Methods, instruments and devices for extragastic reduction of stomach volume

• US 9,155,528 B2
• Filed: 01/29/2013
• Issued: 10/13/2015
• Est. Priority Date: 01/08/2012
• Status: Active Grant

• Current Assignee: Vibrynt, Inc.
• Original Assignee: Vibrynt, Inc.
• Inventors: Bender, Theodore M., Makower, Joshua, Shui, Brian K., Acosta, Pablo G., George, Robert M., Serventi, Lisa, Orbeta, Ed, Early, Scott, Bright, Earl A., Limon, Timothy A.
• Primary Examiner(s): Woo, Julian W
• Application Number:
  US13/753,303
• Publication Number:
  US 20130178698A1
• Time in Patent Office: 987 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 17/00 Surgical instruments, devices or methods, e.g. tourniquets A61B18/00 takes precedence; contraceptive devices, pessaries, or applicators therefor A61F6/00; eye surgery A61F9/007; ear surgery A61F11/00
• 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 17/0401 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 17/0466 Suture bridges
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 2017/00314 Separate linked members
• CPC Class Codes: A61B 2017/00818 Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0462 One way system, i.e. also tensioning the suture
• 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 2017/06009 having additional means for releasably clamping the suture to the needle, e.g. actuating rod slideable within the needle
• CPC Class Codes: A61B 2017/06042 located close to needle tip
• CPC Class Codes: A61B 2017/2944 : Translation of jaw members
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61F 5/0086 : using clamps, folding means or the like

Abstract

Methods, instruments and systems are provided for separating opposite walls of the stomach by extragastric application of suction. Plication of the stomach can be performed between the separated walls after which the separate walls are brought back toward one another. In another aspect, methods, instruments, devices and systems are provided for reducing the effective volume of a stomach by performing one or more extragastric plications of the stomach.

Claims

1. A method for decreasing the effective volume of a patient'"'"'s stomach, said method comprising:

contacting and engaging a length of a first end effector to an external surface of the stomach on a first side of the stomach;

contacting a length of a second end effector to an external surface of the stomach on a second side of the stomach opposite the first side;

separating said first and second end effectors and opposite sides of the stomach apart by movement of at least one of said first and second end effectors away from the other of said first and second end effectors; and

causing a portion of the stomach to move through a gap formed by said separating said first and second end effectors apart.

2. The method of claim 1, further comprising:

moving at least one of the first and second end effectors and at least one of the opposite sides of the stomach toward the other of the first and second end effectors and opposite sides of the stomach to contact folded tissue surfaces adjacent the surfaces engaged by the end effectors into contact with one another.

3. The method of claim 2, further comprising attaching the folded tissue surfaces together in serosa-to-serosa contact.

4. The method of claim 3, wherein said attaching the folded tissue surfaces together comprises driving at least one suture from one of said end effectors through the folded tissues and into connection with at least one anchor on the other of said end effectors.

5. The method of claim 3, wherein said attaching the folded tissue surfaces together comprises manually stitching the folded tissue surfaces together.

6. The method of claim 3, further comprising placing a layer of material adjacent or between a location where the folded tissues are connected together to discourage the stomach from herniating out between connections.

7. The method of claim 3, wherein said attaching the folded tissue surfaces together in serosa-to-serosa contact comprises simultaneously driving a plurality of attachment members through the folded tissue surfaces, wherein the attachment members are configured along a length direction relative to the end effectors.

8. The method of claim 2, further comprising rotating said first and second end effectors together about a longitudinal axis of one of said first and second end effectors, so that the portion of the stomach is superior to the gap;

wherein said causing a portion of the stomach to move through a gap is assisted by gravity as the portion is dropped through the gap between the first and second end effectors; and

wherein said method further comprises counter-rotating said end effectors.

9. The method of claim 2, further comprising inserting an expandable implant in a plication formed by said causing a portion of the stomach to move through a gap formed by said separating said first and second end effectors apart;

and

wherein said moving at least one of the first and second end effectors and at least one of the opposite sides of the stomach toward the other of the first and second end effectors and opposite sides of the stomach to contact folded tissue surfaces adjacent the surfaces engaged by the end effectors into contact with one another surrounds the expandable implant.

10. The method of claim 1, further comprising rotating said first and second end effectors so that the portion of the stomach is superior to the gap;

wherein said causing a portion of the stomach to move through a gap is assisted by gravity as the portion is dropped through the gap between the first and second end effectors.

11. The method of claim 1, wherein said engaging is performed by applying suction to the surfaces through said end effectors.

12. The method of claim 11, wherein said engaging further comprises mechanical clamping of the surfaces by the first and second end effectors which are distal end portions of a clamping tool.

13. The method of claim 1, wherein said engaging is performed by clamping the surfaces via clamping mechanisms of said end effectors.

14. The method of claim 1, further comprising temporarily installing a bougie in the stomach prior to said moving a portion of the stomach, to provide a guide for a resulting size of a lumen through the stomach.

15. The method of claim 14, wherein at least a portion of said bougie has clear walls and said bougie is configured to receive a flexible endoscope therein, said method further comprising inserting the flexible endoscope and visualizing within the stomach through said bougie.