Apparatus and methods for endoscopic suturing

• US 7,736,372 B2
• Filed: 11/10/2004
• Issued: 06/15/2010
• Est. Priority Date: 11/13/2003
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Lam, Cang, Saadat, Vahid, Brenneman, Rodney, Ewers, Richard C., Reydel, Boris
• Primary Examiner(s): Nguyen; Anhtuan T
• Assistant Examiner(s): SONNETT, KATHLEEN C
• Application Number:
  US10/986,461
• Publication Number:
  US 20050119671A1
• Time in Patent Office: 2,043 Days
• Field of Search: 606139-149, 606/167, 606/170, 606/205, 606/206, 606/151, 606/153, 606/157, 606/108, 600101-183, 600201-211
• US Class Current: 606/148
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 2017/00353 one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2090/3614 using optical fibre

Abstract

Apparatus & methods for endoscopic suturing are described herein. A distal tip of the endoscopic device engages the tissue and then approximates the engaged tissue to form a tissue fold. A needle body positioned within a flexible catheter is deployed into or through the newly created tissue fold where it is then detached or released from the endoscopic device. The needle body has a length of suture which depends therefrom and can be used to secure the tissue fold. The entire endoscopic device or its tissue engaging assembly can then be rotated relative to the tissue fold while maintaining engagement with the tissue to maneuver the flexible catheter to the opposing side of the penetrated tissue fold. This procedure can be repeated any number of times to create an interrupted, continuous, or running suture to secure the tissue fold.

Claims

1. A method for endoscopically suturing a region of tissue, comprising:

endoscopically advancing an elongate tubular member to the region of tissue;

engaging the region of tissue with a tissue engagement device comprising a pair of jaws and a flexible tube extending from a distal end of the elongate tubular member;

approximating the tissue relative to the elongate tubular member via the tissue engagement device;

using the approximating motion to simultaneously curve a distal end of a deployment tubular member extending from the elongate tubular member via a linkage pivotably connecting the tissue engagement device and the deployment tubular member such that a distal tip of the deployment tubular member is aligned substantially transversely with the tissue;

deploying a needle body and a length of suture depending therefrom at least partially into or through the tissue from the deployment tubular member;

rotating the deployment tubular member and the flexible tube about a longitudinal axis of the pair of jaws while the tissue engaging device is engaging the region of tissue; and

grasping the deployed needle body with a needle grasper slidably positioned within the deployment tubular member.

2. The method of claim 1 wherein endoscopically advancing an elongate tubular member comprises advancing the tubular member transesophageally into a stomach.

3. The method of claim 1 wherein engaging the region of tissue comprises temporarily engaging the region of tissue.

4. The method of claim 1 wherein approximating the tissue comprises pulling the tissue proximally into a fold via the tissue engagement device.

5. The method of claim 1 wherein deploying a needle body comprises urging the needle body into the tissue via the needle grasper.

6. The method of claim 1 wherein grasping the deployed needle body comprises drawing the needle body into deployment tubular member via the needle grasper.

7. The method of claim 1 further comprising rotating the deployment tubular member about the longitudinal axis while holding the needle body.

8. The method of claim 7 further comprising deploying the needle body and the length of suture through the tissue such that the tissue is secure.

9. The method of claim 1 further comprising deploying an expandable anchor from the needle body for placement against the tissue.