US20200008964A1 - Sleeve Gastrectomy Calibration Tube And Method Of Using Same - Google Patents

Abstract

One or more medical devices may be provided that may be used, for example, in bariatric surgery including a vertical sleeve gastrectomy. The one or more medical devices may include a laparoscopic sleeve gastrectomy stapling guide in conjunction with a calibration tube in accordance with one or more examples. According to an example, the calibration tube may be a flared, multi-diameter calibration tube. The flared, multi-diameter calibration tube may have a first diameter along a portion of the tube and a second diameter that may larger than the first diameter along at least another portion of the tube. The calibration tube may be used in conjunction with the stapling guide to align stomach such that it may be stapled along the stapling guide (e.g., to perform the vertical sleeve gastrectomy).

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. application Ser. No. 14/846,764, filed Sep. 5, 2015, which claims the benefit of U.S. Provisional Application No. 62/046,598, filed Sep. 5, 2014, the disclosures of which are incorporated herein by reference in their entireties.
TECHNICAL FIELD
• The examples herein may be directed to a sleeve gastrectomy, and more particularly to a calibration tube inserted into the stomach and used in conjunction with a sleeve gastrectomy stapling guide or a sleeve gastrectomy stapler such as a full length sleeve gastrectomy stapler. The example devices herein may provide a minimum safe distance from the incisura angularis and other stomach landmarks during the creation of a vertical sleeve gastrectomy.
BACKGROUND
• Obesity is a disease that affects a significant portion of the world's population and leads to multiple chronic medical conditions and premature death from cardiovascular events and cancer. In particular, the United States has a current, and worsening obesity epidemic. The U.S. Centers for Disease Control and Prevention (CDC) reports that over 33% of the US. population is obese, with a Body Mass Index (BMI) of over 30, and another 35-40% of the US population is overweight, with a BMI of 25-30. The CDC reports that the percent of the US population being either overweight or obese by 2018 will be 75%. The CDC also reports that obesity directly costs the U.S. economy $147 billion currently, and projects that the costs will approach $315 billion by 2020.
• Further, obesity has environmental, genetic and behavioral origins but is intractable to most medical and behavioral interventions. To help reduce obesity and/or facilitate weight loss, bariatric surgery may be an option for some patients that may be overweight. Typically, bariatric surgery may be an effective long-term treatment option for patients with a BMI greater than 35. Despite the 20 million patients who are eligible for weight loss surgery in the U.S., the number of procedures per year has plateaued at about 200 thousand, eliminating any public health effect of surgery.
• In recent years, a popular form of bariatric surgery may include a laparoscopic vertical sleeve gastrectomy (e.g., which may remove approximately 80% of the stomach). Laparoscopic vertical sleeve gastrectomy may be a procedure that may be safer and more effective for patients eligible for weight loss surgery. In fact, it has been accepted as the surgery that should be offered to most morbidly obese patients over, for example, laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. As such, the surgery has been adopted by bariatric surgeons and is now the most commonly performed weight loss surgery.
• Vertical sleeve gastrectomy is typically performed using standard laparoscopic equipment. The greater curvature of the stomach is mobilized using vessel-sealing devices, sealing the gastric branches of the gastroepiploic vessels and the short gastric vessels. The posterior adhesions of the stomach are also divided so the stomach is fully mobilized while the blood supply to the lesser curvature remains intact.
• Following mobilization of the stomach a calibration tube is typically introduced into the stomach through the mouth. Resection is accomplished by applying a series of staples from a laparoscopic linear surgical stapler, for example, along the calibration tube in a staple line. The staple line may be important in sleeve gastrectomy as the amount of weight lost and complications or consequences may be a direct result of the quality of the resultant sleeve gastrectomy pouch formed from the staple line (e.g., the portion of the stomach not rescinded by the staple line). The complications or consequences may include gastroesophageal reflux disorder (GERD), weight loss failure or weight regain, food intolerance, staple line bleed, leak, and/or the like.
• To help produce a repeatable sleeve gastrectomy pouch (e.g., from the staple line), a sleeve gastrectomy stapling guide and calibration tube with a constant diameter may be used. Although the combination of the stapling guide and calibration tube may help produce a better staple line and, thus, sleeve gastrectomy pouch, a surgeon may still need to estimate or envision an adequate distance from one or more parts of the stomach such as the IA to not create a stricture at that point with the staple line. Other efforts, devices, and techniques such as balloon catheters, bougies, and/or the like have been made to improve the calibration and, thus, location of the staple line such thereby needing less estimation by the surgeon. Unfortunately, such efforts still make it difficult for a surgeon to envision the staple line and may not help ensure that proper distances are maintained from each landmark along the stomach as the surgeon may still need to estimate distances to create the staple line.
SUMMARY
• In an example herein, one or more medical devices may be provided that may be used, for example, in bariatric surgery including a vertical sleeve gastrectomy. The one or more medical devices may include a laparoscopic sleeve gastrectomy stapling guide in conjunction with a calibration tube in accordance with one or more examples. According to an example, the calibration tube may be a flared, multi-diameter calibration tube. The flared, multi-diameter calibration tube may have a first diameter along a portion of the tube and a second diameter that may larger than the first diameter along at least another portion of the tube. The calibration tube may be used in conjunction with the stapling guide to align stomach such that it may be stapled along the stapling guide (e.g., to perform the vertical sleeve gastrectomy). In examples herein, the one or more devices (e.g., the calibration tube and/or the stapling guide) may provide a proper distance (e.g., a minimum safe distance) from the incisura angularis and other stomach landmarks during the creation of a staple line for the vertical sleeve gastrectomy and may be used to create a repeatable resultant sleeve size of the stomach. For example, a surgeon may have a good idea of what size the resultant sleeve size should be, but the shortcoming of current methods, medical devices, and/or the like may lie in how they may be used to create and repeat such a sleeve—both between different surgeons, and for each surgeon from patient to patient. The use of the flared, calibration tube (e.g., with the different diameters) along with the staple guide may enable a surgeon to create the resultant sleeve size they desire, and a size they know works for effective weight loss while at the same time may improve a surgeon's ability to line up each staple fire and create the resultant sleeve that may be more consistent and repeatable.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 depicts the flared calibration tube complete with a valve for regulated suction and perforations to allow for suction and injection of material into the stomach.
• FIG. 2 depicts a zoomed-in look at the tip of the flared calibration tube, indicating the cylindrical flared portion along with the perforations.
• FIG. 3A depicts the suction regulation valve of the flared calibration tube in the “open” position.
• FIG. 3B depicts the suction regulation valve of the flared calibration tube in the “closed” position.
• FIGS. 4-9 depicts an enlarged view of one or more additional or alternative examples of a flared portion that may be included in the flared, calibration tube.
• FIGS. 10-12B depicts an enlarged view of one or more additional or alternative examples of a flared portion that may be included in the flared, calibration tube.
• FIG. 13A is the formula used to calculate resultant sleeve circumference based on stapling guide width and calibration tube circumference.
• FIG. 13B is the formula used to calculate resultant sleeve diameter based on stapling guide width and calibration tube diameter.
• FIG. 14A depicts a cross-section view of what the calibration tube and stapling guide combination will look like, with the adjacent resection line along the guide.
• FIG. 14B then depicts the resultant size of the sleeve once the calibration tube and stapling guide have been removed.
• FIG. 15 depicts the flared calibration tube once it has been inserted to the pylorus of the stomach.
• FIG. 16 depicts the stapling guide being positioned around the stomach.
• FIG. 17 depicts the stapling guide being positioned at the gastroesophageal junction, in the approximate location of where the resection line will occur.
• FIG. 18 depicts the calibration tube being pulled up from the pylorus and positioned along the incisura angularis, forcing the stapling guide to move laterally into the appropriate position to prepare for stapling and cutting.
• FIGS. 19-23 illustrate an additional or alternative example method or procedure that may be performed using the flared, calibration tube in one or more examples.
• FIGS. 24-28 illustrate an additional or alternative example method or procedure that may be performed using the flared, calibration tube in one or more examples.
• FIG. 29 depicts a calibration tube that is meant to generally represent the alternative embodiments listed above, used in conjunction with the stapling guide to assist in guide and resection line alignment.
• FIG. 30 depicts the resultant sleeve after the stapling and cutting has been executed. The resection line is about 2 cm off the incisura angularis, about 1 cm off of the GE junction, is vertical, and has complete fundus removal.
• FIG. 31 depicts a calibration tube in accordance with another embodiment of the invention and used in conjunction with a stapling guide to assist in guide and resection line alignment.
• FIG. 32 depicts a calibration tube in accordance with another embodiment of the invention and used in conjunction with a stapling guide to assist in guide and resection line alignment.
• FIG. 33 depicts a table illustrating different sizes of the flared, calibration tube and/or the stapling guide that may provide different sizes to a resultant sleeve of a stomach in one or more examples herein.
DETAILED DESCRIPTION
• As described herein, systems and/or methods may be provided for performing a sleeve gastrectomy. For example, a first medical device may be positioned in an interior of the stomach. The first medical device may include or have a first diameter along a first portion thereof (e.g., a calibration or medical tube) and a second diameter that may be larger than the first diameter along a second portion thereof (e.g., a flared portion or a radially-outward projecting portion of a medical tube). The first medical device may be positioned, for example, by inserting the first medical device into a mouth of a patient to access the interior of the stomach and positioning the second portion at a landmark (e.g., a first landmark such as an incisura angularis (IA)) of the stomach. According to an example, the first medical device may be moved proximally and/or distally (e.g., from a first position to a second position) to position the first medical device at the landmark.
• Further, in one example, a second medical device such as a clamp or stapler may be positioned on an exterior of the stomach relative to or based on an interaction with the first medical device (e.g., adjacent to, near, in proximity to, and/or interaction with the second portion of the first medical device) such that the second medical device may be configured to demonstrate or create a path such as a resection line or staple line) along the stomach at which the sleeve gastrectomy may be performed. As such, the first medical device may be used as a reference to position the second medical device. For example, an interaction (e.g., positioning the second medical device relative to the first medical device may position the second medical device in a desired position to demonstrate or provide the path. In one example, movement of the first medical device causes a corresponding movement or sliding of the second medical device (e.g., from a first position to a second position) along the exterior of the stomach to position the second medical device in the desired position to demonstrate the path. The second medical device may be fixed relative to another landmark and/or additional landmarks of the stomach (e.g., a second and/or a third landmark) as part of its positioning to create and/or demonstrate the path.
• In additional examples, the first medical device itself may create and/or demonstrate the path to perform the sleeve gastrectomy as described herein (e.g., without use of the second medical device). In such an example the path may be demonstrated and/or created along the second portion (e.g., the flared portion) of the first medical device (e.g., the tube).
• The sleeve gastrectomy (e.g., resection of part of the stomach) may be performed along the path thereby producing a resultant sleeve of the stomach. For example, a resection or staple line may be created (e.g., using a surgical stapler) along the path thereby producing the resultant sleeve. In one or more examples herein, the resultant sleeve of the stomach that may be created by the path (e.g., the resection or staple line) may include a diameter of approximately 1 to 3 cm near the first landmark (e.g., the IA), approximately 2 to 6 cm near a second landmark (e.g., a pylorus) of the stomach, and approximately 0 to 2 cm near a third landmark (e.g., a gastroesophageal junction (GEJ or GE junction)) of the stomach.
• In one example, the first medical device may be a flared, multi-diameter calibration tube and may include a tube that may include a flared portion at a distal end thereof. In an example, the tube may be the first portion and the flared portion may be the second portion. The tube may have or include a first diameter (e.g., a constant diameter as described herein) that may be proximal and distal to the flared portion. The flared portion may have or include a second diameter (e.g., a maximum diameter as described herein) that may be larger than the first diameter. As described herein, the tube (e.g., that may be the first medical device or part of the first medical device) may be configured to be inserted or may be inserted into an interior of the stomach and the flared portion may be positioned at a first landmark thereof (e.g., the IA) such that the flared portion that may be positioned at the first landmark may be configured to facilitate alignment of a resection line or staple line (e.g., the path) during the sleeve gastrectomy that produces the resultant sleeve described herein. For example, the flared portion may include a first point and a second potion at an opposite end thereof forming the second diameter thereacross. The first point of the flared portion may be configured to be positioned near the first landmark as described herein and the second point of the flared portion may be configured to form the resection line (e.g., a line that includes the second point) that produces the resultant sleeve.
• In an example, alignment of resection or staple line may further be facilitated by the second medical device (e.g., a clamp or stapler) positioned relative to the first medical device. For example, the flared portion may include a first point and a second point at an opposite end thereof forming the second diameter thereacross. The first point of the flared portion may be configured to be positioned near the first landmark as described herein and the second medial device may be configured to be positioned near the second point of the flared portion to form the resection line (e.g., a line along a side of the clamp opposite of the side positioned near the second point) that produces the resultant sleeve.
• FIG. 1 depicts the flared calibration tube complete with a valve for regulated suction and perforations to allow for suction and injection of material into the stomach. As shown inFIG. 1, a flared, calibration tube12 (e.g., a first medical device) in accordance with one or more examples herein may be provided. According to an example herein, the flared,calibration tube12 may be used in conjunction with a second medical device (e.g., a clamp or a surgical stapler) as described herein (not shown inFIG. 1 but an example of which may be shown as staplingguide88 inFIGS. 15-32) to perform a vertical sleeve gastrectomy. In an example, the flared,calibration tube12 may have a first diameter along a portion thereof that may be constant (e.g.,6) and a second diameter along another portion thereof (e.g.,2) that may be larger than the first diameter as described herein.
• For example, as shown, the flared,calibration tube12 may include a tube14 (e.g., a first portion of the first medical device or calibration tube) and asuction regulation valve16 that may cap the tube14 (e.g., a body of the tube14). As shown, thetube14 may be generally cylindrical in shape and may be made of, for example, rubber, silicone, polyurethane, a plastic polymer, and/or any other suitable material. The tube may be hollow, solid, and/or the like in one or more examples. Thetube14 may include a proximal end PE that may be closer to a surgeon that may interact with the flared,calibration tube12 to a distal end DE that may be farther away from the surgeon. As shown, thetube14 may include alower tip10 at the distal end DE and a flared out portion3 (e.g., a second portion of the first medical device or calibration tube) and may be capped off by thesuction regulation valve16 at the proximal end PE.
• Thelower tip10 of thetube14 may be long enough to allow for easy insertion into the mouth, esophagus, and stomach, and/or may enable or allow thetube14 of the flared,calibration tube12 to be navigated down to the pylorus of the stomach. Moving proximally up from thelower tip10 at the distal end DE, the tube14 (e.g., the generally cylindrical shape of the tube14) may include a flared portion3 (e.g., a cylindrical flared portion).
• FIG. 2 depicts an enlarged view of thelower tip10 of thetube14 that may be included in the flared,calibration tube12 including the flared portion3. As shown inFIG. 2, thetube14 may begin to flare out4 from theconstant diameter6 until it reaches themaximum diameter2 at which point it may begin to flare in5 until it may return back to theconstant diameter6 thereby forming the flared out portion3. As described herein, the flared out portion3 may be used to align and calibrate a stapling guide such that a more accurate staple line (e.g., path or resection line) may be formed for resection during the vertical sleeve gastrectomy according to examples herein. As shown, themaximum diameter2 may be formed by points (e.g., a first and second point such as P and P′) at opposite ends or sides of the flared portion3.
• In an example, the flared portion3 may be approximately 2 cm long from the beginning of theflare4 to the end of theflare5. Further, as shown, themaximum diameter2 of the flared portion3 may be approximately. Additionally, as described herein (e.g., above), the flared portion3 may narrow at4 and5 until it may return to the constant diameter6 (e.g., that may be substantially maintained throughout the rest of the tube14). Example dimensional ranges of theconstant diameter portion6 of the tube may be from 0.3 cm to 1.5 cm and example dimensional ranges of the flared portion3 are contemplated to range from 0.5 cm to 2.0 cm (e.g., including the maximum diameter2). Such ranges may be provided based on a spacer (e.g., the spacer60) that may be 1 cm in width according the formulas F1 and F2 described with respect toFIGS. 13A-13B and 14A-14B. In one or more examples, the resultant sleeve diameter range may be 1 cm (or 30 French) to 2 cm (or 60 French) for the cylindrical portion near or above the incisura angularis (e.g., a first landmark), may be 2 cm to 6 cm for the portion near the pylorus (e.g., a second landmark), and/or 0 cm to 2 cm for the portion near the GEJ (e.g., a third landmark). The flared portion3 may have a wider resultant sleeve diameter of 1.2 cm (or 36 French) to 2.6 cm (or 78 French) according to examples herein.
• As shown inFIG. 2, according to one example, the flared portion3 may be integrally formed as part of thetube14, for example, during manufacturing. In additional or alternative examples, the flared portion3 may be separately coupled and/or fixedly attached to thetube14 and/or may include two separate pieces (e.g., as shown inFIGS. 4-8). In additional embodiments, the flared portion3 may be a constant diameter (e.g., the constant diameter6) and/or a smaller diameter than theconstant diameter6 until use of the flared,calibration tube12 during the vertical sleeve gastrectomy during which the flared portion3 may be enlarged to themaximum diameter2 by inflation and/or actuation such as mechanical actuation (e.g., as shown inFIGS. 10-12).
• In examples herein, thediameter2 of the flared out portion3 may be used as a form of alignment and calibration, and/or may be the point at which a stapling guide (not shown inFIG. 1 and which may be shown as88 inFIGS. 15-32) may be positioned adjacent to an incisura angularis (IA) (e.g., not shown inFIG. 1 and which may be shown as40dinFIGS. 15-32). As such, the flared, calibration tube12 (e.g., via tube14) may include aconstant diameter6 and a maximum diameter2 (e.g., Di inFIG. 13A) of a flared portion3 such that the flared,calibration tube12 may enable a surgeon to more reliably create a sleeve pouch with a different (wider) diameter at the IA (e.g., D2 inFIG. 13B) than the GE junction. In such an example, the stapling guide may be used as a spacer, otherwise, the flared portion3 may not fit past the narrower upper sleeve of the stomach (e.g.,40eas shown inFIGS. 15-18).
• In an example, as shown inFIG. 2, thetube14 may include one ormore perforations26. For example, as shown, thelower tip10, the flared portion3, and/or a portion of thetube14 proximal to the flared portion include the one ormore perforations26 therein. In an example, the one ormore perforations26 may be holes in thetube14 that may be used to collect or suction tissue debris from the stomach that may be suctioned proximally up through thetube14 during the vertical sleeve gastrectomy and expunged therefrom as described herein.
• Referring back toFIG. 1, the body of thetube14 may be capped24 by asuction control valve16 that may be used to regulate when and how suction may be applied to the distal end DE (e.g., shown inFIG. 2) of thetube14. As shown, thesuction control valve16 may include aswitch22 that may be used to open and/or close the suction control valve thereby allowing and/or not allow air flow through the tube.
• FIG. 3A depicts thesuction control valve16 of the flared,calibration tube12 in an “open”position20. In an example, when theswitch22 of thevalve16 may be in the “open”position20, air may flow out of thetube14 through an opening at aproximal tip18 of the flared,calibration tube12. As described herein, in the “open”position20, thesuction control valve16 may enable tissue debris to be removed during the vertical sleeve gastrectomy and expunged therefrom as described herein. For example, the debris that may be collected by the one ormore perforations26 may be suctioned through thetube14 and out of the opening in theproximal tip18 when thesuction control valve16 may be in the “open”position20.
• FIG. 3B depicts thesuction control valve16 of the flared,calibration tube12 in a “closed”position28. According to an example, when theswitch22 of thevalve16 may be in the “closed”position28, air may not flow out (e.g., air may be blocked) of thetube14 through the opening at aproximal tip18 of the flared,calibration tube12. In the “closed”position28, tissue debris may not be expunged and/or removed during the vertical sleeve gastrectomy.
• FIGS. 4-8 depicts an enlarged view of one or more additional or alternative examples of the flaredportion33 that may be included in the flared,calibration tube12. As shown inFIGS. 4-6, a separate, flared portion33 (e.g., that may have the same or similar properties including themaximum diameter2, and/or the like as described herein with respect to the flared portion3) may be coupled or attached onto an existing stock gastric tube34 (e.g., that may have the same or similar properties including theconstant diameter6, and/or the like as described herein with respect to the tube14). This may enable the flared portion33 (e.g., the add on) to be sold separately and assembled at bedside or prior to the surgery. In examples herein, the flaredportion33 may be slid onto thetube34, may be snapped around thetube34, may be glued on thetube34, and/or may be coupled and/or fixedly attached to thetube34 using any other suitable coupling or attachment mechanism. The flaredportion33 may include and/or have a tapered face (e.g., similar to the flared portion3 tapering to4 and5) to slide along the oropharyngeal, esophageal and gastric mucosa without damaging the mucosal surfaces and/or getting snagged. The flared portion13 may be made rubber, silicone, polyurethane, a plastic polymer, and/or any other suitable material.
• FIGS. 5A-5B illustrate examples of the flaredportion33 that may be coupled or attached onto thetube34. As shown inFIG. 5A, the flaredportion33 may include a first flaredportion40 and a second flaredportion42. As shown, the first flaredportion40 and the second flaredportion42 may havecrevices44a,44brespectively. Thecrevices44a,44bmay be convex depression that may extend along the outer diameter of thetube34 and may when combined take the shape of the outer diameter of thetube34. For example, when the first andsecond portions40,42 may coupled or attached together (e.g., connected via one or more snaps (not shown), glue, and/or the like), thecrevices44a,44bmay receive and surround thetube34. As shown inFIG. 5B, the first andsecond portions40,42 may include ahinge48a,48bthat may be used to pivot the first and second portions,40,42 to surround thetube34.
• In an example, as shown inFIG. 6, the flaredportion33 may be used with different diameter tubes. For example, the flaredportion33 may include and/or have agripping surface50 and ascrew52 and/orcap54 that may be inserted into one or more sides of thetube34. The grippingsurface50 may includeteeth51 that may be used to prevent the flaredportion33 from sliding up and down thetube34. For example, the flaredportion33 may be slid over thetube34 and theteeth51 of thegripping surface50 may help secure the flaredportion33 at the appropriate location on thetube34 thereby preventing the flaredportion33 from sliding freely up and down thetube34. In one example (e.g., once the flaredportion33 may be positioned at the appropriate location), the screw may be inserted over thetube34 and screwed, for example, in a distal end of the flaredportion33 and thecap52 may be inserted over thetube34 and snapped into a proximal end of the flaredportion33 thereby further securing the flaredportion33 on thetube34 and preventing movement thereof.
• According to examples, as shown inFIGS. 7-8, a tube with two diameters (e.g., a first and second diameter) and/or a first andsecond tube64,74 may be inserted within each other may be used to form a flared portion73 (e.g., that may have the same or similar properties including themaximum diameter2, and/or the like as described herein with respect to the flared portion3). For example, thefirst tube64 may include a 16 or 18 French polymer or latex orogastric tube that may be used as the smaller diameter tube (e.g., that may have the same or similar properties of thetube14 including theconstant diameter6, and/or the like). Thesecond tube74 may include a tapered wider section of a tube (e.g., a polymer or latex orogastric tube) with an inner diameter that may be equivalent to, larger, and/or substantially similar to the outer diameter of the tube14 (e.g., constant diameter6) and an outer diameter equivalent to the diameter of the flared portion3 (e.g., the maximum diameter2). Further, as shown inFIG. 8, thetube74 may taper similar to thetapering4,5 of the flared portion3. According to an example, thesecond tube74 may be slid over and positioned at the appropriate location on the first tube64 (e.g., a location approximately near thedistal end10 similar to the flared portion3). The second tube74 (e.g., once positioned) may be fixedly attached and/or coupled to thefirst tube64 via any suitable technique including solvent bonding via asolvent bond75.
• FIG. 9 illustrates an example of one or more lights that may be included in the flaredportion3,33, and/or73 in one or more examples. For example, the flaredportion3,33, and/or73 (e.g., the wider section) of thetubes14,34, and/or74 (e.g., that may be combined with the tube64) may be fitted withlights78,79 such as LED or fiber optic lights to better visualize the position of the tube within the stomach. According to an example, havinglights78,79 that may indicate the flared portion may enable or the surgeon to accurately place the wider portion of the calibration tube adjacent the incisura angularis (IA).
• FIGS. 10-12B depicts an enlarged view of one or more additional or alternative examples of the flaredportion83 that may be included in the flared,calibration tube12. As shown inFIG. 10, in one example, atube84 that may be included in the flared,calibration tube12 may include a first diameter D1′ that may be adjustable to a second diameter D2′ to form the flaredportion83. For example, thetube84 may include aballoon86 that may be used to form the flaredportion93. Theballoon86 may be relaxed or deflated prior to use and insertion of the flared,calibration tube12 in the stomach. In such an example (e.g., prior to insertion and use), thetube84 with theballoon86 in the relaxed or deflatedstate51 may have a substantially constant diameter (e.g., similar to the constant diameter6). The first diameter D1′ may be the substantially constant diameter. Theballoon86 may be inflated to an inflated state S2 upon insertion of thetube84 that may be part of the flared,calibration tube12 into the stomach to the appropriate position such as adjacent to the incisura angularis and interaction therewith. According to an example, the inflated state S2 may form the flaredportion83 that may have the second diameter D2′ (e.g., similar to the maximum diameter2). Thetube84 with the flaredportion83 formed by theballoon86 may enable the staple line to be performed with a single cartridge sleeve gastrectomy stapler. For example, thetube84 may be placed with theballoon86 adjacent the incisura angularis (e.g., as described inFIGS. 24-28 below) in thestate51. The stapler may then placed in apposition but not fully clamped, the balloon may be inflated to the state S2 to form the flaredportion83, and the flaredportion83 formed by the theballoon86 in the state S2 may widen the area adjacent the incisura angularis prior to stapling. After stapling, theballoon86 may be deflated tostate51 such that thetube84 may return to the first diameter D1′ and may be removed.
• Further, as shown inFIG. 11, a tube94 that may be included in the flared,calibration tube12 may include a first diameter DI″ that may be adjustable to a second diameter D2″ to form the flaredportion93. For example, the tube94 may include a split tube95 at a distal end (e.g., the distal tip10) and a solid portion96 (e.g., that may have properties similar to thetube14 including the constant diameter6) extending proximally from the split tube95 and the distal end. The split tube95 may be used to form a flared portion93 (e.g., that may have similar properties to the flared portion3) similar to theballoon86 used in thetube84 described with respect toFIG. 10. In an example, the split tube95 may include afirst portion98 and asecond portion99 that may be widened to form the flaredportion93. For example, the split tube95 may be relaxed or compressed prior to use and insertion of the flared,calibration tube12 in the stomach. In such an example (e.g., prior to insertion and use), the first andsecond portions98,99 of the split tube95 may be in contact with each other in a relaxed orcompressed state51′ such that the split tube95 may have a substantially constant diameter (e.g., that may be similar and/or smaller than the constant diameter6) that may be diameter D1″. The split tube95 may be widened (e.g., the first andsecond portions98,99 may be separated) from the relaxed orcompressed state51′ to an expanded state S2′ that may form the flaredportion93 upon insertion of the tube94 into the stomach to the appropriate position such as adjacent to the incisura angularis and interaction therewith (e.g., similar to that described inFIGS. 24-28). Such an interaction may include, for example, shortening a distance from the distal tip to the solid portion of the tube94 by pulling on a control element (e.g., at the proximal end of the tube94 not shown). As shown, in the second state S2′, the first andsecond portions98,99 of the split tube95 may be adjusted from the first diameter DI″ to a second diameter D2″ (e.g. may become wider along an x-axis) the first andsecond portions98,99 may be wider along the x axis. In additional or alternative examples, the split tube95 may include three portions, four portions, and/or the like that may be expanded and/or become wider along the x and z axes to form the flaredportion93.
• In an example as shown inFIG. 12A-12B, atube104 may include a bowing out portion that may be used to form the flaredportion103 that may be included in the flared,calibration tube12. As described herein thetube104 may include one or more properties similar to thetube4 such as theconstant diameter6, and/or the like. Similarly, the flaredportion103 that may be formed may include one or more properties similar to the flared portion3 such as the maximum diameter2 (e.g., upon actuation and/or insertion). The flaredportion103 may be formed from bowing out asail105 attached to thetube104 using asheath106. For example, thetube104 may have a sail portion105 (e.g., a portion that bows out) that may be connected to thetube104 at the distal end and asecond point 20 to 30 cm proximally. Alternatively, thesail portion105 is connected distally and extends beyond the proximal end oftube104. In this configuration, thesail portion105 is extendable when portion extending beyondtube104 is pushed intotube104 and retractable when portion extending beyondtube104 is lengthened. Thesail portion105 may be adjusted to form the faredportion103, for example, by applying force thereto using asheath106, and/or the like. For example, the flared,calibration tube12 may include asheath106. Thesheath106 may be inserted over thetube104 at the proximal end (e.g., PE) to apply the force to thesail portion105 thereby adjusting thesail portion105 to form the flaredportion103 relative totube104. In an example, thetube104 with thesail portion105 may be inserted into the stomach and positioned such that the flaredportion103 when formed may be adjacent to the incisura angularis. Thesheath106 may then be pushed distally down thetube104, and may be moved distally and/or proximally to form and adjust the area that bows out to form the flaredportion103. In an example, thesail portion105 may be combined with either a stapler or a stapling guide to make the flaredportion103 and/or the resultant sleeve formed thereby wider at the incisura angularis.
• FIGS. 13A-13B depict example formulas, F1 and F2, that may be used to calculate a resultant sleeve circumference and diameter, respectively, based on stapling guide width and calibration tube circumference, respectively.
• As described herein, using the flared, calibration tube with a sleeve gastrectomy stapling guide may help to create a repeatable sleeve gastrectomy anatomy based on a size a surgeon may want to achieve for their patient. The formulas
• $F1,{\mathrm{<figure-callout\; label="C"\; filenames="US20200008964A1-20200109-D00004.png,US20200008964A1-20200109-D00009.png"\; state="\{\{state\}\}">C</figure-callout>}}_1+2{\mathrm{<figure-callout\; label="L"\; filenames="US20200008964A1-20200109-D00004.png,US20200008964A1-20200109-D00009.png"\; state="\{\{state\}\}">L</figure-callout>}}_1={\mathrm{<figure-callout\; label="C"\; filenames="US20200008964A1-20200109-D00004.png,US20200008964A1-20200109-D00007.png"\; state="\{\{state\}\}">C</figure-callout>}}_2,\mathrm{and}F2,{\mathrm{<figure-callout\; label="D"\; filenames="US20200008964A1-20200109-D00004.png,US20200008964A1-20200109-D00009.png"\; state="\{\{state\}\}">D</figure-callout>}}_1+\frac{2{\mathrm{<figure-callout\; label="L"\; filenames="US20200008964A1-20200109-D00004.png,US20200008964A1-20200109-D00009.png"\; state="\{\{state\}\}">L</figure-callout>}}_1}{\pi }={\mathrm{<figure-callout\; label="D"\; filenames="US20200008964A1-20200109-D00004.png,US20200008964A1-20200109-D00007.png"\; state="\{\{state\}\}">D</figure-callout>}}_2,$
• may be used such that the flared, calibration tube and the stapling guide or clamp may create a reproducible sleeve diameter. In examples, D₁represents the diameter of the calibration tube used and C₁represents its circumference (e.g., at the IA, or the narrowest point), L₁represents the distance/width of the (e.g., top and bottom) stapling guide, D₂represents the diameter of a resultant sleeve size, and/or C₂represents its resultant circumference.
• For example, a surgeon may aim or want to create a resultant sleeve size equivalent to using that of a 36 French (Fr) bougie (or 1.2 cm), which may be D₂. If the stapling guide may be 1 cm in width (L₁), using the formula F2, the diameter of the calibration tube may be approximately 0.5634 cm (D₁), or 16.9014 Fr. As such, to create a sleeve size resultant of using a 36 Fr bougie, a 16.9 Fr flared, calibration tube should be used in conjunction with a stapling guide.
• As described herein, one of the main focuses of this process, and the calibration tube, is the fact that it keeps the resection line at least 2 cm off of the IA. The desired resultant diameter above was 36 Fr, but this is only equivalent to 1.2 cm. While 36 Fr is a good estimate of the average diameter of the various calibration tubes used, surgeons achieve the 2 cm IA offset by inserting their calibration tube, and stapling (i.e. estimating) slightly off the calibration tube, guessing at where they think 2 cm is.
• To overcome this, the calibration tube may configured to flair out at its widest point (e.g., themaximum diameter2 of the flared portion3,13, and/or23), which may be the same point where it may be lined up adjacent to the IA and the stapling guide, and may create a resultant diameter of 2 cm. Inserting 2 cm as D₂into F1, with L₁still 1 cm, D₁may be calculated as 1.3634 cm, or 40.9014 Fr. Thus, at its widest point, the flared, calibration tube may be about 41 Fr. The rest of the tube may narrow as it moves proximally (e.g., to 4) until it reaches the constant diameter or a smaller diameter such that this point in the tube, for example, the flared portion or maximum diameter thereof may be emphasized and easier to see from the surgeon's perspective. The 41 Fr flair may subsequently narrow to something closer to the examples described herein, of around 15 or 16 Fr, so the rest of the tube may not be as wide thereby facilitating fundus removal, which may be important to the procedure. This narrowing from the maximum diameter (e.g., to 4 and/or 5) may also allow the stapling guide to be positioned at the GEJ. Based on the width and shape of the stapling guide along with the diameter of the flared, calibration tube, a 1 cm offset from the GEJ and a squared off final cut may be provided (e.g., ensured). As such, in an example, with a 10 mm stapling guide as a spacer, a calibration tube with a 41 Fr flare portion and 16.9 Fr body, a surgeon may be able to achieve a safe distance from the incisura angularis and create a sleeve gastrectomy tube with a consistent resultant diameter of 36 Fr.
• Further, in one or more examples, other surgeons may want 1.5 cm or 2.5 cm offset (e.g., even though a 2 cm offset at the IA may be believed to be ideal) or some other distance along their staple line, so various sizes of flared, calibration tubes may be used in one or more examples herein to accommodate surgeon needs to maximize what they think is the best, most effective sleeve. A table as shown inFIG. 33 with the different sizes D₁, D₂, L₁, C₁, and/or C₂may be provided to assist a surgeon in knowing the resultant sleeve volume with different sizes of the flared, calibration tube and/or the stapling guide. As such, according to examples herein, different flared, calibration tubes with different diameters may be used with a stapling guide with a particular width to achieve a resultant sleeve diameter using the formulas F1 and F2 (e.g., calculated thereby).
• FIG. 14A depicts a cross-section view of what the calibration tube and stapling guide combination will look like, with the adjacent resection line along the guide. In an example herein, the formula F1 illustrated inFIG. 13A may be used to calculate the resultant sleeve circumference58 (02) from thecircumference54 of thecalibration tube50 used (C₁) and the width60 (L₁) of astapling guide88 used as shown inFIG. 14A.
• FIG. 14B depicts the resultant size of the sleeve once the calibration tube and stapling guide may be removed. In one or more examples herein, the formula F2 as described herein may be used. Here, the diameter56 (D₂) of theresultant sleeve40gmay be calculated from the diameter52 (D₁) of thecalibration tube50 used and the width60 (L₁) of the staplingguide88 used.
• FIG. 15-18 depicts an example method or procedure that may be performed using the flared,calibration tube12 in one or more examples. As shown inFIG. 15, thecalibration tube12 may be positioned into an interior of a stomach. For example (e.g., to position), thecalibration tube12 may be inserted into astomach40 through the mouth and esophagus, and passed down into the pylorus. A staplingguide88 may be positioned on an exterior of the stomach relative to thecalibration tube12. For example, the staplingguide88 may be passed around thestomach40 as shown inFIG. 15 until it may be placed into position, with the proximal portion being on theGE junction40eas shown in inFIG. 17. In examples, the staplingguide88 may be inserted through a trocar or laparoscopic device to be positioned on the exterior of the stomach. The flared,calibration tube12 may then be pulled up by the surgeon until the flared portion3 (e.g., themaximum diameter2 thereof) of thetube14 may reach theincisura angularis40das shown inFIG. 18. Because the gap between theincisura angularis40dand thestapling guide88 may be narrower than the flared portion3 of thetube14, as the flared portion3 moves vertically, it (e.g., via the point P′) may push (e.g., a side of) thestapling guide88 to the anatomic left that the staplingguide88 may be positioned relative to. The surgeon may hold thestapling guide88 in place at theGE junction40e, so that the staplingguide88 may swing over and create a line (e.g., along point P1, P2, and P3 as shown inFIGS. 18 and 19 and opposite to a side positioned relative to the calibration tube12) up thestomach40. In examples, P1 may be the distance from the pylorus, which may vary from surgeon to surgeon, but may typically be 2-6 cm from the pylorus on the gastric antrum along the greater curve (e.g., and may be40cof the resultant sleeve inFIG. 30), P2 may be adjacent to the incisura angularis, and P3 may be the distance from the gastroesophageal junction (GEJ) (e.g., and may be40einFIGS. 15-18 and the resultant sleeve ofFIG. 30). Further, P2 may be defined by an internal diameter of the flared portion3 of thetube14 plus the spacer effect of the stapling guide (e.g., using the formula F1 and F2 described with respect toFIGS. 13A-13B). The edge of the stapling guide88 (e.g., where a surgical stapler may be deployed and the staple line formed along P1, P2, and P3) may then be approximately 2 cm off of the incisura angularis40dand approximately 1.0 cm off of theGE junction40e(e.g., which as described herein may be ideal for the surgeon).
• In an example (e.g., when the staplingguide88 may be so aligned), the stomach portions may be separated and reconnected along the edge of the staplingguide88 at the path, staple line, resection line, or line (e.g., formed by P1, P2, and P3) using the surgical stapler such as a conventional surgical stapler. In the example described above, the stapling guide and the surgical stapler may be separate elements. In an additional or alternative embodiment, however, the stapling guide and the surgical stapler may be integrated into a single device. Once that device may be aligned, such as with the calibration tube described above, it may be activated as described herein to form the staple line along the vertical line thereby separating and reconnecting the stomach portions without further positioning.
• Theresultant sleeve40g, post stapling, may be illustrated inFIG. 30. The example dimensions (e.g., about 2 cm off of the incisura angularis40dand about 1 cm off of theGE junction40e) may be provided for theresultant sleeve40g. For example, theresultant sleeve40gcreated or provided by the path, resection line, staple line, or line may include a diameter of 1 to 3 cm near the first landmark (e.g., theIA40d), 2 to 6 cm near a second landmark (e.g., a pylorus near 40c) of the stomach, and 0 to 2 cm near a third landmark (e.g., a gastroesophageal junction (GEJ) orGE junction40e) of the stomach.
• FIGS. 19-23 illustrate another or additional example method or procedure that may be performed using the flared,calibration tube12 in one or more examples. As shown, in examples, the method or procedure shown inFIGS. 19-23 may be used with thetubes64,74 with the flaredportion73 described with respect toFIGS. 7-8 and/or thetube34 with the flaredportion33 described with respect toFIGS. 4-6 (not shown).FIG. 19 shows the points P1, P2, and P3 on the stomach that a surgeon may want to form a staple line as described herein (e.g., inFIGS. 15-18) to create a sleeve gastrectomy associate with such points. As described herein, in one or more examples, different surgeons may have different methods and distances that they may be trying to achieve but they may want it wider at P2 to prevent kinking around the bend although the width may vary from 50% wider to 300% wider between the surgeons. Further, with respect to P3 (e.g.,40cinFIGS. 18 and 30), the surgeons may try to stay 0.5 cm to 1 cm away from the GEJ to preserve the sling fibers of the cardia, which play a role in the antireflux mechanism.
• As shown inFIG. 20, an orogastric tube (e.g., as shown the first andsecond tubes64,74) with a flared portion (e.g., the flared portion73) may be positioned in an interior of the stomach. For example (e.g., to position), the first andsecond tubes64,74 may be inserted into thestomach40 through the mouth and esophagus, and passed down into the pylorus. Thetubes64,74 may be placed along the lesser curve such that the flaredportion73 with the wider diameter (e.g., the maximum diameter2) may be placed at theincisura angularis40d. The staplingguide88 may be positioned on an exterior of the stomach relative to thetubes64,74. For example, the staplingguide88 may be passed around thestomach40 as shown inFIG. 21 until it may be placed into position (e.g., near point P′), with the proximal portion being on theGE junction40eas shown in inFIG. 22. For example, as shown inFIG. 21, the staplingguide88 may be placed just medial to the desired resection line, staple line, or line that may be defined by P1 to P2. In an example, P2 may be defined by an internal diameter of the flared portion23 of the orogastric tube (e.g.,64 and74) plus the spacer effect of the stapling guide (e.g., using the formula F1 and F2 described with respect toFIGS. 13A-13B). As shown inFIGS. 21 and 22, the surgeon may move thestapling guide88 relative to thestomach40 to align P2 with P3 such that P1, P2, and P3 may be in alignment and adjacent to a lateral edge or side of the surgical clamp88 (e.g., opposite to an edge or side near or adjacent to the point P′) ready to be stapled therealong to form or create the staple line, line, resection line, or path. As described herein, the edge of the stapling guide88 (e.g., where a surgical stapler may be deployed and the staple line formed) may be approximately 2 cm off of the incisura angularis40dand approximately 1.0 cm off of theGE junction40e(e.g., which as described herein may be ideal for the surgeon) as shown inFIG. 22. The surgical stapler may be actuated along the line defined by P1, P2, and P3 as described herein.
• Theresultant sleeve40g, post stapling along the line of P1, P2, and P3, may be illustrated inFIG. 23. Theresultant sleeve40gand its dimensions (e.g., about 2 cm off of the incisura angularis40dand about 1 cm off of theGE junction40e) may be provided. For example, theresultant sleeve40gcreated or provided by the path, resection line, staple line, or line may include a diameter of 1 to 3 cm near the first landmark (e.g., theIA40d), 2 to 6 cm near a second landmark (e.g., a pylorus near 40c) of the stomach, and 0 to 2 cm near a third landmark (e.g., a gastroesophageal junction (GEJ) orGE junction40e) of the stomach. In an example, the lengths of the lines defined by P1 to P2 and P2 to P3 may be changed during clamping thereby enabling the formation of theresultant sleeve40gand its dimensions. The orientation and position of the stomach may be changed in examples by the placement of thetubes64,74 and thestapling guide88 and the stomach may snap back into shape after the manipulation and stapling. Thus, the interaction between theclamp88 and the flaredcalibration tube64,74 aligns the points P1, P2 and P3 to enable a straight staple line to become a curved resultant sleeve.
• FIGS. 24-28 illustrate another or additional example method or procedure that may be performed using the flared,calibration tube12 in one or more examples. As shown, in examples, the method or procedure shown inFIGS. 24-28 may be used with thetubes84 with the flaredportion83 described with respect toFIG. 10 and/or thetubes94,104 with the flaredportion93,103 described with respect toFIGS. 11-12B (not shown). As shown inFIG. 24, similar to the method or procedure described above with respect toFIGS. 15-18 and 1923, a surgeon may want to form a staple line or resection line along the line defined by P1, P2, and P3.
• InFIG. 25, a calibration tube such as thetube84 with a balloon such as theballoon86 on the distal end (e.g., in state S1 as described above) that may form the flaredportion83 may be positioned in an interior of the stomach. For example, thetube84 may be inserted into thestomach40 through the mouth and esophagus, and passed down into the pylorus. Thetube84 may be inserted such that theballoon86 that may form the flaredportion83 may be placed along the lesser curve adjacent theincisura angularis40d.
• In an example, as shown inFIG. 26, a single cartridge stapler110 or thestapling guide88 may be positioned on an exterior of the stomach. For example, the stapler110 may be placed along P1 and P3 or thestapling guide88 may be placed medial to P1 and P3. P1 and P3 may be stabilized by partial clamping the stapler110 or positing the staplingguide88 as described herein (e.g., above), and/or using similar stabilization with accessory instruments.
• As shown inFIG. 27, theballoon86 may be inflated (e.g., from state S1 to state S2 as described above) to form the flaredportion83. The flaredportion83 formed by theballoon86 may align P2 with P1 and P3 as described herein by moving or the stapler110 and/or thestapling guide88 and/or the stomach to create or demonstrate the stapling line, resection line, path, and/or the like. For example, the flaredportion83 via the point P′ that may be near an edge or side of the stapler110 or staplingguide88 may move the stapler110 or staplingguide88 to create the staple line, resection line, path, line, and/or the like (e.g., with the points P1, P2, and P3) along the edge of the stapler110 or stapling guide110 opposite of the edge near the point P′. As described herein, the edge of the stapler110 or the stapling guide88 (e.g., where a surgical stapler may be deployed and the staple line formed) may be approximately 2 cm off of the incisura angularis40dand approximately 1.0 cm off of theGE junction40e(e.g., which as described herein may be ideal for the surgeon) as shown inFIG. 22. The stapler may be actuated along the line defined by P1, P2, and P3 as described herein above. This may also be illustrated for thetube104 inFIG. 12B.
• Theresultant sleeve40g, post stapling along the vertical line of P1, P2, and P3, may be illustrated inFIG. 28. Theresultant sleeve40gand its dimensions (about 2 cm off of the incisura angularis40dand about 1 cm off of theGE junction40e) may be provided. For example, theresultant sleeve40gcreated or provided by the path, resection line, staple line, or line may include a diameter of 1 to 3 cm near the first landmark (e.g., theIA40d), 2 to 6 cm near a second landmark (e.g., a pylorus near 40c) of the stomach, and 0 to 2 cm near a third landmark (e.g., a gastroesophageal junction (GEJ) orGE junction40e) of the stomach. After the stapler may be removed, the stomach may return to a curved shape after resection as described herein.
• FIG. 29 may illustrate a representation of what an example method or procedure may include if one of several alternative or additional examples may be used. Here, theexample device66 may be used similar to the flaredcalibration tube12 in that it may help align thestapling guide88 and create proper spacing as described herein to provide aresultant sleeve40g.
• Additional or alternative examples of the calibration tubes that may be used inFIG. 29 may be provided inFIGS. 31 and 32.FIG. 31 illustrates acalibration tube62 withlights64 running down the length of thetube62. Thelights64 may assist the surgeon in seeing the placement and outline of the tube and improve their understanding of what their resultant sleeve will look like. The exact number and spacing of thelights64 may vary to achieve the desired illumination. Further,FIG. 32 illustrates aspecialized balloon bougie68 that may be inflated to create a variable-sized balloon70 that may be used to regulate the spacing to the stapling guide or single cartridge sleeve gastrectomy stapler and the volume of the sleeve. According to examples herein, theballoon70 may be configured to have a consistent size and shape such that the sleeve may be sized and shaped to this template with the use of the stapling guide or single cartridge sleeve gastrectomy stapler. Thus, theballoon70 may act as a mold from which to create the resultant sleeve lumen at a constant pressure (15 to 100 cm of water). Using either thetube62 or the bougie68, a resultant sleeve may be provided with the dimensions described herein as shown by40ginFIG. 30 or similar dimensions to that of40g.
• While several devices and components thereof have been discussed in detail above, it should be understood that the components, features, configurations, and methods of using the devices discussed are not limited to the contexts provided above. In particular, components, features, configurations, and methods of use described in the context of one of the devices may be incorporated into any of the other devices. Furthermore, not limited to the further description provided below, additional and alternative suitable components, features, configurations, and methods of using the devices, as well as various ways in which the teachings herein may be combined and interchanged, will be apparent to those of ordinary skill in the art in view of the teachings herein.
• Versions of the devices described above may be actuated mechanically or electromechanically (e.g., using one or more electrical motors, solenoids, etc.). However, other actuation modes may be suitable as well including but not limited to pneumatic and/or hydraulic actuation, etc. Various suitable ways in which such alternative forms of actuation may be provided in a device as described above will be apparent to those of ordinary skill in the art in view of the teachings herein.
• Versions of the devices described above may have various types of construction. By way of example only, any of the devices described herein, or components thereof, may be constructed from a variety of metal and/or plastic materials.
• Having shown and described various versions in the present disclosure, further adaptations of the methods and systems described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the present invention. Several of such potential modifications have been mentioned, and others will be apparent to those skilled in the art. For instance, the examples, versions, geometrics, materials, dimensions, ratios, steps, and the like discussed above are illustrative and are not required. Accordingly, the scope of the present invention should be considered in terms of the following claims and is understood not to be limited to the details of structure and operation shown and described in the specification and drawings.

Claims (20)

What is claimed is:

1. A method for performing a sleeve gastrectomy, the method comprising the steps of:

providing a first medical device including:

(i) a tube for insertion into an interior of a stomach, the tube having a proximal end and a distal end; and

(ii) a balloon portion, the balloon portion having a first deflated configuration for insertion into the interior of the stomach and a second inflated configuration, wherein the balloon portion is positioned at about the distal end of the tube;

providing a second medical device, the second medical device being a single-use linear stapler, wherein the single-use linear stapler has a single cartridge such that a complete gastrectomy staple line is formed with the single cartridge along a resection line, the resection line being defined at least partially by the balloon portion in the second inflated configuration in cooperation with the single-use linear stapler;

inserting the first medical device into an interior of a stomach;

positioning the second medical device on an exterior of the stomach relative to and anatomically lateral to the first medical device; and

cutting the stomach using the second medical device to resect a portion of the stomach to form a sleeve.

2. The method ofclaim 1, further comprising operating the second medical device to provide a staple line.

3. The method ofclaim 1, wherein the second medical device has a first end and a second end and having a length therebetween, the length extending from about a pylorus of the stomach to about a gastroesophageal junction (GEJ) of the stomach.

4. The method ofclaim 3, wherein the second medical device is positioned relative to and anatomically lateral to the balloon portion of the first medical device such that the first end of the second medical device is positioned about one centimeter to about three centimeters laterally from the balloon portion of the first medical device.

5. The method ofclaim 3, wherein the second medical device is positioned about zero to about two centimeters relative to and anatomically lateral to the calibration tube at the GEJ.

6. The method ofclaim 3, wherein the second end of the second medical device is positioned anatomically lateral to the calibration tube at the GEJ.

7. The method ofclaim 6, wherein the second end of the second medical device is positioned about zero to about two centimeters relative to the calibration tube at the GEJ.

8. The method ofclaim 3, wherein the second medical device is positioned relative to and anatomically lateral to the first medical device such that a substantially linear resection line for the sleeve gastrectomy is defined by the balloon portion of the first medical device and the second medical device;

9. The method ofclaim 1, wherein the balloon portion includes a non-compliant balloon.

10. The method ofclaim 1, wherein the tube has a first diameter and the balloon portion has a second diameter larger than the first diameter.

11. The method ofclaim 1, wherein, after being inserted, the balloon portion is positioned at about an incisura angularis along a lesser curvature of the stomach.

12. The method ofclaim 1, wherein the balloon portion has a first deflated position for insertion into the stomach and a second inflated position for laterally displacing the lesser curvature of the stomach.

13. The method ofclaim 12, wherein the balloon portion has a first diameter in the first deflated position and a second diameter in the second inflated position, wherein the second diameter is from about 0.5 cm to about 2 cm.

14. The method ofclaim 13, wherein the first diameter of the balloon portion in the first deflated position is substantially the same as the first diameter of the tube.

15. The method ofclaim 1, wherein an interaction between the first medical device and the second medical device positions the second medical device in a desired position.

16. The method ofclaim 1, wherein positioning the second medical device further comprises:

moving the first medical device from a first position to a second position,

wherein the movement of the first medical device from the first position to a second position causes a corresponding movement of the second medical device from a first position to a second position.

17. A method for performing a sleeve gastrectomy, the method comprising the steps of:

providing a first medical device including:

(i) a tube portion for insertion into an interior of a stomach; and

(ii) a balloon portion, the balloon portion having a first deflated configuration for insertion into the interior of the stomach and a second inflated configuration;

providing a second medical device, the second medical device being a linear stapler, wherein the linear stapler has a single cartridge such that a complete gastrectomy staple line is formed with the single cartridge along a resection line, the resection line being defined at least partially by the balloon portion in the second inflated configuration in cooperation with the linear stapler;

inserting the first medical device into an interior of a stomach;

positioning the second medical device on an exterior of the stomach relative to and anatomically lateral to the first medical device; and

cutting the stomach using the second medical device to resect a portion of the stomach to form a sleeve.

18. The method ofclaim 1, further comprising operating the second medical device to provide a staple line.

19. The method ofclaim 1, wherein an interaction between the first medical device and the second medical device positions the second medical device in a desired position.

20. The method ofclaim 1, wherein positioning the second medical device further comprises:

moving the first medical device from a first position to a second position,

wherein the movement of the first medical device from the first position to a second position causes a corresponding movement of the second medical device from a first position to a second position.

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