Tissue reconfiguration

• US 7,153,314 B2
• Filed: 08/16/2002
• Issued: 12/26/2006
• Est. Priority Date: 06/22/1999
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ndo Surgical
• Inventors: Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos G.
• Primary Examiner(s): Woo, Julian W.
• Application Number:
  US10/219,258
• Publication Number:
  US 20020193816A1
• Time in Patent Office: 1,593 Days
• Field of Search: 606/153, 606/219, 606/220, 606/221, 606/232, 606/144, 606/148, 606/150, 606/151, 227/175.1, 600/104, 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 17/0218 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
• 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
• 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

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 transverse to the first plane such that the distal end effector is retroflexed out of alignment with the elongated member; and

a tissue piercing element coupled with the first member;

wherein the distal end effector further includes a third member configured to engage stomach tissue, the third member being movable in a distal direction relative to the first and second members, wherein the third member includes a tissue engaging portion, the tissue engaging portion comprising a coil having a tissue penetrating tip.

2. 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 such that the distal end effector is retroflexed out of alignment with the elongated member;

a tissue piercing element coupled with the first member; and

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

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.

3. The apparatus of claim 2 wherein the securing element is configured for deployment from the first member.

4. The apparatus of claim 2 wherein the first member includes a deploying element for deploying the securing element from the first member.

5. 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 such that the distal end effector is retroflexed out of alignment with the elongated member; and

a tissue piercing element coupled with the first member, wherein the tissue piercing element defines a channel for receiving a securing element.

6. 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 such that the distal end effector is retroflexed out of alignment with the elongated member; and

a tissue piercing element coupled with the first member;

wherein the first member includes a second tissue piercing element.

7. The apparatus of claim 6 wherein the second tissue piercing element defines a channel for receiving a securing element.

8. 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;

moving the distal end effector relative to the elongated member in a second plane generally transverse to the first plane such that the distal end effector is retroflexed out of alignment with the elongated member to position the first and second members for engagement with the tissue;

piercing tissue with a tissue piercing element associated with the first member; and

engaging tissue by moving the first and second members relatively toward one another generally in the first plane;

wherein 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.

9. The method of claim 8 further comprising deploying the securing element through the tissue piercing element.

10. The method of claim 8 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.

11. 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;

moving the distal end effector relative to the elongated member in a second plane generally transverse to the first plane such that the distal end effector is retroflexed out of alignment with the elongated member to position the first and second members for engagement with the tissue;

piercing tissue with a tissue piercing element associated with the first member; and

piercing the tissue with a third member of the distal end effector prior to engaging the tissue with the first and second members.

12. 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 pinch the plurality of regions of engaged stomach tissue together thereby reconfiguring tissue in a vicinity of a gastroesophageal junction; and

securing the engaged plurality of regions of stomach tissue together by deploying two securing elements connected by suture through the engaged plurality of regions of stomach tissue.

13. 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 to wrap tissue in a vicinity of a gastroesophageal junction around the gastroesophageal junction; and

securing the engaged plurality of regions of tissue together by deploying two securing elements connected by suture through the engaged plurality of regions of tissue.

14. 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 to pinch the plurality of regions of engaged 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 together by deploying two securing elements connected by suture through the engaged plurality of regions of tissue.

15. 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 to circumferentially relative to a circumference of a gastroesophageal junction to pinch the plurality of regions of engaged tissue together thereby reconfiguring tissue in a vicinity of the gastroesophageal junction; and

securing the engaged plurality of regions of tissue together by deploying two securing elements connected by suture through the engaged plurality of regions of tissue.

16. 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 with a plurality of members from within the first organ;

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

securing the engaged plurality of regions of tissue together by deploying two securing elements connected by suture through the engaged plurality of regions of tissue.