APPARATUS AND METHOD FOR RESECTIONING GASTRO-ESOPHAGEAL TISSUE
A system for stapling tissue comprises a flexible endoscope and an operative head including a pair of opposed, curved tissue clamping jaws sized to pass through an esophagus, the jaws being moveable with respect to one another between an open tissue receiving configuration and a closed tissue clamping configuration, a first one of the curved jaws including a stapling mechanism and a second one of the jaws including a staple forming anvil surface, the stapling mechanism including staple slots through which staples are fired arranged in a row extending from a proximal end of the first jaw to a distal end thereof in combination with a control handle which, when the operative head is in an operative position within one of a patient's stomach and esophagus, remains outside the patient, the control handle including a first actuator for moving the jaws relative to one another and a second actuator for operating the stapling mechanism.
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The present invention relates to endoscopic devices for performing localized resections of gastro-esophageal lesions.
BACKGROUND OF THE INVENTIONEndoscopic surgical stapling apparatus are known in the art and are utilized to provide a variety of surgical procedures. For example, U.S. Pat. No. 5,040,715 to Green, et al. discloses an endoscopic stapling device configured to be inserted through a small entrance wound in the abdominal cavity to place rows of staples in body tissue. This device has a limited range of motion in that the stapling assembly at the distal end of the instrument can only be rotated about the central axis of the instrument.
An endoscopic stapling apparatus purporting to have a greater range of motion is disclosed in U.S. Pat. No. 5,326,013 to Green et al. This device has an articulating stapling assembly mounted for pivotal movement about an axis extending transverse to the central axis of the instrument. An endoscopic stapling device designed to be inserted through a small incision in a body wall and purporting to have an increased range of motion is described in U.S. Pat. No. 5,389,098 to Tsuruta et al. A stapling assembly of this device curves away from a central axis of the instrument to a 90.degree. angle so that it can more easily reach tissue spaced from the central axis. This device incises tissue clamped within the stapling assembly and places staggered lines of staples on both sides of the incision.
SUMMARY OF THE INVENTIONThe present invention is directed to a system for stapling tissue comprising a flexible endoscope and an operative head including a pair of opposed, curved tissue clamping jaws sized to pass through an esophagus, the jaws being moveable with respect to one another between an open tissue receiving configuration and a closed tissue clamping configuration, a first one of the curved jaws including a stapling mechanism and a second one of the jaws including a staple forming anvil surface, the stapling mechanism including staple slots through which staples are fired arranged in a row extending from a proximal end of the first jaw to a distal end thereof in combination with a control handle which, when the operative head is in an operative position within one of a patient's stomach and esophagus, remains outside the patient, the control handle including a first actuator for moving the jaws relative to one another and a second actuator for operating the stapling mechanism.
A detailed description of illustrative embodiments of the present invention is provided in conjunction with the attached drawings. In the descriptions of the various embodiments and the corresponding drawings, like reference numerals refer to like elements.
A method and apparatus for resectioning anastomized lumenal tissue is disclosed in U.S. Pat. No. 5,868,760 to McGuckin et al., the disclosure of which is hereby incorporated by reference in its entirety. The disclosed apparatus includes a flexible tubular body and a distal operating capsule that may be inserted through either a naturally occurring body orifice or a surgical incision and guided to an operative site endoscopically or using radiologic imaging guidance. In use the target tissue is stapled, cut and captured within the operating capsule for removal from the body. The healthy tissue is thereby anastomized by surgical staples.
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Furthermore, those skilled in the art will understand that the system may operate with any of a variety of commercially available medical endoscopes which may include, for example, a proximal handle portion 22, an elongated flexible body portion 24 through which one or more interior lumena extend for accommodating, for example, a fiber optic bundle or other image transmission structure, a working channel for the grasping device 30, etc. Those skilled in the art will understand that the fiber optic bundle (or other image transmitting structure) allows a user to remotely visually monitor a field of view at the distal end of the endoscope (e.g., an operative site S within the esophagus E). As would be further understood by those of skill in the art, the tissue grasping device 30 may include a handle portion 32, an elongated flexible body portion 34 and a pair of opposable jaws 36a and 36b.
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As described above, actuation of the lower handle 12a causes the C-shaped clamp member 60 to move along an arc the length of the curved stapling assembly 16 to finely approximate the jaws 17 toward one another. As shown in
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The above described embodiments are for purposes of illustration only and the various modifications of these embodiments which will be apparent are considered to be within the scope of the teachings of this invention which is to be limited only by the claims appended hereto.
Claims
1. A system for stapling tissue comprising:
- an operative head including a pair of opposed, curved tissue clamping jaws sized to pass through an esophagus, the jaws being moveable with respect to one another between an open tissue receiving configuration and a closed tissue clamping configuration, a first one of the curved jaws including a stapling mechanism and a second one of the jaws including a staple forming anvil surface, the stapling mechanism including staple slots through which staples are fired arranged in a row extending from a proximal end of the first jaw to a distal end thereof; and
- a control handle which, when the operative head is in an operative position within one of a patient's stomach and esophagus, remains outside the patient, the control handle including a first actuator for moving the jaws relative to one another and a second actuator for operating the stapling mechanism.
2. The system according to claim 1, further comprising a tissue cutting mechanism for severing from the patient's body tissue located radially within the row of staples.
3. The system according to claim 1, further comprising a staple pusher mounted for movement within the first jaw along a path substantially parallel to the row of staples.
4. The system according to claim 3, wherein the stapling mechanism fires staples in a plurality of substantially parallel rows.
5. The system according to claim 3, further comprising a tissue cutting mechanism for severing from the patient's body tissue located radially within the row of staples wherein the tissue cutting mechanism comprises a blade coupled to the staple pusher.
6. The system according to claim 1, wherein the operative head further includes a first jaw moving mechanism for gross adjustment of the position of the jaws relative to one another and a second jaw moving mechanism for fine adjustment of the jaws relative to one another.
7. The system according to claim 6, wherein the second jaw moving mechanism includes a substantially C-shaped clamp received around the first and second jaws.
8. The system according to claim 7, wherein the substantially C-shaped clamp includes a tissue cutting blade integrally formed therewith.
9. The system according to claim 6, wherein the first jaw includes a curved cam slot substantially parallel to the row of staples and wherein the substantially C-shaped clamp includes a cam follower riding within the cam slot.
10. The system according to claim 9, wherein the staple pusher is coupled to the C-shaped clamp for movement therewith.
11. The system according to claim 10, wherein the stapling mechanism includes a plurality of staple driving members, each staple driving member being received within a respective staple slot and wherein the staple pusher includes an angled surface which, when the staple pusher is driven along the path substantially parallel to the row of staples, the angled surface sequentially contacts the staple pushers to drive the staples out of the first jaw toward the second jaw.
12. The system according to claim 11, wherein the tissue cutting blade is coupled to the C-shaped clamp so that, as the stapling mechanism is operated, it trails the angled surface of the staple pusher so that tissue is cut only after a corresponding radially outer portion of tissue has been staped.
13. The system according to claim 6, wherein the second jaw moving mechanism includes an I-beam member a web of which extends through corresponding slots in the first and second jaws with a first portion of the I-beam member being received within the first jaw and a second portion of the I-beam member being received within the second jaw.
14. The system according to claim 13, wherein the I-beam member serves as the staple pusher and wherein a first portion of the I-beam member includes a camming surface which sequentially contacts each of a plurality of staple pushers as the I-beam member is moved through the corresponding slots in the first and second jaws.
15. The system according to claim 13, wherein the I-beam member includes a tissue cutting blade extending from the web between the first and second portions of the I-beam member.
16. The system according to claim 1, wherein the gross adjustment mechanism includes a cable extending between the control handle and the operative head, wherein the cable extends around a pivot member coupled to one of the first and second jaws to couple to the other of the first and second jaws.
17. A method for stapling tissue comprising the steps of:
- inserting into a patient's mouth a flexible endoscope device including an operative head having a pair of opposed, curved tissue clamping jaws, a first one of the curved jaws including a stapling mechanism and a second one of the jaws including a staple forming anvil surface;
- moving the jaws relative to one another from a closed position to an open tissue receiving position;
- drawing a folded, full-thickness portion of tissue from one of the patient's stomach and esophagus between the jaws;
- moving the jaws from the open position to the closed position to clamp the tissue between staple slots formed in the first jaw through which staples are fired by the stapling mechanism and the staple forming surface, wherein the staple slots are arranged in a row extending from a proximal end of the first jaw to a distal end thereof; and
- actuating the stapling mechanism to drive staples out of the staple slots through the tissue and against the staple forming surface to couple the folds of tissue to one another.
18. The method according to claim 17, wherein the tissue is located in the patient's stomach and the folds of tissue are coupled to one another to reduce a size of an interior space of the stomach.
19. The method according to claim 18, wherein tissue radially within the row of staples is left in place.
20. The method according to claim 17, wherein tissue radially within the row of staples is severed from the stapled tissue.
Type: Application
Filed: Sep 9, 2019
Publication Date: Dec 26, 2019
Applicant: REX Medical, L.P. (Conshohocken, PA)
Inventors: James F. MCGUCKIN, JR. (Radnor, PA), Peter HINCHLIFFE (Downington, PA)
Application Number: 16/564,543