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EP-4437929-B1 - ENDOSCOPIC SUTURING SYSTEM HAVING EXTERNAL INSTRUMENT CHANNEL

EP4437929B1EP 4437929 B1EP4437929 B1EP 4437929B1EP-4437929-B1

Inventors

  • MITELBERG, VLADIMIR
  • NEUDECK, THOMAS
  • MIMS, John
  • GILKEY, Ryan
  • GILKEY, LANDON

Dates

Publication Date
20260513
Application Date
20170809

Claims (9)

  1. A distal cap apparatus (50) for use with an endoscope (12) having a proximal end and a distal end and a longitudinal axis extending therebetween, comprising: a mount (350) configured for mounting to the distal end of the endoscope; and a strap (392) connected to the mount (350) and configured for banding about the distal end (44) of the endoscope when the distal end of the endoscope is received in the mount, wherein the mount defines a strap slot (352) configured to receive an end (394) of the strap to configure the strap in a banded configuration, wherein the strap slot (352) and the strap (392) are configured such that once the distal end of the endoscope is positioned as desired with respect to the mount (350), the strap (392) can be pulled through the strap slot (352) to tighten the strap (392) against the endoscope to secure it to the mount (350), and wherein the strap slot (352) and the strap (392) are configured to provide resistance to pulling the strap (392) through the strap slot (352).
  2. The apparatus according to claim 1, wherein: the strap slot is dimensioned to compress the strap when the strap is in the strap slot, or the strap is frictionally engaged in the strap slot to retain the strap positioned relative to the strap slot.
  3. The apparatus according to claim 1 or claim 2 wherein: the strap is frictionally engaged in the strap slot to retain the strap positioned relative to the strap slot, and the mount defines a cutting blade slot (354) and a blade bearing surface (355), the cutting blade slot extending longitudinally in a direction intersecting with a pathway of the strap in the strap slot, and wherein the blade bearing surface extends in a plane at a fixed angle that intersects with a plane of the strap in the strap slot.
  4. The apparatus according to claim 1, 2 or 3, wherein: the mount has a locking tab (456) that extends into the strap slot and is configured to engage with the strap when the strap is in the strap slot.
  5. The apparatus according to claim 4, wherein the strap has a plurality of teeth and grooves that engage the locking tab when the strap is moved through the slot.
  6. The apparatus according to claim 4 or 5, wherein: the locking tab is configured to permit the strap to move in only one direction through the strap slot.
  7. The apparatus according to any of claims 1-6, wherein: the distal cap apparatus has a plurality of straps and the mount defines a plurality of strap slots corresponding to each of the straps.
  8. The apparatus according to any of the preceding claims, wherein: the strap is elastic.
  9. The apparatus according to any of claims 1-3 or 7-8 when not dependent on any of claims 4-6, further comprising a wedge (356) attached to the mount (350) by a hinge pin (358).

Description

CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Patent Application No. 15/468,962, filed March 24, 2017, and to U.S. Patent Application No. 15/233,737, filed August 10, 2016. BACKGROUND 1. Field The present invention relates to a treatment device which can be inserted into a body through a natural orifice with an endoscope or other steerable guide member. The present invention may be used to perform suturing on the tissue of a mammal, whether human or not, and whether or not alive, but is not limited thereto. 2. State of the Art US Pat. No. 7,344,545 to Takemoto discloses an endoscopic suturing system having many embodiments to perform a surgical operation. This suturing system generally comprises an assembly having first and second arms which are actuatable by a push rod to rotatably approach each other while one arm grasps tissue and the second arm drives a curved needle through the tissue. The system also includes a needle recovery member requiring a rigid alignment with the curved needle arm. While this system affords the ability to grasp thick tissue, the tissue grasping arm and the arrangement of the needle recovery member provides bulk to the system making it difficult to use in endoscopic procedures. Co-owned US Pat. Nos. 8,287,556 to Gilkey et al. describes a system that addresses various limitations of the system by Takemoto. Gilkey describes an endoscopic treatment device having a structure enabling a small profile for delivery while providing an end effector with both a wide opening and closing angle that produces the large needle force for piercing tissue to perform a surgical operation such as tissue approximation and suturing within the body. The Gilkey system comprises a transmission assembly coupled to a proximal handle assembly for operation outside of the body and a distal cap assembly where the cap assembly is adapted to engage the distal end of an endoscope. The transmission assembly is connected to a link mechanism and is actuated to cause a needle assembly having a needle holder arm and needle coupled to the cap assembly to move in a direction to puncture tissue and a direction to be removed from tissue. The endoscope to which the cap assembly is coupled has first and second instrument channels to receive cooperative devices therethrough. The first device is positioned within the first instrument channel of the endoscope and has a distal end adapted to receive and grasp the needle and a proximal end coupled to a handle assembly. The second device is positioned within the second instrument channel of the endoscope to engage tissue, and draw the tissue back into the path of the needle so that the tissue can be pierced by the needle as the needle is moved from an open to a closed position. While the Gilkey system works very well, it presently requires association with an endoscope having two instrument channels. This may limit use of the system to larger endoscopes with such features. However, smaller endoscopes are gaining favor. Such smaller endoscopes, with their smaller profile, can be more easily advanced through a natural orifice. However, the reduced profile of the smaller endoscopes cannot accommodate the two instrument channels required for the Gilkey suturing system. US 2014/0343358 A1 discloses detachable secondary imaging endoscopic devices that can be used in conjunction with an endoscope. US 2013/0134272 A1 discloses apparatuses to attach a first medical device to a second medical device. EP 1 875 869 B1 discloses a deployment system for introducing a surgical instrument in a patient's body. US 2005/149067 A1 discloses examples of endoscopic suturing systems. SUMMARY The invention is defined by the claims. An endoscopic suturing system includes an endoscope, a suturing device, a needle assembly movable through tissue by the suturing device, and first and second devices used in association with the suturing device. In accord with an embodiment, the endoscope can be a small profile endoscope, generally 5 - 10 mm in diameter, and can have one or more instrument channels, and optionally no instrument channel. As such, the number of instrument channels is not critical to operation of the system. The endoscope includes a distal end and a proximal end. The suturing device includes a distal cap assembly adapted to be mounted at the distal end of the endoscope, and transmission assembly extending between the cap assembly and a proximal handle adapted to apply a force to the transmission assembly and operate the cap assembly remotely from the distal cap assembly. The cap assembly includes a mount, a support bracket extending distally from the mount, and a needle arm rotatably mounted on the bracket. A bell crank is also rotatably mounted on the support bracket and engages the needle arm. The distal end of the transmission assembly is attached to the bell crank, such that when the transmission assembly is operated by the handle, movement of the bell cr