SYSTEMS AND TECHNIQUES FOR MINIMALLY INVASIVE GASTROINTESTINAL PROCEDURES

• US 20070129735A1
• Filed: 07/13/2006
• Published: 06/07/2007
• Est. Priority Date: 07/13/2005
• Status: Active Grant

• Current Assignee: Creighton University
• Original Assignee: Creighton University
• Inventors: Klopfenstein, Scott, Filipi, Charles, Addink, Jason
• Granted Patent: US 8,641,729 B2
• Time in Patent Office: Days
• US Class Current: 606/144
• 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 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• 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 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• CPC Class Codes: A61B 17/12099 characterised by the location of the occluder
• CPC Class Codes: A61B 17/12131 characterised by the type of occluding device
• CPC Class Codes: A61B 17/12136 Balloons
• 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 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/06076 helically or spirally coiled for sutures A61B2017/06171
• CPC Class Codes: A61B 2017/22054 with two balloons
• CPC Class Codes: A61B 2017/22067 Blocking; Occlusion A61B2017/22054 takes precedence
• CPC Class Codes: A61B 2017/22068 Centering
• CPC Class Codes: A61B 2017/22069 Immobilising; Stabilising
• CPC Class Codes: A61B 2017/22071 Steering
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2018/144 : Wire

Abstract

A surgical system for performing gastroplasty is disclosed. The system includes an elongated body adapted to be inserted into the esophagus with a proximal end extending from a body orifice. A working member includes a pair of elongated suction cavities that capture and excise portions of the anterior and posterior stomach walls and apply sutures to the captured tissue, which, when drawn tight, serve to create a modified lumen in the stomach.

Claims

1. A method for joining stomach walls to reduce the interior volume of the stomach comprising:

(a) providing a surgical system inside a stomach via the esophagus, the system including an elongated body having a proximal end extending from a body orifice, an anchoring device in or distal to the pyloric sphincter, and at least one working member operably associated with the elongated body, said at least one working member defining first and second suction cavities;

(b) capturing an anterior portion of the stomach wall with said first suction cavity;

(c) applying a first suture to the acquired anterior portion of the stomach wall;

(d) capturing a posterior portion of the stomach wall with said second suction cavity;

(e) applying a second suture to the acquired posterior portion of the stomach wall; and

(f) drawing the first and second sutures together to join the anterior and posterior wall portions;

wherein during at least a portion of at least one of (b) and (d) said elongated body is aligned along the lesser curvature of the stomach.

2. The method of claim 1 wherein said elongated body is aligned along the lesser curvature of the stomach during at least a portion of (b), (c), (d) and (e).

3. The method of claim 1 wherein said at least one working member is slideably disposed within said elongated body during (b), (c), (d) and (e), and said working member acquires the stomach wall portions through at least one opening along the length of said elongated body.

4. The method of claim 1 wherein the anchoring device is a balloon and a distal end of the elongated body receives a catheter extending from said balloon.

5. The method of claim 4 further comprising applying tension to said catheter to bias the elongated body against the lesser curvature.

6. The method of claim 4 wherein the elongated body occludes the proximal portion of the stomach and the balloon occludes the distal portion of the stomach, the method further comprising adjusting the gas pressure in the stomach to expand or contract the stomach.

7. The method of claim 4 wherein a plurality of first sutures are drawn to a corresponding plurality of second sutures to join the anterior and posterior walls thereby creating a modified lumen in the stomach, the method further comprising using said balloon to plug the distal portion of the modified lumen during visual inspection of the surgical site.

8. The method of claim 1 wherein, prior to drawing said first and second sutures together, at least a portion of the anterior portion of the stomach wall and at least a portion of the posterior portion of the stomach wall are excised.

9. The method of claim 8 wherein the excision is of at least the mucosal layer.

10. The method of claim 8 wherein the excision is performed with a cutting device in the first and second cavities.

11. The method of claim 10 wherein an infusate is injected prior to the excision.

12. The method of claim 10 wherein said cutting device operates in a plane dividing said suction cavities into upper and lower portions, the method further comprising applying a different amount of suction to the upper than to the lower portion of at least one of the cavities.

13. A method for joining stomach walls to reduce the interior volume of the stomach comprising:

(a) providing a surgical system inside a stomach via the esophagus, the system including an elongated body having a proximal end extending from a body orifice, at least one working member operably associated with a working portion of the elongated body, and an anchoring device distal to the working portion for orienting the elongated body along the lesser curvature, the at least one working member defining at least one suction cavity and excision device for excising at least the mucosal layer of tissue captured in the cavity;

(b) capturing and excising an anterior portion of the stomach wall with said at least one suction cavity and excision device;

(c) capturing and excising a posterior portion of the stomach wall with said at least one suction cavity and excision device; and

(d) joining the excised anterior and posterior wall portions.

14. The method of claim 13 wherein an infusate is injected prior to the excising.

15. The method of claim 13 wherein said excision device operates in a plane dividing said suction cavity into an upper and lower portion, the method further comprising controllably applying suction to the upper portion and to the lower portions of the cavity.

16. The method of claim 13 wherein during at least a portion of at least one of (b) and (c) said elongated body is aligned along the lesser curvature of the stomach.

17. The method of claim 13 wherein the excised anterior and posterior wall portions are joined with a plurality of sutures applied to the captured and excised anterior and posterior wall portions to create a modified lumen in the stomach.

18. The method of claim 17 wherein tissue is captured in two elongated suction cavities and a plurality of sutures are applied via a needle carrying a suture thread along a generally helical path, the generally helical path having an axis inside said elongated body.

19. The method of claim 18 wherein at least a portion of the generally helical path is defined by grooves in an interior surface of said elongated body.

20. The method of claim 13 wherein (d) further comprises:

(e) applying suture to the captured anterior and posterior wall portions;

(f) releasing the captured wall portions; and

then

(g) drawing the tissue sections together by tightening the applied suture.

21. The method of claim 20 wherein the at least one working member includes a suturing device slideably disposed within said elongated body and comprising a needle having a generally helical shape.

22. The method of claim 21 further comprising sliding the suturing device proximally after (d) and before (f).

23. The method of claim 21 wherein said needle is driven by one or more rollers having a plurality of larger diameter needle contacting sections separated by smaller diameter connecting sections.

24. The method of claim 13 further comprising expanding a spacing member along the length of said elongated body to increase the effective cross sectional area of said elongated body.

25. The method of claim 24 wherein the spacing member is inflatable and is positioned against the lesser curvature of the stomach.

26. The method of claim 13 wherein at least one clamping member is provided along their length of said cavity, the method further comprising holding the captured tissue with the clamping member during or after the excision.

27. A method for joining stomach walls to reduce the interior volume of the stomach comprising:

(a) providing a surgical system inside the stomach via the esophagus, the system including an elongated body having a proximal end extending from a body orifice and at least one working member operably associated with a working portion of the elongated body, the at least one working member comprising first and second elongated suction channels and a helical needle suturing device;

(b) capturing an anterior portion of the stomach wall in said first suction channel;

(c) capturing a posterior portion of the stomach wall with said second suction channel; and

(d) helically suturing the captured anterior portion to the captured posterior portion with the suturing device.

28. The method of claim 27 wherein the system further comprises an anchoring device distal to said working portion for orienting the elongated body along the lesser curvature of the stomach during (b) and (c).

29. The method of claim 27 wherein the suturing is along a generally helical path having an axis inside said working portion of said elongated body.

30. The method of claim 29 wherein the suturing is in a distal to proximal direction.

31. The method of claim 27 wherein said suturing device is slideably disposed within the working portion of said elongated body, the method further comprising:

(e) releasing the captured wall portions;

(f) sliding the suturing device proximally; and

then

(f) tightening the sutures.

32. The method of claim 31 wherein at least the mucosal layer of the captured tissue sections is excised prior to (e).

33. A surgical system comprising:

an elongated body adapted to be inserted into an esophagus with a proximal end extending from a body orifice, said elongated body including a tapered distal portion and a working portion having an outer surface defining at least one side opening therein;

at least one working member disposed within the working portion of said elongated body, said at least one working member comprising at least two tissue acquisition and excision assemblies, said assemblies each comprising a suction cavity open to the at least one side opening and an excision device for excising at least the mucosal layer of tissue captured in the cavity.

34. The system of claim 33 wherein said excision device comprises a blade or a wire.

35. The system of claim 34 wherein said excision device is operable along a path which divides the suction cavity into upper and lower portions and wherein suction may be selectively applied to the upper and to lower portions of the cavity.

36. The system of claim 33 further comprising one or more injection needles in each suction cavity for delivering an infusate to captured tissue prior to excision.

37. The system of claim 33 further comprising a suturing mechanism disposed within the elongated body for attaching sutures to tissue captured in the cavities.

38. The system of claim 37 wherein said suturing mechanism comprises at least one of a curved needle, a straight needle, and a generally helical needle.

39. The system of claim 38 wherein said suturing mechanism includes a needle that is hollow.

40. The system of claim 37 wherein said suturing mechanism includes a needle driven along a generally helical path about an axis inside said working portion of said elongated body.

41. The system of claim 40 wherein said suturing mechanism includes at least one roller for driving said needle along the generally helical path.

42. The system of claim 41 wherein said at least one roller comprises a plurality of larger diameter needle contacting sections separated by smaller diameter connecting sections.

43. The system of claim 40 wherein the helical path is at least partially defined by grooves in said elongated body.

44. The system of claim 37 wherein along the entire length of said at least one side opening, said elongated body has an outer diameter between 15 and 25 mm.

45. The system of claim 43 wherein said at least one side opening extends at least about 10 cm along the length of said elongated body.

46. The system of claim 37 wherein said tissue acquisition and excision assembly is slideably and rotatably disposed within said elongated body so as to be longitudinally and radially positionable relative to the at least one side opening.

47. The system of claim 37 wherein said elongated member includes one or more lumens having openings thereto distal to said at least one side opening.

48. The system of claim 47 wherein said lumens include a larger endoscope lumen and a smaller guiding lumen.

49. The system of claim 48 further comprising a balloon catheter having a self closing valve at its distal end for use in said guiding lumen.

50. The surgical system of claim 37 used to treat GERD by:

capturing and excising tissue with the tissue acquisition and excision assemblies; and

forming plications by applying sutures to the captured tissue with the suturing device.