Patent Description:
This disclosure generally relates to medical systems, devices, and related methods that may be used to treat a subject. Aspects of the disclosure relate to medical systems, devices, and methods for endoscopic medical procedures, such as manipulating and cutting tissue with one or more medical devices during resection and dissection procedures, among other aspects.

Organ walls are composed of several layers: the mucosa (the surface layer), the submucosa, the muscularis (muscle layer), and the serosa (connective tissue layer). In gastrointestinal, colonic, and esophageal cancer, lesions or cancerous masses may form along the mucosa and often extend into the lumens of the organs. Conventionally, the condition is treated by cutting out a portion of the affected organ wall. This procedure, however, may cause discomfort to patients, and pose health risks.

Physicians have adopted minimally invasive techniques called endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR methods are typically used for removal of small cancerous or abnormal tissues (e.g., polyps), and ESD methods are typically used for en bloc removal of large cancerous or abnormal tissues (e.g., lesions). These procedures are generally performed with an endoscope, which is a long, narrow member optionally equipped with a light, imaging equipment, and other instruments. During these procedures, the endoscope may be passed through a percutaneous incision, passed down the throat, or guided through the rectum to reach tissue targeted for resection or dissection, such as tissue having an abnormality such as a lesion or cancerous mass in an affected organ. The lesion is generally identified and marked. The lesion is subsequently removed using the same or different medical instrument.

Multiband mucosectomy (MBM) is a widely used EMR technique, which uses a modified variceal band ligator. The MBM device consists of a control handle that is attached to the proximal end of an endoscope and which is connected to a plastic cap with a number of rubber bands attached to the endoscope via a tripwire. By suctioning a mucosal lesion into the cap and then releasing a rubber band, a pseudopolyp may be created that can be resected using an electrocautery snare or other device. No submucosal lifting via needle injection or pre-looping of the snare in the cap is required for MBM.

<CIT> discloses a foreign body retrieval device for use with an endoscope having pivoting distal grasping members. <CIT> discloses an endoscopic cap having a clip applying set.

The systems, devices, and methods of this disclosure aim to improve upon the conventional methods described above or address other aspects of the art.

Examples of the disclosure relate to, among other things, systems, devices, and methods for performing one or more medical procedures with the medical systems and devices. Each of the examples disclosed herein may include one or more of the features described in connection with any of the other disclosed examples.

In one example, a medical device may be adapted for use with a delivery device, and the medical device may include a handle including at least one actuator; a body adapted to releasably mount to a distal portion of the delivery device, the body supporting a pair of jaws rotatably coupled to the body; and a control wire coupled to the pair of jaws and the actuator. The actuator may be configured to open and close the pair of jaws.

In other aspects, the medical device may include one or more of the following features. The handle may be configured to mount to a handle of the delivery device, and the delivery device may be an endoscope. The control wire may include a first control wire and an actuation wire coupled to the first control wire, and the actuation wire may be Y-shaped, V-shaped, or U-shaped. Proximal movement of the at least one actuator may move the control wire proximally and closes the pair of jaws. The control wire may be configured to be positioned within a working channel of the endoscope. The control wire may be positioned within a tube outside of the delivery device. The control wire may include a first control wire coupled to a first jaw of the pair of jaws and a second control wire coupled to a second jaw of the pair of jaws. The handle may include (<NUM>) a handle body on which the actuator translates, and (<NUM>) a connector configured to couple to a port of the delivery device. The actuator may be a first actuator, and the medical device may further include: at least one clip positioned around an exterior surface of the body; a tripwire releasably coupled to the at least one clip and extending from the body to the handle; and a second actuator, wherein actuation of the second actuator is configured to deploy the at least one clip from the body.

In other aspects, the medical device may include one or more of the following features. The tripwire may be positioned radially-outer from the pair of jaws relative to a central longitudinal axis of the body. The handle may include a first body, the first actuator moveably coupled to the first body; and a second body comprising a bracket configured to couple to a handle of the delivery device, wherein the second actuator is knob rotatably coupled to the second body. The handle may include a first body including a bracket configured to couple to a handle of the delivery device; wherein the first actuator is a first knob rotatably coupled to the first body; and wherein the second actuator is knob rotatably coupled to the first body. The tripwire and the control wire may be positioned within a tube extending outside of the delivery device; and the tube may be coupled to the handle. The at least one clip may include at least one of: a first clip including a first side coupled to a second side via two square pegs, wherein each of the first side and the second side includes shape memory material; a second clip including a first side and a second side, wherein the first side includes a first contoured edge portion including a sharp edge, and the second side includes a second contoured edge portion including a sharp edge, wherein the first contoured edge portion is complimentary to the second contoured edge portion; a third clip including a plurality of pointed portions pointed towards a center of a central lumen of the third clip when the third clip is in an equilibrium state, wherein the plurality of pointed portions are pointed in a distal direction when the third clip is in a loaded state on the body; and a fourth clip including a plurality of saw-toothed portions facing towards a center of a central lumen of the fourth clip when the fourth clip is in an equilibrium state, wherein the plurality of saw-toothed portions are pointed in a distal direction when the fourth clip is in a loaded state on the body. The control wire is configured to be coupled to a source of electrical energy to transmit electrical energy to the pair of jaws.

In other aspects, a medical device may be adapted for use with a delivery device, and the medical device may include a body adapted to releasably mount to a distal portion of the delivery device, the body supporting a pair of jaws rotatably coupled to the body; at least one clip positioned around an exterior surface of the body; and a tripwire releasably coupled to the at least one clip and extending proximally from the body; and a control wire coupled to the pair of jaws, wherein translation of the control wire is configured to open and close the pair of jaws to close; wherein proximal movement of the tripwire is configured to dispense the at least one clip from the body.

In other aspects, the medical device may include one or more of the following features. The body may include a coupler portion configured to mate with the distal portion of the delivery device. A tube may extend proximally from the barrel, the tripwire and the control wire may be positioned within the tube, and the tube may be positioned outside of the delivery device.

In other aspects, a medical device may be adapted for use with a delivery device, and the medical device may include: a body adapted to mount to a distal portion of the delivery device, the body supporting a pair of jaws rotatably coupled to the barrel: at least one clip positioned around an exterior surface of the body; and a handle including a first knob and a second knob and adapted to mount to a handle of the delivery device; wherein actuation of the first knob is configured to open and close the pair of jaws; and wherein rotation of the second knob is configured to dispense the at least one clip from the barrel. In some examples, the handle may further include a third knob, wherein the third knob is configured to move the tripwire to tighten or loosen the tripwire.

It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of this disclosure.

The terms "proximal" and "distal" are used herein to refer to the relative positions of the components of an exemplary medical system and exemplary medical devices. When used herein, "proximal" refers to a position relatively closer to the exterior of the body or closer to a medical professional using the medical system or medical device. In contrast, "distal" refers to a position relatively further away from the medical professional using the medical system or medical device, or closer to the interior of the body. Proximal and distal directions are labeled with arrows marked "P" and "D", respectively, throughout the figures. As used herein, the terms "comprises," "comprising," "having," "including," or other variations thereof, are intended to cover a non-exclusive inclusion, such that a system, device, or method that comprises a list of elements does not include only those elements, but may include other elements not expressly listed or inherent thereto. Unless stated otherwise, the term "exemplary" is used in the sense of "example" rather than "ideal. " As used herein, the terms "about," "substantially," and "approximately," indicate a range of values within +/- <NUM>% of a stated value.

Embodiments of this disclosure include devices, systems, and methods for manipulating, cutting, grabbing, ligating, and/or otherwise treating tissue. In some examples, the devices, systems and/or methods discussed herein may be utilized during endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD) procedures. In examples, EMR and ESD include endoluminal placement of one or more devices for grasping and cutting tissue proximate to a target area within the body of a patient. Placement of the one or more medical devices may be via a catheter, scope (endoscope, bronchoscope, colonoscope, gastroscope, duodenoscope, etc.), tube, or sheath, inserted into the GI tract via a natural orifice or incision. The orifice can be, for example, the nose, mouth, or anus, and the placement can be in any portion of the GI tract, including the esophagus, stomach, duodenum, large intestine, or small intestine. Placement also can be in other organs reachable via the GI tract. The patient's tissue may be grasped using suction from one or more medical devices and/or a grasper, and then the tissue may be cut by a cutting device for subsequent removal from the patient's body. Although EMR and ESD are discussed herein, the disclosure is not so limited. Embodiments of the disclosure include devices and systems that may be used in any suitable procedure in any body lumen or organ.

Reference will now be made in detail to examples of this disclosure described above and illustrated in the accompanying drawings.

<FIG> illustrates a perspective view of an exemplary medical device assembly <NUM> including an endoscope <NUM>. Although medical device assembly <NUM> is shown with endoscope <NUM>, any other similar insertion device may be used in medical device assembly <NUM>, such as a bronchoscope, colonoscope, gastroscope, duodenoscope, etc. Endoscope <NUM> may include a handle <NUM>, actuators <NUM>, and a body <NUM> extending from handle <NUM> to a distal end <NUM>. A working channel <NUM> may extend from a working channel port <NUM> positioned on the handle <NUM> to an opening at distal end <NUM>. Distal end <NUM> of endoscope <NUM> may also include a camera <NUM>, and movement of distal end <NUM> and functionality of camera <NUM> may be controlled via one or more actuators <NUM> on handle <NUM>. Actuators <NUM> may include knob actuators <NUM>, <NUM>, button actuators <NUM>, <NUM>, and any other types of actuators known in the art. An umbilicus <NUM> may connect endoscope <NUM> to a control unit, a fluid source, a suction source, and/or other exterior devices such as a monitor for viewing images from camera <NUM>. A control unit connected to umbilicus may control any aspect of endoscope <NUM>, such as camera <NUM>. Endoscope <NUM> may have a central longitudinal axis <NUM> extending longitudinally through a central portion of handle <NUM> and body <NUM>.

<FIG> illustrates a perspective view of an exemplary medical device <NUM> in a partially disassembled state for illustration purposes. Medical device <NUM> may include a handle <NUM>, a connector <NUM> coupled to a distal end of the handle <NUM>, a tube <NUM> extending distally from connector <NUM>, and a distal portion <NUM>. Distal portion <NUM> may include a body <NUM>, a coupler <NUM>, a pair of jaws <NUM>, <NUM>, and a control wire <NUM>. Control wire <NUM> is shown extending through coupler <NUM> for illustration purposes only, and, in at least some embodiments, would extend through tube <NUM>, connector <NUM>, and handle <NUM> when medical device <NUM> is fully assembled. Control wire <NUM> may be coupled to actuator <NUM> of handle <NUM> via fastener <NUM>. In some examples, a portion of control wire <NUM> may extend through side tube <NUM>. Handle <NUM> may be connected to an electrical supply through fastener <NUM> to electrify control wire <NUM> and jaws <NUM>, <NUM> and provide a means for electrical cautery. Handle <NUM> may include a ring portion <NUM> at a proximal end of handle <NUM>, and ring portion <NUM> may be configured to receive one or more fingers of a user. A handle body <NUM> may extend distally from ring portion <NUM>, and actuator <NUM> may be cylindrical and configured to move proximally and distally relative to handle body <NUM>. Actuator <NUM> may include a convex radially-outer surface relative to a longitudinal axis <NUM> of handle <NUM>, and may be configured to accommodate one or more of a user's fingers. A reference mark <NUM> may be on an exterior surface of handle <NUM>. Actuator <NUM> may receive fastener <NUM> and side tube <NUM>, and may be configured to couple to a proximal portion of control wire <NUM>. Side tube <NUM> may be configured to receive a portion of control wire <NUM> proximal of fastener <NUM>, may be flexible, and may be configured to protect a user's fingers and hand from an electrified control wire <NUM>.

Connector <NUM> may be coupled to a distalmost end of handle <NUM> and may be coupled to a proximal end of tube <NUM>. Connector <NUM> may be Y-shaped and may include a main body <NUM> and a side port <NUM>. Each of main body <NUM> and side port <NUM> may be substantially cylindrical. Main body <NUM> may be configured to receive control wire <NUM>, and side port <NUM> may be configured to provide access to tube <NUM>, such as for insertion of other medical devices into tube <NUM>. Tube <NUM> may be substantially the same length as medical device <NUM>, and may connect distal portion <NUM> with connector <NUM>. In some examples, medical device <NUM> may not include connector <NUM>, and tube <NUM> may connect handle <NUM> with distal portion <NUM>. Tube <NUM> may be flexible and may be made of any suitable material known in the art, such as a polymer or other similar material.

<FIG> shows a magnified view of distal portion <NUM> in <FIG>. Body <NUM> may be cylindrical (shown in <FIG>) and may include a central lumen <NUM> extending from a distal opening <NUM> of body <NUM>. In other examples, body <NUM> may be hexagonal, octagonal, polygonal, oval shaped, or any other suitable shape. Coupler <NUM> may be fixedly coupled to a proximal end of body <NUM>. Coupler <NUM> may be an elastomer and may be configured to extend around an exterior surface of distal portion <NUM> of endoscope <NUM>. Coupler <NUM> may be cylindrical, hexagonal, octagonal, polygonal, oval shaped, or any other suitable shape. Coupler <NUM> may be configured to cap a distal end of endoscope <NUM> (via a friction fit, for example), such that distal portion <NUM> couples to distal portion <NUM> of endoscope <NUM>. The circumference of lumen <NUM> may be larger than the circumference of distal portion <NUM>. In some examples, body <NUM> and/or coupler <NUM> may be transparent or semi-transparent. Tube <NUM> may be coupled to a radially-outward facing surface <NUM> relative to a central longitudinal axis <NUM> of body <NUM>. A central lumen extending through the length of tube <NUM> may connect to lumen <NUM> of body <NUM>.

Pair of jaws <NUM>, <NUM> may be positioned within lumen <NUM> and coupled to an inner wall <NUM> of body <NUM>. Inner wall <NUM> may be a radially-inward facing surface of body <NUM> relative to axis <NUM>. Jaws <NUM>, <NUM> may be rotatably coupled to molded hinges on inner wall <NUM>. In other examples, jaws <NUM>, <NUM> may be coupled to inner wall <NUM> via one or more fasteners (e.g. a rivet, screw, pivot pin, or other mechanism), and jaws <NUM>, <NUM> may be rotatable about one or more shafts of the one or more fasteners. Each jaw <NUM>, <NUM> may be rotatable relative to hinge points <NUM>, <NUM>.

<FIG> illustrates jaw <NUM> removed from medical device <NUM>. Jaw <NUM> may include apertures <NUM>, <NUM> configured to receive a molded hinge of inner wall <NUM> or a fastener. Jaw <NUM> may be curved, arch shaped, and/or semi-circular. In other examples, jaw <NUM> may be V-shaped, M-shaped, irregularly curved, or any other suitable shape. Jaw <NUM> may include a sharp edge <NUM> configured to cut tissue. In some examples (not shown), edge <NUM> may be jagged, teeth-shaped, include a series of sharp points, or serrated. In other examples, edge <NUM> may be dull and configured to grab tissue but not cut tissue. In some examples, edge <NUM> of jaw <NUM> may be configured to mate with an opposing edge of jaw <NUM>. Jaw <NUM> may include a proximal arm <NUM>, and proximal arm <NUM> may extend proximally relative to aperture <NUM>. Proximal arm <NUM> may include an aperture <NUM> extending through proximal arm <NUM>, and aperture <NUM> may be configured to receive an actuation wire <NUM>. As shown in <FIG>, actuation wire <NUM> may include a Z-shaped bend, at least a portion of which is configured to be positioned within lumen <NUM>, to secure wire <NUM> to jaw <NUM>.

Actuation wire <NUM> may be a single wire and, as shown in <FIG>, may be Y-shaped, V-shaped, U-shaped, or any other suitable shape. As shown in <FIG>, actuation wire <NUM> may have a first end coupled to proximal arm <NUM> of jaw <NUM>, may extend through a first guide hole or guide clip <NUM>, through a distal loop <NUM> of control wire <NUM>, through a second guide hole or guide clip <NUM>, and may be coupled to a proximal arm <NUM> of jaw <NUM> at a second end of actuation wire <NUM>. Actuation wire <NUM> may include a Z-shaped bend <NUM> at each of the first and second ends of actuation wire <NUM>. Guide holes or guide clips <NUM>, <NUM> may be positioned on inner wall <NUM> of body <NUM>, and may extend radially-inward towards central longitudinal axis <NUM> of body <NUM>. Guide holes or guide clips <NUM>, <NUM> may maintain a specific direction of movement of actuation wire <NUM>, may provide leverage to actuation wire <NUM>, and/or may limit the maximum and/or minimum rotation of jaws <NUM>, <NUM>. In some examples, guide clips <NUM>, <NUM> may be cylindrical, and in other examples guide clips may be U-shaped and configured to be clipped or snapped into position around actuation wire <NUM>. Each of the first and second ends of actuation wire <NUM> may be biased to move radially-outward from central longitudinal axis <NUM> when positioned within lumen <NUM> of body <NUM>. In some examples, actuation wire <NUM> may be coupled to control wire <NUM> at a midpoint of actuation wire <NUM>, and actuation wire <NUM> may include a ring portion <NUM> at a midpoint of actuation wire <NUM>. Ring portion <NUM> may be configured to receive control wire <NUM> and/or a coupler attached to control wire <NUM>. In some examples, control wire <NUM> may be inserted through ring portion <NUM> and then a crimp sleeve or lock sleeve may be positioned over control wire <NUM> to couple control wire <NUM> to ring portion <NUM>. In other examples, control wire <NUM> may be soldered, glued, or otherwise directly coupled to actuation wire <NUM>, and actuation wire <NUM> may not include ring portion <NUM>. In some examples, actuation wire <NUM> may include two separate wires and a ring portion <NUM>, with one wire extending from jaw <NUM> to ring portion <NUM> and another wire extending from jaw <NUM> to ring portion <NUM>.

By providing actuation wire <NUM> with ring portion <NUM>, medical device <NUM> may position control wire <NUM> through a working channel <NUM> of endoscope <NUM>, then position control wire <NUM> through ring portion <NUM> of actuation wire <NUM>, followed by positioning a lock sleeve or other coupling mechanism around control wire <NUM> to couple control wire <NUM> to ring portion <NUM>. In some examples when control wire <NUM> may extend through tube <NUM>, a portion of actuation wire <NUM> may extend within tube <NUM> and actuation wire <NUM> may curve towards tube <NUM>. Ring portion <NUM> may allow control wire <NUM> to move actuation wire <NUM> proximally and distally when control wire <NUM> is moved proximally and distally, respectively.

<FIG> illustrates a front view of distal portion <NUM> of medical device <NUM>. As shown in <FIG>, jaws <NUM>, <NUM> are in a completely closed position and edge <NUM> of jaw <NUM> contacts a like edge of jaw <NUM>. In some examples, jaws <NUM>, <NUM> may have a limited range of motion, and a user may not be able to completely close jaws <NUM>, <NUM> together. In some examples (as shown in <FIG>), jaws <NUM>, <NUM> may be transparent or semi-transparent, to permit visualization distal of jaws <NUM>, <NUM> via an imager of endoscope <NUM>. Inner wall <NUM> may include planar portions <NUM>, <NUM> configured to be adjacent to jaws <NUM>, <NUM>, and curved portions <NUM>, <NUM>. In some examples, planar portions <NUM>, <NUM> may each include a protrusion (not shown) configured to mate with one of apertures <NUM>, <NUM> of jaws <NUM>, <NUM>; and each protrusion may be sized to extend through an aperture <NUM>, <NUM> of both jaws <NUM>, <NUM>, and act as a pivot point for jaws <NUM>, <NUM>. In other examples, planar portions <NUM>, <NUM> may not include protrusions, and jaws <NUM>, <NUM> may be coupled to planar portions <NUM>, <NUM> via a coupler, such as a screw, rivet, or pivot pin.

In some examples, medical device <NUM> may include a sheath or protective cover (not shown) that may extend from distal portion <NUM> to handle <NUM>, and may facilitate gathering or bundling tube <NUM> and shaft <NUM> of endoscope <NUM>.

In an exemplary embodiment, control wire <NUM> may be coupled to actuation wire <NUM>, extend through tube <NUM>, through connector <NUM>, and into handle <NUM>. Control wire <NUM> may be coupled to actuator <NUM> via fastener <NUM>. Fastener may also be connected to an electrical power source and supply electrical energy to control wire <NUM>, actuation wire <NUM>, and jaws <NUM>, <NUM>. In some examples, a user may position actuator <NUM> at reference mark <NUM> on handle body <NUM>, and then pull control wire <NUM> taught such that jaws <NUM>, <NUM> are in a closed position before fastening control wire <NUM> to actuator <NUM>. After fastening wire <NUM> to actuator <NUM>, a user may move actuator <NUM> proximally relative to handle <NUM> to cause the edges of jaws <NUM>, <NUM> to move together, closing jaws <NUM>, <NUM>. When a user moves actuator <NUM> proximally, control wire <NUM> will move proximally and pull actuation wire <NUM> proximally, which moves proximal arms <NUM>, <NUM> proximally and causes jaws <NUM>, <NUM> to rotate about hinge points <NUM>, <NUM>. When a user subsequently moves actuator <NUM> distally relative to handle <NUM>, control wire <NUM> moves distally and pushes actuation wire <NUM> distally. The distal movement of actuation wire <NUM> moves proximal arms <NUM>, <NUM> distally and causes jaws <NUM>, <NUM> to rotate about hinge points <NUM>, <NUM>, and jaws <NUM>, <NUM> move towards each other to close or clamp down. When control wire <NUM> is positioned within tube <NUM>, a user may couple distal portion <NUM> to endoscope <NUM> and be ready to operate device, which may facilitate operation of medical device <NUM> and reduce procedure time.

In another exemplary embodiment, control wire <NUM> may be positioned outside of tube <NUM>. In this embodiment, control wire <NUM> may extend through a working channel <NUM> of endoscope <NUM> during operation, and may be connected to handle <NUM> after exiting working channel port <NUM>. This embodiment does not require tube <NUM>. When tube <NUM> is omitted from medical device <NUM>, connector <NUM> may be directly coupled to working channel port <NUM>. By removing tube <NUM> from medical device <NUM>, the overall size of medical device <NUM> is reduced which may reduce trauma to a patient during operation and facilitate movement of endoscope <NUM> and medical device <NUM> through a body. Once control wire <NUM> is positioned within working channel <NUM>, and coupled to actuator <NUM> of handle <NUM>, a user may operate the device in the same manner as the previously described embodiment.

<FIG> shows another exemplary medical device <NUM>, with a portion of the device omitted. Medical device <NUM> may include a handle <NUM>, actuator <NUM>, connector <NUM>, distal portion <NUM>, and control wires <NUM>, <NUM>. Any of the features discussed hereinabove regarding medical device <NUM> may be incorporated into medical device <NUM>. Connector <NUM> is also shown in <FIG> and may replace connector <NUM> in some embodiments of medical device <NUM>. Medical device <NUM> may include two control wires <NUM>, <NUM>, one extending from each jaw <NUM>, <NUM>, respectively, through connector <NUM> into handle <NUM> and coupled to actuator <NUM>. As shown in <FIG>, excess portions of control wires <NUM>, <NUM> may be positioned within side tube <NUM> after control wires <NUM>, <NUM> are pulled taught and coupled to actuator <NUM> via fastener <NUM>. Similar to medical device <NUM>, a user may position actuator <NUM> at guide marker <NUM> on handle body <NUM> before coupling control wires <NUM>, <NUM> to actuator <NUM>. Connector <NUM> may include an adapter <NUM> configured to mate with (e.g. screw into, snap-fit couple to, etc.) working channel port <NUM> of endoscope. Portions of control wires <NUM>, <NUM> are omitted from <FIG> for illustration purposes only. Distal portion <NUM> of medical device <NUM> may include body <NUM> and coupler <NUM> which may have any of the above-described features of body <NUM> and coupler <NUM>.

<FIG> illustrates distal portion <NUM> of medical device <NUM>, with control wires <NUM>, <NUM> extending from distal portion <NUM> into working channel <NUM> of endoscope <NUM>. Distal portion may include jaws <NUM>, <NUM> rotatably coupled to body <NUM>, and body <NUM> may include guide clips <NUM>, <NUM> for receiving control wires <NUM>, <NUM>. In some examples (as shown in <FIG>), jaws <NUM>, <NUM> may extend distally from a distalmost surface <NUM> of body <NUM> when jaws <NUM>, <NUM> are in a closed position. Tube input port <NUM> may be positioned on a radially-outer surface of body <NUM> or connector <NUM>, relative to central longitudinal axis <NUM> of distal portion <NUM>, and may be configured to receive a tube similar to tube <NUM>. In some examples, distal portion <NUM> may not include tube input port <NUM>. In other examples, both control wires <NUM>, <NUM> may be positioned within a tube coupled to tube input port <NUM> and extend to handle <NUM> outside of endoscope <NUM>. Coupler <NUM> may include an alignment marker <NUM> on a radially-outer surface relative to central longitudinal axis <NUM> of distal portion <NUM>. Alignment marker <NUM> may facilitate alignment of distal portion <NUM> with distal portion <NUM> of endoscope <NUM> when a user couples distal portion <NUM> to distal portion <NUM>.

In operation, a user may first cover control wires <NUM>, <NUM> temporarily with a sheath to facilitate moving control wires <NUM>, <NUM> through working channel <NUM>. In other examples, control wires <NUM>, <NUM> may not be sheathed and may be directly inserted into a distal opening <NUM> of working channel <NUM> to position control wires <NUM>, <NUM> within working channel <NUM>. Once control wires <NUM>, <NUM> are pushed through working channel <NUM> and exit working channel port <NUM>, a user may remove any temporary sheath positioned over control wires <NUM>, <NUM>, and may then insert control wires <NUM>, <NUM> into handle <NUM>, and specifically first through adapter <NUM>. At this point, the user may also couple distal portion <NUM> to distal portion <NUM> by positioning coupler <NUM> around an exterior surface of distal portion <NUM>; and then couple connector <NUM> to working channel port <NUM> via adapter <NUM>. Alignment marker <NUM> may facilitate aligning the positioning of jaws <NUM>, <NUM> relative to camera <NUM>. The user may then position actuator <NUM> at guide marker <NUM>, pull guide wires <NUM>, <NUM> taught such that jaws <NUM>, <NUM> are in a closed position, and fasten control wires <NUM>, <NUM> to actuator <NUM> via fastener <NUM>. Extra portions of control wires <NUM>, <NUM> proximal of actuator <NUM> may be positioned within side tube <NUM>. In some examples, the user may then connect fastener <NUM> to a source of electrical power to supply electrical energy to control wires <NUM>, <NUM> and jaws <NUM>, <NUM>. In other examples, handle <NUM> may include an additional actuator (e.g. button, dial, etc.) to selectively apply electrical energy to control wires <NUM>, <NUM>. The user may then move actuator <NUM> distally relative to handle body <NUM> to open jaws <NUM>, <NUM>; and move actuator <NUM> proximally relative to handle body <NUM> to close jaws <NUM>, <NUM>. In some examples, a user may apply air suction (aspiration) to working channel <NUM> to pull tissue into body <NUM> (with jaws <NUM>, <NUM> in an open position) and allow jaws <NUM>, <NUM> to cut tissue. In some examples, one of actuators <NUM>, <NUM> may actuate a suction source connected to endoscope <NUM> via umbilicus <NUM> and apply suction to distal portion <NUM> of endoscope <NUM>, such as via working channel <NUM>. In other examples, air suction may be applied to a tube connected to tube port <NUM>. Any of the components of medical devices <NUM> and <NUM> may be transparent, which may facilitate visualization of a target area using camera <NUM> and/or increase a field of view of camera <NUM> during operation.

<FIG> illustrates a perspective view of a partially assembled, exemplary medical device <NUM>. Medical device <NUM> may include any of the features described herein in connection with any of the other exemplary medical devices <NUM>, <NUM>. Medical device <NUM> may be configured to deploy clips <NUM>-<NUM>. Medical device <NUM> may include handle <NUM>, connector <NUM>, tube <NUM>, and distal portion <NUM>. Handle <NUM> may include actuator <NUM>, side tube <NUM>, fastener <NUM>, proximal loop portion <NUM>, and a plurality of markings <NUM>. Distal portion <NUM> may include body <NUM>, coupler <NUM>, one or more clips <NUM>-<NUM> (shown in <FIG>), a trip wire <NUM>, and cord <NUM>. In some examples, clips <NUM>-<NUM> may be spring loaded, may include a shape-memory material, and may be made of metal, polymer, nitinol, or any other suitable material. Clips <NUM>-<NUM> will be discussed in more detail below with relation to <FIG>. An outer sheath <NUM> may be positioned around a portion of body <NUM>, connector <NUM>, and tube <NUM>. Outer sheath <NUM> may facilitating shielding tube <NUM> and coupler <NUM> during operation, and may prevent unnecessary movement of tube <NUM> relative to coupler <NUM>. Outer sheath <NUM> may also facilitate insertion of medical device <NUM> coupled to endoscope <NUM> into a body. Coupler <NUM> may couple to a distal portion <NUM> of endoscope <NUM> in the same manner as described above in relation to couplers <NUM>, <NUM>. Cord <NUM> may be coupled to each of clips <NUM>-<NUM> and extend within lumen <NUM> of body <NUM> and connector <NUM>. Cord <NUM> may be coupled to tripwire <NUM>. In some examples, cord <NUM> may include a loop <NUM> and tripwire <NUM> may include a hook <NUM> at a distalmost end of tripwire <NUM>, and the hook of tripwire <NUM> may be positioned through loop <NUM>. <FIG> shows a magnified view of cord <NUM> with loop <NUM> and tripwire <NUM> with hook <NUM>. Hook <NUM> may facilitate coupling tripwire <NUM> to cord <NUM>. Once hook of trip wire <NUM> is positioned within loop <NUM>, a lock sleeve <NUM>, which is shown proximal to loop <NUM> and hook <NUM> in <FIG>, may be positioned over loop <NUM> and hook of tripwire <NUM> to fixedly couple tripwire <NUM> to cord <NUM>. Any of the actuation wires or tripwires discussed in this disclosure may include a cable, a suture, or any other elongate member capable of transferring a force from a handle/actuator to a distal tool (jaws, clips, etc.).

Lock sleeve <NUM> is shown proximal to loop <NUM> in <FIG>, and lock sleeve <NUM> would be slid down tripwire <NUM> and over loop <NUM> to fixedly couple cord <NUM> to tripwire <NUM>. In other examples, medical device <NUM> may not include lock sleeve <NUM>, and tripwire <NUM> may be coupled to cord <NUM> via an adhesive, a coupler, or any other coupling means known in the art. In a fully assembled state, tripwire <NUM> may extend through tube <NUM> and connector <NUM>, and be coupled to actuator <NUM>. Fastener <NUM> may couple tripwire <NUM> to actuator <NUM>. In other examples, tripwire <NUM> may be positioned within working channel <NUM> of endoscope <NUM>, tube <NUM> may be omitted from medical device <NUM>, and connector <NUM> may be coupled to working channel port <NUM>.

<FIG> shows a magnified view of distal portion <NUM> including body <NUM>, tube <NUM>, cord <NUM>, and clips <NUM>-<NUM>. Cord <NUM> may be fixedly coupled to each of clips <NUM>-<NUM>, and a prescribed length of cord <NUM> may be wrapped around an exterior portion of body <NUM> between points in which cord <NUM> is coupled to each clip <NUM>-<NUM>. In some examples, cord <NUM> may be releasably coupled to each clip via a knot, an adhesive, a coupler, a loop of cord <NUM>, and/or any other coupling means known in the art. A clip <NUM>-<NUM> may be released, deployed, or dispensed from body <NUM> when cord <NUM> pulls the clip distally beyond the distalmost surface <NUM> of body <NUM>.

<FIG> illustrate two different exemplary configurations of cord <NUM> coupled to exemplary clips <NUM>, <NUM>. <FIG> shows a magnified view of a portion of body <NUM> with exemplary portions of clips <NUM>, <NUM> positioned around body <NUM>. Portions of body <NUM>, clips <NUM>, <NUM>, o-ring <NUM>, and cord <NUM> are removed for illustration purposes. In the embodiment of body <NUM> shown in <FIG>, distalmost surface <NUM> of body <NUM> may include a series of notches <NUM>-<NUM>, and cord <NUM> may be positioned within each of the series of notches <NUM>-<NUM>. An elastic o-ring <NUM> or other elastic member may be positioned around body <NUM> and may be positioned within a groove <NUM> extending circumferentially around an exterior surface of body <NUM> (<FIG> shows o-ring <NUM> above groove <NUM> for illustrative purposes only). Elastic o-ring <NUM> may be positioned proximal to each clip <NUM>, <NUM>. The distalmost end <NUM> of cord <NUM> may be coupled to a portion of body <NUM> via a knot, glue, tension in cord <NUM>, a coupler, or any other means known in the art. A first length <NUM> of cord <NUM> may extend proximally from distalmost end <NUM> to first loop <NUM> of cord <NUM>. First length <NUM> may be positioned underneath clip <NUM> and o-ring <NUM>, and may extend over (or radially-outer relative to central longitudinal axis <NUM> of body <NUM>) clip <NUM>. A second length <NUM> of cord <NUM><NUM> may extend from loop <NUM> to notch <NUM>, and may be positioned underneath, or radially-inner relative to central longitudinal axis <NUM> of body <NUM> from, o-ring <NUM> and clips <NUM>, <NUM>. A third length <NUM> may extend from notch <NUM> over clips <NUM>, <NUM>, and underneath o-ring <NUM> to loop <NUM>; and a fourth length <NUM> may extend from loop <NUM> underneath o-ring <NUM>, over clip <NUM>, and underneath clip <NUM> to notch <NUM>. A fifth length <NUM> of cord <NUM> may extend from notch <NUM> to tripwire <NUM> (not shown in <FIG>).

Each length <NUM>-<NUM> may be the same distance such that a user may move an actuator coupled to tripwire <NUM> the same distance, or rotate an actuator coupled to tripwire <NUM> the same number of degrees, to deploy a single clip <NUM>-<NUM>. When a user pulls tripwire <NUM> proximally, cord <NUM> may be pulled proximally and loop <NUM> may move distally relative to body <NUM>. When loop <NUM> moves distally, loop <NUM> will travel underneath o-ring <NUM> and over clip <NUM> until loop meets clip <NUM>. Once loop <NUM> meets clip <NUM>, clip <NUM> may be pulled distally by loop <NUM> until clip <NUM> is released from body <NUM> and moves distal relative to distalmost surface <NUM>. For purposes of this disclosure, cord <NUM> may be releasably coupled to a clip <NUM>, <NUM>, <NUM>, <NUM> when cord <NUM> is in contact with a clip <NUM>, <NUM>, <NUM>, <NUM> and/or positioned between a clip <NUM>, <NUM>, <NUM>, <NUM> and body <NUM>.

<FIG> shows an exemplary configuration of cord <NUM> coupled to exemplary clips <NUM>, <NUM>. <FIG> shows a magnified view of a portion of body <NUM> with exemplary portions of clips <NUM>, <NUM> positioned around body <NUM>. Portions of body <NUM>, clips <NUM>, <NUM>, o-ring <NUM>, and cord <NUM> are removed for illustration purposes. In this embodiment of body <NUM> shown in <FIG>, distalmost surface <NUM> of body <NUM> may include a series of notches <NUM>-<NUM>, and cord <NUM> may be positioned within each of the series of notches <NUM>-<NUM>. An elastic o-ring <NUM> or other elastic member may be positioned around body <NUM> and may be positioned within a groove <NUM> extending circumferentially around an exterior surface of body <NUM>. Elastic o-ring <NUM> may be positioned proximal to each clip <NUM>, <NUM>. The distalmost end <NUM> of cord <NUM> may be coupled to a portion of body <NUM> via a knot, glue, tension in cord <NUM>, a coupler, or any other means known in the art. A first length <NUM> of cord <NUM> may extend proximally from distalmost end <NUM> to first loop <NUM> of cord <NUM>. First length <NUM> may be positioned underneath clips <NUM>, <NUM> and o-ring <NUM>. A second length <NUM> of cord <NUM> may extend from loop <NUM> to notch <NUM>, and may be positioned underneath, or radially-inner relative to central longitudinal axis <NUM> of body <NUM> from, o-ring <NUM> and clips <NUM>, <NUM>. A bead <NUM> may be fixedly coupled to length <NUM> of cord <NUM>, and bead <NUM> may be positioned proximal to clip <NUM>. A third length <NUM> of cord <NUM> may extend from notch <NUM> underneath clip <NUM>, over clip <NUM>, and underneath o-ring <NUM> to loop <NUM>; and a fourth length <NUM> may extend from loop <NUM> underneath o-ring <NUM>, over clip <NUM>, and underneath clip <NUM> to notch <NUM>. A bead <NUM> may be fixedly coupled to length <NUM>, and bead <NUM> may be positioned between clip <NUM> and clip <NUM>. A fifth length <NUM> of cord <NUM> may extend from notch <NUM> to tripwire <NUM> (not shown in <FIG>).

Each length <NUM>-<NUM> may be the same distance such that a user may move an actuator coupled to tripwire <NUM> the same distance, or rotate of an actuator coupled to tripwire <NUM> the same number of degrees, to deploy a single clip <NUM>-<NUM>. When a user pulls tripwire <NUM> proximally, cord <NUM> may be pulled proximally, and loop <NUM> and bead <NUM> may move distally relative to body <NUM>. Once bead <NUM> engages clip <NUM> (abuts with or comes into contact with), clip <NUM> may be pushed distally by bead <NUM> until clip <NUM> is released from body <NUM> and moves distal relative to distalmost surface <NUM>. Once clip <NUM> is released from body <NUM>, the user may continue to pull cord <NUM> proximally, causing length <NUM> to be moved distally relative to body <NUM> and bead <NUM> to engage clip <NUM>. Bead <NUM> may then push clip <NUM> distally as length <NUM> moves distally until clip <NUM> is pushed distal to body <NUM> and released. In other examples, beads <NUM>, <NUM> may be replaced with knots, crimps, tubes, or similar components.

<FIG> illustrate two different methods for deploying clips from medical device <NUM> using cord <NUM>. Other methods of deployment of clips may be found in <CIT>; <CIT>; <CIT>; and <CIT>.

In operation, when tripwire <NUM> is positioned within tube <NUM> and fastened to actuator <NUM>, a user may first couple coupler <NUM> to distal portion <NUM> of endoscope <NUM>. The user may the position distal portions <NUM>, <NUM> proximate to a target site within a body of a patient. The user may then release one of clips <NUM>-<NUM> from body <NUM> by moving actuator <NUM> proximally relative to handle body <NUM>. In some examples, the user may move actuator <NUM> proximally to align with a distalmost marking <NUM> on handle <NUM> to release a first clip <NUM> from body <NUM>. In some examples, actuator <NUM> may be a ratcheted actuator, may be limited to only move in a proximal direction and prevented from moving distally, and may provide an audible click after the user positions actuator <NUM> in alignment with a marking <NUM>, to release a clip. Clip <NUM> may be spring loaded and may compress onto tissue when released from body <NUM>. To deploy another clip <NUM>, the user may again move actuator <NUM> proximally and into alignment with the next marking <NUM> on handle <NUM>.

<FIG> shows an end of an exemplary clip <NUM> in an equilibrium state. Clip <NUM> may include a central lumen <NUM>. Clip <NUM> may be manufactured by laser cutting or stamping clip <NUM> from a nitinol sheet. Sides of clip <NUM> may be pulled in opposing lateral directions <NUM>, <NUM> to open lumen <NUM> and transition clip <NUM> from an equilibrium state (shown in <FIG>) to an expanded/loaded state (shown in <FIG>). For example, when a loaded clip <NUM> is release from body <NUM>, the clip will return towards its equilibrium state (shown in <FIG>). Lumen <NUM> may be sized such that in a loaded state, clip <NUM> fits around body <NUM> of medical device <NUM>.

<FIG> illustrates another embodiment of a clip <NUM> in a loaded state. Clip <NUM> may be made in a single piece of nitinol or other shape memory material as shown in <FIG> shows a top view <NUM> and an end view <NUM> of clip <NUM> in an equilibrium state. Top portion <NUM> of clip <NUM> may be pulled in a first lateral direction <NUM>, and bottom portion <NUM> may be pulled in a second lateral direction <NUM> which is opposite the first lateral direction <NUM>. <FIG> shows an alternative embodiment of a clip <NUM> similar to clip <NUM>, however pins <NUM>, <NUM> are used to couple each side <NUM>, <NUM> of clip <NUM> together. Pins <NUM>, <NUM> may have a square cross-sectional shape to prevent sides <NUM>, <NUM> from losing their closure elasticity (or tendency towards the equilibrium state). In some examples, pins <NUM>, <NUM> may act as torsional springs. Pins <NUM>, <NUM> may be made of nitinol or other shape memory materials. <FIG> shows a plurality of clips <NUM> stacked on top of each other with lumens <NUM> aligned along a central axis <NUM>.

<FIG> illustrate an exemplary clip <NUM> including a contoured edge portion <NUM>. <FIG> shows clip <NUM> in an equilibrium state, and <FIG> shows clip <NUM> in a loaded state similar to the loaded state of clip <NUM>. Contour edge portion <NUM> may include a first contoured edge <NUM> on a first side <NUM> of clip <NUM>, and a second contoured edge <NUM> on a second side <NUM> of clip <NUM>. Each contoured edge <NUM>, <NUM> may include sharp or dull teeth, which may be used to cut or to grip tissue. Clip <NUM> may be made of a single piece of flat nitinol or other shape memory material, or may be made of more than one piece of material. In some examples, first side <NUM> may be moved in a first lateral direction <NUM>, and second side <NUM> may be moved in a second lateral direction <NUM> to position clip <NUM> around body <NUM>. In addition, first contoured edge <NUM> may face a proximal direction and second contoured edge <NUM> may face a distal direction when positioned around body <NUM>.

<FIG> illustrate another exemplary clip <NUM>. <FIG> shows clip <NUM> in an equilibrium state with five pointed portions <NUM>-<NUM> pointed towards a center of central lumen <NUM> of clip <NUM>. Pointed portions <NUM>-<NUM> may be sharp and may be configured to cut tissue, may be dull and configured to grab tissue but not pierce tissue, may be rounded, may be flat-ended, or any combination thereof. Although clip <NUM> is shown with five pointed portions <NUM>-<NUM>, any number of pointed portions may be included in clip <NUM>. In an equilibrium state, surface <NUM> of clip <NUM> may be directed radially-inward towards a central longitudinal axis <NUM> of lumen <NUM>. <FIG> shows clip <NUM> in a loaded state. Portions of clip <NUM> may be rotated relative to positions of those portions in the equilibrium state, to attain the loaded state. In the loaded state, surface <NUM> faces distally and in a parallel direction to central longitudinal axis <NUM>. Also in the loaded state, pointed portions <NUM>-<NUM> point distally. When in a loaded state, clip <NUM> may be configured to extend around body <NUM>. <FIG> shows three identical clips <NUM>, <NUM>, <NUM> stacked together, with pointed portions <NUM>-<NUM> aligned and nested together to conserve space when stacked together. In operation, when clip <NUM> is pulled by cord <NUM> off of body <NUM>, clip <NUM> may transition from a loaded state shown in <FIG> to an equilibrium state shown in <FIG>.

<FIG> illustrates exemplary clips <NUM>-<NUM>, with clips <NUM>-<NUM> positioned around an exemplary body <NUM>. Clips <NUM>-<NUM> may include any of the above-described features of clip <NUM>. Clip <NUM> is shown in an equilibrium state with surface <NUM> facing radially-inward towards central longitudinal axis <NUM> of lumen <NUM>, and clips <NUM>-<NUM> are shown in a loaded state. In some examples, pointed portions <NUM>, <NUM>, <NUM> of clips <NUM>-<NUM> may be sharp and configured to cut tissue. Clips <NUM>-<NUM> overlap each other on body <NUM>; and each clip <NUM>-<NUM> is rotated about central longitudinal axis <NUM> relative to adjacent clips <NUM>-<NUM>.

<FIG> illustrates exemplary clips <NUM>-<NUM>, with clips <NUM>-<NUM> positioned around an exemplary body <NUM>. Clip <NUM> is shown in an equilibrium state, and clips <NUM>-<NUM> are shown in loaded states. Each of clips <NUM>-<NUM> may include saw-toothed portions <NUM>, <NUM> configured to engage tissue. Saw toothed portions <NUM>, <NUM> may face radially-inward towards central longitudinal axis <NUM> of lumen <NUM> when clip <NUM> is in an equilibrium state. Clip <NUM> includes five saw toothed portions <NUM>, <NUM>. In other embodiments, any number of saw toothed portions <NUM>, <NUM> may be included in a clip. Clips <NUM>-<NUM> are shown nested within each other and positioned over body <NUM>. Nesting clips <NUM>-<NUM> within adjacent clips <NUM>-<NUM> when positioned on body <NUM> may allow a larger number of clips <NUM>-<NUM> to be positioned on body <NUM>. When clip <NUM> transitions from a loaded state, as shown in clips <NUM>-<NUM> in <FIG>, to an equilibrium state, toothed portions <NUM>, <NUM> may move towards central longitudinal axis <NUM>. When clips <NUM>-<NUM> are in an equilibrium state, saw toothed portions <NUM>, <NUM> may be aligned with central longitudinal axis <NUM>. Saw toothed portions <NUM>, <NUM> may enhance the grip of the clip <NUM>-<NUM> onto tissue.

<FIG> illustrates an exemplary handle assembly <NUM> and portions of endoscope <NUM>. Handle assembly <NUM> may be used with any of the medical devices described in this disclosure and may have any of the features discussed in relation to any of the medical devices described in this disclosure. Handle <NUM> including actuator <NUM> may be coupled to a flexible connector <NUM>. Flexible connector <NUM> may include an adapter <NUM> configured to couple to working channel port <NUM> of endoscope handle <NUM>. Actuator <NUM> may translate on a handle <NUM>. Distal portion <NUM> of an exemplary medical device may be coupled to distal portion <NUM> of endoscope <NUM> via coupler <NUM>. Distal portion <NUM> may be any of distal portions <NUM>, <NUM>, <NUM>, and actuator <NUM> may be used to either open and close a jaws assembly or deploy clips from distal portion <NUM>. In handle assembly <NUM>, control wire <NUM>, control wires <NUM>, <NUM>, or tripwire <NUM> may be positioned within working channel <NUM> of endoscope <NUM> and within connector <NUM>, and ultimately connect to actuator <NUM>.

<FIG> illustrates an exemplary handle assembly <NUM> for use with medical device <NUM>. Handle assembly <NUM> may include handle <NUM>, handle hub <NUM>, knob <NUM>, connector <NUM>, and an electric plug (not shown). Handle <NUM> may include an aperture <NUM> configured to receive fingers and/or a hand or a user. Knob <NUM> may include two markings <NUM>, <NUM> and an arrow <NUM>. Arrows <NUM>, <NUM> may indicate the direction a user needs to rotate knob <NUM> to deploy or dispense a clip. By utilizing a knob <NUM> instead of an actuator similar to actuator <NUM>, a larger amount of tripwire and/or cord may be used in a medical device and a large amount of clips may be dispensed from the medical device, such as medical device <NUM>. That larger amount of tripwire and/or cord can be spooled around a portion of knob <NUM>, or other portion of assembly <NUM>, as knob <NUM> is rotated to dispense clips. In some examples, rotating knob <NUM> approximately one hundred and eighty degrees will dispense one clip from a medical device. In some examples, when one of markings <NUM>, <NUM> is aligned with the star mark <NUM>, handle <NUM> may generate an audible ratchet or click sound, and knob <NUM> may be prevented from rotating in the direction opposite of arrow <NUM>, which may keep tripwire or cord of the medical device taught. Handle hub <NUM> may be rotatable relative to handle <NUM>, and connector <NUM> may provide access to interior portions of the medical device, such as access to tube <NUM> of medical device <NUM>.

<FIG> illustrates an exemplary medical device <NUM> with handle assembly <NUM>. Handle assembly <NUM> may be used with any of the medical devices described in this disclosure, such as medical device <NUM>, and medical device <NUM> may include any of the features described in this disclosure in connection with medical device <NUM>. Medical device <NUM> may include tube <NUM> connecting handle assembly <NUM> with distal portion <NUM>, and distal portion <NUM> may be coupled to shaft <NUM> of endoscope <NUM>. Tube <NUM> may include a loop <NUM> at a proximal portion of tube <NUM> to take up excess length of a longer than needed tube <NUM>. Handle assembly <NUM> may be coupled to handle <NUM> via a bracket <NUM>, and bracket <NUM> may be configured to couple handle assembly <NUM> to handle <NUM> at a portion of handle <NUM> distal to working channel port <NUM>. A tripwire of medical device <NUM> similar to tripwire <NUM> may extend from distal portion <NUM> through tube <NUM> to handle body <NUM>. Tripwire <NUM> may be coupled to knob <NUM>, and knob <NUM> may be rotatably coupled to handle body <NUM>. In some examples, when knob <NUM> is rotated in the A or B direction approximately one hundred and eighty degrees, a clip is dispensed from distal portion <NUM>. In other examples, a clip may be dispensed from distal portion <NUM> when knob <NUM> is rotated any suitable number of degrees in the A or B direction. In some examples, knob <NUM> may include a ratchet assembly and may be prevented from rotating in the opposite direction (A or B) from the direction the knob is turned to dispense a clip once a clip is deployed. In other examples, handle assembly <NUM> may be coupled to working channel port <NUM>, may receive a tripwire from working channel port, and may not include tube <NUM>. In some examples, handle assembly <NUM> may include a slack knob (not shown) which may be used to tighten a tripwire and take up slack in tripwire.

<FIG> illustrates components of an alternative embodiment of a handle assembly that may include any of the above-described features of handle assembly <NUM>. <FIG> will be discussed in further detail below in relation to medical device <NUM>.

<FIG> illustrates a distal portion <NUM> of an exemplary medical device <NUM>, and <FIG> illustrates proximal and distal portions of medical device <NUM> coupled to endoscope <NUM>. Medical device <NUM> may have any of the features described in this disclosure in relation to any of the other medical devices <NUM>, <NUM>, <NUM>. Medical device <NUM> may include coupler <NUM>, body <NUM>, jaws <NUM>, <NUM>, actuation wire <NUM>, and control wire <NUM>. Jaws <NUM>, <NUM> may be opened and closed via proximal and distal movement of control wire <NUM> in the same manner as jaws <NUM>, <NUM> in medical device <NUM>. Body <NUM> and coupler <NUM> may include a central lumen <NUM> extending longitudinally through body <NUM> and coupler <NUM>, and lumen <NUM> may be configured to receive tissue. A tube port <NUM> may be on body <NUM> and may be configured to couple to a tube to provide access to the interior of body <NUM>. In other examples, body <NUM> may not include tube port <NUM>. Medical device <NUM> may also include clips <NUM>-<NUM> positioned around body <NUM>. A tripwire <NUM> is shown disconnected from a cord <NUM> for illustration purposes only, and tripwire <NUM> would be coupled to cord <NUM>, via a lock sleeve <NUM>, during operation of medical device <NUM>, as in prior described embodiments. Tripwire <NUM> and control wire <NUM> may be color-coded, lock sleeves on each of tripwire <NUM> and control wire <NUM> may be color coded, and/or one of tripwire <NUM> and control wire <NUM> may be longer than the other to allow a user to distinguish between tripwire <NUM> and control wire <NUM>. Clips <NUM>-<NUM> would be dispensed or deployed from medical device <NUM> in the same manner as described herein in relation to medical device <NUM>. Cord <NUM> of medical device <NUM> is positioned radially-outer from jaws <NUM>, <NUM> relative to central longitudinal axis <NUM> of medical device <NUM>, which may prevent cord <NUM> from being cut by jaws <NUM>, <NUM> during operation. In some examples, both tripwire <NUM> and control wire <NUM> may be positioned within working channel <NUM> of endoscope <NUM> during use of medical device <NUM>. In other examples, one or both of tripwire <NUM> and control wire <NUM> may be positioned within a tube extending from side tube port <NUM> during use of medical device <NUM>, and the tube would extend outside of endoscope <NUM>.

<FIG> illustrates proximal and distal portions of medical device <NUM> coupled to endoscope <NUM>. Handle assembly <NUM> of medical device <NUM> may include a handle <NUM> and a knob assembly <NUM>. Handle assembly <NUM> may include any of the features discussed in this disclosure related to other medical devices and other handle assemblies, such as handles <NUM>, <NUM>, <NUM> and handle assembly <NUM>, <NUM>, <NUM>. Distal portion <NUM> may be coupled to distal portion <NUM> of endoscope <NUM> with coupler <NUM> positioned around shaft <NUM>. In handle assembly <NUM>, actuator <NUM> may be connected to control wire <NUM> and may be configured to open and close jaws <NUM>, <NUM> via proximal and distal movement of actuator <NUM> relative to handle <NUM>. Control wire <NUM> may be positioned within working channel <NUM> of endoscope <NUM>, and may extend through connector <NUM> to be coupled to actuator <NUM> within handle <NUM>. Tripwire <NUM> may also extend from distal portion <NUM> through working channel <NUM> and out of working channel port <NUM> into knob assembly <NUM>. Knob assembly <NUM> may control deployment of clips <NUM>-<NUM>, and rotation of knob <NUM> relative to body <NUM> may deploy one or more clips <NUM>-<NUM>. Bracket <NUM> may couple knob assembly <NUM> to handle <NUM> such that tripwire <NUM> may extend into knob assembly <NUM> while allowing space for control wire <NUM> to be positioned in connector <NUM> and working channel port <NUM>. In some examples, adapter <NUM> may connect working channel port <NUM> with both connector <NUM> and knob assembly <NUM>, such that tripwire <NUM> may extend through adapter <NUM> into knob assembly <NUM>, and control wire <NUM> may extend through adapter <NUM> into connector <NUM>.

<FIG> illustrates components of an alternative embodiment of a handle assembly <NUM> that includes three knobs <NUM>, <NUM>, <NUM>, and may be referred to herein as a dual-reel handle assembly. The body of this dual-reel handle assembly is removed for illustration purposes. Any of the features discussed in this disclosure may be incorporated into a dual-reel handle assembly using the components shown in <FIG>. Dual reel handle assembly <NUM> may be configured for use with distal portion <NUM> of medical device <NUM>. A first knob <NUM> may be coupled to a tripwire <NUM> via an axle <NUM>, and tripwire <NUM> may correspond to tripwire <NUM> of medical device <NUM>. A second knob <NUM> may be coupled to a control wire <NUM> via an axle <NUM>, and control wire <NUM> may correspond to control wire <NUM> of medical device <NUM>. Axle <NUM> is positioned through an aperture in axle <NUM> and an aperture in <NUM>, to connect axle <NUM> to <NUM>. Axle <NUM> rotates within <NUM>. Axle <NUM> rotates over axle <NUM>. Tripwire <NUM> and control wire <NUM> may be positioned within working channel <NUM> of endoscope <NUM> during operation, and dual-reel handle assembly <NUM> may receive tripwire <NUM> and control wire <NUM> from working channel port <NUM>. Alternatively tripwire <NUM> and control wire <NUM> may be positioned within a tube positioned outside of endoscope <NUM>, similar to tube <NUM> shown in <FIG>, during operation, and dual-reel handle assembly may receive tripwire <NUM> and control wire <NUM> from the tube. A third knob <NUM> may be also coupled to tripwire <NUM>, via a fixed connection between knob <NUM> and axle <NUM>. Knob <NUM> may be configured to adjust the slack in tripwire <NUM> prior to and during operation of the medical device. In some examples, first knob <NUM> may be ratcheted and may be limited to rotation in only one direction. A user may rotate first knob <NUM> to deploy one or more clips <NUM>-<NUM> from the medical device. The user may also rotate second knob <NUM> to move control wire <NUM> proximally or distally to open or close jaws <NUM>, <NUM>. By providing a dual-reel handle assembly including components of <FIG>, a user may not require help from additional users during operation of the medical device, because a user's first hand may hold handle <NUM> of endoscope <NUM> and the user's second hand may actuate knobs <NUM>-<NUM> of the dual-reel handle assembly to operate medical device <NUM>. In other examples, a similar knob assembly as shown in <FIG> may be utilized in a handle assembly similar to handle assembly <NUM>.

To use medical device <NUM>, a user may first couple coupler <NUM> to distal portion <NUM> of endoscope <NUM>. In some examples, the user may first position control wire <NUM> and tripwire <NUM> within working channel <NUM>, and then couple control wire <NUM> to actuation wire <NUM> and couple tripwire <NUM> to cord <NUM>. In some examples, the user may feed each of control wire <NUM> and tripwire <NUM> from a proximal end of endoscope <NUM> through working channel port <NUM> and through working channel <NUM> to distal portion <NUM>, and then couple control wire <NUM> to actuation wire <NUM> and couple tripwire <NUM> to cord <NUM>. The user may then adjust the length of tripwire <NUM> and/or control wire <NUM>, such as via third knob <NUM>, to tighten each wire and take up any slack in the wires. In other examples, a user may couple coupler <NUM> to distal portion <NUM>, and tripwire <NUM> and control wire <NUM> may already be positioned within a tube separate from endoscope <NUM>.

The user may then insert endoscope <NUM> and medical device <NUM> into a body of a patient, and position the devices proximate to a target area within the body. The user may then apply suction to working channel <NUM> or another channel within endoscope <NUM> to pull tissue into lumen <NUM>. The user may then grasp or cut tissue by closing jaws <NUM>, <NUM> via moving control wire <NUM> proximally. In some examples, the user may move actuator <NUM> of handle assembly <NUM> proximally to close jaws <NUM>, <NUM>, and in other examples the user may rotate second knob <NUM> of dual reel handle assembly <NUM> discussed in relation to <FIG>. The user may then deploy one or more clips <NUM>-<NUM> by moving tripwire <NUM> proximally. In some examples, the user may rotate knob <NUM> of handle assembly <NUM> to deploy one or more clips <NUM>-<NUM>. In other examples, the user may rotate first knob <NUM> of dual reel handle assembly <NUM> discussed in relation to <FIG> to deploy one or more clips <NUM>-<NUM>. The user may repeat the steps of opening and closing jaws and deploying clips <NUM>-<NUM> multiple times during a single procedure. The user may then remove endoscope <NUM> and medical device <NUM> from the body of the patient.

It also should be understood that one or more aspects of any of the medical devices, systems, and methods described herein may be used for cutting, dissecting, treating, or ablating tissue in any part of the human body. For example, any of the medical devices described herein may be used in medical procedures such as for Endoscopic Submucosal Dissection (ESD), cancer treatment, kidney or bladder biopsies or resections, and/or other procedures where removal, clipping, dissection, fulguration, and/or ablation of the type of tissue is needed. Any of the clips <NUM>-<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>-<NUM> discussed in this disclosure may be used as marker bands, radiopaque marker bands, or elastic bands.

Various aspects discussed herein may help reduce procedure time, increase tissue treatment effectiveness, reduce the risks to the subject, etc..

Although the exemplary embodiments described above have been disclosed in connection with medical devices for manipulating and resecting human tissue through the working channel of a medical device, a natural orifice, or by incision, a person skilled in the art will understand that the principles set out above can be applied to any medical device or medical method and can be implemented in different ways without departing from the scope of the disclosure as defined by the claims. In particular, constructional details, including manufacturing techniques and materials, are well within the understanding of those of skill in the art and have not been set out in any detail here. These and other modifications and variations are well within the scope of the this disclosure and can be envisioned and implemented by those of skill in the art.

Moreover, while specific exemplary embodiments may have been illustrated and described collectively herein, it should be appreciated that any subsequent arrangement designed to achieve the same or similar purpose may be substituted for the specific embodiments described and shown herein. This disclosure is intended to cover any and all subsequent adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the description.

While principles of the disclosure are described herein with reference to illustrative aspects for particular applications, it should be understood that the disclosure is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, aspects, and substitution of equivalents all fall within the scope of the aspects described herein. Accordingly, the disclosure is not to be considered as limited by the foregoing description.

Claim 1:
A medical device adapted for use with a delivery device (<NUM>), the medical device comprising:
a handle (<NUM>; <NUM>; <NUM>; <NUM>) including at least one actuator (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>);
a body (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>) adapted to releasably mount to a distal portion of the delivery device (<NUM>), the body supporting a pair of jaws (<NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>) rotatably coupled to the body; and
a control wire (<NUM>, <NUM>; <NUM>, <NUM>; <NUM>; <NUM>) coupled to the pair of jaws and the actuator;
wherein the actuator (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>) is configured to open and close the pair of jaws (<NUM>, <NUM>; <NUM>, <NUM>; <NUM>, <NUM>);
characterised in that
the actuator (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>) is a first actuator, and the medical device further comprises:
at least one clip (<NUM>-<NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>; <NUM>, <NUM>; <NUM>-<NUM>; <NUM>-<NUM>; <NUM>-<NUM>; <NUM>, <NUM>; <NUM>, <NUM>) positioned around an exterior surface of the body;
a tripwire (<NUM>; <NUM>; <NUM>) releasably coupled to the at least one clip and extending from the body to the handle; and
a second actuator (<NUM>; <NUM>; <NUM>), wherein actuation of the second actuator is configured to deploy the at least one clip from the body.