APPARATUS AND METHOD FOR ENDOSCOPIC COLECTOMY

• US 20080154288A1
• Filed: 02/07/2008
• Published: 06/26/2008
• Est. Priority Date: 01/09/2002
• Status: Active Grant

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Neoguide Systems, Inc. (Intuitive Surgical Holdings, LLC)
• Inventors: Belson, Amir
• Granted Patent: US 8,361,090 B2
• Time in Patent Office: Days
• US Class Current: 606/150
• CPC Class Codes: A61B 1/00147 Holding or positioning arrangements
• CPC Class Codes: A61B 1/0055 Constructional details of insertion parts, e.g. vertebral elements
• CPC Class Codes: A61B 1/0058 using shape-memory elements
• CPC Class Codes: A61B 1/008 Articulations
• CPC Class Codes: A61B 1/05 characterised by the image sensor, e.g. camera, being in the distal end portion
• CPC Class Codes: A61B 1/31 for the rectum, e.g. proctoscopes, sigmoidoscopes , colonoscopes
• 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 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00314 Separate linked members
• CPC Class Codes: A61B 2017/00323 Cables or rods
• 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 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/1103 Approximator
• CPC Class Codes: A61B 2017/1132 End-to-end connections
• CPC Class Codes: A61B 2017/22034 for gripping the obstruction or the tissue part from inside
• CPC Class Codes: A61B 2017/22054 with two balloons
• CPC Class Codes: A61B 2034/2059 : Mechanical position encoders

Abstract

Apparatus and methods for endoscopic colectomy are described herein. A colectomy device having a first and a second tissue approximation device is mounted on a colonoscope separated from one another. During deployment of the colectomy device, a diseased portion of the colon is positioned inbetween the tissue approximation devices. The tissue approximation devices are radially expanded such that they contact and grasp the colon wall at two sites adjacent to the diseased portion of the colon. The diseased portion is separated from the omentum and is transected using a laparoscope or is drawn into the colonoscope for later removal. The tissue approximation devices are then urged towards one another over the colonoscope to approximate the two free edges of the colon into contact together where they are fastened to one another using the tissue approximation device as a surgical stapler to create an end-to-end anastomosis.

Claims

1. An endoscopic device for approximating tissue within a hollow body organ, comprising:

an elongated body having a plurality of articulatable segments and a steerable distal portion, wherein each of the segments are configurable to assume a selected shape along an arbitrary path when the elongated body is advanced distally or proximally;

a first tissue approximation component positioned about the elongated body, wherein the first component is adapted to radially expand and adhere a first region of tissue to a plurality of tissue gripping regions circumferentially located about the first component; and

a second tissue approximation component positioned about the elongated body proximally of the first component, wherein the second component is adapted to radially expand and adhere a second region of tissue to a plurality of tissue gripping regions circumferentially located about the second component,

wherein the first component and the second component are adapted to approximate and securely fasten the first region to the second region of tissue.

2. The endoscopic device of claim 1 wherein the first and the second tissue approximation components each comprise a radially expandable ring.

3. The endoscopic device of claim 1 wherein the first and the second tissue approximation components each comprise a radially expandable balloon.

4. The endoscopic device of claim 1 wherein the plurality of tissue gripping regions on each of the first and the second tissue approximation components comprise vacuum ports.

5. The endoscopic device of claim 1 wherein the plurality of tissue gripping regions on each of the first and the second tissue approximation components comprise retractable fasteners.

6. The endoscopic device of claim 5 wherein the retractable fasteners are selected from the group consisting of needles, hooks, and barbs.

7. The endoscopic device of claim 1 wherein the first tissue approximation component is adapted to slide longitudinally towards the second tissue approximation component along at least a portion of the elongated body within rails or grooves defined along the elongated body such that the first region is adjacent to the second region of tissue.

8. The endoscopic device of claim 1 wherein the second tissue approximation component is adapted to slide longitudinally towards the first tissue approximation component along at least a portion of the elongated body within rails or grooves defined along the elongated body such that the first region is adjacent to the second region of tissue.

9. The endoscopic device of claim 1 wherein the first and the second tissue approximation components are each adapted to slide longitudinally towards one another along at least a portion of the elongated body within rails or grooves defined along the elongated body such that the first region is adjacent to the second region of tissue.

10. The endoscopic device of claim 1 wherein the first or the second tissue approximation component contains a plurality of fasteners adapted to fasten the first region to the second region of tissue.

11. The endoscopic device of claim 10 wherein the fasteners are selected from the group consisting of staples, clips, screws, adhesives, sutures, and combinations thereof.

12. A method of endoscopically approximating tissue within a hollow body organ, comprising:

positioning an elongated body adjacent to a portion of tissue to be excised from the hollow body organ;

releasably fastening a first region of tissue circumferentially about a first tissue approximation component and a second region of tissue circumferentially about a second tissue approximation component such that the tissue to be excised is positioned between the first and the second tissue approximation components;

removing the tissue to be excised from between the first and the second tissue approximation components;

approximating the first and the second tissue approximation components such that the first and the second regions of tissue are adjacent to one another; and

fastening the first region of tissue to the second region of tissue.

13. The method of claim 12 wherein the first and the second regions of tissue are releasably fastened to the first and the second tissue approximation components, respectively, via a vacuum force.

14. The method of claim 12 wherein the first and the second regions of tissue are releasably fastened to the first and the second tissue approximation components, respectively, via a plurality of fasteners.

15. The method of claim 14 wherein the fasteners are retractable.

16. The method of claim 12 wherein releasably fastening comprises radially expanding the first and the second tissue approximation components into contact with the first and the second regions of tissue, respectively.

17. The method of claim 12 wherein removing the tissue to be excised comprises laparoscopically excising the tissue from between the first and the second tissue approximation components.

18. The method of claim 12 wherein approximating the first and the second tissue approximation components comprises longitudinally translating the first and the second tissue approximation components towards one another along the elongated body.

19. The method of claim 12 wherein fastening the first region of tissue to the second region of tissue comprises stapling or suturing the first region to the second region via the first or the second tissue approximation component.

20. The method of claim 12 further comprising radially reducing a diameter of the first and the second tissue approximation components.