A system (10) for endoscopic suturing is provided having an endoscope (14), such as a gastroscope, with a distal end (14b) locatable in the body of a patient and a flexible shaft (14a) extending to the distal end, a flexible accessory tube (12) coupled to the endoscope (14) to flex relative to the endoscope's shaft (14a), and a tip (26) coupled to the shaft (14a) of the endoscope having an opening (26a) through which one end of the accessory tube (12) is received. A tissue suturing instrument (16) and a suture securing instrument (130) are provided each having a sufficiently flexible shaft locatable through the accessory tube (12).

System for endoscopic suturing

Methods and apparatus for delivering a medical instrument over the exterior of an endoscope while the endoscope is installed in the patient's body allow the use of instruments which are too large to fit through the lumena of an endoscope. Furthermore, the invention allows the elimination of working lumena in an endoscope thereby minimizing the likelihood of contamination.

Methods and apparatus for delivering a medical instrument over an endoscope while the endoscope is in a body lumen

A surgical apparatus and methods for severing and welding tissue, in particular blood vessels. The apparatus includes an elongated shaft having a pair of relatively movable jaws at a distal end thereof. A first heating element on one of the jaws is adapted to heat up to a first temperature and form a welded region within the tissue, while a second heating element on one of the jaws is adapted to heat up to a second temperature and sever the tissue within the welded region. The first and second heating elements may be provided on the same or opposite jaws. A control handle provided on the proximal end of the elongated shaft includes controls for opening and closing the jaws, and may include an actuator for sending current through the first and second heating elements. The first and second heating elements may be electrically connected in series, and the first heating element may be bifurcated such that it conducts about one half of the current as the second heating element. A force-limiting mechanism provided either within the control handle, in the elongated shaft, or at the jaws limits the pressure applied to the tissue by the jaws to ensure that the tissue is severed and the ends effectively welded within a short amount of time.

Tissue welding and cutting apparatus and method

Devices and methods for detachably engaging an insertion section of an endoscope and selectively articulating an endoscopic surgical access channel are provided. A device (10, 70, 80) comprises an articulating main body (30) having a stationary first body (31, 71, 81), an articulatable second body (32, 72, 82, 92, 112) and coupler (19) having a mounting member (37, 43, 77, 84) and an articulation link member (36, 44, 76, 78, 85) configured to articulatively couple the second body to the first body. The stationary first body has a distal end (31'), a proximal end (31'), and a first longitudinal axis (39). The articulatable second body has a proximal opening (34, 74, 84) and a distal opening (35, 75, 85) defining an accessory channel member passageway (33, 73, 83), the distal opening having a second longitudinal axis (38, 89) oriented toward a space exterior to the first body distal end, wherein the second body longitudinal axis is capable of articulating relative to the first body longitudinal axis. The devices and methods, as taught herein, provide control over the position and/or orientation of a diagnostic, monitoring, scope, sewing device, cutting device, suturing device, forceps, grabbing device, instrument, or other tool within the visual field beyond the distal opening of the endoscope.

Endoscopic surgical access devices and methods of articulating an external accessory channel

An endoscope including; a fixing member detachably mounted to a distal end portion of an endoscope insertion part for detachably fixing and holding a distal end portion of an indwelling tube or a distal end portion of a guide member for guiding the indwelling tube, both of which are provided along the axial direction of the insertion part, to the distal end portion of the insertion part.

Endoscopic system and method for positioning an indwelling tube

A minimally invasive technique for harvesting saphenous veins and the like for use as autografts in coronary artery bypass grafting surgery include a microsurgical instrument adapted to be demountably secured to the distal end of an endoscope. The instrument is inserted through an entry incision in the patient's skin, at the end of the endoscope which is used by a surgeon to advance the instrument along the saphenous vein, using the vein as a guide for the instrument. The instrument is tapered to provide initial separation of surrounding tissues from the vein, and cutting means supported by the instrument and viewed via the endoscope allow dissection of all tissues and side branch vessels from the saphenous vein. The instrument further provides a protective hood which prevents tissues or skin from blocking the endoscope. The desired length of saphenous vein is transected and is extracted via the entry incision. The technique minimizes trauma to the patient and to the saphenous vein graft.

Mike Hooven

Papers

Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like