System for endoscopic suturing

Abstract

A system for endoscopic suturing is provided having an endoscope, such as a gastroscope, with a distal end locatable in the body of a patient and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and a tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. A tissue suturing instrument is provided having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft. The tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue through an opening in the vacuum sleeve. Two needles are provided which extend through the shaft of the suturing instrument. Each needle is separately actuated into a gap in the instrument's tip, through tissue suctioned into the opening of the vacuum sleeve and into a ferrule at each end of a loop of suture. The system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft. After removal of the suturing instrument from the accessory tube, a loop of suture extends through the tissue and the accessory tube, the suture securing instrument receives the free ends of the loop of suture at its distal end through a sleeve member, and the suture securing instrument is then inserted through the accessory tube to the location of the suture in the tissue. The suture securing instrument crimps the sleeve member and cuts the free ends of the suture to secure the suture closed. The suturing instrument and suture securing instrument are passed through the accessory tube without removal of the endoscope from the patient. The endoscope provides viewing by an operator of the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.

1 - 32 . (canceled)  
     
     
         33 . A method for suturing tissue comprising the steps of: 
 providing an endoscope having a flexible shaft and an accessory tube coupled externally to said shaft which flexes in accordance with flexing of said shaft;    locating an endoscope with said coupled accessory tube in the body of a patient; and    inserting a suturing instrument through said accessory tube into the body of the patient to place two ends of a loop of suture through tissue.    
     
     
         34 . The method according to  claim 33  wherein said inserting step further comprises the steps of: 
 providing a shaft for said suturing instrument and a distal tissue engaging end coupled to said shaft of said suturing instrument having a sew tip with a gap; and    applying suction along said shaft to said gap of said sew tip to enable tissue to be pulled into said gap when each end of said loop of suture is place in tissue.    
     
     
         35 . An attachment for a flexible endoscope having a shaft extending to a distal end comprising: 
 a flexible tube capable of being coupled externally to said endoscope to be flexible with flexing of said shaft of said endoscope; and    said tube having a distal end attached to said shaft of said endoscope.    
     
     
         36 . The attachment according to  claim 35  wherein said proximal end of said tube has a sealable opening which opens to allow an instrument to pass into said tube and closes when the instrument is removed from the tube.  
     
     
         37 . The attachment according to  claim 35  further comprising: 
 a plurality of guides each attached at a location along said shaft of said endoscope and having an opening through which said tube extends in which said tube is capable of sliding through said opening in response to flexing of said shaft of said endoscope.    
     
     
         38 . The attachment according to  claim 36  wherein said sealable opening is provided by a cannula attached to said tube having a sealable passage in communication with said tube.  
     
     
         39 . The attachment according to  claim 35  wherein said tube represents a conduit enabling enables access of an instrument independent of said endoscope near said distal end of the shaft of the endoscope.  
     
     
         40 . A suturing instrument comprising: 
 a housing;    a shaft extending from said housing;    a tissue engaging end coupled to said shaft at the distal end of the instrument;    one or more needles which extend through said housing through said shaft to said tissue engaging end;    a suture channel extending through said housing and said shaft to said tissue engaging end;    said tissue engaging end having a sew tip with an opening through which said needles are extendable to each capture one end of suture extending through said suture channel to said sew tip; and    said shaft having a first section and a second section, said first section being rigid and extends from said housing, and said second section being flexible and extends from the first section to the tissue engaging end of said suturing instrument.    
     
     
         41 . The suturing instrument of  claim 40  wherein said opening of said sew tip represents a first opening and said suture channel having first and second ends in which said first end is adjacent said sew tip, and said suturing instrument further comprises: 
 a sleeve over said sew tip having one end capped and an second opening in communication with said first opening of said sew tip;    means for selectably providing suction to said suture channel along said shaft to said first opening of said sew tip to enable tissue to be pulled into said first opening through said second opening of said sleeve when said needle extends through said opening of said sew tip in which said capped sleeve enables suction to be communicated to said distal end of the instrument; and    means for selectably closing said second end of said suture channel to enable suction to be provided at said sew tip by said suction providing means.    
     
     
         42 . The suturing instrument of  claim 40  wherein said needle comprises first and second members and a spring which couples said first and second members, and said second member has a tip positionable in said sew tip.  
     
     
         43 . A suture securing instrument comprising: 
 a shaft which is at least partially flexible;    a distal tissue end coupled to said shaft;    means for retaining in a sleeve member at said distal end two free ends of a loop of suture extending through tissue; and    means for cutting the two free ends of the loop of suture near said sleeve member.    
     
     
         44 . (canceled)  
     
     
         45 . The attachment according to  claim 35  further comprising: 
 one or more first members through which said tube is slidable and said first members are attachable at locations along said shaft of said endoscope; and    a second member attached to said distal end of said tube in which said second member is attachable to the distal end of the shaft of the endoscope, in which said tube operates as a conduit for passage or one or more instruments along outside said shaft of said endoscope.    
     
     
         46 . An apparatus for use with an endoscope having a flexible shaft with a distal end comprising: 
 a flexible tube having a distal end;    a member attachable to said distal end of the shaft of the endoscope and to said distal end of said tube; and    means for enabling the shaft of the endoscope and said tube to slide with respect to each other in response to flexing of said shaft of said endoscope, in which said tube operates as a conduit for passage of one or more instruments.    
     
     
         47 . The apparatus according to  claim 46  wherein said means maintains said tube substantially coaxial with the shaft of the endoscope.  
     
     
         48 . A suturing instrument comprising: 
 a shaft;    a tissue engaging end coupled to said shaft at the distal end of the instrument;    one or more needles which extend through said shaft to said tissue engaging end;    means for carrying suture along said shaft to said tissue engaging end;    said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and    means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended, wherein said shaft is not part of an endoscope.    
     
     
         49 . The suturing instrument of  claim 48  wherein each of said needles comprises first and second members and a spring which couples said first and second members to aid in flexibility of said needles.  
     
     
         50 . The suturing instrument of  claim 48  wherein: 
 said shaft has a first section and a second section;    said tissue engaging end is coupled to said second section of said shaft;    said one or more needles extend through said first and second sections of said shaft to said tissue engaging end;    said suture carrying means comprises a suture channel extending through said first and second sections of said shaft to said tissue engaging end;    said first section has an outer tube and a first guide member extending in said outer tube having a plurality of tracks for said needles and suture;    said second section of said shaft has a second guide member having a plurality of tracks for said needles and suture; and    said shaft has an outer layer extending over at least said second guide member to said tissue engaging end, and a coupler member coupling said first guide member to said second guide member to enable rotation to be translated from said first section to said tissue engaging end through said second section.    
     
     
         51 . The suturing instrument of  claim 48  further comprising means for steering said shaft.  
     
     
         52 . The suturing instrument of  claim 51  wherein said steering means comprises: 
 a chamber at or near the proximal end of said instrument having a fluid and a piston in said chamber movable to change the volume of the fluid in said chamber, an opening to said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and    a cylinder along said shaft having a piston coupled to said distal end movable responsive to changes in said volume of fluid in said chamber communicated through said tube to said cylinder to steer said distal end.    
     
     
         53 . The suturing instrument of  claim 51  wherein said steering means comprises: 
 a chamber at or near the proximal end of said instrument having a medium and a piston in said chamber movable to change the volume of said medium in said chamber, an opening in said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and    a folding piston coupled to said distal end expandable and retractable responsive to changes in said volume of said medium in said chamber communicated through said tube to said cylinder to steer said distal end.