Methods and devices for closing tissue defects
Patent Information
- Authority / Receiving Office
- JP · JP
- Patent Type
- Patents
- Current Assignee / Owner
- DAVOL INC
- Filing Date
- 2022-05-06
- Publication Date
- 2026-07-31
Smart Images
Figure 0007898459000001 
Figure 0007898459000002 
Figure 0007898459000003
Abstract
Description
Technical Field
[0005]
[0001] Cross - Reference to Related Applications
[0001] This application claims the priority of U.S. Application No. 63 / 185,685, filed on May 7, 2021, the disclosure of which is incorporated herein by reference in its entirety.
[0002]
[0002] The disclosed embodiments relate to methods and devices for closing tissue defects.
Background Art
[0003]
[0003] Closing an opening in tissue, such as a defect in fascial tissue, is a common surgical procedure. Such openings can be formed during surgery, for example, by creating an incision. In some cases, such openings occur naturally, such as in the case of a hernia. Suture and patch closures are often used to close and repair openings in tissue.
Summary of the Invention
[0004]
[0004] In one aspect, a tissue closure device includes a first tissue gripper, a second tissue gripper, a spring operably coupled to the first tissue gripper and the second tissue gripper, and a lock configured to hold the first tissue gripper and the second tissue gripper in an extended configuration in a locked configuration, the spring being configured to bias the first tissue gripper and the second tissue gripper toward a contracted configuration when the lock is in an unlocked configuration.
[0005]
[0005] Another aspect leads to a method for closing an opening in the tissue. In some embodiments, the method includes holding a first tissue gripper engaged with a first tissue portion and a second tissue gripper engaged with a second tissue portion in an extended configuration; changing a lock from a locked configuration to an unlocked configuration in order to release the first tissue gripper and the second tissue gripper from the extended configuration; and biasing the first tissue gripper toward the second tissue gripper in order to move the first tissue gripper and the first tissue portion toward the second tissue gripper and the second tissue portion.
[0006]
[0006] In another embodiment, a tissue closure device is provided. According to some embodiments, the tissue closure device comprises a first tissue gripper, a second tissue gripper, a spring operably coupled to the first and second tissue grippers, a housing including a first housing portion and a second housing portion, wherein the first tissue gripper is operably coupled to the first housing portion and the second gripper is operably coupled to the second housing portion, and the spring is configured to bias the first and second tissue grippers from an extension configuration to a contraction configuration, and a force indicator configured to visually indicate the contraction force applied to the first and second tissue portions by the first and second tissue grippers.
[0007]
[0007] In yet another embodiment, a method for closing an opening in tissue is provided. In some embodiments, the method includes holding a first tissue gripper engaged with a first tissue portion and a second tissue gripper engaged with a second tissue portion in an extended configuration; biasing the first tissue gripper toward the second tissue gripper in order to move the first tissue gripper and the first tissue portion toward the second tissue gripper and the second tissue portion; and visually indicating the contraction force applied to the first and second tissue portions by the first and second tissue grippers using a force indicator.
[0008]
[0008] The concepts described above and the additional concepts discussed below can be arranged in any suitable combination, as the disclosure is not limited in this respect. Furthermore, other advantages and novel features of the disclosure will become apparent from the detailed description below of various non-limiting embodiments when considered with respect to the accompanying drawings.
[0009]
[0009] The attached drawings are not intended to be drawn to a fixed scale. In the drawings, each identical or nearly identical component shown in various drawings may be represented by similar numbers. For clarity, not all components are to be labeled in any of the drawings. [Brief explanation of the drawing]
[0010] [Figure 1A]
[0010] A schematic cross-sectional view of a device for tissue closure according to a specific embodiment is shown. [Figure 1B]
[0010] A schematic cross-sectional view of a device for tissue closure according to a specific embodiment is shown. [Figure 1C]
[0010] A schematic cross-sectional view of a device for tissue closure according to a specific embodiment is shown. [Figure 2A]
[0011] A perspective view of a device for tissue closure according to a specific embodiment is shown. [Figure 2B]
[0011] A perspective view of a device for tissue closure according to a specific embodiment is shown. [Figure 3]
[0012] A disassembled and assembled perspective view of a device for tissue closure with a lock, according to a specific embodiment, is shown. [Figure 4A]
[0013] This figure shows a device for tissue closure according to a specific embodiment. [Figure 4B]
[0013] This figure shows a device for tissue closure according to a specific embodiment. [Figure 5A]
[0014] This figure shows a housing with a cantilever lock according to a specific embodiment. [Figure 5B]
[0014] This figure shows a housing with a cantilever lock according to a particular embodiment. [Figure 5C]
[0014] This figure shows a housing with a cantilever lock according to a particular embodiment. [Modes for carrying out the invention]
[0011]
[0015] Generally, devices and methods are provided for closing tissue openings (defects in fascial tissue). Closure of tissue openings, for example, using sutures and patch closures, is generally surgical. However, in connection with the present disclosure, it has been recognized that there is a need for improved methods and devices for closing tissue openings without trauma and for determining the force required to completely close the opening and / or maintain the closed opening. In some embodiments, methods and devices are generally provided for using a tissue gripper to engage a tissue portion, and subsequently biasing the tissue gripper and the tissue portion toward each other to assist in closing an opening formed within the tissue.
[0012]
[0016] The inventors understood that defects within fascial tissue, such as those formed during a hernia or intentionally created during other surgical procedures, can be difficult to close and repair without risking further damage to the fascial tissue. For example, sutures used to close fascial defects may puncture the fascial tissue when tightened, causing the defect to reopen and inflict additional damage. In these cases, the difficulty of repairing the tissue can increase with the width of the fascial defect, and in some cases, with the width of the fascial defect. Specifically, fascial defects with widths between 8 cm and 20 cm, or widths equal to 8 cm and 20 cm, may be difficult to close using standard closure procedures.
[0013]
[0017] The difficulties associated with fascial defect closure can also be exacerbated by the lack of visual indicators of tension acting on the fascial tissue during typical procedures. For example, many fascial tissue repairs are performed under robotic control. When performing such fascial tissue repairs, the primary visual indicator of excessive stress on the fascial tissue, due to the lack of tactile feedback, is suture and / or tissue rupture. Therefore, the inventors have recognized that it may be desirable to provide visual indication of the tension applied during fascial defect repair.
[0014]
[0018] In view of the foregoing, the inventors have recognized the benefits associated with a device that can be attached to the opposite portion of a fascial defect and that is transitionable between an extension configuration and a contraction configuration for applying a force to help close the fascial defect. In addition to applying tension to the fascial tissue surrounding the fascial defect, in some embodiments described herein, the device may also provide visual indication of the force applied to the tissue by the device.
[0015]
[0019] In one embodiment, the tissue closure device may include a first tissue gripper configured to engage with a first tissue portion, and a second tissue gripper configured to engage with a second tissue portion, the grippers of which may be maintained in a first extended configuration. In some embodiments, the device includes a lock that can transition from a locked configuration to an unlocked configuration in order to release the first and second tissue grippers from the extended configuration. Once the grippers are released from the extended configuration by the lock, the first tissue gripper may be biased toward the second tissue gripper in order to move the first tissue gripper and first tissue portion toward the second tissue gripper and second tissue portion. In some embodiments, including a lock may allow the user to attach the first and second tissue grippers to the tissue before applying a closing force to an opening formed in the tissue.
[0016]
[0020] In another embodiment, the tissue closure device may be configured to indicate the force applied to the tissue. The device may include a first tissue gripper configured to engage with a first tissue portion, and a second tissue gripper configured to engage with a second tissue portion in a first stretch configuration. The first tissue gripper may be biased toward the second tissue gripper to move the first tissue gripper and the first tissue portion toward the second tissue gripper and the second tissue portion. In some embodiments, the tissue closure device may include a force indicator configured to provide indication of the contractile force applied by the first and second tissue grippers to the first and second tissue portions as described herein. Such measurement of contractile force may help inform the surgeon of the force that may be required to close the opening. For example, this may help the surgeon determine how best to close the opening, including the application of sutures, tissue patches, component separation, and / or additional devices for tissue closure.
[0017]
[0021] Depending on the embodiment, the above concepts using locks and / or force indicators can be used individually and / or together. For example, in one embodiment, the devices described herein can, in some embodiments, be used to close an opening within tissue. As a specific non-limiting example, in certain embodiments, since the devices described herein can be inserted into a tissue opening (fascia defect) locked in an extended configuration, a first tissue gripper can engage a first portion of the tissue (e.g., fascia tissue). Next, a second tissue gripper is then operated to engage a second portion of the tissue (e.g., fascia tissue) according to some embodiments. Following these steps, the device can be switched from a locked configuration to an unlocked configuration (e.g., using a robotic surgical system). If the device can provide sufficient contraction force without slipping, the spring of the device in the unlocked configuration will bias the first tissue gripper toward the second tissue gripper to move the first tissue gripper and the first tissue portion toward the second tissue gripper and the second tissue portion. If desired, additional devices can be introduced until the tissue opening is sufficiently closed to allow for surgical repair. In some embodiments, if the initial device cannot fully contract by itself, the need for an additional device can be indicated by a force indicator on the initial device. When the opening is fully closed, in some embodiments, the tissues can be sutured together and the device can be removed. As an alternative or addition to sutures, a tissue patch can be used to close the opening. In some embodiments, when the tissue opening is at least partially sutured or patched, the device for tissue closure can be separated from the tissue portion and / or removed from the tissue opening.
[0018]
[0022] As described above, in some embodiments, the device may include a force indicator configured to visually indicate the contraction force applied to the first and second tissue portions by the first and second tissue grippers (for example, which may be used to determine the contraction force applied by the first and second tissue grippers). Any suitable type of force indicator may be used. For example, in some embodiments, the force indicator includes a plurality of markings on the outer surface of the first and / or second housing portion, and a marker configured to move with respect to the plurality of markings to indicate the force applied as the device transitions between an extension configuration and a contraction configuration to indicate the contraction force. Of course, since the disclosure is not limited in this way, other types of force indicators may be used, including force dials, digital reading displays, and / or any other suitable type of force indicator capable of visually indicating the force applied to the associated tissue.
[0019]
[0023] According to certain embodiments, the device comprises a housing. The housing may include a first housing portion and a second housing portion. In some embodiments, a first tissue gripper is operably coupled to the first housing portion, and a second tissue gripper is operably coupled to the second housing portion. A spring may be operably coupled to the first housing portion and the second housing portion to bias the first housing portion toward the second housing portion. In some embodiments, at least a portion of the second housing portion is configured to slide within the internal volume of the first housing portion. In certain embodiments, the spring is disposed at least partially within the internal volume of the first housing portion and / or at least partially within the internal volume of the second housing portion.
[0020]
[0024] In some embodiments, the device may include a longitudinal axis (e.g., an axis extending along the pulling direction of the tissue closure device comprising the housing). According to certain embodiments, the device has a maximum longitudinal dimension (e.g., length). Any suitable maximum longitudinal dimension may be used depending on the desired application. However, according to certain embodiments, the advantageous maximum longitudinal dimension of the device in the extended configuration may approximately correspond to the maximum width of an opening (e.g., a fascial defect) in the tissue that the device is attempting to close. Thus, in some embodiments, the device in the extended configuration may include a maximum longitudinal dimension that is greater than or equal to 5 cm, greater than or equal to 8 cm, greater than or equal to 10 cm, greater than or equal to 12 cm, greater than or equal to 15 cm, or any other suitable dimension. In some embodiments, in the extended configuration, the device has a maximum longitudinal dimension that is less than or equal to 20 cm, less than or equal to 18 cm, less than or equal to 15 cm, less than or equal to 12 cm, less than or equal to 10 cm, less than or equal to 8 cm, or any other suitable dimension. These ranges can be combined. For example, in some embodiments, the device in the extended configuration may have a maximum longitudinal dimension that is greater than or equal to 5 cm and less than or equal to 20 cm. Of course, since the present disclosure is not so limited, maximum longitudinal dimensions in the extended configuration that are both greater and less than the aforementioned dimensions are also contemplated.
[0021]
[0025] In the shrinkable configuration, in some embodiments, the device has a maximum vertical dimension of greater than or equal to 1 cm, greater than or equal to 1.2 cm, greater than or equal to 1.5 cm, greater than or equal to 2 cm, greater than or equal to 3 cm, greater than or equal to 5 cm, greater than or equal to 8 cm, or any other suitable dimension. In the shrinkable configuration, in some embodiments, the device has a maximum vertical dimension of less than or equal to 10 cm, less than or equal to 8 cm, less than or equal to 5 cm, less than or equal to 3 cm, less than or equal to 2.5 cm, less than or equal to 2 cm, less than or equal to 1.5 cm, or any other suitable dimension. These ranges can be combined. For example, in some embodiments, the device in the shrinkable configuration has a maximum vertical dimension of greater than or equal to 1 cm and less than or equal to 10 cm. Of course, since this disclosure is not limited in that way, maximum vertical dimensions in the shrinkable configuration that are both greater than and less than the aforementioned dimensions are also intended.
[0022]
[0026] In some embodiments, the device may have a longitudinal distance between the first tissue gripper and the second tissue gripper of the device, which may vary when the device transitions between an extended configuration and a contracted configuration. In the extended configuration, in some embodiments, the longitudinal distance between the first and second tissue grippers is greater than or equal to 1 cm, greater than or equal to 4 cm, greater than or equal to 6 cm, greater than or equal to 8 cm, greater than or equal to 10 cm, or any other suitable dimension. In the extended configuration, in some embodiments, the longitudinal distance between the first and second tissue grippers is less than or equal to 18 cm, less than or equal to 15 cm, less than or equal to 12 cm, less than or equal to 10 cm, greater than or equal to 8 cm, or any other suitable dimension. These ranges can be combined. For example, in some embodiments, in the extended configuration, the longitudinal distance between the first and second tissue grippers is greater than or equal to 1 cm and less than or equal to 18 cm. Of course, both distances greater than and smaller than those mentioned above are also considered.
[0023]
[0027] In some embodiments of the shrink configuration, the longitudinal distance between the first and second tissue grippers of the device is greater than or equal to 0 cm, greater than or equal to 0.2 cm, greater than or equal to 0.5 cm, greater than or equal to 0.8 cm, greater than or equal to 1 cm, greater than or equal to 1.2 cm, greater than or equal to 1.5 cm, or any other suitable dimension. In some embodiments of the shrink configuration, the longitudinal distance between the first and second tissue grippers is less than or equal to 2 cm, less than or equal to 1.5 cm, less than or equal to 1.2 cm, less than or equal to 1 cm, greater than or equal to 0.8 cm, greater than or equal to 0.5 cm, or any other suitable dimension. These ranges can be combined. For example, in some embodiments of the shrink configuration, the longitudinal distance between the first and second tissue grippers is greater than or equal to 0 cm and less than or equal to 2 cm. As a more specific example, in some embodiments, in a shrinkage configuration, the minimum distance between the first tissue gripper and the second tissue gripper is greater than or equal to 1 cm and less than or equal to 2 cm. Of course, this disclosure is not limited in that way, and ranges other than those described above are also intended.
[0024]
[0028] According to certain embodiments, the device has a maximum transverse dimension, such as width or diameter, which may be perpendicular to the maximum longitudinal dimension of the device. Any suitable maximum transverse dimension can be selected. However, according to certain embodiments for selecting the maximum transverse dimension, it may be advantageous to allow the device to be inserted via a surgical trocar. In some embodiments, the device has a maximum transverse dimension of 3 mm or more, 4 mm or more, 5 mm or more, 6 mm or more, 7 mm or more, or any other suitable dimension. In some embodiments, the housing has a maximum transverse dimension of 8 mm or less, 7 mm or less, 6 mm or less, 5 mm or less, 4 mm or less, or any other suitable dimension. These ranges can be combined. For example, in some embodiments, the housing has a maximum transverse dimension of 3 mm or more and 8 mm or less. In some embodiments, for example, when it is not necessary to insert the device via a surgical trocar, the device may have a maximum transverse dimension of 8 mm or more. In addition, since the disclosure is not limited in that way, any other suitable range of the maximum transverse dimension, both greater than and less than the aforementioned dimension, may also be used.
[0025]
[0029] Various embodiments disclosed herein may utilize springs. It should be understood that in these embodiments, any suitable spring capable of applying a force to bias the tissue grippers of the device toward each other may be used. In some embodiments, the use of tension springs may be advantageous. According to certain embodiments, the spring is a coil spring (e.g., a spring comprising a coil of a material such as metal) configured to act as a tension spring. For example, the spring may be operably connected to a first tissue gripper and another tissue gripper so as to increase the distance between the first and second tissue grippers, tension in the spring will be produced. According to certain embodiments, the spring is a coil spring (e.g., a spring comprising a coil of a material such as metal) configured to act as a compression spring. For example, the spring may be positioned between a first portion of a housing and a second portion of a housing so as the first housing portion slides away from the second housing portion, the coil spring will be compressed between the two housing portions. The spring may also be an elastic component such as an elastic band, an elastic tube, and / or any other elastic structure that can be used as a spring (for example, comprising a polymer material that can be elastically deformed by a magnitude greater than or equal to 20%, greater than or equal to 30%, greater than or equal to 50%, greater than or equal to 100%, or more, of its undeformed length under an applied load). Other suitable types of springs include, but are not limited to, traction bar springs, gas springs, torsion springs, rotary springs, and / or any other suitable types of springs, as this disclosure is not so limited.
[0026]
[0030] According to certain embodiments, it may be advantageous for the spring to be nearly linearly elastic. Generally, a change in the force applied to a linear elastic spring results in a change proportional to the length of the linear elastic spring. According to certain embodiments, this may be advantageous for determining the contraction force applied by a first and second tissue gripper operably coupled to the spring, as the contraction force is proportional to the displacement and it is possible to determine the contraction force using regularly spaced markers to indicate the displacement. However, a linear elastic spring is not a requirement, and in some embodiments, irregularly spaced markers or other methods may be used to indicate the contraction force, as will be described in more detail below.
[0027]
[0031] Next, considering the tissue gripper, in some embodiments, the tissue gripper is configured to engage with a tissue portion (for example, to apply a contractile force to the tissue portion). Generally, the tissue gripper can have any suitable dimensions. However, to reduce the possibility of damage to the tissue portion, it may be advantageous for the tissue gripper to distribute the force (e.g., contractile force) over a relatively wide area. For example, according to certain embodiments, the tissue gripper has a length that can extend in a direction parallel to the longitudinal axis of the gripper and / or the entire device. In addition, the gripper length may extend in a direction configured perpendicular to the edge of the portion of tissue engaged by the gripper. In some embodiments, the tissue gripper has a length of 1 cm or more, 1.2 cm or more, 1.4 cm or more, 1.6 cm or more, 1.8 cm or more, or any other suitable dimension. In some embodiments, the tissue gripper has a length of less than or equal to 2 cm, less than or equal to 1.8 cm, less than or equal to 1.6 cm, less than or equal to 1.4 cm, less than or equal to 1.2 cm, or any other suitable dimension. These ranges can be combined. For example, in some embodiments, the tissue gripper has a length greater than or equal to 1 cm and less than or equal to 2 cm, but since the disclosure is not limited in that way, both ranges greater than and less than these are also contemplated.
[0028]
[0032] In some embodiments, the tissue gripper has a width that may extend laterally with respect to the longitudinal axis of the gripper and / or the entire device. In addition, the gripper width may extend in a direction configured to be parallel to the edge of a portion of the tissue to be engaged by the gripper. The tissue gripper may have any suitable width. However, as mentioned above, it may be advantageous to select a width that allows the device to be inserted through a surgical trocar. In some embodiments, the tissue gripper has a width greater than or equal to 3 mm, greater than or equal to 4 mm, greater than or equal to 5 mm, greater than or equal to 6 mm, greater than or equal to 7 mm. In some embodiments, the tissue gripper has a width less than or equal to 8 mm, less than or equal to 7 mm, less than or equal to 6 mm, less than or equal to 5 mm, less than or equal to 4 mm. These ranges can be combined. For example, in some embodiments, the tissue gripper has a width greater than or equal to 3 mm and less than or equal to 8 mm. In some embodiments, for example, when the device does not need to be inserted via a surgical trocar or via the use of a flexible or foldable tissue gripper, the tissue gripper may have a width greater than 8 mm, as this disclosure is not limited to that extent.
[0029]
[0033] According to some embodiments, the tissue gripper is configured to apply a combination of forces to the tissue portion used during engagement. In some embodiments, these forces may include a first component force corresponding to a compressive force applied to the tissue positioned between the opposing jaws of the gripper, and a second component force that may correspond to a shear force applied to the tissue when drawing the opposing portions of the tissue opening. In some cases, this shear force may also be called a retaining force that holds the tissue within the tissue gripper when tension is applied to the gripper.
[0030]
[0034] In some embodiments, the clamping force applied to the tissue by the tissue gripper engaged with the tissue can be applied uniformly across the gripper's area. However, embodiments in which a non-uniform force distribution is applied to the tissue by the tissue gripper are also intended. According to certain embodiments, the total clamping force applied to the engaged tissue by the gripper is greater than or equal to 0.5 N, greater than or equal to 1 N, greater than or equal to 1.5 N, greater than or equal to 2 N, greater than or equal to 3 N, greater than or equal to 5 N, greater than or equal to 8 N, greater than or equal to 10 N, greater than or equal to 15 N, or any other suitable clamping force. In some embodiments, the total clamping force is less than or equal to 20 N, less than or equal to 15 N, less than or equal to 10 N, less than or equal to 8 N, less than or equal to 5 N, less than or equal to 3 N, less than or equal to 2 N, less than or equal to 1.5 N, or any other suitable clamping force. These ranges can be combined. For example, in some embodiments, the total clamping force is greater than or equal to 0.5 N and less than or equal to 20 N. In some cases, the clamping force applied by the tissue gripper may be measured using a load cell and / or calculated based on known design parameters of the gripper.
[0031]
[0035] In some embodiments, the tissue gripper may be configured to apply maximum holding force to the tissue held within the tissue gripper before the tissue slides within the gripper. In some embodiments, the maximum holding force of the tissue gripper is designed to address the maximum breaking force of the existing absorbable suture. The maximum holding force may be greater than or equal to 2.5 N, greater than or equal to 3 N, greater than or equal to 3.5 N, greater than or equal to 4 N, greater than or equal to 4.5 N, greater than or equal to 5 N, or any other suitable holding force. In some embodiments, the maximum holding force of the tissue gripper may be less than or equal to 6 N, less than or equal to 5.5 N, less than or equal to 5 N, less than or equal to 4.5 N, less than or equal to 4 N, less than or equal to 3.5 N, or any other suitable holding force. These ranges can be combined. For example, in some embodiments, the maximum holding force of the tissue gripper may be greater than or equal to 2.5 N and less than or equal to 6 N. The maximum holding force of a tissue gripper can, according to a particular embodiment, be measured by measuring the maximum shear force that can be applied in a tensile testing machine when the gripper is engaged with tissue similar to human tissue (for example, fascial tissue collected from a pig with an appropriate thickness to be gripped by the tissue gripper for testing).
[0032]
[0036] In some embodiments, if the tissue gripper is configured to apply a retaining force to the engaged tissue portion, the contractile force applied by the tissue gripper to the opposing tissue portion of the tissue opening may be equal to the retaining force applied by the tissue gripper to the engaged tissue. Thus, the above-mentioned maximum retaining force may also correspond to the maximum contractile force that can be applied by a given tissue gripper in some embodiments. Of course, the disclosure is not limited in this way, and contractile and / or retaining forces greater or less than those described above are also intended.
[0033]
[0037] Any suitable type of tissue gripper capable of transitioning between a closed configuration for engaging with tissue and an open configuration for releasing tissue may be used with the various embodiments described herein. For example, in some embodiments, the tissue gripper may be single-action (e.g., transitioning between an open configuration and a closed configuration via the movement of a single jaw against the device). The tissue gripper may also be double-action (e.g., transitioning between an open configuration and a closed configuration via the movement of two jaws against the device). The tissue gripper may be windowed (e.g., an open area or window may be incorporated within one or both jaws to provide a more secure grip). The tissue gripper may be windowless (e.g., it may have solid jaws that rely on friction to hold tissue). In addition, in some embodiments, the first and / or second tissue gripper may be biased toward the closed configuration. For example, a tissue gripper may include a spring clip that can be biased by a spring, such as a torsion spring (e.g., a rotary spring), a compression spring (e.g., a coil spring configured to operate under pressure), or an expansion spring as described above. However, in other embodiments, the first tissue gripper and / or the second tissue gripper are biased toward an open configuration. As one non-limiting example, in some embodiments, the overtube is configured to close a tissue gripper biased toward an open configuration when the overtube slides toward the end of the tissue gripper, causing the jaws of the gripper to close. In view of the above, it should be understood that these embodiments are non-limiting and that any method and / or structure for providing a tissue gripper capable of releasably engaging tissue may be used, as this disclosure is not limited in this manner.
[0034]
[0038] In some embodiments, it may be desirable to avoid damaging the tissue engaged by the tissue gripper. Therefore, the tissue gripper (e.g., a first tissue gripper, a second tissue gripper) may, in certain embodiments, be configured to apply force to a tissue portion without trauma (e.g., without puncture, tear, compression, or other damage to the tissue portion). Generally, the application of force without trauma can be provided in various ways. For example, the first and / or second tissue engagement surfaces of the tissue gripper may have one or more types of texture mechanisms, such as ridges, bumps, grooves, and / or teeth, configured to provide frictional engagement with the tissue without damaging it. In some embodiments, the inclusion of a texture mechanism on the tissue engagement surface of the tissue gripper may increase the maximum holding force of the tissue gripper without the risk of additional traumatic damage to the engaged tissue portion. In some embodiments, the tissue gripper of the device may be configured to release the associated engaged tissue portion without trauma if the contractile force otherwise exceeds a threshold. In some embodiments, this threshold force is smaller than the maximum holding force of the static friction of the tissue gripper as described above, which may result in the release of the tissue portion. The advantage of these embodiments is that they reduce the risk of tissue damage, where applying a contractile force to the tissue could otherwise cause the tissue to slip within the tissue gripper.
[0035]
[0039] According to a particular embodiment, the device further comprises a lock configured such that when the lock is in a locked configuration, the device is held in an extended configuration. In the locked configuration, the first and second tissue grippers are held at a fixed distance from each other, whereas in the unlocked configuration, the first and second tissue grippers may move relative to each other in response to external and bias forces applied to the tissue grippers by a spring or other structure. The inclusion of the lock may be advantageous for several reasons. For example, the lock may be used to maintain the extended configuration of the device prior to engagement of the tissue grippers of the device with a tissue portion, thereby reducing the need for external manipulation of the device and / or tissue prior to unlocking the device.
[0036]
[0040] Any suitable locking mechanism may be used. For example, in some embodiments, the lock is a slot-and-key lock, comprising a slot located in a first part of the device housing and a key located in a second part of the device housing. In such embodiments, the device can be locked or unlocked via a rotational movement of one housing portion relative to the other portion, so that the key can slide into or out of a slot that is configured to receive and hold the key in the lock configuration. In some embodiments, the lock is a spring retainer, wherein in the lock configuration, a spring is configured to trap a ball or other structure that is configured to receive a hole, recess or other type of retainer for locking the device in a desired configuration. In some embodiments, the lock is a cantilever lock, for example, where the second housing portion comprises a cantilever connected to the key, and the first housing portion comprises a catch, such as a hole, recess or other structure configured to receive the key. In some such embodiments, pressing down on the key elastically deforms the cantilever and releases the key from the catch, allowing the first housing portion to slide relative to the second housing portion. In such embodiments, the second housing portion may include multiple catch, return, or keyway mechanisms to allow the first housing portion to be unilaterally indexed to a specified extension length prior to being used to address various defect sizes. Other locking mechanisms are possible and are therefore not limited to this disclosure. For certain applications, including surgeries performed using a robotic surgical system, push-button locks such as cantilever locks and / or slot and key locks may be advantageous because they are more easily operated by the robotic surgical system.
[0037]
[0041] In some embodiments, the devices described herein may be non-toxic and sterile before use. The devices may comprise any suitable material. For example, the devices described herein may comprise any suitable combination of biocompatible metals, polymers, ceramics, combinations thereof, and / or any other suitable type of material. In some embodiments, the devices are configured for reuse. However, in some embodiments, the devices are intended to be disposable and single-use.
[0038]
[0042] In some embodiments, the materials used to construct the devices described herein may be readily sterilizable. Various techniques exist for sterilizing materials, including sterilization using UV irradiation, ethylene oxide (ETO) sterilization, gamma irradiation, high-pressure steam sterilization, or dry heating. In some embodiments, polymer materials are selected because they are more readily sterilizable for single use (e.g., using ETO or gamma irradiation). However, in some embodiments, metals may be selected because they are more readily sterilizable for multiple uses. For example, in some embodiments, metals are autoclavable and have a low tendency to degrade during autoclaving and / or sterilization using dry heating.
[0039]
[0043] In some embodiments, the material may be selected based on its mechanical properties. For example, in some embodiments, metal may be a preferred material for springs because metal springs are less prone to shattering than polymer springs, or because metal springs may have more linear elastic behavior than polymer springs. However, in other embodiments, polymers may be preferred for springs (e.g., elastic bands) because they are less expensive or because they have a preferred elastic deformation profile. Similar advantages and disadvantages for each material exist for each component described herein. Therefore, depending on the application, in some embodiments, the device may comprise both plastic and metal components, and this disclosure is not thus limited.
[0040]
[0044] The devices and methods described herein may be used to close any type of opening in tissue. For example, the opening may, in some embodiments, be a defect in fascial tissue. Such fascial defects may occur spontaneously, for example, as a result of hernia formation. Tissue openings, and openings in fascial tissue, may also be formed as a result of cuts made during surgical procedures, and closing these openings may be difficult by conventional means, especially in the case of large cuts. Fascial defects may also occur as a result of traumatic injury. The applications and methods described herein may be used to close tissue openings regardless of their origin, and the disclosure is not limited thereto.
[0041]
[0045] In some embodiments, the devices and methods described herein may be used in laparoscopic surgery. In some such embodiments, the devices may be inserted into the patient via a trocar inserted through an incision smaller than 2 cm in diameter. In certain embodiments, the devices and methods described herein may be performed using a robotic surgical system. For example, the devices and methods herein may be performed laparoscopically using a robotic surgical system. The robotic surgical system may include components configured, according to a particular embodiment, to operate the lock of the device and / or to provide visual feedback to the operator of the robotic surgical system. In some embodiments, the robotic surgical system may be used to engage or separate a tissue gripper from a tissue portion. In certain embodiments, the locks and tissue grippers described herein may be selected to be operable by the robotic surgical system.
[0042]
[0046] Next, the figures illustrate certain non-limiting embodiments in more detail. It should be understood that the various systems, components, mechanisms, and methods described in relation to these embodiments are not limited to the specific embodiments described herein and may be used individually and / or in any desired combination.
[0043]
[0047] Figures 1A to 1C illustrate exemplary embodiments of a tissue closure device according to a particular embodiment. As shown in Figure 1A, the tissue closure device 101 may comprise a first tissue gripper 102 and a second tissue gripper 103. Each tissue gripper may comprise two opposing jaws with two tissue engagement surfaces 119 oriented toward each other. In Figure 1A, the first tissue gripper 102 engages with a first tissue portion 105, and one tissue engagement surface is pressed against each side of the first tissue portion 105, so that the first tissue portion is compressed between the opposing tissue engagement surfaces of the opposing jaws of the first tissue gripper. The second tissue gripper 103 is shown in an open configuration so that it does not engage with the second tissue portion 107, since only one of the tissue engagement surfaces 119 is pressed against the second tissue portion 107. The second tissue gripper is shown in a closed configuration in Figure 1B. Each tissue engagement surface may have one or more types of texture mechanisms, such as ridges, bumps, grooves, and / or teeth (not shown). Each tissue gripper may have a hinge 160 or other connecting structure that movably connects the jaws of associated grippers to each other, allowing the tissue gripper to transition between an open configuration and a closed configuration. In some embodiments, the hinge 160 is associated with a torsion spring (not shown), which in some embodiments is configured to bias the associated tissue gripper towards a closed configuration. However, other types of tissue grippers may also be used, as detailed above.
[0044]
[0048] Each of the tissue grippers 102 and 103 may, in some embodiments, be connected to the device housing 170 using any suitable type of connection. In the shown embodiment, a hinge 160 connects the jaws of the tissue gripper to the housing, to the associated portion of the housing. However, since the disclosure is not so limited, other types of connections may also be used. In the shown embodiment, the housing comprises a first housing portion 111 and a second housing portion 113. In some embodiments, such as those shown in Figures 1A to 1C, the first housing portion 111 and the second housing portion 113 are tubes with open ends oriented toward each other and coaxially aligned. The tubes are sized and formed such that the open ends allow the second housing portion 113 to slide at least partially within the internal volume of the first housing portion 111. However, the first and second housing portions may have any suitable shape and / or overall structure such that the housing portions can move relative to each other to transition between an extended configuration and a contracted configuration.
[0045]
[0049] As shown in the figures, in some embodiments, the second housing portion 113 is configured so that at least a portion of the second housing portion 113 slides within the first housing portion 111. A spring 109 is disposed within the housing 170, shown in the extended configuration in the example of Figure 1A. In some embodiments, the spring 109 is connected to the first housing portion 111 and the second housing portion 113 so that the device 101 is biased toward a closed configuration. The spring 109 may be coaxial with the housing 170, as shown in Figures 1A to 1C, but it is also intended that the spring may not be coaxial with the housing portion to which it is associated. As shown in the figures, in some embodiments, the spring 109 is at least partially disposed within the internal volume of the first housing portion 111 and / or within the internal volume of the second housing portion 113. As shown in Figure 1A, the device 101 may have a maximum longitudinal dimension, i.e., length C, in the extended configuration, as described elsewhere in this specification. Device 101 may also have a maximum transverse dimension, i.e., width Z, and a minimum distance, X, between tissue grippers, as described elsewhere in this specification.
[0046]
[0050] The spring 109 may be connected to the housing 170 by any suitable method. For example, the spring may be operably coupled to device parts such as the first tissue gripper 102, the second tissue gripper 103, the first housing part 111, and / or the second housing part 113 using mechanical fasteners, pins, hooks, loops, mechanical interlock parts, welds, adhesives, combinations thereof, and / or any other suitable type of connection. While several non-limiting types of connections for connecting the spring to the associated part of the housing are described above, it should be understood that any suitable type of structure and / or method may be used to connect the spring to a part of the housing, as this disclosure is not so limiting.
[0047]
[0051] Figure 1B shows the device of Figure 1A in a contracted configuration, where the second tissue gripper is closed to engage the second tissue portion 107. The device is also released so that a spring 109 applies a biasing force to the housing portion and the associated tissue gripper toward each other. Correspondingly, a contraction force is applied to the first tissue portion 105 and the second tissue portion 107, causing these opposing tissue portions to be pulled toward each other as the device transitions from the initial extended configuration to the contracted configuration. If the first housing portion 111 and the second housing portion 113 are replaced in letters, according to a particular embodiment, the tension applied to the housing portions by the biasing spring 109 toward each other is reduced, and the portion of the second housing portion 113 that is located inside the first housing portion 111 is increased. Figure 1C shows the device of Figure 1A rotated 90 degrees around the longitudinal axis of the device so that the width A and length B of the jaws of the tissue gripper are visible.
[0048]
[0052] Next, moving from Figure 2A to Figure 2B, one embodiment of the tissue closure device 201 is shown. In the exemplary embodiment of Figure 2A, the tissue closure device 201 is shown in a retractable configuration and comprises first and second tissue grippers 202 and 203, each having a hinge 260 and tissue engagement surface 219 formed on two opposing jaws of the tissue gripper. In embodiments such as those of Figures 2A to 2B, the first and second tissue grippers are connected to corresponding first and second housing portions 211 and 213 of the housing 270 of the tissue closure device 201. Similar to the embodiments of Figures 1A to 1C, the first housing portion 211 may include an internal volume sized and formed to receive at least a portion of the second housing portion 213.
[0049]
[0053] As described above, in some embodiments, the device may include a force indicator configured to visually indicate the contraction force applied to the first and second tissue portions (not shown) by the first tissue gripper 202 and the second tissue gripper 203. In the shown example, a groove 242 is formed and extends at least partially along the length of the first housing portion. Correspondingly, a marker 223 may be operably coupled to the second housing portion and aligned and / or positioned with the groove. A plurality of markings 225, such as force indications, may be provided on the first housing portion 211, i.e., formed by printing, engraving, or other means. In some embodiments, the plurality of markings 225 are arranged regularly spaced apart, and irregularly spaced markings may also be used, but may be used to determine the displacement of the marker from the contraction configuration. As the housing portions move relative to each other, the marker 223 connected to the second housing portion 213 is configured to move in associated grooves formed within the first housing portion for the plurality of markings. Therefore, as the device transitions between an extended and a contracted configuration, the marker can be aligned with various markings to indicate the applied contraction force. In this embodiment, the marker 223 is shown as a rectangular prism connected to a portion of the housing. However, generally, any suitable type of marking can be used, including, for example, protrusions of different shapes, indicator markings printed or formed on a portion of the housing, labels affixed to the housing, and / or any other suitable mechanism attached to, connected to, or otherwise associated with a portion of the device housing that can be used to indicate the force applied to the tissue.
[0050]
[0054] Figure 2B shows the device 201 of Figure 2A in an extended configuration. In Figure 2A, marker 223 corresponds to the 0 marking 225, indicating that the device is fully retracted, whereas in Figure 2B, marker 223 corresponds to the position 225 of the final marking, indicating that the device 201 is in an extended configuration. In the configuration in between, the relative positions between marker 225 and multiple markings 225 can be used to visually indicate the force currently being applied to the tissue by the device 201.
[0051]
[0055] Figure 3 shows an exploded perspective view of another tissue closure device 301 according to one embodiment. Similar to the embodiment described above, the tissue closure device 301 comprises a first tissue gripper 302 and a second tissue gripper 303 connected to first and second housing portions 311 and 313. The housing portions may again be formed as tubes having at least one open end, but other structures may also be used. A groove 342 may be formed within the first housing portion and may extend along at least a portion of the length of the first housing portion. The groove may include a first locking portion 321 positioned along the length of the groove. In the shown embodiment, the first locking portion corresponds to a slot formed at a predetermined position along the length of the groove. A corresponding second locking portion 323 may be coupled to a second housing portion. In some embodiments, the second locking portion is a key, such as a projection shown, which may be positioned within the groove and may be sized and formed to slide along the groove. The key may also be sized and formed to fit inside the slot corresponding to the first locking portion when the device is in both the extended and locked configurations. In the shown embodiment, when the device 301 is in the extended configuration, the device can be locked in the extended configuration by rotating the first and second housings relative to each other in order to move the key into an engaged state with the slot. The device 301 can then be moved from the locked configuration to the unlocked configuration by rotating the second housing portion 313 in the opposite direction relative to the first housing portion 311 in order to move the second locking portion 323 out of the first locking portion 321 and into an aligned state with the groove, so that when the first and second housing portions are moved axially relative to each other, the key can move axially within the groove.
[0052]
[0056] As described above, in some embodiments, such as the embodiment in Figure 3, the device 301 also includes a spring 309 that biases the tissue grippers 302 and 303 associated with the housing portions 311 and 313 toward a contraction configuration. The spring 309 is configured to operably connect to the first housing portion 311 and the second housing portion 313 via any suitable connection between the first housing portion 311 and the second housing portion 313 (corresponding hooks for engaging the spring loop 380 are not shown). In some embodiments, the device may also include a force indicator as described above. In this particular embodiment, the second lock portion 323 may function as the marker described above with respect to Figures 2A and 2B. For example, the force indicator may include a plurality of markings 325 on the first housing portion 311. When released, the second locking portion 323, connected to the second housing portion 313, moves axially within grooves 342 associated with multiple markings as the device transitions between an extended and a retracted configuration to indicate a contraction force. Thus, in some embodiments, such as the embodiment shown in Figure 3, the locking mechanism can also be used as a marker for a force indicator.
[0053]
[0057] While specific types of locking and force indicator structures are described above with respect to Figures 2A to 3, it should be understood that any suitable type of lock and / or force indicator may be used as described above. In addition, since this disclosure is not limited in that way, the disclosed concepts may be used in combination with each other or individually.
[0054]
[0058] Figures 4A and 4B show another embodiment of the device for tissue closure. Figure 4A shows the tissue closure device 401 in an extended configuration according to a particular embodiment. In some embodiments, such as those in Figures 1A to 1C, Figures 2A to 2B, and Figure 3, when the device transitions from an extended configuration to a contracted configuration, the tissue grippers are oriented so that the engaged tissue portion is pulled toward the spring. In such embodiments, the clamping force can be symmetric, so the contracted force is equal to the holding force of the tissue grippers. However, in some embodiments, such as the embodiment shown in Figure 4A, the first tissue grippers 402 and 403 are oriented so that when the device 401 transitions from an extended configuration to a contracted configuration, the engaged tissue portion is not pulled toward the spring enclosed within the housing 470 of the device 401. Rather, in some embodiments, the tissue portion engaged by the first tissue gripper 402 and the second tissue gripper 403 is pulled in an axial direction, parallel to and offset from the housing 470 and the spring disposed inside, when the device transitions from an extended configuration to a contracted configuration.
[0055]
[0059] In some embodiments, such as the embodiment shown in Figure 4A, the first tissue gripper 402 is connected to the first housing portion 411 via a first arm 482. In some embodiments, such as the embodiment shown in Figure 4A, the second tissue gripper 403 is connected to the second housing portion 413 via a second arm 483. The first arm 482 and / or the second arm 483 may be rigid connections attached to any suitable portion of the housing, including, for example, the end of the housing 470. In the shown embodiment, the arms extend around the end of the housing 470 in order to bend away from the housing 470 and extend parallel to and adjacent to the housing 470 before connecting to the associated tissue gripper. According to certain embodiments, such a configuration may be advantageous because it may allow a minimum distance X between the first tissue gripper 402 and the second tissue gripper 403 that is shorter than the axial length C of the housing in the contracted configuration. In some embodiments, this means that the minimum distance X between the first tissue gripper 402 and the second tissue gripper 403 can be shortened to 0. In other words, the grippers can be arranged relative to each other in a fully contracted configuration in some embodiments. For example, Figure 4B shows the device of Figure 4A in a contracted configuration, with the first and second tissue grippers about to come into contact.
[0056]
[0060] In some embodiments, the tissue closure device includes a cantilever lock. In some embodiments, such as the type shown in Figure 5A, the device includes a first housing portion 511 having a first locking portion 521 which may be a catch such as a hole shown, or any other structure configured to receive a key in a locking configuration. The device may further include a second housing portion 513 having a cantilever 540 connected to a second locking portion 523 (shown as a key in Figure 5A) configured to be received by the first locking portion 521.
[0057]
[0061] Figure 5B shows the assembled housing portion of Figure 5A in the locked and extended configurations. Here, the key connected to the cantilever 540, the second locking portion 523, engages with the first locking portion 521, and the key is positioned in a hole formed in the other housing portion to lock the first housing portion 511 against the second housing portion 513 in the extended configuration. To unlock the device, in some embodiments, a force may be applied to the second locking mechanism, pushing down the key and disengaging it from the illustrated catch. Specifically, a force oriented radially inward relative to the device is applied to the key, elastically deforming the cantilever by a sufficient amount to separate the first locking portion 521 from the second locking portion 523, allowing the first housing portion 511 to slide against the second housing portion 513. Optionally, the first housing portion 511 may include a groove 542, a recess, or other structure sized and formed to allow the second locking portion, i.e., the indicated key, to be displaced axially after it has been separated from the first locking portion. As shown in Figures 5A to 5C, the use of a groove or a similar axially extending structure can prevent the first housing portion 511 from rotating relative to the second housing portion 513 in the unlocked configuration. However, a groove is not required in all embodiments, since the first housing portion 511 is still slidable relative to the second housing portion 513 in the unlocked configuration, even when the cantilever is under stress to press against the inner surface of the second housing portion.
[0058]
[0062] While this instruction has been described in relation to various embodiments and examples, it is not intended to be limited to these embodiments or examples. Rather, as those skilled in the art will understand, this instruction encompasses a variety of alternatives, modifications, and equivalents. Therefore, the foregoing description and figures are merely illustrative.
[0059]
[0063] While several embodiments of the present invention have been described and illustrated herein, those skilled in the art will readily conceivable various other means and / or structures for performing the function and / or obtaining one or more of the results and / or benefits described herein, and each of such variations and / or modifications will be considered within the scope of the present invention. More generally, those skilled in the art will readily understand that all parameters, dimensions, materials and configurations described herein are intended to be illustrative, and that actual parameters, dimensions, materials and / or configurations will depend on the specific application in which the teachings of the present invention are used. Those skilled in the art will understand or confirm many equivalents to the specific embodiments of the present invention described herein using mere routine experimentation. Thus, it will be understood that the embodiments described herein are presented merely as examples within the scope of the appended claims and their equivalents, and that the present invention can be practiced in ways other than those specifically described and claimed. The present invention covers each individual mechanism, system, article, material, kit and / or method described herein. In addition, any combination of two or more such mechanisms, systems, articles, materials, kits, and / or methods is included within the scope of the present invention, provided that such mechanisms, systems, articles, materials, kits, and / or methods are not contradictory to each other.
[0060]
[0064] Where used herein and in the claims, the indefinite articles "a" and "an" should be understood to mean "at least one" unless explicitly stated otherwise.
[0061]
[0065] It should be understood that, when used herein and in the claims, the phrase "and / or" means "either or both" of the elements thus combined, i.e., elements that are sometimes conjunctive and sometimes non-conjunctive. The other elements may exist, at their discretion, in addition to those specifically identified by the "and / or" clause, whether related to or unrelated to those specifically identified elements, unless explicitly indicated otherwise. Thus, as a non-restrictive example, when used in relation to open-ended language such as "equipped with," in one embodiment, it may refer to A without B (optionally including elements other than B), in another embodiment, it may refer to B without A (optionally including elements other than A), and in yet another embodiment, it may refer to both A and B (optionally including other elements).
[0062]
[0066] Where used herein and in the claims, “or” should be understood to have the same meaning as “and / or” as defined above. For example, when dividing items in a list, “or” or “and / or” should be interpreted as inclusive, that is, including at least one of the number of elements or list, but also including two or more, and optionally including items not in the additional list. Only terms that are explicitly indicated as the opposite, such as “one of” or “exactly one of” or “consisting of” as shown in the claims, refer to the inclusion of exactly one of the number of elements or list. In general, where used herein, the term “or” should be interpreted only as referring to exclusive substitutes (i.e., “one or the other, but not both”) when preceded by terms of exclusivity such as “either,” “one of,” “one of,” or “exactly one of.” Where used in the claims, “essentially consisting of” should have its usual meaning where used in the field of patent law.
[0063]
[0067] As used herein and in the claims, the phrase “at least one” in relation to a list of one or more elements means at least one element selected from any one or more elements in the list of elements, but not necessarily including each element specifically listed in the list of elements and at least one of any elements, and not excluding any combination of elements in the list of elements. This definition also allows for elements other than those specifically identified to exist in the list of elements to which the phrase “at least one” refers, whether those elements are related to or unrelated to those specifically identified elements, as an optional choice. Therefore, as a non-restrictive example, "at least one of A and B" (or equivalently, "at least one of A or B" or equivalently, "at least one of A and / or B") may mean, in one embodiment, at least one, optionally two or more, A is included and B is absent (and optionally, elements other than B are included); in another embodiment, at least one, optionally two or more, B is included and A is absent (and optionally, elements other than A are included); and in yet another embodiment, at least one, optionally two or more, A is included and at least one, optionally two or more, B is included (and optionally, other elements are included), and so on.
[0064]
[0068] Within the claims, the use of ordinary terms such as “first,” “second,” and “third” to modify a claim element does not in itself imply any priority, precedence, or order in which one claim element prevails over another, or a temporal order in which the actions of the method are performed, but is used simply as a label to distinguish one claim element having a specific name from another element having the same name (but for the purpose of ordinary terminology use) to distinguish the claim element.
[0065]
[0069] In the claims and the above specification, all transitional phrases such as “equipment,” “includes,” “carry,” “possess,” “contain,” “involve,” and “hold” should be understood to be open-ended, meaning they include but are not limited to. Only the transitional phrases “consist of” and “essentially consist of” are considered closed or semi-closed transitional phrases, respectively, as shown in Section 2111.03 of the U.S. Patent and Trademark Examination Manual.
Claims
1. The first organizational gripper, The second organization, Grippa, A spring operably coupled to the first tissue gripper and the second tissue gripper, A lock configured to hold the first tissue gripper and the second tissue gripper in an extended configuration in a lock configuration, wherein the spring is configured to bias the first tissue gripper and the second tissue gripper toward a contracted configuration when the lock is in an unlocked configuration, A housing comprising a first housing portion and a second housing portion, The first tissue gripper is operably coupled to the first housing portion, The second tissue gripper is operably coupled to the second housing portion. At least a portion of the second housing portion is configured to slide within the internal volume of the first housing portion. Tissue closure device.
2. The first organizational gripper, The second organization, Grippa, A spring operably coupled to the first tissue gripper and the second tissue gripper, A housing comprising a first housing portion and a second housing portion, wherein the first tissue gripper is operably coupled to the first housing portion, the second tissue gripper is operably coupled to the second housing portion, and the spring is configured to bias the first and second tissue grippers from an extended configuration to a contracted configuration. The system comprises a force indicator configured to visually show the contractile force applied to the first tissue portion and the second tissue portion by the first and second tissue grippers, A tissue closure device wherein at least a portion of the second housing portion is configured to slide within the internal volume of the first housing portion.
3. The tissue closure device according to claim 2, further comprising a lock configured to hold the first tissue gripper and the second tissue gripper in the extended configuration in the lock configuration.
4. The tissue closure device according to claim 1 or 3, wherein the lock is selected from a group consisting of a cantilever lock, a slot, and a key lock.
5. The tissue closure device according to claim 1 or 2, wherein the minimum distance between the first tissue gripper and the second tissue gripper in the contraction configuration is greater than or equal to 0 cm and less than or equal to 2 cm.
6. The tissue closure device according to claim 1 or 2, wherein the maximum vertical dimension of the tissue closure device is greater than or equal to 5 cm and less than or equal to 20 cm.
7. The tissue closure device according to claim 1 or 2, wherein the maximum lateral dimension of the housing is greater than or equal to 3 mm and less than or equal to 8 mm.
8. The tissue closure device according to claim 1 or 2, wherein the widths of the first tissue gripper and the second tissue gripper are greater than or equal to 3 mm and less than or equal to 8 mm.
9. The tissue closure device according to claim 1 or 2, wherein the lengths of the first tissue gripper and the second tissue gripper are greater than or equal to 1 cm and greater than or equal to 2 cm.
10. The tissue closure device according to claim 1 or 2, wherein the spring is operably coupled to the first housing portion and the second housing portion in order to bias the first housing portion toward the second housing portion.
11. The tissue closure device according to claim 1, wherein in the contraction configuration, a portion of the second housing portion disposed within the internal volume of the first housing portion is maximized.
12. The tissue closure device according to claim 2 or 3, wherein the housing and the spring are coaxial.
13. The tissue closure device according to claim 2 or 3, wherein the spring is at least partially disposed within the internal volume of the first housing portion and / or the second housing portion.
14. The tissue closure device according to claim 1, further comprising a force indicator configured to visually indicate the contractile forces applied to the first tissue portion and the second tissue portion by the first and second tissue grippers.
15. The tissue closure device according to claim 2 or 14, wherein the force indicator comprises a plurality of markings on the outer surface of the first housing portion and / or the second housing portion, and a marker configured to move with respect to the plurality of markings as the first and second tissue grippers transition between the extension configuration and the contraction configuration to indicate the contraction force.
16. The tissue closure device according to claim 1 or 2, wherein the spring is at least one selected from the group consisting of a coil spring, a rotary spring, a gas spring, a traction rod spring, and an elastic component.
17. The tissue closure device according to claim 1 or 2, wherein the spring is configured to apply a contractile force greater than or equal to 2.5 N and less than or equal to 6 N.
18. The first tissue gripper and the second tissue gripper have a closed configuration and an open configuration. The tissue closure device according to claim 1 or 2, wherein the first tissue gripper and the second tissue gripper are biased toward the closed configuration.
19. The tissue closure device according to claim 1 or 2, wherein the first tissue gripper and the second tissue gripper are configured to apply force to the tissue portion without causing trauma.
20. The tissue closure device according to claim 1 or 2, wherein the first tissue gripper and / or the second tissue gripper are configured to release when the contractile force is greater than a threshold contractile force.
21. The first tissue gripper is configured to move together with the first housing portion in the same direction as the first housing portion, The tissue closure device according to claim 1 or 2, wherein the second tissue gripper is configured to move together with the second housing portion in the same direction as the second housing portion.