Overtube apparatus for insertion into a body

• US 20030065359A1
• Filed: 05/23/2002
• Published: 04/03/2003
• Est. Priority Date: 05/30/2001
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Satiety, Inc.
• Inventors: French, Ronald G., Sutton, Douglas S., Gifford, Hanson S. III, Andreas, Bernard H., Deem, Mark E., Gerbi, Craig, Gannoe, James, Weller, Gary
• Granted Patent: US 7,083,629 B2
• Time in Patent Office: Days
• US Class Current: 606/213
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• 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 17/072 for applying a row of staples in a single action , e.g. the staples being applied simultaneously
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 17/08 Wound clamps or clips, i.e. not or only partly penetrating the tissue suture bridges A61B17/0466; Devices for bringing together the edges of a wound
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/0648 threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2017/0649 Coils or spirals
• CPC Class Codes: A61B 2017/081 Tissue approximator A61B2017/1103, A61B17/8866 take precedence
• CPC Class Codes: A61B 2017/1139 : Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61B 2017/12018 : Elastic band ligators
• CPC Class Codes: A61B 2017/2926 : Details of heads or jaws
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2090/395 : with marking agent for marking skin or other tissue
• CPC Class Codes: A61F 5/0083 : Reducing the size of the stomach, e.g. gastroplasty surgical interventions A61B17/00

Abstract

An overtube apparatus for insertion into a body is described herein. The assembly includes an overtube having a lumen defined throughout. The distal end of the overtube member has two or more windows in apposition configured to draw in tissue via a vacuum. A drive tube, which also defines a lumen, is inserted and is freely adjustable within the overtube. A spiral or helical fastener, which is temporarily attached to the drive tube distal end, is positioned within the overtube lumen. Endoscopic devices can be inserted within the drive tube lumen and advanced past the distal ends of both the drive tube and overtube. A pump provides the vacuum to draw apposed regions of tissue from within a hollow body organ into the windows of the overtube. Once the tissue has been invaginated, the drive tube is rotated to advance the fastener into the tissue to fasten them together.

Claims

1. An overtube system for insertion into a body, comprising:

an elongate overtube having a proximal end, a distal end, and a length therebetween, wherein the overtube defines at least one opening near or at the distal end of the overtube and wherein the opening is adapted to adhere tissue thereto;

a tubular member adjustably disposed within a first lumen defined within the overtube, wherein the tubular member defines a second lumen therethrough; and

a fastening assembly disposed within the first lumen and adapted to fasten the tissue adhered to the opening.

2. The system of claim 1 wherein the overtube defines at least two openings near or at the distal end of the overtube in apposition with one another.

3. The system of claim 2 wherein the openings are slots longitudinally defined along the length of the overtube.

4. The system of claim 2 wherein the overtube further comprises a wall extending longitudinally within the overtube at least partially and which separates the first lumen between the two openings.

5. The system of claim 1 wherein the overtube defines a plurality of openings near the distal end, wherein each of the openings are defined in an alternating and apposing pattern between adjacent openings.

6. The system of claim 1 wherein the overtube distal end is in fluid communication with the proximal end through the first lumen.

7. The system of claim 1 wherein the elongate overtube is adapted to conform to an arbitrary configuration when in a relaxed state and to selectively maintain the arbitrary configuration when in a rigidized state.

8. The system of claim 7 wherein the elongate overtube further comprises at least one tensioning member disposed throughout the length of the overtube, the tensioning member being manipulatable at its proximal end whereby applying a tensile force to the member causes the overtube to rigidize and relaxing the member causes the overtube to become flexible.

9. The system of claim 1 wherein a distal end portion of the elongate overtube is adapted to be manipulatable via a controller located proximally of and in communication with the distal end portion.

10. The system of claim 1 wherein the tubular member is disposed within the overtube such that the tubular member is rotatable about a longitudinal axis defined by the tubular member.

11. The system of claim 1 wherein the second lumen of the tubular member is adapted to slidingly receive an endoscope shaft.

12. The system of claim 1 wherein the proximal end of the overtube comprises a fluid port in communication with the distal end of the overtube via the first lumen.

13. The system of claim 1 wherein the proximal end of the overtube comprises an entry port through which the tubular member is disposed, wherein the entry port is adapted to form a fluid-tight seal with an outer surface of the tubular member.

14. The system of claim 1 wherein the fastening assembly comprises a fastener having a helically shaped elongate member having a tapered distal end.

15. The system of claim 14 wherein the fastener is disposed distally of the tubular member, wherein a distal end of the tubular member is adapted to engage and distally advance the fastener.

16. The system of claim 14 wherein the distal end of the tubular member comprises an engagement surface adapted to engage a proximal end of the fastener, wherein rotating the tubular member about its longitudinal axis rotates and distally advances the fastener.

17. The system of claim 1 wherein the fastening assembly comprises an elongated shaft having a proximal end and a distal end with a stapling device attached thereto.

18. The system of claim 1 wherein the fastening assembly comprises a staple.

19. The system of claim 1 wherein the fastening assembly comprises an elongate member having a tapered distal end.

20. The system of claim 1 further comprising a guard member slidably disposed along the length of the overtube, wherein the guard member is adapted for placement about an opening into the body for providing structural support to the overtube.

21. The system of claim 1 wherein the overtube comprises at least one mark defined on an outer surface near or at the proximal end of the overtube, wherein the mark corresponds to a circumferential position of the opening near or at the distal end of the overtube.

22. The system of claim 1 further comprising a mandrel insertable within the length of the overtube for defining a shape of the distal end of the overtube.

23. The system of claim 22 wherein the mandrel has a straight configuration and constrains the overtube into a straightened configuration when inserted within the length of the overtube.

24. The system of claim 22 wherein the mandrel has a distal end which defines a curved shape.

25. An overtube system for insertion into a body, comprising:

an elongate overtube having a proximal end, a distal end, and a length therebetween, wherein the overtube defines at least one opening near or at the distal end of the overtube and wherein the opening is adapted to adhere tissue thereto;

a tubular member adjustably disposed within a first lumen defined within the overtube, wherein the tubular member defines a second lumen therethrough;

a fastening assembly disposed within the first lumen and adapted to fasten the tissue adhered to the opening; and

,

a pump in fluid communication with the first lumen of the overtube.

26. The system of claim 25 wherein the pump is connected to the overtube via a fluid port defined near or at the proximal end of the overtube.

27. The system of claim 25 wherein the pump comprises a negative pressure pump.

28. The system of claim 25 wherein the pump comprises a positive pressure pump.

29. The system of claim 25 wherein the proximal end of the overtube comprises an entry port through which the tubular member is disposed, wherein the entry port is adapted to form a fluid-tight seal with an outer surface of the tubular member.

30. The system of claim 25 further comprising an endoscope for insertion into the second lumen of the tubular member.

31. An overtube system for insertion into a body, comprising:

an elongate overtube having a proximal end, a distal end, and a length therebetween, wherein the overtube defines at least a first and a second opening in apposition with one another near or at the distal end of the overtube, wherein the openings are separated from one another by a wall at least partially extending longitudinally within the overtube such that a first and a second lumen are defined within the overtube, and wherein the openings are adapted to adhere tissue thereto;

a tubular member adjustably disposed proximally of the wall within the overtube, wherein the tubular member defines an inner lumen therethrough; and

a fastening assembly disposed within the inner lumen and adapted to fasten the tissue adhered to the openings.

32. The system of claim 31 wherein the first opening is in fluid communication with the first lumen and the second opening is in fluid communication with the second lumen.

33. The system of claim 31 wherein the openings are slots longitudinally defined along the length of the overtube.

34. A method of treating a hollow body organ from within the hollow body organ comprising:

advancing a distal end of an overtube within the hollow body organ, the overtube defining at least one opening near or at the distal end and wherein the opening is adapted to adhere tissue from the hollow body organ thereto;

drawing apposed regions from the tissue of interest within the at least one opening;

distally advancing a tubular member through a lumen defined within the overtube such that a fastening assembly disposed within the lumen and engaged to a distal end of the tubular member is advanced distally; and

engaging the apposed regions of tissue within the lumen with the fastener.

35. The method of claim 34 wherein advancing the distal end of the overtube comprises advancing the overtube in a relaxed state to conform to an arbitrary configuration and further rigidizing the overtube to maintain the arbitrary configuration.

36. The method of claim 35 wherein the arbitrary configuration is defined by a controllable distal end portion of an endoscope inserted within the overtube.

37. The method of claim 35 wherein rigidizing the overtube comprises applying a tensile force to a tensioning member disposed within the overtube.

38. The method of claim 34 wherein drawing apposed regions from the tissue of interest comprises drawing the tissue within the opening via a vacuum force.

39. The method of claim 38 wherein the tissue is drawn from at least two apposed regions.

40. The method of claim 38 wherein the tissue is drawn from alternating and apposed regions.

41. The method of claim 34 further comprising advancing an endoscope distally through the lumen defined within the overtube to identify at least one region of tissue of interest prior to drawing the apposed regions from the tissue of interest.

42. The method of claim 41 wherein advancing the endoscope distally comprises advancing a distal end of the endoscope beyond the distal end of the overtube.

43. The method of claim 41 further comprising withdrawing the endoscope proximally into the lumen prior to distally advancing the tubular member.

44. The method of claim 41 wherein the tubular member is advanced distally over the endoscope disposed within the lumen.

45. The method of claim 34 wherein distally advancing the tubular member comprises advancing the tubular member longitudinally.

46. The method of claim 45 wherein distally advancing the tubular member further comprises rotating the tubular member about a longitudinal axis defined by the tubular member.

47. The method of claim 34 wherein engaging the apposed regions of tissue further comprises approximating the tissue with the fastener.

48. The method of claim 34 wherein engaging the apposed regions of tissue comprises piercing the tissue with the fastener.

49. The method of claim 34 further comprising orienting the overtube relative to the hollow body organ by aligning at least one mark defined on the overtube with a landmark located externally of the hollow body organ prior to drawing the apposed regions from the tissue of interest.

50. The method of claim 34 wherein engaging the apposed regions of tissue comprises clamping the tissue with the fastening assembly while engaging the tissue with the fastener.