Method and apparatus for advancing an instrument along an arbitrary path using an introducer sheath

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 of advancing an instrument along an arbitrary path, comprising: 
 selectively steering a distal portion of the instrument to assume a selected shape along an arbitrary path;    advancing the instrument distally while configuring a controllable portion of the instrument to assume the selected shape of the distal portion, wherein the controllable portion is proximal of the distal portion;    advancing an introducer sheath along the instrument such that a portion of the introducer sheath conforms to and assumes the selected shape; and    maintaining a position of the introducer sheath while advancing the instrument along the introducer sheath such that a proximal portion of the instrument assumes the selected shape defined by the introducer sheath,    wherein the introducer sheath is freely slidable along the instrument such that advancing of the instrument along the introducer sheath is unconstrained.    
     
     
         36 . The method of  claim 35  further comprising measuring a depth change of the instrument while advancing the instrument distally.  
     
     
         37 . The method of  claim 36  further comprising incrementing a current depth by the depth change.  
     
     
         38 . The method of  claim 35  further comprising releasing the position of the introducer sheath and further advancing the introducer sheath along the instrument.  
     
     
         39 . The method of  claim 35  further comprising withdrawing the introducer sheath from the instrument.  
     
     
         40 . The method of  claim 35  wherein the introducer sheath is advanced along by passing the instrument through a lumen within the introducer sheath.  
     
     
         41 . The method of  claim 35  wherein the distal portion of the instrument selectively assumes a second shape when the instrument is advanced along the introducer sheath.  
     
     
         42 . The method of  claim 35  wherein maintaining the position of the introducer sheath comprises rigidizing the introducer sheath such that the introducer sheath rigidly assumes a position of the selected shape.  
     
     
         43 . The method of  claim 42  wherein rigidizing the introducer sheath comprises applying tension to a tensioning member disposed within the introducer sheath such that a plurality of adjacent segments comprising the introducer sheath are compressed.  
     
     
         44 . The method of  claim 42  wherein rigidizing the introducer sheath comprises applying a compressive force to an exterior of the introducer sheath such that a plurality of adjacent segments comprising the introducer sheath are compressed.  
     
     
         45 . An apparatus for insertion into a body cavity, comprising: 
 an elongate body having a proximal portion and a selectively steerable distal portion and defining a lumen therebetween, the steerable distal portion being configurable to assume a selected shape along an arbitrary path;    an introducer sheath having a proximal section, a distal section, and a length therebetween, the introducer sheath being slidably disposed without constraint over the elongate body to selectively support the elongate body,    wherein the introducer sheath is configured to conform to and selectively maintain the selected shape assumed by the steerable distal portion, and wherein the proximal portion of the elongate body when advanced distally is configured to conform to the selected curve maintained by the introducer sheath.    
     
     
         46 . The apparatus of  claim 45  further comprising a controllable portion located proximally of the distal portion, wherein the controllable portion is configured to propagate the selected shape to the controllable portion.  
     
     
         47 . The apparatus of  claim 46  wherein the selectively steerable distal portion is configurable via a control located externally of the body cavity.  
     
     
         48 . The apparatus of  claim 45  wherein the proximal section comprises a flexible tubular member.  
     
     
         49 . The apparatus of  claim 48  wherein the introducer sheath comprises a plurality of pivotally connected segments.  
     
     
         50 . The apparatus of  claim 45  wherein the introducer sheath is configured to assume the selected shape when the introducer sheath is in a flexible state and wherein the introducer sheath is further configured to maintain the selected shape when the introducer sheath is in a rigidized state.  
     
     
         51 . The apparatus of  claim 50  wherein the introducer sheath is configured to selectively rigidize along the length of the introducer sheath to maintain the selected shape in the rigidized state.  
     
     
         52 . The apparatus of  claim 50  wherein the proximal section of the introducer sheath is in communication with a introducer sheath controller for selectively rigidizing the introducer sheath along its length.  
     
     
         53 . The apparatus of  claim 50  wherein the introducer sheath comprises a plurality of adjacent segments each defining a channel therethrough such that a common channel is defined through the length of the introducer sheath.  
     
     
         54 . The apparatus of  claim 53  further comprising a tensioning member slidably extending through the plurality of adjacent segments such that applying a force to the tensioning member compresses the adjacent segments together.  
     
     
         55 . The apparatus of  claim 53  wherein the introducer sheath is configured to maintain a position of adjacent segments relative to each other upon applying a compressive force to an exterior of the plurality of adjacent segments.  
     
     
         56 . The apparatus of  claim 55  further comprising an expandable balloon.  
     
     
         57 . The apparatus of  claim 45  further comprising a tubular covering disposed over at least a majority of the length of the introducer sheath.  
     
     
         58 . A method of advancing an instrument along an arbitrary path, comprising: 
 selectively steering a distal portion of the instrument to assume a selected shape along an arbitrary path;    advancing an introducer sheath along the instrument such that a portion of the introducer sheath conforms to and assumes the selected shape;    maintaining a position of the introducer sheath while advancing the instrument along the introducer sheath such that a proximal portion of the instrument assumes the selected shape defined by the introducer sheath; and    measuring a depth change of the instrument while advancing the instrument distally,    wherein the introducer sheath is freely slidable along the instrument such that advancing of the instrument along the introducer sheath is unconstrained.    
     
     
         59 . The method of  claim 58  wherein, prior to advancing the introducer sheath along the instrument, further comprising advancing the instrument distally while configuring a controllable portion of the instrument to assume the selected shape of the distal portion, wherein the controllable portion is proximal of the distal portion.  
     
     
         60 . The method of  claim 58  further comprising incrementing a current depth by the depth change.  
     
     
         61 . The method of  claim 58  further comprising releasing the position of the introducer sheath and further advancing the introducer sheath along the instrument.  
     
     
         62 . The method of  claim 58  further comprising withdrawing the introducer sheath from the instrument.  
     
     
         63 . The method of  claim 58  wherein the introducer sheath is advanced along by passing the instrument through a lumen within the introducer sheath.  
     
     
         64 . The method of  claim 58  wherein the distal portion of the instrument selectively assumes a second shape when the instrument is advanced along the introducer sheath.  
     
     
         65 . The method of  claim 58  wherein maintaining the position of the introducer sheath comprises rigidizing the introducer sheath such that the introducer sheath rigidly assumes a position of the selected shape.  
     
     
         66 . The method of  claim 65  wherein rigidizing the introducer sheath comprises applying tension to a tensioning member disposed within the introducer sheath such that a plurality of adjacent segments comprising the introducer sheath are compressed.  
     
     
         67 . The method of  claim 65  wherein rigidizing the introducer sheath comprises applying a compressive force to an exterior of the introducer sheath such that a plurality of adjacent segments comprising the introducer sheath are compressed.  
     
     
         68 . An apparatus for insertion into a body cavity, comprising: 
 an elongate body having a selectively steerable distal portion, a controllable portion located proximally of the distal portion, and a lumen defined therebetween, the steerable distal portion being configurable to assume a selected shape along an arbitrary path;    an introducer sheath having a proximal section, a distal section, and a length therebetween, the introducer sheath being slidably disposed without constraint over the elongate body to selectively support the elongate body,    wherein the introducer sheath is configured to conform to and selectively maintain the selected shape assumed by the steerable distal portion, and wherein the controllable portion of the elongate body when advanced distally is configured to propogate the selected shape to the contollable portion and conform to the selected curve maintained by the introducer sheath.    
     
     
         69 . The apparatus of  claim 68  wherein the selectively steerable distal portion is configurable via a control located externally of the body cavity.  
     
     
         70 . The apparatus of  claim 68  wherein the proximal section comprises a flexible tubular member.  
     
     
         71 . The apparatus of  claim 70  wherein the introducer sheath comprises a plurality of pivotally connected segments.  
     
     
         72 . The apparatus of  claim 68  wherein the introducer sheath is configured to assume the selected shape when the introducer sheath is in a flexible state and wherein the introducer sheath is further configured to maintain the selected shape when the introducer sheath is in a rigidized state.  
     
     
         73 . The apparatus of  claim 72  wherein the introducer sheath is configured to selectively rigidize along the length of the introducer sheath to maintain the selected shape in the rigidized state.  
     
     
         74 . The apparatus of  claim 72  wherein the proximal section of the introducer sheath is in communication with a introducer sheath controller for selectively rigidizing the introducer sheath along its length.  
     
     
         75 . The apparatus of  claim 72  wherein the introducer sheath comprises a plurality of adjacent segments each defining a channel therethrough such that a common channel is defined through the length of the introducer sheath.  
     
     
         76 . The apparatus of  claim 75  further comprising a tensioning member slidably extending through the plurality of adjacent segments such that applying a force to the tensioning member compresses the adjacent segments together.  
     
     
         77 . The apparatus of  claim 75  wherein the introducer sheath is configured to maintain a position of adjacent segments relative to each other upon applying a compressive force to an exterior of the plurality of adjacent segments.  
     
     
         78 . The apparatus of  claim 77  further comprising an expandable balloon.  
     
     
         79 . The apparatus of  claim 68  further comprising a tubular covering disposed over at least a majority of the length of the introducer sheath.  
     
     
         80 . An apparatus for insertion into a body cavity, comprising: 
 an elongate body having a proximal portion, a selectively steerable distal portion, and a lumen defined therebetween, the steerable distal portion being configurable to assume a selected shape along an arbitrary path;    an introducer sheath having a proximal section, a distal section, and a length therebetween, the proximal section comprising a flexible tubular member, the introducer sheath comprising a plurality of pivotally connected segments and being slidably disposed without constraint over the elongate body to selectively support the elongate body,    wherein the introducer sheath is configured to conform to and selectively maintain the selected shape assumed by the steerable distal portion, and wherein the proximal portion of the elongate body when advanced distally is configured to conform to the selected curve maintained by the introducer sheath.    
     
     
         81 . The apparatus of  claim 80  further comprising a controllable portion located proximally of the distal portion, wherein the controllable portion is configured to propagate the selected shape to the controllable portion.  
     
     
         82 . The apparatus of  claim 81  wherein the selectively steerable distal portion is configurable via a control located externally of the body cavity.  
     
     
         83 . The apparatus of  claim 80  wherein the introducer sheath is configured to assume the selected shape when the introducer sheath is in a flexible state and wherein the introducer sheath is further configured to maintain the selected shape when the introducer sheath is in a rigidized state.  
     
     
         84 . The apparatus of  claim 83  wherein the introducer sheath is configured to selectively rigidize along the length of the introducer sheath to maintain the selected shape in the rigidized state.  
     
     
         85 . The apparatus of  claim 83  wherein the proximal section of the introducer sheath is in communication with a introducer sheath controller for selectively rigidizing the introducer sheath along its length.  
     
     
         86 . The apparatus of  claim 83  wherein the plurality of pivotally connected segments of the introducer sheath further comprises a plurality of adjacent segments each defining a channel through the introducer sheath such that a common channel is defined through the length of the introducer sheath.  
     
     
         87 . The apparatus of  claim 86  further comprising a tensioning member slidably extending through the plurality of adjacent segments such that applying a force to the tensioning member compresses the adjacent segments together.  
     
     
         88 . The apparatus of  claim 86  wherein the introducer sheath is configured to maintain a position of adjacent segments relative to each other upon applying a compressive force to an exterior of the plurality of adjacent segments.  
     
     
         89 . The apparatus of  claim 88  further comprising an expandable balloon.  
     
     
         90 . The apparatus of  claim 80  further comprising a tubular covering disposed over at least a majority of the length of the introducer sheath.  
     
     
         91 . A method of advancing an instrument along an arbitrary path, comprising: 
 selectively steering a distal portion of the instrument to assume a selected shape along an arbitrary path;    advancing an introducer sheath along the instrument by passing the instrument through a lumen within the introducer sheath, such that a portion of the introducer sheath conforms to and assumes the selected shape; and    maintaining a position of the introducer sheath while advancing the instrument along the introducer sheath such that a proximal portion of the instrument assumes the selected shape defined by the introducer sheath,    wherein the introducer sheath is freely slidable along the instrument such that advancing of the instrument along the introducer sheath is unconstrained.    
     
     
         92 . The method of  claim 91  wherein, prior to advancing the introducer sheath along the instrument, further comprising advancing the instrument distally while configuring a controllable portion of the instrument to assume the selected shape of the distal portion, wherein the controllable portion is proximal of the distal portion.  
     
     
         93 . The method of  claim 91  further comprising measuring a depth change of the instrument while advancing the instrument distally.  
     
     
         94 . The method of  claim 93  further comprising incrementing a current depth by the depth change.  
     
     
         95 . The method of  claim 91  further comprising releasing the position of the introducer sheath and further advancing the introducer sheath along the instrument.  
     
     
         96 . The method of  claim 91  further comprising withdrawing the introducer sheath from the instrument.  
     
     
         97 . The method of  claim 91  wherein the distal portion of the instrument selectively assumes a second shape when the instrument is advanced along the introducer sheath.  
     
     
         98 . The method of  claim 91  wherein maintaining the position of the introducer sheath comprises rigidizing the introducer sheath such that the introducer sheath rigidly assumes a position of the selected shape.  
     
     
         99 . The method of  claim 98  wherein rigidizing the introducer sheath comprises applying tension to a tensioning member disposed within the introducer sheath such that a plurality of adjacent segments comprising the introducer sheath are compressed.  
     
     
         100 . The method of  claim 98  wherein rigidizing the introducer sheath comprises applying a compressive force to an exterior of the introducer sheath such that a plurality of adjacent segments comprising the introducer sheath are compressed.