Abstract: The suturing instrument includes an elongate member having a distal end, a distal portion coupled to the distal end of the elongate member, and an actuation mechanism. The distal portion is movably coupled to the elongate member such that the distal portion is configured to move from a first position to a second position.

Abstract: The suturing instrument includes an elongate member having an articulating distal portion biased offset from the elongate member, and a sheath slideably disposed about the elongate member. The user positions the sheath in contact with the articulating distal portion to actuate the distal portion relative to the elongate member. The articulating distal portion is pivotally coupled to the elongate member for improved maneuverability within the body of a patient during surgical procedures.

Abstract: The suturing instrument includes an elongate member having an articulating distal portion biased offset from the elongate member, and a sheath slideably disposed about the elongate member. The user positions the sheath in contact with the articulating distal portion to actuate the distal portion relative to the elongate member. The articulating distal portion is pivotally coupled to the elongate member for improved maneuverability within the body of a patient during surgical procedures.

Abstract: An instrument for controlling bleeding includes an outer shaft, an intermediate shaft telescopically received within a central lumen of the outer shaft, and an inner shaft telescopically received within a central lumen of the intermediate shaft, the inner shaft having a proximal end and a distal end that extends distally from the intermediate shaft. The instrument includes a hemostat disposed at the distal end of the inner shaft, and a fluid-resistant element connected to the distal end of the outer shaft and surrounding the hemostat. The fluid-resistant element has a breakable, fluid-resistant seal at a distal end thereof that protects the hemostat from fluids until the hemostat is delivered and deployed onto tissue. In one embodiment, the instrument includes an inflatable balloon to deploy and tamponade the hemostat.

Abstract: An instrument for deploying hemostats has an intermediate shaft having a proximal end, a distal end, and a central lumen, and an inner shaft telescopically received within the central lumen of the intermediate shaft. The instrument includes an inflatable balloon, a first actuator for inflating the balloon, and a second actuator for moving the distal ends of the intermediate and inner shafts relative to one another for changing the shape of the inflated balloon. A proximal end of the balloon is secured to the distal end of the intermediate shaft and the distal end of the balloon is secured to the distal end of the inner shaft. The intermediate and inner shafts are moveable so that the inflated balloon has a toroidal shape and a flattened distal face. The inflated balloon has a major axis that is perpendicular to the longitudinal axis of the intermediate shaft.

Abstract: The suturing instrument includes an elongate member having an articulating distal portion biased offset from the elongate member, and a sheath slideably disposed about the elongate member. The user positions the sheath in contact with the articulating distal portion to actuate the distal portion relative to the elongate member. The articulating distal portion is pivotally coupled to the elongate member for improved maneuverability within the body of a patient during surgical procedures.

Abstract: The suturing instrument includes an elongate member having an articulating distal portion biased offset from the elongate member, and a sheath slideably disposed about the elongate member. The user positions the sheath in contact with the articulating distal portion to actuate the distal portion relative to the elongate member. The articulating distal portion is pivotally coupled to the elongate member for improved maneuverability within the body of a patient during surgical procedures.

Abstract: An instrument used for the delivery, deployment, and tamponade of a hemostat such as a topically applied hemostat includes an intermediate shaft having a proximal end, a distal end, and a central lumen extending to the distal end, and an inner shaft telescopically received within the central lumen of the intermediate shaft, the inner shaft having a proximal end and a distal end that extends distally from the intermediate shaft. The instrument includes an inflatable balloon having a proximal end secured to the intermediate shaft and a distal end secured to the inner shaft, a first actuator for inflating the balloon, and a second actuator for moving the distal ends of the intermediate and inner shafts relative to one another between a first position and a second position for changing the shape of the balloon when the balloon is inflated. The proximal end of the balloon is secured to the distal end of the intermediate shaft and the distal end of the balloon is secured to the distal end of the inner shaft.

Abstract: An instrument for controlling bleeding includes an outer shaft having a proximal end, a distal end, and a central lumen extending to the distal end thereof, an intermediate shaft telescopically received within the central lumen of the outer shaft, the intermediate shaft having a proximal end, a distal end, and a central lumen extending to the distal end thereof, and an inner shaft telescopically received within the central lumen of the intermediate shaft, the inner shaft having a proximal end and a distal end that extends distally from the intermediate shaft. The instrument includes a hemostat disposed at the distal end of the inner shaft, and a fluid-resistant element connected to the distal end of the outer shaft and surrounding the hemostat. The fluid-resistant element has a breakable, fluid-resistant seal at a distal end thereof that protects the hemostat from fluids until the hemostat is delivered and deployed onto tissue.

Abstract: A ductal access device is provided for accessing a breast duct and collecting biological material from within the duct. The access device may include an elongated member having an outer diameter sized for positioning within the breast duct and an internal lumen for infusing a fluid into the breast duct and collecting fluid from the breast duct. The elongated member may include a central axis extending through the internal lumen and a different axis being parallel to the central axis defining an off-axis configuration. An elongated distal tip extends beyond the distal end of the internal lumen and along the different axis. The elongated distal tip has a closed distal end for navigating within the breast duct. The elongated distal tip may include an internal passageway that is sized to slidiably or removably receive an elongated introducer.

Abstract: Methods and apparatus for occluding an anatomical structure including a device having at least first and second clamp portions adapted to cooperate to move from an open position adjacent an anatomical structure to a closed position engaging and occluding the anatomical structure. A system for delivery of a fluid to affect occlusion of an anatomical structure is provided, as well as an applicator for deploying occlusion devices having different sizes.

Abstract: A medical instrument including a ductal access device comprising a low profile, ergonomic manifold hub usable to introduce fluids into a breast duct and collect ductal fluid samples including ductal epithelial cells and clumps of ductal epithelial cells from within a breast duct. The ductal access device also comprises an elongated access catheter having a distal end, one lumen and dimensions which permit introduction of the distal end through a ductal orifice so that a distal end of the catheter may be positioned distal to the ductal sphincter of a human breast. The medical instrument may also include at least one spacing member for adjustably positioning the manifold hub a desired distance above the surface of the nipple. The spacing member may control the insertion depth of the catheter into the duct. The medical instrument may also include at least one member for anchoring the device to the breast.

Abstract: A conduit is provided to provide a bypass around a blockage in the coronary artery. The conduit is adapted to be positioned in the myocardium or heart wall to provide a passage for blood to flow between a chamber of the heart such as the left ventricle and the coronary artery, distal to the blockage. The stent is self-expanding or uses a balloon to expand the stent in the heart wall. Various attachment means are provided to anchor the stent and prevent its migration.

Abstract: A stent suitable for implantation in myocardial tissue to enhance perfusion therein may include a tubular member having first and second ends and a lumen. The first end of the stent may be configured to pierce myocardial tissue and the lumen may be configured to be placed in flow communication with a coronary vessel. The stent may further include a means for retaining the tubular member within the myocardial tissue. A method for implanting the stent may include positioning the first end of the stent at a desired implantation site and applying force to the second end of the stent to implant the stent within the myocardial tissue. The method may further include engaging the means for retaining with the myocardial tissue to retain the stent in position.

Abstract: Described herein are various methods and apparatuses for delivering stents and other devices into the myocardium of a patient. One preferred stent delivery system provides access to the insertion site in the myocardium by advancing a delivery catheter through a blockage in a coronary artery, or around the blockage through a coronary vein or through a channel or tunnel formed around the blockage. In one embodiment, once the distal end of the delivery catheter is adjacent the myocardium, an angled bend is created in the catheter by actuating expandable steering guides mounted to the catheter which cooperate with the walls of the blood vessel to cause the catheter to turn. Then, a guidewire is advanced through the delivery catheter and into the myocardium. In another embodiment, a tip-deflecting pull wire extends from the distal end of the delivery catheter which may be actuated to turn towards and then inserted into the myocardium.

Abstract: Left ventricular conduits and related methods are disclosed for achieving bypass of a partially or completely occluded coronary artery. More broadly, conduits for allowing communication of bodily fluids from one portion of a patient's body to another and related methods are disclosed, including conduits for forming a blood flow path from a chamber of the heart to a vessel or from one vessel to another. In other embodiments, the conduits achieve a coronary artery bypass by allowing blood communication between the left ventricle and the coronary artery or between a proximal portion of the coronary artery and a distal portion of the coronary artery. The conduits may be placed completely through the heart wall or extend only partially therein. Conduits may take on a variety of configurations for allowing the control of blood flow therethrough, including curved or tapered shapes.

Abstract: Described herein are various methods and apparatuses for delivering stents or conduits and other devices into the myocardium of a patient. One preferred stent delivery system provides access to the insertion site in the myocardium by advancing a delivery catheter through a blockage in a coronary artery, or around the blockage through a coronary vein or through a channel or tunnel formed around the blockage. In one embodiment, once the distal end of the delivery catheter is adjacent the myocardium, an angled bend is created in the catheter by actuating expandable steering guides mounted to the catheter which cooperate with the walls of the blood vessel to cause the catheter to turn. Then, a guidewire is advanced through the delivery catheter and into the myocardium. In another embodiment, a tip-deflecting pull wire extends from the distal end of the delivery catheter which may be actuated to turn towards and then inserted into the myocardium.

Abstract: Disclosed is a conduit that provides a bypass around a stenosis or occlusion in a coronary artery. The conduit is adapted to be positioned in the myocardium to provide a passage for blood to flow from a heart chamber to a coronary artery, at a site distal to the blockage or stenosis in the coronary artery. The conduit has a one-way valve positioned therein to prevent the backflow of blood from the coronary artery into the heart chamber.

Abstract: Disclosed is a conduit that provides a bypass around a stenosis or occlusion in a coronary artery. The conduit is adapted to be positioned in the myocardium to provide a passage for blood to flow from a heart chamber to a coronary artery, at a site distal to the blockage or stenosis in the coronary artery. The conduit has a one-way valve positioned therein to prevent the backflow of blood from the coronary artery into the heart chamber.

Abstract: A conduit is provided to provide a bypass around a blockage in the coronary artery. The conduit is adapted to be positioned in the myocardium or heart wall to provide a passage for blood to flow between a chamber of the heart such as the left ventricle and the coronary artery, distal to the blockage. The stent is self-expanding or uses a balloon to expand the stent in the heart wall. Various attachment means are provided to anchor the stent and prevent its migration.