Abstract: An apparatus and method for reducing the circumference of a vascular structure comprising the steps of providing a plurality of sutures and a plurality of discrete suture support segments of a biocompatible, inert material, each suture support segment having at least two suture holes spaced a predetermined distance (D) apart; individually suturing each discrete suture support segment to the vascular structure with one of the plurality of sutures by effecting a horizontal mattress (U-shaped) suture along the vascular structure through a length of tissue of the vascular structure such that the length (D') of tissue sutured is greater than distance (D); and tightening and tying off the suture, whereby each sutured suture support segment creates an imbrication in the vascular structure, thereby reducing the circumference thereof.

Abstract: A ligation clip remover removes closed ligation clips from a ligated vessel. The remover includes a handle assembly having a squeezable trigger and a slender barrel assembly connected to the handle assembly. A clip separating mechanism is connected to a distal end of the barrel assembly, and a shaft is slidably disposed in the barrel assembly for operating the clip separating mechanism when the trigger is squeezed.

Abstract: An apparatus and method of treating an aneurysm by applying to an aneurysmal blood vessel a band around its exterior surface, at the position where the attachment system of the graft attaches the graft to the vessel. A strap gun device and a method for using a strap gun device permits a surgeon to secure the material band or strap around the blood vessel with the use of only a single hand.

Abstract: A system, a closure, and method of use for sealing a percutaneous puncture in a blood vessel. The puncture includes an opening in the vessel wall and a tract leading to the opening. The system includes an introducer sheath and associated positioning device, a hemostatic puncture closure, and a deployment instrument. The positioning device enables the introducer sheath to be positioned at a desired position within the vessel. The deployment instrument includes a tubular carrier holding the closure. The closure comprises a rigid, e.g., radio-opaque, anchor, a compressed collagen plug, and a thin filament connecting the two in a-pulley-like arrangement. The instrument and introducer are used to introduce the closure into the puncture, with the anchor located within the artery and with the collagen plug within the puncture tract. A locking member is provided to hold the closure in place at its operative position, whereupon hemostasis occurs rapidly, thereby sealing the puncture.

Abstract: Apparatus for attaching a surgical needle having an end portion with an elongated aperture defined therein and a suture having a generally elongated end portion to be positioned in the elongated aperture of the needle, includes a pair of dies, each die defining a longitudinal axis and having an inner die surface. The inner die surface includes at least two raised swaging portions extending generally along the longitudinal axis of the die and a generally recessed portion defined between adjacent swaging portions and extending substantially along the lengths thereof. The swaging portions each have an engaging surface defining a plane angularly oriented relative to a longitudinal bisecting plane of the dies.

Abstract: A surgical staple line reinforcement device for use with a variety of surgical staplers to protect against tissue damage from surgical staples. The device comprises a tube of bio-implantable material that can be quickly and readily applied by a surgical team to provide tissue reinforcement. The device preferably comprises a stretched or expanded polytetrafluoroethylene (PTFE) with pre-established tear lines therein. The device allows for fast and safe staple reinforcement and rapid stapler separation and removal following installation.

Abstract: A surgical clip applying instrument is disclosed which includes a handle portion having a first handle and a second handle mounted for relative movement. The handles define a single closing stroke between an open position and a closed position. The closing stroke includes an initial throw, an intermediate throw, and a final throw. The clip applying instrument includes body portion extending distally from the handle portion and defining a longitudinal axis, and a plurality of surgical clips disposed within the body portion. A jaw assembly including first and second jaw portions is mounted at the distal end portion of the body portion and is movable between an approximated position and a spaced position. A jaw control mechanism is configured to move the jaw portions to the spaced position for reception of a distalmost clip in response to the initial throw of the handles. The jaw control mechanism is configured to maintain the jaw portions in the spaced position during the intermediate throw of the handles.

Abstract: A method and device for the placement of sutures and for the purpose of approximating tissue. A particular utility is effected in the approximation of the tissue separated by means of an endosurgical trocar being inserted into a body cavity. The invention provides for the loading of suture material including needles into the device, introduction and placement of the device into the body cavity, with the distal end having deployable needle guides, extending the needle guides either simultaneously or individually to the periphery of the wound, engaging the wound with the needle guides, driving the needles and suture material through the tissue to be approximated into a catch mechanism, retracting the needle guides and withdrawing the device, leaving a loop of suture material in the margin of tissue. The suture may then be tied to approximate the wound and excess suture material cut off.

Abstract: A surgical suturing apparatus for closing an incision penetrating a plurality of layers of tissue includes a tubular body in which a "J"-shaped suture needle resides. In this position the tubular body may be inserted into the incision without damaging tissue. Once the tubular body has been inserted into the incision, the pointed end and suture gate of the suture needle are deployable out of a slot through the side of the tubular body to permit deep suturing of tissue layers without also suturing surface tissue layers. Several embodiments are presented for deploying the needle, including one in which the straight section of the suture needle having the pointed tip is biased to flare away from the other straight section of the suture needle, and the deploying is accomplished by moving the pointed tip section adjacent the tubular body slot and permitting the bias to cause that section to flare out of the slot.

Abstract: A surgical instrument for carrying and attaching separate components of a compression anastomosis device to the end of tissue of a tubular hollow organ, which includes an elongated housing having a proximal end and a distal end; first and second compression anastomosis device components; a supporting member operatively associated with the distal end of the elongated housing, for supporting the first and second compression anastomosis device components; and assembling structure associated with the supporting member and operable from the proximal end of the elongated housing, for assembling the first and second compression anastomosis device components within tubular body tissue.

Abstract: An arthroscopic method and apparatus for implanting a suture anchor into tissue using a cannulated tissue-shifting guide. Tissue at a repair site is secured with a cannulated tissue-shifting guide. Suture material is appended to a suture anchor. The suture anchor is attached to a device driver and installed through the cannulated tissue-shifting guide at the repair site and into bone. A power drill can be attached to the device driver and used to drive the suture anchor during installation.

Abstract: A method and apparatus for creating abdominal visceral anastomoses. A first magnet is placed within a first viscera and a second, larger magnet is placed within a second viscera. The magnets each have a raised rim around their perimeters. The two magnets couple to each other by virtue of their mutual attraction, thereby capturing a portion of the intervening visceral walls between them. The coupling of the magnets is automatically self-centering, as the smaller magnet is forced to rest within the raised rim of the larger magnet. Additionally, the raised rim of the smaller magnet acts as a fine cutting edge in order to accelerate the process of ischemic necrosis of the tissue captured between the two magnets, thereby forming the anastomosis. Use of the present invention avoids the need for general anasthesia and a laparotic incision, resulting in fewer surgical and post-surgical complications.

Abstract: A surgical implement particularly useful for implanting a prosthetic valve in an excised annulus includes a manually grippable handle, and a suture retainer carried by the handle and having an outer face carrying a coiled spring whose coils define an annular array of slits each having opposed yielding surfaces for receiving and releasably retaining sutures between selected coils. Optimum spacing of the sutures according to the shape of the excised annulus is attained by providing reference ribs between selected coils of the spring, and also by making the outer annular face of the suture retainer of substantially the same shape as that of the excised annulus. Embodiments are also described including an illuminating device for artificially illuminating the working area. Also described is a method of implanting a prosthetic valve in a quick and efficient manner using such an implement.

Abstract: A suture anchor is described which in one form may be easily fabricated from extruded material by angular cuts and bore holes which provide an offset pulling force to the suture. In an alternate and preferred embodiment the suture anchor is injection molded having an annular displaced corner and abutment wall which act to seat the suture anchor firmly within a bore hole. Novel application means are also disclosed which hold the suture anchor on a frangible shaft for insertion and upon completion of the insertion permit fracture of the frangible portion and removal of the instrument.

Abstract: A vascular occluder clip including a resiliently-biased pair of clamping elements extending transversely to longitudinally-extending members. Gripping loops or pads are provided for grasping by the user and compression of the members against the biasing force to separate the clamping elements. The gripping loops or pads extend from the longitudinal members on the opposite side thereof from the clamping elements.

Abstract: A knotless suture anchor assembly for the attachment or reattachment or repair of tissue to a bone mass. The assembly allows for an endoscopic or open surgical procedure to take place without the requirement of tying a knot for reattachment of tissue to bone mass. A spike member is inserted through tissue mass through a loop and inserted into a dowel-like hollow anchoring sleeve which has been inserted into a bone mass. The spike member is securely fastened or attached to the anchoring sleeve with a ratcheting mechanism thereby pulling or adhering (attaching) the tissue to the bone mass.

Abstract: A taper point surgical needle having improved needle point strength is disclosed. In one embodiment of the needle, a tip portion includes first and second integral tapered regions having first and second cross-sectional areas respectively which decrease progressively toward the tip of the needle in accordance with first and second angles of inclination respectively, with the first angle being greater than the second angle. In another embodiment of the needle of the present invention, the tip portion includes a third tapered region integral with the second tapered region and having a cross-sectional area which decreases progressively toward the needle tip in accordance with a third angle of inclination which is smaller than the second angle.

Abstract: An arthroscopic method and apparatus for implanting a suture fixation device or other appliance into tissue using a hollow cannulated grasper. Tissue at a repair site is secured with a hollow grasper. Suture material is appended to a suture anchor. The suture anchor or other appliance is attached to a device driver and installed through the hollow grasper into the repair site, where it is drilled into bone.

Abstract: A ligation apparatus includes an opening portion at a front end of a rod, in communication with the front end side, the left side, and the right side, having a cross section of substantially a U-shaped configuration in the direction of axis of the rod, and a mobile unit in the opening portion. The mobile unit includes a body held in a movable manner, and a thread supporting unit having the tip end protruding from the opening portion for supporting a ligature at the front end. The ligature has one end tied to the thread supporting unit of the mobile unit, and the other end translated downwards from the upper side of the mobile unit according to a predetermined direction of rotation, whereby a knot of the ligature is formed. Therefore, a ligation site can be ligated extracorporeally even if the hole puncture in a somatic layer is small.

Abstract: A surgical instrument facilitates tying of a knot in a length of suture material at a remote surgical location. The instrument is comprised of a rod having a length of suture wrapped over the rod in a particular pattern. A needle may be secured to a free end of the suture and the pattern of wrapping the suture on the rod enables loops of suture to move off the rod end and over the needle to form a knot in the suture.