Apparatus and methods for achieving prolonged maintenance of gastrointestinal tissue folds

• US 20060020276A1
• Filed: 07/23/2004
• Published: 01/26/2006
• Est. Priority Date: 07/23/2004
• Status: Abandoned Application

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Saadat, Vahid, Birkett, Desmond
• Application Number:
  US10/898,683
• Publication Number:
  US 20060020276A1
• Time in Patent Office: Days
• US Class Current: 606/153
• 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 17/08 Wound clamps or clips, i.e. not or only partly penetrating the tissue suture bridges A61B17/0466; Devices for bringing together the edges of a wound
• 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 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• 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 2017/081 Tissue approximator A61B2017/1103, A61B17/8866 take precedence
• CPC Class Codes: A61B 2018/00291 using suction

Abstract

Apparatus and methods are provided for achieving prolonged maintenance of gastrointestinal (“GI”) tissue folds. The apparatus and methods are adapted to form, secure, approximate and promote healing of tissue folds. Such healing may comprise remodeling the tissue folds along region(s) of opposing tissue contact to facilitate prolonged maintenance of the folds. In one variation, the apparatus and methods may be utilized to achieve gastric reduction. The apparatus may be provided as a system of tools.

Claims

1. Apparatus for achieving prolonged maintenance of gastrointestinal tissue folds, the apparatus comprising an injuring device adapted to injure a region of tissue and remove at least a portion of the injured tissue.

2. The apparatus of claim 1, further comprising a tissue plication device for forming at least two tissue folds to be maintained.

3. The apparatus of claim 2, further comprising a tissue approximation device for approximating the at least two tissue folds such that the at least two tissue folds contact one another along a region of injured tissue, thereby promoting healing between the at least two tissue folds.

4. The apparatus of claim 1, further comprising a shape-lockable device through which the injuring device is adapted to be advanced.

5. The apparatus of claim 1, wherein the injuring device comprises an injury or removal modality chosen from the group consisting of ablation, burning, charring, cutting, abrasion, chemical irritation, biological irritation and combinations thereof.

6. The apparatus of claim 2, wherein the injuring device is integrated into the tissue plication device.

7. The apparatus of claim 3, wherein the injuring device is integrated into the tissue approximation device.

8. The apparatus of claim 1 further comprising a securement device for securing the injured region of tissue.

9. The apparatus of claim 1 further comprising at least one securing element for securing the injured region of tissue.

10. The apparatus of claim 9, wherein the at least one securing element is configured to secure the injured region of tissue.

11. The apparatus of claim 9, wherein the at least one securing element is biodegradable.

12. The apparatus of claim 9, wherein the at least one securing element is configured for removal.

13. The apparatus of claim 9, wherein the at least one securing element is configured to temporarily secure the injured region of tissue.

14. The apparatus of claim 9, wherein the at least one securing element is configured to permanently secure the injured region of tissue.

15. The apparatus of claim 4, wherein the shape-lockable device is steerable.

16. A method for achieving prolonged maintenance of gastrointestinal tissue folds, the method comprising:

injuring at least a first region of tissue to be approximated against a second region of tissue;

removing at least a portion of injured tissue from the first region to be approximated; and

contacting the first region of tissue against the second region of tissue to promote healing between the first and second regions of tissue.

17. The method of claim 16, further comprising injuring the second region of tissue prior to or after contacting the first region of tissue against the second region of tissue.

18. The method of claim 17, further comprising removing at least a portion of injured tissue from the second region to be approximated.

19. The method of claim 17, further comprising approximating the first region and second region of tissue such that the injured tissue contacts one another such that healing between the injured tissue is promoted.

20. The method of claim 16, wherein injuring at least a first region of tissue comprises ablating the tissue.

21. The method of claim 16, wherein injuring at least a first region of tissue comprises abrading the tissue.

22. The method of claim 16, wherein injuring at least a first region of tissue comprises cutting the tissue.

23. The method of claim 16, further comprising securing the first region of tissue to the second region of tissue.

24. The method of claim 23, wherein securing the first region of tissue against the second region of tissue further comprises temporarily securing the tissue folds.

25. The method of claim 16, wherein injuring at least a first region of tissue further comprises controlling a depth of tissue injury.

26. A method for achieving prolonged maintenance of gastrointestinal tissue folds, the method comprising:

endoluminally advancing a device to a target tissue region;

shape-locking the device;

forming at least two tissue folds at the target tissue region with instruments advanced along or coupled to the device;

injuring or removing tissue disposed between the at least two tissue folds; and

approximating the at least two tissue folds such that the at least two tissue folds contact one another in a region of injured or removed tissue, thereby promoting healing between the at least two tissue folds.

27. The method of claim 26, wherein injuring or removing tissue comprises ablating the tissue.

28. The method of claim 26, wherein injuring or removing tissue comprises abrading the tissue.

29. The method of claim 26, wherein injuring or removing tissue comprises cutting the tissue.

30. The method of claim 26, further comprising capturing and removing injured tissue.

31. The method of claim 26, further comprising securing the approximated tissue folds together.

32. The method of claim 31, wherein securing the approximated tissue folds together further comprises temporarily securing the approximated tissue folds.

33. The method of claim 26, wherein injuring or removing tissue further comprises controlling a depth of tissue injury or removal.

34. A method for performing gastric reduction, the method comprising:

forming anterior and posterior tissue folds within a patient'"'"'s stomach in a vicinity of the patient'"'"'s gastroesophageal junction;

injuring or removing tissue disposed between the anterior and posterior tissue folds;

approximating the anterior and posterior tissue folds such that the approximated tissue folds contact one another in a region of injured or removed tissue, thereby promoting healing between the at least two tissue folds; and

repeating the method at at least one adjacent location within the patient'"'"'s stomach to reduce the patient'"'"'s stomach.

35. The method of claim 34, wherein the method is performed endoluminally.

36. A system of tools for achieving prolonged maintenance of gastrointestinal tissue folds, the apparatus comprising:

a shape-lockable access tool;

a tool for forming tissue folds;

a tool for injuring or removing tissue disposed between tissue folds; and

a tool for approximating tissue folds.

37. The system of tools of claim 36 further comprising a tool for securing tissue folds.

38. Apparatus for achieving prolonged maintenance of gastrointestinal tissue folds, the apparatus comprising:

a device for forming at least two tissue folds;

a device for injuring or removing tissue disposed between the at least two tissue folds; and

a device for approximating the at least two tissue folds such that the at least two tissue folds contact one another in a region of injured or removed tissue, thereby promoting healing between the at least two tissue folds,

wherein the device for injuring or removing tissue comprises an element for controlling a depth of tissue injury or removal.