Methods and devices for tissue reconfiguration

• US 7,736,373 B2
• Filed: 04/08/2004
• Issued: 06/15/2010
• 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: Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos G.
• Primary Examiner(s): Woo; Julian W
• Application Number:
  US10/819,995
• Publication Number:
  US 20040193184A1
• Time in Patent Office: 2,259 Days
• Field of Search: 606/153, 606/151, 606/213, 606/219, 606/220, 606/142, 128/898, 607/127, 607/131, 227/66, 227/67, 227/175.1, 227/178.1, 600/561, 600/564
• 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 17/0401 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 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• 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 for applying suture clamps, clips or locks A61B2017/0488
• 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 2017/0472 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 2017/061 : hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/0647 : having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0649 : Coils or spirals
• 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: A61M 25/0133 : Tip steering devices

Abstract

Methods and devices are provided for reconfiguring a tissue within a hollow body organ using an entirely endoscopic approach in order to effectively reduce flow of fluid contents into a second hollow body organ in fluid communication with the first.

Claims

1. A method for treating gastroesophageal reflux in a subject comprising:

grasping a first portion of at least an inner lining of the stomach of a subject, the first portion being disposed near the opening of the esophagus of the subject into the stomach of the subject;

grasping at least two additional portions of at least the inner lining of the stomach, the two additional portions being disposed near the opening of the esophagus into the stomach and straddling the first engaged portion;

reconfiguring at least a portion of the stomach by

(a) moving the additional engaged portions and the first engaged portion relative to one another and

(b) bringing the additional engaged portions toward one another; and

permanently securing together the additional engaged, reconfigured portion of the stomach with at least one tissue fixation device so as to retain the shape of the reconfigured portion.

2. The method of claim 1 wherein the steps of engaging, reconfiguring, and securing are performed endoscopically.

3. The method of claim 1 wherein the engaging is reversible and essentially atraumatic.

4. The method of claim 1 wherein the engaging comprises clamping.

5. The method of claim 1 wherein the engaging comprises application of a corkscrew-like retractor.

6. The method of claim 1 wherein the shape assumed by the reconfigured portion comprises a plication.

7. The method of claim 1 wherein the shape assumed by the reconfigured portion comprises a bulge.

8. The method of claim 1 wherein the shape assumed by the reconfigured portion is effective for bringing sealing surfaces at an opening of the esophagus into the stomach into closer apposition.

9. The method of claim 1 wherein the securing comprises stapling.

10. The method of claim 1 wherein the securing comprises application of a two-part fastener.

11. The method of claim 1 further comprising measuring tissue pressure at the gastroesophageal junction in association with at least one of the steps of engaging, reconfiguring, and securing.

12. The method of claim 1 further comprising measuring yield pressure in association with at least one of the steps of engaging, reconfiguring, and securing.

13. A method for treating gastroesophageal reflux in a subject comprising:

engaging a first portion of at least an inner surface of the stomach of a subject;

manipulating the first engaged portion, so that the first engaged portion is disposed near the opening of the esophagus into the stomach of the subject;

engaging at least two additional portions of at least the inner surface of the stomach which are adjacent to and on opposite sides of the manipulated first engaged portion of the stomach;

moving the at least two additional engaged portions toward one another to create a reconfigured portion of the stomach; and

permanently securing the reconfigured portion of the stomach with at least one tissue fixation device so as to retain the shape of the reconfigured portion.

14. The method of claim 13 wherein the steps of engaging, reconfiguring, and securing are performed endoscopically.

15. The method of claim 13 wherein the engaging is reversible and essentially atraumatic.

16. The method of claim 13 wherein the engaging comprises clamping.

17. The method of claim 13 wherein the engaging of the at least two additional portions comprises application of a corkscrew-like retractor.

18. The method of claim 13 wherein the shape assumed by the reconfigured portion comprises a bulge.

19. The method of claim 13 wherein the shape assumed by the reconfigured portion comprises a flap.

20. The method of claim 13 wherein the shape assumed by the reconfigured portion is effective for bringing sealing surfaces at an opening of the esophagus into the stomach into closer apposition.

21. The method of claim 13 wherein the securing comprises stapling.

22. The method of claim 13 wherein the securing comprises application of a two-part fastener.

23. The method of claim 13 further comprising measuring tissue pressure at the gastroesophageal junction in association with at least one of the steps of engaging, manipulating, and securing.

24. The method of claim 13 further comprising measuring yield pressure in association with at least one of the steps of engaging, manipulating, and securing.