Methods and apparatus for revision of obesity procedures

• US 20070175488A1
• Filed: 01/27/2006
• Published: 08/02/2007
• Est. Priority Date: 01/27/2006
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Chen, Eugene, Lam, Cang, Cox, John, Ewers, Richard, Maahs, Tracy, Swanstrom, Lee
• Granted Patent: US 8,726,909 B2
• Time in Patent Office: Days
• US Class Current: 128/898
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• 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 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/1103 Approximator
• CPC Class Codes: A61B 2017/1125 Forceps, specially adapted for performing or assisting anastomosis
• CPC Class Codes: A61B 2017/1142 Purse-string sutures
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61F 5/0083 Reducing the size of the stomach, e.g. gastroplasty surgical interventions A61B17/00
• CPC Class Codes: A61F 5/0086 using clamps, folding means or the like

Abstract

Methods and apparatus for the endoluminal revision of previously performed obesity procedures which have failed are described. One or more endoluminal instruments may be advanced per-orally into the previously formed failed pouch where a number of different procedures can be performed. One or more tissue folds can be formed and secured to reduce the size of the pouch, or the stoma connecting the pouch to the intestinal tract can be reduced in size using endoluminally deployed tissue anchors. These procedures can be performed entirely from within the pouch lumen or upon the exterior surface of the pouch via transgastric entry of the instruments into the peritoneal cavity of a patient. Alternatively, the interior tissue within the pouch can be injured or sclerosed to shrink the pouch lumen. In another alterative, a length of the Roux limb can be shortened endoluminally to create a malabsorptive region.

Claims

1. A method for correcting a failed surgically-created pouch within a patient body, comprising:

advancing a tissue manipulation assembly endoluminally into the failed surgically-created pouch;

forming at least one tissue fold within the pouch via the tissue manipulation assembly; and

securing the at least one tissue fold formed by the tissue manipulation assembly via at least one tissue anchor such that a volume of the pouch is reduced.

2. The method of claim 1 wherein advancing a tissue manipulation assembly endoluminally comprises advancing the assembly per-orally and trans-esophageally into the pouch.

3. The method of claim 1 wherein advancing a tissue manipulation assembly endoluminally comprises advancing a rigidizable elongate body endoluminally into the pouch and advancing the tissue manipulation assembly through at least one lumen defined through the elongate body.

4. The method of claim 3 further comprising rigidizing the elongate body to maintain a configuration after advancing the rigidizable elongate body endoluminally into the pouch.

5. The method of claim 1 wherein advancing a tissue manipulation assembly endoluminally comprises directing the assembly to a region of tissue within the pouch.

6. The method of claim 1 wherein forming at least one tissue fold comprises engaging a tissue region within the pouch via articulatable jaw members of the tissue manipulation assembly.

7. The method of claim 1 wherein forming at least one tissue fold comprises collapsing the tissue of the pouch onto the tissue manipulation assembly.

8. The method of claim 7 wherein collapsing the tissue of the pouch comprises evacuating air from within the pouch.

9. The method of claim 7 wherein collapsing the tissue of the pouch comprises insufflating a peritoneal space exterior to the pouch.

10. The method of claim 1 wherein forming at least one tissue fold comprises pushing a region of tissue into the pouch via a laparoscopic instrument pressed against an outer surface of the pouch.

11. The method of claim 1 wherein forming at least one tissue fold comprises pushing a region of tissue into the pouch via a finger pressed against an outer surface of the pouch.

12. The method of claim 1 further comprising forming a plurality of additional tissue folds within the pouch.

13. The method of claim 1 wherein forming at least one tissue fold comprises injuring and/or removing a portion of the tissue fold to promote healing of the tissue fold.

14. The method of claim 1 further comprising removing a portion of the tissue fold such that the volume of the pouch is further reduced.

15. The method of claim 1 further comprising deploying at least one additional tissue anchor into a region of tissue around an opening between the pouch and a length of anastomosed intestinal tissue via the tissue manipulation assembly.

16. The method of claim 15 further comprising approximating the at least one additional tissue anchor such that the opening between the pouch and the intestinal tissue is reduced in size.

17. The method of claim 1 further comprising deploying at least one additional tissue anchor into a region of tissue within the pouch and purse-stringing the tissue anchor and the at least one additional tissue anchor together.

18. A method for correcting a failed surgically-created pouch within a patient body, comprising:

advancing a tissue manipulation assembly endoluminally into the failed surgically-created pouch;

deploying at least one tissue anchor into a region of tissue around an opening between the pouch and a length of anastomosed intestinal tissue via the tissue manipulation assembly; and

approximating the at least one tissue anchor such that the opening between the pouch and the intestinal tissue is reduced in size.

19. The method of claim 18 wherein advancing a tissue manipulation assembly endoluminally comprises advancing the assembly per-orally and trans-esophageally into the pouch.

20. The method of claim 18 wherein advancing a tissue manipulation assembly endoluminally comprises advancing a rigidizable elongate body endoluminally into the pouch and advancing the tissue manipulation assembly through at least one lumen defined through the elongate body.

21. The method of claim 20 further comprising rigidizing the elongate body to maintain a configuration after advancing the rigidizable elongate body endoluminally into the pouch.

22. The method of claim 18 wherein deploying at least one tissue anchor comprises passing the at least one tissue anchor between the pouch and the intestinal tissue around the opening via a needle assembly delivered by the tissue manipulation assembly.

23. The method of claim 18 further comprising deploying a plurality of additional tissue anchors into the region of tissue around the opening.

24. The method of claim 18 wherein the at least one tissue anchor is deployed into at least a portion of pouch tissue and at least a portion of intestinal tissue.

25. The method of claim 18 wherein the at least one tissue anchor is deployed into a portion of pouch tissue surrounding the opening.

26. The method of claim 25 wherein the at least one tissue anchor is deployed in a radial configuration with respect to the opening.

27. The method of claim 25 wherein the at least one tissue anchor is deployed in a circumferential or annular pattern with respect to the opening.

28. The method of claim 18 further comprising forming at least one tissue fold within the pouch via the tissue manipulation assembly.

29. The method of claim 28 further comprising forming a plurality of additional tissue folds within the pouch.

30. The method of claim 18 wherein approximating the at least one tissue anchor comprises drawing tissue anchors towards one another such that the opening between the pouch and the intestinal tissue is reduced in size.

31. The method of claim 18 further comprising forming at least one tissue fold within the pouch via the tissue manipulation assembly.

32. The method of claim 31 further comprising securing the at least one tissue fold formed by the tissue manipulation assembly via at least one additional tissue anchor such that a volume of the pouch is reduced.

33. The method of claim 31 further comprising purse-stringing the tissue anchor and the at least one additional tissue anchor together.

34. A method for correcting a failed surgically-created pouch within a patient body, comprising:

advancing an elongate body endoluminally through the pouch and into a length of intestinal tissue connected to the pouch via a pouch anastomosis;

retroflexing a distal portion of the elongate body relative to a proximal length of the elongate body such that a distal portion of the intestinal tissue is brought into proximity of the pouch;

forming an opening endoluminally between the distal portion of intestinal tissue and the pouch; and

securing the distal portion of intestinal tissue to the pouch.

35. The method of claim 34 wherein advancing an elongate body endoluminally comprises rigidizing at least a portion of the elongate body to maintain a configuration of the elongate body within the pouch.

36. The method of claim 34 wherein forming an opening endoluminally comprises advancing a tissue piercing and/or ablating instrument through the elongate body and creating the opening between the distal portion of intestinal tissue and the pouch.

37. The method of claim 34 further comprising advancing a tissue manipulation assembly through at least one lumen defined through the elongate body.

38. The method of claim 37 wherein securing the distal portion comprises deploying at least one tissue anchor from the tissue manipulation assembly into the distal portion of intestinal tissue and the pouch.

39. The method of claim 34 wherein forming an opening further comprises dilating the opening.

40. The method of claim 34 further comprising closing the pouch anastomosis between the pouch and the length of intestinal tissue.

41. The method of claim 34 further comprising withdrawing the elongate body from the pouch and the length of intestinal tissue.

42. The method of claim 34 further comprising cutting a first portion of the intestinal tissue from the pouch anastomosis.

43. The method of claim 42 further comprising cutting a second portion of the intestinal tissue proximal to the distal portion of intestinal tissue.

44. The method of claim 43 further comprising endoluminally removing an excised portion of the intestinal tissue proximally through the pouch.