US20060009792A1 - Tissue fixation assembly having prepositioned fasteners and method - Google Patents

Abstract

A tissue fastener assembly delivers a fastener for deployment. The assembly includes a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members. The first member has a longitudinal axis and a through channel along the axis. The assembly further includes a deployment wire slidingly received within the through channel of the first member that pierces into the tissue and guides the first member through the tissue, a guide structure defining a lumen that receives the fastener and deployment wire and guides the deployment wire and fastener to the tissue, and a fastener configuration structure that orientates the second member in a predetermined position relative to the first member within the lumen for dependable deployment.

Description

RELATED APPLICATION DATA
• The present patent application is a continuation-in-part application of U.S. patent application Ser. No. 10/783,717, filed Feb. 20, 2004.
FIELD OF THE INVENTION
• The present invention generally relates to tissue fixation devices, and more particularly to assemblies for deploying the same. The present invention more particularly relates to such assemblies wherein tissue fixation fasteners are prepositioned for reliable deployment.
BACKGROUND
• Gastroesophageal reflux disease (GERD) is a chronic condition caused by the failure of the anti-reflux barrier located at the gastroesophageal junction to keep the contents of the stomach from splashing into the esophagus. The splashing is known as gastroesophageal reflux. The stomach acid is designed to digest meat, and will digest esophageal tissue when persistently splashed into the esophagus.
• A principal reason for regurgitation associated with GERD is the mechanical failure of a deteriorated gastroesophageal flap to close and seal against high pressure in the stomach. Due to reasons including lifestyle, a Grade I normal gastroesophageal flap may deteriorate into a malfunctioning Grade III or absent valve Grade IV gastroesophageal flap. With a deteriorated gastroesophageal flap, the stomach contents are more likely to be regurgitated into the esophagus, the mouth, and even the lungs. The regurgitation is referred to as “heartburn” because the most common symptom is a burning discomfort in the chest under the breastbone. Burning discomfort in the chest and regurgitation (burping up) of sour-tasting gastric juice into the mouth are classic symptoms of gastroesophageal reflux disease (GERD). When stomach acid is regurgitated into the esophagus, it is usually cleared quickly by esophageal contractions. Heartburn (backwashing of stomach acid and bile onto the esophagus) results when stomach acid is frequently regurgitated into the esophagus and the esophageal wall is inflamed.
• Complications develop for some people who have GERD. Esophagitis (inflammation of the esophagus) with erosions and ulcerations (breaks in the lining of the esophagus) can occur from repeated and prolonged acid exposure. If these breaks are deep, bleeding or scarring of the esophagus with formation of a stricture (narrowing of the esophagus) can occur. If the esophagus narrows significantly, then food sticks in the esophagus and the symptom is known as dysphagia. GERD has been shown to be one of the most important risk factors for the development of esophageal adenocarcinoma. In a subset of people who have severe GERD, if acid exposure continues, the injured squamous lining is replaced by a precancerous lining (called Barrett's Esophagus) in which a cancerous esophageal adenocarcinoma can develop.
• Other complications of GERD may not appear to be related to esophageal disease at all. Some people with GERD may develop recurrent pneumonia (lung infection), asthma (wheezing), or a chronic cough from acid backing up into the esophagus and all the way up through the upper esophageal sphincter into the lungs. In many instances, this occurs at night, while the person is in a supine position and sleeping. Occasionally, a person with severe GERD will be awakened from sleep with a choking sensation. Hoarseness can also occur due to acid reaching the vocal cords, causing a chronic inflammation or injury.
• GERD never improves without intervention. Life style changes combined with both medical and surgical treatments exist for GERD. Medical therapies include antacids and proton pump inhibitors. However, the medical therapies only mask the reflux. Patients still get reflux and perhaps emphysema because of particles refluxed into the lungs. Barrett's esophagus results in about 10% of the GERD cases. The esophageal epithelium changes into tissue that tends to become cancerous from repeated acid washing despite the medication.
• Several open laparotomy and laproscopic surgical procedures are available for treating GERD. One surgical approach is the Nissen fundoplication. The Nissen approach typically involves a 360-degree wrap of the fundus around the gastroesophageal junction. The procedure has a high incidence of postoperative complications. The Nissen approach creates a 360-degree moveable flap without a fixed portion. Hence, Nissen does not restore the normal movable flap. The patient cannot burp because the fundus was used to make the repair, and may frequently experience dysphagia. Another surgical approach to treating GERD is the Belsey Mark IV (Belsey) fundoplication. The Belsey procedure involves creating a valve by suturing a portion of the stomach to an anterior surface of the esophagus. It reduces some of the postoperative complications encountered with the Nissen fundoplication, but still does not restore the normal movable flap. None of these procedures fully restores the normal anatomical anatomy or produces a normally functioning gastroesophageal junction. Another surgical approach is the Hill repair. In the Hill repair, the gastroesophageal junction is anchored to the posterior abdominal areas, and a 180-degree valve is created by a system of sutures. The Hill procedure restores the moveable flap, the cardiac notch and the Angle of His. However, all of these surgical procedures are very invasive, regardless of whether done as a laproscopic or an open procedure.
• New, less surgically invasive approaches to treating GERD involve transoral endoscopic procedures. One procedure contemplates a machine device with robotic arms that is inserted transorally into the stomach. While observing through an endoscope, an endoscopist guides the machine within the stomach to engage a portion of the fundus with a corkscrew-like device on one arm. The arm then pulls on the engaged portion to create a fold of tissue or radial plication at the gastroesophageal junction. Another arm of the machine pinches the excess tissue together and fastens the excess tissue with one pre-tied implant. This procedure does not restore normal anatomy. The fold created does not have anything in common with a valve. In fact, the direction of the radial fold prevents the fold or plication from acting as a flap of a valve.
• Another transoral procedure contemplates making a fold of fundus tissue near the deteriorated gastroesophageal flap to recreate the lower esophageal sphincter (LES). The procedure requires placing multiple U-shaped tissue clips around the folded fundus to hold it in shape and in place.
• This and the previously discussed procedure are both highly dependent on the skill, experience, aggressiveness, and courage of the endoscopist. In addition, these and other procedures may involve esophageal tissue in the repair. Esophageal tissue is fragile and weak. Involvement of esophageal tissue in the repair of a gastroesophageal flap valve poses unnecessary risks to the patient.
• A new and improved apparatus and method for restoration of a gastroesophageal flap valve is fully disclosed in U.S. Pat. No. 6,790,214, is assigned to the assignee of this invention, and is incorporated herein by reference. That apparatus and method provides a transoral endoscopic gastroesophageal flap valve restoration. A longitudinal member arranged for transoral placement into a stomach carries a tissue shaper that non-invasively grips and shapes stomach tissue. A tissue fixation device is then deployed to maintain the shaped stomach tissue in a shape approximating and restoring a gastroesophageal flap.
• Whenever tissue is to be maintained in a shape as, for example, in the improved assembly last mentioned above, it is necessary to fasten at least two layers of tissue together. In applications such as gastroesophageal flap valve restoration, there is very limited room to maneuver a fastener deployment device. For example, this and other medical fastening applications provide confined working channels and spaces and often must be fed through an endoscope to permit visualization or other small lumen guide catheters to the place where the fasteners are to be deployed. To make matters worse, multiple fasteners may also be required. Hence, with current fasteners and deployment arrangements, it is often difficult to direct a single fastener to its intended location, let alone a number of such fasteners.
• Once the fastening site is located, the fasteners employed must be truly able to securely maintain the tissue. Also, quite obviously, the fasteners are preferably deployable in the tissue in a manner which does not unduly traumatize the tissue. Moreover, the fasteners and deployment assemblies must assure dependable operation to negate the need for repeated deployment attempts.
SUMMARY
• The invention provides a fastener assembly comprising a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members. The first member has a longitudinal axis and a through channel along the axis. The assembly further comprises a deployment wire slidingly received within the through channel of the first member that pierces into the tissue and guides the first member through the tissue, a guide structure defining a lumen that receives the fastener and deployment wire and guides the deployment wire and fastener to the tissue, and a fastener configuration structure that orientates the second member in a predetermined position relative to the first member within the lumen.
• The fastener configuration structure orientates the second member along side the first member. The fastener configuration structure orientates the second member along side the first member with the connecting member between the first and second members. The fastener configuration structure orientates the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue.
• The first member of the fastener may have a lengthwise slit communicating with the through channel and the deployment wire may be received into the through channel through the slit.
• The assembly may further comprise a fastener loader that guides the first member slit into engagement with the deployment wire. The fastener loader is preferably arranged to hold a plurality of the fasteners. The fastener configuration structure may comprise a wall converging with the deployment wire and an outlet communicating with the lumen. The wall preferably converges with the deployment wire in a direction towards the tissue so that, when the second member engages the wall, the wall directs the second member to the predetermined position relative to the first member. The wall thus orientates the second member along side the first member.
• The invention further provides a fastener assembly comprising a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members. The first member has a longitudinal axis and a through channel along the axis. The assembly further comprises a deployment wire slidingly received within the through channel of the first member that pierces into the tissue and guides the first member through the tissue, and a guide structure defining a lumen that receives the fastener and deployment wire and guides the deployment wire and fastener to the tissue. The second member of the fastener is along side the first member with the connecting member between the first and second members within the lumen.
• The invention still further provides a method comprising providing a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members. The first member has a longitudinal axis and a through channel along the axis. The method further comprises mounting the fastener onto a deployment wire with the deployment wire slidingly received by the through channel of the first member, translating the fastener to within a lumen dimensioned to receive the fastener and deployment wire and which guides the deployment wire and fastener to tissue, and orientating the second member in a predetermined position relative to the first member as the fastener is translated to within the lumen.
BRIEF DESCRIPTION OF THE DRAWINGS
• The features of the present invention which are believed to be novel are set forth with particularity in the appended claims. The invention, together with further objects and advantages thereof, may best be understood by making reference to the following description taken in conjunction with the accompanying drawings, in the several figures of which like referenced numerals identify like elements, and wherein:
• FIG. 1 is a front cross-sectional view of the esophageal-gastro-intestinal tract from a lower portion of the esophagus to the duodenum;
• FIG. 2 is a front cross-sectional view of the esophageal-gastro-intestinal tract illustrating a Grade I normal appearance movable flap of the gastroesophageal flap valve (in dashed lines) and a Grade III reflux appearance gastroesophageal flap of the gastroesophageal flap valve (in solid lines);
• FIG. 3 is a perspective view of a fastener according to an embodiment of the invention;
• FIG. 4 is a perspective view of another fastener according to an embodiment of the invention;
• FIG. 5 is a perspective view with portions cut away of a fastener assembly according to an embodiment of the invention with the fastener prepositioned according to this embodiment and in an early stage of deployment;
• FIG. 6 is a perspective view of the assembly ofFIG. 5 shown with the fastener being driven in the tissue layers to be fastened;
• FIG. 7 is a perspective view of the assembly ofFIG. 5 shown with the fastener extending through the tissue layers to be fastened;
• FIG. 8 is a perspective view of the assembly ofFIG. 5 shown with the fastener initially deployed;
• FIG. 9 is a perspective view showing the fastener of the assembly ofFIG. 5 fully deployed and securely fastening a pair of tissue layers together;
• FIG. 10 is a perspective view of a further fastener embodying the invention;
• FIG. 11 is a side view of the fastener ofFIG. 10;
• FIG. 12 is a perspective view with portions cut away of a fastener assembly according to another embodiment of the invention with the fastener prepositioned and in an early stage of being deployed;
• FIG. 13 is a perspective view of the assembly ofFIG. 12 shown with the fastener being driven in the tissue layers to be fastened;
• FIG. 14 is a perspective view of the assembly ofFIG. 12 shown with the fastener in an intermediate stage of deployment;
• FIG. 15 is a perspective view of the assembly ofFIG. 12 shown with the fastener almost completely deployed;
• FIG. 16 is a perspective view showing the fastener of the assembly ofFIG. 5 fully deployed;
• FIG. 17 is a perspective view of a fastener assembly according to an embodiment of the invention;
• FIG. 18 is a perspective view, with portions cut away, of the assembly ofFIG. 18 showing a fastener being driven into a fastener configuration structure according to an embodiment of the invention;
• FIG. 19 is a simplified side view, partly in section, of the fastener configuration structure ofFIG. 19; and
• FIG. 20 is a perspective view of the assembly ofFIGS. 18 and 19 along with a fastener loader according to an embodiment of the invention for loading fasteners into the deployment assembly.
DETAILED DESCRIPTION
• FIG. 1 is a front cross-sectional view of the esophageal-gastro-intestinal tract40 from a lower portion of theesophagus41 to theduodenum42. Thestomach43 is characterized by thegreater curvature44 on the anatomical left side and thelesser curvature45 on the anatomical right side. The tissue of the outer surfaces of those curvatures is referred to in the art as serosa tissue. As will be seen subsequently, the nature of the serosa tissue is used to advantage for its ability to bond to like serosa tissue. Thefundus46 of thegreater curvature44 forms the superior portion of thestomach43, and traps gas and air bubbles for burping. Theesophageal tract41 enters thestomach43 at an esophageal orifice below the superior portion of thefundus46, forming acardiac notch47 and an acute angle with respect to thefundus46 known as the Angle of His57. The lower esophageal sphincter (LES)48 is a discriminating sphincter able to distinguish between burping gas, liquids, and solids, and works in conjunction with thefundus46 to burp. The gastroesophageal flap valve (GEFV)49 includes a moveable portion and an opposing more stationary portion. The moveable portion of theGEFV49 is an approximately 180 degree, semicircular, gastroesophageal flap50 (alternatively referred to as a “normal moveable flap” or “moveable flap”) formed of tissue at the intersection between theesophagus41 and thestomach43. The opposing more stationary portion of theGEFV49 comprises a portion of thelesser curvature45 of thestomach43 adjacent to its junction with theesophagus41. Thegastroesophageal flap50 of theGEFV49 principally comprises tissue adjacent to thefundus46 portion of thestomach43, is about 4 to 5 cm long (51) at it longest portion, and the length may taper at its anterior and posterior ends. Thegastroesophageal flap50 is partially held against thelesser curvature45 portion of thestomach43 by the pressure differential between thestomach43 and the thorax, and partially by the resiliency and the anatomical structure of theGEFV49, thus providing the valving function. TheGEFV49 is similar to a flutter valve, with thegastroesophageal flap50 being flexible and closeable against the other more stationary side.
• The esophageal tract is controlled by an upper esophageal sphincter (UES) in the neck near the mouth for swallowing, and by theLES48 and theGEFV49 at the stomach. The normal anti-reflux barrier is primarily formed by theLES48 and theGEFV49 acting in concert to allow food and liquid to enter the stomach, and to considerably resist reflux of stomach contents into theesophagus41 past thegastroesophageal tissue junction52. Tissue aboral of thegastroesophageal tissue junction52 is generally considered part of the stomach because the tissue protected from stomach acid by its own protective mechanisms. Tissue oral of thegastroesophageal junction52 is generally considered part of the esophagus and it is not protected from injury by prolonged exposure to stomach acid. At thegastroesophageal junction52, the juncture of the stomach and esophageal tissues form a zigzag line, which is sometimes referred to as the “Z-line.” For the purposes of these specifications, including the claims, “stomach” means the tissue aboral of thegastroesophageal junction52.
• FIG. 2 is a front cross-sectional view of an esophageal-gastro-intestinal tract illustrating a Grade I normal appearancemovable flap50 of the GEFV49 (shown in dashed lines) and a deteriorated Grade IIIgastroesophageal flap55 of the GEFV49 (shown in solid lines). As previously mentioned, a principal reason for regurgitation associated with GERD is the mechanical failure of the deteriorated (or reflux appearance)gastroesophageal flap55 of theGEFV49 to close and seal against the higher pressure in the stomach. Due to reasons including lifestyle, a Grade I normalgastroesophageal flap50 of theGEFV49 may deteriorate into a Grade III deterioratedgastroesophageal flap55. The anatomical results of the deterioration include moving a portion of theesophagus41 that includes thegastroesophageal junction52 andLES48 toward the mouth, straightening of thecardiac notch47, and increasing the Angle of His57. This effectively reshapes the anatomy aboral of thegastroesophageal junction52 and forms a flattenedfundus56. The deterioratedgastroesophageal flap55 illustrates agastroesophageal flap valve49 andcardiac notch47 that have both significantly degraded. Dr. Hill and colleagues developed a grading system to describe the appearance of the GEFV and the likelihood that a patient will experience chronic acid reflux. L. D. Hill, et al.,The gastroesophageal flap valve: in vitro and in vivo observations, Gastrointestinal Endoscopy 1996:44:541-547. Under Dr. Hill's grading system, the normalmovable flap50 of theGEFV49 illustrates a Grade I flap valve that is the least likely to experience reflux. The deterioratedgastroesophageal flap55 of theGEFV49 illustrates a Grade III (almost Grade IV) flap valve. A Grade IV flap valve is the most likely to experience reflux. Grades II and III reflect intermediate grades of deterioration and, as in the case of III, a high likelihood of experiencing reflux. With the deteriorated GEFV represented by deterioratedgastroesophageal flap55 and thefundus46 moved inferior, the stomach contents are presented a funnel-like opening directing the contents into theesophagus41 and the greatest likelihood of experiencing reflux. Disclosed subsequently is a device for restoring the normal gastroesophageal flap valve anatomy, which device is one embodiment of the present invention.
• Referring now toFIG. 3, it is a perspective view of afastener100 according to an embodiment of the invention. Thefastener100 generally includes afirst member102, asecond member104, and a connectingmember106. As may be noted inFIG. 3, thefirst member102 andsecond member104 are substantially parallel and substantially perpendicular to the connectingmember106 which connects thefirst member102 to thesecond member104.
• The first andsecond members102 and104 are generally cylindrical. Each has alongitudinal axis108 and110 and a throughchannel112 and114 along thelongitudinal axes108 and110. The throughchannels112 and114 are formed by through bores which are dimensioned to be slidingly received on a tissue piercing deployment wire to be described hereinafter.
• Thefirst member102 also includes afirst end116 and asecond end118. Similarly, thesecond member114 includes afirst end120 and asecond end122. The first ends116 and120 form pointeddilation tips124 and126, respectively. Thedilation tips124 and126 are conical and more particularly take the shape of truncated cones. The pointedtips129 and126 are pointed in opposite directions.
• The first andsecond members102 and104 and the connecting106 may be formed of different materials and have different textures. These materials may include, for example, plastic materials such as polypropylene, polyethylene, polyglycolic acid, polyurethane, or a thermoplastic elastomer. As may be further noted inFIG. 3, the connectingmember106 has avertical dimension128 and ahorizontal dimension130 which is transverse to the vertical dimension. The horizontal dimension is substantially less than the vertical dimension to render the connectingmember106 readily bendable in a horizontal plane. The connecting member is further rendered bendable by the nature of the plastic material from which thefastener100 is formed. The connecting member may be formed from either an elastic plastic or a permanently deformable plastic. An elastic material would prevent compression necrosis in some applications.
• Referring now toFIG. 4, it illustrates anotherfastener140 embodying the present invention. As with thefastener100 ofFIG. 3, thefastener140 includes afirst member142, asecond member144, and a connectingmember146. Thefastener140 may be formed in one piece and a plastic material similar to thefastener100 ofFIG. 3. Thefasteners100 and140 may be formed of a plastic material which includes a color pigment, for example pthalocyanine blue, for contrasting with the color of body tissue to enable visualization of the fastener with an endoscope during the deployment of the fasteners. In addition, as may be seen inFIG. 4, thefastener140 is impregnated with radioopaque material148 so as to render thefastener140 at least partially viewable under fluoroscopy. The radio opaque particles may be, for example, barium sulfate, bismuth subcarbonate, tungsten powder or tantalum powder.
• In addition to the foregoing, thesecond member144 of thefastener140 includes a plurality of longitudinally spacedvertical slots150. This renders thesecond member144 flexible in a direction opposite the slots but stiff in a direction of the slots. Hence, thesecond member144 is resistant to bending in a first direction indicated byarrow152 while being substantially less resistant to bending in a direction indicated byarrow154. The reduced resistance to bending in thedirection154 of thesecond member144 of thefastener140 may be utilized to advantage in the deployment of thefastener140.
• Referring now toFIG. 5, it is a perspective view with portions cut away of a fastener assembly embodying the present invention. The tissue layer portions above thefastener162 have been shown cut away inFIGS. 5-9 to enable the deployment procedure to be seen more clearly. Theassembly160 generally includes afastener162, adeployment wire164, apusher166, and aguide tube168.
• Thefastener162 takes the form of a further fastener embodiment of the present invention and includes afirst member172, asecond member174, and a connectingmember176. Thefastener162 differs from thefasteners100 and140 ofFIGS. 3 and 4, respectively, in that thesecond member174 is of solid construction and does not include a longitudinal through channel or a pointed tip. However, thefirst member172 includes a through channel as previously described and apointed tip175.
• Thefirst member172 of thefastener162 is slidingly received on thedeployment wire164. Thedeployment wire164 has a pointedtip178 for piercing the tissue layers180 and182 to be fastened together. As will be seen hereinafter, and in accordance with further aspects of the present invention, the tissue layers180 and182 may be folded stomach tissue which are to be fastened and maintained together to form and maintain a gastroesophageal flap valve.
• As will be noted inFIG. 5, thetissue piercing wire164,fastener162, and thepusher166 are all within theguide tube168. Theguide tube168 may take the form of a lumen within most any lumen providing structure such as a catheter, for example.
• As will be further noted inFIG. 5, and according to this embodiment of the present invention, thesecond member174 is disposed along side thefirst member172. This is rendered possible by the flexibility of the connectingmember176. Preferably, the first member, connecting member, and second member are arranged so that the connectingmember176 lies between thefirst member172 and thesecond member174 and, as illustrated, with thesecond member174 trailing thefirst member172 with respect to the tissue layers180 and182.
• With thefirst member172 of thefastener162 slidingly received on thetissue piercing wire164 and with thepusher166 just touching thefirst member172 on thetissue piercing wire164, thetip178 of thetissue piercing wire164 pierces the tissue layers180 and182. The subassembly of thetissue piercing wire164,fastener162, andpusher166 may be guided to its intended location relative to the tissue layers180 and182 by theguide tube168.
• Once thetissue piercing wire164 has pierced the tissue layers180 and182 to be fastened together, thepusher166 may be utilized to push thefirst member172 of thefastener162 through the tissue layers180 and182 on thetissue piercing wire164. This is illustrated inFIG. 6. As thepusher166 pushes thefirst member172 through the tissue layers180 and182, the connectingmember176 follows along beside and immediately adjacent to thefirst member172 of thefastener162 and thepusher166. As may be seen inFIG. 7, thepusher166 continues to push thefirst member172 of thefastener162 through the tissue layers180 and182 on thetissue piercing wire164 until theend173 of thefirst member172 engaging thepusher166 clears thesecond tissue layer182. It may also be noted that at this time, thesecond member174 of thefastener162 has engaged thesurface181 oftissue layer180.
• Referring now toFIG. 8, it will be seen that once theend173 of thefirst member172 has cleared thetissue layer182, thetissue piercing wire164 is then retracted within thepusher166 to release thefirst member172. Thefirst member172 being thus released from thetissue piercing wire164 will return to its original configuration substantially parallel to thesecond member174 and substantially perpendicular to the connectingmember176. When thefirst member172 is deployed as shown inFIG. 8, thetissue piercing wire164 andpusher166 may be withdrawn.
• FIG. 9 illustrates thefastener162 in its deployed position. It will be noted that the tissue layers180 and182 are fastened together between thefirst member172 of thefastener162 and thesecond member174 of thefastener162. The connectingmember176 extends through the tissue layers180 and182.
• FIG. 10 is a perspective view andFIG. 11 is a side view of anotherfastener200 embodying the present invention. Thefastener200 generally includes afirst member202, asecond member204, and a connectingmember206. As may be noted inFIG. 10, thefirst member202 andsecond member204 are substantially parallel to each other and substantially perpendicular to the connectingmember206 which connects thefirst member202 to thesecond member204.
• Thefirst member202 is generally cylindrical or can have any other shape. It has alongitudinal axis208 and a throughchannel212 along thelongitudinal axis208. The throughchannel212 is formed by a through bore which is dimensioned to be slidingly received on a tissue piercing deployment wire to be described.
• Thefirst member202 also includes afirst end216 and asecond end218. Similarly, thesecond member204 includes afirst end220 and asecond end222. Thefirst end216 ofmember202 forms apointed dilation tip224. Thedilation tip224 may be conical and more particularly takes the shape of a truncated cone. The tip can also be shaped to have a cutting edge in order to reduce tissue resistance.
• The first andsecond members202 and204 and the connectingmember206 may be formed of different materials and have different textures. These materials may include, for example, plastic materials such as polypropylene, polyethylene, polyglycolic acid, polyurethane, or a thermoplastic elastomer. The plastic materials may include a pigment contrasting with body tissue color to enable better visualization of the fastener during its deployment. Alternatively, the fastener may be formed of a metal, such as stainless steel or a shape memory metal, such as Nitinol.
• As may be further noted inFIG. 10, the connectingmember206 has avertical dimension228 and ahorizontal dimension230 which is transverse to the vertical dimension. The horizontal dimension is substantially less than the vertical dimension to render the connectingmember206 readily bendable in a horizontal plane. The connecting member is further rendered bendable by the nature of the material from which thefastener200 is formed. The connecting member may be formed from either an elastic plastic or a permanently deformable plastic. An elastic material would prevent compression necrosis in some applications.
• It may be noted inFIGS. 10 and 11, that thefirst member202 has a continuouslengthwise slit225 extending between the first and second ends216 and218. Theslit225 includes anoptional slot portion226 that communications with the throughchannel212. Theslot226 has a transverse dimension for more readily enabling receipt of a tissue piercing deployment wire during deployment of thefastener200. Also, because thefastener number202 is formed of flexible material, theslit225 may be made larger through separation to allow the deployment wire to be snapped into and released from the throughchannel212 as will be seen subsequently. This permits release of thefirst member202 during deployment. Theslit225 extends substantially parallel to the throughchannel212 and thecenter axis208 of thefirst member202. It may also be noted that theslit225 has a width dimension that is smaller or less than the diameter of the throughchannel212. This assures that thefastener200 will remain on a tissue piercing deployment wire as it is pushed towards and into the tissue as will be seen subsequently.
• Referring now toFIG. 12, it is a perspective view with portions cut away of afastener assembly300 embodying the present invention for deploying thefastener200. The tissue layer portions above thefastener200 have been shown cut away inFIGS. 12-16 to enable the deployment procedure to be seen more clearly. Theassembly300 generally includes thefastener200, adeployment wire264, apusher266, and aguide tube268.
• Thefirst member202 of thefastener200 is slidingly received on thedeployment wire264. Thedeployment wire264 has a pointedtip278 for piercing the tissue layers180 and182 to be fastened together and to cut sufficient tissue to enable thefastener member202 to readily pass through the tissue layers180 and182. It may also serve as a guide to guide thewire264 off of themember202 at the end of the deployment. Thetissue piercing wire264,fastener200, and thepusher266 are all within theguide tube268. Theguide tube268 may take the form of a catheter, for example, as previously mentioned, or a guide channel within a block of material.
• As will be further noted inFIG. 12, and according to this embodiment of the invention thesecond member204 is disposed along side thefirst member202, with the connecting member between thefirst member202 and thesecond member204. Thesecond member204 also trails thefirst member202 with respect to the tissue layers180 and182. This is all rendered possible due to the flexibility of the connectingmember206.
• With thefirst member202 of thefastener200 slidingly received on thetissue piercing wire264 and with thepusher266 just touching thefirst member202 on thetissue piercing wire264, thetip278 of thetissue piercing wire264 pierces the tissue layers180 and182. The subassembly of thetissue piercing wire264,fastener200, andpusher266 may be guided to its intended location relative to the tissue layers280 and282 by theguide tube268.
• As shown inFIG. 13, thetissue piercing wire264 has pierced the tissue layers180 and182 and thepusher266 has pushed thefirst member202 of thefastener200 through the tissue layers180 and182 on thetissue piercing wire264. This may be accomplished by moving thewire264 and thepusher266 together.
• As may be seen inFIG. 14,wire264 has been pushed further forward and independently from thefirst member202 and thepusher266. Thefirst member202 has also been pushed forward by thepusher266 to cause thesecond member204 to engage thetissue layer180. Continued pushing of thefirst member202 causes the first member to pivot in a counter clockwise direction because thesecond member204 is held by thetissue layer180. The counter clockwise movement of thefirst member202 causes thewire264 to spread theslit225 open, to pass down the slit to enterslot portion226 and to eventually pass through theslit225 atend218. Thefastener200 is then released from thewire264.
• InFIG. 15, it will now be seen that thesecond end218 of thefirst member202 has cleared thewire264 andtissue layer182. Thetissue piercing wire264 may now be retracted into thepusher266 and thetissue piercing wire264 andpusher266 may be withdrawn.
• FIG. 16 illustrates thefastener200 in its fully deployed position. It will be noted that the fastener has returned to its original shape. The tissue layers180 and182 are fastened together between thefirst member202 of thefastener200 and thesecond member204 of thefastener200. The connectingmember106 extends through the tissue layers180 and182.
• Referring now toFIGS. 17 and 18,FIGS. 17 and 18 illustrate acontrol assembly400 for controlling the delivery and deployment of fasteners according to an embodiment of the present invention. More specifically, theassembly400, according to this embodiment, is adapted to be located at the proximal end of an assembly, such as those shown inFIGS. 5-9 and12-16 for deploying fasteners into stomach tissue for maintaining manipulated stomach tissue which has been folded and molded to restore a GEFV flap.
• Theassembly400 generally includes ahousing402. The housing includes identical, side-by-side control assemblies404 and406. Since thecontrol assemblies404 and406 are identical, only assembly404 will be described in detail herein.
• Theassembly404 includes abolt410, areceiver412 that slidingly receives thebolt410 and thepusher266. Projecting from the bolt is ahandle414. The handle extends through atrack416 in thehousing402 and restricts and measures the movement of thebolt410.
• As previously mentioned, thecontrol assemblies404 and406 are side-bi-side and identical. Hence, theassembly406 may also be seen to include abolt510, apusher366, areceiver512, and ahandle514 projecting through atrack516. The operation of theassembly406 is identical to the operation of theassembly404 to be described subsequently.
• Theassembly404 still further includes afastener loading station420. Theloading station420 has alength dimension422 sufficient to receive a fastener loader to be described subsequently with respect toFIG. 20. The fastener loader and loading station facilitate loading of fasteners onto thedeployment stylet264. Theassembly406 also includes such aloading station520.
• As may be best seen inFIG. 18, thebolt410 ofassembly404 is attached to the proximal end of thestylet264. Hence, the bolt and stylet are arranged for linear movement when thebolt410 is moved within thereceiver412 with thehandle414 along thetrack416.
• Thepusher264 intersects the path of thestylet264 at anintersection point418. The pusher, as best described in copending application Ser. No. 11/043,903, includes an opening at theintersection418. The opening permits the stylet to be fed into the pusher and hence to allow thepusher266 to be carried by thestylet264 distal to theintersection418. As previously seen, this permits thepusher266 to engage thefastener200. Also, theloading station420 is distal to theintersection418 to permit thefastener200 to be loaded onto thestylet264 and engaged by thepusher266.
• Thebolt410 further includes alumen411 that slidingly receives thepusher266. This permits the movement of thepusher266 to be controlled independently of the movement of thebolt410 and thestylet264. Thebolt510 also includes such alumen511 as may be seen inFIG. 17.
• As may be further noted inFIG. 18, theassembly404 further includes afastener configuration structure428 including a funnel shapedwall430 between theloading station420 and theguide lumen269. As may be recalled fromFIGS. 12-16, theguide lumen269 guides thestylet264,fastener200, andpusher266 to the desired location for deploying the fasteners. The funnel shapedwall430 serves to preposition thesecond member204 of thefastener200 within theguide lumen269 as best seen inFIG. 12. Thesecond member204 is prepositioned as a trailing member along side thefirst member202 with the connectingmember206 therebetween. This fastener configuration and prepositioning assists in the proper functioning of thesecond member204 as thefastener200 is deployed. Thesecond member204 is automatically rendered in its preposition along side thefirst member202 with the connectingmember206 therebetween as thefastener200 is translated distally through the funnel shaped wall section towards theguide lumen269.
• FIG. 19 illustrates this in greater detail. Here we see afastener200 as it is pushed through the fastener configuration structure432. As the fastener enters thefastener configuration structure428, thesecond member204 of thefastener200 engages the funnel shapedwall430. The funnel shapedwall430 guides thesecond member204. As thesecond member204 follows the funnel shaped wall downward, it begins to trail thefirst member202. Also, the connectingmember206 is folded back to be between thefirst member202 and thesecond member206 of thefastener200. As a result, by the time thefastener200 reaches thefastener configuration outlet431 communicating with theguide lumen269, thesecond member204 is automatically disposed trailing and along side thefirst member202 with the connectingmember206 therebetween. The fastener is now configured for dependable deployment.
• When it is time to advance thestylet264 in through the tissue as shown inFIG. 15, for example, thehandle414 ofassembly400 is moved in a distal direction forcing thestylet264 to move distally. The handle and thus the stylet movement is restricted and measured by a transverse portion ofslot417 of thetrack416. Thehandle414 may be locked in a longitudinal position within thetransverse portion417 of the track. Thefastener200 is advanced by thepusher266. After a fastener is deployed, the distal end of the pusher is drawn back to be proximal to theloading station420 to permit another fastener to be loaded onto thestylet264.
• The fasteners are loaded onto the stylet by presenting theslit225 of the fasteners to the stylet. The slit225 (FIG. 11) is widened by thestylet264 and thestylet264 slips through theslit225 and into the throughchannel212 of the fastenerfirst member202.
• FIG. 20 shows afastener loader450 which may be employed for loading the fasteners onto the stylet. Theloader450 has ahandle452 permitting it to be readily hand-holdable. At the distal end, the loader is arranged to carry a plurality offasteners200. The loader presents the fasteners so that theslit225 will be aligned with thestylet264.
• The holder has awidth dimension454 that is less than the length dimension422 (FIGS. 17 and 18) of theloading station420. Hence, as seen inFIG. 20, theloader450 may be inserted into a loading station for mounting a fastener onto a corresponding stylet. Theloader450 may be used on either side of theassembly400 for loading a fastener ontostylet264 at loadingstation420 or loading a fastener onto stylet364 at loadingstation520.
• While particular embodiments of the present invention have been shown and described, modifications may be made, and it is therefore intended in the appended claims to cover all such changes and modifications which fall within the true spirit and scope of the invention.

Claims (26)

1. A fastener assembly comprising:

a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members, the first member having a longitudinal axis and a through channel along the axis;

a deployment wire slidingly received within the through channel of the first member that pierces into the tissue and guides the first member through the tissue;

a guide structure defining a lumen that receives the fastener and deployment wire and guides the deployment wire and fastener to the tissue; and

a fastener configuration structure that orientates the second member in a predetermined position relative to the first member within the lumen.

2. The assembly ofclaim 1, wherein the fastener configuration structure orientates the second member along side the first member.

3. The assembly ofclaim 1, wherein the fastener configuration structure orientates the second member along side the first member with the connecting member between the first and second members.

4. The assembly ofclaim 1, wherein the fastener configuration structure orientates the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue.

5. The assembly ofclaim 1, wherein the first member of the fastener has a lengthwise slit communicating with the through channel and wherein the deployment wire is received into the through channel through the slit.

6. The assembly ofclaim 5, further comprising a fastener loader that guides the first member slit into engagement with the deployment wire.

7. The assembly ofclaim 6, wherein the fastener loader is arranged to hold a plurality of the fasteners.

8. The assembly ofclaim 1, wherein the fastener configuration structure comprises a wall converging with the deployment wire and an outlet communicating with the lumen.

9. The assembly ofclaim 8, wherein the wall converges with the deployment wire in a direction towards the tissue so that, when the second member engages the wall, the wall directs the second member to the predetermined position relative to the first member.

10. The assembly ofclaim 9, wherein the wall orientates the second member along side the first member.

11. The assembly ofclaim 9, wherein the wall orientates the second member along side the first member with the connecting member between the first and second members.

12. The assembly ofclaim 9, wherein the wall orientates the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue.

13. A fastener assembly comprising:

a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members, the first member having a longitudinal axis and a through channel along the axis;

a deployment wire slidingly received within the through channel of the first member that pierces into the tissue and guides the first member through the tissue; and

a guide structure defining a lumen that receives the fastener and deployment wire and guides the deployment wire and fastener to the tissue, the second member of the fastener being along side the first member with the connecting member between the first and second members within the lumen.

14. The assembly ofclaim 13, wherein the second member is along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue.

15. The assembly ofclaim 14, further comprising a fastener configuration structure that orientates the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue within the lumen.

16. The assembly ofclaim 15, wherein the fastener configuration structure comprises a funnel-shaped member having a wall converging with the deployment wire and an outlet communicating with the lumen.

17. The assembly ofclaim 16, wherein the wall converges with the deployment wire in a direction towards the tissue so that, when the second member engages the wall, the wall directs the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue.

18. The assembly ofclaim 17, further comprising a pusher that pushes the fastener along the deployment wire towards the tissue to cause the second member to engage the wall, to cause the wall to direct the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue, and to cause the fastener to exit the outlet into the lumen as the pusher pushes the fastener along the deployment wire towards the tissue.

19. The assembly ofclaim 13, wherein the first member of the fastener has a lengthwise slit communicating with the through channel and wherein the deployment wire is received into the through channel through the slit.

20. The assembly ofclaim 19, further comprising a fastener loader that guides the first member slit into engagement with the deployment wire.

21. The assembly ofclaim 20, wherein the fastener loader is arranged to hold a plurality of the fasteners.

22. A method comprising:

providing a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members, the first member having a longitudinal axis and a through channel along the axis;

mounting the fastener onto a deployment wire with the deployment wire slidingly received by the through channel of the first member;

translating the fastener to within a lumen dimensioned to receive the fastener and deployment wire and which guides the deployment wire and fastener to tissue; and

orientating the second member in a predetermined position relative to the first member as the fastener is translated to within the lumen.

23. The method ofclaim 22, wherein the orientating step comprises positioning the second member along side the first member.

24. The method ofclaim 22, wherein the orientating step comprises orientating the second member along side the first member with the connecting member between the first and second members.

25. The method ofclaim 22, wherein the orientating step comprises orientating the second member along side the first member with the connecting member between the first and second members and with the second member trailing the first member with respect to the tissue.

26. The method ofclaim 22, wherein the first member of the fastener has a lengthwise slit communicating with the through channel and wherein the mounting step includes causing the deployment wire to be received within the through channel through the slit.

Images