Endoscopic tissue approximation system and methods

A cinch deployment system for cinching suture within a mammalian body during an endoscopic procedure with an endoscope having an instrument channel, comprising:

• a delivery system sized and adapted for passage through the instrument channel of the endoscope, the delivery system having,
• a flexible tubular member with a proximal end and a distal end, and
• a flexible control member having a proximal end and a distal end, the control member longitudinally displaceable relative to the tubular member and having a retainer at the distal end of the control member;
• and
• a cinch including,
• an inner tubular housing having proximal and distal ends;
• a compressible gripper having proximal and distal ends and a suture passage extending therethrough for receipt and passage of the suture, the gripper positioned within the inner tubular housing;
• and
• a resilient structure biased to compress the gripper to reduce the size of the suture passage of the gripper, the resilient structure having a first configuration in which the resilient structure is constrained from applying sufficient compression to the gripper to prevent movement of the gripper on the suture extending within the suture passage of the gripper, and the resilient structure having a second configuration in which the resilient structure applies a compression to the gripper sufficient to secure the gripper on the suture extending within the suture passage of the gripper,
• wherein the retainer of the delivery system is positioned relative to the resilient structure to retain the resilient structure in a position that prevents compressing the compressible gripper by an amount that would prevent relative movement of the suture and the cinch, and
• wherein the delivery system is operable to move the control member relative to the tubular member to displace the retainer relative to the resilient structure such that the resilient structure compresses the compressible gripper by an amount that results in preventing relative movement of the suture and the cinch.

A method of securing a cinch on a suture within a mammalian body, comprising:

• a) providing a suture coupled to tissue within the mammalian body;
• b) providing a delivery system with a releasable cinch,
• the cinch having an inner housing, a compressible material within the inner housing, the compressible material defining a suture passage, and a spring structure adapted to compress the compressible material to reduce the size of the suture passage,
• the delivery system adapted to move a retainer between a first position and a second position, wherein in the first position the retainer retains the spring structure from compressing the compressible material in an amount that sufficiently reduces the suture passage to prevent relative movement of the suture and the cinch, and in the second position the retains permits the spring structure to sufficiently compress the compressible material on the suture to fix the position of the cinch on the suture
• the retainer provided in the first position;
• c) advancing the cinch over the suture to a location adjacent the tissue,
• d) applying tension to the suture;
• e) moving the retainer from the first position to the second position to cause the spring structure to compress the compressible material to sufficiently reduce the suture passage and prevent relative movement between the suture and the cinch;
• f) cutting the suture to release the cinch from the deployment system;
• and
• g) withdrawing the delivery system from the mammalian body.