摘要:
Transgastric abdominal access methods and apparatus are described herein. A shape-lockable elongate body can be advanced endoluminally in a flexible state into the stomach, where an opening is created through the stomach wall. The opening can be created endoluminally or by incising instruments placed through the abdominal wall. The elongate body can be transitioned to a rigid state prior to, during, or after advancement into the patient and is passed through the opening into the peritoneal cavity. A dilation balloon can be positioned simultaneously within the elongate body and within the tissue opening such that the elongate body can be advanced through the tissue opening. A flexible needle catheter can also be delivered through the elongate body or an endoscope to provide for insufflation prior to cutting or piercing through the stomach wall. Also, tissue closure devices and methods to close the opening created through the stomach wall.
摘要:
The present invention provides methods for performing gastroplasty by reducing the effective volume or cross-sectional area of the stomach via approximation of gastric tissue. Such reduction preferably is achieved endoluminally, either with or without laparoscopic ports. In one variation, a sleeve, pouch, Magenstrasse and Mill, Vertical Banded Gastroplasty (“VBG”), etc., is formed within the stomach by approximating opposing anterior and posterior segments or ridges of the stomach wall at locations inferior to the gastroesophageal junction. In another variation, opposing walls of the stomach are approximated at a plurality of substantially random locations to reduce an effective volume of the stomach. In yet another variation, both a sleeve and random approximations are formed, the random approximations preferably disposed in a portion of the stomach excluded by the sleeve. In still another variation, opposing walls of the stomach are approximated over significant lengths at random or specified locations.
摘要:
A system for treating gastroesophageal reflux disease (GERD) is disclosed herein. A variety of tools, such as a shape-lockable endoscopic device, can be advanced trans-esophageally and into the stomach or through the stomach wall to access regions of the tissue in and around the gastroesophageal junction. Utilizing expandable tissue anchors, the angle of Hiss can be reconfigured by deploying the anchors within the esophagus and fundus and approximating the two. Alternatively, the esophagus can be lengthened by approximating tissue from within the stomach to follow the lesser curve of the stomach. Alternatively, one or more tissue folds can be formed within or adjacent to the GEJ to form a barrier to refluxing stomach contents.
摘要:
A system for treating gastroesophageal reflux disease (GERD) is disclosed herein. A variety of tools, such as a shape-lockable endoscopic device, can be advanced trans-esophageally and into the stomach or through the stomach wall to access regions of the tissue in and around the gastroesophageal junction. Utilizing expandable tissue anchors, the angle of Hiss can be reconfigured by deploying the anchors within the esophagus and fundus and approximating the two. Alternatively, the esophagus can be lengthened by approximating tissue from within the stomach to follow the lesser curve of the stomach. Alternatively, one or more tissue folds can be formed within or adjacent to the GEJ to form a barrier to refluxing stomach contents.
摘要:
The present invention provides methods and apparatus for pleating at least a portion of a patient's body lumen, such as the colon. Pleating is achieved via relative motion between an endoscope and a flexible conduit having an engagement element configured to reversibly engage the body lumen.
摘要:
Apparatus and methods are provided for placing and advancing a diagnostic of therapeutic instrument in a hollow body organ of a tortuous or unsupported anatomy, comprising a handle, an overtube, a distal region having an atraumatic tip. The overtube may be removable from the handle, and have a longitudinal axis disposed at an angle relative to the handle. The overtube may be selectively stiffened to reduce distension of the organ caused by advancement of the diagnostic or therapeutic instrument. The distal region permits passive steering of the overtube caused by deflection of the diagnostic or therapeutic instrument while the atraumatic tip prevents the wall of the organ from becoming caught or pinched during manipulation of the diagnostic or therapeutic instrument.
摘要:
Systems, devices and methods are provided for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Embodiments of the systems include an elongated main body having a scope therethrough and at least one steerable tool arm which extends from the distal end of the main body. In preferred embodiments, the system includes two tool arms, each arm steerable to form a curve laterally outward which then bends laterally inward so that the arms form an angular shape. In addition, end effectors extend from the distal ends of each tool arm for use in manipulation of tissue. The angular shape brings the end effectors together in view of the scope for cooperative movements which are continuously visible by the surgeon. In addition, the tool arms may be steerable in any additional direction and may be rotateable to allow grasping, elevation and more complex manipulation of tissue.
摘要:
Apparatus and methods are provided for forming a gastrointestinal tissue fold by engaging tissue at a first tissue contact point and moving the first tissue contact point from a position initially distal to, or in line with, a second tissue contact point to a position proximal of the second contact point, thereby forming the tissue fold, and extending an anchor assembly through the tissue fold from a vicinity of the second tissue contact point. Adjustable anchor assemblies; as well as anchor delivery systems, shape-lockable guides and methods for endoluminally performing medical procedures, such as gastric reduction, treatment of gastroesophageal reflux disease, resection of lesions, and treatment of bleeding sites; are also provided.
摘要:
Systems, devices and methods are provided for endoscopic procedures involving tissue manipulations beyond the capabilities of traditional endoscopic instruments. Embodiments of the systems include an elongated main body having a scope therethrough and at least one steerable tool arm which extends from the distal end of the main body. In preferred embodiments, the system includes two tool arms, each arm steerable to form a curve laterally outward which then bends laterally inward so that the arms form an angular shape. In addition, end effectors extend from the distal ends of each tool arm for use in manipulation of tissue. The angular shape brings the end effectors together in view of the scope for cooperative movements which are continuously visible by the surgeon. In addition, the tool arms may be steerable in any additional direction and may be rotateable to allow grasping, elevation and more complex manipulation of tissue.
摘要:
A delivery catheter for a gastric reduction system includes an elongate torqueable tube, a needle translatably disposed within the torqueable tube, an anchor translatably disposed within the needle and a stabilization device for holding a distal tip of the torqueable tube against a tissue wall.