Clip devices, systems, and methods for engaging tissue

Abstract

The present invention relates to compression clips, and more particularly to compression clips that are delivered by an endoscope to a target site for tissue resection, e.g., within the gastrointestinal tract. In an example, the clip is configured to be actuatable to transition between an open configuration and a closed configuration in response to a compressive force. In one embodiment, a tissue clamping device may include a first member having a plurality of arms. Each of the arms may extend from a first end to a second end, and the first end of each arm may be received within the first member. The arm is movable between the open configuration and the closed configuration. A second member may be slidably disposed relative to the first member.

Description

priority

[0001] This application claims the benefit of priority under 35 USC §119 to U.S. Provisional Patent Application Serial No. 62 / 753,540, filed on October 31, 2018, and entitled “Universal Clip Enabling Opening from Any Angle,” and U.S. Provisional Patent Application Serial No. 62 / 837,041, filed on April 22, 2019, and entitled “Clip Devices, Systems, and Methods for Engaging Tissue,” both of which are incorporated herein by reference in their entirety and for all purposes. Technical Field

[0002] The present invention relates to clips, and more particularly to compression clips that are delivered endoscopically to a target site for tissue resection, such as within the gastrointestinal tract. Background Art

[0003] Manipulating a device for engaging tissue may require related techniques for positioning and orienting the device and associated medical instruments. For example, endoscopic submucosal dissection (ESD) is a procedure that enables tissue resection within the gastrointestinal tract. One aspect of ESD that may be difficult is positioning and manipulating (e.g., retracting) the resected tissue flap during and after resection.

[0004] With these considerations in mind, a variety of beneficial medical outcomes can be achieved through the medical devices, systems, and methods of the present invention. Summary of the invention

[0005] In various embodiments, the present invention relates to a tissue clamping device, which may include an opening mechanism configured to grasp from multiple angles relative to the longitudinal axis of the clamp device. The opening mechanism may include first and second members configured to shift relative to each other along the longitudinal axis of the clamp device to an open configuration in response to applying a compressive force. The opening mechanism may include a cam member extending from a first end to a second end, the first end may be fixedly coupled to the first member and may be slidably coupled to the second member. A plurality of clamp arms may each extend from a first end to a second end, and the first end of each clamp arm may be received in the opening mechanism. The clamp arms may move between an open configuration and a closed tissue clamping configuration, in which the second ends of the clamp arms are separated from each other, and in the closed tissue clamping configuration, the second ends of the clamp arms move toward each other. Each of the clamp arms may include a spring portion configured to form a spring space between the spring portions. When the first and second members move to the open configuration, the cam member may move into the spring space, so that when the gear member moves into the spring space, the cam member may deviate the spring members away from each other to move the clamp arms to the open configuration.

[0006] In the described and other embodiments, the first and second members may include angled surfaces configured to move the first and second members away from each other in opposite directions in response to applying a compressive force to the angled surfaces. The cam member may include a U-shaped bend at the second end and two legs extending from the U-shaped bend to the first end. The legs may be configured to be slidably received by the second member and may be fixedly coupled to the first member. The cam member may include a wedge centrally positioned on the U-shaped bend. The wedge may extend from the U-shaped bend toward the first end between the legs of the cam member. The wedge may be configured to be received in the space between the spring portions so that movement of the wedge toward the second member may cause the wedge to deviate the spring portions away from each other to move the clamp arm to an open configuration. The wedge may taper from a first end at the first end of the cam member to a second end between the legs of the gear member. The clamp arm may be formed by a single line bent in a middle portion, and the middle portion may form the first end of the clamp arm. The second member of the opening mechanism may include a channel configured to receive the first end of the clamp arm. The clamp arms may be biased into a closed configuration.

[0007] In various embodiments, the present invention also relates to a clamp device, which includes an opening mechanism, which may include a clamping member. The deformable fluid chamber may be configured to grasp from multiple angles. The fluid chamber may define a chamber therein, which may be configured to be filled with a fluid. The balloon chamber may define a chamber therein. When filled with a fluid, the balloon chamber may be inflated from a static state. At least one connecting channel may extend from a first end open to the chamber of the fluid chamber to a second end open to the chamber of the balloon chamber to provide fluid communication between the fluid chamber and the balloon chamber, so that when the fluid chamber is compressed, the fluid may be dissipated from the fluid chamber to the balloon chamber via the connecting channel to inflate the balloon chamber. The clamp device may also include a clamp arm extending from a first end to a second end. The first end may be connected to the clamping member. The clamp arm may move between an open configuration and a closed tissue clamping configuration, in which the second ends of the clamp arms may be separated from each other, and in a closed tissue clamping configuration, the second ends of the clamp arms may move toward each other. Each of the clamp arms may include a spring portion configured to form a spring space between the spring portions. The spring space may receive the balloon chamber so that when the balloon chamber is inflated, the spring members may deflect away from each other to move the clamp arms to an open configuration.

[0008] In the described and other embodiments, the clamping member may include an extension extending through a central closed cavity in the fluid chamber to couple to the first end of the clamp arm. The fluid chamber may be filled with one of saline, water, gel, or other suitable fluids. The spring portion may be formed as a bend in the clamp arm, and the bend may extend toward the central axis of the clamp device. The clamp arm may be biased to a closed configuration. The clamping member may be configured to be clamped by a clamp tool. The clamp arm may be formed by a line bent in a mid-portion to form the first end of the clamp arm.

[0009] In various embodiments, the present invention also relates to a method for positioning a clip system on a target tissue from multiple angles. The clip system can be inserted into the target site via a working channel of an insertion device. The clip system can include a first clip device. The first clip device can include an opening mechanism that can be configured to grasp from multiple angles relative to the longitudinal axis of the clip device. The opening mechanism can include first and second members that can be configured to shift relative to each other along the longitudinal axis of the clip device to an open configuration in response to the application of a compressive force. The opening mechanism can include a cam member extending from a first end to a second end, and the first end can be fixedly coupled to the first member and slidably coupled to the second member. A plurality of clamp arms can each extend from a first end to a second end, and the first end of each clamp arm can be received in the opening mechanism. The clamp arms can move between an open configuration and a closed tissue clamping configuration, in which the second ends of the clamp arms can be separated from each other, and in the closed tissue clamping configuration, the second ends of the clamp arms can move toward each other. Each of the clamp arms can include a spring portion that is configured to form a spring space between the spring portions. When the first and second members move to the open configuration, the cam member can move into the spring space so that when the gear member moves into the bullet space, the cam member can cause the spring members to deviate away from each other to move the clamp arm to the open configuration. The method may include inserting a clamp tool into the target site via a working channel. The method may include grasping an opening mechanism of the first clamp device via the clamp tool to move the clamp arm of the first clamp device to the open configuration. The method may include positioning the clamp arm of the first clamp device so that a first portion of the target tissue is received between the clamp arms of the first clamp device. The method may include releasing the clamp tool to move the clamp arm of the first clamp device from the open configuration to the closed configuration to clamp the first portion of the target tissue.

[0010] In the described and other embodiments, the method may further include coupling the first clamp device to the second clamp device via a tether. In the described and other embodiments, a method may further include grasping an opening mechanism of the second clamp device from a clamp tool to move the clamp arm of the second clamp device to an open configuration. The method may include positioning a second portion of the target tissue between the clamp arms of the second clamp device. The method may include releasing the clamp tool to move the clamp arm of the second clamp device from an open configuration to a closed tissue clamping configuration to clamp the second portion of the target tissue, and the position of the second target portion of the tissue may be selected so that when the first and second target portions of the tissue are clamped by the first and second clamp devices, respectively, a desired level of tension may be applied to the first target portion of the tissue via the tether. The first and second members may include angled surfaces configured to move the first and second members away from the applied compressive force in opposite directions. The clamp arms may be biased to a closed configuration.

[0011] In various embodiments, the present invention relates to a tissue clamping device, which may include a first member. One or more arms extending from a first end to a second end may each be received in the first member. Each of the arms may include a spring portion configured to form a spring space between the spring portions. The arms may move between an open configuration and a closed configuration, in which the spring portions of the arms are biased toward each other, and in a closed configuration, the spring portions of the arms are separated from each other. The second member may be slidably arranged around a plurality of arms. The gripper may have a first end engaged between the arms, and a second end that may include jaws configured to engage tissue. The first member and the second member may be configured to grip from multiple angles relative to the longitudinal axis of the clamping device, and may be configured to shift relative to each other along the longitudinal axis of the clamping device in response to the application of a compressive force. The cam member may extend from the first end to the second end, the first end may be fixedly coupled to the second member, and the second end may be configured to engage the spring space. When the first and second components are displaced relative to each other, the second end of the cam component can move to engage with and disengage from the spring space, so that when the first and second components are displaced separately from each other, the second end of the cam component can disengage from the spring space and the arm can present an open form, and when the first and second components are displaced toward each other, the second end of the cam component can move to engage with the spring space and the arm is converted to a closed form.

[0012] In the described and other embodiments, the first and second members may include angled surfaces configured to displace the first and second members apart from each other in response to applying a compressive force to the angled surfaces. The cam member may include a U-shaped bend at the second end of the cam member and two legs that may extend from the U-shaped bend to the first end of the cam member. The cam member may include a wedge positioned centrally on the U-shaped bend, and when the wedge extends from the U-shaped bend between the legs toward the first end of the cam member, the wedge may gradually decrease to a smaller width transverse to the longitudinal axis. The wedge may be configured to engage the spring space. The arm may be formed by a single line bent in the middle portion, and the middle portion may form the first end of the arm. The first member may include a channel configured to receive the first end of the arm fixedly. The arm may be biased to an open configuration. The gripper may include first and second gripper arms in a cross configuration. When the first end moves closer together, the second end may move away from each other.

[0013] In various embodiments, the present invention also relates to a tissue clamping device, which may include a first member. The device may include a plurality of arms. Each of the arms may extend from a first end to a second end. The first end of each arm may be received within the first member. The arm may move between an open configuration and a closed configuration. The second member may be slidably disposed relative to the first member. The first member and the second member may be configured to grip from a plurality of angles relative to the longitudinal axis of the clamping device. The first member and the second member may be configured to shift relative to each other along the longitudinal axis of the clamping device in response to the application of a compressive force. The first and second members may include angled surfaces configured to shift the first and second members apart from each other in response to the application of a compressive force to the angled surfaces, so that when the first and second members are shifted relative to each other, the arms may switch between an open configuration and a closed configuration.

[0014] In various embodiments, the present invention relates to a tissue clamping device, which may include a first member. One or more arms extending from a first end to a second end may be received in the first member. The arms may move between an open configuration and a closed configuration, in which the second ends of the arms may be separated from each other, and in a closed configuration, the second ends of the arms may be biased toward each other. Each of the arms may include a spring portion configured to form a spring space between the spring portions. A second member may be slidably arranged around a plurality of arms. The second member may have one or more channels inside the second member, which may engage with the relative inclined surfaces of the arms. The first member and the second member may be configured to grip from multiple angles relative to the longitudinal axis of the clamping device, and may be configured to shift relative to each other along the longitudinal axis of the clamping device in response to the application of a compressive force. When the first and second members shift relative to each other, one or more channels may move to engage with the relative inclined surfaces of the arms and disengage from the relative inclined surfaces of the arms to convert the arms between the closed configuration and the open configuration.

[0015] In the described and other embodiments, the relative inclined surfaces of the arms can be inclined toward each other and the longitudinal axis so that when the first and second members are displaced apart from each other, one or more channels can move into engagement with the inclined surfaces, thereby separating the arms into an open configuration, and when the first and second members are displaced toward each other, one or more channels can disengage from the inclined surfaces and the arms transition to a closed configuration. In other embodiments, the relative inclined surfaces of the arms can be inclined away from each other and the longitudinal axis so that when the first and second members are displaced apart from each other, one or more channels can move into engagement with the inclined surfaces, thereby bringing the arms together into an open configuration, and when the first and second members are displaced toward each other, one or more channels can disengage from the inclined surfaces and the arms transition to a closed configuration.

[0016] In the described and other embodiments, the arms can be biased to a closed configuration in which the arms are oriented toward each other in the spring space. The first and second members can include angled surfaces configured to displace the first and second members away from each other in response to applying a compressive force to the angled surfaces. The arms can be formed from a single body bent at a midsection. The midsection can form a first end of the arm. A gripper can be disposed between the second ends of the arms.

[0017] In various embodiments, the present invention relates to a tissue clamping device. The device may include a housing that defines a chamber and may have a first end that can move within the chamber toward a second end of the housing. A plurality of arms extending from the first end to the second end may be received within the chamber. The arms may move between an open configuration and a closed configuration, in which the second ends of the arms may be separated from each other, and in which the second ends of the arms may be displaced toward each other. An inner layer may be disposed around a piston housing and may extend proximally of the housing to define a chamber configured to contain a fluid. The chamber may be compressed from a plurality of angles relative to a longitudinal axis of the clamping device in response to the application of a compressive force. In response to applying a compressive force to the chamber, the first end of the housing may move toward the second end of the housing, thereby extending the arms to an open configuration. When a compressive force is not applied to the chamber, the first end of the housing may be displaced away from the second end of the housing, thereby retracting the arms to a closed configuration.

[0018] In the described and other embodiments, the outer layer can be disposed around the inner layer, and the outer layer can be configured to grip from multiple angles relative to the longitudinal axis of the clamping device to apply a compressive force to the chamber. The inner layer can be configured to grip from multiple angles relative to the longitudinal axis of the clamping device to apply a compressive force to the chamber. The arm can be formed from a single wire that is bent in a middle portion. The middle portion can form a first end of the arm. The arm can be biased to an open configuration. BRIEF DESCRIPTION OF THE DRAWINGS

[0019] Non-limiting embodiments of the present invention are described by way of example with reference to the accompanying drawings, which are schematic and not intended to be drawn to scale. In the drawings, each identical or nearly identical component shown is generally represented by a single numeral. For clarity, not every component is labeled in every drawing, nor is every component of every embodiment shown where an illustration is not necessary to enable one of ordinary skill in the art to understand the present invention. In the drawings:

[0020] Figure 1 shows a top view of a clip device according to one embodiment of the present invention in a closed configuration;

[0021] Figure 2 Shows the opening pattern Figure 1 A top view of a clamp device;

[0022] Figure 3 Shows Figure 2 A partial cross-sectional view of a clamp device;

[0023] Figure 4 An embodiment of the present invention is shown. Figure 1 A three-dimensional view of a cam member of a clamp device;

[0024] Figure 5A perspective view of a tether pulling clip system according to one embodiment of the present invention is shown;

[0025] Figure 6 shows a top view of a clip device according to one embodiment of the present invention in a closed configuration;

[0026] Figure 7 Shown in closed form Figure 6 A partial cross-sectional view of a clamp device;

[0027] Figure 8 Shows the opening pattern Figure 6 A top view of a clamp device;

[0028] Fig. 9 Shows the opening pattern Figure 6 A partial cross-sectional view of a clamp device;

[0029] Fig.10 Shows Figure 6 Another cross-sectional view of the clamp device;

[0030] Fig.11A shows a top view of a tissue clamping device in a closed configuration according to one embodiment of the present invention;

[0031] Fig. 11B Shows the opening pattern Fig.11A A top view of the device;

[0032] Fig. 11C Shows Fig.11A and 11B A perspective view of a cam member of the device;

[0033] Fig.11D Shows Fig.11A and 11B An isometric view of the device;

[0034] Fig. 12A shows a top view of a tissue clamping device in a closed configuration according to one embodiment of the present invention;

[0035] Fig. 12B Shows the opening pattern Fig. 12A A top view of the device;

[0036] Fig.13A shows a top view of a tissue clamping device in a closed configuration according to one embodiment of the present invention;

[0037] Fig. 13B Shows the opening pattern Fig.13A A top view of the device;

[0038] Fig.14 shows a top view of a clip device according to one embodiment of the present invention in an open configuration;

[0039] Fig.15 Shows Fig.14 A cross-sectional view of a clamp device;

[0040] Fig.16 Shown in closed form Fig.14 and 15 A top view of a clamp device;

[0041] Fig.17 Shown in closed form Figures 14 to 16 A cross-sectional view of a clamp device;

[0042] Fig.18A shows an angled view of a tissue clamping device in a closed configuration according to one embodiment of the present invention;

[0043] Fig.18B Shown in closed form Fig.18A An internal view of a tissue clamping device;

[0044] Fig.18C Shows the opening pattern Fig.18A and 18B An angled view of the device;

[0045] Fig.18D Shows the opening pattern Figures 18A to 18C An internal view of a tissue clamping device;

[0046] Fig.19 shows a top view of a clip device according to one embodiment of the present invention in an open configuration;

[0047] Fig. 20 Shows the opening pattern Fig.19 A partial cross-sectional view of a clamp device;

[0048] Fig.21 Shown in closed form Fig.19 A top view of a clamp device;

[0049] Fig. 22 shows a top view of a clip device according to an exemplary embodiment of the present invention in a closed configuration;

[0050] Fig.23 Shows the opening pattern Fig. 22 A top view of a clamp device;

[0051] Fig.24Shown in closed form Fig. 22 A front view of a clamp arm of a clamp device;

[0052] Fig.25 Shows the opening pattern Fig. 22 A front view of a clamp arm of a clamp device;

[0053] Fig.26 A tether pulling clip system according to one embodiment of the present invention is shown;

[0054] Fig. 27 Shown with Figures 11A to 11D The steps of an exemplary method for use with a clamp device;

[0055] Fig.28 Shown with Figures 11A to 11D The steps of an exemplary method for use with a clamp device;

[0056] Fig.29 Shown with Figures 11A to 11D Steps of an exemplary method for use with a clamp device. DETAILED DESCRIPTION

[0057] The present invention is not limited to the specific embodiments described. The terms used herein are only for the purpose of describing specific embodiments and are not intended to be limited beyond the scope of the appended claims. Unless otherwise specified, all technical terms used herein have the same meaning as those generally understood by ordinary technicians in the field to which the present invention belongs.

[0058] Although embodiments of the present invention are described with reference to particular body cavities and tissues, it will be appreciated that such devices, systems and methods may be used with a variety of anatomical structures, including the gastrointestinal tract, bronchi, mucosal tissue, epithelial tissue, connective tissue, muscle tissue, and the like.

[0059] As used herein, the singular forms "a", "an" and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. When used herein, the terms "include" and / or "comprise" or "include" and / or "comprising" specify the presence of stated features, regions, steps, elements and / or components, but do not exclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components and / or combinations thereof.

[0060] As used herein, the term "distal" refers to the end of a medical device farthest from a medical professional when the device is introduced into a patient, and the term "proximal" refers to the end of a medical device closest to a medical professional when the medical device is introduced into a patient.

[0061] As used herein, the conjunction "and" includes each of the so connected structures, components, features, etc. unless the context clearly indicates otherwise, and the conjunction "or" includes one or the other of the so connected structures, components, features, etc., individually and in any combination and quantity unless the context clearly indicates otherwise.

[0062] As used herein, the terms "element" and "member" may be used interchangeably in the description of the drawings, discussion of the various embodiments, and in the claims.

[0063] All numerical values ​​are assumed to be modified by the term "about" herein, regardless of whether or not explicitly indicated. In the context of numerical values, the term "about" generally refers to a numerical range that is considered by those skilled in the art to be equivalent to the quoted value (i.e., having the same function or result). In many cases, the term "about" may include a number rounded to the nearest significant figure. Unless otherwise specified, the term "about" (i.e., in the context other than numerical values) may be assumed to have its common and customary definition, as understood and consistent with the context of this specification. The reference to the numerical range represented by the endpoint includes all numbers within the range, including the endpoint (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4 and 5).

[0064] It should be noted that references in the specification to "one embodiment", "some embodiments", "other embodiments", etc. indicate that the described embodiments may include a particular feature, structure, or characteristic, but each embodiment may not necessarily include the particular feature, structure, or characteristic. In addition, such phrases do not necessarily refer to the same embodiment. In addition, when a particular feature, structure, or characteristic is described in conjunction with one embodiment, whether or not explicitly described, it is within the knowledge of those skilled in the art to implement such feature, structure, or characteristic in conjunction with other embodiments, unless explicitly stated to the contrary. That is, even if not explicitly shown in a particular combination, the various individual elements described below are still considered to be combinable or arranged with each other to form other additional embodiments or to supplement and / or enrich the described embodiments, as will be understood by those of ordinary skill in the art.

[0065] The present invention may be further understood with reference to the following description and accompanying drawings, in which like elements are indicated by like reference numerals. The present invention relates to a clamp opening mechanism for an endoscopic tissue traction device, for example, in endoscopic mucosal resection (ESD) and / or endoscopic mucosal resection (EMR). Exemplary embodiments of the present invention describe a clamp device comprising an opening mechanism that allows a physician to open and reposition the clamp device from any angle. In these embodiments, the physician is able to grasp the opening mechanism of the clamp device from any approach angle and open the clamp to attach to tissue. In an exemplary embodiment of the present invention, two clamp devices may be used in conjunction with a tether to form a tethered traction clamp device.

[0066] In various embodiments, the clamp devices described herein can be used interchangeably in a system in a substantially similar manner. Various clamp devices can have one or more clamping elements or members that can move relative to each other so that the device and / or system can be converted between an open configuration and a closed configuration. It will be understood that the clamping elements or members described with respect to a particular embodiment can be added or used interchangeably with the clamping elements or members of another embodiment in a substantially similar manner.

[0067] Tethered traction clip devices can be used to manipulate tissue flaps during ESD. However, these clip devices may be difficult to open, close and / or position because the clip devices may need to be clamped along a specific angle or plane. Other tissue clamping devices, for example, tissue traction devices for ESD may include an opening mechanism for engaging and manipulating tissue. As an example, operating such a device may be difficult for medical professionals due to viewing angles, devices or anatomical structures that block the field of view, the size of the operating tool, or a strict angle related to the proper engagement of the device. For example, the clamping device can be engaged by another instrument controlled by the medical professional to orient the device and / or manipulate the arm of the device. As described above, the device can be controlled during surgery by engaging the device substantially along the longitudinal axis of the device. Attempts to engage the device at angles that are not substantially along the longitudinal axis may not properly control the device, resulting in surgical errors or delays or frustration of medical professionals. Therefore, for these considerations, the present improvement may help allow physicians to open, close and / or reposition the clip from multiple angles.

[0068] like Figures 1 to 4 As shown, a clip device 100 according to an exemplary embodiment of the present invention is configured to be coupled to a tether 20 (e.g., with respect to Figures 11A to 11D The device 1100 Figure 51 and 12. The clamping portion 104 includes a clamping arm 106 and a second clamping arm 106. The clamping arm 106 includes a gripping portion 102 and a clamping portion 104 and can be inserted through, for example, a working channel of a flexible endoscope to a target tissue to be treated. The gripping portion 102 includes first and second conical clamping elements 116, 114 and a cam member 122. The clamping portion 104 includes a clamping arm 106. The clamping device 100 has sufficient flexibility to allow it to traverse a tortuous path through the body, for example, through the working channel of an endoscope inserted through a natural body orifice into a natural body cavity. The clamping portion 104 includes a clamping arm 106, which, in this embodiment, is formed by a single wire 108. As shown in FIG. Figure 3 1, the wire 108 is bent at a mid-portion to form a first end 110 of a clamp arm 106, the first end 110 being closest to the coupling end 101 of the clip device 100. The first and second clamp arms 106 each extend from the first end 110 to a second end 112 at the clamping end 103 of the clip device 100. The clamp arms 106 can be moved between an open configuration, in which the second ends 112 of the clamp arms 106 are separated from each other to receive target tissue therebetween, and a closed configuration, in which the second ends 112 of the clamp arms 106 are moved toward each other, for example, to clamp the target tissue therebetween, or to reduce the overall size of the device compared to when the clamp arms 106 are moved apart from each other. The clamping portion 104 of the clip device 100 is coupled to the gripping portion 102 via a second conical clamping element 114. The clamp arms 106 can be moved between an open configuration and a closed configuration via movement of the second conical clamping element 114 relative to the first conical clamping element 116. The coupling end 101 of the clip device 100 of this embodiment is configured to be coupled to the tether 20 ( Figures 22 to 25 ), as will be described in more detail below.

[0069] like Figure 3 As further shown in FIG. 1 , the clamp arms 106 are joined at a first end 110 and extend to a second end 112. As will be appreciated by one skilled in the art, the clamp arms 106 of this embodiment are biased toward a closed configuration. When the gripping portion 102 of the clamp device 100 is activated as described below, the clamp arms 106 are forced into an open configuration. The profile of each of the clamp arms 106 of this embodiment is configured to include a spring portion 120 formed as a curve or bend in the clamp arm 106 extending toward the longitudinal axis of the clamp device 100. The spring portions 120 form a space therebetween that is sized and shaped to receive a first end of a cam member 122 of the clamp portion 104. The cam member 122, which in this embodiment includes a triangular wedge 124 at its first end, deflects the clamp arms 106 away from each other to an open configuration as it is advanced between the clamp arms 106 toward their first ends 110.

[0070] The clamping portion 102 includes a first clamping element 116 (i.e., closer to the coupling end 101 of the clamp device 100) and a second clamping element 114 (i.e., closer to the clamping end 103 of the clamp device 100), and a cam member 122 having a wedge 124. In this embodiment, the first and second clamping elements 116, 114 are substantially conical (e.g., frustoconical) with diameters increasing as the distance between the ends adjacent to each other of the first and second clamping elements 116, 114 increases. Figure 1 As shown, when the first and second clamping elements 116, 114 are adjacent to each other, each of the first and second clamping elements 116, 114 tapers to a minimum diameter at the ends located adjacent to each other, thereby forming an hourglass shape. Specifically, the first clamping element 116 tapers from its first end to its second end, and the distal clamping element 114 tapers from its second end to its first end (the first end is adjacent to the second end of the first clamping element 116). The hourglass shape is used as a clamping cylinder, which allows a user to clamp the clamp device 100 (for example, using a clamp tool 10 ( Fig.28 )), regardless of the orientation of the clip relative to the endoscope. Figure 3 , the second clamping element 114 includes a curved channel 126 therein extending from a first end 128 to a second end 130, the first and second ends 128, 130 opening at a second end 132 of the distal clamping element 114. The channel 126 is sized and shaped to receive a first portion 133 of the clamp arm 106 extending therethrough between the first end 112 and the spring portion 120. A surface or ledge 134 of the second end of the second clamping element 114 between the open first and second ends 128, 130 of the curved channel 126 is positioned between the first portion 133 of the clamp arm 106 to provide a stop that controls the maximum opening of the clamp arm 106 and prevents the clamp arm 106 from being disengaged from the second clamping element 114. The second clamping element 114 also includes two through holes (not shown) extending from the first end to the second end of the distal clamping element 114, each through hole being configured to receive a leg 138 of the cam member 122.

[0071] like Figure 4The cam member 122 of the illustrated embodiment is substantially U-shaped, with two legs 138 extending from a distal U-shaped bend 140 toward the coupling end 101. Each of the legs 138 includes an enlarged stop member 148. The wedge 124 is centrally located in the U-shaped bend and is substantially triangular in shape. Specifically, the wedge 124 tapers from a second end 142 closest to the clamping end 103 to a first end 144 closest to the coupling end 101. The wedge 124 extends from the U-shaped bend 140 between the two legs 138 toward the coupling end 101. The legs 138 of the cam member 122 are slidably received by a through hole (not shown) in the first clamping element 116. The blind hole partially extends through the length of the first clamping element 116, extending a distance equal to the length of the stop member 148. The blind hole has a diameter substantially equal to the stop member 148. However, the opening of the blind hole at the second end of the first clamping element 116 has a smaller diameter (i.e., a diameter equal to the diameter of the clamp arm 106), so that the stop member 148 of the cam member 122 is prevented from coming out of the first clamping element 116. Therefore, the first clamping element 116 and the cam member 122 cannot move relative to each other. It should be noted that the first end of the cam member 122 can be coupled to the first clamping element 116 in any other preferred method, such as bonding, welding, etc., as long as the components do not move relative to each other.

[0072] In use, when the clamp device 100 is in the closed configuration, the spring portions 120 of the clamp arms 106 are spaced apart a distance that is less than the width of the wedge 124 of the cam member 122 (i.e., the dimension between the two clamp arms 106 extending in a plane perpendicular to the longitudinal axis of the clamp device 100). Fig.26 ) applies a radially inward force (i.e., a clamping force), the first and second clamping elements 116, 114 are displaced relative to each other (i.e., move away from each other along the longitudinal axis of the clamp device 100), such as Figure 2 This linear motion actuates the cam member 122, causing the wedge 124 to move toward the first end 110 of the clamp arm 106 into the space between the spring portions 120, thereby deflecting the spring portions 120 away from each other and moving the clamp arm 106 to the open configuration, as shown. Figure 3 Subsequently, when the force originating from the clamp tool 10 is removed from the proximal and distal clamping elements 116, 114, the cam member 122 is forced to its original position due to the spring action of the clamp arms 106 against the triangular surface of the wedge 124, thereby pulling the clamp arms 106 toward each other into a tissue clamping configuration to clamp any tissue received between the second ends 112 of the clamp arms 106.

[0073] like Figures 6 to 10 As shown, a clip device 200 according to an exemplary embodiment of the present invention is substantially similar to the clip device 100, except as described herein. Specifically, the clip device 200 extends from a coupling end 201 to an opposite clamping end 203 and includes a grasping portion 202 and a clamping portion 204. The clip device 200 can be inserted into a target tissue to be treated through a working channel of an endoscope, for example. The clamping portion 204 includes a clamp arm 206, which in this embodiment is formed by a single wire 208, such as Figure 7 As shown. Figure 7 20, the wire 208 is bent at a mid-portion to form a first end 210 of the clamp arm 106, the first end 206 being closest to the coupling end 201. The clamp arm 206 extends from the first end 210 to a second end 212 located at the clamping end 203 of the clamp device 200. The clamp arms 206 are biased to a closed configuration, but they each include a bent portion that forms a spring portion 220 similar to the spring portion 120.

[0074] The gripping portion 202 includes a conical clamping element 216, a fluid chamber 214, a distal balloon chamber 216, and two connecting channels 219. The conical clamping element 216 is substantially similar in shape to the first conical clamping element 116, except that it includes an extension 222 extending in the direction of the clamping end 203, as shown in FIG. Figure 7 The extension 222 is configured to extend through the central lumen 228 of the fluid chamber 214. The second end 224 (closest to the clamping end 203) of the distal extension 222 extends beyond the second end (closest to the clamping end 203) of the fluid chamber 214 to couple to the first end 210 of the clamp arm 206, as shown in FIG. Fig.10 In this embodiment, the second end 224 of the distal extension 222 is a hook or loop 226 that defines a central space that is sized and shaped to receive the first end 210 of the clamp arm 206 therethrough.

[0075] The shape of the fluid chamber 214 is substantially spherical, wherein the closed cavity 228 extends from its first end to the second end. The fluid chamber 214 includes an internal chamber 230, which is configured to be filled with a fluid, such as, for example, saline, sterile water, gel or any other minimally compressible fluid suitable for internal medication. The fluid chamber 214 is formed of a deformable material, such as, for example, nylon, PEBAX, polyethylene terephthalate (PET), rubber or silicone, so that when external pressure is applied thereto by, for example, the gripper tool 10, the fluid chamber contracts inwardly, thereby reducing the internal volume and dispersing the fluid from it into the connecting channel 219. The connecting channel 219 extends from the fluid chamber 214 to the balloon chamber 218 and provides fluid communication therebetween. That is, when an external force is applied, the fluid forced to leave the fluid chamber 214 moves through the connecting channel 219 and enters the balloon chamber 218. When the balloon chamber 218 is filled with fluid, the balloon chamber 218 can be expanded from a normal zoom state ( Figure 7 The balloon chamber 218 is positioned between the spring portions 220 of the clamp arms 206 so that when fluid is forced into it, the balloon chamber 218 inflates, thereby generating sufficient pressure to open the clamp arms 206, as shown. Fig. 9 When the external force is removed from the fluid chamber 214 , the spring portion 220 exerts an inward force on the balloon chamber 218 , thereby reducing the internal volume of the balloon chamber 218 , causing the fluid to move back through the connecting passage 219 and into the fluid chamber 214 .

[0076] exist Figures 6 to 10 In the embodiments described above or elsewhere within the scope of the present invention, various clip devices can have one or more chambers that can be engaged and disengaged, such that one or more chambers can be compressed or inflated to transition the device between a tissue receiving configuration and a tissue engaging configuration. It will be understood that the chambers described with respect to a particular embodiment can be used additionally or interchangeably with respect to the chambers of another embodiment in a substantially similar manner.

[0077] refer to Figures 11A to 11D, shows an embodiment of a tissue clamping device 1100, which includes a first member 1102 and a second member 1104 that are substantially truncated cone-shaped. Two clamp arms 1110 extend from a first end 1110p to a second end 1110d. The first end 1110p of each arm 1110 is received in the first member 1102 via a channel 1120 extending through the first member 1102. The clamp arms 1110 are formed by a single line that is bent at a middle portion 1122, forming the first end 1110p of the arm 1110. A gripper 1130 for engaging tissue is engaged (e.g., held) between the second ends 1110d of the arms 1110. The gripper 1130 has a first end 1130p between the arms 1110 and a second end 1130d including jaws for engaging tissue. The gripper 1130 has first and second gripper arms in a cross configuration. The spring force contained in the bend at the middle portion 1122 of the clamp arm 1110 contained in the first member 1102 creates a bias at the second end 1110d of the clamp arm 1110, thereby urging the arms toward each other, such that the spring portion 1116 of the arm 1110 is driven toward each other, e.g., so as to substantially contact each other. Fig. 11B ), the grasper 1130 assumes an open configuration. The spring force may be applied by a torsion spring, a leaf spring, or the like. The clamp arm 1110 is movable so that the grasper 1130 may be in a closed configuration (e.g., for spreading and / or engaging tissue) (e.g., for example ... Fig.11A , wherein the spring portions 1116 of the clamp arms 1110 are separated from each other) and an open configuration (eg, for receiving tissue) (eg, Fig. 11B 1100, wherein the spring portions 1116 of the clamp arms 1110 contact each other). The spring portions 1116 of each of the arms 1110 form a spring space 1114 between the spring portions 1116. When the device 1100 is in the closed configuration ( Fig.11A ), the spring space 1114 is open, and when the device 1100 is in the open configuration ( Fig. 11B), the spring space 1114 is closed. The second member 1104 is slidably positioned around the plurality of arms 1110. The arms 1110 extend through the tapered channel 1126 of the second member 1104. Each of the first member 1102 and the second member 1104 can be gripped from multiple angles individually or together relative to the longitudinal axis l of the clamping device 1100. The first member 1102 and the second member 1104 can each be separately displaced relative to each other along the longitudinal axis l of the clamping device 1100 in response to applying a compressive force 1132 to an open configuration. The cam member 1112 extends from a first end 1112p to a second end 1112d. In the closed configuration, the first end 1112p of the cam member 1112 is fixedly coupled to the second member 1104, and the second end 1112p extends into the spring space 1114 and engages the spring space 1114. When the first and second members 1102, 1104 are displaced relative to each other into the open configuration, the cam member 1112 is disengaged from the spring space 1114, so that when the cam member 1112 is disengaged from the spring space 1114, the spring portions 1116 of the plurality of arms 1110 are moved toward each other due to the spring force. As a result, the arms 1110 move the gripper jaws 1130 at the second end 1130d to the open configuration. When the cam member 1112 is engaged between the spring portions 1116 in the spring space 1114, the device 1100 is in the closed configuration and the clamp arms 1110 are prevented from switching the device 1100 to the open configuration while the device 1100 is in a static state (i.e., without any substantial compressive force 1132 being applied). When the compressive force 1132 is not applied, the first and second members 1102, 1104 are displaced toward each other to substantially contact each other, for example, by a linear spring extending between the members 1102, 1104. The linear spring 1128 is in the closed state ( Fig.11A ) is in a static state and in an open state ( Fig. 11B) is in an extended state (stretched) in the cam member 1102. The extended state of the linear spring 1128 has a spring force that pulls the members 1102, 1104 together, thereby moving the second end 1112d of the cam member 1112 into engagement with the spring space 1114 and the spring portion 1116 of the arm 1110. The cam member 1112 includes a U-shaped bend at the second end 1112d, two legs extending from the U-shaped bend to the first end 1112p, and a wedge 1118 centrally positioned on the U-shaped bend at the second end 1112d. When the wedge 1118 extends from the U-shaped bend toward the first end 1112p between the legs of the cam member 1112, the wedge 1118 tapers to a smaller width transverse to the longitudinal axis l. The wedge 1118 can be received in the spring space 1114. The first and second members 1102, 1104 include angled surfaces 1106 that allow the members 1102, 1104 to move away from each other in opposite directions in response to application of a compressive force 1132 to the angled surfaces 1106. A loop 1124 extends from the first member 1102 for attachment to another device, such as an elastic tether.

[0078] In an exemplary embodiment, the clip device 1100 can be coupled to the tether 20 to form a tether pulling clip system 150, such as Figure 5 as shown in . Figure 5 Device 1100 is shown as an example, but it will be understood that any embodiment of the clamping device of the present invention can be used in a substantially similar manner. In this embodiment, the tether traction system 150 includes two clip devices 1100, which are connected together via a tether 20 extending therebetween. Specifically, the opposite ends of the tether 20 are connected to the connection end 1124 of the clip device 1100. The tether 20 can be formed of an elastomeric material with high energy recovery properties, such as, for example, natural rubber latex, thermoplastic elastomers and silicone rubber. Alternatively or additionally, the tether 20 can be composed of a metal spring or a shape memory material. As will be described in further detail below, in this embodiment, the tether traction system 150 allows the physician to adjust the selected portion of the tissue to provide the physician with a clearer line of sight to the desired target tissue. For example, the first clip device 1100 can be connected to the resected tissue portion, and the second clip device 1100 can be connected to the nearby tissue so that the tether 20 provides enough tension to keep the resected tissue portion in the desired position.

[0079] refer to Figures 12A to 12B, shows an embodiment of a tissue clamping device 1200 for engaging tissue, which includes a first member 1202 that is substantially truncated cone-shaped. Two clamp arms 1210 extend from a first end 1210p to a second end 1210d. The first end 1210p of each arm 1210 is received within the first member 1202 via a channel 1220 extending through the first member 1202. The clamp arms 1210 are formed by a single wire that is bent at a mid-portion 1222 that forms the first end 1210p of the arm 1210. The clamp arms 1210 can be used in a variety of configurations, such as Fig. 12A The closed form depicted in Fig. 12B1204 is a first member 1202 that is configured to move between the closed configuration, in which the second ends 1210d of the arms 1210 are positioned toward each other, and in the open configuration, the second ends 1210d of the arms 1210 are separated away from each other. Each of the clamp arms 1210 includes a spring portion 1216 that extends radially toward the longitudinal axis l of the clamping device 1200 and is configured to form a spring space between the spring portions 1216. The spring force contained in the bend at the intermediate portion 1222 of the clamp arm 1210 in the first member 1202 creates a bias toward the closed configuration at the second end 1210d of the clamp arm 1210. The second member 1204 is slidably positioned around the plurality of arms 1210, wherein the arms 1210 extend through the tapered channels 1226 of the second member 1204. The tapered channels 1226 each taper (i.e., decrease in diameter) in a direction toward the first member 1202. The tapered channel 1226 is inside the second member 1204 and can engage with the opposite inclined surface of the spring portion 1216 of the arm 1210. The opposite inclined surfaces of the spring portion 1216 of the arm 1210 are inclined toward each other and the longitudinal axis l, so that when the first and second members 1202, 1204 are displaced apart from each other, the tapered channel 1226 moves to engage with the inclined surface of the spring portion 1216, thereby separating the arm 1210 into an open configuration. When the first and second members 1202, 1204 are displaced to substantially contact each other, the tapered channel 1226 disengages from the inclined surface of the spring portion 1216, and the arm 1210 is converted to a closed configuration, wherein the spring portions of the arms are biased toward each other. Like the first member 1202, the second member 1204 is also substantially truncated cone-shaped. Each of the first member 1202 and the second member 1204 can be gripped from multiple angles relative to the longitudinal axis l of the clamping device 1200, either individually or together. The first member 1202 and the second member 1204 can each be displaced relative to each other along the longitudinal axis 1 of the clamping device 1200 into an open configuration in response to applying a compressive force 1232. The first member 1202 and the second member 1204 include angled outer surfaces that allow the members 1202, 1204 to move longitudinally in opposite directions away from each other along the longitudinal axis 1 in response to applying a compressive force 1232 to the angled outer surfaces. Although the first member 1202 cannot move relative to the arm 1210, since the end 1210p extends through the first member 1202, the first member 1202 can move away from the second member 1204 with the arm 1210. When the first and second members 1202, 1204 are displaced relative to each other, the tapered channel 1226 moves into engagement with and out of engagement with the opposite inclined surfaces of the spring portion 1216 of the arm 1210, thereby converting the arm 1210 between the closed configuration and the open configuration.The second member 1204 or the arm 1210 can be longitudinally moved relative to each other while one of the second member 1204 or the arm 1210 is fixed, or both the second member 1204 and the arm 1210 can be longitudinally moved relative to each other. When the device 1200 is in a static state (i.e., without any substantial compressive force 1232 applied), the clamp arms 1210 are biased to a closed configuration, wherein the spring force of the middle portion 1222 biases the arms 1210 together and the first and second members 1202, 1204 are displaced toward each other. The loop 1224 can extend from the first member 1202 to allow another device to be attached or grasped thereon (e.g., using a tether therebetween).

[0080] refer to Fig.13A and 13B , shows an embodiment of a tissue clamping device 1300 for engaging tissue, which includes a first member 1302 that is substantially truncated cone-shaped. Two clamp arms 1310 extend from a first end 1310p to a second end 1310d. The first end 1310p of each arm 1310 is received within the first member 1302 via a channel 1320 extending through the first member 1302. The clamp arms 1310 are formed by a single line that is bent at a mid-portion 1322 that forms the first end 1310p of the arm 1310. The clamp arms 1310 can be used in a variety of configurations, such as Fig.13A The closed form depicted in Fig. 13B1302, wherein the second ends 1310d of the arms 1310 are positioned toward each other in the closed configuration, and the second ends 1310d of the arms 1310 are separated away from each other in the open configuration. Each of the clamp arms 1310 includes a spring portion 1316 that extends radially away from the longitudinal axis 1 of the clamping device 1300 and is configured to form a spring space between the arms 1310 at the spring portion 1316. The spring force contained in the bend at the intermediate portion 1322 of the clamp arms 1310 in the first member 1302 creates a bias toward the closed configuration at the second ends 1310d of the clamp arms 1310. The second member 1304 is slidably positioned around the plurality of arms 1310, and the arms 1310 extend through the tapered channels 1326 of the second member 1304. The tapered channels 1326 each taper (e.g., reduce in diameter) toward the first member 1302. The tapered channel 1326 is inside the second member 1304 and can engage with the opposite inclined surface of the spring portion 1316 of the arm 1310. The opposite inclined surfaces of the spring portion 1316 of the arm 1310 are inclined away from each other and the longitudinal axis 1, so that when the first and second members 1302, 1304 are displaced apart from each other, the tapered channel 1326 moves to engage with the inclined surface of the spring portion 1316 to convert the arm 1310 into an open configuration. When the first and second members 1302, 1304 are displaced to substantially contact each other, the tapered channel 1326 disengages from the inclined surface of the spring portion 1316, and the arm 1310 is converted to a closed configuration. Like the first member 1302, the second member 1304 is also substantially truncated cone-shaped. Each of the first member 1302 and the second member 1304 can be gripped from multiple angles relative to the longitudinal axis 1 of the clamping device 1300, either individually or together. The first member 1302 and the second member 1304 can each be displaced relative to each other along the longitudinal axis l of the clamping device 1300 in response to applying a compressive force 1332 to an open configuration. The first member 1302 and the second member 1304 include external angled surfaces that allow the members 1302, 1304 to move away from each other in opposite directions in response to applying a compressive force 1332 to the external angled surfaces. Although the first member 1302 cannot move relative to the arm 1310, since the end 1310p extends through the first member 1302, the first member 1302 can move away from the second member 1304 with the arm 1310. When the first and second members 1302, 1304 are displaced relative to each other, the tapered channel 1326 moves into engagement and disengagement with the opposite inclined surfaces of the spring portion 1316 of the arm 1310, thereby converting the arm 1310 between the closed configuration and the open configuration.The second member 1304 or the arm 1310 can be longitudinally moved relative to each other while one of the second member 1304 or the arm 1310 is fixed, or both the second member 1304 and the arm 1310 can be longitudinally moved relative to each other. When the device 1300 is in a static state (i.e., without any substantial compressive force 1332 being applied), the clamp arms 1310 are biased to a closed configuration, wherein the spring force of the middle portion 1322 biases the arms 1310 together and the first and second members 1302, 1304 are displaced toward each other. The loop 1313 can extend from the first member 1302 to allow another device to be attached or grasped thereon (e.g., using a tether therebetween).

[0081] exist Figures 14 to 17 , a clamp device 300 according to another exemplary embodiment of the present invention is shown in FIG. In this embodiment, the clamp device 300 includes a first chamber 314 proximate to a coupling end 301 of the clamp device 300, and a second chamber 316 proximate to an opposite clamping end 303 of the device. The coupling end 301 can be attached to another device, for example, Figure 5 or tether 20 of 27-29. The first and second chambers 314, 316 are connected via a two-way valve so that material or fluid can be exchanged therebetween to open and close the clamp device 300. In an exemplary embodiment, the material is memory foam or a similar material. In another embodiment, a viscous fluid or a similar material can be used. Similar to the clamp devices 100, 200, the clamp device 300 includes first and second clamp arms 306, which in this embodiment are formed by a single wire 308. As shown in FIG. Fig.15 As can be seen in FIG. 3 , the wire 308 bends at a mid-portion to form a first end 310 of the first and second clamp arms 306, which extend from the first end 310 to a second end 312 at the clamping end 303 of the clamp device 300. However, in this embodiment, the clamp arms 306 are spring biased to an open configuration. For example, in one embodiment, the clamp arms 306 bend outwardly at their mid-portion (i.e., in a direction away from the central longitudinal axis of the clamp device 300). As shown in FIG. Fig.15 and 17 , the clip arms 306 can be bent inwardly (i.e., in a direction toward the central longitudinal axis of the clip device 300) at their spring portions 320 such that the clip arms 306 substantially cross each other at the central longitudinal axis of the clip device 300. Thus, the second portion 318 of the clip arm 306 extending from the spring portion 320 to the second end 312 will extend away from the central longitudinal axis of the clip device 300 on the side of the central longitudinal axis opposite the first portion 317 of the clip arm 306 extending from the first end 310 to the spring portion 320.

[0082] The clamp arm 306 is disposed in a dual chamber, wherein the first portion 317 is disposed in the proximal chamber and the second portion 318 is partially disposed in the second chamber 316 and partially extends beyond the second end of the second chamber 316 closest to the clamping end 303, as can be seen in FIG. Fig.15 . The first and second chambers 314, 316 are substantially spherical in shape and include internal chambers 315, 319, respectively, configured to hold memory foam material. The first and second chambers 314, 316 are formed of a deformable material that allows the first and second chambers 314, 316 to expand and contract due to the passage of material therebetween. As described above, the first and second chambers 314, 316 are coupled to each other via a two-way valve that allows free movement of fluid between the two chambers 314, 316. Thus, for example, when external pressure is applied to the first chamber 314 by, for example, the gripper tool 10, the first chamber 314 contracts inwardly, thereby reducing the internal volume and dispersing the fluid therefrom to the second chamber 316. Conversely, when external pressure is applied to the second chamber 316 by the gripper tool 10, the second chamber 316 contracts inwardly, thereby reducing the internal volume and dispersing the fluid therefrom to the first chamber 314. Alternatively, the contraction force exerted by the material of the first chamber 314 can be greater than the contraction force provided by the material of the second chamber 316, so that when the grasper is released from the second chamber 316, the first chamber 314 automatically contracts, thereby forcing the material out of the first chamber 314 and into the second chamber 316, automatically drawing the clamp arms 306 together into the tissue clamping configuration.

[0083] In use, the clamp arm 306 moves to Fig.16 The closed configuration depicted in FIG. 3 is used to insert the first chamber 314 by squeezing the first chamber 314 until the material therein moves to the second chamber 316, as shown in FIG. Fig.15 . This movement of material to the second chamber 316 forces the clamp arms 306 to a closed configuration by laterally inflating the second chamber 316 of the second portion 318 of the clamp arms 306. This inflation of the second chamber 316 pushes the clamp arms 306 toward each other and into a closed tissue clamping configuration. Once the clamp device 300 has been positioned at a target site adjacent to the target tissue, the clamp tool 10 is used to apply pressure to the second chamber 316, as shown in FIG. Fig.17 As shown, the material is forced to move back into the first chamber 314. With the pressure removed from the second portion 318 of the clamp arm 306, the clamp arm 306 moves to the open configuration under its pre-configured bias, as shown in FIG. Fig.14 Subsequently, the clamp ends 312 of the clamp arms 306 are positioned on either side of the target tissue and the clamp arms 306 are moved again to the closed configuration by applying pressure to the first chamber 314 using the clamp tool 10, thereby clamping the target tissue.

[0084] refer to Figures 18A to 18D, an embodiment of a tissue clamping device 1800 for engaging tissue is shown. Fig.18A and 18B The device 1800 is shown in a closed configuration, and Fig.18C and 18D The device 1800 is shown in an open configuration. Fig.18B and 18D 18 is a partial cross-sectional view of the device 1800 for removing / leaking out a portion. The device 1800 includes a housing 1804 that defines a chamber 1804c having a first end 1804p that is movable within the chamber 1804c toward a second end 1804d. Within the chamber 1804 are two clamping arms 1810 extending from a first end 1810p to a second end 1810d. The first end 1810p of each arm 1810 is received within the chamber 1804c. The clamping arms 1810 can be in an open configuration (e.g., Fig.18C and 18D ) and closed forms (e.g., as depicted in Fig.18A and 18B1804) between the second ends 1810d of the arms 1810, in the open configuration, the second ends 1810d of the arms 1810 are separated from each other, and in the closed configuration, the second ends 1810d of the arms 1810 are displaced toward each other. The arms 1810 are biased or shaped in a manner in the open configuration so that when they extend out of the chamber 1804c of the housing 1804 and mostly beyond the second ends 1804d, the arms 1810 move into the open configuration. The second end 1804d of the housing 1804 constrains the arms 1810 into the closed configuration. When the spring element is in the relaxed configuration, the spring element that biases the ends 1804p, 1804d away from each other into the closed configuration is contained in the chamber 1804c of the housing 1804. The housing 1804 is within the inner layer 1820. The inner layer 1820 extends proximally of the housing 1804 into the chamber 1822 containing the fluid. The inner layer 1820 can be compressed into an open configuration by a force 1832 from multiple angles relative to the longitudinal axis l of the clamping device 1800. When compressed, the inner layer 1820 pushes the fluid 1822 against the first end 1804p of the housing 1804, causing the first end 1804p to move toward the second end 1804d of the housing 1804. When the compressive force 1832 is not applied to the layers 1802, 1820 and the chamber 1822, the first end 1804p of the housing 1804 is displaced away from the second end 1804d of the housing 1804, thereby retracting the arms 1810 to the closed configuration. When the ends 1804p, 1804d of the housing move toward each other, the second ends 1810d of the arms 1810 move away from each other to the open configuration. The outer layer 1802 is layered above the inner layer 1820 and, like the inner layer 1802, can be gripped from multiple angles relative to the longitudinal axis l. The inner layer 1820 may include a flexible and compliant material, while the outer layer 1802 may include a still flexible material that is more rigid and less compliant relative to the inner layer 1820. Examples of materials comprising the inner layer 1802 include thermoplastic elastomers (TPE) with low hardness, polyisoprene, nitrile, polysiloxane. Examples of materials comprising the outer layer 1802 include puncture-resistant materials such as polyurethane, thermoplastic urethane elastomers, and polyesteramide elastomers, copolyetherester elastomers. The arm 1810 may be formed by a single wire at the first end 1810p that is bent in the middle portion.

[0085] exist Figures 19 to 214 shows a clamp device 400 according to another exemplary embodiment of the present invention. In this embodiment, the clamp device 400 includes a clamp arm 406, a slidable sheath 414, and a stop member 416. As in other embodiments, the clamp arm 406 can be formed as a wire. In this embodiment, the clamp arm 406 extends between a first end 410 connected to the stop member 416 and an opposite second end 412. In this embodiment, each of the clamp arms 406 is bent radially outward away from the longitudinal axis of the clamp device 400 at a spring portion 420, thereby biasing the clamp arm 406 toward an open configuration, such as Fig. 20 406). The sheath 414 is substantially cylindrical in this embodiment and includes a cavity 418 extending therethrough from a first end proximal to the stop member 416 of the clamp device 400 to a second end proximal to the clamping end 403 of the clamp device 400. The sheath 414 may be formed of any suitable material, such as, for example, stainless steel or a similar metal, a polymer such as polycarbonate, polyoxymethylene, or acrylonitrile butadiene styrene (ABS). The cavity 418 is sized and shaped to slidably receive the clamp arm 406 therethrough. The stop member 416 is located on the side of the slidable sheath 414 proximal to the stop member 416 and acts as a stop for the slidable sheath 414 and a first gripping point for the clamp tool 10 as the sheath 414 moves longitudinally along the clamp arm 406. Thus, the sheath 414 can slide along the clamp arm 406 from the stop member 416 to the second end 412 of the clamp arm 406. The clamp arm 406 is sized so that when in its closed configuration, its combined width (i.e., the dimension perpendicular to the longitudinal axis of the clamp device 400) is greater than the inner diameter of the sheath 414. Additionally, friction between the clamp arm 406 and the sheath 414 will prevent the sheath 414 from sliding longitudinally relative to the clamp arm 406. Although the stop member 416 is shown as being substantially spherical in the figures, those skilled in the art will appreciate that the stop member 416 can have any shape as long as it can be retained by the gripping member.

[0086] In use, the clip device 400 is inserted into the body in an insertion configuration with the sheath 414 positioned adjacent the second end 412 of the clip arm 406 such that the clip arm 406 is in a closed configuration. When the clip device 400 is positioned adjacent the target site of tissue, the stop member 416 is retained by the first gripper tool 10 and the sheath 414 is retained by the second gripper tool 10. The retention stop member 416 provides the leverage required to move the sheath 414 toward the first end 410 of the clip arm 406, thereby allowing the clip arm 406 to spring to the closed position. Fig.194. Subsequently, the second ends 412 of the clamp arms 406 are positioned on either side of the target tissue in the open configuration. When the second ends 412 are in the desired position on the target tissue, the second clamp tool 10 is again used to move the sheath 414 toward the second ends 412 of the clamp arms, thereby moving the clamp arms 406 toward each other to close the second ends 412 over the target tissue, as shown in FIG. Fig.21 Depicted in.

[0087] exist Figures 22 to 25 , a clamp device 500 according to another exemplary embodiment of the present invention is shown. The clamp device 500 uses a sliding ball actuator that acts as a fulcrum for a plurality of clamp arms 506. In this embodiment, the clamp arms 506 are radially positioned about a central longitudinal axis of the clamp device 500, thereby forming a substantially cylindrical clamping portion 504 of the clamp device 500. The clamp arms 506 are formed with teeth 511 at their second ends 512 (i.e., the ends closest to the clamping end 503 of the clamp device 500), such as Figures 24 to 25 As shown. The teeth 511 enable the clamp device 500 to capture tissue therein. Each of the clamp arms 506 includes a gripping portion 526 extending from a first end 510 closest to the coupling end 501 of the clamp device 500 to a first curved stop portion 524. The gripping portion 526 is configured to be gripped by the clamp tool 10 to actuate the clamp arm 506. Each of the clamp arms 506 also includes a pivoting portion 528 extending from the first curved stop portion 524 to a second curved stop portion 530. The pivoting portion 528 is configured to move around a sliding ball actuator 532 retained therein. The gripping portion 526 and the pivoting portion 528 are separated by the first curved stop portion 524 of each clamp arm 506. The first curved stop portion 524 and the second curved stop portion 530 prevent the sliding ball actuator 532 from moving out of the pivoting portion 528. The clamp arm 506 is spring biased toward the closed position via an outer sleeve 520 positioned on the outer surface of the clamp arm 506. That is, the elastomeric outer sleeve 520 provides the force necessary to bias the clamp arm 506 toward the closed position, wherein the sliding ball actuator 532 is at the first end of the pivot portion 528 closest to the coupling end 501 (i.e., at the first curved stop portion 524). Figures 22 to 25 Teeth 511 and second end 512 are described, but it will be appreciated that these features may be used in addition to or interchangeably with other embodiments in a substantially similar manner.

[0088] As described above, when in the closed configuration, the sliding ball actuator 532 is located at the first end of the pivot portion 528, such as Fig. 22, while the elastomeric outer sleeve 520 positions the second ends 512 of the clamp arms 506 toward each other in a closed configuration, such as a tissue clamping configuration. When in use, the clamp arms 506 are moved to an open configuration, such as a tissue receiving configuration, by clamping the gripping portion 526 of the clamp arms 506 with the clamp tool 10. Since in this embodiment, the elastomeric outer sleeve 520 is cylindrical and the plurality of clamp arms are arranged in a cylindrical layout, the elastomeric outer sleeve provides a surface that can be clamped at any angle. Therefore, when the clamp tool 10 clamps the gripping portion 526, the sliding ball actuator 532 acts as a fulcrum about which the pivot portion 528 moves, thereby extending the elastomeric outer sleeve 520 to a larger diameter, such as Fig.23 Continuing to clamp the clamp device 500 drives the sliding ball actuator 532 toward the second curved stop portion 530, thereby further opening the clamp arms 506 and further extending the elastomeric outer sleeve 520. When the second end 512 of the clamp arm 506 is positioned around the target tissue as desired, the clamping force from the clamp tool 10 is released and the elastomeric outer sleeve 520 forces the clamp arms 506 to close, thereby pushing the sliding ball actuator 532 toward the first curved stop portion 524. The closing of the elastomeric outer sleeve 520 enables the tissue captured within the teeth to be retained, thereby allowing traction of the tissue to be pulled by placing a second clamp device 500 attached to the opposite end of the tether traction clamp device.

[0089] When reaching and grasping tools (i.e., clip devices 100, 200, 300, 400, 500, and others described herein) at a distance during minimally invasive procedures such as ESD and / or EMR procedures, one challenge may be contacting the grasping points on the clip device with the gripper tool. In an exemplary embodiment, Fig.26 A tether pulling clip system is depicted that includes magnets that can be used to provide easier and faster interaction between a gripper and a gripping point on a clip (such as the clip devices 100, 200, 300, 400, 500, 1100, 1200, 1300, 1800 and others described herein). Fig.26A gripper tool 10 and a clamp device 600 are depicted coupled together via a tether 20. In this embodiment, each of the clamp devices 600 includes a first magnet 602 of the same polarity positioned on its gripping point 604. A second magnet 606 of opposite polarity is positioned on a gripping portion 608 of the gripper tool 10. Thus, when the gripper tool 10 is brought into the general vicinity of one of the gripper devices 600, the magnets 602, 606 of the gripper device 600 and the gripper tool 10, respectively, force the gripper device 600 and the gripper tool 10 to orient themselves to each other in a desired configuration. It is noted that the gripper device 600 of this embodiment is exemplary only and may take the form of any of the gripper devices 100, 200, 300, 400, 500, 1100, 1200, 1300, or 1800. For example, the first magnet 602 can be positioned on the proximal gripping portion 102 of the clip device 100, the proximal gripping portion 202 of the clip device 200, the first chamber of the clip device 300, the stop member 414 and / or the sheath 416 of the clip device 400, or the gripping portion 526 of the clip device 500. In various embodiments, the magnets can be embedded in and / or on the surface of the conical clamping element, the first member, and / or the second member.

[0090] exist Figures 27 to 29 An exemplary method for using an embodiment of a clip device for endoscopic mucosal resection according to the present invention is shown in FIG. Figures 27 to 29 Depicted Figures 11A to 11D The present invention also provides a method for inserting a clip device 1100 into the body. However, it will be understood that any of the other embodiments of the clip devices described herein or within the scope of the present invention can be used in a substantially similar manner. Prior to insertion into the body, the two clip devices 1100 are coupled to either end of an elongated elastic tether 20 to form a tether-pulling clip system 150. The clip device 1100 and tether 20 are then inserted into the body (e.g., via a natural body cavity) adjacent to a target portion of tissue or a lesion 40 to be removed using any known delivery device. The clip device 1100 and tether 20 are extended or pushed out of the working channel of the endoscope via a clamp tool 10 also positioned within the working channel proximal to the clip device 100. When extended out of the working channel, the clip device 1100 and tether 20 will rest against adjacent tissue within the target body cavity. As will be appreciated by those skilled in the art, the lesion 40 (i.e., the target tissue) may have been previously marked and manipulated to make it more accessible (e.g., the tissue may have been pulled or pushed to change the fold of the tissue so that the lesion is exposed and not located deep within the tissue fold). A filler may also be injected into the target tissue to lift the lesion 40 away from the underlying muscle layer.

[0091] Subsequently, the gripper tool 10 is used to grasp the clamping device, for example, the members 1102, 1104 of the clip device 1100, thereby opening the clip device 1100. It is noted that the longitudinal length of the jaws of the gripper tool 10 can preferably be selected to be smaller than the diameter of the members 1102, 1104 of the clip device 1100, so that the gripper tool 10 does not inadvertently grasp tissue that may be adjacent to (e.g., lean against) the clip device 1100. Subsequently, the first clip device 1100 is positioned in the open configuration so that the first target portion of the lesion 40 (or adjacent tissue) is located between the separated arms of the gripper 1130. The gripper tool 10 then releases one or more members 1102, 1104 of the first clip device 1100, thereby allowing the springs 1128 attached to the members 1102, 1104 to be pulled toward each other under the natural bias of the device 1100, and also allowing the cam member 1118 to move into the spring space 1114 between the arms 1110 to close the device 1100 so that the first target portion of tissue is clamped and clamped by the closed arms of the grasper 1130. When the clip device 1100 has been clamped to the first target portion of tissue, another clip device 1100 is then attached to a nearby second target portion of tissue 60. The tether 20 applies tension between the two clip devices 1100, and thus applies tension to the first and second target portions of tissue 60, in this example, the tension member 40 and the second target portion of tissue 60. With both clip devices 100 in place, the gripper tool 10 is removed from the endoscope 30 and the resection device 70 is inserted through the working channel of the endoscope 30. The user then operates the resection device 70 in a known manner to make an initial incision in the lesion 40, thereby allowing a portion of the resected lesion (lesion flap 50) to be lifted away from the underlying muscle via the applied tension created by the clip device 1100 and the tether 20. This enables the physician to more clearly visualize the resection, e.g., the cutting plane of the lesion, as shown in FIG. Fig.29 As shown. When a larger surface area of ​​the lesion is removed, the tension provided by the clip device 1100 and the tether 20 may decrease. At this time, the excision device 70 can be removed from the working channel and the clamp tool 10 can be reinserted. Then, the clamp tool 10 is used to reposition the clip device 1100, which is initially placed to engage with the tissue 60 on a different portion of the tissue 60, so that the desired tension level is provided to the lesion flap 50 again, and the process for excising the desired tissue without excising the surrounding tissue is repeated. This process is repeated until all of the lesion 40 has been excised from the tissue below. At this point, the attachment 1100 is disengaged from the tissue 60 via the clamp tool 10 and the tether traction clip system 150, and the tether traction clip system 150 is removed from the patient's body together with the lesion tissue clamped by the clamp device 1100.

[0092] In various embodiments, the arms of the device can have a variety of shapes. Such shapes can include one or more bends, protrusions, or curves. The arms can be continuous and / or extensions of each other. The arms can include recesses, ridges, friction surfaces, or additional materials configured to engage tissue or graspers. The device can have any number of arms, for example, 1, 2, 3, 4, 6, 10, 20, etc., which can be composed of one or more wires. One or more graspers can be integral with the end of the arm, removably engaged with it or attached to it.

[0093] In various embodiments, the channel of the device can have a variety of shapes. The channel can substantially match the shape or curve of the arm, or the channel can be shaped to accept one or more arms with a volume of unoccupied space around at least a portion of the arm. Various channels throughout the present invention are tapered, but the channel can also have a substantially uniform diameter throughout and still be able to manipulate one or more arms.

[0094] In various embodiments, the shapes of the first and second members can vary. For example, the members can include one or more angles that are configured to be engaged by a tool so that one or more of the members are displaced to engage one or more arms. The members can be symmetrical or asymmetrical with respect to each other. For example, the members can be generally truncated cone-shaped so that the apex of each truncated cone is oriented toward the other member so as to form an hourglass shape when they are substantially in contact with each other. The members can be configured so that the proximal and / or distal members are displaced while the other member is fixed or also displaced.

[0095] In various embodiments, one or more arms of the device can be used to manipulate the grasper. The arms can open and close to receive or engage the grasper. Movement of the second end of the arm can create an opposite movement at the second end of the jaws of the grasper (e.g., Fig. 11B The arms of the device may be arranged to close in order to open the jaws of the grasper and vice versa.

[0096] In various embodiments, other methods of using the devices described herein may include inserting a tissue clamping device into a patient. The components of the clamping device may be engaged by another medical device from multiple angles relative to the longitudinal axis of the clamping device. The components of the clamping device may be displaced separately from another component so that it engages and manipulates one or more arms of the device to enter an open configuration. The device may be manipulated so that the arm receives tissue. The component may be displaced to substantially contact another component so that it disengages from one or more arms and the arm is converted from an open configuration to a closed configuration. The device may be fixed to the tissue. When the device engages with the tissue, the device may move so that the device and the tissue move together to be removed (e.g., excised) from the patient.

[0097] In various embodiments, the arms of the device may include a single wire or may be multiple separate wires. One or more wires may be attached to a member and may extend through another member. The spring portion of one or more wires may bias the arms toward or away from each other.

[0098] It will be appreciated by those skilled in the art that the above-mentioned embodiments can be changed without departing from the inventive concept thereof. It should also be understood that the structural features and methods associated with one of the embodiments can be incorporated into other embodiments. Therefore, it should be understood that the present invention is not limited to the specific embodiments disclosed, but modifications are also covered within the scope of the present invention as defined by the appended claims. According to the present invention, all devices and / or methods disclosed and claimed herein can be manufactured and executed without requiring excessive experiments. Although the device and method of the present invention have been described with preferred embodiments, it will be apparent to those skilled in the art that changes can be applied to the device and / or method and the steps of the methods described herein or in the sequence of steps without departing from the concept, spirit and scope of the present invention. All such similar substitutions and modifications apparent to those skilled in the art are considered to be within the spirit, scope and concept of the present invention as defined by the appended claims.

Claims

1. A tissue clamping device, comprising: proximal member; a distal member movable relative to the proximal member; and a pair of arms, each arm extending from a proximal end to a distal end, the proximal end of each arm being operably associated with at least one of the proximal member or the distal member; wherein the proximal member or the distal member has a surface extending circumferentially therearound and is configured to cause the distal end of the proximal member and the proximal end of the distal member to shift apart from each other in response to a radially inward force applied to the surface so that the arm moves between an open form and a closed form.

2. The tissue clamping device according to claim 1, wherein: The surfaces of the distal and proximal members are configured to be grasped by a gripper tool regardless of the orientation of the gripper tool relative to the surfaces to move the proximal and distal members apart from each other when grasped by the gripper tool.

3. The tissue clamping device according to claim 1, wherein: The surfaces of the proximal and distal members include angled surfaces configured to longitudinally displace the proximal and distal members spaced apart from one another in response to the radially inward force being applied to the angled surfaces.

4. The tissue grasping device of claim 1 further comprising a grasper having a first end and a second end, the first end being engaged between the arms, the second end comprising jaws configured to engage tissue.

5. The tissue clamping device according to claim 4, wherein: The gripper includes a first gripper arm and a second gripper arm in a crossed configuration in which the second ends of the gripper arms move away from each other as the first ends of the gripper arms move closer together.

6. The tissue clamping device according to claim 1, wherein: The arms are biased to the closed configuration.

7. The tissue clamping device according to claim 1, wherein: The arm is received within the distal member.

8. The tissue grasping device of claim 1, further comprising a cam movable with one of the proximal member or the distal member to move the arm between the closed configuration and the open configuration.

9. The tissue clamping device according to claim 1, wherein: The arm is mechanically constrained relative to one of the proximal member or the distal member such that the arm displaces when the proximal member is longitudinally displaced relative to the distal member.

10. The tissue clamping device according to claim 1, wherein: One of the proximal member or the distal member is disposed about the arm, and the proximal member is slidable relative to the distal member to move the arm between the open configuration and the closed configuration.

11. The tissue clamping device according to claim 1, wherein: The surfaces include surfaces that are inclined toward each other, and the surfaces that are inclined toward each other are configured to displace the proximal member and the distal member longitudinally away from each other in response to a radially inward force applied to the inclined surfaces.

12. A tissue clamping device comprising: a gripping portion comprising first and second members movable relative to each other along a longitudinal axis of the tissue grasping device; and a pair of arms, each arm extending from a first end to a second end; Wherein the longitudinal ends of the first and second members are configured to move away from each other in response to a radially inward force applied to the outer surfaces of the first and second members to transition the arms between the closed and open configurations.

13. The tissue clamping device according to claim 12, wherein: The first and second members have outer surfaces configured to be grasped by a gripper tool, regardless of the orientation of the gripper tool relative to the surfaces, so that when grasped by the gripper tool, the first and second members are longitudinally displaced away from each other to move the arms between the closed and open configurations.

14. The tissue clamping device according to claim 12, wherein: The arms are biased to the closed configuration.

15. The tissue clamping device according to claim 12, wherein: The first and second members include adjacent angled surfaces configured to displace the first and second members away from each other in response to the radially inward force being applied to the angled surfaces.

16. The tissue clamping device according to claim 12, wherein: The arm is formed from a single body bent at a mid-portion, the mid-portion forming the first end of the arm.

17. The tissue grasping device of claim 12, further comprising a grasper disposed between the second ends of the arms.

18. A tissue clamping device comprising: a gripping portion comprising a first member and a second member movable relative to each other; and a pair of arms, each arm extending from a first end to a second end; Wherein, the first member and the second member are configured to be displaced relative to each other in response to a radially inward force applied to mating surfaces at ends of the first member and the second member to transition the arm between a closed configuration and an open configuration.

19. The tissue clamping device according to claim 18, wherein: The mating surfaces of the first and second components are configured to be grasped by a gripper tool regardless of the orientation of the gripper tool relative to the mating surfaces to move the first and second components apart from each other when grasped by the gripper tool.

20. The tissue clamping device according to claim 18, wherein: The mating surfaces are inclined surfaces at adjacent ends of the first member and the second member.

21. A tissue clamping device comprising: a pair of arms, each arm extending from a first end to a second end, wherein the second ends are movable between an open configuration spaced apart from each other and a closed configuration adjacent to each other to clamp tissue therebetween; and a first member and a second member coupled to the pair of arms and movable relative to each other to transition the pair of arms between the open configuration and the closed configuration; in: The first member and the second member are configured to form a gripping cylinder that can be gripped by a gripper tool regardless of the orientation of the gripper tool relative to the gripping cylinder; and A radially inward force is applied to the clamping cylinder by the clamping tool, causing the clamping cylinder to transform the configuration of the pair of arms.

22. The tissue clamping device according to claim 21, wherein: The first member and the second member are each conical and taper toward each other such that the first member and the second member together form an hourglass-shaped clamping cylinder.

23. The tissue clamping device according to claim 21, wherein: The first member and the second member each include an angled surface configured to displace the first member and the second member relative to each other in response to the radially inward force applied thereto.

24. The tissue clamping device according to any one of claims 21 to 23, wherein: The first member and the second member are configured to move relative to each other when the radially inward force is applied between the first member and the second member.

25. The tissue clamping device according to any one of claims 21 to 24, wherein: Upon application of the radially inward force to the clamping cylinder, the first member and the second member move away from each other.

26. The tissue grasping device according to any one of claims 21-25, further comprising a cam member movable into and out of engagement with the first arm and the second arm to transition the pair of arms between the open configuration and the closed configuration.

27. The tissue clamping device according to claim 26, wherein: The cam member includes an angled surface on each of the first member and the second member.

28. The tissue clamping device according to any one of claims 21 to 27, wherein: The first arm and the second arm are biased to the closed configuration.

29. The tissue clamping device according to any one of claims 21 to 27, wherein: The first arm and the second arm are biased to the open configuration.

30. A tissue clamping device comprising: a gripping portion comprising a first member and a second member movable relative to each other; and a clamping portion, the clamping portion comprising a first arm and a second arm, each arm extending from a first end to a second end, the arms being movable between an open configuration in which the second ends of the arms are spaced apart from one another and a closed configuration in which the second ends of the arms are adjacent one another to clamp tissue therebetween; in: The gripping portion is mounted on the clamping portion; and The first and second members are configured to be displaceable relative to each other in response to a radially inward force applied to the first and second members at any angle relative to the clamping device.

31. The tissue clamping device according to claim 30, wherein: The first member and the second member each have an angled surface and are displaceable relative to each other in response to the radially inward force being applied to the angled surfaces.

32. The tissue clamping device according to claim 31, wherein: The gripping portion is mounted relative to the first end of the first arm and the second arm of the clamping portion; and The angled surfaces of the first and second members are configured to displace the first and second members relative to each other in response to the radially inward force applied thereto.

33. A tissue clamping device comprising: a gripping portion comprising a first member and a second member movable relative to each other; and a clamping portion, the clamping portion comprising a first arm and a second arm, each arm extending from a first end to a second end, the arms being movable between an open configuration in which the second ends of the arms are spaced apart from one another and a closed configuration in which the second ends of the arms are adjacent one another to clamp tissue therebetween; in: The gripping portion is mounted on the clamping portion; and The gripping portion is configured to grip at any angle relative to the clamping device to move the first member and the second member from a position adjacent to each other to a position spaced apart from each other to transition the arm between the open configuration and the closed configuration.

34. The tissue clamping device according to claim 33, wherein: The gripping portion is mounted relative to the first end of the first arm and the second arm of the clamping portion; and The first member and the second member have respective ends adjacent to each other, and upon application of a radially inward force to the grip portion, the ends move to positions spaced apart from each other.

35. A tissue clamping device comprising: a housing defining a chamber and having a first end movable within the chamber toward a second end of the housing; a plurality of arms, each of the arms extending from a first end to a second end, the first end of each arm being received within the chamber, the arms being movable between an open configuration in which the second ends of the arms are separated from one another and a closed configuration in which the second ends of the arms are displaced toward one another; an inner layer disposed about the housing and extending proximally of the housing to define a chamber configured to contain a fluid; wherein the chamber is compressible from a plurality of angles relative to a longitudinal axis of the clamping device in response to application of a compressive force; as well as wherein in response to the compressive force being applied to the chamber, the first end of the shell moves toward the second end of the shell, thereby extending the arm to the open configuration, and when the compressive force is not applied to the chamber, the first end of the shell shifts away from the second end of the shell, thereby retracting the arm to the closed configuration.

36. The clamping device of claim 35, further comprising an outer layer disposed about the inner layer, the outer layer being configured to grip from a plurality of angles relative to a longitudinal axis of the clamping device to apply the compressive force to the chamber.

37. A clamping device according to any one of claims 35 to 36, wherein the inner layer is configured to grip from a plurality of angles relative to a longitudinal axis of the clamping device to apply the compressive force to the chamber.

38. A clamping device according to any one of claims 35 to 37, wherein the arm is formed from a single wire bent in a mid-section, the mid-section forming the first end of the arm, and wherein the arm is biased towards the open configuration.

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