CA2149779A1 - Method and apparatus for sealing luminal tissue - Google Patents

Method and apparatus for sealing luminal tissue

Info

Publication number
CA2149779A1
CA2149779A1 CA002149779A CA2149779A CA2149779A1 CA 2149779 A1 CA2149779 A1 CA 2149779A1 CA 002149779 A CA002149779 A CA 002149779A CA 2149779 A CA2149779 A CA 2149779A CA 2149779 A1 CA2149779 A1 CA 2149779A1
Authority
CA
Canada
Prior art keywords
tissue
tubular assembly
luminal tissue
energy
sealing
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002149779A
Other languages
French (fr)
Other versions
CA2149779C (en
Inventor
Dallas W. Anderson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Premier Laser Systems Inc
Original Assignee
Dallas W. Anderson
Proclosure Inc.
Premier Laser Systems, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Dallas W. Anderson, Proclosure Inc., Premier Laser Systems, Inc. filed Critical Dallas W. Anderson
Publication of CA2149779A1 publication Critical patent/CA2149779A1/en
Application granted granted Critical
Publication of CA2149779C publication Critical patent/CA2149779C/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A61B2017/00504—Tissue welding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A61B2017/00504—Tissue welding
    • A61B2017/00508—Tissue welding using laser
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00973—Surgical instruments, devices or methods, e.g. tourniquets pedal-operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy

Abstract

A method and apparatus for sealing and/or grasping lesions or incisions of luminal tissue is provided. The apparatus (10) has a generally tubular assembly (12) with portions (18, 22) which expand away from each other. The apparatus is inserted into the lumen of a tissue and placed adjacent the area to be sealed. The portions expand to contact tho inner wall of the luminal tissue. Energy is delivered with a media (28) through the expanded tubular assembly to heat the tissue to a nondestructive range where the tissue forms a denatured proteinaceous substance. The media delivering the energy is rotated in the expanded tubular assembly to heat different areas of the tissue without moving the tubular assembly itself.
CA002149779A 1992-11-25 1993-11-16 Method and apparatus for sealing luminal tissue Expired - Fee Related CA2149779C (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US07/981,197 US5364389A (en) 1992-11-25 1992-11-25 Method and apparatus for sealing and/or grasping luminal tissue
US981,197 1992-11-25
PCT/US1993/011128 WO1994012106A1 (en) 1992-11-25 1993-11-16 Method and apparatus for sealing luminal tissue

Publications (2)

Publication Number Publication Date
CA2149779A1 true CA2149779A1 (en) 1994-06-09
CA2149779C CA2149779C (en) 2001-03-27

Family

ID=25528197

Family Applications (1)

Application Number Title Priority Date Filing Date
CA002149779A Expired - Fee Related CA2149779C (en) 1992-11-25 1993-11-16 Method and apparatus for sealing luminal tissue

Country Status (7)

Country Link
US (1) US5364389A (en)
EP (1) EP0735840A1 (en)
JP (1) JPH08503635A (en)
KR (1) KR950703894A (en)
AU (1) AU684057B2 (en)
CA (1) CA2149779C (en)
WO (1) WO1994012106A1 (en)

Families Citing this family (107)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6063085A (en) 1992-04-23 2000-05-16 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US5810810A (en) 1992-04-23 1998-09-22 Scimed Life Systems, Inc. Apparatus and method for sealing vascular punctures
US5593403A (en) * 1994-09-14 1997-01-14 Scimed Life Systems Inc. Method for modifying a stent in an implanted site
US5624452A (en) * 1995-04-07 1997-04-29 Ethicon Endo-Surgery, Inc. Hemostatic surgical cutting or stapling instrument
US5709224A (en) * 1995-06-07 1998-01-20 Radiotherapeutics Corporation Method and device for permanent vessel occlusion
ATE515237T1 (en) * 1995-10-13 2011-07-15 Medtronic Vascular Inc DEVICE AND SYSTEM FOR AN INTERSTITIAL TRANSVASCULAR PROCEDURE
AU733332B2 (en) 1996-02-02 2001-05-10 Transvascular, Inc. Methods and apparatus for blocking flow through blood vessels
CA2244066A1 (en) * 1996-02-02 1997-08-07 Transvascular, Inc. A device, system and method for interstitial transvascular intervention
US5827265A (en) * 1996-02-07 1998-10-27 Regents Of The University Of California Intraluminal tissue welding for anastomosis
US5827268A (en) * 1996-10-30 1998-10-27 Hearten Medical, Inc. Device for the treatment of patent ductus arteriosus and method of using the device
US5928224A (en) * 1997-01-24 1999-07-27 Hearten Medical, Inc. Device for the treatment of damaged heart valve leaflets and methods of using the device
US6026814A (en) 1997-03-06 2000-02-22 Scimed Life Systems, Inc. System and method for percutaneous coronary artery bypass
US6056762A (en) 1997-05-22 2000-05-02 Kensey Nash Corporation Anastomosis system and method of use
US6063114A (en) * 1997-09-04 2000-05-16 Kensey Nash Corporation Connector system for vessels, ducts, lumens or hollow organs and methods of use
US5922022A (en) * 1997-09-04 1999-07-13 Kensey Nash Corporation Bifurcated connector system for coronary bypass grafts and methods of use
US6017352A (en) * 1997-09-04 2000-01-25 Kensey Nash Corporation Systems for intravascular procedures and methods of use
US6562037B2 (en) * 1998-02-12 2003-05-13 Boris E. Paton Bonding of soft biological tissues by passing high frequency electric current therethrough
US6461320B1 (en) 1998-08-12 2002-10-08 Cardica, Inc. Method and system for attaching a graft to a blood vessel
US6206913B1 (en) 1998-08-12 2001-03-27 Vascular Innovations, Inc. Method and system for attaching a graft to a blood vessel
US6106515A (en) 1998-08-13 2000-08-22 Intraluminal Therapeutics, Inc. Expandable laser catheter
US6719769B2 (en) 1999-11-15 2004-04-13 Cardica, Inc. Integrated anastomosis tool with graft vessel attachment device and cutting device
US6428550B1 (en) 1999-05-18 2002-08-06 Cardica, Inc. Sutureless closure and deployment system for connecting blood vessels
AU5150600A (en) 1999-05-18 2000-12-05 Vascular Innovations, Inc. Tissue punch
US6673088B1 (en) 1999-05-18 2004-01-06 Cardica, Inc. Tissue punch
AU5143000A (en) 1999-05-18 2000-12-05 Vascular Innovations, Inc. Implantable medical device such as an anastomosis device
US7048751B2 (en) 2001-12-06 2006-05-23 Cardica, Inc. Implantable medical device such as an anastomosis device
US7063712B2 (en) 2001-04-27 2006-06-20 Cardica, Inc. Anastomosis method
US7682368B1 (en) 1999-07-28 2010-03-23 Cardica, Inc. Anastomosis tool actuated with stored energy
US7300444B1 (en) 1999-07-28 2007-11-27 Cardica, Inc. Surgical system and method for connecting hollow tissue structures
US20050154406A1 (en) 1999-07-28 2005-07-14 Cardica, Inc. Method for anastomosing vessels
US7371243B1 (en) 1999-07-28 2008-05-13 Cardica, Inc. Surgical apparatus and method for anastomosis
US7766924B1 (en) 1999-07-28 2010-08-03 Cardica, Inc. System for performing anastomosis
US7850703B2 (en) 1999-07-28 2010-12-14 Cardica, Inc. System for performing anastomosis
US6391038B2 (en) 1999-07-28 2002-05-21 Cardica, Inc. Anastomosis system and method for controlling a tissue site
US7014644B1 (en) 1999-07-28 2006-03-21 Cardica, Inc. Tissue bonding system and method for controlling a tissue site during anastomosis
JP2003513691A (en) 1999-10-25 2003-04-15 シーラス、コーポレイション Use of focused ultrasound to seal blood vessels
US20050240170A1 (en) * 1999-10-25 2005-10-27 Therus Corporation Insertable ultrasound probes, systems, and methods for thermal therapy
US6626855B1 (en) 1999-11-26 2003-09-30 Therus Corpoation Controlled high efficiency lesion formation using high intensity ultrasound
JP2004512856A (en) * 1999-12-23 2004-04-30 シーラス、コーポレイション Imaging and therapeutic ultrasound transducers
US6776785B1 (en) 2000-10-12 2004-08-17 Cardica, Inc. Implantable superelastic anastomosis device
US6471713B1 (en) 2000-11-13 2002-10-29 Cardica, Inc. System for deploying an anastomosis device and method of performing anastomosis
WO2002069813A2 (en) 2001-02-05 2002-09-12 A-Med Systems, Inc. Anastomosis system and related methods
US6913579B2 (en) 2001-05-01 2005-07-05 Surgrx, Inc. Electrosurgical working end and method for obtaining tissue samples for biopsy
US6802843B2 (en) 2001-09-13 2004-10-12 Csaba Truckai Electrosurgical working end with resistive gradient electrodes
US6773409B2 (en) 2001-09-19 2004-08-10 Surgrx Llc Surgical system for applying ultrasonic energy to tissue
ATE519438T1 (en) 2001-09-26 2011-08-15 Rice University OPTICALLY ABSORBING NANOPARTICLES FOR IMPROVED TISSUE REPAIR
US7070597B2 (en) 2001-10-18 2006-07-04 Surgrx, Inc. Electrosurgical working end for controlled energy delivery
US6929644B2 (en) 2001-10-22 2005-08-16 Surgrx Inc. Electrosurgical jaw structure for controlled energy delivery
US7011657B2 (en) 2001-10-22 2006-03-14 Surgrx, Inc. Jaw structure for electrosurgical instrument and method of use
US7083619B2 (en) 2001-10-22 2006-08-01 Surgrx, Inc. Electrosurgical instrument and method of use
US7354440B2 (en) 2001-10-22 2008-04-08 Surgrx, Inc. Electrosurgical instrument and method of use
US7041102B2 (en) 2001-10-22 2006-05-09 Surgrx, Inc. Electrosurgical working end with replaceable cartridges
US6926716B2 (en) 2001-11-09 2005-08-09 Surgrx Inc. Electrosurgical instrument
US6905497B2 (en) 2001-10-22 2005-06-14 Surgrx, Inc. Jaw structure for electrosurgical instrument
US7189233B2 (en) 2001-10-22 2007-03-13 Surgrx, Inc. Electrosurgical instrument
US8075558B2 (en) 2002-04-30 2011-12-13 Surgrx, Inc. Electrosurgical instrument and method
WO2003059151A2 (en) * 2002-01-09 2003-07-24 Neoguide Systems, Inc. Apparatus and method for endoscopic colectomy
US7335216B2 (en) 2002-01-22 2008-02-26 Cardica, Inc. Tool for creating an opening in tissue
US7029482B1 (en) 2002-01-22 2006-04-18 Cardica, Inc. Integrated anastomosis system
US8012164B1 (en) 2002-01-22 2011-09-06 Cardica, Inc. Method and apparatus for creating an opening in the wall of a tubular vessel
EP2298153B1 (en) 2002-01-22 2017-03-08 Ethicon Endo-Surgery, Inc. Electrosurgical instrument
US7223274B2 (en) 2002-01-23 2007-05-29 Cardica, Inc. Method of performing anastomosis
US6733498B2 (en) 2002-02-19 2004-05-11 Live Tissue Connect, Inc. System and method for control of tissue welding
US7087054B2 (en) 2002-10-01 2006-08-08 Surgrx, Inc. Electrosurgical instrument and method of use
US7223266B2 (en) 2003-02-04 2007-05-29 Cardiodex Ltd. Methods and apparatus for hemostasis following arterial catheterization
US7257450B2 (en) 2003-02-13 2007-08-14 Coaptus Medical Corporation Systems and methods for securing cardiovascular tissue
US8021359B2 (en) 2003-02-13 2011-09-20 Coaptus Medical Corporation Transseptal closure of a patent foramen ovale and other cardiac defects
US7169146B2 (en) 2003-02-14 2007-01-30 Surgrx, Inc. Electrosurgical probe and method of use
US7309849B2 (en) 2003-11-19 2007-12-18 Surgrx, Inc. Polymer compositions exhibiting a PTC property and methods of fabrication
FR2864202B1 (en) * 2003-12-22 2006-08-04 Commissariat Energie Atomique INSTRUMENT TUBULAR DEVICE FOR TRANSPORTING A PRESSURIZED FLUID
US7585306B2 (en) 2003-12-24 2009-09-08 Maquet Cardiovascular Llc Anastomosis device, tools and methods of using
US7632269B2 (en) 2004-01-16 2009-12-15 Ethicon Endo-Surgery, Inc. Electrosurgical instrument with replaceable cartridge
US7955331B2 (en) 2004-03-12 2011-06-07 Ethicon Endo-Surgery, Inc. Electrosurgical instrument and method of use
US20050267520A1 (en) * 2004-05-12 2005-12-01 Modesitt D B Access and closure device and method
US8162963B2 (en) 2004-06-17 2012-04-24 Maquet Cardiovascular Llc Angled anastomosis device, tools and method of using
US7678133B2 (en) * 2004-07-10 2010-03-16 Arstasis, Inc. Biological tissue closure device and method
US7473252B2 (en) 2004-10-07 2009-01-06 Coaptus Medical Corporation Systems and methods for shrinking and/or securing cardiovascular tissue
EP1814478A4 (en) 2004-11-22 2011-05-18 Cardiodex Ltd Techniques for heat-treating varicose veins
CN103190942A (en) * 2005-05-12 2013-07-10 阿尔斯塔西斯公司 Access and closure device and method
US20070233185A1 (en) 2005-10-20 2007-10-04 Thomas Anderson Systems and methods for sealing a vascular opening
US20080017043A1 (en) * 2006-06-01 2008-01-24 The Coca-Cola Company Tea Stick Brewing Package and Method
US8251983B2 (en) * 2007-05-14 2012-08-28 The Regents Of The University Of Colorado, A Body Corporate Laser tissue fusion of septal membranes
EP2182875A4 (en) 2007-08-15 2011-08-24 Cardiodex Ltd Systems and methods for puncture closure
US8070036B1 (en) 2007-09-06 2011-12-06 Cardica, Inc True multi-fire surgical stapler configured to fire staples of different sizes
US7988026B2 (en) 2007-09-06 2011-08-02 Cardica, Inc. Endocutter with staple feed
US9168039B1 (en) 2007-09-06 2015-10-27 Cardica, Inc. Surgical stapler with staples of different sizes
US8308763B2 (en) 2007-10-05 2012-11-13 Coaptus Medical Corporation Systems and methods for transeptal cardiac procedures, including separable guidewires
US8979882B2 (en) 2008-07-21 2015-03-17 Arstasis, Inc. Devices, methods, and kits for forming tracts in tissue
US8517962B2 (en) 2009-10-12 2013-08-27 Kona Medical, Inc. Energetic modulation of nerves
US20110092880A1 (en) 2009-10-12 2011-04-21 Michael Gertner Energetic modulation of nerves
US8295912B2 (en) 2009-10-12 2012-10-23 Kona Medical, Inc. Method and system to inhibit a function of a nerve traveling with an artery
US9119951B2 (en) 2009-10-12 2015-09-01 Kona Medical, Inc. Energetic modulation of nerves
US8469904B2 (en) 2009-10-12 2013-06-25 Kona Medical, Inc. Energetic modulation of nerves
US8986211B2 (en) 2009-10-12 2015-03-24 Kona Medical, Inc. Energetic modulation of nerves
US8986231B2 (en) 2009-10-12 2015-03-24 Kona Medical, Inc. Energetic modulation of nerves
US20110118600A1 (en) 2009-11-16 2011-05-19 Michael Gertner External Autonomic Modulation
US20160059044A1 (en) 2009-10-12 2016-03-03 Kona Medical, Inc. Energy delivery to intraparenchymal regions of the kidney to treat hypertension
US9174065B2 (en) 2009-10-12 2015-11-03 Kona Medical, Inc. Energetic modulation of nerves
CA2807492C (en) * 2010-08-10 2019-01-22 Patient Pocket, Llc Laser optical fiber storage
US20130317481A1 (en) 2012-05-25 2013-11-28 Arstasis, Inc. Vascular access configuration
US20130317438A1 (en) 2012-05-25 2013-11-28 Arstasis, Inc. Vascular access configuration
US11877796B2 (en) 2014-05-29 2024-01-23 The Spectranetics Corporation Material removal catheter having an expandable distal end
US10054753B2 (en) * 2014-10-27 2018-08-21 Commscope Technologies Llc Fiber optic cable with flexible conduit
US10925579B2 (en) 2014-11-05 2021-02-23 Otsuka Medical Devices Co., Ltd. Systems and methods for real-time tracking of a target tissue using imaging before and during therapy delivery
WO2017161310A1 (en) 2016-03-18 2017-09-21 Commscope Technologies Llc Optic fiber cable fanout conduit arrangements; components, and methods
CN109716194B (en) 2016-10-13 2021-07-16 康普技术有限责任公司 Fiber optic branch transition assembly including epoxy plug and cable strain relief
WO2018208518A1 (en) 2017-05-08 2018-11-15 Commscope Technologies Llc Fiber-optic breakout transition assembly

Family Cites Families (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4667673A (en) * 1984-03-12 1987-05-26 American Cyanamid Company Anastomotic device applicator and method
US4892098A (en) * 1985-06-26 1990-01-09 Sauer Jude S Tubular tissue welding device without moving parts
US4633870A (en) * 1985-06-26 1987-01-06 Sauer Jude S Apparatus for effecting anastomosis of tubular tissue by laser welding
US4690684A (en) * 1985-07-12 1987-09-01 C. R. Bard, Inc. Meltable stent for anastomosis
JPH01171534A (en) * 1987-12-28 1989-07-06 Matsushita Electric Ind Co Ltd Blood vessel suturing auxiliary utensil
US5026367A (en) * 1988-03-18 1991-06-25 Cardiovascular Laser Systems, Inc. Laser angioplasty catheter and a method for use thereof
US4907591A (en) * 1988-03-29 1990-03-13 Pfizer Hospital Products Group, Inc. Surgical instrument for establishing compression anastomosis
US5061265A (en) * 1989-06-20 1991-10-29 University Of Florida Laser treatment apparatus and method
CA2052196A1 (en) * 1990-10-11 1992-04-12 Jude S. Sauer Clamp for approximating tissue sections
US5197649A (en) * 1991-10-29 1993-03-30 The Trustees Of Columbia University In The City Of New York Gastrointestinal endoscoptic stapler

Also Published As

Publication number Publication date
CA2149779C (en) 2001-03-27
WO1994012106A1 (en) 1994-06-09
US5364389A (en) 1994-11-15
AU5669994A (en) 1994-06-22
EP0735840A1 (en) 1996-10-09
KR950703894A (en) 1995-11-17
AU684057B2 (en) 1997-12-04
JPH08503635A (en) 1996-04-23
EP0735840A4 (en) 1996-05-15

Similar Documents

Publication Publication Date Title
CA2149779A1 (en) Method and apparatus for sealing luminal tissue
CA2147269A1 (en) Apparatus for applying thermal energy to luminal tissue
CA2225764A1 (en) Stent fabrication method and apparatus
CA2272655A1 (en) Aneurysm patch apparatus and method for treating an aneurysm
AU617818B2 (en) A corrugated pipe, a method of forming the corrugated pipe and an apparatus for manufacturing the same
CA2138197A1 (en) Absorbent composition including a microfiber
AU1995095A (en) Method for manufacturing expanded polytetrafluoroethylene products
CA2206633A1 (en) Internal ultrasonic tip amplifier
CA2134071A1 (en) Apparatus and Method for Sealing Vascular Punctures
CA2221624A1 (en) Microwave-driven plasma spraying apparatus and method for spraying
CA2185564A1 (en) Dimensionally Adjustable Soft Tissue Expander and Method
AU1603495A (en) Instrument and method for incising into body
AU6451996A (en) Method and apparatus for vacuum diode heat pump
AU5340898A (en) Refrigeration apparatus and method of manufacturing the same
EP0249500A3 (en) Microwave-based apparatus and kjeldahl method
CA2087733A1 (en) Adjustable catheter contamination shield
NO20003784D0 (en) Process for the preparation of enansiomerically pure cycloalkanoindolecarboxylic acid and azaindolecarboxylic acids and pyrimido 1,2a indolecarboxylic acids and derivatives thereof
AU3631497A (en) Natural-draught air condenser apparatus and method of operation thereof
AU622792B2 (en) A method and an apparatus for sterilizing objects by means of a gaseous sterilization agent
AU4679296A (en) Apparatus and method for the transfer of heat with the aid of air
EP0721818A4 (en) Method of manufacturing laser welded pipes and apparatus for manufacturing the same
CA2189787A1 (en) Flavouring base
AU3455397A (en) A process for the separation of amino acids and their salts from an aqueous solution
AU6538898A (en) Method and apparatus for altering the osmotic pressure of cryopreserved white stem cells
AU8853098A (en) Polymerisates of unsaturated saccharide acids and their derivatives, copolymerisates thereof with ethylenically unsaturated compounds and method for preparing the same

Legal Events

Date Code Title Description
EEER Examination request
MKLA Lapsed