Patent Description:
Surgical devices, systems, and methods are provided for loading band ligation instruments.

Band ligation of tissue is often performed using various band ligation instruments, such as endoscopic surgical devices. For example, one illustrative instrument can have an elongate shaft with at least one lumen therethrough and a ligation barrel disposed on a distal end thereof. The ligation barrel can have a plurality of ligation bands disposed around a radially outer surface thereof. The bands can be engaged with one or more beads on band deployment cords that extend distally along the radially outer surface of the ligation barrel, loop around a distal-most end of the ligation barrel, and extend proximally through the lumen of the elongate shaft to engage with an actuation mechanism on a proximal end thereof. In use, tissue is drawn into the ligation barrel, and proximal retraction of the band deployment cords is effective to eject the distal-most band from the barrel such that the band extends around and engages the tissue drawn into the ligation barrel. Additional tissue can be drawn into the ligation barrel and the band deployment cords can be further retracted to deploy additional bands.

During loading of the ligation barrel, the one or more cords need to be positioned to extend through the elongate shaft from the distal end to the proximal end thereof. Passing the one or more cords proximally through the lumen of the surgical instrument can require repeatedly passing various loading wires or members with hooks on distal ends thereof through an entire length of the lumen to engage the one or more cords and then to position proximal ends of the cords through the lumen, which can be difficult and time-consuming. Further complicating the loading process, many endoscopic surgical devices can have multiple lumens therethrough and/or various Y-connections therealong that allow for application of suction, fluid, passing of other surgical instruments therethrough, etc. Thus, a user can be required to navigate various lumens and channels with thin, difficult-to-maneuver loading devices while handling the band deployment cords which can twist and kink. Additionally, the distal end of the elongate shaft is inserted into a proximal end of the band ligation barrel after successfully translating the band deployment cords. Force applied to the elongate shaft and the band ligation barrel during loading can risk causing accidental deployment of one or more of the ligation bands thereon and/or causing damage to the barrel itself. Document <CIT> discloses an endoscopic ligating apparatus. Document <CIT> discloses a medical device having an electro-magnetic device tip and related method of use. Document <CIT> discloses a channel mounted activating mechanism for an endoscopic ligator. Document <CIT> discloses a ligator and method of use. Document <CIT> discloses a tissue ligation apparatus with a rotating spool assembly and a valve assembly.

Therefore, improved band ligation loading techniques are needed.

Methods, devices, and systems are provided herein for loading a band ligation barrel onto a surgical instrument.

In one aspect, a surgical system is provided for loading a band ligation barrel onto a surgical instrument is according to annexed independent claim <NUM>.

Other advantagueous features are defined in the annexed depedent claims related to the system. In another aspect, an assembly comprising the system and the surgical instrument is defined in annexed claims <NUM> to <NUM>.

In another aspect, a method of loading a band ligation barrel onto a surgical instrument is according to annexed independent claim <NUM>.

Other advantagueous features are defined in the annexed depedent claims related to the method.

The embodiments described above will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings. The drawings are not intended to be drawn to scale. In the drawings:.

Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention as defined by the appended claims.

Various exemplary methods, devices, and systems are provided for loading a band ligation barrel onto a surgical instrument, such as an endoscopic surgical device. The band ligation loading system can simplify the loading process by enabling band deployment cords to be translated through a surgical device without requiring various loading members to be passed both distally and proximally. It can also prevent tangling of the band deployment cords during loading, and can secure the band deployment cords and ligation bands during loading to prevent or limit accidental band deployment. In one exemplary embodiment, a loading system is provided having a loading tube, a loading cap, and a loading key. The loading tube can be sized and shaped to be inserted into a distal open and translated proximally along one or more lumens of a surgical instrument to pass one or more deployment cords of a band ligation barrel therethrough. The loading cap can be removably insertable into a distal opening of the band ligation barrel and can receive a distal end of the loading tube therein. As such, the loading cap can secure the one or more deployment cords therein during loading. The loading key can be insertable into a proximal opening and advanced distally through one of a plurality of lumens of the surgical instrument to engage with and guide the loading tube proximally into the one of the plurality of lumens when the loading tube is inserted into the surgical instrument during loading. For example, the loading key can serve to guide the loading tube through a Y-shaped channel in a handle of the endoscopic surgical device so as to easily allow the deployment cords to be passed through the Y-shaped channel without requiring various loading members to be passed both distally and proximally therethrough.

<FIG> illustrates one embodiment of a band ligation loading system with a loading tube <NUM>, a loading cap <NUM>, and a loading key <NUM>. Loading tube <NUM> is sized and shaped to be inserted into a distal opening and advanced proximally along one or more lumens of a surgical instrument to pass one or more band deployment cords 30a, 30b of a band ligation barrel <NUM> therethrough. It has an elongate shaft with proximal and distal ends 100p, 100d and a lumen therebetween that receives the one or more cords 30a, 30b therealong. The distal end 100d can be removably received in the loading cap <NUM> during loading, as discussed below. Furthermore, the proximal end 100p can receive a distal end of the loading key <NUM> therein and secure it thereto during loading, as discussed below. The loading tube <NUM> can have a longitudinal length that is greater than a length of one or more lumens of the surgical instrument into which it is inserted such that the loading tube <NUM> can protrude both distally and proximally from the surgical instrument. The loading tube <NUM> can be flexible but semi-rigid for insertion through various curved and/or angled channels of the surgical instrument, and it can be made from a variety of materials, such as plastics, polymers, etc. The loading tube <NUM> can be transparent such that the cords 30a, 30b are visible therethrough or it can be opaque to obscure viewing of the cords 30a, 30b.

The loading tube <NUM> can be pre-loaded with the one or more cords 30a, 30b to assist a user in loading the cords 30a, 30b through the surgical instrument. The cords 30a, 30b can be contained within the loading tube <NUM> until they have been extended through the surgical instrument and a user has withdrawn the tube from the surgical instrument, as discussed below. As such, there is minimal risk of the cords 30a, 30b twisting, tangling, kinking, knotting, etc. during placement and a user is not required to perform significant cord management, tie any knots or engagement points in the cords for engagement with the actuation mechanism, etc. As illustrated in <FIG> and <FIG>, the loading tube <NUM> can be pre-loaded with the one or more cords 30a, 30b using a variety of techniques, such as by using a loading wire <NUM> with a hook <NUM> on a distal end thereof. The loading wire <NUM> can be inserted from a proximal end to a distal end of the loading tube <NUM>, engage with a proximal loop <NUM> and knot <NUM> of the one or more cords 30a, 30b, and be withdrawn proximally through the tube <NUM> so that the cords 30a, 30b are disposed therein. This can be achieved during manufacture such that a user receives the loading tube <NUM> with the cords 30a, 30b predisposed therein.

The loading cap <NUM> can secure the one or more cords 30a, 30b relative to the loading tube <NUM> and the band ligation barrel <NUM> during loading by a user to prevent or reduce any accidental ligation band deployment and cord twisting, as illustrated in <FIG>. The loading cap <NUM> can be removably insertable into a distal opening of the band ligation barrel <NUM> to secure the one or more cords 30a, 30b therein during loading. It can also receive the distal end 100d of the loading tube <NUM> (and thus ends of the cords 30a, 30b protruding distally from the tube <NUM>) therein such that the tube <NUM> extends longitudinally through a lumen extending through the band ligation barrel <NUM>. As such, the loading tube <NUM>, the loading cap <NUM>, and the band ligation barrel <NUM> can be removably coupled together during loading so that relative positions of the band ligation barrel <NUM> and the cords 30a, 30b are fixed. This prevents or reduces strain on the deployment cords 30a, 30b that might accidentally deploy one or more of a plurality of ligation bands <NUM> on the barrel <NUM> or twisting or fouling of the cords 30a, 30b during loading of the barrel <NUM> onto the surgical instrument.

In an exemplary embodiment, the loading cap <NUM> has a distal lip <NUM>, a middle stopper <NUM>, and a proximal receiver <NUM>, as illustrated in <FIG>. The distal lip <NUM> receives a distal-most end 20d of the band ligation barrel <NUM> therein, and it has a ring structure with a groove or channel <NUM> into which the distal-most end 20d can be received. As such, the distal lip <NUM> can at least partially extend proximally along the inner and outer radial surfaces of the band ligation barrel <NUM> at the distal-most end 20d. The distal-most end 20d is thus enveloped in and protected by the distal lip <NUM>. Furthermore, the distal lip <NUM> can apply secure frictional engagement to the one or more cords 30a, 30b that loop around the distal-most end 20d to prevent or reduce cord twisting or accidental ligation band deployment. If a ligation band <NUM> accidentally deploys during loading, the distal lip <NUM> can obstruct a distal deployment path of the band <NUM> to retain it on the barrel <NUM> because the distal lip <NUM> has a larger radial diameter than the distal-most end 20d. The middle stopper <NUM> protrudes proximally from the distal lip <NUM> and is inserted proximally into the distal opening defined by the distal-most end 20d of the band ligation barrel <NUM>. As such, it fills the opening and occludes at least a distal portion of the lumen extending through the band ligation barrel <NUM>. It has a cylindrical shape with a radial diameter that fits in a secure engagement against an inner radial surface of at least the distal end of the lumen of the barrel <NUM> so that it provides secure frictional engagement to the cords 30a, 30b extending therealong, thereby preventing movement of the cords 30a, 30b. The proximal receiver <NUM> protrudes proximally from the middle stopper <NUM> and has a lumen that removably receives the distal end 100d of the tube <NUM> in a secure frictional engagement when the tube <NUM> is inserted to extend longitudinally through the barrel <NUM> during loading. The lumen terminates at the middle stopper <NUM>. The loading cap <NUM> can be made from a variety of materials, such as plastics, polymers, etc., and it can be transparent or opaque.

As indicated above, the loading cap <NUM> can be inserted into the band ligation barrel <NUM> to secure the cords 30a, 30b against the barrel <NUM> at several locations as the cords 30a, 30b extend along the tube <NUM>, the cap <NUM>, and the barrel <NUM>. In particular, the cords 30a, 30b have a proximal end disposed within the tube <NUM>, and have a distal end positioned proximal of a proximal-most band. The cords 30a, 30b follow a path that extends distally from the distal end 100d of the tube <NUM>, and proximally around the distal end 100d of the tube <NUM>. They are held in frictional engagement between the distal end 100d of the tube <NUM> and a proximal-most surface of the middle stopper <NUM>. They further extend proximally along and are held in frictional engagement between an outer radial surface of the tube <NUM> and the inner radial surface of the lumen of the proximal receiver <NUM>. The cords 30a, 30b then extend proximally and then distally around a proximal end of the proximal receiver <NUM> and are held in frictional engagement between the outer radial surface of the middle stopper <NUM> and the inner radial surface of the lumen of the band ligation barrel <NUM>. The cords 30a, 30b then extend distally and then proximally around the distal-most end 20d of the barrel <NUM> and are held in frictional engagement between the distal-most end 20d and the distal lip <NUM>. The cords 30a, 30b continue to extend proximally along the outer radial surface of the barrel <NUM> and extend through one or more ligation bands <NUM>, with a terminal end of the cords 30a, 30b positioned just proximal to a proximal-most ligation band (not shown). Thus, a pathway of each cord 30a, 30b from the distal end 100d of the tube <NUM> to engagement with the ligation bands <NUM> on the outer radial surface of the barrel <NUM> follow an approximate S shape, as illustrated by superimposed lines in <FIG>.

The loading cap can have a variety of different configurations. <FIG> illustrates another embodiment of a loading cap <NUM> similar to loading cap <NUM>. Loading cap <NUM> secures one or more cords 30a relative to the loading tube <NUM> and the band ligation barrel <NUM> during loading, and it has a distal lip <NUM>, a middle stopper <NUM>, and a proximal receiver <NUM>. The lumen that receives the distal end 100d of the tube <NUM> extends through both the proximal receiver <NUM> and the middle stopper <NUM> such that the one or more cords 30a extend distally from the tube <NUM> into frictional engagement with the distal lip <NUM>. A channel <NUM> extends the lengths of the proximal receiver <NUM> and the middle stopper <NUM> and terminates in an opening 282a in a center of the distal lip <NUM> and connects with a channel 282b that extends between the opening 282a and an outer radial surface of the distal lip <NUM>. The channels <NUM>, 282b and opening 282a thus collectively form an approximate L shape through the loading cap <NUM> and allow for visualization of placement of the distal end 100d of the tube <NUM> in the loading cap <NUM>. However, the channels <NUM>, 282b and opening 282a are narrower than a diameter of the tube <NUM> such that the tube <NUM> can still be secured in the loading cap <NUM> in a frictional engagement.

As indicated above, the loading system also includes a loading key <NUM> which is insertable distally through various ligation actuation mechanisms, such as through a lumen in a handle <NUM>, and through one or more lumens of the surgical instrument to engage with and guide the loading tube <NUM> proximally along the one or more lumens when the loading tube <NUM> is inserted into the surgical instrument during loading. For example, the loading key <NUM> can serve as a guide to the loading tube <NUM> through a Y-shaped connection in the handle of the surgical instrument, as discussed below. In an exemplary embodiment, the loading key <NUM> is in the form of an elongate shaft having a distal end 300d that protrudes distally out of a lumen extending through the handle <NUM> and a handle stem <NUM>, and a proximal end 300p that protrudes proximally from the lumen of the handle <NUM>. The distal end 300d of the key <NUM> can be configured engage with the proximal end 100p of the tube <NUM> as the tube <NUM> is inserted into the distal end and advanced proximally through the surgical device. As illustrated, the distal end 300d is tapered, narrowing to a distal-most point <NUM>. The taper functions to center the distal-most point <NUM> of the key <NUM> approximately along a central longitudinal axis of the surgical instrument lumen so that the key <NUM> and the surgical instrument lumen are approximately coaxial. When the proximal end 100p of the tube <NUM> is advanced toward the loading key <NUM> during loading, the tapered point of the distal end 300d will enter the opening in the proximal end 100p of the tube <NUM> and can thus guide a distal portion <NUM> of the key <NUM> into a proximal portion of the lumen of the tube <NUM>. In some embodiments, as the tube <NUM> continues to be inserted proximally, the distal portion <NUM> of the key <NUM> can enter the proximal portion of the tube <NUM> in a secure frictional fit such that the key <NUM> and the tube <NUM> engage to function as a single, unitary tube, as illustrated in <FIG>. The loading key <NUM>, when joined to the tube <NUM>, is thus pushed proximally with continued proximal insertion of the tube <NUM> and acts as a guide for the proximal end 100p of the tube <NUM> by guiding it along the key's insertion path. The loading key <NUM> thus guides the tube <NUM> proximally out of the lumen of the surgical instrument and proximally out of the lumen of the handle <NUM>. Such a configuration is particularly advantageous where the lumen extending through the surgical instrument is Y-shaped within the handle, as the key <NUM> can guide the loading tube <NUM> into a desired proximal lumen when the tube encounters a junction in the lumen. The loading key <NUM> can also guide initial insertion of the stem <NUM> of the handle <NUM> through various ports, biopsy valves, etc. of the surgical instrument.

As indicated above, the distal portion <NUM> of the key <NUM> is tapered and can thus proximally radially expand from the distal-most point <NUM> to a stepped portion <NUM> that has an outer diameter that corresponds to an outer diameter of the tube <NUM>. As such, once the proximal portion of the tube <NUM> is fully advanced over the distal portion <NUM> of the key <NUM>, the outer diameter of the tube <NUM> will abut the stepped portion <NUM>. The tube <NUM> will engage the tapered portion of the key <NUM> and the outer diameter of the tube <NUM> and outer diameter of the key <NUM> will form a smooth outer surface to avoid catching or engaging on any instrument surfaces or elements during further proximal movement.

The distal portion <NUM> can be made of a softer or more flexible material than the remaining key <NUM> to provide further secure engagement between the key <NUM> and the tube <NUM>, and in some embodiments, the distal portion <NUM> can at least slightly dilate the proximal portion of the tube <NUM> upon insertion therein. In some embodiments, the loading key <NUM> can have a sufficient length such that, upon initial placement in the handle <NUM> and the surgical instrument, the key <NUM> extends distally through a Y-shaped connector in the handle of the surgical instrument. The distal portion <NUM> can thus extending distally beyond a junction of the Y-lumen to receive and engage the tube <NUM> and guide the tube <NUM> through the Y-connector and proximally out of the handle <NUM>, as discussed below. The loading key <NUM> can be made from a variety of materials, such as plastics, polymers, etc., and it can be transparent or opaque.

Various other embodiments of a loading key are possible. For example, <FIG> illustrates another embodiment of a loading key <NUM> similar to loading key <NUM>. Loading key <NUM> can extend through the handle <NUM> and through one or more lumens of the surgical instrument. Loading key <NUM> has a distal barrel <NUM> on a proximal end 350p thereof that can rest against a proximal end of the lumen through the handle <NUM> and/or a proximal surface of the handle <NUM>. When the key <NUM> and the handle <NUM> are initially positioned in a surgical instrument during loading, the distal barrel <NUM> can position a distal end 350d of the loading key <NUM> at a predetermined distance from the proximal opening. For example, in some embodiments, the surgical instrument can have a Y-lumen extending therethrough, with the distal portion of the lumen slitting at a junction into two proximal lumens. The length of the loading key <NUM> can be configured such that, when the proximal barrel <NUM> rests against the handle <NUM> upon full insertion of the loading key <NUM>, the key <NUM> extends through the handle <NUM>, past the junction of the Y lumen of the surgical instrument, and into the distal lumen. A distal portion <NUM> of the loading key <NUM> can receive and engage the tube <NUM> during proximal advancement of the tube <NUM> into the lumen and it can guide the tube <NUM> proximally through the junction of the Y lumen and out of the handle <NUM>.

The distal portion <NUM> can have a plurality of stepped regions 362a, 362b, 362c with each having an outer diameter that corresponds to a different outer diameter of a loading tube such that tubes of different diameters can be used with one key. As such, loading tubes with internal diameters of different sizes can be selected depending on an internal diameter of a combined channel in a surgical device, such as a diagnostic endoscope and/or a therapeutic endoscope, without requiring multiple loading keys. In other embodiments, each stepped region 362a, 362b, 362c can provide a further dilation and engagement point along the distal portion <NUM> as the tube <NUM> is advanced over the distal portion <NUM>. The proximal-most stepped region 362c can have an outer diameter that is the same as the outer diameter of the tube <NUM>, similar to stepped region <NUM>.

Numerous other embodiments of loading key(s) and/or loading tube(s) can also be provided that have a variety of different connection interfaces between each corresponding key and tube in which the loading key is not tapered. <FIG> illustrates an embodiment of a loading key <NUM> similar to loading key <NUM> and a loading tube <NUM> similar to loading tube <NUM>. Loading key <NUM> can extend through the handle <NUM> and through one or more lumens of the surgical instrument to engage the tube <NUM>, which can be proximally advanced into the lumen. Loading key <NUM> has a magnetic component 352a at a distal end thereof, and the loading tube <NUM> has a magnetic component 102a at a proximal end thereof. The magnetic components 352a, 102a can be magnets of opposite polarity, or one component can be magnetic while the other component can be a material that is magnetically attracted, such as various metals, metallic alloys, etc. When the loading key <NUM> engages the tube <NUM>, the magnetic components 352a, 102a can thus engage one another to allow the key <NUM> to guide the tube <NUM> proximally through the junction of the Y lumen and out of the handle <NUM>. The magnetic components 352a, 102a provide a simple way to ensure engagement between the key <NUM> and the tube <NUM> during loading. The magnetic components 352a, 102a can take a variety of forms, such as being rectangular, circular, ring-shaped to surround the lumen of the tube <NUM>, etc., and the components 352a, 102a can be embedded in the material used to make the loading key <NUM> and the tube <NUM> such that the components 352a, 102a themselves are not directly exposed to biological tissue, fluids, etc..

<FIG> illustrates another embodiment of a loading key <NUM> similar to loading key <NUM> and the loading tube <NUM>. Loading key <NUM> can extend through the handle <NUM> and through one or more lumens of the surgical instrument to engage the tube <NUM>. Loading key <NUM> has one or more tube engagement means 354a, 354b, 354c at a distal end thereof that are received within the proximal end of the loading tube <NUM> during loading to cause the key <NUM> to engage the tube <NUM>. The illustrated engagement means 354a, 354b, 354c are spherical structures that sequentially decrease in diameter from the proximal-most and largest engagement means 354c to the distal-most and smallest engagement means 354a. During loading, the smallest engagement means 354a is prevented from resting against an edge of the surgical instrument lumen because of the larger diameters of the engagement means 354b, 354c and the key <NUM>, and instead, the engagement means 354a is positioned within a middle area along a central longitudinal axis of the surgical instrument lumen. This positioning ensures that the engagement means 354a is able to enter the opening in the proximal end of the tube <NUM> and can thus guide the subsequent engagement means 354b, 354c into the lumen of the tube <NUM>. The engagement means 354a, 354b, 354c can then provide secure engagement between the key <NUM> and the tube <NUM> to allow easier loading. Other embodiments can have a different number of engagement means, such as one, two, four, five, etc., and the engagement means can have different shapes, such as ovular, cylindrical, etc..

In use, a kit can be provided to a user having the band ligation barrel <NUM>, the tube <NUM>, the loading cap <NUM>, and the loading key <NUM>. As illustrated in <FIG>, the tube <NUM>, the loading cap <NUM>, and the band ligation barrel <NUM> can be pre-assembled such that the cords 30a, 30b extend through the tube <NUM>, the distal end 100d of the tube <NUM> is passed longitudinally through the band ligation barrel <NUM> and engaged with the loading cap <NUM>, and the loading cap <NUM> is inserted distally into the distal opening of the barrel <NUM> to secure the cords 30a, 30b. The plurality of ligation bands <NUM> can be pre-loaded onto the barrel <NUM> such that the cords 30a, 30b are disposed through each ligation band <NUM> along the outer radial surface of the barrel <NUM>. The cords 30a, 30b can have one or more beads positioned thereon that engage each ligation band <NUM>. Because the tube <NUM> and the band ligation barrel <NUM> can be provided to a user pre-engaged with one another, the user can simply insert the tube <NUM> proximally into the device <NUM>, insert the key <NUM> distally into the device <NUM>, and thus be able to rapidly and correctly load the device in preparation for use without difficulty. While the tube <NUM>, the loading cap <NUM>, and the band ligation barrel <NUM> are pre-assembled, in other embodiments one or more components can be assembled or adjusted by a user in an operating space. Additionally, the loading tube <NUM> can be pre-disposed to a coiled configuration and can be configured to maintain its coiled configuration during maneuvering and loading to assist in keeping the tube <NUM> from contacting any surfaces or interfering with the operating space.

To load the band ligation barrel <NUM> onto a surgical instrument, such as an endoscopic surgical device <NUM>, in anticipation of band deployment, the loading key <NUM> can be inserted into the lumen of the handle <NUM>, and the loading key <NUM> and the stem <NUM> of the handle <NUM> can both be inserted into an auxiliary channel <NUM> of the endoscopic surgical device <NUM>, as illustrated in <FIG>. The illustrated endoscopic surgical device <NUM> can have at least a main channel <NUM>, the auxiliary channel <NUM>, a combined channel <NUM>, and a Y-connector <NUM> that merges the main channel <NUM> and the auxiliary channel <NUM> on a proximal end thereof into the combined channel <NUM> on a distal end thereof. The loading key <NUM> can assist in guiding placement of the stem <NUM> into the auxiliary channel <NUM> through any ports, biopsy valves, etc. therein. The loading key <NUM> can also be inserted distally into the auxiliary channel <NUM> through the lumen of the handle <NUM> until the key <NUM> extends through the auxiliary channel, the Y-connector <NUM>, and into the combined channel <NUM> such that the distal end 300d of the key <NUM> protrudes at least partially into the combined channel <NUM>. While the illustrated loading key <NUM> can be inserted to a variety of depths into the device <NUM>, other embodiments of the loading key can be used herein with distal barrels similar to distal barrel <NUM> of the key <NUM> discussed above to control a desired insertion depth, such as to easily and controllably protrude at least partially into the combined channel <NUM> through the Y-connector <NUM>. Additionally, while the endoscopic surgical device <NUM> is illustrated herein, a variety of surgical instruments can be used. The main channel <NUM> can also have various uses, such as allowing suction and/or fluid to be applied thereto, allowing tools to be inserted therealong, etc. The endoscopic surgical device <NUM> can also have a plurality of channels or lumens therethrough and can have an imaging device disposed therein such that imaging of an area distal to the device <NUM> is possible.

The user can insert the proximal end 100p of the tube <NUM> into a distal end 508d of the combined channel <NUM> of the device <NUM>, as illustrated in <FIG>. The user can begin to advance or translate the tube <NUM> proximally within the combined channel <NUM> until the proximal end 100p of the tube <NUM> encounters the distal end 300d of the loading key <NUM> distal to the Y-connector <NUM>. As discussed above, the two ends 100p, 300d can merge such that the distal end 300d extends into the proximal end 100p and engages the key <NUM> such that the key <NUM> and tube <NUM> are maneuvered as a single, unitary shaft. The user may feel the engagement between the two ends 100p, 300d based on tactile feedback on the tube <NUM>. The user can continue to advance the joined tube <NUM> and loading key <NUM> until the key <NUM> and a proximal portion of the tube <NUM> extend proximally from the handle <NUM>, as illustrated in <FIG>. In the illustrated embodiment, the main channel <NUM> of the device <NUM> is coaxial with the combined channel <NUM>, and the auxiliary channel <NUM> extends at a non-zero angle from the coaxial main and combined channels <NUM>, <NUM>. Thus, without the loading key <NUM>, unguided proximal translation of the proximal end 100p of the tube <NUM> can result in the tube <NUM> passing through the Y-connector <NUM> and into the main channel <NUM> rather than the auxiliary channel <NUM>. However, because the loading key <NUM> is initially inserted through the Y-connector <NUM> from the auxiliary channel <NUM> rather than the main channel <NUM> and extends therethrough when engagement is made, proximal translation of the combined loading key <NUM> and tube <NUM> relative to the device <NUM> follows the initial insertion path of the key <NUM> through the Y-connector <NUM> and through the auxiliary channel <NUM>. The proximal end 100p of the tube <NUM> can thus avoid proximal insertion into the main channel <NUM> even when translation of the proximal end 100p must occur at a non-zero angle in the Y-connector <NUM> to successfully pass through the Y-connector <NUM> and into the auxiliary channel <NUM>.

As the proximal portion of the tube <NUM> extends proximally from the handle <NUM>, the user can insert a distal end 500d of the device <NUM> into the proximal end 20p of the band ligation barrel <NUM> such that the barrel <NUM> and the device <NUM> engage in a secure frictional fit, as illustrated in <FIG>. In some embodiments, an alignment indicator 20c in the form of a rectangular line on the band ligation barrel <NUM> can be aligned with the combined channel <NUM> during engagement of the barrel <NUM> and the device <NUM>. For example, this alignment can be preferable in embodiments in which the device <NUM> has a plurality of lumens or channels therethrough that are not coaxial with one another and the cords 30a, 30b are arranged such that parallel alignment of the cords 30a, 30b through the combined channel <NUM> is preferred to ensure smooth translation of the cord 30a, 30b during band deployment.

When the barrel <NUM> is securely engaged with the distal end 500d of the device <NUM>, such as by a friction fit, the user can grasp the loading key <NUM> and/or the proximal portion of the tube <NUM> protruding from the handle <NUM> and they can pull the combined key <NUM> and tube <NUM> proximally relative to the handle <NUM> and the device <NUM>. The distal end 100d of the tube <NUM> is translated proximally out of frictional engagement with the proximal receiver <NUM> of the loading cap <NUM> upon application of the proximal pulling force because the barrel <NUM> is in engagement with the distal end 500d of the device <NUM> and retains the loading cap <NUM> therein. The distal end 100d of the tube <NUM> can continue to be translated proximally by the user through the barrel <NUM>, the combined channel <NUM>, the Y-connector <NUM>, the auxiliary channel <NUM>, and finally proximally out of the handle <NUM>. As the distal end 100d is translated proximally, the cords 30a, 30b remain in frictional engagement with the barrel <NUM> because of the engagement points with the loading cap <NUM> and the ligation bands <NUM> on the band ligation barrel <NUM>. Thus, proximal translation of the tube <NUM> causes the cords 30a, 30b to be withdrawn from the distal end 100d of the tube <NUM> and to remain extending along the combined channel <NUM>, the Y-connector <NUM>, the auxiliary channel <NUM>, the handle <NUM>, and finally proximally from the handle <NUM>, as illustrated in <FIG>.

When the one or more cords 30a, 30b are completely withdrawn from the tube <NUM>, the loop <NUM> and the knot <NUM> joining the cords 30a, 30b on distal ends thereof are exposed. The user can engage the cords 30a, 30b with the handle <NUM> in preparation for actuation and band deployment. For example, the user can engage the loop <NUM> with a hook <NUM> disposed on a rotational spool <NUM> of the handle <NUM>, and the user can rotate the rotational spool <NUM> to wrap the cords 30a, 30b therearound to remove excess cord, as illustrated in <FIG>. Thus, the loading key <NUM> allows the tube <NUM> to be loaded into the instrument from a distal-to-proximal direction through the Y-connector <NUM>, rather than a proximal-to-distal direction, and allows fast and efficient loading to speed up the loading process and prevent or reduce accidents during the loading process.

When the one or more cords 30a, 30b are engaged with the handle <NUM> and in condition for actuation, the loading cap <NUM> can be removed from the band ligation barrel <NUM>, as illustrated in <FIG>. After successfully loading the band ligation barrel <NUM> onto the surgical device <NUM>, tissue ligation can proceed, for example as discussed in WIPO Patent Pub. No. <CIT> and WIPO Patent Pub.

Thus, using one or more of the components of the loading system discussed herein, the band ligation barrel <NUM> can be loaded onto the distal end 500d of the endoscopic surgical device <NUM> and the one or more cords 30a, 30b can be extended through the device <NUM> for engagement with and eventual actuation by the handle <NUM> in a rapid and simple manner while avoiding or reducing cord entanglement and accidental band deployment.

All of the devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the devices can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the devices, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the devices can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the devices can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly.

Claim 1:
A surgical system for loading a band ligation barrel onto a surgical instrument, comprising:
a band ligation barrel (<NUM>) provided with one or more band deployment cords (30a, 30b);
a loading tube (<NUM>) having a proximal end (100p), a distal end (100d), and a lumen extending therebetween, the lumen being configured to receive the one or more band deployment cords (30a, 30b) of the band ligation barrel (<NUM>) therethrough, and the loading tube (<NUM>) being configured to be inserted through a first lumen of a surgical instrument (<NUM>); and
a loading key (<NUM>, <NUM>, <NUM>, <NUM>) having a proximal end (300p) and a distal end (300d), the loading key (<NUM>, <NUM>, <NUM>, <NUM>) being configured to be inserted into a second lumen of the surgical instrument (<NUM>), and the distal end (300d) being configured to securably engage with the proximal end (100p) of the loading tube (<NUM>),
characterized in that it further comprises a loading cap (<NUM>) having a proximal portion (<NUM>) with a lumen configured to removably receive the distal end (100d) of the loading tube (<NUM>) therein and a distal portion (<NUM>) configured to be removably insertable into a distal-most opening (20d) of the band ligation barrel (<NUM>) to secure the one or more band deployment cords (30a, 30b) therein relative to the band ligation barrel (<NUM>) and to obstruct a deployment path of one or more ligation bands (<NUM>) disposed on the band ligation barrel (<NUM>).