Tissue reconfiguration

• US 7,713,277 B2
• Filed: 04/21/2004
• Issued: 05/11/2010
• Est. Priority Date: 06/22/1999
• Status: Expired due to Term

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Andrews, Richard, Chinnock, Randall B., Marshall, Neal H., Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos, Barenboym, Michael, Chuttani, Ram, O'Keefe, Jonathan, Puicci, Vincent A. Jr.
• Primary Examiner(s): Woo; Julian W
• Application Number:
  US10/828,469
• Publication Number:
  US 20040194790A1
• Time in Patent Office: 2,211 Days
• Field of Search: 606/142, 606/151, 606/153, 606/213, 606/215, 606/219, 606/220, 128/898, 227/175.1, 227/66, 227/67
• 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 method comprising:

puncturing stomach tissue from within the stomach with a piercing member;

pulling the piercing member into a pair of coacting jaws to pull the punctured tissue into the pair of coacting jaws;

engaging the punctured stomach tissue with the pair of coacting jaws from within the stomach; and

piercing the stomach tissue with at least one of the jaws.

2. The method of claim 1 wherein the at least one jaw includes an implant that pierces the tissue.

3. The method of claim 2 wherein the at least one jaw includes a tissue piercing element that delivers at least a portion of an implant.

4. The method of claim 1 wherein the jaws are configured to deploy an implant into the stomach tissue.

5. The method of claim 1 wherein engaging stomach tissue includes placing parts of a tissue fixation device coupled to the jaws in contact with the stomach tissue.

6. A method of treatment comprising:

puncturing stomach tissue with a piercing member from within the stomach;

pulling the piercing member into a plurality of members to pull the punctured stomach tissue into the plurality of members;

engaging the pierced stomach tissue with a plurality of members from within the stomach; and

moving at least one of the plurality of members to place exterior surface regions of the stomach in apposition.

7. The method of claim 6 wherein engaging includes piercing the stomach tissue with the plurality of members.

8. The method of claim 6 further comprising fixing the exterior surface regions of the stomach to each other.

9. The method of claim 8 wherein fixing includes placing at least one tissue fixation device through at least one full-thickness layer of the stomach.

10. The method of claim 8 wherein fixing includes delivering a tissue fixation device to the stomach tissue while the stomach tissue is engaged.

11. The method of claim 6 wherein engaging includes applying pressure to the stomach tissue.

12. The method of claim 6 wherein engaging includes pulling the stomach tissue into a tissue securing device.

13. The method of claim 12 further comprising securing the exterior surface regions using the tissue securing device.

14. A method of treatment comprising:

piercing stomach tissue with a coil from within the stomach;

pulling the coil to reposition the pierced stomach tissue;

engaging the pierced stomach tissue with at least one of a plurality of members from within the stomach;

moving the plurality of members to place exterior surface regions of the stomach in apposition; and

fixing the exterior surface regions of the stomach to each other.

15. The method of claim 14 wherein engaging includes piercing the stomach tissue with the plurality of members.

16. The method of claim 14 wherein fixing includes placing at least one tissue fixation device through at least one full-thickness layer of the stomach.

17. The method of claim 14 wherein fixing includes delivering a tissue fixation device to the stomach tissue while the stomach tissue is engaged.

18. The method of claim 14 wherein engaging includes applying pressure to the stomach tissue.

19. The method of claim 14 wherein engaging includes pulling the stomach tissue into a tissue securing device.

20. The method of claim 19 further comprising securing the exterior surface regions using the tissue securing device.