System and method for articulated wire guidance

Abstract

A steering assembly of a medical device can include a handle having a recess and a first guidewire guide and a second guidewire guide disposed within the recess. At least one of the first guidewire guide or the second guidewire guide can be keyed into the recess to prevent rotation of the first guidewire guide or the second guidewire guide within the recess. A first guidewire segment and a second guidewire segment can be configured to steer a sheath coupled to the steering assembly in a first direction and a second direction. The first guidewire segment can pass through a first gap between the first guidewire guide and the second guidewire guide. The second guidewire segment can pass through a second gap between the first guidewire guide and the second guidewire guide. Neither the first gap nor the second gap occupies any overlapping space.

Description

[0001] Cross-references to Related Literature

[0002] This application claims priority to U.S. Provisional Application No. 62 / 841,290, filed May 1, 2019, the entirety of which is incorporated by reference herein. TECHNICAL FIELD

[0003] The present disclosure relates generally to steering mechanisms of medical devices, including endoscopes. In particular, the present disclosure relates to systems and methods for articulation wire guidance. BACKGROUND

[0004] The handle of an endoscope houses a plurality of components (e.g., steering components) that are separated from one another. The placement of such components in the handle involves the use of chains or similar components. Such components increase manufacturing costs by adding part costs and assembly costs, making them unsuitable for production of disposable devices. Thus, there is a need for a simple and cost-effective steering assembly for endoscopes or other medical devices. SUMMARY

[0005] In one example, a steering assembly of a medical device can include a handle having a recess and a first wire guide and a second wire guide disposed within the recess. At least one of the first wire guide or the second wire guide can be keyed into the recess to prevent rotation of the first wire guide or the second wire guide within the recess. A first wire segment and a second wire segment can be configured to steer a sheath coupled to the steering assembly in a first direction and a second direction. The first wire segment can pass through a first gap between the first wire guide and the second wire guide. The second wire segment can pass through a second gap between the first wire guide and the second wire guide. Neither the first gap nor the second gap occupies any overlapping space.

[0006] Any of the examples of the steering assembly described herein can have any of the following features. The steering assembly can further include a third guide wire guide and third and fourth guide wire segments configured to steer the sheath in third and fourth directions. The third guide wire segment can pass through a third gap between the second guide wire guide and the third guide wire guide. The fourth guide wire segment can pass through a fourth gap between the second guide wire guide and the third guide wire guide. The first and second gaps can be offset from each other. The first and second guide wire segments can be configured to control left / right movement of a sheath coupled to the steering assembly. The third and fourth guide wire segments can be configured to control up / down movement of a sheath coupled to the steering assembly. None of the first, second, third, or fourth gaps can occupy any overlapping space. The first guide wire guide can include a first opening for receiving a first shaft component. The second guide wire guide can include a second opening for receiving a second shaft component. The third guide wire guide can include a third opening for receiving a third shaft component. Each of the first, second, and third openings can have a different diameter. Each of the first and second guide wire guides can be keyed with a groove to prevent rotation relative to the groove when disposed in the groove. Each of the first, second, and third guide wire guides can be disposed in a groove. Each of the first, second, and third guide wire guides can be keyed with a groove to prevent rotation relative to the groove when disposed in the groove. The steering assembly can further include a first pulley coupled with the first and second guide wire segments. The first pulley can be disposed between the first and second guide wire guides. A second pulley can be coupled with the third and fourth guide wire segments. The second pulley can be disposed between the second and third guide wire guides. A thickness of the first pulley can maintain the first and second gaps. A thickness of the second pulley can maintain the third and fourth gaps. The first guide wire guide can have first and second offset surfaces that define first portions of the first and second gaps, respectively. The second guide wire guide can have third and fourth offset surfaces that define second portions of the first and second gaps, respectively. The first guide wire guide can have a first step surface extending from the first offset surface to the second offset surface. The second guide wire guide can have a second step surface extending from the third offset surface to the fourth offset surface. The first and second step surfaces can define third portions of the first and second gaps, respectively.

[0007] In another example, a steering assembly of a medical device can include a handle, a first guide wire guide disposed in the handle, a second guide wire guide, and a third guide wire guide. At least one of the first, second, or third guide wire segments can be constrained by the shaft. The first and second guide wire segments can be configured to control movement of a sheath connected to the handle in a first direction and a second direction, and the third and fourth guide wire segments can be configured to control movement of the sheath in a third direction and a fourth direction. The first guide wire segment can pass through a first gap between the first and second guide wire guides. The second guide wire segment can pass through a second gap between the first and second guide wire guides. The third guide wire segment can pass through a third gap between the second and third guide wire guides. The fourth guide wire segment can pass through a fourth gap between the second and third guide wire guides.

[0008] Any of the examples of steering assemblies described herein can have any of the following features. None of the first, second, third, or fourth gaps can occupy any overlapping space. The first and second gaps can be offset from each other.

[0009] In another example, a steering assembly of a medical device can include a first guide wire guide, a second guide wire guide, and a third guide wire guide disposed in a handle, and a first pulley having a first guide wire and a second guide wire. The first pulley can be disposed between the first and second guide wire guides. A second pulley can have a third guide wire and a fourth guide wire. The second pulley can be disposed between the second and third guide wire guides. The first, second, and third guide wire guides and the first and second pulleys can be stacked relative to each other to completely contain the first, second, third, and fourth guide wire segments within separate compartments.

[0010] Any of the examples of steering assemblies described herein can further include a handle. The handle can include a recess. Each of the first, second, and third guide wire guides can be keyed to the recess to prevent rotation relative to the recess when contained therein.

[0011] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the application, as claimed. As used herein, the terms "comprises," "comprising," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but can include other elements not expressly listed or inherent to such process, method, article, or apparatus. The term "exemplary" is used in the sense of "example," rather than "ideal." As used herein, the term "proximal" refers to the direction closer to the operator, and the term "distal" refers to the direction farther from the operator. Although reference is made herein to endoscopes, reference to endoscopes or endoscopes should not be understood as limiting the possible applications of the disclosed handles and other aspects. For example, the disclosed aspects can be used in duodenoscopes, bronchoscopes, ureteroscopes, colonoscopes, catheters, diagnostic or therapeutic tools or devices, or other types of medical devices. BRIEF DESCRIPTION OF DRAWINGS

[0012] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate examples of the disclosure and, together with the description, serve to explain the principles of the disclosure.

[0013] Figure 1A A perspective view of a medical device is described.

[0014] Figure 1B A perspective view of a handle component of a medical device of Figure 1A is described.

[0015] Figure 2 A cross-sectional view of a portion of a medical device of Figure 1A is shown.

[0016] Figure 3 A perspective view of a medical device in a partially assembled state of Figure 1A is shown.

[0017] Figures 4A-4D A view of a first guidewire guide is shown.

[0018] Figures 5A-5B A perspective view of a handle component of a medical device in a partially assembled state of Figure 1A is shown.

[0019] Figures 6A-6D A view of a second guidewire guide is shown.

[0020] Figures 7A-7B A perspective view of a handle component of a medical device in a partially assembled state of Figure 1A is shown.

[0021] Figures 8A-8C A view of a third guidewire guide is shown.

[0022] Figure 9 A perspective view of a handle component of a medical device is shown in partial assembly. Figure 1A A perspective view of a handle component of a medical device is shown in partial assembly. DETAILED DESCRIPTION

[0023] The handle of an endoscope (e.g., the operating portion of the endoscope) can include components used by an operator when using the endoscope to perform a procedure. For example, the handle of an endoscope can include steering components or steering assemblies that can be used to deflect the distal end of the sheath of the endoscope. These steering components or steering assemblies can include, for example, pulleys, barrels, and / or wires. The wires of the steering assemblies can pass from the distal side of the handle (e.g., the grip) into the sheath (e.g., the insertion portion) of the endoscope and through the sheath toward the distal end of the sheath. The wires can be used to deflect the distal end of the sheath in one or more directions. For example, the sheath can include a hinged joint that is able to move in various directions (e.g., 90-360 degrees of movement). Alternatively, the sheath can include any other mechanism or structure that can be used to effect movement of the distal end of the sheath. In order to effectively deflect the distal end of the sheath, it can be important to prevent the wires of the steering assemblies from crossing one another. It can also be important to minimize friction of the barrels and / or pulleys and optimize control of the barrels and / or pulleys. It can also be desirable to utilize components that are relatively inexpensive and / or easier to assemble. Accordingly, aspects of the present disclosure are directed to wire guides for positioning and housing the wires, barrels, and / or pulleys within an endoscope.

[0024] FIG. 1 depicts a device 10. The device 10 can be an endoscope, a duodenoscope, a bronchoscope, a ureteroscope, a colonoscope, a catheter, or other type of medical device. The device 10 can include a handle 12. The handle 12 can have any of the features described in the concurrently filed U.S. Provisional Patent Application entitled “Chambered Handle for Medical Devices,” Attorney Docket No. 06530-0876-00600, the entire disclosure of which is incorporated by reference herein. The device 10 can also include a sheath 14 or other type of tool that can be inserted into a body lumen of a subject during a medical procedure. The proximal end of the sheath 14 can be connected with the handle 12. The sheath 14 can include a distal end 16. A distal tip 18 can be the most distal feature of the distal end 16. The distal tip 18 can include various components such as elevators, air / water / suction ports, working channel ports, optical elements (e.g., cameras and / or lenses), illumination devices (e.g., light emitting diodes), etc. A hinged section 20 can be proximal to the distal tip 18. The hinged section 20 can include a mechanism configured to facilitate deflection of the distal end 16 in one or more directions (e.g., in upward, downward, leftward, and / or rightward directions, perpendicular to the longitudinal axis of the device 10).

[0025] The connecting strap 24 can extend from the handle 12. The connecting strap 24 can be used to connect the device 10 to components such as controllers (for providing optical controls, such as cameras, video, light or other optical controls), air and / or water supply, and / or suction supply.

[0026] Handle 12 may include several components for an operator to control device 10 before, during, or after surgery involving device 10. For example, handle 12 may include a steering component 30. Steering component 30 can be used to control the deflection of hinge segment 20. Steering component 30 may be a steering assembly 100 (see...) Figure 2 As part of this, it will be discussed in further detail below. For example, the steering component 30 may include two knobs 32, 34 for deflecting the distal end 16 of the sheath 14. For example, one of the knobs 32, 34 may be used to deflect the distal end 16 of the sheath 14 in a left / right direction, and the other of the knobs 32, 34 may be used to deflect the distal end 16 of the sheath 14 in an up / down direction. The steering component 30 may also include locking mechanisms 36, 38 for preventing or limiting movement of the distal end 16 in the left / right and / or up / down directions when in the locked position. For example, the locking mechanism 36 may be a knob that operably prevents movement of the knob 32, thereby preventing the distal end 16 from deflecting in the left / right direction. The locking mechanism 38 may be an operable lever to prevent movement of the knob 34, thereby preventing deflection of the distal end 16 in the up / down direction. Any other suitable feature may be used to prevent movement of the knobs 32, 34.

[0027] Handle 12 may also include ports and / or valves. For example, handle 12 may include a working channel port 40 for passing instruments or other equipment down through a working channel in sheath 14. The working channel port 40 may be housed in a port housing 42. Port 40 may include a valve to prevent leakage. Handle 12 may also include fluid dynamic components, such as valves 52 for supplying air, water, and / or suction. Valves 52 may be connected to tubing in connecting strap 24, handle 12, and / or sheath 14, such that pressing valves 52, 54, allows the corresponding function. For example, one of valves 52 may be used to supply air and / or water. Another of valves 52 may be used to provide suction and may be connected to a working channel extending from the working channel port 40.

[0028] The handle 12 may also include other components, such as a lifting lever 60, which can be used to move the lifter (not shown) up and / or down at the distal tip 18 of the sheath 14. For example, in the case where the device 10 is a duodenoscope, the lifting lever 60 may be included.

[0029] A longitudinal axis of the device 10 is an axis extending along the handle 12 and the sheath 14, and a longitudinal direction is a direction along the longitudinal axis. A radial direction is a direction perpendicular to the longitudinal axis.

[0030] Figure 1B A main body 70 of the handle 12 is shown, without many components for operating the device 10 installed. The main body 70 can include a first recess 80. The first recess 80 can have a wall 82 around a portion, but not all, of the first recess 80. The first recess 80 can be open at a distal end of the first recess 80 and an outer side of the main body 70. The first recess 80 can have a rounded proximal side or proximal end 84, which can be semi-circular or U-shaped. An inner surface (which can be a bottom surface) 83 of the first recess 80 can extend from the open distal end to the rounded proximal end 84, which is opposite the open outer side. The inner surface 83 can be parallel or approximately parallel to a longitudinal axis of the main body 70 and / or the device 10. The first recess 80 can have two side surfaces 86 extending between the open distal end and the rounded proximal side 84. As used herein, an outward direction refers to a direction extending from the inner surface 83 to the open outer side of the first recess 80, and an inward direction is the opposite direction. Additionally, the first recess 80 can have a wall 82 around other subsets of the first recess 80. The first recess 80 can include a second recess 88, which can be recessed deeper than the first recess 80 relative to the open outer side of the first recess 80. For example, the second recess 88 can be recessed from the inner surface 83.

[0031] The wall 82 can have a uniform height, or can have different heights measured in a radial direction of the main body 70. A ridge 90 can extend around a portion of a circumference of the first recess 80. For example, the ridge 90 can extend around the curved proximal side 84 of the first recess 80. The ridge 90 can also extend along a portion of the side surfaces 86 of the first recess 80. For example, the ridge 90 can extend along a portion of the straight sides of the first recess 80 that are closer to the connecting band 24.

[0032] As Figure 2As shown, the cable steering assembly 100 can fit within, be disposed on, or otherwise be connected to the handle 12. For example, the cable steering assembly 100 can be received into the first recess 80. The cable steering assembly 100 can include a shaft assembly 120, which can include one or more shafts, as discussed in further detail below. The cable steering assembly can also include two pairs of wire pairs 122, 124 for effecting deflection of the distal end 16 of the sheath 14. The wire pairs 122, 124 can each include two separate wires that can each terminate in a ferrule and be affixed to a groove of a pulley (as discussed in further detail below). Alternatively, each pair of wire pairs 122, 124 can include a pair of wire segments formed from a single wire that is looped around a shaft or pulley. The first pair of wires 122 can control movement in one direction, e.g., in a left / right direction. The second pair of wires 124 can control movement in another direction, e.g., in an up / down direction. The configuration of the wire pairs 122, 124 is merely exemplary. Other configurations can be used, and the wire pairs 122, 124 can be omitted in favor of other types of mechanisms for deflecting the distal end 16 of the sheath 14.

[0033] The first pair of wires 122 can include a first wire (or wire segment) 132 and a second wire (or wire segment) 134. Proximal movement of the first wire 132 can deflect the distal end 16 of the sheath 14 in a first direction, e.g., a rightward direction. Proximal movement of the second wire 134 can deflect the distal end 16 of the sheath 14 in a second direction opposite the first direction, e.g., a leftward direction. Proximal movement of the first wire 132 can be accompanied by distal movement of the second wire 134. Proximal movement of the second wire 134 can be accompanied by distal movement of the first wire 132. The first wire 132 and the second wire 134 can be moved proximally or distally by, e.g., turning the knob 32 or by activating an alternative mechanism, such as another component of the steering assembly 30. Turning the knob 32 in the first direction can cause deflection in the first direction, while turning the knob 32 in the second direction can cause deflection in the second direction.

[0034] The second pair of guide wires 124 can include a third guide wire 136 and a fourth guide wire 138. Moving the third guide wire 136 proximally can cause the distal end 16 of the sheath 14 to deflect in a third direction (e.g., a downward direction). Moving the fourth guide wire 138 proximally can cause the distal end 16 of the sheath 14 to deflect in a fourth direction (e.g., an upward direction) opposite the third direction. Proximal movement of the third guide wire 136 can be accompanied by distal movement of the fourth guide wire 138. Proximal movement of the fourth guide wire 138 can be accompanied by distal movement of the third guide wire 136. The third guide wire 136 and the fourth guide wire 138 can be moved proximally or distally by turning the knob 34 or by activating an alternative mechanism, such as another component of the steering assembly 30. Turning the knob 34 in the first direction can cause deflection in the third direction, while turning the knob 34 in the second direction can cause deflection in the fourth direction.

[0035] As shown in FIG. 1, the first pair of guide wires 122 can include a first guide wire 132 and a second guide wire 134. Moving the first guide wire 132 proximally can cause the distal end 16 of the sheath 14 to deflect in a first direction (e.g., a rightward direction). Moving the second guide wire 134 proximally can cause the distal end 16 of the sheath 14 to deflect in a second direction (e.g., a leftward direction) opposite the first direction. Proximal movement of the first guide wire 132 can be accompanied by distal movement of the second guide wire 134. Proximal movement of the second guide wire 134 can be accompanied by distal movement of the first guide wire 132. The first guide wire 132 and the second guide wire 134 can be moved proximally or distally by turning the knob 34 or by activating an alternative mechanism, such as another component of the steering assembly 30. Turning the knob 34 in the first direction can cause deflection in the first direction, while turning the knob 34 in the second direction can cause deflection in the second direction. Figure 2 As shown in FIG. 1, the first pair of guide wires 122 can include a first guide wire 132 and a second guide wire 134. Moving the first guide wire 132 proximally can cause the distal end 16 of the sheath 14 to deflect in a first direction (e.g., a rightward direction). Moving the second guide wire 134 proximally can cause the distal end 16 of the sheath 14 to deflect in a second direction (e.g., a leftward direction) opposite the first direction. Proximal movement of the first guide wire 132 can be accompanied by distal movement of the second guide wire 134. Proximal movement of the second guide wire 134 can be accompanied by distal movement of the first guide wire 132. The first guide wire 132 and the second guide wire 134 can be moved proximally or distally by turning the knob 34 or by activating an alternative mechanism, such as another component of the steering assembly 30. Turning the knob 34 in the first direction can cause deflection in the first direction, while turning the knob 34 in the second direction can cause deflection in the second direction. Figure 2 As shown in FIG. 1, the first pair of guide wires 122 can include a first guide wire 132 and a second guide wire 134. Moving the first guide wire 132 proximally can cause the distal end 16 of the sheath 14 to deflect in a first direction (e.g., a rightward direction). Moving the second guide wire 134 proximally can cause the distal end 16 of the sheath 14 to deflect in a second direction (e.g., a leftward direction) opposite the first direction. Proximal movement of the first guide wire 132 can be accompanied by distal movement of the second guide wire 134. Proximal movement of the second guide wire 134 can be accompanied by distal movement of the first guide wire 132. The first guide wire 132 and the second guide wire 134 can be moved proximally or distally by turning the knob 34 or by activating an alternative mechanism, such as another component of the steering assembly 30. Turning the knob 34 in the first direction can cause deflection in the first direction, while turning the knob 34 in the second direction can cause deflection in the second direction.

[0036] The guide wire guides 142, 144, 146 can separate the guide wires 132, 134, 136, and 138 from one another. For example, the guide wire guides 142, 144, 146 can be arranged to separate the guide wires 132, 134, 136, and 138 from one another and maintain their positions on the respective pulleys. In other words, the guide wire guides 142, 144, and 146 can form a barrier that prevents the guide wires 132, 134, 136, and 138 from contacting one another. This can help to avoid crossing of the guide wires 132, 134, 136, and 138, which can interfere with steering of the distal end 16 of the sheath 14. Furthermore, this can also help to ensure that the guide wires remain in the proper position relative to the pulleys.

[0037] Figure 3 A first recess 80 and ridge 90 are shown, which are isolated from other components of handle 12. A shaft 172 of a turning component 30 can be secured to the body of handle 12. For example, shaft 172 can be secured to the body of handle 12 with a washer or flange 174. Flange 174 can have a shape that is complementary to second recess 88, such that a keying relationship exists between flange 174 and second recess 88. The keying relationship between flange 174 and second recess 88 can minimize or completely prevent rotation of flange 174 within second recess 88.

[0038] Figures 4A-4D Aspects of a first guidewire guide 142 are shown. Figure 4A A front view of a first guidewire guide 142 is shown. Figure 4B And 4C A perspective view of a first guidewire guide 142 is shown.

[0039] Figure 4D A bottom view of a first guidewire guide 142 is shown. Figure 5A And 5B A first guidewire guide 142 is shown in position in a first recess 80. First guidewire guide 142 can have a periphery that is complementary to the shape of first recess 80. For example, as shown in Figure 4A the proximal-most portion or edge 180 of first guidewire guide 142 can have a rounded shape. The radius of curvature of proximal-most edge 180 of first guidewire guide 142 can be the same as or slightly less than the radius of curvature of proximal-most edge 84 of first recess 80. First guidewire guide 142 can have a keying relationship with first recess 80 to minimize or prevent rotation of first guidewire guide 142 relative to first recess 80. As shown in Figure 4A the first guidewire guide can include a distal-most edge 182, which can be straight. First guidewire guide 142 can also include a first side 184 and a second side 186, each of which can extend between proximal-most edge 180 and distal-most edge 182. First side 184 and second side 186 can be shaped such that they mate with walls 86 of first recess 80. For example, first side 184 and second side 186 can be straight. The shape of first guidewire guide 142 can facilitate quick installation of first guidewire guide 142, since guidewire guide 142 is asymmetric, and installation should be performed such that curved proximal-most edge 180 of first guidewire guide 142 is adjacent to proximal-most edge 84 of first recess 80.

[0040] The first guidewire guide 142 can have an opening 190. The opening 190 can have a circular shape (e.g., a circular shape). The opening 190 can be sized to have substantially the same diameter as the shaft 172 or a slightly larger diameter than the diameter of the shaft 172. The opening 190 can be positioned closer to the proximal-most side 184 than the distal-most side 182. The opening of any guidewire guide disclosed herein can be constrained by the interaction between the opening of the guidewire guide and the shaft 172 (or other shaft or rod).

[0041] The first guidewire guide 142 can have a first side 192 and a second side 194, each of which can extend from the proximal-most side 180 to the distal-most side 182. Figure 4B Aspects of the first side 192 are specifically shown. Figure 4C Aspects of the second side 194 are specifically shown.

[0042] The first guidewire guide 142 can have a proximal portion 196. The proximal portion 196 can have a washer shape. For example, the proximal portion 196 can include the opening 190 and can include a portion of the first guidewire guide 142 that is coaxial with the opening 190.

[0043] The first guidewire guide 142 can also have a first distal portion 202 and a second distal portion 204. The first distal portion 202 can extend from the first side 184 toward the second side 186, but can terminate before the second side 186. The second distal portion 204 can extend from the second side 186 toward the first side 184, but can terminate before the first side 184. For example, each of the first distal portion 202 and the second distal portion 204 can terminate at about half or a half of the distance between the first side 184 and the second side 186, although other dimensions are contemplated. Each of the first distal portion 202 and the second distal portion 204 can have a thickness that is greater than the proximal portion 196. In other words, the distance between the first side 192 and the second side 194 at each of the first distal portion 202 and the second distal portion 204 can be greater than the distance at the proximal portion 196. As shown, the first distal portion 202 and the second distal portion 204 can be raised or protrude relative to the proximal portion 196 of the first side 192. Figure 4B

[0044] With specific reference to Figure 4B On the first side 192, the first distal portion 202 can be raised more relative to the proximal portion 196 than the second distal portion 204. The first distal portion 202 can be thicker than the second distal portion 204. In other words, the distance between the first side 192 and the second side 194 at the first distal portion 202 can be greater than the distance at the second distal portion 204.​

[0045] Figure 4D A bottom view of the first guidewire guide 142 is shown, thus showing the distal-most side 182. Along the distal-most side 182, the second side 194 can be flat. Along the distal-most side 182, the first side 192 can be stepped so as to have a first flat portion 206 (along the first distal portion 202) and a second flat portion 208 (along the second distal portion 204) with a step 210 between the first flat portion 206 and the second flat portion 208. The first flat portion 206 and the second flat portion 208 can be offset from one another. The first flat portion 206 and the second flat portion 208 can be substantially parallel to one another. The step 210 can form a boundary between the first flat portion 206 and the second flat portion 208. The step 210 can be substantially perpendicular to both the first flat portion 206 and the second flat portion 208.

[0046] On the first side 192, the first distal portion 202 can have a proximal edge 212 and the second distal portion 204 can have a proximal edge 214. The proximal edges 212, 214 of the first distal portion 202 and the second distal portion 204, respectively, can be adjacent to the proximal portion 196. The proximal edges 212, 214 can have a rounded, concave shape, each of which can be a segment of the same circle. As shown, the proximal edges 212, 214 can have the same or similar shape when viewed from the front of the first side 192, although the proximal edges 212, 214 can have different thicknesses. For example, the proximal edge 212 can be thicker than the proximal edge 214. The difference in thickness between the proximal edge 212 and the proximal edge 214 can correspond to the difference in thickness between the first distal portion 202 and the second distal portion 204. Figure 4A

[0047] With specific reference to Figure 4C ​The first distal portion 202 can be hollow so that the first distal portion 202 includes a recess 230 on the second side 194. The recess 230 can have an inner wall 232 that follows the contour of the first distal portion 202. The fact that the first distal portion 202 can be hollow can result in a reduction in manufacturing cost and weight of the first guidewire guide 142. The recess 230 can maintain the thickness of the wall of the first guidewire guide 142 constant, facilitating the molding of the first guidewire guide 142 or other manufacturing techniques of the first guidewire guide 142. Alternatively, the recess 230 can have any of the characteristics of the recess 430, discussed below with respect to the third guidewire guide 146. The recess 230 or another portion of the first guidewire guide 142 can also include an indicator mark 234. The indicator mark 234 can indicate, for example, the orientation of the guidewire guide 142 within the handle 12. For example, the indicator mark 234 can be a "B", for example, a first mark, or any other suitable mark, indicating that the first guidewire guide 142 is the bottom guidewire guide that will be adjacent to the inner surface 83 of the recess 80. In addition, other indicator marks can also be used.

[0048] Figure 5A The first guidewire guide 142 is shown placed in the recess 80. Figure 5BA first pulley 250 is shown mounted adjacent to a first side edge 192 of the first guidewire guide 142 (above the first guidewire guide 142). Here, the terms "above" or "over" mean an outward direction, toward the open outer side of the recess 80. The terms "below" or "under" mean an inward direction, toward the inner surface 83. The first guidewire guide 142 can be positioned in the first recess 80 so that a second side edge 194 of the first guidewire guide 142 is adjacent to the inner surface 83 of the first recess 80. The first side edge 192 can face toward the open outer side of the first recess 80. The shaft 172 can extend through the opening 190. For example, the first guidewire guide 142 can be positioned so that the shaft 172 is aligned with the opening 190, and then the first guidewire guide 142 can be advanced along the shaft 172 until it stops on the inner surface 83 of the first recess 80. The first pulley 250 can interface with the first guidewire guide 142, or there can be a gap between the first pulley 250 and the first guidewire guide 142. The first pulley 250 can have the shape of a spool. The first pulley 250 can have an outer diameter so that the first pulley 250 is aligned with a proximal portion 196 of the first guidewire guide 144 and interfaces with the proximal edges 212, 214. For example, the proximal portion 196 can have a diameter that is substantially equal to the diameter of the first pulley 250. The first pair of guidewires 122 (the first guidewire 132 and the second guidewire 134) can be wound around the first pulley 250. As discussed above, the first pair of guidewires 122 can be a single continuous guidewire, or can include separate guidewires. The first pulley 250 can be attached to a first pulley shaft 252, which can be a component of the shaft assembly 120, and which can be coaxial with the shaft 172. The first pulley shaft 252 can be fixed relative to the first pulley 250 so that rotation of the first pulley shaft 252 causes rotation of the first pulley 250. The first pulley shaft 252 can be operatively connected to the knob 32 to cause rotation of the first pulley shaft 252. The first guidewire 132 can pass along a first plane 206 of the first distal portion 202. The second guidewire 134 can pass along a second plane 206 of the second distal portion 204.

[0049] Figures 6A-6D Aspects of the second guidewire guide 144 are shown. Figures 7A-7B A second guidewire guide 144 is shown mounted in the first recess 80 of the handle 12. The perimeter shape of the second guidewire guide 144 can have any of the features of the perimeter shape of the first guidewire guide 142 discussed above. For example, the second guidewire guide 144 can have the same perimeter shape as the first guidewire guide 142. For example, as discussed above with respect to the first guidewire guide 142, the second guidewire guide 144 can have a perimeter shape that is complementary to the shape of the first recess 80.

[0050] The second guidewire guide 144 may include a nearest side 280, which may be curved, and a farthest side 282, which may be straight. The second guidewire guide 144 may also include a first side 284 and a second side 286, each of which extends between the nearest side 280 and the farthest side 282. The shapes of the first side 284 and the second side 286 allow them to mate with the side surface 86 of the first recess 80. For example, the first side 284 and the second side 286 may be straight. The shape of the first guidewire guide 144 facilitates quick installation of the second guidewire guide 144.

[0051] The second guide wire guide 144 may have an opening 290. The opening 290 may be circular in shape (e.g., a circle). The opening 290 may be sized to have approximately the same diameter as the first pulley shaft 252. The opening 290 may have a slightly larger diameter than the first pulley shaft 252. The opening 290 may be positioned closer to the nearest side 280 than the farthest side 282. The diameter of the opening 290 may be larger than the opening 190 because the first pulley shaft 252 may have a larger diameter than shaft 172.

[0052] The second guide wire guide 144 may have a first side 292 (see...) Figure 6A , 6B ) and second side 294 (see Figure 6C Each side may extend from the nearest side 280 to the farthest side 282. The first side 292 and the second side 294 may be identical to each other when viewed from the front. Therefore, although Figure 6A The first side 292 is described in detail, but the first side 292 may be the same as the second side 294.

[0053] The second guidewire guide 144 may have a proximal portion 296. The proximal portion 296 may have a washer-like shape. For example, the proximal portion 296 may include an opening 290 and may include a portion of the second guidewire guide 144 coaxial with the opening 290.

[0054] The second guidewire guide 144 can also have a first distal portion 302 and a second distal portion 304. The first distal portion 302 can extend from the first side 284 toward the second side 286, but can terminate before the second side 286. The second distal portion 304 can extend from the second side 286 toward the first side 284, but can terminate before the first side 284. For example, each of the first distal portion 302 and the second distal portion 304 can terminate at about half or a half of the distance between the first side 284 and the second side 286. Each of the first distal portion 302 and the second distal portion 304 can have a thickness that is greater than the thickness of the proximal portion 296. In other words, the distance between the first side edge 292 and the second side edge 294 at each of the first distal portion 302 and the second distal portion 304 can be greater than the distance at the proximal portion 296. As shown in FIGS. 3 and 4, the first distal portion 302 and the second distal portion 304 can be raised or protrude on the first side edge 292 and the second side edge 294 relative to the proximal portion 296. Figure 4B As shown in FIGS. 3 and 4, the first distal portion 302 and the second distal portion 304 can be raised or protrude on the first side edge 292 and the second side edge 294 relative to the proximal portion 296.

[0055] As shown in FIGS. 3 and 4, the first distal portion 302 and the second distal portion 304 can be raised or protrude on the first side edge 292 and the second side edge 294 relative to the proximal portion 296. Figure 6A and 6B On the first side edge 292, the first distal portion 302 can be raised or protrude further relative to the plane defining the proximal portion 296 than the second distal portion 304. On the second side edge 294, the second distal portion 304 can be raised or protrude further relative to the plane defining the proximal portion 296 than the first distal portion 302.

[0056] Figure 6DA bottom view of the second guidewire guide 144 is shown in the proximal direction, thus showing the distal-most edge 282. The thickness of the first distal portion 302 at the distal-most edge 282 can be the same as the thickness of the second distal portion 304 at the distal-most edge 282. Alternatively, the thickness of the first distal end portion 302 can be different than the thickness of the second distal end portion 304 at the distal-most edge 282. Along the first side edge 292 and the second side edge 294, the distal-most edge 282 can be stepped. On the first side edge 292, there can be a first planar portion 306 (along the first distal portion 302) and a second planar portion 308 (along the second distal portion 304) with a first step 336 between the first planar portion 306 and the second planar portion 308 (as described below, the first distal portion 302 can be hollow on the surface of the first side edge 292, but planar along the distal-most edge 282 and the second side edge 294). The first planar portion 306 can be substantially parallel to and offset from the second planar portion 308, while the step 336 can be substantially perpendicular to both the first planar portion 306 and the second planar portion 308. On the second side edge 294, there can be a third planar portion 310 and a fourth planar portion 312 (as described below, the second distal portion 304 can be hollow on the surface of the second side edge 294, but planar along the distal-most edge 282 and the first side edge 292) with a second step 338 between the third planar portion 310 and the fourth planar portion 312. The third planar portion 310 can be substantially parallel to and offset from the fourth planar portion 312, while the step 338 can be substantially perpendicular to both the third planar portion 310 and the fourth planar portion 312. The first step 336 and the second step 338 can be about half the distance between the first side 284 and the second side 286, although other dimensions can be considered. The first step 336 and the second step 338 can be aligned or offset from each other.

[0057] On the first side edge 292, the first distal portion 302 can have a first side edge proximal edge 316 and the second distal portion 304 can have a first side edge proximal edge 320. On the second side edge 294, the first distal portion 302 can have a second side edge proximal edge 318 and the second distal portion 304 can have a second side edge proximal edge 322. The proximal edges 316, 318, 320, 322 can be adjacent to the proximal portion 296. The proximal edges 316, 318, 320, 322 can have a rounded, concave shape, each of which can be a segment of the same circle. The proximal edges 316, 318, 320, 322 can have the same or similar shape when the first side edge 192 or the second side edge 194 is viewed from the front (although the proximal edges 316, 318, 320, 322 can have different thicknesses). The first side edge proximal edge 316 of the first distal portion 302 can have a greater thickness than the second side edge proximal edge 318 of the first distal portion 302. The second side edge proximal edge 322 of the second distal portion 304 can have a greater thickness than the first side edge proximal edge 320 of the second distal portion 304. The first side edge proximal edge 316 of the first distal portion 302 can have a greater thickness than the first side edge proximal edge 320 of the second distal portion 304. The second distal portion 304 can be more raised or prominent on the second side edge 294 than the first distal portion 302, and the second side edge proximal edge 322 of the second distal portion 304 can have a greater thickness than the second side edge proximal edge 318 of the first distal portion 302.

[0058] The first distal portion 302 and the second distal portion 304 can be hollow. For example, the first distal portion 302 can include a recess 340 on the first side edge 292. The recess 340 can have an inner wall 342 that follows the contour of the first distal portion 302. The second distal portion 304 can include a recess 350 on the second side edge 294. Referring to Figure 6C , the recess 350 can have an inner wall 352 that follows the contour of the second distal portion 304. The fact that the first distal portion 302, 304 can be hollow can result in a reduction in manufacturing costs and weight of the second guidewire guide 242.

[0059] One or both of the recesses 340, 350 can include an indicator marking 360. The indicator marking 360 can indicate, for example, the orientation of the second guidewire guide 144 in the handle 12. For example, the indicator marking 350 can be an "M" or a second marking different from the indicator marking 234 indicating that the second guidewire guide 144 is the middle guidewire guide that will be above the first guidewire guide 142. Alternatively, other indicator markings can be used.

[0060] Figure 7A The second guidewire guide 144 is shown placed in the recess 80.Figure 7B A second pulley 360 is shown installed adjacent to (above) the first pulley 250. The second wire guide 144 can be positioned in the first groove 80 with the second side edge 294 facing the inner surface 83 of the first groove 80. The first side edge 292 can face the open side of the first groove 80 that is external. It should be noted that since the first side edge 292 and the second side edge 294 can be identical, the second wire guide 144 can be positioned with the second side edge 294 facing the inner surface 83. As shown in FIG. 6, the second wire guide 144 can be positioned in the first groove 80 with the second side edge 294 facing the inner surface 83 of the first groove 80. The first side edge 292 can face the open side of the first groove 80 that is external. Figure 7A and 7B As shown, the first pulley shaft 252 can extend through the opening 290. For example, the second wire guide 144 can be positioned so that the first pulley shaft 252 is aligned with the opening 290, and then the second wire guide 144 can be advanced along the first pulley shaft 252 until the second side edge 294 is adjacent to the first pulley 250.

[0061] The proximal portion 296 of the second guidewire guide 144 can be positioned adjacent to a surface of the first pulley 250 facing the open exterior side of the recess 80. The second side 294 of the proximal portion 296 of the second guidewire guide 144 can rest on the outer surface of the first pulley 250, and the second side 294 can face the open exterior side of the recess 80. The first pulley 250 can have an outer diameter such that the first pulley 250 can be aligned with the proximal portion 296 of the second guidewire guide 144. For example, the first pulley 250 can have a diameter substantially equal to the diameter of the proximal portion 296. Due to the thickness of the first pulley 250 and the relative height difference between the guidewire guides 142, 144 and the pulley 250, a gap can be formed between the first side 192 of the first guidewire guide 142 and the second side 294 of the second guidewire guide 144. More specifically, a first gap 366 can be formed between the first side 192 of the first distal portion 202 of the first guidewire guide 142 and the second side 294 of the first distal portion 302 of the second guidewire guide 144. A second gap 368 can be formed between the first side 192 of the second distal portion 204 of the first guidewire guide 142 and the second side 294 of the second distal portion 304 of the second guidewire guide 144. The first gap 366 and the second gap 368 can not occupy any overlapping space. The first gap 366 can be offset from the second gap 368. The first guidewire 132 can pass through the gap 366, and the second guidewire 134 can pass through the gap 368. The wall 210 and / or the wall 338 can limit the lateral movement of the first guidewire 132 and / or the second guidewire 134 through the wall 210 and / or the wall 338. For example, the wall 210 and / or the wall 338 can limit the movement of the guidewire 132 and / or the guidewire 134 through the centerline of the first recess 80. The gap 366 can be an aperture or compartment formed by the first side 192 of the first distal portion 202 of the first guidewire guide 142, the second side 294 of the first distal portion 302 of the second guidewire guide 144, the step 338, and the side surface 86 of the first recess 80. The gap 368 can be an aperture or compartment formed by the first side 192 of the second distal portion 204 of the first guidewire guide 142, the second side 294 of the second distal portion 304 of the second guidewire guide 144, the step 210, and the side surface 86 of the first recess 80. The gap 366 and / or the gap 368 can have a substantially rectangular cross-section. The gap 366 and / or the gap 368 can be enclosed on four sides or not completely enclosed. For example, the gap 366 can be open to the gap 368 through the space between the wall 210 and the wall 338.

[0062] As Figure 7BAs shown, the second pulley 360 can be disposed adjacent to (e.g., above) the second guidewire guide 144. The second pulley 360 can have a spool shape. The outer diameter of the second pulley 360 can be such that the second pulley 360 is aligned with the outer diameter of the proximal portion 296 of the second guidewire guide 144. For example, the second pulley 360 can have an outer diameter that is substantially equal to the outer diameter of the first pulley 250 and / or the proximal portions 186, 296. The second pair of guidewires 124 (the third guidewire 136 and the fourth guidewire 138) can be coupled with the second pulley 360. As described above, the second pair of guidewires 124 can be a single continuous guidewire or can include separate guidewires. The second pulley 360 can be attached to a second pulley shaft 370, which can be coaxial with the shaft 172 and / or the first pulley shaft 252 and can be a component of the shaft assembly 120. The second pulley shaft 370 can be fixed relative to the second pulley 360 such that rotation of the second pulley shaft 370 causes rotation of the second pulley 360. The second pulley shaft 370 can have an outer diameter that is larger than the first pulley shaft 252, and the second pulley shaft 370 can fit over the first pulley shaft 252 as part of the shaft assembly 120. The second pulley shaft 370 can be operatively connected to the knob 34 to cause rotation of the second pulley shaft 370. The third guidewire 136 can pass along the first distal portion 302. The fourth guidewire 138 can pass along the second distal portion 204.

[0063] Figures 8A-8C Aspects of the third guidewire guide 146 are shown. Figure 9 A third guidewire guide is shown installed in the cable steering assembly 100. The third guidewire guide 146 can have any of the features of the first guidewire guide 142 or the second guidewire guide 144. For example, the third guidewire guide 146 can have a shape that is complementary to the first groove 80. For example, the most proximal portion or edge 380 of the third guidewire guide 146 can have a rounded shape. The radius of curvature of the most proximal edge 380 of the third guidewire guide 146 can be the same or similar to the radius of curvature of the most proximal edge 84 of the first groove 80. The third guidewire guide 146 can have a keyed relationship with the first groove 80 to minimize or prevent rotation of the third guidewire guide 146 relative to the first groove 80 or the ridge 90. The third guidewire guide 146 can include a most distal edge 382, which can be straight. The third guidewire guide 146 can also include a first side 384 and a second side 386, each of which can extend between the most proximal edge 380 and the most distal edge 382.

[0064] The third guidewire guide 146 can have an opening 390. The opening 390 can have a shape of a circle (e.g., a circular shape). The opening 390 can be sized to have substantially the same diameter as the second pulley shaft 370. The opening 390 can have a diameter that is slightly larger than the diameter of the second pulley shaft 370. The opening 390 can be positioned closer to the proximal-most end 380 of the third guidewire guide 146 than to the distal-most end 382 of the third guidewire guide 146. The opening 390 can be larger than each of the opening 190 and the opening 290.

[0065] The third guidewire guide 146 can have a first side 392 (see Figure 8B ) and a second side 394 (see Figure 8A ), each of which can extend from the proximal-most edge 380 to the distal-most edge 382. The first side 392 of the third guidewire guide 146 can be the same as the first side 192 of the first guidewire guide 142, except that the opening 390 can be larger than the opening 190 to account for the size of the second pulley shaft 370 being larger than the shaft 172.

[0066] The third guidewire guide 146 can have a proximal portion 396. The proximal portion 396 can have a shape of a washer. For example, the proximal portion 396 can include the opening 390 and can include a portion of the third guidewire guide 146 that is coaxial with the opening 390. For example, the proximal portion 396 can have an inner diameter that is substantially the same as the diameter of the second pulley shaft 370, and an outer diameter that is substantially the same as the outer diameter of the second pulley 360. The second pulley 360 can be aligned with the proximal portion 396.

[0067] The third guidewire guide 146 can also have a first distal portion 402 and a second distal portion 404. The first distal portion 402 can extend from the second side 386 toward the first side 384, but can terminate before the first side 384. The second distal portion 404 can extend from the first side 384 toward the second side 386, but can terminate before the second side 386. For example, each of the first distal portion 402 and the second distal portion 404 can terminate at about half or a half of the distance between the first side 384 and the second side 386, although other dimensions can be considered. Each of the first distal portion 402 and the second distal portion 404 can have a thickness that is greater than the proximal portion 396. In other words, the distance between the first side 392 and the second side 394 at each of the first distal portion 402 and the second distal portion 404 can be greater than the distance at the proximal portion 396. The first distal portion 402 and the second distal portion 404 can be raised or protrude relative to the proximal portion 396 on the first side 392.

[0068] On the first side 392, the first distal portion 402 can be more protruding or raised more from the proximal portion 396 than the second proximal portion 404. The first distal portion 402 can be thicker than the second distal portion 404. In other words, the distance between the first side 392 and the second side 394 at the first distal portion 402 can be greater than the distance at the second distal portion 404.

[0069] Figure 8C A bottom view of the third guidewire guide 146 is shown, thus showing the distal-most side 382. The distal-most side 382 has a greater cross-section in the first distal portion 402 than in the second distal portion 404. In other words, the distance between the first side 392 and the second side 394 along the distal-most side 382 in the first distal portion 402 can be greater than the distance in the second distal portion 404. Along the distal-most side 382, the first side 392 can be staggered so as to have a first planar portion 406 (along the first distal portion 402) and a second planar portion 408 (along the second distal portion 404), and a step 410 between the first planar portion 406 and the second planar portion 408. The first planar portion 406 and the second planar portion 408 can be substantially parallel to each other and offset from each other. The step 410 can form a boundary between the first planar portion 406 and the second planar portion 408. The step 410 can be substantially perpendicular to both the first planar portion 406 and the second planar portion 408.

[0070] On the first side 392, the first distal portion 402 can have a proximal edge 412, while the second distal portion 404 can have a proximal edge 414. The proximal edges 412, 414 of the first distal portion 402 and the second distal portion 404, respectively, can be adjacent to the proximal portion 396. The proximal edges 412, 414 can have a rounded, concave shape, each of which can be a segment of the same circle. The proximal edges 412, 414 can have the same or similar shape when the first side 192 is viewed from the front, although the proximal edges 412, 414 can have different thicknesses. For example, the proximal edge 414 can be thicker than the proximal edge 412 due to the fact that the first distal portion 202 is more protruding from the proximal portion 396 than the second distal portion 204.

[0071] With specific reference to Figure 8AThe first distal portion 402 can be hollow so that the first distal portion 402 includes a recess 430 on the second side 194. The recess 430 can have an inner wall 432 that follows the contour of the first distal portion 402. Alternatively, the recess 430 can only include an inner wall 432 corresponding to the proximal edge 412 and the wall 410 so that the recess 430 is open at the distal most edge 382 of the third wire guide 146 and the second side 386 of the third wire guide 146. The fact that the first distal portion 402 can be hollow can result in a reduction in manufacturing cost and weight of the third wire guide 146. The shape of the recess 430 can also facilitate the placement of other mechanisms in the handle 12 (e.g., a riser articulation mechanism or other mechanisms). The recess 430 or another portion of the third wire guide 146 can also include an indicator 434. The indicator 434 can indicate, for example, the orientation of the third wire guide 146 in the handle 12. For example, the indicator 434 can be a "T" or a third indicator different from the indicators 234, 360 that indicates that the third wire guide 146 is a top wire guide and will face outward from the recess 80. Alternatively, other indicators can be used.

[0072] Figure 9 The third wire guide 146 is shown installed in the cable steering assembly 100. The third wire guide 146 can be positioned within, around, or on the first recess 80 so that the first side 392 of the third wire guide 146 is adjacent to the surface of the second pulley 360 facing the open outer surface of the first recess 80. The second side 394 can face the open outer surface of the first recess 80. The second pulley shaft 370 can extend through the opening 390. For example, the third wire guide 146 can be positioned so that the second pulley shaft 370 is aligned with the opening 390, and then the third wire guide 146 can be advanced along the third pulley shaft 370 until the third wire guide 146 rests against the surface of the second pulley 360 closest to the open outer surface of the first recess 80. The proximal portion 396 of the third wire guide 146 can be adjacent to and rest against the outward facing surface of the second pulley 360. As described above, the second pulley 360 can have an outer diameter so that the second pulley 360 can be aligned with the proximal portion 396 of the third wire guide 146. For example, the second pulley 360 can have substantially the same outer diameter as the proximal portion 396.

[0073] A gap can be formed between the first side 292 of the second guidewire guide 144 and the first side 392 of the third guidewire guide 146. More specifically, a third gap 466 can be formed between the first side 292 of the first distal portion 302 of the second guidewire guide 144 and the first side 392 of the second distal portion 404 of the third guidewire guide 146 due to the thickness of the second pulley 360. A fourth gap 468 can be formed between the first side 292 of the second distal portion 304 of the second guidewire guide 144 and the first side 392 of the first distal portion 402 of the third guidewire guide 146 due to the thickness of the second pulley 360. Each of the third gap 466 and the fourth gap 468 can be offset from each other and from each of the first gap 366 and the second gap 368. The third gap 466 and the fourth gap 468 can be separated by one or more of the wall 336 and the wall 410. None of the first gap 366, the second gap 368, the third gap 466, and the fourth gap 468 can occupy any overlapping space. The third guidewire 136 can pass through the third gap 466, and the fourth guidewire 138 can pass through the fourth gap 468. The wall 410 and / or the wall 336 can limit lateral movement of the third guidewire 136 and / or the fourth guidewire 138. For example, the wall 410 and / or the wall 336 can limit the guidewire 136 and / or the guidewire 138 from passing through the centerline of the first recess 80. The third gap 466 can be an aperture or compartment formed by the first side 292 of the first distal portion 302 of the second guidewire guide 144, the first side 392 of the second distal portion 404 of the third guidewire guide 146, the wall 410, and the side surface 86 of the first recess 80. The fourth gap 468 can be an aperture or compartment formed by the first side 392 of the second distal portion 304 of the second guidewire guide 144, the first side 392 of the first distal portion 402 of the third guidewire guide 146, the wall 336, and the side surface 86 of the first recess 80. The gap 466 and / or the gap 468 can have a substantially rectangular cross-section. The gap 466 and / or the gap 468 can be enclosed on four sides or not completely enclosed. For example, the gap 466 can be open to the gap 468 through the space between the wall 410 and the wall 336.

[0074] The second side 394 of the third guidewire guide 146 can be the component of the cable steering assembly 100 closest to the open side of the first recess 80, and the second side of the third guidewire guide 146 can form a flat surface except for the recess 430.

[0075] The opening 290 of the second guidewire guide 144 can be larger than the opening 190 of the first guidewire guide 142 to accommodate the larger diameter of the first pulley shaft 252 opposite the shaft 172. The opening 390 can be larger than the opening 290 and the opening 190 to accommodate the larger diameter of the second pulley shaft 370 compared to the first pulley shaft 252 and the shaft 172. The thickness of the distal-most side 282 of the second guidewire guide 244 can be larger than the thickness of each of the distal-most side 182 of the first guidewire guide 142 and the distal-most side 382 of the third guidewire guide 146. The first guidewire guide 142, the second guidewire guide 144, and the third guidewire guide 146 can have the same circumference measurement. Specifically, the proximal portions 196, 296, 396 of the first guidewire guide 142, the second guidewire guide 144, and the third guidewire guide 146, respectively, can have the same outer diameter. The first guidewire guide and the third guidewire guide can be identical except for the size of the opening 190, the opening 290, the indicator 434, and the indicator 234 and / or the shape of the recess 230, the recess 430. For example, the opening 290 can be larger than the opening 190 and the recess 430 can have an open side while the recess 230 can be completely closed.

[0076] While the principles of this disclosure have been described with reference to illustrative examples in particular applications, it should be understood that the disclosure is not limited thereto. Those skilled in the art having the benefit of the teachings herein will appreciate additional modifications, applications, and equivalents thereof falling within the scope of the examples described herein. Accordingly, the disclosure should not be viewed as being limited by the foregoing description.

Claims

1. A steering assembly of a medical device, the steering assembly comprising: a handle having a recess; a first and a second guidewire guide disposed within the recess, wherein at least one of the first or second guidewire guides is keyed into the recess to prevent rotation of the first or second guidewire guide within the recess; and a first and a second guidewire segment configured to steer a sheath coupled to the steering assembly in a first and a second direction; wherein the first guidewire segment passes through a first gap between the first and second guidewire guides and the second guidewire segment passes through a second gap between the first and second guidewire guides, and wherein neither the first nor the second gap occupies any overlapping space.

2. The steering assembly of claim 1, further comprising: a third guidewire guide; and a third and a fourth guidewire segment configured to steer the sheath in a third and a fourth direction; wherein the third guidewire segment passes through a third gap between the second and third guidewire guides and the fourth guidewire segment passes through a fourth gap between the second and third guidewire guides.

3. The steering assembly of either of claims 1 or 2, wherein the first and second gaps are offset from each other.

4. The steering assembly of any of claims 1-3, wherein the first and second guidewire segments are configured to control left / right movement of the sheath coupled to the steering assembly, and wherein neither the first nor the second guidewire segment is within a first or second guidewire guide.

5. The steering assembly of claim 2, wherein the third and fourth guidewire segments are configured to control up / down movement of the sheath coupled to the steering assembly.

6. The steering assembly of either of claims 2 or 5, wherein none of the first, second, third, or fourth gaps occupies any overlapping space.

7. The steering assembly of any of claims 2, 5, or 6, wherein the first guidewire guide comprises a first opening for receiving a first shaft component, the second guidewire guide comprises a second opening for receiving a second shaft component, and the third guidewire guide comprises a third opening for receiving a third shaft component, and each of the first, second, and third openings has a different diameter.

8. The steering assembly of any of claims 1-7, wherein each of the first and second guidewire guides is keyed with the recess to prevent rotation relative to the recess when disposed in the recess.

9. The steering assembly of any of claims 2 or 5-7, wherein each of the first, second, and third guidewire guides is disposed in the recess. ​ 10. The steering assembly of any of claims 2, 5-7, or 9, wherein each of the first, second, and third guide wires guides are keyed with the recess to prevent rotation relative to the recess when disposed in the recess.

11. The steering assembly of any of claims 2 or 5-9, further comprising: a first pulley coupled with the first and second guide wire segments, the first pulley disposed between the first and second guide wire guides, and a second pulley coupled with the third and fourth guide wire segments, the second pulley disposed between the second and third guide wire guides.

12. The steering assembly of claim 11, wherein a thickness of the first pulley maintains the first and second gaps.

13. The pulley assembly of any of claims 11-12, wherein a thickness of the second pulley maintains third and fourth gaps.

14. The steering assembly of any of claims 1-13, wherein the first guide wire guide has first and second offset surfaces that define first portions of the first and second gaps, respectively, and wherein the second guide wire guide has third and fourth offset surfaces that define second portions of the first and second gaps, respectively.

15. The steering assembly of claim 14, wherein the first guide wire guide has a first step surface extending from the first offset surface to the second offset surface, and wherein the second guide wire guide has a second step surface extending from the third offset surface to the fourth offset surface, and wherein the first and second step surfaces define third portions of the first and second gaps, respectively.

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