# Patent

## Title
Apparatus for treating hemorrhoids

## Abstract

An apparatus and method for effecting at least one anatomical structure of a body including at least one first arrangement structured to be at least partially inserted into the body and including an opening, at least one third arrangement configured to increase and/or decrease a size of the opening by a motion thereof in a first direction, and at least one second arrangement coupled to the third arrangement(s). When the anatomical structure(s) is/are inserted in the opening and is pressed on by the second arrangement(s), a first motion of the third arrangement(s) toward the anatomical structure(s) in the first direction is reduced and/or terminated while a second motion of the second arrangement(s) either (i) remains at least approximately the same, and/or (ii) is reduced to a lesser extent than that of the first motion.

## Background
FIELD OF THE DISCLOSURE
The present disclosure relates to an apparatus and method for effecting at least one anatomical structure, and more particularly to exemplary embodiments of the apparatus and method to effectuate a surgical treatment of tissue masses located inside the human body, e.g., in the hollow internal organs such as the colon. The exemplary apparatus and methods can be suitable for, e.g., a treatment of hemorrhoids, as well as other conditions. The exemplary apparatus and method can be implemented to, e.g., compress a hemorrhoid or/and reduce its blood supply with a clamping instrument, while preventing a cutting of the hemorrhoid or its blood vessels with such exemplary instrument.
BACKGROUND INFORMATION
There are a variety of abnormal conditions in the body which can be related to the wall(s) of hollow organs. Colonic polyps and tumors, endothelial vascular lesions, diverticuli, symptomatic internal hemorrhoids are some of the examples of these abnormal conditions. A treatment to such abnormal conditions from inside a hollow organ cavity or a lumen (so-called intra-luminal or endolumenal approach) may be beneficial to the patient since a surgical access trauma is reduced or eliminated.
One common condition that can be easily treated with the endoluminal approach is a symptomatic internal hemorrhoids condition. Internal hemorrhoids are conventionally treated using a variety of interventional and non-interventional endoluminal methods. An immediate proximity of internal hemorrhoids to the external orifice allows for a relatively easy access thereto. Several technologies for treating the internal hemorrhoids are currently available, but are fairly complex and/or frequently have less than acceptable clinical outcomes and/or high costs associated therewith.
Hemorrhoidal disease is a very common condition that can occur in more than half of the population by the age of 50. Currently, over 10 million people suffer symptoms from hemorrhoids in the United States, and one million new cases of symptomatic hemorrhoids are diagnosed annually. Approximately 10-20 percent of such cases may need a surgical removal of the hemorrhoid, which is associated with significant postoperative morbidity and high cost to the individuals and society.
The term “hemorrhoid” is generally used to refer to the disturbing perianal symptoms related to vascular complexes in the lower rectum and anus. This is usually associated with enlargement of this naturally occurring vascular tissue, which is responsible for its subsequent bleeding, prolapsing, thrombosis, itching, burning, etc. Repetitive straining due to constipation appears to be a leading factor in forming and progressing of hemorrhoids. The chances of having symptomatic hemorrhoids increase with age, pregnancy, obesity, sedimentary life, heavy lifting and genetic predisposition.
Various treatments can be tailored to the type and severity of the specific hemorrhoids. A pharmacological treatment, which is aimed at the regulation of defecation and symptomatic relief, may be less beneficial as likely having only a temporary and frequently incomplete effect. Current interventional, non-excisional, therapies are designed to obliterate blood supply to part of or to the entire hemorrhoid (e.g., rubber band ligation, infrared coagulation, injection sclerotherapy, ultrasound guided hemorrhoidal artery ligation, etc.). These treatments have modest, inconsistent clinical success with a frequent recurrence rate.
Rubber band ligation is one popular treatment method of hemorrhoids. In the rubber band ligation, some hemorrhoidal tissue is pulled into the ligator, and a rubber band is placed around the base of the pulled tissue. This causes a strangulation of the blood supply to a portion of the internal hemorrhoid and its overlying rectal mucosa. An ischemic necrosis and autoamputation of the hemorrhoid can generally follow in a few days, leaving an open rectal wound, which heals over several days. Severe and possibly debilitating postoperative pain is rare, but significant anal discomfort and tenesmus (a painfully urgent but ineffectual sensation or attempt to defecate) are frequent. Recurrences after the rubber band ligation are also frequent. In addition, since such treatment leaves the patient with an open wound in the anus for several days, the rubber band ligation may be rendered unsuitable for HIV-positive patients, and may require a demanding preparation for patients with bleeding disorders.
Sclerotherapy is another method for treatment of small internal hemorrhoids. A sclerosing agent is injected via a needle into and around the internal hemorrhoid. The rates of complications and recurrence of sclerotherapy can be high.
An ultrasound guided hemorrhoidal artery ligation involves manual suturing of the rectal tissues containing the hemorrhoial artery. The artery can be located by ultrasound radiation with an appropriate ultrasound arrangement. A resulting regression of the corresponding internal hemorrhoid would be expected. Since the suture-ligation can be performed above the internal hemorrhoid in the pain-insensitive zone, the procedure should be painless. However, such technique is demanding, and is highly dependent on the operator's experience and dexterity. Inexperience or lack of skill of the operator is responsible for both “missing” the hemorrhoidal artery and inadvertent rectal and vascular injuries. Hemorrhoidal artery injuries with resulting severe bleeding, rectal wall injury, etc. have been reported, and the recurrences are frequent.
The treatment of internal hemorrhoids with infrared coagulation can involve a blind heat coagulation of the branches of superior hemorrhoidal artery. Theoretically, when the branches of superior hemorrhoidal artery are successfully targeted, it can cause a subsequent regression of the corresponding internal hemorrhoid. However, since the exact location of the artery is not known, there is no guarantee that the infrared coagulation pulses reach the vessels and hence have any effect on hemorrhoids. Multiple treatments in a time span of several months are currently recommended by the distributor and treating doctors. The proper application of the infrared probe can be difficult with larger hemorrhoids due to obscurity of the interface between the probe and mucosa. Recurrences and ineffective treatment can be frequent.
Traditional surgical excision of hemorrhoids can be an effective but often a debilitating form of treatment. The hemorrhoidal tissue can be removed in longitudinal (parallel to main rectal axis) direction. Surgical excision of hemorrhoids may require the use of an anesthesia, and can cause a severe postoperative pain to the patient for several weeks along with a significant loss of work time therefor. Such technique is also dependent on the technical skill of the operator.
Another procedure, i.e., a Procedure for Prolapse and Hemorrhoids (PPH) can be used which involves circumferential excision of the rectal mucosa and submucosal layer proximal to the internal hemorrhoids using a circular stapler. As a result, a superior hemorrhoidal blood supply can be interrupted, while the hemorrhoidal tissue itself is left to ischemically regress. Since the excision is performed above the dentate line, a decreased postoperative pain and faster recovery (when compared to traditional hemorrhoidectomy) would likely occur. The internal hemorrhoids can consequently shrink within four to six weeks after such procedure. This PPH technique requires the implementation by highly skilled operators, as well as a significant learning curve, a general or regional anesthesia, and an expensive instrumental set-up. In addition, the use of PPH creates a substantial circumferential rectal trauma, which is likely excessive in the majority of cases when only 1 or 2 hemorrhoids are enlarged. A substantial circumferential injury of the anal canal and subsequent scarring can cause a rectal stricture (narrowing), which is debilitating and difficult to treat in patients. Serious complications during and after PPH have been previously reported.
Thus, there are several less invasive procedures than conventional surgery methods for the treatment of symptomatic internal hemorrhoids. However, such methods do not have the desired combination of simplicity, effectiveness and being substantially painless, minimally invasive, and inexpensive.
Accordingly, there is a need to provide a device and method which overcome at least some of the deficiencies with the previous devices and methods.
SUMMARY OF EXEMPLARY EMBODIMENTS OF THE DISCLOSURE
At least some of the objects of the present invention are to provide exemplary devices and methods to overcome at least some of the deficiencies indicated hereinabove. For example, the exemplary embodiment of the method and device may be provided which can be useful in the treatment of hemorrhoids and/or associated tissues, and can facilitate a less traumatic experience than the conventional methods and devices for the treatment of hemorrhoids. The exemplary device and method can also be utilized for treatment of other pathologies in locations remote from body openings.
With one exemplary embodiment of the method and device of the present disclosure, it is possible to effectuate an approximately constant tissue compression by a clamp arrangement, which is at least partially independent of the clamp-actuating force applied by a user to the associated handle of the exemplary device. In the exemplary embodiments described below in this Summary Section, the first component, first part and first arrangement are used interchangeably, and designated by reference numeral I in the drawings. The second component, second part and second arrangement are used interchangeably, and designated by reference numeral II in the drawings. The third component, third part and third arrangement are used interchangeably, and designated by reference numeral III in the drawings. The first spring in exemplary embodiments is designated by reference numeral 12 and the second spring is designated by reference numeral 13. The first closure member in exemplary embodiments corresponds to the first closure member 9 of part II and the second closure member in exemplary embodiments corresponds to second closure member 10 of part III.
According to one exemplary embodiment of the present disclosure, a surgical instrument can be provided which comprises an insertable arrangement having a window, and a closure member movably connected to the insertable arrangement for alternately covering and uncovering the window, and applying pressure to or clamp any material provided within the window. The insertable arrangement can have a first (e.g., clamping) surface along an edge of the window, and the closure member can have a second (e.g., clamping) surface situated opposite to the first surface to be able to selectively cover and uncover the window so as to apply a force to or clamp any tissue or object provided within the window. The exemplary instrument also includes a tissue effecting component coupled to the insertable arrangement and/or the closure member for acting on tissues gripped or clamped between the first surface and the second surface. The exemplary instruments also have a further arrangement which is configured to propel the second surface toward the first surface so as to apply pressure to or clamp any object or tissue provided in the window, and also to prevent further pressure or clamping to be applied to the object or tissue if the pressure and/or clamping thereon exceeds a particular amount of pressure.
According to a particular exemplary embodiment of the present disclosure, the closure member can have a second closure member which includes the second clamping surface and a first closure member which is connected to a second handle grip. The second handle grip can be part of a second arrangement. The first and second closure members can slide in relation to each other, and are connected to one another via a spring, referred to herein as the second spring.
In accordance with another embodiment of the present disclosure, the device has at least two springs. A first spring is affixed to a first handle grip at one end and to the first closure member at another end thereof at their fixation points. The first handle grip is part of a first arrangement. A second spring is affixed to the first closure member at one end, and to the second closure member at another end thereof at their respective fixation points. For example, according to one exemplary embodiment of the present disclosure, the springs can stretch between the fixation points during the window closure when the grip handles of the first and second parts (arrangements) are moved toward one another. The second spring provides an ability to effectuate an approximately constant tissue compression function, and avoid an unwanted excessive compression of the tissue. Each of the springs (e.g., the first spring) can facilitate a return of the closure member to its non-deployed (open) position so as to maintain the window open for another insertion of the tissue or object therein.
In an exemplary operation, when a squeezing force is applied to the handle, e.g., for the purpose of compressing the tissue between the first and second clamping surfaces, a second handle grip of the second component moves towards a first handle grip of the first component (proximal in relation to the insertion tip of the device) located distal of the second handle grip. In one exemplary embodiment, this causes the first closure member to move towards the insertion tip of the device, and the second (e.g., clamping) surface of the second closure member moves towards the clamping surface of the first component. As the first closure member moves forward toward the clamping surface of the first component, the first and second springs are pulled in a general direction of the window, and are stretched
The first spring facilitates gliding of the first closure member during the closure and helps return the closure member to its non-deployed (open) position after the handle is released.
The second proximal spring provides the constant tissue compression function during closure and facilitates returning of the second closure member to its non-deployed position after the handle is released.
When the first closure member is actuated by squeezing the handle of the device and hence the second handle grip and the associated first closure member move forward, the second proximal spring (which is connected between first and second closure members) pulls and moves forward the second closure member. If the second closure member doesn't meet an obstacle in the window, for example, a protruding tissue, the second clamping surface of the second closure member meets the first clamping surface of the first component without substantially stretching the spring. The device's parts are dimensioned so that when the first and second handle grips meet, the opposing first and second clamping surfaces touch each other and the window closes.
If the second closure member meets an obstacle in the window, for example, a protruding tissue, the second closure member (and second clamping surface) stops, while the first closure member continues its forward movement and slides over the second closure member. As a result, the second spring stretches and an additional (after movement of the second closure member is stopped by the tissue) squeezing force of the handle by an operator translates into forward movement of the first closure member of the second component and stretching of the second proximal spring. Consequently, only constant compression to the tissue is delivered as designed by the strength of the second spring and the compressing tissue properties, regardless of the additional force used by an operator.
When the handle is released, the first spring pulls back on first closure member and its associated second handle grip and brings it back to its non-deployed (open) position.
As the first closure member and its associated second handle grip is returning to its open position, the first closure member pulls back on the second closure member and returns it to its non-deployed (open) position. As a result, the window is opened and the tissue is released.
In addition, according to one exemplary embodiment of the present disclosure, it is possible to provide a device which can be an endoluminal intervention assembly that includes an accessory system for the delivery and support (e.g., optically and/or mechanically) of instrumentation to surgical sites remote from the body openings.
In accordance with yet another exemplary embodiment of the present disclosure, apparatus and method for effecting at least one anatomical structure of a body can be provided, including at least one first arrangement which is structured to be at least partially inserted into the body and including an opening. In addition, at least one third arrangement can be provided which is configured to increase and/or decrease a size of the opening by a motion thereof in a first direction e.g., a distal direction. Further, at least one second arrangement can be provided which can be coupled to the third arrangement(s), and configured to move at least in a distal direction which is at least approximately parallel to the first direction. In particular, when the anatomical structure(s) is/are provided or inserted in the opening and is pressed on by the third arrangement(s), a first motion of the third arrangement(s) toward the anatomical structure(s) in the first direction is reduced and/or terminated while a second motion of the second arrangement(s) in the second direction either (i) remains at least approximately the same, and/or (ii) is reduced to a lesser extent than that of the first motion.
In addition, at least one tension-setting arrangement can be provided which couples the third and second arrangements to one another. The tension-setting arrangement(s) can include at least one spring, and when the anatomical structure is pressed by the third arrangement(s), a tension of the at least one spring can be increased which causes the third arrangement(s) to at least reduce the first motion in the first direction while facilitating the second motion of the second arrangement(s) to be unreduced or reduced less than the first motion. The spring(s) can generate a force on the second arrangement(s) which can facilitate a gradual constant tissue compression.
According to yet another exemplary embodiment of the present disclosure, the third arrangement(s) can comprise a closure arrangement which is structured to be moved toward and away from a tip portion of the first arrangement(s), and can include a contacting surface which is configured to increase and/or reduce the size of the opening and contact the anatomical structure(s). The first arrangement can include a first handle structure, and the second arrangement(s) can include a second handle structure which is configured to move toward the first handle structure. In addition, a tension-setting arrangement can be provided which couples the first and second arrangements to one another and can include a constant force spring that is attached between the first handle structure and the closure arrangement of the second arrangement.
According to still another exemplary embodiment, when the anatomical structure is pressed by the closure arrangement of the third arrangement, a motion of the closure arrangement can be reduced or stopped, and the second arrangement(s) can slide over the closure arrangement of the third arrangement in the first direction. Further, when the anatomical structure is pressed by the third arrangement(s), a tension of the spring is increased which likely causes the second arrangement(s) to at least reduce the first motion of the closure arrangement in the first direction and facilitate the second arrangement to slide over the closure arrangement of the third arrangement.
In yet a further exemplary embodiment of the present disclosure, the first arrangement(s) can include a first handle structure and an anascope structure non-releasably connected to one another. A second arrangement can also be provided which can include at least one further spring arrangement coupling the first and second arrangements to one another. The first arrangement(s) can include at least one handle portion, and the second arrangement(s) can comprise a first closure arrangement which is structured to be moved toward and away from a tip portion of the first arrangement. The further spring arrangement(s) can be coupled to the handle portion(s) of the first handle structure and the first closure arrangement. The further spring arrangement(s) can facilitate a movement of the closure arrangement in a direction that is at least approximately opposite to the first direction. The first direction can be a distal direction.
According to yet a further exemplary embodiment of the present disclosure, the second arrangement(s) can include therein or thereon at least one electrode provided at or near the contacting surface. The electrode can be powered by an electrical power source. Such electrode(s) can be at least partially embedded within the first arrangement(s). The electrode(s) can be configured to irradiate at least one area of the anatomical structure(s) when the anatomical structure is constricted in the opening by the second arrangement(s). Further, the second arrangement(s) can include therein or thereon at least one illumination arrangement which provides light to the anatomical structure(s).
These and other objects, features and advantages of the exemplary embodiment of the present disclosure will become apparent upon reading the following detailed description of the exemplary embodiments of the present disclosure, when taken in conjunction with the appended claims.



BRIEF DESCRIPTION OF THE DRAWINGS
Further objects, features and advantages of the present disclosure will become apparent from the following detailed description taken in conjunction with the accompanying figures showing illustrative embodiments of the present disclosure, in which:
FIG. 1 is a side cross-sectional view of an exemplary embodiment of a device according to the present disclosure in an open position; FIG. 1A is a side cross-sectional view of an alternate embodiment of the device of the present disclosure in an open position; FIG. 1B is a side cross-sectional view of another alternate embodiment of the device of the present disclosure shown in an open position; and FIG. 1C is a side cross-sectional view of another alternate embodiment of the device of the present disclosure shown in an open position;
FIG. 2 is a side cross-sectional view of the device of FIG. 1 in a closed position;
FIG. 2A is a side cross-sectional view of the device of FIG. 1 in a fully open position; and FIG. 2B is an exploded view of the device of FIG. 1;
FIG. 3A is a left side cross-sectional view of a first part (component) of the device of FIGS. 1 and 2;
FIG. 3B is a right side cross-sectional view of the first part shown in FIG. 3A;
FIG. 3C is a right side perspective view of the first part shown in FIG. 3A;
FIG. 3D is a left side perspective view of the first part shown in FIG. 3A;
FIG. 4A is a right side view of a second part (component) of the device of FIG. 1;
FIG. 4B is a rear view of the second part shown in FIG. 4A;
FIG. 4C is a right side view of the second part shown in FIG. 4A;
FIG. 4D is a perspective view of the second part shown in FIG. 4A;
FIG. 5A is a side view of a third part (component) of the device of FIG. 1;
FIG. 5B is a top view of the third part shown in FIG. 5A;
FIG. 5C is a right side perspective view of the third part shown in FIG. 5A;
FIG. 5D is a left side perspective view of the third part shown in FIG. 5A;
FIG. 6A is a lateral side view of a spring used in the device of FIG. 1; and
FIG. 6B is a front view of the spring illustrated in FIG. 6A.



Throughout the figures, the same reference numerals and characters, unless otherwise stated, are used to denote like features, elements, components or portions of the illustrated embodiments. Moreover, while the subject disclosure will now be described in detail with reference to the figures, it is done so in connection with the illustrative embodiments. It is intended that changes and modifications can be made to the described exemplary embodiments without departing from the true scope and spirit of the subject disclosure as defined by the appended claims.
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
FIGS. 1-6B show various components of an exemplary embodiment of a device according to the present disclosure. As shown in these drawings, the exemplary device has three primary parts, e.g., a first part or component (or member) I, a second part or component (or member) II and a third part or component (or member) III. The first part I (as shown in, e.g., FIGS. 1-3D) comprises a hollow portion 1 which includes a tapered end or insertion tip 16 which is structured or configured for insertion into or propagation through a bodily lumen or another anatomical structure, a first handle grip 5 (which is proximal (closer to the user) with respect to the tip 16) and a connecting section 4. The second part II (as shown in, e.g., FIGS. 1, 2, 2A, 2B and 4A-4D) comprises a second handle grip 8 (which is proximal with respect to the tip 16) and a first closure member 9, which can be non-releasibly connected. The third part III (as shown in, e.g., FIGS. 1, 2, 2A, 2B and 5A-5D) comprises a second closure member 10. The exemplary device provides a handle 2 (FIG. 1) which comprises the first handle grip 5 of the first part I and the second handle grip 8 of the second part II.
Referring to FIGS. 1, 2, 2A, 2B, 6A and 6B, the exemplary device has a first spring 12 and a second spring 13, whereas the first spring 12 can be provided closer to the tip 16 than the second spring 13, and both of which can have two or more fixation points. Thus, the second spring 13 can be provided more proximal than the first spring 12. The first spring 12 can include (i) a first fixation point 12a provided at or on the first handle grip 5 of the first part I (as also shown in FIGS. 3A and 3C) and (ii) a second fixation point 14 (as also shown in FIGS. 2B, 4A, 4C and 4D) located on and below a surface of the first closure member 9 of the second part II. The second spring 13 also has (i) a first fixation point 13a located on or at the second closure member 10 of third part III (as also shown in FIGS. 5B and 5C), and (ii) a second fixation point 15 located on and below the surface of the first closure member 9 of second part II (as also shown in FIG. 4D).
When the exemplary device is assembled, the second spring 13 is provided or positioned just below a particular surface 20 of the second closure member 10, while also being coupled to the first fixation point 13a thereof. Any of the fixation points 12a, 13a, 14 and/or 15 can be metal and/or plastic knob(s) or other members to which the respective first and second springs 12, 13 can be attached, clipped unto and/or adhered to, e.g., possibly with glue, clips, etc. The exemplary details of the first and second springs 12, 13 are illustrated in FIGS. 6A and 6B. However, it should be understood that other shapes and/or or sizes of the springs are conceivable and are within the scope of the exemplary embodiments of the present disclosure.
FIGS. 1, 2, 2A and 2B show that the first spring 12 couples the first part I and the second part II to one another. These drawings also illustrate that the second spring 13 couples the first and second closure members 9, 10 of respective parts II and III to one another, which are slidably engaged with each other.
As shown in FIGS. 1 and 2, the exemplary device includes a window 6 which is enclosed between and formed by at least two opposing clamping surfaces, e.g., a first opposing clamping surface 7a (which is part of the hollow portion 1 of the first part I), and a second opposing clamping surface 7b (which is part of the second closure member 10 of the third part III and provided on the edge thereof). The second clamping surface 7b is moved toward the first clamping surface 7a by moving the third part III toward the first clamping surface 7a to close or reduce the size of the window 6 and away from such first clamping surface 7a to open or increase the size of the window 6. Such movement of the third part III can be actuated by squeezing and/or releasing the handle 2 of the exemplary device.
For example, according to one exemplary embodiment of the present disclosure, when the second handle grip 8 is moved toward the first handle grip 5 by squeezing (see arrow of FIG. 2), during such exemplary squeezing motion by the operator's hand, the window 6 size is reduced, by, e.g., being closed until it meets an obstacle, such as, for example, a protruding tissue 17 (as shown in FIG. 1). In addition, the window 6 is intended to be closed when the first and second opposing clamping surfaces 7a, 7b meet each other (as shown in FIG. 2). Thus, the window 6 becomes bigger when the second closure member 10 moves away from the first opposing clamping surface 7a of the first part I, and smaller when the second closure member 10 moves towards the first opposing clamping surface 7a of the first part I.
In an exemplary operation, when the second handle grip 8 of the second part II. is moved toward the first handle grip 5 of the first part I (see FIG. 2), for example, during a squeezing motion by the hand of the operator, the second part II pulls on the second spring 13. This is because the second spring 13 is connected at one end thereof to the second part II via the second fixation point 15 (as shown in FIGS. 2A, 2B and 4D) which is located on and below a surface of the first closure member 9 of the second part II. The strength of the second spring 13 is selected or configured so as to facilitate the second main part II to pull the second closure member 10 of the third part III in the same direction as the direction of propagation of the first closure member 9. Indeed, during the exemplary operation, the second closure member 10 of the third part III is moved by the first closure member 9 of the second part II forward toward the first clamping surface 7a by pulling (e.g., likely without significant stretching) the second spring 13, provided that the second closure member 10 does not meet the obstacle in the window 6. Indeed, such pulling motion is effectuated since another end of the second spring 13 is connected to the first fixation point 13a located on or at the second closure member 10 and below the particular surface 20 thereof (as also shown in FIGS. 5B and 5C). Thus, the second spring 13 acts as a spring coupling arrangement between the second part II and the third part III.
As shown in FIG. 1, if the second closure member 10 of the third part III meets the obstacle in the window 6 (e.g., the protruding tissue), the forward motion of the second closure member 10 in the same direction as that of the second part II stops completely or for the most part. At the same time, the second part II of the exemplary device continues to move forward in the same direction, and also (simultaneously) causes the second spring 13 to stretch. As a result, the first closure member 9 of second part II slides over the second closure member 10 of the third part III towards the first clamping surface 7a or the end or tip 16, without further affecting the forward movement of the second closure member 10 of the third part III and absent any further significant compression of the tissue situated within the window 6.
This exemplary effect is caused by the fact that when the second opposing clamping surface 7b of the second closure member 10 of the third part III contacts and attempts to press on the tissue provided within the window 6, this negative pressure cases the second spring 13 to stretch. In this manner, while the second closure member 10 of the third part III is prevented from moving forward by the tissue, a tension is continued on the second spring 13, allowing the first closure member 9 of the second part II to continue its forward motion toward the tip 16. Such tension on the second spring 13 facilitates an approximately constant compression on the tissue. Indeed, as a result, a constant tissue compression (e.g., on the tissue or on any other object) can be accomplished in the window 6. Such constant tension or compression can be largely separate from or independent of the force exerted by the operator on the handle 2, for example, the compression of the tissue can be mainly dependent upon various properties of the second spring 13, the connections thereof to the second and third parts II, III, and the properties of the compressed tissue 17 in the window 6.
In addition, according to another exemplary embodiment of the present disclosure, the first spring 12 can be useful in facilitating the operation of the exemplary device. For example, when the second handle grip 8 of part II is moved toward the first handle grip 5 of part I (see arrow of FIG. 2), e.g., during the squeezing motion by the hand of the operator, the second part II is simultaneously pulled on and stretches the first spring 12 (as shown in FIG. 2). This is because one end of the first spring 12 is coupled to the second fixation point 14 (as shown in FIGS. 2B, 4A, 4C and 4D) located on and below the surface of the first closure member 9 of the second part II, and the other end of the first spring 12 is coupled to the first fixation point 12a provided at or on the first handle grip 5 of the first part I (as shown in FIGS. 3A and 3C). In this manner, the first spring 12 is stretched by the forward movement of the first closure member 9 of the second part II toward the first clamping surface 7a or the end or tip 16 of the first part I, while the first part I is stationary with respect to the tip 16.
During the exemplary operation, and referring to FIGS. 1 and 2A, when the squeezed handle 2 is released, the first spring 12 has the tension to cause itself to return to its original (e.g., non-stretched or less-stretch) configuration, thereby pulling on the first closure member 9 of the second part II until the second part II returns proximally to its non-deployed (e.g., open or original) position. Again, this is caused by the first spring 12 being attached to a stationary first part I via the first fixation point 12a, and pulling the first closure member 9 of the second part II back to its original position due to the first spring 12 being connected to the second fixation point 14 of the first closure member 9. In addition, as the second part II is in the process of returning to its non-deployed position (shown in FIG. 2A) with the assistance of the first spring 12, the second part II also pulls on and effectuates further tension of the second spring 13, which pulls back the second closure member 10 due to its coupling to the first fixation point 13a thereof until the second closure member 10 returns to its non-deployed position. When the second closure member 10 moves back to such position, the window 6 becomes enlarged, e.g., until it is fully open (as shown in FIG. 2A).
FIGS. 1A and 1B illustrate an electrode provided at or near the contacting surface as referenced above. The electrode 20 in FIG. 1A is shown embedded in the first part I. In the alternate embodiment of FIG. 113, the electrode 22 is provided on second part II near the contacting surface of the clamping surface. FIG. 1C illustrates an illumination arrangement 24 on the second part II to provide light to the anatomical structure.
It will further be appreciated by those having ordinary skill in the art that, in general, terms used herein, and especially in the appended claims, are generally intended as open. In addition, to the extent that the prior art knowledge has not been explicitly incorporated by reference herein above, it is explicitly being incorporated herein in its entirety. All publications referenced above are incorporated herein by reference in their entireties. In the event of a conflict between the teachings of the application and those of the incorporated documents, the teachings of the application shall control. Various exemplary embodiments described herein can be used together, in combination and/or separately from one another in accordance with further exemplary embodiments of the present disclosure.

## Claims

1. An apparatus for treating hemorrhoids comprising:
a first part having a body including a hollow portion, a tapered end configured for insertion through a body lumen, and a first clamping surface;
a second part including a first closure member;
a third part including a second closure member having a second clamping surface, the first and second clamping surfaces defining a window, the second clamping surface being movable in relation to the first clamping surface to vary a size of the window; and
a spring coupling arrangement connecting the second part to the third part such that movement of the second part toward the hollow portion in relation to the first part causes movement of the second clamping surface toward the first clamping surface to decrease the size of the window, wherein the spring coupling arrangement is adapted to facilitate movement of the second part independently of the third part, while maintaining a distally directed force on the third part, when distal movement of the second clamping surface is obstructed by tissue positioned within the window.

2. The apparatus according to claim 1, further including a first spring connected between the first part and the second part, the first spring being adapted to urge the second part in relation to the first part to urge the second clamping surface away from the first clamping surface.

3. The apparatus according to claim 2, wherein the spring coupling arrangement includes a second spring connected between the second part and the third part.

4. The apparatus according to claim 3, wherein the first and second springs operate in tension.

5. The apparatus according to claim 1, wherein the second part is positioned to slide over the third part when the second part moves independently of the third part.

6. The apparatus of claim 1, further comprising an electrode supported on the first part.

7. The apparatus according to claim 6, wherein the electrode is supported on the first part adjacent the first clamping surface.

8. The apparatus according to claim 1, further comprising an illumination arrangement to provide light to the tissue within the window.

9. The apparatus according to claim 1, wherein the tapered end of the first part is closed and positioned distally of the window.

10. An apparatus for treating hemorrhoids comprising:
a first part having a body including a hollow portion, a tapered end configured for insertion through a body lumen, a first handle grip, and a first clamping surface;
a second part including a second handle grip and a first closure member connected to the second handle grip;
a third part including a second closure member having a second clamping surface, the first and second clamping surfaces defining a window, the second clamping surface being movable in relation to the first clamping surface to vary a size of the window; and
a spring coupling arrangement connecting the second part to the third part such that movement of the second handle grip towards the first handle grip moves the second clamping surface toward the first clamping surface to decrease the size of the window, wherein the spring coupling arrangement is adapted to facilitate movement of the second part independently of the third part, while maintaining a distally directed force on the third part, when distal movement of the second clamping surface is obstructed by tissue positioned within the window.

11. The apparatus according to claim 10, further including a first spring connected between the first part and the second part, the first spring being adapted to urge the second handle grip away from the first handle grip to urge the second clamping surface away from the first clamping surface.

12. The apparatus according to claim 11, wherein the spring coupling arrangement includes a second spring connected between the second part and the third part.

13. The apparatus according to claim 12, wherein the first and second springs operate in tension.

14. The apparatus according to claim 10, wherein the second part is positioned to slide over the third part when the second part moves independently of the third part.

15. The apparatus of claim 10, further comprising an electrode supported on the first part.

16. The apparatus according to claim 15, wherein the electrode is supported on the first part adjacent the first clamping surface.

17. The apparatus according to claim 10, further comprising an illumination arrangement to provide light to the tissue within the window.

18. The apparatus according to claim 10, wherein the tapered end of the first part is closed and positioned distally of the window.