# US 2021/0330320 A1 · Endoscopic suturing system having external instrument channel > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2021/0330320 A1 - Document ID: US20210330320A1 - Status: Published application - Kind: A1 - Application number: 17/367,874 - Filed: 2021-07-06 - Published: 2021-10-28 - Earliest claimed: 2016-08-10 - Assignees: Apollo Endosurgery US, Inc. - Applicants: Apollo Endosurgery US, Inc. - Inventors: Vladimir Mitelberg; Thomas Neudeck; John Mims - Web page: https://patentgrep.com/patent/US20210330320A1 ## CPC - A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery} - A61B 1/00087: {Tools (A61B17/00234 takes precedence)} - A61B 1/00101: {the distal tip features being detachable} - A61B 1/0014: {Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands} - A61B 1/018: for receiving instruments - A61B 17/0625: {the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator (A61B17/06109 takes precedence)} - A61B 2017/00296: {mounted on an endoscope} - A61B 2017/00314: {Separate linked members} - 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 2017/06042: {located close to needle tip} - A61B 2017/306: {holding by means of suction} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract An endoscopic suturing system includes an endoscope, a suturing device, a needle assembly movable through tissue by the suturing device, and first and second devices used in association with the suturing device. The cap assembly includes a rotatable needle arm supporting the needle assembly and actuatable by a proximal handle via a transmission assembly. First and second separate lumen extends outside the endoscope from the cap assembly to a proximal handle to advance instruments therethrough to engage the needle assembly and target the tissue. The cap assembly is retained at an end of the endoscope by a securing arm. The securing arm may be resilient or rotatable. Ancillary clips are also provided about the first and second lumen and transmission assembly to couple them to the endoscope. ## Claims ### Claim 1 An endoscopic treatment system for use with an endoscope having a proximal end and a distal end and a longitudinal axis extending therebetween, comprising: a) a distal cap assembly having an end effector rotatable on an axis between open and closed positions, the end effector having a free end; b) a transmission assembly having proximal and distal ends, the distal end operably coupled to the end effector such that displacement of at least a portion of the transmission assembly rotates the end effector between the open and closed positions; c) a proximal handle assembly coupled to the transmission assembly and adapted to effect the displacement of at the least a portion of the transmission assembly to rotate the end effector; d) first and second lumen extending from the cap assembly to the proximal handle assembly for receiving instruments therethrough, the first lumen in alignment with the free end of the end effector, and the second lumen position between the first lumen and the axis on which the end effector rotates; e) a peripheral engagement structure adapted to be positioned about greater than 180° of a circumference of the distal end of the endoscope, the peripheral engagement structure in an abutting relationship with a proximal end of the cap assembly; and f) a plurality of spaced apart ancillary clips, the ancillary clips adapted to retain the transmission assembly and the first and second lumen relative to the endoscope. ### Claim 2 (depends on 1) The endoscopic treatment system according to claim 1, further comprising: a needle assembly having a needle and suture, wherein the needle assembly is removably coupled to the end effector. ### Claim 3 (depends on 2) The endoscopic treatment system according to claim 2, wherein: when the end effector is in the closed position, the needle assembly is oriented parallel to longituidnal axis. ### Claim 4 (depends on 1) The endoscopic treatment system according to claim 1, wherein: the cap assembly includes a mount supporting the end effector and defining first and second throughbores, and the first and second lumen extend into the first and second throughbores. ### Claim 5 (depends on 1) The endoscopic treatment system according to claim 1, wherein: the first and second lumen are defined by discrete catheters. ### Claim 6 (depends on 5) The endoscopic treatment system according to claim 5, further comprising: a common sheath covering at least a portion of both discrete catheters. ### Claim 7 (depends on 1) The endoscopic treatment system according to claim 1, wherein: the first and second lumen are defined by a common catheter. ### Claim 8 (depends on 4) The endoscopic treatment system according to claim 4, wherein: the first and second throughbores are parallel to each other. ### Claim 9 (depends on 4) The endoscopic treatment system according to claim 4, wherein: the first and second throughbores are obliquely oriented relative to each other. ### Claim 10 (depends on 1) The endoscopic treatment system according to claim 1, wherein: the ancillary clips include with slots provided with material having a high coefficient of friction than the clips. ### Claim 11 (depends on 1) The endoscopic treatment system according to claim 1, wherein: the peripheral engagement structure comprises a recess and an arm that is resiliently deformed to receive the distal end of the endoscope within the recess. ### Claim 12 (depends on 11) The endoscopic treatment system according to claim 11, wherein: the peripheral engagement structure further comprises a tape or banding wrapped around the arm. ### Claim 13 (depends on 1) The endoscopic treatment system according to claim 1, wherein: the peripheral engagement structure comprises a recess and an arm that is rotatable on a hinge to receive and then engage the distal end of the endoscope within the recess. ### Claim 14 (depends on 13) The endoscopic treatment system according to claim 13, wherein: the arm is rotatable about a hinge pin. ### Claim 15 (depends on 13) The endoscopic treatment system according to claim 13, wherein: the peripheral engagement structure further comprises a lock to fix a location of the arm. ### Claim 16 (depends on 15) The endoscopic treatment system according to claim 15, wherein: the lock is a set screw. ### Claim 17 (depends on 15) The endoscopic treatment system according to claim 15, wherein: the peripheral engagement structure further comprises a cam applies a force against the arm to move and/or retain the arm into a closed position. ### Claim 18 (depends on 15) The endoscopic treatment system according to claim 15, wherein: the peripheral engagement structure further comprises a spring that biases the arm into a closed position. ### Claim 19 (depends on 1) The endoscopic treatment system according to claim 1, further comprising: the endoscope having the proximal end and the distal end and the longitudinal axis extending therebetween, wherein the endoscopic treatment system is coupled to the endoscope. ### Claim 20 (depends on 19) The endoscope treatment system according to claim 19, wherein: the endoscope has at most one instrument channel for receiving instruments therethrough. ### Claim 21 An endoscopic treatment system for use with an endoscope having a proximal end and a distal end, a longitudinal axis extending therebetween, and a circumference, comprising: a) a distal cap assembly having an end effector rotatable on an axis between open and closed positions, the end effector having a free end; b) a transmission assembly having proximal and distal ends, the distal end operably coupled to the end effector such that displacement of at least a portion of the transmission assembly rotates the end effector between the open and closed positions; c) a proximal handle assembly coupled to the transmission assembly and adapted to effect the displacement of at the least a portion of the transmission assembly to rotate the end effector; d) first and second lumen extending from the cap assembly to the proximal handle assembly for receiving instruments therethrough, the first lumen in alignment with the free end of the end effector, and the second lumen position between the first lumen and the axis on which the end effector rotates; and f) a plurality of clips spaced apart along the transmission assembly and first and second lumen, the clips each having a body adapted to extend greater than 180° about the circumference of the endoscope, the clips defining slots filled with a material having a higher coefficient of friction than the body. ### Claim 22 An endoscopic treatment system for use with an endoscope having a proximal end and a distal end and a longitudinal axis extending therebetween, comprising: a) a distal cap assembly having an end effector rotatable on an axis between open and closed positions, the end effector having a free end; b) a transmission assembly having proximal and distal ends, the distal end operably coupled to the end effector such that displacement of at least a portion of the transmission assembly rotates the end effector between the open and closed positions; c) a proximal handle assembly coupled to the transmission assembly and adapted to effect the displacement of at the least a portion of the transmission assembly to rotate the end effector; d) first and second lumen extending from the cap assembly to the proximal handle assembly for receiving instruments therethrough, the first lumen in alignment with the free end of the end effector, and the second lumen position between the first lumen and the axis on which the end effector rotates; and e) a peripheral engagement structure adapted to be positioned about greater than 180° of a circumference of the distal end of the endoscope, the peripheral engagement structure integrated with the cap assembly. ### Claim 23 (depends on 22) The endoscopic treatment system according to claim 22, wherein: the peripheral engagement structure includes a resilient arm. ### Claim 24 (depends on 22) The endoscopic treatment system according to claim 22, wherein: the peripheral engagement structure includes an arm rotatable on a hinge.