Apparatus for the endoluminal treatment of gastroesophageal reflux disease (GERD)

• US 7,232,445 B2
• Filed: 12/06/2001
• Issued: 06/19/2007
• Est. Priority Date: 12/06/2000
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: ID Company Limited
• Inventors: Kortenbach, Juergen A., Slater, Charles R., Sixto, Robert Jr., Smith, Kevin W., Gottlieb, Saul
• Primary Examiner(s): Nguyen; Anhtuan T.
• Assistant Examiner(s): EREZO, DARWIN P
• Application Number:
  US10/010,247
• Publication Number:
  US 20020068946A1
• Time in Patent Office: 2,021 Days
• Field of Search: 606/142, 606/143, 606/205, 606/207
• US Class Current: 606/142
• CPC Class Codes: A61B 1/00073 with externally grooved shaft
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
• CPC Class Codes: A61B 1/0014 Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 10/06 Biopsy forceps , e.g. with cup-shaped jaws
• 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 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 18/1445 at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
• CPC Class Codes: A61B 2017/00292 mounted on or guided by flexible, e.g. catheter-like, means
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00464 for use with different instruments
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/2936 Pins in guiding slots
• CPC Class Codes: A61B 2017/320064 with tissue or sample retaining means
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2090/306 : using optical fibres
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms

Abstract

An apparatus for the transoral invagination and fundoplication of the stomach to the esophagus includes a clip applier having sharp toothed jaws for grasping and damaging the fundus prior to applying the clip. The clip applier has an overall diameter of less than 7 mm. The clip applier jaws are coupled to a pull wire via a linkage which increases the mechanical advantage and thus permits greater grasping force. A plurality of clip designs are also provided.

Claims

1. A surgical clip applier for applying a surgical clip having two clip arms each with a longitudinal length and a substantially rectangular cross-section, the clip applier comprising:

a) a hollow member having a proximal end and a distal end;

b) a clevis coupled to said distal end of said hollow member;

c) a first jaw rotatably coupled to said clevis;

d) a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said first and second jaws having a respective longitudinal extent, at least one of said first and second jaws defining a clip-sliding channel;

extending substantially along said longitudinal extent;

having a rectangular cross-section substantially corresponding to the cross-section of one surgical clip arm;

having a longitudinal length greater than the longitudinal length of the one arm to define a clip-holding portion and a clip-sliding portion; and

slidably guiding the surgical clip longitudinally along said clip-sliding portion when said first and second jaws apply the surgical clip to tissue disposed therebetween;

e) at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member;

f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position, wherein

at least one of said jaws is provided with a plurality of teeth arranged to puncture and damage tissue adjacent to the surgical clip.

2. A surgical clip applier according to claim 1, wherein:

both of said jaws are provided with a plurality of teeth arranged to puncture and damage tissue adjacent two sides of the surgical clip.

3. A surgical clip applier according to claim 1, wherein at least one of said jaws has a clip guiding channel and a hook shaped anvil at the end of said channel.

4. A surgical clip applier according to claim 3, wherein each of said first and second jaws has said clip sliding channel and a hook shaped anvil at the end of said clip-sliding channel.

5. A surgical clip applier according to claim 4, wherein:

each of said anvils has a helical surface.

6. A surgical clip applier according to claim 4, wherein:

each of said anvils has a curved surface.

7. A surgical clip applier according to claim 6, wherein:

said surface is curved about a single axis.

8. A surgical clip applier according to claim 4, wherein:

each of said jaws has a longitudinal axis and a vertical axis perpendicular to the longitudinal axis, and

each of said channels is arranged at an angle relative to said vertical axis.

9. A surgical clip applier according to claim 8, wherein:

said angle is approximately 22 degrees.

10. A surgical clip applier for applying a surgical clip having two clip arms each with a longitudinal length and a substantially rectangular cross-section, the clip applier comprising:

a) a hollow member having a proximal end and a distal end;

b) a clevis coupled to said distal end of said hollow member;

c) a first jaw rotatably coupled to said clevis, said first jaw having a longitudinal extent and a first clip-sliding channel disposed substantially along said longitudinal extent and terminating in a first anvil;

d) a second jaw rotatably coupled to said clevis in opposed relation to said first jaw, said second jaw having longitudinal extent and a second clip-sliding channel disposed substantially along said longitudinal extent and terminating in a second anvil, each of said first and second clip-sliding channels;

having a rectangular cross-section substantially corresponding to the cross-section of one of the surgical clip arms;

a longitudinal length greater than the longitudinal length of the respective arm to define a clip-holding portion and a clip-sliding portion; and

slidably guiding the surgical clip longitudinally along said clip-sliding portion when said first and second jaws apply the surgical clip to tissue disposed therebetween;

e) at least one pull/push wire coupled to said first and second jaws and extending through said hollow member to said proximal end of said hollow member; and

f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first and second jaws about said clevis from an open to a closed position.

11. A surgical clip applier according to claim 10, wherein:

each of said anvils has a curved surface.

12. A surgical clip applier according to claim 10, wherein:

each of said anvils has a helical surface.

13. A surgical clip applier according to claim 10, wherein:

each of said jaws has a longitudinal axis and a vertical axis perpendicular to the longitudinal axis, and

each of said channels is arranged at an angle relative to said vertical axis.

14. A surgical clip applier according to claim 13, wherein:

said angle is approximately 22 degrees.

15. An endoscopic surgical instrument, comprising:

a) a hollow member having a proximal end and a distal end;

b) a clevis coupled to said distal end of said hollow member;

c) a first end effector rotatably coupled to said clevis;

d) a first pull/push wire extending through said hollow member to said proximal end of said hollow member;

e) a first linkage including a first rotating element rotatably coupled to said clevis and coupled to said first push/pull wire, and a second element rotatably coupled to said first element and rotatably coupled to said first end effector for increasing mechanical advantage of effector closure; and

f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis.

16. An endoscopic surgical instrument according to claim 15, further comprising:

g) a second end effector rotatably coupled to said clevis and in opposed relation to said first end effector;

h) a second pull/push wire extending through said hollow member to said proximal end of said hollow member; and

i) a second linkage including third and fourth elements, said third element rotatably coupled to said clevis and coupled to said second push/pull wire, and said fourth element rotatably coupled to said third element and rotatably coupled to said second end effector for increasing mechanical advantage of effector closure,

wherein said actuation means is coupled to said second push/pull wire for moving said second push/pull wire through said hollow member to cause a rotation of said second end effector about said clevis.

17. An endoscopic surgical instrument according to claim 16, wherein:

said first and third elements each comprise a substantially L-shaped member having an elbow rotatably coupled to said clevis.

18. An endoscopic surgical instrument according to claim 17, wherein:

each substantially L-shaped member has a first arm of a first length to which said first and second push/pull wires are respectively coupled and a second arm of a second length to which said second and fourth elements are respectively coupled, said first length being longer than said second length.

19. An endoscopic surgical instrument according to claim 18, wherein:

said second element has a third length, said third length being shorter than said first length.

20. An endoscopic surgical instrument according to claim 16, wherein said second end effector has an enclosure adapted to apply the surgical clip.

21. An endoscopic surgical instrument according to claim 15, wherein:

said first element is a substantially L-shaped member having an elbow rotatably coupled to said clevis.

22. An endoscopic surgical instrument according to claim 21, wherein:

said substantially L-shaped member has a first arm of a first length to which said first push/pull wire is coupled and a second arm of a second length to which said second element is coupled, said first length being longer than said second length.

23. An endoscopic surgical instrument according to claim 22, wherein:

said second element has a third length, said third length being shorter than said first length.

24. An endoscopic surgical instrument, comprising:

a) a hollow member having a proximal end and a distal end;

b) a clevis coupled to said distal end of said hollow member;

c) a first end effector rotatably coupled to said clevis;

d) a first pull/push wire extending through said hollow member to said proximal end of said hollow member;

e) a first linkage including at least two elements;

a first of said two elements rotatably coupled to said clevis and coupled to said first push/pull wire; and

a second of said two elements rotatably coupled to said first element and to said first end effector, said first linkage providing mechanical advantage in rotating said first end effector; and

f) actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis.

25. An endoscopic surgical instrument according to claim 24 further comprising:

g) a second end effector rotatably coupled to said clevis;

h) a second pull/push wire extending through said hollow member to said proximal end of said hollow member;

i) a second linkage including at least two elements;

a first of said two elements rotatably coupled to said clevis and coupled to said second push/pull wire; and

a second of said two elements coupled to said first element and to said second end effector, said second linkage providing mechanical advantage in rotating said second end effector; and

said actuation means coupled to said proximal end of said second push/pull wire for moving said second push/pull wire through said hollow member to cause a rotation of said second end effector about said clevis.

26. An endoscopic surgical instrument according to claim 25, wherein said second end effector has an enclosure adapted to apply the surgical clip.

27. An endoscopic surgical instrument, comprising:

a hollow member having a proximal end and a distal end;

a clevis coupled to said distal end of said hollow member;

a first end effector rotatably coupled to said clevis and adapted to grasp and manipulate tissue;

a first pull/push wire extending through said hollow member to said proximal end of said hollow member;

a first linkage including a first rotating element separate from said end effector, rotatably coupled to said clevis, and coupled to said first push/pull wire, and a second element rotatably coupled to said first element and rotatably coupled to said first end effector; and

actuation means coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis.

28. An endoscopic surgical instrument, comprising:

a hollow member having a proximal end and a distal end;

a clevis coupled to said distal end of said hollow member;

a first end effector rotatably coupled to said clevis and adapted to grasp and manipulate tissue;

a first pull/push wire extending through said hollow member to said proximal end of said hollow member;

a first linkage including a first rotating element separate from said end effector, rotatably coupled to said clevis, and coupled to said first push/pull wire, and a second element rotatably coupled to said first element and rotatably coupled to said first end effector; and

an actuator coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause rotation of said first end effector about said clevis.

29. An endoscopic surgical instrument, comprising:

a hollow member having a proximal end and a distal end;

a clevis coupled to said distal end of said hollow member;

a first end effector rotatably coupled to said clevis and adapted to grasp and manipulate tissue;

a first pull/push wire extending through said hollow member to said proximal end of said hollow member;

a first linkage including at least two elements;

a first of said two elements separate from said first end effector, rotatably coupled to said clevis, and coupled to said first push/pull wire; and

a second of said two elements rotatably coupled to said first element and to said first end effector, said first linkage providing mechanical advantage in rotating said first end effector; and

actuation means coupled to said proximal end of said hollow member and to said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis.

30. An endoscopic surgical instrument, comprising:

a hollow member having a proximal end and a distal end;

a clevis coupled to said distal end of said hollow member;

a first end effector rotatably coupled to said clevis and adapted to grasp and manipulate tissue;

a first pull/push wire extending through said hollow member to said proximal end of said hollow member;

a first linkage including at least two elements;

a first of said two elements separate from said first end effector rotatably coupled to said clevis and coupled to said first push/pull wire; and

a second of said two elements rotatably coupled to said first element and to said first end effector, said first linkage providing mechanical advantage in rotating said first end effector; and

an actuator coupled to said proximal end of said hollow member and said proximal end of said first push/pull wire for moving said first push/pull wire through said hollow member to cause a rotation of said first end effector about said clevis.

31. An endoscopic surgical instrument, comprising:

a hollow member having a proximal end and a distal end;

a clevis coupled to said distal end of said hollow member;

an end effector separate from and rotatably coupled to said clevis and adapted to grasp and manipulate tissue;

at least one pull/push wire extending through said hollow member to said proximal end of said hollow member;

a linkage wholly proximal to distal end of said clevis and having;

a rotating element separate from said end effector, pivotally coupled to said clevis, and coupled to said first push/pull wire; and

a means for coupling said rotating element and said end effector; and

an actuator coupled to said proximal end of said hollow member and said proximal end of said push/pull wire for moving said push/pull wire through said hollow member to cause a rotation of said end effector about said clevis.

32. An endoscopic surgical instrument, comprising:

a hollow member having a proximal end and a distal end;

a clevis coupled to said distal end of said hollow member;

an end effector separate from and rotatably coupled to said clevis and adapted to grasp and manipulate tissue;

at least one pull/push wire extending through said hollow member to said proximal end of said hollow member;

a linkage wholly proximal to the distal end of said clevis and having;

a rotating element separate from said end effector, pivotally coupled to said clevis, and coupled to said first push/pull wire; and

a couple coupling said rotating element and sad end effector; and

an actuator coupled to said proximal end of said hollow member and said proximal end of said push/pull wire for moving said push/pull wire through said hollow member to cause a rotation of said end effector about said clevis.