Abstract: A suture passing device includes a notchless tubular needle having a preformed curved shape. One or more cleats are disposed within the needle to help secure suture engaged by the sharp distal tip of the needle and to prevent further bifurcation of the suture. The deformable needle is housed in a channel of a lower jaw having a curved guidepath that approximates the curved geometry of the preformed needle, thereby facilitating the consistent return of the needle to its preformed shape each time the needle exits the channel. A dual needle suture passing device is also provided having a second notchless needle to enable a mattress stitch. Methods of loading a suture onto a notchless needle in a suture passer are also provided.

Abstract: An endoloop having a screw-coupling rear end section. Screw threads which respectively engage with each other are formed at a portion of a hollow rod and a portion of a rear end section which engage with each other such that the hollow rod and the rear end portion can be coupled with or separated from each other through screw engagement. The rear end section can be separated from the hollow rod even without being applied with strong force. A stitching procedure using the endoloop can be carried out more easily.

Abstract: A device useful for ligating an anatomical structure, e.g., a uterine artery, includes a crochet hook-like shaft, and tubular filament holder, and a housing that includes a thumb-slide attached to the shaft. After inserting the filament holder into tissue adjacent to the artery, the shaft is inserted to a point next to the holder, and a hook on the end of the shaft is used to snare the filament and pull it around the artery. The filament can then be tied down, ligating the artery.

Abstract: A wound closure device and method are disclosed. The wound closure device includes a housing, a needle driver assembly, a needle guard assembly, and optionally, a bolster. Use of the device and method reduces the length of time it takes to successfully close a wound or incision when compared to manual suturing as well as decreases the risk of complications such as internal organ damage and hemorrhage caused by the suture needles and eventual herniation through the abdominal wall caused by a poorly and ineffectively closed wound or incision.

Abstract: An anastomotic system including a plurality of needles loaded with sutures and a delivery tool. The sutures include a suture core and crimp or fastener member at a proximal end of the core. An anchoring sleeve is optionally provided at a distal end. The anchoring sleeve is configured to collapse and prevent retraction of the suture after insertion through the tissue wall. A method of deploying the needles using the delivery tool is also disclosed.

Abstract: Methods for suturing tissue by forming a locking loop of suture material. In particular, method of using a suture passer to arthroscopically create a locking loop of suture in difficult to access tissues. As used herein a locking loop of suture is a loop of suture that is passed through a tissue from a first side to a second side of the tissue; one or more of the legs of the loop extending from the first side are passed through the tissue to the second side of the tissue and are then passed through the loop, and the loop is cinched to tighten closed over the one or more legs. The resulting locking loops stitches are extremely strong and distribute the stresses across the tissue in a desirable manner.

Abstract: A method and apparatus for securing separate loops of suture with a coaxial mechanical fastener. Separate loops of suture extend from opposite ends of the mechanical fastener. A wire snare facilitates pulling the suture through the fastener. A suturing instrument provides for the infusion of pressurized physiologic solutions into the left ventricle so that the proper replacement suture length can be demonstrated real time prior to crimping the fastener. The instrument incorporates a slotted release site so that the fastener and suture can be released from the device tip once the fastener is secured. A method of securing suture coming from cardiac valve leaflets and or other structures like papillary muscles permits a more atraumatic orientation of the fastener coaxial with the suture strands.

Abstract: A vascular closure assembly includes a suture placement device and a sealant delivery device. The suture placement device is operable to position at least one suture across the puncture to form a primary seal of the puncture. The sealant delivery device includes a sealant delivery tube having a first lumen sized to receive the at least one suture, and a second lumen configured to deliver a volume of sealant to the puncture after forming the primary seal to create a secondary seal of the puncture. The sealant delivery device is slidable along the at least one suture to the puncture.

Abstract: A suturing device includes a handle, an elongated body, at least one suture snag, at least one pair of needles, and at least one suture pair. The suture snag is moveable between a deployed position in which two distal arm portions thereof radially extend away from the elongated body and a retracted position in which the two distal arm portions are disposed within the elongated body. The suture pair is slidingly disposed through the needle pair. The suturing device deploys the suture snag within a vessel adjacent to an arteriotomy, extends the needle pair through a vessel wall around the arteriotomy and through the deployed suture snag, extends the suture pair beyond the distal ends of the needle pair, and then utilizes the suture snag to capture the extended suture pair by retracting the suture snag to pull first or distal ends of the sutures back into the suturing device. An inflatable balloon or an expandable suture capture component may be alternatives to the suture snag for capturing the suture ends.

Abstract: A suturing device includes a handle, an elongated body, at least one suture snag, at least one pair of needles, and at least one suture pair. The suture snag is moveable between a deployed position in which two distal arm portions thereof radially extend away from the elongated body and a retracted position in which the two distal arm portions are disposed within the elongated body. The suture pair is slidingly disposed through the needle pair. The suturing device deploys the suture snag within a vessel adjacent to an arteriotomy, extends the needle pair through a vessel wall around the arteriotomy and through the deployed suture snag, extends the suture pair beyond the distal ends of the needle pair, and then utilizes the suture snag to capture the extended suture pair by retracting the suture snag to pull first or distal ends of the sutures back into the suturing device.

Abstract: A device useful for ligating an anatomical structure, e.g., a uterine artery, includes a crochet hook-like shaft, and tubular filament holder, and a housing that includes a thumb-slide attached to the shaft. After inserting the filament holder into tissue adjacent to the artery, the shaft is inserted to a point next to the holder, and a hook on the end of the shaft is used to snare the filament and pull it around the artery. The filament can then be tied down, ligating the artery.

Abstract: A suture cutting device including a housing, a cutting member, a suture recess, and an actuator. The cutting member is positioned in the housing. The suture recess is formed in the housing and configured to releasably connect the housing to the suture. The actuator is accessible outside of the housing and operable to move the cutting member laterally relative to the suture within the housing from a first position out of contact with the suture to a second position cutting the suture.

Abstract: Described here are closure devices and methods for ligating tissue, such as the left atrial appendage. The closure devices may comprise a snare loop assembly comprising a snare and a suture loop releasably attached thereto. The snare may be releasable from an elongate body of the closure device. In some instances, the closure device may comprise one or more markers to allow a user to determine whether the snare loop assembly is twisted.

Abstract: A suturing device includes a handle, an elongated body, at least one suture snag, at least one pair of needles, and at least one suture pair. The suture snag is moveable between a deployed position in which two distal arm portions thereof radially extend away from the elongated body and a retracted position in which the two distal arm portions are disposed within the elongated body. The suture pair is slidingly disposed through the needle pair. The suturing device deploys the suture snag within a vessel adjacent to an arteriotomy, extends the needle pair through a vessel wall around the arteriotomy and through the deployed suture snag, extends the suture pair beyond the distal ends of the needle pair, and then utilizes the suture snag to capture the extended suture pair by retracting the suture snag to pull first or distal ends of the sutures back into the suturing device. An inflatable balloon or an expandable suture capture component may be alternatives to the suture snag for capturing the suture ends.

Abstract: A needle driver, comprising a first elongated body having a substantially hollow interior portion and a first and second end, a second elongated body having a substantially hollow interior portion slideably disposed in the first elongated body, a clamping device having a clamping end and a connected end, the clamping device at least partially disposed in the first elongated body and in the second elongated body, wherein the connected end is affixed to the first elongated body, and a slideable actuator affixed to the second elongated body.

Abstract: A suturing device includes a handle, an elongated body, at least one suture snag, at least one pair of needles, and at least one suture pair. The suture snag is moveable between a deployed position in which two distal arm portions thereof radially extend away from the elongated body and a retracted position in which the two distal arm portions are disposed within the elongated body. The suture pair is slidingly disposed through the needle pair. The suturing device deploys the suture snag within a vessel adjacent to an arteriotomy, extends the needle pair through a vessel wall around the arteriotomy and through the deployed suture snag, extends the suture pair beyond the distal ends of the needle pair, and then utilizes the suture snag to capture the extended suture pair by retracting the suture snag to pull first or distal ends of the sutures back into the suturing device.

Abstract: Suture passer devices, including suture passers configured with an axially slideable jaw that includes a tissue-penetrating distal end region. Also described are suture passers including jaws housing tissue penetrating needles to pass suture that are substantially thin. Methods of using such devices to pass a suture through tissue are provided.

Abstract: A vascular closure delivery system is provided comprising a needle and suture delivery unit and a suture knot system. The delivery unit may comprise a tube, a leg, a tensioning device, a pusher, a needle, and an actuator, the tube being configured to house the needle. In an open position, the tensioning device exerts tension on the leg, and the pusher and suturing apparatus are in a delivery configuration for delivering the needle to the internal tissue wall. Further, actuation of the actuator moves the pusher towards an expulsion end of the tube such that the pusher engages the needle and expels the needle from the tube. The suture knot system comprises a shaft, an inner tubular member, and an inner rod. The inner tubular member is radially translatable with respect to the shaft. The inner rod is slidably coupled to and is axially translatable within the inner tubular member.

Abstract: Instruments and methods facilitate reconstruction, repair, and the closure of apertures in soft tissues, including the anulus fibrosus (AF), heart, lung, abdomen, thorax, vascular structures and other organs. Flexible longitudinal fixation components (i.e., sutures) are positioned across apertures in soft tissues, preferably to closes the inlets and/or outlets of such apertures. Tension on the flexible longitudinal fixation components may be used to narrow or close the apertures. Knotless fixation technologies such as suture welding are preferably used to fasten the ends of the flexible longitudinal fixation components. Certain embodiments include an intra-aperture component dimensioned for positioning within a defect in the AF, with one or more components being used to maintain the intra-aperture component in position. For example, the flexible longitudinal fixation component(s) may be anchored to one of the upper and lower vertebral bodies.

Abstract: An automated needle deployment device is provided. In one embodiment, the automated needle deployment device comprises a pusher, a needle, a tube, and an actuator. The pusher has a needle engaging end. The needle has a sharp end and an opposite end. A suture is associated with the needle. The pusher and needle are slidably disposed within the tube. The actuator comprises a control and a spring and is operatively associated with the pusher. Actuation of the actuator moves the pusher towards the needle expulsion end of the tube such that the needle engaging end of the pusher engages the needle and expels the needle from the tube.

Abstract: In repairing soft tissue with a bone anchoring instrument (such as reattaching a tendon of a torn rotator cuff), the bone anchoring instrument may be used to anchor the soft tissue to a region of bone. The anchors inserted into the underlying bone may have one or more lengths of suture or wire attached thereto which may be tensioned independently of one another to affix the soft tissue to the bone by having a selector mechanism selectively engage and disengage ratcheted tensioning wheels from one another. Suture loading mechanisms may be employed for passing suture lengths into and/or through the anchors prior to deployment into the bone where such mechanisms may employ suture snares which are configured to reconfigure from an expanded shape through which suture lengths may be easily passed to a low-profile shape which secures the suture lengths within the snare.

Abstract: A vascular closure device includes an anchor, a suture carrying portion, and a plurality of needles. The anchor is positionable through a vessel puncture in a vessel wall and operable between expanded and contracted positions. The suture carrying portion is positioned distal of the anchor and configured to carry at least one suture. The plurality of needles are operable between an advanced position extending through the vessel wall adjacent to the vessel puncture to connect to the at least one suture, and a retracted position in which the plurality of needles position the at least one suture through the vessel wall. At least one of the plurality of needles extends through an aperture in the anchor when in the advanced position.

Abstract: A micro-camera guided suturing device is disclosed comprising an elongate suture body having at least one lumen disposed therein and an imaging structure disposed within the at least one lumen of the suture. The imaging structure comprises a SSID optically coupled to a lens system. In one aspect, the suturing device further comprises a conductive element detachably coupled to the suture. In yet another aspect, the suture body comprises a shape memory material.

Abstract: Methods and devices are provided for anchoring suture to tissue, incorporating anchoring devices constructed substantially from suture. The anchoring devices are constructed as longitudinally extended, preformed knot configurations that upon deployment are reconfigured to form anchoring knots having an increased cross-section relative to the preformed knot configuration, for secure lodging in tissue. The anchoring devices are suitable for single and multi-anchor surgical procedures in soft tissue or bone, and multiple anchors can be delivered using a single delivery device.

Abstract: A suture passer device may include a first jaw, a second jaw, and a tissue penetrator which may penetrate through tissue positioned between the first and second jaws to carry a suture. Further, the device may include an actuator which may manipulate at least one of the first or second jaws and the tissue penetrator Additionally, the first and second jaws may be substantially parallel to one another at any position to which the at least one jaw is manipulated. Additionally, the tissue penetrator may travel along an arcuate path from a first position, recessed within the first jaw, to a second position where the tissue penetrator extends through the tissue to be positioned in communication with the second jaw.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose with first and second noose limbs connected, preferably slidably, to the filament engagement feature. The first and second noose limbs emerge from the anchor as first and second free filament limbs that are capable of being passed through tissue to be repaired and then passable through the noose. The noose is capable of receiving the free filament limbs and strangulating them when tension is applied to at least one of the free filament limbs and the noose to enable incremental tensioning of the tissue after anchor fixation. Preferably, the snare assembly further includes a flexible sleeve joining at least some portion of the first and second free filament limbs to facilitate passing of the free filament limbs as a single unit.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose with first and second noose limbs connected, preferably slidably, to the filament engagement feature. The first and second noose limbs emerge from the anchor as first and second free filament limbs that are capable of being passed through tissue to be repaired and then passable through the noose. The noose is capable of receiving the free filament limbs and strangulating them when tension is applied to at least one of the free filament limbs and the noose to enable incremental tensioning of the tissue after anchor fixation. Preferably, the snare assembly further includes a flexible sleeve joining at least some portion of the first and second free filament limbs to facilitate passing of the free filament limbs as a single unit.

Abstract: An apparatus and method for minimally invasive suturing is disclosed. A suturing device for minimally invasive suturing includes proximal section having a proximal end, a distal end, and a longitudinal axis therebetween; a suture head assembly extending from the distal end of the proximal section; a suturing needle having a pointed end and a blunt end, the suturing needle capable of rotating about an axis approximately perpendicular to a longitudinal axis of the proximal section, wherein the pointed end of the suturing needle is positioned within the suture head assembly prior to and after rotation of the suturing needle; and an actuator extending from the proximal end of the proximal section to actuate a drive mechanism having a needle driver for engaging and rotating the suturing needle.

Abstract: An adjustable anchor system for securing tissue to bone, including an anchor having at least one passage extending from a proximal end toward a distal end. The passage defines a restriction such as a restricted opening. The anchor has at least one bone-engaging feature disposed between the proximal and distal ends. The system further includes a first material formed as a closed loop and capable of being placed through a portion of the tissue, and a second filament having a terminal end, a post limb and a sliding knot tied between the terminal end and the post limb to establish an elongated, adjustable-length loop which extends beyond the proximal end of the anchor and captures the closed loop of the first material. The knot of the second filament is restrained by the restricted opening when tension is applied as desired to the post limb to shorten the elongated loop to draw the tissue toward the anchor.

Abstract: A device for loading a surgical knotting element on an applicator tool. One embodiment of the device includes a channel dimensioned to receive an applicator tool comprising a coupling. A surgical knotting element comprises a coupling complementary to the coupling of an applicator tool and a suture path. A carriage receives the surgical knotting element. The carriage is moveable in a transverse direction relative the channel between a first position where the knotting element is misaligned with the channel and a second position where the couplings are engaged with one another.

Abstract: The present disclosure relates to a tissue repair device. The device includes a handle, a knob coupled to the handle, and a needle coupled to the handle. The needle includes a proximal end and a distal end, the distal end including a slot, wherein a first anchor is housed within the distal end and a second anchor is housed within the slot and located proximal to the first anchor. An actuator disposed within the needle and operatively coupled to the knob, wherein advancement of the knob allows for engagement of the actuator with the first anchor and subsequent advancement of the first anchor via the actuator. A method of tissue repair is also disclosed.

Abstract: An arthroscopic meniscal tear repair device includes a catch needle and a transfer needle. which are pierced into a torn meniscus and advanced past the tear. Suture is transferred by a suture needle from the transfer needle through the meniscus and into the catch needle. The catch needle has an internal mechanism that retains the suture. The suture needle is then retracted back to its home position inside the transfer needle, leaving the free end of the suture across the meniscus and in the catch needle. The device is then retracted out of the meniscus, leaving behind a stitch across the meniscal tear inside the meniscus . A pre-tied knot of suture is then slid down the device and cinched up using a knot pusher having a dilation tip, thus completing the repair.

Abstract: Methods and devices are provided for repairing a tear in a meniscus. A pair of fixation member each entailing a preformed knot configuration coupled together by a suture length. The fixation members are placed on the meniscal tissue with the suture length spanning the tear, the knot configurations are expanded to form anchoring knots and the suture length is shortened to close the tear.

Abstract: A surgical filament snare assembly including an anchor capable of being fixated in bone and having a filament engagement feature. A first filament has a noose on a first portion of at least a first limb and has a second portion connected to the filament engagement feature of the anchor. Preferably, at least one free filament limb, which in some embodiments is a length of the first filament and in other embodiments is a second filament, is capable of being passed through tissue to be repaired and has at least one end passable through the noose to enable incremental tensioning of the tissue after the anchor is fixated in bone. The noose strangulates the free filament limb when tension is applied to at least one of the free filament limb and the noose.

Abstract: A device is provided for closing a wound, such as a percutaneous access site. The device is inserted into the wound, and a helically shaped pusher is actuated to penetrate a wall of the wound. The pusher extends a suture through the tissue wall. After the suture is extending through the tissue wall, the pusher is retracted out of the tissue, while the suture remains extending through the tissue. The suture may then be used to close the wound.

Abstract: A suture passing instrument including an operation handle, a needle member, and a suture holder assembly. The operation handle has at least one actuator movable between a first position and a second position. The needle member extends from the operation handle. The needle member has a curved end portion and defines an eyelet extending therethrough. The suture holder assembly extends from the operation handle and has a movable suture carrier at a distal end configured to hold a suture. The movable suture carrier has a suture pusher telescopically and movably received in the movable suture carrier. The suture carrier is movable between a retracted position and an extended position. The suture pusher is movable beyond the suture carrier to carry the suture through the eyelet.

Abstract: Described herein are suture passers that may be used for repair of the meniscus of the knee. These suture passers typically include an elongate body having a pair of arms. One or more of the arms may be radiused at the distal end region relative to the long axis of the device, to better fit between a target tissue and a body non-target tissue (e.g., the curvature of the femoral condyle). The arms may form a distal-facing opening that is configured to fit the target tissue. One arm may be movable in the axial direction (e.g., the direction of the long axis of the device), while the other arm may be bendable. A tissue penetrator may be housed within one of the arms to extend across the distal opening between the arms. Thus, a suture may be passed from a first side of the tissue to a second side.

Abstract: A suturing instrument includes a suturing head that is coupled to the shaft of an elongate body member of the instrument by a connector member which may be biased in either a linear orientation along the longitudinal axis of the shaft or any one of a variety of non-linear orientations with respect to the shaft's longitudinal axis. The connector member can comprise a resilient material such that an external force may be applied to the suturing head and move the suturing head from a biased orientation (e.g., linear) to an unbiased orientation (e.g., non-linear). Once the external force is removed, the resiliency of the connector member allows the suturing head to return from the unbiased orientation to the biased orientation. Therefore, a user may adjust the shape of the instrument by applying or removing an external force on the suturing head.

Abstract: A device configured as a knot pusher and/or a suture trimmer is provided. The device can deliver and secure a suture knot. The apparatus can also trim the suture after the suture knot is secured.

Abstract: Methods and devices for treating female stress urinary incontinence are disclosed. The methods include transvaginally accessing the pelvic cavity and introducing a suburethral sling into the retropubic space. In some embodiments the ends of the sling are attached to an anatomical support structure. In other embodiments, the ends of the suburethral sling are not attached to an anatomical support structure. The devices include a surgical instrument for blunt dissection of the pelvic cavity which includes a curved shaft and a blunt distal end. A hook deployment device may optionally be attached to the surgical instrument.

Abstract: Devices and methods are presented for securing a suture to facilitate a surgical procedure.

Abstract: A surgical suturing device (10) having an axis extending between a proximal end and a distal end is operable to move a suture (32) through body tissue (34). A handle assembly (110) is coupled to an elongated shaft (14) having a hollow configuration. An actuating rod (16) is disposed to extend between the handle assembly (110) and the shaft (14). A thumb actuation assembly is coupled to a proximal end of the actuating rod (16) for moving the rod both axially and rotationally. A needle assembly (2) at the distal end of the actuating rod (16) is movable with the actuating rod (16) between an extended state and a retracted state and at various angular orientations.

Abstract: A device for suturing an opening in a tissue, having an elongated shaft, at least two arms movable to a deployed positioning which the arms are non-perpendicular to the shaft, the arms having needle receiving portions; and needles advanceable longitudinally along the shaft toward the needle receiving portions, the needles exiting through side walls of the shaft at a location proximal to the arms.

Abstract: A suture manipulating instrument for passing and retrieving suture through a tissue includes a handle mechanism, an elongate shaft extending from the handle, and a working distal end. The working distal end includes a needle body, a lumen defined by the needle body, a tissue penetrating distal tip, and a lateral slot. A preformed inner member is movably disposed within the lumen of the needle. The handle mechanism is used to extend the wire from the lateral slot of the needle, and to retract the wire into the lateral slot, allowing the working end of the instrument to grasp and manipulate suture by pinning and/or trapping the suture against the needle. In embodiments the inner member is further retracted within the needle lumen, drawing a length of suture into the needle lumen. The suture is subsequently ejected from the needle lumen to form a suture loop.

Abstract: Disclosed are a system and method for performing a medical procedure using direct percutaneous access of an aorta. A main sheath is introduced through an incision formed in proximity to the sternum, and positioned along (and preferable against) a posterior portion of the sternum. Instruments passed through the main sheath are used to form a purse-string suture in an exterior wall of the aorta. An opening is formed in the wall of the aorta in a region encircled by the purse-string suture, and a distal end of an introducer sheath is advanced through the opening into the aorta. A medical procedure, which may be a transcatheter aortic valve replacement, is performed using instruments passed through the introducer sheath into the aorta. After the medical procedure, the introducer sheath is withdrawn from the aorta and, as the introducer sheath is withdrawn, the purse-string suture is tightened to close the opening.

Abstract: A method and apparatus for reattaching the opposed ends of a member, such as a tendon, ligament or bone, during preparing and healing of the member using a surgical repair device that can be securely attached to the member and then safely guided through tortuous anatomy for reattachment and repair. The repair device further includes structural means so as to secure opposed ends of the member against separation during healing. Devices for aiding in the positioning of the surgical repair device are provided.

Abstract: A surgical pledget assembly includes a pledget body having first and second apertures extending through the body, one or more snares passing through the apertures in the pledget body and including first and second suture engaging loops disposed on a distal side of the pledget, an optional third folding loop disposed on a proximal side of the pledget, and a handle secured to the ends of the snare or snares proximal to the pledget.

Abstract: A needle delivery device that has particular application for providing needles for minimally invasive spinal surgical procedures. The device includes an elongated pincher having opposing rails that is slidable within a channel defined in an extended base portion. Widened end portions of the rails hold the needle and push it out of an end of the device where it is released. The pincher is then retracted to a location where the end portions can pick up a next needle to be delivered.

Abstract: The present disclosure relates to a tissue repair device. The device includes a handle, a knob coupled to the handle, and a needle coupled to the handle. The needle includes a proximal end and a distal end, the distal end including a slot, wherein a first anchor is housed within the distal end and a second anchor is housed within the slot and located proximal to the first anchor. An actuator disposed within the needle and operatively coupled to the knob, wherein advancement of the knob allows for engagement of the actuator with the first anchor and subsequent advancement of the first anchor via the actuator. A method of tissue repair is also disclosed.

Abstract: An instrument for delivering a suture transfascially may include a handle, a shaft extending from the handle, and a pair of needles that are moveable to an extended position beyond the end of the shaft. One or more sutures are carried by the instrument and may be delivered transfascially. A transfascial suture assembly includes a suture having first and second segments and an intermediate segment therebetween. A force distributing member is locatable at the intermediate segment. Suture retainers may be provided at the end of each suture segment, and may have a connection that is moveable relative to the suture segment. A method of delivering transfascial sutures includes inserting a twin-needle instrument loaded with one or more sutures into an abdominal cavity and deploying, from within the abdominal cavity, the suture carrying needles through a soft tissue repair patch and then through at least part of the abdominal wall.