Methods for the surgical application of a fastener and the endoluminal treatment of gastroesphageal reflux disease (GERD)

• US 20040059358A1
• Filed: 09/20/2002
• Published: 03/25/2004
• Est. Priority Date: 09/20/2002
• Status: Active Grant

• Current Assignee: ID Company Limited
• Original Assignee: ID Company Limited
• Inventors: Kortenbach, Juergen A., Sixto, Robert Jr., Smith, Kevin W.
• Granted Patent: US 7,678,122 B2
• Time in Patent Office: Days
• US Class Current: 606/153
• 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/2905 flexible

Abstract

A surgical instrument includes an end effector having a clevis and first and second jaws mutually rotatable between open and closed positions. The jaws are proximally directed and laterally displaced relative to a longitudinal axis of a control shaft of the instrument. The jaws hold first and second parts of a fastener, respectively. The first part includes a base having upstanding tissue piercing posts, and the second part includes another base defining apertures for receiving the posts, as well as a portion movable relative to the second base. When the upstanding posts are inserted into the apertures, the movable portion can be moved into a second configuration to lock the parts of the fastener together. The instrument is adapted to move the second part into the second configuration. A method for using the apparatus and fastener are also provided.

Claims

1. A method, comprising:

a) coupling a medical instrument having a distal end to an endoscope having a distal end;

b) inserting the distal end of the endoscope into a patient;

c) inserting the distal end of the instrument into the patient;

d) decoupling the instrument from the endoscope such that the instrument and the endoscope are separated within the patient; and

then

e) manipulating tissue in the patient with the instrument.

2. A method according to claim 1, wherein:

said coupling is to an exterior of the endoscope.

3. A method according to claim 1, wherein:

said coupling is to the distal end of the endoscope.

4. A method according to claim 1, wherein:

said distal end of said endoscope is inserted into the patient before the distal end of the instrument.

5. A method according to claim 1, wherein:

said distal end of the instrument is inserted into the patient before the distal end of the endoscope.

6. A method according to claim 1, wherein:

said tissue is stomach tissue.

7. A method according to claim 1, further comprising:

e) recoupling the instrument with the endoscope; and

f) withdrawing the recoupled instrument and endoscope from the patient.

8. A method of inserting medical instruments into the human body, comprising:

a) inserting an endoscope having a distal end into a body lumen; and

b) advancing a medical instrument over a portion of said endoscope and off the distal end of the endoscope.

9. A method according to claim 8, further comprising:

c) coupling the instrument to the endoscope;

d) withdrawing the coupled endoscope and instrument from the body lumen.

10. A method of inserting medical instruments into the human body, comprising:

a) inserting an endoscope having a distal portion into a body lumen;

b) retroflexing said distal portion of said endoscope; and

c) advancing a medical instrument over a portion of said endoscope under observation by said endoscope.

11. A method according to claim 10, wherein:

the medical instrument is coupled to the endoscope prior to inserting the endoscope.

12. A method of performing a treatment for gastroesophagheal reflux disease (GERD), comprising:

a) inserting in a first direction a medical instrument having a proximally facing end effector through the esophagus;

b) retracting the instrument in a second direction substantially opposite said first direction;

c) contacting said end effector against said stomach wall at a location substantially adjacent said esophagus; and

d) manipulating said stomach wall with said end effector.

13. A method according to claim 12, wherein:

said first and second directions are substantially parallel to the esophagus.

14. A method according to claim 12, wherein:

said manipulating includes plicating a portion of said stomach wall.

15. A method according to claim 14, further comprising:

e) using a second instrument in conjunction with said end effector to effect said plicating.

16. A method according to claim 14, further comprising:

e) applying a fastener about the plicated portion.

17. A method according to claim 14, further comprising:

e) piercing the plicated portion.

18. A method according to claim 17, wherein:

said end effector includes two jaws, each of which is provided with one part of a two-part fastener, and with respect to each jaw, one of said jaw and the part of the two-part fastener includes tissue piercing means.

19. A method of creating a plication in the tissue wall of a body cavity, comprising:

a) first inserting an endoscope and a fastening instrument having jaws into the body cavity;

b) second inserting a tissue grabbing instrument through the endoscope;

c) using the tissue grabbing instrument to grab the tissue wall and pierce the mucosa and muscularis layers of the tissue wall to thereby engage both such layers;

d) fixing the location of the pierced layers;

e) pivoting the jaws of the fastening instrument about the fixed location of the pierced layers to form a plication;

f) fastening portions of the plicated tissue together to surgically maintain the plication.

20. A method according to claim 19, wherein:

the body cavity is the stomach.

21. A method according to claim 19, wherein:

said first inserting includes inserting the endoscope and the fastening instrument separately into the body cavity and in a parallel arrangement in which neither of the endoscope and the fastening instrument extends through the other.

22. A method of inserting a two-part locking fastener about tissue, comprising:

a) positioning about the tissue two parts of the fastener such that the tissue is clamped between the two parts of the fastener;

b) leaving the fastener clamped about the tissue in a first location for a period for time;

c) repositioning the fastener into a second location about the tissue; and

d) locking the fastener about the tissue in the second location.

23. A method of locking a fastener having male and female elements about a tissue, comprising:

a) clamping the male and female elements about the tissue such that the tissue is compressed between the male and female elements, but the male and female elements are not locked together;

then

b) deciding whether to lock the male and female elements together; and

then

c) if the decision is positive, locking the male and female elements together.

24. A method according to claim 23, wherein:

said locking is performed without applying additional clamping force to the tissue.

25. A method of locking a surgical fastener about a tissue, the fastener having a male element with at least one tissue piercing post and a female element adapted to receive the at least one tissue piercing post, said method comprising:

a) clamping the male and female elements about the tissue such that the at least one tissue piercing post is received by the female element, and the male and female elements are obliquely angled relative to each other; and

b) locking the male and female elements together in the obliquely angled configuration.

26. A method according to claim 25, wherein:

the tissue is a plication of the stomach wall.

27. A method, comprising:

a) inserting a guidewire into a body cavity of the patient;

b) extending a distal end of a medical instrument over the guidewire and into the body cavity;

c) inserting a distal end of an endoscope alongside a portion of the medical instrument and into the body cavity; and

d) manipulating tissue in the body cavity with the instrument under view of the endoscope.

28. A method according to claim 27, wherein:

said body cavity is a stomach.

29. A method according to claim 27, further comprising:

e) before inserting the guidewire, inserting an endoscope into a body cavity of a patient; and

f) after inserting the guidewire, removing the endoscope from the body cavity while maintaining the distal end of the guidewire in the body cavity.

30. A method according to claim 29, wherein:

said inserting the guidewire comprises inserting the guidewire through a working channel of the endoscope until the distal end of the guidewire is in the body cavity.