# US 11,998,205 B2 · Gastrointestinal tissue approximation clip (GI TAC) system

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- Number: US 11,998,205 B2
- Document ID: US11998205B2
- Status: Granted
- Kind: B2
- Application number: 17/461,646
- Filed: 2021-08-30
- Published: 2021-12-16
- Granted: 2024-06-04
- Earliest claimed: 2020-01-13
- Applicants: Brian Lim
- Inventors: Brian Lim
- Web page: https://patentgrep.com/patent/US11998205B2

## CPC

- A61B 17/0401: {Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors (A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811)}
- A61B 17/083: {Clips, e.g. resilient}
- A61B 17/0466: {Suture bridges}
- A61B 17/0467: {Instruments for cutting sutures (surgical cutting instruments A61B17/32)}
- A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery}
- A61B 17/0483: {Hand-held instruments for holding sutures (A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30)}
- A61B 17/0487: {Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks (suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122)}
- A61B 17/06061: {Holders for needles or sutures, e.g. racks, stands (hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008)}
- A61B 17/10: for applying or removing wound clamps {, e.g. containing only one clamp or staple (A61B17/076 takes precedence; containing multiple wound clamps A61B17/068)}; Wound clamp magazines
- A61B 17/0482: {Needle or suture guides (guides for drills, pins or wire A61B17/17; guides for puncturing needles A61B17/3403)}
- A61B 17/0485: {Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet}
- A61B 2017/0034: {adapted to be inserted through a working channel of an endoscope}
- A61B 2017/00349: {Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue (A61B17/06066 takes precedence)}
- A61B 2017/00818: {Treatment of the gastro-intestinal system}
- A61B 2017/00876: {magnetic}
- A61B 2017/0409: {Instruments for applying suture anchors}
- A61B 2017/0414: {having a suture-receiving opening, e.g. lateral opening}
- A61B 2017/0464: {for soft tissue}
- A61B 2017/0488: {Instruments for applying suture clamps, clips or locks}
- A61B 2017/081: {Tissue approximator (A61B2017/1103, A61B17/8866 take precedence)}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A gastrointestinal tissue approximation clip (“GI TAC”) system for approximating tissue defects, the GI TAC system including an applicator that is sized to travel through an instrument channel of an endoscope; a plurality of tissue approximation clips that are transported to a plurality of locations about a tissue defect by the applicator; a suture coupled to at least one of the tissue approximation clips; and a clip approximation means for approximating the tissue approximation clips. The clip approximation means and the tissue approximation clips are sized respectively to travel through the instrument channel, and the tissue approximation clips are adapted to be detachably coupled to the applicator.

## Claims

### Claim 1

A gastrointestinal tissue approximation clip (“GI TAC”) system for approximating tissue defects, the GI TAC system comprising:
an applicator that is sized to travel through an instrument channel of an endoscope;
a plurality of tissue approximation clips that are transported to a plurality of locations about a tissue defect respectively by the applicator;
a suture coupled to at least one of the tissue approximation clips; and
a clip approximation means for approximating the tissue approximation clips,
wherein the clip approximation means and the tissue approximation clips are sized respectively to travel through the instrument channel, and
wherein the tissue approximation clips are adapted to be detachably coupled to the applicator;
wherein the clip approximation means is a suture adjoining clamp, the suture adjoining clamp comprising movable arms,
wherein each of the arms of the suture adjoining clamp includes a grip and a through-hole through which threading of the suture is permitted, and
wherein the arms of the suture adjoining clamp are movable from a spaced-apart position to an approximated position, and movable from the approximated position to the spaced-apart position;
wherein the suture adjoining clamp further comprising a cutting device which includes:
a tube having an end; and
a blade to cut the suture,
wherein the cutting device is sized to pass through the instrument channel of the endoscope,
wherein the blade is constructed to slide away from about an edge of the tube end to open the end of the tube,
wherein the blade is constructed to slide towards to at least about the edge of the tube end to cut the suture, and
wherein the end, when opened, creates a through-hole that permits the suture to pass through.

### Claim 2 (depends on 1)

The GI TAC system of claim 1, wherein each of the tissue approximation clips comprises:
a body portion; and
a grasping portion that is coupled to the body portion; and
a pass-through hole,
wherein the grasping portion includes first and second jaw portions that are constructed to move from a spaced-apart position to an approximated position, and move from the approximated position to the spaced-apart position,
wherein the grasping portion is constructed to grasp a portion of a tissue about the tissue defect, and
wherein the body portion is constructed to be detachably coupled to the applicator.

### Claim 3 (depends on 2)

The GI TAC system of claim 2, wherein the first and second jaw portions of the grasping portion is of a rat-toothed configuration, or wherein an end of the first jaw portion includes a protrusion,
and the second jaw portion includes a hole to accommodate the protrusion when the first jaw portion in the approximated position with the second jaw portion.

### Claim 4 (depends on 2)

The GI TAC system of claim 2, wherein the first and second jaw portions include a plurality of protrusions,
wherein the protrusions of the first jaw portion are not aligned with respect to the protrusions of the second jaw portion, and
wherein the protrusions of the first jaw portion interlock with the protrusions of the second jaw portion when the first and second jaw portions are closed together.

### Claim 5 (depends on 2)

The GI TAC system of claim 2, wherein each of the tissue approximation clips further comprises a corkscrew element that is configured to interact with the tissue, and wherein the first and second jaw portions of the tissue approximation clips are constructed to open, up to 180° from each other.

### Claim 6 (depends on 2)

The GI TAC system of claim 2, wherein each of the tissue approximation clips further comprises a ring that forms the passthrough hole.

### Claim 7 (depends on 6)

The GI TAC system of claim 6, wherein the ring includes a loop portion that forms the pass-through hole,
wherein the body portion includes the ring and a surrounding groove that accepts a portion of the ring therein, wherein the groove is constructed to keep the ring positioned about the groove,
wherein the ring is rotatable about the groove, and
wherein the suture passes through the holes of the tissue approximation clips such that the suture approximates the tissue approximation clips together, when the suture is pulled, and the tissue defect is approximated.

### Claim 8 (depends on 2)

The GI TAC system of claim 2, wherein the grasping portion includes at least one of the pass-through hole.

### Claim 9 (depends on 1)

A method for approximating a tissue defect using a gastrointestinal tissue approximation clip (“GI TAC”) system according to claim 1, the method comprising the steps of:
positioning a distal end of an insertion tube of an endoscope towards a tissue defect inside of a patient;
directing, via an applicator through an instrument channel of the endoscope and towards the tissue defect, a first tissue approximation clip of a plurality of tissue approximation clips, the first tissue approximation clip detachably attached to the applicator and coupled to a suture, wherein the first tissue approximation clip has a pass-through hole;
placing the first tissue approximation clip on a first location about the tissue defect and clamping the first tissue approximation clip thereon;
detaching the applicator from the first tissue approximation clip and withdrawing the applicator from the instrument channel of the endoscope;
threading the suture through a pass-through hole of a second tissue approximation clip of the plurality of tissue approximation clips;
directing, via the applicator, the second tissue approximation clip, detachably attached to the applicator, through the instrument channel of the endoscope and towards the tissue defect;
placing the second tissue approximation clip on a second location about the tissue defect and clamping the second tissue approximation clip thereon; and
detaching the applicator from the second tissue approximation clip and withdrawing the applicator from the instrument channel of the endoscope.

### Claim 10 (depends on 9)

The method of claim 9, wherein each of the tissue approximation clips includes:
a body portion;
a grasping portion coupled to the body portion; and
the pass-through hole that is sized for the suture, wherein the body portion is detachably coupled to the applicator,
wherein the grasping portion includes first and second jaw portions that are constructed to move from a spaced-apart position to an approximated position, or move from the approximated position to the spaced-apart position, and
wherein the grasping portion is configured to grasp onto tissue during the placing steps.

### Claim 11 (depends on 10)

The method of claim 10, wherein the first and second jaw portions of the grasping portion is a rat-toothed configuration,
wherein an end of the first jaw portion includes a protrusion, and the second jaw portion includes a hole to accommodate the protrusion when the first jaw portion in the approximated position with the second jaw portion, or
wherein each of the tissue approximation clips further comprises a corkscrew element that is configured to interact with the tissue such that the first second jaw portions of the tissue approximation clips are constructed to open, up to about 180° from each other.

### Claim 12 (depends on 10)

The method of claim 10, wherein the first and second jaw portions include a plurality of protrusions,
wherein the protrusions of the first jaw portion are not aligned with respect to the protrusions of the second jaw portion, and
wherein the protrusions of the first jaw portion interlock with the protrusions of second jaw portion when the first and second jaw portions are closed together.

### Claim 13 (depends on 10)

The method of claim 10, wherein each of the tissue approximation clips further comprises a ring that forms the passthrough hole.

### Claim 14 (depends on 9)

The method of claim 9, further comprising the steps of:
repeating the placing and detaching steps using additional tissue approximation clips from the plurality of tissue approximation clips at additional locations about the tissue defect wherein the suture travels from first tissue approximation clip to the second tissue approximation clip, and then to the additional tissue approximation clips;
directing a clip approximating means towards the tissue approximation clips such that the tissue approximation clips move towards each other to approximate with each other and form a multi-tissue approximation clip complex; and
cutting, using the clip approximation means or a cutting devices, the suture from the tissue approximation clips,
wherein the first, second, and additional locations about the tissue defect are approximated to each other following the directing step, and
wherein the clip approximation means and the cutting devices are sized to travel through the instrument channel of the endoscope.

### Claim 15 (depends on 14)

The method of claim 14, wherein the clip approximation means is a suture adjoining clamp,
wherein the suture adjoining clamp includes moveable arms wherein each of the arms of the suture adjoining clamp includes a grip and a through-hole through which permits threading of the suture,
wherein the arms of the suture adjoining clamp are movable from a spaced-apart position to an approximated position, and movable from the approximated position to the spaced-apart position,
wherein the suture adjoining clamp is detachably coupled to the applicator,
wherein, when the suture adjoining clamp is used in the cutting step, the cutting devices for cutting the suture is deployed.