Tissue tagging instrument and method

Abstract

Surgical instruments and methods for application of tissue tags. In one example a surgical instrument includes two tissue tags held in a releasable fashion at a distal end of the surgical instrument. The surgical instrument may further include an actuator for causing the first and second tissue tags to transition from disengaged states to engaged states.

Description

[0001] Attorney Ref. MDA25-097PCT (090723-1556482) UNITED STATES INTERNATIONAL PATENT APPLICATION FOR:

[0002] TISSUE TAGGING INSTRUMENT AND METHOD

[0003] CROSS-REFERENCE TO RELATED APPLICATIONS

[0004]

[0001] This application claims priority to and the benefit of United States Provisional Patent Application Serial No. 63 / 789,579, filed April 16, 2025, the content of which is incorporated herein by this reference as if fully set forth herein.

[0005] RELATED FIELDS

[0006]

[0002] Surgical instruments and methods for applying tags to tissue, such as but not limited to for the purpose of tracking tumor margins.

[0007] BACKGROUND

[0008]

[0003] Soft tissue sarcomas (STS) are aggressive tumors with a high recurrence rate (40-50%) due to challenges in achieving and verifying negative margins. Typical margin assessment methods— such as sutures, dyes, and photographs— lack precision and standardization, leading to suboptimal communication between surgeons and pathologists in conveying specimen orientation and high-risk zones. This results in inaccurate histopathological evaluation and subjects patients to inappropriate management and subsequent poor clinical outcomes. Similar and other challenges apply to other soft tissue tumors and other applications in which it is desirable to tag tissue during a surgical procedure.Attorney Ref. MDA25-097PCT (090723-1556482)

[0009] SUMMARY

[0010]

[0004] This patent describes several examples of surgical instruments and methods for applying one or more tags to tissue during a surgical procedure. In some implementations these example instruments and methods provide a way to accurately mark tumor margins and track orientation in patients with soft tissue tumors undergoing tumor resection or for other procedures involving tissue resection for surgeons to improve standardization and enhance communication. In some implementations the example instruments and methods provide lasting physical labeling for both the specimen and defect, orients the specimen and marks high-risk zones, correlates adjacent margins, is compatible with imaging, and enhances communication.

[0011]

[0005] In one example a surgical instrument includes a first tissue tag, a second tissue tag, and an actuator. The first tissue tag is held in a releasable fashion at a distal end of the surgical instrument. The first tissue tag has a disengaged state and an engaged state. The second tissue tag is held in a releasable fashion at the distal end of the surgical instrument and spaced apart from the first tissue tag. The second tissue tag has a disengaged state and an engaged state. Actuating the actuator causes the first and second tissue tags to transition from the disengaged states to the engaged states.

[0012]

[0006] In this example the surgical instrument may also include a resection tool extending between the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument.

[0013]

[0007] In this example the surgical instrument may have an instrument body configured to hold the first and second tissue tags in the releasable fashion. The distal end of the surgical instrument may be a distal end of the instrument body. The resection tool may beAttorney Ref. MDA25-097PCT (090723-1556482) movable relative to the instrument body to adjust a relative position of a distal end of the resection tool relative to the distal end of the instrument body.

[0014]

[0008] In this example the surgical instrument may have a resection configuration and a tagging configuration. Moving the resection tool relative to the instrument body transitions the surgical instrument between the resection and tagging configurations.

[0015]

[0009] In this example the instrument body may receive the resection tool in a removable fashion.

[0016]

[0010] In this example the surgical instrument may also include at least one tissue gripper at the distal end of the surgical instrument. The tissue gripper may have an open state and a gripping state. Actuating the actuator may cause the at least one tissue gripper to transition from the open state to the engaged state.

[0017] [Oil] In this example the actuator may have a first position, a second position, and a third position. When the actuator is at the first position the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument may be in the disengaged state and the tissue gripper may be in the open state. When the actuator is at the second position the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument may be in the disengaged state and the tissue gripper is in the engaged state. When the actuator is at the third position the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument may be in the engaged state and the tissue gripper may be in the engaged state.

[0018]

[0012] In this example the actuator may be a first actuator and a second actuator. Actuation of the first actuator may causes the first and second tissue tags to transition from the disengaged states to the engaged states. Actuation of the second actuator may cause the gripper to transition from the open state to the engaged state.Attorney Ref. MDA25-097PCT (090723-1556482)

[0013] In this example the at least one tissue gripper may be a first tissue gripper and a second tissue gripper, in which the first tissue gripper is adjacent the first tissue tag held in the releasable fashion at the distal end of the surgical instrument, and the second tissue gripper is adjacent the second tissue tag held in the releasable fashion at the distal end of the surgical instrument.

[0019]

[0014] In this example the at least one tissue gripper may be tissue gripping jaws, and wherein the surgical instrument further comprises tissue tag jaws configured to transition the first and second tissue tags from the disengaged states to the engaged states.

[0020]

[0015] In another example a surgical instrument includes a resection tool, a tissue tag, and an actuator. The tissue tag may be held in a releasable fashion at a distal end of the surgical instrument, the tissue tag having a disengaged state and an engaged state. Actuating the actuator may cause the tissue tag to transition from the disengaged state to the engaged state.

[0021]

[0016] In this example the surgical instrument may have an instrument body configured to hold the tissue tag in the releasable fashion, the distal end of the surgical instrument being a distal end of the instrument body. The resection tool may be movable relative to the instrument body to adjust a relative position of a distal end of the resection tool relative to the distal end of the instrument body.

[0022]

[0017] In this example the surgical instrument may have a resection configuration and a tagging configuration, in which moving the resection tool relative to the instrument body transitions the surgical instrument between the resection and tagging configurations.

[0023]

[0018] In this example the surgical instrument may also include a tissue gripper at the distal end of the surgical instrument, in which the tissue gripper has an open state and aAttorney Ref. MDA25-097PCT (090723-1556482) gripping state, and actuating the actuator causes tissue gripper to transition from the open state to the gripping state.

[0024]

[0019] In another example a tissue tagging method may include, using a surgical instrument with a first tissue tag and a second tissue tag held in a releasable fashion at a distal end of the surgical instrument, positioning the surgical instrument relative to a planned resection path such that the first tissue tag is on a first side of the planned resection path and the second tissue tag is on a second side of the planned resection path opposite the first side. In this example the method further includes actuating the surgical instrument to cause the first and second tissue tags to transition from disengaged states to engaged states such that the first tissue tag is engaged with tissue on the first side of the planned resection path and the second tissue tag is engaged with tissue on the second side of the planned resection path.

[0025]

[0020] In this example the method may further include, after engaging the first and second tissue tags, loading third and fourth tissue tags at the distal end of the surgical instrument.

[0026]

[0021] In this example the first and second tissue tags may have first location indicia, and the third and fourth tissue tags may have second location indicia, with the first location indicia being different from the second location indicia.

[0027]

[0022] In this example the method may further include, after the first and second tissue tags are engaged with tissue, using a resection tool to resect along the planned resection path.

[0028]

[0023] In this example the surgical instrument may have an instrument body configured to hold the first and second tissue tags in the releasable fashion, in which the distal end of the surgical instrument is a distal end of the instrument body. The tissue tagging method may further include, prior to using the resection tool to resect along the plannedAttorney Ref. MDA25-097PCT (090723-1556482) resection path, moving the resection tool relative to the instrument body to adjust a relative position of a distal end of the resection tool relative to the distal end of the instrument body.

[0029]

[0024] In this example the method may further include, prior to actuating the surgical instrument to cause the first and second tissue tags to transition from disengaged states to engaged states, actuating the surgical instrument to cause at least one tissue gripper at the distal end of the surgical instrument to transition from an open state to a gripping state.

[0030] BRIEF DESCRIPTION OF FIGURES

[0031]

[0025] FIGS. 1 and 2 show an example of a surgical instrument for applying tissue tags.

[0032]

[0026] FIG. 3 shows an example of a tissue tag usable with the surgical instrument of FIGS, l and 2.

[0033]

[0027] FIG. 4 shows an example of a cartridge for holding tissue tags.

[0034]

[0028] FIG. 5 shows the distal end of the surgical instrument of FIGS. 1 and 2 in greater detail.

[0035]

[0029] FIGS. 6-8 show a schematic example of actuation of an actuator of a surgical instrument and resulting state changes of the distal end of the instrument in response to its actuation.

[0036]

[0030] FIG. 9 shows another example of a surgical instrument for applying tissue tags in which the surgical instrument includes a resection tool.

[0037]

[0031] FIG. 10 shows the surgical instrument of FIG. 9 in a resection configuration.

[0038]

[0032] FIG. 11 shows the surgical instrument of FIG. 10 in a tagging configuration.

[0039]

[0033] FIGS. 12-13 schematically illustrate a method using the surgical instrument of FIG. 9.Attorney Ref. MDA25-097PCT (090723-1556482)

[0034] FIG. 14 shows another example of a surgical instrument (the distal end of the instrument) and another example of a tissue tag.

[0040]

[0035] FIG. 15 shows another example of a method of using a surgical instrument to apply tissue tags.

[0041]

[0036] FIG. 16-18 shows another example of portions of a surgical instrument.

[0042]

[0037] FIG. 19 shows another example of a portion of a surgical instrument.

[0043] DETAILED DESCRIPTION

[0044]

[0038] FIGS. 1-19 show examples of surgical instruments for tagging tissue, tissue tags for use with those instruments, and example tissue tagging methods. The example instruments and methods shown in these examples enhance surgical accuracy. In some implementations, the example instruments and methods allow for simultaneously tagging tumor margins and defect sites at the point of resection. In some implementations, the example instruments and methods integrate seamlessly into surgical workflows by using radiopaque, indicia identified tags for imaging compatibility and long term surveillance. In some implementations, the example instruments and methods are compatible with or may integrally incorporate a resection tool (e.g., LigaSure, Bovie pencil, scalpel, etc.) with a telescoping holder. In other implementations, the example instruments and methods may be used without a resection tool, or may be used with a separate resection tool.

[0045]

[0039] In some implementations the example instruments and methods are configured for intraoperative resection margin marking in patients with operable tumors and enable precise labeling of corresponding margins on both the tumor specimen and the surgical cavity to improve surgical accuracy and postoperative surveillance. In some implementations the example instruments and methods facilitate real-time margin markingAttorney Ref. MDA25-097PCT (090723-1556482) during tumor resection by simultaneously inserting radiopaque tags into both the excised tumor section and the corresponding margins inside the body cavity. These markers help clinicians (pathologists, radiologists, oncologists) orient specimens, identify high-risk areas, and track prior surgical margins for long-term monitoring and targeted therapies in case of recurrence. By providing a standardized, streamlined workflow, the example instruments and methods described herein may enhance surgical precision, histopathological evaluation, and imaging-based surveillance.

[0046]

[0040] In one illustrative example the instrument includes a hollow application piece designed to accommodate standard surgical tools (e.g. single-shaft resection tools of a shaft diameter of 5-10 mm) such as but not limited to a LigaSure, Bovie pencil, or scalpel. The application piece fits around the resection tool and connects to the device which can be manually extended or retracted for optimal visibility and function. One or more radiopaque tags are inserted into the distal end of the device. The surgeon actuates an actuator of the instrument, causing jaws to close and grip tissue at the desired resection margin. The surgeon further actuates the actuator to close a second set of jaws, securely applying the radiopaque tag(s) onto the grasped tissue. The instrument is then retracted, leaving the tag(s) securely in place while the surgeon proceeds with resection. The process may be repeated for some or all of the six primary margins (e.g. Superior, Inferior, Anterior, Posterior, Medial, Lateral, or at least three of those margins) or any additional high-risk areas. Once all margins are marked, the device is removed and disposed of after the procedure.

[0047]

[0041] In the above illustrative example, the instrument may be constructed from biocompatible surgical-grade materials, including: Stainless steel (structural and gripping components); Titanium (for lightweight, durable parts); PTFE (Teflon) coating (for smooth operation and reduced friction); Plastic composites & polymers (handle and outer casing)Attorney Ref. MDA25-097PCT (090723-1556482)

[0042] In the above illustrative example, the tissue tags may be: Non-ferromagnetic (MRI-compatible); X-ray & CT-visible; and similar in structure to ligating clips for strength and durability. The tissue tags may incorporate a locking mechanism for retaining the tissue tag in an engaged state. Additionally, the tissue tags may include in some implementations a series of embedded, small metallic / radiopaque elements (e.g. a number of spheres corresponding to the specific margin and cross shaped elements for high risk areas) (e.g. 1 sphere = superior margins; 2 spheres = inferior margins; ... cross shape = high risk area). In some implementations the tissue tag may be a hybrid including a polymer body with embedded titanium spheres / cross shaped elements.

[0048]

[0043] In the above illustrative example, the instrument operates completely mechanically, with manual triggers to deploy the tags. Springs will assist in jaw opening after release. An adaptive applier mechanism will allow compatibility with different surgical tool cross-sections.

[0049]

[0044] FIGS. 1-5 show an example of a surgical instrument 100, an example of a tissue tag 200 (see FIG. 3) usable with that surgical instrument 100, and an example of a cartridge 300 (see FIG.4) for holding additional tissue tags 200 to be loaded into the surgical instrument. Although not shown in FIGS. 1-5, when loaded, the surgical instrument in this example holds two tissue tags 200 in a releasable fashion at a distal end 102 of the surgical instrument. The tissue tags 200 are loaded into the instrument 100 in a disengaged state (e.g. an open state as shown in FIG. 3). The instrument 100 includes an actuator 104 that, when actuated, causes the two tissue tags 200 to transition from their disengaged states to engaged states (e.g. closed states), allowing the tissue tags 200 to be clamped onto tissue.

[0050]

[0045] In the example shown in FIG. 3 the tissue tag 200 is similar to a ligating clip, including jaws 202, 204 that are open when the tissue tag 200 is in the disengaged state andAttorney Ref. MDA25-097PCT (090723-1556482) closed when the tissue tag 200 is in the engaged state (e.g. facilitating clamping the tissue tag 200 onto tissue). A locking mechanism 206 (i.e. in this example a resilient protrusion that fits into a correspondingly shaped cavity) may retain the tissue tag 200 in the engaged state, clamping the tissue tag 200 onto a tissue in use.

[0051]

[0046] In some implementations the tissue tag 200 may be made of a radio-opaque material. In other implementations the tissue tag 200 may be made of a radio-lucent material and contain or otherwise be marked with a radio-opaque marker. For instance, in some implementations, the tissue tags 200 may contain radio-opaque small spheres. The tissue tag 200 may be configured such that at least some of the tissue tags 200 can be differentiated from one another. For instance, the number of radio-opaque spheres in the tissue tag 200 may vary, allowing different tissue tags 200 to be used to label different parts of a tissue. As just one illustrative example, tissue tags 200 with one radio-opaque sphere each may be used for medial labeling, two spheres may be used for lateral labeling, three spheres may be used for superior labeling, etc. In other implementations, radio-opaque inks or other radio-opaque material may be marked onto the exterior of the tissue tag 200 allowing for discrimination between applied tissue tags. In these and otherfashionsthe tissue tags 200 may be configured to function as location indicia, allowing orientation of specimens, identification of high-risk areas, and tracking of prior surgical margins for long-term monitoring and targeted therapies in case of recurrence.

[0052]

[0047] One or more cartridges, such as the cartridge shown in FIG. 300, may be used to hold tissue tags 200 prior to loading into the instrument 100. The tissue tags 200 may be labeled or otherwise organized in the cartridge 300 so that different tissue tags 200 can be identified. For instance, tissue tags 200 for medial tagging may be arranged in one section of the cartridge 300, tissue tags 200 for lateral tagging may be arranged in another section of theAttorney Ref. MDA25-097PCT (090723-1556482) cartridge 300, etc. In other implementations, multiple cartridges 300 may be used, with each cartridge 300 holding a particular type of tissue tags 200 (e.g. one cartridge for medial tagging, another for lateral tagging, etc.).

[0053]

[0048] Returning to FIGS. 1-2, the surgical instrument 100 has an instrument body 106 that is configured to hold two tissue tags 200 in a releasable fashion at its distal end 102 and is also configured to receive a resection tool 400 (not shown in FIGS. 1-2) in a removable fashion. The instrument body 106 includes a cavity extending along its length such that a resection tool 400 can be inserted therethrough. The surgical instrument 100 further includes a manual tool extender 108 that may be connected to the resection tool 400 allowing controlled movement of the resection tool 400 relative to the instrument body 106.

[0054]

[0049] FIG. 9 shows another example of a surgical instrument 100 in which the instrument body 106 receives a resection tool 400 in a removable fashion. In the example shown in FIG. 9, tissue tag jaws 110 of the instrument body 106 hold tissue tags (not shown) in a releasable fashion at the distal end 102 of the surgical instrument 100. The resection tool 400 extends between the tissue tags held by the tissue tag jaws 110. The resection tool 400 is movable relative to the instrument body 106 to adjust a relative position of a distal end 402 of the resection tool 400 relative to the distal end 102 of the instrument body 106. Moving the resection tool 400 relative to the instrument body 106 transitions the surgical instrument 100 between a resection configuration and a tagging configuration. FIG. 10 shows the surgical instrument of FIG. 9 in a resection configuration with the distal end 402 of the resection tool extending past the distal end 102 of the instrument body. FIG. 11 shows the surgical instrument of FIG. 9 in a tagging configuration in which the distal end of the resection tool is recessed relative to the distal end 102 of the instrument body 106. In the particular exampleAttorney Ref. MDA25-097PCT (090723-1556482) of FIG. 11, when in the tagging configuration, the distal end of the resection tool is withdrawn into the instrument body 106 and is not visible.

[0055]

[0050] In the examples shown in the figures the resection tool 400 is a separate tool that is removably installed in the surgical instrument 100. In other implementations, the resection tool 400 may be an integral part of the surgical instrument 100.

[0056]

[0051] With reference to FIGS. 1-2 and 5, the surgical instrument 100 in this example is configured to hold two tissue tags in a releasable fashion at the distal end 102 of the instrument body 106. In this example the instrument 100 includes tissue tag jaws 110 for holding the tissue tags. The tissue tag jaws 110 hold the tissue tags 200 between the jaws 110 and base plates 112 of the instrument body 106. The tissue tag jaws 110 are each adjacent to and surrounded by a tissue gripper 114 (with the tissue gripper 114 in this example being another jaw member that includes a slot for receiving a tissue tag jaw).

[0057]

[0052] The tissue tag jaws 110 and the tissue grippers 114 are all movable and controlled by the actuator 104. The tissue grippers 114 are movable between an open state and a gripping state. Actuating the actuator 104 causes the tissue grippers 114 to transition from the open state (in which tissue can be positioned between the tissue grippers 114 and the base plates 112) to the gripping state (in which tissue can be gripped between the tissue grippers 114 and the base plates 112). The tissue tag jaws 110 may similarly be transitioned between open and closed states, with the open state allowing tissue tags 200 in their disengaged states to be positioned between the tissue tag jaws 110 and the base plates 112, with transition to the closed state of the tissue tag jaws 110 closing the tissue tags 200 to their engaged states. The tissue tag jaws 110 and / or the base plates 112 can be configured with detents or other structure / mechanisms to temporarily retain the tissue tags 200 in their disengaged states.Attorney Ref. MDA25-097PCT (090723-1556482)

[0053] FIGS. 6-8 schematically illustrate portions of the surgical instrument 100 of FIGS. 1-2 and 5, illustrating operation of the actuator 104 and effect on the states of a tissue tag 200, tissue tag jaw 110, and tissue gripper 114. In FIG. 6 the actuator 104 is in an initial position with the tissue tag 200 in a disengaged state and the tissue gripper 114 in an open state. In FIG. 7 the actuator 104 has been moved back to a second position, which, via linkages (e.g. linkage 116 shown in FIG. 1) in the instrument, causes the tissue gripper 114 to close to a gripping state. As shown in FIG. 7 the tissue tag jaw 110 remains open such that the tissue tag 200 remains in its disengaged state. In FIG. 8 the actuator has been moved back to a third position, which causes the tissue tag jaw 110 to close (e.g. vial linkage 118 in FIG. 1) which thereby closes the tissue tag 200 into its engaged state. In the example of FIGS. 6-8, this multi-step actuation allows for the instrument to initially grip and stabilize the tissue, with tissue tags subsequently being engaged to the tissue.

[0058]

[0054] The examples in the figures show a single actuator being used for both the tissue tag jaws 110 and the tissue grippers 114. In other examples the actuator may include separate triggers for operating the tissue tag jaws 100 and tissue grippers 114 respectively.

[0059]

[0055] The examples in the figures show instruments configured to apply two tissue tags, with a resection tool located between the two tissue tags. In other implementations the instrument may be configured to apply a single tissue tag.

[0060]

[0056] FIGS. 12 and 13 schematically illustrate an example of a tissue tagging method. In FIG. 12, a surgical instrument 100 with tissue tags (not visible in FIG. 12) held in a releasable fashion at a distal end 102 of the surgical instrument 100 is positioned relative to a planned resection path 500 such that one of the tissue tags is on one side of the planned resection path 500 and the other tissue tag is on the other side of the planned resection path 500. InAttorney Ref. MDA25-097PCT (090723-1556482) some implementations, the planned resection path 500 may be aligned with a tumor margin, separating what is believed to be tumor tissue from adjacent tissue.

[0061]

[0057] In FIG. 12, the surgical instrument 100 is positioned relative to the planned resection path 500 with a resection tool of the surgical instrument 100 in a recessed position and not shown in FIG. 12.

[0062]

[0058] With the surgical instrument 100 positioned as shown in FIG. 12, the surgical instrument 100 may be actuated to cause the tissue grippers 114 at the distal end 102 of the surgical instrument 100 to transition from an open state to a gripping state (e.g. as shown in FIGS. 6-7). Next, the surgical instrument 100 may be further actuated to cause the tissue tags 200 to transition from disengaged states to engaged states such that one of the tissue tags 200 is engaged with tissue 502 on one side of the planned resection path 500 and the other tissue tag 200 is engaged with tissue 504 on the other side of the planned resection path 500.

[0063]

[0059] As shown in FIG. 13, after the tissue tags 200 are engaged with the tissue 502, 504 on either side of the planned resection path 500, resection tool 400 may be moved to an extended position and used to resect along the planned resection path 500.

[0064]

[0060] Subsequently, additional tissue tags 200 may be loaded at the distal end 102 of the surgical instrument 100. In some implementations, and as discussed above, the additional tissue tags 200 may have different location indicia than the already applied tissue tags 200, allowing for spatial discrimination between the different tissue tags 200 applied during the surgical procedure.

[0065]

[0061] The above described instrumentsand methods are provided by way of example only. Various changes can be made to those instruments and methods without departing from the scope or spirit of the claimed inventions. Additional non-limiting examples or instruments and methods are shown in FIGS. 14-19. For instance, FIGS. 16-18 illustrate some of theAttorney Ref. MDA25-097PCT (090723-1556482) components of another example of a surgical instrument for applying tissue tags, and illustrate how a rack and pinion mechanism may be used to drive actuation to the tissue tag jaws and another rack and pinion mechanism may be used to control movement of a resection tool held in the instrument.

Claims

Attorney Ref. MDA25-097PCT (090723-1556482) Claims:

1. A surgical instrument comprising:(a) a first tissue tag held in a releasable fashion at a distal end of the surgical instrument, the first tissue tag comprising a disengaged state and an engaged state;(b) a second tissue tag held in a releasable fashion at the distal end of the surgical instrument and spaced apart from the first tissue tag, the second tissue tag comprising a disengaged state and an engaged state; and(c) an actuator, wherein actuating the actuator causes the first and second tissue tags to transition from the disengaged states to the engaged states.

2. The surgical instrument of claim 1 further comprising a resection tool extending between the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument.

3. The surgical instrument of claim 2 further comprising an instrument body configured to hold the first and second tissue tags in the releasable fashion, wherein the distal end of the surgical instrument comprises a distal end of the instrument body, and wherein the resection tool is movable relative to the instrument body to adjust a relative position of a distal end of the resection tool relative to the distal end of the instrument body.

4. The surgical instrument of claim 3 wherein the surgical instrument comprises a resection configuration and a tagging configuration, wherein moving the resection toolAttorney Ref. MDA25-097PCT (090723-1556482) relative to the instrument body transitions the surgical instrument between the resection and tagging configurations.

5. The surgical instrument of claim 3 wherein the instrument body receives the resection tool in a removable fashion.

6. The surgical instrument of claim 1 further comprising at least one tissue gripper at the distal end of the surgical instrument, the tissue gripper comprising an open state and a gripping state, wherein actuating the actuator causes the at least one tissue gripper to transition from the open state to the engaged state.

7. The surgical instrument of claim 6 wherein the actuator comprises a first position, a second position, and a third position, wherein:(i) when the actuator is at the first position the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument are in the disengaged state and the tissue gripper is in the open state;(ii) when the actuator is at the second position the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument are in the disengaged state and the tissue gripper is in the engaged state; and(iii) when the actuator is at the third position the first and second tissue tags held in the releasable fashion at the distal end of the surgical instrument are in the engaged state and the tissue gripper is in the engaged state.Attorney Ref. MDA25-097PCT (090723-1556482) 8. The surgical instrument of claim 6, wherein the actuator comprises a first actuator and a second actuator, wherein actuation of the first actuator causes the first and second tissue tags to transition from the disengaged states to the engaged states, and wherein actuation of the second actuator causes the gripper to transition from the open state to the engaged state.

9. The surgical instrument of claim 6 wherein the at least one tissue gripper comprises a first tissue gripper and a second tissue gripper, the first tissue gripper adjacent the first tissue tag held in the releasable fashion at the distal end of the surgical instrument, the second tissue gripper adjacent the second tissue tag held in the releasable fashion at the distal end of the surgical instrument.

10. The surgical instrument of claim 6 wherein the at least one tissue gripper comprises tissue gripping jaws, and wherein the surgical instrument further comprises tissue tag jaws configured to transition the first and second tissue tags from the disengaged states to the engaged states.

11. A surgical instrument comprising:(a) a resection tool;(b) a tissue tag held in a releasable fashion at a distal end of the surgical instrument, the tissue tag comprising a disengaged state and an engaged state; and(c) an actuator, wherein actuating the actuator causes the tissue tag to transition from the disengaged state to the engaged state.Attorney Ref. MDA25-097PCT (090723-1556482) 12. The surgical instrument of claim 11 further comprising an instrument body configured to hold the tissue tag in the releasable fashion, wherein the distal end of the surgical instrument comprises a distal end of the instrument body, and wherein the resection tool is movable relative to the instrument body to adjust a relative position of a distal end of the resection tool relative to the distal end of the instrument body.

13. The surgical instrument of claim 12 wherein the surgical instrument comprises a resection configuration and a tagging configuration, wherein moving the resection tool relative to the instrument body transitions the surgical instrument between the resection and tagging configurations.

14. The surgical instrument of claim 11 further comprising a tissue gripper at the distal end of the surgical instrument, the tissue gripper comprising an open state and a gripping state, wherein actuating the actuator causes tissue gripper to transition from the open state to the gripping state.

15. A tissue tagging method comprising:using a surgical instrument with a first tissue tag and a second tissue tag held in a releasable fashion at a distal end of the surgical instrument, positioning the surgical instrument relative to a planned resection path such that the first tissue tag is on a first side of the planned resection path and the second tissue tag is on a second side of the planned resection path opposite the first side;actuating the surgical instrument to cause the first and second tissue tags to transition from disengaged states to engaged states such that the first tissue tag is engaged with tissue on theAttorney Ref. MDA25-097PCT (090723-1556482) first side of the planned resection path and the second tissue tag is engaged with tissue on the second side of the planned resection path.

16. The tissue tagging method of claim 15 further comprising, after engaging the first and second tissue tags, loading third and fourth tissue tags at the distal end of the surgical instrument.

17. The tissue tagging method of claim 16, wherein the first and second tissue tags comprise first location indicia, wherein the third and fourth tissue tags comprise second location indicia, and wherein the first location indicia is different from the second location indicia.

18. The tissue tagging method of claim 15 further comprising, after the first and second tissue tags are engaged with tissue, using a resection tool to resect along the planned resection path.

19. The tissue tagging method of claim 18 wherein the surgical instrument further comprises an instrument body configured to hold the first and second tissue tags in the releasable fashion, wherein the distal end of the surgical instrument comprises a distal end of the instrument body, and wherein the tissue tagging method comprises, prior to using the resection tool to resect along the planned resection path, moving the resection tool relative to the instrument body to adjust a relative position of a distal end of the resection tool relative to the distal end of the instrument body.Attorney Ref. MDA25-097PCT (090723-1556482) 20. The tissue tagging method of claim 15 further comprising, prior to actuating the surgical instrument to cause the first and second tissue tags to transition from disengaged states to engaged states, actuating the surgical instrument to cause at least one tissue gripper at the distal end of the surgical instrument to transition from an open state to a gripping state.

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