Methods and devices for endoscopic resection

Abstract

A device for performing endoscopic resection comprising at least two members (including a piercing tip and optionally a stopper), and a coiled central portion connecting the at least two members. A first member is attached to one mucosal margin of a lesion, and a second member is attached to the other mucosal margin of the catheter. The device is released and the central portion is allowed to coil, thereby pulling the first and second members together to shrink and compress the lesion, thereby reducing at least one dimension of the lesion. A deployment catheter for releasing the device onto the lesion, the deployment catheter comprising an outer catheter and an inner catheter with a mechanism for delivering the resection device.

Description

[0001] Citation of relevant applications

[0002] This application claims priority to U.S. Provisional Application No. 62 / 957,954, filed January 7, 2020, entitled “Method and Apparatus for Endoscopic Resection,” the entire contents of which are incorporated herein by reference. Technical Field

[0003] This specification generally relates to the field of endoscopic examination. More specifically, this specification relates to an apparatus and method for performing endoscopic resection. Background Technology

[0004] Endoscopic mucosal resection (EMR) or endoscopic full-thickness resection (EFTR) is a surgical procedure used to remove early-stage cancer and precancerous growths from the inner lining of the digestive tract. Endoscopic mucosal or full-thickness resections are typically performed using a long, narrow tube equipped with a light and camera. During EMR or EFTR in the upper digestive tract, the clinician inserts an endoscope down through the patient's throat into the esophagus, stomach, or upper part of the small intestine (duodenum). To reach the colon, the clinician may guide a catheter up through the anus. The clinician then inserts instruments through the catheter to perform various resection procedures.

[0005] EMR or EFTR is typically used to treat health conditions or to collect tissue samples during diagnostic procedures. EMR or EFTR is a less invasive alternative to surgery for removing abnormal tissue from the digestive tract or its lining. Summary of the Invention

[0006] The following embodiments and features are described and illustrated in conjunction with systems, tools, and methods, and are merely exemplary and illustrative, and do not constitute a limitation on the scope of the invention. This application discloses numerous embodiments.

[0007] This specification discloses an apparatus for endoscopic resection, the apparatus comprising: a first member, wherein the first member includes at least one first puncture tip for puncturing a first location on a lesion in a patient's body; a second member, wherein the second member includes at least one second puncture tip for puncturing a second location on a lesion in a patient's body; and a central portion having a first end and a second end, wherein the first member is attached to the first end of the central portion, the second member is attached to the second end of the central portion, wherein the central portion is configured to deform from a first straight shape to a second coiled shape, wherein, when the apparatus is attached to the lesion, the at least one first member is configured to grasp the first location, the at least one second member is configured to grasp the second location, and the central portion is configured to deform from the first straight shape to the second coiled shape to contract, thereby compressing the lesion and reducing at least one size of the lesion.

[0008] Optionally, the first component and the second component each include a hook.

[0009] Optionally, the device further includes a deployment conduit configured to include the device and maintain the central portion in a first straight-line configuration. Optionally, the central portion is configured to deform into a second coiled configuration upon exiting the deployment conduit.

[0010] Optionally, the central portion includes at least one of a spring, a coil, or an elastic band.

[0011] Optionally, the central portion includes a shape memory material. Optionally, the shape memory material is a nickel-titanium alloy.

[0012] Optionally, the first position is located around the edge of the lesion, opposite to the second position.

[0013] Optionally, the device further includes a third component, wherein the third component includes at least one third puncture tip for puncturing a third location on a lesion within the patient's body. Optionally, the first location, the second location, and the third location are equidistantly spaced around the edge of the lesion.

[0014] This specification also discloses a method for performing endoscopic resection, the method comprising: providing a resection device comprising: a first member, wherein the first member includes at least one first puncture tip for puncturing a first location on a lesion in a patient's body; a second member, wherein the second member includes at least one second puncture tip for puncturing a second location on a lesion in a patient's body; a central portion having a first end and a second end, wherein the first member is attached to the first end of the central portion, the second member is attached to the second end of the central portion, wherein the central portion is configured to deform from a first straight shape to a second coiled shape; and a deployment catheter configured to include the device and maintain the central portion in the first straight shape; extending the resection device from a distal end of the deployment catheter such that the at least one first puncture tip is inserted into the first location; retracting the catheter such that the resection device is pulled across the lesion, and the at least one second puncture tip of the second member is inserted into the second location; and removing the catheter and releasing the central portion across the lesion to allow the central portion to deform from the first straight shape to the second coiled shape, thereby compressing the lesion and reducing at least one size of the lesion. Optionally, the method further includes using submucosal injection to lift the lesion away from the patient's muscle layer. Optionally, the method further includes using an electrosurgical device to remove the lesion. This electrosurgical device may be a needle / knife.

[0015] Optionally, the deployment catheter further includes a lumen through which fluid can be injected into or near the lesion. Optionally, the fluid is hot saline, and the temperature of the hot saline is between 50°C and 100°C.

[0016] Optionally, the method further includes at least one stop located near the first member or the second member, wherein at least one dimension of the at least one stop is greater than the diameter of the first member or the second member.

[0017] Optionally, the central portion includes at least one of a spring, a coil, an elastic band, or a shape memory material. The shape memory material may be a nickel-titanium alloy.

[0018] This specification also discloses a method for endoscopic resection, the method comprising: pushing an anchor out of a deployment catheter and placing a first hook on a first edge of the lesion; pulling the anchor across the lesion and placing a second hook on a second edge of the lesion; releasing the anchor across the lesion to allow the central portion or coil to retract, thereby pulling the first hook and the second hook together so that the two edges of the lesion are closer together.

[0019] Optionally, the method further includes lifting the lesions using a ligator, needle knife, or any other suitable excision technique when the lesions are clustered together.

[0020] Optionally, the method may also include using submucosal injection of saline or another lifting agent to lift the lesion.

[0021] This specification also discloses a distal attachment cap for endoscopic resection and capable of being connected to the distal end of an endoscope, the distal attachment cap comprising: two electrocautery wires connected to a distal opening of an insulating ring, sphere, or ball, wherein the insulating ring, sphere, or ball has a central opening for engagement with a catheter or electrosurgical scalpel / needle passing through a channel of the endoscope, wherein the catheter is capable of manipulating the ring, sphere, or ball to improve contact between the cutting wires and the target tissue.

[0022] Optionally, the cutting line is connected to a high-frequency electrocautery device.

[0023] Optionally, the cutting line has a slack, and the ring, sphere, or ball can extend a distance of 1 mm to 50 mm.

[0024] Optionally, the ring is offset from the center of the distal opening and configured to align with the endoscope's channel.

[0025] Optionally, one cutting line is the anode and the second cutting line is the cathode.

[0026] Alternatively, the cutting line may function as an anode or cathode, while the conduit may function as the opposite electrode.

[0027] Optionally, the cutting wire operates as an anode or cathode, while the electrosurgical scalpel / needle operates as the opposite electrode.

[0028] This specification also discloses a device having multiple hooks and an expandable intermediate or central portion. In an embodiment, a first hook may be attached to one mucosal edge of a lesion, and a second hook may be attached to another mucosal edge of a catheter to allow a connector between the two hooks to contract and compress the lesion, thereby reducing the size of the lesion (or “aggregating” the lesion). In one embodiment, the device generates a pulling force from the periphery of the lesion toward the center of the lesion, thereby tightening the lesion. The lesion can then be removed using an electrosurgical device. Optionally, a submucosal injection may be used to lift the lesion away from the muscle layer. Optionally, the electrosurgical device may be a ligator. Optionally, the electrosurgical device may be a ligator or any electrosurgical instrument known in the fields of needle / knife or endoscopic surgery. Optionally, the intermediate or central portion is a spring, coil, or elastic band or any other type of expandable portion configured to pull the periphery of the lesion toward the center of the lesion. Optionally, at least one stop is located on the hook, wherein at least one dimension of the stop is larger than the diameter of the hook line. Optionally, the stop is at least partially made of a magnetic or ferromagnetic material.

[0029] This specification also discloses a distal attachment cap reversibly attached to the distal end of an endoscope having one or more electrocautery wires connected to a distal opening of the distal attachment cap with an insulating ring, sphere, or ball, wherein the insulating ring, sphere, or ball has a central opening for engagement with a catheter or electrosurgical scalpel / needle passing through a channel of the endoscope, wherein the catheter is configured to manipulate the ring, sphere, or ball to improve contact between the cutting wire and target tissue; and wherein the cutting wire is connected to a high-frequency electrocautery device. Optionally, the scalpel / needle or catheter has a manipulable end with one or more degrees of freedom of movement. In embodiments, the cutting wire is extendable, such that the ring, sphere, or ball can extend from 1 mm to 50 mm. Optionally, the ring is offset from the center of the distal opening to align with the biopsy channel of the endoscope. Optionally, the size, shape, and arrangement of the ring, sphere, or ball do not significantly interfere with visualization using the endoscope. Optionally, the first cutting line is the anode, and the second cutting line is the cathode. Optionally, the cutting line functions as either the anode or cathode, while the catheter functions as the opposite electrode. Optionally, the cutting line functions as either the anode or cathode, while the electrosurgical scalpel / needle functions as the opposite electrode. Optionally, a grounding pad mounted on the skin surface serves as the opposite electrode to the scalpel / needle and / or the cap. Optionally, the catheter has an inner lumen for injecting fluid into the tissue. Optionally, the fluid is hot saline solution, wherein the temperature of the saline solution is between 50°C and 100°C.

[0030] Optionally, the scalpel / needle or cap delivers electrosurgical radiofrequency energy at a frequency greater than or equal to 1 kHz, which is combined with nerve stimulation pulses at a frequency less than 1 kHz. The electrosurgical pulses contain higher energy than the nerve stimulation pulses.

[0031] This specification also discloses a strangler removal device having one or more integrated magnetic or ferromagnetic elements. In various embodiments, the magnetic or ferromagnetic elements are fixed to a metal wire of the strangler removal device or are freely movable. In various embodiments, the polarities of the magnetic or ferromagnetic elements are arranged such that each magnetic / ferromagnetic element repels adjacent magnetic / ferromagnetic elements, so that these elements do not aggregate together on the strangler, thereby preventing aggregated elements from blocking the opening and closing function of the strangler. In various embodiments, the magnetic / ferromagnetic elements are designed to engage with the magnetic or ferromagnetic elements of a retraction hook and coil (anchor) device.

[0032] The above-described embodiments and other embodiments of the present invention will be described in more detail with reference to the accompanying drawings and the following detailed description. Attached Figure Description

[0033] These features and advantages, as well as other features and advantages, can be better understood from the following detailed description with reference to the accompanying drawings. In the drawings:

[0034] Figure 1 This specification illustrates a cutting device utilizing anchorage achieved by a first component and a second component, as shown in an embodiment of the present specification.

[0035] Figure 2A The use of one embodiment shown in this specification is as follows: Figure 1 The method of the cutting device having a first component and a second component or a retractable hook includes multiple steps;

[0036] Figure 2B This is one embodiment of the present specification. Figure 2A A flowchart of the multiple steps of the method;

[0037] Figure 3 An embodiment of the resection device design used in the embodiments of this specification is shown;

[0038] Figure 4 An embodiment of the delivery conduit used in the embodiments described in this specification is shown;

[0039] Figure 5 The resection device mounted on the inner catheter of the delivery device is shown in the embodiments described in this specification;

[0040] Figure 6 Two resection devices applied across the lesion are shown in the embodiments described in this specification;

[0041] Figure 7 Various resection devices used in the embodiments described herein are shown;

[0042] Figure 8 The dimensions of an exemplary cutting device used in the embodiments described in this specification are shown;

[0043] Figure 9 The dimensions of exemplary cutting devices used in other embodiments of this specification are shown;

[0044] Figure 10A The three-component or hook-type cutting device used in the embodiments described herein is shown;

[0045] Figure 10B The three-component or hook-type cutting device used in other embodiments of this specification is shown;

[0046] Figure 10C This is a flowchart of several exemplary steps of a method for deploying a three-component or hook-type cutting device according to some embodiments of this specification;

[0047] Figure 11 Examples of various piercing components or hooks used in the embodiments described in this specification are shown;

[0048] Figure 12 Examples of various non-piercing components or hooks used in the embodiments described in this specification are shown;

[0049] Figure 13 An embodiment of a component or hook with an insulating coating used in the embodiments described in this specification is shown;

[0050] Figure 14 An embodiment is shown for a central portion used to engage at least two components or hooks and to provide elasticity for aggregated lesions;

[0051] Figure 15 The embodiments shown in this specification illustrate the connection between at least two components or hooks and at least one central portion or coil;

[0052] Figure 16 The resection device used in the embodiments described herein is shown;

[0053] Figure 17 Various embodiments of connectors that can be used to connect components or hooks and central portions or coils are shown in the examples described in this specification;

[0054] Figure 18 An exemplary configuration of the electrosurgical device used in the embodiments described in this specification is shown;

[0055] Figure 19A An exemplary configuration of the electrosurgical scalpel used in the embodiments described herein is shown;

[0056] Figure 19B This is a longitudinal cross-sectional view of a heating chamber including an assembled first electrode and a second electrode, according to some embodiments of this specification.

[0057] Figure 20A The excision device used in the excision procedure is shown in the embodiments described in this specification;

[0058] Figure 20B This is one embodiment of a magnetic detonator device configured to operate in conjunction with the cutting device described in this specification;

[0059] Figure 20C This specification illustrates an embodiment of a magnetic debridement device used in conjunction with a resection apparatus to remove lesions;

[0060] Figure 20D Some embodiments described in this specification will be used in resection surgery. Figure 20A A flowchart of several exemplary steps of a method for using a strangulation device in combination with a cutting device;

[0061] Figure 20E Some embodiments described in this specification will be used in resection surgery. Figure 20B A flowchart of several exemplary steps of a method for using a magnetic detonator device in combination with a three-component or hook-type cutting device;

[0062] Figure 20F A variable-size strangulation device is shown for use in conjunction with the excision device described in this specification;

[0063] Figure 21 The submucosal resection procedure using a resection device is illustrated in the embodiments of this specification;

[0064] Figure 22 This is a schematic diagram of a directional grounding cap used in conjunction with the embodiments described in this specification;

[0065] Figure 23 The embodiments shown herein are used in conjunction with the examples described herein. Figure 22 The function of the directional grounding cap is shown;

[0066] Figure 24 An embodiment of a bipolar cap excider used in conjunction with the embodiments in this specification is shown; and

[0067] Figure 25 Another embodiment of the bipolar cap excider used in conjunction with the embodiments in this specification is shown. Detailed Implementation

[0068] This specification relates to an apparatus and method for performing endoscopic resection (ER) or endoscopic full-thickness resection (EFTR) of a lesion. This specification discloses a resection apparatus utilizing anchoring achieved by a first member and a second member. The first and second members are joined by a central portion configured to coil upon deployment, thereby pulling the first and second members together on the tissue portion of the lesion already grasped within the body, thereby contracting and compressing the lesion and reducing at least one size of the lesion. This ability to gather or tighten the lesion makes it easier to remove the lesion using a strangulation device or electrocautery.

[0069] This specification relates to several embodiments. The purpose of the following disclosure is to enable those skilled in the art to practice the invention. The language used in this description should be understood as it is meant herein and should not be construed as excluding any particular embodiment or limiting the appended claims. The general principles defined herein also apply to other embodiments and applications without departing from the spirit and scope of the invention. Moreover, the terminology and expressions used are for illustrative purposes only and should not be construed as restrictive. Therefore, the invention should be understood in the broadest sense, encompassing numerous alternatives, modifications, and equivalents consistent with the disclosed principles and characteristics. For clarity, details of technical materials well-known in the art related to this invention have not been described in detail to avoid obscuring the invention.

[0070] In the specification and claims of this application, each of the terms "comprising," "including," and "having," and their various forms, is not necessarily limited to the members of the list associated with that term. It should be noted that, unless explicitly stated otherwise, any feature or component described in connection with a particular embodiment may be used and implemented in any other embodiment.

[0071] Figure 1 An embodiment of the resection device 100 anchored by a first component 102a and a second component 102b is illustrated in this specification. In an embodiment, the first component 102a and the second component 102b include retraction hooks. In an embodiment, the first and second components or the retraction hooks 102a, 102b can be deployed using a conduit structure 105. In an embodiment, the conduit 105 includes an inner conduit 106 and an outer conduit 107, the inner conduit 106 being configured to hold and deploy the resection device 100, and the outer conduit 107 coaxially covering the inner conduit 106 and for delivering the inner conduit 106 and the resection device 100 to the target tissue. The outer conduit 107 includes a distal end and an outer surface to prevent damage and retracts when placed near the target tissue to expose the inner conduit 106 and the resection device 100.

[0072] In an embodiment, the first and second components, or each retraction hook 102a, 102b, include a puncture tip 103 for piercing body tissue. In an embodiment, the first component or retraction hook 102a is positioned on a first end or distal end 112 of the central portion 104 (e.g., a coil) of the device 100, while the second component or retraction hook 102b is positioned on a second end or proximal end 113 of the central portion. The components or retraction hooks 102a, 102b are configured to act as anchors when wound around the central portion 104, thereby pulling the two pierced ends of the tissue together. In an embodiment, the first and second components or retraction hooks 102a, 102b also include a stop 108 located between the puncture tip 103 and the central portion 104 to provide a stopping point for piercing the tissue. Optionally, at least one stop 108 is arranged on each hook 102a, 102b, wherein at least one dimension of the stop 108 is larger than the diameter of the hook line 109. In some embodiments, the diameter of the stop 108 is in the range of 0.5 to 5 mm. In some embodiments, the length l of the retraction hooks 102a, 102b from one end of the stop 108 adjacent to the central portion 104 to one end of the puncture tip 103 opposite to the end of the stop is in the range of 1 to 10 mm. In some embodiments, the stop 108 is composed of ferromagnetic or magnetic elements. The magnetic elements may be rare earth magnets. In embodiments, the stop 108 is coated with an insulating layer, such as a ceramic layer or PTFE. The resection device 100 is mounted on an internal catheter 106 having mechanisms for deploying and positioning the two retraction hooks 102a, 102b into one or more target regions within an organ.

[0073] Figure 115 shows the resection device 100 in a first fully extended straight shape. After the second member or retraction hook 102b grasps or engages a second portion of body tissue (e.g., a lesion) and the central portion 104 is fully coiled, the resection device 100 transforms from the first fully extended straight shape shown in Figure 115 to a second fully coiled shape shown in Figure 117. Figure 116 shows the resection device 100 during deformation into a partially coiled or bent shape, where the first member or retraction hook 102a grasps or engages a first portion of body tissue or lesion and is deployed from the inner catheter by a coil. In an embodiment, the length of the resection device 100 is reduced by 10% to 90% as it transitions from the first fully extended straight shape shown in Figure 115 to the second fully coiled shape shown in Figure 117. Figure 118 shows the resection device 100 mounted on the inner catheter 106 of the catheter structure 105. In an embodiment, the resection device 100 (especially the central portion 104) has shape memory properties to facilitate changes in shape. In some embodiments, the ablation device 100 or only the central portion 104 is made of a nickel-titanium alloy. In some embodiments, the ablation device 100 or only the central portion 104 is made of a thermosensitive material that changes shape when exposed to a specific temperature (e.g., normal human body temperature). In some embodiments, the central portion 104 is made of an elastic material, such as silicone, latex rubber, or latex-free nitrile.

[0074] Figure 2A The use of, as shown Figure 1 The method 200 of the cutting device having a first component and a second component or a retractable hook comprises multiple steps, while Figure 2B This is a flowchart of the multiple steps of method 200 according to one embodiment of this specification. Please refer to it now. Figure 2A and 2B In step 222, the cutting device 200 (including Figure 1The first and second components or retraction hooks 102a, 102b and the central portion 104) extend from the distal end of the deployment catheter 205, and the first component or retraction hook 202a pierces or grasps the first portion or edge 220a of the lesion 220 at a first position. In step 224, the catheter 205 is retracted such that the resection device 200 is pulled across the lesion 220, and the second component or retraction hook 202b pierces or grasps the second portion or edge 220b of the lesion 220 at a second position. In an embodiment, the second position is on the opposite edge of the lesion 220 relative to the first position. In step 226, the catheter 205 is removed and the resection device 200 spanning the lesion 220 is released to allow the central portion or coil 204 to retract and pull the first component or retraction hook 202a and the second component or retraction hook 202b together, so that the two edges 220a, 220b of the lesion 220 are brought closer together and the edges 220a, 220b of the lesion 220 are pulled toward the center of the lesion 220, thereby reducing at least one size of the lesion 220.

[0075] Figure 3 An embodiment of the resection device design used in the embodiments described herein is illustrated. In one embodiment, the resection device 302 includes a first component or retraction hook 304 located at a first end of the resection device 302 and a second component or retraction hook 306 located at a second end of the resection device 302 opposite to the first end. The first component or retraction hook 304 includes a first puncture tip 307 and a first stop 308, and the second component or retraction hook 306 includes a second puncture tip 309 and a second stop 310. The two components or hooks 304, 306 are connected by a central portion 312, which includes a coil made of a shape memory material (e.g., a nickel-titanium alloy). In another embodiment, the resection device 303 includes a first component or retraction hook 304 located at a first end of the resection device 302 and a second component or retraction hook 306 located at a second end of the resection device 302 opposite to the first end. The first component or retraction hook 304 includes a first piercing tip 307 and a first stop 308, and the second component or retraction hook 306 includes a second piercing tip 309 and a second stop 310. These two components or hooks 304, 306 are connected by a central portion 313, which includes a resilient connector made of silicone, latex rubber, or latex-free nitrile. In an embodiment, the stop 308 is made of ceramic, PTFE, silicone, glass, SST, nickel-titanium alloy, or a ferromagnetic or magnetic material (e.g., rare-earth magnet). In an embodiment, the diameter of the stop ranges from 0.5 to 5 mm.

[0076] Figure 4An embodiment of the delivery catheter used in the embodiments described in this specification is shown. In the embodiment, the delivery catheter 400 includes an inner catheter 402 and an outer catheter 404. In the embodiment, the distal end 412 of the inner catheter 402 includes at least one first groove 408 configured to engage with a first member or retraction hook 422 of the resection device 420 to secure a first end of the resection device 420. The inner catheter 402 also includes a slit 414 extending proximally from the at least one first groove 408 and at least one second groove 409, the slit 414 being configured to slidably receive a first member or retraction hook 422, a second member or second retraction hook 424 and / or a portion of a central portion 421 of the resection device 420, the second groove 409 being located at the end of the slit 414 and configured to engage with a second member or retraction hook 424 of the resection device 420 to secure a second end of the resection device 420 opposite to the first end. In one embodiment shown in the inner catheter 402, the at least one first groove 408 is located at the end of the distal end 412 of the inner catheter 402. In another embodiment shown in the inner catheter 428, the at least one first groove 418 is located on one side of the distal end 412 of the inner catheter 428.

[0077] Figure 5 A cutting device 500 is shown mounted on an inner catheter 502 of a catheter delivery device in another embodiment. In one embodiment, the cutting device 500 is pre-mounted onto the inner catheter 502. In one embodiment, the circular profile of the inner catheter 502 accommodates a stop 508 of the cutting device 500, while a central portion 506 surrounds the inner catheter 502. A slit 504 is provided along the length of the inner catheter 502 to slidably receive and accommodate at least a portion of the central portion 506. The slit 504 allows the central portion 506 to slide along the inner catheter 502, such that it can be pushed out from an outer catheter (e.g., Figure 4 (As shown by reference numeral 404 in the attached drawing). The slit 504 has a hook-like structure 510 at one end to prevent accidental slippage of the central portion 506. The hook-like structure 510 of the slit 504 also allows the first and second components or retraction hooks 512a, 512b on the end of the central portion 506 of the cutting device to be hooked and pulled.

[0078] Figure 6 The use of two cutting devices 610a, 610b (each including) is shown. Figure 1The first and second components, or retraction hooks 102a, 102b and central portion 104, are removed, and these two resection devices are applied across the lesion 612 in the pre-deployment configuration 620 and post-deployment configuration 625 as used in the embodiments of this specification and as described with reference to FIG2. After the lesion 612 is "aggregated" or its size is reduced, the lesion 612 is removed using a ligator 630 or a needle knife or any other suitable resection technique. Furthermore, in embodiments, the lesion 612 can be lifted using a submucosal injection of saline or another lifting agent. In the case of endoscopic dissection, the resection margin of the lesion 612 is pulled toward the center of the lesion 612, thereby lifting the resection margin to move it from the resection point toward the center of the lesion 612, thereby exposing the anatomical plane for access to further dissection.

[0079] Figure 7 The first, second, third, and fourth configurations 700a, 700b, 700c, and 700d of the resection device used in the embodiments described herein are shown.

[0080] Figure 8 Exemplary dimensions of the cutting device 800 used in embodiments described herein are shown. In an embodiment, the cutting device 800 has a total length ranging from 5 to 35 mm, while in a fully wound configuration after deployment, the length of the central portion 804 ranges from 5 to 25 mm. In an embodiment, the central portion 804 has a width of 2 to 10 mm when in a fully wound configuration after deployment. In an embodiment, the length of a single turn of the coil 805 ranges from 0.2 to 1.5 mm when the cutting device 800 is in a fully wound configuration after deployment. In an embodiment, each stop 808 has a diameter ranging from 0.5 to 10 mm. In an embodiment, each component or retraction hook 802 (including a stop and a puncture tip 803) has a length of 3 to 20 mm measured extending from the central portion 804.

[0081] Figure 9Exemplary dimensions of the cutting devices 900 and 920 used in other embodiments of this specification are shown. In an embodiment, when in a fully wound configuration after deployment, the cutting device 900 has a total width De ranging from 3 to 20 mm and is configured to fit within a space having a height H ranging from 3 to 25 mm. The cutting device 900 has a length L0 ranging from 5 to 35 mm from the inner surface of the first member or retraction hook 902a to the inner surface of the second member or retraction hook 902b. In an embodiment, when the cutting device 905 is in a fully wound configuration after deployment, the length d of a single turn of the coil 900 is in the range of 0.2 to 1.5 mm. In an embodiment, the first member or retraction hook 902a is located in a first plane offset from the second plane, wherein the second member or retraction hook 902b is located at a 90-degree position. In an embodiment, the cutting device 920 has a total length L of 5 to 35 mm when in a fully wound configuration after deployment. When the cutting device is in its fully wound deployed configuration, the first component or retraction hook 922a and the second component or retraction hook 922b each have a height H extending from one end of the central portion 924 to the bent end of each hook 922a, 922b, the height H ranging from 1.5 to 15 mm. When the cutting device 920 is in its fully wound deployed configuration, a gap 925 exists between each end of the central portion and each puncture end 923 of each hook, and the gap 925 has a length G ranging from 1 to 10 mm. When the cutting device 920 is in its fully wound deployed configuration, the central portion 924 forms a coil with an outer diameter OD ranging from 3 to 35 mm.

[0082] As mentioned above Figure 1 As discussed in the embodiments, the resection device of this specification includes a member having a penetrating or sharp end for grasping or piercing an organ, or, in other embodiments, a member having a blunt end for engaging with the organ surface or defects in the organ surface. In all embodiments, the puncturing or blunt end anchors the member to the organ surface. In some embodiments, the blunt end may be placed within a defect created in the inner layer of the organ using a separate device or electrocautery technique. The resection device has a stop mechanism or stop on each hook that prevents the member or hook from being buried too deeply in the organ when the member or hook is pulled toward each other. The pulling action generates a tightening force rather than burying the hook too deeply, thereby avoiding perforation of the organ wall.

[0083] Figure 10AThe three-component or hook-type excision device 1000, 1020 used in embodiments of this specification are shown. Anchor 1000 includes three components or retractable hooks 1002, each component or retractable hook including at least one stop 1008 and a puncture tip 1003 for piercing target tissue or lesion portions in a first, second, and third position. In an embodiment, the first, second, and third positions are equidistantly spaced around the edge of the lesion. Each component or retractable hook 1002 is connected to a central connecting hub 1006 via a central portion 1004. In an embodiment, each central portion 1004 includes a resilient connector. Please refer to... Figure 10B and three In other embodiments, the component or hook-type cutting devices 1030, 1040, do not include a central connecting hub, and the ends of each central portion 1004 opposite to each component or hook 1002 are attached together, for example, by stitching, binding, gluing, or welding. Please refer again to Figure 10A The resection device 1020 includes three components or retraction hooks 1002, each component or retraction hook including at least one stop 1008 and a puncture tip 1003. Each component or retraction hook 1002 is connected to a central connecting hub 1007 via a central portion 1005. In an embodiment, each central portion 1005 includes a nitinol connector. In an embodiment, the central connecting hubs 1006, 1007 include ball-and-socket joints to allow articulation of the central portion 1004 of the resilient connector of the resection device 1000 and the hook 1002, or the central portion 1005 of the nitinol connector of the resection device 1020 and the hook 1002, relative to the central connecting hubs 1006, 1007. The hook 1002 is configured to reversibly engage with an internal component of a delivery catheter for positioning and repositioning the hook 1002 as needed.

[0084] Figure 10C This is a flowchart illustrating several exemplary steps of a method for deploying a three-component or hook-shaped resection device (e.g., device 1000, 1020, 1030, or 1040) according to some embodiments of this specification. In step 1050, the three-component or hook-shaped resection device extends from the distal end of the deployment catheter, and the first component or retraction hook grasps or penetrates a first edge or portion of the lesion or target tissue. In step 1052, the deployment catheter is moved laterally in a first direction and proximally, and the second component or retraction hook grasps or penetrates a second edge or portion of the lesion or target tissue. In step 1054, the deployment catheter is moved laterally in a second direction opposite to the first direction and proximally, and the third component or retraction hook penetrates a third edge or portion of the lesion or target tissue.

[0085] In step 1056, the deployment catheter is removed and the resection device spanning the lesion or target tissue is released to allow the first central portion, the second central portion, and the third central portion (each central portion connecting the first, second, and third components or retraction hooks to or attaching them together to the central connecting hub) to retract and pull the first, second, and third components or retraction hooks together, so that the first, second, and third edges or portions of the lesion or target tissue are closer together and the edges or portions of the lesion or target tissue are pulled generally toward the center of the lesion or target tissue.

[0086] Figure 11 Various embodiments of the penetrating or puncturing ends 1104a, 1104b, 1104c, 1104d of the components or retractable hooks 1102a, 1102b, 1102c, 1102d of the excision device according to some embodiments of this specification are shown. Each puncturing end includes at least one first sharp portion extending in a first direction and at least one second sharp portion extending in the opposite direction to create barbs 1106a, 1106b, 1106c, 1106d configured to pierce into body tissue. Each retractable hook 1102a, 1102b, 1102c, 1102d also includes at least one stop 1108a, 1108b, 1108c, 1108d.

[0087] Figure 12 Various embodiments of the components or retraction hooks 1202a, 1202b, 1202c, 1202d, 1202e, 1202f, 1202g, 1202h with non-penetrating or non-puncturing ends 1204a, 1204b, 1204c, 1204d, 1204e, 1204f, 1204g, 1204h used in the embodiments of this specification are shown. The non-penetrating or non-puncture tips 1204a, 1204b, 1204c, 1204d, 1204e, 1204f, 1204g, and 1204h include blunt tips 1209a, 1209b, 1209c, 1209d, 1209e, 1209f, 1209g, and 1209h configured to engage with an organ through an independent incision or defect created by different tools (e.g., an electrosurgical scalpel or a cauterization tip). The non-penetrating or non-puncture tips 1204a, 1204b, 1204c, 1204d, 1204e, 1204f, 1204g, and 1204h are configured to hold the hook in place within a defect or wall of the inner layer of tissue without penetrating the tissue. Please refer to [reference needed]. Figure 12 The components or retraction hooks 1202e, 1202f, 1202g, and 1202h each include at least one stop 1208. In some embodiments, the stop material or element is used to produce blunt ends 1209a, 1209b, 1209c, 1209d, 1209e, 1209f, 1209g, and 1209h.

[0088] Figure 13 An embodiment of a resection device component or retraction hook 1300 with an insulating coating 1302, used in the embodiments described herein, is shown. This embodiment prevents the transmission of electricity from electrosurgical instruments in contact with the resection device into the tissue and thereby prevents accidental tissue damage in and around the resection device.

[0089] Figure 14 A front-to-back cross-sectional view is shown of one embodiment of a central portion 1400 for engaging at least two components or retractable hooks of a resection device and providing elasticity to the convergent lesion. In this embodiment, the central portion 1400 includes a core 1402, which is preferably made of an elastic material, such as silicone, Teflon, rubber, or latex. A metal or alloy coil 1404 surrounds the core 1402. Finally, an elastic sleeve 1406 is provided around the elastic core / coil 1402, 1404. Preferably, the sleeve 1406 is made of an insulating material to insulate the coil 1400 from electrosurgical instruments.

[0090] Figure 15 A lateral cross-sectional view is shown of the connection between two components or retraction hooks 1502a, 1502b and a central portion 1504 of a cutting device 1500 according to some embodiments of this specification. In an embodiment, the central portion 1504 includes a core 1512, which is preferably made of an elastic material. A metal or alloy coil 1514 surrounds the core 1512. Finally, an elastic sleeve 1516 is provided around the elastic core / coil 1512, 1514. Preferably, the sleeve 1516 is made of an insulating material. In an embodiment, ball joints 1508a, 1508b are provided at each end of the central portion 1504 to attach the components or retraction hooks 1502a, 1502b and allow articulation of the components or retraction hooks 1502a, 1502b relative to the central portion 1504. In addition, the ball joints 1508a and 1508b are made of or covered with insulating material to electrically insulate the components or hooks 1502a and 1502b from the central portion 1504.

[0091] Figure 16A lateral cross-sectional view of a resection device 1600 according to some embodiments of this specification is shown. The resection device 1600 includes a central portion 1604 comprising a coil 1614 coated with an elastic material 1616. In one embodiment, ball joints 1608a, 1608b allow articulation of the member or retraction hooks 1602a, 1602b relative to the central portion 1604 in one or more directions within a range of 10 to 90 degrees. Advantageously, the long axes of the hooks 1602a, 1602b can rotate relatively freely relative to the long axis of the central portion 1604, which facilitates anchoring in different planes or directions on irregular surfaces of lesions or organs.

[0092] Figure 17 Various embodiments of connector 1708, as illustrated in this specification, are shown. Connector 1708 can be used to connect a component or hook 1702 to the central portion of a cutting device or coil 1704. In various embodiments, connector 1708 includes, but is not limited to, rod and ring (elbow) 1708a, hook 1708b, box hook 1708c, lobster claw 1708c, magnet 1708e, spring coil 1708f, screw 1708g, sliding lock 1708h, hinge clip 1708i, torsion clip 1708j, plug 1708k, ball socket 17081, sliding buckle 1708m, buckle 1708n, button buckle 1708o, spring lock (table buckle) 1708p, table buckle converter 1708q, table buckle combination 1708r, pull ring lock 1708s, button stud rivet 1708t, anchor hook ring 1708u, pop-out type 1708v, lock 1708w, and tube lock type 1708x connector.

[0093] Figure 18 An exemplary configuration of a system 1801 including an electrocautery unit (ESU) 1820 for use with the excision device 1800 in various embodiments of this specification is shown. The ESU 1820 provides an internal circuit 1821 for a monopolar device 1822 and an electrical path 1824 leading to a grounding pad 1826 on the skin 1828. In other embodiments, the ESU 1820 provides a bipolar system, wherein the electrical path runs from one electrode point in contact with one region of the target tissue to another electrode point in contact with another region of the target tissue. Initially deployed at the target lesion 1812. Figure 18The resection device 1800 comprises three components or retraction hooks 1802, each including a stop 1808 and a puncture tip 1803. The resection device 1800 also includes a central connecting hub 1807, and each component or retraction hook 1802 is connected to the central connecting hub 1807 via a central portion 1805 including a nickel-titanium alloy connector, similar to the resection device 1020 shown in Figure 10. The retraction hooks 1802 pull the edges of the lesion 1812 together and towards the center of the lesion 1812. The raised lesion 1812 is then cut off using a ligator or electrosurgical scalpel 1825. An ESU 1820 provides electrocautery to aid in the removal of the lesion 1812.

[0094] Figure 19A An exemplary configuration of an electrosurgical scalpel or needle knife 1900 for use with the resection device in the embodiments of this specification is shown. In an embodiment, an electrical connector 1902 is provided on an external conduit 1904. In an embodiment, the outer diameter of the external conduit ranges from 2 to 4 mm, and the length ranges from 110 to 450 cm. The electrosurgical scalpel or needle knife 1900 also includes a needle / knife 1906, which is coaxially deployed within the external conduit 1904 and can extend 1 mm to 10 mm beyond the distal end of the external conduit. In an embodiment, the needle / knife 1906 has a specification in the range of 28G to 16G. Optionally, the distal end of the external conduit and / or the proximal portion of the needle / knife 1906 are insulated to prevent damage to nearby non-target tissue. In an embodiment, an electrical connector 1902 is provided to connect the needle / knife 1906 to, for example... Figure 18The electrocautery unit (ESU) 1800 shown is used to apply electrocautery. An input port 1910 is provided for delivering a fluid, such as saline solution. An additional side port 1912 is provided for injecting additional fluid to deliver fluid through a second output port 1929 at the distal end of the outer conduit 1904 to cool the outer conduit 1904 or a tissue area. Heating chambers 1920 are arranged in a straight line within the outer conduit 1904 to heat the fluid delivered through the input port 1910 to a range of 50 to 100 degrees Celsius. The heating chambers 1920 can be deployed at any location along the length of the outer conduit 1904, from the conduit handle to the distal end of the outer conduit 1904. In some embodiments, the heating chamber 1920 includes a plurality of electrodes configured to receive current and heat the fluid flowing through the heating chamber, as described below. In some embodiments, the heating chamber 1920 is configured to heat fluid (provided from the input port 1910) to deliver it to or near the target tissue via a first output port 1927 at the distal end of the external conduit 1904 to assist the resection process. The heating chamber 1920 is configured to heat the fluid / saline solution while ensuring that the fluid / saline solution does not evaporate. In an embodiment, the external conduit 1904 includes at least one first cavity for delivering a first fluid (saline solution) provided through the input port 1910 and heated by the heating chamber 1920, at least one second cavity 1924 for delivering a second fluid provided from a side port for cooling, and a wire 1926 for delivering current to the needle / knife 1906.

[0095] The at least one first lumen 1920 is in fluid communication with an input port 1910 and a first output port 1927 located at the distal end of the external conduit 1904. The at least one second lumen 1924 is in fluid communication with a side port 1912 and a second output port 1929 located at the distal end of the external conduit 1904. A wire 1926 is in electrical communication with an electrical connector 1902 and a needle / blade 1906. The electrical connector 1902 is connected to the ESU to provide electrocautery through the needle / blade 1906.

[0096] Figure 19BThis is a longitudinal cross-sectional view of a heating chamber 1920 including assembled first electrode 136 and second electrode 138, according to some embodiments of this specification. Multiple electrodes configured as the first electrode array 136 and the second electrode array 138 respectively include metal rings 142, 144, and multiple electrode fins or elements 136', 138' extend radially and longitudinally from the metal rings 142, 144 along the longitudinal axis 150 of the heating chamber 1920. In other words, each of the electrode fins 136', 138' has a first dimension along the radius of the heating chamber 1920 and a second dimension along the longitudinal axis 150 of the heating chamber 1920. The electrode fins or elements 136', 138' define multiple segmented spaces 140 between them through which brine / water flows and is heated. Current is introduced from a controller into an outer conduit, through a first inner cavity, and to the electrodes 136, 138, causing the fins or elements 136', 138' to generate heat, which is then transferred to the brine to heat it. The first and second dimensions allow electrodes 136 and 138 to have increased surface areas for heating saline / water flowing in space 140. According to one embodiment, the first electrode 136 has a first polarity, and the second electrode 138 has a second polarity opposite to the first polarity. In one embodiment, the first polarity is negative (cathode), and the second polarity is positive (anode). Electrodes 136 and 138 (including rings 142 and 144 and fins or elements 136' and 138') are flexible to allow the distal portion or tip of the catheter to bend, thereby improving the positioning of the external catheter during resection.

[0097] like Figure 19B As shown, when assembling the heating chamber 1920, the electrode fins or elements 136', 138' interlock or cross each other (similar to the fingers of two clenched hands), such that the cathode and anode elements are arranged alternately, while the space 140 separates each cathode and anode element. In various embodiments, each space 140 has a distance of 0.01 mm to 2 mm from the cathode element to the anode element. In some embodiments, the first electrode array 136 has 1 to 50 electrode fins 136', preferably 4 electrode fins 136', while the second electrode array 138 has 1 to 50 electrode fins 138', preferably 4 electrode fins 138'. In various embodiments, the heating chamber 130 has a width w ranging from 1 to 5 mm and a length l ranging from 5 to 50 mm. In some embodiments, the heating chamber 1920 includes at least one sensor 137. In various embodiments, the at least one sensor 137 includes an impedance, temperature, pressure, or flow sensor, with pressure sensors being less preferred. In one embodiment, the impedance of electrode arrays 136 and 138 can be sensed. In other embodiments, the temperature of the fluid, the temperature of the electrode array, the flow rate of the fluid, pressure, or similar parameters can be sensed.

[0098] Figure 20A A strangulation device used in conjunction with a resection device during an excision procedure as illustrated in the embodiments of this specification is shown. The strangulation device 2020 extends through a channel 2023 of an endoscope 2024. The resection device 2000 is deployed to “aggregate” or “tighten” the lesion 2012. After the lesion 2012 has been “aggregated,” a submucosal injection 2028 of saline or another lifting agent known to those skilled in the art can be used to further lift the lesion 2012. Subsequently, the lesion 2012 is excised using the strangulation device 2020. An electric current is supplied to the ring 2021 of the strangulation device for removing the lesion 2012 by electrocautery. In some embodiments, the strangulation device used is similar to the strangulation device disclosed in U.S. Patent Application Publication No. US 2017-0007279 A1, the contents of which are incorporated herein by reference in their entirety.

[0099] In some embodiments, the strangulation device further includes magnetic or ferromagnetic elements for connection to one or more stops on the retraction hook, thereby securing a portion of the strangulation ring of the strangulation device to the retraction hook of the cutting device. In various embodiments, the magnetic or ferromagnetic elements are fixed to or freely movable along the metal wire of the strangulation ring of the strangulation cutting device. In various embodiments, the polarity of these magnetic or ferromagnetic elements is configured such that they repel adjacent magnetic / ferromagnetic elements, preventing them from pooling together on the strangulation device and thus preventing obstruction of the opening and closing function of the strangulation device. In various embodiments, the magnetic / ferromagnetic elements are designed to engage with the magnetic or ferromagnetic elements of the retraction hook.

[0100] Figure 20BThis is one embodiment of a magnetic buckler device 2030 configured to operate in conjunction with the excision device described in this specification. The buckler ring 2031 is made of a non-ferromagnetic material (e.g., nylon) or a nickel-titanium alloy. At least one first magnet 2032 is coaxially positioned on or attached to the metal wire of the buckler ring 2031 and is relatively fixed relative to the length of the buckler ring 2031. At least one second magnet 2033 is threaded through the buckler ring 2031 and is relatively movable relative to the length of the buckler ring 2031. The magnetic buckler device 2030 also includes at least one fixed non-ferromagnetic actuating element 2034, coaxially positioned on or attached to the buckler ring 2031 and positioned proximal to each movable magnet 2033, the actuating element 2034 being configured to push the movable magnet 2033 out of the body 2035 of the magnetic buckler device 2030. In one embodiment, the actuating element 2034 is a bead attached to the exterminator ring 2031, configured to push the movable magnet 2033 out of the body 2035 and prevent the movable magnet 2033 from moving proximally along the exterminator ring 2031. In some embodiments, at least one third magnet 2037 is attached to the exterminator sheath 2036. In various embodiments, the at least one third magnet is attached to the exterminator sheath 2036 or is detachable from the exterminator sheath 2036.

[0101] The polarities of the movable magnets 2033 are arranged such that the two movable magnets 2033 on the exterminator ring 2031 repel each other. The magnetic exterminator device 2030 includes an electrosurgical connector 2038 for connection to the ESU. The magnetic exterminator device 2030 is configured to deliver electrosurgical current from the electrosurgical connector 2038 to the exterminator ring 2031 via a metal wire 2040 extending through the magnetic exterminator device 2030, or to deliver alternative energy through the lumen 2039 of the exterminator sheath 2036. The magnetic exterminator device 2030 also includes a handle 2041 for actuating the device 2030. In an embodiment, the handle 2041 includes a first finger hole portion 2042 arranged coaxially around a second finger hole portion 2043 and slidable longitudinally within a slot 2044 of the second finger hole portion 2043. In one embodiment, sliding the first finger hole portion 2042 proximally while simultaneously moving the second finger hole portion 2043 distally closes the remover ring 2031.

[0102] Figure 20CThe embodiment of this specification illustrates the use of a magnetic excision device 2070 in conjunction with an excision device 2050 to excise a lesion. The excision device 2070 passes through a channel 2083 of an endoscope 2084. The excision device 2050 is deployed to "converge" or "tighten" the lesion 2092. The distal fixing magnet 2072 on the excision ring 2071 engages with the first ferromagnetic stop 2058a of the first component or retraction hook 2052a of the excision device 2050. This component or retraction hook 2052a is connected to a central connecting hub 2057 via a central portion 2054 or coil of the excision device 2050.

[0103] When the exterminator ring 2071 is opened, the two non-fixed magnets 2073a, 2073b engage with one or more ferromagnetic stops 2058b, 2058c on the second and third components or retraction hooks 2052b, 2052c of the exterminator device 2050. An optional actuating element 2074 is used to push the magnets 2073a, 2073b out of the exterminator body 2075 and hold them within 80% of the distal side of the exterminator ring 2071. Upon closing the exterminator ring 2071, the actuating element 2074 retracts into the exterminator body 2075 without significantly interfering with the function of the exterminator device 2070. Before and during the application of electrocautery or alternative excision energy, the metal wire of the excider ring 2071 slides relative to the moving magnets 2073a, 2073b, thereby further tightening the lesion 2092 while maintaining the position of the metal wire relative to the stop and the lesion. Before and during the application of electrocautery or alternative excision energy, the fixed magnet 2072 coupled to the distal ferromagnetic stop 2058a pulls the distal edge of the lesion 2092 toward the excider body 2075, thereby further tightening the lesion 2092.

[0104] Figure 20D Some embodiments described in this specification will be used in resection surgery. Figure 20A A flowchart of several exemplary steps of the method 2000d for using a strangulation device in combination with a cutting device. In various embodiments, the cutting device may be a device having two components or a retractable hook (as shown in reference). Figure 1 (as shown), or a device with three components or a retraction hook (as shown in reference). Figure 10A and 10B (As shown).

[0105] In step 2002d, the resection device is deployed to "aggregate" or "tighten" the lesion or target tissue. In some embodiments, after the lesion or target tissue has been "aggregated," it may be further lifted submucosally using saline or another lifting agent known to those skilled in the art. In some embodiments, the resection device is positioned by extending it from the distal end of the deployment catheter, and the device is manipulated to engage two or more retraction hooks of the device with two or more edges or regions of the lesion or target tissue. In some embodiments, the deployment catheter is passed through the passage of an endoscope.

[0106] In step 2004d, the deployment catheter is removed and the excision device is positioned such that the ring of the excision device surrounds the lesion or target tissue. In some embodiments, the excision device is deployed by passing it through the channel of an endoscope. In step 2006d, an electric current is passed through the ring of the excision device to remove the lesion or target tissue by electrocautery.

[0107] Figure 20E Some embodiments described in this specification will be used in resection surgery. Figure 20B A flowchart of several exemplary steps of a method 2000e using a magnetic excision device in combination with a three-component or hook-type resection device. In step 2030e, the three-component or hook-type resection device extends from the distal end of a deployment catheter, and the first component or retraction hook pierces a first edge or portion of the lesion or target tissue. In step 2032e, the deployment catheter is moved laterally in a first direction and proximally, and the second component or retraction hook grasps or pierces a second edge or portion of the lesion or target tissue. In step 2034e, the deployment catheter is moved laterally in a second direction opposite to the first direction and proximally, and the third component or retraction hook pierces a third edge or portion of the lesion or target tissue. In step 2036e, the deployment catheter is removed, and the resection device spanning the lesion or target tissue is released to allow the first, second, and third central portions (each central portion connecting the first, second, and third retraction hooks to or attaching them together to the central connecting hub) to retract and pull the first, second, and third retraction members or hooks together, such that the first, second, and third edges or portions of the lesion or target tissue are brought closer together, and the edges or portions of the lesion or target tissue are pulled generally towards the center of the lesion or target tissue. In step 2038e, the magnetic exciter device is passed through the endoscope channel. In step 2040e, the magnetic exciter is extended beyond the distal end of the endoscope, and the distal fixing magnet on the exciter ring engages with the first ferromagnetic stop of the first member or retraction hook.

[0108] In step 2042e, the magnetic remover ring is opened, and the first and second non-fixed magnets of the remover ring are engaged with the second and third members of the cutting device or the second and third ferromagnetic stops of the retraction hook, respectively. In some embodiments, the first and second non-fixed magnets are pushed out of the remover body using an optional pushing element, and the first and second non-fixed magnets are held in a position within 80% of the distal side of the remover ring.

[0109] In step 2044e, with the excision device engaged at the edge of the lesion or target tissue, the pushing element and the excision ring are retracted into the excision body, thereby closing the excision ring around the lesion or target tissue. The metal wire of the excision ring slides relative to the first and second non-fixed / movable magnets, thereby further tightening the lesion or target tissue. In step 2046e, current is passed through the ring of the excision device to excise the lesion or target tissue by electrocautery.

[0110] Figure 20F A variable-sized strangulation device 2100f is shown for use in conjunction with the excision device described in this specification. The strangulation device 2100f includes a handle 705 coupled to a strangulation sheath 715. The strangulation sheath 715 has a proximal end 716 coupled to the handle 705 and a distal end 717 coupled to a strangulation ring 710. Metal wires (e.g., a pair of metal wires 720 shown in the embodiment) are disposed within the strangulation sheath 715 such that the proximal end of the metal wires 720 extends from the proximal end 716 of the sheath 715 and connects to the handle 705, and the distal end of the strangulation wires 720 extends from the distal end 717 of the sheath 715 and connects to the strangulation ring 710. The strangulation sheath 715 and the metal wires 720 present in the strangulation sheath 715 are controlled by an operator via the handle 705.

[0111] In one embodiment, the remover ring 710 includes a first segment 761 and a second segment 762, wherein the distal ends of both segments 761 and 762 are coupled to a third segment 763. The proximal ends of the first segment 761 and 762 are coupled to a remover metal wire 720 disposed within a remover sheath 715. In one embodiment, the third segment 763 comprises nearly half the total circumference of the remover ring 710 and is substantially circular in shape. In one embodiment, the first segment 761 further includes multiple sub-segments, such as sub-segments 761a, 761b, and 761c, and the second segment 762 includes multiple sub-segments, such as sub-segments 762a, 762b, and 762c. In an embodiment, each sub-segment (e.g., 761a, 761b, 761c, 762a, 762b, and 762c) is coupled to other segments of the remover ring at a different angle 711. In one embodiment, the length and angular orientation of segment 761a are aligned with the length and angular orientation of segment 762a, the length and angular orientation of segment 761b are aligned with the length and angular orientation of segment 762b, and the length and angular orientation of segment 761c are aligned with the length and angular orientation of segment 762c. In an embodiment, the size of the exterminator ring 710 can be modified by extending or retracting portions of the first segment 761 and the second segment 762 within the sheath 715. In one embodiment, the size of the exterminator ring 710 can be modified in discontinuous steps to reduce the size of the exterminator ring 710 such that segments 761a and 762a are simultaneously retracted into the exterminator sheath 715. Similarly, segments 761b and 762b can be simultaneously retracted into the exterminator sheath 715 to further reduce the size of the exterminator ring 710. To further reduce the size of the exterminator ring 710, segments 761c and 762c are also retracted into the exterminator sheath 715. Since the corresponding segments (e.g., segments 761a and 762a) are aligned with each other in length and angular orientation, the exterminator ring 710 essentially retains its original shape as the size of the exterminator ring 710 is changed through discontinuous steps. In other words, due to the length and angular orientation of segments 761a, 761b, 761c, 762a, 762b, and 762c, as the size of the exterminator ring 710 is reduced through discontinuous steps, these gradually decrease the third segment 763 while still essentially maintaining the original shape of the ring 710.

[0112] In one embodiment, the buckler ring 710 is made of a shape memory alloy (e.g., a nickel-titanium alloy) and has two different stiffness levels over a certain temperature range. In one embodiment, the buckler ring 710 has a first stiffness level at temperatures below 30 degrees Celsius and a second stiffness level at temperatures above 30 degrees Celsius, wherein the second stiffness is greater than the first stiffness.

[0113] Figure 21A submucosal resection procedure using the resection device 2100, as described in this specification, is illustrated. In this embodiment, the resection device 2100 has been deployed on the lesion 2112. While resecting the edge 2113 of the lesion 2112, the central portion 2104 of the resection device 2100 is further wound (because the resected lesion edge 2113 is free and may be pulled back by a member or retraction hook 2102), thereby exposing the base 2114 of the lesion. As the edge 2113 is removed (in some embodiments, this is done using a scalpel or scissors 2120 via an endoscope 2122), the winding mechanism of the resection device 2104 lifts and retracts the anatomical edge 2113 of the lesion 2112 toward the center of the lesion 2112 and away from the anatomical point, thereby facilitating resection.

[0114] Figure 22 This is a schematic diagram of the directional grounding cap 2200 of the embodiment in this specification. Figure 23 It shows Figure 22 The directional grounding cap shown in the embodiments of this specification demonstrates its function. Please refer to... Figure 22 and 23 In one embodiment, multiple grounding electrodes 2202 are distributed around the circumference of a directional grounding cap 2200. The directional grounding cap 2200 also includes a grounding cable 2204 and a distal attachment cap 2206. In one embodiment, the directional grounding cap 2200 is electrically connected to an endoscope 2302 via the grounding cable 2204 and an electrosurgical catheter 2306. Grounding electrodes 2202 can be selected individually or in groups to direct electrosurgical current 2330 from selected healthy tissue to selected diseased tissue, thereby preventing electrosurgical damage to selected healthy tissue. In one embodiment, a first group of grounding electrodes 2202a is "on," and a second group of grounding electrodes 2202b is "off," with electrical energy directed from the muscularis propria 2308 to the mucosa 2310 or submucosal space 2312. The ESU can sample the impedance value of each grounding electrode 2202 and automatically select the optimal grounding electrode for electrocautery or electrosurgery.

[0115] Figure 24An embodiment of a bipolar cap exciter 2400, as described in this specification, is illustrated. The bipolar cap exciter 2400 includes a cap or housing 2401 having at least one cutting line 2402 connected to an insulating ring / bead / ball structure 2404. The bipolar cap exciter 2400 includes a central opening 2405 for engaging a catheter through a biopsy channel of an endoscope 2408 to manipulate the ring 2404 to improve contact between the at least one cutting line 2402 and the tissue. The catheter has a squeezable end that can be manipulated in one or more directions to move the ring / bead / ball 2404 and attach the at least one cutting line 2402 to improve contact with the tissue to be excised. In an embodiment, the at least one cutting line 2402 includes a mechanism for creating slack in the line to allow the line 2402 and the ring 2404 to be pushed out from their position within the cap. In one embodiment, the cutting wire 2402 has a mechanism for generating relaxation, wherein the ring / bead / ball 2404 can extend from 1 mm to 50 mm. In one embodiment, the cutting wire 2402 serves as a first electrode (anode or cathode), while the inserted conduit serves as a second electrode (with the opposite polarity to the first electrode). In one embodiment, the cutting wire 2402 may be partially insulated along its length from the cap to the insulating ring 2404. In one embodiment, the insulating ring 2404 is offset from the center of the cap 2401 and aligned with the channel of the endoscope 2408 so as to be able to engage with the channel of the endoscope 2408. In one embodiment, the insulating ring 2404 is offset from the camera of the endoscope 2408 to avoid interfering with visualization using the endoscope 2408. In one embodiment, the inner diameter of the insulating ring / bead / ball 2404 ranges from greater than or equal to 0.1 mm to less than or equal to 10 mm. In one embodiment, both electrodes are connected to the ESU 2409 using conduits.

[0116] Figure 25Another embodiment of a bipolar cap excider for use with the embodiments described herein is shown. The bipolar cap excider 2500 includes at least one cutting line 2502 connected to an insulating ring / bead / ball structure 2504, which includes a central opening 2501 for engagement with an electrosurgical needle or scalpel 2510. The electrosurgical needle or scalpel 2510 passes through a channel of an endoscope 2508 to manipulate the ring 2504, thereby improving contact between the at least one cutting line 2502 and tissue. In one embodiment, the at least one cutting line 2502 serves as a first electrode, while the electrosurgical needle / scalpel 2510 serves as a second electrode. In another embodiment, the at least one cutting line 2502 includes a mechanism for generating relaxation, enabling the line 2502 and the ring 2504 to be extended from their position within the cap or housing 2501. In yet another embodiment, the at least one cutting line 2502 has a mechanism for generating relaxation, wherein the ring / bead / ball 2504 can extend a distance of 1 mm to 50 mm. In one embodiment, the at least one cutting line 2502 may be partially insulated along its length from the cap to the insulating ring 2504. In another embodiment, the insulating ring 2504 is off-center and aligned with the channel of the endoscope 2508 so as to engage with the channel of the endoscope 2508. In yet another embodiment, the inner diameter of the insulating ring / bead / ball 2504 ranges from greater than or equal to 0.1 mm to less than or equal to 5 mm.

[0117] In various embodiments, saline solution heated to between 50°C and 100°C is injected to coagulate small blood vessels, thereby preventing bleeding during electrosurgery and providing a lifting function to separate various tissue layers to create anatomical planes. Alternative energy sources such as microwaves, lasers, and cryogens can be used to heat the fluid or tissue. The energy delivered in a single treatment session ranges from 50 joules to 50,000 joules, with each discontinuous energy application ranging from 1 joule to 50 joules.

[0118] In various embodiments, the ESU mixes an electrosurgical radiofrequency (RF) current with a frequency greater than 1 kHz with an electrical stimulation radiofrequency current with a frequency less than 1 kHz to prevent or treat bleeding during electrosurgical procedures. The frequency of the electrical stimulation radiofrequency current can range from about 1 microhertz (μHz) to about 1 kHz (KHz), although the methods described herein can also be implemented by applying an electrical stimulation radiofrequency current with a frequency outside this range. Typically, the electrical stimulation radiofrequency current can have a frequency from about 1 millihertz to about 1 kHz, for example, from about 0.1 Hz to about 10 Hz. In some embodiments, electrical stimulation can be applied at a frequency of 1 Hz. In some embodiments, electrical stimulation can be applied at a frequency of 10 Hz. Furthermore, some treatments may include multiple electrical stimulations, including any combination of frequencies. A specific range of electrical stimulation radiofrequency currents that can be used in this invention to prevent or treat bleeding during electrosurgical resection is also disclosed in U.S. Patent No. 10,603,489, which is incorporated herein by reference in its entirety.

[0119] In various embodiments, other fixation methods known in the art (such as hinged clips or magnets) may be used instead of hook elements to secure the device to tissue.

[0120] The examples above are merely some examples of the numerous applications of the systems and methods described in this specification. While only some embodiments of the invention have been described above, it should be understood that the invention may be implemented in many other specific forms without departing from the spirit or scope thereof. Therefore, the examples and embodiments herein are exemplary only and not restrictive, and modifications may be made to the invention within the scope defined by the appended claims.

Claims

1. An apparatus for performing endoscopic resection surgery, comprising: Including the deployment of internal catheters; A first component, wherein the first component includes at least one first puncture tip for puncturing a first location on tissue within a patient's body; The second component includes at least one second puncture tip for puncturing a second location on tissue within the patient's body; as well as A central portion having a first end and a second end, wherein a first member is fixedly attached to the first end of the central portion, and a second member is fixedly attached to the second end of the central portion, wherein the central portion is an elastic band, wherein, when deployed inside the catheter, the elastic band is configured to surround the inner catheter, wherein a slit is provided along the length of the inner catheter to slidably receive and accommodate at least a portion of the central portion, wherein, upon release of the first member, the second member, and the central portion from the device toward the tissue, the at least one first member is configured to grasp a first position, the at least one second member is configured to grasp a second position, and the central portion is configured to deform from a first form to a second form, thereby compressing the tissue and reducing at least one size of the tissue, wherein the elastic band is disposed between the first member and the second member such that, during deployment, the first member is first released and penetrates the tissue, and then the elastic band detaches from the inner catheter.

2. The apparatus of claim 1, wherein the first position is opposite to the second position around the edge of the tissue.

3. The apparatus of claim 1 further comprises a third component, wherein the third component includes at least one third puncture tip for puncturing a third location in tissue within the patient's body.

4. The apparatus of claim 3, wherein the first position, the second position, and the third position are equidistantly spaced around the edge of the tissue.

5. The device of claim 1, wherein the first member, the second member, and the central portion are disposed within the lumen such that, upon release from the catheter, the first member is configured to first puncture tissue, the second member is configured to second puncture tissue, and the central portion is configured to retract and pull the first member and the second member together.

6. The apparatus of claim 1, wherein, The deployment catheter includes a lumen through which fluid can be passed and injected into the tissue.

7. The apparatus of claim 6, wherein the fluid is hot brine, and wherein the temperature of the hot brine is between 50°C and 100°C.

8. The apparatus of claim 1, further comprising at least one stop located near the first member or the second member, wherein at least one dimension of the at least one stop is greater than the diameter of the first member or the second member.

9. The device of claim 1, further comprising additional central portions, each additional central portion being connected to an additional first member and an additional second member, wherein each additional central portion is an elastic band and is configured to surround the inner conduit such that a plurality of elastic bands are simultaneously loaded into the device.

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