Non-invasive treatment of gastroesophageal reflux disease

• US 5,571,116 A
• Filed: 10/02/1994
• Issued: 11/05/1996
• Est. Priority Date: 10/02/1994
• Status: Expired due to Term

• Current Assignee: United States Surgical Corporation (Medtronic Plc)
• Original Assignee: United States Surgical Corporation (Medtronic Plc)
• Inventors: Bolanos, Henry, Blewett, Jeffrey J., Van Leeuwen, Timothy O.
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US08/334,614
• Time in Patent Office: 765 Days
• Field of Search: 606/143, 606/151, 606/219, 606/139, 227/19, 227/175, 227/180
• US Class Current: 606/139
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/07214 Stapler heads
• CPC Class Codes: A61B 2017/0725 with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
• CPC Class Codes: A61B 2017/2926 Details of heads or jaws
• CPC Class Codes: A61B 2017/301 with three legs
• CPC Class Codes: A61B 2018/00553 Sphincter

Abstract

Instrumentation for transoral treatment of gastroesophageal reflux disease (GERD) are disclosed. In a preferred embodiment, an instrument includes a remotely operable invagination device for atraumatically approximating the lower esophagus and fundus of the stomach and for invaginating the gastroesophageal junction into the stomach thereby involuting the surrounding fundic wall. The same or a separate instrument includes a remotely operable surgical fastening instrument for fastening together the invaginated lower esophagus and fundic wall. A method of surgically treating GERD is also disclosed.

Claims

1. A surgical stapler comprising:

a staple carrying cartridge having at least two rows of staples;

and first and second independently actuable staple ejecting members longitudinally slidably disposed within the staple carrying cartridge, the first staple ejecting member movable from a first position to a second position to fire at least one said rows of staples while the second staple ejecting member remains in the cartridge.

2. A surgical stapler comprising:

a frame member having a stationary handgrip and a movable trigger;

an elongated portion extending distally from the frame member;

a staple carrying cartridge disposed at a distal end of the elongated portion, the staple carrying member having at least two staple pushing members longitudinally slidably disposed therein;

a clutch assembly disposed within the frame member, the clutch assembly having at least two rotatable members capable of independent rotation; and

at least two elongate firing members having proximal and distal ends, each firing member proximal end being secured to one of the at least two rotatable members and each firing member distal end being secured to one of the at least two staple pushing members;

wherein a first movement of the trigger causes rotation of one of the rotatable members, thereby causing longitudinal movement of one of the staple pushing members and a second, subsequent movement of the trigger causes rotation of another of the rotatable members, thereby causing movement of another of the staple pushing members.

3. A staple carrying cartridge comprising:

a tissue contacting surface having a plurality of staple receiving slots;

a plurality of staples disposed within the staple receiving slots;

a staple ejecting member longitudinally slidably disposed within the staple carrying cartridge; and

a tissue traumatizing member vertically movable from a first position below the tissue contacting surface, to a second position above the tissue contacting surface;

wherein longitudinal movement of the staple ejecting member causes the tissue traumatizing member to move from the first position to the second position.

4. A fastener carrying cartridge comprising first and second tissue contacting surfaces, each tissue contacting surface defining a plane and having a parallel row of fastener receiving slots, and at least one fastener ejecting member slidably disposed at an angle to one another within the faster carrying cartridge for sequentially ejecting at least one said first and second rows of fasteners, wherein said first tissue contacting surface is disposed at an angle with said second tissue contacting surface.

5. In combination, a surgical stapling device and guide therefore, comprising

a) a surgical stapler having:

i) a cartridge frame;

ii) a staple cartridge disposed in the cartridge frame; and

iii) an anvil pivotally mounted with respect to the cartridge frame; and

b) a surgical stapler guiding device having;

i) an elongate member having a distal end and a proximal end;

ii) at least one longitudinal channel disposed between the elongate member distal and proximal ends; and

iii) a slot extending along at least a portion of in the exterior of the elongate member;

wherein the cartridge frame, staple cartridge and anvil of the surgical stapler are insertable into the proximal end of the longitudinal channel of the surgical stapler guiding device and the slot is adapted to permit the anvil to pass therethrough wherein the anvil is pivotable from a first position within the stapler guiding device to a second position wherein the anvil is at least partially disposed exterior to the stapler guiding device.

6. A method of placing a surgical fastener into body tissue comprising the steps of:

a) providing a surgical fastening device having;

i) a cartridge frame having proximal and distal portions;

ii) fastener carrying cartridge at least partially disposed in the frame; and

iii) an anvil member pivotally secured to the frame;

b) inserting the fastening device into the mouth of a patient;

c) guiding the fastening device through the patient'"'"'s esophagus;

d) invaginating at least a portion of the esophagus into the stomach prior to the step of applying the at least one fastener, wherein the stem of invagination is accomplished by providing an invagination device for gripping the gastroesogeal junction and

(e) applying at least one fastener to esophageal tissue, wherein the surgical fastening device is insertable within the invagination device and the step of applying the at least one fastener is preceded by a step of inserting the fastening device within invagination device.

7. The method of claim 6, wherein the step of invaginating comprises the step of gripping a portion of the gastroesophageal junction.

8. The method of claim 6, wherein the step of invaginating is at least partially accomplished by clamping tissue between the fastener carrying cartridge and the anvil member.

9. The method of claim 6, wherein the step of providing the invagination device includes providing the device with at least one movable member adapted to grip the gastroesophageal junction.

10. The method of claim 6, wherein the anvil member is pivotally secured to the distal end of the frame and the step of invaginating is at least partially accomplished by:

a) advancing the fastening device at least partially past the gastroesophageal junction;

b) positioning tissue between the anvil member and the fastener carrying cartridge;

c) gripping the positioned tissue; and

d) advancing the fastening device and gripped tissue towards the patient'"'"'s stomach.

11. The method of claim 6, further comprising the step of applying additional fasteners at different location in the esophagus.

12. The method of claim 6, wherein the surgical fasteners are staples and the step of applying comprises ejecting the staples from the fastener carrying cartridge and forming the staples against the anvil member.

13. A method of firing rows of staples from a surgical stapler, the method comprising the steps of:

a) providing a staple carrying cartridge having first and second parallel rows of staples;

b) providing an anvil member;

c) disposing the anvil member adjacent the staple carrying cartridge such that staples ejected from the cartridge can be formed against the anvil member;

d) ejecting the first row of staples from the staple carrying cartridge, thereby forming the staples against the anvil member;

e) maintaining the anvil member adjacent the staple carrying cartridge; and

f) ejecting the second row of staples from the staple cartridge.