Device and method for internal ligation of tubular structures

Abstract

A surgical device for performing internal ligation of a fallopian tube or other tubular anatomical structure, by application of one or more ligating bands to a folded portion of the wall of the tubular structure. A method of using the device is also disclosed. The inventive method and device may be used for sterilization to prevent undesired pregnancies, or for other medical applications. One embodiment of the device includes an elongated tubular element that is inserted into the fallopian tube, a grasper that extends out of the tubular element, grasps the interior of the fallopian tube and retracts into the tubular element in a folded bundle of the fallopian tube tissue; and a pusher balloon for pushing a ligating band from the tip of the tubular element onto the tissue bundle. A fold assist mechanism may be included to help evert a section of a fallopian, or other, tube.

1 - 21 . (canceled)  
     
     
         22 . A device for grasping tissue on an interior of a tubular anatomical structure and applying at least one ligating band to the grasped tissue, comprising: 
 an elongated tubular element comprising a first end, a second end, and a lumen, wherein the first end is adapted for insertion into the tubular anatomical structure and configured to hold the at least one ligating band on an exterior thereof;    a grasper slidably disposed within the elongated tubular element, the grasper capable of extending out of the elongated tubular element, grasping tissue on an interior of the tubular anatomical structure, and retracting into the elongated tubular element with the grasped tissue to form a tissue bundle; and    a pusher movably disposed at the first end of the elongated tubular element and adapted for pushing the at least one ligating band off the first end of the elongated tubular element.    
     
     
         23 . The device of  claim 22 , further comprising a control segment connected to the second end of the elongated tubular element and adapted for controlling and mechanically supporting the device.  
     
     
         24 . The device of  claim 23 , wherein the control segment comprises: 
 a steering control for controlling insertion of the elongated tubular element into the tubular anatomical structure;    an extension control for controlling extension and retraction of the grasper;    a grasp control for controlling grasping of the tissue by the grasper; and    a push control for controlling the pusher to push the at least one ligating band off the first end of the elongated tubular element.    
     
     
         25 . The device of  claim 22 , wherein the grasper comprises: 
 an elongated catheter slidably disposed within the elongated tubular element and having an inflatable end portion; and    a plurality of hooking structures positioned about and capable of moving with the inflatable end portion;    wherein the inflatable end portion may be expanded by increasing pressure of a fluid within the elongated catheter.    
     
     
         26 . The device of  claim 25 , wherein the elongated catheter comprises an inflatable catheter having a closed end and formed of a pliable material, the pliable material permitting inflation of the inflatable catheter at the inflatable end portion when the pressure of the fluid within the inflatable catheter is increased.  
     
     
         27 . The device of  claim 25 , wherein the elongated catheter comprises: 
 a shaft having an outer wall, a central lumen surrounded by the outer wall, and at least one channel through the outer wall providing communication between the central lumen and an exterior of the shaft; and    a balloon attached to the exterior of the shaft and covering a portion of the exterior including the at least one channel through the outer wall, the balloon having an outer surface and an interior, the interior of the balloon communicating with the central lumen of the shaft via the at least one channel.    
     
     
         28 . The device of  claim 25 , wherein the plurality of hooking structures comprises a plurality of elongated wires disposed about a circumference of the elongated catheter and substantially parallel with a long axis of the elongated catheter, an end of each of the plurality of wires being bent outward from the elongated catheter at the inflatable end portion to form a hook.  
     
     
         29 . The device of  claim 25 , wherein the plurality of hooking structures comprises a plurality of barbs, each of the plurality of barbs comprising: 
 a shaft having a first end and a second end, the first end of the shaft secured to the elongated catheter at the inflatable end portion;    a pointed tip at the second end of the shaft; and    at least one backward-extending point connected to the second end of the shaft and extending toward the first end of the shaft.    
     
     
         30 . The device of  claim 22 , wherein the pusher comprises a pusher balloon having a substantially toroidal shape, fitting around and secured to the first end of the elongated tubular element, and capable of being expanded to push the at least one ligating band off the first end of the elongated tubular element.  
     
     
         31 . The device of  claim 23 , wherein the pusher comprises a pusher disk having a central aperture sized to fit slidably about the first end of the elongated tubular element and driven by at least one pusher rod linked to and controlled by the control segment.  
     
     
         32 . The device of  claim 22 , wherein the pusher comprises an elongated tubular sleeve disposed about and coaxial with the elongated tubular element and capable of sliding with respect to the elongated tubular element a distance sufficient to push the at least one ligating band off the first end of the elongated tubular element.  
     
     
         33 . The device of  claim 22 , wherein the first end of the elongated tubular element is adapted to hold a first ligating band and a second ligating band on the exterior thereof, wherein the pusher is adapted to extend to at least a first position and a second position, wherein extension of the pusher to the first position pushes the first ligating band off of the first end, and wherein extension of the pusher to the second position pushes the second ligating band off of the first end.  
     
     
         34 . The device of  claim 25 , wherein the pusher comprises a pusher balloon having a substantially toroidal shape, fitting around and secured to the first end of the elongated tubular element, and capable of being expanded to push the at least one ligating band off the first end of the elongated tubular element.  
     
     
         35 . The device of  claim 23 , wherein the pusher comprises a pusher disk having a central aperture sized to fit slidably about the first end of the elongated tubular element and driven by at least one pusher rod linked to and controlled by the control segment.  
     
     
         36 . The device of  claim 25 , wherein the pusher comprises an elongated tubular sleeve disposed about and coaxial with the elongated tubular element and capable of sliding with respect to the elongated tubular element a distance sufficient to push the at least one ligating band off the first end of the elongated tubular element.  
     
     
         37 . The device of  claim 22 , further comprising a drug delivery lumen for delivering a drug into the tubular anatomical structure at the first end of the elongated tubular element.  
     
     
         38 . The device of  claim 22 , further comprising a current source connected to the grasper and configured for passing current through the grasper and into the grasped tissue.  
     
     
         39 . The device of  claim 22 , wherein the grasper comprises: 
 an inflatable catheter having a closed end and formed of a pliable material, the pliable material permitting inflation of the inflatable catheter at an end portion when pressure of a fluid within the inflatable catheter is increased; and    a plurality of elongated wires disposed about a circumference of the inflatable catheter and substantially parallel with a long axis of the inflatable catheter, an end of each of the plurality of wires being bent outward from the inflatable catheter at the end portion to form a hook;    wherein the pusher comprises an elongated tubular sleeve disposed about and coaxial with the elongated tubular element and capable of sliding with respect to the elongated tubular element a distance sufficient to push the at least one ligating band off the first end of the elongated tubular element.    
     
     
         40 . A device for grasping an interior of a tubular anatomical structure, comprising: 
 an elongated catheter capable of being inserted into the tubular anatomical structure and having an inflatable end portion; and    a plurality of hooking structures positioned about and capable of moving with the inflatable end portion.    
     
     
         41 . The device of  claim 40 , wherein the elongated catheter comprises an inflatable catheter having a closed end and formed of a pliable material, the pliable material permitting inflation of the inflatable catheter at the inflatable end portion when pressure of a fluid within the inflatable catheter is increased, and wherein the plurality of hooking structures comprises a plurality of elongated wires disposed about a circumference of the inflatable catheter and substantially parallel with a long axis of the inflatable catheter, an end of each of the plurality of wires being bent outward from the inflatable catheter at the end portion to form a hook.  
     
     
         42 . The device of  claim 40 , wherein the elongated catheter comprises: 
 a shaft having an outer wall, a central lumen surrounded by the outer wall, and at least one channel through the outer wall providing communication between the central lumen and an exterior of the shaft; and    a balloon attached to the exterior of the shaft and covering a portion of the exterior including the at least one channel through the outer wall, the balloon having an outer surface and an interior, the interior of the balloon communicating with the central lumen of the shaft via the at least one channel; and    wherein the plurality of hooking structures comprises a plurality of barbs, each of the plurality of barbs comprising:    a shaft having a first end and a second end, the first end secured to the outer surface of the balloon;    a pointed tip on the second end of the shaft; and    at least one backward-extending point connected to the second end of the shaft and extending toward the first end of the shaft.