Apparatus and methods for mapping out endoluminal gastrointestinal surgery

• US 20050203500A1
• Filed: 09/29/2004
• Published: 09/15/2005
• Est. Priority Date: 03/09/2004
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Saadat, Vahid, Ewers, Richard C., Peh, Ruey-Feng, Rothe, Chris
• Granted Patent: US 7,703,459 B2
• Time in Patent Office: Days
• US Class Current: 606/27
• 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 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• 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 17/32075 Pullback cutting; combined forward and pullback cutting, e.g. with cutters at both sides of the plaque
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00269 endoscopic mucosal resection EMR
• 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 2017/00818 Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/00986 Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0411 Instruments for removing suture anchors for removing suture clamps, clips or locks A61B2017/049
• CPC Class Codes: A61B 2017/0419 H-fasteners
• 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 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/308 with suction cups
• CPC Class Codes: A61B 2017/320044 : Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2018/00029 : open
• CPC Class Codes: A61B 2018/00244 : adapted to separate target tissue from other tissue
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00494 : Stomach, intestines or bowel
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00595 : Cauterization
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1415 : multiple blades
• CPC Class Codes: A61B 2018/144 : Wire
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2090/036 : abutting on tissue or skin
• CPC Class Codes: A61B 2090/3908 : Soft tissue, e.g. breast tissue
• CPC Class Codes: A61B 2090/3912 : Body cavities
• CPC Class Codes: A61B 2090/3937 : Visible markers
• CPC Class Codes: A61B 2090/395 : with marking agent for marking skin or other tissue
• CPC Class Codes: A61B 2090/3987 : Applicators for implanting markers
• CPC Class Codes: A61B 2090/3991 : having specific anchoring means to fixate the marker to the tissue, e.g. hooks
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 5/0013 : Implantable devices or invasive measures

Abstract

Apparatus and methods are provided for mapping out endoluminal gastrointestinal surgery, including endoluminal gastric reduction. Mapping is achieved by locally marking the interior of the gastrointestinal lumen at specified locations. In some variations, mucosectomy and/or mucosal ablation are performed to map out endoluminal GI surgery, to facilitate direct endoluminal engagement of underlying muscularis tissue and/or to initiate a wound healing response. Specialized apparatus may be provided to achieve desired spacing and/or positioning of tissue markings, as well as to actually form the markings. Methods of using apparatus of the present invention are provided.

Claims

1. A method for directly engaging muscularis tissue from an interior of a patient'"'"'s stomach, the method comprising:

removing mucosal tissue from the interior of the patient'"'"'s stomach to expose underlying muscularis tissue; and

engaging the exposed underlying muscularis tissue.

2. The method of claim 1, wherein removing mucosal tissue further comprises removing the mucosal tissue at desired locations to form physical markings, thereby mapping out endoluminal gastrointestinal surgery.

3. The method of claim 2, wherein mapping out endoluminal gastrointestinal surgery further comprises mapping out endoluminal gastric reduction.

4. The method of claim 1, wherein removing mucosal tissue further comprises mechanically cutting the mucosal tissue.

5. The method of claim 1, wherein removing mucosal tissue further comprises ablating the mucosal tissue.

6. The method of claim 1 further comprising aspirating removed mucosal tissue from the patient'"'"'s stomach.

7. The method of claim 1 further comprising cauterizing mucosal tissue that has not been removed to stanch bleeding.

8. The method of claim 7, wherein cauterizing further comprises electrocauterizing.

9. The method of claim 1, wherein removing mucosal tissue further comprises removing plugs of mucosal tissue.

10. The method of claim 1, wherein removing mucosal tissue further comprises removing mucosal tissue along opposing anterior and posterior segments of the patient'"'"'s stomach.

11. The method of claim 10, wherein engaging exposed underlying muscularis tissue further comprises engaging muscularis tissue along the opposing anterior and posterior segments.

12. The method of claim 11 further comprising forming opposing tissue folds along the opposing engaged segments of muscularis tissue.

13. The method of claim 12 further comprising approximating the opposing tissue folds to partition the patient'"'"'s stomach.

14. The method of claim 13 further comprising initiating a wound healing response along one or more points of contact between the approximated opposing tissue folds.

15. The method of claim 14, wherein initiating a wound healing response comprises removing mucosal tissue along the one or more points of contact.

16. The method of claim 14, wherein initiating a wound healing response comprises ablating mucosal tissue along the one or more points of contact.

17. The method of claim 10, wherein removing mucosal tissue along opposing anterior and posterior segments further comprises determining locations for mucosal tissue removal by specifying distances between the anterior and posterior segments.

18. The method of claim 17, wherein specifying distances further comprises measuring the distances.

19. The method of claim 13 further comprising welding the approximated opposing tissue folds together along one or more points of contact between the approximated folds.

20. The method of claim 19, wherein welding the approximated opposing tissue folds together further comprises placing a tissue solder along the one or more points of contact.

21. The method of claim 20, wherein welding the approximated opposing tissue folds together further comprises heating the tissue solder.

22. The method of claim 12, wherein forming opposing tissue folds along the opposing engaged segments further comprises forming opposing rows of tissue folds along the opposing engage segments.

23. The method of claim 22 further comprising approximating the opposing rows of tissue folds to partition the patient'"'"'s stomach.

24. The method of claim 1, wherein removing mucosal tissue further comprises separating the mucosal tissue from the underlying muscularis tissue prior to removal of the mucosal tissue.

25. The method of claim 24, wherein separating the mucosal tissue from the underlying muscularis tissue further comprises injecting a bolus of fluid into a submucosal space between the mucosal tissue and the muscularis tissue.

26. Apparatus for mapping out endoluminal gastrointestinal surgery, the apparatus comprising:

reconfigurable measuring apparatus adapted for determining distances within the patient'"'"'s gastrointestinal lumen; and

at least one tissue marking element coupled to the reconfigurable measuring apparatus for marking tissue at desired locations to map out the surgery.

27. The apparatus of claim 26, wherein the at least one tissue marking element comprises at least one tissue ablation element.

28. The apparatus of claim 26, wherein the at least one tissue marking element comprises at least one mucosectomy element.

29. A method for mapping out endoluminal gastric reduction, the method comprising:

removing mucosal tissue from an interior of a patient'"'"'s stomach at desired locations to form a surgical map of physical markings; and

performing endoluminal gastric reduction utilizing the surgical map.

30. The method of claim 29, wherein removing mucosal tissue further comprises exposing underlying muscularis tissue.

31. The method of claim 30, wherein performing endoluminal gastric reduction further comprises engaging the exposed underlying muscularis tissue.

32. The method of claim 30, wherein removing mucosal tissue at desired locations further comprises removing mucosal tissue along opposing anterior and posterior segments of the patient'"'"'s stomach.

33. The method of claim 32, wherein performing endoluminal gastric reduction further comprises approximating the opposing anterior and posterior segments to initiate a wound healing response along approximated muscularis tissue.

34. The method of claim 30, wherein removing mucosal tissue further comprises separating the mucosal tissue from the underlying muscularis tissue prior to removal of the mucosal tissue.

35. The method of claim 34, wherein separating the mucosal tissue from the underlying muscularis tissue further comprises injecting a bolus of fluid into a submucosal space between the mucosal tissue and the muscularis tissue.