Systems, devices, and related methods for fixing tissues

Abstract

According to one aspect, a tissue fixation device may include a first body including a proximal end and a distal end and defining a longitudinal axis, and a fixation device coupled to the distal end of the first body. The fixation device may include a longitudinal body with a cartridge configured to hold one or more fasteners, an anvil rotatable relative to the cartridge on the longitudinal body, a fastener actuator configured to move relative to the cartridge to deploy one or more fasteners from the cartridge, and an actuation wire coupled to the fastener actuator, extending through the first body, and at least partially external to the longitudinal body, the cartridge, or the anvil.

Description

Technical Field

[0001] Various aspects of the present disclosure generally relate to tissue manipulation, including visualizing, drawing in, and joining tissue. More specifically, at least certain embodiments of the present disclosure relate, among other things, to systems, devices, and related methods for fixing tissue. This application claims the benefit of priority of U.S. Provisional Patent Application No. 63 / 156,027, filed on Mar. 3, 2021, which is hereby incorporated by reference in its entirety.

Background Art

[0002] Technological developments have provided users of medical systems, devices, and methods with the ability to perform increasingly complex procedures on subjects. For example, joining tissue in a subject's gastrointestinal tract is a type of procedure that can be difficult. Surgical devices can join tissue with a surgical fastener after gripping or clamping the tissue between opposing jaw structures.

[0003] Some actuators within surgical staplers involve pushing or pulling a wire through the device. When the stapler is placed within a tortuous path, movement of the wire through the fixation device can become difficult because of increased strain or other forces applied to the wire from other parts of the stapler. There is a need for systems, devices, and related methods for fixing tissue that include features to address this difficulty.

Summary of the Invention

[0004] Aspects of the present disclosure relate, among other things, to systems, devices, and methods for fixing tissue. Each of the aspects disclosed herein may include one or more of the features described in relation to any of the other disclosed aspects.

[0005] In one embodiment, the tissue fixation device may include a first body defining a longitudinal axis and having a proximal and distal end, and a fixation device coupled to the distal end of the first body. The fixation device may include a longitudinal body having a cartridge configured to hold one or more fixation devices, an anvil rotatable with respect to the cartridge of the longitudinal body, a fixation device actuator configured to deploy one or more fixation devices from the cartridge by moving relative to the cartridge, and an actuation wire coupled to the fixation device actuator, extending through the first body and at least partially located outside the longitudinal body, the cartridge, or the anvil.

[0006] In other embodiments, the fixing device may include one or more of the following features: The longitudinal body may be pivotably coupled to the first body. A longitudinal member may be coupled to the proximal end of the longitudinal body. The first body may include a first lumen extending from the proximal portion of the first body to a first lumen opening in the distal portion of the first body. The longitudinal member and the actuation wire are at least partially located within the first lumen. The longitudinal member may include a longitudinal channel, and the actuation wire may be located within the longitudinal channel. The first body may include a second lumen opening within the first lumen, and the first lumen opening may be located on the opposite side of the first body from the second lumen opening. The first body may include a first lumen and a second lumen. The longitudinal member may be located within the first lumen, and the actuation wire may be located within the second lumen.

[0007] In other embodiments, the fixing device may include one or more of the following features: The fixing actuator may be located within a longitudinal slot of the longitudinal body. The fixing actuator may include at least one inclined portion and an extended portion extending through the longitudinal slot. A spring may be coupled to the first body and the longitudinal body. The spring may be configured to bias the fixing device toward a position where the longitudinal axis of the longitudinal body intersects the longitudinal axis of the first body. The longitudinal member may be coupled to the proximal end of the longitudinal body via a coupling, the coupling may have a width greater than the width of the first lumen opening. A cable may be rotatably coupled to the longitudinal body and located within the first body. The cable may be configured to allow movement of the fixing device. The longitudinal body may be rotatably coupled to the first body at a position between the proximal and distal ends of the longitudinal body. The longitudinal member and the actuation wire may each extend through at least one opening in the first body at a position that is generally close to the fixing device.

[0008] In other embodiments, the tissue fixation device may include a first body defining a longitudinal axis and including a first lumen, and a fixation device rotatably coupled to the distal end of the first body. The fixation device may include a longitudinal body, a cartridge at least partially located within the longitudinal body and equipped with one or more fixation devices, an anvil mounted adjacent to the cartridge, and an actuating wire. The actuating wire is coupled to a fixation device actuator at its distal end. The fixation device actuator is located within a channel. The fixation device may include a second body including a second lumen, the second body located within and movable within the first lumen and extending from the first lumen, and a cable rotatably coupled to the longitudinal body and extending through the first lumen. The actuating wire may be located within the second lumen. The fixation device may be pivotable around the first body as the cable moves proximal and / or distally. In some examples, the first body may be rotatably coupled to the longitudinal body at a position between the proximal and distal ends of the longitudinal body.

[0009] In another embodiment, the tissue fixation device may include a first body defining a longitudinal axis and a fixation device rotatably coupled to the distal end of the first body. The fixation device may include a longitudinal body configured to hold one or more fixation devices, an anvil rotatable with respect to the longitudinal body, a fixation device actuator configured to deploy the one or more fixation devices from the fixation device by moving proximal to the longitudinal body, and an actuation wire coupled to the fixation device actuator, extending through the first body and at least partially located outside the longitudinal body and the anvil.

[0010] In other embodiments, the fixing device may include one or more of the following features: A spring may be coupled to the longitudinal body and the first body. A second body may be coupled to the longitudinal body and extend through the first body. The second body may be movable within the first body and may be configured to rotate the fixing device relative to the first body by proximal or distal movement of the second body.

[0011] The general description above and the detailed description below are illustrative and descriptive only and do not limit the inventions described in the claims. The accompanying drawings incorporated herein and constituting part of herein illustrate exemplary embodiments of this disclosure and serve to illustrate the principles of this disclosure together with the description. [Brief explanation of the drawing]

[0012] [Figure 1] Figure 1 is a perspective view of the distal end of an exemplary medical fixation system according to an aspect of this disclosure. [Figure 2] Figure 2 is a perspective view of the distal end of an exemplary surgical stapler of the medical fixation system of Figure 1 according to an aspect of this disclosure. [Figure 3] Figure 3 is a side view of a portion of the exemplary surgical stapler shown in Figure 2 according to an aspect of this disclosure. [Figure 4] Figures 4A and 4B are top views of the distal end of the surgical stapler of Figure 2 according to an embodiment of the present disclosure. [Figure 5] Figures 5A and 5B are cross-sectional views of exemplary longitudinal members according to embodiments of the present disclosure. [Figure 6] Figure 6 is a perspective view of an exemplary portion of a surgical stapler according to an aspect of the present disclosure. [Figure 7] Figure 7 is a perspective view of an exemplary distal portion of a surgical stapler according to an embodiment of the present disclosure. [Figure 8] Figure 8 is a perspective view of an exemplary portion of a surgical stapler according to an aspect of the present disclosure. [Modes for carrying out the invention]

[0013] This disclosure relates, in particular, to systems, devices, and methods for fixing tissue, among other aspects. Hereinafter, aspects of this disclosure will be referenced in detail, and examples thereof will be shown in the accompanying drawings. Wherever possible, the same or similar reference numerals will be used throughout the drawings to refer to identical or similar parts. The term “distal” refers to the part of the device furthest from the user when the device is introduced into the patient. In contrast, the term “proximal” refers to the part of the device closest to the user when the device is placed in the patient. Throughout the drawings, the proximal and distal directions are indicated by arrows labeled “D” for the distal direction and arrows labeled “P” for the proximal direction. The term “joining tissue together” may refer, for example, to stapling, fixing, attaching, securing, or otherwise joining two parts of tissue together. The term “fixation device” may include staples, clips, elastic bands, sutures, or any other fixation devices known in the art. As used herein, the terms “equipped,” “equipped,” or any other variation thereof are intended to cover non-exclusive inclusion, such that a process, method, article, or apparatus containing a list of elements does not necessarily contain only those elements, but may include other elements not expressly enumerated or that are specific to such process, method, article, or apparatus. The term “exemplary” is used in the sense of “example” rather than “ideal.”

[0014] Embodiments of the present disclosure may be used to visualize, cut, excise, and / or join together target tissue within a luminal space, or to facilitate such processes. In particular, some embodiments include a pivotable tissue stapler device. The stapler device may be delivered to the target tissue via an endoscopic working channel to the target tissue site. An actuating wire may move through the stapler device to deploy one or more fixation devices within the target tissue site. All or part of the tissue stapler device may be metal, plastic, or include shape memory metal (e.g., nitinol), shape memory polymer, polymer, or any combination of materials.

[0015] Figure 1 shows the distal portion of a medical system 100 including an endoscope 101 and a surgical stapler 200. The endoscope 101 may include an imaging device 104, such as a camera, fluid channels 110, 112, an illuminator 106, and a working channel 108. The distal surface 102 of the endoscope 101 may include the distal openings of the fluid channels 110, 112 and the working channel 108. The endoscope 101 may extend proximal to a handle (not shown) that articulates and / or has one or more actuators for operating the imaging device 104, the illuminator 106, and / or one or more fluid channels 110, 112. The surgical stapler 200 is shown positioned within the working channel 108 of the endoscope 101, and the surgical stapler 200 may extend proximal to a handle at the proximal end of the surgical stapler 200 via the endoscope 101. The handle of the surgical stapler 200 may include one or more actuators for operating one or more features of the surgical stapler 200. Specific examples of handles for the surgical stapler 200 or any other embodiment of the surgical stapler disclosed herein are detailed in U.S. Patent Application No. 16 / 804,887, filed February 28, 2020, which is incorporated by reference in its entirety.

[0016] The surgical stapler 200 is a stapler device configured to engage with body tissue and apply multiple surgical fixation devices to body tissue during minimally invasive surgical procedures such as laparoscopy or endoscopic procedures. In some examples, the surgical stapler 200 may create incisions in the fixed body tissue during the procedure. The surgical stapler 200 may be used to apply surgical clips or other fixation devices, but is primarily described in the context of applying staples from a staple cartridge located within a part of the device body, such as a loading unit.

[0017] As shown in Figure 1, the surgical stapler 200 includes a stapler device 201 and a longitudinal body 202. The longitudinal body 202 may extend from the stapler device 201 at the distal end 299 of the surgical stapler 200 to a handle assembly (not shown) at the proximal end of the surgical stapler 200. The longitudinal body 202 may extend to any length suitable for endoscopic or laparoscopic procedures and may be configured to be positioned within the working channel of an endoscope. In some embodiments, the longitudinal body 202 may be detachable from the handle assembly to facilitate insertion of the longitudinal body 202 into the working channel of an endoscope or a channel of another device, for example, by backloading the longitudinal body 202 into the working channel 108. In other embodiments, the surgical stapler 200 may not include a handle. In some embodiments, the longitudinal body 202 may be flexible and / or rotatable about its central longitudinal axis. The longitudinal body 202 may include a lumen for positioning an actuating wire for operating the surgical stapler 200 within the longitudinal body 202, and such actuating wire may be connected to a handle assembly. The longitudinal body 202 may be configured to receive multiple actuating wires or a single actuating wire (e.g., actuating wire 216). In some examples, the longitudinal body 202 may be fixedly coupled to the stapler device 201, while in other embodiments, the longitudinal body 202 may be detachably or releaseably coupled to the stapler device 201. As shown in Figure 1, the longitudinal body 202 may be pivotably coupled to the stapler device 201 via a connector 204. In some examples, the connector 204 may be located between the proximal and distal ends of the body 208 of the stapler device 201. The connector 204 may be offset from the longitudinal axis 239 of the body 208 of the stapler device 201.

[0018] The distal portion 299 of the surgical stapler 200 includes a stapler device 201 coupled to the distal portion of the longitudinal body 202. In some examples, the body 208 of the stapler device 201 may include a cartridge 218 disposed within a channel of the body 208. The cartridge 218 may be fixed to the body 208, movably coupled, or detachable from the body 208. In some examples, the cartridge 218 may be integrally formed with the body 208. In the proximal portion of the body 208, an anvil 210 may be rotatably or pivotally coupled to the body 208 at a pivot axis 229. The anvil 210 may extend distally toward the distal end of the stapler device 201. In some embodiments, the anvil 210 may be rotatably biased and may be biased to an open configuration. In other words, the anvil 210 can be biased away from the body 208 and cartridge 218 to create a space between the distal portion of the anvil 210 and the distal portions of the body 208 and cartridge 218. The anvil 210 can be rotatable about the pivot axis 229 so as to contact the body 208 or to sandwich tissue between the anvil 210 and the body 208 and to provide a surface from which staples can be driven when extruded from the cartridge 218.

[0019] In some examples, the body 208 may include channels supporting the cartridge 218. The cartridge 218 may contain multiple surgical fixation devices, such as staples. The fixation devices may be deployed from the cartridge 218 when under the influence of a driving force exerted by an actuating thread, such as one of the actuating threads 673,772 shown in Figures 6 and 7. Multiple spaced longitudinal slots 231,232 within the cartridge 218 allow the staples to pass through the cartridge 218 and perforate the tissue. In some examples, the actuating threads 673,772 move longitudinally (or parallel to the axis 239) proximal to the distal end of the cartridge 218 and / or body 208 when actuated, contacting the fixation devices within the cartridge 218 and pushing the fixation devices through the longitudinal slots 231,232 to bond the fixation devices to the tissue. In some examples, a single fixation device may extend through each slot 231,232. Each fastener may be partially present within slots 231, 232 before deployment to assist in aligning the fastener with slots 231, 232. In some examples, two actuation threads may be required to actuate two different longitudinal rows of fasteners within cartridge 218. Alternatively, one actuation thread 673 may include two inclined sections 671, 672, each inclined section 671, 672, which may be aligned with separate longitudinal rows of slots 231, 232 on cartridge 218.

[0020] In some examples, cartridge 218 may further include a longitudinal slot (not shown) configured to receive and / or support a cutting tool, such as a knife blade (not shown). The cutting tool may be actuated via an additional separate actuating wire from the actuating wire that translates the actuating thread 673,772, or it may be actuated via the same actuating wire as the actuating thread 673,772 to translate both the actuating thread and the cutting tool simultaneously. Further descriptions of using a cutting tool with cartridge 218 can be found in U.S. Patent Application No. 16 / 804,887, filed February 28, 2020.

[0021] In some embodiments, the longitudinal body 202 can be rigid and can be coupled to a flexible body configured to pass through an endoscope or other medical device. The longitudinal body 202 can be manufactured from polyetheretherketone (PEEK), stainless steel, or other suitable materials. The longitudinal member 206 can extend within the lumen 212 of the longitudinal body 202 and can exit the lumen 212 at a location near the distal end of the longitudinal body 202. The lumen 212 of the longitudinal body 202 can extend longitudinally from the proximal end to the distal portion of the longitudinal body 202. The lumen 212 can include an outlet opening 261 in the sidewall of the longitudinal body 202.

[0022] The longitudinal member 206 can be fixedly coupled to the proximal end of the body 208. The longitudinal member 206 can be movable within the longitudinal body 202 and can exit the lumen 212 through the outlet opening 261 at the proximal portion of the surgical stapler 200. The longitudinal member 206 can be configured to move proximally and distally through the lumen 212. In some examples, the longitudinal member 206 can be a non-compressible member such as a Bowden cable. The longitudinal member 206 can include a second lumen (not shown, separate from the lumen 212) for receiving the actuating wire and other components of the surgical stapler 200.

[0023] In some examples, the connector 204 enables pivoting of the stapler device 201 relative to the longitudinal body 202. For example, the stapler device can pivot about the connector 204 such that 1) the longitudinal axis 239 of the stapler device 201 is parallel to the longitudinal axis of the longitudinal body 202, and 2) the stapler device 201 can move between a position where the longitudinal axis of the stapler device 201 crosses the longitudinal axis of the longitudinal body 202. In an embodiment, the connector 204 can enable such pivoting such that when the longitudinal axis 239 of the stapler device 201 is parallel to the longitudinal axis of the longitudinal body 202, the angle between the longitudinal axis of the longitudinal body 202 and the axis 239 is greater than 0 degrees and up to 180 degrees. In some examples, the exit opening 261 can be elliptical, allowing the longitudinal member 206 to smoothly transition in and out of the longitudinal body 202, and being elongated in the longitudinal direction of the longitudinal body 202 to minimize friction between the exit opening 261 of the lumen 212 and the longitudinal member 206 when the longitudinal member 206 moves through the lumen 212.

[0024] The user can pivot the stapler device 201 by pushing or pulling the longitudinal member 206 (moving the longitudinal member 206 proximally or distally), and then rotate the stapler device 201 about the connector 204 by pushing or pulling the stapler device 201. In some embodiments, the connector 204 can include a pin extending through the device at the distal end of the longitudinal body 202 and a flange extending from the stapler device 201. The stapler device 201 can include a pair of flanges extending from a portion of its body and including an opening for the pin. The longitudinal body 202 can include a device including an opening extending from the distal end of the longitudinal body 202 and configured to align with the opening of the pair of flanges. The pin can be positioned with the opening of the pair of flanges and the opening of the device extending from the distal end of the longitudinal body 202 to form the connector 204.

[0025] The actuating wire 216 may extend from the ram actuator thread of the stapler device 201 through a second lumen 214 of the longitudinal body 202 to the proximal portion of the stapler device 201. The actuating wire 216 may be entirely external to the body 208 and the anvil 210. In other examples, the actuating wire 216 and the longitudinal member 206 may extend through the same lumen 212. The second actuating wire may extend through the longitudinal member 206 and be configured to actuate the movement of the anvil 210 toward or away from the body 208. In some examples, the actuating wire 216 may be coupled to the handle of the stapler device 201. The actuating wire 216 may be configured to move proximal or distal through a portion of the longitudinal body 202. The actuating wire 216 may be located outside the main body 208 and the anvil 210, and may be coupled to the inclined actuating threads 673,772 which are at least partially located within the stapler device 201. The actuating wire 216 may be configured to actuate the deployment of the fasteners from the stapler device 201 by pulling the inclined actuating threads 673,772 proximal. The actuating wire 216 may enter the longitudinal body 202 at a position proximal to the distal end of the stapler device 201 and proximal to the distal end of the longitudinal body 202.

[0026] In some examples, the actuating wire may extend into the body 208 and / or anvil 210 via the longitudinal member 206, but the combination of torsion and stiffness of the longitudinal member 206, body 208, and anvil 210 may make it difficult for the actuating wire to move through the longitudinal member 206, and the positioning of the actuating wire relative to the body 208 and longitudinal body 202 may increase the friction caused by the movement of the actuating wire. By positioning the actuating wire 216 outside the body 208 rather than inside it, the force applied to the actuating wire 216 by the longitudinal member 206 may be reduced, making it easier for the user to pull the actuating wire 216 proximal. In addition, the actuating wire 216 may be at least partially outside the longitudinal member 206 and the portion of the longitudinal body 202. By positioning the actuating wire 216 at least partially outside the longitudinal member 206 and portions of the longitudinal body 202, the load and frictional forces are reduced, making it easier to pull the actuating wire 216 proximal. Pulling the actuating wire 216 proximal allows the actuating thread 673 to move proximal, enabling it to push one or more fixtures out of the cartridge 218.

[0027] The user can use the surgical stapler 200 to fasten one or more fasteners to tissue by first positioning the tissue within the working area of ​​the stapler device 201 or between the body 208 and the anvil 210. Once the tissue is positioned within the working area of ​​the stapler device 201, the user can actuate the actuator on the handle of the stapler device 201, and then translate the actuating wire proximal through the longitudinal member 206 to close the anvil 210 on the tissue positioned within the working area of ​​the stapler device. While the user holds the stapler device 201 in the engaged position and thus maintains the fasteners of the stapler device on the tissue, the user can pull (or actuate) the actuating wire 216 proximal to translate the actuating thread 673 within the stapler device 201. When the actuating threads 673,772 are translated proximally via the actuating wire 216, the inclined portions 671,672,792 of the actuating threads 673,772 engage with the fixation devices in the cartridge 218, pushing the fixation devices through the longitudinal slots 231,232 and penetrating the tissue. When the fixation devices are deployed by the actuating threads 673,772, the fixation portions then engage with the anvil 210 and can bond layers of tissue together. In some examples, the actuating wire 216 can actuate the actuating threads and the excision tool (not shown), translating both the actuating threads and the excision tool simultaneously to penetrate the tissue, fix the tissue with one or more fixation devices, and excise the tissue.

[0028] Figure 2 shows the distal portion of an alternative embodiment of the surgical stapler 200, including a stapler device 301. The stapler device 301 may include a longitudinal body 302, a stapler body 308, an anvil 310, a longitudinal member 306, a connector 304, and an actuating wire 316. The surgical stapler 300 may include any of the features described herein with respect to the surgical stapler 200. The longitudinal body 302 may include a single lumen 360. The actuating wire 316 and the longitudinal member 306 may each extend through the lumen 360. The longitudinal member 306 may extend through a first distal opening 312 of the lumen. The actuating wire 316 may extend through a second distal opening 314 of the longitudinal body 302 opposite to the first distal opening 312. The longitudinal body 302 may include a distal portion 320. The distal portion 320 includes a connector 304 at its distal end. The connector 304 can pivotally connect the stapler device 301 to the longitudinal body 302. The connector 304 may be located at the distal end portion of the stapler device 301. The connector 304 may include a pivot pin 340. The connector 304 may be rotatable about the pivot pin 340. The projection 333 of the connector 304 may be fixedly connected to the stapler body 308 and may extend proximal to the stapler body 308. The longitudinal member 306 may be rotatably connected to the projection 333 via a coupling 355. In other examples, the longitudinal member 306 may be fixedly connected to the projection 333 by the coupling 355 or any other means known in the art. Proximal or distal movement of the longitudinal member 306 can cause rotation of the stapler device around the pivot pin 340.

[0029] Figure 3 shows a rear view of the distal portion of the surgical stapler 300. As shown in Figure 3, the connector 355 may be cylindrical, and its outer circumference around its longitudinal axis may be larger than the outer circumference around the longitudinal axis of the longitudinal member 306. The larger outer circumference of the connector 355 can prevent the connector 355 from being pulled into the lumen 360 through the first distal opening 312 when the longitudinal member 306 is pulled proximal. In some examples, the connector 355 can restrict the rotation of the stapler device 301 around the pivot pin 340. The actuating wire 316 may be connected to the actuating thread 373 via a pin 352 of the actuating thread 373 that extends through a slot (not shown) at the bottom of the stapler body 308. In some examples, the actuating wire 316 is wrapped around the pin 352 to connect the actuating wire 316 to the pin 352. In other examples, the actuating wire 316 may be coupled to the pin 352 via a crimping tube, adhesive, and / or any other coupling mechanism known in the art. As shown in Figure 3, part of the pin 352 is outside the stapler body 308, and the actuating wire 316 is coupled to the actuating thread 373 in a position completely outside the stapler body 308.

[0030] Figures 4A and 4B show top views of the distal portion of the surgical stapler 300. Figure 4A shows the stapler device 301 positioned substantially parallel to the longitudinal body 302, and Figure 4B shows the stapler device 301 angled with respect to the longitudinal body 302. To move the surgical stapler 300 from the position shown in Figure 4A to the position shown in Figure 4B, the user can rotate the stapler device 301 around the pivot pin 340 by pushing the longitudinal member 306 distally through the longitudinal body 302. To move the surgical stapler 300 from the position shown in Figure 4B to the position shown in Figure 4A, the user can pivot the stapler device 301 around the pivot pin 340 by moving the body 208 and anvil 310 by pulling the longitudinal member 306 proximal through the longitudinal body 302.

[0031] Figures 5A and 5B show cross-sectional views of two examples of longitudinal members 500 and 501, respectively. Each of the longitudinal members 500 and 501 may have any of the features disclosed herein with respect to the longitudinal members 206 and 306. The longitudinal member 500 may have a cylindrical shape and may be configured to be located within the longitudinal bodies 202 and 302. The longitudinal member 501 may include a substantially circular cross-section and a slotted portion 502. The slotted portion 502 may extend longitudinally along the entire length of the longitudinal member 501 or extend longitudinally over only a portion of the length of the longitudinal member 501. The slotted portion 502 may include a curved surface configured to engage with the outer surface of the actuation wire 316. By providing a slot portion 502 that extends longitudinally through the longitudinal member 501, less space is required within the lumen 360 to accommodate the longitudinal member 501 and the actuation wire 316, while allowing the longitudinal member 501 and the actuation wire 316 to move relative to each other within the lumen 360.

[0032] Figure 6 shows an exemplary stapler body 608, actuating thread 673, and actuating wire 616 that can be incorporated into one of the stapler devices 201,301 described herein. The stapler body 608 may include a longitudinal slot 675 configured to receive an extension 670 of the actuating thread 673. The extension 670 may be T-shaped and may be connected to the distal end of the actuating wire 616. The extension 670 may be configured to connect to the actuating wire 616 in a position entirely outside the stapler body 608. In other examples, the actuating wire 616 may be connected to the actuating thread 673 in a position partially inside the stapler body 608 and / or within the longitudinal slot 675. The actuating thread 673 may include two inclined portions 671,672 located within a channel 685 of the stapler body 608. The channel 685 may be configured to receive a stapler cartridge 218. The inclined sections 671 and 672 may be made sufficiently wide so that the inclined sections 671 and 672 as a whole or individually are wider than the width of the longitudinal slot 675. The actuation thread 673 may be pulled proximal through the channel 685 when the actuation wire 616 is pulled proximal.

[0033] Figure 7 shows the distal portion of the components of an alternative stapler device, including a stapler body 708, a longitudinal body 702, a pivot pin 740, a longitudinal member 706, and an actuating wire 716. Any features described herein with respect to surgical staplers 200, 300 and stapler body 608 may be included in a surgical stapler including the components of Figure 7. The stapler body 708 includes a channel 775, which receives an actuating thread 772. The actuating thread 772 includes a slanted portion 792 and is coupled to an actuating wire 716. The actuating wire 716 extends to the proximal portion of the device via the longitudinal member 706. In embodiments of staplers utilizing the components of Figure 7, the longitudinal member 706 is not used to rotate the stapler body around the pivot pin 740, but instead may protect the actuating wire 716. In this example, the longitudinal member 706 may be flexible, but does not need to be rigid enough to move the stapler body 708 by proximal or distal movement of the longitudinal member 706. The cable 717 may pass through the lumen of the longitudinal body 702 and extend through the lumen opening 721. The distal end of the cable 717 may be rotatably connected to the stapler body 708. For example, as shown in Figure 7, the cable 717 may include a loop portion 718 at its distal end. The loop portion 718 may be formed by the distal end of the cable 717 coupled to the proximal end of the cable 717. The loop portion 718 may be formed using a crimp tube 719 or a crimp sleeve. In other examples, the loop portion 718 may not include a crimp tube 719. The loop portion 718 may extend through one or more openings 781 of the stapler body 708. The cable 717 may be sufficiently rigid so that proximal or distal movement of the cable 717 can move the stapler body 708. In some examples, the cable 717 may be a Bowden cable. The cable 717 may be made from stainless steel, Nitinol, or any other suitable material. To rotate the stapler body 708 around the pivot pin 740, the user may move the cable 717 proximal or distal.By providing a means for rotating the stapler body 708 around a pivot pin 740 separated from the longitudinal member 706, the amount of force applied to the actuating wire 716 by the longitudinal member 706 during the operation of the stapler can be reduced, and difficulties in moving the actuating wire 716 via the longitudinal member 706 can be prevented.

[0034] Figure 8 shows the distal portion of a surgical stapler 800, which includes a stapler body 808, an anvil 810, a longitudinal body 802, and a longitudinal member 806. The longitudinal member 806 may be coupled to the stapler body 808 via a projection 851 and a coupling 855, similar to the projection 333 and coupling 355 of the surgical stapler 300. Any features described herein with respect to surgical staplers 200, 300 may be incorporated into the surgical stapler 800. The stapler body 808 may be pivotably coupled to the longitudinal body 802. The stapler body 808 may rotate around a pivot pin 840. A spring 850 may be coupled to the stapler body 808 and the longitudinal body 802. The spring 850 may be located close to the pivot pin 840 and, in some embodiments, may be coupled to a portion of the projection 851. The spring 850 can exert force on the stapler body 808 and the longitudinal body 802 such that the stapler body 808 is spring-biased toward a position angled with respect to the longitudinal body 802. For example, the spring 850 can move the stapler body 808 such that its distal end moves proximal to the longitudinal body 802.

[0035] The user can pivot the stapler body 808 to a position substantially parallel to the longitudinal member 802 by pulling the longitudinal member 806 proximal. When the user releases the tension applied to the longitudinal member 806, the stapler body 808 rotates, and the distal end of the stapler body 808 can move proximal by the force applied by the spring 850. By providing the spring 850, the user can rotate the stapler body 808 around the pivot pin 840 in either direction (clockwise or counterclockwise) simply by applying or releasing tension in the longitudinal member 806. By providing the surgical stapler 800 with a mechanism that does not require the user to push the longitudinal member 806 distally to rotate the stapler body 808, the user can avoid potential buckling of the longitudinal member 806 caused by pushing it distally. In another example, the spring 850 may bias the stapler body 808 toward a position where its longitudinal axis is substantially parallel to the longitudinal axis of the longitudinal body 802.

[0036] Each of the above-described devices and systems may be used to visualize, join, and / or excise tissue. In some embodiments, the user may load the longitudinal body of the stapler device into the working channel of the endoscope by pulling the longitudinal body back through the distal end of the endoscopic working channel and positioning a portion of the longitudinal body within the working channel. Once the longitudinal body is positioned within the working channel, a handle assembly may be coupled to the proximal end of the longitudinal body. The user may then introduce the endoscope into the patient's body and move the endoscope toward the target area. The user may use the endoscope to determine the location of a target area (such as a tumor or other affected tissue) present within the body lumen of the subject by directly visualizing the target area using an image sensor. Once the user positions the distal end of the endoscope close to the target area, the user may actuate the stapler device to the open position, creating a space between the stapler anvil and body. The user may then position the target tissue within the active part of the stapler device and move the anvil and body of the stapler device to the closed position, allowing the user to grasp the tissue using the stapler device. The user can move the operating thread of the stapler device to the proximal position by operating an actuator to pull the operating wire. By moving the operating thread to the proximal position via the actuator, the user can deploy the fastener within the grasped tissue and relative to the anvil of the stapler device.

[0037] It will be apparent to those skilled in the art that various modifications and variations can be made to the disclosed apparatus and methods without departing from the scope of this disclosure. Other aspects of this disclosure will be apparent to those skilled in the art from the discussion herein and the implementation of the features disclosed herein. This specification and the examples are intended to be illustrative only.

Claims

1. A tissue fixation device, The first body, The proximal end and The distal end and A first lumen extending from the proximal portion of the first body to the first opening in the distal portion of the first body, The second opening in the distal portion of the first body and The first body includes, which defines the longitudinal axis, A fixing device coupled to the distal end of the first main body, A longitudinal body comprising a cartridge configured to hold one or more fasteners, A rotatable anvil relative to the cartridge of the longitudinal body, A fixing device actuator configured to deploy one or more fixing devices from the cartridge by moving relative to the cartridge, The actuation wire is coupled to the fixture actuator, extends through the first body and through the second opening, and is at least partially located outside the longitudinal body, the cartridge and the anvil. The fixing device includes, A longitudinal member connected to the longitudinal body, extending through the first lumen and through the first opening, A tissue fixation device equipped with the following features.

2. The tissue fixation device according to claim 1, wherein the longitudinal body is pivotably coupled to the first body.

3. The tissue fixation device according to claim 1, wherein the longitudinal member and the operating wire are at least partially located within the first lumen.

4. The tissue fixation apparatus according to claim 1, wherein the longitudinal member includes a longitudinal channel and the operating wire is located within the longitudinal channel.

5. The tissue fixation device according to any one of claims 1 to 4, wherein the second opening opens into the first lumen, and the first opening is located on the side of the first body opposite to the side of the first body on which the second opening is located.

6. The tissue fixation device according to claim 1, wherein the first body includes a second lumen, and the operating wire is at least partially located within the second lumen.

7. The tissue fixation device according to any one of claims 1 to 6, wherein the fixing actuator is located within the longitudinal slot of the longitudinal body.

8. The tissue fixation device according to claim 7, wherein the fixation actuator includes at least one inclined portion and an extended portion extending through the longitudinal slot.

9. The tissue fixation device according to any one of claims 1 to 8, further comprising a spring coupled to the first body and the longitudinal body.

10. The tissue fixation device according to claim 9, wherein the spring is configured to bias the fixation device toward a position where the longitudinal axis of the longitudinal body intersects the longitudinal axis of the first body.

11. The tissue fixation apparatus according to claim 1, wherein the longitudinal member is connected to the proximal end of the longitudinal body via a connector, and the connector has a width greater than the width of the first opening.

12. The tissue fixation device according to any one of claims 1 to 11, further comprising a cable rotatably coupled to the longitudinal body and located within the first body, wherein the cable is configured to allow movement of the fixation device.

13. The tissue fixation device according to any one of claims 1 to 12, wherein the longitudinal body is rotatably coupled to the first body at a position between the proximal and distal ends of the longitudinal body.

14. The tissue fixation device according to claim 1, wherein the first opening and the second opening are located proximal to the fixation device.

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