Endoluminal tool deployment system

Abstract

Systems, devices and methods are provided for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Embodiments of the systems include an elongated main body having a scope therethrough. Some embodiments of the systems include an elongated main body which is rigidizable and/or torque transmitting to improve manipulation through passageways in the body.

1 . A system for providing endoscopic access into the body of a patient for one or more flexible instruments, comprising:
 a primary handle having a primary steering actuator;   a primary shaft attached at a proximal end to the handle, the primary shaft comprising:
 a primary tube having a generally circular cross-sectional shape and a length sufficient to access a target location within the body of the patient, with the primary tube comprising a wall having an interior surface and an exterior surface, the wall of the primary tube having an outer diameter of from about 5 mm to about 25 mm and a thickness of from about 0.5 mm to about 5 mm to thereby define a central lumen extending through the primary tube; 
 at least one scope tube extending through at least a distal region of the central lumen, with each scope tube comprising a wall having an interior surface and an exterior surface, with the interior surface of the wall of each scope tube defining a scope lumen having a diameter of from about 2 mm to about 10 mm; 
 at least two working tubes extending through at least a distal region of the central lumen, with each working tube comprising a wall having an interior surface and an exterior surface, with the interior surface of the wall of each working tube defining a working lumen having a diameter of from about 0.5 mm to about 10 mm; and 
 a primary steering section located at or near a distal end of the primary shaft, the primary steering section having a plurality of substantially longitudinally-aligned links and having a first condition in which the primary steering section is substantially straight and a second condition in which the primary steering section is substantially curved; 
 wherein the primary shaft is flexible over substantially all of its length; 
   a primary steering wire extending through the primary shaft and connecting the primary steering actuator to the primary steering section;   a flexible instrument positioned within the working lumen of one of said working tubes, the flexible instrument comprising:
 an instrument handle; 
 a flexible instrument shaft attached at a proximal end to the instrument handle; and 
 an end effector disposed at or near a distal end of the instrument shaft, the end effector having a tissue engaging member configured to engage tissue at the target location within the body of the patient; 
 wherein the instrument shaft is movable within the working lumen during use; and 
   an endoscope positioned within the scope lumen of the scope tube, said endoscope comprising an insertion tube that is movable within the scope lumen during use.   
     
     
         2 . The system of  claim 1 , wherein the primary steering wire lies substantially within the wall of the primary tube. 
     
     
         3 . The system of  claim 1 , wherein the primary steering wire lies substantially within the central lumen. 
     
     
         4 . The system of  claim 1 , wherein each working lumen has a diameter of about 6 mm. 
     
     
         5 . The system of  claim 1 , wherein each scope lumen has a diameter of from about 4 mm to about 6 mm. 
     
     
         6 . The system of  claim 1  further comprising a secondary steering section located at or near a distal end of the instrument shaft, the secondary steering section having a first condition in which the secondary steering section is substantially straight and a second condition in which the secondary steering section is substantially curved. 
     
     
         7 . The system of  claim 5 , wherein the secondary steering section includes a plurality of substantially longitudinally-aligned links. 
     
     
         8 . The system of  claim 1 , wherein the instrument shaft includes a braid reinforcement member. 
     
     
         9 . The system of  claim 1 , wherein the instrument shaft is axially and rotationally translatable within the working lumen during use. 
     
     
         10 . The system of  claim 1 , wherein the endoscope is axially and rotationally translatable within the scope lumen during use. 
     
     
         11 . The system of  claim 1 , wherein the end effector includes a tissue fixation device comprising a tie connecting a pair of tissue anchors. 
     
     
         12 . The system of  claim 1 , further comprising an insufflation source in fluid communication with one of said working lumens. 
     
     
         13 . The system of  claim 1 , further comprising an external covering having a wall thickness of from about 0.5 mm to about 5 mm and covering at least a portion of an external surface of the wall of the primary tube. 
     
     
         14 . The system of  claim 1 , further comprising at least one auxiliary tube extending through at least a distal region of the central lumen, with each auxiliary tube comprising a wall having an interior surface and an exterior surface, with the interior surface of the wall of each auxiliary tube defining an auxiliary lumen having a diameter of from about 0.5 mm to about 5 mm. 
     
     
         15 . The system of  claim 14 , wherein each auxiliary lumen has a diameter of from about 2 mm to about 4 mm. 
     
     
         16 . The system of  claim 14 , further comprising a tool inserted through the auxiliary lumen.