MXPA06008892A - Method and apparatus for endoscopically performing gastric reduction surgery - Google Patents

Abstract

An articulating endoscopic instrument is adapted for properly orienting the stomach for cutting and stapling in an efficient manner. The instrument includes a body member having a first end and a second end, a plurality of suction holes along the body member in fluid communication with a suction inlet at the first end of the body member for the creation of suction along the body member and an articulating joint positioned along the body member. A method for gastric reduction surgery is achieved by inserting an articulating endoscopic instrument within the stomach and articulating the articulating endoscopic instrument to generally assume the shape of the relaxed stomach, applying suction through the articulating endoscopic instrument to draw the stomach tissue into contact with the articulating endoscopic instrument, articulating the articulating endoscopic instrument to a desired orientation and completing the gastric reduction surgery.

Description

METHOD AND APPARATUS FOR PERFORMING ENDOSCOPICALLY GASTRIC REDUCTION SURGERY FIELD OF THE INVENTION The present invention relates to gastric reduction surgery. More particularly, the invention relates to a method and apparatus performing gastric reduction surgery endoscopically.

BACKGROUND OF THE INVENTION Pathological obesity is a serious medical condition. In fact, pathological obesity has become highly pervasive in the United States, as well as other countries, and the trend seems to be orienting 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 markedly decreased life expectancy. With this in mind, and as those skilled in the art will certainly appreciate, the monetary and physical 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 of the most commonly performed procedures is Roux-en-Y gastric bypass (RYGB). This procedure is highly complex, and is used to treat people who exhibit pathological obesity. Even though this is a complex operation, more than 100,000 procedures are performed annually in the United States alone. Other forms of bariatric surgery include Fobi bag, biliopancreatic diversion, and gastroplastic stapling or "stomach stapling". In addition, implantable devices are known that limit the passage of food through the stomach and affect satiety. RYGB involves the movement of the jejunum to a high 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 pouch), using an automatic stapling device. The upper pouch typically measures less than about 20 cm 3, while the larger lower pouch generally remains intact, and continues to secrete stomach juices that flow through the bowel path. A segment of the small intestine is then taken from the lower abdomen and joined with the upper pouch to form an anastomosis created through an opening of 1.27 cm, also called the stoma. This segment of the small intestine is called the "Roux's loop", and carries the food from the upper pouch to the rest of the intestines, where the food is digested. The remaining lower pouch, and the bound duodenum segment, are then reconnected to form another anastomotic connection with the Roux handle at a site 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 of the bypass enter the jejunum and ileum to aid in the digestion of the food. Due to the small size of the upper pouch, patients are forced to eat at a slower pace, and are satiated much more quickly. This results in a reduction in caloric intake. The conventional RYGB procedure requires a large amount of operating time. Due to the degree of invasiveness, the post-operative recovery time can be quite long and painful. In view of the highly invasive nature of the common RYGB procedure, other less invasive procedures have been developed. The most common form of gastric reduction surgery includes the application of vertical staples along the stomach to create an adequate pouch. This procedure is commonly performed laparoscopically and, as such, requires substantial preoperative, operative and post-operative resources. Due to the degree of invasiveness, it is desirable to provide instruments and procedures that help reduce operating time and improve the overall procedure. The present invention provides an instrument and method to assist in the performance of gastric reduction surgery with less invasive procedures that result in reduced patient morbidity.

BRIEF DESCRIPTION OF THE INVENTION It is, therefore, an object of the present invention to provide an articulatable endoscopic instrument adapted to properly orient the stomach for cutting and stapling in an efficient manner. The instrument includes the member of a body having a first end and a second end, a plurality of suction holes along the body member in fluid communication with a suction inlet at the first end of the body member for the creation of suction along the body member, and an articulation hinge positioned along the body member. It is also an object of the present invention to provide a method for gastric reduction surgery. The method is achieved by inserting an articulatable endoscopic instrument into the stomach, and articulating the articulatable endoscopic instrument to assume in general the shape of the relaxed stomach, applying suction through the endoscopic articulable instrument to put the stomach tissue in contact with the articulating endoscopic instrument. , articulating the articulatable endoscopic instrument to a desired orientation, and concluding gastric reduction surgery. Other objects and advantages of the present invention will become apparent from the following detailed description when viewed in conjunction with the accompanying drawings, which set forth certain embodiments of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS Figures 1 to 4 show the steps in the use of the present articulated endoscopic apparatus. Figure 5 is a perspective view of the present articulatable endoscopic apparatus. Figures 6 and 7 are detailed views of the distal end of the articulatable endoscopic apparatus, shown respectively in a substantially straight configuration and curved configuration.

DETAILED DESCRIPTION OF THE PREFERRED MODALITIES The detailed embodiment of the present invention is described herein. However, it should be understood that the described mode is only an example of the invention, which can be described in various ways. Therefore, the details described herein should not be construed as limiting, but only as the basis for the claims and as a basis for teaching one skilled in the art how to make and / or use the invention. As those skilled in the art will certainly understand, RYGB involves movement of the jejunum to a high position using a retrocolic Roux-en-Y loop. The stomach is completely divided into two unequal portions (a smaller upper portion and a larger lower gastric pouch), using an automatic stapling device with the surface of the blade reinforced with additional sutures. The upper pouch typically measures less than about 20 cm 3, while the larger lower pouch generally remains intact, and continues to secrete stomach juices that flow through the bowel path. A segment of the small intestine (barely distal to the duodenum or proximal to the jejunum) is then brought from the lower abdomen and joined to the upper pouch to form an anastomosis created through an opening of 1.27 cm, also called the stoma. This segment of the small intestine is called the "Roux limb," and it carries the food from the upper pouch to the rest of the intestines, where the food is digested. The remaining lower pouch, and the bound duodenum segment, are then reconnected to form another anastomotic connection with the Roux handle at a site 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 of the bypass enter the jejunum and ileum to aid in the digestion of the food. Due to the small size of the upper pouch, patients are forced to eat at a slower pace, and are satiated much more quickly. This results in a reduction in caloric intake.

As discussed above, the stomach is completely divided into two unequal portions using an automatic stapling device with the cutting surface reinforced with additional sutures. However, due to the natural shape of the stomach and the desire for the smaller upper portion to be curved, it is commonly difficult to cut and staple the cut end of the smaller upper portion. The present invention addresses this problem by providing an articulatable endoscopic instrument 10 adapted to properly orient the stomach for cutting and stapling the stomach in an efficient manner. With reference to Figures 5, 6 and 7, the instrument 10 generally includes a body member 12 having a first end 14 and a second end 16. The first end 14 includes a coupling structure 18 for attachment to the distal end of the body. an axis that extends proximally. More particularly, the first end 14 includes a suction inlet 20 adapted for fluid communication with a suction line for the purpose of creating suction in a manner that will be described in more detail below. The coupling structure 18 further includes a connection member 22 for connecting the control cable 24 of the joint to the proximal end of the gastroscope for adjustment of the endoscopic instrument articulated by the individual performing the surgery. Between the first end 14 and the second end 16 of the body member 12, are the operating components of the present instrument 10. In particular, the instrument 10 includes a series of suction holes 26 that extend along the length of the member 12 of the body. The suction holes 26 are in fluid communication with the suction inlet 20 for the suction application along the body member 12 in a manner discussed below in greater detail. In accordance with a preferred embodiment of the present invention, the suction holes 26 are divided between the proximal end 28 of the body member 12 and the distal end 30 of the body member 12 with a hinge hinge 32 positioned therebetween. As such, the suction holes 26 generally define a proximal suction section 34 and a distal suction section 36. The hinge joint 32 is generally a flexible section along the length of the body member 12 which, under the control of the articulation wire 24, it moves in a desired shape between a substantially straight configuration (see Fig. 6) and a curved configuration (see Fig. 7). According to a preferred embodiment of the present invention, the articulation wire 24 is off-center, and therefore creates torque around a neutral axis when it is tensioned in a shape that flexes the body member 12. In general, the articulatable endoscopic instrument 10 uses tissue suction and pull to articulate the stomach tissue of its naturally curved shape (see Figures 1, 2 and 4) to a straightened form (see Figure 3), so that it can a straightened staple line 38 is applied. The straightened line of staples 38 is subsequently bent after the articulatable endoscopic instrument 10 is removed, and the stomach tissue is relaxed to its original configuration. The articulatable endoscopic instrument 10 is generally inserted transorally, and is articulated by means of the articulation wire 22 to assume a desired shape, forcing the gastric pouch to a desired shape. In practice, and in accordance with a preferred embodiment of the present invention, the articulatable endoscopic instrument 10 is inserted into the stomach transorally (see Figure 1), and is articulated to assume the shape of the gastric pouch. Then, suction is applied, putting the stomach tissue in contact with the articulatable endoscopic instrument 10 (see Figure 2). After, the articulatable endoscopic instrument 10 is straightened, providing an ideal staple line 38 for the application of staples and cutting of stomach tissue (see Figure 3). Once the stomach is oriented in a predetermined and desirable straight configuration, a laparoscopic endocuchilla is fired along the axis of the manipulator as many times as required to create the bag for the RYGB procedure. More specifically, the endocuchilla is positioned along the manipulator straightened and fired to cut the wall of the stomach in a desired manner. As those skilled in the art will certainly appreciate, a variety of endocuchillas are known in the art, and can be used in accordance with the present invention. Then, the suction applied to the articulatable endoscopic instrument 10 is released, and the line of staples 38 relaxes again towards its curved orientation. The articulatable endoscopic instrument is then removed, and the RYGB procedure can then be concluded (see Figure 4). The use of the present articulatable endoscopic and laparoscopic endocuchilla instrument in accordance with the present invention and as described above, results in a stomach that is completely divided into two unequal portions (a smaller upper portion and a larger lower gastric bag). In accordance with the preferred application of the RYGB method, the upper pouch is typically formed so that it measures less than about 20 cm 3, while the lower larger pouch continues to be generally intact, and continues to secrete stomach juices that follow through the intestinal trajectory. As those skilled in the art will certainly appreciate, the present articulable endoscope and associated technique particularly focus on the creation of the smaller upper portion and the larger lower gastric pouch. Once these elements are formed, a segment of the small intestine (barely distal to the duodenum or proximal to the jejunum) is taken from the lower abdomen and joined with the upper pouch to form a pointed tip anastomosis created through an opening of 1.27 cm. , also called the stoma. The segment of the small intestine is called the Roux limb, and carries the food from the upper pouch to the rest of the intestines, where the food is digested. The remaining lower pouch, and the bound duodenum segment, are then reconnected to form another anastomotic connection with the Roux extremity at a site 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 of the bypass enter the jejunum and ileum to aid in the digestion of the food. Due to the small size of the upper pouch, patients are forced to eat at a slower pace, and are satiated much more quickly. This results in a reduction in caloric intake. Although the preferred embodiments have been shown and described, it will be understood that there is no attempt to limit the invention using such a description, but rather it is intended to encompass all modifications and alternate constructions that are within the spirit and scope of the invention.

Claims (10)

NOVELTY OF THE INVENTION CLAIMS

1. - An articulatable endoscopic instrument adapted to properly orient the stomach for cutting and stapling in an efficient manner, comprising: the member of a body having a first end and a second end; a plurality of suction holes along the body member in fluid communication with a suction inlet at the first end of the body member for the creation of suction along the body member; and an articulation hinge positioned along the length of the body member.

2. The articulated endoscopic instrument according to claim 1, further characterized in that the body member includes suction holes positioned proximally and distally of the articulation hinge.

3. The articulated endoscopic instrument according to claim 1, further characterized in that it includes an articulation cable that controls the movement of the body member around the articulation hinge.

4. A method for gastric reduction surgery, which comprises the following steps: insert an endoscopic articulable instrument into the stomach, and articulate the articulatable endoscopic instrument to assume in general the shape of the relaxed stomach; apply suction through the articulatable endoscopic instrument to put the stomach tissue in contact with the endoscopic articulable instrument; articulate the articulatable endoscopic instrument toward a desired orientation; and conclude gastric reduction surgery.

5. The method according to claim 4, further characterized in that the articulated endoscopic instrument comprises the member of a body having a first end and a second end, the first end of the body member including means for coupling to an elongated shaft; a plurality of suction holes along the body member in fluid communication with a suction inlet at the first end of the body member for the creation of suction along the body member; and an articulation hinge positioned along the body member.

6. The method according to claim 4, further characterized in that the insertion step is performed transorally.

7. The method according to claim 4, further characterized in that the step of articulation to a desired orientation includes articulation of the endoscopic instrument articulated to a substantially straight configuration.

8. The method according to claim 4, further characterized in that the step of termination includes stapling and cutting of the stomach tissue along the endoscopic articulable instrument.

9. The method according to claim 8, further characterized in that the step of articulation to a desired orientation, includes the articulation of the endoscopic instrument articulated to a substantially straight configuration.

10. The method according to claim 8, further characterized in that the termination step further includes performing a RYGB procedure.