Abstract: A self-closing fastener is described that comprises a clip passable through a tissue opening. The fastener is adapted for holding by a mechanism in an open configuration for passing through the tissue, followed by releasing the fastener from the holding mechanism, allowing the clip to remain in the tissue in a shape that can clip two or more locations on the tissue. The fastener and delivery devices are particularly useful for tissue approximation, such as anastomosis. When used for anastomosis, the inventive clips provide intima-to-intima contact with a minimal amount of intraluminal exposure.

Abstract: A tissue approximation device and method, particularly in the mid-face region, are provided. The device is an implantable, biodegradable construct that has attachment points emanating from a supportive backing. The device also has an extension member or leash which extends from the backing which is configured to receive a tissue or bone attachment device at one of a plurality of selectable locations along the elongated member, for example via engagement holes extending in a line away from the backing. Once tissue is engaged with the attachment points, the extension member is pulled until the tissue is approximated in the desired position. Then the appropriate extension member hole(s) are selected to attach the extension member to supportive tissue or bone (for example temporal fascia) for permanent tissue approximation.

Abstract: In a medical clip consisting of a platelet of an elastic bio-compatible material, the platelet is provided with a central H-shaped cut-out so as to form a frame structure with tongues extending from the frame structure toward each other and having adjacent front edges forming grasping elements, and the frame structure is curved and elastically biases the front edges toward each other.

Abstract: In a medical clip consisting of a platelet of an elastic bio-compatible material, the platelet is provided with a central H-shaped cut-out so as to form a frame structure with tongues extending from the frame structure toward each other and having adjacent front edges forming grasping elements, and the frame structure is curved and elastically biases the front edges toward each other.

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

Abstract: A device for closing a septal defect, such as a patent foramen ovale, includes a clip formed from a superelastic material that is inserted into a septum wall of a heart. The clip is advanced through a patient's vasculature, e.g., within a delivery apparatus, until the clip is disposed within a first chamber adjacent the septal defect. Tines of the clip are directed through a flap of tissue of the septal defect until the tines of the clip are disposed within a second opposing chamber. The clip then transforms into its relaxed state, wherein the tines of the clip engage with a surface of the second chamber, thereby substantially closing the septal opening.

Abstract: The invention concerns a prosthetic mounting clip (1) having a monolithic structure, made of a biologically absorbable plastic material, comprising a distal anchoring element (2) in an anatomical support (8), a proximal stop element (3) relative to a prosthetic part (9), and a connecting rod (4) linking the distal anchoring element (2) and the proximal stop element (3), the connecting rod (4) being arranged relative to the distal anchoring element (2), to determine at least two positions of said connecting rod (4), namely an inoperative position wherein the connecting rod (4) is arranged along a direction (R) relative to the distal anchoring element (2), and another stressed position wherein the connecting rod (4) is folded back against the distal anchoring element (2) along a second direction (P).

Abstract: Apparatus and methods are provided for reducing the volume of a lung using a clip including a plurality of tines. The clip is advanced along an interior of a bronchial passage to a predetermined location with the tines in a contracted condition. The tines are expanded outwardly to engage surrounding tissue, and then collapsed towards the contracted condition, thereby drawing the surrounding tissue inwardly to substantially close the bronchial passage from air flow therethrough. Optionally, electrical energy may be applied to the surrounding tissue after collapsing the tines to the contracted condition, thereby fusing the surrounding tissue together. The clip is then released within or removed from the passage.

Abstract: A surgical staple is provided having a base portion and a respective leg extending from each end of the base portion and terminating at a free end. The base portion is deformable to bring the free ends of the legs together to penetrate a liquid-carrying vessel at the site of a puncture and hold the opposite edges of the puncture together. The base portion and legs lie in substantially a common plane except for a center portion (40C) of the base portion which is deformed in a loop in a direction perpendicular to the common plane. The center portion of the staple allows the staple to straddle a blood locator tube projecting from the end of a stapler, so that the staple can be closed at the center of a puncture wound in which the tube is located. A method for stapling is also provided.

Abstract: Apparatus and methods are provided for partitioning a gastro-intestinal lumen by intraluminally reducing a local cross-sectional area thereof. The apparatus comprises a plurality of anchors adapted for intraluminal penetration into a wall of the gastro-intestinal lumen to prevent migration or dislodgement of the apparatus, and a partition, which may include a drawstring or a toroidal balloon, coupled to the plurality of anchors to provide a local reduction in the cross-sectional area of the gastro-intestinal lumen.

Abstract: A multi-barbed apparatus is provided, and methods of use, for penetrating two sides of a wound and holding the edges in apposition. The apparatus may be inserted within a wound or underneath the skin, and mechanically adheres the two sides of the wound together. The apparatus includes a biocompatible substrate carrying a multiplicity of tissue penetrating barbs on a least one side thereof, and may be formed as a rigid or flexible sheet, tube or other shape.

Abstract: The suture delivery system utilizes two sutures. Each suture has a filament body and a toggle bar. The delivery system includes an elongated central tube with two needle retainer guides and a cam distally disposed on the central tube. The needles have piercing needle ends and each needle end carries a respective toggle bar for a suture disposed thereon. A longitudinally movable member is coupled to the needles. The needles are movably disposed in respective needle retainer guides. An actuator is coupled to the movable member such that when the actuator moves, the needles extend outward such that the needle ends move over the cam. In a further embodiment, the actuator includes a first user actuation surface coupled to the movable member and the central tube includes a second user actuation surface which is generally static. In a further embodiment, a locking member is disposed on the second user actuation surface. The cam may take one of a variety of shapes.

Abstract: An introducer comprises a sheath, a guide rod, at least one wire stabilization guide, and a loop actuation wire for securing and centering a wound opening during a medical procedure (e.g., wherein a transluminal device is utilized) and during closure of the wound. The guide rod is sized to fit within the inside diameter of the sheath. The guide rod has at least one slot along its length for releasably holding the loop actuation wire. One or more wire stabilization guides or elongated members are coupled to the sheath. In one exemplary embodiment, the elongated members may be actuated to form a loop, so that when the sheath is approximated to a wound site, the loop portion is approximated to tissue surrounding the wound site to hold the sheath approximately centered on the wound site.

Abstract: A staple and stapler and introducer are disclosed for closing a wound and for wound site management. The staple is deformable, and includes a plurality of tissue-piercing prongs which are expanded outwardly, inserted into tissue and collapsed inwardly to close the wound. The stapler includes a plurality of mechanisms to deform the staple into various positions. An introducer is provided that includes a plurality of spaced-apart wire guides for securing and centering the wound opening during a medical procedure, and during closure of the wound.

Abstract: A tissue approximation device and processes for using the device are provided. The device is an implantable, biodegradable construct (except for hernia repairs) that has attachment points emanating from a supportive backing. The device improves the mechanical phase of wound healing and evenly distributes tension over the contact area between the device and tissue. Processes for using the device include wound closure, vascular anastomoses, soft tissue attachment and soft tissue to bone attachment. Several variations are particularly applicable to facilitating tissue approximation in surgical cosmetic applications, particularly brow lifts. Generally, scalp tissue to be lifted may be set on a brow lift device via attachment points, and the device may then be secured to a patient's cranium. Variations of the device are described along with a method of installing the brow lift device. Also described is a tool particularly useful for installing a brow lift device.

Abstract: The self securing suture includes a suture having at least one terminal end and a toggle, formed of suture material, at the suture's terminal end. In one embodiment, the suture toggle is a bar. In another embodiment the suture is a wire and the toggle is a wire element toggle. The wire element toggle is a double strand segment or an open loop segment. The suture delivery system includes a slotted needle configured such that a protruding tab or leg of the toggle bar fits within slot of the needle. For wire sutures, the open loop wire element toggle fits within the slotted needle. In another embodiment, a depending wire tip, from the wire element toggle, fits within the slot in the needle.

Abstract: An apparatus for inserting a staple into torn tissue such as the meniscus of the knee. The apparatus includes a pair of shafts individually movable in a longitudinal directing which are actuable from a handle mechanism. The shafts are movable sequentially so that the shafts disjunctively advance the prongs of the staple which is releasably held adjacent distal end portions of the shafts. A further embodiment of the device consists of a pair of needles detachably secured to a pair of anchoring members having a plurality of barb-like projections extending outwardly therefrom. The anchoring members are joined by a suture which connects adjacent the trailing ends of the anchoring members opposite the penetration end of the needles.

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

Abstract: An apparatus for inserting a staple into torn tissue such as the meniscus of the knee. The apparatus includes a pair of shafts individually movable in a longitudinal direction which are actuable from a handle mechanism. The shafts are movable sequentially so that the shafts disjunctively advance the prongs of the staple which is releasably held adjacent distal end portions of the shafts. A further embodiment of the device consists of a pair of needles detachably secured to a pair of anchoring members having a plurality of barb-like projections extending outwardly therefrom. The anchoring members are joined by a suture which connects adjacent the trailing ends of the anchoring members opposite the penetration end of the needles.

Abstract: A biodegradable, subcuticular surgical clip having a pair of interconnected arms each having piercing prongs directed toward the other arm is provided. The fastener does not have interlockable members.

Abstract: A clip unit for hernia repair surgery has first and second arms joined at a hinge joint. A latch or hook locks the arms together after they are closed. A mesh material extends around the outside edges of the clip. In use, the clip is placed over a portion of the elevated peritoneum and then closed and locked. The mesh is fixed to the surrounding peritoneum. The clip and surgical method expedites hernia repair surgery and reduces trauma and medical costs.

Abstract: A method of clamping suture strand by applying heat and compressive force to a polymeric surgical clip having first and second opposed leg members so as to clamp the suture strand between the opposed inner clamping surfaces of the first and second leg members; a surgical clip defined by first and second leg members, the first leg member having a hole therein; and a surgical device for clamping a clip about a suture, such device defined by a trigger-activated handle, clamping jaws with a heating element disposed on one of the clamping members of the clamping jaws, a shaft connecting the jaws to the handle, and means for activating the heating element and for delivering compressive force to the clamping jaws to close the clip about a suture.

Abstract: A surgical fastening clip of a shape memory alloy which applies a first clamping force to a site when the alloy is in its martensitic condition and a second clamping force to the site when the alloy heats due to surrounding tissue such that the alloy transforms to its austenitic condition. The second clamping force is greater than the first clamping force and prevents the clip from slipping or falling off the clamped site due to shrinkage or movement of the site. For instance, the site could be a blood vessel which becomes thinner due to the compressive force of the clip and shrinks, but the clip maintains a clamping force on the blood vessel due to the shape memory effect of the alloy. A method of using a surgical fastening clip formed of a shape memory alloy by placing opposed legs of the clip around a site, deforming the legs to a closed configuration and heating the clip by the natural surroundings to cause further closing of the legs and thereby increasing the clamping force.

Abstract: A metal clip for the simultaneous suture of the cutaneous tissue and subcutaneous tissue, consisting of two arch-shaped arms of larger radius with two points at their ends, and two arch-shaped arms of smaller radius with two points at their ends. The arms are joined together by a common segment to form a rigid system.

Abstract: A surgical staple is made from highly flexible material and has at least two piercing projections or points spaced from each other a first predetermined linear distance in a generally unstressed, neutral and inoperative condition of the staple. The staple is stressed in a selected fashion causing the piercing projections to be spaced from each other a second predetermined linear distance greater than the first predetermined linear distance. While the piercing projections are spaced from each other, the second predetermined linear distance under the induced forces, the staple is implanted by penetrating the skin with the piercing projections at opposite sides of an associated wound or incision. The forces are then removed from the surgical staple which inherently rebounds to its generally unstressed condition which in turn automatically draws opposite margins of the wound toward each other.

Abstract: A surgical staple is made from highly flexible material and has at least two piercing projections or points spaced from each other a first predetermined linear distance in a generally unstressed, neutral and inoperative condition of the staple. The staple is stressed in a selected fashion causing the piercing projections to be spaced from each other a second predetermined linear distance greater than the first predetermined linear distance. While the piercing projections are spaced from each other, the second predetermined linear distance under the induced forces, the staple is implanted by penetrating the skin with the piercing projections at opposite sides of an associated wound or incision. The forces are then removed from the surgical staple which inherently rebounds to its generally unstressed condition which in turn automatically draws opposite margins of the wound toward each other.

Abstract: A surgical clip for repairing tears in fibrocartilage and soft tissue. The clip has a pair of opposed legs formed of rigid biodegradable material. Each leg has at least one barb for easily penetrating the cartilage and soft tissue, and for opposing withdrawal from it. The legs are interconnected by a flexible section that is also biodegradable. The instrument for applying these clips has a pair of opposed jaws, each with at least one notch for holding the barbs of the clip. The jaws are biased apart in a normally open position and are interconnected to an actuating handle.