Abstract: A surgical instrument includes a hollow member having a sidewall provided with a window and a closure member movably connected to the hollow member for alternately covering and uncovering the window. The hollow member has a first clamping surface along an edge of the window, while the closure member has a second clamping surface opposing the first clamping surface and disposable substantially adjacent thereto in a clamping or closure configuration of the instrument. The instrument additionally comprises a tissue occlusion component mounted to at least one of the hollow member and the closure member for acting on tissues gripped between the first clamping surface and the second clamping surface, to couple the tissues to each other.

Abstract: An endoscope system including an endoscope insertion part to be inserted into a body cavity via a trocar stabbed in a body wall, the endoscope system comprising: a detecting device detecting whether a tip of the endoscope insertion part has been drawn inside the trocar; and a trocar cleaning device cleaning the inside of the trocar by supplying a predetermined fluid into the trocar when it is detected by the detecting device that the tip of the endoscope insertion part has been drawn inside the trocar.

Abstract: An in vivo capsule has a cauterization element that may be deployed by physician while in vivo for cauterizing a lesion, such as bleeding. Energy is transferred from outside of the patient's body to the capsule and specifically to the ablating element, such as via a resonance circuit. Accordingly, it is the object of the present invention to provide a method and apparatus for precisely cauterizing or ablating tissue in-vivo. Embodiments of the invention may provide an in-vivo device having a cauterization or ablation element incorporated therein and a system and method for controlled navigation of the in-vivo cauterization device through a body lumen.

Abstract: A self propelled, endoscopic apparatus formed of a flexible, fluid-filled toroid and a motorized or powerable frame The apparatus may be used to advance a variety of accessory devices into generally tubular spaces and environments for medical and non-medical applications. The apparatus when inserted into a tubular space or environment, such as the colon of a patient undergoing a colonoscopy, is advanced by the motion of the toroid. The toroid's surface circulates around itself in a continuous motion from inside its central cavity along its central axis to the outside where its surface travels in the opposite direction until it again rotates into its central cavity. As the device advances within the varying sizes, shapes and contours of body lumens, the toroid compresses and expands to accommodate and navigate the environment. The motion of the toroid can be powered or unpowered and the direction and speed may be controlled.

Abstract: A treatment tool for an endoscope including: an insertion section inserted from a mouth ring provided at the base-end portion of a channel of the endoscope to the inside of the channel; an operation section provided at the base end of the insertion section; a rigid guide member having a tubular shape, externally fitted around the insertion section at the base end of the insertion section, and fixed to the operation section; and a fixing section that is externally fitted around the guide member, firmly attaches between the inner wall of the mouth ring or the channel and the guide member, and fixes the guide member to the inner wall of the mouth ring or the channel.

Abstract: An endoscope for removing tissue at a surgical site includes an elongated tubular body insertable within a mammalian cavity of a patient. An instrument channel extends between a first opening at a distal end and a second opening at a proximal end of the tubular body and is sized and configured to receive a surgical cutting assembly that includes an aspiration channel configured to remove material entering the endoscope via a distal end of the surgical cutting assembly. A torque generation component configured to generate torque is positioned within the distal end and configured to provide the generated torque to a coupling component. The coupling component is positioned at the distal end of the elongated tubular member and configured to actuate a cutting component of the surgical cutting assembly responsive to actuation of the torque generation component.

Abstract: A method of implanting electrically conductive leads in the gastrointestinal musculature for stimulation of target tissues involves an endoscopic approach through the esophagus. An endoscope is inserted into the esophagus of a patient. The mucosal surface of the anterior esophagus is punctured in the region encompassing the lower esophageal sphincter (LES). A tunnel is created through the submucosa and exits at the muscularis propria, adventitia, or serosal side of the stomach. The lead is navigated further to the anterior abdominal wall. A first end of the lead remains within the gastrointestinal musculature while a second end of the lead is positioned just outside the anterior abdominal wall. The first end of the lead comprises at least one electrode. An implantable pulse generator (IPG) is implanted and operably connected to the second end of the lead to provide electrical stimulation to target tissues.

Abstract: Medical apparatus includes an endoscope, which includes a distal end configured for insertion into a body cavity and which includes an imaging assembly, configured to capture and output an image of a region of the body cavity in proximity to the distal end. An energy source is configured to emit pulses of energy through an energy guide. A control unit is configured to process the image so as to identify a target mass in the body cavity and to verify that an aiming beam directed through the energy guide is incident on the target mass and, responsively to so verifying, to actuate the energy source to direct a pulse of the energy via the energy guide onto the target mass.

Abstract: A novel approach to diagnostic and therapeutic interventions in the peritoneal cavity is described. More specifically, a technique for accessing the peritoneal cavity via the wall of the digestive tract is provided so that examination of and/or a surgical procedure in the peritoneal cavity can be conducted via the wall of the digestive tract with the use of a flexible endoscope. As presently proposed, the technique is particularly adapted to transgastric peritoneoscopy. However, access in addition or in the alternative through the intestinal wall is contemplated and described as well. Transgastric and/or transintestinal peritoneoscopy will have an excellent cosmetic result as there are no incisions in the abdominal wall and no potential for visible post-surgical scars or hernias.

Abstract: Described herein are delivery devices and methods of using the devices for delivering an ocular implant into a suprachoroidal space without use of a goniolens. The delivery device includes a handle including a channel extending from a proximal end of the handle to a distal end of the handle, an applier coupled to the handle, the applier including a blunt distal tip and an elongate, flexible wire insertable through a fluid channel of an ocular implant, and a fiber optic image bundle reversibly inserted through the channel such that the fiber optic image bundle extends to a region proximal to the blunt distal tip of the applier.

Abstract: A balloon access device for use with an endoscope is disclosed. A transparent balloon attached to the distal end of the endoscope allows a user to both separate collapsed intestinal tissue and visualize the path of the endoscope without administering insufflation gas to the collapsed area of a patient. The attachment of the balloon to the endoscope is achieved by the various embodiments of the balloon access device disclosed herein.

Abstract: Medical devices including devices and systems for endoscopic interventions that may access the biliary tree. An example biliary catheter system may include an endoscope having a working channel formed therein. An endoscopic instrument may be disposed in the channel. The endoscopic instrument may have a tool channel formed therein, a distal end, and a plurality of stabilizing members extending from the distal end. The plurality of stabilizing members may be configured to surround the ampulla of Vater during a biliary tract intervention.

Abstract: A surgical device for displacement of organs within a body cavity for providing at least visual access to a selected site includes an expandable bladder, wherein the elasticity of the bladder varies across the surface of the bladder, said variation in elasticity selected to provide a predetermined, non-spherical shape when expanded; and a valve on the proximal end on the inflatable bladder for introduction of a pressurizing gas into the soft bladder.

Abstract: A system for treating a diverticulum in a body lumen includes a tubular member including a lumen and an elongate member in an elongated state within the lumen of the tubular member. The elongate member is configured to form a coiled state when removed from the tubular member.

Abstract: An adaptor for an endoscope includes: an endoscope attachment portion; a duct body that communicates with a treatment instrument insertion port of the endoscope; a duct member; a water feeding duct cover including an insulating member, the water feeding duct cover covering at least a part of an outer surface of the duct member and including an extension portion that spreads toward a proximal end side; and a duct body cover including an insulating member, the duct body cover covering at least a part of an outer surface of the duct body, and covering the extension portion of the water feeding duct cover so as to prevent the water feeding duct cover from moving to a distal end side of the duct member and coming off.

Abstract: The teachings provided herein are directed to a methods and devices for treating a hemorrhoid in a subject in a manner that produces substantially less post-procedural pain in the subject, the method minimizing or avoiding a removing or a necrosis of a rectal tissue fold.

Abstract: Systems and methods are described herein for tracking an elongate instrument or other medical instrument in an image.

Abstract: A method for endoscopic treatment that performs treatment on a subject under an endoscope includes irradiating the subject with white light, switching, after irradiation with the white light, to irradiation of a living tissue of the subject with band-limited light having a predetermined peak wavelength, and administering medicine to the subject after irradiation with the band-limited light.

Abstract: A catheter for delivering securing elements to a tissue, such as a blood vessel, and imaging the tissue before, after, or during the imaging. The catheters incorporate intravascular ultrasound (IVUS) imaging, including Focused Acoustic Computed Tomography (FACT), as well as optical coherence tomography (OCT).

Abstract: In one aspect, the invention provides injectable compositions that comprise a suitable hydrophilic polymer (e.g., a suitable polysaccharide) and water, as well as other optional components. In various embodiments, the composition may be provided in a suitable container, for example, in a pre-loaded syringe. In another aspect, methods of performing medical procedures in a tract of a body are provided. In yet another aspect, the invention provides systems for performing medical procedures in a tract of a body.

Abstract: The invention relates to a medical instrument for removing tissue, in particular a shaver, drill, or morcellator, having a tool that can be set in rotation and a motorized drive for driving the tool, and having an elongate body and a handle that projects laterally from said elongate body. The handle is fastened in a detachable manner to the body.

Abstract: The present technology relates generally to devices and methods for intravascular evaluation of blood vessels. Many embodiments of the technology relate to the intravascular evaluation of blood vessels before, during and after creation of autologous valves. In one embodiment, for example, the present technology is directed to a method comprising intravascularly delivering a delivery catheter to a target location adjacent a vessel wall and engaging the vessel wall along a portion of the delivery catheter. The method can further include determining the location of a first circumferential periphery of a dissection pouch formed within the vessel wall, determining the location of a second circumferential periphery of the dissection pouch, and determining an angular width of the dissection pouch based on the location of the first circumferential periphery and the second circumferential periphery.

Abstract: Devices and systems are provided for controlling movement of a working end of a surgical device by means of a robotic system. In one embodiment, systems and devices are provided for moving an end effector on a distal end of a surgical fastening device. Movement can include rotational movement of the end effector about an axis of the shaft, articulation of the end effector relative to the shaft, and actuation of an end effector, e.g., closing, firing, and/or cutting.

Abstract: An endoscope collar for use with an endoscope. The endoscope collar comprising a main portion comprising a proximal end that detachably couples to an end of the endoscope and a collar protrusion extending from the main portion. The collar protrusion is configured to be removably located within the aperture of a tube (e.g., a feeding tube).

Abstract: A device and system for removing cerebrospinal fluid (CSF) from a CSF space within a patient's body includes a housing adapted for implantation into a subcutaneous body space remote from the CSF space. A fluid pump is mounted inside the device housing. The pump has a pump actuator, a fluid inlet extending through the housing wall and a fluid outlet extending through the housing wall. A battery-powered electric motor is mounted inside the housing and is operatively coupled to the pump actuator. Device control circuitry controls operation of the electric motor. The device control circuitry includes a processor responsive to CSF space pressure signals, outflow pressure signals, and CSF flow rate signals to calculate CSF space pressures, CSF outflow pressures, and CSF removal volumes. A telemetry unit includes a transmitter to wirelessly transmit pump data and a receiver to receive external operational commands.

Abstract: Methods and apparatuses are described for processing 3D vision algorithms. A 3D vision processor device comprises one or more 3D vision processing cores. Each 3D vision processing core includes one or more memory blocks for storing location values associated with 3D point cloud images and an arithmetic logic unit coupled to the one or more memory modules. The arithmetic logic unit includes a plurality of memory registers for temporarily storing location values associated with a point in a 3D point cloud image and a processing unit coupled to the plurality of memory registers for performing arithmetic operations on the location values stored in the memory registers, the arithmetic operations used for 3D vision processing algorithms. The 3D vision processing core also includes a communication link for transferring data between the arithmetic logic unit and the memory modules.

Abstract: A method and system for diagnosing and treating infection or disease, in which an individual takes a photograph of an infected or diseased area of a body using a camera connected to a microprocessor. The photograph is sent to a diagnosing center having a server with a second microprocessor and a database of photographs correlated with different diseases and infections. The second microprocessor scans the image received from the camera and compares it to the photographs in the database. If a match is found, the second microprocessor then notes the disease or bacteria corresponding to the matching photograph. The second microprocessor then searches an additional database correlated to the match, to further refine the diagnosis. The second microprocessor then searches the second database for a treatment corresponding to the identified disease or bacteria. Once a treatment is identified, information regarding this treatment is automatically sent to the individual's microprocessor.

Abstract: A surgical instrument extends through a guide tube and exits at an intermediate position of the guide tube. The instrument includes a parallel motion mechanism that changes the position of a distal end of the surgical instrument without changing the orientation of the distal end. An image capture component is at the distal end of the guide tube, and a joint allows the image capture component to move while the intermediate position remains stationary. The configuration allows a cross section of the guide tube to be oblong. In some aspects, a joint for the image capture component is placed between exit ports for surgical instruments, which allows the guide tube cross section to be further reduced.

Abstract: A medical operation device is attachable to an insertion portion of a medical instrument for observation.

Abstract: An apparatus for cleaning a lens, or one or more lenses, of an endoscopic camera while the endoscope is deployed in a patient during a medical procedure, such as a minimally invasive procedure, or a therapeutic or diagnostic procedure, is disclosed. The cleaning apparatus generally includes a conduit having a fluid delivery port, an alignment system, and a flexible supply tube to fluidly connect the conduit to one or both of a source of a fluid and a suction device.

Abstract: A medical system includes: a treatment instrument having an insertion portion configured by an exterior member, and an insertion member that is inserted into the exterior member and is longer than the exterior member; an insertion portion inserting/pulling-out device to transmit a driving force to the exterior member or the insertion member configuring the insertion portion of the treatment instrument, the insertion portion inserting/pulling-out device advancing/retreating at least one of the exterior member and the insertion member; and a driving force non-transmitting portion provided to the insertion member, the driving force non-transmitting portion preventing a driving force of the insertion portion inserting/pulling-out device from being transmitted to the exterior member when the insertion member is moved by a predetermined distance.

Abstract: A method of treating a prostate condition, including the steps of providing a needleless injector that includes a body at a proximal end, an injection shaft extending from the body to a distal end of the injection shaft, an injection orifice at the distal end of the injection shaft and positioned for fluid ejection in a lateral direction relative to a longitudinal axis of the injection shaft, a pressure source in communication with the fluid chamber, and an extendable tissue tensioner located at the distal end of the injection shaft proximal to the injection orifice; inserting the injection shaft into a urethra so the injection orifice is located within the prostatic urethra; actuating the tissue tensioner to contact urethral tissue, and injecting fluid from the injection orifice into the prostate.

Abstract: An endoscopic pedicle probe for use during spinal surgery to form a hole in a pedicle for reception of a pedicle screw has an enlarged proximal end for cooperation with the hand of the surgeon and an elongate shaft terminating in a distal tip that may be pushed through the pedicle to form the hole. An integrated endoscope and light extend through the shaft to enable the surgeon to visually observe the target area, and a conduit extends through the shaft to convey a fluid to irrigate the target area. In a preferred form the probe is connected with an electromyographic monitoring system to alert the surgeon when a breach is about to occur. In a further embodiment, two endoscopes are associated with the probe. The complete probe may be disposable, or just the tip may be detachable for disposal or replacement.

Abstract: A treatment endoscope includes that a body cavity insertion portion which includes a main body distal hard portion, and a main body curving portion provided to a proximal side of the main body distal hard portion, one or more treatment arm/arms projecting to a distal side from the main body distal hard portion, each of the treatment arm/arms including a curving mechanism, an operation portion provided to the proximal side of the body cavity insertion portion, and an observation section configured to image a field of view in a body cavity, the observation section including an imaging section provided within the main body distal hard portion. The treatment endoscope includes that an operation portion attaching/detaching mechanism configured to removably attach the operation portion to the body cavity insertion portion, and an observation section attaching/detaching mechanism configured to removably attach the observation section to the body cavity insertion portion.

Abstract: A support system including a rail, a lower support, and an instrument support. The lower support is configured to receive a portion of a bronchoscope and to selectively fix the bronchoscope relative to the rail. The instrument support is slidably disposed on the rail and is selectively lockable to the rail. The instrument support is configured to releasably couple to a surgical instrument inserted through the bronchoscope to fix the position of a portion of the surgical instrument relative to the bronchoscope.

Abstract: An exemplary apparatus for imaging at least one anatomical structure can be provided. For example, the apparatus can include an endoscopic first arrangement, a radiation source second arrangement which provides at least one electro-magnetic radiation, and a third arrangement attached to at least one portion of the endoscopic arrangement. The third arrangement can contain an optical arrangement which, upon impact by the at least one electro-magnetic radiation and based thereon, may transmit a first radiation and reflects a second radiation. The first radiation can impact at least one first portion of the anatomical structure(s), and the second radiation can impact at least one second portion of the anatomical structure(s). The first and second portions can be at least partially different from one another. Further, the first and second radiations can have characteristics which are different from one another.

Abstract: An endoscopic treatment tool includes: a treatment part which is adapted to conduct treatment of tissue within a body cavity; an operation part which is adapted to operate the treatment part; an operation shaft member which connects the treatment part and the operation part; and a coil sheath part through which the operation shaft member passes so that the operation shaft member is capable of forward or backward movement, in which: the coil sheath part comprises: a first coil sheath around which wire is helically wound; and a second coil sheath that has a lower compressive resistance than the first coil sheath, and that has a higher rotation follow-up capability than the first coil sheath; the first coil sheath and the second coil sheath are disposed so as to coaxially and radially overlap; a first end part and a second end part of the second coil sheath are respectively connected to the treatment part and the operation part so as to be incapable of relative rotation around an axis of the second coil sheath;

Abstract: Apparatus includes Flexible Sheath extending from a proximal end which extends into living body; Capsule extending from a proximal to a distal end and having an opening formed in a proximal end thereof; Clip Assembly provided in Capsule and configured to be operably movable between a closed configuration in which first and second arms of Clip Assembly are drawn toward one another and an expanded configuration in which the first and second arms are separated from one another to receive target tissue therebetween; Bushing extending between a proximal end coupled to Sheath and a distal end releasably coupled to Capsule via a tab on the distal end of Bushing engaging the opening of Capsule; and Control Member a distal end of which is releasably coupled to Clip Assembly to transmit to Clip Assembly forces applied thereto to move Clip Assembly between the insertion and expanded configurations.

Abstract: The present invention relates to an improved cannula that enables a plurality of applications to such as tools to be utilised through a single cannula. According to the present invention there is a cannula having a distal end for insertion into a body, the distal end defining an opening to a primary conduit extending along the longitudinal axis of the cannula. The cannula further comprises a tool element for providing a tool function at or adjacent the distal end of the cannula. At least a portion of the tool element is arranged to be moveable outwardly relative to the longitudinal axis of the cannula. Accordingly, it is beneficial that more than one function can be provided at the distal end of the cannula reducing the trauma to the patient and improving access for the surgeon.

Abstract: An optical coupler is disclosed for mounting at a distal end of an optical imaging device for visualizing a surface area covered with an opaque fluid and/or particulate matter. The coupler includes a visualization section at one end of the coupler and an attachment section connected to and extending away from the visualization section. The attachment section is dimensioned to be mounted at the distal end of the optical imaging device. The visualization section includes a proximal surface for engaging the distal end of the optical imaging device. The visualization section includes an outer surface spaced apart from the proximal surface. The outer surface extends continuously from a first outer side boundary across to a second opposite outer side boundary of the visualization section. The visualization section may include a hollow instrument channel extending from the proximal surface toward the outer surface.

Abstract: A surgical instrument includes a housing supporting first and second actuators, an elongated shaft extending distally from the housing, and an end effector supported by a distal portion of the elongated shaft. A tensile member extending through the elongated shaft is coupled to the first actuator and the end effector such that first actuator may be manipulated to induce motion of the end effector. A locking mechanism associated with the tensile member selectively impedes motion of the end effector. The locking mechanism includes a collet disposed about the tensile member and a collet clamp for receiving the collet. Receipt of the collet into the collet clamp induces radial compression of the collet to impede the motion of the tensile member therethrough. An actuation member extending through the elongated shaft induces insertion and withdrawal of the collet from the collet clamp.

Abstract: A medical robotic system includes an entry guide with articulatable instruments extending out of its distal end, an entry guide manipulator providing controllable four degrees-of-freedom movement of the entry guide, and a controller configured to limit joint velocities in the entry guide manipulator so as to prevent movement of tips of the articulatable instruments from exceeding a maximum allowable linear velocity when the entry guide manipulator is being used to move the entry guide.

Abstract: Methods and apparatus for treating disorders of the ear, nose, throat or paranasal sinuses, including methods and apparatus for dilating ostia, passageways and other anatomical structures, endoscopic methods and apparatus for endoscopic visualization of structures within the ear, nose, throat or paranasal sinuses, navigation devices for use in conjunction with image guidance or navigation system and hand held devices having pistol type grips and other handpieces.

Abstract: A treatment tool for an endoscope includes a forcep sheath, a first forcep cup and a second forcep cup which are attached to a distal end of the forcep sheath, and which cooperate with each other to be openable/closable as a whole, an operation wire which is movably arranged in the forcep sheath along an axial direction thereof, which is connected to the first forcep cup and the second forcep cup, and which opens/closes the first forcep cup and the second forcep cup when moved in its axial direction, wherein a sharp needle-shaped portion is formed on a distal end of the first forcep cup, the sharp needle-shaped portion extending farther than a distal end of the second forcep cup, and the sharp needle-shaped portion is arranged so that at least a portion thereof overlaps the second forcep cup.

Abstract: A treatment device for endoscope includes a flexible sheath, an operation wire that is advanceably/retreatably inserted into the sheath, a treatment part comprising at least one elastic wires that can enter and exit a tip side inner part of the sheath, and a connecting member that secures to each other a tip of the operation wire and ends of the elastic wires. The connecting member includes a cylindrical body part, and a plurality of walls that extend from one end face of the body part in the direction of the axis of the body unit. A proximal end of the operation wire is secured to the body part, and the plurality of ends of the elastic wires are secured to the wall in the direction of the axis; when viewed from the wall side in the direction of the axis, at least one of the ends of the elastic wires overlaps with the body part. The interval between mutually adjacent walls is narrower than the outer diameter of the elastic wires.

Abstract: A surgical instrument adapted and configured for use in minimally invasive surgical procedures includes a shaft, an end effector and a proximal handle. The longitudinal shaft has proximal and distal end portions, and defines a longitudinal axis of the surgical instrument. The distal end effector is connected to the distal end portion of the shaft, and is adapted and configured for performing a surgical task. The proximal handle portion is operably connected to the proximal end portion of the longitudinal shaft and has an actuatable portion operably connected to the end effector to result in movement of the end effector. The distal end portion of the shaft can be laterally offset from the longitudinal axis of the shaft and/or have one or more bends or curves formed therein. The proximal portion of the shaft can include at least one bend to allow for comfortable positioning of a surgeon's hands.

Abstract: A method for surgically removing a tumor from a woman's breast is provided. The method can include inserting an optical trocar having a working channel and a transparent tip through a skin incision, guiding the transparent tip of the trocar through breast tissue with visualization such that the transparent tip of the trocar is placed adjacent to the tumor, insufflating gas via the working channel of the trocar to create a cavity in an operative field next to the tumor, dissecting the tumor free with a surgical instrument inserted through the working channel and removing the tumor through the trocar.

Abstract: An apparatus for imaging a body structure within a body cavity includes a catheter including proximal and distal ends, an imaging element on the distal end, and an extension extending distally from the distal end for contacting a surface of a body cavity into which the catheter is introduced. The extension has a length to maintain the optical imaging element away from the surface. Optionally, a transparent member, e.g., an expandable balloon, may be attached to the distal end of the tubular member and the extension to isolate the imaging element from contact with fluid within the body cavity. During use, the catheter is inserted into a chamber of a beating heart, and the extension and/or balloon is placed against the wall of the chamber. Sufficient force is applied to stabilize the imaging element relative to the wall while the heart is beating.

Abstract: The present invention provides a system and method for creating a percutaneous fluidic connection. In one embodiment, the system includes an endoscope having an end cap with a tube that defines a distal cavity and an internal magnet circumferentially arranged around the distal end of the tube. The internal magnet is delivered into the patient's stomach and pressed against an inner wall of the stomach. An external magnet is placed on an external surface of the patient's skin corresponding to the location of the internal magnet and the inner and external magnets are coupled together. An incision is made through the skin to access the distal cavity, and an overtube containing a PEG device is inserted into the distal cavity. The magnets are decoupled and removed, leaving the overtube in place, which is subsequently retracted from the PEG device, allowing the PEG device to be anchored in place.

Abstract: A surgical instrument includes a hollow member having a sidewall provided with a window and a closure member movably connected to the hollow member for alternately covering and uncovering the window. The hollow member has a first clamping surface along an edge of the window, while the closure member has a second clamping surface opposing the first clamping surface and disposable substantially adjacent thereto in a clamping or closure configuration of the instrument. The instrument additionally comprises a tissue occlusion component mounted to at least one of the hollow member and the closure member for acting on tissues gripped between the first clamping surface and the second clamping surface, to couple the tissues to each other.