Surgery – Miscellaneous – Methods
Reexamination Certificate
2002-05-31
2003-04-08
McDermott, Corrine (Department: 3738)
Surgery
Miscellaneous
Methods
Reexamination Certificate
active
06543456
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates, in general, to surgery and, more particularly, to a method of performing a surgical procedure on the digestive system.
BACKGROUND OF THE INVENTION
The percentage of the world population suffering from morbid obesity is steadily increasing. Severely obese persons are susceptible to increased risk of heart disease, stroke, diabetes, pulmonary disease, and accidents. Because of the effect of morbid obesity to the life of the patient, methods of treating morbid obesity are being researched.
Numerous non-operative therapies for morbid obesity have been tried with virtually no permanent success. Dietary counseling, behavior modification, wiring a patient's jaws shut, and pharmacologic methods have all been tried, and, though temporarily effective, failed to correct the condition. Nonsurgical approaches using mechanical devices, such as esophago-gastric balloons to fill the stomach have also been used to treat the condition. Such devices cannot be employed over a long term, however, as they often cause severe irritation, necessitating their periodic removal and hence interruption of treatment. Thus, the medical community has evolved surgical approaches to treatment of morbid obesity. Many surgical procedures for treatment of morbid obesity may generally be classified as being directed toward creation of a smaller stomach, also known as gastro-restrictive surgery, or toward the prevention of absorption of food, the most common of which is the gastric bypass. In variations of the gastric bypass, the stomach is divided into two pouches, with the upper pouch connected to the esophagus and having a small food capacity. The lower pouch remains in situ connected to the duodenum. The upper pouch is then surgically attached to a portion of the small intestine, called the jejunum, through a small opening. The opening restricts the passage of food by the greatly reduced useable stomach. The smaller stomach causes a feeling of fullness, or early satiety, with less food consumption, causing the patient to eat less food overall.
Minimally invasive methods to perform gastric bypass have been developed. These methods can involve five to seven laparoscopic ports inserted into the abdominal cavity. Instruments are used through the ports to create a small gastric pouch to restrict food intake and to bypass a portion of the intestine to cause malabsorption of ingesta. The procedure is described in Wittgrove, Alan C., MD, Clark, G. Wesley, MD, and Tremblay, Laurier J. MD
Laparoscopic Gastric Bypass, Roux
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en
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Y: Preliminary Report of Five Cases, Obesity Surgery,
Volume 4, Number 4 (November, 1994), pp. 353-357. In the procedure, a gastric pouch is formed by dissecting the stomach. Repeated applications of an endoscopic linear cutter are used to separate a small portion of the stomach just distal to the esophagus from the rest of the stomach. The jejunum is then transected distally with a linear stapler. (An example of a linear stapler can be found in U.S. Pat. No. 5,673,840, issued on Oct. 7, 1997 which is hereby incorporated herein by reference.) Thereafter, the distal portion of the jejunum, called the Roux-limb, is brought to form an anastomosis with the gastric pouch, often referred to as a gastroenterostomy. The gastroenterostomy can be performed with a linear stapler, circular stapler, or hand sewing. (An example of a circular stapler can be found in U.S. Pat. No. 5,104,025 issued on Apr. 14, 1992, which is hereby incorporated herein by reference.) Following the gastroenterostomy, a side to side anastomosis is performed to join the Roux-limb to the portion of the jejunum extending below the lower portion of the dissected stomach, often referred to as a enteroenterostomy. The enteroenterostomy often occurs approximately 75 centimeters distal to the gastroenterostomy.
Current minimally invasive techniques are difficult for surgeons to master, and have many additional drawbacks. For instance, a laparoscopically inserted circular stapler requires an incision in the intestines to perform its function. The incision increases chances of contamination of the abdomen with bowel contents, and requires closure.
Therefore, there exists in a gastric bypass operation a need to simplify the procedure, to reduce the number and size of laparoscopic ports opened into the human body, and to reduce the potential for abdominal leakage and contamination.
SUMMARY OF THE INVENTION
A method to perform a gastric bypass procedure on the digestive system, using surgical tools and anastomosis members inserted transorally, is disclosed. Two anastomosis members are placed transorally and passed into the distal small intestine. The small intestine is transected proximally to the two members to create a drainage loop and the Roux limb. An anastomosis instrument is inserted transorally to join the most distal anastomosis member to the drainage loop. The stomach is then transected to form a small gastric pouch. An anastomosis instrument then is inserted transorally to join the more proximal anastomosis member to the gastric pouch. The method reduces the number of laparoscopic ports, avoids a laparoscopic insertion of an anastomosis instrument into an enlarged surgical port, and eliminates the need for an enterotomy and an enterotomy closure. The anastomotic members within the digestive system can be distinguished to ensure proper rerouting of the digestive system.
REFERENCES:
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patent: 5411508 (1995-05-01), Bessler et al.
patent: 6279809 (2001-08-01), Nicolo
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Alternative Operative Techniques in Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity, Borao et al. JSJS (2001) 5:123-129.
Laparoscopic Roux-en-Y Gastric Bypass: Transoral or Transgastric Anvil Placement? Scott et al. Obesity Surgery, 10, 361-365.
Laparoscopic Gastric Bypass: Roux-en-Y Gastric Bypass—500 Patients: Techniques and Results, with 3-60 month follow-up, Wittgrove et al., Obesity Surgery, 10, 233-239.
Laparoscopic Gastric Bypass: Roux-en-Y-Preliminary Report of Five Cases, Wittgrove et al., Obesity Surgery, 4, 353-357.
Correspondence: Laparoscopic Gastric Bypass: Endostapler Transoral or Transabdominal Anvil Placement, Wittgrove et al., Obesity Surgery, 10, 376-377.
Website: www.pmi2.com.
Sales Brochure from Power Medical Interventions.
Ethicon Endo-Surgery Inc.
Matthews William H
McDermott Corrine
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