Abstract: Shadow suppression is provided in ultrasound imaging, such as in steered spatial compounding. Using a transform or other approach, the data of a frame of data along the steering direction is projected. The projection is used to determine weights. The frame is weighted with the projection-based weights, reducing or removing shadows based on the one frame rather than based on registration with other frames. In the steered spatial compounding example, a compounded frame with independently shadow suppressed component frames may have little or no fork-like image artifacts due to shadowing.

Abstract: Embodiments of the present disclosure disclose a method and a device for adjusting ultrasonic cavitation intensity. The adjusting method includes: controlling to adjust a jth cavitation coefficient according to an ith cavitation intensity value and a target cavitation intensity value, so as to calculate to obtain an (i+1)th cavitation intensity value; and continuing to control to adjust a (j+1)th cavitation coefficient according to the (i+1)th cavitation intensity value and the target cavitation intensity value, so as to calculate to obtain an (i+2)th cavitation intensity value if the absolute value of a difference between the (i+1)th cavitation intensity value and the target cavitation intensity value is greater than a set threshold value, and ending the method when it is determined that the absolute value of the difference between the (i+1)th cavitation intensity value and the target cavitation intensity value is less than or equal to the set threshold value.

Abstract: A biological sample collection, storage, and transport device includes a collection assembly and a sheath, wherein the collection assembly includes a support shaft, a swab head, and a handle, the swab head mechanically couples to a distal support shaft end, the handle couples to a proximal support shaft end, and the collection assembly slideably couples to the sheath and is configurable in a retracted position with the swab head entirely disposed within the sheath or an extended position with the swab head extending outside of the sheath. A distal sheath end includes an aperture, the aperture having a circumference large enough to allow the swab head to pass through said aperture when the collection assembly is configured in the extended position, and a seal is applied to the distal sheath end after the swab head has collected a biological sample and the collection assembly has been reconfigured into the retracted position.

Abstract: A biopsy needle actuator includes an adjustable stop plate setting the distance a needle and cannula move when the actuator is fired, a shot counter tracking the number of shots taken with the actuator during a biopsy procedure, and a lifecycle indicator tracking the cumulative number of shots of the actuator during a recommended service life. A threaded rod sets the throw distance of the needle and cannula allowing the actuator to excise a biopsy tissue specimen of between 20 mm and 60 mm. A number wheel in the shot counter is moved upon firing of a needle carrier. The lifecycle indicator registers arming of the actuator and indicates when the mechanical components of the actuator need servicing. A biopsy needle within a cannula is mounted in the actuator where by the core bed of the needle is orientated downward when in use aiding in extraction of the tissue sample.

Abstract: A biopsy device includes a housing body, and a cannula assembly having a first elongate cannula and a second elongate cannula coaxial with the first elongate cannula. The second elongate cannula has a side wall and a lumen. The side wall has a vacuum side port in fluid communication with the lumen. A vacuum source is positioned in the housing body. The vacuum source has a chamber side wall, which may define a U-shaped volume, and has a chamber vacuum port. A seal is interposed in sealing engagement between the chamber vacuum port and the second elongate cannula. A trigger slide assembly is configured to move the second elongate cannula to align the vacuum side port of the second elongate cannula with the chamber vacuum port of the vacuum source to supply vacuum from the vacuum source to the lumen of the second elongate cannula.

Abstract: A tissue removal device includes an outer tubular member coupled to a housing and a having a tissue resection window, an inner tubular member slidably disposed within the outer tubular member, a tissue trap having a sealed interior in fluid communication with a vacuum chamber, an open proximal end of the inner tubular member being disposed within the tissue trap interior, and an actuator moveably coupled to the housing and operatively connected to a movable piston in the vacuum chamber, such that movement of the actuator relative to the housing generates a vacuum in the tissue trap.

Abstract: A surgical system which may include a controller, a data entry device, a powered surgical handpiece and a surgical tool adapted to couple to the surgical handpiece. The surgical handpiece can include motor direction control and feedback, safety stop features, stimulation and nerve integrity monitoring, a tool connector assembly configured to retain a variety of surgical tools and optional navigation and/or electric ratcheting features.

Abstract: A closure system for delivering a sealant to an arteriotomy. A distal section of the closure system can include overlapping inner and outer sleeves that can expand with expansion of the sealant. A proximal section of the closure system can include a handle portion and a sheath adapter extending from the handle portion. The handle portion can include one or more actuators that when depressed or engaged can assist in deployment of the sealant in the arteriotomy and can further include tamping of the sealant and/or retraction of an expandable member. The sheath adapter can removably engage a side port or an irrigation line of a standard procedural sheath. When the sheath adapter is secured to the procedural sheath, movement of the closure system can also move the procedural sheath.

Abstract: A sealant for sealing a puncture through tissue includes a first section, e.g., formed from freeze-dried hydrogel, and a second section extending from the distal end. The second section may be formed from PEG-precursors including PEG-ester and PEG-amine, e.g., in an equivalent ratio of active group sites of PEG-ester/PEG-amine greater than one-to-one, e.g., such that excess esters may provide faster activation upon contact with physiological fluids and enhance adhesion of the sealant within a puncture. At least some of the precursors remain in an unreactive state until exposed to an aqueous physiological environment, e.g., within a puncture, whereupon the precursors undergo in-situ cross-linking to provide adhesion to tissue adjacent the puncture. For example, the PEG-amine precursors may include the free amine form and the salt form. The free amine form at least partially cross-links with the PEG-ester and the salt form remains in the unreactive state in the sealant before introduction into the puncture.

Abstract: Devices, methods, and systems provide a surgical access device comprising an internal retractor device integrated with or coupled to a body wall or wound retractor. The wound retractor retracts an opening in a body wall into a body cavity, while the internal retractor permits a user to control the positions of internal structures within the body cavity, thereby permitting a user to define a surgical field. Embodiments of the internal retractor are adjustable.

Abstract: An apparatus includes a gripping instrument that includes a first arm and a second arm disposed opposite the first arm. The first arm and the second arm are joined at a joint, where an end of the first arm opposite the joint is configured to move towards an end of the second arm opposite the joint in a gripping direction. The apparatus further includes a blade disposed on the first arm, where the blade is oriented at an angle that is non-parallel to the gripping direction.

Abstract: An assembly and method for the protection of medical personnel from accidental suture needle sticks is described. The assembly includes a case containing a needle which can be retracted when not in use. The needle is extended and retracted through the engagement of a needle driver which compresses a compressible member. The compressible member exerts a force on the needle which in turn extends the needle's point beyond the casing so that the user can suture tissue. Disengaging the needle driver retracts the needle point which protects the user from accidentally receiving a needle prick from a contaminated needle between punctures.

Abstract: A method for suture lacing includes providing a suture with a needle attached thereto, inserting the needle and suture into an organ through a passageway, throwing a single stitch through a first tissue member, throwing a single stitch through an opposed and spaced apart second tissue member, repeating the preceding step at least once, bringing the first and second tissue members in contact by tensioning the suture, whereby suture drag is minimized during the tensioning and even tissue compression substantially achieved, and securing the suture.

Abstract: Implantable materials for use with end effectors like surgical stapling devices, and methods for using the same, are generally provided. In some embodiments, a staple cartridge assembly for use with a surgical stapler can include a cartridge body having a plurality of staple cavities configured to seat staples therein and an adjunct material being associated with the cartridge such that the adjunct material is configured to be securely coupled to the cartridge body and configured to be securely attached to tissue by staples in the cartridge. The adjunct material can have positively-charged particles such that the adjunct material is configured to enhance healing in the tissue. Other implants, devices, and methods for surgical stapling are also provided.

Abstract: An implant insertion device is adapted for use with a shape memory implant. The shape memory implant includes a bridge interconnecting first, second, and third legs. The shape memory implant is movable between a first shape in which at least the first leg is substantially non-parallel and a second shape in which at least the first leg is substantially parallel. The implant insertion device engages the shape memory implant to maintain the shape memory implant in its second shape until the delivery of the shape memory implant into tissue or bone.

Abstract: An implant insertion device is adapted for use with a shape memory implant. The shape memory implant includes a bridge interconnecting first and second legs. The shape memory implant is movable between a first shape in which the first and second legs are substantially non-parallel and a second shape in which the first and second legs are substantially parallel. The implant insertion device engages the shape memory implant to maintain the shape memory implant in its second shape until the delivery of the shape memory implant into tissue or bone.

Abstract: An end effector for use with a surgical instrument includes a lower jaw, an anvil, and a resilient member. The anvil is pivotable relative to the lower jaw between a fully opened position and a fully closed position. The resilient member is configured to bias the anvil to remain in the fully opened position when the anvil is in the fully opened position. The end effector may include a closure ring coupled with the anvil that is translatable relative to the lower jaw and configured to engage the anvil at an interface as the closure ring translates proximally relative to the lower jaw to thereby pivot the anvil relative to the lower jaw toward the fully opened position. In various embodiments, the resilient member may comprise elastomeric material positioned between the closure ring and the anvil or a pair of springs or resilient arms that engage the anvil.

Abstract: A surgical cutting and fastening instrument that is motorized. The instrument comprises in one embodiment a charge accumulator device, separate from a battery, that provides additional power to the motor under certain conditions. In addition, the motor may comprise multiple windings.

Abstract: A method for resetting an apparatus configured for stapling tissue includes providing the apparatus with a cam member of the apparatus in a fired position. The method further includes changing the polarity of a motor of the apparatus and activating the motor such that the cam member rotates in a second direction from the fired position back to a home position. The apparatus further includes a stapling head assembly and a shaft assembly coupled to the stapling head assembly. The apparatus further includes a body coupled to the shaft assembly. The body comprises a motor and a cam member that is configured to rotate in response to activation of the motor. Rotation of the cam member in a first direction from the home position to the fired position results in actuation of the stapling head assembly.

Abstract: A surgical instrument comprising a handle assembly, a body, a tool assembly and an articulation assembly is disclosed. The articulation mechanism includes a receptacle, and a main shaft. A lower clutch is fixedly positioned within the receptacle and has a serrated portion including a plurality of serrations. An upper clutch includes at least one projection positioned to engage the serrations of the lower clutch to releasably retain the main shaft at a rotatably fixed position. An angle between a first pair of adjacent serrations is defined as a first angle, an angle between a second pair of adjacent serrations is defined as a second angle, and an angle between a third pair of adjacent serrations is defined as a third angle. The first angle, the second angle, and the third angle are each different from one another.

Abstract: An apparatus for closing a surgical incision comprises left and right base panels, a plurality of closure components, and a plurality of left and right axial supports coupled to the respective base panels. The closure components couple the left and right base panels to each other laterally and have left and right ends coupled to the respective base panels. The closure components are positioned laterally across the left and right panels, the left axial supports are disposed between pairs of left closure component ends, the right axial supports are disposed between pairs of right closure component ends, and the left and right axial supports are offset from one another such that a serpentine arrangement of consecutive closure components and axial supports is formed. The apparatus can be made of antimicrobial materials or materials impregnated with antimicrobial agents. A flexible adhesive cover can be provided over the apparatus when in use.

Abstract: A medical instrument has an elongated channel configured to support a staple cartridge, the staple cartridge comprising a plurality of staples. The medical instrument also has an anvil mechanically coupled to the elongated channel, wherein the anvil comprises an exterior surface extending between a proximal end and a distal end. In addition, the medical instrument has at least one electrical circuit at least partially positioned on the exterior surface of the anvil, an indicator system comprising at least one indicator, and a logic circuit electrically in electrical communication with the at least one electrical circuit and the indicator system, wherein the logic circuit is configured to activate the at least one indicator when an electrical continuity of the at least one electrical circuit is interrupted.

Abstract: A surgical device for temporary protection of an anastomosis in the colon, the rectum, or the anal passage, including: a semi-rigid hollow longitudinal temporary anchor element, a first wall of which includes a substantially cylindrical main portion with a substantially circular section having a length of at least 50 mm, the first wall having an outside diameter that may be varied in a controlled manner; and a flexible sheath fixed to the anchor element against, preferably around, the first wall and having a length downstream of the anchor element of at least 50 cm, and an outside diameter when at rest in the range 20 mm to 40 mm, and the sheath is made from a biocompatible elastomer material having a wall thickness in the range 0.05 mm to 1 mm.

Abstract: A seal element for sealing between tissue lumens includes a first material for allowing tissue ingrowth and a second sealant material.

Abstract: A surgical stapling assembly is disclosed. The stapling instrument comprises a staple cartridge configured to staple the tissue of a patient and a cutting member configure to incise the tissue. The stapling instrument further comprises an anvil movable between an open position and a closed position to clamp tissue against the staple cartridge. The anvil is configured to deform the staples when the staples are ejected from the staple cartridge. In at least one embodiment, the stapling instrument comprises a lockout configured to prevent the cutting member from incising the tissue until after the staples have been formed. In at least one embodiment, the stapling instrument comprises a lockout configured to prevent the anvil from being opened while the cutting member is exposed.

Abstract: A bariatric clamp may include substrate members overmolded in polymer forming first and second elongated portions, a bight portion having a flexible hinge, a fastener portion, and an engagement portion for retaining the clamp in a closed position to partition the stomach. A method for installing may include creating an opening in a patient's abdominal cavity to access the stomach, removing tissue connected to the stomach adjacent areas the clamp is to be positioned, positioning the clamp in an open position wherein first ends of the first and second elongated portions are open relative to one another, inserting the clamp into the abdominal cavity in the open position and the first and second elongated portions of the clamp separately pass through the opening in the abdominal cavity, positioning the first and second elongated portions adjacent first and second sides of the stomach, and closing the clamp to partition the stomach.

Abstract: A surgical saw blade for being coupled to a drive hub of a surgical saw. The surgical saw blade includes an attachment portion configured to be removably coupled to the drive hub. The surgical saw blade also includes a cutting portion opposite the attachment portion that includes a plurality of teeth. Additionally, the attachment portion defines a pair of indents. The first indent and the second indent are each defined by at least one curved surface. The curved surface is radially outwardly convex.

Abstract: A prosthesis may have an articulating component formed via casting and a 3D printed bone anchoring component with a joint-facing side and a bone-facing side. The bone-facing side may have a bone engagement surface with a porous structure with pores selected to facilitate in-growth of the bone into the pores. The bone facing side may further have a surface layer of Titanium Dioxide nanotubes. The joint-facing side may be secured to the articulating component by melting Titanium nanoparticles at a temperature below the melting temperatures of the major constituents of the articulating component and/or the bone anchoring component, such as Cobalt, Chromium, and/or Titanium, so as to avoid significantly modifying the crystalline structures of the articulating component and/or the bone anchoring component. The melting temperature of the Titanium nanoparticles may be about 500° C.

Abstract: A bur for dental implantology, including a dental coupling, a bur shank, a bur neck and a bur tip having at least one tip cutting edge, the tip cutting edge being partly rounded.

Abstract: An expandable reamer includes, inter alia, an outer tube, an inner shaft, a movable blade, and an actuator assembly. The expandable reamers can be used to remove diseased bone.

Abstract: Disclosed are devices and methods for creating a bore in bone. The devices and methods described involve driving a rotating bit in an axial direction such that both rotation and linear movement are controlled and measurable. The instrument is useful for a surgeon to control and simultaneously measure the travel of the tool into the bone and prevent injury to surrounding structures.

Abstract: A device for minimally invasive bone harvesting surgery described herein includes a cutter, a sleeve, and a drive control system. The cutter includes a head and a spiral conveying portion. An external screw thread is disposed on a surface of the spiral conveying portion, the sleeve is sleeved on the cutter, and the head and at least a part of the screw thread of the surface of the spiral conveying portion are exposed from the sleeve. The drive control system drives and controls the cutter to work. The device for minimally invasive bone harvesting surgery in this invention only needs a very tiny skin incision and bone window, cuts or grinds cancellous bone to bone fragments and then conveys them through a screw thread channel, which realizes the oriented conveying of the harvested bone.

Abstract: A bone broach is formed from a plurality of substantially planar members which are positioned adjacent to each other with each of the substantially planar members attached to at least one other substantially planar member. At least some of the substantially planar members defines at least one cutting profile at its perimeter. The plurality of substantially planar members include a first group of substantially planar members defining planes which are substantially parallel to each other, and at least one additional substantially planar member defining a plane which is angled relative to the planes defined by the first group of substantially planar members.

Abstract: An apparatus and method for penetrating bone marrow is provided. The apparatus may include a housing such as a handheld body, a penetrator assembly, a connector that releasably attaches the penetrator assembly to a drill shaft, a gear mechanism, a motor and a power supply and associated circuitry operable to power the motor. The penetrator assembly may include a removable inner trocar and an outer penetrator or needle. It may also include a grooved trocar that allows bone chips to be expelled as the apparatus is inserted into bone marrow. Various connectors are provided to attach the penetrator assembly to the drill shaft.

Abstract: A discharge device and method are disclosed that can discharge a discharge substance with a desired discharge amount at a desired flow rate. A storage unit provided in a discharge device includes a storage space which can store a discharge substance, and a discharge section which can discharge the discharge substance stored in the storage space toward the proximal side of a main body in an axial direction, and is configured to be capable of expanding deformation and contracting deformation in response to introduction and discharge of the discharge substance.

Abstract: Methods for restoring blood flow in occluded blood vessels using an apparatus having a self-expandable distal segment that is pre-formed to assume a superimposed structure in an unconstrained condition but can be made to take on a volume-reduced form making it possible to introduce it with a microcatheter and a push wire arranged at the proximal end, with the distal segment in its superimposed structure assuming the form of a longitudinally open tube and having a mesh structure of interconnected strings or filaments or struts. In a preferred embodiment, the distal segment has a tapering structure at its proximal end where the strings or filaments or struts converge at a connection point.

Abstract: A catheter is provided with a collection chamber located between a seal and a cap. The seal is located distal from the collection chamber, and the cap is located proximal from the collection chamber. The seal may be opened and closed to alternately allow the passage of material into the collection chamber and prevent fluid from escaping from the shaft lumen. The cap may be opened and closed to allow the removal of a mass from the collection chamber and to prevent fluid from escaping during collection of the mass.

Abstract: A medical clamping instrument includes first and second tubular members pivotally connected together, a first rod member pivotally connected to the second tubular member, a second rod member pivotally connected to the first rod member, first and second claw arms respectively providing first and second clamping portions and first and second connecting portions and respectively pivotally connected to the second tubular member, third and fourth rod members respectively pivotally connected to the first and second connecting portions, a screw nut pivotally connected to the third and fourth rod members, a screw rod threaded into the screw nut and driven by a driving rod via the first universal joint, the fifth rod member and the second universal joint. Thus, operating the driving rod can move the first and second clamping portions, maintaining the clamping force stably.

Abstract: The teachings herein provide an instrument comprising a forceps. The forceps comprise a hand piece; a tubular member connected to the hand piece; and a jaw assembly connected to the hand piece. The jaw assembly includes a first jaw element and a second jaw element. The first jaw element includes a gripping section and a flexing section. The flexing section includes an arcuate section. The second jaw element opposes the first jaw element and includes a gripping section. The tubular member is moveable onto the arcuate section of the first jaw element so that the flexing section of the first jaw element is flexed and the jaw assembly is moved into a closed position. The first jaw element, the second jaw element, or both include a stiffening spine so that the jaw assembly is substantially rigid in the closed position.

Abstract: A tissue shaver and methods of use is disclosed. The tissue shaver operates to remove tissue.

Abstract: A surgical system includes an ultrasonic surgical instrument and a cooling module. The instrument includes a waveguide defining a blade and having a lumen, an inflow conduit disposed in communication with the lumen and configured to supply fluid to the lumen, and a return conduit disposed in communication with the lumen and configured to receive fluid from the lumen. The cooling module includes a pump assembly operably coupled to the inflow and return conduits and configured to pump fluid through the inflow conduit, into the lumen, and back through the return conduit for cooling the blade. The cooling module also includes at least one sensor configured to sense a property of the fluid pumped into the inflow conduit and/or a property of the fluid returned from the return conduit, and a controller configured to control the pump assembly according to the sensed property(s).

Abstract: An apparatus for operating on tissue includes a body, a shaft assembly, and an end effector. The shaft assembly extends distally from the body and includes an acoustic waveguide. The waveguide is configured to acoustically couple with an ultrasonic transducer. The end effector includes an ultrasonic blade, a clamp arm, and a clamp pad. The blade is in acoustic communication with the waveguide. The clamp arm is configured to pivot about a first pivot point toward and away from the ultrasonic blade and includes a coupling feature. The clamp pad is selectively attachable to the blade to acoustically isolate the clamp arm from the ultrasonic blade. The coupling feature of the clamp arm is configured to provide a snap fit between the clamp pad and the clamp arm and thereby permit manipulation of the clamp pad for removal of the clamp pad from the clamp arm.

Abstract: An ultrasonic surgical device includes a handle body, an ultrasonic waveguide engaged with the handle body and extending distally therefrom and including a proximal end portion disposed at the handle body, an ultrasonic generator releasably engagable with the handle body and including a first set of contacts, and an ultrasonic transducer releasably engagable with the handle body independently of the ultrasonic generator. The ultrasonic transducer includes a distal end portion configured to engage the proximal end portion of the ultrasonic waveguide and a second set of contacts configured to electrically couple to the first set of contacts.

Abstract: A device for intra-vascular embolic-thrombolic protection, as well as embolectomy/thrombectomy and atherectomy interventional procedures and methods. At least a portion of the working end of the device may be formed monolithically from a single hypodermic tube, or may be formed of monolithic inner and outer tubes with fixed or movable guide wire elements and imaging modalities. The device may comprise structures enabling coring, expansion within a vascular structure and vascular wall shaving, as well as filtration, stabilization and capturing of thrombotic or embolitic material during an intervention procedure.

Abstract: Assemblies and methods for scoring a stenotic region within a vessel of a patient are disclosed. An assembly can comprise a scoring member and a deployment member. The scoring member can include an elongate push structure and a tubular, self-expanding scaffold. The elongate push structure can be positioned proximal of the self-expanding scaffold and, at its distal end portion, eccentrically coupled with a proximal end portion of the self-expanding scaffold. The deployment member can be removably positioned within a central lumen of the self-expanding scaffold and detachably engageable with a portion of the self-expanding scaffold. The self-expanding scaffold can be movable between a downsized configuration, when receiving axial tension from the deployment member, and an expanded configuration, in the absence of axial tension.

Abstract: A tissue removing catheter includes an apposition mechanism that selectively imparts an axially compressive load on the catheter body to bend the catheter and urge a tissue-removing element toward a blood vessel wall. The apposition mechanism can include one or more adjustment lines and an adjustment mechanism for selectively tensioning one of the adjustment lines to impart the compressive load on the catheter body. Two adjustment lines can have diametrically opposed positions and be wound onto a spool of the adjustment mechanism in opposite directions so that rotation of the spool simultaneously shortens one adjustment line and lengthens the other. The catheter body can have a more flexible bending segment adjacent the tissue-removing element to promote bending near the tissue-removing element operative to urge the tissue-removing element in apposition with the blood vessel.

Abstract: A disposable circumcision apparatus includes a fixture device including a surrounding wall, the surrounding wall including an opening; a blade formed along an interior surface of the surrounding wall, the blade including a first blade mating portion and a second blade mating portion that mate with each other when the fixture device is in a closed position, the blade further including a blade interior circumferential edge; a cushion ring for being positioned against the blade further including a groove formed along a blade interior circumferential edge; means for maintaining the fixture device in a closed position; and a balanus ferrule for placement within the cushion ring and fixture device; wherein the cushion ring includes a groove formed along an interior circumferential edge of the cushion ring for receiving the blade interior circumferential edge.

Abstract: A device comprises a retractable shaft; a shaft biasing spring; and an actuator button. The retractable shaft is biased away from the actuator button by the shaft biasing spring. A magnetic attracting force is created between the retractable shaft and the actuator button upon actuation of the actuator button. Before actuation, a distance between the actuator button and the retractable shaft is great enough that the magnetic attracting force is less than a biasing force of the shaft biasing spring such that the retractable shaft is biased away from the actuator button. Upon actuation, the actuator button is depressed to make the distance between the actuator button and the retractable shaft sufficiently small such that the magnetic attracting force is greater than the biasing force of the shaft biasing spring to allow the retractable shaft to be biased towards the actuator button.

Abstract: A medical injection assembly is provided and includes an introducer with a handle, a sheath, a scope lumen configured to receive an endoscope at a first proximal end of the handle and hold the endoscope in a desired position, a cap attached to the distal end of the scope lumen configured to isolate the scope lumen from the external environment, and a cannula lumen configured to receive a cannula at a second proximal end of the handle and hold the cannula in a desired position. The medical injection assembly includes a cannula configured such that the distance between the distal tip of the cannula and the axis defined by the sheath of the introducer increases as the cannula is moved in a distal direction and a syringe.

Abstract: An endoscopic surgical device and an overtube that allows the state of a distal end of a treatment tool to be easily checked while reducing the diameter of the overtube and can improve surgical efficiency. An endoscope insertion part of an endoscope and a treatment tool insertion part of a treatment tool are insertable through an overtube inserted into a body wall, and a slider is provided for moving the endoscope insertion part and the treatment tool insertion part forward and backward in an interlocking manner. A guide part that guides the endoscope insertion part in a direction away from a distal end of the treatment tool insertion part is provided in the vicinity of an endoscope delivery port in a distal end cap at the distal end of the overtube, and the endoscope insertion part is delivered in an oblique direction from the endoscope delivery port.