Abstract: An electrical connector for a cardiac device is disclosed. The connector has a wire and an electrode at the distal end of the wire. The wire is attached to a patch, and the patch is coated with an adhesive film for adhering the patch to tissue. The preferred connector is a bipolar temporary cardiac pacing wire. The use of an adhesive film eliminates or reduces the need for suturing the patch to tissue, thus avoiding or significantly reducing tissue trauma associated with suturing.

Abstract: An applier for delivering and deploying a biopsy marker to a surgical biopsy site is disclosed. The applier has a ferrule with a forming surface to form the marker on the distal end of a flexible tube. The marker is held at the distal end of the flexible tube in a marker holder. A forming rod slidable in the flexible tube urges the marker into contact with the forming surface of the ferrule for marker formation. The distal end of the flexible tube is delivered through an egress tube, which in turn is delivered through a biopsy cannula adapted for taking the biopsy sample. The egress tube has an alignment hub at its proximal end adapted for orientational alignment with a hub receiver on the biopsy cannula. When properly aligned, the egress opening of the distal end of the egress tube is orientationally aligned with the biopsy port of the biopsy cannula for proper delivery and deployment of the marker.

Abstract: An anoscope adapted for the suturing of hemorrhoids during a hemorrhoid removal procedure is disclosed. The anoscope has a distal conical tip, a channel body extending proximally from the distal conical tip and a flange radiused outwardly from the channel. A slot is formed in the channel body and runs longitudinally from the distal conical tip through the flange and is flanked by a pair of mutually opposed finger wings that extend out from the flange. The finger wings each have a distal finger wing tip and a concave surface embedded within the finger wing tips. The concave surfaces are sized for the placement of a finger of a user therein.

Abstract: A device for sealing puncture wounds in blood vessels is open at one end and closed at the other end. The tube closure is generally flat and pivotable, and the tube region near the closed end is expandable. The device is initially contained in a sleeve, which is inserted through a cannula, so that the closed end is within the vessel to be sealed. After the cannula is removed, the closure is pivoted and the device withdrawn to a point where the closure abuts the puncture wound. After the sleeve is removed, the expandable region is expanded, so that the blood vessel wall around the puncture is sandwiched between the closure and the expanded region. The device prevents blood from seeping out of the punctured vessel during the healing process.

Abstract: A circular sapling instrument for the removal of hemorrhoids has a stapling end effector having a casing, a hollow staple driver within the casing, an annular blade having an open distal end is located within the staple driver, and a elongated interior drive shaft is reciprocable within the staple driver and the annular blade. A first inner chamber is defined between the staple driver and the interior drive shaft, and a second inner chamber is defined between the annular blade and the drive shaft. The first chamber communicates with the second chamber. The casing has an exterior surface and a substantially unobstructed passageway extends within the casing surface, into the first inner chamber, into the second inner chamber, and through the open distal end of the second inner chamber for insertion and withdrawal of a surgical instrument therethrough.

Abstract: A method for using a circular stapling instrument for the removal of hemorrhoids is disclosed. The circular stapling instrument has a stapling end effector having a stapling head assembly and an anvil assembly movable from an open position spaced away from the stapling head to a closed position adjacent to the stapling head. A first inner chamber and a second inner chamber communicate within the stapling head assembly wherein the second inner chamber has an open distal end when the anvil is in an open position. A substantially unobstructed passageway extends from an exterior casing surface of the stapling head assembly through the first inner chamber, through the second inner chamber, and through the open distal end of the second inner chamber. A suture is placed into the hemorrhoid of a patient and the open stapling end effector is placed into the anus of a patient.

Abstract: A surgical instrument for excising a targeted tissue mass to be biopsied from adjacent bodily tissue on a surgical patient is disclosed. The instrument has an elongated tube and a tissue penetrating spiral having a spiral lumen therethrough mounted within the elongated tube for rotational movement. When the spiral is rotated, it penetrates distally into the targeted tissue mass. The mass is received in the spiral lumen for subsequent excision of the mass to be biopsied. A large biopsy sample can be obtained because of the ample space within the lumen of the tissue penetrating spiral. Since a large biopsy sample can be taken, the number of samples which need to be taken is minimized, and the consequent trauma to the patient is significantly reduced.

Abstract: A vacuum-actuated tissue-lifting device and method for performing a surgical procedure in an operative space of a patient are disclosed. The preferred device has a shell with a profile configured to surround a tissue surface of the patient, a vacuum port located on the shell for applying a vacuum between the shell and the tissue surface, and an air conduit extending through the shell to permit air to pass into the operative space of the patient when vacuum is applied. In a preferred embodiment, the device has an entry port located on the shell and a perforable membrane located on the entry port to provide a seal when a surgical instrument is inserted through the membrane during the procedure. The device and method of the invention eliminate the need for carbon dioxide insufflation, mechanical lifting devices which create obstructions and high stress zones on tissues within the operative space created, and unwanted displacement of internal organs when the targeted tissue surface is lifted.

Abstract: A method for establishing a surgical port for endoscopic or arthroscopic surgery is disclosed. A trocar is initially provided, and the obturator of the trocar includes a flat cutting blade, a shield that moves proximally and distally from a precock position to an extended position, a precock lever to move the shield proximally to expose the flat cutting blade, and a shield retaining assembly to constrain the shield in the proximal position. "Precocking" the trocar of the present invention moves the shield from the distal position wherein the flat blade is covered, to a proximal position wherein the flat blade is exposed, and the shield is constrained by the shield retaining assembly. Once the flat cutting blade is exposed, the skin of the patient is incised with the flat cutting blade of the obturator. The flat blade of the trocar is inserted into the incision and a penetrating force is applied so that the flat blade penetrates into the internal body cavity of the patient.

Abstract: A biopsy probe is provided for the collection of at least one soft tissue sample from a surgical patient. The probe comprises a frame having distal and proximal ends. The probe further comprises an elongated piercing element attached to the distal end of the frame. The piercing element has a sharpened distal end for piercing tissue, and a port located proximal to the sharpened distal end for receiving a portion of tissue mass positioned adjacent to the port. The probe further includes an elongated cutter having proximal and distal ends. The cutter is disposed coaxially and slideably relative to the piercing element and has a cutting blade on the distal end for cutting the portion of tissue protruding into the port of the piercing element when the cutter slides distally past the port, thereby depositing the portion of cut tissue within the cutter lumen of the cutter proximal to the cutting blade.

Abstract: A multiple clip applier includes a handle portion and a pair of handles pivotably connected to opposite sides of the housing. A shaft extends from the housing and has a plurality of clips located within. A pair of opposed moveable jaws are attached to and extend from the distal end of the shaft. The jaws receive one of the clips serially when they are open and form the clip received serially when they close. A moveable forming mechanism is operatively connected to the handles by a pair of forming links. As the handles close, the forming mechanism closes the jaws to form the clip received therein, and as the handles are opened, the forming mechanism opens the jaws to receive another clip therein . A feeding mechanism is provided that has a moveable feed plate attached to the handles by a pair of feed links. The feed plate is releasably coupled to a clip pusher. As the handles are closed, the clip pusher remains stationary and uncoupled with the moving feed plate.

Abstract: A surgical needle holder for use in open or laparoscopic surgery, that grasps a needle or a suture filament . The needle holder has a lower jaw, and an upper jaw moveable from an open to a closed position. The lower jaw has a pair of lower jaw ledge surfaces and a groove. The upper jaw has a grasping protrusion surface that can be embedded within a groove in the lower jaw, when the upper jaw is closed. When the jaws are closed on a needle, it is grasped with a three point needle contact system. The needle contact points are the two lower jaw ledges and the upper jaw grasping protrusion surface. Closure of the jaws on a curved needle "rights" the needle. When the jaws are closed on a suture filament, the upper jaw protrusion surface and the groove form a labyrinth path that effectively grasps the suture filament relative to the end effector. This enables the surgeon to apply tension to a suture to produce a tight knot or, when proximating tissue, tension a suture loop.

Abstract: An implantable marker for implantation in tissue of a surgical patient is disclosed. The marker has a base and an elevated bridge. A pair of legs descend from first and second transitions of the bridge. Each leg has a distal tip, a generally straight leg arm adjacent the tip, and a camming marker surface between the transitions of the base and the straight leg arm. The camming marker surfaces extend outwardly from the straight leg arms of the legs. In its open configuration, the first and second straight leg arms of the legs of the marker are generally parallel to each other. In its closed configuration, the first and second straight leg arms converge towards each other, and a marker apex is formed at the distal tips of the legs. The marker is particularly adapted for fixation in tissue to mark the site of a lesion or other abnormal tissue which may be removed during a biopsy procedure, for example a breast biopsy procedure.

Abstract: A trocar which has an obturator assembly for establishment of a surgical port for endoscopic or arthroscopic surgery is disclosed. The obturator includes a flat cutting blade, a shield that moves proximally and distally, a precock lever to move the shield proximally to expose the flat cutting blade, and a shield retaining assembly to constrain the shield in the proximal position. "Precocking" the trocar moves the shield from the distal position wherein the flat blade is covered, to a proximal position wherein the flat blade is exposed, and the shield is constrained by the shield retaining assembly. The exposed flat cutting blade of the precocked trocar can be used to incise or pierce tissue, thus avoiding the need to use a separate surgical sharp.

Abstract: An implantable marking device is provided which is designed to percutaneously deliver permanent markers to desired tissue locations within a patient's body, even if the desired locations are laterally disposed relative to the distal end of the delivery device, as is the case for conduit or cavity walls. This provides several advantages to the physician in diagnosis and management of tissue abnormalities, such as a means of localization of a tissue abnormality for follow-up surgical treatment, and a means of tissue abnormality site identification for purposes of ongoing diagnostic follow-up. In one preferred construction, a radiographic clip is configured in the form of a surgical staple. A disposable tissue marker applier, which comprises a flexible tube, pull wire, and squeeze handle, is employed to advance and deploy the clip to a desired tissue location. Either a flexible or a rigid introducer is also provided for providing access to the site to be marked.

Abstract: An endoscopic instrument assembly for fastening bodily tissue is disclosed. The assembly includes a surgical instrument for insertion into and withdrawal from the passageway of a cannula. The instrument has a tube with a neckdown region between the proximal and distal ends of the tube. The proximal and distal ends of the tube have a diameter greater than the neckdown region. When the instrument is inserted into the passageway of the cannula, the radial clearance at the neckdown region of the tube is greater than the clearance at the tube distal end. The instrument includes a suture filament for fastening the tissue, and a needle attached to the distal end of the filament. When the instrument is inserted through the cannula, the filament has a length where the needle lies adjacent the neckdown region of the tube and is contained within the greater radial clearance offered by the neckdown region.

Abstract: A partially tied surgical knot is disclosed. It has a proximal loop, first loop, plurality of knot loops, and a core loop received in a common loop core formed by the knot loops. The partially tied knot can be readily converted into a non-slip knot to provide enhanced suture knot security. The technique for deployment ensures the user that the conversion will be performed consistently each time, therefore providing a consistent knot security for multiple applications. Also disclosed is an assembly which features the partially tied knot in combination with a core tube to facilitate the conversion of the partially tied knot into the fully tied knot.

Abstract: A suture cartridge assembly is disclosed. The assembly has a suture cartridge containing a slot for receiving a suture filament and a cartridge top for covering at least a portion of the filament. A grasping jaw faces the cartridge top, and it is movable from an open position spaced from the cartridge top to a closed position adjacent the cartridge top. The slot in the cartridge for receiving the filament facilitates the formation and placement of surgical knots made from the suture filament, particularly when knots are needed at remote surgical sites such as during minimally invasive surgery. The placement and deployment of the knot is further facilitated because the grasping jaw can grasp the filament or the tissue which is desired to be sutured when the jaw is moved from its open to closed positions.

Abstract: A surgical stapling instrument with a remotely articulated staple head assembly on a rotatable support shaft. A joy stick mounted to the shaft of the instrument near the handle allows for remote articulation of the staple head assembly. The staple head assembly includes a narrow contour for insertion between adjacent rib pairs without rib spreading. The staple head assembly further includes a reloadable staple cartridge which may be replaced with differently sized staples of a second cartridge. A closure trigger clamps tissue prior to stapling and cooperates with a second trigger that performs the staple firing operation. The triggers include a safety lock mechanism for preventing premature staple firing.

Abstract: A surgical instrument for forming a fully tied knot to fasten bodily tissue is disclosed. The instrument has a handle assembly for actuating first and second actuators. The first actuator remotely effects movement of a grasping jaw from an open position to a closed position relative to a suture cartridge contained in a cartridge carrier at the distal end of the instrument. Accordingly, the first actuator is capable of causing the manipulation of bodily tissue or suture filament contained in the suture cartridge. The second actuator is operatively connected to the suture filament in the suture cartridge. A portion of the suture filament is configured into a partially tied knot, and when the second actuator is actuated, it causes the proximal end of the filament to be pulled for converting the partially tied knot into a fully formed knot.