Apparatus, device, and method for increasing force distribution at suture-tissue interface

The present disclosure relates generally to apparatus, devices, and methods for increasing force distribution at a suture-tissue interface. In some embodiments, a tissue suturing device may include a deployment device and a plurality of tissue supports deployable from the deployment device towards a target tissue. The plurality of tissue supports may each include a central opening for receiving a suture during deployment.

FIELD

The present disclosure relates generally to suturing devices and, more particularly, to suturing devices for increasing force distribution at a suture-tissue interface.

BACKGROUND

Suturing is used during a wide variety of endoscopic procedures, such as closing a wound, anchoring a stent or other implant, or shorting curvature in the stomach. Several types of sutures and devices for implantation and extraction have been developed. In some approaches, suturing is performed by repeatedly passing a sharp suture needle attached to a length of suture material through portions of tissue to be sutured together. The free ends of the suture material are then tied together to complete the suturing procedure.

Many endoscopic procedures pull tissue together and hold the tissue in a new configuration. However, reconfiguring and constraining tissue generates tension between the tissue and the suture. While current sutures and suturing approaches may provide an adequate temporary solution to holding tissue, over time the force required to hold the tissue in place becomes too great to sustain an equilibrium. As a result, when the tissue relaxes the suture can tear through the tissue. It is with the above considerations in mind that the improvements of the present disclosure may be useful.

SUMMARY

The present disclosure in its various embodiments relates generally to apparatuses, devices, and methods for redistributing force at the tissue-suture interface to increase long-term effectiveness of an endoscopic suturing procedure.

In one or more embodiments, a tissue suturing apparatus for use with an endoscope may include a tissue suturing device coupleable to a distal end of the endoscope, the tissue suturing device comprising a plurality of tissue supports, wherein each of the plurality of tissue supports is deployable towards a target tissue, and wherein one or more tissue supports of the plurality of tissue supports receives a suture during deployment. In some embodiments, the tissue suturing device may further include a needle, wherein the needle engages a tissue support of the plurality of tissue supports to deploy the tissue support. In some embodiments, the tissue suturing apparatus may further include a collar extending from a fixed end of the tissue suturing device, wherein the collar defines a collar opening aligned with a working channel of the endoscope, and wherein each of the plurality of tissue supports extends around an exterior of the collar prior to deployment. In some embodiments, the deployment device may include a housing containing the plurality of tissue supports, and a cover extending across the housing, the cover including an opening to permit access to the plurality of tissue supports by a needle attached to the suture. In some embodiments, the deployment device may include an interior channel and a biasing device for biasing the plurality of tissue supports within the interior channel, wherein the plurality of tissue supports are arranged end-to-end within the interior channel. In some embodiments, the deployment device may include a mandrel defining a central channel, wherein each of the plurality of tissue supports is disposed concentrically around the mandrel. In some embodiments, the suture may include a core and a sheath, wherein the sheath is operable to expand radially from the core in an area adjacent the target tissue. In some embodiments the sheath may include a plurality of flexible strands. In some embodiments, the plurality of tissue supports may include one or more of the following: a flexible washer, a sprayable adhesive, a pledget, and a spring-loaded wire.

In one or more embodiments, a tissue suturing device may include a deployment device and a plurality of tissue supports deployable from the deployment device towards a target tissue. The plurality of tissue supports may include a central opening for receiving a suture during deployment. In some embodiments, the tissue suturing device may further include a fixed end secured to a distal end of an endoscope, and a free end opposite the fixed end, wherein the deployment device is coupled to one of: the fixed end, and the free end. In some embodiments, the deployment device may include a collar extending from the fixed end, wherein the collar defines a collar opening aligned with a working channel of the endoscope, and wherein each of the plurality of tissue supports extends around an exterior of the collar prior to deployment. In some embodiments, the deployment device may include a housing surrounding the plurality of tissue supports, and a cover extending across the housing, the cover including an opening to permit access to the plurality of tissue supports by a needle attached to the suture. In some embodiments, the housing may include an interior channel and a biasing device for biasing the plurality of tissue supports within the interior channel, wherein the plurality of tissue supports are arranged end-to-end within the interior channel.

In one or more embodiments, a method may include passing a needle and a suture of a tissue suturing device through a target tissue, the tissue suturing device extending from a distal end of an endoscope. The method may further include deploying a first tissue support from the tissue suturing device to a position along a first portion of the target tissue, and deploying a second tissue support from the tissue suturing device to a position along a second portion of the target tissue, wherein tightening the suture brings the first tissue support and second tissue support closer together. In some embodiments, the method may further include housing a plurality of tissue supports within a deployment device, wherein the first tissue support is exposed within a suture cavity, engaging the first tissue support within the suture cavity by the needle to remove the first tissue support from the deployment device, exposing the second tissue support within the suture cavity, and engaging the second tissue support within the suture cavity by the needle to remove the second tissue support from the deployment device. In some embodiments, the method may further include accessing the plurality of tissue supports through an opening of a cover extending across the deployment device. In some embodiments, the method may further include biasing the plurality of tissue supports towards the suture cavity using a biasing device. In some embodiments, the method may include removing the first tissue support from the tissue suturing device using a set of prongs, removing the first tissue support from the set of prongs and onto the suture, removing the second tissue support from the tissue suturing device using the set of prongs, and removing the second tissue support from the set of prongs and onto the suture.

Various one or more of the features summarized above may be interchanged, exchanged, combined or substituted with or for other features summarized above, for use in connection with the apparatuses, devices, and methods summarized above, and with respect to the embodiments described in greater detail below and embodiments otherwise within the scope of the present disclosure.

DETAILED DESCRIPTION

The present disclosure is not limited to the particular embodiments described herein. The terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting beyond the scope of the appended claims. Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the disclosure belongs.

Embodiments herein disclose endoscopic tissue suturing apparatuses, devices, and methods for increasing force distribution at a suture-tissue interface. Those skilled in the art will appreciate that while the approaches of the present disclosure will herein be described with reference to suturing an area of the stomach, the approaches may be utilized in other gastrointestinal transluminal procedures, and may be introduced transorally as well as transanally.

Although non-limiting, approaches of the present disclosure may be effective for treating gastroesophageal reflux disease (GERD) by performing procedures such as partial circumferential endoscopic mucosal resection (EMR) or submucosal dissection (ESD) of a patient's gastrointestinal tract.

Turning now toFIG.1, a tissue suturing apparatus (hereinafter “apparatus”)100according to embodiments of the present disclosure will be described. As shown, the apparatus100may include a tissue suturing device (hereinafter “device”)110extending from a distal end112of a scope, such as an endoscope114. The device110may be used with other types of scopes as well, such as bronchoscopes, duodenoscopes, gastroscopes, colonoscopes, etc. The device110may include a head or cap115having a fixed end116directly coupled to the endoscope114, and a free end118opposite the fixed end116. In some embodiments, the cap115may be coupled to the endoscope114using a variety of techniques, such as by mechanical fasteners, glue, suture, press fit, tape, overmolding, etc. In other embodiments, the dispenser cap may be integrally formed with the endoscope.

During use, a needle120may be passed back and forth between the fixed end116and the free end118along a longitudinal axis, the needle120including one or more pointed tips for puncturing a target tissue122with each pass. In some embodiments, a tissue grasper124may be delivered through a channel126of the cap115to engage the target tissue122, bringing the target tissue122into a suture cavity130located between the fixed end116and the free end118.

The device110may include a deployment device135containing a plurality of tissue supports (not shown) therein. As will be explained in greater detail below, the tissue supports may be added between a suture and the target tissue122during one or more passes of the needle120. In some embodiments, the deployment device135may be coupled to the free end118of the device110, positioned generally opposite the fixed end116.

Turning now toFIG.2, an example deployment device235according to embodiments of the present disclosure will be described. As shown, the deployment device235may be a cartridge including a housing238containing a plurality of tissue supports240therein. The housing238may include an interior channel242and a biasing device244(e.g., a spring) for biasing the plurality of tissue supports240through the interior channel242. In some embodiments, the plurality of tissue supports240are solid, flexible components arranged end-to-end. During suturing, a needle220enters a suture cavity230, puncturing an exposed tissue support240A of the plurality of tissue supports240. As the exposed tissue support240A is brought away from the deployment device235, attached to the needle220, the biasing device244may cause the next tissue support of the plurality of tissue supports240to enter the suture cavity230for subsequent engagement by the needle220on the next pass. One or more of the plurality of tissue supports240may be added every time the needle220passes through the tissue such that the interface between a suture and the tissue becomes more robust as the procedure continues. In some embodiments, the deployment device235may include a rigid plate246positioned behind the exposed tissue support240A to prevent the needle220from extending into the housing238. Furthermore, the deployment device235may include an overhang248, which may keep the exposed tissue support240A aligned within the suture cavity230.

Turning now toFIGS.3A-3B, various deployment devices according to embodiments of the present disclosure will be described in greater detail. As shown, a deployment device335may include a plurality of tissue supports340stacked atop one another within a housing338. The deployment device335may include a cover350extending across the housing338. In the embodiment ofFIG.3A, the cover350may include one or more membranes351extending across the housing338. The membrane(s)351may define a slot or opening352to permit access to the plurality of tissue supports340by a needle (not shown). The membrane(s)351may be durable enough to hold the plurality of tissue supports340in place within the deployment device335, yet flexible enough to allow an exposed tissue support of the plurality of tissue supports340to be pulled from the deployment device335by the needle.

In the embodiment ofFIG.3B, the cover350may include a plurality of components, such as slats354extending across a frame356of the housing338to hold the plurality of tissue supports340in place. In various examples, the plurality of slats354may be oriented laterally, longitudinally and/or diagonally. As shown, the plurality of slats354may define an opening358to allow a needle to enter the deployment device335and puncture an exposed tissue support of the plurality of tissue supports340. The exposed tissue support may then be folded or bent, and then pulled through the opening358.

As shown inFIG.4A, a deployment device435may include a mandrel460within a housing438. In some embodiments, the mandrel460may be a tubular shaped component defining a central channel461therein. As will be described in greater detail below, the central channel461permits a needle to enter the deployment device435and retain one or more of a plurality of tissue supports440. In this embodiment, the plurality of tissue supports440may be cylindrical washers disposed concentrically around an exterior surface462of the mandrel460. Furthermore, the plurality of tissue supports440may elastically expand to fit the mandrel460in the deployment device435. After deployment, the plurality of tissue supports440may shrink or constrict to effectively close around a suture.

Turning now toFIGS.4B-4E, cross-sectional views demonstrating operation of the deployment device435ofFIG.4Awill be described in greater detail. As shown inFIG.4B, the deployment device435contains a plurality of tissue supports440(e.g., four) disposed around the mandrel460. The deployment device435may operate with a needle shuttling system464, which may include two or more nested hypo-tubes, such as an inner tube466and an outer tube468operable to shuttle a needle420and a suture421back and forth through a target tissue422. In some embodiments, a set of prongs470may extend from the inner tube466. In various examples, the inner tube466and the outer tube468may move together or independently.

As shown inFIG.4C, the inner tube466of the needle shuttling system464may be passed distally over the needle420to interact with the deployment device435. For example, the prongs470on the end of the inner tube466may be deformable to fit alongside/adjacent the plurality of tissue supports440. In some embodiments, a depth that the prongs470enter the deployment device435can be controlled at the handle (not shown) by an operator. In other embodiments, the prongs470merely abut a proximal end469of the deployment device435. Although not shown, the deployment device435may include a spring system (e.g., one or more springs, or other biasing mechanisms) incorporated into a distal end467of the deployment device435to continually or selectively push the plurality of tissue supports440to the proximal end469for engagement with the prongs470. For example, in response to the needle being received in the deployment device435, a proximal-most tissue support440may be deployed onto the prongs470.

When the needle shuttling system464is retracted from the deployment device435, an outermost tissue support440A of the plurality of tissue supports440may be removed from the mandrel460, for example, as shown inFIG.4D. In some embodiments, the outermost tissue support440A may extend around the suture421and remain on the prongs470while the inner tube466moves farther away from the deployment device435. The outermost tissue support440A may contract, thereby remaining on the prongs470by tension. Furthermore, the prongs may include one or more curved ends472(e.g., curved radially outward) to prevent the outermost tissue support440A from sliding off the prong470.

Next, as shown inFIG.4E, the outer tube468of the needle shuttling system464may be advanced distally in relation to the inner tube466, pushing the outermost tissue support440A off the prongs470and onto the suture421, for example, between the needle420and the target tissue422. The position of the outer tube468can then be reset in relation to the inner tube466so the needle shuttling system464is ready for another needle pass. In some embodiments, a tissue support may not be added in between each suture pass. Furthermore, it will be appreciated that the number of tissue supports deployed depends on the needs of the procedure, physician, and/or the capacity of the deployment device435. Embodiments herein are not limited in this context.

Turning now toFIGS.5-6, a tissue suturing device (hereinafter “device”)510according to embodiments of the present disclosure will be described. The device510may include a head or cap515having a fixed end516coupleable with an endoscope (not shown), and a free end518opposite the fixed end516. In some embodiments, the cap515may be integrally formed with an endoscope or other instrument. During use, a needle520and a suture521may be passed back and forth between the fixed end516and the free end518along a longitudinal axis, puncturing a target tissue (not shown) positioned in a suture cavity530.

As further shown, the device510may include a deployment device535coupled to the fixed end516of the cap515. In this embodiment, the deployment device535may include a plurality of tissue supports540A-540B extending around a collar572. During assembly, the suture521, which is connected to the needle520, may be threaded between tissue support540A and tissue support540B to allow distal most positioned tissue support540A to be placed between the needle520and the tissue.

As shown, the collar572may secure the device510onto a distal end of the endoscope. In other embodiments, the collar572is integrally formed with the endoscope or other tubular instrument. Although non-limiting, each of the plurality of tissue supports540A-540B may be a washer-shaped support disposed around an exterior of the collar572. The collar572may define a collar opening574aligned with a working channel of the endoscope. The needle520may pass in and out of the collar opening574during suturing, as will be described in greater detail below. While situated on the collar572, the plurality of tissue supports540are stretched for deployment over the needle520and the suture521. As the suture521is pulled at the proximal handle of the device510, each of the plurality of tissue supports540may be deployed separately. Advantageously, the plurality of tissue supports540A-540B may be deployed on opposite sides of the target tissue being tensioned together, for example, after the operator has passed the needle520through the target tissue a desired number of times but before the suture521is cinched.

In some embodiments, the plurality of tissue supports540are deployed using an additional suture (not shown). For example, the additional suture may be connected to one or more of the plurality of tissue supports540A-540B. As the additional suture is pulled towards the fixed end516, the additional suture may release distal most positioned tissue support540A from the collar572. In some embodiments, the collar572may include an aperture (not shown) through a sidewall thereof, the aperture allowing the additional suture to exit from the central bore of the collar572. Having the plurality of tissue supports540A-540B situated on the collar572with the additional suture may allow the needle520to shuttle back and forth normally as many times as the operator needs.

Turning now toFIGS.7A-7H, operation of the device510according to embodiments of the present disclosure will be described in greater detail. InFIGS.7A-7B, the needle520and the suture521may be passed through a first piece of the target tissue522, and then through a second piece of the target tissue522, as demonstrated inFIGS.7C-7D. As shown inFIGS.7E-7F, the needle520may then be pulled through the collar572of the deployment device535and into a working channel575of an endoscope514. In some embodiments, the suture521may extend around just the distal most positioned tissue support540A. During deployment, as demonstrated inFIG.7G, the distal most positioned tissue support540A may be released from the deployment device535and then brought into position on one side of the target tissue522. A second tissue support540B may then be released from the deployment device535, and then brought into position on an opposite side of the target tissue522, as shown inFIG.7H. In some embodiments, the endoscope514(FIG.7F) may be move away from the target tissue522to bring the needle520into contact with one side of the target tissue522, while the suture521pulled to deploy the second tissue support540B onto the suture521. Finally, as shown inFIG.7I, the suture521may be pulled tight and secured, for example, using a cinching device578. The cinching device578may bring the distal most positioned tissue support540A and second tissue support540B on opposite sides of the target tissue522closer together by pulling the suture521to bring the needle520towards the deployment device535.

Turning now toFIGS.8A-8D, a suture821according to embodiments of the present disclosure will be described. The suture821may include a rigid or semi-rigid tip823operable to pierce a target tissue822. The rigid tip823may be connected to a plurality of flexible strands or filaments825. As shown inFIG.8A, the suture821may initially pass through the target tissue822in a direction demonstrated by arrow827. In this configuration, the filaments are generally straight and elongated. As demonstrated inFIG.8B, the suture821may include one or more retention wires829surrounding the filaments825. The retention wires829may be used to pull the suture821back towards the target tissue822, for example, in a direction shown by arrow834inFIG.8C. Pulling the suture821toward the target tissue822causes the filaments825to extend radially, creating a malecot configuration against a surface831of the target tissue822. As shown inFIG.8D, an interface833between the filaments825and the target tissue822may generally have larger area due the expanded configuration of filaments825. Force is therefore better distributed at the interface833, making it less likely that the target tissue822will rupture.

Turning now toFIGS.9A-9D, a suture921according to embodiments of the present disclosure will be described. The suture921may include a rigid tip923connected to a polymer body939, wherein the polymer body939may be rigid or flexible. As shown inFIG.9A, the suture921may initially pass through at an interface933of the target tissue922in a direction shown by arrow927. In this configuration, the polymer body939is generally straight and elongated. However, as demonstrated inFIG.9B, an outer material943of the polymer body939may expand or grow radially when it comes into contact with a fluid (not shown), such as water, saline, blood, etc.

In some embodiments the outer material943of the polymer body939may be a hydrogel. The term “hydrogel” may indicate a crosslinked, water insoluble, water containing material. Suitable cross-linkable polymers include but are not limited to one or a mixture of polymers selected from the group consisting of polyhydroxy ethyl methacrylate, polyvinyl alcohol, polyacrylamide, poly (N-vinyl pyrrolidone), polyethylene oxide, hydrolysed polyacrylonitrile, polyacrylic acid, polymethacrylic acid, polyethylene amine, alginic acid, pectinic acid, carboxy methyl cellulose, hyaluronic acid, heparin, heparin sulfate, chitosan, carboxymethyl chitosan, chitin, pullulan, gellan, xanthan, carboxymethyl starch, carboxymethyl dextran, chondroitin sulfate, cationic guar, cationic starch as well as salts and esters thereof. The hydrogel produces may have having improved mechanical properties, such as improved stiffness, modulus, yield stress, strength, etc., at the interface933.

As shown inFIG.9C, as the suture921is retracted, the outer material943of the polymer body939begins to bunch. Further retraction of the suture921towards the target tissue922, as demonstrated inFIG.9D, causes the outer material943to gather as a bundle along a surface931of the target tissue922. The interface933between the outer material943and the target tissue922generally has a larger area due to the expansion of the outer material943. Force is therefore better distributed at the interface933, making it less likely that the target tissue922will rupture.

Turning now toFIGS.10A-10C, a suture1021according to embodiments of the present disclosure will be described. As shown, the suture1021may include a core1047surrounded by a sheath1049. A portion of the core1047extending outside of the sheath1049may correspond to a tip1053of the suture1021. In some embodiments, the sheath1049is capable of expanding radially from the core1047. Furthermore, the sheath1049may move independent of the core1047to allow for bunching of the sheath, as demonstrated inFIG.10C. In this embodiment, the sheath1049may be a continuous or sheet-like covering that bulbs and buckles upon expansion and retraction of the core1047, creating a solid plug-like interface where the suture1021meets a target tissue (not shown). In some embodiments, the sheath1049is disposed concentrically around the core1047.

In the embodiment ofFIGS.11A-11B, a sheath1149of a suture1121may include a plurality of flexible strands. As shown, as a core1147of the suture1121is retracted, the flexible strands bunch-up, expanding to create a mesh-like network with increased surface area. In some embodiments, the sheath1149is disposed concentrically around the core1147.

Turning now toFIGS.12A-12B, the use of a sprayable adhesive1280applied to an area of target tissue1222according to embodiments of the present disclosure will be described in greater detail. As shown, a sprayable adhesive1280may be delivered through an endoscope1214. The sprayable adhesive1280may be applied to the target tissue1222at each interface1233where the suture1221and the needle1220penetrate the target tissue1222. As a result, the interface1233may be less susceptible to tearing under the pull of the suture1221.

During use, a physician may conduct an endoscopic procedure. The physician may retract a device occupying the working channel (e.g., visualization device) and advance a needle or catheter1281. Once this feature reaches the working channel, a syringe (not shown) with a medical grade, silicone-based spray adhesive, for example, would be coupled to the proximal end of the catheter1281(e.g., via a Luer connector). The syringe may be actuated, forcing the sprayable adhesive1280to eject from the distal end of the endoscope1214. As shown inFIG.12B, as the sprayable adhesive sets, the surface of the target tissue1222that a cinch1282and needle1220are in contact with will harden and prevent expansion, thus preventing the cinch1282and/or needle1220from passing through the hole in the target tissue1222at each interface1233.

In the non-limiting embodiment ofFIGS.13A-13C, a curable glue1380(e.g., moisture or UV curable) may be added to a target tissue1322at each end of a suture1321to distribute force applied on an interface1333between the target tissue1322and the suture1321. Due to the flexible nature of the curable glue1380prior to curing, the curable glue1380can more easily pass through the working channel of the endoscope1314and be applied at the target tissue1322. In addition, the curable glue1380may allow the physician to better customize a final shape for the curable glue1380based on the demands of the procedure, location of the wound, his/her preference, etc. For example, as shown inFIGS.13B-13C, the curable glue1380may be fashioned into one or more cylindrical washers1385each having a central opening1387. As a result, the suture1321(FIG.13C) may pass through the central openings1387. Furthermore, use of the curable glue1380also gives the physician the freedom to add additional glue at various points in the procedure, for example, to improve the force distribution as needed pre- or post-suturing. In some embodiments, as shown inFIG.13C, the needle1320may remain on top of the curable glue1380following suturing. To improve visibility, the curable glue1380can also be dyed in alternative embodiments.

In the non-limiting embodiment ofFIGS.14A-14C, one or more tubular tissue supports (e.g., washers)1440may be used on opposite sides of a target tissue1422. As shown, the tubular tissue supports1440may include a slot1489through which a suture1421can run, allowing the tubular tissue supports1440to be placed anywhere along the suture1421after the suture421is threaded through the target tissue1422. In some embodiments, the tubular tissue supports1440may be delivered endoscopically and maneuvered into place using a grasper or similar tool to protect the target tissue1422after the suture1421is placed, but before the suture1421is cinched.

Turning now toFIG.15, tissue supports in the form of one or more elastic elements or spring-loaded wires will be described. As shown, a wire1590may be deployed from an endoscope1514and onto a suture1521as a needle1520and the suture1521traverse through a target tissue1522. In the non-limiting embodiment shown, the wire1590may be a metallic, spring-loaded wire with shape memory, which is preloaded into a delivery catheter of the endoscope1514. As the wire1590is advanced beyond a distal tip of the endoscope1514, it begins to curl. The wire1590may create a hook1592as it begins to curl, the hook being engageable with the suture1521between the cinch1591and the target tissue1522, and/or between the needle1520and the target tissue1522.

Once the suture1521is acquired by the hook1592, the rest of the wire1590may be fed out of the endoscope1514. The wire1590continues to curl until a proximal end is expelled. Use of the wire1590allows for a low-profile during delivery and, once deployed, a large solid surface area for the cinch1591and the needle1520to interface with, thus preventing pull through. In non-limiting embodiments, the wire1590may be made of steel, Nitinol or any other material with a high spring constant. In other embodiments, the wire1590may also take on the profile of a ribbon, which may also increase a contact surface area between the wire1590and the cinch1591and the needle1520.

Alternatively, the wire1590could be a bi-stable spring that is straight in one orientation and curved in another. The wire1590may be advanced until it is positioned between the cinch1591and the needle1520. Once positioned appropriately, the spring may be shifted to a second orientation, causing it to curve into a coil or spiral-like orientation.

Turning now toFIG.16, a method1600according to embodiments of the present disclosure will be described in greater detail. At block1601, the method may include passing a needle and a suture of a tissue suturing device through a target tissue, the tissue suturing device extending from a distal end of an endoscope. In some embodiments, the plurality of tissue supports are housed within a deployment device, wherein a first tissue support is exposed within a suture cavity. In some embodiments, the deployment device may be a cartridge or collar. In some embodiments, a cover may extend across the deployment device, the cover including an opening to permit access to the plurality of tissue supports by a needle. In some embodiments, the tissue supports may include one or more of the following: a flexible washer, an adhesive, a pledget, and an elastic or spring-loaded wire.

At block1603, the method1600may include deploying a first tissue support from the tissue suturing device to a position along a first portion of the target tissue. In some embodiments, the first tissue support may be engaged within the suture cavity by the needle to remove the first tissue support from the deployment device. At block1605, the method1600may include deploying a second tissue support from the tissue suturing device to a position along a second portion of the target tissue, wherein tightening the suture brings the first tissue support and the second tissue support closer together.

Although the illustrative method1600is described above as a series of acts or events, the present disclosure is not limited by the illustrated ordering of such acts or events unless specifically stated. For example, some acts may occur in different orders and/or concurrently with other acts or events apart from those illustrated and/or described herein, in accordance with the disclosure. In addition, not all illustrated acts or events may be required to implement a methodology in accordance with the present disclosure. Furthermore, the method1600may be implemented in association with the formation and/or processing of structures illustrated and described herein as well as in association with other structures not illustrated.

As used herein, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms, “comprises” and/or “comprising,” or “includes” and/or “including” when used herein, specify the presence of stated features, regions, steps elements and/or components, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components and/or groups thereof.

Furthermore, the terms “substantial” or “substantially,” as well as the terms “approximate” or “approximately,” can be used interchangeably in some embodiments, and can be described using any relative measures acceptable by one of skill. For example, these terms can serve as a comparison to a reference parameter, to indicate a deviation that will still provide the intended function. Although non-limiting, the deviation from the reference parameter can be, for example, in an amount of less than 1%, less than 3%, less than 5%, less than 10%, less than 15%, less than 20%, and so on.