Abstract: A catheter comprising a shaft (1) and a distal tip (3). In order to simplify renal ablation, for example, and to shorten the amount of time the patient is exposed to pain, a torsionally stiff wire (5) rotatable about the axis thereof is disposed between the shaft (1) and the tip (3), the wire being connected to a preloaded film (7, 7.1, 7.2, 7.3, 7.4) rolled up around the wire (5), on the outer surface (8) of which at least one conductor point (9), preferably a plurality of conductor points, is disposed, wherein each conductor point (9) can be connected to a current and/or voltage source.

Abstract: Embodiments of the present disclosure include a medical device. The medical device may include a proximal handle, a distal tool, an elongate member connecting the distal tool to the proximal handle and including a first portion and a second portion, wherein the elongate member may be configured to deliver electrical energy to the distal tool, and a coupling mechanism configured to connect and disconnect the first and second portions of the elongate member.

Abstract: A device positionable in a cavity of a bodily organ (e.g., a heart) may discriminate between fluid (e.g., blood) and non-fluid tissue (e.g., wall of heart) to provide information or a mapping indicative of a position and/or orientation of the device in the cavity. Discrimination may be based on flow, or some other characteristic, for example electrical permittivity or force. The device may selectively ablate portions of the non-fluid tissue based on the information or mapping. The device may detect characteristics (e.g., electrical potentials) indicative of whether ablation was successful. The device may include a plurality of transducers, intravascularly guided in an unexpanded configuration and positioned proximate the non-fluid tissue in an expanded configuration. Expansion mechanism may include helical member(s) or inflatable member(s).

Abstract: An apparatus comprises a body, a shaft, an end effector, and a firing beam. The shaft extends distally from the body. The end effector is positioned at the distal end of the shaft. The end effector comprises a first jaw and a second jaw, with the first jaw being pivotable toward the second jaw. The firing beam is operable to translate relative to the end effector to thereby drive the first jaw toward the second jaw. The firing beam includes a deformable portion operable to deform in response to a stress imposed by the end effector on the firing beam as the jaws clamp on dense or thick tissue. The deformable portion is defined in part by a cutout. A compliance restriction feature restricts deformation in the firing beam. A resilient member biases the firing beam to a non-deformed configuration.

Abstract: The invention relates to an electrosurgical gripping instrument which includes a cutting section for cutting tissue without deformation. The cutting section can be deflected from an idle position for cutting purposes which brings it into contact with the tissue.

Abstract: An apparatus for use with a clamp including a base member configured to be secured to the clamp and at least one energy transmission device carried by the base member. An apparatus for use with a clamp and a probe that carries at least one energy transmission device including a base member configured to be secured to the clamp and an engagement device associated with the base member and configured to engage the probe. A clamp including first and second clamp members, at least one of which is malleable, and a movement apparatus that moves at least one of the first and second clamp members relative to the other. A surgical system including a clamp with first and second clamp members and a device that removably mounts at least one electrode on at least one of the first and second clamp members.

Abstract: A flail chest stabilizing device to permit transportation of injured patients that finds effective use in battlefield and emergency medical settings.

Abstract: An external fixation system includes a clamp system configured to capture a fixation element. The clamp system has a first and a second jaw and a first and a second link attached to the first and second jaws that are configured to control the motion of the jaws. The links are arranged such that, when the first and second jaws are moved to a closed position, the action of trying to open the jaws is resisted by the position of the links, and to open the jaws, the links must be actuated.

Abstract: A screw assembly and method developed for the fixation of femoral neck fractures without interruption of the growth process is disclosed. The screw assembly includes a male component that is attached to the lateral cortex and a female component that is attached at the proximal epiphysis. Anchorage of the components is achieved through screw-type fixation. The screw has a built-in feature that allows for free extension of its length as the fracture site or the slipped capital physeal plate heals and normal patient growth continues. Stable fixation and rotational stability are created at the fracture (slip) site while avoiding compression forces, thus avoiding premature closure of the physeal plate.

Abstract: A bone nail has a shaft with a leading section and a trailing section, wherein the trailing section includes an end surface having at least one depressed portion and at least one elevated portion. The transition between one of the depressed portions and the adjacent elevated portion is smooth. The end surface is formed so as to transmit rotational forces as well as translational forces from a medical device to the shaft of the bone nail, when the medical device is coupled at the end surface to the trailing section of the bone nail.

Abstract: A dynamic bone plate and method of bone compression is disclosed. The dynamic bone plate comprises a first bone plate component and a second bone plate component. The first bone plate component comprises at least one hole configured for receiving bone screws for attachment to a first bone segment; and a male component. The second bone plate component comprises at least one hole configured for receiving bone screws for attachment to a second bone segment; and a female component configured for mating with the male component of the first bone plate component.

Abstract: An implant for stabilizing two separated bone portions relative to each other an implant includes a peg, a bridge assembly and a securing element. The peg and bridge assembly include at least two peg portions and a bridge portion, wherein the bridge portion is arranged between the peg portions and wherein the peg and bridge portions are rigidly connected. The peg and bridge assembly is positioned relative to the bone portions such that one peg portion extends into the bone tissue of each one of the bone portions and the bridge portion extends across the gap separating the bone portions. The securing element is anchored in the bone tissue of one of the bone portions, its proximal end extending through an opening in an assembly portion extending parallel to a bone surface or across a notch in a proximal edge of an assembly portion.

Abstract: The present invention provides a circular bone tunneling device, comprising: a hollow elongate body comprising a hollow elongate body head, said hollow elongate body head defining a rigid circular arc, comprising a surgical needle; an extendable and retractable support element, reconfigurable from an extended configuration to a retracted configuration; said support element, in said extended configuration, adapted to be located along said path formed by said rigid circular arc; said support element and said hollow elongate body head are adapted to grasp said bone from at least two points along the circumference of said bone; a stabilizing element.

Abstract: Methods and devices are provided for forming holes in bone to stimulate bone growth. In one exemplary embodiment, a surgical instrument set can include a driver having a first mating element, and a bone pick have a second mating element configured to releasably mate with the first mating element at any of a plurality of angular orientations. When releasably mated together, the driver and the bone pick can be configured to be adjustably positioned relative to one another with three degrees of freedom, e.g., pitch, yaw, and roll. The bone pick can include a piercing tip configured to form a hole in a bone, such as in microfracture. When the driver and the bone pick are releasably mated together, the driver can be configured to be struck, impacted, or otherwise manipulated to drive the piercing tip into the bone.

Abstract: The present invention features new methods, apparatuses and devices for fixing adjacent bone segments, segments of a bony structure and adjacent vertebrate of a spine. The methods, apparatuses and devices utilize a new apparatus for forming a channel in a surface of the bone or bony structure segments or adjacent vertebra or a channel submerged within the bone or bony structure segments or adjacent vertebra. In more particular embodiments such apparatuses and methods including forming an arcuate channel and which channel can receive therein a curved rod or implant member, which also preferably is arcuate, and avoids the associated problems with prior cage or straight rod and screw systems. Also featured are systems, apparatuses and methods for repairing, replacing or augmenting the nucleus and/or annulus of a disc.

Abstract: A surgical instrument for removing an implanted glenoid component from the glenoid of a patient includes a protective cannula and a flexible wire saw. The flexible wire saw is positioned in the protective cannula such that both ends of the flexible wire saw extend out of one end of the protective cannula, with a portion of the middle section of the wire saw forming a loop that extends out of the other end of the protective cannula. Surgical methods for the use of such a surgical instrument are also disclosed.

Abstract: Various exemplary methods and devices are provided for removing abnormalities from bone. In general, the methods and devices can be used to allow excess bone to be scraped from a bone surface. In an exemplary embodiment, a scraper tool is provided that includes an elongate shaft having a plurality of blades movably disposed therein. The blades can be configured to move as a unit between a retracted configuration, in which the blades can be entirely disposed within the elongate shaft, and an advanced configuration, in which at least a portion of the blades can extend distally from the elongate shaft and/or flare away from one another. A distal portion of each of the blades can have a radius of curvature corresponding to a radius of curvature of the bone to be scraped.

Abstract: A surgical instrument comprises a first member, an intermediate member and a second member. The intermediate member includes a first part and a second part. The second member includes a first arm and a second arm that extend from the first part. The arms are rotatable relative to the first part and engageable with the second part to axially translate the intermediate member for engagement with the first member to move the first member between a first orientation and a second orientation to space vertebral tissue. Systems and methods are disclosed.

Abstract: A portable assembly for treating desiccated and injured spinal discs includes a collapsible stretcher including a rectangular frame and a plurality of legs connected with the frame; a spinal stretching assembly connected with one end of the stretcher and an adjustable harness connected with the stretcher another end of the stretcher. The portable assembly operates to stretch and apply tension and decompression through the thoracic and lumbar regions of a patient lying on the stretcher. A method for treating desiccated and injured spinal discs includes the steps of administering at least one dietary supplement to the patient; administering at least one medication to the patient; hydrating the patient; positioning the patient on a stretcher in a prone position; stretching and applying tension and decompression through thoracic and lumbar regions of the patient via a spinal stretching assembly; and executing Chi breathing.

Abstract: A device for facilitating implantation of an intramedullary nail includes a coupling portion extending from a first end configured to couple to a proximal end of an intramedullary nail to a joint portion and a radiolucent handle coupled to the joint portion and extending distally therefrom along a path which, when the coupling portion is coupled to an intramedullary nail in a desired orientation, extends substantially parallel to a longitudinal axis of a proximal portion of the nail, the radiolucent part including first and second radiopaque markers positioned and oriented so that, when the nail is coupled to the coupling portion in the desired orientation, the first and second markers align with edges of the proximal portion of the nail.

Abstract: A medical device deployment assembly includes a retractable sheath and a catheter positioned inside the retractable sheath. A medical device is compressed between an outer surface of the catheter and an inner surface of the retractable sheath. A spring is positioned inside the retractable sheath, and a pusher band is positioned inside the retractable sheath between the medical device and the spring. The spring biases the medical device deployment assembly toward a deployment configuration in which a distal tip of the retractable sheath is proximal to a proximal tip of the medical device.

Abstract: A method and apparatus for the storage and retrieval of patient personal and medical information and records in the eye of an implanted or patient. Patient medical information or other personalized data in the form of indicia is imparted to an implant which is engaged into a mounted position in the eye during eye surgery or a needle insertion. The indicia may be read through the clear tissue of the eye, using an optical magnifier once implanted. Indicia is imparted to the implant using a laser or photographically or printing. Conventionally employed laser surgery equipment used for LASIK and similar surgeries can be easily adapted to both impart the indicia to the implant and form a cavity to hold the implant for subsequent viewing of the visible indicia.

Abstract: The invention relates to an aspiration catheter (1) for the extraction of thrombotic material from blood vessels, with a first (3) and a second lumen (6), wherein the first lumen (3) is distally provided with an aspiration opening (5) and the second lumen (6) of smaller cross section than the first lumen (3) and extending coaxially in the distal region (2) of the first lumen (3) being provided with a lateral (7) as well as distally located opening (8), said lateral opening (7) reaching through the wall of the catheter. Within the first lumen (3) a stabilization wire (11) is movably arranged which terminates distally of the lateral opening (7) of the second lumen (6) but proximally of the aspiration opening (5) of the first lumen (3).

Abstract: The present invention relates to a minimally invasive surgical instrument having a joint section comprising spherical components. According to one embodiment of the present invention, a minimally invasive surgical instrument comprises a shaft, a joint section connected to one end of the shaft, and an end effector which is connected to the joint section and thus is capable of articulatory movement, wherein the joint section comprises multiple spherical components and multiple joint links, and at least some of the multiple joint links move in the pitch direction or in the yaw direction in accordance with the shape of slots formed in the spherical components housed therein, enabling the end effector to move in the pitch or the yaw direction.

Abstract: A grooming apparatus including a tick remover. The tick remover may be a slot having opposing edges for engaging a tick therebetween for removal from the skin of a host. The slot may extend in a direction corresponding to the longitudinal axis of the grooming apparatus.

Abstract: Devices, systems, and methods for implanting radially expandable prostheses in the body lumens rely on tacking or anchoring the prostheses with separately introduced fasteners. The prostheses may be self-expanding or balloon expandable, and may include a single lumen or more than one lumen. After initial placement, a fastener applier system is introduced within the expanded prostheses to deploy a plurality of fasteners to at least one prosthesis end. The fasteners are usually helical fasteners which are releasably restrained on the fastener driver, and are delivered by rotation of the fastener driver. The fasteners may be applied singly, typically in circumferentially spaced-apart patterns about the interior of at least one end of the prosthesis. A lumen extension or lumens may be coupled to the prosthesis to extend the reach of the prosthesis within the implantation site. Fasteners may also be applied to the lumen extensions.

Abstract: A ligating band dispenser for attachment to an endoscope having sliding elements that are positioned on the outer surface of a support structure of the ligating band dispenser. The sliding elements may be slidably engaged to the support structure. For example, the sliding elements may slide along a groove on the outer surface of the support structure. The sliding elements are advanced forward along the groove, causing the sliding elements to impact a ligating band and push the ligating band forward until it is deployed off the dispenser.

Abstract: The present disclosure relates to a tissue repair device. The device includes a handle, a knob coupled to the handle, and a needle coupled to the handle. The needle includes a proximal end and a distal end, the distal end including a slot, wherein a first anchor is housed within the distal end and a second anchor is housed within the slot and located proximal to the first anchor. An actuator disposed within the needle and operatively coupled to the knob, wherein advancement of the knob allows for engagement of the actuator with the first anchor and subsequent advancement of the first anchor via the actuator. A method of tissue repair is also disclosed.

Abstract: A tensioning device comprises an elongate member, preferably a band, and a frame having first and second sides. The band has a first end that is attachable to the first side of the frame and a second end that is releasably securable to the second side of the frame. A movable clamping member on the frame secures the second end of the band to the second side of the frame by cinching the second end of the band between an engagement surface on the band and a mating engagement surface on the second side of the frame. A restraining member is provided for restraining the clamping member to a first position spaced from the mating locking surface on the second side of the frame, when the restraining member is in a restraining orientation. The restraining member is movable out of the restraining orientation after the band is tensioned to a predetermined level using the second end.

Abstract: The present disclosure is directed to devices for approximating body vessels and method for performing the same. In accordance with one aspect of the present disclosure, the device includes an inner member having a first expandable anchor operatively coupled near a distal end thereof, an outer member having a second expandable anchor, and a sleeve disposed about at least a portion of the inner member and the outer member.

Abstract: The present disclosure is directed to devices for approximating body vessels and method for performing the same. In accordance with one aspect of the present disclosure, the device includes an inner member having a first expandable anchor operatively coupled near a distal end thereof, an outer member having a second expandable anchor, and a sleeve disposed about at least a portion of the inner member and the outer member.

Abstract: A catheter having a distal balloon and a deformable guidewire shaft of the catheter. The deformable guidewire shaft is adjacent to and external to the balloon. Inflation of the balloon bends the deformable guidewire shaft in order to orient or deflect a distal tip of the deformable guidewire shaft in a desired direction to guide and direct a guidewire extending through the deformable guidewire shaft towards a specific endovascular region. For example, it may be desired to orient the distal tip of the guidewire shaft towards a target vessel of a bifurcation or the balloon catheter may be used to bypass a Chronic Total Occlusion (CTO).

Abstract: A catheter having a distal balloon and a deformable guidewire shaft of the catheter. The deformable guidewire shaft is adjacent to and external to the balloon. Inflation of the balloon bends the deformable guidewire shaft in order to orient or deflect a distal tip of the deformable guidewire shaft in a desired direction to guide and direct a guidewire extending through the deformable guidewire shaft towards a specific endovascular region. For example, it may be desired to orient the distal tip of the guidewire shaft towards a target vessel of a bifurcation or the balloon catheter may be used to bypass a Chronic Total Occlusion (CTO).

Abstract: A thrombus removal apparatus (10) includes a catheter (12) having at its distal end (14) a solenoid coil section (16) within which there is disposed a piercing element (20) made of electromagnetic material. Within the solenoid coil section (16) there is provided a solenoid coil (26) which can be powered to generate an electromagnetic field which causes the piercing element (20) to reciprocate into and out of the coil section (16), in practice to pierce into and fragment a thrombus disposed in a patient's vessel. An aspiration unit may be provided for aspirating thrombus fragments into the assembly (10) for removal from the patient's vasculature. The apparatus (10) is able to remove dense thrombus material from within a patient, which cannot be otherwise removed by means of thrombolytic agents.

Abstract: A catheter assembly includes an inner mandrel and an outer sheath slidably coupled along the inner mandrel. The catheter assembly includes a scrubbing assembly coupled between the inner mandrel and the outer sheath. The scrubbing assembly includes a plurality of deformable struts deflectable according to movement of the inner mandrel relative to the outer sheath. The scrubbing assembly includes a proximal shoulder coupled with the outer sheath, and a distal shoulder coupled with the inner mandrel. The plurality of struts extend between the proximal and distal shoulders. The scrubbing assembly is movable between a stored configuration and a deployed configuration according to movement of the inner mandrel relative to the outer sheath. In the stored configuration the proximal and distal shoulders are remote from each other. In the deployed configuration the proximal shoulder is engaged with the distal shoulder, and the deformable struts are deflected into bristles.

Abstract: A valvuloplasty system comprises a balloon adapted to be placed adjacent leaflets of a valve. The balloon is inflatable with a liquid. The system further includes a shock wave generator within the balloon that produces shock waves that propagate through the liquid for impinging upon the valve. The shock wave generator is moveable within the balloon to vary shock wave impingement on the valve.

Abstract: An instrument for removing debris from an eye during the treatment of an ocular disorder has a swab and a rigid member. The swab includes a tip portion sized to provide access to the debris on an eyelid of the eye. The rigid member has a distal end portion affixed to the swab and a proximal end portion with a cross-sectional member profile. The cross-sectional member profile is non-circular and has a first groove. The first groove extends longitudinally along the proximal end portion for cooperating with a chuck such that rotation of the proximal end portion within the chuck is inhibited.

Abstract: Full-thickness excision of tissue of a lesion in a lumen is performed through a natural orifice. Specifically, the tissue surrounding the lesion that is in a folded state is joined and severed using a linear stapler. The linear stapler includes a cutter and is inserted into the lumen. Joining and cutting is performed while organs outside of the lumen are pushed in a direction away from the lesion with the tip of the linear stapler. As a result of these steps being repeatedly performed along the periphery of the lesion, the lesion is excised.

Abstract: Ultrasound catheter devices and methods provide enhanced disruption of blood vessel obstructions. Generally, an ultrasound catheter includes an elongate flexible catheter body with one or more lumens. An ultrasound transmission member or wire extends longitudinally through the catheter body lumen and, in many embodiments, a guide wire tube also extends through the same lumen. A distal head is fixed to or otherwise mechanically coupled with the distal end of the ultrasound transmission member or wire and is positioned adjacent the distal end of the catheter body. Although the distal end of the catheter body overlaps the distal head, the distal head is not directly affixed to the distal end of the catheter body. Thus, the distal tip may move freely, relative to the distal end of the catheter body when ultrasonic energy is applied through the ultrasound transmission member.

Abstract: Disclosed is a blood lancet device including a shaft which is driven toward a lancet, a blood collection button for launching the shaft, a tensioning unit for tensioning the shaft, and a depth-adjusting unit for adjusting a puncturing depth of a needle of the lancet. The shaft is provided inside a body, tensioned by operation of the tensioning unit, and combined with the lancet at a front end thereof. The blood collection button is provided outside the shaft, elastically supported by an inside surface of the body, and arranged to protrude outward from an end of the body. The tensioning unit is arranged in line with the blood collection button. The depth-adjusting unit is combined with a front end of the body in a rotatable manner, has a hole provided in a center portion of a front surface thereof, and covers the lancet.

Abstract: Devices and methods for treating obesity are provided. More particularly, intragastric devices and methods of fabricating, deploying, inflating, monitoring, and retrieving the same are provided.

Abstract: A percutaneous transluminal angioplasty device includes an embolic filter mounted to the catheter shaft at a location distal to the angioplasty balloon. Thus the filter can be down-stream from the blockage and can be properly positioned to capture embolic particles that may be set loose into the blood stream as the angioplasty procedure can be performed. The embolic filter can be normally un-deployed against the catheter shaft to facilitate introduction and withdrawal of the device to and from the operative site. Once the angioplasty balloon can be properly positioned, however, means operatively associated with the embolic filter can be actuated to erect the filter to position a filter mesh across the lumen of the vessel.

Abstract: A process for forming a catheter balloon includes subjecting a tubular parison in a mold to molding fluid pressure. The resulting catheter balloon includes a balloon portion having two ends and tubular leg portions extending from either end. The ends of the balloon portion are tapered to the tubular leg portions. While in the mold, the tubular leg portions are drawn axially sufficiently to form permanent creases in the tapered ends. This drawing may be sufficient to cause the material of the tapered ends to exceed the yield strength, particularly with the balloon material in a malleable state. Anomalies on tapered parts of the mold may include ribs or spiral ribs to assist in the creasing process.

Abstract: The present disclosure concerns embodiments of an expandable and collapsible embolic deflector that can be collapsed to a very small profile for insertion through a patient's vasculature and then expanded once inside the body. The embolic deflector comprises a flexible, inflatable frame that supports a blood-permeable membrane that prevents emboli above a predetermined size from entering vasculature that is blocked by the membrane. The frame comprises an inflatable body made of a soft polymeric material, such as urethane, Pebax, or nylon, similar to a balloon of a balloon catheter. In particular embodiments, the frame does not include any metal components. In certain embodiments, the frame can include one or more radiopaque markers, which can be made of a metal or metal alloy. In either case, the risk of potential trauma to the patient can be reduced since the amount of hard metal components is significantly reduced or completely eliminated.

Abstract: A percutaneous thrombus extraction device for removing a thrombus from within a blood vessel includes a flexible outer sheath defining a first passage between a proximal end and a distal end. An inner sheath is movably positionable within the first passage. The inner sheath defines a second passage between a proximal end and a distal end. The inner sheath is moveable in a radial direction between a collapsed configuration and an expanded configuration along a length of the inner sheath defined between the proximal end and the distal end. A catheter is movably positionable within the second passage, and has an expandable body at a distal end portion of the catheter. The expandable body is movable between a collapsed configuration and an expanded configuration.

Abstract: A device and method of treating an aneurysm in a cranial artery of a patient includes providing a coil delivery system having a bypass catheter with a proximal end portion, a distal end portion, and an intermediate portion. The bypass catheter also includes a bypass lumen extending from the proximal end portion to the distal end portion and a coil delivery lumen that extends from the proximal end portion to a coil delivery opening in a side wall of the bypass catheter. The coil delivery system also includes an embolic coil or multiple coils capable of being deployed separately through the coil delivery opening and electrolytically detached, and at least one balloon disposed about an outer surface of the bypass catheter and capable of substantially preventing blood flow around the outer surface of the bypass catheter when inflated.

Abstract: A vessel protector system includes an outer sheath, an inner tube disposed within the outer sheath and moveable in a longitudinal direction relative to the outer sheath and at least one protector coupled to the inner tube, each of the at least one protector having a body formed from a filtering material and extending between a leading end and trailing end coupled to the inner tube, the body having a collapsed configuration and an expanded configuration. A snare is coupled to the leading end of the body at one end, and having a second end passing through the interior of the outer sheath, whereby the exertion of a pulling force on the second end of the snare contracts the at least one protector.

Abstract: A vascular plug includes a plurality of cells which extend from a front face of the plug towards a distal end of the plug. The cells form at least a periphery of the plug and are in the preferred embodiment closed at their distal ends. The cells may form a central chamber to the plug or may extend across the entirety of the front face of the plug. The cells will fill with blood from the patient's vessel, to inflate the plug and create a barrier to fluid flow. Static blood within the plug will clot over time, creating enhanced occlusion. The plug can also be configured as a vascular filter.

Abstract: Apparatus, systems, and methods are described for closing the base of a left atrial appendage or other tissue structure. A tissue closure device comprises a pair of legs having compliant surfaces for engaging against opposite sides of the tissue structure. A plurality of axially spaced-apart tissue-penetrating fasteners are delivered from one leg to the other to pierce the intervening tissue and hold the closure device in place on the tissue structure.

Abstract: An apparatus for sealing a puncture through tissue to a vessel includes an elongate occlusion member including an expandable member, a cartridge carried on the occlusion member, and a sealant carried within the cartridge. The cartridge includes an outer member and a pusher member within the outer member. The sealant is disposed within the outer member adjacent the expandable member distal to the pusher member. During use, the occlusion member is introduced into a puncture until the expandable member and the sealant extend from the puncture into the vessel. The expandable member is expanded, and withdrawn until the expanded expandable member contacts the vessel wall, thereby withdrawing the sealant back into the puncture. The outer member is withdrawn to expose the sealant within the puncture, while the pusher member prevents removal of the sealant, and then the cartridge, occlusion member, and pusher member are successively removed.