Endoscopic instrument

Abstract

An endoscopic surgical instrument includes a flexible tube, a grasping and fastening end effector coupled to the distal end of the tube, and a manual actuator coupled to the proximal end of the tube. The manual actuator is coupled to the end effector by a plurality of flexible cables which extend through the tube. The tube contains a lumen for receiving a manipulable endoscope and the end effector includes a passage for the distal end of the endoscope. The end effector has a store for a plurality of male fastener parts, a store for a plurality of female fastener parts, a rotatable grasper, a rotatable fastener head for aligning a female fastener part and a male fastener part with tissues therebetween, and a firing member for pressing a male fastener part through tissues grasped by the grasper and into a female fastener part. According to a presently preferred embodiment the overall diameters of the flexible tube and the end effector (when rotated to the open position) do not exceed approximately 20 mm so that the instrument may be delivered transorally to the fundus of the stomach. The manual actuator is provides with a lock-out feature which prevents firing male fastener parts before the fastener head is closed. The instrument is advantageously utilized in a fundoplication procedure.

1 - 109 . (canceled) 
     
     
         110 . An endoscopic instrument for fastening tissue within a body, comprising:
 an elongated tube having a longitudinal axis, and   a distal member coupled to the tube, the distal member comprising   (a) an opening, and   (b) a movable member having a free end and a connected end,   wherein, the movable member is configured to move between a first position in which the free end is aligned with the longitudinal axis and is located distally of the connected end, and a second position different than the first position.   
     
     
         111 . The instrument of  claim 110 , wherein the opening is configured to hold a tissue piercing member. 
     
     
         112 . The instrument of  claim 110 , wherein the free end rotates about an axis transverse to the longitudinal axis from the first position to the second position. 
     
     
         113 . The instrument of  claim 110 , wherein the movable member is a first movable member, and the distal member comprises a second movable member having a free end. 
     
     
         114 . The instrument of  claim 113 , wherein each of the free ends of the first and second movable members is configured to contact target tissue. 
     
     
         115 . The instrument of  claim 110 , wherein the distal member is configured to fold at least one layer of target tissue. 
     
     
         116 . The instrument of  claim 110 , further comprising one or more control members extending through the elongated tube for controlling the movable member. 
     
     
         117 . An endoscopic instrument for fastening tissue within a body comprising:
 an elongated tube having a longitudinal axis; and   a distal member coupled to the tube, the distal member comprising:
 a stationary member aligned with the longitudinal axis, and 
 a movable member comprising:
 a connected end connected to the stationary member, and 
 a free end configured to rotate about an axis transverse to the longitudinal axis via a pivot axle. 
 
   
     
     
         118 . The instrument of  claim 117 , wherein the distal member further comprises an opening configured to hold a tissue piercing member. 
     
     
         119 . The instrument of  claim 117 , wherein the movable member is a first movable member, and the distal member further comprises a second movable member having a free end. 
     
     
         120 . The instrument of  claim 119 , wherein each of the free ends of the first and second movable members is configured to contact target tissue. 
     
     
         121 . The instrument of  claim 117 , wherein the movable member is configured to move between a first position in which the free end is aligned with the longitudinal axis and is located distally of the connected end, and a second position different than the first position. 
     
     
         122 . The instrument of  claim 117 , further comprising one or more control members extending through the elongated tube for controlling the movable member. 
     
     
         123 . An endoscopic instrument for fastening tissue within a body, comprising:
 an elongated tube having a longitudinal axis;   a distal member coupled to the tube, wherein the distal member includes a movable member having a free end and a connected end, and the movable member is configured to move between a first position in which the free end is aligned with the longitudinal axis, and a second position different than the first position; and   an actuator configured to actuate the movable member to rotate the free end about an axis transverse to the longitudinal axis.   
     
     
         124 . The instrument of  claim 123 , wherein the free end rotates via a pivot axle. 
     
     
         125 . The instrument of  claim 123 , wherein the distal member is configured to fold at least one layer of target tissue. 
     
     
         126 . The instrument of  claim 123 , wherein the distal member includes an opening configured to hold a tissue piercing member. 
     
     
         127 . The instrument of  claim 123 , wherein the movable member is a first movable member, and the distal member comprises a second movable member having a free end. 
     
     
         128 . The instrument of  claim 123 , wherein the actuator is coupled to an elongate actuation member extending through the tube. 
     
     
         129 . The instrument of  claim 128 , wherein a distal end of the actuation member is coupled to the movable member, and the actuator is coupled to a handle member.