DEVICES AND METHODS FOR ENDOLUMINAL PLICATION

• US 20130153626A1
• Filed: 12/15/2011
• Published: 06/20/2013
• Est. Priority Date: 12/15/2011
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Felder, Kevin D., Crainich, Lawrence, Sherrill, Justin W., Harris, Jason L., Zeiner, Mark S.
• Granted Patent: US 9,173,657 B2
• Time in Patent Office: Days
• US Class Current: 227/175.1
• 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 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/072 for applying a row of staples in a single action , e.g. the staples being applied simultaneously
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 2017/00323 Cables or rods
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00561 creating a vacuum
• CPC Class Codes: A61B 2017/00685 Archimedes screw
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/07214 Stapler heads
• CPC Class Codes: A61B 2017/2902 characterized by features of the actuating rod
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: A61B 2017/2947 Pivots
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

Devices and methods are provided for forming and securing a tissue plication. More particularly, the devices and methods of the present invention can be used to create multiple tissue folds on an anterior and posterior wall of a stomach cavity to reduce the volume thereof. In one aspect, a method of gastric volume reduction is disclosed that includes advancing a tissue acquisition and fixation device endoscopically into a stomach, manipulating the device to form a first fold of tissue on an interior surface of an anterior wall of the stomach, and manipulating the device to form a second fold of tissue on an interior surface of a posterior wall of the stomach, where the second fold is not attached to the first fold.

Claims

1. A method for gastric volume reduction, comprising:

advancing a tissue acquisition and fixation device endoscopically through an esophagus and into a stomach;

manipulating the tissue acquisition and fixation device within the stomach to form a first fold of tissue on an interior surface of an anterior wall of the stomach;

manipulating the tissue acquisition and fixation device within the stomach to form a second fold of tissue on an interior surface of a posterior wall of the stomach, wherein the second fold is not attached to the first fold.

2. The method of claim 1, wherein a first fastener secures the first fold and a second fastener secures the second fold.

3. The method of claim 1, further comprising inserting at least one fastener through the first fold of tissue, and inserting at least one fastener through the second fold of tissue.

4. The method of claim 1, further comprising securing the first fold with at least one row of fasteners and securing the second fold with at least one row of fasteners.

5. The method of claim 1, wherein manipulating the tissue acquisition and fixation device comprises positioning first and second jaws of the tissue acquisition and fixation device to extend substantially parallel to the anterior wall of the stomach, and acquiring tissue to form the first and second folds.

6. The method of claim 5, wherein acquiring tissue comprises activating a vacuum source to draw tissue to a tissue acquisition member of the tissue acquisition and fixation device, and manipulating the tissue acquisition member to draw the tissue through the first and second jaws of the tissue acquisition and fixation device.

7. The method of claim 6, wherein acquiring tissue further comprises engaging a secondary acquirer coupled to the tissue acquisition member to retain the tissue in position relative to the tissue acquisition member.

8. The method of claim 1, wherein manipulating the tissue acquisition and fixation device comprises moving a tissue acquisition member from a first position, in which a distance between a longitudinal axis of the tissue acquisition member and a longitudinal axis of the device is minimized, to a second position in which the tissue acquisition member is offset from the device such that the distance between the longitudinal axes of the tissue acquisition member and the device is greater than in the first position.

9. A method for gastric volume reduction, comprising:

advancing a tissue acquisition and fixation device endoscopically into a stomach of a patient;

applying a vacuum to a tissue acquisition member to engage tissue;

manipulating the device to cause the tissue acquisition member to position the engaged tissue between opposed jaws coupled to the tissue acquisition member;

actuating the device to move the opposed jaws to a closed position in which the opposed jaws engage the tissue; and

actuating the device to cause the opposed jaws to deliver at least one fastener through the engaged tissue.

10. The method of claim 9, further comprising, prior to applying a vacuum to the tissue acquisition member, positioning the tissue acquisition and fixation device such that a longitudinal axis of the device is substantially parallel to the tissue surface.

11. The method of claim 9, wherein manipulating the device to position the engaged tissue between opposed jaws further comprises actuating a hinge linkage coupling the tissue acquisition member to at least one of the jaws in order to move the tissue acquisition member relative to at least one of the jaws.

12. The method of claim 11, wherein actuating the hinge linkage comprises translating an actuating cable coupled to the hinge linkage.

13. The method of claim 9, further comprising moving the opposed jaws to an open position, any of translating and vertically moving the tissue acquisition member to re-position the tissue between the opposed jaws, and re-actuating the device to move the opposed jaws to a closed position and to cause the opposed jaws to deliver at least a second fastener through the tissue.

14. The method of claim 13, wherein translating the tissue acquisition member comprises rotating a lead screw to cause the tissue acquisition member to translate with respect to the opposed jaws.

15. The method of claim 13, further comprising repeating the steps of moving the tissue acquisition member and re-actuating the device to create a row of fasteners.

16. The method of claim 9, further comprising, prior to manipulating the device, engaging a secondary acquirer coupled to the tissue acquisition member to retain the tissue in position relative to the tissue acquisition member.

17. A method for gastric volume reduction, comprising:

manipulating a surgical device to form at least one plication on at least one of an anterior and a posterior inner surface of a fundus region of a patient'"'"'s stomach;

after forming the at least one plication, advancing the surgical device distally from the fundus toward an antrum of the stomach and manipulating the surgical device to form a plurality of plications on at least one of an anterior and a posterior inner surface of the stomach.

18. The method of claim 17, wherein an end effector of the surgical device is articulated in a retroflexed position when the at least one plication is formed in the fundus.

19. The method of claim 18, wherein advancing the surgical device distally from the fundus further comprises un-articulating the end effector to return the end effector to a position in which the end effector is substantially aligned with at least a distal portion of an insertion shaft having the end effector mated thereto.

20. The method of claim 17, wherein forming a plurality of plications in the stomach includes articulating an end effector of the surgical device to access portions of the stomach.

21. The method of claim 17, wherein the plurality of plications are formed in a distal-to-proximal direction.