Abstract: A surgical stapling apparatus comprises a handle assembly, an actuation shaft having a connector, and a retraction mechanism positioned within the handle assembly. The retraction mechanism includes a motor coupled to a transmission shaft, a first gear rotatably mounted on the transmission shaft, the first gear configured to engage a second gear, a clutch operatively attached to the second gear, a main shaft rotatably connected to the clutch, and a pulley coupled to the main shaft, the pulley being operatively attached to the connector. The connector and the pulley may be attached via a cable. The retraction mechanism may include a spring motor for maintaining the cable in tension. The spring motor may have a spring element wrapped around and interconnecting at least two arbors.

Abstract: An end effector is provided and includes an outer tube, a coil member, a plurality of fasteners, and an engagement member. The outer tube defines a viewing window and a lockout window. The coil member is disposed within the outer tube. The plurality of fasteners are disposed in the coil member. The engagement member is disposed proximal to the plurality of fasteners and is visible through the viewing window of the outer tube. The engagement member is configured to translate proximal to the plurality of fasteners to provide a count of the plurality of fasteners remaining in the end effector.

Abstract: Implantable medical devices for connecting tissue layers, such as for connecting a gallbladder and a portion of a gastrointestinal tract to create an anastomosis, include a tubular structure having a plurality of apposition portions, a central region, and a covering material. The devices are endoscopically deployable and may include flange members having hinge members or variable properties such as length, angle, shape, material stiffness, and wire diameter.

Abstract: A nerve guidance conduit includes one or more guidance channels formed as porous polymeric structures. The guidance channels are within an outer tubular structure that includes randomly-oriented nanofibers. The guidance channels may have electrospun nanofibers on their inner and outer surfaces in a parallel alignment with the guidance channels. Such aligned nanofibers may also be present on the inner surface of the outer tubular structure. The outer surfaces of the guidance channels and the inner surface of the tubular structure define additional guidance channels. Such a nerve guidance conduit provides augmented surface areas for providing directional guidance and enhancing peripheral nerve regeneration. The structure also has the mechanical and nutrient transport requirements required over long regeneration periods.

Abstract: A surgical stapling instrument is disclosed, the instrument having a handle assembly, a body portion having a staple cartridge assembly, and an anvil assembly. The anvil assembly includes an anvil head, an anvil member, an anvil shaft, and a biasing member. The anvil shaft defines a longitudinal axis and the anvil member is pivotally secured to the anvil head. The biasing member is supported on the anvil assembly to urge the anvil member from a first position to a second position defining an angle with respect to the longitudinal axis.

Abstract: An implant device can include a frame and a cover member for delivery to and occlusion of a target body vessel. The frame can include proximal and distal members, coupled by a link member structure, and can expand from a collapsed configuration to an expanded configuration. In the collapsed configuration, a first plane passes through the proximal member and a second plane passes through the distal member, and the link member extends substantially parallel relative to a longitudinal axis of the device. In moving to the expanded configuration, the first and second planes each move angularly, relative to the longitudinal axis, from the collapsed configuration by between about 10 degrees and about 170 degrees, and the link member foreshortens along the longitudinal axis to bias the proximal member toward the distal member.

Abstract: A blood flow reducing assembly includes a catheter shaft and an expandable occlusion member assembled with the catheter shaft. The expandable occlusion member includes foldable protrusions. One or more manipulation members are connected to the foldable protrusions and operative to move the foldable protrusions closer to or further away from one other. Movement of the foldable protrusions modifies occlusion ability of the foldable protrusions.

Abstract: An apparatus for application of surgical clips includes a lockout system selectively engagable with a pusher bar to prevent the pusher bar from returning to a home position and to prevent a trigger from completing a full stroke when a plurality of clips are substantially exhausted. The apparatus may include a trip mechanism including a trip lever biased into contact with the pusher bar, wherein distal movement of the drive bar moves the trip mechanism until the trip lever engages a lip of the pusher bar and in turn distally moves the pusher bar. The apparatus may include a wedge plate including a distal end placeable between spaced-apart jaw members, wherein the wedge plate is moved proximally to withdraw the distal end thereof from between the jaw members when a drive channel is moved in a distal direction.

Abstract: A tourniquet for application to a patient's limb in an emergency situation, and a method for its application. The tourniquet includes a tension-sensing mechanism used to establish a baseline tension in a loop around an injured limb, and a tension-increasing mechanism to reduce the circumference of the loop and tighten the tourniquet as required beyond the baseline tension. The tension-sensing mechanism may be incorporated in a buckle in which when sufficient tension is developed in the loop a pin protrudes to engage and maintain tension in a strap member which is part of the loop. A latch may be incorporated in the buckle to keep it in a condition in which the pin protrudes to engage the strap and maintain the baseline tension. A release tab operable to release the latch is located where it is protected against inadvertent operation.

Abstract: A bone reamer includes a first member having a first hub and a second member having a second hub. The first hub can extend along a first axis and have a pair of elongated cutting arms that are fixed to the first hub. The elongated cutting arms can extend along a second axis that is generally perpendicular relative to the first axis. The first hub can define a track thereon. The second hub can extend along a third axis. The second member can have a second pair of elongated cutting arms that are fixed to the second hub and extend along a fourth axis that is generally perpendicular to the third axis. The second member can have a track follower extending thereon and that is configured to slidably advance along the track causing the first and second members to move between a collapsed position and an expanded position.

Abstract: The invention concerns a cranial drill system comprising one or more surgical drill elements for drilling into the brain. The invention also concerns a cranial drilling system comprising a surgical drill element for drilling into the skull and an element for penetrating the dura. The surgical drill element may comprise a profile that forms an opening in the skull having a narrower diameter portion and a wider diameter portion and the piercing element may be arranged to be a close fit in the narrower diameter portion of the opening. The invention also concerns a cranial drill system comprising a guiding element to be located in a hole formed through the skull and a piercing element for piercing the dura. The guiding element may have a passageway or channel therein for receiving the piercing element such that the piercing element is movable relative to the guide element to pierce the dura.

Abstract: Drill bit guide assemblies related to surgical operations for guiding and stabilizing a drill bit. A guide member houses a fixed bore through which a drill bit may pass. The guide member may also house a bore selection member which houses a plurality of selectable bores. The selectable bores may have a variety of diameters such that a user may choose the selectable bore corresponding to the drill bit diameter being used and align that selectable bore with the fixed bore such that the drill bit may pass through the length of the assembly along the reference axis. The similar diameters of the selectable bore and the drill bit may cause the assembly to stabilize and guide the drill bit.

Abstract: An orthopedic surgical instrument system for use in preparing a patient's bone is disclosed. The surgical instrument includes a cutting guide block configured to be secured to a surgically-prepared surface of the patient's bone, and a cutting tool to be used in conjunction with the cutting guide block to resect a section of the patient's bone. A method of performing an orthopedic surgery is also disclosed.

Abstract: A system for performing a total joint arthroplasty procedure on a patient's damaged bone region. A CT image or other suitable image is formed of the damaged bone surfaces, and location coordinate values (xn,yn,zn) are determined for a selected sequence of bone surface locations using the CT image data. A mathematical model z=f(x,y) of a surface that accurately matches the bone surface coordinates at the selected bone slice locations, or matches surface normal vector components at selected bone surface locations, is determined. The model provides a production file from which a cutting jig and an implant device (optional), each patient-specific and having controllable alignment, are fabricated for the damaged bone by automated processing.

Abstract: A system comprised of custom radiographically designed tibial and talar cutting guides, a tibial reaming guide and bit, and instrumentalities for use in total ankle replacement surgery and a computer-based system and method for making the custom radiographically designed tibial and talar cutting guides.

Abstract: A clot retrieval device for removal of occlusive clot from a blood vessel comprises a clot engaging element 700 having a constrained delivery configuration and an expanded deployed configuration. In the expanded configuration peripheral portions are laterally spaced-apart and the clot engaging section 700 extends between the peripheral portions. The device 700 may have two superimposed wave patterns provided by a large amplitude curve 723 and shorter pitch sinusoidal patterns 721, 722. A wave shape varies the contact pressure between a clot and the device along the length of the device, reducing the compression of the clot by the device at some locations. The device can elongate when placed under tension which aids elongation of the clot during dislodgement.

Abstract: An articulated hand-held medical instrument is provided. The instrument is primarily intended to be used in minimally invasive surgical procedures. The articulated instrument comprises a master-slave architecture whereby user hand movements on a proximal handle element are replicated on a distal end-effector. The proximal handle comprises a number of handle links joined by handle joints that correspond to a number of end-effector links joined by end-effector joints. The articulated hand-held medical instrument can be used in standard laparoscopic procedures in various port arrangements and through the use of standard equipment such as trocars, and movements inside the patient's body may be tracked using available endoscopic cameras.

Abstract: Unitary endoscopic vessel harvesting devices are disclosed. In some embodiments, such devices comprise an elongated body having a proximal end and a distal end; an inflatable, coated or conditioned tip disposed at the distal end of the elongated body; and a cutting unit having a first cutting portion and a second cutting portion, the first cutting portion and the second cutting portion being moveable in a longitudinal direction relative to the elongated body to capture a blood vessel between the first cutting portion and the second cutting portion, and being rotatable relative to one another circumferentially about the tip to cut the captured blood vessel.

Abstract: An ablation system for treating atrial fibrillation in a patient including an elongate shaft having proximal and distal ends, a lumen therebetween and a housing adjacent the distal end of the elongate shaft. An energy source is coupled to the housing and is adapted to deliver energy to a target tissue so as to create a zone of ablation in the target tissue that blocks abnormal electrical activity thereby reducing or eliminating the atrial fibrillation in the patient. A sensor is adjacent the energy source and adapted to detect relative position of the energy source to the target tissue or characteristics of the target tissue. The system also has a reflecting element operably coupled with the energy source and adapted to redirect energy emitted from the energy source in a desired direction or pattern.

Abstract: A surgical instrument for use during a surgical procedure includes an instrument body, an ultrasonic transducer assembly extending along a longitudinal axis, a power cord, and a transducer slip joint. The ultrasonic transducer assembly is rotatably mounted within the instrument body about the longitudinal axis and defines a first outer profile. The power cord projects from the instrument body to provide electrical power to the ultrasonic transducer assembly for operating an acoustic waveguide. The transducer slip joint is positioned between the power cord and the ultrasonic transducer assembly and electrically and mechanically connects the power cord to the ultrasonic transducer assembly. The ultrasonic transducer assembly selectively rotates relative to the power cord for inhibiting the power cord from winding upon rotation of the ultrasonic transducer assembly. The transducer slip joint also defines a second outer profile that fits within the first outer profile of the ultrasonic transducer assembly.

Abstract: A method and a hand-held device for dermaplaning is disclosed that includes a blade assembly which includes a blade, a blade holder and a safety cage. In accordance with an important aspect of the invention, the safety cage limits the amount of penetration of the blade into the facial skin to enable the device to be safely used by non-professionals. The dermaplaning device includes a vibration generator that causes the blade to vibrate at a predetermined frequency. Various embodiments of the hand-held dermaplaning device are disclosed for vibrating the blade.

Abstract: An ultrasonic surgical instrument includes a cooling system having a blade conduit disposed within the blade and a cooling fluid. The cooling fluid configured to absorb heat from the blade as the cooling fluid flows through the blade conduit. A surgical system having an ultrasonic surgical instrument and a cooling system is also disclosed. The cooling system can include a fluid control system that automatically pumps a cooling fluid through a blade conduit disposed within the blade of the surgical instrument based on feedback received from sensors.

Abstract: Disclosed are nozzles and nozzle assemblies of liquid jet-forming surgical instruments, surgical instruments employing such nozzles and/or nozzle assemblies, and methods of fabricating the nozzle assemblies in forming surgical instruments. Also, disclosed are liquid jet-forming surgical instruments including both liquid jet-forming nozzles and optional evacuation lumens, which when provided can be configured to receive the liquid jet and evacuate the liquid forming the liquid jet. Certain embodiments of such surgical instruments include inventive nozzle alignment component(s) to facilitate alignment of the nozzles and evacuation lumen upon assembly. In certain embodiments, surgical instruments are provided that include a nozzle that is shaped to form a liquid jet, which has surfaces that are optically smooth.

Abstract: An atherectomy catheter includes a deflectable distal tip, a rotatable cutter proximal to the distal tip, a cutter drive shaft configured to rotate the rotatable cutter, and a pull shaft concentric with the drive shaft and coupled to the distal tip. The pull shaft is configured such that pulling the pull shaft deflects the distal tip, thereby exposing the rotatable cutter. Also disclosed herein is a magnetic drive system configured for non-contact actuation of a catheter.

Abstract: A system and method involving an electrode system can include a flexible shaft.

Abstract: Method and apparatuses for providing access to a body cavity of a living animal through an access port inserted in an incision made in a wall of the body cavity are disclosed. In some embodiments, the apparatus includes a cap configured to attach to the access port, the cap including an opening configured to permit insertion of a medical instrument through the cap and access port into the body cavity, and a tubular sleeve including a distal end sealingly connected at the opening and extending outwardly therefrom, the sleeve including a proximal end configured to receive and provide a seal with the medical instrument when received. The apparatus also includes a closure disposed to temporarily seal the sleeve prior to insertion of the medical instrument through the opening in the cap.

Abstract: A medical device includes an elongate member. The elongate member has a first end portion and a second end portion. The second end portion of the elongate member has an upper surface and a lower surface disposed opposite the upper surface. The lower surface has a planar portion. The upper surface has a planar portion and a concave portion.

Abstract: Disclosed herein is a medical device. The medical device includes outer, middle, and inner tubular members. The outer tubular member has a proximal end and a distal end. The middle tubular member has a proximal end and a distal end. The middle tubular member is configured to be received within the outer tubular member and capable of being rotatable relative to the outer tubular member. The inner tubular member is configured to be received within the middle tubular member and capable of reciprocating and also capable of being rotatable relative to the middle tubular member. The inner tubular member is configured to reciprocate and rotate while the middle tubular member and the outer tubular member are configured to be stationary. The middle tubular member is configured to be rotatable relative to the outer tubular member while the inner tubular member is configured to be stationary.

Abstract: Methods, systems, and devices for skin care are provided. Some embodiments may include a device or system for skin care that may include a skin tool head portion, a skin tool head support that may be coupled with the skin tool head portion, and/or a portable microscope connector that may be configured to couple a portable microscope with the skin tool head support. Some embodiments include a device for skin care that may include a spacer configured to couple with a portable microscope. The spacer includes at least one aperture configured to facilitate the use of a skin tool. Some embodiments include a spacer coupled with a compressible structure configured to preclude a skin tool from contacting a portion of skin when in an uncompressed state and to allow the skin tool to contact the portion of skin when in a compressed state.

Abstract: The invention provides improved instruments and related methods for percutaneously delivering a revision implant to a surgical site in a spine of a patient having an existing implant installed therein. In one aspect, a percutaneous delivery instrument is provided with an inner shaft with a threaded portion at its distal end to engage a percutaneous revision implant, an outer sleeve with a hollow cavity, hinges, and features to engage the percutaneous revision implant at its distal end, and a translator in which the outer sleeve is disposed. The percutaneous delivery instrument may be employed to deliver and install a percutaneous revision implant to extend the existing implant such that it spans additional portions of the spine.

Abstract: A spinal construct includes at least one body including a first biasing member engageable with a longitudinal element for translation thereof relative to the body in a first direction. A second biasing member is engageable with a lock. The lock is connected with the longitudinal element to resist and/or prevent translation of the longitudinal element relative to the body in a second direction. Implants, surgical instruments, systems and methods are disclosed.

Abstract: A polyaxial bone screw assembly includes a threaded shank body having an integral upper portion receivable in a receiver, the receiver having an upper channel for receiving a longitudinal connecting member and a lower cavity cooperating with a lower opening. The shank upper portion expands a retaining member in the receiver cavity to capture the shank upper portion in the receiver. The retaining member and attached shank are pivotable with respect to the receiver until locked in place with respect to the receiver. A pre-assembled receiver, retaining member and compression insert may be popped-on or snapped-on to the shank upper portion prior to or after implantation of the shank into a vertebra.

Abstract: The present invention provides interspinous vertebral and lumbosacral stabilization devices, and methods of using these devices for treating spinal instability conditions. The invention includes interspinous vertebral stabilization devices adapted for placement between the spinous processes of two or more adjacent vertebrae. The invention also includes lumbar stabilization devices adapted to be placed between a lumbar vertebra and an adjacent vertebra, including the first sacral vertebra (S1), to stabilize the lumbosacral region of a patient, and method for using such devices.

Abstract: Vertebral plate revision apparatuses, kits, and methods, and osteosynthesis systems useful in the treatment of vertebrae are described. An example vertebral plate revision apparatus is comprised of an extension plate, a connecting plate, a connecting member, and a set of locking members. An example osteosynthesis system comprises a vertebral plate revision apparatus, a previously-implanted plate, and a set of anchors.

Abstract: Bone anchor assemblies and related instrumentation are disclosed herein. In some embodiments, a modular bone anchor assembly allows for a bone anchor to be driven into bone and a head or receiver member to be attached thereto at some later point in time. The bone anchor can have a smaller footprint than the complete assembly, which can improve visualization and anatomical spatial awareness during insertion of the bone anchor and during other surgical steps performed prior to attaching the head or receiver member to the bone anchor. A variety of modular head types are disclosed, as are various instruments for driving a bone anchor, attaching a head to a bone anchor, removing a head from a bone anchor, and making a unilateral attachment to a head of a bone anchor assembly. Drive interfaces for driving a bone anchor are disclosed, as are features that allow a bone anchor to act as a fixation point for soft tissue retraction, disc space distraction, derotation, and the like.

Abstract: An intramedullary nail for fixation and stabilization of a fractured bone that also allows for a controlled amount of longitudinal motion at the fracture site to encourage bone remodeling and healing is described. The intramedullary nail has a proximal portion and a distal portion that are coupled together in a manner by a biasing assembly that provides for a controlled movement of the proximal and distal portions relative to each other so that when a patient puts pressure on the bone, such as when walking, the fracture site compresses and the bone ends move together, and when the pressure is released from the bone, the bone ends are biased apart by a controlled amount.

Abstract: A porous bionic internal fixation device for promoting healing of a fractured bone includes a lag screw in a round rod shape, the lag screw is provided with fixation structures at both ends thereof, and on a body of the lag screw, a plurality of apertures directing laterally or obliquely are provided, and densely distributed micro-holes are provided on the body of the lag screw between the adjacent apertures. When in use, the both ends of the lag screw are respectively located in the bone at opposite sides of the fractured bone, so that the longitudinal direction of the apertures is aligned with the direction of the tensile trabeculae or the compressive trabeculae at the fractured bone, and the position of the apertures corresponds to the fractured bone.

Abstract: A bone fastening system may include a cannulated screw component, a seating component, and a holding component. The screw component may include a screw head arranged in the region of a proximal end of the screw component, and an elongate screw shaft extending from the screw head along a longitudinal axis towards a distal end of the screw component. The screw head may include a proximal surface on a front side facing the proximal end and a distal surface on a back side facing the distal end. A portion of the distal surface may form a contact surface. The seating component may include a central opening having an opening diameter larger than the maximum diameter of the screw shaft and smaller than the maximum diameter of the screw head.

Abstract: A perforated sheath is anchored in a tissue opening with the aid of a tool, wherein the anchorage is achieved with the aid of mechanical vibration and a material which is liquefiable by the vibration. The tool includes a vibrating element and a counter element. Distal portions of both elements are introduced into the sheath to be in contact with each other at an interface. The vibrating element is connected to a vibration source and the vibrating element and the counter element are held against each other for effecting liquefaction of the liquefiable material at the interface. Under the effect of the force applied to the vibrating and counter element for holding them against each other, the liquefied material flows from the interface through the sheath perforation and penetrates the tissue.

Abstract: An electrosurgical apparatus and method for cutting and resecting a tissue volume is described. The apparatus includes one or more electrosurgical filaments and capture components deployable by forward extension at or near a forward tip of an elongated shaft of the apparatus to form an elliptical path that defines, with the other capture components, a spheroidal receptacle configured to surround a tissue volume for resection. The elliptical path is formable by a first extension followed by a second extension, said first extension having a first axial component and a radial expansion component, and said second extension having a second axial component and a radial contraction component, where at least one of the capture components is of varying stiffness.

Abstract: Devices, systems, and methods treat cosmetic defects, and often apply cooling with at least one tissue-penetrating probe inserted through of the skin of a patient. The cooling may remodel one or more target tissue so as to effect a desired change in a composition of the target tissue and/or a change in its behavior. Exemplary embodiments of the cooling treatments will interfere with the nerve/muscle contractile function chain so as to mitigate wrinkles of the skin. Related treatments may be used therapeutically for treatment of back and other muscle spasms, chronic pain, and the like. Some embodiments may remodel subcutaneous adipose tissue so as to alter a shape or appearance of the skin surface.

Abstract: An apparatus, probe and method for a cryogenic system are described. According to certain embodiments of the invention there is provided an apparatus for cryosurgery comprising: an exhaust line configured to receive cryogen from a probe; and a vacuum source configured to be in fluid communication with the exhaust line.

Abstract: An electrosurgical assembly is disclosed, the assembly having two, three or more electrodes configured to provide advantageous tissue removal and precision for conducting electrosurgical procedures, including improved ablation and coagulation of tissue. The electrodes are configured and arranged so that energy can be applied in a highly uniform and precise fashion, depending upon the application. In addition, the electrosurgical assembly allows flexibility in use by, in some embodiments, allowing selective switching of the active and return electrodes, and also selective switching between ablation and coagulation modes. In certain embodiments the invention includes one or more electrodes having the ability to undergo changes in shape.

Abstract: An energy output section outputs first electric energy so that a high-frequency current flows between electrodes through a treated target, and outputs second electric energy so that heat occurs in an end effector. A controller outputs the first electric energy at the same time as the second electric energy in at least a part of a period during which the heat is continuously denaturing the treated target from an output start of the second electric energy. The controller makes, based on judging that the treated target entered a predetermined state, an electric power of the first electric energy increased.

Abstract: Disclosed are systems, devices, and methods for interdigitation of waveforms for dual-output electrosurgical generators. Such methods may comprise outputting DC energy from a power supply, converting DC energy from the power supply, by a plurality of amplifiers coupled to the power supply, into a plurality of RF waveforms, and controlling the plurality of RF amplifiers to interdigitate the first and second RF waveforms.

Abstract: A surgical knife has been developed. The knife includes a blade with an edge that contacts tissue of a patient and a differential amplifier circuit that provides a signal of voltage and current to the blade at a certain frequency and waveform. The device also includes an output monitor feedback circuit that monitors frequency and amplitude data from the differential amplifier circuit and a return monitor feedback circuit that monitors that monitors frequency and amplitude data from the tissue of the patient. The device has a microprocessor that receives the frequency and amplitude data from the output monitor and the return monitor and adjust the voltage, frequency and waveform provided by the differential amplifier.

Abstract: An electrosurgical unit having power monitoring circuitry for reducing leakage current in an electrosurgical unit. The electrosurgical unit includes a power source configured to produce direct current, an RF waveform generator configured to convert the direct current into an RF signal, a voltage sensor configured to measure DC input voltage to the RF waveform generator, a current sensor configured to measure output current feedback, and a processor. The processor is configured to estimate output voltage feedback based at least upon the measured DC input voltage and the measured output current feedback, and output a control signal to control the DC input voltage to the RF waveform generator, the control signal based at least upon the estimated output voltage and the output current feedback.

Abstract: Instruments and methods are provided for performing submucosal medical procedures in a desired area of the digestive tract using endoscopy. The instruments include a mucosal resection device, a tissue grasper and a snare. Systems include a combination of one or more of such instruments. Embodiments of various methods for performing the procedures are also provided.

Abstract: Methods, devices, and systems related to electrosurgical tools are provided. The electrosurgical tools can include an electrode formed of non-linear resistance material for allowing energy to be transmitted to the electrode for heating the electrode or to tissue adjacent the electrode for heating the tissue. Such transmission of the energy can depend upon a characteristic of the electrical energy, such as voltage or frequency of the energy, which can affect the resistance properties of the electrode.

Abstract: A system for controlling operation of a radiofrequency treatment device to apply radiofrequency energy to tissue to treat tissue to create lesions without ablating the tissue. The system includes a first treatment device having a plurality of electrodes. The electrodes are maintained in axial alignment and fixed radial spacing in retracted and extended positions. The device includes a basket having a plurality of arms. The arms are maintained in a fixed radial spacing in the collapsed position of the basket.