Adaptive Devices and Methods for Endoscopic Wound Closures
This invention is directed to devices and methods for improving wound closures produced during endoscopic surgery. These methods are directed to delivering and applying a quantity of hemostatic agents in either powder, solid, liquid, or gel form onto an open wound produced e.g., by polyp removal, followed by the application of pressure. The method is implemented preferably using existing endoscopic equipment; however, modifications to existing endoscopic insertion tubes, application and tamping devices and endoscopic clips deployed from the distal end of the insertion tube during endoscopic surgery are also within the scope of this invention.
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This application is a continuation of application Ser. No. 15/022,281, filed Mar. 16, 2016, which is a 371 of PCT/US14/56011, filed Sep. 17, 2014, which claims benefit of Application No. 61/878,677, filed Sep. 17, 2013.
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENTNot applicable
INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED ON A COMPACT DISCNot applicable
BACKGROUND OF THE INVENTION Field of the InventionThis invention is directed to a method for improving wound closures during endoscopic surgery after polyp removal and biopsy samples are taken. More specifically, this disclosure is directed to applying a quantity of resin ferrate or other hemostatic substances in either powder, solid, liquid or gel form onto an open wound, followed by the application of pressure. The methods are implemented preferably using existing endoscopic equipment; however, modifications to existing endoscopic insertion tubes and adaptive devices are also within the scope of this invention. The wound may be located in the alimentary tract or other serosal mucosa.
Description of Related ArtEndoscopy is the medical science of looking inside or typically within the body for medical reasons using an endoscope. An endoscope is an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ.
An endoscope typically includes a rigid or flexible tube, a light delivery system to illuminate the organ. The light source is typically being positioned outside the body, the light being directed typically by an optical fiber system to illuminate the interior organ. The endoscope also includes a lens system for transmitting the image from the objective lens to the viewer, and an eyepiece. Additional channels are provided to allow entry of medical instruments and manipulators.
A healthcare provider may use an endoscope for any of a plurality of purposes, including investigation of symptoms such as symptoms in the digestive system including nausea, vomiting, abnormal pain, difficulty swallowing, and gastrointestinal bleeding. The endoscope may also be used to confirm a diagnosis, most commonly by performing a biopsy, to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system. Treatment may also be administered by an endoscope such as cauterization of a bleeding vessel, the widening of a narrow esophagus, cutting off of a polyp or removing a foreign object within the organ.
One particularly useful application of the endoscope is the removal of polyps and other growths within the interior walls of the organ under examination. However, the techniques for removing the polyp include typically either a cutting device or a heated loop device, both of which leave a wound at the base of the polyp which typically bleeds profusely. To arrest the blood flow from the incision, surgical clamps are the most preferable means of arresting that blood flow. A plurality of these small surgical clamps is attached around and across the wound so as to effect a wound closure. However, these clamps are difficult to apply, are small and unable to approximate wide wounds, and do not often effect a complete wound closure leaving some bleeding. Moreover, the clamps must be left in place for a time sufficient to arrest bleeding, after which they are eventually eliminated by normal bowel movement in the colon or intestine.
Another means for arresting blood flow from a wound of this nature is to simply spray a powder starch-like material onto the wound until it is sufficiently covered to absorb the blood flow and cause the cessation of blood flow from that wound. However, due to a lack of containment of this powder, a large quantity of this material is required to effect bleeding cessation, leaving a substantially greater amount of material than typically needed if applied directly to the wound from an exposed wound.
The present invention provides a method of wound closure after a polyp or removal during endoscopic surgery and the like. This method is directed to applying a quantity of a hemostatic substance in either powder, solid, liquid, or gel form onto the open wound followed by the application of pressure. Various adaptive devices are provided to accomplish both the deployment of the hemostatic substance onto the wound and the application of pressure thereagainst to effect complete hemostasis.
The foregoing examples of the related art and limitations related therewith are intended to be illustrative and not exclusive. Other limitations of the related art will become apparent to those skilled in the art upon a reading of the specification and a study of the drawings.
BRIEF SUMMARY OF THE INVENTIONThis invention is directed to a method for improving wound closures after polyp removal during endoscopic surgery. This method is directed to applying a quantity of a hemostatic substance e.g., resin ferrate in either powder, solid, liquid, or gel form onto an open wound produced by polyp removal followed by the application of pressure. The method is implemented preferably using existing endoscopic equipment, however, modifications to existing endoscopic insertion tubes is also within the scope of this invention.
Powder Form of Hemostatic SubstanceUsing the powder or granular form of the resin ferrate or other granular or particulate hemostatic substance, this material may be delivered through the central channel of an endoscope by air pressure, by plunger, by a screw feed, by gravity, or by a liquid carrier. To direct and apply pressure against the resin ferrate powder, several devices may be employed. For example, a flexible bowl or funnel formed of thin resilient material deployed against and covering the wound. Powder directed into the bowl or funnel is then pressed against the wound. When the powder is combined with magnetite, thin magnetic wires deployed from the distal end of the endoscope will capture the magnetic powder, after which the magnetic wires are directed against the wound for a time sufficient for the powder to become affixed onto the open wound. Other powder deployment and pressure application devices are also disclosed.
Tablet/Solid Form of Hemostatic SubstanceSeveral embodiments of this disclosure utilize a solid or compressed powder device for deployment onto the wound. One embodiment is in the form of a donut-shaped disc which is held within the end of the insertion tube and provides viewing access by the camera within the insertion tube. The camera thus provides accurate placement of the disc over the wound site.
In another embodiment, a solid disc is temporarily bonded or adhered on the side of the bleeding tip providing guided positioning and pressure of the disc against the wound site for a time sufficient to adhere the disc to the wound site.
Mini-sized solid tablets which slidably translate within a delivery tube are delivered sequentially onto the wound site. The column of tablets may be pushed by a plunger or connected by an elongated suture and pulled from the end of the bending tip. The hemostatic substance forming the disc may include magnetite which may be manipulated and applied by a magnet.
Motive ForceA number of means for moving the hemostatic powder or solid tablets along the hollow interior of a delivery tube within the insertion tube may be employed, namely, a plunger, gas or air pressure, a venture, and various forms of augers or feed screws.
The following embodiments and aspects thereof are described and illustrated in conjunction with systems, tools and methods which are meant to be exemplary and illustrative and not limiting in scope. In various embodiments one or more of the above-described problems have been reduced or eliminated while other embodiments are directed to other improvements. In addition to the exemplary aspects and embodiments described above, further aspects and embodiments will become apparent by reference to the drawings and by study of the following descriptions.
Exemplary embodiments are illustrated in reference figures of the drawings. It is intended that the embodiments and figures disclosed herein are to be considered to be illustrative rather than limiting.
DETAILED DESCRIPTION OF THE INVENTION Nomenclature
- 10. endoscopic assembly
- 12. light guide connector
- 14. universal cord
- 16. endoscope head
- 18. eyepiece
- 20. controls
- 22. biopsy port
- 24. insertion tube
- 26. bending tip
- 28. biopsy suction channel
- 30. fiber optic light guides
- 32. fiber optic image bundle
- 34. water tube
- 36. air tube
- 38. tip bending control wires
- 40. hemostatic powder
- 42. flexible bowl
- 44. funnel shaped bowl
- 46. magnetic arm bowl
- 48. elastic ring
- 50. hemostatic powder with magnetite
- 52. barbed bowl
- 54. inflatable balloon
- 56. balloon tamponade
- 58. magnet
- 60. balloon
- 62. stent
- 64. application catheter
- 66. clear cap
- 68. application catheter
- 68a. venturi
- 70. magnet
- 72. FE+3 spray
- 74. spray nozzle
- 76. endoclip
- 78. resilient wire jaws
- 80. insertion tool
- 82. magnetized barrel
- 84. styptic powder
- 86. hemostatic tablet
- 88. hemostatic tablet
- 90. camera
- 92. hemostatic tablet
- 100. wound covering
- 102. hemostatic powder with magnets and magnetite
- 104. plunger
- 106. hemostatic tablets
- 108. suture
- 110. barbed magnets
- 112. barb
- 114. barbed anchor
- 116. barb
- 118. barbed anchor
- 120. barb
- 122. wire
- 124. hemostatic powder coated sheet
- 130. hemostatic powder distribution head assembly
- 132. distribution head
- 134. apertures
- 140. spring wire clip
- 142. spring wire
- 144. barbs
- 146. pivot anchor
- 148. push/pull wire
- 150. funnel
- 152. drive auger
- 154. outer auger
- 156. central feed passage
- 158. wire auger
As referenced herein, the term “hemostatic powder” is preferably WOUNDSEAL powder, a resin/ferrate or hydrogen resin as taught in U.S. Pat. No. 6,187,347. The term “hemostatic tablet or solid” is preferably STATSEAL, refers to a compressed form of WOUNDSEAL powder. The term “intestine” is used to designate the alimentary tract or other serosal mucosa.
Referring now to
In well known fashion, the insertion tube 24 houses a biopsy suction channel 28, fiber optic light guides 30, a fiber optic image bundle 32, a water tube 34, an air tube 36, and a plurality of evenly spaced tip bending control wires 38. These control wires 38 are controlledly actuated to bend the bending tip 26 in any desired direction as seen in
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In one embodiment, the sides of the bowl 52 may be elastic, and there may be an elastic ring 48 at the end of the insertion tube as seen in
In another embodiment, the arms of the bowl 52 are made of wire. The bowl 52 is attached and filled with powder as previously described, after which the insertion tube 24 is rotated whereupon the wires wrap around themselves, closing the bowl 52, applying pressure on the hemostatic powder 40 against the wound, approximating the wound. The rotation then shears the wires, leaving the bowl 52 connected to the wound site.
In another embodiment, the arms of bowl 52 are made of wire. The bowl 52 is deployed and attached around the wound after which the bowl 52 is filled with powder 40 and then retracted into the bending tip 26. Applying pressure to the powder against the wound approximates the wound. The locking ring 48 closes the small end of the bowl 52, and the wires are cut/broken closing the bowl 52 and leaving it in place.
In another embodiment after attachment and fill of the bowl 52 the bowl 52 may be crushed, holding its crushed shape. The crushing applies pressure to the hemostatic powder 40 on the wound. This design would not approximate the wound.
In further embodiments, an outer bowl 52 may be used to hold an inner collapsible netting in place until it can be deployed and filled with hemostatic powder 40. The bowl 52 may also be magnetized to allow it to hold a magnetic hemostat 50. The bowl 52 could be filled with hemostatic powder 50 prior to adhering to the intestine walls. The bowl 52 may also be adhered to means other than barbed points. The barbed points may be made from biosorbable materials, metal, or plastic,
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While a number of exemplary aspects and embodiments have been discussed above, those of skill in the art will recognize certain modifications, permutations and additions and subcombinations thereof. It is therefore intended that the following appended claims and claims hereinafter introduced are interpreted to include all such modifications, permutations, additions and subcombinations that are within their true spirit and scope.
Claims
1. A device for arresting blood flow from a wound within the alimentary canal of a living organism accessible only from a natural body orifice by endoscopic surgery, comprising:
- an endoscopic instrument inserting into the living organism through the natural body orifice;
- a retaining device traversing said endoscopic instrument for positioning in close proximity to, or in contact with the wound;
- a hemostatic substance traversing and exiting said endoscopic instrument into close proximity to the wound;
- said retaining device retaining said hemostatic substance adjacent to the wound for a time period sufficient to achieve hemostasis; and
- said hemostatic substance being a resin/ferrate or hydrogen resin in powder or tablet form.
2. A device for arresting blood flow from a wound within the alimentary canal of a living organism as set forth in claim 1, said retaining device comprising:
- an expandable bowl traversing said endoscopic instrument and expanding upon exiting said endoscopic instrument for positioning in close proximity to, or in contact with the wound;
- said expandable bowl retaining said hemostatic substance adjacent to the wound for a time period sufficient to achieve hemostasis and to form a scab over the wound.
3. A device for arresting blood flow as set forth in claim 2, further including:
- a plurality of barbed ends coupled to said expandable bowl for penetrating the alimentary canal adjacent to the wound for holding said expandable bowl in place.
4. A device for arresting blood flow as set forth in claim 1, wherein:
- said expandable bowl includes an expandable magnetic bowl; and
- said hemostatic substance includes magnetite for holding said hemostatic substance against the wound.
5. A device for arresting blood flow from a wound within the alimentary canal of a living organism as set forth in claim 1, said retaining device comprising:
- a first barbed magnet traversing said endoscopic instrument and piercing the alimentary canal in close proximity to, or in contact with the wound;
- a second barbed magnet traversing said endoscopic instrument and piercing the alimentary canal in close proximity to, or in contact with the wound;
- a pull suture interengaging between said first barbed magnet and said second barbed magnet to pull said first barbed magnet and said second barbed magnet together to close the wound;
- said first barbed magnet and said second barbed magnet retaining said hemostatic substance adjacent to the wound for a time period sufficient to achieve hemostasis.
6. A device for arresting blood flow from a wound within the alimentary canal of a living organism as set forth in claim 1, said retaining device comprising:
- a push/pull wire coupling with a spring wire traversing said endoscopic instrument and rotating said spring wire upon exiting said endoscopic instrument for positioning in close proximity to, or in contact with the wound;
- a first and second barbed ends coupled to said spring wire for penetrating the alimentary canal adjacent to the wound for holding said spring wire in place; and
- said spring wire defining an arcuate form upon said spring wire abutting said endoscopic instrument and causing said first and said second barbed ends to pull together and close the wound.
7. A device for arresting blood flow from a wound within the alimentary canal of a living organism as set forth in claim 1, said retaining device comprising:
- an expandable clip traversing said endoscopic instrument and expanding upon exiting said endoscopic instrument for engaging in close proximity to, or in contact with the wound;
- said expandable clip collapsing for defining a wire jaw to pull together and close the wound;
- a magnetic barrel coupled to said expandable clip;
- a hemostatic substance and magnetite magnetically coupled to said magnetic barrel and retaining said hemostatic substance adjacent to the wound for a time period sufficient to achieve hemostasis.
8. A device for arresting blood flow from a wound within the alimentary canal of a living organism accessible only from a natural body orifice by endoscopic surgery, consisting of:
- an endoscopic instrument insertable into the living organism through the natural body orifice;
- an expandable bowl traversing said endoscopic instrument and expanding upon exiting said endoscopic instrument for positioning in close proximity to, or in contact with the wound;
- a hemostatic substance traversing and exiting said endoscopic instrument into close proximity to the wound;
- said expandable bowl retaining said hemostatic substance adjacent to the wound for a time period sufficient to achieve hemostasis and to form a scab over the wound; and
- said hemostatic substance being a resin/ferrate or hydrogen resin in powder or tablet form.
Type: Application
Filed: Mar 7, 2018
Publication Date: Jul 12, 2018
Applicant:
Inventors: Talmadge Kelly Keene (Ruskin, FL), John Tifton Fordham (Indialantic, FL), Louis M. Guzzi (Longwood, FL), Charles E. Entenmann (Key Largo, FL)
Application Number: 15/914,282