Device and method for treating hemorrhoids using suction

Abstract

A device includes a handle having a trigger coupled to a distal portion, the distal portion including a rigid, elongated hollow member for receiving tissue therein, and a plunger assembled and configured to slide longitudinally within the hollow member when the plunger moves proximally within the hollow member to induce suction at the distal end of the hollow member. The trigger is hingedly coupled to the plunger such that pulling the trigger causes the plunger to slide proximally relative to the hollow member to generate suction to draw tissue into the distal end of the hollow member. The device also includes a tissue handling mechanism for enclosing the tissue received at the distal end of the hollow member.

Description

[0001] Inventors: Kevin Windheuser, Oscar R. Carrillo Jr., Shane Dennis Comey, Michael McGovern, Kevin L. Bagley, and Nestor Allen Ibanez

[0002] Priority claim

[0003] This disclosure claims priority to U.S. Provisional Patent Application Serial No. 62 / 874,536, filed on July 16, 2019; the disclosure of which is incorporated herein by reference. Technical Field

[0004] The present disclosure relates to the treatment of hemorrhoids and, more particularly, to a device and method for inducing suction to draw tissue in and further surrounding the tissue with a therapeutic mechanism. Background Art

[0005] Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum. Hemorrhoids can be external, forming under the skin around the anus, or internal, forming in the lining of the anus and lower rectum. Internal hemorrhoids are difficult to visually inspect and treat. Given the above considerations, the improvements disclosed herein may be useful. Summary of the Invention

[0006] The present disclosure relates to a device comprising a handle including a trigger coupled to a distal portion, the distal portion comprising a rigid, elongated hollow member for receiving tissue therein, and a plunger assembled and configured to slide longitudinally within the hollow member so as to induce suction at a distal end of the hollow member when the plunger moves proximally within the hollow member. The trigger is hingedly coupled to the plunger such that pulling the trigger causes the plunger to slide proximally relative to the hollow member to generate suction to draw tissue into the distal end of the hollow member. The device also includes a tissue handling mechanism for surrounding tissue received at the distal end of the hollow member.

[0007] One embodiment further includes an optical port extending from the handle and an optical lens disposed on a distal surface of the plunger for visualizing a distal region of the device, the optical lens coupled to the optical port.

[0008] Embodiments further include an optical camera for viewing the distal region via the optical lens, wherein the optical camera is coupled to the optical port for attachment to the endoscopic device.

[0009] In one embodiment, the distal portion includes a locking tab and is attachable to the handle via a corresponding locking slot in the handle.

[0010] In one embodiment, the distal portion is integrally formed with the handle.

[0011] In one embodiment, the tissue treatment mechanism includes a ligature deployment mechanism for releasing a ligature from the distal end of the elongated hollow member to be contracted about tissue received therein.

[0012] In one embodiment, the ligature tie deployment mechanism includes a carrier cord having a portion extending longitudinally outside of the hollow member and having a ligature tie loaded around the hollow member and the cord.

[0013] In one embodiment, when the tie deployment mechanism is actuated, the portion of the carrying string on the exterior of the hollow member moves distally, and the movement of the carrying string brings the loaded ligature to the distal end of the hollow member.

[0014] In one embodiment, the ligature deployment mechanism includes one of a ratchet, gear, or pulley for moving the carrier line distally.

[0015] In one embodiment, the tissue processing mechanism includes a snare mechanism for releasing a snare from the distal end of the elongate hollow member such that the snare severs tissue received therein.

[0016] In one embodiment, the snare is powered.

[0017] The present disclosure also relates to a method comprising inserting a distal end of a rigid, elongated hollow member of a device into a cavity, the device having a plunger assembled with the hollow member, the plunger being configured to slide longitudinally within the hollow member when the plunger moves proximally within the hollow member to induce suction at the distal end of the hollow member. The method further comprises pulling a trigger hinged to the plunger so that the plunger slides proximally relative to the hollow member to generate suction to draw tissue into the distal end of the hollow member. The method further comprises actuating a tissue processing mechanism to surround the tissue received at the distal end of the hollow member.

[0018] The present disclosure also relates to a device comprising a hollow housing including a trigger, a viewing port, and a rigid, elongated distal portion for receiving tissue therein through an open distal end. The device further comprises a plunger disposed at a proximal end of the housing for inducing suction at the open distal end, wherein the viewing port allows viewing through the hollow housing toward the distal side and exterior of the distal portion. The trigger actuates a ligature deployment mechanism to release the ligature from the open distal end to contract around the received tissue.

[0019] Furthermore, the present disclosure relates to a device comprising a rigid hollow elongated member having an open distal end for receiving tissue therein and a plunger disposed at a proximal end of a housing for inducing suction at the open distal end. The device also includes a slider configured to slide over an exterior of the hollow elongated member and push a ligature away from the open distal end to constrict around the received tissue. BRIEF DESCRIPTION OF THE DRAWINGS

[0020] Figure 1 A first device for ligating hemorrhoids according to a first exemplary embodiment of the present disclosure is shown.

[0021] Figure 2 Shown Figure 1 Front view of the disposable distal portion of the device.

[0022] Figure 3 Shown Figure 1 Cross-sectional front view of the assembled device.

[0023] Figure 4 Shown Figure 1 Side view of the reusable proximal portion of the device.

[0024] Figure 5 Shown Figure 1 Side view of the disposable distal portion of the device with a ligature loaded thereon.

[0025] Figure 6 A second device for ligating hemorrhoids according to a second exemplary embodiment of the present disclosure is shown.

[0026] Figure 7 A third device for ligating hemorrhoids according to a third exemplary embodiment of the present disclosure is shown.

[0027] Figure 8 A fourth device for ligating hemorrhoids according to a fourth exemplary embodiment of the present disclosure is shown.

[0028] Figure 9 A fifth device for ligating hemorrhoids according to a fifth exemplary embodiment of the present disclosure is shown.

[0029] Figure 10 Shown Figure 8 The plunger of the device. Specific embodiments

[0030] The present disclosure may be further understood with reference to the following description and accompanying drawings, in which like elements are designated by like reference numerals. Exemplary embodiments of the present disclosure describe partially or fully disposable devices for treating hemorrhoids. Each device includes a mechanism for drawing a vacuum and receiving a hemorrhoid within a tubular portion of the device. Certain embodiments described herein are ligature devices for applying a ligature to the base of a hemorrhoid, while other embodiments described herein are snare devices for removing hemorrhoidal tissue. It should be noted that, as used herein, the terms proximal and distal are intended to refer to directions toward (proximal) and away from (distal) a user of the device.

[0031] like Figure 1-5As shown, the device 100 for ligating hemorrhoids includes a proximal handle portion 102 including a body 104 supporting a trigger 106. The trigger 106 is coupled to a plunger 110 via a hinge mechanism 108, e.g. Figure 4 10. The hinge shown. Actuation of the trigger causes the hinge mechanism 108 to move the plunger 110 longitudinally (proximally and distally). The proximal portion 102 of this embodiment is a reusable portion that is configured to be attached to a disposable distal portion 130. The proximal portion 102 has two locking slots 122 that are sized and shaped to receive corresponding locking tabs 136 that extend radially from the disposable distal portion 130. The locking tabs 136 of this embodiment are rectangular (corresponding to the rectangular locking slots 122) but can have any different shape to insert into the correspondingly shaped slots 122. The locking tabs 136 engage the locking slots 122 by snapping into the slots 122 or by rotating into the slots 122, as shown. Figure 3 The handle portion 102 also includes a port 120 at the proximal end of the body 104 for attaching electronic equipment and / or viewing equipment, such as a fiber optic cable or cable connected to a vision system, such as an endoscope tower (not shown) for visualizing the ligation process.

[0032] The disposable distal portion 130 includes a hollow tube 132 for receiving a hemorrhoid therein during a ligation procedure. The hollow tube 132 may include a flange at its proximal end with a locking tab 136 extending radially outward for connection to the handle 104. When the disposable distal portion 130 is attached to the reusable proximal portion 102, the plunger 110 is positioned within the hollow tube 132, with the proximal end of the plunger 110 attached to the hinge mechanism 108. As will be appreciated by those skilled in the art, the distal end 112 of the plunger 110 has a cross-section sized and shaped to correspond to the inner diameter of the hollow tube 132, such that when the plunger 110 is moved proximally through the tube 132, suction is generated to draw the target tissue into the hollow tube 132. Actuation of the trigger 106 causes the plunger 110 to move proximally from its initial distal position, thereby drawing a partial vacuum within the tube 132 to draw the hemorrhoidal tissue into the hollow tube 132. Moving the plunger 110 distally to the distal position releases the vacuum and facilitates separation of the device from the surrounding tissue.

[0033] The tube 132 is sized to capture a hemorrhoid so that the base of the hemorrhoid is exposed directly distal to the distal end of the tube 132. The plunger 110 includes an optical lens 114 at the distal end of the plunger 110 that faces and extends beyond the distal end of the tube 132. The plunger 110 of this embodiment includes a camera 116 disposed proximal to the optical lens 114 and connected to additional components of a vision system via port 120 via suitable wiring. The device 100 of this embodiment includes a light source 118 attached to the camera 116. The light source 118 is directed distally to illuminate a target area within the field of view of the camera 116 so that when the device 100 is directed toward a portion of target tissue within the anal cavity or rectum, the camera 116 provides an image of the target tissue to the vision system. The physician can then use the view provided by the camera 116 and the vision system, for example, as shown on a display on an endoscope tower (not shown), to guide the procedure.

[0034] A second aspect of the device 100 is a band deployment mechanism for releasing a ligature 140 from the distal end of the tube 132. Any number of ligatures 140 can be preloaded on the device 100 for deployment during a medical procedure, with the bands 140 being arranged in an expanded configuration at the distal end of the hollow tube 132. The band deployment mechanism is separate from the articulated mechanism 108 for pulling the plunger 110 proximally and distally within the tube 132. The band deployment mechanism can be any of a variety of mechanisms known in the art. In one embodiment, the band deployment mechanism includes a band carrier string 138 onto which one or more ligatures 140, such as a ligature, are loaded. Figure 5 The carrier cord 138 of this embodiment extends through a cord channel 134 extending longitudinally through the wall of the tube 132 and exits the distal end of the channel 134, wraps around the distal end of the tube 132 and extends back proximally to engage the ligature 140, which is stretched around the outside of the tube 132.

[0035] When the handle portion 102 and the disposable portion 130 are engaged, the proximal end of the cord 138 can be configured to attach to the reusable handle portion 102 so that the cord 138 can be pulled proximally through the channel 134, thereby pulling the portion of the cord 138 on the exterior of the tube 132 distally to release a ligature 140 from the tube 132, which contracts around tissue drawn into the tube 132, as will be understood by those skilled in the art. When the band 140 is released from the tube 132, the band can contract to a reduced diameter, thereby contracting the selected tissue.

[0036] As will be appreciated by those skilled in the art, the string 138 can be wrapped around or otherwise engage the ligatures 140 loaded onto the tube 132 so that pulling the string 138 proximally pulls the ligatures 140 distally on the tube 132 so that they can be deployed one by one as needed. In an alternative embodiment, the string 138 can have a beaded portion that pushes the ligatures 140 as the string 138 moves proximally. In either embodiment, the proximal movement of the string 138 ultimately brings one or more ligatures 140 to the distal end of the tube 132 and immediately releases the ligatures 140 distally of the tube 132. When the hemorrhoidal tissue has been drawn into the tube 132, as will be appreciated by those skilled in the art, the release of the ligatures 140 allows the ligatures 140 to retract around the exposed portion of the tissue.

[0037] The proximal handle portion 102 of the device 100 includes elements of a strap deployment mechanism that can be attached to a cord 138. In one embodiment, the cord 138 is pulled by a ratchet mechanism that only allows the cord 138 to move in one direction in controlled increments to deploy the strap 140. In alternative embodiments, the strap deployment mechanism can include gears or pulleys. The strap deployment mechanism can be actuated, for example, by a button on the exterior of the handle 102 that pulls the cord 138 a predetermined distance each time the button is pressed. However, other embodiments of an actuator for the strap deployment mechanism can be used.

[0038] The ligation procedure is performed by first connecting the reusable handle portion 102 to the disposable distal portion 130. A cord 138 is attached to an element of the band deployment mechanism in the handle 102 before the locking tab 136 is inserted into the locking groove 122 and locked therein. In the first (unactuated) configuration of the device 100, the plunger 110 is positioned toward the distal end of the hollow tube 132. To advance to the second configuration, the trigger 106 is actuated and the articulated mechanism 108 pulls the plunger 110 toward the proximal end of the tube 132, creating a partial vacuum. When the device 100 is being used in a ligation procedure and the distal end of the tube 132 has been placed near a target portion of tissue (e.g., a target hemorrhoid), the vacuum created by the trigger stroke draws the hemorrhoid into the tube 132. After the vacuum is drawn, the band deployment mechanism can be activated to apply the ligating band 140 around the base of the hemorrhoid that has been drawn into the tube 132.

[0039] After applying band 140, device 100 can return to first configuration, move plunger distally and release suction, allow band hemorrhoid to be released from tube 132.Using camera 116, doctor can reposition device 100 near second hemorrhoid and pull plunger 110 (by trigger 106) to pull second hemorrhoid into tube 132 to proximally.Can repeat this process then to release second band 140 (previously positioned in the band 140 proximal of the band 140 that just released) around the base of second hemorrhoid.Ligation process can be repeated until ligation band 140 has been fully deployed or until all target hemorrhoids have been treated, and then doctor can remove device 100 from patient.Distal part 130 can then separate from proximal handle portion 102 and be discarded, and proximal part is sterilized for next use simultaneously.

[0040] In a second embodiment, a device 200 for ligating hemorrhoids includes a housing 204 that serves as a handle and includes a distal hollow tube portion 232, such as Figure 6 2. Device 200 is a single, disposable device having a hinge actuation mechanism 208 coupled to a plunger 210, similar to the components of device 100. Plunger 210 includes a camera and lens configuration similar to that of device 100, allowing camera 116 to provide an image so that a user can view the procedure through tube 232 via distal-facing lens 114, with the camera connected to the endoscopic device via endoscope port 120. The strap deployment mechanism of device 200 can be similar to that of device 100. However, the strap deployment mechanism of device 200 can be manufactured without the features of device 100 that allow the tether 138 to be connected to the proximal portion 102. In some embodiments, device 200 can be manufactured as a single piece, rather than having a disposable portion and a reusable portion connected by a locking means.

[0041] In an alternative embodiment, the plunger 210 is coupled to an optical viewing port 220 and no camera is used. The surgeon can observe the ligation process through the viewing port 220 on the proximal end of the device 200. The viewing port 220 is concentric with the plunger 210. In other words, the viewing port 220 extends cylindrically around the plunger 210. The hinge mechanism 208 for moving the plunger 210 in this embodiment has a U-shape to avoid covering the viewing axis of the viewing port 220, and the viewing port 220 has a slot to allow the hinge mechanism 208 to move proximally and distally within the viewing port 220. In this way, the plunger 210 can move within the viewing port 220 while maintaining a line of sight from the viewing port 220 to the exterior of the plunger's distal end 212. The plunger 210 includes an optical lens 114 disposed at the distal end 212 of the plunger 210.

[0042] A physician can perform a ligation procedure using device 200 in a manner substantially similar to that described above with device 100. Device 200 is advanced from a first configuration to a second configuration to draw the hemorrhoid into hollow tube 232. When using the alternative embodiment of device 200, the physician guides the procedure using viewing port 220 at the proximal end of device 200. The band deployment mechanism can be any of the methods described above with respect to device 100. After the ligation procedure is complete, the entire device 200 can be discarded.

[0043] In a third embodiment, the snare device 300 is a single disposable device similar to the device 200, including a snare 340 instead of a ligature, such as Figure 7 As shown in FIG. A snare 340 is disposed around the distal end of the hollow tube 332 of the snare device 300 and is configured to remove hemorrhoidal tissue by excising the hemorrhoid at its base, as will be understood by those skilled in the art. A camera 116, or alternatively an optical viewing port similar to the optical viewing port 220, may be used in the device 300 to allow a physician to guide the snare procedure in a manner similar to that described with respect to the device 200. Thus, the plunger 310 operates to aspirate the hemorrhoid into the tube 332 via the articulated mechanism 308 in a manner substantially similar to that of the device 200. However, once the hemorrhoid has been drawn into the tube 332 until the base of the hemorrhoid abuts the distal end of the tube 332, the snare 340 is actuated and removes the hemorrhoid at the portion abutting the distal end of the tube 332.

[0044] In an alternative embodiment, the snare 340 can be powered by an active cord 344 coupled to the snare 340 via suitable wiring in the device 300. For example, the device 300 can be operably coupled to an energy source via the active cord 344 for delivering energy to the snare 340. In this manner, the thermal snare removes a majority of the hemorrhoid and cauterizes the wound.

[0045] The snare 340 can be actuated by the movement of the plunger 310 or can be actuated externally. For example, a cable 342 can connect the snare 340 to the hinge mechanism 308. When the hinge / plunger is retracted, the cable 342 can be pulled, thereby retracting the snare 340. The components can be designed so that the snare 340 does not retract until the plunger 310 reaches its closest position. Alternatively, the cable 342 can extend from the exterior of the device 300 and be pulled separately from the plunger 310. When a thermal snare is used, the snare 340 can be energized when the trigger 306 is actuated. Multiple hemorrhoidal treatments can be performed without removing the device 300 from the patient's anatomy. The trapped hemorrhoidal tissue can remain in the tube 332 or can fall out of the device 300 for removal upon completion of the snare procedure.

[0046] In a fourth embodiment, the ligation device 400 is a single disposable device comprising a body 404 having a distal tube portion 412 for receiving a hemorrhoid, such as Figure 8 4 , similar to the previously described embodiments. However, the device 400 includes a plunger 410 disposed at the proximal end of the housing 404, which is configured to be manually actuated by a medical professional. The plunger 410 has a handle portion on the outside of the device 400 and an internal portion that fits into the interior of the device 400 along the axis L, such that pulling the handle portion proximally along the axis L applies a partial vacuum to the interior of the device and the distal end of the tube 412. The body 404 serves as a handle for the device 400 and includes a viewing port 420, with a viewing shaft extending through the tube 412 so that the surgeon can observe the ligation process. The body 404 has a trigger 406 for actuating the band deployment mechanism and releasing the ligation band 440 loaded on the tube 412.

[0047] In one embodiment, the band deployment mechanism is similar to that of previously described devices and includes a carrier cord that deploys the bands when the cord is pulled along the exterior of tube 412. In an alternative embodiment, the band deployment mechanism is a simple tab or lever that is used to disengage the distal-most band 440 from the distal end of tube 412. In this alternative embodiment, multiple bands 440 can be preloaded onto device 400, however, after the first band 440 is deployed, the remaining bands are manually advanced distally to assume the deployed position.

[0048] In the ligation process, the doctor uses, for example, the power light 418 on the distal end of the pipe 412 to illuminate the target tissue and locate the hemorrhoid through the viewing port 420. The power light 418 in the present embodiment can be, for example, battery-powered. With the distal end of the pipe 412 near the hemorrhoid, the doctor can manually actuate the plunger 410 (which has a handle that stays outside the patient's body) to apply vacuum and to aspirate the hemorrhoid into the pipe 412. Once the hemorrhoid is aspirated into the pipe 412, the doctor actuates the trigger 406 so that the ligature 440 is applied to the hemorrhoid. The doctor then releases vacuum and removes the device 400 from the patient. The doctor can manually advance the second ligature 440 to the distal end of the pipe 412 and repeat the process to treat any remaining hemorrhoid.

[0049] In the fifth embodiment, the ligation device 500 is a single-use disposable device comprising a hollow tube 512 with a flexible slider 550 disposed along a substantial portion of the exterior of the tube 512. Figure 9 As shown. The plunger 510 is provided at the proximal end of the tube 512. Figure 10As shown, the device 500 is used to draw a partial vacuum within the tube to draw the target tissue into the tube 512. The plunger 510 may include two finger rings 514 and a thumb ring 516 for the user to draw the target tissue into the tube 512. A pusher 562 on the distal end of the flexible slider 550 is operable to push the ligature 540 away from the distal end of the tube 512 and onto the base of the target tissue that has been drawn into the tube. The proximal end of the slider 550 is manually pushed from the proximal portion of the tube 512 outside the patient's body and distally along the tube 512, pushing the pusher 562 against the ligature 540. Once the ligature is applied, the partial vacuum can be released and the hemorrhoid can be released from the tube 512. The device 500 can be manually reloaded with additional ligatures 540 to treat additional tissue. The device 500 does not include a viewing feature, but can be used in conjunction with an anoscope to visualize the procedure. Figure 9 Section AA depicts a cross section of the proximal end of the flexible slider 550, while Figure 9 Section BB depicts a cross section of the distal end of the flexible slider 550 .

[0050] It will be appreciated by those skilled in the art that the above-described embodiments may be modified without departing from the scope of the present invention. It will also be appreciated that the structural features and methods associated with one of the embodiments may be incorporated into other embodiments. Therefore, it will be appreciated that the present invention is not limited to the specific embodiments disclosed, but encompasses modifications within the scope of the invention as defined by the appended claims. Combinations of the above-described embodiments and other embodiments not specifically described herein will be apparent to those skilled in the art upon reading the above description. Therefore, the scope of the various embodiments includes any other application using the above-described compositions, structures, and methods.

[0051] Some embodiments may be described using the expressions "coupled" and "connected," along with their derivatives. These terms are not synonymous with each other. For example, some embodiments may be described using the terms "connected" and / or "coupled" to indicate that two or more elements are in direct physical or electrical contact with each other. However, the term "coupled" may also mean that two or more elements are not in direct contact with each other, but still cooperate or interact with each other.

[0052] As used herein, the singular forms "a", "an", and "an" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms "comprising" and / or "including" or "having" and / or "having" when used herein specify the presence of stated features, regions, steps, elements, and / or components, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components, and / or groups thereof.

[0053] In addition, the terms "substantially" or "essentially" and the terms "about" or "approximately" can be used interchangeably in some embodiments and can be described using any relevant measure acceptable to a skilled person. For example, these terms can be used as a comparison to a reference parameter to indicate a deviation that will still provide the intended function. Although not limiting, the deviation from the reference parameter can be, for example, less than 1%, less than 3%, less than 5%, less than 10%, less than 15%, less than 20%, etc.

Claims

1. A device comprising: a handle having a trigger; a distal portion comprising a hollow tube configured for receiving tissue therein, and a plunger assembled with the hollow tube and configured to slide longitudinally within the hollow tube to induce suction at a distal end of the hollow tube when the plunger moves proximally within the hollow tube, wherein the trigger is hingedly coupled to the plunger such that pulling the trigger slides the plunger proximally relative to the hollow tube to generate suction to draw the tissue into the distal end of the hollow tube; a tissue handling mechanism for surrounding the tissue received at the distal end of the hollow tube; an optical port extending from the handle; and An optical lens is disposed on a distal surface of the plunger for visualizing an area distal to the device, the optical lens being coupled to the optical port.

2. The apparatus of claim 1 , further comprising: An optical camera is used to observe the distal region via the optical lens, wherein the optical camera is coupled to the optical port for attachment to an endoscopic device.

3. The device of any one of claims 1-2, wherein the tissue treatment mechanism comprises a ligature deployment mechanism for releasing a ligature from the distal end of the hollow tube to contract around tissue received therein, wherein the tissue treatment mechanism comprises at least one ligature.

4. The device of claim 3, wherein the tie deployment mechanism comprises a carrier string having a portion extending longitudinally outside of the hollow tube and having a tie loaded around the hollow tube and the string.

5. The device of any one of claims 1-2, wherein the tissue processing mechanism comprises a snare mechanism for releasing a snare from the distal end of the hollow tube such that the snare severs the tissue received therein, wherein the tissue processing mechanism comprises at least one snare.

6. The device of claim 1, wherein the optical port is at a proximal end of the handle, and the optical port and optical lens are configured to allow a user to directly observe target tissue adjacent to a distal end of the hollow tube through the hollow tube.

7. The device of claim 6, wherein the optical port is concentric with the plunger.

8. The device of claim 1, wherein the plunger is slidably received within the hollow tube.

9. The apparatus of claim 2, further comprising a light source located at a distal end of the hollow tube, the light source configured to provide illumination to an area within a field of view of the optical camera.

10. A device comprising: a hollow housing comprising a trigger, a viewing port, and a distal tube for receiving tissue therein through an open distal end; and a plunger disposed at a proximal end of the housing for inducing suction at the open distal end, wherein the plunger is coupled to the viewing port and includes an optical lens disposed at the distal end of the plunger, wherein the viewing port is concentric with the plunger such that the viewing port extends cylindrically around the plunger and allows viewing distally through the hollow housing and exteriorly of the distal tube; wherein the plunger is movable within the viewing port and a line of sight from the viewing port to the exterior of the distal end of the plunger is maintained, and The trigger actuates a ligature deployment mechanism configured to release the ligature from the open distal end to contract around the received tissue.

11. The device of claim 10, wherein the tie deployment mechanism includes a carrier string having a portion extending longitudinally outside of the hollow housing, and the tie is loaded around the hollow housing and the string.

12. The device of claim 11, wherein when the ligature band deployment mechanism is actuated, the portion of the carrier string on the exterior of the hollow housing moves distally, the movement of the carrier string bringing the loaded ligature band to the distal end of the hollow housing.

13. The device of claim 12, wherein the ligature deployment mechanism comprises one of a ratchet, a gear, or a pulley for moving the carrier tether distally.

14. The device according to claim 10 further includes a hinge mechanism configured to move the plunger proximally relative to the hollow housing, wherein the hinge mechanism has a U-shape to avoid covering the viewing axis of the viewing port, and wherein the viewing port has a slot to allow the hinge mechanism to move proximally and distally within the viewing port.

15. The apparatus of claim 14, wherein there is no camera coupled to the optical lens or viewing port.

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