# US 2019/0167950 A1 · Tissue retraction system for performing minimally invasive procedures > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2019/0167950 A1 - Document ID: US20190167950A1 - Status: Published application - Kind: A1 - Application number: 16/209,247 - Filed: 2018-12-04 - Published: 2019-06-06 - Earliest claimed: 2017-12-05 - Assignees: Boston Scientific Scimed, Inc. - Applicants: Boston Scientific Scimed, Inc. - Inventors: BARRY WEITZNER; GARY J. LEANNA - Web page: https://patentgrep.com/patent/US20190167950A1 ## CPC - A61M 25/0138: {having flexible regions as a result of weakened outer material, e.g. slots, slits, cuts, joints or coils} - A61B 1/00085: {Baskets} - A61B 1/00087: {Tools (A61B17/00234 takes precedence)} - A61B 1/00098: {Deflecting means for inserted tools} - A61B 1/00135: {Oversleeves mounted on the endoscope prior to insertion} - A61B 1/00154: {using guiding arrangements for insertion} - A61B 1/018: for receiving instruments - A61B 17/00234: {for minimally invasive surgery (A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)} - A61B 17/0206: {with antagonistic arms as supports for retractor elements} - A61B 17/0218: {for minimally invasive surgery (A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)} - A61M 25/0136: {Handles therefor} - A61M 25/0662: {Guide tubes} - A61B 1/01: Guiding arrangements therefore - A61B 1/313: for introducing through surgical openings, e.g. laparoscopes - A61B 17/29: Forceps for use in minimally invasive surgery - A61B 17/3423: {Access ports, e.g. toroid shape introducers for instruments or hands (access sites for liquids A61M39/0247)} - A61B 2017/00269: {endoscopic mucosal resection EMR} - A61B 2017/003: {Steerable} - A61B 2017/00323: {Cables or rods} - 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 2017/00477: {Coupling (A61B2017/0046 takes precedence)} - A61B 2017/00818: {Treatment of the gastro-intestinal system} - A61B 2017/0287: {with elastic retracting members connectable to a frame, e.g. hooked elastic wires} - A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A system for performing minimally invasive procedures in a body lumen may include a flexible catheter having a plurality of lumens including a main lumen configured to receive an endoscope and at least one tool lumen; a first working instrument slidably disposed within a first tool lumen of the at least one tool lumen; a plurality of support elements disposed at a distal end of the catheter, the plurality of support elements being configured to shift between delivery and expanded configurations, wherein in the expanded configuration, the plurality of support elements forms an expanded cage to reshape the body lumen and form a working space; wherein at least one of the plurality of support elements is a tubular shaft having an opening proximate the working space; and a filament extending through the tubular shaft to a clip disposed outside the opening, the clip being manipulatable by the first working instrument. ## Claims ### Claim 1 A system for performing minimally invasive procedures in a body lumen, comprising: a flexible catheter having a plurality of lumens extending from a handle housing to a distal end of the flexible catheter, wherein the plurality of lumens includes: a main lumen configured to receive an endoscope; and at least one tool lumen; a first working instrument slidably disposed within a first tool lumen of the at least one tool lumen; a plurality of support elements disposed at the distal end of the flexible catheter, the plurality of support elements being configured to shift between a delivery configuration and an expanded configuration, wherein in the expanded configuration, the plurality of support elements forms an expanded cage to reshape the body lumen and form a working space; wherein at least one of the plurality of support elements is a tubular shaft having a lumen extending from the handle housing to an opening through a side wall of the tubular shaft proximate the working space; and a filament extending through the lumen of the tubular shaft to a clip disposed outside the opening through the side wall of the tubular shaft, the clip being manipulatable by the first working instrument. ### Claim 2 (depends on 1) The system of claim 1, wherein the first working instrument includes a grasping tool. ### Claim 3 (depends on 1) The system of claim 1, wherein the clip is configured to releasably attach to tissue of the body lumen proximate the working space. ### Claim 4 (depends on 3) The system of claim 3, wherein tension applied to the filament retracts the tissue laterally relative to a central longitudinal axis of the flexible catheter. ### Claim 5 (depends on 1) The system of claim 1, further comprising a tension-inducing element disposed at a proximal end of the filament. ### Claim 6 (depends on 5) The system of claim 5, wherein the tension-inducing element is a weight, a spring, or a pull tab. ### Claim 7 (depends on 1) The system of claim 1, wherein at least one of the plurality of support elements is a second tubular shaft having a lumen extending from the handle housing to an opening through a side wall of the second tubular shaft proximate the working space. ### Claim 8 (depends on 7) The system of claim 7, further comprising a second filament extending through the lumen of the second tubular shaft to a second clip disposed outside the opening through the side wall of the second tubular shaft, the second clip being manipulatable by the first working instrument. ### Claim 9 (depends on 1) The system of claim 1, further comprising a second working instrument slidably disposed within a second tool lumen of the at least one tool lumen. ### Claim 10 (depends on 1) The system of claim 1, wherein the first working instrument is configured to manipulate tissue of the body lumen proximate the working space. ### Claim 11 A system for performing minimally invasive procedures in a body lumen, comprising: a flexible catheter having a plurality of lumens extending from a handle housing to a distal end of the flexible catheter, the plurality of lumens including a main lumen configured to receive an endoscope; a first working instrument disposed within a first tool channel slidably disposed within a first tool lumen extending from the handle housing to the distal end of the flexible catheter; a plurality of support elements extending from the plurality of lumens at the distal end of the flexible catheter, the plurality of support elements being configured to shift between a delivery configuration and an expanded configuration, wherein in the expanded configuration, the plurality of support elements forms an expanded cage to reshape the body lumen and form a working space; wherein at least one of the plurality of support elements is a tubular shaft having a lumen extending from the handle housing to an opening through a side wall of the tubular shaft proximate the working space; and a filament extending through the lumen of the tubular shaft to a clip disposed outside the opening through the side wall of the tubular shaft, the clip being manipulatable by the first working instrument to grasp tissue proximate the working space. ### Claim 12 (depends on 11) The system of claim 11, wherein the first tool channel has a distal portion movable from a first position aligned with a longitudinal axis of the first tool lumen when the distal portion of the first tool channel is disposed within the first tool lumen to an angled position with respect to the longitudinal axis of the first tool lumen when the distal portion of the first tool channel is advanced out of the first tool lumen. ### Claim 13 (depends on 12) The system of claim 12, wherein when the distal portion of the first tool channel is in the angled position, the distal portion of the first tool channel includes a first curve extending in a first direction with respect to the longitudinal axis of the first tool lumen and a second curve extending in a second different direction with respect to the longitudinal axis of the first tool lumen. ### Claim 14 (depends on 13) The system of claim 13, wherein a distal end of the first tool channel opens laterally relative to the longitudinal axis of the first tool lumen when the distal portion of the first tool channel is in the angled position. ### Claim 15 (depends on 12) The system of claim 12, wherein the first tool channel is formed from a shape memory material and the distal portion is configured to assume the angled position when unconstrained by the first tool lumen. ### Claim 16 A system for performing minimally invasive procedures in a body lumen, comprising: a flexible catheter having a plurality of lumens extending from a handle housing to a distal end of the flexible catheter, the plurality of lumens including a main lumen configured to receive an endoscope; a first working instrument disposed within a first tool channel slidably disposed within a first tool lumen extending from the handle housing to the distal end of the flexible catheter; a plurality of support elements extending from the plurality of lumens at the distal end of the flexible catheter, the plurality of support elements being configured to shift between a delivery configuration and an expanded configuration, wherein in the expanded configuration, the plurality of support elements forms an expanded cage to reshape the body lumen and form a working space; wherein at least one of the plurality of support elements is a tubular shaft having a lumen extending from the handle housing to an opening through a side wall of the tubular shaft proximate the working space; and a filament extending through the lumen of the tubular shaft to a clip disposed outside the opening through the side wall of the tubular shaft, the clip being manipulatable by the first working instrument to grasp tissue proximate the working space; wherein the opening through the side wall of the tubular shaft is a longitudinally-oriented slot, and the tubular shaft includes an outer tubular shaft slidably disposed over the tubular shaft such that the filament exits the lumen of the tubular shaft at a variable location along the longitudinally-oriented slot as determined by a distal end of the outer tubular shaft. ### Claim 17 (depends on 16) The system of claim 16, wherein at least one of the plurality of support elements is a second tubular shaft having a lumen extending from the handle housing to an opening through a side wall of the second tubular shaft proximate the working space. ### Claim 18 (depends on 17) The system of claim 17, further comprising a second filament extending through the lumen of the second tubular shaft to a second clip disposed outside the opening through the side wall of the second tubular shaft, the second clip being manipulatable by the first working instrument. ### Claim 19 (depends on 18) The system of claim 18, wherein the opening through the side wall of the second tubular shaft is a second longitudinally-oriented slot, and the second tubular shaft includes a second outer tubular shaft slidably disposed over the second tubular shaft such that the filament exits the lumen of the second tubular shaft at a second variable location along the second longitudinally-oriented slot as determined by a distal end of the second outer tubular shaft. ### Claim 20 (depends on 19) The system of claim 19, wherein the flexible catheter defines a central longitudinal axis, and the second variable location along the second longitudinally-oriented slot is located at a different axial position along the central longitudinal axis than the variable location along the longitudinally-oriented slot.