Methods and apparatus for revision of obesity procedures

• US 8,726,909 B2
• Filed: 01/27/2006
• Issued: 05/20/2014
• Est. Priority Date: 01/27/2006
• Status: Active Grant

• Current Assignee: USGI Medical, Inc.
• Original Assignee: USGI Medical, Inc.
• Inventors: Cox, John A., Maahs, Tracy, Ewers, Richard C., Chen, Eugene, Lam, Cang, Swanstrom, Lee
• Primary Examiner(s): IWAMAYE, ANDREW MICHAEL
• Application Number:
  US11/342,288
• Publication Number:
  US 20070175488A1
• Time in Patent Office: 3,035 Days
• Field of Search: 128/898, 606/139
• US Class Current: 128/898
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• 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 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/1103 Approximator
• CPC Class Codes: A61B 2017/1125 Forceps, specially adapted for performing or assisting anastomosis
• CPC Class Codes: A61B 2017/1142 Purse-string sutures
• CPC Class Codes: A61B 2017/2905 flexible
• CPC Class Codes: A61F 5/0083 Reducing the size of the stomach, e.g. gastroplasty surgical interventions A61B17/00
• CPC Class Codes: A61F 5/0086 using clamps, folding means or the like

Abstract

Methods and apparatus for the endoluminal revision of previously performed obesity procedures which have failed are described. One or more endoluminal instruments may be advanced per-orally into the previously formed failed pouch where a number of different procedures can be performed. One or more tissue folds can be formed and secured to reduce the size of the pouch, or the stoma connecting the pouch to the intestinal tract can be reduced in size using endoluminally deployed tissue anchors. These procedures can be performed entirely from within the pouch lumen or upon the exterior surface of the pouch via transgastric entry of the instruments into the peritoneal cavity of a patient. Alternatively, the interior tissue within the pouch can be injured or sclerosed to shrink the pouch lumen. In another alternative, a length of the Roux limb can be shortened endoluminally to create a malabsorptive region.

Claims

1. A method for correcting a failed surgically-created pouch within a patient body, comprising:

advancing a tissue manipulation assembly endoluminally into the failed surgically-created pouch;

evacuating fluid from the pouch to facilitate acquisition of tissue by the tissue manipulation assembly;

deploying at least one tissue anchor into a region of tissue around an opening between the pouch and a length of anastomosed intestinal tissue via the tissue manipulation assembly; and

approximating the at least one tissue anchor such that the opening between the pouch and the intestinal tissue is reduced in size.

2. The method of claim 1 wherein advancing a tissue manipulation assembly endoluminally comprises advancing the assembly per-orally and trans-esophageally into the pouch.

3. The method of claim 1 wherein advancing a tissue manipulation assembly endoluminally comprises advancing a rigidizable elongate body endoluminally into the pouch and advancing the tissue manipulation assembly through at least one lumen defined through the elongate body.

4. The method of claim 3 further comprising rigidizing the elongate body to maintain a configuration after advancing the rigidizable elongate body endoluminally into the pouch.

5. The method of claim 1 wherein deploying at least one tissue anchor comprises passing the at least one tissue anchor between the pouch and the intestinal tissue around the opening via a needle assembly delivered by the tissue manipulation assembly.

6. The method of claim 1 further comprising deploying a plurality of additional tissue anchors into the region of tissue around the opening.

7. The method of claim 1 wherein the at least one tissue anchor is deployed into at least a portion of pouch tissue and at least a portion of intestinal tissue.

8. The method of claim 1 wherein the at least one tissue anchor is deployed into a portion of pouch tissue surrounding the opening.

9. The method of claim 8 wherein the at least one tissue anchor is deployed in a radial configuration with respect to the opening.

10. The method of claim 8 wherein the at least one tissue anchor is deployed in a circumferential or annular pattern with respect to the opening.

11. The method of claim 1 further comprising forming at least one tissue fold within the pouch via the tissue manipulation assembly.

12. The method of claim 11 further comprising forming a plurality of additional tissue folds within the pouch.

13. The method of claim 11 further comprising securing the at least one tissue fold formed by the tissue manipulation assembly via at least one additional tissue anchor such that a volume of the pouch is reduced.

14. The method of claim 13 further comprising purse-stringing the tissue anchor and the at least one additional tissue anchor together.

15. The method of claim 1 wherein approximating the at least one tissue anchor comprises drawing tissue anchors towards one another such that the opening between the pouch and the intestinal tissue is reduced in size.

16. The method of claim 1 wherein advancing a tissue manipulation assembly endoluminally comprises advancing an elongate body endoluminally into the pouch and advancing the tissue manipulation assembly through at least one lumen defined through the elongate body.

17. The method of claim 16 wherein evacuating fluid from the pouch comprises evacuating the fluid through a lumen defined through the elongate body.

18. The method of claim 16 wherein evacuating fluid from the pouch comprises evacuating the fluid through a catheter advanced through the elongate body.