Method and apparatus for transgastric neurostimulation

1. A method of transcutaneously implanting a stimulation electrode in a peritoneal cavity of a patient using transgastric mapping and guidance, the method comprising:

inserting an endoscope having a proximal end and a distal end through a mouth into a stomach;

passing the distal end of the endoscope through an opening in the stomach into the peritoneal cavity;

retroflexing the distal end of the endoscope to orient the distal end of the endoscope towards a diaphragm, the retroflexed distal end of the endoscope configured to bend at least 90 degrees;

inserting a mapping instrument having a mapping electrode through the endoscope and into the peritoneal cavity, the mapping instrument adapted to pass through the retroflexed endoscope;

using the endoscope to place the mapping electrode in contact with the diaphragm of the patient within the peritoneal cavity;

using the mapping electrode, coupled to a mapping stimulator, to map electrical activity in the diaphragm; and

transcutaneously positioning a stimulation electrode using a percutaneous needle into the peritoneal cavity under visualization from the endoscope based on the mapped electrical activity in the diaphragm.

2. The method of claim 1 wherein the step of using the mapping electrode comprises using the mapping electrode to electrically stimulate the diaphragm.

3. The method of claim 1 further comprising grabbing the stimulation electrode with an instrument associated with the endoscope.

4. The method of claim 1 wherein the transcutaneously positioning step comprises inserting the stimulation electrode at an insertion site in an abdominal wall, the method further comprising pulling the abdominal wall away from the stomach.

5. The method of claim 1 , wherein the percutaneous needle is non-coring.

6. A method of implanting a stimulation electrode transcutaneously using transgastric mapping and guidance for stimulating target tissue in or near a peritoneal cavity of a patient, the method comprising:

inserting an endoscope through a mouth into a stomach;

passing the endoscope through an opening in the stomach into the peritoneal cavity;

laparoscopically placing a stimulation electrode at a target site on a diaphragm;

using the endoscope to guide placement of the stimulation electrode based on a map of electrical activity in the diaphragm;

closing the opening in the stomach by placement of a percutaneous endoscopic gastrostomy tube; and

providing a stimulation signal to the stimulation electrode.

7. The method of claim 6 further comprising electrically mapping the diaphragm with a mapping electrode inserted through the endoscope before placing the stimulation electrode.

8. The method of claim 6 wherein the using step comprises inserting the stimulation electrode into the peritoneal cavity percutaneously under visualization from the endoscope.

9. The method of claim 8 further comprising grabbing the stimulation electrode with an instrument associated with the endoscope.

10. The method of claim 6 further comprising grabbing the stimulation electrode with an instrument associated with the endoscope.

11. A method of transcutaneously implanting a stimulation electrode in a diaphragm of a patient using transgastric mapping and guidance, the method comprising:

inserting an endoscope through a mouth into a stomach;

inserting a guidewire percutaneously through an abdominal wall, through a peritoneal cavity, through a stomach wall and into a stomach;

inserting a dilator in a collapsed configuration over the guidewire and through the stomach wall;

expanding the dilator to enlarge an opening in the stomach wall;

passing the endoscope through the opening in the stomach wall into the peritoneal cavity;

passing a mapping electrode through the endoscope;

placing the mapping electrode in contact with a diaphragm of the patient within the peritoneal cavity; and

applying a mapping stimulation signal to the mapping electrode from a mapping stimulator;

identifying a target stimulation site after applying the mapping stimulation signal; and

laparoscopically placing a stimulation electrode at the target stimulation site.

12. The method of claim 11 wherein the laparoscopically placing step is performed while visualizing with the endoscope.

13. The method of claim 11 wherein the laparoscopically placing step is performed by grabbing the stimulation electrode with an instrument associated with the endoscope.

14. The method of claim 11 , wherein the endoscope is passed through the opening by grasping a distal end of the endoscope using a snare and pulling the endoscope through the opening and into the peritoneal cavity.

15. The method of claim 14 , wherein the snare extends from the dilator.