Apparatus and methods for closing a gastrotomy

The present invention relates, in general, to surgical devices and methods of use and, more particularly, to devices and methods relating to closing an opening made through the abdominal wall utilizing laparoscopic surgical instruments and procedures.

Access to the abdominal cavity may, from time to time, be required for diagnostic and therapeutic endeavors for a variety of medical and surgical diseases. Historically, abdominal access has required a formal laparotomy to provide adequate exposure. Such procedures which require incisions to be made in the abdomen are not particularly well-suited for patients that may have extensive abdominal scarring from previous procedures, those persons who are morbidly obese, those individuals with abdominal wall infection, and those patients with diminished abdominal wall integrity, such as patients with burns and skin grafting. Other patients simply do not want to have a scar if it can be avoided.

Minimally invasive procedures are desirable because such procedures can reduce pain and provide relatively quick recovery times as compared with conventional open medical procedures. Many minimally invasive procedures are performed with an endoscope (including without limitation laparoscopes). Such procedures permit a physician to position, manipulate, and view medical instruments and accessories inside the patient through a small access opening in the patient\'s body. Laparoscopy is a term used to describe such an “endosurgical” approach using an endoscope (often a rigid laparoscope). In this type of procedure, accessory devices are often inserted into a patient through trocars placed through the body wall. The trocar must pass through several layers of overlapping tissue/muscle before reaching the abdominal cavity. One of the most significant problems associated with such surgical procedures is the need to provide a secure closure of the gastrotomy site that is required for endoscope passage and, for example, specimen removal. Prior methods required the surgeon to close each of the muscle layers after the procedure is completed.

Still less invasive treatments include those that are performed through insertion of an endoscope through a natural body orifice to a treatment region. Examples of this approach include, but are not limited to, cystoscopy, hysteroscopy, esophagogastroduodenoscopy, and colonoscopy. Many of these procedures employ the use of a flexible endoscope during the procedure. Flexible endoscopes often have a flexible, steerable articulating section near the distal end that can be controlled by the user by utilizing controls at the proximal end. Minimally invasive therapeutic procedures to treat diseased tissue by introducing medical instruments to a tissue treatment region through a natural opening of the patient are known as Natural Orifice Translumenal Endoscopic Surgery (NOTES)™. In the past, however, those instruments suited for insertion through a natural orifice lacked means for performing a gastrotomy that avoids the need for the surgeon to separately close each tissue and muscle layer after the operation is completed.

Consequently a need exists for devices and methods that can be employed through a patient\'s natural orifice for closing a gastrotomy while avoiding the need to separately close the hole in each muscle and tissue layer in the abdominal wall.

The foregoing discussion is intended only to illustrate some of the shortcomings present in the field of the invention at the time, and should not be taken as a disavowal of claim scope.

In one aspect of the invention, there is provided a surgical instrument for forming a gastrotomy. In various embodiments, the instrument comprises a tubular member that has a proximal end and a distal end. A hollow tip is provided on the distal end of the tubular member. The hollow tip has a tip axis and a distal end that extends at an acute angle relative to the tip axis.

In another general aspect of various embodiments of the present invention, there is provided a surgical instrument for forming a gastrotomy. In various embodiments, the surgical instrument comprises a hollow tip that is configured for attachment to a distal end of an endoscope. The hollow tip has a tip axis extending therethrough and a distal end that extends at an acute angle relative to the tip axis.

In still another general aspect of various embodiments of the present invention, there is provided a surgical method for forming a gastrotomy through an organ wall that has an inner layer of tissue and at least one outer layer of tissue that is adjacent to the inner layer of tissue, wherein the inner layer of tissue is stretchable from a first relaxed condition to a stretched condition. The method may comprise stretching the inner layer of tissue to a stretched condition relative to the at least one outer layer of tissue and forming a first hole through the stretched inner layer of tissue and a second hole through the at least one outer layer of adjacent tissue such that the first and second holes are aligned with each other to permit passage of a surgical instrument therethrough. The method may further comprise performing a surgical procedure through the aligned first and second holes and thereafter permitting the inner layer to return to the first relaxed condition such that said first and second holes are no longer aligned with each other.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain various principles of the present invention.

FIG. 1 is a diagrammatical view illustrating the use of one embodiment of a surgical instrument of the present invention inserted through a patient\'s mouth and esophagus to perform a gastrotomy through the stomach wall;

FIG. 2 is partial perspective view of a portion of an endoscope having a hollow tip of one embodiment of the present invention thereon with the hollow tip shown in cross-section for clarity;

FIG. 3 is another view of the endoscope and hollow tip of FIG. 2 in confronting spaced relationship with a portion of the stomach wall;

FIG. 4 is another view of the endoscope and hollow tip of FIGS. 2 and 3 in contact with a portion of the inner layer of tissue of the stomach wall;

FIG. 5 is another view of the endoscope and hollow tip of FIG. 4 with a hole-forming instrument inserted through a working channel in the endoscope and piercing through the inner and outer layers of tissue;

FIG. 6 is another view of the endoscope and hollow tip of FIG. 5 with the hole-forming instrument withdrawn from the inner and outer layers of tissue; and

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Patent Applications in related categories:

20090292163 - Devices and methods for achieving the laparoscopic delivery of a device - Devices and methods are disclosed for delivering an instrument laparoscopically to a targeted tissue. Embodiments of the device comprise a handle, a lift system and two arms extending therebetween and are capable of achieving the parallel closure of the instrument around the targeted tissue. Further, the methods described can be ...


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