Methods and Devices for Diagnostic and Therapeutic Interventions in the Peritoneal Cavity

Abstract

A novel approach to diagnostic and therapeutic interventions in the peritoneal cavity is described. More specifically, a technique for accessing the peritoneal cavity via the wall of the digestive tract is provided so that examination of and/or a surgical procedure in the peritoneal cavity can be conducted via the wall of the digestive tract with the use of a flexible endoscope. As presently proposed, the technique is particularly adapted to transgastric peritoneoscopy. However, access in addition or in the alternative through the intestinal wall is contemplated and described as well. Transgastric and/or transintestinal peritoneoscopy will have an excellent cosmetic result as there are no incisions in the abdominal wall and no potential for visible post-surgical scars or hernias.

What is claimed is: 
     
         1 . A method for incision and dilation to provide access through a wall of an organ or body passage, comprising:
 a) providing an overtube having a distal end including first and second longitudinally spaced-apart and separately inflatable balloons, the overtube defining a lumen;   b) inserting an endoscope through the lumen of the overtube, the endoscope having an accessory channel;   c) advancing the overtube to a location adjacent the wall;   d) providing an incising/dilating device through the accessory channel of the endoscope, the incising/dilating device adapted to sequentially incise and dilate tissue;   e) incising an opening in the wall of the organ or body passage distal of the overtube with the incising/dilating device;   f) after the wall is incised, dilating the incised opening in the wall of the organ or body passage with the incising/dilating device;   g) advancing the overtube through the wall; and   h) inflating the balloons of the overtube on opposing sides of the wall to removably secure the overtube relative to the wall.   
     
     
         2 . The method of  claim 1 , further comprising:
 deflating the incising/dilating device; and   retracting at least the incising portion of the incising/dilating device relative to the wall.   
     
     
         3 . The method of  claim 2 , wherein deflation of the incising/dilating device is effected prior to insertion of the overtube through the dilated tissue. 
     
     
         4 . The method of  claim 1 , further comprising insertion of a guide wire through the opening after the step of incising and before the step of advancing the overtube through the wall. 
     
     
         5 . The method of  claim 1 , wherein the incising/dilating device includes a conduit having a proximal end and a distal end, an elongate dilating balloon provided at the distal end of the conduit, an inflation lumen extending along the conduit for inflating the balloon, a needle knife extendable distally relative to the dilating balloon, and a proximal actuator coupled to the needle knife and the proximal end of the conduit to effect longitudinal displacement of the needle knife relative to the distal end of the conduit and the dilating balloon. 
     
     
         6 . The method according to  claim 5 , wherein the proximal actuator and the needle knife are removable from the conduit and the dilating balloon. 
     
     
         7 . The method according to  claim 6 , wherein a threaded connection is provided between the proximal actuator and the proximal end of the conduit. 
     
     
         8 . The method according to  claim 5 , wherein the retracting includes retracting the needle knife relative to the balloon. 
     
     
         9 . The method according to  claim 5 , wherein the needle knife is an electrosurgical knife adapted to cut and cauterize tissue of the wall. 
     
     
         10 . The method according to  claim 5 , wherein the dilating balloon has an inflated diameter, and a length at least twice the inflated diameter. 
     
     
         11 . The method according to  claim 9 , wherein the dilating balloon has an inflated diameter, and a length three to five times the inflated diameter. 
     
     
         12 . The method according to  claim 1 , wherein the advancing the overtube to a location occurs through a natural body orifice and within a natural body lumen. 
     
     
         13 . A method for incision and dilation to provide access through a wall of an organ or body passage, comprising:
 a) incising the wall with a needle knife to create an incision in the wall;   b) inserting an inflatable elongate dilating balloon across the incision;   c) inflating the dilating balloon to dilate the incision in the wall;   d) deflating the dilating balloon; and   e) advancing an overtube through the dilated incision in the wall;   f) removably securing the overtube within the dilated incision in the wall.   
     
     
         14 . The method according to  claim 13 , further comprising:
 inserting a guide wire through the incision before the overtube is advanced therethrough.   
     
     
         15 . The method according to  claim 13 , wherein the needle knife and the elongate balloon are coupled to a common instrument. 
     
     
         16 . The method according to  claim 15 , wherein the needle knife is retractable relative to the dilating balloon. 
     
     
         17 . The method according to  claim 13 , wherein the needle knife and the elongate balloon are extended through an accessory channel of an endoscope, and the endoscope extends through the overtube. 
     
     
         18 . The method according to  claim 13 , wherein the overtube includes proximal and distal spaced-apart and separately inflatable balloons, and the removably securing includes inflating the proximal and distal balloons on opposite sides of the wall to secure the overtube relative to the wall. 
     
     
         19 . The method according to  claim 18 , wherein the proximal balloon is inflated prior to inflation of the distal balloon to function as a stop for advancement of the overtube through the wall. 
     
     
         20 . The method according to  claim 13 , wherein the needle knife is an electrosurgical knife adapted to cut and cauterize tissue of the wall. 
     
     
         21 . The method according to  claim 13 , wherein the dilating balloon has an inflated diameter, and a length at least twice the inflated diameter. 
     
     
         22 . The method according to  claim 13 , wherein the dilating balloon has an inflated diameter, and a length three to five times the inflated diameter. 
     
     
         23 . A method for incision and dilation to provide access through a wall of an organ or body passage, comprising:
 a) providing a device including an elongate dilating balloon and a needle knife longitudinally displaceable through the dilating balloon;   b) creating an incision in the wall with the needle knife;   c) advancing the dilating balloon through the incision;   d) inflating the dilating balloon to dilate the incision;   e) retracting the needle knife; and   f) deflating the dilating balloon.   
     
     
         24 . The method according to  claim 23 , wherein the needle knife is retracted relative to the dilating balloon prior to advancing the dilating balloon through the incision. 
     
     
         25 . The method according to  claim 23 , further comprising:
 advancing a guide wire through the incision prior to dilating the dilating balloon.   
     
     
         26 . The method according to  claim 25 , further comprising:
 decoupling the needle knife from the dilating balloon; and   withdrawing the needle knife from within the dilating balloon,   
       both prior to advancing the guide wire. 
     
     
         27 . The method according to  claim 23 , wherein the step of creating an incision includes applying a cautery current to the needle knife. 
     
     
         28 . The method according to  claim 23 , wherein the dilating balloon has an inflated diameter, and a length at least twice the inflated diameter. 
     
     
         29 . The method according to  claim 23 , wherein the dilating balloon has an inflated diameter, and a length three to five times the inflated diameter. 
     
     
         30 . The method according to  claim 23 , further comprising advancing an overtube through the dilated incision. 
     
     
         31 . The method according to  claim 30 , further comprising removably securing the overtube to the tissue at the dilated incision. 
     
     
         32 . The method according to  claim 30 , wherein an endoscope extends through the overtube. 
     
     
         33 . The method according to  claim 32 , wherein the endoscope includes an accessory channel, and the dilating balloon and the needle knife are extended through the accessory channel prior to the steps of creating, advancing and inflating. 
     
     
         34 . The method according to  claim 23 , further comprising:
 providing an endoscope with an accessory channel, and the dilating balloon and the needle knife are extended through the accessory channel prior to the steps of creating, advancing and inflating.   
     
     
         35 . A method for incision and dilation to provide access through a wall of an organ or body passage, comprising:
 a) incising the wall with a needle knife to create an incision in the wall;   b) inserting a deflated inflatable elongate dilating balloon to extend across the incision in the wall;   c) inserting a guide wire to extend through the incision in the wall;   d) inflating the dilating balloon to dilate the incision in the wall;   e) deflating the dilating balloon; and   f) retracting the dilating balloon from the incision in the wall   
     
     
         36 . The method according to  claim 35 , further comprising:
 advancing an overtube through the dilated incision in the wall, the overtube defining a central lumen.   
     
     
         37 . The method according to  claim 36 , wherein the needle knife and the dilating balloon are advanced through the overtube prior to advancing the overtube through the incision in the wall. 
     
     
         38 . The method according to  claim 36 , further comprising:
 anchoring the overtube to the wall.   
     
     
         39 . The method according to  claim 35 , wherein the overtube is advanced with an endoscope extending within the central lumen of the overtube. 
     
     
         40 . The method according to  claim 35 , wherein the dilating balloon has a length defining a longitudinal axis, and the needle knife and guidewire each extend coaxially with the dilating balloon during use. 
     
     
         41 . The method according to  claim 35 , wherein the dilated balloon is deflated prior to being retracted. 
     
     
         42 . The method according to  claim 35 , further comprising retracting the needle knife prior to inserting the deflated dilating balloon across the incision. 
     
     
         43 . The method according to  claim 42 , wherein the needle knife is retracted into the dilating balloon prior to inserting the deflated dilating balloon across the incision. 
     
     
         44 . The method according to  claim 35 , further providing an instrument including a conduit having a proximal end and a distal end, the dilating balloon provided at the distal end of the conduit, an inflation lumen extending along the conduit for inflating the balloon, the needle knife extendable distally relative to the dilating balloon, and a proximal actuator handle coupled to the needle knife and to the proximal end of the conduit to effect longitudinal displacement of the needle knife relative to the distal end of the conduit and the dilating balloon. 
     
     
         45 . The method according to  claim 44 , wherein the step of incising the wall includes applying a cautery current to the needle knife 
     
     
         46 . The method according to  claim 35 , wherein the dilating balloon has an inflated diameter, and a length at least twice the inflated diameter. 
     
     
         47 . The method according to  claim 35 , wherein the dilating balloon has an inflated diameter, and a length three to five times the inflated diameter. 
     
     
         48 . The method according to  claim 35 , wherein the needle knife and the elongate balloon are coupled as part of a common instrument, and the common instrument is inserted within an accessory channel of an endoscope.