, the rigidizing device of the present invention can be used as a trocar during endoscopic surgery. FIG 77 shows a dynamically rigidized trocar 4141 and a standard trocar 4138. In general, when a standard trocar 4138 is used, its initial placement may be incorrect, requiring removal and repositioning. In contrast, dynamically rigidizing the trocar 4141 may allow fine adjustments to be made during or after placement of the trocar. As described with respect to other dynamic rigidizing devices in the present disclosure, the dynamic rigidizing trocar 4141 has steering capabilities. With this capability, the trocar 4141 can be bent or deflected in a desired direction and then rigidized, thereby providing greater control than a standard trocar. The dynamically rigidizing trocar 4141 may be used for applications to the heart and/or other parts of the body. In addition, the trocar 4141 can be provided in different sizes or shapes depending on the application.

Referring to fig. 78, a dynamic stiffening device 4200 may be used for aortic bifurcation 4297. This region of the vasculature is often diseased requiring complex repair based on the extremely tortuous anatomy of the site. Currently, many catheters or other delivery devices used to treat the area are advanced up to the apex of the bifurcation and then the tool is deployed down from that point. As shown in fig. 78, the dynamic stiffening device 4200 may use a combination of steering and dynamic (e.g., periodic) stiffening to navigate around the bifurcation 4297 and be able to reach any treatment site in the region. For example, the system shown in fig. 78 can treat CTO (chronic total occlusion lesion) in one leg through a percutaneous passage in the other leg.

Referring to fig. 79, a rigidizing device 4700 having an actively deflecting segment 4746 and a steerable distal portion 4747 may be used with the heart for mitral valve repair. The stiffening device 4700 may be positioned in the left atrium LA such that it may independently remain axially aligned with the treatment site, in this case the mitral valve MV. The rigidizing device 4700 can thus be advanced through the vasculature to the right atrium RA, and through the atrial septum, and into the left atrium LA. The end of the stiffening device may be turned such that the longitudinal axis 4783 extending through the end 4769 of the tube is aligned with a desired treatment area (e.g., a portion of a mitral valve). To achieve the desired positioning, the actively deflected segment 4746 may be curved in a relatively unconstrained space between the IVC and the atrial septum, while the distal steerable portion 4747 may be positioned within the left atrium LA and steered or oriented toward the mitral valve MV. In such a position, the rigidizer 4700 can be bent at an angle of 90 degrees or more and have an arc radius of about 4-6 centimeters, such as 5 centimeters.

Referring to fig. 80, a rigidizing device 4800 (having an actively deflecting segment 4846 and a steerable distal portion 4847) for mitral valve repair can include a distal payload 4848 (e.g., a mitral valve clip, mitral valve replacement, or annuloplasty ring) attached thereto. Attaching distal payload 4848 to rigidizing device 4800 while still incorporating active deflecting segment 4846 and steerable distal portion 4847 can advantageously reduce or eliminate the need for an external large diameter guide catheter during such procedures. Catheter 4800 (or 4700) for mitral valve surgery may be, for example, 14-40Fr, with a length of 80-120 centimeters.

A method of using the rigidizing device 4700 or 4800 can include (1) introducing the device into a distal circulation; (2) advancing the device to a target anatomy (e.g., a heart valve); (3) first bending (e.g., negotiating (about 90 °) a bend between the IVC and the septum of the atrium) with the active deflection segment; (4) locking the active deflection segment in the bent configuration using pressure or vacuum; and (5) using the steerable distal portion to reach the mitral valve plane and mitral valve; and (6) delivering a therapy or payload.

The rigidizing device of the present invention having an actively deflecting portion and a steerable distal portion may also be used, for example, in the placement of a fenestrated graft for the thoracic artery or abdominal aneurysm repair procedures involving critical branch vessels requiring treatment.

The rigidizing devices and systems of the present invention may be used to resect or capture lesions in the gastrointestinal tract.

Referring to fig. 81A-81F, in some embodiments, the rigidizing device 700 may be configured to control the direction of a work tool 777 extending through the working channel 755. For example, the rigidizing device 700 may include a flexible distal end portion 702z that is highly flexible compared to a proximal rigidizing elongate body 703z (which may include rigidizing features as described herein) extending proximally thereof. Referring to FIG. 81A, an endoscope 791 having a scope turn-around portion 776 can be placed within a rigidizer 700 in a blood vessel 760 z. Referring to FIG. 81B, the rigidizing device 700 can be moved distally such that the flexible distal portion 702 is positioned over a turn-around portion 776 of the endoscope 791. As shown in fig. 81C, when the turn-around portion 776 is bent, the flexible distal portion 702z and the connected working channel 755 can bend therewith, thereby providing a turn for a tool 777 in the working channel 755 (e.g., toward a lesion 779 in the blood vessel 736). As shown in fig. 81D, the tool 777 may then be pushed out of the working channel 755 and advanced to a desired location (e.g., lesion 779). Referring to fig. 81E, rigidizing device 700 may then be pulled proximally to move flexible distal end portion 702 away from steerable portion 776, and also to further move working channel 755 proximally. As shown in fig. 81F, this allows the mirror 791 to be steered (using steerable portion 776) without disturbing the placement or orientation of the work tool 777.

The rigidizing devices and systems of the present invention may be used in enteroscopy to pass in almost all of the small intestine to diagnose and/or treat disease.

Enteroscopy is kinetically challenging for several reasons, including because scopes are relatively small in diameter (9 mm) and very long in length (2 m), which often form loops when passing through the gastrointestinal tract to reach the beginning or end of the small intestine (the pylorus or ileocecal valve, respectively).

The rigidizing apparatus and systems of the present invention may be used in IEUS.

The rigidizing devices and systems of the present invention may be used to access the lungs. For example, rigidizer 2100 and scope 2191 can be concentrically assembled (the scope inside the rigidizer), and then placed through the mouth along the trachea to the carina. As detailed in the present invention, a "spot" method can be employed at the carina to advance the scope into either the left or right main bronchus. The "spot-fire" method can be used iteratively to select other deeper branches in the lung.

The rigidizing devices and systems of the present invention may be used to access the kidneys. For example, the stiffening device 2100 and scope 2191 may be concentrically assembled (with the scope inside the stiffening device) and then placed into the bladder through the urethra. As detailed herein, a "spot" approach can be used in the bladder to advance a scope into the left or right ureter. The "spot" method can be reused to help the scope reach the kidney

The rigidizing apparatus and system of the present invention may be used for navigation through a neurological anatomy.

The system of the present invention may be used to access the carotid artery or a distal blood vessel leading to or into the brain.

For example, a guidewire may be placed into the carotid artery. A stiffening device or sheath may be placed over the guidewire and introduced into the carotid artery. When the outer cannula or sheath is placed at the target site, it can be rigidized to reduce the likelihood of the catheter or guidewire prolapsing into the aortic arch during the procedure.

The rigidizing devices and systems of the present invention may be used to approximate and/or treat CTO (chronic total occlusion).

Thus, in some embodiments, rigidizing devices may be incorporated into catheters for interventional cardiology, such that they are very easy to track (flexible), and then may be rigidized, for example, when the device is used to locally push through anatomy, such as when treating a CTO.

The rigidizing apparatus and system of the present invention may be used with laparoscopic hand tools.

The rigidizing apparatus and system of the present invention may be used for contralateral leg access.

The rigidizing devices and systems of the present invention may be used in ear, nose, and throat (ENT) applications.

The rigidizing devices and systems of the present invention may be used to perform treatments during esophageal, gastric, duodenal Examination (EGD), for example, on the top of the stomach.

The rigidizing devices and systems of the present invention may be used in TORS (transoral robotic surgery).

The rigidizing devices and systems of the present invention can be used for NOTES (natural orifice transluminal endoscopic surgery).

The rigidizing devices and systems of the present invention may be used for varying anatomical conditions, including Roux-en-Y.

It should be understood that any feature described herein with respect to one embodiment can be combined with or substituted for any feature described herein with respect to another embodiment. For example, various layers and/or features of the rigidizing apparatus described herein may be combined, substituted, and/or rearranged with respect to other layers.

Additional details concerning the invention, including materials and manufacturing techniques, may be set forth within the level of those skilled in the relevant art. To the extent that additional acts are employed, either generally or logically, the same applies to the method-based aspects of the invention. Furthermore, it is contemplated that any optional feature of the described inventive variations may be set forth and claimed independently, or in combination with any one or more of the features described in the present application. Also, reference to a singular item includes the possibility that there are plural of the same items present. More specifically, as used in this disclosure and the appended claims, the singular forms "a," "and," "said," and "the" include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. Thus, this statement is intended to serve as antecedent basis for use of such exclusive terminology as "solely," "only," and the like in connection with the recitation of claim elements or use of a "negative" limitation. Unless defined otherwise herein, 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. The breadth of the present invention is not to be limited by the present specification, but only by the general meaning of the terms of the claims used.

When a feature or element is described as being "on" another feature or element, it can be directly on the other feature or element or intervening features and/or elements may also be present. In contrast, when a feature or element is described as being "directly on" another feature or element, there are no intervening features or elements present. It will also be understood that when a feature or element is referred to as being "connected," "attached," or "coupled" to another feature or element, it can be directly connected, attached, or coupled to the other feature or element or intervening features or elements may be present. In contrast, when a feature or element is described as being "directly connected," "directly attached" or "directly coupled" to another feature or element, there are no intervening features or elements present. Although described or illustrated with respect to one embodiment, the features and elements so described or illustrated may be applicable to other embodiments. It will also be understood by those of ordinary skill in the art that a structure or feature described as being disposed "adjacent" another feature may have portions that overlap or underlie the adjacent feature.

The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. For example, as used herein, the singular forms "a", "an" and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms "comprises" and/or "comprising," when used in this specification, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. As used herein, the term "and/or" includes any and all combinations of one or more of the associated listed items and may be abbreviated as "/".

Spatially relative terms, such as "below," "lower," "beneath," "above," "upper," and the like, may be used herein for ease of description to describe one element or feature's relationship to another element or feature as illustrated in the figures. It will be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as being "below" or "beneath" another element or feature could also be oriented "above" the other element or feature. Thus, the exemplary term "below" can include both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, the terms "upward," "downward," "vertical," "horizontal," and the like are used herein for illustrative purposes only, unless specifically indicated otherwise.

Although the terms "first" and "second" may be used herein to describe various features/elements, these features/elements should not be limited by these terms unless the context indicates otherwise. These terms may be used to distinguish one feature/element from another feature/element. Thus, a first feature/element described below could be termed a second feature/element, and similarly, a second feature/element described below could be termed a first feature/element, without departing from the teachings of the present invention.

As used in the specification and claims of this application, including as used in the examples, unless otherwise expressly specified, all numbers may be read as if prefaced by the word "about" or "approximately", even if the term does not expressly appear. The phrases "about" or "approximately" may be used when describing magnitude and/or position to indicate that the described value and/or position is within a reasonably expected range of values and/or positions. For example, a numerical value can be +/-0.1% of the stated value (or range of values), +/-1% of the stated value (or range of values), or +/-2% of the stated value (or range of values), +/-5% of the stated value (or range of values), or +/-10% of the stated value (or range of values), and the like. Any numerical range recited herein is intended to include all sub-ranges subsumed therein.