Method and apparatus for endolumenally resectioning tissue

• US 5,868,760 A
• Filed: 12/07/1994
• Issued: 02/09/1999
• Est. Priority Date: 12/07/1994
• Status: Expired due to Term

• Current Assignee: James F. McGuckin Jr.
• Original Assignee: James F. McGuckin Jr.
• Inventors: McGuckin, James F. Jr.
• Primary Examiner(s): Jackson, Gary
• Application Number:
  US08/352,325
• Time in Patent Office: 1,525 Days
• Field of Search: 606/139, 606/151, 606/150, 606/148, 606/153, 606/155, 600/139-142, 227/19, 227/175.1, 227/176.1, 227/178.1, 227/179.1, 227/180.1, 227/181.1
• US Class Current: 606/139
• 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 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 2017/00287 Bags for minimally invasive surgery
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00314 Separate linked members
• CPC Class Codes: A61B 2017/00327 with actuating members moving in opposite directions
• CPC Class Codes: A61B 2017/07214 Stapler heads
• CPC Class Codes: A61B 2017/07221 curved
• CPC Class Codes: A61B 90/30 Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Abstract

Surgical method and apparatus for resectioning tissue, preferably lumenal tissue, with a remaining portion of an organ being anastomized with staples or other fastening means, preferably endolumenally. The apparatus may be inserted via a naturally occurring body orifice or a surgical incision and then advanced using either endoscopic or radiological imaging guidance to an area where surgery is to be performed. Under endoscopic or diagnostic imaging guidance the apparatus is positioned so tissue to be resected is manipulated into an inner cavity of the apparatus. The apparatus then cuts the diseased tissue after stapling and retains the diseased tissue within the apparatus. The rent resulting in a border of healthy tissue is anastomosed with surgical staples.

Claims

1. Apparatus for removing undesired tissue from the colon wall while within the colon, comprising:

a. a longitudinally elongated operating capsule comprising;

i. an outer shell having a curved end at one longitudinal extremity thereof, comprising;

(1) an upper shell portion;

(2) a lower shell portion;

(3) hinge means connecting said upper and lower shell portions and being generally longitudinally aligned and positioned along said longitudinally elongated portion of said shell, facilitating opening of said shell by relative rotation between said shell portions about said hinge means;

(4) said shell portions when closed having respective facing lip portions spaced from one another;

(5) said lip portions extending around a portion of said curved end of said shell and along said longitudinally elongated portion of said capsule;

(6) anvil means resident in one of said facing lip portions, extending along the curved and longitudinally elongated portions thereof;

(7) suturing staple means resident in said remaining lip portion, extending along the curved and longitudinally elongated lip portions facing said anvil means, for passing through any tissue positioned between respective lips and hence between said suturing staple means and said anvil means and curling back, respecting initial direction of suture staple movement perpendicularly to said lip, into said tissue positioned between said respective lips, away from said anvil means due to contact therewith, for securing said tissue together along a line between said suturing staple means and said anvil means;

(8) suturing staple advancement and tissue cutting means movable along said lip portion having said suturing staples resident therewithin, for sequentially advancing said staples serially against said anvil means in said opposing lip portion when said shell portions are closed and thereby effectuating suturing staple securement of tissue between said lip housing said suturing staple means and said lip housing said anvil means;

(9) a transition portion at one end of said shell adjoining said upper and lower shell portions, for connecting said operating capsule to a flexible tubular member carrying cable for operating control of said capsule;

(10) means for opening said shell by effectuating relative rotation of said upper shell portion with respect to said lower shell portion, comprising;

(a) a threaded shaft rotatably mounted within said transition portion;

(b) a carrier threadedly engaging said shaft and moving axially therealong responsively to shaft rotation;

said carrier being pivotally connected to one of said shell portions for pivotally moving said shell portions about said hinge upon movement of said carrier axially along said shaft;

ii. means within said capsule operable responsively to operator manual input for gripping lumenal tissue proximate said undesired tissue and pulling said gripped tissue and said undesired tissue into a cutting zone within said capsule removed from an undisturbed position of said lumenal tissue;

b. said cable carrying flexible tubular member connecting said operating capsule to an operator control module and comprising;

i. an outer cylindrical sheath;

ii. a hollow inner cylindrical sheath within said outer sheath;

iii. a plurality of conical disks between said inner and outer sheaths, each disk comprising;

(1) a hollow central conical portion having an axial aperture at the center thereof, said inner sheath residing within said aperture;

(2) an annular flange at the base of said conical portion;

a convex conical exterior surface of said conical portion extending through said annular flange and fitting into the hollow central conical portion of an adjacent disk, in sliding complemental contact therewith;

(a) said flange having a plurality of slots extending radially inwardly from the flange periphery;

c. said operator control module comprising;

i. knob means connected to said module for facilitating capsule up/down, left/right and open/close motions;

ii. trigger means connected to the exterior of said module for pulling on a first cable and thereby drawing said suturing staple advancement and tissue cutting means along said lip portion of said shell having said suturing staples resident therewithin and thereby advancing said staples serially against said anvil means in said opposing lip portion when said shell portions are closed and effectuating suturing staple securement of tissue between said lip housing said suturing staple means and said lip housing said anvil means;

iii. helical spring means for biasing said trigger against movement in a direction to pull on said first cable;

d. said first cable having a first end wrapped around a pulley within said control module rotated by said trigger, with a second end connecting to said staple advancement and tissue cutting means;

e. a second cable wrapping about said pulley within said control module rotated by knob means for moving said capsule left and right, extending from respective sides of said pulley through said flexible connection means and connecting with a bulkhead portion of said capsule at respective positions left and right of a capsule vertical axis;

f. a third cable wrapping about said pulley within said control module associated with said knob means for moving said capsule up and down, extending from respective sides of said pulley through said flexible connection means and connecting with a bulkhead portion of said capsule at respective positions above and below a capsule horizontal axis;

g. a fourth cable endlessly wrapping around said pulley within said control module associated with said knob means for opening and closing said capsule, extending from respective sides of said pulley through said flexible connection means and connecting with a pulley within said transition portion threadedly engaging a stationary shaft therein extending generally perpendicularly to a plane defined by juncture of said upper and lower shell portions;

h. said cables residing within said slots of said disk flanges within said tubular member and extending therethrough into said operating capsule;

i. said pulley within said transition portion traversing said shaft due to relative rotation therebetween and being connected to said shell upper portion to open and close said shell upper portion relative to said lower portion as said pulley moves respectively up and down said shaft; and

j. an endoscope slidably resident within said inner sheath and said operating capsule.

2. Apparatus for endolumenally removing undesired lumenal tissue and securing remaining lumenal tissue about the site of removal, comprising:

a. means for fastening together portions of lumenal tissue adjacent to undesired lumenal tissue to prevent creation of an aperture in said lumen which would otherwise result upon removal of said undesired lumenal tissue;

b. means for detaching said undesired lumenal tissue from said lumen; and

c. means for gripping lumenal tissue proximate said undesired tissue and pulling said gripped tissue and said undesired tissue into a cutting zone for detachment from said lumen.

3. Apparatus of claim 2, wherein said means for gripping lumenal tissue proximate said undesired tissue and pulling said gripped tissue and said undesired tissue into a cutting zone removed from an undisturbed position of said lumenal tissue further comprises means for gripping said lumenal tissue at positions on two sides of said undesired tissue.

4. A method for endolumenally resectioning lumenal tissue by anastomosing the tissue with artificial fastening means, comprising:

a. inserting a tissue suturing and cutting instrument into a body lumen through a naturally occurring body orifice;

b. advancing said instrument within said lumen to an area of undesired lumenal tissue to be resectioned;

c. drawing said undesired lumenal tissue into a cutting zone of said instrument;

d. stapling said surrounding lumenal tissue to close an orifice which would otherwise result from removal of said undesired lumenal tissue;

e. cutting said undesired lumenal tissue from surrounding lumenal tissue;

wherein said tissue drawing step further comprises;

f. grasping said lumenal wall interior on respective sides of said undesired lumenal tissue;

g. drawing said grasped lumenal wall sufficiently into a cutting zone that the lumenal wall folds against itself in the cutting zone;

and said stapling step further comprises;

h. stapling said folded lumenal wall to retain the lumenal wall exterior in facing contact with itself;

and said cutting step further comprises;

i. cutting said folds of lumenal wall inboard of said position of stapling.

5. The method of claim 4 further comprising:

a. retaining said cut undesired lumenal tissue within said instrument separated from said lumen; and

b. withdrawing said instrument along said lumen and from said body while retaining said cut undesired tissue within said instrument and separated from said lumen.

6. The method of claim 4 further comprising performing said stapling and cutting simultaneously.

7. A method for endolumenally resectioning lumenal tissue by anastomosing the tissue with artificial fastening means, comprising:

a. inserting a tissue suturing and cutting instrument into a body lumen through a naturally occurring body orifice;

b. advancing said instrument within said lumen to an area of undesired lumenal tissue to be resectioned;

c. drawing said undesired lumenal tissue into a cutting zone associated with said instrument;

d. stapling said surrounding lumenal tissue to close an orifice which would otherwise result from removal of said undesired lumenal tissue;

e. cutting said undesired lumenal tissue from surrounding lumenal tissue;

;

f. performing said stapling and cutting simultaneously; and

g. simultaneous suturing and cutting is performed by moving a unitary suture advancer and tissue cutter along a predefined path transversely to direction of suture advancement.

8. The method of claim 7 wherein said path is at least partially straight.

9. The method of claim 7 wherein said path is at least partially curved.

10. The method of claim 7 wherein said path is of adjustably selectable length.

11. Apparatus for endolumenally removing a cylindrical wall section of undesired lumenal tissue and circumferentially securing remaining lumenal wall tissue from either side about the site of said cylindrical removal, comprising:

a. a movable ramp for

i. fastening together circular margins of lumenal tissue which are adjacent to said undesired cylindrical lumenal tissue to prevent creation of a breach in said lumen which would otherwise be created upon removal of said undesired cylindrical lumenal tissue; and

ii. cutting said undesired cylindrical lumenal tissue from said lumen radially inboard of said fastened together circular margins

wherein said tissue fastening and cutting means cuts said tissue simultaneously around the entire 360 degrees of said circular margin.

12. Apparatus for endolumenally removing a cylindrical wall section of undesired lumenal tissue and circumferentially securing remaining lumenal wall tissue from either side about the site of said cylindrical removal, comprising:

a. a movable ramp for,

i. fastening together circular margins of lumenal tissue which are adjacent to said undesired cylindrical lumenal tissue to prevent creation of a breach in said lumen which would otherwise be created upon removal of said undesired cylindrical lumenal tissue; and

ii. cutting said undesired cylindrical lumenal tissue from said lumen radially inboard of said fastened together circular margins wherein said tissue fastening and cutting means fastens said tissue simultaneously around the entire 360 degrees of said circular margin.

13. Apparatus of claim 12 wherein said tissue fastening and cutting means cuts said tissue simultaneously around the entire 360 degrees of said circular margin.

14. A method for endolumenally cylindrically resectioning lumenal tissue comprising:

a. inserting a tissue suturing and cutting instrument into a body lumen through a naturally occurring body orifice;

b. advancing said instrument within said lumen to an area of undesired lumenal tissue to be cylindrically resectioned;

c. drawing said undesired cylindrical lumenal tissue into an annular cutting zone of said instrument;

d. stapling said surrounding lumenal tissue about annular margins of said cylindrical tissue to close an orifice which would otherwise result from removal of said undesired lumenal tissue;

e. cutting said undesired cylindrical lumenal tissue from surrounding lumenal tissue; and

f. retaining the cut undesired cylindrical lumenal tissue within said instrument while withdrawing the instrument from the lumen through the naturally occurring orifice to maintain the cut undesired cylindrical lumenal tissue separated from healthy lumenal wall tissue.

15. A method for endolumenally cylindrically resectioning lumenal tissue comprising:

a. inserting a tissue suturing and cutting instrument into a body lumen through a naturally occurring body orifice;

b. advancing said instrument within said lumen to an area of undesired lumenal tissue to be cylindrically resectioned;

c. drawing said undesired cylindrical lumenal tissue into an annular cutting zone of said instrument,

d. stapling said surrounding lumenal tissue about annular margins of said cylindrical tissue to close an orifice which would otherwise result from removal of said undesired lumenal tissue;

e. cutting said undesired cylindrical lumenal tissue from surrounding lumenal tissue; and

f. stapling said tissue simultaneously around the entire 360 degrees of said circular margin.

16. The method of claim 15 further comprising cutting said tissue simultaneously around the entire 360 degrees of said circular margin.

17. A method for endolumenally cylindrically resectioning lumenal tissue comprising:

a. inserting a tissue suturing and cutting instrument into a body lumen through a naturally occurring body orifice;

b. advancing said instrument within said lumen to an area of undesired lumenal tissue to be cylindrically resectioned;

c. drawing said undesired cylindrical lumenal tissue into an annular cutting zone of said instrument;

d. stapling said surrounding lumenal tissue about annular margins of said cylindrical tissue to close an orifice which would otherwise result from removal of said undesired lumenal tissue;

e. cutting said undesired cylindrical lumenal tissue from surrounding lumenal tissue; and

f. cutting said tissue simultaneously around the entire 360 degrees of said circular margin.