초록 ▼

A device is disclosed for introducing a flexible elongated element through at least two portions of a subject. In an embodiment, the device includes a proximal end and a distal end, as well as an advancement unit for longitudinally advancing the flexible elongated element toward the distal end such

A device is disclosed for introducing a flexible elongated element through at least two portions of a subject. In an embodiment, the device includes a proximal end and a distal end, as well as an advancement unit for longitudinally advancing the flexible elongated element toward the distal end such that a proximal end of the elongated element may pass from the distal end of said device with sufficient force to pass through the portions of the subject. The device also includes a securing unit for variably adjusting a securing force applied by the flexible elongated element to secure together the portions of the subject.

대표청구항 ▼

What is claimed is: 1. A suturing device comprising: a housing; a shaft extending from said housing and having a distal end, the shaft adapted for placement in a lumen of an endoscope, at least a portion of said shaft being flexible and said shaft having multiple discrete contact points arranged f

What is claimed is: 1. A suturing device comprising: a housing; a shaft extending from said housing and having a distal end, the shaft adapted for placement in a lumen of an endoscope, at least a portion of said shaft being flexible and said shaft having multiple discrete contact points arranged for contact area with an inner surface in the lumen of the endoscope to reduce binding therebetween; a pair of opposing jaws located at said distal end of said shaft; a suture drive mechanism adapted to advance suture material through one of said jaws, through a subject to be sutured, and into another of said jaws; and a jaw rotation mechanism adapted to rotate said jaws about an axis lying along at least a portion of said shaft. 2. A suturing device according to claim 1 wherein said shaft is formed out of a flexible material. 3. A suturing device according to claim 1 wherein said shaft is formed out of a plastic material. 4. A suturing device according to claim 3 wherein said plastic material is reinforced with a metal material. 5. A suturing device according to claim 1 wherein said shaft includes a removable portion, wherein removal of said removable portion from said shaft increases flexibility of said shaft. 6. A suturing device according to claim 1 wherein said shaft comprises a distal section, a proximal section and said flexible portion comprises a flexible spine section connecting said distal section to said proximal section. 7. A suturing instrument according to claim 6 wherein said spine section is located on a periphery of said shaft. 8. A suturing instrument according to claim 6 wherein said spine section is located along a center axis of said shaft. 9. A suturing device according to claim 1 wherein said device further comprises: a cutting mechanism adapted for selective movement through said one of said jaws for engagement with, and severing of, suture material extending through said one of said jaws. 10. A suturing device according to claim 9 wherein said cutting mechanism is capable of being withdrawn from said one of said jaws when said cutting mechanism is not engaged in severing the suture material. 11. A suturing device according to claim 9 wherein said cutting mechanism comprises a cutting rod formed out of a flexible material. 12. A suturing device according to claim 9 wherein said one of said jaws is pivotally connected to said distal end of said shaft by a pivot pin, wherein said device further comprises a wire guide for supporting the suture wire at a position proximal to said one of said jaws, and further wherein said wire guide is positioned outboard of said pivot pin. 13. A suturing mechanism according to claim 12 wherein said wire guide is attached to said one of said jaws by a floating mount at a distal end of said wire guide. 14. A suturing device according to claim 1 wherein said multiple discrete contact points comprise a plurality of peaks and a plurality of troughs. 15. A suturing device comprising: a housing; a shaft extending from said housing and having a distal end, at least a portion of said shaft being flexible; a pair of movable jaws pivotally connected to the distal end of said shaft in opposing relation such that said jaws can open and close relative to one another, said jaws operable by a jaw actuating mechanism extending through said shaft; a suture drive mechanism adapted to advance suture material through one of said jaws, through a subject to be sutured, and into another of said jaws; a jaw rotation mechanism adapted to rotate said jaws about an axis lying along at least a portion of said shaft; and a cutting mechanism adapted for selective movement through said one of said jaws for engagement with, and severing of, suture material extending through said one of said jaws, said cutting mechanism operable by a cutter actuating mechanism extending through said shaft; and further wherein said jaw actuating mechanism, said suture material and said cutter actuating mechanism are disposed substantially symmetrically within said shaft. 16. A suturing device according to claim 15 wherein said cutting mechanism is capable of being withdrawn from said one of said jaws when not engaged in severing the suture material. 17. A suturing device according to claim 15 wherein said cutting mechanism comprises a cutting rod formed out of a flexible material. 18. A suturing device according to claim 15 wherein said one of said jaws is pivotally connected to said distal end of said shaft by a pivot pin, wherein said device further comprises a wire guide for supporting the suture wire proximal to said one of said jaws, and further wherein said wire guide is positioned outboard of said pivot pin. 19. A suturing mechanism according to claim 18 said wire guide is attached to said one of said jaws by a floating mount at a distal end of said wire guide. 20. A suturing device comprising: a housing; a shaft extending from said housing and having a distal end; a pair of opposing jaws located at said distal end of said shaft; a suture drive mechanism adapted to advance suture material through one of said jaws, through a subject to be sutured, and into another of said jaws, said wire advancing mechanism comprising a sliding element adapted for distal and proximal movement within said suturing device, said sliding element comprising a first binding element, and further wherein (1) distal movement of said sliding element causes said first binding element to bindingly engage the suture wire and drive the suture wire distally, and (2) proximal movement of said sliding element causes said first binding element to disengage from binding engagement with the suture wire; a jaw rotation mechanism located in said housing and adapted to rotate said jaws about an axis lying along at least a portion of said shaft; and a source of suture material. 21. A suturing instrument according to claim 20 wherein said wire advancing actuator further comprises: a stationary element, said stationary element comprising a second binding element, and further wherein (1) proximal movement of the suture wire causes said second binding element to bindingly engage the suture wire and hold the suture wire stationary, and (2) distal movement of the suture wire causes said second binding element to disengage from binding engagement with the suture wire. 22. The suturing device according to claim 21 wherein the first binding element and the second binding element are each normally biased to engage the suture wire. 23. The suturing device according to claim 21 wherein the sliding element is a sliding cage, the first binding element is a first flexible finger, the stationary element is a stationary cage and the second binding element is a second flexible finger. 24. A method for treating gastroesophogeal reflux disease (GERD), comprising: providing a suturing device comprising: a housing; a shaft extending from said housing and having a distal end, the shaft adapted for placement in a lumen of an endoscope, at least a portion of said shaft being flexible and said shaft having multiple discrete contact points arranged for contact area with an inner surface in the lumen of the endoscope to reduce binding therebetween; a pair of opposing jaws located at said distal end of said shaft; a suture drive mechanism adapted to advance suture material through one of said jaws, through a subject to be sutured, and into another of said jaws; and a jaw rotation mechanism adapted to rotate said jaws about an axis lying along at least a portion of said shaft; advancing said distal end of the suturing device into a patient's stomach so that said distal end of said suturing device is adjacent to a wall of the stomach below the lower esophageal sphincter (LES); gathering together portions of the stomach wall below the LES with said pair of opposing jaws; operating said suture drive mechanism so as to advance suture material through the portions of the stomach wall; and operating the jaw rotation mechanism so as to secure together the portions of the stomach wall. 25. A method according to claim 24 wherein said distal end is advanced into the patient's stomach through the esophagus. 26. A method according to claim 24 wherein the suturing device is advanced into the patient's stomach through the endoscope. 27. A method for treating gastroesophogeal reflux disease (GERD), comprising: providing a suturing device comprising: a housing; a shaft extending from said housing and having a distal end; a pair of opposing jaws located at said distal end of said shaft, said opposing jaws operable by a jaw actuating mechanism extending through said shaft; a suture drive mechanism adapted to advance suture material through one of said jaws, through a subject to be sutured, and into another of said jaws; and a jaw rotation mechanism located in said housing and adapted to rotate said jaws about an axis lying along at least a portion of said shaft; and a cutting mechanism adapted for selective movement through said one of said jaws for engagement with, and severing of, suture material extending through said one of said jaws, said cutting mechanism operable by a cutter actuating mechanism extending through said shaft; and further wherein said jaw actuating mechanism, said suture material and said cutter actuating mechanism are disposed substantially symmetrically within said shaft; advancing the distal end of the suturing device into a patient's stomach so that the distal end of the suturing device is adjacent to a wall of the stomach below the lower esophageal sphincter (LES); gathering together portions of the stomach wall below the LES with the pair of jaws; operating the suture drive mechanism so as to advance suture material through the portions of the stomach wall; and operating the jaw rotation mechanism so as to secure the suture material to the subject and thereby secure together the portions of the stomach wall. 28. A method for treating gastroesophogeal reflux disease (GERD), comprising: providing a suturing device comprising: a housing; a shaft extending from said housing and having a distal end, at least a portion of said shaft being flexible; a pair of opposing jaws located at said distal end of said shaft; a suture drive mechanism adapted to advance suture material through one of said jaws, through a subject to be sutured, and into another of said jaws, said wire advancing mechanism comprising a sliding element adapted for distal and proximal movement within said suturing device, said sliding element comprising a first binding element, and further wherein (1) distal movement of said sliding element causes said first binding element to bindingly engage the suture wire and drive the suture wire distally, and (2) proximal movement of said sliding element causes said first binding element to disengage from binding engagement with the suture wire; a jaw rotation mechanism located in said housing and adapted to rotate said jaws about an axis lying along at least a portion of said shaft; advancing the distal end of the suturing device into a patient's stomach so that the distal end of the suturing device is adjacent to a wall of the stomach below the lower esophageal sphincter (LES); gathering together portions of the stomach wall below the LES with the pair jaws; operating the suture drive mechanism so as to advance suture material through the portions of the stomach wall; and operating the jaw rotation mechanism so as to secure the suture material to the subject and thereby secure together the portions of the stomach wall.