# US 2019/0053805 A1 · Tissue apposition clip application methods > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2019/0053805 A1 - Document ID: US20190053805A1 - Status: Published application - Kind: A1 - Application number: 16/166,833 - Filed: 2018-10-22 - Published: 2019-02-21 - Earliest claimed: 2008-07-14 - Assignees: Ethicon Endo-Surgery, Inc. - Applicants: Ethicon Endo-Surgery, Inc. - Inventors: Jason L. Harris; James T. Spivey - Web page: https://patentgrep.com/patent/US20190053805A1 ## CPC - 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 17/083: {Clips, e.g. resilient} - A61B 17/105: {Wound clamp magazines (for packaging sharps A61B50/3001)} - A61B 17/29: Forceps for use in minimally invasive surgery - A61B 2017/00818: {Treatment of the gastro-intestinal system} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract Surgical methods for closing a gastrotomy. The surgical method for closing an opening in an organ wall comprises positioning a distal end portion of a steerable overtube adjacent a portion of the organ wall through which the opening extends. The surgical method further comprises inserting a flexible clip magazine into the steerable overtube. The surgical method comprises grasping tissue through which the opening extends and drawing a portion of the grasped tissue into a clamping position between upper and lower clip arms of a distal-most tissue apposition clip supported within a distal end of the clip magazine. The surgical method further comprises advancing the distal-most tissue apposition clip onto the portion of grasped tissue. ## Claims ### Claim 1 A surgical method for closing an opening in an organ wall, said surgical method comprising: positioning a distal end portion of a steerable overtube adjacent a portion of the organ wall through which the opening extends; inserting a flexible clip magazine into the steerable overtube, the flexible clip magazine supporting a plurality of tissue apposition clips therein such that upper and lower clip arms thereof are supported in a spaced open position relative to each other, said flexible clip magazine having a distal end portion received within said distal end portion of the steerable overtube such that the tissue apposition clips supported therein may be selectively discharged out through the distal end portion of the steerable overtube; grasping tissue through which the opening extends; drawing a portion of the grasped tissue into a clamping position between upper and lower clip arms of a distal-most one of the tissue apposition clips supported within the distal end portion of the clip magazine; and advancing the distal-most tissue apposition clip onto the portion of grasped tissue. ### Claim 2 (depends on 1) The surgical method of claim 1 further comprising: repositioning the distal end portion of the steerable overtube adjacent another portion of the opening; grasping other tissue through which the opening extends; drawing a portion of the grasped other tissue into a clamping position between upper and lower clip arms of another distal-most one of the tissue apposition clips supported within the distal end portion of the clip magazine; and advancing the another distal-most tissue apposition clip onto the portion of grasped other tissue. ### Claim 3 (depends on 1) The surgical method of claim 1 wherein the opening in the organ wall is selected from a group of openings consisting of an opening in a stomach, an opening in a colon, an opening in a vagina, and an opening in an esophagus. ### Claim 4 (depends on 1) The surgical method of claim 1 further comprising clamping the distal-most one of the tissue apposition clips onto the portion of grasped tissue when the portion of the grasped tissue is drawn into the clamping position between the upper and lower clip arms. ### Claim 5 (depends on 4) The surgical method of claim 4, wherein clamping the distal-most one of the tissue apposition clips onto the portion of the grasped tissue creates a serosa-to-serosa apposition. ### Claim 6 (depends on 4) The surgical method of claim 4, wherein grasping tissue through which the opening extends comprises passing a lumen through holes in the tissue apposition clips. ### Claim 7 A surgical method for closing an opening in a portion of an organ wall, said surgical method comprising: positioning a tissue apposition clip adjacent a distal end of an endoscope; positioning the tissue apposition clip adjacent the opening; grasping the portion of the organ wall through which the opening extends; drawing the grasped portion of the organ wall into a clamping position between upper and lower clip arms of the tissue apposition clip; advancing the tissue apposition clip onto the grasped portion of the organ wall; and applying at least one tissue anchor to the grasped portion of organ wall within the tissue apposition clip. ### Claim 8 (depends on 7) The surgical method of claim 7 wherein said positioning the tissue apposition clip adjacent the distal end of the endoscope, comprises: coupling a clip dispensing adapter to the distal end of the endoscope; releasably supporting the tissue apposition clip on the clip dispensing adapter; and movably manipulating the distal end of the endoscope and adapter adjacent to the opening through the portion of organ wall. ### Claim 9 (depends on 8) The surgical method of claim 8 wherein said positioning the tissue apposition clip adjacent the distal end of the endoscope comprises inserting the distal end of the endoscope and adapter through a natural orifice in a patient and manipulating the distal end of the endoscope and adapter by applying actuation forces thereto from a portion of the endoscope positioned external to the natural orifice. ### Claim 10 (depends on 7) The surgical method of claim 7 wherein said applying at least one tissue anchor to the grasped portion of organ wall within the tissue apposition clip comprises inserting a tissue anchor applier through a hole in the tissue apposition clip to operably engage the grasped portion of organ wall within the tissue apposition clip. ### Claim 11 (depends on 7) The surgical method of claim 7 further comprising clamping the tissue apposition clip onto grasped portion of organ when the grasped portion of organ is drawn into the clamping position between the upper and lower clip arms. ### Claim 12 (depends on 11) The surgical method of claim 11, wherein clamping the tissue apposition clip onto the portion of the grasped tissue creates a serosa-to-serosa apposition. ### Claim 13 A surgical method for closing an opening in tissue, said surgical method comprising: positioning a tissue apposition clip adjacent a distal end of an endoscope; positioning the tissue apposition clip adjacent the opening in the tissue; grasping a portion of the tissue through which the opening extends; drawing the portion of the grasped tissue into a position between upper and lower clip arms of the tissue apposition clip; and advancing the tissue apposition clip onto the portion of grasped tissue. ### Claim 14 (depends on 13) The surgical method of claim 13 further comprising clamping the tissue apposition clip onto the portion of grasped tissue. ### Claim 15 (depends on 14) The surgical method of claim 14, wherein clamping the tissue apposition clip onto the portion of the grasped tissue creates a serosa-to-serosa apposition. ### Claim 16 (depends on 13) The surgical method of claim 13 wherein said positioning the tissue apposition clip adjacent the distal end of the endoscope, comprises: coupling a clip dispensing adapter to the distal end of the endoscope; releasably supporting the tissue apposition clip on the clip dispensing adapter; and movably manipulating the distal end of the endoscope and adapter adjacent to the opening. ### Claim 17 (depends on 13) The surgical method of claim 13 further comprising applying at least one tissue anchor to the portion of grasped tissue within the tissue apposition clip. ### Claim 18 (depends on 17) The surgical method of claim 17 wherein said applying at least one tissue anchor to the portion of grasped tissue within the tissue apposition clip comprises inserting a tissue anchor applier through a hole in the tissue apposition clip to operably engage the portion of grasped tissue within the tissue apposition clip. ### Claim 19 (depends on 13) The surgical method of claim 13, wherein grasping the tissue through which the opening extends comprising passing a lumen through holes in the tissue apposition clips to grasp a portion of the tissue. ### Claim 20 (depends on 13) The surgical method of claim 13 wherein the opening in the tissue comprises an opening in an organ wall.