Methods and Devices for Placement of an Intra-Abdominal or Intra-Thoracic Appliance Through a Natural Body Orifice

Abstract

Natural orifice transenteric surgical methods and devices for placing a band or other appliance around a hollow bodily organ such as the stomach. In one alternative embodiment, such a band is placed in order to reduce the inner volume of the stomach.

1 . A method of placing an appliance on a wall surface of a hollow bodily organ, comprising:
 entering the organ through a naturally occurring orifice;   placing a guide element through the organ wall to access the other surface of the wall of the organ;   guiding the appliance with the guide element to a position on the outer wall surface of the organ; and   removing the guide element and leaving the appliance on the outer wall surface,   
     
     
         2 . The method as in  claim 1 , wherein the hollow bodily organ is one of stomach, intestine, or esophagus. 
     
     
         3 . The method as in  claim 1 , wherein said placing through the organ wall comprises piercing, cutting, injecting and/or burning through the wall to create on opening passage to the other surface of the wall, 
     
     
         4 . The method as in  claim 1  where the appliance is circumferential about the hollow bodily organ, 
     
     
         5 . The method as in  claim 1  where the appliance is initially deployed in its final placed configuration. 
     
     
         6 . The method as in  claim 1 , wherein the an appliance is reconfigured after placement. 
     
     
         7 . The method as in  claim 1 , wherein the appliance is affixed to the wall surface after guiding into position. 
     
     
         8 . The method as in  claim 7 , wherein said affixing includes at least one of suturing, stapling, gluing, tissue-welding, encapsulating, marcupializing, engulfing with tissue, tacking, tethering. 
     
     
         9 . A method of placing an appliance on the outer wall surface of a hollow bodily organ, comprising:
 entering the hollow bodily organ;   making a passageway through the wall of the hollow bodily organ;   placing a guide element through the passageway to the outside of the hollow bodily organ;   placing a conduit guided by the guide element through the wall and out of the hollow bodily organ;   directing the guide element around the outside wall of the hollow bodily organ;   re-entering the hollow bodily organ through the passageway previously made;   sliding the appliance onto the guide element such that it follows the path of the guide element around the hollow bodily organ;   adjusting the circumference of the hollow bodily organ by shortening the appliance length around the hollow bodily organ; and   affixing the appliance in place.   
     
     
         10 . The method as in  claim 9 , wherein the position of the guide element on the outside of the organ can be assessed by the visibility of light coming from a light source on the guide element. 
     
     
         11 . The method as in  claim 9 , wherein directing the guide wire around the outside wall of the hollow bodily organ comprises using a curved conduit. 
     
     
         12 . The method as in  claim 9 , wherein the directing the guide wire around the outside wall of the hollow bodily organ comprises:
 moving through the wall of the hollow bodily organ at a position only partially around the circumference of the hollow bodily organ;   entering the stomach through the wall through a new passageway there created;   placing another guide wire through the entrance hole of the first guide wire through the wall and out of the stomach;   directing the guide wire further around the hollow bodily organ;   re-entering the hollow bodily organ at another position through a new passageway there created that is further around the circumference of the stomach;   attaching the second end of the first wire with the first end of the second wire and pulling the junction through the passage through the wall; and   repeating this process until the organ is completely surrounded by a guide wire with only two ends coming into the hollow bodily organ.   
     
     
         13 . The method of  claim 9 , wherein making a passageway through the wall of the hollow bodily organ comprises using a needle knife to make the passageway; 
     
     
         14 . The method of  claim 9 , wherein making a passageway through the wall of the hollow bodily organ comprises energizing the guide wire with radiofrequency energy where the tip and source connection of the guide wire are electrically conductive; 
     
     
         15 . The method of  claim 9 , wherein the attaching the second end of the first wire with the first end of the second wire is done with magnets. 
     
     
         16 . The method of  claim 9 , wherein the attaching the second end of the first wire with the first end of the second wire is done a threaded connector. 
     
     
         17 . The method of  claim 9 , wherein the attaching the second end of the first wire with the first end of the second wire is done with mechanical means such as twisting, crimping, tying, welding, splicing. 
     
     
         18 . The method of  claim 9 , wherein the attaching the second end of the first wire with the first end of the second wire is done inside the body. 
     
     
         19 . The method of  claim 9 , wherein the attaching the second end of the first wire with the first end of the second wire is done outside of the body. 
     
     
         20 . The method of  claim 9 , wherein directing the guide wire around the outside wall of the hollow bodily organ includes vibrating the wire axially, rotationally, and/or transaxially; 
     
     
         21 . The method of  claim 9 , wherein directing the guide wire around the outside wall of the hollow bodily organ includes displacing tissue anterior to and/or around the guide wire by increasing the effective diameter of the guide wire. 
     
     
         22 . The method of  claim 21 , wherein increasing the effective diameter of the guide wire comprises inflating a balloon. 
     
     
         23 . The method of  claim 21 , wherein increasing the effective diameter of the guide wire comprises moving an inner member of the guide wire relative to an outer member of the guide wire to pivot a dissecting member; 
     
     
         24 . The method of  claim 21 , wherein increasing the effective diameter of the guide wire comprises moving an inner member of the guide wire relative to an outer member of the guide wire to expand the tip diameter of the guide wire 
     
     
         25 . The method of  claim 9 , wherein directing the guide wire comprises moving an inner member of the conduit relative to another member of the conduit so as to flex the tip of the conduit. 
     
     
         26 . The method of  claim 9 , wherein directing the guide wire comprises rotating the conduit relative to the passageway through the wall of the hollow bodily organ. 
     
     
         27 . A method of placing an appliance on the outer wall surface of a hollow bodily organ, comprising:
 entering the hollow bodily organ;   making a passageway through the wall of the hollow bodily organ;   placing the appliance through the passageway to the outside of the hollow bodily organ;   placing a conduit over or adjacent the appliance through the wall and out of the hollow bodily organ;   directing the appliance around the outside wall of the hollow bodily organ;   re-entering the hollow bodily organ through the passageway previously made;   adjusting the circumference of the hollow bodily organ by shortening the appliance length around the hollow bodily organ; and   affixing the appliance in place.   
     
     
         28 . A device for placing an appliance on an outer wall surface of a hollow bodily organ, comprising:
 a delivery tube configured and dimensioned for placement through a natural body opening, the tube having a distal end configured for opening within the hollow bodily organ with a proximal end located outside the patient;   at least one manipulable arm extending from the distal end of the delivery tube, said arm defining a lumen for delivering a guide element, said arm having a proximal end manipulable by a user at the delivery tube proximal end;   a tissue piercing element disposed at the distal end of the at least one manipulable arm;   a viewing device extendable through the delivery tube for viewing of the inside of the hollow body organ.   a guide element adapted to be advanced through said manipulable arm lumen.   
     
     
         29 . The device of  claim 28 , further comprising two manipulable arms disposable in opposition extending from the distal end of the delivery tube.