Systems and methods for less invasive resolution of maladies of tissue including the appendix, gall bladder, and hemorrhoids

Abstract

Systems and methods for transanal inversion and removal of the gall bladder, appendix, and hemorrhoids.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of the appendix manipulator being advanced into the appendix;

FIG. 2 is a perspective view of the appendix manipulator positioned in the appendix;

FIGS. 3 and 4 are perspective views of a first embodiment of the appendix manipulator manipulating the appendix to identify adhesions;

FIGS. 5 and 6 are perspective views of a second embodiment of the appendix manipulator manipulating the appendix to identify adhesions;

FIG. 7 is a cross-sectional view as seen along the line 7-7 in FIG. 6;

FIG. 8 is a perspective view of the proximal control portion of the manipulator device;

FIG. 9 is a perspective view of the manipulator combined with a tissue removal catheter, with portions of the overtube cut away for clarity;

FIG. 10 is a perspective view of the proximal control portion of the catheter shown in FIG. 9;

FIG. 10A is a perspective view of an alternate proximal control portion of the catheter shown in FIG. 9;

FIG. 11 is a side view of the inversion and excision elements of the catheter shown in FIG. 9 positioned adjacent the appendix;

FIG. 12 is a side view of the inversion and excision elements with the appendix inverted;

FIG. 13 is a side view of the inversion and excision elements with the appendix inverted and the ligating loop closed;

FIG. 14 is a side view of the inversion and excision elements with the appendix inverted, the ligating loop closed, and the cautery snare advanced onto the appendix;

FIG. 15 is a side view showing the excision element trimming the ligating loop in phantom and in solid snaring and retrieving the appendix;

FIG. 15A is a side view showing an alternate trimming mechanism;

FIGS. 16-20 are additional side views showing an alternate inverting catheter in combination with an endoscope and vacuum sealing sleeve for removing the appendix, with the sleeve shown in phantom in FIG. 16;

FIG. 21 is a perspective view of the distal portion of the catheter shown in FIGS. 16-20;

FIG. 22 is a perspective view of the proximal control portion of the catheter shown in FIGS. 16-21;

FIG. 23 is a perspective view of the inverter showing the vacuum holes;

FIG. 23A is a perspective view of an alternate inverter;

FIG. 24 is an enlarged view of a portion of the catheter shown in FIG. 23, illustrating a preferred location of vacuum holes;

FIGS. 25-30 are side views showing an alternate inversion catheter that grips tissue such as a hemorrhoid or the appendix and that is guided under fluoroscopy or ultrasound without the need for an endoscope;

FIGS. 31-33 are side views of a tissue ligating device;

FIGS. 34 and 35 show a ligating tie;

FIGS. 36 and 37 show an alternate tie;

FIGS. 38 and 39 are side views of a balloon-anchored guidewire; and

FIG. 40 is a side view of a wing-anchored guidewire.

Claims

1. A tissue inversion catheter comprising: an elongated catheter body transanally advanceable into a patient; andan elongated inverter advanceable distally through the catheter body into a patient tissue sought to be inverted, the inverter including structure for urging the tissue against the inverter so that upon proximal retraction of the inverter the tissue inverts upon itself.

2. The inversion catheter of claim 1, wherein the structure for urging the tissue against the inverter includes plural vacuum holes formed in the inverter and communicating, via at least one vacuum lumen of the inverter, with a source of vacuum external to the patient.

3. The inversion catheter of claim 2, wherein the inverter defines an external surface formed with at least one of: spiral ridges, or recesses that are parallel to each other, the holes being formed in the ridges and/or the recesses.

4. The inversion catheter of claim 1, wherein the inverter reciprocates within a vacuum sealing sleeve in the catheter, the sleeve being positionable at the entry of the tissue being inverted while the inverter is disposed within the tissue to be inverted.

5. The inversion catheter of claim 1, wherein the structure for urging the tissue against the inverter includes a gripping element manipulable between a wide configuration, wherein the gripping element is positioned near the tissue, and a gripping configuration, wherein the gripping element grasps the tissue between gripping arms.

6. The inversion catheter of claim 1, comprising: a ligator holder slidably disposed in the inversion catheter and having a distal end bearing a ligation element, the ligator holder being slidable past the tissue to a ligation point to slide the ligation element around the tissue; anda tightener coupled to the ligator holder to cinch the ligation element around the tissue.

7. The inversion catheter of claim 6, comprising an excision tube and a snare advanceable distally away from the excision tube to snare the tissue after ligation for removing the tissue from the patient.

8. The inversion catheter of claim 1, wherein the catheter body is coupled to an endoscope to enable a person to view tissue as the catheter body is advanced into the patient.

9. The inversion catheter of claim 1, wherein the inversion catheter includes structure for facilitating ultrasonic and/or fluoroscopic guiding at least of the inverter.

10. The inversion catheter of claim 1, further comprising: a manipulator extending through the inversion catheter and being advanceable into the tissue, the manipulator being coupled to an external manipulation control for moving the manipulator within the tissue to determine whether the tissue has restrictive anatomy or undesirable adhesions to nearby tissue prior to attempting inversion of the tissue.

11. The inversion catheter of claim 10, wherein the manipulator includes a stylet wire sufficiently rigid to straighten the tissue.

12. The inversion catheter of claim 10, wherein the manipulator includes a manipulator catheter having an actuator wire anchored near a distal end thereof, the manipulator catheter being sufficiently flexible to adhere to the contour of the tissue, the actuator wire being coupled to an actuator external to the patient and manipulable to cause the manipulator catheter to bend within the tissue, causing the tissue to thereby bend.

13. The inversion catheter of claim 6, wherein the ligation element includes a loop having a textured inner surface to facilitate gripping tissue.

14. The inversion catheter of claim 13, wherein the loop is formed by drawing an elongated flexible ligation member through a locking eye, the ligation member having a textured surface to facilitate frictional self-locking between the locking eye and the ligation member.

15. The inversion catheter of claim 6, wherein the ligation element includes a loop and a tightening member extending away from the loop a direction that is coaxial to the loop and that is manipulable to tighten the loop around tissue.

16. The inversion catheter of claim 1, comprising a guidewire extending through the catheter body and having at least one inflatable balloon at a distal end thereof to hold the guidewire within an appendix.

17. The inversion catheter of claim 1, comprising a guidewire extending through the catheter body and having at least one expandable wing at a distal end thereof to hold the guidewire within an appendix.

18. A method for appendectomy in a patient, comprising: advancing an inverter into the appendix of the patient;using the inverter to invert the appendix; andremoving the inverted appendix from the patient.

19. The method of claim 18, further comprising moving the appendix prior to inverting it to determine whether the appendix is undesirably adhered to nearby tissue.

20. The method of claim 18, further comprising ligating the inverted appendix.

21. The method of claim 18, comprising advancing an inverter into the appendix of the patient through the anus.

22. A method for appendectomy in a patient, comprising: transanally advancing a catheter toward the appendix of the patient; andusing the catheter to remove the appendix from the patient.

23. The method of claim 22, comprising using the catheter to invert the appendix.

24. The method of claim 23, further comprising moving the appendix prior to inverting it to determine whether the appendix is undesirably adhered to nearby tissue.

25. The method of claim 24, further comprising ligating the inverted appendix.

26. A manipulator for moving an appendix, comprising: a manipulator catheter advanceable into the appendix, the manipulator catheter being coupled to an external manipulation control for moving a manipulator element inside the appendix to determine whether the appendix has undesirable adhesions to nearby tissue.

27. The manipulator of claim 26, wherein the manipulator element includes a stylet wire sufficiently rigid to straighten the tissue.

28. The manipulator of claim 26, wherein an actuator wire is anchored near a distal end of the catheter, the manipulator catheter being sufficiently flexible to adhere to the natural contour of the appendix, the actuator wire being coupled to an actuator external to the patient and manipulable to cause the manipulator catheter to bend within the appendix, causing the appendix to thereby bend.

29. A method for determining whether an appendix is subject to undesirable adhesions to tissue nearby the appendix, comprising: advancing a manipulator into the appendix;moving the manipulator to thereby move the appendix; andusing fluoroscopy to determine whether the appendix has adhesions to nearby tissue.

30. A ligation element comprising: a loop having a textured inner surface to facilitate gripping tissue.

31. The ligation element of claim 30, wherein the loop is formed by drawing an elongated flexible ligation member through a locking eye, the ligation member having a textured surface to facilitate frictional self-locking between the locking eye and the ligation member.

32. A ligation element comprising: a loop defining a plane; anda tightening member extending perpendicularly away from the plane of the loop and manipulable to tighten the loop around tissue.

33. A method for removing a gall bladder from a patient, comprising: advancing an inverter into the gall bladder;using the inverter to invert the gall bladder; andremoving the inverted gall bladder from the patient.

34. The method of claim 33, comprising advancing the inverter into the gall bladder of the patient through the anus.

35. A method for gall bladder removal in a patient, comprising: transanally advancing a catheter toward the gall bladder of the patient; and using the catheter to remove the gall bladder from the patient.