Apparatus and method for resectioning gastro-esophageal tissue

• US 20060241692A1
• Filed: 06/20/2006
• Published: 10/26/2006
• Est. Priority Date: 01/31/2001
• Status: Active Grant

• Current Assignee: REX Medical LP
• Original Assignee: REX Medical LP
• Inventors: Hinchliffe, Peter W.J., McGuckin, James F. Jr.
• Granted Patent: US 8,424,741 B2
• Time in Patent Office: Days
• US Class Current: 606/219
• CPC Class Codes: A61B 1/2736 Gastroscopes
• 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 17/068 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 17/072 for applying a row of staples in a single action , e.g. the staples being applied simultaneously
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 17/105 Wound clamp magazines for packaging sharps A61B50/3001
• CPC Class Codes: A61B 17/3205 Excision instruments
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/07214 Stapler heads
• CPC Class Codes: A61B 2017/07221 curved
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2923 Toothed members, e.g. rack and pinion

Abstract

A system for stapling tissue comprises a flexible endoscope and an operative head including a pair of opposed, curved tissue clamping jaws sized to pass through an esophagus, the jaws being moveable with respect to one another between an open tissue receiving configuration and a closed tissue clamping configuration, a first one of the curved jaws including a stapling mechanism and a second one of the jaws including a staple forming anvil surface, the stapling mechanism including staple slots through which staples are fired arranged in a row extending from a proximal end of the first jaw to a distal end thereof in combination with a control handle which, when the operative head is in an operative position within one of a patient'"'"'s stomach and esophagus, remains outside the patient, the control handle including a first actuator for moving the jaws relative to one another and a second actuator for operating the stapling mechanism.

Claims

1. A system for stapling tissue, comprising:

a stapling head including first and second jaws movable with respect to one another between a tissue receiving configuration and a tissue stapling configuration, the first jaw including a stapling mechanism and the second jaw including a staple forming surface, the stapling head further including gross and fine movement mechanisms controlling gross and fine movements, respectively, of one of the first and second jaws relative to the other of the first and second jaws; and

a control unit including a first actuator controlling the gross and fine movement mechanisms and a second actuator operating the stapling mechanism.

2. The system according to claim 1, wherein the fine movement mechanism includes a clamp received around the first and second jaws, wherein the first actuator controls proximal and distal movement of the clamp for controlling fine movement of the first and second jaws.

3. The system according to claim 2, wherein the clamp is substantially C-shaped.

4. The system according to claim 1, wherein the gross movement mechanism includes a cable fixed at a first end to the first jaw, threaded around a spindle in the second jaw and fixed at a second end to the first actuator.

5. The system according to claim 1, wherein the stapling mechanism includes stapling slots arranged in a row extending from a proximal end to a distal end of the first jaw, each of the stapling slots including a staple.

6. The system according to claim 5, wherein the first jaw includes a staple pusher driving staples in the stapling slots successively against the staple forming surface of the second jaw as the staple pusher moves from the proximal end toward the distal end of the first jaw.

7. The system according to claim 6, wherein the stapling head further defines a first surface which, when in the tissue stapling configuration, abuts target tissue, and wherein the stapling head includes a tissue cutter cutting on a side of the stapling head opposite the first surface.

8. The system according to claim 7, wherein the tissue cutter is disposed on a proximal end of the staple pusher.

9. The system according to claim 6, wherein the stapling mechanism includes further stapling slots arranged in a further row substantially parallel to the row of the stapling slots.

10. The system according to claim 9, wherein the tissue cutter cuts tissue between the row and the further row.

11. A method for stapling tissue, comprising the steps of:

inserting into a body tissue resectioning device including a stapling head having a first jaw including a stapling mechanism and a second jaw including a staple forming surface;

drawing a fold of tissue between the first and second jaws;

actuating a gross movement mechanism to move the first and second jaws toward a desired tissue stapling configuration compressing the fold between the first and second jaws;

actuating a fine movement mechanism in the stapling head to finely adjust a position of the first and second jaws to the desired tissue stapling configuration; and

actuating the stapling mechanism to drive staples through the fold and against the staple forming surface.

12. The method according to claim 11, wherein the step of actuating the fine movement mechanism includes:

sliding distally a clamp over the first and second jaws.

13. The method according to claim 12, wherein the clamp is substantially C-shaped.

14. The method according to claim 11, wherein the step of actuating the stapling mechanism includes:

driving staples from stapling slots arranged in a row in the first jaw to form a row of staples in the fold.

15. The method according to claim 14, further comprising:

cutting tissue radially within the row of staples.

16. The method according to claim 15, wherein the driving step includes:

moving a staple pusher in the first jaw distally to drive staples in the stapling slots successively through the fold and against the staple forming surface of the second jaw.

17. A system for stapling tissue, comprising:

a stapling head including first and second jaws moveable with respect to one another between a tissue receiving configuration and a tissue stapling configuration, the first jaw including a stapling mechanism and the second jaw including a staple forming surface, the stapling head further including gross and fine movement mechanisms altering a distance between the first and second jaws;

a control unit including a first actuator controlling the gross and fine movement mechanisms and a second actuator operating the stapling mechanism; and

a flexible shaft coupling the control unit to the stapling head.

18. The system according to claim 17, wherein the stapling head is slidably coupleable to an endoscope.

19. The system according to claim 18, wherein the flexible shaft includes a drive cable having a first end coupled to the first actuator and a second end couple to the fine movement mechanism.

20. The system according to claim 19, wherein the stapling head includes a translation arrangement translating rotation of the drive cable into linear movement of a clamp received around the first and second jaws.

21. The system according to claim 20, wherein the clamp is substantially C-shaped.

22. The system according to claim 17, wherein the flexible shaft includes an actuation cable having a first end coupled to the first actuator and a second end coupled to the gross movement mechanism.

23. The system according to claim 22, wherein the actuation cable is fixed at the second end to the first jaw and threaded around a spindle in the second jaw, wherein the first actuator controls a proximal force applied to the cable for controlling gross movement of the first and second jaws.

24. A method for reducing a volume of a stomach, comprising:

inserting and endoscope into the stomach;

sliding a tissue resectioning device along the endoscope into the stomach, the tissue resectioning device including a stapling head having a first jaw including a stapling mechanism and a second jaw including a staple forming surface, the stapling head further including a tissue cutting mechanism;

drawing a fold of tissue between the first and second jaws;

actuating a gross movement mechanism in the stapling head to move the first and second jaws toward a desired tissue stapling configuration so that the fold is compressed between the first and second jaws to the desired tissue stapling configuration;

actuating a fine movement mechanism in the stapling head to finely adjust a position of the first and second jaws;

actuating the stapling mechanism to drive staples through the fold and against the staple forming surface; and

actuating the tissue cutting mechanism to resect a portion of the fold.