Abstract: Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

Abstract: Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture.

Abstract: Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

Abstract: Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture.

Abstract: Described here are devices and methods for suture management. In some variations, the devices comprise an elongate tubular member having a proximal end, a distal end, a lumen therebetween, a cantilever blade positioned near the distal end of the elongate tubular member, and an expandable member positioned adjacent the cantilever blade for actuating the cantilever blade. Also described are devices comprising an elongate tubular member having a proximal end, a distal end, a lumen at least partially therebetween, and an aperture in a wall thereof for passage of a suture therethrough. These devices further comprise a blade connected to a blade housing disposed within the lumen, where the blade is oriented parallel to the longitudinal axis of the lumen. The blade and blade housing may be slidable within the lumen, or an inner shaft for may be slidable within the lumen. Methods of using the devices are also described.

Abstract: Described here are devices, systems and methods for forming a fistula between two blood vessels. Generally, the systems may comprise a first catheter which may comprise a fistula-forming element. The fistula-forming element may comprise one or more electrodes, mechanical cutting elements, laser sources, or combinations thereof, and may be used to assist in fistula formation. In some instances, a system may comprise a second catheter, which may comprise a fistula-forming element. One or more of the catheters may comprise one or more markers, magnetic alignment elements, and/or one shape-changing elements.

Abstract: Described here are devices for closing one or more tissues, and handles for controlling these devices. Generally, the devices described here comprise a snare loop assembly, wherein the snare loop assembly comprises a snare and a suture loop, and a handle for controlling the snare loop assembly. In some variations the snare loop assembly may comprise a retention member that may releasably connect the suture loop to the snare. In other variations the devices comprise one or more force-reducing suture locks to help prevent the suture loop from inadvertently disengaging from the snare loop assembly. In still other variations, the excess-suture management features. The handles described here may be configured to remove excess suture from a suture loop, and may also be configured to release the suture loop from the snare loop assembly.

Abstract: Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture therethrough.

Abstract: Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture therethrough.

Abstract: Described here are devices and methods for suture management. In some variations, the devices comprise an elongate tubular member having a proximal end, a distal end, a lumen therebetween, a cantilever blade positioned near the distal end of the elongate tubular member, and an expandable member positioned adjacent the cantilever blade for actuating the cantilever blade. Also described are devices comprising an elongate tubular member having a proximal end, a distal end, a lumen at least partially therebetween, and an aperture in a wall thereof for passage of a suture therethrough. These devices further comprise a blade connected to a blade housing disposed within the lumen, where the blade is oriented parallel to the longitudinal axis of the lumen. The blade and blade housing may be slidable within the lumen, or an inner shaft for may be slidable within the lumen. Methods of using the devices are also described.

Abstract: Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture therethrough.

Abstract: A catheter having expandable electrodes for applying energy to a hollow anatomical structure such as a vein. When used on a vein, the catheter is useful for a minimally invasive treatment of venous insufficiency. The catheter includes conductive end rings to which the electrodes are attached, for mechanically connecting and electrically tying electrodes together to provide for a single wire electrical connection points, for transmitting energy while more evenly spacing the electrodes. Expandable arms are formed of electrically conductive material and insulated along their length except for an intermediate section that functions as the electrode. The arms are tapered to allow more room for wiring and to reduce the possibility of shorting between the ends of the arms. The catheter further includes thermocouples in the electrodes for measuring temperatures on the outer surface of the electrode. Slots are formed in the arms for mounting the thermocouples.

Abstract: Described is a surgical instrument and method for treating female urinary stress incontinence. The instrument includes a curved needle-like element defining in part a curved shaft having a distal end and a proximal end. A tape attaches to the needle for implanting into the lower abdomen of a female to provide support to the urethra. The needle defines an inner lumen for passage of optical devices and/or fluids. A surgical optical system may interface directly with the needle, or alternatively, the needle hand piece or handle may be modified to accept the optical system. The tip of the needle is also modified to contain a window or viewing port that allows for the transmission of light from the ambient target tissue into the imaging lens of the optical system. The optical system allows the surgeon to maintain continuous anatomic visualization during introduction and navigation of the needle within the lower abdomen.

Abstract: A medical scope adapted for use in viewing an image of an interior section of a body includes a housing having a viewing mechanism for viewing the image. An elongated shaft extends from the housing and includes a sheath and an image transmitting mechanism extending through the sheath for optically transmitting the image from the interior section to the viewing mechanism. The sheath is made from a superelastic material such that the sheath has an elasticity greater than that of the image transmitting mechanism, whereby the bending of the shaft and hence the image transmitting mechanism is restricted primarily by the elastic limit of the image transmitting mechanism and not by the elastic limit of the sheath. The medical scope of the present invention can be any type of medical scopes, including rigid, semi-flexible and flexible endoscopes, medical telescopes, hysteroscopes, bronchialscopes and cystoscopes.

Abstract: A catheter having expandable electrodes for applying energy to a hollow anatomical structure such as a vein. When used on a vein, the catheter is useful for a minimally invasive treatment of venous insufficiency. The catheter includes conductive end rings to which the electrodes are attached, for mechanically connecting and electrically tying electrodes together to provide for a single wire electrical connection points, for transmitting energy while more evenly spacing the electrodes. Expandable arms are formed of electrically conductive material and insulated along their length except for an intermediate section that functions as the electrode. The arms are tapered to allow more room for wiring and to reduce the possibility of shorting between the ends of the arms. The catheter further includes thermocouples in the electrodes for measuring temperatures on the outer surface of the electrode. Slots are formed in the arms for mounting the thermocouples.

Abstract: A delivery device and method for intraluminally deploying a clip appliance within a body lumen or cavity of a patient, for example a vein. The clip is configured from a wire-like, bendable material, having a "W"-like sinusoidal shape. The clip is constructed with sharpened slanted edges at the tips which provide preferential bending and straightening when the clip is deployed into patient tissue, for example, a venous valve. The delivery device comprises a catheter and a structure for bending and releasing the clip. The catheter is configured with an elongate flexible tubular member secured to a slotted housing having a distal tapered tip. A handle is secured to the proximal end of the flexible tubular member. A balloon and actuator arm combination is disclosed for forcing a clip against an anvil to bend the clip from an open to a closed condition and for releasing the clip from a slot in a side wall of the housing. The housing may be configured to retain and deploy a plurality of clip appliances.

Abstract: The invention provides exemplary electrosurgical probes and methods for their use. In one exemplary embodiment, an electrosurgical probe comprises a probe body having a proximal end, a distal end and at least one lumen. An electrode assembly is operably coupled to the distal end. The electrode assembly includes an electrode and a jacket disposed to cover at least a portion of the electrode. The jacket and the electrode have a combined mass sufficient to dissipate heat during operation of the electrode so that the electrode does not experience material degradation. Further, the jacket provides insulation between the electrode and a conductive medium such that the electrode is operable in the conductive medium.

Abstract: A test system and method for evaluating the efficiency of the venous pump in leg muscles and for identifying incompetent venous valves. The test system comprises a legging having inflatable bladders, a manifold and a system controller. A pressurized inflation source is provided which is in fluid communication with the manifold and the legging. The controller sequences valves within the manifold to inflate and deflate the bladders of the legging. The test system further includes a Doppler blood flow sensor interfaced to the controller. The sensor is configured with a housing which contains a rotatable disk, upon which two pairs of crystals are disposed. The sensor housing is secured a leg of a patient proximate a blood vessel in which blood flow is to be measured. The patient is positioned on a reclinable test station, upon which the controller and manifold may be mounted.

Abstract: Valve construction for use with an introducer assembly having a tubular member with a valve housing at one end thereof for receiving the valve construction to permit a medical instrument to be introduced therethrough. The valve construction is comprised of a body formed of an elastic material. The body has a cylindrical wall with an axially-extending bore. The body is provided with a first planar wall formed integral with the cylindrical wall and extending across the first end of the bore. The first wall has a centrally-disposed opening therein aligned with the bore. The body is also provided with a second wall formed integral with the cylindrical wall and extending across the second end of the bore. The second wall has a slit therein extending diametrically of the bore to provide first and second leaflets.

Abstract: A catheter system for dilating the prostatic urethra of a male patient. The catheter has an elongated tubular catheter body with an inner lumen extending therein, an inflatable relatively inelastic balloon on the distal extremity of the catheter body, a core member extending through the balloon interior and at least to and preferably out the distal end of the catheter body where a flexible body such as a helical coil is disposed about and secured thereto. The catheter body proximal to the balloon has a diameter which is sufficiently small to allow the catheter shaft to be slidably disposed within the working channel of a flexible cystoscope. The flexible cystoscope can be utilized to allow the physician performing the dilatation to observe the external sphincter to ensure that there is no dilation thereof.