Method and apparatus for transgastric neurostimulation
First Claim
1. A method of transcutaneously implanting a stimulation electrode in a peritoneal cavity of a patient using transgastric mapping and guidance, the method comprising:
- inserting an endoscope having a proximal end and a distal end through a mouth into a stomach;
passing the distal end of the endoscope through an opening in the stomach into the peritoneal cavity;
retroflexing the distal end of the endoscope to orient the distal end of the endoscope towards a diaphragm, the retroflexed distal end of the endoscope configured to bend at least 90 degrees;
inserting a mapping instrument having a mapping electrode through the endoscope and into the peritoneal cavity, the mapping instrument adapted to pass through the retroflexed endoscope;
using the endoscope to place the mapping electrode in contact with the diaphragm of the patient within the peritoneal cavity;
using the mapping electrode, coupled to a mapping stimulator, to map electrical activity in the diaphragm; and
transcutaneously positioning a stimulation electrode using a percutaneous needle into the peritoneal cavity under visualization from the endoscope based on the mapped electrical activity in the diaphragm.
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Accused Products
Abstract
A method of placing an electrode in a peritoneal cavity including the following steps: inserting an endoscope through a patient'"'"'s mouth into the patient'"'"'s stomach; passing the endoscope through an opening in the stomach into the peritoneal cavity; and using the endoscope to place the electrode in contact with tissue within the peritoneal cavity other than stomach tissue. Another aspect of the invention provides a method of electrically mapping tissue accessed from a peritoneal cavity including the following steps: inserting an endoscope through a patient'"'"'s mouth into the patient'"'"'s stomach; passing the endoscope through an opening in the stomach into the peritoneal cavity; passing an electrode through the endoscope; placing the electrode in contact with tissue within the peritoneal cavity other than stomach tissue; and applying a mapping stimulation signal to the electrode from a mapping stimulator.
182 Citations
15 Claims
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1. A method of transcutaneously implanting a stimulation electrode in a peritoneal cavity of a patient using transgastric mapping and guidance, the method comprising:
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inserting an endoscope having a proximal end and a distal end through a mouth into a stomach; passing the distal end of the endoscope through an opening in the stomach into the peritoneal cavity; retroflexing the distal end of the endoscope to orient the distal end of the endoscope towards a diaphragm, the retroflexed distal end of the endoscope configured to bend at least 90 degrees; inserting a mapping instrument having a mapping electrode through the endoscope and into the peritoneal cavity, the mapping instrument adapted to pass through the retroflexed endoscope; using the endoscope to place the mapping electrode in contact with the diaphragm of the patient within the peritoneal cavity; using the mapping electrode, coupled to a mapping stimulator, to map electrical activity in the diaphragm; and transcutaneously positioning a stimulation electrode using a percutaneous needle into the peritoneal cavity under visualization from the endoscope based on the mapped electrical activity in the diaphragm. - View Dependent Claims (2, 3, 4, 5)
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6. A method of implanting a stimulation electrode transcutaneously using transgastric mapping and guidance for stimulating target tissue in or near a peritoneal cavity of a patient, the method comprising:
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inserting an endoscope through a mouth into a stomach; passing the endoscope through an opening in the stomach into the peritoneal cavity; laparoscopically placing a stimulation electrode at a target site on a diaphragm; using the endoscope to guide placement of the stimulation electrode based on a map of electrical activity in the diaphragm; closing the opening in the stomach by placement of a percutaneous endoscopic gastrostomy tube; and providing a stimulation signal to the stimulation electrode. - View Dependent Claims (7, 8, 9, 10)
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11. A method of transcutaneously implanting a stimulation electrode in a diaphragm of a patient using transgastric mapping and guidance, the method comprising:
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inserting an endoscope through a mouth into a stomach; inserting a guidewire percutaneously through an abdominal wall, through a peritoneal cavity, through a stomach wall and into a stomach; inserting a dilator in a collapsed configuration over the guidewire and through the stomach wall; expanding the dilator to enlarge an opening in the stomach wall; passing the endoscope through the opening in the stomach wall into the peritoneal cavity; passing a mapping electrode through the endoscope; placing the mapping electrode in contact with a diaphragm of the patient within the peritoneal cavity; and applying a mapping stimulation signal to the mapping electrode from a mapping stimulator; identifying a target stimulation site after applying the mapping stimulation signal; and laparoscopically placing a stimulation electrode at the target stimulation site. - View Dependent Claims (12, 13, 14, 15)
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Specification