| Apparatus and methods for performing mucosectomy -> Monitor Keywords |
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Apparatus and methods for performing mucosectomyApparatus and methods for performing mucosectomy description/claimsThe Patent Description & Claims data below is from USPTO Patent Application 20090270856, Apparatus and methods for performing mucosectomy. Brief Patent Description - Full Patent Description - Patent Application Claims
This application is a divisional of co-pending U.S. patent application Ser. No. 11/069,890, filed on Feb. 28, 2005, which is a continuation-in-part application of co-pending U.S. patent application Ser. No. 10/954,658 filed Sep. 29, 2004, which is a continuation-in-part application of co-pending U.S. patent application Ser. No. 10/797,910 filed Mar. 9, 2004, the contents of which are incorporated herein by reference in their entirety. 1. Field of the Invention The present invention relates to methods and apparatus for performing mucosectomy. More particularly, the present invention relates to methods and apparatus for mapping out gastrointestinal (“GI”) surgery, such as endoluminal gastric reduction, via mucosectomy. Morbid obesity is a serious medical condition pervasive in the United States and other countries. Its complications include hypertension, diabetes, coronary artery disease, stroke, congestive heart failure, multiple orthopedic problems and pulmonary insufficiency with markedly decreased life expectancy. Several open surgical techniques have been developed to treat morbid obesity, e.g., bypassing an absorptive surface of the small intestine, or reducing the stomach size. These procedures are difficult to perform in morbidly obese patients because it is often difficult to gain access to the digestive organs. In particular, the layers of fat encountered in morbidly obese patients make difficult direct exposure of the digestive organs with a wound retractor, and standard laparoscopic trocars may be of inadequate length. In addition, previously known open surgical procedures may present numerous life-threatening post-operative complications, and may cause atypical diarrhea, electrolytic imbalance, unpredictable weight loss and reflux of nutritious chyme proximal to the site of the anastomosis. Applicant has previously described methods and apparatus for laparoscopically reducing a patient\'s stomach, for example, in co-pending U.S. patent application Ser. No. 10/8434,682, filed May 10, 2004, which is incorporated herein by reference. Furthermore, Applicant has previously described methods and apparatus for endoluminally reducing a patient\'s stomach, for example, in co-pending U.S. patent application Ser. No. 10/735,030, filed Dec. 12, 2003, which also is incorporated herein by reference. Those applications describe techniques for creating a small pouch from within the patient\'s stomach that is positioned below the gastroesopliageal junction to limit food intake and promote a feeling of satiety. The endoluminal pouch is expected to act in a manner similar to a Vertical Banded Gastroplasty (“VBG”). The gastrointestinal lumen includes four tissue layers, wherein the mucosa layer is the top (innermost) tissue layer, followed by connective tissue, the muscularis layer and the serosa layer. One problem with endoluminal gastrointestinal reduction systems is that the anchors (or staples) must engage at least the muscularis tissue layer in order to provide a proper foundation, since the mucosa and connective tissue layers tend to stretch elastically tinder the tensile loads imposed by normal movement of the stomach wall during ingestion and processing of food. Applicant\'s previously-described techniques for stomach reduction address this concern by reconfiguring the stomach lumen via engagement of at least the muscularis layer of tissue. It is expected that proper placement of anchors or suture to achieve such stomach reduction will present significant challenges to a medical practitioner, due, for example, to the limited working space, as well as the limited visualization provided by an endoscope or fiberscope. U.S. Pat. No. 6,558,400 to Deem et al. describes methods and apparatus for marking the interior of the stomach from the esophagus to the pylorus to map out an endolutninal reduction procedure. Marking is achieved with dye channeled through ports in a marking device or bougie. The bougie optionally may comprise suction ports for evacuating the stomach about the bougie, at which point the dye may be injected to stain the stomach along points that contact the dye ports. The stomach then may be insulated for performing the endoscopic reduction procedure utilizing the map provided by the dye marks stained onto the stomach mucosa. A significant drawback of the marking technique described by Deem et al. is that dyes have a tendency to spread and are difficult to localize, especially in a fluid environment such as that which contacts the mucosa layer of the stomach. As such, it is expected that dye that does not penetrate beyond the mucosa will provide an inaccurate and/or unstable map for performing endoscopic gastric reduction. This, in turn, may yield an incorrectly sized or poorly sealed stomach pouch, which may render the procedure ineffective in facilitating weight loss and/or may result in dangerous complications. In view of the aforementioned limitations, it would be desirable to provide methods and apparatus for mapping out endoluminal gastrointestinal surgery that may be readily localized, that enhance accuracy and stability of the surgical map, that facilitate direct engagement of muscularis tissue from within the stomach and/or that initiate a wound healing response along approximated tissue. In view of the foregoing, the present invention provides apparatus and methods for marking the interior of a patient\'s gastrointestinal lumen. In a first variation, the surgical map comprises localized RF scarring or mucosal ablation. In an alternative variation, the map comprises pegs, e.g. colored pegs, which may be biodegradable, e.g. fabricated from polyglycolic acid. Alternatively, the pegs may comprise one or more corkscrews advanced into tissue surrounding the GI lumen. In yet another alternative variation, the map comprises dye injected into at least the submucosa. The dye may be fluorescent or of varying colors. Alternatively, the dye may be disposed within nanospheres or microspheres implanted submucosally. In addition, or as an alternative,. to dye spheres, the spheres may be magnetic, heat-able ferromagnetic or Curie point, plastic and inert, radiopaque, etc. As a still further alternative, the map may comprise the shaft of an endoluminal surgical tool having specified dimensions and/or color-coding, etc. In another alternative variation, the map may be formed from surgical mesh. Additional mapping apparatus will be apparent. In one preferred variation, placement of the map is accurately achieved using suction ports and/or an inflatable member disposed along an endoluminal support, such as a shaft or other tool associated with the endoluminal GI surgery. When using suction, the stomach may be deflated about the support prior to deployment of the surgical map. When using an inflatable member, the inflatable member may be inflated to contact tissue prior to deployment of the map. As will be apparent, a combination of suction and inflation may be used to properly orient tissue prior to mapping. In additional variations, mucosectomy and/or mucosal ablation is performed to map out endoluminal GI surgery, to facilitate direct endoluminal engagement of underlying muscularis tissue and/or to initiate a wound healing response. Specialized apparatus may be provided to achieve desired spacing and/or positioning of tissue markings, and may be provided to actually form the markings. Methods of using apparatus of the present invention also are provided. Continue reading about Apparatus and methods for performing mucosectomy... Full patent description for Apparatus and methods for performing mucosectomy Brief Patent Description - Full Patent Description - Patent Application Claims Click on the above for other options relating to this Apparatus and methods for performing mucosectomy patent application. ###  How KEYWORD MONITOR works... a FREE service from FreshPatents1. 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