Devices and methods for placement of partitions within a hollow body organ

• US 20070167960A1
• Filed: 12/29/2006
• Published: 07/19/2007
• Est. Priority Date: 03/09/2004
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Pamichev, Chris, Julian, Christopher, Gerbi, Craig, Gannoe, James, Weller, Gary, Gaiser, John, Hancock, Andrew, Roth, Alex, Lee, Crystine
• Granted Patent: US 8,449,560 B2
• Time in Patent Office: Days
• US Class Current: 606/153
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3474 Insufflating needles, e.g. Veress needles
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/07214 Stapler heads
• CPC Class Codes: A61B 2017/07242 achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
• CPC Class Codes: A61B 2017/0725 with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 90/92 coded with colour
• CPC Class Codes: A61F 5/0083 Reducing the size of the stomach, e.g. gastroplasty surgical interventions A61B17/00

Abstract

Devices and methods for tissue acquisition and fixation, or gastroplasty, are described. Generally, the devices of the system may be advanced in a minimally invasive manner within a patient'"'"'s body to create one or more plications within the hollow body organ. A tissue treatment device attached to a distal end of a flexible elongated member and has a cartridge member opposite an anvil member. The cartridge member and the anvil member are movable between a closed position and an open position, and a moveable barrier is disposed between the cartridge and anvil members to help acquire a dual fold of tissue. The tissue treatment device can be repositioned to form multiple plications within the organ.

Claims

1. A gastroplasty device used to place plications within at least one cavity, comprising:

a flexible elongated member having a proximal end and a distal end, and a lumen disposed between the proximal end and the distal end;

a handle attached to the proximal end;

a tissue treatment device attached to the distal end of the flexible elongated member and having a first jaw opposite a second jaw being movably operable between a closed position and an open position, and the first jaw and the second jaw each having a releasably adhering region for acquiring tissue of the at least one cavity;

a septum slidably attached to a rail disposed between the first jaw and the second jaw, and the septum being moveable from a first position to a second position, wherein the septum in the first position separates tissue acquired by the releasably adhering regions of the first and second jaws, and in the second position the septum is distal to the first position.

2. The device of claim 1, further comprising a retractor wire disposed along the tissue treatment device and movable from a delivery configuration to a retraction configuration to manage tissue of the cavity.

3. The device of claim 2, wherein the septum includes a sail attached to the rail, the sail being extendable from a collapsed configuration to an extended configuration.

4. The device of claim 3, wherein the sail is attached to the retractor wire and the retractor wire extends the sail when the retractor wire moves from the delivery configuration to the retraction configuration.

5. The device of claim 4, wherein the retractor wire moves from the retraction configuration to the delivery configuration, the retractor wire collapses the sail.

6. The device of claim 3, wherein the sail is flexible.

7. The device of claim 1, further comprising an atraumatic tip attached to a distal end of the tissue treatment device.

8. The device of claim 7, wherein the atraumatic tip includes a cylindrical body with a proximal end and a distal end, and the proximal end of the atraumatic tip having a slit disposed therein, wherein the proximal end of the atraumatic tip being moveable between an open position and a closed position in response to the movement of the first and second jaws.

9. The device of claim 1, further comprising an atraumatic tail attached to a proximal end of the tissue treatment device.

10. The device of claim 1, wherein the flexible elongated member includes individual circular links attached to one another.

11. The device of claim 10, wherein the circular links form a scope lumen that provides a passageway for an endoscope.

12. The device of claim 10, wherein the circular links include flexible members.

13. The device of claim 1, wherein the septum is movable to any position between the first position and the second position.

14. The device of claim 1, wherein the second position of the septum is distal to the first and second jaws of the tissue treatment device.

15. The device of claim 1, further comprising a detection mechanism attached to the first jaw of the tissue treatment device, wherein the detection mechanism detects when the first and second jaw of the tissue treatment device are in the closed position.

16. The device of claim 1, further comprising a closing mechanism to close the first and second jaws of the tissue treatment device in a parallel relationship to one another.

17. The device of claim 16, wherein the closing mechanism includes a proximal clamping cable disposed at a proximal end of the tissue treatment device and a distal clamping cable disposed at a distal end of the tissue treatment device.

18. The device of claim 16, wherein the closing mechanism includes a proximal clamping cable disposed at a proximal end of the tissue treatment device and the second jaw being bent to offset deflection of the distal end of the tissue treatment device when moving to the closed position after acquiring tissue between the first and second jaws.

19. The device of claim 16, wherein the closing mechanism includes a clamping cable disposed at one end of the tissue treatment device and the second jaw having a taper to offset deflection of the opposite end of the tissue treatment device when moving to the closed position after acquiring tissue between the first and second jaws.

20. The device of claim 1, where in the second jaw is offset from the first jaw to compensate for the tissue acquired between the first and second jaws.

21. A method for reducing the volume of a stomach cavity, comprising:

inserting a tissue treatment device having a proximal end and a distal end transorally to the stomach cavity, the tissue treatment device having a first jaw opposite a second jaw and the first jaw being loaded with at least one fastener;

positioning the proximal end of the tissue treatment device within the stomach at the region of gastroesophageal junction and the distal end of the tissue treatment device within the stomach cavity;

acquiring tissue from the gastroesophageal junction and the stomach with the tissue treatment device; and

forming a plication extending from the gastroesophageal junction downward into the body of the stomach using the at least one fastener loaded within the first jaw.

22. The method of claim 21, further comprising deploying a retractor disposed along the tissue treatment device and movable from a delivery configuration to a retraction configuration to manage stomach tissue relative to the tissue treatment device, allowing the acquired tissue from the gastroesophageal junction and the stomach to be treated with the tissue treatment device.

23. The method of claim 22, further comprising extending a barrier disposed between the first jaw and the second jaw of the tissue treatment device and movable from a collapsed configuration to an extended configuration.

24. The method of claim 23, wherein extending the barrier between the first jaw and second jaw before acquiring tissue from the gastroesophageal junction and the stomach with the tissue treatment device.

25. The method of claim 23, wherein the barrier is connected to the retractor.

26. The method of claim 23, further comprising removing the barrier from between the first jaw and the second jaw before forming the plication extending from the gastroesophageal junction downward into the body of the stomach.

27. The method of claim 26, wherein removing the barrier includes sliding the barrier past the distal end of the tissue treatment device.

28. The method of claim 27, wherein sliding the barrier includes moving a wire attached to the barrier distally.

29. The method of claim 21, further comprising viewing at least a portion of the acquiring tissue from the gastroesophageal junction and the stomach with an endoscope.

30. The method of claim 21, wherein forming the plication extending from the gastroesophageal junction downward towards the pylorus forms a pouch along the lesser curve of the stomach.

31. The method of claim 21, wherein acquiring tissue from the gastroesophageal junction and stomach using a vacuum generated within vacuum pods disposed within the tissue treatment device.

32. A method of providing therapy to the stomach cavity of a patient, comprising:

inserting at least a portion of a tissue treatment device within the stomach cavity; and

forming a pouch extending downward from the gastroesophageal junction into the body of the stomach cavity by placing a first plication at least partially within the stomach cavity with the tissue treatment device, and the pouch having a distal outlet.

33. The method of claim 32, wherein forming the pouch includes acquiring tissue from the lower esophageal sphincter and stomach with the tissue treatment device.

34. The method of claim 32, wherein acquiring tissue from the gastroesophageal junction and stomach using a vacuum generated within vacuum pods disposed within the tissue treatment device.

35. The method of claim 32, further comprising positioning a restrictor device adjacent the distal outlet of the pouch and forming at least one restricting plication near the distal outlet of the pouch with the restrictor device reducing the size of the distal outlet.

36. The method of claim 35, wherein the restrictor device plicates a single fold of tissue.

37. The method of claim 32, wherein placing at least one restricting plication near the distal outlet of the pouch with the tissue treatment device.

38. The method of claim 32, further comprising positioning the tissue treatment device adjacent the distal outlet of the pouch and extending the length of the pouch by forming a second plication generally in-line with first plication.

39. The method of claim 38, wherein extending the length of the pouch the second plication at least partially overlaps the first plication.

40. The method of claim 38, wherein extending the length of the pouch includes aligning a septum disposed on the tissue treatment device with the first plication.

41. The method of claim 40, wherein aligning the septum with the first plication includes extending a retractor wire attached to the septum to extend the septum, and translating the septum along the tissue treatment device to come into contact with a distal end of the first plication.

42. The method of claim 32, wherein forming the pouch with the tissue treatment device, the tissue treatment device plicates a dual fold of tissue.

43. A method of providing therapy to the stomach cavity of a patient, comprising:

inserting at least a portion of a tissue treatment device within the stomach cavity;

forming a first plication with the tissue treatment device, the first plication extending downward from the gastroesophageal junction into the stomach cavity;

repositioning the tissue treatment device near a distal end of the first plication; and

forming a second plication near the first plication with the tissue treatment device, wherein the first and second plications form a pouch along the lesser curve of the stomach with a distal outlet.

44. The method of claim 43, wherein forming the second plication generally in-line with the first plication.

45. The method of claim 43, further comprising acquiring tissue from the lower esophageal sphincter and stomach with the tissue treatment device to form the first plication.

46. The method of claim 43, further comprising positioning a restrictor device adjacent the distal outlet of the pouch and forming at least one restricting application near the distal outlet of the pouch with the restrictor device reducing the size of the distal outlet.

47. The method of claim 46, further comprising repositioning the restrictor device within the pouch and forming multiple restricting plications within the pouch.

48. The method of claim 43, further comprising positioning a restrictor device between the first plication and the second plication and forming a restricting plication to close a stoma between the first plication and the second plication.

49. The method of claim 43, wherein forming a second plication with the tissue treatment device, the second plication is continuous with the first plication.

50. The method of claim 43, wherein forming a second plication with the tissue treatment device, the second plication overlaps the distal end of the first plication.