Abstract:
An endoscopic surgical rotary capture instrument is used in minimally invasive laparoscopic surgery for closing a gastric band having a buckle end a free end. The rotary capture instrument includes a pusher end that has a stationary jaw and a movable jaw. The movable jaw is actuated by rotary motion of an inner shaft. The jaws are used to gasp securely and push the tube end of the gastric band after it has been threaded through the buckle end of the band. A hook instrument is used to hold the buckle end securely while the rotary capture instrument is used to push the free end of the gastric band.

Description:
CROSS REFERENCE TO RELATED CO-PENDING APPLICATIONS 
     This application is a continuation of and claims the benefit of U.S. non-provisional application Ser. No. 11/316,194 filed on Dec. 22, 2005, now abandoned, and entitled SURGICAL ROTARY CAPTURE INSTRUMENT FOR GASTRIC BAND CLOSING which is commonly assigned and the contents of which are expressly incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to an endoscopic surgical rotary capture instrument, and more particularly to a surgical rotary capture instrument used in minimally invasive laparoscopic surgery for closing a gastric band. 
     BACKGROUND OF THE INVENTION 
     One method of controlling the intake of food in an obese person is to place an adjustable restriction band  10  around the upper stomach  20 , shown in  FIG. 1 . This creates a new small stomach pouch in the upper stomach  20  for holding a small amount of food and leaves the larger part of the stomach below the band so the stomach volume available for holding food is reduced. The band also controls the stoma, i.e., stomach outlet, between the upper stomach and the lower stomach  30 . The size of the stoma regulates the flow of food from the upper stomach to the lower stomach. When the stoma is small the patient feels full sooner and has a feeling of satiety that lasts longer. 
     One specific type of an adjustable restriction band  10  is the LAP-BAND system manufactured by INAMED Corporation, shown in  FIG. 2A  and  FIG. 2B . The LAP-BAND system is described in U.S. Pat. No. 5,601,604, the contents of which are incorporated herein by reference. Referring to  FIG. 2A , the gastric band  10  of the LAP-BAND system includes a body portion  11  a head portion  12  and a tail portion  13 . The head portion  12  has a buckle  19  with a pull tab  18  and the pull tab  18  has a hole  18   a  for receiving a post. The tail portion  13  has a tube  14  extending from one end, a triangular shaped member  13   a  and a conical shaped barb  13   b . Tube  14  is in communication with an inflatable member  16  of the inner surface  15  of the body portion  11 . The inflatable member  16  is gradually inflated by injecting a saline solution through the tube  14 . The inflated member  16  presses against and constricts the stomach wall underlying the band  10 . This results in decreasing the diameter of the stoma. The amount of the injected solution controls the size of the inflated member  16  and accordingly the diameter of the stoma. 
     During a minimally invasive laparoscopic surgical procedure, the tube  14  of the gastric band  10  is pushed through a laparoscopic cannula and is inserted in the patient&#39;s abdomen. The gastric band  10  is then placed around the patient&#39;s upper stomach and the tail portion  13  is inserted into the buckle  19  thereby forming a ring structure around the upper stomach. The triangular shaped member  13   a  of the tail portion  13  interlocks with the buckle  19  and prevents the tube  14  from slipping backwards. The process of inserting the tail portion  13  into the buckle  19  requires simultaneously grasping the buckle  19 , inserting the tube  14  through the buckle conduit  19   a  and then pushing the tube  14 . Minimally invasive tools are used for performing these mechanical manipulations needed for tightening the gastric band around the upper stomach. 
     A prior art combination tool for grasping the pull tab  18  and pushing the tube  14  is described in U.S. Pat. No. 5,658,298. This prior art tool includes two elongated slidably mounted cylindrical members and a handpiece. At the distal end of the first cylindrical member there is a post extending downwards that is dimensioned to engage the hole  18   a  of the tab  18  from the top side, shown in FIG. 6 of U.S. Pat. No. 5,658,298. The second cylindrical member which is slidably mounted with respect to the first cylindrical member has mounted on its distal end a seat or a fork, shown in FIG. 3A of U.S. Pat. No. 5,658,298. This fork is dimensioned to capture protuberances such as the conical barb  13   b  at the tube end of the band  10  and push the tube  14  through the buckle conduit  19   a , while the first cylindrical member engages and pulls on the pull tab  18 . Surgeons performing this type of laparoscopic surgery have encountered the problems of the post unintentionally slipping out of the hole  18   a  and the fork unintentionally releasing the tube end of the band  10  during the band tightening procedure. This requires regrasping the tube end of the band  10  and the tab  18  several times during the procedure which increases both the operation time and the complexity of the operation. 
     Accordingly there is a need for an improved grasping and pushing tool used in tightening a band having a buckle end and a free end that does not disengage unintentionally and provides better stability and control during the tightening procedure. 
     SUMMARY OF THE INVENTION 
     In general, in one aspect, the invention features an endoscopic surgical capture tool used in minimally invasive surgery through a cannula for grasping and tightening a ligature band. The ligature band comprises an elongated strap having a buckle end and a distal end, the buckle end having an aperture and a pull tab having a hole thereon. The elongated strap is configured to encircle an internal organ and the distal end is configured to pass through and lockingly engage the aperture thereby tightening the ligature band around the internal organ. The capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle. The capture end is configured to engage a protuberance of the distal end and push the distal end after it has been threaded through the aperture. The capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft. 
     Implementations of this aspect of the invention may include one or more of the following features. The elongated shaft is dimensioned to enter one end, pass through and extend beyond the other end of the cannula. The handle comprises a mechanism for actuating the rotational motion of the inner shaft, thereby actuating the rotationally movable jaw. The mechanism comprises squeezing a handle component. The handle comprises a cylindrical body having first and second side indentations opposite to each other and a thumb indentation on a top surface of the cylindrical body, the thumb indentation being aligned with the rotationally movable jaw. The handle further comprises a latch for keeping the rotationally movable jaw closed. The stationary jaw and the rotationally movable jaw form a circle when closed. The stationary jaw and the rotationally movable jaw comprise rounded edges. The stationary jaw and the rotationally movable jaw comprise a metal, ceramic, polymer, Teflon, alloys, rubber or composites. The stationary jaw and the rotationally movable jaw may have inner surfaces that are spherical, sloped, conical, or have one or more steps or grooves. The internal organ may be stomach, artery, intestines, heart, lung, pancreas, kidney, liver or bone. 
     In general, in another aspect, the invention features an endoscopic surgical capture tool used in minimally invasive surgery through a cannula for grasping an organ or another tool having a circular cross-section. The capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle. The capture end is configured to engage a protuberance of the organs or the other tool. The capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft. 
     In general, in another aspect, the invention features an endoscopic surgical instrument used in minimally invasive surgery through a cannula for grasping and tightening a ligature band around an internal organ. The ligature band comprises an elongated strap having a buckle end and a distal end, the buckle end having an aperture and a pull tab having a hole thereon. The elongated strap is configured to encircle the internal organ and the distal end is configured to pass through and lockingly engage the aperture thereby tightening the ligature band around the internal organ. The instrument comprises a hook tool configured to engage the hole and pull the pull tab in a first direction while the distal end is threaded through the aperture and pushed opposite to the first direction and a capture tool configured to engage a protuberance of the distal end and push the distal end. The hook tool comprises a hook having a flat portion and a bend portion extending from the flat portion and the flat portion is configured to slide along a flat surface of the pull tab and the bend portion has an inner surface radius matching a radius of the hole. The capture tool comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of an elongated shaft. The hook tool and the capture tool apply opposing forces on the ligature band for tightening the ligature band around the internal organ. 
     In general, in another aspect, the invention features a method for tightening a ligature band around an internal organ via minimally invasive surgery. The method comprises first providing a ligature band comprising an elongated strap having a buckle end and a distal end. The buckle end has an aperture and a pull tab having a hole thereon. Next, inserting the ligature band into a patient&#39;s body through a minimally invasive cannula and encircling the internal organ with the elongated strap. Next, inserting a surgical hook tool through the cannula. The hook tool comprises an elongated shaft having a hook end and a handle. The hook end comprises a flat portion and a bend portion extending from the flat portion and the flat portion is configured to slide along a flat surface of the pull tab and the bend portion has an inner surface radius matching a radius of the hole. Next, engaging the hole with the hook end. Next, inserting a surgical capture tool through the cannula. The capture tool comprises an elongated shaft having an outer shaft, a rotatable inner shaft, a capture end and a handle. The capture end comprises a stationary jaw and a rotationally movable jaw and the rotationally movable jaw is actuated by rotational motion of the inner shaft. Next, engaging a protuberance in the distal end with the capture tool and inserting the distal end through the aperture. Finally, pulling the pull tab in a first direction with the hook tool while pushing the distal end with the capture tool opposite to the first direction. 
     Among the advantages of this invention may be one or more of the following. The rotationally movable jaw provides flexibility in capturing an elongated organ, vessel, or other tool having a variety of circular cross-sectional dimensions. The rounded edges of the jaws prevent the jaws from digging and cutting into the organ or tool. The angle between the axis of the elongated shaft and the jaw axis may be varied depending upon the geometry of the organ that needs to be grasped. The inner surfaces of the jaws may be sloped, conical or have one or more steps. These configurations are useful in grasping organs with various cross-sectional geometries. The bend portion of the hook end together with the extension and the flat portion form a C-shaped hook that grasps securely the pull tab. The risk of unintentional disengagement is very low. The extension helps prevent slippage of the hook out of the hole. The inner surface of the bend portion is formed with a radius that matches the inside of the hole in the pull tab. This distributes the pulling force uniformly around the hole and prevents damaging of the pull tab during pulling. The flat portion of the hook end allows the hook end to slide easily underneath or above the pull tab. The capture tool may also be used in non-endoscopic procedures. 
     The details of one or more embodiments of the invention are set forth in the accompanying drawings and description below. Other features, objects and advantages of the invention will be apparent from the following description of the preferred embodiments, the drawings and from the claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Referring to the figures, wherein like numerals represent like parts throughout the several views: 
         FIG. 1  is a side view of a stomach with an adjustable gastric band around the upper part of the stomach; 
         FIG. 2A  is a perspective view of an open LAP-BAND gastric band; 
         FIG. 2B  is the gastric band of  FIG. 2A  in a closed position forming a ring structure; 
         FIG. 3  is a perspective view of the endoscopic rotary capture instrument of this invention; 
         FIG. 4 - FIG. 8  are perspective views of the pusher end of the instrument of  FIG. 3 ; 
         FIG. 9 - FIG. 12  are perspective views of the pusher end of the instrument of  FIG. 3  engaging and pushing the barb end of the gastric band of  FIG. 2A ; 
         FIG. 13  is side view of the handle of the instrument of  FIG. 3 ; 
         FIG. 14  is a top view of the handle of the instrument of  FIG. 3 ; 
         FIG. 15 - FIG. 16  are perspective views of the pusher end of the instrument of  FIG. 3  engaging and pushing the barb end of the gastric band of  FIG. 2A  through a buckle while a hook instrument is holding the buckle; 
         FIG. 17 - FIG. 19  are perspective views of another embodiment of the rotary capture instrument of this invention; 
         FIG. 20  is a perspective view of the endoscopic hook instrument of this invention; 
         FIG. 21  is a perspective view of the hook end of the instrument of  FIG. 20 ; 
         FIG. 22  is a side view of the hook of  FIG. 21 ; 
         FIG. 23  is a top view of the hook of  FIG. 21 ; 
         FIG. 24  is perspective view of the handle of the instrument of  FIG. 20 ; 
         FIG. 25  is side view of the hook end of the instrument of  FIG. 20  engaging the hole in the tab of the buckle of the gastric band of  FIG. 2A ; and 
         FIG. 26  is a perspective view of the hook end of the instrument of  FIG. 20  engaging the hole in the tab of the buckle of the gastric band of  FIG. 2A . 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Referring to  FIG. 3 , a surgical rotary capture instrument  200  includes a handle  210 , an elongated shaft  220  and a distal end component  230 . The handle  210  features a tactile control of the distal end component  230 . Referring to  FIG. 13-14  the handle  210  features a cylindrical body having a diameter of 15.9 mm and a length of 11.4 cm and it includes two side indentations  211 ,  212  opposite to each other and a thumb indentation  213  on the top surface. The handle  210  also features a squeeze-to-close, spring-loaded-open design. By squeezing the handle piece  215 , a rack actuates a gear, developing a rotary motion that actuates a movable jaw  232  at the end component  230  through a drive shaft  224 . The handle  210  also incorporates a latch  216  to keep the instrument in the closed position. The handle actuation could be any number of mechanical means that imparts the rotary motion required. 
     The elongated shaft  220  has a cylindrical shape and is dimensioned to fit through a laparoscopic cannula for minimally invasive surgery. In one example, the elongated shaft  220  has a length of 45 cm and a diameter of 5 mm, shown in  FIG. 19 . Shaft  220  includes an outer shaft  222  and an inner shaft  224 . Referring to  FIG. 4-12 , and  FIG. 17-18  the end component  230  includes a stationary jaw  234  and a movable jaw  232 . The movable jaw  232  is actuated by rotary motion of the inner shaft  224 . In one example, in closed position jaws  234 ,  232  form a circle having an inner diameter  235  of 4.8 mm and an outer diameter  236  of 7.6 mm. The front edge of opening  235  is rounded having a radius that matches the corner radius at the rear of barb  13   b  and the diameter of the tube  14 . The rounded edge prevents the jaws from digging in and cutting into the tube  14 . In the open position the maximum distance  237  between the movable jaw  232  and the stationary jaw  234  is 10.5 mm. In this embodiment, the angle  53  between the axis  52  of the elongated shaft  220  and the jaw axis  54  is 75 degrees, as shown in  FIG. 11  and  FIG. 17 . This angle  53  may be varied depending upon the geometry of the item that needs to be grasped. 
     Referring to  FIGS. 9-12 , jaw  232  is rotated open and jaws  232 ,  234  are positioned around the tube  14  of the gastric band  10  adjacent to an integral conical shaped barb  13   b  that is intended to assist in closure. The handle  210  is then actuated causing the movable jaw  232  to rotate closed. This motion captures securely the tube  14 . The diameter  240  of the barb  13   b  is larger than the inner diameter  235  of the closed jaws. The surgeon can then push the closed jaws  232 ,  234 , against the integral barb  13   b , thereby causing the tube  14  to move forward. 
     Referring to  FIG. 15  and  FIG. 16 , the surgeon threads the tube  14  through side  19   b  of the buckle conduit  19   a , then captures the tube  14  from the other side  19   c  of the buckle conduit  19   a  with the jaws  232 ,  234  and pushes the tube  14  in the direction  50  away from the buckle  19  by pushing the closed jaws  232 ,  234  against the barb  13   b . While pushing tube  14  through the buckle conduit  19   a , a hook instrument  100  is used to pull the pull tab  18  of the buckle  19 . The triangular shaped member  13   a  of the tail portion  13  interlocks with the buckle conduit  19   a  and prevents the tube  14  from slipping backwards. The hook instrument  100  and the rotary capture instrument  200  apply opposing forces on the gastric band  10  in order to cinch and lock the band closed. 
     In another embodiment, the rotary capture instrument  200  of this invention is used to capture a vessel or a component, such as the anvil  250  of  FIG. 17 . In this case the shape of the jaws is selected so that they do not cause any damage to the component  250 . This is accomplished by adjusting the angle  53  between the axis of the jaws  54  and the shaft axis  52 . In one example the angle  53  is 60 degrees. The shape of the inner jaw surfaces  232   a ,  234   a  may also be varied to conform to the specific geometry of the component  250  For example, the inner surfaces  232   a ,  234   a , may be sloped, conical, have one or more steps or have grooves that assist in grasping the component  250 . The opening  235 , shown in  FIG. 7 , is slightly larger than the diameter of the anvil stem. This allows the anvil stem to float slightly for ease of alignment with the mating stapler (not shown). Inner surfaces may also be coated with protective coatings such as Teflon. 
     Referring to  FIG. 20 , a surgical hook instrument  100  includes a handle  110 , an elongated shaft  120  and a hook end  130 . The handle  110  features a tactile control of the hook end. Referring to  FIG. 24  the handle  110  features a cylindrical body having a diameter of 15.9 mm and a length of 11.4 cm and it includes two side indentations  111 ,  112  opposite to each other and a thumb indentation  113  on the top surface. The elongated shaft  120  has a cylindrical shape and is dimensioned to fit through a laparoscopic cannula for minimally invasive surgery. In one example, the elongated shaft  120  has a length of 45 cm and a diameter of 5 mm. Referring to  FIG. 21  and  FIG. 22 , the hook end  130  includes an angled portion, a flat portion  130  a bend portion  134  and an extension  136 . The angled portion  131  has a flat bottom surface  131   a  and a downwards sloped top surface  131   b  forming an angle  133  with the top surface  124  of the elongated shaft  120 . The flat portion  132  has a flat top surface  132   b  and a flat bottom surface  132   a  that extends continuously from the bottom surface  122  of the elongated shaft  120  and the bottom surface  131   a  of the angled portion  131 . The top surface  132   b  of the flat portion  132  forms an angle  135  with the top surface  131   b  of the angled portion  131 . Angles  133  and  135  are supplementary to each other, i.e., their sum is 180 degrees. In one example, angle  133  is 20 degrees and angle  135  is 160 degrees. In one example, the flat portion  132  has a thickness of 1.3 mm, a width of 3.3 mm and a length of 13.4 mm. The bend portion  134  extends from the flat portion  132  and is bend upwards and towards the handle  110 . The inner surface  134   a  of the bend portion  134  forms an angle  137  with the top surface  132   b  of the flat portion  132 . Inner surface  134   a  is formed with a radius that matches the inside of the hole  18   a  in the pull tab  18 . This distributes the pulling force uniformly around the hole and prevents damaging of the pull tab  18  during pulling. The outer surface  134   b  of the bend portion  134  is curved and forms an angle  138  with the top surface  132   b  of the flat portion  132 . In one example angles  137  and  138  are 40 and 60 degrees, respectively. Extension  136  extends from the bend portion  134 , points towards the handle  110  and is parallel to the flat portion  132 . In one example it has a length of 2.0 mm and a thickness of 0.8 mm. Extension  136  helps prevent slippage of the hook out of the hole  18   a . The inner surface of  136  forms an angle with the inner surface  134   a , which facilitates pickup of the hole  18   a  by the hook  130 . 
     Referring to  FIG. 25  and  FIG. 26 , the flat portion  132  of the hook end  130  is placed underneath the pull tab  18  of the gastric band buckle and the bend portion is inserted into the hole  18   a  thereby engaging the pull tab. The bend portion  134  together with the extension  136  and the flat portion  132  form a C-shaped hook that grasps securely the pull tab  18 . The risk of unintentional disengagement is very low. While holding the buckle end  19  securely with the hook end  130  a rotary capture instrument  200  (shown in  FIG. 15 ) is used to capture and push the tube  14  of the gastric band  10  through the buckle conduit  19   a . The triangular shaped member  13   a  of the tail portion  13  interlocks with the buckle conduit  19   a  and prevents the tube  14  from slipping backwards. The hook instrument  100  and the rotary capture instrument  200  apply opposing forces on the gastric band  10  in order to cinch and lock the band closed. 
     Several embodiments of the present invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, other embodiments are within the scope of the following claims.