US20140275769A1 - Apparatus for tissue dissection with suction ring - Google Patents
Apparatus for tissue dissection with suction ring Download PDFInfo
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- US20140275769A1 US20140275769A1 US14/204,670 US201414204670A US2014275769A1 US 20140275769 A1 US20140275769 A1 US 20140275769A1 US 201414204670 A US201414204670 A US 201414204670A US 2014275769 A1 US2014275769 A1 US 2014275769A1
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- medical device
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- tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00094—Suction openings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
- A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
- A61B1/00101—Insertion part of the endoscope body characterised by distal tip features the distal tip features being detachable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00137—End pieces at either end of the endoscope, e.g. caps, seals or forceps plugs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/32056—Surgical snare instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00269—Type of minimally invasive operation endoscopic mucosal resection EMR
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
- A61B2017/308—Surgical pincettes without pivotal connections holding by means of suction with suction cups
Definitions
- EMR endoscopic mucosal resection
- GI gastrointestinal
- endoscopic mucosal resection is a minimally invasive technique used for removing, e.g., malignant/non-malignant lesions and/or otherwise unwanted tissue.
- Endoscopic medical procedures for example EMR, may excise sessile adenomas (i.e., tumors attached to a bodily surface) in an anatomical lumen. Such procedures often require the dissection of one tissue plane while leaving an underlying tissue plane intact.
- it is desirable for the resection to leave clean margins at the treatment site in order to minimize any further disruption of the surrounding anatomy.
- adenoma is flat against a lumen wall, however, excising the adenoma can be difficult.
- one of several techniques may be used to raise the flat adenoma so that it may be excised appropriately without harming underlying tissue layers.
- forceps can be used to raise the flat adenoma.
- injections of a solution into, e.g., the submucosal or an underlying tissue layer can create a space or opening under the tissue, creating a buffer zone. The space lifts the flat adenoma above the underlying tissue to facilitate removal, and minimizes mechanical or electrocautery damage to the deeper tissue layers.
- a medical device may include a housing.
- the housing may include an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall.
- the distal end of the outer wall may be disposed proximally from the distal end of the inner wall.
- the housing may further define a passageway therethrough.
- the cavity may be in fluid communication with a port configured to adjust pressure within the cavity.
- FIG. 3 is a cross-sectional view of the exemplary tissue resection apparatus including an endoscope therein and in cooperating with tissue, according to an embodiment of the present disclosure.
- FIG. 4 is a schematic view of an exemplary tissue resection apparatus in combination with a suitable cutting device, in accordance with another embodiment of the present disclosure.
- FIG. 5 is a cross-sectional view of an exemplary tissue resecting apparatus, according to a further aspect of the present disclosure.
- FIG. 6B is a bottom view of the apparatus of FIG. 5 .
- FIGS. 7A-7B depict an alternate embodiment of an apparatus in accordance with a further embodiment of the present disclosure.
- FIG. 8 depicts a further embodiment of an apparatus in accordance with the present disclosure.
- FIGS. 9A-9C depict exemplary structures to facilitate separating a first tissue layer from a second tissue layer, in accordance with the present disclosure.
- FIG. 1 and FIG. 2 illustrate an exemplary tissue resection apparatus 1 , according to an embodiment of the present disclosure.
- the apparatus may include a housing 3 having an outer wall 5 and an inner wall 7 disposed within the housing 3 .
- the inner wall 7 is surrounded by the outer wall 5 and separated by a specific distance so that there is a cavity 11 or a hollow gap (referred hereinafter as the “cavity”) formed between the outer wall 5 and the inner wall 7 .
- FIG. 3 illustrates a cross-sectional view of the apparatus 1 being placed against a tissue layer “L”.
- the suction applied from the suction source (not shown) via the port 9 draws in the targeted tissue “L” into the cavity 11 , thereby forming a ridge of tissue, as illustrated in FIG. 3 .
- port 9 may be in fluid communication with cavity 11 , so that a vacuum applied to portion 9 may be realized throughout cavity 11 .
- port 9 may be offset relative to a longitudinal axis of housing 3 such that cavity 13 (discussed below) may receive tubular member 17 therein.
- a portion of port 9 may be configured to extend away from a proximal end of housing 3 .
- the raised ridge of tissue drawn into the cavity 11 may facilitate snaring or other resection methods.
- the cavity 11 may be preferably narrow so that the non-targeted sub tissue layer (e.g., tissue layer “SL”) is excluded from being drawn up into the cavity, thereby reducing the risk of perforating the SL tissue layer.
- tissue layer “SL” tissue layer “SL”
- the apparatus 1 may include a hollow chamber 13 for accommodating an elongated tubular member (e.g., tubular member 17 ).
- the apparatus 1 may be configured as an endoscopic cap, and the elongated tubular member 17 may be an endoscope with various endoscope functionalities, including visualization, illumination, flushing, irrigation, suction, and the like, and using a variety of tools through its working channels (not shown).
- tubular member 17 may include any suitable introduction sheath known in the art.
- one or more internal working channels may be included inside the tubular member 17 for receiving endoscopic instruments, such as an optical scope or as an aspiration path connected to the suction source.
- the internal working channels may have non-circular cross-sectional shapes, and may be in any shapes depending on the types of endoscopic instrument and/or application of the working channel(s).
- the tubular member 17 may include a number of additional lumens for receiving control wires, which may extend from various control sources (e.g., actuation handle, knobs, steering controls, etc.) disposed at the proximal end of tubular member 17 through the tubular member 17 .
- An external shape and dimension of the tubular member 17 may be substantially the same as the hollow chamber 13 .
- the dimension (e.g., width) of the tubular member 17 may be slightly larger than the size of the hollow chamber 13 in order to facilitate a tight fitting of the tubular member 17 into the hollow chamber 13 .
- the surroundings of the proximal opening of the hollow chamber 13 and/or the inner wall 7 may be made of a flexible material that is elastically deformable to accommodate the larger tubular member 17 into the hollow chamber 13 .
- the tubular member 17 may be made of a flexible material that is elastically deformable, so that the tubular member 15 can be snuggly fitted into the hollow chamber 13 .
- one or more ledges or ridges 19 may be formed on an interior wall of the hollow chamber 13 to prevent the tubular member 17 from passing through the entire hollow chamber 13 .
- a position of ledges or ridges 19 along inner wall 7 may be varied as desired to alter a position of tubular member 17 relative to housing 3 .
- the apparatus 1 may be configured so that the elongated tubular member 17 can pass completely through the hollow chamber 13 , which will allow for extension and retraction of the apparatus 1 relative to the tubular member 17 (e.g., endoscope). In such embodiments, therefore, ledges or ridges 19 may be excluded.
- FIG. 4 illustrates an exemplary embodiment of the apparatus 1 equipped with a snare 21 .
- snare 21 can be opened and preloaded around the exterior of the apparatus 1 prior to drawing in the tissue.
- tissue layer (“L”) is drawn into the cavity 11 as shown in FIG. 2
- the snare 21 can be closed around the base of the raised circumferential ridge of the drawn up tissue for resection.
- the tubular member 17 may be surrounded by a sheath 23 , which may contain at least one auxiliary working channel 25 .
- the sheath 23 may include a flexible tubular member extending proximally away from a proximal end of the housing 3 .
- Auxiliary working channel 25 may include a lumen in the aforementioned sheath 23 or another tubular member operably coupled to the sheath 23 .
- the auxiliary working channel 25 may accommodate the snare 21 .
- the sheath 23 may include a plurality of auxiliary working channels 25 for various other functionalities.
- one of the working channels may function as the aspiration path between the port 9 and the suction source (not shown). Additional auxiliary working channels may be included in the sheath 23 to accommodate various other instruments and functionalities.
- the apparatus 1 and the tubular member 17 have been described in the context of an endoscope cap with a snare, it is contemplated that the tubular member 17 also may be any other medical device, such as a catheter or guiding tube that includes any number of the features and characteristics disclosed herein. Further, various tissue dissection/resection tools may be also used in conjunction with the apparatus 1 for tissue resection or other endoscopic treatment.
- FIG. 5 illustrates additional details of the apparatus 1 .
- the distal end portion of the outer wall 5 may be rounded and bent towards the inner wall 7 at a predetermined angle. This angle may promote drawing in the tissue positioned underneath the hollow chamber 13 (i.e., the tissue layer “L” surrounded by the most distal end/tip 27 of the inner wall 7 ) so that tissue underneath the hollow chamber 13 becomes taut as illustrated by the arrows in FIG. 3 .
- the distal most end/tip 27 of the inner wall 7 is substantially co-planar with the distal most end/tip 29 of the outer wall 5 .
- the tip 27 of the inner wall 7 may be recessed towards the proximal end of the housing 3 relative to the tip 29 of the outer wall 5 as shown in FIG. 5 .
- the tip 29 of the outer wall 5 is extended closer to the surface of the tissue layer (“L”) than the tip 27 of the inner wall 7 .
- the hollow chamber 13 may not be completely isolated from the suction applied via the port 9 by the inner wall 7 .
- the tissue layer (“L”) enclosed within the tip 29 of the outer wall 5 may be drawn up (i.e., lifted) to the level of the tip 27 of the inner wall 7 initially.
- a seal may be formed so that the cavity 11 is isolated from the hollow chamber 13 .
- the recessed inner wall 7 elevates the tissue layer (“L”) approximately equal to the vertical distance (“D1” shown in FIG. 5 ) between the tip 29 of the outer wall 5 and the tip 27 of the inner wall 7 .
- tissue layer “L” which is enclosed within the housing 3 , is elevated and the hollow chamber 13 is isolated from the suction applied via the port 9 , the tissue layer “L” may be further drawn into the cavity 11 to form a ridge of tissue surrounding the substantially flat tissue underneath the hollow chamber 13 . It is contemplated that the elevation of tissue within the housing 3 can prevent the snare 21 from snagging on the inner wall 7 during resection procedure, e.g.
- a distal tip 27 of inner wall 7 may be longer than tip 29 of outer wall 5 .
- apparatus 80 may include an outer wall 82 and an inner wall 84 .
- Inner wall 84 may be configured to extend distally further than outer wall 82 to ensure proper suction on the targeted tissue is maintained. In other embodiments, however, the distal ends of both inner and outer walls 82 and 84 may be flush with one another.
- the hollow chamber 13 may be provided with its own aspiration port 31 to provide negative/positive pressure in the hollow chamber 13 .
- negative pressure may be applied to draw tissue into the disclosed apparatus.
- positive pressure may be used to expel tissue lodged in the disclosed apparatus or otherwise in contact with the disclosed apparatus.
- a tubular member 15 may include an internal or an auxiliary working channel (not shown) providing an aspiration path for the hollow chamber 13 .
- ports 9 and 31 may be used to introduce, e.g., irrigation or insufflation, to a location within a patient's body.
- the inner wall 7 When it is not necessary to elevate the tissue prior to forming the ridge of tissue, the inner wall 7 may be extended in the distal direction so that the tip 27 of the inner wall 7 is substantially co-planar with the tip 29 of the outer wall 5 , thereby creating instant isolation of the hollow chamber 13 from the suction applied via the port 9 .
- outer wall 5 may be also configured to be adjustable in substantially the same manner as inner wall 7 .
- the adjustable inner wall 7 may include a plurality of telescoping segments 33 that are arranged to slide, e.g., in and out relative to one another, as depicted in FIG. 5 .
- the elongated tubular member 15 may be used in exerting the force necessary for extending and/or retracting the telescoping segments 33 .
- the elongated member 15 may include one or more grooves that may selectively couple with one or more of ridges 19 or may abut a fixed portion of the inner wall 7 , such that the vertical length (“D2”) of the inner wall 7 may be controlled by pushing in and/or pulling out the tubular member 15 .
- some portion of the inner wall 7 may be formed as a screw thread, a helical ridge, a spiral groove and/or appropriate gearing mechanisms, such that the distance between the tip 27 of the inner wall 7 and the tip 29 of the outer wall 5 is adjusted by applying rotational force to move the inner wall 7 in the proximal or distal directions relative to outer wall 5 .
- a portion of an external wall of the elongated tubular member 15 may include a screw thread corresponding to a screw thread on the inner wall 7 , so that rotational force applied to the tubular member 15 facilitates moving the inner wall 7 relative outer wall 5 .
- other control means that are operable via the working channel and/or the lumen may be used in implementing the adjustable inner wall 7 .
- Such other control means may include, e.g., an electric motor disposed in the housing 3 or the tubular member 15 controlled via the control lines extending through the lumen in the tubular member 15 .
- the size (e.g., a width or volume) of the resected tissue may be controlled by the amount of tissue drawn into the cavity 11 .
- the apparatus 1 may further include a number of depth limiters 35 disposed within the cavity 11 to adjust and/or control the amount of tissue drawn into the cavity 11 , as shown in FIGS. 5 , 6 A and 6 B.
- the depth limiters 35 may include a plurality of blocks, panels, or other suitable structures that extend between the outer wall 5 and the inner wall 7 at a specific depth (e.g., “D3” shown in FIG. 5 ) within and around the cavity 11 .
- the plurality of depth limiters 35 may be arranged relative to each other in such a way that a plurality of gaps 37 is formed between every two adjacent depth limiters 35 .
- the size of each gap 37 formed between the depth limiters 35 should be sufficient to maintain the air-flow necessary for drawing tissue into the cavity 11 while preventing the tissue from passing through the gap 37 .
- the size of the gaps 37 formed between each of the depth limiters 35 may vary depending on the type of tissues and/or the type of resection procedures.
- the depth of the vertical distance (“D3”) of the depth limiters relative to the tip 29 of the outer wall 5 may be adjustable.
- some portion of the inner wall 7 may include one or more slots for receiving the depth limiters 35 , so that the depth limiter 35 can be moved distally or proximally within the cavity 11 .
- the depth limiters may extend from or be received in an inner surface of outer wall 5 .
- One of the internal or the auxiliary working channels may be used for extending a control mechanism for moving depth limiters 35 within the cavity 11 .
- the control mechanism may be a rotatable rod or a cable configured to push and pull the depth limiters 35 along the cavity 11 .
- the depth limiters 35 may utilize a screw thread, a helical ridge, a spiral grove and/or other suitable mechanisms configured for adjusting the position of depth limiters 35 .
- the control mechanism may also be an electrical motor disposed in the housing 3 or the tubular member 15 , providing sufficient force to move the depth limiters 35 as desired.
- each depth limiter 35 may be separately adjustable by providing an independent control mechanism for each depth limiter 35 . This configuration may allow for more precise control over the amount of tissue being drawn into the cavity 11 as each of the depth limiters 35 around the cavity 11 may be adjusted to be at differing depths. It should be appreciated that various other control mechanisms and configurations may be used in implementing the adjustable depth limiters 35 .
- the disclosed apparatus may include suitable cutting and/or ligating instruments.
- the device 70 may be provided with a cutting tool 72 disposed about a periphery of opening 74 .
- Cutting tool 72 may include any suitable tool known in the art.
- cutting tool 72 may include a snare, which may or may not include electro-cautery capabilities.
- cutting tool 72 may include a ligating band or shuttling wire in some embodiments.
- the depicted embodiment illustrates that cutting tool 72 is disposed adjacent outer wall 76 , those of ordinary skill in the art will understand that cutting tool 72 may be disposed adjacent inner wall 78 .
- FIGS. 9A-9C depict embodiments of an alternative apparatus in accordance with the present disclosure.
- inner wall 90 may be longer than outer wall 94 . Together inner wall 90 and outer wall 94 may define a groove 96 therebetween for receiving tissue.
- a cutting tool 98 (as discussed above) may be disposed adjacent outer wall 94 .
- a distal end of inner wall 90 may be angled away from outer wall 94 .
- an outer, distal edge of outer wall 94 may include a bevel or chamfer.
- Groove 96 may include a generally rectangular cross-sectional configuration.
Abstract
A medical device may include a housing. The housing may include an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall. The distal end of the outer wall may be disposed proximally from the distal end of the inner wall. The housing may further define a passageway therethrough. The cavity may be in fluid communication with a port configured to adjust pressure within the cavity.
Description
- This application claims the benefit of priority from U.S. Provisional Application No. 61/777,988, filed on Mar. 12, 2013, and U.S. Provisional Application No. 61/798,690, filed on Mar. 15, 2013, each of which is incorporated by reference herein in its entirety.
- 1. Field of the Disclosure
- The present disclosure generally relates to a medical instrument, and more particularly to an apparatus for tissue resection.
- 2. Background
- A wide variety of medical techniques and instruments have been developed for diagnosis and/or treatment within a patient's body, such as the gastrointestinal (GI) tract. For example, endoscopic mucosal resection (EMR) is a minimally invasive technique used for removing, e.g., malignant/non-malignant lesions and/or otherwise unwanted tissue. Endoscopic medical procedures, for example EMR, may excise sessile adenomas (i.e., tumors attached to a bodily surface) in an anatomical lumen. Such procedures often require the dissection of one tissue plane while leaving an underlying tissue plane intact. When performing these procedures, it is desirable to cleanly cut and retrieve a uniform tissue sample of sufficient size, particularly where a pathology study of the sample might be necessary. In addition, it is desirable for the resection to leave clean margins at the treatment site in order to minimize any further disruption of the surrounding anatomy.
- If the adenoma is flat against a lumen wall, however, excising the adenoma can be difficult. In such cases, one of several techniques may be used to raise the flat adenoma so that it may be excised appropriately without harming underlying tissue layers. For instance, forceps can be used to raise the flat adenoma. Also, injections of a solution into, e.g., the submucosal or an underlying tissue layer can create a space or opening under the tissue, creating a buffer zone. The space lifts the flat adenoma above the underlying tissue to facilitate removal, and minimizes mechanical or electrocautery damage to the deeper tissue layers.
- These conventional techniques and instruments, however, have many disadvantages and/or limitations. For example, perforation is a key concern as it poses a serious safety risk the patient. The present disclosure is described to overcome one or more of the above limitations and/or other shortcomings in the art.
- The present disclosure relates to a embodiments of apparatus and methods for tissue resection, which may reduce the risk of perforating underlying tissue layers by, e.g., lifting and separating the mucosa from the muscularis, around the perimeter of the lesion or other unwanted tissue.
- In one embodiment, a medical device may include a housing. The housing may include an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall. The distal end of the outer wall may be disposed proximally from the distal end of the inner wall. The housing may further define a passageway therethrough. The cavity may be in fluid communication with a port configured to adjust pressure within the cavity.
- In another embodiment, an endoscopic mucosal resection device may include an elongate member. The elongate member may include a proximal end, a distal end, and a lumen extending therebetween. The device may also include a housing operably coupled and movable relative to the distal end of the elongate member. The housing may include an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall. The distal end of the outer wall may be disposed proximally from the distal end of the inner wall. The housing may further define a passageway therethrough. A proximal portion of the passageway may be configured to receive the elongate member therein. The device may also include a cutting device.
- In a further embodiment, a method of resecting tissue from within a patient may include advancing an endoscopic mucosal resection device to a target location within the patient. The endoscopic mucosal resection device may include a housing operably coupled and movable relative to the distal end of an elongate member. The housing may include an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall. The housing may further define a passageway therethrough. A proximal portion of the passageway may be configured to receive the elongate member therein. The method may also include disposing a distal end of the housing adjacent a tissue wall. The method may also include applying suction to the cavity to draw at least one layer of the tissue wall into the cavity. The method may also include resecting a portion of tissue drawn into the cavity.
- Other aspects and features of the disclosure will be evident from reading the following detailed description of the preferred embodiments, which are intended to illustrate, not limit, the disclosure.
- The present disclosure is further described in the detailed description which follows, in reference to the drawings, by way of non-limiting examples of preferred embodiments of the present disclosure, in which like characters represent like elements throughout the several views of the drawings.
-
FIG. 1 illustrates a perspective view of an exemplary tissue resection apparatus according to an embodiment of the present disclosure. -
FIG. 2 is a cross-sectional view of the exemplary tissue resection apparatus ofFIG. 1 . -
FIG. 3 is a cross-sectional view of the exemplary tissue resection apparatus including an endoscope therein and in cooperating with tissue, according to an embodiment of the present disclosure. -
FIG. 4 is a schematic view of an exemplary tissue resection apparatus in combination with a suitable cutting device, in accordance with another embodiment of the present disclosure. -
FIG. 5 is a cross-sectional view of an exemplary tissue resecting apparatus, according to a further aspect of the present disclosure. -
FIG. 6A is a top view of the apparatus ofFIG. 5 . -
FIG. 6B is a bottom view of the apparatus ofFIG. 5 . -
FIGS. 7A-7B depict an alternate embodiment of an apparatus in accordance with a further embodiment of the present disclosure. -
FIG. 8 depicts a further embodiment of an apparatus in accordance with the present disclosure. -
FIGS. 9A-9C depict exemplary structures to facilitate separating a first tissue layer from a second tissue layer, in accordance with the present disclosure. - Reference will now be made in detail to the exemplary embodiments of the disclosure illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
- The present disclosure relates to an apparatus for endoscopic treatment, which may reduce the risk of perforating an underlying tissue layer, e.g., by lifting and separating the tissue layer intended for resection from the underlying layer, which is not intended for the resection.
FIG. 1 andFIG. 2 illustrate an exemplary tissue resection apparatus 1, according to an embodiment of the present disclosure. As shown, the apparatus may include ahousing 3 having anouter wall 5 and aninner wall 7 disposed within thehousing 3. Theinner wall 7 is surrounded by theouter wall 5 and separated by a specific distance so that there is acavity 11 or a hollow gap (referred hereinafter as the “cavity”) formed between theouter wall 5 and theinner wall 7. In one embodiment, thecavity 11 may be substantially annular or completely annular, extending completely aboutchamber 13. The distal end of thehousing 3 is opened so that thehousing 3 is adapted to be placed against a surface of tissue. Thehousing 3 further includes a connection to a suction source, for example theport 9, for applying suction in thecavity 11 to draw tissue into thecavity 11. - In some embodiments, the space surrounded by the
inner wall 7 may be hollow, forming ahollow chamber 13, as depicted inFIG. 2 . As will be described in further detail below, thehousing 3 may include aproximal opening 15, providing access to thehollow chamber 13, so that an elongated tubular member (not shown inFIG. 2 ) can be inserted into thehollow chamber 13. -
FIG. 3 illustrates a cross-sectional view of the apparatus 1 being placed against a tissue layer “L”. When the apparatus is placed against the surface of targeted tissue layer “L”, the suction applied from the suction source (not shown) via theport 9 draws in the targeted tissue “L” into thecavity 11, thereby forming a ridge of tissue, as illustrated inFIG. 3 . In one embodiment,port 9 may be in fluid communication withcavity 11, so that a vacuum applied toportion 9 may be realized throughoutcavity 11. As shown inFIG. 1 , e.g.,port 9 may be offset relative to a longitudinal axis ofhousing 3 such that cavity 13 (discussed below) may receivetubular member 17 therein. A portion ofport 9 may be configured to extend away from a proximal end ofhousing 3. The raised ridge of tissue drawn into thecavity 11 may facilitate snaring or other resection methods. Thecavity 11 may be preferably narrow so that the non-targeted sub tissue layer (e.g., tissue layer “SL”) is excluded from being drawn up into the cavity, thereby reducing the risk of perforating the SL tissue layer. - In some embodiments, the
housing 3 may include a substantially cylindrical shape. In such a case, a continuous circular cavity will be formed between theouter wall 5 and theinner wall 7, and the tissue drawn into thecavity 11 will form a circumferential ridge of tissue surrounding a substantially flat tissue surface in the middle, as illustrated inFIG. 3 . However, it should be noted that thehousing 3 can be in any shape suitable for forming thecavity 11 for drawing tissue therein. For example,housing 3 may include a square or rectangular configuration shown in, e.g.,FIGS. 7A , 7B, and 8. More particularly,housing 3 defines an opening having at least one straight edge to facilitate removal of tissue via a tessellation technique. - As briefly described above, the apparatus 1 may include a
hollow chamber 13 for accommodating an elongated tubular member (e.g., tubular member 17). In an aspect, the apparatus 1 may be configured as an endoscopic cap, and theelongated tubular member 17 may be an endoscope with various endoscope functionalities, including visualization, illumination, flushing, irrigation, suction, and the like, and using a variety of tools through its working channels (not shown). Those of ordinary skill in the art will understand thattubular member 17 may include any suitable introduction sheath known in the art. - In some embodiments, one or more internal working channels may be included inside the
tubular member 17 for receiving endoscopic instruments, such as an optical scope or as an aspiration path connected to the suction source. It should be noted that the internal working channels may have non-circular cross-sectional shapes, and may be in any shapes depending on the types of endoscopic instrument and/or application of the working channel(s). Further, thetubular member 17 may include a number of additional lumens for receiving control wires, which may extend from various control sources (e.g., actuation handle, knobs, steering controls, etc.) disposed at the proximal end oftubular member 17 through thetubular member 17. - An external shape and dimension of the
tubular member 17 may be substantially the same as thehollow chamber 13. In some embodiments, the dimension (e.g., width) of thetubular member 17 may be slightly larger than the size of thehollow chamber 13 in order to facilitate a tight fitting of thetubular member 17 into thehollow chamber 13. In such cases, the surroundings of the proximal opening of thehollow chamber 13 and/or theinner wall 7 may be made of a flexible material that is elastically deformable to accommodate the largertubular member 17 into thehollow chamber 13. In some embodiments, thetubular member 17 may be made of a flexible material that is elastically deformable, so that thetubular member 15 can be snuggly fitted into thehollow chamber 13. In addition, one or more ledges orridges 19 may be formed on an interior wall of thehollow chamber 13 to prevent thetubular member 17 from passing through the entirehollow chamber 13. A position of ledges orridges 19 alonginner wall 7 may be varied as desired to alter a position oftubular member 17 relative tohousing 3. Also, in some other embodiments, the apparatus 1 may be configured so that theelongated tubular member 17 can pass completely through thehollow chamber 13, which will allow for extension and retraction of the apparatus 1 relative to the tubular member 17 (e.g., endoscope). In such embodiments, therefore, ledges orridges 19 may be excluded. -
FIG. 4 illustrates an exemplary embodiment of the apparatus 1 equipped with asnare 21. Those of ordinary skill in the art will understand that any suitable cutting device may be used in conjunction with apparatus 1. As shown, snare 21 can be opened and preloaded around the exterior of the apparatus 1 prior to drawing in the tissue. When the tissue layer (“L”) is drawn into thecavity 11 as shown inFIG. 2 , thesnare 21 can be closed around the base of the raised circumferential ridge of the drawn up tissue for resection. In this example, thetubular member 17 may be surrounded by asheath 23, which may contain at least oneauxiliary working channel 25. Thesheath 23 may include a flexible tubular member extending proximally away from a proximal end of thehousing 3. Auxiliary workingchannel 25 may include a lumen in theaforementioned sheath 23 or another tubular member operably coupled to thesheath 23. For instance, theauxiliary working channel 25 may accommodate thesnare 21. It should be appreciated that thesheath 23 may include a plurality of auxiliary workingchannels 25 for various other functionalities. For example, one of the working channels may function as the aspiration path between theport 9 and the suction source (not shown). Additional auxiliary working channels may be included in thesheath 23 to accommodate various other instruments and functionalities. Although the apparatus 1 and thetubular member 17 have been described in the context of an endoscope cap with a snare, it is contemplated that thetubular member 17 also may be any other medical device, such as a catheter or guiding tube that includes any number of the features and characteristics disclosed herein. Further, various tissue dissection/resection tools may be also used in conjunction with the apparatus 1 for tissue resection or other endoscopic treatment. -
FIG. 5 illustrates additional details of the apparatus 1. The distal end portion of theouter wall 5 may be rounded and bent towards theinner wall 7 at a predetermined angle. This angle may promote drawing in the tissue positioned underneath the hollow chamber 13 (i.e., the tissue layer “L” surrounded by the most distal end/tip 27 of the inner wall 7) so that tissue underneath thehollow chamber 13 becomes taut as illustrated by the arrows inFIG. 3 . - In some embodiments, the distal most end/
tip 27 of theinner wall 7 is substantially co-planar with the distal most end/tip 29 of theouter wall 5. In other embodiments, however, thetip 27 of theinner wall 7 may be recessed towards the proximal end of thehousing 3 relative to thetip 29 of theouter wall 5 as shown inFIG. 5 . In other words, thetip 29 of theouter wall 5 is extended closer to the surface of the tissue layer (“L”) than thetip 27 of theinner wall 7. In this configuration, thehollow chamber 13 may not be completely isolated from the suction applied via theport 9 by theinner wall 7. Accordingly, when the suction is applied from the suction source, the tissue layer (“L”) enclosed within thetip 29 of theouter wall 5 may be drawn up (i.e., lifted) to the level of thetip 27 of theinner wall 7 initially. When the tissue layer (“L”) contacts thetip 27 of the recessedinner wall 7, a seal may be formed so that thecavity 11 is isolated from thehollow chamber 13. In other words, the recessedinner wall 7 elevates the tissue layer (“L”) approximately equal to the vertical distance (“D1” shown inFIG. 5 ) between thetip 29 of theouter wall 5 and thetip 27 of theinner wall 7. - Once the tissue layer “L”, which is enclosed within the
housing 3, is elevated and thehollow chamber 13 is isolated from the suction applied via theport 9, the tissue layer “L” may be further drawn into thecavity 11 to form a ridge of tissue surrounding the substantially flat tissue underneath thehollow chamber 13. It is contemplated that the elevation of tissue within thehousing 3 can prevent thesnare 21 from snagging on theinner wall 7 during resection procedure, e.g. - Further, in some embodiments, a
distal tip 27 ofinner wall 7 may be longer thantip 29 ofouter wall 5. For example, with reference toFIG. 8 ,apparatus 80 may include anouter wall 82 and aninner wall 84.Inner wall 84 may be configured to extend distally further thanouter wall 82 to ensure proper suction on the targeted tissue is maintained. In other embodiments, however, the distal ends of both inner andouter walls - In some embodiments, the
hollow chamber 13 may be provided with itsown aspiration port 31 to provide negative/positive pressure in thehollow chamber 13. For example, negative pressure may be applied to draw tissue into the disclosed apparatus. In the embodiments where positive pressure is applied, the positive pressure may be used to expel tissue lodged in the disclosed apparatus or otherwise in contact with the disclosed apparatus. In such embodiments, atubular member 15 may include an internal or an auxiliary working channel (not shown) providing an aspiration path for thehollow chamber 13. In some embodiments, one or both ofports - In some embodiments, the length of the inner wall 7 (e.g., the vertical length “D2”) may be adjustable, such that the
tip 27 of theinner wall 7 may be extended and/or retracted in distal and proximal directions relative towall 5. It is contemplated that the adjustableinner wall 7 enables controlling the amount of elevation of the tissue required for creating the seal (e.g., isolating thehollow chamber 13 from the port 9), at which point the tissue will be drawn into thecavity 11 to form the ridge of tissue. Adjustinginner wall 7 may also allow sufficiently separating tissue layers so that an underlying tissue is not perforated during a resection procedure. When it is not necessary to elevate the tissue prior to forming the ridge of tissue, theinner wall 7 may be extended in the distal direction so that thetip 27 of theinner wall 7 is substantially co-planar with thetip 29 of theouter wall 5, thereby creating instant isolation of thehollow chamber 13 from the suction applied via theport 9. Those of ordinary skill in the art will readily recognize thatouter wall 5 may be also configured to be adjustable in substantially the same manner asinner wall 7. - Various types of mechanisms and configurations may be employed in implementing the adjustable
inner wall 7 orouter wall 5. For the purposes of efficiency, the adjustable mechanisms will be only described relative toinner wall 7, however those of ordinary skill will understand that the same principles may be applied toouter wall 5. In an exemplary embodiment, theinner wall 7 may include a plurality oftelescoping segments 33 that are arranged to slide, e.g., in and out relative to one another, as depicted inFIG. 5 . In this example, theelongated tubular member 15 may be used in exerting the force necessary for extending and/or retracting thetelescoping segments 33. For instance, theelongated member 15 may include one or more grooves that may selectively couple with one or more ofridges 19 or may abut a fixed portion of theinner wall 7, such that the vertical length (“D2”) of theinner wall 7 may be controlled by pushing in and/or pulling out thetubular member 15. In some other embodiments, some portion of theinner wall 7 may be formed as a screw thread, a helical ridge, a spiral groove and/or appropriate gearing mechanisms, such that the distance between thetip 27 of theinner wall 7 and thetip 29 of theouter wall 5 is adjusted by applying rotational force to move theinner wall 7 in the proximal or distal directions relative toouter wall 5. For example, a portion of an external wall of theelongated tubular member 15 may include a screw thread corresponding to a screw thread on theinner wall 7, so that rotational force applied to thetubular member 15 facilitates moving theinner wall 7 relativeouter wall 5. In some other embodiments, other control means that are operable via the working channel and/or the lumen may be used in implementing the adjustableinner wall 7. Such other control means may include, e.g., an electric motor disposed in thehousing 3 or thetubular member 15 controlled via the control lines extending through the lumen in thetubular member 15. - The size (e.g., a width or volume) of the resected tissue may be controlled by the amount of tissue drawn into the
cavity 11. Accordingly, in some embodiments, the apparatus 1 may further include a number ofdepth limiters 35 disposed within thecavity 11 to adjust and/or control the amount of tissue drawn into thecavity 11, as shown inFIGS. 5 , 6A and 6B. The depth limiters 35 may include a plurality of blocks, panels, or other suitable structures that extend between theouter wall 5 and theinner wall 7 at a specific depth (e.g., “D3” shown inFIG. 5 ) within and around thecavity 11. The plurality ofdepth limiters 35 may be arranged relative to each other in such a way that a plurality ofgaps 37 is formed between every twoadjacent depth limiters 35. The size of eachgap 37 formed between thedepth limiters 35 should be sufficient to maintain the air-flow necessary for drawing tissue into thecavity 11 while preventing the tissue from passing through thegap 37. The size of thegaps 37 formed between each of thedepth limiters 35 may vary depending on the type of tissues and/or the type of resection procedures. - In some embodiments, the depth of the vertical distance (“D3”) of the depth limiters relative to the
tip 29 of theouter wall 5 may be adjustable. By way of an example, some portion of theinner wall 7 may include one or more slots for receiving thedepth limiters 35, so that thedepth limiter 35 can be moved distally or proximally within thecavity 11. Similarly, the depth limiters may extend from or be received in an inner surface ofouter wall 5. One of the internal or the auxiliary working channels may be used for extending a control mechanism for movingdepth limiters 35 within thecavity 11. The control mechanism may be a rotatable rod or a cable configured to push and pull thedepth limiters 35 along thecavity 11. In some other embodiments, thedepth limiters 35 may utilize a screw thread, a helical ridge, a spiral grove and/or other suitable mechanisms configured for adjusting the position ofdepth limiters 35. The control mechanism may also be an electrical motor disposed in thehousing 3 or thetubular member 15, providing sufficient force to move thedepth limiters 35 as desired. - Further, the plurality of
depth limiters 35 may be formed as a single piece structure in order to simplify the control mechanism for adjusting thedepth limiter 35. Alternatively, eachdepth limiter 35 may be separately adjustable by providing an independent control mechanism for eachdepth limiter 35. This configuration may allow for more precise control over the amount of tissue being drawn into thecavity 11 as each of thedepth limiters 35 around thecavity 11 may be adjusted to be at differing depths. It should be appreciated that various other control mechanisms and configurations may be used in implementing theadjustable depth limiters 35. - In some embodiments, the disclosed apparatus may include suitable cutting and/or ligating instruments. For example, as shown in
FIG. 7B , thedevice 70 may be provided with acutting tool 72 disposed about a periphery ofopening 74. Cuttingtool 72 may include any suitable tool known in the art. For example, in one embodiment, cuttingtool 72 may include a snare, which may or may not include electro-cautery capabilities. Further, cuttingtool 72 may include a ligating band or shuttling wire in some embodiments. Further, although the depicted embodiment illustrates that cuttingtool 72 is disposed adjacentouter wall 76, those of ordinary skill in the art will understand that cuttingtool 72 may be disposed adjacentinner wall 78. -
FIGS. 9A-9C depict embodiments of an alternative apparatus in accordance with the present disclosure. For example, as shown inFIG. 9A ,inner wall 90 may be longer thanouter wall 94. Togetherinner wall 90 andouter wall 94 may define agroove 96 therebetween for receiving tissue. A cutting tool 98 (as discussed above) may be disposed adjacentouter wall 94. A distal end ofinner wall 90 may be angled away fromouter wall 94. Further, an outer, distal edge ofouter wall 94 may include a bevel or chamfer.Groove 96 may include a generally rectangular cross-sectional configuration. - With reference to
FIG. 9B , e.g., a distal end ofinner wall 90 may be substantially planar. However,outer wall 94 may include a configuration that anglesouter wall 94 towardinner wall 90. Turning now toFIG. 9C ,inner wall 96 may include afirst portion 96 a movably coupled to asecond portion 96 b.First portion 96 a may be configured to move reciprocally in the directions ofarrow 100.Second portion 96 b may be configured to transition between a first configuration and a second configuration, wherein in the second configuration, thesecond portion 96 b is configured to trap tissue betweensecond portion 96 b and an inner surface ofouter wall 94. - It should be understood that this disclosure is, in many respects, only illustrative. Changes may be made in details, particularly in matters of shape, size, length, and arrangement of components without exceeding the scope of the present disclosure. Thus, the present disclosure is intended to cover alternatives, modifications, and equivalents, which may be included within the spirit and scope of the present disclosure as defined by the claims.
Claims (20)
1. A medical device, comprising:
a housing including an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall, wherein the distal end of the outer wall is disposed proximally from the distal end of the inner wall, the housing further defines a passageway therethrough, and the cavity is in fluid communication with a port configured to adjust pressure within the cavity.
2. The medical device of claim 1 , further comprising a plurality a depth limiters disposed in the cavity, wherein the plurality of depth limiters extend from one of the inner or outer walls.
3. The medical device of claim 1 , further comprising an element capable of resecting tissue provided external to the inner wall.
4. The medical device of claim 3 , wherein the element capable of resecting tissue is a snare.
5. The medical device of claim 1 , wherein the inner wall includes at least one ledge projecting into the passageway for limiting a travel of the elongate member.
6. The medical device of claim 1 , wherein the housing defines an opening having at least one straight edge.
7. The medical device of claim 8 , wherein the housing defines an opening having a plurality of straight edges.
8. The medical device of claim 1 , wherein the inner wall is adjustable relative to the outer wall.
9. The medical device of claim 1 , wherein the elongate member includes an endoscope including at least one imaging device.
10. The medical device of claim 1 , wherein the housing includes a sheath extending proximally therefrom, and wherein the sheath includes a lumen configured to receive an endoscopic cutting device.
11. The medical device of claim 1 , wherein a distal end of the outer wall is curved towards the inner wall.
12. An endoscopic mucosal resection device, comprising:
an elongate member including a proximal end, a distal end, and a lumen extending therebetween;
a housing operably coupled and movable relative to the distal end of the elongate member, the housing including an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall, wherein the distal end of the outer wall is disposed proximally from the distal end of the inner wall, the housing further defines a passageway therethrough, and a proximal portion of the passageway is configured to receive the elongate member therein; and
a cutting device.
13. The medical device of claim 12 , wherein the cavity is in fluid communication with a port configured to adjust pressure within the cavity.
14. The medical device of claim 12 , wherein the cutting device is provided external to the inner wall.
15. The medical device of claim 12 , wherein the inner wall includes at least one ledge projecting into the passageway for limiting travel of the elongate member.
16. The medical device of claim 12 , wherein the inner wall is adjustable relative to the outer wall.
17. The medical device of claim 12 , further including at least one depth limiter disposed in the cavity and extending from one of the inner or outer walls.
18. The medical device of claim 12 , wherein the housing includes a sheath extending proximally therefrom, the sheath including a lumen for receiving a portion of the cutting device.
19. A method of resecting tissue from within a patient, comprising:
advancing an endoscopic mucosal resection device to a target location within the patient, the endoscopic mucosal resection device comprising:
a housing operably coupled and movable relative to the distal end of an elongate member, the housing including an outer wall, an inner wall spaced from the outer wall, and a cavity defined by the outer wall and the inner wall, wherein the housing further defines a passageway therethrough, a proximal portion of the passageway being configured to receive the elongate member therein;
disposing a distal end of the housing adjacent a tissue wall;
applying suction to the cavity to draw at least one layer of the tissue wall into the cavity; and
resecting a portion of tissue drawn into the cavity.
20. The method of claim 19 , wherein a distal end of the outer wall is disposed proximally of a distal end of the inner wall.
Priority Applications (1)
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US14/204,670 US20140275769A1 (en) | 2013-03-12 | 2014-03-11 | Apparatus for tissue dissection with suction ring |
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US201361777988P | 2013-03-12 | 2013-03-12 | |
US201361798690P | 2013-03-15 | 2013-03-15 | |
US14/204,670 US20140275769A1 (en) | 2013-03-12 | 2014-03-11 | Apparatus for tissue dissection with suction ring |
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US20140275769A1 true US20140275769A1 (en) | 2014-09-18 |
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US14/204,670 Abandoned US20140275769A1 (en) | 2013-03-12 | 2014-03-11 | Apparatus for tissue dissection with suction ring |
US14/204,808 Expired - Fee Related US10058344B2 (en) | 2013-03-12 | 2014-03-11 | Apparatus for tissue dissection with suction ring |
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US14/204,808 Expired - Fee Related US10058344B2 (en) | 2013-03-12 | 2014-03-11 | Apparatus for tissue dissection with suction ring |
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EP (1) | EP2967624B1 (en) |
JP (1) | JP6373959B2 (en) |
CN (1) | CN105188574B (en) |
AU (1) | AU2014248907B2 (en) |
CA (1) | CA2901925A1 (en) |
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US20140214063A1 (en) * | 2013-01-31 | 2014-07-31 | Olympus Medical Systems Corp. | Operative method for lumen |
US10631893B2 (en) * | 2015-07-10 | 2020-04-28 | Warsaw Orthopedic, Inc. | Nerve and soft tissue removal device |
US11033290B2 (en) * | 2015-12-21 | 2021-06-15 | Boston Scientific Scimed, Inc | Medical device and methods of use |
WO2021108240A1 (en) * | 2019-11-27 | 2021-06-03 | Boston Scientific Scimed, Inc. | Devices and systems for securing tissue |
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Also Published As
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AU2014248907A1 (en) | 2015-09-10 |
AU2014248907B2 (en) | 2018-09-13 |
JP6373959B2 (en) | 2018-08-15 |
WO2014164840A1 (en) | 2014-10-09 |
CN105188574A (en) | 2015-12-23 |
US20140276909A1 (en) | 2014-09-18 |
EP2967624A1 (en) | 2016-01-20 |
CN105188574B (en) | 2018-09-28 |
EP2967624B1 (en) | 2017-02-01 |
CA2901925A1 (en) | 2014-10-09 |
US10058344B2 (en) | 2018-08-28 |
JP2016512076A (en) | 2016-04-25 |
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Owner name: BOSTON SCIENTIFIC SCIMED, INC., MINNESOTA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:RAYBIN, SAMUEL;SMITH, PAUL;SUON, NAROUN;AND OTHERS;SIGNING DATES FROM 20140304 TO 20140306;REEL/FRAME:032437/0695 |
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STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |