Abstract: Methods and devices are provided for performing various procedures using interchangeable end effectors. In general, the methods and devices allow a surgeon to remotely and selectively attach various interchangeable surgical end effectors to a shaft located within a patient's body, thus allowing the surgeon to perform various procedures without the need to remove the shaft from the patient's body. In an exemplary embodiment, multiple end effectors can be introduced into a body cavity. The end effectors can be disassociated or separate from one another such that they float within the body cavity. A distal end of a shaft can be positioned within the body cavity and it can be used to selectively engage one of the end effectors. In particular, the device can be configured to allow each end effector to be remotely attached and detached from the distal end of the shaft.

Abstract: Methods and compositions are provided for treating weight related conditions and metabolic disorders by altering microbiota in a subject. One aspect provides methods and compositions to alter microbiota in a subject by administering to the subject a composition that includes a substantially purified microbiota from phyla such as Bacteroidetes, Proteobacteria, Firmicutes and Verrucomicrobia or orders such as Bacteroidales, Verrucomicrobiales, Clostridiales and Enterobacteriales or genera such as Alistipes, Clostridium, Escherichia, and Akkermansia. Another aspect includes a pharmaceutical composition for altering microbiota that includes a therapeutically effective amount of substantially purified microbiota and a pharmaceutically acceptable carrier. Yet another aspect includes methods for treating a disorder, such as obesity, in a subject in need of such treatment by changing relative abundance of microbiota in a gastrointestinal tract of the subject without or in addition to a surgical procedure.

Abstract: Methods and compositions are provided for treating weight related conditions and metabolic disorders by altering microbiota in a subject. One aspect provides methods and compositions to alter microbiota in a subject by administering to the subject a composition that includes a substantially purified microbiota from phyla such as Bacteroidetes, Proteobacteria, Firmicutes and Verrucomicrobia or orders such as Bacteroidales, Verrucomicrobiales, Clostridiales and Enterobacteriales or genera such as Alistipes, Clostridium, Escherichia, and Akkermansia. Another aspect includes a pharmaceutical composition for altering microbiota that includes a therapeutically effective amount of substantially purified microbiota and a pharmaceutically acceptable carrier. Yet another aspect includes methods for treating a disorder, such as obesity, in a subject in need of such treatment by changing relative abundance of microbiota in a gastrointestinal tract of the subject without or in addition to a surgical procedure.

Abstract: Methods and devices are provided for activating brown adipose tissue with targeted substance delivery. Generally, the methods and devices can activate BAT to increase thermogenesis, e.g., increase heat production in the patient, which over time can lead to weight loss and/or improved metabolic function. In one embodiment, a chemical configured to stimulate nerves that activate the BAT and/or to stimulate brown adipocytes directly can be delivered to a patient, thereby increasing thermogenesis in the BAT and inducing weight loss and/or improved metabolic function through energy expenditure. The chemical can be delivered to the patient locally and/or systemically to stimulate the nerves and/or the brown adipocytes.

Abstract: A surgical clip is provided for ligating or transecting tissue, such as vessels, other tubular ducts, and the like and a surgical clip applier device for delivering and applying the surgical clip to the tissue. The surgical clip can include a spine and opposed arms extending from the spine where the arms can define a clamping length. In a resting state, the clip can be biased to a closed position such that the ends of each opposed arm are disposed in proximity to each other. With such biasing, when applied to a tissue, such as with a surgical clip applier, the clip can exert a positive clamping pressure to the tissue along the clamping length to seal the tissue and limit passage of fluids, such as blood, from the tissue.

Abstract: Surgical methods for closing a gastrotomy. The surgical method for closing an opening in an organ wall comprises positioning a distal end portion of a steerable overtube adjacent a portion of the organ wall through which the opening extends. The surgical method further comprises inserting a flexible clip magazine into the steerable overtube. The surgical method comprises grasping tissue through which the opening extends and drawing a portion of the grasped tissue into a clamping position between upper and lower clip arms of a distal-most tissue apposition clip supported within a distal end of the clip magazine. The surgical method further comprises advancing the distal-most tissue apposition clip onto the portion of grasped tissue.

Abstract: A surgical instrument configured to deliver electrical energy to the tissue of a patient is disclosed. The surgical instrument comprises a frame, a first electrode, a second electrode, and a guard movable between a first position and a second position. The surgical instrument further comprises a spring positioned intermediate the guard and the frame. The spring is configured to bias the guard into the first position. When the guard is in the first position, a distal end of the guard is positioned at least flush with distal ends of the first electrode and the second electrode, which prevents current from arcing between the first electrode and the second electrode. When the guard is in the second position, the distal end of the guard is in contact with the tissue, which prevents current from arcing between the first electrode and the second electrode without passing through the tissue.

Abstract: A surgical system for performing a surgical procedure includes an ex-vivo positioning mechanism and an in-vivo instrument magnetically attracted to the ex-vivo positioning mechanism. The in-vivo instrument can be positioned within a patient by moving the ex-vivo positioning mechanism. In addition, the surgical system includes a percutaneous member introducible into the patient independent from the ex-vivo positioning mechanism, the percutaneous member comprising a connector at a distal end thereof, wherein the connector is selectively couplable to the in-vivo instrument within the patient.

Abstract: Mechanisms for altering the shape of a cell or chamber of a shaft or an actuation drive of an instrument are provided. The mechanisms may selectively rigidize the shaft of surgical or diagnostic instruments. The shaft assembly includes a shaft operatively connectable to a control member, at least one cell or a set of cells defined within the shaft, a shape altering material contained within the cell or cells, and, an activation link operatively connectable to a source of activation energy for delivering activation energy to each cell for activating the shape altering material to selectively rigidize or unrigidize the shaft. An actuator for producing work is also provided that includes an element within a housing that defines a cell or a set of cells. The shape altering material is contained within the cells, and a source of activation energy operatively connected to each cell for activating the shape altering material to expand or contract the cell.

Abstract: A surgical stapling instrument (1) comprises a staple fastening assembly (4) in the distal region of said instrument, the staple fastening assembly (4) including a cartridge device (8) which comprises at least one closed row (17, 18) of staples and defines a wavy distal end surface (14), and an anvil (9) which defines a wavy proximal staple forming surface (20) substantially matching the distal end surface (14) and which is adapted to cooperate with the cartridge device (8) for forming the ends of the staples exiting from the cartridge device (8), wherein the distal end surface (14) and the staple forming surface (20) have a globally wavy shape including two opposite peaks (21) and two opposite valleys (22) angularly spaced at about 90° from the adjacent peaks (21) and in that said two-peaks-two-valleys wavy shape is formed by a stepped configuration of said surfaces (14, 20).

Abstract: Various devices are provided for allowing multiple surgical instruments to be inserted through a single surgical access device at variable angles of insertion, allowing for ease of manipulation within a patient's body while maintaining insufflation. Safety shields and release mechanisms are also provided for use with various surgical access devices.

Abstract: An electrical ablation apparatus comprises first and second electrodes. Each electrode comprises a first end configured to couple an energy source and a second end configured to couple to a tissue treatment region. An energy source is coupled to the first and second electrodes. The energy source is configured to deliver a first series of electrical pulses sufficient to induce cell necrosis by irreversible electroporation and a second series of electrical pulses sufficient to induce cell necrosis by thermal heating, through at least one of the first and second electrodes. The first series of electrical pulses is characterized by a first amplitude, a first pulse length, and a first frequency. The second series of electrical pulses is characterized by a second amplitude, a second pulse length, and a second frequency.

Abstract: An apparatus comprises a surgical instrument and a buttress configured to hold a fluid adhesive. In some versions, the buttress contains a two-part fluid adhesive where two fluid materials form a fluid adhesive when combined. In some versions, the buttress is configured to be compressed by the surgical instrument thereby pressurizing a portion of the buttress. Thereafter, the buttress may be severed and the pressurized region may be operable to urge the fluid adhesive to a tissue site.

Abstract: A method of creating a switch, comprising disposing a switching element movably within an interior cavity of the switch to define first and second positions along a switching axis of the switching element, disposing a biasing element about the switching element to impart a biasing force to the switching element to place the switching element in one of the first and second positions until an external force imparted to the switching element exceeds the biasing force to cause the switching element to move to the other position, disposing a biasing force-adjusting element in cooperative engagement with the biasing element such that a magnitude of the biasing force is adjustable, and coupling a conductive contact to the switching element to define a first switching state when the switching element is in the first position and a second switching state when the switching element is in the second position.

Abstract: Methods and devices are provided for controlling movement of a distal end of a surgical instrument. In general, the methods and devices can allow for controlling movement of surgical tools, and in particular for causing mimicked motion between an external control unit and a surgical tool positioned within a patient's body. In one embodiment, a surgical system is provided having a master assembly including an input tool and a slave assembly including a surgical instrument. The master assembly and the slave assembly can be configured to be electronically coupled together such that movement of the master assembly can be electronically communicated to the slave assembly to cause mimicked movement of the slave assembly.

Abstract: A switch comprising an interior cavity and a switching element movably disposed within the interior cavity to define a first position and a second position, the second position being different from the first position. A biasing element imparts a biasing force to the switching element to place the switching element in either the first or the second position until an external force imparted to the switching element exceeds the biasing force, thereby causing the switching element to move to the other one of the first or the second position. A biasing force-adjusting element is cooperatively engaged with the biasing element, wherein a magnitude of the biasing force is adjustable using the biasing force-adjusting element. An electrically-conductive contact, coupled to the switching element, defines a first switching state when the switching element is in the first position and a second switching state when the switching element is in the second position.

Abstract: An electrically powered surgical instrument includes a surgical end effector having a surgical procedure effecting actuation assembly. A handle is coupled with the end effector. An electric motor is disposed within a shell of the handle and has power terminals and a drive train actuating the assembly when the motor is supplied with power. A break-before-make power supply switch at the handle selectively controls supply of power to the motor. A post-termination braking circuit electrically short-circuits the power terminals when the switch does not supply power to the motor. A method for post-termination braking of an electrical motor utilizes the permanent magnetic field of the motor to counteract an inertia-induced over-stroke characteristic of the motor, drive train, and/or actuation assembly after powered operation by short-circuiting the still-spinning motor to create an electrically generated magnetic field in opposition to the permanent magnetic field upon ceasing supply of power to the motor.

Abstract: A device for manipulating a magnetic coupling force across tissue in response to a monitored coupling force is described. The device includes a magnetic field source assembly, a positioning assembly operatively connected to the magnetic field force assembly, and a magnetic coupling force monitor. The magnetic field source assembly includes magnets that provide an external magnetic field source for providing a magnetic field across tissue. The positioning assembly adjusts the position of the magnetic field source. The magnetic field creates a magnetic coupling force between the external magnetic field source and an object positioned in use in a patient during a procedure, wherein the object has or is associated with an internal magnetic field.

Abstract: A system for stimulating the release of satiety hormone in a subject comprises a stimulus device which is implantable in the subject and adapted to apply an electrical stimulus to a tissue of a gastrointestinal system of said subject, and a detection device which is implantable in the subject and adapted to continuously monitoring at least one of a mechanical characteristic and an electrical characteristic of the subject to detect an ingestion of food by said subject, wherein the detection device cooperates with the stimulus device such that the stimulus device applies said electrical stimulus in response to a detected ingestion of food.

Abstract: An energy source for use with an electrosurgical system is disclosed. In one embodiment, the energy source includes a power supply, one or more capacitors coupled to the power supply, and a switching component coupled to the one or more capacitors. The switching component is configured to output pulses of a biphasic waveform. The pulses are capable of treating undesired tissue by inducing a change in voltage potential across cell membranes of a plurality of cells in the undesired tissue to promote non-thermal cell death in the plurality of cells. The pulses are also capable of treating the undesired tissue with no or minimal muscle contractions in patient tissue within reach of the biphasic waveform during treatment of the undesired tissue.