Endoluminal device with retractor system

Abstract

Improved methods and devices for performing an endoscopic surgery are provided. Systems are taught for operatively treating gastrointestinal disorders endoscopically in a stable, yet dynamic operative environment, and in a minimally-invasive manner. Such systems include, for example, an endoscopic surgical suite. The surgical suite can have a reversibly-expandable retractor that expands to provide a stable, operative environment within a subject. The expansion can be asymmetric around a stabilizer subsystem to maximize space for a tool and an endoscope to each be maneuvered independently to visualize a target tissue and treat the target tissue from outside the patient in a minimally invasive manner.

We claim: 
     
       1. An endoluminal device for insertion into a lumen within a patient, the endoluminal device comprising:
 a tubular member having at least one lumen formed therein dimensioned to receive an endoscopic instrument, the lumen having a proximal opening at a proximal portion of the tubular member and a distal opening communicating with the lumen, the lumen terminating in the distal opening; and 
 a chamber at a distal portion of the device, the chamber positioned distal of the distal opening and lumen and the distal opening communicating with the chamber, the chamber including first, second and third elements, the second and third elements connected at a distal portion of the second and third elements to a distal nexus, the distal nexus having an opening dimensioned for passage of an endoscope, the second and third elements movable from an insertion position for insertion into the body lumen of the patient to a second expanded position to create a chamber of increased transverse dimension, the first element providing a stiffened structure distal of the tubular member and distal opening and along the chamber to stabilize the chamber. 
 
     
     
       2. The endoluminal device of  claim 1 , further comprising a stiffening member, the stiffening member movable axially from a first position to a second more distal position to stiffen the first element, the stiffening member having a distal end distal of the distal opening in the second position. 
     
     
       3. The endoluminal device of  claim 2 , wherein the stiffening member is axially slidable to slidably engage the first element to transition the first element from a first condition to a second more stiffened condition. 
     
     
       4. The endoluminal device of  claim 2 , further comprising an actuator operatively connected to the stiffening member, the actuator operable to slide the stiffening member axially from the first position to the second more distal position. 
     
     
       5. The endoluminal device of  claim 4 , further comprising a second actuator independent of the first actuator and operatively connected to the second and third elements to move the second and third elements between the insertion and expanded positions. 
     
     
       6. The endoluminal device of  claim 5 , wherein the actuator has multiple fixed positions for achieving multiple fixed expanded positions of the second and third elements. 
     
     
       7. The endoluminal device of  claim 1 , wherein the first element forms a substantially rigid beam to provide structural support for the chamber, the substantially rigid beam is closer to a longitudinal axis of the device than the second and third elements in the expanded position. 
     
     
       8. The endoluminal device of  claim 1 , wherein the tubular member is dimensioned to receive an imaging device. 
     
     
       9. The endoluminal device of  claim 1 , wherein the chamber expands asymmetrically such that the chamber extends radially more to one side of a longitudinal axis of the device. 
     
     
       10. The endoluminal device of  claim 1 , wherein the tubular member comprises a multi-lumen tube with at least two radially spaced working channels to receive an endoscopic instrument through each working channel. 
     
     
       11. The endoluminal device of  claim 1 , wherein the tubular member comprises a multi-lumen tube having radially spaced lumens to receive at least two tool channels to guide insertion of endoscopic tools, the tool channels being bendable within the chamber to angle a distal end of the endoscopic tool inserted therethrough. 
     
     
       12. The endoluminal device of  claim 1 , wherein the first element provides stiffened structure stiffer than the second and third elements. 
     
     
       13. An endoluminal device for insertion into a lumen within a patient, the endoluminal device comprising:
 a tubular member having at least one lumen formed therein dimensioned to receive an endoscopic instrument and an opening communicating with the lumen; 
 a chamber at a distal portion of the device, the chamber including first, second and third elements, the second and third elements connected at a distal portion of the second and third elements and movable from an insertion position for insertion into the body lumen of the patient to a second expanded position to create a chamber of increased transverse dimension, the first element providing a stiffened structure along the chamber to stabilize the chamber; 
 a stiffening member, the stiffening member movable from a first position to a second more distal position to stiffen the first element; and 
 the first element includes a lumen formed therein and the stiffening member is movable within the lumen to transition the first element from a first condition to a second more stiffened condition. 
 
     
     
       14. An endoluminal device for insertion within a lumen of a patient comprising:
 a tubular member having at least one lumen formed therein to receive an endoscopic instrument and a distal opening communicating with the lumen, the lumen terminating distally at the distal opening; and 
 a chamber positioned distal of the distal opening and lumen such that the distal opening is proximal of the chamber and communicates with the chamber, the chamber having an insertion position and at least one expanded position creating a space distal of the distal opening, and further having a flexible condition and a more stiffened condition, and an elongated longitudinally extending substantially rigid beam movable within a lumen of a first element, the rigid beam causing the chamber to be in the more stiffened condition in a position distal of the distal opening and lumen, wherein the two retractor elements extend laterally outwardly to a greater extent than the substantially rigid beam when the chamber is in the expanded position. 
 
     
     
       15. The endoluminal device of  claim 14 , further comprising an axially slidable member to transition the chamber to the more stiffened condition, the axially slidable member positionable distal of the distal opening. 
     
     
       16. The endoluminal device of  claim 14 , wherein the chamber includes a plurality of flexible elements and expansion of the flexible elements is disproportionately greater on a side between the substantially rigid beam and target tissue than on a side between the substantially rigid beam and an opposing wall of the target tissue. 
     
     
       17. The endoluminal device of  claim 14 , further comprising a first actuator for reversibly moving the chamber between the insertion and expanded positions. 
     
     
       18. The endoluminal device of  claim 17 , further comprising a second actuator independent of the first actuator for reversibly moving the chamber between the flexible condition and more stiffened condition.