METHODS FOR CLOSING A GASTROTOMY

• US 20110124964A1
• Filed: 02/04/2011
• Published: 05/26/2011
• Est. Priority Date: 10/31/2007
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Nobis, Rudolph H.
• Granted Patent: US 8,939,897 B2
• Time in Patent Office: Days
• US Class Current: 600/129
• CPC Class Codes: A61B 1/12 with cooling or rinsing arrangements
• CPC Class Codes: A61B 1/2736 Gastroscopes

Abstract

A surgical instrument for forming a gastrotomy. In various embodiments, the surgical instrument may comprise a hollow tip for attachment to a distal end of a tubular member such as an endoscope. In other embodiments, the hollow tip is integrally formed on the distal end of the endoscope. The hollow tip is configured such that when it is brought into contact with the inner layer of tissue in the stomach, the tissue is caused to stretch. A hole-forming device may be passed through the hollow tip to pierce through the stretched inner layer and adjacent outer layers of tissue to form a passageway therethrough for permitting surgical procedures to be performed therethrough. After the surgical procedures are performed through the passageway, the hollow tip is removed from contact with the inner layer of tissue to permit the inner layer of tissue to relax and to cause the holes formed through the inner layer and outer layers of tissue to be offset from each other.

Claims

1. A surgical method for forming a gastrotomy through an organ wall having an inner layer of tissue and at least one outer layer of tissue adjacent to said inner layer of tissue, wherein the inner layer of tissue is stretchable from a first relaxed condition to a stretched condition, said method comprising:

stretching the inner layer of tissue to a stretched condition relative to the at least one outer layer of tissue;

forming a first hole through the stretched inner layer of tissue and a second hole through the at least one outer layer of adjacent tissue such that said first and second holes are aligned with each other to permit passage of a surgical instrument therethrough;

performing a surgical procedure through the aligned first and second holes; and

permitting the inner layer to return to the first relaxed condition such that the first and second holes are no longer aligned with each other.

2. The surgical method of claim 1 wherein said stretching comprises:

providing a surgical instrument having a hollow tip thereon, the hollow tip having a tip axis and a distal end that extends at an acute angle relative to the tip axis; and

pushing the angled distal end of the hollow tip into contact with the inner layer of tissue to cause a portion of the inner layer of tissue to move to the stretched condition.

3. The surgical method of claim 2 wherein said forming comprises:

inserting a hole-forming instrument through the surgical instrument and the hollow tip; and

piercing a portion of the hole forming instrument through the portion of stretched inner layer of tissue and the at least one outer layer of tissue adjacent to the portion of stretched inner layer of tissue.

4. The surgical method of claim 2 further comprising applying suction within the hollow tip.

5. The surgical method of claim 2 wherein the surgical instrument comprises an endoscope.

6. The surgical method of claim 5 wherein said pushing comprises:

inserting a portion of the endoscope having the hollow tip thereon through a natural orifice in a patient to bring the hollow tip into engagement with the inner layer of tissue;

an applying a pushing force to another portion of the endoscope protruding out of the natural orifice.

7. The surgical method of claim 2 wherein said permitting comprises removing the angled distal end of the hollow tip from contact with the inner layer of tissue.

8. The surgical method of claim 1 wherein said performing a surgical procedure comprises performing transgastric access.

9. The surgical method of claim 1 wherein said performing a surgical procedure comprises inserting one of a guide wire and a dilating balloon through the aligned first and second holes.

10. The surgical method of claim 2 further comprising

sterilizing the instrument after said removing;

and

storing the instrument in a sterile container.

11. A surgical method for forming a gastrotomy through the stomach wall of a patient, said surgical method comprising:

inserting a hollow portion of a surgical instrument through the patient'"'"'s mouth and esophagus into the patient'"'"'s stomach such that a hollow tip portion is adjacent a portion of the stomach wall through which the gastrotomy is to be formed;

pressing the hollow tip portion of the surgical instrument into engagement with an inner lining of the stomach wall to stretch the inner lining corresponding to the portion of the stomach wall through which the gastrotomy is to be formed relative to a second layer of stomach wall;

inserting a hole forming device through the hollow portion of the instrument;

forming a first passage through the inner lining and a second passage through the second layer that is axially aligned with the first passage when the inner lining is retained in a stretched condition relative to the second layer of stomach wall;

withdrawing the hole forming device from the instrument;

inserting at least one other surgical instrument through the hollow portion of the instrument and through the aligned first and second passages to perform at least one surgical procedure;

withdrawing all of the at least one other surgical instruments from the hollow portion of the surgical instrument after performing the at least one surgical procedure;

removing the hollow tip portion of the surgical instrument from stretching contact with the inner lining to permit the inner lining to assume an unstretched orientation such that the first passage is no longer aligned with the second passage; and

withdrawing the surgical instrument out of the patient.

12. The surgical method of claim 11 further comprising applying a vacuum within the hollow tip portion to draw the corresponding portion of inner lining into stretched sealing engagement therewith.

13. The surgical method of claim 12 wherein said applying a vacuum comprises applying a suction to the hollow portion of the surgical instrument and maintaining the suction during said forming and performing at least one surgical procedure.

14. The surgical method of claim 11 wherein the hole forming device is selected from the group of surgical instruments comprising a sphinctorotome and a needle knife.

15. The method of claim 11 further comprising inserting a guide wire through the aligned first and second passages prior to withdrawing the hole forming instrument.

16. The method of claim 11 further comprising:

inserting a dilating balloon into the aligned first and second passages after withdrawing the hole forming instrument;

dilating the dilating balloon to expand the aligned first and second passages; and

withdrawing the dilating balloon from the expanded aligned first and second passages prior to inserting the at least one other surgical instrument therethrough.

17. The method of claim 11 wherein the hollow tip portion is removable from the surgical instrument and wherein said method further comprises:

removing the hollow tip portion from the surgical instrument after the surgical instrument has been withdrawn from the patient;

sterilizing the hollow tip portion; and

packaging the sterilized hollow tip portion in a sterile package for reuse.

18. The method of claim 17 further comprising:

sterilizing the surgical instrument; and

packaging the sterilized surgical instrument and the sterilized hollow tip portion in the form of a sterile surgical kit.