Suturing device

Abstract

To provide a system, a suturing device and a method for deployment of a stranded anchor via an endoscope.SOLUTION: The present disclosure relates generally to devices for endoscopic suture ends. In some embodiments, a suturing device 100 may include an elongate member 102 having a working channel 110 and a suture channel 112, the elongate member 102 having a proximal end 106 and a distal end 108. The suturing device 100 may further include a suture extending through the suture channel 112 and a plurality of anchor elements coupled to the suture such that the suture and the plurality of anchor elements may be deployed from the elongate member 102 for engagement with the target tissue 116.SELECTED DRAWING: Figure 2A

Description

[Technical Field]

[0001] The present invention relates to the treatment of tissue defects, and more particularly to systems, devices and methods for tissue closure. [Background technology]

[0002] During surgical procedures performed within body passageways, such as the digestive tract, openings in tissue may be created, for example, by dissection of one or more lesions. Efficient closure of such openings may be hindered if the surgical procedure is performed with instruments not configured for such closure. Accordingly, various advantages may be realized by medical devices and methods for closure of openings in tissue according to the present disclosure. Summary of the Invention

[0003] In various embodiments, the present disclosure generally relates to systems, suturing devices, and methods for endoscopic deployment of stranded anchors. In one or more embodiments, the suturing device may include an elongate member having a working channel and a suture channel, the elongate member having a proximal end and a distal end, and a suture extending through the suture channel. The suturing device may further include a plurality of anchor elements coupled to the suture, the suture and the plurality of anchor elements being deployable from the elongate member for engagement with target tissue. In some embodiments, the suturing device may further include a delivery device extending within the suture channel and usable to deploy the anchor elements of the plurality of anchor elements. In some embodiments, the delivery device may be retractable toward the proximal end of the elongate member to deploy the anchor elements of the plurality of anchor elements. In some embodiments, the anchor elements of the plurality of anchor elements may include a plurality of legs biasable from a first, contracted configuration to a second, expanded configuration upon deployment, and an attachment device coupled to the plurality of legs, the attachment device being directly connected to the suture. In some embodiments, the attachment device may be a loop that encircles the suture wire. In some embodiments, the suturing apparatus may further include an instrument within the working channel that can be used to deform the attachment device to secure the anchor elements to the suture wire. In some embodiments, each of the multiple anchor elements may be positioned along a suture axis within the delivery device prior to deployment. In some embodiments, the delivery device may extend beyond the distal end of the elongate member.

[0004] In one or more embodiments, the endoscopic medical instrument may include an elongate member having a working channel and a suture channel, the elongate member having a proximal end and a distal end, and a delivery device extending through the suture channel. The endoscopic medical instrument may further include a suture extending through the delivery device and a plurality of anchor elements coupled to the suture, the suture and the plurality of anchor elements being deployable from the delivery device for engagement with the target tissue. In some embodiments, the delivery device is extendable toward the target tissue prior to deployment to position a distal-most anchor element of the plurality of anchor elements adjacent to the target tissue. In some embodiments, the delivery device is retractable toward the proximal end of the elongate member to deploy the distal-most anchor element of the plurality of anchor elements. In some embodiments, each of the plurality of anchor elements may include a plurality of legs that can be biased from a first, contracted configuration to a second, expanded configuration upon deployment. Each of the anchor elements may further include an attachment device coupled to the plurality of legs, the attachment device being directly connected to the suture. In some embodiments, the attachment device includes a loop that encircles the suture wire. In some embodiments, the endoscopic medical instrument may further include an instrument within the working channel that can be used to deform the attachment device and secure the anchor element to the suture wire. In some embodiments, the delivery device may extend beyond the distal end of the elongate member.

[0005] In one or more embodiments, a method may include inserting a suturing device into a patient for treatment of a target tissue, the suturing device including: an elongate member having a working channel and a suture channel, the elongate member having a proximal end and a distal end; a delivery device extending through the suture channel; and a plurality of anchor elements coupled to a suture, the plurality of anchor elements and the suture disposed within the delivery device. The method may further include deploying the suture and one or more of the plurality of anchor elements for engagement with the target tissue. In some embodiments, the method may further include extending the delivery device toward the target tissue to position a distal-most anchor element of the plurality of anchor elements adjacent to the target tissue, and retracting the delivery device toward the proximal end of the elongate member to deploy the distal-most anchor element of the plurality of anchor elements. In some embodiments, the method may further include biasing a plurality of legs of the distal-most anchor element from a first, contracted configuration to a second, expanded configuration upon deployment. In some embodiments, the method may further include securing one or more of the plurality of anchor elements to a suture. In some embodiments, the method may further include extending a suture through each attachment device of the plurality of anchor elements.

[0006] One or more of the various features summarized above may be substituted for, exchanged with, combined with, or substituted for other features summarized above for use in connection with the medical systems and methods summarized above, and with respect to the embodiments described in more detail below and other embodiments within the scope of the present disclosure.

[0007] Non-limiting embodiments of the present disclosure are described, by way of example, with reference to the accompanying drawings, which are not drawn to scale. In the figures, each identical or nearly identical illustrated component is typically represented by a single numeral. For clarity, not every component is labeled in every view, nor are every component of each embodiment shown unless illustration is necessary to enable those skilled in the art to understand the disclosure. Furthermore, some of the drawings include cross-sectional views in the form of "slices" or "close-up" cross-sections, which, for clarity, omit certain background lines or shapes that would appear in a "true" cross-section. [Brief explanation of the drawings]

[0008] [Figure 1A] 10A-10C illustrate various examples of stitching patterns according to embodiments of the present disclosure. [Figure 1B] 10A-10C illustrate various examples of stitching patterns according to embodiments of the present disclosure. [Figure 1C] 10A-10C illustrate various examples of stitching patterns according to embodiments of the present disclosure. [Figure 2A] FIG. 1 is a perspective view of a system according to an embodiment of the present disclosure. [Figure 2B] FIG. 2B is a side view of a handle for operating the system of FIG. 2A according to an embodiment of the present disclosure. [Figure 2C] FIG. 2B is a side view of a handle for operating the system of FIG. 2A according to an embodiment of the present disclosure. [Figure 3] 2B is a side cross-sectional view of the system of FIG. 2A according to an embodiment of the present disclosure. [Figure 4A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 4B] 4B illustrates a suture pattern obtained by the system of FIG. 4A according to an embodiment of the present disclosure. [Figure 5A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 5B] 5B illustrates a suture pattern obtained by the system of FIG. 5A according to an embodiment of the present disclosure. [Figure 6A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 6B] 6B illustrates a suture pattern obtained by the system of FIG. 6A according to an embodiment of the present disclosure. [Figure 7A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 7B] 7B illustrates a suture pattern obtained by the system of FIG. 7A according to an embodiment of the present disclosure. [Figure 8A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 8B] 8B illustrates a suture pattern obtained by the system of FIG. 8A according to an embodiment of the present disclosure. [Figure 9A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 9B] 9B illustrates a suture pattern obtained by the system of FIG. 9A according to an embodiment of the present disclosure. [Figure 10A] FIG. 2B is a side view of the system of FIG. 2A in use, according to an embodiment of the present disclosure. [Figure 10B] 10B illustrates a suture pattern obtained by the system of FIG. 10A according to an embodiment of the present disclosure. [Figure 11] FIG. 1 is a flow diagram of a method according to an embodiment of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0009] The present disclosure is not limited to the specific embodiments described herein. The terms used herein are intended to describe specific embodiments only and are not intended to limit the scope of the appended claims. Unless otherwise defined, the technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

[0010] Medical trends are shifting from laparoscopic and open surgery to miniaturized endoscopic surgery. Endoscopists are able to perform more complex non-invasive or minimally invasive procedures under direct visualization. Current endoscopes provide working channels that allow the use of specialized instruments for such treatment, but may not include specific functionality for treating and manipulating the tissue being accessed and inspected. There is a need for endoscopes with built-in specific treatment capabilities. Such endoscopes could facilitate a wide range of procedural interventions that are increasingly prevalent in hospitals and could lead to the development of significantly more sophisticated and complex scope designs.

[0011] Additionally, infection prevention and control in clinical settings has created a demand for disposable scopes to reduce the risk of patient infection and associated serious adverse events. For example, currently available duodenoscopes often include distal ends with complex mechanical geometries. Such complexity can make it difficult to properly disinfect reusable scopes between procedures, potentially contributing to patient infections.

[0012] Embodiments include closure devices fabricated from a superelastic material such as Nitinol, although other materials, such as polymers, with suitable elastic properties may be used. In some embodiments, the closure device may be delivered through an endoscope, and in other embodiments, the closure device may be delivered through a needle. The closure device may be disposed within a lumen of a delivery device and delivered to the target tissue site in a straight / constrained configuration. The delivery device may deploy the closure device beyond the distal end of the device / lumen. Upon deployment, the closure device may assume a configuration that facilitates engagement of opposing portions of the target tissue.

[0013] Additionally, the present disclosure may relate to medical devices, such as endoscopes, gastroscopes, bronchoscopes, colonoscopes, ureteroscopes, and the like, having an integrated configuration for capturing, manipulating, and closing an opening in a target tissue. While a single-use endoscope is described herein, it will be understood that embodiments of the present disclosure may also be included in reusable medical devices, such as endoscopes. As described in more detail below, embodiments herein provide suturing devices, systems, and methods that include an integrated mechanism that facilitates the execution of a variety of different suturing patterns for closing tissue. For example, one type of integrated mechanism may be a set of anchors continuously stranded, e.g., serially linked, into a suture line that can be delivered through a channel in an elongate member of the suturing device. In use, each anchor may be compressed or constrained within a delivery tube and may be expanded or unconstrained upon deployment into tissue. The anchors may be fabricated from a shape memory alloy or a programmable polymer to achieve both the compressed and expanded configurations.

[0014] Current endoscopic suturing may be performed according to one or more suture patterns, which refers to the design or layout of the sutures across the target tissue during and / or after the suturing procedure. For example, FIG. 1A shows an example of a suture pattern in which each of sutures 5A-5N may be a discontinuous or interrupted portion of suture wire secured around the circumference 10 of target tissue 15. In this case, each of sutures 5A-5N represents a suture line that has been cut and secured in the arrangement shown. Without limitation, sutures 5A-5N extend substantially parallel to one another across target tissue 15.

[0015] Another example of a suture pattern is shown in Figure 1B, in which a single continuous suture 5 may be sewn around the periphery 10 of the target tissue 15. In this case, the suture 5 may pass through the target tissue 15 multiple times without cutting or breaking the suture 5. Without limitation, the suture 5 may extend across the target tissue 15 in a zigzag configuration.

[0016] Another example of a suture pattern is shown in Figure 1C, where one or more sutures 5 may be threaded around the circumference 10 of the target tissue 15, for example, in a substantially figure-of-eight configuration. In this case, the suture 5 may be a single continuous suture line or multiple suture lines. This figure-of-eight suture pattern may be particularly beneficial for treating fistulas, for example.

[0017] 2A , the elongate member 102 of a suturing device or system 100 according to an embodiment of the present disclosure will be described in more detail. As shown, the elongate member 102 may be a hollow tube, such as the distal end of an endoscope, gastroscope, bronchoscope, colonoscope, ureteroscope, or the like. The elongate member 102 may include a proximal portion 106 opposite the distal end 108. In some embodiments, the elongate member 102 may be a flexible material, including silicone to allow for flexing of the scope, thermoplastic elastomers including polyamide and polyether backbone blocks, polyurethane, or the like. In other embodiments, the elongate member 102 may be a rigid material, such as polycarbonate, acrylonitrile butadiene styrene (ABS), or the like, to provide a more direct positioning response.

[0018] As further shown, the elongate member 102 may have a working channel 110 and a suture channel 112 extending between the proximal end 106 and the distal end 108. Without limitation, the working channel and the suture channel 112 may extend generally parallel to one another within the elongate member 102. The working channel 110 may accommodate instruments such as visualization tools, cutting tools, and manipulation tools. In other embodiments, the elongate member 102 may include, for example, one or more integrated visualization and / or illumination devices 113 (e.g., a wired or wireless camera and / or LEDs and / or fiber optics) disposed along its distal surface 114. The suture channel 112 may include a delivery device 115 extending therethrough, which can be used to deploy multiple anchor elements (not shown) into the target tissue 116. In some embodiments, the delivery device 115 may be a sheath or tube linearly movable within the suture channel 112. Although a single working channel 110 and suture channel 112 are shown, it will be understood that in other embodiments, more channels may be present within elongate member 102 .

[0019] 2B-2C , a user interface or handle 150 for operating the system 100 according to a non-limiting embodiment of the present disclosure will be described. As shown, the handle 150 may include a body 151 and one or more controls, such as a first rotary dial 152, a second rotary dial 153, and a locking hinge 154. The suture channel 112 and the working channel 110 extend through the body 151, and the suture 120 and the delivery device 115 extend through the suture channel 112. In use, as shown in FIG. 2B , the locking hinge 154 may be released to allow the second rotary dial 153 to move away from the body 151, thereby allowing movement of the delivery device 115, for example, along the direction indicated by arrow 157. While not shown in detail, the second rotary dial 153 may include one or more mechanical features usable to engage / disengage with the delivery device 115.

[0020] As shown in FIG. 2C , after suturing, the delivery device 115 may be retracted along the direction indicated by arrow 158 to deploy a set of anchors (not shown) stranded on the suture line 120. To accomplish this, tension may be maintained on the suture 120 by anchors 159 on the body 151 while the second rotary dial 153 is engaged with the delivery device 115. Rotation of the second rotary dial 153 (e.g., in the direction indicated by arrow 161) moves the delivery device 115 axially within the suture channel 112. In some embodiments, the locking hinge 154 may enable fine advancement of the delivery device 115. For example, the locking hinge 154 may include a lever 163 and one or more restraining features (not shown) actuable by a mechanical detent 165 on the second rotary dial 153 to divide the rotation of the second rotary dial into discrete increments. The embodiments herein are not limited in this context. As shown in FIG. 3 , the system 100 may further include a suture 120 extending through the suture channel 112. More specifically, the suture 120 may extend through the interior of the delivery device 115 to deploy one or more anchor elements 122 within the target tissue 116. The delivery device 115 may extend beyond the distal end 108 of the elongate member 102 to deploy the anchor elements 122. In some embodiments, each anchor element 122 may include multiple legs 124 that can be biased from a first, contracted configuration when disposed within the delivery device 115 to a second, expanded configuration upon deployment from the distal end 126 of the delivery device 115. For example, the multiple legs 124 may be coupled to connection points 135 disposed along the suture axis 123. Each of the multiple legs 124 may include a fixed end and a free end, and the free end may extend toward the distal end 108 of the elongate member 102. After being released from the distal end 126 of the delivery device 115, the legs 124 may swing away from the suture axis 123 and pivot about the connection point 135. The inner surface 137 of the delivery device 115 may physically restrain the legs 124 to maintain the anchor element 122 in a contracted configuration prior to deployment.

[0021] Upon deployment, the legs 124 of the anchor element 122 may initially function as a straight stylet, piercing the target tissue 122 as it is deployed. In some embodiments, the legs 124 may extend at least partially beyond the distal end 126 of the delivery device 115, allowing the legs 124 to be an initial point of engagement with the target tissue 116. In other embodiments, the distal end 126 of the delivery device 115 may initially penetrate the target tissue 116, for example, using a needle or electrocautery. In still other embodiments, the distal end 126 of the delivery device 115 may abut or engage the target tissue 116 without penetrating it. The anchor element 122 may then be deployed into the target tissue 116. Without limitation, the anchor element 122 may be fabricated from a shape memory alloy or a programmable polymer to achieve both a compressed and an expanded configuration.

[0022] As further shown, anchor element 122 may include an attachment device 128 coupled to the plurality of legs 124, the attachment device 128 further connected to suture 120. For example, attachment device 128 may be a loop that extends around suture 120. The loop may be sized to allow suture 120 to pass freely therethrough. As described in more detail below, attachment device 128 may be deformed or crimped to secure attachment device 128 to suture 120 after engagement of the plurality of legs 124 with target tissue 116.

[0023] 4A-9B, non-limiting examples illustrating the operation of system 100 will be described in more detail. It will be understood that FIGS. 4A, 5A, 6A, 7A, 8A, and 9A illustrate side views of system 100 in use, and FIGS. 4B, 5B, 6B, 7B, 8B, and 9B illustrate corresponding suturing patterns that may be achieved. As initially shown in FIGS. 4A-4B, elongate member 102 may be directed to a location proximal to target tissue 116 corresponding to a tissue site containing a laceration, defect, or opening to be closed by suture 120. Delivery device 115 may extend from distal end 108 of elongate member 102 when directed to contact or be positioned directly adjacent target tissue 116, for example, along a perimeter 134 that surrounds target tissue 116. Without limitation, the delivery device 115 may be relatively upright (ie, perpendicular) to the target tissue 116 to allow for better delivery of the anchor elements 122 .

[0024] Next, as shown in FIGS. 5A-5B , the first, most distal anchoring element 122A may be deployed from the delivery device 115 as the delivery device 115 traverses the periphery 134. In some embodiments, the delivery device 115 is retracted into the suture channel 112 of the elongate member 102. As shown, the suture 120 may extend adjacent to the first anchoring element 122A, which extends both inside and outside the delivery device 115. As shown in FIGS. 6A-6B , the elongate member 102 may continue to move along the periphery 134, allowing the first anchoring element 122A to fully deploy from the delivery device 115. More specifically, the plurality of legs 124 are expanded to secure the first anchoring element 122A in place within the target tissue 116. Additionally, the suture 120 may extend through an opening in the attachment device 128. 7A-7B, one or more additional anchoring elements 122B-122E may be further deployed at desired locations in or around the target tissue 116. In the non-limiting embodiment shown, the suture 120 may be patterned in a "W" configuration around the perimeter 134 of the target tissue 116. However, it will be understood that many alternative suture and anchoring element configurations are possible within the scope of the present disclosure.

[0025] Next, as shown in FIGS. 8A-8B , a first tool 140 may extend from the working channel 110 of the elongate member 102 and engage one of the anchoring elements 122A-122E. For example, the first tool 140 may be a crimping tool that can be used to deform the attachment device 128 around the suture 120 to prevent the suture 120 from moving relative to the attachment device 128. In some embodiments, after the last anchoring element (e.g., anchoring element 122E) is deployed, the suture 120 may be tightened to close the defect in the target tissue 116. The anchoring element 122E may then be crimped and the suture 120 may be severed, as shown in FIGS. 9A-9B . In some embodiments, a second tool 144 (e.g., a cutting tool) may be inserted through the working channel 110 to sever the suture 120 at a location between the anchoring element 122E and the distal end 108 of the elongate member 102. 10A-10B, first tool 140 may be extended again through working channel 110 to crimp one or more of anchoring elements 122A-122D. In other embodiments, some or all of anchoring elements 122A-122E may be crimped prior to severing suture 120. In other words, it may be more efficient to remove first tool 140 from working channel 110 and crimp all of anchoring elements 122A-122E before inserting second tool 144. In yet other embodiments, there may be multiple working channels that allow for both first tool 140 and second tool 144 to be used sequentially.

[0026] 11 is a flow diagram of a method 200 according to an embodiment of the present disclosure. At block 201, the method 200 comprises inserting into a patient a suturing apparatus for treatment of a target tissue, the suturing apparatus including an elongate member having a working channel and a suture channel, the elongate member having a proximal end and a distal end, a delivery device extending through the suture channel, and a plurality of anchor elements coupled to a suture, the plurality of anchor elements and the suture disposed within the delivery device.

[0027] At block 203, method 200 includes deploying a suture and one or more anchor elements of the plurality of anchor elements for engagement with the target tissue. In some embodiments, the delivery device may be extended toward the target tissue to position the distal-most anchor element of the plurality of anchor elements adjacent the target tissue. The delivery device may then be retracted toward the proximal end of the elongate member to deploy the distal-most anchor element of the plurality of anchor elements.

[0028] In some embodiments, the anchoring elements may each include multiple legs connected to an attachment device. When the anchoring elements are deployed from a delivery device into a target tissue, the multiple legs may be biased from a first contracted configuration to a second expanded configuration within the target tissue. In some embodiments, the attachment device may connect the anchor elements to a suture. In some embodiments, the suture may extend through the attachment device, for example, if the attachment device includes a loop or channel.

[0029] At block 205, method 200 may optionally include tensioning the suture to close the defect. In some embodiments, the target tissue may be clamped inward to close the opening or laceration. At block 207, method 200 may optionally include deforming the attachment device of one or more anchoring elements. In some embodiments, a first tool, such as a crimper, may be placed within the working channel of the elongate member. The crimper may extend from the distal end of the elongate member and crimp the attachment device to secure the anchoring elements in place along the suture wire.

[0030] At block 209, the method 200 may optionally include severing the suture to complete the suturing procedure. In some embodiments, a second tool, such as a knife or blade, may extend from the working channel to sever the suture between one of the anchoring elements and the elongate member. With the suture secured with the anchoring elements, the suture will not unravel.

[0031] It will be appreciated that a variety of different materials may be used in the manufacture of the devices described herein. In some cases, a variety of different metals may be used. Illustrative, non-limiting examples of suitable metals include titanium, stainless steel, magnesium, cobalt chrome, and the like. In some embodiments, for example, the devices described herein may comprise any suitable polymeric material, including biocompatible materials such as polyurethane or silicone. Other suitable polymers include, but are not limited to, polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene (FEP), polyoxymethylene (POM, e.g., DELRIN® available from DuPont), polyether block esters, polyurethanes (e.g., polyurethane 85A), polypropylene (PP), polyvinylchloride (PVC), polyether-esters (e.g., DSM Engineering Plastics), and the like. ARNITEL® available from DuPont Plastics), ether or ester copolymers (e.g., butylene / poly(alkylene ether) phthalates and / or other polyester elastomers such as HYTREL® available from DuPont), polyamides (e.g., DURETHAN® available from Bayer or CRISTAMID® available from Elf Atochem), elastomeric polyamides, block polyamide / ethers, polyether block amides (e.g., polyether block amide (PEBA) available under the trade name PEBAX®), ethylene vinyl acetate copolymers (EVA), and the like.copolymer), silicone, polyethylene (PE), Marlex high density polyethylene, Marlex low density polyethylene, linear low density polyethylene (e.g., REXELL®), polyester, polybutylene terephthalate (PBT), polyethylene terephthalate (PET), polytrimethylene terephthalate, polyethylene naphthalate (PEN), polyetheretherketone (PEEK), polyimide (PI), polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide (PPO), polyparaphenylene terephthalamide (e.g., KEVLAR®), polysulfone, nylon, nylon-12 (EMS American Grillon) The polymers may include, but are not limited to, GRILAMID® available from Grillon, perfluoro(propyl vinyl ether) (PFA), ethylene vinyl alcohol, polyolefins, polystyrene, epoxies, polyvinylidene chloride (PVdC), poly(styrene-b-isobutylene-b-styrene) (e.g., SIBS and / or SIBS 50A), polycarbonates, ionomers, biocompatible polymers, other suitable materials, or mixtures, combinations, copolymers, polymer / metal composites, and the like.

[0032] Some embodiments may be described using the terms "coupled" and "connected," along with their derivatives. These terms are not intended as synonyms for each other. For example, some embodiments may be described using the terms "connected" and / or "coupled" to indicate that two or more elements are in direct physical or electrical contact with each other. However, the term "coupled" may also mean that two or more elements are not in direct contact with each other, but still cooperate or interact with each other.

[0033] All directional references (e.g., proximal, distal, upper, lower, upward, downward, left, right, side, longitudinal, front, back, top, bottom, up, down, vertical, horizontal, radial, axial, clockwise, counterclockwise) are used for identification purposes only to aid the reader in understanding this disclosure and are not intended to impose any limitations as to the location, orientation, or use of the particular disclosure. Without limitation, when used herein with respect to an elongate member, the term "proximal" may refer to the portion of the endoscope closest to the system's handle or user interface, and the term "distal" may refer to the portion of the endoscope furthest from the system's handle or user interface.

[0034] As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms thereof unless the context clearly dictates otherwise. It will be further understood that as used herein, the terms "comprise" and / or "comrising" or "includes" and / or "including" specify the presence of stated features, regions, steps, elements, and / or components, but do not exclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components, and / or groups.

[0035] Furthermore, the terms "substantial" or "substantially" and "approximately" or "approximately" can be used interchangeably in some embodiments and can be described using any relative measure accepted by those skilled in the art. For example, these terms can serve as a comparison to a reference parameter to indicate a deviation that still provides the intended function. Without limitation, deviation from the reference parameter can be, for example, less than 1%, less than 3%, less than 5%, less than 10%, less than 15%, less than 20%, etc.

[0036] Although specific embodiments have been illustrated and described herein, it will be understood that any configuration calculated to achieve the same purpose may be substituted for the specific embodiments shown. The present disclosure is intended to cover any and all adaptations or modifications of the various embodiments. It is understood that the above description is illustrative only and not limiting. Combinations of the above embodiments with other embodiments not specifically described herein will be apparent to those skilled in the art upon reviewing the above description. Accordingly, the scope of the various embodiments includes any other applications in which the above compositions, structures, and methods are used.

[0037] Furthermore, although exemplary method 200 is described above as a series of acts or events, unless specifically stated, the present disclosure is not limited to the exemplary ordering of such acts or events. For example, some acts may occur in a different order or concurrently with other acts or events, or separately from what is illustrated and described herein according to the disclosure. Furthermore, not all illustrated acts or events are required to implement a methodology according to the present disclosure.

[0038] Although the present subject matter has been described in terms of particular structural features and / or methodological acts, it should be understood that the present subject matter defined in the appended claims is not necessarily limited to the specific features or acts described above. Rather, the specific features and acts described above are disclosed as example forms of implementing the claims.

Claims

1. an elongate member having a working channel and a suture channel, the elongate member having a proximal end and a distal end; a suture extending through the suture channel; a plurality of anchor elements coupled to the suture, the suture and the plurality of anchor elements being deployable from the elongate member for engagement with target tissue.

2. The suturing apparatus of claim 1 , further comprising a delivery device extending within the suture channel.

3. The suturing apparatus of claim 2 , wherein the delivery device is axially movable within the suture channel toward the proximal and distal ends of the elongate member.

4. Each of the plurality of anchor elements is a plurality of legs that can be biased from a first contracted configuration to a second expanded configuration; The suturing apparatus of any one of claims 1 to 3, comprising an attachment device coupled to the plurality of legs, the attachment device engaging the suture.

5. The suturing apparatus of claim 4 , wherein the attachment device comprises a loop that encircles the suture wire.

6. The suturing device of any one of claims 1 to 5, further comprising an instrument within the working channel that can be used to deform the loop to secure the anchor element to the suture wire.

7. The suturing apparatus of claim 6 , wherein the instrument extends beyond the distal end of the elongate member to engage the attachment device.

8. The suturing device of any one of claims 4 to 5, wherein the plurality of legs extend partially beyond the distal end of the delivery device to enable the plurality of legs to initially engage the target tissue.

9. The suturing device of any one of claims 4 to 5, wherein the plurality of legs are connected together at connection points disposed along a suture axis.

10. The suturing device of claim 9 , wherein the plurality of legs expand away from the suturing shaft upon deployment.

11. The suturing apparatus of any one of claims 9 to 10, wherein each of the plurality of anchor elements is positioned along a suture axis within the delivery device prior to deployment.

12. The suturing apparatus of claim 2 , wherein the delivery device extends beyond the distal end of the elongate member.

13. The suturing apparatus of claim 12, wherein an inner surface of the delivery device abuts the plurality of anchor elements such that the plurality of anchor elements maintain a contracted configuration within the elongate member.

14. The suturing device of any one of claims 1 to 13, wherein the plurality of anchor elements comprise a shape memory material.

15. The suturing device of any one of claims 1 to 14, wherein the elongate member further comprises a visualization device along a distal surface.

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