Interface mechanism for repositioning and deployment of over-the-scope clips

Abstract

A system for treating tissue includes a cap mounted on a distal end of an endoscope, and a clip mountable on the cap and including first and second jaws that are movably coupled to one another between an insertion configuration in which the first and second jaws extend onto the cap to receive target tissue therebetween, an inspection configuration in which at least a portion of the clip extends within a field of view of the endoscope's optical system, and a deployed configuration in which the clip is moved distally away from the cap and the first and second jaws are drawn toward one another. A control element is configured to move the clip from the insertion configuration to the inspection configuration by proximal movement through the cap a first distance and to move the clip from the inspection configuration to the deployed configuration by a second distance.

Description

[Technical field]

[0001] The present disclosure relates to endoscopic devices, and more particularly, to endoscopic clipping devices for treating tissue along the gastrointestinal tract. [Background technology]

[0002] Physicians are becoming more willing to perform aggressive interventional and therapeutic endoscopic gastrointestinal (GI) procedures, which may increase the risk of perforating the wall of the GI tract or may require closure of the GI tract wall as part of the procedure. Such procedures may include, for example, removal of large lesions, tunneling under the mucosal layer of the GI tract to treat tissue below the mucosa, full thickness removal of tissue, entering the body via the GI tract and penetrating tissue to exit the GI tract to operate on tissue outside the GI tract, as well as endoscopic treatment / repair of post-operative problems (e.g., post-operative leakage, failure of surgical staple lines, and anastomotic leakage).

[0003] Currently, tissue may be treated via endoscopic closure devices, including through-the-scope clips or over-the-scope clips. Over-the-scope clips may be particularly useful for achieving closure of larger tissue defects. These endoscopic closure devices may save hospitals money and provide benefits to patients. However, in some cases, current endoscopic closure devices may be difficult to use, time-consuming to position, or inadequate for certain perforations, conditions, and anatomical shapes. For example, current over-the-scope clips generally require the clip to be delivered from a position where the clip itself is not visible to the operator. That is, prior to clipping, the operator may visualize the target tissue to be clipped, and based on this visualization of the target tissue, may determine that the distal end of the device and the clip are in the desired position relative to the target tissue. Then, based on observation of the target tissue, the operator deploys the clip without being able to see the clip itself until it is deployed. Summary of the Invention

[0004] The present embodiment relates to a clipping system for treating tissue, including a cap. The cap is configured to be mounted on a distal end of an endoscope, the cap extending longitudinally from a proximal end to a distal end and including a channel extending therethrough such that the cap may be positioned adjacent to a target tissue in vivo. The clip is configured to be mounted on the cap, the clip including a first jaw and a second jaw, the first jaw and the second jaw being movably coupled to one another via a hinge biased to draw the first jaw and the second jaw toward one another, the clip being configured to: (a) extend on the cap such that the first jaw and the second jaw are spaced apart from one another to receive the target tissue therebetween and to avoid obstructions to the optics of the endoscope to which the cap is mounted; The clip is movable relative to the cap between (a) an insertion configuration in which the clip is moved distally relative to the cap such that at least a portion of the clip extends distally until the clip extends within the field of view of the optical system of an endoscope to which the cap is attached, and (b) a deployed configuration in which the clip is moved distally away from the cap such that the first and second jaws are drawn toward one another under the bias of the hinge to close and clip tissue received between the first and second jaws. The control element extends from a distal end releasably coupled to the clip, through a channel in the cap and the endoscope to which it is coupled, to a proximal end, and in use the control element remains outside of the living body while the cap is adjacent to the target tissue. The control element is configured such that proximal movement of the control element through the cap moves the clip distally relative to the cap, and such that proximal movement of the control element a first distance through the cap moves the clip from the insertion configuration to the inspection configuration, and such that proximal movement of the control element a second distance through the cap moves the clip from the inspection configuration to the deployed configuration.

[0005] In one embodiment, the system may further include an actuation assembly coupled to a proximal end of the control element, the actuation assembly including a first actuator configured, upon actuation, to move the control element proximally a first distance through the endoscope to move the clip from the insertion configuration to the inspection configuration.

[0006] In one embodiment, the first actuator may include a first elongate member and a second elongate member pivotally connected to one another, such that when proximal portions of the first elongate member and the second elongate member are drawn toward one another, distal portions of the first elongate member and the second elongate member are correspondingly drawn toward one another.

[0007] In one embodiment, the actuation assembly may further include a second actuator configured such that, upon actuation, the control element is moved proximally a second distance through the endoscope to move the clip from the inspection configuration to the deployed configuration.

[0008] In one embodiment, the actuating assembly may further include a moving element and a pulley mechanism, where the control element is routed through the pulley mechanism to be coupled to the moving element, such that when the first elongated member and the second elongated member are drawn toward each other, the moving element moves from a proximal position toward a distal position relative to the housing of the actuating assembly to pull the control element proximally through the endoscope, thereby moving the clip from the insertion configuration toward the inspection configuration.

[0009] In one embodiment, the second actuator may include a push button including a tab that extends into the housing of the actuation assembly, such that when the clip is in the inspection configuration, pressing the push button applies additional tension along the control element, engaging a portion of the control element such that the clip moves from the inspection configuration toward the deployed configuration.

[0010] In one embodiment, the actuation assembly may further include a biasing element that biases the first actuator toward the insertion configuration. In one embodiment, the actuation assembly may include a locking mechanism for locking the clip into the service configuration.

[0011] In one embodiment, the first actuator may include a handle portion configured to be grasped by an operator of the system and a lever movably coupled to the handle portion, wherein a proximal end of a control element is coupled to the lever such that when the lever is pressed against the handle portion, the control element moves proximally a first distance through the endoscope to move the clip from the insertion configuration toward the inspection configuration.

[0012] In one embodiment, the first actuator may include a housing and a rotation handle rotatably coupled to the housing, with a proximal end of a control element connected to a moving element that is threadably coupled to a portion of the rotation handle, and rotation of the rotation handle relative to the housing moves the control element proximally through the endoscope.

[0013] The present embodiment also relates to a clipping system for treating tissue comprising an endoscope including a shaft extending longitudinally from a proximal end to a distal end. A cap extending longitudinally from the proximal end to the distal end includes a channel extending through the cap such that the cap is slidably mounted on a distal portion of the shaft of the endoscope. The clip includes a first jaw and a second jaw movably coupled to one another via a plurality of hinges, at least one of the plurality of hinges being biased to draw the first jaw and the second jaw toward one another, and the clip is mountable on the cap such that the first jaw and the second jaw extend over opposite sides of the cap such that the first jaw and the second jaw are spaced apart from one another to receive target tissue therebetween. Distal movement of the cap relative to the endoscope from a proximal position along the endoscope to a distal position along the endoscope moves the clip from an insertion configuration to an inspection configuration where the clip extends distally until at least a portion of the clip extends within the field of view of the optical system of the endoscope. Distal movement of the clip relative to the cap moves the clip from an inspection configuration to a deployed configuration where the clip moves distally away from the clip and where the first and second jaws are drawn together under the bias of the at least one hinge to close on tissue received therebetween. The repositioning element extends from a distal end coupled to the cap, through a channel in the cap and the endoscope to a proximal end, and remains outside the living body in use. The repositioning element is configured to move the cap distally along the endoscope from the insertion configuration to the inspection configuration by moving the repositioning element proximally through the endoscope. The deployment element extends from a distal end releasably coupled to the clip, through a channel in the cap and the endoscope to a proximal end, and remains outside the living body during use, The deployment element is configured such that proximal movement of the deployment element through the endoscope moves the clip distally relative to the cap toward the deployed configuration.The actuation assembly includes a first actuator configured to control movement of the repositioning element and a second actuator configured to control movement of the deployment element.

[0014] In one embodiment, the actuation assembly further comprises a housing through which the proximal ends of the repositioning element and the deployment element extend to be coupled to the first and second actuators.

[0015] In one embodiment, the first actuator may include a lever pivotally connected to the handle, with a proximal end of the repositioning element connected to a portion of the handle such that movement of the lever toward the housing moves the repositioning element proximally through the endoscope to move the cap and clip from the insertion configuration toward the inspection configuration.

[0016] In one embodiment, the second actuator may include a push button extending into the housing and coupled to a proximal end of the deployment element, such that as the push button is pushed further into the housing, the deployment element moves proximally through the endoscope and the clip moves distally relative to the cap from the inspection configuration toward the deployment configuration.

[0017] In one embodiment, the system may further include a biasing element extending between the distal end of the cap and a stop at the distal-most end of the endoscope to which the cap is attached, the biasing element biasing the cap toward the insertion configuration with the entirety of the clip mounted on the cap proximal to the distal-most end of the endoscope, such that when the lever is released, the cap and clip return toward the insertion configuration.

[0018] The present embodiment also relates to a method for treating tissue, in which a clip is inserted through an endoscope into a target area in a body lumen in an insertion configuration, the clip being mounted on a distal end of the endoscope through a transparent cap, the proximal end of the cap extending over the distal end of the endoscope, the distal portion of the cap extending distally from the distal end of the endoscope, and the clip being mounted on a proximal portion of the cap such that the jaws of the clip are spaced apart from each other. Suction is applied through a working channel of the endoscope, thereby drawing tissue into the channel of the cap and between the jaws of the clip. A first actuator is actuated to move a control element releasably coupled to the clip proximally a first distance through the endoscope to move the clip towards an inspection configuration. In the inspection configuration, the clip is moved distally along the cap such that the clip extends over a distal portion of the cap such that the clip is within the field of view of the endoscope in the inspection configuration. When the clip is in the inspection configuration, it is determined whether the clip is in a desired position relative to the target tissue. While the clip is in the inspection configuration, the second actuator is actuated to apply additional tension to the control element, which moves the control element further proximally relative to the endoscope a second distance and moves the clip distally away from the cap toward the deployed configuration in which the clip moves back toward the biased closed configuration in which the jaws are drawn together to grasp tissue therebetween. [Brief description of the drawings]

[0019] [Figure 1] 1 is a longitudinal side view of a distal portion of a tissue clipping system according to an exemplary embodiment of the present disclosure, in an insertion configuration. [Diagram 2] FIG. 2 is a longitudinal side view of a distal portion of the system of FIG. 1 in an inspection configuration. [Diagram 3] FIG. 2 is a longitudinal side view of a distal portion of the system of FIG. 1 in a deployed configuration. [Figure 4] 2 is a perspective view of an actuation assembly for controlling movement of a clip by the system of FIG. 1. [Diagram 5] 5 is a cross-sectional longitudinal side view of the actuation assembly of FIG. 4 in a first configuration. [Figure 6] 5 is a cross-sectional longitudinal side view of the actuation assembly of FIG. 4 in a second configuration. [Figure 7] FIG. 13 is a perspective view of an actuation assembly according to another exemplary embodiment of the present disclosure. [Figure 8] FIG. 8 is another perspective view of the actuation assembly of FIG. [Figure 9] 8 is a cross-sectional side view of the actuation assembly of FIG. 7 in a first configuration. [Figure 10] 8 is a side cross-sectional view of the actuation assembly of FIG. 7 in a second configuration. [Figure 11] FIG. 13 is a perspective view of an actuation assembly according to another exemplary embodiment of the present disclosure. [Figure 12] FIG. 12 is a side view of the actuation assembly of FIG. [Figure 13] 12 is a cross-sectional side view of the actuation assembly of FIG. 11 in a first configuration. [Figure 14] 12 is a cross-sectional side view of the actuation assembly of FIG. 11 in a second configuration. [Figure 15] 12 is another cross-sectional side view of the actuation assembly of FIG. 11 in a first configuration. [Figure 16] 12 is another cross-sectional side view of the actuation assembly of FIG. 11 in a second configuration. [Figure 17] FIG. 13 is a perspective view of an actuation assembly according to yet another exemplary embodiment of the present disclosure. [Figure 18] FIG. 18 is a transparent perspective view of the actuation assembly of FIG. 17. [Figure 19] FIG. 18 is a cross-sectional side view of the actuation assembly of FIG. 17. [Figure 20] FIG. 18 is a transparent perspective view of a distal portion of the actuation assembly of FIG. 17. [Figure 21] 13 is a longitudinal side view of a distal portion of a tissue clipping system according to another exemplary embodiment of the present disclosure, in an insertion configuration; FIG. [Figure 22]FIG. 22 is a longitudinal side view of a distal portion of the system of FIG. 21 in an inspection configuration. [Diagram 23] FIG. 22 is a longitudinal side view of a distal portion of the system of FIG. 21 in an inspection configuration. [Figure 24] 22 is a perspective view of an actuation assembly for controlling movement of a clip by the system of FIG. 21. [Diagram 25] FIG. 25 is a cross-sectional side view of the actuation assembly of FIG. 24. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0020] The present disclosure may be further understood with reference to the following description and the accompanying drawings, in which like components are referred to with the same reference numerals. The present disclosure relates to a clipping system, and in particular to an over-the-scope endoscopic clipping system in which the initial placement of the clip may be viewed and adjusted prior to its deployment via an actuation assembly. An exemplary embodiment of the present disclosure includes a clip mountable onto a distal end of an endoscope via a cap, and an actuation assembly that controls movement of the clip relative to the endoscope between an insertion configuration, an inspection configuration, and a deployment configuration. In the insertion configuration, the clip is mounted onto the distal end of the endoscope such that jaws of the clip are spaced apart toward an open configuration in which tissue may be received therebetween.

[0021] In the inspection configuration, the clip is moved distally relative to the endoscope such that at least a portion of the clip extends within the field of view of the endoscope. In this inspection configuration, the clip remains mounted on the cap toward the open configuration with the jaws spaced apart to receive the target tissue therebetween while being visible through the endoscope so that an operator of the system can determine whether the clip is in a desired position relative to the target tissue. When it is determined that the clip is in a desired position relative to the target tissue, the clip may be moved toward the deployed configuration.

[0022] In the deployed configuration, the clip is moved distally away from the cap, causing the clip to return toward the biased closed configuration and grasp the target tissue between its jaws. An actuation assembly is releasably coupled to the clip via a control element to enable movement of the clip relative to the endoscope between the insertion, inspection, and deployed configurations. It will be understood by those skilled in the art that as the clip moves toward the deployed configuration, it is completely spaced from the endoscope and permanently released within the body. It will be understood by those skilled in the art that as used herein, the terms proximal and distal are intended to refer to directions toward and away from the user of the device, respectively.

[0023] As shown in FIGS. 1-6 , a tissue clipping system 100 for treating tissue defects and / or perforations according to an exemplary embodiment of the present disclosure includes a clip 102 configured to be mounted onto a distal end 106 of an endoscope 104 via a transparent cap 108. The clip 102 is releasably coupled to a control element 110 such that tension of the control element 110 moves the clip 102 distally relative to the endoscope 104 (and the cap 108 mounted thereon) from an insertion configuration, as shown in FIG. 1 , to an inspection configuration, as shown in FIG. 2 . Once the clip 102 is determined by an operator (e.g., a surgeon) of the system 100 to be in a desired position relative to the target tissue, further tension of the control element 110 moves the clip 102 from the inspection configuration toward a deployed configuration in which the clip 102 is released from the cap 108 and closed onto the target tissue, as shown in FIG. 3 . In the insertion configuration, as shown in FIG. 1, the clip 102 is mounted on a cap 108 which holds the clip 102 in an open position with the jaws 114 of the clip 102 spread apart around the periphery of the cap 108 so that the tissue to be clipped can be drawn between the jaws 114 through a channel 116 in the cap 108.

[0024] In this insertion configuration, the entire clip 102 (including jaws 114) of this embodiment is mounted on the proximal portion 138 of the cap 108, thus minimizing obstruction of the field of view of the optics of the endoscope 104, such that the user can fully view the tissue adjacent to the cap 108 through the open end of the cap 108, as well as through the walls of the cap 108. To move the clip 102 from the insertion configuration toward the inspection configuration, tension is applied to the control element 110 to push the clip 102 distally along the cap 108 until a portion of the clip 102 abuts a protrusion 120 formed on the cap 108, as shown in FIG. 2. This provides tactile feedback to the operator that the clip 102 is in the inspection configuration. In the inspection configuration, the jaws 114 remain spread over the distal portion 140 of the cap 108 and extend distally beyond the distal end 106 of the endoscope 104, and the jaws 114 remain open adjacent the cap 108 and spaced apart from one another. The cap 108 is transparent so that the clip 102 is within the field of view of the optical system of the endoscope 104 when the clip 102 is installed on the distal portion 140 of the cap 108.

[0025] In the inspection configuration, the operator may visually determine whether the clip 102 is in the desired position relative to the target tissue (e.g., a portion of tissue drawn into the cap 108). If the operator determines that the clip 102 is not in the desired position relative to the target tissue, the tissue may be released from the cap 108 and the distal end 106 of the endoscope 104 is repositioned until the target tissue is desired drawn into the cap 108 between the jaws 114 of the clip 102. Once the clip 102 is determined to be in the desired position, the target tissue is drawn into the cap 108 (e.g., by applying suction or a grasper through the working channel of the endoscope 104).

[0026] The clip 102 is then deployed by tensioning the control element 110 until the force applied to the control element 110 exceeds a predetermined force that pushes the clip 102 over the projections 120 and disengages it from the cap 108, as shown in FIGURE 3. As the clip 102 is pushed out of the cap 108, the jaws 114 of the clip 102 close due to their natural bias to grasp tissue drawn into the cap 108. As described in more detail below, an actuation assembly 124 at the proximal end of the endoscope 104 is coupled to the control element 110 to control the tensioning of the control element 110 and the movement of the clip 102 relative to the endoscope 104 between the insertion, inspection and deployment configurations.

[0027] The clip 102 of this embodiment may be attached to any standard endoscope 104 via a cap 108 that is sized, shaped, and configured to be mounted onto (e.g., slid over) the distal end 106 of the endoscope 104 and held there via a friction fit. As will be appreciated by one of ordinary skill in the art, the endoscope 104 is configured to be inserted through a body lumen to a target area within the lumen and therefore must be flexible enough to navigate even the tortuous paths of a body lumen, although the devices described herein may be configured to operate with any other type of endoscope or insertion device.

[0028] According to an exemplary embodiment, the proximal end of the endoscope 104 includes a handle member that resides outside the body accessible to a physician or other user to enable the user to guide the endoscope 104 through a body lumen (e.g., the gastrointestinal tract) to a target site. In one embodiment, the actuation assembly 124 is coupled to the handle member of the endoscope 104. In another embodiment, the actuation assembly 124 is usable independently of the handle member of the endoscope 104. Although the exemplary embodiment describes the use of the clip 102 with the endoscope 104, it will be understood by those skilled in the art that the cap 108 may be sized and shaped to be mounted onto the distal end of any insertion device (flexible or rigid) suitable for accessing an internal target site where the tissue to be clipped is located.

[0029] The cap 108 extends longitudinally from the proximal end 136 to the distal end 118 and includes a channel 116 extending longitudinally therethrough. The cap 108 is configured to be mounted onto the distal end 106 of the endoscope 104 such that the channel 116 of the cap 108 is substantially aligned with the longitudinal axis of the endoscope 104 and in communication with the channel of the endoscope 104. The channel 116 extends away from the distal end 106 of the endoscope 104 such that obstruction of the field of view of the endoscope 104 is minimized. The cap 108 is sized and shaped to correspond to the cross-sectional shape of the endoscope 104 such that the cap 108 fits thereover via a friction fit.

[0030] The cap 108 is configured such that when the cap 108 is mounted on the distal end 106 of the endoscope, a proximal portion 138 of the cap 108 extends over the endoscope shaft while a distal portion 140 of the cap 108 extends distally beyond the distal end 106 of the endoscope 104. The cap 108 is formed from a transparent material such that a portion of the clip 102 that extends on or beyond the distal portion 140 of the cap 108 will be within the field of view of the endoscope 104. According to one exemplary embodiment, the length of the distal portion 140 of the cap 108 is selected to maintain a portion of the clip 102 visible even when tissue is aspirated into the cap 108. In one example, the distal portion 140 may have a length of approximately 10 mm.

[0031] The cap 108 includes one or more protrusions 120 extending from its outer surface 142. The protrusions 120 are configured to engage a portion of the clip 102. In one embodiment, the cap 108 includes a pair of protrusions 120 diametrically opposed and positioned along the cap 108 such that when the clip 102 engages the protrusions 120, the clip 102 extends beyond the cap 108 in the service configuration. The protrusions 120 are sized, shaped, and configured such that when a distal force exceeding a predetermined threshold is applied to the clip 102, the clip 102 moves distally beyond the protrusions toward the deployed configuration.

[0032] The clip 102 includes a pair of jaws 114 connected to one another via a hinge 126 that allows the jaws 114 to move relative to one another between an open configuration in which the jaws 114 are spaced apart from one another and a closed configuration in which the jaws 114 are moved toward one another to grasp tissue. Each of the jaws 114 in this embodiment extends along a curve from a first end 128 to a second end 130, with a first one of the hinges 126 connecting the first ends 128 of the jaws 114 to one another and a second one of the hinges 126 connecting the second ends 130 of the jaws 114 to one another. According to one exemplary embodiment, each of the hinges 126 is a living hinge that includes a groove 132 sized and shaped to engage the protrusion 120 of the cap 108. The hinge 126 in this embodiment is a biasing spring, biasing the jaws 114 towards the closed configuration. In one exemplary embodiment, each of the jaws 114 includes gripping features, such as teeth 122, such that when the jaws 114 are moved towards each other into the closed configuration, tissue is grasped between the jaws 114 via the teeth 122.

[0033] When the clip 102 is installed onto the cap 108, the jaws 114 are spread open over portions of either side of the cap 108 to cover the outer surface 142 of the cap 108. The cap 108 holds the clip 102 open with the jaws 114 spaced apart in the open configuration such that tissue drawn into the channel 116 of the cap 108 passes between the jaws 114. As will be appreciated by one of ordinary skill in the art, tissue may be drawn into the channel 116 via, for example, suction applied through the endoscope 104 or a grasping device inserted through a working channel of the endoscope 104.

[0034] In the insertion configuration, the clip 102 is positioned on the proximal portion 138 of the cap 108. However, in the inspection configuration, the clip 102 is moved distally relative to the cap 108 until the grooves 132 of the clip 102 engage the projections 120 and the clip 102 extends beyond the distal portion 140 of the cap 108. In one embodiment, the tines 122 of the clip 102 extend distally beyond the distal end 118 of the cap 108 in the inspection configuration. Thus, the clip 102 and the position of the tines 122 relative to the target tissue are visible to the operator via the optics of the endoscope 104.

[0035] When the clip 102 is moved distally away from the cap 108, the clip 102 returns to its biased closed configuration to grasp any tissue drawn into the channel 116 between the jaws 114. It will be understood by those skilled in the art that the hinge 126 and / or jaws 114 of the clip 102 may be formed from any of a variety of materials, so long as the hinge 126 biases the jaws 114 toward the closed configuration with sufficient force to apply the desired clipping force to the tissue, as described above. In one example, a portion of the clip 102 (e.g., the hinge 126) may be formed from a shape memory alloy, such as, for example, Nitinol.

[0036] As described above, the clip 102 is moved relative to the cap 108 from the insertion configuration to the inspection configuration, and from the inspection configuration to the deployment configuration, via the control element 110. The control element 110 may be formed as a thread, wire, strand, filament, or other similar flexible longitudinal element extending from a distal end 144 releasably coupled to the clip 102 to a proximal end 145 connected to the actuation assembly 124.

[0037] According to an exemplary embodiment, distal end 144 includes an enlarged end configured as a knot or an enlarged end in one example. A distal portion 148 of control element 110 is wrapped around a portion of clip 102 such that a portion of control element 110 is crimped between clip 102 and outer surface 142 of cap 108 and the knot engages a portion of clip 102. The remaining length of control element 110 extends distally from clip 102, through a distal opening of channel 116 in cap 108, and proximally through channel 116 and the working channel of endoscope 104 to actuation assembly 124.

[0038] In one embodiment, a distal portion 148 of the control element 110 is wrapped around a first one of the jaws 114 with a knot engaged to the clip 102 between two adjacent teeth 122. More specifically, a knot at a distal end 144 of the control element 110 is engaged between adjacent teeth 122 and wrapped around the first one of the jaws 114 such that a portion of the control element 110 immediately proximal to the knot is crimped between the clip 102 and the outer surface 142 of the cap 108. The distal portion 148 is wrapped around the first one of the jaws 114 such that the remaining length of the control element 110 extends distally from the clip 102, through a distal opening of the channel 116 in the cap 108, proximally through the channel 116 and the working channel of the endoscope 104. Thus, by retracting the control element 110 proximally relative to the endoscope 104 and applying tension thereto, the clip 102 moves distally relative to the cap 108 .

[0039] When the clip 102 is mounted on the cap 108 in the insertion configuration, the control element 110 may be retracted proximally relative to the endoscope 104 a first distance such that the grooves 132 of the clip 102 abut the projections 120 and the clip 102 is retracted into the inspection configuration. From the inspection configuration, the control element 110 may be retracted further proximally relative to the endoscope 104 a second distance, with application of a force exceeding a predetermined threshold resulting in the clip 102 moving distally past the projections 120 toward the deployed configuration. As the clip 102 moves distally away from the cap 108 toward the deployed configuration, the distal portion 148 of the control element 110 disengages the clip 102, thereby releasing the clip 102 from the remainder of the device and leaving the clip 102 on the target tissue while the endoscope and cap 108 are withdrawn from the body. Thus, one skilled in the art will appreciate that the control element 110 must be able to withstand forces exceeding a predetermined threshold.

[0040] In the inspection configuration, the clip 102 remains mounted on the cap 108 with the jaws 114 of the clip 102 in the open configuration so that if it is determined that the clip 102 is not in the desired position relative to the target tissue, the operator may simply release the tissue from the channel 116 and reposition the distal end 106 of the endoscope 104 as desired. In particular, the distal end 106 may be repositioned until the operator visually confirms that the target tissue has been drawn into the channel 116 between the jaws 114 of the clip 102 as desired. As discussed above, in the inspection configuration, the clip 102 extends onto the distal portion 148 of the cap 108, distal to the distal end 106 of the endoscope 104, such that the clip 102 is within the field of view of the endoscope 104.

[0041] The actuation assembly 124 may be used to actuate the control element 110 to move the clip 102 from the insertion configuration to the inspection configuration by applying tension along the control element 110, as shown in FIGS. 4-6, and from the inspection configuration toward the deployment configuration once the desired positioning of the clip 102 relative to the target tissue is visually confirmed. In one embodiment, the actuation assembly 124 may be coupled to a handle member at the proximal end of the endoscope 104 and connected to a proximal end 145 of the control element 110 that extends through a channel of the endoscope 104. In another embodiment, the actuation assembly 124 may be utilized independent of the endoscope 104. In other words, the actuation assembly 124 may be utilized without being directly coupled to any portion of the handle member of the endoscope 104 or any portion of the shaft of the endoscope 104. In particular, the proximal end 145 of the control element 110 may extend from the proximal end of the endoscope 104 to be connected to the actuation assembly 124.

[0042] According to an exemplary embodiment, as shown in Figures 4-6, the actuation assembly 124 includes a first actuator 161 for actuating movement of the clip 102 from the insertion configuration towards the inspection configuration and a second actuator 185 for actuating movement of the clip 102 from the inspection configuration towards the deployment configuration. In one embodiment, the first actuator 161 includes first and second elongate members 162, 164 pivotally coupled to one another and movable relative to one another to move the clip 102 from the insertion configuration towards the inspection configuration. The first and second elongate members 162, 164 are pivotally coupled to one another in a substantially scissor-like manner, for example via a connecting pin 165, such that when proximal portions 166, 168 of the first and second elongate members 162, 164 are drawn towards one another, distal portions 170, 172 are also drawn towards one another. The distal portions 170 , 172 are received within the housing 125 and are movably coupled to a moving element 174 , which is connected to the proximal end 145 of the control element 110 .

[0043] In one exemplary embodiment, distal portions 170, 172 are coupled to housing 125 via connecting pins 165 such that housing 125 is longitudinally fixed relative to elongate members 162, 164. Distal portions 170, 172 may be moved toward and away from one another within housing 125 and are connected to moving element 174 such that as distal portions 170, 172 are drawn toward one another, moving element 174 moves from a proximal position relative to elongate members 162, 164 to a distal position relative to elongate members 162, 164.

[0044] In one exemplary embodiment, moving element 174 is coupled to distal portions 170, 172 via a sliding pin 176 that extends from moving element 174 and is received in an elongate slot 178 along the distal portion 170 of first elongate member 162. Pin 176 of moving element 174 is slidably received in slot 178 such that when proximal portions 166, 168 of first and second elongate members 162, 164 are drawn toward one another, correspondingly moving distal portions 170, 172 toward one another, pin 176 slides distally along slot 178 to move moving element 174 from a proximal position to a distal position. However, those skilled in the art will understand that the moving element 174 can be coupled to the first elongate member 162 and the second elongate member 164 in any of a number of ways, so long as the moving element 174 is coupled such that it can slide longitudinally relative to the first elongate member 162 and the second elongate member 164 between proximal and distal positions, as described above.

[0045] In one exemplary embodiment, the proximal portions 166, 168 are biased away from one another, for example via a compression spring 182. The compression spring 182 prevents the proximal portions 166, 168 from being inadvertently drawn together to move the clip 102 toward the inspection configuration. In this embodiment, the proximal portions 166, 168 include a ratchet mechanism 184 extending therebetween, which prevents the proximal portions 166, 168 from returning to their biased configuration when the proximal portions 166, 168 are drawn toward one another. Thus, when the proximal portions 166, 168 are drawn toward one another, the moving element 174 is locked in a distal position, thereby locking the clip 102 into the inspection configuration. Once the proximal portions 166, 168 are locked into the inspection configuration, the clip 102 can be visualized and readjusted as needed without having to continually hold the proximal portions 166, 168 toward one another to keep the clip 102 in the inspection configuration.

[0046] 5-6, the control element 110 is routed to couple to the moving element 174 through a pulley mechanism 180 in the housing 125. In particular, the control element 110 extends from a distal end 144 connected to the clip 102, through the endoscope 104, and through the housing 125 such that the control element 110 is routed through the pulley mechanism 180 such that the proximal end 145 is coupled to the moving element 174. The pulley mechanism 180 is configured such that as the moving element 174 is moved from a proximal position to a distal position, the proximal end 145 of the control element 110 is moved proximally, moving the control element 110 along the pulley mechanism 180 such that tension is applied to the control element 110. The first and second elongate members 162, 164 are configured such that when the proximal portions 166, 168 are drawn toward one another, the tension applied to the control element 110 is sufficient to move the clip 102 from the insertion configuration to the inspection configuration such that a portion of the clip 102 engages the protrusion 120.

[0047] In one embodiment, when moving element 174 is in a proximal position (see FIG. 5), pulley mechanism 180 is disposed within a portion of housing 125 substantially longitudinally aligned with proximal end 145 of control element 110. When proximal portions 166, 168 are drawn toward one another and moving element 174 is moved toward a distal position, proximal end 145 of control element 110 is also moved distally such that a portion of control element 110 extends from pulley mechanism 180 along a portion of housing 125 that is in communication with second actuator 185 (see FIG. 6).

[0048] The second actuator 185 for actuating the movement of the clip 102 from the inspection configuration to the deployed configuration, in one exemplary embodiment, includes a push button 186. The push button 186 includes a push portion 188 that is user accessible along the exterior of the housing 125 and a tab 190 that extends into the housing 125. As shown in FIG. 6 , as the moving element 174 moves from the proximal position toward the distal position, a portion of the control element 110 moves into engagement with the tab 190 of the push button 186 while tension is applied along the control element 110. Thus, when it is desired to move the clip 102 from the inspection configuration toward the deployed configuration, an operator of the system 100 presses the push portion 188, causing the tab 190 to move further into the housing 125 and depress the portion of the control element 110 that is engaged with the tab 190. Thus, when push portion 188 is pressed, tab 190 pushes further into control element 110, applying additional tension along control element 110, causing the length of control element 110 that extends through the endoscope to move proximally relative to endoscope 104 with sufficient force to move clip 102 distally along cap 108 and past protrusions 120 from the inspection configuration toward the deployed configuration. Once clip 102 is pushed distally from cap 108, clip 102 returns to its biased configuration so that it is clipped onto the target tissue.

[0049] According to an exemplary method for tissue closure utilizing the system 100, as shown in FIGS. 1-6, an endoscope 104 having a cap 108 and clip 102 attached thereto is inserted into a body opening and passed through a body lumen, such as the gastrointestinal tract, to reach a target area within the lumen. As described above, in the insertion configuration, as shown in FIG. 1, the clip 102 is mounted on a proximal portion 138 of the cap 108 mounted on a distal end 106 of the endoscope 104, so that the jaws 114 are spaced apart toward the open configuration. The clip 102 is guided to the target area via the endoscope 104 and positioned over the target tissue. The target tissue is then drawn into the cap 108, for example, by suction applied through a working channel of the endoscope 104.

[0050] The clip 102 is then moved toward the inspection configuration by using the first actuator 161 to move the clip 102 distally relative to the cap 108. In particular, the proximal portions 166, 168 of the first and second elongate members 162, 164 are moved toward each other such that the moving element 174, to which the proximal end 145 of the control element 110 is attached, moves from a proximal position toward a distal position as described above. The first and second elongate members 162, 164 can then be locked relative to each other via the ratchet mechanism 184 such that the clip 102 is locked in the inspection configuration. In the inspection configuration, the clip 102 extends over the distal portion 140 of the cap 108 such that the position of the clip 102 relative to the target tissue is within the field of view of the endoscope 104. Thus, in the inspection configuration, the user determines whether the clip 102 is in a desired gripping position relative to the target tissue.

[0051] As described above, the actuation assembly 124 may be locked in the inspection configuration. Thus, if during the inspection configuration it is determined that the clip 102 is not in the desired position relative to the target tissue, the tissue drawn into the cap 108 is released therefrom and the distal end 106 of the endoscope 104, and thus the clip 102, is repositioned over the target tissue. The clip 102 may be repeatedly repositioned relative to the target tissue as necessary during the inspection configuration until the user can visually confirm that the clip 102 is positioned over the target tissue as desired.

[0052] Once the user has confirmed that the target tissue has been drawn into the channel 116 between the jaws 114 as desired, the clip 102 may be moved from the inspection configuration to the deployed configuration via a second actuator 185 for moving the clip 102. Specifically, the operator presses the push button 186 such that the tab 190 extends further into and engages a portion of the control element 110. The force exerted on the control element 110 via the tab 190 exceeds a predetermined threshold level, which allows the clip 102 to be moved distally past the projection 120 of the cap 108 toward the deployed configuration. The clip 102 is moved distally relative to the cap 108 until the clip 102 is moved distally away from the cap 108 and the clip 102 returns to its biased closed configuration gripping the target tissue. As described above, once the clip 102 is moved to the deployed configuration, the control element 110 disengages the clip 102, releasing the clip 102 within the body, and the clip 102 clips the target tissue as the endoscope 104 and cap 108 are withdrawn from the body.

[0053] 7-10, an actuation assembly 224 according to another exemplary embodiment is substantially similar to actuation assembly 124 and is similarly utilized with clip 102 and endoscope 104 as described above with respect to system 100. Like actuation assembly 124, actuation assembly 224 includes a first actuator 261 for moving clip 102 from an insertion configuration toward an inspection configuration and a second actuator 285 for moving clip 102 from an inspection configuration toward a deployment configuration. Like actuation assembly 124, actuation assembly 224 may be coupled to a handle of endoscope 104 in one embodiment. In another embodiment, actuation assembly 224 may be utilized independently (i.e., without direct coupling to a handle of endoscope 104) to control movement of control element 110 and clip 102.

[0054] However, rather than having pivotally engaged parts, the first actuator 261 may include a lever 264 movable relative to the handle portion 262 to move the control element 110. The proximal end 145 of the control element 110 is coupled to an end of the lever 264 such that when the lever 264 is depressed, the control element 110 is moved proximally relative to the endoscope 104, thereby moving the clip 102 distally along the cap 108 from the insertion configuration toward the inspection configuration. The lever 264 must remain depressed to maintain tension along the control element 110 toward the inspection configuration. In one embodiment, similar to the first actuator 161, the lever 264 may be biased away from the handle portion 262, for example, via a compression spring 282 extending therebetween. Thus, the actuation assembly 224 may further include a lock 284 for locking the lever 264 in the inspection configuration relative to the handle portion 262.

[0055] Similar to the actuation assembly 124, the actuation assembly 224 includes a pulley mechanism 280 in a housing 225 through which a proximal portion of the control element 110 is routed to be connected to the lever 264. The pulley mechanism 280 routes the control element 110 through the housing 225 such that the control element 110 interacts with a second actuator 285. Thus, when it is desired to move the clip 102 from the inspection configuration toward the deployed configuration, the second actuator 285 is used to apply additional tension to the clip 102 sufficient to move the clip 102 distally past the projection 120 of the cap 108. Similar to the second actuator 185, the second actuator 285 includes a push button 286. The push button 286 includes a push portion 288 that is user accessible along the exterior of the housing 225 and a tab 290 that extends into the housing 225.

[0056] 9-10, when it is desired to move clip 102 from the inspection configuration toward the deployed configuration, push portion 288 is pressed, causing tab 290 to move further into housing 225 against control element 110. Thus, as push portion 288 is pressed, tab 290 presses further into control element 210, applying additional tension along the movement of control element 110, causing the length of control element 110 extending through the endoscope to move proximally relative to endoscope 104 with sufficient force to move clip 102 distally from the inspection configuration toward the deployed configuration and past protrusions 120 on cap 108. Once clip 102 is pushed distally out of cap 108, clip 102 returns to the biased configuration clipping tissue drawn into cap 108.

[0057] 11-16, an actuation assembly 324 according to another exemplary embodiment is substantially similar to actuation assemblies 124, 224 and is utilized with clip 102 and endoscope 104 as described above with respect to system 100 for actuating movement of clip 102 between insertion, inspection, and deployment configurations. Similar to actuation assemblies 124, 224, actuation assembly 334 includes a first actuator 361 configured to move clip 102 from the insertion configuration to the inspection configuration and a second actuator 385 configured to move clip 102 from the inspection configuration to the deployment configuration. Actuation assembly 324 may be coupled to endoscope 104, as shown in FIG. 11, or utilized independent of the endoscope, as shown in FIG. 12.

[0058] The handle portion 362 in this embodiment is an ergonomic, substantially T-shaped handle configured to be grasped by an operator of the system 100, for example. In particular, in one embodiment, the handle portion 362 extends substantially perpendicular to the housing portion 325, and the control element 110 extends from the endoscope 104 through the housing portion. Furthermore, rather than a long lever or handle as described above with respect to the actuation assembly 124, 224, the first actuator 361 in this embodiment includes a lever 364 that extends along the handle portion 362, which may be grasped via a power grip. The proximal end 145 of the control element 110 is connected to the lever 364, and when the lever 364 is pressed against the handle portion 362, the length of the control element 110 that passes through the endoscope 104 moves proximally relative to the endoscope 104 and the clip 102 moves distally along the cap 108 from the insertion configuration towards the inspection configuration.

[0059] Similar to the previously described actuation assemblies, the lever 364 is biased away from the handle portion 362, for example, via a compression spring 382 extending between the handle portion 362 and the lever 364. To maintain tension along the control element 110 and lock the clip 102 in the service configuration, the actuation assembly 324 further includes a lock 384. The lock 384, in this embodiment, includes a button disposed on the handle portion 362 such that when the button is pressed into the handle portion 362, a portion of the button engages a portion of the lever 364 received within the handle portion 362 to engage and hold the lever 364 in a position corresponding to the service configuration relative to the handle portion 362 (see FIG. 14). In particular, as shown in FIG. 16, a portion of the button of the lock 384 extends into and engages a slot 392 in the lever 364 to lock the lever 364 relative to the handle portion 362.

[0060] As the control element 110 is retracted proximally relative to the endoscope 104 from the insertion configuration toward the inspection configuration, a proximal portion of the control element is retracted proximally through a portion of the housing 325 that interacts with the second actuator 385. Similar to the previously described actuation assemblies, the second actuator 385 in this embodiment includes a push button 386 that includes a push portion 388 and a tab 390 that extends into the housing 325. When it is desired to move the clip 102 from the inspection configuration toward the deployed configuration, the operator presses the push portion 388 to move the tab 390 further into the housing 325 such that the tab 390 presses against the control element 110, providing additional tension to the control element 110. This tension causes the length of the control element 110 that extends through the endoscope 104 to move proximally relative to the endoscope 104 with sufficient force to move the clip 102 distally past the protrusions 120 from the inspection configuration toward the deployed configuration. When the clip 102 is pushed distally out of the cap 108, the clip 102 returns to its biased configuration for clipping on the target tissue.

[0061] While the exemplary embodiment illustrates and describes the target tissue being drawn into the channel 116 of the cap 108 via suction applied, for example, through the working channel of the endoscope 104, it will be understood by one of ordinary skill in the art that tissue may also be drawn into the channel 116 using other methods. For example, in other embodiments, tissue may be drawn into the channel and between the spaced jaws 114 of the clip 102 when the clip 102 is in, for example, an inspection configuration, by using a device such as a tissue grasper that is passed through the endoscope 104 to its distal end 106. The actuation assembly 324 further includes a port 396 that extends through a proximal end 397 of the housing 325, the port 396 being configured to receive a device such as a tissue grasper. Tissue adjacent the distal end 106 may be drawn into the channel 116 of the cap 108 by inserting a tissue grasper through the port 396 and the working channel of the endoscope 104, substantially as described above with respect to the system 100. In one embodiment, a tissue grasper (or other similar device) is inserted into port 396 and through a corresponding channel that extends through housing 325 and lever 364 .

[0062] 17-20, an actuation assembly 424 according to another exemplary embodiment is substantially similar to the actuation assemblies described above. The actuation assembly 424 may be utilized to control the movement of the clip 102 relative to the endoscope 104, as described above with respect to the system 100. The actuation assembly 424 includes a single actuator 461 that can control both the movement of the clip 102 from the insertion configuration to the inspection configuration and the movement of the clip 102 from the inspection configuration toward the deployment configuration.

[0063] According to an exemplary embodiment, the actuation assembly 424 includes a rotation handle 464 rotatable about a housing 425 in which the control element 110 from the endoscope 104 is received. The rotation handle 464 extends from a first end 490 coupled to the housing 425 to a second end 492 that maintains accessibility to an operator of the system so that the rotation handle 464 can be rotated about the housing 425. In one embodiment, the first end 490 includes a coupling member 491 that is rotatably received within the housing 425 and configured to receive a moving element 474. The moving element 474 in this embodiment is threadably received within the coupling member 491 of the rotation handle 464 such that when the rotation handle 464 is rotated about the housing 425, the moving element 474 moves longitudinally relative to the housing 425 as the rotation handle 464 rotates.

[0064] In one embodiment, when the rotation handle 464 is rotated in a first direction relative to the housing 425, the moving element 474 moves proximally relative to the housing. The proximal end 145 of the control element 110 is connected to the moving element 474. Thus, when the rotation handle 464 is rotated in a first direction, the control element 110 moves proximally relative to the housing 425 and thus the endoscope 104, causing the clip 102 to move distally along the cap 108.

[0065] Similar to the actuation assemblies described above, the actuation assembly 424 includes, for example, a compression spring or other biasing element that biases the rotation handle toward the insertion configuration. To move the clip 102 toward the inspection configuration, the operator actively rotates the rotation handle. In an exemplary embodiment, the housing 425 includes a pin 494 or other protrusion along a portion of the housing 425. The pin 494 interacts with the rotation handle 464 as it rotates about the housing 425. The pin 494 is disposed along the housing 425 such that the rotation handle 464 engages the pin 494 when the control element 110 is moved a proximal distance sufficient to move the clip 102 from the insertion configuration toward the inspection configuration as the rotation handle 464 rotates about the housing 425.

[0066] The engagement between the pin 494 and the rotation handle 464 provides tactile feedback to the operator that the clip 102 is engaged with the protrusions 120 along the cap 108 and is in the inspection configuration. When it is desired to move the clip 102 from the inspection configuration toward the deployed configuration, the operator further rotates the rotation handle 464 about the housing 425 in the first direction, pushing the rotation handle 464 past the pin 494. As the rotation handle 464 is rotated past the pin 494, the clip 102 is correspondingly pushed distally past the protrusions 120 until the clip 102 is pushed distally out of the cap 108 and allowed to return to the biased closed configuration for gripping the target tissue.

[0067] Similar to actuation assembly 324, actuation assembly 424 further includes a port 496 extending through a proximal end 497 of housing 425, which is configured to receive a device such as a tissue grasper. The tissue grasper can be inserted through port 496 and a working channel of endoscope 104 to draw tissue adjacent to distal end 106 into channel 116 of cap 108, substantially as described above with respect to system 100. In one embodiment, the tissue grasper (or other similar device) is inserted into port 496 and through a corresponding channel extending across moving element 474 to be received within endoscope 104.

[0068] As shown in Figures 21-25, another exemplary embodiment of a tissue clipping system 500 is substantially similar to system 100 and includes a clip 502 mountable on a distal end 506 of an endoscope 504 via a cap 508 such that the clip 502 is movable between an insertion configuration, an inspection configuration, and a deployed configuration relative to the endoscope 504. As with system 100, the clip 502 may be moved from an insertion configuration, as shown in Figure 21, to an inspection configuration, as shown in Figure 22, and then upon verifying that the target tissue is received between the jaws 514 of the clip 502 as desired, the clip 502 is moved from the inspection configuration toward the deployed configuration, as shown in Figure 23. The system 500 is configured such that if, during the inspection configuration, an operator of the system 500 determines that the clip 502 is not in a desired position relative to the target tissue, the clip 502 may be moved from the inspection configuration back to the insertion configuration such that the distal end 506 and the clip 502 may be repositioned relative to the target tissue when the clip 502 is in the insertion configuration.

[0069] Accordingly, system 500 further includes a repositioning element 512 configured to permit movement of clip 502 between the insertion configuration and the inspection configuration, and a deployment element 510 configured to permit movement from the inspection configuration to the deployed configuration when clip 502 is determined to be in a desired position relative to the target tissue. As discussed above, deployment element 510 and repositioning element 512 are connected to an actuation assembly 524 substantially similar to actuation assemblies 124-324 described above with respect to system 100. The actuation assembly includes a first actuator 561 for moving clip 502 between the insertion configuration and the inspection configuration, and a second actuator 585 for moving clip 502 from the inspection configuration toward the deployed configuration.

[0070] Similar to system 100, in the insertion configuration, clip 502 is mounted on cap 508 in an open configuration with its jaws 514 spaced apart to receive tissue therebetween. Clip 502 is preferably inserted into a target site within the body in this insertion configuration. To improve the field of view of endoscope 504, clip 502 is moved from the insertion configuration to an inspection configuration by moving clip 502 distally relative to endoscope 504 so that the position of clip 502 relative to the target tissue is visible to an operator of system 500 (e.g., a surgeon or other user).

[0071] However, rather than moving the clip 502 relative to the cap 508, the cap 508 to which the clip 502 is attached is moved distally relative to the endoscope 504 to move the clip 502 from the insertion configuration toward the inspection configuration. The clip 502 is mounted on the cap 508 such that a portion of the clip 502 extends distally beyond the distal end 518 of the cap 508 while maintaining the clip 502 in the open position, such that as the cap 508 is moved distally relative to the endoscope 504 toward the inspection configuration, a portion of the clip 502 extends distally of the distal end 506 of the endoscope 504, and thus the portion of the clip 502 extending distally beyond the distal end 506 is within the field of view of the endoscope 504.

[0072] If the operator determines that the clip 502 is in the desired position relative to the target tissue, the clip 502 may be moved from the inspection configuration toward the deployed configuration. However, if the operator determines that the clip 502 is not in the desired position relative to the target tissue, the clip 502 may be moved from the inspection configuration back to the insertion configuration to release any tissue that was drawn into the cap 508 and reposition the clip 502 as desired relative to the target tissue.

[0073] To enable movement of the cap 508 and clip 502 relative to the endoscope 504 between the insertion configuration and the inspection configuration, the system 500 further includes a biasing element 520 that extends between the cap 508 and the distal-most end 507 of the endoscope 504 to bias the cap 508 and the clip 502 mounted thereon toward the insertion configuration. The repositioning element 512 has its distal end 550 connected to the cap 508 and can be used to move the cap 508 and clip 502 between the insertion configuration and the inspection configuration as needed until the operator determines that the clip 502 is in the desired configuration relative to the target tissue.

[0074] Once the operator determines that the clip 502 is in the desired position relative to the target tissue, a deployment element 510, the distal end 544 of which is releasably coupled to the clip 502, may be used to move the clip 502 distally away from the cap 508 toward a deployed configuration. In the deployed configuration, the clip 502 moves under its own bias back toward the closed configuration to grasp the target tissue received between the jaws 514. Manipulation of the deployment element 510 and / or the repositioning element 512 to move the clip 502 between the insertion, inspection, and deployed configurations may be controlled via an actuation assembly 524 at the proximal end of the endoscope 504.

[0075] Those skilled in the art will appreciate that endoscope 504 can be substantially similar to endoscope 104 and extends longitudinally from a proximal end including a handle member 534 to a distal end 506 at which a cap 508 is attached. Endoscope 504 includes a channel 505 extending therethrough. In this embodiment, endoscope 504 further includes a stop 570, shoulder, or other protrusion extending from an outer surface 542 of cap 508 at a distal-most end 507 for engaging a distal end 572 of biasing element 520 and for stopping distal end 572 of biasing element 520 from extending distally beyond stop 570.

[0076] Cap 508 may also be substantially similar to cap 108, extending longitudinally from a proximal end 536 to a distal end 518 and forming a channel 516 therein. Channel 516 corresponds to the size of endoscope 504 such that cap 508 may be movably mounted thereon. In one embodiment, cap 508 also includes an opening extending through a wall thereof that is configured to receive repositioning element 512 therein, as described in further detail below.

[0077] The biasing element 520 in this embodiment extends between the distal end 518 of the cap 508 and a stop 570 on the endoscope 504 to bias the cap 508 toward the insertion configuration. According to one exemplary embodiment, the biasing element 520 may be configured as a spring that extends around the distal end 518 of the endoscope 504 between the distal end 506 of the cap 508 and a stop 570 at the distal-most end 507 of the endoscope 504. In the insertion configuration, a clip 502, which is substantially similar to clip 102, is mounted on the cap 508 such that jaws 514 of the clip 502 are spread open on the cap 508.

[0078] An outer surface 542 of the cap 508 holds the jaws 514 open so that the jaws 514 can be spaced apart to receive tissue therebetween. The clip 502 may be mounted on the cap 508 such that, for example, the tines 522 extend distally beyond the distal end 518 of the cap 508. However, in the insertion configuration, the distal end 518 of the cap 508 is spaced a selected distance from the distal-most end 507 of the endoscope 504 such that the tines 522 do not extend distally beyond the distal-most end 507 of the endoscope 504.

[0079] To move clip 502 toward the inspection configuration, cap 508 is moved distally relative to endoscope 504 to compress biasing element 520 until tines 522 extend distally beyond the distal-most end 507 of endoscope 504 such that tines 522 are within the field of view of endoscope 504. Thus, in the inspection configuration, an operator or user may determine whether clip 502 is in a desired position relative to the target tissue. When clip 502 is in the desired position, clip 502 may be moved toward the deployed configuration by pushing clip 502 distally away from cap 508.

[0080] However, if it is determined that the clip 502 is not in the desired position relative to the target tissue, the compressive force on the biasing element 520 is released, causing the biasing element 520 to return to its biased configuration and the cap 508 to be pushed proximally along the endoscope 504 toward the insertion configuration such that any tissue previously drawn into the cap 508 may be released and the clip 502 repositioned. As described in more detail below, movement of the clip 502 between the insertion configuration and the inspection configuration is controlled via the repositioning element 512, and movement of the clip 502 from the inspection configuration toward the deployed configuration is controlled via the deployment element 510.

[0081] The deployment element 510 of this embodiment is substantially similar to the control element 110, e.g., comprises a thread, wire, strand, filament, or other similar flexible longitudinal element extending from a distal end 544 releasably coupled to the clip 502 to a proximal end connected to the actuation assembly 524. The deployment element 510 of this embodiment is releasably coupled to the clip 502 in substantially the same manner as the coupling between the clip 102 and the control element 110. In the exemplary embodiment, a distal portion 548 of the deployment element 510 is wrapped around a portion of a first one of the jaws 514 such that a portion of the deployment element 510 is crimped between the clip 502 and the outer surface 542 of the cap 508, while a knot or other enlargement, e.g., at the distal end 544, is engaged between adjacent teeth 522 of the first one of the jaws 514.

[0082] The remaining length of the deployment element 510 extends distally from the clip 502, passes through a distal opening of the channel of the endoscope 504, and extends proximally through the endoscope 504. Thus, pulling the deployment element 510 proximally relative to the endoscope 504 moves the clip 502 distally relative to the cap 508, moving the clip 502 toward the deployed configuration. As described above, when the clip 502 is pushed distally toward the deployed configuration, away from the cap 508, the distal portion 548 of the deployment element 510 unwinds from the clip 502, the knot disengages from the clip 502, and the clip 502 is released to clip the target tissue.

[0083] The repositioning element 512 may include, for example, a thread, strand, wire filament, or other similar flexible longitudinal element. However, rather than being releasably connected to the clip 502, the distal end 550 of the repositioning element 512 may be non-releasably secured to a portion of the cap 508. According to one exemplary embodiment, the distal end 550 includes an enlarged end, such as, for example, a knot, such that when the repositioning element 512 passes through an opening extending through a wall of the cap 508, the knot 552 prevents the distal end 550 from passing therethrough. Thus, the knot of the repositioning element 512 engages the cap 508 along the outer surface 542 of the cap 508, causing the remaining length of the repositioning element 512 to extend through the opening distally between the inner surface of the cap 508 and the outer surface of the endoscope 504 and distally between the biasing element 520 and the outer surface of the endoscope 504, such that the repositioning element 512 is received within the distal opening of the channel of the endoscope 504 and extends proximally through the endoscope 504.

[0084] Thus, movement of repositioning element 512 proximally relative to endoscope 504 causes cap 508 to move distally relative to endoscope 504 from the insertion configuration toward the inspection configuration. In this inspection configuration, biasing element 520 is maintained in a compressed configuration via tension along repositioning element 512. However, if during the inspection configuration it is determined that clip 502 is not in a desired position relative to the target tissue, the tension along repositioning element 512 can be released to allow biasing element 520 to return to its biased configuration, thereby moving cap 508 proximally relative to endoscope 504 from the inspection configuration toward the insertion configuration.

[0085] The proximal ends of each of the deployment element 510 and the repositioning element 512, in this embodiment, are coupled to an actuation assembly 524 and are coupled to a handle member of the endoscope 504. The actuation assembly 524 is substantially similar to the actuation assemblies described above and includes a first actuator 561 for moving the clip 502 from the insertion configuration toward the inspection configuration and a second actuator 585 for moving the clip 502 from the inspection configuration toward the deployed configuration. The actuation assembly 524 may also include a housing 525 through which the proximal ends of the repositioning element 512 and the deployment element 510 extend such that they are coupled to the first and second actuators 561, 585.

[0086] According to an exemplary embodiment, as shown in FIGS. 24-25 , actuation assembly 524, first actuator 561 may include a lever 564 configured to control movement of repositioning element 512 relative to endoscope 504, and second actuator 585 may include a push button 586 for controlling movement of deployment element 510 relative to endoscope 504. Lever 564 is pivotally coupled to housing 525 such that when lever 564 is pressed toward housing 525, repositioning element 512 is retracted proximally through endoscope 504. In particular, a proximal end of repositioning element 512 is coupled to lever 564 such that when lever 564 is pressed, repositioning element 512 is moved proximally relative to endoscope 504, thereby moving cap 508 distally relative to endoscope from the insertion configuration toward the inspection configuration. Lever 564 must be maintained in a depressed state to maintain tension along repositioning element 512 toward the inspection configuration and to maintain biasing element 520 in a compressed state.

[0087] If, during this inspection configuration, the operator determines that the clip 502 is in a desired position relative to the target tissue, the operator presses push button 586, for example using a thumb. Push button 586 extends into housing 525 and is coupled to a proximal end of deployment element 510 such that, when pressed, deployment element 510 is retracted proximally relative to endoscope 504, moving clip 502 distally relative to cap 508 until clip 502 moves distally away from cap 508. However, if, during the inspection configuration, the operator determines that clip 502 is not in a desired position relative to the target tissue, the operator releases lever 564, thereby releasing tension there along and allowing biasing element 520 to return to its biased configuration. As biasing element 520 returns toward its biased configuration, biasing element 520 releases any tissue that was retracted within cap 508 before pushing cap 508 proximally along endoscope 504 from the inspection configuration toward the insertion configuration so that clip 502 can be repositioned as needed.

[0088] An exemplary method of clipping tissue using clipping system 500 may be substantially similar to the method of clipping tissue using system 100. Similar to system 100, clip 502, mounted on a distal end 506 of endoscope 504 via cap 508 in an insertion configuration, is inserted through a body lumen (e.g., in the gastrointestinal tract) to a target site within the body, as shown in FIG. 21. Cap 508 is biased toward the insertion configuration via biasing element 520, as described above.

[0089] Once the clip 502 is positioned on the target tissue, the tissue is drawn into the cap 508 (e.g., via suction, which may be applied through the working channel of the endoscope 504) so ​​that it extends between the jaws 514 of the clip 502. The clip 502 is then moved from the insertion configuration toward the inspection configuration by moving the repositioning element 512 proximally relative to the endoscope 504, thereby moving the cap 508 distally and compressing the biasing element 520, as shown in FIG. 22. In the inspection configuration, the tines 522 of this embodiment extend distally beyond the distal-most end 507 of the endoscope 504 such that the position of the tines 522 relative to the target tissue is visible through the endoscope 504.

[0090] When clip 502 is in the inspection configuration, the operator may determine whether clip 502 is in the desired position relative to the target tissue. If clip 502 is not in the desired position, tension along repositioning element 512 may be released, causing biasing element 520 to return to its biasing configuration, thereby moving cap 508 from the inspection configuration back to the insertion configuration. Any tissue that was drawn into cap 508 may then be released, and with clip 502 now in the insertion configuration, endoscope 504 and cap 508 may be repositioned relative to the target tissue until cap 508 and clip 502 are in the desired position relative to the target tissue. Clip 502 may then again be moved toward the inspection configuration, and this procedure may be repeated as necessary until clip 502 is determined to be in the desired position relative to the target tissue.

[0091] Once it is determined that the clip 502 is in the desired position, the clip 502 may be moved toward the deployed configuration by moving the deployment element 510 proximally relative to the endoscope 504 until the clip 502 is pushed distally away from the cap 508, as shown in FIGURE 23. As discussed above, once the clip 502 has been pushed distally away from the cap 508, the clip 502 is freed to return to the biased closed configuration, thereby grasping the target tissue between the jaws 514.

[0092] Additionally, because the deployment element 510 is no longer crimped between the clip 502 and the cap 508, the distal portion 548 of the deployment element 510 becomes unraveled from the clip 502 such that the knot 546 disengages from the clip 502, releasing the clip so that it remains clipped on the target tissue as the endoscope 504 is withdrawn from the body along with the cap 508. It will be understood by those skilled in the art that because the repositioning element 512 is coupled to the cap 508, and never coupled to the clip 502, the repositioning element 512 does not need to be released or disengaged from the cap 508.

[0093] It will be apparent to those skilled in the art that various modifications may be made in the present disclosure without departing from the scope of the present disclosure. Furthermore, those skilled in the art will understand that the features of any of the various embodiments may be combined in any manner not inconsistent with the description and / or functionality of the embodiments. The technical ideas that can be understood from the above-described embodiment will be described below as supplementary notes. [Appendix 1] 1. A clipping system for treating tissue, comprising: a cap configured to be mounted onto a distal end of an endoscope, the cap extending longitudinally from a proximal end to a distal end and including a channel extending therethrough such that the cap may be positioned adjacent a target tissue in vivo; A clip configured to be mounted on the cap, the clip including a first jaw and a second jaw movably connected to one another via a hinge, the hinge being biased to draw the first jaw and the second jaw toward one another, the clip configured to: (a) extend the first jaw and the second jaw onto the cap such that the first jaw and the second jaw are spaced apart from one another to receive the target tissue therebetween and with minimal obstruction of an optical system of the endoscope to which the cap is mounted; (b) an insertion configuration in which the clip is moved distally relative to the cap to extend a portion of the clip distally until at least a portion of the clip extends within a field of view of the optical system to which the cap is attached; and (c) a deployed configuration in which the clip is moved distally away from the cap to draw the first and second jaws toward each other under the bias of the hinge to close and clip tissue received between the first and second jaws. a control element extending from a distal end releasably coupled to the clip, through the channel of the cap and the endoscope to which the cap is coupled, to a proximal end, and in use remaining outside the living body while the cap is adjacent to the target tissue, the control element configured to move the clip distally relative to the cap by proximal movement of the control element through the cap, the control element configured to move the clip from the insertion configuration to the inspection configuration by proximal movement of the control element a first distance through the cap, and to move the clip from the inspection configuration to the deployment configuration by proximal movement of the control element a second distance through the cap. [Appendix 2] 2. The system of claim 1, further comprising an actuation assembly coupled to a proximal end of the control element, the actuation assembly including a first actuator configured, upon actuation, to move the control element proximally the first distance through the endoscope to move the clip from the insertion configuration to the inspection configuration. [Appendix 3] 3. The system of claim 2, wherein the first actuator includes a first elongate member and a second elongate member pivotally connected to each other, and when proximal portions of the first elongate member and the second elongate member are drawn toward each other, distal portions of the first elongate member and the second elongate member are correspondingly drawn toward each other. [Appendix 4] 4. The system of claim 3, wherein the actuation assembly further includes a second actuator configured, upon actuation, to move the control element proximally a second distance through the endoscope to move the clip from the inspection configuration to the deployed configuration. [Appendix 5] The system of claim 4, wherein the actuating assembly further comprises a moving element and a pulley mechanism, the control element being routed through the pulley mechanism to be coupled to the moving element, and when the first elongated member and the second elongated member are drawn toward each other, the moving element moves from a proximal position toward a distal position relative to a housing of the actuating assembly, pulling the control element proximally through the endoscope, thereby moving the clip from the insertion configuration toward the inspection configuration. [Appendix 6] 5. The system of claim 4, wherein the second actuator includes a push button including a tab that extends into a housing of the actuation assembly, wherein when the clip is in the inspection configuration, pressing the push button applies additional tension along the control element to move the clip from the inspection configuration toward the deployed configuration, the tab engaging a portion of the control element. [Appendix 7] 7. The system of any one of claims 2 to 6, wherein the actuation assembly further comprises a biasing element that biases the first actuator toward the insertion configuration. [Appendix 8] 7. The system of any one of claims 2 to 6, wherein the actuation assembly includes a locking mechanism for locking the clip toward the inspection configuration. [Appendix 9] 7. The system of any one of claims 2 to 6, wherein the first actuator includes a handle portion configured to be grasped by an operator of the system and a lever movably connected to the handle portion, the proximal end of the control element is connected to the lever, and when the lever is pressed against the handle portion, the control element moves proximally the first distance through the endoscope to move the clip from the insertion configuration toward the inspection configuration. [Appendix 10] 7. The system of any one of claims 2 to 6, wherein the first actuator includes a housing and a rotating handle rotatably coupled to the housing, the proximal end of the control element is connected to a moving element that is threadedly coupled to a portion of the rotating handle, and rotation of the rotating handle relative to the housing moves the control element proximally through the endoscope. [Appendix 11] 1. A clipping system for treating tissue, comprising: an endoscope including a shaft extending longitudinally from a proximal end to a distal end; a cap extending longitudinally from a proximal end to a distal end, the cap including a channel extending therethrough such that the cap is slidably mounted onto a distal portion of the shaft of the endoscope; A clip including a first jaw and a second jaw movably connected to one another via a plurality of hinges, at least one of the plurality of hinges being biased to draw the first jaw and the second jaw toward one another, the clip being mountable on the cap such that the first jaw and the second jaw extend over opposite sides of the cap with the first jaw and the second jaw spaced apart from one another to receive target tissue therebetween, and the clip is mountable on the cap such that the first jaw and the second jaw extend over opposite sides of the cap with the first jaw and the second jaw spaced apart from one another to receive target tissue therebetween, the clip being mountable on the cap such that the first jaw and the second jaw extend a clip, wherein distal movement of the clip relative to the cap moves the clip from an insertion configuration towards an inspection configuration in which the clip extends distally until at least a portion of the clip extends within a field of view of the endoscope's optical system, and wherein distal movement of the clip relative to the cap moves the clip from the inspection configuration towards a deployed configuration in which the clip moves distally away from the cap and in which the first and second jaws are drawn together under the bias of the at least one hinge to close on tissue received therebetween; a repositioning element extending from a distal end coupled to the cap, through the channel of the cap and the endoscope to a proximal end, wherein in use the repositioning element remains outside of the living body and is configured such that moving the repositioning element proximally through the endoscope moves the cap distally along the endoscope from the insertion configuration towards the inspection configuration; a deployment element extending from a distal end releasably coupled to the clip, through the channel in the cap and the endoscope to a proximal end, wherein in use the deployment element remains outside of the living body and the deployment element is configured such that proximal movement of the deployment element through the endoscope moves the clip distally relative to the cap toward the deployed configuration; an actuation assembly including a first actuator configured to control movement of the repositioning element and a second actuator configured to control movement of the deployment element. [Appendix 12] 12. The system of claim 11, wherein the actuation assembly further comprises a housing through which the proximal ends of the repositioning element and the deployment element extend to be coupled to the first actuator and the second actuator. [Appendix 13] 13. The system of claim 12, wherein the first actuator includes a lever pivotally connected to a handle, and the proximal end of the repositioning element is connected to a portion of the handle, such that as the lever moves toward the housing, the repositioning element moves proximally through the endoscope to move the cap and clip from the insertion configuration toward the inspection configuration. [Appendix 14] 13. The system of claim 12, wherein the second actuator includes a push button extending into the housing and coupled to the proximal end of the deployment element, wherein when the push button is pushed further into the housing, the deployment element moves proximally through the endoscope and the clip moves distally relative to the cap from the inspection configuration toward the deployment configuration. [Appendix 15] 14. The system of claim 13, further comprising a biasing element extending between a distal end of the cap and a stop at the distal-most end of the endoscope to which the cap is attached, the biasing element biasing the cap toward the insertion configuration and an entirety of the clip mounted on the cap proximal to the distal-most end of the endoscope, whereby when the lever is released, the cap and clip return toward the insertion configuration.

Claims

1. 1. A clipping system for treating tissue, comprising: a cap configured to be mounted onto a distal end of an endoscope, the cap extending longitudinally from a proximal end to a distal end and including a channel extending therethrough such that the cap may be positioned adjacent a target tissue in vivo; A clip configured to be mounted on the cap, the clip including a first jaw and a second jaw movably connected to one another via a hinge, the hinge being biased to draw the first jaw and the second jaw toward one another, the clip comprising: (a) a first jaw and a second jaw extending over the cap such that the first jaw and the second jaw are spaced apart from one another to receive the target tissue therebetween and with minimal obstruction of an optical system of the endoscope to which the cap is mounted; (b) an insertion configuration in which the clip is moved distally relative to the cap to cause a portion of the clip to extend distally until at least a portion of the clip extends within a field of view of the optical system to which the cap is attached; and (c) a deployed configuration in which the clip is moved distally away from the cap to cause the first and second jaws to close by drawing toward one another under the bias of the hinge to clip tissue received between the first and second jaws. a control element extending from a distal end releasably coupled to the clip, through the channel of the cap and the endoscope to which the cap is coupled, to a proximal end, and remaining outside the living body in use while the cap is adjacent to the target tissue, the control element configured such that proximal movement of the control element through the cap moves the clip distally relative to the cap, and such that proximal movement of the control element a first distance through the cap moves the clip from the insertion configuration to the inspection configuration, and proximal movement of the control element a second distance through the cap moves the clip from the inspection configuration to the deployed configuration; and an actuation assembly including a locking mechanism for locking the clip toward the inspection configuration.

2. The system described in claim 1, wherein the actuation assembly includes a first actuator coupled to a proximal end of the control element, the actuation assembly being configured such that, upon actuation, the control element is moved proximally a first distance through the endoscope to move the clip from the insertion configuration to the inspection configuration.

3. 3. The system of claim 2, wherein the first actuator includes a first elongate member and a second elongate member pivotally connected to one another, and when proximal portions of the first elongate member and the second elongate member are drawn toward one another, distal portions of the first elongate member and the second elongate member are correspondingly drawn toward one another.

4. 4. The system of claim 3, wherein the actuation assembly further includes a second actuator configured, upon actuation, to move the control element proximally the second distance through the endoscope to move the clip from the inspection configuration to the deployed configuration.

5. 5. The system of claim 4, wherein the actuating assembly further comprises a moving element and a pulley mechanism, the control element being routed through the pulley mechanism to be coupled to the moving element, and when the first elongated member and the second elongated member are drawn toward each other, the moving element moves from a proximal position toward a distal position relative to a housing of the actuating assembly to pull the control element proximally through the endoscope, thereby moving the clip from the insertion configuration toward the inspection configuration.

6. 5. The system of claim 4, wherein the second actuator includes a push button including a tab that extends into a housing of the actuation assembly, the tab engaging a portion of the control element such that when the clip is in the inspection configuration, pressing the push button applies additional tension along the control element to move the clip from the inspection configuration toward the deployed configuration.

7. The system of claim 2 , wherein the actuation assembly further comprises a biasing element that biases the first actuator toward the insertion configuration.

8. 3. The system of claim 2, wherein the first actuator includes a handle portion configured to be grasped by an operator of the system and a lever movably coupled to the handle portion, the proximal end of the control element being coupled to the lever such that when the lever is pressed against the handle portion, the control element moves proximally the first distance through the endoscope to move the clip from the insertion configuration toward the inspection configuration.

9. 3. The system of claim 2, wherein the first actuator includes a housing and a rotation handle rotatably coupled to the housing, the proximal end of the control element is connected to a moving element that is threadedly coupled to a portion of the rotation handle, and rotation of the rotation handle relative to the housing moves the control element proximally through the endoscope.

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