Patent Application
20120130283
Not Applicable
In some embodiments this invention relates to an adjustable gastric band to treat obesity. Some embodiments are directed to methods of adjusting the size of an implanted adjustable gastric band. Other embodiments relate to luminal dimensions assessments in humans, as well as in inanimate conduits or devices.
At the turn of the 21st century, obesity is the epidemic with the greatest prevalence and incidence in the United States. Obesity is defined as having a body mass index (BMI)≧30 kg/m2, and morbid obesity, or clinically severe obesity, is defined as having a BMI≧40 kg/m2, or a BMI≧35 kg/m2 with co-existing comorbid conditions. It is estimated that there are approximately 20 million people in the United States who are morbidly obese.
Obesity is not primarily a cosmetic problem. Obesity and morbid obesity are associated with: hypertension; atherosclerotic cardiovascular disease (coronary, cerebral, and peripheral); hypercholesterolemia; type 2 diabetes; asthma; obstructive sleep apnea; gallstones; cirrhosis and carcinoma of the liver; carcinoma of breast and uterus; low-back syndrome and herniated disks; weight bearing osteoarthritis of the hips, knees, ankles, and feet; lower extremity edema and varicosities; thrombophlebitis and pulmonary emboli; skin fold rashes; and many other diseases. Furthermore, in our society, the obese and morbidly obese have psychological, social, marital, and sexual problems. Obesity is also an economic problem associated with denial of employment, restriction of career advancement and higher educational opportunities, and uninsurability or high insurance premiums.
Unfortunately, medical diet and drug therapy today may not be as effective as desired with respect to obesity, and most certainly morbid obesity. This disease has, however, definitively been shown to respond to bariatric or obesity surgery.
Bariatric surgery can be divided by mechanisms of action into four categories: malabsorptive, malabsorptive/restrictive, restrictive, and other procedures and approaches. Adjustable gastric banding, laparoscopic or non-laparoscopic, is restrictive in intent. The restrictive procedures of bariatric surgery can be performed more rapidly and are more physiological than any of the other bariatric procedures, since, as a rule, no part of the gastrointestinal tract is resected, bypassed, or rerouted.
In the last few years, gastric banding has become a dominant force in bariatric surgery operative technology, and has fairly well displaced the stapled and banded gastroplasty. It is the most utilized bariatric procedure in Europe and Australia and, though still second to gastric bypass, is gaining in popularity in the United States.
Adjustable gastric band placement is usually performed laparoscopically but could be performed by open or endoscopic surgery. This intervention creates a restriction of the upper gastric lumen, effectively separating the gastric lumen into a small (approximately 15 ml) upper pouch and the remainder of the gastric lumen, the gastric remnant The gastric band's constriction of the upper gastric lumen and, therefore, its ability to regulate gastric flow to control food intake, is a function of adjustable inflation of the lumen of the band via a catheter and a subcutaneous port. There are different and patented engineering concepts for the construction of the different adjustable gastric bands, the catheters and ports, and the filling techniques. To the best of the inventors' knowledge, there are no existing patents or disclosures for directly determining the lumen size, diameter, or volume enclosed by the gastric band in a patient and, thereby, determining the unrestricted flow path for luminal contents, i.e., food.
Weight loss success of adjustable gastric banding, to a major degree, resides in follow-up care after band placement. Follow-up care is primarily a function of obtaining, maintaining, or adjusting the gastric lumen size of the gastric pathway through the constricting band. Optimal gastric lumen size provides for food restriction in comfortable balance with food intake, leading to a hypocaloric state and weight loss. To achieve this state, it is necessary to adjust the intraband fluid volume using the band's catheter and port or other mechanism.
This gastric lumen adjustment needs to take place up to or beyond six times per year, especially in the first year after band placement. The band volume adjustment is performed by a physician or a skilled nurse guided by the patient's subjective sensations of fullness or discomfort; expensive, radioactive exposure to x-rays and/or fluoroscopy; or newer technology equating intraband pressure with optimal gastric lumen size. None of these methods measures directly the gastric lumen size of the band and the size (diameter or volume) of the intragastric conduit within the encircling band. There is today no available technology directly to measure these parameters of gastric lumen size, and, thereby, determine the optimal adjustment of the intraband volume and constriction of the gastric lumen. Gastric band efficacy for each individual patient would be optimized if the gastric lumen size parameters could be directly measured. It may also be feasible to determine a formula or algorithm for gastric lumen size adjustment useable in adjustable gastric band patients as a class.
In summary, utilization of our method may allow for optimization of gastric lumen size adjustment and provide for comfortable weight loss with the adjustable gastric band, placed laparoscopically or nonlaparoscopically, and weight loss results beyond those achievable today, as well as enhanced patient satisfaction.
Gastric bands are described in U.S. Pat. Nos. 5,938,669, 6,210,347, 6,676,674, and 7,338,433, the entire contents of each being expressly incorporated herein by reference.
The art referred to and/or described above is not intended to constitute an admission that any patent, publication or other information referred to herein is “prior art” with respect to this invention.
All US patents and applications and all other published documents mentioned anywhere in this application are incorporated herein by reference in their entirety.
Without limiting the scope of the invention, a brief summary of some of the claimed embodiments of the invention is set forth below. Additional details of the summarized embodiments of the invention and/or additional embodiments of the invention may be found in the Detailed Description of the Invention below.
A brief abstract of the technical disclosure in the specification is provided for the purposes of complying with 37 C.F.R. §1.72.
In at least one embodiment, the invention is directed to a system for measuring the size of a gastric lumen utilizing ultrasound. The system comprises a gastric banding device, an antenna positioned outside of the patient's body, and a receiver in operative communication with the antenna. The banding device comprises two orthogonal ultrasonic transceiver modules, a microprocessor, and a transmitter in electrical communication with the microprocessor. The microprocessor is in operative communication with each of the two transceiver modules. The transmitter is constructed and arranged for transmitting signals to a receiver positioned outside of a patient's body.
In some embodiments, the system comprises a gastric banding device having a first coiled conductor. The system further comprises a circuit external to the banding device, the circuit comprising a second coiled conductor. The circuit further comprises a tunable frequency generator and a spectrum analyzer, the circuit being tunable to allow a resonant frequency.
In at least one embodiment, the invention is directed to a method of measuring the size of a gastric lumen, the method comprising providing a system for measuring the size of a gastric lumen. The system comprises a gastric banding device having a first coiled conductor. The system further comprises a circuit external to the banding device, the circuit comprising a second coiled conductor. The circuit further comprises a tunable frequency generator and a spectrum analyzer, the circuit being tunable to allow a resonant frequency. The method further includes tuning the circuit external to the banding device to a first resonant frequency in the absence of a patient. The method further includes recording the first resonant frequency. The method further includes positioning the second coiled conductor near the patient. The method further includes providing a water solution for the patient to swallow. The method further includes tuning the circuit external to the banding device to a second resonant frequency in the presence of the patient. The method further includes calculating the size of the gastric lumen based on the difference between the first resonant frequency and the second resonant frequency.
In some embodiments, the present invention is directed towards a method of equipment verification using a gastric magnetic susceptibility phantom and system for measuring the size of a gastric lumen. The method comprises filling a peristaltic pump with a magnetic resonance imaging contrast material, the peristaltic pump having a longitudinal axis. The method further comprises disposing a first, second, and third gastric banding devices of claim 1 about the peristaltic pump, the first, second, and third banding devices being offset from one another along the longitudinal axis. The method further comprises setting the pump to a speed approximately equal to the speed of human swallowing. The method further comprises pumping the contrast material through the pump. The method further comprises positioning the second coiled conductor about the first banding device and determining the maximum deviation of the resonant frequency of the first banding device from the spectrum analyzer while contrast material is pumped through the pump. The method further comprises positioning the second coiled conductor about the second banding device and determining the resonant frequency of the second banding device from the spectrum analyzer while contrast material is pumped through the phantom. The method further comprises positioning the second coiled conductor about the third banding device and determining the resonant frequency of the third banding device from the spectrum analyzer while contrast material is pumped through the phantom. The method further comprises calculating the area of each of the first, second, and third bands based on their resonant frequencies.
These and other embodiments which characterize the invention are pointed out with particularity in the claims annexed hereto and forming a part hereof. However, for further understanding of the invention, its advantages and objectives obtained by its use, reference can be made to the drawings which form a further part hereof and the accompanying descriptive matter, in which there is illustrated and described an embodiments of the invention.
A detailed description of the invention is hereafter described with specific reference being made to the drawings.
While this invention may be embodied in many different forms, there are described in detail herein specific embodiments of the invention. This description is an exemplification of the principles of the invention and is not intended to limit the invention to the particular embodiments illustrated.
For the purposes of this disclosure, like reference numerals in the figures shall refer to like features unless otherwise indicated.
Referring now to
The system further includes appropriate capacitance, inductance, and resistance to allow resonance both when a patient is absent and when the patient is present, as will be described in detail below. For example, the system shown in
The system 10 may also include a device 24 for controlling heating within the interior coil 12, shown in
In at least one embodiment, the electrical leads are accessible via an access port on the patient's body, as seen in
It should be noted that in the above-described embodiments, no battery or radiofrequency (RF) module is needed because the current in the lap band is a result of induction.
The system may further include a computer 35, depicted in
Two embodiments of the present invention utilize induction to calculate the area of a gastric lumen. The first embodiment using induction to be considered is when the inner coil and the outer coil are placed concentrically and coaxially relative one another, as shown schematically in
It is assumed that the external coil is excited with the following current:
I=I0 sin ωt, (1)
where ω=the angular frequency of the current source and I0 is the maximum current of the current source. Then, the magnetic field B for a relatively long coil is given by the relation:
B=μ•N
1
I
0•sin(ω•t)/d1, (2)
where N1 is the number of turns in the coil, and d1 is the length of the coil. The magnetic flux from the larger external coil subtended by the LAGB is:
Φ=A2•B=A2•μ•N1•I0•sin(ω•t)/d1, (3)
where μ is the magnetic susceptibility of the material contained within the area A2 of the inner coil, B is the magnetic field density, and N1 is the number of turns in the coil. The electromotive force (emf) generated by coil 1 in coil 2 is given by the relation:
E=−dΦ/dt=−A
2
•B=A
2
•μ•N
1•ω1•I0•(cos ωt)/d1 (4)
The voltage induced in the entire LAGB is given by the relation:
E
T
=N
2
•E=′−A
2
•μ•N
1
•N
2•ω1•I0•cos(ω•t)/d1 (5)
The self inductance (L) of a coil is defined as:
L=N•Φ/i=N•A•μ•N/l=N
2
•A•μ/d
1 (6)
The self induced emf in the coil is then
V=−LDI/dt=−ω•N
2
•A•μ•I
0•cos(ω•t)/d1 (7)
The mutual inductance (M) of the two coils is defined as
M
21
=N
2•Φ21/i1, (8)
where the current in coil 1 generates a flux in coil 2.
N
2•Φ21=N2•B1•π•R22, (9)
and also
N
2•Φ21=N2•N1•π•μ0•R22•i1/2•R1, (10)
Thus the mutual inductance for the LAGB and the external coil can be given by
M
21
=N
2
•N
1•π•μ0•R212/2•R1 (11)
It should be noted that although the magnetic field generated by the larger coil is essentially constant through the smaller coil, this is not true of the field induced by the smaller coil in the larger. But the mutual inductance of the larger coil upon the smaller is equal to that of the smaller coil upon the larger.
Continuing with the derivation, the voltage of a circuit is the sum of the voltages resulting from the resistance (VR), capacitance (VC), and inductance (VL) such that
V=V
R
+V
C
+V
L, (12)
or as a function of time in integro-differential form,
v(t)=I1•R+L1•dI1/dt+1/C•∫I1dt, (13)
or expressed completely as a differential equation:
If the variable frequency oscillator applies an excitation of
v(t)=V0 sin(ωt) (15)
to the external coil and associated resistor and capacitor, then equation (14) can be written as
The tuned (or resonant) circuit including the external loop has a natural frequency given by:
ωn=√{square root over (1/(L•C))} (18)
The quality factor, or Q, of a resonant circuit is given by:
Q=ω
n
•L/R=√{square root over (1/(L•C))}•L/R=1/R•√{square root over (L/C)} (19)
The bandwidth (ω2−ω1) of the frequency plot (i.e. the width at half maximum response as measured by the spectrum analyzer) is given by:
ω2−ω1=ωn/Q=R/L1=1/τ0 (20)
If the induced emf in the LAGB coil is known, then
V=N
2
•−A
2
•B=A
2
•μ•N
1
•I
0
ω/d
1(cos ωt) (21)
Considering the external tuned circuit without the LAGB included, then:
dV/dt=L•d
2
I/dt
2
+R•dI/dt+1/C•I, (22)
which is the general equation for a series RLC circuit. So,
1/L•dV/dt=d2I/dt2+(1/τ)•dI/dt+ω02•I, (23)
where
τ=L/R, (24)
and
ωn=√{square root over (1/(L•C))} (25)
The proportional half power frequencies are given by the relationship
Δω0/ωn=1/2Q=1/τ•ω=R/L•√{square root over (1/LC)}=R•√{square root over (C/L)} (26)
Now, an inductive circuit (which is a single conductive loop with no other resistance) is included in the external circuit that includes the LAGB. If the external coil is circuit 1 and the LAGB is circuit 2, then:
V
1
=L
1
•d
2
I
1
/dt
2
+M•d
2
I
2
/dt
2
+I
1
•R
1+1/C•∫I1•dt, (27)
and because there is no applied voltage in the lap band, and because the resistance is small in the lap band,
V
2=0=L2•d2I2/dt2+M•d2I1/dt2 (28)
Because we observe only the current parameters in the external coil circuit, the current in the LAGB can be eliminated, leaving:
d
2
I
2
/dt
2
=−M/L
2
•d
2
I
1
/dt
2, (29)
then substituting into equation (27) gives
V
1
=L
1
•d
2
I
1
/dt
2
+M•−M/L
2
•d
2
I
1
/dt
2
+I
1
•R
1+1/C•∫I1•dt.( 30)
Taking the derivative of equation (30):
dV/dt=(L1•L2−M2)/L2)•d2I/dt2+R•dI/dt+1/C•I, (31)
which equals
L
2/(L1•L2−M2)•dV/dt=d2I1/dt2+R•L2/(L1•L2−M2)•dI1/dt+L2/C•(L1•L2−M2)•I1, (32)
which equals
L
2/(L1•L2−M2)•dV/dt=d2I/dt2+(1/τ)•dI/dt+ω02•I. (33)
The resonance frequency of the external coil changes in the presence of the LAGB, as does the bandwidth of the frequency, as shown below:
ω02=L2/C•(L1•L2−M2), (34)
and where
τ=(L1•L2−M2)/R•L2 (35)
Comparing the square of resonance frequency of the external coil in isolation and when concentric to the LAGB, the following ratio is obtained:
ωno
where ωno
Q=ω
n
•L/R=√{square root over (1/(L•C))}•L/R=1/R•√{square root over (L/C)} (37)
The values of L1, L2, and M depend on the geometry of the coils. As stated above, the first embodiment is directed toward a configuration in which the inner coil and the outer coil are placed concentrically and coaxially, as in
M=πμN
1
N
2
R
2
2/2R1=μN1N2A2/2R1, (38)
L
1
=N
1
2
•A
1
•μ/d
1, (39)
and
L
2
=N
2
2
•A
2
•μ/d
2, (40)
where R1 and R2 are the radii of the two coils, d1 and d2 are the lengths of the two coils, and A1 and A2 are the respective areas enclosed by the coils.
Based on equations (38)-(40) for M, L1, L2,
M
2
/L
1
L
2=π•μ2•N12•N22•A22•d1•d2/4•N12•N22•A12•A2•μ2=π•A2•d1•d2/4•A12 (41)
Substituting into equation (36) results in
ωno
Solving for the area A2 of the inner coil results in
A
2=(1−ωno
The second embodiment using induction to be considered is when the inner coil 12 and the outer coil 20 are placed in a coaxial non-concentric arrangement relative to one another, as shown schematically in
As stated earlier, the values of L1, L2, and M depend on the geometry of the coils. With the geometry of the second embodiment, namely of two coaxial non-concentric coils, L1, L2, and M are as follows:
M=μN
1
N
2
A
1
A
2/2π(R12+z2)3/2, (44)
and
L
1
=N
1
2
•A
1
•μ/d
1, (45)
and
L
2
=N
2
2
•A
2
•μ/d
2 (46)
Based on equations (44)-(46) for M, L1, L2,
M
2/(L1•L2)=μ2N21N22A12A22d1d2/41π2(R12+z2)3N12N22A1A2μ2=A1A2d1d2/4π2(R12+z2)3 (47)
Substituting into equation (36) results in
Solving for the area A2 of the inner coil results in
A
2=(1−ωno
The area of the concentric coaxial embodiment of equation (43) and the non-concentric coaxial embodiment of equation (49) can be summarized with the following equation:
A
2
=k•(1−ωno
where k depends on the geometry of the coils. Thus, the area is proportional to the absolute value of one minus the ratio of the squares of the maximum resonant frequencies, as measured by the spectrum analyzer.
The effect of the LAGB coil on the external coil is given by
Δω0/ωn=1/2Q=1/τ•ω (51)
Thus, the change in resonance frequency peak and the change in bandwidth can both be used to determine the product of the area and the magnetic susceptibility of the gastric lumen enclosed by the lap band. In both embodiments of the induction method, the external coil can be adjusted in both height and orientation relative to the LAGB coil to give maximum resonance frequency variation from isolation to insure proper relative position. The use of high magnetic susceptibility fluid in the lumen ensures that only the lumen area is measured rather than include the stomach tissue.
As stated earlier, the system may include a computer for calculating the area of the gastric lumen. A person of ordinary skill in the art would readily understand how to write software that calculates the area of the inner coil, as presented in equations (43) and (49) above, based on the foregoing.
In order to adjust the external coil to produce a maximum resonance frequency, some embodiments of the present invention include a coil holder to which the external coil is secured. Referring now to
Referring now to
Referring now to
Referring now to
The peristaltic pump is filled with a magnetic contrast material and the pump is set to a speed consistent with the speed of human swallowing. As shown in
Referring now to
The above technique does not give an image of the gastric lumen. However, the data collected can be displayed graphically, as shown in
It should be noted that the external frequency generating apparatus described earlier can be modified to scan across the gastric lumen using appropriate radiofrequency excitation, thereby mimicking a rudimentary flow sensing magnetic resonance imaging apparatus. Such an apparatus would provide an image, using appropriate frequency domain software.
The method of determining the size of a gastric lumen using a gastric magnetic susceptibility phantom is shown in
It should be noted that the steps in the method described in
Referring now to
The time between transmission of the ultrasonic pulse and reception of the echo is given by:
t=2•d/U, (52)
or
d=U•t/2, (53)
where U is the speed of sound in the medium, typically water, and d is the diameter of the lumen.
If the speed of sound is known, a dimension can be computed from the time between transmission and reception. If transmission occurs in two orthogonal directions, two dimensions of the lumen can be determined, and thus the area of the lumen can be computed. Assuming the lumen is an ellipse, the equation for the area of an ellipse using the major (a) and minor (b) axes is as follows:
A=π•a•b=(π•U
2
•t
1
•t
2)/16 (54)
The lumen is differentiated from the gastric tissue by instructing the patient to drink water, thus flushing the gastric area. If the lumen is clear, a clear echo signal is obtained and the time of flight of the ultrasound pulse is obtained in the clear area to determine lumen area.
To detect the presence of persistent solid mater in the gastric lumen, two methods are used. First, the orthogonal signal, that is the amplitude of the scattered ultrasonic pulse in the orthogonal direction, is compared with the original pulse echo return. And second, the amount of false return in the original pulse echo may even determine the ratio of solid to liquid matter in the cross section of the lumen encompassed by the LAGB.
Referring now to
The band 14 further includes a microprocessor 104 that measures the time of flight from each transceiver module. The microprocessor is capable of distinguishing between tissue echoes and the empty gastric lumen. The microprocessor is also capable of preparing a signal for transmission. The microprocessor is in electrical communication with a computer 105. In some embodiments, the computer and the microprocessor are incorporated into the same component. In at least one embodiment, the computer may be a look up table, capable of determining the semi-major axis, the semi-minor axis, and the scatter associated with the lumen.
The band 14 also includes a transmitter 106 capable of transmitting the signals from the band to a location outside of the body. The transmitter 106 can include an antenna for transmission, or an antenna in the band (not shown) can be in electrical communication with the transmitter.
The band 14 also includes a module 108 either containing a battery or capable of powering the laparoscopically adjustable gastric band electronics inductively.
External to the patient is an antenna 110 for receiving the transmitted signals and a receiver 112 in operative communication with the antenna. As before, a computer 35 may be included that has software capable of decoding and processing the signals transmitted by the transmitter 106 and received by the receiver 112. The computer software is capable of measuring the time of flight of horizontal and vertical ultrasonic pulses to determine the length and width of the gastric lumen, and combining the length and width to find the area of the gastric lumen. It should be noted that from the scatter of the horizontal into the vertical receiver and the scatter of the vertical into the horizontal receiver, the material in the gastric lumen can be determined
The ultrasonic system can be calibrated in a manner similar to that described above with regards to
In some embodiments, the banding device has an inner side and an outer side where the inner side being closer to the gastric lumen than the outer side, the two ultrasonic modules being positioned on the outer side of the banding device, as in
Some embodiments of the present invention relate to luminal dimensions assessments in humans, as well as in inanimate conduits or devices.
The above disclosure is intended to be illustrative and not exhaustive. This description will suggest many variations and alternatives to one of ordinary skill in this art. The various elements shown in the individual figures and described above may be combined or modified for combination as desired. All these alternatives and variations are intended to be included within the scope of the claims where the term “comprising” means “including, but not limited to”.
Further, the particular features presented in the dependent claims can be combined with each other in other manners within the scope of the invention such that the invention should be recognized as also specifically directed to other embodiments having any other possible combination of the features of the dependent claims. For instance, for purposes of claim publication, any dependent claim which follows should be taken as alternatively written in a multiple dependent form from all prior claims which possess all antecedents referenced in such dependent claim if such multiple dependent format is an accepted format within the jurisdiction (e.g. each claim depending directly from claim 1 should be alternatively taken as depending from all previous claims). In jurisdictions where multiple dependent claim formats are restricted, the following dependent claims should each be also taken as alternatively written in each singly dependent claim format which creates a dependency from a prior antecedent-possessing claim other than the specific claim listed in such dependent claim below.
This completes the description of the invention. Those skilled in the art may recognize other equivalents to the specific embodiment described herein which equivalents are intended to be encompassed by the claims attached hereto.
This application is a continuation application of U.S. application Ser. No. 12/179,927, entitled, “Device for Monitoring Size of Luminal Cavity,” by Henry Buchwald and Thomas J. O'Dea, and filed on Jul. 25, 2008, the entire contents of which is incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | 12179927 | Jul 2008 | US |
| Child | 13362246 | US |
