Abstract: A circular anastomosis stapler is provided and includes a handle assembly having a firing trigger that is actuatable between a first firing stroke and a second firing stroke. A shell assembly includes a pusher assembly having a main pusher, a staple pusher and a knife pusher. A compressible member positioned between the main pusher and the knife pusher is movable between a first configuration for advancing the staple pusher through the first firing stroke to drive at least one staple from the shell assembly to staple tissue and a second configuration for advancing the knife pusher through the second firing stroke to drive a knife from the shell assembly to core the stapled tissue.

Abstract: A magnet delivery system for forming an anastomosis that comprises a wire guide; a catheter having a delivery portion for advancement into a visceral space, the delivery portion having a lumen extending at least partially therethrough and an expandable balloon for dilation and a lumen extending therethrough, a first port and a second port in communication with the lumen through which the wire guide is disposed; a magnet comprising a lumen therethrough wherein the magnet is removably secured to the delivery portion of the catheter between the first and second ports by disposing the wire guide through the lumen of the magnet, the first port and the second port.

Abstract: One exemplary process for manufacturing a surgical apparatus may include providing a flat, generally-planar strip of biocompatible material; cutting the strip to produce a feeder belt with at least one lateral edge, and staples affixed to the feeder belt in proximity to at least one lateral edge, where the staples and feeder belt are substantially aligned along a first plane; and bending at least one staple out of the first plane, while the feeder belt remains in the first plane. Another exemplary process for manufacturing a surgical apparatus may include providing a flat, generally-planar strip of biocompatible material; cutting that strip to produce a feeder belt with edges, and staples affixed to different edges of the feeder belt; and coining at least one staple after the cutting.

Abstract: A combination tissue apposition and suture capturing device (100) for performing endoscopic procedures typically in the gastro-esophageal tract. The device (100) is particularly adapted for forming multiple plications used in a gastroplasty procedure devised to cure or ameliorate gastro-esophageal reflux disease. The device include a tissue sewing capsule (102) attached to the distal end of an endoscope having a needle (120) that is deposited in a capsule (102) distal tip cavity following the suturing of a tissue fold and retrieved to enable the suturing of a subsequent tissue fold without the need for multiple intubations. A suture clip delivery device (200) is also disclosed that is adapted to fit within the capsule to enable suture capture without the need for multiple intubations. The combination device eliminates the need for an overtube and maximizes the speed efficiency of the gastroplasty procedure. A method for using the combination device is also disclosed.

Abstract: Techniques for sutureless vascular anastomosis are described, including an incision seal including a base configured to partially house an outer surface of a main vessel, the base being formed using a material that is configured to be penetrated by a barb disposed on a connector the main vessel being secured to the base when the base is at least partially pierced by the barb, an upper lumen configured to guide a graft vessel, and a housing opening configured to receive the graft vessel.

Abstract: Described are methods and devices relating to reconnecting tissue of the urethra, e.g., connecting the urethra and bladder after a radical prostatectomy, wherein the devices incorporate tissue approximating structure such as tines to maintain contact between severed tissue, such as a severed bladder neck tissue and a severed urethral stump tissue, preferably without the use of sutures.

Abstract: A method for interconnection of two tubular organs via an opening at one end of an end portion of a first organ and an aperture in a side wall of a second organ. The end portion is initially passed through a first passage of a first element until the end portion projects past an end edge of the element, whereupon the end portion is everted round the end edge. Gripping parts of a second element with a second passage are then inserted in the second organ via the aperture. Finally, the first element with the everted portion of the first organ is inserted in the second passage, whereby the gripping parts are influenced in such a manner that they come into engagement with the inside of an edge portion of the aperture. A device for implementation of the method.

Abstract: The present embodiments provide medical apparatuses and methods for rapidly forming an anastomosis between two viscera. The medical apparatus generally comprises affixing a clamp to an elongate member. The method generally comprises positioning and then deploying the medical apparatus between and within two stomas via an elongate member.

Abstract: A magnamosis system for auto-anastomosing a region of the body using implants with magnetic members that may be individually delivered to different locations in the body. The implants with their magnetic members have a mating surface and polar alignment that generates an attractive force to compress tissue in the region between them. The tissue in the region necroses as a result of the compressive force such that tissue surrounding the necrosed tissue heals together to form an anastomosis.

Abstract: The invention is an implantable magnetic anastomosis device having an exoskeleton that directs self-assembly. The design allows the device to be delivered in a linear configuration using a minimally-invasive technique, such as endoscopy or laparoscopy, whereupon the device self-assembles into, e.g., a polygon. A coupled set of polygons define a circumscribed tissue that can be perforated, or the tissue can be allowed to naturally necrose and perforate. The device can be used to create anastomoses in a variety of tissues, such as tissues found in the gastrointestinal, renal/urinary, and reproductive tracts. New procedures for using anastomoses, e.g., surgical bypass are also disclosed.

Abstract: A sheath is configured for elongation from a first length to a second, longer length and a retention member retains the sheath at the first length. A portion of the retention member is removed or disengaged, the sheath is released and expands in situ to the second longer length. A method for releasing the retention member is also disclosed.

Abstract: An anastomotic device (10) is suitable for approximating and keeping close to each other a first tissue portion (12) and a second tissue portion (14) intended to form an anastomosis. The anastomotic device (10) comprises an abutment portion (18) suitable for the abutment against a surface of the first tissue portion (12) and a locking portion (20) suitable for being placed opposite the abutment portion (18) with respect to the first and second tissue portion (12, 14). The locking portion (20) and the abutment portion (18) are mutually connectable through the first and second tissue portions approximated, to keep them connected. The anastomotic device (10) is suitable for being connected to a guide means comprising at least one guide wire (A, B).

Abstract: Apparatus and methods are provided for forming a gastrointestinal tissue fold by engaging tissue at a first tissue contact point, moving the first tissue contact point from a position initially distal to a second tissue contact point to a position proximal of the second contact point to form a tissue fold, and extending an anchor assembly through the tissue fold near the second tissue contact point. Adjustable anchor assemblies, as well as anchor delivery systems, are also provided.

Abstract: Described are methods and devices relating to reconnecting the urethra and bladder after a radical prostatectomy, wherein the devices incorporate tissue approximating structure to maintain contact between a severed bladder neck tissue and a severed urethral stump tissue, preferably without the use of sutures.

Abstract: An anastomotic instrument includes first and second units. The first unit is attached to a distal end portion of an insert section of an endoscope, and has a self-propellable apparatus and an anvil. The second unit is attached behind the first unit, and has a cartridge and a balloon. The insert section with the anastomotic instrument is inserted into the alimentary canal. In the alimentary canal, fluid is sucked out from space enclosed by the first and second unit through a suction port provided in the cartridge, to bring the space into negative pressure. While the alimentary canal is shrunk in the space, the second unit is shifted relative to the first unit. In a state where the shrunk alimentary canal is caught between the first and second units, a cutter resects living body tissue, and staples are struck to join edges of an incision of the alimentary canal.

Abstract: The present invention relates to a device for endoscopy or endosonography-guided transluminal interventions whereby two luminal structures in the body may be drawn toward each other and a fluid conduit formed in between. The device may have a hollow central member to which is coupled a distal retention member and in one embodiment a proximal retention member. The retention members may each be positioned inside one of the luminal structures and expanded from a first condition to an expanded second condition having an increased radius. The length of the central member may be shortened and its diameter expanded to approximate the two retention members and thereby the luminal structures.

Abstract: Endoscopic devices and methods used for fastening multiple tissue layers, such as, for example, an endoscopic fundoplication procedure, are disclosed. The endoluminal device includes a tissue fastener, a flexible needle having means for grasping and releasing a portion of the tissue fastener, and a deflector for deflecting and guiding the needle toward the multiple tissue layers.

Abstract: Apparatus and methods are provided for thermally and/or mechanically treating tissue, such as valvular structures, to reconfigure or shrink the tissue in a controlled manner. Mechanical clips are implanted over the leaflets of a valve, e.g., in the heart, either alone or after thermal treatment to cause the valve to close more tightly. The clips are delivered by a catheter and may be configured to traverse directly over the valve itself or to lie partially over the periphery of the valve to prevent obstruction of the valve channel. The clips can be coated with drugs or a radiopaque coating. Alternatively, individual anchors with a tensioning element, like a suture, may be used to approximate the valves towards each other. The catheter can also incorporate sensors or energy delivery devices, e.g., transducers, on its distal end.

Abstract: A closure device having evertable arms for capturing and everting tissue and method for its use with an invasive scope, such as an endoscope, for full-thickness closure of perforations and leaks in the walls of an intraluminal bodily space.

Abstract: A system and a method for joining an upper and lower esophageal sacs in an infant are provided. The system includes a first elongate member having a first magnet, the first magnet including an end portion configured to abut an interior surface of the upper esophageal sac. The system also includes a second elongate member having a second magnet, the second magnet including an end portion configured to abut an interior surface of the lower esophageal sac. The system further includes a third elongate member having a third magnet and a spacer positioned distal to the third magnet. The third elongate member is positionable in the upper esophageal sac after the first elongate member has been removed. A magnetic force between the first magnet and the second magnet is configured to pull the first magnet and the second magnet towards each other to lengthen the upper and lower esophageal sacs.

Abstract: An anastomosis device has first and second components which each having first and second parts. The first and second components are magnetically attracted to one another. The device forms a throughhole when in use. The first parts of the first and second components are positioned radially outward from the second parts relative to the longitudinal axis with the first parts of the first and second components contacting one another and being magnetically attracted to one another. The second parts of the first and second components also being magnetically attracted to one another and are separated by the vessel walls.

Abstract: A cannula for placement within a salivary gland duct having a first end adjacent an oral cavity and a second end adjacent a salivary gland is provided. The cannula includes an elongate body having a lumen and a first and a second plate offset from a proximal end of the elongate body. The first plate is located on one side of the elongate body and the second plate is correspondingly located on the other side of the elongate body and adjacent the first plate. The first plate has a first hole that is operable to suture the first plate to a location adjacent the first end of the salivary duct adjacent the oral cavity, whereby upon placement of the cannula within the salivary gland duct, saliva flows through the elongate body's lumen from the salivary gland to the oral cavity.

Abstract: A medical device comprising an actuator, an extension portion, and a tissue interaction portion. The extension portion is coupled to the actuator and comprises at least first and second telescoping sections with each telescoping section having (i) at least one extended hook section having a head portion and a neck portion, and (ii) at least one body section being one of coupled and integrated to the at least one extended hook section. The at least one extended hook section of the first telescoping section is operatively coupled to the body section of the second telescoping section. The tissue interaction portion is operatively coupled to the extension portion and comprises at least one of a gripping mechanism, a stapling mechanism, and a cutting mechanism. The actuator is adapted to control at least one of the extension portion and tissue interaction portion.

Abstract: Apparatus for performing a surgical anastomosis include a tubular body having an expandable anchor operatively coupled near a distal end thereof. The apparatus further includes a sleeve slidably received about the tubular body. The sleeve has an expandable anchor operatively coupled near a distal end thereof. The expandable anchor of the tubular body has an annular ring concentric with a longitudinal axis defined by the tubular body.

Abstract: The present invention discloses an inflatable contour-balloon useful in minimal invasive and/or open surgery. The inflatable contour-balloon positioned in the contour of a mesh and/or a patch and/or a net. The inflatable contour-balloon is adapted to spread and/or deploy the mesh and/or the patch and/or the net in the abdominal cavity and/or pre-peritoneal and/or space and/or hollow body organs and/or natural and/or artificial orifices and/or spaces and/or post operative spaces. The present invention also discloses an elongate open-bored applicator (EOBP) adapted to spread and/or deploy a mesh and/or a patch and/or a net. The EOBP is useful in minimal invasive surgery. The EOBP has a distal portion that is insertable into the abdominal cavity and/or pre-peritoneal and/or space arid/or hollow body organs and/or natural and/or artificial orifices and/or spaces and/or post operative spaces; and a proximal portion that remains outside the body.

Abstract: Devices and methods for anastomosis are provided. The devices can include a first and a second member of a generally hollow open configuration. The first and second members may each include a rigid part and an elastic part arranged circumferentially of the rigid part. The devices may also include a connection member for interlocking the first and second members such that anastomosis is obtained at a contact area in-between the elastic parts. The methods can include arranging an elastic part inside a tubular structure at a first end of the tubular structure, folding an edge of the first end over the elastic part, and mounting the elastic part on a rigid part, forming a first member. This may be repeated at a second end of the tubular structure, forming a second member, and the first and second members may be locked to each other by a connection member.

Abstract: Methods and devices for placing a target vessel in fluid communication with a source of blood and a target vessel. A conduit includes first portion adapted to be placed in fluid communication with a source of blood, such as a heart chamber, and a second portion adapted to be placed in fluid communication with a target vessel having a lumen, such as coronary artery. The first and second conduit portions are transverse to each other such that the conduit is generally T-shaped. The conduit lies on an exterior of the heart between the blood source and the target vessel and is configured to deliver blood in multiple directions into the lumen of the target vessel. For example, in an occluded coronary artery, blood flows both toward and away from the occlusion. The conduit may be flexible, rigid, collapsible or non-collapsible, and may be formed of synthetic vascular graft material, tissue, or a combination of the two.

Abstract: Methods, devices, apparatus, assemblies, and kits for performing a vascular anastomosis are disclosed. A device for a vascular anastomosis includes tissue engaging portions that can move between at least two configurations. In some embodiments, the tissue engaging portions move without the aid of moving parts, while in other embodiments the tissue engaging portions extend from one or more movable wings. The tissue engaging portions may be separated by a first distance when in a pre-deployment configuration and by a second distance when in a deployed configuration. A method includes engaging a plurality of tissue engaging members of a coupling device against first end tissue. After selectively engaging the tissue engaging members and first end tissue, the first end tissue is stretched by at least moving the tissue engaging members. The stretched first end tissue is coupled to the second end tissue by mating the coupling device to a mating anastomosis device.

Abstract: The invention provides devices, systems and methods for tissue approximation and repair at treatment sites. The devices, systems and methods of the invention will find use in a variety of therapeutic procedures, including endovascular, minimally-invasive, and open surgical procedures, and can be used in various anatomical regions, including the abdomen, thorax, cardiovascular system, heart, intestinal tract, stomach, urinary tract, bladder, lung, and other organs, vessels, and tissues. The invention is particularly useful in those procedures requiring minimally-invasive or endovascular access to remote tissue locations, where the instruments utilized must negotiate long, narrow, and tortuous pathways to the treatment site. In addition, many of the devices and systems of the invention are adapted to be reversible and removable from the patient at any point without interference with or trauma to internal tissues.

Abstract: A method and device for controlling the compression of tissue include clamping tissue between a first clamping member and a second clamping member by driving at least one of the clamping members with an electric motor toward a predetermined tissue gap between the clamping members and, during the clamping, monitoring a parameter of the electric motor indicative of a clamping force exerted to the tissue by the clamping members. The method and device include, during the clamping, controlling the electric motor, based on the monitored parameter, to limit the clamping force to a predetermined maximum limit.

Abstract: A system for coupling a first space within the body of a patient with a second space within the body of the patient including a flow connector insertable into the first and second spaces within the body, the flow connector having a conduit having a lumen having a first orifice at a first portion of the conduit and a second orifice at a second portion of the conduit, the conduit providing communication between the first and second spaces within the body. A retention device retains the conduit with respect to the first space within the body and is engageable with the first space within the body.

Abstract: A method of implanting and securing an implantable flow connector in a body of a patient for providing communication of a first space within the body of the patient with a second space within the body of the patient. The method includes providing a flow connector having a lumen having a first orifice and a second orifice, inserting a retention device into the first space within the body, subsequently inserting the flow connector through an opening in the retention device so the second portion of the flow connector extends into the first space within the body and placing the second space within the body over the retention device.

Abstract: The invention relates a sheath that is affixed to a body lumen, proximal to an anastomosis site. The sheath includes a sleeve defining a passage. A grasping structure is positioned distally of the distal opening of the sheath to facilitate elongation of the sleeve from a first length to a second longer length. A method for using the sheath is also disclosed.

Abstract: Tissue management methods can include inserting a clamping device into a vessel and clamping a vessel wall via the clamping device. Tissue can be dilated about the clamping device and an anastomotic device provided to the vessel.

Abstract: Apparatus for performing a surgical anastomosis include a tubular body having an expandable anchor operatively coupled near a distal end thereof. The apparatus further includes a sleeve slidably received about the tubular body. The sleeve has an expandable anchor operatively coupled near a distal end thereof. The expandable anchor of the tubular body has an annular ring concentric with a longitudinal axis defined by the tubular body.

Abstract: An apparatus for assisting in a vascular procedure includes an obturator operable to be mounted on a medical device to guide the medical device into a targeted region, whereby the obturator is substantially blunt such that it exhibits a snag-resistant property. In alternative embodiments, the apparatus includes an interface element operable to be used in conjunction with the obturator and to engage an interface of the targeted region such that pressure is maintained within the targeted region. The interface element includes a convex portion that operates to seat the interface element at a selected location. The interface element is substantially transparent and includes a magnification element that magnifies materials underlying the interface element. In other embodiments, the apparatus includes a tray operable to provide a mold for forming the obturator, which may include a gas, water, sugar, clotted blood, a gelatinous material, a protein, a saline solution, or dry-ice.

Abstract: Methods and devices for modifying the location at which bodily fluids interact with nutrients in a gastrointestinal tract. The methods and devices utilize a conduit configured to divert bodily fluids from an entrance within a gastrointestinal tract to a location downstream from the entrance.

Abstract: Methods, instruments and systems are provided for separating opposite walls of the stomach by extragastric application of suction. Plication of the stomach can be performed between the separated walls after which the separate walls are brought back toward one another. In another aspect, methods, instruments, devices and systems are provided for reducing the effective volume of a stomach by performing one or more extragastric plications of the stomach.

Abstract: A surgical staple for connecting two tubular tissue structures may include a substantially rectangular base having a first edge and a second edge substantially parallel to one another, and a third edge substantially perpendicular to the first and said second edges; and may also include at least three deformable tines extending from the first and second edges of said base; where no tine that extends from the first edge may be positioned at substantially the same distance from the third edge as any said tine that extends from the second edge; and where deformation of the tines secures the tubular tissue structures together.

Abstract: A surgical stapler instrument has surgical stapler jaws, at least one staple line reinforcement material, and a fastener including a hook and a loop. The hook can be disposed on one of the surgical stapler jaws and the loop can be disposed on the staple line reinforcement material. Alternatively, the hook can be disposed on the staple line reinforcement material and the look on one of the surgical stapler jaws.

Abstract: Medical devices and related methods are disclosed for delivering an implant into the body of a patient. The devices include a damping assembly having an internal chamber with a varying inner diameter, and a piston slideably disposed therein. The piston is operably connected with a catheter portion such that movement of the piston is associated with concurrent movement of the catheter for implant delivery. The varying inner diameter of the damping assembly results in a decrease in damping force during implant delivery, thus providing a substantially constant velocity of implant delivery.

Abstract: A device for forming an anastomosis of blood vessels or ducts includes a first inner cylindrical element for engaging a corresponding first blood vessel/prosthesis end portion and a first middle cylindrical element into which the first inner cylindrical element is inserted to bend the legs of the first inner cylindrical element inwards to a predetermined extent so that deformable legs thereof engage the vessel/prosthesis wall. The device includes a second inner cylindrical element for engaging a corresponding second blood vessel/prosthesis end portion and a second middle cylindrical element into which the second inner cylindrical element can be inserted to bend the legs of the second inner cylindrical element inwards to a predetermined extent so that deformable legs thereof engage the vessel/prosthesis wall. The device also includes an outer element for reciprocally connecting the first and second middle cylindrical elements.

Abstract: The present disclosure relates a device for joining a first body vessel to a second body vessel, including an inner member having a distal end portion and defining a longitudinal axis, an outer member defining a lumen dimensioned to receive the inner member therein, and a radially expandable anchor disposed at the distal end of the inner member, the expandable anchor having an initial condition wherein the expandable anchor is disposed between the outer member and the inner member and an expanded condition wherein the expandable anchor is radially larger than the expandable anchor in the initial condition.

Abstract: An apparatus for applying sealant to a target tissue of a surgical site is provided. The apparatus includes a handle, conduit and an end effector. The handle has means configured and adapted for operating the end effector and dispensing biological sealant to the surgical site via the end effector. The conduit stores and/or carries sealant towards the end effector. The end effector is configured to clamp around a body organ or tissue and apply and confine biological sealant in a substantially uniform manner thereto.

Abstract: A device and method for achieving hemostasis and leakage control in vascular structures and other body ducts or vessels in an emergency room or trauma situation. The device has at least one shunt that contains an obturator on an end of the shunt. The shunt is inserted into a damaged vessel or lumen for sealing the leak or hemorrhage. Two shunts that both contain obturators on one of their ends can be inserted into two different vessels or lumens when the vessel or lumen has been severed. The obturators allow for the improved ease of insertion into the vessel or lumen. The two shunts are then releasably attached to restore fluid communication through the vessel or lumen. The shunt is placed temporarily within the patient and then removed when definitive repair can be achieved by a qualified physician.

Abstract: A surgical fastening system can comprise a plurality of fasteners, wherein each fastener can comprise, one, a base and, two, a leg extending from the base, wherein each leg can comprise a tip. The fastener system can further comprise a retention matrix comprising a first side facing toward the bases of the fasteners, a second side facing away from the bases of the fasteners, and a plurality of retention members configured to engage the legs. The fastener system can further comprise a cover configured to cover the staple tips, wherein the cover can comprise a sheet of material and/or a plurality of caps.

Abstract: A vascular graft for anastomosis of blood vessels or ducts comprises piercing means (3) for engaging an end portion (8/8?) of a blood vessel or prosthesis and means (6, 6?) for precisely guiding one or more piercing elements (3) to pierce the wall of the vessel or prosthesis to a predetermined depth and in a predetermined direction.

Abstract: An endoluminal treatment device and method includes introducing an endoluminal device into a lumen of a patient and engaging a wall of the lumen with an end effector of the endoscopic device. A plication can be formed in the wall of the lumen such that an open pocket is formed in the wall of the lumen or such that an artificial biologic tube is formed.

Abstract: A clip for closing a puncture in a body lumen comprises a clip having a resiliently expandable circumference and a plurality of barbed prongs extending at least approximately in the same direction from one edge of the clip. A device for deploying such a clip is described. A method for deploying such a clip is also described.

Abstract: Described herein are endoscopic plicators passed transorally into the stomach and used to plicate stomach tissue by engaging tissue from inside of the stomach and drawing it inwardly. In the disclosed embodiments, the tissue is drawn inwardly into a vacuum chamber, causing sections of serosal tissue on the exterior of the stomach to be positioned facing one another. The disclosed plicators allow the opposed sections of tissue to be moved into contact with one another, and preferably deliver sutures, staples or other means for maintaining contact between the tissue sections at least until serosal bonds form between them. Each of these steps may be performed wholly from the inside of the stomach and thus can eliminate the need for any surgical or laparoscopic intervention. After one or more plications is formed, medical devices may be coupled to the plication(s) for retention within the stomach.