Overtube introducer for use in endoscopic bariatric surgery

Abstract

This application describes an overtube device that gives diagnostic and/or therapeutic access to body cavities using natural orifices of the body. The overtube includes an elongate flexible body having a distal portion deflectable in response to activation of a control cable. Proximal features of the overtube include an insufflations port and seals for minimizing loss of insufflations pressure around the shafts of instruments passed through the tube. In some embodiments, retractor elements are including on the distal portion of the overtube.

1 . An endogastric overtube for use in a stomach of a patient, comprising:
 a flexible elongate tube having a proximal end and a distal end, the tube proportioned such that when the distal end is in the stomach, the proximal end is positioned outside the patient, the tube including at least one lumen extending from the proximal end to the distal end, the tube having a maximum outer diameter of at least approximately 10 mm; and   a control cable extending through a wall of the tube, the control cable coupled to a distal portion of the tube such that engagement of the control cable causes deflection of the distal portion.   
     
     
         2 . The endogastric overtube of  claim 1 , wherein the tube further includes a reinforcement on a distal portion of the tube. 
     
     
         3 . The endogastric overtube of  claim 2 , wherein the tube is a formed of polymeric material and wherein the reinforcement is embedded within the polymeric material. 
     
     
         4 . The endogastric overtube of  claim 2 , wherein the tube is a formed of polymeric material and wherein the reinforcement is positioned on an inner surface of the lumen or an outer surface of the tube. 
     
     
         5 . The endogastric overtube of  claim 2 , wherein the reinforcement is a resilient coil. 
     
     
         6 . The endogastric overtube of  claim 2 , wherein the reinforcement is at least one resilient ring. 
     
     
         7 . The endogastric overtube of  claim 2 , wherein the reinforcement is at least one partial ring. 
     
     
         8 . The endogastric overtube of  claim 6 , wherein the resilient ring is circular. 
     
     
         9 . The endogastric overtube of  claim 6 , wherein the resilient ring is elliptical. 
     
     
         10 . The endogastric overtube of  claim 2 , wherein the reinforcement includes a mesh element. 
     
     
         11 . The endogastric overtube of  claim 2 , wherein the lumen has a diameter, and wherein the tube is expandable from a first position to a second position in response to introduction of an instrument having a diameter exceeding the lumen diameter into the lumen, and wherein the reinforcement is configured to restore the tube to the first position upon removal of the instrument from the lumen. 
     
     
         12 . The endogastric tube of  claim 1 , further including a removable atraumatic tip on the distal end. 
     
     
         13 . The endogastric tube of  claim 12 , wherein the atraumatic tip is positioned on an elongate member extending through the lumen. 
     
     
         14 . The endogastric tube of  claim 12 , wherein the atraumatic tip is a cap at least partially covering the distal end of the tip. 
     
     
         15 . The endogastric tube of  claim 12 , wherein the elongate element is retractable in a proximal direction to invert the cap into the lumen. 
     
     
         16 . The endogastric tube of  claim 12 , wherein the elongate element is advanceable in a distal direction to collapse the cap into a collapsed position, and wherein the elongate element is retractactable to withdraw the cap in the collapsed position through the lumen. 
     
     
         17 . The endogastric tube of  claim 5 , wherein the control cable is coupled to the spring element. 
     
     
         18 . The endogastric tube of  claim 1 , further including a retractor element on the distal end of the tube, the retractor element moveable from a first position to a second position in which the retractor element extends laterally from the tube. 
     
     
         19 . The endogastric tube of  claim 18 , wherein the retractor element extends longitudinally when in the first position. 
     
     
         20 . The endogastric tube of  claim 18 , wherein the retractor element includes a first portion coupled to a first ring and a second portion coupled to a second ring, and wherein relative movement of the second ring towards the first ring moves the retractor element from the first position to the second position. 
     
     
         21 . The endogastric tube of  claim 20 , wherein the retractor element includes a hinge, and wherein the first portion and the second portion are on opposite sides of the hinge. 
     
     
         22 . The endogastric tube of  claim 20 , wherein the first portion is an elongate member, and wherein the second portion is a pivot element pivotably coupled between the elongate member and the second ring. 
     
     
         23 . The endogastric tube of  claim 18  wherein the retractor element includes a mount for receiving an implant to be implanted in the stomach. 
     
     
         24 . The endogastric tube of  claim 1 , further including a retractor element on the distal end of the tube, the retractor element including a plurality of segments and a cable extending between the segments, the retractor having a first, flexible, position and a second, more rigid, position, the cable retractable to move the retractor from the first to the second position. 
     
     
         25 . The endogastric tube of  claim 24 , wherein the segments are positioned on a cable loop and wherein the retractor element in the second position forms a retractor hoop. 
     
     
         26 . The endogastric tube of  claim 25 , further including a second retractor element including a plurality of second segments and a second cable extending between the segments, the second cable retractable to move the second retractor from a flexible position to a more rigid position. 
     
     
         27 . The endogastric tube of  claim 26 , wherein the second retractor in the second position forms a retractor hoop. 
     
     
         28 . The endogastric tube of  claim 1 , wherein the tube includes a seal positioned to seal against an instrument inserted into the lumen. 
     
     
         29 . The endogastric tube of  claim 1 , wherein the proximal portion of the tube includes a port positionable in fluid communication with a source of insufflation gas. 
     
     
         30 . The endogastric tube of  claim 1 , wherein the tube has a maximum outer diameter of between approximately 10 mm-20 mm. 
     
     
         31 . The endogastric tube of  claim 30 , wherein the tube has a maximum out diameter of between approximately 15 mm-20 mm. 
     
     
         32 . The endogastric tube of  claim 30 , wherein the tube has a maximum outer diameter of approximately 20 mm. 
     
     
         33 . The endogastric tube of  claim 1 , wherein the tube has a maximum outer diameter of approximately 18-22 mm. 
     
     
         34 . The endogastric tube of  claim 1 , wherein the tube has a maximum wall thickness of 0.1-0.2 mm. 
     
     
         35 . An endogastric overtube for use in a stomach of a patient, comprising:
 a flexible elongate tube having a proximal end and a distal end, the tube proportioned such that when the distal end is in the stomach, the proximal end is positioned outside the patient, the tube including at least one lumen extending from the proximal end to the distal end, the tube having a maximum outer diameter of at least approximately 10 mm; and   a retractor element on the distal end of the tube, the retractor element moveable from a first position to a second position in which the retractor element extends laterally from the tube.   
     
     
         36 . The endogastric tube of  claim 35 , wherein the retractor element extends longitudinally when in the first position. 
     
     
         37 . The endogastric tube of  claim 35 , wherein the retractor element includes a first portion coupled to a first ring and a second portion coupled to a second ring, and wherein relative movement of the second ring towards the first ring moves the retractor element from the first position to the second position. 
     
     
         38 . The endogastric tube of  claim 37 , wherein the retractor element includes a hinge, and wherein the first portion and the second portion are on opposite sides of the hinge. 
     
     
         39 . The endogastric tube of  claim 37 , wherein the first portion is an elongate member, and wherein the second portion is a pivot element pivotably coupled between the elongate member and the second ring. 
     
     
         40 . The endogastric tube of  claim 37 , wherein the retractor element includes a mount for receiving an implant to be implanted in the stomach. 
     
     
         41 . The endogastric tube of  claim 35 , further including a retractor element on the distal end of the tube, the retractor element including a plurality of segments and a cable extending between the segments, the retractor having a first, flexible, position and a second, more rigid, position, the cable retractable to move the retractor from the first to the second position. 
     
     
         42 . The endogastric tube of  claim 41 , wherein the segments are positioned on a cable loop and wherein the retractor element in the second position forms a retractor hoop. 
     
     
         43 . The endogastric tube of  claim 42 , further including a second retractor element including a plurality of second segments and a second cable extending between the segments, the second cable retractable to move the second retractor from a flexible position to a more rigid position. 
     
     
         44 . The endogastric tube of  claim 43 , wherein the second retractor in the second position forms a retractor hoop. 
     
     
         45 . The endogastric tube of  claim 35 , wherein the tube includes a seal positioned to seal against an instrument inserted into the lumen. 
     
     
         46 . The endogastric tube of  claim 35 , wherein the proximal portion of the tube includes a port positionable in fluid communication with a source of insufflation gas. 
     
     
         47 . The endogastric tube of  claim 35 , wherein the tube has a maximum outer diameter of between approximately 10 mm-20 mm. 
     
     
         48 . The endogastric tube of  claim 47 , wherein the tube has a maximum out diameter of between approximately 15 mm-20 mm. 
     
     
         49 . The endogastric tube of  claim 35 , wherein the tube has a maximum outer diameter of approximately 20 mm. 
     
     
         50 . The endogastric tube of  claim 35 , wherein the tube has a maximum outer diameter of approximately 18-22 mm. 
     
     
         51 . The endogastric tube of  claim 35 , wherein the tube has a maximum wall thickness of 0.1-0.2 mm.