Method and devices for tissue reconfiguration

• US 20040010245A1
• Filed: 05/15/2003
• Published: 01/15/2004
• Est. Priority Date: 06/22/1999
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Gordon, Joseph M., OʼKeefe, Jonathan, Ray, Cheryne, Robson, David, Petrie, Aidan, Cerier, Jeffrey C., Nelsen, Daniel, Cruz, Amos G.
• Granted Patent: US 8,287,554 B2
• Time in Patent Office: Days
• US Class Current: 606/1
• 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 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• 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 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/285 combined with cutting implements
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• 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 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00827 Treatment of gastro-esophageal reflux
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0441 the shaft being a rigid coil or spiral
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/061 : hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/0649 : Coils or spirals
• CPC Class Codes: A61B 2017/2905 : flexible
• CPC Class Codes: A61B 2017/2915 : arcuate shaped guiding means
• CPC Class Codes: A61B 2017/2916 : pins in guiding slots
• CPC Class Codes: A61B 2017/2917 : with flexible part
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires

Abstract

An instrument for reconfiguring stomach tissue includes a sealing member that seals a section of a tissue manipulator from contact with bodily fluids. The tissue manipulator includes a first portion that is configured for releasable coupling to an actuating member and a second portion configured to receive an implant to be deployed within the patient. The tissue manipulator also includes a rectangular member and a cavity for receiving a coupler of the actuating member. The tissue manipulator has a first member with tissue penetrating elements and a second member with engaging elements configured to deflect the tissue penetrating elements upon relative movement of the first and second members. The actuating member includes a tissue penetrating element support positioned to limit bending of the tissue manipulator. The instrument includes an actuating mechanism that is configured to move at least one of the first and second members of the tissue manipulator.

Claims

1. A medical instrument, comprising:

a tissue manipulator configured for introduction into a patient and including at least one movable member, and

a sealing member configured to substantially seal a section of the tissue manipulator from contact with bodily fluids, the movable member being movable within the sealing member and having a portion extending out of the sealing member.

2. The medical instrument of claim 1 wherein the tissue manipulator includes a second movable member that is movable within the sealing member and has a portion extending out of the sealing member.

3. The medical instrument of claim 2 wherein the tissue manipulator includes pivots about which the movable members rotate in opposite directions.

4. The medical instrument of claim 1 wherein the sealing member defines a hole for receiving a guide wire to permit advancement of the tissue manipulator into the patient over the guide wire.

5. The medical instrument of claim 1 wherein the sealing member comprises a flexible member.

6. The medical instrument of claim 1 further comprising:

a flexible linkage coupled to the tissue manipulator, and

a sealing portion covering the linkage.

7. The medical instrument of claim 6 wherein the sealing portion abuts the sealing member.

8. A medical device, comprising:

an apparatus sized to be entirely received within an organ of a patient, the apparatus having a first portion configured for releasable coupling to an actuating member, and a second portion configured to receive an implant to be deployed within the patient, the apparatus defining a through hole for receiving a guide wire to permit advancement of the apparatus into the patient over the guide wire.

9. The medical device of claim 8 wherein the second portion is configured to be frangibly connected to the implant.

10. The medical device of claim 8 wherein the apparatus includes a pair of jaw members that are configured to move in response to actuation by the actuating member.

11. The medical device of claim 10 wherein each jaw member defines a through hole, the through holes overlapping when the jaw members are closed to form the guide wire receiving through hole.

12. The medical device of claim 10 wherein the jaw members each include a tissue manipulator and a shell over the tissue manipulator.

13. The medical device of claim 12 wherein each tissue manipulator has a coupler that forms part of the first portion of the apparatus.

14. The medical device of claim 12 wherein one tissue manipulator includes a region having a frangible connection to a portion of the implant, and the other tissue manipulator includes a region defining an opening for receiving another portion of the implant, the two regions forming the second portion of the apparatus.

15. The medical device of claim 12 wherein each shell defines a through hole that forms part of the guide wire receiving through hole.

16. A medical device, comprising:

an apparatus sized to be entirely received within an organ of a patient, the apparatus having a first portion configured for releasable coupling to an actuating member, and a second portion configured to receive an implant to be deployed within the patient, the apparatus being configured to decouple from the actuating member when in the patient upon application of an overload to the actuating member.

17. The medical device of claim 16 wherein the first portion includes a retainer that moves under application of an overload to decouple the apparatus from the actuating member.

18. The medical device of claim 17 wherein the retainer is configured such that the overload applied to the actuating arm is less than a load that causes the implant to be pulled through muscle tissue of the patient.

19. The medical device of claim 17 wherein the retainer is configured such that the overload applied to the actuating member is less than or equal to about 27 pounds.

20. A medical device, comprising:

a first member having at least two tissue penetrating elements connected thereto by a frangible connection, and

a second member having an engaging element configured to deflect the tissue penetrating elements in opposite directions and disengage the tissue penetrating elements from the first member at the frangible connection upon relative movement of the first and second members.

21. The medical device of claim 20 wherein the engaging element defines angled surfaces against which the tissue penetrating elements are pushed when the first and second members are moved together.

22. The medical device of claim 20 further comprising a flexible member coupling the at least two tissue penetrating elements.

23. A medical device, comprising:

an apparatus sized to be entirely received within an organ of a patient, the apparatus having a first portion configured for releasable coupling to an actuating member, and a second portion configured to receive an implant to be deployed within the patient, the apparatus including

a first member having tissue penetrating elements, and

a second member having an engaging element configured to deflect the tissue penetrating elements in opposite directions upon relative movement of the first and second members.

24. The medical device of claim 23 wherein the engaging element defines angled surfaces against which the tissue penetrating elements are pushed when the first and second members are moved together.

25. The medical device of claim 23 further comprising a flexible member coupling the at least two tissue penetrating elements.

26. A medical device, comprising:

an apparatus sized to be entirely received within an organ of a patient, the apparatus having a first portion configured for releasable coupling to an actuating member, and a second portion configured to receive an implant to be deployed within the patient, the first portion defining

a rectangular opening for receiving the actuating member, and

a cavity for receiving a coupler of the actuating member, the cavity having a length of at least 0.7 inches.

27. The medical device of claim 26 wherein the first portion includes a shaped region configured to receive a corresponding shaped region of the actuating member.

28. The medical device of claim 26 wherein the first portion defines a slot shaped to receive a lip of the actuating member.

29. The medical device of claim 26 wherein the apparatus includes a pair of jaw members.

30. The medical device of claim 29 wherein one of the jaw members includes a tissue penetrating element positioned relative to the cavity to be supported by the coupler.

31. The medical device of claim 29 wherein one of the jaw members includes an engaging element positioned relative to the cavity to be supported by the coupler.

32. A medical device, comprising:

an apparatus sized to be entirely received within an organ of a patient, the apparatus including a pair of jaw members, each jaw member having a first portion configured for releasable coupling to an actuating member, and a second portion configured to receive an implant to be deployed within the patient, the first portion defining

a rectangular opening for receiving the actuating member, and

a cavity for receiving a coupler of the actuating member, the cavity having a length of at least 0.7 inches,

one of the jaw members including a tissue penetrating element positioned to be supported by the coupler, and the other jaw member including an engaging element positioned to be supported by the coupler.

33. A medical device, comprising:

an actuating member, and

an end effector configured for releasable coupling to the actuating member, the end effector having a tissue penetrating element,

the actuating member including a tissue penetrating element support positioned to limit bending of the end effector when the tissue penetrating element penetrates tissue.

34. The medical device of claim 33 further comprising a second end effector including a tip engaging element configured to deflect the tissue penetrating element upon relative movement of the end effectors.

35. The medical device of claim 34 wherein the actuating member includes a tip engaging element support positioned to limit bending of the second end effector when the tip engaging element deflects the tissue penetrating element.

36. The medical device of claim 35 wherein the actuating member includes two arms, one arm including the tissue penetrating element support and the other arm including the tip engaging element support.

37. A medical assembly comprising:

a cartridge configured for releasable attachment to a medical instrument, and

a resilient holder configured to receive the cartridge such that the cartridge automatically aligns relative to the medical instrument during attachment of the cartridge to the medical instrument.

38. The medical assembly of claim 37 wherein the resilient holder includes resilient portions that are configured to flex upon attachment of the cartridge to the medical instrument if the cartridge is not aligned with the portions.

39. A medical instrument, comprising:

a tissue manipulator including first and second members, and

an actuating mechanism including a cable that is placed under tension to move at least one of the first and second members toward the other member to engage tissue, the actuating mechanism being configured to limit overtensioning of the cable.

40. The medical instrument of claim 39 wherein the actuating mechanism is configured to limit the application of a tension to the cable of greater than or equal to about 72 pounds.

41. The medical instrument of claim 39 wherein the actuating mechanism includes a clutch configured to slip when an overtension is applied to the cable.

42. A medical instrument, comprising:

a tissue manipulator including first and second members, and

an actuating mechanism including a cable that is placed under tension by an external force to move at least one of the first and second members toward the other member, the actuating mechanism being configured to limit loss of tension on the cable when the external force is removed during deployment.

43. The medical instrument of claim 42 wherein the actuating mechanism includes a knob for applying the external force.

44. The medical instrument of claim 43 wherein the actuating mechanism includes a pawl and a ratchet coupled to the knob, the pawl and the ratchet engage to limit loss of tension on the cable when the external force is removed during deployment.