Surgical fastener deployment system

Abstract

A system includes a first tube, a sharp coil at a distal end of the first tube, a second tube displaceable within the first tube, and a sharp housing at a distal of the second tube for storing fasteners. The housing can be positioned at a first tissue, and the coil rotated to advance the coil into engagement with the first tissue. The first tube is retracted to retract the first tissue, and then a first fastener is deployed at the first tissue location. Then, without removing the system from the patient, the distal end of the system is moved adjacent a second tissue location, and the process is repeated for a second fastener at the second tissue location. A suture extends between the first and second fasteners, and tension is applied to the suture to draw the first and second tissues toward each other to reconfigure the tissue.

What is claimed is: 
     
         1 . A tissue fastener deployment system, comprising:
 a) a handle;   b) a first tubular member having a proximal end and a distal end and defining a longitudinal axis, the proximal end rotatably coupled to the handle;   c) a coil having a tissue-piercing distal tip, the coil rotationally fixed relative to the first tubular member, such that rotation of the first tubular member relative to the handle results in rotation of the coil, wherein when the distal tip of the coil is rotated against tissue the distal tip of the coil is adapted to pierce and engage the tissue;   d) at least one fastener axially displaceable relative to the distal end of the first tubular member and through the coil, the fastener having a first configuration when in the deployment system, and a second configuration when deployed in tissue, wherein in the second configuration portions of the fastener are displaced apart from each other relative to the first configuration;   e) a push member longitudinally displaceable relative to the first tubular member and adapted to apply an axial displacement force against the at least one fastener; and   f) an actuator movably coupled relative to the handle, wherein actuating the actuator results in longitudinal displacement of the push member relative to the first tubular member and to apply an axial displacement force against the at least one fastener to deploy one of the at least one fastener from the deployment system.   
     
     
         2 . The tissue fastener deployment system according to  claim 1 , wherein:
 the first configuration is a constrained configuration that constrains the portions against an inherent spring bias, and in the second configuration the portions displace in accord with the inherent spring bias.   
     
     
         3 . The tissue fastener deployment system according to  claim 2 , wherein:
 the portions are jaw arms that are biased outwardly from each other.   
     
     
         4 . The tissue fastener deployment system according to  claim 3 , wherein:
 the jaw arms have teeth.   
     
     
         5 . The tissue fastener deployment system according to  claim 1 , wherein:
 the distal end of the fastener is sharpened, and the proximal end is blunt.   
     
     
         6 . The tissue fastener deployment system according to  claim 1 , wherein:
 the at least one fastener includes proximal and distal ends, a side wall, an axial bore from the proximal end to the distal end, a longitudinal slot extending through the side wall along a portion of the length of the axial bore, and a crossbar bridging across the longitudinal slot to the side wall on opposite sides of the longitudinal slot at a location between the proximal and distal ends.   
     
     
         7 . The tissue fastener deployment system according to  claim 6 , wherein:
 the distal end of the at least one fastener is sharpened, and the proximal end is blunt.   
     
     
         8 . The tissue fastener deployment system according to  claim 6 , further comprising:
 a suture,   wherein the at least one fastener includes a plurality of fasteners, and the suture is retained relative to the crossbar of a distalmost fastener of the plurality of fasteners, and extends completely through the axial bore of each relatively proximal fastener of the plurality of fasteners.   
     
     
         9 . The tissue fastener deployment system according to  claim 1 , wherein:
 the first tubular member and the push member are sufficiently flexible to be positioned through a tortuous path.   
     
     
         10 . The tissue fastener deployment system according to  claim 1 , wherein:
 the first tubular member comprises a flat-wound coil.   
     
     
         11 . The tissue fastener deployment system according to  claim 1 , wherein:
 the coil is a tapered helix.   
     
     
         12 . A tissue fastener for use in an endoscopic deployment system, comprising:
 a tubular structure defining a proximal end, a distal end, a side wall extending from the proximal end to the distal end, an axial bore extending from the proximal end to the distal end, a longitudinal slot extending through the side wall along a portion of the length of the axial bore, and a crossbar bridging across the longitudinal slot,
 a distal portion of the tubular structure defining a plurality of jaw arms that are resiliently biased outwardly relative to each other. 
   
     
     
         13 . The tissue fastener according to  claim 12 , wherein:
 the distal end is sharp, and the proximal end is blunt.   
     
     
         14 . The tissue fastener according to  claim 12 , wherein:
 the jaw arms have teeth.   
     
     
         15 . The tissue fastener according to  claim 14 , wherein:
 the teeth on the jaw arms face each other.   
     
     
         16 . A tissue fastener deployable from a surgical fastener deployment system in conjunction with suture, consisting of:
 a unitary element having a blunt proximal end and a sharp distal end, a peripheral side wall between the proximal and distal ends, a longitudinal axial bore extending between the proximal and distal ends and sized to receive the suture, a longitudinal slot from the bore through the side wall, and a suture retainer at a longitudinally proximal location along the side wall.   
     
     
         17 . The tissue fastener of  claim 16 , wherein:
 the suture retainer is a crossbar extending across the longitudinal slot and joining opposing portions of the side wall.   
     
     
         18 . The tissue fastener of  claim 16 , wherein:
 the unitary element is a portion of a hypotube.   
     
     
         19 . The tissue fastener of  claim 16 , wherein:
 the fastener includes jaw arms positioned distal to said suture retainer, sad jaw arms being resiliently biased outwardly from the longitudinal axis.   
     
     
         20 . The tissue fastener of  claim 16 , wherein:
 the distal end of the fastener is adapted to mate against a proximal end of a like fastener.   
     
     
         21 . A train of tissue fasteners deployable from a surgical fastener deployment system in conjunction with suture, the train of fasteners comprising:
 a plurality of like fasteners arranged end to end, the fasteners including a distalmost fastener and relatively proximal fasteners,   each fastener consisting of a unitary element having proximal and distal ends, a peripheral side wall between the proximal and distal ends, a longitudinal axial bore extending between the proximal and distal ends and sized to receive the suture, a longitudinal slot from the bore through the side wall, and a suture retainer at a longitudinally proximal location bridging the longitudinal slot,   a suture having a distal end retained relative to the suture retainer of the distalmost fastener, and a length extending through the axial bore at the proximal end of the distalmost fastener and through the axial bores of each of the relatively proximal fasteners.   
     
     
         22 . The train of tissue fasteners of  claim 21 , wherein:
 the distal end of the suture is retained relative to the suture retainer with a knot, bead, or tie.   
     
     
         23 . The train of tissue fasteners of  claim 21 , wherein:
 the suture can be drawn at a perpendicular angle relative to each fastener at its suture retainer.   
     
     
         24 . The train of tissue fasteners of  claim 21 , wherein:
 the proximal and distal ends of each fastener are blunt.   
     
     
         25 . The train of tissue fasteners of  claim 21 , wherein:
 the proximal end of the distalmost fastener is adapted to mate against the distal end of a relatively proximal fastener, and the proximal and distal ends of the fasteners are oriented non-orthogonal relative to the axial bore.   
     
     
         26 . The train of tissue fasteners of  claim 21 , wherein:
 the proximal and distal ends are obliquely angled relative to the axial bore.   
     
     
         27 . A method of deploying a fastener into tissue, comprising:
 a) providing a fastener deployment system having a proximal end and distal end, the deployment system including,   i) a handle,   ii) a first tubular member having a proximal end and a distal end and defining a longitudinal axis, the proximal end rotatably coupled to the handle,   iii) a coil having a tissue-piercing distal tip, the coil rotationally fixed relative to the first tubular member, such that rotation of the first tubular member relative to the handle results in rotation of the coil, wherein when the distal tip of the coil is rotated against tissue the distal tip of the coil is adapted to pierce and engage the tissue, and   iv) a fastener axially displaceable relative to the distal end of the first tubular member and through the coil, the fastener having a first configuration when in the deployment system, and a second configuration when deployed in tissue, wherein in the second configuration portions of the fastener are displaced apart from each other relative to the first configuration;   b) positioning the distal end of the deployment system adjacent a first tissue location;   c) rotating the coil about the longitudinal axis to advance the coil into engagement with the first tissue location;   d) retracting the first tubular member to retract the first tissue location engaged by the coil; and   e) advancing the fastener at least partially through the coil and into the first tissue location, wherein the fastener in the first tissue location is provided in the second configuration.   
     
     
         28 . The method according to  claim 27 , wherein:
 the fastener deployment system houses a plurality of fasteners, and further comprising, for each fastener to be deployed,   positioning the distal end of the deployment system adjacent a respective tissue location   rotating the coil about the longitudinal axis to advance the coil into engagement with the respective tissue location;   retracting the first tubular member to retract the respective tissue location engaged by the coil; and   advancing the fastener at least partially through the coil and into the respective tissue location, wherein the fastener in the respective tissue location is provided in the second configuration.   
     
     
         29 . The method according to  claim 28 , wherein:
 the plurality of fasteners are coupled to a common suture, and applying tension on the suture between the deployed fasteners to reconfigure the first and respective tissue locations relative to each other, and then retaining the applied tension to the suture.   
     
     
         30 . The method according to  claim 29 , further comprising:
 providing an endoscope having a working channel, and the first tubular member and coil of the deployment system are advanced through the working channel prior to the engagement between the coil with the first tissue location piercing.   
     
     
         31 . The method according to  claim 30 , wherein:
 the endoscope is positioned within a natural body orifice.