Devices, systems and methods for tissue traction

Abstract

The invention relates to a tissue traction device having a section which is defined along a confinement of a periphery of the tissue traction device and which is more flexible than a surrounding area of the tissue traction device. The tissue traction device is actuatable to flex along its more flexible section substantially in a lateral direction opposite the tissue traction device and its more flexible section. The tissue traction device may be formed from one or more flexible tubular elements, wherein the flexible section is along a confined extent of the perimeter of the one or more tubular elements. A tissue traction system may be configured to provide an actuation medium, such as an expansion medium, to the tissue traction device to control movement of the tissue traction device. The tissue traction system may include one or more flexible tubular elements whose distal ends form the tissue traction device.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of priority to U.S. Provisional Application No. 63 / 342,780, filed on May 17, 2022, the entire disclosure of which is hereby incorporated by reference into this document for all purposes. Technical Field

[0002] The present disclosure relates generally to the field of devices, systems and methods for applying traction to tissue. More specifically, the present disclosure relates to devices, systems and methods for applying traction to tissue for applying traction to tissue in controllable directions, such as more than one direction. Background Art

[0003] Various endoscopic surgical procedures require manipulation of various anatomical structures. Some operations (such as endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), preoral endoscopic myotomy (POEM), etc.) allow minimally invasive endoscopic removal of benign and early malignant lesions, such as in the gastrointestinal (GI) tract. Compared to open or laparoscopic surgery, this type of minimally invasive surgical technique generally allows for faster recovery. However, because such operations are minimally invasive, there is limited space to manipulate in vivo, and such operations generally require a high degree of expertise. In operations involving tissue cutting, one of the biggest time and complexity drivers is the management of the tissue being cut. Loose tissue segments can hinder visibility, such as by falling on the endoscope, blocking the visibility of the camera, and creating obstacles that affect the movement of the instruments used during the operation and affect all areas and depths of the target tissue being cut. Various solutions have been developed for lifting the cut (and usually hanging) tissue blocks, thereby clearing the path for visibility and operation of medical tools and devices. However, positioning of the elements used by such solutions can be challenging, particularly in space-constrained environments. Additionally, the elements used by such solutions may require medical tools that are independent of those used to perform the procedure, and such tools may even require a separate working channel of the endoscope, potentially increasing the size and / or complexity of the endoscope. Alternative solutions for lifting tissue during surgery that reduce the cost, complexity, and cognitive load presented by existing solutions would be welcome. Summary of the invention

[0004] The present invention content of the present disclosure is given to assist understanding, and those skilled in the art will understand that each of the various aspects and features of the present disclosure can be advantageously used alone in some cases, or in combination with other aspects and features of the present disclosure in other cases. The inclusion or non-inclusion of elements, components, etc. in the present invention content is not intended to limit the scope of the claimed subject matter.

[0005] According to various aspects of the present disclosure, a tissue traction system has a tissue traction device and one or more elongated elements that are operatively coupled to the tissue traction device to actuate bending of the tissue traction device. In some aspects, a longitudinal circumferential region of the tissue traction device is more flexible than a surrounding region of the tissue traction device, so that actuation of the tissue traction device causes bending along the more flexible region toward a less flexible region.

[0006] In some embodiments, the tissue traction device is formed by the distal extent of one or more elongated elements, and the distal extent extends a certain length proximal to the distal end of the one or more elongated elements. In some embodiments, at least one of the elongated elements is a flexible tubular element. In some embodiments, at least one flexible tubular element has a sealed distal end. In some embodiments, the tissue traction system also includes an actuation mechanism that is operatively connected to one or more elongated elements to cause bending of the tissue traction device. In some embodiments, the distal extent of at least one flexible tubular element forms a flexible tubular element of the tissue traction device; the longitudinal circumferential region of the tissue traction device is formed along the distal region of at least one flexible tubular element and is more expansible than the surrounding region of the tissue traction device; and the actuation mechanism delivers an expansion medium through at least one flexible tubular element to the tissue traction device so that the longitudinal circumferential region of the tissue traction device expands relative to the surrounding region of the tissue traction device to cause the tissue traction device to bend.

[0007] In some embodiments, the tissue retraction system further comprises an actuation mechanism operatively coupled to the one or more elongated elements to induce bending of the tissue retraction device.

[0008] In some embodiments, reinforcing elements are applied along the perimeter of the tissue retraction device along the restricted area, thereby causing the surrounding area to be relatively more flexible.

[0009] In some embodiments, one or more elongated elements include a flexible tubular element having a sealed distal end; the tissue traction device is formed by a distal extent of the flexible tubular element, which extends a certain length proximal to the sealed distal end of the flexible tubular element; and the tissue traction device is directionally expandable when an expansion medium is applied thereto, thereby causing a more flexible region of the tissue traction device to expand and causing the tissue traction device to bend toward the reinforcement element.

[0010] According to various principles of the present disclosure, a tissue retraction device has an elongated cylindrical body extending along a longitudinal axis and having a distal end and a proximal end and a flexible section therebetween, the flexible section extending along only a portion of the periphery of the cylindrical body. In some aspects, the flexible section is more flexible than the surrounding portion of the cylindrical body to facilitate bending of the cylindrical body along the flexible section.

[0011] In some embodiments, the cylindrical body is tubular and expandable; and the flexible segment is more expandable than the surrounding portion of the cylindrical body, so that expansion of the tubular cylindrical body causes the flexible segment to expand and bend the flexible segment toward the less expandable side portion of the cylindrical body.

[0012] In some embodiments, the flexible section extends only along a limited range along the longitudinal axis of the cylindrical body.

[0013] In some embodiments, the cylindrical body is formed of a flexible material, and the reinforcing element is applied to a limited range of the periphery of the flexible cylindrical body, the flexible section being defined opposite the reinforcing element.

[0014] In some embodiments, the cylindrical body is a distal section of a flexible tubular element of a tissue retraction system.

[0015] In some aspects, a method for applying traction with a tissue traction device includes actuating the tissue traction device to bend along a flexible region of a gripping end thereof toward a region of the tissue traction device opposite the flexible region to cause the tissue traction device to apply traction via the gripping end thereof, the gripping end being more flexible than the surrounding region. In some aspects, the tissue traction device is tubular, and the method further includes actuating the tissue traction device to expand the flexible segment of the tissue traction device relative to the surrounding region by delivering an inflation medium to a lumen defined within the tissue traction device to cause the tissue traction device to bend in a direction generally opposite to the flexible segment.

[0016] In some embodiments, the tissue traction device includes a plurality of flexible tubular elements coupled together along a common bonding region; the flexible section of the tissue traction device is formed along a section of each of the plurality of flexible tubular elements generally opposite the common bonding region; and the method includes selectively actuating one or more of the plurality of flexible tubular elements of the tissue traction device to control the bending of the actuated flexible tubular element toward the common bonding region and to control the bending of the tissue traction device in more than one direction. In some embodiments, each flexible tubular element is formed by a distal section of a flexible tubular element forming a tissue traction system, each flexible tubular element having a lumen for delivering an expansion medium to the tissue traction device and sealing a distal end, and the method also includes selectively delivering an expansion medium through one or more of the flexible tubular elements to control the bending of the tissue traction device in more than one direction.

[0017] In some embodiments, a flexible tubular element of a tissue traction device is formed along a distal section of the flexible tubular element, the flexible tubular element having a lumen for delivering an expansion medium to the tissue traction device and sealing the distal end; a reinforcement element is applied along a restricted area of ​​the periphery of the flexible tubular element of the tissue traction device so that the surrounding area defines a more flexible area of ​​the tissue traction device; and the method also includes selectively delivering an expansion medium through the flexible tubular element to control the bending of the tissue traction device toward the reinforcement element.

[0018] In some aspects, a method for applying traction to a target tissue includes engaging a first tissue engaging feature of a tissue traction device with the target tissue; engaging a second tissue engaging feature of the tissue traction device with tissue separated from the target tissue; and actuating the tissue traction device to bend along a flexible section thereof toward an area of ​​the tissue traction device opposite the flexible region to cause the tissue traction device to apply traction to the target tissue, the flexible section being more flexible than the surrounding area.

[0019] In some embodiments, the tissue traction device is tubular, and the method further includes actuating the tissue traction device to expand the flexible section of the tissue traction device relative to the surrounding area by delivering an expansion medium to a lumen, the lumen being defined within the tissue traction device, to cause the tissue traction device to bend in a direction generally opposite to the flexible section. In some embodiments, the tissue traction device includes a plurality of flexible tubular elements coupled together along a common bonding region; the flexible section of the tissue traction device is formed along a section of each of the plurality of flexible tubular elements generally opposite to the common bonding region; and the method further includes selectively actuating one or more of the plurality of flexible tubular elements of the tissue traction device to control the bending of the actuated flexible tubular element toward the common bonding region and to control the bending of the tissue traction device in more than one direction. In some embodiments, each flexible tubular element is formed by a distal section of a flexible tubular element forming a tissue traction system, each flexible tubular element having a lumen for delivering an expansion medium to the tissue traction device and sealing a distal end, and the method further includes selectively delivering an expansion medium through one or more of the flexible tubular elements to control the bending of the tissue traction device in more than one direction. In some embodiments, a flexible tubular element of a tissue traction device is formed along a distal section of the flexible tubular element, the flexible tubular element having a lumen for delivering an expansion medium to the tissue traction device and sealing the distal end; a reinforcement element is applied along a restricted area of ​​the periphery of the flexible tubular element of the tissue traction device so that the surrounding area defines a more flexible area of ​​the tissue traction device; and the method also includes selectively delivering an expansion medium through the flexible tubular element to control the bending of the tissue traction device toward the reinforcement element.

[0020] These and other features and advantages of the present disclosure will be apparent from the following detailed description, and the scope of the invention to be protected is set forth in the appended claims. Although the following disclosure is presented in the form of multiple aspects and embodiments, it should be understood that independent aspects may be claimed individually or in combination with aspects and features of this embodiment or any other embodiment. BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Non-limiting embodiments of the present disclosure are described with reference to the accompanying drawings by way of example, and these drawings are schematic and are not intended to be drawn to scale. The accompanying drawings are provided for illustrative purposes only, and the dimensions, positions, orders, and relative sizes reflected by the numbers in the accompanying drawings may change. For example, the device may be enlarged so that the details are discernible, but is intended to be reduced, for example, to fit within the working channel of a delivery catheter or endoscope. In the figures, the same or nearly the same or equivalent elements are generally represented by the same reference numerals, and similar elements are generally named with similar reference numerals in increments of 100, with redundant descriptions omitted. For the purpose of clarity and simplicity, not every element is marked in each figure, and each element of each embodiment is not shown in the case where the illustration is not necessary for allowing a person skilled in the art to understand the present disclosure.

[0022] The detailed description will be better understood in conjunction with the accompanying drawings, wherein like reference numerals represent like elements, as follows:

[0023] Figure 1 A perspective view showing an example of an embodiment of a tissue traction system and a tissue traction device formed according to various principles of the present disclosure;

[0024] Figure 2 Shows Figure 1 A cross-sectional view of a portion of the tissue pulling device along line II-II;

[0025] Figure 3 A perspective view showing an example of one embodiment of a tissue retraction system and actuation mechanism according to various principles of the present disclosure;

[0026] Figure 4 Shows such as Figures 1 to 3 Operation of an example of an embodiment of a tissue traction system is shown;

[0027] Figure 5 Shows such as Figures 1 to 3 Operation of an example of an embodiment of a tissue traction system is shown;

[0028] Figure 6 A perspective view showing another example of an embodiment of a tissue traction system and a tissue traction device formed according to various principles of the present disclosure;

[0029] Figure 7 Shows such as Figure 6 Operation of an example of one embodiment of a tissue retraction system is shown. DETAILED DESCRIPTION

[0030] The following specific embodiments should be read with reference to the accompanying drawings, which show illustrative embodiments. It should be understood that the present disclosure is not limited to the described specific embodiments and can therefore be changed. All devices and systems and methods discussed herein are examples of devices and / or systems and / or methods implemented according to one or more principles of the present disclosure. Each example of the embodiment is provided by way of explanation, and is not the only way to implement these principles, but only as an example. Therefore, references to elements or structures or features in the accompanying drawings must be understood as references to examples of embodiments of the present disclosure, and should not be understood as limiting the present disclosure to the specific elements, structures or features shown. When reading the present disclosure, those skilled in the art will think of other ways to implement the disclosed principles. In fact, it will be apparent to those skilled in the art that various modifications and variations can be made in the present disclosure without departing from the scope and spirit of the subject matter of the present invention. For example, a feature shown or described as a part of an embodiment can be used together with another embodiment to produce another embodiment. Therefore, it is expected that the subject matter of the present invention covers such modifications and variations that fall within the scope of the appended claims and their equivalents.

[0031] It should be understood that the present disclosure is set forth in various levels of detail in this application. In some cases, details that are not necessary for a person skilled in the art to understand the present disclosure or that make other details difficult to perceive may have been omitted. 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 defined, the technical terms used herein should be understood as commonly understood by those skilled in the art to which the present disclosure belongs. According to the present disclosure, all devices and / or methods disclosed and claimed herein can be made and executed without excessive experimentation.

[0032] As used herein, "proximal" refers to the direction or position closest to a user (a medical professional or clinician or technician or operator or physician, etc., such terms may be used interchangeably herein and are not intended to be limiting, and include automated controller systems, etc.), such as when utilizing the device (e.g., introducing the device into a patient, or during implantation, positioning, or delivery), and / or the direction or position closest to a delivery device; while "distal" refers to the direction or position farthest from a user, such as when utilizing the device (e.g., introducing the device into a patient, or during implantation, positioning, or delivery), and / or the direction or position closest to a delivery device. "Longitudinal" means extending along the longer or larger dimension of an element. A "longitudinal axis" extends along the longitudinal extent of an element, but is not necessarily straight and does not necessarily maintain a fixed configuration when the element is flexed or bent. "Center" means at least approximately bisecting a center point and / or being approximately equidistant from a perimeter or border; and "central axis" means, relative to an opening, a line at least approximately bisecting a center point of the opening, which line extends longitudinally along the length of the opening when the opening comprises, for example, a tubular element, a strut, a passage, a cavity, or a hole. As used herein, a "passage" or "hole" is not limited to a circular cross-section. As used herein, a "free end" of an element is a terminal end beyond which such element does not extend.

[0033] According to various principles of the present disclosure, tissue traction systems and tissue traction devices are constructed and designed to apply traction to a tissue segment that is separated (e.g., cut) from surrounding tissue at a treatment site (e.g., apply tension to it, such as to retract it). It should be understood that terms such as segment, portion, area, section, etc. may be used interchangeably herein without limitation; for the purpose of convenient distinction and without limitation, sections are generally referred to as general areas, and segments are referred to as specific parts. For the purpose of convenience and without limitation, the separated sections of tissue may be referred to as tissue flaps herein. In addition, it should be understood that the treatment site may be alternatively referred to herein as an anatomical site, a delivery site, a deployment site, an implant / implantation site, a target site, etc., without limitation.

[0034] More specifically, according to various principles of the present disclosure, the tissue traction device is configured to bend in a desired (e.g., predetermined) direction to apply traction to a tissue flap, which is operatively engaged to the tissue flap. It should be understood that terms such as engagement (and other grammatical forms) can be used interchangeably herein with terms such as coupling, grasping, holding, snapping, clamping, anchoring, associating, attaching, attaching, fixing, etc. (and their other grammatical forms), and are not intended to be limiting. In some embodiments, the tissue traction device has an elongated cylindrical body having a substantially cylindrical surface. One or more tissue engagement features may be operatively associated with the tissue traction device, such as extending along its surface. In some embodiments, the tissue engagement feature is configured to be operatively engaged by a tissue engagement member. In some embodiments, the tissue engagement feature is an extension, such as a ring-shaped object that a separately formed tissue engagement member can engage, such as a tissue clamp, which is configured to operatively engage the tissue traction device with tissue at the treatment site. In some embodiments, the tissue engagement feature is formed with a device engagement member, such as a clamp or a clamping claw that has been coupled thereto, which is configured to grasp the tissue.

[0035] The tissue traction system can be used to actuate the tissue traction device to bend in one or more different directions. In some embodiments, the tissue traction system includes one or more elongated elements that are coupled to the tissue traction device to actuate the movement of the tissue traction device. In some embodiments, the tissue traction device includes a region; the region is more flexible than the surrounding region, so that actuation of the tissue traction device causes the tissue traction device to bend along the more flexible region in the direction of the less flexible surrounding region (roughly toward the region substantially diametrically opposite to the more flexible region). In some embodiments, only a limited tangential section of the tissue traction device (a section defined along the surface of the tissue traction device and defined by longitudinally extending boundaries that are circumferentially / circumferentially separated from each other) has increased flexibility and / or expansibility relative to the surrounding region. Therefore, since only a portion of the periphery of the tissue traction device is flexed to a greater extent than the surrounding region of the tissue traction device, the tissue traction device will bend at such a flexible region, usually toward the opposite side of the less flexible tissue traction device. The flexible region may extend along only a limited longitudinal extent of the tissue traction device or along the entire length of the tissue traction device. The flexible region may be a limited pre-stretched region and / or may be formed of a different material than the surrounding less flexible region; and / or may have a thinner wall thickness than the surrounding region to allow for relatively increased flexibility, and / or may be otherwise asymmetrically formed around its perimeter to allow for flexure of the tissue traction device to be oriented in a particular direction. It should be understood that the flexible section may extend along only a limited longitudinal extent of the tissue traction device or along the entire length of the tissue traction device.

[0036] In some embodiments, the traction device includes at least one flexible tubular element. The flexible section of such a tissue traction device may additionally or alternatively be more expandable than other regions of the tissue traction device. Application of an expansion medium to the flexible tubular element of the tissue traction device causes the flexible tubular element to expand and bend along the flexible and / or expandable region, thereby applying traction to the tissue to which the traction device is coupled.

[0037] In some embodiments, the tissue traction system and the tissue traction device use pneumatic or hydraulic force to apply and maintain traction on the tissue flap. For example, the tissue traction system can be configured to deliver an expansion medium to the expansion lumen in the flexible tubular element of the tissue traction device to cause the tissue traction device to expand along its flexible and / or expansibility region and thus bend toward a lower expansibility region (e.g., opposite to the flexible and / or expansibility region) to apply traction to the tissue flap. In some embodiments, the flexible tubular element has a flexible expansion region surrounded by a lower flexibility region. The application of the expansion medium to the flexible tubular element of the tissue traction device causes the flexible expansion region of the flexible tubular element to expand. However, the lower flexibility region does not expand (or can expand, but significantly less than the flexible expansion region). Therefore, due to the increase in size / length of the more flexible region (and the formation of the outer portion of the curved tube with a larger radius of curvature), the flexible tubular element of the tissue traction device bends toward the lower flexibility region.

[0038] In some embodiments, the tissue traction system includes one or more elongated elements that are operatively connected to the tissue traction device to actuate the tissue traction device to cause the tissue traction device to bend in the desired direction. In some embodiments, the tissue traction system and device utilize one or more tubular elements. The tubular element can be configured to form a traction device at its distal end region (at the distal end and at a limited longitudinal range on its proximal side), which is connected to the tissue and the traction force will be applied to the tissue. For example, only a limited area of ​​the distal end of each of the one or more tubular elements of the tissue traction system is configured to form a tissue traction device (e.g., a flexible tubular element of the tissue traction device). In addition, to allow the tissue traction device to be directed when it is actuated by the tissue traction system (e.g., the application and / or delivery of the actuating medium to the tissue traction device), only a limited area of ​​the periphery of the distal end region of each of the one or more tubular elements of the tissue traction system (forming the tissue traction device) is less flexible. In other words, only a limited portion of the tubular element at its distal end (which distal end region forms the tissue traction device) has a limited range of regions around the periphery of the tubular element that have greater flexibility and / or expandability than the remaining area of ​​the tubular element. Thus, due to flexing or expanding to a greater extent along only a limited portion of the periphery of the tissue traction device than the surrounding area, the tissue traction device will bend at such flexible expandability regions, typically toward the opposite side of the less flexible and / or expandable tissue traction device. The flexible expandability region may be a limited pre-stretched region and / or may be formed of a different material than the surrounding less flexible and / or expandable region; and / or may have a thinner wall thickness than the surrounding region to allow for relatively increased flexibility and expandability, and / or be otherwise asymmetrically formed around its periphery to allow flexure to be directed in a particular direction.

[0039] It should be understood that instead of a limited area (a limited range along the periphery of the tissue traction device, with increased flexibility and / or expandability), the tubular element forming the tissue traction device may be formed of a material having a substantially uniform property along its length and periphery, wherein the limited area along the limited range of the periphery of the tissue traction device has an increased rigidity relative to the flexibility of the tubular element. Therefore, the portion of the flexible tubular element forming the tissue traction device expands to a larger range in multiple areas around the area with increased rigidity, and thus, the tissue traction device is bent toward the area with increased rigidity. In some embodiments, the tissue traction device is formed along the distal area of ​​the flexible tubular element of the tissue traction system, and the increased rigidity / rigidity section is formed along a limited area, which is along the limited range of the periphery of the tissue traction device (i.e., along only one side or vertical section of the surface of the tissue traction device). For example, a reinforcing element may be applied longitudinally along the limited periphery of the tissue traction device along the tissue traction device. The rigid element may be a material with reduced flexibility or expandability relative to the tubular element, which forms the tissue traction device; or may simply increase its wall thickness in other ways. A reinforcing element may be a material or coating applied to limited areas of the tube wall to reinforce or otherwise reduce the extensibility of such areas.

[0040] Various embodiments of tissue traction systems and tissue traction devices will now be described with reference to the examples shown in the accompanying drawings. References to "one embodiment", "embodiment", "some embodiments", "other embodiments", etc. in this specification indicate that one or more specific features, structures, concepts and / or characteristics according to the principles of the present disclosure can be used in combination with the embodiment. However, such references do not necessarily mean that all embodiments include specific features, structures, concepts, and / or characteristics, or that one embodiment includes all features, structures, concepts and / or characteristics. Some embodiments may include one or more such features, structures, concepts and / or characteristics (in various combinations thereof). It should be understood that one or more of the features, structures, concepts and / or characteristics described with reference to one embodiment can be combined with one or more of the features, structures, concepts and / or characteristics of any of the other embodiments provided herein. That is, any of the features, structures, concepts and / or characteristics described herein can be mixed and matched to produce a hybrid embodiment, and such a hybrid embodiment is within the scope of the present disclosure. In addition, references to "one embodiment," "embodiments," "some embodiments," "other embodiments," and the like throughout this specification do not necessarily always refer to the same embodiment, and independent or alternative embodiments are not necessarily mutually exclusive of other embodiments. It should also be understood that the various features, structures, concepts, and / or characteristics of the disclosed embodiments are independent and separate from each other, and may be used or present alone or in various combinations with each other to produce alternative embodiments that are considered part of the present disclosure. Therefore, the present disclosure is not limited to only the embodiments specifically described herein, as it would be too cumbersome to describe all the various possible combinations and sub-combinations of features, structures, concepts, and / or characteristics; and the examples of the embodiments disclosed herein are not considered to limit the broader aspects of the present disclosure. The following descriptions are merely illustrative examples of embodiments and are not intended to limit the broader aspects of the present disclosure.

[0041] In the accompanying drawings, it should be understood that common features are identified by common reference elements, and for the purpose of brevity and convenience and not intended to be limiting, the description of common features is generally not repeated. For the purpose of clarity, all parts with the same reference numerals are not numbered. In addition, a group of similar elements can be indicated by numbers and letters, and one or more such elements or such elements can usually be referred to as a group by numbers only (excluding letters associated with each similar element). It should be understood that in the following description, similar elements or parts between various illustrated embodiments are generally named with the same reference numerals in increments of 100, and redundant descriptions are generally omitted for the purpose of brevity. In addition, certain features in one embodiment can be used in different embodiments; and when they appear in different embodiments, they are not necessarily individually marked. Finally, it should be understood that the relative proportions of the elements of the illustrative system and device and the environment in which the system and device are shown are not necessarily drawn to scale.

[0042] Turning now to the attached drawings, Figure 1 An example of one embodiment of a tissue traction system 100 is shown, wherein one or more elongated elements 110 form the tissue traction system 100, which can apply a force (such as a traction force) to tissue for lifting the tissue. In the illustrated example of one embodiment of the tissue traction system 100, the tissue traction device 120 is defined by the longitudinal extent of the elongated element 110, which extends proximally from the distal end 111 of the elongated element 110 a desired distance to define a length L of the tissue traction device 120 along the longitudinal axis LA. For example, when used in the gastrointestinal system, the distance should be sufficient to reach the stomach wall or the intestinal wall, depending on the specific location of the tissue traction device 120. However, other configurations are within the scope and spirit of the present disclosure.

[0043] According to various principles of the present disclosure, the elongated cylindrical body with a section 124 is configured to be more flexible and / or expansible than the surrounding area of ​​the tissue traction device 120. Such a section 124 may be limited to the circumference / peripheral range of the circumference / periphery of the tissue traction device 120 to allow flexure or bending in a controllable and predictable direction. It should be understood that terms such as flexure, bending, navigation, steering, movement, etc. (and their other grammatical forms) are used interchangeably herein, but are not intended to be limiting. In addition, it should be understood that the cylindrical body of the tissue traction device 120 may have a circular cross-section and therefore have a circumference, or may have a cross-section of a different shape and therefore may more generally refer to its periphery. References to the circumference or periphery herein may be for the purpose of convenience, and should not be understood as limiting the cross-section of the tissue traction device 120 to a specific shape. Typically, the flexible and / or expansible section 124 is defined by the tissue traction device 120, and is therefore limited to the length L of the tissue traction device 120 in its longitudinal range. However, it should be understood that the flexible and / or expandable section 124 may extend along only a limited longitudinal extent of the tissue retraction device 120 (not along the entire length L).

[0044] More particularly, in accordance with various principles of the present disclosure, the flexible and / or expandable section 124 described above is a longitudinal circumferential section 124 of the tissue pulling device 120 that is formed to have increased flexibility and / or expandability relative to a surrounding area of ​​the tissue pulling device 120. For example, the flexible and / or expandable section 124 may be a limited pre-stretched area (e.g., causing the area to be able to stretch to a greater extent than the surrounding area), and / or may be formed of a different material than the surrounding area, and / or may have a thinner wall thickness than the surrounding area to allow for increased flexibility and expandability relative to the surrounding area along the periphery of the tissue pulling device 120. In some embodiments, such a flexible and / or expandable section 124 is formed asymmetrically around the periphery of the tissue pulling device 120 to allow for directional flexing of the tissue pulling device 120 (i.e., to cause flexing of the tissue pulling device 120 to be oriented in a particular direction, typically opposite to the flexible and / or expandable section 124, such as diametrically opposite). At least in Figure 1 In the example of the illustrated embodiment, the flexible and / or expandable section 124 is a longitudinal circumferential section 124 that extends longitudinally along at least a portion of the length L of the tissue traction device 120, wherein the longitudinal boundaries are circumferentially spaced from each other. In other words, the longitudinal circumferential section 124 extends along only a portion of the side of the longitudinal extent of the tissue traction device 120. In some embodiments, the longitudinal extent L of the longitudinal circumferential section 124 is along the entire length L of the tissue traction device 120. However, it should be understood that the longitudinal circumferential section 124 may be shorter than the full length L of the tissue traction device 120 and may be strategically positioned to cause the bending of the tissue traction device 120 at a desired area along the length L of the tissue traction device 120. For the purpose of simplicity and without limitation, the flexible / expandable section / longitudinal circumferential section 124 may be referred to herein as the flexible and / or expandable bending area 124 of the tissue traction device 120.

[0045] Additionally or alternatively, the area of ​​the tissue pulling device 120 surrounding the flexible and / or expansible bending zone 124 is formed to have reduced flexibility and / or expansibility relative to the flexible and / or expansible bending zone 124. Because the flexible and / or expansible bending zone 124 does not extend along the entire perimeter or circumference of the tissue pulling device 120, actuation (e.g., expansion) thereof causes the tissue pulling device 120 to bend in the area of ​​the flexible and / or expansible bending zone 124 toward a less flexible and / or less expansible area, as described in more detail below.

[0046] According to various principles of the present disclosure, the one or more elongated elements 110 of the tissue traction system 100 are one or more flexible tubular elements 110, and the one or more flexible tubular elements 110 define a tissue traction device 120 along a distal length L of the flexible tubular element 110. The distal end 111 of the flexible tubular element 110 is sealed so that an actuation medium can be delivered to the tissue traction device 120 through the tissue traction system 100 to actuate the tissue traction device 120. In some embodiments, the actuation medium is an expansion medium. The flexible / expandable bending area 124 is configured to expand to a larger extent than the surrounding area of ​​the tissue traction device 120 when the expansion medium is delivered into the tissue traction device 120. The expansion of the flexible / expandable bending area 124 increases the length of such area / segment of the tissue traction device 120 relative to the length of the surrounding segment / area, thereby causing the tissue traction device 120 to bend toward a lower flexibility / expandability area of ​​the tissue traction device 120 (usually opposite to the flexible and / or expandable bending area 124, such as opposite in diameter). The flexible / expandable bend region 124 defines the outer bend of the tissue pulling device 120; or in other words, is positioned along a curved surface of the tissue pulling device 120 having a larger radius of curvature (resulting from actuation of the tissue pulling system 100 that causes the tissue pulling device 120 to bend).

[0047] In some embodiments, the tissue engaging feature 122a is disposed along the distal end 121 of the tissue pulling device 120. For example, if a plurality of flexible elements 110 form the tissue pulling device 120, the tissue engaging feature 122a may be disposed along the distal end 111 of each of the flexible elements 110. The tissue engaging feature 122a may be a protrusion that facilitates attachment of the tissue pulling device 120 to tissue, such as by utilizing a tissue engaging member. Figure 1 In the example of the illustrated embodiment, the tissue engaging feature 122a is a loop to which a separately formed tissue engaging member 130 is engaged. Figure 1The example of the embodiment of the tissue engaging member 130 shown has one or more jaws 132, one or more jaws 132 are configured to grasp the tissue at the treatment site TS, such as the target tissue TT, and the traction force is applied to the tissue by the tissue traction device 120 and the tissue traction system 100. However, it should be understood that other forms of tissue engaging members such as those known to those skilled in the art are within the scope and spirit of the present disclosure. In addition, it should be understood that the tissue engaging member can be integrally formed with the tissue engaging feature 122a, rather than being connected to a separate forming element of the tissue engaging feature 122a. The tissue engaging member 130 can be connected to or arranged with the tissue engaging feature 122a during the transportation of the tissue traction device 120 to the treatment site TS. The tissue engaging member 130 can be actuated to grasp the tissue at the treatment site TS to deploy / couple the tissue traction device 120 to the treatment site TS. Any desired actuator or end effector known to those skilled in the art (whose details are not critical to the present disclosure) can be used to actuate the tissue engaging member 130.

[0048] In some embodiments, one or more additional tissue engaging features (such as proximal tissue engaging feature 122b, e.g. Figure 1 122a) is disposed along the proximal end 123 of the tissue retraction device 120. Such additional tissue engagement features may be similar in form to the tissue engagement features 122a described above (reference to such description for purposes of brevity), or to other configurations that facilitate engagement of the tissue retraction device 120 with tissue. Figure 1 The proximal tissue engagement feature 122b shown is similar to the distal tissue engagement feature 122a described above. However, typically, the tissue engagement member 130 is not engaged with the proximal tissue engagement feature 122b during delivery of the tissue traction device 120 to the treatment site TS. Instead, the tissue engagement member 130 is typically delivered separately and actuated to grasp the proximal tissue engagement feature 122b and then grasp tissue spaced from the target tissue TT to apply traction to the target tissue TT in a manner understood by those skilled in the art. The following provides an example of a method for applying traction to the target tissue TT. Figure 1 Further details of an example use of the tissue retraction system 100 and tissue retraction device 120 are shown.

[0049] like Figure 2 As shown, Figure 2 Shown along Figure 1 A cross-sectional view along line II-II, Figure 1The illustrated example of the embodiment of the tissue traction device 120 of the present invention can be formed with one or more flexible tubular elements 126. Each of the flexible tubular elements 126 can be formed along a corresponding flexible tubular element 110 forming the tissue traction system 100. More specifically, the flexible tubular element 126 can be formed along a distal section of the flexible tubular element 110 of the tissue traction system 100, and the flexible tubular element 110 extends proximally from its corresponding distal end 111. In the illustrated example of the embodiment, the tissue traction device 120 is formed with three flexible tubular elements 126, which are arranged in a generally triangular configuration to be co-bonded (or at least positioned adjacent to each other in the case of not bonding) along a common bonding area 116. The common bonding area 115 generally inhibits the expansibility of the wall of the flexible tubular element 126 in such an area. Therefore, the area surrounding the common bonding area 115 forms a flexible and / or expansible bending area 124 of the flexible tubular element 126 of the tissue traction device 120. In some embodiments, the flexible tubular element 126 is formed of an elastic material (e.g., silicone or other suitable biocompatible material) to allow it to expand at least in the radial direction of the flexible and / or expandable curved region 124. In some embodiments, the flexible and / or expandable curved region 124 is pre-stretched along a defined length to further facilitate its expansion and allow the tissue retraction device 120 to reach the tissue wall where the procedure is to be performed.

[0050] According to various principles of the present disclosure, the tissue retraction device 120 is actuated to bend in a manner such as Figure 1 ) is an expansion of the flexible and / or expandable bending region 124 of the tissue retraction device 120 caused by selective expansion of the distal portion of the flexible tubular element 110 forming the tissue retraction device 120. For example, Figure 3 As shown, one or more actuation mechanisms 140 are operatively coupled to respective proximal ends 113 of the flexible tubular element 110 of the tissue retraction system 100, such as at Figure 1 and Figure 2 In some embodiments, the actuation mechanism 140 is a syringe that applies an actuation medium, such as an inflation medium (e.g., saline or other biocompatible fluid, such as carbon dioxide gas), to the tissue traction device 120 via the flexible tubular element 110. The actuation mechanism 140 is shown next to a separately formed control handle 150. However, other arrangements are within the scope and spirit of the present disclosure. The control handle 150 can be used to control an endoscope 160, which can be delivered to the treatment site TS along with an instrument, device, tool, etc. (such terms are used interchangeably herein and are not intended to be limiting) to perform the intended procedure at the treatment site TS. For example, Figure 1As shown, endoscope 160 can deliver a cutting tool 170 (e.g., a blade, a scalpel, an electrocautery device, etc., the present disclosure is not limited to a particular such tool) to perform tissue dissection or excision, wherein tissue traction device 120 applies traction to the resulting tissue flap. Figure 1 and Figure 3 In the example of the illustrated embodiment, the tissue retraction system 100 is configured to extend outside of the endoscope 160, rather than extending through the working channel 162 of the endoscope 160. This configuration frees the working channel 162 of the endoscope 160 for delivery of the cutting tool 170 when the tissue retraction system 100 is in place and operable. The tissue retraction system 100 can be coupled to the endoscope 160. The tissue retraction system 100 can be freely movable relative to the endoscope 160, whether coupled to the endoscope 160 or not.

[0051] like Figure 3 As shown, the selective application of an actuation medium (such as controlled by one of the actuation mechanisms 140) causes expansion of only the flexible and / or expandable bending regions 124 that are in fluid communication with the flexible tubular elements 110 that are operatively associated with the actuated actuation mechanism 140. For example, application of the actuation medium to selected flexible tubular elements 126 of the tissue pulling device 120 increases the pressure within such flexible tubular elements to cause expansion of the flexible and / or expandable bending regions 124. The walls of the flexible tubular elements 126 of the tissue pulling device 120 along the area of ​​the common bonding area 115 are less susceptible to expansion (e.g., may be more rigid, or at least do not have any space in which they can expand). Thus, expansion of the flexible and / or expandable bending region 124 of the actuated flexible tubular element 126 of the tissue pulling device 120 causes the actuated flexible tubular element 126 to bend toward the common bonding region 115 (e.g., by effectively increasing the length of the flexible and / or expandable bending region 124 without equally increasing the length of the common bonding region 115 of the actuated flexible tubular element). A medical professional operating the tissue pulling system 100 may decide to actuate (e.g., pressurize) the tissue pulling system 100 and the flexible tubular elements 126 of the tissue pulling device 120 to direct bending of the tissue pulling device 120 in a desired direction. For example, a medical professional may actuate a selected actuation mechanism 140 to expand one or more flexible tubular elements 126 forming the tissue pulling device 120 to cause such actuated flexible tubular elements 126 to bend and thereby cause the tissue pulling device 120 to bend to lift the target tissue TT in different directions or along different angles (e.g., along different force vectors), such as Figure 4 and Figure 5 shown.

[0052] like Figure 1 , Figure 2 , Figure 3 , Figure 4 and Figure 5 The illustrated example of the operation of the tissue traction system 100 and tissue traction device 120 is as follows. The tissue engaging member 130 is introduced into the endoscope 160 and the tissue engaging member 130 is attached to the tissue engaging feature 122a at the distal end 121 of the tissue traction device 120. Optionally, although not necessarily, the tissue engaging member 130 is introduced into the endoscope 160, wherein the endoscope 160 is outside the patient's body. The endoscope 160 is introduced into the patient's body and the tissue engaging member 130 (operably engaging the tissue engaging feature 122a on the tissue traction device 120) is attached to the target tissue TT. The second tissue engaging member 130 is introduced through the working channel 162 of the endoscope 160. The medical professional selects one of the additional tissue engaging features, such as the illustrated proximal tissue engaging feature 122b; and attaches the second tissue engaging member 130 thereto and to tissue spaced apart from the target tissue TT (e.g., on the opposite side of the lumen wall in which the target tissue TT is located). The medical professional controls the position of the target tissue TT using the actuation mechanism 140 in the manner described above.

[0053] It should be understood that various modifications to the tissue traction system 100 and / or tissue traction device 120 described above are within the scope and spirit of the present disclosure. For example, only one elastically flexible tubular element may be used in a tissue traction system to form a tissue traction device. In such embodiments, Figure 7 8, a limited area of ​​the tissue traction device 220 formed by a single flexible tubular element 210 of the illustrated example of an embodiment of the tissue traction system 200 may be less flexible to provide the above-described Figures 1 to 5Similar bending actions described for the tissue traction system 100 and tissue traction device 120 shown. For example, the longitudinal circumferential section 224 (along only a portion of the periphery or circumference or surface of the flexible tubular element 210) is less flexible / more rigid and / or less extensible than other surrounding areas. As in the examples of the embodiments described above, the longitudinal circumferential section may extend along the entire length L or along only a limited range of the length L of the tissue traction device 220. The limited less flexible and / or less extensible bending section 224 may have a similar effect as the flexible and / or extensible bending section 124 of the tissue traction device 120 of the above-described examples of embodiments of the tissue traction system 100, thereby allowing the tissue traction device 220 to bend in only one direction toward the less flexible and / or less extensible bending section 224. In some embodiments, the less flexible and / or less extensible curved section 224 is formed by applying a reinforcing element such as an additional material (patch or coating, etc.) along a limited range of the perimeter of the tissue pulling device 220 and optionally along a limited length of the tissue pulling device 220. Thus, this solution may be simpler than the previously described embodiments, but may lack some of the steerable options applicable to the previously described embodiments. It should be understood that Figure 6 and Figure 7 The examples of embodiments shown are Figure 1-5 The examples shown have various other common features. Therefore, common features are identified by common reference numerals increased by 100, and for the sake of brevity, the description of common features will not be repeated. For the sake of clarity, all parts with the same reference numeral are not numbered.

[0054] Such as Figure 6 and Figure 7 The tissue traction system 200 shown can be used in the same manner as described above with respect to Figure 1-5 The tissue traction system 100 described above operates in a similar manner, and therefore, for the sake of brevity, reference is made to the description of the operating example above, and is not intended to be limiting. It should be understood that in various embodiments, some steps of assembling the tissue traction device can be performed outside the patient's body, while other steps involved in assembling the tissue traction device can be performed inside the patient's body. The steps described herein are not necessarily performed in a specific order and / or time.

[0055] It should be understood that further modifications to the tissue traction system and tissue traction device described above are within the scope and spirit of the present disclosure. For example, a tissue traction device formed according to the various principles of the present disclosure need not be coextensive with the elongated elements that form the tissue traction system formed according to the various principles of the present disclosure. For example, the tissue traction device can be formed by flexible tubular elements that are formed separately from the elongated elements that form the tissue traction system. Therefore, the diameter of the elongated elements that form the tissue traction system can be smaller than the diameter of the components of the tissue traction device to facilitate transluminal / transcatheter navigation of the tissue traction system. This configuration can facilitate the formation of a tissue traction device with a section of increased flexibility and / or rigidity.

[0056] Those skilled in the art may understand various other benefits of various aspects, features, components and structures of tissue traction systems and / or tissue traction devices such as those described and discussed above. All devices and methods discussed herein are examples of devices and / or methods implemented according to one or more principles of the present disclosure. These examples are not the only way to implement these principles, but are only examples and are not intended to limit the broader aspects of the present disclosure. Therefore, references to elements or structures or features in the accompanying drawings must be understood as references to examples of embodiments of the present disclosure, and should not be understood as limiting the present disclosure to the specific elements, structures or features shown. When reading the present disclosure, those skilled in the art will think of other ways to implement the disclosed principles. It should be understood that the features described with respect to one embodiment are generally applicable to another embodiment, whether or not explicitly indicated. The various features described below may be used individually or in any combination thereof. Therefore, the present invention is not limited to the embodiments specifically described herein alone.

[0057] The foregoing discussion has wide application and has been presented for the purpose of illustration and description, and is not intended to limit the present disclosure to one or more forms disclosed herein. It should be understood that various additions, modifications and substitutions can be made to the embodiments disclosed herein without departing from the concept, spirit and scope of the present disclosure. In particular, it will be apparent to those skilled in the art that the principles of the present disclosure can be implemented in other forms, structures, arrangements, proportions, with other elements, materials and components without departing from its concept, spirit, scope or characteristics. For example, for the purpose of simplifying the disclosure, the various features of the present disclosure are grouped in one or more aspects, embodiments or configurations. However, it should be understood that the various features of certain aspects, embodiments or configurations of the present disclosure can be combined with alternative aspects, embodiments or configurations. Although the present disclosure is presented in the form of an embodiment, it should be understood that the various independent features of the subject matter of the present invention do not need to exist all the time to achieve at least some desired characteristics and / or benefits of the subject matter of the present invention or such independent features. It will be understood by those skilled in the art that the present disclosure can be used together with many modifications of the structure, arrangement, proportion, material, components, etc. used to practice the present disclosure, which are particularly suitable for specific environments and operating requirements without departing from the principle or spirit or scope of the present disclosure. For example, an element shown as integrally formed may be composed of multiple parts, or an element shown as multiple parts may be integrally formed, the operation of the element may be reversed or otherwise changed, and the size or dimensions of the element may be changed. Similarly, although the operation or action or procedure is described in a particular order, this should not be understood as requiring such a particular order or performing all operations or actions or imaging to achieve the desired result. In addition, other embodiments may be within the scope of the following claims. In some cases, the actions described in the claims can be performed in different orders and still achieve the desired results. Therefore, the currently disclosed embodiments should be regarded as illustrative and non-restrictive in all aspects, and the scope of the claimed subject matter is indicated by the attached claims and is not limited to the foregoing description or specific embodiments or arrangements described or shown herein. According to the foregoing, the independent features of any embodiment can be used and can be claimed alone or in combination with the features of the embodiment or any other embodiment; the scope of the subject matter is indicated by the attached claims and is not limited to the foregoing description.

[0058] In the foregoing description and the following claims, the following will be understood. As used herein, the phrases "at least one", "one or more" and "and / or" are open expressions that are linked and transitional in operation. The terms "one", "a kind", "the", "first", "second", etc. do not exclude plural numbers. For example, as used herein, the term "one" or "a kind" entity refers to one or more of the entity. Therefore, the terms "one" (or "a kind"), "one (kind) or more (kinds)" and "at least one (kind)" can be used interchangeably herein. As used in this specification and the appended claims, the term "or" is generally used in its sense of including "and / or", unless the context clearly indicates otherwise. As used herein, the conjunction "and" includes each of the structures, components, features, etc. so combined, unless the context clearly indicates otherwise; and the conjunction "or" includes one or the other of the structures, components, features, etc. so combined, individually and in any combination and quantity, unless the context clearly indicates otherwise. All directional references (e.g., proximal, distal, upper, lower, upward, downward, left, right, lateral, longitudinal, front, rear, top, bottom, above, below, vertical, horizontal, radial, axial, clockwise, counterclockwise, etc.) are used only for identification purposes to assist the reader in understanding the present disclosure, and / or to distinguish the regions of related elements from each other, and in particular, the related elements are not limited to the position, orientation or use of the present disclosure. Connection references (e.g., attachment, connection, connection, engagement and coupling) should be interpreted broadly and may include intermediate members between sets of elements and relative movement between elements, unless otherwise specified. Therefore, connection references do not necessarily infer that two elements are directly connected and are in a fixed relationship to each other. Identification references (e.g., primary, secondary, first, second, third, fourth, etc.) are not intended to imply importance or priority, but are used to distinguish features from each other.

[0059] The following claims are hereby incorporated by reference into the detailed description, with each claim standing on its own as an independent embodiment of the present disclosure. In the claims, the terms "comprises," "comprising," "includes," and "including" do not exclude the presence of other elements, parts, features, groups, regions, integers, steps, operations, etc. In addition, although independent features may be included in different claims, these features may be advantageously combined, and the inclusion in different claims does not mean that the combination of features is not feasible and / or not advantageous. In addition, singular references do not exclude pluralities. Reference signs in the claims are provided only as clarifying examples and should not be construed as limiting the scope of the claims in any way.

Claims

1. A tissue traction system, comprising: tissue traction device; and one or more elongated elements operatively coupled to the tissue retraction device to actuate bending of the tissue retraction device; Wherein a longitudinal circumferential region of the tissue pulling device is more flexible than a surrounding region of the tissue pulling device, such that actuation of the tissue pulling device causes bending along the more flexible region towards the less flexible region.

2. The tissue traction system according to claim 1, wherein: The tissue retraction device is formed by a distal extent of the one or more elongated elements, the distal extent extending a certain length proximal to the distal end of the one or more elongated elements.

3. The tissue traction system according to any one of claims 1 to 2, wherein: At least one of the elongated elements is a flexible tubular element.

4. The tissue traction system according to claim 3, wherein: The at least one flexible tubular element has a sealed distal end.

5. The tissue retraction system of any one of claims 1 to 4, further comprising an actuation mechanism operatively coupled to the one or more elongated elements to induce bending of the tissue retraction device.

6. The tissue traction system according to claim 5, wherein: The distal extent of the at least one flexible tubular element forms a flexible tubular element of the tissue retraction device; The longitudinal circumferential region of the tissue retraction device is formed along a distal region of the at least one flexible tubular element and is more expandable than a surrounding region of the tissue retraction device; and The actuation mechanism delivers an expansion medium through the at least one flexible tubular element to the tissue retraction device to expand the longitudinal circumferential region of the tissue retraction device relative to a surrounding region of the tissue retraction device to cause the tissue retraction device to bend.

7. The tissue traction system according to claim 1, wherein: Reinforcing elements are applied along the periphery of the tissue retraction device along the restricted area, thereby causing the surrounding area to be relatively more flexible.

8. The tissue traction system according to any one of claims 1 to 7, wherein: The one or more elongated elements include a flexible tubular element having a sealed distal end; The tissue retraction device is formed by a distal extent of the flexible tubular element, the distal extent extending a certain length proximal to the sealed distal end of the flexible tubular element; and The tissue pulling device is directionally expandable upon application of an expansion medium thereto, thereby causing the more flexible region of the tissue pulling device to expand and bend the tissue pulling device toward the reinforcement element.

9. A tissue traction device, comprising: an elongated cylindrical body extending along a longitudinal axis and having distal and proximal ends and a flexible section therebetween, the flexible section extending along only a portion of the periphery of the cylindrical body; The flexible section is more flexible than the surrounding portion of the cylindrical body to facilitate bending of the cylindrical body along the flexible section.

10. The tissue pulling device according to claim 9, wherein: The cylindrical body is tubular and expandable; and The flexible section is more expansive than surrounding portions of the cylindrical body, such that expansion of the tubular cylindrical body causes the flexible section to expand and bend toward a relatively less expansive side of the cylindrical body.

11. The tissue pulling device according to any one of claims 9 to 10, wherein: The flexible section extends only along a limited range along the longitudinal axis of the cylindrical body.

12. The tissue pulling device according to any one of claims 9 to 11, wherein: The cylindrical body is formed of a flexible material, and a reinforcing element is applied to a limited range of the circumference of the flexible cylindrical body, and the flexible section is defined to be opposite to the reinforcing element.

13. The tissue pulling device according to any one of claims 9 to 11, wherein: The cylindrical body is the distal section of the flexible tubular element of the tissue retraction system.

14. A method for actuating a tissue retraction device having a tissue engaging feature at a distal end thereof, the method comprising: The tissue traction device is actuated to bend along a flexible region adjacent to its distal end toward an area of ​​the tissue traction device opposite the flexible region, so as to cause the distal end of the tissue traction device to bend relative to the proximal end of the tissue traction device, the flexible region being more flexible than the surrounding area.

15. The method according to claim 14, wherein: The tissue traction device is tubular, and the method also includes actuating the tissue traction device to expand the flexible section of the tissue traction device relative to the surrounding area by delivering an inflation medium into a lumen defined within the tissue traction device to cause the tissue traction device to bend in a direction generally opposite to the flexible section.

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