US20140330294A1 - Methods and devices for endosonography-guided fundoplexy - Google Patents
Methods and devices for endosonography-guided fundoplexy Download PDFInfo
- Publication number
- US20140330294A1 US20140330294A1 US14/337,014 US201414337014A US2014330294A1 US 20140330294 A1 US20140330294 A1 US 20140330294A1 US 201414337014 A US201414337014 A US 201414337014A US 2014330294 A1 US2014330294 A1 US 2014330294A1
- Authority
- US
- United States
- Prior art keywords
- needle
- stomach
- needle tip
- connecting element
- loop
- 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
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00818—Treatment of the gastro-intestinal system
- A61B2017/00827—Treatment of gastro-esophageal reflux
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0409—Instruments for applying suture anchors
Definitions
- the present invention relates to a tissue securement system, device and method for endoscopy or endosonography-guided transluminal interventions whereby a ligation or anchor is placed and secured into soft tissue.
- Gastroesophageal reflux disease is a chronic condition caused by the failure of the anti-reflux barrier located at the gastroesophageal junction to keep the contents of the stomach from refluxing back into the esophagus.
- Surgical fundoplication is the gold standard for anatomic correction of the cardia in patients with GERD.
- this procedure can have a high incidence of postoperative complications and extended recovery times. Therefore endoscopic methods for enhancing the lower esophageal sphincter have been developed as an alternative to surgery. Endoscopic treatments of GERD target the esophageal and gastric wall in the region of the lower esophageal sphincter.
- Methods including suture plication, radiofrequency energy ablation, and implant insertion are employed to prevent reflux by mechanisms that include the creation of a mechanical barrier by narrowing the lumen, altering the esophago-gastric angle (angle of His or “flap valve”), and altering the lower esophageal sphincter to enhance its function or decrease transient lower esophageal sphincter relaxations.
- the endoscopic methods can be performed entirely through the endoscope placed transorally, avoiding any abdominal incisions.
- Endoscopic treatment is often limited because the operator can only visualize the mucosal lining of the gastrointestinal wall that is located directly in front of the endoscope. Structures deep within the wall, and outside the wall, cannot be seen. The ability to visualize these structures may influence the proper placement of a treatment apparatus and may expand the therapeutic strategies. For example placement of a suture or ligating element through the esophageal and fundal walls that also includes placement through the diaphragmatic crura may be useful. The use of endoscopic ultrasonography may address this limitation. In this procedure a combination endoscope and ultrasound instrument called an echoendoscope is utilized.
- LES lower esophageal sphincter
- the diaphragmatic crura are typically seen interposed between the distal esophageal wall and the fundus of the stomach.
- One aspect of this invention utilizes the visualization capabilities of ultrasound endoscopy to permit a novel device and method for treating GERD.
- an objective of this invention is to provide a method to reduce gastroesophageal reflux by endosonography-guided intervention.
- endosonography is used to insert a ligation element through the esophageal wall, through the diaphragmatic crus and into the fundus of the stomach.
- This ligation element placed from the esophagus and around the angle of His may create a barrier to gastroesophageal reflux.
- the present invention is directed to a device, system and method that, as embodied and broadly described herein, includes an implantable ligation element for fastening layers of tissue together.
- the ligation element has proximal and distal ends and is suitable for insertion through the esophageal wall, the crura and into the fundus of the stomach.
- the distal end of the ligation element can be brought from the fundus, around the gastro-esophageal flap valve and secured to the proximal end of the ligation element in the esophagus.
- This ligating element forms a loop that can be used to draw the tissues described together.
- a system for fastening tissue includes a tissue securement apparatus that can be initially positioned in the esophagus using an echoendoscope.
- the securement apparatus is comprised of a hollow needle with a detachable needle tip.
- a connecting element is positioned inside the needle and attached to the needle tip. When an inner stylet is advanced, the needle tip separates from the needle body and the needle tip with a portion of the connecting element moves apart from the needle body to reside in the fundus of the stomach.
- the system for fastening tissue also includes a ligating element that can be attached to the proximal end of the connecting element once the hollow needle is removed.
- the ligating element may utilize a dilating element positioned at its distal end that is sized to dilate a tissue tunnel so that the ligating element may be drawn more easily through the tissue structures.
- the system may also utilize an endoscopically guided grasper to grasp the distal end of a connecting element and pull the ligating element across the esophageal wall and into the stomach.
- the system may also utilize a securement element that is configured to engage the proximal and distal ends of the ligating element together. This may prevent the ligating element loop from loosening.
- the present invention includes a method of treating gastroesophageal reflux disease.
- a ligating element having a proximal end and a distal end is passed transorally through the esophagus to a position near the junction between the esophagus and the stomach.
- the distal end of the ligating element is placed through the wall of the esophagus, through a portion of the diaphragmatic crura and into the gastric fundus using ultrasonic guidance.
- the distal end of the ligating element is grasped in the fundus, wrapped around the gastro-esophageal flap valve and secured to the proximal end of the ligation element in the esophagus.
- FIG. 1 is a cross sectional view of the esophageal-gastro-intestinal tract.
- FIG. 2 is a view of the esophagus and stomach showing an echoendoscope placed in the distal portion of the esophagus;
- FIG. 3 is a section view of a needle having a detachable needle tip
- FIG. 4 is a view similar to FIG. 2 showing the needle tip detached from the needle body after placement through a tissue wall;
- FIG. 5 is a view of a ligating element with an attached dilating element
- FIG. 6 a is a view of a ligating element including one embodiment of a securement element
- FIG. 6 b is a view of a ligating element showing an alternative embodiment of a securement element
- FIG. 7 is a view showing a lower esophageal wall with a delivery needle inserted into the fundus from the esophagus;
- FIG. 8 is a view showing a gastroscope in the stomach with an extended grasper capturing the retrieval loop on the needle tip;
- FIG. 9 is a view showing a gastroscope in the lower esophagus with the ligating element forming a loop around the gastro-esophageal flap valve and the stomach drawn up to the lower esophageal wall.
- This tissue securement system has several embodiments that are intended to work together to create a novel device and method for the treatment of GERD. However these embodiments also function independently and some of the embodiments of this system may be removed and the system may still achieve its desired function. Alternatively several of these embodiments may be useful as stand alone devices.
- the principle elements of this system are; an echoendoscope, a delivery needle, a stylet, a needle tip, a connecting element, a ligating element and securement elements.
- FIG. 1 is a cross sectional view of the esophageal-gastro-intestinal tract shown from the esophagus 1 to the stomach 2 .
- the fundus 3 forms the superior portion of the stomach 2 .
- the esophagus 1 enters the stomach 2 at a point below the fundus 3 forming the cardiac notch 4 and an acute angle with respect to the fundus 3 known as the Angle of His 5 .
- the lower esophageal sphincter (LES) 6 is an important primary sphincter that controls the movement of fluids and food into the stomach.
- the gastro-esophageal flap valve 7 includes a moveable portion and a more stationary portion.
- the moveable portion is a moveable flap that is formed at the junction of the esophagus 1 and the stomach 2 .
- This flap is approximately 4-5 cm long and is partially held against the opposing wall of the stomach 2 by the internal pressures of the stomach.
- the esophageal tract is primarily controlled by the LES 6 and the gastro-esophageal flap valve 7 .
- the condition known as Gastroesophageal Reflux Disease (GERD) can occur. It is the intent of this invention to provide a treatment method for GERD by supporting the LES 6 and the gastro-esophageal flap valve 7 .
- a first component of the tissue securement system, the delivery needle 10 is shown in FIGS. 2 and 3 and is designed to be inserted through the instrumentation channel of an endoscope or preferably an echoendoscope 12 .
- the delivery needle 10 can be manually advanced and retracted.
- the proximal end of the delivery needle may include a handle (not shown) which can be secured to the inlet port of the instrumentation channel by a luer lock mechanism.
- the delivery needle 10 can be housed in a protective outer sheath 18 which serves to protect the instrumentation channel of an endoscope or echoendoscope from damage from the sharp needle tip and to provide support as the delivery needle 10 is advanced.
- the outer sheath 18 can be manually advanced to cover the length of the delivery needle 10 .
- the delivery needle 10 consists of a needle body 20 which is constructed from a hollow tube and utilizes a hollow stylet 22 located coaxially inside.
- the delivery needle 10 is sized to fit through the working channel of an echoendoscope although this system may function equally well with larger diametric requirements.
- the size of the delivery needle 10 is preferably 18 to 26 gauge. More preferably the size is 19 to 23 gauge.
- a needle tip 24 is located near the distal end 26 of the needle body and is detachably coupled to the needle body 20 .
- the needle body 20 has an inner diameter 30 that provides support to the needle tip 24 during insertion.
- the needle tip 24 has a mating retention boss 32 located on the proximal end of the needle tip that is formed so that the needle tip 24 fits snugly inside the inner diameter 30 of the needle body 20 .
- a peg and hole arrangement is depicted in the drawings, various other features such as a tongue and groove, a bayonet and slot or other common mechanical stabilizing features could easily function with the same intended result; to hold and support the needle tip 24 in position at the end portion of the needle body 20 until the delivery needle is deployed as described later.
- a connecting element 40 is connected to the needle tip 24 at point 41 and the connecting element 40 extends through the hollow pusher stylet 22 to the proximal end of the needle where it can be manipulated by the operator outside the patient's body.
- the operator Upon advancement of the delivery needle 10 into soft tissue, the operator places tension on the connecting element 40 which firmly seats the needle tip 24 in the needle body 20 . This facilitates the introduction of the needle body 20 and needle tip 24 through tissue and into a targeted delivery site. Once at the delivery site, the tension can be released.
- the connecting element 40 is preferably a suture, thread, plastic filament or wire.
- the pusher stylet 22 extends along the length of the needle body 20 to the proximal end of the needle tip located at the retention boss 32 .
- the stylet 22 can be used to deploy the needle tip 24 and connecting element 40 .
- the needle tip 24 separates from the needle body 20 and the needle tip 24 and the attached connecting element 40 are delivered to the delivery site.
- the stylet 22 is next withdrawn into the needle body 20 and the delivery needle 10 can be withdrawn into the protective sheath 18 inside the working channel of an endoscope or echoendoscope.
- the echoendoscope along with the delivery needle 10 is then withdrawn leaving behind the needle tip 24 with the connecting element 40 extending out through the patient's mouth.
- the needle tip 24 helps prevent inadvertently pulling out the connecting element 40 from the soft tissue as the echoendoscope 12 and the delivery needle 10 are withdrawn.
- the connecting element 40 can be attached to the proximal end of the needle tip at 41 or can be connected to a center portion of the tip so that the tip swivels away from the connecting element 40 further preventing inadvertent pullout of the connecting element 40 .
- the needle tip 24 may utilize a retrieval loop 44 attached near its apex 46 as illustrated in FIGS. 3 and 4 .
- the retrieval loop 44 is a small piece of string or wire that is collapsed along the side of the needle tip 24 while the needle tip 24 is inside the protective sheath 18 .
- the retrieval loop 44 expands once the needle tip 24 and connecting element 40 are deployed as shown in FIG. 4 .
- the retrieval loop 44 may be positioned inside a groove 50 that is formed or cut into the side wall 52 of the needle tip 24 .
- the retrieval loop 44 may be important to guide the needle tip 24 into the working lumen of a gastroscope as the needle tip 24 and connecting element 40 are retrieved as part of the method of this application.
- the delivery needle 10 has several potential advantages over other delivery systems that deliver T-tags, plugs or anchors.
- the working channel of a standard echoendoscope has a small diameter in the range of 2.8 mm. This small size limits the size of the needle and T-tag that can be delivered through the working channel.
- a T-tag may be preloaded inside the hollow core of a needle, but this requires that the T-tag be very small for the procedure. T-tags of this size are difficult to handle by the physician and may be less effective.
- T-tag placed within a needle requires multiple instrument exchanges whereby first a needle is delivered to the intended site, a guidewire is inserted through the needle lumen, the needle coaxially exchanged for a sheath over the guidewire and the guidewire removed so that a T-tag can be delivered with a pushing stylet.
- the delivery needle 10 described in this application facilitates a simple delivery of a 19-23 gauge needle tip that acts like a T-tag. This delivery needle can save the operator time and permit delivery of an anchor with a single instrument.
- the system so far described is designed to deliver a connecting element 40 and needle tip 24 through soft tissue to an intended delivery site. More preferably this system is designed to deliver the connecting element 40 and the needle tip 24 through the esophageal and stomach wall for the treatment of GERD. In this position, the connecting element 40 can be used to pull another component of the system, a ligating element 60 , through soft tissue.
- the ligating element 60 as shown in FIG. 5 is a length of material that is suitable for long term contact with patient tissue, and is used to tie together layers of soft tissue. It may be a suture, a tie, a thread, a band, a web, a strap, a belt, an elongated piece of mesh, a wire, or a Teflon patch. It may be a single filament or may be folded or coiled up for delivery as illustrated in side “A” of FIG. 5 and then be deployed in an unfolded or uncoiled configuration as illustrated in side “B” of FIG. 5 once in position. It should have enough bulk to reduce the potential for pulling out of soft tissue when force is applied to the ligating element 60 .
- the ligating element 60 has a proximal end 62 and a distal end 64 .
- the distal end 64 of the ligating element 60 can be connected to the proximal end of the connecting element 40 outside the patient's body.
- the distal end 64 of the ligating element may have a dilating element 66 that is intended to dilate and widen the initial channel through tissue formed by the connecting element 40 .
- the dilating element 66 is a tapered element or bougie that has a diameter similar to the connecting element 40 at its distal end and a diameter similar to the ligating element 60 at its proximal end. It is formed or attached coaxially to the ligating element 60 . As the ligating element 60 is drawn into tissue, the dilating element 66 expands the lumen so that the ligating element 60 , which may have a larger profile, can transverse the lumen without high forces or causing clinically unacceptable tissue trauma.
- the proximal end 62 and distal end 64 of the ligating element 60 may have securement elements 70 and 72 respectively as illustrated in FIGS. 6 a and 6 b.
- the securement elements 70 and 72 are designed to connect both ends of the ligation element 60 together so that the ligation element 60 forms a loop.
- the securement elements 70 and 72 may incorporate an additional feature which will permit one way slippage so that the diameter of the loop formed can be reduced but not increased.
- the ligating element 60 may function equally as well without any securement elements incorporated into the ligating element 60 .
- a simple crimping ferrule or wire clip may be utilized with similar results.
- the securement elements 70 and 72 function similarly to a string loop secured with a slip knot that can be pulled at one end and the loop diameter reduced.
- the securement element 70 is a suture loop 74 attached to the proximal end of the ligating element 60 formed using a slip knot.
- the loop 74 is large enough so that a gastroscope can be introduced through the loop.
- the loop reduces and secures the ligating element 60 in position.
- FIG. 6 b Another embodiment of the securement element 70 , shown in FIG. 6 b, has a pre formed loop 80 attached to the proximal end 62 of the ligating element 60 .
- the loop 80 is large enough so that a gastroscope can be introduced through the loop 80 .
- the dilating element 66 located near the distal end 64 of the ligating element 60 has a series of grooves 82 that are formed or cut in the side of the tapered dilating element 66 . As the dilating element 66 is brought through the loop 80 , the series of grooves 82 contact the pre formed loop 80 and the loop 80 successively moves into the recesses of the grooves.
- FIGS. 1-8 Methods of treating GERD are discussed with reference to FIGS. 1-8 . Although the invention is described in connection with the structure shown in these figures, and in connection with treating GERD, it should be understood that the system in its broadest sense is not so limited.
- an echoendoscope 12 is positioned through the patient's esophagus 1 to a position near the lower esophageal sphincter (LES) 6 .
- LES lower esophageal sphincter
- an endoscope 12 may be used an echoendoscope is preferred so that structures and hollow spaces that are positioned behind tissue walls can be visualized.
- the working channel is directed toward the inner wall of the esophagus 100 and the delivery needle 10 is advanced.
- the delivery needle 10 pierces the esophageal wall 100 and is then directed through the diaphragmatic crura 106 under ultrasonic guidance and through the wall of the stomach 108 and into fundus 3 .
- the delivery needle 10 transverse the diaphragmatic crura 106 because is thought that this is a stable structure that will anchor the system as opposed to anchoring to soft tissue alone.
- the distal end 64 of the ligating element is attached to the proximal end of the connecting element 40 outside the patient's body.
- a gastroscope 112 is then inserted into the patient's mouth down the esophagus 1 and into the stomach and positioned so that the needle tip 24 and the retrieval loop 44 can be visualized.
- a grasper 114 is extended from the working channel of the gastroscope 112 and it grabs the retrieval loop 44 of the needle tip 24 .
- the needle tip 24 and connecting element 40 are pulled by the grasper 114 into the working lumen of the gastroscope.
- the connecting element 40 in turn pulls the ligating element 60 down the esophagus 1 through the esophageal wall 100 and into the fundus 3 .
- the ligating element 60 is drawn near the end of the gastroscope and the gastroscope is withdrawn from the stomach to a position near the LES 6 as shown in FIG. 9 .
- a loop 120 consisting primarily of the ligating element is formed. This loop 120 formed when the ligating element 60 transverses the esophageal wall 100 , the diaphragmatic crura 106 , and the fundus 3 of the stomach, around the gastro-esophageal flap valve 7 and back to the esophageal wall 100 .
- the securement formed between the two ends of the ligating element is slidable so that the diameter of the loop 120 can be reduced to cinch various anatomical features together.
- the fundus 3 of the stomach 2 is drawn into close proximity with the esophageal wall 100 .
- the stomach applies a compressive force to the esophagus 1 that tends to reduce the internal luminal diameter of the esophagus.
- the compressive force reduces the likelihood of the stomach contents being able to pass through the esophagus 1 .
- the lower esophagus functions like a properly functioning lower esophageal sphincter.
Abstract
Description
- This application is a continuation of U.S. patent application Ser. No. 11/449,365, filed Jun. 8, 2006, which claims priority to U.S. Provisional Application No. 60/688,837, filed Jun. 9, 2005, the entire contents of which are hereby incorporated by reference.
- All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
- The present invention relates to a tissue securement system, device and method for endoscopy or endosonography-guided transluminal interventions whereby a ligation or anchor is placed and secured into soft tissue.
- Gastroesophageal reflux disease (GERD) is a chronic condition caused by the failure of the anti-reflux barrier located at the gastroesophageal junction to keep the contents of the stomach from refluxing back into the esophagus.
- Surgical fundoplication is the gold standard for anatomic correction of the cardia in patients with GERD. However this procedure can have a high incidence of postoperative complications and extended recovery times. Therefore endoscopic methods for enhancing the lower esophageal sphincter have been developed as an alternative to surgery. Endoscopic treatments of GERD target the esophageal and gastric wall in the region of the lower esophageal sphincter. Methods including suture plication, radiofrequency energy ablation, and implant insertion are employed to prevent reflux by mechanisms that include the creation of a mechanical barrier by narrowing the lumen, altering the esophago-gastric angle (angle of His or “flap valve”), and altering the lower esophageal sphincter to enhance its function or decrease transient lower esophageal sphincter relaxations. The endoscopic methods can be performed entirely through the endoscope placed transorally, avoiding any abdominal incisions.
- Endoscopic treatment is often limited because the operator can only visualize the mucosal lining of the gastrointestinal wall that is located directly in front of the endoscope. Structures deep within the wall, and outside the wall, cannot be seen. The ability to visualize these structures may influence the proper placement of a treatment apparatus and may expand the therapeutic strategies. For example placement of a suture or ligating element through the esophageal and fundal walls that also includes placement through the diaphragmatic crura may be useful. The use of endoscopic ultrasonography may address this limitation. In this procedure a combination endoscope and ultrasound instrument called an echoendoscope is utilized. From the distal esophagus, pertinent structures visualized with the echoendoscope include the lower esophageal sphincter (LES) within the wall, the crural diaphragm, and the fundus of the stomach. The diaphragmatic crura are typically seen interposed between the distal esophageal wall and the fundus of the stomach. One aspect of this invention utilizes the visualization capabilities of ultrasound endoscopy to permit a novel device and method for treating GERD.
- Accordingly, an objective of this invention is to provide a method to reduce gastroesophageal reflux by endosonography-guided intervention. Specifically, endosonography is used to insert a ligation element through the esophageal wall, through the diaphragmatic crus and into the fundus of the stomach. This ligation element placed from the esophagus and around the angle of His may create a barrier to gastroesophageal reflux.
- The present invention is directed to a device, system and method that, as embodied and broadly described herein, includes an implantable ligation element for fastening layers of tissue together. The ligation element has proximal and distal ends and is suitable for insertion through the esophageal wall, the crura and into the fundus of the stomach. The distal end of the ligation element can be brought from the fundus, around the gastro-esophageal flap valve and secured to the proximal end of the ligation element in the esophagus. This ligating element forms a loop that can be used to draw the tissues described together.
- In a further aspect of the invention, a system for fastening tissue is provided. The system includes a tissue securement apparatus that can be initially positioned in the esophagus using an echoendoscope. The securement apparatus is comprised of a hollow needle with a detachable needle tip. A connecting element is positioned inside the needle and attached to the needle tip. When an inner stylet is advanced, the needle tip separates from the needle body and the needle tip with a portion of the connecting element moves apart from the needle body to reside in the fundus of the stomach.
- In another aspect of the invention, the system for fastening tissue also includes a ligating element that can be attached to the proximal end of the connecting element once the hollow needle is removed. The ligating element may utilize a dilating element positioned at its distal end that is sized to dilate a tissue tunnel so that the ligating element may be drawn more easily through the tissue structures.
- In still another aspect of the invention, the system may also utilize an endoscopically guided grasper to grasp the distal end of a connecting element and pull the ligating element across the esophageal wall and into the stomach. The system may also utilize a securement element that is configured to engage the proximal and distal ends of the ligating element together. This may prevent the ligating element loop from loosening.
- In yet another aspect, the present invention includes a method of treating gastroesophageal reflux disease. In the method, a ligating element having a proximal end and a distal end is passed transorally through the esophagus to a position near the junction between the esophagus and the stomach. The distal end of the ligating element is placed through the wall of the esophagus, through a portion of the diaphragmatic crura and into the gastric fundus using ultrasonic guidance. The distal end of the ligating element is grasped in the fundus, wrapped around the gastro-esophageal flap valve and secured to the proximal end of the ligation element in the esophagus.
- All of these embodiments are intended to be within the scope of the present invention herein disclosed. These and other embodiments of the present invention will become readily apparent to those skilled in the art from the following detailed description of the preferred embodiments having reference to the attached figures. The invention is not limited to any particular preferred embodiment(s) disclosed.
-
FIG. 1 is a cross sectional view of the esophageal-gastro-intestinal tract. -
FIG. 2 is a view of the esophagus and stomach showing an echoendoscope placed in the distal portion of the esophagus; -
FIG. 3 is a section view of a needle having a detachable needle tip; -
FIG. 4 is a view similar toFIG. 2 showing the needle tip detached from the needle body after placement through a tissue wall; -
FIG. 5 is a view of a ligating element with an attached dilating element; -
FIG. 6 a is a view of a ligating element including one embodiment of a securement element; -
FIG. 6 b is a view of a ligating element showing an alternative embodiment of a securement element; -
FIG. 7 is a view showing a lower esophageal wall with a delivery needle inserted into the fundus from the esophagus; -
FIG. 8 is a view showing a gastroscope in the stomach with an extended grasper capturing the retrieval loop on the needle tip; -
FIG. 9 is a view showing a gastroscope in the lower esophagus with the ligating element forming a loop around the gastro-esophageal flap valve and the stomach drawn up to the lower esophageal wall. - The system and method described herein may offer improvements over the techniques currently utilized to perform endoscopic procedures. This tissue securement system has several embodiments that are intended to work together to create a novel device and method for the treatment of GERD. However these embodiments also function independently and some of the embodiments of this system may be removed and the system may still achieve its desired function. Alternatively several of these embodiments may be useful as stand alone devices. The principle elements of this system are; an echoendoscope, a delivery needle, a stylet, a needle tip, a connecting element, a ligating element and securement elements.
-
FIG. 1 is a cross sectional view of the esophageal-gastro-intestinal tract shown from the esophagus 1 to thestomach 2. Thefundus 3 forms the superior portion of thestomach 2. The esophagus 1 enters thestomach 2 at a point below thefundus 3 forming thecardiac notch 4 and an acute angle with respect to thefundus 3 known as the Angle of His 5. The lower esophageal sphincter (LES) 6 is an important primary sphincter that controls the movement of fluids and food into the stomach. The gastro-esophageal flap valve 7 includes a moveable portion and a more stationary portion. The moveable portion is a moveable flap that is formed at the junction of the esophagus 1 and thestomach 2. This flap is approximately 4-5 cm long and is partially held against the opposing wall of thestomach 2 by the internal pressures of the stomach. The esophageal tract is primarily controlled by theLES 6 and the gastro-esophageal flap valve 7. When either theLES 6 or the gastro-esophageal flap valve 7 does not close properly the condition known as Gastroesophageal Reflux Disease (GERD) can occur. It is the intent of this invention to provide a treatment method for GERD by supporting theLES 6 and the gastro-esophageal flap valve 7. - A first component of the tissue securement system, the
delivery needle 10, is shown inFIGS. 2 and 3 and is designed to be inserted through the instrumentation channel of an endoscope or preferably anechoendoscope 12. Thedelivery needle 10 can be manually advanced and retracted. The proximal end of the delivery needle may include a handle (not shown) which can be secured to the inlet port of the instrumentation channel by a luer lock mechanism. Thedelivery needle 10 can be housed in a protectiveouter sheath 18 which serves to protect the instrumentation channel of an endoscope or echoendoscope from damage from the sharp needle tip and to provide support as thedelivery needle 10 is advanced. Theouter sheath 18 can be manually advanced to cover the length of thedelivery needle 10. - In one embodiment shown in
FIG. 3 , thedelivery needle 10 consists of aneedle body 20 which is constructed from a hollow tube and utilizes ahollow stylet 22 located coaxially inside. Thedelivery needle 10 is sized to fit through the working channel of an echoendoscope although this system may function equally well with larger diametric requirements. The size of thedelivery needle 10 is preferably 18 to 26 gauge. More preferably the size is 19 to 23 gauge. Aneedle tip 24 is located near thedistal end 26 of the needle body and is detachably coupled to theneedle body 20. Theneedle body 20 has aninner diameter 30 that provides support to theneedle tip 24 during insertion. Theneedle tip 24 has amating retention boss 32 located on the proximal end of the needle tip that is formed so that theneedle tip 24 fits snugly inside theinner diameter 30 of theneedle body 20. Although a peg and hole arrangement is depicted in the drawings, various other features such as a tongue and groove, a bayonet and slot or other common mechanical stabilizing features could easily function with the same intended result; to hold and support theneedle tip 24 in position at the end portion of theneedle body 20 until the delivery needle is deployed as described later. - A connecting
element 40 is connected to theneedle tip 24 atpoint 41 and the connectingelement 40 extends through thehollow pusher stylet 22 to the proximal end of the needle where it can be manipulated by the operator outside the patient's body. Upon advancement of thedelivery needle 10 into soft tissue, the operator places tension on the connectingelement 40 which firmly seats theneedle tip 24 in theneedle body 20. This facilitates the introduction of theneedle body 20 andneedle tip 24 through tissue and into a targeted delivery site. Once at the delivery site, the tension can be released. The connectingelement 40 is preferably a suture, thread, plastic filament or wire. Thepusher stylet 22 extends along the length of theneedle body 20 to the proximal end of the needle tip located at theretention boss 32. - Once the
delivery needle 10 is advanced to a point where theneedle tip 24 is at the delivery site, thestylet 22 can be used to deploy theneedle tip 24 and connectingelement 40. As shown inFIG. 4 , when thestylet 22 is advanced theneedle tip 24 separates from theneedle body 20 and theneedle tip 24 and the attached connectingelement 40 are delivered to the delivery site. Thestylet 22 is next withdrawn into theneedle body 20 and thedelivery needle 10 can be withdrawn into theprotective sheath 18 inside the working channel of an endoscope or echoendoscope. The echoendoscope along with thedelivery needle 10 is then withdrawn leaving behind theneedle tip 24 with the connectingelement 40 extending out through the patient's mouth. Theneedle tip 24 helps prevent inadvertently pulling out the connectingelement 40 from the soft tissue as theechoendoscope 12 and thedelivery needle 10 are withdrawn. The connectingelement 40 can be attached to the proximal end of the needle tip at 41 or can be connected to a center portion of the tip so that the tip swivels away from the connectingelement 40 further preventing inadvertent pullout of the connectingelement 40. - The
needle tip 24 may utilize aretrieval loop 44 attached near its apex 46 as illustrated inFIGS. 3 and 4 . Theretrieval loop 44 is a small piece of string or wire that is collapsed along the side of theneedle tip 24 while theneedle tip 24 is inside theprotective sheath 18. Theretrieval loop 44 expands once theneedle tip 24 and connectingelement 40 are deployed as shown inFIG. 4 . Theretrieval loop 44 may be positioned inside agroove 50 that is formed or cut into theside wall 52 of theneedle tip 24. Theretrieval loop 44 may be important to guide theneedle tip 24 into the working lumen of a gastroscope as theneedle tip 24 and connectingelement 40 are retrieved as part of the method of this application. - The
delivery needle 10 has several potential advantages over other delivery systems that deliver T-tags, plugs or anchors. First, the working channel of a standard echoendoscope has a small diameter in the range of 2.8 mm. This small size limits the size of the needle and T-tag that can be delivered through the working channel. A T-tag may be preloaded inside the hollow core of a needle, but this requires that the T-tag be very small for the procedure. T-tags of this size are difficult to handle by the physician and may be less effective. An alternative to placing the T-tag within a needle requires multiple instrument exchanges whereby first a needle is delivered to the intended site, a guidewire is inserted through the needle lumen, the needle coaxially exchanged for a sheath over the guidewire and the guidewire removed so that a T-tag can be delivered with a pushing stylet. Thedelivery needle 10 described in this application facilitates a simple delivery of a 19-23 gauge needle tip that acts like a T-tag. This delivery needle can save the operator time and permit delivery of an anchor with a single instrument. - The system so far described is designed to deliver a connecting
element 40 andneedle tip 24 through soft tissue to an intended delivery site. More preferably this system is designed to deliver the connectingelement 40 and theneedle tip 24 through the esophageal and stomach wall for the treatment of GERD. In this position, the connectingelement 40 can be used to pull another component of the system, a ligatingelement 60, through soft tissue. - The ligating
element 60 as shown inFIG. 5 is a length of material that is suitable for long term contact with patient tissue, and is used to tie together layers of soft tissue. It may be a suture, a tie, a thread, a band, a web, a strap, a belt, an elongated piece of mesh, a wire, or a Teflon patch. It may be a single filament or may be folded or coiled up for delivery as illustrated in side “A” ofFIG. 5 and then be deployed in an unfolded or uncoiled configuration as illustrated in side “B” ofFIG. 5 once in position. It should have enough bulk to reduce the potential for pulling out of soft tissue when force is applied to the ligatingelement 60. The ligatingelement 60 has aproximal end 62 and adistal end 64. Thedistal end 64 of the ligatingelement 60 can be connected to the proximal end of the connectingelement 40 outside the patient's body. Thedistal end 64 of the ligating element may have a dilatingelement 66 that is intended to dilate and widen the initial channel through tissue formed by the connectingelement 40. The dilatingelement 66 is a tapered element or bougie that has a diameter similar to the connectingelement 40 at its distal end and a diameter similar to the ligatingelement 60 at its proximal end. It is formed or attached coaxially to the ligatingelement 60. As the ligatingelement 60 is drawn into tissue, the dilatingelement 66 expands the lumen so that the ligatingelement 60, which may have a larger profile, can transverse the lumen without high forces or causing clinically unacceptable tissue trauma. - The
proximal end 62 anddistal end 64 of the ligatingelement 60 may havesecurement elements FIGS. 6 a and 6 b. Thesecurement elements ligation element 60 together so that theligation element 60 forms a loop. Thesecurement elements element 60 may function equally as well without any securement elements incorporated into the ligatingelement 60. By example a simple crimping ferrule or wire clip may be utilized with similar results. Thesecurement elements FIG. 6 a, thesecurement element 70 is asuture loop 74 attached to the proximal end of the ligatingelement 60 formed using a slip knot. Theloop 74 is large enough so that a gastroscope can be introduced through the loop. As thedistal end 64 of the ligating element is brought through theloop 74, the loop reduces and secures the ligatingelement 60 in position. - Another embodiment of the
securement element 70, shown inFIG. 6 b, has a pre formedloop 80 attached to theproximal end 62 of the ligatingelement 60. Theloop 80 is large enough so that a gastroscope can be introduced through theloop 80. The dilatingelement 66 located near thedistal end 64 of the ligatingelement 60 has a series ofgrooves 82 that are formed or cut in the side of the tapered dilatingelement 66. As the dilatingelement 66 is brought through theloop 80, the series ofgrooves 82 contact the pre formedloop 80 and theloop 80 successively moves into the recesses of the grooves. This prevents the dilatingelement 66 from pulling out of theloop 80 but the ligatingelement 60 can be successively tightened as the dilatingelement 66 is drawn into theloop 80. Many other types of securement elements such as a rack and pinion, mechanical ratchet are possible and the examples illustrated here are not meant to be limiting. In fact many other suture retention apparatus are equally feasible as known to those in the art. - Methods of treating GERD are discussed with reference to
FIGS. 1-8 . Although the invention is described in connection with the structure shown in these figures, and in connection with treating GERD, it should be understood that the system in its broadest sense is not so limited. - As shown in
FIG. 7 , anechoendoscope 12 is positioned through the patient's esophagus 1 to a position near the lower esophageal sphincter (LES) 6. Although anendoscope 12 may be used an echoendoscope is preferred so that structures and hollow spaces that are positioned behind tissue walls can be visualized. When theechoendoscope 12 is properly positioned, the working channel is directed toward the inner wall of theesophagus 100 and thedelivery needle 10 is advanced. Thedelivery needle 10 pierces theesophageal wall 100 and is then directed through thediaphragmatic crura 106 under ultrasonic guidance and through the wall of thestomach 108 and intofundus 3. It is important that thedelivery needle 10 transverse thediaphragmatic crura 106 because is thought that this is a stable structure that will anchor the system as opposed to anchoring to soft tissue alone. Once thedistal end 26 of the delivery needle is positioned in thefundus 3, thestylet 22 is advanced to separate theneedle tip 24 from theneedle body 20. Theneedle tip 24 with the attached connectingelement 40 is deposited in thefundus 3 and thedelivery needle 24 is withdrawn. Theechoendoscope 12 can be withdrawn leaving behind the connectingelement 40 extending from thefundus 3 to the mouth of the patient. - The
distal end 64 of the ligating element is attached to the proximal end of the connectingelement 40 outside the patient's body. As shown inFIG. 8 , agastroscope 112 is then inserted into the patient's mouth down the esophagus 1 and into the stomach and positioned so that theneedle tip 24 and theretrieval loop 44 can be visualized. Agrasper 114 is extended from the working channel of thegastroscope 112 and it grabs theretrieval loop 44 of theneedle tip 24. Theneedle tip 24 and connectingelement 40 are pulled by thegrasper 114 into the working lumen of the gastroscope. The connectingelement 40 in turn pulls the ligatingelement 60 down the esophagus 1 through theesophageal wall 100 and into thefundus 3. The ligatingelement 60 is drawn near the end of the gastroscope and the gastroscope is withdrawn from the stomach to a position near theLES 6 as shown inFIG. 9 . When thesecurement elements loop 120 consisting primarily of the ligating element is formed. Thisloop 120 formed when the ligatingelement 60 transverses theesophageal wall 100, thediaphragmatic crura 106, and thefundus 3 of the stomach, around the gastro-esophageal flap valve 7 and back to theesophageal wall 100. - An important feature of the securement elements is that the securement formed between the two ends of the ligating element is slidable so that the diameter of the
loop 120 can be reduced to cinch various anatomical features together. By cinching down theloop 120, thefundus 3 of thestomach 2 is drawn into close proximity with theesophageal wall 100. This causes thestomach 2 to be partially wrapped around the esophagus so that esophagus 1 andstomach 2 are positioned in a method similar to a Nissen fundoplication procedure. As the internal pressure of thestomach 2 increases during digestion, the stomach applies a compressive force to the esophagus 1 that tends to reduce the internal luminal diameter of the esophagus. The compressive force reduces the likelihood of the stomach contents being able to pass through the esophagus 1. In other words the lower esophagus functions like a properly functioning lower esophageal sphincter. - This invention has been described and specific examples of the invention have been portrayed. The use of those specifics is not intended to limit the invention in anyway. Additionally, to the extent that there are variations of the invention, which are within the spirit of the disclosure or equivalent to the inventions found in the claims, it is my intent that this patent will cover those variations as well.
Claims (1)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/337,014 US20140330294A1 (en) | 2005-06-09 | 2014-07-21 | Methods and devices for endosonography-guided fundoplexy |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US68883705P | 2005-06-09 | 2005-06-09 | |
US11/449,365 US8784437B2 (en) | 2005-06-09 | 2006-06-08 | Methods and devices for endosonography-guided fundoplexy |
US14/337,014 US20140330294A1 (en) | 2005-06-09 | 2014-07-21 | Methods and devices for endosonography-guided fundoplexy |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US11/449,365 Continuation US8784437B2 (en) | 2005-06-09 | 2006-06-08 | Methods and devices for endosonography-guided fundoplexy |
Publications (1)
Publication Number | Publication Date |
---|---|
US20140330294A1 true US20140330294A1 (en) | 2014-11-06 |
Family
ID=46205962
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US11/449,365 Active 2028-01-19 US8784437B2 (en) | 2005-06-09 | 2006-06-08 | Methods and devices for endosonography-guided fundoplexy |
US14/337,014 Abandoned US20140330294A1 (en) | 2005-06-09 | 2014-07-21 | Methods and devices for endosonography-guided fundoplexy |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US11/449,365 Active 2028-01-19 US8784437B2 (en) | 2005-06-09 | 2006-06-08 | Methods and devices for endosonography-guided fundoplexy |
Country Status (1)
Country | Link |
---|---|
US (2) | US8784437B2 (en) |
Families Citing this family (26)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP1261282B1 (en) | 2000-03-03 | 2013-09-25 | C. R. Bard, Inc. | Endoscopic tissue apposition device with multiple suction ports |
ES2435094T3 (en) | 2000-05-19 | 2013-12-18 | C.R. Bard, Inc. | Device and method of tissue capture and suturing |
US7737109B2 (en) | 2000-08-11 | 2010-06-15 | Temple University Of The Commonwealth System Of Higher Education | Obesity controlling method |
US8425539B2 (en) | 2004-04-12 | 2013-04-23 | Xlumena, Inc. | Luminal structure anchoring devices and methods |
US8172857B2 (en) | 2004-08-27 | 2012-05-08 | Davol, Inc. | Endoscopic tissue apposition device and method of use |
EP1858396B1 (en) | 2004-12-08 | 2019-02-06 | Boston Scientific Scimed, Inc. | Apparatus for performing needle guided interventions |
US8088132B2 (en) | 2004-12-21 | 2012-01-03 | Davol, Inc. (a C.R. Bard Company) | Anastomotic outlet revision |
US8087413B2 (en) * | 2005-01-14 | 2012-01-03 | Usgi Medical Inc. | Attenuation of environmental parameters on a gastric lumen |
US8777967B2 (en) | 2005-06-09 | 2014-07-15 | Xlumena, Inc. | Methods and devices for anchoring to tissue |
US8092472B2 (en) * | 2007-02-22 | 2012-01-10 | Cerier Jeffrey C | Methods and devices for endoscopic treatment of organs |
US8034063B2 (en) * | 2007-07-13 | 2011-10-11 | Xlumena, Inc. | Methods and systems for treating hiatal hernias |
US8454632B2 (en) | 2008-05-12 | 2013-06-04 | Xlumena, Inc. | Tissue anchor for securing tissue layers |
US8702641B2 (en) | 2009-04-03 | 2014-04-22 | Metamodix, Inc. | Gastrointestinal prostheses having partial bypass configurations |
US9173760B2 (en) | 2009-04-03 | 2015-11-03 | Metamodix, Inc. | Delivery devices and methods for gastrointestinal implants |
US9278019B2 (en) | 2009-04-03 | 2016-03-08 | Metamodix, Inc | Anchors and methods for intestinal bypass sleeves |
JP2012522595A (en) | 2009-04-03 | 2012-09-27 | メタモディクス インコーポレイテッド | Modular gastrointestinal prosthesis |
US9364259B2 (en) | 2009-04-21 | 2016-06-14 | Xlumena, Inc. | System and method for delivering expanding trocar through a sheath |
JP5535313B2 (en) | 2009-05-29 | 2014-07-02 | エックスルミナ, インコーポレイテッド | Device and method for deploying a stent across adjacent tissue layers |
EP2451411B1 (en) | 2009-07-10 | 2016-06-01 | Metamodix, Inc. | External anchoring configurations for modular gastrointestinal prostheses |
US8968362B2 (en) | 2010-04-08 | 2015-03-03 | Covidien Lp | Coated looped suture |
JP6360042B2 (en) | 2012-05-17 | 2018-07-18 | ボストン サイエンティフィック サイムド,インコーポレイテッドBoston Scientific Scimed,Inc. | Method and device for access across adjacent tissue layers |
EP2945566A4 (en) | 2013-01-15 | 2016-10-26 | Metamodix Inc | System and method for affecting intestinal microbial flora |
ES2813871T3 (en) | 2013-02-21 | 2021-03-25 | Boston Scient Scimed Inc | Devices to form an anastomosis |
US9622897B1 (en) | 2016-03-03 | 2017-04-18 | Metamodix, Inc. | Pyloric anchors and methods for intestinal bypass sleeves |
WO2017201424A1 (en) | 2016-05-19 | 2017-11-23 | Metamodix, Inc. | Pyloric anchor retrieval tools and methods |
CA3129020A1 (en) | 2019-02-07 | 2020-08-13 | Nxt Biomedical, Llc | Rivet shunt and method of deployment |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5382257A (en) * | 1990-09-06 | 1995-01-17 | United States Surgical Corporation | Implant assist apparatus |
Family Cites Families (284)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2127903A (en) | 1936-05-05 | 1938-08-23 | Davis & Geck Inc | Tube for surgical purposes and method of preparing and using the same |
US3039468A (en) | 1959-01-07 | 1962-06-19 | Joseph L Price | Trocar and method of treating bloat |
US3717151A (en) | 1971-03-11 | 1973-02-20 | R Collett | Flesh penetrating apparatus |
US3874388A (en) | 1973-02-12 | 1975-04-01 | Ochsner Med Found Alton | Shunt defect closure system |
US3970090A (en) | 1975-02-03 | 1976-07-20 | Physio Medics, Inc. | Catheter |
US4173392A (en) | 1977-07-20 | 1979-11-06 | American Hospital Supply Corporation | Glass fiber light guide and method of making the same |
US4235238A (en) | 1978-05-11 | 1980-11-25 | Olympus Optical Co., Ltd. | Apparatus for suturing coeliac tissues |
DE2821048C2 (en) | 1978-05-13 | 1980-07-17 | Willy Ruesch Gmbh & Co Kg, 7053 Kernen | Medical instrument |
US6656182B1 (en) * | 1982-05-20 | 2003-12-02 | John O. Hayhurst | Tissue manipulation |
US4587972A (en) | 1984-07-16 | 1986-05-13 | Morantte Jr Bernardo D | Device for diagnostic and therapeutic intravascular intervention |
US4790813A (en) | 1984-12-17 | 1988-12-13 | Intravascular Surgical Instruments, Inc. | Method and apparatus for surgically removing remote deposits |
US4608965A (en) | 1985-03-27 | 1986-09-02 | Anspach Jr William E | Endoscope retainer and tissue retracting device |
US4705040A (en) | 1985-11-18 | 1987-11-10 | Medi-Tech, Incorporated | Percutaneous fixation of hollow organs |
US5000185A (en) | 1986-02-28 | 1991-03-19 | Cardiovascular Imaging Systems, Inc. | Method for intravascular two-dimensional ultrasonography and recanalization |
US4920967A (en) | 1986-07-18 | 1990-05-01 | Pfizer Hospital Products Group, Inc. | Doppler tip wire guide |
US4990139A (en) | 1986-09-10 | 1991-02-05 | Jang G David | Tandem independently inflatable/deflatable multiple diameter balloon angioplasty catheter systems |
JPH0755222B2 (en) | 1986-12-12 | 1995-06-14 | オリンパス光学工業株式会社 | Treatment tool |
US4917097A (en) | 1987-10-27 | 1990-04-17 | Endosonics Corporation | Apparatus and method for imaging small cavities |
US5180392A (en) | 1988-02-01 | 1993-01-19 | Einar Skeie | Anastomotic device |
US4869263A (en) | 1988-02-04 | 1989-09-26 | Cardiometrics, Inc. | Device and method for measuring volumetric blood flow in a vessel |
US5588432A (en) | 1988-03-21 | 1996-12-31 | Boston Scientific Corporation | Catheters for imaging, sensing electrical potentials, and ablating tissue |
US4973317A (en) | 1989-07-14 | 1990-11-27 | Bobrove Arthur M | Automatic sheath protection of hypodermic needle |
DE69020075T2 (en) | 1989-08-09 | 1995-11-16 | Bard Inc C R | Catheter guide and guidewire for rapid catheter replacement. |
US5211651A (en) | 1989-08-18 | 1993-05-18 | Evi Corporation | Catheter atherotome |
US5024655A (en) | 1989-09-05 | 1991-06-18 | Freeman Andrew B | Epidural catheter apparatus and associated method |
US5330497A (en) | 1989-11-22 | 1994-07-19 | Dexide, Inc. | Locking trocar sleeve |
US4950285A (en) * | 1989-11-27 | 1990-08-21 | Wilk Peter J | Suture device |
US5207229A (en) | 1989-12-21 | 1993-05-04 | Advanced Biomedical Devices, Inc. | Flexibility steerable guidewire with inflatable balloon |
US5197971A (en) | 1990-03-02 | 1993-03-30 | Bonutti Peter M | Arthroscopic retractor and method of using the same |
US5064435A (en) | 1990-06-28 | 1991-11-12 | Schneider (Usa) Inc. | Self-expanding prosthesis having stable axial length |
US5234447A (en) | 1990-08-28 | 1993-08-10 | Robert L. Kaster | Side-to-end vascular anastomotic staple apparatus |
US5368595A (en) * | 1990-09-06 | 1994-11-29 | United States Surgical Corporation | Implant assist apparatus |
ATE121303T1 (en) | 1990-10-04 | 1995-05-15 | Schneider Europ Ag | BALLOON DILATION CATHETER. |
CA2052310A1 (en) | 1990-10-09 | 1992-04-10 | Thomas L. Foster | Surgical access sheath |
JP3269556B2 (en) | 1990-11-20 | 2002-03-25 | インナーダイン インコーポレイティド | Apparatus for forming percutaneous perforations in body cavities |
US5221258A (en) | 1991-01-22 | 1993-06-22 | Shturman Technologies, Inc. | Introduction balloon catheter |
US5275610A (en) | 1991-05-13 | 1994-01-04 | Cook Incorporated | Surgical retractors and method of use |
US5183464A (en) | 1991-05-17 | 1993-02-02 | Interventional Thermodynamics, Inc. | Radially expandable dilator |
US5183033A (en) | 1991-07-15 | 1993-02-02 | Wilk Peter J | Surgical instrument assembly and apparatus and surgical method |
EP0533321A3 (en) | 1991-07-22 | 1993-05-12 | Dow Corning Wright Corporation | Expanding atherectomy device |
US5199419A (en) | 1991-08-05 | 1993-04-06 | United States Surgical Corporation | Surgical retractor |
US5258000A (en) | 1991-11-25 | 1993-11-02 | Cook Incorporated | Tissue aperture repair device |
US5713870A (en) | 1991-11-27 | 1998-02-03 | Yoon; Inbae | Retractable safety penetrating instrument with laterally extendable spring strip |
US5395349A (en) | 1991-12-13 | 1995-03-07 | Endovascular Technologies, Inc. | Dual valve reinforced sheath and method |
US5224945A (en) | 1992-01-13 | 1993-07-06 | Interventional Technologies, Inc. | Compressible/expandable atherectomy cutter |
US5209727A (en) | 1992-01-29 | 1993-05-11 | Interventional Technologies, Inc. | Guide wire with integral angioplasty balloon |
US5257990A (en) | 1992-02-24 | 1993-11-02 | Kensey Nash Corporation | Electrosurgical catheter instrument with impacting working head and method of use |
US5226421A (en) | 1992-03-06 | 1993-07-13 | Cardiometrics, Inc. | Doppler elongate flexible member having an inflatable balloon mounted thereon |
US5246007A (en) | 1992-03-13 | 1993-09-21 | Cardiometrics, Inc. | Vascular catheter for measuring flow characteristics and method |
US5707362A (en) | 1992-04-15 | 1998-01-13 | Yoon; Inbae | Penetrating instrument having an expandable anchoring portion for triggering protrusion of a safety member and/or retraction of a penetrating member |
US5536248A (en) | 1992-05-11 | 1996-07-16 | Arrow Precision Products, Inc. | Method and apparatus for electrosurgically obtaining access to the biliary tree and placing a stent therein |
US5443484A (en) | 1992-06-16 | 1995-08-22 | Loma Linda University Medical Center | Trocar and method for endoscopic surgery |
DE4221390C1 (en) | 1992-06-30 | 1993-04-01 | Haindl, Hans, Dr.Med., 3015 Wennigsen, De | |
US5261920A (en) | 1992-08-21 | 1993-11-16 | Ethicon, Inc. | Anvil bushing for circular stapler |
US5458131A (en) | 1992-08-25 | 1995-10-17 | Wilk; Peter J. | Method for use in intra-abdominal surgery |
US5364408A (en) | 1992-09-04 | 1994-11-15 | Laurus Medical Corporation | Endoscopic suture system |
EP0596162B1 (en) | 1992-11-06 | 2002-08-21 | Texas Instruments Incorporated | hypodermic needle with a protrusion |
IL103737A (en) | 1992-11-13 | 1997-02-18 | Technion Res & Dev Foundation | Stapler device particularly useful in medical suturing |
US5972000A (en) | 1992-11-13 | 1999-10-26 | Influence Medical Technologies, Ltd. | Non-linear anchor inserter device and bone anchors |
US5304198A (en) | 1992-11-13 | 1994-04-19 | Target Therapeutics | Single-lumen balloon catheter having a directional valve |
US5372588A (en) | 1992-11-24 | 1994-12-13 | Farley; Kevin | Trocar having blunt tip |
US5431676A (en) | 1993-03-05 | 1995-07-11 | Innerdyne Medical, Inc. | Trocar system having expandable port |
WO1994023786A1 (en) | 1993-04-13 | 1994-10-27 | Boston Scientific Corporation | Prosthesis delivery system |
US5897567A (en) | 1993-04-29 | 1999-04-27 | Scimed Life Systems, Inc. | Expandable intravascular occlusion material removal devices and methods of use |
US5417687A (en) | 1993-04-30 | 1995-05-23 | Medical Scientific, Inc. | Bipolar electrosurgical trocar |
US5462561A (en) | 1993-08-05 | 1995-10-31 | Voda; Jan K. | Suture device |
US5449355A (en) | 1993-11-24 | 1995-09-12 | Valleylab Inc. | Retrograde tissue splitter and method |
RU2089131C1 (en) | 1993-12-28 | 1997-09-10 | Сергей Апполонович Пульнев | Stent-expander |
US5728122A (en) | 1994-01-18 | 1998-03-17 | Datascope Investment Corp. | Guide wire with releaseable barb anchor |
US5843116A (en) | 1996-05-02 | 1998-12-01 | Cardiovascular Dynamics, Inc. | Focalized intraluminal balloons |
US5415664A (en) | 1994-03-30 | 1995-05-16 | Corvita Corporation | Method and apparatus for introducing a stent or a stent-graft |
US5470337A (en) | 1994-05-17 | 1995-11-28 | Moss; Gerald | Surgical fastener |
EP0765137B1 (en) | 1994-06-17 | 2003-07-30 | Heartport, Inc. | Surgical stapling instrument |
US5725552A (en) | 1994-07-08 | 1998-03-10 | Aga Medical Corporation | Percutaneous catheter directed intravascular occlusion devices |
US5843127A (en) | 1994-08-22 | 1998-12-01 | Le Medical Technologies, Inc. | Fixation device and method for installing same |
US5531699A (en) | 1994-09-19 | 1996-07-02 | Abbott Laboratories | Spring-loaded reciprocable stylet holder |
JP3614943B2 (en) | 1994-09-29 | 2005-01-26 | オリンパス株式会社 | Endoscopic puncture needle |
US5620457A (en) | 1994-11-23 | 1997-04-15 | Medinol Ltd. | Catheter balloon |
US5904697A (en) | 1995-02-24 | 1999-05-18 | Heartport, Inc. | Devices and methods for performing a vascular anastomosis |
US5749851A (en) | 1995-03-02 | 1998-05-12 | Scimed Life Systems, Inc. | Stent installation method using balloon catheter having stepped compliance curve |
US5495851A (en) | 1995-03-23 | 1996-03-05 | Roanoke Gastroenterology, P.C. | Use of endoscopic ultrasound and stimulated bilary drainage in the diagnosis of cholecystitis and microlithiasis |
US6575967B1 (en) | 1995-03-24 | 2003-06-10 | The Board Of Regents Of The University Of Nebraska | Method and systems for volumetric tissue ablation |
US5868740A (en) | 1995-03-24 | 1999-02-09 | Board Of Regents-Univ Of Nebraska | Method for volumetric tissue ablation |
US5857999A (en) | 1995-05-05 | 1999-01-12 | Imagyn Medical Technologies, Inc. | Small diameter introducer for laparoscopic instruments |
US5702418A (en) | 1995-09-12 | 1997-12-30 | Boston Scientific Corporation | Stent delivery system |
IL124038A (en) | 1995-10-13 | 2004-02-19 | Transvascular Inc | Apparatus for bypassing arterial obstructions and/or performing other transvascular procedures |
IL124037A (en) | 1995-10-13 | 2003-01-12 | Transvascular Inc | Device and system for interstitial transvascular intervention |
US5709671A (en) | 1995-10-16 | 1998-01-20 | Ethicon Endo-Surgery, Inc. | Trocar having an improved tip configuration |
US5620456A (en) | 1995-10-20 | 1997-04-15 | Lasersurge, Inc. | Trocar assembly |
DE69612507T2 (en) | 1995-10-30 | 2001-08-09 | Childrens Medical Center | SELF-CENTERING, SHIELD-LIKE DEVICE FOR CLOSING A SEPTAL DEFECT |
US5632762A (en) | 1995-11-09 | 1997-05-27 | Hemodynamics, Inc. | Ostial stent balloon |
US5697944A (en) | 1995-11-15 | 1997-12-16 | Interventional Technologies Inc. | Universal dilator with expandable incisor |
WO1997027898A1 (en) | 1996-02-02 | 1997-08-07 | Transvascular, Inc. | Methods and apparatus for connecting openings formed in adjacent blood vessels or other anatomical structures |
US5951588A (en) | 1996-02-29 | 1999-09-14 | Moenning; Stephen P. | Apparatus and method for protecting a port site opening in the wall of a body cavity |
US5817062A (en) | 1996-03-12 | 1998-10-06 | Heartport, Inc. | Trocar |
US5853422A (en) | 1996-03-22 | 1998-12-29 | Scimed Life Systems, Inc. | Apparatus and method for closing a septal defect |
US5893856A (en) | 1996-06-12 | 1999-04-13 | Mitek Surgical Products, Inc. | Apparatus and method for binding a first layer of material to a second layer of material |
US6007544A (en) | 1996-06-14 | 1999-12-28 | Beth Israel Deaconess Medical Center | Catheter apparatus having an improved shape-memory alloy cuff and inflatable on-demand balloon for creating a bypass graft in-vivo |
US6358264B2 (en) | 1996-07-24 | 2002-03-19 | Surgical Design Corporation | Surgical instruments with movable member |
US5993447A (en) | 1996-08-16 | 1999-11-30 | United States Surgical | Apparatus for thermal treatment of tissue |
US6007522A (en) | 1996-09-13 | 1999-12-28 | Boston Scientific Corporation | Single operator exchange biliary catheter |
US5935107A (en) | 1996-10-07 | 1999-08-10 | Applied Medical Resources Corporation | Apparatus and method for surgically accessing a body cavity |
US6379319B1 (en) | 1996-10-11 | 2002-04-30 | Transvascular, Inc. | Systems and methods for directing and snaring guidewires |
US6682536B2 (en) | 2000-03-22 | 2004-01-27 | Advanced Stent Technologies, Inc. | Guidewire introducer sheath |
EP1011458A2 (en) | 1996-11-08 | 2000-06-28 | Russell A. Houser | Percutaneous bypass graft and securing system |
US6458069B1 (en) | 1998-02-19 | 2002-10-01 | Endology, Inc. | Multi layer radiation delivery balloon |
DE29708149U1 (en) | 1997-05-07 | 1997-09-25 | Binmoeller Kenneth F Dr | Biopsy device |
US6071292A (en) | 1997-06-28 | 2000-06-06 | Transvascular, Inc. | Transluminal methods and devices for closing, forming attachments to, and/or forming anastomotic junctions in, luminal anatomical structures |
US6017352A (en) | 1997-09-04 | 2000-01-25 | Kensey Nash Corporation | Systems for intravascular procedures and methods of use |
ATE520356T1 (en) | 1997-09-26 | 2011-09-15 | Cryolife Inc | SEAMLESS ANASTOMOTIS DEVICE |
US6074416A (en) | 1997-10-09 | 2000-06-13 | St. Jude Medical Cardiovascular Group, Inc. | Wire connector structures for tubular grafts |
NL1007349C2 (en) | 1997-10-24 | 1999-04-27 | Suyker Wilhelmus Joseph Leonardus | System for the mechanical production of anastomoses between hollow structures; as well as device and applicator for use therewith. |
EP1030603B1 (en) | 1997-11-12 | 2008-08-13 | Genesis Technologies LLC. | Biological passageway occlusion removal |
US6635068B1 (en) | 1998-02-10 | 2003-10-21 | Artemis Medical, Inc. | Occlusion, anchoring, tensioning and flow direction apparatus and methods for use |
US6626919B1 (en) | 1997-12-29 | 2003-09-30 | Lee L. Swanstrom | Method and apparatus for attaching or locking an implant to an anatomic vessel or hollow organ wall |
US5989231A (en) | 1998-01-15 | 1999-11-23 | Scimed Life Systems, Inc. | Optical gastrostomy and jejunostomy |
JP4187411B2 (en) | 1998-01-30 | 2008-11-26 | セント ジュード メディカル エーティージー, インコーポレイテッド | Device for use in closing a septal defect |
US5944738A (en) | 1998-02-06 | 1999-08-31 | Aga Medical Corporation | Percutaneous catheter directed constricting occlusion device |
US7027398B2 (en) | 2001-04-12 | 2006-04-11 | General Instrument Corporation | Method and apparatus for monitoring voice conversations from customer premises equipment |
US5951576A (en) | 1998-03-02 | 1999-09-14 | Wakabayashi; Akio | End-to-side vascular anastomosing stapling device |
CA2333121C (en) | 1998-05-21 | 2006-07-25 | Christopher J. Walshe | A tissue anchor system |
US6113609A (en) | 1998-05-26 | 2000-09-05 | Scimed Life Systems, Inc. | Implantable tissue fastener and system for treating gastroesophageal reflux disease |
US6113611A (en) | 1998-05-28 | 2000-09-05 | Advanced Vascular Technologies, Llc | Surgical fastener and delivery system |
US6402770B1 (en) | 1998-06-01 | 2002-06-11 | Avatar Design & Development, Inc. | Method and apparatus for placing and maintaining a percutaneous tube into a body cavity |
US6514265B2 (en) | 1999-03-01 | 2003-02-04 | Coalescent Surgical, Inc. | Tissue connector apparatus with cable release |
US6187000B1 (en) | 1998-08-20 | 2001-02-13 | Endius Incorporated | Cannula for receiving surgical instruments |
US6746489B2 (en) | 1998-08-31 | 2004-06-08 | Wilson-Cook Medical Incorporated | Prosthesis having a sleeve valve |
US6022362A (en) | 1998-09-03 | 2000-02-08 | Rubicor Medical, Inc. | Excisional biopsy devices and methods |
JP3581591B2 (en) | 1999-02-25 | 2004-10-27 | ペンタックス株式会社 | Drainage tube indwelling device for endoscope |
US6290728B1 (en) | 1998-09-10 | 2001-09-18 | Percardia, Inc. | Designs for left ventricular conduit |
US6036698A (en) | 1998-10-30 | 2000-03-14 | Vivant Medical, Inc. | Expandable ring percutaneous tissue removal device |
US6508252B1 (en) | 1998-11-06 | 2003-01-21 | St. Jude Medical Atg, Inc. | Medical grafting methods and apparatus |
US6475222B1 (en) | 1998-11-06 | 2002-11-05 | St. Jude Medical Atg, Inc. | Minimally invasive revascularization apparatus and methods |
US20030032975A1 (en) | 1999-01-06 | 2003-02-13 | Bonutti Peter M. | Arthroscopic retractors |
US6022359A (en) | 1999-01-13 | 2000-02-08 | Frantzen; John J. | Stent delivery system featuring a flexible balloon |
US6231515B1 (en) | 1999-01-13 | 2001-05-15 | Scimed Life Systems, Inc. | Safety mechanism and method to prevent rotating imaging guide device from exiting a catheter |
JP2002534208A (en) | 1999-01-15 | 2002-10-15 | ベントリカ, インコーポレイテッド | Methods and devices for forming a vascular anastomosis |
US7018401B1 (en) | 1999-02-01 | 2006-03-28 | Board Of Regents, The University Of Texas System | Woven intravascular devices and methods for making the same and apparatus for delivery of the same |
US6632197B2 (en) | 1999-04-16 | 2003-10-14 | Thomas R. Lyon | Clear view cannula |
US6656206B2 (en) | 1999-05-13 | 2003-12-02 | Cardia, Inc. | Occlusion device with non-thrombogenic properties |
US6428550B1 (en) | 1999-05-18 | 2002-08-06 | Cardica, Inc. | Sutureless closure and deployment system for connecting blood vessels |
US6241758B1 (en) | 1999-05-28 | 2001-06-05 | Advanced Cardiovascular Systems, Inc. | Self-expanding stent delivery system and method of use |
US6375668B1 (en) | 1999-06-02 | 2002-04-23 | Hanson S. Gifford | Devices and methods for treating vascular malformations |
US6494888B1 (en) | 1999-06-22 | 2002-12-17 | Ndo Surgical, Inc. | Tissue reconfiguration |
US20040122456A1 (en) | 2002-12-11 | 2004-06-24 | Saadat Vahid C. | Methods and apparatus for gastric reduction |
US7416554B2 (en) * | 2002-12-11 | 2008-08-26 | Usgi Medical Inc | Apparatus and methods for forming and securing gastrointestinal tissue folds |
WO2001012255A1 (en) | 1999-08-12 | 2001-02-22 | Wilson-Cook Medical Inc. | Dilation balloon having multiple diameters |
WO2001017435A1 (en) | 1999-09-07 | 2001-03-15 | Microvena Corporation | Retrievable septal defect closure device |
US6231561B1 (en) | 1999-09-20 | 2001-05-15 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
US6964674B1 (en) | 1999-09-20 | 2005-11-15 | Nuvasive, Inc. | Annulotomy closure device |
WO2001021247A1 (en) | 1999-09-20 | 2001-03-29 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
US6436119B1 (en) | 1999-09-30 | 2002-08-20 | Raymedica, Inc. | Adjustable surgical dilator |
JP2001095747A (en) | 1999-09-30 | 2001-04-10 | Olympus Optical Co Ltd | Electronic endoscope |
AU1233301A (en) | 1999-10-26 | 2001-05-08 | H. Randall Craig | Helical suture instrument |
US6669708B1 (en) | 1999-12-09 | 2003-12-30 | Michael Nissenbaum | Devices, systems and methods for creating sutureless on-demand vascular anastomoses and hollow organ communication channels |
US6547776B1 (en) | 2000-01-03 | 2003-04-15 | Curon Medical, Inc. | Systems and methods for treating tissue in the crura |
US6264675B1 (en) * | 2000-02-04 | 2001-07-24 | Gregory R. Brotz | Single suture structure |
US6475185B1 (en) | 2000-02-24 | 2002-11-05 | Scimed Life Systems, Inc. | Occlusion device |
US6468303B1 (en) | 2000-03-27 | 2002-10-22 | Aga Medical Corporation | Retrievable self expanding shunt |
US6592596B1 (en) | 2000-05-10 | 2003-07-15 | Scimed Life Systems, Inc. | Devices and related methods for securing a tissue fold |
US8105351B2 (en) | 2001-05-18 | 2012-01-31 | C.R. Bard, Inc. | Method of promoting tissue adhesion |
US6921361B2 (en) * | 2000-07-24 | 2005-07-26 | Olympus Corporation | Endoscopic instrument for forming an artificial valve |
JP2004511275A (en) | 2000-09-01 | 2004-04-15 | アンジオリンク・コーポレイション | Wound site management and wound closure devices |
US6432040B1 (en) * | 2000-09-14 | 2002-08-13 | Nizam N. Meah | Implantable esophageal sphincter apparatus for gastroesophageal reflux disease and method |
US7037324B2 (en) | 2000-09-15 | 2006-05-02 | United States Surgical Corporation | Knotless tissue anchor |
US6736828B1 (en) | 2000-09-29 | 2004-05-18 | Scimed Life Systems, Inc. | Method for performing endoluminal fundoplication and apparatus for use in the method |
JP2002177201A (en) | 2000-10-02 | 2002-06-25 | Olympus Optical Co Ltd | Endoscope |
US6447524B1 (en) | 2000-10-19 | 2002-09-10 | Ethicon Endo-Surgery, Inc. | Fastener for hernia mesh fixation |
US6966917B1 (en) | 2000-11-09 | 2005-11-22 | Innovation Interventional Technologies B.V. | Deformable connector for mechanically connecting hollow structures |
US6475168B1 (en) | 2000-11-10 | 2002-11-05 | Scimed Life Systems, Inc. | Guide wire having x-ray transparent window for x-ray catheter |
US6695867B2 (en) | 2002-02-21 | 2004-02-24 | Integrated Vascular Systems, Inc. | Plunger apparatus and methods for delivering a closure device |
US6614595B2 (en) | 2001-02-16 | 2003-09-02 | Olympus Optical Co., Ltd. | Stereo endoscope |
JP4261814B2 (en) | 2001-04-04 | 2009-04-30 | オリンパス株式会社 | Tissue puncture system |
US6620122B2 (en) | 2001-04-26 | 2003-09-16 | Scimed Life Systems, Inc. | Gastric pseudocyst drainage and stent delivery system for use therein |
AU2002257241A1 (en) | 2001-05-01 | 2002-11-11 | Mayo Foundation For Medical Education And Research | Vascular needle |
US6535764B2 (en) | 2001-05-01 | 2003-03-18 | Intrapace, Inc. | Gastric treatment and diagnosis device and method |
US6916332B2 (en) | 2001-05-23 | 2005-07-12 | Scimed Life Systems, Inc. | Endoluminal fundoplication device and related method for installing tissue fastener |
US7338514B2 (en) | 2001-06-01 | 2008-03-04 | St. Jude Medical, Cardiology Division, Inc. | Closure devices, related delivery methods and tools, and related methods of use |
US20020188301A1 (en) | 2001-06-11 | 2002-12-12 | Dallara Mark Douglas | Tissue anchor insertion system |
US7115136B2 (en) | 2001-06-20 | 2006-10-03 | Park Medical Llc | Anastomotic device |
US6645205B2 (en) | 2001-08-15 | 2003-11-11 | Core Medical, Inc. | Apparatus and methods for reducing lung volume |
US20030040803A1 (en) | 2001-08-23 | 2003-02-27 | Rioux Robert F. | Maintaining an open passageway through a body lumen |
US6629988B2 (en) | 2001-08-28 | 2003-10-07 | Ethicon, Inc. | Composite staple for completing an anastomosis |
US6776784B2 (en) | 2001-09-06 | 2004-08-17 | Core Medical, Inc. | Clip apparatus for closing septal defects and methods of use |
US6702835B2 (en) | 2001-09-07 | 2004-03-09 | Core Medical, Inc. | Needle apparatus for closing septal defects and methods for using such apparatus |
US7736336B2 (en) | 2001-09-13 | 2010-06-15 | Allegiance Corporation | Paracentesis device having multiple detachable components |
AU2002336575A1 (en) | 2001-09-14 | 2003-04-01 | Arthrocare Corporation | Electrosurgical apparatus and methods for tissue treatment and removal |
US7892247B2 (en) | 2001-10-03 | 2011-02-22 | Bioconnect Systems, Inc. | Devices and methods for interconnecting vessels |
JP2003116982A (en) | 2001-10-10 | 2003-04-22 | Medicos Hirata:Kk | System for drainage of gallbladder through duodenum under endoscope |
US6893431B2 (en) | 2001-10-15 | 2005-05-17 | Scimed Life Systems, Inc. | Medical device for delivering patches |
WO2003034206A2 (en) | 2001-10-18 | 2003-04-24 | Matsushita Electric Industrial Co., Ltd. | Host network interface device and drive network interface device |
US6942678B2 (en) | 2001-11-06 | 2005-09-13 | Possis Medical, Inc. | Gas inflation/evacuation system and sealing system for guidewire assembly having occlusive device |
US7169161B2 (en) | 2001-11-06 | 2007-01-30 | Possis Medical, Inc. | Guidewire having occlusive device and repeatably crimpable proximal end |
US7150723B2 (en) | 2001-11-29 | 2006-12-19 | C-I-Medic Co., Ltd. | Medical device including guide wire and balloon catheter for curing a coronary artery |
US7182771B1 (en) | 2001-12-20 | 2007-02-27 | Russell A. Houser | Vascular couplers, techniques, methods, and accessories |
ATE473695T1 (en) | 2002-02-25 | 2010-07-15 | Jeffrey E Yeung | EXPANDABLE FASTENING ELEMENT WITH COMPRESSABLE GRIPPING ELEMENTS |
US6960233B1 (en) | 2002-12-10 | 2005-11-01 | Torax Medical, Inc. | Methods and apparatus for improving the function of biological passages |
US7077850B2 (en) | 2002-05-01 | 2006-07-18 | Scimed Life Systems, Inc. | Tissue fastening devices and related insertion tools and methods |
US7377897B1 (en) | 2002-05-02 | 2008-05-27 | Kunkel Sanford S | Portal device |
WO2003099352A2 (en) | 2002-05-28 | 2003-12-04 | Endobionics, Inc. | Methods and apparatus for aspiration and priming of inflatable structures in catheters |
US7182756B2 (en) | 2002-05-29 | 2007-02-27 | Wilson-Cook Medical, Inc. | Device for directing a wire guide |
EP1513440A2 (en) | 2002-05-30 | 2005-03-16 | The Board of Trustees of The Leland Stanford Junior University | Apparatus and method for coronary sinus access |
US7125413B2 (en) | 2002-06-20 | 2006-10-24 | Scimed Life Systems, Inc. | Endoscopic fundoplication devices and methods for treatment of gastroesophageal reflux disease |
AU2003279116A1 (en) | 2002-06-20 | 2004-01-06 | Tyco Healthcare Group, Lp | Method and apparatus for anastomosis including annular joining member |
US6773440B2 (en) | 2002-07-02 | 2004-08-10 | Satiety, Inc. | Method and device for use in tissue approximation and fixation |
US7309334B2 (en) | 2002-07-23 | 2007-12-18 | Von Hoffmann Gerard | Intracranial aspiration catheter |
US6902535B2 (en) | 2002-08-26 | 2005-06-07 | Kansey Nash Corporation | Guide-wire mounted balloon modulation device and methods of use |
US6835189B2 (en) | 2002-10-15 | 2004-12-28 | Scimed Life Systems, Inc. | Controlled deployment balloon |
US6974467B1 (en) | 2002-11-04 | 2005-12-13 | Gonzales Jr Antonio | Method and apparatus for making a precise surgical incision |
US8187324B2 (en) | 2002-11-15 | 2012-05-29 | Advanced Cardiovascular Systems, Inc. | Telescoping apparatus for delivering and adjusting a medical device in a vessel |
US9149602B2 (en) | 2005-04-22 | 2015-10-06 | Advanced Cardiovascular Systems, Inc. | Dual needle delivery system |
DE10362223B4 (en) | 2003-01-21 | 2010-02-04 | pfm Produkte für die Medizin AG | Basic coil shape |
US8021359B2 (en) | 2003-02-13 | 2011-09-20 | Coaptus Medical Corporation | Transseptal closure of a patent foramen ovale and other cardiac defects |
JP4477382B2 (en) | 2003-03-04 | 2010-06-09 | オリンパス株式会社 | Endoscopic intraperitoneal treatment system |
GB0307715D0 (en) | 2003-04-03 | 2003-05-07 | Ethicon Endo Surgery Inc | Guide wire structure for insertion into an internal space |
GB0307826D0 (en) | 2003-04-04 | 2003-05-07 | Univ London | A device for transfixing and joining tissue |
US7621924B2 (en) | 2003-04-16 | 2009-11-24 | Tyco Healthcare Group Lp | Method and apparatus for radical prostatectomy anastomosis including an anchor for engaging a body vessel and deployable sutures |
WO2004096335A1 (en) | 2003-04-25 | 2004-11-11 | Cook Incorporated | Delivery catheter |
EP1653884B1 (en) | 2003-07-31 | 2008-06-25 | Wilson-Cook Medical Inc. | System for introducing a prosthesis |
CA2482697C (en) | 2003-09-30 | 2012-11-20 | Ethicon Endo-Surgery, Inc. | Applier for a surgical device |
US8211142B2 (en) | 2003-09-30 | 2012-07-03 | Ortiz Mark S | Method for hybrid gastro-jejunostomy |
CA2482707C (en) | 2003-09-30 | 2013-07-02 | Ethicon Endo-Surgery, Inc. | Applier having automated release of surgical device |
US7309341B2 (en) | 2003-09-30 | 2007-12-18 | Ethicon Endo-Surgery, Inc. | Single lumen anastomosis applier for self-deploying fastener |
US20050075654A1 (en) * | 2003-10-06 | 2005-04-07 | Brian Kelleher | Methods and devices for soft tissue securement |
US20050080444A1 (en) | 2003-10-14 | 2005-04-14 | Kraemer Stefan J.M. | Transesophageal gastric reduction device, system and method |
US7229457B2 (en) | 2003-10-31 | 2007-06-12 | Medtronic, Inc. | Surgical instrument with adjustable rotary cutting tool and method of cutting |
WO2005055834A1 (en) | 2003-11-20 | 2005-06-23 | Nmt Medical, Inc. | Device, with electrospun fabric, for a percutaneous transluminal procedure, and methods thereof |
US7361180B2 (en) * | 2004-05-07 | 2008-04-22 | Usgi Medical, Inc. | Apparatus for manipulating and securing tissue |
US7632287B2 (en) | 2004-02-20 | 2009-12-15 | Endogastric Solutions, Inc. | Tissue fixation devices and assemblies for deploying the same |
US20060142790A1 (en) | 2004-03-23 | 2006-06-29 | Michael Gertner | Methods and devices to facilitate connections between body lumens |
US20050228312A1 (en) | 2004-03-31 | 2005-10-13 | Vihar Surti | Biopsy needle system |
US8425539B2 (en) | 2004-04-12 | 2013-04-23 | Xlumena, Inc. | Luminal structure anchoring devices and methods |
US20050228413A1 (en) | 2004-04-12 | 2005-10-13 | Binmoeller Kenneth F | Automated transluminal tissue targeting and anchoring devices and methods |
US7803150B2 (en) | 2004-04-21 | 2010-09-28 | Acclarent, Inc. | Devices, systems and methods useable for treating sinusitis |
US20050251208A1 (en) | 2004-05-07 | 2005-11-10 | Usgi Medical Inc. | Linear anchors for anchoring to tissue |
US20050251159A1 (en) * | 2004-05-07 | 2005-11-10 | Usgi Medical Inc. | Methods and apparatus for grasping and cinching tissue anchors |
AU2005253930B2 (en) | 2004-05-11 | 2011-04-28 | Oregon Health And Science University | Interfacial stent and method of maintaining patency of surgical fenestrations |
US8475476B2 (en) | 2004-06-01 | 2013-07-02 | Cook Medical Technologies Llc | System and method for accessing a body cavity |
US7678135B2 (en) | 2004-06-09 | 2010-03-16 | Usgi Medical, Inc. | Compressible tissue anchor assemblies |
US8206417B2 (en) | 2004-06-09 | 2012-06-26 | Usgi Medical Inc. | Apparatus and methods for optimizing anchoring force |
US7429264B2 (en) | 2004-06-15 | 2008-09-30 | Warsaw Orthopedic, Inc. | Minimally invasive deployable cutting instrument |
EP1607036A1 (en) | 2004-06-18 | 2005-12-21 | Universite Libre De Bruxelles | Toolholder mountable on an endoscope and comprising a ring |
US9326756B2 (en) | 2006-05-17 | 2016-05-03 | St. Jude Medical, Atrial Fibrillation Division, Inc. | Transseptal catheterization assembly and methods |
US20060062996A1 (en) | 2004-09-22 | 2006-03-23 | Yun-Chao Yeh | Resin matrix composite with aluminum for lubrication in drilling |
US7845536B2 (en) | 2004-10-18 | 2010-12-07 | Tyco Healthcare Group Lp | Annular adhesive structure |
ITMI20042129A1 (en) | 2004-11-05 | 2005-02-05 | Ethicon Endo Surgery Inc | DEVICE AND METHOD FOR OBESITY THERAPY |
US20060116697A1 (en) | 2004-11-30 | 2006-06-01 | Esophyx, Inc. | Flexible transoral endoscopic gastroesophageal flap valve restoration device and method |
US20060142703A1 (en) | 2004-12-07 | 2006-06-29 | Cook Incorporated | Catheter aperture with related structures and method |
EP1858396B1 (en) | 2004-12-08 | 2019-02-06 | Boston Scientific Scimed, Inc. | Apparatus for performing needle guided interventions |
ATE508674T1 (en) | 2005-01-06 | 2011-05-15 | G I View Ltd | GASTROINTESTINAL INSTRUMENT VIA GUIDE ELEMENT |
WO2006083679A1 (en) | 2005-01-27 | 2006-08-10 | Wilson-Cook Medical, Inc. | Endoscopic cutting device |
EP1850689A4 (en) | 2005-02-10 | 2013-05-22 | G I View Ltd | Advancement techniques for gastrointestinal tool with guiding element |
JP2006223338A (en) | 2005-02-15 | 2006-08-31 | Humed Co Ltd | Catheter |
US20060190021A1 (en) | 2005-02-18 | 2006-08-24 | Michael Hausman | Cutting device for subcutaneous incisions |
US20060259074A1 (en) | 2005-02-22 | 2006-11-16 | Brian Kelleher | Methods and devices for anchoring to soft tissue |
US7942890B2 (en) | 2005-03-15 | 2011-05-17 | Tyco Healthcare Group Lp | Anastomosis composite gasket |
DE102005016103B4 (en) | 2005-04-08 | 2014-10-09 | Merit Medical Systems, Inc. | Duodenumstent |
US7534247B2 (en) | 2005-05-03 | 2009-05-19 | Ethicon Endo-Surgery, Inc. | Sheathless anastomotic ring applier device |
US8777967B2 (en) | 2005-06-09 | 2014-07-15 | Xlumena, Inc. | Methods and devices for anchoring to tissue |
US7591828B2 (en) | 2005-07-22 | 2009-09-22 | Ethicon Endo-Surgery, Inc. | Resposable anastomotic ring applier device |
EP1906844A1 (en) | 2005-07-25 | 2008-04-09 | Endogun Medical Systems Ltd. | Anastomosis device and system |
US8790396B2 (en) | 2005-07-27 | 2014-07-29 | Medtronic 3F Therapeutics, Inc. | Methods and systems for cardiac valve delivery |
CA2618492C (en) | 2005-08-08 | 2018-09-11 | Smart Medical Systems Ltd. | Balloon guided endoscopy |
US20070078297A1 (en) | 2005-08-31 | 2007-04-05 | Medtronic Vascular, Inc. | Device for Treating Mitral Valve Regurgitation |
US20070123934A1 (en) | 2005-09-26 | 2007-05-31 | Whisenant Brian K | Delivery system for patent foramen ovale closure device |
US20070123840A1 (en) | 2005-10-18 | 2007-05-31 | Usgi Medical, Inc. | Instrument assisted abdominal access |
US7758565B2 (en) | 2005-10-18 | 2010-07-20 | Cook Incorporated | Identifiable wire guide |
US7731693B2 (en) | 2005-10-27 | 2010-06-08 | Cook Incorporated | Coupling wire guide |
EP2243507A1 (en) | 2005-10-29 | 2010-10-27 | PNN Medical SA | Stent with anchoring portion |
US7815659B2 (en) | 2005-11-15 | 2010-10-19 | Ethicon Endo-Surgery, Inc. | Suture anchor applicator |
US20070112363A1 (en) | 2005-11-15 | 2007-05-17 | Endogastric Solutions, Inc. | Apparatus including multiple invaginators for restoring a gastroesophageal flap valve and method |
US20070123917A1 (en) | 2005-11-29 | 2007-05-31 | Ortiz Mark S | Anastomotic device promoting tissue necrosis |
US20110004058A1 (en) | 2006-01-30 | 2011-01-06 | Vision - Sciences Inc. | Controllable Endoscope |
US7785275B2 (en) | 2006-01-31 | 2010-08-31 | Cook Incorporated | Wire guide having distal coupling tip |
EP2004066A1 (en) | 2006-03-31 | 2008-12-24 | NMT Medical, Inc. | Adjustable length patent foramen ovale (pfo) occluder and catch system |
US20070260273A1 (en) | 2006-05-08 | 2007-11-08 | Ethicon Endo-Surgery, Inc. | Endoscopic Translumenal Surgical Systems |
US7993302B2 (en) | 2006-05-09 | 2011-08-09 | Stephen Hebert | Clot retrieval device |
US8034063B2 (en) | 2007-07-13 | 2011-10-11 | Xlumena, Inc. | Methods and systems for treating hiatal hernias |
US20090281379A1 (en) | 2008-05-12 | 2009-11-12 | Xlumena, Inc. | System and method for transluminal access |
US8454632B2 (en) | 2008-05-12 | 2013-06-04 | Xlumena, Inc. | Tissue anchor for securing tissue layers |
US20110137394A1 (en) | 2009-05-29 | 2011-06-09 | Xlumena, Inc. | Methods and systems for penetrating adjacent tissue layers |
US20100268029A1 (en) | 2009-04-21 | 2010-10-21 | Xlumena, Inc. | Methods and apparatus for advancing a device from one body lumen to another |
US9364259B2 (en) | 2009-04-21 | 2016-06-14 | Xlumena, Inc. | System and method for delivering expanding trocar through a sheath |
JP5535313B2 (en) | 2009-05-29 | 2014-07-02 | エックスルミナ, インコーポレイテッド | Device and method for deploying a stent across adjacent tissue layers |
-
2006
- 2006-06-08 US US11/449,365 patent/US8784437B2/en active Active
-
2014
- 2014-07-21 US US14/337,014 patent/US20140330294A1/en not_active Abandoned
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5382257A (en) * | 1990-09-06 | 1995-01-17 | United States Surgical Corporation | Implant assist apparatus |
Also Published As
Publication number | Publication date |
---|---|
US8784437B2 (en) | 2014-07-22 |
US20060282087A1 (en) | 2006-12-14 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US8784437B2 (en) | Methods and devices for endosonography-guided fundoplexy | |
US8777967B2 (en) | Methods and devices for anchoring to tissue | |
US10716569B2 (en) | Invaginator for gastroesophageal flap valve restoration device | |
US10350050B2 (en) | Method for gastric volume reduction surgery | |
US8551118B2 (en) | Hybrid endoscopic/laparoscopic method for forming serosa to serosa plications in a gastric cavity | |
US8979895B2 (en) | Method and apparatus of endoscopic suturing | |
US8556934B2 (en) | Article, system, and method for securing medical devices to treat obesity, gastro-esophageal reflux disease (GERD) and irritable bowel syndrome (IBS) reversibly | |
EP2222230B1 (en) | Apparatuses for delivering anchoring devices into body passage walls | |
US20090024144A1 (en) | Hybrid endoscopic/laparoscopic device for forming serosa to serosa plications in a gastric cavity | |
US8187176B2 (en) | Device for insufflating the interior of a gastric cavity of a patient | |
US20060235446A1 (en) | Article, system, and method for securing medical device to tissue or organ | |
US20040162568A1 (en) | Apparatus and methods for forming and securing gastrointestinal tissue folds | |
BR112021010505A2 (en) | Endoscopic tissue approximation system and methods | |
US20130217957A1 (en) | Devices and methods for the endolumenal treatment of obesity | |
EP2307081B1 (en) | A device for insufflating the interior of a gastric cavity of a patient | |
WO2007145684A2 (en) | Methods and devices for anchoring to soft tissue | |
US20090024077A1 (en) | Method of insufflating the interior of a gastric cavity of a patient. | |
EP2016909A2 (en) | Device for insufflating the interior of a gastric cavity of a patient | |
US20090138093A1 (en) | System and method for esophageal sphincter repair |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: XLUMENA, INC., CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:BINMOELLER, KENNETH F.;REEL/FRAME:035144/0600 Effective date: 20071204 Owner name: BINMOELLER, KENNETH F., CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:XLUMENA, INC.;REEL/FRAME:035144/0605 Effective date: 20140818 Owner name: ADVENT MEDICAL, INC., NEVADA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:BINMOELLER, KENNETH F.;REEL/FRAME:035144/0642 Effective date: 20141231 |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |