Tissue reconfiguration

• US 20040193194A1
• Filed: 04/08/2004
• Published: 09/30/2004
• Est. Priority Date: 06/22/1999
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: NDO Surgical, Inc.
• Inventors: Andrews, Richard, Marshall, Neal H., Chinnock, Randal B., Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos, Barenboym, Michael, Chuttani, Ram, Piucci, Vincent A. Jr., OʼKeefe, Jonathan
• Granted Patent: US 7,857,823 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 coil, 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.

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 cartridge assembly, comprising:

first and second members configure for releasable attachment to a medial instrument, and

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

15. A medical instrument, comprising:

a shaft,

a tissue manipulator located at a distal portion of the shaft, and

a cover over at least a portion of the tissue manipulator during delivery of the tissue manipulator to a treatment site, thereby facilitating atraumatic delivery of the tissue manipulator to the treatment site.

16. The medical instrument of claim 15 wherein the cover is configured to move with the tissue manipulator.

17. The medical instrument of claim 15 wherein the tissue manipulator includes first and second members, and the cover includes a first portion over the first member and a second portion over the second member, the first portion configured to move with the first member, and the second portion configured to move with the second member.

18. The medical instrument of claim 15 wherein the cover comprises a dissolvable material.

19. A medical instrument, comprising:

a shaft,

a tissue manipulator coupled to the shaft for movement between a first position and a second position,

an actuating member coupled to the tissue manipulator for transmitting a force applied to the actuating member to the tissue manipulator to move the tissue manipulator between the first and second positions, wherein a force applied to the tissue manipulator by the actuating member is greater than the force applied to the actuating member.

20. The medical instrument of claim 19 further comprising at least two pulleys about which the force transmitter is routed.

21. The medical instrument of claim 20 comprising three pulleys about which the force transmitter is routed.

22. A medical instrument, comprising:

a flexible shaft,

a tissue manipulator coupled to a distal portion of the shaft for movement relative to the shaft between a first position and a second position, the tissue manipulator defining an angled slot,

an actuating member coupled to the tissue manipulator by the slot such that movement of the actuating member relative to the slot moves the tissue manipulator between the first and second positions.

23. The medical instrument of claim 22 wherein the slot is curved.

24. The medical instrument of claim 22 further comprising an implant coupled to the tissue manipulator, the implant being deployed upon movement of the tissue manipulator to the second position.

25. The medical instrument of claim 22 wherein the tissue manipulator includes first and second members movable between a spaced, open position and a closed position, each of the first and second members including an angled slot coupled to the actuating member.

26. A medical device comprising:

a first member including an implant removably coupled thereto,

a second member including a surface for engaging the implant,

at least one of the first and second members being movable to engage the implant with the surface, engagement of the implant with the surface causing release of the implant from the first member.

27. The medical device of claim 26 wherein the surface comprises a curved surface.

28. The medical device of claim 26 further comprising a spring member defining the surface.

29. The medical device of claim 26 wherein the first member includes a post removably receiving the implant, the post being oriented to contact the implant with the surface.

30. The medical device of claim 29 wherein the post comprises a tube.

31. A medical instrument, comprising:

a handle including actuating controls,

a flexible shaft defining a lumen housing actuating members, the shaft being coupled to the handle with the actuating controls coupled to the actuating members,

a tissue piercing coil extending through the lumen,

a distal actuating assembly coupled to the flexible shaft and the actuating members, and

first and second members releasably attached to the distal actuating assembly, at least one of the first and second members including an implant, wherein moving the actuating controls acts to position the distal actuating assembly and deploy the implant.

32. A medical instrument comprising:

a tissue piercing coil;

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

a stop configured to limit the relative movement between the member and the coil.

33. The medical instrument of claim 32 wherein the member comprises a tube surrounding the coil.

34. A medical instrument, comprising:

a control mount configured for coupling to an endoscope in a fixed position during use,

a sleeve including an end effector, the sleeve defining a lumen for receiving the endoscope during use, and

a flexible conduit coupling the sleeve to the control mount.

35. The medical instrument of claim 34 wherein the end effector comprises a tissue plicator.

36. A medical instrument, comprising:

an endoscope including a handle and an endoscope control knob for manipulating the endoscope,

an end effector coupled to a distal end of the endoscope, the end effector including an implant,

a control knob coupled to the endoscope at a proximal region of the endoscope, and

actuating members connecting the rotary control knob and the end effector, such that rotation of the rotary control knob actuates the end effector.

37. The medical instrument of claim 36 wherein the end effector is configured to plicate tissue.

38. The medical instrument of claim 36 wherein the control knob is a rotary control knob.

39. A medical instrument, comprising:

a flexible coil shaft,

a tissue piercing coil coupled to a distal end of the shaft, the tissue piercing coil being wound differently than at least a portion of the shaft.

40. The medical instrument of claim 39 further comprising a member positioned over the shaft.

41. The medical instrument of claim 40 wherein the member and the shaft are configured for relative movement.

42. The medical instrument of claim 40 wherein the member is configured to stabilize tissue.

43. A medical instrument, comprising:

an elongate, flexible coil shaft,

a tissue piercing coil coupled to a distal end of the shaft, and

a member positioned over the shaft, wherein the member and the shaft are configured for relative movement.

44. The medical instrument of claim 43 wherein the tissue piercing coil is formed from the shaft.

45. The medical instrument of claim 43 wherein the member is configured to stabilize tissue.