Surgical procedure for joining tissue in an internal body cavity

• US 5,220,928 A
• Filed: 01/31/1992
• Issued: 06/22/1993
• Est. Priority Date: 08/22/1983
• Status: Expired due to Fees

• Current Assignee: Stryker Sales Corporation (Stryker Corporation)
• Original Assignee: Stryker Sales Corporation (Stryker Corporation)
• Inventors: Oddsen, Robert R., Ger, Ralph
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US07/830,216
• Time in Patent Office: 508 Days
• Field of Search: 606/219, 128/898, 227/19, 227/20, 227/175, 227/176, 227/177, 227/178, 227/181
• US Class Current: 128/898
• 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 17/0684 having a forming anvil staying above the tissue during stapling
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/306 holding by means of suction

Abstract

A surgical procedure is disclosed for joining, e.g., by stapling or clipping, body tissue of a patient situated in an internal body cavity of the patient from within the body cavity through a small opening into the body cavity. For example, the surgical procedure may be employed to repair indirect inquinial or femoral hernias in a laparoscopic procedure. A small opening is made into the body cavity at a site on the patient'"'"'s body remote from the body tissue to be joined in the internal body cavity. The body cavity is insufflated. An elongate tissue-joining instrument is inserted into the body cavity through the small opening. The instrument is moved through the insufflated internal body cavity to position a distal end of the instrument close to and on an internal side of the body tissue to be joined in the body cavity. The pieces of body tissue are then joined by the instrument by manipulation of the instrument at a proximal end thereof.

Claims

1. A procedure for joining body tissue in a body cavity from within the body cavity through a small opening into the body cavity which is remove from the body tissue to be joined, comprising:

insufflating a body cavity;

inserting a cannula into said cavity through an opening into said cavity remote from the body tissue to be joined, said cannula providing a selectively sealable opening into said cavity through which a tissue-joining instrument may be introduced into said cavity with a fluid-tight seal between said cannula and said instrument inserted therethrough and with a fluid-tight seal between said cannula and tissue defining said opening through which said cannula is inserted, said seals being effective to substantially maintain insufflation of said cavity when said cannula is inserted in said body opening and said instrument is inserted into said cavity;

providing an instrument having a distal end which includes means for applying a clip-like or staple-like device for piercing and joining body tissue, a proximal end from which said means for applying at said distal end, is activated to apply said clip-like or staple-like device, and a fluid-tight internal seal between said distal and proximal ends effective to substantially maintain insufflation of said cavity when said instrument is in said cannula;

inserting said instrument into said insufflated cavity through said cannula and positioning said distal end of said instrument remote from said opening near said body tissue to be joined; and

activating said means for applying said clip-like or staple-like device to join said body tissue with a said clip-like or staple-like device applied by said instrument distal end in said insufflated cavity.

2. The procedure according to claim 1 including the step of introducing a laparoscope into said cavity.

3. A procedure for intra-abdominally repairing a hernia, comprising:

insufflating the abdomen of a patient;

inserting a cannula into said abdomen to provide a selectively sealable opening into said abdomen through which a stapling instrument may be introduced into said abdomen, said cannula providing a fluid-tight seal between said cannula and said stapling instrument and a fluid-tight seal between said cannula and tissue defining an opening through which said cannula is inserted, said seals being effective to substantially maintain insufflation of said abdomen;

providing a stapling instrument which applies a clip-like or staple-like device for piercing and joining body tissue and which has a fluid-tight internal seal effective to substantially maintain insufflation of said abdomen;

inserting said instrument into said abdomen through said cannula; and

stapling said body tissue with said stapling instrument adjacent a hernia to repair it.

4. The procedure according to claim 3 including the step of introducing a laparoscope into said abdomen.

5. The procedure according to claim 3 wherein said cannula is inserted above the scarpia'"'"'s fascia of said patient.

6. A method for stapling body tissue of a patient situated in an internal body cavity of the patient from within the body cavity through a small opening into the body cavity, said method comprising the steps of:

making a small opening into the body cavity at a site on the patient'"'"'s body remote from body tissue to be stapled in an internal body cavity;

insufflating said body cavity;

inserting an elongate stapling instrument through said small opening;

moving said instrument through said small opening and through said insufflated internal body cavity so that a distal end of said instrument is close to said body tissue to be stapled and on an internal side of said body tissue in said body cavity;

gripping, approximating and holding together in a stapling position two pieces of said body tissue from said internal side thereof, the composite step of gripping, approximating and holding being performed remotely from the body tissue pieces with said instrument by manipulation at a proximal end thereof; and

stapling together said two pieces of said body tissue from said internal side, said step of stapling being performed with said instrument by manipulation at said proximal end thereof.

7. The method defined in claim 6, further comprising the step of rotating a staple-storing cartridge at said distal end of said instrument upon insertion thereof through said small opening into said body cavity, said step of rotating being accomplished via manipulation at said proximal end of said instrument.

8. The method defined in claim 7 wherein said composite step of gripping, approximating and holding includes the steps of inserting ends of tong-like gripper members into said two pieces of body tissue and moving said tong-like gripper members towards one another and towards said distal end of said instrument.

9. The method defined in claim 8 wherein said composite step of gripping, approximating and holding is accomplished by manipulation of a first mechanism of said instrument, including said tong-like gripper members, and wherein said step of stapling is accomplished by manipulation of a second mechanism of said instrument separate and distinct from said first mechanism.

10. The method defined in claim 6, further comprising the step of inserting a distal end of a laparoscope into said body cavity to provide for visual inspection of said body tissue and the distal end of said instrument during a stapling operation.

11. The method defined in claim 10 wherein said distal end of said laparoscope is inserted through another small opening of the patient different from said small opening.

12. The method defined in claim 6 wherein said small opening is up to approximately one-half inch wide.

13. The method defined in claim 6 wherein said composite step of gripping, approximating and holding includes the steps of inserting ends of tong-like gripper members into said two pieces of body tissue and moving said tong-like gripper members towards one another and towards said distal end of said instrument.

14. The method defined in claim 13 wherein said composite step of gripping, approximating and holding is accomplished by manipulation of a first mechanism of said instrument, including said tong-like gripper members, and wherein said step of stapling is accomplished by manipulation of a second mechanism of said instrument separate and distinct from said first mechanism.

15. A method for stapling body tissue of a patient to close an internal opening in a body wall situated in an internal body cavity of the patient from within the body cavity through a small opening into the body cavity, said method comprising the steps of:

making a small opening into an internal body cavity at a site on a patient'"'"'s body remote from body tissue to be stapled;

insufflating said internal body cavity;

inserting an elongate stapling instrument through said small opening;

moving said instrument through said small opening and through said insufflated internal body cavity so that a distal end of said instrument is close to and on an internal side of an internal opening in said body cavity;

gripping, approximating and holding together in a stapling position two pieces of said body tissue on opposite sides of said internal opening from said internal side thereof, the composite step of gripping, approximating and holding being performed remotely from said internal opening with said instrument by manipulation at a proximal end thereof; and

stapling together said two pieces of said body tissue to close said internal opening from said internal side, said step of stapling being performed with said instrument by manipulation at said proximal end thereof.

16. The method defined in claim 15, further comprising the step of rotating a staple-storing cartridge at said distal end of said instrument upon insertion thereof through said small opening into said body cavity, said step of rotating being accomplished via manipulation at said proximal end of said instrument.

17. The method defined in claim 16 wherein said composite step of gripping, approximating and holding includes the steps of inserting ends of tong-like gripper members into said two pieces of body tissue and moving said tong-like gripper members towards one another and towards said distal end of said instrument.

18. The method defined in claim 17 wherein said composite step of gripping, approximating and holding is accomplished by manipulation of a first mechanism of said instrument, including said tong-like gripper members, and wherein said step of stapling is accomplished by manipulation of a second mechanism of said instrument separate and distinct from said first mechanism.

19. The method defined in claim 16, further comprising the step of inserting a distal end of a laparoscope into said body cavity to provide for visual inspection of said body tissue and the distal end of said instrument during a stapling operation.

20. The method defined in claim 19 wherein said distal end of said laparoscope is inserted through another small opening of the patient different from said small opening.

21. The method defined in claim 15 wherein said small opening is up to approximately one-half inch wide.

22. The method defined in claim 15 wherein said composite step of gripping, approximating and holding includes the steps of inserting ends of tong-like gripper members into said two pieces of body tissue and moving said tong-like gripper members towards one another and towards said distal end of said instrument.

23. The method defined in claim 15 wherein said composite step of gripping, approximating and holding is accomplished by manipulation of a first mechanism of said instrument, including said tong-like gripper members, and wherein said step of stapling is accomplished by manipulation of a second mechanism of said instrument separate and distinct from said first mechanism.