Apparatus and methods for endoscopic suturing

Abstract

Apparatus & methods for endoscopic suturing are described herein. A distal tip of the endoscopic device engages the tissue and then approximates the engaged tissue to form a tissue fold. A needle body positioned within a flexible catheter is deployed into or through the newly created tissue fold where it is then detached or released from the endoscopic device. The needle body has a length of suture which depends therefrom and can be used to secure the tissue fold. The entire endoscopic device or its tissue engaging assembly can then be rotated relative to the tissue fold while maintaining engagement with the tissue to maneuver the flexible catheter to the opposing side of the penetrated tissue fold. This procedure can be repeated any number of times to create an interrupted, continuous, or running suture to secure the tissue fold.

1 . A system for endoscopically suturing a region of tissue, comprising:
 an elongate tubular member having a proximal end, a distal end, and a length therebetween;   a tissue engagement device having a flexible shaft and a distal portion extending from the tubular member distal end, the distal portion of the tissue engagement device comprising a pair of jaws adapted to releasably engage tissue thereto, wherein the pair of jaws is rotatable about its longitudinal axis relative to the flexible shaft;   a deployment tube having a distal end attached by a linkage to the flexible shaft of the tissue engagement device such that the deployment tube is rotatable about the longitudinal axis of the pair of jaws, with the linkage having a first end attached to the deployment tube and a second end attached to the flexible shaft;   a needle grasper movably positioned within the deployment tube; and   a needle body which defines a channel therein, wherein the needle body is removably disposed within the deployment tube.   
     
     
         2 . The system of  claim 1  further comprising a length of suture depending from the needle body. 
     
     
         3 . The system of  claim 2  wherein the needle grasper is adapted to releasably hold the needle body. 
     
     
         4 . The system of  claim 1  further comprising an expandable tissue anchor for placement within the channel. 
     
     
         5 . The system of  claim 1  wherein the elongate tubular member comprises a flexible catheter. 
     
     
         6 . The system of  claim 1  wherein the pair of jaws comprises a grasper articulatable via a handle located at its proximal end. 
     
     
         7 . The system of  claim 1  wherein the tissue engagement device is slidably disposed within a lumen defined through the elongate tubular member. 
     
     
         8 . The system of  claim 1  wherein the distal portion of the tissue engagement device is adapted to be rotated while maintaining engagement with the tissue. 
     
     
         9 . The system of  claim 1  wherein the deployment tube defines a distal portion adapted to bend relative to the elongate tubular member. 
     
     
         10 . The system of  claim 1  wherein the needle grasper is adapted to slide through the deployment tube while holding a needle body therein. 
     
     
         11 . The system of  claim 1  further comprising an imager adapted to be positioned proximally of the needle grasper. 
     
     
         12 . The system of  claim 11  wherein the imager comprises a gastroscope. 
     
     
         13 . The system of  claim 12  wherein the imager comprises an articulatable distal end.