Systems and methods for performing bariatric surgery
Systems and methods for effecting bariatric procedures are disclosed. Each system includes an instrument, a control valve and, optionally, a suction controller. The instrument is in the form of an elongated, flexible sizing tube having a distal end portion including a plurality of apertures. The control valve enables suction to be applied to the patient's stomach via the apertures to drain gastric fluids and to bring adjacent portions of the patient's stomach into engagement the sizing tube to provide a visually perceptible delineation line along which a portion of the stomach may be resected, sealed and tested.
1. A method of sizing a patient's stomach for a bariatric procedure, said method comprising:
a) introducing a non-expandable instrument comprising a sizing tube comprising a single member into the stomach of the patient through the patient's esophagus so that a portion of said sizing tube is disposed along the lesser curvature of the patient's stomach, said sizing tube comprising an elongated member having a longitudinal axis and a circular cross-section having a circular outer surface, whereupon when said sizing tube is disposed along the lesser curvature of the patient's stomach the circular outer surface of said sizing tube is exposed for engagement by portions of the patient's stomach, a hollow interior defining a passageway, a distal end portion and a proximal end portion, said distal end portion terminating in a free end tip, said distal end portion having a predetermined outside diameter and a plurality of apertures disposed about said circular outer surface of said distal end portion, said plurality of apertures being directed in a plurality of different radial directions from said longitudinal axis and being in fluid communication with said passageway, said circular outer surface being entirely continuous along an entire length of said sizing tube between said apertures;
b) connecting said passageway of said sizing tube to a source of controlled suction whereupon controlled suction is applied to the interior of the patient's stomach via said plurality of apertures to pull the lesser curvature of the patient's stomach into engagement with a portion of said sizing tube without any portion of said instrument being interposed between said entirely continuous circular outer surface of said sizing tube and the interior of the patient's stomach, and to produce a suction-created visually perceptible delineation line on the exterior of the patient's stomach along a portion of said entirely continuous circular outer surface of said sizing tube facing the greater curvature of the patient's stomach; and
c) laparoscopically sealing the patient's stomach from the outside of the patient's stomach along a seal line, said seal line being adjacent said visually perceptible delineation line.
2. The method of claim 1 , additionally comprising resecting the patient's stomach along a resection line, said resection line being located adjacent said seal line, whereupon when the patient's stomach is resected along said resection line such action creates a residual portion of the patient's stomach.
3. The method of claim 2 wherein said seal line is produced at least 0.5 cm from said delineation line on the opposite side of said delineation line from the position of said sizing tube near the gastric esophageal junction (GEJ) and the Angle of HIS.
4. The method of claim 2 , wherein said seal line is produced at least 0.5 cm from said delineation line on the opposite side of said delineation line from the position of said sizing tube adjacent the incisura angularis.
5. The method of claim 2 , wherein said seal line is formed by stapling or suturing.
6. The method of claim 5 additionally comprising testing said seal line for leakage by introducing a fluid into said residual portion of the patient's stomach to provide an observable indication of leakage.
7. The method of claim 6 , wherein said fluid introduced into said residual portion of the patient's stomach is air and whereupon said method additionally comprises applying a liquid along said seal line while said air is introduced into said residual portion of the patient's stomach and observing if any air bubbles egress through said seal line.
8. The method of claim 7 , wherein if during the application of suction to the patient's stomach via said sizing tube the patient's stomach becomes folded with at least one fold to obscure or interfere with the visualization of said visually perceptible delineation line, said method additionally comprises:
(c) discontinuing the application of suction to the patient's stomach via said sizing tube; and
(d) introducing a fluid into the patient's stomach through said sizing tube to thereby remove the at least one fold, whereupon suction can be reapplied to the patient's stomach to hold those portions of the patient's stomach in such engagement with said sizing tube to thereby provide said visually perceptible delineation line.
9. The method of claim 1 wherein when the controlled suction is applied to the hollow interior of said sizing tube it results in a force in the range of 0.1 to 200 pounds holding said sizing tube in position.
10. The method of claim 1 wherein the level of suction to be applied is in the range of 25-200 mm Hg.
11. The method of claim 1 , wherein said controlled suction applied to the interior of the patient's stomach results in a force in a range of 0.05 to 200 pounds anchoring said sizing tube in position within the patient's stomach.
12. The method of claim 11 , wherein said controlled suction applied to the interior of the patient's stomach results in a suction force per unit length in a range of 0.02 to 21 pounds per inch.