Field of the Invention
The present invention relates to a treatment method for hollow organs.
Description of Related Art
Conventionally, as a surgical procedure for obesity, Roux-en-Y gastric bypass has been known (e.g. see US2011/0113863A1). In a Roux-en-Y gastric bypass for obesity, the stomach is divided into one region (a pouch) connected to the esophagus and another region (the remaining stomach) connected to the duodenum. Afterward, the jejunum is cut, a cut end of a distal side is anastomosed to the pouch, and the cut end of a proximal side is anastomosed to the distal side of the jejunum anastomosed with the pouch.
Due to this procedure, as food ingested from the mouth passes only the pouch in which the food can be stored only in small amounts, ingestion of excessive food is suppressed. Also, since a part of the jejunum is bypassed and is not used for digestion and absorption, the ability to digest and absorb the ingested food is also reduced compared to prior to the procedure. Due to these behaviors, it can improve obesity.
The present invention provides a tissue treatment method combined with a bypass procedure of a luminal organ, which includes a first process of dividing the hollow organ into a first region of a distal side of the hollow organ and a second region of a proximal side of the hollow organ, a second process of forming a damaged part of a predetermined size on an outer surface of at least one of the first and second regions, and a third process of fixing the first and second regions such that the damaged part is kept in close contact with an outer surface of the other of the first and second regions.
One problem of a Roux-en-Y gastric bypass is an endoscopic approach to a duodenum, a bile duct, a remaining stomach, etc. after a procedure. Since a stomach is divided into a pouch and a remaining stomach, a distal end of an endoscope inserted from a mouth is first advanced to an anastomotic part with a jejunum in order to approach each of the aforementioned pieces of tissue using the endoscope, and the endoscope should be advanced so as to retrograde from there toward the duodenum. This approach has a very high level of difficulty because a path is very long and a manipulating strength of the endoscope is not easily transmitted to the distal end of the endoscope in the retrograde approach. For this reason, in patients who have received a Roux-en-Y gastric bypass, there is often no alternative but to give up the endoscopic approach to each of the aforementioned pieces of tissue.
In the present invention, in consideration of the above problems, predetermined processes are added to the bypass procedure of the hollow organs, and thereby an approach to predetermined tissue after the procedure is remarkably facilitated. Here, an embodiment of the present invention will be described with reference to
First, as illustrated in
Next, as illustrated in
In the present invention, the term “damage” refers to the extent to which self-repair of tissue so at to generate adhesion to be described below is initiated in an injury that does not communicate with a lumen of the hollow organ. Accordingly, as long as the damage is sufficient to initiate self-repair, its type or form such as excoriation, rupture, burn, loss of tissue, a chemical injury, etc., does not matter.
The size of the damaged part 1 can be adequately set. However, since there is a possibility of passing the endoscope after the procedure as will be described below. As the damaged part 1, for instance, a circle having a diameter of 20 mm or more is preferred. As long as the size of the damaged part is a circle having a diameter of 20 mm or more, it is possible to form a through-hole into which almost the entirety of the endoscope currently being used can be inserted in the order to be described below. When the damaged part is not a circle, a form in which a circle inscribed within the damaged part has a diameter of 20 mm or more is preferred.
The damaged part may not be formed in a sheet shape. For example, the damaged part may be formed in a line or strip shape surrounding a predetermined region. In this case, the size of the surrounded region is defined as the size of the damaged part. Therefore, the surrounded region preferably has dimensions meeting the aforementioned conditions.
Next, as illustrated in
The tissue treatment method of the present embodiment is completed through the aforementioned first to third processes. The operator performs the remaining processes of the Roux-en-Y gastric bypass as needed, and may perform the tissue treatment method of the present embodiment after the procedure of the Roux-en-Y gastric bypass is completed. Further, one or more processes of the Roux-en-Y gastric bypass may be performed between processes of the tissue treatment method.
After the procedure, the self-repair of the damaged part 1 is initiated in the body of the patient. Since the damaged part 1 is in close contact with the remaining stomach St2, the damaged part 1 and the remaining stomach St2 are adhered in a process in which the damaged part 1 is self-repaired, and thereby the pouch St1 and the remaining stomach St2 are coapted.
A mechanism of the adhesion will not be fully explained, but a known mechanism includes inter-tissue adhesion using collagen. Among polymers contained in body tissue, collagen is one of the materials having highest adhesiveness. Therefore, an injury in which a protein containing collagen is exposed is a preferred form of the damage to the damaged part of the present invention.
The pouch St1 and the remaining stomach St2 are adhered by coapting them in a non-communicating state as illustrated in
An order in which the remaining stomach St2 or the duodenum is accessed after the procedure will be described.
First, as illustrated in
After the adhered part is specified, the ultrasonic endoscope 200 is removed and replaced with an optically observable endoscope such as a video scope. Prior to the removal of the ultrasonic endoscope 200, as illustrated in
After the optically observable endoscope (optical endoscope) is introduced into the pouch St1, the adhered part is incised using, for instance, the high-frequency knife inserted into the optical endoscope while the adhered part is being observed by the optical endoscope. Thereby, a though-hole 10 communicating the pouch St1 and the remaining stomach St2 with each other is formed (fourth process). Since the through-hole 10 is formed in the adhered part, the periphery of the through-hole 10 is sealed by adhesion. Therefore, a liquid, etc. inside the pouch St1 or the remaining stomach St2 does not leak from the through-hole 10 into the abdominal cavity.
When an endoscope capable of performing both ultrasonic observation and optical observation is used, after the adhered part is specified, the adhered part may be continuously incised to form the through-hole.
After the through-hole 10 is formed, the optical endoscope 210 can be introduced into the remaining stomach St2 by inserting the optical endoscope 210, as illustrated in
After the optical endoscope 210 is introduced into the remaining stomach St2, a desired procedure can be performed on the remaining stomach, the duodenum, the bile duct, and so on (fifth process). A specific example of the fifth process includes observation and lesion excision of the remaining stomach (including endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)), observation and lesion excision of the duodenum (including polypectomy), incision of duodenal papilla, observation of the bile and pancreatic ducts including endoscopic retrograde cholangiopancreatography (ERCP), destruction and recovery of gallstones, placement of a bile duct stent, and so on. Each of the aforementioned procedures may be performed by a combination of the optical endoscope 210 and a scope or a treatment tool introduced into the abdominal cavity from, for instance, a trocar. This procedure is defined herein as “internal/external combined operation,” and also includes a case of performing a surgical operation while giving support from an alimentary canal. For example, when a lesion portion of the duodenum is excised using an instrument introduced into the abdominal cavity, an example in which the excision is also performed to give support from an endoscope introduced into the alimentary canal to optimize an excision margin is given.
The endoscope used in the fifth process is not limited to a direct-view endoscope illustrated in
Since anterogradely approach can be performed on the remaining stomach, the duodenum, and the bile duct after the endoscope is introduced into the remaining stomach St2, the operator can perform a desired procedure in approximately the same order as under normal circumstances.
After the desired procedure is performed, the operator removes the optical endoscope 210 from the through-hole 10, and closes the through-hole 10 (sixth process). In
As described above, according to the tissue treatment method of the present embodiment, in combination with the bypass procedure of the hollow organ, the path communicating the first region and the second region, which is separated in the non-communicating state, with each other can be easily provided after the bypass procedure. As a result, after the bypass procedure, the endoscope is possible to access desired spots easier compared to the approach through the lumen into which it is difficult to introduce the endoscope.
In the tissue treatment method of the present embodiment, various changes are possible.
In the second process, there is no particular limitation to means for forming the damaged part, which has already been described. Therefore, it is possible to use a variety of instruments for the surgical operation or a variety of energy treatment tools that treat tissue using a high-frequency current, heat, ultrasound, and so on. Hereinafter, an example of the treatment tool capable of easily forming the damaged part having a predetermined size is shown.
A treatment tool 50 illustrated on the left in
When the damaged part is formed using the treatment tool 50, the needle part 52 pierces the target tissue (the first region or the second region). Afterward, if the arm 53 is opened such that the distal end of the arm 53 is away from the needle part 52, and the treatment tool 50 is rotated about the needle part 52 one turn while a current is applied to the cauterizing part 54, a circular damaged part 1A illustrated on the right in
In
A treatment tool 70 illustrated on the left in
In the treatment tool 70, an annular damaged part 1B illustrated on the right in
A treatment tool 80 illustrated on the left in
In a treatment tool 90 illustrated on the left in
In each of the aforementioned treatment tools, the cauterizing part may be an electrode supplied with a high-frequency current, or a heater energized to reach a high temperature.
Although one embodiment of the present invention has been described, the technical scope of the present invention is not limited to the aforementioned embodiment, but it is possible to change a combination of the components, and apply or remove various modifications to or from each component without departing from the spirit or teachings of the present invention.
For example, in the second process of the present invention, the damaged part may be formed at only one or both of the pieces of tissue generating the adhesion as described above. When the damaged part is formed at only one of the pieces of tissue, the damaged part may be formed at any tissue. Therefore, in the aforementioned example, the damaged part may be formed only at the remaining stomach St2. When the damaged part is formed at both of the pieces of tissue, the forms of the respective damaged parts may be the same as or different from each other.
Further, the tissue generating the adhesion is not limited to the aforementioned pouch and remaining stomach.
For example, as illustrated in
However, if one of the first and second regions being coapted by the adhesion is used as the remaining stomach, the endoscope protrudes into the remaining stomach having a relatively wide space when the endoscope is inserted into the formed through-hole. Thus, there are merits in that subsequent manipulation becomes easy and that the endoscope can anterogradely approach both the remaining stomach and the duodenum.
Also, the surgical procedure to which the tissue treatment method of the present invention is applied is not limited to the aforementioned Roux-en-Y gastric bypass. In
In the third process, the means for fixing the second region is not limited to the aforementioned suture. Therefore, the means may be a tagged suture unit 3 as illustrated in
Here, a portion at which the second region is fixed is not limited to the periphery of the damaged part. Therefore, as illustrated in
Also, in the second process, marking may be performed on an inner wall around the portion at which the damaged part is formed, for instance, by a clip. Since there is a chance to insert the endoscope into the hollow organ in order to check for leakage (leakage of the anastomotic part) in the bypass procedure of the hollow organ, the marking is performed at that time. Thereby, when the through-hole is formed early after the procedure, the marking can be used as a guide for the adhered part.