Methods and systems for performing submucosal medical procedures
Instruments, systems and methods are provided for performing submucosal medical procedures in a desired area of the digestive tract using endoscopy. Instruments include a safe access needle injection instrument, a submucosal tunneling instrument, a submucosal dissection instrument, a mucosal resection device. Systems include a combination of one or more of such instruments with or without injectable agents. Embodiments of various methods for performing the procedures are also provided.
1. A method of performing submucosal dissection of a mucosal layer of tissue and an underlying connected submucosal layer of tissue of a patient, said method comprising:
engaging mucosal tissue of the patient with a portion of a shaft of a needle injection instrument;
defining a target area of tissue;
piercing the target area of tissue with a needle portion of the needle injection instrument to enter the underlying submucosal layer of tissue;
delivering an injectable dissection material through a lumen defined through the needle portion, the injectable dissection material dissolving the submucosal layer of tissue below the mucosal tissue of the target area of tissue to dissect the target area of tissue.
2. The method of performing submucosal dissection according to claim 1 , wherein:
the shaft has a tubular wall with the lumen extending therethrough; and
said method further comprises advancing the needle portion of the needle injection instrument through the lumen of the shaft to advance a distal end of the needle portion into the target area of tissue.
3. The method of performing submucosal dissection system according to claim 1 , further comprising advancing the needle portion of the needle injection instrument through the lumen of the shaft and into the engaged mucosal layer of tissue.
4. The method of performing submucosal dissection according to claim 1 , wherein injecting the injectable dissection material comprises injecting a material selected from the group consisting of sodium 2-mercaptoethanesulfanate, acid, enzymes, semisolid gelatin capable of mechanically breaking the submucosal connective tissue, an injectable solution which solidifies upon entering a submucosal space of tissue, or gelled microspheres dispersed in a solution capable of mechanically breaking submucosal connective tissue.
5. The method of performing submucosal dissection according to claim 1 , wherein defining the targeted area of tissue comprises injecting fluid into a submucosal area of tissue beneath the engaged mucosal layer of tissue to form a submucosal bleb.
6. The method of performing submucosal dissection according to claim 5 , wherein delivering the injectable dissection material comprises delivering the injectable dissection material into the submucosal layer of tissue in the region of the bleb.
7. A method of performing submucosal dissection of a mucosal layer of tissue and an underlying connected submucosal layer of tissue of a patient, said method comprising:
engaging mucosal layer of tissue of the patient with a portion of a shaft of a needle injection instrument;
piercing the engaged mucosal layer of tissue with a needle portion of the needle injection instrument;
delivering a fluid through a lumen of the needle portion to form a bleb; and
dissecting tissue in the region of the bleb.
8. The method of performing submucosal dissection according to claim 7 , wherein:
the shaft has a tubular wall with the lumen extending therethrough and a window formed in a distal portion of the tubular wall; and
engaging the mucosal layer of tissue of the patient comprises applying a vacuum to the lumen of the shaft to suction the mucosal layer of tissue into the window.
9. The method of performing submucosal dissection according to claim 8 , wherein piercing the engaged mucosal layer of tissue with the needle portion of the needle injection instrument comprises advancing a distal end of the needle portion from a position proximal to the window to a position within the window and into the engaged mucosal layer of tissue.
10. The method of performing submucosal dissection according to claim 7 , wherein:
the shaft includes a pair of jaw members; and
engaging the mucosal layer of tissue of the patient comprises grasping the mucosal layer of tissue with the pair of jaw members.
11. The method of performing submucosal dissection according to claim 10 , wherein:
the shaft has the lumen defined therethrough; and
said method further comprises advancing the needle portion of the needle injection instrument through the shaft lumen from a position proximal to the pair of jaw members to a position between the pair of jaw members to pierce the engaged mucosal layer of tissue.
12. The method of performing submucosal dissection according to claim 10 , further comprising rotating the shaft and the pair of jaw members relative to each other.
13. The method of performing submucosal dissection according to claim 7 , wherein:
the needle portion of the needle injection instrument includes a stop member; and
said method further comprises advancing the needle into the engaged mucosal layer of tissue until the stop member engages the engaged mucosal tissue.
14. The method of performing submucosal dissection according to claim 7 , further comprising injecting fluid into a submucosal area beneath the engaged mucosal tissue to form a submucosal bleb.
15. The method of performing submucosal dissection according to claim 7 , wherein:
piercing the engaged mucosal layer of tissue with the needle portion of the needle injection instrument comprises advancing a tip of the needle portion to enter the underlying submucosal layer of tissue; and
delivering a fluid to form a bleb comprises delivering the fluid into a region of the submucosal layer of tissue to elevate a region of submucosal layer of tissue to form the bleb beneath the mucosal layer of tissue.
16. The method of performing submucosal dissection according to claim 7 , further comprising injecting an injectable dissection material into tissue in a region of the bleb to dissect the tissue.
17. The method of performing submucosal dissection according to claim 16 , wherein injecting the injectable dissection material comprises injecting a material selected from the group consisting of sodium 2-mercaptoethanesulfanate, acid, enzymes, semisolid gelatin capable of mechanically breaking submucosal connective tissue, or gelled microspheres dispersed in a solution capable of mechanically breaking the submucosal connective tissue.
18. A method of performing submucosal dissection of a mucosal layer of tissue and an underlying connected submucosal layer of tissue of a patient, said method comprising:
engaging the mucosal layer of tissue of the patient with a portion of a shaft of a needle injection instrument;
delivering a fluid through a lumen of a needle portion of the needle injection instrument and into a region of the submucosal layer of tissue below the engaged mucosal layer of tissue to form a bleb beneath the mucosal layer of tissue; and
delivering an injectable dissection material through the lumen of the needle portion into the submucosal layer of tissue in the region of the bleb to dissolve the submucosal layer of tissue.
19. The method of performing submucosal dissection according to claim 18 , wherein injecting the injectable dissection material comprises injecting a material selected from the group consisting of sodium 2-mercaptoethanesulfanate, acid, enzymes, semisolid gelatin capable of mechanically breaking the submucosal connective tissue, or gelled microspheres dispersed in a solution capable of mechanically breaking submucosal connective tissue.
20. The method of performing submucosal dissection according to claim 18 , wherein:
the shaft has a tubular wall with the lumen extending therethrough; and
said method further comprises advancing the needle portion of the needle injection instrument through the lumen of the shaft to advance a distal end of the needle portion into tissue.