Apparatus and methods for closing a gastrotomy

Abstract

A surgical instrument for forming a gastrotomy. In various embodiments, the surgical instrument may comprise a hollow tip for attachment to a distal end of a tubular member such as an endoscope. In other embodiments, the hollow tip is integrally formed on the distal end of the endoscope. The hollow tip is configured such that when it is brought into contact with the inner layer of tissue in the stomach, the tissue is caused to stretch. A hole-forming device may be passed through the hollow tip to pierce through the stretched inner layer and adjacent outer layers of tissue to form a passageway therethrough for permitting surgical procedures to be performed therethrough. After the surgical procedures are performed through the passageway, the hollow tip is removed from contact with the inner layer of tissue to permit the inner layer of tissue to relax and to cause the holes formed through the inner layer and outer layers of tissue to be offset from each other.

1 . A surgical instrument for forming a gastrotomy, said surgical instrument comprising:
 a tubular member sized to receive a surgical instrument, said tubular member having a proximal end and a distal end; and   a non-piercing hollow tip on said distal end of said tubular member, said hollow tip defining a tip axis and having a distal end extending at an acute angle relative to said tip axis.   
   
   
       2 . The surgical instrument of  claim 1  wherein said acute angle is approximately forty-five degrees. 
   
   
       3 . The surgical instrument of  claim 1  wherein said hollow tip is attached to said distal end of said tubular member by a frictional fit. 
   
   
       4 . The surgical instrument of  claim 1  wherein said hollow tip is attached to said tubular member by adhesive. 
   
   
       5 . The surgical instrument of  claim 1  wherein said hollow tip is integrally formed on said distal end of said tubular member. 
   
   
       6 . The surgical instrument of  claim 1  wherein said tubular member comprises an endoscope. 
   
   
       7 . The surgical instrument of  claim 5  wherein said endoscope has at least one working channel therethrough to receive a hole-forming device therethrough. 
   
   
       8 . The surgical instrument of  claim 7  wherein said endoscope has a working channel therethrough for receiving a vacuum forming instrument therethrough. 
   
   
       9 . A method for processing an instrument for surgery, the method comprising:
 obtaining the surgical instrument of  claim 1 ;   sterilizing the instrument; and   storing the instrument in a sterile container.   
   
   
       10 . A surgical instrument for forming a gastrotomy, said surgical instrument comprising a non-piercing hollow tip configured for attachment to a distal end of an endoscope, said hollow tip defining a tip axis and having a distal end extending at an acute angle relative to said tip axis. 
   
   
       11 . The surgical instrument of  claim 10  wherein said acute angle is approximately 45 degrees. 
   
   
       12 . A method for processing an instrument for surgery, the method comprising:
 obtaining the hollow tip of  claim 10 ;   sterilizing the hollow tip; and   storing the hollow tip in a sterile container.   
   
   
       13 . A surgical kit comprising:
 an endoscope; and   a hollow tip of  claim 11 .   
   
   
       14 . A surgical method for forming a gastrotomy through an organ wall having an inner layer of tissue and at least one outer layer of tissue adjacent to said inner layer of tissue, wherein the inner layer of tissue is stretchable from a first relaxed condition to a stretched condition, said method comprising:
 stretching the inner layer of tissue to a stretched condition relative to the at least one outer layer of tissue;   forming a first hole through the stretched inner layer of tissue and a second hole through the at least one outer layer of adjacent tissue such that said first and second holes are aligned with each other to permit passage of a surgical instrument therethrough;   performing a surgical procedure through the aligned first and second holes; and   permitting the inner layer to return to the first relaxed condition such that the first and second holes are no longer aligned with each other.   
   
   
       15 . The surgical method of  claim 14  wherein said stretching comprises:
 providing a surgical instrument having a hollow tip thereon, the hollow tip having a tip axis and a distal end that extends at an acute angle relative to the tip axis; and   pushing the angled distal end of the hollow tip into contact with the inner layer of tissue to cause a portion of the inner layer of tissue to move to the stretched condition.   
   
   
       16 . The surgical method of  claim 15  wherein said forming comprises:
 inserting a hole-forming instrument through the surgical instrument and the hollow tip; and   piercing a portion of the hole forming instrument through the portion of stretched inner layer of tissue and the at least one outer layer of tissue adjacent to the portion of stretched inner layer of tissue.   
   
   
       17 . The surgical method of  claim 15  further comprising applying suction within the hollow tip. 
   
   
       18 . The surgical method of  claim 15  wherein the surgical instrument comprises an endoscope. 
   
   
       19 . The surgical method of  claim 18  wherein said pushing comprises:
 inserting a portion of the endoscope having the hollow tip thereon through a natural orifice in a patient to bring the hollow tip into engagement with the inner layer of tissue;   an applying a pushing force to another portion of the endoscope protruding out of the natural orifice.   
   
   
       20 . The surgical method of  claim 15  wherein said permitting comprises removing the angled distal end of the hollow tip from contact with the inner layer of tissue. 
   
   
       21 . The surgical method of  claim 14  wherein said performing a surgical procedure comprises performing transgastric access. 
   
   
       22 . The surgical method of  claim 14  wherein said performing a surgical procedure comprises inserting one of a guide wire and a dilating balloon through the aligned first and second holes.