Locking features for hemostatic clips

Abstract

An applicator of a clamping system includes an elongate member, a bushing coupled to a distal end of the elongate member, and a coupling movably attached to the bushing. The compartment is coupled to the coupling member via a coupling member hooked on a hook of the coupling member. The proximal ends of the clip arms are housed within the compartment, and a core member housed between and connected to the proximal ends of the arms includes a protrusion and a failure point distal to the protrusion. The core member is coupled to the control member such that movement of the control member relative to the elongate member opens and closes the arms. The protrusions are configured such that when the clip is gripped on tissue, the coupling member is pulled into the body and the protrusions drive the coupling member radially outwardly out of the hook to release the capsule.

Description

Priority claim

[0001] This disclosure claims priority to U.S. Provisional Patent Application Serial No. 63 / 377,260, filed on September 27, 2022; the disclosure of that application is incorporated herein by reference. Technical Field

[0002] The present invention relates to endoscopic devices, and in particular to endoscopic gripping devices for manipulating tissue along the gastrointestinal tract. Background Art

[0003] In gastrointestinal (GI) surgery or other body cavity surgery, it is often necessary to close tissue openings. Currently, such openings are usually closed using hemostatic clips. However, some of these clips may produce loose parts when deployed on the tissue, which may get stuck in the tissue opening being treated or may cause other harm to the patient. Summary of the invention

[0004] The present disclosure relates to a clamping system for treating tissue. The system includes an applicator, a clamp and a core member. The applicator includes a flexible, slender member extending from a proximal end to a distal end, the proximal end being maintained outside the body during use, and the distal end being inserted into the body to a position adjacent to a target tissue to be clamped during use. The applicator includes: a control member extending through the applicator; and a sleeve coupled to the distal end of the flexible, slender member, the sleeve including a proximal body coupled to the distal end of the flexible, slender member and a distal coupling member movably attached to the proximal body.

[0005] The clamp includes a capsule that is releasably coupled to a distal coupling member of the hub via a first coupling member thereof, the first coupling member of the capsule hooking onto a corresponding first hook of the distal coupling member of the hub. The capsule includes a channel extending therethrough. The clamp also includes a pair of clamp arms, the proximal ends of which are slidably received in the channel to move between an open configuration in which the distal ends of the clamp arms are separated from each other to receive tissue therebetween, and a closed configuration in which the distal ends of the clamp arms are pulled toward each other to grasp tissue.

[0006] The core member is received between and connected to the proximal ends of the clamp arms and includes a first lateral projection and a first failure point located distal to the first lateral projection. The first failure point separates the distal portion of the core member from its proximal portion. The core member is coupled to the distal end of the control member so that longitudinal movement of the control member relative to the flexible elongated member moves the clamp arms between an open configuration and a closed configuration, and the lateral extent of the first lateral projection is selected so that when the clamp is clamped on the target tissue, the first lateral projection is pulled proximally to move the distal coupling member into the proximal body of the sleeve, and the first lateral projection drives the first coupling member radially outward beyond the outer end of the first hook to release the compartment from the sleeve.

[0007] In one embodiment, the core member includes a first pin and a second pin, the first pin being received in a hole in the proximal portion of the first clamp arm and the second pin being received in a hole in the proximal portion of the second clamp arm.

[0008] In one embodiment, the distal coupling is slidably coupled to the proximal body of the hub to move proximally and distally into and out of the distal end of the proximal body.

[0009] In one embodiment, the proximal body of the bushing includes a proximal segment having an outer diameter substantially equal to an outer diameter of the flexible elongated member, and a distal segment of the proximal body of the bushing having an outer diameter substantially equal to an outer diameter of the capsule.

[0010] In one embodiment, the inner diameter of the passage is substantially equal to the inner diameter of the distal section of the proximal body of the bushing.

[0011] In one embodiment, the lateral extent of the first lateral protrusion is selected to be substantially equal to the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, and wherein the inner diameter of the proximal portion of the distal coupling member is slightly smaller than the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, such that the first lateral protrusion is snap-fitted against the distal coupling member within the sleeve.

[0012] In one embodiment, the core member includes a second failure point proximal to the first failure point, the core member defining a distal portion distal to the first failure point, an intermediate portion between the first and second failure points, and a proximal segment proximal to the second failure point.

[0013] In one embodiment, the clamp arm is configured to limit the proximal-most position of the clamp arm within the capsule such that when a proximal tension applied to the control member exceeds a first threshold level after the clamp arm has reached the proximal-most position, the core member separates at a first failure point, allowing the middle and proximal portions of the core member to move proximally, pulling the first lateral protrusion proximally out of the capsule, driving the first coupling member of the capsule radially outward beyond the outer end of the first hook of the distal coupling member of the sleeve to separate the capsule from the sleeve.

[0014] The present disclosure also relates to a device for clamping tissue. The device includes a sleeve, the sleeve includes a proximal body and a distal coupling member, the proximal body is configured to be coupled to the distal end of a flexible applicator, the distal coupling member is movably attached to the proximal body, and the distal coupling member includes a first hook. The device also includes a clamp, the clamp includes: a cabin, which is releasably coupled to the distal coupling member via its first coupling member, the first coupling member of the cabin is hooked on the first hook, the cabin includes a channel extending therethrough; and a pair of clamp arms, the proximal ends of the clamp arms are slidably received in the channel to move between an open configuration and a closed configuration, in which the distal ends of the clamp arms are separated from each other to accommodate tissue therebetween, and in the closed configuration, the distal ends of the clamp arms are pulled toward each other to grasp the tissue. In addition, the device includes a core member, which is accommodated between and connected to the proximal ends of the clamp arms, and includes a first lateral protrusion and a first failure point located distal to the first lateral protrusion, the first failure point separating the distal portion of the core member from its proximal portion, the core member being configured to be coupled to the distal end of a control member so that longitudinal movement of the control member relative to the flexible applicator causes the clamp arms to move between an open configuration and a closed configuration, the lateral range of the first lateral protrusion being selected so that when the clamp is clamped on the target tissue, the first lateral protrusion is pulled proximally to move the distal coupling member into the proximal body of the sleeve, the first lateral protrusion drives the first coupling member radially outward beyond the outer end of the first hook to release the compartment from the sleeve.

[0015] In one embodiment, the core member includes a first pin and a second pin, the first pin being received in a hole in the proximal portion of the first clamp arm and the second pin being received in a hole in the proximal portion of the second clamp arm.

[0016] In one embodiment, the distal coupling is slidably coupled to the proximal body of the hub to move proximally and distally into and out of the distal end of the proximal body.

[0017] In one embodiment, the proximal body of the bushing includes a proximal segment having an outer diameter substantially equal to an outer diameter of the flexible applicator, and a distal segment of the proximal body of the bushing having an outer diameter substantially equal to an outer diameter of the capsule.

[0018] In one embodiment, the inner diameter of the passage is substantially equal to the inner diameter of the distal section of the proximal body of the bushing.

[0019] In one embodiment, the lateral extent of the first lateral protrusion is selected to be substantially equal to the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, and wherein the inner diameter of the proximal portion of the distal coupler is slightly smaller than the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, such that the first lateral protrusion snaps into place against the distal coupling within the sleeve.

[0020] In one embodiment, the core member includes a second failure point proximal to the first failure point, the core member defining a distal portion distal to the first failure point, an intermediate portion between the first and second failure points, and a proximal segment proximal to the second failure point.

[0021] The present disclosure also relates to a method for clamping tissue. The method includes: inserting the distal portion of a flexible, slender member into a biological body to a position adjacent to a target tissue to be clamped, while keeping the proximal end of the flexible, slender member outside the biological body, wherein a control member extends through an applicator and a sleeve coupled to the distal end of the flexible, extensible member, and includes a proximal body coupled to the distal end of the flexible, slender member and a distal coupling member movably attached to the proximal body; positioning a clamp coupled to the sleeve near the target tissue, the clamp including: a cabin, which is releasably coupled to the distal coupling member of the sleeve via a first coupling member of the cabin, the first coupling member of the cabin hooked on a corresponding first hook of the distal coupling member of the sleeve, the cabin including a channel extending therethrough; and a pair of clamp arms, whose proximal ends are slidably accommodated in the channel; causing the control member to move distally relative to the flexible, slender member so that the clamp arms move to an open configuration, in which The distal ends of the clamp arms are separated from each other to accommodate tissue therebetween; the control member is pulled proximally relative to the flexible slender member to move the clamp arms to a closed configuration in which the distal ends of the clamp arms are pulled toward each other so that the target tissue is grasped by the clamp arms; and the control member is further pulled proximally to increase the tension applied to the core member, the core member is coupled to the distal end of the control member and is accommodated between and connected to the proximal ends of the clamp arms until the tension reaches a predetermined level at which the distal portion of the core member is separated from the proximal portion thereof, wherein the lateral extent of the first lateral protrusion of the proximal portion of the core member is selected so that when the distal portion of the core member is separated from the proximal portion of the core member, the first lateral protrusion is pulled proximally, causing the distal coupling member to move into the proximal body of the sleeve, driving the first coupling member radially outward beyond the outer end of the first hook to release the capsule from the sleeve.

[0022] In one embodiment, the distal coupling is slidably coupled to the proximal body of the hub to move proximally and distally into and out of the distal end of the proximal body.

[0023] In one embodiment, the inner diameter of the passage is substantially equal to the inner diameter of the distal section of the proximal body of the bushing.

[0024] In one embodiment, the lateral extent of the first lateral protrusion is selected to be substantially equal to the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, and wherein the inner diameter of the proximal portion of the distal coupling member is slightly smaller than the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, such that the first lateral protrusion is snap-fitted against the distal coupling member within the sleeve.

[0025] In one embodiment, the core member includes a second failure point proximal to the first failure point, the core member defining a distal portion distal to the first failure point, an intermediate portion between the first and second failure points, and a proximal segment proximal to the second failure point. BRIEF DESCRIPTION OF THE DRAWINGS

[0026] Figure 1 shows a side view of a distal portion of a clamping system according to an exemplary embodiment of the present disclosure, wherein components of the clamping system are separated from one another; Figure 2 Shows connecting the control line to Figure 1 A side view of components of a fixture of an exemplary system with a cabin of the fixture removed; Figure 3 Show according to Figure 1 A side view of a clamp according to an embodiment of the present invention; Figure 4A Shows the basis of the cabin coupled to the fixture Figure 1 A side view of a bushing of an embodiment of the present invention; Figure 4B Shown is the compartment separated from the clamp Figure 4A A side view of the bushing; Figure 5A Show Figure 1 An exploded side view of a distal portion of a clamping system; Figure 5B Shown relative to Figure 5A Rotate 90 degrees Figure 1 An exploded side view of a distal portion of a clamping system; Figure 6 Show Figure 1 A partial cross-sectional view of a distal portion of a clamping system; Fig. 7A Show Figure 1 a sleeve of a system wherein the movable portion of the sleeve is separate from the proximal portion of the sleeve; Figure 7B Shown relative to Fig. 7A Rotate 90 degrees Fig. 7A Bushings; Figure 8 The distal end of the applicator is shown Figure 1 A partial cross-sectional view of a distal portion of a clamping system; Fig. 9 The distal end of the arm including the distal end of the applicator and the clamp is shown. Figure 1 A partial cross-sectional view of a distal portion of a clamping system; Fig.10 The distal end of the applicator is shown Figure 1a partial cross-sectional view of a distal portion of a clamping system of the present invention, wherein the compartment of the clamp is separated from the bushing and the distal portion of the core member is separated from the intermediate portion of the core member; Fig.11 The distal end of the applicator is shown Figure 1 a partial cross-sectional view of a distal portion of a clamping system of the present invention, wherein the bay of the clamp is separated from the bushing and the intermediate portion of the core member is separated from the proximal portion of the core member; Fig. 12A Shown in an open tissue containment configuration, Figure 1 A partial cross-sectional view of the distal portion of the clamping system, the Figure 1 The clamping system comprises a locking arrangement that locks the clamp closed in the tissue clamping configuration; Fig. 12B Shown in a closed tissue gripping configuration, Figure 1 A partial cross-sectional view of the distal portion of the clamping system, the Figure 1 The clamping system comprises a locking arrangement that locks the clamp closed in the tissue clamping configuration; Fig.13A shows a side view of a core member according to another embodiment; Fig. 13B Shown relative to Fig.13A Rotate 90 degrees Fig.13A a side view of a core member; Fig.14 The distal end of the applicator is shown as including Fig.13A and Fig. 13B a partial cross-sectional view of a distal portion of a clamping system of a core member shown with the bay of the clamp separated from the hub and the distal portion of the core member separated from the proximal portion of the core member; Fig.15 Shown is a device comprising a handle, an applicator and a clamp. Fig.14 Partial cross-sectional view of the clamping system. DETAILED DESCRIPTION

[0027] The present disclosure may be further understood with reference to the following description and accompanying drawings, in which like elements are represented by like reference symbols. The present disclosure relates to an endoscopic clamping system for treating internal tissue perforations, defects and / or bleeding. Exemplary embodiments of the present disclosure describe a clamping system comprising a clamp releasably coupled to a proximal portion of the system, the clamp comprising a pair of clamp arms, the proximal ends of the clamp arms being slidable within a cabin to move the clamp arms between an open configuration and a closed configuration, wherein the distal ends of the clamp arms are separated from each other to accommodate target tissue therebetween, and wherein the clamp arms are pulled into the cabin in a closed configuration such that the distal ends of the clamp arms move toward each other to grasp the target tissue therebetween. The clamping system comprises a novel mechanism for separating the clamp from the applicator, which minimizes the risk of falling off and shortens the length of the clamp.

[0028] An exemplary clamping system includes an applicator including a flexible member extending from a handle to a distal end that is releasably coupled to a clamp. The applicator includes a flexible, elongated member extending from the handle and a control member slidably contained therein. The control member is coupled to an actuator on the handle that allows a user to move the control member proximally and distally within the elongated member. The compartment of the clamp is coupled to the distal end of the elongated member, and the distal end of the control member is coupled to a unit member that can slide within the compartment, which connects the control member to the arm of the clamp. Movement of the control line causes the unit member to move proximally and distally, so that the arm of the clamp extends from the compartment and is pulled into the compartment to move the arm between an open tissue containment configuration and a closed tissue clamping configuration.

[0029] The user deploys the clamp by closing the clamp arms over the target portion of tissue and applying a proximal force to the unitary members via the control member until the failure point on the unitary members breaks, whereupon the clamp arms are locked in a closed tissue clamping configuration and a portion of the unitary members proximal to the failure point is pulled proximally out of the capsule, separating the capsule from the elongated member.

[0030] As will be described in greater detail below, the portion of the unit member proximal to the failure point includes a protrusion extending radially outward therefrom, the protrusion being configured to engage and bend a radially outward portion of the proximal end of the capsule, which proximal portion has been previously bent over a tab at the distal end of the sleeve to releasably couple the sleeve to the capsule. Thus, when the proximal portion of the unit member is separated from the distal portion of the unit member, effectively separating the clamp arm from the control member, and the capsule from the sleeve, the clamp is completely separated from the applicator, and the applicator can be removed from the body while leaving the clamp clamped in place on the target tissue.

[0031] As will be described in more detail below, the structure of the unit member and the sleeve allows the separated proximal portion of the unit member to be received within the sleeve. This allows the clamp structure to have a shorter compartment, which is different from many clamps available on the market, such as the Resolution 1000 available from Boston Scientific / SciMed. TM and Resolution 360 TM Compared with a clamp, the overall length of the clamp is reduced. As will be appreciated by those skilled in the art, a shorter clamp can improve visualization of the target site and allow better operability when, for example, multiple clamps are placed. Some current clamp designs can also produce loose parts during the deployment process of separating the clamp from the catheter, which may remain in the body and pass naturally through the gastrointestinal tract. The embodiments described herein minimize the risk of producing loose parts. Specifically, the control member is constructed so that its failure stress is significantly higher than the failure stress of the unit member. In addition, the separated proximal portion of the unit member is contained in the sleeve and withdrawn from the body during deployment. Therefore, the distal end of the control member will not be separated from the proximal portion of the control member, and the distal ends of the unit member and the control member are controlled and prevented from becoming loose parts.

[0032] Figures 1 to 11 and Fig.15 A clamping system 100 for treating a tissue defect is shown, which includes a clamping device 104 that can be releasably coupled to an insertion device such as an applicator 104 (see Figures 8 to 11 ) (e.g., a catheter or other flexible tube). The clamp 102 includes a pair of clamp arms 106, whose proximal ends 108 are coupled to each other via a core member 110, and the core member 110 is slidably received in a compartment 112 to enable the clamp 102 to move between an open configuration, in which the distal ends 114 of the clamp arms 106 are separated from each other to receive tissue therebetween, and a closed configuration in which the distal ends 114 of the clamp arms 106 are pulled toward each other to grasp tissue therebetween.

[0033] The clamp arm 106 is moved between the open configuration and the closed configuration via the control member 116, the distal end 118 of the control member 116 being received within the cavity 120 of the core member 110 and the reduced proximal portion 122 of the control member 116 extending proximally therefrom to pass away from the core member 110 (see Figure 2 ).like Fig.15 As shown, the proximal portion 122 of the control member 116 extends through the applicator 104 to a user-accessible proximal end of the system 100. In this embodiment, the distal end 118 of the control member is enlarged (i.e., has a larger diameter) relative to the proximal portion 122 of the control member 116. Figure 5B As can be seen, core member 110 includes an opening 119 that is sized and shaped to allow distal end 118 to pass therethrough.

[0034] The control member 116 is then rotated to seat the distal end 118 in the cavity 120, which is sized and shaped to snugly accommodate the distal end 118. In this embodiment, the distal end 118 and the cavity 120 are both substantially cylindrical, and the cavity 120 is slightly larger than the distal end 118, with a tolerance that allows the distal end 118 to be securely seated therein. Figure 5B It can be seen that a longitudinal notch 117 is formed on the side of the core member 110 opposite to the side where the cavity 120 is formed, and the longitudinal notch 117 extends proximally from the opening 119, so that when the distal end 118 is rotated to a position within the cavity 120, the most distal portion of the proximal portion 122 of the control member 116 is disposed in the longitudinal notch 117. Therefore, when the user moves the control member 116 longitudinally (i.e., proximally and distally) relative to the applicator 104, the distal end 118 engages the proximal end 120p and the distal end 120d of the cavity 120, respectively, so that the core member 110 and the clamp arm 106 move proximally and distally relative to the compartment 112, so that the clamp 102 moves between the open configuration and the closed configuration.

[0035] Specifically, distal movement of the control member 116 relative to the capsule 112 causes the clamp arms 106 to move out of the capsule 112, such that the clamp arms 106 spring away from each other (e.g., under a natural bias applied to the clamp arms 106). In one embodiment, each clamp arm 106 is formed of an elastic material such as a nickel-titanium alloy and is preformed (e.g., thermoformed) into a shape that matches the shape of the clamp arms 106 when in the open configuration. Therefore, when not constrained by the capsule 112 and held in the closed configuration, the clamp arms 106 spring away from each other into the open configuration.

[0036] As will be explained in more detail below, the clamp 102 is releasably coupled to the applicator 104 via a sleeve 128 coupled to the distal end of the applicator 104, so that the applicator 104 and the sleeve 128 form an applicator that is inserted through an insertion instrument (e.g., a flexible endoscope) to a target site in a living body. In this embodiment, the applicator 104 extends proximally from the sleeve 128 to the handle 101 (see Fig.15 ) is formed as a coil 105 of a flexible material, such as stainless steel, so that the applicator 104 can travel through even the more tortuous paths traversed by the most flexible endoscopes.

[0037] The desired orientation of the clamp arms 106 in the present embodiment within the capsule 112 is maintained by tabs 121 formed as part of the capsule 112, which are folded radially inward through the distal opening of the capsule 112 and are received between the clamp arms 106. The size of the tabs 121 is selected so that the space allowed for each clamp arm 106 in the open distal end of the capsule 112 is sufficient to allow the clamp arm 106 to slide into and out of the capsule 112 only when aligned with the tabs 121. The proximal end 108 of each clamp arm 106 is coupled to the distal end of the core member 110 via pins 111 extending radially outward from opposite sides of the core member 110.

[0038] Each pin 111 passes through an opening 107 at the proximal end of a corresponding one of the clamp arms 106, so that when the control member 116 is moved proximally and distally by the applicator 104, the clamp arm 106 moves proximally and distally within the chamber 112. Thus, movement of the control member 116 relative to the applicator 104 causes the clamp arm 106 to move proximally into the chamber 112 and distally out of the chamber 112, so that the clamp arm 106 moves between an open configuration and a closed configuration. In addition, when the clamp arm 106 is held in a desired orientation within the chamber 112 by the tab 121, the connection between the pin 111 and the clamp arm 106 maintains the core member 110 in the desired orientation within the chamber 112.

[0039] As described above, the applicator 104 includes a sleeve 128 at its distal end for releasably coupling the applicator 104 to the clamp 102. The control member 116 extends through the applicator 104 distally into the sleeve 128, where it is connected to the core member 110, as described above. Figure 5A and 5B It can be seen that the bushing 128 of this embodiment includes a proximal segment 130 and a distal segment 132. The outer diameter of the proximal segment 130 is equal to the outer diameter of the distal end of the coil 105, and the outer diameter of the distal segment 132 is smaller than that of the proximal segment 130. The outer diameter of the distal segment 132 in this embodiment is equal to the outer diameter of the chamber 112.

[0040] As will be appreciated by those skilled in the art, the coil 105, sleeve 128 and chamber 112 in the present embodiment are all roughly cylindrical. However, the shapes of these components can be changed in any desired manner as long as the applicator and clamp 102 can be inserted through the working channel of a delivery device (e.g., a flexible endoscope) and operated as needed without damaging the delivery device. The sleeve 128 in the device ensures that after the user deploys the clamp 102, the clamp 102 is completely separated from the applicator 104, while excluding parts that fall off. Specifically, it is important that after deployment, the applicator 104 is completely separated from the clamp 102 to prevent the clamp 102 from being locked and gripped on the tissue in the body while the applicator remains connected to the clamp. As will be appreciated by those skilled in the art, if it is impossible to separate the applicator 104 from the clamp 102, a separate procedure may be required to separate the clamp from the tissue or applicator it clamps.

[0041] In this embodiment, the bushing 128 includes a mobile coupler 134 that is slidably received in the distal segment 132. A pair of pins 136 extending radially outward from opposite sides of the mobile coupler 134 of this embodiment are received in corresponding slots 138 that extend longitudinally through a portion of each opposite side of the distal segment 132, so that the mobile coupler 134 can slide proximally and distally within the distal segment 132 along the distance defined by the slots 138. The mobile coupler 134 includes a pair of distally extending wings 140, each wing 140 defining two recesses 142 (see Fig. 7A and 7B ). The size and position of each recess are designed to accommodate a corresponding locking feature at the proximal end 113 of the compartment 112.

[0042] In this embodiment, the locking feature of the capsule is formed as a series of openings 144 formed between the proximal web 146 and the proximal end 148 of the cylindrical portion of the capsule 112. Prior to assembly, the proximal end of the capsule 112 is generally cylindrical, and when the mobile coupler 134 is inserted into the capsule 112, the proximal end of the capsule is compressed radially inwardly, so that each web 146 is forced into a corresponding one of the recesses 142, and the plurality of protrusions 150 (four protrusions 150 in this embodiment) of the mobile coupler 134 extending distally of the recess 142 are each received in a corresponding one of the openings 144, releasably locking the capsule 112 to the bushing 128. Figure 5A and 7B As can be seen, the wings 140 of the mobile coupler 134 are separated from one another by slots 152, each of which extends longitudinally from an open distal end 154 to a closed proximal end 156. In this configuration, the web 146 extends through the slots 152.

[0043] The core member 110 of the present embodiment includes a proximal portion 158 coupled to an intermediate portion 162 extending distally from the proximal portion 158 and coupled to the intermediate portion 162 via a first break point 164. A distal portion 166 extending distally from the intermediate portion 162 is coupled to the intermediate portion 162 via a second break point 168. The proximal portion 158 includes the opening 119 and the cavity 120 and the longitudinal notch 117, while the intermediate portion 162 includes a pair of diametrically opposed lateral projections 160 extending outwardly a distance selected to substantially match the inner diameter of the capsule 112 and the inner diameter of the distal segment 132 of the bushing 128. The distal portion 166 includes the pin 111 and two opposing surfaces 268 on which the proximal end 108 of the clamp arm 106 is received.

[0044] As described below, each lateral protrusion 160 is movable to contact and radially outwardly bend a corresponding portion of the capsule 112 that has been hooked on the distal portion of the bushing 128. When pulled proximally from the capsule 112, the lateral protrusions 160 bend these portions of the capsule 112 radially outward beyond the extent of the portions that have been hooked on the bushing 128 to release the capsule 112 from the bushing 128. Therefore, the distance that the lateral protrusions 160 extend radially outward should preferably be greater than the radial extent of the portion of the capsule 112 that is hooked on the bushing 128, so that these portions of the capsule are pushed radially outward beyond the portion of the bushing 128. As described below, it may be desirable to configure the lateral protrusions 160 so that they extend radially outward to slide on the inner surface of the capsule 112, which will allow the hooked portion of the capsule 112 to expand radially outward to the greatest extent.

[0045] The core member 110 and the bushing 128 of the present embodiment work together to ensure that when the clamp 102 is deployed to lock onto the target tissue, the clamp 102 will be successfully separated from the applicator 104, so that the applicator 104 can be withdrawn from the body while the clamp 102 is held in place on the target tissue. Specifically, it is noted that when the clamp 102 is assembled, the clamp arms 106 and thus the core member 110 are retained in a desired orientation within the chamber 112 via the tabs 121. In the desired orientation, the intermediate portion 162 and the distal portion 166 of the core member 110 are respectively received within the chamber 112, wherein the lateral protrusions 160 are aligned with the grooves 152 in the distal segment 132 of the bushing 128.

[0046] like Fig. 12A and 12BAs shown, each clamp arm 106 of the clamp 102 of the present embodiment includes a locking feature at its proximal end 108. In the present embodiment, the locking feature of each clamp arm 106 is formed as a tab 172, and the proximal end 108 of the clamp arm 106 is biased to spring radially outward. The proximal end 108 of the clamp arm 106 is restrained in a radially inner position, wherein the tab 172 is separated from the chamber 112 by the overhanging portion of the lateral protrusion 160. Therefore, when the clamp 102 is moved between the open configuration and the closed configuration and the core member 110 remains intact, the lateral protrusion 160 holds the proximal end 108 and the tab 172 in an unlocked configuration, so that the clamp 102 can be opened and closed until the desired portion of the tissue is clamped by the clamp 102. When the user determines that the target portion of tissue has been grasped as desired and the clamp 102 is to be deployed, as will be described in more detail below, the user operates the actuator on the handle 101 until the tension on the control member 116 and the core member 110 exceeds a predetermined level, and at this predetermined level, the core member 110 fails at the second breaking point 168, thereby causing the proximal portion 158 and the intermediate portion 162 of the core member 110, including the lateral projections 160, to move proximally relative to the clamp 102. Therefore, when the lateral projections 160 are no longer depending from the proximal ends 108 of the clamp arms 106, the tabs 172 are released to spring radially outward.

[0047] The projections 172 are positioned so that when the clamp arm 106 is pulled proximally into the chamber 112 to the greatest extent and the lateral projections 160 are withdrawn from the chamber 112, the projections 172 spring outwardly into windows 174 formed adjacent the proximal end 113 of the chamber. Each tab 172 engages the distal surface of a corresponding one of the windows 174, thereby locking the clamp arm 106 in a closed configuration for grasping the target tissue. Those skilled in the art will appreciate that this locking mechanism is merely exemplary, and any known clamp locking mechanism may be substituted for this exemplary mechanism. The proximal portion 158 and the intermediate portion 162 of the core member 110 are each pulled into the bushing 128, and the distal portion 166 of the core member 110 is retained within the chamber 112, so that the deployment of the clamp 102 does not result in any loose parts.

[0048] As will be appreciated by those skilled in the art, in use, the user advances the clamp 102 to a target site adjacent to the target tissue to be clamped (e.g., advancing the applicator 104 and the clamp 102 through the working channel of a flexible endoscope). When the clamp 102 is positioned as desired, the user advances the control member 116 distally relative to the applicator 104 (e.g., via the thumb ring and slider of the handle 101) to move the core member 110 and the clamp arm 106 distally through the compartment 112. As the clamp arms 106 protrude distally from the compartment 112, the clamp arms 106 separate from each other under their natural bias into an open tissue containment configuration. The clamp 102 is then further advanced distally until the distal ends 114 of the clamp arms 106 contact the target tissue.

[0049] While maintaining distal pressure on the target tissue, the user withdraws the control member 116 proximally, thereby pulling the clamp arms 106 together as they are pulled back into the chamber 112. This causes the distal ends 114 of the clamp arms to grasp tissue between the clamp arms 106 until the clamp arms 106 reach a point where they can no longer be pulled proximally into the chamber. For example, the clamp arms 106 of the present embodiment include a distal portion 115 that is wider than the proximal portion 109 of the clamp arms 106. The narrower proximal portions 109 of the clamp arms 106 have a width that allows them to be accommodated within the chamber 112, while the width of the distal portion 115 is greater than the width that can be accommodated within the chamber 112. Thus, when the user withdraws the clamp arm 106 proximally into the chamber 112 to a point where the proximal end of the distal portion 115 of the clamp arm 106 contacts the distal end of the chamber 112, the continued proximal force applied to the control member 116 increases the tension on the control member 116 and thereby increases the tension on the core member 110.

[0050] When the tension reaches a first threshold level, the second breaking point 168 breaks, separating the distal portion 166 from the middle portion of the core member 110. This releases the middle portion 162 and the proximal portion 158 of the core member 110 to move proximally. As the middle portion 162 moves proximally through the open proximal end of the compartment 112, the lateral projections 160 move proximally through the slot 152, such that the inclined proximal surface 170 of the lateral projection engages the web 146 and bends it radially outward from the recess 142. When the lateral projections 160 contact the closed end 156 of the slot 152, further proximal movement of the middle portion 162 and the lateral projections 160 drives the mobile coupler 134 proximally into the distal segment 132.

[0051] As the lateral projections 160 are drawn into the distal segment, the webs 146 will be forced radially outward, ensuring that they are driven away from the recess 142 separating the liner 128 from the compartment 112. The lateral projections 160 move proximally into the distal segment 132 until they contact a hard stop 176 extending radially inward within the distal segment 132 of the liner 128, the hard stop 176 being configured to define a proximal-most point at which the lateral projections and the intermediate portion 162 of the core member 110 can be drawn into the liner 128.

[0052] After reaching this point, the additional proximal tension thus increases the tension applied to the proximal portion 158 and the intermediate portion 162 of the control member 116 and the core member 110, respectively. When the second threshold tension (a tension greater than the first threshold tension) is reached, the first breaking point 164 fails and the intermediate portion 162 separates from the proximal portion 158.

[0053] Those skilled in the art will appreciate that the embodiments described herein reduce the risk of falling parts by designing the control member 116 to have sufficient strength to remain intact when the tension required to separate the core member 110 to the point of failure is reached, so that the control member 116 will not fail during the deployment of the clamp. That is, the core member 110 will fail before the tension on the control member 116 reaches a level at which the control member 116 will fail. Even after the clamp has been deployed, the distal end of the control member 116 remains coupled to the proximal portion of the control member 116 and is retained within the proximal portion of the core member 110 located in the sleeve 128 for removal from the body. Since only the distal portion 166 of the core member 110 is retained in the chamber 112, and the intermediate portion 162 and the proximal portion 158 of the core member 110 are respectively withdrawn proximally into the sleeve 128 for withdrawal from the body, the clamp 102 can be shorter than most conventional clamps. For example, the length of a clamp according to the disclosed embodiments (from the distal end 114 of the clamp arm 106 to the proximal end of the capsule 112) may be as short as 8 mm to 9 mm.

[0054] Those skilled in the art will appreciate that this operation provides a variety of feedback to the user. First, the user will understand that after opening the clamp 102 and closing it on the target tissue, the increase in resistance to further proximal movement of the control member 116 indicates that the distal portion 115 of the clamp arm 106 has contacted the distal end of the compartment 112. Then, as the tension applied to the control member 116 increases, the user will feel the tension relax (and possibly hear a click) when the second breaking point 168 fails. This lets the user know that the clamp 102 is locked and clamped on the target tissue.

[0055] Then, after the control member 116 is further moved proximally, the user will feel a new resistance to further proximal movement of the control member 116 as the intermediate portion 162 snaps into the distal segment 132 of the bushing 128. Finally, after increasing the tension on the control member, the user will feel the tension on the control member 116 relax and may hear another click as the first break point 164 fails. This will notify the user that the clamp 102 has been successfully clamped on the target tissue and that the clamp 102 has been separated from the applicator 104. The applicator can then be withdrawn from the insertion instrument, leaving the clamp 102 in the body.

[0056] Fig.13A , 13B and Fig.14A clamping system 200 is shown according to another embodiment and includes a clamp 202 releasably coupled to an insertion device, such as an applicator 204. The clamp 202 includes a pair of clamp arms 206 having proximal ends 208 coupled to each other via a core member 210 that is slidably received within a compartment 212 to enable the clamp 202 to move between an open configuration, in which distal ends 214 of the clamp arms 206 are separated from each other to receive tissue therebetween, and a closed configuration, in which distal ends 214 of the clamp arms 206 are pulled toward each other to grasp tissue.

[0057] The clamp arm 206 is moved between an open configuration and a closed configuration via a control member 216, the distal end 218 of the control member 216 being received within the cavity 220 of the core member 210, and the reduced-size proximal portion 222 of the control member 216 extending proximally therefrom to pass through the core member 210. The proximal portion 222 of the control member 216 extends through the applicator 204 to a proximal end accessible to a user of the system 200. In this embodiment, the distal end 218 of the control member is enlarged (i.e., has a larger diameter) relative to the proximal portion 222 of the control member 216. The core member 210 includes an opening 219 that is sized and shaped to allow the distal end 218 to pass therethrough.

[0058] As previously described with respect to system 100, control member 216 is then rotated to seat distal end 218 in cavity 220, which is sized and shaped to snugly accommodate distal end 218. In this embodiment, distal end 218 and cavity 220 are both generally cylindrical, and cavity 220 is slightly larger than distal end 218, with a tolerance that allows distal end 218 to be securely seated therein. Fig. 13B It can be seen that a longitudinal notch 217 is formed on the side of the core member 210 opposite to the side where the cavity 220 is formed, and the longitudinal notch 217 extends proximally from the opening 219, so that when the distal end 218 is rotated to a position within the cavity 220, the most distal portion of the proximal portion 222 of the control member 216 is disposed in the longitudinal notch 217. Therefore, when the user moves the control member 216 longitudinally (i.e., proximally and distally) relative to the applicator 204, the distal end 218 engages the proximal end 220p and the distal end 220d of the cavity 220, respectively, whereby the core member 210 and the clamp arm 206 move proximally and distally relative to the compartment 212, thereby moving the clamp 202 between the open configuration and the closed configuration.

[0059] Distal movement of the control member 216 relative to the capsule 212 causes the clamp arms 206 to move out of the capsule 212, such that the clamp arms 206 spring away from each other (e.g., under a natural bias applied to the clamp arms 206). In one embodiment, each clamp arm 206 is formed of a resilient material such as a nickel-titanium alloy and is preformed (e.g., thermoformed) into a shape that matches the shape of the clamp arms 206 when in the open configuration. Thus, when not constrained by the capsule 212 and held in the closed configuration, the clamp arms 206 spring away from each other into the open configuration.

[0060] As will be explained in more detail below, the clamp 202 is releasably coupled to the applicator 204 via a sleeve 228 coupled to the distal end of the applicator 204, so that the applicator 204 and the sleeve 228 form an applicator that is inserted through an insertion instrument (e.g., a flexible endoscope) to a target site within a living body. The portion of the applicator 204 that extends proximally from the sleeve 228 to the handle, such as Fig.15 As shown, coil 205 formed of a flexible material, such as stainless steel, allows applicator 204 to travel through even the more tortuous paths traversed by the most flexible endoscopes.

[0061] The desired orientation of the clamp arms 206 within the capsule 212 in this embodiment is maintained by tabs 221 which are folded radially inward through the distal opening of the capsule 212 and are received between the clamp arms 206. The size of the tabs 221 is selected so that the space allowed for each clamp arm 206 in the open distal end of the capsule 212 is sufficient to allow the clamp arms 206 to slide into and out of the capsule 212 only when aligned with the tabs 221. The proximal end 208 of each clamp arm 206 is coupled to the distal end of the core member 210 via pins 211 extending radially outward from opposite sides of the core member 210. Each pin 211 passes through an opening 207 in the proximal end of a corresponding one of the clamp arms 206 so that the clamp arms 206 move proximally and distally within the capsule 212 as the control member 216 is moved proximally and distally by the applicator 204. Movement of the control member 216 relative to the applicator 204 causes the clamp arm 206 to move proximally into the compartment 212 and distally out of the compartment 212, thereby moving the clamp arm 206 between the open configuration and the closed configuration. In addition, when the clamp arm 206 is maintained in a desired orientation within the compartment 212 by the tab 221, the connection between the pin 211 and the clamp arm 206 maintains the desired orientation of the core member 210 within the compartment 212.

[0062] As described above, the applicator 204 includes a sleeve 228 at its distal end for releasably coupling the applicator 204 to the fixture 202. The sleeve 228 and its coupling to the capsule 212 are substantially the same as described with respect to the sleeve 128 and the capsule 112, and the interaction between the core member 210 and the connection between the sleeve 228 and the core member 210 are also substantially the same as described above with respect to the operation of the core member and its role in separating the capsule 112 from the sleeve 128. Fig.14 It can be seen that the bushing 228 includes a proximal segment 230 and a distal segment 232, the proximal segment 230 has an outer diameter equal to the outer diameter of the distal end of the coil 205, and the distal segment 232 has an outer diameter reduced relative to the proximal segment 230. The outer diameter of the distal segment 232 is equal to the outer diameter of the capsule 212. The bushing 228 includes a mobile coupler 234 slidably received in the distal segment 232.

[0063] A pair of pins 236 extending radially outward from opposite sides of the mobile coupler 234 are received in corresponding slots 238 that extend longitudinally through a portion of each opposite side of the distal segment 232 so that the mobile coupler 234 can slide proximally and distally within the distal portion 232 along the distance defined by the slots 238. The mobile coupler 234 includes a pair of distally extending wings 240, each wing 240 defining two recesses 242. The size and position of each recess 242 are designed to accommodate a corresponding locking feature at the proximal end 213 of the compartment 212. In this embodiment, the locking feature of the compartment is formed as a series of openings 244 formed between the proximal web 246 and the proximal end 248 of the cylindrical portion of the compartment 212.

[0064] like Fig.14 As can be seen, prior to assembly, the proximal end of the capsule 212 is generally cylindrical, and when the mobile coupler 234 is inserted into the capsule 212, the proximal end of the capsule 212 is compressed radially inwardly, so that each web 246 is forced into a corresponding one of the recesses 242, and the plurality of tabs 250 (four tabs 250 in this embodiment) of the mobile coupler 234 extending distally of the recesses 242 are each received in a corresponding one of the openings 244, releasably locking the capsule 212 to the bushing 228. The wings 240 of the mobile coupler 234 are separated from each other via slots similar to the slots 152 of the bushing 128, each slot extending longitudinally from an open distal end to a closed proximal end. In this configuration, the webs 246 extend through the slots 252 in the same manner as previously described with respect to the system 100.

[0065] The core member 210 of this embodiment includes a proximal portion 258 coupled to a distal portion 262 extending distally from the proximal portion 258 and coupled to the proximal portion 258 via a break point 264. The proximal portion 258 includes an opening 219 and a cavity 220 and a longitudinal notch 217, while the distal portion 262 includes a pair of diametrically opposed lateral projections 260 extending outwardly a distance selected to substantially match the inner diameter of the capsule 212 and the inner diameter of the distal segment 232 of the bushing 228. The distal portion 262 also includes a pin 211 and two opposing surfaces 268 on which the proximal end 208 of the clamp arm 206 is received.

[0066] The core member 210 and the bushing 228 of the present embodiment operate together in a substantially similar manner as the core member 110 and the bushing 128 to ensure that when the clamp 202 is deployed to lock onto the target tissue, the clamp 202 will be successfully separated from the applicator 204 so that the applicator 204 can be withdrawn from the body while leaving the clamp 202 clamped in place on the target tissue. Specifically, it is noted that when the clamp 202 is assembled, the clamp arms 206 and, in turn, the core member 210 are retained in a desired orientation within the chamber 212 via the tabs 221. In the desired orientation, the distal end of the proximal portion 258 of the core member 210, including the lateral protrusions 260, and the distal portion 262 are received within the chamber 212, wherein the lateral protrusions 260 are aligned with the grooves in the distal segment 232 of the bushing 228.

[0067] As will be appreciated by those skilled in the art, in use, the user advances the clamp 202 to a target site adjacent to the target tissue to be clamped (e.g., advancing the applicator 204 and the clamp 202 through the working channel of a flexible endoscope). When the clamp 202 is positioned as desired, the user advances the control member 216 distally relative to the applicator 204 to move the core member 210 and the clamp arms 206 distally through the compartment 212. As the clamp arms 206 protrude distally from the compartment 212, the clamp arms 206 separate from each other under their natural bias into an open tissue receiving configuration. The clamp 202 is then further advanced distally until the distal ends 214 of the clamp arms 206 contact the target tissue.

[0068] While maintaining distal pressure on the target tissue, the user withdraws the control member 216 proximally, thereby pulling the clamp arms 206 together as they are withdrawn into the bay 212. This draws the distal ends 214 of the clamp arms 206 together, grasping the tissue between the clamp arms 206 until the clamp arms 206 reach a point where they can no longer be pulled proximally into the bay 212. The clamp arms 206 of this embodiment include a distal portion 215 that is wider than the proximal portion 231 of the clamp arms 206.

[0069] The narrower proximal portions 231 of the clamp arms 206 have a width that allows them to be received within the capsule 212, while the width of the distal portions 215 is greater than the width that can be received within the capsule 212. Thus, when the user draws the clamp arms 206 proximally into the capsule 212 to a point where the proximal ends of the distal portions 215 of the clamp arms 206 contact the distal ends of the capsule 212, the continued proximal force applied to the control member 216 increases the tension on the control member 216, thereby increasing the tension on the core member 210.

[0070] When the tension reaches a threshold level, the breaking point 264 breaks, separating the distal portion 166 from the proximal portion of the core member 210. This releases the proximal portion 158 of the core member 210 to move proximally. As the distal end of the proximal portion 158 moves proximally through the open proximal end of the compartment 212, the lateral projection 260 moves proximally through the slot in the distal portion of the distal segment 232 of the bushing 228, whereby the inclined proximal surface 270 of the lateral projection 260 engages the web 246 and causes it to bend radially outward from the recess 242.

[0071] When the lateral projections 260 contact the closed end of the slot in the distal segment 232, further proximal movement of the proximal portion 158 and the lateral projections 260 will drive the mobile coupler 234 proximally into the distal segment 232. As the lateral projections 260 are pulled into the distal segment 232, whose inner diameter substantially matches the radial extent of the lateral projections 260, the webs 246 will be forced radially outward along the inclined surfaces 270, ensuring that they are driven away from the recess 242 separating the bushing 228 from the compartment 212. The lateral projections 260 are then snapped into the distal segment 232 by contacting the inner wall of the distal segment 232, thereby preventing further proximal movement of the proximal portion 158.

[0072] Those skilled in the art will appreciate that this operation provides a variety of feedback to the user. First, the user will understand that after opening the clamp 202 and closing it on the target tissue, the increase in resistance to further proximal movement of the control mechanism 216 indicates that the distal portion 215 of the clamp arm 206 has contacted the distal end of the cabin 212. Then, as the tension applied to the control member 216 increases, the user will feel the tension relax (and possibly hear a click) when the breaking point 264 fails. This lets the user know that the clamp 202 has been locked and clamped on the target tissue. Then, after the control member 216 is further moved proximally, the user will feel a new resistance to further proximal movement of the control member 216 when the proximal portion 158 is embedded in the distal segment 232 of the bushing 228. This will notify the user that the clamp 202 has been successfully clamped on the target tissue and that the clamp 202 has been separated from the applicator 204. The applicator can then be withdrawn from the insertion instrument, leaving the clamp 202 in place in the body.

[0073] It will be clear to those skilled in the art that various modifications may be made without departing from the scope of the present disclosure. Although specific embodiments have been illustrated and described herein, it will be understood that any arrangement intended to achieve the same purpose may replace the specific embodiments shown. The present disclosure is intended to cover any and all modifications or variations of the various embodiments. It will be understood that the above description is in an illustrative and non-restrictive manner. Combinations of the above embodiments and other embodiments not specifically described herein will be clear to those skilled in the art after reading the above description. Therefore, the scope of the various embodiments includes any other applications using the above-mentioned compositions, structures and methods.

Claims

1. A clamping system for processing tissue, comprising: An applicator, comprising a flexible elongated member, the flexible elongated member extending from a proximal end to a distal end, the proximal end being maintained outside the body during use, the distal end being inserted into the body during use to reach a position adjacent to a target tissue to be clamped, the applicator comprising: a control member extending through the applicator; as well as a bushing coupled to the distal end of the flexible elongated member, the bushing comprising a proximal body coupled to the distal end of the flexible elongated member and a distal coupling movably attached to the proximal body; a fixture comprising: a capsule releasably coupled to the distal coupling of the bushing via a first coupling member of the capsule, the first coupling member of the capsule hooking onto a corresponding first hook of the distal coupling of the bushing, the capsule comprising a passage extending therethrough; and a pair of clamp arms having proximal ends slidably received within the channel to move between an open configuration in which distal ends of the clamp arms are separated from one another to receive tissue therebetween and a closed configuration in which the distal ends of the clamp arms are drawn toward one another to grasp tissue; as well as A core member, which is accommodated between and connected to the proximal ends of the clamp arms, and includes a first lateral protrusion and a first failure point located distal to the first lateral protrusion, the first failure point separating the distal portion of the core member from its proximal portion, the core member being coupled to the distal end of the control member so that longitudinal movement of the control member relative to the flexible slender member causes the clamp arms to move between the open configuration and the closed configuration, the lateral range of the first lateral protrusion being selected so that when the clamp is clamped on the target tissue, the first lateral protrusion is pulled proximally to move the distal coupling member into the proximal body of the bushing, the first lateral protrusion driving the first coupling member radially outward beyond the outer end of the first hook to release the compartment from the bushing.

2. The system of claim 1, wherein the core member comprises a first pin and a second pin, the first pin being received in a hole in a proximal portion of a first of the clamp arms and the second pin being received in a hole in a proximal portion of a second of the clamp arms.

3. The system of any one of claims 1 to 2, wherein the distal coupling is slidably coupled to the proximal body of the bushing to move proximally and distally into and out of the distal end of the proximal body.

4. A system according to any one of claims 1 to 3, wherein the proximal body of the sleeve includes a proximal segment, the outer diameter of the proximal segment is substantially equal to the outer diameter of the flexible slender member, and the outer diameter of the distal segment of the proximal body of the sleeve is substantially equal to the outer diameter of the compartment.

5. The system of claim 4, wherein the inner diameter of the passage is substantially equal to the inner diameter of the distal section of the proximal body of the bushing.

6. A system according to claim 5, wherein the lateral extent of the first lateral protrusion is selected to be substantially equal to the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, and wherein the inner diameter of the proximal portion of the distal coupling member is slightly smaller than the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the sleeve, so that the first lateral protrusion is snap-fitted against the distal coupling member within the sleeve.

7. The system of claim 6, wherein the core member includes a second failure point located proximal to the first failure point, the core member defining a distal portion located distal to the first failure point, an intermediate portion located between the first failure point and the second failure point, and a proximal segment located proximal to the second failure point.

8. The system of claim 7 , wherein the clamp arm is configured to define a proximal-most position of the clamp arm within the capsule such that when a proximal tension applied to the control member exceeds a first threshold level after the clamp arm has reached the proximal-most position, the core member separates at the first failure point, allowing the intermediate portion and the proximal portion of the core member to move proximally, pulling the first lateral protrusion proximally out of the capsule, driving the first coupling member of the capsule radially outward beyond the outer end of the first hook of the distal coupling member of the bushing to separate the capsule from the bushing.

9. A device for clamping tissue, comprising: a bushing comprising a proximal body and a distal coupling, the proximal body being configured to be coupled to a distal end of a flexible applicator, the distal coupling being movably attached to the proximal body, the distal coupling comprising a first hook; a clamp comprising: a capsule releasably coupled to the distal coupling via a first coupling member of the capsule, the first coupling member of the capsule hooking on the first hook, the capsule comprising a passage extending therethrough; and a pair of clamp arms having proximal ends slidably received within the channel to move between an open configuration in which distal ends of the clamp arms are separated from one another to receive tissue therebetween and a closed configuration in which the distal ends of the clamp arms are drawn toward one another to grasp tissue; as well as A core member, which is accommodated between and connected to the proximal ends of the clamp arms, and includes a first lateral protrusion and a first failure point located distal to the first lateral protrusion, the first failure point separating the distal portion of the core member from its proximal portion, the core member being configured to be coupled to the distal end of a control member so that longitudinal movement of the control member relative to the flexible applicator causes the clamp arms to move between the open configuration and the closed configuration, the lateral range of the first lateral protrusion being selected so that when the clamp is clamped on the target tissue, the first lateral protrusion is pulled proximally to move the distal coupling member into the proximal body of the bushing, the first lateral protrusion driving the first coupling member radially outward beyond the outer end of the first hook to release the compartment from the bushing.

10. The device of claim 9, wherein the core member comprises a first pin received in a hole in a proximal portion of a first of the clamp arms and a second pin received in a hole in a proximal portion of a second of the clamp arms.

11. The device according to any one of claims 9 to 10, wherein the distal coupling is slidably coupled to the proximal body of the hub to move proximally and distally into and out of the distal end of the proximal body.

12. A device according to any one of claims 9 to 11, wherein the proximal body of the sleeve includes a proximal segment, the outer diameter of the proximal segment is substantially equal to the outer diameter of the flexible applicator, and the outer diameter of the distal segment of the proximal body of the sleeve is substantially equal to the outer diameter of the compartment.

13. The device of claim 12, wherein the inner diameter of the passage is substantially equal to the inner diameter of the distal section of the proximal body of the bushing.

14. A device according to claim 13, wherein the lateral range of the first lateral protrusion is selected to be substantially equal to the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the bushing, and wherein the inner diameter of the proximal portion of the distal coupling member is slightly smaller than the inner diameter of the channel and the inner diameter of the distal segment of the proximal body of the bushing, so that the first lateral protrusion is engaged against the distal coupling member within the bushing.

15. The device of claim 14, wherein the core member comprises a second failure point proximal to the first failure point, the core member defining a distal portion distal to the first failure point, an intermediate portion between the first and second failure points, and a proximal segment proximal to the second failure point.

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