Abstract: An electrosurgical instrument with a movable fluid delivery sheath assembly for variable fluid supply during surgical procedures is disclosed. The instrument comprises at least one active electrode and at least one return electrode, positioned on the instrument distal end. The sheath assembly has an outer sheath that is external to the instrument shaft, to provide a lumen. The sheath assembly lumen is axially movable between first and second positions relative to a fluid delivery element, for varying target site treatment and fluid delivery. In the first position the shaft distal end is axially distal to a leading edge of the sheath assembly. In the second position the sheath assembly distal leading edge is positioned axially adjacent or distal to the end of the shaft. The fluid delivery element comprises an inner lumen extending through at least a portion of the shaft, and at least one port extending radially through the shaft. The port is in communication with the inner lumen.

Abstract: An innovative bone anchor and methods for securing soft tissue, such as tendons, to bone are described herein. Such devices and methods permit a suture attachment that lies beneath the cortical bone surface and does not require tying of knots in the suture.

Abstract: An electrosurgical instrument having active and return electrodes with a movable suction sheath for variable fluid and debris removal during surgical procedures is disclosed. The suction apparatus has an outer sheath that is external to a shaft to provide a lumen. The sheath assembly is axially movable relative to the fluid aspiration element between first and second positions for treating the target site and fluid and debris removal, respectively. The first position positions the distal end of the shaft axially distal to a leading edge of the sheath assembly. The second position positions the distal leading edge of the sheath assembly axially adjacent to the end of the shaft. The fluid aspiration element comprises an inner lumen extending through the shaft, and at least one port extending radially through the shaft. The port is in communication with the inner lumen. A vacuum provides suction through the port and inner lumen.

Abstract: A bipolar, plasma-generating electrosurgical apparatus and system wherein the return electrode is enclosed within an electrosurgical shaft, and the active electrode is located on the outside surface of the shaft such that in treating the tissue, the tissue is exposed to plasma generated on the active electrode, but is minimally exposed to electric fields generated between the active and return electrodes. Due to the configuration of the electrodes, electric fields generated between the electrodes are directed away from the target tissue and inwardly towards the return electrode within the shaft, thereby electrical stimulation of neuromuscular structures in the tissue by the electric fields is minimized.

Abstract: An electrosurgical controller with wave-shaping. At least some embodiments are methods including generating an alternating current (AC) voltage signal within an electrosurgical controller. The generating may be by inducing an intermediate AC voltage signal on a secondary winding of a first transformer, and wave-shaping the intermediate AC voltage signal by a second winding of a second transformer coupled to the first transformer, and thereby creating a final AC voltage signal. Thereafter, the method includes applying the final AC voltage signal to electrical pins of a connector configured to couple to an electrosurgical wand.

Abstract: System and method for selectively applying electrical energy to structures within or on the surface of a patient's body and controlling the flow of an electrically conductive fluid from the application site to provide or maintain a desired operating condition of the electrosurgical device. An electrosurgical probe is in communication with a fluid transport apparatus through a fluid transport lumen having an opening at an end proximate the application site and disposed proximate the electrosurgical probe. A controller in communication with the fluid transport apparatus provides control signals to the fluid transport apparatus in response to at least one operating parameter associated with the system. Based on the received control signals, the fluid transport apparatus adjusts a flow rate of the electrically conductive fluid at the application site through the fluid transport lumen in response to at least one operating parameter associated with the system.

Abstract: A surgical instrument and method for manipulating surgical suture during minimally invasive surgical procedures. Surgical instrument includes an elongate body with a handle at the elongate body's proximal end. Elongate body also includes a distal portion, a longitudinal axis and an outer surface, and the distal portion includes at least one moveable wire. This wire moves so as to selectively capture and release a suture and suture purchase may be substantially obtained between the wire and the elongate body outer surface. The instrument also includes an actuation mechanism connecting the handle to the wire. The wire is moved via the actuation mechanism and a substantial component of the motion of the wire is eccentric rotation.

Abstract: A knotless bone anchor and method for securing soft tissue, such as tendons, to bone, includes a plurality of discrete components. In one variation of the invention, the bone anchor includes a proximal toggle component, an intermediate plug component, and a distal sleeve component. Suture is looped around the plug component and once the anchor is actuated, the suture is compressed between the plug and the sleeve components. Advantageously, one or more of the components may be made of a biocompatible polymer. The polymeric components may be detachably joined to a drive shaft using a plurality of sacrificial fills. The sacrificial fills are broken or severed during deployment of the anchor. Related instruments and methods are also described.

Abstract: A kit for packing and supporting the nasal cavities after surgical procedures performed on the nose having two inflatable non-elastomeric balloons (6?, 6?) and inflation port arrangement (27) arranged so that, in use, each balloon (6?, 6?) can be located in a nasal cavity and inflated.

Abstract: An innovative bone anchor and methods for securing soft tissue, such as tendons, to bone are described herein Such devices and methods permit a suture attachment that lies beneath the cortical bone surface and does not require tying of knots in the suture.

Abstract: An electrosurgical system and method for treating hard and soft tissues in the body comprises a shaft, a distal end section, an active electrode associated with the distal end section, a first fluid supply adapted to deliver a first electrically conductive fluid to the target site, and a second fluid supply adapted to deliver a second electrically conductive fluid to the active electrode. The system is adapted to treat a wide variety of hard tissues such as, for example, bones, calcified structures, calcified deposits, teeth, plaque, kidney-stones, gall-stones and other types of tissue by generating plasma in the vicinity of the active electrode, and applying the plasma to the tissue or structures.

Abstract: An innovative bone anchor and methods for securing connective tissue, such as tendons, to bone are disclosed which permit a suture attachment which lies entirely beneath the cortical bone surface, and wherein the suturing material between the connective tissue and the bone anchor is oriented in a direction generally transverse to the longitudinal axis of the bone anchor, so that axial pull-out forces exerted on the bone anchor are minimized. The suture attachment to the bone anchor involves the looping of a substantial length of suturing material around a shaft of the anchor, thereby avoiding an eyelet connection which requires a knot and which concentrates stress on a very small portion of the suturing material. Thus, failure rates are greatly decreased over conventional techniques, and the inventive procedures are significantly easier to perform than conventional techniques.

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: Electrosurgical systems, apparatus, and methods for the controlled removal and treatment of a target tissue. An instrument of the invention includes a rotating member housed longitudinally within a shaft, a tissue removal port disposed at the shaft distal end portion, and an active electrode disposed at the instrument distal end. The active electrode is adapted to electrosurgically remove at least a portion of the target tissue as the rotating member rotates within the shaft. According to alternative embodiments, the active electrode may be disposed on the rotating member or on the shaft.

Abstract: Apparatus and methods for ablating, severing, cutting, shrinking, coagulating, or otherwise modifying a target tissue to be treated. In a method for treating a target tissue, an active electrode of an electrosurgical probe is positioned in at least close proximity to the target tissue in the presence of an electrically conductive fluid. A high frequency voltage is then applied between the active electrode and a return electrode, wherein, the high frequency voltage is sufficient to volumetrically remove (ablate), sever, or modify at least a portion of the target tissue. The probe comprises a multi-lumen shaft having a plurality of internal lumens, and a return electrode coil oriented substantially parallel to the shaft distal end. The active electrode may be in the form of a metal disc, a hook, or an active electrode coil. In the latter embodiment, the active electrode coil is typically arranged substantially orthogonal to the return electrode coil.

Abstract: Implant and delivery systems for soft tissue repair which affix soft tissue portions to a region of bone are described. Generally, the assembly includes two bone anchors preloaded through an inserter handle such that each anchor is penetrated into the bone directly. The first anchor is inserted through the tissue and into the bone, where it is locked into position. The first anchor has a suture or wire that protrudes through the tissue and threads through the second anchor and is secured to a rotatable suture reel located along the handle. The second anchor is inserted through the tissue and into the bone independently of the first anchor. Once the second anchor is deployed, the suture or wire is tensioned to secure the soft tissue to the bone and a suture plug within the second anchor is deployed to lock the suture or wire in place.

Abstract: The present invention provides systems and methods for selectively applying electrical energy to a target location within a patient's body, particularly including tissue in the spine. The present invention applies high frequency (RF) electrical energy to one or more electrode terminals in the presence of electrically conductive fluid or saline-rich tissue to contract collagen fibers within the tissue structures. In one aspect of the invention, a system and method is provided for contracting a portion of the nucleus pulposus of a vertebral disc by applying a high frequency voltage between an active electrode and a return electrode within the portion of the nucleus pulposus, where contraction of the portion of nucleus pulposus inhibits migration of the portion nucleus pulposus through the fissure.

Abstract: Methods and apparatus for performing a medical procedure which involves penetrating a bone structure are disclosed. According to one aspect of the present invention, a method for performing a surgical procedure includes introducing an assembly that includes a threaded cannula and a stylet into a bone structure. The threads have a shape that allows the cannula tip to be pushed into the bone body yet prevent the tip from being pulled out of the bone body. In one embodiment, the threads have a buttress shape. The method may also include applying a rotational motion, as for example a torque, to the threaded cannula to adjust the depth of insertion with respect to the implantation site when it is determined that the depth of insertion is to be adjusted.

Abstract: A surgical device and method are disclosed for harvesting bone portions. The device has a guide which facilitates control of at least one dimension of the harvested portion. Embodiments of the invention are particularly, but not exclusively, suited to harvesting bone portions for graft surgery, particularly patella tendon grafts.