Fixed elements for controllable equipment

Abstract

The present invention relates to a steerable instrument (1) comprising a flexible, axially elongated member (2), at least one actuation means (3, 30) arranged along the circumference of said elongated member, at least one fastening means (4) configured to at least partially fasten the at least one actuation means to the distal end of the flexible elongated member, the at least one fastening means being in direct contact with the flexible elongated member, and at least one anti-return means (5, 51-57) configured to prevent the at least one actuation means from sliding along the circumference of the distal end of the flexible elongated member, characterized in that the at least one anti-return means and the at least one fastening means are in axial abutment.

Description

Technical Field

[0001] The present invention relates to a steerable device, for example, such a device is used as a guide for a catheter or an endoscope for inspecting the inside of a tubular element such as a pipe, a duct or an artery. The device of the present invention is particularly suitable for use in the field of surgical examination within the body of a subject.

[0002] The device is designed for surgical use, but can also be used in other areas that require non-destructive control or diagnosis, such as pipeline systems.

Background Art

[0003] For example, there is a wide range of applications where it is necessary to place the distal portion of a flexible tube at a specific location and use a device inside a pipe, duct or tube for inspection, drug delivery, or functionality at a remote or difficult-to-access location.

[0004] When displacing a flexible and elongated device within the lumen of a pipe, duct or tube, it is important that the user can carefully and accurately control the movement and placement of such a device. Placing such a device into a pipe is a technical problem known in the oil industry or automotive industry. For example, placing a device into an internal body tube through a small hole (such as in veins, arteries, gastrointestinal tract, etc.) is also known to be highly difficult in the medical field.

[0005] In the medical field, surgical or endovascular techniques can be used to treat many cardiovascular diseases that are fatal worldwide. One of the encountered medical conditions is myocardial infarction associated with peripheral vascular disease. In the past few decades, the use of catheters and guidewires to reach diseased areas for delivering stents or balloons has emerged as an easily implementable solution. These endovascular techniques are less invasive compared to conventional surgeries. These endovascular techniques are accompanied by a shortened recovery time and a reduction in postoperative complications.

[0006] However, generally speaking, the surgeon's skill and experience are the primary success factors in complex interventions, but recent developments aim to facilitate navigation through complex anatomical structures as independently as possible of the surgeon's skill and experience.

[0007] For this purpose, for example, there is a known international publication, Brochure 95 / 06494, which discloses a flexible elongated device comprising a flexible elongated member having a proximal and distal end. The shape memory element is placed within the flexible elongated member and can be in a martensite or austenite state, and has a first portion and a second portion. A conductive material layer is formed on at least one of the portions. This layer has a conductivity greater than that of the shape memory element. Current is supplied to the shape memory element. The conductive layer acts as a conductor of the current, shunting the current around the portion of the shape memory element having the conductive material layer. However, this disclosure requires a complex assembly with multiple internal connections inside the elongated device, which carries a high risk of disassembly between the shape memory element and its associated internal knots.

[0008] To overcome such complexity, reduce the risk of disassembly, and improve manufacturability, there is also a known International Publication No. 2018167300 disclosing a system for guiding a catheter or endoscope, comprising an elongated flexible member having at least one projection projecting from the elongated flexible member in a cross-section along at least a portion of its longitudinal axis, having a distal end and a proximal end, and defining two sides projecting from the elongated flexible member in a cross-section, and a wire, wherein the at least one projection comprises at least one lateral holding and passing means near the distal end of the projection, the holding and passing means extending laterally with respect to the side of the projection, the wire alternately passing through the holding and passing means from one side of the projection to the other side of the projection, the adhesion between the wire and the holding and passing means holding the wire and ensuring the wire is fixed to the holding and passing means. [Overview of the project] [Problems that the invention aims to solve]

[0009] These prior art devices are complex and / or cumbersome and do not provide sufficient flexibility to navigate inside the lumen of a tube or pipe. The primary object of the present invention is to provide a maneuverable device comprising an actuator and fixing means that is easy to manufacture, compact, and repeatable. According to the present invention, the resulting maneuverable device has sufficient flexibility to be easily navigated inside a lumen, tube, or pipe. [Means for solving the problem]

[0010] Therefore, the present invention is a maneuverable device configured to advance within the lumen of a tubular element, - A flexible, axially elongated member having a proximal end and a distal end, -At least one actuation means arranged along the periphery of the elongated member, -At least one fastening means configured to fasten at least partially to the distal end of a flexible elongated member, the fastening means being in direct contact with the flexible elongated member, -At least one anti-return means configured to prevent at least one actuation means from sliding along the circumference of the distal end of the flexible elongated member A controllable device equipped with, The present invention relates to a controllable device characterized in that at least one return-preventing means and at least one fastening means are in axial contact with each other to prevent at least one actuating means from sliding once it has been actuated.

[0011] In a preferred embodiment, at least one actuarial means is made from a shape memory alloy such as a NiTi alloy. Such alloys are used in the surgical field in this invention due to their biocompatibility and low density. The bending motion is achieved by passing an electric current through which a phase transformation is induced in the material by the Joule effect. When the current stops flowing, the actuarial means returns to its initial straight position by the rebound force of the assembly. A larger current results in a larger bending angle to the threshold.

[0012] In a preferred embodiment, at least one actuation means comprises a spring or wire that is more practical, lighter, and more compact for use with small diameter pipes, lumens, or tubes.

[0013] Preferably, at least one axially elongated flexible member is wire-shaped or blade-shaped. The elongated member may have a cross-sectional profile selected from star-shaped, circular, semicircular, square, rectangular, triangular, pyramidal, or any combination thereof.

[0014] In another alternative configuration, at least one axially elongated flexible member is spring-shaped. More preferably, the spring is a helical spring.

[0015] Preferably, at least one axially elongated flexible member is blade-shaped to improve assembly and have a preferred common bending plane for the actuator. In an alternative embodiment, the axially elongated flexible member is wire-shaped.

[0016] In an alternative embodiment, the fastening means is a ligature thread around the flexible elongated member. As with the actuation means, the ligature thread is easy to implement and reduces spatial congestion.

[0017] In an alternative embodiment, the anti-return means is an adhesive-filled tube, and the actuation means passes through the tube. The advantage of this configuration is that the actuation means is very firmly fixed, while the thickness of the tube end serves as an axial contact for the fastening means.

[0018] In the modified configuration, the anti-return mechanism is a crimped tube, and the actuation mechanism passes through the tube. The advantage of this alternative configuration is that the actuation mechanism is similarly very firmly fixed, while the thickness of the tube end serves as an axial contact point for the fastening mechanism.

[0019] Advantageously, a second anti-returning mechanism is formed integrally with the flexible elongated member to maintain the fastening means in place. In particular, the anti-returning mechanism is a recess incorporated into the flexible elongated member and configured to accommodate at least one fastening means. Preferably, the recess extends in a direction perpendicular to the longitudinal axis of the flexible elongated member. In this case, where the anti-returning mechanism is formed integrally with the flexible elongated member, the device according to the present invention is easy to manufacture, compact, and has a low risk of disassembly of the anti-returning mechanism. Furthermore, the robustness of the assembly is improved.

[0020] In exemplary embodiments, the return prevention means is formed integrally with the actuation means. In other configurations as well, the device according to the present invention is easy to manufacture, compact, and has a low risk of disassembly of the return prevention means.

[0021] In exemplary embodiments, at least one anti-return means is a loop that at least partially encloses at least one fastening means, or the loop is a contact portion for at least one fastening means. The loop is obtained by modifying the shape of the actuarial means. It is also possible to have a configuration in which at least one anti-return means is a knot, weld, or any local reinforcement located at the distal end of at least one actuarial means. These configurations add simplicity to a low risk of disassembly.

[0022] Advantageously, at least one anti-return means is a groove incorporated into the actuating means and configured to receive at least one fastening means. This configuration adds simplicity with a low disassembly risk. Preferably, the groove extends in a direction perpendicular to the longitudinal axis of the flexible elongate member. The groove can be formed by a press-fit process.

[0023] In an advantageous embodiment, at least one actuating means is inside an electrically insulating material such as a tube or a coating. This material preferably has an electrical and / or temperature blocking effect.

[0024] In another advantageous embodiment, at least one actuating means is arranged along the outer periphery of the elongate member. In this case, the assembly of the device is facilitated.

[0025] In another advantageous embodiment, at least one actuating means is arranged along the inner periphery of the elongate member. In this case, the outer diameter is constant and the device according to the invention is not bulky.

[0026] The object of the invention is further a method for assembling an actuatable device according to the invention, - providing a flexible axially elongate member having a proximal end and a distal end; - arranging at least one actuating means along the periphery of the elongate member; - fastening the at least one actuating means to the distal end of the flexible elongate member using at least one fastening means; - providing at least one anti-return means configured to prevent the at least one actuating means from sliding along the periphery of the distal end of the flexible elongate member which comprises a method of assembly, characterized in that at least one anti-return means and at least one fastening means are axially abutted so as to prevent the at least one actuating means from sliding once it is actuated.

[0027] In a preferred embodiment, in the method according to the present invention, at least one actuation means is arranged along the outer circumference of the elongated member. In this case, assembly of the device is facilitated.

[0028] In another advantageous embodiment, in the method according to the present invention, at least one actuation means is arranged along the inner circumference of the elongated member. In this case, the outer diameter is constant, and the device obtained according to the method of the present invention is not bulky.

[0029] The assembly method according to the present invention comprises at least one actuation means being a wire, at least one fastening means being a ligating thread, and at least one anti-return means being obtained by increasing the contact pressure between the wire and the ligating thread, wherein the ligating thread may alternately advance above and below the wire to longitudinally ligate a portion of the wire with a flexible elongated member. This method is easy to implement and reduces spatial congestion of the equipment according to the present invention. definition

[0030] In this invention, the following terms have the meanings set forth below. • The term "approximately" is used herein to indicate roughly, about, or within a range thereof. When the term "approximately" is used with a numerical range, it modifies that range by extending the boundary above and below the indicated number. According to one embodiment, the term "approximately" preceding a number means ±10% of the value of the number. An "actuator" can be any type of string, cable, wire, ribbon, tube, or any set thereof that can act on a body to which it is attached in order to cause a function in that area of ​​the body to which it is attached, or to induce bending in that area. Actuators can be materials and devices that can change their shape in response to environmental conditions, temperature changes (shape memory materials), and can perform mechanical work, but this is not an exclusive option. Actuators can transmit energy. In most cases, actuators convert the energy they receive into another type of energy. In one embodiment, an actuator receives an electric current that is converted into heat by the Joule effect and contracts under the action of heat. A “catheter” is a tubular medical device inserted into a tube, blood vessel, passage or body cavity for diagnostic, surgical, or therapeutic purposes, such as enabling the injection / retrieval of fluid, keeping a passage open, examining internal organs and tissues, and positioning a medical device in place for a medical procedure within the body of an animal or human. In this invention, the term “catheter” encompasses any cannula or medical probe designed for insertion into a tube, blood vessel, passage or body cavity of a human or animal. • "To curve" means to take on a curved form, to bend. Having curvature, or being curved, is used in the opposite sense of being straight. The term "curvature" refers to a non-zero curvature. Curvature can be positive or negative. "Long and slender" refers to elements such as bodies, equipment, or systems that extend in the longitudinal direction. • "Means" refers to elements or structures in the context of this invention. "Flexibility" refers to an object that can be bent without being destroyed. • “Anti-slip mechanism” refers to an element or configuration that can prevent another element to which it is connected from sliding. In the case of a configuration, such a configuration prevents the element in question from sliding. [Brief explanation of the drawing]

[0031] [Figure 1] This is a top view and a perspective view of the device according to the present invention, which has a recess in a flexible, axially elongated member as a means of preventing return. This perspective view shows a different configuration of a flat wire actuation means having a narrower width. [Figure 2] This figure shows a device according to the present invention having a loop as a means of preventing return, and illustrates the state in which such a loop is independent (2A), partially enclosing the fastening means (2B), and completely enclosing the fastening means (2C). [Figure 3] Figure 3A shows one knot, and Figure 3B shows two knots, illustrating the device according to the present invention, which has a knot as a means of preventing it from returning to its original position. [Figure 4] This is a diagram of a device according to the present invention, which has a return prevention mechanism, in which the operating mechanism is configured to move in and out of the ligating thread that serves as the fastening mechanism. [Figure 5] This figure shows a device according to the present invention having a welded seam formed integrally with the actuation means as a means of preventing return, wherein such a welded seam is spaced apart in the longitudinal direction and separated by the winding of the fastening means (5A), a welded seam continuously and uniformly distributed along the actuation means (5B), and a welded seam as a local reinforcement (5C). [Figure 6] These are three different figures of a device according to the present invention, which has grooves incorporated into the operating mechanism as a means of preventing return, and the figures show such grooves spaced apart in the longitudinal direction. [Figure 7] This is a diagram of the device according to the present invention, which has a crimped tube (7A) or an adhesive-filled tube (7B) as a means for preventing return. [Figure 8] This figure shows a device according to the present invention, illustrating one embodiment in which a return prevention means and an operating means are arranged along the inner circumference of a flexible elongated member. Figure 8A shows the inner portion of the flexible elongated member, and Figure 8B shows it viewed from the outside. [Modes for carrying out the invention]

[0032] The following detailed description will be better understood when read in conjunction with the drawings. For illustrative purposes, the apparatus according to the present invention is shown in preferred embodiments. However, it should be understood that this application is not limited to the exact arrangement, structure, features, embodiments, and aspects shown. The drawings are not drawn to actual size and are not intended to limit the scope of the claims to the embodiments shown. Therefore, where reference numerals follow features mentioned in the appended claims, such numerals are included solely for the purpose of improving the understanding of the claims and do not limit the scope of the claims.

[0033] Figures 1A and 1B are a top view and a perspective view of an exemplary configuration of the device 1 according to the present invention, having recesses 5 within a flexible, axially elongated member 2 as a return prevention means. In these figures, the flexible, axially elongated member 2 is a blade, and such a blade is formed integrally with the return prevention means 5 in the form of two recesses. Although a blade is used in this embodiment, a tubular element is also possible as the flexible, axially elongated member 2. The return prevention means 5 (here recesses) extend transversely toward the axis A1 of the elongated member 2. The actuating means 3 is a flat wire extending longitudinally while in surface contact with the elongated member 2. The actuating means 3 is thin compared to the diameter of the ligating thread 4. Each of the return prevention means 5 accommodates the ligating thread 4 such that the wire wound around the return prevention means 5 forms a coil winding having the same axis as the elongation axis A1 of the elongated member 2. The ligating thread 4 ties the actuarial means 3 (in this case, a flat wire) and fastens the actuarial means 3 to the elongated member 2 through a groove formed within the actuarial means 3. The combination of the ligating thread 4, the actuarial means groove (1B), and optionally a recess (generally speaking, any type of anti-return means 5) prevents the actuarial means 3 from sliding when actuated, for example by the Joule effect, if the actuarial means 3 is a shape memory alloy such as a NiTi type. In a preferred embodiment, the base of the recess of the flexible, axially elongated member 2 and the base of the groove of the actuarial means 3 hardly coincide in the radial direction, as shown in Figure 1A.

[0034] Regardless of the embodiment, device 1 represents a diameter that falls within the range of 200 μm to 5 mm.

[0035] Figures 2A, 2B, and 2C show exemplary configurations of the device 1 according to the present invention, which has a loop 51 integrally formed with the wire 30 as a means of preventing return. In these figures, the flexible, axially elongated member 2 is a blade, but it may also be a tubular element. In Figure 2A, the loop 51 functions as a means of preventing return. The loop 51 is in axial contact with the ligating thread 4 that connects the wire 30 to the elongated member 2. In Figure 2B, the loop 51 functions as a means of preventing return. The loop 51 is in axial contact with a portion of the ligating thread 4 that connects the wire 30 to the elongated member 2, and at the same time, it further surrounds, i.e., covers, another portion of the ligating thread 4, thereby enhancing the return prevention effect. In Figure 2C, the loop 51 functions as a means of preventing return. The loop 51 is in axial contact with the ligating thread 4 that connects the wire 30 to the elongated member 2, and at the same time, it surrounds, i.e., covers the ligating thread 4, thereby enhancing the anti-return effect. The winding of the ligating thread 4 is trapped within the closed loop 51 made of the wire 30. The combination of the ligating thread 4 that connects the wire 30 to the elongated member 2 and the closed loop 51 prevents the wire 30 from sliding when it is actuated, for example, by the Joule effect, if the wire 30 is a shape memory alloy such as a NiTi type.

[0036] Figures 3A and 3B show an exemplary configuration of the device 1 according to the present invention, which has two knots 52 formed integrally with the wire 30 as a means of preventing unwinding. In these figures, the flexible, axially elongated member 2 is a blade, but it may also be a tubular element. In Figure 3A, there is only one knot, and in Figure 3B, there are two knots spaced apart in the longitudinal direction, and the knots 52 function as a means of preventing unwinding. The knots 52 are in axial contact with the ligating thread 4 that connects the wire 30 to the elongated member 2.

[0037] In Figure 4, the return prevention means 57 is configured such that the wire 30 and the ligating thread 4 are intertwined (not shown precisely for clarity), and the wire 30 alternately moves above and below the winding of the ligating thread 4 so that a portion of the wire 30 is longitudinally ligated to the flexible elongated member 2. This configuration increases the contact pressure between the actuating means 30 and the ligating thread 4, thereby increasing the adhesion force between the actuating means 30 and the ligating thread 4, which creates axial contact. The ligating thread 4 ties the wire 30 to the elongated member 2, preventing the wire 30 from sliding when actuated, for example, by the Joule effect, if the wire 30 is a shape memory alloy such as a NiTi type.

[0038] Figures 5A, 5B, and 5C show exemplary configurations of the apparatus 1 according to the present invention, which has additional materials 52, 53, and 54 formed integrally with the wire 30 as anti-rebound means. In these figures, the flexible, axially elongated member 2 is a blade, but it may be a tubular element. In Figure 5A, three weld seams function as anti-rebound means. The weld seams are spaced apart longitudinally and are in axial contact with the winding of the ligating thread 4 that connects the wire 30 to the elongated member 2. In Figure 5B, a discontinuous weld spot 53 functions as an anti-rebound means. The weld spot 53 is in axial contact with the winding of the ligating thread 4 that connects the wire 30 to the elongated member 2. In Figure 5C, a local reinforcement 54 functions as an anti-rebound means, and such a local reinforcement 54 is axially offset in Figure 5C, but may be located between both ends of the ligating thread 4. The local reinforcement may or may not be formed as a result of welding. The local reinforcement portion 54 is in axial contact with the winding of the ligating thread 4 that ties the wire 30 to the elongated member 2. The ligating thread 4 ties the wire 30 to the elongated member 2. The combination of the ligating thread and the anti-return means makes it possible to prevent the wire 30 from sliding when it is actuated, for example by the Joule effect, if the wire 30 is a shape memory alloy such as NiTi type.

[0039] Figures 6A, 6B, and 6C show exemplary configurations of the device 1 according to the present invention, which has grooves 55 integrally formed with the wire 30 as a means of preventing return. In these figures, the flexible, axially elongated member 2 is a blade, but it may be a tubular element. In Figure 6A, three grooves function as means of preventing return. The three grooves are spaced apart in the longitudinal direction and are in axial contact with the winding of the contained ligating thread 4 that ties the wire 30 to the elongated member 2. The grooves are obtained by different processes, such as press-fitting, pressure flattening, or laser local welding. Figures 6B and 6C show grooves obtained on the wire by different methods, as an example. The ligating thread 4 ties the wire 30 to the elongated member 2. The combination of the ligating thread and at least one groove can prevent the wire 30 from sliding when actuated, for example by the Joule effect, if the wire 30 is a shape memory alloy such as a NiTi type.

[0040] Figures 7A and 7B show embodiments in which the return prevention means 56 is a crimped tube (Figure 7A) or a tube filled with adhesive (Figure 7B). In either case, the tube 56 comprises a wire 30 passing through the tube 56. The adhesive or crimping functions as a retaining element that holds the wire 30 in place. In Figures 7A and 7B, the tube 56 has windings of ligating thread 4 on both sides, but a configuration with only one winding of ligating thread 4 is also possible, as long as axial contact is obtained. The combination of the ligating thread 4 that ties the wire 30 to the elongated member 2 and the crimping or adhesive effect can prevent the wire 30 from sliding when actuated, for example by the Joule effect, if the wire 30 is a shape memory alloy such as NiTi type.

[0041] Figures 8A and 8B show the interior (8A) and exterior (8B) of the flexible elongated member. In Figure 8A, the actuation mechanism, such as the shape memory alloy (SMA) wire 3, is fixed to the inner surface of the flexible elongated member 2. The winding of the ligating thread 4 is in axial contact with the knot 5 to prevent the SMA wire 3 from sliding once actuated. Figure 8B is an external view showing the winding of the ligating thread 4 passing through the recess for mounting.

[0042] While various embodiments have been described and illustrated, the detailed description should not be construed as limiting to this specification. Various modifications to the embodiments can be made by those skilled in the art without departing from the true spirit and scope of this disclosure as defined by the claims. [Explanation of Symbols]

[0043] 1. Controllable equipment 2. Flexible, axially elongated member 3. 30 Operating means 4 Fastening means 5, 51, 52, 53, 54, 55, 56, 57 Reversal prevention means

Claims

1. A maneuverable device (1) configured to advance within the lumen of a tubular element, A flexible, axially elongated member (2) having a proximal end and a distal end, At least one operating means (3, 30) is arranged around the periphery of the elongated member (2), At least one fastening means (4) configured to fasten at least partially to the distal end of the flexible elongated member (2) the at least one operating means (3, 30), the at least one fastening means (4) being in direct contact with the at least one operating means (3, 30), At least one return-preventing means (5, 51, 52, 53, 54, 55, 56, 57) is configured to prevent the at least one actuating means (3, 30) from sliding along the circumference of the distal end of the flexible elongated member (2), A controllable device (1) equipped with, The at least one return prevention means (5, 51, 52, 53, 54, 55, 56, 57) and the at least one fastening means (4) are in axial contact with the at least one operating means (3, 30) to prevent it from sliding once it is activated. The at least one of the operating means (3, 30) is made from a shape memory alloy such as a NiTi alloy, and The at least one axially elongated flexible member (2) is wire or blade-shaped. A controllable device (1) characterized by the following features.

2. The controllable device according to claim 1, wherein the at least one actuation means (3) comprises a spring or a wire (30).

3. The maneuverable device according to claim 1 or 2, wherein the flexible, axially elongated member (2) has a cross-sectional profile selected from star-shaped, circular, semicircular, square, rectangular, triangular, pyramidal, or any combination thereof.

4. The operable device according to any one of claims 1 to 3, wherein the fastening means (4) is a ligating thread around the flexible elongated member (2).

5. The controllable device according to any one of claims 1 to 4, wherein the return prevention means (5) is a tube (56) filled with adhesive or crimped, and the actuation means (3, 30) passes through the tube (56).

6. The operable device according to any one of claims 1 to 4, further comprising a second return prevention means (5) formed integrally with the flexible elongated member (2) to maintain the fastening means (4) in a fixed position.

7. The controllable device according to claim 6, wherein the return prevention means (5) is a recess incorporated into the flexible elongated member (2) and configured to accommodate the at least one fastening means (4).

8. The return prevention means (51, 52, 53, 54, 55) are formed integrally with the actuation means (3, 30), as described in any one of claims 1 to 4, 6, or 7, for the operable device according to claim 7.

9. The operable device according to claim 8, wherein the at least one return prevention means (5) is a loop (51) that at least partially surrounds the at least one fastening means (4), or the loop (51) is a contact portion for the at least one fastening means (4).

10. The controllable device according to claim 8, wherein the at least one return prevention means (5) is a knot (52), a weld (53), or an arbitrary local reinforcement (54) located at the distal end of the at least one actuation means (3, 30).

11. The operable device according to claim 8, wherein the at least one return prevention means (5) is a groove (55) incorporated into the actuation means (3, 30) and configured to accommodate the at least one fastening means (4).

12. The groove (55) is obtained by press-fitting, as described in claim 11.

13. The operable device according to any one of claims 1 to 12, wherein the at least one actuation means (3, 30) is located inside an electrically insulating material such as a tube or coating.

14. The controllable device according to any one of claims 1 to 13, wherein the at least one actuation means (3, 30) is arranged along the outer circumference of the elongated member (2).

15. A method for assembling a controllable device according to any one of claims 1 to 14, The steps include providing a flexible, axially elongated member (2) having a proximal end and a distal end, The steps include arranging at least one operating means (3, 30) around the elongated member (2), The steps include providing at least one return-preventing means (5) configured to prevent the at least one actuating means (3, 30) from sliding along the circumference of the distal end of the flexible elongated member (2), The steps include fastening at least one actuating means (3, 30) to the distal end of the flexible elongated member (2) using at least one fastening means (4), An assembly method including, An assembly method characterized in that the at least one return prevention means (5) and the at least one fastening means (4) are in axial contact with the at least one operating means (3, 30) to prevent it from sliding once it is operated.

16. The assembly method according to claim 15, wherein the at least one actuating means (3) is a wire (30), the at least one fastening means (4) is a ligating thread, and the at least one anti-returning means (57) is obtained by increasing the contact pressure between the wire (30) and the ligating thread (4), the ligating thread alternately moves above and below the wire so as to tie a portion of the wire to the flexible elongated member (2) in the longitudinal direction.

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