Apparatus and methods for endoscopic suturing

• US 20050119671A1
• Filed: 11/10/2004
• Published: 06/02/2005
• Est. Priority Date: 11/13/2003
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Saadat, Vahid, Brenneman, Rodney, Ewers, Richard C., Reydel, Boris, Lam, Cang
• Granted Patent: US 7,736,372 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• 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 17/0469 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 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2090/3614 using optical fibre

Abstract

Apparatus & methods for endoscopic suturing are described herein. A distal tip of the endoscopic device engages the tissue and then approximates the engaged tissue to form a tissue fold. A needle body positioned within a flexible catheter is deployed into or through the newly created tissue fold where it is then detached or released from the endoscopic device. The needle body has a length of suture which depends therefrom and can be used to secure the tissue fold. The entire endoscopic device or its tissue engaging assembly can then be rotated relative to the tissue fold while maintaining engagement with the tissue to maneuver the flexible catheter to the opposing side of the penetrated tissue fold. This procedure can be repeated any number of times to create an interrupted, continuous, or running suture to secure the tissue fold.

Claims

1. A system for endoscopically suturing a region of tissue, comprising:

an elongate tubular member having a proximal end, a distal end, and a length therebetween;

a tissue engagement device having a distal portion extending from the tubular member distal end and adapted to releasably engage tissue thereto, wherein the distal portion is rotatable about its longitudinal axis relative to the tissue engagement device;

a deployment tubular member having a distal end pivotally movable relative to the elongate tubular member; and

a needle grasper slidably positioned within the deployment tubular member.

2. The system of claim 1 further comprising a needle body and a length of suture depending therefrom, wherein the needle body is removably disposed within the deployment tubular member.

3. The system of claim 2 wherein the needle grasper is adapted to releasably hold the needle body.

4. The system of claim 1 further comprising a needle body which defines a channel therein, wherein the needle body is removably disposed within the deployment tubular member.

5. The system of claim 4 further comprising an expandable tissue anchor for placement within the channel.

6. The system of claim 1 wherein the elongate tubular member comprises a flexible catheter.

7. The system of claim 1 wherein the tissue engagement device comprises a grasper articulatable via its proximal end.

8. The system of claim 1 wherein the tissue engagement device is slidably disposed within a lumen defined through the elongate tubular member.

9. The system of claim 1 wherein the distal portion of the tissue engagement device is adapted to be rotated while maintaining engagement with the tissue.

10. The system of claim 1 wherein the deployment tubular member defines a distal portion adapted to bend relative to the elongate tubular member.

11. The system of claim 1 wherein the deployment tubular member distal end is pivotally connected via a link to the tissue engagement device.

12. The system of claim 1 wherein the needle grasper is adapted to slide through the deployment tubular member while holding a needle body therein.

13. The system of claim 1 further comprising an imager adapted to be positioned proximally of the needle grasper.

14. The system of claim 13 wherein the imager comprises a gastroscope.

15. The system of claim 14 wherein the imager comprises an articulatable distal end.

16. A method for endoscopically suturing a region of tissue, comprising:

endoscopically advancing an elongate tubular member to the region of tissue;

engaging the region of tissue with a tissue engagement device extending from a distal end of the elongate tubular member;

approximating the tissue relative to the elongate tubular member via the tissue engagement device;

deploying a needle body and a length of suture depending therefrom at least partially into or through the tissue from a deployment tubular member extending from the elongate tubular member;

rotating the deployment tubular member about a longitudinal axis of the elongate tubular member; and

grasping the deployed needle body with a needle grasper slidably positioned within the deployment tubular member.

17. The method of claim 16 wherein endoscopically advancing an elongate tubular member comprises advancing the tubular member transesophageally into a stomach.

18. The method of claim 16 wherein engaging the region of tissue comprises temporarily engaging the region of tissue.

19. The method of claim 16 wherein engaging the region of tissue comprises grasping the region of tissue via a grasper.

20. The method of claim 16 wherein approximating the tissue comprises pulling the tissue proximally into a fold via the tissue engagement device.

21. The method of claim 16 further comprising configuring a distal portion of the deployment tubular member transverse to the tissue prior to deploying a needle body.

22. The method of claim 16 wherein deploying a needle body comprises urging the needle body into the tissue via the needle grasper.

23. The method of claim 16 wherein rotating the deployment tubular member comprises rotating a distal portion of the tissue engagement device.

24. The method of claim 23 wherein the distal portion of the tissue engagement device is rotated while maintaining engagement with the tissue.

25. The method of claim 16 wherein grasping the deployed needle body comprises drawing the needle body into deployment tubular member via the needle grasper.

26. The method of claim 16 further comprising rotating the deployment tubular member about the longitudinal axis while holding the needle body.

27. The method of claim 26 further comprising deploying the needle body and the length of suture through the tissue such that the tissue is secure.

28. The method of claim 16 further comprising deploying an expandable anchor from the needle body for placement against the tissue.