Method for performing endoluminal fundoplication and apparatus for use in the method

• US 6,736,828 B1
• Filed: 09/29/2000
• Issued: 05/18/2004
• Est. Priority Date: 09/29/2000
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed, Inc. (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: Pugsley, Charles H. Jr., Adams, Ronald D.
• Primary Examiner(s): Milano, Michael J.
• Assistant Examiner(s): Baxter, Jessica R
• Application Number:
  US09/675,601
• Time in Patent Office: 1,327 Days
• Field of Search: 606/153, 606/21-221, 606/205, 128/898, 600/104
• US Class Current: 606/213
• 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 17/0643 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 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/2905 flexible

Abstract

A method and device for performing endoluminal fundoplication are described. A device is inserted in the patient'"'"'s stomach through the esophagus, including an unit adapted to grasp and pull a portion of the gastroesophageal junction into the stomach, and an unit adapted to move a portion of the fundus towards the esophagus. The device also can place fasteners to hold the gastric wall and the esophageal wall secured together, thus forming a valve between esophagus and stomach. An adhesive compound can be used to stabilize the juncture of the two walls.

Claims

1. A method for performing endoluminal fundoplication of a patient'"'"'s esophagus and stomach, comprising:

introducing an endoscopic device through the patient'"'"'s esophagus, the endoscopic device comprising an endoscope, a tissue displacement device, and a fastener delivery device;

forming an intussusception of the esophagus into the stomach by pressing against a fundus portion of the stomach towards the esophagus with the tissue displacement device;

placing a fastener across the intussusception with the fastener delivery device after the step of forming the intussusception so as to maintain an esophageal wall and a gastric wall adjacent to one another; and

injecting a bonding agent between the esophageal wall and the gastric wall.

2. The method according to claim 1, wherein the step of forming the intussusception further comprises pulling a selected portion of the esophagus into the stomach.

3. The method according to claim 2, wherein the step of pulling the selected portion of the esophagus into the stomach is performed by a grasping device, the grasping device being configured to extend from the endoscopic device and grasp and pull the selected portion of the esophagus into the stomach.

4. The method according to claim 1, further comprising removing the fastener after bonding the intussusception.

5. The method according to claim 1, further comprising extending the tissue displacement device from the endoscopic device.

6. The method according to claim 1, further comprising:

introducing through the esophagus and positioning the fastener delivery device adjacent to the intussusception at a desired fastening location; and

delivering the fastener from the fastener delivery device for placing the fastener across the intussusception.

7. The method according to claim 6, further comprising;

extending a hypotube from the fastener delivery device across the intussusception;

deploying a distal end of the fastener from the hypotube onto one of the stomach and esophageal sides;

withdrawing the hypotube from the intussusception; and

deploying a proximate end of the fastener onto the other of the stomach and esophageal sides to maintain the esophageal wall and the gastric wall adjacent to one another.

8. The method according to claim 7, wherein the deploying steps further comprise inflating bladders disposed at at least one of the distal and proximate ends of the fastener.

9. The method according to claim 8, further comprising successively positioning the fastener delivery device and delivering the fastener at selected positions around a circumference of the intussusception.

10. The method according to claim 7, wherein the deploying steps further comprise extending a deformable portion disposed at at least one of the distal and proximate ends of the fastener.

11. The method according to claim 6, further comprising repeating the positioning and delivering steps a selected number of times.

12. The method according to claim 1, further comprising extending from the endoscopic device the fastener delivery device for placing the fastener across the intussusception.

13. The method according to claim 1, wherein the injecting step further comprises injecting at least one of an adhesive and a sclerosant agent.

14. The method according to claim 1, wherein the tissue displacement device further comprises an anvil portion and a tissue displacing it portion pivotally coupled to the anvil portion, and wherein pressing against the fundus portion includes pivotally moving the tissue displacing portion with respect to the anvil portion of the tissue displacement device, such that the gastric wall and the esophageal wall are positioned between the anvil portion and the tissue displacing portion.

15. A method for performing endoluminal fundoplication of a patient'"'"'s body, comprising:

inserting an endoscopic device through a patient'"'"'s esophagus, the endoscopic device comprising an endoscope, a tissue displacement device, and a fastening device;

positioning the endoscopic device adjacent the gastroesophageal junction;

grasping a selected portion of the esophageal wall;

pressing a fundus wall of the stomach towards the esophageal wall with the tissue displacement device; and

inserting a fastener through the esophageal wall and the fundus wall with the fastening device, after pressing the fundus wall of the stomach towards the esophageal wall.

16. The method according to claim 15, further comprising injecting one of an adhesive agent and a sclerosant agent between the fundus wall and the esophageal wall.

17. The method according to claim 15, wherein the endoscopic device further comprises a grasping device, wherein the step of grasping the selected portion of the esophageal wall is performed with the grasping device.

18. The method according to claim 15, wherein the endoscopic device includes an overtube having at least one channel for accommodating at least one of the endoscope and the tissue displacement device.

19. The method according to claim 15, further comprising rotating the fastening device about an axis of the esophagus by a selected rotational angle and repeating the step of deploying the fastener.

20. The method according to claim 19, wherein the rotating step comprises rotating the fastening device by about 30 degrees.

21. The method according to claim 15, further comprising removing the fastener after bonding of the fundus wall to the esophageal wall.

22. The method according to claim 15, further comprising pulling the grasped selected portion of the esophagus into the stomach.

23. The method according to claim 15, further comprising;

extending a hypotube from the fastening device across the esophageal wall and the fundus wall;

deploying a distal end of the fastener from the hypotube onto one of stomach and esophageal sides;

withdrawing the hypotube from the esophageal wall and the fundus wall; and

deploying a proximate end of the fastener onto the other of the stomach and esophageal sides to maintain the esophageal wall and the fundus wall adjacent to one another.