System for endoscopic suturing

Abstract

A system for endoscopic suturing is provided having an endoscope, such as a gastroscope, with a distal end locatable in the body of a patient and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and a tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. A tissue suturing instrument is provided having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft. The tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue through an opening in the vacuum sleeve. Two needles are provided which extend through the shaft of the suturing instrument. Each needle is separately actuated into a gap in the instrument's tip, through tissue suctioned into the opening of the vacuum sleeve and into a ferrule at each end of a loop of suture. The system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft. After removal of the suturing instrument from the accessory tube, a loop of suture extends through the tissue and the accessory tube, the suture securing instrument receives the free ends of the loop of suture at its distal end through a sleeve member, and the suture securing instrument is then inserted through the accessory tube to the location of the suture in the tissue. The suture securing instrument crimps the sleeve member and cuts the free ends of the suture to secure the suture closed. The suturing instrument and suture securing instrument are passed through the accessory tube without removal of the endoscope from the patient. The endoscope provides viewing by an operator of the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.

1 - 44 . (canceled) 
     
     
         45 . An instrument having a steerable distal end comprising:
 a proximal end;   a distal end;   an at least partially flexible shaft extending from said proximal end to said distal end;   a housing coupled to said distal end having walls with folds capable of expanding or contracting said housing along a dimension to change the length of the housing along said dimension;   a medium; and   means for controlling one or more of volume and pressure of said medium within the housing to change length of said housing along said dimension to steer said distal end, in which said housing expands along said folds responsive to increase in one or more of volume and pressure of said medium in said housing, and said housing contracts along said folds response to decrease in one or more of pressure and volume of said medium in said housing.   
     
     
         46 . The instrument according to  claim 45  wherein said means for controlling comprises a conduit for passing said medium into and out of said housing. 
     
     
         47 . The instrument according to  claim 46  wherein said means for controlling is located at said proximal end. 
     
     
         48 . The instrument according to  claim 45  wherein said housing is longitudinally expandable or contractible along said folds. 
     
     
         49 . The instrument according to  claim 45  wherein said housing is cylindrical. 
     
     
         50 . The instrument according to  claim 45  wherein said medium is a liquid. 
     
     
         51 . The instrument according to  claim 45  wherein said means for controlling comprises a chamber, a positionable piston in said chamber to change the volume of said medium in said chamber, a first opening in said chamber, a tube coupled to said opening, and said tube extending along said shaft to pass said medium between said chamber and said housing responsive to said change in volume of said medium in said chamber. 
     
     
         52 . The instrument according to  claim 45  further comprising:
 a tissue engaging end coupled to said shaft at the distal end of the instrument; and 
 one or more needles which extend through said shaft to said tissue engaging end. 
 
     
     
         53 . The instrument according to  claim 52  further comprising:
 means for carrying suture along said shaft to said tissue engaging end; 
 said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and 
 means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended. 
 
     
     
         54 . An instrument having a remotely steerable distal end comprising
 a proximal end;   a distal end;   a shaft extending from said proximal end to said distal end;   a chamber at or near said proximal end having a medium;   a first piston in said chamber movable to change the volume of said medium in said chamber;   an opening in said chamber; and   a tube coupled to said opening extending along said shaft to said distal end; and   a second piston coupled to said distal end said second piston having walls which are longitudinally expandable responsive to increase pressure and volume in said second piston when communicated through said tube from said first piston, and longitudinally contractible responsive to decease in pressure and volume of said medium in said second piston when communicated through said tube from said first piston, communicated through said tube to said piston to steer said distal end.   
     
     
         55 . An instrument having a steerable distal end comprising:
 a flexible shaft having a distal end passable through a flexible internal or external conduit associated with an endoscope having a first steering means; and   second means for steering said distal end of said shaft separately operative from said first steering means when the distal end of said shaft is passed through said flexible internal or external conduit associated with the endoscope.   
     
     
         56 . The instrument according to  claim 55  wherein said second steering means is mechanically actuated. 
     
     
         57 . The instrument according to  claim 55  wherein said second steering means is hydraulically actuated. 
     
     
         58 . The instrument according to  claim 57  wherein said second steering means comprises:
 a chamber at or near the proximal end of said instrument having a fluid and a piston in said chamber movable to change the volume of the fluid in said chamber, an opening to said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and 
 a cylinder along said shaft having a piston coupled to said distal end movable responsive to changes in said volume of fluid in said chamber communicated through said tube to said cylinder to steer said distal end. 
 
     
     
         59 . The instrument according to  claim 57  wherein said second steering means comprises:
 a housing coupled to said distal end having walls with folds capable of expanding or contracting said housing along a dimension to change the length of the housing along said dimension; 
 a medium; and 
 means for controlling one or more of volume and pressure of said medium within the housing to change length of said housing along said dimension to steer said distal end, in which said housing expands along said folds responsive to increase in one or more of volume and pressure of said medium in said housing, and said housing contracts along said folds response to decrease in one or more of pressure and volume of said medium in said housing. 
 
     
     
         60 . The instrument according to  claim 57  wherein said second steering means comprises:
 a chamber at or near the proximal end of said instrument having a medium and a piston in said chamber movable to change the volume of said medium in said chamber, an opening in said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and 
 a folding housing coupled to said distal end expandable and retractable responsive to changes in said volume of said medium in said chamber communicated through said tube to said piston to steer said distal end. 
 
     
     
         61 . The instrument according to  claim 55  further comprising:
 a tissue engaging end coupled to said shaft at the distal end of the instrument; and 
 one or more flexible needles which extend through said shaft to said tissue engaging end. 
 
     
     
         62 . The instrument according to  claim 61  further comprising:
 means for carrying suture along said shaft to said tissue engaging end; 
 said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and 
 means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended.