Abdominal instrument and method

Abstract

To provide a surgical instrument for placement of a movement restriction device for use in a surgical procedure for treating reflux disease in a patient.SOLUTION: A surgical instrument (100) comprises a sleeve (113) and a holding device (111) configured to engage to a movement restriction device, where the holding device is configured to be placed within the sleeve and be displaceable in relation to the sleeve. The instrument further comprises a first handling portion (101) connected to the sleeve, and a second handling portion (102) connected to the holding device. The handling of at least one of the first and second handling portions creates relative displacement of the holding device in relation to the sleeve, which disengages the holding device from the movement restriction device for performing the placement of the movement restriction device.SELECTED DRAWING: Figure 5

Description

[Technical field]

[0001] The present invention generally relates to a method for treating gastroesophageal reflux disease (GERD) and / or obesity in a human patient. This document relates to an instrument for

[0002] Gastroesophageal reflux disease (GERD), or acid reflux disease, is the repeated backflow of acid into the esophagus. This is a chronic disease that causes damage to the lining of the esophagus, usually the area between the esophagus and stomach. This is due to temporary or permanent changes in the barrier of the lower esophageal sphincter (LES). dysfunction, transient LED relaxation, impaired emptying of the esophagus from the stomach, or hiatal herniation A may be the cause.

[0003] Gastroesophageal reflux disease can be treated in a number of ways, with surgical treatment being preferred over long-term medical therapy. The standard surgical treatment is the Nissen fundoplication, which strengthens the sphincter. , wrapping the top of the stomach around the LES to prevent acid reflux and repair hiatal hernias The procedure is often performed laparoscopically and is difficult to perform via the mouth.

[0004] Another surgical treatment is to create an anti-reflux valve in the underlying tissue. This treatment involves visualizing the line, drawing the tissue in to create the appropriate flap, and then fixing it in place. Such treatment is difficult and requires an experienced endoscopist. Each procedure involves many steps, typically manipulating the tissue more than once and applying multiple separate fasteners. A suction cup is applied to create an anti-reflux valve. Some patients may require additional steps to heal. They also suffer from hiatal hernias, which are a common problem in endoscopists. This increases the time and effort required by endoscopists. Each additional step increases the risk of making a mistake that may be difficult to undo.

[0005] Experience with medical device implantation has shown that sutures between implanted devices and human tissue can be difficult to remove in the long term. For long-term implantation of the device, it is important to keep the device in place. There are two possibilities to hold the tissue in place. The first solution is to suture human tissue to human tissue, which The second approach was to hold the device in place by To provide sutures to hold the vice in place and to hold the device in place long term The primary goal was to allow human tissue to grow into the device.

[0006] A problem with providing an implantable device related to the esophagus is that the outer surface of the esophagus is The main drawback is that it is made up entirely of meat tissue, which is very easy to damage or move. This is probably because the Anglechik prosthesis mentioned above has many complications such as migration. This is one of the reasons why.

[0007] The stomach, on the other hand, has a serous membrane on its outside, which provides a much stronger membrane for suturing. Therefore, suturing the device directly to the stomach wall is much more effective than suturing the implanted device to the esophagus. This gives better results than

[0008] Today, there are long-term treatments for GERD that are more effective than previous treatments and do not cause serious complications. is needed.

[0009] Surgical treatment of the upper gastrointestinal tract today is generally performed in a minimally or non-invasive manner. The level of invasiveness of the treatment depends on the placement of the surgical instruments and their handling. In order to perform surgical procedures in a more effective manner than conventional instruments for surgical treatment in the gastric cavity, There exists a need for such equipment.

[0010] The object of the present invention is to overcome some of the problems associated with existing surgical treatments for gastroesophageal reflux disease (GERD). Another object of the present invention is to overcome or at least reduce some of the problems associated with gastroesophageal reflux disease. The present invention provides an apparatus and method for treating these objects and The rest are obtained by the appended claims.

[0011] Placing a motion restriction device for use in a surgical procedure to treat reflux disease in a patient A surgical instrument for performing a surgical procedure is provided, the surgical instrument comprising a sleeve and a motion restriction device adapted to engage the sleeve and the motion restriction device. and a retaining device configured as follows: the retaining device is disposed within the sleeve and is configured to be fixed to the sleeve. The device is configured to be displaceable by a first handling part connected to the sleeve and a holding part. and a second handling unit connected to the device. Handling of at least one of the gripping portions causes a relative displacement of the holding device with respect to the sleeve, This disengages the retaining device from the motion restriction device, and the placement of the motion restriction device is performed. The device securely holds the motion restriction device during the surgical procedure and is easily removed upon completion of the surgical procedure. The device may also be adapted to have the motion restriction device move to its locked position when the device is retracted. Reduce the risk of dislodgment or displacement from the

[0012] According to one embodiment, the surgical instrument includes a distal portion adapted to enter the patient's body during use. and a proximal portion configured to remain outside the patient's body during use. is disposed in the distal portion and the first and second handling portions are disposed in the proximal portion.

[0013] According to one embodiment, the holding device is on an elongate member connected to the second handling part. To be placed.

[0014] According to one embodiment, the retention device has a protrusion configured to engage with a recess in the movement restriction device. It is provided with a projection member.

[0015] According to one embodiment, the first handling part is connected to the second handling part along the main longitudinal axis of the instrument. In an alternative embodiment, the first handling part is , the second handling part is rotationally displaceable about a main longitudinal axis of the instrument.

[0016] The first handling unit rotates the first handling unit relative to the second handling unit. The threaded part and the second handling part are connected such that the displacement generates a linear displacement of the first handling part. and a sleeve. The part relating to the handling section.

[0017] According to one embodiment, the distal portion is curved relative to the major longitudinal axis of the instrument. 20° or more to the major axis of the instrument, 30° or more to the major axis of the instrument, or The device or the main longitudinal axis of the device can be bent at 60° or more. or more than 75° to the major axis of the device, or more than 90° to the major axis of the device More than 100° bending allows you to rotate the instrument and position it where you need it.

[0018] The distal portion of the sleeve may be rigid and the distal portion of the elongate member may be flexible. Alternatively, the distal portion of the sleeve is flexible and the distal portion of the elongate member is rigid. do.

[0019] According to one embodiment, the distal portion can be bent relative to the major longitudinal axis of the instrument. The distal portion is flexible to allow the surgeon to bend the distal portion during the surgical procedure. The distal portion may be operably flexible so as to allow the surgeon to bend the distal portion during the surgical procedure. In one embodiment, the elongate member is operatively flexible so that it can be moved. The operably flexible distal portion is configured to bend greater than 30°. In one embodiment, the operably flexible distal portion is configured to be bent greater than 45°. In a configuration, the operably flexible distal portion is configured to bend greater than 60 degrees. In one embodiment, the operably flexible distal portion is configured to bend greater than 75°. In one embodiment, the operably flexible distal portion is adapted to be bent beyond 90°. It is composed.

[0020] According to one embodiment, the proximal portion manipulates the operably flexible distal portion during a surgical procedure. The third handling section further includes a third handling section for operating during a surgical procedure. To allow for manipulation of the flexible distal portion, a second handling section is attached along the main longitudinal axis of the instrument. In an alternative embodiment, the third handling section may be , a second longitudinal axis of the instrument for manipulating the flexible distal portion during a surgical procedure. The handling portion is capable of being rotated and displaced relative to the handling portion.

[0021] According to one embodiment, the third handling part comprises a screw part and the second handling part comprises A rotational displacement of the third handling part relative to the second handling part, the rotational displacement being provided with a corresponding threaded part. The second handling portion is attached to the instrument along the major longitudinal axis thereof so as to be operable during a surgical procedure. The third handling part provides a linear displacement for manipulating the position part.

[0022] According to one embodiment, the sleeve comprises a rigid portion and a flexible portion configured to bend. a sleeve that is displaceable relative to the retainer and a point on the surgical instrument where bending begins; can be moved.

[0023] A surgical instrument according to any one of the embodiments herein is inserted into the patient's abdomen through a trocar. The connector may be configured to be inserted into the connector.

[0024] According to one embodiment, the first handling section is connected to at least one of the second handling sections. Preferably, the first portion includes at least one groove or recess adapted to receive the first portion. The handling portion of the device has at least two grooves or recesses extending along the length of the device. The groove or recess supports the second handling part during the displacement. The recess prevents or impedes movement of the instrument across its width axis.

[0025] According to one embodiment, the at least one groove or recess is provided in the second handling part and Preferably, the second handling part is adapted to allow a relative displacement of the first handling part. During the relative displacement of the first handling section with respect to the handling section, At least a portion of is disposed in the at least one groove or recess.

[0026] According to some embodiments, the holding device is an elongated The retention device may be integrally formed with the elongate member. This can be accomplished by providing the elongate member in the form of a wire.

[0027] According to some embodiments, the second handling portion is integral with the elongate member. The second handling portion may be integrally formed with the elongated member. This can be achieved by providing the wire in the form of a

[0028] According to some embodiments, the second handling part is distal to the motion restriction device. The second handling portion is formed at the end of the elongated member and loops the elongated member at the end. In the example where the elongated member is a wire, the wire may be looped. The second handling portion can then be formed by attaching the loop portion to the first handling portion. The loop may be disposed in at least one groove or recess in the dripping portion. The tool user can easily grab the second handling part.

[0029] According to some embodiments, the retention device is at an end of the elongate member proximal to the motion restriction device. In the example where the elongate member is a wire, the end of the wire may be a retainer. The recess in the motion restriction device may be sized to allow the end of the wire to engage the recess. good.

[0030] In some embodiments, at least a portion of the second handling portion has a curved shape. do.

[0031] Placing a motion restriction device for use in a surgical procedure to treat reflux disease in a patient The disclosed elements of the surgical instrument for holding and supporting an implant or surgical instrument within the body. The sleeve can be used for other purposes that require release of the patient. a retaining device configured to engage a medical implant or a surgical tool, The retaining device may be disposed within the sleeve and configured to be displaceable relative to the sleeve; The first handling part is connected to the sleeve, and the second handling part is connected to the holding device. At least one of the first and second handling units is a sliding unit. The present invention relates to a method for positioning a medical implant or a surgical tool by providing a relative displacement of the holding device with respect to the bar. The holding device is detached from the medical implant or surgical tool to perform the placement.

[0032] Treating reflux disease in patients by implanting motion restriction devices using surgical tools A surgical method is further provided. The surgical method comprises making at least one incision in the patient's abdomen. The surgical instrument holding the motility restriction device is inserted slightly into the patient's abdomen. The procedure involves at least partially inserting the catheter into the stomach and placing a restriction on the outside of the stomach. The movement restriction device is fixed to the fundus wall, and the movement is controlled by moving the sleeve relative to the holding device. Remove the movement restriction device.

[0033] According to one embodiment, the step of fastening the motion restriction device comprises gastric-to-gastric sutures or staples. The method includes invaginating a motility restriction device into the fundus wall using a LA.

[0034] According to one embodiment, the surgical method includes fastening the stomach to the esophagus using stapler sutures. The method further includes the step of:

[0035] In embodiments where the distal portion of the surgical instrument is curved, the surgical procedure may involve positioning the motion restriction device. Positioning may include bending and rotating the instrument.

[0036] In embodiments in which the distal portion of the surgical instrument is operatively flexible, the surgical procedure may include operating the operably flexible distal portion to position the restriction device. It may include.

[0037] According to one embodiment, the retaining device comprises a protruding member, and the motion restriction device engages the protruding member. The sleeve is provided with a recess configured to allow the sleeve to be displaced relative to the holding device to control the movement. The step of releasing the limiting device includes releasing the protruding member from the recessed portion.

[0038] The surgical method may be a laparoscopic surgical method, in which case the method comprises the following steps: may further include at least one of: A tube is introduced through the abdominal wall Filling the abdominal cavity with fluid or gas, Two or more trocars are introduced into the abdominal cavity, Introduce a camera into the abdominal cavity through one of the trocars Using laparoscopic instruments, an incision is made in the abdomen, Introducing surgical instruments into the abdominal cavity through the trocar Suturing or stapling with a laparoscopic suturing or stapling instrument; and Remove the surgical instruments through the trocar and into the abdominal cavity.

[0039] Embodiments or parts of embodiments, as well as methods or parts of methods or devices or apparatus part or function or part of a function or system or part of a system or diagram or Part of the figure is the relevant method. All examples in this specification are to be considered as part of the general description. should be possible and therefore can be combined in some way in general terms. [Brief description of the drawings]

[0040] The invention will now be described, by way of example only, with reference to the accompanying drawings, in which:

[0041] [Figure 1] FIG. 1 shows a patient with an implanted motion restriction device.

[0042] [Diagram 2] Figure 2 shows the anatomy of the stomach, lower esophagus, and diaphragm.

[0043] [Diagram 3] FIG. 3 shows a surgical instrument according to a first embodiment.

[0044] [Figure 4] FIG. 4 shows a cross-section of the surgical instrument according to the first embodiment in a straightened state.

[0045] [Diagram 5] FIG. 5 shows a cross-section of a surgical instrument according to a first embodiment in a bent state.

[0046] [Figure 6A] FIG. 6A shows a cross-sectional view of a surgical instrument with a motion restriction device removed according to a first embodiment.

[0047] [Figure 6B] FIG. 6B shows a cross-sectional view of the surgical instrument according to the alternative first embodiment with the motion restriction device removed.

[0048] [Figure 7A] FIG. 7A shows a cross-section of a surgical instrument according to a second embodiment when the motion restriction device is removed.

[0049] [Figure 7B]FIG. 7B shows a surgical instrument according to the second embodiment in cross section with the motion restriction device removed.

[0050] [Figure 8A-8D] 8A-8D show steps of a surgical procedure for treating reflux disease using surgical instruments.

[0051] [Figure 9] FIG. 9 shows a cross-section of the esophagus and upper stomach when a movement restriction device is in place.

[0052] [Figure 10] FIG. 10 shows a medical device according to a third embodiment.

[0053] [Figure 11A] FIG. 11A shows a surgical instrument when engaging a motion restriction device according to a third embodiment.

[0054] [Figure 11B] FIG. 11B shows the surgical instrument according to the third embodiment when the motion restriction device is removed.

[0055] [Figure 12A] FIG. 12A shows a surgical instrument positioned inside a trocar and engaging a motion restriction device, according to a third embodiment.

[0056] [Figure 12B] FIG. 12B shows a surgical instrument according to the third embodiment when placed within a trocar and engaged with a motion restriction device. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0057] In the following, a detailed description of embodiments of the present invention is given with reference to the accompanying drawings. It should be understood that the drawings are for illustrative purposes only and are not intended to limit the scope of the invention in any way. Accordingly, references to directions such as "up" or "down" should be understood to be consistent with the It should be noted that features with the same reference number have the same function. and features of different embodiments with different first digits but the same last two digits, i.e. 1 It should further be noted that 10, 210 and 310 are similar. Unless expressly contradicted, an embodiment may refer to a feature from another embodiment having the same last two digits. Therefore, descriptions of similar functions with the same last two digits are interchangeable. They are considered to complement each other in explaining the fundamental ideas and thereby demonstrating the versatility of the functions. It is necessary to do so.

[0058] The terms cardiac sphincter, cardiac muscle, and lower esophageal sphincter refer to the sphincter in the esophagus that transports stomach contents and It should be understood that the sedative acts to prevent stomach acid from reaching the esophagus.

[0059] A surgical procedure is any type of surgical procedure, open or laparoscopic. In all of the embodiments herein, the surgical instrument is to be understood as a surgical instrument. It may be configured to be inserted into the patient's abdomen through a laparoscopic trocar. , the surgical instrument is a abdominal instrument having a diameter of 80 mm, 100 mm, 120 mm or 150 mm It may be configured for insertion into a laparoscopic trocar.

[0060] FIG. 1 shows a human patient 1 as a surgical procedure for the treatment of reflux disease is performed. The motion restriction device 10 is placed in the fundus portion of the stomach 12. Function and The operation is described and explained in detail in the following description.

[0061] FIG. 2 further illustrates a patient's esophagus 5 passing through a thoracic diaphragm 18 supporting a cardiac sphincter 14. The stomach area is the area of ​​the stomach that prevents stomach contents and stomach acid from reaching the area of ​​the esophagus 5. The esophagus is a substantially tubular tissue that extends to the stomach 12, including the esophagus itself. The esophagus has a central axis 4, A substantially circumferential surface substantially aligned with the patient's craniocaudal axis and substantially aligned with the horizontal plane of an upright patient. The esophagus 5 has a substantially cylindrical inner wall extending radially relative to the central axis 4 of the esophagus 5. It further has a surface 2 and an outer surface 3 .

[0062] In patients with reflux disease, the cardiac sphincter 14 slides upward through a hole 18' in the thoracic diaphragm 18. , and is therefore no longer supported by the thoracic diaphragm 18. Reflux disease causes the stomach contents and Gastric acid causes a burning sensation in the esophagus and esophageal tissue, and prolonged exposure can damage the lining of the esophageal tissue. Affects cell structure, changing it from squamous to glandular, increasing the risk of adenocarcinoma The esophagus 5 connects to the stomach at the gastroesophageal junction 8, which is normally located below the thoracic diaphragm 18. When the cardiac sphincter slides upward through the foramen 18' in the diaphragm 18, it penetrates the gastroesophageal junction 8 is placed in the hole 18' or in the chest.

[0063] FIG. 3 illustrates a motion restriction device 1 for use in a surgical procedure to treat reflux disease in a patient. 1 shows a first embodiment of a surgical instrument 100 for placing the surgical instrument 10. The instrument 100 includes: The distal part DP is adapted to be inserted into the patient's abdomen during a surgical procedure, and the distal part DP is adapted to remain outside the patient's body. The surgical instrument is made up of a proximal part PP, which is adapted to be handled by the surgeon. The instrument 100 comprises a sleeve 113, the main part of which is disposed in the distal portion DP. The sleeve 113 is a first handling unit that is movable relative to the second handling unit 102. In the embodiment shown in FIG. A portion of the section is flexible such that the distal section can bend relative to the major longitudinal axis LA of the device 100. As shown in FIG. 3, the distal portion DP can bend. The flexible portion is operatively flexible to allow a surgeon to bend the distal portion during a surgical procedure. In an alternative embodiment, the flexible portion is flexible to allow for proper angulation of the flexible distal portion. , it can only be bent manually, outside the patient and prior to a surgical procedure.

[0064] Returning to the embodiment shown in FIG. 3, the distal portion of the sleeve 113 is connected to the flexible sleeve portion 112. The flexible sleeve portion 112 may be, for example, a spirally wound metal sleeve, a polymeric material, or the like. The sleeve may be a flexible sleeve made of a material, a woven flexible metal sleeve, or a combination of the above. do.

[0065] The distal portion DP of the instrument 100 engages with the motion restriction device 110 during a surgical procedure, thus restricting movement. The device further comprises a retention device 111 configured to retain the motion restriction device 110. 111 is disposed within the sleeve 113 and is displaceable relative to the sleeve 113. As shown in FIG. 3, the holding device 111 is engaged with a recess of the movement restriction device 110. The movement restriction device 110 includes a protruding member configured to engage the movement restriction device 110 and thereby retain the movement restriction device 110. The movement limiting device is connected to or integrated with the third operating part 103. The retaining device 111 is It is displaceable relative to the handling portion 102 (described in more detail with reference to FIGS. 4 to 6). (I).

[0066] 4 and 5 show a surgical instrument 100 in cross section according to a first embodiment. To start from the distal portion, the motion restriction device 110 is engaged in the recess of the motion restriction device 110. The protruding member is held by a holding device 111 having a mating protruding member at its top 1 The elongated member 114 is secured to or integral with the distal portion 14' by the surgeon during the surgical procedure. The minute DP is operatively flexible so that it can be bent.

[0067] The manipulation device for generating the bending movement comprises a plurality of bending elements 116 having a triangular cross section. Thus, bending elements 116 contact each other on the left side of elongate member 114 and are separated by a gap on the right side. The pull wire 115 is fixed to the right side of the top bending element 116. and configured to apply a tensile force to the top bending element, thereby bending element 116 The geometry of the flexure 116 causes the elongated member 114 to bend, reducing the gap between the bending elements 116. The flexible sleeve portion 112 bends with the elongated member 114 disposed therein. The sleeve 113 includes a rigid portion and a flexible sleeve portion 112 that is configured to bend. In addition, the sleeve 113 is displaceable relative to the elongated member 114 and the retaining device, so that the sleeve 113 is bent. The point on the surgical instrument where the cutting begins is moved by moving the sleeve 113, causing the instrument to Creates further avenues for adjustment.

[0068] The proximal portion of the elongated member 114 is connected to or integral with the second handling portion 102. , and therefore the top 114' of the elongated member 114 and the second handling portion 102 The wire 115 is connected to the distal most portion of the device 100, the first The third handling unit 103 is connected to the third handling unit 103. The third handling unit 103 is connected to the third handling unit 103. The second handling part 102 is rotatably displaceable about the main longitudinal axis LA of the instrument in order to During the surgical procedure, the wire 115 and thus the flexible distal portion can be manipulated. The handling portion 103 has a screw portion 103T, and the second handling portion 102 has a corresponding screw portion 103T. The third handling unit 103 is provided for the second handling unit 102. The rotational displacement of the third handling unit 103 causes a linear displacement of the third handling unit 103. Ear 115 is pulled proximally, causing the operatively flexible distal portion to bend.

[0069] FIG. 5 shows the third handling unit 103 being rotated and the pull wire 115 being bent. The element 116 is pulled a sufficient distance to bend the steerable flexible distal portion to an angle. 1 shows a first embodiment of a surgical instrument 100 when tensioned. The main longitudinal axis LA and bending axis B of the instrument are shown. A between the top 114' of the elongated member and the long axis of the retainer 111. In one embodiment, the operably flexible distal portion is configured to bend. In one embodiment, the operably flexible distal portion can be oriented such that it can be oriented at an angle α of more than 30°. In one embodiment, the operably flexible distal portion is configured to bend at a 45° angle. In one embodiment, the operably flexible distal portion is configured to bend to an angle α greater than , configured to bend to an angle α of greater than 60°. The distal portion is configured to bend at an angle α greater than 75°. The highly flexible distal portion is configured to bend to an angle α greater than 90°.

[0070] In another embodiment, the third handling section may be a straight puller that pulls the pull wire 115 in a straight line. In such an embodiment, the third handling part is a linearly displaceable handling part. The handling part is slidably connected to the second handling part, and in such an embodiment, the main It can be pulled proximally along its long axis LA, creating a bend in the steerable, flexible distal section. Bring out.

[0071] We now turn our attention to the operation of the holding device 111. FIG. The linear configuration of the device 100 is shown in cross section. The first handling part 101 is the main length of the device. The first handling part 102 is linearly displaceable along an axis LA relative to the second handling part 102. When the handling unit 101 is integrated with the sleeve 113, the first handling unit 101 The linear distal displacement also moves the most distal portion of sleeve 113 in the distal direction. This relative displacement of the sleeve 113 and the retaining device 111 causes the retaining device 111 to pass over the top. The protruding member of the device is disengaged from the holding device 111, thereby turning the holding device 111 into a motion limiting device. 110. Thus, the surgical instrument 100 positions the motion restriction device within the patient's body, It can then be removed from the abdomen.

[0072] FIG. 6B shows how the first handling portion 101 is rotated around the main longitudinal axis LA of the instrument by the second handling portion 102. 1 illustrates an alternative embodiment of a surgical instrument 100 that is rotationally displaceable relative to a jaw portion 102. The handling part 101 has a screw part 101T, and the second handling part 102 and / or or sleeve 113 has a corresponding threaded portion 113T and is adapted to be connected to the second handling portion 102. The rotational displacement of the first handling part 101 corresponds to the rotational displacement of the second handling part 102 along the main longitudinal axis LA of the instrument. A linear displacement is generated in relation to the angle of the first handling part 101 relative to the driving part 101. To make.

[0073] 7A and 7B show a second embodiment of a surgical instrument 200. The distal portion DP is bent relative to the main longitudinal axis LA of the instrument 200 by a fixed bend. In the embodiment shown in FIG. 7A, the main longitudinal axis LA is aligned with the retention device 211 and the motion limiting device 212. 210 is bent at an angle β relative to the bending axis BA of the In one embodiment, the bend angle β is greater than 30°. , the bend angle β is greater than 45°. In one embodiment, the bend angle β is greater than 60°. In one embodiment, the bend angle β is greater than 75°. exceeds 90°.

[0074] In the embodiment shown in FIG. 1, in FIG. 7A, the sleeve 213 is rigid and the rigid bend 21 3B, but the distal portion of the elongated member 214 is flexible and is flexible within the sleeve 213. The bend 214B is formed so that the elongated member 214 can be moved relative to the sleeve 21 even if the bend is fixed. Can be displaced relative to 3.

[0075] In an alternative embodiment, the distal portion of the elongate member 214 is rigid and includes a rigid bend, The distal portion of the sleeve 213 is flexible and forms a flexible bend, thereby Even though the bending is fixed, the elongated member 214 can be displaced relative to the sleeve 213. can.

[0076] FIG. 7B illustrates the change in length of the elongated member 214, and therefore the retainer 211, relative to the sleeve 213. FIG. 2 is a second embodiment of a surgical instrument 200 with the motion restriction device 210 removed from the instrument. Shows.

[0077] The device according to the second embodiment has a sleeve 213 directly aligned with the elongated member 214. 6, the device according to the second embodiment is shown as being displaceable in the It is likewise conceivable to provide a rotating first handling part in the second handling part.

[0078] 8A-8D show a surgical instrument 300 according to one of the embodiments herein, which is used to control motion. 3 illustrates a surgical method for treating reflux disease in a patient by implanting a limiting device 310.

[0079] In FIG. 8A, an instrument 300 holding a motion restriction device 310 is inserted into a patient's abdomen through an incision. The patient's abdomen is inserted into the stomach, including the fundus, prior to the procedural step shown in FIG. A step of incising the area is performed so that the motion restriction device 310 engages the fundus of the patient's eye. The surgical instrument can be operated to place a motility control device on the outside of the stomach in contact with the fundus of the stomach. The grasper is used to hold the stomach wall at the fundus while the limiting device is placed. When the surgical instrument is bent, the instrument is bent to position the motion restriction device. The distal portion of the surgical instrument may be positioned by rotating the instrument with the In embodiments where the motion restriction device is operably flexible, the motion restriction device may be operably flexible to position the motion restriction device. The instrument can be positioned by actuating the distal portion of the anus.

[0080] Placing a motion restriction device for use in a surgical procedure to treat reflux disease in a patient The disclosed elements of the surgical instrument for holding an implant or a surgical tool within a patient's body. If the device needs to be released, it can be used for other purposes. a retaining device configured to engage a sleeve, a medical implant or a surgical tool; The retaining device may be disposed within the sleeve, and a first retaining device connected to the sleeve. The first handling section is displaceable relative to the second handling section connected to the holding device. At least one of the first and second handling units is configured to be capable of The ring provides relative displacement of the retention device with respect to the sleeve, and is adapted to retain the medical implant or Detaching the holding device from the medical implant or surgical tool to perform the placement of the surgical tool. vinegar.

[0081] In the surgical procedure shown in FIGS. 8A-8D, the motion restriction device is inserted through the stomach with a surgical needle. The stomach is invaginated into the fundus wall by the suture 301. However, the motility restriction device is attached to the stomach wall. The use of a stapling device in the invaginating step is also contemplated.

[0082] 8B and 8C show that the motion restriction device 310 is attached to the outside of the stomach wall, and the created por Additional sutures are then added to anchor the motion restriction device 310 in place so that it is fixedly positioned in the ankle. show.

[0083] FIG. 8D shows the motion restriction by displacing the sleeve 313 relative to the retainer 311. 8A-8D show the steps of the device removal tool. In FIG. 8A-8D, the retaining device 311 has a protrusion The motion restriction device 310 includes a recess configured to engage the protruding member, and the motion restriction device 310 includes a retention member. A step of releasing the motion restriction device 310 by displacing the sleeve 313 relative to the device. Step 311 involves removing the protruding member from the recess. The instrument 310 is then inserted into the patient. The abdomen of the subject is then removed.

[0084] The procedural steps shown in FIGS. 8A-8D are steps of a laparoscopic surgical procedure, in which The surgical method involves introducing a tube through the abdominal wall to fill the abdominal cavity with fluid or gas; The method further includes the step of expanding the abdominal cavity to create a visual space. 2. introducing two or more trocars into the abdominal cavity and The method then includes introducing a camera into the abdominal cavity through a trocar. This involves opening the abdomen using laparoscopic cutting instruments before introducing surgical instruments. Fixation with a stapler is performed using a laparoscopic suture or stapling device. The procedure is completed by removal of the surgical instruments through the trocar into the abdominal cavity. do.

[0085] Figure 9 shows the esophagus and upper part of the stomach when the motion restriction device is implanted in the fundus wall. The device is secured by invaginating it into the wall of the stomach 12 with a number of sutures 305. In the illustrated embodiment, as shown in FIG. 9, the motion restriction device is fixed by the motion restriction device 31. This is preceded by fixation of the fundus wall to the esophagus with sutures 305' for fixed placement of the esophagus. The motion restriction device 310 is preferably made of an elastic biocompatible material that may include at least one layer. Made from compatible silicone materials, e.g. metal layers, parylene layers, polytetrafluoroethylene layers It is an ethylene layer or a polyurethane layer.

[0086] The movement restriction device must have a maximum diameter of less than 40 mm, or a maximum diameter of less than 30 mm, or It may have a maximum diameter of less than 0 mm.

[0087] FIG. 10 is a motion restriction device for use in a surgical procedure to treat reflux disease in a patient. 1 shows a third embodiment of the surgical instrument 100 for placement at 110. The device shown is similar to the device shown in the first embodiment, and corresponding elements are similarly numbered. The device 100 includes a sleeve 113. The sleeve 113 includes a first The first handling section 101 is connected to or integrated with the first handling section 101. The first handling portion 101 preferably has a groove or recess. The second handling section 102 can be used to place components. The ring portion 102 is preferably an elongated member extending along the inner longitudinal axis of the sleeve 113. The second handling portion 102 is elongated so as to be able to hold The proximal end of the member may be formed by forming a loop therein. The elongated member is preferably a wire. The first handling unit 101 is configured to move relative to the second handling unit 102 by a predetermined amount of displacement. The at least one stop 104a, 104b is adapted to stop the position. This is also fine.

[0088] The instrument 100 engages with the motion restriction device 110 during a surgical procedure, and thus The holding device 111 is configured to hold the vice 110. 1 is disposed within the sleeve 113 and configured to be displaceable relative to the sleeve 113. The holding device 111 is disposed between the first handling unit 101 and the second handling unit. The three 102 may be integral with the elongated member 114 so that the relative displacement of the three 102 occurs. This results in a relative displacement between the retaining device 111 and the retaining spring 113. As shown in FIG. The device 111 engages a recess in the movement restriction device 110, thereby retaining the movement restriction device 110. The protruding member is configured to hold the

[0089] Next, the operation of the holding device 111 will be described. A surgical instrument 100 is shown. In FIG. 11A, the second handling part 102 is holding an elongated member 1 14, which is formed as a looped proximal end and is partially inserted into a groove or recess in the first handling portion. The proximal end of the elongated member 114 terminates in a retainer 111. When the handling unit 102 is placed in a proximal position of the first handling unit 101, the holding device 111 A retaining member 111 extends from the sleeve 113. The retaining member 111 is engaged with the motion restriction device 110. It can be combined.

[0090] The first handling part 101 is connected to the second handling part 102 along the main longitudinal axis of the instrument. The first handling portion 101 is integral with the sleeve 113. Then, the sleeve 113 is moved in a distal linear direction by the first handling part 101. The distal-most portion of the sleeve 113 also moves distally, thus passing over the top. This relative displacement of the retaining device 111 causes the protruding member of the retaining device 111 to come out of the recess. In this way, the holding device 111 is removed from the motion restriction device 110. In practice, as shown in FIG. This relative displacement causes the second handling unit 102 to move to a distal position of the first handling unit 101. This can be achieved by handling the sample from the sample holder to a proximal position of the first handling section. As a result, the sleeve 113 and the holding device 111 are displaced relative to each other, and the holding device 111 moves. The surgical instrument 100 is then disengaged from the motion restriction device 110. Thus, the surgical instrument 100 disengages the motion restriction device from the patient's body. The device can be placed within the abdomen and then removed from the abdomen.

[0091] 12A and 12B show the third catheter when placed inside a trocar 112 in a side view. 1 shows a surgical instrument 100 according to an embodiment of the present invention. The trocar 112 is connected to a motion restriction device 110. As described above, the surgical instrument 1 is used to assist in the expansion of abdominal wall tissue so that the surgical instrument 1 can be placed against the stomach wall. Once the surgical instrument 100 has positioned the motion restriction device within the body, the surgical instrument 100 is removed from the trocar 112. 12. The trocar 112 may then be removed from the body.

[0092] Embodiments or parts of embodiments, as well as methods or parts of methods or devices or apparatus Any part or function or part of a function or system or part of a system may be It should be noted that all examples herein may be combined in a general manner. should be considered part of the general description and therefore should not be incorporated in any way in general terms. It is possible to match.

Claims

1. A surgical procedure for treating reflux disease in a patient, comprising: A surgical instrument for abdominal placement of a movement restriction device (10) adapted to restrict movement 100), The surgical instrument comprises: - sleeve (113), a movement restriction device arranged within the sleeve and configured to be displaceable relative to the sleeve; a retaining device (111) configured to engage with the a first handling part (101) connected to said sleeve, a second handling part (102) connected to said holding device, With At least one of the first and second handling units is handled by the three This causes a relative displacement of the retaining device with respect to the bob, thereby displacing the retaining device from the motion limiting device. and performing placement of the motion restriction device.

2. The surgical instrument comprises: a distal portion (DP) configured to enter the patient's body when in use; a proximal portion (PP) configured to remain outside, The retaining device is disposed in the distal portion, and the first and second handling portions are disposed within the proximal portion. The surgical instrument of claim 1 .

3. The holding device is arranged on an elongated member (1) connected to the second handling part.

3. The surgical instrument of claim 1 ,

4. The retention device includes a protruding member configured to engage a recess in the motion restriction device. The surgical instrument according to any one of claims 1 to 3.

5. The first handling part is arranged to move the second handling part along the major longitudinal axis (LA) of the instrument. The surgical instrument according to any one of claims 1 to 4, which is linearly displaceable with respect to the ring portion. 。

6. The first handling portion is adapted to rotate the second handling portion about a major longitudinal axis of the instrument. The surgical instrument according to any one of claims 1 to 5, wherein the surgical instrument is rotationally displaceable relative to the

7. The first handling part is a screw part (101T), and the second handling part and the thread part are At least one of the sleeves has a corresponding threaded portion (113T) and is attached to the second handling portion. The rotational displacement of the first handling part relative to the second handling part along the major longitudinal axis of the instrument. The surgical instrument of claim 6 , wherein the first handling portion is adapted to move linearly relative to the first handling portion.

8. The distal portion is curved relative to the primary longitudinal axis of the surgical instrument.

8. A surgical instrument according to any one of claims 7 to 7.

9. The distal portion is bent greater than 20 degrees relative to the primary longitudinal axis of the surgical instrument.

9. The surgical instrument of claim 8,

10. a distal portion of the sleeve being rigid and a distal portion of the elongate member being flexible; The surgical instrument according to any one of claims 1 to 9.

11. a distal portion of the sleeve is flexible and a distal portion of the elongate member is rigid. The surgical instrument according to any one of claims 1 to 9.

12. The distal portion may be movable such that the distal portion is bendable relative to the primary longitudinal axis of the instrument. The surgical instrument of any one of claims 1 to 7, which is flexible.

13. The distal portion may be configured to bend or bend the distal portion such that a surgeon can bend the distal portion during the surgical procedure.

13. The surgical instrument of claim 12, wherein the surgical instrument is operatively flexible.

14. The elongate member may be configured to bend the distal portion of the distal end of the proximal end ... proximal end of the proximal end of the proximal end of the proximal The surgical instrument of claim 12, wherein the surgical instrument is operatively flexible.

15. the proximal portion for manipulating the operatively flexible distal portion during the surgical procedure. The method according to any one of claims 12 to 14, further comprising a third handling section (103). Medical instruments.

16. The third handling portion manipulates the steerable flexible distal portion during the surgical procedure. and displacing the second handling portion linearly along a major longitudinal axis of the instrument to The surgical instrument of claim 15 .

17. The third handling portion manipulates the steerable flexible distal portion during the surgical procedure. and a second handling part which is rotatably displaceable about a main longitudinal axis of the instrument to thereby The surgical instrument of claim 15.

18. The third handling portion includes a screw portion (103T), and the third handling portion a corresponding threaded portion (102T) and said third hand for said second handling portion Rotational displacement of the ring portion of the second handling portion along the first longitudinal axis of the instrument. a surgical instrument that operates during a surgical procedure to generate a linear displacement of the third handling portion relative to the 20. The surgical instrument of claim 17, including means for manipulating the possibly flexible distal portion.

19. At least a portion of the surgical instrument is adapted to be inserted into the patient's abdomen through a trocar. The surgical instrument according to any one of claims 1 to 18, wherein the surgical instrument is configured as follows:

20. The sleeve includes a rigid portion and a flexible portion (112) configured to bend. The sleeve can move the point on the surgical instrument where bending can be initiated. The surgical device according to any one of claims 1 to 19, wherein the surgical device is displaceable relative to the holding device. Equipment.

21. The first handling section (101) is at least one of the second handling sections (102).

2. The method of claim 1, further comprising:

21. A surgical instrument according to any one of claims 1 to 20.

22. The at least one groove or recess is provided between the second handling portion (102) and the 2. The method according to claim 1, further comprising the steps of:

2. The surgical instrument according to claim 1.

23. The holding device is connected to the second handling part (102). 102). The surgical instrument of claim 3 .

24. The second handling portion (102) is integral with the elongated member (114).

23. The surgical instrument of claim 22.

25. The second handling portion is disposed on the elongated member distal to the motion restriction device (110). A surgical instrument according to any of claims 23 to 24, formed from an end of (114).

26. The retention device is adapted to hold the elongated member (114) in close proximity to the motion restriction device (110). The surgical instrument of any one of claims 23 to 25, formed from an end portion.

27. At least a portion of the second handling portion (102) has a curved shape. The surgical instrument according to any one of claims 1 to 26.

28. sleeve, a motion restriction device disposed within the sleeve and configured to be displaceable relative to the sleeve; a retaining device configured to engage with the a first handling portion connected to the sleeve; a second handling unit connected to the holding device; and implanting the motion restriction device using a surgical instrument comprising: A surgical method for the treatment of The surgical method comprises: Making at least one incision in the patient's abdomen; Dissect in the area containing the fundus of the stomach. The surgical instrument holding the motion restriction device is at least partially inserted into the patient's abdomen. Enter, placing the motility restriction device on the outside of the stomach in contact with the fundus; Fixing the movement restriction device to the fundus wall. Disengaging the motion restriction device by moving the sleeve relative to the retention device. do, A surgical method comprising:

29. The step of fixing the movement restriction device may further comprise using a stomach to fix the movement restriction device in the fundus wall of the stomach.

29. The method of claim 28, further comprising: infusing the stomach into a suture or stapler. The surgical method described above.

30. The surgical method further includes the step of fastening the stomach to the esophagus with sutures of a stapler.

30. The surgical method of claim 28, comprising:

31. The surgical method includes bending a distal portion of the surgical instrument and performing the surgical procedure. rotating the instrument at the bend to position a restriction device. A surgical method according to any one of claims 28 to 30.

32. The distal portion of the surgical instrument is operatively flexible and the surgical procedure is performed using a motion-limiting device. and manipulating the operable flexible distal portion to position the chair.

22. The surgical method of claim 21. A surgical method according to any one of claims 28 to 30.

33. The retention device includes a protruding member, and the motion restriction device is configured to engage the protruding member. and a recess formed in the sleeve, the movement of which is controlled by displacing the sleeve relative to the holding device. The step of releasing the limiting device includes releasing the protruding member from the recess.

33. The surgical method according to any one of 28 to 32.

34. The surgical method comprises the steps of: - Introducing a tube through the abdominal wall, - filling the abdominal cavity with fluid or gas, - introducing two or more trocars into the abdominal cavity, - introducing a camera into the abdominal cavity through one of said trocars, - making an incision in the abdomen using laparoscopic cutting instruments; - Introducing surgical instruments into the abdominal cavity through the trocar, - suturing or stapling using laparoscopic suturing or stapling instruments, and Beauty, - Removing surgical instruments through the trocar into the abdominal cavity; A laparoscopic surgical method further comprising at least one of the following: A surgical method according to any one of claims 28 to 33.

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