Method and apparatus for endoscopically performing gastric reduction surgery in a single pass

Abstract

A gastric reduction apparatus provides for the secure attachment of multiple fasteners into the gastric wall, the fasteners being linked with a flexible member in a manner permitting the reduction of the effective size of an individual's stomach. The apparatus includes an applicator head including a proximal end and a distal end. The applicator head of the gastric reduction apparatus includes a cavity shaped and dimensioned for receiving tissue. A fastener attachment mechanism is positioned within the cavity for access to tissue that is pulled within the cavity and the fastener attachment mechanism includes a plurality of fasteners.

1 . A gastric reduction apparatus which provides for the secure attachment of multiple fasteners into the gastric wall, the fasteners being linked with a flexible member in a manner permitting the reduction of the effective size of an individual's stomach, comprising:
 an applicator head including a proximal end and a distal end;   the applicator head of the gastric reduction apparatus includes a cavity shaped and dimensioned for receiving tissue;   a fastener attachment mechanism is positioned within the cavity for access to tissue that is pulled within the cavity, the fastener attachment mechanism includes at least one fastener.   
     
     
         2 . The gastric reduction apparatus according to  claim 1 , wherein the proximal end is shaped and dimensioned for secure attachment to a distal end of a gastroscope. 
     
     
         3 . The gastric reduction apparatus according to  claim 1 , wherein the cavity is substantially bell-shaped providing a wide opening for receiving tissue for the purpose of securing fasteners thereto while the tissue is pulled within the cavity. 
     
     
         4 . The gastric reduction apparatus according to  claim 1 , wherein the fastener attachment mechanism includes a firing mechanism composed of electroactive polymers. 
     
     
         5 . The gastric reduction apparatus according to  claim 1 , wherein a fastener attachment mechanism includes a hook and an anvil. 
     
     
         6 . The gastric reduction apparatus according to  claim 5 , wherein the hook includes a first end and a second end, the first end of the hook is shaped and dimensioned for grabbing an uppermost fastener supported by the fastener attachment mechanism and drawing it against the anvil to close the fastener in a configuration coupling the fastener to the tissue drawn within the cavity. 
     
     
         7 . The gastric reduction apparatus according to  claim 6 , wherein the second end of the hook is coupled to a firing mechanism. 
     
     
         8 . The gastric reduction apparatus according to  claim 7 , wherein the firing mechanism includes a cable, bar, or rod that extends to the hook allowing the hook to be manipulated. 
     
     
         9 . The gastric reduction apparatus according to  claim 7 , wherein the firing mechanism further includes a mechanism, which draws the hook proximally in a controlled manner. 
     
     
         10 . The gastric reduction apparatus according to  claim 1 , wherein internal space defined by the cavity is in fluid communication with a vacuum line. 
     
     
         11 . The gastric reduction apparatus according to  claim 1 , wherein the apparatus includes an elongated shaft which runs down along the side of a gastroscope, the shaft includes a proximal end and a distal end, the proximal end including access to control mechanisms of the fastener attachment mechanism and the applicator head is secured to the distal end of the elongated shaft. 
     
     
         12 . The gastric reduction apparatus according to  claim 11 , wherein the elongated shaft is composed of a selectively rigidized track. 
     
     
         13 . The gastric reduction apparatus according to  claim 12 , wherein the track is composed of a plurality of links disposed on a common cable. 
     
     
         14 . The gastric reduction apparatus according to  claim 13 , wherein the links are loosely associated with each other and controlled via a tensioning cable extending between the distal end and proximal end of the track. 
     
     
         15 . The gastric reduction apparatus according to  claim 13 , wherein the track is rotatable via a pivotal connection between the track and a handle. 
     
     
         16 . The gastric reduction apparatus according to  claim 13 , wherein the plurality of links have locking faces along respective mating ends. 
     
     
         17 . The gastric reduction apparatus according to  claim 1 , wherein the fastener attachment mechanism includes a fastener press and anvil wherein the fastener press receives a fastener and then moves the fastener into contact with the anvil. 
     
     
         18 . The gastric reduction apparatus according to  claim 17 , wherein the fastener attachment mechanism further includes a linkage assembly for moving the fastener press between a retracted position and fired position. 
     
     
         19 . A method for gastric reduction surgery, comprising the following steps:
 inserting a gastric reduction apparatus within the stomach, the gastric reduction apparatus including an applicator head having a proximal end and a distal end, the applicator head of the gastric reduction apparatus includes a cavity shaped and dimensioned for receiving tissue, a fastener attachment mechanism is positioned within the cavity for access to tissue that is pulled within the cavity, the fastener attachment mechanism includes a plurality of fasteners;   positioning the gastric reduction apparatus such that the opening of the cavity is adjacent a predetermined portion of the stomach wall;   creating a vacuum within the cavity, drawing predetermined tissue of the stomach wall within the cavity;   actuating the fastener attachment mechanism to secure the fastener within the tissue of the stomach.   
     
     
         20 . The method according to  claim 19 , wherein the process is repeated at a variety of predetermined stomach wall locations. 
     
     
         21 . The method according to  claim 19 , wherein the fasteners are applied vertically along the stomach. 
     
     
         22 . The method according to  claim 21 , wherein the fasteners are applied vertically along the stomach creating a fastener arrangement necessary to ultimately form a suturing pattern. 
     
     
         23 . The method according to  claim 19 , wherein the fasteners are applied to the stomach wall alternating between the anterior wall and posterior wall of the stomach. 
     
     
         24 . The method according to  claim 19 , wherein a flexible member is prestrung to the fasteners. 
     
     
         25 . The method according to  claim 24 , wherein the flexible member is strung to create a stitch pattern within the stomach. 
     
     
         26 . The method according to  claim 24 , wherein the flexible member is strung to create a stitch pattern within the stomach in a substantially vertical direction extending distally and proximally within the stomach.