Methods and devices for tissue reconfiguration

• US 6,773,441 B1
• Filed: 09/05/2000
• Issued: 08/10/2004
• 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., Cruz, Amos G., Laufer, Michael D.
• Primary Examiner(s): Woo, Julian W.
• Application Number:
  US09/654,655
• Time in Patent Office: 1,435 Days
• Field of Search: 606/153-155, 606/213, 606/219-221, 128/898
• 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 17/0401 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 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• 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
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0441 the shaft being a rigid coil or spiral
• 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 2017/061 : hollow or tubular
• CPC Class Codes: A61B 2017/0647 : having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0649 : Coils or spirals
• 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: A61M 25/0133 : Tip steering devices

Abstract

Methods and devices are provided for reconfiguring a tissue within a hollow body organ using an entirely endoscopic approach in order to effectively reduce flow of fluid contents into a second hollow body organ in fluid communication with the first.

Claims

1. A method of treatment, comprising:

engaging a plurality of regions of stomach tissue beyond the gastroesophlageal junction with a plurality of members from within the stomach, and

moving the plurality of members relatively toward one another to pinch the plurality of regions of stomach tissue together thereby reconfiguring tissue in a vicinity of a gastroesophageal junction.

2. The method of claim 1 wherein this moving further comprises forming a bulge in such tissue.

3. The method of claim 1 wherein the moving further comprises wrapping stomach tissue around an esophagus.

4. The method of claim 1 wherein the moving further comprises wrapping tissue around the gastroesophageal junction.

5. The method of claim 1 further comprising securing the engaged plurality of regions of stomach tissue together.

6. The method of claim 1 wherein the plurality of members includes first and second members and 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, the method further comprising moving a securing element of the first securing part into engagement with the second securing part to secure the second securing part t(o the first securing part.

7. The method of claim 1 further comprising pulling tissue located between the plurality of regions of stomach tissue prior to engaging the plurality of regions of stomach tissue.

8. The method of claim 1 further comprising measuring tissue pressure.

9. The method of claim 1 further comprising measuring yield pressure.

10. The method of claim 1 being effective to treat gastroesophageal reflux disease.

11. The method of claim 1 further comprising securing the reconfigured tissue.

12. The method of claim 11 wherein reconfiguring tissue comprises placing exterior surface regions of the stomach in apposition.

13. The method of claim 12 wherein securing the reconfigured tissue comprises securing the tissue such that the exterior surface regions are in apposition.

14. The method of claim 12 wherein securing the exterior surface regions in apposition includes delivering a tissue fixation device to the reconfigured tissue.

15. The method of claim 14 wherein delivering the tissue fixation device includes delivering while the members are engaging the tissue.

16. The method of claim 1 wherein engaging the plurality of regions of stomach tissue beyond the gastroesophageal junction comprises engaging the plurality of regions of stomach tissue near the gastroesophageal junction.

17. The method of claim 1 further comprising piercing stomach tissue.

18. The method of claim 1 wherein engaging the plurality of regions of stomach tissue includes piercing at least one of the plurality of regions of stomach tissue with at least one of the plurality of members.

19. The method of claim 1 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

20. The method of claim 1 wherein the reconfigured tissue is in the form of a tissue fold.

21. The method of claim 20 wherein reconfiguring tissue comprises piercing tissue with a first element on a side of the tissue fold.

22. The method of claim 21 further comprising commenting the first element to a second element on another side of the tissue fold.

23. A method of treatment, comprising:

engaging a plurality of regions of stomach tissue with a plurality of members from within the stomach,

moving the plurality of members relatively toward one another to wrap stomach tissue in a vicinity of a pastroesophapeal junction around the gastroesophageal junction, and

securing the engaged plurality of regions of tissue together.

24. The method of claim 23 wherein the moving further comprises forming a tissue bulge in such tissue.

25. The method of claim 23 wherein the moving further comprises wrapping tissue around the esophagus.

26. The method of claim 23 wherein the engaging tissue includes engaging stomach tissue beyond the gastroesophageal junction.

27. The method of claim 23 further comprising measuring tissue pressure.

28. The method of claim 23 further comprising measuring yield pressure.

29. The method of claim 23 being effective to treat gastroesophageal reflux disease.

30. The method of claim 23 wherein securing the engaged plurality of regions of tissue together comprises securing the stomach tissue such that exterior surface regions of the stomach are in apposition.

31. The method of claim 23 further comprising piercing stomach tissue.

32. The method of claim 23 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

33. A method of treatment, comprising:

engaging a plurality of regions of stomach tissue with a plurality of members from within the stomach, and

moving the plurality of members relatively toward one another to wrap stomach tissue in a vicinity of a gastroesophaizeal junction around the gastroesophageal junction,

wherein the plurality of members include first and second members and 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, the method further comprising 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.

34. The method of claim 33 further comprising securing the engaged plurality of regions of stomach tissue together.

35. The method of claim 34 wherein securing the engaged plurality of regions of stomach tissue comprises securing stomach tissue such that exterior surface regions of the stomach are in apposition.

36. The method of claim 33 further comprising pulling tissue located between the plurality of regions of stomach tissue prior to engaging the plurality of regions of stomach tissue.

37. The method of claim 33 being effective to treat gastroesophageal reflux disease.

38. The method of claim 33 further comprising piercing stomach tissue.

39. The method of claim 33 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

40. A method of treatment, comprising:

engaging a plurality of regions of stomach tissue with a plurality of members from within the stomach,

moving the plurality of members relatively toward one another to wrap stomach tissue in a vicinity of a gastroesophageal junction around the gastroesophageal junction, and

pulling tissue located between the plurality of regions of tissue prior to engaging the plurality of regions of tissue.

41. The method of claim 40 further comprising securing the engaged plurality of regions of stomach tissue together.

42. The method of claim 41 wherein securing the engaged plurality of regions of stomach tissue comprises securing stomach tissue such that exterior surface regions of the stomach tissue are in apposition.

43. The method of claim 40 being effective to treat gastroesophageal reflux disease.

44. The method of claim 40 further comprising piercing stomach tissue.

45. The method of claim 40 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

46. The method of claim 40 wherein securing the reconfigured tissue comprises securing the tissue such that exterior surface regions of the stomach are in apposition.

47. A method of treatment, comprising:

engaging a plurality of regions of tissue with a plurality of members from within the stomach, and

moving the plurality of members relatively toward one another to pinch the plurality of regions of tissue together in a non-intussuscepting manner thereby reconfiguring tissue in a vicinity of a gastroesophageal junction and securing the engaged plurality of regions of tissue with the plurality of members.

48. The method of claim 47 wherein the moving further comprises forming a bulge in such tissue.

49. The method of claim 47 wherein the moving further comprises wrapping stomach tissue around an esophagus.

50. The method of claim 47 wherein the moving further comprises wrapping tissue around the gastroesophageal junction.

51. The method of claim 47 wherein the plurality of members include first and second members and 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, the method further comprising 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.

52. The method of claim 47 wherein the engaging tissue includes engaging stomach tissue beyond the gastroesophageal junction.

53. The method of claim 47 further comprising pulling tissue located between the plurality of regions of tissue prior to engaging the plurality of regions of tissue.

54. The method of claim 47 further comprising measuring tissue pressure.

55. The method of claim 47 further comprising measuring yield pressure.

56. The method of claim 47 further comprising piercing stomach tissue.

57. The method of claim 47 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

58. A method of treatment, comprising:

engaging a plurality of regions of tissue with a plurality of members from within the stomach,

moving the plurality of members relatively toward one another circumferentially relative to a circumference of a gastroesophageal function to pinch the plurality of regions of tissue together thereby reconfiguring tissue in a vicinity of the gastroesophageal junction, and

securing the engaged plurality of regions of tissue together.

59. The method of claim 58 wherein the moving further comprises forming a bulge in such tissue.

60. The method of claim 58 wherein the moving further comprises wrapping stomach tissue around an esophagus.

61. The method of claim 58 wherein the moving further comprises wrapping tissue around the gastroesophageal junction.

62. The method of claim 58 wherein the engaging tissue includes engaging stomach tissue beyond an esophageal junction.

63. The method of claim 58 further comprising measuring tissue pressure.

64. The method of claim 58 wherein comprising measuring yield pressure.

65. The method of claim 58 being effective to treat gastroesophageal reflux disease.

66. The method of claim 58 wherein securing the engaged plurality of regions of tissue comprises securing the tissue such that exterior surface regions of the stomach are in apposition.

67. The method of claim 58 further comprising piercing stomach tissue.

68. The method of claim 58 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

69. A method of treatment, comprising:

engaging a plurality of regions of tissue with a plurality of members from within the stomach, and

moving the plurality of members relatively toward one another circumferentially relative to a circumference of a gastroesophageal junction to pinch the plurality of regions of tissue together thereby reconfiguring tissue in a vicinity of the gastroesophageal junction,

wherein the plurality of members include first and second members and 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, the method further comprising 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.

70. The method of claim 69 further comprising securing the engaged plurality of regions of stomach tissue together.

71. The method of claim 70 wherein securing the engaged plurality of regions of stomach tissue together comprises securing the tissue such that exterior surface regions of the stomach are in apposition.

72. The method of claim 69 further comprising pulling tissue located between the plurality of regions of stomach tissue prior to engaging the plurality of regions of stomach tissue.

73. The method of claim 69 being effective to treat gastroesophageal reflux disease.

74. The method of claim 69 further comprising piercing stomach tissue.

75. The method of claim 69 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

76. A method of treatment, comprising:

engaging a plurality of regions of tissue with a plurality of members from within the stomach,

moving the plurality of members relatively toward one another circumferentially relative to a circumference of a gastroesophageal junction to pinch the plurality of regions of tissue together thereby reconfiguring tissue in a vicinity of the pastroesophageal junction, and

pulling tissue located between the plurality of regions of tissue prior to engaging the plurality of regions of tissue.

77. The method of claim 76 further comprising securing the engaged plurality of regions of stomach tissue together.

78. The method of claim 77 wherein securing the engaged plurality of regions of stomach tissue comprises securing the tissue such that exterior surface regions of the stomach are in apposition.

79. The method of claim 76 being effective to treat gastroesophageal reflux disease.

80. The method of claim 76 further comprising piercing stomach tissue.

81. The method of claim 76 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

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

engaging a plurality of regions of tissue of the first organ beyond the junction with a plurality of members from within the first organ, and

moving the plurality of members relatively toward one another to pinch the plurality of regions of tissue of the first organ together thereby reconfiguring tissue in a vicinity of the junction.

83. The method of claim 82 wherein the moving further comprises forming a bulge in such tissue.

84. The method of claim 82 wherein the moving further comprises wrapping tissue of the first organ around the second organ.

85. The method of claim 82 wherein the moving further comprises wrapping tissue of the first organ around the junction.

86. The method of claim 82 further comprising securing the engaged plurality of regions of tissue together.

87. The method of claim 82 wherein the plurality of members includes first and second members and 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, the method further comprising 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.

88. The method of claim 82 wherein the junction comprises a region of transition between the organs and includes tissue of both organs.

89. The method of claim 82 further comprising pulling tissue located between the plurality of regions of tissue of the first organ prior to engaging the plurality of regions of tissue of the first organ.

90. The method of claim 82 further comprising measuring tissue pressure.

91. The method of claim 82 further comprising measuring yield pressure.

92. The method of claim 82 being effective to treat gastroesophageal reflux disease.

93. The method of claim 82 further comprising securing the reconfigured tissue.

94. The method of claim 93 wherein reconfiguring tissue comprises placing exterior surface regions of the first organ in apposition.

95. The method of claim 94 securing the reconfigured tissue comprises securing the tissue such that the exterior surface regions are in apposition.

96. The method of claim 95 wherein securing the exterior surface regions in apposition includes delivering a tissue fixation device to the reconfigured tissue.

97. The method of claim 96 wherein delivering the tissue fixation device includes delivering while the members are engaging the tissue.

98. The method of claim 82 wherein engaging the plurality of regions of tissue beyond the junction comprises engaging the plurality of regions of tissue near the junction.

99. The method of claim 82 further comprising piercing stomach tissue.

100. The method of claim 82 wherein engaging the plurality of regions of tissue includes piercing at least one of the plurality of regions of tissue with at least one of the plurality of members.

101. The method of claim 82 wherein the plurality of members include first and second members and further comprising pulling tissue between the members.

102. The method of claim 82 wherein the reconfigured tissues in the form of a tissue fold.

103. The method of claim 102 wherein reconfiguring tissue comprises piercing tissue with a first element on a side of the tissue fold.

104. The method of claim 103 further comprising connecting the first element to a second element on another side of the tissue fold.