Tissue reconfiguration

• US 20020040226A1
• Filed: 05/18/2001
• Published: 04/04/2002
• Est. Priority Date: 06/22/1999
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: NDO Surgical, Inc.
• Inventors: Oʼkeefe, Jonathan, Andrews, Richard, Chinnock, Randall B., Marshall, Neal H., Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos, Barenboym, Michael, Chuttani, Ram, Puicci, Vincent A. Jr.
• Granted Patent: US 6,821,285 B2
• Time in Patent Office: Days
• US Class Current: 606/153
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/0686 having a forming anvil staying below the tissue during stapling
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00314 Separate linked members
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 : H-fasteners
• CPC Class Codes: A61B 2017/0441 : the shaft being a rigid coil or spiral
• CPC Class Codes: A61B 2017/0458 : Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 : for soft tissue
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/06052 : Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/061 : hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/2905 : flexible
• CPC Class Codes: A61B 2017/2915 : arcuate shaped guiding means
• CPC Class Codes: A61B 2017/2916 : pins in guiding slots
• CPC Class Codes: A61B 2017/2917 : with flexible part
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2932 : Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/308 : with suction cups
• CPC Class Codes: A61B 2090/065 : for measuring contact or contact pressure
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires

Abstract

A medical instrument for engaging tissue includes a flexible shaft, a tissue piercing coil at a distal portion of the shaft, and a tissue stabilizer positioned over the shaft and biased in a distal direction such that as the tissue piercing coil enters tissue, the tissue stabilizer is urged against a surface of the tissue. A medical instrument for reconfiguring tissue includes a flexible shaft defining a lumen housing actuating controls, and a distal actuating assembly with a sealing portion configured to substantially seal the shaft lumen from contact with bodily fluids. A cartridge assembly includes first and second members configured for releasable attachment to a medical instrument, and a holder configured to receive the first and second members and to be released from the first and second members upon action of the first and second members attaching to the medical instrument.

Claims

1. A medical instrument, comprising:

a flexible shaft,

a tissue piercing coil at a distal portion of the shaft, and

a member positioned over the shaft, the member and the coil coupled for relative movement.

2. The medical instrument of claim 1 wherein the member is biased in a distal direction.

3. The medical instrument of claim 2 further comprising a spring biasing the member in the distal direction.

4. The medical instrument of claim 1 wherein the shaft includes a length of coil.

5. The medical instrument of claim 4 wherein the shaft coil and the tissue piercing coil are wound in opposite directions.

6. A medical instrument, comprising:

a flexible shaft,

a tissue piercing member at a distal portion of the shaft, and

a tissue stabilizer coupled to the shaft for movement relative to the tissue piercing member, the tissue stabilizer being biased in a distal direction such that as the tissue piercing member enters tissue, the tissue stabilizer is urged against a surface of the tissue.

7. The medical instrument of claim 6 further comprising a spring biasing the tissue stabilizer in the distal direction.

8. The medical instrument of claim 6 wherein the shaft includes a length of coil.

9. A medical instrument, comprising:

a tissue piercing coil, and

a tissue stabilizer coupled to the coil for movement relative to the coil, the tissue stabilizer being biased in a distal direction such that as the coil enters tissue, the tissue stabilizer is urged against a surface of the tissue.

10. The medical instrument of claim 9 further comprising a spring biasing the tissue stabilizer in the distal direction.

11. A method of treatment, comprising:

advancing a flexible shaft to a treatment site, and

piercing tissue with a coil portion of the shaft.

15. The medical instrument of claim 14 wherein the distal actuating assembly further comprises the implant located distal of the sealing portion.

16. The medical instrument of claim 14 wherein the sealing portion comprises a cover over a section of the assembly.

17. The medical instrument of claim 14 wherein the sealing portion comprises a seal surrounding an actuating member extending through the seal.

19. The medical device of claim 18 wherein the first attachment portion includes a flexing section between the side wall and the mating contour.

20. The medical device of claim 18 wherein the second portion includes tubes configured to pass through tissue.

12. A method of treatment, comprising:

advancing a flexible shaft to a treatment site,

piercing tissue with a member located at a distal portion of the shaft, and

stabilizing tissue being pierced by contacting a surface of the tissue with a tissue stabilizer biased in a distal direction such that as the tissue piercing member enters tissue, the tissue stabilizer is urged against the surface of the tissue.

13. A method of treatment, comprising:

piercing tissue with a coil, and

stabilizing tissue being pierced by contacting a surface of the tissue with a tissue stabilizer biased in a distal direction such that as the coil enters tissue, the tissue stabilizer is urged against the surface of the tissue.

14. A medical instrument, comprising:

a flexible shaft defining a lumen housing actuating member, and

a distal actuating assembly including

a sealing portion configured to substantially seal the shaft lumen from contact with bodily fluids, and

a tissue manipulator located distal of the sealing portion, the actuating member being coupled to the tissue manipulator such that the tissue manipulator is actuatable to deploy an implant located distal of the sealing portion.

18. A medical device, comprising:

first and second members each including a body having a first attachment portion and a second attachment portion,

the first attachment portion including a member with a side wall defining a slot and a mating contour having a straight, proximal edge for releasably attaching the body to a distal portion of a medical instrument such that the body can be exchanged with a replacement body,

the second portion being configured to releasably receive an implant.

21. A medical device, comprising:

an implant including a suture, and

first and second members configured to releasably attach to a distal portion of a medical instrument such that the members can be exchanged with replacement members, at least one of the members being configured to releasably receive the implant for delivery of the implant to a treatment site.

22. The medical device of claim 21 wherein the members each include a wall defining a slot for attaching the member to the medical instrument.

23. The medical device of claim 21 wherein the members each include a mating contour having a flat, proximal edge for attaching the member to the medical instrument.

24. The medical device of claim 23 wherein the mating contour comprised an opening.

25. The medical device of claim 21 wherein the members each include a flexing section.

26. The medical device of claim 21 wherein the members each include tubes configured to pass through tissue to which the implant is coupled.

27. A cartridge assembly, comprising:

first and second members configured for releasable attachment to a medical instrument, and

a holder configured to receive the first and second members and to be released from the first and second members upon action of the first and second members attaching to the medical instrument.