摘要:
Devices and methods for laparoscopically repairing a hernia are described. In some embodiments, a laparoscopic instrument is used to deploy one or more tissue anchor assemblies into the edges of the fascia tissue surrounding or adjacent to the hernia defect. The tissue anchor assemblies are used to cause the fascia tissue to be approximated to facilitate the repair procedure, to improve healing, and to reduce the incidence of recurrence.
摘要:
Methods for performing gastroplasty include 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:
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:
An attachment or locking apparatus which can effectively secure an implant, such as a stent or stent graft, to a vessel or hollow organ wall and which allows minimally-invasive techniques, such as laparoscopy, to be used to attach the implant. The locking element is inserted through an anatomic vessel or hollow organ wall and the implant from outside of the vessel or hollow organ. The locking element preferably is composed of a thin retaining element and a clamping element at one end of the retaining element. A positioning device with an attached locking element may be inserted into the patient's body, such that the positioning device penetrates both the vascular or hollow organ wall and the implant deployed within the vascular or hollow organ wall. The clamping element, held within the positioning device, is then ejected into the vessel or hollow organ. The locking element is pulled tight, and then the locking element is secured into place. The locking element made be secured in place by physically deforming a portion of the retaining element outside of the vascular or hollow organ wall, by either winding or bending the retaining element.
摘要:
Apparatus and methods are provided for performing mucosectomy, such as to map out gastrointestinal surgery, including endoluminal gastric reduction. In one variation, tie apparatus comprises a separating element and an integrated resection element. In one variation, the apparatus is configured to simultaneously separate mucosal tissue from underlying muscularis tissue and to resect the separated mucosal tissue. Methods of using the apparatus are provided.
摘要:
Apparatus and methods are provided for performing mucosectomy, such as to map out gastrointestinal surgery, including endoluminal gastric reduction. In one variation, the apparatus comprises a separating element and an integrated resection element. In one variation, the apparatus is configured to simultaneously separate mucosal tissue from underlying muscularis tissue and to resect the separated mucosal tissue. Methods of using the apparatus are provided.
摘要:
An attachment or locking apparatus which can effectively secure an implant, such as a stent or stent graft, to a vessel or hollow organ wall and which allows minimally-invasive techniques, such as laparoscopy, to be used to attach the implant. The locking element is inserted through an anatomic vessel or hollow organ wall and the implant from outside of the vessel or hollow organ. The locking element preferably is composed of a thin retaining element and a clamping element joined flexibly at one end of the retaining element. A fixing element is secured in position on the retaining element to secure or attach the implant in place. A positioning device, including a thin cannula with an attached locking element, may be inserted into the patient's body, such that the cannula penetrates both the vascular or hollow organ wall and the implant deployed within the vascular wall. The clamping element, held within the cannula, is then ejected into the vessel or hollow organ. The locking element is pulled tight, and pressure-distribution and/or pressure elements are then slid down the locking element toward the vessel wall or hollow organ. A fixing element is then slid against the pressure-distribution and/or pressure elements, and secured into place. The free end of the locking element may then be cut off near the fixing element.
摘要:
A catheter includes an introducer and a flow isolator adapted for disposition in a primary conduit to facilitate flow in the primary conduit while inhibiting flow and intersecting secondary conduits. The flow isolator may include a tubular mesh and surrounding balloon structure. Alternatively, a sleeve can be provided with a primary opening and a secondary opening which are sized to inflate the sleeve with the body fluid. Structures for deploying the sleeve between a low-profile state and high-profile state may include expandable fingers, or pneumatic chambers inflatable from an external source. In operation the sleeve can be forced by the body fluid against the intersection with the secondary conduits to achieve isolation. Alternatively, the pneumatic chambers can be inflated to form seals with the primary conduit. A blood filter or snare is contemplated to filter any blood clots which may develop around the flow isolator.
摘要:
A surgical scissors instrument having disposed at its distal end two bipolar electrode structures which function to coagulate tissue immediately prior to its being severed by scissor action. The instrument comprises a first scissors blade having a distal end and a second scissors blade having a distal end, wherein at least one of the blades is pivotable in relation to the other blade. A first electrically insulated bipolar electrode structure is disposed longitudinally distally from the distal end of the first scissors blade, and a second electrically insulated bipolar electrode structure is disposed longitudinally distally from the distal end of the second scissors blade. The instrument thereby permits a physician to precisely apply electrical energy only at the distal end of the scissor's blades, and to thereafter immediately cut coagulated tissue situated immediately forward of the blade members.