Device for fastening tissue

Abstract

According to one aspect, a fastening device may include a coupling body having (1) a portion configured to couple to a distal end of a medical device, (2) a cartridge holder, and (3) a chopping board pivotally coupled to the cartridge holder. The cassette holder and the chopping block may extend distally from the portion and may be configured to extend distally from a distal-most surface of the medical device when the portion is coupled to the distal end of the medical device. A flexible member may be configured to extend through a channel of the medical device. A fastener cartridge may be coupled to a distal end of the flexible member, including at least one fastener, and may be configured for releasable coupling to the cartridge holder.

Description

This application is a divisional application of Chinese application No. 202080052691.3, entitled "Apparatus for Fastening Mechanism". Cross-reference to related applications

[0001] This application claims priority to U.S. Provisional Application No. 62 / 878,141, filed July 24, 2019, the entire contents of which are incorporated herein by reference. Technical Field

[0002] This disclosure relates in general to tissue closure. More particularly, at least some embodiments of this disclosure relate to an anchoring mechanism (e.g., an endoscopic anchor) for a medical device, and related methods utilizing the anchoring mechanism. Background of the Invention

[0003] Staplers are used in many medical procedures, including, for example, laparoscopic surgery. These procedures typically involve removing portions or segments of tissue, which are then closed using a stapler. An exemplary procedure is colorectal stapler closure. In hybrid surgical procedures where the surgeon utilizes both a laparoscopic and endoscopic platform to perform the procedure, rigid staplers are typically used. Linear staplers (which may include long, rigid members) may not be able to navigate through tortuous anatomical structures without causing tissue trauma. Summary of the Invention

[0004] This disclosure relates to systems, apparatus, and methods for fastening organizations, etc. Each of the aspects disclosed herein may include one or more features described in combination with any of the other disclosed aspects.

[0005] According to one aspect, the fastening device may include a coupling body having (1) a portion configured to be coupled to a distal end of a medical device, (2) a cartridge retainer, and (3) an anvil plate pivotally coupled to the cartridge retainer. The cartridge retainer and the anvil plate may extend distally from the portion and may be configured to extend distally from the distal surface of the medical device when the portion is coupled to the distal end of the medical device. A flexible member may be configured to extend through a channel in the medical device. A fastener cartridge may be coupled to the distal end of the flexible member, includes at least one fastener, and is configured for releasable coupling to the cartridge retainer.

[0006] In other aspects of this disclosure, the device may include one or more of the following features: The fastener cartridge may include a protrusion, and the cartridge retainer may include a recess configured to receive the protrusion. The recess may be a first recess, and the protrusion may be a first protrusion; the fastener cartridge may include a second protrusion, and the cartridge retainer may include a second recess configured to receive a second protrusion. The device may include a blade for cutting tissue. The blade may be configured to move from a chamber within the cartridge retainer through a channel in the fastener cartridge. When the fastener cartridge is coupled to the cartridge retainer, the most distal end of the fastener cartridge may be distal to the chamber. The blade may be configured to move proximally from a chamber at a distal portion of the cartridge retainer. As the blade moves proximally, the blade may be positioned adjacent to the fastener cartridge and within a channel in the cartridge retainer. The blade may include a first proximal-facing sharp edge. The anvil may include a channel configured to receive the blade. The cartridge retainer may include a channel for receiving the fastener cartridge; and at least one shank may extend into the channel. The fastener cartridge may include at least one recess configured to receive at least one shank, and the at least one shank may be positioned within the at least one recess when the fastener cartridge is coupled to a cartridge holder. The anvil may include a distal portion and two spaced-apart proximal portions extending from the proximal ends of the distal portion, and each of the two proximal portions may be pivotally coupled to a coupling body. The flexible member may be a first flexible member, and the device further includes a second flexible member and an actuation wire coupled to the coupling body and configured to extend to the proximal portion of the medical device, and the actuation wire extending through the second flexible member. The actuation wire may be configured to move the anvil toward and / or away from the cartridge holder. The cartridge holder may include a protrusion at the distal portion of the cartridge holder, and the protrusion may be configured to contact the anvil when the anvil moves toward the cartridge holder to stop the movement of the anvil toward the cartridge holder and to allow flow out of the space between the fastener cartridge and the anvil. The coupling body may include a flange configured to restrict movement of the anvil relative to the cartridge holder. The flexible component may include at least one actuation wire configured to deploy at least one fastener from the fastener box.

[0007] In other aspects, the medical device may include a flexible member configured to extend through a channel of the endoscope; and a stapler cartridge may be coupled to a distal end of the flexible member and may include a plurality of staplers. The stapler cartridge may be configured to extend through a channel of the endoscope and removably coupled to a cartridge holder.

[0008] In other aspects of this disclosure, the device may include one or more of the following features: The stitcher cartridge may include a protrusion configured to be positioned within a recess of the cartridge holder when the fastener cartridge is engaged with the cartridge holder. The stapler cartridge may define a longitudinal channel configured to receive a blade.

[0009] In other respects, the medical method may include inserting a flexible medical device into a natural orifice of the body; deploying at least one fastener from a fastener cartridge coupled to a cartridge retainer at a distal end of the medical device; disengaging the fastener cartridge from the cartridge retainer while the flexible medical device, cartridge retainer, and fastener cartridge are in the body; and removing the fastener cartridge from the body by moving it proximally through a channel of the medical device.

[0010] In other aspects, the medical method of other aspects of the present invention may include one or more of the following features: the fastener cartridge may be a first fastener cartridge; and the method may further include moving a second fastener cartridge distally through a channel while the flexible medical device is in the body, and coupling the second fastener cartridge to a cartridge holder.

[0011] It is understood that the foregoing general description and the following detailed description are merely exemplary and explanatory, and do not limit the claimed invention. Brief description of the attached diagram

[0012] The accompanying drawings, which are incorporated in and form part of this specification, illustrate exemplary aspects of this disclosure and, together with the description, serve to explain the principles of this disclosure.

[0013] Figure 1 This is a perspective view of an exemplary medical device coupled to an endoscope, according to aspects of this disclosure.

[0014] Figure 2 Based on the aspects of this disclosure, Figure 1 A perspective view of an exemplary portion of a medical device.

[0015] Figure 3 Based on the aspects of this disclosure, Figure 1 A perspective view of an exemplary portion of a medical device.

[0016] Figures 4A to 4C This is a cross-sectional view of a portion of the exemplary connection features of a medical device according to aspects of this disclosure.

[0017] Figures 5A to 5C This is a cross-sectional view of a portion of the exemplary connection features of a medical device according to aspects of this disclosure.

[0018] Figure 6A and Figure 6B This is a side view of an exemplary medical device according to aspects of this disclosure.

[0019] Figure 7 This is a side view of an exemplary medical device according to aspects of this disclosure.

[0020] Figure 8This is a perspective view of a portion of an exemplary medical device according to aspects of this disclosure.

[0021] Figure 9 This is a perspective view of a portion of an exemplary medical device according to aspects of this disclosure.

[0022] Figure 10A and Figure 10B This is a perspective view of a portion of an exemplary medical device according to aspects of this disclosure.

[0023] Figure 11 Based on the aspects of this disclosure, Figure 10B A side sectional view of a portion of the exemplary medical device shown. Detailed Implementation

[0024] This disclosure relates to systems, apparatus, and methods for joining, cutting, dissecting, and / or removing tissues, etc. Reference will now be made in detail to several aspects of this disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or similar reference numerals will be used in all figures to refer to the same or similar parts. The term “distal” refers to the portion furthest from the user when the device is introduced into the patient's body. Conversely, the term “proximal” refers to the portion closest to the user when the device is placed in the patient's body. In all figures, the distal direction is indicated by an arrow marked “D”, and the proximal direction by an arrow marked “P.” The term “joining tissues together” may, for example, refer to fastening, securing, attaching, tightening, or otherwise combining two portions of tissue. The term “fastener” may include staplers, clamps, elastic bands, sutures, or any other fasteners known in the art. As used herein, the terms “comprising,” “including,” or any other variations thereof are intended to cover a non-exclusive inclusion, such that a process, method, article of manufacture, or apparatus that comprises a list of elements does not necessarily include only those elements, but may include other elements not expressly listed or inherent to such process, method, article of manufacture, or apparatus. The term “exemplary” is used in the sense of “example” rather than “ideal.”

[0025] The embodiments of this disclosure can be used to visualize, remove, and / or assemble target tissue in an intracavitary space, or to facilitate such a process. In particular, some embodiments combine a tissue removal device with a tissue stapling device. Other embodiments may include a stapling device without a removal mechanism. For example, the device may include a removal or cutting mechanism (e.g., an integrated blade) and a stapling mechanism (stapling device). The device may be coupled to an endoscope, arthroscopy, colonoscope, hysteroscope, sheath, catheter, or other medical device and may be delivered to the target tissue site via the device. In some instances, a cylinder for holding fasteners (such as stapling elements) may be delivered to the device via a working channel of the medical device, in which the device is coupled. All or part of the device may be metallic, plastic, or may include shape memory metals (such as nitinol), shape memory polymers, polymers, or any combination of materials.

[0026] Figure 1 According to one embodiment of this disclosure, a distal portion of a medical device 101 is shown coupled to a distal end 100 of an endoscope 103. The device 101 may be a surgical stapling device configured to engage body tissue, apply one or more fasteners to the body tissue, and optionally form an incision in the stapled body tissue during minimally invasive surgery (such as laparoscopic or endoscopic surgery). The device 101 is removably coupled to the distal end 100 of a medical device (such as an endoscope 103). The end 100 is composed of… Figure 1 The device 101 is part of the device body to cover. The device 101 can be used to apply surgical clamps or other fasteners, but will be discussed primarily in the context of applying fasteners from a fastener cartridge located in a part of the device body, such as a loading unit.

[0027] like Figure 1As shown, the distal segment of device 101 may include a coupling body or first body 108, a second body 104 (coupled to the first body 108), an anvil 102, a case 106, and two elongated bodies 110, 112 (extending from the distal segment to the proximal segment of device 101). Each elongated body 110, 112 may extend to any length suitable for endoscopic or laparoscopic surgery and, in some instances, may be configured to be positioned adjacent to the radially outer surface of endoscope 103 or other medical device. The elongated bodies 110, 112 may be coupled at their proximal ends to an actuation assembly, such as a shank having one or more actuators. In some instances, each elongated body 110, 112 may be flexible and / or rotatable about its axis. Elongated bodies 110, 112 may be positioned within elongated cap bodies 113, 114 and may extend through longitudinal lumens of elongated cap bodies 111, 113. Elongated cap bodies 111, 113 may be made of a polymer material and may protect elongated bodies 110, 112 from contact with internal surfaces of the patient's body. Each elongated body 110, 112 may include a lumen for positioning an actuation wire therein.

[0028] These actuation wires, positioned within one or more lumens of one or more elongated bodies 110, 112, can serve a variety of possible functions. In one exemplary embodiment, the first body 108 may include an internal channel (not shown) in which the elongated bodies 110, 112 (or only the wires 110a, 112a of the bodies 110, 112) extend, such that the distal ends of these bodies 110, 112 are connected to an anvil 102 (to pivot the anvil 102 about a pivot point 114) and / or to an actuation mechanism within a second body 104, which deploys a pin. The wires 110a, 112a may extend from the anvil 102 through the lumen within the first body 108 to provide a means for positioning the anvil 102 in an open position. Figure 1 The anvil 102 moves between a closed position and a closed position, with a portion of the anvil 102 contacting the second body 104 in the closed position. In other instances, wires (such as 110a, 112a) may extend from the anvil 102 to the outside of the first body 108. In these instances, actuation wires (such as wires 110a, 112a) may be coupled to a position on the anvil 102 such that movement of the actuation wires will cause the anvil 102 to pivot about a first pivot point 114 and a second pivot point (located on the side of the first body 108 opposite to the first pivot point 114) (not shown). In some instances, a biasing member may bias the anvil 102 toward the open position. Figure 1As shown), pulling one or more wires (such as wires 110a, 112a) (which are connected to the anvil 102 near pivot point 114) moves the anvil 102 from an open position to a closed position. In some instances, the elongated bodies 110, 112 may each be a Bowden cable including wires within a coil / sheath. In some instances, the elongated bodies 110, 112 may be fixedly connected to the first body 108, and in other instances, the elongated bodies 110, 112 may be removably or releasably connected to the first body 108. In some instances (not shown), the device 101 may include only one elongated body 110, 112 or two or more elongated bodies 110, 112.

[0029] A first body 108 may be configured to support an anvil 102 and a second body 104. For example, the distal end 100 of an endoscope 103 may be inserted into a lumen 129 of the first body 108 to couple device 101 to the distal end 100. In some instances, the first body 108 may be annular and / or partially annular and may be configured to receive the distal end 100 of the endoscope 103 or other medical devices. In some instances, the first body 108 may include a first annular portion 108a that receives a second annular portion 108b, and the second annular portion 108b may be configured to couple to the distal end 100. The first body 108 may include a first radial protrusion 108c located on the radially outermost surface of the second annular portion 108b, and may include a second radial protrusion 108d located on the radially outermost surface of the first annular portion 108a. In some instances, additional annular protrusions (not shown) may be located on the first body 108. The first annular protrusion 108c and the second annular protrusion 108d may include openings to an internal channel of the first body 108 and may be configured to receive elongated bodies 110, 112, cover elongated bodies 111, 113, and / or wires 110a, 112a. The distal flange 108f of the first annular portion 108a may be positioned adjacent to the pivot point 114 and may restrict rotation of the anvil 102. Figure 2 Device 101 is shown, wherein anvil 102, a portion of the second annular portion 108b, and elongated bodies 110, 112 are removed. First body 108 may include a rough or irregular radial inner surface within lumen 129, which facilitates coupling of first body 108 to endoscope 103 via friction or interference fit.

[0030] In some instances, when fully inserted into the lumen 129 of the first body 108, the distal anterior surface 120 of the distal end 100 may contact the proximal surface of the second body 104, such that the body 104 acts as a stop for the insertion of the endoscope 103.

[0031] Anvil 102 may be rotatably or pivotally coupled to a proximal portion of first body 108 at one or more pivot points 114. Anvil 102 may be Y-shaped (e.g., having two proximal arms, each extending to a distal portion 132 of anvil) and may extend distally from first body 108. In some instances, anvil 102 may be rotatably biased and may be biased to an open configuration, i.e., biased away from body 104 and cartridge 106, thereby forming a space between the distal portion of anvil 102 and the distal portions of body 104 and cartridge 106. Anvil 102 may be rotatable to contact body 104 or clamp tissue between anvil 102 and body 104, and provides a surface that can drive the staples when they are ejected from cartridge 106. The space 131 between the distal portion 132 of the anvil 102 and the distal anterior surface 120 of the endoscope 103 provides space for one or more tools positioned distal to the distal anterior surface 120 of the endoscope 103 when the anvil is in a closed or open position. For example, the space 131 allows a user to pull tissue between the anvil 102 and the second body 104, and the user can then actuate the anvil 102 to clamp tissue between the anvil 102 and the second body 104 without preventing the tools from completely closing the anvil 102 onto the second body 104.

[0032] The second body 104 may be fixedly coupled to the first body 108 and may extend distally from the first body 108. In other embodiments (not shown), the second body 104 may be pivotally coupled to the first body 108 and may rotate relative to a fixed anvil. When the device 101 is coupled to the endoscope 103, the second body 104 may be longitudinally aligned with the endoscope 103 such that the central longitudinal axis of the endoscope 103 is substantially parallel to the longitudinal axis of the second body 104. When the device 101 is coupled to the distal end 100, the second body 104 may be configured to align with and / or extend adjacent to the central longitudinal axis of the endoscope 103's working channel 116. The second body 104 may include one or more chambers at the distal portion of the second body 104, and the one or more chambers may be configured to receive one or more actuators, such as actuated slides or actuation mechanisms, for deploying stapling elements. The chamber may be located within the distal portions 132, 134 and may be configured to hold one or more actuating slides and / or one or more means (such as blades) for cutting tissue. For example, the distal portion 128 of the second body 104 ( Figure 2As shown, the distal portion 128 (with its top surface removed) is configured to receive a blade 126 for cutting tissue. In some instances, the distal portion 128 may include a pocket 135 configured to receive the blade 126 and prevent the blade 126 from contacting the patient's tissue during device insertion or during certain other surgical steps, such as staples. The distal portion 128 and the pocket (or chamber) 135 may protrude from the top surface 191 of the cartridge 106 such that the anvil 102 contacts the distal portion 128 when in the closed position, thereby forming a gap between the anvil 102 and the top surface 191 of the cartridge 106. By forming the gap between the anvil 102 and the top surface 191, this gap may provide sufficient space to one or more tissue layers. In some instances, the anvil 102 may include a recess (not shown) configured to receive the distal portion 128 of the second body 104 when the anvil 102 is in the closed position.

[0033] In some instances, the second body 104 may include a channel 136 supporting the cartridge 106. The channel 136 may extend along the second body 104 in a direction generally parallel to the central longitudinal axis of the endoscope 103. The cartridge 106 may contain a plurality of surgical fasteners (such as staples), and the fasteners may be deployed from the cartridge 106 under the influence of a driving force (such as a driving force supplied by an actuator that moves through or along the cartridge 106). A plurality of spaced longitudinal slots 122 in the cartridge 106 allow the staples to pass through the cartridge 106 and puncture tissue. In some instances, an actuating slide or mechanism, when actuated, is longitudinally movable from the distal end of the cartridge 106 and / or the second body 104 toward the proximal end, thereby contacting the fasteners within the cartridge 106 and pushing the fasteners through the longitudinal slots 122 to engage the fasteners with the tissue. In some instances, fasteners may be deployed from cartridge 106 in the same or similar manner as disclosed in U.S. Patent Application No. 62 / 812,538, filed March 1, 2019, entitled "Systems, Devices, and Related Methods for Fastening Tissue," the entire contents of which are incorporated herein by reference. The fastener may pierce the tissue and contact anvil 102 to attach the fastener to the tissue. In some instances, a single fastener may extend through each slot 122. Each fastener may be partially within the slot 122 prior to deployment to assist in alignment of the fastener with the slot 122. In some instances, different actuators may be required to actuate fasteners in different longitudinal rows within cartridge 106.

[0034] The cartridge 106 may also include a longitudinal slot or channel 124. The longitudinal slot 124 may be configured to receive and / or support a cutting tool, such as a blade 126 or other means for cutting tissue. The longitudinal slot 124 may be located in the center of the cartridge 106 and may extend longitudinally from a proximal portion of the cartridge 106 to a distal end. In some instances, an equal number of spaced longitudinal slots 122 may be located on each side of the longitudinal slot 124. The anvil 102 may include a longitudinally positioned recess (not shown) that aligns with the longitudinal slot 124 when the anvil 102 is in a closed position (e.g., when the anvil 102 is rotated such that the distal portion of the anvil 102 contacts the second body 104 and / or the cartridge 106, or when tissue is clamped between the anvil 102 and the body 104), and such recesses may be configured to receive a cutting tool (such as a blade 126 or other sharp cutting tool) within the longitudinal slot 124. The cutting tool can be actuated via an actuation wire or other mechanism to move the blade 126 proximally. The cartridge 106 can be fixedly coupled to the second body 104 or can be removed from the second body 104. In some instances, the cartridge 106 can be integrally formed in the second body 104. Actuation wires for actuation slides with deployable fasteners and / or for moving devices for removing tissue (such as the blade 126) can extend through one or more of the proximal elongated members 144 of the elongated bodies 110, 112 and / or the cartridge 106.

[0035] Figure 3An exemplary cartridge 106 is shown, comprising a slot 122, a longitudinal slot 124, a channel 152, a proximal elongated member 144, and a coupling protrusion 125. The channel 152 extends longitudinally through the cartridge 106 and is configured to receive an actuator for deploying fasteners from the slot 122. In some instances, each channel 152 may accommodate an actuator (such as an actuating slider) configured to move from a distal end of the cartridge 106 to a proximal end of the cartridge 106, thereby deploying fasteners as it moves proximally. For example, the actuating slider may be an element (such as a ramp or other component) configured to engage a fastener as the actuating slider moves in a proximal direction and extend in an upward direction through the longitudinal slot 122. The proximal elongated member 144 may be fixedly coupled to the cartridge 106 and may include one or more lumens. The proximal elongated member 144 may be configured to receive one or more actuation wires extending from the cartridge 106 to a proximal portion of the proximal elongated member 144. In some instances, the proximal elongated member 144 may be flexible and may be configured to bend to allow movement through a tortuous pathway through the patient's body. For example, the proximal elongated member 144 may include one or more articulated joints (not shown) that allow the proximal elongated member 144 to bend through a tortuous pathway. Suitable articulated joints may be any known joint in the field of medical devices (including endoscopic devices, such as endoscopes) that allow the device to be suspended. In some instances, the proximal end of the proximal elongated member 144 may include a reel-type handle or a wheel-shaped knob configured to deploy a fastener in the cartridge 106 by pulling or rotating the reel-type handle or wheel-shaped knob (e.g., actuating an actuating slider), but any suitable handle or actuator may be used. The cartridge 106 can be sized to fit within the working channel 116, allowing the user to move the cartridge 106 through the working channel 116 and attach the cartridge 106 to the second body 104. In some embodiments, the cartridge 106 can be replaceable to deploy additional stapling components without removing the endoscope and device 101 from the patient's body lumen.

[0036] The coupling protrusion 125 may be located at a distal portion of the cartridge 106 and may extend from a surface 190 on the opposite side of the second body 104 away from a surface 191 including a slot 122. The coupling protrusion 125 may be configured to be positioned within a recess 142 of the channel 136. In some embodiments, the coupling protrusion 125 may be configured to removably couple the cartridge 106 to the second body 104. The coupling protrusion 125 may include recesses 150, 151, which are configured to receive a protrusion 143 in the recess 142. The coupling protrusion 125 may extend from each side of the cartridge 106 (e.g., generally perpendicular to the central longitudinal axis of the endoscope 103) such that the coupling protrusion 125 is on each side of the channel 124, or the coupling protrusion 125 may extend only from one side of the channel 124. In some instances, the connecting protrusion 125 and / or recess 142 may be one or more of a boss, protrusion, pawl, fin, pin, hook, ball, notch, socket, recess, snap, tab, key, or constraint, or otherwise form a friction or interference fit. In some instances, the connecting protrusion 125 may be overmolded. The surface defining the recess 142 may be configured to deflect, bend, and / or flex as the connecting protrusion 125 moves within the recess 142 to provide a snap-fit ​​engagement between the recess 142 and the connecting protrusion 125.

[0037] Figures 4A to 4C A cross-sectional view of an exemplary coupling mechanism is shown, which can be used to engage a coupling protrusion 125 within a recess 142. Figure 4A In the middle, the connecting protrusion 125 of the casing 106 is inserted into the recess 142. For example... Figure 4B As shown, when the connecting protrusion 125 contacts the protrusions 401, 402 within the recess 142, the sidewalls / surfaces 404, 405 forming the recess 142 elastically deflect or expand outward from the central longitudinal axis of the recess 142 (via... Figure 4B (As indicated by the arrows) until the recesses 150, 151 are aligned with the protrusions 401, 402. Once the protrusions 401, 402 are positioned within the recesses 150, 151, the connecting protrusion 125 can be fully connected within the recess 142 to withstand the forces applied during the medical procedure and to remain within the recess 142. Figures 5A to 5C A cross-sectional view of an additional exemplary coupling mechanism is shown, which can be used to engage the coupling protrusion 125 within the recess 142 and is generally similar to... Figures 4A to 4C The connecting mechanism shown. Figures 5A to 5CIn this process, a portion of the material forming the channel 142 extends outward as the connecting protrusion 125 is inserted into the recess 142. The material forming the channel 142 may be biased such that the protrusions 501, 502 move or snap into the recesses 150, 151 to engage the connecting protrusion 125 within the recess 142. To position the connecting protrusion 125 within the recess 142 and thus engage the cartridge 106 to the second body 104 within the channel 136, the user may pull, push, rotate, or otherwise move the proximal elongated member 144, or use a separate tool inserted into the endoscope channel to engage the cartridge 106 to the second body 104. Similarly, the user may pull, push, rotate, or otherwise move the proximal elongated member 144 or use a separate tool to release the cartridge 106 from the second body 104. By providing a releasable coupling mechanism between the cartridge 106 and the second body 104, the user can exchange cartridges using the working channel 116 without removing the device 101 and endoscope 103 from a location inside the patient's body. This prevents irritation or injury to the patient during the procedure and reduces the overall duration of the procedure.

[0038] Before using the device 101 in surgery, the user can connect the device 101 to the endoscope 103 and position the proximal elongated member 144 together with the cartridge 106 within the working channel 116. In some instances, the user may first connect the first body 108 to the distal end 100 of the endoscope 103, and then position the proximal elongated member 144 within the working channel 116 and connect the cartridge 106 to the channel 136 of the second body 104. For use of the device 101, the cartridge 106 is positioned within the channel 136 to deploy fasteners from the cartridge 106. By first positioning tissue within the active area of ​​the device 101 between the anvil 102 and the second body 104, the user can use the device 101 to attach one or more fasteners to the tissue. Once the tissue is positioned within the active area of ​​the device 101, the user can actuate an actuator using one or more of the elongated bodies 110, 112 as described above, which can then cause the anvil 102 to close onto the tissue located within the active area. When the user holds the anvil 102 in the closed position (thus holding the retainer clasp of the stapler device to the tissue), the user can deploy one or more staples from the slot 122, for example, by pulling proximally on the actuator to translate an actuation wire coupled to an actuation slider in the cartridge 106 or the second body 104. As the actuation slider or mechanism translates proximally via the actuation wire, the actuator can push the fastener through the longitudinal slot 122 to pierce the tissue. As the fastener is deployed via the actuator, it can subsequently engage the anvil 102 and bind the tissue layers together. In some instances, the actuator can actuate an actuation wire coupled to both the actuation slider or mechanism and the cutting tool (such as the blade 126), and can simultaneously translate both the actuation slider and the cutting tool to pierce the tissue and secure and remove the tissue with one or more fasteners.

[0039] Figure 6A and Figure 6B A side view of a device 601, similar to device 101, is shown. Device 601 includes a cutting board 602, a first body 608, a second body 604, and a proximal elongated member 644 (not shown) of a cartridge, the proximal elongated member 644 extending through the second body 604. Figure 6A and Figure 6B As shown, when device 601 is attached to endoscope 603, proximal elongated member 644 can be fed rearward through working channel 610 of endoscope 603. Once first body 608 is attached to distal end of endoscope 603, distal front end face 620 can contact a portion of device 601.

[0040] Figure 7An alternative embodiment of a cartridge 706 and a proximal elongated member 761 is shown, the proximal elongated member 761 extending away from the working channel 716 of the distal end 700 of the medical device. The cartridge 706 may include a coupling protrusion 725 having any one or more features of the coupling protrusion 125. The surface of the cartridge 706 may include cuts, slots, ridges, or other features that increase the flexibility of the cartridge 706, thereby allowing the cartridge 706 to extend more easily through the channel 716. The cartridge 706 is coupling to the proximal elongated member 761 via a connector 763. The connector 763 may engage with the cartridge 706 and may be releasable via an actuator. In some instances, the connector 763 may include an overmolded feature 726 shaped like the cartridge 706, and the overmolded feature 726 may be cylindrical. In some instances, the overmolding feature 726 of the connector 763 can be overmolded into the shape of the cartridge 706 such that once the cartridge 706 is closed onto the tissue, the tension exerted by the operator on the entire assembly exceeds the material strength of the connector 763, and thus the elongated member 761 can be pushed into the material of the connector 763, which then releases the cartridge 706.

[0041] Figure 8 A perspective view of a portion of the second body 804 is shown, which is generally similar to the second body 104. A cartridge 806 is shown attached to the second body 804, and a blade 826 has been moved from a chamber within a distal portion 828 of the second body 804 into a channel 824 of the cartridge 806. The blade 826 is movable through the channel 824 to cut the patient's tissue before, during, or after the deployment of a fastener from the cartridge 806 into the patient's tissue. The blade 826 includes a proximal cutting edge 833 and a blunt or other non-traumatic distal cutting edge 835; the blunt or other non-traumatic distal cutting edge 835 prevents accidental cutting of tissue during operation (as the device moves distally).

[0042] Figure 9 A perspective view of an alternative embodiment of a second body 904 is shown, the second body 904 being used in a device generally similar to device 101. Figure 9 In this configuration, the cartridge 906 is located only on one side of the channel 924 and extends parallel to the channel 924. The channel 924 receives the blade 926 from a chamber or pouch 940 within the distal portion 928 of the second body 904. By providing the cartridge 906 only on one side of the channel 924, the user can remove tissue from the patient and secure or pin only one side of the cut tissue. Either the second body 804 or the second body 904 may incorporate and / or have any of the features previously described with respect to device 101.

[0043] Figure 10A and Figure 10BA perspective view of a portion of device 1001 is shown. Device 1001 may include any of the features previously described relative to device 101. Device 1001 may include a first body 1008, a second body 1004, a cartridge 1006, and a channel 1024. The cartridge 1006 includes a slot 1022 for fasteners, and the channel 1024 is configured to receive a knife 1026. The second body 1004 may include a channel 1036 configured to receive the cartridge 1006. A pair of flanges or shanks 1075, 1076 may extend from the surface defining the channel 1036 and may be flexible. The shanks 1075, 1076 may be configured to bend, allowing a user to slide the cartridge 1006 within the channel 1036, and the shanks 1075, 1076 will bend as the bottom surface 1080 of the cartridge 1006 moves distally and contacts the surface defining the channel 1036. When the recess 1078 in the bottom surface 1080 is aligned with the feet 1075, 1076, the feet 1075, 1076 can spring up and / or move into the recess 1078. The feet 1075, 1076 may include a curved distal portion 1077. Figure 11 (As shown). The curved distal portion 1077 can be configured to slide along the surface of the cartridge 1006 to facilitate positioning of the handles 1075, 1076 within the recess 1078 of the cartridge 1006. The curved distal portion 1077 can bend downward away from the channel 1036. In some embodiments, the curved distal portion 1077 can facilitate proximal movement of the cartridge 1006 by deflecting the handles 1075, 1076 downward away from the channel 1036 when the distal surface 1097 of the recess 1078 contacts the handles 1075, 1076 as the cartridge 1006 moves proximally. Edge protrusions 1070, 1071 can extend above the upper surface of the inserted cartridge 1006 into the distal portion of the channel 1036 to retain the cartridge 1006 within the channel 1036. For example, as the user moves the case 1006 to the distal side and positions the distal portion of the case 1006 below the edge protrusions 1070, 1071 (along... Figure 10B Line 11-11 is shown in sectional view. Figure 11In the middle section, the user can slide the cartridge 1006 within the channel 1036 and bend the handles 1075, 1076. The recess 1078 of the cartridge 1006 is positioned such that the handles 1075, 1076 are received by the recess 1078 when the distal portion of the cartridge 1006 is positioned below the edge protrusions 1070, 1071. The combination of the handles 1075, 1076 located within the recess 1078 and the edge protrusions 1070, 1071 on the cartridge 1006 retains the cartridge 1006 within the channel 1036. The recess 1078 of the bottom surface 1080 may include an inclined proximal surface 1096 and an inclined distal surface 1097, and the angle of the inclined distal surface 1097 may be set to be less than ninety degrees relative to the longitudinal axis of the cartridge 1006. In some instances, the inclined distal surface 1097 may be positioned at an angle relative to the longitudinal axis of the cartridge 1006, an angle greater than the angle relative to the longitudinal axis of the proximal surface 1096. The distal surface 1097 may be at a greater angle relative to the proximal surface 1096, such that a greater force is required to remove the cartridge 1006 from the channel 1036 of the second body 1004 (e.g., by moving the cartridge 1006 proximally) than the force required to insert the cartridge 1006 into the channel 1036 (e.g., to position the handles 1075, 1076 within the recess 1078 by moving the cartridge 1006 distally). An intermediate surface 1098 of the recess 1078 may be located between the proximal surface 1096 and the distal surface 1097, and the intermediate surface 1098 may be generally parallel to the longitudinal axis of the cartridge 1006.

[0044] like Figure 10B As shown, some embodiments of the device may include a blade 1026 positioned proximal to the distal end of the cartridge 1006, including proximal to some of the distal slots 1022 and associated fasteners. By positioning the blade 1026 proximal to the end of the cartridge 1006 and at an initial position proximal to the distal slots 1022 of the cartridge 1006, a user can staple the entire length of tissue cut by the blade 1026 as it moves proximal. For example, a user can hold tissue between the second body 1004 and an anvil (similar to anvil 102) to staple the tissue together, and then actuate the blade 1026 to move it proximal and cut a portion of the tissue adjacent to the stapled tissue without cutting beyond the distal end of the stapled tissue. Additionally, the distal anterior surface 1028 of the second body 1004 is distal to the blade 1026, and prevents the blade 1026 from contacting tissue when it is located at the distal end of the channel 1024. For example, the distal anterior surface 1028 may extend radially inward relative to the central longitudinal axis of the second body 1008, and in some instances may be angled to the edge of the blade 1026.

[0045] The aforementioned devices and apparatus can each be used for visualization, attachment, and / or cutting of tissue. In some instances, the user can load the proximal elongated member 144 of the cartridge 106 into the working channel of the endoscope by advancing the proximal elongated member 144 rearward through the distal end of the working channel to position a portion of the proximal elongated member 144 within the working channel. Once the proximal elongated member 144 is positioned within the working channel, the handle assembly or actuation assembly can be coupled to the proximal end of the proximal elongated member 144. In other instances, the user can move the cartridge 106 and the proximal elongated member 144 from the proximal portion of the endoscope 103 through the working channel 116, and can engage the cartridge 106 to the second body 104 by moving the proximal portion of the proximal elongated member 144 to move the cartridge 106 within the channel 136 and engage the protrusion 125 within the recess 142. The user can then introduce the endoscope 103 into the patient's body and move the endoscope 103 toward the target area. By utilizing an image sensor to directly visualize the target area, the user can use an endoscope to locate the target area (such as a tumor or other lesion tissue) within a patient's body cavity. When the distal end of the endoscope is positioned at the target area, the user can actuate device 101 to move anvil 102 to an open position, thereby creating a space between the anvil 102 and the second body 104 of the stapler. The user can then move tissue from or near the target area between or close to the moving portions of device 101 (e.g., the space between the anvil 102 and the second body 104 of the stapler device). The user can use a tissue acquisition device (such as a gripper located within the working channel 116 of endoscope 103) to pull the tissue into the moving portion of device 101. Once the tissue is within the moving portion of the stapler device, the user can move the anvil 102 of the stapler device to a closed position, and the device 101 clamps the grasped tissue. The user can then actuate an actuator to pull the actuation wire, thereby moving the actuation slider of the device proximally. By moving the actuating slider or mechanism proximally via an actuator, the user can deploy the fastener from the cartridge 106 into the held tissue and abut against the anvil 102. In some instances, the user can actuate the blade 126 in the device 101 to cut multiple portions of the target tissue before or after the tissue is secured together via the fastener.

[0046] An endoscopic stapler device according to an exemplary embodiment includes a fastener cartridge that can be removed and replaced during surgery via the working channel of the medical device. Using such a device reduces the duration of surgery and limits patient irritation and / or injury caused by repeated removal and insertion of the medical device into the patient (due to the need to replace the fastener cartridge of the stapler). Endoscopic stapler fixation can be particularly useful in endoscopic, outpatient procedures. The scope of this disclosure is defined by the appended claims and does not address the specific problems.

[0047] It will be apparent to those skilled in the art that various modifications and alterations can be made to the disclosed apparatus and methods without departing from the scope of this disclosure. Other aspects of this disclosure will be apparent to those skilled in the art in light of the practice of the specification and the features disclosed herein. This specification and examples are provided for illustrative purposes only.

Claims

1. A medical system comprising: Medical devices with a working channel; as well as Fastening device, the fastening device comprising: Case retainer; Anvil plate pivotally connected to the cartridge retainer; A flexible member extending through the working channel of the medical device; and A fastener cartridge connected to the distal end of the flexible member, wherein the fastener cartridge includes at least one fastener and a protrusion, and wherein the cartridge retainer includes a recess configured to receive the protrusion.

2. The system according to claim 1, wherein, The protrusion has a first recessed portion and a second recessed portion, and the recessed portion has a first raised portion and a second raised portion.

3. The system according to claim 2, wherein, The recess is configured to receive the protrusion such that a first protruding portion of the recess is received within a first recessed portion of the protrusion, and a second protruding portion of the recess is received within a second recessed portion of the protrusion.

4. The system according to claim 3, wherein, The recess is a first recess, the protrusion of the fastener box is a first protrusion, wherein the fastener box further includes a second protrusion, and the box retainer further includes a second recess configured to receive the second protrusion.

5. The system according to any one of claims 1 to 4, wherein, The fastener cartridge is removed by moving it proximally using the flexible member.

6. The system according to claim 1, wherein, The fastening device also includes a coupling body that connects the fastening device to the outer surface of the shaft of the medical device.

7. The system according to claim 6, wherein, Disconnecting the fastener box from the box retainer will cause the flexible member to detach from the coupling body.

8. The system according to claim 6 or 7, wherein, The flexible member and the fastener box are configured such that, after the fastener box is detached from the box retainer, it can move proximally through the working channel.

9. The system according to claim 6 or 7, wherein, The protrusion is located on the distal portion of the cartridge retainer, wherein the protrusion is configured to contact the anvil as the anvil moves toward the cartridge retainer to prevent the anvil from moving toward the cartridge retainer and to leave space between the fastener cartridge and the anvil.

10. The system according to claim 6 or 7, wherein, The flexible member is a first flexible member, and the fastening device further includes: A second flexible member, connected to the connecting body and configured to extend to a proximal portion of the medical device; and An actuation line extends through the second flexible member, wherein the actuation line is configured to move the anvil toward and / or away from the cartridge retainer.

11. The system of claim 1, further comprising a blade for cutting tissue, wherein the blade is configured to move from a chamber within the cartridge holder through a channel in the fastener cartridge.

12. The system according to claim 1, wherein, The fastener case includes a plurality of openings for deploying fasteners, wherein the protrusion is located on the fastener case on a side opposite to the plurality of openings.

13. The system according to claim 11 or 12, wherein, The blade is configured to move proximally from the chamber at the distal portion of the cartridge retainer, wherein as the blade moves proximally, it is positioned adjacent to the fastener cartridge of the cartridge retainer.

14. The system according to claim 1, wherein, The fastening device includes: Channel, the channel being used to receive the fastener box; and At least one handle, the at least one handle extending into the channel.

15. The system according to claim 14, wherein, The fastener case includes at least one recess configured to receive the at least one shank, wherein when the fastener case is coupled to the case retainer, the at least one shank is positioned within the at least one recess.

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