ENDOSCOPIC STAPLING DEVICES AND METHODS
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Abstract
Described herein are endoscopic staplers used to apply one or more fasteners to body tissue. In one embodiment, a fastener-applying device, which is preferably a stapler, is passed transorally into the stomach and used to plicate stomach tissue by engaging tissue from inside of the stomach and drawing it inwardly. In the disclosed embodiments, the tissue is drawn inwardly into a vacuum chamber, causing sections of serosal tissue on the exterior of the stomach to be positioned facing one another. The disclosed staplers allow the opposed sections of tissue to be moved into contact with one another, and preferably deliver staples for maintaining contact between the tissue sections at least until serosal bonds form between them. Each of these steps may be performed wholly from the inside of the stomach and thus can eliminate the need for any surgical or laparoscopic intervention. After one or more plications are formed, medical devices may optionally be coupled to the plication(s) for retention within the stomach.
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Citations
218 Claims
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1-198. -198. (canceled)
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119-242. -242. (canceled)
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199. An articulating medical device, comprising:
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an elongate shaft having a flexible distal portion and a proximal portion; a handle on the proximal portion; a knob rotatably mounted on the handle, the knob rotatable relative to the handle, the knob including a threaded bore; a first cable extending from the handle through the elongate shaft and having a distal end coupled to the distal portion of the elongate shaft; a second cable extending from the handle through the elongate shaft and having a distal end coupled to the distal portion of the elongate shaft; wherein the knob is rotatable from a first position to a second position to apply tension to the first cable and to thereby cause deflection of the catheter in a first direction, and wherein the knob is further rotatable from the second position to the first position to apply tension to the second cable and to thereby cause deflection of the catheter in a second direction.
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200. The medical device of claim 199, wherein:
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the handle includes a threaded bore; the medical device includes a carriage disposed within the threaded bore, the carriage having a threaded exterior engaged with the threaded bore; and the first cable includes a proximal end coupled to the carriage; a second cable includes a proximal end coupled to the handle; and wherein the knob is rotatable from a first position to a second position to effect translation of the carriage in a proximal direction to effect translation of the carriage in a distal direction.
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201. The medical device of claim 200, further including:
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a sliding member having a proximal portion coupled to the carriage and a distal portion coupled to the second cable; and wherein the knob is rotatable from a first position to a second position to effect translation of the carriage in a proximal direction, thereby applying tension to the first cable and causing deflection of the shaft in a first direction, and wherein the knob is further rotatable from the second position to the first position to effect translation of the carriage and the proximal portion of the sliding member in a distal direction, thereby applying tension to the first cable and causing deflection of the shaft in a second direction.
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202. The medical device of claim 201, further including a first tube positioned such that the first cable extends through the first tube, the first tube including a first end mounted to the handle.
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203. The medical device of claim 202, wherein the first end of the first tube is attached to the handle such that the first end remains in a longitudinally fixed position during translation of the carriage.
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204. The medical device of claim 201, wherein the sliding member comprises a second tube and wherein the second cable extends through the second tube.
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205. The medical device of claim 204, wherein the second cable is mounted to the handle such that the proximal end of the second cable remains in a longitudinally fixed position during translation of the carriage.
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206. The medical device of claim 201, further including an instrument lumen extending longitudinally through the carriage and elongate shaft.
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207. The medical device of claim 199 wherein the flexible distal portion of the elongate shaft includes an elongate spine formed of a plurality of spine segments threaded over the first and second cables.
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208. The medical device of claim 199, wherein fluid line extends through the shaft.
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209. The medical device of claim 199 wherein the fluid line includes a section formed of tubing formed into a longitudinally expandable shape.
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210. The medical device of claim 209 wherein the longitudinally expandable shape is a coil.
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211. The medical device of claim 209 wherein the longitudinally expandable shape is an undulating shape.
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212. A method of articulating a medical device, the method comprising:
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providing an elongate shaft having a flexible distal portion, a proximal portion including a handle, and first and second cables extending between the handle and the flexible distal portion; axially rotating a knob on the handle in a first direction to apply tension to the first cable, causing the first distal portion to deflect in a first direction; and axially rotating the knob in a second direction opposite to the first direction to apply tension to the second cable, causing the distal portion to deflect in a second direction.
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213. The method according to claim 212, wherein the method provides the handle to include a carriage engaged to the knob by threads, wherein the cable has a proximal end coupled to the carriage, and wherein axially rotating the knob in the first direction causes translation of the carriage and the proximal end of the first cable in a first direction.
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214. The method according to claim 213 wherein axially rotating the knob in the second direction causes translation of the carriage in a second direction opposite to the first direction.
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215. The method according to claim 214 wherein:
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the method provides the medical device to include a sliding member having a first end attached to the carriage and a second end attached to the second cable, and further provides the second cable to have a proximal end attached to the handle; and translating the carriage in the second direction causes translation of the sliding member in the second direction, said translation of the sliding member applying tension to the second cable.
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216. The method according to claim 212, wherein the knob remains longitudinally fixed relative to the handle during axial rotation of the knob.
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217. The method according to claim 213, wherein the carriage remains rotationally fixed relative to the handle during translation.
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218. The method according to claim 212, wherein the method further includes passing an instrument through an instrument port extending longitudinally through the handle and elongate member;
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Specification