摘要:
Tissue imaging system variations are described herein. Such a system may include a deployment catheter and an attached imaging hood deployable into an expanded configuration. In use, the imaging hood is placed against or adjacent to a region of tissue to be imaged in a body lumen that is normally filled with an opaque bodily fluid such as blood. A translucent or transparent fluid, such as saline, can be pumped into the imaging hood until the fluid displaces any blood, thereby leaving a clear region of tissue to be imaged via an imaging element in the deployment catheter. Additionally, the system can be deployed in a number of various ways such as clearing blood clots, emboli, and other debris which may be present in a body lumen. Other variations may also be used for facilitating trans-septal access across tissue regions as well as for balancing body fluids during a procedure.
摘要:
Apparatus and methods are provided for thermally and/or mechanically treating tissue, such as valvular structures, to reconfigure or shrink the tissue in a controlled manner. Mechanical clips are implanted over the leaflets of a valve, e.g., in the heart, either alone or after thermal treatment to cause the valve to close more tightly. The clips are delivered by a catheter and may be configured to traverse directly over the valve itself or to lie partially over the periphery of the valve to prevent obstruction of the valve channel. The clips can be coated with drugs or a radiopaque coating. Alternatively, individual anchors with a tensioning element, like a suture, may be used to approximate the valves towards each other. The catheter can also incorporate sensors or energy delivery devices, e.g., transducers, on its distal end.
摘要:
Methods and apparatus for maintaining sterility during transluminal procedures are described. The sterility is achieved by making use of a membrane in either the form, e.g., of a sheath, cap or umbrella to keep the instruments (endoscopes, overtubes, etc.) sterile while being advanced through lumens in the body and into the various cavities. Methods, such as vacuum acquisition, mechanical tissue anchoring, etc., of the underlying tissue followed by incision of the tissue with, e.g., a needle knife, can be utilized to gain access to the various cavities. It is expected that this procedure will provide the desired level of sterility for transluminal procedures.
摘要:
A multi-barbed apparatus is provided, and methods of use, for penetrating two sides of a wound and holding the edges in apposition. The apparatus may be inserted within a wound or underneath the skin, and mechanically adheres the two sides of the wound together. The apparatus includes a biocompatible substrate carrying a multiplicity of tissue penetrating barbs on a least one side thereof, and may be formed as a rigid or flexible sheet, tube or other shape.
摘要:
Methods and apparatus for performing endoluminal procedures are described herein. An endoluminal tissue manipulation assembly is disclosed which provides for a stable endoluminal platform and which also provides for effective triangulation of tools. Such an apparatus may comprise an optionally shape-lockable elongate body defining a longitudinal axis and adapted for endoluminal advancement in a patient body, at least one articulatable visualization lumen disposed near or at a distal region of the elongate body, the at least one articulating visualization lumen being adapted to articulate off-axis relative to a longitudinal axis of the elongate body, and at least one articulatable tool arm member disposed near or at the distal region of the elongate body, the at least one articulatable tool arm member being adapted to articulate off-axis and manipulate a tissue region of interest.
摘要:
Methods and apparatus for performing malabsorptive bypass procedures within a patient's gastrointestinal lumen are described comprising, for example, gastroenterostomy procedures that are preferably performed in an endoscopic or laparoscopic fashion. Anastomosis between the patient's stomach and intestine allows food to bypass at least a portion of the patient's stomach and/or intestine, thereby providing a malabsorptive region. The malabsorptive procedure may be accompanied by additional procedures, for example, pyloric occlusion, pyloroplasty, gastroplasty, gastric tissue destruction and/or intestinal pleating.
摘要:
A manipulatable grasping needle is described herein. A piercing and grasping assembly generally comprises a needle body, which is optionally hollow, having a piercing tip and a grasping arm positioned proximally of the tip, wherein the grasping arm is adapted to project from the needle body and releasably retain a length of suture. Alternatively, opposing jaws can form a singular piercing tip when the jaws are closed. The assembly is positioned at the distal end of an elongate member which can be rigid or flexible for advancement through an endoscopic device. The elongate member can also comprise one or more articulatable sections to enable manipulation of the assembly into various shapes to facilitate suture and tissue manipulation. Moreover, either the needle body or grasping arm can define a notch for receiving suture material. A hooking member can also be provided to facilitate suture retrieval when grasping suture.
摘要:
Methods and apparatus for creating a working space within a patient's stomach are described. The working space is created by internally spreading or pushing the walls of the stomach apart. Advantageously, such spreading is achieved without pressurizing the patient's stomach, i.e. without injecting a pressurized gas or other fluid directly into the stomach. Diagnostic or therapeutic instruments may be deployed within the working space. It is expected that spreading the walls without pressurizing the stomach will facilitate engagement and/or manipulation of the stomach wall for, e.g., endoluminal treatment of obesity.
摘要:
Apparatus and methods for positioning and securing anchors are disclosed herein. The anchors are adapted to be delivered and implanted into or upon tissue, particularly tissue within the gastrointestinal system of a patient. The anchor is adapted to slide uni-directionally over suture such that a tissue plication may be cinched between anchors. A locking mechanism either within the anchor itself of positioned proximally of the anchor may allow for the uni-directional translation while enabling the anchor to be locked onto the suture if the anchor is pulled, pushed, or otherwise urged in the opposite direction along the suture. This uni-directional anchor locking mechanism facilitates the cinching of the tissue plication between the anchors and it may be utilized in one or several anchors in cinching a tissue fold.
摘要:
Interlocking tissue anchor apparatus and methods are described herein. In creating tissue folds within the body of a patient, a tissue manipulation assembly may generally have an elongate tubular member, an engagement member slidably disposed through the tubular member and a distal end adapted to engage tissue via a helical member, tissue stabilizing members positioned at the tubular member distal end which are adapted to stabilize tissue therebetween, and a delivery tube pivotable about the tissue stabilizer. Anchor assemblies can be delivered via the tissue manipulation assembly into or through the tissue. The anchors can incorporate various temporary interlocking features or spacing elements between one another to ensure that an anchor is not prematurely ejected from the needle assembly. This allows the anchor assembly to be advanced distally as well as withdrawn proximally within a deployment sheath while avoiding inadvertently ejecting an anchor.