Abstract: A polyaxial screwdriver for inserting a bone screw in a vertebra. A polyaxial bone screw assembly includes a coupling element. When a screw engaging end of the polyaxial screwdriver is lowered on the head of the bone screw, the complimentary surfaces of the screw engaging end of the screwdriver and the head of the screw self-align. A ratchet mechanism formed in the screwdriver provides progressive and automatic locking of the polyaxial screwdriver to the coupling element and prevents the accidental unthreading from the coupling element. In another embodiment of the polyaxial screwdriver, a collet slides over the outside surface of the upper end of the coupling element and locks on to the coupling element. In yet another embodiment of a polyaxial screwdriver, the outer sleeve of the polyaxial screwdriver has a split end that securely engages the coupling element.

Abstract: Apparatus and devices for percutaneously extending an existing spinal construct ipsilaterally with an additional spinal construct in a patient are disclosed. The additional spinal construct comprises a rod connector that includes an elongate additional rod integrally attached thereto. The additional rod is placed through an access port in a first orientation generally parallel to the longitudinal axis of the access port and rotated to a different second orientation generally transverse to the longitudinal axis of the access port. During such rotation the additional rod is moved subcutaneously beneath the skin of the patient from the existing spinal rod to an additional bone engaging implant. In another arrangement, the extension of an existing spinal construct in a minimally invasive procedure comprises a rod connector having an offset support for receiving an additional spinal rod that may be placed laterally interiorly or exteriorly of the existing spinal construct.

Abstract: A surgical tool adaptor includes a distal interface member and a proximal holder. The surgical tool adaptor is formed with a lumen through the distal interface member and the proximal holder for passing a guiding element (e.g., K-wire) distally through the distal interface member. The proximal holder includes a locking element for locking the guiding element in the lumen and the distal interface member includes a connecting element for connecting to a surgical tool. The proximal holder is movable relative to the distal interface member so that the proximal holder is movable to a position wherein the guiding element does not protrude proximally out of the proximal holder.

Abstract: A device configured to provide a faster and more accurate measurement of depths of holes for placement of bone screws and fastener for bone implant fixation procedures. The device includes a combination of a bone probe for physical examination of a hole drilled in a bone and a depth gauge member for determining a depth of the hole and providing digital measurement of the depth.

Abstract: A device configured to provide a faster and more accurate measurement of depths of holes for placement of bone screws and fastener for bone implant fixation procedures. The device includes a combination of a bone probe for physical examination of a hole drilled in a bone and a depth gauge member for determining a depth of the hole and providing digital measurement of the depth via a display on the instrument and/or via a wireless exchange of measurement data to a remote computing device, such as a tablet or smartphone.

Abstract: Neurophysiological instruments and techniques are improved through various enhancements. Stimulation of an instrument is possible while it is advancing into the spine or elsewhere, alerting the surgeon to the first sign the instrument or device (screw) may be too near a nerve. A directional probe helps surgeons determine the location of the hole in the pedicle. Electrically insulating sleeves prevent shunting into the soft tissues. According to a different improvement, the same probe to be used to stimulate different devices, such as screws and wires. Electrical impulses may be recorded from non-muscle regions of the body, including the spine and other portions of the central nervous system as opposed to just the extremities.

Abstract: A composite implant comprising an injectable matrix material which is flowable and settable, and at least one reinforcing element for integration with the injectable matrix material, the at least one reinforcing element adding sufficient strength to the injectable matrix material such that when the composite implant is disposed in a cavity in a bone, the composite implant supports the bone.

Abstract: An intramedullary nail includes a first nail module having an elongated body and at least one notch on a first connecting end, a second nail module having an elongated body and at least one notch on a second connecting end, and a key. The key has a ring having a first ridge on a top side and a second ridge on a bottom side, the key configured to be positioned between the connecting ends of the first and the second nail modules with the first ridge of the key fitting into the notch of the first nail module and the second ridge of the key fitting into the notch of the second nail module. The first ridge is offset from the second ridge and the offset between the first ridge and the second ridge determines a relative orientation between the first nail module and the second nail module.

Abstract: Illustrative embodiments of orthopedic implants and methods for surgically repairing hammertoe are disclosed. According to at least one illustrative embodiment, an orthopedic implant includes a proximal segment comprising a number of spring arms forming an anchored barb at a first end of the implant, a distal segment extending between the proximal segment and a second end of the implant, and a central segment disposed between the proximal and distal segment.

Abstract: A femur fixation apparatus capable of firmly fixing in place an anti-rotation member, which includes an intramedullary nail, an anti-rotation pin configured to be inserted through the intramedullary nail, and an adjuster fitted in the intramedullary nail. The adjuster includes a rotation part and a sliding part. The rotation part is rotatably and threadedly engaged in the intramedullary nail and rotatably connected to the upper end of the sliding part. The sliding part is formed with a space through which the anti-rotation pin is inserted. An urging member extends from a side wall of the space into the space. When the rotation part is rotated in a predetermined direction relative to the intramedullary nail, then the adjuster moves downward, and the urging member presses downward and fixes in place the anti-rotation pin.

Abstract: Self-aligning plating systems and methods are disclosed. The self-aligning plating system may include an interbody spacer, a medical device plate, and an insertion member. The interbody spacer may be inserted between a top vertebra and a bottom vertebra of a patient's spinal column. A medical device plate may slide along an insertion member in operable connectivity with the interbody spacer so that the medical device plate comes into contact with and can be secured to the patient's anatomy.

Abstract: An orthopedic locking screw arranged in a bore of an orthopedic implant enables easy removal of a broken locking screw out of the implant. The orthopedic locking screw for a cooperation with a thread in the orthopedic implant comprises a longitudinally extending shaft. The shaft comprises a thread pattern section extending at least partially along the shaft. The thread pattern section comprises a first thread with a first direction, which is a functional thread configured for the cooperation with the thread in the orthopedic implant. The thread pattern section further comprises a second thread with a second direction opposite to the first direction of the first thread. The second thread is superimposed on the first thread and intersects the first thread. An orthopedic locking system comprises the orthopedic locking screw and the orthopedic implant. The locking screw is manufactured by applying the thread pattern section to the longitudinally extending shaft.

Abstract: An assembly has a bone anchoring base and a screw. The bone anchoring base has at least one protrusion configured to be inserted in a hole arranged in the cancellous portion of a bone. The screw has a thread suitable for engaging with the cancellous portion of the bone. The protrusion is inwardly hollow and comprises an orifice at its distal free end, the screw being configured to be engaged through the protrusion and screwed in the cancellous portion of the bone through the orifice. The orifice is tapped at the pitch of the thread of the screw and the thickness of a distal wall is such that it is possible to arrange more than half of a turn of the threading therein, suitable for receiving the thread of the screw, such that, during the placement of the screw, the thread of this screw engages with said distal wall.

Abstract: Surgical methods and devices are provided for bending spinal rods. In one embodiment, a handheld tool is provided having an elongate shaft with a lumen formed therein that is configured to accommodate a spinal rod. The tool can include an opening in a proximal end that is configured to permit the loading of the spinal rod into the lumen, and a plurality of openings spaced along a longitudinal axis thereof that intersect the lumen for allowing a user to view and/or grasp a rod extending through the rod-receiving lumen and positioned within one of the plurality of openings. The tool can further be configured to permit a bent spinal rod to be received within the lumen. For example, the tool can include a channel in a lower surface thereof that allows a rod to exit the lumen and to extend laterally away from the tool.

Abstract: An orthopedic clamp to assist in reducing the displacement between bone ends of a fracture, and to position a fixation device, during open fracture reduction surgery is described. The clamp includes a holder to hold the fixation device against the bone. The clamp may also swivel in relation to the holder while the position of the fixation device remains unchanged.

Abstract: A driver for inserting and removing flexible and non-flexible fastening devices. The driver has an attachment for interfacing with the proximal end of the device and a flexible driver rod for interfacing with the distal end of the device. Alternatively, the flexible driver rod can interface with both the distal and proximal ends of the fastening device. The driver further interfaces with a guide wire or other means that connect with the interior of the device.

Abstract: A vapor delivery system and method is provided that is adapted for ablating bladder tissue to treat overactive bladder (OAB). The vapor delivery system includes an anchor tip configured anchor the system in the bladder while condensable vapor is delivered to target tissue. In one method, the vapor delivery system is advanced transurethrally into the patient to access the target tissue of the bladder, which can include a surface sensor of the bladder responsible for creating an urge incontinence sensation. The vapor delivery system includes a vapor source that provides a high quality vapor for delivery to tissue.

Abstract: Methods and devices for performing ablation. In some examples an ablation delivery system is configured to allow separate voltage levels of a capacitor stack to be accessed for use in therapy delivery. Ablation therapy systems switchable between current and voltage controlled output are described. Methods of treating a patient using adjustable interphase or interpulse delay are disclosed as well.

Abstract: A sealing and/or cutting instrument having a thermally active surface or element which may be used to seal and then cut tissue, ducts, vessels, etc., apart. The instrument may include a thermally active surface or element comprised of a conductor covered with a ferromagnetic material. The instrument may contact tissue with one or more surfaces comprised of a non-stick material. A sensor in communication with the instrument may be used to monitor a therapeutic procedure and signal when sealing and/or cutting of a tissue is complete.

Abstract: A flexible catheter has an ablation electrode disposed in its distal segment. The ablation electrode a cavity formed in its external surface, a microelectrode configured to fit into the cavity, a conductive wire lead connecting the microelectrode to receiving circuitry, and an electrical shield surrounding the wire lead. A power generator is connected to the ablation electrode and the electrical shield in a generator circuit. A back patch electrode adapted to contact with the subject is connected in the generator circuit. The microelectrodes can be active while energizing the ablation electrode.

Abstract: Methods and devices for performing ablation using spatially multiplexed waveforms are disclosed. The increased efficacy of monophasic waveforms is combined with the reduced side effects of biphasic waveforms by distributing components of the waveform across multiple electrodes. Charge balancing occurs upon completion of therapy delivery within a time period that avoids muscle stimulation, while allowing unbalanced waveforms to be delivered during stimulation.

Abstract: An electrode instrument for use in a resectoscope, the electrode instrument having an elongate shaft portion with two support arms through which a conductor extends that forms an electrode at the distal end of the electrode instrument that can be subjected to high-frequency current and is arranged between the distal ends of the support arms, wherein at least one of the support arms has in its distal end region a tissue contact part for holding tissue fragments that is arranged on the outer wall of the support arm and angled in relation to the longitudinal axis of the support arm; and to a corresponding resectoscope.

Abstract: A reusable tip for minimally invasive surgical instruments can include an end effector, a two-part hub, and a yoke. The end effector can include one or more movable portions enabling the end effector to move between first (e.g., open) and second (e.g., closed) positions via manipulation of the yoke within the hub. The hub can include a proximal hub and a distal hub coupled together. The end effector can be coupled to the distal hub, which can be made of a metal to provide high strength and secure shape to the distal hub. The proximal hub can be made of an autoclavable insulation material capable of maintaining a removable coupling with a control shaft. The proximal hub can be made of polyetheretherketone (PEEK).

Abstract: A surgical instrument includes a housing having an elongated shaft extending distally therefrom configured to support an end effector at a distal end thereof. A handle operably couples to a drive assembly and is moveable to actuate the end effector. The drive assembly includes: front and rear drive tubes, the rear drive tube including a front washer disposed at a distal end thereof, the front drive tube including a rear washer disposed at a proximal end thereof; a stopper slidably disposed atop the front tube, the stopper and the rear washer defining a dead space therebetween; and a spring operably associated with the stopper. Initial actuation of the handle moves the front and rear drive tubes to close the end effector to grasp tissue and, once closed, further movement of the handle moves the rear drive tube to slide the stopper to eliminate the dead space.

Abstract: A forceps includes a housing, an elongated shaft assembly, and a cam assembly. The housing includes a movable handle pivotally coupled to the housing. The elongated shaft assembly is coupled to the housing and extends distally to support jaw members at a distal end thereof. One or both of the jaw members is selectively moveable relative to the other jaw member between a spaced apart position for manipulating tissue and a closed position for compressing tissue therebetween. The cam assembly is supported in the housing and includes an eccentric cam cable and an eccentric cam.

Abstract: An endoscopic bipolar forceps includes a housing and a shaft affixed to the housing. The shaft includes a longitudinal axis defined therethrough and a pair of jaw members attached to a distal end thereof. The forceps also includes a drive assembly for moving one of the jaw members relative to the other jaw member from a first position wherein the movable jaw members are disposed in spaced relation relative to each other to a second position wherein the jaw members are closer one another for manipulating tissue. A movable handle is included which is rotatable about a pivot to force a drive flange of the movable handle into mechanical cooperation with the drive assembly to move the jaw members from the open and closed positions. The pivot is located a fixed distance from the longitudinal axis and the drive flange is located generally along the longitudinal axis.

Abstract: An endoscopic bipolar forceps includes a housing and a shaft affixed to the housing. The shaft includes a longitudinal axis defined therethrough and a pair of jaw members attached to a distal end thereof. The forceps also includes a drive assembly for moving one of the jaw members relative to the other jaw member from a first position wherein the movable jaw members are disposed in spaced relation relative to each other to a second position wherein the jaw members are closer one another for manipulating tissue. A movable handle is included which is rotatable about a pivot to force a drive flange of the movable handle into mechanical cooperation with the drive assembly to move the jaw members from the open and closed positions. The pivot is located a fixed distance from the longitudinal axis and the drive flange is located generally along the longitudinal axis.

Abstract: An electrosurgical instrument which is capable of simultaneously ablating an area of tissue with microwave energy and performing resection with RF energy. The instrument comprises a structure for conveying both RF and microwave energy to an instrument tip that is configured to emit the microwave energy in a manner suitable for ablation (e.g. as a substantially spherical field) and to emit the RF energy in a more focussed manner to enable accurate and controllable resection to be performed. The energy conveying structure comprises a coaxial transmission line for conveying microwave energy. The coaxial transmission line has a hollow inner conductor that defines a passage that supports a second transmission line for conveying radiofrequency energy.

Abstract: The present disclosure relates to a device assembly and a method for treating heart failure by normalizing elevated blood pressure in the left atrium of a heart of a mammal Disclosed herein is a RF energy-based transcatheter interatrial septum excision device configured to create a sized interatrial aperture between the right and left atria of a heart for the relief of elevated left atrial pressure. The device assembly comprises a delivery catheter, a tissue stabilizer attached to a tissue stabilizer catheter, a tissue cutter attached to a tissue cutter catheter, a remotely located RF generator connected to an RF cathode and anode of the device assembly.

Abstract: Systems, devices, and methods for electroporation ablation therapy are disclosed, with the device including a set of splines coupled to a catheter for medical ablation therapy. Each spline of the set of splines may include a set of electrodes formed on that spline. The set of splines may be configured for translation to transition between a first configuration and a second configuration. The devices described herein may be used to form a lesion via focal ablation.

Abstract: An electrosurgical apparatus for tightening ligaments using microwave energy. A detector is used to obtain information about a treatment zone. Based on this information, an energy delivery profile is determined. The energy delivery profile is selected to cause desired thermal effects in target tissue (e.g. ligaments, tendons or the like) without unwanted thermal side effects is determined and delivered. With this apparatus, energy can be delivered in a precise manner to the target tissue. The energy delivery profile may be based on a complex impedance, or attenuation and/or phase constants of the type of body tissue in the treatment zone.

Abstract: An electrosurgical instrument for applying microwave energy to biological tissue, where the instrument is capable of freezing biological tissue in a region around a radiating tip portion and applying microwave energy to the frozen tissue. By freezing the region around the radiating tip portion, microwave energy radiated from the radiating tip portion can be transmitted through the frozen region with low losses and into tissue surrounding the frozen region. This enables the size of the treatment area to be increased without having to increase the amount of microwave energy delivered to the radiating tip portion. The instrument comprises a transmission line, a radiating tip, a fluid feed for conveying a tissue-freezing fluid, and a thermal transfer portion arranged to provide thermal communication between the tissue-freezing fluid and biological tissue in a treatment zone.

Abstract: A microwave ablation device including a cable assembly configured to connect a microwave ablation device to an energy source and a feedline in electrical communication with the cable assembly. The microwave ablation device further includes a balun on an outer conductor of the feedline, and a temperature sensor on the balun sensing the temperature of the balun.

Abstract: An articulating, steerable surgical probe includes an elongated, flexible transfer tube adapted for insertion into a surgical region for endoscopic laryngeal laser surgery. A lumen is defined by an interior of the transfer tube, and a laser fiber extends through the lumen for delivering a therapeutic laser signal to a distal end of the laser fiber. An articulating tip at the distal end of the transfer tube is responsive to articulating forces from a retractable tether for directing the treatment probe in a direction of the articulation, and a linkage to the tether from a control module effects controlled retraction of the tether for articulating the tip towards a surgical target, such that the articulating tip imposing a bend radius based on a signal loss through the laser fiber.

Abstract: [Object] To provide an ablation system capable of suppressing heat damages to the lumen intima. [Solution] An ablation system 10 has an ablation device 11 in which a balloon 21 is provided on the distal end side of a shaft 22 and an in-side tube 27 causing a fluid to flow into the balloon 21, the internal space of the shaft 22 causing a fluid to flow out of the balloon 21, and an optical fiber 29 guiding laser light into the balloon 21 are individually provided along the shaft 22, a laser light generating unit 12 emitting laser light to the optical fiber 29, and a fluid returning unit 13 returning a fluid into the internal space of the balloon 21. The ablation device 11 has a reflector 33 reflecting laser light emitted from the optical fiber 29 in the balloon 21, in which the reflector 33 is movable along the axial direction 191 in the balloon 21 and is rotatable in the axial direction 101 as the axis line.

Abstract: The technology described herein can be embodied in a method that includes obtaining a representation of a first image of a surgical scene using electromagnetic radiation of a first wavelength range outside the visible range of wavelengths, wherein an amount of electromagnetic radiation of the first wavelength range received from a first tissue type is lower than that received for a second tissue type. The method also includes obtaining a representation of a second image using electromagnetic radiation of a second wavelength range outside the visible range of wavelengths, wherein an amount of electromagnetic radiation of the second wavelength range received from the second tissue type is substantially different from that received for the first tissue type. The visual representation of the surgical scene is rendered on the one or more displays using the representation of the first image and the representation of the second image.

Abstract: A method of planning an image-guided interventional procedure to be performed on a patient, where expected motion of the patient, such as that of a breathing cycle, is determined on a sequence of preoperative images, and the procedure trajectory is planned accordingly. The method takes into account the initial positions of the interventional entry, the target region, and any obstructions or forbidden regions between the entry point and the target region, and uses object tracking methods of image processing on the preoperative images to determine how the positions of these three elements change relative to each other during the patient's motion cycle. The method may automatically search in at least some of the preoperative images taken at different temporal points of the motion cycle, for a path connecting the entry point with the target and avoiding the obstacles, which provides minimal lateral pressure on the patient's tissues.

Abstract: A surgical visualization system for use with a robotic surgical system that includes a surgical tool movable with respect to a tissue of a patient in response to an instrument motion control signal is disclosed. The surgical visualization system includes a camera and a control circuit coupled to the camera. The control circuit is configured to determine a distance between the surgical tool and the tissue and adjust a magnification of the camera based on the distance between the surgical tool and the tissue.

Abstract: Systems, methods and apparatus are disclosed for properly using and locating object retention wands via the use of at least one sensor located on or in the wand body for determining when the wand is capable of properly scanning a target area. In one form, a proximity sensor is used. In another form a motion sensor is used. In still other forms, both a proximity sensor and motion sensor are used. In some forms, the wand system further includes an indicator for indicating whether the wand is within proper read range, speed and/or orientation of a target area so as to confirm proper use of the wand to locate retained objects before concluding a procedure. In other forms one or more of a user interface, scanner and network interface may also be used with the system. Further systems, methods and apparatus are also disclosed herein.

Abstract: Methods and systems for x-ray and fluoroscopic image capture and, in particular, to a versatile, multimode imaging system incorporating a hand-held x-ray emitter operative to capture digital or thermal images of a target; a stage operative to capture static x-ray and dynamic fluoroscopic images of the target; a system for the tracking and positioning of the x-ray emission; a device to automatically limit the field of the x-ray emission; and methods of use and use of such systems to register a virtual model of an anatomic structure to the corresponding anatomic structure.

Abstract: Methods and systems for x-ray and fluoroscopic image capture and, in particular, to a versatile, multimode imaging system incorporating a hand-held x-ray emitter operative to capture digital or thermal images of a target; a stage operative to capture static x-ray and dynamic fluoroscopic images of the target; a system for the tracking and positioning of the x-ray emission; a device to automatically limit the field of the x-ray emission; and methods of use and use of such systems to register a virtual model of an anatomic structure to the corresponding anatomic structure.

Abstract: A method and system for determining a target location for a medical device having complex geometry relative to an anatomical feature, and for navigating and positioning the medical device at the target location. The system may include a medical device including a treatment element having a centroid, one or more navigation electrodes, and a longitudinal axis and a navigation system in communication with the one or more navigation electrodes, the navigation system including a processing unit. The processing unit may be programmed to define a plane that approximates a surface of the anatomical feature, define a centroid of the anatomical feature, define a vector that is normal to the plane and extends away from the centroid of the anatomical feature, and determine a target location for the treatment element of the medical device based on the vector to assist the user in placing the device for treatment.

Abstract: Methods are provided for planning, performing, and assessing of surgical correction to the spine during a spinal surgical procedure. These methods are implemented by a control unit through a GUI to digitize screw locations, digitize anatomical reference points, accept one or more correction inputs, and generate one or more rod solution outputs shaped to engage the screws at locations distinct from the originally digitized locations.

Abstract: Systems and methods are provided in which intraoperatively acquired surface data is employed to verify the correspondence of an intraoperatively selected spinal level with a spinal level that is pre-selected based on volumetric image data. Segmented surface data corresponding to the pre-selected spinal levels may be obtained from the volumetric image data, such that the segmented surface data corresponds to a spinal segment that is expected to be exposed and identified intraoperatively during the surgical procedure.

Abstract: A handheld user interface device for controlling a robotic system may include a member, a housing at least partially disposed around the member and configured to be held in the hand of a user, and a tracking sensor system disposed on the member and configured to detect at least one of position and orientation of at least a portion of the device. At least one of the detected position of the portion of the device and detected orientation of the portion of the device is correlatable to a control of the robotic system.

Abstract: A method of operating a robotic system involves servoing a multitude of joints of the robotic system in a first joint velocity space. The movement of the multitude of joints in the first velocity space moves a remote center or an end effector of the robotic system. The method further involves floating the multitude of joints in a second velocity space. The movement of the multitude of joints in the second velocity space moves the end effector or the remote center, respectively. The method further involves controlling motion of the multitude of joints in a third velocity space. The movement of the multitude of joints in the third velocity space does not move the end effector and does not move the remote center.

Abstract: A surgical system includes a surgical instrument that is sensitive to backlash that would adversely affect the transmission of controlled torque and position to the surgical instrument. The surgical instrument is coupled to motors in a surgical instrument manipulator assembly via a mechanical interface. The combination of the mechanical interface and surgical instrument manipulator assembly have low backlash, e.g., less than 0.7 degrees. The backlash is controlled in the surgical instrument manipulator assembly. From the drive output disk in the surgical instrument manipulator assembly to the driven disk of the surgical instrument, the mechanical interface has zero backlash for torque levels used in surgical procedures.

Abstract: A support system, a support method, and a support program in the form of a non-transitory computer readable medium are disclosed that support a medical action during an operation. The support system includes a data acquisition unit configured to acquire, during an operation, use state data on a use state of a medical device during the operation, and target lesion data on a target lesion of a patient during the operation, a learning unit configured to perform machine learning using the use state data and the target lesion data, and a presentation unit configured to present a recommended operation policy based on a result of the machine learning.

Abstract: An input control device is disclosed. The input control device includes a central portion coupled to a multi-axis force and torque sensor, which is configured to receive input control motions from a surgeon. The central portion is flexibly supported on a base. The input control device also includes a rotary joint coupled to a rotary sensor. The input control device is configured to provide control motions to a robotic arm and/or a robotic tool based on input controls detected by the multi-axis force and torque sensor and the rotary sensor.

Abstract: An input control device is disclosed. The input control device can be configured to operate in different modes depending on proximity data provided by a proximity detection system. The input control device can include a feedback generator configured to generate feedback in response to the input control device switching between operational modes, the proximity data provided by the proximity detection system, and/or other conditions of the surgical procedure, robotic surgical tool, surgical site, and/or patient. The input control device can include a variable resistance assembly for resisting input control motions applied to an actuator thereof. Additionally or alternatively, the input control device can include an end effector actuator assembly for repositioning the end effector actuator based on feedback from a paired robotic surgical tool.