Surgery – Instruments – Suture – ligature – elastic band or clip applier
Reexamination Certificate
2000-04-19
2002-08-20
Reip, David O. (Department: 3731)
Surgery
Instruments
Suture, ligature, elastic band or clip applier
C606S139000
Reexamination Certificate
active
06436108
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates to a movable ligating band dispenser, and in particular, to a movable ligating band dispenser that can assume a retracted position, to provide a substantially unimpaired field of view for an image sensing device of a hosting endoscope or laparoscope as well as greater mobility during exploration for such devices, and an extended position, for enabling a conventional ligation procedure.
BACKGROUND OF THE INVENTION
Ligation is a medical procedure in which an elastic band, or ligating band, is placed about tissue to prevent fluid flow therethrough. Where a ligating band is placed about, for example, a ballooning varix, polyp, hemorrhoid, or pre-cancerous lesion, a contracted ligating band induces fusion and healing in the base tissue and subjects the ligated tissue to necrosis. The necrotic tissue eventually separates from the surrounding tissue and passes into the human system. Alternatively, ligation may also be used for purposes of sterilization, wherein a ligating band may be placed over a folded loop portion of a Fallopian tube or a vas deferens to prevent the passage of internal reproductive fluids.
Means for delivering ligating bands, or ligating band dispensers, take various forms. One such form is a dedicated ligating band dispenser instrument which has a dispensing portion at a distal end, an actuating mechanism at a proximal end, and a typically rigid shaft therebetween. These instruments are useful for ligating tissue in which the user has access to the tissue to be ligated, e.g., tissue exposed through an invasive surgical procedure.
In contrast, ligating band dispensers may be positioned on the distal tip of an endoscope or a laparoscope. An endoscope is a conventional medical device used for viewing, exploring, and delivering therapies to internal regions of a patient. A laparoscope is a specialized endoscope for viewing a patient's peritoneal cavity. Unlike dedicated ligating band dispensing instruments, an endoscope allows minimally invasive intrusion into a patient.
FIGS. 1 and 2
illustrate a conventional endoscope. Endoscope
10
has a control portion
12
and a insertion portion
14
terminating at insertion tip
16
. Insertion portion
14
is of such a length to permit access to internal regions of a patient.
FIG. 2
illustrates the face of insertion tip
16
. A number of channels extend from the control portion
12
to the insertion tip
16
, where the channels terminate in functional outlets
18
-
26
. For the purposes of this example, outlet
18
is a light source; outlet
20
is a wide-field image sensing device, which transmits a video or fiber optic signal to a coupled monitor or eyepiece (not shown) at control portion
12
; outlet
22
delivers a stream of water or air for clearing the image receiving device or flushing an internal bodily region; and outlet
24
is an outlet to a working (or biopsy) channel. Inlet
28
of the working channel can be coupled to a suction device or a lavage fluid source (not shown) or can receive various medical instrumentation (not shown) for passage through the working channel and outlet
24
. Optional outlet
26
, for larger diameter endoscopes, is an outlet for a second working channel. A second working channel allows additional operations in a manner consistent with the working channel described above.
Endoscope ligating band dispensers are fixedly mounted about and protrude from insertion tip
16
of a hosting endoscope, wherein such dispensers carry one or more expanded ligating bands about their outer diameter. Projecting from insertion tip
16
, conventional dispensers inherently narrow the field of view of the image sensing device of outlet
20
. In an effort to improve such impairment, some conventional devices are fabricated from a transparent material. While such material may facilitate the outward passage of light from outlet
18
, such material does not practically improve the field of view for the wide-field image sensing device. Specifically, the use of transparent material commonly induces distortion about the periphery of a displayed image. Distortion is a product of both the curvature of the dispenser and the accumulation of bodily fluids about the outer surface of the dispenser. Ligating bands stored on the outer diameter of these dispensers further obstruct the field of view through the dispenser material.
A conventional endoscope ligating band dispenser is shown in FIG.
3
. Dispenser
1000
is capable of dispensing multiple ligating bands
1002
, whether individually or sequentially. Typical of the prior art, dispenser
1000
is cylindrical and hollow in nature, where an inner periphery of dispenser
1000
defines a cavity and an outer periphery carries the ligating bands
1002
. Dispenser
1000
projects from the distal end of insertion tip
16
. Accordingly, dispenser
1000
inhibits the field of view of a wide-field image sensing device (not shown) of the hosting endoscope in accordance with the limitations of conventional devices outlined above.
Conventional dispensers, such as dispenser
1000
, increase the length of insertion tip
16
. A ligating band dispenser-equipped endoscope is commonly used within a hollow body cavity, for example, an esophagus. Insertion tip
16
must assume almost a 90° bend with respect to the longitudinal axis of the insertion portion
14
to obtain a clear view normal to the inner surface of an esophagus. The additional length of the ligating band dispenser from insertion tip
16
can significantly restrict the motion and flexibility of insertion tip
16
within a hollow body cavity. Accordingly, the added length, coupled with the severely restricted peripheral view, makes the presence of conventional ligating band dispensers an operational liability during the exploration and placement phases of ligation procedures.
SUMMARY OF THE INVENTION
The present invention is directed to a ligating band dispensing device adapted to be movably received on a distal end of an insertion portion of an endoscope having a fixed seal. The dispensing device has a proximal end that movably receives an insertion portion of an endoscope, a distal end, and an interior surface that, when in an operative position, at least partially encompasses a portion of the insertion portion of the endoscope and at least a portion of the seal. The seal is adapted to establish a sealing relationship between the endoscope and the dispensing device during a ligation procedure. Operatively, the dispensing device is capable of movement from a retracted position to at least a dispensing position.
A dispensing device in accordance with another aspect of the present invention includes a ligating band dispenser, an actuating mechanism, and a sealing member for placement on the insertion portion of an endoscope. The ligating band dispenser is adapted to be slidably mounted on the distal end of the insertion portion of the endoscope. The actuating mechanism is coupled to the ligating band dispenser and is adapted to selectively effect movement of the dispenser from a first position to at least a second position, relative to the sealing member fixed to the insertion portion of the endoscope. In the second position, the distal end of the dispenser is distally spaced from the distal end of the endoscope, creating a volume substantially defined by the dispenser sufficient to perform a ligation procedure. In the first position, the volume is reduced to expose, at least in part, a face of the distal end of the insertion portion of the endoscope.
A system for dispensing a ligating band to ligate tissue in accordance with another aspect of the present invention includes an endoscope, a member, and a dispensing device. The endoscope has an insertion portion for insertion into a patient. The member is positioned on the insertion portion of the endoscope. The member further includes a proximal end that includes an abutting surface to abut a distal face of the insertion portion of the endoscope. The dispensing device is movably positioned on the insertion portion of
EnSurg, Inc.
Reip David O.
Sidley Austin Brown & Wood LLP
Woo Julian W.
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