Abstract:
Surgical devices with integrated, visualization and cauterization are described herein where such devices include an elongate structure having a central lumen and an expandable space-creating structure having at least one expandable leaflet mounted in the vicinity of the distal end and is configured for placement within a mammalian body proximate to a therapeutic target. Also included is a proximal terminal having an actuator mounted in the vicinity of the proximal end and is configured to remain outside of said body and provide an actuation mechanism for actuating the space-creating structure. Additionally, at least one fluid connector and said central lumen is in fluid communication between an interior of the expandable space-creating structure and the at least one fluid connector.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. patent application Ser. No. 14/168,717 filed Jan. 30, 2014, which claims the benefit of U.S. Provisional Application No. 61/762,660, filed Feb. 8, 2013, the content of which is incorporated herein by reference in its entirety. 
     
    
     BRIEF SUMMARY OF THE INVENTION 
       [0002]    It is an object of this invention to provide a surgical device comprising a means for accessing a therapeutic target within a mammalian body, a means for creating space proximate to the therapeutic target, a means for visualizing the therapeutic target and surroundings, and a means for providing therapy. 
         [0003]    In accordance with another aspect of this invention is a surgical device comprising a means for accessing a therapeutic target within a mammalian body, a means for creating space proximate to the therapeutic target, a means for visualizing the therapeutic target and surroundings, and a means for providing therapy, configured to access the therapeutic target through a natural bodily orifice. 
         [0004]    In accordance with another aspect of this invention is a surgical device comprising a means for accessing a therapeutic target within a mammalian body, a means for creating space proximate to the therapeutic target, a means for visualizing, the therapeutic target and surroundings, and a means for providing therapy, configured to access the therapeutic target through a surgically created orifice. 
         [0005]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and at least one fluid connector, whereby said expandable structure comprises at least one expandable leaflet, and said central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0006]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and at least one fluid connector, whereby said expandable structure comprises at least one optically transparent expandable leaflet, and said central lumen is in fluidic communication between the interior of the expandable space-creating structure, and the at least one fluid connector. 
         [0007]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to rerun in outside of said body and provide the user with a means for actuating the space-creating structure, and at least one fluid connector, whereby said expandable space-creating structure comprises at least one optically transparent expandable leaflet, and at least one internally mounted imaging device, and said central lumen is in fluidic, communication between the interior of the expandable space creating structure and the at least one fluid connector. 
         [0008]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one optically transparent expandable leaflet, at least one internally mounted imaging device, and at least one internally mounted light emitting device, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the expandable space-creating structure, and at least one fluid connector, whereby, said imaging device is a camera, and said light emitting device is an array of light emitting diodes, and the central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0009]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one optically transparent expandable leaflet, at least one internally mounted imaging device, and at least one internally mounted light emitting device, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the expandable space-creating structure, and at least one fluid connector, whereby, said imaging device comprises a coherent optical bundle, and the central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0010]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one optically transparent expandable leaflet, at least one internally mounted imaging device, and at least one internally mounted light emitting device, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the expandable space-creating structure, and at least one fluid connector, whereby, said the aim of said imaging device is associated with the expansion of said leaflet, and the central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0011]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one optically transparent expandable leaflet, two internally mounted imaging devices, and at least one internally mounted light emitting device, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the expandable space-creating structure, and at least one fluid connector, whereby, said imaging devices are configured for three dimensional imaging, and the central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0012]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one optically transparent expandable leaflet, at least one internally mounted imaging device, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the expandable space-creating structure, and at least one fluid connector, whereby, said imaging device comprises and ultrasonic imaging transducer, and the central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0013]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen: an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least one fluid connector, and at least one electrical connector, whereby said expandable structure comprises at least one expandable leaflet comprising a radiofrequency electrode surface disposed in the vicinity of its edge, and in electrical communication with said at least one electrical connector, and said central lumen is in fluidic communication between the interior of the expandable space creating structure and the at least one fluid connector. 
         [0014]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, and a central lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least one fluid connector, and at least two electrical connectors, whereby said expandable structure comprises at least one expandable leaflet comprising a radiofrequency electrode surface disposed in the vicinity of its edge, a second electrode surface disposed in opposition to the first electrode surface with the first electrode surface in electrical communication with one electrical connector, and the second electrode surface in electrical communication with the second electrical connector, and said central lumen is in fluidic communication between the interior of the expandable space-creating structure and the at least one fluid connector. 
         [0015]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication with the second fluid connector, wherein the central lumen is configured for aspiration, and the second lumen is configured for irrigation. 
         [0016]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between the distal end of said expandable leaflet, and the second fluid connector, wherein the central lumen is configured for aspiration, and the second lumen is configured for irrigation. 
         [0017]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between the distal end of said expandable leaflet, and the second fluid connector, wherein the central lumen is configured for aspiration, and the second lumen is configured for hydro-dissection. 
         [0018]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least two opposing expandable leaflets, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between the distal end of each said expandable leaflet, and the second fluid connector, wherein the central lumen is configured for aspiration, and the second lumen is configured for hydro-dissection, wherein the hydro-dissection may be in a determined direction including distal, proximal, or lateral directions. 
         [0019]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, and a mechanical macerator disposed within the central lumen, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between interior of said expandable space-creating structure, and the second fluid connector, wherein said mechanical macerator is configured for maceration of tissue occupying the internal space of said expandable space-creating structure during therapy. 
         [0020]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, and a cryo-ablation probe disposed within the central lumen, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is m fluidic communication between interior of said expandable space-creating structure, and the second fluid connector, wherein said cryo-ablation probe is configured for cryo-ablation of tissue occupying the internal space of said expandable space-creating structure during therapy. 
         [0021]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, and a laser ablation disposed within the central lumen, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between interior of said expandable space-creating structure, and the second fluid connector, wherein said laser ablation probe is configured for laser ablation of tissue occupying the internal space of said expandable space-creating structure during therapy. 
         [0022]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, and a microwave ablation probe disposed within the central lumen, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between interior of said expandable space-creating structure, and the second fluid connector, wherein microwave ablation probe is configured for microwave ablation of tissue occupying the internal space of said expandable space-creating structure during therapy. 
         [0023]    In accordance with another aspect of this invention is a surgical device comprising an elongated flexible structure comprising a distal end, a proximal end, a central lumen, and at least one additional lumen; an expandable space-creating structure mounted in the vicinity of the distal end configured for placement within a mammalian body proximate to a therapeutic target comprising at least one expandable leaflet, and a proximal terminal comprising an actuator mounted in the vicinity of the proximal end configured to remain outside of said body and provide the user with a means for actuating the space-creating structure, and comprises at least two fluid connectors, and a ultrasonic energy ablation probe disposed within the central lumen, whereby said central lumen is in fluidic communication between the interior of the expandable space-creating structure and one fluid connector, and said at least one additional lumen is in fluidic communication between interior of said expandable space-creating structure, and the second fluid connector, wherein said ultrasonic energy ablation probe is configured for ultrasonic energy ablation of tissue occupying the internal space of said expandable space-creating, structure during therapy. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0024]      FIGS. 1A-1C  show perspective views of a hi-leaflet embodiment of the present invention. 
           [0025]      FIGS. 2A-2D  show side and end views of another embodiment where a camera is mounted within the transparent or translucent space of leaflet. 
           [0026]      FIGS. 3A-3C  perspective views of a lower leaflet that is capable of performing ablation and cauterization of the tissue. 
           [0027]      FIGS. 4A and 4B  show perspective views of another embodiment incorporating fluid irrigation. 
           [0028]      FIGS. 5A-5C  show another embodiment with a plurality of leaflets. 
           [0029]      FIGS. 6A-6D  show a device for actuation of the subject invention. 
           [0030]      FIGS. 7A-7D  show another embodiment where the device is constructed of a metallic or hard polymer to allow it to puncture the skin of an individual. 
           [0031]      FIGS. 8A-8B  show another embodiment where the removal of the resected tissue segment is assisted by the use of high pressure fluid carried to a region near the distal end of the device. 
           [0032]      FIG. 9  shows another embodiment where a morcellator assists in the removal of the tissue by breaking it up into small pieces. 
           [0033]      FIG. 10  shows another embodiment whereby two jets of high pressure fluid exit a region near the tip of the device through ports. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0034]      FIGS. 1A-1C  show a bi-leaflet embodiment of the present invention. In  FIG. 1A  the two leaflets are identified as elements  110  and  111 . Either one or both of these leaflets can be made transparent or translucent for a visualizing element, which might be inserted in the outer sheath  120  of the device to see through these leaflets and provide guidance for the operator while travers in the tissue to get to a target site. This visualizing element can be a rigid or flexible endoscope, a digital micro camera like the ones that Medigus or Awaiba markets, it could also be a fiber optic image bundle or any other image-carrying device. Transparent or translucent leaflets make visualization thru closed leaflets possible. 
         [0035]      FIG. 1B  shows another view of the present invention where the inner tube  112  is visible through the transparent leaflets. As this inner tube,  112  moves forward, it acts upon the leaflets  110  and  111  pushing them outward as explained below in  FIG. 1C . 
         [0036]    As  FIG. 1C  illustrates, the bi-leaflet structure is actuated and opened in an outward direction in order to achieve the desired tissue dilation and visualization. Element  112  is a tube tightly fitting within the outer sheath  120  and is in turn connected to the arm  114  through hinge  113 . The arm  114  is in turn connected to the leaflet  111  through hinge  115 . Forward motion of the tube  112  in cooperation with elements  113 ,  114 , and  115  places an outward force on leaflets  110  and  111  leading to their movement away from the central axis of the sheath  120 . This force will be modulated by the mechanical advantage within the handle of the device to maintain a constant dilation force by the leaflet. 
         [0037]      FIG. 2A  shows another embodiment of the current invention where a camera  280  is mounted within the transparent or translucent space of leaflet  211  and looks forward through the leaflet  211  long the optical axis  216 , in a somewhat paraxial arrangement. Camera  280  is connected to the top leaflet,  211  through arm  214  and aim  214  in turn is connected to the leaflet and camera through hinges  213  and  215 .  FIG. 2B  shows the current embodiment with the leaflets slightly opened. Camera  280  is now looking slightly downward towards the central axis of the sheath  220 . 
         [0038]      FIG. 2C  illustrates further opening of the leaflets and now camera  28  is looking even further inward toward the optical axis and thereby provides a more relevant image to the operator who is interested in the tissue that is closer to the opening of the device.  FIG. 2D  is a front view of the subject invention illustrating the full lumen access upon opening of the leaflet as was mentioned before. 
         [0039]      FIG. 3A  shows the lower leaflet of the subject invention,  300  that is capable of performing ablation and cauterization of the tissue. This embodiment of the subject invention is intended to take a partial bite of the tissue, which makes it easier to remove the dissected tissue that would be contained within the space between the two leaflets when the leaflets are closed and the tissue that&#39;s contained between the leaflets is separated from the surrounding area and the leaflets are touching alongside their length. In procedures where the operator is dependent on the clear visualization, cauterizing of the remaining surface of the dissected tissue prevents bleeding and creating turbidity in the irrigating fluid and thereby clouding the view. The leaflet can be made out of many different materials as described before. 
         [0040]    Element  310  represents the lower leaflet that could be metallic or transparent or translucent as described before. Element  340  represents the portion of the lower leaflet which is conducive to electrical energy and in cooperation with the upper leaflet is utilized to resect the tissue by radio frequency. Element  330  is a high temperature non-conductive material with an expansion coefficient that is properly chosen to minimize the relative motion between elements  310 ,  330 ,  340 . Examples of such materials include ceramics, polyimide, polysulfone, silicone, and other materials that have the qualities that were described. 
         [0041]    Element  340  is a conductor chosen from the metallic group of materials or conductive polymer materials. This element will be electrically connected to a source of energy that would be used to cut and cauterize tissue. There is an identical element to  340 , identified as  341 , which is located on the upper leaflet. Elements  340  and  341  could also he made out of a fiber optic that can be connected to a source of high power laser so the tissue is optically cut and cauterized as known in the art. When electrical energy applied to ablate and cauterize the tissue a radio frequency generator might be utilized to supply the required energy to this element which would in turn conduct this energy through the tissue and by the virtue of ohmic resistance of the tissue heat the tissue up to very high temperature quickly and thereby vaporize the intervening tissue between elements  340  on the lower leaflet and element  341 , its mating part on the upper leaflet,  341 . In case of and RE energy source that is bipolar as known in the art, conduction of energy occurs between these two elements, the upper and lower leaflets ( 340 ,  341 ). One can also utilize a mono-polar source of RF energy, which would be connected to both elements  340 ,  341  with a single wire and would require a reference patch at a remote location on the patient&#39;s body to complete the circuit. 
         [0042]    Element  350  identifies an insulator which could be made out of hard foam, silicone, cork, acrylic,  335  polycarbonate and similar materials. Element  340  is a conductive metallic. structure that has a sharp tip in the direction of the opposite leaflet. Element  330  is the insulator as described previously. 
         [0043]      FIG. 3B  shows the current invention with both leaflets  310  and  311  in the open position. The sheath  360  is connected to these leaflets through the hinges and arms as previously described. 
         [0044]      FIG. 3C  one can see both leaflets in a closed position. The conductive elements  340  and  341  are contiguous or adjacent with very close proximity. Elements  350  and  351  show the insulating material as described the benefit of this insulating material is evident in this figure in as much as they prevent premature contact of the two blades when the energy source is of a Bipolar nature and also they limit the size of the tissue that is resected with each closure of the leaflets. 
         [0045]      FIG. 4A  shows the device of the current invention incorporating irrigation and aspiration. Lumen  420  carries the irrigating fluid to the source outside the device at an appropriate pressure to the opening  430  where the irrigating fluid exits and through the inner tube  412  is aspirated. The arrow  440  shows the direction of the flow of the irrigating fluid. 
         [0046]      FIG. 4B  shows another embodiment of the current invention incorporating fluid irrigation where the path of the fluid is between openings  430  and  431  carried by lumens  420  and  421 . Arrow  410  shows the direction of the flow of the fluid between openings  430  and  431 . This embodiment of the current invention will provide the benefit of clearing of the operating area from blood and debris with a fluid flow path that extends beyond the distal end of the device. 
         [0047]      FIG. 5A  shows yet another embodiment of the subject invention with a plurality of leaflets which is comprised of 6 leaflets in this embodiment. This embodiment also incorporate an opening  590  which when the leaflets are in the closed, position to provide a path to follow a guide wire that may have been inserted through the path of the interest to make it easier for this embodiment of the device to navigate through the tissue to the target. 
         [0048]      FIG. 5B  shows the device of the  FIG. 5A  in an open position. The mechanism of opening of each of these leaflets can be inferred from  FIG. 1C . 
         [0049]      FIG. 5C  shows the device in a completely open position accentuating the fact that the main lumen of the device  580  is unobstructed and fully available for passing of the tools of interest. 
         [0050]      FIG. 6 , A through C show a device for actuation of the subject invention which includes a handle  610 , a trigger  620 , a shaft  630  a flexible section  640 , and a distal end effector  650 . Figures A through C show the sequential movement of the trigger  620  and the opening of the end effector  650  further and further with the gradually increasing pressure applied to the trigger  620 . As this increasing pressure is being applied, where the trigger moves between positions  1 ,  2 , and  3  the distal multi leaflet structure opens wider and wider. Outer tube  660  contains an inner flexible tube  612 , which is shown in  FIG. 6D  in the cross sectional, view. Tube  612  is flexible enough to follow the flexible section,  640  of this device. 
         [0051]      FIG. 6D  shows the relationship of the outer tube  660  and the inner tube  612 . The tube  612  and  660  are chosen such that the inner diameter of the tube  660  closely matches the outer diameter of the flexible tube  612  in order to prevent undesirable movement from tube  612  while maintaining a small gap to allow relative longitudinal motion between these tubes. 
         [0052]      FIG. 7A  shows another embodiment of the subject invention where the device is constructed of a metallic or hard polymer to allow it to puncture the skin of an individual. The lower leaflet of the device  700 , which is identified  710 , is made rigid to have high column strength in order to make it easier to penetrate the skin like a common hypodermic needle. The upper leaflet  711  is hinged to the body of the device. 
         [0053]      FIG. 7B  shows the position of the camera within the upper leaflet  711  of the device. 
         [0054]      FIG. 7C  shows the device  700  with a leaflet separated and camera  712  can be seen in a position where the field of view is looking forward at the field of interest. 
         [0055]      FIG. 7D  shows the device  700  from a frontal point of view and as with the previous described devices the lumen  790  is unobstructed and fully available for the insertion of tools, fluids or performing aspiration. 
         [0056]      FIG. 8A  shows yet another embodiment of the present invention  800  where the removal of the resected tissue segment  820  is assisted by the use of high pressure fluid in two streams of  840  and  841  that are carried to a region near the distal end of the device and once the leaflet  810  and  811  come together and form a seal as in  FIG. 8B  they induce pressure where they push the resected tissue segment  820  back into the tube  860  and pushes it all the way out of this tube into the proximal section of the tube outside the body of the patient. 
         [0057]      FIG. 9  shows another embodiment of this invention where morcellator  970  assists in the removal of the tissue by breaking it up into small pieces and thereby allowing it to be removed by vacuum applied at the proximal end of the tube  960  and prevents the clogging, of the tube by a large piece of tissue. 
         [0058]      FIG. 10  shows another embodiment of the present invention whereby two jets of high pressure fluid  1040  and  1041  exit a region near the tip of the device through ports  1030  and  1031  which are unitary with leaflets  1010  and  1011 . Fluid jet  1040  and  1041  exit ports  1030  and  1031  at high velocities enabling the device to perform hydro dissection as known in the art. These jets of fluid can be applied in either open or closed positions of the leaflets.