The present disclosure relates generally to systems and methods for performing endoscopic procedures, and, more particularly, to location and access devices, systems, and methods for gastrojejunostomy procedures.
Viewing, locating, and manipulating anatomies, devices, and/or anatomies containing one or more devices, such as a body lumen, may be difficult. During a procedure a medical professional may need to externally locate a particular portion of a body lumen. Locating a desired portion of a body lumen may be difficult due to a lack of or low amount of illumination, intervening anatomy, and/or lengthy additional portions of the body lumen. It is with respect to these and other considerations that the present improvements may be useful.
In one aspect of the present disclosure, a medical device locator may include an elongate member having a proximal end, a distal end, a longitudinal axis, and a length extending along the longitudinal axis. An inflatable member may be disposed about the distal end of the elongate member. The inflatable member may have a first inflated volume and a second inflated volume larger than the first inflated volume. The elongate member may include a fluid lumen extending therealong in fluid communication with the inflatable member. The fluid lumen may be configured to pulsate the inflatable member between the first inflated volume and the second inflated volume.
In various embodiments described herein or otherwise within the scope of the present disclosure, a first light emitting diode (LED) may be disposed along the inflatable member. The elongate member may be a multi-lumen catheter including a second lumen extending along the longitudinal axis of the catheter. The second lumen may include a lead electrically coupled to the first LED. The catheter may include a third lumen extending along the longitudinal axis of the catheter distally past the inflatable member, the third lumen configured to deliver a flow of contrast fluid. The first LED may be actuatable to emit a light having a wavelength corresponding to a green light, a red light, or both. The first LED may extend along the inflatable member substantially parallel with the longitudinal axis. A controller may be electrically communicative with the first LED. The controller may be configured to actuate the first LED in a pulsating fashion. The controller may be in communication with a reciprocating fluid supply. The controller may be configured to substantially synchronize the second inflated volume of the inflatable member with actuation of the first LED and substantially synchronize the first inflated volume of the inflatable member with a deactivation of the first LED. The controller may be in communication with the reciprocating fluid supply. The controller may be configured to transition the inflatable member between the first inflated volume and the second inflated volume at a first frequency. The controller may be configurated to actuate the first LED at a second frequency that is larger than the first frequency. A second LED may be disposed along the inflatable member and electrically communicative with the controller. The controller may be configured to sequentially actuate the first LED and the second LED. The first LED may extend helically about the longitudinal axis along a length of the inflatable member. The second inflated volume of the inflatable member may have a first diameter larger than a second diameter of a relaxed body lumen. The inflatable member in the first inflated volume may be extendable within a body lumen. The inflatable member in the second inflated volume may be configured to stretch a wall of the relaxed body lumen such that the wall of the body lumen about the inflatable member is thinner than the wall about the inflatable member in the first inflated volume. The inflatable member may be a compliant balloon. An oscillator may be coupled to the elongate member configured to oscillate the distal end of the elongate member across the longitudinal axis when actuated.
In an aspect, a system for locating a medical device may include a catheter extendable within a first body lumen. An inflatable member may be disposed about a distal end of the catheter in fluid communication with a fluid lumen extending along the catheter. The inflatable member may have a first inflated volume and a second inflated volume larger than the first inflated volume. An LED may be disposed along the inflatable member. An endoscope may be extendable within a second body lumen toward the catheter between opposing walls of the first and second body lumens.
In various embodiments described herein or otherwise within the scope of the present disclosure, a controller may be electrically coupled to a fluid supply in fluid communication with the inflatable member. The controller may be configured to actuate the inflatable member between the first inflated volume and the second inflated volume. The controller may be electrically coupled to the LED and may be configured to substantially synchronize the second inflated volume of the inflatable member with actuation of the LED and substantially synchronize the first inflated volume of the inflatable member with deactivation of the LED.
In an aspect, a method of locating a medical device across a wall of a first body lumen may include extending an inflatable member comprising an LED within the first body lumen. The inflatable member may pulsate between a first inflated volume and a second inflated volume. The LED may be actuated during the pulsated second inflated volume. The actuated LED, the second inflated volume of the inflatable member, or both, may be used to locate the medical device from across the wall of the first body lumen.
In various embodiments described herein or otherwise within the scope of the present disclosure, a cutting tool from within a second body lumen, may be extended across a wall of the second body lumen toward the wall of the first body lumen and cutting into the wall of the first body lumen. Viewing actuated LED may be from within the peritoneal cavity space between the wall of the first body lumen and the wall of the second body lumen.
Non-limiting embodiments of the present disclosure are described by way of example with reference to the accompanying figures, which are schematic and not intended to be drawn to scale. In the figures, each identical or nearly identical component illustrated is typically represented by a single numeral. For purposes of clarity, not every component is labeled in every figure, nor is every component of each embodiment shown where illustration is not necessary to allow those of ordinary skill in the art to understand the disclosure. In the figures:
The present disclosure is not limited to the particular embodiments described. The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting beyond the scope of the appended claims. Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the disclosure belongs.
Although embodiments of the present disclosure may be described with specific reference to medical devices and systems (e.g., endoscopic devices, accessory tools, and/or guidewires inserted near or through a jejunum, or the like), it should be appreciated that such medical devices and systems may be used in a variety of medical procedures for navigating one or more devices through ductal, luminal, vascular, or body lumen anatomies, including, for example, interventional radiology procedures, balloon angioplasty/angiography procedures, thrombolysis procedures, urological or gynecological procedures, and the like. The medical devices herein may include a variety of medical devices for navigating body lumens, including, for example, catheters, ureteroscopes, bronchoscopes, colonoscopes, arthro scopes, cystoscopes, hysteroscopes, and the like. The disclosed medical devices and systems may also be inserted via different access points and approaches, e.g., percutaneously, endoscopically, laparoscopically, or combinations thereof.
As used herein, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. The terms “comprises” and/or “comprising,” or “includes” and/or “including” when used herein, specify the presence of stated features, regions, steps, elements and/or components, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components and/or groups thereof.
As used herein, “proximal end” refers to the end of a device that lies closest to the medical professional along the device when introducing the device into a patient, and “distal end” refers to the end of a device or object that lies furthest from the medical professional along the device during implantation, positioning, or delivery.
As used herein, the conjunction “and” includes each of the structures, components, features, or the like, which are so conjoined, unless the context clearly indicates otherwise, and the conjunction “or” includes one or the others of the structures, components, features, or the like, which are so conjoined, singly and in any combination and number, unless the context clearly indicates otherwise.
All numeric values are herein assumed to be modified by the term “about,” whether or not explicitly indicated. The term “about”, in the context of numeric values, generally refers to a range of numbers that one of skill in the art would consider equivalent to the recited value (i.e., having the same function or result). In many instances, the term “about” may include numbers that are rounded to the nearest significant figure. Other uses of the term “about” (i.e., in a context other than numeric values) may be assumed to have their ordinary and customary definition(s), as understood from and consistent with the context of the specification, unless otherwise specified. The recitation of numerical ranges by endpoints includes all numbers within that range, including the endpoints (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5).
It is noted that references in the specification to “an embodiment”, “some embodiments”, “other embodiments”, etc., indicate that the embodiment(s) described may include a particular feature, structure, or characteristic, but every embodiment may not necessarily include the particular feature, structure, or characteristic. Moreover, such phrases are not necessarily referring to the same embodiment. Further, when a particular feature, structure, or characteristic is described in connection with an embodiment, it would be within the knowledge of one skilled in the art to affect such feature, structure, or characteristic in connection with other embodiments, whether or not explicitly described, unless clearly stated to the contrary. That is, the various individual elements described below, even if not explicitly shown in a particular combination, are nevertheless contemplated as being combinable or arrangeable with each other to form other additional embodiments or to complement and/or enrich the described embodiment(s), as would be understood by one of ordinary skill in the art. Exemplary devices, systems, and methods with which embodiments of the present disclosure may be implemented include, but are not limited to, those described in the complete disclosures of U.S. Pub. No. 2018/0271530, filed Mar. 26, 2018, published Sep. 27, 2018, and titled, “Systems and Methods to Effect Movement of Tissue Structures,” International Pub. No. 2019/140097, filed Jan. 10, 2019, published Jul. 18, 2019, and titled, “Systems, Methods And Devices For Connecting Non-Adherent Structures,” and U.S. Provisional Patent Application having an Attorney Docket No. 8150.0739Z, filed Sep. 1, 2020 and titled, “Grasping Devices, Systems, and Methods for Tissue Approximation and Apposition,” each of which disclosures are herein incorporated by reference in their entirety.
In many embodiments, the present disclosure relates to devices, systems, and methods for performing a procedure, e.g., an endoscopic, laparoscopic, and/or open surgical procedure, to create a gastrojejunal anastomosis. For example, devices and systems described herein may aide gastrojejunal anastomosis placement by reliably and repeatably locating a desired position in a patient's gastrointestinal system, e.g., distinguishing a position in the jejunum 120 proximal and/or distal to the Ligament of Treitz 130. Additionally, devices and systems herein may allow for a medical professional to locate, grasp, hold, and/or cut a portion of the small bowel 125 during a gastrojejunal anastomosis procedure. Optionally a stent or other conduit may be placed across the bypass bridging the walls of the stomach and jejunum where the openings are created. The stent or conduit may assist with establishing or maintaining the anastomosis open until it is stable. The stent may or may not be subsequently removed. Although the systems and devices are described herein with respect to a gastrointestinal system, it may be understood that exemplary embodiments of devices and systems in accordance with the present disclosure may be advantageous for use in any other procedures and/or anatomy, where selective location is blind and grasping, manipulation, or cutting of tissue (e.g., a body lumen and/or other sensitive tissue structures) is indicated.
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In various embodiments, an inflatable member may pulsate by repeatedly transitioning between a first inflation volume and a larger second inflation volume. When positioned within a desired portion of a body lumen, the pulsating repeated transitioning of the inflatable volume between the first inflated volume and the second inflated volume may temporarily and repeatably expand the desired portion of the body lumen to be larger than adjacent portions of the body lumen. Transfer of such pulsating volume variances from the inflatable member to the desired portion of a body lumen may assist with identifying the desired portion when viewed externally from the body lumen.
In various embodiments, LEDs along an inflatable member may be actuated such that they are viewable across a tissue of a desired portion of a body lumen. An inflated inflatable member may bring the LEDs into contact with tissue of the body lumen. The larger diameter of an inflatable member compared to the inner diameter of the body lumen may cause circumferential apposition to stretch out the elastic tissue of the body lumen at the desired portion such that the tissue is thinner at the desired portion than at adjacent portions and light emitted from the LEDs more easily passes through the thinned tissue of the desired portion.
In various embodiments, a controller may control inflation fluid and/or actuation of LEDs of an inflation member via a multi-lumen elongate member including one or more fluid lumens and one or more electrical leads. Actuation of the LEDs may be synchronized with a second larger inflation volume of an inflatable member such that the LEDs are only actuated when they are more likely viewable in proximity to the tissue wall of a body lumen compared to a remote position away from the tissue. The LEDs may be synchronized such that they are deactivated during a first smaller inflation volume of an inflatable member. LED synchronization may reduce heat and/or energy consumption of a device. Synchronization actuation of the LEDs with a second larger inflation volume of the inflatable member may be at different frequencies. For example, the frequency of actuating the LEDs may be larger (i.e., shorter duration intervals) than the frequency of the second inflation volume such that the LEDs may illuminate multiple times during a single duration of the larger second inflation volume, which may be more noticeable to a medical professional viewing a desired portion of a body lumen from external to the body lumen, compared to a smaller actuation frequency of the LEDs (i.e., longer duration intervals). One or more LEDs may have variable illumination wavelengths that correspond to visual colors, e.g., red, green, yellow, blue, white, a combination thereof, or the like that may be more viewable to a medical professional than other colors. Multiple LEDs may be sequentially actuated.
In various embodiments, an inflatable member and/or an elongate member may include a vibrating or oscillating body. The vibrating or oscillating body may be actuated to move the inflatable member such that motion is transferred to a desired portion of a body lumen for external visual locating. Alternatively, a vibrating or oscillating body may replace an inflatable member of an embodiment herein such that the elongate member transfers motion to a desired portion of a body lumen for external visual locating.
In various embodiments, an inflatable member may comprise a compliant material. A compliant material may allow for the inflatable member to conform to walls of a desired portion of a body lumen when inflated. An inflatable member may comprise a non-compliant material. A non-compliant material may allow for a particular shape of the inflatable member and may not stress the LEDs of the inflatable member compared to a compliant material.
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In various embodiments, a fluid from a fluid needle may be a visible medical ink. A fluid needle may be configured to deliver a fluid into layers of a tissue wall of a body lumen. A fluid may be a desirable medium for marking a tissue because it does not introduce significant heat into the body even during prolonged exposure, compared to other electro-mechanical methods of locating a desired portion of a body lumen that may dissipate heat. A fluid may comprise a fluorescent ink that illuminates, i.e., glows, when succumbed to particular light conditions, e.g., about 465 nm wavelength light or the like. A fluid may comprise various fluorescent materials such as fluorescent supramolecular nanoparticles encapsulating a fluorescent conjugated polymer, or the like. Various light wavelengths may be delivered through an endoscope, e.g., via fiber optics or from a light source within the endoscope itself. Fluids visible under various lighting conditions may differentiate marked anatomies. A fluid may comprise a biodegradable material.
All of the devices and/or methods disclosed and claimed herein can be made and executed without undue experimentation in light of the present disclosure. While the devices and methods of this disclosure have been described in terms of preferred embodiments, it may be apparent to those of skill in the art that variations can be applied to the devices and/or methods and in the steps or in the sequence of steps of the method described herein without departing from the concept, spirit and scope of the disclosure. All such similar substitutes and modifications apparent to those skilled in the art are deemed to be within the spirit, scope and concept of the disclosure as defined by the appended claims.
The present application is a non-provisional of, and claims the benefit of priority under 35 U.S.C. § 119 to, U.S. Provisional Application Ser. No. 63/084,033, filed Sep. 28, 2020, the disclosure of which is hereby incorporated herein by reference in its entirety for all purposes.
Number | Date | Country | |
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63084033 | Sep 2020 | US |