CA2175793C - Percutaneous tract measuring device - Google Patents
Percutaneous tract measuring device Download PDFInfo
- Publication number
- CA2175793C CA2175793C CA002175793A CA2175793A CA2175793C CA 2175793 C CA2175793 C CA 2175793C CA 002175793 A CA002175793 A CA 002175793A CA 2175793 A CA2175793 A CA 2175793A CA 2175793 C CA2175793 C CA 2175793C
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- CA
- Canada
- Prior art keywords
- tract
- cannula
- tubular member
- handle
- surgical tool
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
- A61J15/00—Feeding-tubes for therapeutic purposes
- A61J15/0015—Gastrostomy feeding-tubes
- A61J15/0019—Gastrostomy feeding-tubes inserted by using a pull-wire
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
- A61J15/00—Feeding-tubes for therapeutic purposes
- A61J15/0015—Gastrostomy feeding-tubes
- A61J15/0023—Gastrostomy feeding-tubes inserted by using a sheath
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
- A61J15/00—Feeding-tubes for therapeutic purposes
- A61J15/0026—Parts, details or accessories for feeding-tubes
- A61J15/003—Means for fixing the tube inside the body, e.g. balloons, retaining means
- A61J15/0034—Retainers adjacent to a body opening to prevent that the tube slips through, e.g. bolsters
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61J—CONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
- A61J15/00—Feeding-tubes for therapeutic purposes
- A61J15/0026—Parts, details or accessories for feeding-tubes
- A61J15/0053—Means for fixing the tube outside of the body, e.g. by a special shape, by fixing it to the skin
- A61J15/0065—Fixing means and tube being one part
Abstract
A surgical tool (10) for use in initial placement of a gastrostomy device in a patient includes an obturator (20), a cannula (14) and an outer flexible tubular member (16). A pointed end (38) of the obturator and an adjacent dilator (18) cooperate to incise a tract through the abdominal and stomach walls of the patient. The obturator is removed, leaving the cannula and outer tubular member in place. A deformable section (44) of the flexible tubular member is expanded by movement of the cannula. The outwardly deformed section is then pulled up against the inner wall of the stomach wherein the thickness of the stomach and abdominal walls can be measured by use of visible scale indicia (48) carried on the external surface of the flexible tubular member. Subsequent to the noted measurement, a guide wire or pull wire (108) is passed through a lumen provided by the cannula. The guide wire is used for placing a gastrostomy device of suitable size in the incised tract.
Description
W0 95112429 PCT1US93/I I l I8 21'~~793 v a.
1 $ERCUTANEOUS TRACT MEASURING DEVICE
1 $ERCUTANEOUS TRACT MEASURING DEVICE
4 The present invention relates in general to tract measuring devices and, in particular, to a surgical tool adapted to create 6 and to measure the length of an incised tract.
8 Over the years, devices have developed to allow fluid 9 communication between an interior body cavity and an external surface of the body. Specifically, enteral feeding tubes and 11 gastrostomy devices have been developed to provide nourishment 12 to patients unable to otherwise ingest food due to the effects 13 of a stroke, coma, serious injury or other medical problem.
14 Enteral feeding tubes are generally used only for limited periods of time while gastrostomy devices and, preferably low-16 profile gastrostomy devices, are used in long-term or permanent ~ 17 installations. A primary consideration during installation of ' 18 either the feeding tube or the gastrostomy device is the 19 relatively precise installed fit necessary to prevent infection, the migration of bodily fluids from the internal body cavity, and WO 95/12429 ~ PCfIUS93/11118 y'~J
~~2 1 the proper formation of a mature stoma.
2 Since the length of the tract from the external surface to 3 the inner body cavity varies from patient to patient due to 4 various factors such as age, weight, and sex, the enteral feeding , tube, which is typically adjustable to accommodate a range of 6 incised tract lengths, is conventionally initially installed 7 within the incised tract regardless of the anticipated period of 8 need for fluid communication between the inner body cavity and 9 the external surface. Thereafter, if long-term fluid communication is required, the feeding tube is removed and 11 replaced by a gastrostomy device. The gastrostomy device is 12, typically not adjustable to accommodate multiple tract lengths 13 and therefore must be custom-fit to closely match the incised 14 tract length for each patient.
Preliminary to the installation of any device to extend 16 between the external surface of the body and the interior body 17 cavity, an incised tract must be formed. The incised tract is 18 conventionally formed by inserting a trocar and cannula through 19 the external body surface and into the internal body cavity.
Thereafter, the enteral feeding tube is installed within the 21 just-formed tract.
22 Such an enteral feeding tube, as represented by United 23 States Patent No. 4,758,219, is typically introduced into the 24 stomach via the mouth and esoLohagus, and then partially removed from the incised tract formed by a previously-inserted trocar and 26 cannula. An internal end of the feeding tube mountingly ' 27 accommodates an enlarged portion serving as a stop means while 28 an external end of the feeding tube includes an adjustable skin ~i'75'~J3 1 protecting ring or bolster. The distance between the stop means 2 and the bolster is adjusted by moving the bolster along the 3 length of the feeding tube, firmly trapping the external surface 4 of the body and the inner wall of the internal body cavity between the ring and stop means.
6 Other enteral feeding tubes are designed to be inserted 7 through the incised tract from the external body surface into the 8 internal body cavity, and include an internal end portion which 9 is inflatable or otherwise expandable to define a stop surface.
United States Patent No. 5,074,846 is exemplary of devices of 11 this type. A lengthwise adjustable outer skin engaging ring or 12 bolster is used to compensate for variations in tract length, as 13 in the '219 patent.
14 Outwardly deformable tubes or sheaths similar to the type shown in the '846 patent have also been used in catheters to 16 retain the inner end of the catheter within an inner body cavity 17 such as the bladder or peritoneum, as evidenced by United States 18 Patent Nos. 2,649,092 and 3,241,554. The catheter of the '554 19 patent also includes a depth gauge to indicate how far the catheter has been inserted into the abdominal wall.
21 Although the devices and methods for installing enteral 22 feeding tubes illustrated above are satisfactory for short-term 23 use, such feeding tubes are generally considered undesirable for 24 long-term or permanent use due to the external length of the tube and awkwardness associated therewith. Therefore, for long-term 26 installations, a low-profile gastrostomy device preferably 27 replaces the enteral feeding tube after a mature stoma between 28 the exterior body surface and internal body cavity has been established. The gastrostomy device, which, due to its low-profile nature, does not include a length adjustment feature, must be specifically sized to match the stoma length.
Therefore, prior to installation of a gastrostomy device, the stoma length is conventionally determined by measuring the length of the feeding tube from the external surface of the body to the internal stop surface. Typically, this is accomplished by placing a reference mark on the feeding tube adjacent the external surface, removing the feeding tube from the body by reversing the installation steps, and then measuring the distance from the reference mark to the stop surface. The appropriate size of the gastrostomy device is derived from this measurement.
Thereafter, the gastrostomy device is inserted into the stoma to complete the replacement procedure.
Alternatively, stoma length can be determined by a measuring device such as disclosed by United States Patent No. 4,972,845.
The stoma measuring device of the X845 patent includes an elongated tubular member which provides scale indicia on an exterior surface thereof. A distal end of the tubular member is inflatable to serve as a stop means to temporarily prevent the removal of the distal end from an inner body cavity, allowing the length of the stoma to be measured via the scale indicia.
United States Patent No. 4, 863, 438, which is assigned to the assignee of the present invention, is exemplary of low profile gastrostomy device which is designed to replace an enteral feeding tube within an existing stoma. A stylet is used to elongate and stretch the enlarged intragastric head of the gastrostomy device, WO 95112429 ~ ~ ~ ~ ~.~ ~ PCTJUS93111118 o~
1 which is thereafter pushed through the stoma into the internal 2 body cavity. A tubular midportion is received by the stoma while 3 a pair of oppositely directed wings engage the external body 4 surface. Additional gastrostomy feeding ports are shown in United States Patent Nos. 4,850,953 and 4,944,732.
6 In all of the aforementioned gastrostomy devices, the 7 gastrostomy device must fit snugly within the stoma between the 8 inner wall of the internal body cavity and the external body 9 surface. In the aforementioned prior art this has necessitated the initial installation of an enteral feeding tube in the 11 incised tract to allow the incised tract to mature and become a 12 permanent stoma and to thereafter allow an accurate measurement 13 of the stoma length.
14 Therefore, in the aforementioned prior art, the steps of forming an incised tract, inserting an enteral feeding tube, 16 allowing the incised tract to mature into a stoma, removing the 17 enteral feeding tube, and measuring the stoma length are required 18 before the gastrostomy device can be installed within the stoma.
19 In response to this costly and time consuming process, it has been proposed that a low-profile gastrostomy device be 21 directly installed within an incised tract without the need for 22 the preliminary placement of a feeding tube therein. Initially 23 placing a low-profile gastrostomy device in an incised tract 24 allows the patient to immediately benefit from the advantages inherent in use of a low profile gastrostomy device as opposed 26 to an enteral feeding tube. Moreover, eliminating the need for 27 the initial placement of a feeding tube reduces the cost and 28 trauma traditionally associated with the installation of a ~o gastrostomy device. United States Patent No. 5,084,014, which is owned by the assignee of the present invention, is directed towards a low-profile gastrostomy device adapted to be mounted within a recently-formed incised tract.
The '014 patent discloses a package for the initial placement of a gastrostomy device wherein an external body surface-engaging portion is outwardly pulled through the incised tract. The package includes a shroud which retains wing-like members of the external body surface-engaging portion in a deformed configuration, generally parallel to a tubular midportion of the device. Installation occurs by inserting the package into the stomach, pulling it through the incised tract until an enlarged intragastric portion engages the inner wall of the stomach, and thereafter removing the shroud to allow the wings to return to their undeformed, outwardly extending configuration. Once installed, the device functions generally identically to the gastrostomy device disclosed in the '438 patent.
Although the installation package of the X014 patent works satisfactorily, proper sizing of the gastrostomy device still requires the prior measurement of the incised tract length.
United States Patent No. 5,343,874, is directed towards a device and method for measuring the length of an incised tract.
The device includes an elongated member having scale indicia along at least a portion of its length, and stop means at one end of the scale indicia.
In the disclosed method of the '874 patent, an incised tract between an external surface of a body and an inner wall of an internal body cavity is formed by a trocar and cannula.
Thereafter, the device is inserted into the stomach via the mouth and esophagus, and a distal end of the elongated member is inserted through the incised tract until the stop means engages the inner wall of the internal body cavity. The elongated member extends out of the incised tract, making the scale indicia thereon visible and allowing the determination of tract length.
Thereafter, the incised tract measuring device is removed and a low profile device sized to match the measured tract length is installed, preferably in accordance with the device and method of Patent No. 5,084,014.
Although the aforementioned incised tract measuring device and method represents an improvement over the prior art method of measuring length, it suffers from the disadvantage that it requires insertion and removal via the esophagus, creating additional irritation and trauma for the patient. Moreover, a separate trocar and cannula are required to form the incised tract prior to insertion of the measuring device through the tract.
Therefore, there exists a need in the art for a surgical tool for the measurement of an incised tract length which does not require insertion or removal via the esophagus. Moreover, there exists a need in the art for a surgical tool which is capable of creating and measuring an incised tract.
~~'~5?93 1 $LTMMARY OF THE INVENTION
2 In accordance with the present invention, a surgical tool 3 is provided to form a tract extending from an external surface 4 of a living body to an internal body cavity, and to measure the length of the tract so formed. The surgical tool includes a 6 handle means having first and second relatively movable handle 7 sections, a cannula attached to the second handle section, and 8 a flexible tubular member covering at least a portion of the 9 cannula and being attached to the first handle section. The flexible tubular member includes an outwardly deformable section 11 which is adapted to be manually movable between undeformed and 12 outwardly deformed configurations.
13 In further accordance with the present invention, relative 14 movement of the first handle section away from the second handle section causes the deformable section to outwardly deform and 16 thereby define a stop surface. The stop surface is adapted to 17 engage an inner wall of the interior body cavity to prevent 18 removal of the surgical tool from the incised tract. Visible 19 scale indicia provided by the flexible tubular member are visible on an exterior of the body when the stop means engages the inner 21 wall of the interior body cavity to allow the determination of 22 the tract length. The stop surface is located at an origin of 23 the scale indicia.
24 Preferably, distal ends of the cannula and tubular member are interconnected and covered by a dilator. The dilator 26 includes a central bore through which an obturator extends. The 27 dilator and obturator cooperate to allow the insertion of the WO 95112429 ~, ~, ~ ,7 ~ ~ ~ PCT/US93lIIIIS
1 surgical tool through the body from the external surface to the 2 internal body cavity. Later removal of the obturator allows the 3 insertion of a guidewire into the internal body cavity to 4 facilitate the placement of a gastrostomy device within the just-formed tract.
6 Preferably, the first and second handle sections of the 7 handle means are adapted to easily receive a user's fingers, as 8 well as to provide a pair of bearing surfaces. In the preferred 9 embodiment, each of the handle sections includes a forward and a rearward surface against which the user's force is directed to 11 alternatively move the handle sections relatively toward or away 12 from each other.
13 In further accordance with the invention, a method of 14 forming and measuring a tract with the device of the above-noted type includes the steps of inserting the device from an external 16 body surface into an internal body cavity, outwardly deforming 17 a portion of the tubular member to form a stop surface, engaging 18 the stop surface with an interior wall of the inner body cavity, 19 and viewing the tract length indicating means to determine the tract length.
21 In further accordance with the present invention, a method 22 of sizing and placing a gastrostomy device within an incised 23 tract comprises the above-mentioned tract formation and 24 measurement steps in addition to the steps of choosing an appropriately sized gastrostomy device in accordance with the 26 measured tract length, positioning the gastrostomy device within 27 the inner body cavity and inserting a portion of the gastrostomy 28 device through the incised tract. Preferably, the gastrostomy /D
device includes an enlarged intragastric portion, a tubular midportion, and an external portion.
ERIEF DESCRIPTION OF THE DRAAINGS
These and further aspects of the present invention will be apparent with reference to the following description and drawings, wherein:
FIG. 1 is a perspective view of a surgical tool in accordance with a first embodiment of the present invention;
FIG. 2 is a top plan view of the surgical tool in accordance with a first embodiment of the present invention;
FIG. 3 is a perspective view of a surgical tool in accordance with a further embodiment of the present invention.
FIG. 4 shows an elevational view, partially in cross-section, of the surgical tool extending from an external body surface into an internal body cavity;
FIG. 5 shows an elevational view, partially in cross-section, of the surgical tool with the stop surface engaging an inner wall of an internal body cavity and the scale indicia visible adjacent an exterior surface of the body;
FIG. 6 shows a side elevational view of the terminal end of the surgical tool with the deformable section in the deformed configuration;
FIG. 7 is a longitudinal, partial, cross-sectional view of a gastrostomy device package to be inserted into the incised tract created and measured in accordance with the present R'O 95112429 PCT/US93J11118 1 invention;
2 FIG. 8 is an exploded view of the gastrostomy device package 3 of FIG. 7;
4 FIGS. 9A-9G sequentially illustrate the methodology for creating and measuring an incised tract; as well as for placing 6 a gastrostomy device within the incised tract.
7 DETAINED DESCRIPTION OF TdiE PREFERRED EMBODIMENTS
8 With reference to FIGS. 1 and 2, a surgical tool l0 in 9 accordance with a first embodiment is shown. The surgical tool includes a handle means 12, a cannula 14, a flexible outer 11I tubular member 16, a dilator 18, and an obturator 20.
12 The handle means 12 includes first and second handle 13 sections 22 and 24. As illustrated, the first handle section 22 14 is bifurcated, having a pair of diametrically opposed ring-shaped finger receiving portions 26. The second handle section 24 16 includes a single ring-shaped finger receiving portion 28.
17 Preferably, and as will be recognized by one skilled in the 18 art, the first handle section 22 is adapted to receive a pair of 19 fingers while the second handle section 24 is adapted to receive a single finger and, more specifically, a thumb. The first and 21 second handle sections 22 and 24 are relatively movable towards 22 and away from each other by retaining one of the first or second 23 sections and moving the other section. As will be recognized by 24 one skilled in the art, each of the first and second handle sections 22, 24 include a pair of bearing surfaces to facilitate 26 moving the handle sections relative to each other.
W095112429 PCT/US93I11118 '~
2~."~5a'~93 'z 1 The cannula 14 includes a distal end 30 which is attached 2 to a distal end 32 of the tubular member 16 and a proximal end 3 34 of the dilator 18. As illustrated, the dilator 18 preferably 4 is crimped, pinned, or otherwise permanently attached to the distal ends of the cannula 14. and tubular member 16.
6 The cannula 14 is enclosed by the tubular member 16 between 7 the dilator 18 and the first handle section 22. The cannula 14 8 is slidably received by the first handle section 22 and is 9 attached to and extends through the second handle section 24.
A lumen 36 provided by the cannula 14 is accessible via the 11 second handle section.
12 The obturator 20 is slidably received within the cannula 13 lumen 36, and includes a pointed or otherwise sharpened distal 14 end 38 and a handle 40 attached to its proximal end 41. The pointed distal end 38 of the obturator extends out of a distal 16 end 42 of the dilator 18 when the obturator handle 40 engages the 17 second handle section 24, as illustrated in FIG. 2. The 18 obturator handle 40 is positioned and adapted to be engaged by 19 a user's thumb which extends through the second handle section 24, ensuring that the distal end 38 of the obturator 20 extends 21 out of the dilator 18 when the surgical tool 10 is being used to 22 form an incised tract, as will be discussed more fully hereafter.
23 The flexible tubular member 16 extends between the first 24 handle section 22 and the dilator 18 and slidably receives the cannula 14. Rearwardly spaced a short distance from the distal 26 end 32, the tubular member 16 includes a deformable section 44.
27 The deformable section 44 is formed in the tubular member 16 by 28 a plurality of short longitudinal cuts therethrough. A series W0 95/12429 . _. . PCTlUS93111118 1 of measurement or scale indicia 48 are provided along a portion 2 of the tubular member. Preferably, the deformable section 44 is 3 located at one end or the origin of the scale indicia 48.
4 Naturally, the tubular member 16 could be transparent and the scale indicia 48 placed on the cannula 14 therein without 6 departing from the scope and spirit of the present invention.
7 As illustrated in FIG. 3, a second embodiment of the present 8 invention is generally identical to the aforementioned first 9 embodiment (FIGS. 1 and 2) with the exception of the first handle section 50. Therefore, identical reference numerals are used 11 when possible. The first handle section 50 of the second 12 embodiment is generally spool-shaped, having proximal and distal 13/ annular surfaces 52 which extend radially outward from a 14 generally cylindrical body 54. The remainder of the second embodiment is generally identical to the first embodiment, and 16 will not be described more fully hereinafter.
17 Use of the surgical tool 10 of either embodiment of the 18 present invention for forming and measuring an incised tract 19 between an external body surface and an internal body cavity, or, more particularly, from the skin to the stomach, is illustrated 21 in FIGS. 4-6. The surgical tool 10, with the sharpened distal 22 end 38 of the obturator 20 projecting out of the distal end 42 23 of the dilator i8, is inserted through the abdominal wall 56 and 24 stomach wall 58 (FIG. 4) and into the stomach 60. Thereafter, the first and second handle sections 22 and 24 are moved 26 relatively apart, causing the deformable section 44 of the 27 flexible tubular member 16 to outwardly deform (FIG. 6). The 28 surgical tool 10 is pulled relatively away from the body, causing R'O 95/12429 PCT/US93/1I I IS S
r 1 the stop surface defined by deformed section 44 to the engage the 2 stomach wall 58 (FIG.5). As so positioned, the scale indicia 3 48 provided by the flexible tubular member 16 are visible 4 adjacent the ext eriorsurface of the body, allowing length the of the incised tractformed by the surgical tool 10 to be 6 measured.
7 The measurement derived from the scale indicia 48 is used 8 to select a low profile gastrostomy device to be inserted into 9 the incised tract. Preferably, the low profile gastrostomy is of the type described in United States Patent No. 4,863,438, and, 11 most preferably, a gastrostomy device package and method of 12I installation as described in U.S. Patent No. 5,084,014 is used.
13 Turning to FIGS. 7 and 8, a gastrostomy device package 62 14 to be inserted into an incised tract which was created and measured in accordance with the present invention is illustrated.
16 The package 62 is generally elongated so as to extend along a 17 longitudinal x-x axis, as illustrated. The oackaae i ~ r~r,m",-; Qo,a 18 of two major portions, namely, a low profile gastrostomy device 19 64, often referred to in the art as a "gastrostomy button", and a shroud means 66 comprised primarily of a dilator member 68, and 21 a plastic film material 70 constituting a tubular -sleeve 22 extending generally completely over the dilator 68.
23 The gastrostomy device 64 includes an intragastric portion 24 72 located at one end of a tubular midportion 74 having at its other end a resilient external portion 76. The device is 26 preferably formed of a biocompatable silicone rubber material so 27 as to be flexible and elastorneric. The length of the tubular 28 portion 74 is sized to be dimensionally compatible with the ~J~
1 combined thickness of, for example, a patient's stomach 58 and 2 abdominal walls 56, which was determined by using the surgical 3 tool l0, as previously described.
4 The external portion 76 of the gastrostomy device 64 includes a pair of diametrically opposed wing-like projections 6 78, one of which has extending from it a plug retainer 80 which 7 has a distal end providing a plug 82, wherein the plug retainer 8 80 can be folded over to permit insertion of the plug 82 into a 9 feeding tube receptor port 84. As is known in the art, when positioned within, for example, a human or animal patient 11 undergoing medical treatment, an enteral feeding tube can be 12 inserted into the port 84 through the tubular midportion 74 and 13 / into the intragastric portion 72 to effect the flow of fluid 14 either into or out of a body cavity, such as the patient's stomach, within which the intragastric portion is located. It 16 is to be noted that the intragastric portion 72 includes within 17 the usual normally closed reflux valve (not shaven) which prevents 18 egress of fluid outwardly through the tubular midportion 74 when 19 the enteral feeding tube is not maintaining the valve in an open position.
21 With particular reference to FIG. 7, the flexible wing-like 22 projections 78, including the associated plug retainer 80 and 23 plug 82, are shown in a folded or collapsed condition so that 24 they extend along parallel lines adjacent to the axis x-x, as illustrated. The dilator member 68 which provides a pair of 26 opposed flats or recesses 86 against which the wing-like 27 projections 78 are held in their folded or collapsed position by 28 the plastic film 70 in the preferred form of a tubular sleeve of /G
1 heat-shrink or shrink-wrap type plastic film. In its collapsed 2 condition, the external portion 76 (FIG. 8) is contained within 3 and compressed by the shroud means 66, and, more specifically, 4 the plastic film 70.
The dilator member 68 further includes a plug retainer 6 recess or flat 88 having a plug recess 90 into which the plug 82 7 fits, as illustrated in FIG. 7. The dilator member 68 has a 8 tapered distal end 92 which is provided with a pull wire loop 94 9 embedded within the dilator member, as illustrated. The dilator member is also provided with a reduced diameter portion 96 which 11 forms an inboard part of a retainer tip 98 that extends and snaps 12/ into the external end 28, i.e., port 28, of the tubular 13 midportion 74, as illustrated.
14 The gastrostomy device 64 is provided with an annular or circular lip 100 that fits into the reduced diameter portion 96, 16 constituting a circular groove, so as to provide a releasable 17 locking means holding the gastrostomy device 64 in position 18 relative to the dilator member 68. It can also be seen that an 19 open, or leftward end as viewed in FIG. 7, of the plastic film 70 constituting a tubular sleeve extends beyond and over the 21 circular lip and its associated annular groove constituted by 22 reduced diameter portion 96 of the retainer tip 98, so as to hold 23 and compress the circular lip 100 into the reduced diameter 24 portion 96 of the dilator member 68.
With reference to FIG. 8, a guide groove 102 is provided, 26 as illustrated, on a surface of the dilator member 68 spaced from 27 the external portion 76 of the gastrostomy device 64 when in its 28 position as illustrated in FIG. 7. The guide groove 102 provides an indicator point for a partially cutting the plastic film 70 and peeling it around and away from the dilator member 68, as illustrated in FIG. 8, so that the gastrostomy device 64 and the dilator member 68 can be separated from each other so as to allow the resilient wing-like projections 78 to return to a normal expanded position as illustrated in FIG. 8.
Thus, FIG. 7 illustrates a gastrostomy device package 62 for initial placement of the gastrostomy device 64 in a patient, as discussed below, while FIG. 8 illustrates the package 62 in a disassembled form after the device 64 has been placed within an incision in the patient, as will now be discussed.
Turning to FIG. 9A, there is schematically illustrated a patient having an inner body cavity such as a stomach 60 within which is to be placed the gastrostomy device 64 in accordance with the present invention. It is to be noted that the gastrostomy device package 62 and method of placement described hereinafter are more fully described in U.S. Patent No. 5,084,014. Moreover, the surgical tool 10 and method of use can be used for creating and measuring incised tracts into other viscera of the body for other applications, such as, for example, urinary bladder drainage, ileostomy, jejunostomy, and cystostomy.
The outer surface or skin of the patient extends over the abdominal wall 56, which in turn abuts the stomach wall 58. In a first step for placing the gastrostomy device package 62, the stomach 60 of the patient is insufflated via an endoscope tube 104 extending down through the esophagus 106 of the patient, as illustrated. As illustrated in FIG. 9B, the surgical tool 10 of the present invention is inserted through the abdominal and ". ;
1 stomach walls 56 and 58 of the patient to establish an incised 2 tract that will receive a gastrostomy button (FIG. 4).
3 As shown in FIG. 9C, the first and second handle sections 4 22 and 24 are moved generally away from each other, deforming the deformable section 44 of the flexible tubular member 16 to define 6 a stop surface. Thereafter, the surgical tool 10 is pulled 7 outwardly, placing the stop surface in engagement with the inner 8 surface of the stomach wall 58 and allowing the length of the 9 incised tract to be determined via the scale indicia 48 on the tubular member 16 which is visible adjacent the external body 11 surface (FIG. 5).
12 As shown in FIG. 9D, with the obturator 20 removed from the 13 cannula 14, a pull wire 108 is inserted through the cannula lumen 14 so that its end can be captured by a snare 110 extending through the endoscope tube 104. With further reference to FIG. 9E, the 16 pull wire 108 has been pulled outwardly through the patients 17 mouth so that the pull wire loop 94 of the gastrostomy device 18 package 62 can be attached, as illustrated.
19 Turning to FIG. 9F, the gastrostomy device package 62, by use of the pull wire 108, has been pulled down the esophagus 106 21 of the patient, and then through the incision provided by the 22 surgical tool 10. Generally, the gastrostomy device package 62 23 is the same or larger in diameter as the tubular member 16 of the 24 surgical tool so that the package pushes the surgical tool 10 out of the incised tract as it is inserted therein.
26 Turning to FIG. 9G, the intragastric portion 72 of the 27 gastrostomy device 64 is now located within the stomach 60 of the 28 patient, while a tubular midportion 74 extends through the W0 95112429 PCTlUS93111118 ~1~~~~~
/y' 1 stomach wall 58 and abdominal wall 56, with the wing-like 2 projections 78 in the extended, uncollapsed, normal position 3 engaging the outer surface of the abdominalwall 56, wherein the 4 gastrostomy device 64 is now retained in position.
By use of the surgical tool io to create and measure the 6 incised tract, and the gastrostomy device package 62 and 7 methodology for placing it as illustrated in FIGS. 9A-9G, the use 8 of the traditional enteral feeding tube to establish a fistulas 9 stoma tract is avoided. Thus the cost and patient trauma associated therewith are eliminated, and the inherent benefits 11 afforded by the low profile gastrostomy device are available at 12 an earlier point in time to the patient requiring a gastrostomy.
13 While the preferred embodiments of the present invention are 14 shown and described herein, it is to be understood that the same is not so limited but shall cover and include any and all 16 modifications thereof which fall within the purview of the 17 invention.
8 Over the years, devices have developed to allow fluid 9 communication between an interior body cavity and an external surface of the body. Specifically, enteral feeding tubes and 11 gastrostomy devices have been developed to provide nourishment 12 to patients unable to otherwise ingest food due to the effects 13 of a stroke, coma, serious injury or other medical problem.
14 Enteral feeding tubes are generally used only for limited periods of time while gastrostomy devices and, preferably low-16 profile gastrostomy devices, are used in long-term or permanent ~ 17 installations. A primary consideration during installation of ' 18 either the feeding tube or the gastrostomy device is the 19 relatively precise installed fit necessary to prevent infection, the migration of bodily fluids from the internal body cavity, and WO 95/12429 ~ PCfIUS93/11118 y'~J
~~2 1 the proper formation of a mature stoma.
2 Since the length of the tract from the external surface to 3 the inner body cavity varies from patient to patient due to 4 various factors such as age, weight, and sex, the enteral feeding , tube, which is typically adjustable to accommodate a range of 6 incised tract lengths, is conventionally initially installed 7 within the incised tract regardless of the anticipated period of 8 need for fluid communication between the inner body cavity and 9 the external surface. Thereafter, if long-term fluid communication is required, the feeding tube is removed and 11 replaced by a gastrostomy device. The gastrostomy device is 12, typically not adjustable to accommodate multiple tract lengths 13 and therefore must be custom-fit to closely match the incised 14 tract length for each patient.
Preliminary to the installation of any device to extend 16 between the external surface of the body and the interior body 17 cavity, an incised tract must be formed. The incised tract is 18 conventionally formed by inserting a trocar and cannula through 19 the external body surface and into the internal body cavity.
Thereafter, the enteral feeding tube is installed within the 21 just-formed tract.
22 Such an enteral feeding tube, as represented by United 23 States Patent No. 4,758,219, is typically introduced into the 24 stomach via the mouth and esoLohagus, and then partially removed from the incised tract formed by a previously-inserted trocar and 26 cannula. An internal end of the feeding tube mountingly ' 27 accommodates an enlarged portion serving as a stop means while 28 an external end of the feeding tube includes an adjustable skin ~i'75'~J3 1 protecting ring or bolster. The distance between the stop means 2 and the bolster is adjusted by moving the bolster along the 3 length of the feeding tube, firmly trapping the external surface 4 of the body and the inner wall of the internal body cavity between the ring and stop means.
6 Other enteral feeding tubes are designed to be inserted 7 through the incised tract from the external body surface into the 8 internal body cavity, and include an internal end portion which 9 is inflatable or otherwise expandable to define a stop surface.
United States Patent No. 5,074,846 is exemplary of devices of 11 this type. A lengthwise adjustable outer skin engaging ring or 12 bolster is used to compensate for variations in tract length, as 13 in the '219 patent.
14 Outwardly deformable tubes or sheaths similar to the type shown in the '846 patent have also been used in catheters to 16 retain the inner end of the catheter within an inner body cavity 17 such as the bladder or peritoneum, as evidenced by United States 18 Patent Nos. 2,649,092 and 3,241,554. The catheter of the '554 19 patent also includes a depth gauge to indicate how far the catheter has been inserted into the abdominal wall.
21 Although the devices and methods for installing enteral 22 feeding tubes illustrated above are satisfactory for short-term 23 use, such feeding tubes are generally considered undesirable for 24 long-term or permanent use due to the external length of the tube and awkwardness associated therewith. Therefore, for long-term 26 installations, a low-profile gastrostomy device preferably 27 replaces the enteral feeding tube after a mature stoma between 28 the exterior body surface and internal body cavity has been established. The gastrostomy device, which, due to its low-profile nature, does not include a length adjustment feature, must be specifically sized to match the stoma length.
Therefore, prior to installation of a gastrostomy device, the stoma length is conventionally determined by measuring the length of the feeding tube from the external surface of the body to the internal stop surface. Typically, this is accomplished by placing a reference mark on the feeding tube adjacent the external surface, removing the feeding tube from the body by reversing the installation steps, and then measuring the distance from the reference mark to the stop surface. The appropriate size of the gastrostomy device is derived from this measurement.
Thereafter, the gastrostomy device is inserted into the stoma to complete the replacement procedure.
Alternatively, stoma length can be determined by a measuring device such as disclosed by United States Patent No. 4,972,845.
The stoma measuring device of the X845 patent includes an elongated tubular member which provides scale indicia on an exterior surface thereof. A distal end of the tubular member is inflatable to serve as a stop means to temporarily prevent the removal of the distal end from an inner body cavity, allowing the length of the stoma to be measured via the scale indicia.
United States Patent No. 4, 863, 438, which is assigned to the assignee of the present invention, is exemplary of low profile gastrostomy device which is designed to replace an enteral feeding tube within an existing stoma. A stylet is used to elongate and stretch the enlarged intragastric head of the gastrostomy device, WO 95112429 ~ ~ ~ ~ ~.~ ~ PCTJUS93111118 o~
1 which is thereafter pushed through the stoma into the internal 2 body cavity. A tubular midportion is received by the stoma while 3 a pair of oppositely directed wings engage the external body 4 surface. Additional gastrostomy feeding ports are shown in United States Patent Nos. 4,850,953 and 4,944,732.
6 In all of the aforementioned gastrostomy devices, the 7 gastrostomy device must fit snugly within the stoma between the 8 inner wall of the internal body cavity and the external body 9 surface. In the aforementioned prior art this has necessitated the initial installation of an enteral feeding tube in the 11 incised tract to allow the incised tract to mature and become a 12 permanent stoma and to thereafter allow an accurate measurement 13 of the stoma length.
14 Therefore, in the aforementioned prior art, the steps of forming an incised tract, inserting an enteral feeding tube, 16 allowing the incised tract to mature into a stoma, removing the 17 enteral feeding tube, and measuring the stoma length are required 18 before the gastrostomy device can be installed within the stoma.
19 In response to this costly and time consuming process, it has been proposed that a low-profile gastrostomy device be 21 directly installed within an incised tract without the need for 22 the preliminary placement of a feeding tube therein. Initially 23 placing a low-profile gastrostomy device in an incised tract 24 allows the patient to immediately benefit from the advantages inherent in use of a low profile gastrostomy device as opposed 26 to an enteral feeding tube. Moreover, eliminating the need for 27 the initial placement of a feeding tube reduces the cost and 28 trauma traditionally associated with the installation of a ~o gastrostomy device. United States Patent No. 5,084,014, which is owned by the assignee of the present invention, is directed towards a low-profile gastrostomy device adapted to be mounted within a recently-formed incised tract.
The '014 patent discloses a package for the initial placement of a gastrostomy device wherein an external body surface-engaging portion is outwardly pulled through the incised tract. The package includes a shroud which retains wing-like members of the external body surface-engaging portion in a deformed configuration, generally parallel to a tubular midportion of the device. Installation occurs by inserting the package into the stomach, pulling it through the incised tract until an enlarged intragastric portion engages the inner wall of the stomach, and thereafter removing the shroud to allow the wings to return to their undeformed, outwardly extending configuration. Once installed, the device functions generally identically to the gastrostomy device disclosed in the '438 patent.
Although the installation package of the X014 patent works satisfactorily, proper sizing of the gastrostomy device still requires the prior measurement of the incised tract length.
United States Patent No. 5,343,874, is directed towards a device and method for measuring the length of an incised tract.
The device includes an elongated member having scale indicia along at least a portion of its length, and stop means at one end of the scale indicia.
In the disclosed method of the '874 patent, an incised tract between an external surface of a body and an inner wall of an internal body cavity is formed by a trocar and cannula.
Thereafter, the device is inserted into the stomach via the mouth and esophagus, and a distal end of the elongated member is inserted through the incised tract until the stop means engages the inner wall of the internal body cavity. The elongated member extends out of the incised tract, making the scale indicia thereon visible and allowing the determination of tract length.
Thereafter, the incised tract measuring device is removed and a low profile device sized to match the measured tract length is installed, preferably in accordance with the device and method of Patent No. 5,084,014.
Although the aforementioned incised tract measuring device and method represents an improvement over the prior art method of measuring length, it suffers from the disadvantage that it requires insertion and removal via the esophagus, creating additional irritation and trauma for the patient. Moreover, a separate trocar and cannula are required to form the incised tract prior to insertion of the measuring device through the tract.
Therefore, there exists a need in the art for a surgical tool for the measurement of an incised tract length which does not require insertion or removal via the esophagus. Moreover, there exists a need in the art for a surgical tool which is capable of creating and measuring an incised tract.
~~'~5?93 1 $LTMMARY OF THE INVENTION
2 In accordance with the present invention, a surgical tool 3 is provided to form a tract extending from an external surface 4 of a living body to an internal body cavity, and to measure the length of the tract so formed. The surgical tool includes a 6 handle means having first and second relatively movable handle 7 sections, a cannula attached to the second handle section, and 8 a flexible tubular member covering at least a portion of the 9 cannula and being attached to the first handle section. The flexible tubular member includes an outwardly deformable section 11 which is adapted to be manually movable between undeformed and 12 outwardly deformed configurations.
13 In further accordance with the present invention, relative 14 movement of the first handle section away from the second handle section causes the deformable section to outwardly deform and 16 thereby define a stop surface. The stop surface is adapted to 17 engage an inner wall of the interior body cavity to prevent 18 removal of the surgical tool from the incised tract. Visible 19 scale indicia provided by the flexible tubular member are visible on an exterior of the body when the stop means engages the inner 21 wall of the interior body cavity to allow the determination of 22 the tract length. The stop surface is located at an origin of 23 the scale indicia.
24 Preferably, distal ends of the cannula and tubular member are interconnected and covered by a dilator. The dilator 26 includes a central bore through which an obturator extends. The 27 dilator and obturator cooperate to allow the insertion of the WO 95112429 ~, ~, ~ ,7 ~ ~ ~ PCT/US93lIIIIS
1 surgical tool through the body from the external surface to the 2 internal body cavity. Later removal of the obturator allows the 3 insertion of a guidewire into the internal body cavity to 4 facilitate the placement of a gastrostomy device within the just-formed tract.
6 Preferably, the first and second handle sections of the 7 handle means are adapted to easily receive a user's fingers, as 8 well as to provide a pair of bearing surfaces. In the preferred 9 embodiment, each of the handle sections includes a forward and a rearward surface against which the user's force is directed to 11 alternatively move the handle sections relatively toward or away 12 from each other.
13 In further accordance with the invention, a method of 14 forming and measuring a tract with the device of the above-noted type includes the steps of inserting the device from an external 16 body surface into an internal body cavity, outwardly deforming 17 a portion of the tubular member to form a stop surface, engaging 18 the stop surface with an interior wall of the inner body cavity, 19 and viewing the tract length indicating means to determine the tract length.
21 In further accordance with the present invention, a method 22 of sizing and placing a gastrostomy device within an incised 23 tract comprises the above-mentioned tract formation and 24 measurement steps in addition to the steps of choosing an appropriately sized gastrostomy device in accordance with the 26 measured tract length, positioning the gastrostomy device within 27 the inner body cavity and inserting a portion of the gastrostomy 28 device through the incised tract. Preferably, the gastrostomy /D
device includes an enlarged intragastric portion, a tubular midportion, and an external portion.
ERIEF DESCRIPTION OF THE DRAAINGS
These and further aspects of the present invention will be apparent with reference to the following description and drawings, wherein:
FIG. 1 is a perspective view of a surgical tool in accordance with a first embodiment of the present invention;
FIG. 2 is a top plan view of the surgical tool in accordance with a first embodiment of the present invention;
FIG. 3 is a perspective view of a surgical tool in accordance with a further embodiment of the present invention.
FIG. 4 shows an elevational view, partially in cross-section, of the surgical tool extending from an external body surface into an internal body cavity;
FIG. 5 shows an elevational view, partially in cross-section, of the surgical tool with the stop surface engaging an inner wall of an internal body cavity and the scale indicia visible adjacent an exterior surface of the body;
FIG. 6 shows a side elevational view of the terminal end of the surgical tool with the deformable section in the deformed configuration;
FIG. 7 is a longitudinal, partial, cross-sectional view of a gastrostomy device package to be inserted into the incised tract created and measured in accordance with the present R'O 95112429 PCT/US93J11118 1 invention;
2 FIG. 8 is an exploded view of the gastrostomy device package 3 of FIG. 7;
4 FIGS. 9A-9G sequentially illustrate the methodology for creating and measuring an incised tract; as well as for placing 6 a gastrostomy device within the incised tract.
7 DETAINED DESCRIPTION OF TdiE PREFERRED EMBODIMENTS
8 With reference to FIGS. 1 and 2, a surgical tool l0 in 9 accordance with a first embodiment is shown. The surgical tool includes a handle means 12, a cannula 14, a flexible outer 11I tubular member 16, a dilator 18, and an obturator 20.
12 The handle means 12 includes first and second handle 13 sections 22 and 24. As illustrated, the first handle section 22 14 is bifurcated, having a pair of diametrically opposed ring-shaped finger receiving portions 26. The second handle section 24 16 includes a single ring-shaped finger receiving portion 28.
17 Preferably, and as will be recognized by one skilled in the 18 art, the first handle section 22 is adapted to receive a pair of 19 fingers while the second handle section 24 is adapted to receive a single finger and, more specifically, a thumb. The first and 21 second handle sections 22 and 24 are relatively movable towards 22 and away from each other by retaining one of the first or second 23 sections and moving the other section. As will be recognized by 24 one skilled in the art, each of the first and second handle sections 22, 24 include a pair of bearing surfaces to facilitate 26 moving the handle sections relative to each other.
W095112429 PCT/US93I11118 '~
2~."~5a'~93 'z 1 The cannula 14 includes a distal end 30 which is attached 2 to a distal end 32 of the tubular member 16 and a proximal end 3 34 of the dilator 18. As illustrated, the dilator 18 preferably 4 is crimped, pinned, or otherwise permanently attached to the distal ends of the cannula 14. and tubular member 16.
6 The cannula 14 is enclosed by the tubular member 16 between 7 the dilator 18 and the first handle section 22. The cannula 14 8 is slidably received by the first handle section 22 and is 9 attached to and extends through the second handle section 24.
A lumen 36 provided by the cannula 14 is accessible via the 11 second handle section.
12 The obturator 20 is slidably received within the cannula 13 lumen 36, and includes a pointed or otherwise sharpened distal 14 end 38 and a handle 40 attached to its proximal end 41. The pointed distal end 38 of the obturator extends out of a distal 16 end 42 of the dilator 18 when the obturator handle 40 engages the 17 second handle section 24, as illustrated in FIG. 2. The 18 obturator handle 40 is positioned and adapted to be engaged by 19 a user's thumb which extends through the second handle section 24, ensuring that the distal end 38 of the obturator 20 extends 21 out of the dilator 18 when the surgical tool 10 is being used to 22 form an incised tract, as will be discussed more fully hereafter.
23 The flexible tubular member 16 extends between the first 24 handle section 22 and the dilator 18 and slidably receives the cannula 14. Rearwardly spaced a short distance from the distal 26 end 32, the tubular member 16 includes a deformable section 44.
27 The deformable section 44 is formed in the tubular member 16 by 28 a plurality of short longitudinal cuts therethrough. A series W0 95/12429 . _. . PCTlUS93111118 1 of measurement or scale indicia 48 are provided along a portion 2 of the tubular member. Preferably, the deformable section 44 is 3 located at one end or the origin of the scale indicia 48.
4 Naturally, the tubular member 16 could be transparent and the scale indicia 48 placed on the cannula 14 therein without 6 departing from the scope and spirit of the present invention.
7 As illustrated in FIG. 3, a second embodiment of the present 8 invention is generally identical to the aforementioned first 9 embodiment (FIGS. 1 and 2) with the exception of the first handle section 50. Therefore, identical reference numerals are used 11 when possible. The first handle section 50 of the second 12 embodiment is generally spool-shaped, having proximal and distal 13/ annular surfaces 52 which extend radially outward from a 14 generally cylindrical body 54. The remainder of the second embodiment is generally identical to the first embodiment, and 16 will not be described more fully hereinafter.
17 Use of the surgical tool 10 of either embodiment of the 18 present invention for forming and measuring an incised tract 19 between an external body surface and an internal body cavity, or, more particularly, from the skin to the stomach, is illustrated 21 in FIGS. 4-6. The surgical tool 10, with the sharpened distal 22 end 38 of the obturator 20 projecting out of the distal end 42 23 of the dilator i8, is inserted through the abdominal wall 56 and 24 stomach wall 58 (FIG. 4) and into the stomach 60. Thereafter, the first and second handle sections 22 and 24 are moved 26 relatively apart, causing the deformable section 44 of the 27 flexible tubular member 16 to outwardly deform (FIG. 6). The 28 surgical tool 10 is pulled relatively away from the body, causing R'O 95/12429 PCT/US93/1I I IS S
r 1 the stop surface defined by deformed section 44 to the engage the 2 stomach wall 58 (FIG.5). As so positioned, the scale indicia 3 48 provided by the flexible tubular member 16 are visible 4 adjacent the ext eriorsurface of the body, allowing length the of the incised tractformed by the surgical tool 10 to be 6 measured.
7 The measurement derived from the scale indicia 48 is used 8 to select a low profile gastrostomy device to be inserted into 9 the incised tract. Preferably, the low profile gastrostomy is of the type described in United States Patent No. 4,863,438, and, 11 most preferably, a gastrostomy device package and method of 12I installation as described in U.S. Patent No. 5,084,014 is used.
13 Turning to FIGS. 7 and 8, a gastrostomy device package 62 14 to be inserted into an incised tract which was created and measured in accordance with the present invention is illustrated.
16 The package 62 is generally elongated so as to extend along a 17 longitudinal x-x axis, as illustrated. The oackaae i ~ r~r,m",-; Qo,a 18 of two major portions, namely, a low profile gastrostomy device 19 64, often referred to in the art as a "gastrostomy button", and a shroud means 66 comprised primarily of a dilator member 68, and 21 a plastic film material 70 constituting a tubular -sleeve 22 extending generally completely over the dilator 68.
23 The gastrostomy device 64 includes an intragastric portion 24 72 located at one end of a tubular midportion 74 having at its other end a resilient external portion 76. The device is 26 preferably formed of a biocompatable silicone rubber material so 27 as to be flexible and elastorneric. The length of the tubular 28 portion 74 is sized to be dimensionally compatible with the ~J~
1 combined thickness of, for example, a patient's stomach 58 and 2 abdominal walls 56, which was determined by using the surgical 3 tool l0, as previously described.
4 The external portion 76 of the gastrostomy device 64 includes a pair of diametrically opposed wing-like projections 6 78, one of which has extending from it a plug retainer 80 which 7 has a distal end providing a plug 82, wherein the plug retainer 8 80 can be folded over to permit insertion of the plug 82 into a 9 feeding tube receptor port 84. As is known in the art, when positioned within, for example, a human or animal patient 11 undergoing medical treatment, an enteral feeding tube can be 12 inserted into the port 84 through the tubular midportion 74 and 13 / into the intragastric portion 72 to effect the flow of fluid 14 either into or out of a body cavity, such as the patient's stomach, within which the intragastric portion is located. It 16 is to be noted that the intragastric portion 72 includes within 17 the usual normally closed reflux valve (not shaven) which prevents 18 egress of fluid outwardly through the tubular midportion 74 when 19 the enteral feeding tube is not maintaining the valve in an open position.
21 With particular reference to FIG. 7, the flexible wing-like 22 projections 78, including the associated plug retainer 80 and 23 plug 82, are shown in a folded or collapsed condition so that 24 they extend along parallel lines adjacent to the axis x-x, as illustrated. The dilator member 68 which provides a pair of 26 opposed flats or recesses 86 against which the wing-like 27 projections 78 are held in their folded or collapsed position by 28 the plastic film 70 in the preferred form of a tubular sleeve of /G
1 heat-shrink or shrink-wrap type plastic film. In its collapsed 2 condition, the external portion 76 (FIG. 8) is contained within 3 and compressed by the shroud means 66, and, more specifically, 4 the plastic film 70.
The dilator member 68 further includes a plug retainer 6 recess or flat 88 having a plug recess 90 into which the plug 82 7 fits, as illustrated in FIG. 7. The dilator member 68 has a 8 tapered distal end 92 which is provided with a pull wire loop 94 9 embedded within the dilator member, as illustrated. The dilator member is also provided with a reduced diameter portion 96 which 11 forms an inboard part of a retainer tip 98 that extends and snaps 12/ into the external end 28, i.e., port 28, of the tubular 13 midportion 74, as illustrated.
14 The gastrostomy device 64 is provided with an annular or circular lip 100 that fits into the reduced diameter portion 96, 16 constituting a circular groove, so as to provide a releasable 17 locking means holding the gastrostomy device 64 in position 18 relative to the dilator member 68. It can also be seen that an 19 open, or leftward end as viewed in FIG. 7, of the plastic film 70 constituting a tubular sleeve extends beyond and over the 21 circular lip and its associated annular groove constituted by 22 reduced diameter portion 96 of the retainer tip 98, so as to hold 23 and compress the circular lip 100 into the reduced diameter 24 portion 96 of the dilator member 68.
With reference to FIG. 8, a guide groove 102 is provided, 26 as illustrated, on a surface of the dilator member 68 spaced from 27 the external portion 76 of the gastrostomy device 64 when in its 28 position as illustrated in FIG. 7. The guide groove 102 provides an indicator point for a partially cutting the plastic film 70 and peeling it around and away from the dilator member 68, as illustrated in FIG. 8, so that the gastrostomy device 64 and the dilator member 68 can be separated from each other so as to allow the resilient wing-like projections 78 to return to a normal expanded position as illustrated in FIG. 8.
Thus, FIG. 7 illustrates a gastrostomy device package 62 for initial placement of the gastrostomy device 64 in a patient, as discussed below, while FIG. 8 illustrates the package 62 in a disassembled form after the device 64 has been placed within an incision in the patient, as will now be discussed.
Turning to FIG. 9A, there is schematically illustrated a patient having an inner body cavity such as a stomach 60 within which is to be placed the gastrostomy device 64 in accordance with the present invention. It is to be noted that the gastrostomy device package 62 and method of placement described hereinafter are more fully described in U.S. Patent No. 5,084,014. Moreover, the surgical tool 10 and method of use can be used for creating and measuring incised tracts into other viscera of the body for other applications, such as, for example, urinary bladder drainage, ileostomy, jejunostomy, and cystostomy.
The outer surface or skin of the patient extends over the abdominal wall 56, which in turn abuts the stomach wall 58. In a first step for placing the gastrostomy device package 62, the stomach 60 of the patient is insufflated via an endoscope tube 104 extending down through the esophagus 106 of the patient, as illustrated. As illustrated in FIG. 9B, the surgical tool 10 of the present invention is inserted through the abdominal and ". ;
1 stomach walls 56 and 58 of the patient to establish an incised 2 tract that will receive a gastrostomy button (FIG. 4).
3 As shown in FIG. 9C, the first and second handle sections 4 22 and 24 are moved generally away from each other, deforming the deformable section 44 of the flexible tubular member 16 to define 6 a stop surface. Thereafter, the surgical tool 10 is pulled 7 outwardly, placing the stop surface in engagement with the inner 8 surface of the stomach wall 58 and allowing the length of the 9 incised tract to be determined via the scale indicia 48 on the tubular member 16 which is visible adjacent the external body 11 surface (FIG. 5).
12 As shown in FIG. 9D, with the obturator 20 removed from the 13 cannula 14, a pull wire 108 is inserted through the cannula lumen 14 so that its end can be captured by a snare 110 extending through the endoscope tube 104. With further reference to FIG. 9E, the 16 pull wire 108 has been pulled outwardly through the patients 17 mouth so that the pull wire loop 94 of the gastrostomy device 18 package 62 can be attached, as illustrated.
19 Turning to FIG. 9F, the gastrostomy device package 62, by use of the pull wire 108, has been pulled down the esophagus 106 21 of the patient, and then through the incision provided by the 22 surgical tool 10. Generally, the gastrostomy device package 62 23 is the same or larger in diameter as the tubular member 16 of the 24 surgical tool so that the package pushes the surgical tool 10 out of the incised tract as it is inserted therein.
26 Turning to FIG. 9G, the intragastric portion 72 of the 27 gastrostomy device 64 is now located within the stomach 60 of the 28 patient, while a tubular midportion 74 extends through the W0 95112429 PCTlUS93111118 ~1~~~~~
/y' 1 stomach wall 58 and abdominal wall 56, with the wing-like 2 projections 78 in the extended, uncollapsed, normal position 3 engaging the outer surface of the abdominalwall 56, wherein the 4 gastrostomy device 64 is now retained in position.
By use of the surgical tool io to create and measure the 6 incised tract, and the gastrostomy device package 62 and 7 methodology for placing it as illustrated in FIGS. 9A-9G, the use 8 of the traditional enteral feeding tube to establish a fistulas 9 stoma tract is avoided. Thus the cost and patient trauma associated therewith are eliminated, and the inherent benefits 11 afforded by the low profile gastrostomy device are available at 12 an earlier point in time to the patient requiring a gastrostomy.
13 While the preferred embodiments of the present invention are 14 shown and described herein, it is to be understood that the same is not so limited but shall cover and include any and all 16 modifications thereof which fall within the purview of the 17 invention.
Claims (22)
1. A surgical tool for forming an incised tract and for measuring the tract so formed, comprising a handle means having first and second relatively movable handle sections, at least one of said first and second handle sections having a ring-shaped finger receiving portion, said finger receiving portion providing bearing surfaces to facilitate movement of said first and second handle sections toward and away from one another, a cannula slidably movable with respect to the first handle section an obturator slidably received by the cannula, a dilator secured to one end of the cannula and the second handle section being secured to an opposite end of the cannula, said dilator having a sharpened distal end of the obturator projecting out of a distal end thereof, said sharpened end of the obturator and said dilator cooperating to form the incised tract when forced into and through a body being operated upon, and a flexible tubular member generally covering at least a portion of the cannula and including an outwardly deformable section, said tubular member having a proximal end secured to the first handle section and a distal end secured to the dilator, wherein movement of the first handle section relative to the second handle section causes the deformable section of the tubular member to outwardly deform and thereby define a stop surface, said stop surface being adapted to engage a surface surrounding an inner terminal end of the tract being measured, wherein a portion of the tubular member projecting from an outer terminal end of the tract includes scale indicia which are used to determine the tract length.
2. A surgical tool as recited in claim 1, wherein the cannula is slidably received by the first handle section.
3. A surgical tool as recited in claim 1, wherein the deformable section is formed by longitudinally cutting the tubular member.
4. A surgical tool as recited in claim 3, wherein the deformable section is adjacent the dilator.
5. A surgical tool for forming and measuring an incised tract in a body, comprising a handle means having first and second relatively movable handle sections, at least one of said first and second handle sections having a ring-shaped finger receiving portion, said finger receiving portion providing bearing surfaces to facilitate movement of said first and second handle sections toward and away from one another, a cannula secured to the second handle section, an obturator slidably and removably insertable within a lumen provided by the cannula, said obturator having a sharpened distal end which is adapted to form the incised tract, and a tubular member covering at least a portion of the cannula and having a proximal end secured to the first handle section and a distal end secured to the cannula, wherein longitudinal movement of the first handle section and cannula relative to the second handle section causes a deformable section provided by the tubular member to outwardly deform and thereby define a stop surface, said stop surface being engageable with a wall surrounding an inner terminal end of the tract, and tract length indicating means, said tract length indicating means being provided by one of the cannula or tubular member and being visible adjacent an external surface of the body when the stop surface engages the inner wall, said tract length indicating means being adapted to allow the tract length to be measured.
6. A surgical tool as recited in claim 5, wherein distal ends of the cannula and tubular member are secured to a dilator.
7. A surgical tool as in claim 6, wherein the sharpened distal end of the obturator slidably projects from an end of the dilator.
8. A surgical tool as in claim 7, wherein the deformable section is adjacent the dilator.
9. A surgical tool as in claim 8, wherein the tract length indicating means comprise scale indicia on the tubular member.
10. A surgical tool as in claim 5, wherein the tract length indicating means comprise scale indicia on the tubular member.
11. A tract measuring device, comprising a handle means comprising first and second relatively movable handle sections, a cannula secured to the second handle section, an obturator slidably received within the cannula and having a sharpened distal end projecting out of the cannula, a tubular member generally covering at least a portion of the cannula and including an outwardly deformable section, said tubular member having a proximal end attached to the first handle section and a distal end attached to the cannula, at least one of said first and second handle sections have a ring-shaped finger receiving portion, said finger receiving portion providing bearing surfaces to facilitate movement of said first and second handle sections toward and away from one another, wherein relative movement of the first handle section away from the second handle section causes the deformable section of the tubular member to outwardly deform and thereby define a stop surface, said stop surface being adapted to engage an internal wall surrounding an inner end of the tract being measured, and tract length indicating means, said indicating means being provided by either the cannula or the tubular member and being visible adjacent an external surface of the body when the stop surface engages the internal wall.
12. A device as recited in claim 11, wherein the tract length indicating means comprises scale indicia, said scale indicia being located on the tubular member.
13. A device as recited in claim 12, wherein the cannula is slidably received by the first handle section.
14. A device as recited in claim 13, wherein lumen of the cannula is accessible at the second handle section.
15. A surgical tool for the formation and measurement of an incised tract in a body, said tract extending from an exterior surface of the body to an internal body cavity, comprising:
first and second handle members, at least one of said first and second handle members having a ring-shaped finger receiving portion, said finger receiving portion providing bearing surfaces to facilitate movement of said first and second handle members toward and away from one another;
means for forming an incised tract, said tract forming means including an obturator and a dilator, said obturator having a sharpened distal end which projects from the dilator and is operable to pierce tissue and thereby form the incised tract as the surgical tool is inserted into the body, said dilator being operable to enlarge the tract during insertion of the surgical tool into the body;
a deformable member on said tract forming means, said deformable member defining a stop surface which is adapted to engage an inner wall defining said cavity;
means for deforming said deformable member by movement of said handle members;
means for measuring the incised tract length, said measuring means located on said tract forming means and being visible adjacent the exterior surface of the body to indicate tract length.
first and second handle members, at least one of said first and second handle members having a ring-shaped finger receiving portion, said finger receiving portion providing bearing surfaces to facilitate movement of said first and second handle members toward and away from one another;
means for forming an incised tract, said tract forming means including an obturator and a dilator, said obturator having a sharpened distal end which projects from the dilator and is operable to pierce tissue and thereby form the incised tract as the surgical tool is inserted into the body, said dilator being operable to enlarge the tract during insertion of the surgical tool into the body;
a deformable member on said tract forming means, said deformable member defining a stop surface which is adapted to engage an inner wall defining said cavity;
means for deforming said deformable member by movement of said handle members;
means for measuring the incised tract length, said measuring means located on said tract forming means and being visible adjacent the exterior surface of the body to indicate tract length.
16. A surgical tool as recited in claim 15, wherein the tract forming means further comprises a cannula, the obturator being slidably received within said cannula, said dilator being secured to the cannula.
17. A surgical tool as recited in claim 16, wherein a tubular member comprises the deformable member and encloses a portion of the cannula.
18. A surgical tool as recited in claim 17, wherein the deformable member comprises the handle members, the cannula and the tubular member, the tubular member is secured at opposite ends to one of the handle members and a distal end of the cannula while a proximal end of the cannula is secured to the other of the handle members such that movement of the handle members relatively away from each other causes the cannula to slide within the tubular member, compressing the tubular member and outwardly deforming the deformable member.
19. A surgical tool as recited in claim 18, wherein the deformable member is adjacent the dilator.
20. A surgical tool as recited in claim 19, wherein the tract length indicating means comprise scale indicia on the tubular member.
21. Use of a surgical tool as defined in any one of claims 1 to 10 and 15 to 20, for the formation and measurement of an incised tract in a body.
22. Use of a tract measuring device as defined in any one of claims 11 to 14, for the measurement of an incised tract in a body.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US07/965,219 US5356382A (en) | 1992-10-23 | 1992-10-23 | Percutaneous tract measuring and forming device |
| PCT/US1993/011118 WO1995012429A1 (en) | 1992-10-23 | 1993-11-03 | Percutaneous tract measuring device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2175793A1 CA2175793A1 (en) | 1995-05-11 |
| CA2175793C true CA2175793C (en) | 2001-01-16 |
Family
ID=26787118
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002175793A Expired - Fee Related CA2175793C (en) | 1992-10-23 | 1993-11-03 | Percutaneous tract measuring device |
Country Status (7)
| Country | Link |
|---|---|
| US (1) | US5356382A (en) |
| EP (1) | EP0726788B1 (en) |
| JP (1) | JP2968044B2 (en) |
| AU (1) | AU687774B2 (en) |
| CA (1) | CA2175793C (en) |
| DE (1) | DE69331808T2 (en) |
| WO (1) | WO1995012429A1 (en) |
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-
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- 1993-11-03 EP EP94904385A patent/EP0726788B1/en not_active Expired - Lifetime
- 1993-11-03 WO PCT/US1993/011118 patent/WO1995012429A1/en active IP Right Grant
- 1993-11-03 JP JP7513184A patent/JP2968044B2/en not_active Expired - Fee Related
- 1993-11-03 AU AU58456/94A patent/AU687774B2/en not_active Ceased
- 1993-11-03 DE DE69331808T patent/DE69331808T2/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| CA2175793A1 (en) | 1995-05-11 |
| DE69331808T2 (en) | 2002-12-12 |
| US5356382A (en) | 1994-10-18 |
| AU5845694A (en) | 1995-05-23 |
| JPH09507398A (en) | 1997-07-29 |
| EP0726788A4 (en) | 1997-12-29 |
| DE69331808D1 (en) | 2002-05-16 |
| EP0726788B1 (en) | 2002-04-10 |
| EP0726788A1 (en) | 1996-08-21 |
| AU687774B2 (en) | 1998-03-05 |
| JP2968044B2 (en) | 1999-10-25 |
| WO1995012429A1 (en) | 1995-05-11 |
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| EEER | Examination request | ||
| MKLA | Lapsed |