Tissue reconfiguration

• US 6,821,285 B2
• Filed: 05/18/2001
• Issued: 11/23/2004
• 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: Andrews, Richard, Chinnock, Randall B., Marshall, Neal H., Cruz, Amos, Barenboym, Michael, Chuttani, Ram, Puicci, Vincent A. Jr., OʼKeefe, Jonathan, Cerier, Jeffrey C., Laufer, Michael D.
• Primary Examiner(s): Woo, Julian W.
• Application Number:
  US09/859,579
• Publication Number:
  US 20020040226A1
• Time in Patent Office: 1,285 Days
• Field of Search: 606/153-158, 606/139, 606/142, 606/143, 606/144, 606/148, 606/216, 606/219, 606/221, 606/108, 606/151, 600/104, 227/175.1
• 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 2017/00314 Separate linked members
• 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 2017/0458 : 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
• CPC Class Codes: A61B 2017/061 : hollow or tubular
• 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

A medical instrument for engaging tissue includes a flexible shaft, a tissue piercing coil at a distal portion of the shaft, and a tissue stabilizer positioned over the shaft and biased in a distal direction such that as the tissue piercing coil enters tissue, the tissue stabilizer is urged against a surface of the tissue. A medical instrument for reconfiguring tissue includes a flexible shaft defining a lumen housing actuating controls, and a distal actuating assembly with a sealing portion configured to substantially seal the shaft lumen from contact with bodily fluids. A cartridge assembly includes first and second members configured for releasable attachment to a medical instrument, and a holder configured to receive the first and second members and to be released from the first and second members upon action of the first and second members attaching to the medical instrument.

Claims

1. A medical device, comprising:

first and second members each including a body having a first attachment portion and a second attachment portion,

the first attachment portion having a proximal portion, a distal portion, a first wall between the proximal and distal portions, and a second wall between the proximal and distal portions, wherein the first wall defines a slot therein and the second wall defines an opening therein having a straight, proximal edge, the slot and the opening for releasably attaching the body to a distal portion of a medical instrument such that the body can be exchanged with a replacement body,

the second attachment portion being configured to releasably receive an implant.

2. The medical device of claim 1 wherein the first attachment portion includes a flexing section between the side wall and the mating contour.

3. The medical device of claim 1 wherein the second portion includes tubes configured to pass through tissue.

4. A medical device, comprising:

an implant including a suture thread, and

first and second members configured to releasably attach to a distal portion of a medical instrument such that the members can be exchanged with replacement members, at least one of the members being configured to releasably receive the implant for delivery of the implant to a treatment site.

5. The medical device of claim 4 wherein the members each include a wall defining a slot for attaching the member to the medical instrument.

6. The medical device of claim 4 wherein the members each include a mating contour having a flat, proximal edge for attaching the member to the medical instrument.

7. The medical device of claim 6 wherein the mating contour comprises an opening.

8. The medical device of claim 4 wherein the members each include a flexing section.

9. The medical device of claim 4 wherein the members each include tubes configured to pass through tissue to which the implant is coupled.

10. The medical device of claim 4 wherein the suture has a predetermined length.

11. The medical device of claim 4 wherein the members and the implant are configured for remote deployment of the implant at the treatment site with the implant maintaining a pre-deployment shape.

12. A medical instrument, comprising:

a flexible shaft,

an implant including a suture thread, and

first and second members coupled to a distal end of the shaft and configured to releasably receive the implant for remote deployment of the implant at the treatment site with the implant maintaining a pre-deployment shape.

13. A medical device, comprising:

a body sized to be entirely received within an organ of a patient, the body having a first portion configured for releasable coupling to an actuating member having a width dimension, a thickness dimension, and a length dimension, the width dimension being transverse to a direction of actuation of the actuating member, and a second portion configured to receive an implant to be deployed within the patient, the first portion including;

an opening for receiving the actuating member, and

a slot configured to receive the actuating member, the slot being spaced from the opening in a direction corresponding to the width dimension of the actuating member.

14. An apparatus comprising:

first and second members configured to be operable at a distal portion of a flexible device, the first member including an implant having two rigid portions coupled by a flexible portion, the first and second members configured to interact to deploy the implant in a patient such that the rigid portions are deployed at a fixed relative distance predetermined by at least one of the members.

15. The apparatus of claim 14 wherein the flexible portion is formed of a material different than that of the rigid portions.

16. The apparatus of claim 14 wherein the flexible portion comprises suture.

17. The apparatus of claim 14 wherein the rigid portions each define a hole for receiving the flexible portion.

18. The apparatus of claim 14 wherein the second member includes a part of the implant.

19. The apparatus of claim 14 wherein the first member defines channels for receiving the rigid portions at the predetermined relative distance.

20. The apparatus of claim 19 wherein the first member further comprises tissue piercing elements defining the channels.

21. The apparatus of claim 20 wherein the second member defines apertures for receiving the tissue piercing elements.

22. The apparatus of claim 14 wherein the rigid portions are coupled to the first member at the predetermined fixed relative distance.

23. The apparatus of claim 14 wherein the rigid portions are configured for piercing tissue.

24. The apparatus of claim 14 wherein the rigid portions are frangibly connected to the first member.

25. The apparatus of claim 14 wherein the rigid portions are connected to the first member by one of a press fit, crimp, or spot laser welding.

26. The apparatus of claim 14 wherein the second member is configured to separate the rigid portions from the first member.

27. An apparatus comprising:

a member configured to pierce body tissue and including an implant having rigid portions connected by a flexible portion, the member configured to be operable at a distal portion of a flexible device to deploy the rigid portions of the implant through the body tissue at a fixed relative distance predetermined by the member.

28. The apparatus of claim 27 wherein the flexible portion is formed of a material different than that of the rigid portions.

29. The apparatus of claim 27 wherein the flexible portion comprises suture.

30. The apparatus of claim 27 wherein the rigid portions each define a hole for receiving the flexible member.

31. The apparatus of claim 27 further comprising a second member including a part of the implant.

32. The apparatus of claim 27 wherein the fixed member defines channels for receiving the rigid portions at the predetermined fixed relative distance.

33. The apparatus of claim 32 wherein the member further comprises elements defining the channels, the elements being configured to pierce body tissue.

34. The apparatus of claim 33 further comprising a second member defining apertures for receiving the elements.

35. The apparatus of claim 27 wherein the rigid portions components are connected to the member at the predetermined relative distance.

36. The apparatus of claim 27 wherein the rigid portions are configured to pierce body tissue.

37. The apparatus of claim 27 wherein the rigid portions are frangibly connected to the member.

38. The apparatus of claim 27 wherein the rigid portions are connected to the member by one of a press fit, crimp, or spot laser welding.

39. The apparatus of claim 27 further comprising a second member configured to separate the rigid portions from the first member.

40. An apparatus comprising:

two tissue piercing elements,

an implant including rigid portions connected by a flexible portion, the rigid and flexible portions being made from different materials, wherein the tissue piercing elements are configured to deploy the rigid portions of the implant through body tissue, the tissue piercing elements defining channels for receiving the rigid portions.

41. An apparatus comprising:

two tissue piercing elements,

an implant including rigid portions connected by a flexible portion, the rigid and flexible portions being made from different materials, wherein the tissue piercing elements are configured to deploy the rigid portions of the implant through body tissue, the rigid portions forming a distal portion of the tissue piercing elements.

42. The apparatus of claim 41 wherein the rigid portions are frangibly connected to the remainder of the tissue piercing elements.

43. The apparatus of claim 41 wherein the rigid portions are connected to the remainder of the tissue piercing elements by one of a press fit, crimp, or spot laser welding.

44. An apparatus comprising:

two tissue piercing elements, and

an implant including rigid portions connected by suture, the rigid portions forming a distal portion of the tissue piercing elements and being frangibly connected to the remainder of the tissue piercing elements, wherein the tissue piercing elements are configured to deploy the rigid portions of the implant through body tissue.

45. An apparatus comprising:

two tissue piercing elements, and

an implant including rigid portions connected by suture, the rigid portions forming a distal portion of the tissue piercing elements and being connected to the remainder of the tissue piercing elements by one of a press fit, crimp, or spot laser welding, wherein the tissue piercing elements are configured to deploy the rigid portions of the implant through body tissue.

46. A medical device, comprising:

first and second members each including a body having a first attachment portion and a second attachment portion,

the first attachment portion including a member with a side wall defining a slot and a mating contour having a straight, proximal edge, the slot and the mating contour for releasably attaching the body to a distal portion of a medical instrument such that the body can be exchanged with a replacement body,

the second attachment portion including tubes configured to pass through tissue and being configured to releasably receive an implant.

47. A medical device, comprising:

an implant including a suture, and

first and second members configured to releasably attach to a distal portion of a medical instrument such that the members can be exchanged with replacement members, at least one of the members being configured to releasably receive the implant for delivery of the in plant to a treatment site, the members each including tubes configured to pass through tissue to which the implant is coupled.

48. An apparatus comprising:

first and second members configured to be operable at a distal portion of a flexible device, the first member including an implant having two rigid portions coupled by at flexible portion, the first and second members configured to interact to deploy the implant in a patient such that the rigid portions are deployed at a predetermined relative distance, wherein the first member defines channels for receiving the rigid portions at the predetermined relative distance.

49. The apparatus of claim 48 wherein the first member further comprises tissue piercing elements defining the channels.

50. The apparatus of claim 49 wherein the second member defines apertures for receiving the tissue piercing elements.

51. An apparatus comprising:

first and second members configured to be operable at a distal portion of a flexible device, the first member including an implant having two rigid portions coupled by a flexible portion, the rigid portions being configured for piercing tissue, the first and second members configured to interact to deploy the implant in a patient such that the rigid portions are deployed at a predetermined relative distance.

52. An apparatus comprising:

first and second members configured to be operable at a distal portion of a flexible device, the first member including an implant having two rigid portions coupled by a flexible portion, the rigid portions being frangibly connected to the first member, the first and second members configured to interact to deploy the implant in a patient such that the rigid portions are deployed at a predetermined relative distance.

53. An apparatus comprising:

first and second members configured to be operable at a distal portion of a flexible device, the first member including an implant having two rigid portions coupled by a flexible portion, the rigid portions being connected to the first member by one of a press fit, crimp, or spot laser welding, the first and second members configured to interact to deploy the implant in a patient such that the rigid portions are deployed at a predetermined relative distance.

54. An apparatus comprising:

first and second members configured to be operable at a distal portion of a flexible device, the first member including an implant having two rigid portions coupled by a flexible portion, the first and second members configured to interact to deploy the implant in a patient such that the rigid portions arc deployed at a predetermined relative distance, wherein the second member is configured to separate the rigid portions from the first member.

55. An apparatus comprising:

a member configured to pierce body tissue and including an implant having rigid portions connected by a flexible portion, the member configured to be operable at a distal portion of a flexible device to deploy the rigid portions of the implant through the body tissue at a predetermined relative distance, wherein the first member defines channels for receiving the rigid portions components at the predetermined relative distance.

56. The apparatus of claim 55 wherein the first member further comprises elements defining the channels, the elements being configured to pierce body tissue.

57. The apparatus of claim 56 wherein the second member defines apertures for receiving the elements.

58. An apparatus comprising:

a member configured to pierce body tissue and including an implant having rigid portions connected by a flexible portion, the rigid portions being configured to pierce body tissue, the member configured to be operable at a distal portion of a flexible device to deploy the rigid portions of the implant through the body tissue at a predetermined relative distance.

59. An apparatus comprising:

a member configured to pierce body tissue and including an implant having rigid portions connected by a flexible portion, the rigid portions being frangibly connected to the member, the member configured to be operable at a distal portion of a flexible device to deploy the rigid portions of the implant through the body tissue at a predetermined relative distance.

60. An apparatus comprising:

a member configured to pierce body tissue and including an implant having rigid portions connected by a flexible portion, the rigid portions being connected to the first member by one of a press fit, crimp, or spot laser welding, the member configured to be operable at a distal portion of a flexible device to deploy the rigid portions of the implant through the body tissue at a predetermined relative distance.

61. An apparatus comprising:

a member configured to pierce body tissue and including an implant having rigid portions connected by a flexible portion, the member configured to be operable at a distal portion of a flexible device to deploy the rigid portions of the implant through the body tissue at a predetermined relative distance, and

a second member configured to separate the rigid portions from the first member.