Devices, systems, and methods for tissue retraction

Abstract

A tissue traction device configured to apply traction to a target tissue within a patient's body by attaching an end of the tissue traction device to anchoring tissue spaced apart from the target tissue. The tissue traction device includes at least one weakened region that facilitates severing the tissue traction device along it as compared to surrounding non-weakened regions. The at least one weakened region can be visually identifiable to facilitate severing the tissue traction device along it within the patient's body. The tissue traction device can be formed from differently formed portions, such as but not limited to a closed shape, such as a loop, having an aperture therethrough.

Description

Cross-reference to related applications

[0001] This application claims priority to U.S. Provisional Application No. 63 / 617,881, filed January 5, 2024, the entire disclosure of which is incorporated herein by reference for all purposes. Technical Field

[0002] This disclosure relates to the field of tissue traction devices, systems, and methods, such as tissue traction devices, systems, and methods that can be used to retract tissue during endoscopic resection or dissection procedures. Background Technology

[0003] Various surgical procedures involve lifting or separating target tissue (a designated portion of tissue) at the treatment site, such as when the target tissue is still attached to the treatment site. Tissue traction elements can be used to lift the target tissue away from the treatment site from which the surgery is being performed. In some cases, the target tissue is an unhealthy, diseased (i.e., cancerous, precancerous, etc.) or otherwise undesirable portion of tissue (which can be healthy or unhealthy). “Target tissue” can also include tissue suspected of being unhealthy or diseased but requiring surgical removal to verify their disease status via biopsy. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are examples of outpatient procedures used to remove deep tumors from the gastrointestinal tract (GI). Although this technique allows patients to recover faster and is generally less painful than open or laparoscopic surgery, such techniques require a high degree of expertise and are therefore not yet widely adopted. One of the biggest drivers of time and complexity is managing the tissue being dissected / removed. When medical professionals cut tissue, the cutting plane (the tissue to be cut) becomes increasingly difficult to observe as the tissue remains above it, and also as the professionals need to cut deeper into the tissue. Accurate and efficient execution of endoscopic procedures (such as endoscopic tissue resection and / or dissection) involves maintaining traction on the target tissue above the cutting plane while the boundaries of the target tissue are cut and the traction is being lifted. Various traction devices exist to apply traction to the target tissue (e.g., lifting the cut area of ​​the tissue away from surrounding tissue) to facilitate observation and easy resection / dissection. These traction devices include filament mechanisms, magnetic mechanisms, and reinforced polymer elements. The device should have good flexibility and sufficient tensile strength to generate traction and should not interfere with the tissue resection / dissection procedure used with it. However, known traction systems can present challenges in maintaining and / or regulating the tension applied to the target tissue, potentially hindering the medical professional's observation of the target tissue and / or interfering with access to and / or use of auxiliary tools at the target site. These difficulties can directly lead to increased procedure time, complexity, and the risk of perforation or bleeding. Therefore, improved traction devices, systems, and methods remain needed. Summary of the Invention

[0004] This summary provides a simplified overview of selected concepts that will be further described in detail below in the specific embodiments. This summary is not intended to necessarily identify key or essential features of the claimed subject matter, nor is it intended to serve as an aid in determining the scope of the claimed subject matter. Those skilled in the art will understand that each of the aspects and features of this disclosure may be advantageously used alone in some cases, or in combination with other aspects and features of this disclosure in others, whether or not described in this summary. The inclusion or exclusion of elements, components, etc., in this summary is not intended to limit the scope of the claimed subject matter.

[0005] According to various principles of this disclosure, a tissue traction device has a first end and a second end, and further includes: a first segment configured and adapted for attachment to tissue at a first location in a patient's body; a second segment configured and adapted for attachment to tissue at a second location in the patient's body spaced apart from the first location; and at least one weakened region between the first and second ends, configured and adapted to be more easily cut by a cutting tool than the surrounding region.

[0006] In some aspects, the first and second segments are configured and adapted for attachment to tissue using a tissue-engaging member. In some aspects, the tissue traction device further includes a tissue-engaging member having a first jaw and a second jaw, wherein the first jaw is engaged with the first segment. In some aspects, the first segment includes an attachment segment sized to engage and retain in proper position on the jaws of the tissue-engaging member.

[0007] In some respects, the at least one weakened region is set along at least one of the first segment or the second segment.

[0008] In some respects, the at least one weakened region is located between the first segment and the second segment.

[0009] In some aspects, the traction device also includes a third section between the first and second sections. In some aspects, the weakening region is positioned along an elongated section that separates the first and third sections and / or the second and third sections.

[0010] In some respects, at least one of the first or second segments includes a ring.

[0011] In some aspects, the tissue traction device also includes an attachment section positioned within a first section and sized to engage and hold in proper place on the jaws of a tissue engagement member for attaching the tissue traction device to tissue at the first location.

[0012] According to various principles of this disclosure, an elongated tissue traction device extending between a first end and a second end includes: two or more distinctly formed segments that are distinguishable from each other; and at least one weakened region that runs along and / or between the two or more distinctly formed segments and is configured and adapted to be more easily cut by a cutting tool than the surrounding area.

[0013] In some respects, the at least one weakened region is a stepped diameter-reducing portion along at least one of two or more differently formed segments.

[0014] In some respects, the at least one weakened region is located along an elongated segment that separates adjacent, differently formed segments.

[0015] In some aspects, the tissue traction device further includes an attachment section sized to engage and remain in proper position on the jaws of a tissue engagement member, which is delivered to the target tissue site together with the tissue traction device. In some aspects, the attachment section is positioned within a section at a first end of the tissue traction device.

[0016] According to various principles of this disclosure, a method for applying traction to tissue within a patient includes: anchoring a first end of a tissue traction device to tissue at a first location within the patient; anchoring a second end of the tissue traction device to tissue at a second location within the patient spaced apart from the first location to apply traction to the tissue at the first location; and cutting the tissue traction device along a weakened region of the tissue traction device.

[0017] In some aspects, the method further includes cutting the tissue traction device to release traction on the tissue at the first location. In some aspects, the method further includes removing the tissue at the first location.

[0018] In some aspects, the method also includes anchoring a portion of the tissue traction device between a first end and a second end to tissue at a third location within the patient's body.

[0019] In some aspects, the method also includes visually identifying the weakened region before cutting the tissue traction device along the weakened region.

[0020] In one embodiment, the traction device includes a weakened region along the perimeter (circumference) of at least one of two or more closed loop segments to facilitate cutting off the traction device. The traction device may optionally include different segments formed in a shape distinguishable from one another. Optionally, the different segments are closed loops. It should be understood that the loops can be any of a variety of shapes (e.g., not necessarily circular, elliptical, or other shapes).

[0021] These and other features and advantages of this disclosure will become apparent from the following detailed description, the scope of which is set forth in the appended claims. Although the following disclosure is presented in the form of aspects or embodiments, it should be understood that each aspect may be claimed individually or in combination with aspects and features of that embodiment or any other embodiment. Attached Figure Description

[0022] Non-limiting embodiments of this disclosure are described by way of example with reference to the accompanying drawings, which are schematic and not intended to be drawn to scale. The drawings are provided for illustrative purposes only, and the dimensions, positions, orders, and relative sizes reflected in the drawings may vary. For example, an apparatus may be enlarged so that details are discernible, but is intended to be scaled down relative to, for example, its fit within the working channel of a delivery catheter or endoscope. In the drawings, identical or substantially identical or equivalent elements are generally denoted by the same reference numerals, and similar elements are generally denoted by similar reference numerals that differ in increments of 1000, with redundant descriptions omitted. For clarity and simplicity, not every element is labeled in every figure, and each element of each embodiment is not shown where it would be unnecessary for those skilled in the art to understand this disclosure.

[0023] The detailed description will be better understood in conjunction with the accompanying drawings, in which the same reference numerals denote the same elements, as follows:

[0024] Figure 1A An example environment is shown in which apparatuses, systems, and methods according to the various principles of this disclosure can be used with example embodiments of traction devices and systems that are being implemented.

[0025] Figure 1B As shown Figure 1A Examples of environments in the example, where Figure 1A Examples of embodiments of the traction device and system are further implemented.

[0026] Figure 1C It shows Figure 1B A detailed view shows a section of the traction device being cut off.

[0027] Figure 2A plan view showing an example embodiment of a traction device formed according to various principles of this disclosure is shown.

[0028] Figure 3 A plan view showing an example embodiment of a traction device formed according to various principles of this disclosure is shown.

[0029] Figure 4 A plan view showing an example embodiment of a traction device formed according to various principles of this disclosure is shown.

[0030] Figure 4A It shows along Figure 4 Sectional view of line 4A-4A.

[0031] Figure 4B It shows along Figure 4 Sectional view of line 4B-4B.

[0032] Figure 4C It shows along Figure 4 Sectional view of line 4C-4C.

[0033] Figure 5 A plan view showing an example embodiment of a traction device formed according to various principles of this disclosure is shown.

[0034] Figure 6 A plan view showing an example embodiment of a traction device formed according to various principles of this disclosure is shown. Detailed Implementation

[0035] The following detailed description should be read with reference to the accompanying drawings, which depict illustrative embodiments. It should be understood that this disclosure is not limited to the specific embodiments described, as such embodiments can vary. All devices, systems, and methods discussed herein are examples of devices and / or systems and / or methods implemented according to one or more principles of this disclosure. Each example of an embodiment is provided for explanation and is not the only way to implement these principles, but merely an example. Therefore, references to elements or structures or features in the drawings should be understood as references to examples of embodiments of this disclosure and should not be construed as limiting this disclosure to the specific elements, structures, or features shown. After reading this disclosure, those skilled in the art will conceive of other examples of ways to implement the disclosed principles. Indeed, it will be apparent to those skilled in the art that various modifications and variations can be made to this disclosure without departing from the scope or spirit of the subject matter. For example, a feature shown or described as part of one embodiment may be used with another embodiment to produce yet another embodiment. Therefore, this subject matter is intended to cover such modifications and variations that fall within the scope of the appended claims and their equivalents.

[0036] It should be understood that this disclosure is presented in various levels of detail throughout this application. In some cases, details that are unnecessary for a person of ordinary skill in the art to understand this disclosure, or details that make other details difficult to perceive, may have been omitted. The terminology used herein is for the purpose of describing particular embodiments only and is not intended to limit the scope beyond the appended claims. Unless otherwise defined, the technical terms used herein should be understood to have the meaning commonly understood by a person of ordinary skill in the art to which this disclosure pertains. All apparatuses and / or methods disclosed and claimed herein can be made and performed without excessive experimentation based on this disclosure.

[0037] As used herein, “proximal” refers to the direction or location closest to the user (medical professional, clinician, technician, operator, or physician, etc.; these terms are used interchangeably herein and are not intended to be limiting, and include automated control systems, etc.), such as when using the device (e.g., introducing the device into a patient, or during implantation, positioning, or delivery), and / or the direction or location closest to the delivery device, and “distal” refers to the direction or location furthest from the user, such as when using the device (e.g., introducing the device into a patient, or during implantation, positioning, or delivery), and / or the direction or location closest to the delivery device. “Longitudinal” refers to extending along the longer or larger dimension of the element. “Longitudinal axis” extends along the longitudinal extent of the element, although it is not necessarily straight, and if the element is bent or flexed, it does not necessarily maintain a fixed construction, and “axial” generally refers to along the longitudinal axis. However, it should be understood that references to axial or longitudinal movement relative to the aforementioned system or its elements are not strictly limited to axial and / or longitudinal movement along the longitudinal axis or central axis of the mentioned element. "Center" means at least approximately bisects the center point and / or is approximately equidistant from the periphery or boundary. As used herein, the "free end" of an element is the end of the element that does not extend beyond its extension. It should be understood that terms such as at the end, on the end, near the end, or along the end are used interchangeably herein and are not intended to be restrictive unless otherwise stated, and are intended to indicate a general relative spatial relationship rather than a precise limitation of location. Finally, references to "at" a location or part are intended to include at and / or near that location or part (e.g., along, adjacent, close to, etc.). As understood herein, "correspondence" is intended to convey a relationship between parts, sections, elements, etc., that are constructed to interact with each other or have another anticipated relationship.

[0038] This disclosure relates to various devices, systems, and methods for applying traction to tissues within the body. Many medical procedures, including but not limited to those performed along the digestive tract and / or bile duct, utilize medical devices to access tissues within the body intended for resection (e.g., “target tissues”). For example, in some current medical procedures (e.g., endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), peroral endoscopic myotomy (POEM), cholecystectomy, video-assisted thoracoscopic surgery (VATS)), medical professionals can use endoscopes or similar medical devices during access to and removal of diseased lesions. Endoscopes can both access the target tissue site (the location of the target tissue, including surrounding tissues) and allow for the deployment of various tissue manipulation devices through them. Such tissue manipulation devices include, but are not limited to, devices for removing target tissue, including but not limited to cutting devices such as scalpels, surgical knives, scissors, electrocautery devices, end effectors, graspers, snares, forceps, dissectors, energy-based tissue coagulants or cutters, clamps, tissue suture devices, tissue loops, applicators, suture delivery instruments, etc. Specific devices are not critical to this disclosure. It should be understood that terms such as medical instrument, device, and apparatus are used interchangeably herein and are not intended to be limiting. Furthermore, in some cases, endoscopes may incorporate features that assist medical professionals in observing and / or imaging tissue dissection / resection procedures to facilitate surgical execution. For example, some endoscopes may include lights and / or cameras designed to illuminate and / or observe the treatment site / target tissue area when the endoscope is guided and positioned adjacent to the target tissue site. Additionally, some endoscopes may include a lumen (e.g., a working channel) through which additional instruments and optionally a delivery sheath for the instruments may be deployed and used. Other observation methods (e.g., fluoroscopy) may be employed alternatively or additionally. It should be understood that this article refers to tissue resection (and its other grammatical forms) for convenience, and the term encompasses tissue stripping, cutting, manipulation, etc. (and their other grammatical forms) and is not intended to be restrictive.

[0039] Although physicians are becoming increasingly adept at removing diseased lesions from within the body (e.g., the digestive tract, abdominal cavity, thoracic cavity, etc.), current traction methods may still be inefficient for them. For example, in some cases, poor visibility and limited ability to engage and manipulate tissue can lead to prolonged tissue dissection procedures. It may be desirable to elevate or pull tissue out of the field of vision or away from the path of the instruments used to perform the procedure. For example, in some EMR / ESD procedures, physicians may use a separate device to provide means of tissue traction to move tissue relative to surrounding tissue. Positioning and manipulating (e.g., traction) the resected tissue flap during and after resection presents various challenges. Such procedures may involve the manipulation and / or exchange of multiple devices, resulting in prolonged operative time. Such systems may not be able to maintain or regulate the traction or tension applied to the target tissue, and / or may maintain or regulate the traction or tension applied to the target tissue in an inefficient or inconsistent manner.

[0040] Based on the various principles of this disclosure, tissue traction devices are used to apply traction to tissue in order to facilitate surgical procedures against such tissue. In some aspects, the tissue traction device (which may be referred to herein, alternatively, as a tether, for convenience and not intended to be limiting) is elongated or otherwise shaped to facilitate extension from the target tissue site to the tissue anchoring site. More specifically, in some aspects, the tissue traction device has a first end configured to engage with the target tissue at the target tissue site and a second end configured to engage with the anchoring tissue at the tissue anchoring site, with an elongated extension between them. It should be understood that terms such as engagement (and other grammatical forms thereof) are used interchangeably herein with terms such as, but not limited to, joining, grasping, holding, fastening, clamping, anchoring, attaching, fixing, securing, and fastening (and other grammatical forms thereof), and are not intended to be limiting. It should be understood that terms such as “anchoring tissue” and “tissue anchoring site” are used for convenience and may alternatively be referred to by terms such as traction tissue site, anchoring site, etc., to describe the location where a portion, segment, or section of tissue traction can be engaged to apply traction to the target tissue site. The target tissue site is typically the part, segment, or section of the tissue traction device where it is initially engaged to lift or otherwise apply traction. It should be understood that terms such as part, segment, and section are used interchangeably herein and are not intended to be limiting unless otherwise stated. The tissue anchoring site is typically spaced apart from the target tissue site, such as across a body cavity or on the side of the body cavity opposite to the target tissue. Thus, engagement of a second end with the anchoring tissue after engagement of the first end with the target tissue allows traction to be applied to the target tissue to lift it away from surrounding tissue. The traction force can range from at least about 0.7 N to up to about 4.7 N (inclusive of increments of 0.1 N). In some aspects, the tissue traction device formed according to the various principles of this disclosure is stretchable and / or elongated. It should be understood that the tether can advantageously be elastic and / or elastomeric (e.g., formed of rubber), although elasticity and / or stretchability are not essential aspects of the traction device formed according to the various principles of this disclosure.

[0041] In some aspects, one or more anchoring tissue engagement segments are disposed between the first and second ends of the tissue traction device. It should be understood that terms such as part, region, segment, and section are used interchangeably herein and are not intended to be limiting; generally, a segment is referred to as a general region, and a section as a specific part, for ease of distinction and not for limitation. Engagement of one or more additional engagement segments of the tissue traction device with additional anchoring tissue spaced apart from the anchoring tissue engaged with the second end of the tissue traction device allows modification of the magnitude and / or direction of the force vector applied to the target tissue by the tissue traction device. In some aspects, the one or more anchoring tissue engagement segments are configured and positioned to engage with tissue directly or indirectly (e.g., using tissue engagement members) at the site of the target tissue. As the target tissue engaged with the first end of the tissue traction device moves relative to surrounding tissue (e.g., is cut relative to surrounding tissue), the traction applied thereto by the tissue traction device may decrease. According to various principles of this disclosure, instead of moving the second end of the tissue traction device to another location to increase tension on the target tissue, one or more anchoring tissue engagement segments of the tissue traction device can engage with anchoring tissue to increase the traction applied to the target tissue. It should be understood that the additional anchoring tissue engagement segments of the tissue traction device can engage at substantially the same anchoring tissue site (depending on the size, shape, construction, and / or location of the various traction tissue engagement segments) or at different anchoring tissue sites (such as increasingly distant from the target tissue). For example, if the distance between the target tissue and the various anchoring tissue engagement segments of the tissue traction device differs, different anchoring tissue engagement segments can apply different traction force vectors even when engaging at a common traction tissue site.

[0042] In some aspects, tissue traction devices formed according to various principles of this disclosure are shaped to define different attachment points of the tissue traction device to the tissue, such as utilizing tissue engagement members. For example, in some embodiments, one or more anchoring tissue engagement segments / parts are formed as different gripping sections or segments, such as having different boundaries and / or shapes and / or cross-sections from another gripping section or segment. It should be understood that terms such as segment or section or region or part are used interchangeably herein and are not intended to be limiting. Different anchoring tissue engagement sections of the tissue traction device can be distinguished from each other as different gripping segments defined along the sections of the tissue traction device, such as by differences in shape or orientation relative to another gripping segment of the tissue traction device (such as, but not limited to, adjacent or contiguous gripping segments). In some aspects, the anchoring tissue engagement section is formed as a closed shape having an opening therethrough to allow a portion of the tissue engagement member (e.g., one of a pair of jaws of the tissue engagement member) to extend through it. For example, one or more anchoring tissue engagement sections may be in the form of a ring.

[0043] To facilitate the release of traction (and / or retrieval of target tissue and / or portions of the tissue traction device), tissue traction devices formed according to various principles of this disclosure include weakened regions along their length. It should be understood that the weakened regions are not weak enough to break under the traction forces anticipated by the surgery in which the tissue traction device is designed for use. Rather, the weakened regions are weakened to allow for their destruction, such as by a cutting device. Any of various cutting devices (such as scalpels, forceps, electrocautery scalpels, snares, etc.) can be used to apply sufficient force to a selected weakened region to break (e.g., sever, fracture, cut, disconnect, etc., these terms are used interchangeably herein and are not intended to be limiting) the tissue traction device to release traction and / or allow retrieval of target tissue. Optionally, the cutting device is a means for removing the target tissue. The weakened region can be formed along any portion of the tissue traction device, such as along anchored tissue junction sections and / or between adjacent anchored tissue junction sections. As used herein, the term "weakened region" refers to a region of material that facilitates or reinforces the cutting of a structure. Thus, the weakened region can be made by reducing the cross-sectional dimensions of the tissue traction device at that region. The weakened region may have the same or different cross-sectional shape as the surrounding area of ​​the tissue traction device that is not considered "weakened," and this disclosure is not limited in this respect. Alternatively or additionally, the material may be modified to allow for intentional cutting through it without affecting tensile strength (and therefore without affecting the traction force that the tissue traction device can apply to the target tissue). Alternatively or additionally, the tissue traction device may be mechanically or chemically modified at the weakened region to create or reinforce the weakened region. For example, including but not limited to embossing, notching, or cutting; or non-mechanical means, including but not limited to chemical etching; laser, heat; or a combination of mechanical and non-mechanical means. It should be understood that, in some aspects, a portion of the tissue traction device anchored to the anchored tissue by the tissue bonding member may remain engaged with the anchored tissue. Such a portion of the tissue traction device and the tissue bonding member will eventually detach naturally.

[0044] Various embodiments of tissue traction devices, systems, and associated methods will now be described with reference to the examples shown in the accompanying drawings. References to “one embodiment,” “embodiment,” “some embodiments,” “other embodiments,” etc., throughout this specification indicate that one or more specific features, structures, concepts, and / or characteristics according to the principles of this disclosure may be included in association with that embodiment. However, such references do not necessarily imply that all embodiments include the specific features, structures, concepts, and / or characteristics, or that embodiments include all features, structures, concepts, and / or characteristics. Some embodiments may include one or more such features, structures, concepts, and / or characteristics in various combinations. It should be understood that one or more features, structures, concepts, and / or characteristics described with reference to one embodiment may be combined with one or more features, structures, concepts, and / or characteristics of any other embodiment provided herein. That is, any features, structures, concepts, and / or characteristics described herein may be mixed and matched to create hybrid embodiments, and such hybrid embodiments are within the scope of this disclosure. Furthermore, references to “one embodiment,” “embodiment,” “some embodiments,” “other embodiments,” etc., throughout the specification do not necessarily refer to the same embodiment, and individual or alternative embodiments are not necessarily mutually exclusive with other embodiments. It should also be understood that the various features, structures, concepts, and / or characteristics of the disclosed embodiments are independent and separate from each other, and can be used individually or in various combinations thereof to create alternative embodiments that are considered part of this disclosure. Therefore, this disclosure is not limited to the embodiments specifically described herein, as describing all the numerous possible combinations and sub-combinations of features, structures, concepts, and / or characteristics would be overly cumbersome, and the examples of embodiments disclosed herein are not intended to limit the broader aspects of this disclosure. It should be understood that the various dimensions provided herein are examples, and those skilled in the art can readily determine appropriate ranges of standard deviations and acceptable variations, which are covered by this disclosure and any claims associated therewith. The following description is merely illustrative of embodiments and is not intended to limit the broader aspects of this disclosure.

[0045] It should be understood that common features are identified by common reference elements, and for the sake of brevity and convenience, and not intended to be limiting, descriptions of common features are generally not repeated. For clarity, not all parts having the same reference numerals are numbered. It should be understood that in the following description, similar elements or parts having more than 1000 reference numerals across various illustrated embodiments are generally indicated by the same reference numerals increasing by multiples of 1000, and redundant descriptions are generally omitted for brevity. Furthermore, certain features in one embodiment may be used across different embodiments and are not necessarily labeled separately when appearing in different embodiments. Therefore, common features are identified by common reference elements, and for the sake of brevity, descriptions of common features will not be repeated. For clarity, not all parts having the same reference numerals are numbered; similar elements may be identified by common reference numerals ending with different reference letters, and these elements are generally simply indicated by the common reference numerals.

[0046] Now turn to the attached diagram. Figure 1A and Figure 1B An example of use of an embodiment of the tissue traction device 100 according to various principles of this disclosure is shown. The illustrated embodiment of the tissue traction device 100 has a target tissue engagement first end 101 that engages with target tissue TT at a target tissue site TS (directly or indirectly, such as using tissue engagement member 300 described further in detail below), and an anchor tissue engagement end 102 that engages with an anchor tissue AT spaced apart from the target tissue TT (directly or indirectly, such as using a second tissue engagement member 302). With this engagement, the tissue traction device 100 applies traction to the target tissue TT. It should be understood that references to the first or second end of the tissue traction device are for simplicity and should not be construed as limited to the ends of elongated elements, but can also be applied to other locations along the element, such as, but not limited to, elongated elements.

[0047] It should be understood that the tissue traction device 100 can be delivered to the target tissue site TS using any suitable delivery device 200. For example, the tissue traction device 100 can be delivered within a tubular elongated member. In some aspects, the tubular elongated member is flexible enough to guide through tortuous body passages. It should be understood that the body passages referred to include naturally occurring passages (e.g., the colon) and medically created passages (e.g., passages created using medical devices that would not exist without medical intervention) or others. In some aspects, the delivery device 200 is a medical endoscope, such as an endoscope, having a working channel 201 defined through the delivery device 200, through which the tissue traction device 100 can be delivered. The tissue traction device 100 can be delivered in a generally extended configuration or a more compact configuration, and this disclosure is not limited in this respect. Preferably, when the tissue traction device 100 is in any of the various delivery configurations within the delivery device 200, the size of the tissue traction device 100 is selected to fit within a series of inner diameters of a series of delivery devices 200. In some aspects, the tissue traction device 100 is delivered together with a tissue engagement member 300 at the first end 101 of the tissue traction device 100, as discussed in further detail below. In some aspects, the tissue traction device 100 includes an attachment section 110 to facilitate attachment of the tissue engagement member 300 to the tissue traction device 100. Figure 2 In the illustrated embodiment example, the attachment segment 110 is a ring or orifice formed within the first end 101 of the tissue traction device 100. In embodiments where the attachment segment 110 is located at the first end 101 of the tissue traction device 100, the attachment segment 110 may also be referred to as the main ring 110. The attachment segment 110 may be constructed, adapted, and sized to engage and remain in proper position on the tissue engagement member 300, such as by interference fit. For example, the attachment segment 110 may have sufficient resilience or elasticity to be stretched onto a portion of the tissue engagement member 300 (e.g., one of a pair of jaws of the tissue engagement member 300 in the form of a clamp) and to retract at such a portion of the tissue engagement member 300 to remain in place, such as by circumferential strength or friction or other means. It should be understood that other configurations of the attachment segment 110 that allow the tissue engagement member 300 to be securely attached thereto are within the scope of this disclosure, which is not limited to rings.

[0048] Once the tissue traction device 100 has been delivered to the target tissue site TS, the tissue engagement member 300 can engage with the tissue at the target tissue site TS, such as... Figure 1AAs shown. Specifically, the tissue engagement member 300 can engage with target tissue TT intended to be removed from the surrounding tissue at the target tissue site TS, thereby connecting the first end 101 of the tissue traction device 100 to the target tissue TT, allowing the tissue traction device 100 to apply traction to the target tissue TT. More specifically, once the first end 101 of the tissue traction device 100 is engaged with the target tissue TT, the second end 102 of the tissue traction device 100 can extend to an anchoring tissue site AT spaced apart from the target tissue site TS. Figure 1A and Figure 1B In the schematically illustrated anatomical setting, the target tissue site TS is located on one side of a body cavity (e.g., small intestine, large intestine, esophagus, etc.), and the anchoring tissue site AT is located on the side of the body cavity substantially opposite to the side where the target tissue site TS is located, to optimize the traction applied by the tissue traction device 100. In other settings such as body cavities (e.g., within organs such as the stomach), the anchoring tissue site AT is selected to be sufficiently far from the target tissue site TS so that the tissue traction device 100 can apply appropriate / desired traction to the target tissue TT. It should be understood that those skilled in the art will recognize that the selection of the anchoring tissue site AT may include considerations beyond its location and distance from the target tissue site TS, such as the length, elasticity, tensile strength, maximum elongation, and / or other material properties of the tissue traction device 100.

[0049] like Figure 1A As shown, the second end 102 of the tissue traction device 100 can be anchored relative to the anchored tissue site AT with the aid of the second tissue engagement member 302. The second tissue engagement member 302 may be constructed similarly to the first tissue engagement member 300 used to anchor the first end 101 of the tissue traction device 100 to the target tissue TT, or it may be a tissue engagement member of a different type or construction; this disclosure is not limited in this respect. In some aspects, the second end 102 includes an anchoring tissue engagement segment 120, which is constructed and adapted to facilitate its gripping and attachment to the tissue for anchoring thereto. In some aspects, the anchoring tissue engagement segment 120 is a closed shape having an opening therethrough, which is constructed and adapted to allow at least a portion of the tissue engagement members 300, 302 (e.g., one of the jaws of a pair of jaws of the tissue engagement members 300, 302) to extend through it. In some aspects, the tissue traction device 100 includes more than one anchoring tissue engagement segment 120, as will be described in further detail below.

[0050] With the tissue traction device 100 engaged with the target tissue TT along the target tissue site TS and also with the tissue at the anchoring tissue site AT, a medical professional can begin cutting the target tissue TT to remove at least a portion of the target tissue TT. The cutting instrument 400 can advance through the delivery device 200 (e.g., through a working channel 201 defined by the delivery device 200, such as the tissue traction device 100 through its delivery working channel, or an additional working channel 201) and reach the target tissue site TS. As the cutting instrument 400 begins cutting the tissue at the target tissue site TS, the target tissue TT begins to separate (e.g., lift) from the surrounding tissue at the target tissue site TS. The traction applied to the target tissue TT by the tissue traction device 100 is thus affected (e.g., reduced). To correct (e.g., increase size and / or change direction) the force vector of the traction applied by the tissue traction device 100, one or more anchoring tissue engagement segments 120 of the tissue traction device 100 between the first end 101 and the second end 102 of the tissue traction device 100 may be anchored relative to the second anchoring tissue portion AT2, while the second end 102 remains anchored relative to the first anchoring tissue portion AT1, as shown below. Figure 1B As shown. One or more anchoring tissue engagement segments 120 are constructed and adapted for attachment to tissue, such as anchoring tissue spaced apart from the target tissue site TS. According to various principles of this disclosure, one or more anchoring tissue engagement segments 120 are disposed between a first end 101 and a second end 102 of the tissue traction device 100. Further according to various principles of this disclosure, the anchoring tissue engagement segments 120 may differ from each other in size, shape, construction, and / or dimensions, such that the anchoring tissue engagement segments 120 are distinct and / or distinguishable from each other, and / or can be individually gripped and anchored to the anchoring tissue site AT to apply different force vectors on the target tissue TT. In the embodiment example shown in the figures, each anchoring tissue engagement segment 120 is a closed shape having an orifice / opening through it to facilitate gripping by the tissue engagement member 300 for anchoring relative to the anchoring tissue site AT. The location where the tissue engagement member 300 engages the anchoring tissue engagement segment 120 is not limited, but can be at any of various points along the periphery of the anchoring tissue engagement segment 120. It should be understood that other shapes or configurations of the anchoring tissue joint section 120 are within the scope of this disclosure, which is not limited to the examples of embodiments shown in the accompanying drawings.

[0051] Once cutting and / or any additional surgical procedures have been performed at or relative to the target tissue TT and / or target tissue site TS, it may be desirable to remove at least a portion of the tissue traction device 100 from the patient. According to various principles of this disclosure, the tissue traction device 100 is configured to facilitate disengagement by including one or more weakened regions 130. The weakened regions 130 are configured and adapted to facilitate cutting along them of the tissue traction device 100. For example, in some embodiments, the weakened regions 130 have a smaller cross-sectional dimension than other (e.g., surrounding) regions of the tissue traction device 100. The smaller cross-sectional dimension and / or longitudinal / circumferential extension of the weakened regions 130 are selected so as not to adversely affect (e.g., reduce) the tensile strength of the tissue traction device 100 in that region, so as not to affect the ability of the tissue traction device 100 to apply traction to the target tissue TT. However, the reduced cross-sectional size is sufficiently reduced that the weakened region 130 is identifiable within the patient (e.g., by observation using an imaging system, such as a delivery device 200, or a medical endoscope), and is easier to cut than other areas of the tissue traction device 100. In some respects, the tissue traction device 100 can be cut using the same cutting instrument 400 used for cutting tissue at the target tissue site TS, such as... Figure 1C As shown. In some respects, a portion of the tissue traction device 100 held by the tissue engagement member 300 can remain attached to the tissue within the patient's body. However, other portions of the tissue traction device 100, such as those attached to the target tissue TT that has been removed and taken from the patient's body, can be removed, for example, when the tissue traction device 100 is cut along the weakened region 130 of the tissue traction device 100. It should be understood that the portions of the tissue traction device 100 that remain attached to the tissue within the patient's body (along with any tissue engagement members 300 attached thereto) are ultimately expected to detach during the natural functioning of the tissue.

[0052] The weakened region 130, formed according to various principles of this disclosure, can be positioned at one or more points along the tissue traction device 100, such as along the first end 101, the second end 102, the anchored tissue engagement segment 120, and / or between adjacent anchored tissue engagement segments 120. The weakened region 130 typically extends at least about 15% of the circumference of the anchored tissue engagement segment 120 (e.g., to facilitate identification for cutting in a patient's body), up to about 20% of the circumference. However, in some embodiments, the weakened region 130 can extend up to about 80% of the circumference of the anchored tissue engagement segment 120 (including increments of 1% from 15% to 80%). The circumferential extension of the weakened region 130 allows for the use of various different tissue engagement members 300 of various sizes to grip onto non-weakened areas of a given anchored tissue engagement segment 120, and also allows the cutting instrument 400 to approach the weakened region 130. Examples of various embodiments of tissue traction devices having weakened regions formed according to various principles of this disclosure are provided in [the following text is missing from the original extract]. Figure 2-6 As shown in the figure, it will now be described.

[0053] Turning Figure 2 The illustrated embodiment of the tissue traction device 2100 has a first end 2101, a second end 2102, and one or more anchoring tissue engagement segments 2120 extending therebetween. More specifically, attachment segments 2110 may be provided along the first end 2101 to allow tissue engagement members 300 (such as those shown in FIG. 1) to be attached thereto, for example, for delivery together with the tissue traction device 2100, as described above regarding... Figure 1A-1C As described. Figure 2 The second end 2102 of the tissue traction device 2100 shown is in the form of a loop, although other configurations are within the scope of this disclosure. In some aspects, a load-bearing bridging section 2140 is formed between adjacent anchored tissue engagement sections 2120 to increase the load-bearing capacity of the tissue traction device 2100 while applying traction to the target tissue TT.

[0054] According to various principles of this disclosure, one or more weakened regions 2130 are formed between the first end 2101 and the second end 2102 of the tissue traction device 2100 along its longitudinal extension. For example, in some aspects, the weakened region 2130a may be provided along the anchoring tissue engagement section 2120 provided at the second end 2102 of the tissue traction device 2100. Such a weakened region 2130a can allow a greater extension of the tissue traction device 2100 to separate / disengage from the anchoring tissue site AT, and the second end 2102 of the tissue traction device 2100 may be separated via a tissue engagement member 302 (such as...). Figure 1A or Figure 1B(As shown) it remains attached to the anchored tissue site AT. In some respects, the weakened region 2130a is spaced proximally from the distal end 2100d of the tissue traction device 2100 so as to cut the second end 2102 of the tissue traction device 2100 at a location where the cutting instrument 400 has sufficient space to avoid affecting (e.g., contacting) the anchored tissue site AT.

[0055] For reference Figure 2 As can be further understood from the illustrated embodiment of the tissue traction device 2100, two or more anchored tissue engagement segments 2120 may be disposed between the first end 2101 and the second end 2102 of the tissue traction device 2100. One or two of the illustrated anchored tissue engagement segments 2120 may include one or more weakened regions 2130 (e.g., additional weakened regions 2130b, 2130c) formed according to various principles of this disclosure. The weakened regions 2130 may be formed at any location along the circumferential or longitudinal extension of the anchored tissue engagement segment 2120. For example, the weakened regions 2130 may be spaced apart along the extension of the tissue traction device 2100 between its first end 2101 and second end 2102. Alternatively or additionally, the weakened regions 2130 may all be located at the same location along a given anchored tissue engagement segment 2120 (e.g., closer to the first end 2101 or closer to the second end 2102 of the tissue traction device 2100) (such as...). Figure 2 (As shown, they are all closer to the first end 2101), or each weakened region 2130 can be located at different longitudinal / circumferential positions along a given anchored tissue junction segment 2120.

[0056] For reference Figure 3 As can be understood from the illustrated embodiment of the tissue traction device 3100, the longitudinal / circumferential extension range of the weakened region 3130 of the tissue traction device formed according to various principles of this disclosure may differ. Figure 2 The example shown is an embodiment. More specifically, Figure 3 The weakened region 3130 of the tissue traction device 3100 shown can have a greater than Figure 2 The weakened region 2130 of the tissue traction device 2100 shown has a longer longitudinal / circumferential extension. In some aspects, the weakened region 3130 of the tissue traction device 3100 may not all have the same longitudinal / circumferential extension. More specifically, in Figure 3In the illustrated embodiment of the tissue traction device 3100, the anchoring tissue engagement section 3120i adjacent to the first end 3101 and the anchoring tissue engagement section 3120ii adjacent to the second end 3102 of the tissue traction device 3100 may each have weakened regions 3130i and 3130ii, respectively, which have a longer longitudinal / circumferential extension than the weakened regions 3130m of one or more intermediate anchoring tissue engagement sections 3120m. Various alternative configurations, such as the weakened region 3130m of the intermediate anchoring tissue engagement section 3120m being longer than other weakened regions 3130 of the tissue traction device 3100, are also within the scope of this disclosure. Alternatively or additionally, as referenced above... Figure 2 The tissue traction device 2100 shown indicates that... Figure 3 The weakened region 3130 of the tissue traction device 3100 shown can be located at different positions along a given anchored tissue engagement segment 3120. For example, one or more anchored tissue engagement segments 3120 (e.g., adjacent to the second end 3102 and / or intermediate anchored tissue engagement segments 3120m) may include a weakened region 3130 closer to the first end 3101 of the tissue traction device 3100, while one or more anchored tissue engagement segments 3120 (e.g., the anchored tissue engagement segment 3120i closest to the first end 3101) may include a weakened region 3130 closer to the second end 3102 of the tissue traction device 3100. Other combinations / locations / extends of the weakened region 3130 are within the scope of this disclosure and are not limited thereto. Figure 3 The limitations of the illustrated embodiments are as follows.

[0057] It should be understood that the traction device 3100 also includes the attachment section 3110 as shown in Figure 1 and Figure 2 The different alternative locations are shown. More specifically, they do not extend away from the adjacent anchoring tissue junction section 3120. Figure 3 The attachment section 3110 of the illustrated tissue traction device 3100 is positioned within the boundary of the anchoring tissue engagement section 3120i closest to the first end 3101 of the tissue traction device 3100 (e.g., within an open space defined within the anchoring tissue engagement section 3120i). The attachment section 3110 is formed in such a way that it allows for a thicker / larger cross-sectional area to offset the smaller overall size of the attachment section 3110 (e.g., compared to the anchoring tissue engagement section 3120) and / or provides additional retaining strength (e.g., circumferential strength) to securely mount and attach to a portion of the tissue engagement member 300. Other configurations are within the scope of this disclosure, which is not limited thereto. Figure 3 or Figure 2 The longitudinal / circumferential extension range is shown. In some respects, with Figure 2 The tissue traction device is the same as that of the 2100. Figure 3The tissue traction device 3100 may include a load-bearing bridging section 3140 between adjacent anchored tissue joint sections 3120 to increase the load-bearing capacity of the tissue traction device 3100 while applying traction to the target tissue TT.

[0058] In respectively Figure 2 and Figure 3 The weakened regions 2130, 3130 of the tissue traction devices 2100, 3100 shown are generally constructed and sized to be distinct from / distinguishable from adjacent regions of the tissue traction devices 2100, 3100. For example, the weakened regions 2130, 3130 are at least visually identifiable within the body by a medical professional, such as using conventional observation methods (e.g., the optical system of an endoscope). In some respects, the weakened regions 2130, 3130 are relative to... Figure 2 and Figure 3 The surrounding regions of the illustrated tissue traction devices 2100, 3100 may have a generally stepped reduction in cross-sectional area and / or diameter. It should be understood that "stepped reduction," as used herein, is not limited to abrupt reductions (e.g., such as a square wave), but may include short taper sections between multiple weakening regions 2130, 3130, which are sufficient to minimize sharp ends, but whose circumferential / longitudinal extension is not so long that the transition appears more like a taper than a step. Those skilled in the art may refer to… Figure 2 and Figure 3 This serves as an example to understand appropriate constructions based on the various principles of this disclosure.

[0059] It should be understood that, in some respects, the weakened region of the tissue traction device formed according to the various principles of this disclosure may not be as different from other parts of the tissue traction device. Conversely, the reduced cross-sectional size of the weakened region 4130 of the tissue traction device 4100 formed according to the various principles of this disclosure may be a reduction that is less easily distinguishable, such as... Figure 4 , Figure 4A , Figure 4B and Figure 4C As shown. More specifically, Figure 4 The illustrated tissue traction device 4100 has an anchoring tissue engagement section 4120 having a weakening region 4130, the anchoring tissue engagement section 4120 having a gradual transition to its weakening region 4130 (e.g., a subtle step-like decrease in thickness, such as in...). Figure 2 and Figure 3 (Example of the embodiment shown). As in the comparison Figure 4A and Figure 4B It is understandable that the cross-sectional area of ​​the non-weakened portion of the anchoring tissue joint section 4120, such as along... Figure 4 Line 4A-4A (e.g.) Figure 4AAs shown), the cross-sectional area of ​​at least a portion of the weakened region 4130 of the anchoring tissue junction section 4120 is larger than that of the anchoring tissue junction section 4120, such as along Figure 4 Line 4B-4B (e.g.) Figure 4B (As shown). In some respects, with each Figure 2 and Figure 3 The tissue traction devices 2100 and 3100 are the same. Figure 4 The tissue traction device 4100 may include a load-bearing bridging section 4140 between adjacent anchored tissue engagement sections 4120 to increase the load-bearing capacity of the tissue traction device 4100 while applying traction to the target tissue TT. (See reference...) Figure 4C Understandable. Figure 4C It shows along Figure 4 The cross-section of the bridging section 4140 of line 4C-4C is larger than the cross-sectional area of ​​at least a portion of the weakened region 4130 of the anchoring tissue joint section 4120, such as... Figure 4B As shown. Optionally, the cross-sectional area of ​​the bridging section 4140 is greater than (or at least equal to) that of the bridging section. Figure 4A The cross-sectional area of ​​the anchoring tissue joint section 4120 shown.

[0060] According to the principles of this disclosure, the weakened region is not formed along the anchored tissue junction segment of the tissue traction device, but can be formed between the anchored tissue junction segments. For example, in respectively in Figure 5 and Figure 6 In the embodiment examples of the tissue traction devices 5100 and 6100 shown, weakened regions 5130 and 6130 are formed between the anchored tissue engagement sections 5120 and 6120, such as in the form of separate sections with different shapes from the proximal and distal anchored tissue engagement sections 5120 and 6120. Figure 5 and Figure 6 In the illustrated embodiment example, weakened regions 5130 and 6130 are elongated segments that separate adjacent anchoring tissue bonding segments 5120 and 6120. (As in comparison...) Figure 5 The tissue traction device 5100 shown and Figure 6 As can be understood with the tissue traction device 6100 shown, the relative size, shape, construction, and / or dimensions of the anchored tissue junction sections 5120, 6120 and the weakened regions 5130, 6130 can vary without departing from the principles of this disclosure. For example, Figure 5 The anchoring tissue junction section 5120 of the tissue traction device 5100 shown is compared to Figure 6The more elliptical anchoring tissue engagement segment 6120 of the illustrated tissue traction device 6100 is more rounded. Alternatively or additionally, the weakening region 6130 of the tissue traction device 6100 may be more elongated, thereby defining a greater distance between adjacent anchoring tissue engagement segments 6120 than the weakening region 5130 of the tissue traction device 5100. It should be understood that the attachment segments 5110 and 6110 of the tissue traction devices 5100 and 6100 may be separated from the nearest anchoring tissue engagement segments 5120 and 6120 by the weakening regions 5130 and 6130, respectively, so as to facilitate the separation and removal together of the portion of the tissue traction device 5100 and 6100 attached to the excised target tissue TT.

[0061] It should be understood that the tissue traction device described herein can be formed from any of a variety of biocompatible materials, such as polymers, including but not limited to polyethylene, polypropylene, nylon, etc., which are capable of applying the desired traction force but can also be cut along their weakened regions. Such materials can be used to form the tissue traction device in any of a variety of ways known in the art or known to date, including but not limited to injection molding, 3D printing, vacuum casting, etc. As will be understood, a variety of different shapes and sizes of tissue traction devices can be formed according to the various principles of this disclosure. Typical tissue traction devices formed according to the various principles of this disclosure can have a thickness of at least about 0.3 mm to up to about 0.8 mm (inclusive of 0.1 mm increments), although this disclosure is not intended to be limited in this respect. Typical tissue traction devices formed according to the various principles of this disclosure can have a length of at least about 15 mm to up to about 25 mm (inclusive of 0.1 mm increments), although this disclosure is not intended to be limited in this respect. As mentioned above, the anchoring tissue junction segment can be a closed shape, typically having an opening through it. For example, the anchoring tissue engagement segment can be circular, oval, elliptical, etc., or preferably other shapes without sharp edges or other constructions that might interfere with its operation. The outer diameter of the anchoring tissue engagement segment can be as small as about 3 mm to as large as about 6 mm (inclusive of 0.1 mm increments) to allow sufficient extension range along which the anchoring tissue engagement segment can be grasped or otherwise engaged by the tissue engagement member while in the patient's body. The inner diameter of the orifice can be at least about 1.3 mm or at least about 1.6 mm (inclusive of 0.1 mm increments) to allow sufficient space for at least a portion of the tissue engagement member to extend through it. Providing more than one anchoring tissue engagement segment provides greater flexibility for medical professionals to reposition the tissue traction device during a given procedure. In some aspects, the cross-sectional shape of the tissue traction device is circular or oval to facilitate its manufacture. In some embodiments, the tissue traction device can be color-coded to indicate size, dimensions, strength, intended anatomical use, etc.

[0062] It should be understood that any of the various tissue engagement members 300 can be used with the tissue traction device of this disclosure. In some aspects, as described above, a portion of the tissue engagement member 300 is coupled to the tissue traction device to remain connected to the tissue traction device during delivery and deployment. The tissue engagement member 300 may directly or indirectly engage, mount, couple to, attach to, or attach to tissue traction devices formed according to various principles of this disclosure. The tissue engagement member may alternatively be referred to or cited as a tissue fastener or clamp or other mechanical fixation device (e.g., hemostatic clip, clamp, gripper, basket, holder, magnet, adhesive, etc.) and is not intended to be limiting. In some embodiments, the tissue engagement member is repositionable after partial deployment. For example, the tissue engagement member may be configured to allow the tissue engagement member to releasably engage with tissue in a first configuration (e.g., closed but not locked into engagement) and to lock in a second closed configuration to prevent opening and disengagement from the tissue engagement. In some embodiments, the tissue engagement member has gripper arms or jaws that can selectively move away from each other to engage tissue between them and can move toward each other to grip the engaged tissue. The gripper arms may be hinged together (e.g., as a single piece) or formed separately and movable relative to each other, for example, by means of pivoting about a pivot point. The gripper arms may have one or more additional gripping features, such as serrated or wavy profiles or teeth, at the ends of the gripper arms and / or along the edges of the gripper arms. In some embodiments, the tissue engagement member is movable relative to the tissue traction device, even when coupled to it. Movement of the tissue engagement member, such as rotation (e.g., 360° rotation), may be controlled by a proximal control knob, adapter, or other actuator element. In some embodiments, the tissue engagement member may be manipulated, such as rotated, wherein there is a one-to-one correspondence between the movement of the control knob and the tissue engagement member.

[0063] It should also be understood that the delivery device used therewith can be any suitable size, cross-sectional shape or area and / or construction that allows not only the introduction and passage of tissue traction devices (optionally having tissue engagement members coupled thereto) formed according to various principles of this disclosure, but also the passage of one or more additional medical devices. It is generally advantageous that the delivery device is maneuverable, and that the delivery device can have different regions of varying flexibility or stiffness to facilitate maneuverability. The delivery device can take the form of a flexible, elongated tubular member and can include one or more working channels or lumens that extend generally longitudinally (axially) between the proximal and distal ends of the delivery device.

[0064] It will be understood by those skilled in the art that this discussion is merely a description of illustrative examples of embodiments and is not intended to limit the broader aspects of this disclosure. Various further advantages of the aspects, features, components, and structures of the above-discussed traction devices will be apparent to those skilled in the art, in addition to those discussed above. It should be understood that all devices and methods discussed herein are examples of devices and / or methods implemented according to one or more principles of this disclosure. These examples are not the only ways to implement these principles, but are merely examples and are not intended to limit the broader aspects of this disclosure. Therefore, references to elements or structures or features in the drawings should be understood as references to examples of embodiments of this disclosure and should not be construed as limiting this disclosure to the specific elements, structures, or features shown. After reading this disclosure, those skilled in the art will conceive of other examples of ways to implement the disclosed principles. It will be apparent to those skilled in the art that variations can be applied to the order of steps of the disclosed devices, systems, and / or methods and / or the methods described herein without departing from the concept, spirit, and scope of this disclosure. It should be understood that various features described with respect to one embodiment can generally be applied to another embodiment, whether or not explicitly indicated. The various features described below can be used alone or in any combination thereof. Therefore, the present invention is not limited to the embodiments specifically described herein, and all alternatives and modifications that are obvious to those skilled in the art are considered to fall within the spirit, scope and concept of this disclosure as defined by the appended claims.

[0065] The foregoing discussion has broad applications and has been presented for illustrative and descriptive purposes, and is not intended to limit this disclosure to the forms disclosed herein. It should be understood that various additions, modifications, and substitutions can be made to the embodiments disclosed herein without departing from the concept, spirit, and scope of this disclosure. Specifically, it will be apparent to those skilled in the art that the principles of this disclosure may be embodied in other forms, structures, arrangements, proportions, and using other elements, materials, and components without departing from its concept, spirit, scope, or characteristics. For example, various features of this disclosure may be combined in one or more aspects, embodiments, or constructions to simplify the purposes of this disclosure. However, it should be understood that various features of certain aspects, embodiments, or constructions of this disclosure may be combined in alternative aspects, embodiments, or constructions. Although this disclosure is presented in the form of embodiments, it should be understood that not all individual features of the subject matter need to be present to achieve at least some of the desired characteristics and / or advantages of the subject matter or these individual features. Those skilled in the art will understand that this disclosure can be used with numerous modifications or variations to the structures, arrangements, proportions, materials, components, etc., used in the practice of this disclosure without departing from the principles, spirit, or scope thereof, and these modifications or variations are particularly suited to specific environments and operational requirements. For example, an element shown as integrally formed may be composed of multiple parts, or an element shown as multiple parts may be integrally formed; the operation of an element may be reversed or otherwise altered; and the size or dimensions of an element may be changed. Similarly, although operations or actions or processes are described in a particular order, this should not be construed as requiring such a particular order, or requiring all operations or actions or processes to be performed to achieve the desired result. Furthermore, other embodiments are within the scope of the following claims. In some cases, the actions recited in the claims may be performed in a different order and still achieve the desired result. Therefore, the embodiments currently disclosed should be considered illustrative rather than restrictive in all respects, and the scope of the claimed subject matter is indicated by the appended claims and is not limited to the specific embodiments or arrangements described or shown herein. In view of the foregoing, any individual feature of any embodiment may be used and may be claimed individually or in combination with features of that embodiment or any other embodiment, the scope of which is indicated by the appended claims and is not limited to the foregoing description.

[0066] The following will be understood in the foregoing description and the following claims. As used herein, the phrases “at least one,” “one or more,” and “and / or” are open-ended expressions that are both operationally connective and disjoint. The terms “a,” “an,” “the,” “first,” “second,” etc., do not exclude multiple entities. For example, as used herein, the term “a” or “an” refers to one or more of that entity. Therefore, the terms “a” (or “an”), “one or more,” and “at least one” are used interchangeably herein. As used in this specification and the appended claims, the term “or” is generally used in its sense including “and / or” unless the context explicitly specifies otherwise. As used herein, the conjunction “and” includes each structure, component, feature, etc. so combined unless the context explicitly specifies otherwise, and the conjunction “or” includes one or the other of such structures, components, features, etc., individually and in any combination and number, unless the context explicitly specifies otherwise. All directional references (e.g., proximal, distal, up, down, upward, downward, left, right, lateral, longitudinal, front, back, top, bottom, above, below, vertical, horizontal, radial, axial, clockwise, counterclockwise, etc.) are used solely for identification purposes to aid the reader's understanding of this disclosure, and / or to distinguish areas of related elements from one another, and do not limit the related elements, particularly regarding their location, orientation, or use in this disclosure. Connection references (e.g., attachment, joint, connection, engagement, bonding, etc.) should be interpreted broadly and may include intermediate members between sets of elements and relative movement between elements, unless otherwise stated. Therefore, connection references do not necessarily infer that two elements are directly connected and fixed to each other. Identification references (e.g., primary, secondary, first, second, third, fourth, etc.) are not intended to imply importance or priority, but are used to distinguish one feature from another.

[0067] The following claims are hereby incorporated by reference in this detailed description, each claim being an independent embodiment of this disclosure. In the claims, the terms “comprising,” “including,” “containing,” and “having” do not exclude the presence of other elements, components, features, groups, regions, integers, steps, operations, etc. Furthermore, although individual features may be included in different claims, these may be advantageously combined, and inclusion in different claims does not imply that the combination of features is not feasible and / or advantageous. Moreover, singular references do not exclude plural. Reference numerals in the claims are provided as clarifying examples only and should not be construed as limiting the scope of the claims in any way.

Claims

1. A tissue traction device having a first end and a second end, and comprising: A first segment, the first segment being constructed and adapted for attachment to tissue at a first location within the patient's body; The second segment is configured and adapted for attachment to tissue in the patient body at a second location spaced apart from the first location; as well as At least one weakened region, located between the first end and the second end, is constructed and adapted to be more easily cut by a cutting tool than the surrounding region.

2. The tissue traction device according to claim 1, wherein, The first segment and the second segment are constructed and adapted for attachment to tissue using tissue bonding members.

3. The tissue traction device according to any one of claims 1-2 further includes a tissue engagement member having a first jaw and a second jaw, wherein the first jaw is connected to the first segment.

4. The tissue traction device according to claim 3, wherein, The first segment includes an attachment segment, the size of which is configured to engage and remain in the proper position on the jaws of the tissue engagement member.

5. The tissue traction device according to any one of claims 1-4, wherein, The at least one weakened region is set along at least one of the first segment or the second segment.

6. The tissue traction device according to any one of claims 1-5, wherein, The at least one weakened region is disposed between the first segment and the second segment.

7. The tissue traction device according to any one of claims 1-6, further comprising a third section between the first section and the second section.

8. The tissue traction device according to any one of claims 1-7, wherein, The weakened region is located along an elongated segment that separates the first segment and the third segment and / or separates the second segment and the third segment.

9. The tissue traction device according to any one of claims 1-8, wherein, At least one of the first segment or the second segment includes a ring.

10. The tissue traction device according to any one of claims 1-9, further comprising an attachment section positioned within the first section and sized to engage and hold in a suitable position on the jaws of the tissue engagement member for attaching the tissue traction device to tissue at the first position.

11. An elongated tissue traction device extending between a first end and a second end, the elongated tissue traction device comprising: Two or more distinctly formed segments, which are distinguishable from one another; as well as At least one weakened region, said at least one weakened region along and / or between said two or more differently formed segments, and is constructed and adapted to be more easily cut by a cutting tool than the surrounding area.

12. The tissue traction device according to claim 11, wherein, The at least one weakened region is a stepped diameter-reducing portion along at least one of the two or more differently formed segments.

13. The tissue traction device according to any one of claims 11-12, wherein, The at least one weakened region is located along an elongated segment that separates adjacent, differently formed segments.

14. The tissue traction device according to any one of claims 11-13, further comprising an attachment section sized to engage and hold in a suitable position on the jaws of a tissue engagement member, the tissue engagement member being delivered together with the tissue traction device to a target tissue site.

15. The tissue traction device according to claim 14, wherein, The attachment section is located within the section at the first end of the tissue traction device.

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