Apparatus for forming an anastomosis

• US 8,828,031 B2
• Filed: 01/12/2009
• Issued: 09/09/2014
• Est. Priority Date: 01/12/2009
• Status: Active Grant

• Current Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Fox, William D., Trusty, Robert M.
• Primary Examiner(s): ANDERSON, GREGORY A
• Application Number:
  US12/352,451
• Publication Number:
  US 20100179510A1
• Time in Patent Office: 2,066 Days
• Field of Search: 606/151, 606153-156, 606/213, 600/12
• US Class Current: 606/153
• CPC Class Codes: A61B 17/11 for performing anastomosis; Buttons for anastomosis
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/1117 adapted for discharge after necrotisation, e.g. by evacuation, expulsion or excretion
• CPC Class Codes: A61B 2017/1139 Side-to-side connections, e.g. shunt or X-connections
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/2945 Curved jaws
• CPC Class Codes: A61B 2017/32096 for slowly cutting through tissue, e.g. stent like temporary implants having sharp edges

Abstract

A surgical instrument, for forming an anastomosis between first and second lumens in a patient, includes a first catheter, a second catheter, a hollow needle, a guide wire, an inflatable member, and a hollow sleeve. The first catheter includes at least one first opening, which may be configured to slidably receive the hollow needle and the guide wire, which may be disposed within the hollow portion of the needle, and at least one second opening. The hollow needle includes a rotary needle. The inflatable member is mounted near the distal end of the first catheter and is in fluid communication with the second opening. The magnet is polarized such that magnetic attraction occurs perpendicular to an axis of the cylindrical body. The hollow sleeve is configured to retain at least a portion of the inflatable member, the guide wire, the hollow needle, and the magnet.

Claims

1. A surgical instrument for forming an anastomosis between two lumens, the surgical instrument comprising:

a first catheter comprising a proximal end, a distal end, at least one first opening and at least one second opening, the at least one first opening configured to slidably receive a hollow needle from the proximal end to the distal end of the first catheter;

a hollow sleeve slidably receivable over the distal end of the first catheter;

a magnet defining an opening there-through, wherein the magnet is retained within the hollow sleeve;

an inflatable member mounted near the distal end of the first catheter and in fluid communication with the at least one second opening, wherein the inflatable member is configured to pass through the opening of the magnet when the inflatable member is in a deflated state, retain the magnet when the inflatable member is in an inflated state, wherein the hollow sleeve retains at least a portion of the inflatable member in an inflated state, wherein the hollow sleeve is slidably removable from the magnet and the inflatable member, and be removed from the magnet when the inflatable member is in a deflated state; and

wherein the inflatable member is inflatable to an inner diameter of the hollow sleeve, wherein the hollow sleeve prevents over inflation of the inflatable member, and wherein the inflatable member may be deflated when the hollow sleeve is slidably removed from the magnet and inflatable member.

2. The surgical instrument of claim 1, wherein the hollow needle comprises a rotary needle.

3. The surgical instrument of claim 2, wherein the rotary needle is rotatable by rotating a proximal portion of the rotary needle to penetrate tissue at a distal end of the rotary needle.

4. The surgical instrument of claim 2, wherein the rotary needle is chamfered around a periphery of the rotary needle at a distal end of the rotary needle.

5. The surgical instrument of claim 1 comprising a guide wire configured to be slidably disposed within the hollow needle, wherein the guide wire extends from the proximal end to the distal end of the first catheter.

6. The surgical instrument of claim 1, wherein the magnet comprises a cylindrical body, and wherein the opening is defined along an axis of the cylindrical body.

7. The surgical instrument of claim 6, wherein the magnet is diametrically polarized.

8. The surgical instrument of claim 1, wherein the hollow sleeve is configured to retain a guide wire, the hollow needle, and the magnet.

9. The surgical instrument of claim 1, wherein the hollow sleeve is attached to a second catheter, the second catheter configured to slidably retain the first catheter and extending from the distal end of the first catheter to near the proximal end of the first catheter.

10. The surgical instrument of claim 1 comprising a Y portion connected to the proximal end of the first catheter, wherein the Y portion comprises a first portion connected to the proximal end of the first catheter, a second portion, and a third portion.

11. The surgical instrument of claim 10, wherein the second portion of the Y portion is in communication with the first opening, wherein the hollow needle and the guide wire extend from the second portion of the Y portion at a proximal end of the surgical instrument, and wherein the third portion of the Y portion is in fluid communication with the second opening.

12. A method for forming an anastomosis between first and second lumens in a patient, comprising:

placing a first magnet within a hollow outer sleeve slidably receivable over a catheter, the first magnet having a cylindrical body defining an opening along an axis of the cylindrical body, wherein the first magnet is diametrically polarized;

forming a first opening in the first lumen, wherein the first opening is formed by a tissue penetrating tip attached to the catheter;

inserting the catheter, the tissue penetrating tip, and the hollow outer sleeve through the first opening;

forming a second opening in the second lumen using the tissue penetrating tip;

inserting the catheter, the tissue penetrating tip, and the hollow outer sleeve within the second opening;

inserting an inflatable member through the opening of the first magnet;

inflating the inflatable member within the hollow outer sleeve to form a contiguous surface from a proximal portion of the hollow outer sleeve to a distal portion of the hollow outer sleeve such that the first magnet is retained on the inflatable member;

retracting the hollow outer sleeve in a distal direction to expose the inflatable member and the first magnet;

deflating the inflatable member to allow the inflatable member to be withdrawn from the opening of the first magnet to place the first magnet within the second opening;

removing the hollow outer sleeve and inflatable member from the first and second openings;

placing a second magnet within the hollow outer sleeve, wherein the second magnet is substantially similar to the first magnet;

inserting the hollow outer sleeve through the first opening;

inserting the inflatable member through the opening of the second magnet;

inflating the inflatable member within the hollow outer sleeve to form a contiguous surface from a proximal portion of the hollow outer sleeve to a distal portion of the hollow outer sleeve such that the second magnet is retained on the inflatable member;

retracting the hollow outer sleeve in a distal direction to expose the inflatable member and the second magnet;

deflating the inflatable member to allow the inflatable member to be withdrawn from the opening of the second magnet to place the second magnet within the first opening;

attracting the first magnet toward the second magnet using magnetic force wherein the first magnet retains the second magnet in contact with the first lumen to create an anastomosis between the first and second lumens.

13. The method of claim 12 comprising passing a hole-forming instrument through a natural orifice in the patient into the first lumen, creating the first opening in the first lumen by placing a rotary needle in contact with the first lumen and rotating the rotary needle to form the first opening in the first lumen.

14. The method of claim 12 comprising inserting a guide wire, a balloon, and a hole-forming instrument of a magnet placement assembly through the opening of the first magnet.

15. The method of claim 12, comprising:

inflating a balloon to form a contiguous surface from a distal portion of a magnet placement assembly to a distal portion of a sleeve partially surrounding the magnet placement assembly;

locating the magnet placement assembly and the sleeve through the first opening and the second opening;

retracting the sleeve proximally to fully expose the first magnet;

deflating the balloon; and

moving the magnet placement assembly to allow the first magnet to drop from the magnet placement assembly into the second lumen.