Abstract: A surgical device for use in combination with a percutaneous elongate shaft defining a longitudinal axis. The shaft comprises a distal end and a proximal end, the distal end comprising an attachment mechanism. A surgical end effector is selectively attachable in vivo and detachable in vivo to the attachment mechanism of the percutaneous elongate shaft. A percutaneous elongate loader comprises an articulating distal end. The distal end comprises a tube with an opening at the distal tip, the tube being dimensioned to receive the surgical end effector. The distal end further comprises an engagement feature capable of frictionally holding the surgical end effector in the tube during in vivo attachment to and in vivo detachment from the percutaneous elongate shaft.

Abstract: A laparoscopic surgical method comprises obtaining a first instrument comprising an elongate shaft with a distal end and a proximal end connected to a first handle. The distal end of the first instrument is passed through a percutaneous incision. A surgical end effector is obtained having a distal end with operable jaws and a proximal end selectively attachable to and detachable from the distal end of the first instrument. A second instrument is obtained comprising a distal end and a proximal end connected to a second handle. The surgical end effector is loaded ex vivo on the distal end of the second instrument. The distal end of the second instrument with the loaded surgical end effector is passed through a second incision spaced from the percutaneous incision. The proximal end of the surgical end effector is attached in vivo to the distal end of the first instrument. Tissue is manipulated by actuating the handle of the first instrument to operate the jaws of the surgical end effector.

Abstract: A surgical device including an elongated shaft having a distal end and a proximal end, an arm pivotally connected to the distal end and moveable through a dissection plane, and a cutting element disposed on the arm and adapted to move from an un-deployed configuration to a deployed configuration, wherein the cutting element is generally aligned with the dissection plane when in the un-deployed configuration and at least partially transverse with respect to the dissection plane when in the deployed configuration.

Abstract: Various methods and devices are provided for penetrating tissue. In one embodiment, a tissue-penetrating device is provided and includes a flexible elongate shaft and a flexible elongate wire extending through the elongate shaft and having a needle tip at a distal end thereof for penetrating tissue. The needle tip can be conductive and the elongate wire can be adapted to couple to an energy source for delivering energy to the needle tip to facilitate penetration of the needle tip through tissue. The device can also include a protective sheath disposed over at least a portion of the elongate shaft and movable relative to the elongate shaft between a distal position and a proximal position. The protective sheath is configured to either protect the needle tip or electrically isolate the needle tip after the needle tip is penetrated through tissue, thereby preventing unintentional penetration of adjacent tissue.

Abstract: A medical tubular assembly includes four medical coilpipes together having a distal end portion insertable into a patient. The four medical coilpipes include a central coilpipe and three peripheral coilpipes disposed outward of the central coilpipe. The four medical coilpipes are wound from a continuous length of wire. In one example, a lengthwise translatable medical-end-effector activation cable is located in the central coilpipe, a separate and lengthwise translatable medical-instrument-member articulation cable is located in each of the three peripheral coilpipes, and the distal end portion is endoscopically insertable into the patient. Other examples are left to those skilled in the art.

Abstract: Disclosed herein are devices and methods for forming multidirectional cuts in tissue. The tissue cutting devices disclosed herein generally include a flexible elongate member with at least first, second, and third wires that are at least partially constrained within or along a portion of the member. A distal portion of the wires is anchored on or within a portion of the elongate member. When tension is applied to at least one of the wires, such as by an actuator at a proximal end of the device, the elongate member bows while an unconstrained portion of the wire becomes exposed relative to the adjacent portion of the elongate member, assuming a tissue-cutting configuration.

Abstract: Methods and devices are provided for providing access through tissue to a surgical site. In one embodiment, a surgical access device can be configured to move between a first, expanded configuration, and a second, compressed configuration. As the device moves from the first configuration to the second configuration, a longitudinal length of the device can decrease, thereby allowing the device to be securely positioned in tissue and reducing a distance that the device extends into a body cavity.

Abstract: Methods and devices are provided for providing access through tissue to a surgical site. In one embodiment, a surgical access device can be configured to move between a first, expanded configuration, and a second, compressed configuration. As the device moves from the first configuration to the second configuration, a longitudinal length of the device can decrease, thereby allowing the device to be securely positioned in tissue and reducing a distance that the device extends into a body cavity.

Abstract: The present invention is a method for accessing the abdominal cavity of a patient in order to perform a medical procedure therein. In one embodiment the method includes the step of inserting a guide wire into the upper gastrointestinal tract, via a gastric opening in the gastric wall and an abdominal opening in the abdominal wall of the patient, the guide wire having a first end that extends from the mouth of the patient, and a second end that extends from the abdominal opening of the patient. The method further includes providing an access device in the form of an elongated sheath having a lumen therethrough, attaching the first end of the guide wire to the distal end of the elongated sheath, and pulling the second end of the guide wire to position the access device into the upper gastrointestinal tract, wherein the distal end of the access device extends into the abdominal cavity while the proximal end of the access device extends out of the mouth of the patient.

Abstract: A bone plating apparatus includes a handle having extending therefrom a tissue expander for insertion through a skin incision and through the subcutaneous tissue surrounding a fractured bone. A bone plate may be secured to the handle during advancement of the tissue expander so as to deliver the bone plate to a desired location proximate to the fractured bone. Both the tissue expander and the bone plate may be advanced to the desired location proximate to the fractured bone under the visualization of an endoscope. A screw alignment jig is secured to the handle and has a guide hole which aligns with an access hole of the tissue expander. The alignment of the guide hole and the access hole allow for percutaneous screw insertion into the delivered bone plate. A method for plating a fractured bone is also disclosed.

Abstract: Devices and methods are provided which may be used for suturing, including performing a totally transoral surgical procedure, such as a posterior gastropexy procedure. A suture lock and cut assembly is provided to lock and cut one or more sutures in one motion, which motion can be a non-curved, non rotational linear motion. The suture lock and cut assembly with one or more sutures threaded therethrough may be pushed through, for example, a patient's esophagus and into the stomach by the tip of an endoscope, or alternatively, sized to be fed through the working channel of the endoscope.

Abstract: A medical instrument handle includes a medical-instrument-handle body, manually-slidable first and second slides, and medical-instrument-member first and second articulation cables. The handle body has a longitudinal axis, a proximal body portion, and a distal body portion. The first slide is slidably attached to the handle body. The first articulation cable includes a first proximal cable portion which has a first centerline and which is connected to the first slide. The second slide is slidably attached to the handle body. The second articulation cable includes a second proximal cable portion which is connected to the second slide. A medical instrument also includes a flexible shaft and a medical end effector.

Abstract: A positionable imaging device includes a body defining a first end and a second end. The body is configured to be received within an internal body cavity. An imaging device is located at the first end of the body. A releasable fastener is coupled to the body to removably attach the imaging device to tissue within the internal body cavity. A release mechanism is coupled to the releasable fastener to detach the imaging device from the tissue.

Abstract: A medical device is provided for use with an endoscope. The medical device can include a tissue resection device comprising an RF cutting wire. The tissue resection device can be supported for proximal and distal movement relative to the endoscope.

Abstract: A method for resecting tissue from an organ of a patient, the organ being comprised of at least a first layer, a second layer and a third layer, the method including the steps of providing an EMR device with access to the organ, the EMR device including at least one deployable cutting element disposed on at least one moveable arm, identifying a target tissue area for resection, forming an incision through the first and second layers without penetrating the third layer, positioning the EMR device through the incision such that the device is positioned between the first third layers, advancing the moveable arm between the first and third layers, deploying the cutting element such that the cutting element is advanced in the direction of the first layer and away from the third layer and, while the EMR device is positioned between the first and third layers, cutting through the first layer.

Abstract: A surgical device is disclosed. The device includes an elongate shaft having a distal end coupled to a proximal end of an articulation joint, and an actuation wire extending through the elongate shaft and the articulation joint. The device further includes an end effector having a distal tip coupled to a distal end of the articulation joint and receiving therethrough a distal end of the actuation wire. The end effector includes a hook knife disposed adjacent the distal tip and having a proximal end connected to the distal end of the actuation wire. The actuation wire is translatable along a longitudinal axis of the elongate shaft to extend and retract the distal end of the hook knife relative to the distal tip of the end effector, and the articulation joint is laterally articulatable relative to the longitudinal axis of the elongate shaft to allow the end effector to be angularly oriented relative to the elongate shaft.

Abstract: Methods and devices are provided for controlling movement of a working end of a surgical device, and in particular for performing various surgical procedures using an instrument having an end effector that can be articulated relative to an elongate shaft of the device. A decoupling member can isolate the actuation of the end effector from the articulation of the end effector. In certain embodiments, the end effector can also optionally rotate relative to the elongate shaft of the device, and/or the shaft can rotate relative to a handle of the device.

Abstract: An anastomosis device formed from a Shape Memory Alloy (SME) wire that is annealed into a tight coil (e.g., flat coil, helical coil, cylindrical coil) that is subsequently substantially straightened (e.g., straight, longitudinally stretched spring-like shape) for being constrained within an elongate member of an anastomosis introducer instrument. After positioning and holding two tissue walls of adjacent lumens into apposition with a distally presented grasper of the instrument, a piercing tip of the anastomosis device is dispensed and inserted through the tissue walls before being allowed to relax to its tight coil shape, thereby forming the anastomosis attachment. The anastomosis device is released from the anastomosis introducer instrument, such as by fully dispensing its proximal end. Thereby, efficient single lumen anastomosis of gastrointestinal, bilatory, or other vessels may be achieved with a minimum of laparoscopic punctures, or perhaps performed fully as an endoscopic procedure.

Abstract: A surgical instrument for forming a gastrotomy. In various embodiments, the surgical instrument may comprise a hollow tip for attachment to a distal end of a tubular member such as an endoscope. In other embodiments, the hollow tip is integrally formed on the distal end of the endoscope. The hollow tip is configured such that when it is brought into contact with the inner layer of tissue in the stomach, the tissue is caused to stretch. A hole-forming device may be passed through the hollow tip to pierce through the stretched inner layer and adjacent outer layers of tissue to form a passageway therethrough for permitting surgical procedures to be performed therethrough. After the surgical procedures are performed through the passageway, the hollow tip is removed from contact with the inner layer of tissue to permit the inner layer of tissue to relax and to cause the holes formed through the inner layer and outer layers of tissue to be offset from each other.

Abstract: Various exemplary methods and devices are provided for manipulating and/or anchoring devices and body parts during surgical procedures. In one embodiment, an anchor member is provided for anchoring a device or body part to tissue, such as an internal wall of a body cavity. The device can be, for example, an endoscopic device, an accessory channel coupled to an endoscopic device, or a support member adapted to support or manipulate an organ. The anchor member can include or form an opening through which the device can be inserted. The anchor member or device can thus be manipulated relative to the tissue to control movement of and/or provide support to the device, tools inserted through the device, and/or organs grasped by the device or tools.