Access visualization systems

Abstract

Methods and devices described herein facilitate improved access of locations within the body.

What s claimed is: 
     
         1 . An endoscopic system comprising:
 an endoscope configured to provide remote visualization;   a dilator member having a proximal portion, a distal portion, a distal end, and a dilator passage extending from the proximal portion through the distal end, the dilator member further comprising a dilation surface located about an outer surface at the distal portion, where a profile of the dilator surface increases in size along a proximal direction such that insertion of the dilator portion in an opening in tissue dilates the tissue;   a guide tube extending from the distal end of the dilator member and having a guide passage in fluid communication with the dilator passage; and   where the endoscope is advanceable through the guide tube passage such that a visualization end of the endoscope can be repositioned within the guide tube.   
     
     
         2 . The endoscopic system of  claim 1 , further comprising a second endoscope extending through the dilator member and radially offset from the guide tube, 
     
     
         3 . The endoscopic system of  claim 2 , where the second endoscope comprises a second visualization end exiting at a dilation surface of the dilator member. 
     
     
         4 . The endoscopic system of  claim 1 , where the dilator member is slidable relative to the guide member. 
     
     
         5 . The endoscopic system of  claim 1 , where the guide member is transparent 
     
     
         6 . The endoscopic system of  claim 1 , where the dilator member is transparent. 
     
     
         7 . The endoscopic system of  claim 1 , where the guide member is flexible. 
     
     
         8 . The endoscopic system of  claim 1 , where the dilator member is flexible. 
     
     
         9 . The endoscopic system of  claim 1 , where the guide member is removable from the dilator member. 
     
     
         10 . The endoscopic system of  claim 1 , where the endoscope is advanceable through the dilator passage. 
     
     
         11 . The endoscopic system of  claim 1 , where the distal end of the guide tube is tapered. 
     
     
         12 . The endoscopic system of  claim 1 , further comprising a second dilator member slidable over the dilator member. 
     
     
         13 . The endoscopic system of  claim 1 , where endoscope further comprises a flexible a body having the visualization end located at a distal portion of the flexible body. 
     
     
         14 . A dilation system for use with an endoscope configured to provide remote visualization, the endoscope comprising a visualization end located at a distal portion, the dilation system comprising:
 a dilator member having a proximal portion, a distal portion, a distal end, and a dilator passage extending from the proximal portion through the distal end, the dilator member further comprising a dilation surface located about an outer surface at the distal portion, where a profile of the dilator surface increases in size along a proximal direction such that insertion of the dilator portion in an opening in tissue dilates the tissue;   a guide tube extending from the distal end of the dilator member and having a guide passage in fluid communication with the dilator passage; and   where the endoscope is advanceable through the guide tube passage such that the visualization end of the endoscope can be repositioned within the guide tube.   
     
     
         15 . The endoscopic system of  claim 14 , further comprising a second endoscope extending through the dilator member and radially offset from the guide tube. 
     
     
         16 . The endoscopic system of  claim 15 , where the second endoscope comprises a second visualization end exiting at a dilation surface of the dilator member. 
     
     
         17 . The endoscopic system of  claim 14 , where the dilator member is slidable relative to the guide member. 
     
     
         18 . The endoscopic system of  claim 14 , where the guide member is transparent. 
     
     
         19 . The endoscopic system of  claim 14 , where the dilator member is transparent. 
     
     
         20 . The endoscopic system of  claim 14 , where the guide member is flexible. 
     
     
         21 . The endoscopic system of  claim 14 , where the dilator member is flexible. 
     
     
         22 . The endoscopic system of  claim 14 , where the guide member is removable from the dilator member. 
     
     
         23 . The endoscopic system of  claim 14 , where the endoscope is advanceable through the dilator passage. 
     
     
         24 . The endoscopic system of  claim 14 , where the distal, end of the guide tube is tapered. 
     
     
         25 . The endoscopic system of  claim 14 , further comprising a second dilator member slidable over the dilator member. 
     
     
         26 . A method for placement of an endoscope adjacent to a target site, the method comprising;
 positioning an access device adjacent to an opening in tissue, the access device comprising a guide tube and a dilator member, where the guide tube is coupled to at a distal end of the dilator member;   inserting the guide tube of the access device within the opening in tissue;   dilating the opening in tissue by advancing the dilator member of the access device through the opening in tissue; and   imaging the target site using the endoscope while the endoscope is positioned through the dilator member.   
     
     
         27 . The method of  claim 26 , further comprising visualizing using the endoscope while inserting the guide tube of the access device within the opening. 
     
     
         28 . The method of  claim 26 , where the opening in tissue comprises an opening in a pericardial space. 
     
     
         29 . The method of  claim 26 , where the guide tube is transparent and further comprising visualizing through a wall of the guide tube using the endoscope. 
     
     
         30 . The method of  claim 26 , where the dilator is transparent and further comprising visualizing through a wall of the guide tube using the endoscope. 
     
     
         31 . The method of  claim 26 , further comprising advancing, the endoscope through the dilator member. 
     
     
         32 . The method of  claim 31 , further comprising advancing the endoscope through the guide tube. 
     
     
         33 . The method of  claim 26 , where the endoscope is affixed to the dilator member and where imaging the target site using the endoscope while the endoscope is positioned through the dilator member comprises repositioning the dilator member to reposition the endoscope. 
     
     
         34 . The method of  claim 33 , further comprising advancing a second endoscope through the guide tube 
     
     
         35 . The method of  claim 26 , further comprising advancing a guidewire through the opening in tissue and where inserting the guide tube comprises advancing the guide tube over the guidewire. 
     
     
         36 . The method of  claim 26 , where the dilator member is moveable over guide tube. 
     
     
         37 . The method of  claim 36 , further comprising removing the dilator from the guide tube and advancing a second dilator over the guide tube. 
     
     
         38 . The method of  claim 36 , further comprising advancing a hollow member over the dilator and removing the dilator from the opening in tissue. 
     
     
         39 . The method of  claim 38 , further comprising advancing one or more medical devices through the hollow member. 
     
     
         40 . The method of  claim 26 , wherein the dilator comprises an expandable member.