Tissue reconfiguration

• US 6,494,888 B1
• Filed: 05/19/2000
• Issued: 12/17/2002
• Est. Priority Date: 06/22/1999
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: NDO Surgical, Inc.
• Inventors: Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos G.
• Primary Examiner(s): Reip, David O.
• Assistant Examiner(s): Woo, Julian W.
• Application Number:
  US09/574,424
• Time in Patent Office: 942 Days
• Field of Search: 606/219-221, 606/232, 606/144, 606/148, 606/150, 606/153, 600/104
• US Class Current: 606/153
• 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 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• 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 17/0686 having a forming anvil staying below the tissue during stapling
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• 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 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0458 : Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 : for soft tissue
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/06052 : Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/061 : hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/2905 : flexible
• CPC Class Codes: A61B 2017/2915 : arcuate shaped guiding means
• CPC Class Codes: A61B 2017/2916 : pins in guiding slots
• CPC Class Codes: A61B 2017/2917 : with flexible part
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2932 : Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/308 : with suction cups
• CPC Class Codes: A61B 2090/065 : for measuring contact or contact pressure
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires

Abstract

An apparatus includes an elongated member configured for transoral placement into a stomach, and a distal end effector including first and second members configured to engage stomach tissue, e.g., tissue beyond the: esophageal junction. The first and second members are movable relatively toward one another generally in a first plane, and the distal end effector is movable relative to the elongated member in a second plane generally transverse to the first plane. A third member of the distal end effector is configured to engage stomach tissue. The third member is movable in a distal direction relative to the first and second members. A tissue securement member of the apparatus is coupled to at least one of the first and second members for securing together tissue engaged thereby. The tissue securement member includes first and second parts, a suture attached to the first part, and a securing element attached to the suture and configured for engagement with the second part when the first and second members move relatively toward one another to engage tissue, to thereby secure the second part to the first part.

Claims

1. Apparatus comprising:

an elongated member configured for transoral placement into a stomach,

a distal end effector including first and second members configured to engage stomach tissue, the first and second members being movable relatively toward one another generally in a first plane, the distal end effector being movable relative to the elongated member in a second plane generally perpendicular to the first plane, the first member including first and second tissue piercing elements each defining a channel,

a third member including a tissue engaging portion for engaging stomach tissue, the third member being movable in a distal direction relative to the first and second members, and

a tissue securement member including a first part for coupling to the first member for engagement with a first tissue section, a second part for coupling to the second member for engagement with a second tissue section to be secured to the first tissue section, a suture attached to the first part, and first and second securing elements attached to the suture and deployable through the channels of the first and second tissue piercing elements for engagement with the second part when the first and second members move relatively toward one another to engage the first and second tissue sections, thereby to secure the second part to the first part.

2. A method of treatment, comprising:

engaging first and second regions of stomach tissue with first and second members from within the stomach, and

moving the first and second members relatively toward one another to pinch the first and second regions of stomach tissue together thereby reconfiguring tissue in a vicinity of a gastroesophageal junction, the moving of the first and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part and causes a tissue piercing element of the first member to pierce tissue, and

moving a securing element of the first securing part into engagement with the second securing part by deploying the securing element through the tissue piercing element to secure the second securing part to the first securing part.

3. The method of claim 2 wherein the moving of the first and second members causes a second tissue piercing element of the first member to pierce tissue, the method further comprising deploying a second element of the securing element through the second tissue piercing element.

4. A method of treatment, comprising:

engaging first and second regions of tissue with first and second members from within the stomach,

moving the first and second members relatively toward one another to wrap tissue in a vicinity of a gastroesophageal junction around the gastroesophageal junction, the moving of the first and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part and causes a tissue piercing element of the first member to pierce tissue, and

moving a securing element of the first securing part into engagement with the second securing part by deploying the securing element through the tissue piercing element to secure the second securing part to the first securing part.

5. The method of claim 4 wherein the moving of the first and second members causes a second tissue piercing element of the first member to pierce tissue, the method further comprising deploying a second element of the securing element through the second tissue piercing element.

6. A method of treatment, comprising:

engaging first and second regions of tissue with first and second members from within the stomach, and

moving the first and second members relatively toward one another to pinch the first and second regions of tissue together in a non-intussuscepting manner thereby reconfiguring tissue in a vicinity of a gastroesophageal junction, the moving of the first and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part and causes a tissue piercing element of the first member to pierce tissue, and

moving a securing element of the first securing part into engagement with the second securing part by deploying the securing element through the tissue piercing element to secure the second securing part to the first securing part.

7. The method of claim 6 wherein the moving of the first and second members causes a second tissue piercing element of the first member to pierce tissue, the method further comprising deploying a second element of the securing element through the second tissue piercing element.

8. A method of treatment, comprising:

engaging first and second regions of tissue with first and second members from within the stomach,

moving the first and second members relatively toward one another circumferentially relative to a circumference of a gastroesophageal junction to pinch the first and second regions of tissue together thereby reconfiguring tissue in a vicinity of the gastroesophageal junction, the moving of the first and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part and causes a tissue piercing element of the first member to pierce tissue, and

moving a securing element of the first securing part into engagement with the second securing part by deploying the securing element through the tissue piercing element to secure the second securing part to the first securing part.

9. The method of claim 8 wherein the moving of the first and second members causes a second tissue piercing element of the first member to pierce tissue, the method further comprising deploying a second element of the securing element through the second tissue piercing element.

10. A method of reconfiguring tissue in the vicinity of a junction between first and second hollow organs, comprising:

engaging first and second regions of tissue of the first organ with first and second members from within the first organ,

moving the first and second members relatively toward one another to pinch the first and second regions of tissue of the first organ together thereby reconfiguring tissue in a vicinity of the junction, the moving of the first and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part and causes a tissue piercing element of the first member to pierce tissue, and

moving a securing element of the first securing part into engagement with the second securing part by deploying the securing element through the tissue piercing element to secure the second securing part to the first securing part.

11. The method of claim 10 wherein the moving of the first and second members causes a second tissue piercing element of the first member to pierce tissue, the method further comprising deploying a second element of the securing element through the second tissue piercing element.

12. Apparatus comprising:

an elongated member configured for transoral placement into a stomach,

a distal end effector including first and second members configured to engage stomach tissue, the first and second members being movable relatively toward one another generally in a first plane, the distal end effector being movable relative to the elongated member in a second plane generally transverse to the first plane, and a third member configured to engage stomach tissue, the third member being movable in a distal direction relative to the first and second members, the third member having a tissue engaging portion including a coil with a tissue penetrating tip.

13. The apparatus of claim 12 wherein the second plane is generally perpendicular to the first plane.

14. The apparatus of claim 12 wherein the distal end effector is configured for movement between a first position generally aligned with the elongated member and a second position in which the distal end effector has moved in the second plane out of alignment with the elongated member.

15. The apparatus of claim 14 further including a cable actuatable from a proximal end of the apparatus and coupled to the distal end effector for moving the distal end effector in the second plane.

16. The apparatus of claim 12 further including a cable actuatable from a proximal end of the apparatus and coupled to the distal end effector for moving the first and second members generally in the first plane.

17. The apparatus of claim 12 wherein the elongated member defines a channel for receiving an endoscope.

18. Apparatus comprising:

an elongated member configured for transoral placement into a stomach,

a distal end effector including first and second members configured to engage stomach tissue, the first and second members being movable relatively toward one another generally in a first plane, the distal end effector being movable relative to the elongated member in a second plane generally transverse to the first plane, and

a tissue securement member for coupling to at least one of the first and second members for securing together tissue engaged thereby.

19. The apparatus of claim 18 wherein the tissue securement member comprises

a first part for coupling to the first member for engagement with a first tissue section,

a second part for coupling to the second member for engagement with a second tissue section to be secured to the first tissue section,

a suture attached to the first part, and

a securing element attached to the suture and configured for engagement with the second part when the first and second members are moved relatively toward one another to engage the first and second tissue sections, thereby to secure the second part to the first part.

20. The apparatus of claim 19 wherein the securing element is configured for deployment from the first member.

21. The apparatus of claim 19 wherein the first member includes a deploying element for deploying the securing element from the first member.

22. The apparatus of claim 18 wherein the second plane is generally perpendicular to the first plane.

23. The apparatus of claim 18 wherein the distal end effector is configured for movement between a first position generally aligned with the elongated member and a second position in which the distal end effector has moved in the second plane out of alignment with the elongated member.

24. The apparatus of claim 23 further including a cable actuatable from a proximal end of the apparatus and coupled to the distal end effector for moving the distal end effector in the second plane.

25. The apparatus of claim 18 further including a cable actuatable from a proximal end of the apparatus and coupled to the distal end effector for moving the first and second members generally in the first plane.

26. The apparatus of claim 18 wherein the elongated member defines a channel for receiving an endoscope.

27. Apparatus comprising:

an elongated member configured for transoral placement into a stomach, and

a distal end effector including first and second members configured to engage stomach tissue, the first and second members being movable relatively toward one another generally in a first plane, the distal end effector being movable relative to the elongated member in a second plane generally transverse to the first plane, the first member including a tissue piercing element.

28. The apparatus of claim 27 wherein the tissue piercing element defines a channel for receiving a securing element.

29. The apparatus of claim 27 wherein the first member includes a second tissue piercing element.

30. The apparatus of claim 29 wherein the second tissue piercing element defines a channel for receiving a securing element.

31. The apparatus of claim 27 wherein the second plane is generally perpendicular to the first plane.

32. The apparatus of claim 27 wherein the distal end effector is configured for movement between a first position generally aligned with the elongated member and a second position in which the distal end effector has moved in the second plane out of alignment with the elongated member.

33. The apparatus of claim 32 further including a cable actuatable from a proximal end of the apparatus and coupled to the distal end effector for moving the distal end effector in the second plane.

34. The apparatus of claim 27 further including a cable actuatable from a proximal end of the apparatus and coupled to the distal end effector for moving the first and second members generally in the first plane.

35. The apparatus of claim 27 wherein the elongated member defines a channel for receiving an endoscope.

36. A method comprising:

advancing an apparatus including an elongated member transorally into the stomach, the apparatus including a distal end effector having first and second members configured to engage stomach tissue, the first and second members being movable relatively toward one another generally in a first plane,

then moving the distal end effector relative to the elongated member in a second plane generally transverse to the first plane to position the first and second members for engagement with the tissue,

engaging tissue by moving the first and second members relatively toward one another generally in the first plane, wherein the moving of the fist and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part, and

moving a securing element of the first securing part into engagement with the second securing part to secure the second securing part to the first securing part.

37. The method of claim 36 wherein the moving of the first and second members causes a tissue piercing element of the first member to pierce tissue, the method further comprising deploying the securing element through the tissue piercing element.

38. The method of claim 36 wherein the moving of the first and second members causes first and second tissue piercing elements of the first member to pierce tissue, the method further comprising deploying first and second elements of the securing element each through one of the first and second tissue piercing elements.

39. The method of claim 36 wherein the engaging tissue includes engaging stomach tissue beyond an esophageal junction.

40. The method of claim 36 further comprising piercing the tissue with a third member of the distal end effector prior to engaging the tissue with the first and second members.

41. The method of claim 36 wherein the moving of the distal end effector relative to the elongated member includes moving the distal end effector in the second plane generally perpendicular to the first plane.