Patent Description:
This disclosure relates to minimally invasive (e.g., endoscopic and/or laparoscopic) medical devices and related methods of use. In embodiments, the disclosure relates to one or more devices for sealing perforations, leaks, or wounds in the gastrointestinal tract, devices for advancing these sealing devices, and related methods of use, among other aspects. An example of a prior art device is disclosed in <CIT>.

Endoscopic and open surgical procedures of the gastrointestinal (Gl) tract include, for example, colonic resection, bariatric surgery, esophagectomy, gastric bypass, and sleeve gastrectomy, among others. These procedures may result in perforation, post-surgical leaks, or other wounds of the tract. Limited treatment options exist for managing such wounds, which have significant morbidity and mortality rates. Options include surgical re-operation and endoscopic placement of a stent or clips. Surgery is relatively invasive and also has high morbidity and mortality rates. Endoscopic stent placement is a less invasive option. The placed stent, however, can migrate from the intended location and/or wall off infection at the treatment site, inhibiting drainage.

According to an aspect, a medical system includes a porous body connected to a distal end of a vacuum tube, and a patch defining a lumen therethrough for accommodating the vacuum tube, wherein the patch is configured to fluidly seal the porous body from a body lumen when the patch is deployed in a subject.

A diameter of the lumen of the patch may be approximately equal to an outer diameter of the vacuum tube, and the patch may be slidable along an exterior of the vacuum tube.

The patch may include a patch tube extending from a first surface of the patch, wherein the patch tube may define a tube lumen in fluid communication with the lumen of the patch, and wherein the patch tube may be configured to seal around a circumference of the vacuum tube when the patch is deployed in the subject.

The medical system may further comprise a sealing fluid configured to be applied to an intersection between the patch and a tissue of the subject.

A diameter of the lumen of the patch may be greater than an outer diameter of the vacuum tube, and wherein a gap may be formed between the patch and the vacuum tube when the patch and the vacuum tube are deployed in the body.

A sealing fluid may be configured to be supplied to the gap to seal the body lumen from the porous body.

The patch may define a plurality of recesses on a surface of the patch facing the porous body, and wherein at least one recess of the plurality of recesses may be configured to overlap a tissue of the body lumen in the deployed configuration.

The plurality of recesses may be in fluid communication with a lumen of the vacuum tube.

The plurality of recesses may communicate with a lumen of the vacuum tube via one or more channels in the patch.

The medical system further comprises an overtube configured to contact the patch during a deployment of the patch.

The overtube is configured to be releasably attached to the patch during the deployment of the patch, and is configured to be disconnected from the patch when the patch is deployed in the subject.

The porous body may include a plurality of holes, pores, or channels which may permit fluid outside of the porous body to flow through the porous body and into a lumen of the vacuum tube.

The medical system may further comprise a vacuum device configured to be attached to a proximal end of the vacuum tube and may be configured to supply a negative pressure to the porous body.

According to another aspect, a medical system comprises a flexible tube having a central vacuum lumen, a porous body attached to a distal end of the flexible tube, and a patch extending radially outward from the flexible tube, wherein the patch includes a plurality of recesses in fluid communication with the central lumen.

The porous body may configured to be placed at a target site in a subject, and wherein a negative pressure may be supplied to the central vacuum lumen and may be configured to cause the patch to adhere to a tissue of a body lumen of the subject via the plurality of recesses.

A fluid disposed at the target site may be configured to pass through holes, pores, or channels in the porous body and at least one recess of the plurality of recesses in the patch toward a proximal end of the flexible tube.

According to yet another aspect, not forming part of the claimed invention, there is disclosed a method of treating a target site of a body lumen of a subject comprises advancing a porous body to the target site, wherein the porous body is attached to a distal end of a flexible tube defining a central lumen, advancing a patch over the flexible tube, connecting the patch to a tissue of the body lumen, and removing a fluid from the target site when the patch is connected to the tissue.

The method may further comprise supplying a negative pressure to the central lumen, wherein the negative pressure is configured to one or more of remove the fluid from the target site or connect the patch to the tissue of the body lumen.

For ease of description, portions of the disclosed devices and/or their components are referred to as proximal and distal portions. It should be noted that the term "proximal" is intended to refer to portions closer to a user of the devices, and the term "distal" is used herein to refer to portions further away from the user. Similarly, "extends distally" indicates that a component extends in a distal direction, and "extends proximally" indicates that a component extends in a proximal direction. Further, as used herein, the terms "about," "approximately," and "substantially" indicate a range of values within +/- <NUM>% of a stated or implied value. Terms that indicate the geometric shape of a component/surface refer to exact and approximate shapes. This disclosure may be understood with reference to the following description and the appended drawings, wherein like elements are referred to with the same reference numerals.

Endoluminal vacuum therapy (EVAC) has been proposed. In EVAC, negative pressure is delivered to the wound site in the GI tract, for example through a nasogastric tube having a sponge at its terminal end. The sponge is placed endoscopically into the perforation, leak, or other wound. Negative pressure then is applied. Devices and systems suited for EVAC are limited, however.

Embodiments of this disclosure include devices, systems, and methods for endoluminal vacuum therapy (EVAC). In examples, EVAC includes endoluminal placement of a sponge or other like material into the wound site (e.g., a target site), including a perforation, a leak, a cyst, an anastomosis, etc. Placement of the material may be via a catheter, scope (endoscope, bronchoscope, colonoscope, duodenoscope, gastroscope, etc.), tube, or sheath, inserted into the GI tract via a natural orifice. 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 of the material also can be in other organs (e.g., pancreas) reachable via the GI tract.

<FIG> illustrates a distal end of an EVAC system <NUM> in accordance with an example of this disclosure. System <NUM> may be inserted into a patient for treatment of chronic wounds using negative pressure via a vacuum. System <NUM> generally includes an EVAC device <NUM>, a patch <NUM>, and an overtube <NUM>.

EVAC device <NUM> may include a sponge <NUM> (or other mesh-like material or porous body) and a vacuum tube <NUM>. Sponge <NUM> is attached to a distal end of vacuum tube <NUM>. Sponge <NUM> may include openings <NUM> on an outer surface thereof. Openings <NUM> may be any hole, pore, or channel which provides access to interconnecting channels and pores throughout sponge <NUM>. Openings <NUM> may include different sizes and shapes, and may be selected based on a location of treatment within the body. Sponge <NUM> is illustrated as having a spherical shape, but may be any shape, including cylindrical (see, e.g., <FIG>), cuboidal, irregular, or the like. Sponge <NUM> may be compressed into a lower profile during insertion to a target site and may expand during deployment at a target site <NUM> (see, e.g., <FIG>).

In embodiments of this disclosure, sponge <NUM> may be any suitable biocompatible material that may absorb liquids and/or permit liquid or other materials to pass therethrough via negative pressure. The material may be flexible, compressible, porous, hydrophilic, sterile, and/or disposable. The sponge material may be an open-cell foam. Suitable materials include polyurethanes, esters, ethers, composite materials, and other medical-grade materials.

Vacuum tube <NUM> may include an outer wall <NUM> defining one or more lumens <NUM>. Lumen <NUM> is open at both a proximal end and the distal end of vacuum tube <NUM>. Outer wall <NUM> may include a plurality of holes around a circumference of the distal end of vacuum tube <NUM> and in fluid communication with lumen <NUM>, which may increase the flow of fluid or material into lumen <NUM> as disclosed herein. The distal end of vacuum tube <NUM> may be attached to sponge <NUM> via sutures, an adhesive, or the like. In one example, a recess (not shown) may be provided in sponge <NUM> to receive the distal end of vacuum tube <NUM>. Vacuum tube <NUM> may be attached within the recess of sponge <NUM>, which may provide additional structural support between sponge <NUM> and vacuum tube <NUM>. The proximal end of vacuum tube <NUM> may be connected to a vacuum source (not shown), which may supply a negative pressure to sponge <NUM>. For example, a negative pressure of approximately <NUM> Hg, or approximately <NUM> pounds per square inch (PSI), may be supplied to sponge <NUM>. Other suitable amounts of negative pressure may be used. This negative pressure may pull fluid, material, and/or other debris into lumen <NUM> of vacuum tube <NUM> via openings <NUM>, which may promote healing of target site <NUM> (<FIG>).

With continued reference to <FIG>, patch <NUM> may include a body <NUM> with a lumen <NUM> extending from a first side of patch <NUM> through to a second, opposite side of patch <NUM>. As will be explained herein, vacuum tube <NUM> may extend through lumen <NUM>. Lumen <NUM> may be sized and shaped to create a fluid seal with vacuum tube <NUM>. For example, a diameter of lumen <NUM> may be approximately equal to a diameter of an outer surface of vacuum tube <NUM>, but is not limited thereto. In some embodiments, the diameter of lumen <NUM> may be smaller than an outer diameter of tube <NUM>. In such an instance, a flexibility of patch <NUM> may permit tube <NUM> to fit within lumen <NUM>. Such a tighter fit may provide an even more effective seal. In some instances, patch <NUM> (and any patch described herein) may be thicker around lumen <NUM> and/or may include a different or an additional material having different mechanical properties, which may prevent tears in patch <NUM> at lumen <NUM>.

Patch <NUM> may be any size and shape sufficient to seal an opening between a GI tract <NUM> (e.g., a body lumen) and target site <NUM> (<FIG>). Patch <NUM> is shown as rectangular. The shape of patch <NUM>, however, could be circular, irregular, etc. Patch <NUM> also may be cut to the shape of the opening to target site <NUM>. According to an example, patch <NUM> may include Chitosan or other similar material that is configured to adhere to tissue of GI tract <NUM> and create a seal with the tissue. Alternatively, patch <NUM> may include any medical grade material suitable for sealing the opening between GI tract <NUM> and target site <NUM>. In embodiments, patch <NUM> may include a material that becomes an adhesive when activated by a complementary fluid/agent, for example, pH based crosslinking polymers, temperature or light activated polymers that crosslink to tissue, or the like. Patch <NUM> may be durable and may be suitable for use in GI tract <NUM> for two to three days, or more, without being replaced. Patch <NUM> (and any patch describe in this disclosure) may be flexible and/or compressible for delivery through a tortuous body lumen to target site <NUM>. In some instances, lumen <NUM> may be formed in patch <NUM> by, e.g., cutting, after patch <NUM> is delivered to target site <NUM>. In this instance, sponge <NUM> may be delivered in a compressed state through lumen <NUM> to target site <NUM>, and sponge <NUM> may expand from the compressed state to an expanded state at target site <NUM> in any manner described in this disclosure.

Overtube <NUM> may include an outer wall <NUM> defining a central lumen <NUM>, and central lumen <NUM> may extend from a distal end of overtube <NUM> to a proximal end thereof. As will be explained herein, overtube <NUM> may be configured to be placed over vacuum line <NUM> to push patch <NUM> into the correct position at target site <NUM>. A diameter of lumen <NUM> may be greater than the diameter of the outer surface of outer wall <NUM> of vacuum tube <NUM>, which may allow overtube <NUM> to be moved in distal and proximal directions relative to vacuum tube <NUM>. Overtube <NUM> may be made of any medical grade material, and may include a columnar strength suitable to push patch <NUM> along vacuum line <NUM> toward sponge <NUM>. According to an example, a handle or other gripping member may be provided at the proximal end of overtube <NUM>, which may assist in moving overtube <NUM> relative to vacuum line <NUM>. In this manner, the distal end of overtube <NUM> may push patch <NUM> along vacuum line <NUM> to target site <NUM>.

An example of system <NUM> disposed in the body at target site <NUM> is shown in <FIG>. Sponge <NUM> is disposed within target site <NUM>. The distal end of vacuum line <NUM> is attached to sponge <NUM> and extends proximally into GI tract <NUM> and out of the body. Patch <NUM> seals an opening between target site <NUM> and GI tract <NUM>. Overtube <NUM> coaxially surrounds a portion of vacuum line <NUM>. The distal end of overtube <NUM> abuts a proximal side of patch <NUM> via a connection region <NUM>, such that overtube <NUM> is not connected to patch <NUM>. Alternatively, connection region <NUM> may include an adhesive, a perforation, a snap-fit connection, a suture, or other connection mechanism to connect patch <NUM> to overtube <NUM>. In use, a twisting or turning motion of overtube <NUM> about a longitudinal axis of overtube <NUM> may overcome the connection force between patch <NUM> and overtube <NUM> at connection region <NUM>, allowing overtube <NUM> to be disconnected from patch <NUM> and removed from the body.

An example of patch <NUM> sealing target site <NUM> from GI tract <NUM> is shown in <FIG>. As discussed herein, patch <NUM> may interact with a fluid in the body, e.g., fluid in GI tract <NUM>, and may become adhesive such that body <NUM> of patch <NUM> may adhere to the tissue in GI tract <NUM> surrounding target site <NUM>. Further, according to an example, the outer diameter of lumen <NUM> (<FIG>) of patch <NUM> may be approximately equal to the diameter of the outer surface of outer wall <NUM> such that patch <NUM> is fluidly sealed with vacuum tube <NUM>. In this manner, a fluid seal may be created between target site <NUM> and GI tract <NUM>. Such a seal can inhibit or prevent material within GI tract <NUM> (e.g., fecal matter) from entering target site <NUM> and, for example, passing through a post-surgical leak and into another body organ. Since patch <NUM> is pushed along vacuum tube <NUM>, vacuum tube <NUM> acts as a guide to aid patch <NUM> to be deployed at target site <NUM>.

A method of using system <NUM> will now be described. Sponge <NUM> may be introduced through an orifice (e.g., a natural body orifice) and advanced to target site <NUM> using a catheter or other known mechanism. Once sponge <NUM> is disposed at target site <NUM>, a proximal end of vacuum tube <NUM> is placed into lumen <NUM> of patch <NUM>. The proximal end of vacuum tube <NUM> is subsequently placed into a distal end of central lumen <NUM> of overtube <NUM>. Overtube <NUM> is pushed distally, causing patch <NUM> to move distally relative to vacuum tube <NUM>. As patch <NUM> approaches target site <NUM>, the user may urge or push patch <NUM> against the tissue surrounding target site <NUM>. According to examples, the fluid of GI tract <NUM> may activate an adhesive on patch <NUM> to adhere patch <NUM> to the tissue. Alternatively, fluid may be introduced to patch <NUM> via a tool or an instrument to activate the adhesive of patch <NUM>. After patch <NUM> is attached to the tissue surrounding target site <NUM>, overtube <NUM> may be moved proximally and removed from the body via the orifice. As discussed herein, overtube <NUM> may be connected to patch <NUM> via an adhesive, snap fit, or the like. In this example, overtube <NUM> may be rotated about the longitudinal axis to overcome a connection force between overtube <NUM> and patch <NUM>, thereby disconnecting overtube <NUM> from patch <NUM>. Once overtube <NUM> has been removed from the body, vacuum line <NUM> may be attached to a vacuum source and a negative pressure of approximately <NUM> Hg, or approximately <NUM>, may be supplied to sponge <NUM>.

<FIG> illustrates an additional or alternative mechanism for sealing patch <NUM> to the tissue of GI tract <NUM>. A fluid <NUM> may be sprayed along an intersection of patch <NUM> and the wall of GI tract <NUM>, about the perimeter of patch <NUM>. Fluid <NUM> may include a liquid-based Chitosan or other material suitable for sealing patch <NUM> to tissue on the wall of GI tract <NUM>, including any suitable material mentioned in this disclosure. Additionally, or alternatively, sealing patch <NUM> may include modified versions of Chitosan such as a thiolated, a catechol, or an aldehyde of Chitosan, acrylated polyurethanes, methylmethacrylates, gelatin methacryloyl (GelMA), polyethylene glycol (PEG), or the like. Fluid <NUM> may further include any liquid, gel, aerosolized material, or the like. Fluid <NUM> may fill spaces between patch <NUM> and the wall of GI tract <NUM>, which may decrease the possibility that fluid or other materials will travel from GI tract <NUM> into target site <NUM>. Furthermore, fluid <NUM> may interact with and may seal to both patch <NUM> and the tissue of the wall of GI tract <NUM>, which may increase the sealing strength between patch <NUM> and GI tract <NUM>. This increased sealing strength may prevent patch <NUM> from becoming detached prematurely from the tissue when covering target site <NUM> due to, e.g., material or other debris traveling within GI tract <NUM>. Fluid <NUM> may be introduced to a target area, e.g., at the intersection of patch <NUM> and the wall of GI tract <NUM>, via a catheter or other delivery device. Fluid <NUM> may be in an aerosolized configuration and certain properties, e.g., an adhesive property, of fluid <NUM> may be activated when fluid <NUM> is contacted by a liquid. For example, moisture or liquid of GI tract <NUM> may activate fluid <NUM>. Alternatively, or additionally, a liquid may be supplied by the catheter or other delivery device to activate fluid <NUM> after fluid <NUM> is supplied to GI tract <NUM>.

EVAC device <NUM>, including sponge <NUM> and vacuum tube <NUM>, and patch <NUM> in <FIG> may be deployed to target site <NUM> in a similar manner discussed with reference to <FIG> and <FIG>. After positioning patch <NUM> at target site <NUM>, fluid <NUM> may be deployed from a distal end of a catheter or other similar deployment device. A liquid or other activation agent may also be supplied to fluid <NUM>. After deployment of fluid <NUM> and any activation agent, the catheter or other deployment device may be removed via the body orifice.

<FIG> illustrates another example of an EVAC system <NUM>. EVAC system <NUM> of <FIG> includes similar components as shown in <FIG>. A patch <NUM>' may be similar to patch <NUM>, and may further include a tube <NUM>' (e.g., a patch tube) connected to and extending from a proximal surface of patch <NUM>'. An inner lumen of patch <NUM>' may be an extension of a lumen of patch <NUM>' (e.g., lumen <NUM> of patch <NUM> shown in <FIG>). When deployed in the body, tube <NUM>' may extend proximally from patch <NUM>' and may provide an additional seal around vacuum tube <NUM>. In some examples, tube <NUM>' may taper from patch <NUM>' in the proximal direction. A diameter of the lumen defined by tube <NUM>' may be approximately equal to the lumen of patch <NUM>'. In some examples, the diameter of central lumen <NUM> of overtube <NUM> may be less than an outer diameter of tube <NUM>' such that, during deployment, the distal end of overtube <NUM> may contact a proximal end of tube <NUM>'. Alternatively, the diameter of central lumen <NUM> may be greater than the outer diameter of tube <NUM>', such that the distal end of overtube <NUM> may contact a portion of patch <NUM>' other than tube <NUM>' during deployment, similar to the deployment of patch <NUM> described herein. It will be understood that EVAC system <NUM> may be deployed in any manner described herein. Tube <NUM>' may also be flexible to bend and thereby conform to a shape of vacuum tube <NUM>.

<FIG> illustrates another example of an EVAC system <NUM>. EVAC system <NUM> of <FIG> includes similar components as shown in <FIG>. A patch <NUM>" may be similar to patch <NUM>, and may include a lumen (similar to lumen <NUM> in <FIG>) having a diameter greater than the outer diameter of vacuum tube <NUM>. In this example, patch <NUM>" may slide more freely along vacuum tube <NUM> during deployment and friction forces between a wall that defines the lumen of patch <NUM>" and vacuum tube <NUM> during deployment may be reduced. Reducing these friction forces may reduce shearing and/or strain forces on vacuum tube <NUM> during deployment of patch <NUM>", which may prevent or reduce deterioration of vacuum tube <NUM>.

When deployed, a space or a gap may be created between patch <NUM>" and vacuum tube <NUM>, such that target site <NUM> is not completely sealed from GI tract <NUM>. A seal <NUM> may be disposed in the space created between vacuum tube <NUM> and the wall defining the lumen of patch <NUM>" to seal target site <NUM> from GI tract <NUM>. For example, seal <NUM> may be similar to fluid <NUM> and may be, e.g., Chitosan or other material suitable for creating a seal between vacuum tube <NUM> and patch <NUM>". Seal <NUM> may be deployed in a similar manner as fluid <NUM>, e.g., via a catheter or the like. Alternatively, seal <NUM> may be a silicone seal (or other suitable material) placed between the wall defining the lumen of patch <NUM>" and tube <NUM>, and may be deployed using a catheter having an end effector capable of grasping seal <NUM> or other similar device.

Sponge <NUM> and patch <NUM>" may be deployed in a manner similar to that described with respect to <FIG> and <FIG>. For example, after positioning sponge <NUM> at target site <NUM>, patch <NUM>" may be advanced along vacuum tube <NUM> to seal target site <NUM> from GI tract <NUM> using overtube <NUM>. Once patch <NUM>" is positioned at target site <NUM>, seal <NUM> may be deployed into lumen <NUM>" via a catheter, an end effector, or other deployment device. In some examples, fluid <NUM> shown in <FIG> may also be deployed at the intersection of patch <NUM>" and the inner wall of GI tract <NUM> to further seal target site <NUM> from GI tract <NUM>. After deployment, overtube <NUM> and any other deployment mechanisms may be removed from the body.

<FIG> illustrate yet another example of a patch <NUM>‴ according to an example. Sponge <NUM> is attached to the distal end of vacuum tube <NUM>, similar to sponge <NUM>' and vacuum tube <NUM> shown in <FIG>. Patch <NUM>‴ may be fixed to vacuum tube <NUM> proximal of sponge <NUM>. According to an example, a body <NUM>‴ of patch <NUM>‴ may include a plurality of recesses 52a facing sponge <NUM>'. Recesses 52a may be connected to one or more channels 52b defined by outer walls of patch <NUM>"'. As shown in <FIG>, channels 52b may be connected by one or more openings 44a in vacuum tube <NUM>, such that lumen <NUM> of vacuum tube <NUM> may be fluidly connected to recesses 52a. In this example, a negative pressure supplied to sponge <NUM>' may also be supplied to recesses 52a via channels 52b. The vacuum supplied to recesses 52a may cause patch <NUM>‴ to attach to the tissue of the sidewall of GI tract <NUM> surrounding the opening to target site <NUM>, thereby sealing target site <NUM> from GI tract <NUM>. Recesses 52a may be in any pattern and/or randomly spaced about the surface of <NUM>‴ facing sponge <NUM>'. In an example, some recesses 52a may overlap the opening between target site <NUM> and GI tract <NUM> and may provide additional paths for fluids and other materials to be removed from target site <NUM>. Alternatively, or additionally, a second vacuum tube may be attached to patch <NUM>‴. In this example, tube <NUM> does not require openings 44a, and vacuum pressure supplied lumen <NUM> is independently controlled of the vacuum pressure supplied to channels 52b and recesses 52a. The additional vacuum tube may allow patch <NUM>‴ to be positioned and attached to the tissue of the sidewall of GI tact <NUM> and seal treatment site <NUM> from GI tract <NUM> independently of and, in some instances, before removing fluid or materials from treatment site <NUM>. While patch <NUM>‴ is fixedly attached to vacuum tube <NUM> in <FIG>, patch <NUM>‴ may be placed over vacuum tube <NUM> and advanced to a target site in any manner described herein. For example, if patch <NUM>‴ is attached to the second vacuum tube, separate from vacuum tube <NUM>, patch <NUM>‴ may be advanced along vacuum tube <NUM> and may be moved relative to vacuum tube <NUM> and independently of sponge <NUM>'. Sponge <NUM>' and patch <NUM>‴ may be deployed to target site <NUM> and may remove debris and other material from target site <NUM> in any manner described herein. Patch <NUM>‴ may be any material described herein suitable for sealing target site <NUM> from GI tract <NUM>, e.g., Chitosan.

It will be understood that any of the patches described herein may be used alone or in combination with one or more sponges described herein. It will also be understood that features of any of the patches described herein may be used with any other patches described herein.

While different medical systems have been described, it will be understood that the particular arrangements of elements in these systems are not limited. Moreover, a size, a shape, and/or the materials of the sealing devices in the EVAC system are not limited. As described herein, there are included patches or sealing devices for sealing a sponge and a target site from a body lumen. For example, performing various medical procedures may be improved by ensuring a proper seal between the target site and any debris or materials in a body lumen. This seal may prevent these materials (e.g., fecal matter) from entering the target site and passing into another body organ through, e.g., a post-surgical leak, and causing infections or other medical issues.

Claim 1:
A medical system (<NUM>) comprising:
a porous body (<NUM>, <NUM>') connected to a distal end of a vacuum tube (<NUM>);
a patch (<NUM>, <NUM>', <NUM>", <NUM>‴) defining a lumen (<NUM>) therethrough for accommodating the vacuum tube (<NUM>),
an overtube (<NUM>) configured to contact the patch (<NUM>, <NUM>', <NUM>", <NUM>‴) during a deployment of the patch (<NUM>, <NUM>', <NUM>", <NUM>‴) and configured to be releasably attached to the patch (<NUM>, <NUM>', <NUM>", <NUM>‴) during the deployment of the patch (<NUM>, <NUM>', <NUM>", <NUM>‴),
wherein the patch (<NUM>, <NUM>', <NUM>", <NUM>‴) is configured to fluidly seal the porous body (<NUM>, <NUM>') from a body lumen when the patch is deployed in a subject and the overtube (<NUM>) is configured to be disconnected from the patch (<NUM>, <NUM>', <NUM>", <NUM>‴) when the patch is deployed in the subject.