Abstract:
This invention is directed to devices and methods for improving wound closures produced during endoscopic surgery. These methods are directed to delivering and applying a quantity of hemostatic agents in either powder, solid, liquid, or gel form onto an open wound produced e.g., by polyp removal, followed by the application of pressure. The method is implemented preferably using existing endoscopic equipment; however, modifications to existing endoscopic insertion tubes, application and tamping devices and endoscopic clips deployed from the distal end of the insertion tube during endoscopic surgery are also within the scope of this invention.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    Not applicable 
       STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0002]    Not applicable 
       INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED ON A COMPACT DISC 
       [0003]    Not applicable 
       BACKGROUND OF THE INVENTION 
       [0004]    1. Field of the Invention 
         [0005]    This invention is directed to a method for improving wound closures during endoscopic surgery after polyp removal and biopsy samples are taken. More specifically, this disclosure is directed to applying a quantity of resin ferrate or other hemostatic substances in either powder, solid, liquid or gel form onto an open wound, followed by the application of pressure. The methods are implemented preferably using existing endoscopic equipment; however, modifications to existing endoscopic insertion tubes and adaptive devices are also within the scope of this invention. The wound may be located in the alimentary tract or other serosal mucosa. 
         [0006]    2. Description of Related Art 
         [0007]    Endoscopy is the medical science of looking inside or typically within the body for medical reasons using an endoscope. An endoscope is an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ. 
         [0008]    An endoscope typically includes a rigid or flexible tube, a light delivery system to illuminate the organ. The light source is typically being positioned outside the body, the light being directed typically by an optical fiber system to illuminate the interior organ. The endoscope also includes a lens system for transmitting the image from the objective lens to the viewer, and an eyepiece. Additional channels are provided to allow entry of medical instruments and manipulators. 
         [0009]    A healthcare provider may use an endoscope for any of a plurality of purposes, including investigation of symptoms such as symptoms in the digestive system including nausea, vomiting, abnormal pain, difficulty swallowing, and gastrointestinal bleeding. The endoscope may also be used to confirm a diagnosis, most commonly by performing a biopsy, to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system. Treatment may also be administered by an endoscope such as cauterization of a bleeding vessel, the widening of a narrow esophagus, cutting off of a polyp or removing a foreign object within the organ. 
         [0010]    One particularly useful application of the endoscope is the removal of polyps and other growths within the interior walls of the organ under examination. However, the techniques for removing the polyp include typically either a cutting device or a heated loop device, both of which leave a wound at the base of the polyp which typically bleeds profusely. To arrest the blood flow from the incision, surgical clamps are the most preferable means of arresting that blood flow. A plurality of these small surgical clamps is attached around and across the wound so as to effect a wound closure. However, these clamps are difficult to apply, are small and unable to approximate wide wounds, and do not often effect a complete wound closure leaving some bleeding. Moreover, the clamps must be left in place for a time sufficient to arrest bleeding, after which they are eventually eliminated by normal bowel movement in the colon or intestine. 
         [0011]    Another means for arresting blood flow from a wound of this nature is to simply spray a powder starch-like material onto the wound until it is sufficiently covered to absorb the blood flow and cause the cessation of blood flow from that wound. However, due to a lack of containment of this powder, a large quantity of this material is required to effect bleeding cessation, leaving a substantially greater amount of material than typically needed if applied directly to the wound from an exposed wound. 
         [0012]    The present invention provides a method of wound closure after a polyp or removal during endoscopic surgery and the like. This method is directed to applying a quantity of a hemostatic substance in either powder, solid, liquid, or gel form onto the open wound followed by the application of pressure. Various adaptive devices are provided to accomplish both the deployment of the hemostatic substance onto the wound and the application of pressure thereagainst to effect complete hemostasis. 
         [0013]    The foregoing examples of the related art and limitations related therewith are intended to be illustrative and not exclusive. Other limitations of the related art will become apparent to those skilled in the art upon a reading of the specification and a study of the drawings. 
       BRIEF SUMMARY OF THE INVENTION 
       [0014]    This invention is directed to a method for improving wound closures after polyp removal during endoscopic surgery. This method is directed to applying a quantity of a hemostatic substance e.g., resin ferrate in either powder, solid, liquid, or gel form onto an open wound produced by polyp removal followed by the application of pressure. The method is implemented preferably using existing endoscopic equipment, however, modifications to existing endoscopic insertion tubes is also within the scope of this invention. 
       Powder form of Hemostatic Substance 
       [0015]    Using the powder or granular form of the resin ferrate or other granular or particulate hemostatic substance, this material may be delivered through the central channel of an endoscope by air pressure, by plunger, by a screw feed, by gravity, or by a liquid carrier. To direct and apply pressure against the resin ferrate powder, several devices may be employed. For example, a flexible bowl or funnel formed of thin resilient material deployed against and covering the wound. Powder directed into the bowl or funnel is then pressed against the wound. When the powder is combined with magnetite, thin magnetic wires deployed from the distal end of the endoscope will capture the magnetic powder, after which the magnetic wires are directed against the wound for a time sufficient for the powder to become affixed onto the open wound. Other powder deployment and pressure application devices are also disclosed. 
       Tablet/Solid Form of Hemostatic Substance 
       [0016]    Several embodiments of this disclosure utilize a solid or compressed powder device for deployment onto the wound. One embodiment is in the form of a donut-shaped disc which is held within the end of the insertion tube and provides viewing access by the camera within the insertion tube. The camera thus provides accurate placement of the disc over the wound site. 
         [0017]    In another embodiment, a solid disc is temporarily bonded or adhered on the side of the bleeding tip providing guided positioning and pressure of the disc against the wound site for a time sufficient to adhere the disc to the wound site. 
         [0018]    Mini-sized solid tablets which slidably translate within a delivery tube are delivered sequentially onto the wound site. The column of tablets may be pushed by a plunger or connected by an elongated suture and pulled from the end of the bending tip. The hemostatic substance forming the disc may include magnetite which may be manipulated and applied by a magnet. 
       Motive Force 
       [0019]    A number of means for moving the hemostatic powder or solid tablets along the hollow interior of a delivery tube within the insertion tube may be employed, namely, a plunger, gas or air pressure, a venture, and various forms of augers or feed screws. 
         [0020]    The following embodiments and aspects thereof are described and illustrated in conjunction with systems, tools and methods which are meant to be exemplary and illustrative and not limiting in scope. In various embodiments one or more of the above-described problems have been reduced or eliminated while other embodiments are directed to other improvements. In addition to the exemplary aspects and embodiments described above, further aspects and embodiments will become apparent by reference to the drawings and by study of the following descriptions. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S) 
         [0021]      FIG. 1  is a pictorial view of a typical endoscope assembly. 
           [0022]      FIG. 2  is a section view in the direction of arrows  2 - 2  in  FIG. 1 . 
           [0023]      FIG. 3  is a schematic section view of the deployment of one embodiment of the invention by applying a quantity of a hemostatic powder over a wound site within an intestine. 
           [0024]      FIG. 4  is a schematic section view of another embodiment of the invention showing deployment of a quantity of a hemostatic substance powder over a wound site within an intestine. 
           [0025]      FIG. 5  is a schematic section view of another embodiment of the invention deploying a quantity of a hemostatic powder over a wound site of an intestine. 
           [0026]      FIG. 6A, 6B and 6C  are schematic section views of another embodiment of the invention showing placement of a quantity of a hemostatic powder over a wound site within an intestine. 
           [0027]      FIG. 7  is a schematic section view of another embodiment of the invention being deployed to place a quantity of a hemostatic powder over a wound site within an intestine. 
           [0028]      FIGS. 8A and 8B  are schematic section views showing the deployment of another embodiment of the invention utilizing a balloon tamponade to place and press hemostatic powder against a wound site. 
           [0029]      FIG. 9  is a schematic section view of another embodiment of the invention incorporating a balloon tamponade with an internal magnet to deploy and compress hemostatic powder containing magnetite against a wound site. 
           [0030]      FIG. 10  is a schematic section view of another embodiment of the invention in the form of a large inflatable balloon which has been deployed and then inflated to fill the intestine to apply pressure against a hemostatic powder over the wound site. 
           [0031]      FIG. 11  is a schematic section view showing the deployment of yet another embodiment of the invention in the form of an expandable stent to apply pressure against a hemostatic powder after being applied over the wound site. 
           [0032]      FIGS. 12A and 12B  are schematic section views showing the sequential application of a hemostatic powder onto a wound site through a second scope line and then deploying a balloon tamponade through a main line to apply pressure thereagainst. 
           [0033]      FIG. 12C and 12D  are schematic section views showing the sequential deployment of a hemostatic powder through an application catheter and confined by a clear cap which is also used to apply pressure against the hemostatic powder. 
           [0034]      FIG. 13  is a schematic section view showing the hemostatic powder with magnetite being applied over a wound site as facilitated by an external magnet. 
           [0035]      FIG. 14  is a schematic section view showing the application of a ferrate spray solution in the form of Fe+ 3  against a wound site. 
           [0036]      FIGS. 15A, 15B and 15C  are schematic section views showing sequential deployment of an endoscopic clip formed of magnetic material which attracts and holds a quantity of hemostatic powder plus magnetite powder magnetically adhered thereto ready for being applied against a wound site as or after the clip is engaged the tissue around the wound site. 
           [0037]      FIGS. 16A and 16B  show the sequential application of a hemostatic tablet having a viewing hole formed centrally therethrough for a camera to facilitate accurate positioning of the hemostatic tablet directly over a wound site. 
           [0038]      FIGS. 17A and 17B  show the sequential application of a hemostatic tablet adhered against the exterior surface of the bending tip to be forcibly applied against the wound site. 
           [0039]      FIG. 18  is a schematic section view showing a hemostatic tablet adhered to the end of a delivery tube being held against a wound site for a time sufficient for adherence of the hemostatic tablet against the wound site. 
           [0040]      FIG. 19  shows another embodiment of the invention which includes a rapid dissolve substance mixed with a hemostatic powder or tablet that leaves some hemostatic powder behind as it is being held against a wound site. 
           [0041]      FIG. 20  is a pictorial view of another embodiment of the invention utilizing a delivery tube to pump a hemostatic powder beneath a wound covering placed over a wound site. 
           [0042]      FIG. 21  is a schematic section view showing another embodiment of the invention including the delivery of a quantity of a hemostatic powder plus magnetite mixed with tiny magnets against a wound site. 
           [0043]      FIGS. 22A and 22B  are schematic section views that show the sequential delivery of a plurality of mini hemostatic tablets through a delivery tube, one at a time, as forced to move by a plunger through a delivery tube, the mini hemostatic tablets extending over the wound and being retained in place when the resin plus ferrate reacts with blood in the wound site. 
           [0044]      FIGS. 23A and 23B  are similar views to  FIGS. 22A and 22B  except that the mini hemostatic tablets are connected together by a suture which is pulled in the direction of the arrow to deliver each of the mini hemostatic tablets over the wound site one at a time. 
           [0045]      FIGS. 24A and 24B  show the deployment of small magnets having barbs disposed on one end which pierce and are retained within the wound site, the magnets being applied by a plunger through a hollow delivery tube, after which a quantity of a hemostatic powder plus is applied over the anchored magnets to hold the powder in place within the wound site. 
           [0046]      FIGS. 25A and 25B  are sequential schematic views showing deployment of barbed anchors opposingly attached across a wound site and a pull suture interengaged between the anchors to pull the anchors together to close the wound. 
           [0047]      FIG. 26  is a perspective view of another embodiment of the invention including a coiled hemostatic powder-coated sheet which uncoils when deployed from a hollow delivery tube after which it is positioned against the wound site. 
           [0048]      FIGS. 27A and 27B  are schematic section views showing the deployment of a hemostatic powder through a hollow expandable distributing head having apertures formed along its outwardly facing surface, the hemostatic powder being distributed over the wound site, after which the distributing head is then utilized in  FIG. 26B  to tamp the hemostatic powder into place over the wound site. 
           [0049]      FIGS. 28A, 28B and 28C  are sequential schematic section views of the deployment of an end-barbed spring clip which engages into the edges of the wound site to be drawn together to close the wound as a pull wire is drawn into the delivery tube as the clip spring is arcuately formed. 
           [0050]      FIGS. 29 to 34  show a number of embodiments of means for delivering the hemostatic powder or solid pellets through the insertion tube and bending tip. In  FIG. 29 , a plunger is utilized while in  FIG. 30 , gas under pressure forces the hemostatic powder for discharge through the bending tip. In  FIG. 31 , a venturi is utilized to draw the hemostatic powder into the venturi for discharge under gas pressure from the end of the bending tip.  FIG. 32  shows a drill auger utilized to force the hemostatic powder or solid pellets through the insertion tube.  FIG. 33 , shows the utilization of an outer auger to force the hemostatic powder or solid pellets through the insertion tube.  FIG. 34  discloses a wire auger for the same purpose. 
           [0051]    Exemplary embodiments are illustrated in reference figures of the drawings. It is intended that the embodiments and figures disclosed herein are to be considered to be illustrative rather than limiting. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Nomenclature 
       [0052]      10 . endoscopic assembly 
         [0053]      12 . light guide connector 
         [0054]      14 . universal cord 
         [0055]      16 . endoscope head 
         [0056]      18 . eyepiece 
         [0057]      20 . controls 
         [0058]      22 . biopsy port 
         [0059]      24 . insertion tube 
         [0060]      26 . bending tip 
         [0061]      28 . biopsy suction channel 
         [0062]      30 . fiber optic light guides 
         [0063]      32 . fiber optic image bundle 
         [0064]      34 . water tube 
         [0065]      36 . air tube 
         [0066]      38 . tip bending control wires 
         [0067]      40 . hemostatic powder 
         [0068]      42 . flexible bowl 
         [0069]      44 . funnel shaped bowl 
         [0070]      46 . magnetic arm bowl 
         [0071]      48 . elastic ring 
         [0072]      50 . hemostatic powder with magnetite 
         [0073]      52 . barbed bowl 
         [0074]      54 . inflatable balloon 
         [0075]      56 . balloon tamponade 
         [0076]      58 . magnet 
         [0077]      60 . balloon 
         [0078]      62 . stent 
         [0079]      64 . application catheter 
         [0080]      66 . clear cap 
         [0081]      68 . application catheter 
         [0082]      68   a . venturi 
         [0083]      70 . magnet 
         [0084]      72 . FE +3  spray 
         [0085]      74 . spray nozzle 
         [0086]      76 . endoclip 
         [0087]      78 . resilient wire jaws 
         [0088]      80 . insertion tool 
         [0089]      82 . magnetized barrel 
         [0090]      84 . styptic powder 
         [0091]      86 . hemostatic tablet 
         [0092]      88 . hemostatic tablet 
         [0093]      90 . camera 
         [0094]      92 . hemostatic tablet 
         [0095]      100 . wound covering 
         [0096]      102 . hemostatic powder with magnets and magnetite 
         [0097]      104 . plunger 
         [0098]      106 . hemostatic tablets 
         [0099]      108 . suture 
         [0100]      110 . barbed magnets 
         [0101]      112 . barb 
         [0102]      114 . barbed anchor 
         [0103]      116 . barb 
         [0104]      118 . barbed anchor 
         [0105]      120 . barb 
         [0106]      122 . wire 
         [0107]      124 . hemostatic powder coated sheet 
         [0108]      130 . hemostatic powder distribution head assembly 
         [0109]      132 . distribution head 
         [0110]      134 . apertures 
         [0111]      140 . spring wire clip 
         [0112]      142 . spring wire 
         [0113]      144 . barbs 
         [0114]      146 . pivot anchor 
         [0115]      148 . push/pull wire 
         [0116]      150 . funnel 
         [0117]      152 . drive auger 
         [0118]      154 . outer auger 
         [0119]      156 . central feed passage 
         [0120]      158 . wire auger 
         [0121]    As referenced herein, the term “hemostatic powder” is preferably WOUNDSEAL powder, a resin/ferrate or hydrogen resin as taught in U.S. Pat. No. 6,187,347. The term “hemostatic tablet or solid” is preferably STATSEAL, refers to a compressed form of WOUNDSEAL powder. The term “intestine” is used to designate the alimentary tract or other serosal mucosa. 
         [0122]    Referring now to  FIGS. 1 and 2 , an endoscope assembly is shown generally at numeral  10  and includes an endoscope head  16  having an eye piece  18  and controls  20  thereon. The endoscope assembly  10  also includes a side insertion biopsy port  22  which leads to an elongated insertion tube  24 . Connected to the side of the eyepiece  16  is an elongated flexible inward cord  14  having a light guide connector  12  disposed at the distal end of universal cord  14 . 
         [0123]    In well known fashion, the insertion tube  24  houses a biopsy suction channel  28 , fiber optic light guides  30 , a fiber optic image bundle  32 , a water tube  34 , an air tube  36 , and a plurality of evenly spaced tip bending control wires  38 . These control wires  38  are controlledly actuated to bend the bending tip  26  in any desired direction as seen in  FIG. 1 . The endoscopic assembly  10  is the working tube that is inserted through an endoscope. The insertion tube  24  may pass directly through the endoscope head  16  or may be covered with a sheath to protect the hemostatic substance. Both sheath and tube pass through the endoscope head  16 . 
         [0124]      FIGS. 3 to 11  depict expandable devices which are deployed in collapsed form through the insertion tube  24  and then automatically expand when exiting the bending tip  26 .  FIG. 3  shows a flexibly expandable bowl  42  applied over the wound after bending tip  26  as shown. Hemostatic powder  40  is forced through the insertion tube  24  into the bowl  42 . The bowl  42  is then compressed in the direction of arrow A to apply pressure to the wound to press the powder  40  into contact with the wound to stop bleeding. The bowl  42  may have a rigid bottom with flexible sides that move in accordion fashion. The sides of the bowl  42  may flex outwards allowing pressure to be applied. The entire bowl  42  may be flexible. 
         [0125]    In  FIG. 4 , a flexibly expandable funnel shaped bowl  44  is applied over the wound and hemostatic powder  40  is forced through the insertion tube  24  into the bowl  44  which is then compressed to apply pressure to press the powder  40  into contact with the wound to stop bleeding. The bowl  44  may have a rigid bottom with flexible sides that accordion. The sides of the bowl  44  may flex outwards allowing pressure to be applied. 
         [0126]      FIG. 5  shows an expandable magnetic arm bowl  46  in combination with hemostatic powder with magnetite  50  which is held within the magnetic bowl  46  to facilitate application against the wound. The magnetic bowl  46  may be deployed with the hemostatic powder  50  attached prior to application or forced through the insertion tube  24  after deployment. 
         [0127]    In  FIGS. 6A, 6B and 6C , a barbed expandable netted bowl  52  includes barbed end points which are designed to penetrate the tissue and hold the bowl  52  in place when forced in the direction of D. The bowl  52  is then filled with hemostatic powder  40 , after which the following actions may take place in any order. The bowl  52  closes, detaches from the bending tip  26 , and then collapses. The collapsing of the bowl  52 , forces the hemostatic powder  40  onto the wound, while slightly approximating the wound. 
         [0128]    In one embodiment, the sides of the bowl  52  may be elastic, and there may be an elastic ring  48  at the end of the insertion tube as seen in  FIG. 6A . The bowl  52  is attached to the intestine around the wound which is then filled with powder. There are wires attached to the barbs to keep the bowl  52  open during filling and open for attachment. After attachment of the barbs and removal of the insertion tube  24  in  FIG. 6B , the wires pull from the barbs, and the elastic net plunger collapses about itself in all directions, closing and applying pressure on the hemostatic powder  40  against the wound approximating the wound. The bowl  52  remains at the wound site. 
         [0129]    In another embodiment, the arms of the bowl  52  are made of wire. The bowl  52  is attached and filled with powder as previously described, after which the insertion tube  24  is rotated whereupon the wires wrap around themselves, closing the bowl  52 , applying pressure on the hemostatic powder  40  against the wound, approximating the wound. The rotation then shears the wires, leaving the bowl  52  connected to the wound site. 
         [0130]    In another embodiment, the arms of bowl  52  are made of wire. The bowl  52  is deployed and attached around the wound after which the bowl  52  is filled with powder  40  and then retracted into the bending tip  26 . Applying pressure to the powder against the wound approximates the wound. The locking ring  48  closes the small end of the bowl  52 , and the wires are cut/broken closing the bowl  52  and leaving it in place. 
         [0131]    In another embodiment after attachment and fill of the bowl  52  the bowl  52  may be crushed, holding its crushed shape. The crushing applies pressure to the hemostatic powder  40  on the wound. This design would not approximate the wound. 
         [0132]    In further embodiments, an outer bowl  52  may be used to hold an inner collapsible netting in place until it can be deployed and filled with hemostatic powder  40 . The bowl  52  may also be magnetized to allow it to hold a magnetic hemostat  50 . The bowl  52  could be filled with hemostatic powder  50  prior to adhering to the intestine walls. The bowl  52  may also be adhered to means other than barbed points. The barbed points may be made from biosorbable materials, metal, or plastic. 
         [0133]    In  FIG. 7 , an inflatably expandable balloon  54  is employed to both contain the hemostatic powder  40  and to apply pressure via mechanical force (pushing the tube) on further inflation of the balloon. An application catheter  68  is extendable from the bending tip to deliver the hemostatic powder  40  to the wound site. The balloon  54  may be designed to create a funnel at low pressure and create a flatter surface with increased pressure against the wound site. 
         [0134]      FIGS. 8A and 8B  disclose an expandable balloon tamponade  56  to place and press the hemostatic powder  40  against a wound site. The balloon tamponade  56  contains the hemostatic powder around the wound site, after which the side is used as a tamponade to apply pressure to the wound in the direction of arrow G in  FIG. 8B . 
         [0135]      FIG. 9  incorporates the expandable balloon tamponade  56  with an internal magnet  58  to deploy and compress magnetic hemostatic powder  50  containing magnetite against a wound site. The powder  50  may be on the balloon prior to application or applied after the balloon  56  is inflated via a second tube or through an alternative tube. The magnet  58  holds the powder  50  in place so that it can be applied to the wound. 
         [0136]    In  FIG. 10 , a large inflatable balloon  60  is deployed through and from the insertion tube  24  and then inflated to fill the intestine to apply pressure against hemostatic powder  40  over the wound site. A magnet may be used in conjunction with the balloon, powder or a solid tablet. 
         [0137]      FIG. 11  shows an expandable stent  62  which applies pressure against hemostatic powder  40  after being applied and expanded over the wound site. The stent  62  may be biosorbable or removable, and may also be magnetic or a portion thereof to hold and concentrate the powder  40 . 
         [0138]      FIGS. 12A and 12B  show the sequential application of hemostatic powder  40  onto a wound site through a second application catheter  64 , after which the balloon tamponade  56  is deployed through the application catheter  68  after which the bending tip  26  is straightened at  26   a  and urged in the direction of arrow J to apply pressure against the powder. In  FIG. 12C and 12D , the sequential deployment of hemostatic powder  40  through an application catheter  64  and confinement of the hemostatic powder  40  within a clear cap  66  attached over the end of the bending tip  26  is there shown. The cap  66  is also used to apply pressure against the powder  40  as seen in  FIG. 12D  by urging the cap  66  in the direction of arrow K after straightening the bending tip  26 . The cap  66  may also contain a clear disk through which powder is filled. This disc may act as a plunger as the cap is used to apply pressure. 
         [0139]      FIG. 13  shows the hemostatic powder with magnetite  50  being applied over a wound site as facilitated by an external magnet  70 . In  FIG. 14 , application of a ferrate spray solution  72  in the form of Fe+ 3  from a spray nozzle  74  against a wound site is there shown. If sufficient quantity of trivalent salts are applied to blood, it will clot very rapidly. The Fe+ 3  spray  72  may be any trivalent soluble salt solution, a gel solution containing a soluble trivalent salt, or a bio-derived substance that induces clotting or absorbs blood components. Examples would be a collagen solution/gel, a thrombin containing solution/gel, or a fibrin containing solution/gel. The gel component may be polyvinyl alcohol, gelatin, or the like. The spray  72  may be used in conjunction with any other components in this application, for example, with the clear cap or a balloon funnel. The purpose is to contain, direct and concentrate the spray  72 . The spray  72  may be used in conjunction with a gauze or other device for retention and pressure application. 
         [0140]      FIGS. 15A and 15B  show sequential deployment of an endoscopic clip  76  (“endoclip”) formed having a magnetic barrel  82  which attracts and holds a quantity of hemostatic powder with magnetite powder  50  magnetically adhered thereto ready for being applied against a wound site as or after the resilient wire jaws  78  of the endoscopic clip  76  have engaged the tissue around the wound site by urging of an insertion tool  80  in the direction of arrow L. After urging of the wire jaws  78  into the tissue surrounding the wound, the insertion tool is urged in the direction of L′ to further set the wire jaws and close the wound. The magnetic hemostatic powder  50  will simultaneously be deposited over the closed wound to effect hemostasis. The magnetic hemostatic powder  50  may be applied to the magnetic barrel  82  prior to use or after deployment of the endoscopic clip  76 . 
         [0141]      FIG. 15C  shows the endoscopic clip containing a styptic powder  84 , or a bio-derived substance that induces hemostasis or clot formation. The styptic powder  84  is designed to release after endoscopic clip  76  deployment to assist with hemostasis. The styptic may be a solid or gel. 
         [0142]    In  FIGS. 16A and 16B , the sequential application of a hemostatic tablet  86  having a viewing hole formed centrally therethrough for a camera  90  facilitates accurate positioning of the hemostatic tablet  86  directly over a wound site. A clear disc (not shown) may be used between the scope and the tablet to protect the scope. The camera  90  extends coaxially with the bending tip  26  and with the tablet  86  which is frictionally held in the position shown until deployed in the direction of arrow M. The tablet  86  may be designed to stay whole or break apart upon deployment and may need a protective coating to prevent it from wetting during deployment. 
         [0143]      FIGS. 17A and 17B  show the sequential deployment of a hemostatic tablet  88  adhered against the exterior surface of the bending tip  26  to be forcibly applied against the wound site in the direction of arrow N. The tablet  88  may need a protective coating to prevent it from wetting during deployment. 
         [0144]      FIG. 18  is a view showing a hemostatic tablet  92  adhered to the end of the delivery tube  68  and being urged in the direction of O against a wound site for a time sufficient for adherence of the tablet  92  to effect hemostasis against the wound site. 
         [0145]    In  FIG. 19 , another embodiment includes a rapid-dissolve substance mixed with hemostatic powder to form a tablet  94  that leaves the hemostatic powder behind as it is being held against a wound site. This rapid-dissolve substance may either be a rapidly dissolving component in the tablet or a dissolving coating. 
         [0146]      FIG. 20  shows a delivery tube  68  pumping hemostatic powder beneath a wound covering  100  placed over a wound site. The covering  100  may also contain an agent to induce or assist with hemostasis or clot formation. Examples would be a trivalent salt solution or solid, thrombin, fibrin, activated cellulose or a combination. The covering  100  is attached to the wound through the interaction of the moisture in the tract, e.g. a PVA coating with an absorptive backing that works similar to a stamp used for postage. 
         [0147]    In  FIG. 21 , delivery of a quantity of hemostatic powder with magnetite  102  is mixed with tiny magnets against a wound site. The combination of components would form a malleable solid. 
         [0148]      FIGS. 22A and 22B  show the sequential delivery of a plurality of mini hemostatic tablets  106  through a delivery tube  68 , one at a time in the direction of arrow P, as forced to move by a plunger  104  through the delivery tube  68 , The mini hemostatic tablets  106  are deployed to extend over the wound and retained in place by reaction with blood in the wound site. Upon wetting and/or when force is applied to the tablets  106 , they may, at least in part, disintegrate into powder. 
         [0149]      FIGS. 23A and 23B  are similar views to  FIGS. 22A and 22B  except that the mini hemostatic tablets  106  are connected together by a flexible suture  108  which is pulled in the direction of arrow R to deliver each of the mini hemostatic tablets  106  over the wound site, one at a time. The tablets  106  may break away from the suture  108  as indicated into separate tablets, or the tablets may be connected together by a second suture (not shown). 
         [0150]      FIGS. 24A and 24B  show the sequential deployment of small magnets  110  having end barbs  112  which pierce and are retained within the wound site. The magnets  110  are applied by a plunger  104  through a hollow delivery tube  68 , after which a quantity of hemostatic powder with magnetite  50  is applied over the anchored magnets  110  to hold the powder  50  in place within the wound site. As many magnets  110  as are needed may be deployed to completely cover the wound site. 
         [0151]      FIGS. 25A and 25B  show deployment of barbed anchors  114  and  118  opposingly attached across a wound site and a pull suture  122  interengaged between the anchors  114  and  118  to pull the anchors  114  and  118  together in the direction of arrow S to close the wound. The anchors  114  and  118  may be deployed in pairs and pulled to approximate the wound or several anchors may be deployed. The multi anchor system may have one anchor  114  fixed to the end of the pull suture  122  and every anchor  118  subsequent to the first being a one-way pull type allowing the wound to be slowly approximated in the direction of arrows T-T. The anchors  114  and  118  may be magnetic to allow a magnetic hemostatic powder to be applied and held in place after the anchors are deployed or the anchors may be coated with a styptic or other hemostatic agent. 
         [0152]    In  FIG. 26 , a coiled hemostatic powder-coated sheet  124  uncoils when deployed from the hollow delivery tube  68 , after which it is positionable against the wound site. The sheet  124  may be coiled with the hemostatic agent  40  on either side thereof. A sheath may be necessary to protect the hemostatic powder  46 . 
         [0153]      FIGS. 27A and 27B  show the deployment of hemostatic powder  40  through a hollow expandable distributing head assembly  130  having apertures  134  formed along its outwardly facing surface, the powder  40  being distributed through apertures  134  in the direction of arrow U over the wound site, after which the distributing head  132  is then utilized in  FIG. 26B  to tamp the powder  40  in the direction of arrow V into place over the wound site. 
         [0154]      FIGS. 28A, 28B and 28C  are sequential views of the deployment of spring wire clip  140  having barbs  144  at each end of a spring wire  142  which engage into tissue at the edges of the wound site when push/pull wire  148  is extended in the direction of arrow W. As the spring wire clip  140  is deployed from the application catheter  68  by pushing the push/pull wire  148  in the direction of arrow W, the spring wire pivots about pivot anchor  146  as seen in  FIG. 28B . After the barbs  144  are set, they are drawn together in the direction of arrow X to close the wound as the push/pull wire  148  is drawn in the direction of arrow W′ into the delivery tube as the spring wire  142  is arcuately formed to close the wound. The clip  140  may also be constructed of a material that retains shape, like titanium, and when pulled, it springs back from a straight wire into a loop. This clip would be much smaller than other endoclips currently marketed. 
         [0155]      FIGS. 29 to 34  show a number of embodiments for delivering the hemostatic powder  40  or hemostatic pellets through the application catheter  68 . In  FIG. 29 , the plunger  104  is utilized to push the hemostatic powder  40  while in  FIG. 30 , gas under pressure forces the hemostatic powder  40  to discharge from the application catheter  68 . In  FIG. 31 , a venturi  68   a  is utilized to draw the hemostatic powder  40  or  50  into the venturi  68   a  for discharge under gas pressure from the end of the application catheter  68 .  FIG. 32  shows a drill auger  152  utilized to force the hemostatic powder  40  or hemostatic pellets out through the application catheter  68 .  FIG. 33 , shows the utilization of an outer auger  154  to force the hemostatic powder  40  or hemostatic pellets through a central feed passage  156  and outwardly from the application catheter  68 .  FIG. 34  discloses a wire auger  158  for the same purpose. 
         [0156]    While a number of exemplary aspects and embodiments have been discussed above, those of skill in the art will recognize certain modifications, permutations and additions and subcombinations thereof. It is therefore intended that the following appended claims and claims hereinafter introduced are interpreted to include all such modifications, permutations, additions and subcombinations that are within their true spirit and scope.