Patent Publication Number: US-2016220413-A1

Title: Minimally invasive surgical stabilization devices and methods

Description:
RELATED APPLICATIONS 
     This application is a divisional of U.S. patent application Ser. No. 11/800,187, filed May 3, 2007, which is a continuation-in-part of U.S. patent application Ser. No. 11/165,733, filed on Jun. 24, 2005, entitled “Minimally Invasive Surgical Stabilization Devices and Methods” which has been published as US patent application publication US 2006-0293560 A1, and is hereby incorporated herein by reference in its entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present invention relates to the field of minimally invasive surgical medical devices and medical procedures. More specifically, the invention relates to devices and methods used for transcervical gynecological procedures. 
     2. Discussion of Related Art 
     Female contraception and/or sterilization may be affected by transervically introducing an object (e.g. a coil) into a fallopian tube to inhibit conception. Devices, systems and methods for such a contraceptive approach have been described in various patents and patent applications assigned to the present assignee. For example, PCT Patent Application No. 99/15116 and U.S. Pat. No. 6,526,979 and U.S. Pat. No. 6,634,361, and is hereby incorporated herein by reference in its entirety, describe devices that are transcervically inserted into an ostium of a fallopian tube and mechanically anchored within the fallopian tube. The devices described in these patents and patent applications may promote a tissue in-growth around and within the inserted device, which may be referred to as an implant or an insert. One example of such devices is the device known as “Essure” from Conceptus, Inc. of Mountain View, Calif. This tissue in-growth tends to provide long-term contraception and/or permanent sterilization without the need for surgical procedures. 
     The device used to insert the contraceptive implant into the fallopian tube may be an intrafallopian contraceptive delivery device such as the one illustrated in  FIG. 1 a   .  FIG. 1 a    illustrates a device similar to the Essure device. The intrafallopian contraceptive delivery device  101  of  FIG. 1 a    is typically formed of a control device, such as a handle  102 , a delivery catheter system  103 , and a guidewire  104  onto which is held the contraceptive implant to be placed within the fallopian tube. The delivery catheter system  103  contains the guidewire  104 , a release catheter (not shown) and the contraceptive implant and the guidewire  104  within the release catheter. The delivery catheter system  103  is transcervically positioned into the uterus and the fallopian tubes via a hysteroscope, such as hysteroscope  100  illustrated in  FIG. 1 b   . The delivery catheter system  103  and guidewire  104  enter the hysteroscope  100  through the working channel  110  of the hysteroscope  100 . A distention valve  120  is typically positioned at the tip of the working channel  110 . The distention valve  120  seals the entrance of the working channel  110  to prevent a distention fluid, such as saline, to flow out of the hysteroscope  100  as a device, such as the delivery catheter system  103  and guidewire  104  of the intrafallopian contraceptive delivery device  101 , is introduced into the working channel  110 . The opening  130  into the distention valve  120  is designed to prevent the leakage of any fluid out of the hysteroscope  100  and therefore has the smallest opening possible to allow a very tight fit between the device and the valve opening. To prevent damaging the tip  105  of the guidewire  104  or the contraceptive implant to be inserted into the fallopian tube, the guidewire  104  and delivery catheter system  103  are introduced into the distention valve  120  through an introducer sheath  140 . The introducer sheath  140  is formed of a soft flexible material such as plastic or Teflon and has a slit  145  to aid in grasping and in the removal of the introducer sheath  140 . The introducer sheath  140  must therefore be inserted into the opening  130  of the distention valve  120  while on a stiff mandrel  150  as illustrated in  FIG. 1 b   . Once the mandrel  150  are placed within the distention valve  120  and the channel  110  to the desired depth the mandrel  150  is removed, leaving the introducer sheath  140  within the working channel  110  and the distention valve  120  as illustrated in  FIG. 1 c   . After placing the introducer sheath  140  into the distention valve  120  the tip  105  of the guidewire  104  and the delivery catheter system  103  may be inserted into the introducer sheath  140  and introduced into the distention valve  120  and the working channel  110  as illustrated in  FIG. 1 d   . The introducer sheath  140  may then be removed. The distention valve  120  may have a tight opening that places pressure on the delivery catheter and causes friction. This friction may make the positioning of the insert within the fallopian tubes difficult. Friction may be created even if the introducer sheath  140  is left within the opening  130  of the distention valve  120 . The distention valve  120  prevents fluid leakage from the working channel  110 . If an introducer sheath  140  is inserted through the distention valve  120 , fluid can spray out of the valve and onto the physician or physician&#39;s assistant. The amount of fluid spray-back can be significant depending on the fluid pressure used during the procedure. 
     Once a physician has positioned the delivery catheter system  103  and the guidewire  104  at a position within the fallopian tube where the contraceptive implant may be deposited, it may be awkward and difficult for the physician to maintain the position and may require the physician to use an assistant to aid in the proper stabilization of the system relative to the hysteroscope. 
     The contraceptive implant devices in the above references require disengaging from a delivery catheter by using an axial torque. In practice this requires the delivery catheter and endoscope in combination to be fully rotated to disengage a contraceptive implant device from the delivery catheter in order to deposit the contraceptive implant device into a fallopian tube. This maneuver may be difficult and cumbersome to perform considering that the device must remain axially aligned in the fallopian tube. 
     SUMMARY OF THE DESCRIPTION 
     Various different embodiments are disclosed below and the following summary provides a brief description of only some of these embodiments. According to one aspect of the invention, certain embodiments described below relate to a medical device to stabilize a device for a minimally invasive gynecological procedure with respect to a device that provides a transcervical pathway. The device for the minimally invasive gynecological procedure may be an intrafallopian contraceptive delivery device. The device that provides a transcervical pathway may be a hysteroscope or a catheter. In an embodiment, the stabilization device may maintain a fixed longitudinal distance between an intrafallopian contraceptive device and a hysteroscope. The stabilization device may include a port for the insertion of a catheter to deliver a topical anesthetic or a contrast media to a patient during a minimally invasive gynecological procedure. The stabilization device may include a handle for manipulating a hysteroscope. Further embodiments describe methods of stabilizing the device for the minimally invasive gynecological procedure with respect to the device that provides a transcervical pathway using a stabilization device. 
     The minimally invasive gynecological procedure may include coupling a handle of a catheter to an endoscope. The procedure may include inserting a sterilization device coupled to a distal portion of the catheter into a fallopian tube of the patient, the sterilization device having an outer expandable portion. The procedure may include activating the outer expandable portion of the sterilization device to expand inside the fallopian tube. The procedure may include decoupling a catheter from an expanded sterilization device while keeping the endoscope and catheter in a stable position rotationally relative to the patient. The procedure may include using a stabilization device to limit depth of insertion of a sterilization device. 
     The minimally invasive gynecological procedure may be part of a system which may include a stabilization arm coupled on an endoscope. The system may include a wireless camera coupled to an endoscope. The wireless camera may capture an image or a sequence of images of an ostium of a fallopian tube and transmit that image or sequence of images to a wireless receiver which provides the image or sequence of images to a display. The system may include a catheter configured for a transcervical medical procedure coupled to an endoscope. 
     Various other devices and methods for using devices, including kits for use in treating patients, are also described below. Other features of the present invention will be apparent from the accompanying drawings and from the detailed description that follows. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1 a    is an illustration of an intrafallopian contraceptive delivery device. 
         FIG. 1 b    is an illustration of a hysteroscope and an introducer sheath on a mandrel designed for insertion into a distention valve of a hysteroscope. 
         FIG. 1 c    is an illustration of the hysteroscope of  FIG. 1 b    after the introducer sheath has been inserted into the distention valve of the hysteroscope. 
         FIG. 1 d    is an illustration of a delivery catheter of an intrafallopian contraceptive delivery device before its insertion into the introducer sheath and hysteroscope. 
         FIG. 1 e    is an illustration of a delivery catheter of an intrafallopian contraceptive delivery device after its insertion into the hysteroscope and the removal of the introducer sheath. 
         FIG. 2 a    is an illustration of a side view of a stabilization device formed of a sleeve and a mechanical means for coupling the proximal end of the stabilization device to a control device of a device for a gynecological procedure. 
         FIG. 2 b    is an illustration of a cross-sectional view of the sleeve of the stabilization device of  FIG. 2   a.    
         FIG. 2 c    is an illustration of a cross-sectional view of a transverse membrane within the stabilization device of  FIG. 2 a    having a cross-hatched opening. 
         FIG. 2 d    is an illustration of a cross-sectional view of a transverse membrane within the stabilization device of  FIG. 2 a    having a slit opening. 
         FIG. 2 e    is an illustration of a cross-sectional view of a transverse membrane within the stabilization device of  FIG. 2 a    having a hole opening. 
         FIG. 2 f    is an illustration of a side view of a stabilization device formed of a sleeve and an adjustable O-ring for coupling the proximal end of the stabilization device to a device for a gynecological procedure. 
         FIG. 2 g    is an end-on view of the proximal end of the adjustable O-ring in an open position. 
         FIG. 2 h    is a side view of the stabilization device of  2   f  after screwing down the adjustable O-ring to partially close the O-ring. 
         FIG. 2 i    is an end-on view of the proximal end of the partially closed adjustable O-ring of  FIG. 2   h.    
         FIG. 2 j    is a side view of the stabilization device of  FIG. 2 h    after further screwing down the adjustable O-ring to close the O-ring. 
         FIG. 2 k    is an end-on view of the distal end of the closed adjustable O-ring of  FIG. 2   j.    
         FIG. 2 l    is an illustration of a side view of a stabilization device formed of a sleeve, an adjustable O-ring, and a duckbill valve. 
         FIG. 2 m    is an illustration of a side view of a stabilization device formed of a sleeve, an O-ring, and a duckbill valve. 
         FIG. 2 n    is an illustration of a top view of the duckbill valve of  FIG. 2   m.    
         FIG. 2 o    is an illustration of a detailed view of the duckbill valve of  FIGS. 2 l -2 n    through which a catheter has been inserted. 
         FIG. 3 a    is an illustration of a side view of a stabilization device formed of a sleeve and of a textured friction fitting. 
         FIG. 3 b    is an illustration of a side view of a stabilization device formed of a sleeve and of a tapered friction fitting. 
         FIG. 3 c    is an illustration of a side view of a stabilization device formed of a sleeve and of a screw fitting. 
         FIG. 4 a    is an illustration of a side view of a stabilization device having a first marker and a second marker on the outside of the sleeve. 
         FIG. 4 b    is an illustration of a side view of a stabilization device formed of a sleeve having a flexible portion and an inflexible portion. 
         FIG. 4 c    is an illustration of a side view of a stabilization device formed of a flexible sleeve. 
         FIG. 4 d    is an illustration of a side view of a stabilization device formed of a sleeve curved on the proximal end. 
         FIG. 4 e    is an illustration of a side view of a stabilization device formed of a sleeve curved on the distal end. 
         FIGS. 4 f  and 4 g    illustrate two embodiments of a stabilization devices which include at least one additional port. 
         FIG. 5 a    is an illustration of a side view of a stabilization device having an embodiment of a distention valve for a hysteroscope attached to the sleeve. 
         FIG. 5 b    is an illustration of a cross-sectional view of the distention valve of  FIG. 5   a.    
         FIG. 5 c    is an illustration of a cross-sectional view of a stabilization device having another embodiment of a distention valve for a hysteroscope attached to the sleeve. 
         FIG. 5 d    illustrates a kit containing a stabilization device and an intrafallopian contraceptive delivery device. 
         FIG. 6 a    illustrates a hysteroscope and a stabilization device positioned for insertion into the distention valve of the hysteroscope. 
         FIG. 6 b    illustrates a stabilization device inserted into a distention valve and a channel of the hysteroscope. 
         FIG. 6 c    illustrates a cut-away side view of the stabilization device within the distention valve and channel of the hysteroscope. 
         FIG. 6 d    illustrates a stabilization device having a distention valve positioned for insertion into the working channel of a hysteroscope. 
         FIG. 6 e    illustrates a stabilization device having a distention valve and a length sufficient to reach beyond the end of the hysteroscope. 
         FIG. 6 f    illustrates a stabilization device inserted into a hysteroscope and a delivery catheter of an intrafallopian contraceptive delivery device inserted into the stabilization device and the hysteroscope. 
         FIG. 6 g    illustrates a stabilization device coupled to both a hysteroscope and a control device of an intrafallopian contraceptive delivery device. 
         FIG. 6 h    illustrates a stabilization device coupled to the delivery catheter of an intrafallopian delivery device by an adjustable O-ring. 
         FIG. 6 i    illustrates a stabilization device having a mechanical fitting designed to couple to an adaptor on the end of the control device of an intrafallopian contraceptive delivery device. 
         FIG. 6 j    illustrates the stabilization device of  FIG. 6 h    coupled to the adaptor on the end of the control device of the intrafallopian contraceptive delivery device. 
         FIG. 6 k    illustrates a cut-away side view of a handle of an intrafallopian contraceptive delivery device before tracking forward the delivery catheter. 
         FIG. 6 l    illustrates a cut-away side view of a handle of an intrafallopian contraceptive delivery device after tracking forward the delivery catheter. 
         FIG. 6 m    illustrates a cut-away side view of a handle of an intrafallopian contraceptive delivery device. 
         FIG. 7 a    illustrates a cut-away side view of an access catheter. 
         FIG. 7 b    illustrates a side view of the outside surface of an access catheter. 
         FIG. 7 c    illustrates a side view of an access catheter that has been positioned within the cervix. 
         FIG. 7 d    illustrates a side view of the access catheter once the balloon on its distal end has been expanded to fix the position of the access catheter within the cervix. 
         FIG. 8 a    illustrates a kit containing a stabilization device having a port for an anesthetic delivery catheter, an anesthetic delivery catheter that has static mixer capabilities, and a dual-barrel syringe. 
         FIG. 8 b    illustrates a stabilization device having a port for an anesthetic delivery catheter coupled to a syringe containing an anesthetic and anesthetic carrier. 
         FIG. 9  illustrates a stabilization device permanently coupled to a hysteroscope. 
         FIG. 10  illustrates an embodiment of a stabilization device shaped like an arm. 
         FIG. 11 a    is an isometric view of a stabilization arm. 
         FIG. 11 b    is an isometric view of the stabilization arm of  FIG. 11 a    mounted to an endoscope and holstering a medical device such as a control device for performing a transcervical medical procedure. 
         FIG. 12 a    is an isometric view of a stabilization arm. 
         FIG. 12 b    is an isometric view of the stabilization arm of  FIG. 12 a    mounted to an endoscope and holstering a medical device such as a control device for performing a transcervical medical procedure. 
         FIG. 13 a    shows an endoscope approaching the ostium of a fallopian tube in a cross sectional view. 
         FIG. 13 b    is a side view of a sterilization device in an expanded configuration. 
         FIGS. 13 c , 13 d , and 13 e    show side views of a sterilization device in an non-expanded configuration coupled to a delivery catheter. 
         FIG. 13 f    is a cross sectional view of a sterilization device coupled to a delivery catheter by an interference fit. 
         FIG. 13 g    is a cross sectional view of a sterilization device uncoupled from a delivery catheter. 
         FIG. 13 h    shows a portion of a top view of a handle. 
         FIG. 13 i    shows an internal side view of a handle. 
         FIG. 14  is a schematic for a wireless camera system using an endoscope. 
         FIG. 15 a    is a schematic for a wireless endoscope. 
         FIG. 15 b    is a schematic for a wireless camera which couples to a standard endoscope. 
     
    
    
     DETAILED DESCRIPTION OF THE PRESENT INVENTION 
     The subject invention will be described with reference to numerous details set forth below, and the accompanying drawings will illustrate the invention. The following description and drawings are illustrative of the invention and are not to be construed as limiting the invention. Numerous specific details are described to provide a thorough understanding of the present invention. However, in certain instances, well-known or conventional details are not described in order to not unnecessarily obscure the present invention in detail. 
     The various embodiments of the present inventions provide stabilization devices and methods for use of the stabilization devices with minimally invasive gynecological procedures such as methods of preventing pregnancy by inserting intrafallopian contraceptive devices into the fallopian tubes, the removal of uterine polyps, endometrial ablation, cryotherapy of the uterus, myomectomy, radiologic fibroid embolization, uterine and vaginal relaxation, female urological disorders, dilation and curettage, endometrial biopsy, colposcopy, hysterosalpinograpy, excision of submucous myoma, polypectomy or intrauterine adhesions, laparoscopy, mini-laparoscopy, surgery for urinary incontinence, reconstructive pelvic procedure, treatment for infertility such as renastamosis, selective salpingectomy, salpingostomy, fibrioplasty, and tubal cannulation. The intrafallopian contraceptive devices may provide permanent contraception or sterilization. Examples of contraceptive devices and method for using these devices with delivery systems are provided in U.S. Pat. No. 6,526,979 and U.S. Pat. No. 6,634,361, both of which are incorporated herein by reference as well as other types of contraceptive devices which may employ other structures. It is to be understood that embodiments of the current invention may also be used with non-gynecological minimally invasive surgeries that employ endoscopes. Examples of non-gynecological minimally invasive surgeries include angioscopy, arthroscopy, bronchoscopy, cystoscopy, solonoscopy, systourethroscopy, esophagogastroduodenoscopy, gastroscopy, largyngoscopy, protosigmoidoscopy, rhinolaryngoscopy, subfacial edoscopic perforating vein surgery, and sigmoidoscopy. 
     The delivery systems for the intrafallopian contraceptive devices are generally formed of a catheter containing the contraceptive device or devices and a handle that is used to control the placement of the catheter. The intrafallopian contraceptive devices may be positioned by the retraction of the catheter to expose the contraceptive device and the deposition of the contraceptive device within the fallopian tube. The stabilization devices are adapted to be coupled to a control device of an intrafallopian contraceptive delivery device, such as the handle of the delivery systems described in the above-referenced patents, and to a device that provides a pathway through the cervix to maintain a fixed longitudinal distance between the control device and the device that provides a pathway through the cervix. This device may free up one of the hands of a physician performing the procedure by maintaining the fixed distance between the control device and an endoscope. Examples of endoscopes include a hysteroscope, an angioscope, an arthroscope, a bronchoscope, a choledochoscope, a colonoscope, a colposcope, a cystoscope, a cystourethroscope, a duodenoscope, an esophagoscope, an esophagogastroduodenoscope, a falloposcope, a gastroscope, a laryngoscope, a laparoscope, a mini-laparoscope, an ostoscope, an opthalmoscope, a proctoscope, a proctosigmoidoscope, a sigmoidoscope, and a thoraco scope. 
     In an embodiment, the endoscope may be a hysteroscope for gynecological procedures such as the placement of the contraceptive devices within the fallopian tubes. The accuracy of the placement of the contraceptive devices within the fallopian tubes may be increased due to the greater stabilization and the standardization of the longitudinal distance between the control device and the hysteroscope. In an embodiment, the stabilization device may also facilitate the delivery of a topical anesthetic to the cervix and the uterus. In another embodiment, the stabilization device may facilitate the delivery of a contrast media into the uterus for ultrasound or radiography. 
     The stabilization device is formed of a means for coupling the stabilization device to a device for a minimally invasive gynecological procedure and of a means for coupling the stabilization device to a device that provides a transcervical pathway. The device that provides a transcervical pathway may be a hysteroscope or a catheter, for example. By coupling the stabilization device to both the device for the minimally invasive gynecological procedure and the device that provides a transcervical pathway, the stabilization device may stabilize the position of the device for the minimally invasive gynecological procedure with respect to the device that provides a transcervical pathway. The stabilization of these devices with respect to one another may facilitate the ease with which the gynecological procedures are performed as well as increase the accuracy of the gynecological procedures. For example, the stabilization device may be adapted to be coupled to an intrafallopian contraceptive delivery device and to a hysteroscope to maintain a fixed longitudinal distance between the intrafallopian contraceptive device and the hysteroscope. 
     In one embodiment, the stabilization device may be a sleeve such as the one illustrated in  FIG. 2 a   .  FIG. 2 a    illustrates a stabilization device  200  formed of a sleeve  210  and a means  220  for coupling the stabilization device to a control device of an intrafallopian contraceptive device. The sleeve  210  may be formed of a material having a stiffness sufficient to stabilize the control device with respect to the hysteroscope. Any hysteroscope that is capable of performing the methods described herein may be used, but in particular embodiments the hysteroscope may be an Olympus Storz Bettocchi, a Wolf, a Wolf 45° “Panoview Plus”, or a Circon ACMI. The material used to form the sleeve  210  may be a metal such as stainless steel or nitinol or a material such as polycarbonate or PEEK (polyetheretherketone). The sleeve  210  may also be coated with a soft polymer coating to increase the ability of the ball valve within the channel of the hysteroscope to grip the stabilization device  200  and to hold it in place. The sleeve may have a length in the approximate range of 1 cm and 150 cm, and more particularly in the range of 3.5 cm and 12.0 cm. The length of the sleeve may vary depending on the use. In an embodiment, the sleeve may have a length sufficient to extend through a working channel of a hysteroscope. In another embodiment the sleeve may have a length sufficient to extend through the entire length of a hysteroscope. In an alternate embodiment, the sleeve may have a length sufficient to reach the fallopian tubes through a device that provides a transcervical pathway, such as a catheter. 
     The sleeve  210  has a lumen  230  extending longitudinally through the entire sleeve. The lumen  230 , as illustrated in a cross-section A-A in  FIG. 2 b   , has a diameter large enough to fit around a catheter that is part of a delivery device for an intrafallopian contraceptive device. This is to prevent friction between the sleeve  210  and the delivery catheter during insertion of the delivery catheter and guide wire and during retraction of the delivery catheter. In an embodiment, the diameter of the lumen  230  may be in the approximate range of 2 French and 9 French, and in another embodiment may have a diameter of approximately 5 French. The distal end  240  of the stabilization device  200  may be tapered as illustrated in  FIG. 2 a    to enable the distal end to be fitted into a distention valve of a hysteroscope. The selection of the shape of the distal end  240  of the stabilization device  200  may be influenced by the shape of the opening into the rubber-like material of the distention valve as well as the stiffness of the rubber-like material that forms the distention valve. A tapered distal end  240  of the stabilization device  200  may be valuable for insertion of the stabilization device  200  into a stiff or tight opening in the distention valve. In an alternate embodiment the distal end  240  of the stabilization device  200  may be blunt, such as in embodiments where the distention valve is part of the stabilization device  200 . The means for coupling the stabilization device to the device that provides a transcervical pathway, such as the control device of an intrafallopian contraceptive device, may be a mechanical fitting such as that illustrated in  FIG. 2 a    at the proximal end of the sleeve  210 . The mechanical fitting  220  may include a transverse membrane  250  to prevent the backflow of fluid from the hysteroscope from spilling out onto the operator and the control device of the intrafallopian contraceptive delivery device. The transverse membrane  250  is illustrated in  FIGS. 2 c , 2 d , and 2 e    as the B-B cross-section of the mechanical fitting  220 . The transverse membrane  250  is formed with an opening through which the catheter of the intrafallopian contraceptive delivery device can fit. The opening in the transverse membrane forms a seal around the catheter to prevent the backflow of fluid. The opening may be a crosshatch seal  252  as illustrated in  FIG. 2 c   , a slit seal as illustrated in  FIG. 2 d   , or a hole seal as illustrated in  FIG. 2 e   . In alternate embodiments the transverse membrane  250  may be a double membrane having different or the same combinations of the various types of seals. For example, the double membrane may be a combination of a slit seal and a hole seal, a hole seal and a slit seal, a hole seal and a crosshatch seal. The seal combinations of the double membrane may also vary with respect to which seal is distal and which seal is proximal. 
     In an alternate embodiment, the means for coupling the stabilization device  200  to the delivery catheter of a device for a minimally invasive gynecological procedure, such as an intrafallopian contraceptive delivery device, may be an adjustable O-ring  260  such as that illustrated in  FIGS. 2 f -2 k   .  FIGS. 2 f  and 2 g    illustrate the adjustable O-ring  260  in a fully open position. The adjustable O-ring is formed of an O-ring within a first sleeve  280 . The outer surface of the first sleeve  280  has screw threads that are threaded by the screw threads inside the second sleeve  285 . In the fully open position, the second sleeve  285  has not been screwed onto the first sleeve  280 .  FIGS. 2 h  and 2 i    illustrate the adjustable O-ring after the second sleeve  285  has been screwed onto the first sleeve  280  to reduce the diameter of the O-ring  270 . Continuing to screw the second sleeve  285  onto the first sleeve  280  will seal closed the O-ring  270  completely, as illustrated in  FIGS. 2 j  and 2 k   . The adjustable O-ring may be adjusted to form a seal around a delivery catheter to hold the stabilization device  200  in place. The seal also serves to prevent backflow of fluid from the hysteroscope out of the stabilization device  200 . 
     As illustrated in  FIG. 2 l   , the stabilization device may further include a duckbill valve  290 . The duckbill valve  290  may be coupled to the adjustable O-ring  260  at the proximal end of the sleeve  210  to form a continuous lumen with the adjustable O-ring  260 . The duckbill valve  290  may provide a further seal to prevent the backflow of fluid out of stabilization device  200 , particularly when tightening the adjustable O-ring  260  onto a delivery catheter. The duckbill valve  290  may also be used in combination with a non-adjustable O-ring  295 .  FIG. 2 m    illustrates a side-view of the duckbill valve  290  in combination with the non-adjustable O-ring  295 .  FIG. 2 n    illustrates a top-view of the duckbill valve  290  in combination with the non-adjustable O-ring  295 . The non-adjustable O-ring  295  may have an opening having a diameter sufficient to form a seal around a delivery catheter. In this embodiment, the duckbill valve  290  also serves to further prevent the backflow of fluid out of the stabilization device  200 . The non-adjustable O-ring  295  may also be used alone, without the duckbill valve  290 , as a means for coupling the stabilization device  200  to a device for a gynecological procedure. A detailed view of the duckbill valve  290  is illustrated in  FIG. 2 o   .  FIG. 2 o    illustrates a catheter  292  through a lumen in the center of the duckbill valve  290 . The catheter  292  exits the duckbill valve  290  through a slit seal  294  at the distal end (the duckbill) of the duckbill valve  290 . Because the duckbill valve  290  is formed of a flexible rubber-like material the slit seal  294  of the duck bill valve  290  forms a seal around the catheter  292 . 
     The means for coupling the stabilization device  200  to the control device of the intrafallopian contraceptive delivery device may alternatively be a friction fitting that is designed to fit into a control device of a device for a gynecological procedure, such as the handle of an intrafallopian contraceptive delivery device. The friction fitting may be formed as a textured portion  310  on the distal end of the sleeve  210  as illustrated in  FIG. 3 a   , as a portion of the sleeve  210  with a more narrow diameter  320  as illustrated in  FIG. 3 b   , or a portion of the sleeve  210  having a screw thread  330  as illustrated in  FIG. 3   c.    
     In another embodiment, the stabilization device of  FIG. 2 a    may have an insertion marker  410  as illustrated in  FIG. 4 a    on an outside surface of the sleeve  210  at a position selected to indicate that the distal end of the sleeve has been inserted to a predetermined distance into the distention valve and working channel of the hysteroscope.  FIG. 4 a    illustrates an insertion marker  410  formed of two markings, a distal marking  401  and a proximal marking  402 , on the outside of the sleeve  210 . In an embodiment illustrated in  FIG. 6 a   , the stabilization device  200  is inserted into the distention valve  610  of a hysteroscope  600  such that the distal marking  401  is inserted completely within the distention valve  610  and the working channel  620  of the hysteroscope  600  and the proximal marking  402  is outside of the distention valve  610  as illustrated in  FIGS. 6 b  and 6 c   . In an embodiment, the proximal marking  402  is positioned so that the distal end of the stabilization device is inserted into the working channel to a depth sufficient to be clamped by the ball valve clamps  630  of the port valve switch  640 . By inserting the stabilization device past the ball valve clamps  630  the possibility that the ball valve clamps may pinch or cut the delivery catheter of the intrafallopian contraceptive delivery device may be minimized.  FIG. 6 c    illustrates a cut-away view of the inside of the distention valve  610  and the working channel  620  of the hysteroscope  600 . Other embodiments of the insertion marker  410  are also contemplated by the invention, such as a single marking on the outside surface of the sleeve  210 . 
       FIG. 4 b    illustrates yet another embodiment of the stabilization device  200  where a portion  420  of the sleeve  210  is flexible and a portion  430  is inflexible. In some instances it may be beneficial for the stabilization device to have some flexibility to increase the maneuverability of the intrafallopian contraceptive delivery device to aid in the positioning of the insert within the fallopian tube. The flexibility of the sleeve  210  may also be valuable in enabling the operator of the delivery device to maneuver the handle around the hysteroscope if the angle of the working channel on the hysteroscope is close to the body of the hysteroscope. The flexible portion  420  of the sleeve  210  may be formed of a coil  430  coated with a polymer tubing material  440  that may also coat the inflexible portion  430 . In an alternate embodiment, the entire sleeve  210  may be flexible. In one embodiment the flexible sleeve  210  illustrated in  FIG. 4 c    may be formed of a coil  430  coated with a polymer tubing material  440 . 
     In another embodiment the sleeve  210  of the stabilization sheath  200  may have a curved portion to increase the maneuverability of the device for the gynecological procedure. The sleeve  210  may have a proximal curved portion  450  as illustrated in  FIG. 5 d   . Alternatively the sleeve  210  may have a distal curved portion  460  as illustrated in  FIG. 4 e   . The distal curved portion  460  may facilitate the positioning of a fallopian tube insert from an intrafallopian contraceptive delivery device into a fallopian tube. In this embodiment the sleeve  210  may have a length sufficient to reach the fallopian tubes. The distal curved portion  460  may be formed of an inflexible material or it may be formed of a flexible material that may be bent at a desired angle by using adjustment wires (not illustrated) that would run the length of the sleeve  210  up to the distal curved portion. 
       FIGS. 4 f  and 4 g    illustrate two embodiments of a stabilization device  200  having an additional port  470 . The port  470  has a lumen continuous with the lumen of the sleeve  210 . An additional delivery catheter may be inserted into a device that provides a transcervical pathway through the port  470 , in addition to a delivery catheter that is coupled to a device for a gynecological procedure. In an embodiment, the port  470  may provide a pathway for an anesthetic delivery catheter or a contrast media delivery catheter. The port  470  may be straight or slightly curved and jutting from the sleeve  210  at any angle that is practical for the insertion of a catheter. In an embodiment illustrated in  FIG. 4 g    the port  470  may have a screw thread  475  on the proximal end for the attachment of a screw-on device such as the tip of a syringe. 
       FIG. 5 a    illustrates a stabilization device  200  that has a distention valve  500  coupled to the distal end of the sleeve  210 . The distention valve may be formed of a soft rubber-like material that can form a seal around the working channel of a hysteroscope or another type of device that provides a transcervical pathway to prevent the backflow of fluid. In this exemplary embodiment the distention valve  500  is formed of a portion  510  that fits around a working channel of a hysteroscope. As illustrated in  FIGS. 5 a  and 5 b   , the portion  520  of the distention valve  500  may have a smaller diameter than the portion  510  such that a shelf  530  is formed. The distention valve  500  couples to the sleeve  210  of the stabilization device  200  to form a continuous lumen between the distention valve  500  and the sleeve  210 . In alternate embodiments the distention valve  500  may have a single diameter without the shelf  530 .  FIG. 5 c    illustrates an alternate embodiment of a distention valve  540  formed of a stiff material and containing an O-ring  560  to form a seal around the hysteroscope or another type of device that provides a transcervical pathway. The distention valve  540  may be formed of hard plastic and may have a screw-threaded portion  550  to be screwed on to a working channel of a hysteroscope or other device. The distention valves  500  and  540  illustrated in  FIGS. 5 a -5 c    may be fixed into place at any point on the sleeve  210  of the stabilization device  200  or may be movable along the sleeve  210  of the stabilization device  200 . 
       FIG. 5 d    illustrates a kit  570  containing an intrafallopian contraceptive delivery device  580  and a stabilization device  200 . The intrafallopian contraceptive delivery device may have a delivery catheter  581  and a control device  582  similar to the Essure device described above. The stabilization device  200  may have a sleeve  210  and a means for coupling the stabilization device to the control device  582  of the intrafallopian contraceptive delivery device. The stabilization device may alternately be any of the embodiments described above. The kit  570  may also include a hysteroscope such as the one illustrated in  FIG. 6 a   . In another embodiment, the kit  570  may include a syringe loaded with a topical anesthetic. The syringe may have a first barrel and a second barrel, the first barrel loaded with the topical anesthetic and the second barrel loaded with a carrier. The topical anesthetic and the carrier may be mixed at the point of use with the use of a static mixer adapted to be coupled to the syringe. The static mixer may also be part of the kit  570 . 
     In general, the current invention includes a method of coupling a stabilization device to a device that provides a transcervical pathway and coupling the stabilization device to a device for a minimally invasive gynecological procedure to stabilize the device for the minimally invasive gynecological procedure with respect to the device that provides the transcervical pathway. In one particular embodiment a control device of an intrafallopian contraceptive delivery device is stabilized with respect to a hysteroscope to fix the position of the fallopian tube insert within the fallopian tube. In this method, the delivery catheter of the intrafallopian contraceptive delivery device is inserted into a hysteroscope. The fallopian tube insert is then positioned within the fallopian tube for deployment. The position of the holding device with respect to the hysteroscope is then stabilized to fix the deployment position of the fallopian tube insert within the fallopian tube. The fallopian tube insert may then be deployed within the fallopian tube. The stabilization devices described above may be used to stabilize the position of the holding device with respect to the hysteroscope. 
     In an exemplary method of using the stabilization device  200 , the stabilization device  200  is first coupled to the hysteroscope  600 . The stabilization device  200  may be a sleeve  210  having a lumen and may be inserted into the working channel  620  of the hysteroscope  200  through a distention valve  610  that is attached to the end of the working channel  620  as illustrated in  FIG. 6 a   . In this embodiment the distal end of the stabilization device  200  is inserted into the distention valve  610 . The stabilization device  200  may be inserted into the distention valve  610  and the working channel  620  past a valve clamp  640 . By inserting the sleeve  210  of the stabilization device  200  past the valve clamp  640  the valve clamp  640  may be used to couple the stabilization device  200  to the hysteroscope  200 . Also, the sleeve  210  may be formed of a material that is hard enough not to be cut by the valve clamp  640  once it is clamped onto the sleeve  210 . The valve clamp  640  may be a ball valve  630  as illustrated in  FIG. 6 c   . Inserting the stabilization device  200  past the valve clamp  640  may also prevent the valve clamp  640  from snagging, pinching or cutting the delivery catheter and/or the guidewire of the intrafallopian contraceptive delivery device. 
     Markers may be placed on the outside of the sleeve  210  to indicate the depth to which the sleeve  210  should be inserted into the working channel  620 .  FIGS. 6 a  and 6 b    illustrate an embodiment where two markers  410 , a distal marker  401  and a proximal marker  402 , are on the outside of the sleeve  210 . In this embodiment a first portion of the stabilization device  200  is inserted into the working channel  620  of the hysteroscope  600  until the distal marker  401  is entirely within the hysteroscope  600  and the proximal marker  402  is exposed immediately outside of the hysteroscope  600 . In an alternate embodiment, there may be a single marker on the outside of the sleeve  210 . In this embodiment, a first portion of the distal end of the sleeve  210  is inserted into the working channel  620  through the distention valve  610  until the marker is entirely within the hysteroscope  600 , which in a particular embodiment may mean that the marker is entirely within the distention valve  610 , and the proximal second portion of the stabilization device  200  remains outside of the hysteroscope  600 . 
     In another embodiment, the stabilization device  200  may be coupled to a distention valve  500 , such as those illustrated in  FIGS. 5 a -5 c    and in  FIG. 6 d   . In this embodiment, the stabilization device may be coupled to the hysteroscope  600  by coupling the distention valve  500  to the proximal end of the working channel  620  of the hysteroscope  600 . As illustrated in  FIG. 6 d   , the distention valve  500  coupled the stabilization device  200  may be coupled to the hysteroscope  600  after inserting the distal end of the sleeve  210  of the stabilization device  200  into the working channel  620  of the hysteroscope. The distention valve  500  may be a rubber-like material that may fit onto the proximal end of the working channel  620  to form a seal. The distention valve  500  may also be screwed onto the proximal end of a working channel  620  having a screw thread (not illustrated.) The distention valve  500  in this embodiment may be fixed in place on the sleeve  210 , in which case the depth at which the sleeve  210  is inserted into the hysteroscope  600  is determined by where the distention valve  500  is positioned on the sleeve  210 . In another embodiment, the distention valve  500  is movable along the sleeve  210  and the depth at which the sleeve  210  is inserted into the hysteroscope  600  may be adjusted. In one particular embodiment, the sleeve  210  of the stabilization device  200  may have a length such that the sleeve  210  extends beyond the tip of the channel  670  of the hysteroscope  600 . The insertion of the distal end of the sleeve  210  into the hysteroscope  600  in this embodiment may be facilitated by the coupling of the distention valve  500  to the sleeve  210 . In this embodiment, the length of the sleeve  210  may be sufficient to reach the fallopian tubes of a patient. In this embodiment the distal end of the sleeve  210  may be slightly curved or bendable to guide a delivery catheter of an intrafallopian contraceptive delivery device towards the opening of a fallopian tube. The stabilization device  200  may be further coupled to the hysteroscope  600  by clamping the valve clamp  630  onto the sleeve  210 , as illustrated in  FIGS. 6 b    and  6   c.    
     As illustrated in  FIG. 6 f   , an intrafallopian contraceptive delivery device is inserted into the lumen of the stabilization device and the hysteroscope  600 . The intrafallopian contraceptive delivery device may be formed of a delivery catheter  660  coupled to a holding device  665 . In this embodiment, the delivery catheter  660  is inserted into the sleeve  210  of the stabilization device  200  and into the hysteroscope  600  through the working channel  610  and the channel  670 . The delivery catheter  660  contains a fallopian tube insert for deployment into a fallopian tube. After passing through the channel  670  of the hysteroscope  600 , the delivery catheter  660  passes through the uterus and into one of the fallopian tubes where the delivery catheter  660  is positioned for deployment of the fallopian tube insert. Once the delivery catheter  660  is positioned for deployment of the fallopian tube insert, the operator of the intrafallopian contraceptive delivery device may verify the position of the fallopian tube insert before coupling the stabilization device  200  to the control device  665 . 
     The stabilization device  200  may then be coupled to the holding device  665 .  FIG. 6 g    illustrates an embodiment where the stabilization device  200  is coupled to the holding device  665  mechanically by a mechanical fitting  210  that snaps onto the holding device  665 . In an alternate embodiment the stabilization device  200  may be coupled to the holding device  665  by a friction fitting, such as those illustrated in  FIGS. 3 a   - 3   c.    
     In another embodiment, the stabilization device  200  may be coupled to the intrafallopian contraceptive device by coupling the stabilization device  200  to the delivery catheter  660 . An example of this embodiment is illustrated in  FIG. 6 h   .  FIG. 6 h    illustrates a stabilization device  200  having an adjustable O-ring  260  at the proximal end. The inner diameter of the O-ring  270  may be tightened around the delivery catheter  660  by screwing the second sleeve  285  of the adjustable O-ring  260  onto the first sleeve  280  of the adjustable O-ring. The stabilization device  200  may also be coupled to the delivery catheter  660  by a simple O-ring having an inner diameter sufficient to form a seal around the delivery catheter  660 . The adjustable O-ring  260  or a single O-ring may be formed in combination with a duckbill valve. 
       FIG. 6 i    illustrates another embodiment of a stabilization device  200  that may be coupled to the control device  665  of the intrafallopian contraceptive delivery device by a mechanical fitting. In this embodiment the mechanical fitting  685  is designed to mechanically fit onto an adaptor  680  that is coupled to the intrafallopian contraceptive delivery device. The adaptor  680  may be coupled to the control device  665  or to the delivery catheter  660 . After positioning the intrafallopian contraceptive delivery device to deploy a fallopian tube insert the stabilization device  200  may be coupled to the intrafallopian contraceptive delivery device by mechanically fitting the mechanical fitting  685  to the adaptor  680 . 
     In yet another embodiment, the stabilization device  200  may be pre-coupled to the intrafallopian contraceptive delivery device. In this embodiment it would not be necessary to couple the stabilization device  200  to the intrafallopian contraceptive delivery device. 
     The position of the fallopian tube insert for deployment from the delivery catheter  660  may be verified and adjusted again before coupling or re-coupling the stabilization device  200  to the hysteroscope  600 . In one embodiment, the verification and potential adjustment of the position of the fallopian tube insert for deployment may be performed prior to clamping the valve clamp  630  onto the sleeve  210  of the stabilization device  200 . In one embodiment, the positioning of the fallopian tube insert for deployment may be adjusted after coupling the stabilization device to the intrafallopian contraceptive delivery device by using a feed-forward mechanism of the intrafallopian contraceptive delivery device.  FIGS. 6 k -6 m    illustrate this embodiment with a cut-away side view of the control device  665  of an intrafallopian contraceptive delivery device. In  FIG. 6 k    the distal tip of the intrafallopian contraceptive delivery device is at a first position beyond the ostium  675  within a fallopian tube and the stabilization sheath  200  is coupled to the adapter  680  by the mechanical fitting  685 . In  FIG. 6 l   , a user of the control device  665  may then roll back the thumbwheel  667  of the control device  665  to mechanically fit the adapter  680  to the control device mechanical fitting  687  and to feed-forward the core wire  671 . In an embodiment, the core wire  671  is moved forward into the fallopian tube by approximately 1.6 cm to compensate for user error. In  FIG. 6 m   , rolling back the thumbwheel  667  will break away a portion  672  of the sheath  673  that contains the delivery catheter  660 . After the portion  672  of the sheath  673  breaks away inside of the control device  665 , the delivery catheter  660  is retracted to uncover the core wire  671  to expose the fallopian tube insert (not shown) that is wound down over the core wire  671 . 
     The position of the delivery catheter  660  for the deployment of the fallopian tube insert may be verified by fluoroscopy, ultrasound (including hysterosalpingo-contrast-ultrasonography (HyCoSy) and stimulated acoustic emission (SAE-HyCoSy)), radiography, or visual orientation using a camera placed through the hysteroscope  600 . In one embodiment the distal end of the delivery catheter  660  or the distal end of a stabilization device  200  having a length sufficient to reach the fallopian tubes may be marked with a radiopaque material that may be viewed by radiography. In this embodiment the positioning and verification of the position of the delivery catheter  660  for the deployment of the fallopian tube insert may be done by viewing the radiopaque mark on either the delivery catheter  20  or on the distal end of the stabilization device  200 . 
     Alternatively, the uterus may be distended using a contrast media that is visible by either ultrasound or radiography for the positioning and verification of the position of the delivery catheter  660  for the deployment of the fallopian tube insert. In one embodiment, the contrast media may be a fluid or gel containing microbubbles that are a shell filled with a contrast agent such as a gas or other ultrasound contrast enhancing agent viewable by ultrasound such as perfluorocarbon-exposed sonicated dextrose albumin microbubbles. In an embodiment, the microbubbles may contain a topical anesthetic such as lidocaine that may be delivered to the uterine cavity by applying ultrasound at an energy sufficient to cause the microbubbles to burst and release the anesthetic. In one exemplary method, the positioning of the stabilization sheath  200  or the delivery catheter  600  may be accomplished using ultrasound to view the contrast media within the microbubbles. The microbubbles may then be burst by changing the ultrasound energy to release the anesthetic into the uterine cavity. The release of the anesthetic from the microbubbles may be monitored and regulated by measuring the harmonic response to the ultrasound energy. In another embodiment the anesthetic may be released from some of the microbubbles prior to the performance of the minimally invasive gynecological procedure to an extent that would anesthetize the tissues surrounding the uterine cavity but to still have microbubbles remaining for ultrasound positioning of the device for the minimally invasive gynecological procedure. 
       FIGS. 7 a -7 d    illustrate an alternate embodiment where the device that provides the transcervical pathway is an access catheter. In this embodiment the access catheter has a balloon to form a seal between the access catheter and the cervix and to fix the position of the access catheter during a minimally invasive gynecological procedure.  FIG. 7 a    illustrates a cut-away side view of the access catheter  700  having a tubular catheter body  710  that includes a distal end  712  and a proximal end  714  and a lumen  715 . The lumen  715  provides a transcervical pathway to access the uterine cavity with a surgical instrument. An elongated inflatable balloon  720  (illustrated in the deflated state) is sealingly affixed to and encloses a distal portion of the catheter body  710 . The balloon  720  contains a fixed residual volume of fluid which is displaced by operation of the fluid displacement sleeve  730 .  FIG. 7 b    illustrates the outer surface of the access catheter  700 .  FIG. 7 c    illustrates the balloon  720  of the access catheter  700  once it is placed within the os of the cervix. 
     The displacement sleeve  730  may then be slid along the outside of the catheter  710  towards the distal end  712  of the tubular catheter body  710  to displace the fixed residual volume of fluid into the portion of the balloon  720  that is within the os of the cervix.  FIG. 7 d    illustrates the expanded balloon  720  in the cervix region after the displacement sleeve  730  has been slid towards the distal end  712  of the tubular catheter body  710 . The expanded balloon  720  serves to hold the access catheter  700  in place during a minimally invasive gynecological procedure such as the use of an intrafallopian contraceptive delivery device to place fallopian tube inserts within the fallopian tubes. 
     Similar to the use of the stabilization sheath  200  with the hysteroscope  600 , the stabilization sheath  200  may be coupled to the end of the access catheter  700  to provide a pathway for a device for a nonsurgical gynecological procedure and to provide a means for coupling the stabilization device to the device for the nonsurgical gynecological procedure. The stabilization device  200  may be coupled to the access catheter  700  by a distention valve  500  that has formed a seal by friction fitting with the tubular catheter body  710 . The stabilization device  200  may be coupled to the tubular catheter body  710  by other means such as an O-ring, and adjustable O-ring, or a screw thread. The stabilization device  200  also has a means for coupling the stabilization device  200  to the device for a minimally invasive gynecological procedure such as a mechanical fitting  220  or any of the other embodiments described above in relation to the hysteroscope embodiment. The stabilization device  200  may also have a port  470 . Any of the methods described above in relation to the hysteroscope embodiment may be applied to the use of the access catheter  700  in place of the hysteroscope. The stabilization device  200  may be valuable for use with the access catheter because it provides a stable fixed longitudinal distance between the device for the minimally invasive gynecological procedure and the access catheter during the gynecological procedure. This may significantly improve the accuracy of the gynecological procedure. For example, the accuracy of placement of fallopian tube inserts from an intrafallopian contraceptive delivery device may be improved. 
     In another embodiment, prior to a minimally invasive gynecological procedure, a topical anesthetic may be applied to the uterus. In a method of a minimally invasive procedure of placing fallopian tube inserts into the fallopian tubes the topical anesthetic may be applied to a region around the opening of the fallopian tubes (the ostium). The topical anesthetic may be delivered to the uterus using a port on a stabilization device.  FIG. 8 a    illustrates a kit  800  containing a stabilization device  200  having a port  470 , a syringe  810 , and an anesthetic delivery catheter  870 . The stabilization device  200  having a port  470  may be in the form of any of the embodiments discussed above. In the embodiment illustrated in  FIG. 8 a    the stabilization device  200  is formed of a sleeve  210  to which a distention valve such as  540  may be coupled and to which an adjustable O-ring  260  may be coupled. The port  475  may also include a screw thread at the proximal end to screw the syringe  810  to the port  470 . The syringe  810  may be a single-barreled syringe or a dual-barreled syringe as illustrated in  FIG. 8 a   . A single-barreled syringe may be pre-loaded with an anesthetic mixture or may be filled by a physician performing a gynecological procedure. 
     The anesthetic mixture may by an anesthetic such as lidocaine hydrochloride and may have a concentration in the range of 0.5% and 15%, and more particularly in the range of 5% and 10%. In an alternate embodiment, the topical anesthetic may be a mixture of an amide anesthetic such as lidocaine, lignocaine, marcaine, or carbocaine, a buffering agent to bring the pH of the mixture to at least 5.5, optionally a viscosity agent and/or a solubilising agent. In an embodiment, the viscosity agent is present in an amount sufficient to give the topical anesthetic a viscosity greater than water and to maintain viscosity at body temperature. In one particular embodiment, the viscosity agent may be hydroxypropyl methylcellulose. The solubilizing agent serves to inhibit crystallization and therefore also the precipitation of the anesthetic compounds within the topical anesthetic mixture. An example of a solubilizing agent that may be used in the formulation is N-methyl-2-pyrrolidone. The solubilizing agent enables the solution to hold a higher concentration of the anesthetic agent and thereby increases the bio-availability, potency, and effect of the anesthetic agent. Additionally, the topical anesthetic may contain materials that enhance the absorption of the anesthetic into a patient&#39;s tissues. 
     The topical anesthetic may be mixed at a point of use to further prevent the precipitation of the anesthetic agent before application and to prolong the shelf-life of the anesthetic agent. The potency of the topical anesthetic may decrease once the anesthetic agent is mixed with a carrier material, therefore point of use mixing ensures that the topical anesthetic applied to the uterus and the fallopian tubes is potent. 
     A dual-barreled syringe  810  may be used to mix the topical anesthetic at the point of use. The dual-barreled syringe has a first barrel  820  to contain a topical anesthetic such as lidocaine hydrochloride. The topical anesthetic within the first barrel  820  may have a concentration in the range of 2% and 15% anesthetic, and more particularly may have a concentration of approximately 12%. The topical anesthetic may be a liquid, a paste, or a gel. The second barrel  830  may contain a carrier material that will be mixed with the topical anesthetic from the first barrel  820 . In an embodiment, the carrier material may be a buffer agent or a buffer agent in combination with a solubilizing agent and a viscosity agent. The topical anesthetic may further contain materials that prolong the shelf-life of the anesthetic if the syringe is pre-loaded. 
     The syringe  810  also has a plunger  850  and a tip  860  that may have a screw thread for attachment to the anesthetic delivery catheter  890  or the port  470 . The syringe  810  may also include a lock  840  to prevent the leakage of the contents of the syringe if pre-loaded. 
     The kit  800  may also include an anesthetic delivery catheter  870 . The anesthetic delivery catheter  870  may have a length sufficient to apply the topical anesthetic mixture to any portion of a uterus or a cervix. In an embodiment, the length of the anesthetic delivery catheter is a length sufficient to apply the topical anesthetic mixture to the region in the uterus around the fallopian tubes. The anesthetic delivery catheter  870  may also have static mixing portions  880  to mix the contents of a dual barrel syringe at the point of use as the topical anesthetic and the carrier are mixed. The static mixer portions  880  may extend the entire length of the anesthetic delivery catheter  870  or may extend for only the length necessary to sufficiently mix the topical anesthetic with the carrier. The anesthetic delivery catheter  870  may also be an ordinary catheter without static mixing capabilities. The anesthetic delivery catheter  890  may have a screw thread at the proximal end for coupling with the syringe  810  or with the proximal end of the port  470  after insertion of the anesthetic delivery catheter into the port  470 . A biocompatible polymer may be used to form the anesthetic delivery catheter  870  and may be flexible. The anesthetic delivery catheter  870  may be reusable or disposable. 
     The kit  800  may also include a static mixing tip (not illustrated). The proximal end of the static mixing tip may be coupled to the tip  860  of the syringe  810 . The length of the static mixing tip depends on the amount of mixing necessary to sufficiently mix a topical anesthetic with a carrier. The distal end of the static mixing tip may be coupled to and anesthetic delivery catheter  870  and/or to the port  470 . 
       FIG. 8 b    illustrates the use of the components of the kit  800  with a hysteroscope  600 . The components of the kit  800  and the different embodiments of the components of the kit  800  may also be used with an access catheter  700  such as the one illustrated in  FIGS. 7 a -7 d   . A stabilization device  200  having a port  470  into which the anesthetic delivery catheter has been inserted and to which a syringe  810  has been coupled is illustrated. The topical anesthetic may be applied to the uterus or cervix before inserting the delivery catheter  660  for the intrafallopian contraceptive device into the stabilization device  200  and the hysteroscope  600 . 
     In an embodiment, the topical anesthetic may be a mixed with a carrier at the point of use using a static mixer within the anesthetic delivery catheter  870  once the topical anesthetic in the first barrel  820  and the carrier in the second barrel  830  of the dual barrel syringe  810  are injected into the anesthetic delivery catheter  870  by unlocking the lock  840  and depressing the plunger  850 . The syringe  810  may have been pre-loaded or may be loaded at the point of use. The anesthetic delivery catheter may be positioned to deliver the topical anesthetic to a particular region of the uterus or cervix by ultrasound or radiography, as well as by visual orientation using a camera in a hysteroscope. To position the anesthetic delivery catheter by radiography, the tip of the anesthetic delivery catheter may have a radiographic marker at the distal end. Alternatively, the uterus may be distended with a contrast media for ultrasound or radiography prior to the application of the topical anesthetic. The minimally-invasive gynecological procedure may be performed between 2 minutes to 24 hours after the application of the topical anesthetic. The topical anesthetic may need a few minutes to take effect. In one particular embodiment, the minimally-invasive gynecological procedure may be performed within the approximate range of 5 minutes and 20 minutes after the application of the topical anesthetic. 
     Once the delivery catheter of the intrafallopian contraceptive delivery device is positioned to deploy the fallopian tube insert the fallopian tube insert is deployed into the fallopian tube. In an embodiment, the fallopian tube insert may have the general structure of a metal frame formed from a metal such as stainless steel or superelastic or shape memory material. The frame may be expanded radially from a first diameter to a second diameter that is larger than the first diameter. The insert may expand in a way that causes it to resiliently apply an anchoring force against the wall of the fallopian tube. The surface of the insert may be designed to facilitate epithelial growth; one way of doing this is to provide the insert with and open or lattice-like framework to promote and support epithelial growth into as well as around the insert to ensure secure attachment to an embodiment within the wall of the body lumen. The hollow inner portion within the frame may include a tissue ingrowth agent such as a polyester fiber or other materials known to facilitate fibrotic or epithelial growth. The surface of the frame may also be modified or treated or include such a tissue ingrowth material. 
     In other embodiments, the device may be coated or seeded to spur epithelialization. For example, the device can be coated with a polymer having impregnated therein a drug, enzyme or protein for inducing or promoting epithelial tissue growth. Once a fallopian tube insert has been placed into one fallopian tube the methods described above may be repeated to place a fallopian tube insert into the second fallopian tube. This may be done with the same delivery catheter  660  if the delivery catheter  660  contains two fallopian tube inserts in series or in parallel within a delivery catheter that has two lumens. Alternatively the second fallopian tube insert may be inserted with a second intrafallopian contraceptive delivery device. 
     In an alternate embodiment, illustrated in  FIG. 9 , the stabilization device  910  may be permanently coupled to a hysteroscope  900 . The stabilization device  910  may be coupled to the working channel  920  as an integrated part. 
     In another embodiment, the stabilization device may be an arm.  FIG. 10  illustrates one example of this embodiment where the stabilization device is an arm  1010  that is coupled to the hysteroscope  1000  and the handle of the control device  1065  to create a fixed distance between the hysteroscope  1000  and the control device  1065 . In this particular embodiment, the stabilization device shaped like an arm is coupled to the working channel  1020  and to the front portion of the handle of the control device  1065 . The stabilization device  1010  shaped like an arm may be coupled to the hysteroscope  1000  and to the control device  1065  at other various points sufficient to fix the position of the hysteroscope  1000  with respect to the control device  1065 . 
       FIG. 11 a    shows a stabilization arm  1110 . The arm has an elongated body with a first fitting  1120  for coupling to a endoscope and a contoured holster  1130  for mounting a medical device. A second optional fitting  1140  for coupling to the endoscope is also shown. A mounting point  1150  for an optional handle  1160  is also shown. The handle  1160  may be shaped to be grasped by an operator&#39;s hand. The mounting point  1150  may also be used for other attachments, such as a table clamp or pole mount. The stabilization arm  1110  may be made out of a flexible polymer allowing the first fitting  1120  and second fitting  1140  to “snap” onto the endoscope. Alternatively the stabilization arm  1110  may be made out of a harder plastic or metal allowing the stabilization arm  1110  to slide onto an endoscope. The use of the stabilization arm  1110  is advantageous because it allows an operator to perform a medical procedure without a second assistant to manipulate the medical device or endoscope. The stabilization arm  1110  also helps to prevent a too distal placement of a medical implant, such as a fallopian tube contraceptive implant device. The handle  1160  may be locked in a position relative to the hysteroscope or other type of endoscope by the stabilization arm  1110 , and this position prevents a deployment of the implant in a too distal position (or too proximal location or both). Hence, in addition to making it easier to control and use the delivery catheters which is controlled by the handle  1160 , the stabilization arm  1110  improves the accuracy of placement of the implant which is deployed by the delivery catheter. 
       FIG. 11 b    shows the stabilization arm  1110  mounted to an endoscope  1170 . The medical device  1180  is shown holstered securely into the stabilization arm  1110 . The optional handle  1160  is installed. The optional handle  1160  allows the operator to use the endoscope  1170  while grasping onto the handle  1160  as the primary point of manipulation. The medical device  1180  may be a proximal control handle for deploying a fallopian tube contraceptive implant, such as a control device  665  or similar devices. 
       FIG. 12 a    shows a stabilization arm  1200 . The stabilization arm  1200  includes a circular clamp  1210  for mounting onto an endoscope. An optional extension member  1220  extends from the clamp  1210 . The clamp  1210  includes an elongated member rotatably hinged to the clamp  1210 . A holster  1230  for mounting a medical device slides and rotatably hinges on the clamp allowing maximum adjustment capability. 
       FIG. 12 b    shows the stabilization arm  1200  mounted onto an endoscope  1240 . A medical device  1250  is shown holstered into the stabilization arm  1200 . 
       FIG. 13 a    shows the approach of a delivery of a sterilization device  1300 , which is a form of a contraceptive fallopian tube implant, inside a endoscope C into a fallopian tube A. The ostium section B is also shown. 
       FIG. 13 b    shows a sterilization device  1300  in an expanded configuration, which typically exists after the device  1300  has been deployed in a fallopian tube. The sterilization device  1300  includes an expandable outer coil  1302 , an inner coil  1304 , and polymer fiber  1306  such as PET to encourage tissue growth. One or both of the inner and outer coils may be constructed from a super elastic material, such as a Nickel-Titanium (Ni—Ti) alloy. The inner and outer coils may be coated with a layer of titanium oxide (TiO). A TiO coating will aid in biocompatibility and visibility of the sterilization device  1300 . Heat treating a Ni—Ti causes a controlled layer of TiO to form, and different thicknesses of coating correspond to different color effects of the TiO. For example the inner and outer coils may be heat treated until a 60 nm TiO layer is present, upon which the inner and outer coils will give a bluish appearance which provides a contrast relative to a color of human reproductive organs. 
       FIG. 13 c    shows the sterilization device  1300  in a non-expanded configuration coupled to a delivery catheter  1308 . The delivery catheter  1308  includes an outer portion or catheter  1310 , and inner portion or catheter  1312  (not shown), and a core wire  1314  (not shown). As shown, the black marker  1316  on the outer catheter  1310  may be first aligned with the ostium of the fallopian tube (not shown) under fluoroscopy. 
       FIG. 13 d    shows the sterilization device  1300  in a non-expanded configuration coupled to a delivery catheter  1308 . The outer catheter  1310  is withdrawn at the proximal part of the catheter  1308  exposing the expandable outer coil  1302  while fully wound down in a non-expanded state. As shown in close-up view A-A a gold band  1318  on the inner catheter  1312  may be used to check alignment with the ostium, as the black marker  1316  is withdrawn with the outer catheter  1310 . While the gold band  1318  remains aligned, a release wire  1320  coupled to the outer coil  1302  is pulled in the proximal direction to expand the outer coil  1302 . 
       FIG. 13 e    shows the sterilization device  1300  in an expanded configuration coupled to a delivery catheter  1308 . The device  1300  remains attached to the core wire  1314  at the inner coil  1304 . The core wire is withdrawn to fully disengage the device  1300 . 
       FIG. 13 f    shows a magnified cross sectional view of the core wire  1314  and inner coil  1304  interference fit before disengagement. The inner coil  1304  is expanded over the core wire  1314  to provide a frictional interference fit. The interference fit allows the device to be disengaged in an axial movement with the endoscope and delivery catheter remaining in a stable position and without requiring rotation of the endoscope and the delivery catheter as a unit and without requiring rotation of the delivery catheter relative to the endoscope. No radial torque is required as opposed to the devices in U.S. Pat. No. 6,526,979 and U.S. Pat. No. 6,634,361. This is beneficial as alignment with the fallopian tube is easily maintained when the endoscope, delivery catheter and any additional stabilization device is not rotated and thus remain in a rotationally stable position relative to a patient. Further, the operator may need to use only a rotary knob or thumbwheel to release the sterilization device from the delivery catheter. The interference fit is also more reliable in disengagement and detachment than a fit which requires a radial torque, for example by eliminating interference between PET fibers and the core wire which develop from radial movement. 
       FIG. 13 g    shows a magnified cross sectional view of the core wire  1314  and inner coil  1304  interference fit after disengagement. The core wire  1314  is withdrawn from the inner coil  1304  to disengage the device  1300 . The inner catheter  1312  remains stationary to buttress against the inner coil  1304  while the core wire  1314  is being withdrawn. After the core wire  1314  is disengaged, the entire delivery catheter  1308  may be withdrawn from the patient. 
       FIG. 13 h    shows a portion of a top view of a handle  1320  of a sterilization device  1300 . The handle  1320  includes a thumbwheel  1322  at an initial position. The handle  1320  includes a second thumbwheel position with a first indicator  1324 . The first indicator  1324  functions as a visual reminder to an operator and refers to withdrawing the outer catheter  1310  by rotating the thumbwheel  1322  in a proximal direction until the thumbwheel  1322  stops, which exposes the expandable outer coil  1302  (this step is performed after previously aligning the black marker  1316  with the ostium). As shown the first indicator  1324  is labeled “1” to indicate a first operation, however other labels may be used to indicate a first operation, for example “A”. The first indicator  1324  may be imprinted onto, or molded into the handle  1320 . 
     The handle  1320  includes a second position with a second indicator  1326 . The second indicator  1326  functions as a visual reminder to the operator to check alignment of the gold band  1318  on the inner catheter  1312  with the ostium, as the black marker  1316  has been withdrawn with the outer catheter  1310 . As shown the second indicator  1326  is labeled “2” and includes a check mark to indicate a second operation, however other labels may be used to indicate a second operation, for example “B” or a check mark alone or a combination thereof. The second indicator  1326  may be imprinted onto, or molded into the handle  1320 . 
     The handle  1320  includes a safety button  1330  with a third indicator  1328 . The third indicator  1328  functions as a labeled operation for pressing the safety button. The safety button  1330  is pressed after checking alignment with of the gold band  1318  with the ostium. Pressing the safety button  1330  allows thumbwheel to travel to a second position and allows the operator to proceed to the next operation of delivery. As shown the third indicator  1328  is labeled “3” to indicate a third operation, however other labels may be used to indicate a third operation, for example “C”. The third indicator  1328  may be imprinted onto, or molded into the safety button  1330 . 
     The handle  1320  includes a final thumbwheel position with a forth indicator  1328 . The forth indicator  1332  functions as a visual reminder to an operator and refers to rotating the thumbwheel  1322  until it stops, which pulls the release wire  1320  coupled to the outer coil  1302  to expand the outer coil  1302  and also withdraws the core wire  1314  from the inner coil  1304  to fully disengage the device  1300 . As shown the forth indicator  1328  is labeled “4” to indicate a forth operation, however other labels may be used to indicate a forth operation, for example “D”. The forth indicator  1328  may be imprinted onto, or molded into the handle  1320 . 
     The handle  1320  may also include arrow marks  1334  to indicate the direction of thumbwheel travel, which as shown is a proximal direction away from the patient. The arrow marks  1334  may be imprinted onto, or molded into the handle  1320 . Alternatively the indicators  1324 ,  1326 ,  1328 ,  1332  and arrow marks  1334  may incrementally glow or incrementally light up via powered LED lights to indicate to the operator which operations have been performed in the delivery of the sterilization device  1300 . This is advantageous as it allows the operator to know which operation have been performed if the operator has deviated attention from the delivery of the sterilization device  1300 . Alternatively an audible signal may work in lieu of or in conjunction with the indicators. The audible signal may have different tonality for each indicator, or use a recorded or electronically generated voice signal (e.g. at indicator  1332  a signal stating “CHECK”). The handle would include a power source such as a battery for lights or audible signals. Alternatively the handle may include a wireless transmitter which transmits one or more analog or digital electronic signals to an external device. The external device would be capable if processing the signal in to an audible signal and/or a visual signal, for example a flashing light on a set-top box, a speaker on a set-top box, or a visual cue digitally overlaid on a television screen currently projecting the procedure. The handle may use an analog radio frequency signal or wireless data connection such as a WiFi (IEEE 802.11a or b or g standard) connection or a Bluetooth wireless connection or a wireless USB connection or other WPAN (Wireless Personal Area Network) connection standards. 
       FIG. 13 i    shows an internal side view of one side of the handle  1320 . The handle  1320  also includes an opposite side which is not shown. The handle includes the thumbwheel  1322  which includes a gear  1338  shown in hidden lines. The slideable outer catheter  1310  is coupled to a rack  1336 , the stationary inner portion or catheter  1312  resides within the outer portion or catheter  1310  and is coupled to the handle  1320 , and the core wire  1314  resides slideably within the inner catheter  1312  and is coupled to a slideable core wire holder  1340 . The gear  1338  meshes with the rack  1336  and thus may move the outer catheter  1310 . When the thumbwheel is rotated clockwise from an initial position, movement of the gear  1338  causes the rack  1336  to travel in a proximal direction away from the sterilization device  1300 . The thumbwheel  1322  and rack  1336  have three incremented positions, not including positions traveling between, which is an initial position where the sterilization device  1300  is at least partially covered by the outer catheter  1310 , a second position where the outer catheter  1310  has withdrawn to expose the sterilization device  1300 , and a final position where the sterilization device is released. As shown the thumbwheel  1322  and rack  1336  are in the second position. A detent mechanism  1340  shown in hidden lines allows the rack  1336  to ratchet only in the proximal direction. 
     As shown the thumbwheel  1322  and rack  1336  are in the second position. The safety button includes a pivot  1342  where the safety button  1328  hinges upon the handle  1320 . As shown the rack  1336  is in contact with the safety button  1328 , thus when the safety button is not depressed the rack  1336  cannot travel farther. The rack  1336  is stopped by the most proximal position  1346  of the safety button  1328  which blocks the rack  1336 . At the most distal position  1346  of the safety button, shown in hidden lines, the safety button is kept from depressing by a standoff  1348 , shown in hidden lines. Pressing the safety button causes the most distal portion  1346  to travel in the counter clockwise direction about the pivot  1342  and elastically deform the standoff  1348 . After the most distal portion  1346  passes by the standoff  1348 , the standoff  1348  will return to its original position and thereby block the most distal portion  1346  from traveling back into the clockwise direction. Pressing the safety button  1328  also causes the most distal portion  1344  of the safety button  1328  to travel counter clockwise about the pivot  1342  and thus raise above and allow the rack  1336  to travel in the proximal direction. 
     After the safety button is depressed, the rack  1336  is free to travel in the proximal direction. Continued proximal travel of the rack by clockwise rotation of the thumbwheel  1322  will cause the rack to contact the slideable core wire holder  1340  (to which the core wire  1314  is coupled to) and in turn cause the core wire  1314  and the release wire  1320  (not shown) to move in the proximate direction and to ultimately release the sterilization device  1300  when the rack reaches the final position. 
       FIG. 14  shows a system for a wireless endoscope. A wireless camera  1400  integrated into or connected onto a endoscope  1410  transmits a wireless camera signal to a wireless host controller  1420 . The wireless host  1420  may be controlled by a computer  1430  which receives and transmits the camera signal to a monitor  1440 . The system may use a wireless data connection such as a WiFi (IEEE 802.11a or b or g standard) connection or a Bluetooth wireless connection or a wireless USB connection or other WPAN (Wireless Personal Area Network) connection standards. Alternatively the host controller  1420  may transmit a wireless signal to a secondary or alternative display  1450 , such as a heads up display integrated into eye glasses or other headmounted displays. The wireless camera  1400  may serve as the host controller and transmit wireless signals to any display which can receive the signals. 
       FIG. 15 a    shows a schematic for a wireless endoscope  1500 . A CMOS or CCD imaging sensor  1510  transmits a signal to a processor  1520  which in turn transmits the signal to a wireless transmitter  1530  mounted in a handle. The transmitter  1530  in turn transmits the signal to a system as shown in  FIG. 14 . The processor may also convert the signal into a viewable signal for direct transmission to a display. A battery  1540  powers a LED light source  1550  at the distal end of the endoscope. Alternatively a fiber optic light source may be used. The endoscope also includes elements not shown including hand controls and wires for manipulation and a working channel for inserting devices. 
       FIG. 15 b    shows a schematic for a wireless endoscope camera  1560 . The camera  1560  may be used on standard fiberscopes. The camera  1560  mechanically couples to the eyepiece of an endoscope  1570 . The camera  1560  includes a digital camera  1580 , a battery  1585 , and a transmitter  1590  to transmit signal to a system as shown in  FIG. 14 . Examples of standard sized fiberscopes for use in a minimally invasive method of sterilization include rigid scopes with a 5.5 mm outer diameter (O.D.), flexible scopes with a 4.0 mm O.D., both of which have at least a 5 french working channel, and range in length from 30-40 cm. 
     While the exemplary embodiment of the present invention has been described in some detail for clarity of understanding and by way of example, a variety of adaptations, changes and modifications will be obvious to those who are skilled in the art. Hence the scope of the present invention is limited solely by the following claims.