Method of creating an operating space endoscopically at an obstructed site

A method of creating a space endoscopically at an obstructed anatomical site in a body including the steps of

• contacting anatomical tissue of the body with a distal end of a middle member concentrically disposed between a portal sleeve and a penetrating member of an expandable multifunctional instrument with a distal end of the penetrating member disposed distally of a distal end of the portal sleeve and the distal end of the middle member shielding the distal end of the penetrating member;
• moving the middle member proximally relative to the penetrating member to expose the distal end of the penetrating member;
• penetrating the anatomical tissue with the distal end of the penetrating member to introduce a first expandable member, carried by the portal sleeve and disposed in a non-expanded position, at the obstructed site in the body;
• moving the middle member distally relative to the penetrating member to position a second expandable member, carried by the middle member and disposed in a non-expanded position, at the obstructed site such that the second expandable member is spaced from the first expandable member;
• introducing an endoscope at the obstructed site;
• moving the first and second expandable members from the non-expanded positions to expanded positions, respectively, to displace the anatomical tissue to create a space at the obstructed site;
• and
• visualizing the space with the endoscope from external of the body.

A method of creating a space endoscopically at an obstructed site in anatomical tissue including the steps of

• providing a remote visualization device and an expandable multifunctional instrument, the expandable multifunctional instrument including a sleeve having a distal end, a penetrating member disposed in the sleeve and having a distal end disposed distally of the distal end of the sleeve, a middle member disposed between the penetrating member and the sleeve and having a distal end, the middle member being biased distally to extend distally beyond the distal end of the penetrating member, a first expandable member carried by the sleeve and disposed in a non-expanded position and a second expandable member carried by the middle member and disposed in a non-expanded position;
• contacting the anatomical tissue with the distal end of the middle member to cause the middle member to move proximally relative to the penetrating member against the bias to expose the distal end of the penetrating member;
• penetrating the anatomical tissue with the distal end of the penetrating member to position the first expandable member at the obstructed site;
• moving the middle member distally relative to the penetrating member to position the second expandable member at the obstructed site distally spaced from the first expandable member;
• moving the first and second expandable members from the non-expanded positions to expanded positions, respectively, to displace the anatomical tissue to create a space at the obstructed site;
• and
• visualizing the space endoscopically with a remote visualization device introduced at the obstructed site.