Abstract:
A septal stapling apparatus includes an instrument body having proximal and distal end portions. A handle at the distal end portion enables a user to hold and manipulate the instrument body. A pair of spaced apart arms are extending from the handle and include a staple arm and a tensioning arm. The body provides a trigger that moves between resting and firing positions. An actuator link moves between first and second positions, the actuator link being moved by the trigger, wherein the actuator link includes a staple moving member that is attached to the staple arm. The staple arm has a staple bank that includes multiple staples. The trigger, actuator link, staple bank, and staple moving member are configured to move a staple to a stapling position when the trigger is pulled. The staple arm and tensioning arm move together when the trigger is pulled.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
   U.S. Provisional Patent Application No. 60/646,734, filed 25 Jan. 2005, and U.S. Provisional Patent Application No. 60/733,714, filed 4 Nov. 2005, are incorporated herein by reference. Priority of those applications is hereby claimed. 

   STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
   Not applicable 
   REFERENCE TO A “MICROFICHE APPENDIX” 
   Not applicable 
   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   The present invention relates to septal surgery. More particularly, the present invention relates to an improved septal stapler apparatus that places surgical staples in a patient&#39;s septal tissue responsive to a trigger pull that moves two elongated spaced apart appendages together, one pushing a staple toward the other and through the selected tissue. 
   2. General Background of the Invention 
   The following U.S. Patent, which contain background information, are incorporated herein by reference: 
   
     
       
             
             
             
           
         
             
               TABLE I 
             
             
                 
             
             
               U.S. PAT. NO. 
               TITLE 
               ISSUE DATE 
             
             
                 
             
           
           
             
               5,540,240 
               Intranasal Septal Fastener Driving 
               30 Jul. 1996 
             
             
                 
               Method 
             
             
               5,361,782 
               Intranasal Septal Stapling Method 
               8 Nov. 1994 
             
             
               5,370,294 
               Intranasal Septal Stapling Device 
               6 Dec. 1994 
             
             
                 
               and Method 
             
             
               6,283,121 
               Manual Pump and Ambu Bag 
               4 Sep. 2001 
             
             
               6,131,790 
               Surgical Stapler and Cartridge 
               17 Oct. 2000 
             
             
               5,351,871 
               Intranasal Septal Stapling Device 
               4 Oct. 1994 
             
             
               5,915,615 
               Tissue Fastening Device 
               29 Jun. 1999 
             
             
                 
             
           
        
       
     
   
   BRIEF SUMMARY OF THE INVENTION 
   The present invention provides an improved septal stapling apparatus that provides an instrument body having proximal and distal end portions. A handle at the proximal end portion enables a user to hold and manipulate the instrument body. A pair of spaced apart arms extend distally from the handle. The arms include a staple arm and a tensioning arm. There is a gap between the arms that enables placement of the arms on opposing sides of the tissue to be stapled. 
   The body provides a trigger that moves between resting and firing positions. The trigger moves an actuator link between first and second positions. The actuator link includes a staple moving member that is attached to the staple arm. 
   The staple arm has a staple bank that includes multiple staples. The trigger, actuator link, staple bank, and staple moving member are configured to move a staple to a stapling position when the trigger is pulled. The staple arm and tensioning arm move together when the trigger is pulled in order to place the staple in the selected tissue. 
   The present invention includes a septal stapling apparatus, having an instrument body with proximal and distal end portions. A handle at the distal end portion enables a user to hold and manipulate the instrument body. 
   A pair of spaced apart arms extends from the handle. The arms include a staple arm and a tensioning arm. The body has a trigger that moves between resting and firing positions. An actuator link moves between first and second positions, the actuator link being moved by the trigger. The actuator link includes a staple moving member that is attached to the staple arm. 
   The staple arm carries a staple bank that includes multiple staples. The trigger, actuator link, staple bank and staple moving member are configured to move a staple to stapling position when the trigger is pulled. The staple arm and tensioning arm move together when the trigger is pulled. Preferably, the tensioning arm has a receptacle that receives at least a part of a staple during stapling. Preferably, the tensioning arm pivots relative to the body during stapling. 
   The staple arm is preferably fixed relative to the body. The actuator preferably slides relative to the body. The actuator and staple moving member can be pivotally attached. The staple arm can house the staple magazine with a bank of staples therein. The actuator slides relative to the body and simultaneously causes the staple moving member to pivot, engaging and dispensing a staple from the staple magazine. Preferably, the staple arm and tensioning arm each have head portions that come together to dispense a staple when the trigger is pulled. 
   The handle fits comfortably in an operator&#39;s palm, and can permit equal access to the trigger from either side, i.e. either right hand or left hand operation. Emanating from the handle are the staple arm and the tensioning arm. These are of suitable dimensions to be inserted into a typical patient&#39;s nose, one arm into each nostril. At the end of the staple arm is the staple head which houses a bank of staples which are dispensed one-at-a-time. 
   The end of the tensioning arm can provide a recess for accommodating the heads of the staples as they are pushed from the staple head. 
   The tensioning arm moves so that the device can pass the relatively wide columella at the base of the nose between the nostrils but still gently come together on opposite sides of the relatively thin mucosal layers inside the nose which are to be stapled. 
   A handle cover and handle base can be fastened together (as with recessed Philips-head screws) to form the handle. The trigger slides within the handle, against the force of a trigger spring. The motion of the trigger causes the movement of the tensioning arm which pivots at the back of the handle cover. 
   Movement of the trigger also causes the translation of the actuator link by pivoting the trigger link about a fulcrum which protrudes from the inner surface of the handle base. The motion of the actuator link is transferred to the head link, causing one of the staples in the bank of staples to be dispensed from the staple head. The bank of staples are positioned by the staple advance rod which is moved by the advance rod spring being compressed between the body of the staple advance rod and the advance rod base. 
   The contoured shape of the tensioning arm mates with a projection or peg of the trigger. During the first part of the trigger&#39;s travel, the projection or peg pushes against the force of the tensioning arm spring to bring the tensioning arm into the proper position for stapling. The final portion of the trigger&#39;s travel acts to maintain the same position of the tensioning arm. 
   The trigger link moves and pivots, e.g. on a fulcrum on the inner wall of the handle base. When the bottom of the link is pressed by the trigger, the top moves the actuator link. The actuator link is retracted by the actuator spring. 

   
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
     For a further understanding of the nature, objects, and advantages of the present invention, reference should be had to the following detailed description, read in conjunction with the following drawings, wherein like reference numerals denote like elements and wherein: 
       FIG. 1  is a perspective view of the preferred embodiment of the apparatus of the present invention in an open position; 
       FIG. 2  is a front, fragmentary view of the preferred embodiment of the apparatus of the present invention showing a staple; 
       FIG. 3  is a side, fragmentary view of the preferred embodiment of the apparatus of the present invention showing a staple; 
       FIG. 4  is a partial perspective view of the preferred embodiment of the apparatus of the present invention showing a staple bank; 
       FIG. 5  is a partial side view of the preferred embodiment of the apparatus of the present invention in an open position showing a staple bank; 
       FIG. 6  is an exploded perspective view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 7  is a sectional view taken along lines  7 - 7  of  FIG. 1 ; 
       FIG. 8  is a partial perspective view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 9  is a partial, cut-away view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 10  is a partial sectional, side view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 11  is a perspective view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 12  is a partial, perspective cut-away view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 13  is a partial, sectional, elevation view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 14  is a partial, sectional, elevation view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 15  is a perspective view of the preferred embodiment of the apparatus of the present invention shown in stapling position; 
       FIG. 16  is a partial perspective view of the preferred embodiment of the apparatus of the present invention shown in stapling position; 
       FIG. 17  is a partial sectional view of the preferred embodiment of the apparatus of the present invention shown in stapling position; 
       FIG. 18  is a partial sectional view of the preferred embodiment of the apparatus of the present invention shown in stapling position; 
       FIG. 19  is a fragmentary perspective view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 20  is a partial perspective view of the preferred embodiment of the apparatus of the present invention; 
       FIG. 21  is a sectional, elevation view of an alternate embodiment of the apparatus of the present invention; 
       FIG. 22  is a sectional, elevation view of an alternate embodiment of the apparatus of the present invention; 
       FIG. 23  is a perspective view of a third embodiment of the apparatus of the present invention; 
       FIG. 24  is another perspective view of the third embodiment of the apparatus of the present invention; 
       FIG. 25  is a partial, sectional, elevation view of a fourth embodiment of the apparatus of the present invention; and 
       FIG. 26  is a partial, sectional, elevation view of a fourth embodiment of the apparatus of the present invention. 
   

   DETAILED DESCRIPTION OF THE INVENTION 
   FIGS.  1  and  6 - 20  show the preferred embodiment of the apparatus of the present invention designated generally by the numeral  10 . Septal stapler apparatus  10  provides a tool body  11  having a proximal end portion  12  and a distal end portion  13 . A trigger  14  is movably mounted to the tool body  11 . The trigger  14  is used to activate the device when it is held by a user  48 . A user  48  grips the tool body  11 , depresses the trigger  14  in the direction of arrow  49  in  FIG. 11 , which then dispenses a staple  50  from staple bank  51  to the selected septal tissue layers  59 ,  60 .  FIGS. 2 and 3  show one embodiment of a single shaft staple  50  with one end pointed to facilitate membrane penetration.  FIGS. 4 and 5  show a bank of staples  51  which is housed in the staple head  55 . The bank of staples can be formed of any material. Polymeric staples, even absorbable ones, may be molded as a bank of staples by any number of processes, including injection molding, fused deposition, etc. Metal, ceramic or polymeric staples may be formed, cast, molded or machined individually and then adhesively attached together to form a bank of staples or loaded into the stapler body individually and held in a bank by friction at the surfaces. 
   A pair of arms are attached to the tool body  11 . These include a moving arm  15  and a fixed arm  16 . The moving arm  15  has a proximal end portion  17  and a distal end portion  18 . The distal end portion  18  provides a receptacle  19  having a socket  20  that is receptive of an end portion (pointed section  42 ) of a staple  50  when the trigger  14  is depressed in the direction of arrow  49  in  FIG. 11  and the moving arm  15  pivots in the direction of arrow  66  in  FIG. 11  to meet the fixed arm  16  (see  FIG. 14 ). 
   The moving arm  15  provides a contoured section  21  having a concavity  22  (see  FIG. 12 ). This concavity  22  engages a camming surface  24  on projection or peg  23  of trigger  14  in the open position before the trigger  14  is depressed. When a user  48  depresses the trigger  14 , the camming surface  24  of the projection  23  moves proximally (see arrow  56 ,  FIG. 12 ), disengaging from the concavity  22  and thus rotating the moving arm  15  toward the fixed arm  16 . 
   The trigger  14  is biased to return to a relaxed beginning position by compressive trigger spring  25 . This trigger spring  25  can be mounted at its end portions on respective cylinders  26 ,  27 . One of the cylinders  26  is mounted on the trigger  14 . The other cylinder  27  is mounted on the tool body  11  (see  FIGS. 6 ,  8 ,  9 , and  13 ). 
   When the trigger  14  is depressed, lever  28  ( FIGS. 6 ,  13 ) is rotated to push staple actuator link  34  in a distal direction. The lever  28  has a lower end portion  29  that is engaged by rod  57  on the rear surface of the trigger  14  when the trigger is depressed. The lever  28  rotates about fulcrum  30  so that its upper end portion  33  pushes the staple actuator link  34  distally. The central portion  31  of the link  28  engages the fulcrum  30 . Upper end portion  33  of the lever  28  provides a transverse pin  32  that is mounted in slotted portion  40  provided at the proximal end  35  of staple actuator link  34 . 
   Spring  37  connects at its end portions to hooks  38 ,  39 . The hook  38  is attached to and travels with staple actuator link  34 . The hook  39  is attached to the tool body  11 . When the trigger  14  is depressed, lever  28  rotates so that the transverse pin  32  pushes the staple actuator link  34  in a distal direction. 
   Distal end portion  36  ( FIG. 6 ) of actuator link  34  has a rectangularly shaped head  41  that engages a staple  50  to be placed in the selected tissue. The staple  50  is one of a plurality of staples that form a staple bank  51  (see  FIGS. 2-5 ). The rectangularly shaped head  41  can be pivotally attached to the distal end  36  of the staple actuator link  34 . The head  41  provides a transverse bar  43  ( FIG. 6 ) that contacts the transverse beam  58  ( FIG. 2 ) of staple  50  when the trigger  14  is depressed. The bar  43  of rectangular head  41  initially travels in a longitudinal slot  44  ( FIG. 10 ), then curved slot  47 , then in transverse slot  46 . The longitudinal slot  44  and transverse slot  46  are connected with the curved transition slot section  47 . 
   When the trigger  14  is depressed, the staple actuator link  34  ( FIG. 14 ) moves distally, forcing the transverse bar  43  of rectangular head  41  to engage a staple  50  of staple bank  51 . The transverse bar  43  engages the nearest staple  50  and pushes its pointed section  42  into the selected tissue  59 ,  60  ( FIG. 18 ). The staple bank  51  is advanced using a staple advance rod  53  ( FIGS. 6 ,  17 ). Rod  53  is urged in a distal direction with rod-advance spring  54 . The advance rod  53  can provide an enlarged head  55  ( FIGS. 6 ,  14 ) that is sized and shaped to contact and push staple bank  51 . 
     FIGS. 8-18  show the interplay of the trigger  14  and the trigger link  28 .  FIG. 9  corresponds to the first part of the motion of trigger  14  (which moves the moving or tensioning arm  15 , as in  FIG. 6 ).  FIGS. 9 and 13  show the point in the travel when the trigger  14  first contacts the trigger link  28 .  FIGS. 11 ,  17  and  18  show the full extent of the travel of the trigger  14 , having pushed the bottom of the link  28  back, causing its upper end  33  to move forward, thus pushing the actuator link  34  forward. 
     FIG. 18  depicts the staple head at the distal end  13  portion of the arm  16  and partially broken away to show the locations of the bank  51  of staples  50 , the head  41  and the actuator link  34 . 
     FIGS. 10 ,  14 , and  18  show views of the ends of the staple arm  16  and moving arm  15  during the process of dispensing a staple  50  from the bank  51  of staples and when joining two mucosal membrane layers  59 ,  60  or tissue flaps together with a staple  50 .  FIGS. 10 and 14  represent the pre-stapled state, after the cartilage and bone are removed during the septoplasty operation.  FIG. 14  represents the state after the first stage of trigger  14  actuation when the arm  15  moves to bring the two membranes  59 ,  60  into contact.  FIG. 18  represents the state after complete trigger  14  actuation when the lead staple  50  penetrates the two membranes  59 ,  60 . After the trigger  14  is released, leaving the staple  50  holding the two membranes  59 ,  60  together, the arms  15 ,  16  return to the starting position of  FIGS. 7-10 . 
   The present invention encompasses other mechanisms for imparting the necessary driving force to a staple within the geometrical constraints of a typical nasal passageway, in addition to a compression linkage. A description of three of these alternate embodiments or mechanisms follows with reference to  FIGS. 21-26 . Each may be housed within a chassis similar to that envisioned for the compression linkage, namely an arm carrying a bank of staples opposite an arm with a staple receptacle. 
   The first embodiment variant  61  ( FIG. 21 ) is based on magnetic or electromagnetic principles, whereby the force to move staples  50  is provided by a magnetic field at magnet  62 . The magnet  62  can be either permanent, e.g., a rare earth magnet, or induced by an electric current, e.g., a solenoid.  FIGS. 21 and 22  show staples  50  being sequentially acted upon by an actuating member, such as plunger  65 , or a bar, link, or the like, which moves in relation to arm  16  which holds the staples  50  in the ready position as with the preferred embodiment. A moving arm  15  moves into proximity of the staple  50  and carries a magnetic field e.g. magnet  62 . Arm  15  can be made either completely or partially from magnetic material and/or contain an electromagnet coil. The magnetic attraction pulls the actuating arm member  15  to arm  16 , causing the staple  50  to fire into the membranes  59 ,  60  to be stapled. After firing, the magnetic force on the actuating member is diminished through moving the arm  15  away from arm  16  and/or turning off the electromagnet  62 .  FIGS. 21 and 22  show external representations of the arms  15 ,  16  and how the actuating member (e.g. plunger  65 ) may be held in, and returned to, the ready position by an actuator return spring  64  (leaf, tension, or compression).  FIG. 21  shows a leaf spring  64  supporting the actuating member  65  in the ready position.  FIG. 22  shows the actuating member  65  in the actuated position, i.e., at the end of a staple stroke, wherein the magnetic force of the swing arm overcomes the lesser restraining force of the leaf spring  64  to pull the plunger  65  and dispense staple  50 . Once the magnetic force is diminished, the actuating member or plunger  65  returns to the position shown in  FIG. 21  under the action of the leaf spring  64 . 
   An additional variant, depicted in  FIGS. 23 and 24 , is based on the rotation of shaft  67  and cam  68  which presses on the head of the staple  50  to be fired. The rotation of the cam  68  can be caused by the torsional twist of attached shaft  67 .  FIG. 23  shows the cam  68  in the un-actuated position in contact with the staple  50  to be fired from the bank  51  of staples.  FIG. 24  shows the same staple  50  being displaced by the movement of the cam  68  due to the twist of the torsion shaft  67 . The twist of the shaft  67  can be induced from the linear or angular motion of a trigger  114  using gears, linkages, bearings, and/or the like.  FIG. 24  shows a bearing surface fixed to a trigger  114  pushing a helix-shaped bearing surface  72  on the surface of a torsional cylinder  69 .  FIGS. 23 and 24  show details of the bearing interaction between peg  70  on the translating trigger  114  and the rotating cylinder  69 . A torsional spring  71  provides the constraint to return the cam  68  and shaft  67  to the un-actuated position against the motion of the trigger  114 . 
   Another variant shown in  FIGS. 25 and 26  and designated by the numeral  73  is configured to fire staples utilizing the resultant force from pressurizing a cavity. This can be accomplished with either a gas (e.g., air for a pneumatic device) or a liquid (e.g., water for a hydraulic device). The cavity  74  can be the space adjacent the staple  50 , sealed with a translating surface (e.g., a piston), an expanding bladder (e.g., a balloon or diaphragm), or combination of the two. The liquid or gas system can either be closed or open. An open system would vent the pressurized medium when the staple exits, e.g., through an orifice normally sealed by a staple. A closed system, such as the embodiment depicted in  FIGS. 25 and 26 , would use the motion of a trigger to push water down a pressurization tube  75  and expand an elastic balloon  76  into a volume which displaces the staple to be fired from the staple bank  51 .  FIG. 25  shows the balloon  76  in the ready, contracted state.  FIG. 26  shows the balloon  76  in the inflated, stapling state. 
   It should be understood that the staple  50  can be any shape that will be passed through the mucosal bilayer of the nasal septum and may include cartilage between the mucosal layer. This staple  50  will pull the mucosal layers in proximity preventing the formation of a hematoma. The staple  50  will preferably be made of an absorbable material such as polyglycolic acid (PGA) or polylactic acid (PLA) or may be made as a combination of copolymers. 
   The stapler and staples may be produced and packaged in a sterile environment or sterilized before use. A range of options is available and the choice will depend in part on the particular component materials employed. Irradiation, as with gamma rays or electron beams, can be used assuming all components are compatible, particularly component rubbers and plastics. Exposure to sterilizing gasses, such as ethylene oxide, may be used, as long as component plastics do not retain amounts which exceed accepted levels. Likewise, liquids may also be used, such as those containing glutaraldehyde, in accordance with accepted standards. 
   The present invention can also include a nasal spray which facilitates the absorption of the staple polymer. The spray is preferably made of ingredients that will maintain moisture in the nasal cavity such as saline, but will also be formulated to increase degradation of the staple  50  which may include either a base or acid, an enzyme such as pepsin, or the formulation may be hypertonic to pull moisture into the nasal cavity. The nasal spray is preferably used around 6-8 times per day for 4-6 weeks (or until the staples  50  are completely absorbed). 
   PARTS LIST 
   The following is a list of parts and materials suitable for use in the present invention: 
   
     
       
             
             
           
             
             
           
         
             
                 
             
             
               Part 
                 
             
             
               Number 
               Description 
             
             
                 
             
           
           
             
                 
             
           
        
         
             
               10 
               septal stapler apparatus 
             
             
               11 
               tool body (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal 
             
             
                 
               such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 7-15 cm long, 2-6 cm high, and 2-5 cm wide) 
             
             
               12 
               proximal end portion 
             
             
               13 
               distal end portion 
             
             
               14 
               trigger (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal such 
             
             
                 
               as aluminum, stainless steel, or titanium - e.g. 1-5 cm 
             
             
                 
               long, 1-4 cm high, and 1-4 cm wide) 
             
             
               15 
               moving or tensioning arm (unfilled or filled plastic such 
             
             
                 
               as ABS, PVC, polypropylene, polyester or polycarbonate, 
             
             
                 
               or metal such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 5-16 cm long, 2-8 mm high, and 1-5 mm wide) 
             
             
               16 
               fixed arm (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal such 
             
             
                 
               as aluminum, stainless steel, or titanium - e.g. 5-16 cm 
             
             
                 
               long, 2-8 mm high, and 1-5 mm wide) 
             
             
               17 
               proximal end portion 
             
             
               18 
               distal end portion 
             
             
               19 
               receptacle 
             
             
               20 
               socket 
             
             
               21 
               contoured section 
             
             
               22 
               concavity 
             
             
               23 
               projection 
             
             
               24 
               camming surface 
             
             
               25 
               trigger spring (such as model no. C0240-020-2000-S 
             
             
                 
               produced by Associated Spring Raymond, a subsidiary 
             
             
                 
               of Barnes Group, Inc. of 1705 Indian Wood Circle, 
             
             
                 
               Maumee, OH 43537, US) 
             
             
               26 
               cylinder 
             
             
               27 
               cylinder 
             
             
               28 
               lever (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal such 
             
             
                 
               as aluminum, stainless steel, or titanium - e.g. 1-2 cm 
             
             
                 
               long, 1-4 mm high, and 1-4 mm wide) 
             
             
               29 
               lower end portion 
             
             
               30 
               fulcrum 
             
             
               31 
               central portion 
             
             
               32 
               transverse pin 
             
             
               33 
               upper end portion 
             
             
               34 
               staple actuator link (unfilled or filled plastic such as 
             
             
                 
               ABS, PVC, polypropylene, polyester or polycarbonate, or 
             
             
                 
               metal such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 5-16 cm long, 2-8 mm high, and 1-5 mm wide) 
             
             
               35 
               proximal end 
             
             
               36 
               distal end 
             
             
               37 
               spring (such as model no. E0063-007-0250-S 
             
             
                 
               produced by Associated Spring Raymond, a subsidiary of 
             
             
                 
               Barnes Group, Inc. of 1705 Indian Wood Circle, Maumee, 
             
             
                 
               OH 43537, US) 
             
             
               38 
               hook 
             
             
               39 
               hook 
             
             
               40 
               slotted portion 
             
             
               41 
               rectangular head (unfilled or filled plastic such as 
             
             
                 
               ABS, PVC, polypropylene, polyester or polycarbonate, 
             
             
                 
               or metal such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 3-8 mm long, 3-8 mm wide, and 0.5-1.5 mm thick) 
             
             
               42 
               pivotal connection 
             
             
               43 
               transverse bar 
             
             
               44 
               longitudinal slot 
             
             
               46 
               transverse slot 
             
             
               47 
               curved slot section 
             
             
               48 
               user 
             
             
               49 
               arrow 
             
             
               50 
               staple (bio-absorbable polymers or copolymers such as 
             
             
                 
               polyglycolic acid (PGA), polylactic acid (PLA), 
             
             
                 
               polydioxanone, polycaprolactone, polyhydroxybutyrate, 
             
             
                 
               polyester, or other polymer such as PVC, polypropylene, 
             
             
                 
               or polycarbonate, or metal such as aluminum, stainless 
             
             
                 
               steel, or titanium - e.g. 2-6 mm long and 0.5-2.5 mm 
             
             
                 
               thick) 
             
             
               51 
               staple bank 
             
             
               52 
               pointed section 
             
             
               53 
               staple advance rod (unfilled or filled plastic such as 
             
             
                 
               ABS, PVC, polypropylene, polyester or polycarbonate, 
             
             
                 
               or metal such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 4-10 cm long, 0.5-5 mm high, and 0.5-5 mm wide) 
             
             
               54 
               advance rod spring (such as model no. C0057-006-0310-S 
             
             
                 
               produced by Associated Spring Raymond, a subsidiary of 
             
             
                 
               Barnes Group, Inc. of 1705 Indian Wood Circle, Maumee, 
             
             
                 
               OH 43537, US) 
             
             
               55 
               enlarged head 
             
             
               56 
               arrow 
             
             
               57 
               rod 
             
             
               58 
               transverse beam 
             
             
               59 
               mucosal membrane layer 
             
             
               60 
               mucosal membrane layer 
             
             
               61 
               septal stapler apparatus 
             
             
               62 
               magnet 
             
             
               64 
               leaf spring (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal such 
             
             
                 
               as aluminum, stainless steel, or titanium - e.g. 1-10 mm 
             
             
                 
               long, 0.1-2 mm high, and 0.1-2 mm wide) 
             
             
               65 
               plunger (a magnetic material containing such substances 
             
             
                 
               as iron, nickel, cobalt, wairauite, magnetite, oxides, 
             
             
                 
               or sulfides in whole or in part) 
             
             
               66 
               variant with cam 
             
             
               67 
               shaft (unfilled or filled plastic such as ABS, 
             
             
                 
               PVC, polypropylene, polyester or polycarbonate, 
             
             
                 
               or metal such as aluminum, stainless steel, or 
             
             
                 
               titanium - e.g. 5-16 cm long, 2-4 mm 
             
             
                 
               diameter,) 
             
             
               68 
               cam (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal 
             
             
                 
               such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 3-8 mm long, 0.5-2 mm thick, and 0.5-2 mm 
             
             
                 
               wide) 
             
             
               69 
               cylinder (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal 
             
             
                 
               such as aluminum, stainless steel, or titanium - 
             
             
                 
               e.g. 1-3 cm long, 1-2 cm diameter) 
             
             
               70 
               peg 
             
             
               71 
               torsional spring 
             
             
               72 
               bearing surface 
             
             
               73 
               variant with pressure 
             
             
               74 
               cavity 
             
             
               75 
               pressurization tube 
             
             
               76 
               balloon (an elastic material such as rubber, latex or 
             
             
                 
               silicone) 
             
             
               77 
               cavity 
             
             
               114 
               trigger (unfilled or filled plastic such as ABS, PVC, 
             
             
                 
               polypropylene, polyester or polycarbonate, or metal such 
             
             
                 
               as aluminum, stainless steel, or titanium - e.g. 1-5 cm 
             
             
                 
               long, 1-4 cm high, and 1-4 cm wide) 
             
             
                 
             
           
        
       
     
   
   All measurements disclosed herein are at standard temperature and pressure, at sea level on Earth, unless indicated otherwise. All materials used or intended to be used in a human being are biocompatible, unless indicated otherwise. 
   The foregoing embodiments are presented by way of example only; the scope of the present invention is to be limited only by the following claims.