Deflection mechanism for ENT tools

Abstract

The medical tool includes a deflectable distal tip, at least one pull wire, and a deflection assembly. The at least one pull wire has a first end coupled to the distal tip of the medical tool and is configured to be operated to deflect the distal tip. The deflection assembly is coupled to a second end of the at least one pull wire and is configured to control deflection of the distal tip. The deflection assembly includes a first gear having a first rotation axis and a second gear having a second rotation axis and including a knurled surface for mating with the first gear. The knurled surface is inclined relative to the second rotation axis, such that rotation of the first gear causes the second gear to be rotated by the first gear and move along the second rotation axis, moving the pull wire and thereby deflecting the distal tip.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application is related to U.S. Patent Application No. ID-1758 / BIO6271USNP1 / 1002-2126, entitled "Non-circular working channel of an ear-nose-throat tool." This application is also related to U.S. Patent Application No. ID-1776 / BIO6273USNP1 / 1002-2129, entitled "Preventing twisting of pull wires when deflecting an ear-nose-throat tool." The disclosures of these related applications are incorporated herein by reference.

[0002] FIELD OF THEINVENTION The present invention relates generally to medical devices, and more particularly to methods and systems for deflecting ear, nose and throat (ENT) tools. [Background technology]

[0003] Some medical tools, such as ear, nose and throat (ENT) tools, may have bending capabilities.

[0004] For example, U.S. Patent Application Publication No. 2011 / 0295242 describes devices and systems for controlling the movement of a working end of a surgical device by a robotic system. In one embodiment, a system and device are provided for operating an end effector at a distal end of a surgical fastening apparatus. Operation can include rotational movement of the end effector about the axis of the shaft, articulation of the end effector relative to the shaft, and actuation of the end effector, e.g., closing, firing, and / or cutting.

[0005] No. 6,485,455 describes a catheter having an electrode tip assembly that is bendable in two different directions at the user's option, the electrode tip assembly assuming different, predefined, asymmetrical curved configurations when bent in the two directions, and is manipulated by steering wires adjustably connected tangentially to the lateral edges of rotatable cams located within the catheter handle. Summary of the Invention [Means for solving the problem]

[0006] One embodiment of the present invention described herein provides a medical tool including a rotatable hollow tube and one or more electrical wires. The rotatable hollow tube defines a working channel therein for inserting a medical instrument into a cavity of a patient's body. The one or more electrical wires pass through the working channel for exchanging electrical signals with one or more electronic devices located at a distal end of the rotatable hollow tube. The working channel has a non-circular cross-section to allow for the passage of both the medical instrument and the one or more electrical wires and to allow for rotation of the rotatable hollow tube relative to the medical instrument located within the working channel in the presence of the one or more electrical wires.

[0007] In some embodiments, the cavity includes a nasal cavity in the patient's head, and the medical instrument is selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT treatment tool, and (g) any combination thereof. In other embodiments, the medical tool includes a rotatable knob configured to rotate at least one of the rotatable hollow tube and the medical instrument using a rotation mechanism. In yet other embodiments, the rotatable knob is configured to rotate in at least one of a clockwise and a counterclockwise rotational direction over a range of rotation angles between 0° and 180°.

[0008] In one embodiment, the medical tool includes one or more pull wires, each having a first end coupled to the distal end and a second end coupled to a deflection mechanism for deflecting the distal end by pulling the one or more pull wires. The rotatable hollow tube includes a retainer configured to couple between the hollow tube and the deflection mechanism to prevent twisting of the one or more pull wires around a component of the medical tool. In another embodiment, the one or more electrical wires include a wire braid.

[0009] A method for manufacturing a medical tool according to an embodiment of the present invention is further presented, comprising providing a rotatable hollow tube defining a working channel therein for inserting a medical instrument into a cavity of a patient's body. One or more electrical wires are threaded through the working channel for exchanging electrical signals with one or more electronic devices located at a distal end of the rotatable hollow tube. The working channel has a non-circular cross-section for passing both the medical instrument and the one or more electrical wires and for enabling rotation of the rotatable hollow tube relative to the medical instrument located inside the working channel in the presence of the one or more electrical wires.

[0010] Another embodiment of the present invention provides a medical tool including a deflectable distal tip, at least one pull wire, and a deflection assembly. The at least one pull wire has a first end coupled to the distal tip of the medical tool and is configured to be moved to deflect the distal tip. The deflection assembly is coupled to a second end of the at least one pull wire and configured to control deflection of the distal tip. The deflection assembly includes a first gear having a first axis of rotation and a second gear having a second axis of rotation and including a knurled surface for coupling with the first gear. The knurled surface is inclined relative to the second axis of rotation such that as the first gear rotates, the second gear is rotated by the first gear to move along the second axis of rotation and is configured to move the pull wire to deflect the distal tip.

[0011] In some embodiments, the second gear has a circumferential portion having (i) a first section having (a) a first thickness along the second axis of rotation and (b) a first knurled section of the knurled surface extending from the first section, and (ii) a second section having (a) a second thickness along the second axis of rotation less than the first thickness and (b) a second knurled section of the knurled surface extending from the second section. When the second gear rotates, the distal end is deflected a first amount when the first knurled section is in contact with the first gear, and the distal end is deflected a second amount less than the first amount when the second knurled section is in contact with the first gear. In other embodiments, the medical tool includes a rotatable knob coupled to the first gear and configured to control the deflection by rotating the first gear. In yet another embodiment, the medical tool includes a coupling element coupled to a second end of the at least one pull wire and configured to be moved by the second gear along a second axis of rotation.

[0012] In one embodiment, the second gear is hollow and the medical tool includes one or more rods parallel to the second axis of rotation that pass through the second gear such that the second gear is moved by the one or more rods along the second axis of rotation. In another embodiment, the medical tool includes a hollow tube disposed between the distal end and the deflection assembly, the hollow tube defining a working channel therein for inserting a medical instrument through the distal end and into a cavity of the patient's body. In yet another embodiment, the cavity includes a nasal cavity in the patient's head, and the working channel is for inserting a medical instrument selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT treatment tool, and (g) any combination thereof.

[0013] According to an embodiment of the present invention, there is additionally provided a method of manufacturing a medical tool, the method comprising providing a deflectable distal tip. The distal tip of the medical tool is coupled to a first end of at least one pull wire that is moved to deflect the distal tip. A second end of the at least one pull wire is coupled to a deflection assembly to control deflection of the distal tip. The deflection assembly comprises a first gear having a first axis of rotation and a second gear having a second axis of rotation, the second gear including a knurled surface for coupling with the first gear. The knurled surface is inclined relative to the second axis of rotation such that, as the first gear rotates, the second gear is rotated by the first gear to move along the second axis of rotation and is configured to move the pull wire to deflect the distal tip.

[0014] Another embodiment of the present invention provides a medical tool including a deflectable distal end, at least one pull wire, and a coupling element. The at least one pull wire has a first end coupled to the distal end of the medical tool and is configured to be moved to deflect the distal end. The coupling element is coupled to a second end of the pull wire and has at least two bore holes configured to receive at least two respective rods passing therethrough. The coupling element is configured to be moved along a rotation axis of an associated rotatable element, the bore holes and respective rods configured to prevent rotation of the coupling element.

[0015] In some embodiments, the linking element has at least one additional borehole, and the pull wire passes through the additional borehole. In other embodiments, the rotatable element includes a hollow gear surrounding at least a portion of the linking element, and when the hollow gear rotates, the linking element moves along the axis of rotation, and the rod prevents the linking element from rotating with the hollow gear. In yet other embodiments, the linking element has a panel coupled to a second end of the pull wire and in physical contact with the rotatable element to be moved along the axis of rotation.

[0016] In one embodiment, the coupling element has an additional borehole defining a working channel therein for inserting a medical instrument into a cavity of the patient's body, hi another embodiment, the cavity comprises a nasal cavity in the patient's head, and the medical instrument is selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT therapeutic tool, and (g) any combination thereof.

[0017] According to an embodiment of the present invention, there is additionally provided a method of manufacturing a medical tool, the method comprising providing a deflectable distal end. A first end of at least one pull wire, which is moved to deflect the distal end, is coupled to the distal end of the medical tool. A linking element having at least two bore holes is coupled to a second end of the pull wire, and at least two respective corresponding rods are inserted through the at least two bore holes. A rotatable element for moving the linking element along a rotation axis of the rotatable element is coupled to the linking element, such that the bore holes and the respective corresponding rods prevent rotation of the linking element.

[0018] The invention will be more fully understood from consideration of the following detailed description taken in conjunction with the drawings, in which: [Brief description of the drawings]

[0019] [Figure 1] 1 is a pictorial schematic diagram of an ENT procedure using an Ear Nose and Throat ENT system, in accordance with one embodiment of the present invention; [Figure 2A] 1 is a pictorial schematic diagram of a rotatable hollow tube, in accordance with an embodiment of the present invention; [Figure 2B] 1 is a pictorial schematic diagram of a rotation mechanism of an ENT tool, in accordance with an embodiment of the present invention. [Figure 3A] 1 is a schematic, pictorial illustration of a deflection mechanism of a distal tip assembly, in accordance with one embodiment of the present invention; FIG. [Figure 3B]1 is a pictorial schematic diagram of a wire holder, in accordance with one embodiment of the present invention; FIG. [Figure 4] 1 is a flow chart that generally illustrates a method for manufacturing an ENT tool, according to an embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0020] Overview Some medical procedures require the insertion of medical tools into the branched organs of a patient. For example, a balloon sinuplasty procedure involves the insertion of a guidewire into the patient's ear, nose and throat (ENT) sinuses and moving a balloon over the guidewire into the sinus ostium to open up the ostium blockage. In other procedures, a physician may insert a pumping tube to draw mucus from the sinus or a surgical tool to cut tissue (e.g., cartilage, bone, or polyps) in the patient's ENT organs.

[0021] The embodiments of the invention described hereinafter provide methods and apparatus for improving the functionality and handling of ENT tools. In some embodiments, an ENT system includes an ENT tool and a control console. The ENT tool includes a distal end that is inserted by a physician into a branched organ, such as a sinus, of a patient. The ENT tool includes a rotatable hollow tube that defines a working channel for inserting a medical instrument, such as, but not limited to, the aforementioned guidewire, balloon, pumping tube, surgical tool, or any combination thereof, into the sinus.

[0022] In some embodiments, the ENT tool includes a rotation mechanism and a deflection mechanism to improve maneuverability of the distal tip and insert the instrument into the sinus. The ENT tool includes an electronic device, such as a camera and a light emitting diode (LED), coupled to the distal tip and configured to acquire images of the target tissue. In some embodiments, the ENT system includes one or more electrical wires, typically incorporated into a braid that passes through the working channel and configured to exchange power and imaging signals between the console and the electronic device at the distal tip.

[0023] During an ENT procedure, a physician rotates and / or deflects the distal end of an ENT tool that has one or more of a medical instrument and a braid of electrical wires within the working channel. In some cases, the braid may be wrapped around the medical instrument and may tear and / or impede movement of the medical instrument.

[0024] In some embodiments, the working channel has a non-circular cross-section for passing both the medical device and the wire braid, allowing rotation of the medical device relative to the hollow tube in the presence of the wire braid.

[0025] In some embodiments, the ENT tool comprises a rotatable knob configured to rotate at least one of the rotatable hollow tube and the medical instrument, the rotatable knob configured to rotate clockwise and counterclockwise through a range of rotation angles between 0° and 180°.

[0026] In some embodiments, the ENT tool comprises one or more pull wires, the pull wires having (a) a distal end coupled to the distal end of the ENT tool and (b) a proximal end coupled to a deflection mechanism, also referred to herein as a deflection assembly of the ENT tool. In some embodiments, the deflection assembly comprises (i) a first gear configured to rotate about a first axis of rotation and controlled by a deflection knob operated by a physician, and (ii) a second gear that rotates about a second axis of rotation and includes a knurled surface for coupling with the first gear. The knurled surface is inclined relative to the second axis of rotation, such that when the physician rotates the deflection knob, the second gear is rotated by the first gear to move along the second axis of rotation and deflect the distal end by moving the pull wire.

[0027] In some embodiments, the ENT tool includes a wire holder, also referred to herein as a coupling element, that is in physical contact with the second gear and is coupled to a proximal end of one or more pull wires. In such embodiments, the wire holder is configured to be moved along the second axis of rotation by the second gear.

[0028] Physical contact between the wire holder and the second gear can cause the wire holder to rotate with the second gear, which can result in the pull wires twisting around each other and / or other elements of the ENT tool. In some embodiments, the wire holder has at least two bore holes and is configured to receive at least two respective rods passing therethrough. In such embodiments, the bore holes and rods are configured to prevent rotation of the coupling element, and thus, twisting of the pull wires.

[0029] In some embodiments, the pull wire may have additional bore holes that allow for the passage of one or more medical instruments and various components of the ENT tool, such as, but not limited to, the pull wires mentioned above.

[0030] The disclosed technology improves the functionality of medical tools by enabling simultaneous operation of multiple diagnostic and / or therapeutic devices by a single physician. Additionally, the disclosed technology improves the maneuverability of such multi-functional medical tools in various branched systems such as ENT, bronchoscopy, or neurological surgery, but may require adjustments to the configuration for specific applications.

[0031] System Description 1 is a pictorial schematic diagram of an ear, nose and throat (ENT) procedure using an ENT system 20, according to one embodiment of the present invention. In some embodiments, the ENT procedure is a balloon sinuplasty procedure in which a balloon is inserted into a clogged sinus 48 and inflated to open the sinus and allow normal flow and drainage of mucus from the sinus through the nasal cavity 26 of the patient 22. In other embodiments, the ENT procedure may include any other diagnostic or therapeutic procedure performed in the patient's ENT. In such an embodiment, the ENT system 20 includes a medical catheter, in this example an ENT tool 28, that is configured to perform one or more types of ENT procedures on one or more sinuses 48 of the patient 22.

[0032] In some embodiments, the ENT tool 28 comprises a rotatable hollow tube (referred to herein as tube 52) that is inserted by the physician 24 into a cavity, such as the aforementioned nasal cavity 26, of the patient 22. The ENT tool 28 further comprises a handheld device 30 coupled to a proximal end of the tube 52, the handheld device 30 being configured to assist the physician 24 in performing an ENT procedure on the head 41 of the patient 22, as described in more detail below.

[0033] Referring now to inset 45, in some embodiments, the ENT tool 28 includes a distal tip assembly 77 coupled to the distal end of the tube 52. The distal tip assembly 77, which may comprise a nickel-titanium alloy such as Nitinol™, or any other suitable material, is configured to be deflected and rotated, as described in more detail below.

[0034] In some embodiments, the handheld device 30 comprises a grip 58 that is held by the fingers of the physician 24. In some embodiments, the handheld device 30 comprises a slider 70 that is moved by the thumb of the physician 24 along the longitudinal axis of the ENT tool 28. In the example of inset 45, the physician 24 moves the slider 70 in two directions, shown as double-headed arrow 72, to insert and / or withdraw a medical instrument, such as a balloon (not shown), into and / or from the head 41 of the patient 22.

[0035] Referring again to the general view of Figure 1, in one embodiment, the system 20 further comprises a magnetic position tracking system configured to track the position of one or more position sensors in the head 41. The magnetic position tracking system comprises a magnetic field generator 44 and a position sensor 55 that generates a position signal in response to sensing an external magnetic field generated by the magnetic field generator 44, thereby enabling the processor 34 (described in more detail below) to estimate the position of the position sensor 55 within the head 41 of the patient 22.

[0036] This position sensing method has been implemented in a variety of medical applications, for example in the CARTO™ system manufactured by Biosense Webster Inc. (Irvine, Calif.), and is described in detail in U.S. Pat. Nos. 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, and 6,332,089, PCT / WO96 / 05768, and U.S. Patent Application Publication Nos. 2002 / 0065455(A1), 2003 / 0120150(A1), and 2004 / 0068178(A1), the disclosures of which are all incorporated herein by reference.

[0037] In some embodiments, system 20 further comprises a localization pad 40 comprising magnetic field generators 44 fixed on a frame 46. In the exemplary configuration shown in FIG. 1 , pad 40 comprises five magnetic field generators 44, but may alternatively comprise any other suitable number of magnetic field generators 44. Pad 40 further comprises a pillow (not shown) placed under head 41 of patient 22 such that magnetic field generators 44 are positioned at a fixed, known location external to head 41.

[0038] In some embodiments, the system 20 comprises a console 33 comprising a memory 49 and a driver circuit 42 configured to drive a magnetic field generator 44 with a suitable signal via a cable 37 to generate a magnetic field within a predefined working volume in the space surrounding the head 41.

[0039] In some embodiments, the console 33 includes a processor 34, which is typically a general-purpose computer with suitable front-end and interface circuitry for receiving signals from the ENT tool 28 to which the one or more magnetic sensors 55 are coupled via cable 32, and for controlling the other components of the system 20 described herein.

[0040] In some embodiments, the processor 34 is configured to estimate a position of each position sensor 55. Based on the estimated position of each sensor in the coordinate system of the magnetic position tracking system, the processor 34 is configured to derive the position, orientation, and radius of curvature of the distal end assembly 77.

[0041] In the context of the present invention and the claims, the terms “flexion” and “deflection” are used interchangeably and refer to the deflection of one or more segments of the ENT tool 28 .

[0042] In some embodiments, the processor 34 is configured to receive one or more anatomical images via an interface (not shown), such as computed tomography (CT) images depicting segmented two-dimensional (2D) slices of the head 41, acquired using an external CT system (not shown). The term "segmentation" refers to displaying the different types of tissues identified in each slice by measuring the tissues' respective attenuation in the CT system.

[0043] The console 33 further includes an input device 39 for controlling operation of the system 20, and a user display 36 configured to display data (e.g., images) received from the processor 34 and / or to display inputs inserted by the physician 24 or other user of the input device 39.

[0044] In some embodiments, the processor 34 is configured to select one or more slices from the CT image (e.g., anatomical image 35) and display the selected slices on the user display 36. In the example of FIG. 1, the anatomical image 35 illustrates a cross-sectional anterior view of one or more paranasal sinuses 48 of the patient 22.

[0045] In some embodiments, the processor 34 is configured to align between the coordinate system of the CT system and the magnetic position tracking system and overlay the position of the distal end assembly 77 onto the anatomical image 35 .

[0046] Reference is now made again to inset 45. In some embodiments, the handheld device 30 includes a deflection knob, referred to herein as knob 66, controlled by the physician 24, which is configured to deflect the distal tip assembly 77 by rotating it clockwise and counterclockwise about its axis, as indicated by double arrow 69.

[0047] In some embodiments, the handheld device 30 further comprises a rotation knob, referred to herein as knob 54. The knob 54 is configured to rotate clockwise and counterclockwise as indicated by double arrow 68 to rotate at least one of the tube 52, the distal end assembly 77, and the medical instrument inside the tube 52 (shown in Figures 2A, 2B, 3A, and 3B below) about the longitudinal axis 50. In this example, the knob 54 rotates both the tube 52 and the distal end assembly 77 about the longitudinal axis 50, while the medical instrument is not rotated. In some embodiments, the knob 54 is configured to rotate 180° clockwise and 180° counterclockwise, as described in detail in Figures 2A and 2B below.

[0048] In some embodiments, the distal tip assembly 77 includes an electronic device 56, which may include, but is not limited to, a camera and one or more light emitting diodes (LEDs), etc. The electronic device 56 is coupled to a distal end of the distal tip assembly 77 and is configured to illuminate the ENT tissue of interest and obtain anatomical images of the ENT tissue during an ENT procedure.

[0049] Referring again to the overall diagram of Figure 1, it should be noted that Figure 1 shows only elements relevant to the disclosed technique for simplicity and clarity. System 20 typically includes additional modules and elements that are not directly related to the disclosed technology, and these modules and elements have been intentionally omitted from Figure 1 and the description of system 20 for the reasons discussed above.

[0050] The processor 34 may be programmed to perform functions used by the system and to store in memory 49 data that is processed or otherwise used by the software. This software may be downloaded to the processor in electronic form, for example over a network, or may be provided on a non-transitory tangible medium, such as an optical, magnetic, or electronic memory medium. Alternatively, some or all of the functions of the processor 34 may be performed by dedicated or programmable digital hardware components.

[0051] This particular configuration of ENT tool 28 is shown by way of example to explain the particular problem addressed by embodiments of the present invention and to demonstrate the application of these embodiments in improving the performance of such systems, however, embodiments of the present invention are not limited to this particular type of exemplary ENT tool and the principles described herein may be applied to other types of medical diagnostic and / or treatment tools and / or systems as well.

[0052] Rotatable hollow tube having a working channel with a non-circular cross section FIG. 2A is a pictorial schematic diagram of a rotatable hollow tube 52, according to an embodiment of the present invention. In some embodiments, the rotatable hollow tube 52 defines a working channel (WC) 62 therein for inserting a medical instrument 88 into the sinus 48 (or any other cavity) of the patient 22. In some embodiments, the working portion 88 of the medical instrument may comprise (a) a balloon or another instrument that is moved along a guidewire to perform the sinuplasty procedure described in FIG. 1 above, (b) a pumping tube connected to a pump for drawing mucus from the patient after, for example, opening a clogged stoma, (c) any suitable type of ENT surgical tool, for example, for cutting polyps or resecting other tissue of the patient 22, (d) an ear, nose and throat diagnostic tool, (e) an ear, nose and throat treatment tool, (f) any other suitable type of ENT medical instrument, or (g) any suitable combination thereof. It should be noted that in FIG. 2A, the medical instrument 88 is shown generally in cross-section and may have any suitable size and shape.

[0053] In some embodiments, when at least the distal end assembly 77 is inserted into the nasal cavity 26, the physician 24 applies the slider 70 to insert the medical instrument 88 (e.g., the aforementioned rhinoplasty balloon) into the targeted tissue, such as the paranasal sinus 48.

[0054] In some embodiments, the system 20 includes one or more electrical wires, in this example a braid of wires 90, passing through the working channel (WC) 62 for exchanging electrical signals between the console 33 and the one or more electronic devices 56.

[0055] In some embodiments, rotation of tube 52 by knob 54 is limited to 180° clockwise and 180° counterclockwise to prevent braid 90 from wrapping around medical device 88. If rotation is not limited, wrapping may occur, which may result in tearing or damage to at least one of the wires and / or make it difficult to move medical device 88.

[0056] In some embodiments, the working channel (WC) 62 has a non-circular cross-section for passing (a) one or more medical devices 88 and (b) the braid 90. The non-circular shape of the working channel (WC) 62 allows for rotation of the tube 52 relative to the medical device 88 (located within the working channel (WC) 62) in the presence of the braid 90. In some embodiments, at least one of the medical device 88 and the tube 52 are configured to rotate about an axis 50. In such embodiments, the non-circular cross-sectional shape of the working channel (WC) 62 allows for relative rotation between the medical device 88 and the tube 52 without wrapping one or more wires of the braid 90 around the medical device 88.

[0057] In some embodiments, the proximal end of the working channel (WC) 62 can have the non-circular cross-sectional shape described above, and the distal end of the working channel (WC) 62 can have any other cross-sectional shape, such as, but not limited to, a circular or non-circular cross-sectional shape.

[0058] In some embodiments, tube 52 is coupled to housing 53, and in the example of system 20, housing 53 is integrated with tube 52 as a single molded piece. In other configurations, tube 52 may be coupled to housing 53 using any suitable technique.

[0059] In some embodiments, the housing 53 has one or more retainers 60 configured to hold the housing 53 attached to at least one of the rotation mechanisms shown in Figure 2B below and a deflection mechanism described in detail in Figure 3A below. In such embodiments, as the physician 24 rotates the knob 54, the retainers 60 prevent kinking of the pull wire by holding the pull wire to rotate with the tube 52 (shown in Figures 3A and 3B below).

[0060] In some embodiments, the housing 53 has one or more openings 73 configured to hold the housing 53 attached to the knob 54 and the rotation mechanism described above.

[0061] 2B is a pictorial schematic diagram of a rotation mechanism 89 of tube 52 and distal tip assembly 77, in accordance with one embodiment of the present invention. In the example of FIG. 2B, some components of ENT tool 28, such as knob 54, housing 53, and tube 52, have been omitted from the drawing for conceptual clarity, in order to show elements of the rotation mechanism 89 that are typically hidden from view when ENT tool 28 is assembled.

[0062] In some embodiments, the rotation mechanism 89 is configured to fit snugly within the housing 53. In some embodiments, the rotation mechanism 89 comprises a disk 59 having a non-circular opening that surrounds the medical device 88 and the braid 90. In some embodiments, the shape of the non-circular opening is typically similar to the shape of the working channel (WC) 62, although in other embodiments the opening may have any other suitable shape.

[0063] In some embodiments, the rotation mechanism 89 has one or more openings 61, each configured to fit over a corresponding retainer 60 (shown in FIG. 2A above) to mount the housing 53 to the rotation mechanism 89, rotate the housing 53 therewith, and hold the pull wires (shown in FIGS. 3A and 3B below) in rotation with the tube 52. This configuration prevents the pull wires from twisting around each other and / or around other components of the ENT tool 28 (e.g., the medical device 88 and / or the braid 90).

[0064] In some embodiments, the rotation mechanism 89 includes one or more protrusions 75, each of which is configured to fit into a corresponding opening 73 to provide a connection between the housing 53 and the rotation mechanism 89. In such embodiments, the housing 53 and the tube 52 fit over the rotation mechanism 89 such that the physician 24 can insert a medical instrument 88 through a working channel (WC) 62 defined in the tube 52 and into a cavity of interest (e.g., a sinus 48) of the patient 22.

[0065] In some embodiments, the rotation mechanism 89 is coupled to the knob 54 to rotate at least one of the tube 52, the distal tip assembly 77, and the medical instrument 88 about the longitudinal axis 50 of the ENT tool 28. In this example, the physician 24 applies the knob 54 to rotate the tube 52 and the distal tip assembly 77 about the longitudinal axis 50.

[0066] The rotation mechanism 89, tube 52, and housing 53 are provided by way of example to illustrate a particular problem, namely, to enable the physician 24 to improve control over the rotation of at least one of the tube 52, distal tip assembly 77, and medical instrument 88, which is typically performed during one or more of the aforementioned ENT procedures. Such problems are addressed by embodiments of the present invention, and the above configurations demonstrate the applicability of these embodiments in enhancing the performance of such ENT systems. However, embodiments of the present invention are in no way limited to this particular type of exemplary system, and the principles described herein may be applied to other types of rotatable ENT and medical systems as well.

[0067] Deflection mechanism for ENT tools. 3A is a pictorial schematic diagram of a deflection mechanism 99 of the distal tip assembly 77, in accordance with one embodiment of the present invention. In some embodiments, the deflection mechanism 99 is actuated by a knob 66 ​​that is manipulated by the physician 24. In the context of this disclosure and in the claims, the terms "deflection mechanism" and "deflection assembly" are used interchangeably.

[0068] Reference is now made to inset 87, which shows a perspective view of deflection mechanism 99 from the distal end of ENT tool 28. In some embodiments, deflection mechanism 99 comprises gear 96 coupled to and rotated by knob 66. Gear 96 includes a knurled surface that mates with knurled surface 112 of gear 111. Thus, in an exemplary configuration of deflection mechanism 99, gear 111 is hollow and configured to rotate about a rotation axis 122. In this example, rotation axis 122 is substantially parallel to longitudinal axis 50 of ENT tool 28 and substantially perpendicular to the rotation axes of knob 66 ​​and gear 96. In other embodiments, the rotation axes of gears 96 and 111 may have any other suitable orientation angle between them, different from the perpendicular angle in this exemplary configuration. In alternative embodiments, rotation axis 122 may have any suitable orientation relative to longitudinal axis 50, e.g., a non-parallel orientation.

[0069] In some embodiments, the ENT tool 28 includes one or more pull wires 92 having a first end coupled to the distal tip assembly 77 and a second end coupled to a deflection mechanism 99, as described below. At least one of the pull wires 92 may have any suitable diameter between about 0.1 and about 0.5 mm. At least one of the pull wires 92 may also include stainless steel, nanosilk, also known as spider silk, aramid such as Kevlar™, or any other suitable material having a tensile strength greater than about 10 kgf. It is noted that the pull wire diameter 92 is selected based on the specified range of tensile strength and force applied to the pull wire 92 to deflect the distal tip assembly 77. In some embodiments, the pull wire is configured to be movable with the deflection mechanism 99 to deflect the distal tip assembly 77.

[0070] In the context of this disclosure and claims, the term "about" or "approximately" in relation to any numerical value or range of numerical values ​​indicates a suitable dimensional tolerance that enables a portion of a component or a collection of components to function according to its intended purpose as described herein. For example, "about" or "approximately" may refer to a range of values ​​of ±20% of the recited value, e.g., "about 90%" may refer to a range of values ​​of 72% to 100%.

[0071] In some embodiments, the deflection mechanism 99 is configured to control the deflection of the distal tip assembly 77 based on the engagement of gear 96 and gear 111 .

[0072] In some embodiments, gear 111 is hollow so that pull wire 92 and one or more rods 120 (in this example, two rods 120) pass through it. In some embodiments, knurled surface 112 is inclined relative to axis of rotation 122, defining an inclination angle 114 between knurled surface 112 and axis of rotation 122.

[0073] In some embodiments, the tilt angle 114 may have any suitable angle suitable for obtaining movement of the gear 111, with an exemplary range of approximately 1-12 mm.

[0074] In some embodiments, the ENT tool 28 has a wire holder 132 having a panel 133 and additional elements described in detail below in FIG. 3B. The gear 111 can rotate about the wire holder 132 and can have physical contact with the panel 133 of the wire holder 132. The rod 120, medical implement 88, and pull wire 92 can all pass through the borehole 132 in the wire holder, as described in detail below.

[0075] In some embodiments, the gear 111 may have a circumference that may be disposed parallel to the axis of rotation 122. The gear 111 has a segment 116 and a segment 118 located at different positions on the circumference of the gear 111. In such an embodiment, each segment has a knurled surface segment 112, one of segments 116 and 118, configured to make physical contact with the panel 133. In such an embodiment, the knurled segment 113 of the knurled surface 112 extends from segment 116, and the knurled segment 115 of the knurled surface 112 extends from segment 118. However, it should be noted that in the configuration of the deflection mechanism 99, the panel 133 is not rotatable, as described in FIG. 3B below. As shown in inset 87, the shape of the gear 111 causes the thickness of segment 116 along the axis of rotation 122 to be greater than the thickness of segment 118.

[0076] In some embodiments, when physician 24 uses knob 66 ​​to rotate gear 96, jagged surfaces 97 and 112 engage with one another and gear 111 is configured to rotate about axis of rotation 122 by rotation of gear 96, which rotates but does not translate relative to knob 66.

[0077] In such an embodiment, when the knurled segment 113 contacts the knurled surface 97 of the gear 96, the gear 111 is configured to move in a direction 117 along the axis of rotation 122 and is configured to deflect the distal tip assembly 77 a maximum amount by moving the pull wire 92, as described below. Similarly, when the knurled segment 115 contacts the knurled surface 97, the gear 111 is configured to move in a direction 119 along the axis of rotation 122 and thereby straighten the distal tip assembly 77. Additionally, the physician 24 can control the amount of deflection of the distal tip assembly 77 by rotating the knob 66 ​​such that any other knurled segment 97 of the gear 111 is brought into contact with the knurled surface of the gear 96. For example, physician 24 can obtain a partial deflection of distal tip assembly 77 by rotating knob 66 ​​such that a given knurled surface located between knurled surfaces 113 and 115 is in contact with knurled surface 97 of gear 96. Note that the amount of deflection when a given knurled surface is in contact with knurled surface 97 is less than the amount of deflection when knurled portion 113 is in contact with knurled surface 97.

[0078] 1, the distal tip assembly 77 may include Nitinol™ which acts as a spring when deflected. In other words, when the distal tip assembly 77 is deflected, the nickel titanium alloy exerts a force on the pull wire 92 to return to a straight (i.e., undeflected) position.

[0079] In some embodiments, when knurled section 113 is mated with knurled surface 97 of gear 96, pull wire 92 moves with gear 111 in direction 117, holding distal tip assembly 77 in the deflected position. When knurled section 115 (of section 118) is mated with knurled surface 97, pull wire 92 moves with gear 111 in direction 119, and slack may develop so that the internal force of the Nitinol forces distal tip assembly 77 into a straight, undeflected position. Note that rod 120 acts as a rail for movement of gear 111 in directions 117 and 119.

[0080] Reference is now made to FIG. 91, an inset showing a perspective view of the deflection mechanism 99 as viewed from the proximal end of the ENT tool 28. As described in inset 87 above, the jagged surface 112 is inclined relative to the axis of rotation 122, as indicated by the inclination angle 114.

[0081] As depicted in inset 87 above, rod 120, medical implement 88, and pull wires 92 all pass through bore holes in wire holder 132. As shown in inset 91, rod 120, medical implement 88, and pull wires 92 protrude through panel 133, with one or more pull wires 92 passing through bore holes 94 and coupled to the outer surface of panel 133.

[0082] In some embodiments, rod 120 acts as a rail for movement of wire holder 132 and gear 111 along axis of rotation 122. Thus, when physician 24 rotates knob 66, rod 120 is configured to prevent panel 133 of wire holder 132 from rotating with gear 111, yet still allow pull wire 92 to move along axis of rotation 122 and inhibit deflection of distal tip assembly 77, as described above.

[0083] The configuration of deflection mechanism 99 is shown by way of example only and incorporates interfaces with rod 120, medical instrument 88, and pull wire 92 to enable deflection of distal tip assembly 77. However, embodiments of the invention are in no way limited to this particular type of exemplary configuration, and the principles described herein may be similarly applied to other types of deflection mechanisms used in other types of medical tools and / or systems, or other types of deflection devices.

[0084] Prevents pull wires from twisting when deflecting the distal tip assembly 3B is a pictorial schematic diagram of a wire holder 132, according to one embodiment of the present invention. In some embodiments, the wire holder 132, also referred to herein as a connecting element, has a bore hole 134 for passing a rod 120 therethrough. In the exemplary configuration of FIGs. 3A and 3B, the ENT tool 28 can include two rods 120, and thus the wire holder 132 has two bore holes 134. In other embodiments, the ENT tool 28 can have any other suitable number of one or more rods 120 and corresponding one or more bore holes 134.

[0085] In some embodiments, the wire holder 132 has one borehole 136 defining a working channel, such as working channel (WC) 62, for passing a medical instrument 88. In other embodiments, the wire holder 132 may include multiple boreholes 136 for respectively passing multiple medical instruments 88. Additionally or alternatively, the boreholes may have any suitable cross-section, which may vary in size, shape, or any other parameter thereof.

[0086] As shown and described in inset 91 of FIG. 3A, wire holder 132 has a bore hole 94 (not shown in FIG. 3B) through which pull wire 92 passes. In some embodiments, wire holder 132 can function as the aforementioned coupling element coupled to the proximal end of pull wire 92, which coupling element is configured to be moved by gear 111 along axis of rotation 122, as described above. In some embodiments already described, bore hole 134 and respective rod 120 are configured to prevent rotation of coupling element (wire holder 132 in this example) when gear 111 rotates about axis of rotation 122. In such an embodiment, bore hole 134 and respective rod 120 are configured to prevent twisting of pull wire 92 when distal end assembly 77 is deflected (and straightened).

[0087] 2A and 2B. It should be noted that when the retainers 60 are inserted into their respective openings 61, the pull wires 92 rotate together with the rotation mechanism 89 and the tube 52 and therefore do not twist around each other or any other components of the ENT tool 28. In some embodiments, when the retainers 60 are inserted into their respective openings 61, the rod 120 (passing through the borehole 134) and the panel 133 rotate with the rotation mechanism 89 when the physician 24 rotates the knob 54. In such embodiments, the entire structure of the wire holder 132 rotates with the rotation mechanism 89 when the physician 24 rotates the knob 54.

[0088] In some embodiments, when the physician 24 rotates the knob 66 ​​to deflect the distal end assembly 77, the gear 111 rotates about the axis of rotation 122, but the bore holes 134 and their respective rods 120 are configured to prevent rotation of the wire holder 132 and thus twisting of the pull wire 92 as described above.

[0089] 3B, in some embodiments, the wire holder 132 includes a surface 131, which is typically circular, such that when the physician 24 rotates the knob 66, the inner surface (not shown) of the gear 111, which is hollow, fits over and rotates about the surface 131.

[0090] In some embodiments, the wire holder 132 comprises a surface 135 that is the inner surface 133 of the panel, and the surface 135 is configured to contact the gear 111. In such an embodiment, when the knurled section 113 contacts the knurled surface 97 (as shown in inset 87 of FIG. 3A above), the gear 111 may move in direction 117 and exert a force on the surface 135 to move the wire holder 132 in direction 117 and deflect the distal tip assembly 77. When the physician 24 controls the gear 111 to move it in direction 119, the internal force of the Nitinol™ acts as a spring to move the pull wire 92 in direction 119, straightening the distal tip assembly 77 into a non-deflected position.

[0091] The configuration of the wire holder 132 is provided by way of example only and may be simplified for conceptual clarity. In other embodiments, the wire holder 132 may include additional boreholes and / or some of the boreholes shown in FIG. 3B may be combined to form a single borehole.

[0092] 4 is a flow chart that generally illustrates a method for manufacturing an ENT tool 28, according to one embodiment of the present invention. The method begins with a step 200 of providing a handheld device, whereby a handheld device 30 of the ENT tool 28 is provided. In a step 202 of connecting a deflection mechanism, a deflection mechanism 99 controlled by a knob 66 ​​is connected to the handheld device 30. As described above in FIG. 3A, the deflection mechanism 99 includes a gear 111. The gear 111 is hollow and rotates about and moves along an axis of rotation 122.

[0093] In a wire holder coupling step 204, the wire holder 132 is coupled to the gear 111, for example, by fitting the wire holder 132 into an opening in the hollow gear 111, as described in inset 87 of FIG. 3A above. In some embodiments, the wire holder 132 has a mechanism for moving along the axis of rotation 122 and preventing rotation about the axis of rotation 122. In this example, as described in FIG. 3B above, the wire holder 132 has a bore hole 134 for passing the rod 120 therethrough, thereby allowing movement of the wire holder 132 along the axis of rotation 122 while preventing rotation of the wire holder 132 about the axis of rotation 122. In some embodiments, a method for manufacturing an ENT tool 28 includes fitting the wire holder 132 into a hollow portion of the gear 111 and inserting the rod 120 into the bore hole 134.

[0094] At a coupling rotation mechanism step 206, a rotation mechanism 89 controlled by knob 54 is coupled to handheld device 30. At a coupling rotatable hollow tube step 208, a rotatable hollow tube 52 is coupled to rotation mechanism 89. In some embodiments, a housing 53 coupled to tube 52 may be used for coupling between tube 52 and rotation mechanism 89. In such embodiments, rotation mechanism 89 includes one or more protrusions 75, each of which is configured to fit into a corresponding opening 73 in housing 53, thereby coupling between tube 52 and rotation mechanism 89 (using housing 53). In some embodiments, hollow section 52 within tube 52 defines a working channel 62 having a non-circular cross-section, as described above in FIG. 2A.

[0095] In a deflectable distal end coupling step 210, a distal end assembly 77 is coupled to a distal end of tube 52. In an electronic device mating step 212, a position sensor 55 and one or more electronic devices 56 are attached to the distal end assembly 77. In a wire coupling step 214, one or more wires in the wire braid 90 of this example are passed through the working channel 62 and coupled to the position sensor 55 and one or more electronic devices 56. During a procedure, a user of system 20, e.g., physician 24, may couple the proximal end of braid 90 to console 33 to enable exchange of power and electrical signals between the console 33, the position sensor 55, and the electronic device 56 via the wires of braid 90.

[0096] At a pull wire connection step 216, one or more pull wires 92 are connected between the distal end assembly 77 and the wire holder 132. In this example system 20, the one or more pull wires 92 pass through bore holes 94 in the wire holder 132 and are connected to the exterior surface of the panel 133, as described above in Figures 3A and 3B.

[0097] In some embodiments, the pull wire attachment step 216 concludes the method of Figure 4. In other embodiments, the order of steps 202-216 may differ from the order shown in Figure 4. For example, (i) the wire attachment step 214 may occur before the electronic device mating step 212, or (ii) the electronic device mating step 212 may be performed before the distal end attachment step 210.

[0098] 4 is simplified for conceptual clarity, and a complete manufacturing process for ENT tool 28 may include additional steps, such as, but not limited to, alignment between borehole 136 and working channel 62. This alignment can be performed and tested so that (i) physician 24 can easily insert one or more medical instruments 88 into a cavity of interest within patient 22, and (ii) braid 90 can be placed within ENT tool 28 and its wires can be coupled to position sensor 55 and electronic device 56.

[0099] Although the embodiments described herein primarily address ENT tools, the methods and systems described herein may also be used in other applications.

[0100] Therefore, it will be understood that the above-mentioned embodiments are cited by way of example, and that the present invention is not limited to what has been particularly shown and described above. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described in the above specification, as well as variations and modifications thereof not disclosed in the prior art that would occur to one skilled in the art upon reading the foregoing description. Documents incorporated by reference into this patent application shall be considered an integral part of this application, except that to the extent that any term is defined in such incorporated documents in a manner that is inconsistent with the definitions expressly or impliedly made herein, only the definitions in this specification shall be considered.

[0101] [Embodiment] (1) A medical tool, a deflectable distal end; at least one pull wire having a first end coupled to the distal end of the medical tool and configured to be moved to deflect the distal end; a deflection assembly coupled to a second end of at least one of the pull wires and configured to control deflection of the distal end, the deflection assembly comprising: a first gear having a first axis of rotation; and a second gear having a second axis of rotation, the second gear including a knurled surface for mating with the first gear, the knurled surface being inclined relative to the second axis of rotation, the second gear being rotated by the first gear to move along the second axis of rotation as the first gear rotates and configured to move the pull wire thereby deflecting the distal tip; a deflection assembly comprising: A medical tool comprising: (2) the second gear has a circumferential portion comprising: (i) a first section having (a) a first thickness along the second axis of rotation and (b) a first jagged section of the jagged surface extending from the first section; and (ii) a second section having (a) a second thickness along the second axis of rotation that is less than the first thickness and (b) a second jagged section of the jagged surface extending from the second section; When the second gear rotates, when the first jagged section contacts the first gear, the distal end is deflected a first amount; When the second jagged section contacts the first gear, the distal end is deflected a second amount that is less than the first amount. A medical tool as described in embodiment 1. (3) The medical tool of embodiment 1, comprising a rotatable knob coupled to the first gear and configured to control the deflection by rotating the first gear. (4) The medical tool of embodiment 1, further comprising a coupling element coupled to the second end of at least one of the pull wires and configured to be moved by the second gear along the second axis of rotation. (5) The medical tool of embodiment 1, wherein the second gear is hollow and comprises one or more rods that are parallel to the second axis of rotation and pass through the second gear, such that the second gear is moved by the one or more rods along the second axis of rotation.

[0102] (6) The medical tool of embodiment 5, further comprising a hollow tube disposed between the distal end and the deflection assembly, the hollow tube defining a working channel therein for inserting a medical instrument through the distal end and into a cavity of a patient's body. (7) The medical tool of embodiment 6, wherein the cavity comprises a nasal cavity in the patient's head, and the working channel is for inserting the medical instrument selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT therapeutic tool, and (g) any combination thereof. (8) A method for manufacturing a medical tool, comprising: Providing a deflectable distal end; coupling a first end of at least one pull wire to the distal end of the medical tool, the first end being moved to deflect the distal end; coupling a deflection assembly to a second end of at least one of the pull wires to control deflection of the distal end, the deflection assembly comprising: a first gear having a first axis of rotation; and a second gear having a second axis of rotation, the second gear including a knurled surface for mating with the first gear, the knurled surface being inclined relative to the second axis of rotation, such that as the first gear rotates, the second gear is rotated by the first gear and translated along the second axis of rotation to move the pull wire and thereby deflect the distal tip; A method comprising: (9) The second gear has a circumferential portion comprising: (i) a first section having (a) a first thickness along the second axis of rotation and (b) a first jagged section of the jagged surface extending from the first section; and (ii) a second section having (a) a second thickness along the second axis of rotation that is less than the first thickness and (b) a second jagged section of the jagged surface extending from the second section; When the second gear rotates, when the first jagged section contacts the first gear, the distal end is deflected a first amount; When the second jagged section contacts the first gear, the distal end is deflected a second amount that is less than the first amount. The method according to embodiment 8. (10) The method of claim 8, further comprising a rotatable knob coupled to the first gear and configured to control the deflection by rotating the first gear.

[0103] (11) The method of embodiment 8, comprising coupling a coupling element to the second end of at least one of the pull wires, the coupling element being moved along the second axis of rotation by the second gear. (12) The method of embodiment 8, wherein the second gear is hollow and the method includes inserting one or more rods through the second gear, the one or more rods being parallel to the second axis of rotation and passing through the second gear, such that the second gear is moved by the one or more rods along the second axis of rotation. (13) The method of claim 12, further comprising disposing a hollow tube between the distal end and the deflection assembly, the hollow tube defining a working channel therein for inserting a medical instrument through the distal end and into a cavity of a patient's body. (14) The method of claim 13, wherein the cavity comprises a nasal cavity in the patient's head, and the working channel is for inserting the medical instrument selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT therapeutic tool, and (g) any combination thereof.

Claims

1. A medical tool comprising: a deflectable distal end; at least one pull wire having a first end coupled to the distal end of the medical tool and configured to be moved to deflect the distal end; a deflection assembly coupled to a second end of at least one of the pull wires and configured to control deflection of the distal end, the deflection assembly comprising: a first gear having a first axis of rotation; and a second gear having a second axis of rotation, the second gear including a knurled surface for mating with the first gear, the knurled surface being inclined relative to the second axis of rotation, the second gear being configured to be rotated by the first gear to move along the second axis of rotation as the first gear rotates and to move the pull wire thereby deflecting the distal tip; a deflection assembly comprising: A medical tool comprising:

2. the second gear has a circumferential portion comprising: (i) a first section having (a) a first thickness along the second axis of rotation; and (b) a first jagged section of the jagged surface extending from the first section; and (ii) a second section having (a) a second thickness along the second axis of rotation that is less than the first thickness; and (b) a second jagged section of the jagged surface extending from the second section; When the second gear rotates, when the first jagged section contacts the first gear, the distal end is deflected a first amount; when the second jagged section contacts the first gear, the distal end is deflected a second amount less than the first amount. The medical tool of claim 1 .

3. The medical tool of claim 1 , comprising a rotatable knob coupled to the first gear and configured to control the deflection by rotating the first gear.

4. 10. The medical tool of claim 1, comprising a coupling element coupled to the second end of at least one of the pull wires and configured to be moved by the second gear along the second axis of rotation.

5. 2. The medical tool of claim 1, wherein the second gear is hollow and comprises one or more rods that are parallel to the second axis of rotation and pass through the second gear, the one or more rods acting as rails for the second gear to move along the second axis of rotation.

6. 6. The medical tool of claim 5, comprising a hollow tube disposed between the distal end and the deflection assembly, the hollow tube defining a working channel therein for inserting a medical instrument through the distal end and into a cavity of a patient's body.

7. 7. The medical tool of claim 6, wherein the cavity comprises a nasal cavity in the patient's head, and the working channel is for inserting the medical instrument selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT therapeutic tool, and (g) any combination thereof.

8. 1. A method for manufacturing a medical tool, comprising: Providing a deflectable distal end; coupling a first end of at least one pull wire to the distal end of the medical tool, the first end being moved to deflect the distal end; coupling a deflection assembly to a second end of at least one of the pull wires to control deflection of the distal end, the deflection assembly comprising: a first gear having a first axis of rotation; and a second gear having a second axis of rotation, the second gear including a knurled surface for mating with the first gear, the knurled surface being inclined relative to the second axis of rotation, such that as the first gear rotates, the second gear is rotated by the first gear and translated along the second axis of rotation to move the pull wire and thereby deflect the distal tip; A method comprising:

9. the second gear has a circumferential portion comprising: (i) a first section having (a) a first thickness along the second axis of rotation; and (b) a first jagged section of the jagged surface extending from the first section; and (ii) a second section having (a) a second thickness along the second axis of rotation that is less than the first thickness; and (b) a second jagged section of the jagged surface extending from the second section; When the second gear rotates, when the first jagged section contacts the first gear, the distal end is deflected a first amount; when the second jagged section contacts the first gear, the distal end is deflected a second amount less than the first amount. The method according to claim 8.

10. The method of claim 8 , comprising a rotatable knob coupled to the first gear and configured to control the deflection by rotating the first gear.

11. 9. The method of claim 8, comprising coupling a coupling element to the second end of at least one of the pull wires, the coupling element being moved along the second axis of rotation by the second gear.

12. 9. The method of claim 8, wherein the second gear is hollow, the method including inserting one or more rods through the second gear, the one or more rods being parallel to the second axis of rotation and passing through the second gear, the one or more rods acting as rails for the second gear to move along the second axis of rotation.

13. 13. The method of claim 12, comprising disposing a hollow tube between the distal end and the deflection assembly, the hollow tube defining a working channel therein for inserting a medical instrument through the distal end and into a cavity of a patient's body.

14. 14. The method of claim 13, wherein the cavity comprises a nasal cavity in the patient's head, and the working channel is for inserting the medical instrument selected from the list consisting of: (a) a balloon, (b) a guidewire, (c) a pumping tube, (d) a surgical tool, (e) an ENT diagnostic tool, (f) an ENT therapeutic tool, and (g) any combination thereof.

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