Devices and methods for placement of partitions within a hollow body organ

• US 8,449,560 B2
• Filed: 12/29/2006
• Issued: 05/28/2013
• Est. Priority Date: 03/09/2004
• Status: Expired due to Fees

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Incorporated (Johnson & Johnson), Satiety, Inc.
• Inventors: Roth, Alex T., Hancock, Andrew H., Pamichev, Chris, Gaiser, John, Weller, Gary, Julian, Christopher, Gannoe, James, Gerbi, Craig, Lee, Crystine M.
• Primary Examiner(s): Jackson, Gary
• Assistant Examiner(s): YABUT, DIANE D
• Application Number:
  US11/648,708
• Publication Number:
  US 20070167960A1
• Time in Patent Office: 2,342 Days
• Field of Search: 606/139, 606/151, 606/153, 227/175.1
• US Class Current: 606/151
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 17/072 for applying a row of staples in a single action , e.g. the staples being applied simultaneously
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3474 Insufflating needles, e.g. Veress needles
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/07214 Stapler heads
• CPC Class Codes: A61B 2017/07242 achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
• CPC Class Codes: A61B 2017/0725 with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 90/92 coded with colour
• CPC Class Codes: A61F 5/0083 Reducing the size of the stomach, e.g. gastroplasty surgical interventions A61B17/00

Abstract

Devices and methods for tissue acquisition and fixation, or gastroplasty, are described. Generally, the devices of the system may be advanced in a minimally invasive manner within a patient'"'"'s body to create one or more plications within the hollow body organ. A tissue treatment device attached to a distal end of a flexible elongated member and has a cartridge member opposite an anvil member. The cartridge member and the anvil member are movable between a closed position and an open position, and a moveable barrier is disposed between the cartridge and anvil members to help acquire a dual fold of tissue. The tissue treatment device can be repositioned to form multiple plications within the organ.

Claims

1. A method for reducing the volume of a stomach cavity, comprising:

inserting a tissue treatment device having a proximal end and a distal end transorally to the stomach cavity, the tissue treatment device having a first jaw opposite a second jaw and the first jaw being loaded with at least one fastener;

positioning the proximal end of the tissue treatment device within the stomach at the region of gastroesophageal junction and the distal end of the tissue treatment device within the stomach cavity;

acquiring tissue above a Z-line and from the stomach with the tissue treatment device; and

forming a plication from the acquired tissue and extending downward into the body of the stomach using the at least one fastener loaded within the first jaw.

2. The method of claim 1, further comprising deploying a retractor disposed along the tissue treatment device and movable from a delivery configuration to a retraction configuration to manage stomach tissue relative to the tissue treatment device, allowing the acquired tissue from above the Z-line and from the stomach to be treated with the tissue treatment device.

3. The method of claim 2, further comprising extending a barrier disposed between the first jaw and the second jaw of the tissue treatment device and movable from a collapsed configuration to an extended configuration.

4. The method of claim 3, wherein extending the barrier between the first jaw and second jaw before acquiring tissue from above the Z-line and from the stomach with the tissue treatment device.

5. The method of claim 3, wherein the barrier is connected to the retractor.

6. The method of claim 3, further comprising removing the barrier from between the first jaw and the second jaw before forming the plication from the acquired tissue and extending downward into the body of the stomach.

7. The method of claim 6, wherein removing the barrier includes sliding the barrier past the distal end of the tissue treatment device.

8. The method of claim 7, wherein sliding the barrier includes moving a wire attached to the barrier distally.

9. The method of claim 2, wherein deploying the retractor pushes tissue away from the tissue treatment device.

10. The method of claim 1, further comprising viewing at least a portion of the acquiring tissue from above the Z-line and from the stomach with an endoscope.

11. The method of claim 1, wherein forming the plication from the acquired tissue and extending downward into the body of the stomach forms a pouch along the lesser curve of the stomach.

12. The method of claim 1, wherein acquiring tissue from above the Z-line and from the stomach using a vacuum generated within vacuum pods disposed within the tissue treatment device.

13. A method of providing therapy to the stomach cavity of a patient, comprising:

inserting at least a portion of a tissue treatment device within the stomach cavity; and

forming a pouch extending downward from the gastroesophageal junction into the body of the stomach cavity by placing a first plication at least partially within the stomach cavity with the tissue treatment device, and the pouch having a distal outlet, wherein forming the pouch includes acquiring tissue from above a Z-line and from the stomach with the tissue treatment device.

14. The method of claim 13, wherein acquiring tissue from above the Z-line and from the stomach using a vacuum generated within vacuum pods disposed within the tissue treatment device.

15. The method of claim 13, further comprising positioning a restrictor device adjacent the distal outlet of the pouch and forming at least one restricting plication near the distal outlet of the pouch with the restrictor device reducing the size of the distal outlet.

16. The method of claim 15, wherein the restrictor device plicates a single fold of tissue.

17. The method of claim 13, wherein placing at least one restricting plication near the distal outlet of the pouch with the tissue treatment device.

18. The method of claim 13, further comprising positioning the tissue treatment device adjacent the distal outlet of the pouch and extending the length of the pouch by forming a second plication generally in-line with first plication.

19. The method of claim 18, wherein extending the length of the pouch the second plication at least partially overlaps the first plication.

20. The method of claim 18, wherein extending the length of the pouch includes aligning a septum disposed on the tissue treatment device with the first plication.

21. The method of claim 20, wherein aligning the septum with the first plication includes extending a retractor wire attached to the septum to extend the septum, and translating the septum along the tissue treatment device to come into contact with a distal end of the first plication.

22. The method of claim 13, wherein forming the pouch with the tissue treatment device, the tissue treatment device plicates a dual fold of tissue.

23. A method of providing therapy to the stomach cavity of a patient, comprising:

inserting at least a portion of a tissue treatment device within the stomach cavity;

forming a first plication with the tissue treatment device, the first plication extending downward from the gastroesophageal junction into the stomach cavity, and wherein forming the first plication includes acquiring tissue from above a Z-line and from the stomach with the tissue treatment device to form the first plication;

repositioning the tissue treatment device near a distal end of the first plication; and

forming a second plication near the first plication with the tissue treatment device, wherein the first and second plications form a pouch along a lesser curve of the stomach with a distal outlet.

24. The method of claim 23, wherein forming the second plication generally in-line with the first plication.

25. The method of claim 23, further comprising positioning a restrictor device adjacent the distal outlet of the pouch and forming at least one restricting application near the distal outlet of the pouch with the restrictor device reducing the size of the distal outlet.

26. The method of claim 25, further comprising repositioning the restrictor device within the pouch and forming multiple restricting plications within the pouch.

27. The method of claim 23, further comprising positioning a restrictor device between the first plication and the second plication and forming a restricting plication to close a stoma between the first plication and the second plication.

28. The method of claim 23, wherein forming the second plication with the tissue treatment device, the second plication is continuous with the first plication.

29. The method of claim 23, wherein forming the second plication with the tissue treatment device, the second plication overlaps the distal end of the first plication.