Methods and apparatus for on-endoscope instruments having end effectors and combinations of on-endoscope and through-endoscope instruments

A surgical system, comprising:

• a) an endoscope having a lumen and a distal end;
• and
• b) a surgical tool coupled to said distal end of said endoscope, said surgical tool including
• i) an end effector including two effecting elements each of which is movable relative to the other, and
• ii) actuation means for actuating said end effector without passing through said lumen of said endoscope.

A surgical system, comprising:

• a) an endoscope having a working channel and a distal end;
• and
• b) a surgical tool coupled to said distal end of said endoscope, said surgical tool including
• i) an end effector including two effecting elements each of which is movable relative to the other, and
• ii) actuation means for actuating said end effector without passing through said lumen of said endoscope,
• wherein said surgical tool is coupled to said endoscope such that neither of said two effecting elements is located directly in front of said working channel.

A surgical system for performing surgery on tissue, comprising:

• a) an endoscope having a lumen and a distal end;
• b) a surgical tool coupled to said distal end of said endoscope, said surgical tool including,
• i) a first end effector including two effecting elements, at least one of which is movable relative to the other, and
• ii) actuation means for actuating said first end effector;
• and
• c) an instrument extendable through said lumen of said endoscope, wherein said instrument includes a second end effector axially extendable beyond said first end effector and adapted to axially pull the tissue between said first end effector for manipulation of the tissue by said first end effector.

A method of performing a surgical procedure, comprising:

• a) providing an endoscope having a lumen, a longitudinal axis, a distal end, and a surgical tool coupled to said distal end, said surgical tool including a first end effector including two effecting elements, at least one of which is movable relative to the other;
• b) opening said two effecting elements of said first end effector to provide a passage therebetween, said passage being parallel to said longitudinal axis;
• c) extending an endoscopic instrument having a second end effector through said lumen until said second end effector extends through said passage between said effecting elements;
• d) grasping a body tissue with said endoscopic instrument;
• e) pulling said body tissue axially between said effecting elements of said first end effector of said surgical tool;
• and
• f) manipulating the body tissue with said effecting elements of said first end effector of said surgical tool.