Method for endoscopic, transgastric access into the abdominal cavity

• US 7,824,368 B2
• Filed: 06/19/2003
• Issued: 11/02/2010
• Est. Priority Date: 06/19/2003
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Hess, Christopher J, Schulze, Dale R., Nobis, Rudolph H., Fegelman, Elliott J., Knight, Gary W., Clem, Michael F.
• Primary Examiner(s): Lucchesi; Nicholas D
• Assistant Examiner(s): FLICK, JASON E
• Application Number:
  US10/465,061
• Publication Number:
  US 20040260245A1
• Time in Patent Office: 2,693 Days
• Field of Search: 604/96.01, 604/171, 604/175
• US Class Current: 604/96.01
• CPC Class Codes: A61B 1/00142 with means for preventing contamination, e.g. by using a sanitary sheath
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/01 Guiding arrangements therefore
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes

Abstract

The present invention is a method for accessing the abdominal cavity of a patient in order to perform a medical procedure therein. In one embodiment the method includes the step of inserting a guide wire into the upper gastrointestinal tract, via a gastric opening in the gastric wall and an abdominal opening in the abdominal wall of the patient, the guide wire having a first end that extends from the mouth of the patient, and a second end that extends from the abdominal opening of the patient. The method further includes providing an access device in the form of an elongated sheath having a lumen therethrough, attaching the first end of the guide wire to the distal end of the elongated sheath, and pulling the second end of the guide wire to position the access device into the upper gastrointestinal tract, wherein the distal end of the access device extends into the abdominal cavity while the proximal end of the access device extends out of the mouth of the patient.

Claims

1. A method for accessing the abdominal cavity of a patient in order to perform a medical procedure therein, said method comprising:

inserting a guide wire into the upper gastrointestinal tract, via a gastric opening in the gastric wall and an abdominal opening in the abdominal wall of the patient, said guide wire having a first end that extends from the mouth of the patient, and a second end that extends from said abdominal opening of the patient;

obtaining an access device comprising an elongated sheath having a lumen therethrough, the sheath having a proximal end and a distal end;

attaching said first end of said guide wire to the distal end of said elongated sheath;

pulling said second end of said guide wire to position said access device into the upper gastrointestinal tract, wherein the distal end of said access device extends from inside the stomach through the gastric opening and into the abdominal cavity while the proximal end of said access device extends out of the mouth of the patient; and

advancing an endoscope in the lumen of the access device from the proximal end of the sheath and into the abdominal cavity.

2. The method of claim 1, further comprising:

detaching said guide wire from the distal end of said elongated sheath;

removing the endoscope from the proximal end of the sheath;

removing said access device from the patient; and

closing said gastric opening.

3. A method for performing a medical procedure inside the abdominal cavity of a patient, said method comprising:

inserting a guide wire into the upper gastrointestinal tract, via a gastric opening in the gastric wall and an abdominal opening in the abdominal wall of the patient, said guide wire having a first end that extends from the mouth of the patient, and a second end that extends from said abdominal opening of the patient;

obtaining an access device comprising an elongated sheath having a lumen therethrough, the elongated sheath having a proximal end and a distal end, and a port associated with the distal end;

attaching said first end of said guide wire to the distal end of said elongated sheath; and

pulling said second end of said guide wire to position said access device into the upper gastrointestinal tract, wherein the distal end of said access device extends from inside the stomach through the gastric opening and into the abdominal cavity while the proximal end of said access device extends out of the mouth of the patient;

detaching said guide wire from the distal end of said elongated sheath;

inserting the endoscopic portion of a flexible endoscopic instrument into said access device through the proximal end of the elongated sheath;

advancing the endoscopic portion of the flexible endoscopic instrument distally through the lumen of the access device and through the port into the abdominal cavity;

performing a medical procedure inside of the abdominal cavity with said flexible endoscopic instrument;

removing said flexible endoscopic instrument from said access device through the proximal end of the sheath;

removing said access device from the patient;

closing said gastric opening; and

closing said abdominal opening.

4. The method of claim 3, wherein closing said gastric opening comprises:

inserting a fixation device into said abdominal wall and said gastric wall;

holding said gastric wall against said abdominal wall with said fixation device until said gastric wall heals to said abdominal wall; and

removing said fixation device.

5. The method of claim 3, further comprising:

dilating said gastric opening with a dilation tip attached to the distal end of said access device.

6. The method of claim 3, wherein the elongated sheath comprises a sheath port spaced proximally of the distal end of the sheath, and further comprising the step of:

expanding said gastric opening with a balloon contained in the distal portion of said access device.

7. The method of claim 3, further comprising:

percutaneously positioning the distal end of said access device.

8. A method for performing a medical procedure inside the abdominal cavity of a patient, said method comprising:

inserting a guide wire into the upper gastrointestinal tract, via a gastric opening in the gastric wall and an abdominal opening in the abdominal wall of the patient, said guide wire having a first end that extends from the mouth of the patient, and a second end that extends from said abdominal opening of the patient;

obtaining an access device comprising an elongated sheath having a lumen therethrough, the elongated sheath having a proximal end and a distal end, and a sheath port spaced proximally from the distal end of the sheath;

attaching said first end of said guide wire to the distal end of said elongated sheath;

positioning the distal end of said access device to extend from inside the stomach through the gastric opening and into the abdominal cavity;

inserting the endoscopic portion of a flexible endoscopic instrument distally through the lumen of the access device and through the side port of the elongated sheath into the abdominal cavity; and

performing a medical procedure inside of the abdominal cavity with said flexible endoscopic instrument.