MXPA06006654A - Endoscopic suturing device - Google Patents

Abstract

An endoscopic apparatus for the continuous application of a suture includes a suturing body that is shaped and dimensioned for attachment to the distal end of a commercially available endoscope in a manner permitting actuation thereof. The suturing body is composed of a suture housing in which a needle and drive assembly are housed for movement of the needle about a continuous circular path facilitating the application of a suture secured to a distal end of the needle. The drive assembly includes a rocker that moves along the suture housing under the control of a drive cable and a pin, wherein actuation of the drive cable and pin cause the rocker to selectively engage and disengage the needle causing the needle to move about a circular path in a continuous manner.

Description

ENDOSCOPIC SUTURE DEVICE BACKGROUND OF THE INVENTION FIELD OF THE INVENTION The present invention relates to laparoscopic surgical instruments. More particularly, the invention relates to an endoscopic suture device for continuous application of suture.

TECHNICAL BACKGROUND Endoscopic procedures have developed rapidly in the past decade. These processes frequently allow the performance of surgical procedures with minimal traumas when compared with previous techniques that required a larger external opening to expose the internal organ or tissue that required repair. In addition to the many areas in which endoscopic procedures have found use, endoscopic procedures have been developed for surgical procedures that address pathological obesity. Pathological obesity is a serious medical condition. In fact, pathological obesity has become highly damaging in the United States, as well as in other countries and the trend seems to be heading in a negative direction.

Complications associated with pathological obesity include hypertension, diabetes, coronary artery disease, stroke, congestive heart failure, multiple orthopedic problems and pulmonary insufficiency with a marked decrease in life expectancy. With this in mind, and as those skilled in the art will certainly appreciate, the physical and monetary costs associated with pathological obesity are substantial. In fact, it is estimated that the costs related to obesity exceed 100 billion dollars in the United States alone. A variety of surgical procedures have been developed to treat obesity. One procedure is the Roux-en-Y gastric bypass (RYGB). This operation is highly complex and is most commonly used to treat people who have pathological obesity. About 35,000 procedures are performed annually in the United States alone. Other forms of bariatric surgery include the Fobi bag, biliopancreatic diversion, and gastroplasty or "stomach stapling." Additionally, implantable devices are known that limit the passage of food through the stomach and affect satiety. RYGB involves a movement of the jejunum to a higher position using a Roux-en-Y loop. The stomach is completely divided into two unequal portions (a smaller upper portion and a larger lower gastric bag) using an automatic stapling device. The upper pouch typically measures less than about 20 cc, while the larger pouch generally remains intact and continues to secrete stomach juices that flow through the intestinal tract. A segment of the small intestine is taken from the lower abdomen and joined with the upper pouch to form an anastomosis created through a 1.25 cm opening also called a stoma. This segment of the small intestine is known as the "Roux's loop" and carries the food from the upper pouch to the rest of the intestines, where the food is digested. The remainder of the lower pouch and the attached segment of the duodenum are then reconnected to form another anastomotic connection to the Roux handle at a location of approximately 50 to 150 cm from the stoma, typically using a stapling instrument. It is in this connection that the digestive juices of the stomach, pancreas and liver that have been derived enter the jejunum and ileus to aid in the digestion of food. Due to the reduced size of the upper pouch, patients are forced to eat at a lower rate and are satiated much more quickly. This results in a reduction in caloric intake. As will be appreciated by those skilled in the art, the conventional RYGB process requires a large amount of operating time. Due to the degree of invasion, the postoperative recovery time can be quite long and painful. By virtue of the highly invasive nature related to the current RYGB procedure, other less invasive procedures have been developed. With this in mind other procedures have been developed to reduce the size of the stomach. The most common form of surgery for gastric reduction involves the application of vertical staples along the stomach to create an appropriate bag. This procedure is commonly performed laparoscopically and as such requires substantial pre-operative, operative and post-operative resources. As they have developed endoscopic devices and procedures, surgeons have begun to employ endoscopic techniques for gastric procedures such as those discussed above in an effort to minimize trauma and reduce the time required for procedures and recovery. With the foregoing in mind, there is a need for procedures and devices that allow gastric reduction surgery to be carried out efficiently in time and in an adequate manner for the patient. An area that has not been adequately addressed is the need for the application of sutures as these gastric procedures and other endoscopic procedures are performed. The present invention provides an endoscopic suture device adapted for the continuous application of sutures.

BRIEF DESCRIPTION OF THE INVENTION It is therefore an object of the present invention to provide an endoscopic apparatus for the continuous application of suture. The apparatus includes a suturing body that is dimensioned and has the shape for attachment to the distal end of a commercially available endoscope in a manner that permits actuation thereof. The suturing body is composed of a suture housing in which a needle and a drive assembly for the movement of the needle are housed around a continuous circular path that facilitates the application of a suture secured to a distal end of a water. The drive assembly includes an oscillator that moves along the suture housing under the control of an activation cable and a pin, where activation of the drive and pin cable causes the oscillator to selectively couple and undock the needle, skirting to the needle to move around a circular path continuously. It is also an object of the present invention to provide an endoscope for the continuous application of a suture. The endoscope includes an endoscope body. The endoscope also includes a suturing body that is shaped and sized for attachment to the distal end of the endoscope body in a manner that permits activation thereof. The suturing body is comprised of a suture housing in which a needle and drive assembly are housed for the movement of a needle around a continuous circular path that facilitates the application of a suture secured to a distal end of the needle. The drive assembly includes an oscillator that moves along the suture housing under the control of a drive cable and a pin, wherein the activation of the drive and pin cable bores the oscillator to couple and uncouple the needle selectively bordering The needle moves around a circular path continuously. It is another object of the present invention to provide an endoscopic apparatus for the continuous application of a suture. The apparatus includes a suturing body that is shaped and dimensioned for attachment to the distal end of a commercially available endoscope in a manner that permits activation thereof. The suturing body is comprised of a suture housing in which a needle and a drive assembly for needle movement are housed around a continuous circular path that facilitates the application of a suture secured to a distal end of the needle. The drive assembly applies an axial movement that causes the movement of the needle around a continuous circular path. Other objects and advantages of the present invention will be apparent from the following detailed description when viewed in conjunction with the accompanying drawings, which establish certain embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a perspective view of the present invention with the vacuum housing secured thereto. Figure 2 is a perspective view of the present invention without the vacuum housing. Figures 3 to 10 are perspective views in section showing the operation of the present invention.

DETAILED DESCRIPTION OF THE INVENTION The detailed embodiment of the present invention is described herein. However, it should be understood that the described modality is a mere example of the invention, which can be modalized in several ways. Therefore, the details described herein should not be construed as restrictive but solely as the basis for the claims and as a basis for showing a person skilled in the art how to make and / or use the invention. With reference to Figures 1 to 10, an endoscopic apparatus 10 for the continuous application of a suture 12 is described. Although the apparatus is particularly adapted for use in the performance of endoscopic gastric reduction procedures, those skilled in the art will certainly appreciate that the device can be used in a wide variety of applications without deviating from the essence of the present invention. The apparatus 10 includes a suturing body 14 that is shaped and dimensioned for attachment to the distal end 16 of a commercially available endoscope 18 in a manner that permits its activation and the creation of a vacuum. With this in mind, the suturing body 14 is secured to the endoscope 18 using bonding structures known and appreciated by those skilled in the art. The suturing body 14 is composed of a first housing element 20 and a second housing element 22 secured to create a housing 24 in which the functional components of the present apparatus 10 are housed for movement in accordance with the present invention. With this in mind, the housing 24 includes a first internal track 26 in which the needle is positioned for movement about a predetermined circular path under the control of the drive assembly 30. The drive assembly 30 is supported within seconds and third tracks 32, 34 positioned around the first inner race 26. The driving assembly 30 applies an axial movement to cause movement of the needle 28 around a continuous circular path. The drive assembly 30 is generally composed of a friction plate 36 statically mounted along the second track 32 and an oscillator 38 that moves along the second track 32 while a pin 40 moves along the length of the second track 32. the third outer race 34. A driving cable 42 is coupled to the pin 40 to control the activation thereof in the manner described below in greater detail. For reasons that will be apparent on the basis of the operation of the present suture apparatus 10 as described below in greater detail, the suturing body 14 has a substantially C-shaped shape with a central opening 44 which tissue is placed during suturing. The C-shape of the suturing body 14 allows the needle 28 to move around a circular path during operation thereof. Referring to Figures 1 and 2, the present endoscopic suture apparatus 10 is attached to commercially available endoscopes by a bracket 17. As mentioned above the suture apparatus 10 can be secured to the endoscope in a number of ways without deviating from the present invention. The suture apparatus 10 is oriented in a manner that allows the user to maintain visibility of the needle 25 and the field of operation, as well as create a small cross-section to aid trans-oral insertion (when the apparatus is used in surgical procedures gastric). A vacuum housing 46 surrounds the suture body 14 of the present suture apparatus 10 defining a cavity 48 on which the suturing body 14 sits. The vacuum housing 46 is attached to the vacuum line 50 of the endoscope 18 such that it is it creates a vacuum within the cavity 48 defined by the vacuum housing 46, as well as the central opening 44 of the suturing body 14. In this way, the application of vacuum attracts the adjacent tissue into the central opening 44 of the suturing body 14. As mentioned before, the housing 24 contains a needle 28 used in the application of a suture 12 to the tissue attracted within the central opening 44. The suture 12 is secured to the distal end of the needle 28 and attracted through the tissue. as the needle 28 is activated in accordance with the present invention as described herein. The needle 28 is curved to rotate about a predetermined circular path. The needle 28 extends along an arc of 240 degrees creating an opening of 120 degrees. However, those skilled in the art will appreciate that the opening may vary; For example, we have contemplated the use of a needle that offers an opening of 140 degrees. The blade 28 includes an inner surface 52 along the inner surface of the arc defined by the needle 28 and an outer surface 54 along the outer surface of the arc defined by the needle 28. A series of notches 56 is cut into the outer surface 54 of the needle 28. As will be appreciated from the following description, the notches 56 are shaped and sized to be used by the drive assembly 30 in the fastening, driving and releasing of the needle 28. Although notches are described along the outer surface of the needle for use in accordance with a preferred embodiment of the present invention, it is contemplated that the needle may be formed without notches such that the drive assembly merely grasps the substantially smooth outer surface of the needle to eject it forward.

The operation of the drive assembly 30 and movement of the needle 28 is described with reference to Figures 3 to 10, wherein a housing half 24 is removed, exposing internal components of the present suture apparatus 10. The drive cable 42 is rigidly attached to the pin 40. As described in detail below, the drive cable 42, pin 40 and oscillator 38 extend and retract to engage and disengage the needle 28 for movement thereof around its circular path. The drive cable 42 is flexible enough to bend in the housing 24 and flex together with the endoscope 18, but rigid enough to be compressed to drive the oscillator 38 to its initial drive stage (see FIG. 4). The oscillator 38 is composed of an arcuate coupling member 58 and a camming member 60 which work in conjunction with the pin 40 to control the position of the coupling element 58 for selective engagement with the needle 28. The coupling element 58 is constructed with internal notches 62 shaped and sized to couple the needle 28 to drive it in a clockwise direction, but allow free movement thereof according to the oscillator 38, ie both the coupling element 58 and the Cam action element move counterclockwise towards the initial drive stage. The coupling element 58 of the oscillator 38 is designed to move in the housing 24 radially towards and away from the needle 28 as well as to move arcuately in a clockwise and counterclockwise direction around the defined arc. by the housing 24. This is achieved through the camming action offered by the interaction between the camming element 60, the pin 40 and the coupling element 58. The camming element 60 is rigidly coupled to the element coupling 58 such that the coupling element 58 moves in and out of engagement with the needle 28 as the radial position of the camming member 60 is altered based on its interaction with the pin 40. It is also contemplated to employ a spring element for forcing the oscillating element 38 against the needle 28. More particularly, as the actuator wire 42 is compressed (i.e., depressed towards front) to move the oscillator 38 counterclockwise, the pin 40 slides into a slot 64 formed in the camming member 60 which forces the coupling member 58 and the camming member 60 to move in a counter-clockwise as well as outward direction of the needle 28. The friction plate 36 helps to urge the coupling member 58 outwardly from the needle 28 as the oscillator 38 moves in this direction contrary to the clock hands. As tension is applied to the drive cable 42 and at the end to the pin 40, the pin 40 slides within the camming member 60 by applying pressure to the coupling member 58 and camming element 60 which causes the coupling element 58 and the cam action member 60 move inwardly to contact the outer surface 54 of the needle 28 due to the camming action that results from the interaction of the pin 40 and the slot 64 within the action element of cam 60. As attention is continuously applied to the drive cable 42, the grooves 62 that are formed along the inner surface of the coupling element 58 grip the notches 56 formed within the outer surface 54 of the needle 28, causing the needle 28 to rotate clockwise until the oscillator 38 is directed to the housing 24 and the procedure can start again. When the career limit is reached, the operator compresses the drive cable 42 by causing the coupling element 58 to disengage from the needle 28 by means of the cam characteristic resulting from the interaction of the pin 40 within the slot 64 of the camming element 60 according to pin 40 slides within slot 64 causing the coupling member 58 and the camming member 60 to move outward and counterclockwise. The compression in the drive cable 42 continues until the oscillator 38 moves counterclockwise to the opposite end of the housing 24. Tension is then applied to move the needle 28 clockwise again. and the procedure is repeated until the needle has moved 360 degrees.

Although the preferred embodiments have been shown and described, it will be understood that it is not intended to limit the invention by such a description, but rather it is intended to cover all modifications and alternative constructions that carry within the essence and scope of the invention.

Claims (19)

NOVELTY OF THE INVENTION REINVIDICATIONS

1. - An endoscopic apparatus for the continuous application of a suture, comprising; a suturing body that is shaped and dimensioned for attachment to the distal end of a commercially available endoscope in a manner that allows activation thereof; the suturing body is composed of a suture housing in which a needle and drive assembly are housed for movement of the needle around a continuous circular path that facilitates the application of a suture attached to a distal end of the needle; the drive assembly includes an oscillator that moves along the suture housing under the control of a drive cable and a pin, wherein activation of the drive and pin cable causes the oscillator to selectively couple and undock the needle making that the needle moves around a circular path continuously.

2. The endoscopic apparatus according to claim 1, further characterized in that a vacuum housing surrounds the suturing body, the vacuum housing being shaped and sized to be coupled to a vacuum line of the endoscope.

3. The endoscopic apparatus according to claim 1, further characterized in that the needle is arcuate.

4. - The endoscopic apparatus according to claim 1, further characterized in that the needle includes an inner surface, an outer surface and a notch formed along the outer surface of the needle, and the oscillator includes a shaped and dimensioned notch for coupling the notch along the outer surface of the needle during activation thereof.

5.- The endoscopic device in accordance with the claim 1, further characterized in that the oscillator is composed of a coupling element and a camming element that work in conjunction with the pin to control the position of the coupling element for selective engagement with the needle.

6. The endoscopic apparatus according to claim 5, further characterized in that the camming element includes a slot in which the pin moves to edge the coupling element to move in and out of engagement with the needle.

7. The endoscopic apparatus according to claim 5, further characterized in that the oscillator only includes a friction plate that helps to control the position of the coupling element.

8. The endoscopic apparatus according to claim 5, further characterized in that the coupling element is arcuate to adapt substantially to the shape of the needle.

9. An endoscope for the continuous application of a suture, comprising: an endoscope body, a suturing body that is shaped and sized for its attachment to the distal end of the endoscope body in a manner that permits activation of the endoscope body; same; the suturing body is composed of a suture housing in which a needle and a drive assembly are housed by the movement of the needle around a continuous circular path that facilitates the application of a suture secured to a distal end of the needle; the drive assembly includes an oscillator that moves along the suture housing under the control of a drive cable and a pin, wherein activation of the drive cable and pin bores the oscillator to selectively couple and uncouple the needle, causing the needle to move around a circular path continuously.

10. The endoscope according to claim 9, further characterized in that a vacuum housing surrounds the suturing body, the vacuum housing is coupled in a vacuum line in the endoscope.

11. The endoscope according to claim 9, further characterized in that the needle is arcuate.

12. The endoscope according to claim 9, further characterized in that the needle includes an inner surface and an outer surface and a groove formed along the outer surface of the needle, and the oscillator includes a groove shaped and sized to attach the groove along the outer surface of the needle during the activation of the same.

13. - The endoscope according to claim 9, further characterized in that the oscillator is composed of a coupling element and a camming element that work in conjunction with the pin to control the position of the coupling element for selective coupling with the needle.

14. The endoscope according to claim 13, further characterized in that the camming element includes a slot in which the pin moves to edge the coupling element to move in and out of engagement with the needle.

15. The endoscope according to claim 13, further characterized in that the oscillator further includes a friction plate that helps to control the position of the coupling element.

16. The endoscope according to claim 13, further characterized in that the coupling element is arcuate to adapt substantially to the shape of the needle.

17. An endoscopic apparatus for the continuous application of a suture, comprising: a suturing body that is shaped and sized for its attachment to the distal end of a commercially available endoscope in a manner that allows its activation; the suturing body is composed of a suture housing in which a needle and actuating element for the movement of the needle is housed around a continuous circular path that facilitates the application of a suture secured to a distal end of the needle; wherein the drive assembly applies axial movement to cause movement of the needle around a continuous circular path.

18. The endoscopic apparatus according to claim 17, further characterized in that a vacuum housing surrounds the suturing body, the vacuum housing is shaped and sized to be coupled to a vacuum line of the endoscope.

19. The endoscopic apparatus according to claim 17, further characterized in that the needle is arched.