Abstract: Implant devices and cutting clamp apparatuses and methods for creating the implants for insertion into a patient's joint to restore anatomic length and assist in final positioning of the bones following removal of cartilage and/or bone in preparation for fusion. A first implant is a biplanar implant having a shape to mimic the normal anatomical shape of the bones the implant is configured to mate with. The first implant may be cut using a cutting clamp and jig having the anatomical shape of the bones the implant will be inserted within or between. A second implant is a cylindrical piece of bone having a convex end and a concave end for mating with bones reamed to have the opposite mating surfaces. The second implant is created using cup and cone reamers having dimensions corresponding to the size of the patient's bones. Surgical methods for inserting the implants within a patient.

Abstract: Apparatus for drilling a hole in material, the apparatus comprising: an angled drill guide comprising a curved distal section, a less-curved proximal section, and a lumen extending therebetween, wherein the less-curved proximal section comprises a flat extending therealong for reducing the effective diameter of the less-curved proximal section so as to minimize interference between the angled drill guide and the side wall of an access cannula.

Abstract: A three-dimensional (3-D) orthopedic drill guide device for accommodating a bone drill during an orthopedic surgery is disclosed. By establishing two specific angles in relation to the bone fascia, the device acts as a guide for bone drilling locations. In one specific instance, it is an optimal 3-D drill guide for the direction and Gamma angle (resulting from the devices Alpha and Beta angles of the device) of a drill hole in a femoral bone when used to replace an injured anterior cruciate ligament (ACL).

Abstract: A femoral sizing jig for use in total arthroplasty of left and right knees, comprises a femoral body, an external-rotation-angle arm which is, preferably pivotable, relative to the femoral body for setting an external angular rotation of a left or right femur, at least one of a cutting-jig guide and a cutting jig which is, preferably slidable, relative to the femoral body and in unison with movement of the external rotation-angle arm, and a medial posterior-condylar locator which is movable in unison with the movement of the external-rotation-angle arm, so as to maintain a fixed or substantially fixed relative distance with a medial side of the at least one of a cutting-jig guide and a cutting jig. A posterior-referencing femur resecting system using said femoral sizing jig and a method of resecting a femur at a knee joint relative to the medial posterior condyle are also provided.

Abstract: A medical instrument has a shaft with a longitudinal axis, a jaw head on a distal end of the shaft having two jaw parts, at least one of the jaw parts being pivotable about a pivot axis extending transversely to the longitudinal axis, the pivotable jaw part having a wheel portion with toothing mounted about the pivot axis, at least one actuation element having a distal end portion with toothing that meshes with the toothing of the wheel portion such that movement of the actuation element along the longitudinal axis pivots the pivotable jaw part, control elements at a proximal end of the shaft controlling movement of the actuation element, said distal end portion with toothing is flexible, one of the jaws having a hollow space arranged distally to the pivot axis, wherein the distal end portion comes in or out of the hollow space when moving the actuation element.

Abstract: Navigation and tissue capture systems and methods for navigation to and/or capture of selected tissue using the innate electrical activity of the selected tissue and/or other tissue are described. In the context of left atrial appendage closure, the systems and methods can be used to navigate to the left atrial appendage and capture/control the appendage while a closure instrument (suture, clip, ring) is placed over the appendage and tightened down or a closure method (ablation, cryogenic procedures, stapling, etc.) is performed to close the left atrial appendage. The use of innate electrical activity for navigating devices may be used in connection with other tissues and/or areas of the body.

Abstract: Systems and methods for aligning directionally operable medical devices with and upon target tissue. Systems and methods for aligning medical devices such as directional ablation catheters to and upon target tissue by monitoring irrigant backpressure. The current disclosure provides solutions to the problem of rotationally or angularly aligning a directional medical device toward tissue.

Abstract: An ultrasonic instrument comprises an ultrasonic transducer, an acoustic waveguide, and an ultrasonic blade. The blade includes a pair of obliquely extending edges. The obliquely extending edges diverge away from the longitudinal axis of the waveguide and away from each other along respective paths extending distally in relation to the waveguide. A distal portion of the blade is wider than a proximal portion of the blade along a plane. The blade further includes a curved distal edge and several laterally presented surfaces. The laterally presented surfaces may provide combinations of concave and convex curvatures. The laterally presented surfaces may be angled and/or curved along one or more orthogonal planes associated with the longitudinal axis of the waveguide.

Abstract: In one general aspect, various embodiments are directed to an ultrasonic surgical instrument that has a cutting blade coupled to a motor and an ultrasonic blade coupled to an ultrasonic transducer. In some embodiments, the cutting blade includes a longitudinally extending lumen and the ultrasonic blade is disposed within the longitudinally extending lumen of the cutting blade. In other embodiments, the ultrasonic blade includes a longitudinally extending lumen and the cutting blade is disposed within the longitudinally extending lumen of the ultrasonic blade. In yet other embodiments, the ultrasonic blade is substantially parallel to the cutting blade.

Abstract: A surgical instrument including a trigger configured to be actuated by a proximally directed force and by a distally directed force. The trigger may include a proximal trigger portion having a first length and a distal trigger hook comprising a distal portion having a second length. The second length may be less than the first length. The distal trigger hook may be coupled to the proximal trigger portion.

Abstract: An ultrasonic treatment apparatus includes a movement unit moving in accordance with at least one of an acting state of a load to a treatment section from a jaw and an opening angle of the jaw relative to the treatment section, a movement detector detecting a moving state of the movement unit, and a peak detecting section detecting a target peak of an ultrasonic impedance value. The ultrasonic treatment apparatus includes a control section controlling the peak detecting section to a detection disallowed state where a detection of the target peak is not executed when the movement unit is not placed within a prescribed range based on a detection result in the movement detector.

Abstract: A fluid stream is directed toward tissue to generate a plurality of shedding clouds. The fluid stream can be scanned such that the plurality of shedding clouds arrive a different overlapping locations. Each of the plurality of shedding clouds can remove a portion of the tissue. In many embodiments, an apparatus to ablate tissue comprises a source of pressurized fluid, and a nozzle coupled to the source of pressurized fluid to release a fluid stream, in which the fluid stream generates a plurality of shedding clouds.

Abstract: An implant for creating incisions in the tissues surrounding the bladder neck and the urethra of a patient, for relaxing the opening of the bladder, the implant includes a central connector and at least one wire, the wires extend radially outwardly from the center of the central connector, the wires apply continuous pressure on the surrounding tissues, the wires are foldable within an implant sheath for enabling delivery and extraction thereof, the implant is implanted within a restricted location of the urethra for a period of time for creating incisions at the locations where the wires apply pressure on the surrounding tissues.

Abstract: A stent retriever assembly having a proximal end and a distal end, and including a mesh tube having a distal and proximal end, and being connected to a first wire. Also, a blood-porous fragment guard is at the distal end of the mesh tube, the fragment guard including spokes joined at a central hub and extending radially and proximally from the central hub, and wherein a second wire is connected to the central hub so that when the second wire is pulled proximally relative to the first wire, the hub is pulled proximally, causing the spokes to spread out and causing the fragment guard to widen.

Abstract: A rotational atherectomy system may include a drive shaft, a motor, and a clutch with a threshold torque where the clutch may include a motor plate rotationally connected to the motor, a drive shaft plate rotationally connected to the drive shaft, and a biasing clutch configured to rotationally engage the motor plate and the drive shaft plate, wherein torques less than the threshold torque are transmitted completely between the motor plate and the drive shaft plate, which remain rotationally coupled by static friction, and wherein torques greater than the threshold torque cause the motor plate and the drive shaft plate to rotate relative to one another and cause a residual torque to be transmitted between the motor and the drive shaft, the residual torque being less than the threshold torque and being determined by a kinetic coefficient of friction.

Abstract: The invention generally relates to methods for manufacturing components for use in a device for generating substantially planar micrografts. The methods of the invention provide for the manufacture of substantially uniform components for a cutter contained within the device, the cutter configured to cut a blister in order to produce a substantially planar graft.

Abstract: Provided is an automatic hair transplanter for transplanting follicles including a housing having a space therein and having an aperture in a front surface, a cartridge installed behind the aperture and having a plurality of holes containing each of needle and rod assemblies, a cartridge driver configured to sequentially cause centers of the needle and rod assemblies to correspond to the center of the aperture by causing the cartridge to make a rectilinear motion or a rotary motion, a needle-and-rod assembly pressurizer configured to pressurize the back end of a needle and rod assembly whose center corresponds to the center of the aperture, and a manipulator having a switch for controlling operations of the cartridge mover and the needle-and-rod assembly pressurizer.

Abstract: A medical device for ablating tissue within a body cavity includes a sheath having a lumen extending therethrough from a proximal end to a distal end and a first channel extending within the lumen, an end-effector extending from a proximal end to a distal end and including an expandable member having a plurality of arms extending between the proximal end and the distal end. The arms are configured to transition between a collapsed state and an expanded state and a mechanism for transporting a fluid through one of the channels to the body cavity to ablate the tissue.

Abstract: A method for easing child birth and, more particularly, to a device for practicing the method for easing child birth and, most particularly, to a device for easing child birth controlled by the individual giving birth to the child. The device mechanically replaces a “manual” contact, which can be applied to the pelvis of a woman in labor, for the purpose of aiding the expulsion of the baby, and reduce the pain and discomfort associated with this process. The device mechanically compresses the ilium portion of the pelvis medially and posteriorly, simultaneously. The pressure applied by the device is under full control of the patient, so that pressure is applied slowly and progressively to a point of maximum comfort. The pressure is decreased immediately upon demand by the patient. The duration of the application of compression corresponds with the length of the contraction period for the woman.

Abstract: An assembly for use in an external fixator, structured to adjustably interconnect at least one or a plurality of bone fixation rods to a pin clamp comprising a base structurally adapted for movable, adjustable interconnection between the pin clamp and the one or more rod clamps. An elongate support shaft is movable with the base and movably connected thereto and at least one or alternatively a plurality of rod clamps are mounted on the support shaft. Each of the plurality of one or more rod clamps is structurally adapted to secure a different fixation rod to the support shaft. The one or more rod clamps are movably connected and adjustably positioned on the support shaft in adjacent relation to one another. The base, the support shaft and one or more rod clamps are movably interconnected relative to one another to define a substantially universal disposition of said plurality of rod clamps relative to the pin clamp.

Abstract: An apparatus (10) includes a fastener (16) engageable with a bone portion to connect a longitudinal member (12) to the bone portion. A housing (40) has a first passage (42) configured to receive the longitudinal member (12) and a second passage (44) extending transverse to the first passage. The fastener (16) extends through an opening (50) in the housing (40) into the second passage (44). A longitudinal axis (18) of the fastener (16) is positionable in any one of a plurality of angular positions relative to a longitudinal axis (46) of the second passage (44). A spacer (60) received in the second passage (44) of the housing (40) is engageable with the fastener (16) and the longitudinal member (12). A member (70) applies a force to prevent relative movement between the fastener (16) and the housing (40) and permit manual movement of the fastener (16) relative to the housing (40) against the force when the longitudinal member (12) is disengaged from the spacer (60).

Abstract: A spinal distraction system includes a distraction rod having a first end and a second end, the first end being configured for affixation to a subject's spine at a first location, the distraction rod having a second end containing a recess having a threaded portion disposed therein. The system further includes an adjustable portion configured for affixation relative to the subject's spine at a second location remote from the first location, the adjustable portion comprising a housing containing a magnetic assembly, the magnetic assembly affixed at one end thereof to a lead screw, the lead screw operatively coupled to the threaded portion. A locking pin may secure the lead screw to the magnetic assembly. An o-ring gland disposed on the end of the housing may form a dynamic seal with the distraction rod.

Abstract: A pedicle screw system and/or a spinal stabilization system includes a pedicle screw having a screw shaft with an external thread and having a screw head supported on the screw shaft in a ball-and-socket joint relationship therewith. The screw head includes a connecting element receptacle for a connecting element of a spinal stabilization system. The pedicle screw system further includes a bone alignment device and a coupling device for at least one of force-locking coupling and form-locking coupling of the bone alignment device and the screw shaft when in an alignment position.

Abstract: A coupling assembly for coupling a rod to a bone anchoring element is provided, wherein the coupling assembly includes a receiving part having a first end, a second end, a central axis extending through the first end and second end, an accommodation space for accommodating a head of an anchoring element, a bore extending from the accommodation space to the first end, and a recess for receiving a rod. The accommodation space has an opening at the second end sized to permit insertion of a head of the bone anchoring element. The coupling assembly further includes a retainer element configured to be positioned at least partially in the accommodation space and being radially expandable and/or compressible to allow retaining a head inserted through the opening. The retainer element is held in position adjacent the opening by an engagement structure provided at or in the accommodation space.

Abstract: A system for correcting a spinal deformity includes an implant fixed to one side of a vertebra and a rod extending along an axis of the spine on a second side of the vertebra. An adjustment member, which may include a reel, is coupled to the rod. A force directing member, such as a cable, extends between the rod and the adjustment member. The force directing member is retractable toward and extendible from the adjustment member. A method of correcting spinal deformity includes providing an implant, a rod, an adjustment member coupled to the rod, and a force directing member extending between the rod and the adjustment member. The adjustment member can be retractable toward and extendible from the adjustment member.

Abstract: A polyaxial bone anchor has a locking element shaped and configured to allow an anchoring member (e.g., a screw or hook) to polyaxially rotate at large angles about a central axis of the bone anchor before compression locking the anchoring member within an anchor head.

Abstract: A spinal construct comprising a first portion. A second portion defines a longitudinal axis and is configured to penetrate tissue. A tether is fastened with the first portion such that a spinal implant connected with the tether is movable to a plurality of orientations relative to the longitudinal axis. Systems and methods are disclosed.

Abstract: A spinal construct comprises a fastener attached with sacral and/or pelvic tissue of a body. A connector is selectively movable in a coronal plane relative to the body. The connector has a first end connected with the fastener and a second end having a locking surface engageable with an implant. A lock element is engageable with the connector and defines an implant cavity. Systems and methods are disclosed.

Abstract: Embodiments disclosed herein provide a method of placing a vertebral fixing system on a vertebra. The vertebral fixing system comprises a connecting part with members forming a space into which a rod may be inserted. The members are moveable relative to each other. A portion of a ligature may be passed through the connecting part to form a loop extending from the connecting part. When the rod is inserted in the space between the members, the ligature may be tensioned against the rod. The members of the connecting part may be driven together to hold the ligature in place. An adjustable locking means may be utilized to fix simultaneously in position the connecting part relative to the rod and at least one portion of the ligature relative to the connecting part, so as to prevent relative displacement of the rod and the vertebra in opposite directions.

Abstract: A method is provided for correcting a curvature or deformity in a patient's spine based on the digitized locations of implanted screws and tracking the placement of the rod as it is placed in a minimally invasive fashion. The method is implemented by a control unit through a GUI to digitize screw locations, accept one or more correction outputs, and generate one or more rod solution outputs shaped to fit at locations distinct from the implanted screw locations.

Abstract: A locking tack for attaching a bone fixation device to a bone includes (a) an elongated body including a distal portion formed of a weldable material and sized to be received within a bore through a portion of a target bone and a proximal portion which, when the distal portion is in a desired position within a target bone, extends out of the bone; (b) a channel extending longitudinally through the elongated body from a proximal end thereof to a channel distal end within the distal portion of the elongated body; and (c) an engaging feature at a distal end of the channel configured to engage an extraction mechanism so that forces applied to the extraction mechanism are transmitted to the distal end of the elongated body.

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: The present disclosure relates, in some embodiments, to locking mechanisms for a fastener (e.g., a bone screw) and associated devices, systems, and methods. According to some embodiments, a lockable bone plate assembly may comprise, for example, a bone plate and a bone screw assembly. A bone plate may comprise, in some embodiments, at least one through hole, the at least one through hole having at least one bone plate hole circumferential recess. According to some embodiments, a bone screw assembly may comprise (a) a bone screw, (b) at least one deployable protrusion, and/or (c) a protrusion driver. The present disclosure further relates, in some embodiments, to methods for bone (e.g., vertebral) fixation. For example, a method may comprise contacting at least a portion of a spine (e.g., cervical spine) of a subject with a lockable bone plate assembly.

Abstract: The present disclosure relates to a system for the fixing of bone segments or bone fragments comprising an implant plate or an implant surface plate having a bore or a cut-out and comprising an implant screw which can be guided through the bore or cut-out of the plate, wherein the implant screw has a screw shaft and a screw head and wherein both the screw shaft and the screw head have a thread with identical pitches.

Abstract: The invention relates to methods of stabilizing bone implants, comprising inserting a self tapping implant having at least two helical grooves running in opposite directions around the implant.

Abstract: A method comprising the steps of: providing an implant support including a first portion frangibly connected to a second portion that defines an implant cavity and supports a bone fastener; connecting a surgical introducer instrument with the implant support and engaging the surgical introducer instrument with the bone fastener; percutaneously introducing the surgical introducer instrument, implant support and bone fastener assembly to a surgical site including tissue; attaching the second portion with the bone fastener to the tissue; and removing the first portion from the second portion. Systems, fasteners and instruments are disclosed.

Abstract: A method for fusing bones using a guide pin and a fastener is disclosed. The method includes inserting a guide pin into two bones. The guide pin including at least one radial marking. The method also including imaging the two bones and guide pin and analyzing the position of the at least one radial marking of the guide pin relative to the two bones. In addition, the method includes selecting a fastener, inserting a drill over the guide pin, drilling an opening through at least one of the two bones, and inserting the fastener into the opening. The guide pin may include an exterior surface with a first end and a second end, a cutting edge at the first end, and at least one radial marking near the first end. A system including a guide pin, a fastener, and a drill is also disclosed.

Abstract: Bone fixation system including methods, apparatus, and kits, for steering a leading end of a fastener within bone. In some embodiments, the system may include (a) a flexible fastener having an external thread, and (b) a guide including a graspable handle attached or attachable to a wire having a distal end portion with a preformed longitudinal curvature in a direction indicated by the handle. The wire may be extendable through the fastener and configured to be advanced longitudinally, while extending through the fastener, such that the distal end portion of the wire penetrates bone ahead of a leading end of the fastener and creates a curved travel path for the leading end of the fastener.

Abstract: A surgical ring and related methods for plantar plate reconstruction and other surgical procedures are described. In particular, the described anchoring systems and surgical methods may include an anchor configured to wrap at least partially around a first bone associated with an affected joint, and wrap at least partially around a tissue alongside the first bone. The anchor may be compressed in a number of ways so as to compress the tissue alongside the first bone against the first bone. The anchor may be formed from a compressible material, configured with an open shape, and/or or include mechanically closeable or compressible features, and the like. The anchor may be formed from various materials including non-bioabsorbable, bioabsorbable, and/or superelastic materials. The first bone may be a metatarsal or phalanx and the tissue alongside the first bone may be a ligament, a plantar plate, or similar tissue.

Abstract: An ablation electrode system includes a handle assembly; a needle electrode assembly supported in and extending from the handle assembly. The needle electrode assembly includes an outer tube having at least a conductive distal tip and defining a cavity therein; and an inner tube disposed at least partially within the cavity of the outer tube and defining a lumen therein. The ablation electrode assembly includes a hub assembly fluidly connected to the needle electrode assembly. The hub assembly defines a first chamber and a second chamber; wherein the proximal end portion of the inner tube is in fluid communication with the first chamber and the proximal end portion of the outer tube is in fluid communication with the second chamber. The ablation electrode assembly includes a first fluid conduit fluidly connected to the first chamber; and a second fluid conduit fluidly connected to the second chamber.

Abstract: Methods and apparatus for the treatment of a body cavity or lumen are described where a heated fluid and/or gas may be introduced through a catheter and into treatment area within the body contained between one or more inflatable/expandable members. The catheter may also have optional pressure and temperature sensing elements which may allow for control of the pressure and temperature within the treatment zone and also prevent the pressure from exceeding a pressure of the inflatable/expandable members to thereby contain the treatment area between these inflatable/expandable members. Optionally, a chilled, room temperature, or warmed fluid such as water may then be used to rapidly terminate the treatment session.

Abstract: Thermochemical ablation techniques may provide ablation of bodily tissue using chemical reaction energy.

Abstract: A surgical instrument includes a shell having a housing and a shaft. The shell including first and second shell components configured to engage one another to form the shell, each of which is monolithically formed to include a housing portion and a shaft portion. Upon engagement of the first and second shell components with one another, the housing portions cooperate to form the housing of the shell while the shaft portions cooperate to form the shaft of the shell. An end effector assembly is operably coupled to the shaft at a distal end of the shaft. A handle assembly is operably coupled to the housing. A drive assembly disposed within the shell is operably coupled between the handle assembly and the end effector assembly such that actuation of the handle assembly manipulates the end effector assembly.

Abstract: The present invention is an ablation device having a screen sphere configuration for the ablation of marginal tissue surrounding a tissue cavity. The device includes a probe having a nonconductive elongated shaft including at least one lumen therethrough and a nonconductive distal portion extending from the shaft. The nonconductive distal portion includes a plurality distal ports and a plurality of proximal ports in communication with the at least one lumen of the shaft. The device further includes an electrode array including a plurality of independent conductive wires extending through the lumen and positioned along an external surface of the nonconductive distal portion, each of the plurality of wires passes through at least an associated one of the proximal ports and through at least a corresponding one of the distal ports.

Abstract: A surgical end effector has a first jaw comprising a first electrode and a second jaw, wherein at least one of the first jaw and the second jaw is movable relative to the other one of the first jaw and the second jaw to transition the end effector between an open configuration, an approximated configuration, and a fully approximated configuration. The second jaw includes a second electrode and a spacer extending from the second electrode, wherein the spacer is configured to maintain a predetermined distance between the first electrode and the second electrode when the end effector is in the fully approximated configuration, wherein the spacer is in contact with the first electrode in the fully approximated configuration, wherein the spacer is spaced apart from the first electrode in the open configuration, and wherein the spacer is comprised of a semi-conductive material.

Abstract: The present disclosure relates to electrosurgical instruments for use in sealing various tissues. The instrument includes a housing having a shaft attached thereto and an end effector assembly attached to a distal end of the shaft, wherein the end effector assembly includes first and second jaw members attached thereto. The jaw members are movable relative to one another from a first position for approximating tissue to at least one additional position for grasping tissue therebetween. The jaw members have an elastomeric material disposed on an inner facing tissue contacting surface thereof with the elastomeric materials including an electrode disposed therein. The electrodes are offset a distance X relative to one another such that when the jaw members are closed about the tissue and when the electrodes are activated, electrosurgical energy flows through the tissue in a generally coplanar manner relative to the tissue contacting surfaces.

Abstract: A branch of an instrument comprising a metal part, which is embodied in one piece seamlessly, which comprises the electrode support as well as the electrode plate and connection webs. Preferably, this metal part is produced in an additive production method, for example selective laser melting (SLM). The branches are suitable for instruments for open surgery as well as for laparoscopic and flexible endoscopic instruments.

Abstract: A surgical instrument includes a housing having an elongated shaft extending distally therefrom. An end effector for treating tissue is supported by the elongated shaft. One or more tensile members extend at least partially through the elongated shaft. A proximal end of a tensile member is operatively coupled to at least one actuator and a distal end is operatively coupled to the end effector such that manipulation of the actuator induces movement of the tensile member to move the end effector. A de-tensioning mechanism is operatively associated with the tensile member to move the tensile member between a first relaxed configuration and a second stressed configuration. The de-tensioning mechanism includes a spacer insertable into a cavity defined in the housing to move the tensile member to the first relaxed configuration and removable from the cavity to move the at least one tensile member to the second stressed configuration.

Abstract: A coaptive surgical sealing tool may be similar to an ordinary hemostat with long (50, 60, 70 or 80 mm) thin jaws for sliding into the liver parenchyma, without tearing the larger blood vessels. The jaws are spring loaded and are designed for uniform compression, and to avoid closing too quickly. The jaws are capable of sealing a 50, 60, 70 or 80 mm sealing length, in a single bite, although it can also seal shorter lengths as well. The tool can be used with existing RF/bi-polar cautery generators.

Abstract: An irrigated needle electrode ablation catheter has a distal tip section with a tip electrode, a needle electrode assembly longitudinal movable relative to the catheter, and a needle centering insert in a channel in the tip electrode. The assembly has a proximal tubing and a distal needle electrode, and the insert supports the needle electrode in the channel at a predetermined separation distance from the tip electrode while enabling irrigation to flow circumferentially around the needle electrode through the channel and exit at the distal end of the tip electrode. The catheter also provides a first dedicated fluid pathway through the assembly and exits at the distal end of the needle electrode, and a second dedicated fluid pathway to supply fluid to the channel in the tip electrode, wherein the second pathway is defined by a guide tube and directed by a plunger member.