Abstract:
According to one aspect, an apparatus for treating tissue may include an elongate tube. The elongate tube may include a slot extending longitudinally along a first side of the elongate tube, a first elongate jaw member on a first side of the slot, and a second elongate jaw member on a second side of the slot. The apparatus may also include a shaft coupled to the elongate tube along a second side of the elongate tube. The first elongate jaw member may be movably coupled to the shaft, such that the first elongate jaw member may be movable toward the second elongate jaw member to converge tissue walls within the slot and cut the tissue walls within the slot.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of priority of U.S. Provisional Application No. 62/343,502, filed on May 31, 2016, which is incorporated herein by reference in its entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    Various aspects of the present disclosure relate generally to devices and related methods for gastrectomies. More specifically, the present disclosure relates to surgical devices and related methods for sleeve gastrectomies. 
       BACKGROUND 
       [0003]    A gastrectomy is a procedure which may involve surgical removal of a part of a subject&#39;s stomach. One type of gastrectomy, a sleeve gastrectomy, is a procedure that may be performed on a subject to facilitate weight loss. In a sleeve gastrectomy, a portion of the subject&#39;s stomach along the greater curvature of the stomach may be removed, leaving a sleeve-like structure (“gastric sleeve”) remaining. Conventionally, a sleeve gastrectomy may be performed laparoscopically, and may entail cutting the subject&#39;s stomach, and then stapling the subject&#39;s stomach to form the gastric sleeve. After undergoing such a procedure, the subject may be at risk of developing a post-surgical leak and associated fistulae at or near the location where the stomach was cut and/or stapled. Such leaks may complicate the subject&#39;s recovery from the procedure, and may be costly to treat. Thus, there remains a need for devices and related methods for gastrectomies, including sleeve gastrectomies, with improved capabilities and outcomes. 
       SUMMARY 
       [0004]    Aspects of the disclosure relate to, among other things, devices and related methods for gastrectomies. Each of the aspects disclosed herein may include one or more of the features described in connection with any of the other disclosed aspects. 
         [0005]    In one aspect of the present disclosure, an apparatus for treating tissue may include an elongate tube. The elongate tube may include a slot extending longitudinally along a first side of the elongate tube, a first elongate jaw member on a first side of the slot, and a second elongate jaw member on a second side of the slot. The apparatus may also include a shaft coupled to the elongate tube along a second side of the elongate tube. The first elongate jaw member may be movably coupled to the shaft, such that the first elongate jaw member may be movable toward the second elongate jaw member to converge tissue walls within the slot and cut the tissue walls within the slot. 
         [0006]    Aspects of the apparatus may include one or more of the features below. The first elongate jaw member may include a first engaging surface defining the first side of the slot, and the second elongate jaw member may include a second engaging surface defining the second side of the slot. The apparatus may include a first strip coupled to the first elongate jaw member, the first strip including a first engaging surface defining the first side of the slot. The apparatus may include a second strip coupled to the second elongate jaw member, the second strip including a second engaging surface defining the second side of the slot. The first strip may be detachable from the first elongate jaw member. The second strip may be detachable from the second elongate jaw member. The first strip may include a protrusion protruding from the first engaging surface. The second strip may include a recess shaped and sized to receive the protrusion. The protrusion and the recess may form at least one of a snap-fit connection and a press seal connection. A length of the protrusion may be equal to a length of the first strip. A length of the recess may be equal to a length of the second strip. The length of the first strip may be equal to a length of the first elongate jaw member. The length of the second strip may be equal to a length of the second elongate jaw member. The elongate tube may be movable between an extended configuration, in which the elongate tube has a first length, and a contracted configuration, in which the elongate tube has a second length, the second length being shorter than the first length. The elongate tube may be deflectable from a straight configuration to a curved configuration. At least one of the first elongate jaw member and the second elongate jaw member may include an electrode. The apparatus may include at least one grasping assembly, wherein the grasping assembly includes a base, a grasping element, and a strand extending between the base and the grasping element, and the grasping element may be configured for deployment from the base through the slot. The apparatus may include at least one of a suction orifice and a magnet on an interior surface of the elongate tube. The first elongate jaw member may include a plurality of support members, and a sleeve supported by the plurality of support members. 
         [0007]    In another aspect of the present disclosure, an apparatus for treating tissue may include a tubular member. The tubular member may include an opening extending longitudinally along a first side of the elongate tubular member. The tubular member also may include a first side portion having a detachable first engaging surface, wherein the detachable first engaging surface extends along a first side of the opening. The tubular member also may include a second side portion having a detachable second engaging surface, wherein the detachable second engaging surface extends along a second side of the opening. The apparatus also may include a shaft coupled to the elongate tubular member at a second side of the elongate member. The first side portion may be movably coupled to the shaft, such that the first side portion is movable toward the second side portion to move the detachable first engaging surface toward the detachable second engaging surface to converge tissue walls, and cut the tissue walls. One of the detachable first engaging surface and the detachable second engaging surface may include a protrusion, and the other of the detachable first engaging surface and the detachable second engaging surface may include a recess complementary to the protrusion. 
         [0008]    Aspects of the apparatus may include one or more of the features below. The detachable first engaging surface may be part of a first strip that is removably attached to a surface of the first side portion, and the detachable second engaging surface may be part of a second strip that is removably attached to a surface of the second side portion. The first strip may be ferromagnetic, and the second strip may include a material that is magnetically attracted by the first strip. 
         [0009]    In yet another aspect of the present disclosure, a method for treating tissue may include positioning an elongate tubular member adjacent tissue. The method also may include bringing a portion of the tissue through an opening extending longitudinally along a side of the elongate tubular member, to position two walls of the tissue between (a) a first side portion of the elongate tubular member having a first engaging surface, wherein the first engaging surface extends along a first side of the opening, and (b) a second side portion of the elongate tubular member having a second engaging surface, wherein the second engaging surface extends along a second side of the opening. The method also may include moving the first side portion toward the second side portion to move the first engaging surface toward the second engaging surface to converge the tissue walls toward one another and cut the tissue walls. Optionally, the method may include sealing the cut tissue walls via interlocking of the first engaging surface and the second engaging surface. 
         [0010]    It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary aspects of the present disclosure and together with the description, serve to explain the principles of the disclosure. 
           [0012]      FIGS. 1A and 1B  are perspective views of a clamp of an endoscopic surgical device in open and closed configurations, in accordance with aspects of the present disclosure. 
           [0013]      FIGS. 2A and 2B  are top views of a clamp of another endoscopic surgical device in open and closed configurations, in accordance with aspects of the present disclosure. 
           [0014]      FIGS. 3A and 3B  are top views of a clamp of yet another endoscopic surgical device in open and closed configurations, in accordance with aspects of the present disclosure. 
           [0015]      FIG. 4  is a top view of the clamp of  FIGS. 1A and 1B , and an instrument for guiding material into the clamp, in accordance with aspects of the present disclosure. 
           [0016]      FIGS. 5A and 5B  are top views of a clamp of another endoscopic surgical device, with a grasping assembly for guiding material into the clamp, in accordance with aspects of the present disclosure. 
           [0017]      FIG. 6  is a top view of a clamp of another endoscopic surgical device, with vacuum orifices for guiding material into the clamp, in accordance with aspects of the present disclosure. 
           [0018]      FIGS. 7A and 7B  are top views of a clamp of yet another endoscopic surgical device, with nozzles and magnets for guiding material into the clamp, in accordance with aspects of the present disclosure. 
           [0019]      FIG. 8A  is a partial top view of a clamp of yet another endoscopic surgical device, with a cutting element for cutting and/or sealing material, in accordance with aspects of the present disclosure. 
           [0020]      FIG. 8B  is a partial top view of a clamp of yet another endoscopic surgical device, with another cutting element for cutting and/or sealing material, in accordance with aspects of the present disclosure. 
           [0021]      FIGS. 9A and 9B  are top views of a clamp of yet another endoscopic surgical device, with features for adjusting the width of the clamp, in accordance with aspects of the present disclosure. 
           [0022]      FIGS. 10A-10C  are side views of a clamp of yet another endoscopic surgical device, with features for adjusting the length of the clamp, in accordance with aspects of the present disclosure. 
           [0023]      FIG. 10D  is a side view of the clamp of  FIGS. 10A-10C , with features for deflecting the clamp, in accordance with aspects of the present disclosure. 
           [0024]      FIGS. 11A-11E  are schematic diagrams illustrating a performance of a sleeve gastrectomy procedure, in accordance with aspects of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0025]    The present disclosure is drawn to devices and related methods for gastrectomies. Reference will now be made in detail to aspects of the present disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or similar reference numbers will be used through the drawings to refer to the same or like parts. The term “distal” refers to a portion farthest away from a user when introducing a device into a patient. By contrast, the term “proximal” refers to a portion closest to the user when placing the device into the patient. 
         [0026]      FIGS. 1A and 1B  show a distal end portion of an endoscopic surgical device  10 . Surgical device  10  may include a clamp  12 , a shaft  14 , and a handle (not shown). The handle may form a proximal end portion of surgical device  10 . Shaft  14  may extend from the handle to clamp  12 . Clamp  12  may be coupled to a distal end portion of shaft  14 . The handle may include one or more control members (not shown) configured to control operation of shaft  14  and/or clamp  12 . For example, the handle may include one or more of a rotatable steering knob, trigger, button, slider, or other suitable actuator, which may be coupled to one or more of a wire, drive shaft, gear assembly, motor, pneumatic line, or other suitable force transmission element, to control operations of clamp  12  and/or shaft  14  in the ways that are described below. 
       Clamp Features 
       [0027]      FIG. 1A  shows clamp  12  in an open configuration. Clamp  12  may include a first side portion or jaw member  16  and a second side portion or jaw member  18 . An opening  19  may be defined between free ends of first and second jaw members  16 ,  18  when clamp  12  is in the open configuration. Opening  19  may define a longitudinally-extending slot. Opening  19  may open into a central passage  20  through clamp  12 . Material  22 , which may include a tissue wall in a subject&#39;s body, such as stomach wall tissue, is shown in dashed line around clamp  12 . Material  22  may extend about outer surfaces of first and second jaw members  16 ,  18 . A portion of material  22 , which may be inverted, may be guided into central passage  20  via opening  19 .  FIG. 1B  shows clamp  12  in a closed configuration. The free ends of first and second jaw members  16 ,  18  may be moved toward each other (thus closing opening  19 ) to move clamp  12  to the closed configuration. The free ends of first and second jaw members  16 ,  18  may come into direct contact. Alternatively, the free ends of first and second jaw members  16 ,  18  may remain separate due, for example, to material  22  being trapped between the free ends. 
         [0028]    At least one of first and second jaw members  16 ,  18  may be movably coupled to shaft  14  to facilitate movement of clamp  12  between the open configuration and the closed configuration.  FIGS. 1A and 1B  show an example of clamp  12  where first and second jaw members  16 ,  18  are both movably coupled to shaft  14  (via, for example, a hinge connection), such that first and second jaw members  16 ,  18  pivot away from each other to move clamp  12  to its open configuration, and toward each other to move clamp  12  to its closed configuration. 
         [0029]      FIGS. 2A and 2B  show an endoscopic surgical device  110 , shaft  114 , clamp  112 , first jaw member  116 , second jaw member  118 , opening  119 , and central passage  120 , similar to those shown in  FIGS. 1A and 1B . Surgical device  110  differs in that first jaw member  116  may be movably coupled to shaft  114 , while second jaw member  118  may be fixedly coupled to shaft  114 . In this example, first jaw member  116  may pivot towards and away from second jaw member  118  while second jaw member  118  remains static, to move clamp  112  into the closed and open configurations, respectively. 
         [0030]      FIGS. 3A and 3B  show an endoscopic surgical device  210 , shaft  214 , clamp  212 , first jaw member  216 , second jaw member  218 , opening  219 , and central passage  220 , similar to those shown in  FIGS. 1A and 1B . Surgical device  210  differs in that first and second jaw members  216 ,  218  may be movably coupled to shaft  214  (via, for example, a linear drive connection) such that first and second jaw members  216 ,  218  may shift away from each other in a translational manner to move surgical device  210  into the open configuration, and first and second jaw members  216 ,  218  may shift toward each other to move surgical device  210  into the closed configuration (as shown by arrows in  FIG. 3B ). It is contemplated that first and second jaw members  216 ,  218  may include linear portions  224 ,  226  where they meet shaft  214  to facilitate the translational opening and closing movements. Alternatively, first jaw member  216  may be movably coupled to shaft  214  while second jaw member  218  may be fixedly coupled to shaft  214 , similar to the arrangement shown in  FIGS. 2A and 2B  (but with translational movements instead of pivoting). It is also contemplated that one or more of clamps  12 ,  112 ,  212 , and any other clamps described herein, may move between the open and closed configurations using a combination of pivoting and translational movements. 
         [0031]    As noted above, the handle (not shown) and any of shafts  14 ,  114 ,  214 , and any other shafts described herein, may include one or more control members (for example, a steering knob, trigger, button, slider, or other suitable actuator), and/or one or more force transmission elements (for example, a wire, drive shaft, gear assembly, pneumatic line, motor, or other suitable element), to cause movement of clamps  12 ,  112 ,  212 , and/or any other clamps described herein, between their respective open and closed configurations. Additionally or alternatively, the free ends of the first and second jaw members of clamps  12 ,  112 ,  212 , and/or any other clamps described herein, may be magnetized, with the free ends of each of the pairs having opposite polarity such that the free ends attract each other. In such an example, the open configuration may be attained by keeping the free ends far enough apart that the attractive force between them cannot draw them together, or by forcibly keeping the free ends apart via the one or more force transmission elements described above. 
         [0032]    While clamps  12 ,  112 ,  212  are each tubular and have a C-shaped cross-sectional profile in  FIGS. 1A, 1B, 2A, 2B, 3A, and 3B , it should be understood that other cross-sectional profiles may be used. For example, one or more of clamps  12 ,  112 ,  212  may have an elliptical cross-sectional profile, a D-shaped cross-sectional profile, a polygonal cross-sectional profile, or an irregularly-shaped cross sectional profile. The particular type of cross-sectional profile selected may depend on factors including, for example, the environment of use, the amount of material  22  to be clamped, cut, and sealed, and/or the type of material  22  to be acted on, among other factors. 
       Internalizing Material 
       [0033]    The insertion of material  22  into clamps  12 ,  112 ,  212 , and/or any other clamps described herein, may be carried out in any suitable manner. A few examples of ways in which the insertion of material  22  may be carried out will now be described with reference to  FIGS. 4, 5A, 5B, 6, 7A, and 7B . It should be understood that each of the ways shown in  FIGS. 4, 5A, 5B, 6, 7A, and 7B  may be used on its own, or used in combination with one or more of the others. 
         [0034]      FIG. 4  shows surgical device  10  with its clamp  12  in the open configuration, and with an instrument  28  guiding material  22  into central passage  20  via opening  19 . Instrument  28  may include, for example, a forceps. A user may open the forceps and close it on material  22  to grasp material  22 . The user may maneuver the forceps to push and pull the grasped material  22 . Instrument  28  may be introduced into the subject laparoscopically, such that it may engage an outer surface of material  22  to stuff material  22  through opening  19  and into central passage  20 , as shown in  FIG. 4 . Alternatively, instrument  28  may be introduced into the subject with surgical device  10 , such that it may be at least initially positioned within central passage  20 , may move out of central passage  20  via opening  19  to engage an inner surface of material  22 , and may pull material  22  into central passage  20  through opening  19 . It should be understood that material  22  in central passage  20  may, for example, have a cross-sectional shape of a single loop, a plurality of lobes, and/or a spiral roll, depending on how much material  22  is contained in central passage  20 . 
         [0035]      FIGS. 5A and 5B  show a surgical device  310 , shaft  314 , clamp  312 , first jaw member  316 , second jaw member  318 , opening  319 , and central passage  320  similar to those shown in  FIGS. 1A and 1B . In  FIG. 5A , material  22  is shown prior to being inserted into central passage  320  and extending around the outside of clamp  312 . Surgical device  310  may include a grasping assembly  330  for guiding material  22  into clamp  312 . Grasping assembly  330  may include a base  332 , a grasping element  334  (for example, a barb), and a strand  336  (for example, a string, filament, cable, or wire) connecting base  332  to grasping element  334 . Base  332  may be mounted on shaft  314 . Initially, grasping element  334  may be coupled to base  332 , with grasping element  334  facing away from base  332  and toward opening  319 . Strand  336  may be stored in shaft  314  and/or base  332 , or may hang freely from base  332 . Grasping element  334  may be propelled from base  332  as a projectile. The propulsion may be provided by, for example, pressurized gas in a pneumatic line (not shown) extending through shaft  14  and in communication with base  332 . Once fired, grasping element  334  may sail across central passage  320 , through opening  319 , and into material  22 . Grasping element  334  may at least partially penetrate and embed into material  22 , thereby coupling to material  22 . A user may pull a proximal end of strand  336 , or may actuate a mechanism (similar to a winch) in base  332 , shaft  314 , or the handle, to pull strand  336 . The pulling may draw material  22  through opening  319  and into central passage  320 , as shown in  FIG. 5B . Material  22  may be pulled until adjacent to, or in contact with, base  332 . It should be understood that a plurality of grasping assemblies may be provided on shaft  314 . The grasping assemblies may be, for example, aligned longitudinally along the surface of shaft  314  that faces opening  319 . The plurality of grasping assemblies may be fired simultaneously or at different times. Each of the strands of the grasping assemblies may be pulled at the same time or at different times. For example, the distalmost strand may be pulled first, followed by the strand proximal to the distalmost strand, after a delay. This pattern may be repeated going proximally to the proximalmost strand. 
         [0036]    Additionally or alternatively, strand(s)  336  and grasping element(s)  334  may be replaced by a relatively rigid cable or wire having a barbed or hooked tip. The cable/wire may be pushed to extend away from shaft  314 , through opening  319 , and into material  22 . After engaging material  22  with the barbed/hooked tip, the cable/wire may be pulled back toward shaft  314  to move material  22  through opening  319  into central passage  320 . 
         [0037]      FIG. 6  shows a surgical device  410 , shaft  414 , clamp  412 , first jaw member  416 , second jaw member  418 , opening  419 , and central passage  420  similar to those shown in  FIGS. 1A and 1B . One or more of first and second jaw members  416 ,  418  may include one or more suction orifices  438 . Each suction orifice  438  may be coupled to one or more suction lumens (not shown) in shaft  414 , first jaw member  416 , and/or second jaw member  418 . The one or more suction lumens may be coupled to a vacuum source (not shown). Clamp  412  may include a cap  440  covering a proximal end of central passage  420 . Cap  440  may include, for example, a flexible membrane that may be capable of covering central passage  420  when clamp  412  is in the open configuration, without hindering movement of clamp  412  into the closed configuration. Clamp  412  also may include a similar cap (not shown) covering a distal end of central passage  420 . The caps may help ensure that the suction force generated in central passage  420  by one or more suction orifices  438  may be concentrated at opening  419  to facilitate the drawing in of material  22  through opening  419  and into central passage  420 . It is contemplated that suction orifices  438  may be spaced circumferentially, as shown in  FIG. 6 , and/or longitudinally. Additionally or alternatively, suction orifices  438  may be activated simultaneously, or in sequence. For example, a distalmost suction orifice may be activated first, followed by the suction orifice proximal to the distalmost suction orifice, after a delay. This pattern may be repeated going proximally to the proximalmost suction orifice. 
         [0038]      FIGS. 7A and 7B  show a surgical device  510 , shaft  514 , clamp  512 , first jaw member  516 , second jaw member  518 , opening  519 , and central passage  520 , similar to those shown in  FIGS. 1A and 1B . One or more of shaft  514 , first jaw member  516 , and second jaw member  518  may include one or more nozzles  542 . Each nozzle  542  may be coupled to one or more fluid lumens (not shown) in shaft  514 , first jaw member  516 , and/or second jaw member  518 . The one or more fluid lumens may be coupled to a fluid source (not shown). The fluid source may include, for example, a supply of one or more of the following: a magnetic paint (for example, a fluid containing magnetic particles or beads); a polymer solution, sol-gel, particulate suspension, or melt, with magnetic particles or beads therein, that may exit nozzle(s)  542  in the form a liquid jet, and dry or cure in flight to form magnetic fiber(s); and/or any other magnetic material that can be sprayed onto a surface. One or more of the fluids may be sprayed onto material  22  via nozzle(s)  542 , as shown in  FIG. 7A . Additionally or alternatively, fluid(s) may be sprayed onto material  22  by one or more instruments  544  separate from surgical device  510 . The sprayed fluid(s) may stick to material  22 , coat material  22 , partially or fully solidify on material  22 , and/or may be absorbed into material  22 . The outer surface and/or the inner surface of material  22  may be sprayed. Once sprayed, material  22  may be drawn into central passage  520  by magnetic attraction between the applied fluid(s) and one or more magnets  546  on one or more of shaft  514 , first jaw member  516 , and second jaw member  518 , as shown in  FIG. 7B . It is contemplated that nozzles  542  may be spaced circumferentially, as shown in  FIGS. 7A, 7B , and/or longitudinally. Additionally or alternatively, nozzles  542  may be activated simultaneously, or in sequence from distal to proximal. It is also contemplated that magnets  546  may be spaced circumferentially and/or longitudinally. Additionally or alternatively, magnets  546  may be activated simultaneously, or in sequence from distal to proximal. 
       Clamping, Cutting, and Sealing 
       [0039]    Each of the above-described clamps may clamp and cut material  22  as the clamp moves toward the closed configuration. It should be understood that the following description of the manner in which clamping and cutting is performed with clamp  12  is applicable to clamps  112 ,  212 ,  312 ,  412 , and  512 . As shown in  FIG. 1A , material  22  may be positioned in central passage  20  and opening  19  in preparation for cutting to be performed. Clamp  12  may move toward the closed configuration to clamp and cut the portion of material  22  between a first engaging surface  48  of first jaw member  16  and a second engaging surface  50  of second jaw member  18 . The length of the cut may be equal to the lengths of first and second engaging surfaces  48 ,  50 . Alternatively, the length of the cut may be less than the lengths of first and second engaging surfaces  48 ,  50 , if a length of material  22  in opening  19  is less than the lengths of first and second engaging surfaces  48 ,  50 . 
         [0040]      FIGS. 8A and 8B  show examples of surgical devices with features for facilitating clamping and cutting of material  22 . For example,  FIG. 8A  shows a surgical device  610  including a first jaw member  616  having a first engaging surface  648  with a cutting element  652  in the form of a protrusion. Cutting element  652  may extend the full length of first engaging surface  648 . Cutting element  652  may have a sharp edge  654 . As first and second engaging surfaces  648 ,  650  are brought together, cutting element  652 , beginning with sharp edge  654 , may press (clamp) material  22  against second engaging surface  650 , and vice-versa. Continued movement may cause sharp edge  654  to cut material  22 . Sharp edge  654  may eventually come into direct contact with second engaging surface  650 , after fully cutting through material  22 . The cut portion of material  22 , which may include the portion of material  22  extending from a radially-inward facing side of cutting element  652  into central passage  620 , may be removed from the subject. It should be understood that cutting element  652  may have any other suitable cross-sectional shape including, for example, a semi-circular, polygonal, and/or irregular cross-sectional shape. It is contemplated that second engaging surface  650  may include a cutting element (not shown) similar to cutting element  652 . The cutting element of second engaging surface  650  may contact cutting element  652  to facilitate cutting in a manner similar to scissor blades. Additionally or alternatively, second engaging surface  650  may include a recess (not shown) for receiving at least a portion of cutting element  652 , thereby reducing or eliminating any gap between first engaging surface  648  and second engaging surface  650 . Additionally or alternatively, cutting elements may be positioned at any location along first engaging surface  648  and second engaging surface  650 , respectively, not just located along their centers. Additionally or alternatively, a plurality of cutting elements may be provided on first engaging surface  648  and/or second engaging surface  650 . Alternatively, neither of first and second engaging surfaces  648 ,  650  may have any cutting elements, and cutting may be performed by first and second jaw members  616 ,  618  by forcing first and second engaging surfaces  648 ,  650  together with sufficient pressure to squeeze material  22  out from between them. Eventually, material  22  may separate. Aspects of first and second jaw members  616 ,  618  may be used with any of first and second jaw members  16 ,  18 , first and second jaw members  116 ,  118 , first and second jaw members  216 ,  218 , first and second jaw members  316 ,  318 , first and second jaw members  416 ,  418 , first and second jaw members  516 ,  518 , and/or any other jaw members described herein. 
         [0041]      FIG. 8B  shows a surgical device  710  including a first jaw member  716  having a first engaging surface  748  with a cutting element  752  in the form of a protrusion. Cutting element  752  may extend the length of first engaging surface  748 . Cutting element  752  may have a stem  760 , and an enlarged end portion  756  having one or more sharp edges  754 . A second jaw member  718  may include a second engaging surface  750  having a recess  758  formed therein. Recess  758  may extend the length of second engaging surface  750 . Recess  758  may have a shape complementary to that of cutting element  752 . As first and second engaging surfaces  748 ,  750  are brought closer together, cutting element  752  may cut material  22  as cutting element  752  approaches and/or enters recess  758 . Cutting element  752  may interlock with recess  758  (for example, via a snap-fit and/or press seal/press-seal/press-and-seal/ziplock/zipper engagement), forming a secure seal. It should be understood that cutting element  752  may have any other suitable cross-sectional shape including, for example, a hook, T, and/or any other suitable shape; and recess  758  may have any suitable complementary cross-sectional shape. Additionally or alternatively, cutting element  752  and recess  758  may be positioned at any location along first and second engaging surfaces  748 ,  750 , respectively, not just located along their centers. Additionally or alternatively, a plurality of cutting elements and recesses may be provided. Aspects of first and second jaw members  716 ,  718  may be used with any of first and second jaw members  16 ,  18 , first and second jaw members  116 ,  118 , first and second jaw members  216 ,  218 , first and second jaw members  316 ,  318 , first and second jaw members  416 ,  418 , first and second jaw members  516 ,  518 , and/or any other jaw members described herein. Additionally or alternatively, cutting element  752  and recess  758  may be engaged in stages, beginning at their distal ends and progressing proximally to finish at their proximal ends. 
         [0042]    One or more of first and second jaw members  716 ,  718  may include a magnet, or may otherwise be magnetic. For example, one of first and second engaging surfaces  748 ,  750  may be part of a magnet (such as a ferromagnetic permanent magnet), and the other of first and second engaging surfaces  748 ,  750  may be a material attracted by the magnet. It is also contemplated that both of first and second engaging surfaces  748 ,  750  may be magnets with opposite polarities, and thus, they may be attracted to each other. The magnetic attraction may facilitate cutting of material  22  by forcing first and second engaging surfaces  748 ,  750  together. Additionally or alternatively, one of first and second engaging surfaces  748 ,  750  may be an electrode (for example, a high-frequency electrode). It is also contemplated that both of first and second engaging surfaces  748 ,  750  may be electrodes. When energized, the electrode(s) may heat material  22  by directing an electrical current into material  22 . Material  22  affected by the electrical current may, for example, vaporize, forming a cut in material  22 . By using a different type and/or amount of electrical energy or current, material  22  at the cut may be cauterized to help seal the cut. Additionally or alternatively, one of first and second engaging surfaces  748 ,  750  may vibrate at a high (for example, ultrasonic) frequency. It is also contemplated that both of first and second engaging surfaces  748 ,  750  may vibrate at a high frequency. The vibration may heat material  22  via friction, causing portions of material  22  exposed to the heat to break down, thereby forming a cut in material  22 . By using a different type and/or amount of ultrasonic energy, material  22  at the cut may be coagulated to help seal the cut. While described with respect to first and second jaw members  716 ,  718 , it should be understood that one or more of the above-described features for facilitating cutting via magnetic attraction, electrosurgery, and/or ultrasound may be used with any of first and second jaw members  16 ,  18 , first and second jaw members  116 ,  118 , first and second jaw members  216 ,  218 , first and second jaw members  316 ,  318 , first and second jaw members  416 ,  418 , first and second jaw members  516 ,  518 , first and second jaw members  616 ,  618 , and/or any other jaw members described herein. 
         [0043]    First and second jaw members  16 ,  18 , first and second jaw members  116 ,  118 , first and second jaw members  216 ,  218 , first and second jaw members  316 ,  318 , first and second jaw members  416 ,  418 , first and second jaw members  516 ,  518 , first and second jaw members  616 ,  618 , first and second jaw members  716 ,  718 , and/or any other jaw members described herein, may have a strip on its free end. The strip may include the engaging surface for cutting material  22 .  FIG. 8B , for example, shows first jaw member  716  including a first strip  762  and second jaw member  718  including a second strip  764 . First strip  762  and/or second strip  764  may be removably coupled to its corresponding jaw member. The removable coupling allows first strip  762  and/or second strip  764  to be replaced with other strips. The other strips may, for example, have different properties. For example, the other strips may have different cutting elements and/or recesses. Additionally or alternatively, the other strips may have different capabilities when it comes to facilitating cutting via magnetic attraction, electrosurgery, and/or ultrasound. It is also contemplated that the removable coupling allows first strip  762  and second strip  764  to remain engaged to each other, and to material  22  (for example, at or near the cut in material  22 ), to maintain a secure seal at the cut and prevent leakage. The removable coupling also may allow magnetically attracted strips to remain engaged to each other, and to material  22  at or near the cut in material  22 , for similar purposes. Any suitable mechanism may be provided to removably couple first and second strips  762 ,  764 , including, for example, providing weakened regions that can be torn to detach the strips, securing the strips to their jaw members by releasable connections (such as by snap-fit), and/or utilizing releasable latches between the strips and their jaw members that can be released via an actuator on the handle. It is further contemplated that strips may engage material  22  and each other via one or more staples along their lengths. 
         [0044]    The strips may be loaded with one or more substances that undergo a change in properties when inside a subject&#39;s body. For example, the strips may be coated with a sealant that, when in a low pH environment outside of the subject, does not release from the strips. Once in a high pH environment inside of the subject, the sealant may be released by the strips to safeguard against leaking at or near the cut. Additionally or alternatively, the strips may be loaded with a healing/therapeutic agent(s), such as CD34 antigen or stem cells (or stem cell factors), to accelerate healing of material  22  at or near the cut. Additionally or alternatively, the strips may be made of biodegradable material (including, but not limited to, polylactic acid (PLA), polyglycolic acid (PGA), copolymers of PLA and PGA, poly-L-lactide (PLLA), poly-D,L-lactide (PDLA), poly-capralactone (PCL), and combinations thereof) to allow degradation around the cut for aiding healing at or near the cut, surgical grade stainless steel, spring steel, conductive polymers, ceramic porcelain, glass-like material, and/or any other suitable material(s). 
         [0000]    Adjustment of Length, Width, and/or Curvature 
         [0045]      FIGS. 9A and 9B and 10A-10D  show exemplary surgical devices with adjustment features. The adjustment features, used alone or in combination, may provide the surgical devices with the ability to adapt to fit a subject&#39;s anatomy. It should be understood that any of the adjustment features described below may be used in combination with features described with respect to any of surgical devices  10 ,  110 ,  210 ,  310 ,  410 ,  510 ,  610 ,  710 , and other surgical devices described herein. 
         [0046]      FIGS. 9A and 9B  show an adjustable surgical device  810  including a clamp  812 . Clamp  812  may include a first jaw member  816  movably coupled to a shaft  814 , and an opposing second jaw member  818  movable coupled to shaft  814 .  FIG. 9A  shows clamp  812  in a first open configuration. Clamp  812  may move from the first open configuration to a first closed configuration by, for example, pivoting at least one of first and second jaw members  816 ,  818  toward the other of first and second jaw members  816 ,  818 .  FIG. 9B  shows clamp  812  in a second open configuration. Clamp  812  may be moved from the first open configuration to the second open configuration by retracting first and second jaw members  816 ,  818  into shaft  814 , as shown by arrows A in  FIG. 9B . Clamp  812  may move from the second open configuration to a second closed configuration by, for example, pivoting at least one of the shortened first and second jaw members  816 ,  818  toward the other of the shortened first and second jaw members  816 ,  818 . First jaw member  816 , second jaw member  818 , shaft  814 , and a central passage  820  of clamp  812  may have a larger cross-sectional area in the first open configuration (cross-sectional area represented by arrows B) than in the second open configuration (cross-sectional area represented by arrows C). Similarly, first jaw member  816 , second jaw member  818 , shaft  814 , and a central passage  820  of clamp  812  may have a larger cross-sectional area in the first closed configuration than in the second closed configuration. The cross-sectional area defined by material  22 , after cutting and removal of a portion of material  22 , may be proportional to the cross-sectional area of clamp  812  in its closed configuration. As such, the cross-sectional area defined by material  22  may be smaller when clamp  812  clamps, cuts, and seals material  22  by moving from the second open configuration to the second closed configuration, than when clamp  812  clamps, cuts, and seals material  22  by moving from the first open configuration to the first closed configuration. 
         [0047]      FIGS. 10A-10C  show an adjustable surgical device  910  including a clamp  912  having an opening  919  and a central passage  920  for receiving material  22 . Clamp  912  may be movably coupled to shaft  914  to not only move between an open configuration ( FIGS. 10A-10C ) and a closed configuration (not shown), but also to move between an extended configuration ( FIG. 10C ) and a contracted configuration ( FIG. 10A ). 
         [0048]    For example, a first jaw member  916  may be movably coupled to a shaft  914  to pivot from the open configuration to the closed configuration (and vice-versa), and to slide longitudinally relative to shaft  914  from the contracted configuration to the extended configuration (and vice-versa). First jaw member  916  may include a plurality of support members  966  (shown by dashed lines) slidably coupled to shaft  914 . Support members  966  may include, for example, curved rigid arms. Support members  966  may be polymeric, metallic, or made of any other suitable material. 
         [0049]    Support members  966  may be covered by a flexible sleeve  968 , and flexible sleeve  968  may be coupled to a similarly flexible strip  962 . Flexible strip  962  may be similar to, for example, strip  762 . In the contracted configuration of clamp  912 , support members  966  may be positioned adjacent one another, for example, with a proximal surface of a support member directly contacting a distal surface of a proximally-adjacent support member, and/or a distal surface of the support member directly contacting a proximal surface of a distally-adjacent support member. Flexible sleeve  968  may be concertinaed and may include a plurality of bends or folds. 
         [0050]    As clamp  912  moves from the contracted configuration toward the extended configuration, support members  966  may move away from each other, causing gaps  967  to form therebetween, and causing the size of those gaps  967  to increase. The movement of support members  966  may extend flexible sleeve  968 , thereby reducing the size and/or number of bends or folds.  FIG. 10B  shows an example where support members  966  are moved in proximal and distal directions to extend clamp  912 . It is also contemplated, however, that support members  966  may be moved in only the proximal direction, or only the distal direction, to extend clamp  912 . 
         [0051]    When clamp  912  reaches the fully extended configuration ( FIG. 10C ), flexible sleeve  968  may be fully extended, such that the bends or folds are no longer present. It should be understood that clamp  912  may be set (for example, selectively locked) at its extended configuration, contracted configuration, and any configuration therebetween, by the user. Shaft  914  may include a longitudinally-extending slot (not shown) to accommodate sliding of support members  966 . Sliding of support members  966  may be caused by one or more actuators (not shown) within shaft  914  that may allow independent movement of support members  966 . For example, the one or more actuators may include one or more telescoping rods, individually actuatable wires for pulling support members  966  along one or more tracks, and/or lost-motion connections between support members  966 . 
         [0052]    Second jaw member  918  may be similar to first jaw member  916 . For example, second jaw member  918  may include support members similar to support member  966 , a flexible sleeve similar to flexible sleeve  968 , and a flexible strip similar to flexible strip  962 . Alternatively, a single flexible sleeve may cover both first jaw member  916  and second jaw member  918 . 
         [0053]    Second jaw member  918  may be a mirror image of first jaw member  916  in the extended configuration, the contracted configuration, and positions therebetween. The length of material  22  inserted into clamp  912  may be equal to or less than the length of the extended portion of clamp  912 . For example, the length of material  22  inserted into clamp  912 , when clamp  912  is in the intermediate configuration shown in  FIG. 10B , may be equal to or less than the extended central portion of clamp  912 . On the other hand, the length of material  22  inserted into clamp  912 , when clamp  912  is in the extended configuration shown in  FIG. 10C , may be equal to or less than the full length of clamp  912 . It is contemplated that clamp  912  may be moved into the closed configuration to engage material  22  from the open, intermediate configuration shown in  FIG. 10B  and/or from the open, extended configuration shown in  FIG. 10C . 
         [0054]    Additionally or alternatively, clamp  912  may be deflected to adapt to a shape of a subject&#39;s anatomy. For example, clamp  912  may be deflected to mimic the lesser curvature of a subject&#39;s stomach, as shown in  FIG. 10D . Shaft  914  may be deflectable, and may include one or more steering wires (not shown) therein for imparting deflection forces. When clamp  912  is deflected, the spacing between portions of support members  966  closer to shaft  914  may be smaller than the spacing between portions of support members  966  farther from shaft  914 . Portions of flexible sleeve  968  closer to shaft  914  may bend or fold, while portions of flexible sleeve  968  further from shaft  914  may be less bent or folded, or fully extended. Similar movements of shaft  914 , flexible sleeve  968 , and support members  966  may take place when clamp  912  is deflected in the opposite direction, or in one or more perpendicular directions. 
       Sleeve Gastrectomy 
       [0055]      FIGS. 11A-11E  show a method of forming a gastric sleeve in a subject using a surgical device  1010 . Surgical device  1010  may include a shaft  1014  and clamp  1012 . Clamp  1012  may include a first jaw member  1016  and a second jaw member  1018 , and may define a central passage  1020  and an opening  1019  into central passage  1020 . Surgical device  1010  may be similar to any of surgical devices  10 ,  110 ,  210 ,  310 ,  410 ,  510 ,  610 ,  710 ,  810 ,  910 , and/or any other surgical devices described herein. 
         [0056]    As shown in  FIG. 11A , surgical device  1010  may be inserted into the stomach  1070  via the esophagus  1072 . An introducer (not shown), such as an endoscope, may be inserted into esophagus  1072  and/or stomach  1070  along with surgical device  1010 . In one example, the introducer may be inserted first, and surgical device  1010  may be inserted into the introducer, and then extended distally from the introducer to the target area. The introducer may include an imaging device that allows a user to visualize esophagus  1072  and/or stomach  1070 , and surgical device  1010  during the procedure. Surgical device  1010  may be inserted to position clamp  1012  at or against the lesser curvature  1074  of stomach  1070 . 
         [0057]    Optionally, the length, width, and/or straightness (curvature) of clamp  1012  may be adjusted by the user. For example, clamp  1012  may be contracted or extended to a length that may provide the desired length for the resulting gastric sleeve. The contraction or extension of length may, for example, be carried out in the manner shown in  FIGS. 10A-10C . In some instances, the user may set the length of clamp  1012  to be equal to the length of stomach  1070  between the lower esophageal sphincter  1078  and the pylorus  1076 . In other instances, the user may set the length of clamp  1012  to be longer than the length of stomach  1070  between the lower esophageal sphincter  1078  and the pylorus  1076 , with only a portion of clamp  1012  within the stomach being used to cut stomach  1070 . Additionally or alternatively, clamp  1012  may be contracted or extended to a width that may provide the desired width for the resulting gastric sleeve. The contraction or extension of width may, for example, be carried out in the manner shown in  FIGS. 9A and 9B . Additionally or alternatively, clamp  1012  may be deflected in the manner shown in  FIG. 10D  to provide the desired shape for the resulting gastric sleeve (for example, a shape that follows the contour of lesser curvature  1074 ). 
         [0058]    Additionally or alternatively, the user may be provided with a kit having a plurality of surgical devices, each with a fixed length, width, and curvature, wherein the length, width, and/or curvature of each of those surgical devices differs from the length, width, and/or curvature of the other surgical devices. The user may select the appropriate surgical device from the kit to fit a subject&#39;s anatomy, rather than adjusting a surgical device to fit the subject&#39;s anatomy. 
         [0059]    As shown in  FIGS. 11B and 11C , a portion of stomach  1070  along a greater curvature  1080  may be guided toward opening  1019 , and internalized through opening  1019  into central passage  1020 . This insertion of the portion of stomach  1070  may be carried out in the manner shown in one or more of  FIGS. 4, 5A, 5B, 6, 7A, 7B, 8A, and 8B , resulting in inversion of the portion of stomach  1070 . In one example, the portion of stomach  1070  may be inserted starting with its distal end and working proximally, eventually ending with its proximal end. By inserting the distal end first and moving proximally therefrom, visualization of the insertion process from esophagus  1072  or a proximal region of stomach  1070  may remain unobstructed, giving the user a better view for confirming that the portion of stomach  1070  is internalized correctly and completely. With this process, the portion of stomach  1070  may be internalized without puncturing stomach  1070 . 
         [0060]    With the portion of stomach  1070  in central passage  1020  and opening  1019 , clamp  1012  may be moved toward the closed configuration. The closing movement may be carried out in the manner shown in one or more of  FIGS. 1A, 1B, 2A, 2B, 3A, 3B, 8A, and 8B . The single closing movement may clamp, cut, and seal the portion of stomach  1070  that lies within opening  1019 . As outlined above, magnetic attraction, electrosurgery, and/or ultrasound may be used to facilitate cutting. Sealing of the cut may be carried out in the manner shown in  FIG. 8B , and may be facilitated by magnetic attraction, electrosurgery, and/or ultrasound, as outlined above. With one step of closing clamp  1012 , clamping, cutting, and sealing can be performed, thereby forming a gastric sleeve  1082  with a fully sealed side. The cut portion of stomach  1070  within central passage  1020  may be removed via, for example, esophagus  1072 , as shown in  FIG. 11D , leaving the completed gastric sleeve  1082  shown in  FIG. 11E . 
         [0061]    It will be apparent to those skilled in the art that various modifications and variations can be made in the disclosed devices and methods without departing from the scope of the disclosure. Other aspects of the disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the features disclosed herein. It is intended that the specification and examples be considered as exemplary only.