Systems, devices, and related methods for fastening tissue

Abstract

A medical device is disclosed that includes an end effector having an upper arm including a first plurality of teeth and a second plurality of teeth; a lower arm including a third plurality of teeth, a fourth plurality of teeth, and an anvil. The third plurality of teeth can be located on a first lateral side of the anvil and the fourth plurality of teeth can be located on a second lateral side of the anvil. A cartridge can be positioned in a cavity of the upper arm such that the first plurality of teeth can be located on a first lateral side of the cartridge and the second plurality of teeth can be located on the second lateral side of the cartridge. Further, a shaft can be coupled to the end effector; and an operating portion can be coupled to the shaft.

Description

Cross-references to related applications

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 594,775, filed October 31, 2023, the entire contents of which are incorporated herein by reference. Technical Field

[0002] This disclosure generally relates to tissue closure. More specifically, at least some embodiments of this disclosure relate to a suturing device or system, such as an endoscopic suturer, and related methods of using the suturing device or system. Background Technology

[0003] Endoscopic surgery typically involves indirect visualization of the surgical field through the insertion of an endoscope or similar device via an incision or natural anatomical opening. Endoscopes are usually long, flexible tubes that include a light conductor and one or more channels for inserting medical devices. Endoscopes provide a platform for employing various tools as end effectors, such as devices for grasping and suturing tissue within the body. For example, auxiliary devices, such as graspers, can be used to grip tissue, and suturers can be used to secure tissue. Summary of the Invention

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

[0005] In one example, a medical device may include an end effector having an upper arm including a first plurality of teeth and a second plurality of teeth; a lower arm including a third plurality of teeth, a fourth plurality of teeth, and an anvil. The third plurality of teeth may be located on a first lateral side of the anvil, and the fourth plurality of teeth may be located on a second lateral side of the anvil. The second lateral side of the anvil may be opposite to the first lateral side of the anvil; and a cartridge may be positioned in a cavity of the upper arm such that the first plurality of teeth are located on the first lateral side of the cartridge, and the second plurality of teeth are located on the second lateral side of the cartridge, such that the second lateral side of the cartridge is opposite to the first lateral side of the cartridge. Furthermore, a shaft may be coupled to the end effector; and an operating portion may be coupled to the shaft.

[0006] Any of the aspects disclosed herein may individually or in any combination include any of the following features: A cable may be coupled to an upper arm, the cable being configured to rotate the upper arm; and a tube may be coupled to a carriage received within a cartridge, the carriage being configured to deliver stitches; wherein at least a portion of the cable is disposed within the tube. The cable may be coupled to a trigger of an operating part. The tube may be coupled to a slider of an operating part. The distal portion of the upper arm may include a protrusion; and the distal portion of the lower arm includes a recess configured to mate with the protrusion. Each of the third and fourth plurality of teeth of the lower arm may include a plurality of ridges and a plurality of recesses, such that the plurality of recesses are recessed relative to the surface of the anvil. The surface of the anvil may be planar. The upper surfaces of the third and fourth plurality of teeth may be substantially flush with the surface of the anvil. Each of the first and second plurality of teeth may include a plurality of ridges and a plurality of recesses. When the end effector is in a closed configuration, the lower surfaces of the plurality of ridges of the first and second plurality of teeth may be located below the surface of the anvil. The upper surfaces of the plurality of recesses of the first plurality of teeth and the plurality of recesses of the second plurality of teeth of the upper arm can be substantially flush with the anvil in the closed configuration. The third plurality of teeth and the fourth plurality of teeth can be arranged substantially linearly. The lower arm may further include a first distal tooth located distal to the first plurality of teeth and a second distal tooth located distal to the second plurality of teeth. The first distal tooth and the second distal tooth can be disposed on a curved surface between the lateral side surface and the distal surface of the lower arm. The first plurality of teeth and the second plurality of teeth can extend downward from the surface of the upper arm defining the cavity. The cavity may have an open proximal end for slidably receiving a cartridge or an open distal end for slidably receiving a cartridge. The cavity may have a first stepped portion, and the cartridge may have a second stepped portion configured to mate with the first stepped portion.

[0007] In another aspect, a medical device may include: an end effector having an upper arm including a first plurality of teeth; a lower arm including a second plurality of teeth and an anvil; and a cartridge positioned in a cavity of the upper arm; and a shaft coupled to the end effector, the shaft including: a cable coupled to the upper arm configured to rotate the upper arm; and a tube coupled to a carriage received within the cartridge, the carriage being configured to deliver suture staples. The cable may be at least partially disposed within the tube and includes an operating portion coupled to the shaft.

[0008] Any of the aspects disclosed herein may include, individually or in any combination, any of the following features: The cavity may have an open proximal end for slidably receiving a cartridge, or the cavity may have an open distal end for slidably receiving a cartridge.

[0009] In yet another example, a medical device may include: an end effector having an upper arm including a first plurality of teeth; and a lower arm including a second plurality of teeth and an anvil. The second plurality of teeth may include a plurality of ridges and a plurality of recesses. The plurality of recesses may be recessed relative to the surface of the anvil. The end effector may also include: a cartridge positioned in a cavity of the upper arm; a shaft coupled to the end effector; and an operating portion coupled to the shaft.

[0010] Any of the aspects disclosed herein may individually or in any combination include any of the following features. The surface of the anvil may be planar, and the upper surface of the second plurality of teeth may be substantially flush with the surface of the anvil. The first plurality of teeth may include: a plurality of ridges and a plurality of recesses. When the end effector is in a closed configuration, the lower surfaces of the plurality of ridges of the first plurality of teeth may be located below the surface of the anvil. Attached Figure Description

[0011] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary aspects of this disclosure and, together with the description, serve to explain the principles of this disclosure.

[0012] Figure 1 An exemplary medical device according to one or more embodiments is depicted.

[0013] Figure 2 A cross-section of a catheter of an exemplary medical device according to one or more embodiments is depicted.

[0014] Figure 3A and Figure 3B The distal portion of the medical device in a first configuration according to one or more embodiments is depicted in side view and perspective view, respectively.

[0015] Figure 4A and Figure 4B A perspective view of the distal portion in a first configuration and a second configuration according to one or more embodiments is depicted.

[0016] Figure 5A A partially transparent view of the distal portion in a second configuration according to one or more embodiments is depicted.

[0017] Figure 5B A partially transparent view of the bin and carriage on the far side according to one or more embodiments is depicted.

[0018] Figure 5C A perspective view of the distal portion according to one or more embodiments is depicted.

[0019] Figure 6A A partially transparent view of the bin and carriage on the far side according to one or more embodiments is depicted.

[0020] Figure 6B A perspective view of the distal portion according to one or more embodiments is depicted. Detailed Implementation

[0021] During surgical procedures, precision end effectors are crucial for ensuring safe, efficient, rapid, and successful outcomes. Furthermore, the time and effort required to change appendages during surgery can prolong the procedure and complicate it. A single appendage with multiple functions can reduce the need for multiple devices, thereby shortening surgical time and reducing surgical complexity.

[0022] This disclosure relates to systems, apparatus, and methods for grasping and suturing tissue. Reference will now be made in detail to various aspects of this disclosure, examples of which are shown in the accompanying drawings.

[0023] Where possible, the same or similar reference numerals will be used in all accompanying figures to refer to the same or similar parts. The term "distal" refers to the part further away from the user when the device is introduced into the subject's body. Conversely, the term "proximal" refers to the part closer to the user when the device is placed in the subject's body. Orientation, such as "up," "down," "top," "bottom," "left," "right," etc., refers to the orientation as shown in the accompanying figures, even where the device can be reoriented.

[0024] The foregoing general description and the following detailed description are exemplary and explanatory only, and are not intended to limit the features as claimed. As used herein, the terms “comprising,” “including,” “having,” “containing,” “comprise,” or other variations thereof are intended to cover non-exclusive inclusion, such that a process, method, article, or apparatus that includes a list of elements may include not only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. Additionally, the term “exemplary” is used herein in the sense of “example” rather than “conventional.” As used herein, the terms “about,” “substantially,” and “approximately” indicate a numerical range within + / - 10% of the stated value, unless otherwise stated.

[0025] This disclosure provides a medical device comprising a tissue gripper having two arms forming a jaw-like structure. The tissue gripper may be an end effector for gripping and manipulating tissue and other target objects. Manipulation may include, but is not limited to, clamping and suturing. The arms of the end effector may be rotatably connected to each other to allow the arms to move between open and closed configurations. The proximal portions of one or both arms may be operatively connected to one or more control members. The control members may extend through an elongated member (e.g., a shaft) from the end effector located at the distal end of the device to an end effector actuator or other type of controller present at its proximal end. Activating the actuator actuates the end effector to achieve opening and closing of the arms, etc. The two arms may be distinguished as an "upper" arm and a "lower" arm. The handle may also include another actuator to deploy a suture staple from the end effector into the tissue. Various exemplary configurations of the actuation, structure, and function of the end effector are described in embodiments of this disclosure. It should be understood that any of the aspects disclosed herein may be used alone or in any combination or sub-combination.

[0026] The aspects disclosed herein may include a handle, a flexible filament, and an end effector (e.g., a stitcher head). The end effector may include a carriage comprising a slider (e.g., a ramp assembly). The carriage may be coupled to one or more wires or wire segments, allowing the carriage to be actuated proximally and / or distally. The handle or other operating portion may include actuators for opening / closing the end effector, actuating the carriage, the hinge axis, and / or rotating the end effector about the longitudinal axis of the device, etc.

[0027] Figures 1 to 6B Aspects of an exemplary medical device 100 that can be used to suture tissue of a subject are illustrated. In some embodiments, the medical device 100 may be a surgical suturing instrument configured to engage body tissue and apply one or more surgical fasteners (e.g., sutures) to it during minimally invasive surgical procedures, such as endoscopic procedures. The medical device 100 may be used to apply other fasteners (e.g., clips, elastic bands, sutures, etc.), but will primarily be discussed in the context of applying suture staples. Fasteners may be used to fasten components (e.g., to suture, fix, attach, secure, or otherwise combine two or more portions of tissue).

[0028] In particular, such as Figure 1 As shown, the medical device 100 may include a handle 110 (operating part), a shaft 200, and an end effector 300. Figure 1Details of shaft 200 are depicted above the illustration of device 100 to show the relative positions of components of shaft 200 with respect to handle 110. As described below, handle 110 may include one or more actuators for actuating aspects of shaft 200 and / or end effector 300. Handle 110 may include body 112 and various actuators for controlling aspects of shaft 200 and / or end effector 300. For example, handle 110 may include trigger 114, which may be a first actuator movable relative to body 112. Handle 110 may also include slider 120 (e.g., spool), which may be a second actuator movable relative to body 112. Handle 110 may also include other actuators, such as lugs, knobs, levers, or other actuators. Although ordinal numbers such as “first,” “second,” etc., are used herein to describe the actuators of handle 110, it should be understood that such terms are for reference only, and any filler words may be applied to any of the actuators. Furthermore, the types of actuators described herein are merely exemplary, and any alternative types of actuators may be used. Figures depicting various aspects of the handle 110 may omit certain features in order to depict details relevant to a particular actuator or other aspect of the handle 110.

[0029] Trigger 114 may be coupled to cable 202 or other actuation / control components. For example, trigger 114 may be coupled to cable 202 via a linkage. The linkage may be integrally formed with cable 202 (formed as a single integral piece), or it may be coupled to a separate component / component of cable 202. Trigger 114 may alternatively be directly coupled to cable 202. Although the term “cable” is used herein to describe various structures, it should be understood that these structures may be other types of control / actuation mechanisms (e.g., wire, slider, linkage, bar, etc.). Furthermore, any of the cables disclosed herein may be a segment that can be combined with other control components of the same or different types. Cable 202 may be formed of metal or other suitable strong and flexible materials, although not shown. A user may squeeze trigger 114 toward body 112 (e.g., proximally), thereby moving the linkage and cable 202 proximally (applying tension to cable 202). As discussed below, proximal movement of cable 202 may actuate end effector 300.

[0030] The slider 120 is movable in a direction substantially coaxial with or parallel to the central longitudinal axis of the handle 110. The slider 120 may be coupled to a tube 204 (e.g., an intermediate tube), which will be discussed in more detail below. Although the term "tube" is used herein, it should be understood that the term includes structures such as coils, rings, multi-cavity extrusions, hyaluronic acid tubes, etc. The tube 204 may be formed of metal or other suitable strong and flexible materials, such as polymers. The tube 204 may include slits (e.g., laser cuts) 204B to increase the flexibility of the tube 204.

[0031] Axis 200 can be any suitable endoscopic component configured to bend and / or hinge to pass through tortuous anatomical structures within the body. Axis 200 may include an outer tube 206 formed of one or more biocompatible materials, such as, for example, HDPE, silicone, polyurethane, ETFE, SIBS, PIB-PUR, or any other suitable medical-grade polymer, and may be flexible and configured to extend through tortuous anatomical structures. Axis 200 may extend to any length suitable for endoscopic or laparoscopic surgery and may be configured to be positioned within the working channel of an endoscope. Alternatively, axis 200 may be positioned within the body without the use of an endoscope. Although references to endoscopes are made herein, references to endoscopes or endoscopic procedures should not be construed as limiting the possible applications of the disclosed aspects. For example, the disclosed aspects may be used with duodenoscopy, bronchoscopy, ureteroscopy, colonoscopy, laparoscopy, catheters, diagnostic or therapeutic instruments or devices, or other types of medical devices.

[0032] like Figure 1 and Figure 2 As shown, the internal cable 202, intermediate tube 204, and outer tube 206 can be telescopically formed and can extend different distances in the proximal direction. The internal cable 202 extends the furthest proximally of the three, extending to the trigger 114 within the body 112 of the handle 110 (made by...). Figure 1 The intermediate tube 204 (indicated by position 202A) is connected to the trigger 114 so that it can be actuated by the trigger 114 (e.g., via a linkage, as discussed above). The intermediate tube 204 extends proximally to the slider 120 and is actuated by the slider 120. The position of the intermediate tube 204 connected to the slider 120 is determined by... Figure 1 Position 204A is indicated in the middle. The outer tube 206 includes internal channels (e.g., cavities) for actuator elements, such as cable 202 and intermediate tube 204. Figure 2 As shown, the inner cable 202 is positioned within and surrounded by the intermediate tube 204, and the intermediate tube 204 is correspondingly positioned within and surrounded by the outer tube 206, with small gaps between each respective element allowing the cable 202 to move longitudinally relative to the tube 204. Similarly, the tube 204 is positioned within and surrounded by the outer tube 206. The outer tube 206 may terminate at the distal portion of the handle at position 206A. The shaft 200 extends from the handle 110 to the end effector 300, wherein the actuator cables (cable 202 and tube 204) actuate elements in the end effector 300.

[0033] Figure 3AThe end effector 300 is depicted in a side view in a first configuration, where the end effector is open, thereby separating the upper arm (upper jaw 300A) from the lower arm (lower jaw) 300B. Figure 3A and Figure 3B In the example shown, the end effector 300 is configured to perform gripping and sewing. The upper arm 300A and / or the lower arm 300B may be coupled to cable 202. The upper arm 300A and / or the lower arm 300B can be actuated by operating trigger 114 to rotate, which can translate cable 202 (e.g., move cable 202 proximally or distally). For example, proximal movement of cable 202 can rotate the upper arm 300A and / or the lower arm 300B to an open position, and distal movement of cable 202 can rotate the upper arm 300A and / or the lower arm 300B to a closed position. In some examples, cable 202 may be coupled only to the upper arm 300A to rotate the upper arm 300A while the lower arm 300B remains stationary. Alternatively, both the upper arm 300A and the lower arm 300B may be coupled to cable 202 (e.g., via a linkage) and thereby rotate. Rotation of the upper arm 300A and / or the lower arm 300B can be achieved by any mechanism known in the art (e.g., linkage, etc.).

[0034] The upper arm 300A includes one or more upper teeth 310A disposed on the lateral side of the upper arm 300A. In some embodiments, the upper teeth 310A may be disposed on the periphery of the upper arm 300A, including on the lateral side of the upper arm 300A. The teeth 310A include a series of ridges 312A and grooves 314A of suitable dimensions. For example, in some embodiments, the teeth 310A may have a height in the range of 0.0040 to 0.0100 inches, and a width of 0.0030 to 0.0036 inches, as measured from the top of one of the ridges 312A to the adjacent ridge 312A. Figure 3A and Figure 3BAs shown, the ridge of tooth 310A can have a rounded "V" shape or a "U" shape with tapered sides. Alternatively, in other embodiments, the ridge can be rectangular, semi-circular, or a combination of shapes. Tooth 310A may include a first set of teeth 3102A (having corresponding ridges and grooves) on a first side of the central longitudinal axis of upper arm 300A and a second set of teeth 3104A on a second opposite side of the central longitudinal axis of upper arm 300A. In some aspects, the first set of teeth 3102A and the second set of teeth 3104A may be symmetrical about each other about the central longitudinal axis of upper arm 300A. The first set of teeth 3102A and the second set of teeth 3104A may extend substantially linearly parallel to the central longitudinal axis of upper arm 300A. In some aspects, the distal ridges 3106A and 3108A of each of the first set of teeth 3102A and the second set of teeth 3104A may be located on a curved surface between the respective lateral side surface of the upper arm 300A and the distal end of the upper arm 300A. Although the distal ridges 3106A and 3108A may be considered as part of the first set of teeth 3102A and the second set of teeth 3104A, they may also be alternatively considered as separate from the first set of teeth 3102A or the second set of teeth 3104A. In some examples, each ridge of the first set of teeth 3102A and the second set of teeth 3104A may have the same height. Alternatively, the ridges may have different heights.

[0035] The lower arm 300B also includes lower teeth 310B. In some embodiments, the lower teeth 310B may be arranged on the periphery of the lower arm 300A, including on the lateral side of the lower arm 300A. The teeth 310B include a series of ridges 312B and grooves 314B of suitable size, and are configured to correspond to the teeth 310A such that they are in a closed configuration (see [link to documentation]). Figure 4B The ridge 312B of the lower tooth 310B is inserted into the groove 314A of the upper tooth 310A, and the ridge 312A of the upper tooth 310A is inserted into the groove 314B of the lower tooth 310B, such that when the jaws of the upper arm 300A and the lower arm 300B are closed, the teeth 310A and 310B mesh with each other. The ridge 312B and the groove 314B may have any of the features of the ridge 312A and the groove 314A discussed above (e.g., shape, etc.). The ridge 312B may be parallel to each other on any axis (e.g., along the longitudinal axis).

[0036] The tooth 310B may include a first set of teeth 3102B (having corresponding ridges and grooves) on a first side of the central longitudinal axis of the lower arm 300B and a second set of teeth 3104B on a second opposite side of the central longitudinal axis of the lower arm 300B. In some aspects, the first set of teeth 3102B and the second set of teeth 3104B may be symmetrical about each other about the central longitudinal axis of the lower arm 300B. The first set of teeth 3102B and the second set of teeth 3104B may extend substantially linearly parallel to the central longitudinal axis of the lower arm 300B. In some aspects, the distal ridges 3106B, 3108B of each of the first set of teeth 3102B and the second set of teeth 3104B may be located on the end of the distal surface of the lower arm 300B or on a curved surface that joins the transverse surface of the lower arm 300B to the distal surface of the lower arm 300B. Although the distal ridges 3106B and 3108B can be considered as part of the first group of teeth 3102B and the second group of teeth 3104B, they can also be alternatively considered as separate from either the first group of teeth 3102B or the second group of teeth 3104B. In some examples, each ridge of the first group of teeth 3102B and the second group of teeth 3104B can have the same height. Alternatively, the ridges can have different heights.

[0037] Especially in Figure 6B As shown and discussed below, the upper arm 300A may include a protrusion 342 located on the distal end 346 of the upper arm 300A. The lower arm 300B may include a corresponding recess 344 located on the distal end 348 of the lower arm 300B. The protrusion 342 may resemble a tooth and may function as a tooth. The protrusion 342 and the recess 344 may extend along all or most of the distal ends 346 and 348, respectively. When the end effector 300 is in a closed configuration, for example, as Figure 6B As shown, the protrusion 342 can be received in the recess 344, such that the lower surface of the protrusion 342 contacts or approaches the surface of the recess 344.

[0038] like Figure 3B As shown, the upper arm 300A includes a cavity 340 for receiving a staple cartridge 320 disposed between a first set of teeth 3102A and a second set of teeth 3102B. The staple cartridge 320 may have staples 322 disposed therein. Figure 5A , Figure 5B and Figure 6A ).like Figure 3B As shown, the upper teeth 310A may extend downward (towards the lower arm 300B) beyond the lower surface of the staple cartridge 320. In some examples, the upper surface of the recess between the ridges of the upper teeth 310A may be approximately flush with the lower surface of the staple cartridge 320.

[0039] The lower arm 300B includes a flat surface (e.g., a level surface) forming the anvil 330. The anvil 330 may include a recess 332 for receiving the suture staple 322. The anvil 330 may be positioned between a first set of lower teeth 3102B and a second set of lower teeth 3104B, and its lateral sides are surrounded by lower teeth 310B. In some examples, particularly as shown... Figure 3B As shown, the upper surface of the ridges of the lower tooth 310B can be approximately flush with the flat top surface of the anvil 330. The lower arm 300B can be formed as a single integral part with the lower tooth 310B and the anvil 330, both formed from a single piece of material. Recesses between the ridges of the lower tooth 310B can be formed in the surface of the lower arm 300B, which is either a lateral side of the anvil 330.

[0040] Therefore, teeth 310A and 310B may be formed only on the periphery of the upper arm 300A and lower arm 300B, respectively. The central portions of the upper arm 300A and lower arm 300B, which define the receiving compartment 320 and anvil 330, respectively, may not have teeth 310A and 310B. Similarly, the protrusions 342 and recesses 344 of the distal ends 346 and 348 may be located on the distal portions of the periphery of the upper arm 300A and 310B, respectively. The compartment 320 / cavity 340 may terminate proximally to the protrusion 342, and the anvil 330 may terminate proximally to the recess 344.

[0041] Figure 4A and Figure 4B Each depicts a first open state according to one or more embodiments. Figure 4A ) and second closed form ( Figure 4B A perspective view of the end effector 300 in [the image / structure]. In the first configuration, the upper arm 300A rotates away from the lower arm 300B, as shown... Figure 3A and Figure 3B As shown. In the second configuration, the upper arm 300A is generally parallel to the lower arm 300B, and one or more portions of the upper arm 300A and the lower arm 300B (e.g., teeth 310A, 310B) can contact each other. The staple cartridge 320 is located inside the cavity 340 and rotates with the upper arm 300A between the first and second configurations.

[0042] The staple cartridge includes staples 322 (e.g.) Figure 3A and Figure 3B (As shown) and carriage 324. Carriage 324 can be slidably received within slot 326 to actuate the suture staple. Slot 326 is in fluid communication with cavity 340. Carriage 324 can have any of the properties of any carriage known in the art for suture staple actuation. For example, as Figure 5BAs shown, the carriage 324 may be wedge-shaped. The carriage 324 may be connected to the tube 204 via a connector 2040, or may be integrally formed with the tube 204, such that the actuating slider 120 (e.g.) Figure 1 (As shown) This will cause tube 204 to move proximally or distally, and thus cause carriage 324 to move axially along slot 326. Connector 2040 may be a linkage that transmits actuation of tube 204 to carriage 324. When carriage 324 moves axially, carriage 324 may interact with suture staple 322, thereby discharging suture staple 322 from cartridge 320. Actuation of slider 120 may be optionally disabled in the first open configuration, such that suturing action occurs only when end effector 300 is in position. Figure 3B This is available in the second closed configuration shown. In the second configuration, where the upper arm 300A contacts the lower arm 300B, one or more recesses 332 on the anvil 330 facing the lower arm 300B discharge the discharged staples. The recesses 332 can interact with the staples 322 to push the arm of the staples 322 and close the staples 322. This is discussed below. Figure 5A and Figure 5B In the view, the suture pin 322 is shown as if it has been ejected and closed by interacting with the recess 332.

[0043] exist Figure 3B In the second closed configuration shown, the upper tooth 310A engages with the lower tooth 310B, and the lateral sides of the reservoir 320 and anvil 330 are surrounded by engaging or mating teeth 310A, 310B. The protrusion 342 may engage with a recess 344 on the distal side of the reservoir 320 and anvil 330. In operation, the user can actuate the trigger 114 to grasp tissue or another object through the mating teeth 310A, 310B (and the mating protrusion 342 and recess 344). Once the tissue or object is grasped, the user can actuate the slider 120 to eject the suture staple from the reservoir 320 through the tissue or object onto the anvil 330. The recess 332 on the anvil 330 can be configured to shape the suture staple into the desired form for proper suturing, such as a B-shape, etc. Figure 5A and Figure 5B As shown and discussed below.

[0044] Figure 5A A partial transparent view of the upper arm 300A of an end effector 300 in a second configuration according to one or more embodiments is depicted. In this view, the cartridge 320 is visible, with the anastomotic staples 322 ejected and formed in a B-shape. The bottom edge of the staples 322 curves upward through a recess 332 formed in the anvil 330. In the second configuration, the surface of the anvil 330 may be flush with the upper surface of the ridges of the lower teeth 310B and the upper surface of the recess located between the ridges of the upper teeth 310A.

[0045] Figure 5B A transparent view of a compartment 320 according to one or more embodiments is depicted, wherein a carriage 324 is positioned within the compartment 320. Figure 5B In the middle, the carriage 324 stops at the proximal end of the compartment 320, wherein after the delivery of the suture staple 322, the carriage 324 has retracted proximally. Before the delivery of the suture staple 322, the slide 120 ( Figure 1 As the slide 324 moves axially to the distal side, the slide 324 connected to the tube 204 is pushed toward the distal end of the compartment 320, thereby traveling within the slot 326. As discussed below, this distal movement of the slide 324 can deliver the stitch 322.

[0046] The carriage 324 includes a central body 324A, a protruding lug 324B, a central inclined portion 324C on the distal end face of the central body 324A, and transverse bodies 324E extending from two transverse sides of the central body 324A. The transverse bodies 324E may include a distal end face having a transverse inclined portion 324D. As the carriage 324 moves distally within the slot 326, the central inclined portion 324C and / or the transverse inclined portion 324D contact the stitching staple 322 and, with a stitching action, push it downward toward the anvil 330 into the compartment 320. Figure 5B As shown, after delivery, the carriage 324 can retract proximally. For example, the slide 120 can be biased proximally by a spring or other structure, such that the carriage 324 is held in the proximal position until the user needs to deliver the suture staple 322, and after the suture staple is delivered, the carriage 324 returns to the biased proximal position.

[0047] Figure 5CThe process of loading and unloading a cartridge 320 into and from the upper arm 300A of an end effector 300 is depicted. The upper arm 300A of the end effector 300 includes a cavity 340 for receiving the cartridge 320. The cavity 340 may have an open proximal end and a closed distal and lateral side. The cartridge 320 (and carriage 324) may be inserted into the proximal opening of the cavity 340 (which may be located on the proximal end of the upper arm 300A) and advanced toward the distal end of the cavity 340. In some examples, the carriage 324 may be inserted into the cartridge 320 before the cartridge 320 is loaded into the cavity 340. In other examples, the carriage 324 may be non-removably coupled to the cartridge 320 and may be removably coupled to the tube 204 (e.g., via control member 2040). Cavity 340 may include a stepped portion 352, and cartridge 320 may include a corresponding stepped portion 354 for engaging within the stepped portion 352 to secure cartridge 320 to end effector 300. For example, stepped portions 352 and 354 may extend laterally outward from the center portions of cavity 340 and cartridge 320, respectively. A protruding lug 324B assists the user in loading carriage 324 into cartridge 320 and in retaining cartridge 320 within cavity 340. In some examples, staples may be preloaded into cartridge 320. Staples 322 may be arranged in two parallel rows in the axial direction, such as... Figures 5A to 5C As shown, or they can be arranged in other forms, such as perpendicular to the axial direction and parallel to each other, or arranged in a single row in the axial direction.

[0048] Figure 6A A transparent view depicting another exemplary cartridge 320' and an alternative carriage 324' is shown. The carriage 324' includes a central body 324A', a protruding lug 324B', a centrally inclined portion 324C' on the distal surface of the central body 324A', and a laterally inclined portion 324D' extending from either side of the centrally inclined portion 324C'. Unless otherwise specified herein, the cartridge 320' may have any of the features of the cartridge 320. In some embodiments, the carriage 324' performs a sewing function by conveying a suture staple 322 traveling from the distal end of the cartridge 320' toward the proximal end of the cartridge 320'. Therefore, the carriage 324' can actuate the suture staple by moving in a direction opposite to the carriage 324. Figure 6A In this configuration, the suture pin 322 is shown in an unactuated, generally rectangular shape, with the carriage 324' located at the distal end of the housing 320'. As the carriage 324' passes over the suture pin 322 within a slot 326' in the housing 320', the suture pin is ejected or deployed via contact achieved from inclined portions 324C' and 324D'. The slot 326' is in fluid communication with the cavity 340'. In such an example, the slide 120 ( Figure 1It can be biased distally rather than proximally, and the proximal movement of the slider 120 can deliver the suture staple 322.

[0049] Figure 6B The description of the requirements according to one or more embodiments Figure 6A An isometric view of the end effector 300' used in conjunction with the housing 320'. Unless otherwise specified herein, the end effector 300' may have any of the properties of the end effector 300. Figure 6B The diagram illustrates loading a cartridge 320' into the upper arm 300A' of an end effector 300'. The upper arm 300A' of the end effector 300' may include a cavity 340' for receiving the cartridge 320'. The cavity 340' may have an open distal end and a closed lateral end and / or proximal end. The cartridge 320' and carriage 324' may be inserted into the open distal end of the cavity 340' and advanced toward the proximal end of the cavity 340'. In some examples, the carriage 324' may be removably coupled to the cartridge 320'. In other examples, the carriage 324' may be non-removably coupled to the cartridge 320'. The carriage 324' may be integrally formed with the control member 2040 (which may be coupled to the tube 204, as discussed above), or it may be attached to the control member 2040 before the carriage 324' and the housing 320' are loaded into the cavity 340' of the upper arm 300A'. Similar to the cavity 340 and the housing 320, the cavity 340' may include a stepped portion 352', and the housing 320' may include a corresponding stepped portion 354' for engaging within the stepped portion 352' to secure the housing 320' to the end effector 300'.

[0050] For either end effector 300 or 300', the grasping and suturing operations involve the same steps. First, a cartridge 320 is loaded into the end effector 300, or an end effector 300 is supplied with a pre-loaded cartridge 320. The cartridge 320 may include one or more suture staples 322. The suture staples 322 may be arranged in two rows, as shown, or in one or more rows. Next, an endoscope is used to access the target site, which may include tissue defects or other areas to be sutured. A trigger 114 is actuated to grasp the target tissue or object, wherein pulling the trigger 114 closes the upper arm 300A / 300A' onto the lower arm 300B, and releasing the trigger opens or separates the arms 300A / 300A' and 300B from each other.

[0051] Once tissue or object is grasped and closed within arms 300A / 300A', 300B, the slider 120 can be moved proximally or distally, as disclosed above, to cause the carriage 324 or 324' to translate axially to eject or deploy the suture staple 322. The suture staple 322 can only be ejected when arms 300A / 300A', 300B are in the closed position. Once the suture staple 322 has been deployed, the user can release the slider 120 and / or trigger 114 to release the tissue or target object from arms 300A / 300A', 300B.

[0052] It will be apparent to those skilled in the art that various modifications and variations can be made to the disclosed apparatus and methods without departing from the scope of this disclosure. Other aspects of this disclosure will become apparent to those skilled in the art upon consideration of this specification and the features disclosed herein. This specification and examples should be considered as exemplary only.

Claims

1. A medical device comprising: An end effector having: Upper arm, the upper arm comprising: The first multiple teeth; and The second set of teeth; Lower arm, the lower arm comprising: Third, multiple teeth; The fourth multiple teeth; and An anvil, wherein the third plurality of teeth are located on a first lateral side of the anvil, and the fourth plurality of teeth are located on a second lateral side of the anvil, wherein the second lateral side of the anvil is opposite to the first lateral side of the anvil; and A compartment is positioned in the cavity of the upper arm such that the first plurality of teeth are located on the first lateral side of the compartment, and the second plurality of teeth are located on the second lateral side of the compartment, wherein the second lateral side of the compartment is opposite to the first lateral side of the compartment. The shaft connected to the end effector; and The operating part connected to the shaft.

2. The medical device according to claim 1, further comprising: A cable connected to the upper arm, the cable being configured to rotate the upper arm; as well as A tube is connected to a carriage, which is received within the compartment and configured to transport stitches; At least a portion of the cable is disposed inside the conduit.

3. The medical device of claim 2, wherein the cable is connected to the trigger of the operating part.

4. The medical device of claim 3, wherein the tube is connected to the slider of the operating portion.

5. The medical device according to any one of claims 1 to 4, wherein the distal portion of the upper arm includes a protrusion; and The distal portion of the lower arm includes a recess configured to mate with the protrusion.

6. The medical device according to any one of claims 1 to 5, wherein each of the third plurality of teeth and the fourth plurality of teeth of the lower arm includes a plurality of ridges and a plurality of recesses, wherein the plurality of recesses are recessed relative to the surface of the anvil.

7. The medical device of claim 6, wherein the surface of the anvil is planar.

8. The medical device of claim 7, wherein the upper surfaces of the third plurality of teeth and the fourth plurality of teeth are substantially flush with the surface of the anvil.

9. The medical device according to any one of claims 7 to 8, wherein each of the first plurality of teeth and the second plurality of teeth comprises a plurality of ridges and a plurality of recesses, wherein when the end effector is in a closed configuration, the lower surfaces of the plurality of ridges of the first plurality of teeth and the lower surfaces of the plurality of ridges of the second plurality of teeth are located below the surface of the anvil.

10. The medical device of claim 9, wherein the upper surfaces of the plurality of recesses of the first plurality of teeth of the upper arm and the plurality of recesses of the second plurality of teeth are substantially flush with the anvil in the closed configuration.

11. The medical device according to any one of claims 1 to 10, wherein the third plurality of teeth and the fourth plurality of teeth are arranged substantially linearly, wherein the lower arm further includes a first distal tooth located distal to the first plurality of teeth and a second distal tooth located distal to the second plurality of teeth, wherein the first distal tooth and the second distal tooth are disposed on a curved surface between the lateral side surface of the lower arm and the distal surface of the lower arm.

12. The medical device according to any one of claims 1 to 11, wherein the first plurality of teeth and the second plurality of teeth extend downward from the surface of the upper arm defining the cavity.

13. The medical device according to any one of claims 1 to 12, wherein the cavity has an open proximal end for slidably receiving the compartment.

14. The medical device according to any one of claims 1 to 13, wherein the cavity has an open distal end for slidably receiving the compartment.

15. The medical device according to any one of claims 1 to 14, wherein the cavity has a first stepped portion, and wherein the compartment has a second stepped portion configured to mate with the first stepped portion.

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