US20230404595A1 - Large tissue defect recruiting device - Google Patents
Large tissue defect recruiting device Download PDFInfo
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- US20230404595A1 US20230404595A1 US18/199,848 US202318199848A US2023404595A1 US 20230404595 A1 US20230404595 A1 US 20230404595A1 US 202318199848 A US202318199848 A US 202318199848A US 2023404595 A1 US2023404595 A1 US 2023404595A1
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Definitions
- the present disclosure relates generally to surgical devices and, more specifically, to an actuation assembly for a tissue recruiting device that allows for improved tissue recruitment to facilitate closure of large defects.
- Tissue recruiting and grasping devices are used in various parts of the body, including the gastrointestinal, urinary, and vascular systems, to treat internal bleeding or defects. These devices may be deployed using an endoscope, such as a flexible endoscope, and may be provided in a variety of forms and may be used with hemostatic devices, including clamps, clips, staples, sutures, and the like. One or more hemostatic devices may be deployed around tissue in the body to apply constrictive forces to blood vessels and surrounding tissue, such as to control and prevent bleeding.
- endoscope such as a flexible endoscope
- hemostatic devices including clamps, clips, staples, sutures, and the like.
- One or more hemostatic devices may be deployed around tissue in the body to apply constrictive forces to blood vessels and surrounding tissue, such as to control and prevent bleeding.
- a hemostatic device may be deployed around a growth of tissue, such as a polyp.
- the hemostatic device may be used to close the defect after the growth has been removed, such as to prevent or otherwise reduce bleeding.
- target tissue may be grasped and recruited, such as into a pseudo-polyp, and the hemostatic device may be used to close the defect after the recruited tissue has been cut or severed, such as to remove the defect.
- the target tissue could be dysplasia, a defect, or the like.
- tissue recruiting techniques often involve extending a tissue recruiting device through an endoscope to the desired location to recruit tissue.
- conventional tissue recruitment techniques can sometimes fail to adequately recruit tissue before the hemostatic device is deployed.
- conventional tissue recruitment techniques may fail to adequately grasp and recruit multiple sides of a defect. Accordingly, there is an unmet need for an improved recruiting device that utilizes separate, independently controlled graspers to improve tissue recruitment.
- an actuation assembly of a tissue recruiting device operable to independently control first and second grasping devices to grasp tissue has a body defining a first channel and a second channel, a first actuation element extending through the first channel and coupled with the first grasping device, and a second actuation element extending through the second channel and coupled with the second grasping device.
- the actuation assembly has at least one first control actuator operable to control the translation and rotation of the first grasping device to grasp tissue via the first actuation element and at least one second control actuator operable to control the translation and rotation of the second grasping device to grasp tissue via the second actuation element.
- the at least one first control actuator is operable to control the translation and rotation of the first grasping device independently from the second grasping device.
- a tissue recruiting device in one example embodiment, includes a first grasping device and a second grasping device, with each grasping device being operable to grasp tissue.
- the tissue recruiting device also has a first actuation element extending through a first channel of a body with a proximal end of the first actuation element being coupled to a first control actuator and a distal end of the first actuation element being coupled to the first grasping device.
- the tissue recruiting device also has a second actuation element extending through a second channel of the body with a proximal end of the second actuation element being coupled to a second control actuator and a distal end of the second actuation element being coupled to the second grasping device.
- the first control actuator is independently operable to translate and rotate the first gasping device to grasp tissue via the first actuation element.
- the second control actuator is independently operable to translate and rotate the second grasping device to grasp tissue via the second actuation element.
- a method for treating a defect with a tissue recruiting device includes the steps of positioning a first grasping device above a first side of the defect, moving a first control actuator to control the translation and rotation of the first grasping device via a first actuation element, grasping the first side of the defect with the first grasping device, positioning a second grasping device above a second side of the defect, moving a second control actuator to control the translation and rotation of the second grasping device via a second actuation element, grasping the second side of the defect with the second grasping device, and retracting the actuation elements to recruit the grasped tissue.
- FIG. 1 is a schematic illustration of a tissue recruiting device
- FIG. 2 is a schematic illustration of another tissue recruiting device
- FIG. 3 is a perspective view of a catheter sheath assembly according to one embodiment of the disclosure.
- FIG. 4 is a front view of the catheter sheath assembly of FIG. 3 ;
- FIGS. 5 A- 5 D are schematic illustrations of the tissue recruiting assembly of the tissue recruiting devices of FIGS. 1 - 2 recruiting tissue;
- FIG. 6 is a schematic illustration of example grasping devices which may be used with a tissue recruiting device
- FIG. 7 is a perspective view of an actuation assembly according to one embodiment
- FIGS. 8 and 9 show various views of a body of the actuation assembly of FIG. 7 ;
- FIG. 10 is a perspective view of the actuation assembly of FIG. 7 with a cover
- FIG. 11 is a perspective view of the cover of FIG. 10 ;
- FIGS. 12 and 13 show a top and perspective view of half of the body of FIGS. 8 - 9 ;
- FIG. 14 is a perspective view of the actuation assembly of FIG. 7 with half of the body removed;
- FIG. 15 is a perspective view of a control actuator of the actuation assembly of FIG. 7 ;
- FIG. 16 is a perspective view of the actuation assembly of FIG. 14 with actuation sheaths
- FIG. 17 A is a cross-sectional schematic view of an actuation element disposed in an actuation sheath according to one embodiment
- FIG. 17 B is a perspective view of an actuation element according to one embodiment
- FIG. 17 C is a perspective view of the distal end of a tissue recruiting device according to one embodiment with the actuation element of FIG. 17 B ;
- FIGS. 17 D and 17 E are perspective views of a catheter according to one embodiment
- FIG. 17 F is a front view of the catheter of FIGS. 17 D- 17 E ;
- FIG. 17 G is a perspective view of a distal portion of the catheter of FIGS. 17 D- 17 E according to one embodiment
- FIG. 18 is a top view of a tissue recruiting device with the actuation assembly of FIG. 10 and two grasping devices according to one embodiment
- FIGS. 19 A- 19 C are perspective views depicting actuation of the tissue recruiting device of FIG. 18 ;
- FIGS. 20 and 21 are perspective and top views of a body of an actuation assembly with a biasing element 234 according to one embodiment
- FIGS. 22 and 23 show various views of a biasing element of FIGS. 20 - 21 ;
- FIG. 24 is a perspective view of the body of FIGS. 20 - 21 with actuation sheaths and control actuators;
- FIGS. 25 and 26 are perspective and top views of the body of FIGS. 20 - 21 with actuation elements, actuation sheaths, and control actuators;
- FIGS. 27 A- 27 D show various views of a cap according to one embodiment for use with the actuation assembly of FIG. 7 ;
- FIG. 28 is a schematic view of an actuation sheath coupled to an actuation element and a control actuator according to one embodiment
- FIG. 29 is a schematic illustration of an actuation assembly with a biasing element according to one embodiment
- FIGS. 30 A and 30 B are perspective and top views of a body with biasing elements according to another embodiment
- FIG. 31 is a top view of a body with a clamp according to one embodiment
- FIG. 32 A is a schematic illustration of an actuation assembly with a clamp according to one embodiment
- FIG. 32 B is a top view of the clamp of FIG. 32 A ;
- FIG. 33 is a schematic illustration of an actuation assembly with two clamps according to one embodiment
- FIGS. 34 A and 34 B are schematic illustrations of an actuation assembly with clamps according to another embodiment
- FIG. 35 is a top view of an actuation assembly with half of the body removed coupled with a lock according to one embodiment
- FIGS. 36 A and 36 B are schematic illustrations of an actuation assembly with a biasing element according to one embodiment, the actuation assembly being configured to produce detectable feedback at rotational intervals of the actuation elements;
- FIG. 38 E is a top view of the actuation assembly of FIGS. 38 A- 38 B with a cover according to another embodiment
- FIG. 38 F is a perspective view of an actuation element and control actuator according to another embodiment for use with the actuation assembly of FIGS. 38 A- 38 B ;
- FIG. 39 is a perspective view of an actuation assembly of FIG. 10 with a strain relief catheter and a distal coupler;
- FIGS. 41 A and 41 B are schematic front and side illustrations of an actuation assembly of another embodiment
- FIG. 43 is a schematic illustration of an actuation assembly with two bodies according to another embodiment
- FIG. 45 is a schematic illustration of an actuation assembly according to another embodiment.
- FIGS. 46 A- 46 C are schematic illustrations depicting the adjustable control of the translational control actuator of FIG. 45 ;
- FIG. 50 is a schematic illustration depicting the translational and rotational control of an actuation element according to another embodiment
- FIGS. 52 A- 52 D are schematic illustrations of the actuation assembly of FIG. 51 recruiting tissue and deploying a clip to close a defect;
- Example embodiments of the present disclosure are directed to devices and methods for recruiting tissue.
- Various embodiments of devices and systems for recruiting tissue are disclosed herein, and any combination of these options can be made unless specifically excluded.
- individual components of the disclosed devices and systems can be combined unless mutually exclusive or otherwise physically impossible.
- FIGS. 1 - 2 A functional block diagram for a tissue recruiting device 100 is illustrated in FIGS. 1 - 2 .
- the tissue recruiting device 100 includes a tissue recruiting assembly 102 at a distal end, an actuation assembly 200 at a proximal end, and a catheter sheath assembly 300 disposed between the tissue recruiting assembly 102 and the actuation assembly 200 .
- the recruiting assembly 102 may include one or more tissue grasping devices 104 configured to grasp.
- the grasping devices 104 may be end effectors or devices capable of grasping tissue. It will be understood that the grasping of the grasping devices 104 encompasses grabbing, pinching, hooking, or otherwise securing tissue with the grasping devices 104 .
- the tissue recruiting device 100 has two grasping devices 104 each coupled with an actuation element 208 .
- the device 100 may have other assemblies and configurations.
- the tissue recruiting assembly 102 may have one or three or more grasping devices 104 and the actuation elements 208 may be coupled to two or more grasping devices 104 .
- the catheter sheath assembly 300 includes one or more catheters 302 operably connected to the distal end of the actuation assembly 200 .
- the tissue grasping devices 104 and the actuation elements 208 may extend through one or more lumens of the one or more catheters 302 .
- the proximal ends of the actuation elements 208 may extend through the proximal end of the catheters 302 to operably couple with other components of the actuation assembly 200 , as described below.
- the one or more catheters 302 may be sized, shaped, and configured such that each grasping device 104 may be distally extended beyond the distal end of the one or more catheters 302 via the actuation elements 208 extending therethrough.
- the catheter sheath assembly 300 is flexible to allow for adequate endoscope maneuverability without compromising the purchase of the tissue recruiting assembly 102 , such as the purchase of the tissue recruiting assembly 102 has on multiple edges of a tissue defect.
- the one or more catheters 302 comprise polyether ether-ketone (PEEK), a thermo-plastic material, nylon, Pellethane, polytetrafluoroethylene (PTFE), polyimide, composite metal and polymer tubing, metal tubing, metal coils, or similar constructions known in the art, or combinations thereof.
- the catheters 302 are metal spring sheaths configured to resist compression and operational forces exerted on the catheters 302 by the actuation elements 208 and/or operational elements as described below.
- catheter sheath assembly 300 of FIGS. 3 - 4 is shown as including two support wires 310 on the top and the bottom of the catheter 302 , it will be understood that the catheter sheath assembly 300 may have other assemblies and configurations.
- the catheter sheath assembly 300 may include one support wire 310 underneath the catheter 302 , one support wire 310 above the catheter 302 , or three or more support wires 310 disposed at various locations around the outer surface of the catheter 302 .
- the device 100 may be configured to recruit tissue across large defects, such as tissue defects greater than 1 cm or tissue defects greater than 3 cm. In some embodiments, the device 100 is configured to recruit tissue across defects greater than 10 cm in diameter. Additionally, the device 100 may be configured to simultaneously recruit multiple sides of a defect, such as to achieve more consistent and circumferential closure of defects.
- the device 100 can be used with any suitable or conventional endoscope or laparoscopic surgical equipment.
- the device 100 is described in the context of use with an endoscope/colonoscope/sigmoidoscope type apparatus of conventional or suitable construction.
- the device may also be used in other manners, such as in any minimally invasive procedure with a suitable natural or artificially created orifice in the body.
- the scope is provided with an elongated body having a controllably flexible projecting end region.
- Surgical instruments, such as the device 100 may be introduced through an instrument channel, such as an accessory channel, which extends through the scope body, for recruiting tissue targeted by the surgeon manipulating the scope.
- the grasping devices 104 may be sized, shaped, and configured such that all the grasping devices 104 may be disposed through the same instrument or accessory channel of the endoscope.
- the actuation elements 208 are operably disposed through one or more sheaths 304 disposed between the actuation elements 208 and the catheter 302 .
- Each actuation element 208 may extend through a separate sheath 304 or the actuation elements 208 may extended through a single sheath 304 , such as a single sheath 304 with two lumens or a sheath 304 with a single lumen.
- the one or more sheaths 304 may cover the actuation elements 208 , as well as any additional control or operational elements, as they are extended through the endoscope and/or the catheter 302 .
- the sheaths 304 may be configured to reduce friction between the actuation elements 208 and/or between the actuation elements 208 and the catheter 302 .
- the sheaths 304 may also be configured to prevent the actuation elements 208 from tangling within the catheter 302 .
- the sheaths 304 may be implemented in embodiments in which the actuation elements 208 are disposed through a single catheter 302 .
- the one or more sheaths 304 may be a spring sheath, a reinforced composite sheath, and/or a tubing, such as a polymer tubing and/or hypotubing.
- each sheath 304 may be operably connected or otherwise coupled with the actuation assembly 200 .
- the distal end of each sheath 304 may extend toward the respective grasping device 104 .
- the sheaths 304 may be sized, shaped, or configured to accommodate the actuation elements 208 therethrough.
- the sheaths 304 may be hollow to at least partially cover the actuation element 208 .
- the sheaths 304 may also be sized, shaped, or configured to accommodate the operational element therethrough.
- the grasping device 104 may include distal jaws normally disposed in a closed position, such as by a spring or other biasing element, and the distal movement of the operational element 290 relative to the grasping device 104 may open the jaws.
- the jaws When the operational element 290 is retracted relative to the grasping device 104 the jaws may move back to the closed position, such as to grasp tissue.
- the device 100 includes an operational element 290 disposed through one of the actuation elements 208 .
- the device 100 may have other configurations and assemblies.
- the device 100 may not include an operational element 290 or an operational element 290 may be disposed through or alongside each of the actuation elements 208 .
- the actuation assembly 200 may include first or translational control actuators 230 a operable to control the linear or translational position of one of the actuation elements 208 , second or rotational control actuators 230 b operable to control the rotational position of one of the actuation elements 208 , and operational control actuators 230 c operable to control the linear or translational position of one of the operational elements 290 .
- an operator may use the translational and rotational control actuators 230 a , 230 b to control the translational and rotational position of the grasping devices 104 via the actuation elements 208 , such as to deploy the grasping devices 104 at the desired location.
- an operator may also use the operational control actuators 230 c to control the operation of the grasping devices 104 via the operational elements 290 , such as to open and/or close the grasping devices 104 to grasp tissue.
- the actuation assembly 200 includes two translational control actuators 230 a , two rotational control actuators 230 b , and one operational control actuator 230 c .
- the actuation assembly 200 may have other suitable configurations and assemblies.
- the actuation assembly 200 may include any suitable number of translational control actuators 230 a , rotational control actuators 230 b , and operational control actuators 230 c.
- each translational control actuator 230 a is disposed near a proximal end of one of the actuation elements 208 proximally from the body 202 and each rotational control actuator 230 b is disposed at the proximal end of one of the actuation elements 208 proximally from the translational control actuator 230 a .
- Each translational control actuator 230 a may be translationally fixed to the respective actuation element 208 such that translational movement of the translational control actuator 230 a translates to translational movement of the actuation element 208 .
- the actuation element 208 may be rotationally decoupled from the translational control actuator 230 a such that the actuation element 208 may rotate independently from the translational control actuator 230 a .
- the translational control actuator 230 a may be depressed or otherwise moved toward the body 202 , such as by a user, to distally extend the actuation element 208 and thereby position the grasping device 104 .
- the rotational control actuator 230 b may be rotationally coupled with the respective actuation element 208 such that rotational movement of the rotational control actuator 230 b translates to rotational movement of the actuation element 208 .
- the rotational control actuator 230 b may be rotated, such as by a user, to rotate the actuation element 208 and thereby rotate the grasping device 104 .
- the rotational control actuator 230 b may be rotated independently from the translational control actuator 230 a.
- the operational control actuator 230 c may be coupled with the operational element 290 via a biasing element such that the operational control actuator 230 c returns to the unactuated position when a user releases the operational control actuator 230 c , thereby retracting the operational element 290 .
- the actuation assembly 200 may have other suitable shapes, assemblies, and configurations.
- the operational control actuator 230 c may be disposed a different side of the body 202 from the other control actuators 230 a , 230 b , one or more of the control actuators 230 may be disposed along the body 202 , the translational control actuators 230 a may not be aligned with the rotational control actuators 230 b , and/or the translational and rotational control actuators 230 a , 230 b may be coupled to the respective grasping device 104 via separate actuation elements 208 .
- the actuation assembly 200 may be operated, such as by a user, to control the tissue recruiting assembly 102 , such as to recruit tissue with one or more grasping devices 104 .
- the grasping devices 104 may be disposed through a distal end of an endoscope (not shown) and the catheter sheath assembly 300 .
- the actuation assembly 200 may be operated by a user at a proximal end of the endoscope via the actuation elements 208 and/or operational elements 290 extending through a channel located within and extending through the endoscope.
- the endoscope and/or the grasping devices 104 may be inserted through the subject such that the grasping devices 104 are disposed in a desired position, such as above an identified defect.
- Each grasping device 104 may be moved via the respective translational control actuator 230 a , rotated via the respective rotational control actuator 230 b , and/or actuated by the respective operational control actuator 230 c to grasp the tissue.
- a user may control the position of the grasping device 104 by positioning the distal end of the endoscope and sliding or otherwise moving the translational control actuator 230 a to extend and/or retract the actuation element 208 .
- the user may control the rotation of the grasping device 104 by rotating the respective rotational control actuator 230 b .
- the user may also control the operation of the grasping device 104 , such as the opening and closing of the grasping device 104 , by engaging and disengaging the operational control actuator 230 c .
- the actuation assembly 200 may be used to recruit the grasped tissue proximally, such as to close a defect or to appose two sides of a defect such that a hemostatic device may be used to close the defect, such as by proximally retracting the translational control actuators 230 a.
- one of the grasping devices 104 may be deployed to engage tissue on a first side of the defect.
- the endoscope, the catheter 302 , and/or the actuation element 208 may be manipulated such that the first grasping device 104 a is oriented to face the first side of the identified defect.
- the actuation element 208 a coupled with the first grasping device 104 a may be translated and rotated, such as via one of the translational control actuators 230 a and one of the rotational control actuators 230 b of the actuation assembly 200 , such that the first grasping device 104 a engages and grasps the tissue on the first side of the defect.
- the second grasping device 104 b may be deployed to engage tissue on a second side of the defect.
- the endoscope, the catheter 302 , and/or the second actuation element 208 b may be manipulated such that the second grasping device 104 b is oriented to face the second side of the identified defect.
- the second grasping device 104 b may be independently controlled or operated from the first grasping device 104 a to grasp tissue on the second side of the defect.
- the second actuation element 208 b may be translated and rotated, such as via one of the translational control actuators 230 a and one of the rotational control actuators 230 b of the actuation assembly 200 , such that the second grasping device 104 b engages and grasps the tissue on the second side of the defect.
- the independent operation of the second grasping device 104 b may permit the tissue recruiting device 100 to extend beyond the limits of standard recruiting devices to treat and close larger defects.
- the flexibility of the tissue recruiting assembly 102 such as the actuation elements 208 , and the independent operation of the grasping devices 104 may permit the device 100 to treat and close larger defects than standard recruiting devices.
- the second grasping device 104 b may also be operated by an operational element 290 , such as via one of the operational control actuators 230 c of the actuation assembly 200 , to grasp the tissue.
- the first grasping device 104 a may remain deployed to grasp tissue on the first side of the defect as the second grasping device 104 b is deployed to grasp tissue on the second side of the defect.
- the device 100 has been described as deploying two grasping devices 104 a , 104 b to grasp tissue, it will be understood that more than two grasping devices 104 may be deployed on multiple sides of the defect.
- the device 100 may include more than two grasping devices 104 or more grasping device 104 may be loaded into the device 100 to be subsequently deployed after the first two grasping devices 104 a , 104 b are deployed to grasp tissue.
- one or both grasping devices 104 a , 104 b may be retracted by proximally retracting the one or more respective actuation elements 208 a , 208 b to recruit the grasped tissue.
- one or both of the translational control actuators 230 a may be actuated to proximally retract the actuation elements 208 a , 208 b .
- the grasping devices 104 a , 104 b may continue to grasp the tissue as the grasping devices 104 are retracted.
- the retraction of one or both grasping devices 104 a , 104 b may substantially close the defect or appose the sides of the defect so that a hemostatic device may be deployed to close the defect.
- the grasping devices 104 a , 104 b may be retracted into a locked position such that the grasping devices 104 a , 104 b are substantially fixed relative to the catheter 302 .
- a tissue closure mechanism such as a cinch or clip, may be disposed around the recruited tissue to treat and/or substantially close the defect.
- the tissue closure mechanism may be deployed around the grasping devices 104 a , 104 b grasping tissue.
- the tissue recruiting assembly 102 may be used with an over-the-scope (OTS) clip or a through-the-scope (TTS) clip to close the defect.
- OTS over-the-scope
- TTS through-the-scope
- the grasping devices 104 may retract and recruit tissue into the OTS housing.
- the grasping devices 104 may recruit the tissue into the distal end of the catheter 302 .
- the OTS clip may be released (deployed) via the actuation assembly 200 or may be released via a separate controller.
- the grasping devices 104 and/or the actuation elements 208 may be decoupled or otherwise disengaged from the tissue.
- the operational element 290 may be actuated to open the grasping device 104 to release the tissue.
- the grasping devices 104 and/or the actuation elements 208 may be withdrawn or otherwise retracted from the closed defect.
- the grasping devices 104 may be end effectors capable of grasping target tissue, such as via one or more actuation elements 208 and/or one or more operational elements 290 .
- the tissue recruiting assembly 102 includes a first grasping device 104 a having a plurality of helical coils 114 extending in a spiral or corkscrew manner and a second grasping device 104 b having at least one movable jaw 113 .
- the helical coils 114 of the first grasping device 104 a may be configured to grasp tissue as the first grasping device 104 a is spiraled or screwed into the tissue.
- the movable jaw 113 of the second grasping device 104 b may be opened and closed to grasp tissue.
- the grasping devices 104 a , 104 b may be operated via the actuation assembly 200 of FIGS. 1 - 2 .
- the second grasping device 104 b may be operated via a second actuation element 208 b and an operational element 290 .
- the second actuation element 208 b may translate and rotate the second grasping device 104 b , such as via the actuation assembly 200 , such that the second grasping device 104 b is properly positioned above target tissue.
- the operational element 290 may be distally extended, such as by actuation of the operational control actuator 230 c , such that the second grasping device 104 b grasps tissue, such as tissue on the other side of a defect from the first grasping device 104 a .
- the distal extension of the operational element 290 may rotate the movable jaw 113 about a pivot such that the movable jaw 113 opens to grasp tissue.
- first grasping device 104 a with helical coils 114 operable by one actuation element 208 a and a second grasping device 104 b with a movable jaw 113 operable by an actuation element 208 b and an operational element 290
- the device 100 may have other assemblies and configurations.
- the tissue recruiting device 100 includes an actuation assembly 200 according to one embodiment configured to independently maneuver and operate the one or more grasping devices 104 .
- the actuation assembly 200 is operable to control the position and rotation of the grasping device 104 , such as to grasp tissue with the grasping device 104 .
- the actuation assembly 200 may also be configured to actuate or otherwise control the operation of each grasping device 104 , such as to open and close the grasping device 104 to grasp tissue.
- the actuation assembly 200 may be operable to independently control two grasping devices 104 , such as grasping devices 104 with helical coils 114 (e.g., FIG. 18 ), to independently grasp tissue at different locations, such as on opposite sides of a defect.
- the actuation assembly 200 includes a body 202 extending from a proximal end 204 to a distal end 206 .
- the body 202 may be sized, shaped, and configured such that the body 202 may be comfortably grasped in the hand of a user.
- the body 202 of the actuation assembly 200 is substantially cylindrical with a narrowed distal portion.
- the body 202 may be other shapes and configurations suitable for a user to grasp during operation.
- the device 100 has been described as grasping opposite sides of a defect, it will be understood that tissue may be grasped at other locations.
- the device 100 may be used to grasp tissue in the center of a defect.
- the actuation assembly may also include a cover 228 configured to be at least partially disposed around the body 202 .
- the cover 228 may be sized, shaped, and configured such that the cover 228 may be comfortably grasped in the hand of a user.
- the cover 228 is configured to retain the first and second halves 202 a , 202 b of the body 202 together when the cover 228 is disposed around the body 202 .
- the proximal end of the cover 228 may be substantially open or hollow such that the cover 228 may be slid over the body 202 and such that the actuation elements 208 may be manipulated, such as described below.
- FIGS. 12 - 14 show the body 202 with the second half 202 b removed.
- the body 202 includes a first channel 210 extending the length of the body 202 from the proximal end 204 to the distal end 206 .
- the body 202 also includes a second channel 214 extending the length of the body 202 from the proximal end 204 to the distal end 206 .
- the first and second channels 210 , 214 are each configured to receive one of the actuation elements 208 .
- the first and second channels 210 , 214 are disposed substantially equidistant to the middle of the body 202 with the first channel 210 mirroring the second channel 214 .
- the first and second channels 210 , 214 may each include a first portion 218 extending distally from the respective proximal opening 212 , 216 .
- the first portions 218 of the first and second channels 210 , 214 may extend substantially straight from the respective proximal opening 212 , 216 .
- the first and second channels 210 , 214 may each also include a second portion 220 extending distally from the first portion 218 .
- the second portions 220 of the first and second channels 210 , 214 may be curved or otherwise angled such that the distal ends of the first and second channels 210 , 214 are disposed adjacent to each other at the distal end 206 of the body 202 .
- the first portions 218 of the first and second channels 210 , 214 may have a width larger than a width of the second portions 220 .
- the second portions 220 of the channels 210 , 214 may be sized to receive one of the actuation elements 208 therethrough and the first portions 218 may be sized to receive one of the actuation elements 208 and an additional component, such as an actuation sheath, therethrough.
- the second portions 220 of the first and second channels 210 , 214 may terminate at a distal opening 222 .
- the distal opening 222 may be sized, shaped, and configured such that actuation elements 208 may extend from each of the first and second channels 210 , 214 through the distal opening 222 . While the body 202 has been described as including a single distal opening 222 , it will be understood that the body 202 may include a distal opening 222 for each channel 210 , 214 .
- Each control actuator 230 may also have a width larger than the proximal openings 212 , 216 such that abutment between the control actuator 230 and the proximal end 204 of the body 202 may prevent the proximal end of the respective actuation element 208 from being extended distally into the body 202 .
- the control actuators 230 are substantially elongated hexagons.
- the elongated hexagonal shape of the control actuators 230 may allow a user to grip and rotate the control actuators 230 , such as between a finger and a thumb, and also still feel comfortable and round to a user.
- the control actuators 230 may have any suitable shape.
- the control actuators 230 may be circular, ovular, elliptical, triangular, rectangular, oblong, or other suitable shape.
- the actuation assembly 200 has been described as having two channels 210 , 214 and two control actuators 230 , it will be understood that the actuation assembly 200 may have other suitable configurations.
- the actuation assembly 200 may have one or three or more channels and one or three or more control actuators 230 , such as corresponding to the number of grasping devices 104 .
- the actuation assembly 200 may also include an actuation sheath 224 disposed around the proximal end of each actuation element 208 and coupled with the respective control actuator 230 .
- the actuation sheaths 224 may be configured to assist in the control of the grasping device 104 during operation.
- the actuation sheath 224 may limit the translational actuation distance of the grasping device 104 and/or may assist in transferring torque from the control actuator 230 to the actuation element 208 .
- the actuation sheaths 224 may have an outer diameter sized to allow the actuation sheaths 224 to translate and rotate within the first portions 218 of the channels 210 , 214 .
- the actuation sheaths 224 may also have an outer diameter which prevents the actuation sheaths 224 from translating into the second portions 220 of the channels 210 , 214 , thereby providing a limit to the actuation distance of the actuation elements 208 .
- the first portion 218 of the channels 210 , 214 and/or the actuation sheaths 224 may have a length corresponding to the desired translational actuation distance of the actuation elements 208 and the grasping devices 104 .
- the proximal openings 212 , 216 have a narrower diameter than the first portions 218 of the channels 210 , 214 .
- the proximal openings 212 , 216 may be sized such that the actuation sheaths 224 (or actuation element 208 in embodiments without actuation sheaths 224 ) may translate and rotate within the channels 210 , 214 .
- the narrower size of the proximal openings 212 , 216 may center the actuation sheath 224 and/or the actuation element 208 in the channel 210 , 214 such that the actuation element 208 and/or actuation sheath 224 is spaced apart from the walls of the channels 210 , 214 .
- the reduced contact with the walls of the channel 210 , 214 may reduce the friction between the channels 210 , 214 and the actuation sheaths 224 and/or actuation elements 208 .
- the narrower proximal openings 212 , 216 may also help ensure that the actuation element 208 and/or actuation sheath 224 stays in the channel 210 , 214 .
- the actuation sheaths 224 may each be a substantially hollow tube with an inner diameter configured to permit the proximal end of the actuation element 208 to extend therethrough.
- Each actuation sheath 224 may comprise stainless steel.
- the actuation sheaths 224 comprise polyetheretherketone (PEEK), high density polyethylene (HDPE), low density polyethylene (LDPE), or ultra high molecular weight polyethylene (UHMW), polycarbonate (PC), acrylonitrile butadiene styrene (ABS), acrylic, a composite structure of these materials, or other suitable materials that allow for adequate stiffness for actuation, or combinations thereof.
- PEEK polyetheretherketone
- HDPE high density polyethylene
- LDPE low density polyethylene
- UHMW ultra high molecular weight polyethylene
- PC polycarbonate
- ABS acrylonitrile butadiene styrene
- acrylic a composite structure of these materials, or other suitable materials that allow for adequate stiffness for
- proximal ends of the actuation element 208 and the actuation sheath 224 may be fixed to the control actuator 230 such that the actuation element 208 and actuation sheath 224 each translate and rotate with the translation and rotation of the control actuator 230 .
- the proximal end of the actuation element 208 is molded into the respective actuation sheath 224 .
- each control actuator 230 includes a bore 232 extending proximally into the distal end of the control actuator 230 .
- the bore 232 may be configured to receive the proximal ends of the actuation element 208 and the actuation sheath 224 .
- the bore 232 may have a shape and a diameter substantially corresponding to the outer surface of the actuation sheath 224 .
- the proximal ends of the actuation sheath 224 and the actuation element 208 may be fixed to the inner surface and/or a proximal end of the bore 232 to couple the control actuator 230 with the actuation sheath 224 and the actuation element 208 .
- control actuator 230 and actuation sheaths 224 have been described as separate components, it will be understood that the control actuators 230 and actuation sheaths 224 may be integrated into a single component (e.g., FIGS. 38 A- 38 B ).
- the actuation element 208 extends through the actuation sheath 224 in a non-linear manner.
- the actuation element 208 may meander in the actuation sheath 224 in an up and down and left and right manner such that the actuation element 208 is prevented or otherwise restricted from being retracted from the actuation sheath 224 .
- the non-linear extension of the actuation element 208 through the actuation sheath 224 may further secure the actuation element 208 in the actuation sheath 224 .
- the actuation sheath 224 may include one or more abutments 226 disposed within the interior of the actuation sheath 224 which cause the actuation element 208 to form a non-linear position when inserted into the actuation sheath 224 and/or which prevent or otherwise restrict the actuation element 208 from being linearly retracted from the actuation sheath 224 .
- the actuation sheath 224 may not include abutments 226 and the actuation element 208 may be molded into the actuation sheath 224 in a non-linear manner, such as via the use of core pins which are removed after the molding process.
- one or more actuation elements 208 may have a non-circular cross-section, such as to reduce friction between the actuation element 208 between the catheter 302 and/or the sheath 304 .
- the actuation elements 208 may have a cross-section which decreases the surface area of the actuation element 208 in contact with the catheter 302 and/or sheath 304 , such as during operation of the device 100 .
- the actuation element 208 has a substantially rectangular cross-section that is twisted.
- the actuation element 208 may have other shapes to decrease the friction between the catheter 302 and/or the sheath 304 .
- the actuation element 208 may be ovular, elliptical, triangular, hexagonal, D-shaped, crescent-shaped, pie-shaped, grooved, or other suitable shape.
- the actuation element 208 may also be twisted to further decrease the frictional contact between the actuation element 208 and the catheter 302 and/or the sheath 304 . It will be understood that the twisting of the actuation element 208 also encompasses actuation elements 208 with helical and spiraled profiles. The twist of the actuation element 208 may also make it easier for a user to identify that the actuation element 208 is turning. Further, the twist of one of the actuation elements 208 may help a user identify which actuation element 208 is being operated. For example, as shown in FIG.
- a first actuation element 208 a with a rectangular cross-section that is twisted along the length of the actuation element 208 a is coupled with a first grasping device 104 a and a second actuation element 208 b with a substantially circular cross-section is coupled with a second actuation element 104 a .
- the difference in shapes between the first and second actuation elements 208 a , 208 b may assist a user in identifying which actuation element 208 a , 208 b and which grasping device 104 a , 104 b is being operated, such as via the actuation assembly 200 .
- the catheter 302 may be configured to increase the compressive resistance of the catheter 302 during operation.
- the catheter 302 may be a spring sheath wound into a spiraled coil with a plurality of compressions 303 disposed along the length of the catheter 302 .
- the compressions 303 may be formed by winding the coil into a narrower spiral at predetermined intervals along the length of the catheter 302 .
- the catheter 302 may also include a plurality of struts 305 extending across the cross-section of the catheter 302 at predetermined intervals.
- the struts 305 may be formed by bending the coil across the cross-section of the catheter 302 which may create the compressions 303 .
- the struts 305 may be substantially aligned such that the struts 305 separate the catheter 302 , such as into lumens, such as to prevent the actuation elements 208 from tangling during operation.
- the struts 305 may define pseudo-lumens extending through the catheter 302 .
- only the distal coil of the catheter 302 is bent to form a strut 305 , such as to separate the actuation elements 208 at the distal end of the device 100 and prevent the actuation elements 208 from tangling during operation.
- the actuation assembly 200 may be operable with two grasping devices 104 with helical coils 114 configured to be spiraled into tissue to grasp the tissue.
- the actuation assembly 200 includes a first control actuator 230 a coupled with a first actuation sheath 224 a and a first actuation element 208 a to control the operation of a first grasping device 104 a .
- the actuation assembly 200 also includes a second control actuator 230 b coupled with a second actuation sheath 224 b to control the operation of a second actuation element 208 b .
- the actuation assembly 200 may be moved from an unactuated configuration to an actuated configuration.
- the control actuators 230 of the actuation assembly 200 may be manipulated, such as by a user, to control the translation and rotation of the actuation elements 208 as the actuation assembly 200 is moved from the unactuated position to the actuated position.
- the control actuators 230 may be independently operated, such as to independently control grasping devices 104 to grasp target tissue.
- the control actuators 230 may be independently operated to translate and rotate the first and second actuation elements 208 a , 208 b such that the helical coils 114 of the first and second grasping devices 104 a , 104 b ( FIG. 18 ) spiral into tissue to securely grasp the tissue.
- the first actuation sheath 224 a may control the translational distance of the first actuation element 208 a and the grasping device 104 .
- the first actuation sheath 224 a may be sized, shaped, or configured such that the actuation sheath 224 may translate and rotate within the first portion 218 of the first channel 210 and such that the first actuation sheath 224 a is prevented from translating into the second portion 220 of the first channel 210 .
- the first actuation sheath 224 a may have an outer diameter larger than the diameter of the second portion 220 of the first channel 210 .
- the narrower diameter of the second portion 220 may prevent the first actuation sheath 224 a from being distally extended beyond the first portion 218 of the first channel 210 .
- the abutment of the distal end of the first actuation sheath 224 and the proximal end of the second portion 220 of the first channel 210 may prevent further distal movement of the first actuation sheath 224 and the first actuation element 208 a , such as to control the linear actuation distance of the first control actuator 230 a , thereby controlling the translational movement of the grasping element 104 a.
- the actuation assembly 200 may be moved from the partially actuated position to the fully actuated position. While the actuation assembly 200 is in the partially actuated position, the endoscope and/or the catheter sheath assembly 300 may be manipulated such that the second grasping device 104 b is substantially aligned with a second location, such as the second side of the defect. The first grasping device 104 a may remain in grasping engagement at the first location (e.g., the first side of the defect). The second control actuators 230 b may be actuated to move the second grasping device 104 b to grasp the target tissue at the second location.
- the second control actuator 230 b may be depressed and/or rotated, such as by a user, to translate and rotate the second actuation element 208 b .
- the second control actuator 230 b may be depressed and rotated to translate and rotate the actuation element 208 b such that the second grasping device 104 b ( FIG. 18 ) spirals into and grasps tissue on the second side of the defect.
- the second actuation sheath 224 b may also be sized, shaped, and configured to control the linear actuation distance of the second control actuator 230 b via abutment with the proximal end of the second portion 220 of the second channel 214 , similarly to the first actuation sheath 224 a.
- the second control actuator 230 b may be actuated to deploy the second grasping device 104 b before the first grasping device 104 a is deployed, the first and second control actuators 230 a , 230 b may be operated substantially simultaneously, or one or both of the control actuators 230 a , 230 b may be operated in reverse to detach the grasping devices 104 a , 104 b , such as if the grasping device 104 a , 104 b was not properly deployed, in which case, the control actuator 230 a , 230 b may be subsequently actuated to maneuver the grasping device 104 a , 104 b to grasp or otherwise reacquire tissue.
- the actuation assembly 200 may be operated to release the grasp of one or both of the grasping devices 104 from the tissue, such as if one or both of the grasping device 104 a , 104 b are improperly disposed or positioned in tissue. If it is determined that one or both of the grasping devices 104 a , 104 b are improperly positioned, the control actuators 230 a , 230 b may be manipulated, such as by a user, to release the grasp of the one or more grasping devices 104 a , 104 b on the tissue.
- the respective control actuator 230 may be proximally retracted from the body 202 such that the grasping devices 104 are retracted from the tissue and/or the control actuator 230 may be rotated such that the grasping devices 104 are released from the tissue.
- the control actuator 230 may be rotated in the direction opposite from the direction that the control actuator 230 is rotated to engage tissue.
- the actuation assembly 200 may be operated to recruit the grasped tissue, such as to deploy a closure mechanism.
- the control actuators 230 may be translated proximally such that the actuation elements 208 and the grasping devices 104 are retracted toward the actuation assembly 200 .
- the control actuators 230 may be retracted back to the unactuated position ( FIG. 19 A ).
- the retraction of the actuation elements 208 and the grasping devices 104 may recruit the grasped tissue toward the catheter 302 .
- a closure mechanism such as a clip, may be disposed around the recruited tissue, such as to close the defect.
- the biasing element 234 may exert a biasing force on each of the actuation elements 208 to prevent or otherwise restrict the actuation element 208 from translating and rotating within the respective channel 210 , 214 .
- the biasing element 234 is configured to maintain the control actuators 230 in a desired position.
- the biasing element 234 may be an additional element or may form a portion of the body 202 .
- the body 202 includes a biasing element receiving portion 236 configured to receive the biasing element 234 .
- the biasing element receiving portion 236 may be disposed substantially between the channels 210 , 214 near the proximal end 204 of the body 202 .
- the biasing element receiving portion 236 may be a recess extending into the adjacent faces of the first and second halves 202 a , 202 b of the body 202 .
- the biasing element receiving portion 236 may be sized, shaped, and configured to receive the biasing element 234 in a normal or unbiased position such that the lateral sides of the biasing element 234 extend into each of the channels 210 , 214 .
- the biasing element receiving portion 236 may also be sized, shaped, and configured to permit the biasing element 234 to depress or otherwise conform when the actuation element 208 and/or the actuation sheath 224 is extended through the channel 210 , 214 such that the biasing element 234 may exert a biasing force on the actuation element 208 and/or the actuation sheath 224 .
- the biasing element receiving portion 236 may also retain the biasing element 234 such that the biasing element 234 is held in place at a proximal portion of the body 202 and prevents the biasing element 234 from moving around in the body 202 .
- the actuation assembly 200 also includes a cap 238 configured to be inserted or otherwise disposed in the proximal end 204 of the body 202 .
- the cap 238 may be configured to couple the first and second halves 202 a , 202 b of the body 202 together.
- the cap 238 may also leave space in the body 202 for the biasing element 234 to be inserted after the halves 202 a , 202 b have been locked together, such as for ease of manufacturing. As shown in FIGS.
- the cap 238 may include prongs 240 extending distally with flanges or projections which engage with detents in the proximal ends of the first and second halves 202 a , 202 b .
- the prongs 240 may couple with the detents of the first and second halves 202 a , 202 b to couple the first and second halves 202 a , 202 b together.
- the cap 238 may also close the proximal end 204 of the body 202 and assist in aligning the actuation elements 208 .
- the cap 238 includes a cutout 242 on each side of the cap 238 . Each cutout 242 may define an edge or side of one of the proximal openings 212 , 216 .
- the cap 238 may abut or otherwise contact the biasing element 234 such that the biasing element 234 remains in the desired position within the body 202 , such as in the biasing element receiving portion 236 .
- the cap 238 may abut the biasing element 234 such that the biasing element 234 remains in position within the body 202 when the biasing element 234 moves between the relaxed position and the biasing position.
- the cap 238 may include a ledge 244 extending between the prongs 240 and defining a space, such as a slot, between the ledge 244 and the proximal end of the cap 238 .
- the proximal end of the biasing element 234 may include projections extending radially inwardly toward a center of the body 202 and separated by a gap.
- the radially inward projections of the biasing element 234 may extend around the ledge 244 and into the gap between the ledge 244 and the proximal portion of the cap 238 .
- the disposition of the projections of the biasing element 234 in the gap of the cap 238 may maintain the biasing element 234 in the biasing element receiving portion 236 as the biasing element 234 is moved between the relaxed position and the biasing position, such as to ensure the radially inward projections of the biasing element 234 are in a bent position to maintain the shape of the biasing element 234 .
- the actuation sheaths 224 may include a groove or narrowed portion 246 near the distal end of the actuation sheath 224 .
- the narrowed portion 246 may be a rounded or grooved channel extending circumferentially around a distal portion of the actuation sheath 224 and extending radially inwardly from the remainder of the outer surface of the actuation sheath 224 .
- the actuation sheaths 224 may be inserted into the first and second channels 210 , 214 with the narrowed portion 246 of each actuation sheath 224 disposed adjacent to the biasing element 234 .
- the disposition of the narrowed portion 246 adjacent to the biasing element 234 may permit the biasing element 234 to move to its relaxed state, such as when the device 100 is packaged.
- the narrowed portion 246 may also be disposed a predetermined distance from the control actuator 230 , such as a distance from the control actuator 230 corresponding to the starting or undeployed position of the grasping devices 104 .
- the actuation elements 208 may include a similar narrowed portion 246 .
- the actuation assembly 200 has been described as including a single, leaf spring biasing element 234 disposed in the biasing element receiving portion 236 , it will be understood that the actuation assembly 200 may have other suitable configurations and assemblies to maintain the translational and/or rotational positions of the actuation elements 208 and/or actuation sheaths 224 extending through the channels 210 , 214 .
- the biasing element 234 may be a helical spring, a coil spring, a worm gear, or an assembly thereof, or other device configured to exert a biasing force on the one or more actuation elements 208 and/or actuation sheaths 224 or may be a portion of the body 202 , as described below.
- actuation assembly 200 has been described as including a single biasing element 234 configured to exert a biasing force on each of the actuation elements 208 , it will be understood that the actuation assembly 200 may include one or more biasing elements 234 configured to exert a biasing force on one or more actuation elements 208 .
- the actuation assembly 200 may also include one or more biasing elements 234 configured to prevent accidental operation of the actuation assembly 200 and/or to return the control actuator 230 to the starting position, such as to recruit the grasped tissue toward the catheter 302 .
- the actuation assembly 200 includes a biasing element 234 disposed around each actuation element 208 between the proximal end 204 of the body 202 and the distal end of the respective control actuator 230 .
- the biasing elements 234 may be helical springs disposed around the actuation elements 208 such that the actuation elements 208 may rotate within the biasing elements 234 .
- the biasing elements 234 may space the control actuators 230 from the proximal end 204 of the body 202 such that the grasping devices 104 are substantially disposed in the undeployed position. As the control actuators 230 are manipulated to control the position and rotation of the actuation element 208 and the grasping device 104 , the biasing elements 234 may compress such that the grasping devices 104 may be deployed to grasp tissue.
- the actuation assembly 200 may include other configurations and assemblies for maintaining the position and rotation of the actuation elements 208 , such as when the user releases the control actuators 230 .
- the biasing element 234 may be one or more biasing projections 248 of the body 202 extending laterally into or across one of the channels 210 , 214 . Each biasing projection 248 may extend laterally from an outer portion of the body 202 at least partially across one of the channels 210 , 214 .
- the biasing projections 248 may be molded or cut into the body 202 , such as into the halves 202 a , 202 b .
- the biasing projections 248 may be connected to the body 202 laterally beyond the respective channel 210 , 214 and may extend medially (e.g., laterally inwardly) into the respective channel 210 , 214 .
- Each biasing projection 248 may be pivotable from a normal or relaxed position in which the biasing projection 248 pivots upwardly into the channel 210 , 214 and a flexed position in which the biasing projection 248 pivots downwardly such that the biasing projection 248 is disposed below the remainder of the channel 210 , 214 .
- the biasing projections 248 may be biased or otherwise configured to normally project radially inwardly in the channels 210 , 214 to engage the actuation element 208 and/or actuation sheath 224 disposed through the respective channel 210 , 214 .
- the top surface of the biasing projection 248 includes an engagement portion configured to engage the outer surface of the actuation element 208 and/or actuation sheath 224 disposed in the channel 210 , 214 .
- the biasing projections 248 When the biasing projections 248 engage with the actuation elements 208 and/or the actuation sheaths 224 , the biasing projections 248 may exert a compressive and/or frictional force on the actuation elements 208 , thereby preventing or otherwise restricting the actuation elements 208 and/or the actuation sheaths 224 from translating and/or rotating.
- the biasing projections 248 have a surface that is sized, shaped, or otherwise configured to correspond to the size and shape of the actuation elements 208 or the actuation sheaths 224 such that the biasing projections 248 prevent or otherwise restrict the actuation elements 208 and/or the actuation sheaths 224 from translating and/or rotating when the biasing projections 248 are engaged with the actuation elements 208 and/or the actuation sheaths 224 .
- the biasing projections 248 are configured to flex or otherwise bend radially outwardly from the channel 210 , 214 when the actuation element 208 is manipulated by a user. When the biasing projections 248 are flexed away or otherwise disengaged from the actuation element 208 , the actuation element 208 may translate and rotate within the channel 210 , 214 .
- each actuation element 208 and/or actuation sheath 224 may include one or more radially outward extending protrusions and/or one or more radially extending indents disposed along the length and around the outer surface of the proximal portion of the actuation element 208 .
- the protrusions and indents may be formed by creating grooves or channels in the actuation element 208 and/or actuation sheath 224 .
- the body 202 may correspondingly include one or more radially inward extending indents and one or more radially outward extending protrusions disposed along the length and around the inner surface of the channels 210 , 214 .
- the protrusions and/or indents of the actuation element 208 may correspond with the indents and/or protrusions of the body 202 at various positions and rotations of the actuation element 208 with respect to the body 202 .
- the interaction of the protrusions and/or indents of the actuation element 208 with the indents and/or protrusions of the body 202 may prevent or otherwise restrict the linear and rotational movement of the actuation element 208 from such a position.
- the interaction may also provide detectable feedback to a user regarding the movement of the actuation element 208 and/or actuation sheath 224 , as described below.
- the actuation assembly 200 may include one or more clamps 250 configured to prevent or otherwise restrict the translational and rotational movement of the actuation elements 208 , such as via frictional engagement with the actuation elements 208 and/or actuation sheaths 224 .
- the clamp 250 may be disposed in the body 202 between the channels 210 , 214 .
- the clamp 250 extends at least partially into each channel 210 , 214 such that the clamp 250 may contact each actuation element 208 and/or actuation sheath 224 disposed through the channels 210 , 214 .
- the clamp 250 may be sized, shaped, and configured to impart a frictional force on the actuation elements 208 and/or actuation sheaths 224 disposed through the channels 210 , 214 .
- the frictional force may be large enough such that the engagement between the clamp 250 and the actuation element 208 and/or actuation sheath 224 maintains the linear and rotational position of the actuation element 208 in the channel 210 , 214 , such as when an operator has released the control actuator 230 .
- the frictional force may also be small enough that the actuation element 208 may easily be moved and rotated within the channel 210 , 214 , such as by an operator via the control actuator 230 .
- the actuation assembly 200 may have other configurations and assemblies.
- the actuation assembly 200 may include a separate clamp 250 configured to extend into each channel 210 , 214 and/or the actuation assembly 200 may include clamps 250 disposed at two or more locations along the length of the channels 210 , 214 .
- the clamp 250 is biased to control the translation and rotation of the actuation element 208 , such as by a spring.
- the clamp 250 may be operably coupled to the proximal ends of each of the actuation elements 208 and/or actuation sheaths 224 (not shown), such as the portions of each actuation element 208 between the body 202 and the control actuator 230 , to maintain the translational and rotational position of the actuation elements 208 .
- the clamp 250 may have two or more engagement portions with each engagement portion configured to be disposed substantially around a proximal portion of one of the actuation elements 208 and/or actuation sheaths 224 .
- the engagement portions may be substantially circular with a slit configured such that the engagement portion may be disposed around the outside surface of one of the actuation elements 208 and/or actuation sheath 224 .
- the inner surface of the engagement portions may have a liner, such as an elastomer liner, configured to impart a frictional force on the respective actuation element 208 and/or actuation sheath 224 .
- the clamp 250 may maintain the rotational and translational positions of the actuation elements 208 when each engagement portion of the clamp 250 are disposed around the actuation elements 208 .
- the engagement portions may be disposed around the actuation elements 208 , such as after the actuation elements 208 have been linearly and rotationally positioned, and the clamp 250 may impart a frictional force on the actuation elements 208 sufficient to maintain the translational and rotational position of the actuation elements 208 .
- the clamp 250 may be disposed around the control actuator 230 , such as after the actuation elements 208 have been rotationally positioned, and the clamp 250 may impart a frictional force on the control actuators 230 sufficient to maintain the rotational position of the actuation elements 208 .
- the actuation assembly 200 may include a clamp 250 disposed around each actuation element 208 and/or actuation sheath 224 (not shown). Each clamp may be substantially tubular and operable to slide along the length of the actuation element 208 and/or actuation sheath 224 . During operation, the clamps 250 may be disposed between the body 202 and the respective control actuator 230 such that the control actuator 230 may be manipulated to control the translation and rotation of the actuation element 208 .
- the respective clamp 250 may be slid distally along the actuation element 208 such that the clamp 250 is partially disposed in the respective proximal opening 212 , 216 .
- the clamp 250 may be disposed between the proximal opening 212 , 216 and the actuation element 208 and/or actuation sheath 224 such that translational and rotational position of the actuation element 208 is maintained.
- the clamp 250 may wedge between the edge of the proximal opening 212 , 216 and the actuation element 208 or actuation sheath 224 such that the actuation element 208 and/or actuation sheath 224 is prevented or otherwise restricted from rotating and translating.
- the process may be repeated with the other control actuator 230 and the other clamp 250 . Additionally, either or both clamps 250 may be proximally retracted from the respective proximal opening 212 , 216 such that the actuation elements 208 may be translated and/or rotated via the respective control actuator 230 .
- the body 202 may include two clamps 250 disposed on the proximal end 204 of the body 202 on either side of the actuation elements 208 , such as near the proximal openings 212 , 216 .
- the clamps 250 may be slidable along the proximal end 204 of the body 202 between a first position in which the clamps 250 are spaced apart from the actuation elements 208 ( FIG. 34 A ) and a second position in which the clamps 250 contact the actuation elements 208 ( FIG. 34 B ).
- the actuation elements 208 When the clamps 250 are in the first position, the actuation elements 208 are relatively unconstrained and may be translated and rotated freely.
- Each clamp 250 may be independently movable, such as to independently lock either actuation element 208 .
- the clamps 250 are slidable by a user.
- the clamps 250 are biased, such as by a spring, toward the actuation elements 208 such that the clamps 250 engage the actuation elements 208 without user manipulation.
- any of the clamps 250 of FIGS. 31 - 33 may be biased, such as via a spring, to contact the actuation elements 208 and/or and apply force to the actuation elements 208 to prevent or otherwise restrict the actuation elements 208 from moving or rotating.
- the actuation assembly 200 may also include an engagement element, such as a slider, button, or the like, disposed on an outer surface of the body 202 or cover 228 and operable to engage one of the one or more clamps 250 with the actuation elements 208 and/or actuation sheaths 224 .
- the actuation assembly 200 may include an engagement element on the proximal end 204 of the body 202 and operable to laterally engage and disengage a clamp 250 around the outer surface of the respective actuation element 208 and/or actuation sheath 224 to maintain the position and rotation of the actuation element 208 .
- the channels 210 , 214 of the body 202 may be sized, shaped, and configured to impart a frictional force on the actuation elements 208 to maintain the linear and/or rotational position of the actuation elements 208 without input from a user.
- the inner surface of the channels 210 , 214 or a liner placed on the inner surface of the channels 210 , 214 may include a plurality of protrusions or teeth which impart a frictional force on the actuation elements 208 and/or actuation sheath 224 .
- the liner may be a woven wire which is disposed through the channel 210 , 214 .
- the fins may be configured to maintain the position and rotation of the actuation element 208 and/or the actuation sheath 224 until a sufficient force is provided, such as by a user, to rotate and/or translate the actuation element 208 and/or the actuation sheath 224 .
- the fins may also be configured to flip or change direction when sufficient force is applied such that the actuation elements 208 may rotate smoothly in the opposite direction.
- the actuation assembly 200 may include a lock 292 configured to operably maintain the rotation and translation of the actuation elements 208 distally from the body 202 .
- the actuation elements 208 may extend from the channels 210 , 214 and through the lock 292 .
- the lock 292 may be coupled with the body 202 and/or the cover 228 .
- the lock 292 may be movable between an unlocked position in which the actuation elements 208 may be translated and rotated through the lock 292 and a locked position in which the rotation and translation positions of the actuation elements 208 are maintained.
- the lock 292 may have a constriction opening that is operable by rotation of the lock 292 .
- the lock may be rotated from the unlocked position such that the constriction opening closes around the actuation elements 208 in the locked position such that the actuation elements 208 are prevented or otherwise restricted from rotating or translating through the lock 292 .
- the lock 292 may be squeezable or compressible to move from the unlocked position to the locked position.
- the actuation elements 208 may have a non-circular cross section such that abutment between the actuation element 208 and the biasing element 234 produces feedback, such as a click, at rotational intervals of the actuation elements 208 and/or actuation sheaths 224 , such as each time the actuation element 208 is rotated a given amount.
- the actuation element 208 may have a width in relation to the biasing element 234 that varies as the actuation element 208 is rotated within the channel 210 , 214 .
- the difference in shapes of actuation elements 208 from the channels 210 , 214 or the lumens of the catheter 302 may reduce friction between the actuation elements 208 and the channels 210 and/or the lumens of the catheter 302 , such as when the actuation elements 208 are translated and/or rotated.
- the actuation element 208 and/or the biasing element 234 may include one or more projections which produce similar feedback as the actuation element 208 is rotated a given amount.
- the feedback may correspond to a tissue engagement depth based upon the number of rotations of the grasping device 104 .
- the actuation elements 208 and the biasing element 234 may be sized, shaped, and configured such that contact between the biasing element 234 and one of the actuation elements 208 produces audible and/or tactile feedback every 90 degrees, every 180 degrees, or every 360 degrees that the actuation element 208 is rotated.
- the actuation assembly 200 may include biasing elements 234 extending into each channel 210 , 214 , such as to control the position and rotation of the actuation sheaths 224 and/or actuation elements 208 , as described above.
- the biasing elements 234 and/or actuation sheaths 224 may also be sized, shaped, and configured to produce detectable feedback when the actuation sheaths 224 are rotated at predetermined intervals.
- the biasing elements 234 are rounded, flexible portions of the body 202 which extend partially into the channels 210 , 214 to contact the actuation sheaths 224 extending therethrough.
- the biasing elements 234 may be internally molded polymer springs molded into the body 202 .
- the actuation sheaths 224 are integral with the actuation elements 208 .
- the actuation sheaths 224 may be a polymer over-molded onto the actuation element 208 .
- the actuation sheaths 224 may comprise a polymer, stainless steel, or a polymer and stainless steel composite assembly.
- the longitudinal channels 245 and biasing elements 234 are also configured such that the biasing element 234 may flex inwardly or disengage from the longitudinal channel 245 and protrusion 235 may contact the other portions of the outer surface of the actuation sheath 224 when the longitudinal channel 245 is rotated out of alignment with the biasing element 234 .
- the actuation sheaths 224 each include one longitudinal channel 245 .
- the actuation sheaths 224 may include other numbers of longitudinal channels 245 .
- the actuation sheaths 224 may include two longitudinal channels 245 on opposite sides of the actuation sheath 224 such that feedback is generated each time the control actuator 230 and actuation sheath 224 are rotated 180 degrees
- the actuation sheaths 224 may include three longitudinal channels 245 equally spaced around the actuation sheath 224 such that feedback is generated each time the control actuator 230 and actuation sheath 224 are rotated 120 degrees
- the actuation sheaths 224 may include four longitudinal channels 245 equally spaced around the actuation sheath 224 such that feedback is generated each time the control actuator 230 and actuation sheath 224 are rotated 90 degrees.
- each control actuator 230 includes an extrusion 247 extending laterally from one side of the control actuator 230 .
- the extrusions 247 may indicate the relative rotational position of the respective actuation sheath 224 , actuation element 208 , and grasping device 104 to a user, such as in relation to the user's fingers during operation.
- the extrusions 247 may be disposed on the control actuators 230 such that extrusions 247 extend up or down when the control actuators 230 , actuation sheaths 224 , actuation elements 208 , and/or grasping devices 104 are in an undeployed and unrotated position, such as the position when the device 100 is packaged.
- the extrusion 247 may rotate around the actuation sheath 224 to indicate the relative orientation of the grasping device 104 . While the extrusions 247 have been described as extending from the control actuators 230 it will be understood that the extrusions 247 may similarly extend from the side of the actuation sheath 224 .
- the actuation assembly 200 of FIGS. 38 A- 38 G has been described producing feedback regarding either rotation of the actuation element 208 or translation of the actuation element 208 , it will be understood that the actuation assembly 200 may be configured and assembled to produce feedback regarding both rotation and translation of the actuation element 208 .
- the actuation elements 208 may have varying widths or diameters at different rotational positions for producing feedback regarding rotation of the actuation element 208 and also include protrusions 252 and/or recesses 254 for producing feedback regarding translation of the actuation element 208 .
- any of the other actuation assemblies 200 described herein may include the biasing elements 234 , protrusions 235 , longitudinal channels 245 , and extrusions 247 described in FIGS. 38 A- 38 G .
- the actuation assembly 200 may include a strain relief tube 260 and a distal coupler 262 .
- the strain relief tube 260 may be disposed around the one or more catheters 302 and the actuation elements 208 .
- the strain relief tube 260 may have an inner diameter larger than the catheter 302 such that the strain relief tube 260 may be disposed around at least a proximal portion of the catheter 302 .
- the strain relief tube 260 may be operable to reduce the stress and/or strain of the catheter 302 and/or actuation elements 208 during operation, such as to prevent the catheter 302 and/or actuation elements 208 from buckling during operation.
- the distal coupler 262 is configured to couple the body 202 or the cover 228 with the catheter 302 and/or the strain relief tube 260 .
- the distal coupler 262 may be coupled to the body 202 , the cover 228 , the catheter 302 , and/or the strain relief tube 260 via adhesives, welding, fasteners, over-molding, heat staking, or the like, or combinations thereof.
- the distal coupler 262 is over-molded onto the catheter 302 and/or the strain relief tube 260 and is press-fit or snap-fit into the distal end of the cover 228 .
- the distal coupler 262 includes one or more ribs 264 .
- the proximal end of the distal coupler 262 may include a rib 264 configured to maintain the rotational and positional coupling of the cover 228 and the distal coupler 262 .
- the rib 264 may fit in a slot of the cover 228 to prevent rotation of the catheter 302 relative to the body 202 and cover 228 .
- the distal end of the distal coupler 262 may also include one or more ribs 264 configured to increase the rigidity of the distal coupler 262 during operation.
- the corresponding catheter 302 (or lumen of the catheter 302 ) and/or the corresponding actuation element 208 may also include markings or other indicia corresponding to the grasping devices 104 a , 104 b to assist operators in identifying between the first and second grasping devices 104 a , 104 b.
- each actuation element 208 couples with the respective translational control actuator 230 a such that the translation of the respective translational control actuator 230 a in the longitudinal slot 280 translates into translation of the actuation element 208 and the corresponding grasping device 104 .
- the actuation element 208 may be coupled with the translational control actuator 230 a such that the actuation element 208 may rotate independently within the translational control actuator 230 a .
- the proximal end of the actuation element 208 may be coupled to the translational control actuator 230 a via a ball-and-socket joint, bearings, a rotary coupling, a slip ring, or other rotationally permissible coupling.
- the body 202 may be mirrored such as to allow for better alignment of grasping devices 104 during operation.
- the control actuators 230 a , 230 b extend through the body 202 such that the control actuators 230 a , 230 b are accessible from either side of the body 202 .
- the actuation assembly 200 may include control actuators 230 linearly arranged along the length of the body 202 with each control actuator 230 operable to control the translation and rotation of one of the grasping devices 104 .
- the control actuators 230 may be linearly aligned such that the body 202 is slimmer and easier to hold.
- the body 202 may include two longitudinal slots 280 longitudinally aligned between the proximal and distal ends of the body 202 .
- Each longitudinal slot 280 includes a control actuator 230 slidably disposed within the longitudinal slot 280 .
- Each control actuator 230 is independently slidable in the respective longitudinal slot 280 to operably control the translation of one of the actuation elements 208 .
- the actuation assembly 200 includes a first actuation element 208 a and a second actuation element 208 b . As shown in FIG. 41 B , the actuation elements 208 a , 208 b may be vertically offset from each other.
- the first actuation element 208 a extends proximally through the body 202 and couples with the distal control actuator 230 .
- the proximal end of the first actuation element 208 a may be translationally and rotationally coupled with the distal control actuator 230 .
- the first actuation element 208 a may be coupled with the distal control actuator 230 such that the first actuation element 208 a translates as the distal control actuator 230 slides along the guide rail 278 and rotates with rotation of the distal control actuator 230 .
- the second actuation element 208 b may extend proximally through the body 202 below the control actuators 230 , as shown in FIG. 41 B .
- the second actuation element 208 b may extend into a channel or slot of the body 202 .
- the proximal end of the second actuation element 208 b may be coupled with the proximal control actuator 230 via one or more gears 274 (e.g., FIGS. 41 B, 46 A- 47 B ; such as with a gear box 276 ).
- the gears 274 may translate with the translation of the proximal control actuator 230 and may be configured to rotate with rotation of the proximal control actuator 230 .
- the second actuation element 208 b may be translationally and rotationally coupled with the proximal control actuator 230 via the gears 274 .
- the second actuation element 208 b may be coupled with the proximal control actuator 230 such that the second actuation element 208 b translates as the proximal control actuator 230 slides along the guide rail 278 and rotates with rotation of the proximal control actuator 230 via the gears 274 .
- the proximal end of the second actuation element 208 b is coupled to the proximal control actuator 230 with two or more gears 274 disposed in series such that the second actuation element 208 b rotates in the same direction as the proximal control actuator 230 .
- the actuation assembly 200 may include more than one body 202 with each body 202 configured to independently control one of the grasping devices 104 .
- the actuation assembly 200 includes two bodies 202 each having a translational control actuator 230 a operable to control the translation of one of the actuation elements 208 and a rotational control actuator 230 b operable to control the rotation of the other actuation element 208 .
- Each body 202 may include a longitudinal slot 280 configured to receive one of the translational control actuators 230 a such that the translational control actuator 230 a may slide within the longitudinal slot 280 .
- the longitudinal slots 280 have a length in the longitudinal direction substantially equivalent to the desired translational actuation distance of the actuation element 208 and the grasping device 104 .
- the translational control actuator 230 a may be coupled with one of the actuation elements 208 such that translation of the actuation element 208 transfers to the actuation element 208 and the grasping device 104 .
- the translational control actuator 230 a may be configured to rotate within the longitudinal slot 280 with rotation of the actuation element 208 .
- Each rotational control actuator 230 b includes a stem 286 which extends proximally into the longitudinal slot 280 and couples with the proximal end of the actuation element 208 .
- the stem 286 may be coupled with the proximal end of one of the actuation elements 208 such that rotation of the rotational control actuator 230 b transfers to the actuation element 208 and the grasping device 104 .
- the stems 286 may be sized, shaped, and configured such that the rotational control actuators 230 b may remain coupled to the actuation elements 208 as the actuation element 208 are translated.
- the translational control actuators 230 a may be omitted and the rotational control actuators 230 b may be operable to control the translation and rotation of the actuation elements 208 .
- one or more of the bodies 202 of the actuation assembly 200 of FIG. 43 may be operable to independently control the translation and rotation of one of the grasping devices 104 as well as the operation (e.g., opening and closing) of the grasping devices 104 .
- Each body 202 may include an operational control actuator 230 c disposed at the proximal end of the body 202 and including a stem 286 extending into longitudinal slot 280 to couple with a proximal end of the respective operational element 290 .
- Each operational control actuator 230 c may be coupled with an operational element 290 such that movement of the operational control actuator 230 c may control the operation of the grasping device 104 coupled with the operational element 290 .
- Each actuation element 208 may couple with one of the control actuators 230 disposed in the longitudinal slot 280 .
- the control actuators 230 may be slidable and rotatable within the longitudinal slot 280 such that the rotation and translation of the control actuator 230 transfers to the actuation element 208 and the grasping device 104 .
- the operational elements 290 extend through the control actuators 230 such that the actuation elements 208 may rotate and translate independently from the operational control actuators 230 c and such that the operational elements 290 may be maneuvered independently from the control actuators 230 .
- one or more of the bodies 202 may include a biasing element 234 configured to keep the control actuators 230 in the unactuated position when the biasing element 234 is in the relaxed or normal state.
- the biasing element 234 may be a helical coil configured to bias the control actuator 230 into the unactuated position and which may be compressed when the control actuator 230 is distally translated to operate the grasping device 104 .
- the actuation element 208 and the operational element 290 may extend through the biasing element 234 such that the operational element 290 may be translationally coupled with the operational control actuator 230 c and the actuation element 208 may be translationally and rotationally coupled with the control actuator 230 .
- the operational control actuators 230 c may be similarly biased with a biasing element 234 disposed between the body 202 and the operational control actuator 230 c.
- the actuation assembly 200 includes one or more locks 292 operable to lock or otherwise prevent the rotation and/or translation of the actuation element 208 and/or the operational element 290 .
- the locks 292 may be disposed along the actuation element 208 and the operational element 290 between one of the bodies 202 and the catheter 302 .
- the lock 292 may be movable between an open configuration which permits the actuation element 208 and the operational element 290 to translate and rotate therethrough and a closed configuration which substantially maintains the translational and rotational positions of the actuation elements 208 and/or operational elements 290 disposed therethrough.
- the lock 292 may be a constriction orifice or valve which may be rotated to close the orifice such that the lock 292 moves from the open configuration to the closed configuration.
- the lock 292 may maintain the translation and rotation of the actuation element 208 when the lock is in the closed position while allowing the operational element 290 to be operated, such as when the operational element 290 extends through the interior of the actuation element 208 .
- each lock 292 is disposed between the bodies 202 and the catheter 302 .
- the locks 292 may be disposed in other manners.
- the locks 292 may be coupled with the distal ends of the bodies 202 or with the proximal end of the catheter 302 .
- any of the other actuation assemblies 200 may include one or more locks 292 operable to maintain the translation and/or rotation of the actuation elements 208 and/or the operational elements 290 .
- the actuation assembly 200 includes two bodies 202 each having a control actuator 230 operable to control the translation and rotation of the actuation element 208 .
- Each control actuator 230 includes a stem 286 which extends distally into a channel 210 extending through the body 202 .
- the channel 210 may have a distal opening sized and shaped to receive the actuation element 208 therethrough and to prevent the stem 286 from distally extending out of the channel 210 .
- the channel 210 also has a proximal opening sized and shaped to receive the stem 286 of the control actuator 230 therethrough.
- the stem 286 is operable to translate and rotate within the proximal portion of the channel 210 .
- the actuation elements 208 may each extend from the distal end of the channel 210 and into the catheter 302 .
- the actuation element 208 may be coupled with the control actuator 230 such that the control actuator 230 is operable to control the translation and rotation of the actuation element 208 .
- the control actuator 230 is coupled with the actuation element 208 such that rotation of the control actuator 230 transfers to the actuation element 208 .
- the stem 286 is linearly translatable within the proximal portion of the channel 210 to control the translation of the actuation element 208 .
- the stem 286 and/or the channel 210 may be sized, shaped, and configured such that the stem 286 is longitudinally movable within the channel 210 a distance substantially equivalent to the desired translational actuation distance of the actuation element 208 and the grasping device 104 .
- the two control actuators 230 of the two bodies 202 may be independently operated to independently control the translation and rotation of the respective actuation element 208 and grasping device 104 .
- Each body 202 may include one or more rings 288 configured for an operator to grasp during operation, such as to grasp while the operator manipulates the respective control actuator 230 .
- the operator may insert fingers through each of the rings 288 to control the body 202 and use his/her thumb or other hand to translate and/or rotate the control actuator 230 .
- the actuation assembly 200 may have other configurations and assemblies.
- the actuation assembly 200 may have a first body 202 with one or more control actuators 230 operable to control the translation and rotation of a first grasping device 104 , such as a grasping device 104 with helical coils 114 , and a second body 202 with one or more control actuators 230 operable to control the translation, rotation, and operation of a second grasping device 104 , such as a grasping device 104 with a movable jaw 113 which may be opened and closed to grasp tissue.
- the actuation assembly 200 may include a single translational control actuator 230 a operable to control the linear position of the actuation elements 208 , a single rotational control actuator 230 b operable to control the rotation of the actuation elements 208 .
- the actuation assembly 200 may also include a single operational control actuator 230 c operable to control the operation of the grasping devices 104 , such as opening and closing the grasping devices 104 .
- the actuation assembly 200 includes a first actuation element 208 a and a first operational element 290 a extending into the body 202 on a first side and a second actuation element 208 b and a second operation element 290 b extending into the body 202 on a second side.
- the first actuation element 208 a and first operational element 290 a may be operable to control the operation of a first grasping device 104 a and the second actuation element 208 b and second operational element 290 b may be operable to control the operation of a second grasping device 104 b.
- the translational control actuator 230 a is slidable on a guide rail 278 within a longitudinal slot 280 to control the translational position of either actuation element 208 a , 208 b .
- the operational control actuator 230 c is slidable on another guide rail 278 within another longitudinal slot 280 to control the translational position of either operational element 290 a , 290 b .
- the rotational control actuator 230 b is a rotational wheel disposed at the proximal end of the body 202 and configured to control the rotation of either actuation element 208 a , 208 b.
- the actuation assembly 200 also includes a selector 272 that is slidably disposed within a lateral slot 282 .
- the selector 272 may be slidable between a first position (e.g., left), a second position (e.g., middle), and a third position (e.g., right).
- the control actuators 230 a , 230 b , 230 c may be coupled with the first actuation element 208 a and the first operational element 290 a such that the first grasping device 104 a may be operated.
- control actuators 230 a , 230 b , 230 c may be coupled with the second actuation element 208 b and the second operational element 290 b such that the second grasping device 104 b may be operated.
- the control actuators 230 a , 230 b , 230 c may be decoupled from the actuation elements 208 a , 208 b and the operational elements 290 a , 290 b , such as to reset the positions of the control actuators 230 a , 230 b , 230 c.
- the selector 272 may operably couple the translational control actuator 230 a to the first actuation element 208 a ( FIG. 46 A ), the second actuation element 208 b ( FIG. 46 C ), or neither actuation element 208 ( FIG. 46 B ).
- the selector 272 may be coupled with the translational control actuator 230 a and the translational control actuator 230 a may be slidable on a guide rail 278 .
- the translational control actuator 230 a may be coupled with the first actuation element 208 a ( FIG. 46 A ), the second actuation element 208 b ( FIG.
- the gears 274 may rotate or slide such that the rotational control actuator 230 b is rotationally coupled with the first actuation element 208 a , the second actuation element 208 b , or neither actuation element 208 .
- control actuator 230 a operable to control the linear position of the actuation elements 208
- the control actuator 230 a may have other configurations and assemblies.
- the control actuator 230 a may be a linear pull trigger coupled to a handle that a user may actuate by squeezing the trigger into the handle, a tangentially extending arm that may be actuated by pivoting the arm about a portion of the body 202 , or the like.
- the actuation assembly 200 is configured to deploy one of the grasping devices 104 via a single motion.
- the actuation assembly 200 may include a control actuator 230 configured to be depressed by a user to move the grasping device 104 from the retracted position to the deployed position.
- the actuation assembly 200 may be configured such that a downward depression or click of the control actuator 230 deploys the grasping device 104 .
- the control actuator 230 may be biased to the unactuated position by a biasing element 234 , such as a helical spring.
- the user may depress the control actuator 230 by exerting sufficient downward force to overcome the biasing element 234 , such as to deploy the grasping device 104 .
- the actuation element 208 (or actuation sheath 224 ) and the channel 210 , 214 may include slots or projections which cause the actuation element 208 to sufficiently rotate as the control actuator 230 is depressed.
- the channels 210 , 214 may each have a spiraling groove extending through the channel 210 , 214 and the actuation element 208 (or actuation sheath 224 ) may include a projection which slides within the spiraling groove.
- the projection of the actuation element 208 may ride within the spiral groove of the channel 210 such that the actuation element 208 rotates and the grasping device 104 is sufficiently rotated to be deployed into tissue.
- each actuation element 208 may be translationally and/or rotationally controlled in other manners.
- the illustrated manners of translational and/or rotation control may be implanted for any of the actuation assemblies 200 described herein.
- Each body 202 may include one or more guide rails 278 extending along the length of the body 202 .
- the actuation assembly 200 includes a translational control actuator 230 a slidably disposed along the length of the guide rail 278 .
- the translational control actuator 230 a is coupled with the actuation element 208 such that translation of the control actuator 230 a along the guide rail 278 is operable to control the translation of the actuation element 208 and grasping device 104 .
- the guide rails 278 may include a gear track.
- the rotational control actuator 230 b may be disposed perpendicularly to the actuation element 208 .
- the rotational control actuator 230 b may be rotationally coupled with the actuation element 208 via a gear box 276 .
- the gear box 276 may be coupled to the translational control actuator 230 a such that the gear box 276 and the rotational control actuator 230 b slide in concert with the translational control actuator 230 a .
- the gear box 276 may include one or more gears 274 configured to transfer rotational movement or torque from the rotational control actuator 230 b to the actuation element 208 such that the actuation element 208 rotates about an axis extending along the length of the actuation element 208 .
- the actuation assembly 200 includes a linear translating motor 294 operably to control the translational movement of the actuation element 208 and a rotational motor 296 operable to control the rotation of the actuation element 208 .
- the linear translating motor 294 may be coupled with the translational control actuator 230 a such that the linear translating motor 294 is operable to drive the translational position of the translation control actuator 230 a along the guide rail 278 .
- the translational control actuator 230 a may be a wheel or gear which is drivable along the length of the guide rail 278 , such as on a gear track of the guide rail 278 .
- the rotational motor 296 may be coupled with the gear box 276 , such as to the rotating wheel axis gear 274 a , such that the rotational motor 296 is operable to drive the rotational position of the actuation element 208 .
- the actuation assembly 200 may also include a controller 298 in communication with the linear translating motor 294 and the rotational motor 296 such that the controller 298 is operable to control the linear translating motor 294 and/or the rotational motor 296 .
- the controller 298 may include user inputs mechanisms, such as buttons, joysticks, toggles, a mouse, and the like, such that a user may input commands to control the operations of the linear translating motor 294 and the rotational motor 296 to control the position and rotation of the actuation element 208 .
- an operator may input commands into the controller 298 to actuate the linear translating motor 294 and/or the rotational motor 296 to translate and/or rotate the actuation element 208 and the grasping device 104 .
- the tissue recruiting device 100 may be used with a snare or cutting device configured to cut the tissue recruited by the grasping devices 104 .
- the tissue recruiting device 100 may be used with a closure mechanism, such as an OTS clip or a TTS clip, configured to cinch the tissue recruited by the grasping devices 104 .
- a closure mechanism may be deployed through the endoscope after the grasping devices 104 has been deployed to circumferentially close the defect.
- the actuation assembly 200 may incorporate or be coupled with a clip deployment system 400 operable to actuate and deploy a closure mechanism or clip 402 , such as an OTS clip ( FIGS. 52 A- 52 E ).
- a clip deployment system 400 operable to actuate and deploy a closure mechanism or clip 402 , such as an OTS clip ( FIGS. 52 A- 52 E ).
- the clip deployment system 400 is incorporated with the body 202 of the actuation assembly 200 .
- the clip deployment system 400 may have other configurations.
- the clip deployment system 400 may be actuated via a separate body, handle, controller, or the like.
- the clip deployment system 400 may be operable to deploy the clip 402 , such as independently from the operation of the grasping devices 104 .
- the clip 402 may be operable to deploy the clip 402 , such as independently from the operation of the grasping devices 104 .
- the grasping devices 104 may be operable to deploy the clip 402 , such as independently from the operation of the grasping devices 104 .
- the clip deployment system 400 may include a clip deployment wire 404 configured to deploy the clip 402 .
- the clip deployment wire 404 may be configured to transfer translational movement or force to deploy the clip deployment wire 404 .
- the clip deployment wire 404 may be a solid cable, a hollow tube, or other suitable elongated object or combination of objects, such as a drive cable, a torque cable, a hypotube, spring sheath, or a catheter, configured to deploy the clip 402 .
- the proximal end of the clip deployment wire 404 may be coupled with a clip actuator 406 .
- the clip actuator 406 may be coupled with the clip deployment wire 404 to control the linear translation of the clip deployment wire 404 .
- the clip actuator 406 is disposed in a longitudinal slot 280 in the body 202 such that the clip actuator 406 may linearly translate within the longitudinal slot 280 .
- the clip actuator 406 may be linearly translated, such as by a user, toward the distal end of the body 202 to distally extend the distal end of the clip deployment wire 404 such that the clip 402 is deployed.
- the clip 402 may be seated around the distal end of the catheter 302 or a housing or shroud coupled to the distal end of the catheter 302 .
- the distal movement of the clip deployment wire 404 may push the clip 402 from its seated position such that the clip 402 is deployed, such as around recruited tissue as described below.
- the distal end of the clip deployment wire 404 may contact the proximal end of the clip 402 when the clip 402 is in an undeployed position. While the clip 402 has been described as being disposed around the clip deployment housing 408 in the undeployed position, it will be understood that the clip 402 may have other suitable positions in the undeployed position. For example, the clip 402 may be disposed around a cover or shroud for the grasping devices 104 or seated around the distal end of a separate catheter 302 .
- the endoscope and/or the device 100 may be oriented above the defect with the clip 402 seated around the clip deployment housing 408 .
- the grasping devices 104 may be used to approximate two or more sides of the defects and may be recruited or pulled into the clip deployment housing 408 .
- the clip 402 may then be deployed around the sides of the defect to circumferentially close the defect.
- the first grasping device 104 a may be operated, such as via the actuation assembly 200 , to grasp tissue on a first side of the defect.
- the first actuation element 208 a may be rotated and translated such that the first grasping device 104 a securely grasps the tissue.
- the first and second actuation elements 208 a , 208 b may be proximally retracted toward the catheter 302 .
- the actuation elements 208 a , 208 b may be proximally retracted, such as via the actuation assembly 200 , such that the grasping devices 104 a , 104 b and grasped tissue are brought toward the catheter 302 .
- the grasping devices 104 a , 104 b may be retracted such that a portion of the grasped tissue is recruited into the clip deployment housing 408 .
- FIG. 53 illustrates an exemplary methodology 500 relating to controlling a tissue recruiting device via an actuation assembly to recruit tissue. While the methodology is shown as being a series of acts that are performed in a sequence, it is to be understood and appreciated that the methodology is not limited by the order of the sequence. For example, some acts can occur concurrently with another act. Further, in some instances, not all acts may be required to implement the methodology described herein.
- a control actuator is moved to translate the first grasping device.
- the control actuator of the actuation assembly is coupled to the first grasping device via a first actuation element.
- the control actuator is operable to control the translation of the first grasping device via the first actuation element.
- the control actuator may be controlled by a user such that the first grasping device is disposed substantially above a first side of the defect.
- the control actuator is a translational control actuator operable to control the linear position of the first grasping device.
- a first side of the defect is grasped with the first grasping device.
- an operational control actuator is coupled to the first grasping device via a first operational element.
- the operational control actuator may be actuated to operate the first grasping device to grasp tissue, such as by opening and closing a movable jaw to grasp tissue, via the first operational element.
- one or more control actuators may be manipulated to translate and rotate the first grasping device via the first actuation element such that the first gasping device pierces into and securely grasps tissue on the first side of the defect.
- a control actuator is moved to translate the second grasping device.
- the endoscope and/or the catheter may be maneuvered such that the second grasping device is disposed substantially above the second side of the defect.
- the control actuator of the actuation assembly is coupled to the second grasping device via a second actuation element.
- the control actuator is operable to control the translation of the second grasping device via the second actuation element independently from the first grasping device.
- the control actuator may be controlled by a user such that the second grasping device is disposed substantially above a second side of the defect.
- the first grasping device may continue to grasp tissue on the first side of the defect as the second grasping device is translated via the second actuation element.
- the control actuator is a translational control actuator operable to control the linear position of the second grasping device.
- the control actuator is different from the control actuator used to translate the first grasping device in step 504 .
- a control actuator is moved to rotate the second grasping device.
- the control actuator of the actuation assembly is coupled to the second grasping device via the second actuation element.
- the control actuator is operable to control the rotation of the second grasping device via the second actuation element independently from the first grasping device.
- the control actuator may be controlled by a user such that the second grasping device is rotated into position to grasp tissue on the second side of the defect.
- the first grasping device may continue to grasp tissue on the first side of the defect as the second grasping device is rotated via the second actuation element.
- the control actuator is a rotational control actuator operable to control the rotation of the second grasping device.
- control actuator is the same control actuator used in step 510 such that a single control actuator is operable to control the translation and rotation of the second grasping device via the second actuation element. In some embodiments, the control actuator is different from the control actuator used to rotate the first grasping device in step 506 .
- a second side of the defect is grasped with the second grasping device.
- an operational control actuator is coupled to the second grasping device via a second operational element.
- the operational control actuator may be actuated to operate the second grasping device to grasp tissue, such as by opening and closing a movable jaw to grasp tissue, via the second operational element.
- the operational control actuator may be different from the operational control actuator of step 512 .
- one or more control actuators may be manipulated to translate and rotate the second grasping device via the second actuation element such that the second grasping device pierces into and securely grasps tissue on the second side of the defect.
- the actuation elements are retracted to recruit the tissue grasped by the first and second grasping devices.
- one or more control actuators may be controlled to proximally retract the actuation elements such that the grasping devices are retracted toward the catheter.
- one or more of the grasping devices may be released from the tissue and the above steps may be repeated such that the grasping devices grasp tissue at the desired locations.
- the catheter may also be advanced distally from the endoscope, such as to close the defect away from the endoscope and prevent the endoscope from restricting the movement of the actuation elements.
- a clip is deployed around the recruited tissue to substantially close the defect.
- the clip may be a hemostatic clip which is deployed circumferentially around the recruited tissue to substantially close the tissue.
- a clip actuator may be actuated to deploy the clip via a clip deployment wire.
- the clip actuator may translate the clip deployment wire such that the clip is pushed off a clip deployment housing to cinch or close the recruited tissue.
Abstract
An actuation assembly for a tissue recruiting device for recruiting tissue and closing a defect. The actuation assembly includes one or more control actuators operable to control the position and rotation of an actuation element coupled to a grasping device. The grasping device is configured to grasp tissue. The actuation assembly is operable by a user to deploy the grasping device via the actuation element to grasp tissue. The actuation assembly may independently deploy multiple grasping devices, such as on opposite sides of a defect. The actuation assembly may also deploy a closure mechanism configured to circumferentially surround the deployed grasping devices to close the defect.
Description
- The present application claims priority to U.S. Provisional Patent Application No. 63/344,063, filed on May 20, 2022, the entire disclosure of which is incorporated herein by reference as though recited herein its entirety.
- The present disclosure relates generally to surgical devices and, more specifically, to an actuation assembly for a tissue recruiting device that allows for improved tissue recruitment to facilitate closure of large defects.
- Tissue recruiting and grasping devices are used in various parts of the body, including the gastrointestinal, urinary, and vascular systems, to treat internal bleeding or defects. These devices may be deployed using an endoscope, such as a flexible endoscope, and may be provided in a variety of forms and may be used with hemostatic devices, including clamps, clips, staples, sutures, and the like. One or more hemostatic devices may be deployed around tissue in the body to apply constrictive forces to blood vessels and surrounding tissue, such as to control and prevent bleeding.
- In some cases, a hemostatic device may be deployed around a growth of tissue, such as a polyp. The hemostatic device may be used to close the defect after the growth has been removed, such as to prevent or otherwise reduce bleeding. In other cases, target tissue may be grasped and recruited, such as into a pseudo-polyp, and the hemostatic device may be used to close the defect after the recruited tissue has been cut or severed, such as to remove the defect. The target tissue could be dysplasia, a defect, or the like. However, in some cases, particularly those involving larger defects and fibrotic tissue, it can be difficult to utilize conventional hemostatic devices to successfully close the defect.
- Most hemostatic devices rely on variations of conventional tissue recruiting techniques to recruit tissue before the hemostatic device is deployed. Conventional tissue recruiting techniques often involve extending a tissue recruiting device through an endoscope to the desired location to recruit tissue. However, conventional tissue recruitment techniques can sometimes fail to adequately recruit tissue before the hemostatic device is deployed. For example, conventional tissue recruitment techniques may fail to adequately grasp and recruit multiple sides of a defect. Accordingly, there is an unmet need for an improved recruiting device that utilizes separate, independently controlled graspers to improve tissue recruitment.
- This summary is meant to provide some examples and is not intended to be limiting of the scope of the invention in any way. For example, any feature included in an example of this summary is not required by the claims, unless the claims explicitly recite the features. Also, the features, components, steps, concepts, etc. described in examples in this summary and elsewhere in this disclosure can be combined in a variety of ways. The description herein relates to systems, assemblies, methods, devices, apparatuses, combinations, etc. that may be utilized for recruiting tissue, such as tissue defects. Various features and steps as described elsewhere in this disclosure may be included in the examples summarized here. Further, the treatment techniques, methods, operations, steps, etc. described or suggested herein can be performed on a living animal or on a non-living simulation, such as on a cadaver, simulator (e.g., with the body parts, tissue, etc. being simulated), etc.
- In one example embodiment, an actuation assembly of a tissue recruiting device operable to independently control first and second grasping devices to grasp tissue is provided. The actuation assembly has a body defining a first channel and a second channel, a first actuation element extending through the first channel and coupled with the first grasping device, and a second actuation element extending through the second channel and coupled with the second grasping device. The actuation assembly has at least one first control actuator operable to control the translation and rotation of the first grasping device to grasp tissue via the first actuation element and at least one second control actuator operable to control the translation and rotation of the second grasping device to grasp tissue via the second actuation element. The at least one first control actuator is operable to control the translation and rotation of the first grasping device independently from the second grasping device.
- In one example embodiment, a tissue recruiting device is provided. The tissue recruiting device includes a first grasping device and a second grasping device, with each grasping device being operable to grasp tissue. The tissue recruiting device also has a first actuation element extending through a first channel of a body with a proximal end of the first actuation element being coupled to a first control actuator and a distal end of the first actuation element being coupled to the first grasping device. The tissue recruiting device also has a second actuation element extending through a second channel of the body with a proximal end of the second actuation element being coupled to a second control actuator and a distal end of the second actuation element being coupled to the second grasping device. The first control actuator is independently operable to translate and rotate the first gasping device to grasp tissue via the first actuation element. The second control actuator is independently operable to translate and rotate the second grasping device to grasp tissue via the second actuation element.
- In one example embodiment, a method for treating a defect with a tissue recruiting device is provided. The method includes the steps of positioning a first grasping device above a first side of the defect, moving a first control actuator to control the translation and rotation of the first grasping device via a first actuation element, grasping the first side of the defect with the first grasping device, positioning a second grasping device above a second side of the defect, moving a second control actuator to control the translation and rotation of the second grasping device via a second actuation element, grasping the second side of the defect with the second grasping device, and retracting the actuation elements to recruit the grasped tissue.
- These and other objects, features, and advantages of the present disclosure will become apparent from the following detailed description of illustrative embodiments thereof, which is to be read in connection with the accompanying drawings.
- To further clarify various aspects of implementations of the present disclosure, a more particular description of the certain examples and implementations will be made by reference to various aspects of the appended drawings. These drawings depict only example implementations of the present disclosure and are therefore not to be considered limiting of the scope of the disclosure. Moreover, while the Figures can be drawn to scale for some examples, the Figures are not necessarily drawn to scale for all examples. Examples and other features and advantages of the present disclosure will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
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FIG. 1 is a schematic illustration of a tissue recruiting device; -
FIG. 2 is a schematic illustration of another tissue recruiting device; -
FIG. 3 is a perspective view of a catheter sheath assembly according to one embodiment of the disclosure; -
FIG. 4 is a front view of the catheter sheath assembly ofFIG. 3 ; -
FIGS. 5A-5D are schematic illustrations of the tissue recruiting assembly of the tissue recruiting devices ofFIGS. 1-2 recruiting tissue; -
FIG. 6 is a schematic illustration of example grasping devices which may be used with a tissue recruiting device; -
FIG. 7 is a perspective view of an actuation assembly according to one embodiment; -
FIGS. 8 and 9 show various views of a body of the actuation assembly ofFIG. 7 ; -
FIG. 10 is a perspective view of the actuation assembly ofFIG. 7 with a cover; -
FIG. 11 is a perspective view of the cover ofFIG. 10 ; -
FIGS. 12 and 13 show a top and perspective view of half of the body ofFIGS. 8-9 ; -
FIG. 14 is a perspective view of the actuation assembly ofFIG. 7 with half of the body removed; -
FIG. 15 is a perspective view of a control actuator of the actuation assembly ofFIG. 7 ; -
FIG. 16 is a perspective view of the actuation assembly ofFIG. 14 with actuation sheaths; -
FIG. 17A is a cross-sectional schematic view of an actuation element disposed in an actuation sheath according to one embodiment; -
FIG. 17B is a perspective view of an actuation element according to one embodiment; -
FIG. 17C is a perspective view of the distal end of a tissue recruiting device according to one embodiment with the actuation element ofFIG. 17B ; -
FIGS. 17D and 17E are perspective views of a catheter according to one embodiment; -
FIG. 17F is a front view of the catheter ofFIGS. 17D-17E ; -
FIG. 17G is a perspective view of a distal portion of the catheter ofFIGS. 17D-17E according to one embodiment; -
FIG. 18 is a top view of a tissue recruiting device with the actuation assembly ofFIG. 10 and two grasping devices according to one embodiment; -
FIGS. 19A-19C are perspective views depicting actuation of the tissue recruiting device ofFIG. 18 ; -
FIGS. 20 and 21 are perspective and top views of a body of an actuation assembly with a biasingelement 234 according to one embodiment; -
FIGS. 22 and 23 show various views of a biasing element ofFIGS. 20-21 ; -
FIG. 24 is a perspective view of the body ofFIGS. 20-21 with actuation sheaths and control actuators; -
FIGS. 25 and 26 are perspective and top views of the body ofFIGS. 20-21 with actuation elements, actuation sheaths, and control actuators; -
FIGS. 27A-27D show various views of a cap according to one embodiment for use with the actuation assembly ofFIG. 7 ; -
FIG. 28 is a schematic view of an actuation sheath coupled to an actuation element and a control actuator according to one embodiment; -
FIG. 29 is a schematic illustration of an actuation assembly with a biasing element according to one embodiment; -
FIGS. 30A and 30B are perspective and top views of a body with biasing elements according to another embodiment; -
FIG. 31 is a top view of a body with a clamp according to one embodiment; -
FIG. 32A is a schematic illustration of an actuation assembly with a clamp according to one embodiment; -
FIG. 32B is a top view of the clamp ofFIG. 32A ; -
FIG. 33 is a schematic illustration of an actuation assembly with two clamps according to one embodiment; -
FIGS. 34A and 34B are schematic illustrations of an actuation assembly with clamps according to another embodiment; -
FIG. 35 is a top view of an actuation assembly with half of the body removed coupled with a lock according to one embodiment; -
FIGS. 36A and 36B are schematic illustrations of an actuation assembly with a biasing element according to one embodiment, the actuation assembly being configured to produce detectable feedback at rotational intervals of the actuation elements; -
FIGS. 37A and 37B are schematic illustrations of an actuation assembly with a biasing element according to another embodiment, the actuation assembly being configured to produce detectable feedback at translation intervals of the actuation elements; -
FIGS. 38A and 38B are top views of an actuation assembly with biasing elements according to another embodiment; -
FIG. 38C is a perspective view of the actuation assembly ofFIGS. 38A-38B with half of the body removed for illustrative purposes; -
FIG. 38D is a top view of the actuation assembly ofFIGS. 38A-38B ; -
FIG. 38E is a top view of the actuation assembly ofFIGS. 38A-38B with a cover according to another embodiment; -
FIG. 38F is a perspective view of an actuation element and control actuator according to another embodiment for use with the actuation assembly ofFIGS. 38A-38B ; -
FIG. 38G is a front view of the actuation assembly ofFIG. 38C with the actuation element and control actuator ofFIG. 38F disposed in a channel; -
FIG. 39 is a perspective view of an actuation assembly ofFIG. 10 with a strain relief catheter and a distal coupler; -
FIG. 40 is a schematic illustration of an actuation assembly of another embodiment; -
FIGS. 41A and 41B are schematic front and side illustrations of an actuation assembly of another embodiment; -
FIG. 42 is a schematic illustration of an actuation assembly with two bodies according to one embodiment; -
FIG. 43 is a schematic illustration of an actuation assembly with two bodies according to another embodiment; -
FIG. 44 is a schematic illustration of an actuation assembly with two bodies according to one embodiment; -
FIG. 45 is a schematic illustration of an actuation assembly according to another embodiment; -
FIGS. 46A-46C are schematic illustrations depicting the adjustable control of the translational control actuator ofFIG. 45 ; -
FIGS. 47A-47B are schematic illustrations depicting the adjustable control of the rotational control actuator ofFIG. 45 ; -
FIG. 48 is a schematic illustration depicting the translational and rotational control of an actuation element according to one embodiment; -
FIG. 49 is a schematic illustration depicting the translational and rotational control of an actuation element according to another embodiment; -
FIG. 50 is a schematic illustration depicting the translational and rotational control of an actuation element according to another embodiment; -
FIG. 51 is a schematic illustration of an actuation assembly with a clip deployment system; and -
FIGS. 52A-52D are schematic illustrations of the actuation assembly ofFIG. 51 recruiting tissue and deploying a clip to close a defect; -
FIG. 53 is an illustrative example depicting a methodology of operating an actuation assembly of a tissue recruiting device to recruit tissue. - The following description refers to the accompanying drawings, which illustrate specific embodiments of the present disclosures, and describes exemplary embodiments in accordance with the general inventive concepts and is not intended to limit the scope of the invention or the claims in any way. Indeed, the invention as described by the claims is broader than and not limited by the exemplary embodiments set forth herein, and the terms used in the claims have their full ordinary meaning.
- The general inventive concepts will be understood more fully from the detailed description given below and from the accompanying drawings of the various exemplary aspects and implementations of the disclosure. This should not be taken to limit the general inventive concepts to the specific aspects or implementations, which are being provided for explanation and understanding only. Example embodiments of the present disclosure are directed to devices and methods for recruiting tissue. Various embodiments of devices and systems for recruiting tissue are disclosed herein, and any combination of these options can be made unless specifically excluded. In other words, individual components of the disclosed devices and systems can be combined unless mutually exclusive or otherwise physically impossible.
- Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art encompassing the general inventive concepts. The terminology set forth in this detailed description is for describing particular embodiments only and is not intended to be limiting of the general inventive concepts. As used in this detailed description and the appended claims, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise.
- As described herein, when one or more components are described as being connected, joined, affixed, coupled, attached, or otherwise interconnected, such interconnection can be direct as between the components or can be indirect such as through the use of one or more intermediary components. Also, as described herein, reference to a “member,” “component,” or “portion” shall not be limited to a single structural member, component, or element, but can include an assembly of components, members, or elements.
- Unless otherwise indicated, all numbers, such as for example, numbers expressing measurements or physical characteristics, used in the specification and claims are to be understood as being modified in all instances by the term “about.” Accordingly, unless otherwise indicated, the numerical properties set forth in the specification and claims are approximations that may vary depending on the suitable properties sought to be obtained in embodiments of the invention. Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the general inventive concepts are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical values, however, inherently contain certain errors necessarily resulting from error found in their respective measurements. Also, as described herein, the terms “substantially” and “about” are defined as at least close to (and includes) a given value or state (preferably within 10% of, more preferably within 1% of, and most preferably within 0.1% of).
- In discussing the exemplary embodiments herein, the terms “proximal” and “distal” may often be used. These terms are used to describe a position or a direction with reference to the operator of the instrument. For example, the proximal position or proximal direction is toward the user or operator of the instrument, and the distal position or direction is away from the user or operator of the instrument, i.e., position or direction toward the object which the operator is attempting to grasp, retain, and/or view.
- The present invention provides a tissue recruiting device to be used through an endoscope. The tissue recruiting device is controllable by an actuation assembly. The tissue recruiting device may be configured to better approximate tissue than standard tissue recruiting devices. The tissue recruiting device may also be configured to recruit tissue over larger defects than standard tissue recruiting devices. For example, the tissue recruiting device of the present disclosure may be configured to approximate tissue defects having a width or diameter between about 1 cm and about 10 cm. In some embodiments, the tissue recruiting device is configured to approximate tissue defects larger than 10 cm in width or diameter. The tissue recruiting device of the present disclosure may also be configured to simultaneously approximate multiple sides of a defect, such as to achieve more consistent and circumferential closure of defects. The tissue recruiting device may be configured to achieve a more consistent and circumferential closure of a tissue defect, such as when a hemostatic device is deployed around the tissue recruited by the tissue recruiting device. While the tissue recruiting device may also be used to grasp intact tissue, such as dysplastic or cancerous tissue. In some embodiments, the tissue recruiting device may be a sterile, single use device such as to reduce cost.
- A functional block diagram for a
tissue recruiting device 100 is illustrated inFIGS. 1-2 . Thetissue recruiting device 100 includes atissue recruiting assembly 102 at a distal end, anactuation assembly 200 at a proximal end, and acatheter sheath assembly 300 disposed between thetissue recruiting assembly 102 and theactuation assembly 200. Therecruiting assembly 102 may include one or moretissue grasping devices 104 configured to grasp. The graspingdevices 104 may be end effectors or devices capable of grasping tissue. It will be understood that the grasping of the graspingdevices 104 encompasses grabbing, pinching, hooking, or otherwise securing tissue with the graspingdevices 104. - The proximal end of each
grasping device 104 may be coupled with anactuation element 208 of theactuation assembly 200. Eachactuation element 208 is configured to control the position and rotation of the attached graspingdevice 104, such as via operation of theactuation assembly 200. Eachactuation element 208 may be configured to transfer both translational movement to position the graspingdevice 104 and torque or rotational movement to rotate the graspingdevice 104. Eachactuation element 208 may be a solid cable, a hollow tube, or other suitable elongated object or combination of objects, such as a drive cable, a torque cable, a hypotube, spring sheath, or a catheter, configured to control the graspingdevice 104. - In the illustrated embodiment, the
tissue recruiting device 100 has twograsping devices 104 each coupled with anactuation element 208. However, thedevice 100 may have other assemblies and configurations. For example, thetissue recruiting assembly 102 may have one or three or moregrasping devices 104 and theactuation elements 208 may be coupled to two or moregrasping devices 104. - The
catheter sheath assembly 300 includes one ormore catheters 302 operably connected to the distal end of theactuation assembly 200. Thetissue grasping devices 104 and theactuation elements 208 may extend through one or more lumens of the one ormore catheters 302. The proximal ends of theactuation elements 208 may extend through the proximal end of thecatheters 302 to operably couple with other components of theactuation assembly 200, as described below. The one ormore catheters 302 may be sized, shaped, and configured such that eachgrasping device 104 may be distally extended beyond the distal end of the one ormore catheters 302 via theactuation elements 208 extending therethrough. In some embodiments, thecatheter sheath assembly 300 is flexible to allow for adequate endoscope maneuverability without compromising the purchase of thetissue recruiting assembly 102, such as the purchase of thetissue recruiting assembly 102 has on multiple edges of a tissue defect. - As shown in
FIG. 1 , each graspingdevice 104 andactuation element 208 pair is disposed through aseparate catheter 302. However, thecatheter sheath assembly 300 may have other configurations and assemblies. For example, as shown inFIG. 2 each graspingdevice 104 andactuation element 208 pair may extend through acatheter 302. Theactuation elements 208 and graspingdevices 104 may extend through separate lumens of thecatheter 302 or all graspingdevices 104 andactuation elements 208 may extend through a single lumen of asingle catheter 302. - In some embodiments, the one or
more catheters 302 comprise polyether ether-ketone (PEEK), a thermo-plastic material, nylon, Pellethane, polytetrafluoroethylene (PTFE), polyimide, composite metal and polymer tubing, metal tubing, metal coils, or similar constructions known in the art, or combinations thereof. In a preferred embodiment, thecatheters 302 are metal spring sheaths configured to resist compression and operational forces exerted on thecatheters 302 by theactuation elements 208 and/or operational elements as described below. In some embodiments, thecatheters 302 include a liner or coating, such as a PTFE liner and/or coating, disposed in the one or more lumens to increase the resiliency of thecatheters 302 and/or to decrease friction between theactuation elements 208 and thecatheter 302. - In some embodiments, as shown in
FIGS. 3-4 , thecatheter 302 is a dual-lumen catheter having a substantially figure-eight-shaped cross-section. Thecatheter sheath assembly 300 also includes one ormore support wires 310 extending along the length of thecatheter 302 between the lumens and above and/or below the outer surface of thecatheter 302, such as in the rounded groove between the lumens. Thesupport wires 310 may reinforce thecatheter 302 to provide strength to the catheter and counter or reduce compressive forces encountered by thedevice 100 during operation. Thesupport wires 310 may comprise stainless steel or a shape memory material, such as Nitinol. Additionally or alternatively, thesupport wires 310 may comprise PEEK, superelastic Nitinol, liquid crystalline polymer (LCP), or other metals or polymers with sufficient strength to resist compressive forces, or combinations thereof. - While the
catheter sheath assembly 300 ofFIGS. 3-4 is shown as including twosupport wires 310 on the top and the bottom of thecatheter 302, it will be understood that thecatheter sheath assembly 300 may have other assemblies and configurations. For example, thecatheter sheath assembly 300 may include onesupport wire 310 underneath thecatheter 302, onesupport wire 310 above thecatheter 302, or three ormore support wires 310 disposed at various locations around the outer surface of thecatheter 302. - Referring back to
FIGS. 1-2 , the graspingdevices 104 may be disposed through a distal end of the endoscope and thecatheter sheath assembly 300. In some embodiments, the graspingdevices 104 may be operated by a user at a proximal end of the endoscope via theactuation elements 208 extending through a channel located within and extending through the endoscope, such as via theactuation assembly 200. In other embodiments, thedevice 100 may be used during minimally invasive procedure with a suitable natural or artificially created orifice in the body. Thedevice 100 is constructed and configured such that it may also be inserted into a subject through an orifice or small incision and operated to recruit target tissue, such as defected tissue. Thedevice 100 may be configured to recruit tissue across large defects, such as tissue defects greater than 1 cm or tissue defects greater than 3 cm. In some embodiments, thedevice 100 is configured to recruit tissue across defects greater than 10 cm in diameter. Additionally, thedevice 100 may be configured to simultaneously recruit multiple sides of a defect, such as to achieve more consistent and circumferential closure of defects. - The
device 100 can be used with any suitable or conventional endoscope or laparoscopic surgical equipment. For purposes of this disclosure, thedevice 100 is described in the context of use with an endoscope/colonoscope/sigmoidoscope type apparatus of conventional or suitable construction. However, the device may also be used in other manners, such as in any minimally invasive procedure with a suitable natural or artificially created orifice in the body. The scope is provided with an elongated body having a controllably flexible projecting end region. Surgical instruments, such as thedevice 100, may be introduced through an instrument channel, such as an accessory channel, which extends through the scope body, for recruiting tissue targeted by the surgeon manipulating the scope. The graspingdevices 104 may be sized, shaped, and configured such that all thegrasping devices 104 may be disposed through the same instrument or accessory channel of the endoscope. - Each grasping
device 104 is configured to grasp tissue, such as defected tissue, such that thetissue recruiting device 100 may recruit the grasped tissue. The graspingdevices 104 may be any suitable device for grasping tissue. For example, the graspingdevices 104 may be forceps, clamps, hooks, pins, talons, helixes, or the like. Each of thetissue grasping devices 104 may be controlled by theactuation assembly 200, such as via theactuation element 208 to which the graspingdevice 104 is attached. In some embodiments, the graspingdevices 104 are independently controllable via theactuation assembly 200. - The
actuation assembly 200 may be operably connected to eachgrasping device 104 via one ormore actuation elements 208. Theactuation element 208 may be configured to control the translational and rotational movements of the respectivegrasping device 104. For example, theactuation elements 208 may be configured such that a user may position the graspingdevice 104, such as on a side of a defect, and deploy or otherwise manipulate the graspingdevice 104, such as to grasp tissue. Theactuation elements 208 may be stiff or rigid enough to translate rotational and linear force to the graspingdevice 104, such as to aim and maintain the graspingdevice 104 at various positions and angles, during operation. Theactuation elements 208 may also be flexible enough such that theactuation elements 208 may be disposed through a channel of the endoscope and/or thecatheter 302 to the desired location and such that deployed or actuated graspingdevices 104 may continue to grasp tissue as the endoscope and/orcatheter sheath assembly 300 are manipulated. In some embodiments, theactuation elements 208 comprise polymers, such as ABS, PC, acrylic, or the like, plastic, or metals, such as stainless steel, Nitinol, or combinations thereof. - The
actuation elements 208 may also be flexible enough such that theactuation elements 208 and thetissue recruiting assembly 102 may be extended to the desired location in a body, such as through the endoscope, and such that the endoscope may be maneuvered with theactuation elements 208 extending therethrough. Theactuation elements 208 may also be stiff enough such that theactuation elements 208 may be operated to grasp tissue, such as described below. In some embodiments, theactuation elements 208 are solid core Nitinol wires with a diameter between about 0.018 inches (0.46 mm) and about 0.030 inches (0.76 mm), such as about 0.024 inches (0.61 mm). In some embodiments theactuation elements 208 provide one-to-one torque response over an endoscopic length, such that the distal end of theactuation element 208 rotates equivalently to rotation of the proximal end of theactuation element 208. - In the illustrated embodiment, the
actuation assembly 200 is operably connected to eachgrasping device 104 via asingle actuation element 208. However, it will be understood that thetissue recruiting device 100 may have other suitable configurations. For example, theactuation assembly 200 may be operably connected to eachgrasping device 104 viamultiple actuation elements 208, such as anactuation element 208 configured to control the translation of the graspingdevice 104 and anactuation element 208 configured to control the rotation of the graspingdevice 104. - In some embodiments, as shown in
FIG. 2 , theactuation elements 208 are operably disposed through one ormore sheaths 304 disposed between theactuation elements 208 and thecatheter 302. Eachactuation element 208 may extend through aseparate sheath 304 or theactuation elements 208 may extended through asingle sheath 304, such as asingle sheath 304 with two lumens or asheath 304 with a single lumen. The one ormore sheaths 304 may cover theactuation elements 208, as well as any additional control or operational elements, as they are extended through the endoscope and/or thecatheter 302. Thesheaths 304 may be configured to reduce friction between theactuation elements 208 and/or between theactuation elements 208 and thecatheter 302. Thesheaths 304 may also be configured to prevent theactuation elements 208 from tangling within thecatheter 302. For example, thesheaths 304 may be implemented in embodiments in which theactuation elements 208 are disposed through asingle catheter 302. The one ormore sheaths 304 may be a spring sheath, a reinforced composite sheath, and/or a tubing, such as a polymer tubing and/or hypotubing. Thesheaths 304 may include a lubricating coating or liner disposed within the lumens of thesheaths 304. Alternatively, as shown inFIG. 1 , theactuation elements 208 may be relatively free floating within the one or more lumens of thecatheter 302, such as without asheath 304 extending therethrough. - The proximal end of each
sheath 304 may be operably connected or otherwise coupled with theactuation assembly 200. The distal end of eachsheath 304 may extend toward the respectivegrasping device 104. Thesheaths 304 may be sized, shaped, or configured to accommodate theactuation elements 208 therethrough. For example, thesheaths 304 may be hollow to at least partially cover theactuation element 208. In some embodiments, such as in embodiments in which one of the graspingdevices 104 is operated via an operational element, thesheaths 304 may also be sized, shaped, or configured to accommodate the operational element therethrough. - In some embodiments, such as in embodiments in which one or more
grasping device 104 may be operated (e.g., opened and closed), theactuation element 208 may be hollow, shaped, or sized to at least partially encompass anoperational element 290 coupled with the graspingdevice 104 and configured to operate the graspingdevice 104. Theoperational element 290 may be a drive cable, a torque cable, a hypotube, spring sheath, a catheter, or other suitable member configured to control the graspingdevice 104. For example, eachoperational element 290 may be configured to convey translational and/or rotational force to actuate the graspingdevice 104. - The
operational element 290 may be movable, such as linearly movable and rotationally movable, relative to theactuation element 208 to control the function or operation of the grasping device 104 (e.g., opening and closing) separately from the translation and/or rotation of the graspingdevice 104. A proximal end of theoperational element 290 may be operably coupled with theactuation assembly 200 such that a user may control the operation of the graspingdevice 104 via theactuation assembly 200. Eachoperational element 290 may be a metal actuation wire or tether configured to impart a translational force which controls the operation of the graspingdevice 104. For example, the graspingdevice 104 may include distal jaws normally disposed in a closed position, such as by a spring or other biasing element, and the distal movement of theoperational element 290 relative to the graspingdevice 104 may open the jaws. When theoperational element 290 is retracted relative to the graspingdevice 104 the jaws may move back to the closed position, such as to grasp tissue. - In the illustrated embodiment, the
device 100 includes anoperational element 290 disposed through one of theactuation elements 208. However, it will be understood that thedevice 100 may have other configurations and assemblies. For example, thedevice 100 may not include anoperational element 290 or anoperational element 290 may be disposed through or alongside each of theactuation elements 208. - The
actuation assembly 200 includes abody 202 configured to be grasped by a user. The proximal ends of theactuation elements 208 and the optionaloperational elements 290 may extend into or through thebody 202. Theactuation assembly 200 also includes a plurality ofcontrol actuators 230 operable to control the position, rotation, and operation of the graspingdevices 104 via theactuation elements 208. Each of theactuation elements 208 and each of theoperational elements 290 may be coupled with one ormore control actuators 230 such that a user may control the position, rotation, and operation of the grasping devices via thecontrol actuators 230. The control actuators 230 may be any suitable device by which a user may actuate to control the position and/or rotation of one of theactuation elements 208 or one of theoperational elements 290. For example, thecontrol actuators 230 may be push buttons, toggles, switches, levers, triggers, sliders, or the like. - In the illustrated embodiment, the
actuation assembly 200 may include first ortranslational control actuators 230 a operable to control the linear or translational position of one of theactuation elements 208, second orrotational control actuators 230 b operable to control the rotational position of one of theactuation elements 208, andoperational control actuators 230 c operable to control the linear or translational position of one of theoperational elements 290. For example, an operator may use the translational androtational control actuators devices 104 via theactuation elements 208, such as to deploy the graspingdevices 104 at the desired location. Optionally, an operator may also use theoperational control actuators 230 c to control the operation of the graspingdevices 104 via theoperational elements 290, such as to open and/or close the graspingdevices 104 to grasp tissue. - In the illustrated embodiment, the
actuation assembly 200 includes twotranslational control actuators 230 a, tworotational control actuators 230 b, and oneoperational control actuator 230 c. However, theactuation assembly 200 may have other suitable configurations and assemblies. For example, theactuation assembly 200 may include any suitable number oftranslational control actuators 230 a,rotational control actuators 230 b, andoperational control actuators 230 c. - In the illustrated embodiment, each
translational control actuator 230 a is disposed near a proximal end of one of theactuation elements 208 proximally from thebody 202 and eachrotational control actuator 230 b is disposed at the proximal end of one of theactuation elements 208 proximally from thetranslational control actuator 230 a. Eachtranslational control actuator 230 a may be translationally fixed to therespective actuation element 208 such that translational movement of thetranslational control actuator 230 a translates to translational movement of theactuation element 208. Theactuation element 208 may be rotationally decoupled from thetranslational control actuator 230 a such that theactuation element 208 may rotate independently from thetranslational control actuator 230 a. Thetranslational control actuator 230 a may be depressed or otherwise moved toward thebody 202, such as by a user, to distally extend theactuation element 208 and thereby position the graspingdevice 104. - The
rotational control actuator 230 b may be rotationally coupled with therespective actuation element 208 such that rotational movement of therotational control actuator 230 b translates to rotational movement of theactuation element 208. Therotational control actuator 230 b may be rotated, such as by a user, to rotate theactuation element 208 and thereby rotate the graspingdevice 104. Therotational control actuator 230 b may be rotated independently from thetranslational control actuator 230 a. - The
operational control actuator 230 c may be disposed on a proximal side of thebody 202, such as proximally to the translational androtational control actuators operational control actuator 230 c may be directly or indirectly coupled with theoperational element 290 to operate theoperational element 290 to actuate the graspingdevice 104. Theoperational control actuator 230 c may be coupled with theoperational element 290 such that depression or activation of theoperational control actuator 230 c translates theoperational element 290 to actuate the respectivegrasping device 104, such as to open or close the graspingdevice 104. Theoperational control actuator 230 c may be coupled with theoperational element 290 via a biasing element such that theoperational control actuator 230 c returns to the unactuated position when a user releases theoperational control actuator 230 c, thereby retracting theoperational element 290. - However, it will be understood that the
actuation assembly 200 may have other suitable shapes, assemblies, and configurations. For example, theoperational control actuator 230 c may be disposed a different side of thebody 202 from theother control actuators control actuators 230 may be disposed along thebody 202, thetranslational control actuators 230 a may not be aligned with therotational control actuators 230 b, and/or the translational androtational control actuators grasping device 104 viaseparate actuation elements 208. Additionally, one or more of thetranslational control actuators 230 a,rotational control actuators 230 b, andoperational control actuators 230 c may be combined. For example, the translational androtational control actuators single control actuator 230 operable to control the translational and rotational position of the graspingdevice 104 via theactuation element 208. - In operation, the
actuation assembly 200 may be operated, such as by a user, to control thetissue recruiting assembly 102, such as to recruit tissue with one or moregrasping devices 104. The graspingdevices 104 may be disposed through a distal end of an endoscope (not shown) and thecatheter sheath assembly 300. Theactuation assembly 200 may be operated by a user at a proximal end of the endoscope via theactuation elements 208 and/oroperational elements 290 extending through a channel located within and extending through the endoscope. The endoscope and/or the graspingdevices 104 may be inserted through the subject such that the graspingdevices 104 are disposed in a desired position, such as above an identified defect. Each graspingdevice 104 may be moved via the respectivetranslational control actuator 230 a, rotated via the respectiverotational control actuator 230 b, and/or actuated by the respectiveoperational control actuator 230 c to grasp the tissue. For example, a user may control the position of the graspingdevice 104 by positioning the distal end of the endoscope and sliding or otherwise moving thetranslational control actuator 230 a to extend and/or retract theactuation element 208. The user may control the rotation of the graspingdevice 104 by rotating the respectiverotational control actuator 230 b. Optionally, the user may also control the operation of the graspingdevice 104, such as the opening and closing of the graspingdevice 104, by engaging and disengaging theoperational control actuator 230 c. After the graspingdevices 104 grasp the tissue, theactuation assembly 200 may be used to recruit the grasped tissue proximally, such as to close a defect or to appose two sides of a defect such that a hemostatic device may be used to close the defect, such as by proximally retracting thetranslational control actuators 230 a. - An exemplary method of operating the grasping
devices 104 of thetissue recruiting assembly 102 is schematically illustrated inFIGS. 5A-5D . As shown inFIG. 5A , thetissue recruiting assembly 102 may be positioned above a defect, such as via thecatheter sheath assembly 300 and the endoscope. The graspingdevices 104 may be extended from the distal end of thecatheter 302 via theactuation elements 208. In some embodiments, the defect is identified and visualized using one or more cameras (not shown) operably connected to the endoscope. In the illustrated embodiment, a firstgrasping device 104 a is coupled with afirst actuation element 208 a and a secondgrasping device 104 b is coupled with asecond actuation element 208 b. - As shown in
FIG. 5B , one of the graspingdevices 104 may be deployed to engage tissue on a first side of the defect. The endoscope, thecatheter 302, and/or theactuation element 208 may be manipulated such that the firstgrasping device 104 a is oriented to face the first side of the identified defect. Theactuation element 208 a coupled with the firstgrasping device 104 a may be translated and rotated, such as via one of thetranslational control actuators 230 a and one of therotational control actuators 230 b of theactuation assembly 200, such that the firstgrasping device 104 a engages and grasps the tissue on the first side of the defect. While not illustrated, the graspingdevice 104 a may also be operated via anoperational element 290, such as via one of theoperational control actuators 230 c of theactuation assembly 200, to grasp the tissue. The secondgrasping device 104 b may remain relatively stationary relative tocatheter 302 as the firstgrasping device 104 a is deployed to grasp tissue. - As shown in
FIG. 5C , the secondgrasping device 104 b may be deployed to engage tissue on a second side of the defect. The endoscope, thecatheter 302, and/or thesecond actuation element 208 b may be manipulated such that the secondgrasping device 104 b is oriented to face the second side of the identified defect. The secondgrasping device 104 b may be independently controlled or operated from the firstgrasping device 104 a to grasp tissue on the second side of the defect. Thesecond actuation element 208 b may be translated and rotated, such as via one of thetranslational control actuators 230 a and one of therotational control actuators 230 b of theactuation assembly 200, such that the secondgrasping device 104 b engages and grasps the tissue on the second side of the defect. The independent operation of the secondgrasping device 104 b may permit thetissue recruiting device 100 to extend beyond the limits of standard recruiting devices to treat and close larger defects. For example, the flexibility of thetissue recruiting assembly 102, such as theactuation elements 208, and the independent operation of the graspingdevices 104 may permit thedevice 100 to treat and close larger defects than standard recruiting devices. While not illustrated, the secondgrasping device 104 b may also be operated by anoperational element 290, such as via one of theoperational control actuators 230 c of theactuation assembly 200, to grasp the tissue. The firstgrasping device 104 a may remain deployed to grasp tissue on the first side of the defect as the secondgrasping device 104 b is deployed to grasp tissue on the second side of the defect. - While the
device 100 has been described as deploying twograsping devices grasping devices 104 may be deployed on multiple sides of the defect. For example, thedevice 100 may include more than twograsping devices 104 or moregrasping device 104 may be loaded into thedevice 100 to be subsequently deployed after the first two graspingdevices - As shown in
FIG. 5D , one or both graspingdevices respective actuation elements translational control actuators 230 a may be actuated to proximally retract theactuation elements devices devices 104 are retracted. The retraction of one or both graspingdevices devices devices catheter 302. - After the grasping
devices devices tissue recruiting assembly 102 may be used with an over-the-scope (OTS) clip or a through-the-scope (TTS) clip to close the defect. In embodiments including an OTS clip, the graspingdevices 104 may retract and recruit tissue into the OTS housing. In embodiments including a TTS clip, the graspingdevices 104 may recruit the tissue into the distal end of thecatheter 302. The OTS clip may be released (deployed) via theactuation assembly 200 or may be released via a separate controller. - In some embodiments, after the recruited tissue has been cinched with a tissue closure mechanism, such as an OTS or TTS clip, the grasping
devices 104 and/or theactuation elements 208 may be decoupled or otherwise disengaged from the tissue. For example, theoperational element 290 may be actuated to open thegrasping device 104 to release the tissue. The graspingdevices 104 and/or theactuation elements 208 may be withdrawn or otherwise retracted from the closed defect. - The grasping
devices 104 may be end effectors capable of grasping target tissue, such as via one ormore actuation elements 208 and/or one or moreoperational elements 290. As shown inFIG. 6 , thetissue recruiting assembly 102 includes a firstgrasping device 104 a having a plurality ofhelical coils 114 extending in a spiral or corkscrew manner and a secondgrasping device 104 b having at least onemovable jaw 113. Thehelical coils 114 of the firstgrasping device 104 a may be configured to grasp tissue as the firstgrasping device 104 a is spiraled or screwed into the tissue. Themovable jaw 113 of the secondgrasping device 104 b may be opened and closed to grasp tissue. The graspingdevices actuation assembly 200 ofFIGS. 1-2 . - The first
grasping device 104 a may be operated via afirst actuation element 208 a operable to translate and rotate the firstgrasping device 104 a such that the firstgrasping device 104 a grasps tissue. For example, thefirst actuation element 208 a may translate and rotate the firstgrasping device 104 a, such as via theactuation assembly 200, such that the firstgrasping device 104 a spirals or screws into tissue such that the firstgrasping device 104 a grasps the tissue. - The second
grasping device 104 b may be operated via asecond actuation element 208 b and anoperational element 290. Thesecond actuation element 208 b may translate and rotate the secondgrasping device 104 b, such as via theactuation assembly 200, such that the secondgrasping device 104 b is properly positioned above target tissue. Theoperational element 290 may be distally extended, such as by actuation of theoperational control actuator 230 c, such that the secondgrasping device 104 b grasps tissue, such as tissue on the other side of a defect from the firstgrasping device 104 a. The distal extension of theoperational element 290 may rotate themovable jaw 113 about a pivot such that themovable jaw 113 opens to grasp tissue. After the tissue is positioned between themovable jaw 113 and the remainder of the secondgrasping device 104 b, theoperational element 290 may be proximally retracted (e.g., theoperational control actuator 230 c may be released) such that themovable jaw 113 pivots closed with the tissue grasped between themovable jaw 113 and the remainder of the secondgrasping device 104 b. Further, the graspingdevice 104 may have more than onemovable jaw 113, such as twomovable jaws 114 that rotate about a central pivot. In the illustrated schematic, theoperational element 290 extends outside theactuation element 208. However, it will be understood that theoperational element 290 may extend through the interior of theactuation element 208. - While the illustrated embodiment includes a first
grasping device 104 a withhelical coils 114 operable by oneactuation element 208 a and a secondgrasping device 104 b with amovable jaw 113 operable by anactuation element 208 b and anoperational element 290, it will be understood that thedevice 100 may have other assemblies and configurations. - Referring now to
FIGS. 7-19C thetissue recruiting device 100 includes anactuation assembly 200 according to one embodiment configured to independently maneuver and operate the one or moregrasping devices 104. In some embodiments, theactuation assembly 200 is operable to control the position and rotation of the graspingdevice 104, such as to grasp tissue with the graspingdevice 104. Theactuation assembly 200 may also be configured to actuate or otherwise control the operation of eachgrasping device 104, such as to open and close the graspingdevice 104 to grasp tissue. - The
actuation assembly 200 may be operable to independently control twograsping devices 104, such as graspingdevices 104 with helical coils 114 (e.g.,FIG. 18 ), to independently grasp tissue at different locations, such as on opposite sides of a defect. Theactuation assembly 200 includes abody 202 extending from aproximal end 204 to adistal end 206. Thebody 202 may be sized, shaped, and configured such that thebody 202 may be comfortably grasped in the hand of a user. In the illustrated embodiment, thebody 202 of theactuation assembly 200 is substantially cylindrical with a narrowed distal portion. However, it will be understood that thebody 202 may be other shapes and configurations suitable for a user to grasp during operation. While thedevice 100 has been described as grasping opposite sides of a defect, it will be understood that tissue may be grasped at other locations. For example, thedevice 100 may be used to grasp tissue in the center of a defect. - In some embodiments, as shown in
FIGS. 8-9 , thebody 202 includes afirst half 202 a and asecond half 202 b which are joined together to form thebody 202. In some embodiments, the first andsecond halves body 202 may be separated into first andsecond halves body 202 may be assembled around theactuation elements 208. - Optionally, as shown in
FIGS. 10-11 , the actuation assembly may also include acover 228 configured to be at least partially disposed around thebody 202. Thecover 228 may be sized, shaped, and configured such that thecover 228 may be comfortably grasped in the hand of a user. In some embodiments, thecover 228 is configured to retain the first andsecond halves body 202 together when thecover 228 is disposed around thebody 202. The proximal end of thecover 228 may be substantially open or hollow such that thecover 228 may be slid over thebody 202 and such that theactuation elements 208 may be manipulated, such as described below. -
FIGS. 12-14 show thebody 202 with thesecond half 202 b removed. Thebody 202 includes afirst channel 210 extending the length of thebody 202 from theproximal end 204 to thedistal end 206. Thebody 202 also includes asecond channel 214 extending the length of thebody 202 from theproximal end 204 to thedistal end 206. The first andsecond channels actuation elements 208. In some embodiments, the first andsecond channels body 202 with thefirst channel 210 mirroring thesecond channel 214. - The
first channel 210 defines a first proximal opening 212 (e.g.,FIG. 9 ) in theproximal end 204 of thebody 202 and thesecond channel 214 defines a secondproximal opening 216 in theproximal end 204 of thebody 202. The first and secondproximal openings actuation element 208 to extend proximally out of therespective channel proximal openings actuation elements 208, such as to receive an actuation sheath therethrough, as described below. The first and secondproximal openings actuation element 208 to be independently controlled, as described below. - The first and
second channels first portion 218 extending distally from the respectiveproximal opening first portions 218 of the first andsecond channels proximal opening second channels second portion 220 extending distally from thefirst portion 218. Thesecond portions 220 of the first andsecond channels second channels distal end 206 of thebody 202. Thefirst portions 218 of the first andsecond channels second portions 220. For example, thesecond portions 220 of thechannels actuation elements 208 therethrough and thefirst portions 218 may be sized to receive one of theactuation elements 208 and an additional component, such as an actuation sheath, therethrough. - The
second portions 220 of the first andsecond channels distal opening 222. Thedistal opening 222 may be sized, shaped, and configured such thatactuation elements 208 may extend from each of the first andsecond channels distal opening 222. While thebody 202 has been described as including a singledistal opening 222, it will be understood that thebody 202 may include adistal opening 222 for eachchannel - The
actuation assembly 200 may also include acontrol actuator 230 coupled with the proximal end of eachactuation element 208. Eachcontrol actuator 230 may be operable to control the position and rotation of one of theactuation elements 208grasping devices 104, as described below. Eachcontrol actuator 230 may be operable to independently control the position and rotation of therespective actuation element 208. Eachcontrol actuator 230 may be fixed to the proximal end of therespective actuation element 208. In some embodiments, eachcontrol actuator 230 is welded to the proximal end of therespective actuation element 208. In other embodiments, thecontrol actuators 230 are coupled to the proximal ends of theactuation elements 208 via adhesives, fasteners, over-molding, press-fitting, snap-fitting, or other similar methods. - Each
control actuator 230 may be sized, shaped, and configured such that it may be twisted by a user, such as between the user's thumb and first finger, to control the rotation of the graspingdevice 104. The control actuators 230 may be sized, shaped, and configured to be ergonomic for the user, make it easier to rotate and translate thecontrol actuators 230 andactuation elements 208, and make it easier for a user to complete a rotation without straining his/her fingers or hand. Eachcontrol actuator 230 may also have a width larger than theproximal openings control actuator 230 and theproximal end 204 of thebody 202 may prevent the proximal end of therespective actuation element 208 from being extended distally into thebody 202. As shown inFIG. 15 , thecontrol actuators 230 are substantially elongated hexagons. The elongated hexagonal shape of thecontrol actuators 230 may allow a user to grip and rotate thecontrol actuators 230, such as between a finger and a thumb, and also still feel comfortable and round to a user. However, it will be understood that thecontrol actuators 230 may have any suitable shape. For example, thecontrol actuators 230 may be circular, ovular, elliptical, triangular, rectangular, oblong, or other suitable shape. - While the
actuation assembly 200 has been described as having twochannels control actuators 230, it will be understood that theactuation assembly 200 may have other suitable configurations. For example, theactuation assembly 200 may have one or three or more channels and one or three ormore control actuators 230, such as corresponding to the number ofgrasping devices 104. - As shown in
FIG. 16 , theactuation assembly 200 may also include anactuation sheath 224 disposed around the proximal end of eachactuation element 208 and coupled with therespective control actuator 230. Theactuation sheaths 224 may be configured to assist in the control of the graspingdevice 104 during operation. For example, theactuation sheath 224 may limit the translational actuation distance of the graspingdevice 104 and/or may assist in transferring torque from thecontrol actuator 230 to theactuation element 208. Theactuation sheaths 224 may have an outer diameter sized to allow theactuation sheaths 224 to translate and rotate within thefirst portions 218 of thechannels actuation sheaths 224 may also have an outer diameter which prevents theactuation sheaths 224 from translating into thesecond portions 220 of thechannels actuation elements 208. Thefirst portion 218 of thechannels actuation sheaths 224 may have a length corresponding to the desired translational actuation distance of theactuation elements 208 and the graspingdevices 104. - In some embodiments, the
proximal openings first portions 218 of thechannels proximal openings actuation element 208 in embodiments without actuation sheaths 224) may translate and rotate within thechannels proximal openings actuation sheath 224 and/or theactuation element 208 in thechannel actuation element 208 and/oractuation sheath 224 is spaced apart from the walls of thechannels channel channels actuation sheaths 224 and/oractuation elements 208. The narrowerproximal openings actuation element 208 and/oractuation sheath 224 stays in thechannel - The
actuation sheaths 224 may each be a substantially hollow tube with an inner diameter configured to permit the proximal end of theactuation element 208 to extend therethrough. Eachactuation sheath 224 may comprise stainless steel. Additionally or alternatively, theactuation sheaths 224 comprise polyetheretherketone (PEEK), high density polyethylene (HDPE), low density polyethylene (LDPE), or ultra high molecular weight polyethylene (UHMW), polycarbonate (PC), acrylonitrile butadiene styrene (ABS), acrylic, a composite structure of these materials, or other suitable materials that allow for adequate stiffness for actuation, or combinations thereof. The proximal ends of theactuation element 208 and theactuation sheath 224 may be fixed to thecontrol actuator 230 such that theactuation element 208 andactuation sheath 224 each translate and rotate with the translation and rotation of thecontrol actuator 230. In some embodiments, the proximal end of theactuation element 208 is molded into therespective actuation sheath 224. - In some embodiments, as shown in
FIGS. 15 , eachcontrol actuator 230 includes abore 232 extending proximally into the distal end of thecontrol actuator 230. Thebore 232 may be configured to receive the proximal ends of theactuation element 208 and theactuation sheath 224. Thebore 232 may have a shape and a diameter substantially corresponding to the outer surface of theactuation sheath 224. The proximal ends of theactuation sheath 224 and theactuation element 208 may be fixed to the inner surface and/or a proximal end of thebore 232 to couple thecontrol actuator 230 with theactuation sheath 224 and theactuation element 208. While thecontrol actuator 230 andactuation sheaths 224 have been described as separate components, it will be understood that thecontrol actuators 230 andactuation sheaths 224 may be integrated into a single component (e.g.,FIGS. 38A-38B ). - In some embodiments, as shown in
FIG. 17A , theactuation element 208 extends through theactuation sheath 224 in a non-linear manner. For example, theactuation element 208 may meander in theactuation sheath 224 in an up and down and left and right manner such that theactuation element 208 is prevented or otherwise restricted from being retracted from theactuation sheath 224. The non-linear extension of theactuation element 208 through theactuation sheath 224 may further secure theactuation element 208 in theactuation sheath 224. Theactuation sheath 224 may include one ormore abutments 226 disposed within the interior of theactuation sheath 224 which cause theactuation element 208 to form a non-linear position when inserted into theactuation sheath 224 and/or which prevent or otherwise restrict theactuation element 208 from being linearly retracted from theactuation sheath 224. In other embodiments, theactuation sheath 224 may not includeabutments 226 and theactuation element 208 may be molded into theactuation sheath 224 in a non-linear manner, such as via the use of core pins which are removed after the molding process. - In some embodiments, as shown in
FIGS. 17B-17C , one ormore actuation elements 208 may have a non-circular cross-section, such as to reduce friction between theactuation element 208 between thecatheter 302 and/or thesheath 304. For example, theactuation elements 208 may have a cross-section which decreases the surface area of theactuation element 208 in contact with thecatheter 302 and/orsheath 304, such as during operation of thedevice 100. In the illustrated embodiment, theactuation element 208 has a substantially rectangular cross-section that is twisted. However, it will be understood that theactuation element 208 may have other shapes to decrease the friction between thecatheter 302 and/or thesheath 304. For example, theactuation element 208 may be ovular, elliptical, triangular, hexagonal, D-shaped, crescent-shaped, pie-shaped, grooved, or other suitable shape. - As shown in
FIGS. 17B-17C , theactuation element 208 may also be twisted to further decrease the frictional contact between theactuation element 208 and thecatheter 302 and/or thesheath 304. It will be understood that the twisting of theactuation element 208 also encompassesactuation elements 208 with helical and spiraled profiles. The twist of theactuation element 208 may also make it easier for a user to identify that theactuation element 208 is turning. Further, the twist of one of theactuation elements 208 may help a user identify whichactuation element 208 is being operated. For example, as shown inFIG. 17C , afirst actuation element 208 a with a rectangular cross-section that is twisted along the length of theactuation element 208 a is coupled with a firstgrasping device 104 a and asecond actuation element 208 b with a substantially circular cross-section is coupled with asecond actuation element 104 a. The difference in shapes between the first andsecond actuation elements actuation element device actuation assembly 200. In the illustrated embodiment, thefirst actuation element 208 a has a rectangular cross-section that is twisted along the length of theactuation element 208 and thesecond actuation element 208 b is substantially circular. However, it will be understood that both actuationelements 208 may have a rectangular cross-section that is twisted along the length of theactuation element 208. - In some embodiments, the
catheter 302 may be configured to increase the compressive resistance of thecatheter 302 during operation. As shown inFIGS. 17D-17G , thecatheter 302 may be a spring sheath wound into a spiraled coil with a plurality ofcompressions 303 disposed along the length of thecatheter 302. Thecompressions 303 may be formed by winding the coil into a narrower spiral at predetermined intervals along the length of thecatheter 302. - The
catheter 302 may also include a plurality ofstruts 305 extending across the cross-section of thecatheter 302 at predetermined intervals. Thestruts 305 may be formed by bending the coil across the cross-section of thecatheter 302 which may create thecompressions 303. Thestruts 305 may be substantially aligned such that thestruts 305 separate thecatheter 302, such as into lumens, such as to prevent theactuation elements 208 from tangling during operation. Thestruts 305 may define pseudo-lumens extending through thecatheter 302. In some embodiments, only the distal coil of thecatheter 302 is bent to form astrut 305, such as to separate theactuation elements 208 at the distal end of thedevice 100 and prevent theactuation elements 208 from tangling during operation. - As shown in
FIG. 18 , theactuation assembly 200 may be operable with twograsping devices 104 withhelical coils 114 configured to be spiraled into tissue to grasp the tissue. In the illustrated embodiment, theactuation assembly 200 includes afirst control actuator 230 a coupled with afirst actuation sheath 224 a and afirst actuation element 208 a to control the operation of a firstgrasping device 104 a. Theactuation assembly 200 also includes asecond control actuator 230 b coupled with asecond actuation sheath 224 b to control the operation of asecond actuation element 208 b. Thefirst actuation element 208 a and thefirst actuation sheath 224 a may extend through thefirst channel 210 and thesecond actuation element 208 b and thesecond actuation sheath 224 b may extend through thesecond channel 214. Theactuation assembly 200 is operable to independently control the deployment of the first and secondgrasping devices actuation assembly 200 is illustrated as independently controlling twograsping devices 104 withhelical coils 114, it will be understood that theactuation assembly 200 may be operable to control other types of graspingdevices 104. - Referring now to
FIGS. 19A-19C , theactuation assembly 200 may be moved from an unactuated configuration to an actuated configuration. The control actuators 230 of theactuation assembly 200 may be manipulated, such as by a user, to control the translation and rotation of theactuation elements 208 as theactuation assembly 200 is moved from the unactuated position to the actuated position. The control actuators 230 may be independently operated, such as to independently control graspingdevices 104 to grasp target tissue. For example, thecontrol actuators 230 may be independently operated to translate and rotate the first andsecond actuation elements helical coils 114 of the first and secondgrasping devices FIG. 18 ) spiral into tissue to securely grasp the tissue. - As shown in
FIG. 19A , in the unactuated position, thecontrol actuators body 202, such as a distance in which the graspingdevices 104 are disposed near the distal end of thecatheter 302. Theactuation elements channels body 202 with the proximal ends of theactuation elements proximal end 204 of thebody 202. - As shown in
FIG. 19B , theactuation assembly 200 may be moved from the unactuated position to a partially actuated position, such as to secure one of the graspingdevices 104 on a first side of a defect. Thefirst control actuator 230 a may be actuated to move the firstgrasping device 104 a to grasp target tissue at a first location. Thefirst control actuator 230 a may be depressed and/or rotated, such as by a user, to translate and rotate thefirst actuation element 208 a. For example, thefirst control actuator 230 a may be depressed and rotated to translate and rotate thefirst actuation element 208 a such that the firstgrasping device 104 a (FIG. 18 ) spirals into and grasps tissue on the first side of the defect. - The
first actuation sheath 224 a may control the translational distance of thefirst actuation element 208 a and the graspingdevice 104. Thefirst actuation sheath 224 a may be sized, shaped, or configured such that theactuation sheath 224 may translate and rotate within thefirst portion 218 of thefirst channel 210 and such that thefirst actuation sheath 224 a is prevented from translating into thesecond portion 220 of thefirst channel 210. For example, thefirst actuation sheath 224 a may have an outer diameter larger than the diameter of thesecond portion 220 of thefirst channel 210. The narrower diameter of thesecond portion 220 may prevent thefirst actuation sheath 224 a from being distally extended beyond thefirst portion 218 of thefirst channel 210. The abutment of the distal end of thefirst actuation sheath 224 and the proximal end of thesecond portion 220 of thefirst channel 210 may prevent further distal movement of thefirst actuation sheath 224 and thefirst actuation element 208 a, such as to control the linear actuation distance of thefirst control actuator 230 a, thereby controlling the translational movement of thegrasping element 104 a. - As shown in
FIG. 19C , theactuation assembly 200 may be moved from the partially actuated position to the fully actuated position. While theactuation assembly 200 is in the partially actuated position, the endoscope and/or thecatheter sheath assembly 300 may be manipulated such that the secondgrasping device 104 b is substantially aligned with a second location, such as the second side of the defect. The firstgrasping device 104 a may remain in grasping engagement at the first location (e.g., the first side of the defect). Thesecond control actuators 230 b may be actuated to move the secondgrasping device 104 b to grasp the target tissue at the second location. Thesecond control actuator 230 b may be depressed and/or rotated, such as by a user, to translate and rotate thesecond actuation element 208 b. For example, thesecond control actuator 230 b may be depressed and rotated to translate and rotate theactuation element 208 b such that the secondgrasping device 104 b (FIG. 18 ) spirals into and grasps tissue on the second side of the defect. Thesecond actuation sheath 224 b may also be sized, shaped, and configured to control the linear actuation distance of thesecond control actuator 230 b via abutment with the proximal end of thesecond portion 220 of thesecond channel 214, similarly to thefirst actuation sheath 224 a. - While the
actuation assembly 200 has been described as deploying the firstgrasping device 104 a via thefirst control actuator 230 a and then deploying the secondgrasping device 104 b via thesecond control actuator 230 b, it will be understood that theactuation assembly 200 may be actuated in other manners. For example, thesecond control actuator 230 b may be actuated to deploy the secondgrasping device 104 b before the firstgrasping device 104 a is deployed, the first andsecond control actuators control actuators devices device control actuator device - In some embodiments, the
actuation assembly 200 may be operated to release the grasp of one or both of the graspingdevices 104 from the tissue, such as if one or both of the graspingdevice devices control actuators grasping devices grasping device 104, therespective control actuator 230 may be proximally retracted from thebody 202 such that the graspingdevices 104 are retracted from the tissue and/or thecontrol actuator 230 may be rotated such that the graspingdevices 104 are released from the tissue. For example, thecontrol actuator 230 may be rotated in the direction opposite from the direction that thecontrol actuator 230 is rotated to engage tissue. - In some embodiments, after the
actuation assembly 200 has been moved to the fully actuated position such that the graspingdevices 104 grasp tissue on multiple sides of a defect, theactuation assembly 200 may be operated to recruit the grasped tissue, such as to deploy a closure mechanism. After the graspingdevices 104 have been properly deployed in tissue, thecontrol actuators 230 may be translated proximally such that theactuation elements 208 and the graspingdevices 104 are retracted toward theactuation assembly 200. The control actuators 230 may be retracted back to the unactuated position (FIG. 19A ). The retraction of theactuation elements 208 and the graspingdevices 104 may recruit the grasped tissue toward thecatheter 302. After the tissue is recruited, a closure mechanism, such as a clip, may be disposed around the recruited tissue, such as to close the defect. - Referring now to
FIGS. 20-30B andFIGS. 36A-38G , theactuation assembly 200 may also include one ormore biasing elements 234 configured to maintain the linear and rotational position of theactuation element 208 in therespective channel element 234 extends into the first andsecond channels element 234 contacts theactuation element 208 and/oractuation sheath 224 extending through therespective channel element 234 may exert a biasing force on each of theactuation elements 208 to prevent or otherwise restrict theactuation element 208 from translating and rotating within therespective channel element 234 is configured to maintain thecontrol actuators 230 in a desired position. The biasingelement 234 may be an additional element or may form a portion of thebody 202. - As shown in
FIGS. 20-26 , the biasingelement 234 may be a leaf spring. The biasingelement 234 may be bulb-shaped or elliptical and disposed in a proximal portion of thebody 202 such that the lateral sides of the biasingelement 234 extend into each of thechannels element 234 may be bent or crimped such that the lateral sides of the biasingelement 234 may exert a biasing force on theactuation elements 208 and/oractuation sheaths 224 extended through thechannels actuation element 208 and/or theactuation sheath 224 from translating and/or rotating in thechannel element 234 may comprise stainless steel or plastic, or combinations thereof. - In some embodiments, the
body 202 includes a biasingelement receiving portion 236 configured to receive thebiasing element 234. The biasingelement receiving portion 236 may be disposed substantially between thechannels proximal end 204 of thebody 202. The biasingelement receiving portion 236 may be a recess extending into the adjacent faces of the first andsecond halves body 202. The biasingelement receiving portion 236 may be sized, shaped, and configured to receive thebiasing element 234 in a normal or unbiased position such that the lateral sides of the biasingelement 234 extend into each of thechannels element receiving portion 236 may also be sized, shaped, and configured to permit thebiasing element 234 to depress or otherwise conform when theactuation element 208 and/or theactuation sheath 224 is extended through thechannel element 234 may exert a biasing force on theactuation element 208 and/or theactuation sheath 224. The biasingelement receiving portion 236 may also retain thebiasing element 234 such that the biasingelement 234 is held in place at a proximal portion of thebody 202 and prevents the biasingelement 234 from moving around in thebody 202. - In some embodiments, the
actuation assembly 200 also includes acap 238 configured to be inserted or otherwise disposed in theproximal end 204 of thebody 202. Thecap 238 may be configured to couple the first andsecond halves body 202 together. Thecap 238 may also leave space in thebody 202 for the biasingelement 234 to be inserted after thehalves FIGS. 27A-27B , thecap 238 may includeprongs 240 extending distally with flanges or projections which engage with detents in the proximal ends of the first andsecond halves cap 238 is inserted into theproximal end 204 of thebody 202, theprongs 240 may couple with the detents of the first andsecond halves second halves - The
cap 238 may also close theproximal end 204 of thebody 202 and assist in aligning theactuation elements 208. In some embodiments, thecap 238 includes acutout 242 on each side of thecap 238. Eachcutout 242 may define an edge or side of one of theproximal openings cap 238 may abut or otherwise contact the biasingelement 234 such that the biasingelement 234 remains in the desired position within thebody 202, such as in the biasingelement receiving portion 236. For example, thecap 238 may abut the biasingelement 234 such that the biasingelement 234 remains in position within thebody 202 when the biasingelement 234 moves between the relaxed position and the biasing position. Thecap 238 may include aledge 244 extending between theprongs 240 and defining a space, such as a slot, between theledge 244 and the proximal end of thecap 238. The proximal end of the biasingelement 234 may include projections extending radially inwardly toward a center of thebody 202 and separated by a gap. When the biasingelement 234 is disposed in the biasingelement receiving portion 236 and thecap 238 is coupled to theproximal end 204 of thebody 202, the radially inward projections of the biasingelement 234 may extend around theledge 244 and into the gap between theledge 244 and the proximal portion of thecap 238. The disposition of the projections of the biasingelement 234 in the gap of thecap 238 may maintain thebiasing element 234 in the biasingelement receiving portion 236 as the biasingelement 234 is moved between the relaxed position and the biasing position, such as to ensure the radially inward projections of the biasingelement 234 are in a bent position to maintain the shape of the biasingelement 234. - In some embodiments, as shown in
FIG. 28 , theactuation sheaths 224 may include a groove or narrowedportion 246 near the distal end of theactuation sheath 224. The narrowedportion 246 may be a rounded or grooved channel extending circumferentially around a distal portion of theactuation sheath 224 and extending radially inwardly from the remainder of the outer surface of theactuation sheath 224. When theactuation assembly 200 is in the unactuated configuration, theactuation sheaths 224 may be inserted into the first andsecond channels portion 246 of eachactuation sheath 224 disposed adjacent to the biasingelement 234. The disposition of the narrowedportion 246 adjacent to the biasingelement 234 may permit thebiasing element 234 to move to its relaxed state, such as when thedevice 100 is packaged. The narrowedportion 246 may also be disposed a predetermined distance from thecontrol actuator 230, such as a distance from thecontrol actuator 230 corresponding to the starting or undeployed position of the graspingdevices 104. In embodiments withoutactuation sheaths 224, theactuation elements 208 may include a similar narrowedportion 246. - While the
actuation assembly 200 has been described as including a single, leafspring biasing element 234 disposed in the biasingelement receiving portion 236, it will be understood that theactuation assembly 200 may have other suitable configurations and assemblies to maintain the translational and/or rotational positions of theactuation elements 208 and/oractuation sheaths 224 extending through thechannels element 234 may be a helical spring, a coil spring, a worm gear, or an assembly thereof, or other device configured to exert a biasing force on the one ormore actuation elements 208 and/oractuation sheaths 224 or may be a portion of thebody 202, as described below. Additionally, while theactuation assembly 200 has been described as including asingle biasing element 234 configured to exert a biasing force on each of theactuation elements 208, it will be understood that theactuation assembly 200 may include one ormore biasing elements 234 configured to exert a biasing force on one ormore actuation elements 208. - The
actuation assembly 200 may also include one ormore biasing elements 234 configured to prevent accidental operation of theactuation assembly 200 and/or to return thecontrol actuator 230 to the starting position, such as to recruit the grasped tissue toward thecatheter 302. As shown inFIG. 29 , theactuation assembly 200 includes a biasingelement 234 disposed around eachactuation element 208 between theproximal end 204 of thebody 202 and the distal end of therespective control actuator 230. The biasingelements 234 may be helical springs disposed around theactuation elements 208 such that theactuation elements 208 may rotate within the biasingelements 234. In the relaxed or unbiased position, the biasingelements 234 may space thecontrol actuators 230 from theproximal end 204 of thebody 202 such that the graspingdevices 104 are substantially disposed in the undeployed position. As thecontrol actuators 230 are manipulated to control the position and rotation of theactuation element 208 and the graspingdevice 104, the biasingelements 234 may compress such that the graspingdevices 104 may be deployed to grasp tissue. - While the
actuation assembly 200 has been described as including anadditional biasing element 234 operable to impart a biasing force on theactuation elements 208 which may maintain the position and rotation of theactuation element 208, theactuation assembly 200 may include other configurations and assemblies for maintaining the position and rotation of theactuation elements 208, such as when the user releases thecontrol actuators 230. Additionally or alternatively, as shown inFIGS. 30A-30B , the biasingelement 234 may be one ormore biasing projections 248 of thebody 202 extending laterally into or across one of thechannels projection 248 may extend laterally from an outer portion of thebody 202 at least partially across one of thechannels projections 248 may be molded or cut into thebody 202, such as into thehalves projections 248 may be connected to thebody 202 laterally beyond therespective channel respective channel projection 248 may be pivotable from a normal or relaxed position in which the biasingprojection 248 pivots upwardly into thechannel projection 248 pivots downwardly such that the biasingprojection 248 is disposed below the remainder of thechannel - The biasing
projections 248 may be biased or otherwise configured to normally project radially inwardly in thechannels actuation element 208 and/oractuation sheath 224 disposed through therespective channel projection 248 includes an engagement portion configured to engage the outer surface of theactuation element 208 and/oractuation sheath 224 disposed in thechannel projections 248 engage with theactuation elements 208 and/or theactuation sheaths 224, the biasingprojections 248 may exert a compressive and/or frictional force on theactuation elements 208, thereby preventing or otherwise restricting theactuation elements 208 and/or theactuation sheaths 224 from translating and/or rotating. In some embodiments, the biasingprojections 248 have a surface that is sized, shaped, or otherwise configured to correspond to the size and shape of theactuation elements 208 or theactuation sheaths 224 such that the biasingprojections 248 prevent or otherwise restrict theactuation elements 208 and/or theactuation sheaths 224 from translating and/or rotating when the biasingprojections 248 are engaged with theactuation elements 208 and/or theactuation sheaths 224. The biasingprojections 248 are configured to flex or otherwise bend radially outwardly from thechannel actuation element 208 is manipulated by a user. When the biasingprojections 248 are flexed away or otherwise disengaged from theactuation element 208, theactuation element 208 may translate and rotate within thechannel - Additionally or alternatively, the
actuation elements 208, theactuation sheaths 224, and/or thechannels actuation elements 208, such as when the user releases thecontrol actuators 230. For example, eachactuation element 208 and/oractuation sheath 224 may include one or more radially outward extending protrusions and/or one or more radially extending indents disposed along the length and around the outer surface of the proximal portion of theactuation element 208. The protrusions and indents may be formed by creating grooves or channels in theactuation element 208 and/oractuation sheath 224. Thebody 202 may correspondingly include one or more radially inward extending indents and one or more radially outward extending protrusions disposed along the length and around the inner surface of thechannels actuation element 208 may correspond with the indents and/or protrusions of thebody 202 at various positions and rotations of theactuation element 208 with respect to thebody 202. The interaction of the protrusions and/or indents of theactuation element 208 with the indents and/or protrusions of thebody 202 may prevent or otherwise restrict the linear and rotational movement of theactuation element 208 from such a position. The interaction may also provide detectable feedback to a user regarding the movement of theactuation element 208 and/oractuation sheath 224, as described below. - Referring now to
FIGS. 31-34B , theactuation assembly 200 may include one ormore clamps 250 configured to prevent or otherwise restrict the translational and rotational movement of theactuation elements 208, such as via frictional engagement with theactuation elements 208 and/oractuation sheaths 224. As shown inFIG. 31 , theclamp 250 may be disposed in thebody 202 between thechannels clamp 250 extends at least partially into eachchannel clamp 250 may contact eachactuation element 208 and/oractuation sheath 224 disposed through thechannels clamp 250 may be sized, shaped, and configured to impart a frictional force on theactuation elements 208 and/oractuation sheaths 224 disposed through thechannels clamp 250 and theactuation element 208 and/oractuation sheath 224 maintains the linear and rotational position of theactuation element 208 in thechannel control actuator 230. The frictional force may also be small enough that theactuation element 208 may easily be moved and rotated within thechannel control actuator 230. While the illustrated embodiment includes asingle clamp 250 disposed in thebody 202 to maintain the position and rotation of each of theactuation elements 208, it will be understood that theactuation assembly 200 may have other configurations and assemblies. For example, theactuation assembly 200 may include aseparate clamp 250 configured to extend into eachchannel actuation assembly 200 may includeclamps 250 disposed at two or more locations along the length of thechannels clamp 250 is biased to control the translation and rotation of theactuation element 208, such as by a spring. - As shown in
FIG. 32A-32B , theclamp 250 may be operably coupled to the proximal ends of each of theactuation elements 208 and/or actuation sheaths 224 (not shown), such as the portions of eachactuation element 208 between thebody 202 and thecontrol actuator 230, to maintain the translational and rotational position of theactuation elements 208. Theclamp 250 may have two or more engagement portions with each engagement portion configured to be disposed substantially around a proximal portion of one of theactuation elements 208 and/oractuation sheaths 224. The engagement portions may be substantially circular with a slit configured such that the engagement portion may be disposed around the outside surface of one of theactuation elements 208 and/oractuation sheath 224. The inner surface of the engagement portions may have a liner, such as an elastomer liner, configured to impart a frictional force on therespective actuation element 208 and/oractuation sheath 224. Theclamp 250 may maintain the rotational and translational positions of theactuation elements 208 when each engagement portion of theclamp 250 are disposed around theactuation elements 208. The engagement portions may be disposed around theactuation elements 208, such as after theactuation elements 208 have been linearly and rotationally positioned, and theclamp 250 may impart a frictional force on theactuation elements 208 sufficient to maintain the translational and rotational position of theactuation elements 208. - Additionally or alternatively, the
actuation assembly 200 may include aclamp 250 configured to be disposed around thecontrol actuators 230 to maintain the translational and/or rotational position of theactuation elements 208. Theclamp 250 may include one or more bores configured to receive thecontrol actuator 230. Each bore may be sized, shaped, and configured to be placed over one of thecontrol actuators 230 and to impart a frictional force on thecontrol actuator 230 to prevent or otherwise restrict thecontrol actuator 230 from rotating. The inner surface of each bore may have a liner, such as an elastomer liner, configured to impart a frictional force on therespective control actuator 230. Additionally or alternatively, the inner surface of each bore may include teeth or gripping members which engage thecontrol actuators 230. Theclamp 250 may be disposed around thecontrol actuator 230, such as after theactuation elements 208 have been rotationally positioned, and theclamp 250 may impart a frictional force on thecontrol actuators 230 sufficient to maintain the rotational position of theactuation elements 208. - As shown in
FIG. 33 , theactuation assembly 200 may include aclamp 250 disposed around eachactuation element 208 and/or actuation sheath 224 (not shown). Each clamp may be substantially tubular and operable to slide along the length of theactuation element 208 and/oractuation sheath 224. During operation, theclamps 250 may be disposed between thebody 202 and therespective control actuator 230 such that thecontrol actuator 230 may be manipulated to control the translation and rotation of theactuation element 208. After one of thecontrol actuators 230 has been manipulated to translate and/or rotate therespective actuation element 208, such as to deploy one of the graspingdevices 104 to grasp tissue, therespective clamp 250 may be slid distally along theactuation element 208 such that theclamp 250 is partially disposed in the respectiveproximal opening clamp 250 may be disposed between theproximal opening actuation element 208 and/oractuation sheath 224 such that translational and rotational position of theactuation element 208 is maintained. For example, theclamp 250 may wedge between the edge of theproximal opening actuation element 208 oractuation sheath 224 such that theactuation element 208 and/oractuation sheath 224 is prevented or otherwise restricted from rotating and translating. - After one of the
control actuators 230 has been manipulated and therespective clamp 250 has been moved to maintain the position of therespective actuation element 208, the process may be repeated with theother control actuator 230 and theother clamp 250. Additionally, either or bothclamps 250 may be proximally retracted from the respectiveproximal opening actuation elements 208 may be translated and/or rotated via therespective control actuator 230. In some embodiments, the inner and/or outer surface of theclamps 250 include protrusions or slots which correspond with protrusions and slots of thechannels proximal openings actuation elements 208, and/or theactuation sheaths 224 such that theclamp 250 operably interlocks with thebody 202, theactuation element 208, and/or theactuation sheath 224 to prevent or otherwise restrict the translation and rotation of theactuation element 208. - As shown in
FIGS. 34A-34B , thebody 202 may include twoclamps 250 disposed on theproximal end 204 of thebody 202 on either side of theactuation elements 208, such as near theproximal openings clamps 250 may be slidable along theproximal end 204 of thebody 202 between a first position in which theclamps 250 are spaced apart from the actuation elements 208 (FIG. 34A ) and a second position in which theclamps 250 contact the actuation elements 208 (FIG. 34B ). When theclamps 250 are in the first position, theactuation elements 208 are relatively unconstrained and may be translated and rotated freely. When theclamps 250 are in the second position, theclamps 250 may at least partially surround theactuation elements 208 such that the rotational and translational positions ofactuation elements 208 are maintained without user intervention. In such embodiments, theactuation elements 208 may have oblong cross-sections such that theclamps 250 maintain a better hold of theactuation elements 208. - Each
clamp 250 may be independently movable, such as to independently lock eitheractuation element 208. In some embodiments, theclamps 250 are slidable by a user. In other embodiments, theclamps 250 are biased, such as by a spring, toward theactuation elements 208 such that theclamps 250 engage theactuation elements 208 without user manipulation. Additionally, any of theclamps 250 ofFIGS. 31-33 , may be biased, such as via a spring, to contact theactuation elements 208 and/or and apply force to theactuation elements 208 to prevent or otherwise restrict theactuation elements 208 from moving or rotating. - Additionally or alternatively, the
actuation assembly 200 may include other configurations or assemblies configured to retain the position and/or rotation of theactuation elements 208. In some embodiments, theactuation assembly 200 includes a clasp disposed around theactuation elements 208 distal to thebody 202 and operable to engage with thebody 202. The clasp may be operably engaged with theactuation elements 208 to prevent or otherwise restrict the movement and/or rotation of theactuation elements 208, such as via friction or an interference fit with theactuation elements 208. Theactuation assembly 200 may also include an engagement element, such as a slider, button, or the like, disposed on an outer surface of thebody 202 or cover 228 and operable to engage one of the one ormore clamps 250 with theactuation elements 208 and/oractuation sheaths 224. For example, theactuation assembly 200 may include an engagement element on theproximal end 204 of thebody 202 and operable to laterally engage and disengage aclamp 250 around the outer surface of therespective actuation element 208 and/oractuation sheath 224 to maintain the position and rotation of theactuation element 208. - Additionally or alternatively, the
channels body 202 may be sized, shaped, and configured to impart a frictional force on theactuation elements 208 to maintain the linear and/or rotational position of theactuation elements 208 without input from a user. For example, the inner surface of thechannels channels actuation elements 208 and/oractuation sheath 224. The liner may be a woven wire which is disposed through thechannel channel actuation element 208 and/oractuation sheath 224. The frictional and/or compressive forces may be large enough such that the linear and rotational position of theactuation elements 208 are maintained without input from a user. The frictional and/or compressive forces may also be small enough such that theactuation element 208 may easily be moved and rotated within thechannel control actuator 230. - Further, the
actuation element 208 or theactuation sheath 224 may include a plurality of fins extending radially outwardly which control the position and rotation of theactuation element 208 and/or theactuation sheath 224. The fins may engage with the surface of thechannel actuation element 208 and/or theactuation sheath 224 to be easily rotated in one direction (e.g., the deployment direction) and which prevents or restricts rotation in the opposite direction (e.g., the release direction). The fins may be configured to maintain the position and rotation of theactuation element 208 and/or theactuation sheath 224 until a sufficient force is provided, such as by a user, to rotate and/or translate theactuation element 208 and/or theactuation sheath 224. The fins may also be configured to flip or change direction when sufficient force is applied such that theactuation elements 208 may rotate smoothly in the opposite direction. - As shown in
FIG. 35 , theactuation assembly 200 may include alock 292 configured to operably maintain the rotation and translation of theactuation elements 208 distally from thebody 202. Theactuation elements 208 may extend from thechannels lock 292. Thelock 292 may be coupled with thebody 202 and/or thecover 228. Thelock 292 may be movable between an unlocked position in which theactuation elements 208 may be translated and rotated through thelock 292 and a locked position in which the rotation and translation positions of theactuation elements 208 are maintained. Thelock 292 may have a constriction opening that is operable by rotation of thelock 292. For example, the lock may be rotated from the unlocked position such that the constriction opening closes around theactuation elements 208 in the locked position such that theactuation elements 208 are prevented or otherwise restricted from rotating or translating through thelock 292. In other embodiments, thelock 292 may be squeezable or compressible to move from the unlocked position to the locked position. - Referring now to
FIGS. 36A-38G , theactuation assembly 200, such as theactuation elements 208 and/or theactuation sheaths 224, may be configured to provide detectable feedback, such as tactile and/or auditory feedback, regarding the movement of theactuation element 208. The feedback may notify an operator at intervals of the amount theactuation element 208 has rotated and/or the amount theactuation element 208 has linearly translated. For example, the biasingelement 234 may abut the outer surface of theactuation sheath 224 or theactuation element 208 during operation to create audio and/or tactile feedback as theactuation element 208 is translated and/or rotated. While the illustrated embodiments describe the feedback as being generated by the biasingelement 234, the feedback may be similarly generated by a clamp 250 (e.g.,FIG. 31 ). - As shown in
FIGS. 36A-36B , theactuation elements 208 may have a non-circular cross section such that abutment between theactuation element 208 and the biasingelement 234 produces feedback, such as a click, at rotational intervals of theactuation elements 208 and/oractuation sheaths 224, such as each time theactuation element 208 is rotated a given amount. Theactuation element 208 may have a width in relation to the biasingelement 234 that varies as theactuation element 208 is rotated within thechannel actuation element 208 may be ovular, triangular, rectangular, or otherwise oblong such that the width of theactuation element 208 varies in relation to the biasingelement 234 as theactuation element 208 is rotated. Theactuation element 208 may have a first width or diameter at a first rotational position and a different second width or diameter at a second rotational position such that the variation between the first and second widths or diameters produces feedback which informs an operator of the rotation of theactuation element 208 and the graspingdevice 104. - It will be understood that the
actuation elements 208 of any of the other embodiments may be similarly ovular, triangular, rectangular, or otherwise oblong. Theactuation elements 208 may have a cross-sectional shape that is different than the cross-sectional shapes of thechannels catheter 302. For example, thechannels catheter 302 may be circular and theactuation elements 208 may be oblong. The difference in shapes ofactuation elements 208 from thechannels catheter 302 may reduce friction between theactuation elements 208 and thechannels 210 and/or the lumens of thecatheter 302, such as when theactuation elements 208 are translated and/or rotated. - As shown in
FIG. 36A , theactuation elements 208 may have a first width or diameter in a first rotational position such that theactuation elements 208 do not contact the biasingelement 234. As shown inFIG. 36B , theactuation elements 208 may have a second width or diameter in a second rotational position such that theactuation elements 208 contact the biasingelement 234. When one of theactuation elements 208 is rotated from the first rotational position to the second rotational position, the contact between theactuation element 208 and the biasingelement 234 may create an audible click and/or tactile feedback. The feedback may inform an operator of the amount theactuation element 208 has been rotated. - Additionally or alternatively, the
actuation element 208 and/or the biasingelement 234 may include one or more projections which produce similar feedback as theactuation element 208 is rotated a given amount. The feedback may correspond to a tissue engagement depth based upon the number of rotations of the graspingdevice 104. For example, theactuation elements 208 and the biasingelement 234 may be sized, shaped, and configured such that contact between the biasingelement 234 and one of theactuation elements 208 produces audible and/or tactile feedback every 90 degrees, every 180 degrees, or every 360 degrees that theactuation element 208 is rotated. - While the detectable feedback has been described as being created by contact between the biasing
element 234 and one of theactuation elements 208, it will be understood that the feedback may be created in other manners. For example, theactuation sheath 224 may have similarly varying widths or diameters which may contact the biasingelement 234 to produce feedback regarding the rotation of theactuation element 208. Additionally, thebody 202 of theactuation assembly 200 may be configured to similarly engage theactuation element 208 and/or theactuation sheath 224 to produce feedback as theactuation element 208 is rotated. - As shown in
FIGS. 37A-37B , theactuation elements 208 may include one ormore protrusions 252 extending radially outwardly from the remainder of theactuation element 208 and/or one ormore recesses 254 extending radially inwardly from the remainder of theactuation element 208 such that the biasingelement 234 produces detectable feedback, such as a click, each time theactuation element 208 is translated a given interval or distance. Theprotrusions 252 and therecesses 254 may extend circumferentially around theactuation element 208. Theprotrusions 252 may have a width that contacts the biasingelement 234 when theprotrusion 252 is laterally aligned with the biasingelement 234 and the recesses may have a width that does not contact the biasingelement 234 when therecess 254 is laterally aligned with the biasingelement 234. The variation in widths along the longitudinal axis of theactuation element 208 may produce feedback which informs an operator of the translation of theactuation element 208 and the graspingdevice 104. - As shown in
FIG. 37A , theactuation elements 208 may be disposed in thechannels protrusions 252 and recesses 254 are proximal to the biasingelement 234. As shown inFIG. 37B , theactuation elements 208 are distally extended through thechannels protrusions 252 contacts the biasingelement 234. The contact between theprotrusion 252 and the biasingelement 234 may produce feedback which informs the operator that theactuation element 208 has been extended a given distance. As theactuation elements 208 are subsequently extended through thechannels element 234 may alternate between not contacting therecesses 254 and contacting thesubsequent protrusions 252. The number of times the feedback has occurred, such as the number of clicks, may inform an operator of the distance theactuation element 208 has been extended. - The
protrusions 252 and recesses 254 may also be configured to control the movement of theactuation element 208 during operation. Theprotrusions 252 may be configured to contact the biasingelement 234 such that the translational and/or rotational position of theactuation element 208 is maintained when the biasingelement 234 abuts or otherwise contacts theprotrusions 252. For example, theprotrusions 252 may be disposed at varying positions along the length of theactuation element 208 such that the translational and rotational position of theactuation element 208 may be locked or otherwise maintained at various positions. Theactuation element 208 may be translated and rotated relatively freely when therecesses 254 are aligned with the biasingelement 234. - As shown in
FIGS. 38A-38G , theactuation assembly 200 may include biasingelements 234 extending into eachchannel actuation sheaths 224 and/oractuation elements 208, as described above. The biasingelements 234 and/oractuation sheaths 224 may also be sized, shaped, and configured to produce detectable feedback when theactuation sheaths 224 are rotated at predetermined intervals. In the illustrated embodiment, the biasingelements 234 are rounded, flexible portions of thebody 202 which extend partially into thechannels actuation sheaths 224 extending therethrough. The biasingelements 234 may be internally molded polymer springs molded into thebody 202. Theactuation sheaths 224 are integral with theactuation elements 208. Theactuation sheaths 224 may be a polymer over-molded onto theactuation element 208. Theactuation sheaths 224 may comprise a polymer, stainless steel, or a polymer and stainless steel composite assembly. - Each biasing
element 234 includes a tab or protrusion 235 (FIG. 38G ) which extends into theadjacent channel actuation sheath 224 as theactuation sheath 224 is rotated in the channel. Eachactuation sheath 224 may include alongitudinal channel 245 extending the length of the actuation sheath 224 (FIG. 38F ). Thelongitudinal channel 245 may be substantially flat. Thelongitudinal channels 245 and biasingelements 234 are configured such that the biasingelement 234 may flex outwardly and theprotrusion 235 may contact thelongitudinal channel 245 when theactuation element 208 is rotated into a position in which thelongitudinal channel 245 is aligned with the biasingelement 234. Thelongitudinal channels 245 and biasingelements 234 are also configured such that the biasingelement 234 may flex inwardly or disengage from thelongitudinal channel 245 andprotrusion 235 may contact the other portions of the outer surface of theactuation sheath 224 when thelongitudinal channel 245 is rotated out of alignment with the biasingelement 234. - As the
actuation sheaths 224 are rotated in thechannel elements 234 and theactuation sheaths 224 produces feedback detectable by a user at rotational intervals of theactuation elements 208 and/oractuation sheaths 224, such as each time the biasingelements 234 engage with and/or disengage from thelongitudinal channels 245. For example, the contact between the biasingelements 234 and theactuation sheaths 224 may produce a clicking sound and/or tactile feedback each time the biasingelements 234 engage with and/or disengage from thelongitudinal channel 245, such as every 360 degrees that thecontrol actuator 230 andactuation sheath 224 are rotated. In the illustrated example, theactuation sheaths 224 each include onelongitudinal channel 245. However, it will be understood that theactuation sheaths 224 may include other numbers oflongitudinal channels 245. For example, theactuation sheaths 224 may include twolongitudinal channels 245 on opposite sides of theactuation sheath 224 such that feedback is generated each time thecontrol actuator 230 andactuation sheath 224 are rotated 180 degrees, theactuation sheaths 224 may include threelongitudinal channels 245 equally spaced around theactuation sheath 224 such that feedback is generated each time thecontrol actuator 230 andactuation sheath 224 are rotated 120 degrees, or theactuation sheaths 224 may include fourlongitudinal channels 245 equally spaced around theactuation sheath 224 such that feedback is generated each time thecontrol actuator 230 andactuation sheath 224 are rotated 90 degrees. - In some embodiments, as shown in
FIG. 38F , eachcontrol actuator 230 includes anextrusion 247 extending laterally from one side of thecontrol actuator 230. Theextrusions 247 may indicate the relative rotational position of therespective actuation sheath 224,actuation element 208, and graspingdevice 104 to a user, such as in relation to the user's fingers during operation. Theextrusions 247 may be disposed on thecontrol actuators 230 such thatextrusions 247 extend up or down when thecontrol actuators 230,actuation sheaths 224,actuation elements 208, and/or graspingdevices 104 are in an undeployed and unrotated position, such as the position when thedevice 100 is packaged. As thecontrol actuator 230,actuation sheath 224, andactuation element 208 are rotated, theextrusion 247 may rotate around theactuation sheath 224 to indicate the relative orientation of the graspingdevice 104. While theextrusions 247 have been described as extending from thecontrol actuators 230 it will be understood that theextrusions 247 may similarly extend from the side of theactuation sheath 224. - In some embodiments, as shown in
FIG. 38E , thecover 228 includeswindows 249 disposed at the distal end of thecover 228. Thewindows 249 may make it easier to injection mold thecover 228. Thewindows 249 may also make it easier for a user to grasp thecover 228 during operation. Thewindows 249 may also reduce the overall cost of thedevice 100 and reduce the materials required to assemble thedevice 100. - While the feedback has been described as being created by contact between the biasing
element 234 and one of theprotrusions 252, it will be understood that the feedback may be created in other manners. For example, theactuation sheath 224 may have similarly varying widths or diameters which may contact the biasingelement 234 to produce feedback regarding the translation of theactuation element 208. Additionally, thebody 202 of theactuation assembly 200 may be configured to similarly engage theactuation element 208 and/or theactuation sheath 224 to produce feedback as theactuation element 208 is translated. - While the
actuation assembly 200 ofFIGS. 38A-38G has been described producing feedback regarding either rotation of theactuation element 208 or translation of theactuation element 208, it will be understood that theactuation assembly 200 may be configured and assembled to produce feedback regarding both rotation and translation of theactuation element 208. For example, theactuation elements 208 may have varying widths or diameters at different rotational positions for producing feedback regarding rotation of theactuation element 208 and also includeprotrusions 252 and/orrecesses 254 for producing feedback regarding translation of theactuation element 208. Additionally, any of theother actuation assemblies 200 described herein may include the biasingelements 234,protrusions 235,longitudinal channels 245, and extrusions 247 described inFIGS. 38A-38G . - As shown in
FIG. 39 , theactuation assembly 200 may include astrain relief tube 260 and adistal coupler 262. Thestrain relief tube 260 may be disposed around the one ormore catheters 302 and theactuation elements 208. Thestrain relief tube 260 may have an inner diameter larger than thecatheter 302 such that thestrain relief tube 260 may be disposed around at least a proximal portion of thecatheter 302. Thestrain relief tube 260 may be operable to reduce the stress and/or strain of thecatheter 302 and/oractuation elements 208 during operation, such as to prevent thecatheter 302 and/oractuation elements 208 from buckling during operation. Thestrain relief tube 260 may comprise HDPE, PTFE, LDPE, PE, or other similar polymer, shape memory metal, such as Nitinol, stainless steel, a heat shrink, over-molded polymer tubing, flexible metal, or the like, or combinations thereof. In a preferred embodiment, thestrain relief tube 260 comprises HDPE. In some embodiments, thestrain relief tube 260 extends from the proximal end of thecatheter 302 to the distal end of thecatheter 302. In other embodiments, thestrain relief tube 260 extends along a proximal portion of thecatheter 302. - The
distal coupler 262 is configured to couple thebody 202 or thecover 228 with thecatheter 302 and/or thestrain relief tube 260. Thedistal coupler 262 may be coupled to thebody 202, thecover 228, thecatheter 302, and/or thestrain relief tube 260 via adhesives, welding, fasteners, over-molding, heat staking, or the like, or combinations thereof. In a preferred embodiment, thedistal coupler 262 is over-molded onto thecatheter 302 and/or thestrain relief tube 260 and is press-fit or snap-fit into the distal end of thecover 228. In some embodiments, thedistal coupler 262 includes one ormore ribs 264. The proximal end of thedistal coupler 262 may include arib 264 configured to maintain the rotational and positional coupling of thecover 228 and thedistal coupler 262. For example, therib 264 may fit in a slot of thecover 228 to prevent rotation of thecatheter 302 relative to thebody 202 andcover 228. The distal end of thedistal coupler 262 may also include one ormore ribs 264 configured to increase the rigidity of thedistal coupler 262 during operation. - In some embodiments, the
tissue recruiting device 100, such as theactuation assembly 200, may include markings or other indicia to assist operators in identifying and operating the graspingdevices grasping devices FIG. 18 ) includes markings or other indicia to assist operators in identifying between the first and secondgrasping devices grasping device 104 a includes first markings or indicia and the secondgrasping device 104 b includes second markings or indicia different than the first markings or indicia to assist operators in identifying between the first and secondgrasping devices grasping device 104 a may have a different color than the secondgrasping device 104 b. In some embodiments, the corresponding catheter 302 (or lumen of the catheter 302) and/or the correspondingactuation element 208 may also include markings or other indicia corresponding to the graspingdevices grasping devices - In some embodiments, the
actuation assembly 200 may also include markings or other indicia to assist operators in identifying the components of theactuation assembly 200 for controlling the respective graspingdevices translational control actuators 230 a,rotational control actuator 230 b, and optionaloperational control actuators 230 c may include markings or other indicia which correspond to the corresponding graspingdevice - Referring now to
FIGS. 40-50 , theactuation assembly 200 may have other configurations and assemblies for independently controlling the graspingdevices 104. For example, theactuation assembly 200 may have a different number ofcontrol actuators 230, a different configuration or combination ofcontrol actuators 230, a different number ofbodies 202, and different methods of independently translating, rotating, and, optionally, operating the graspingdevices 104 via theactuation elements 208 andoperational elements 290. - As shown in
FIG. 40 , the actuation assembly may havetranslational control actuators 230 a for independently controlling the translation of theactuation elements 208 and separaterotational control actuators 230 b for independently controlling the rotation of theactuation elements 208. Thetranslational control actuators 230 a may be sliders which are translationally coupled to the distal end of theactuation elements 208 such that the translational position of theactuation elements 208 may be controlled via translation of the respective control actuator 230 a. Therotational control actuators 230 b may be rotating wheels which are rotationally coupled with theactuation elements 208 such that the rotational position of theactuation elements 208 may be controlled via rotation of therespective control actuator 230 b. - The
body 202 includes twolongitudinal slots 280 toward the proximal end of thebody 202. Thelongitudinal slots 280 may extend through thebody 202. Eachlongitudinal slot 280 is configured to receive one of thetranslational control actuators 230 a such that thetranslational control actuator 230 a may slide within thelongitudinal slot 280. In some embodiments, thelongitudinal slots 280 have a length in the longitudinal direction substantially equivalent to the desired translational actuation distance of theactuation element 208 and the graspingdevice 104. - The
body 202 also includes alateral slot 282 distal to thelongitudinal slots 280. Thelateral slot 282 is configured to receive therotational control actuators 230 b in a lateral arrangement such that eachrotational control actuator 230 b may be independently rotated in thelateral slot 282. While thebody 202 has been described as including a singlelateral slot 282 for receiving bothcontrol actuators 230 b, it will be understood that thebody 202 may include alateral slot 282 for eachcontrol actuator 230 b or thelateral slots 282 may be proximal to thelongitudinal slots 280. Further, thebody 202 may include a biasing element, such as a spring, disposed in thelateral slots 282 and operable to bias therotational control actuator 230 b, such as to provide linear and rotational control. - The channels of the
body 202 may be configured such that eachactuation element 208 extends through one of therotational control actuators 230 b in thelateral slot 282 and couples with thetranslational control actuator 230 a disposed in the correspondinglongitudinal slot 280. Eachactuation element 208 extends through the respectiverotational control actuator 230 b such that theactuation element 208 may translate proximally and distally through therotational control actuator 230 b. Eachactuation element 208 is coupled with therotational control actuator 230 b such that the rotation of therotational control actuator 230 b translates into rotation of theactuation element 208 and the graspingdevice 104. For example, therotational control actuator 230 b may have an internal channel with a size, shape, or configuration operable with the size, shape, and configuration of theactuation element 208 to rotate theactuation element 208 while permitting theactuation element 208 to translate freely through therotational control actuator 230 b. - The proximal end of each
actuation element 208 couples with the respectivetranslational control actuator 230 a such that the translation of the respectivetranslational control actuator 230 a in thelongitudinal slot 280 translates into translation of theactuation element 208 and the corresponding graspingdevice 104. Theactuation element 208 may be coupled with thetranslational control actuator 230 a such that theactuation element 208 may rotate independently within thetranslational control actuator 230 a. For example, the proximal end of theactuation element 208 may be coupled to thetranslational control actuator 230 a via a ball-and-socket joint, bearings, a rotary coupling, a slip ring, or other rotationally permissible coupling. - The
body 202 may be mirrored such as to allow for better alignment of graspingdevices 104 during operation. In some embodiments, thecontrol actuators body 202 such that thecontrol actuators body 202. - In some embodiments, as shown in
FIGS. 41A-41B , theactuation assembly 200 may includecontrol actuators 230 linearly arranged along the length of thebody 202 with eachcontrol actuator 230 operable to control the translation and rotation of one of the graspingdevices 104. For example, thecontrol actuators 230 may be linearly aligned such that thebody 202 is slimmer and easier to hold. - The
body 202 may include twolongitudinal slots 280 longitudinally aligned between the proximal and distal ends of thebody 202. Eachlongitudinal slot 280 includes acontrol actuator 230 slidably disposed within thelongitudinal slot 280. Eachcontrol actuator 230 is independently slidable in the respectivelongitudinal slot 280 to operably control the translation of one of theactuation elements 208. In the illustrated embodiment, theactuation assembly 200 includes afirst actuation element 208 a and asecond actuation element 208 b. As shown inFIG. 41B , theactuation elements - Each
longitudinal slot 280 may include aguide rail 278 extending the length of thelongitudinal slot 280. Eachcontrol actuator 230 may be slidably disposed on one of theguide rails 278 and thecontrol actuator 230 may be rotated on theguide rail 278 to operably rotate theactuation element 208. Eachlongitudinal slot 280 may have a length in the longitudinal direction substantially equivalent to the desired translational actuation distance of theactuation element 208 and the graspingdevice 104. - The
first actuation element 208 a extends proximally through thebody 202 and couples with thedistal control actuator 230. The proximal end of thefirst actuation element 208 a may be translationally and rotationally coupled with thedistal control actuator 230. For example, thefirst actuation element 208 a may be coupled with thedistal control actuator 230 such that thefirst actuation element 208 a translates as thedistal control actuator 230 slides along theguide rail 278 and rotates with rotation of thedistal control actuator 230. - The
second actuation element 208 b may extend proximally through thebody 202 below thecontrol actuators 230, as shown inFIG. 41B . Thesecond actuation element 208 b may extend into a channel or slot of thebody 202. The proximal end of thesecond actuation element 208 b may be coupled with theproximal control actuator 230 via one or more gears 274 (e.g.,FIGS. 41B, 46A-47B ; such as with a gear box 276). Thegears 274 may translate with the translation of theproximal control actuator 230 and may be configured to rotate with rotation of theproximal control actuator 230. Thesecond actuation element 208 b may be translationally and rotationally coupled with theproximal control actuator 230 via thegears 274. For example, thesecond actuation element 208 b may be coupled with theproximal control actuator 230 such that thesecond actuation element 208 b translates as theproximal control actuator 230 slides along theguide rail 278 and rotates with rotation of theproximal control actuator 230 via thegears 274. In the illustrated embodiment, the proximal end of thesecond actuation element 208 b is coupled to theproximal control actuator 230 with two ormore gears 274 disposed in series such that thesecond actuation element 208 b rotates in the same direction as theproximal control actuator 230. - Referring now to
FIGS. 42-44 , theactuation assembly 200 may include more than onebody 202 with eachbody 202 configured to independently control one of the graspingdevices 104. - As shown in
FIG. 42 , theactuation assembly 200 includes twobodies 202 each having atranslational control actuator 230 a operable to control the translation of one of theactuation elements 208 and arotational control actuator 230 b operable to control the rotation of theother actuation element 208. Eachbody 202 may include alongitudinal slot 280 configured to receive one of thetranslational control actuators 230 a such that thetranslational control actuator 230 a may slide within thelongitudinal slot 280. In some embodiments, thelongitudinal slots 280 have a length in the longitudinal direction substantially equivalent to the desired translational actuation distance of theactuation element 208 and the graspingdevice 104. Thetranslational control actuator 230 a may be coupled with one of theactuation elements 208 such that translation of theactuation element 208 transfers to theactuation element 208 and the graspingdevice 104. In some embodiments, thetranslational control actuator 230 a may be configured to rotate within thelongitudinal slot 280 with rotation of theactuation element 208. - The
longitudinal slot 280 extends through an opening at the proximal end of thebody 202. Eachrotational control actuator 230 b includes astem 286 which extends proximally into thelongitudinal slot 280 and couples with the proximal end of theactuation element 208. Thestem 286 may be coupled with the proximal end of one of theactuation elements 208 such that rotation of therotational control actuator 230 b transfers to theactuation element 208 and the graspingdevice 104. The stems 286 may be sized, shaped, and configured such that therotational control actuators 230 b may remain coupled to theactuation elements 208 as theactuation element 208 are translated. In some embodiments, thetranslational control actuators 230 a may be omitted and therotational control actuators 230 b may be operable to control the translation and rotation of theactuation elements 208. - As shown in
FIG. 43 , one or more of thebodies 202 of theactuation assembly 200 ofFIG. 43 may be operable to independently control the translation and rotation of one of the graspingdevices 104 as well as the operation (e.g., opening and closing) of the graspingdevices 104. Eachbody 202 may include anoperational control actuator 230 c disposed at the proximal end of thebody 202 and including astem 286 extending intolongitudinal slot 280 to couple with a proximal end of the respectiveoperational element 290. Eachoperational control actuator 230 c may be coupled with anoperational element 290 such that movement of theoperational control actuator 230 c may control the operation of the graspingdevice 104 coupled with theoperational element 290. - Each
actuation element 208 may couple with one of thecontrol actuators 230 disposed in thelongitudinal slot 280. The control actuators 230 may be slidable and rotatable within thelongitudinal slot 280 such that the rotation and translation of thecontrol actuator 230 transfers to theactuation element 208 and the graspingdevice 104. In some embodiments, theoperational elements 290 extend through thecontrol actuators 230 such that theactuation elements 208 may rotate and translate independently from theoperational control actuators 230 c and such that theoperational elements 290 may be maneuvered independently from thecontrol actuators 230. - In some embodiments, one or more of the
bodies 202 may include abiasing element 234 configured to keep thecontrol actuators 230 in the unactuated position when the biasingelement 234 is in the relaxed or normal state. For example, the biasingelement 234 may be a helical coil configured to bias thecontrol actuator 230 into the unactuated position and which may be compressed when thecontrol actuator 230 is distally translated to operate the graspingdevice 104. Theactuation element 208 and theoperational element 290 may extend through the biasingelement 234 such that theoperational element 290 may be translationally coupled with theoperational control actuator 230 c and theactuation element 208 may be translationally and rotationally coupled with thecontrol actuator 230. Theoperational control actuators 230 c may be similarly biased with a biasingelement 234 disposed between thebody 202 and theoperational control actuator 230 c. - In some embodiments, as shown in
FIG. 43 , theactuation assembly 200 includes one ormore locks 292 operable to lock or otherwise prevent the rotation and/or translation of theactuation element 208 and/or theoperational element 290. Thelocks 292 may be disposed along theactuation element 208 and theoperational element 290 between one of thebodies 202 and thecatheter 302. Thelock 292 may be movable between an open configuration which permits theactuation element 208 and theoperational element 290 to translate and rotate therethrough and a closed configuration which substantially maintains the translational and rotational positions of theactuation elements 208 and/oroperational elements 290 disposed therethrough. For example, thelock 292 may be a constriction orifice or valve which may be rotated to close the orifice such that thelock 292 moves from the open configuration to the closed configuration. In some embodiments, thelock 292 may maintain the translation and rotation of theactuation element 208 when the lock is in the closed position while allowing theoperational element 290 to be operated, such as when theoperational element 290 extends through the interior of theactuation element 208. - In the schematic illustration, each
lock 292 is disposed between thebodies 202 and thecatheter 302. However, it will be understood that thelocks 292 may be disposed in other manners. For example, thelocks 292 may be coupled with the distal ends of thebodies 202 or with the proximal end of thecatheter 302. Additionally, any of theother actuation assemblies 200 may include one ormore locks 292 operable to maintain the translation and/or rotation of theactuation elements 208 and/or theoperational elements 290. - As shown in
FIG. 44 , theactuation assembly 200 includes twobodies 202 each having acontrol actuator 230 operable to control the translation and rotation of theactuation element 208. Eachcontrol actuator 230 includes astem 286 which extends distally into achannel 210 extending through thebody 202. Thechannel 210 may have a distal opening sized and shaped to receive theactuation element 208 therethrough and to prevent thestem 286 from distally extending out of thechannel 210. Thechannel 210 also has a proximal opening sized and shaped to receive thestem 286 of thecontrol actuator 230 therethrough. Thestem 286 is operable to translate and rotate within the proximal portion of thechannel 210. Theactuation elements 208 may each extend from the distal end of thechannel 210 and into thecatheter 302. - The
actuation element 208 may be coupled with thecontrol actuator 230 such that thecontrol actuator 230 is operable to control the translation and rotation of theactuation element 208. Thecontrol actuator 230 is coupled with theactuation element 208 such that rotation of thecontrol actuator 230 transfers to theactuation element 208. Thestem 286 is linearly translatable within the proximal portion of thechannel 210 to control the translation of theactuation element 208. Thestem 286 and/or thechannel 210 may be sized, shaped, and configured such that thestem 286 is longitudinally movable within the channel 210 a distance substantially equivalent to the desired translational actuation distance of theactuation element 208 and the graspingdevice 104. The twocontrol actuators 230 of the twobodies 202 may be independently operated to independently control the translation and rotation of therespective actuation element 208 and graspingdevice 104. - Each
body 202 may include one ormore rings 288 configured for an operator to grasp during operation, such as to grasp while the operator manipulates therespective control actuator 230. For example, the operator may insert fingers through each of therings 288 to control thebody 202 and use his/her thumb or other hand to translate and/or rotate thecontrol actuator 230. - While the
actuation assemblies 200 ofFIGS. 42-44 have been described as including two substantiallysimilar bodies 202 to deploy the graspingdevices 104, it will be understood that theactuation assembly 200 may have other configurations and assemblies. For example, theactuation assembly 200 may have afirst body 202 with one ormore control actuators 230 operable to control the translation and rotation of a firstgrasping device 104, such as a graspingdevice 104 withhelical coils 114, and asecond body 202 with one ormore control actuators 230 operable to control the translation, rotation, and operation of a secondgrasping device 104, such as a graspingdevice 104 with amovable jaw 113 which may be opened and closed to grasp tissue. - Referring now to
FIGS. 45-47A , theactuation assembly 200 may include a singletranslational control actuator 230 a operable to control the linear position of theactuation elements 208, a singlerotational control actuator 230 b operable to control the rotation of theactuation elements 208. Theactuation assembly 200 may also include a singleoperational control actuator 230 c operable to control the operation of the graspingdevices 104, such as opening and closing the graspingdevices 104. - As shown in
FIG. 45 , theactuation assembly 200 includes afirst actuation element 208 a and a firstoperational element 290 a extending into thebody 202 on a first side and asecond actuation element 208 b and asecond operation element 290 b extending into thebody 202 on a second side. Thefirst actuation element 208 a and firstoperational element 290 a may be operable to control the operation of a firstgrasping device 104 a and thesecond actuation element 208 b and secondoperational element 290 b may be operable to control the operation of a secondgrasping device 104 b. - The
translational control actuator 230 a is slidable on aguide rail 278 within alongitudinal slot 280 to control the translational position of eitheractuation element operational control actuator 230 c is slidable on anotherguide rail 278 within anotherlongitudinal slot 280 to control the translational position of eitheroperational element rotational control actuator 230 b is a rotational wheel disposed at the proximal end of thebody 202 and configured to control the rotation of eitheractuation element - The
actuation assembly 200 also includes aselector 272 that is slidably disposed within alateral slot 282. Theselector 272 may be slidable between a first position (e.g., left), a second position (e.g., middle), and a third position (e.g., right). When theselector 272 is in the first position, thecontrol actuators first actuation element 208 a and the firstoperational element 290 a such that the firstgrasping device 104 a may be operated. When theselector 272 is in the third position, thecontrol actuators second actuation element 208 b and the secondoperational element 290 b such that the secondgrasping device 104 b may be operated. When theselector 272 is in the second position, thecontrol actuators actuation elements operational elements control actuators - As shown in
FIGS. 46A-46C , theselector 272 may operably couple thetranslational control actuator 230 a to thefirst actuation element 208 a (FIG. 46A ), thesecond actuation element 208 b (FIG. 46C ), or neither actuation element 208 (FIG. 46B ). Theselector 272 may be coupled with thetranslational control actuator 230 a and thetranslational control actuator 230 a may be slidable on aguide rail 278. As theselector 272 is moved in thelateral slot 282, thetranslational control actuator 230 a may be coupled with thefirst actuation element 208 a (FIG. 46A ), thesecond actuation element 208 b (FIG. 46C ), or neither actuation element 208 (FIG. 46B ). When thetranslational control actuator 230 a is coupled with eitheractuation element actuation element translational control actuator 230 a. Theoperational control actuator 230 c may be similarly controlled by theselector 272 to selectively couple with the firstoperational element 290 a, the secondoperational element 290 b, or neitheroperational element 290. - As shown in
FIGS. 47A-47B , theselector 272 may operably couple therotational control actuator 230 b to thefirst actuation element 208 a (FIG. 47A ), thesecond actuation element 208 b (FIG. 47B ), or neither actuation element 208 (e.g., a position betweenFIGS. 47A and 47B ). Theselector 272 may be coupled with one ormore gears 274 that slide or rotate with the selector. As theselector 272 is moved in thelateral slot 282, thegears 274 may rotate or slide such that therotational control actuator 230 b is rotationally coupled with thefirst actuation element 208 a, thesecond actuation element 208 b, or neitheractuation element 208. - In some embodiments, the
selector 272 may also be operable to control the directional coupling between thecontrol actuators actuation elements 208 and theoperational elements 290, such as between forward and reverse. In the illustrated embodiment, theselector 272 is a slider. However, theselector 272 may have other shapes, assemblies, and configurations. For example, theselector 272 may be a lever or arm, a rotatable dial, or the like. - While the
control actuator 230 a operable to control the linear position of theactuation elements 208 has been described as a slider, thecontrol actuator 230 a may have other configurations and assemblies. For example, thecontrol actuator 230 a may be a linear pull trigger coupled to a handle that a user may actuate by squeezing the trigger into the handle, a tangentially extending arm that may be actuated by pivoting the arm about a portion of thebody 202, or the like. - In some embodiments, the
actuation assembly 200 is configured to deploy one of the graspingdevices 104 via a single motion. Referring back toFIG. 29 , theactuation assembly 200 may include acontrol actuator 230 configured to be depressed by a user to move the graspingdevice 104 from the retracted position to the deployed position. For example, theactuation assembly 200 may be configured such that a downward depression or click of thecontrol actuator 230 deploys the graspingdevice 104. - The
control actuator 230 may be biased to the unactuated position by a biasingelement 234, such as a helical spring. The user may depress thecontrol actuator 230 by exerting sufficient downward force to overcome the biasingelement 234, such as to deploy the graspingdevice 104. The actuation element 208 (or actuation sheath 224) and thechannel actuation element 208 to sufficiently rotate as thecontrol actuator 230 is depressed. For example, thechannels channel control actuator 230 is depressed and theactuation element 208 is moved distally through thechannel 210, the projection of theactuation element 208 may ride within the spiral groove of thechannel 210 such that theactuation element 208 rotates and the graspingdevice 104 is sufficiently rotated to be deployed into tissue. - Referring now to
FIGS. 48-50 , eachactuation element 208 may be translationally and/or rotationally controlled in other manners. The illustrated manners of translational and/or rotation control may be implanted for any of theactuation assemblies 200 described herein. Eachbody 202 may include one ormore guide rails 278 extending along the length of thebody 202. Theactuation assembly 200 includes atranslational control actuator 230 a slidably disposed along the length of theguide rail 278. Thetranslational control actuator 230 a is coupled with theactuation element 208 such that translation of thecontrol actuator 230 a along theguide rail 278 is operable to control the translation of theactuation element 208 and graspingdevice 104. In some embodiments, theguide rails 278 may include a gear track. - The
actuation element 208 may be coupled with a mechanism operable to rotate theactuation element 208 independently from thetranslational control actuator 230 a. As shown inFIG. 48 , the distal end of theactuation element 208 is coupled with arotational control actuator 230 b operable to rotate theactuation element 208. Thecontrol actuator 230 b may be a rotating wheel that is disposed in line with theactuation element 208. - As shown in
FIG. 49 , therotational control actuator 230 b may be disposed perpendicularly to theactuation element 208. Therotational control actuator 230 b may be rotationally coupled with theactuation element 208 via agear box 276. Thegear box 276 may be coupled to thetranslational control actuator 230 a such that thegear box 276 and therotational control actuator 230 b slide in concert with thetranslational control actuator 230 a. Thegear box 276 may include one ormore gears 274 configured to transfer rotational movement or torque from therotational control actuator 230 b to theactuation element 208 such that theactuation element 208 rotates about an axis extending along the length of theactuation element 208. In the illustrated embodiment, thegear box 276 includes a rotatingwheel axis gear 274 a rotationally coupled with therotational control actuator 230 b, such as via a shaft, and ahelix axis gear 274 b coupled with the rotatingwheel axis gear 274 a and theactuation element 208. The rotation of therotational control actuator 230 b may rotate the rotatingwheel axis gear 274 a in the same plane as therotational control actuator 230 b and thehelix axis gear 274 b is configured and oriented to change the plane of rotation such that theactuation element 208 and graspingdevice 104 rotate about the longitudinal axis of theactuation element 208. - As shown in
FIG. 50 , theactuation assembly 200 includes a linear translatingmotor 294 operably to control the translational movement of theactuation element 208 and arotational motor 296 operable to control the rotation of theactuation element 208. The linear translatingmotor 294 may be coupled with thetranslational control actuator 230 a such that the linear translatingmotor 294 is operable to drive the translational position of thetranslation control actuator 230 a along theguide rail 278. Thetranslational control actuator 230 a may be a wheel or gear which is drivable along the length of theguide rail 278, such as on a gear track of theguide rail 278. Therotational motor 296 may be coupled with thegear box 276, such as to the rotatingwheel axis gear 274 a, such that therotational motor 296 is operable to drive the rotational position of theactuation element 208. - The
actuation assembly 200 may also include acontroller 298 in communication with the linear translatingmotor 294 and therotational motor 296 such that thecontroller 298 is operable to control the linear translatingmotor 294 and/or therotational motor 296. Thecontroller 298 may include user inputs mechanisms, such as buttons, joysticks, toggles, a mouse, and the like, such that a user may input commands to control the operations of the linear translatingmotor 294 and therotational motor 296 to control the position and rotation of theactuation element 208. For example, an operator may input commands into thecontroller 298 to actuate the linear translatingmotor 294 and/or therotational motor 296 to translate and/or rotate theactuation element 208 and the graspingdevice 104. - In some embodiments, the
tissue recruiting device 100 may be used with a snare or cutting device configured to cut the tissue recruited by the graspingdevices 104. In some embodiments, thetissue recruiting device 100 may be used with a closure mechanism, such as an OTS clip or a TTS clip, configured to cinch the tissue recruited by the graspingdevices 104. For example, a closure mechanism may be deployed through the endoscope after the graspingdevices 104 has been deployed to circumferentially close the defect. - As shown in
FIG. 51 , theactuation assembly 200 may incorporate or be coupled with aclip deployment system 400 operable to actuate and deploy a closure mechanism orclip 402, such as an OTS clip (FIGS. 52A-52E ). In the illustrated embodiment, theclip deployment system 400 is incorporated with thebody 202 of theactuation assembly 200. However, it will be understood that theclip deployment system 400 may have other configurations. For example, theclip deployment system 400 may be actuated via a separate body, handle, controller, or the like. - The
clip deployment system 400 may be operable to deploy theclip 402, such as independently from the operation of the graspingdevices 104. In some embodiments, the - The
clip deployment system 400 may include aclip deployment wire 404 configured to deploy theclip 402. Theclip deployment wire 404 may be configured to transfer translational movement or force to deploy theclip deployment wire 404. Theclip deployment wire 404 may be a solid cable, a hollow tube, or other suitable elongated object or combination of objects, such as a drive cable, a torque cable, a hypotube, spring sheath, or a catheter, configured to deploy theclip 402. - The proximal end of the
clip deployment wire 404 may be coupled with aclip actuator 406. Theclip actuator 406 may be coupled with theclip deployment wire 404 to control the linear translation of theclip deployment wire 404. In some embodiments, theclip actuator 406 is disposed in alongitudinal slot 280 in thebody 202 such that theclip actuator 406 may linearly translate within thelongitudinal slot 280. Theclip actuator 406 may be linearly translated, such as by a user, toward the distal end of thebody 202 to distally extend the distal end of theclip deployment wire 404 such that theclip 402 is deployed. Theclip 402 may be seated around the distal end of thecatheter 302 or a housing or shroud coupled to the distal end of thecatheter 302. The distal movement of theclip deployment wire 404 may push theclip 402 from its seated position such that theclip 402 is deployed, such as around recruited tissue as described below. - Referring now to
FIGS. 52A-52D , thetissue recruiting device 100 may be operable to recruit target tissue, such that theclip 402 may be deployed to cinch the recruited tissue. Thetissue recruiting device 100 may include at least a firstgrasping device 104 a coupled to afirst actuation element 208 a and a secondgrasping device 104 b coupled to asecond actuation element 208 b distally extended through acatheter 302. The graspingdevices devices 104 described herein. Theclip 402 may be seated around aclip deployment housing 408 coupled to and extending distally from the distal end of thecatheter 302. The distal end of theclip deployment wire 404 may contact the proximal end of theclip 402 when theclip 402 is in an undeployed position. While theclip 402 has been described as being disposed around theclip deployment housing 408 in the undeployed position, it will be understood that theclip 402 may have other suitable positions in the undeployed position. For example, theclip 402 may be disposed around a cover or shroud for the graspingdevices 104 or seated around the distal end of aseparate catheter 302. - After a defect is identified, the endoscope and/or the
device 100 may be oriented above the defect with theclip 402 seated around theclip deployment housing 408. The graspingdevices 104 may be used to approximate two or more sides of the defects and may be recruited or pulled into theclip deployment housing 408. Theclip 402 may then be deployed around the sides of the defect to circumferentially close the defect. - As shown in
FIG. 52A , the firstgrasping device 104 a may be operated, such as via theactuation assembly 200, to grasp tissue on a first side of the defect. For example, thefirst actuation element 208 a may be rotated and translated such that the firstgrasping device 104 a securely grasps the tissue. - As shown in
FIG. 52B , the secondgrasping device 104 b may be operated, such as via theactuation assembly 200, to grasp tissue on a second side of the defect. The endoscope and/orcatheter 302 may be manipulated such that the secondgrasping device 104 b is in a position above the second side of the defect when thesecond actuation element 208 b is manipulated to control the secondgrasping device 104 b. For example, thesecond actuation element 208 b may be rotated and translated such that the secondgrasping device 104 b securely grasps tissue. - As shown in
FIG. 52C , the first andsecond actuation elements catheter 302. Theactuation elements actuation assembly 200, such that the graspingdevices catheter 302. The graspingdevices clip deployment housing 408. - As shown in
FIG. 52D , theclip deployment wire 404 may be actuated, such as via theclip actuator 406, to deploy theclip 402 from theclip deployment housing 408 and around the recruited tissue. Theclip deployment wire 404 may be distally translated to push theclip 402 distally off theclip deployment housing 408. Theclip 402 may be configured to cinch or otherwise constrict around the recruited tissue after theclip 402 is deployed from theclip deployment housing 408. For example, theclip 402 may be biased to move to a closed position after theclip 402 is deployed from theclip deployment housing 408. Theclip 402 may close around the recruited tissue to further close the defect. In some embodiments, the graspingdevices 104 a/b and/or theactuation elements clip 402 is deployed. -
FIG. 53 illustrates anexemplary methodology 500 relating to controlling a tissue recruiting device via an actuation assembly to recruit tissue. While the methodology is shown as being a series of acts that are performed in a sequence, it is to be understood and appreciated that the methodology is not limited by the order of the sequence. For example, some acts can occur concurrently with another act. Further, in some instances, not all acts may be required to implement the methodology described herein. - At
step 502, grasping devices are positioned above an identified defect. The grasping devices may be incorporated into a tissue recruiting assembly of a tissue recruiting device. The grasping devices may be coupled to an actuation assembly via actuation elements such that a user may control the position and rotation of the grasping devices. The grasping devices may be extended through a catheter which is inserted through an endoscope to the desired location. In some embodiments, the grasping devices include helical coils configured to pierce and spiral into tissue to grasp the target tissue. - At
step 504, a control actuator is moved to translate the first grasping device. As described above, the control actuator of the actuation assembly is coupled to the first grasping device via a first actuation element. The control actuator is operable to control the translation of the first grasping device via the first actuation element. The control actuator may be controlled by a user such that the first grasping device is disposed substantially above a first side of the defect. In some embodiments, the control actuator is a translational control actuator operable to control the linear position of the first grasping device. - At
step 506, a control actuator is moved to rotate the first grasping device. As described above, the control actuator of the actuation assembly is coupled to the first grasping device via a first actuation element. The control actuator is operable to control the rotation of the first grasping device via the first actuation element. The control actuator may be controlled by a user such that the first grasping device is rotated into position to grasp tissue on the first side of the defect. In some embodiments, the control actuator is a rotational control actuator operable to control the rotation of the first grasping device. In other embodiments, the control actuator is the same control actuator used instep 504 such that a single control actuator is operable to control the translation and rotation of the first grasping device via the first actuation element. - At
step 508, a first side of the defect is grasped with the first grasping device. In some embodiments, an operational control actuator is coupled to the first grasping device via a first operational element. The operational control actuator may be actuated to operate the first grasping device to grasp tissue, such as by opening and closing a movable jaw to grasp tissue, via the first operational element. In other embodiments, one or more control actuators may be manipulated to translate and rotate the first grasping device via the first actuation element such that the first gasping device pierces into and securely grasps tissue on the first side of the defect. - At
step 510, a control actuator is moved to translate the second grasping device. The endoscope and/or the catheter may be maneuvered such that the second grasping device is disposed substantially above the second side of the defect. As described above, the control actuator of the actuation assembly is coupled to the second grasping device via a second actuation element. The control actuator is operable to control the translation of the second grasping device via the second actuation element independently from the first grasping device. The control actuator may be controlled by a user such that the second grasping device is disposed substantially above a second side of the defect. The first grasping device may continue to grasp tissue on the first side of the defect as the second grasping device is translated via the second actuation element. In some embodiments, the control actuator is a translational control actuator operable to control the linear position of the second grasping device. In some embodiments, the control actuator is different from the control actuator used to translate the first grasping device instep 504. - At
step 512, a control actuator is moved to rotate the second grasping device. As described above, the control actuator of the actuation assembly is coupled to the second grasping device via the second actuation element. The control actuator is operable to control the rotation of the second grasping device via the second actuation element independently from the first grasping device. The control actuator may be controlled by a user such that the second grasping device is rotated into position to grasp tissue on the second side of the defect. The first grasping device may continue to grasp tissue on the first side of the defect as the second grasping device is rotated via the second actuation element. In some embodiments, the control actuator is a rotational control actuator operable to control the rotation of the second grasping device. In other embodiments, the control actuator is the same control actuator used instep 510 such that a single control actuator is operable to control the translation and rotation of the second grasping device via the second actuation element. In some embodiments, the control actuator is different from the control actuator used to rotate the first grasping device instep 506. - At
step 514, a second side of the defect is grasped with the second grasping device. In some embodiments an operational control actuator is coupled to the second grasping device via a second operational element. The operational control actuator may be actuated to operate the second grasping device to grasp tissue, such as by opening and closing a movable jaw to grasp tissue, via the second operational element. The operational control actuator may be different from the operational control actuator ofstep 512. In other embodiments, one or more control actuators may be manipulated to translate and rotate the second grasping device via the second actuation element such that the second grasping device pierces into and securely grasps tissue on the second side of the defect. - At
step 516, the actuation elements are retracted to recruit the tissue grasped by the first and second grasping devices. As described above, one or more control actuators may be controlled to proximally retract the actuation elements such that the grasping devices are retracted toward the catheter. Additionally, before the actuation elements are retracted to recruit the tissue, one or more of the grasping devices may be released from the tissue and the above steps may be repeated such that the grasping devices grasp tissue at the desired locations. The catheter may also be advanced distally from the endoscope, such as to close the defect away from the endoscope and prevent the endoscope from restricting the movement of the actuation elements. - Optionally, at
step 518, a clip is deployed around the recruited tissue to substantially close the defect. The clip may be a hemostatic clip which is deployed circumferentially around the recruited tissue to substantially close the tissue. As described above, a clip actuator may be actuated to deploy the clip via a clip deployment wire. The clip actuator may translate the clip deployment wire such that the clip is pushed off a clip deployment housing to cinch or close the recruited tissue. - It is to be understood that the detailed description is intended to be illustrative, and not limiting to the embodiments described. Other embodiments will be apparent to those of skill in the art upon reading and understanding the above description. Moreover, in some instances, elements described with one embodiment may be readily adapted for use with other embodiments. Therefore, any products, methods and/or systems described herein are not limited to the specific details, the representative embodiments, and/or the illustrative examples shown and described. Accordingly, departures may be made from such details without departing from the spirit or scope of the general aspects of the present disclosure.
- Additionally, the components and materials described hereinafter as making up the various embodiments are intended to be illustrative and not restrictive. It should be appreciated that many suitable components and materials that would perform the same or a similar function as the materials described herein are intended to be embraced within the scope of embodiments of the present disclosure.
Claims (20)
1. An actuation assembly of a tissue recruiting device operable to independently control first and second grasping devices to grasp tissue:
a body defining a first channel and a second channel;
a first actuation element extending through the first channel and coupled with the first grasping device;
a second actuation element extending through the second channel and coupled with the second grasping device;
at least one first control actuator operable to control the translation and rotation of the first grasping device to grasp tissue via the first actuation element;
at least one second control actuator operable to control the translation and rotation of the second grasping device to grasp tissue via the second actuation element;
wherein the at least one first control actuator is operable to control the translation and rotation of the first grasping device independently from the second grasping device.
2. The actuation assembly of claim 1 , further comprising an actuation sheath disposed around the proximal ends of each of the actuation elements.
3. The actuation assembly of claim 1 , further comprising a biasing element configured to maintain the translation and rotation of the actuation elements.
4. The actuation assembly of claim 1 , wherein the biasing element is configured to produce detectable feedback at rotational intervals of the actuation elements.
5. The actuation assembly of claim 3 , wherein the second actuation element is operable to control the translation and rotation of the second grasping device when the first control actuator controls the translation and rotation of the first grasping device.
6. The actuation assembly of claim 1 , wherein the at least one first control actuator comprises a rotational control actuator operable to control the rotation of the first actuation element and a translational control actuator operable to control the translation of the first actuation element.
7. The actuation assembly of claim 6 , wherein the rotational control actuator is disposed perpendicularly to the first actuation element.
8. The actuation assembly of claim 6 , wherein the at least one first control actuator is operable to control the translation and rotation of the second grasping device to grasp tissue via second first actuation element.
9. A tissue recruiting device comprising:
a first grasping device and a second grasping device, each grasping device operable to grasp tissue;
a first actuation element extending through a first channel of a body, a proximal end of the first actuation element being coupled to a first control actuator and a distal end of the first actuation element being coupled to the first grasping device;
a second actuation element extending through a second channel of the body, a proximal end of the second actuation element being coupled to a second control actuator and a distal end of the second actuation element being coupled to the second grasping device;
wherein the first control actuator is independently operable to translate and rotate the first gasping device to grasp tissue via the first actuation element;
wherein the second control actuator is independently operable to translate and rotate the second grasping device to grasp tissue via the second actuation element.
10. The tissue recruiting device of claim 9 , wherein the first grasping device may grasp tissue at a first location and the second grasping device may be moved to grasp tissue at a second location different from the first location.
11. The tissue recruiting device of claim 9 , wherein each grasping device includes a plurality of helical coils configured to grasp tissue.
12. The tissue recruiting device of claim 9 , wherein the control actuators are operable to retract the grasping devices when the grasping devices grasp tissue.
13. The tissue recruiting device of claim 9 , wherein the grasping devices and actuation elements are extended through a catheter.
14. The tissue recruiting device of claim 9 , wherein the control actuators are elongated hexagons.
15. The tissue recruiting device of claim 9 , further comprising a clamp configured to frictionally maintain the translation and rotation of the actuation elements.
16. A method for treating a defect with a tissue recruiting device, the method comprising the steps of:
positioning a first grasping device above a first side of the defect;
moving a first control actuator to control the translation and rotation of the first grasping device via a first actuation element;
grasping the first side of the defect with the first grasping device;
positioning a second grasping device above a second side of the defect;
moving a second control actuator to control the translation and rotation of the second grasping device via a second actuation element;
grasping the second side of the defect with the second grasping device; and
retracting the actuation elements to recruit the grasped tissue.
17. The method of claim 16 , wherein each grasping device includes helical coils configured to grasp tissue.
18. The method of claim 16 , wherein the second control actuator may control the translation and rotation of the second grasping device independently from the first grasping device.
19. The method of claim 16 , wherein the tissue recruiting device includes a biasing element configured to maintain the translation and rotation of the actuation elements.
20. The method of claim 16 , further comprising the step of deploying a clip around the recruited tissue.
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US18/199,848 US20230404595A1 (en) | 2022-05-20 | 2023-05-19 | Large tissue defect recruiting device |
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US18/199,848 US20230404595A1 (en) | 2022-05-20 | 2023-05-19 | Large tissue defect recruiting device |
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US18/199,848 Pending US20230404595A1 (en) | 2022-05-20 | 2023-05-19 | Large tissue defect recruiting device |
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US18/199,888 Pending US20230371938A1 (en) | 2022-05-20 | 2023-05-19 | Large tissue defect recruiting device |
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US4694544A (en) * | 1986-08-22 | 1987-09-22 | Jon Chapman | Releasable connector |
US5511564A (en) * | 1992-07-29 | 1996-04-30 | Valleylab Inc. | Laparoscopic stretching instrument and associated method |
US5336230A (en) * | 1992-11-04 | 1994-08-09 | Charles S. Taylor | Endoscopic suture tying method |
US7384423B1 (en) * | 1995-07-13 | 2008-06-10 | Origin Medsystems, Inc. | Tissue dissection method |
US6126665A (en) * | 1997-05-01 | 2000-10-03 | Yoon; Inbae | Surgical instrument with arcuately movable offset end effectors and method of using the same |
US6976957B1 (en) * | 1998-06-22 | 2005-12-20 | Origin Medsystems, Inc. | Cannula-based surgical instrument and method |
US20030187457A1 (en) * | 2002-04-02 | 2003-10-02 | Weber John A. | Apparatus and method for removing an object from a body |
US9993231B2 (en) * | 2013-11-20 | 2018-06-12 | Covidien Lp | Devices, systems, and methods for navigating a biopsy tool to a target location and obtaining a tissue sample using the same |
US11083580B2 (en) * | 2016-12-30 | 2021-08-10 | Pipeline Medical Technologies, Inc. | Method of securing a leaflet anchor to a mitral valve leaflet |
JP7392950B2 (en) * | 2018-03-23 | 2023-12-06 | 株式会社ジェイ・エム・エス | Biological tissue collection instrument, biological tissue collection device, and biological tissue collection method |
EP4027915A1 (en) * | 2019-11-05 | 2022-07-20 | Boston Scientific Scimed, Inc. | Tissue acquisition helix device |
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