New! View global litigation for patent families

US20080103441A1 - Inside out t-fastener system - Google Patents

Inside out t-fastener system Download PDF

Info

Publication number
US20080103441A1
US20080103441A1 US11870946 US87094607A US2008103441A1 US 20080103441 A1 US20080103441 A1 US 20080103441A1 US 11870946 US11870946 US 11870946 US 87094607 A US87094607 A US 87094607A US 2008103441 A1 US2008103441 A1 US 2008103441A1
Authority
US
Grant status
Application
Patent type
Prior art keywords
tube
guide
device
walls
medical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US11870946
Inventor
Jeffry S. Melsheimer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Cook Inc
Original Assignee
Cook Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0409Instruments for applying suture anchors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417T-fasteners
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B2017/348Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/3484Anchoring means, e.g. spreading-out umbrella-like structure
    • A61B2017/3486Balloon
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02Holding devices, e.g. on the body

Abstract

A medical device for providing wall apposition of two bodily walls in accordance with the teachings of the present invention. The medical device is used at a previously formed puncture site having perforations formed in the walls. By way of example, the two walls are described herein as the abdominal and gastric walls, although it will be recognized that any two bodily walls may be fastened together utilizing the medical device and the methods described herein. It will also be understood that the procedures described herein may be performed using image guidance such as fluoroscopy, although the device and method may readily be performed without such assistance.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • [0001]
    This application claims the benefit of U.S. Provisional Application Ser. No. 60/854,592 filed on Oct. 26, 2006, entitled “INSIDE OUT T-FASTENER”, the entire contents of which are incorporated herein by reference.
  • FIELD OF THE INVENTION
  • [0002]
    The present invention relates generally to medical devices and procedures for wall apposition utilizing tissue fasteners such as “T-fasteners” or “T-anchors”, and more particularly relates to percutaneous image-guided placement of such fasteners and gastrostomy tubes.
  • BACKGROUND OF THE INVENTION
  • [0003]
    The percutaneous image-guided placement of gastrostomy tubes is generally considered safer than endoscopic or surgical placement, but is usually limited to smaller diameter gastrostomy tubes and/or the use of T-fasteners so as not to push the gastric wall away from the abdominal wall. It has been found that one difficulty in using T-fasteners in this manner is that the fasteners sometimes go into the abdominal wall at unfavorable angles, or with unfavorable spacing, such that their efficacy is compromised or an excessive number of T-fasteners are necessary to place the tube.
  • BRIEF SUMMARY OF THE INVENTION
  • [0004]
    A medical device and method is provided for obtaining wall apposition of two bodily walls which reliably and accurately places fasteners at favorable angles, and in a controllable pattern that minimizes the number of fasteners required. The medical device generally includes an access cannula, a guide tube, and a flexible puncturing device. The guide tube is sized to be slidably received by the access cannula and is operable between a first linear configuration and a second non-linear configuration. The flexible puncturing device is sized to be slidably received by the guide tube. The method for providing apposition of two bodily walls utilizes this medical device and generally comprises the steps of forming a puncture site through the two walls, inserting the access cannula into the puncture site, passing the guide tube through the outer cannula, positioning a distal end of the guide tube proximate one of the walls, passing the flexible puncturing device through the guide tube and puncturing the two walls, connecting a fastener to the puncture device, retracting the puncture device to draw the fastener through the two walls, and securing the fastener to maintain apposition of the two walls.
  • [0005]
    According to more detailed aspects, the guide tube retroflexes in the second configuration for engagement of one of the bodily walls. A distal end of the guide tube in the second configuration is thus laterally spaced from the access cannula and is generally rotated about 180 degrees relative to its position in the first configuration. The guide tube is preferably formed of a shape memory material, and may either be biased towards the second non-linear configuration, or may be temperature dependent. In the latter case, the transition temperature is at about body temperature. In the former case, the access cannula is rigid and is used to straighten the guide tube into the first linear configuration. A distal end of the guide tube preferably includes an inflatable balloon for engagement of one of the bodily walls.
  • [0006]
    According to other additional features of the present invention, the positioning of the guide tube includes advancing and retracting the guide tube to engage one of the walls at a desired location. After placement of one fastener, the guide tube may be advanced to disengage the bodily wall, rotated (about an axis of the access cannula), and then retracted to position a distal end of the guide tube at a location spaced from the previously placed fastener. The steps may be repeated with a plurality of fasteners, resulting in a generally circular configuration of fasteners around the primary puncture site. One of many possible uses of the medical device and method is to obtain wall apposition of the abdominal and gastric walls, wherein the primary puncture site is used for placement of a gastrostomy tube.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0007]
    The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention, and together with the description serve to explain the principles of the invention. In the drawings:
  • [0008]
    FIG. 1A is a cross-sectional view of a medical device constructed in accordance with the teachings of the present invention;
  • [0009]
    FIGS. 1B and 1C illustrate deployment of the medical device in FIG. 1A;
  • [0010]
    FIG. 2 is a cross-sectional view of the medical device depicted in FIG. 1A, showing its guide tube in a second configuration;
  • [0011]
    FIG. 3A is a cross-sectional view taken about the line 3-3 in FIG. 2, while FIG. 3B and FIG. 3C are cross-sectional views similar to FIG. 3A but showing alternate embodiments of the medical device constructed in accordance with the teachings of the present invention;
  • [0012]
    FIGS. 4-6 illustrate the placement of a fastener utilizing the medical device depicted in FIG. 1A;
  • [0013]
    FIG. 7 is cross-sectional view illustrating the placement of an additional fastener; and
  • [0014]
    FIG. 8 is a plan view schematically illustrating the placement of several fasteners utilizing the medical device and method of the present invention.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0015]
    Turning now to the figures, FIGS. 1A-1C and 2 depict an embodiment of a medical device 30 for providing wall apposition of two bodily walls 10, 12 in accordance with the teachings of the present invention. The medical device 30 is used at a previously formed puncture site 14 having perforations 16, 18 formed in the walls, 10, 12, respectively. By way of example, the two walls 10, 12 are described herein as the abdominal and gastric walls, although it will be recognized that any two bodily walls may be fastened together utilizing the medical device 30 and the methods described herein. It will also be understood that the procedures described herein may be performed using image guidance such as fluoroscopy, although the device and method may readily be performed without such assistance.
  • [0016]
    To form the puncture site 14, a puncture device such a needle or a trocar is utilized to initially pass through the abdominal and gastric walls, 10, 12, and then deliver a wire guide 20 therethrough, although any known or future cutting means may be utilized. Various dilators (not shown) may be used to enlarge the initial openings to a size sufficient to receive the medical device 30. For example, an initial 16 gauge puncture needle may be utilized, which is then enlarged with dilators to approximately 20 french, for receiving the medical device 30.
  • [0017]
    The medical device 30 generally includes an access cannula 32, a guide tube 38 and a flexible puncturing device 48 (FIG. 4). The access cannula 32 and guide tube 38 may be placed over the wire guide 20, and the wire guide 20 is then removed. A loading dilator may be used during the initial access to take up the space between guide tube 38 and the wire guide 20 (or between guide tube 38 and puncture needle). The access cannula 32 defines an interior lumen 34 for receiving the guide tube 38, and may also include a handle 36 at its proximal end for providing easy manipulation thereof. The access cannula 32 is preferably formed of a rigid and dimensionally stable material, such as stainless steel or another metal, although this is not a necessary requirement and the access cannula can be flexible.
  • [0018]
    Once the access cannula 32 and guide tube 38 are positioned within the puncture site 14, the guide tube 38 may then be advanced relative to the access cannula 32, as shown in FIG. 2. The guide tube 38 also defines an interior lumen 40 and includes a handle 42 at its proximal end to facilitate manipulation and translation of the guide tube 38 relative to the access cannula 32. The handle 42 includes threaded connector 45 for attachment various instruments or devices such as the aforementioned dilator. The guide tube 38 is operable between a first linear configuration as depicted in FIG. 1A and a second non-linear configuration such as depicted in FIG. 2. In one preferred construction, the guide tube 38 is formed (at least in part) of a shape memory material such as nitinol or other similar alloys. As such, the guide tube 38 will be temperature dependent and is designed to transition between the first and second configurations at about body temperature. For example, the guide tube 38 is introduced into the patient at a temperature below body temperature and is a first entry. As the guide tube 38 is warmed to body temperature, it then assumes the second configuration.
  • [0019]
    In the second configuration, a distal portion 45 of the guide tube 38 retroflexes so that the distal end 46 faces the interior surface of the gastric wall 12. Thus, the distal end 46 of the guide tube 38 has been generally rotated about 180 degrees from the first configuration to the second configuration. The device 30 (or at least the guide tube 38) is then retracted so that the gastric wall 12 is engaged from the interior by the distal end 46 of the guide tube 38 for subsequent placement of a fastener at the engaged location. It will be recognized that the radius of curvature in the distal portion 45 in the second configuration, as well as the degree of bend (i.e. between 0 and 180 degrees) may be tailored for specific procedures and patients.
  • [0020]
    In another preferred construction, the guide tube is simply constructed of a resilient material such as nitinol, stainless steel, other metals or alloys, or resilient plastics, and is biased towards the second configuration. In this case, the outer access cannula 32 is utilized to straighten the guide tube 38 into its first linear configuration, and thus the access cannula 32 is sufficiently rigid to straighten the guide tube 38. In either case, upon a distal end 46 of the guide tube 38 passing beyond a distal end of the access cannula 32 and into the gastric lumen, the second configuration of the guide tube 38 is obtained. It will be recognized that numerous other structures and designs of the guide tube 38 can be utilized to achieve the same effect, such as a segmented tube where the segments are controllably rotatable relative to each other by for example, a control wire operably connected along one side of the segments. It will also be recognized that the access cannula 32 and guide tube 38 can have non-circular cross-sections. The access cannula 32 may also have some curvature at its distal end to facilitate the placement of guide tube 38 and the fasteners.
  • [0021]
    The guide tube 38 also preferably includes an inflatable balloon 44 located at its distal end 46 for engaging the gastric wall 12 or other bodily wall. As shown in FIGS. 1B and 1C, once the distal end 46 of the guide tube 38 is advanced beyond the access cannula 32, the balloon 44 may be operated from a deflated state (FIG. 1B) to an inflated state (FIG. 1C). The balloon 44 may be compliant or non-compliant, and provides an enlarged surface for engaging and positioning the gastric wall 12. As best seen in FIG. 3A, the guide tube 38 includes an inflation lumen 39 leading to the inflatable balloon 44. A nitinol tube 43 is securely fit within the primary lumen 41 defined by the guide tube 38. Alternatively, and as shown in FIG. 3B, the guide tube 138 may be formed of a dual lumen tube, i.e. having an outer wall 139 and an inner wall 141 defining an inflation channel therebetween for inflating the balloon 144. The outer and inner walls 139, 141 may be constructed of a flexible plastic, while a nitinol tube 143 is securely fit within the inner wall 141 as shown. Another alternate embodiment of the guide tube 238 is shown in FIG. 3C. Again, an outer wall 139 and an inner wall 141 are oriented to define an inflation passageway therebetween. However, in this embodiment a simple strip 243 of shape-memory material such as nitinol is connected to the inner wall 241 for providing operability between the first linear configuration (FIG. 1A) and the second non-linear configuration (FIG. 2). It will be recognized that numerous other designs may readily be employed for providing a dual lumen guide tube having this operability, such as over molding the inner wall 41 over the shape memory material, or even forming the outer and inner walls 39, 41 of nitinol material and simply connecting the inflatable balloon 44 at the distal end of the nitinol guide tube 38.
  • [0022]
    Radiographic materials may also be formed in or attached to the distal end 46 of the guide tube 38 to assist with fluoroscopic guidance of T-fastener placement. Likewise, the distal end 46 of the guide tube 38 can includes materials and surfaces having enhanced ultrasonic reflectivity, such by being roughened, having dimples or other incongruities, or having embedded particles. It will be recognized that, in addition to fluoroscopy and ultrasound guidance, various other visualization or image guidance systems may be employed. Tactile or visual observation may also be used in conjunction with manipulation of the guide tube 38 to determine placement of T-fasteners.
  • [0023]
    The inflatable balloon 44 may take many forms, such as a donut shape (i.e. having a circular cross-sectional shape) or a bow-tie shape (i.e. having a generally trapezoidal cross-sectional shape) or many others. The balloon 44 increases the area of wall 12 that is engaged for delivery of a fastener 54, and provides an area between distal end 46 and wall 12 within which an anchor can be positioned. This facilitates deployment of the fasteners 54 at favorable angles, as will be described in more detail below.
  • [0024]
    As shown in FIGS. 4 and 5, the distal end 46 of the guide tube 38 and its balloon 44 are laterally spaced from the access cannula 32 and positioned against the gastric wall 12 for placement of a fastener 54. When image guidance is not used, the guide tube 38 may be retracted to a point where the abdominal wall 10 is sufficiently raised to identify the location of the distal end 46. A flexible puncturing device 48 is inserted through the lumen 40 of the guide tube 38 and then passed through the gastric wall 12 and stomach wall 10 to form a second puncture site 24 having openings 26, 28 in the abdominal and gastric walls 10, 12, respectively. Preferably, the flexible puncturing device 48 includes a handle 50 at its proximal end to assist in manipulation of the puncturing device 48, and also includes a sharp taper 52 at its distal end for piercing the bodily walls. The flexible puncturing device 48 is directed generally perpendicular to the surfaces of the walls 10, 12, resulting in the fasteners being placed through the walls at favorable angles. The high level of control provided by the medical device 30 thus ensures that a minimal number of fasteners can be used.
  • [0025]
    Various fasteners may be used to maintain the wall apposition, and one preferred fastener is a tissue fastener or T-fastener 54 having an anchor 56 and connected suture 58, as is well known in the art. An exemplary T-fastener is shown in U.S. Pat. No. 5,123,914 and sold by Cook Incorporated, Bloomington, Ind., and Wilson-Cook Medical Inc. d/b/a Cook Endoscopy, Winston-Salem, N.C., the disclosure of which is incorporated herein by reference in its entirety. As shown in the figures, the flexible puncturing device 48 is preferably a hollow puncturing needle which defines a lumen sized to receive the anchor 56 of the T-fastener 54. The flexible puncturing needle 48 and anchor 56 preferably have a friction fit, whereby the flexible puncturing needle 48 is retracted from the position shown in FIG. 4, with the anchor inside the hollow tip of the puncturing needle 48, to pull the anchor 56 through the puncture site 24 and into the guide tube 38. Alternatively, the fastener 54 may include its own pushing needle 60, as depicted in FIG. 5. In this case, the anchor 56 may be positioned within the T-fastener pushing needle 60, which in turn is connected to the flexible puncture needle 52 and together guide the anchor 56 through the puncture site 24 and into the gastric lumen. Here, the T-fastener pushing needle can also be positioned inside the hollow tip of the puncturing needle 48. In either case, the flexible puncturing device 48 and/or the guide tube 38 serve as a guide to the fastener, which is then secured as is shown in FIG. 6.
  • [0026]
    It will be recognized by those skilled in the art that numerous types of fasteners for maintaining wall apposition of two bodily walls are known in the art, and the medical device and/or fastener can be readily configured to suitably connect the flexible puncturing device to the fastener or otherwise guide their placement through the second puncture site 24 and through the opening 26, 28 formed in the abdominal and gastric walls 10, 12. That is, fasteners/anchors and flexible puncturing devices may be specially designed to include suitable connection features, although the use of existing devices as described above is preferred. The fasteners could also be fed through the guide tube 38 and/or puncture needle 48 so that the connector is placed outside abdominal wall 10.
  • [0027]
    Upon placement of the fastener 54 at the second puncture site 24 (FIG. 6), the device 30 (or at least the guide tube 38) may again be advanced to move the distal end 46 and balloon 44 away from the gastric wall 12, as shown in FIG. 6. Then, the device 30 is rotated (i.e. spun about the axis of access cannula 32), as indicated by the curved arrow. The device 30 is then retracted again to position the distal end 46 and balloon 44 proximate the gastric wall 12 for delivery of a second fastener. As shown in FIGS. 6 and 7, the balloon 44 may remain inflated during repositioning of the guide tube 45. Alternatively, the balloon 44 may be deflated during advancement and rotation of the device 30, and then reinflated once the distal end 46 is positioned at the next puncture site. As shown in the schematic of FIG. 8, utilization of this medical device 30 and the described procedure results in a plurality of puncture sites 24 being formed around the first puncture site 14 along a generally circular path, as indicated by the dotted line 60. While five puncture sites 24 have been depicted, it will be recognized that any number of sites 24 and fasteners 54 may be used depending upon the particular situation.
  • [0028]
    Upon obtaining wall apposition through the placement of a plurality of fasteners 54, the puncturing device 48, guide tube 38, and access cannula 32 may be removed and a gastrostomy tube (not shown) placed at the first puncture site 14. Accordingly, it will be recognized that the present invention also includes a medical kit for placement of a gastrostomy tube, the kit comprising a first puncture device, a wire guide, a dilator, an access cannula, a guide tube operable between the first linear configuration and the second non-linear configuration, a second flexible puncturing device, at least one fastener, and a gastrostomy tube.
  • [0029]
    By way of the present invention, reliable and secure purcutaneous placement of fasteners are provided through two bodily walls. Through use of the medical device and method, puncturing of the walls is provided at favorable angles resulting in reliable and accurate orientation of the fastener. Likewise, the location of the plurality of puncture sites and fasteners are precisely located with respect to one another. That is, by utilizing the initial gastrostomy puncture site for deployment, a relatively static reference point is provided for placement of the fasteners. In this fashion, only a minimum number of fasteners need to be employed, and their efficacy is maximized.
  • [0030]
    The foregoing description of various embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise embodiments disclosed. Numerous modifications or variations are possible in light of the above teachings. The embodiments discussed were chosen and described to provide the best illustration of the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the invention as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly, legally, and equitably entitled.

Claims (22)

  1. 1. A medical device for providing wall apposition of two bodily walls, the medical device comprising:
    an access cannula;
    a guide tube sized to be slidably received by the access cannula, the guide tube operable between a first linear configuration and a second non-linear configuration, a distal end of the guide tube being laterally spaced from the access cannula in the second non-linear configuration; and
    a flexible puncturing device sized to be slidably received by the guide tube in the second non-linear configuration.
  2. 2. The medical device of claim 1, wherein the guide tube retroflexes in the second configuration for engagement of one of the bodily walls.
  3. 3. The medical device of claim 1, wherein a distal end of the guide tube in the second configuration is rotated about 180 degrees relative the distal end in the first configuration.
  4. 4. The medical device of claim 1, wherein a distal end of the guide tube faces generally proximally in the second configuration.
  5. 5. The medical device of claim 1, wherein the guide tube is formed of a shape memory material.
  6. 6. The medical device of claim 1, wherein the guide tube is formed of a polymer and includes a strip of shape memory material extending longitudinally along at least a distal portion of the guide tube.
  7. 7. The medical device of claim 5, wherein the shape memory of the guide tube is temperature dependent, and wherein the transition temperature between the first and second configurations is at about body temperature.
  8. 8. The medical device of claim 1, wherein the guide tube is biased to the second non-linear configuration.
  9. 9. The medical device of claim 1, wherein a distal end of the guide tube includes an inflatable balloon.
  10. 10. The medical device of claim 1, wherein the access cannula is rigid.
  11. 11. The medical device of claim 1, further comprising fastening means selectively connectable to the flexible puncturing device.
  12. 12. The medical device of claim 11, wherein the fastening means comprises a tissue fastener having an anchor and suture material.
  13. 13. The medical device of claim 12, wherein the flexible puncturing device is a flexible puncturing needle, and wherein the anchor is sized to be received within a lumen of the flexible puncturing needle.
  14. 14. A method for providing apposition of two bodily walls, the method comprising the steps of:
    a) forming a puncture site through the two walls;
    b) inserting an access cannula into the puncture site;
    c) passing a guide tube through the access cannula, the guide tube retroflexing after passing beyond a distal end of the access cannula;
    d) positioning a distal end of the guide tube proximate one of the walls;
    e) passing a flexible puncturing device through the guide tube and puncturing the two walls at a second location;
    f) connecting a fastener to the puncturing device;
    g) retracting the puncture device to draw the fastener through the two walls at the second location; and
    h) securing the fastener to maintain apposition of the two walls at the second location.
  15. 15. The method of claim 14, wherein step d) includes retracting the guide tube to engage one of the walls at a desired location.
  16. 16. The method of claim 14, wherein steps d)-h) are repeated with a second fastener at a third location.
  17. 17. The method of claim 15, further comprising the steps of:
    i) advancing the guide tube to disengage the bodily wall at the second location;
    j) rotating the guide tube; and
    k) retracting the guide tube to position a distal end of the guide tube proximate the bodily wall at a third location.
  18. 18. The method of claim 14, steps d)-h) are repeated with a plurality of fasteners that are placed in a generally circular configuration around the puncture site.
  19. 19. The method of claim 14, wherein the positioning step includes inflating a balloon at a distal end of the guide tube.
  20. 20. The method of claim 14, wherein the flexible puncturing device comprises a flexible puncturing needle, and wherein the connecting step includes positioning an anchor of the fastener within the flexible puncturing needle.
  21. 21. The method of claim 14, further comprising the steps of:
    i) removing the puncturing device, guide tube, and access cannula; and
    j) placing a gastrostomy tube at the puncture site.
  22. 22. A medical kit for placement of a gastrostomy tube, the kit comprising:
    a first puncture device;
    a wire guide;
    a dilator;
    an access cannula;
    a guide tube sized to be slidably received by the access cannula, the guide tube operable between a first linear configuration and a second non-linear configuration;
    a second flexible puncturing device sized to be slidably received by the guide tube;
    at least one fastener connectable to the second flexible puncturing device; and
    a gastrostomy tube.
US11870946 2006-10-26 2007-10-11 Inside out t-fastener system Abandoned US20080103441A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US85459206 true 2006-10-26 2006-10-26
US11870946 US20080103441A1 (en) 2006-10-26 2007-10-11 Inside out t-fastener system

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US11870946 US20080103441A1 (en) 2006-10-26 2007-10-11 Inside out t-fastener system
US13204311 US8287558B2 (en) 2006-10-26 2011-08-05 Inside out T-fastener system

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US13204311 Division US8287558B2 (en) 2006-10-26 2011-08-05 Inside out T-fastener system

Publications (1)

Publication Number Publication Date
US20080103441A1 true true US20080103441A1 (en) 2008-05-01

Family

ID=39331204

Family Applications (2)

Application Number Title Priority Date Filing Date
US11870946 Abandoned US20080103441A1 (en) 2006-10-26 2007-10-11 Inside out t-fastener system
US13204311 Active US8287558B2 (en) 2006-10-26 2011-08-05 Inside out T-fastener system

Family Applications After (1)

Application Number Title Priority Date Filing Date
US13204311 Active US8287558B2 (en) 2006-10-26 2011-08-05 Inside out T-fastener system

Country Status (1)

Country Link
US (2) US20080103441A1 (en)

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7879009B1 (en) * 2010-01-29 2011-02-01 Warsaw Orthopedic, Inc. Variable opening delivery system for intervertebral disc therapies
US20120265055A1 (en) * 2011-04-15 2012-10-18 Melsheimer Jeffry S Tubular feeding device having shapeable distal end
US20120277586A1 (en) * 2011-04-26 2012-11-01 Bosel Christopher D Feeding tube having echogenic tip
US9592044B2 (en) 2011-02-09 2017-03-14 C. R. Bard, Inc. T-fastener suture delivery system

Citations (17)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4665906A (en) * 1983-10-14 1987-05-19 Raychem Corporation Medical devices incorporating sim alloy elements
US5123914A (en) * 1986-05-19 1992-06-23 Cook Incorporated Visceral anchor for visceral wall mobilization
US5350385A (en) * 1993-04-28 1994-09-27 Christy William J Surgical stab wound closure device and method
US5741278A (en) * 1994-08-17 1998-04-21 Tahoe Surgical Instruments Endoscopic suture placement tool
US6014633A (en) * 1997-09-24 2000-01-11 Deroyal Business Systems, L.L.C. Method for the analysis and standardization of bills of resources
US6066146A (en) * 1998-06-24 2000-05-23 Carroll; Brendan J. Laparascopic incision closure device
US6210365B1 (en) * 1998-08-14 2001-04-03 Cardiovention, Inc. Perfusion catheter system having sutureless arteriotomy seal and methods of use
US6425887B1 (en) * 1998-12-09 2002-07-30 Cook Incorporated Multi-directional needle medical device
US6491707B2 (en) * 1997-06-28 2002-12-10 Transvascular, Inc. Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures
US6623494B1 (en) * 1999-04-16 2003-09-23 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Methods and systems for intraluminally directed vascular anastomosis
US20040225183A1 (en) * 1999-06-25 2004-11-11 Usgi Medical Apparatus and methods for forming and securing gastrointestinal tissue folds
US6997932B2 (en) * 2001-05-21 2006-02-14 Boston Scientific Scimed, Inc. Suture passer
US20070276427A1 (en) * 2006-05-26 2007-11-29 Charles Louis Euteneuer Torquable balloon catheters and methods
US7322360B2 (en) * 2000-02-18 2008-01-29 Thomas J. Fogarty Device for accurately marking tissue
US20090177183A1 (en) * 2005-10-14 2009-07-09 Kai Pinkernell Cell delivery catheters with distal tip high fidelity sensors
US7625356B2 (en) * 2000-08-08 2009-12-01 Boston Scientific Scimed, Inc. Tortuous path injection device
US7775968B2 (en) * 2004-06-14 2010-08-17 Pneumrx, Inc. Guided access to lung tissues

Family Cites Families (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5151086A (en) * 1991-10-22 1992-09-29 The Regents Of The University Of California Laparoscopic tube placement method
US5318543A (en) * 1992-10-08 1994-06-07 Abbott Laboratories Laparoscopic jejunostomy instrumentation kit
EP0652734A1 (en) * 1993-05-28 1995-05-17 Larry A. Eld Percutaneous gastrostomy feeding tube applicator and method
US5429598A (en) * 1994-04-19 1995-07-04 Applied Medical Resources Corporation Surgical access device and procedure
US5531699A (en) * 1994-09-19 1996-07-02 Abbott Laboratories Spring-loaded reciprocable stylet holder
US5626614A (en) * 1995-12-22 1997-05-06 Applied Medical Resources Corporation T-anchor suturing device and method for using same
US7255675B2 (en) * 2004-03-23 2007-08-14 Michael Gertner Devices and methods to treat a patient
US20050251176A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. System for treating gastroesophageal reflux disease
JP4669315B2 (en) * 2005-04-21 2011-04-13 日本シャーウッド株式会社 Organ-fixing instrument and organ fixture set
US8758375B2 (en) * 2005-09-28 2014-06-24 Olympus Medical Systems Corp Method for suturing perforation
US8092472B2 (en) * 2007-02-22 2012-01-10 Cerier Jeffrey C Methods and devices for endoscopic treatment of organs
WO2009082596A1 (en) 2007-12-18 2009-07-02 Wilson-Cook Medical, Inc. Device and method for placement of tissue anchors

Patent Citations (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4665906A (en) * 1983-10-14 1987-05-19 Raychem Corporation Medical devices incorporating sim alloy elements
US5123914A (en) * 1986-05-19 1992-06-23 Cook Incorporated Visceral anchor for visceral wall mobilization
US5350385A (en) * 1993-04-28 1994-09-27 Christy William J Surgical stab wound closure device and method
US5741278A (en) * 1994-08-17 1998-04-21 Tahoe Surgical Instruments Endoscopic suture placement tool
US7056325B1 (en) * 1997-06-28 2006-06-06 Medtronic Vascular, Inc. Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures
US6491707B2 (en) * 1997-06-28 2002-12-10 Transvascular, Inc. Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures
US6014633A (en) * 1997-09-24 2000-01-11 Deroyal Business Systems, L.L.C. Method for the analysis and standardization of bills of resources
US6066146A (en) * 1998-06-24 2000-05-23 Carroll; Brendan J. Laparascopic incision closure device
US6210365B1 (en) * 1998-08-14 2001-04-03 Cardiovention, Inc. Perfusion catheter system having sutureless arteriotomy seal and methods of use
US6425887B1 (en) * 1998-12-09 2002-07-30 Cook Incorporated Multi-directional needle medical device
US6592559B1 (en) * 1998-12-09 2003-07-15 Cook Incorporated Hollow, curved, superlastic medical needle
US6623494B1 (en) * 1999-04-16 2003-09-23 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Methods and systems for intraluminally directed vascular anastomosis
US20040225183A1 (en) * 1999-06-25 2004-11-11 Usgi Medical Apparatus and methods for forming and securing gastrointestinal tissue folds
US7322360B2 (en) * 2000-02-18 2008-01-29 Thomas J. Fogarty Device for accurately marking tissue
US7625356B2 (en) * 2000-08-08 2009-12-01 Boston Scientific Scimed, Inc. Tortuous path injection device
US6997932B2 (en) * 2001-05-21 2006-02-14 Boston Scientific Scimed, Inc. Suture passer
US7775968B2 (en) * 2004-06-14 2010-08-17 Pneumrx, Inc. Guided access to lung tissues
US20090177183A1 (en) * 2005-10-14 2009-07-09 Kai Pinkernell Cell delivery catheters with distal tip high fidelity sensors
US20070276427A1 (en) * 2006-05-26 2007-11-29 Charles Louis Euteneuer Torquable balloon catheters and methods

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7879009B1 (en) * 2010-01-29 2011-02-01 Warsaw Orthopedic, Inc. Variable opening delivery system for intervertebral disc therapies
US9592044B2 (en) 2011-02-09 2017-03-14 C. R. Bard, Inc. T-fastener suture delivery system
US20120265055A1 (en) * 2011-04-15 2012-10-18 Melsheimer Jeffry S Tubular feeding device having shapeable distal end
US20120277586A1 (en) * 2011-04-26 2012-11-01 Bosel Christopher D Feeding tube having echogenic tip

Also Published As

Publication number Publication date Type
US20110288488A1 (en) 2011-11-24 application
US8287558B2 (en) 2012-10-16 grant

Similar Documents

Publication Publication Date Title
US6030364A (en) Apparatus and method for percutaneous placement of gastro-intestinal tubes
US5127916A (en) Localization needle assembly
US5183463A (en) Apparatus for locating a breast mass
US7261725B2 (en) Endoscopic device with independently actuated legs
US4705040A (en) Percutaneous fixation of hollow organs
US5151086A (en) Laparoscopic tube placement method
US6001109A (en) Device and method for suturing blood vessels
US6077279A (en) Device and method employing adhesive for sealing blood vessels and the like
USRE34021E (en) Percutaneous fixation of hollow organs
US5275611A (en) Tension guide and dilator
US6193731B1 (en) Laparoscopic insertion and deployment device
US7625392B2 (en) Wound closure devices and methods
US20070112384A1 (en) Suture anchor applicator
US20090018507A1 (en) Spinal access system and method
US20060212042A1 (en) Removal and repositioning device
US5814058A (en) Method and apparatus employing conformable sleeve for providing percutaneous access
US6322538B1 (en) Gastro-intestinal tube placement device
EP1767167A2 (en) Post decompression marker introducer system
US20100010520A1 (en) Tissue fastener
US20060237023A1 (en) Transgastric tubal ligation
US6451031B1 (en) Blood vessel suturing device with single guide-wire/needle receiving lumen
US20060015125A1 (en) Devices and methods for gastric surgery
US5980539A (en) Device and method for suturing blood vessels and the like
US20070219411A1 (en) Overtube and endoscopic treatment system
US7776057B2 (en) Methods and devices for tissue reconfiguration

Legal Events

Date Code Title Description
AS Assignment

Owner name: COOK INCORPORATED, INDIANA

Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MELSHEIMER, JEFFRY S.;REEL/FRAME:019958/0777

Effective date: 20071002