Surgical apparatus and method

• US 6,264,086 B1
• Filed: 12/10/1997
• Issued: 07/24/2001
• 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): DAWSON, GLENN K
• Application Number:
  US08/988,052
• Time in Patent Office: 1,322 Days
• Field of Search: 606/1, 606/110, 606/113, 606/114, 606/139, 606/142, 606/143, 606/144, 606/148, 606/150, 606/167, 606/120, 606/219, 606/220, 227/19, 227/175.1, 227/182.1, 600/141, 600/142, 600/146, 600/147
• US Class Current: 227/180.1
• 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 17/07207 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 device, 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. 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 lumen of a body 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 prevent formation of an orifice;

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

2. The method of claim 1 wherein said tissue drawing step further comprises:

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

b. 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;

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

said cutting step further comprises;

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

3. The method of claim 2 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.

4. The method of claim 1 further comprising performing said stapling and cutting simultaneously.

5. The method of claim 4 wherein simultaneous suturing and cutting is performed by moving a unitary suture advancer and tissue cutter along a predefined path transversely to the direction of suture advancement.

6. The method of claim 5 wherein said path is at least partially straight.

7. The method of claim 5 wherein said path is at least partially curved.

8. The method of claim 5 wherein said path is of adjustably selectable length.

9. Apparatus for endolumenally resectioning diseased lumenal tissue and reanastomizing remaining lumenal tissue with fastening means, comprising;

a. means for gripping lumenal tissue on respective sides of said diseased tissue and pulling said gripped tissue and said diseased tissue surrounded thereby into a cutting zone removed from an undisturbed position of said lumenal tissue;

b. means for detaching said diseased lumenal tissue from surrounding healthy lumenal tissues; and

c. means for fastening healthy lumenal tissue together across an aperture therein created by detachment of said diseased lumenal tissue from said healthy lumenal tissue, to close said aperture.

10. The apparatus of claim 9 wherein said tissue fastening means further comprises:

a. a plurality of staples;

b. a movable ramp for serially driving individual ones of said staples through lumenal tissue portions to be fastened together.

11. Apparatus for advancing an endolumenal operating capsule along and within a body lumen by transmitting manually applied force thereto along a curvilinear path, connecting said capsule to an operator control module external of the body and transmitting control signals from said control module to said operating capsule, comprising:

i. a pair of annularly spaced flexible inner and outer tubular sheaths;

ii. a plurality of serially engaging conical disks between said inner and outer sheaths, each disk comprising a plurality of radial apertures being adapted for residence of operating control signal transmission means therein, for transmitting axial force sequentially one to another as said apparatus bends to define said curvilinear path while limiting such curvilinear bending of said apparatus to a preselected degree;

iii. longitudinally elongated means, extending the length of said apparatus and resident within the apertures of said disks, for transmitting said control signals from said control module to said operating capsule.

12. Apparatus of claim 11 wherein each disk further comprises:

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

i. an annular flange at the base of said conical portion;

ii. 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;

iii. said flange having said plurality of radial apertures therein extending radially inwardly from the flange periphery.

13. Apparatus for intralumenally removing undesirable tissue from a lumen wall, comprising:

a. an endolumenal operating capsule comprising;

i. a lip extending along a longitudinally elongated portion of said capsule;

ii. stapling means resident in said lip for passing through tissue layers positioned on said lip and thereby securing said tissue layers together;

iii. staple advancement and tissue cutting means movable along said lip, for advancing said stapling means through said tissue thereby effectuating securement of said tissue and cutting said tissue layers inboard of said tissue securement;

b. tubular apparatus for positioning said capsule along and within said lumen by transmitting manually applied force thereto along a curvilinear path as said tubular apparatus bends to define said curvilinear path while limiting such curvilinear bending of said tubular apparatus to a preselected degree, said tubular apparatus connecting said capsule to an operator control module external of the body and transmitting control signals from said control module to said operating capsule, comprising;

i. a pair of annularly spaced flexible inner and outer tubular sheaths;

ii. longitudinally elongated means, extending the length of said tubular apparatus between said inner and outer sheaths, for transmitting said control signals from said control module to said operating capsule;

iii. means between said inner and outer sheaths for maintaining said longitudinally extending control signal transmission means in circumferentially spaced relation to one another and transmitting capsule positioning force along a curvilinear path as said tubular apparatus bends to define said curvilinear path while limiting such curvilinear bending of said tubular apparatus to a preselected degree;

c. said operator control module for converting operator tactile motions to signals controlling operation of said capsule for input to said control signal transmission means; and

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

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 associated with said instrument;

d. stapling said surrounding lumenal tissue about annular margins of said cylindrical tissue to prevent the formation of an orifice;

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

15. The method of claim 14 further comprising 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.

16. The method of claim 14 further comprising stapling said tissue simultaneously around the entire 360 degrees of said annular margins.

17. The method of claim 16 further comprising cutting said tissue simultaneously around the entire 360 degrees of said annular margins.

18. The method of claim 14 further comprising cutting said tissue simultaneously around the entire 360 degrees of said annular margins.

19. A surgical device, comprising:

an operating capsule, the operating capsule including a staple assembly and a knife assembly, the knife assembly including a substantially flat blade;

a control module; and

a flexible tube having a distal end and a proximal end, wherein the distal end is connected to the operating capsule and the proximal end is connected to the control module;

wherein the flexible tube includes an outer sheath, and wherein the surgical device further comprises an endoscope disposed within the outer sheath; and

wherein a plurality of disks are disposed within the outer sheath, wherein each of the plurality of disks is shaped substantially as a hollow cone, the hollow cone having in inner aperture.

20. The surgical device according to claim 19, wherein each of the plurality of disks includes a convex exterior surface and a concave interior surface.

21. The surgical device according to claim 20, wherein the flexible tube further includes an inner sheath, the inner sheath being at least partly disposed within the inner apertures of the plurality of disks.

22. A surgical device, comprising:

an operating capsule, the operating capsule including a staple assembly and a knife assembly, the knife assembly including a substantially flat blade;

a control module; and

a flexible tube having a distal end and a proximal end, wherein the distal end is connected to the operating capsule and the proximal end is connected to the control module;

wherein the flexible tube includes an outer sheath, and wherein the surgical device further comprises an endoscope disposed within the outer sheath; and

wherein a control wire is disposed within the flexible tube, wherein a proximal end of the control wire is connected to the control module and a distal end of the control wire is connected to the operating capsule, the control module actuating at least one of the staple assembly and the knife assembly via the control wire.

23. The surgical device according to claim 22, wherein the control module actuates the staple assembly and the knife assembly simultaneously.

24. The surgical device according to claim 22, wherein the flexible tube includes an outer sheath and a plurality of disks disposed within the outer sheath, the control wire being disposed within the outer sheath.

25. The surgical device according to claim 24, wherein each of the plurality of disks is shaped substantially as a hollow cone, the hollow cone having an inner aperture.

26. A surgical device, comprising:

an operating capsule, the operating capsule including a staple assembly and a knife assembly, the knife assembly including a substantially flat blade, the operating capsule further including at least one tissue clip;

a control module; and

a flexible tube having a distal end and a proximal end, wherein the distal end is connected to the operating capsule and the proximal end is connected to the control module;

wherein the flexible tube includes an outer sheath and a plurality of disks disposed within the outer sheath, and wherein the surgical device further comprises an endoscope disposed within the outer sheath and wherein each of the plurality of disks is shaped substantially as a hollow cone, the hollow cone having in inner aperture.

27. The surgical device according to claim 26, wherein each of the plurality of disks includes a convex exterior surface and a concave interior surface.

28. The surgical device according to claim 27, wherein the flexible tube further includes an inner sheath, the inner sheath being at least partly disposed within the inner apertures of the plurality of disks.

29. A surgical device, comprising:

an operating capsule, the operating capsule including a staple assembly and a knife assembly, the knife assembly including a substantially flat blade, the operating capsule further including at least one tissue clip;

a control module; and

a flexible tube having a distal end and a proximal end, wherein the distal end is connected to the operating capsule and the proximal end is connected to the control module; and

a control wire and clip cable, each being disposed within the flexible tube, wherein a proximal end of the control wire is connected to the control module and a distal end of the control wire is connected to the operating capsule, the control module actuating at least one of the staple assembly and the knife assembly via the control wire; and

wherein a proximal end of the clip cable is connected to the control module and a distal end of the clip cable is connected to the tissue clip, the control module actuating the tissue clip via the clip cable.

30. The surgical device according to claim 29, wherein the flexible tube includes an outer sheath and a plurality of disks disposed within the outer sheath, the control wire and clip cable being disposed within the outer sheath.

31. The surgical device according to claim 30, wherein each of the plurality of disks is shaped substantially as a hollow cone, the hollow cone having an inner aperture.