Abstract: An apparatus and method for reducing the circumference of a vascular structure comprising the steps of providing a plurality of sutures and a plurality of discrete suture support segments of a biocompatible, inert material, each suture support segment having at least two suture holes spaced a predetermined distance (D) apart; individually suturing each discrete suture support segment to the vascular structure with one of the plurality of sutures by effecting a horizontal mattress (U-shaped) suture along the vascular structure through a length of tissue of the vascular structure such that the length (D') of tissue sutured is greater than distance (D); and tightening and tying off the suture, whereby each sutured suture support segment creates an imbrication in the vascular structure, thereby reducing the circumference thereof.

Abstract: An apparatus for suturing body tissue is disclosed comprising first and second elongated body halves detachably connected to one another and first and second needles movable with respect to the first and second body halves. Each of the needles has a penetrating tip facing in a distal direction. At least one actuator is provided which is operatively associated with each of the first and second needles, wherein actuation of the at least one actuator advances the first and second needles into body tissue. The needles are advanced through the body tissue positioned in the window formed in each of the body halves to engage a ferrule having a suture connected thereto.

Abstract: A driving system and method for endoscopically inserting threaded suture anchors. The driving system incorporates a tubular guide adapted to receive a cylindrical drive shaft having a drive portion at its distal tip for engaging a threaded anchor and a stop member at its proximal end for enabling rotational motion of the drive system relative to the drill guide while limiting longitudinal motion beyond a predetermined point. The stop member is, in the preferred embodiment, an annular shoulder which prevents the drive shaft from advancing the anchor into the bone more than a desired amount sufficient to countersink the anchor below the bone surface. The invention facilitates use of a drive shaft having a minimized shaft diameter. The invention also comprises a method of using the driving system, the method comprising the steps of both turning and longitudinally limiting the motion of the driver from the proximal side of the driver.

Abstract: A surgical clip applicator comprising a housing, a pair of handles pivotally connected to opposite sides of said housing, and a jaw blade assembly fixedly connected to the housing. The jaw blade assembly includes a pair of jaws for receiving and deforming a clip therebetween and a clip carrier for supplying a series of clips to said jaws. A channel assembly is slidably mounted in the housing and envelops said jaw blade assembly. A forming cam is connected between and to said handles and said channel assembly for sliding said channel assembly in a distal direction in response to dosing of said handles together to move said jaws towards each other. A feed cam bar slidably mounted in said channel assembly in overlying relation to said clip carrier, said bar having a nose at its distal end. A pusher bar slidably mounted in said channel assembly for advancing clips along said clip carrier.

Abstract: A manipulator tool for grasping an anastomosis cuff has two gripping fingers with indentations. When the gripping fingers are brought together, the indentations form an aperture between the gripping fingers which is used to surround and grasp the outer surface of an anastomosis cuff. The indentations can have various shapes to conform to different sizes and different shapes of cuffs. The gripping fingers may also be adjustable and replacable. The manipulator tool may also include a latching or locking device for keeping the tool closed in a particular position.

Abstract: A surgical suturing device comprises an elongate body having an axis extending between a proximal end and a distal end. A lumen of the body has a generally axial portion and a transverse portion which extends laterally and is adapted to receive a needle and associated suture. An elongate deployment member is disposed in the axial portion of the lumen and biased to a proximal position. The deployment member is movable to a distal portion to expel the needle and suture from the lumen through tissue surrounding the device. An associated method for operating the device includes the steps of deploying the needle and suture from the lumen, moving the device distally to expose the empty transverse lumen, and reloading the lumen with a second needle and suture.

Abstract: A surgical instrument for applying sutures including an elongated housing having a proximal end and a distal end, means associated with the distal end of the elongated housing for carrying at least one needle, the needle carrier means being movable between a retracted position and an extended position, at least one needle positioned on the needle carrier means, and means associated with the needle carrier means for moving the needle carrier means to the extended position to deploy the at least one needle such that upon movement of the needle carrier means by the moving means, the needle carrier moves from the retracted position to the extended position whereby the at least one needle is caused to travel through a tissue engaging path in one continuous motion.

Abstract: An anastomosis cuff for performing a vascular anastomosis procedure includes a ridge of material that extends in the radial direction. The ridge can be easily grasped with forceps or a hemostat to immobilize the cuff during an anastomosis procedure. Alternately, the anastomosis cuff can be grasped between gripping fingers of a manipulator tool designed to surround the cuff such that the ridge is trapped between and grasped by the gripping fingers.

Abstract: A device for use in securing a thread includes a tube having a distal end and a proximal end. The tube defines a recess at the distal end to receive therein a sleeve having a cavity in which a plug is removably inserted. The device further includes a generally U-shaped stirrup that is movably connected to the tube. The U-shaped stirrup is movable between a first position in which the base of the U holds the sleeve and plug in the recess and a second position in which the sleeve and plug are free to leave the recess. The base of the U is continuous.

Abstract: A suture anchor loader and driver for mounting a suture anchor with a connected suture, that is arranged for mounting and maintaining the suture to the driver distal end while driving the anchor into a bone, whereafter the driver is removed from the anchor, leaving the suture extending from the seated anchor. The driver includes a cylindrical solid body and has an anchor mount formed as its distal end that is for receiving a coupling end of the anchor fitted therethrough and includes a center longitudinal passage, wherethrough the anchor suture is fitted. A first curved passage is formed in the driver body distal end and intersects the center longitudinal passage through the anchor mount, and extends to the driver body surface where it intersects a straight longitudinal groove that is formed along the driver body.

Abstract: A helical fastener having a high retentive surface area is provided and has a first end for enhancing penetration into tissue and a second end comprising a coil sectioning a diameter of the fastener for receiving longitudinal and rotational forces. The helical fasteners are attached to body tissue by a fastener applicator having a proximal portion comprising a handle and an actuator and an elongate distal portion for housing a plurality of fasteners. A transferring action of the actuator provides longitudinal and rotational movement of the fasteners out of the distal portion and into body tissue.

Abstract: A method and device for the placement of sutures and for the purpose of approximating tissue. A particular utility is effected in the approximation of the tissue separated by means of an endosurgical trocar being inserted into a body cavity. The invention provides for the loading of suture material including needles into the device, introduction and placement of the device into the body cavity, with the distal end having deployable needle guides, extending the needle guides either simultaneously or individually to the periphery of the wound, engaging the wound with the needle guides, driving the needles and suture material through the tissue to be approximated into a catch mechanism, retracting the needle guides and withdrawing the device, leaving a loop of suture material in the margin of tissue. The suture may then be tied to approximate the wound and excess suture material cut off.

Abstract: The present invention relates to composite materials having a core portion formed from a first bioabsorbable material and at least one shell portion of a second bioabsorbable material joined to the core portion. The first and second bioabsorbable materials have different rates of bioabsorption. In a preferred embodiment, the core portion is coextruded with the shell portion to form a composite filament or sheet. The materials of the present invention may be used as sutures or formed into medical devices or surgical articles for implantation within a living organism.

Abstract: The present invention provides a delivery system for delivering a device for closing septal defects and the like. The system comprises an elongate, flexible urging member for urging the closure device through a catheter and a remotely located control means for advancing the urging member. The control means includes a threaded, generally tubular shaft connected to the urging member and a manually rotatable rotor mounted on the shaft, the rotor having threads which mate with the threads on the shaft so that rotation of the rotor through a known angle will advance the shaft, and hence the urging member, a known distance. In a preferred embodiment, the urging member includes a core wire adapted to retain a closure device prior to final deployment and a release lever for releasing the closure device from the core wire when the closure device is properly positioned.

Abstract: A method and apparatus for arthroscopic reattachment of torn tissue to a bone at a surgical repair site using at least one suture anchor and a tissue grasper. The torn tissue is grasped with jaws of the tissue grasper. The jaws include a top and bottom jaw. The upper jaw has an aperture, and the bottom jaw has a U-shaped slot. The aperture and slot are aligned with each other when the jaws are closed. A threaded suture anchor is inserted through the aligned aperture and slot in the jaws of the grasper, the grasped tissue, and into the bone in a single drilling step. An outrigger located on the barrel of the grasper is adapted to receive a drill and align the threaded suture anchor such that the suture anchor is automatically aligned with the aperture and slot of the jaws of the grasper at the repair site. After insertion of the suture anchor the grasper is removed from the repair site.

Abstract: A method and device for approximating tissue, particularly the tissue separated by means of an endosurgical trocar being inserted into a body cavity. The invention provides for the introduction and placement of the device into the body cavity, with the distal end having deployable needle guides, extending the needle guides to the periphery of the wound, engaging the wound with the needle guides, driving the needles and suture material through the tissue to be approximated into a catch mechanism, retracting the needle guides and withdrawing the device, leaving a loop of suture material in the margin of tissue. The suture is then tied to approximate the wound and excess suture material cut off.

Abstract: An apparatus for use in minimally invasive surgery includes a articulating segmented endoscopic portion wherein the segments are connected by an angled rotary interface. Rotation of the distal segment moves the distal segment to a position which is angled relative to the proximal segment. A handle grip portion may be likewise articulated.

Abstract: A method of fixation for use within animal and human bodies provides for the insertion of brushes, of cylindrical and conical designs, into openings wherein bristles of the brushes are deflected by walls of the openings such that the brushes are locked in place and resist forces applied thereto. An embodiment of the invention includes boring a hole into a cancellous bone structure and inserting a brush into the hole. The hole is of a smaller diameter than the brush and is locked in the hole by the bristles. Tissue, such as tendon, may then be attached to material affixed to an end of the brush. Another embodiment of the method includes insertion of a brush into a blood vessel such that the blood flow is either occluded or strained by the bristles of the brush.

Abstract: A surgical staple for securing a purse string suture to human tissue comprises a staple body of deformable material formed into a loop through which the purse string suture is threaded. The staple body includes a pair of legs which are deformable into an overlapping configuration upon insertion into the tissue to secure the staple body and the purse string suture to the tissue. Alternatively, the staple body includes two or more legs including barbed ends for anchoring the legs to the tissue. To secure the purse string suture, a plurality of staples is positioned about the periphery of the tubular section of tissue, the purse string suture is threaded through the loops in the staples, and the staples are driven into the tissue to secure the purse string suture thereto. In addition, surgical instruments for open surgery and endoscopic surgery are provided for applying the staples and the purse string suture to the tissue.

Abstract: A surgical tool for endoscopic suture placement which permits a surgeon to place controlled and precise internal ligatures. The tool utilizes a drive rod including an articulating or deflecting portion. When forced to an extended position, the deflecting or articulating portion forms a hook or J-shaped needle, the tip of which can be used to accurately position the suture.