Access Systems and Methods of Intra-Abdominal Surgery
First Claim
1. An access system for accessing a patient'"'"'s peritoneal cavity from a body cavity accessible through a natural orifice, the peritoneal cavity and body cavity separated by an anatomical wall, said access system for use with an endoscope, said access system comprising:
- a) an overtube having a proximal portion and a distal portion with a distal end, and a length therebetween sufficient to extend from a patient'"'"'s mouth to a patient'"'"'s stomach, said overtube defining a lumen for receiving the endoscope therethrough;
b) an anatomical wall securing system at said distal portion of said overtube that temporarily secures said distal portion of said overtube within a hole in the anatomical wall;
c) a handle at said proximal portion of said overtube for operating said securing system; and
d) a tubular port extending from said distal end of said overtube and having a lumen sized to receive an endoscope therethrough, said tubular port having a shape portion with a determinable shape, said shape portion adapted to be in a plurality of shaped configurations including a first shaped configuration when said shape portion is within the body cavity and a second shaped configuration when said shape portion is within the peritoneal cavity.
4 Assignments
0 Petitions
Accused Products
Abstract
An access system includes a proximal handle, an overtube coupled to the handle, and an endoscope port extending through handle and overtube sized for receiving an endoscope therethrough. The overtube includes anatomic wall securing system that secures a distal portion of the overtube within a hole in the anatomic wall. The overtube is provided with a shaped distal portion or a controllably shapeable distal portion that aids in directing an endoscope inserted through the port to a particular location within the peritoneal cavity. The access system includes a system for insufflating/deflating the peritoneal space separately from the body cavity accessible via a natural orifice. The access system includes a closure system to cinch closed the hole made in the anatomical wall after the access system has been removed from the hole. Methods are provided for inserting the access system through the anatomical wall to perform intra-abdominal surgery.
97 Citations
58 Claims
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1. An access system for accessing a patient'"'"'s peritoneal cavity from a body cavity accessible through a natural orifice, the peritoneal cavity and body cavity separated by an anatomical wall, said access system for use with an endoscope, said access system comprising:
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a) an overtube having a proximal portion and a distal portion with a distal end, and a length therebetween sufficient to extend from a patient'"'"'s mouth to a patient'"'"'s stomach, said overtube defining a lumen for receiving the endoscope therethrough; b) an anatomical wall securing system at said distal portion of said overtube that temporarily secures said distal portion of said overtube within a hole in the anatomical wall; c) a handle at said proximal portion of said overtube for operating said securing system; and d) a tubular port extending from said distal end of said overtube and having a lumen sized to receive an endoscope therethrough, said tubular port having a shape portion with a determinable shape, said shape portion adapted to be in a plurality of shaped configurations including a first shaped configuration when said shape portion is within the body cavity and a second shaped configuration when said shape portion is within the peritoneal cavity. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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20. An access system for accessing a patient'"'"'s peritoneal cavity through a from a body cavity through a natural orifice, the peritoneal cavity and natural orifice separated by an anatomical wall of the natural orifice, said access system for use with an endoscope, said access system comprising:
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a) an overtube including a first flexible tubular member having a proximal portion and a distal portion with a distal end, and a length therebetween sufficient to extend from a patient'"'"'s mouth to a patient'"'"'s stomach, said tubular member defining a lumen for receiving the endoscope therethrough; b) an anatomic wall securing system at said distal portion of said overtube that temporarily secures said distal portion of said overtube within a hole in the anatomic wall; c) a handle at said proximal portion of said overtube for operating said securing system; and d) an inflation system integrated into said handle and overtube, said inflation system to at least one of insufflate and desufflate the intragastric space and peritoneal cavity separately from the other, said inflation system including, a first gas port extending from said handle to a location intermediate said handle and said anatomic wall securing system, a second gas port extending from said handle to a location at or distal said anatomic wall securing system, and a gas control at said handle to control injection or evacuation of a gas through the respective first and second gas ports. - View Dependent Claims (21, 22, 23)
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24. An access system for accessing a patient'"'"'s peritoneal cavity through a natural orifice accessible body cavity, the peritoneal cavity and body cavity separated by an anatomic wall, said access system for use with an endoscope, said access system comprising:
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a) an overtube including a first flexible tubular member having a proximal portion and a distal portion with a distal end, and a length therebetween sufficient to extend from a patient'"'"'s mouth to a patient'"'"'s stomach, said tubular member defining a lumen for receiving the endoscope therethrough; b) an anatomic wall securing system at said distal portion of said overtube that temporarily secures said distal portion of said overtube within a hole in the anatomic wall; c) a handle at said proximal portion of said overtube for operating said securing system; and d) a closure system at said distal end of said overtube for deploying fasteners into the anatomic wall and to effect closure of the hole in the anatomic wall by acting on the fasteners. - View Dependent Claims (25, 26, 27, 28)
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29. A method of intra-abdominal surgery, comprising:
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a) inserting a distal end of a natural orifice translucent endoscopic surgery (NOTES) access system into a hole in an anatomic wall, the access system having an overtube with a distal end; b) securing the access system to the anatomic wall at the hole; c) inserting an endoscope through the overtube of the access system; and d) using a port having a shaped portion at the distal end of the overtube to direct the endoscope along a determined trajectory, the endoscope extending through the port. - View Dependent Claims (30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44)
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45. A method of intra-abdominal surgery, comprising:
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a) inserting a distal end of a natural orifice translucent endoscopic surgery (NOTES) access system into a hole in wall of a body cavity accessible through a natural orifice, the access system having an overtube with a distal end; b) securing the access system to the wall at the hole; c) inserting a tunneling instrument through the overtube to form a tunnel between first and second tissues within the peritoneal space; and d) inserting a dissecting instrument through the overtube and into the tunnel and expanding the dissecting instrument to dissect the first and second tissues from each other, wherein at least one of the tunneling instrument and the dissecting instrument includes a balloon which upon expansion tunnels and/or dissects. - View Dependent Claims (46, 47, 48, 49, 50, 51, 52, 53, 54, 55)
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56. A method of modifying the gas pressure between a body cavity accessible through a natural orifice and the peritoneal cavity of the human body, comprising:
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a) securing a natural orifice translucent endoscopic surgery (NOTES) access system within a hole in the wall between the body cavity and the peritoneal cavity, the access system having i) an overtube including a flexible tubular member having a proximal portion and a distal portion with a distal end, said tubular member defining a lumen for receiving the endoscope therethrough, ii) an anatomic wall securing system at said distal portion of said overtube that temporarily secures said distal portion of said overtube within a hole in the wall, iii) a handle at said proximal portion of said overtube for actuating said securing system; and iv) an inflation system integrated into said handle and overtube to insufflate and deflate the body cavity separately from the peritoneal cavity, said inflation system including, a first gas port extending from said handle to a location intermediate said handle and the wall securing system, a second gas port extending from said handle to a location at or distal said anatomic wall securing system, and a gas control at said handle to control injection or evacuation of a gas through the respective first and second gas ports; and b) injecting or evacuating gas through said overtube to modify the gas pressure within the one of the body cavity and the peritoneal cavity.
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57. A method of intra-abdominal surgery within the peritoneal cavity, comprising:
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a) introducing a natural orifice translucent endoscopic surgery (NOTES) access system into a body cavity accessible through a natural orifice, the access system having a proximal end including a handle, and a distal end with a closure system; b) deploying a plurality of hollow needles from the closure system into an anatomic wall separating the body cavity and the peritoneal cavity; c) inserting a plurality of tissue fasteners through the needles, the fasteners each having a flexible element attached at a proximal end thereof; d) retracting the needles from the anatomic wall after each fastener is inserted therethrough; e) defining a hole in the anatomic wall between the inserted fasteners; f) securing the access system within the hole in the anatomic wall; g) performing a surgical procedure within the peritoneal cavity; h) removing the access system from the hole in the anatomic wall; and i) closing the hole in the anatomic wall by cinching together the flexible elements at the proximal ends of the fasteners. - View Dependent Claims (58)
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Specification