Device and method for treating hemorrhoids using suction

Abstract

To address such a problem that it is difficult to visually inspect and treat internal hemorrhoids.SOLUTION: A device includes a handle having a trigger in combination with a distal portion, the distal portion including a rigid elongated hollow member which receives tissue therein and a plunger. The plunger is fitted with the hollow member and configured to slide longitudinally within the hollow member to induce suction at a distal end of the hollow member as the plunger is moved proximally within the hollow member. The trigger is hingedly coupled to the plunger so that pulling the trigger slides the plunger proximally with respect to the hollow member to generate suction to draw the tissue into the distal end of the hollow member. The device further includes a tissue treatment mechanism for encircling the tissue received at the distal end of the hollow member.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to the treatment of hemorrhoids, and more particularly to devices and methods for creating suction to retract tissue, and further to the use of a treatment mechanism to encircle the tissue. [Background technology]

[0002] Hemorrhoids are swollen and inflamed veins around the anus or lower rectum. Hemorrhoids can be external, which form under the skin around the anus, or internal, which form on the lining of the anus and lower rectum. Internal hemorrhoids are difficult to visually inspect and treat. In view of the above, the improvements of the present invention may be useful. Summary of the Invention

[0003] The present invention relates to a device including a handle including a trigger coupled to a distal portion comprising a rigid elongate hollow member for receiving tissue and a plunger attached to the hollow member and configured to slide longitudinally within the hollow member to create suction at the distal end of the hollow member as the plunger moves proximally therethrough. The trigger is hingedly coupled to the plunger such that, when the trigger is depressed, the plunger slides proximally relative to the hollow member, creating suction to draw tissue into the distal end of the hollow member. The device further includes a tissue treatment mechanism for surrounding tissue received at the distal end of the hollow member.

[0004] One embodiment further comprises an optical port extending from the handle and an optical lens disposed on the distal face of the plunger for visualizing a distal region of the device, the optical lens being attached to the optical port. join will be done.

[0005] One embodiment further comprises an optical camera for viewing the distal region through an optical lens, the optical camera being attached to an optical port for attachment to an endoscopic instrument. join will be done. In one embodiment, the distal portion includes a locking tab and is attachable to the handle via a corresponding locking slot in the handle.

[0006] In one embodiment, the distal portion is integrally formed with the handle. In one embodiment, the tissue treatment mechanism comprises a ligating band deployment mechanism for releasing a ligating band from the distal end of the elongate hollow member to tighten around tissue received within the distal end of the elongate hollow member.

[0007] In one embodiment, the ligating band deployment mechanism includes a carrier string having a portion extending longitudinally outside the hollow member, and has a ligating band loaded around the hollow member and the string.

[0008] In one embodiment, the portion of the carrier string that is external to the hollow member moves distally when the ligating band deployment mechanism is actuated, and movement of the carrier string moves the loaded ligating band to the distal end of the hollow member.

[0009] In one embodiment, the ligating band deployment mechanism includes one of a ratchet, a gear, or a pulley to move the carrier string distally. In one embodiment, the tissue treatment mechanism comprises a snare mechanism for actuating a snare from the distal end of the elongate hollow member such that the snare cuts tissue received within the distal end of the elongate hollow member.

[0010] In one embodiment, the snare is energized. The present invention also relates to a method, the method including inserting a distal end of a rigid, elongate, hollow member of a device into a cavity, the device having a plunger attached to the hollow member and configured to slide longitudinally within the hollow member to create suction at the distal end of the hollow member as the plunger moves proximally within the hollow member. The method further includes depressing a trigger hingedly coupled to the plunger to slide the plunger proximally relative to the hollow member and generate suction to draw tissue into the distal end of the hollow member. The method further includes actuating a tissue treatment mechanism to surround tissue received at the distal end of the hollow member.

[0011] The present invention further relates to a device including a hollow housing having a trigger, a viewing port, and a rigid elongated distal portion for receiving tissue through an open distal end. The device further includes a plunger disposed at a proximal end of the housing for creating suction at the open distal end, the viewing port allowing visualization distally through the hollow housing and out of the distal portion. The trigger actuates a ligating band deployment mechanism to release a ligating band from the open distal end and tighten around the received tissue.

[0012] The present invention further relates to a device including a rigid hollow elongate member having an open distal end for receiving tissue, and a plunger disposed at the proximal end of the housing for creating suction at the open distal end, the device further including a slide configured to slide over the exterior of the hollow elongate member and configured to push a ligation band out of the open distal end and tighten around the received tissue. [Brief explanation of the drawings]

[0013] [Figure 1] 1A and 1B illustrate a first device for ligating hemorrhoids according to a first exemplary embodiment of the present invention. [Figure 2] FIG. 2 is a front view of the disposable distal portion of the device of FIG. 1. [Figure 3] FIG. 2 is a cross-sectional front view of the assembled device of FIG. 1. [Figure 4] FIG. 2 is a side view of the reusable proximal portion of the device of FIG. 1. [Figure 5] FIG. 2 is a side view of the disposable distal portion of the device of FIG. 1 with a ligating band loaded thereon. [Figure 6] 10A-10C illustrate a second device for ligating hemorrhoids according to a second exemplary embodiment of the present invention. [Figure 7] 10A-10C show a third device for ligating hemorrhoids according to a third exemplary embodiment of the present invention. [Figure 8] FIG. 10 illustrates a fourth device for ligating hemorrhoids, according to a fourth exemplary embodiment of the present invention. [Figure 9] 10A-10C show a fifth device for ligating hemorrhoids, according to a fifth exemplary embodiment of the present invention. [Figure 10] FIG. 9 shows the plunger of the device of FIG. 8. DETAILED DESCRIPTION OF THE INVENTION

[0014] The present invention can be further understood with reference to the following description and accompanying drawings, in which like elements are referred to by the same reference numerals. Exemplary embodiments of the present invention describe partially or wholly disposable devices for treating hemorrhoids. Each device includes a mechanism for drawing a vacuum and receiving a hemorrhoid within a tubular portion of the device. Certain embodiments described herein are ligation devices for applying a ligation band to the base of a hemorrhoid, while other embodiments described herein are snare devices for removing hemorrhoidal tissue. It should be noted that the terms proximal and distal, as used herein, refer to directions toward (proximal) and away from (distal) the user of the device.

[0015] As shown in FIGS. 1-5, a device 100 for ligating hemorrhoids includes a proximal handle portion 102 including a body 104 that supports a trigger 106. The trigger 106 is coupled to a plunger 110 via a hinged mechanism 108, such as a hinge as shown in FIG. 4. Actuation of the trigger causes the hinged mechanism 108 to move the plunger 110 longitudinally (proximally and distally). Handle part 102 is a reusable portion configured to attach to a disposable distal portion 130. Handle part Disposable distal section 102 has two locking slots 122 sized and shaped to receive corresponding locking tabs 136 extending radially from disposable distal section 130. Locking tabs 136 in this embodiment are rectangular (corresponding to rectangular locking slots 122), but may have any different shape for insertion into correspondingly shaped slots 122. Locking tabs 136 engage locking slots 122 by snapping into slots 122 or by rotating into slots 122 as shown in FIG. 3. Handle portion 102 further includes a port 120 at the proximal end of body 104 for attachment of electronics and / or viewing equipment, such as optical or electrical cables, connected to a vision system, such as an endoscope tower (not shown), for visualizing the ligation procedure.

[0016] The disposable distal portion 130 comprises a hollow tube 132 for receiving the hemorrhoid during the ligation procedure. The hollow tube 132 may include a flange at the proximal end having a locking tab 136 extending radially outward for connecting with the handle 104. Handle part102, plunger 110 resides inside hollow tube 132 with the proximal end of plunger 110 attached to hinged mechanism 108. As will be appreciated by those skilled in the art, distal end 112 of plunger 110 has a cross-section sized and shaped to correspond to the inner diameter of hollow tube 132 so that as plunger 110 moves proximally within tube 132, suction is created that draws target tissue into hollow tube 132. Actuation of trigger 106 moves plunger 110 proximally from an initial distal position, drawing a partial vacuum within tube 132 and drawing hemorrhoidal tissue into hollow tube 132. Moving plunger 110 distally to a distal position releases the vacuum, facilitating separation of the device from surrounding tissue.

[0017] The tube 132 is sized to capture the hemorrhoid such that the base of the hemorrhoid is exposed just distal to the distal end of the tube 132. The plunger 110 includes an optical lens 114 at the distal end of the plunger 110. The optical lens 114 faces distally and outwardly from the distal end of the tube 132. The plunger 110 in this embodiment includes a camera 116 disposed proximal to the optical lens 114 and connected through a port 120 to additional components of a vision system via appropriate wiring. The device 100 in this embodiment includes a light source 118 attached to the camera 116. The light source 118 is directed distally to illuminate a target area within the field of view of the camera 116 so that the camera 116 provides an image of the target tissue to the vision system when the device 100 is aimed at a portion of the target tissue within the anal cavity or rectum. The physician can then guide the procedure using images provided by the camera 116 and vision system as shown, for example on a display in the endoscopy tower (not shown).

[0018] A second aspect of device 100 is a band deployment mechanism for releasing ligating bands 140 from the distal end of tube 132. Any number of ligating bands 140 may be preloaded onto device 100, and the bands 140 are placed in an expanded configuration on the distal end of hollow tube 132 for deployment in a medical procedure. The band deployment mechanism is separate from hinged mechanism 108 for pulling plunger 110 proximally and distally within tube 132. The band deployment mechanism may be any of a variety of mechanisms known in the art. In one embodiment, the band deployment mechanism includes a band carrier string 138 having one or more ligating bands 140 loaded thereon, as shown in FIG. 5 . The carrier string 138 in this embodiment extends into a string channel 134 that extends longitudinally within the wall of the tube 132, exits the distal end of the channel 134, loops around the distal end of the tube 132, and extends proximally again to engage a ligation band 140 that is stretched around the outside of the tube 132.

[0019] The proximal end of string 138 may be configured to attach to reusable handle portion 102 when handle portion 102 and disposable portion 130 are engaged, such that string 138 can be pulled proximally through channel 134, and the portion of string 138 outside of tube 132 can then be pulled distally on the outside of tube 132, releasing one ligation band 140 from tube 132 and tightening around tissue drawn into tube 132, as will be understood by those skilled in the art. As band 140 is released from tube 132, it contracts to a smaller diameter, thereby tightening around selected tissue.

[0020] As will be appreciated by those skilled in the art, string 138 may be wrapped around or otherwise engaged with ligating bands 140 loaded onto canal 132 such that pulling string 138 proximally draws ligating bands 140 distally onto canal 132, allowing ligating bands 140 to be deployed one at a time as desired. In another embodiment, string 138 may have a beaded portion that pushes against ligating bands 140 as string 138 moves proximally. In either embodiment, proximal movement of string 138 ultimately moves one or more of ligating bands 140 to the distal end of canal 132, releasing bands 140 just distal to canal 132. As will be appreciated by those skilled in the art, once hemorrhoidal tissue is drawn into canal 132, releasing bands 140 allows bands 140 to clamp the exposed portion of tissue.

[0021] The proximal handle portion 102 of the device 100 includes elements of a band deployment mechanism that may be attached to a string 138. In one embodiment, the string 138 is pulled by a ratchet mechanism that allows the string 138 to move in only one direction in controlled increments, deploying the band 140. In another embodiment, the band deployment mechanism may include gears or pulleys. The band deployment mechanism may be actuated, for example, by a button on the outside of the handle 102 that pulls the string 138 a predetermined distance each time the button is pressed. However, other implementations of the band deployment mechanism actuator may be used.

[0022] A ligation procedure is performed by first connecting the reusable handle portion 102 to the disposable distal portion 130. A string 138 is attached to an element of the band deployment mechanism within the handle 102 before inserting and locking the locking tab 136 into the locking slot 122. In the first (unactuated) configuration of the device 100, the plunger 110 is positioned toward the distal end of the hollow tube 132. To advance to the second configuration, the trigger 106 is actuated, causing the hinged mechanism 108 to draw the plunger 110 toward the proximal end of the tube 132, creating a partial vacuum. When the device 100 is used in a ligation procedure and the distal end of the tube 132 is positioned adjacent to a target portion of tissue (e.g., a target hemorrhoid), the vacuum drawn by the trigger stroke draws the hemorrhoid into the tube 132. After the vacuum is drawn, the band deployment mechanism can begin to apply the ligating band 140 around the base of the hemorrhoid that has been drawn into the tract 132 .

[0023] After applying the band 140, the device 100 can return to the first configuration, which moves the piston distally, releasing suction and allowing the banded hemorrhoid to be released from the tract 132. Using the camera 116, the physician may reposition the device 100 next to a second hemorrhoid and pull the piston 110 proximally (via the trigger 106) to draw the second hemorrhoid into the tract 132. This process may then be repeated to release a second band 140 (a band 140 previously positioned immediately proximal to the just-released band) around the base of the second hemorrhoid. The ligation procedure may be repeated until all ligating bands 140 have been deployed or all targeted hemorrhoids have been treated, after which the physician can remove the device 100 from the patient. The distal portion 130 can then be detached from the proximal handle portion 102 and discarded, while the proximal portion is sterilized for subsequent use.

[0024] As shown in FIG. 6 , in a second embodiment, a device 200 for ligating hemorrhoids comprises a housing 204 that serves as a handle and includes a distal hollow tube portion 232. The device 200 is a single disposable device with a hinged actuation mechanism 208 coupled to a plunger 210, similar to the components of the device 100. The plunger 210 includes a camera and lens configuration similar to that of the device 100, allowing the camera 116 to provide an image through the distally facing lens 114 so that the user can visualize the procedure within the tube 232, and is coupled to an endoscopic instrument via the endoscope port 120. The band deployment mechanism of the device 200 may be similar to that of the device 100. However, the band deployment mechanism of the device 200 differs from that of the device 100 in that it includes a string 138 and a proximal Handle part 102. In some embodiments, device 200 may be fabricated as a single piece, instead of the disposable and reusable portions being connected via a locking means.

[0025] In another embodiment, the plunger 210 is coupled to an optical viewing port 220, and a camera is not used. The operating physician can visualize the ligation procedure through the viewing port 220 at the proximal end of the device 200. The viewing port 220 is concentric with the plunger 210. In other words, the viewing port 220 extends cylindrically around the plunger 210. The hinged mechanism 208 for moving the plunger 210 in this embodiment has a U-shape to avoid obscuring the visual axis of the viewing port 220, and the viewing port 220 has slots that allow the hinged mechanism 208 to move proximally and distally within the viewing port 220. In this manner, the plunger 210 is movable within the viewing port 220 while maintaining a line of sight through the viewing port 220 and exiting the distal end 212 of the plunger. The plunger 210 includes an optical lens 114 disposed at the distal end 212 of the plunger 210.

[0026] A physician can perform a ligation procedure with device 200 in a manner substantially similar to that described above with respect to device 100. Device 200 is advanced from a first configuration to a second configuration to draw the hemorrhoid that has been drawn into hollow tube 232. When using another embodiment of device 200, the physician guides the procedure using viewing port 220 at the proximal end of device 200. The band deployment mechanism may be any of the methods described above with respect to device 100. The entire device 200 may be discarded after the ligation procedure is completed.

[0027] In a third embodiment, snare device 300 is a single disposable device similar to device 200, but includes a snare 340 instead of a ligating band, as shown in FIG. 7. As will be appreciated by those skilled in the art, snare 340 is disposed around the distal end of hollow tube 332 of snare device 300 and is configured to remove hemorrhoidal tissue by excising the hemorrhoid at its base. Either camera 116 or an optical viewing port similar to optical viewing port 220 may be used with device 300 to allow a physician to guide the snare procedure in a manner similar to that described with respect to device 200. Thus, plunger 310 operates to draw the hemorrhoid into tube 332 via hinged mechanism 308 in a manner substantially similar to device 200. However, once the hemorrhoid is drawn into the canal 332 until the base of the hemorrhoid abuts the distal end of the canal 332 , the snare 340 is actuated and the hemorrhoid is removed at the portion abutting the distal end of the canal 332 .

[0028] In another embodiment, the snare 340 may be energized by an active cord 344 coupled to the snare 340 via suitable wiring within the device 300. For example, the device 300 may be operatively coupled to an energy source via the active cord 344 to deliver energy to the snare 340. In this manner, the hot snare removes most of the hemorrhoid and cauterizes the wound.

[0029] The snare 340 may be actuated by the movement of the plunger 310 or may be actuated externally. For example, a cable 342 may connect the snare 340 to the hinged mechanism 308. When the hinge / plunger is retracted, the cable 342 may be pulled, acting to tighten the snare 340. The components may be designed so that the snare 340 does not tighten until the plunger 310 reaches its proximal-most position. Alternatively, the cable 342 may extend outside the device 300 and be pulled separately from the plunger 310. If a hot snare is used, the snare 340 may be energized when the trigger 306 is activated. Multiple hemorrhoid treatments are possible without removing the device 300 from the patient's anatomy. The snare-resected hemorrhoidal tissue may remain within the tract 332 or may fall out of the device 300 for removal when the snare procedure is complete.

[0030] In the fourth embodiment, the ligation device 400 is a single disposable device including a body 404 having a distal tube 412 for receiving a hemorrhoid, as shown in FIG. 8 , similar to the above-described embodiments. However, the device 400 includes a plunger 410 disposed at the proximal end of the housing 404 and configured to be manually actuated by a medical professional. The plunger 410 has a handle portion exterior to the device 400 and an internal portion attached to the interior of the device 400 along the axis L such that pulling the handle portion proximally along the axis L creates a partial vacuum inside the device and at the distal end of the tube 412. The body 404 serves as a handle for the device 400 and includes a viewing port 420 with a viewing axis extending into the tube 412 so that the operating physician can observe the ligation procedure. The body 404 has a trigger 406 for actuating a band deployment mechanism and releasing a ligation band 440 loaded onto the tube 412.

[0031] In one embodiment, the band deployment mechanism is similar to the band deployment mechanisms of the devices described above and includes a carrier string that deploys the bands when the string is pulled along the outside of tube 412. In another embodiment, the band deployment mechanism is a simple tab or lever for disengaging the distal-most band 440 from the distal end of tube 412. In this alternative embodiment, multiple bands 440 may be pre-loaded onto device 400, but after the first band 440 is deployed, the remaining bands are manually advanced distally to assume their deployed positions.

[0032] During the ligation procedure, the physician locates the hemorrhoid, for example, using a power light 418 at the distal end of the tube 412 to illuminate the target tissue through the viewing port 420. The power light 418 in this embodiment can be battery-powered, for example. Once the physician has moved the distal end of the tube 412 next to the hemorrhoid, they can manually actuate the plunger 410 (with the handle remaining outside the patient) to create a vacuum and draw the hemorrhoid into the tube 412. Once the hemorrhoid has been drawn into the tube 412, the physician actuates the trigger 406 to apply a ligation band 440 to the hemorrhoid. The physician then releases the vacuum and removes the device 400 from the patient. The physician may manually advance a second ligation band 440 to the distal end of the tube 412 and repeat the process to treat any remaining hemorrhoids.

[0033] In a fifth embodiment, ligation device 500 is a single-use, disposable device including a hollow tube 512 with a flexible slide 550 positioned along most of the exterior of tube 512, as shown in FIG. 9. As shown in FIG. 10, a plunger 510 is positioned at the proximal end of tube 512 to draw a partial vacuum within the tube and draw target tissue into tube 512. Plunger 510 may include two finger rings 514 and a thumb ring 516 for a user to draw target tissue into tube 512. A pusher 562 at the distal end of flexible slide 550 is operable to push ligation band 540 from the distal end of tube 512 onto the base of the target tissue drawn into the tube. The proximal end of slide 550 is manually pushed from the proximal portion of tube 512 outside the patient and advanced distally along tube 512, forcing pusher 562 against ligation band 540. Once the ligating band is applied, the partial vacuum can be released, freeing the hemorrhoid from the tract 512. The device 500 is manually reloadable with additional ligating bands 540 to treat additional tissue. The device 500 does not include a viewing feature, but may be used with an anoscope to visualize the procedure. Section AA in FIG. 9 shows a cross section of the proximal end of the flexible slide 550, and section BB in FIG. 9 shows a cross section of the distal end of the flexible slide 550.

[0034] Those skilled in the art will understand that changes can be made to the above-described embodiments without departing from the inventive concept thereof. Furthermore, it will be understood that structural features and methods associated with one of the embodiments can be incorporated into other embodiments. Accordingly, the present invention is not limited to the specific embodiments disclosed; rather, modifications are understood to be encompassed within the scope of the present invention as defined by the appended claims. Combinations of the above-described embodiments and other embodiments not specifically described herein will be apparent to those skilled in the art upon reviewing the above description. Accordingly, the scope of the various embodiments includes any other applications in which the above-described compositions, structures, and methods are used.

[0035] Some embodiments may be described using the terms "coupled" and "connected," along with their derivatives. These terms are not intended as synonyms for each other. For example, some embodiments may be described using the terms "connected" and / or "coupled" to indicate that two or more elements are in direct physical or electrical contact with each other. However, the term "coupled" may also mean that two or more elements are not in direct contact with each other, but yet still cooperate or interact with each other.

[0036] As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. Furthermore, it will be understood that the terms "comprises" and / or "comprising," or "includes" and / or "including," when used herein, specify the presence of stated features, regions, step elements and / or components, but do not exclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components and / or groups thereof.

[0037] Furthermore, the terms "substantial" or "substantially" and "approximate" or "approximately" may be used interchangeably in some embodiments and may be described using any relative measure acceptable to one of ordinary skill in the art. For example, these terms may serve as a comparison to a reference parameter to indicate a deviation that still provides the intended function. Without limitation, the deviation from the reference parameter may be, for example, an amount of less than 1%, less than 3%, less than 5%, less than 10%, less than 15%, less than 20%, etc.

Claims

1. 1. An apparatus comprising: a handle portion including a body supporting a trigger; a hollow member extending distally from the handle portion, the hollow member having an open distal end configured to receive tissue; a plunger configured to slide longitudinally within the hollow member to create suction through the open distal end of the hollow member as the plunger moves proximally within the hollow member, the trigger hingedly coupled to the plunger such that, upon depression of the trigger, the plunger slides proximally within the hollow member, creating suction to draw the tissue into the open distal end of the hollow member; a tissue treatment element comprising a snare surrounding the open distal end of the hollow member or one or more ligating bands mounted on the distal end of the hollow member; a release mechanism configured to release the tissue treatment member from the hollow member when tissue is drawn into the open distal end of the hollow member; an optical port located at a proximal end of the body; an optical lens disposed on a distal surface of the plunger, the optical lens configured to visualize a distal region located distal to the device, the optical lens coupled to the optical port; An apparatus comprising:

2. The device of claim 1 , further comprising an optical camera for viewing the distal region through the optical lens, the optical camera coupled to the optical port for attachment to an endoscopic instrument.

3. The device of claim 1 , wherein the handle portion includes a locking slot and is attachable to the hollow member via a corresponding locking tab on the hollow member.

4. The device of claim 1 , wherein the hollow member is integrally formed with the handle portion.

5. the tissue treatment element is one or more ligating bands; 10. The device of claim 1, wherein the release mechanism is a ligating band deployment mechanism configured to release the ligating band as the tissue treatment member from the open distal end of the hollow member for tightening around the tissue received within the open distal end of the hollow member.

6. 6. The device of claim 5, wherein the ligating band deployment mechanism includes a carrier string having a portion that extends into a longitudinally extending string channel, the portion of the carrier string extending into a wall of the hollow member, exiting a distal end of the string channel to loop around the distal end of the hollow member, and extending proximally again to engage the ligating band.

7. 7. The device of claim 6, wherein a portion of the carrier string exterior to the hollow member is configured to be moved distally upon actuation of the ligating band deployment mechanism, the movement of the carrier string moving one or more loaded ligating bands to the open distal end of the hollow member.

8. The device of claim 7 , wherein the ligating band deployment mechanism includes one of a ratchet, a gear, or a pulley to move the carrier string distally.

9. 6. The device of claim 5, further comprising a ligating band receiving surface located proximal to the open distal end of the hollow member, the ligating band receiving surface configured to receive multiple ligating bands in a stretched state over the hollow member such that when a ligating band is released from the open distal end of the hollow member, the ligating band tightens around tissue received within the hollow member.

10. 2. The device of claim 1, wherein the hollow member includes a flange at a proximal end thereof having a plurality of locking tabs extending radially outward therefrom, the flange configured to be releasably coupleable to the handle portion via the plurality of locking tabs such that the hollow member is configured to be separated from the handle portion.

11. The device of claim 1 , wherein the tissue treatment member is a snare and the release mechanism comprises a snare release mechanism configured to release the snare.

12. The device of claim 11 , wherein the snare is energized.

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