TISSUE APPOSITION CLIP APPLICATION DEVICES AND METHODS

• US 20100010511A1
• Filed: 07/14/2008
• Published: 01/14/2010
• Est. Priority Date: 07/14/2008
• Status: Active Grant

• Current Assignee: Cilag Gmbh International (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Harris, Jason L., Spivey, James T.
• Granted Patent: US 8,888,792 B2
• Time in Patent Office: Days
• US Class Current: 606/143
• CPC Class Codes: A61B 17/083 Clips, e.g. resilient
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/105 Wound clamp magazines for packaging sharps A61B50/3001
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system

Abstract

Surgical instruments and methods for closing a gastrotomy. In various embodiments, the surgical instrument may comprise an overtube that supports a clip magazine therein that houses a plurality of tissue apposition clips in an orientation wherein the upper and lower clip arms thereof are releasably supported in an open orientation. Various embodiments are configured to operably accommodate one or more tissue grasping members for grasping the tissue. Other embodiments comprise clip dispensing adapters that may be affixed to the distal end of an endoscope. The various adapters are configured to support a tissue apposition clip such that the upper and lower clip arms thereof are initially supported in an open orientation relative to each other to enable grasped tissue to be drawn therein. Various tissue apposition clips are disclosed which may be used in connection with conventional tissue anchors and/or sutures.

Claims

1. A clip application device, comprising:

an elongate clip magazine having an axial clip passage therein for receiving a plurality of tissue apposition clips therein;

at least one grasper lumen in said elongate clip magazine apart from said axial clip passage and configured to movably accommodate a corresponding grasper device therethrough to manipulate tissue relative to a distal end of said elongate clip magazine; and

an advancement member for applying an advancement motion to the tissue apposition clips in said axial passage to cause the tissue apposition clips to move out of said axial clip passage in seriatum.

2. The clip application device of claim 1 further comprising at least one camera lumen in said elongate clip magazine for receiving a camera therein.

3. The clip application device of claim 1 wherein the tissue apposition clips each have two clip arms and wherein said axial clip passage is configured to orient the tissue apposition clips to advance onto a portion of each of the grasper devices such that the clip arms of each said tissue apposition clip are biased to an open position away from each other as each of the tissue apposition clips is advanced out of said axial clip passage.

4. The clip application device of claim 1 further comprising an overtube for receiving said clip magazine therein.

5. The clip application device of claim 4 wherein said overtube has a steerable distal end portion.

6. A method for processing a clip application device for surgery, the method comprising:

obtaining the clip application device of claim 1;

sterilizing the clip application device; and

storing the clip application device in a sterile container.

7. An adapter for installing a tissue apposition clip having upper and lower clip arms onto tissue, said adapter comprising:

a body portion couplable to a distal end of an endoscope;

an upper support arm protruding from said body portion;

a lower support arm protruding from said body portion and spaced from said upper support arm to enable a tissue apposition clip to be supported therebetween;

an upper retention lug on said upper support arm configured to releasably engage the upper clip arm of the tissue apposition clip; and

a lower retention lug on said lower support arm configured to releasably engage the lower clip arm of the tissue apposition clip, said upper and lower retention lugs configured to releasably retain the tissue apposition clip in the open position to enable tissue to be drawn therebetween and thereafter enable the tissue apposition clip to be released therefrom onto the tissue upon application of an advancement force to the tissue apposition clip.

8. The adapter of claim 7 wherein said body portion is attached to the distal end of the endoscope by a fastener arrangement selected from a group of fastener arrangements consisting of:

threads, bayonet type connections, and ratchet connections.

9. The adapter of claim 7 wherein said upper and lower retention lugs are each selectively movable from retention positions to releasing positions.

10. The adapter of claim 9 wherein said upper and lower retention lugs are selectively movable from said retention position to said releasing position upon application of a release force thereto.

11. The adapter of claim 10 further comprising a tension member corresponding to each said upper and lower retention lug, each said tension member extending through a corresponding flexible tube coextensive with said endoscope.

12. The adapter of claim 7 further having an opening through said body portion through which surgical tools may pass.

13. A surgical kit comprising:

a tissue grasping device; and

an adapter of claim 7.

14. A surgical method for closing an opening in an organ wall, said surgical method comprising:

positioning a distal end portion of a steerable overtube adjacent a portion of the organ wall through which the opening extends;

inserting a flexible clip magazine into the steerable overtube, the flexible clip magazine supporting a plurality of tissue apposition clips therein such that the upper and lower clip arms thereof are supported in a spaced open position relative to each other, said flexible clip magazine having a distal end portion received within said end of the steerable overtube such that the tissue apposition clips supported therein may be selectively discharged out through the distal end of the steerable overtube;

grasping tissue through which the opening extends;

drawing a portion of the grasped tissue into a clamping position between upper and lower clip arms of a distal-most one of the tissue apposition clips supported within the distal end of the clip magazine; and

advancing the distal-most tissue apposition clip onto the portion of grasped tissue.

15. The surgical method of claim 14 further comprising:

repositioning the distal end portion of the steerable overtube adjacent another portion of the opening;

grasping other tissue through which the opening extends;

drawing a portion of the grasped other tissue into a clamping position between upper and lower clip arms of another distal-most one of the tissue apposition clips supported within the distal end of the clip magazine; and

advancing the another distal-most tissue apposition clip onto the portion of grasped other tissue.

16. The surgical method of claim 14 wherein the opening in the organ wall is selected from a group of openings consisting of an opening in a stomach, an opening in a colon, an opening in a vagina, and an opening in an esophagus.

17. A surgical method for closing an opening in a portion of an organ wall, said surgical method comprising:

positioning a tissue apposition clip adjacent a distal end of an endoscope;

positioning the tissue apposition clip adjacent the opening;

grasping the portion of the organ wall through which the opening extends;

drawing the grasped portion of the organ wall into a clamping position between upper and lower clip arms of the tissue apposition clip;

advancing the tissue apposition clip onto the grasped portion of the organ wall; and

applying at least one tissue anchor to the grasped portion or organ wall clamped within the tissue apposition clip.

18. The surgical method of claim 17 wherein said positioning a tissue apposition clip, comprises:

coupling a clip dispensing adapter to the distal end of the endoscope;

releasably supporting the tissue apposition clip on the clip dispensing adapter; and

movably manipulating the distal end of the endoscope and adapter adjacent to the opening through the portion of organ wall.

19. The surgical method of claim 18 wherein said positioning comprises inserting the distal end of the endoscope and adapter through a natural orifice in a patient and manipulating the distal end of the endoscope and adapter by applying actuation forces thereto from a portion of the endoscope positioned external to the natural orifice.

20. The surgical method of claim 17 wherein said applying at least one tissue anchor to the grasped portion of organ wall clamped within the tissue apposition clip comprises inserting a tissue anchor applier through a hole in the tissue apposition clip to operably engage the grasped portion of organ wall clamped within the tissue apposition clip.