Abstract: Certain aspects relate to systems and techniques for articulating medical instruments. In one aspect, the instrument includes a wrist having at least one degree of freedom of movement, and an end effector coupled to the wrist. The end effector can include a cartridge for delivering a plurality of clips to tissue. The wrist may include one or more cables capable of moving an actuator with one degree of freedom of movement within the end effector to advance one or more clips through the end effector.

Abstract: A valve implant includes an occlusive assembly and a frame coupled to the occlusive assembly. The frame transitions from a collapsed state to an expanded state about a central longitudinal axis and transitioning from the collapsed state to the expanded state causes a proximal end of the frame to expand radially outward from the central longitudinal axis. The valve implant further includes an outer sheet supported on a proximal portion of the frame. The occlusive assembly is supported on a distal portion of the frame such that the inner sheet extends about the central longitudinal axis and an annular opening is defined between the outer sheet and the inner sheet when the frame is in the expanded state.

Abstract: A cardiac valve repair implant, wherein the implant includes a central occluder, and frame and a thin sheet. The central occluder includes a central longitudinal axis. The frame extends proximally from the central occluder and is centered about and forms a circumference around the central longitudinal axis of the central occluder. The frame self-biases from a collapsed state to an expanded state. A proximal end of the frame projects proximally when the frame is in the collapsed state. The proximal end of the frame projects radially outward away from the central longitudinal axis of the central occluder when the frame is in the expanded state. The thin sheet is supported on a proximal portion of the frame. When the frame is in the expanded state, the thin sheet forms an annular surface defining an inner circular opening centered about the central longitudinal axis of the central occluder.

Abstract: Delivery systems for expandable and stented implants include adjustable tensioning members that control the expansion of the implant along the length of the implant. The tensioning members are wound onto one or more rotors located on the distal segment of the delivery system, which are rotated to unwind the tensioning members and incrementally expand the implant. Positioning mechanisms are also provided to adjust the position and orientation of the implant during delivery.

Abstract: A replacement heart valve comprises a unibody, folded, double-wall stent, with a stent cover and a leaflet valve attached to the inner lumen of the stent. The heart valve is delivered using a multi-pulley, suture-based stent restraint assembly provided by fixed guide openings or structures along the distal end of the delivery system that independently permits expansion of the distal and proximal ends of the outer wall of the stent, and control of the inner wall expansion simultaneously with or separately from the expansion of the outer wall.

Abstract: An Anastomosis Device is intended to create an end-to-side anastomosis between a graft vessel and a target vessel. The anastomosis is created by the delivery of staples that connect the graft vessel to the target vessel and the creation of an incision to open a flow path between the graft vessel and the target vessel.

Abstract: The present disclosure provides systems and methods for a replacement mitral valve. The replacement valve may be made of a less rigid material thereby allowing the packed diameter of the replacement valve to be decreased. The less rigid replacement mitral valve may include a ventricular portion and a central portion. The ventricular portion may include a guide channel. A wire may be advanced into the guide channel. The wire in the guide channel may increase the stiffness on the ventricular side of the replacement valve. The increased stiffness may prevent the replacement valve from collapsing through a native valve annulus.

Abstract: The present invention is directed to a tool having a wrist mechanism that provides pitch and yaw rotation in such a way that the tool has no singularity in roll, pitch, and yaw. A positively positionable multi-disk wrist mechanism includes a plurality of disks or vertebrae stacked in series. Each vertebra is configured to rotate in pitch or in yaw with respect to each neighboring vertebra. Actuation cables are used to manipulate and control movement of the vertebrae. In specific embodiments, some of the cables are distal cables that extend from a proximal vertebra through one or more intermediate vertebrae to a distal vertebra, while the remaining cables are medial cables that extend from the proximal vertebra to one or more of the intermediate vertebrae. The cables are actuated by a pivoted plate cable actuator mechanism.

Abstract: A robotic catheter system includes a controller with a master input device. An instrument driver is in communication with the controller and has a guide instrument interface including a plurality of guide instrument drive elements responsive to control signals generated, at least in part, by the master input device. An elongate guide instrument has a base, distal end, and a working lumen, wherein the guide instrument base is operatively coupled to the guide instrument interface. The guide instrument includes a plurality of guide instrument control elements operatively coupled to respective guide drive elements and secured to the distal end of the guide instrument. The guide instrument control elements are axially moveable relative to the guide instrument such that movement of the guide instrument distal end may be controlled by the master input device.

Abstract: Certain aspects relate to silicone sheaths for insulating wristed, electrically conductive instruments. The electrically conductive instruments can include monopolar instruments. The sheaths that are provided can include an internal, tear-resistant braided structure.

Abstract: Certain aspects relate to systems and techniques for articulating medical instruments. In one aspect, the instrument includes a wrist having at least one degree of freedom of movement, and an end effector coupled to the wrist. The end effector can include a cartridge for delivering a plurality of clips to tissue. The wrist may include one or more cables capable of moving an actuator with one degree of freedom of movement within the end effector to advance one or more clips through the end effector.

Abstract: Provided are systems and techniques for a medical procedure. For example, the system may include one or more robotic arms, an imaging device, a master controller, a viewer configured to render one or more digital images based on image data from the imaging device, at least one computer-readable memory having stored thereon executable instructions, and one or more processors. The one or more processors may be configured to execute the instructions to cause the system to: in a first mode of operation, cause movement of at least one of the robotic arms; and in a second mode of operation, cause the viewer to display an interactive menu and a graphical overlay on the one or more digital images.

Abstract: A robotic catheter system includes a controller with a master input device. An instrument driver is in communication with the controller and has a guide instrument interface including a plurality of guide instrument drive elements responsive to control signals generated, at least in part, by the master input device. An elongate guide instrument has a base, distal end, and a working lumen, wherein the guide instrument base is operatively coupled to the guide instrument interface. The guide instrument includes a plurality of guide instrument control elements operatively coupled to respective guide drive elements and secured to the distal end of the guide instrument. The guide instrument control elements are axially moveable relative to the guide instrument such that movement of the guide instrument distal end may be controlled by the master input device.

Abstract: A robotic system can include a high force instrument that amplifies input forces such that output forces are greater than input forces. The high force instrument can include an end effector. The high force instrument can further include a first pulley configured to rotate about a pulley axis and a first jaw member connected to the first pulley by a first drive pin. The high force instrument can also include a second pulley configured to rotate about the pulley axis and a second jaw member connected to the second pulley by a second drive pink. A link can provide a first pivot point about which the first jaw member can pivot and a second pivot point about which the second jaw member can pivot.

Abstract: Certain aspects relate to systems and techniques for articulating medical instruments. In one aspect, the instrument includes a wrist having at least two degrees of freedom of movement, and an end effector coupled to the wrist. The end effector can include an upper jaw, a lower jaw, and a firing mechanism configured to form staples in tissue. Actuation of the firing mechanism can be decoupled from the movement of the wrist in the at least two degrees of freedom.

Abstract: A robotic system can include a high force instrument that amplifies input forces such that output forces are greater than input forces. The high force instrument can include an end effector. The high force instrument can further include a first pulley configured to rotate about a pulley axis and a first jaw member connected to the first pulley by a first drive pin. The high force instrument can also include a second pulley configured to rotate about the pulley axis and a second jaw member connected to the second pulley by a second drive pink. A link can provide a first pivot point about which the first jaw member can pivot and a second pivot point about which the second jaw member can pivot.

Abstract: Provided is a robotic system that includes a surgical instrument with a wrist including an elongate shaft extending between a proximal end and a distal end, a wrist extending from the distal end of the elongate shaft, and an end effector extending from the wrist. The end effector may include a first jaw and a second jaw, the first and second jaw being moveable between an open position in which ends of the jaws are separated from each other, and a closed position in which the ends of the jaws are closer to each other as compared to the open position. The surgical instrument may also include at least one rotary cutter extending from the wrist and positioned at least partially within a recess formed in a face of the first jaw.

Abstract: A robotic system can include a high force instrument that amplifies input forces such that output forces are greater than input forces. The high force instrument can include an end effector. The high force instrument can further include a first pulley configured to rotate about a pulley axis and a first jaw member connected to the first pulley by a first drive pin. The high force instrument can also include a second pulley configured to rotate about the pulley axis and a second jaw member connected to the second pulley by a second drive pink. A link can provide a first pivot point about which the first jaw member can pivot and a second pivot point about which the second jaw member can pivot.

Abstract: The apparatus of one embodiment of the present invention is comprised of a flexible sheath instrument, a flexible guide instrument, and a tool. The flexible sheath instrument comprises a first instrument base removably coupleable to an instrument driver and defines a sheath instrument working lumen. The flexible guide instrument comprises a second instrument base removably coupleable to the instrument driver and is threaded through the sheath instrument working lumen. The guide instrument also defines a guide instrument working lumen. The tool is threaded through the guide instrument working lumen. For this embodiment of the apparatus, the sheath instrument and guide instrument are independently controllable relative to each other.

Abstract: A system for conducting denervation of the neural plexus adjacent the renal artery, comprises a pre-shaped ablative element operatively coupled to an elongate deployment member configured to be navigated into the renal artery, the pre-shaped ablative element comprising one or more RF electrodes disposed in an arcuate pattern; and an energy source operatively coupled to the one or more RF electrodes and being configured to cause current to flow from the pre-shaped ablative element and cause localized heating sufficient to denervate nearby neural tissue.