Patent Description:
A tissue or opening or defect, for example a wound, such as a tissue defect within a body lumen resulting from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), may be large enough that it may be difficult to close on its own, or the time for it to close may be prolonged. A risk of infection may increase the longer the wound remains open. Wounds larger than an immediate working area of an endoscope may also be difficult to close using devices that are sized to extend through a working channel of an endoscope.

It is with the above considerations in mind that the improvements of the present disclosure may be useful.

<CIT> relates to a variceal banding endoscope including an elongated shaft having a distal end and a proximal end that is removably connected to a control unit. The endoscope includes a variceal banding apparatus fixedly attached to the distal end of the endoscope and capable of receiving a plurality of ligation bands. A trigger cable extends from the proximal end to the distal end of the shaft and is digitally actuated by an actuator in the control unit or handle of the scope in response to a user input device.

<CIT> relates to a device for clipping tissue including a clip including first and second arms, a pusher member received over a proximal end of the clip, an outer sleeve distal of the pusher member and received over the first and second arms and being pushed distally over the clip by the pusher member from a first position in which the first and second arms are unconstrained by the outer sleeve in a tissue receiving configuration to a second position in which the first and second arms move to a closed tissue gripping configuration. A clip holder has first and second fingers which are held by the pusher member against corresponding cuts on a proximal end of the clip to couple the clip to the device. When the pusher member is moved distally to the second position, the first and second fingers move radially outward releasing the clip.

<CIT> relates to a tissue closure device having a plurality of configurations providing for delivery and use in minimally invasive procedures. A tissue closure device is provided from shape memory or super-elastic materials for closing a tissue site opening. The device comprises a plurality of tissue anchors extending from a closed loop surface, wherein the plane of said tissue anchors is provided at an angle essentially perpendicular with respect to the plane of said closed loop surface.

<CIT> relates to an apparatus and systems suitable for coupling a graft member to tissue. Tacking devices having a proximal end and a distal end are provided, each having a delivery state suitable for delivery and further comprising a deployed state. In the deployed state, the distal end is configured to engage tissue at a first location, and the proximal end is configured to engage the graft member to secure the graft member to the tissue.

<CIT> relates to an "endovascular suture staple", a component utilized for fastening a medical device to the wall of a blood vessel or inside a hollow body organ. The staple may be specifically utilized for fastening vascular grafts on vessel walls, by means of endovascular sutures.

<CIT> relates to a medical apparatus and to a shape memory wound closing device. The shape memory wound closing device comprises a fiber membrane which is manufactured through an electrostatic spinning method and by using shape memory polymeric materials as raw materials. The fiber membrane has a stretching pre-deformation condition, and an adhering material layer is compounded on one or more side surfaces of the fiber membrane. When being used, the shape memory wound closing device is adhered to the wound in a crossing manner, and then the shape memory effect is activated, so that the shape memory wound closing device is contracted and recovered, then the wound tissue is dragged, and the wound is closed.

<CIT> relates to tissue holding implants which enable two or more layers of tissue to be held in approximation for an extended period. One and two-piece implants are made from materials that are biocompatible and may also be biodegradable. The implants may include a portion which is deformed to capture the tissues to be held, and others are made from a super-elastic or shape memory material and hold the tissues in approximation when the implant is reverted to a known preformed shape.

<CIT> relates to a ligating system with a ligating barrel having an adjustable diameter for use with endoscopes of varying sizes. The adjustable diameter may be provided by a collet, a flexible helical band, a plurality of screws, or a tapered elastomeric section.

Non-limiting examples of the present disclosure are described by way of example with reference to the accompanying figures, which are schematic and not intended to be drawn to scale. For purposes of clarity, not every component is labeled in every figure, nor is every component of each embodiment of the disclosure shown where illustration is not necessary to allow those of skill in the art to understand the disclosure. In the figures:.

It is noted that the drawings are intended to depict only typical or exemplary embodiments of the disclosure. Accordingly, the drawings should not be considered as limiting the scope of the disclosure. The disclosure will now be described in greater detail with reference to the accompanying drawings.

Various embodiments according to the present disclosure are described below. As used herein, "proximal end" refers to the end of a device that lies closest to the medical professional along the device when introducing the device into a patient, and "distal end" refers to the end of a device or object that lies furthest from the medical professional along the device during implantation, positioning, or delivery.

Additionally, when particular features, structures, and/or characteristics are described in connection with one embodiment, it should be understood that such features, structures, and/or characteristics may also be used in connection with other embodiments whether or not explicitly described unless clearly stated to the contrary.

The detailed description should be read with reference to the drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention.

A number of medical procedures, including intravascular procedures, procedures along the digestive, urinary, respiratory, reproductive and/or biliary tracts, thoracic procedures, etc., utilize medical devices to access tissue intended for removal (e.g., "target tissue") within the body. For example, in some current medical procedures (e.g., EMR and ESD), physicians may utilize an endoscope, colonoscope, duodenoscope, bronchoscope, gastroscope, or similar medical device to access and remove diseased lesions, creating a wound or defect in the tissue. A "wound" as used herein may include a defect, injury, bleed, ulcer, lumen opening, or like anatomy, which a medical professional would like to close for sealing, healing, hemostasis, ligation, or the like. In some instances, an endoscope may incorporate features which assist the physician in visualizing and performing the wound closing procedure. For example, some endoscopes may include a light and/or camera designed to illuminate and/or visualize the body lumen as the endoscope is navigated and positioned adjacent to a target tissue site. Additionally, some endoscopes may also include a lumen (e.g., a working channel) through which a resecting device, grasping member, or other accessory devices may be deployed and utilized. Additional visualization and/or external and/or internal imaging methods may be alternatively or additionally employed, e.g., fluoroscopy.

Medical procedures, e.g., EMR and ESD, may result in portions of tissue, e.g., body lumen or organ tissue, such as a mucosal layer, being resected and/or dissected, resulting in a wound or defect in the tissue. In this context, wound closure and healing may be aided by one or more devices substantially approximating wound tissue (e.g., wound edges) such that tissue layers are brought together or closer together across the wound for purposes, among others, of facilitating tissue adhesion and eventually healing of the wound, achieving hemostasis, or the like. Another consideration are wounds that are larger than an immediate working area of an endoscope, which may be difficult to close using devices that are sized to extend through a working channel of an endoscope, e.g., wounds larger than about <NUM> in diameter. These larger wounds may benefit from different configurations of closure devices and/or multiple closure devices as well.

The devices, systems, and methods of the present disclosure may be used alone or together with other devices, systems, and methods to treat wounds. Exemplary devices, systems, and methods with which embodiments of the present disclosure may be implemented include, but are not limited to, those described in <CIT>.

Referring to <FIG>, a distal end of a device, e.g., an endoscope <NUM> for closing a wound <NUM> according to an embodiment of the present disclosure is illustrated, which includes a closure element <NUM> having a shape-memory configuration. The shape-memory configuration of the closure element <NUM> may be a helical coil when deployed, but other shapes are contemplated as described herein. The coils are wider in the delivery configuration than in the deployed configuration. The pitch of the coils is straight along a longitudinal axis of the closure element <NUM>, but the coils may be pitched a number of degrees that may vary between the delivery configuration and the deployed configuration. For example, a pitch of the coils in the deployed configuration may be such that the helix is angled between about <NUM>° and about <NUM>°. The closure element <NUM> is delivered disposed about an endcap <NUM> of an endoscope <NUM>. The endcap <NUM> may be an elongate hollow tube attachable to a distal end of the endoscope <NUM>, such that any of a working channel, imaging device, and/or illumination device remain unobstructed when the endcap <NUM> is attached to the endoscope <NUM>. A diameter of the coils in the relaxed, deployed configuration is less than a diameter of an outer surface of the endcap <NUM> such that the closure element <NUM> constricts around the endcap <NUM> in the delivery configuration. The endcap <NUM> positions the closure element <NUM> distal to and in view of an imaging device, e.g., a camera, of the endoscope <NUM> for a medical professional to visualize the closure element <NUM> and surrounding anatomy. The endcap <NUM> may be substantially translucent such that the medical professional may see through the endcap <NUM> to the closure element and surrounding anatomy. The closure element <NUM> is shown in a delivery configuration about the endcap <NUM> with a shape-memory spring force of the closure element <NUM> restrained by the diameter of the endoscope <NUM> shaft (or by the shaft of another delivery device, catheter, elongated member, or the like), such that the closure element <NUM> is extended to a diameter wide enough to fit about the endcap <NUM>. The closure element <NUM> may be inserted into a body lumen of a patient in the delivery configuration about the endcap <NUM>. A release filament <NUM> has a distal end 102d releasably coupled to the closure element <NUM> and a proximal end extending within the endcap <NUM>. The proximal end of the release filament <NUM> may extend through the endoscope <NUM> and terminate outside of a proximal end of the endoscope <NUM>. The proximal end of the release filament <NUM> may terminate at a handle or another device for actuation within or outside of the endoscope <NUM>. The distal end 102d of the release filament <NUM> is a loop, but the distal end 102d may additionally or alternatively be other coupling mechanisms such as a weld, an adhesive, a hook, or like. The loop of the release filament may extend about more than one coil of the closure element <NUM> and may extend across the entire length of the closure element <NUM>. The assembly of the closure element <NUM>, release filament <NUM>, and endcap <NUM> illustrated in <FIG> may be preloaded on the endoscope <NUM> prior to insertion into a patient. The endcap <NUM> may be oriented toward a wound <NUM> of a tissue <NUM> may a medical professional moving or translating the endoscope <NUM> within the patient.

Referring to <FIG>, the endcap <NUM> of the endoscope <NUM> may be placed about the wound <NUM>, creating a substantial seal between the distal end of the endcap <NUM> and the tissue <NUM> surrounding the wound <NUM>. The area within the endcap <NUM> may be suctioned via a suction and/or vacuum source that is in fluid communication with a suction channel of the endoscope <NUM>. The suction force may create a negative pressure within the endcap <NUM> that displaces at least part of the wound <NUM> and surrounding tissue <NUM> proximally into the endcap <NUM>. With the wound <NUM> at least partially displaced within the endcap <NUM>, the distal end 102d of the release filament <NUM> remains extended out of the distal end of the endcap <NUM> and proximally along an outside of the endcap <NUM> to a point where the loop is coupled to the closure element <NUM> (disposed about the outside of the endcap <NUM> in the delivery configuration).

Referring to <FIG>, with the wound <NUM> and surrounding tissue <NUM> at least partially displaced proximally within the endcap <NUM>, the release filament <NUM> may be translated (e.g., pulled) proximally to begin to transition the closure element <NUM> from the delivery configuration about the endcap <NUM>, to a deployed configuration about the wound <NUM>. In <FIG>, as the release filament <NUM> is translated proximally into the endcap <NUM>, the distal end 102d of the release filament <NUM> displaces the distal end 100d of the closure element <NUM> off of the distal end of the endcap <NUM> and about the wound <NUM>. The suctional force displacing the tissue <NUM> maintains the tissue <NUM> in tension allowing coils of the closure element <NUM> to constrict around margins of wound <NUM>. A delivered closure element <NUM> has an inward closure force while the tissue <NUM> has a counter relaxing force against the closure element <NUM> resulting in a snug fit. The distal end 102d of the release filament <NUM> is decoupled (e.g., slid off of, broken away from, or the like) from the closure element <NUM> as the release filament <NUM> is translated proximally into the endcap <NUM>. The distal end 102d of the release filament <NUM> may decouple from the end of the closure element <NUM> before the closure element <NUM> engages the tissue <NUM> or after the closure element <NUM> engages the tissue <NUM>, e.g., the distal end 102d of the release filament <NUM> may slide off of the closure element <NUM> by temporarily disengaging a portion of the closure element <NUM> from the tissue <NUM> and thereafter the inward closure force of the closure element <NUM> reengages the tissue <NUM>. As portions (e.g., windings of coils) of the closure element <NUM> (e.g., the distal end 100d) are released from the endcap <NUM> and about the wound <NUM>, those portions of the closure element <NUM> transition from the stressed delivery configuration having a larger diameter to the un-stressed deployed configuration having a smaller diameter. The deployed configuration of the distal end 100d of the closure element <NUM> constricts about the wound <NUM> and surrounding tissue <NUM> due to the shape-memory configuration of the closure element <NUM>. The deployed portion of the closure element constricting the tissue <NUM> anchors the distal end 100d of the closure element <NUM> such that the endoscope <NUM> may be translated proximally and the endcap <NUM> may be proximally pulled away from the distal end 100d as the remainder of the closure element <NUM> is released off of the endcap <NUM> and engaged about the wound <NUM>.

Referring to <FIG>, the closure element <NUM> is shown in the deployed configuration about the wound <NUM> and the surrounding tissue <NUM>. The closure element <NUM> is not in a completely relaxed, unstressed state as the tissue <NUM> provides some resistance to the closure element <NUM> constricting the tissue <NUM>. The closure element <NUM> in the deployed configuration may result in a substantially frustum shape having an apex over the wound <NUM> and away from the tissue <NUM>. This shape is the result of a smaller volume of tissue <NUM> within the closure element <NUM> at the wound <NUM> site compared to the larger amount of tissue <NUM> within the closure element <NUM> away from the wound <NUM> site and/or the volume of tissue <NUM> displaced into the endcap <NUM>. Alternatively, the closure element <NUM> may have a substantially cylindrical shape or inverted frustum shape (i.e., compared to the frustum shape of <FIG>) where a larger volume of tissue <NUM> is displaced such that there is more tissue displaced than illustrated in <FIG>. For example, a portion of the tissue <NUM> may extend proximally out of the closure device <NUM> that may form a bulbous or mushroom shape. The exposed area of the wound <NUM> is smaller and the edges of the wound <NUM> are closer together in <FIG> than the larger area and spread out edges of the wound <NUM> in <FIG>. As a diameter of the coils of the closure element <NUM> in the deployed configuration may decrease, a closure force in a radial direction toward the longitudinal axis of the closure element <NUM> may increase.

Referring to <FIG>, a device for closing a wound <NUM> is illustrated according to an embodiment of the present disclosure, which includes a closure element <NUM> having a shape-memory configuration. The shape-memory configuration of the closure element <NUM> is shown as a knot, but other shapes are contemplated as described herein. The closure element <NUM> includes a protrusion 200d at each end of the closure element <NUM> that is configured to penetrate or embed and engage into tissue. The illustrated protrusions 200d are barbs with arrowhead shape, but the protrusions 200d may be hooks, tines, or the like. The closure element <NUM> is disposed about an endcap <NUM> of an endoscope <NUM>. The closure element <NUM> is shown in a delivery configuration about the endcap <NUM> with a shape-memory spring force of the closure element <NUM> expanding and stressing the closure element <NUM> to a diameter wide enough to fit about the endcap <NUM>. The delivery configuration of the closure element <NUM> is illustrated in <FIG>. The closure element <NUM> may be inserted into a body lumen of a patient in the delivery configuration about the endcap <NUM>. A release filament <NUM> has a distal end 202d releasably coupled to the closure element <NUM> and a proximal end extendable within the endcap <NUM>. The distal end 202d of the release filament <NUM> is a loop, but the distal end 202d may additionally or alternatively be other releasable coupling mechanisms such as a spot weld, an adhesive, a hook, or like. The assembly of the closure element <NUM>, release filament <NUM>, and endcap <NUM> illustrated in <FIG> may be preloaded with the endoscope <NUM> prior to insertion into a patient. The endcap <NUM> may be oriented toward a wound <NUM> of a tissue <NUM>.

Referring to <FIG>, the endcap <NUM> of the endoscope <NUM> may be placed about the wound <NUM>, creating a substantial seal between the distal end of the endcap <NUM> and the tissue <NUM> surrounding the wound <NUM>. The area within the endcap <NUM> may be suctioned via a suction and/or vacuum source that is in fluid communication with a suction channel of the endoscope <NUM>. The suction force may create a negative pressure within the endcap <NUM> that displaces at least part of the wound <NUM> and surrounding tissue <NUM> proximally into the endcap <NUM>. With the wound <NUM> displaced into the endcap <NUM>, the release filament <NUM> may be translated proximally to transition the closure element <NUM> from the delivery configuration about the endcap <NUM> to a deployed configuration about the wound <NUM>. As illustrated in <FIG>, as the release filament <NUM> is translated proximally into the endcap <NUM>, the distal end 202d of the release filament <NUM> displaces the closure element <NUM> off of the endcap <NUM> and about the wound <NUM>. The distal end 202d of the release filament <NUM> is decoupled (e.g., slid off of, broken or cut away from, or the like) from the closure element <NUM> as the release filament <NUM> is translated proximally into the endcap <NUM>. The distal end 202d of the release filament <NUM> may decouple from the end of the closure element <NUM> before the closure element <NUM> engages the tissue <NUM> or after the closure element <NUM> engages the tissue <NUM>, e.g., the distal end 202d of the release filament <NUM> may slide off of the closure element <NUM> by temporarily disengaging a portion of the closure element <NUM> from the tissue <NUM> and thereafter the inward closure force of the closure element <NUM> reengages the tissue <NUM>. The release filament may decouple from the closure element <NUM> by breaking from engaging with the protrusion 200d. As the closure element <NUM> is displaced off of the endcap <NUM> and about the wound <NUM>, the closure element <NUM> transitions from the extended delivery configuration having a greater diameter to the unextended deployed configuration having a lesser diameter.

Referring to <FIG>, the deployed configuration of the closure element <NUM> constricts about the wound <NUM> and surrounding tissue <NUM> due to the shape-memory of the closure element <NUM>. The deployed configuration of the closure element <NUM> is illustrated in <FIG>. In the deployed configuration, the closure element transitions to the unstressed, knotted shape-memory orientation (e.g., knotted, pretzel-like, etc.) with the protrusions 200d oriented internally to the closure element 200d such that a portion of the length of the closure element <NUM> overlaps with itself. The protrusions 200d may fully embed, partially embed, or not embed into the tissue <NUM>.

Referring to <FIG>, a device for closing a wound <NUM> according to an embodiment of the present disclosure is illustrated, which includes multiple closure elements <NUM> disposed about an endcap <NUM> in a delivery configuration. The closure elements <NUM> each include a protrusion 300d at each end of the closure element <NUM> that are configured to penetrate or embed and engage tissue. The protrusions 300d are barbs, but the protrusions 300d may be hooks, tines, or the like. The device includes a release filament <NUM> that has a distal portion that is coupled to each of the closure elements <NUM> by a series of loops 302d. A release filament as described elsewhere in this disclosure may be used in a substantially similar manner as the release filament <NUM> illustrated in <FIG> (e.g., the release filament <NUM> with loops about each winding of the release filament <NUM> or one or more release filament <NUM>). Each loop 302d of the release filament <NUM> extends independently around each closure element <NUM> while the closure elements <NUM> are in the delivery configuration. The release filament <NUM> has a proximal portion 302p that extends within the endcap <NUM>. A proximal translation of the proximal portion 302p of the release filament <NUM> translates a pulling force to the distal-most loop 302d-<NUM> because the release filament <NUM> extends from within the endcap <NUM> to outside of the endcap by extending over a distal end 320d of the endcap <NUM>. The distal end 320d of the endcap <NUM> may be oriented toward, about, and/or in contact with a wound <NUM> and/or the surrounding tissue <NUM>. A suction force may be introduced in fluid communication with the endcap <NUM> to displace the wound <NUM> into the endcap <NUM>, as illustrated in <FIG>. The release filament <NUM> may be translated proximally such that a distal-most loop 300d pulls a respective closure element <NUM> distally along the outside of the endcap <NUM>. The release filament <NUM> may be continually translated proximally such that the distal-most closure element <NUM> is displaced off of the endcap <NUM> and transitions from the delivery configuration to the deployed configuration. As illustrated in <FIG>, the closure element <NUM>-<NUM> is deployed into the tissue <NUM>. A proximal translation of the proximal portion 302p of the release filament <NUM> displaces the distal-most loop 302d-<NUM> along with the closure element <NUM>-<NUM> distally along the endcap <NUM>. As the closure element <NUM>-<NUM> is displaced off of the distal end 320d of the endcap <NUM>, the closure element <NUM>-<NUM> begins to transition from the delivery configuration to the deployed configuration and the loop 302d-<NUM> begins to de-couple from the closure element <NUM>-<NUM>. After deployment of the closure element <NUM>-<NUM>, the distal-most closure element <NUM>-<NUM> may be deployed at the same tissue <NUM> location or to another tissue location by proximally translating the proximal portion 302p such that the distal-most loop 302d-<NUM> may be displaced.

With reference to <FIG>, a device according to an embodiment of the present disclosure is illustrated including a closure element <NUM>. The closure element <NUM> has an elongated, un-activated configuration illustrated in <FIG> and a curved, activated configuration illustrated in <FIG>. In the un-activated configuration, the closure element <NUM> extends substantially linearly from one end 400d of the closure element <NUM> to the other end 400d. In the activated configuration, the ends 400d of the closure element <NUM> curl toward each other. The activated configuration of the closure element <NUM> is shown as substantially "C-shaped", but the activated configuration could be a variety of shapes, e.g., "U-shaped", "S-shaped", "Z-shaped", or combinations thereof, etc. The closure element <NUM> includes a plurality of activatable portions <NUM> along a length of the closure element <NUM>. Although four activatable portions <NUM> are depicted, any number of activatable portions <NUM> may be utilized, e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, etc. Additionally, or in the alternative, the activatable portions <NUM> may blend into other portions of the closure element <NUM> such that they mix. A blend of portions may comprise a substantially uniform mixture throughout the blend or the blend may have a varying percentage of each of the portions that increases or decreases along a length of the closure element <NUM>. The activatable portions <NUM> may be sensitive to activation from an external stimulus source such as heat, light, infrared light, electricity, energy, pH, or the like that may cause the activatable portions <NUM> to alter the geometric shape of the closure element <NUM>. Activatable portions <NUM> may be patterned along the closure element <NUM> at specific locations to act as actuating hinges or fold points at or along which the shape of the closure element <NUM> can deform into the activated (e.g., curved) configuration. Each activatable portion <NUM> may contract a number of degrees d (e.g., about <NUM>° to about <NUM>°) such that the closure element <NUM> in the activated configuration has an overall curvature α equal to the number of degrees d multiplied by the number of activatable portions <NUM>. The closure element <NUM> (or other closure elements described herein) may also include biodegradable portions <NUM> along the length of the closure element <NUM>. A closure element <NUM> may comprise of only activatable portions, only biodegradable portions, or neither. The portions may be located at different places along the length of a closure element <NUM> and may have arrangements other than those depicted in the figures. For example, one or more protrusions of a closure element may be non-biodegradable with the remainder of the closure element being biodegradable such that the one or more protrusions remain in tissue while the remainder of the closure element is passed. The biodegradable portions <NUM> may degrade over time after deployment into a patient such that as a wound associated with the closure element <NUM> heals and the closure element <NUM> is no longer needed (e.g., within about seven days, within about fourteen days, within about a month, within about a plurality of months, within about a year, etc., depending on the materials used and depending on characteristics of the wounds), the biodegradable portions <NUM> may degrade sufficiently such that the closure element <NUM> falls away from the tissue. Although three biodegradable portions <NUM> are depicted, any number of biodegradable portions <NUM> may be utilized, e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, etc. Additionally, or in the alternative, the biodegradable portions <NUM> may blend into other portions of the closure filament <NUM> such that they mix. The biodegradable portions <NUM> or other portions may include drugs that may assist a wound or may be otherwise released into the body of a patient (e.g., analgesic, healing, antibacterial, etc.) The ends 400d each include a protrusion that are configured to penetrate, or embed and engage, tissue. The protrusions are shown as sharpened points, but may also be barbs, but may be hooks, tines, or the like.

With reference to <FIG>, the closure element <NUM> of <FIG> may be used to close a wound <NUM>. As illustrated in <FIG>, the wound <NUM> and a surrounding tissue <NUM> may be displaced via a medical instrument <NUM> (e.g., a grasper, a working channel with a suctioning force, a clip, or the like). A delivery device <NUM> (e.g., a needle, a catheter, or the like) having a closure element <NUM> in the elongated un-activated configuration is configured for tissue insertion and may be oriented toward the wound <NUM> and tissue <NUM>. As illustrated in <FIG>, a closure element <NUM> may be delivered into the tissue <NUM> across the wound <NUM> by leading with a protrusion on an end 400d of the closure element <NUM>. The tissue <NUM> may be displaced (e.g., tissue edges approximated) by the medical instrument <NUM> (e.g., forceps or grasper) to allows the end 400d of the closure element <NUM> to puncture through two sides of the tissue <NUM> about the wound <NUM> in one insertion motion along a longitudinal axis of the closure element <NUM>. An additional closure element <NUM> may be delivered from the delivery device <NUM> such that multiple closure elements <NUM> are delivered into the tissue <NUM> across the wound <NUM>, as illustrated in <FIG> (with the tissue <NUM> released from the medical instrument <NUM>). Although four closure elements <NUM> are illustrated in <FIG>, any number of closure elements <NUM> may be used, e.g., <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, a number such the closure elements <NUM> extend across a substantial area of the wound <NUM>, etc. The closure elements <NUM> after being delivered are illustrated in the un-activated configuration in <FIG>. An activator external to the closure element <NUM> may activate the activatable portions <NUM> of each closure element <NUM> such that they transition from the un-activated configuration to the activated configuration. The activated configuration of the closure elements <NUM> across the wound <NUM> is illustrated in <FIG>. The activatable portions <NUM> are contracted such that the ends 400d are curled toward each other and the wound <NUM> is substantially closed or closed such that edges of the wound <NUM> are closer together than in <FIG>. Over time, the biodegradable portions <NUM> may degrade such that the closure members <NUM> fall away from the tissue <NUM>. Alternatively, no portion of the closure members <NUM> may degrade, and as the wound <NUM> heals, scabs, scars, and/or sloughs off, the closure members <NUM> may fall away from the tissue <NUM>.

In various embodiments, a medical professional may attach an endcap to an endoscope, a catheter, or the like. The medical professional may load one or more closure elements onto the endcap. The one or more closure elements may be releasably coupled to a release filament extending within the endcap and may be attached to a handle. The endoscope and assembly may be inserted into a patient. A target wound may be located. The endcap may be oriented toward the wound. The wound or surrounding tissue may be displaced into the endcap. The one or more closure elements may be released about the wound by the medical professional manipulating the release filament.

In various embodiments, a medical professional may insert one or more un-activated closure elements within a delivery device, such as a needle. The delivery device may be inserted into a patient. A target wound may be located. The delivery device may be oriented toward the wound. The one or more closure elements may be deployed into a tissue about the wound. The one or more closure elements may be activated such that the one or more closure elements transition from the un-activated configuration to an activated configuration.

In various embodiments, a closure element may comprise a shape-memory material such as nitinol, stainless steel, nickel titanium, an alloy, a polymer, a rubber, nylon, combinations thereof, or the like. Closure elements may have a shape and/or shape-memory set by a mandrel. Shapes of a closure element may include a coil, a helix, a knot, a pretzel, a straight line, "C-shaped", "V-shaped", "U-shaped", "S-shaped", "Z-shaped", a combination thereof, or the like. A closure element may be heat set at a diameter (e.g., a diameter of about <NUM> to about <NUM>, or the like) that may be selectable based on wound geometry and size.

In various embodiments, an endcap as described and illustrated herein may be coupled to an endoscope, catheter, and/or working channel (e.g., insertable, adhered, manufactured as a unibody, etc.). An endcap may additionally or in the alternative be an extension of an endoscope, catheter, and/or working channel.

Devices according to the embodiments described, and in accordance with other embodiments of the present disclosure, alone or in a system or kit or as part of a method or procedure, including with other accessories, may be used in cavities, lumens, tracts, vessels and organs of the body, such as to access, treat or diagnose conditions in the peritoneal, abdominal, bronchial or thoracic cavities, vascular vessels, gastrointestinal or urinary tract, uterus, bladder, lung and liver organs, etc..

Claim 1:
A device for closing a wound (<NUM>, <NUM>, <NUM>), comprising:
a closure element (<NUM>, <NUM>, <NUM>) having a delivery configuration and a deployed configuration, the closure element configured to be disposed about an endcap (<NUM>, <NUM>, <NUM>) of an endoscope (<NUM>, <NUM>) in the delivery configuration; and
a release filament (<NUM>, <NUM>, <NUM>) having a distal end (102d, 202d) releasably coupled to the closure element and a proximal end extendable within the endcap;
wherein the closure element is configured to substantially close about the wound in the deployed configuration,
wherein the deployed configuration of the closure element is a shape-memory configuration,
wherein the shape-memory configuration of the closure element is a coil, a knot, or a combination thereof.