Surgery – Instruments – Surgical mesh – connector – clip – clamp or band
Reexamination Certificate
2000-05-19
2002-12-17
Reip, David O. (Department: 3731)
Surgery
Instruments
Surgical mesh, connector, clip, clamp or band
C606S139000, C600S104000
Reexamination Certificate
active
06494888
ABSTRACT:
BACKGROUND
This invention relates to methods and apparatus for reconfiguring tissue, and more particularly to reconfiguring tissue in the vicinity of the gastroesophageal junction.
Gastroesophageal reflux disease (GERD) is a common upper-gastrointestinal disorder in which acidic contents of the stomach flow inappropriately from the stomach into the esophagus. Backflow of gastric contents into the esophagus results when gastric pressure is sufficient to overcome the resistance to flow that normally exists at the gastroesophageal junction (GEJ) or when gravity acting on the contents is sufficient to cause flow through the GEJ. Medication, open surgical procedures, minimally invasive surgical techniques, and endoscopic techniques are known for treating GERD.
SUMMARY
According to one aspect of the invention, an apparatus includes an elongated member configured for transoral placement into the stomach, and a distal end effector including first and second members configured to engage stomach tissue, e.g., stomach tissue beyond the esophageal junction. The first and second members are movable relatively toward one another generally in a first plane, and the distal end effector is movable relative to the elongated member in a second plane generally transverse to the first plane.
Embodiments of this aspect of the invention may include one or more of the following features.
The distal end effector includes a third member configured to engage stomach tissue. The third member is movable in a distal direction relative to the first and second members. The third member includes a tissue engaging portion, e.g., a coil having a tissue penetrating tip.
The apparatus includes a tissue securement member for coupling to at least one of the first and second members for securing together tissue engaged thereby. The tissue securement member includes a first part for coupling to the first member for engagement with a first tissue section, a second part for coupling to the second member for engagement with a second tissue section to be secured to the first tissue section, a suture attached to the first part, and a securing element attached to the suture and configured for engagement with the second part when the first and second members are moved relatively toward one another to engage the first and second tissue sections, thereby to secure the second part to the first part. The securing element is configured for deployment from the first member, and the first member includes a deploying element for deploying the securing element from the first member. The first member includes tissue piercing elements defining a channel for receiving securing elements.
The second plane is generally perpendicular to the first plane. The distal end effector is configured for movement between a first position generally aligned with the elongated member and a second position in which the distal end effector has moved in the second plane out of alignment with the elongated member. A cable actuatable from a proximal end of the apparatus and coupled to the distal end effector moves the distal end effector in the second plane. A cable actuatable from the proximal end of the apparatus and coupled to the distal end effector moves the first and second members generally in the first plane.
The elongated member defines a channel for receiving an endoscope.
According to another aspect of the invention, a method includes advancing an apparatus including an elongated member transorally into the stomach. The apparatus includes a distal end effector having first and second members configured to engage stomach tissue. The first and second members are movable relatively toward one another generally in a first plane. The method includes then moving the distal end effector relative to the elongated member in a second plane generally perpendicular to the first plane to position the first and second members for engagement with the tissue.
Embodiments of this aspect of the invention may include one or more of the following features.
The first and second members are moved relatively toward one another in the first plane to engage tissue, e.g., stomach tissue beyond the esophageal junction. Moving the first and second members engages a first tissue section with a first securing part and a second tissue section with a second securing part. The first securing part includes a suture attached thereto and a securing element attached to the suture. The method includes moving the securing element into engagement with the second securing part to secure the second securing part to the first securing part. Moving the first and second members causes tissue piercing elements of the first member to pierce tissue. Securing elements are deployed through the tissue piercing elements.
The method further includes piercing the tissue with a third member of the distal end effector prior to engaging the tissue with the first and second members.
The instrument and method of the invention advantageously provide an endoscopic approach to treating GERD that does not require the surgical formation of portals to access the GEJ. The procedure can be performed as an outpatient procedure done under sedation, without general anesthesia being required. The procedure can be performed by gastroenterologists rather than a surgeon, and takes less time, has fewer complications and side-effects and has lower overall procedure costs than surgical methods. The procedure recreates or augments the natural anatomy, and is easily reversible.
Other features, objects, and advantages of the invention will be apparent from the following detailed description, and from the claims.
REFERENCES:
patent: 3551987 (1971-01-01), Wilinson
patent: 5037433 (1991-08-01), Wilk et al.
patent: 5088979 (1992-02-01), Filipi et al.
patent: 5222963 (1993-06-01), Brinkerhoff et al.
patent: 5254126 (1993-10-01), Filipi et al.
patent: 5346504 (1994-09-01), Ortiz et al.
patent: 5395030 (1995-03-01), Kuramoto et al.
patent: 5403326 (1995-04-01), Harrison et al.
patent: 5433721 (1995-07-01), Hooven et al.
patent: 5465894 (1995-11-01), Clark et al.
patent: 5558665 (1996-09-01), Kieturakis
patent: 5571116 (1996-11-01), Bolanos et al.
patent: 5573496 (1996-11-01), McPherson et al.
patent: 5676674 (1997-10-01), Bolanos et al.
patent: 5787897 (1998-08-01), Kieturakis
patent: 5792153 (1998-08-01), Swain et al.
patent: 5810882 (1998-09-01), Bolduc et al.
patent: 5887594 (1999-03-01), LoCicero, III et al.
patent: 5897562 (1999-04-01), Bolanos et al.
patent: 5901895 (1999-05-01), Heaton et al.
patent: 5984932 (1999-11-01), Yoon
patent: 6009877 (2000-01-01), Edwards
patent: 6086600 (2000-07-01), Kortenbach
patent: 6067990 (2000-08-01), Kieturakis
patent: 6113609 (2000-09-01), Adams
patent: 6325503 (2002-03-01), Matsui et al.
patent: 6387104 (2002-05-01), Pugsley, Jr. et al.
patent: 0 480 428 (1992-04-01), None
patent: 0 576 265 (1993-12-01), None
patent: 0 646 356 (1995-04-01), None
patent: 2 768 324 (1999-03-01), None
patent: WO 99/22649 (1999-05-01), None
patent: WO 02/24080 (2002-03-01), None
International Search Report dated Oct. 16, 2000.
Contractor QQ et al., Endoscopic esophagitis and gastroesophageal flap valve.J Clin Gastroenterol1999 Apr.;28(3):233-7.
Donahue PE et al., Endoscopic control of gastro-esophageal reflux: status report.World J Surg1992 Mar.-Apr.;16(2):343-6.
Donahue PE et al., Endoscopic sclerosis of the gastric cardia for prevention of experimental gastroesophageal reflux.Gastrointest Endosc1990 May-Jun.;36(3):253-6.
Hill LD and Kozarek RA, The gastroesophageal flap valve.J Clin Gastroenterol1999 Apr.;28(3):194-7.
Hill LD et al., Antireflux surgery. A surgeon's look.Gastroenterol Clin North Am1990 Sep.;19(3):745-75.
Hill LD et al., The gastroesophageal flap valve: in vitro and vivo observations.Gastrointest Endosc1996 Nov.;44(5):541-7.
Hill LD, Intraoperative measurement of lower esophageal sphincter pressure.J Thorac Cardiovasc Surg1978 Mar.;75(3):378-82.
Hill LD, Myths of the esophagus.J Thorac Cardiovasc Surg1989 Jul.;98(1):1-10.
Ismail T et al., Yield pressure, anatomy of the cardia and gastr
Cerier Jeffrey C.
Cruz Amos G.
Laufer Michael D.
Fish & Richardson P.C.
ndo surgical, Inc.
Reip David O.
Woo Julian W.
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