Methods and devices for manipulating and fastening tissue

Abstract

A tissue displacing and fastening device is provided for manipulating and fastening tissue together. The device includes a tissue displacing elements, which displaces tissue. A fold is formed from the displaced tissue and the tissue is fastened together to secure the fold.

What is claimed is: 
     
         1 . A tissue grasper, comprising:
 an elongate body having an outer surface, the elongate body defining a longitudinal axis;   a plurality of vacuum orifices positioned on the outer surface of the elongate body, the plurality of vacuum orifices positioned on the outer surface forming a sealing surface to adhere the outer surface of the elongate body to tissue using suction.   
     
     
         2 . The tissue grasper of  claim 1 , wherein:
 the plurality of vacuum orifices include a first section and a second section, the first and second sections both extending partially around the outer surface of the elongate body when viewed along the longitudinal axis.   
     
     
         3 . The tissue grasper of  claim 2 , wherein:
 the first section is rotatable about the longitudinal axis relative to the second section.   
     
     
         4 . The tissue grasper of  claim 3 , wherein:
 the first and second section are both rotatable about the longitudinal axis.   
     
     
         5 . The tissue grasper of  claim 2 , wherein:
 the first section extends less than 100 degrees around the outer surface when viewed along the longitudinal axis.   
     
     
         6 . The tissue grasper of  claim 2 , wherein:
 the first and second sections are movable to the same longitudinal position relative to the longitudinal axis.   
     
     
         7 . The tissue grasper of  claim 6 , wherein:
 the first and second sections form a window when positioned at the same longitudinal position, the window forming a gap between the first and second sections.   
     
     
         8 . The tissue grasper of  claim 7 , further comprising:
 a tissue shaper coupled to the elongate body, the tissue shaper defining a fastener application site, the tissue shaper also having a fastener which is directed through the fastener application site when applied to tissue in the tissue shaper; and   the first and second sections are movable relative to the tissue shaper so that the fastener application site is positioned in the window formed between the first and second sections.   
     
     
         9 . The tissue grasper of  claim 2 , wherein:
 the plurality of vacuum orifices include a third section extending partially around the outer surface of the elongate body when viewed along the longitudinal axis, the first and second sections being rotatable about the longitudinal axis and longitudinally translatable relative to the third section.   
     
     
         10 . The tissue grasper of  claim 1 , wherein:
 the plurality of vacuum orifices form a circumferential sealing surface to adhere the outer surface to tissue.   
     
     
         11 . The tissue grasper of  claim 1 , further comprising:
 a recess extending below the outer surface of at least one of the plurality of vacuum orifices; and   a tissue piercing element movable between a stored position and a working position, the piercing element having a sharp tip to pierce tissue when tissue is drawn into the recess through the at least one vacuum orifice using suction, the piercing element moving outwardly from the recess to engage tissue when moving from the stored position to the working position.   
     
     
         12 . The tissue grasper of  claim 11 , wherein:
 the sharp tip extends no more than 4 mm from the outer surface of the elongate body when in the working position.   
     
     
         13 . The tissue grasper of  claim 11 , wherein:
 the sharp tip is positioned below the outer surface in the stored position.   
     
     
         14 . The tissue grasper of  claim 11 , further comprising:
 an actuator operably coupled to the tissue piercing element to move the tissue piercing element between the stored position and the working position.   
     
     
         15 . The tissue grasper of  claim 14 , wherein:
 the actuator includes a first cam surface; and   the tissue piercing element includes a second cam surface, wherein the first cam surface of the actuator slides against the second cam surface of the tissue piercing element to move the tissue piercing element outwardly from the recess.   
     
     
         16 . The tissue grasper of  claim 14 , wherein:
 the tissue piercing element is biased into the working position by the actuator;   the actuator applying a force to move the tissue piercing element to the working position, the tissue piercing element being in a biased position when in the working position; and   the tissue piercing element moving back to the stored position upon release of the force applied by the actuator.   
     
     
         17 . The tissue grasper of  claim 16 , wherein:
 the actuator includes a wedge coupled to a pull wire, the pull wire being tensioned to move the wedge, the wedge being slidable against the tissue piercing element to move the tissue piercing element to the working position.   
     
     
         18 . The tissue grasper of  claim 11 , wherein:
 the recess includes a slot having sidewalls; and   the tissue piercing element is guided by the sidewalls of the slot when moving from the stored position to the working position.   
     
     
         19 . The tissue grasper of  claim 11 , further comprising:
 the plurality of vacuum orifices include a first section and a second section, the first section extending less than 100 degrees around the elongate body when viewed along the longitudinal axis and being rotatable relative to the second section;   the tissue piercing element is positioned along the first section and extends through a vacuum orifice along the first section.   
     
     
         20 . The tissue grasper of  claim 19 , wherein:
 the second section extends partially around the outer surface of the elongate body when viewed along the longitudinal axis;   the recess extending from at least one vacuum orifice along the first section.   
     
     
         21 . The tissue grasper of  claim 1 , wherein:
 the plurality of vacuum orifices include a first section and a second section which extends partially around the outer surface of the elongate body, the first section being rotatable about the longitudinal axis relative to the second section, the first section extending less than 100 degrees around the outer surface when viewed along the longitudinal axis.   
     
     
         22 . The tissue grasper of  claim 1 , wherein:
 the plurality of vacuum orifices include a first section, a second section, a third section and a fourth section, the first section and the second section together configured to form the circumferential sealing surface with tissue adjacent the elongate body using suction, the third section and the fourth section both extending less than 100 degrees around the outer surface when viewed along the longitudinal axis, the third section being rotatable about the longitudinal axis relative to the first and second sections.   
     
     
         23 . The tissue grasper of  claim 22 , wherein:
 the third section and the fourth section are movable to the same longitudinal position.   
     
     
         24 . The tissue grasper of  claim 1 , further comprising:
 a reinforcing element coupled to the elongate body.   
     
     
         25 . The tissue grasper of  claim 24 , wherein:
 the reinforcing element has a first side and a second side, the tissue grasper supporting the reinforcing element to expose the first and second sides for application of a fastener.   
     
     
         26 . The tissue grasper of  claim 25 , wherein:
 the reinforcing element remains attached to the elongate body after the first side is attached to tissue for controlling the tissue attached to the reinforcing element.   
     
     
         27 . The tissue grasper of  claim 26 , wherein:
 the reinforcing element remains attached to the elongate body after the second side is attached to tissue for controlling the tissue with the reinforcing element.   
     
     
         28 . The tissue grasper of  claim 24 , wherein:
 the reinforcing element includes a woven element having an interstitial space configured to receive a fastener.   
     
     
         29 . The tissue grasper of  claim 24 , wherein:
 the reinforcing element includes a reinforced polymer sheet.   
     
     
         30 . The tissue grasper of  claim 24 , wherein:
 the reinforcing element has a first eyelet which receives a first fastener on the first side and a second eyelet that receives a second fastener on the second side.   
     
     
         31 . The tissue grasper of  claim 1 , further comprising:
 a first tissue shaper having a first shaft coupled to the elongate body, the first shaft extending through the elongate body and being rotatable relative to the elongate body about the longitudinal axis, the first tissue shaper also being longitudinally translatable relative to the elongate body, the first tissue shaper forming a first cavity and also having a first tissue displacing element, the first tissue displacing element having a first tissue engaging element, the first tissue displacing element configured to extend from the first cavity and draw tissue into the first cavity.   
     
     
         32 . The tissue grasper of  claim 31 , wherein:
 the first tissue displacing element is configured to engage tissue outside the first cavity and move the tissue into the first cavity.   
     
     
         33 . The tissue grasper of  claim 31 , wherein:
 the first tissue shaper includes a first mold pivotally coupled to the first shaft, the first shaft extending longitudinally from the elongate body, the first tissue shaper forming the first cavity between the first mold and the first shaft.   
     
     
         34 . The tissue grasper of  claim 31 , further comprising:
 a second tissue shaper having a second shaft coupled to the first shaft, the second tissue shaper being rotatable about the longitudinal axis relative to the first tissue shaper, the second tissue shaper forming a second cavity, the second tissue shaper also including a second tissue displacing element having a second tissue engaging element, the second tissue displacing element configured to engage tissue outside the second tissue shaper and displace the tissue into the second cavity.   
     
     
         35 . The tissue grasper of  claim 34 , wherein:
 the first and second shafts both extending longitudinally from the elongate body.   
     
     
         36 . The tissue grasper of  claim 34 , wherein:
 the second tissue shaper includes a second mold pivotally coupled to the second shaft.   
     
     
         37 . The tissue grasper of  claim 34 , wherein:
 the second tissue shaper has a second cavity formed between the second mold and the first shaft.   
     
     
         38 . The tissue grasper of  claim 33 , further comprising:
 a first tissue shifting element coupled to the first tissue shaper;   the first mold being movable from a closed position to a partially closed position, the closed position configured to mold tissue for application of the fastener to tissue contained in the first mold;   the first tissue shifting element being movable relative to the mold to shift tissue further into the first mold when the first mold is in the partially closed position.   
     
     
         39 . The tissue grasper of  claim 38 , wherein:
 the first tissue shifting element is positioned to shift a radially inner side of tissue contained within the first mold further into the first mold when the first mold is in the partially closed position.   
     
     
         40 . The tissue grasper of  claim 38 , wherein:
 the first tissue shifting element is positioned to shift a radially outer side of tissue contained further into the first mold.   
     
     
         41 . The tissue grasper of  claim 40 , further comprising:
 a second tissue shifting element coupled to the first shaft, the second tissue shifting element positioned to shift a radially inner side of tissue further into the first mold.   
     
     
         42 . The tissue grasper of  claim 41 , wherein:
 the first and second tissue shifting elements shift the radially inner side and the radially outer side simultaneously.   
     
     
         43 . The tissue grasper of  claim 38 , wherein:
 the first tissue shifting element defines an axis of motion when moving tissue within the first mold, the first tissue shifting element having a maximum transverse dimension measured transverse to the axis of motion which is at least 75% of a maximum transverse dimension of the first mold.   
     
     
         45 . The tissue grasper of  claim 38 , wherein:
 the first tissue shifting element is a plate having integrally formed barbs.   
     
     
         47 . A method of forming a fold adjacent and continuous with a previously formed fold, comprising the steps of:
 providing a device having a tissue grasper and a first tissue shaper coupled to the tissue grasper, the tissue grasper having an elongate body and a plurality of vacuum orifices on an outer surface to adhere tissue to the outer surface of the elongate body, the first tissue shaper forming a first cavity and having a first tissue displacing element, the first tissue displacing element configured to engage stomach tissue outside the first cavity and draw the stomach tissue into the first cavity;   forming a first fold with the device using stomach tissue;   fastening the first fold together using a first fastener;   forming a second fold in the first cavity using stomach tissue displaced into the first cavity with the first tissue displacing element, the second fold being continuous with the first fold;   fastening the second fold together with a second fastener;   grasping the first fold with the device; and   spreading apart the tissue shaper from the tissue grasper when the second fold is contained in the cavity and before fastening the second fold with the second fastener.   
     
     
         48 . The method of  claim 47 , wherein:
 the providing step is carried out with the tissue grasper having a first section extending less than 100 degrees around the elongate body when viewed along the longitudinal axis; and   the grasping step is carried out with the first section of the tissue grasper.   
     
     
         49 . The method of  claim 47 , wherein:
 the providing step is carried out with the tissue grasper having a first section and a second section, the first section being rotatable relative to the tissue shaper about the longitudinal axis.   
     
     
         50 . The method of  claim 49 , wherein:
 the grasping step is carried out with the first section grasping the first fold;   the fastening step for forming the first fold being carried out to form the first fold continuous with a prior fold formed by the tissue shaper, the first fold and the prior fold forming a combined fold; and   the grasping step is carried out with the second section grasping the combined fold.   
     
     
         51 . The method of  claim 49 , wherein:
 the providing step is carried out with the second section extending less than 100 degrees relative to the longitudinal axis.   
     
     
         52 . The method of  claim 49 , wherein:
 the spreading step is carried out with the first section being spread apart from the tissue shaper and the second section being spread apart from the first section and the tissue shaper.   
     
     
         53 . The method of  claim 47 , wherein:
 the providing step is carried out with the tissue shaper having a shaft extending longitudinally from the elongate body, the shaft being rotatable relative to the body and longitudinally translatable relative to the tissue grasper, the tissue shaper also having a mold pivotally coupled to the shaft, the cavity being formed between the mold and the shaft when the mold is in a closed position.   
     
     
         54 . The method of  claim 47 , wherein:
 the providing step is carried out with the device having a second tissue shaper forming a second cavity and having a second tissue displacing element, the second tissue displacing element configured to engage stomach tissue outside the second cavity and draw the stomach tissue into the second cavity;   the grasping step being carried out by grasping the first fold with the second tissue shaper.   
     
     
         55 . A method of forming a fold adjacent and continuous with a previously formed fold, comprising the steps of:
 providing a device having a tissue grasper, and a first tissue shaper coupled to the tissue grasper, the tissue grasper having an elongate body and a plurality of vacuum orifices on an outer surface to adhere tissue to the outer surface of the elongate body, the first tissue shaper forming a first cavity and having a first tissue displacing element, the first tissue displacing element configured to engage stomach tissue outside the first cavity and draw the stomach tissue into the first cavity;   displacing tissue toward the first shaper with the first tissue displacing element so that a first fold is formed continuous with a previously formed fold;   displacing tissue toward the second shaper with the second tissue displacing element so that a second fold is formed continuous with the first fold, the first fold being positioned between the previously formed fold and the second fold;   fastening the first fold with a first fastener while grasping the second fold with the second tissue shaper.   
     
     
         56 . The method of  claim 55 , further comprising the step of:
 spreading apart the first tissue shaper from the second tissue shaper.   
     
     
         57 . The method of clam  55 , further comprising the step of:
 the providing step being carried out with the first tissue shaper being rotatable relative to the tissue grasper; and   rotating the first tissue shaper past the second tissue shaper; and   forming a third fold with the second tissue shaper continuous with the second fold while the first tissue shaper holds the second fold.   
     
     
         58 . A method of forming a fold in the stomach adjacent a previously formed fold, comprising the steps of:
 providing a tissue shaper and a tissue grasper, the tissue shaper having a tissue displacing element and the tissue grasper having an elongate body defining a longitudinal axis, the elongate body having a plurality of vacuum orifices on an outer surface, the tissue shaper being coupled to the elongate body;   forming a first fold of stomach tissue;   applying a first fastener to the first fold to secure the first fold;   engaging stomach tissue with the tissue displacing element;   displacing the stomach tissue into the stomach to create a radially inner layer and a radially outer layer;   engaging the radially inner layer with the tissue grasper at a position between the first fastener and the tissue displacing element; and   spreading apart the tissue grasper and the first fastener to apply tension to tissue between the tissue grasper and the first fastener; and   positioning the tissue shaper between the tissue grasper and the first fastener after the spreading step; and   applying a second fastener to the stomach tissue positioned in the tissue shaper while the tissue grasper maintains tension on the tissue.   
     
     
         59 . The method of  claim 58 , wherein:
 the providing step is carried out with the tissue grasper having a first section extending less than 100 degrees around the elongate body;   the spreading step being carried out with the first section of the tissue grasper.