Resection and anastomosis devices and methods

• US 20040092960A1
• Filed: 04/24/2003
• Published: 05/13/2004
• Est. Priority Date: 04/24/2002
• Status: Active Grant

• Current Assignee: Surgical Connections, Inc.
• Original Assignee: Surgical Connections, Inc.
• Inventors: Robinson, Paul J., Hovland, Claire T., Abrams, Jerome H.
• Granted Patent: US 7,141,055 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• CPC Class Codes: A61B 17/0686 having a forming anvil staying below the tissue during stapling
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/115 Staplers for performing anastomosis in a single operation
• CPC Class Codes: A61B 17/1152 applying the staples on the outside of the lumen
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 2017/306 holding by means of suction

Abstract

According to embodiments of the invention, an apparatus for moving a diseased portion of an anatomical structure with respect to a healthy portion of an anatomical structure includes a first vacuum section adapted to apply vacuum force to and hold the healthy portion, and a second vacuum section adapted to apply vacuum force to and hold the diseased portion, wherein the second vacuum section is adapted to withdraw within the first vacuum section.

Claims

1. Apparatus for moving a diseased portion of an anatomical structure with respect to a healthy portion of an anatomical structure, the apparatus comprising:

a first vacuum section adapted to apply vacuum force to and hold the healthy portion; and

a second vacuum section adapted to apply vacuum force to and hold the diseased portion, wherein the second vacuum section is adapted to withdraw within the first vacuum section.

2. The apparatus of claim 1, wherein the second vacuum section is adapted to draw the diseased portion into contact with the second vacuum section and to withdraw the diseased portion within the healthy portion.

3. The apparatus of claim 1, wherein the healthy portion is a first healthy portion;

the apparatus further comprising a third vacuum section operably coupled with the first vacuum section and the second vacuum section, the third vacuum section being adapted to apply vacuum force to and hold a second healthy portion of the anatomical structure disposed on an opposite side of the diseased portion relative to the first healthy portion.

4. The apparatus of claim 3, wherein the third vacuum section is attached to the second vacuum section for movement therewith with respect to the first vacuum section.

5. The apparatus of claim 3, wherein the third vacuum section comprises a cutting blade adapted to cut away the diseased portion.

6. The apparatus of claim 5, further comprising a cutting actuator for actuating the cutting blade, the cutting actuator being disposed within the second vacuum section.

7. The apparatus of claim 3, wherein the third vacuum section comprises a stapling device adapted to fire at least one staple into the anatomical structure.

8. The apparatus of claim 7, further comprising a stapling actuator for actuating the stapling device, the stapling actuator being disposed within the second vacuum section.

9. The apparatus of claim 7, wherein the first vacuum section defines an anvil disposed to act as a backstop for the at least one staple fired by the stapling device.

10. The apparatus of claim 3, wherein the third vacuum section comprises an internal wall, the second vacuum section being supported by the internal wall.

11. The apparatus of claim 10, wherein the internal wall defines vacuum apertures therethrough, the vacuum apertures being adapted to transmit vacuum force in the second vacuum section through the internal wall.

12. The apparatus of claim 1, wherein the first vacuum section is adapted to expand and contract with respect to the anatomical structure.

13. The apparatus of claim 1, further comprising a stapling device adapted to staple the anatomical structure and a cutting device adapted to cut the anatomical structure, the stapling device and the cutting device being operably coupled with the first vacuum section and the second vacuum section.

14. The apparatus of claim 13, further comprising a support adapted for movement with the second vacuum section with respect to the first vacuum section, the support holding one or both of the stapling device and the cutting device.

15. The apparatus of claim 1, wherein the first vacuum section and the second vacuum section are fluidly coupled with a common vacuum source.

16. The apparatus of claim 15, wherein the vacuum source is adapted to create a vacuum force within the first vacuum section, further wherein the apparatus is adapted to transmit the vacuum force from the first vacuum section to the second vacuum section.

17. The apparatus of claim 1, wherein the first vacuum section defines a first diameter and the second vacuum section defines a second diameter, the second diameter being less than about 60% of the first diameter.

18. The apparatus of claim 17, wherein the second diameter is less than about 40% of the first diameter.

19. The apparatus of claim 17, wherein the second diameter is less than about 20% of the first diameter.

20. The apparatus of claim 1, wherein first vacuum section and the second vacuum section are adapted for placement along a longitudinal direction of the anatomical structure, further wherein the second vacuum section defines a plurality of vacuum apertures disposed relative to each other along the longitudinal direction.

21. The apparatus of claim 20, wherein the first vacuum section defines a plurality of vacuum apertures disposed relative to each other along the longitudinal direction.

22. The apparatus of claim 1, wherein the first vacuum section is adapted to hold the healthy portion against movement while the second vacuum section is withdrawn within the first vacuum section.

23. Resection apparatus for use with anatomical tissue, the apparatus comprising:

a proximal portion;

a distal portion operably coupled with the proximal portion;

an intermediate portion operably coupled with the proximal portion and the distal portion, the intermediate portion being adapted for movement within the proximal portion, the intermediate portion further being adapted to apply suction to attract anatomical tissue;

a cutting device adapted to cut anatomical tissue, the cutting device being supported by either the proximal portion or the distal portion; and

a stapling device adapted to staple anatomical tissue, the stapling device being supported by either the proximal portion or the distal portion;

wherein at least one of the proximal portion and the distal portion are adapted to apply suction to attract anatomical tissue.

24. The apparatus of claim 23, wherein both the proximal portion and the distal portion are adapted to apply suction to attract anatomical tissue.

25. The apparatus of claim 23, wherein the intermediate portion supports the distal portion for movement therewith.

26. The apparatus of claim 25, wherein the distal portion comprises an internal support adapted to receive the intermediate portion;

further wherein the distal portion is adapted to apply suction on opposite sides of the internal support to attract anatomical tissue.

27. The apparatus of claim 23, wherein the proximal portion comprises an O-ring for providing a fluid seal relative to the intermediate portion.

28. The apparatus of claim 23, further comprising one or more collars adapted to hold the anatomical tissue with respect to the intermediate portion.

29. The apparatus of claim 28, wherein the one or more collars are adapted to move within the proximal portion as the intermediate portion moves within the proximal portion.

30. Apparatus for treating anatomical tissue, the apparatus comprising:

first means for holding anatomical tissue; and

second means for holding anatomical tissue, the second means for holding being adapted for movement within the first means for holding such that anatomical tissue is moved into the first means for holding.

31. The apparatus of claim 30, wherein at least the first means for holding is adapted to hold the anatomical tissue via suction.

32. The apparatus of claim 30, further comprising means for cutting anatomical tissue and means for stapling anatomical tissue, the means for cutting and the means for stapling being operably coupled with the first and second means for holding.

33. The apparatus of claim 32, wherein one or both of the means for cutting and the means for stapling are supported by the first means for holding.

34. The apparatus of claim 30, wherein the first and second means for holding each define a plurality of vacuum apertures for holding anatomical tissue.

35. The apparatus of claim 30, wherein in an extended configuration at least a portion of the second means for holding extends beyond the first means for holding, further wherein the second means for holding is adapted to attract and hold diseased anatomical tissue generally along the entire portion of the second means for holding that extends beyond the first means for holding.

36. The apparatus of claim 30, wherein in an extended configuration at least a portion of the second means for holding extends beyond the first means for holding, further wherein said portion defines a transverse cross-sectional area that is less than about one-quarter of a cross-sectional area defined by the first means for holding.

37. A resection method, comprising:

inserting a resection device into a structure to be resected;

extending a first portion of the resection device relative to a second portion of the resection device;

moving the structure to be resected toward both the first and second portions of the resection device;

involuting the structure by retracting the first portion into the second portion, wherein said involuting creates an involuted section of the structure;

shortening the structure generally by the length of the involuted section; and

cutting away the involuted section.

38. The method of claim 37, further comprising using the second portion to hold part of the structure against movement while the first portion is being retracted.

39. The method of claim 38, further comprising applying one or more collars to the structure to move the structure toward the first portion or hold the structure with respect to the first portion.

40. The method of claim 39, further comprising moving the collar into the second portion during said involuting.

41. The method of claim 37, further comprising using suction to move the structure to be resected toward both the first and second portions of the resection device.

42. The method of claim 37, further comprising using a device distinct from the resection device to cut away a support for the structure to be resected.

43. The method of claim 42, wherein the structure to be resected is gastrointestinal structure, and the support for the structure to be resected is gastrointestinal mesentery.

44. The method of claim 37, wherein the structure to be resected is anatomical structure.

45. Device for moving anatomical tissue, the device comprising:

a proximal portion defining an interior adapted to receive involuted anatomical tissue;

a distal portion operably coupled with the proximal portion, the distal portion being supported for movement with respect to the proximal portion, the distal portion defining an interior adapted to receive involuted anatomical tissue; and

movement structure adapted to move anatomical tissue into the interior of the proximal portion and into the interior of the distal portion, the movement structure also being adapted to cause involution of the anatomical tissue in the interior of the proximal portion and in the interior of the distal portion.

46. The device of claim 45, wherein the movement structure comprises vacuum apertures defined in the proximal portion and in the distal portion, the vacuum apertures being directed to the interior of the proximal portion and to the interior of the distal portion, respectively, the vacuum apertures being fluidly coupled with at least one vacuum source.

47. The device of claim 46, wherein the vacuum apertures are directed to both the interior and the exterior of the proximal portion and the distal portion.

48. The device of claim 45, further comprising a fastening device, supported by one of the proximal portion and the distal portion, for fastening anatomical tissue.

49. The device of claim 48, further comprising a cutting device, supported by one of the proximal portion and the distal portion, for cutting the involuted anatomical tissue.

50. The device of claim 45, wherein the movement structure comprises at least one vacuum source and defines vacuum apertures fluidly coupled with the vacuum source, the vacuum apertures being defined in at least one of the proximal portion and distal portion;

further wherein the movement structure defines a longitudinal opening in said at least one portion through which anatomical tissue moves into the interior of said at least one portion;

further wherein a total cross-sectional area defined by the vacuum apertures of said at least one portion exceeds a total cross-sectional area of the longitudinal opening defined by said at least one portion such that total vacuum force per unit area applied to the tissue by said at least one portion is sufficient to hold anatomical tissue against the outer circumference of said at least one portion without allowing that anatomical tissue to be pulled into said at least one portion as tissue involution occurs.

51. The device of claim 45, wherein the movement structure comprises at least one vacuum source fluidly coupled with the proximal portion and the distal portion for applying vacuum force;

further wherein the amount of vacuum force applied to the proximal portion and to the distal portion can be controlled individually.

52. The device of claim 51, wherein the movement structure comprises a control knob operably coupled with the vacuum source to individually control the amount of vacuum force applied to the proximal portion and to the distal portion.

53. The device of claim 45, wherein the volume of the interior of the distal portion into which anatomical tissue can be moved is different than the volume of the interior of the proximal portion into which anatomical tissue can be moved.

54. The device of claim 45, wherein the proximal portion and the distal portion are adapted to be disconnected;

further wherein the proximal portion comprises structure for receiving the distal portion such that connection of the distal portion to the proximal portion initiates or allows involution of the anatomical tissue into the distal portion.

55. A method of identifying or marking a lesion in an anatomical structure to be resected, the method comprising:

(a) inserting a light source into the anatomical structure;

(b) shining light from the light source through the anatomical structure;

(c) viewing light from the light source from outside the anatomical structure; and

(d) identifying or marking the lesion based on steps (a)-(c).

56. The method of claim 55, further comprising inserting a resection device to a position determined by step (d).

57. The method of claim 56, wherein the light source is attached to the resection device and is inserted with the resection device.

58. Apparatus for insertion into anatomical tissue, the apparatus comprising:

a proximal portion;

a distal portion adapted for movement relative to the proximal portion;

at least one vacuum source fluidly coupled with the proximal portion and the distal portion, the at least one vacuum source being adapted to apply vacuum force to the proximal portion and the distal portion to draw anatomical tissue toward the proximal portion and distal portion, respectively; and

a controller operably coupled with the at least one vacuum source to adjust the balance of vacuum force applied by the at least one vacuum source between the proximal portion and the distal portion, to favor anatomical tissue movement toward either the proximal portion or distal portion.

59. The apparatus of claim 58, wherein both the proximal portion and the distal portion are adapted to receive involuted anatomical tissue therewithin in response to the application of vacuum force.

60. A method of holding anatomical structure, comprising:

inserting a first holding device into anatomical structure to be held;

involuting the anatomical structure within the first holding device by applying vacuum to the anatomical structure through the first holding device such that the first holding device holds the anatomical structure;

connecting a disconnected second holding device to the first holding device, the second holding device being adapted to hold the anatomical structure;

applying vacuum to the second holding device via the first holding device;

involuting the anatomical structure within the second holding device; and

moving the first holding device and the second holding device toward each other to join the anatomical structure held by the first holding device with the anatomical structure held by the second holding device.

61. The method of claim 60, further comprising tying the anatomical structure to the second holding device before the moving.