ILLUMINATED BOUGIE FOR LAPAROSCOPIC IMPLANTATION OF ANTI-REFLUX PROSTHESIS

Abstract: An illuminating bougie (10) in which an elongate bougie body is formed of material for transmitting and diffusing light laterally to transilluminate adjacent body tissue. A socket (15) for attaching the light-transmitting end (17) of a fiber optic bundle (13) is formed in the proximal end (16) of the bougie (10).

Description: ILLUMINATED BOUGIE FOR LAPAROSCOPIC IMPLANTATION OF ANTI-REFLUX PROSTHESIS This application is a continuation in part of my USA Application S/N 722,332, filed October 7, 1991. This invention relates to a surgical instrument and method of use. More particularly, the invention concerns an instrument for laparoscopically implanting a prosthesis for controlling gastro esophageal reflux. Methods and apparatus for the prevention of gastro esophageal reflux are described in my prior United States Patents Nos. 3,875,928, issued April 8, 1975, and 4,271,828, issued June 9, 1981. An alternate method, generally employing a similar prosthesis is also described in my prior United States Patent No. 4,271,827, issued June 9, 1981. A method for laparoscopically implanting such prostheses is disclosed in my prior United States Patent No. 5,006,106 issued November 9, 1991. The present application is directed to an illuminated bougie and method of use for laparoscopic implantation methods as described in my U.S. Patent 5,006,106. The principal object of the present invention is to provide an illuminated bougie for use in practicing the method disclosed in my issued U.S. Patent No. 5,006,106 and in other diagnostic, therapeutic or surgical procedures. Another principal object of the invention is to provide laparoscopic methods for implantation of an anti reflux prosthesis utilizing an illuminated bougie to assist in locating the distal esophagus. These, other and further objects and advantages of the invention, will be apparent to those skilled in the art from the following detailed description thereof, taken in conjunction with the drawings in which: Fig. 1 depicts an illuminated bougie embodying the present invention; Fig. 2 depicts a procedure for laparoscopic implantation of an anti reflux prosthesis, utilizing the bougie of Fig. 1. The publication entitled Laryngoscope. Volume 96, page 1040 (1986) describes a device consisting of a hollow tapered esophageal bougie. An elliptical portal was formed in the distal end of the bougie. A fiber optic bundle, the terminal end of which was cut at a 40° angle, was then inserted into the lumen of the bougie such that the terminal end of the bundle was positioned in the portal. The terminal end of the bundle was then cemented to fix it in the portal. Thus, the bougie described in this article could only transiUuminate a very small portion of the esophagus which was directly adjacent the oval portal at the distal end of the bougie. By contrast, as will appear more fully below, the bougie which I have invented can transiUuminate a substantial length of the esophagus. Schellenberg, U.S. 1,704,764, disclosed a hollow perforate colonic exploration device formed of transluscent rubber, into which a hot-filament electric lamp could be temporarily inserted, to facilitate taking a picture of the walls of the colons and intestines. Aiken, U.S. 2,797,683, disclosed a rigid bronchoscope formed of a plastic material which transmits light by internal reflection, to be emitted by the leading (distal) end of the device, in a manner similar to the Laryngoscope article cited above. Briefly, in accordance with my invention, my illuminated bougie comprises an elongate bougie, shaped and dimensioned to be inserted into the body, and having a proximal end and a distal end. At least a major portion of the length of the bougie is formed of a light-transmitting material. A socket is formed in the proximal transparent portion of the bougie for attaching the light-transmitting end of a fiber optic bundle. The drawings are presented for the purpose of illustrating the practice of my invention, so as to enable those skilled in the art to understand and practice it, but are not intended as limitations upon the scope of the invention. Further, the drawings illustrate the best mode which I presently contemplate for carrying out my invention, again without intending to limit the scope thereof. In these drawings, like reference characters depict the same elements in the several view. Turning now to the drawings, Fig. 1 depicts the presently perferred embodiment of the invention, consisting of a bougie 10 formed entirely of light-transmitting material. The upper proximal portion A is cylindrically shaped and the remainder is tapered towards the distal end 14. The bougie 10 is imperforate and is preferrably solid. A socket 15 is formed in the proximal end 16 of the bougie 10 to receive the light-transmitting terminal end 17 of a fiber optics bundle 13. The socket 15 and collar 18 cooperate to attach the terminal end 17 of the fiber optic bundle 13 to the proximal end 16 of the bougie 10. In the embodiment depicted in Fig. 1 light from the terminal end 17 of the fiber optic bundle 13 is transmitted throughout the entire length of the bougie 10 for transillumination of adjacent tissue. The shape and dimensions of the bougie can be varied to suit the end use of the device. Thus, for upper laryngeal and esophagus surgery, i.e., Zencker's diverticulum, Barrett's esophagus resections, thoracoscopy, e.g., surgery of the mediastinum, surgery of the abdomen when it is important to see the stomach, esophagus and/or for laparoscopic surgery for ulcer disease, vagotomy, for morbid obesity, for reflux esophagitis and for placement of the prosthesis in accordance with my '106 Patent, the length of the bougie 10 is suitably 20 cm for adults and 15 cm for children. The diameter is suitably 36-40 French for adults and 18-26 French for children. (1 French = % mm.) In the preferred embodiment the bougie 10 is formed of moulded silicone plastic or similar plastic having a hardness of approximately 50 durometer. Micrometalic particles can be dispersed in the plastic to improve lateral diffusion of the light. Polishing the external surface of the bougie causes light to be transmitted further toward the distal end before it is diffused laterally. However, when the esophagus or tissue closes on the bougie, the bougie surface-air interface is altered, causing lateral diffusion of the light along the length contacted by the espohagus. A typical laparoscopic procedure involving use of the bougie of my invention is depicted in Fig. 2. The procedure is facilitated by illuminating by the esophagus 21 by means of the bougie 10 which is inserted intra- orally. The wall 21a of the distal esophagus is sufficiently thin to transmit a substantial portion of the light emitted by the bougie 10, facilitating viewing the esophagus and placement of the prosthesis 22, viewing the procedure through a laparoscopic optical viewing device 23. Since no heat is transmitted through the bougie, it can be left in place during the entire course of the procedure, even several hours, if necessary, without burning the body tissue it contacts, because the light source is a fiber optic bundle attached to a long fiber optic cord and is many feet away from the light source, rather than an incandescent filament inside the bougie. Having now described my invention is such terms as to enable those skilled in the art to understand and practice it without undue experimentation and, having disclosed the best mode I presently contemplate for carrying out my invention, I claim: -5-

Claims: CLAIMS: 1. An illuminated bougie comprising: (a) an elongate bougie, shaped and dimensioned to be inserted into the body, and having a proximal end and a distal end, at least the major portion of the length thereof being formed of a material which transmits and diffuses light laterally to transiUuminate adjacent body tissue along said major length; (b) socket means formed in the proximal portion of said bougie, for attaching the light transmitting end of a fiber optic bundle. -6-

Inventors: ANGELCHIK JEAN PIERRE, ANGELCHIK, JEAN, PIERRE
Applicants: ANGELCHIK JEAN P, ANGELCHIK, JEAN, PIERRE
Application year: 1992
Main classification: A61B1
IPC codes: A61B1, A61B5, A61B17, A61B19