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WO2013004264A1 - Procédé et dispositif pour créer un trajet d'écoulement de bile alternatif - Google Patents

Procédé et dispositif pour créer un trajet d'écoulement de bile alternatif Download PDF

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Publication number
WO2013004264A1
WO2013004264A1 PCT/EP2011/061107 EP2011061107W WO2013004264A1 WO 2013004264 A1 WO2013004264 A1 WO 2013004264A1 EP 2011061107 W EP2011061107 W EP 2011061107W WO 2013004264 A1 WO2013004264 A1 WO 2013004264A1
Authority
WO
WIPO (PCT)
Prior art keywords
selected location
intestine
catheter
catheter device
anchoring
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/EP2011/061107
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English (en)
Inventor
Alessandro Pastorelli
Christopher J. Hess
Mark Steven Ortiz
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Ethicon Endo Surgery Inc
Original Assignee
Ethicon Endo Surgery Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ethicon Endo Surgery Inc filed Critical Ethicon Endo Surgery Inc
Priority to PCT/EP2011/061107 priority Critical patent/WO2013004264A1/fr
Publication of WO2013004264A1 publication Critical patent/WO2013004264A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00876—Material properties magnetic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1103—Approximator
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B2017/1135—End-to-side connections, e.g. T- or Y-connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
    • A61F2002/041—Bile ducts

Definitions

  • the present invention relates, in general, to devices and methods for surgically influencing the digestion of a patient with the aim to treat metabolic disorders, such as morbid obesity, related co-morbidities such as diabetes, heart disease, stroke, pulmonary disease, neoplastic diseases and accidents.
  • metabolic disorders such as morbid obesity, related co-morbidities such as diabetes, heart disease, stroke, pulmonary disease, neoplastic diseases and accidents.
  • cholecystojejunostomy has also been recommended as one option in the palliation of biliary obstruction due to pancreatic carcinoma.
  • an anastomosis is created between the gallbladder and jejunum, providing an alternative route for bile drainage when the distal common bile duct is occluded secondary to carcinoma in the head of the pancreas.
  • a known minimally invasive bypass system and method for modifying the location at which bile and pancreatic secretions interact with nutrients in a gastrointestinal tract has been discussed in US 2005085787 A1 .
  • the known system comprises a conduit which diverts bile and pancreatic secretions from the ampulla of Vater to a location downstream in the gastrointestinal tract.
  • the known conduit catheters extend inside the intestine and tend to bundle up and to be displaced by the peristalsis of the intestinal tract so that the distal end of the catheter is frequently relocated far away from the target position intended by the surgeon.
  • the known endoluminal conduit in order to follow the winding path of the intestine, the known endoluminal conduit must have a significant length which undesirably increases the flow resistance and decreases the flow rate of the bile to the distal target location in the Gl tract. Accordingly, the known conduit is not suitable to obtain a significant acceleration of the bile cycling compared to the natural entero-hepatic bile cycling velocity.
  • an aim of the invention is to provide a method of and a device for diverting bile from the biliary tree including the gallbladder into a section of the intestine significantly distal to the papilla of Vater, which are minimally invasive and which increase the flow rate of the diverted bile towards the target location in the intestine with respect to the physiological entero-hepatic bile cycling.
  • a further aim of the invention is to obviate undesired relocations of the position of the bile diversion with respect to the target location intended by the doctor.
  • At least part of the above identified aims are achieved by a method for diverting biliary fluid from a biliary fluid flow path to a target location in the intestine, the method comprising the steps of:
  • the bile flows directly from the gallbladder to the selected location of intestine and bypasses at least part of the duodenum, while minimizing the length of the bile flow path.
  • the position at which the diverted bile is dispensed into the intestine is defined by the cholecysto-enterostomy and cannot be accidentally dislocated.
  • the selected location of the intestine may be a portion of the small intestine, e.g. a distal portion of duodenum, a portion of jejunum or ileum or a portion of the large intestine, such as for example the transverse or sigmoid colon.
  • the portion of the gastro-intestinal tract accessed by the endoscope device is the selected location of the intestine or, in a different embodiment, a portion of the stomach.
  • the selected location of the intestine is a portion of the jejunum.
  • the selected location of the biliary tract is the gallbladder.
  • the method comprises the steps of:
  • the method comprises the steps of:
  • the method comprises the steps of:
  • distal end 13 and the proximal end 14 comprise anchoring means 17, 18 apt to anchor the catheter device 8 to the body tissue from inside the organs that have been punctured.
  • the invention further relates to an anchoring and approximating device 32 for putting and maintaining two target organs into contact, the device comprising:
  • first guide-wire 30 having a distal end 30', to which first anchoring means 33, 35 are associated
  • - approximating means 34 comprising a tubular structure 36 wherein the first and second guide-wires 30, 31 pass through and that is apt to keep the first and second guide- wires 30, 31 in a close condition.
  • FIG. 1 illustrates devices and steps of a procedure for the diversion of bile through a cholecysto-enterostomy in accordance with an embodiment of the invention
  • FIG. 2A, 2B, 2C, 2D, 2E, 2F illustrate various steps of a procedure for the diversion of bile through a cholecysto-enterostomy in accordance with a different embodiment of the invention
  • FIG. 3 illustrates a device for the diversion of bile through a cholecysto-enterostomy in accordance with an embodiment of the invention
  • FIG. 4 is a side view of a particular of a variant of the device of figure 3;
  • FIGS. 5A, 5B are a side view of a particular of another variant of the device of figure 3, in two different operative conditions;
  • FIGS. 6A, 6B are a side view of a particular of another variant of the device of figure 3, in two different operative conditions;
  • FIG. 7 is a side view of a different particular of a variant of the device of figure 3;
  • FIG. 8 is a side view of an anastomosis device for a cholecysto-enterostomy in accordance with an embodiment of the invention
  • FIGS. 9A, B, C are a perspective view of a particular of the device of figure 8, according to various operative conditions;
  • FIG. 10 illustrates the device of figure 8 in an operative condition
  • FIG. 1 1 illustrates an operative step according to an embodiment of the method of the invention
  • FIG. 12 and 1 3 illustrate a device and method for the diversion of bile through a cholecysto-enterostomy in accordance with an embodiment of the invention, in two different operative conditions;
  • FIG. 14A illustrates a catheter device directing biliary fluid from a biliary fluid flow path, such as a gallbladder, to a target portion in the intestine;
  • FIG. 14B is an enlarged view of anchoring portions of the a catheter device in figure 13A;
  • Figure 14C illustrates the device of figure 13A after deployment in a body of a patient.
  • figure 1 is a partial view of the abdominal cavity of a patient, depicting the stomach 1 , jejunum 2, as well as the biliary tree 3 with the gall bladder 4, the pancreatic duct 5 and the mayor duodenal papilla of Vater 6 through which the bile and pancreatic fluid normally enter the duodenum 2'.
  • Figure 1 shows further an operative step of a method and a device for endoluminally creating a cholecysto-enterostomy for diverting biliary fluid from the gallbladder 4 to a target location in the intestine distal to the papilla of Vater 6.
  • the invention relates to a method that comprises:
  • the portion of the gastro-intestinal tract accessed by the endoscope device is the selected location of the intestine or, in a different embodiment, a portion of the stomach.
  • the selected location of the intestine is a portion of the jejunum.
  • the selected location of the biliary tract is the gallbladder.
  • the method comprises the steps of:
  • the bile flows directly from the gallbladder 4 in the selected location 10 of the intestine and bypasses at least part of the duodenum 2, thus minimizing the length of the bile flow path.
  • the position at which the diverted bile is dispensed into the intestine is defined by the cholecysto-enterostomy 9 and cannot be accidentally dislocated.
  • the selected location 10 of the intestine may be a portion of the small intestine, e.g. a distal portion of duodenum 2', a portion of jejunum 2 or ileum or a portion of the large intestine, such as for example the transverse or sigmoid colon.
  • a cholecysto-jejunostomy is created.
  • a catheter device 8 associated to an endoscope device 7 is provided.
  • the catheter device 8 as depicted in figure 3, comprises a catheter portion 12 of a length selected on the basis of the flow path that has to be established between the selected locations of the biliary tree and of the intestine.
  • the catheter device 8 has a distal end 13 and a proximal end 14.
  • the distal end 13 has an ogival head 15 which terminates at its tip with a hole wherein needle means 16 apt to puncture a body tissue of a starting organ and of a target organ, i.e. an intestine wall and a gallbladder wall, are inserted.
  • the needle means 1 6 are typically connected to an operating wire (not shown) that allows them to be pulled out once the perforation of the body tissues has been accomplished.
  • Further apertures 21 may be provided in order to create a flow communication between the punctured organ and the catheter portion 12.
  • the distal end 13 comprises anchoring means 17 apt to grasp the body tissue from inside the target organ that has been punctured.
  • the proximal end 14 of the catheter device 8 is flared and is provided with anchoring means 18 (see also figure 7) that are apt to grasp the body tissue from inside the starting organ that has been punctured.
  • the proximal end 14 is open to allow an operating wire carrying the needle means 16 to be inserted in the catheter portion 12 and to put in flow communication the two selected locations of the biliary tree and of the intestine, respectively.
  • the anchoring means 17, 18 may be for example barbs, hooks, teeth or the like.
  • the anchoring means 17 are associated to the ogival head 15 of the distal end 13 and are constituted by a plurality of barbs extending downwards from an attachment point 19 on the surface of the head 15.
  • the anchoring means 17 are apt to take an extended position (as shown in figure 4) - wherein they grasp the body tissue and anchor the distal end 13 of the catheter device 8 to the target organ from the inside - and a retracted position (not shown), wherein they are kept to adhere on the surface of the head 13.
  • the anchoring means 17 are made of a flexible material, such as a shape memory alloy material like nitinol, so that they can automatically assume the extended position as soon as they are free.
  • the anchoring means 1 7 are kept in the retracted position by a sleeve (not shown) that can slide along the catheter portion 12 to free the barbs.
  • the anchoring means 17 are already in the extended position when the head 15 punctures the body tissue and are compressed to the retracted position upon passing through the hole in the organ wall, so that, as soon as they pass the organ wall, they are able to return automatically to their extended position.
  • the distal end 13 of the catheter device 8 comprises an annular groove 20 between the ogival head 15 and the catheter portion 12, which serves as a seat to accommodate the lips of the pierced organ wall and cooperates with the anchoring means 17 to avoid or at least to limit an undesired displacement of the device.
  • the ogival head 15 of the catheter device 8 is connected to the catheter portion 12 by a stem portion 22 that accommodates the anchoring means 17.
  • the stem portion 22 has a diameter which is less than the diameter of both the head 15 and the catheter portion 12, so that undercuts 23, 23' are formed.
  • a sleeve 24 is slidably inserted over the catheter portion 12 and can be moved between a closure position (figure 5A) - wherein it abuts against the undercut 23 of the ogival head 15 - and an open position (figure 5B).
  • the anchoring means 17 are constituted by a plurality of barbs, that however extend upwards from an attachment point 25 on the surface of the stem portion 22.
  • the anchoring means 17 are apt to take an extended position (as shown in figure 5B) - wherein they grasp the body tissue and anchor the distal end 13 of the catheter device 8 to the target organ from the inside - and a retracted position (shown in figure 5A), wherein they are kept inside the gap between the stem portion 22 and the sleeve 24.
  • the anchoring means 17 are made of a flexible material, such as a shape memory alloy material like nitinol, so that they can automatically assume the extended position when the sleeve 24 is open.
  • FIGS 6A and 6B differs from the previous embodiment uniquely in that the anchoring means 17 are linked to the undercut 23 of the head 13 instead of on the stem portion 22 and in that they extend downwards from their attachment points 25.
  • the catheter device 8 comprises a catheter portion 12, a distal end 13 and a proximal end 14, wherein the distal end 13 and the proximal end 14 have the same conformation and comprise a tip hole, wherein needle means 16 are inserted so that they emerge from the distal end 13.
  • the needle means 16 may be a rotary needle connected to an operating cable that emerges from the proximal end 14 of the device and can be operated by the doctor from the exterior.
  • Figures 9A, B and C show the distal end 1 3 in three different operating conditions. The description that will be reported herein below is applicable to the proximal end 14 as well.
  • the distal end 13 has an ogival head 15 and a cylindrical body 26 comprising one or more apertures 21 that put into flow communication the target organ with the catheter portion 12.
  • a fixed ring 27 and a first and second slidable rings 28, 28' are positioned around the cylindrical body 26, in such a way that the slidable rings 28, 28' are opposite with respect to the fixed ring 27 and can be made to slide from a rest position to an operative position towards the fixed ring 27, as shown by the arrows in figures 9B and C.
  • a first wire 29 has a first end connected to the first slidable ring 28 and a second end connected to the fixed ring 27.
  • a second wire 29' has a first end connected to the second slidable ring 28' and a second end connected to the fixed ring 27.
  • the first and second wires 29, 29' are wound around the cylindrical body 26, so that, when the slidable rings 28, 28' are in their rest position (figure 9A), the wires 29, 29' stand on the surface of the cylindrical body 26.
  • the wires 29, 29' are made of a flexible material. Typically, they are made of a shape memory alloy material such as nitinol, so that, when the slidable rings 28, 28' are in their operating conditions close to the fixed ring 27, the wires 29, 29' automatically spring to their coiled condition (figure 9C).
  • the correct positioning of the distal end 13 and of the proximal end 14 requires the fixed ring 27 to be positioned at the cross section of the organ wall, while the first slidable ring 28 is positioned outside and the second slidable ring 28' is inside the organ.
  • the coiled wires 29, 29' sandwich the organ wall and anchor the catheter device 8 to the selected locations of the biliary tree and of the intestine, respectively.
  • the movement of the slidable rings 28, 28' can be actuated by the doctor from the exterior.
  • the driving force of the wires 29, 29' that tend to return to their coiled condition can be so high to cause the two slidable rings 28, 28' to be automatically drawn towards the fixed ring 27.
  • the slidable rings 28, 28' must be kept in the rest position of figure 9A by means of a sleeve (not shown) that must be removed after the device has been properly positioned as described above.
  • a catheter device 8 which comprises a catheter portion 12, a distal end 13 and a proximal end 14, wherein the distal end 13 and the proximal end 14 may have the same conformation and comprise a tip hole, wherein needle means 16 are insertable so that they can emerge at least from the distal end 13.
  • the needle means 16 may comprise a rotary needle connected to an operating cable that emerges from the proximal end 14 of the device and that can be operated by the doctor from the exterior.
  • the tip and needle means 16 can be arranged laterally to an inlet or outlet opening of the catheter device 8 or they may be received within such an opening and removable from the distal end 13 and/or from the proximal end 14 after piercing of the tissue walls and placement of the catheter device 8.
  • the catheter device 8 comprises near each one of the distal end 13 and the proximal end 14 an onboard anchoring device having proximal 42, center 43, and distal rings 44 connected respectively by proximal and distal hinged arms which form first and second ring portions 39, 40.
  • the anchoring device has a generally cylindrical shape (about the catheter wall) when unactuated and a rivet shape when actuated.
  • the proximal and distal end portions of the catheter device 8 are introduced endoluminally or laparoscopically through a first otomy 41 in the intestine and through a second otomy 45 in the gallbladder 8 wall, wherein the otomies can be created by means of the piercing needle 16 when being forced through the wall of the intestine and of the gallbladder.
  • the first and second otomies 41 , 45 may be created with a standard endoscopic or laparoscopic cutting instrument.
  • proximal ring 42 and the distal ring 44 are shifted towards each other to deform the anchoring device in the rivet shape and clamp the wall of the gallbladder and of the intestine, respectively, thereby reliably anchoring the catheter device 8.
  • the approximation movement of the proximal and distal rings 42, 44 can be activated locally or extracorporeal ⁇ by means of pulling strings or ring pushing devices and at least one snap connector may be provided which snap connects or snap ratchet connects the first ring portion 14 and the second ring portion 15 (or in other words: the proximal ring 42 and the distal ring 44) to one another.
  • a portion of the jejunum 2 is accessed transorally by means of an endoscope device 7 until a selected location 10 is reached.
  • the endoscope device 7 carries a catheter device 8.
  • a catheter device 8 as the ones described previously can conveniently be used.
  • An operating wire or cable ending with a needle means 16 is inserted in the catheter device 8 and emerges from its distal end 13. Then, the tip of the needle means 16 is pushed from inside the selected location 10 of the jejunum 2 against the intestine wall to perforate the intestine wall so that the needle means 16 emerges from the jejunum 2 into the abdominal space.
  • the endoscope device 7 is then advanced through the intestine wall to gain direct visual access of the abdominal cavity.
  • the catheter device together with the needle means 16 are advanced to the said selected location and the needle means 16 is pushed from outside against the wall of the selected location 1 1 to perforate the gallbladder wall.
  • the catheter device 8 is then anchored to the selected locations 10, 1 1 of the jejunum 2 and the gallbladder 4, as explained above in relation to the various embodiments of the device.
  • This intervention can be performed according to the NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique.
  • the transluminal perforations of the gallbladder 4 and of the intestine are preferably guided and monitored by ultrasound imaging.
  • an ultrasound transducer may be installed on the distal tip of the endoscope device 7.
  • the commercially available endoscope GF-UC160P-O L5 with E U-C60 ultrasound processor by Olympus may be used for this purpose.
  • an external ultrasound transducer can be used for monitoring and guidance of the position of the operating wire carrying the needle means 16 and of the catheter device 8.
  • the method comprises the steps of:
  • This method provides for the use of the same catheter devices 8 as descried above.
  • a portion of the jejunum 2 is accessed transorally by means of an endoscope device 7 until a selected location 10 is reached.
  • the endoscope device 7 carries a catheter device 8.
  • An operating wire or cable ending with a needle means 16 is inserted in the catheter device 8 and emerges from its distal end 13. Then, the tip of the needle means 16 is pushed from inside the selected location 10 of the jejunum 2 against the intestine wall to perforate the intestine wall so that the needle means 16 emerges from the jejunum 2 into the abdominal space.
  • the catheter device 8 is then advanced through the intestine wall. After having identified a selected location 1 1 of the gallbladder 4, the catheter device together with the needle means 16 is advanced to the said selected location and the needle means 16 is pushed from outside against the wall of the selected location 1 1 to perforate the gallbladder wall.
  • the catheter device 8 is then anchored to the selected locations 10, 1 1 of the jejunum 2 and of the gallbladder 4 as explained above in relation to the various embodiments of the device.
  • This intervention can be performed according to the NOTES (Natural Orifice Transluminal Endoscopic Surgery) technique.
  • the transluminal perforations of the gallbladder 4 and of the intestine are preferably guided and monitored by ultrasound imaging.
  • an ultrasound transducer may be installed on the distal tip of the endoscope device 7.
  • the commercially available endoscope GF-UC160P-O L5 with E U-C60 ultrasound processor by Olympus may be used for this purpose.
  • an external ultrasound transducer can be used for monitoring and guidance of the position of the operating wire carrying the needle means 16 and of the catheter device 8.
  • the method comprises:
  • This embodiment of the method can conveniently be performed when the selected location 10 of the intestine can not be easily reached endoluminally by either a transoral or a transanal technique.
  • the selected location 1 1 of the biliary tree 3 is the gallbladder 4.
  • an anchoring and approximating device 32 is used.
  • the device 32 comprises a first guide-wire 30, a second guide-wire 31 and approximating means 34.
  • the first and second guide-wires 30, 31 have a respective proximal end (not shown), apt to be operated by a doctor, and a distal end 30', 31 ' , to which anchoring means 33, 33' are associated.
  • the anchoring means 33, 33' may be a T-tag (as shown in figures 2A-2F) or, in a different embodiment, a magnetic ring 35, 35' (see figure 1 1 ).
  • the magnetic ring 35 of the first guide-wire 30 and the magnetic ring 35' of the second guide-wire 31 must be of opposite polarity, in order to be attracted each other and to provide for a junction of the two selected locations 10, 1 1 .
  • one of the two magnetic rings 35, 35' is a magnet and the other one is made of a ferromagnetic material that can be attracted by the magnet.
  • the magnetic rings 35, 35' can be made in a collapsible structure, so that the ring can be collapsed to an elongated shape that facilitates the introduction of the ring through the organ wall at the selected location 1 0, 1 1 .
  • the ring 35, 35' Once the ring 35, 35' has been introduced into the target organ , it can assume its open configuration that allows the corresponding guide-wire 30, 31 to be anchored to the intestine and the gallbladder, respectively.
  • the approximating means 34 are constituted by a tubular structure 36 having a first and a second open end 36a, 36b and a longitudinal lumen 37 extending between such ends, wherein the first and second guide-wires 30, 31 can be inserted.
  • the guide- wires 30,31 after having been anchored to the respective selected locations 10, 1 1 , are pulled from outside, they are kept in an approached condition by the approximating means 34, so that finally their respective distal ends 30', 31 ' are also approached together with the selected locations 10, 1 1 of the target organs which they are anchored to.
  • the approximating means 34 are constituted by a tubular structure 36 having a first and a second open end 36a, 36b and a longitudinal lumen 37 extending between such ends, wherein the wall of the tubular structure 36 comprises a hole 38, which is preferably positioned at a median distance from the open ends 36a, 36b.
  • the guide-wires 30, 31 are made to pass through the hole 38 and to extend their respective distal ends 30', 31 ' out of the opposite open ends 36a, 36b of the tubular structure 36.
  • the operation of the device according to this embodiment is analogous to the one described just above.
  • the approximating means 34 are constituted by a tubular structure 36 having a first and a second open end 36a, 36b and a longitudinal lumen 37 extending between such ends, wherein the wall of the tubular structure 36 comprises a hole 38, which is preferably positioned at a median distance from the open ends 36a, 36b.
  • the difference consists in the fact that the tubular structure 36 or the first and second open ends 36a, 36b thereof are made of, or comprise barbs or the like made of a shape memory alloy material such as nitinol, that, in the rest position, are bent as indicated by the dotted lines in figure 13.
  • a portion of the stomach 1 is accessed transorally by means of an endoscope device 7.
  • the endoscope device 7 carries puncturing means (not shown) to perforate the organ walls and an anchoring and approximating device 32, such as the ones described herein above.
  • puncturing means By means of the puncturing means, the stomach 1 wall is perforated, in order to access transgastrically the abdominal space with the endoscope device 7.
  • the endoscope device 7 is then advanced through the stomach wall to gain direct visual access of the abdominal cavity.
  • the endoscope device 7 After having identified a selected location 10 of the intestine 2, 2', the endoscope device 7 is advanced to the said selected location and the puncturing means are pushed from outside against the wall of the selected location 10 to perforate the intestine wall, to allow the anchoring means 33, 33' associated to the first guide-wire 30 to pass through the intestine wall.
  • the anchoring means 33, 33' are constituted by T-tags, an endoluminal T-tag applicator will normally be used in place of said puncturing means.
  • the endoscope device 7 is then advanced in the abdominal cavity to identify a selected location 1 1 of the biliary tree 3, i.e. the gallbladder 4 (figure 2B)., and the above operation is repeated.
  • the two guide-wires 30, 31 are pulled from the outside by the operator, while at the same time they are kept close each other by means of the approximating means 34.
  • the effect is that the two selected locations 10, 1 1 of the intestine and of the gallbladder, respectively, are put into contact (figure 2D).
  • the interested portion of the target organs is at least partially brought inside the approximating means 34 (figures 2F or 13).
  • the doctor can suitably operate an anastomosis of the two organs.
  • the guide-wires 30, 31 are cut or torn in order to be retracted and the endoscope device 7 is also retracted from the patient's body.
  • the anchoring means 33, 33' are constituted by the magnetic rings 35, 35' described above, the attractive pressure to which the selected locations 10, 1 1 of the target organs are subjected may cause a necrosis of the tissue over time, so that the anastomosis can naturally be established without the direct intervention of the surgeon.
  • the transluminal perforations of the gallbladder 4 and of the intestine are preferably guided and monitored by ultrasound imaging.
  • an ultrasound transducer may be installed on the distal tip of the endoscope device 7.
  • the commercially available endoscope GF-UC160P-OL5 with E U-C60 ultrasound processor by Olympus may be used for this purpose.
  • an external ultrasound transducer can be used for monitoring and guidance of the position of the operating wire carrying the needle means 16 and of the catheter device 8.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Surgery (AREA)
  • Physiology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Pulmonology (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne d'une manière générale des dispositifs et des procédés pour influencer de manière chirurgicale la digestion d'un patient en vue de traiter des troubles métaboliques, telle que l'obésité morbide, des comorbidités apparentées, telles que le diabète, la cardiopathie, l'accident vasculaire cérébral, les maladies pulmonaires, les maladies néoplasiques et les accidents. En particulier, l'invention concerne un procédé pour dévier un fluide biliaire d'un trajet d'écoulement de fluide biliaire par mise en communication fluidique d'un emplacement sélectionné de l'arbre biliaire avec un emplacement sélectionné de l'intestin à distance d'une papille duodénale de Vater, le procédé consistant à : - accéder par voie endoluminale à une partie du tractus gastro-intestinal d'un patient avec un dispositif endoscope ; - obtenir un accès visuel de la cavité abdominale du patient ; - accéder par voie transluminale à la cavité abdominale ; - créer une liaison entre un emplacement sélectionné de l'arbre biliaire et un emplacement sélectionné de l'intestin ; - mettre en communication fluidique l'emplacement sélectionné de l'arbre biliaire avec l'emplacement sélectionné de l'intestin. Le procédé permet l'utilisation d'un dispositif cathéter pour mettre en communication fluidique deux organes cibles ou permet l'utilisation d'un dispositif d'ancrage et d'approche pour s'approcher des deux organes cibles qui doivent être anastomosés, comme décrit dans la demande de brevet.
PCT/EP2011/061107 2011-07-01 2011-07-01 Procédé et dispositif pour créer un trajet d'écoulement de bile alternatif Ceased WO2013004264A1 (fr)

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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016054387A1 (fr) * 2014-10-01 2016-04-07 Boston Scientific Scimed, Inc. Étiquettes en t à boucle et crochet et/ou magnétiques
WO2018183591A1 (fr) * 2017-03-30 2018-10-04 Boston Scientific Scimed, Inc. Endoprothèses avec caractéristiques d'ancrage à double paroi tissulaire
US10449075B2 (en) 2015-12-15 2019-10-22 Steven Sounyoung Yu Biliary diversion catheter
CN115243631A (zh) * 2020-01-07 2022-10-25 维兰德.K.沙马 用于内窥镜下切除的方法和装置

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020151913A1 (en) * 1997-10-09 2002-10-17 Berg Todd A. Wire connector structures for tubular grafts
US20030236535A1 (en) * 2002-05-08 2003-12-25 Olympus Optical Co., Ltd. Apparatus for ligating/suturing living tissues and system for resecting/suturing living tissues
US20050085787A1 (en) 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass
US20050137700A1 (en) * 2003-12-23 2005-06-23 Spence Paul A. Tissue fastening systems and methods utilizing magnetic guidance
EP1769749A1 (fr) * 2005-09-28 2007-04-04 Olympus Medical Systems Corp. Instrument chirurgical de suture
EP1894514A2 (fr) * 2006-08-28 2008-03-05 Olympus Medical Systems Corp. Endoscope ultrasonique, cathéter avec ballon, dispositif à demeure magnétique, et ensemble magnétique
US20090112237A1 (en) * 2007-10-26 2009-04-30 Cook Critical Care Incorporated Vascular conduit and delivery system for open surgical placement
GB2460287A (en) * 2007-11-30 2009-11-25 Treus Medical Inc Biliary shunt to connect gall bladder and gastrointestinal tract

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020151913A1 (en) * 1997-10-09 2002-10-17 Berg Todd A. Wire connector structures for tubular grafts
US20030236535A1 (en) * 2002-05-08 2003-12-25 Olympus Optical Co., Ltd. Apparatus for ligating/suturing living tissues and system for resecting/suturing living tissues
US20050085787A1 (en) 2003-10-17 2005-04-21 Laufer Michael D. Minimally invasive gastrointestinal bypass
US20050137700A1 (en) * 2003-12-23 2005-06-23 Spence Paul A. Tissue fastening systems and methods utilizing magnetic guidance
EP1769749A1 (fr) * 2005-09-28 2007-04-04 Olympus Medical Systems Corp. Instrument chirurgical de suture
EP1894514A2 (fr) * 2006-08-28 2008-03-05 Olympus Medical Systems Corp. Endoscope ultrasonique, cathéter avec ballon, dispositif à demeure magnétique, et ensemble magnétique
US20090112237A1 (en) * 2007-10-26 2009-04-30 Cook Critical Care Incorporated Vascular conduit and delivery system for open surgical placement
GB2460287A (en) * 2007-11-30 2009-11-25 Treus Medical Inc Biliary shunt to connect gall bladder and gastrointestinal tract

Cited By (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016054387A1 (fr) * 2014-10-01 2016-04-07 Boston Scientific Scimed, Inc. Étiquettes en t à boucle et crochet et/ou magnétiques
US10449075B2 (en) 2015-12-15 2019-10-22 Steven Sounyoung Yu Biliary diversion catheter
WO2018183591A1 (fr) * 2017-03-30 2018-10-04 Boston Scientific Scimed, Inc. Endoprothèses avec caractéristiques d'ancrage à double paroi tissulaire
KR20190132462A (ko) * 2017-03-30 2019-11-27 보스톤 싸이엔티픽 싸이메드 인코포레이티드 이중 조직-벽 고정 특징부를 갖는 스텐트
AU2018244748B2 (en) * 2017-03-30 2020-08-27 Boston Scientific Scimed, Inc. Stents with dual tissue-wall anchoring features
US10779967B2 (en) 2017-03-30 2020-09-22 Boston Scientific Scimed, Inc. Stents with dual tissue-wall anchoring features
KR102300249B1 (ko) 2017-03-30 2021-09-10 보스톤 싸이엔티픽 싸이메드 인코포레이티드 이중 조직-벽 고정 특징부를 갖는 스텐트
KR20210111895A (ko) * 2017-03-30 2021-09-13 보스톤 싸이엔티픽 싸이메드 인코포레이티드 이중 조직-벽 고정 특징부를 갖는 스텐트
KR102403050B1 (ko) 2017-03-30 2022-05-26 보스톤 싸이엔티픽 싸이메드 인코포레이티드 이중 조직-벽 고정 특징부를 갖는 스텐트
KR20230158630A (ko) 2017-03-30 2023-11-20 보스톤 싸이엔티픽 싸이메드 인코포레이티드 이중 조직-벽 고정 특징부를 갖는 스텐트
CN115243631A (zh) * 2020-01-07 2022-10-25 维兰德.K.沙马 用于内窥镜下切除的方法和装置

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