Abstract: An instrument assembly for performing anatomical tissue ligation includes a passage defining member having a distal end for being disposed at an internal operative site, a proximal end for being disposed externally of the internal operative site and a passage between the distal and proximal ends. A grasping member is disposed at the distal end of the passage defining member for grasping anatomical tissue at the internal operative site. A contractible ligature loop of filamentous ligature material is carried by the passage defining member and is disposed externally of the distal end thereof for positioning around the anatomical tissue grasped by the grasping member. The ligature loop is contractible, from externally of the internal operative site, around the anatomical tissue to form a ligature allowing a complete anatomical tissue ligation to be performed with a single instrument assembly.

Abstract: A tool for installing a suture anchor which supports first and second suture segments having free ends, the tool including an installation end adapted to accommodate the suture anchor and to transmit mechanical power for driving the suture anchor, and a guiding arrangement adapted to guide and support the first and second suture segments in a non-parallel configuration at the installation end. The guiding arrangement may include at least one suture guide adapted to support the first and second suture segments, respectively, at least at a first and a second support points, which are spaced laterally with respect to a direction of installation of the suture anchor.

Abstract: The methods and devices of the invention include an encoder, an endoscopic robotic instrument, and an encoder/robotic instrument interface. A preferred embodiment of the encoder has a chest/shoulder plate provided with telescoping tubes and joints. Each joint is provided with a direct drive potentiometer to monitor movement and provide a corresponding signal. The chest plate is preferably adaptable to a large range of human chest sizes and the telescopic segments are strapped to the arms of the practitioner at the elbows. A pistol grip is provided at the wrist end of the telescopic segments. According to the presently preferred embodiment, the encoder encodes flexion and rotation at the shoulder, elbow and wrist of each arm in addition to gripping at each hand. The encoding device is coupled to a circuit which operates a servo system. The servo system includes a series of servo motors. A series of pulleys corresponding to the number of servo motors are arranged in a housing.

Abstract: A suturing apparatus adapted to close an incision and an anterior tissue wall includes an elongate support structure having an axis extending between a proximal end and distal end. A receiver disposed at the distal end is insertable through the incision in a low-profile state and expanded to a high-profile state on the far side of the tissue wall. Needles carried by the support structure are operable to extend through the support wall on either side of the incision and into the expanded receiver. Sutures advanced through the needles are captured by the receiver after the needles are removed and the receiver is returned to its low-profile state. Removal of the suturing apparatus from the incision draws the captured suture ends outwardly through the incision. A novel suture knot can be tied in the four suture ends and moved into proximity with the tissue wall to close the incision.

Abstract: An ultrasonic surgical clamp coagulator apparatus is configured to effect cutting, coagulation, and clamping of tissue by cooperation of a clamping mechanism of the apparatus with an associated ultrasonic end-effector. Selective, indexed rotational positioning of the clamping mechanism and end-effector is achieved by the provision of a detent mechanism incorporated into the clamp drive mechanism of the apparatus. The arrangement permits an elongated portion of the apparatus to be selectively rotatably positioned with respect to an apparatus housing, with an associated ultrasonic drive unit operatively coupled to a waveguide of the apparatus for rotation together with the clamping mechanism. The detent mechanism desirably resists relative rotation of the apparatus unless a predetermined torque is applied thereto, thus facilitating efficient and convenient use during surgical procedures.

Abstract: A device for expansion within a blood vessel having a wall defining a lumen in the body. A first elongate tubular member has proximal and distal extremities and has a longitudinal axis. An expansile member is carried by the distal extremity of the first elongate tubular member and is movable between contracted and expanded positions. The expansile member has a predetermined configuration in the expanded position. A deformable membrane covers the expansile member and is sized so as to be capable of overlying and underlying the expansile member in the expanded position. A deployment mechanism is carried by the proximal extremity of the first elongate tubular member and is adapted to be operated by the human hand for controlling movement of the expansile member between the contracted and expanded positions. A biological sealant introducer is connected to the first elongate tubular member for introducing a biological sealant into the body proximal to the expansile member and external to the lumen of the vessel.

Abstract: The treatment and correction of spinal deformities, such as scoliosis, is accomplished without the need for fusion of the intervertebral disc space. A surgical technique is provided in which opening and closing osteotomies are created in the affected vertebrae. Correction devices are provided which hold the osteotomies in either their closed or open orientations. The correction devices include staples holding the vertebral body on opposite sides of the body to retain the osteotomies in their desired orientation. In the opening osteotomies, the correction devices include a wedge member that is disposed within the opened wedge osteotomy and in contact with the vertebral body. The correction devices also include connection members which can be used to engage the devices to an elongated member spanning the spine, such as a spinal rod. Once bone union has occurred in the instrumented vertebrae, the spinal rod can be disconnected from the correction devices and removed from the patient.

Abstract: A closure prosthesis and transcatheter delivery system are disclosed, wherein the closure prosthesis seals across an opening of a fluid passageway within a living body. The closure prosthesis is a flexible disk including a flexible ring and diaphragm having a plurality of hollow flexible wire segments attached thereto. Delivery of the closure prosthesis is accomplished using a hollow sheath and a pusher catheter slidable within the sheath, wherein filaments are looped through the wire segments to releasably connect the disk to the pusher catheter. The disk is resiliently compressed within the sheath and, upon release therefrom, the disk resiliently expands into a larger, unrestrained shape. Tension applied to the filaments resiliently bends the wire segments so that they may be drawn through the opening of the defect. Upon releasing the filaments from the disk, the wire segments resiliently expand to trap the disk in place to seal across the opening.

Abstract: Disclosed are wound closure strips which have an uniaxially oriented, silica filled, polyolefin substrate, a medical grade pressure sensitive adhesive, and a release sheet covering the pressure sensitive adhesive. Such strips are breathable, tearable to size, and may be removed from the skin with an alcohol wipe. Multiple wound closure strips are mounted on the upper surface of a backing sheet and pressure sensitive adhesive patch coated on the lower surface of the backing sheet, thereby making it possible to adhere the backing sheet to a surface near the intended point of use and, then, easily remove and handle the wound closure strips with a gloved hand. The wound closure strips may be color-coded and used not only for incisions and wounds but also for attaching catheters, and other medically related uses. Sterile packages of multiple wound closure strips make them useable in a sterile operation room arena.

Abstract: A system for suture anchor placement includes an apparatus having a handle portion and an operating portion. The handle portion includes a spring, a needle park, and a member for releasably holding a length of the suture. The operating portion includes a sheath tube and a plunger rod slidably disposed within the bore of the sheath tube. The plunger rod is fixedly mounted at its proximal end to the handle. The suture anchor is releasably engaged to the distal end portion of the plunger rod. The sheath tube is mounted to the handle and movable with respect to the handle between a distal position and a proximal position, the sheath tube being resiliently biased to the distal position by the spring and movable to the proximal position in response to proximally directed force of sufficient magnitude applied to the distal end of the sheath tube.

Abstract: A collapsible medical device and associated method for occluding an abnormal opening in, for example, a body organ, wherein the medical device is shaped from a shape memory metal fabric. The device may be used, for example, to non-surgically treat a patient having a Patent Foramen Ovale (PFO) and resulting paradoxical cerebral emboli. The device is preferably made from a continuous tubular metal fabric and includes two outer occluding portions and a resilient central, spring-like interconnecting member. The metal fabric may be heat treated within a mold in order to substantially set a desired shape of the device. The medical device includes a fastener for attaching to the end of a guide wire or delivery catheter. The medical device having the desired relaxed shape may be collapsed and delivered through a catheter or the like for deployment in a desired channel or opening in a patient's body.

Abstract: A vasoocclusive member, such as embolic coil, that mechanically joins an instrument for delivering that vasoocclusive member to a selected site within the vasculature or other lumen of a human body via the use of a catheter is provided. A thermoplastic member augments the junction to enhance variously the friction at an integrity of the junction. Once the vasoocclusive member is delivered to the desired site, radio frequency energy is supplied to the thermoplastic member in an amount sufficient to soften the thermoplastic member, allowing mechanical disengagement to then take place.

Abstract: An occluder apparatus for obstructing the flow of blood in a blood vessel has an elongated hollow tubular body having a leading end sized for reception in the blood vessel and includes portion of the body fabricated from a material soluble in blood, and a piercing device for inserting the body through the wall of the blood vessel to extend the leading end into the interior of the blood vessel. An inflatable diaphragm is carried by the body in a collapsed, deflated condition, and the apparatus includes a passage for conducting an inflating fluid from an external source, which is into fluid communication with the interior of the diaphragm, to effect expansion the diaphragm. Elongated openings in the body enable the diaphragm to be released in an inflated state from the body into flexible occluding engagement with the interior wall of the blood vessel about the full circumference of a transverse section thereof.

Abstract: A surgical tool system (20) with replaceable surgical cutting accessories (26) and attachments (34) for holding the tools. This system includes a handpiece (22) to which the cutting accessory and attachment are releasably attached. Collet (50) located inside a drill housing (44) located at one end of the handpiece securely fastens the surgical tool to a motor (24) also located in the handpiece. Leaf spring assembly (46) flush with the drill housing releasably secures the attachment in place. A single actuating collar (52) located around the outside of the drill housing both controls the locking force supplied by the collet and selectively relaxes the leaf spring assembly.

Abstract: This device is an apparatus for endovascular occlusion through the formation of thrombi in arteries, veins, aneurysms, vascular malformations, and arteriovenous fistulas. In particular, the device includes multiple vaso-occlusive members connected by electrolytically disintegratible links. Each link connects to the vaso-occlusive member by electrically insulative and conductive joints on opposite ends of the link. The vaso-occlusive members are delivered through a delivery catheter having on its distal end an electrode for electrical contact with the vaso-occlusive member. Upon application of an electrical current through electrode to the vaso-occlusive member and its conductive joint to electrolytically disintegratible link, the link disintegrates, selectively detaching the desired number of vaso-occlusive members into the target thrombus formation site.

Abstract: Devices and methods for minimally invasive harvesting of a vessel or vascular conduit, especially the saphenous vein for coronary artery bypass grafting, are disclosed. Generally, an instrument is provided which has one or more specially designed end effectors which are permanently or detachably mounted to a harvesting implement, and may also be interchangeable with each other. The end effectors have features or elements which facilitate separation of connective tissue from the vessel and/or engagement of side branches to be separated from the vessel. In various embodiments, the instrument also provides means for quickly and easily attaching and detaching the end effectors as well as means for engaging with an endoscope, if desired. The harvesting methods provide for use of the instruments through one or more minimally invasive incisions.

Abstract: A handle assembly for a drive tool includes a plunger actuator configured to move a plunger of the drive tool between a retracted position and an extended position, an outer tube actuator configured to move an outer tube of the drive tool between a retracted position and an extended position, and a coupler configured to move the outer tube from its extended position to its retracted position in response to movement of the plunger from its extended position to its retracted position. The drive tool delivers a suture securing device to a surgical site. When the plunger actuator moves the plunger to its extended position, a second member of the device is secured to a first member of the device. When the plunger actuator moves the plunger to a second, further extended position, the plunger deploys the secured first and second members from the drive tool.

Abstract: A configuration register is incorporated into an electrically powered tourniquet apparatus for enabling an operator to change the values of parameters initially employed at the time of the next use of the apparatus, such as the initial pressure settings and elapsed time limits. These changed initial values of parameters are stored in memory and remain there despite inadvertent or intentional interruption of electrical power to the apparatus. An event register provides capability for recording the occurrence of events (cuff inflation, cuff deflation, etc.) and for relating the occurrence of the events to hazards and undesirable outcomes such as nerve damage associated with tourniquet usage. A safety circuit is included to detect and respond safely to certain failures which are possible within the tourniquet apparatus.

Abstract: The present invention relates to an integrated cannula and vascular clamp assembly. The integrated cannula and vascular clamp assembly includes a pair of clamping members made of a physiologically acceptable material that are pivotally coupled to a cannula for movement between an open position for at least partially surrounding a portion of a blood vessel section to be occluded and a clamping position for compressing the blood vessel with pressure sufficient to occlude blood flow through the section.

Abstract: Disclosed is an assembly catheter for intracardiac suture. The assembly catheter includes a hooking catheter 3 provided with a suture-hooking means 32 at a distal end and with a manipulating element (grip) 33 at a proximal end; a piercing catheter 2 having lumen 21 for movably holding the hooking catheter 3 and provided with a piercing needle 25 at a distal end and with a hemostatic valve 24 as a hemostatic means at a proximal end, the distal portion 28 of the piercing catheter adjacent to the piercing needle 25 being easily bendable; a sheath 1 having a lumen 11 for movably holding the piercing catheter 2 and provided with a hemostatic valve 14 as a hemostatic means at a proximal end; and a catheter-bending means 4 connected to the piercing needle 25 of the piercing catheter 2; in which the distal portion 28 of the piercing catheter 2 can be bent by the catheter-bending means 4. The catheter assembly is applicable to intracardiac suture for various configurations of ASD.