Abstract: A ring for use in anastomosis. Preferably, the ring is integrally formed from metal, and includes a ring portion and tines and docking members that extend from the ring portion. The ring portion and tines are malleable, and preferably also the docking members are malleable. The ring portion and tines are malleable in the sense that once deformed from a first shape into a second shape, they will not relax back into the first shape from the second. To install the ring in a vessel with the ring portion extending around an incision or other orifice, the tines pierce the tissue around the orifice and are curled against an anvil. The action of curling the tines inverts the tissue near the orifice edges to expose the inside surface of the vessel or organ.

Abstract: A device for excising tissue and closing a wound that results from excision of the tissue includes structure defining an aperture into which tissue to be excised is exposed. The device also includes a cutting member for excising the tissue, a closure member for closing the wound, and an actuatable drive member associated with the structure. The drive member is actuatable to move the cutting member relative to the aperture for excising the tissue that is exposed in the aperture and for closing the wound with the closure member.

Abstract: Apparatus and methods for repairing damaged tendons or ligaments. Various repair apparatus include an elongate tensile member and a pair of anchor assemblies connected for movement along the tensile member on either side of a repair site, such as a tear or laceration. The anchor assemblies or structures may take many forms, and may include barbed, helical, and crimp-type anchors. In the preferred embodiments, at least one anchor structure is movable along the elongate tensile member to assist with adjusting a tendon segment to an appropriate repair position and the anchor structure or structures are then lockable onto the elongate tensile member to assist with affixing the tendon at the repair position. Tendon and/or ligament-to-bone repair apparatus and methods employ similar concepts.

Abstract: Wire fasteners having legs with lengths that can be one hundred times the width of the fastener are used to secure items, such as prosthesis valves to a patient during minimally invasive surgery. The fasteners are manipulated into position and then are immobilized by means of the legs thereof for tensioning, cutting and forming in situ. The fasteners are manipulated, tensioned and formed from the leg end of the fasteners. Tools for initially placing the fasteners and for immobilizing, tensioning, cutting and bending the fastener legs are disclosed. Once the fasteners are initially placed, the prosthesis is placed on the long legs of the placed fasteners and is guided into position on the legs. Once the prosthesis is in position, the legs of the fasteners are immobilized, tensioned, cut and bent into staple-like shapes to secure the prosthesis to the patient. A method for carrying out the procedure using the long fastener is also disclosed.

Abstract: Mechanical elements and/or adhesive is used in conjunction with or in place of suction to releasably attach elements of a system for manipulating a heart during cardiac surgery to the heart. The elements of the heart manipulation system are disclosed in the application Ser. No. 09/087,511 filed on May 29, 1998 and in the patent application Ser. No. 08/936,184 filed on Sep. 17, 1997. One form of the system can be used in minimally invasive surgery.

Abstract: An anastomosis is performed using a mounting structure mounted on the outside of at least one vessel. The mounting structure includes a flexible mounting structure that is attached to the vessel by a special instrument. A graft vessel is attached to the mounting structure either directly or by means of another mounting structure attached to the graft vessel. Tools for attaching a mounting structure to a vessel are disclosed, and a tool for attaching two mounting structures together is also disclosed. Methods for carrying out the anastomosis according to the invention are also disclosed.

Abstract: A system for manipulating a heart during cardiac surgery links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system for manipulating a heart during cardiac surgery of the present invention. The system is an improvement on the retractor disclosed in parent application Ser. No. 08/936,184 filed on Sep. 17, 1997 and locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired.

Abstract: Apparatus and methods for repairing damaged tendons or ligaments. Various repair apparatus include an elongate tensile member and a pair of anchor structures connected for movement along the tensile member on either side of a repair site, such as a tear or laceration. The anchor structures may take many forms, and may include barbed, helical, and crimp-type anchors. In the preferred embodiments, at least one anchor structure is movable along the elongate tensile member to assist with adjusting a tendon segment to an appropriate repair position and the anchor structure or structures are then lockable onto the elongate tensile member to assist with affixing the tendon at the repair position. Tendon-to-bone repair apparatus and methods are also disclosed employing similar concepts. Tendon retrieval devices include helical members for rotating into a tendon end and subsequently moving the tendon to an appropriate operating position.

Abstract: A cap for curable material dispensing containers prevents the material from curing after opening the dispensing nozzle. Thus, when mounted on a partially-dispensed container, the nozzle cap preserves flowable materials such as air-cured glues, sealants, caulks, etc. In particular, a deformable sealant in the cap remains pliant, conforming in and/or around the nozzle tip to create a seal. A retention member frictionally grips the nozzle to prevent inadvertent release of the cap, yet accommodates nozzle tips cut to varying lengths.

Abstract: A suture package (30) including a panel having a series of superimposed subpanels (32a). A suture (20) loops back and forth on the subpanels (32a) such that adjacent loops are retained on adjacent subpanels (32a) and the adjacent subpanels separate the adjacent loops from one another. In the preferred embodiment, an accordion style panel (32) is utilized and the series of subpanels (32a) are folded into a superimposed relationship. Various features are incorporated to reduce the instances or likelihood of kinking and tangling of the suture (20) when pulled from the package (30) by a user.

Abstract: An anastomosis is performed using a mounting structure mounted on the outside of at least one vessel. The mounting structure includes a flexible mounting structure that is attached to the vessel by a special instrument. A graft vessel is attached to the mounting structure either directly or by means of another mounting structure attached to the graft vessel. Tools for attaching a mounting structure to a vessel are disclosed, and a tool for attaching two mounting structures together is also disclosed. Methods for carrying out the anastomosis according to the invention are also disclosed.

Abstract: The present disclosure relates to a ligating instrument and end effector assemblies for use in laparoscopic tubal ligation procedures. The ligating instrument includes an integral grasping assembly and an integral end effector actuator and is configured to perform a ligating procedure by operation of a single hand of a user. The ligating instrument includes an integral grasper assembly for grasping a tubular tissue section and removable end effector or suture deployment mechanism for holding open a suture to be positioned about the tubular section. The grasper is configured to draw the tubular section into the open loop of suture material and cinch the suture material about the tubular tissue section. A rotator knob may be provided to orient grasper members associated with the grasper assembly relative to the tissue section.

Abstract: A clamping and fluid delivery device (50) for occluding a vessel (12) during a surgical procedure. Generally, the device (50) includes an internal core portion (52) having a distal end (52a) with a sealing surface and opposite side surfaces comprising sealing surfaces. The core portion (52) is inserted transversely into the vessel (12). Opposed, external clamping arms (62, 64) move together outside the vessel (12) and clamp the vessel (12) against the core portion (52). Padding (124) the sealing surfaces on opposite sides of the core portion (52), as well as on the distal end (52a) engage the internal walls (12a) of the vessel (12) and are opposed by padded clamping surfaces (120, 122) of the arms (62, 64). The core portion moves distally simultaneously with the clamping action of the arms to provide a distal seal. A bypass cannula (58) and cardioplegia cannula (60) fluidly couple the core portion (52) to deliver blood and cardioplegia fluid to opposite sides of the core portion (52).

Abstract: A system for manipulating a heart during cardiac surgery links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system for manipulating a heart during cardiac surgery of the present invention. The system is an improvement on the retractor disclosed in parent application Ser. No. 08/936,184 filed on Sep. 17, 1997 and locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired.

Abstract: A surgical loop delivery device is disclosed in parent disclosures Ser. No. 09/071,811 and U.S. Pat. No. 5,766,217. This device is improved to permit tissue targets larger than the device to be ligated while also maintaining a clear sight path between the surgeon and the target. The surgical loop is also stable during the procedure.

Abstract: An anastomosis is performed using a flexible mounting structure mounted on the outside of at least one vessel. Fasteners extend through the vessel and are bent towards the incision to attach the flexible mounting structure to the vessel in a manner that controls the edge of the vessel adjacent to the incision. The mounting structures are oriented on each vessel so fasteners on one mounting structure interdigitate with fasteners on the other mounting structure at the location of contact between the vessels when the two vessels are brought together. This creates two complementary sinusoidal-shaped vessel edges with peaks of one edge being accommodated in the valleys of the other edge. The peak-to-valley orientation forms a sinusoidal-shaped joint which is leak free. The fasteners are spaced so proper pressure is applied to the tissue to promote healing without leaking. Furthermore, the fasteners are sized and shaped to properly engage the tissue and bend in a desired manner.

Abstract: An anastomosis is performed using a flexible mounting structure mounted on the outside of at least one vessel. Fasteners extend through the vessel and are bent towards the incision to attach the flexible mounting structure to the vessel in a manner that controls the edge of the vessel adjacent to the incision. The mounting structures are oriented on each vessel so fasteners on one mounting structure interdigitate with fasteners on the other mounting structure at the location of contact between the vessels when the two vessels are brought together. This creates two complementary sinusoidal-shaped vessel edges with peaks of one edge being accommodated in the valleys of the other edge. The peak-to-valley orientation forms a sinusoidal-shaped joint which is leak free. The fasteners are spaced so proper pressure is applied to the tissue to promote healing without leaking. Furthermore, the fasteners are sized and shaped to properly engage the tissue and bend in a desired manner.

Abstract: An access and cannulation device includes a mounting element such as the anastomosis mounting element disclosed in U.S. application Ser. No. 08/714,615 (now U.S. Pat. No. 5,868,763) and U.S. application Ser. No. 09/200,796. The device is used to provide access therethrough and via an incision to the interior of a hollow anatomical structure such as a vessel, an organ or the like during surgery, especially minimally invasive surgery. It includes a flexible sleeve with a suture therein for closing the sleeve and locating edges of the structure adjacent to the incision in position for proper healing after completion of a surgical procedure. A tool is also disclosed for manipulating the device to configure it for the surgery and to close it after completion of the surgery whereby the edges of the wall of the structure adjacent to an incision are approximated to promote proper healing.

Abstract: A suture package (30) including a panel having a series of superimposed subpanels (32a). A suture (20) loops back and forth on the subpanels (32a) such that adjacent loops are retained on adjacent subpanels (32a) and the adjacent subpanels separate the adjacent loops from one another. In the preferred embodiment, an accordion style panel (32) is utilized and the series of subpanels (32a) are folded into a superimposed relationship. Various features are incorporated to reduce the instances or likelihood of kinking and tangling of the suture (20) when pulled from the package (30) by a user.

Abstract: Devices and methods are disclosed for stabilizing tissue within a patient's body during a surgical operation to provide a relatively motionless surgical field, such as during a coronary artery bypass graft procedure. The devices include tissue stabilizers which engage and provide stabilization to a targeted area of tissue and further have the ability to engage and manipulate some portion of tissue within or adjacent the targeted area to improve the surgical presentation of that portion of tissue. The tissue stabilizer typically has one or more stabilizer feet which have a first foot portion configured to provide stabilization to the targeted tissue and a second foot portion moveable relative to the first foot portion for manipulating a portion of tissue to improve the surgical presentation.