Flexible endoscopic surgical instrument for invagination and fundoplication
First Claim
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1. An endoscopic surgical instrument for deploying a two part fastener having a male fastener part and a female fastener part, comprising:
- a) a flexible tube having a proximal end and a distal end;
b) at least one control cable having a proximal end and a distal end and extending through said tube;
c) an end effector coupled to said distal end of said tube, said end effector including means for holding the male fastener part and the female fastener part in opposed relation;
d) movable fastening means coupled to said distal end of said at least one control cable for moving one of the male fastener part and the female fastener part into locking relation with the other of the male fastener part and the female fastener part; and
e) actuation means coupled to said proximal end of said tube and said proximal end of said at least one cable for moving said movable fastening means.
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Abstract
An endoscopic surgical instrument includes a flexible tube, a grasping and fastening end effector coupled to the distal end of the tube, and a manual actuator coupled to the proximal end of the tube. The manual actuator is coupled to the end effector by a plurality of flexible cables which extend through the tube. The tube contains a lumen for receiving a manipulable endoscope and the end effector includes a passage for the distal end of the endoscope. The end effector has a store for a plurality of male fastener parts, a store for a plurality of female fastener parts, a rotatable grasper, a rotatable fastener head for aligning a female fastener part and a male fastener part with tissues therebetween, and a firing member for pressing a male fastener part through tissues grasped by the grasper and into a female fastener part. According to a presently preferred embodiment the overall diameters of the flexible tube and the end effector (when rotated to the open position) do not exceed approximately 20 mm so that the instrument may be delivered transorally to the fundus of the stomach. The manual actuator is provides with a lock-out feature which prevents firing male fastener parts before the fastener head is closed. The instrument is advantageously utilized in a fundoplication procedure.
231 Citations
109 Claims
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1. An endoscopic surgical instrument for deploying a two part fastener having a male fastener part and a female fastener part, comprising:
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a) a flexible tube having a proximal end and a distal end;
b) at least one control cable having a proximal end and a distal end and extending through said tube;
c) an end effector coupled to said distal end of said tube, said end effector including means for holding the male fastener part and the female fastener part in opposed relation;
d) movable fastening means coupled to said distal end of said at least one control cable for moving one of the male fastener part and the female fastener part into locking relation with the other of the male fastener part and the female fastener part; and
e) actuation means coupled to said proximal end of said tube and said proximal end of said at least one cable for moving said movable fastening means. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27)
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28. A surgical instrument for deploying a two part fastener having a male fastener part and a female fastener part, comprising:
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a) a tube having a proximal end and a distal end;
b) at least one control member having a proximal end and a distal end and extending through said tube;
c) an end effector coupled to said distal end of said tube, said end effector including i) a stationary part having a proximal end and a distal end, and means for holding one of the male and female fastener parts, ii) a first rotatable member rotatably coupled to said distal end of said stationary part and having means for holding the other of the male and female fastener parts, said first rotatable member being coupled to said distal end of said at least one control member; and
d) actuation means coupled to said proximal end of said tube and said proximal end of said at least one control member for rotating said first rotatable member from a first open position to a second closed position where said first rotatable member extends substantially proximally from said distal end of said stationary member. - View Dependent Claims (29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57)
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58. A surgical instrument, comprising:
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a) a tube having a proximal end and a distal end;
b) at least one control member having a proximal end and a distal end and extending through said tube;
c) an end effector coupled to said distal end of said tube, said end effector including i) a stationary part having a proximal end and a distal end, ii) a first rotatable member rotatably coupled to said distal end of said stationary part, said first rotatable member being coupled to said distal end of said at least one control member, one of said stationary part and said first rotatable member having means for carrying a deployable fastener, and iii) a gripping means coupled to said at least one control member; and
d) actuation means coupled to said proximal end of said tube and said proximal end of said at least one control member for rotating said first rotatable member from a first open position to a second closed position and for opening and closing said gripping means. - View Dependent Claims (59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69)
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70. A surgical instrument, comprising:
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a) a tube having a proximal end and a distal end;
b) at least one control member having a proximal end and a distal end and extending through said tube;
c) an end effector coupled to said distal end of said tube, said end effector including means for holding a deployable fastener having a sharp end and means for ejecting the deployable fastener, said means for ejecting being coupled to said distal end of said at least one control member;
d) a first rotatable member coupled to said distal end of said end effector and coupled to said at least one control cable, said first rotatable member having means for receiving the sharp end of the deployable fastener; and
e) actuation means coupled to said proximal end of said tube and said proximal end of said at least one control member for moving said first rotatable member from a first open position in which said first rotatable member extends away from said end effector to a second closed position in which said means for receiving is aligned with said means for ejecting, said actuation means also for actuating said means for ejecting and including lock-out means for preventing actuation of said means for ejecting when said first rotatable member is not in said second closed position. - View Dependent Claims (71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81)
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82. An endoscopic surgical instrument, comprising:
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a) a flexible tube having a proximal end and a distal end;
b) at least one control cable having a proximal end and a distal end and extending through said tube;
c) an end effector coupled to said distal end of said tube, said end effector including i) a stationary part having a proximal end and a distal end, and means for holding one of a male and female fastener part, ii) a first rotatable member rotatably coupled to said distal end of said stationary part and having means for holding the other of a male and female fastener part, said first rotatable member being coupled to said distal end of said at least one control member, iii) a gripping means coupled to said at least one control member, and iv) movable fastening means coupled to said distal end of said at least one control cable for moving one of said male fastener part and said female fastener part into locking relation with the other of said male fastener part and said female fastener part; and
d) actuation means coupled to said proximal end of said tube and said proximal end of said at least one control member for i) opening and closing said gripping means, ii) rotating said first rotatable member from a first open position to a second closed position, and iii) actuating said movable fastening means, wherein said actuating means includes lock-out means for preventing actuation of said movable fastening means when said first rotatable member is not in said second closed position. - View Dependent Claims (83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107)
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108. A method of performing invagination and fundoplication, comprising:
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a) inserting a grasping and fastening instrument through the mouth and throat into the stomach;
b) grasping the fundus of the esophagus with the instrument;
c) invaginating the fundus with the instrument;
d) applying a two part fastener with the instrument to plicate the fundus.
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109. A method of performing invagination and fundoplication, comprising:
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a) inserting a fastening instrument through the mouth and throat into the stomach;
b) grasping the fundus of the esophagus;
c) invaginating the fundus;
d) applying a two part fastener with the instrument to plicate the fundus.
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Specification
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Current AssigneeSymbiosis Corporation (Boston Scientific Corporation)
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Original AssigneeSymbiosis Corporation (Boston Scientific Corporation)
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InventorsKortenbach, Juergen Andrew
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Granted Patent
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Time in Patent OfficeDays
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Field of Search
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US Class Current606/139
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CPC Class CodesA61B 1/00087 Tools A61B17/00234 takes pr...A61B 1/00179 for off-axis viewingA61B 1/273 for the upper alimentary ca...A61B 17/00234 for minimally invasive surg...A61B 17/0643 with separate closing membe...A61B 17/068 Surgical staplers , e.g. co...A61B 17/10 for applying or removing wo...A61B 17/29 Forceps for use in minimall...A61B 2017/00827 Treatment of gastro-esophag...A61B 2017/0647 having one single leg, e.g....A61B 2017/2905 flexibleA61B 2017/2923 Toothed members, e.g. rack ...A61F 5/0086 using clamps, folding means...
