Method of navigating a therapeutic instrument with an apparatus having a handle coupled to an overtube

Abstract

An endoscope with guiding apparatus is described herein. A steerable endoscope is described having an elongate body with a manually or selectively steerable distal portion, an automatically controlled portion, a flexible and passively manipulated proximal portion, and an externally controlled and manipulatable tracking rod or guide. The tracking rod or guide is positioned within a guide channel within the endoscope and slides relative to the endoscope. When the guide is in a flexible state, it can conform to a curve or path defined by the steerable distal portion and the automatically controlled portion. The guide can then be selectively rigidized to assume that curve or path. Once set, the endoscope can be advanced over the rigidized guide in a monorail or “piggy-back” fashion so that the flexible proximal portion follows the curve held by the guide until the endoscope reaches a next point of curvature within a body lumen.

1 - 34 . (canceled)  
     
     
         35 . A method for advancing a first diagnostic or therapeutic instrument having a steerable distal tip into an unsupported, hollow body organ, the method comprising: 
 providing an apparatus having a handle, an overtube coupled to the handle, the overtube comprising an elongated portion having a distal opening, a lumen extending therethrough to permit passage of the first diagnostic or therapeutic instrument, and a flexible distal region, and an atraumatic tip disposed on the flexible distal region;    inserting the first diagnostic or therapeutic instrument through the lumen so that the steerable distal tip is aligned with the flexible distal region; and    navigating the first diagnostic or therapeutic instrument together with the overtube through the unsupported, hollow body organ by steering the steerable distal tip of the first diagnostic or therapeutic instrument, thereby deflecting the flexible distal region of the overtube.    
     
     
         36 . The method of  claim 35  further comprising: 
 locking the overtube in a bent configuration; and    advancing the first diagnostic or therapeutic instrument through the lumen of the overtube in the bent configuration.    
     
     
         37 . The method of  claim 36  wherein providing an apparatus comprises providing an apparatus wherein the overtube comprises a plurality of nestable elements, and a tensioning mechanism that selectively applies a clamping load to the plurality of nestable elements, and locking the overtube in a bent configuration comprises actuating the tensioning mechanism.  
     
     
         38 . The method of  claim 36  wherein providing an apparatus comprises providing an apparatus wherein the overtube comprises a plurality of links, each link having a bore that defines the lumen of the overtube, and locking the overtube in a bent configuration comprises applying a clamping load to the plurality of links.  
     
     
         39 . The method of  claim 35  further comprising deflecting the unsupported, hollow body organ with the atraumatic tip so that tissue is not caught or pinched when the first diagnostic or therapeutic instrument is translated through the distal opening.  
     
     
         40 . The method of  claim 35 , wherein providing an apparatus comprises providing an apparatus wherein the lumen is dimensioned to permit passage of a second diagnostic or therapeutic instrument alongside the first diagnostic or therapeutic instrument, the method further comprising: 
 advancing the second diagnostic or therapeutic instrument alongside the first diagnostic or therapeutic instrument.