# Patent

## Title
Multifunction surgical device

## Abstract

A surgical device is disclosed along with methods of using the same. The surgical device may include an outer sheath and a collar assembly. The collar assembly may be coupled to the outer sheath and may include a first arm coupled to the outer sheath at a first hinge; a second arm coupled to the first arm at a second hinge; and a collar coupled to the second arm. The collar assembly may be movable from an un-deployed position where the first arm and the second arm extend the collar distally from the outer sheath to a deployed position where the collar is aligned with the first channel of the outer sheath. Also, the first arm, the second arm, and the collar may be positioned substantially within a cross-sectional area of a distal end of the outer sheath when the collar assembly is in the un-deployed position.

## Background
BACKGROUND
Various embodiments are directed to multifunctional surgical devices and methods of using the same.
In endoscopic, laparoscopic, and other noninvasive surgical techniques, internal suturing or other tissue fastening must be performed with instruments small enough to fit through a trocar or endoscope working channel, which can often be quite narrow. For example, the working channel of a typical flexible endoscope has a diameter in the range of about 2.5 to about 4 millimeters. Current staplers and suturing devices cannot be easily redesigned to work through such small openings. In addition, performing procedures by way of the working channel does not easily permit using two instruments positioned at different angles with respect to the wound site in order to “pass and catch” a needle and apply sutures.
Various clips, suture fasteners and anchors have been developed such that clinicians may endoscopically close tissue perforations resulting from, for example, ulcers, polypectomy, incisions, etc. One type of suture anchor is known as a “T-tag” fastener. The T-tag is a small metallic pin with a suture attached at the middle. The physician may load the T-tag into the end of a cannulated needle of an applicator that may be inserted through the working channel of an endoscope. The physician may push the needle into the tissue near the perforation and implant the T-tag into the tissue with the attached suture trailing through the working channel and out the proximal end of the endoscope. After two or more T-tags are attached to the tissue near the wound in this manner, the physician may pull the sutures to appose the tissue around the wound. The physician may then fasten the sutures together by applying a plurality of alternating, right and left overhand knots using a knot pushing device or by applying a knotting element or other type of fastener through the working channel of the endoscope.
FIGS. 1-5 illustrate an example procedure for repairing a wound, such as a gastric bleeding ulcer in the stomach wall of the patient, through a working channel of an endoscope. FIG. 1 illustrates a flexible endoscopic portion 16 of a gastroscope 14 inserted into the upper gastrointestinal tract of a patient. As shown in FIG. 2, the clinician (e.g., gastroenterologist) inserts a suture anchor applicator 18 through the gastroscope 14 and penetrates a cannulated needle 19 through the stomach wall near the diseased area or wound. The needle 19 contains at least one suture anchor such that, as shown in FIG. 3, the physician may deploy a first suture anchor 20 attached to a first suture 24 to one side of the wound and a second suture anchor 22 attached to a second suture 26 to the opposite side of the wound. The free ends of the first and second sutures 24, 26 may extend through the proximal end of the gastroscope 14 such that, as shown in FIG. 4, the physician may draw the first and second sutures 24, 26 together to appose the tissue around the wound. The physician may then fasten the first and second sutures 24, 26 together by knotting them, or using a knotting element or fastener. FIG. 5 illustrates an example knotting element 28 applied to sutures 24, 26. Excess suture may be trimmed near the knot using an endoscopic cutting instrument.
An issue typically associated with current suture anchor applicators, such as those described in FIGS. 1-5, is the risk that nearby organs may be accidentally injured by the needle 19 of the applicator. The physician normally cannot see anatomical structures on the distal side of the tissue layers when the needle is being pushed through the tissue layers. Therefore, there is a risk that adjacent organs may be accidentally injured by the penetrating needle.



FIGURES
The novel features of the various embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows.
FIG. 1 is a drawing of one embodiment of a flexible, endoscopic portion of a gastroscope inserted into the upper gastrointestinal tract of a patient.
FIG. 2 is a drawing of the distal portion of one embodiment of a suture anchor applicator extending from the distal end of the gastroscope while a first suture anchor is deployed into the stomach wall near a wound.
FIG. 3 is a drawing of one embodiment of the applicator of FIG. 2 while a second suture anchor is deployed into the stomach wall on the opposing side of the wound.
FIG. 4 is a drawing of one embodiment of the applicator of FIG. 2 while a pair of sutures of the first and second suture anchors are drawn together to appose the tissue on each side of the wound.
FIG. 5 is a drawing of the pair of sutures of FIG. 4 fastened together with a knotting element, thereby holding the tissue in apposition.
FIG. 6 illustrates one embodiment of a distal end effector of a surgical device.
FIG. 7 illustrates one embodiment of the end effector of FIG. 6 with the collar assembly in the un-deployed position.
FIG. 8 illustrates one embodiment of an end effector with a wire-operated collar assembly.
FIG. 9 illustrates one embodiment of the end effector of FIG. 8 with the collar assembly in the deployed position.
FIG. 10 illustrates an alternative view of the end effector of FIG. 8 with the collar assembly in the deployed position showing the wires and the channel.
FIG. 11 illustrates one embodiment of an end effector with an alternate collar.
FIGS. 12A and 12B illustrate one embodiment of the end effector of FIG. 6 being used to suture tissue.
FIGS. 13A, 13B, and 13C illustrate an alternate method of suturing tissue using the end effector of FIG. 6.
FIGS. 14A, 14B and 14C illustrate another alternate method of suturing tissue using the end effector of FIG. 8.
FIGS. 15A and 15B illustrates one embodiment of the end effector of FIG. 6 being used to create a continuous stitch.
FIGS. 16A and 16B illustrate another embodiment of the end effector of FIG. 6 being used to create a continuous stitch.
FIG. 17 illustrates one embodiment of an end effector configured to perform bipolar procedures, such as electrocoagulation.



DESCRIPTION
FIG. 6 illustrates one embodiment of a surgical end effector 100. The end effector 100 may comprise an outer sheath 102, a suture applicator, such as a needle 106, and a collar assembly 104. The outer sheath 102 may extend proximally to a handle (not shown) of the surgical instrument. The needle 106 may be positioned within a channel 108 of the outer sheath 102 and may be extended distally to apply suture and/or suturing anchors to tissue. Although various embodiments are described with a suture applicator needle 106, it will be appreciated that various other suture applicator devices may be substituted.
The collar assembly 104 may perform various functions during suturing. For example, a hollow collar 114 of the collar assembly 104 may be deployed distally in line with the needle 106 as shown. The collar 114 may be positioned relative to the needle 106 on the opposite side of tissue to be sutured. When the needle 106 is extended distally through the tissue, the collar 114 may provide a counter force or counter-traction on the opposite side of the tissue. This counter-traction may make it easier for the needle 106 to penetrate the tissue. In various embodiments, the collar 114 may define a cavity 118 having a cap 120, which may arrest distal movement of the needle 106 and prevent it from extending too far and injuring surrounding organs and tissue. Also, according to various embodiments, the collar assembly 104 may be used to grasp and/or position tissue before the needle 106 is extended.
The end effector 100 may be utilized with any suitable surgical device type and may be introduced to a surgical site according to any suitable method. For example, the end effector 100 may be utilized in a traditional open surgical environment, or may be introduced via a trocar in a laparoscopic surgical environment or via a working channel of an endoscope in an endoscopic surgical environment. According to various embodiments, the end effector 100 may be introduced via natural orifices and may be combined with trans-organ techniques. In one embodiment, Natural Orifice Translumenal Endoscopic Surgery (NOTES)TM techniques may be employed to introduce instruments into the patient and carry out the various procedures described hereinbelow. A NOTESTM technique is a minimally invasive therapeutic procedure that may be employed to treat diseased tissue or perform other therapeutic operations through a natural opening of the patient without making incisions in the abdomen. A natural opening may be the mouth, anus, and/or vagina. Medical implantable instruments may be introduced into the patient to the target area via the natural opening. In a NOTESTM technique, a surgeon inserts a flexible endoscope into one or more natural openings of the patient to view the target area using a camera. During endoscopic surgery, the surgeon inserts surgical devices through one or more lumens or working channels of the endoscope to perform various key surgical activities (KSA). These KSAs include forming an anastomosis between organs, repairing ulcers and other wounds, etc.
Referring again to FIG. 6, the collar assembly 104 may comprise an inner arm 110, an outer arm 112 and the collar 114. The inner arm 110 may be coupled to the outer sheath 102 at a hinge 116. The inner arm 110 may also be coupled to the outer arm 112 at a hinge 122. The collar 114 may be coupled to the outer arm 112 according to any suitable method (e.g., adhesive, welding, fasteners, etc.). According to various embodiments, the outer arm 112 and the collar 114 may be formed from a single piece of material.
The collar assembly 104 may be oriented in a deployed position, as illustrated in FIG. 6, or an un-deployed position. FIG. 7 illustrates one embodiment of the end effector 100 with the collar assembly 104 in the un-deployed position. In the un-deployed position, the various components of the collar assembly 104 may be extended distally to be roughly in line with the outer sheath 102. When the collar assembly 104 is in the un-deployed position, its distal cross section may be less than when it is in the deployed position. This may allow the end effector 100 to more easily pass through a trocar or endoscope working channel. According to various embodiments, the cross-sectional area of the collar assembly 104 may substantially within the cross-sectional area of the outer sheath 102 when the collar assembly 104 is in the un-deployed position. Once the end effector 100 has passed through the trocar or endoscope working channel, the collar assembly 104 may be transitioned to the deployed position for use.
The collar assembly 104 may be transitioned between the deployed and un-deployed positions according to any suitable method. For example, as shown in FIGS. 1 and 2, the collar assembly 104 may comprise a spring rod 124 coupled between the outer arm 112 and the inner arm 110. The spring rod 124 may exert a force tending to bias the collar assembly 104 to the deployed position illustrated in FIG. 6. To introduce the end effector 100 to a surgical site, the clinician, manually or otherwise, may hold the collar assembly 104 in the un-deployed position illustrated in FIG. 7 and place it in a proximal end of a trocar or endoscope working channel. When the end effector 100 emerges from a distal end of the trocar or endoscope working channel, the spring rod 124 may bias the collar assembly 104 back to the deployed position.
FIG. 8 illustrates one embodiment of an end effector 100′ with a wire-operated collar assembly 104′. Like the end effector 100, the end effector 100′ may comprise an outer sheath 102′, a suture applicator needle 106′ (not shown in FIG. 8) and the collar assembly 104′. The collar assembly 104′ of the end effector 100′, however, may be wire-operated. A spring rod 802 may be coupled to the outer arm 112 and the inner arm 110. Unlike the spring rod 124, the spring rod 802 may exert a force on the outer and inner arms, tending to hold the collar assembly 104′ in the un-deployed position, as shown in FIG. 8. One or more wires 804 may be coupled to the outer arm 112 at mounts 808. The wires 804 may also be routed through the inner arm 110′ via holes 810. The wires 804 may then extend proximally to a handle (not shown) of the surgical instrument via a channel 806 of the outer sheath 102′. When a clinician retracts the wires 804 proximally (e.g., by depressing a trigger or other actuator of the surgical device), the wires may exert a force on the collar assembly 104′ that opposes the force generated by the spring rod 802 and causes the collar assembly 104′ to transition to the deployed position. FIG. 9 illustrates one embodiment of the end effector 100′ with the collar assembly 104′ in the deployed position. Also, FIG. 10 illustrates an alternative view of the end effector 100′ with the collar assembly 104′ in the deployed position, showing the wires 804 and the channel 806.
FIG. 11 illustrates one embodiment of the end effector 100 with an alternate collar 114′′. The collar 114′′ defines a cavity 118′′ extending completely therethrough (e.g., no cap 120 may be present). Accordingly, the needle 106 may extend through the collar 114′′. The collar 114′′ may provide counter-traction when placed on the opposite side of tissue to be sutured and may allow the clinician to grasp tissue, for example, as described herein. The collar 114′′ may be used with any of the end effectors 100, 100′ described herein. Although the collar 114′′ is illustrated with the end effector 100, it may also be used with the end effector 100′.
The end effectors 100 and 100′ may be used, according to various embodiments, to suture tissue. FIG. 12A illustrates one embodiment of the end effector 100 being used to suture tissue 1200. The tissue 1200 may have an opening 1202 to be closed by suturing. The opening 1202 may be an ulcer, incision, polypectomy, or other perforation. In use, the clinician may extend the collar 114 and outer arm 112 through the opening 1202, as shown, with the needle 106 retracted within the channel 108. The clinician may then extend the needle 106 into or through the tissue 1200, as shown in FIG. 12B. The collar 114 may provide counter-traction, making it easier for the needle 106 to penetrate the tissue 1200. The needle 106 may serve to place a suture or suture anchor (not shown) either into or through the tissue 1200, for example, as described above. When the needle 106 has been fully extended distally, it may contact the cap 120, which may arrest further extension, although embodiments utilizing a collar 114′′ lacking a cap 120 may also be used. It will be appreciated that the end effector 100′ may be used in a manner similar to that shown in FIGS. 12A and 12B.
FIGS. 13A, 13B, and 13C illustrate an alternate method of suturing tissue using the end effector 100. In FIG. 13A, the end effector 100 is positioned above tissue 1300. The tissue 1300 may have an opening 1302, which may be an ulcer, incision, polypectomy, or other perforation. While the needle 106 is retracted, the clinician may utilize the collar assembly 104 to position a portion of the tissue 1300 between the collar 114 and a distal end of the outer sheath 102 (e.g., the surface including the channel 108). FIG. 13B shows the end effector 100 with the tissue 1300 positioned between the collar 114 and the distal end of the outer sheath 102. The clinician may position the tissue 1300 using any suitable surgical technique. For example, the clinician may place the collar 114 against the tissue 1300 at a desired location. The clinician may then pull the outer sheath 102 proximally. Friction and resistance from the tissue 1300 may prevent the collar 114 from moving with the outer sheath 102. Accordingly, the collar 114 and outer arm 112 may oppose the force of the spring rod 124 and increase the gap between the collar 114 and the outer sheath 102. The clinician may then maneuver the end effector 100 until a desired portion of tissue 1300 is positioned between the collar 114 and the outer sheath 102. Then, the clinician may move the outer sheath 102 distally, allowing the spring rod 124 to force the collar assembly 104 to the deployed position. As a result, the tissue 1300 may be held in position, as shown in FIG. 13B. In some embodiments, and in some surgical situations, the spring rod 124 may provide sufficient force to clamp the tissue 1300 between the collar 114 and the outer sheath 102. Once the tissue 1300 is positioned, the needle 106 may be deployed to place a suture or suture anchor (not shown) either into or through the tissue 1300. Again, when the needle 106 has been fully extended distally, it may contact the cap 120, which may arrest further extension, although embodiments utilizing a collar 114′′ lacking a cap 120 may also be used.
FIGS. 14A, 14B and 14C illustrate another alternate method of suturing tissue using the end effector 100′. In FIG. 14A, the end effector 100′ is positioned above the tissue 1300. While the needle 106′ is retracted, the clinician may utilize the collar assembly 104′ to position a portion of the tissue 1300 between the collar 114′ and a distal end of the outer sheath 102′ as shown in FIG. 14B. To position the tissue, the clinician may release tension on wires 804. This may allow the spring rod 802 to push the collar 114′ and the outer sheath 102′ away from one another. A portion of the tissue 1300 may then be positioned between the collar 114′ and the outer sheath 102′ according to any suitable method. The wire 804 may then be retracted proximally, pulling the collar 114′ toward the outer sheath 102′ and clamping the tissue 1300. In various embodiments, the clinician may exert proximal force on the wire 804 sufficient to clamp the tissue between the collar 114′ and the outer sheath 102′. Once the tissue 1300 is placed, the needle 106′ may be deployed through the tissue 1300 to place a suture or suture anchor (not shown) as described above. When the needle 106′ is fully extended, it may contact the cap 120′. This may arrest further distal movement of the needle 106′, although embodiments utilizing a collar 114′′ lacking a cap 120 may also be used.
In FIGS. 13A, 13B and 13C as well as in FIGS. 14A, 14B and 14C, the portion of tissue positioned and/or clamped between the collar 114, 114′ and the outer sheath 102, 102′ includes the opening 1302. Thus, the collar assembly 104, 104′ tends to close the opening 1302 between the collar 114, 114′ and the outer sheath 102, 102′. It will be appreciated that, in various embodiments, tissue not including an opening such as opening 1302 may be clamped by the collar assembly 104, 104′. For example, it may be desirable to place sutures or suture anchors adjacent to an opening, or even away from an opening, as the surgical situation dictates.
According to various embodiments, end effectors 100, 100′ utilizing a collar 114′′ having a cavity 118′′ extending completely therethrough, for example, as shown in FIG. 11, may be utilized to place a continuous stitch. For example, FIGS. 15A and 15B illustrate one embodiment of the end effector 100 being used to create a continuous stitch. As shown in FIG. 15A, the needle 106 is extended through the tissue 1200 and through the cavity 118′′ of the collar 114′′. Then a suture anchor 1502 connected to a suture 1504 (FIG. 15B) may be deployed from a distal end of the needle 106. The suture anchor 1502 may either expand and/or change its orientation after being deployed from the needle 106. As a result, the suture anchor 1502 may assume a cross-section too large to be pulled proximally through the collar 114′′. Accordingly, the anchor 1502 may become lodged on a distal end of the collar 114′′, allowing the clinician to pull the anchor 1502 and suture 1504 proximally by pulling the collar 114′′ proximally. The end effector 100 may then be removed from the surgical site, pulling the suture 1504 to the clinician. The suture 1504 may then be reloaded into the needle 106 with the anchor 1502 or a new anchor (not shown) allowing the clinician to make another stitch.
FIGS. 16A and 16B illustrate another embodiment of the end effector 100 being used to create a continuous stitch. The needle 106 may be extended through tissue 1300 and through the cavity 118′′. A suture anchor 1502 and suture 1504 (FIG. 16B) may be deployed from the needle 106. As described above, the suture anchor 1502 may either pivot or expand after being deployed from the needle, making it larger than the cavity 118′′. This may cause the suture anchor 1502 to become lodged against the collar 114′′, allowing the clinician to remove the suture anchor 1502 and suture 1504 from the surgical site with the collar 114′′. As described above, the suture 1504 may then be re-loaded into the needle 106 and advanced to the surgical site to make another stitch. Although FIGS. 15A, 15B, 16A, and 16B are illustrated with the end effector 100, it will be appreciated that the end effector 100′ may be substituted and used in a similar manner.
According to various embodiments, the various end effectors 100, 100′ may be used to perform surgical tasks other than suturing including, for example, grasping, punch biopsy, electrocoagulation, bipolar electrocoagulation, etc. Any suitable method may be utilized. For example, a clinician may grasp tissue using one of the techniques illustrated in FIGS. 12A-B, FIGS. 13A-C and/or FIGS. 14A-C without extending the needle 106. Some embodiments of the end effectors 100, 100′ may be specifically designed for non-suturing tasks and may omit the needle 106.
FIG. 17 illustrates one embodiment of an end effector 100′′′ configured to perform bipolar procedures, such as electrocoagulation. The collar 114′′′ may comprise a first electrode 1702. A second electrode 1704 may be positioned on the inner arm 110′′′, or may be positioned on the outer sheath 102′′′. When the end effector 100′′′ is in the deployed position, the electrodes 1702, 1704 may be positioned approximately opposite one another. The electrodes 1702, 1704 may be in electrical communication with a power source (not shown), which, for example, may be located away from the surgical site. In use, the clinician may position tissue between the electrodes 1702, 1704, for example, similar to the way that tissue was positioned for suturing in the embodiments described above. When tissue is positioned between the electrodes 1702, 1704, the clinician may activate the power source, which energizes the electrodes causing the tissue to be electrocoagulated, or otherwise electrically acted upon. Some embodiments of the end effector 100′′′ may also include a needle (not shown) or other suturing applicator that may be used as described above.
The electrodes 1702, 1704 may be placed in electrical communication with the power source according to any suitable methods. For example, electrical wires (not shown) may extend proximally from the electrodes 1702, 1704 through the outer sheath 102′′′ to the power source. In some embodiments, the outer arm 112′′′ and/or the inner arm 110′′′ may comprise lumens for receiving the electrical wires. Also, it will be appreciated that the electrodes 1702, 1704 may be electrically isolated from each other. For example, the inner arm 110′′′ and the outer arm 112′′′ and/or collar 114′′′ may be made of dielectric materials that are not good conductors of electricity. According to various embodiments, dedicated electrodes 1702, 1704 may be omitted, with other components of the end effector 100′′′ serving as electrodes. For example, the collar 114′′′ and/or outer arm 112′′′ may serve as one electrode while the inner arm 110′′′ may serve as a second electrode. In these embodiments, the inner arm 110′′′ and the outer arm 112′′′ and/or collar 114′′′ may be electrically isolated from one another. Although the end effector 100′′′ is illustrated as a wire-operated collar assembly 104′′′, it will be appreciated that other embodiments may be transitioned between the deployed and un-deployed positions similar to end effector 100 described above.
In various embodiments, surgical instruments utilizing various embodiments of the end effectors 100 100′ may be employed in conjunction with a flexible endoscope, such as a GIF-100 model available from Olympus Corporation, for example. In at least one such embodiment, the endoscope, a laparoscope, or a thoracoscope, for example, may be introduced into the patient trans-anally through the colon, the abdomen via an incision or keyhole and a trocar, or trans-orally through the esophagus, for example. These devices may assist the surgeon to guide and position the electrical ablation system near the tissue treatment region to treat diseased tissue on organs such as the liver, for example. In another embodiment, these devices may be positioned to treat diseased tissue near the gastrointestinal (GI) tract, esophagus, and/or lung, for example. In various embodiments, the endoscope may comprise a flexible shaft where the distal end of the flexible shaft may comprise a light source, a viewing port, and at least one working channel. In at least one such embodiment, the viewing port may transmit an image within its field of view to an optical device such as a charge coupled device (CCD) camera within the endoscope, for example, so that an operator may view the image on a display monitor (not shown).
It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a clinician manipulating an end of an instrument extending from the clinician to a surgical site (e.g., through a trocar, through a natural orifice, through an open surgical site, etc.). The term “proximal” refers to the portion closest to the clinician, and the term “distal” refers to the portion located away from the surgeon. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.
While several embodiments have been illustrated and described, and while several illustrative embodiments have been described in considerable detail, the embodiments are not intended to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art. Those of ordinary skill in the art will readily appreciate the different advantages provided by these various embodiments.
While several embodiments have been described, it should be apparent, however, that various modifications, alterations and adaptations to those embodiments may occur to persons skilled in the art with the attainment of some or all of the advantages of the embodiments. For example, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. This application is therefore intended to cover all such modifications, alterations and adaptations without departing from the scope of the appended claims.
The devices disclosed herein may be designed to be disposed of after a single use, or they may be designed to be used multiple times. In either case, however, the device may be reconditioned for reuse after at least one use. Reconditioning may include a combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device may be disassembled, and any number of particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device may be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those of ordinary skill in the art will appreciate that the reconditioning of a device may utilize a variety of different techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
Preferably, the embodiments described herein will be processed before surgery. First a new or used instrument is obtained and, if necessary, cleaned. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that may penetrate the container, such as gamma radiation, x-rays, or higher energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials do not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
The embodiments are not to be construed as limited to the particular embodiments disclosed. The embodiments are therefore to be regarded as illustrative rather than restrictive. Variations and changes may be made by others without departing from the scope of the claims. Accordingly, it is expressly intended that all such equivalents, variations and changes that fall within the scope of the claims be embraced thereby.
In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more embodiments has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more embodiments were chosen and described in order to illustrate principles and practical applications to thereby enable one of ordinary skill in the art to utilize the various embodiments and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.

## Claims

1. A surgical device comprising:
an outer sheath defining a first channel therein;
a suturing applicator;
a collar assembly coupled to the outer sheath, wherein the collar assembly comprises:
a first arm coupled to the outer sheath at a first hinge positioned substantially at a first end of the first arm;
a second arm coupled to the first arm at a second hinge positioned substantially at a second end of the first arm; and
a collar coupled to an end of the second arm opposite the second hinge; and

wherein the collar assembly is movable from an un-deployed position where the first arm and the second arm extend the collar distally from the outer sheath to a deployed position where the collar is aligned with the first channel of the outer sheath, wherein the suturing applicator is distally extendable from the first channel toward the collar, when the collar assembly is in the deployed position, and wherein a distal cross section of the collar assembly is smaller when the collar assembly is in the un-deployed position than when the collar assembly is in the deployed position.

2. The surgical device of claim 1, wherein the first arm, the second arm, and the collar are positioned substantially within a cross-sectional area of a distal end of the outer sheath when the collar assembly is in the un-deployed position.

3. The surgical device of claim 1, wherein the collar assembly further comprises a spring rod extending from the first arm to at least one of the second arm and the collar, wherein the spring rod biases the collar assembly to the deployed position.

4. The surgical device of claim 1, wherein the collar assembly further comprises a spring rod extending from the first arm to at least one of the second arm and the collar, wherein the spring rod biases the collar assembly to the un-deployed position.

5. The surgical device of claim 4, wherein the collar assembly further comprises a wire extending proximally from at least one of the second arm and the collar through the outer sheath, wherein the wire is configured to transmit a proximally directed force to at least one of the second arm and the collar to move the collar assembly to the deployed position.

6. The surgical device of claim 1, wherein the suturing applicator is a needle.

7. The surgical device of claim 6, wherein the collar comprises a cap preventing the suturing needle from extending through the cap when the collar assembly is in the deployed position.

8. The surgical device of claim 1, wherein the collar comprises a hollow center aligned with the first channel of the outer sheath and positioned to receive at least a portion of the suturing applicator.

9. The surgical device of claim 8, wherein the collar comprises a cap on a distally oriented side of the hollow center.

10. The surgical device of claim 1, further comprising a first electrode and a second electrode.

11. The surgical device of claim 10, wherein the first electrode and the second electrode are positioned opposite one another when the collar assembly is in the deployed position.

12. The surgical device of claim 10, wherein the first electrode is positioned on the collar and wherein the second electrode is positioned on the first arm.

13. The surgical device of claim 10, wherein the collar assembly is the first electrode and the first arm is the second electrode.