Abstract:
Devices and systems related to surgical fasteners and more specifically to surgical fasteners suitable for use in both open procedures, and minimally or less invasive procedures where the operative site is remote from the surgeon.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     The present invention is a continuation of U.S. patent application Ser. No. 10/798,018 filed on Mar. 11, 2004, the entirety of which is incorporated by reference. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present invention relates to surgical fasteners and more specifically to surgical fasteners suitable for use in both open procedures, and minimally or less invasive procedures where the operative or surgical site is not directly accessible by the surgeon.  
       BACKGROUND OF THE INVENTION  
       [0003]     Surgical fasteners are known to be an alternative to traditional suturing techniques for procedures involving tissue closure, connection, or repair. One undesirable aspect of manual suturing is that the suturing process adds time to the overall surgical process. Moreover, manual suturing often requires that the operative area is readily accessible so that the medical practitioner can manipulate the suture and associated needle through both sides of the tissue, connection or repair site. Presently, surgical fasteners are known to provide a means to close an open surgical incision or wound, hold together pieces of soft tissue, attach devices to tissue, or repair tom tissue in orthopedic/musculoskeletal applications. Such surgical fasteners are often used where there is adequate access to the operative area, or for invasive, open procedures.  
         [0004]     Due to the inherent risks and complexities of invasive surgical procedures, there is an increasing need for the ability to perform surgical procedures in a minimally invasive manner. In most cases, the recuperative time and lowered expense of a minimally invasive procedure makes it a far more desirable option to an alternative comparable invasive/open surgical procedure. The use of surgical fasteners in minimally invasive procedures may be desirable to increase the speed and efficiency of the procedure. Such fasteners may also open the possibility of performing a minimally invasive procedure for what was previously limited to an open surgical procedure.  
         [0005]     In addition, suturing techniques requires considerable skill and dexterity especially when tying knots in the suture or otherwise manipulating the suture. The ability of a medical practitioner to manipulate a suture as well as knot the ends of the suture are further complicated when the site is not directly accessible to the practitioner. In such cases, even if the complexity of suturing does not prevent the procedure from being completed in a minimally invasive manner, the length of the procedure is likely to increase.  
         [0006]     Conventional fasteners do not easily lend themselves for use in minimally invasive surgical procedure. As one example, the complexity of the known fastener-delivery devices requires devices with large profiles and limited flexibility further thereby limiting the potential for such devices to access remote locations. Conventional surgical fasteners, especially, “I-shaped” or “H-shaped” fasteners are unsuitable for remote procedures due to their complex deployment mechanisms and inability to navigate tortuous pathways using access devices commonly used for minimally invasive procedures (e.g., catheters, introducer devices, scope-type devices such as endoscopes, bronchoscopes, colonoscopies, etc.). Examples of such fasteners and devices are discussed in U.S. Pat. No. 4,006,747 to Kronenthal et al, U.S. Pat. No. 4,235,238 to Ogiu et al., U.S. Pat. No. 4,669,473 to Richards et al., U.S. Pat. No. 5,941,439 to Kammerer et al, U.S. Pat. No. 6,039,753 to Meislin, and U.S. Patent Publications U.S. 2003/0097148 to Valimaa et al, U.S. 2003/0187465 to Bailly et al. Each of the foregoing patents and/or patent applications is hereby incorporated in their entirety by reference.  
       SUMMARY OF THE INVENTION  
       [0007]     The present invention includes a surgical fastener for deployment through a device (such as a needle, cannula, catheter, etc.), where the fastener comprises a first anchor member, a second anchor member, and a connecting portion separating the first and second anchor members, where at least the first anchor member and the second anchor member each are expandable from a first state to a second state where the second state is of a larger size than the first state, where the larger size may be achieved by an increase in displacement (e.g., volume, profile, configuration, etc.) of a portion of the fastener or the entire fastener. For example, as it assumes the second state, the anchor may change in shape or conform to a profile that is of a larger size than the profile of the first state. Alternatively, or in combination, the increase in volume may be achieved by relaxing a previous state of compression of the fastener portion. In the latter case, the fastener portion may comprise a resilient material that is compressible, and/or the fastener portion may be hollow, or have a cavity, such that the outer perimeter of the anchor portion may be folded into the cavity to assume the first state, or compress the cavity to conform to a smaller state.  
         [0008]     The surgical fastener may also comprise a first means for anchoring the fastener, a second means for anchoring the fastener and a connecting portion separating the first and second means for anchoring. Where the means for anchoring may be any of the anchor portions described herein.  
         [0009]     The invention also includes a surgical fastening system comprising, a tubular member having a proximal and distal end and a lumen extending therebetween, the tubular member being sufficiently flexible to navigate tortuous anatomical passages within a human body, a distal portion located at the distal end of the tubular member, the distal portion having a distal tip being configured to pierce tissue, the distal portion having a lumen extending between the tubular member lumen and an opening in the distal portion, at least one surgical fastener slidably located entirely inside the tubular member lumen, where the surgical fastener comprises a first anchor member, a second anchor member, and a connecting portion separating the first and second anchor members, and an advancing member slidably located within the tubular member lumen such that advancement causes a distal portion of the advancing member to advance the surgical fastener through the tubular member. The system of the present invention may be directed to the desired site using a catheter-guidewire configuration, shaped catheter, a steerable catheter, a scope-type of device (e.g., such as endoscopes, gastroscope, colonoscope, bronchoscope, or any type of scope used to access sites within the body.)  
         [0010]     It should be noted that alternate variations of the present invention include fastening system of the present invention used with conventional fasteners and/or fasteners of as described herein.  
         [0011]     The present invention is useful in many surgical procedures requiring fastening systems, including but not limited to, procedures for fastening or repairing tissue or attachment of implant materials to tissue. The present invention is suitable for, but not limited to, use in the heart, stomach, gastro-intestinal tract, etc. While the faster and fastening system may be used in open procedures, the devices and systems may also be used in minimally invasive procedures where the operative site is remotely accessed using minimally invasive techniques including catheterization and/or endoscopic or similar means.  
         [0012]     The inventive devices are especially suited for advancement via a minimally invasive technique by providing features which improve the ability of the surgeon to deploy the fastener with accuracy and effectuate a proper seal with the fastener. The minimally invasive technique also may allow for visual inspection of the placement of the anchor.  
         [0013]     This application incorporates by reference an application filed Mar. 11, 2004 entitled “SURGICAL FASTENER” having application Ser. No. 10/798,465. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]      FIGS. 1A-1B , illustrate a side view of a basic variation of a fastener of the present invention.  
         [0015]      FIGS. 2A-2H  illustrate additional examples of various fasteners.  
         [0016]      FIGS. 3A-3B  illustrate a variation of a fastener having a single diameter (or similar cross-sectional measurement) prior to deployment.  
         [0017]      FIG. 3C  illustrates a variation of a fastener having an insert.  
         [0018]      FIG. 4A-4C  illustrate an example of a fastener system deploying a fastener.  
         [0019]      FIG. 4D  illustrates another variation of a fastener system deploying a fastener.  
         [0020]      FIGS. 5A-5B  illustrate another variation of a fastener system.  
         [0021]      FIG. 6A  illustrates a deployed fastener having elastic properties.  
         [0022]      FIG. 7A-7C  illustrate variations of fastening systems of the present invention.  
         [0023]      FIG. 7D  illustrates a variation of a fastening system of the present invention having a plurality of connected fasteners.  
         [0024]      FIGS. 8A-8F  illustrate additional features of fastening systems of the present invention.  
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0025]     The following illustrations are provided as variations of the present invention. It should be understood that there are many combinations of the present invention and that figures illustrating all variations of the invention would be numerous. Therefore, the invention is intended to include combinations of aspects and features of the illustrated embodiments, or combinations of the specific embodiments themselves.  
         [0026]      FIGS. 1A-1B , illustrate a side view of a basic variation of the inventive fastener  100 . As seen in  FIG. 1A , the fastener  100  includes a first anchor member  102  and a second anchor member  104  and a connecting portion  106  separating the two anchor members  102   104 . The “I-type” fastener shape illustrated in  FIGS. 1A-1B  is merely for illustrative purposes. Naturally, the anchor portions  102   104  may have a variety of shapes, cross-sections, and configuration as discussed herein. However, the anchor portions  102   104  will generally have a shape that allows for retention of a medium (for example, torn/damaged tissue, two or more discrete pieces of tissues, one or more implants to tissue, a combination thereof, etc.) between the anchor portions  102   104  upon deployment of the anchor  100 . Portion(s) of the fastener  100  will be operable between a first and second state where in the second state, a portion or portions of the fastener  100  will be of a larger size and/or profile than the first state. In the variation shown in  FIG. 1B , the fastener  100  anchors  102   104  are configured so that they expand from the first state, shown in  FIG. 1A , to a larger second state.  
         [0027]     In use, the fastener  100  may be delivered to the operative site when the portions of the fastener  100  are in the first state. Upon deployment, selected portions of the fastener  100  assume the larger second state. This configuration allows for delivery of the fastener  100  through an opening in the medium where the opening is smaller than a diameter (or other similar dimension) of the fastener  100  portions after deployment. In some variations of the invention, construction of the fastener  100  allows only a portion (e.g., a single anchor, both anchors, the connecting portion, or a combination thereof) to expand into the second state. In other variations, the entire fastener  100  may be constructed to assume the second state upon deployment. It is contemplated, that the various portions of the fastener  100  may expand differently as required for the particular application (e.g., one or more portions expand at a different rate, a different size, etc.)  
         [0028]     Expansion of the fastener  100  from the first to the second state may be accomplished a variety of ways. For example, the fastener  100  may be constructed of a shape or material that allows compression of the fastener portion, either by application of a compressive force or application of a vacuum, etc. Alternatively, or in combination, the fastener  100  may include a material that swells or expands given the addition of a fluid (e.g., natural body fluids or fluids introduced during the surgical procedure.)  
         [0029]     Examples of these materials include biodegradeable and non-biodegradeable polymers, elastomers, shape-memory alloys, other alloys, etc.) For example, carbonate copolymer, polyether ester copolymer, albumin, gelatin, starch, cellulose, dextrans, polysaccharides, fibrinogen, poly (D,L lactide), poly (D,L-lactide-co-glycolide), poly (glycolide), poly (hydroxybutyrate), poly (alkylcarbonate) and poly (orthoesters), EVA copolymers, silicone rubber and poly (methylmethacrylate). Particularly preferred polymeric carriers include poly (ethylene-vinyl acetate), poly (D,L-lactic acid) oligomers and polymers, poly (L-lactic acid) oligomers and polymers, poly (glycolic acid), copolymers of lactic acid and glycolic acid, poly (caprolactone), poly (valerolactone), polyanhydrides, copolymers of poly (caprolactone) or poly (lactic acid) with polyethylene glycol, PET, PETE, and blends thereof.  
         [0030]     In any case, the second state of the fastener comprises a larger profile or configuration as compared to the first state. As stated above, this permits securing of the anchoring portions  102   104  about the medium and/or securing of the connecting portion  106  within the medium. Another advantage of the invention is that the opening in the medium created during deployment of the fastener  100  may be smaller than would otherwise be possible if the fastener did not expand into the second state upon or after deployment.  
         [0031]     It is also contemplated that the fastener may incorporate a variety of additives, coatings, adjuncts, etc. For example, the fastener (or only portions of the fastener) may include a lubricious coating to improve advancement of the fastener in the delivery system. The fastener may include non-proliferative drugs, thrombogenic additives, non-thrombogenic additives, non-inflammatory medicines, additives to induce fibrosis for wound closure, anti-platelet, anti-coagulent, growth factors, gene-transductors, cell matrix, glue, cement, protein, hydrophilic, hydrophobic, lipidphillic, lipidphobic, or combinations where appropriate.  
         [0032]      FIGS. 2A-2H  illustrate examples of various fasteners  100  of the present invention. It should be understood that the fasteners  100  of the present invention may have a number of configurations as required for the specific application. These figures are intended to illustrate some possible variations of the invention. As noted herein, where possible, combinations of features of various embodiments and the embodiments themselves are within the scope of the invention.  FIG. 2A  illustrates a fastener  100  similar to that shown in  FIGS. 1A-1B . FIG. It is contemplated that for the basic configuration of the fastener  100  illustrated in  FIG. 2A  (and where appropriate for other variations) the anchor portion  102   104  or the connecting portion  106 , individually or collectively, may have cross sections of a variety of shapes, including but not limited to circular, rectangular, square, star-shaped, etc.  
         [0033]      FIG. 2B  illustrates a variation of the fastener  100  where the anchor portions  102   104  have a spherical shape. In this variation, the anchor portions  102   104  are illustrated as having a cavity  108 . The cavity  108  may assist in reducing the size of the anchor portions  102   104  into the first state. Moreover, as described herein, the cavity  108  (as well as other portions of the fastener  100 ) may serve as a reservoir for various medications, drugs, etc. Furthermore, variations of fasteners of the present invention may be non-porous if the particular application requires (e.g., where prevention of tissue in-growth is required. Alternatively, variations of the fastener may be porous. Furthermore, the fastener may be selected such that certain portions of the fastener are porous while others are non-porous (e.g., porous anchor members combined with a non-porous connecting member, non-porous anchors with a porous connecting member, etc.) In such variations, porous materials may be selected for construction of the anchor or non-porous materials may be altered to contain pores.  
         [0034]      FIG. 2C  illustrates another variation of the fastener  100  in which the anchor portions  102   104  comprise cross-shaped members.  FIG. 2D  illustrates a fastener  100  having anchor portions  102   104  that are planar-disc-shaped. In such a configuration, the increased surface area of the anchor portions  102   104  may provide better contact between the fastener  100  and the medium to allow for tissue in-growth or for delivery of a therapeutic substance carried by the fastener  100 .  FIG. 2E  illustrates a variation of a fastener  100  of the present invention where the first anchor portion  102  and the second anchor portion  104  comprise different shapes. It should be noted that variations of the invention include fasteners  100  having combinations of anchor portions as illustrated herein or variations thereof.  
         [0035]      FIG. 2F  illustrates a variation of a fastener  100  of the present invention where the first anchor portion  102  and the second anchor portion  104  extend in different directions.  
         [0036]      FIG. 2G  illustrates a variation of the fastener  100  of the present invention where the anchor portions  102  and  104  comprise “pig-tail” type fasteners. In this variation, the anchor portions  102  and  104  the coils of the pig-tail may separate to capture tissue therebetween. Alternatively, the opposing anchor portions  102  and  104  may be used to capture the tissue. During placement of the fastener  100  the pig-tail anchors may be straightened in the device for delivery. Alternatively, the coils may be compressed in a radial dimension to expand upon deployment from the delivery system. A variation of a pig-tail fastener may include a helical shaped fastener or fastener with helical anchor portions.  
         [0037]      FIG. 2H  illustrates another variation of the invention where a fastener  100  includes protrusions  112 . The protrusions  112  may assist in retaining the anchors and or fastener in the deployment site. Alternatively, or in combination, the protrusions  112  may comprise bio-active substances as described herein. Although the figure illustrates the protrusions as on the anchor portions only, the invention includes fasteners  100  having protrusions  112  on the connecting portion  106  as well. Alternatively, the protrusions  112  may be located only on the connecting portion  106 .  
         [0038]     The invention also contemplates that the anchor portions described herein may be configured/suited for attachment of external devices/implants/objects/etc. For example, one possible use of the inventive fastener is placing the fastener in the wall of an organ, then attaching an implant to the organ&#39;s wall by attaching the implant to the anchor portions of the fastener.  
         [0039]      FIGS. 3A-3B  illustrate another variation of a fastener  100  of the present invention. In this variation, as shown in  FIG. 3A , in the pre-deployment or first state, the anchor portions  102   104  have substantially the same cross sectional measurement as the connecting portion  106 . As illustrated in  FIG. 3B , when the anchor portions  102   104  assume the second state, they expand to a greater size than the connecting portion  106 . As discussed herein, the anchor portions  102   104  may be constructed from a material similar to that of the connecting portion  106  but having different additives or structure to allow for expansion into the second state. Alternatively, portions of the fastener  100  may be formed from different materials and joined, or molded together to form the composite fastener.  
         [0040]      FIG. 3C  illustrates another variation of a fastener  100  of the present invention. In this variation, the fastener  100  includes an insert  110 . The insert  110  may comprise a bioabsorbable material which dissolves/ is absorbed by the body at a slower rate than the remainder of the fastener  100 . Alternatively, the insert  110  may be a nonbiodegradeable/non-bioabsorable material such that as tissue replaces the absorbable fastener material, the insert remains to provide long term retention of tissue. Moreover, the insert  110  may comprise a metallic material to provide a radiopaque marker for placement, or for subsequent location of the fastening site. Such a combination may be used with absorbable and non-absorbable fasteners. Although the insert  110  illustrated in  FIG. 3C  comprises end portions having a larger dimension than the center portion, the invention is not limited as such.  
         [0041]      FIG. 4A-4C  illustrate a basic example of a system  150  which deploys fasteners  100  of the present invention. As shown in  FIG. 4A , the system  150  includes a tubular member  152  that is sufficiently flexible so that it may navigate tortuous passages to access the surgical site yet it will have sufficient column strength so that it may penetrate tissue to deploy the fastener  100 . As such, variations of the tubular member  152  may be reinforced to minimize kinking of the tubular member as it navigates toward the surgical site. In this variation, the tubular member  152  retains a fastener  100  in a lumen  154  that extends between a proximal and distal end of the tubular member  152 . The fastener  100  is slidably located inside the tubular member  152  and may be advanced using an advancing member  156  that is also slidably located within the tubular member lumen  154 .  
         [0042]     It is contemplated that various methods known in the field may be employed to advance/retract the advancing member. For example, the advancing member may simply push the fastener using a linear or rotary type drive system. Alternatively, the advancing member may be an auger type system that advances the fastener with the assistance of rotatable vanes within the tubular member. A pneumatic, hydraulic, or fluid filled actuation may also be used to advance/retract the advancing member. The advancing member  156  may be a guidewire or other similar type device that is able to deploy the fastener  100  at the operative site. Although not illustrated, the fastener  100  may be removably attached to the advancing member  156  to improve accuracy in deployment of the fastener  100 . In some variations of the invention, the fastener  100  is configured relative to the lumen  154  so that friction retains the fastener  100  within the lumen  154  until deployment of the fastener  100 . In such cases, the wall surface and/or diameter of the lumen  154  may be selected to increase the sliding resistance of the fastener  100 . In any case, the system will be configured so that upon deployment of the first anchor the fastener  100  will release from the device rather than pulling out of the tissue.  
         [0043]     The system  150  also includes a distal portion  158  located at the distal end of the system  150 . The distal portion  158  has a distal tip  160  configured to pierce tissue and has an opening  162  through which the fastener  100  exits the device. In some variations of the invention, the distal tip  160  is configured to prevent “coring” of the tissue to minimize the size of any opening created during deployment of the fastener. Instead, the tip  160  configuration has a sharpened area and a taper proximal to the sharpened area so that the tip  160  makes a small puncture and then dilates the opening in the tissue.  
         [0044]      FIG. 4B  illustrates the system  150  of  FIG. 4A  after the distal portion  158  advances through two layers of tissue  1  and  2  and one anchor portion  102  exits from the system  150 . As discussed herein, the fastener  100  may expand upon exiting the system  150  via being released from the constraint of the system  150 . Alternatively, or in combination, fluids (not shown) may cause the fastener  100  to increase in size. Such fluids may be introduced during the procedure or may be naturally occurring at the operative site. Therefore, the fastener  100  may expands to a size greater than the opening in tissue that is created by the fastening system  150 . Next, the distal portion  158  and tubular member  152  are retracted through the tissue  1 . Once retracted, the system  150  deploys the second anchor portion (not illustrated) thereby retaining the tissues  1  between the anchor portions  102   104 .  
         [0045]      FIG. 4C  illustrates the system  150  of  FIGS. 4A and 4B  after the distal portion  158  is withdrawn through the tissue  1  sufficiently enough so that the opening  162  is on the near side of the tissue  1 . Once in the appropriate position, the device  150  deploys the remaining anchor portion  104 . It should be understood that the system illustrated in  FIGS. 4A-4C  is depicted to show a basic variation of the invention. It is contemplated that the invention includes variations configured to first deploy an anchor portion on a near side of the tissue (e.g., prior to insertion of the distal tip into the tissue), then advance the distal tip into the tissue to deploy the remaining anchor portion on the far side of the tissue.  
         [0046]      FIG. 4D  illustrates a variation of a fastening system of the present invention. In this variation, the distal tip  160  is inserted into the distal portion  158 .  
         [0047]     Although the fastener of the present invention may be delivered through any tubular device such as a cannula, a catheter, polymeric tubing, etc., the fastener may be part of a fastening system that permits deployment of the fastener in remote parts of the body through a variety of minimally invasive procedures. In such cases, the system may include a steerable catheter, or the system may be guided to the site via a separate catheter, a separate steerable catheter, a endoscope-type device, pre-shaped catheter, etc.  
         [0048]      FIGS. 5A-5B  illustrate another variation of a system  150  of the present invention. In this variation, the opening  162  is located at a distal end of the device rather than in a side-wall of the distal portion. In such a variation, the fastener  100  may be located immediately adjacent the opening  162  to prevent the coring of tissue as the distal tip  160  advances through tissue.  FIG. 5B  illustrates a sectional view taken along the line  5 B- 5 B of  FIG. 5A . As illustrated, the system  150  may include a lumen that is appropriately shaped to orient the anchor and central portions of the fastener  100 . For example, the lumen may be extruded to form a channel for the central portion. Additionally, as shown in  FIG. 5B , the system may include a multi-lumen design to allow for fluid delivery ports  164  if required.  
         [0049]     As discussed herein, upon deployment of the fastener  100  from the system  150 , the fastener  100  portions shall increase in size from the first state to a second state where the larger size may be achieved by an increase in volume and/or profile a portion of the fastener or the entire fastener. The invention contemplates that the fastening delivery system  150  may be used to constrain the fastener  100  into the first state, via a compression mechanism. Alternatively, or in combination, the fastener  100  or portions of the fastener may be configured to increase in size given the application of a fluid. The fluid may comprise naturally occurring bodily fluid or fluid delivered by the fastening system or even fluid delivered via a separate device.  
         [0050]     As discussed above, one of the functions of the inventive tissue fastener is to retain two pieces of tissue together, retain an implant to the tissue, or close an opening in tissue. The feature of the inventive fastener  100  relating to expansion of the anchor portions  102   104  permits placement of the fastener  100  using an opening in the tissue that is smaller would otherwise be required. Moreover, fasteners of the present invention may also be configured such that the central portion  106  expands into a second state as well. In such variations, expansion of the center portion may allow for expedited healing of the opening in tissue, or for closure and sealing of the opening in the tissue. In additional variations of the invention, the central portion  106  may be configured from a material that allows stretching of the center portion  106  during deployment. As shown in  FIG. 6A , such a fastener  100  having elastic properties allows for an increased compressive force on the medium being retained between the fastener. An additional benefit of such an elastic fastener is that the length of the fastener  100  (e.g., as measured in a direction along the central portion) can accommodate a greater range of tissue and/or material thicknesses.  
         [0051]      FIG. 7A  illustrates a variation of a fastening system  150  of the present invention. Although the system  150  depicts a single fastener  100  located within the device, it is contemplated that the system  150  may comprise a number of fasteners  100  to permit serial deployment during use of the system. As illustrated, the system  150  includes a flexible tubular member  152  extending between having proximal and distal ends and a lumen extending between the ends. The system  150  includes a distal portion  158  the distal end of the tubular member  152 . It is contemplated that the distal portion  158  may comprise a separate material or insert that is coupled to the tubular member  152 . Alternatively, the distal portion  158  may be formed from the same material as the tubular member  152 . The distal portion  158  includes a distal tip  160  for penetrating tissue (and/or an implant, etc.). The distal portion  158  includes a lumen that is in fluid communication with a lumen of the tubular member  152 . The distal portion  158  also includes an opening  162  through which the fastener  100  deploys.  
         [0052]     In the illustrated variation, the opening  162  is located in a side wall of the distal portion  158 . However, as discussed herein, the opening may be at the distal tip  160 . It is contemplated that the tubular member  152  will have sufficient column strength to allow for penetration of tissue via advancement of the system  150 . Accordingly, the tubular member  152  may be constructed of a material that provides sufficient flexibility and column strength. Alternatively, the tubular member  152  may include a reinforcing member  166 , such as a coil, braid, or fiber reinforcement. Furthermore, as discussed above, the system  150  includes an advancing member  156  that permits advancement and/or deployment of the fastener  100 . To improve advancement and deployment of the fastener, the tubular member and/or advancing member may be selected from materials that minimize the friction between the two members. Alternatively, or in combination, these items may include a lubricious coating to minimize friction. Although not illustrated, the system  150  may include an additional fluid delivery means, such as a fluid source where delivery of the fluid occurs via the lumen of the device, an additional fluid lumen, a separate catheter-type device for delivery of the fluid, etc.  
         [0053]      FIG. 7B  illustrates an additional variation of a fastening system  150  of the present invention. In this variation, the fastener  100  is depicted as being partially ejected from the system  150 . As shown, the distal portion  158  may include one or more fluid delivery ports  170  in fluid communication with fluid delivery lumen(s)  164  of the tubular member  152 .  FIG. 7C  is a sectional view taken along the lines of  7 C- 7 C of  FIG. 7B . As shown, the tubular member  152  may include a channel  155  to aid in maintaining an orientation of the fastener and/or assist in advancement of the fastener.  FIG. 7C  also illustrates fluid delivery lumens  164  of the tubular member  152 . It is understood that the system may include a single or multiple fluid delivery lumens(s).  
         [0054]      FIG. 7D  illustrates a variation of a fastening system of the present invention  150  having a plurality of connected fasteners  100 .  
         [0055]      FIGS. 8A-8F  illustrate variations of the fastening  150  of the present invention having features that aid in dispensing fasteners.  FIGS. 8A-8C  illustrate delivery systems having gate members  168  of a valve-type configuration. For example, the gate member  168  of these variations may comprise a flexible valve having a slit, gap, or opening therein. The gate member will function to impede movement of a portion of a surgical fastener from the system. Accordingly, a portion of the gate member will interfere with a portion of the fastener during its advancement in the system or out of the system. Although the gate  168  is illustrated as being placed in the opening  162  of the distal portion  158 , the gate  168  may also be located within a lumen of the system.  FIG. 8C  illustrates a variation of the fastening system  150  of the present invention depicting a fastener  100  that is partially deployed from the system  150 .  
         [0056]      FIGS. 8D-8E  illustrate additional features of a fastening system  150  of the present invention. The fastener and other features of the system are omitted for the sake of clarity. In the variation of  FIG. 8D , the system  150  includes a gate member  168  located on a rotatable insert  170  located within the tubular member  152 . The rotatable insert  170  may have the same or similar features of the tubular member  152  and tubular member lumen as described above. In use, rotation of the rotatable insert  170  causes the gate member  168  (which may be formed by an opening in the rotatable insert) to impinge upon a portion of the fastener (not shown) as the fastener exits from the system  150 . In some variations of the invention, application of an increased torque to the gate member  170  may permit severing or cutting of the fastener or a connection between adjacent fastener. For example, some variations of the invention include fasteners that have a severable connection.  FIG. 8E  illustrates a variation of the fastening system  150  where a gate member  168  is located on a distal end of a slidable insert  172 . The effect of the slidable insert  172  may be similar to that of the rotatable insert described above where the operative mechanism is advancement and retraction of the slidable insert. The slidable insert  172  may move independently of any advancing member (not shown) to allow proper dispensing of a fastener.  
         [0057]      FIG. 8F  illustrates another variation of a fastening system of the present invention, in this variation the fastening system  150  may include an advancing member  156  that is coupled to a fastener  100  via a detachable joint  172 . The detachable joint  172  may comprise a low-melt temperature polymer that is bonded to both the fastener  100  and the advancing member  156 . In such a variation, the advancing member  156  will be configured to heat the joint (for example, via conductive, resistive, chemical, etc, means.) Alternatively, the detachable joint  172  may comprise an electrolytic joint. In such a case, the fastener may comprise a metallic frame  110  as described above. In use, the fastener  100  may be positioned, and upon confirmation of its placement, the detachable joint  172  is activated to release the fastener.