WO2003059151A2 - Apparatus and method for endoscopic colectomy - Google Patents
Apparatus and method for endoscopic colectomy Download PDFInfo
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- WO2003059151A2 WO2003059151A2 PCT/US2002/041358 US0241358W WO03059151A2 WO 2003059151 A2 WO2003059151 A2 WO 2003059151A2 US 0241358 W US0241358 W US 0241358W WO 03059151 A2 WO03059151 A2 WO 03059151A2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00147—Holding or positioning arrangements
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
- A61B1/0051—Flexible endoscopes with controlled bending of insertion part
- A61B1/0055—Constructional details of insertion parts, e.g. vertebral elements
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- A61B1/31—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
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- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
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Definitions
- the present invention relates generally to surgical methods and apparatus.
- Endoscopy studies the intralumenal aspects of hollow organs of the upper and lower intestine including the esophagus, stomach and the colon through cannulation of the lumen via the mouth or anus.
- Endoscopic polypectomy is presently limited to a submucosal resection. The endoscopist is often unable to completely resect a sessile polyp or lesion and therefore the patient is subjected to subsequent definitive surgery, i.e. resection of the base of the tumor. Endoscopic polypectomy can be used to debulk sessile masses but it is unable to resect mural disease.
- Incomplete resection of a sessile polyp may destroy the biopsy specimen and alter the relationship of the gross specimen given to the pathologist thereby resulting in the pathologist possibly providing incorrect or incomplete study results.
- the endoscopist is also unable to correct uncommon, but life threatening, procedural complications such as perforations.
- Other cases where resection is required are invasive tumors, perforation from different causes, inflammatory bowel disease, diverticulosis and others.
- Surgical approaches for resecting diseased tissue are largely practiced by making large laparotomy incisions or using minimally invasive techniques such as laparoscopic surgery in which tissues are resected and repaired through small incisions.
- There are numerous surgical devices enabling surgeons to resect diseased tissue and subsequently anastomose remaining tissue either through a conventional incision or using a laparoscope and making one or more relatively small incisions.
- endoscopically assisted stapling devices are known which enable surgeons to remotely anastomose lumenal structures such as the bowel. Endoscopically assisted bowel anastomosis nevertheless typically requires extralumenal assistance via a traditional laparotomy incision or use of a laparoscope.
- laparoscopic colectomy today the colon is separated from its omentum laparoscopically and then the colon is exteriorized out of the abdominal cavity, through a laparotomy incision where the resection and anastomosis are performed extracorporeally.
- Disadvantages of the laparoscopic method include the need to traverse the abdominal wall, increased operating time secondary to the lack of exposure for the procedure and possibly the need to convert to an "open" laparotomy in the course of performing the procedure.
- GIA and EEA staplers which can be used to transect tissue in a linear or circular fashion, respectively, with subsequent anastomosis with staples.
- the linear GIA is relatively versatile.
- the EEA is primarily suited for lower colonic circular anastomosis after a lesion has been surgically removed (via laparotomy or laparoscopically) or during a colostomy takedown procedure.
- the present invention takes the form of methods and apparatus for performing endoscopic colectomy that combine the advantages of the laparoscopic and endolumenal approaches.
- the diseased portion of the colon to be resected is identified using either laparoscopic and/or colonoscopic techniques or using another imaging modality.
- a colectomy device mounted on a colonoscope grasps the colon wall at two sites adjacent to a diseased portion of the colon.
- laparoscopic techniques the diseased portion of the colon is separated from the omentum and the blood vessels supplying it are ligated or cauterized.
- the colon wall is transected to remove the diseased portion and the excised tissue is removed using the laparoscope or drawn into the colectomy device for later removal upon withdrawal of the colonoscope.
- the colectomy device approximates the two ends of the colon and performs an end-to-end anastomosis. If the part to be resected is a tumor, prior to the resection, the edges of the segment to be resected will be stapled to seal it and prevent spillage of malignant cells to the healthy tissue.
- the methods and apparatus of the present invention provide a number of benefits not realized by the prior art approaches to colectomy.
- the purely endolumenal approach does not provide for separation of the colon from the omentum, which is necessary when resecting more than just a small portion of the colon wall.
- the present invention overcomes this deficiency in the prior art allowing a more comprehensive approach to colectomy.
- the colon does not need to be exteriorized for excision of the diseased portion or anastomosis of the remaining colon.
- the colonoscope-mounted colectomy device approximates the ends of the colon and performs an anastomosis from the interior of the lumen of the colon.
- the excised tissue can be drawn into the colectomy device for removal through the lumen of the colon along with the colonoscope or can be taken out by the laparoscope, which can be done through a very small incision in the patient's skin.
- the prior art approach also does not protect from leaking of malignant cells to the periphery. This idea will enable sealing of the tissue with staples at its ends to prevent such leakage. Optionally, it will be done with the help of a laparoscopic device that will serve as an anvil.
- the present invention will optionally use a balloon inflated in the lumen of the colon or any other resected organ before stapling, and by this assure the anastomosis will be ideal with the best possible approximation of the edges.
- colonoscopic techniques provides another benefit not realized by a purely laparoscopic approach. Since colonoscopic examination is at present the most definitive diagnostic method for identifying diseases of the colon, locating the lesions through the exterior of the colon by laparoscopy or even by direct visualization can be somewhat problematic. Using the colonoscope to identify and isolate the diseased portion of the colon from within the lumen helps assure that the correct portions of the colon wall are excised and makes clean surgical margins without residual disease more assured as well.
- the present invention utilizes a steerable colonoscope as described in U.S. Patent Application Serial Nos. 09/790,204 (now U.S. Patent No. 6,468,203); 09/969,927; and 10/229,577, which have been incorporated by reference.
- the steerable colonoscope described therein provides a number of additional benefits for performing endoscopic colectomy according to the present invention.
- the steerable colonoscope uses serpentine motion to facilitate rapid and safe insertion of the colonoscope into the patient's colon, which allows the endoscopic colectomy method to be performed more quickly and more safely.
- the steerable colonoscope has the capability to create a three-dimensional mathematical model or map of the patient's colon and the location of any lesions identified during the initial examination. Lesions found during a previous examination by CT, MRI or any other imaging technology can also be mapped onto the three-dimensional mathematical model of the colon.
- the system knows where each part of the endoscope is in the colon and will be able to localize the two parts of the dissecting and stapling system exactly in the desired location. During surgery, this information can be used to quickly and accurately return the colonoscope to the location of the identified lesions where the colonoscope-mounted colectomy device will be used to complete the endoscopic colectomy procedure.
- FIG 1 is a phantom drawing illustrating a diseased portion of the colon being separated from the omentum using laparoscopic techniques through a small incision in a patient's abdomen.
- FIG 2 is a cutaway drawing illustrating a steerable colonoscope with a colectomy device mounted thereon being inserted through the lumen of a patient's colon.
- FIG 3 is a cutaway drawing showing the gripping mechanism of the colonoscope-mounted colectomy device expanded within the lumen of the colon.
- FIG 4 illustrates the colon after the diseased portion has been excised and removed with the colonoscope-mounted colectomy device in position to approximate the transected ends of the colon.
- FIG 5 illustrates the colonoscope-mounted colectomy device performing an end-to-end anastomosis to complete the endoscopic colectomy procedure.
- DETAILED DESCRIPTION OF THE INVENTION [0021]
- FIG 2 is a cutaway drawing illustrating a steerable colonoscope 100 with a colectomy device 102 mounted thereon being inserted through the lumen of a patient's colon. As mentioned before, the same technique may apply for every other tubular shaped organ.
- the steerable colonoscope 100 is constructed as described in U.S. Patent Application Serial Nos. 09/790,204 (now U.S. Patent No.
- control system of the steerable colonoscope 100 has the capability to construct a three-dimensional mathematical model or map of the colon as it advances through lumen under control of the operator.
- the three-dimensional mathematical model of the colon and the location and nature of any lesions identified in the course of an initial colonoscopic examination can be stored and used in performance of the endoscopic colectomy procedure.
- the colectomy device 102 of the present invention may be mounted on a colonoscope of a different design and construction.
- the colectomy device 102 can be permanently or removably mounted on the steerable colonoscope 100.
- the colectomy device 102 has a distal component 104 and a proximal component 106.
- the distal component 104 and the proximal component 106 each have an expandable member 108 and a gripping mechanism 110 for gripping the wall of the colon.
- the expandable member 108 may be an inflatable balloon or a mechanically expandable mechanism.
- the gripping mechanism 110 may comprise a plurality of circumferentially located ports within which attachment points 112, e.g., needles, hooks, barbs, etc., may be retractably positioned about an exterior surface of the expandable member 108.
- the gripping mechanism 110 may utilize a vacuum gripper through a plurality of circumferentially located ports around the distal component 104 and/or the proximal component 106 or other known gripping mechanisms.
- gripping mechanism 110 is in fluid communication through the ports and through the colonoscope 100 to the proximal end of the colonoscope 100 to a vacuum pump (not shown).
- a vacuum pump not shown.
- At least one, and optionally both, of the distal component 104 and the proximal component 106 are movable longitudinally with respect to the body of the steerable colonoscope 100.
- Rails, grooves or the like 114 may be provided on the body of the steerable colonoscope 100 for guiding the longitudinal movement of the distal component 104 and the proximal component 106.
- the colectomy device 102 includes a surgical stapler 116 or other anastomosis mechanism.
- the surgical stapler 116 is carried on either the distal component 104 or the proximal component 106 and a stapler anvil 118 is carried on the other of these components.
- the surgical stapler 116 may be configured similarly to any number of conventional stapling devices which are adapted to actuate staples into tissue. Another option is that there is a stapler and an anvil on both components for stapling and sealing the edges.
- the colectomy device 102 may include a cutting device and/or electrocautery and/or a laser device for transecting the colon wall.
- the colectomy device 102 may also include a vacuum mechanism or the like for drawing the excised tissue into the colectomy device 102 for later removal along with the steerable colonoscope 100.
- FIG 2 shows the steerable colonoscope 100 with the expandable members
- the control system of the steerable colonoscope 100 monitors the position of each segment of the colonoscope 100 as it is advanced within the colon and can signal to the operator when the segments carrying the distal component 104 and the proximal component 106 of the colectomy device 102 are correctly positioned with respect to a previously detected lesion in the colon.
- FIG 3 is a cutaway drawing showing the expandable members 108 of the distal component 104 and the proximal component 106 of the colonoscope-mounted colectomy device 102 expanded within the lumen of the colon so that the gripping mechanism 110 grips the wall of the colon.
- the distal component 104 and the proximal component 106 may be expanded through any number of expansion devices. For instance, they may be radially expanded upon spoke-like support structures or they may be configured to radially expand in a rotational motion until the desired expansion diameter is attained.
- the diseased portion of the colon identified and isolated by the colonoscope-mounted colectomy device 102, the diseased portion is separated from the omentum and the blood vessels supplying it are ligated and/or cauterized using laparoscopic techniques.
- FIG 1 is a phantom drawing illustrating a diseased portion of the colon being separated from the omentum using laparoscopic techniques through a small incision in a patient's abdomen.
- the diseased portion of the colon is excised by transecting the colon at the proximal and distal end of the diseased portion.
- the colon may be transected using laparoscopic techniques or using a cutting mechanism and/or electrocautery device mounted on the colectomy device 102.
- the excised tissue is removed using the laparoscope or drawn into the colectomy device 102 for later removal upon withdrawal of the steerable colonoscope 100.
- FIG 4 illustrates the colon after the diseased portion has been excised and removed with the colonoscope-mounted colectomy device 102 in position to approximate the transected ends of the colon.
- the remaining ends of the colon are approximated one to the other by moving the distal component 104 and/or the proximal component 106 longitudinally with respect to the body of the steerable colonoscope 100, as shown by the arrows.
- the proximal component 106 may be longitudinally translated towards the distal component
- FIG 5 illustrates the colonoscope-mounted colectomy device performing an end-to-end anastomosis 120 to complete the endoscopic colectomy procedure.
- the expandable members 108 of the distal component 104 and the proximal component 106 are deflated or contracted and the steerable colonoscope 100 and the colectomy device 102 are withdrawn from the patient's body.
- the expanded members will assure a very accurate end-to-end anastomosis and prevent stenosis that can happen as a result of inaccurate approximation of the two ends.
- the diseased portion of the colon may be excised using a cutting device within the colectomy device 102 after the ends of the diseased portion have been approximated and anastomosed.
- the excised tissue is drawn into the colectomy device 102 and removed when the steerable colonoscope 100 is withdrawn from the patient.
- the colectomy procedure may be performed entirely from the endolumenal approach using the colonoscope-mounted colectomy device 102 without laparoscopic assistance. This method would be particularly advantageous for resection of small portions of the colon where it may not be necessary to mobilize an extended portion of the colon from the omentum to achieve successful approximation and anastomosis.
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Abstract
Description
Claims
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2003559322A JP2005514145A (en) | 2002-01-09 | 2002-12-20 | Apparatus and method for endoscopic colectomy |
EP02794411.5A EP1469781B1 (en) | 2002-01-09 | 2002-12-20 | Apparatus for endoscopic colectomy |
IL16269602A IL162696A0 (en) | 2002-01-09 | 2002-12-20 | Apparatus and method for endoscopiccolectomy |
AU2002359847A AU2002359847A1 (en) | 2002-01-09 | 2002-12-20 | Apparatus and method for endoscopic colectomy |
CA002472207A CA2472207A1 (en) | 2002-01-09 | 2002-12-20 | Apparatus and method for endoscopic colectomy |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US34767402P | 2002-01-09 | 2002-01-09 | |
US60/347,674 | 2002-01-09 |
Publications (2)
Publication Number | Publication Date |
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WO2003059151A2 true WO2003059151A2 (en) | 2003-07-24 |
WO2003059151A3 WO2003059151A3 (en) | 2003-09-12 |
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Application Number | Title | Priority Date | Filing Date |
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PCT/US2002/041358 WO2003059151A2 (en) | 2002-01-09 | 2002-12-20 | Apparatus and method for endoscopic colectomy |
Country Status (8)
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US (6) | US7338505B2 (en) |
EP (1) | EP1469781B1 (en) |
JP (1) | JP2005514145A (en) |
CN (1) | CN1764416A (en) |
AU (1) | AU2002359847A1 (en) |
CA (1) | CA2472207A1 (en) |
IL (1) | IL162696A0 (en) |
WO (1) | WO2003059151A2 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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EP2399529A3 (en) * | 2010-06-25 | 2013-06-12 | Triple-c Medical Corporation | Slot drive type anastomosis device |
Families Citing this family (514)
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CA2397121C (en) | 2000-01-18 | 2009-04-07 | Tyco Healthcare Group Lp | Anastomosis instrument and method for performing same |
US8517923B2 (en) | 2000-04-03 | 2013-08-27 | Intuitive Surgical Operations, Inc. | Apparatus and methods for facilitating treatment of tissue via improved delivery of energy based and non-energy based modalities |
US6468203B2 (en) | 2000-04-03 | 2002-10-22 | Neoguide Systems, Inc. | Steerable endoscope and improved method of insertion |
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US7338505B2 (en) | 2008-03-04 |
US20030171775A1 (en) | 2003-09-11 |
US20160331376A1 (en) | 2016-11-17 |
CN1764416A (en) | 2006-04-26 |
EP1469781A2 (en) | 2004-10-27 |
US10349816B2 (en) | 2019-07-16 |
AU2002359847A1 (en) | 2003-07-30 |
JP2005514145A (en) | 2005-05-19 |
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EP1469781A4 (en) | 2008-03-26 |
US20130116712A1 (en) | 2013-05-09 |
US20140188142A1 (en) | 2014-07-03 |
EP1469781B1 (en) | 2016-06-29 |
US8361090B2 (en) | 2013-01-29 |
WO2003059151A3 (en) | 2003-09-12 |
IL162696A0 (en) | 2005-11-20 |
US8696694B2 (en) | 2014-04-15 |
CA2472207A1 (en) | 2003-07-24 |
US9421016B2 (en) | 2016-08-23 |
US20200000322A1 (en) | 2020-01-02 |
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