# US 10,869,670 B2 · Procedure for endoscopic full-thickness resection

> Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt

- Number: US 10,869,670 B2
- Document ID: US10869670B2
- Status: Granted
- Kind: B2
- Application number: 15/935,419
- Filed: 2018-03-26
- Published: 2019-09-26
- Granted: 2020-12-22
- Earliest claimed: 2018-03-26
- Assignees: Olympus Corporation
- Applicants: Olympus Corporation
- Inventors: Osamu Goto
- Web page: https://patentgrep.com/patent/US10869670B2

## CPC

- A61B 17/1114: {of the digestive tract, e.g. bowels or oesophagus}
- A61B 18/1492: {having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence)}
- A61B 1/018: for receiving instruments
- A61B 1/313: for introducing through surgical openings, e.g. laparoscopes
- A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery}
- A61B 17/320016: {Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes (A61B10/0233, A61B17/29, A61B17/3207 take precedence)}
- A61B 17/3209: Incision instruments
- A61B 2017/00269: {endoscopic mucosal resection EMR}
- A61B 2017/0034: {adapted to be inserted through a working channel of an endoscope}
- A61B 2017/00818: {Treatment of the gastro-intestinal system}
- A61B 2017/1121: {adapted for performing tissue or graft eversion}
- A61B 2017/306: {holding by means of suction}
- A61B 2017/320056: {Tunnelers}
- A61B 2018/00494: {Stomach, intestines or bowel}
- A61B 2018/00601: {Cutting}
- A61B 2018/1412: {Blade}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A method of resecting entire layers of a digestive tract includes: an insertion step of inserting an endoscope into the digestive tract; an everting step performed after the insertion step, to suture mucosal layers located on both sides of a target region including a lesion, cover the target region with the mucosal layers, and evert a tract wall including the target region to a side of an abdominal cavity, in the digestive tract; and an incision step performed after the everting step, to position an incision tool between the target region and the mucosal layers to incise the tract wall around the lesion by the incision tool.

## Claims

### Claim 1

A method of resecting entire layers of a digestive tract, comprising:
inserting an endoscope into the digestive tract, the digestive tract comprising a tract wall that includes a mucosal layer, a muscle layer, and a target region including a lesion;
then suturing areas of the mucosal layer that are located on both sides of the target region so as to: (i) cover the target region with the sutured areas of the mucosal layer, and (ii) evert a portion of the tract wall including the target region to a side of an abdominal cavity with a space being formed between the target region and the sutured areas of the mucosal layer;
inserting the endoscope into the space; and
incising the tract wall around the lesion by an incision tool that is positioned between the target region and the sutured areas of the mucosal layer after the portion of the tract wall is everted to the side of the abdominal cavity, the incising including:
causing the incision tool to protrude from a channel of the endoscope that has entered into the space; and
incising the muscle layer around the target region with the incision tool while observing the target region with the endoscope.

### Claim 2 (depends on 1)

The method according to claim 1, further comprising before suturing the areas of the mucosal layer:
incising the mucosal layer around the target region so as to form cut ends; and
separating the mucosal layer around the cut ends from the muscle layer without resection, and
wherein:
the areas of the mucosal layer are sutured in a state in which the cut ends sandwiching the target region therebetween are stuck together, and
the incision of the tract wall around the lesion includes incising the muscle layer and serosa around the target region with the incision tool inserted in the space to separate the target region from the digestive tract.

### Claim 3 (depends on 1)

The method according to claim 1, further comprising:
forming a tunnel extending along the tract wall in communication with the space and having an opening at a location remote from the space,
wherein the endoscope is inserted into the space through the opening and the tunnel.

### Claim 4 (depends on 3)

The method according to claim 3, wherein:
the forming of the tunnel includes:
resecting the mucosal layer of the tract wall at a position located between the target region and a position away from the target region to form a mucous membrane defect region; and
suturing opposing portions of the mucosal layer that sandwich the mucous membrane defect region therebetween to cover the mucous membrane defect region.

### Claim 5 (depends on 4)

The method according to claim 4, further comprising:
separating the lesion from the digestive tract and collecting the lesion via the tunnel.

### Claim 6

A method of resecting entire layers of a digestive tract, comprising:
inserting an endoscope into the digestive tract, the digestive tract including a tract wall that includes:
a target region including a lesion, and
a first region and a second region that are located on both sides of the target region;
then suturing together a mucosal layer of the first region and a mucosal layer of the second region without suturing a muscle layer of the first region or a muscle layer of the second region such that the target region, the muscle layer of the first region, and the muscle layer of the second region are everted to an abdominal cavity side of the mucosal layer of the first region and the mucosal layer of the second region; and
then incising the tract wall around the lesion by an incision tool, which is positioned between: (i) the target region and (ii) the mucosal layer of the first region and the mucosal layer of the second region, by incising the muscle layer of the first region or the muscle layer of the second region, which are positioned on the abdominal cavity side of the mucosal layer of the first region and the mucosal layer of the second region.

### Claim 7 (depends on 6)

The method according to claim 6, wherein:
a space is formed between the target region and the mucosal layer of the first region and the mucosal layer of the second region when the target region, the muscle layer of the first region, and the muscle layer of the second region are everted to an abdominal cavity side of the mucosal layer of the first region and the mucosal layer of the second region.

### Claim 8 (depends on 7)

The method according to claim 7, further comprising:
inserting the endoscope into the space,
wherein the incising of the tract wall includes:
causing the incision tool to protrude from a channel of the endoscope that has entered the space, and
incising the muscle layer of the first region or the muscle layer of the second region with the incision tool while observing the target region with the endoscope.

### Claim 9 (depends on 8)

The method according to claim 8, further comprising before suturing the first region and the second region:
incising the mucosal layer of the first region and the mucosal layer of the second region around the target region so as to form cut ends; and
separating the mucosal layer of the first region and the mucosal layer of the second region around the cut ends from the muscle layer of the first region and the muscle layer of the second region, respectively, without resection,
wherein:
the mucosal layer of the first region is sutured to the mucosal layer of the second region in a state in which the cut ends sandwiching the target region therebetween are stuck together, and
the incision of the tract wall around the lesion includes incising the muscle layer of the first region or the muscle layer of the second region and serosa around the target region with the incision tool inserted in the space to separate the target region from the digestive tract.

### Claim 10 (depends on 8)

The method according to claim 8, further comprising:
forming a tunnel extending along the tract wall in communication with the space and having an opening at a location remote from the space,
wherein the endoscope is inserted into the space through the opening and the tunnel.

### Claim 11 (depends on 10)

The method according to claim 10, wherein:
the forming of the tunnel includes:
resecting the mucosal layer of the tract wall at a position located between the target region and a position away from the target region to form a mucous membrane defect region; and
suturing opposing portions of the mucosal layer that sandwich the mucous membrane defect region therebetween to cover the mucous membrane defect region.

### Claim 12 (depends on 11)

The method according to claim 11, further comprising:
separating the lesion from the digestive tract and collecting the lesion via the tunnel.