Endoscopic plication device and method

Abstract

In a method of stapling layers of tissue within a body cavity, an engaging instrument is passed between a stapler cartridge and anvil and used to engage a region of tissue. The engaging instrument is retracted to move the engaged tissue into the stapling position, and driving staples from the cartridge through at least two layers of the engaged tissue. The method and associated system may be used to form plications in body tissue, such as stomach wall tissue. Staples simultaneously driven through tissue may simultaneously capture a reinforcing elements positioned adjacent the cartridge and/or anvil prior to stapling.

1 . A method of stapling layers of tissue within a body cavity, comprising the steps of:
 positioning a stapler having a cartridge, an anvil and a stapling position between the cartridge and anvil, within the body cavity;   passing an engaging instrument through the stapling position and engaging the region of tissue using the engaging instrument;   retracting the engaging instrument to move the engaged tissue into the stapling position; and   driving staples from the cartridge through at least two layers of the engaged tissue.   
   
   
       2 . The method of  claim 1 , wherein driving the staples from the cartridge includes driving a staple driver into the cartridge using fluid pressure. 
   
   
       3 . The method of  claim 1 , wherein engaging the region of tissue includes applying suction to the region of tissue. 
   
   
       4 . The method of  claim 1 , wherein engaging the region of tissue includes pinching the region of tissue. 
   
   
       5 . The method of  claim 1 , wherein driving the staples forms a fold of stapled tissue. 
   
   
       6 . The method of  claim 1 , wherein driving the staples includes driving the staples through a reinforcing element adjacent to the engaged tissue, causing the staples to engage the reinforcing element. 
   
   
       7 . The method of  claim 5 , wherein the method includes positioning the reinforcing element adjacent to the anvil prior to driving the staples. 
   
   
       8 . The method of  claim 5 , wherein the method includes positioning the reinforcing element adjacent to the cartridge prior to driving the staples. 
   
   
       9 . The method of  claim 1 , further including advancing at least one of the anvil and cartridge to compress the engaged tissue prior to driving the staples. 
   
   
       10 . The method of  claim 1 , further including forming a cut through the engaged tissue using a cutting element other than a staple. 
   
   
       11 . The method of  claim 10 , wherein forming the cut includes forming a cutout through the tissue. 
   
   
       12 . The method of  claim 11 , wherein the staples encircle the cutout. 
   
   
       13 . The method of  claim 3 , wherein the suction is applied to a first surface of the tissue, and wherein the method further includes expanding an engaging element adjacent a second surface of the tissue opposite from the first, the engaging element including a tether extending through the tissue, and wherein moving the engaged tissue includes pulling the engaging element to move the engaged tissue into the stapling position. 
   
   
       14 . The method of  claim 13 , wherein driving the staples includes driving the staples through the engaging element. 
   
   
       15 . The method of  claim 1 , further including introducing a shaft into the body cavity, a distal portion of the shaft including a first branch having the cartridge and anvil thereon and a second branch having the engaging instrument thereon, and wherein engaging the region of tissue includes passing the second branch between the cartridge and anvil. 
   
   
       16 . The method of  claim 15 , wherein moving the region of tissue includes withdrawing the second branch to draw the engaged tissue into the stapling position. 
   
   
       17 . A stapling system, including:
 a stapler head on a first elongate shaft, the stapler head having a cartridge containing staples and an anvil; and   an engaging instrument on a second elongate shaft, the engaging instrument advanceable in a first direction from a first position on a first side of the stapler head, between the cartridge and anvil, to a second position on a second side of the stapler head and into engagement with tissue on the second side, the engaging instrument retractable in a second direction from the second position to retract engaged tissue to a stapling position between the cartridge an anvil.   
   
   
       18 . The stapling system including:
 a main shaft having a distal portion, wherein the first elongate shaft forms a first branch of the distal portion and the second elongate shaft forms a second branch of the distal portion.   
   
   
       19 . The stapling system according to  claim 17 , wherein the engaging instrument includes a vacuum head. 
   
   
       20 . The stapling system according to  claim 17 , wherein the engaging instrument including a grasping element. 
   
   
       21 . The stapling system according to  claim 17 , further including a reinforcing element positioned adjacent the cartridge and/or anvil such that staples driven from the cartridge engage the reinforcing element. 
   
   
       22 . The stapling system according to  claim 17 , further including a cutting element operatively associated with the stapler head to form a cut through tissue during stapling using staples in the cartridge. 
   
   
       23 . The stapling system according to  claim 21 , wherein the cutting element is a punch shaped to punch a hole through the tissue. 
   
   
       24 . The stapling system according to  claim 21 , wherein the cutting element is positioned such that the cut is formed to be surrounded by staples. 
   
   
       25 . The stapling system according to  claim 19 , wherein the vacuum head is collapsible. 
   
   
       26 . The stapling system according to  claim 17 , further including a piston coupled to a staple driver, a chamber housing the piston, and a fluid source fluidly coupled to the housing, the staple driver positioned such that directing fluid from the fluid source into the chamber advances the staple driver to the staple cartridge. 
   
   
       27 . The stapling system according to  claim 26 , further include a cutting element carried by the staple driver into engagement with tissue during advancement of the staple driver. 
   
   
       28 . The stapling system according to  claim 17 , further including a piston coupled to the cartridge, a chamber housing the piston, and a fluid source fluidly coupled to the housing, the cartridge positioned such that directing fluid from the fluid source into the chamber advances the cartridge towards the anvil for tissue compression. 
   
   
       29 . A method of reinforcing an array of staples delivered to tissue, the method comprising;
 providing a staple reinforcement comprising a framework having at least one member and at least one opening;   positioning the staple reinforcement adjacent to a anvil or cartridge of a stapler;   positioning body tissue between the cartridge and anvil;   simultaneously driving a plurality of staples from the cartridge, causing legs of the staples to fold around the member.   
   
   
       30 . The method of  claim 29 , wherein driving the staples causes legs of the staples to pass through the at least one opening. 
   
   
       31 . The method of  claim 30 , wherein the reinforcement is provided to include a lattice having a plurality of openings, and wherein driving the staples causes a plurality of legs to pass through a plurality of the openings. 
   
   
       32 . The method of  claim 31 , wherein the reinforcement is a lattice having the plurality of openings. 
   
   
       33 . The method of  claim 31 , further including the step of allowing tissue ingrowth to form in a plurality of the openings.