Endoluminal tool deployment system

• US 7,918,845 B2
• Filed: 11/16/2004
• Issued: 04/05/2011
• Est. Priority Date: 01/15/2003
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Saadat, Vahid, Miller, David, Chen, Eugene, Ewers, Richard C.
• Primary Examiner(s): Woo; Julian W
• Application Number:
  US10/991,118
• Publication Number:
  US 20050065397A1
• Time in Patent Office: 2,331 Days
• Field of Search: 606/139, 606/144, 606/159, 606/205, 606/194, 606/1, 604/22, 600/104, 600/139, 600/141, 600/142, 600/146, 600/149, 227/66, 227/67
• US Class Current: 606/1
• CPC Class Codes: A61B 1/0055 Constructional details of insertion parts, e.g. vertebral elements
• CPC Class Codes: A61B 1/0057 Constructional details of force transmission elements, e.g. control wires
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• 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 2017/003 Steerable
• CPC Class Codes: A61B 2017/00323 Cables or rods
• 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 2017/2906 Multiple forceps
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/508 with releasable brake mechanisms
• CPC Class Codes: A61M 2025/0096 being laterally outward extensions or tools, e.g. hooks or fibres
• CPC Class Codes: A61M 25/0043 characterised by structural features
• CPC Class Codes: A61M 25/0105 Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/0147 with movable mechanical means, e.g. pull wires

Abstract

Systems, devices and methods are provided for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Embodiments of the systems include an elongated main body having a scope therethrough and at least one steerable tool arm which extends from the distal end of the main body. In preferred embodiments, the system includes two tool arms, each arm steerable to form a curve laterally outward which then bends laterally inward so that the arms form an angular shape. In addition, end effectors extend from the distal ends of each tool arm for use in manipulation of tissue. The angular shape brings the end effectors together in view of the scope for cooperative movements which are continuously visible by the surgeon. In addition, the tool arms may be steerable in any additional direction and may be rotateable to allow grasping, elevation and more complex manipulation of tissue.

Claims

1. An apparatus for manipulating tissue, comprising:

an end effector having first and second arm members each adapted to be flexible along its length and further adapted to be endoscopically deployed, the first and second arm members defining a longitudinal axis extending between the first and second arm members; and

an actuating mechanism including at least one tensioning member that is adapted to be tensioned to reconfigure at least the first or second arm member such that tissue is engaged between the arm members;

wherein at least one of the first and second arm members has a first distal section comprising a first plurality of links, and a second distal section comprising a second plurality of links, with said first distal section being located proximally of said second distal section;

wherein said first distal section is configured to deflect substantially away from the longitudinal axis and said second distal section is configured to deflect substantially toward the longitudinal axis upon application of an axial force on said at least one tensioning member.

2. The apparatus of claim 1, wherein the first and second flexible arm members are comprised of a plurality of adjacent links.

3. The apparatus of claim 1, wherein the first and second flexible arm members are adapted to be reconfigured upon actuation of the at least one cable.

4. The apparatus of claim 1, wherein at least one of the first or second flexible arm members defines a lumen through which a tool is positionable.

5. The apparatus of claim 4, wherein the tool is selected from the group consisting of knives, needles, sutures, staplers, fasteners, clippers, electrosurgical or hemostatic cutters, electrosurgical or hemostatic coagulators, laser welders, cryosurgery instruments, secondary scopes, Forceps, laser, hooks tongs, graspers, retractors, probes, clamps, scissors, tissue approximation devices, suction applicators, and combinations thereof.

6. The apparatus of claim 1, wherein distal ends of the first and second arm members are adapted to lock its configuration.

7. The apparatus of claim 1, further comprising at least a second tensioning member that is adapted to be tensioned in combination with the at least one tensioning member to reconfigure the first and second arm members.

8. The apparatus of claim 1, wherein the at least one tensioning member is routed through an endoscopic device to the end effector.

9. The apparatus of claim 1, wherein the first and second flexible arm members are positioned upon a distal end of an endoscopic device.

10. The apparatus of claim 9, wherein the endoscopic device is adapted to have a steerable distal end.

11. The apparatus of claim 9, wherein the endoscopic device is adapted to lock its configuration along a length of the endoscopic device.

12. The apparatus of claim 9, wherein the endoscopic device is comprised of a plurality of links.

13. An apparatus for manipulating tissue, comprising:

an end effector having first and second flexible arm members each adapted to be flexible along its length and wherein at least the first arm member includes a piercing member disposed therein or thereon which is adapted to penetrate tissue, the first and second flexible arm members defining a longitudinal axis extending between the first and second arm members; and

an actuating mechanism including at least one tensioning member that is adapted to be tensioned to reconfigure at least the first or second arm member such that tissue is penetrated by the piercing member between the first and second arm members;

wherein at least one of the first and second arm members has a first distal section comprising a first plurality of links, and a second distal section comprising a second plurality of links, with said first distal section being located proximally of said second distal section;

wherein said first distal section is configured to deflect substantially away from the longitudinal axis and said second distal section is configured to deflect substantially toward the longitudinal axis upon application of an axial force on said at least one tensioning member.

14. The apparatus of claim 13, wherein the first and second flexible arm members are comprised of a plurality of adjacent links.

15. The apparatus of claim 13, wherein the first and second flexible arm members are adapted to be reconfigured upon actuation of the at least one tensioning member.

16. The apparatus of claim 13, wherein at least one of the first or second flexible arm members defines a lumen through which a tool is positionable.

17. The apparatus of claim 13, wherein the piercing member comprises a fixation device adapted to pass through the first or second arm member.

18. The apparatus of claim 13, wherein the piercing member further comprises a tie adapted to pass through the tissue and at least one anchor connected to the tie adapted to hold the tissue.

19. The apparatus of claim 18, wherein the tie is selected from the group consisting of sutures, wires, and rods.

20. The apparatus of claim 18, wherein the at least one anchor is selected from the group consisting of knots, disks, and expandable umbrellas.

21. The apparatus of claim 13, wherein distal ends of the first and second arm members are adapted to lock its configuration.

22. The apparatus of claim 13, further comprising at least a second cable that is adapted to be tensioned in combination with the at least one tensioning member to reconfigure the first and second arm members.

23. The apparatus of claim 13, wherein the at least one tensioning member is routed through an endoscopic device to the end effector.

24. The apparatus of claim 13, wherein the first and second flexible arm members are positioned upon a distal end of an endoscopic device.

25. The apparatus of claim 24, wherein the endoscopic device is adapted to have a steerable distal end.

26. The apparatus of claim 24, wherein the endoscopic device is adapted to lock its configuration along a length of the endoscopic device.

27. The apparatus of claim 24, wherein the endoscopic device is comprised of a plurality of links.

28. A system for manipulating tissue, comprising:

an elongate endoscopic device having a proximal end, a distal end, and a length therebetween, the elongate endoscopic device having a longitudinal axis;

an end effector having first and second flexible arm members each adapted to be flexible along its length and extending from the distal end of the endoscopic device; and

an actuating mechanism including at least one tensioning member cable that is adapted to be tensioned to reconfigure at least the first or second arm member such that tissue is engaged between the arm members;

wherein at least one of the first and second arm members has a first distal section comprising a first plurality of links, and a second distal section comprising a second plurality of links, with said first distal section being located proximally of said second distal section;

wherein said first distal section is configured to deflect substantially away from the longitudinal axis and said second distal section is configured to deflect substantially toward the longitudinal axis upon application of an axial force on said at least one tensioning member.

29. The system of claim 28, wherein the length of the elongate endoscopic device is lockable to retain a deflection along the length.

30. The system of claim 28, wherein the endoscopic device is adapted to have a steerable distal end.

31. The system of claim 28, wherein the endoscopic device is comprised of a plurality of links.

32. The system of claim 28, wherein the first and second flexible arm members are comprised of a plurality of adjacent links.

33. The system of claim 28, wherein the first and second flexible arm members are adapted to be reconfigured upon actuation of the at least one tensioning member.

34. The system of claim 28, wherein at least one of the first or second flexible arm members defines a lumen through which a tool is positionable.

35. The system of claim 28, wherein distal ends of the first and second arm members are adapted to lock its configuration.

36. The system of claim 28, further comprising at least a second tensioning member that is adapted to be tensioned in combination with the at least one tensioning member to reconfigure the first and second arm members.

37. The system of claim 28 wherein the at least one tensioning member is routed through the elongate endoscopic device to the end effector.

38. The system of claim 28 wherein the first and second flexible arm members are positioned upon the distal end of the elongate endoscopic device.

39. The system of claim 28, wherein substantially all of at least said first plurality of links are pivotally connected to each adjacent link by a hinge, with substantially all of said hinges being aligned in a substantially parallel relationship relative to each adjacent hinge such that deflection of said first distal section of said arm member is substantially limited to a single plane.

40. The system of claim 39, wherein substantially all of the hinges comprise pivot pins.

41. The system of claim 39, wherein substantially all of the hinges comprise a male bearing surface on a first link and a female bearing surface on an adjacent second link.

42. The system of claim 39, wherein each of said flexible arm members extends through a tool lumen defined by said endoscopic device, and each of said arm members is axially and rotatably translatable within its corresponding tool lumen.