Abstract: A hydraulically actuated medical instrument includes an elongated shaft having proximal and distal ends, a hydraulically actuated end effector at the distal end of the shaft and a fluid flow path extending through the shaft to the end effector. The end effector may be directly manually operated by way of a handle located at the proximal end of the shaft or remotely, for example, via robotic controller. Articulation joints may be provided along the shaft, between the shaft and end effector or handle, or elsewhere. The hydraulic actuation of the present invention permits multiple axis instrument articulation, miniaturization and simplified instrument fabrication.

Abstract: A method for closing a patent foramen ovale in the heart tissue of a patient may include percutaneously advancing a connector applicator to the patent foramen ovale, registering the connector applicator with the patent foramen ovale, deploying connectors into heart tissue to close the patent foramen ovale; and percutaneously removing the connector applicator from the heart. One or more anchors may be used to register the connector applicator with the patent foramen ovale. The connector applicator may include a driver having a longitudinal passage therein, where at least part of at least one connector is positioned within said passage.

Abstract: A system for closing an opening in tissue may include an end effector that holds a staple, where the staple is plastically deformed to a splayed configuration for engaging tissue, then plastically deformed to a closed condition for closing the opening. The system may include one or more butterfly members configured to register the opening to the end effector.

Abstract: A method for closing an opening in tissue, such as an opening in heart tissue, may include moving a housing to a location in proximity to the opening, registering the housing to the opening, and deploying a staple from the housing into tissue in proximity to the opening. The opening in heart tissue may be a patent foramen ovale, atrial septal defect, or other opening. The housing may be moved to the opening through the vasculature, utilizing a guidewire, steering catheter, or other mechanism.

Abstract: An anastomosis tool may include a connector holder connected to an anvil. The connector holder may be bifurcated and configured to straddle the graft vessel. The connector holder may be generally U-shaped. The connector holder may be shaped to extend around more than half of the circumference of the graft vessel.

Abstract: A system for performing anastomosis between a graft vessel and a target vessel includes a tissue effector that may be configured to deploy a user-selectable number of connectors. The system includes an anvil that enters the wall of the target vessel through an entry hole that is spaced apart from the anastomosis site, and at least one anvil entry hole sealer may be utilized to substantially seal the anvil entry hole upon withdrawal of the anvil. The system may include a shield and a cutter, both of which are movable relative to the anvil, where the shield is configured to protect the graft vessel from the cutter. The cutter may include an incising element movable from a stowed position to an active position.

Abstract: An anastomosis system for connecting a graft vessel to a target vessel includes an elongated anvil arm for insertion into the target vessel. The anvil arm includes a contact surface that contacts the inner surface of the wall of the target vessel. The anvil arm includes a channel through which a cutting element translates, and a opening that extends between the channel and the contact surface of the anvil arm. The cutting element is translated along the channel, and is controlled to extend through the opening and make an incision in the wall of the target vessel at a selected location. The incision is made at a location spaced apart from the penetration site at which the anvil arm is inserted into the target vessel, resulting in a tissue bridge between the incision and the penetration site.

Abstract: An anastomosis staple has a base from which multiple deformable tines extend. At least one tine may be offset from at least one other tine. The tines are moveable from a first configuration to a second configuration. The staple optionally includes at least one alignment guide.

Abstract: A surgical device for manipulating tissue. The device includes an elongated shaft having a proximal end and a distal end extending therefrom. There is also an elongated end effector having a proximal end attached to the distal end of the shaft, a distal end extending therefrom. The end effector has first and second opposing jaws which are movable with respect to each other from an open position, wherein the jaws are spaced apart, to a closed position wherein the jaws are in close approximation to one another. At least one of the jaws has an expandable member disposed thereon for selectively increasing the size of the jaw in a direction perpendicular to the longitudinal axis so as to increase the rigidity of the end effector.

Abstract: A hydraulically actuated medical instrument includes an elongated shaft having proximal and distal ends, a hydraulically actuated end effector at the distal end of the shaft and a fluid flow path extending through the shaft to the end effector. The end effector may be directly manually operated by way of a handle located at the proximal end of the shaft or remotely, for example, via robotic controller. Articulation joints may be provided along the shaft, between the shaft and end effector or handle, or elsewhere. The hydraulic actuation of the present invention permits multiple axis instrument articulation, miniaturization and simplified instrument fabrication.

Abstract: A hydraulically actuated medical instrument includes an elongated shaft having proximal and distal ends, a hydraulically actuated end effector at the distal end of the shaft and a fluid flow path extending through the shaft to the end effector. The shaft may be capable of an angled configuration where at least a portion of the shaft is manually movable to a direction in which it extends at an angle to another portion of the shaft. The end effector is not limited to a linear configuration and at least a portion of an elongated end effector extends at an angle relative to another portion of the end effector as is needed or desirable for the particular procedure to be performed.

Abstract: An endoscopic clip applier is adapted to retain a plurality of polymeric latching clips in an elongate assembly, and includes a jaw assembly for applying a polymeric latching clip. The jaw assembly extends from the distal end of the elongate assembly. A clip feeding member is moveable between a proximal position and a distal position to advance clips in the clip applier and to feed a clip from the distal end of the elongate assembly to the jaw assembly. Additionally, a jaw actuating member is moveable between a proximal position and a distal position, and includes cam surfaces for closing the jaw assembly. The actuator assembly actuates the clip feeding member to advance clips in the clip-containing elongate assembly and into the jaw assembly and subsequently advances the jaw actuating member to close the jaw assembly.

Abstract: An apparatus and method for ejecting fluid from a fluid delivery system. The fluid delivery system has a pneumatic assembly that when triggered injects gas into a hydraulic assembly, which in turn ejects fluid through an external interface. An electronic interface displays various measurements, for example, how much fluid has been ejected and if the hydraulic system is closed the pressure of the system. The pneumatic assembly can also be depressurized such that fluid can reenter the hydraulic assembly through the external interface.

Abstract: A device having a cutting implement movable in a direction generally parallel to a tissue surface and creating a cut line that does not extend to the proximal end of tissue adjacent the device is disclosed. The device has a cutting implement that emerges from a tissue engaging surface and cuts tissue only between a proximal and distal ends of the adjoining staple lines. A method is further provided for anastomosing two lumens without extending the passageway between them to the openings made for the forks of the anastomosis device.

Abstract: A device having a cutting implement movable in a direction generally parallel to a tissue surface and creating a cut line that does not extend to the proximal end of tissue adjacent the device is disclosed. The device has a cutting implement that emerges from a tissue engaging surface and cuts tissue only between a proximal and distal ends of the adjoining staple lines. A method is further provided for anastomosing two lumens without extending the passageway between them to the openings made for the forks of the anastomosis device.

Abstract: In accordance with the present invention there is provided a surgical fastening instrument. The instrument includes a handle and a shaft extending from the handle. The shaft contains a plurality of surgical fasteners therein. The instrument also has a mechanism for first distally deploying a penetrating member from the distal end of the shaft and thereafter feeding at least one of the surgical fasteners distally from the penetrating member. The instrument further includes a lockout mechanism for preventing the penetrating member from deploying from the shaft upon feeding all of the plurality of surgical fasteners from the shaft.

Abstract: A hydraulically actuated medical instrument includes an elongated shaft having proximal and distal ends, a hydraulically actuated end effector at the distal end of the shaft and a fluid flow path extending through the shaft to the end effector. The shaft may be capable of an angled configuration where at least a portion of the shaft is manually movable to a direction in which it extends at an angle to another portion of the shaft. The end effector is not limited to a linear configuration and at least a portion of an elongated end effector extends at an angle relative to another portion of the end effector as is needed or desirable for the particular procedure to be performed.

Abstract: In accordance with the present invention, there is provided a surgical device for manipulating tissue. The device includes an elongated shaft having a proximal end and a distal end extending therefrom. There is also an elongated end effector having a proximal end attached to the distal end of the shaft, a distal end extending therefrom. The end effector has first and second opposing jaws which are movable with respect to each other from an open position, wherein the jaws are spaced apart, to a closed position wherein the jaws are in close approximation to one another. At least one of the jaws has an expandable member disposed thereon for selectively increasing the size of the jaw in a direction perpendicular to the longitudinal axis so as to increase the rigidity of the end effector.

Abstract: In accordance with the present invention, there is provided a surgical device for manipulating tissue. The device includes an elongated shaft having a proximal end and a distal end extending therefrom. There is also an elongated end effector having a proximal end attached to the distal end of the shaft, a distal end extending therefrom. The end effector has first and second opposing jaws which are movable with respect to each other from an open position, wherein the jaws are spaced apart, to a closed position wherein the jaws are in close approximation to one another. At least one of the jaws has an expandable member disposed thereon for selectively increasing the size of the jaw in a direction perpendicular to the longitudinal axis so as to increase the rigidity of the end effector.

Abstract: A delivery device for delivering a plurality of individual surgical fasteners is disclosed. The delivery device has a drive mechanism having a distal and a proximal end, and a first and a second opposing member. The members are moveable proximally and distally with respect to the delivery device, and individually with respect to each other. The device further includes at least one surgical fastener located between the first and the second members. Each of the at least one surgical fasteners has a proximal end and a distal end. The surgical fasteners are preferably made from a superelastic nickel titanium alloy. Additionally an actuator having at least three sequential positions is included. The first position of the actuator is for moving the drive mechanism distally. The second position is for moving the first member proximally to partially deploy the distal end of the fastener. The third position of the actuator is for moving the second member proximally, to fully deploy the distal end of the fastener.