Methods and devices for tissue reconfiguration

• US 7,776,057 B2
• Filed: 11/19/2004
• Issued: 08/17/2010
• 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, Marshall, Neal H., Chinnock, Randal B., Cerier, Jeffrey C., Laufer, Michael D., Cruz, Amos, Barenboym, Michael, O'Keefe, Jonathan, Puicci, Vincent A. Jr.
• Primary Examiner(s): TRUONG, KEVIN THAO
• Application Number:
  US10/992,228
• Publication Number:
  US 20060025789A1
• Time in Patent Office: 2,097 Days
• Field of Search: 606/139, 606/144, 606/148, 606/150, 606/153, 606205-210, 606219-221, 606/232
• US Class Current: 606/139
• 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 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/285 combined with cutting implements
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• 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 2017/00349 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 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2090/065 : for measuring contact or contact pressure
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires

Abstract

A method includes advancing an apparatus having an elongated member transorally into the stomach. The apparatus includes a distal end effector having first and second members configured to engage tissue. The first and second members are movable relatively toward one another generally in a first plane. The method includes moving the distal end effector relative to the elongated member in 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. At least one of the first and second members carries a fixation device for fixing engaged portions of tissue together.

Claims

1. 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 tissue, the first and second members being movable relatively toward one another generally in a first plane, and

moving the distal end effector relative to the elongated member in a second plane that is substantially orthogonal to the first plane to position the first and second members for grasping tissue distal to a distal-most end of the distal end effector along a greater curvature of a stomach, at least one of the first and second members carrying a fixation device for fixing engaged portions of tissue together.

2. The method of claim 1, further comprising engaging tissue by moving the first and second members relatively toward one another generally in the first plane.

3. The method of claim 2, wherein the moving of the first and second members engages a first tissue section of the greater curvature of the stomach with a first securing part of the fixation-device and a second tissue section of the greater curvature of the stomach with a second securing part of the fixation device.

4. The method of claim 1, further comprising piercing the tissue with a third member of the distal end effector prior to engaging the tissue with the first and second members.

5. The method of claim 4, further comprising manipulating the tissue pierced by the third member into position between the first and second members.

6. The method of claim 1, wherein advancing an apparatus transorally into the stomach includes advancing a substantially flexible elongated member transorally into the stomach.

7. The method of claim 1, wherein advancing an apparatus transorally into the stomach includes advancing an elongated member disposed within an overtube transorally into the stomach.

8. A method for approximating tissue, comprising:

advancing an apparatus including an elongated flexible member into a body through a natural orifice, the apparatus including a distal end effector movable relative to the elongated flexible member and having first and second members configured to engage tissue, at least one of the first and second members being movable relative to the other generally in a first plane;

orienting the flexible elongated member into a desired location near a desired surgical site;

visualizing at least the first and second members as they are moved into position to engage tissue;

grasping substantially concave tissue to be approximated distal to a distal-most end of the distal end effector using the first and second members;

manipulating the grasped tissue into a desired configuration; and

approximating the grasped tissue using a fixation device deployed from at least one of the first and second members.

9. The method of claim 8, further including advancing a tissue retractor to engage tissue and retract the engaged tissue into position between the first and second members.

10. The method of claim 9, wherein advancing the tissue retractor includes advancing one of a corkscrew-like retractor, a grasper retractor, and a suction retractor to retract tissue into position between the first and second members.

11. The method of claim 8, wherein approximating the grasped tissue includes applying a biocompatible fastener selected from the group consisting of a staple, a clip, a tack, a rivet, a two-part fastener, a helical fastener, a suture, and a T-bar suture.

12. The method of claim 8, wherein visualizing includes endoscopically visualizing at least a portion of at least one of the steps of advancing, grasping, manipulating, and approximating.

13. The method of claim 8, wherein advancing the elongate flexible shaft includes advancing the elongate flexible shaft disposed within an overtube.

14. The method of claim 8, wherein manipulating the grasped tissue into a desired configuration includes manipulating the grasped tissue to form a tissue bulge.

15. A method comprising:

advancing an apparatus including an elongated member transorally into the stomach, the apparatus including a distal end effector movable relative to the elongated member and having first and second members configured to engage tissue, the first and second members being movable relatively toward one another generally in a first plane, at least one of the first and second members carrying a fixation device for fixing engaged portions of tissue together;

grasping tissue distal to a distal-most end of the distal end effector along a greater curvature of the stomach; and

plicating the tissue of the stomach with the fixation device to reduce a volume of the stomach.

16. The method of claim 15, further comprising moving the first and second members relatively toward one another to grasp two portions of tissue along the greater curvature of the stomach to form a fold of tissue along the greater curvature.

17. The method of claim 15, further including advancing a tissue retractor to engage tissue and retract the engaged tissue into position between the first and second members.

18. The method of claim 17, wherein advancing the tissue retractor includes advancing one of a corkscrew-like retractor, a grasper retractor, and a suction retractor to retract tissue into position between the first and second members.

19. The method of claim 15, wherein plicating the tissue of the stomach with the fixation device comprises applying a biocompatible fixation device selected from the group consisting of a staple, a clip, a tack, a rivet, a two-part fastener, a helical fastener, a suture, and a T-bar suture.

20. The method of claim 15, further comprising endoscopically visualizing at least a portion of at least one of the steps of advancing, grasping, and plicating.