METHODS AND DEVICES FOR PERFORMING GASTRECTOMIES AND GASTROPLASTIES

• US 20100081864A1
• Filed: 09/30/2008
• Published: 04/01/2010
• Est. Priority Date: 09/30/2008
• Status: Abandoned Application

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Myers, Stephan Ray, Hess, Christopher J., Weisenburgh, William Bruce II, Murray, Michael A., Gill, Robert P., Powell, Darrel M., Trusty, Robert M., Voegele, James Walden
• Application Number:
  US12/242,353
• Publication Number:
  US 20100081864A1
• Time in Patent Office: Days
• US Class Current: 600/37
• 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 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/0212 Cushions or pads, without holding arms, as tissue retainers, e.g. for retracting viscera
• CPC Class Codes: A61B 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61B 2017/2906 Multiple forceps
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3466 for simultaneous sealing of multiple instruments
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/571 for clamping a support arm to a bed or other supports
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

Methods and devices are provided for performing gastrectomies and gastroplasties. In one embodiment, a method includes gaining access to a stomach of a patient through an opening formed in the patient'"'"'s abdominal wall and an opening formed in the patient'"'"'s vaginal wall. Tissue attached to the stomach can be tensioned using a surgical instrument inserted through one of the abdominal and vaginal openings and can be separated from the stomach to free the stomach fundus using a dissecting surgical instrument inserted through another opening, e.g., through one of the abdominal and vaginal openings. The fundus can be at least partially transected using a surgical stapler inserted through one of the abdominal and vaginal openings, thereby forming a stomach “sleeve.” In another embodiment, the method is modified to form another opening in the patient'"'"'s abdominal wall instead of forming an opening in the vaginal wall.

Claims

1. A surgical method, comprising:

forming a first access hole in an abdominal wall of a patient by positioning a housing having a plurality of sealing ports in the abdominal wall;

forming a second access hole in a vaginal wall of the patient;

tensioning a tissue attached to a stomach of the patient using a first surgical instrument inserted through the second access hole;

detaching the tissue from the stomach using a second surgical instrument inserted through one of the sealing ports in the housing; and

transecting a portion of the stomach using a third surgical instrument inserted through one of the sealing ports in the housing.

2. The method of claim 1, further comprising retracting a liver of the patient using a device inserted through one of the sealing ports in the housing.

3. The method of claim 1, further comprising removing the transected portion of the stomach from the patient through one of the first and second access holes.

4. The method of claim 1, wherein the first surgical instrument comprises a first grasper, and the method further comprises tensioning the tissue using a second grasper inserted through the second access hole.

5. The method of claim 1, further comprising advancing a scoping device with a viewing element located thereon into the patient through the second access hole.

6. The method of claim 5, wherein advancing a scoping device comprises bending the scoping device in at least two directions relative to a longitudinal axis of the scoping device to visualize the stomach in a direction toward a fundus of the stomach.

7. The method of claim 1, further comprising transorally introducing a sizing device into the stomach and using the sizing device to size the portion of the stomach to be transected.

8. A surgical method, comprising:

forming first and second access holes in an abdominal wall of a patient;

forming a third access hole in a vaginal wall of the patient;

tensioning a tissue attached to the stomach using a surgical instrument inserted through the second access hole;

visualizing the stomach using a scoping device with a viewing element located thereon inserted into the patient through the third access hole; and

transecting a portion of a stomach of the patient less than an entire length of the stomach using a surgical stapler inserted through the first access hole.

9. The method of claim 8, wherein the first access hole has a diameter greater than a diameter of the second access hole.

10. The method of claim 8, further comprising retracting a liver of the patient using a device inserted into the patient through the first access hole.

11. The method of claim 8, wherein transecting a portion of the stomach comprises separating a fundus of the stomach from an area of the stomach substantially near an esophagus of the patient, wherein the fundus retains fluid communication with a pyloric valve of the patient.

12. The method of claim 8, wherein visualizing the stomach using a scoping device comprises bending the scoping device in at least two directions relative to a longitudinal axis of the scoping device to visualize the stomach in a direction toward a fundus of the stomach.

13. The method of claim 12, wherein bending the scoping device comprises bending the scoping device in a first direction at a first location along the longitudinal axis and bending an overtube disposed over the scoping device in a second direction at a second location along the longitudinal axis.

14. The method of claim 8, further comprising transorally introducing a sizing device into the stomach and using the sizing device to size the portion of the stomach to be transected.

15. The method of claim 8, further comprising mounting the scoping device to a support external to the patient.

16. The method of claim 8, further comprising inserting a grasper through the third access hole to tension a tissue surrounding the stomach.

17. The method of claim 8, wherein forming the third access hole comprises piercing the vaginal wall using an optically clear tapered tip of a surgical instrument.

18. The method of claim 8, further comprising sedating the patient using a conscious sedation system.

19. The method of claim 8, further comprising delivering a drug-eluting device into the stomach.

20. A surgical method, comprising:

forming first and second access holes in an abdominal wall of a patient;

forming a third access hole in a vaginal wall of the patient;

tensioning a tissue attached to a stomach of the patient using a first surgical instrument inserted through the second access hole;

detaching the tissue from the stomach using a second surgical instrument inserted through the first access hole; and

transecting a portion of the stomach using a third surgical instrument inserted through the first access hole.

21. The method of claim 20, wherein the first access hole has a diameter greater than a diameter of the second access hole.

22. The method of claim 20, wherein detaching the tissue occurs when the tissue is being tensioned using the first surgical instrument.

23. The method of claim 20, wherein the first surgical instrument comprises at least one grasper and the second surgical instrument comprises a harmonic scalpel.

24. The method of claim 20, further comprising advancing a scoping device with a viewing element located thereon into the patient through the third access hole.

25. The method of claim 24, wherein advancing a scoping device comprises bending the scoping device in at least two directions relative to a longitudinal axis of the scoping device to visualize the stomach in a direction toward a fundus of the stomach.

26. The method of claim 25, wherein bending the scoping device comprises bending the scoping device in a first direction at a first location along the longitudinal axis and bending an overtube disposed over the scoping device in a second direction at a second location along the longitudinal axis.

27. The method of claim 24, further comprising mounting the scoping device to a support external to the patient.

28. The method of claim 24, further comprising inserting a grasper through the third access hole to tension a tissue surrounding the stomach.

29. The method of claim 20, further comprising transorally introducing a sizing device into the stomach and using the sizing device to size the portion of the stomach to be transected.

30. The method of claim 20, wherein forming the third access hole comprises piercing the vaginal wall using an optically clear tapered tip of a surgical instrument.

31. The method of claim 20, further comprising sedating the patient using a conscious sedation system.

32. The method of claim 20, further comprising delivering a drug-eluting device into the stomach.

33. A surgical method, comprising:

forming a first access hole in an abdominal wall of a patient;

forming a second access hole in a vaginal wall of the patient;

tensioning a tissue attached to a stomach of the patient using a first surgical instrument inserted through the second access hole;

detaching the tissue from the stomach using a second surgical instrument inserted through the first access hole; and

transecting a portion of the stomach using a surgical stapler inserted through the second access hole.

34. The method of claim 33, wherein tensioning a tissue comprises using at least two graspers inserted through the second access hole to tension the tissue.

35. The method of claim 33, further comprising manipulating stomach tissue to be stapled by the surgical stapler using at least one grasper inserted through the first access hole.

36. The method of claim 33, wherein forming a first access hole comprises positioning a housing having a plurality of sealing ports in the abdominal wall.

37. The method of claim 33, further comprising advancing a scoping device with a viewing element located thereon into the patient through the first access hole.

38. The method of claim 33, further comprising removing the transected portion of the stomach from the patient through one of the first and second access holes.

39. The method of claim 33, further comprising transorally introducing a sizing device into the stomach and using the sizing device to size the portion of the stomach to be transected.