CA2615782A1 - Surgical instrument guide device - Google Patents

Abstract

An instrument guide device comprises an elongated guide shaft having proximal and distal ends and including an instrument lumen for receiving therethrough a manually operated instrument having an instrument shaft. A distal bendable member is disposed at the distal end of the guide shaft and a proximal bendable member is disposed at the proximal end of the guide shaft. Actuation means extends between the distal and proximal bendable members and provides a bending of the distal bendable member controlled from the proximal bendable member. The proximal bendable member is controlled from the manually operated instrument to cause a corresponding bending of said distal bendable member.

Description

3 Related Applications 4 The present application claims priority to earlier filed U.S. Provisional Application 60/700,776, filed on July 20, 2005. The present invention also relates to 6 earlier filed U.S. Application Serial No. 10/822,08 1, filed on April 12, 2004 which, 7 in turn, claims priority to U.S. Provisional Application Serial No.
60/515,560, filed 8 on October 30, 2003, as well as U.S. Application Serial No. 11/185,911, filed on July 9 20, 2005 which, in turn, claims priority to U.S. Provisional Application Serial No.
60/671,189, filed on April 14, 2005. The content of all of the aforementioned 11 applications are hereby incorporated by reference herein in their entirety.

13 Technical Field 14 The present invention relates in general to surgical instruments, and more particularly to manually-operated surgical instruments that are intended for use in 16 ininimally invasive surgery or other forms of surgical procedures or techniques. Even 17 more particularly the present invention relates to a guide apparatus for a medical 18 instrument. The instrument described herein maybe used for laparoscopic procedures, 19 however, it is to be understood that the instnunent and guide of the present invention can be used for a wide variety of other procedures, including intraluminal procedures.

22 Background of the Invention 23 Endoscopic and laparoscopic instruments currently available in the marlcet are 24 extremely difficult to learn to operate and use, mainly due to a lack of dexterity in their use. For instance, when using a typical laparoscopic instrument during surgery, 26 the orientation of the tool of the instrn,unent is solely dictated by the locations of the 27 target and the incision. These instruments generally fiinction with a fulcrum effect 28 using the patients own incision area as the fulcrum. As a result, cominon tasks such 29 as suturing, la-iotting atzd fine dissection have become challenging to master. Various 1 laparoscopic instruments have been developed over the years to overcome this 2 deficiency, usually by providing an extra articulation often controlled by a separately 3 disposed control meinber for added control. However, even so these instruments still 4 do not provide enough dexterity to allow the surgeon to perform cominon tasks such as suturing, particularly at any arbitrarily selected orientation.
6 My above identified related earlier filed applications describe an improved 7 instrument employing bendable section on the instrument itself.
8 An object of the present invention is to provide a guide device or apparatus 9 that can be used With either conventional or the above identified instruments for laparoscopic, endoscopic or other surgical procedures and that allows the surgeon to 11 readily manipulate the tool or working end of the surgical instrument with greater 12 dexterity.

13 Another object of the present invention is to provide an improved surgical 14 instnunent and guide that has a wide variety of applications, including, but not limited to, through incisions, through natural body orifices or extending intraluminally.

17 Summary of the Invention 18 To accomplish the foregoing and other obj ects, features and advantages of this 19 invention, there is provided an instrument guide device that is comprised of an elongated guide shaft having proximal and distal ends and including an instrusnent 21 lumen for receiving therethrough a manually operated instrument having an 22 instrument shaft and handle. A distal bendable meznber is disposed at the distal end 23 of the guide shaft and a proximal bendable member id disposed at the proximal end 24 of the guide shaft. Actuation means extends between the distal and proximal bendable ineinbers for providing a bending of the distal bendable member controlled from the 26 proximal bendable member. The proximal bendable member is controlled fiom the 27 manually operated instrLunent to cause a corresponding bending of the distal bendable 28 lneinber.

1 In accordance with other aspects of the present invention there is provided an 2 instrulnent guide device wherein the actuation means is constructed and arranged so 3 that a bending of the proximal bendable member causes a like direction bending of the 4 distal bendable member, or, alternatively, the actuation means is constructed and arranged so that a bending of the proximal bendable member causes an opposite 6 direction bending of the distal bendable member. The proximal bendable member is 7 preferably moveable in any direction. A grip may be disposed between the proximal 8 bendable member and the handle of the instrument and constructed and arranged to 9 have a passage through which the instrument shaft extends. The grip may be forined as two pieces including a grip portion and a rotation knob and the grip and kn.ob 11 portions are supported for relative rotation therebetween. Means maybe provided for 12 securing the instrument handle to the grip. The bendable members may each coznprise 13 a unitary slotted structure having a plurality of discs separated by slots.
The guide 14 shaft may be rigid, flexible or partially flexible. The instrurnent guide device may include a plurality of proximal bendable members and a plurality of distal bendable 16 inembers. The actuation means may comprise a plurality of cables that interconn.ect 17 proximal and distal bendable meinbers. The guide shaft may have at least two lumens 18 for respectively accommodating separate instrument shafts. The instrument that is 19 inserted in the guide device may have instrument proximal and distal bendable meinbers.

21 In an other embodiment of the present invention there is provided a surgical 22 institirment assembly that coinprises an elongated instn.unent shaft having proxiinal 23 and distal ends, a worlcing member coupled from the distal end of the instrument shaft, 24 a control handle disposed at the proximal end of the instrument shaft and a guide member for receiving the instrument shaft. The guide member includes a guide shaft, 26 a distal motion means at the distal end of the guide shaft, a proximal motion ineans 27 at the proximal end of the guide shaft and actuation means extending between the 28 distal and proximal motion meaizs. The working member extends beyond a distal end 1 of the guide shaft at an operative site. Any deflection of the proximal motion means 2 causes a corresponding deflection of the distal motion means for control of the 3 working member.

4 In accordance with still other aspects of the present invention there is provided a surgical instrument asseinbly in which the distal motion means comprises a distal 6 bendable member and the proximal motion means comprises a proximal bendable 7 member that is moveable in any direction. A grip may be disposed between the 8 proximal bendable member and the handle of the instrument and constructed and 9 arranged to have a passage through which the instrument shaft extends. The grip may be fonned as two pieces including a grip portion and a rotation lmob and the grip and 11 knob portions are supported for relative rotation therebetween. The proximal bendable 12 meinber may comprise a unitary slotted structure having a plurality of discs separated 13 by slots and further including a plurality ofribs interconnecting adjacent discs, the ribs 14 being disposed at intervals about the member of less than 90 degrees.

In a further embodiment of the present invention there is provided a surgical 16 instrument that is comprised of an elongated instruinent shaft having proximal and 17 distal ends, a working member disposed at the distal end of the instrument shaft and 18 a control handle disposed at the proximal end of the instrument shaft. The working 19 member is coupled to the distal end of the elongated instrument shaft via a distal motion member. The control handle is coupled to the proximal end of the elongated 21 instrt.iinent shaft via a proximal bendable member. Actuation means extends between 22 the distal and proximal members whereby any deflectioli of the control handle with 23 respect to the elongated instrument shaft causes a corresponding bending of the distal 24 motion member for control of the working member. At least the proximal bendable member comprises a unitary slotted structure having a plurality of discs separated by 26 slots.

27 In accordance with still other aspects of the present invention there is provided 28 an instruineilt guide device in which the distal motion member also comprises a 1 bendable meinber formed as a iuiitary slotted stnicture having a phirality of discs 2 separated by slots. The proximal bendable member may include a plurality of ribs 3 intercomiectiuig adjacent discs, the ribs being disposed at intervals about the member 4 of less than 90 degrees. The ribs may be disposed at an interval on the order of 60 5 degrees.

7 Description of the Drawings 8 It should be understood that the drawings are provided for the purpose of 9 ilh.tstration only and are not intended to define the limits of the disclosure. The foregoing and other obj ects and advantages of the embodiments described herein will 11 become apparent with reference to the following detailed description when taken in 12 conjlulction with the accompanyiiig drawings, in which:
13 Fig. 1 is an exploded side view of a first einbodiment of a surgical instru.ment 14 and guide device using a rigid guide tube shaft;
Fig. 2 is a view of the proxiinal end of the guide device of Fig. 1, as talfen 16 along line 2-2 of Fig. 1;
17 Fig. 3 is a schematic side view of the instrument and guide asseinbly in use as 18 inserted through a patient's skin at an incision;
19 Fig. 4 is a fragmentary enlarged cross-sectional side view of the asseinbly of Fig. 3;
21 Fig. 5 is a cross-sectional view of the proximal bendable member, as taken 22 along line 5 5 of Fig. 4;
23 Fig. 6 is an exploded perspective view of the guide apparatus or device 24 illustrated in Figs. 1-5;
Fig. 7 is a schematic cross-sectional side view illustrating the bending action 26 of the assembly of Fig. 4;

27 Fig. 8 is a schematic cross-sectional side view illustrating an alternate bending 28 action;

1 Fig. 9 is a fiaginentary cross-sectional side view similar to that shown in Fig.
2 4, but illustrating a second embodiment of the guide assembly having an added 3 rotational feature;

4 Fig. 10 is a schematic side view of the guide assembly of Fig. 9 in use with the jaw end effector of Fig. 1;

6 Fig. 11 is a schematic side view of a third embodiment of the guide assembly 7 or device eniploying a flexible main shaft on the guide device;

8 Fig. 12 is an exploded side view of a fourth embodiment of the guide device 9 used with a second embodiment of a surgical instrument;

Fig. 13 is a view of the proximal end of the guide device of Fig. 12, as talcen 11 along line 13-13 of Fig. 12;

12 Fig. 14 is a schematic side view of the instrument and guide assembly of Fig.
13 12 in use;

14 Fig. 15 is an exploded side view of a fifth embodiment of the guide device with a tlzird embodiment of the surgical instrument;

16 Fig. 16 is a view of the proximal end of the guide device of Fig. 15, as taken 17 along line 16-16 of Fig. 15;

18 Fig. 17 is a schematic side view of the instruinent and guide asseinbly of Fig.
19 15 in use as inserted through a patient's skin at an incision;

Fig. 18 is an exploded side view of a sixth embodiment ofthe guide device and 21 a fourth einbodiznent of the surgical instruinent;

22 Fig. 19 is a schematic side view of the instruinent and guide assembly of Fig.
23 18 in use as inserted through a patient's skin at an incision;
24 Fig. 20 is an exploded side view of the fifth einbodiment of the guide device as used with a fifth embodiment of the surgical instnnnent;

26 ' Fig. 21 is a schematic side view of the instrument and guide asseinbly of Fig.
27 20 in use as inserted through a patient's skin at an incision;

28 Fig. 22 is an exploded side view of the sixth embodiment of the guide device 29 as used with a sixth embodiment of the surgical instruznent;

1 Fig. 23 is a schematic side view of the insti-uinent and guide asseinbly of Fig.
2 22 in use as inserted through a patient's skin at an incision;
3 Fig. 24 is a perspective view of another embodiment of the guide device 4 useable witli two or more instruinents; and Fig. 25 is a side view of still another einbodiment of the invention using 6 inultiple bendable members both proximally and distally on the guide member.

8 Detailed Description 9 The instrument and guide member of the present invention may be used to perform minimally invasive procedures or virtually any otller types of surgical or 11 medical procedures. "Minimally invasive procedure" refers herein to a surgical 12 procedure in which a surgeon operates through a small cut or incision, the small 13 incision being used to access the operative site. In one embodiinent, the incision 14 length ranges from 1 inm to 20 mm in diameter, preferably from 5 mm to 10 mYn in diameter. This procedure contrasts those procedures requiring a large cut to access the 16 operative site. Thus, the instrument assembly is preferably used for insertion through 17 such small incisions and/or through a natural body luinen or cavity, so as to locate the 18 instrument at an internal target site for a particular surgical or medical procedure. The 19 introduction of the surgical instniment assembly into the anatomy may also be by percutaneous or surgical access to a himen or vessel, or by introduction through a 21 natural orifice in the anatomy. Also, even though the instrument assembly is 22 preferably used for MIS surgery it can also be used for open surgery or any other 23 surgical or medical procedures.
24 Ll addition to use in a laparoscopic procedure, the instn,unent and guide of the present invention may be used in a variety of other medical or surgical procedures 26 including, but not limited to, colonoscopic, upper GI, arthroscopic, sinus, thorasic, 27 transvaginal and cardiac procedures. Depending upon the particular procedure, the 28 instrument shaft may be rigid, seini-rigid or flexible.

1 Although reference is made herein to a surgical instrument and guide, it is 2 contemplated that the principles of this invention also apply to other medical 3 instruments, not necessarily for surgery, and including, but not limited to, suc11 other 4 iinplements as catheters, endoscopes, optics, as well as diagnostic and therapeutic instnuneilts and iinpleinents.

6 Still anotlier aspect of the surgical guide instrument of the present invention 7 is the ability to adapt the instrument and guide to a wide variety of medical procedure.
8 This includes, but is not limited to, access to a body cavity such as through an incision 9 or intraluininal use such as through a natural body aperture to a body hunen. The introduction of the instrument into the anatomy may also be by percutaneous or 11 surgical access to a lumen, cavity or vessel, or by introduction through a natural orifice 12 in the anatomy.

13 The concepts of the present invention relate to the use of a manually 14 controllable guide member or device through which either a conventional instrument shaft may be inserted or through which a novel instrument may be inserted, such as 16 the novel instrument described in iny previously identified related pending 17 applications. With the use of the guide meinber of the present invention, the user can 18 insert the instrument shaft through the guide member and then use the bendable 19 ineinbers of the guide member to control the manipulation of the instrument. Thus, by deflecting the instruinent, once positioned in the guide member, this causes a 21 deflection or bending at the proximal bendable member that is transferred to the distal 22 bendable member (usuallyby cabling) to control the positioning ofthe distal tool. This 23 bending control at the guide member is preferably in all directions.
24 It should be noted that the amount of guide member bending motion produced at the distal bending meznber is dete.rmined by the dimension of the proximal 26 bendable member in coinparison to that of tlie distal bendable member. In the 27 disclosed embodiment the proximal bendable member may be approximately three 28 tiines the diaineter of the distal bendable meinber, and as a result, the motion produced 29 at the distal bendable member is about three times the magnitude of the motion at the 1 proximal bendable member. A1tllough Fig. 3 sliows only the side view where only 2 pitch motion is illustrated, it should be noted that the proxiinal bendable meinber can 3 be bent in any and all directions controlling the distal bendable member to bend in 4 either the same or an opposite direction, but in the saine plane. As a result, as depicted in Fig. 3 the surgeon is able to roll the instrument tool about its longitudinal axis at 6 any orientation simplyby a rolling action at the proximal bendable meinber, controlled 7 primarily by manipulation of the handle of the inserted instrument bearing against the 8 guide member.
9 In this description reference is made to bendable members. These members may also be referred to as tuinable members or flexible members. In the descriptions 11 set out herein, tenns such as bendable section, bendable segment, bendable motion 12 meinber, or tunlable member refer to an element of the guide instrninent that is 13 controllably bendable in comparison to an elelnent that is pivoted at a joint. The 14 bendable elements of the present invention enable bending in any direction without any singularity and that is furtlier characterized by a ready capability to bend in any 16 direction, all with a single unitary or uni-body structure. A definition of these 17 bendable motion members is --a guide eleinent, formed either as a controlling means 18 or a controlled means, and that is capable of being constrained by tension or 19 coinpression forces to deviate from a straight line to a curved configuration witlzout 2 0 any sharp breaks or angularity--.
21 The first embodiment is described in Figs. 1-6. The guide member or 22 instt-ument 10 has a proximal bendable member 20 and distal bendable member 23 an.d receives the instruinent 12 such as depicted in Fig. 3 in the inserted position of the 24 instnunent 12, depicted as the assembled instrument system 14. The instruznent 12 may be conventional and is secured in the guide meznber 10 so that motions at the 26 instrument handle 40 are essentially transferred through the guide member 10 to 27 control the positioning of the end effector. In other words a deflection of the handle 28 40 causes a bending of the proximal bendable member 20 (as in Fig. 3) which, in turn, 29 bends the distal bendable znernber 22 to control the placeinent of the tool or end 1 effector. This first einbodiment also includes a grip 16 that provides the interface 2 between the handle 40 and the proximal bendable member 20. The grip 16, in this 3 particular embodiment, is one-piece so the only rotation of the instrument is by 4 rotating the entire instruanent and guide meinber. The instni.ment 12 is locked to the 5 guide member 10 so there is no linear motion of the instrument relative to the guide 6 member.
7 Referring to Fig. 1, the surgical instnunent 12 may be considered as of 8 conventional design and is comprised of a handle 40 at the proximal end of the 9 instnunent, an elongated flexible instrument shaft 36 and a tool or end effector 38 10 disposed at the distal end of the surgical instrument 12. In the disclosed einbodiment 11 the instrument shaft 36 is preferably constr-ucted so as to be at least partially flexible 12 or bendable so as to sufficiently bend with the bending of the bendable members of 13 the guide member 10. The tool 38 is illustrated as including a fixed jaw 54 a.nd a 14 moveable jaw 52. The tool 38 is actuated by means of an actuation cable 50 that extends through the instnunent shaft 3 6 and is controlled from the slider 46 and return 16 spring 48. A lever 42 operates the slider 46 through the linkage or transfer bar 44. The 17 closure of the lever 42 pulls the cable 50 to close the jaws 52, 54.
18 In the drawings a set ofj aws is depicted, however, other tools or devices may 19 be readily adapted for use with the instnunent of the present invention.
These include, but are not limited to, caxneras, detectors, optics, scope, fluid delivery devices, 21 syriiiges, etc. The tool may include a variety of articulated tools such as j aws, scissors, 22 graspers, needle holders, micro dissectors, staple appliers, tackers, suction irrigation 23 tools and clip appliers. In addition, the tool may include a non-articulated tool such 24 as a cutting blade, probe, irrigator, catheter or suction orifice.
In Figs. 1-6, the guide meinber or guide instrument 10 is depicted separately 26 from the surgical instrument 12 as in Fig. 1. Iii Fig. 3, there is shown the assembled 27 system 14 with the instrument having been inserted into and through the guide 28 meinber 10. In Fig. 3 note that the guide member shaft 18 extends tluough the 29 camiula 8 at the insertion site 6 of the patient's skin 4. The end effector or too138 is 1 disclosed in Fig. 3 as extending from the distal bendable meinber 22. Fig. 3 also 2 shows a protective sheat1124 that may extend about the distal flex member 22.
3 The guide meinber 10, in addition to including the guide shaft 18, also includes 4 the proximal flexible or bendable member 20 and the distal flexable or bendable meinber 22. A-ii adaptor cover 26 is disposed about a poi-tion of the proximal bendable 6 ineinber 20. The adaptor cover 26 includes a fiuinel or conical-shaped portion 96 (see 7 Fig. 6) for receiving ends of the proximal bendable member 20 and the guide shaft 18.
8 The grip 16 of the guide member 10 receives the other end of the proximal bendable 9 meinber 20. The grip 16 is preferably 'a single piece structure having a cavity 28 for receiving the boss 30 of the conventional instruinent 12. The boss 30 may also be 11 provided with a recess 32 for receiving a locking screw 34 that extends through the 12 grip 16 into the cavity 28 and into the recess 32. The use of the locking screw 34 13 secures the instrument 12 within the guide member 10. Motions of the instrLunent are 14 thus directly transferred to the grip 16 and, in turn, to the proximal bendable member 20. The length of the guide nlember is selected so that the instrument tool extends 16 beyond the end of the guide member, as depicted in Fig. 3.
17 This first embodiment also discloses the details of the proximal and distal 18 bendable members 20 and 22, particularly in Figs. 4-6. Bendable member 20 has a 19 central passage 56 through which the instrulnent shaft 36 caii extend. Fig.
4 also illustrates the lumen 58 defined by the guide shaft 18 with the instrument shaft 36 21 extending therethrougll. Similarly, the distal bendable meinber 22 includes a passage 22 60 for receiving the instrument shaft 36. In Fig. 4 the guide shaft 18 is shown as rigid, 23 but could also be partially rigid or flexible. The guide shaft 18 maybe made of a light 24 weight metal material or of plastic.
The grip 16 includes a cavity 62 (see Fig. 6) for receiving one end of the 26 proxiinal bendable meinber 20. This bendable member 20 is seated at the end wal164 27 of the grip 16. The wall 64 has a tapered or conical passage 66 for receiving the 28 iiistrument shaft 36. As depicted in Fig. 6, there are also provided several passages 29 68 for cabling. The grip 16 also includes a cavity 70 for the anchors 86 and springs 1 88. This includes a plurality of proximal anchors 86 and related springs 88.
The 2 springs 88 are for tensioning the associated cables 76-82. The distal bendable meinber 3 22 includes an extending end 94 for receiving the distal anchors 84 that secure the 4 distal ends of the actuation cables 76-82. The grip 16 also preferably includes a raised lip 72 that is useful in grasping the guide grip 16. The raised lip 72 preferably 6 has spaced finger grooves 74.
7 The control between the proximal and distal bendable members is carried out 8 primarily by means of a set of cables that extend between these bendable members.
9 A bending at the proximal bendable member causes a pulling of one or more cables while there is a relaxing of other opposed cables causing a corresponding bending 11 action at the distal benda.ble member. The cabling that is used includes flexible cables 12 76, 78, 80 and 82 that extend between the proximal and distal bendable members. A
13 plurality of distal an.chors 84 are used at the distal end of the cabling.
Cable passages 14 90 are provided in the proximal bendable inember 20, and cable passages 92 are provided in fihe distal bendable ineinber 22. The passages 90 and 92 accommodate 16 these cables. Also, guide discs (not shown) may be provided along the cables, 17 particularly witliin the guide shaft 18 so assure that the cables are maintined in 18 position as they extend from one end of the guide shaft to the other end.
19 The proximal bendable member 20 is comprised of a series of adjacent discs 98 that define therebetween spaces or slots 100. Connecting ribs 102 extend between 21 adj acent discs 98. Fig. 5 depicts the location of the ribs 102. In a similar manner, the 22 distal bendable member 22 includes a series of discs 104 that define therebetween 23 slots or spaces 106. Ribs 108 extend between adjacent discs 104. For furtller details 24 of the bendable members and the prefered relationship between the disks, slots and ribs, refer to Application Serial No. 11/185,911, filed on July 20, 2005, the content of 26 wliich is hereby incorporated by reference herein.
2 7 Figs. 7 and 8 depict the guide member with the instriunent inserted therein and 28 also depicts the various motions that occur depending upon the position of the control 29 cables that control the bending actions. In. Fig. 7, a downward movement of the 1 proximal bendable member 20 causes an upward movement of the distal bendable 2 member 22. Alternatively, in Fig. 8 a downward moveznent of the proximal bendable 3 member 20 causes a downward moveinent of the distal bendable member 22. This all 4 occurs by virtue of the cabling being either extended or retracted as the proximal bendable member is manipulated.The different direction bending comes about by 6 either having the cabling straight, as in Fig. 7 or crossed 180 degrees, as in Fig. S. Iil 7 Figs. 7 aiid 8, the instnunent handle is shown fixed to the grip portion 16, and by 8 manipulating of the handle, this causes a direct inanipulation of the grip portion, 9 which, in turn, controls the bending at the proximal bendable member. The bending at the proximal bendable member, in turn, controls the positioning of the distal 11 bendable member and end effector.
12 A second embodiment of the present invention is shown in Figs. 9 and 10.
This 13 uses a two-piece grip 116 with a rotation laiob 112. This embodiment allows the saine 14 bending action as in the first embodiment via proximal and distal bendable members, but additionally allows the user to rotate the guide member relative to the grip portion 16 116. This rotation action causes rotation of the bendable members 20, 22 and guide 17 shaft 36 on their axes.
18 The einbodiment of Figs. 9 and 10 also illustrates the instrument handle being 19 fixedly supported to the grip 116. In this particular embodiment, rather than a single-piece grip, there is provided an essentially two-piece grip that also includes the 21 rotation knob 112. A boss 114 is provided on the knob 112 terminating in an end 22 wall 118 of the rotation laiob 112. The grip 116 is provided with a cavity 120 for 23 receiving the boss 114. Retention means 122 (annular innwardly extending rib) 24 extends from tlle grip 116 into an almular slot. Iii this way the rotation knob 112 is engaged with the grip 116 but is freely rotatable relative to the grip 116.
Fig. 10 also 26 shows the arrow 111 indicating rotation of the instrument handle 12 relative to the 27 knob 112. A.iTow 113 indicates the corresponding rotation at the end effector 38. Even 1 though the itein 112 is refered to as a rotation laiob, it is understood that the luzob 112 2 can be held non-rotatable while the grip 116 is rotated relative thereto, such as 3 depicted by the arrows 111, 113 in Fig. 10.
4 In the first two einbodiments of the invention described in Figs. l-10, the guide shaft itself may be rigid, flexible or semi-rigid, but is basically depicted as rigid. The 6 instrument shaft itself is preferably at least partially flexible so that it can flex as the 7 proxiinal end distal members are operated.
8 A third embodirnent of the present invention is shown in Fig. 11 illustrating 9 a flexible or partially flexible guide shaft or tube 126. In the first two einbodiments the guide shafts can be rigid or partially flexible and the instrument shaft should be at 11 least partially flexible so as to flex when the bendable members are in action. The 12 embodiinent illustrated in Fig. 11 is meant to use a flexible or semi-flexible guide tube 13 126. This is illustrated as being placed through a carmula 8 at an insertion site 6 of the 14 patient's skin 4, such as for laparoscopic use. Fig. 11 also schematically illustrates the instn.iment handle 12, the grip and the proximal and distal bendable members 20 and 16 22. Other than the guide shaft 126, the rest of the guide member may be substantially 17 identical to that described in either Fig. 1-8 or 9 and 10. This particular einbodiment 18 also lends itself to use of the instrument and guide assembly intraluminally, such a 19 through an incision or natural body orifice. The end effector may be located in the lu.inen or the instrument inay be positioned so that the end effector is either located in 21 a body cavity or extends tlirough a body lusnen or vessel to a cavity.
22 This third embodiment may also accommodate a conventional endoscope 23 within the guide member. The endoscope is inserted in the guide member.
Such an 24 endoscope may have chanuels for instnunentation, for optics or for other puiposes such as irrigation. In that case, the guide member of the present invention can be used 26 for steering the endoscope. This may be quite usefitl, particularly for intraluxninal 27 applications, wherein the endoscope is required to navigate tight curvatures in the 28 anatoinic lumen.

1 A fourth embodiment is shown in Figs. 12-14 using a one-piece grip that 2 allows the guide ineinber to be rotatable relative to the instrument handle.
Fig. 12 is 3 an exploded side view of this fourth embodiment of the guide device used with a 4 second einbodiment of a surgical instrtunent, namely one that includes an interlock 5 between the instruxnent and guide member. Fig. 13 is a view of the proximal end of 6 the guide device of Fig. 12, as taken along line 13-13 of Fig. 12. Fig. 14 is a scliematic 7 side view of the instrument and guide assembly of Fig. 12 in use through an incision.
8 The einbodiment of Figs. 12-14 may be considered as a quiclc discomlect via the use 9 of a catch that readily enables the instrument to be connected and disconnected with 10 the guide member.
11 As shown in Fig. 14 rotation can occur of either the handle or grip. The 12 embodiment depicted in Figs. 12-14 uses a one-piece grip 130 having at one end a 13 raised lip 132 with a catch 133 that extends into the cavity 134. The grip 130 maybe 14 substantially the salne as the grip depicted in Figs. 1-6. The boss 138 on the handle 40 15 has an annular groove 139. The catch 133 is engaged within the annular groove 139 16 once the instru.inent is inserted into the guide member 128. hi the embodiment of 17 Figs. 12-14, the guide member 128 is connected with the instrument in a maimer 18 where the guide meinber 128 can be rotated relative to the instrument or vice versa.

19 This occurs by virtue of the catch 133 being readily rotatable within the groove 139 of the instrument handle. In essence, either the grip 130 can be rotated to rotate the 21 entire guide member or the handle of the instniment itself can be rotated.
These two 22 different rotations are illustrated by separate arrows 121, 123 in Fig. 14 and 23 corresponding arrows 125, 127 at the distal end of the instrument. The rotation arrow 24 121 associated with the handle controls the rotation depicted by the distal arrow 127.
The rotation arrow 123 associated with the grip controls the rotation depicted by the 26 distal arrow 125.
27 In Fig. 14 note that the guide member shaft 18 extends through the cannula 28 at the insertion site 6 of the patient's skin 4. The end effector or tool 38 is disclosed 1 in Fig. 14 as extending from the distal bendable meinber 22. A protective sheath may 2 extend about the distal flex member 22.

3 A locking device or mechanism may also be associated with the instruinent 4 assembly of Fig. 14 in wliich case the cabling between the proximal and distal bendable members 20, 22 is pinched off holding the bendable members in a fixed 6 bendable orientation. Refer to co-pending Application Serial No. 10/822,081, filed 7 April 12, 2004, which is hereby iii.corporated by reference in its entirety, for an 8 illustration of a locking mechanism, particularly set forth in Fig. 27. This is described 9 as locking the cables in a particular position so that the orientation of the bendable ineinbers are fixed. With this arrangement if the guide member is rotated witli the 11 members 20, 22 bent then there is a rotation of the curved distal bendable member, 12 thus displacing the end effector and providing an additional degree of control thereof.
13 This additional degree of control can be provided with several of the embodiments 14 described in this application. Rotation of the instnunent itself rotates the end effector within the guide member.
16 A fifth embodimen.t is shown in Figs. 15-17 in wllich the guide member 17 operates as before, but the additional feature is the support of the instrument that 18 allows a sliding action of the instrument within the guide ineinber, as well as a 19 rotation of the instrument. When the instrument is engaged with the guide member the bending motions can be transferred as in earlier embodiments. In addition the user cail 21 move the instn.unent linearly in and out within the guide member, and can rotate the 22 instrument within the guide member. This embodiment is, in particular, advantageous 23 for intraluminal use of the instrument asseinbly wlZere is may be desirable to have the 24 capability to linearly move the instrument within a body luinen.

Fig. 15 is an exploded side view of the fifth eznbodiment of the guide device 26 with a third einbodiment of the surgical instrument. Fig. 16 is a view of the proximal 27 end of the guide device of Fig. 15, as taken along line 16-16 of Fig. 15.
Fig. 17 is a 28 schematic side view of the instilunent and guide assembly of Fig. 15 in use as inserted 29 through a patient's skin at an incision. As mentioned before the instruinent assembly 1 may also be used intraluixiinally in which case the instrument and guide shafts are both 2 flexible along their respective lengths.
3 In the embodiment of Figs. 15-17, it is noted that the grip 142 has associated 4 therewith a rotational knob 144. The grip and rotationa11mob may be supported such as in the mantler previously described in Fig. 4. In the illustrated embodiment the grip 6 portion and rotation knob are preferably one-piece. The grip portion 142 includes an 7 end wall 146 and a tapered passage 148 for receiving the instn.unent shaft 36. The 8 very proximal end 141 of the shaft 36 may be seated in the tapered passage 148.
9 Because the surgical instrument itself is not secured into the grip, it is possible to move the surgical instrument linearly such as in the direction of the arrow 145 in Fig.
11 17 to provide the coiTesponding linear translation of the end effector as in the direction 12 of arrow 147 illustrated in Fig. 17. In addition to this linear inoveinent, there is, of 13 course, also bending action as occurs in previous elnbodiments between the proximal 14 and distal bendable meinbers of the guide tube.
In the embodiment of Figs. 15-17, the instrument is also capable of being 16 rotated. Arrows in Fig. 17 indicate rotation of the handle and deflection of the 17 proxiinal bendable member. Corresponding arrows indicate motion at the distal end 18 of the iiistrument assembly. Arrow 151 indicates a bending at the proximal bendable 19 member 20 and arrow 153 indicates a corresponding bending at the distal bendable member 22. Arrow 155 indicates a rotation at the instrument handle and arrow 21 indicates a corresponding rotation at the end effector. In Fig. 17 the instrument shaft 22 is shown with a certain length, but it is understood that the length thereof may vary 23 depending upon the particular medical use.
24 Fig. 18 is an exploded side view of a sixth embodiment of the guide device and a fourth embodiment of the surgical instruinent. Fig. 19 is a schematic side view of 26 the instruinent and guide assembly of Fig. 18 in use as inserted tl-irough a patient's 27 skin at an incision. The sixth einbodiment shown in Figs. 18 and 19 uses a one-piece 28 grip including grip portion 142 and 1mob portion 144. The instnunent itself has a 29 rotation lmob 156 witli a boss 158 that extends witliin a cavity 160 of the handle 40.

1 Fig. 18 also illustrates the instrument shaft 162. An end effector 38 is also illustrated 2 at the vely distal end of the instrument shaft. A push-pull cable 164 extends tluough 3 the instrument shaft 162 and is secured at a rotational barrel 166 witliin the slider 168.
4 End effector actuation occurs via the lever 167.The view of Fig. 19 illustrates the insti~zment having been insei-ted into the guide member. At the proximal end of the 6 assembly, there are provided one bendable ineinber 20 of the guide meinber, a rotation 7 lmob and grip on the guide member and and a rotation lo.lob 156 of the instri.unent 8 handle. At the distal end of the instrument, there is provided distal bendable meinber 9 22 of the guide member. The embodiment of Figs. 18 and 19 allows bending at the proximal bendable member and also allows rotation at the knob 156. The catch 11 in the azulular slot 172 of coupler 170 prevents any linear translation of the instnunent 12 relative to the guide member but pennits relative rotation of tlie instrument handle.
13 The 170 is adapted to fit within the cinical cavity 174 of the guide member.

14 In the embodiment of Figs. 18 and 19 there are several degrees of motion that are possibly due to the bendable members that are used and the rotations that are 16 possible. Some of these motion are illustrated in Fig. 19 by means of corresponding 17 arrows. Arrow 171 indicates a rotation of the instnunent and arrow 173 indicates a 18 corresponding rotation at the instrument end effector. Arrow 175 indicates a rotation 19 of the guide member at the grip 142 and arrow 177 indicates a coiTesponding rotation at the distal end of the guide member. Arrow 179 indicates a bending at the bendable 21 section 20 and arrow 181 indicates a corresponding bending at the distal bendable 22 member 22.

23 Reference is now made to related Application Serial Nos. 10/822,081 filed 24 April 12, 2004 and 11/185,911 filed July 20, 2005 which are hereby incorporated by reference herein and considered as a part of the disclosure in the instant application.
26 The subject matter of these applications incorporates proximal and distal bendable 27 members within the instru.inent itself. An instrument of this type can also be used in associationwithtlieguidemeinberofthepresentinventionthatalsoinch.idesproximal 1 and distal bendable sections or members. Embodiments are now described that 2 incoiporate bendable members in both the instrument and guide inember.
3 A seventh embodiment is shown in Figs. 20 and 21. This embodiment employs 4 a non-conventional instrument such as the instrument described in co-pending Application Serial No. 11/185,911, filed July 20, 2005 whichuses proximal and distal 6 bendable sections of the instrument. Thus, the combined assembly actually has two 7 proximal bendable members and two distal bendable members so as to provide greater 8 degrees of control of the end effector. There is a proximal bendable member on the 9 guide meinber and one on the instrument itself. There is a distal bendable member on the guide member and one on the instrument itself.
11 Fig. 20 is an exploded side view of the fifth einbodiment of the guide device 12 as used with a fifth embodiment of the surgical instruinent. Fig. 21 is a schematic side 13 view of the insti-ument and guide assembly of Fig. 20 in use as inserted through a 14 patient's skin at an incision. The embodiment of Figs. 20 and 21 differs from the einbodiinent of Figs. 18 and 19 primarily in that it has the ability to linearly translate 16 the instrument within the guide member. Fig. 21 shows the various motions of the 17 assembly as illustrated by the arrows.
18 Accordingly, in the ei.nbodiinent of Figs., 20 and 21 there is provided an 19 instruinent that has a rotation kn.ob 182 with a boss 184 that extends within a cavity 2 0 186 of the handle 40. Fig. 20 also illustrates the instrument shaft 162, the proximal 21 bendable member 188 and the distal bendable member 190. An end effector 38 is also 22 illustrated at the very distal end of the instrument shaft. A push-pull cable 164 23 extends through the instrulnent shaft 162 and is secured at a rotational balTel 166 24 within the slider 168. For further details of the instrument described in Fig. 20, refer to Application Serial Nos. 10/822,081 and 11/185,911 and, in particular, Fig.
8 of 26 Serial No. 11/185,911.
27 The embodiment in Figs. 20 and 21 also includes the grip portion 142 and the 28 rotation lclob 144 that have been described previously in connection wit11 Figs. 15-17.
29 In Fig. 20 the guide member 140 also includes proxiinal bendable menzber 20, distal 1 bendable member 22 at7d guide shaft 18. The coupler 26 connects the proximal 2 bendable inember with the guide shaft.

3 The view of Fig. 21 illustrates the instrument having been inserted into the 4 guide member. At the proximal end of the assembly, there are provided two bendable 5 meinbers, nainely, proximal bendable meinbers 20 and 188, associated, respectively, 6 with the grip 142 and the instrument handle 40. At the distal end of the instrument, 7 there are provided distal bendable members 22 and 190 associated, respectively, with 8 the guide shaft 18 and the instrument shaft 162. The version of Fig. 21 also can 9 provide linear translation of the instrument within the guide.. The arrows in Fig. 21 10 show tlie various motions.
11 In the embodiinent of Figs. 20 and 21 there are several degrees of motion that 12 are possibly due to the several bendable melnbers that are used and the rotations that 13 are possible. Some of these motion are ilh.istrated in Fig. 21 by means of 14 corresponding arrows. A.rrow 171 indicates a rotation of the instruinent at the laiob 15 182 and arrow 173 indicates a corresponding rotation at the instrument end effector.
16 Arrow 175 indicates a rotation of the guide member at the grip 142 and aiTow 177 17= indicates a corresponding rotation at the distal end of the guide member.
Arrow 179 18 indicates a bending at the bendable section 20 and arrow 181 indicates a 19 coiTesponding bending at the distal bendable mernber 22. AiTow 183 indicates a 20 bending at the bendable section 188 and arrow 185 indicates a corresponding bending 21 at the distal bendable member 190.

22 An eighth embodiment of the invention is illustrated in Figs. 22 and 23.
This 23 embodiment is quite similar to the embodiment illustrated in Figs. 20 and 21 in that 24 it uses the two pairs of cooperating bendable sections, one pair on the instrlunent and the otlier pair on the guide member. However, in this embodiment a one-piece grip 26 portion is employed with a catch 176 for securing the instrument within the grip 27 portion, while allowing rotation, but no linear translation. Refer to Figs.
12-14 for 28 f-urther details of the grip portion of the guide menzber.

1 Fig. 22 is an exploded side view of the sixth embodiment of the guide device 2 as used with a sixtli einbodiment of the surgical instruinent. Fig. 23 is a scheinatic side 3 view of the instruinent and guide assembly of Fig. 22 in use as inserted through a 4 patient's skin at an incision. In Fig. 22 the guide meinber 142 has a conical cavity 174 into which the catch 176 can extend for engagement with the instrument body.
This 6 engagelnent allows relative rotation but not linear translation. , 7 Accordingly, in the embodiment of Figs. 22 and 23 there is provided an 8 instruinent 194 that has a rotation Itnob 182 with a boss 184 that extends within a 9 cavity 186 of the handle 40. Fig. 22 also illustrates the instrument shaft 162, the proximal bendable member 188 and the distal bendable member 190. An end effector 11 3 8 is also illustrated at the very distal end of the instrument shaft. A
push-pull cable 12 164 extends tlirough the instrument shaft 162 and is secured at a rotational barrel 166 13 within the slider 168. For fiirther details of the instrLunent described in Fig. 22, refer 14 to Application Serial Nos. 10/822,081 and 11/185,911 and, in particular, Fig. 8 of Serial No. 11/185,911.
16 The einbodiment in Figs. 22 and 23 also includes an instrument having a 17 cover or coupler 192 that connects the proximal bendable member 188 with the guide 18 shaft 162. The coupler 192 has an annular groove 196 that is adapted to receive the 19 free end of the catc11176. This catch and groove arrangement allows rotation between the instrument and the guide member. The conical surface of the coupler 192 mates 21 with the conical shaped cavity 174 in the grip 142. Fig. 23 shows the instrument fiilly 22 and operably engaged with the guide member.
23 In the embodiment of Figs. 22 and 23 there are several degrees of motion that 24 are possibly due to the several bendable menzbers that are used and the rotations tliat are possible. Some - of these motion are illustrated in Fig. 23 by means of 26 corresponding arrows. Arrow 171 indicates a rotation of the instrument at the kn.ob 27 182 and arrow 173 indicates a corresponding rotation at the instrument end effector.
28 Arrow 175 indicates a rotation of the guide member at the grip 142 and arrow 177 29 indicates a corresponding rotation at the distal end of the guide member.
Arrow 179 1 indicates a bending at the bendable section 20 and arrow 181 indicates a 2 corresponding bending at the distal bendable member 22. Arrow 183 indicates a 3 bending at the bendable section 188 and arrow 185 indicates a corresponding bending 4 at the distal bendable member 190.

A nineth em.bodiinent of the present invention is shown in Fig. 24 in which the 6 guide member accoinmodates lnultiple instruments as well as other possible 7 instrui.nentation. Any of the various instru.inents that have been previously illustrated 8 may be used in this einbodiinent. Fig. 24 shows a channel that may be used, for 9 example, for iirigation purposes or for optics. Fig. 24 is an einbodiment in which the guide shaft has multiple chanllels for receiving multiple instruments or other devices 11 and may be either flexible, rigid or semi-flexible. Fig. 24 shows a connector 216 12 coupled to a proximal end of a catheter or other tubular device 214 that can be used 13 either for optics or for other purposes. The tube 214 extends through one of the 14 ltilnens within the guide member 200. Both of the instruments illustrated in Fig. 24 inay be considered as of the same type as previously described in either Fig.
20 or 22.
16 Each of these instruments is illustrated as controling a respective end effector 38.
17 In the embodiment of Fig. 24 there is provided a one-piece grip 202 having a 18 raised lip 204 that maybe grasped by the user. In an alternate einbodiment a two-piece 19 grip may be used. The guide zneinber has a proximal bendable member 206 and a distal bendable member 208. Cabling connects between these bendable members in 21 the same manner as previously described with guide members having only one lumen.
22 The guide meinber 200 may be considered as having three separate lumens;
two 23 lumens 210 accommodate the respective instru.znents 180 and one lumen 212 is for 24 receiving the catlzeter, tube or sliaft 214. hi this embodiment because the instnunents ilave been described before there is no detailed description herein. Refer to Figs. 19-26 23. Each of the instruments includes a proximal bendable section 188 and a distal 27 , bendable section 190. Each also includes a control knob 182.

28 hi the einbodiment of Fig. 24 there are several degrees of motion that are 29 possible due to the several bendable members that are used and the rotations that are 1 possible. Sonie of these motion are illustrated in Fig. 24 by means of corresponding 2 aiTows. Arrow 171 indicates a rotation of the instnunent at the luiob 182 and arrow 3 173 indicates a corresponding rotation at the instruinent end effector.
AiTow 175 4 indicates a rotation of the guide member at the grip 142 and arrow 177 indicates a corresponding rotation at the distal end of the guide member. Arrow 179 indicates a 6 bending at the bendable section 20 and arrow 181 indicates a corresponding bending 7 at the distal bendable member 22. Arrow 183 indicates a bending at the bendable 8 section 188 and arrow 185 indicates a corresponding bendii7g at the distal bendable 9 member 190.
Reference is now made to a fiirther einbodiment of the present invention 11 illustrated in Fig. 25 in which the guide member accepts one or more instruments, but 12 instead of having a single bendable member on each end of the guide shaft there are 13 two or more bendable meinbers or sections on each end. A first proximal bendable 14 ineinber controls a first distal bendable member and a second proximal bendable meinber controls a second distal bendable member. The control is by means of first 16 cabling that extends between the respective first bendable members and separate 17 second cabling that extends between the respective second bendable members.
h.i this 18 way, an instrument inserted in the guide member has enhanced control by virtue of 19 added degrees of control with the multiple proximal bendable members controlling respective multiple distal bendable members.
21 Fig. 25 shows an instnzment guide member that incorporates the multiple 22 bendable member concepts. This guide member 220 may be similar to that described 23 previously in Fig. 1 but includes multiple bendable sections at botli ends of the guide 24 member. Although only two bendable meinbers are illustrated at each end of the guide member, it is understood that more than two may be incoiporated in the guide device 26 220. The guide member 220 may receive an instru.ment such as the instrument 27 disclosed in Fig. 1, but can also receive other instrument designs such as other ones 28 disclosed herein or in the related application mentioned herein. The particular 29 instnunent of Fig. 1 locks to the grip portion 222 of the gz.iide member 220 by means 1 of the locking screw 224. Ail end effector (not shown) extends from the veiy distal 2 end of the guide inember 220 when the instrument is fully inserted in the guide 3 member. The guide of Fig. 25 may also acconunodate multiple instruments, as in Fig.
4 24.

In Fig. 25, the guide member or guide instruinent 220 is depicted separately 6 from the surgical instrument as in Fig. 1. The assembled system has the instrument 7 inserted into and through the guide member 220. The guide member 220 includes a 8 guide shaft 226 that may extend through a cannula at an insertion site of the patient 9 disposing the proximal bendable members outside the patient and the distal bendable inembers within the patient adjacent the operative site. The end effector or tool 11 extends fiom the very distal end of the guide meinber. A protective sheath may 12 extend about one or both of the distal flexible or bendable members.
13 The guide member 220, in addition to including the guide shaft 226, also 14 includes a first proximal flexible or bendable member 228A and a second proximal flexible or bendable member 228B. An adaptor cover 232 is disposed about a portion 16 of the proximal bendable member 228B. The adaptor cover 232 includes a fumlel or 17 conical-shapedportionorcavity234(seecavity96inFig. 6) for respectively receiving 18 ends of the proximal bendable meinber 228B and the guide shaft 226. The more 19 proximal end of the proximal bendable meinber 228B is held in an intermediate member 236 that may be of various lengths depending upon the particular medical 21 application. The intermediate section 236 may be rigid, flexible or semi-flexible, but 22 is preferably rigid. The intermediate member 236 also holds the more distal end of the 23 proximal bendable meinber 228A. The bendable members 228A and 228B are thus 24 separately mounted and can be separately controlled from the instrument handle actions.

26 The grip 222 of the guide meinber 220 receives the other end of the proximal 27 bendable meinber 228A. The grip 222 is preferably a single piece structure having a 28 cavity 238 for receiving the boss of the instruinent, as depicted in Fig.
1. The boss 29 may also be provided with a recess for receiving the locking screw 224 that extends 1 tlirough the grip 222 into the cavity 238 and into the recess in the instnunent. The use 2 of the locking screw 224 secures the instruinent within the guide melnber 222.
3 Motions of the instrument are thus directly transferred to the grip 222 and both of the 4 proxilnal bendable members. The lengtli of the gLude meinber is selected so that the 5 instnament tool extends beyond the end of the guide member, as depicted in Fig. 3.
6 The embodiment ofFig. 25 also discloses the details ofthe proximal and distal 7 bendable members 228 and 230. Each of the members inay be constructed as 8 illustarted before in Figs. 4-6. All of these bendable member have a central passage 9 througli wliich the instnunent shaft can extend. Fig. 25 also illustrates the lumen 240 10 defined by the guide shaft 226 with the instrument shaft extendable tllerethrough.
11 Similarly, the distal bendable meinbers include a centrally disposed passage for 12 receiving the more distal end of the instrument shaft. In. Fig. 25 the guide shaft 226 is 13 shown as rigid, but-could also be partially flexible or flexible. The guide shaft 226 14 may be made of a light weight metal material or of plastic.

15 The grip 222 inch.ides a cavity (see Fig. 6) for receiving one end of the 16 proximal bendable meinber 228A. The grip 222 also preferably inchides a raised lip 17 that is useful in grasping the guide grip 222. The raised lip preferably has spaced 18 finger grooves. This bendable member 228A is seated at an end wall of the grip 222.
19 This end wall may have a tapered or conical passage for receiving the instruznent 20 shaft. As depicted in Fig. 6, there are also provided several passages for cabling. The 21 grip 222 inay also include a cavity for anchors and springs, as depicted in the first 22 einbodiment described herein. This includes a plurality of proximal anchors and 23 related springs. The springs are for tensioning the associated cables. For the proximal 24 bendable member 228B the anchors and springs may be disposed in the intennediate 25 member 236. Cabling associated wit11 the proximal bendable member 228A
passes 26 through the intennediate member 236.

27 The guide member 220, at the distal end thereof, includes a pair of spacedly 28 disposed distal bendable members 230A and 230B separated by the intennediate 29 ineinber 244. The distal bendable members 230A and 230B may include an extending 1 end 242 for receiving distal anchors that secure the distal ends of the actuation cables.
2 The actuatioii cables associated with the distal bendable mem.ber 230A inay be 3 disposed in the inteniiediate section 244 between the distal bendable meinbers 230A, 4 230B. The control between the proxiinal and distal bendable members is carried out primarily by means of a set of cables that extend between these bendable meinbers.
6 A bending at the proximal bendable member causes a pulling of one or more cables 7 while there is a relaxing of otller opposed cables causing a correspondiiig bending 8 action at the distal bendable member. The cabling may be provided in either the 9 arragement of Fig. 7 or of Fig. 8, depending on the desired direction of bending.
The cabling that is used includes flexible cables that extend between the 11 proximal and distal bendable members. Refer to Fig. 1. A plurality of distal anchors 12 are used at each end of the cabling. Cable passages are provided in the proximal 13 bendable meinbers and the distal bendable lneznbers. The passages accommodate 14 these cables. Also, guide discs (not shown) may be provided along the cables, .15 particularly witlii.n the guide shaft so as to assure that the cables are maintined in 16 position as they extend from one end of the guide shaft to the other end.
17 The proximal bendable members are each coinprised of a series of adjacent 18 discs that define therebetween spaces or slots, as in Figs. 4-6. Conuecting ribs extend 19 between adjacent discs. Fig. 5 depicts the location of the ribs. In a similar manner, the distal bendable members each include a series of discs that define therebetween slots 21 or spaces. Ribs extend between adjacent discs. For further details of the bendable 22 members and the preferred relationship between the disks, slots and ribs, refer to 23 Application Serial No. 11/185,911, filed on July 20, 2005, the content of which is 24 hereby incorporated by reference herein.
Now, in the embodiment of Fig. 25 the cabling is preferably connected so that 26 there are four cables between the proximal bendable member 228A and the distal 27 bendable member 230B, and likewise there are four cables between the proximal 28 bendable member 228B and the distal bendable meinber 230A. In an alternate 29 an-angeinent the cabling from the proximal bendable member 228A may control the 1 distal bendable ineinber 230A and the cabling from the proximal bei7dable meinber 2 228B may control the distal bendable meinber 230B. Also, fewer or greater numbers 3 of cables may b e used for control between the proximal and distal bendable members.
4 The user ofthe instrument system may grasp the instn.unent handle, engage the instzliment with the guide, as in Fig. 3 and manipulate the guide member essentially 6 by manipulating the instrument handle which is secured to the guide grip 222. A
7 deflection, for example, of the proximal bezidable member 228A causes the cables to 8 be tensioned and relaxed so as to cause the distal bendable member 230B to be 9 correspondingly deflected. This deflection maybe in the saine direction or in opposed directions. See Figs. 7 and 8. Similarly, a deflection of the proximal bendable member 11 228B causes the cables to be tensioned and relaxed so as to cause the distal bendable 12 member 230A to be correspondingly deflected.
13 Having now described one embodiment of the present invention, it should now 14 be apparent to those skilled in the art that numerous other embodiments and modifications thereof are contemplated as falling within the scope of the present 16 invention as defined by the appended claims.
17 What is claimed is:

Claims (23)

1. An instrument guide device comprising:

an elongated guide shaft having proximal and distal ends and including an instrument lumen for receiving therethrough a manually operated instrument having an instrument shaft and handle;

a distal bendable member disposed at the distal end of the guide shaft, a proximal bendable member disposed at the proximal end of the guide shaft;
and actuation means extending between said distal and proximal bendable members and providing a bending of said distal bendable member controlled from said proximal bendable member;

whereby said proximal bendable member is controlled from said manually operated instrument to cause a corresponding bending of said distal bendable member.

2. The instrument guide device of claim 1 wherein said actuation means is constructed and arranged so that a bending of the proximal bendable member causes a like direction bending of the distal bendable member

3 The instrument guide device of claim 1 wherein said actuation means is constructed and arranged so that a bending of the proximal bendable member causes an opposite direction bending of the distal bendable member.

4. The instrument guide device of claim 1 wherein said proximal bendable member is moveable in any direction.

5. The instrument guide device of claim 1 including a grip disposed between said proximal bendable member and the handle of said instrument and constructed and arranged to have a passage through which the instrument shaft extends.

6. The instrument guide device of claim 5 wherein said grip is formed as two pieces including a grip portion and a rotation knob and said grip and knob portions are supported for relative rotation therebetween.

7. The instrument guide device of claim 5 including means or securing the instrument handle to the grip.

8. The instrument guide device of claim 1 wherein said bendable members each comprise a unitary slotted structure having a plurality of discs separated by slots.

9. The instrument guide device of claim 1 wherein said guide shaft is rigid.

10. The instrument guide device of claim 1 wherein said guide shaft is flexible.

11. The instrument guide device of claim 1 including a plurality of proximal bendable members and a plurality of distal bendable members.

12. The instrument guide device of claim 1 wherein said actuation means comprises a plurality of cables that interconnect proximal and distal bendable members.

13. The instrument guide device of claim 1 wherein said guide shaft has at least two lumens for respectively accommodating separate instrument shafts.

14. The instrument guide device of claim 1 wherein said instrument has instrument proximal and distal bendable members.

15. A surgical instrument assembly comprising:

an elongated instrument shaft having proximal and distal ends;

a working member coupled from the distal end of the instrument shaft;
a control handle disposed at the proximal end of the instrument shaft;
a guide member for receiving the instrument shaft and including;

a guide shaft;

a distal motion means at the distal end of said guide shaft;

a proximal motion means at the proximal end of said guide shaft; and actuation means extending between said distal and proximal motion means;
said working member extending beyond a distal end of the guide shaft at an operative site;

whereby any deflection of said proximal motion means causes a corresponding deflection of said distal motion means for control of said working member.

16. The surgical instrument assembly of claim 15 wherein said distal motion means comprises a distal bendable member and said proximal motion means comprises a proximal bendable member that is moveable in any direction.

17. The instrument guide device of claim 16 including a grip disposed between said proximal bendable member and the handle of said instrument and constructed and arranged to have a passage through which the instrument shaft extends.

18. The instrument guide device of claim 17 wherein said grip is formed as two pieces including a grip portion and a rotation knob and said grip and knob portions are supported for relative rotation therebetween.

19. The instrument guide device of claim 16 wherein said proximal bendable member comprises a unitary slotted structure having a plurality of discs separated by slots and further including a plurality of ribs interconnecting adjacent discs, said ribs being disposed at intervals about the member of less than 90 degrees.

20. A surgical instrument comprising:

an elongated instrument shaft having proximal and distal ends;

a working member disposed at the distal end of the instrument shaft; and a control handle disposed at the proximal end of the instrument shaft, said working member being coupled to the distal end of said elongated instrument shaft via a distal motion member;

said control handle coupled to the proximal end of said elongated instrument shaft via a proximal bendable member;

actuation means extending between said distal and proximal members whereby any deflection of said control handle with respect to said elongated instrument shaft causes a corresponding bending of said distal motion member for control of said working member;

wherein at least said proximal bendable member comprises a unitary slotted structure having a plurality of discs separated by slots.

21. The instrument guide device of claim 20 wherein said distal motion member also comprises a bendable member formed as a unitary slotted structure having a plurality of discs separated by slots.

22. The instrument guide device of claim 16 wherein said proximal bendable member includes a plurality of ribs interconnecting adjacent discs, said ribs being disposed at intervals about the member of less than 90 degrees.

23. The instrument guide device of claim 22 wherein said ribs are disposed at an interval on the order of 60 degrees.