Abstract: The present application relates to surgical guiding tools that may be used for guiding a surgical instrument during bone surgery. A surgical guiding tool may include a body including one or more clamps configured to attach the surgical guiding tool to one or more portions of the bone, wherein a first clamp of the one or more clamps includes a snap-fit portion including a flexible structure for increasing a clamping force of the first clamp and allowing ease of removal of the surgical guiding tool from the bone. The surgical guiding tool may further include at least one aperture for guiding a surgical instrument. The present application further provides methods for manufacturing surgical guiding tools and uses of the tools for placement onto a bone.

Abstract: A medical device may include an elongate member including a proximal end, a distal end, and a lumen extending therebetween, wherein a distal end of the lumen includes a wall disposed substantially perpendicular to a longitudinal axis of the elongate sheath, wherein the wall includes at least one opening therethrough. The medical device may also include an actuation assembly operably coupled to the proximal end, an actuating member coupled to a portion of the actuation assembly and extending into the lumen of the elongate member, and at least one loop having a first portion coupled to a distal end of the actuating member and a second portion extending through the at least one opening.

Abstract: A tissue removal tool for use with an endoscope. The tool includes a loop formed by a piece of wire. The loop is movable between an open position and a closed position. The shape of the loop is defined in the open position by a proximal portion and a distal portion. The piece of wire may have a cross-sectional height in the proximal portion unequal to a cross-sectional height in the distal portion.

Abstract: Devices for restoring blood flow to facilitate lysis of clots and/or enable capture of clots are disclosed. The devices can be configured to be disposed within a lumen of a microcatheter that is inserted within neurovasculature above a carotid siphon to a location of a clot. The devices can include an elongate pusher member and a self-expandable capturing member coupled to a distal end of the elongate pusher member. The capturing member can comprise a generally cylindrical body having an cell structure that is configured to compress the clot against an inner wall of the neurovasculature and capture the clot at least partially on a surface of the generally cylindrical body upon deployment of the capturing member from the microcatheter, thereby restoring blood flow to the neurovasculature downstream of the clot.

Abstract: In accordance with certain illustrative embodiments, methods and apparatuses of treating obstructive disorders of the structure of an eye or eyelid are disclosed. The treating may involve applying heat to the structure containing the obstructive disorder to melt an obstruction in the structure and place the obstruction in a melted state. The heat may be maintained for a time period to melt the obstruction and place the obstruction in the melted state. The structure may be treated by expressing the melted obstruction from the structure. The treating may be carried out either during the time period or after the time period when heat is applied but while the obstruction is in the melted state. In certain embodiments, the method further involves subsequently treating the structure by use of a pharmacological agent.

Abstract: A surgical instrument includes a housing supporting first and second actuators, an elongated shaft extending distally from the housing, and an end effector supported by a distal portion of the elongated shaft. A tensile member extending through the elongated shaft is coupled to the first actuator and the end effector such that first actuator may be manipulated to induce motion of the end effector. A locking mechanism associated with the tensile member selectively impedes motion of the end effector. The locking mechanism includes a collet disposed about the tensile member and a collet clamp for receiving the collet. Receipt of the collet into the collet clamp induces radial compression of the collet to impede the motion of the tensile member therethrough. An actuation member extending through the elongated shaft induces insertion and withdrawal of the collet from the collet clamp.

Abstract: Surgical forceps with a shaft at the distal end of which a jaws piece including jaws is removably mounted. The jaws piece is connected in a rotationally fixed manner to the distal end of an actuating rod running parallel to the shaft. The proximal end of the actuating rod can be coupled in a rotationally fixed and longitudinally displaceable manner to a handle arranged on the proximal end of the shaft for transferring movements executed in the longitudinal direction of the shaft. The surgical forceps are characterized in that the handle is designed in such a manner that the rotationally fixed coupling to the actuating rod disengages when the handle is actuated to open the jaws piece.

Abstract: A surgical instrument and method for freeing tissue in a nerve decompression operation. Tissue is freed from the area surrounding a nerve with use of the blunt tip on one jaw of the instrument. The freed tissue is then cut with the bladed region of the instrument and removed from the area surrounding the nerve while leaving the nerve untouched. The instrument includes a pair of pivotally connected arms. Each of the arms is elongated and has a free end and a handle end, the free end of each having a blade, the handle end of each having a finger loop for the surgeon to grasp. One of the free ends is longer than the other, with a blunt, rounded tip and edge for freeing tissue without cutting. The scissors are curved, to the right or left, to further insure against the nerve being nicked during the operation.

Abstract: The present invention provides skin grafting and devices that comprise a systematic approach to the process of skin grafting, i.e., harvesting, post-excision processing and application of donor skin and pre and post-graft treatment of the recipient site.

Abstract: A handle assembly for use in conjunction with a surgical cutting device is provided. The handle assembly can generally include two, detachable pieces or housings. The first housing can include electrical and mechanical components for driving a cutting assembly, such as a motor, while the second housing can include a fluid flow path that allows fluid to flow from the surgical site to a location outside of the cutting device. At least a portion of the fluid flow path can extend substantially adjacent to at least a portion of one or more components used to drive the cutting assembly to help manage the heat output of the components. The fluid flow path allows the fluid to exit the device without coming into contact with components like a motor, while also helping to cool the handle assembly. Systems and methods for cutting tissue are also provided.

Abstract: A steerable transseptal punch system and method of using the steerable transseptal punch system to access the left atrium.

Abstract: A battery-powered, modular surgical device comprising an electrically powered surgical instrument that requires a pre-determined minimum amount of electrical energy to complete a surgical procedure, and a power module assembly that has a battery that powers the surgical instrument and has a current state of electrical charge, and a control circuit that is electrically coupled to the battery and the surgical instrument and has a memory and a microprocessor. The microprocessor determines the current state of electrical charge of the battery, compares the current state of electrical charge to the pre-determined minimum amount of electrical energy, permits the battery to discharge if the current state of electrical charge is above the pre-determined minimum amount of electrical energy, and maintains the battery in a non-discharge state if the current state of electrical charge is below the pre-determined minimum amount of electrical energy.

Abstract: In one embodiment, a surgical instrument comprises an articulable waveguide. The articulable waveguide may be configured to transmit ultrasonic energy therealong. The articulable waveguide comprises a proximal drive section, an end effector and a first flexible. The proximal drive section is configured to couple to an ultrasonic transducer. The end effector is located at a distal portion of the articulable waveguide. The first flexible section comprises a flex bias and be positioned between the proximal drive section and the end effector. The surgical instrument further comprises a first tine extending longitudinally relative to the articulable waveguide.

Abstract: Disclosed are ultrasonic and electrosurgical devices. The disclosed embodiments include a surgical instrument comprising an end effector and a cooling system. The end effector may comprise an ultrasonic blade and a clamp arm, wherein the clamp arm may comprises a movable jaw member. The cooling system may be in fluid communication with the ultrasonic blade.

Abstract: An adjustable, disposable dermal curette is structured to allow a user-practitioner to ergonomically grip a handle and manipulate an adjustable slider with a digit of their hand in order to change the diameter size of the flexible blade formed in an adjustable loop to the useful range of diameter sizes required. The user-practitioner can lock and unlock the slider in place quickly without the need to interrupt their procedure. The adjustable curette solves the problem of requiring multiple curette loop sizes for a procedure and results in improved quality of care and a savings of time and healthcare dollars.

Abstract: Instruments, systems and methods are provided for performing submucosal medical procedures in a desired area of the digestive tract using endoscopy. Instruments include a safe access needle injection instrument, a submucosal tunneling instrument, a submucosal dissection instrument, a mucosal resection device. Systems include a combination of one or more of such instruments with or without injectable agents. Embodiments of various methods for performing the procedures are also provided.

Abstract: The success rate of the insertion of a dull needle into a puncture hole is improved. A puncture needle is provided which is inserted into a puncture route that is formed to cover from a skin surface to a shunt vessel surface so as to expand an incision of a puncture hole formed in the shunt vessel surface. The puncture needle has an inclined end face that is inclined toward a front end of the needle, and a front end part of the inclined end face has an edge having no sharpness. Right and left side parts of the inclined end face which are contiguous with the front end part are respectively inclined outward, and side edges of the side parts are provided with cutting lines.

Abstract: A trocar assembly for use in minimally invasive surgical procedures includes a cannula subassembly and an obturator subassembly. The obturator assembly includes an obturator shaft member defining a longitudinal axis and an obturator tip configured to be removable from the obturator shaft member or, alternatively, constructed with the obturator member as a single unit. Various designs of the obturator tip are contemplated.

Abstract: Single use inserter system comprising a housing part and a lid part, the inserter system comprising a carrier part in an initial position in the housing and a drive unit comprising a first drive part attached to the housing, the drive unit comprising at least one spring element supported by the first drive part, wherein the drive unit is configured for moving the carrier part from a first position to a second position in relation to the housing in an insertion direction along a first axis. The inserter system comprises a transcutaneous device having a proximal surface and a distal surface, wherein the transcutaneous device is detachably attached to the carrier part, the inserter system comprising at least one transport protection element preventing movement of the carrier part in a direction along the first axis thereby supporting the carrier part in the initial position.

Abstract: A spinal construct includes a guide having a first member and a second member. The first member includes an inner surface defining a guide cavity. The second member extends in a transverse orientation relative to the first member. A first fastener includes a first end and a second end. The first end defines an implant cavity and a second end is configured for penetrating tissue. A second fastener is disposable in the guide cavity such that the inner surface aligns the second fastener for penetrating tissue. Systems and methods are disclosed.

Abstract: A spinal stabilization system includes a shaped spinal rod and a plurality of bone screws. The shaped spinal rod includes a body portion, a head portion, and a neck portion connecting the body portion to the head portion. The shaped spinal rod provides coronal rigidity for a complex deformity construct, and allows for rotation of the shaped spinal rod in a medial and lateral direction to facilitate insertion into the screw head. The bone screws include a housing portion and a screw shaft distally extending from the housing portion. The housing portion includes an inner housing and an outer housing slidably surrounding at least a portion of the inner housing. The inner housing defines a slot configured and dimensioned to releasably secure the body portion of the shaped spinal rod therein. The outer housing is movable relative to the inner housing between an unlock state and a locked state.

Abstract: A growing rod for mounting between attachment mechanisms that are secured to anatomical structures of a patient having scoliosis. The growing rod includes an outer housing and an inner housing disposed within the outer housing. The inner housing includes a magnet assembly including a magnet having a first pole and a second pole and a gear reduction mechanism coupled to the magnet. A first rod is secured to the inner housing and a second rod is secured to the outer housing. The gear reduction mechanism reduces an output rotation of the magnet to rotate a driver that operates to move the inner housing along a longitudinal axis with respect to the outer housing.

Abstract: A bone fastener assembly for connecting a bone to a stabilizing construct includes a connecting member, a fastener seat, and a bone fastener. The connecting member includes a connecting member axis, a first opening, a second opening, and a first spherical surface. The connecting member axis extends from a proximal end to a distal end. The first opening is adjacent the proximal end. The second opening is adjacent the distal end. The fastener seat includes a first end, a second end, a passageway, and a second spherical surface. The passageway extends from the first end to the second end along a seat axis. The second spherical surface is configured to slidably engage the first spherical surface. The bone fastener includes a shank and a head. The shank extends though the passageway. The head engages a head-mating surface of the fastener seat.

Abstract: A surgical implant comprising a screw element having a screw head, a first thread having a first thread pitch, a second thread having a second thread pitch and an intermediate portion coupling the first and second thread pitches with the first and second thread pitches being different. The implant has a buttressing head associated with the first thread, and it is dimensioned to be larger than a diameter of the first threads to provide external buttressing as the first and second threads compress a first bone and a second bone together.

Abstract: A rod insertion device for inserting a rod into a bone anchor includes a shaft having a first end, a second end, and a shaft axis; a rod holding member connected to the first end of the shaft and configured to pivot relative to the shaft about a pivot axis and to receive a portion of a rod therein, the rod holding member comprising at least two recesses in an outer surface of the rod holding member and separated from each other along a circumferential direction about the pivot axis; a handle at the second end of the shaft; a locking member configured to lock an inserted rod in the rod holding member; and a detent member configured to selectively engage the rod holding member to latch a pivot position of the rod holding member relative to the shaft.

Abstract: System, including methods, devices, and kits, for hip fixation. The system may include a fixation element configured to be placed obliquely into a proximal femur and anchored in a head of the proximal femur. The system also may include a plate member including (a) a mounting portion configured to be placed on and attached to a lateral cortex of the proximal femur and (b) a barrel portion configured to be placed into a lateral region of the proximal femur and positioned around a portion of the fixation element. The system further may include a compliant member positioned or positionable at least partially in the plate member and configured to be reversibly deformed in response to a load applied to the head of the proximal femur, to change an angular orientation of the fixation element with respect to the plate member.

Abstract: System, including methods, devices, and kits, for hip fixation. The system may comprise an intramedullary nail configured to be placed longitudinally into a proximal femur. The system also may comprise a fixation element configured to be placed transversely through the nail, such that the fixation element is slideable along its long axis in the nail and extends out of the nail to a head of the proximal femur and is anchored in the head. A compliant member may be located in the nail and configured to deform reversibly in response to a load applied to the head of the proximal femur after placement of the fixation element, to reversibly change an angular orientation of the fixation element with respect to the nail.

Abstract: An intramedullary device, delivery system, surgical method for implanting the device, and a method of assembling the device are disclosed. The intramedullary device includes a nail with a first segment proximate a distal end, a second segment proximate a proximal end, and a delivery segment connecting the first and second segments. The delivery system including a nail and a dispersion device. The nail including at least one first segment, at least one second segment, and a delivery system between the at least one first and second segments. The dispersion device configured to slidingly engage the nail. The surgical method may include inserting an intramedullary device into a canal within a bone and dispensing a biomedical material to the bone. The method of assembling an intramedullary device may include selecting a first segment, delivery segment, and second segment and securing the delivery segment between the first segment and second segment.

Abstract: System, including methods, devices, and kits, for hip fixation. The system may include a support member defining an aperture and including an intramedullary nail for a proximal femur or a plate member for a proximal femur. The system also may include a fixation element having a compliant region and configured to be received in the aperture of the support member such that the fixation element extends out of the support member from the aperture and into a head of the proximal femur and is slideable with respect to the support member along a long axis defined by the fixation element. The system further may include a set of stiffening inserts each insertable into the fixation element and configured to stiffen the compliant region differently from one another.

Abstract: A method of reinforcing a femoral neck comprises creating a bore proximate to at least one of a Ward's triangle and a greater trochanter, creating at least one cavity in a cancellous bone region of the femoral neck, inserting a substantially collapsed support structure through the bore and into the at least one cavity, expanding the support structure, and allowing at least a portion of the load from the femoral neck bone to be transferred to the support structure. The support structure compresses at least a portion of the cancellous bone upon expansion. A cavity created by the expansion is adapted to receive a filler material such as, but not limited to, bone cement.

Abstract: A bone plate includes a first surface which, when the bone plate is positioned over a bone, faces the bone, and a second surface opposing the first surface, the bone plate comprising an elongate shaft portion extending along a longitudinal axis of the bone plate and including a plurality of through holes extending therethrough from the first surface to the second surface to receive a bone anchor therethrough and a head portion extending from an end of the elongate shaft portion along a length smaller than a length of the elongate shaft portion, a width of the head between lateral walls connecting edges of the first and second surface being greater than a width of the shaft distance between the lateral walls, wherein the second surface includes a cavity extending between a first one of the plurality of through holes situated closest to the head portion and the head portion.

Abstract: A bone plate system is provided that permits rapid, secure stabilization of a plurality of bones, such as portions of a cut rib. The bone plate system includes a bone plate having anchor devices for securing the bone plate to, for example, cortical bone of the cut rib portions. The anchor devices have an open configuration that permits the anchor devices to be connected to the cortical bone of the cut rib portions and a clamping configuration that fixes the bone plate to the cortical bone of the cut portions. The bone plate connects the cut rib portions and stabilizes the cut rib portions against relative movement therebetween.

Abstract: The invention proposes a tensioning element (1) for fixing the fracture ends of the bones in a bone fracture with a contoured body which is hollow when viewed from above and comprises a circumferential wall (6). The contoured body comprises two face sided receiving sections (a, 8b) lying opposite to each other, for receiving fastening means that can be pushed through the contoured body, and two lateral flanks with angled sections (10). The circumferential wall (6) of the contoured body is, at least in sections, in the region of the face side receiving sections (8a, 8b) and the lateral angled sections (10) resiliently deformable. Further, a defined elastic behavior of the tensioning element (1) is impressed via the angled sections (10) in such a way that a predetermined tension can be generated between the receiving sections (a, 8b).

Abstract: A bone screw and method of producing the same is described. The method of producing a bone screw includes forming a one-piece headless screw body out of a rigid metallic foam that is entirely porous throughout and defines a plurality of inter-connected pores having a size of about 30 to about 500 microns in diameter. The method includes providing at least one thread on an external surface of the screw body, and forming a bore extending through an entire axial length of the screw body, the bore forming a cannula that defines an annular radial wall thickness of the screw body. The method further includes disposing the inter-connected pores throughout the radial wall thickness of the screw body such as to allow for bone in-growth through the full radial wall thickness and into the cannula.

Abstract: Systems, apparatuses and methods for bone fusion are disclosed. In particular, a fixation screw assembly is provided that comprises a bone engagement portion including a shaft and a head member. The assembly also includes a flexible washer member that can be operably attached and secured around the head member of the bone engagement portion. The washer member is polyaxial relative to the bone engagement portion, such that it can assume a variety of angles. The washer member can help prevent back out of the bone engagement portion when the bone engagement portion is implanted into a bone member. The design of the fixation screw assembly can be used in different fusion procedures, including fusion of the sacroiliac joint.

Abstract: Devices for introducing materials into the body include collapsible material-filled tubes with pressure members, movable along the tubes. When the pressure members are advanced toward the tube opening, the tube collapses causing material to be emitted from the tube to the desired location or surgical site in the body.

Abstract: A method and device for improving the placement of a second guide wire in relation to a first guide wire. A body having a first guide wire channel extends from a proximal end to a distal end. The distal end includes a needle-like tip arranged to receive a first guide wire from the first guide wire channel. The body further includes at least one parallel guide wire conduit in close proximity and substantially parallel to the channel. An elongated slot, with a wide opening on the distal end, narrows at the proximal end with a terminus exiting the body in close proximity to the needle-like tip. A second guide wire can be selectively inserted in either the at least one parallel conduit or in the slot to arrange the second guide wire in close and parallel proximity to, or in close and intersecting the trajectory of, the first guide wire.

Abstract: Various embodiments of a device for tensioning an apparatus for fusion, stabilization, and/or fixation of bones are disclosed. In one embodiment, a device for tensioning an orthopedic device is provided, the device comprising: a screw drive; a screw gear; a body portion comprising a first cam lever and a second cam lever; and a cable operatively connected to the orthopedic device and operatively connected to the body portion; wherein rotation of the screw gear causes translation of the screw drive.

Abstract: A catheter adapted for use in the pericardial sac to sense temperature of an ablation site and surrounding heart tissue within one of the heart's ventricles or atria via proximity with the epicardium in the pericardial sac, includes a catheter body and a temperature sensing array adapted for placement on and contact with the epicardium. The temperature sensing array may comprise a 2-D body, with a surface adapted to contact an area on the epicardial tissue or in pericardial space. The array may also comprise at least one finger member, each having at least one temperature sensing location. The array may further comprise an elongated body having a generally circular configuration, a distal portion of which is movable to a spirally inward position.

Abstract: A cryoablation method, system, and device that allows for real-time and accurate assessment and monitoring of PV occlusion and lesion formation without the need for expensive imaging systems and without patient exposure to radiation. The system includes a cryoballoon catheter with a cryoballoon, a distal electrode, a proximal electrode, and a temperature sensor. Impedance measurements recorded by the electrodes may be used to predict ice formation, quality of pulmonary vein occlusion, and lesion formation.

Abstract: An ultrasonic medical device includes a first ultrasonic transmitter, emitting a first ultrasonic with frequency f1, and a second ultrasonic transmitter, emitting a second ultrasonic with frequency f2. The pathways of these ultrasonics overlap at least a portion of each other in one medical treatment area, forming a first composite ultrasonic with frequency f3 in the medical treatment area. Both f1 and f2 are larger than f3. The composite ultrasonic can be used in medical treatment.

Abstract: A vapor delivery system and method is provided that is adapted for treating prostate tissue. The vapor delivery system includes a vapor delivery needle configured to deliver condensable vapor energy to tissue. In one method, the vapor delivery system is advanced transurethrally into the patient to access the prostate tissue. The vapor delivery system is properly positioned by measuring and advancing the system based on a field-of-view of an endoscope or camera disposed within the system.

Abstract: The current invention concerns systems, devices and methods for the ablation of a vessel's wall from the inside, more specifically to implant devices and to the ablation of the wall of one or more renal arteries from the inside, preferably transmural ablation. Hereby, one or more implant devices can be implanted in the vessels and can subsequently be heated by external energy-providing means.

Abstract: A cartridge assembly to couple an electrosurgical device to treat tissue with an electro surgical unit includes a cartridge member to operate with a power delivery apparatus of the electro surgical unit and a fluid delivery apparatus of the electro surgical unit. An electrosurgical unit includes a power delivery apparatus and a fluid delivery apparatus arranged to operate with a cartridge member to be located in a cartridge receptacle of the electrosurgical unit. An electrosurgical device includes a first electrode spaced alongside the second electrode, with each electrode having a blade shaped member. Each blade shaped member has opposing sides bounded by edges, with the edges having a medial edge and a lateral edge. At least one fluid outlet is adjacent each blade shaped member, and each fluid outlet is in fluid communication with a fluid passage.

Abstract: Aspects of the invention include minimally invasive tissue modification systems. Embodiments of the systems include a minimally invasive access device having a proximal end, a distal end and an internal passageway. Positioned among the distal ends of the devices are a visualization element and an illumination element. Also provided are methods of using the systems in tissue modification applications, as well as kits for practicing the methods of the invention. Internal tissue visualization devices having RF-shielded visualization sensor modules are also provided. Minimally invasive RF tissue modulation devices are provided. In some aspects, the devices include a hand-held control unit and an elongated member. In some aspects, RF tissue modulation devices are provided and include an adapter that operably couples to a hand-held medical device. The adapter generates RF energy for delivery to a plasma generator on an elongated member.

Abstract: The invention provides a system and method for percutaneous energy delivery in an effective manner using one or more probes. Additional variations of the system include an array of probes configured to minimize the energy required to produce the desired effect.

Abstract: Regions of tissue having reduced electrical propagation are created in a bladder to affect its electrical or mechanical properties. To create these tissue regions, a tubular device is advanced through the urethra leading to the interior of the bladder, a distal expandable structure of the device is expanded to contact the inner wall of the bladder, and electrodes or other active energy delivery elements of the device are activated to deliver ablation energy. The electrodes or other active energy delivery elements are disposed over the expandable structure which is shaped to conform to the interior of the bladder. The inner wall of the organ is ablated in a predetermined pattern. The same or other electrodes disposed over the expandable structure can used to electrically map the bladder. This map of electrical activity can be used to create the predetermined pattern.

Abstract: A hand-held instrument is provided for smoke evacuation at a tissue site. The instrument may include a housing sized for hand-held use and defining at least a portion of an internal volume of the instrument. An inlet port and an outlet port are provided for gas passage in to and out of the internal volume, wherein an impeller is disposed within the internal volume between the inlet port and the outlet port. In some embodiments, an on-board motor may be disposed within the internal volume to rotate the impeller and induce gas flow in to the inlet port and out of the outlet port. A filter may be located at the outlet port for filtering gas flowing out of the outlet port. In some embodiments, an energy emission component (e.g., an electrosurgical electrode) may be integrated into the hand-held instrument. Additionally, some embodiments may include one or a plurality of light emitters for emitting light in a direction distal to a distal end of the hand-held instrument.

Abstract: Regions of tissue having reduced electrical propagation are created in a bladder to affect its electrical or mechanical properties. To create these tissue regions, a tubular device is advanced through the urethra leading to the interior of the bladder, a distal expandable structure of the device is expanded to contact the inner wall of the bladder, and electrodes or other active energy delivery elements of the device are activated to deliver ablation energy. The electrodes or other active energy delivery elements are disposed over the expandable structure which is shaped to conform to the interior of the bladder. The inner wall of the organ is ablated in a predetermined pattern. The same or other electrodes disposed over the expandable structure can used to electrically map the bladder. This map of electrical activity can be used to create the predetermined pattern.

Abstract: A bipolar electrosurgical device may include an active wire with an active exposed portion configured to contact tissue at a treatment site. The active wire may be movably disposed in an active wire lumen of an elongate tubular member, except at a distal portion where the active exposed portion may be disposed outside of the tubular member. At the distal portion, a recess may extend in a body of the tubular member, where a return electrode may be disposed. The return electrode may be an exposed portion of a return path configured to contact tissue at the treatment site.