Abstract: An endoscope for removing tissue at a surgical site includes an elongated tubular body insertable within a mammalian cavity of a patient. An instrument channel extends between a first opening at a distal end and a second opening at a proximal end of the tubular body and is sized and configured to receive a surgical cutting assembly that includes an aspiration channel configured to remove material entering the endoscope via a distal end of the surgical cutting assembly. A torque generation component configured to generate torque is positioned within the distal end and configured to provide the generated torque to a coupling component. The coupling component is positioned at the distal end of the elongated tubular member and configured to actuate a cutting component of the surgical cutting assembly responsive to actuation of the torque generation component.

Abstract: An endoscopic endocap for excising a target portion of a native tissue from a remaining portion of the native tissue during a surgical procedure includes an annular main body. The main body has a proximal end and an oppositely disposed distal end. The distal end includes an extension that protrudes longitudinally beyond a remaining portion of the distal end. An outer surface of the distal end, and an inner surface of the main body, extend longitudinally between the proximal and distal ends. The inner surface defines at least one lumen with an opening terminating at the terminal portion of the distal end. At least one excisor is disposed on the extension with the excisor is laterally spaced from the outer surface of the annular main body. The excisor remains stationary with respect to the lumen during use of the excisor to excise the target portion of the native tissue.

Abstract: The teachings provided herein are directed to a methods and devices for treating a hemorrhoid in a subject in a manner that produces substantially less post-procedural pain in the subject, the method minimizing or avoiding a removing or a necrosis of a rectal tissue fold.

Abstract: A tool for manipulating a foreign body (e.g., a deployed medical device) can include an operative portion. The operative portion can be used to move the foreign body in the proximal and/or distal directions with respect to the removal/repositioning tool and/or the tissue surrounding the foreign body. In some embodiments, the tool can include a compressing portion that can be used to compress the foreign body as the foreign body is pulled by the operative portion in the proximal direction. The tool can further include a sleeve that can be used to transition the operative portion and/or compressing portion between an opened configuration and a closed configuration. In some embodiments, the tool can be used in conjunction with an endoscope to navigate the tool to the site of a foreign body within the body of a patient.

Abstract: Surgical instruments and surgical systems including the surgical instrument and a morcellator. The surgical instrument includes a tool assembly having an articulating joint and a screw positioned at a distal end of the articulating joint. The articulating joint is configured to articulate a distal portion of the tool assembly at an angle in relation to the longitudinal axis of the surgical instrument. The screw is configured to engage tissue, for example, a myoma in the uterine wall of a patient, and is configured to pitch and roll the tissue to expose cutting planes. The morcellator is configured to engage the tissue to morcellate the tissue and remove the tissue from a patient.

Abstract: Methods of providing suction may include providing suction patterns having varying intensity levels, such as a “crescendo suction” pattern. Cycles of crescendo suction patterns may comprise variable intensities of negative suction in a crescendo pattern (such as a small intensity negative suction pressure, a medium intensity negative suction pressure, and a large intensity negative suction pressure). The suction patterns may include pauses or temporary stops to the negative suction pressure.

Abstract: The present embodiments provide apparatus and methods suitable for removing lymph nodes or providing a tissue anchor during a translumenal procedure. In one embodiment, an apparatus suitable for facilitating removal of a lymph node comprises an expandable device including at least one deployable member having contracted and expanded states. The deployable member may be delivered in the contacted state to a location distal to the lymph node using an insertion tool adapted to be disposed beyond the lymph node. In the expanded state, the deployable member comprises a configuration sized to at least partially circumferentially surround and engage the lymph node. In an alternative embodiment, the deployable member may anchor into an outer portion of a visceral wall to promote stabilization of a system during a medical procedure.

Abstract: The present disclosure relates generally to the field of tissue removal and more particularly to methods and devices for use in medical applications involving selective tissue removal. One exemplary method includes the steps of providing a tissue cutting instrument capable of distinguishing between target tissue to be removed and non-target tissue, urging the instrument against the target tissue and the non-target tissue, and allowing the instrument to cut the target tissue while automatically avoiding cutting of non-target tissue. Various tools for carrying out this method are also described.

Abstract: A tissue resecting system includes an assembly having first and second tubular members. An electrical motor drive and controller moves the second member to resect tissue received in a window of the first member. A tachometer sends motor drive rotational signals to the controller, and the controller modulates a motor voltage in response to the signals from the tachometer both to drive the second member at a predetermined speed and to calculate resistance to driving the second member at the predetermined speed.

Abstract: Sinusitis, enlarged nasal turbinates, tumors, infections, hearing disorders, allergic conditions, facial fractures and other disorders of the ear, nose and throat are diagnosed and/or treated using minimally invasive approaches and, in many cases, flexible catheters as opposed to instruments having rigid shafts. Various diagnostic procedures and devices are used to perform imaging studies, mucus flow studies, air/gas flow studies, anatomic dimension studies, endoscopic studies and transillumination studies. Access and occluder devices may be used to establish fluid tight seals in the anterior or posterior nasal cavities/nasopharynx and to facilitate insertion of working devices (e.g., scopes, guidewires, catheters, tissue cutting or remodeling devices, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc.

Abstract: A kit for surgically removing stones comprising: a double barreled sheath including a first barrel and a second barrel joined side-by-side; a first connector which is engaged at the proximal end of the first barrel; a second connector which is engaged at the proximal end of the second barrel; a first rigid tube interconnecting the first barrel with the first connector with the first connector being releasably engaged to the first rigid tube and the first rigid tube, first barrel and first connector being co-axial; a second rigid tube interconnecting the second barrel with the second connector with the second connector being releasably engaged to the second rigid tube and the second rigid tube, second barrel and second connector being co-axial; and a wire basket retriever adapted for insertion into one of the barrels and being releasably engaged with a connector or an actuation device.

Abstract: The present invention provides an endoscopic abrasion device and methods of use thereof. The device includes a catheter having an inflation balloon including one or more elements disposed on the balloon for abrasion of tissue when the balloon is rotated about the longitudinal axis of the catheter. The device may be used to treat and diagnose diseases of the esophageal passage, such as Barrett's disease.

Abstract: In laparoscopic surgery, small (5-12 mm diameter) incisions are made in the abdominal wall through which instruments dissect and remove specimens that may be several centimeters in diameter. Removal of the sample typically requires either enlarging these incisions or morcellating the sample to pass through the sub-centimeter ports. The laparoscopic device permits extraction of the sample to be removed in a female using the vagina, which has sufficient elasticity to accommodate removal of large specimens. The posterior portion of the vagina communicates to the abdomen through a few tissue layers, and is distant from vital anatomic structures. Utilizing the vagina is optimal due to its ease of access to the abdomen and repair, minimal scarring and post-operative pain, and faster recovery following surgery. A deployable collection bag is housed in a sheath, which is deployed into the vagina or abdominal cavity to extract a large (multiple-centimeter) specimen(s) through the vagina.

Abstract: A medical device may include tubular member having a proximal end, a distal end, and a lumen extending therebetween. The tubular member may include an opening at a distal portion of the tubular member, wherein the opening is in communication with the lumen, wherein a distal end of the opening is disposed proximate of the distal end of the tubular member, and wherein the distal portion of the tubular member is configured to bend in at least one plane. The medical device may further include an actuation member extending at least partially within the tubular member, wherein a distal portion of the actuation member is configured to exit the tubular member at a location proximate the opening, wherein a distal end of the actuation member is coupled to the distal end of the tubular member, and wherein pulling the actuation member proximally is configured to cause the distal portion of tubular member to form a loop with itself.

Abstract: Disclosed is an infinitely adjustable depth stop for a laparoscopic instrument having a shaft, the depth stop including a first component having a first annular space adapted to allow the shaft to be fitted therethrough. The first annular space has a reducible diameter and an interference surface against which the shaft may be fitted. Upon reduction of the reducible diameter, the interference surface frictionally engages the shaft to arrest relative movement of the depth stop along the shaft. The frictional engagement may be along a curve, a spiral curve, or an area. Means are also provided to reopen the reducible diameter to release the depth stop.

Abstract: An apparatus has an elongate element with a proximal end and a distal end. A connection element is disposed at the proximal end of the elongate element. A morcellator is disposed proximate the distal end. The morcellator has a shank with a base and a leading surface. The base is operably connected to the distal end of the elongate element. The shank at least partially defines a flute disposed substantially helically about an outer surface of the shaft. At least one cutting edge is disposed on the leading surface and proximate the at least one flute.

Abstract: Methods for distinguishing between two interspersed biological tissues, for procedures such as surgical resection, include exposing the tissues to at least two components, a first of which components produces or is capable of producing a detectable signal, and the other of which components either blocks the produced signal of the first component or activates the first component to produce the detectable signal. One of the components is selectively taken up by one of the tissues at a concentration which is greater than the concentration by which it is taken up by the other tissue to provide a distinguishable difference in the detectable signal originating from the two tissues.

Abstract: A chlorotoxin conjugate detectable by fluorescence imaging that allows for intra-operative visualization of cancerous tissues, compositions that include the chlorotoxin conjugate, and methods for using the chlorotoxin conjugate.

Abstract: Methods for prognosis and diagnosis of pancreatic cysts are disclosed. In particular, the invention relates to the use of biomarkers from pancreatic cyst fluid to aid in the diagnosis, prognosis, and treatment of pancreatic cysts. More specifically, differential expression of certain metabolites, including glucose and kynurenine, and the protein, amphiregulin, is used to distinguish benign, pre-malignant, and malignant pancreatic cysts.

Abstract: Methods for identifying the presence of cancerous cells or tissue by: applying a compound of formula (I), or salts thereof, to a living body, wherein R1 represents hydrogen or the same or different one to four substituents; R2, R3, R4, R5, R6, and R7 independently represent hydrogen, hydroxy, alkyl, or halogen; R8 and R9 independently represent hydrogen or alkyl; and X represents C1-C3 alkylene; and detecting fluorescence emitted by a compound of formula (II), wherein R1, R2, R3, R4, R5, R6, R7, R8, and R9 are as defined above; wherein fluorescence emitted by a compound of formula (II) is indicative of the presence of cancerous cells or tissue.

Abstract: A medical instrument converts linear movement of a shaft at a proximal end of the instrument to a rotational movement of an end effector of the instrument. According to one embodiment, the medical instrument includes an end effector formed of a snare loop connected to a shaft that is located within a sleeve. Once the sleeve is located near a desired location within a patient, the snare loop may be rotationally positioned with linear movement of the shaft by the operator. The shaft is formed with a threaded portion that matches threads formed in a torque transmitter element fixed within the sleeve. Linear movement of the shaft through the torque transmitter element causes the shaft to rotate. The medical instrument may also include a pivot connector for reducing torque build-up of the shaft and/or a clutch assembly for restricting controlled rotation of the snare loop to only one direction.

Abstract: A surgical instrument includes a hollow member having a sidewall provided with a window and a closure member movably connected to the hollow member for alternately covering and uncovering the window. The hollow member has a first clamping surface along an edge of the window, while the closure member has a second clamping surface opposing the first clamping surface and disposable substantially adjacent thereto in a clamping or closure configuration of the instrument. The instrument additionally comprises a tissue occlusion component mounted to at least one of the hollow member and the closure member for acting on tissues gripped between the first clamping surface and the second clamping surface, to couple the tissues to each other.

Abstract: An electrosurgical device is provided for removing polyps from the gastrointestinal tract of a patient. In one implementation, an electrosurgical device comprises a snare support member and a snare positioning assembly mounted on an exterior surface of the snare support member. The snare positioning assembly has a longitudinal axis substantially parallel with and offset from the longitudinal axis of the snare support member. The device also includes a base member attached to a distal end of the snare support member and has a longitudinal axis substantially aligned with the longitudinal axis of the snare support member. An aperture is formed through a side wall of the base member. Also included is a polyp snare extending through a first channel of the snare positioning assembly, through the aperture, and through a second channel of the base member.

Abstract: A system and associated method for altering or destroying tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders. In one aspect, the system includes a device configured to deploy devices for altering the lobes of a prostate.

Abstract: A snare device and methods of making and using the same. The snare device may include a sheath having a proximal end region, a distal end region, and a shaft slidably disposed therein. A handle may be coupled to the shaft and disposed adjacent the proximal end region. The snare device may also include a swivel disposed adjacent the distal end region of the sheath and coupled to the shaft and to a snare loop.

Abstract: A surgical instrument for removing a gallbladder is provided. The surgical instrument includes a handle assembly, an elongated body portion extending distally from the handle assembly, and a capture portion operably mounted on a distal end of the elongated body portion. The capture portion defines a tissue receiving opening when in an open configuration and is configured for receipt through an incision when in the capture portion is in a closed configuration. The capture portion includes at least one sharpened member for cutting tissue received within the tissue receiving opening as the capture portion moves from the open configuration to the closed configuration. Also provided is a method of removing a gallbladder using a surgical instrument.

Abstract: A device for transcatheter gathering of tissue of a heart valve leaflet may include an elongated tube extending in a longitudinal direction and a capture tool moveable in the elongated tube between a retracted position and an extended position. The elongated tube may have at least one slot extending generally in the longitudinal direction from a distal end of the elongated tube. The at least one slot may have an open end at the distal end of the elongated tube and a closed end remote therefrom. The capture tool may be operable to gather tissue of the heart valve leaflet into the at least one slot. The gathered tissue may have a pleated configuration.

Abstract: hysteroscopic system includes a hysteroscope having a main body coupled to an extension portion. The extension portion may be a shaft configured to extend transcervically to a patient's uterine cavity. First, second, and third channels extend from the main body to a distal end of the extension portion. A fluid source is coupleable to a proximal end of the first channel, and a pressure sensor is coupleable to a proximal end of the second channel. A tissue resecting probe is configured for introduction through the third channel. At least one resistance feature is included which is configured to provide a selected level of resistance to axial sliding of the probe through the third channel while permitting rotation of the probe within the third channel.

Abstract: The teachings provided herein are directed to a methods and devices for treating a hemorrhoid in a subject in a manner that produces substantially less post-procedural pain in the subject, the method minimizing or avoiding a removing or a necrosis of a rectal tissue fold.

Abstract: Provided herein is a method for treating spinal stenosis comprising percutaneously accessing the epidural space from a first side of the spine. The first side of the spine is located on one side of the medial plane with respect to the spinal cord. A tissue removal tool is then advanced through the first side of the epidural space into the other side of the epidural space, where the other side of the epidural space is located on the other side of the medial plane of the spinal cord. Once the tissue removal tool is located on the second side of the medial plane, stenosis can be reduced using the tissue removal tool.

Abstract: According to an aspect of the present invention, a medical device is provided, which comprises the following: (a) a hollow elongate body (e.g., a elongate cylinder, such as a needle) having distal and proximal ends; and (b) a rotatable member comprising a tissue morselizer and an elongate shaft (e.g., an auger-like tissue-drilling bit). In the devices of the present invention, the elongate shaft is disposed within the hollow elongate body and cooperates with the hollow elongate body to (i) advance material (e.g., morselated tissue) toward the proximal end of the hollow elongate body when the shaft is rotated in a first direction, and (ii) advance material (e.g., a therapeutic agent and/or a bulking agent) toward the distal end of the hollow elongate body when the shaft is rotated in a second direction that is opposite the first direction.

Abstract: Sinusitis, enlarged nasal turbinates, tumors, infections, hearing disorders, allergic conditions, facial fractures and other disorders of the ear, nose and throat are diagnosed and/or treated using minimally invasive approaches and, in many cases, flexible catheters as opposed to instruments having rigid shafts. Various diagnostic procedures and devices are used to perform imaging studies, mucus flow studies, air/gas flow studies, anatomic dimension studies, endoscopic studies and transillumination studies. Access and occluder devices may be used to establish fluid tight seals in the anterior or posterior nasal cavities/nasopharynx and to facilitate insertion of working devices (e.g., scopes, guidewires, catheters, tissue cutting or remodeling devices, electrosurgical devices, energy emitting devices, devices for injecting diagnostic or therapeutic agents, devices for implanting devices such as stents, substance eluting devices, substance delivery implants, etc.

Abstract: A kit for surgically removing stones comprising: a double barreled sheath including a first barrel and a second barrel joined side-by-side; a first connector which is engaged at the proximal end of the first barrel; a second connector which is engaged at the proximal end of the second barrel; a first rigid tube interconnecting the first barrel with the first connector with the first connector being releasably engaged to the first rigid tube and the first rigid tube, first barrel and first connector being co-axial; a second rigid tube interconnecting the second barrel with the second connector with the second connector being releasably engaged to the second rigid tube and the second rigid tube, second barrel and second connector being co-axial; and a wire basket retriever adapted for insertion into one the barrel and being releasably engaged with a connector or an actuation device.

Abstract: The invention is directed to improved handles for medical devices. Embodiments of the invention include handles that allow for the device's introduction, positioning, and actuation with a single hand of an operator, handles that allow an operator to simultaneously position and manipulate two devices relative to each other as well as relative to an additional medical device, such as an endoscope, and handles that allow an operator to simultaneously manipulate an endoscope and an additional medical device without the help of an assistant.

Abstract: Embodiments of a medical device and related methods of use are provided for extracting tissue. The device may include an elongate member having a proximal end and a distal end. Two or more channels may extend through the elongate member from the proximal end to the distal end, and a morcellating device may be included in one of the channels. In addition, one of the channels may be configured as a return channel for extracting the morcellated tissue.

Abstract: Exemplary embodiments of apparatus and method for effecting at least one anatomical structure of a body can be provided. For example, at least one first arrangement can be provided which is structured to be at least partially inserted into the body and including an opening. In addition, at least one second arrangement can be provided which configured to increase and/or decrease a size of the opening by a motion thereof in a first direction. Further, at least one third arrangement can be provided which can be coupled to the second arrangement(s), and configured to move at least in a second direction which is at least approximately parallel to the second direction.

Abstract: A surgical instrument includes a hollow member having a sidewall provided with a window and a closure member movably connected to the hollow member for alternately covering and uncovering the window. The hollow member has a first clamping surface along an edge of the window, while the closure member has a second clamping surface opposing the first clamping surface and disposable substantially adjacent thereto in a clamping or closure configuration of the instrument. The instrument additionally comprises a tissue occlusion component mounted to at least one of the hollow member and the closure member for acting on tissues gripped between the first clamping surface and the second clamping surface, to couple the tissues to each other.

Abstract: A device for cutting, stapling and dividing the bowel allowing surgery to be performed laparoscopically and associated method of use. The device is inserted transanally and positioned within the bowel, ligatures secure the bowel to the device. The bowel is then cut by the device while securing the open end to minimize spillage and the bowel stapled. The bowel can be re-attached using additional staples and further cuts made to allow the device to be removed.

Abstract: A medical instrument converts linear movement of a shaft at a proximal end of the instrument to a rotational movement of an end effector of the instrument. According to one embodiment, the medical instrument includes an end effector formed of a snare loop connected to a shaft that is located within a sleeve. Once the sleeve is located near a desired location within a patient, the snare loop may be rotationally positioned with linear movement of the shaft by the operator. The shaft is formed with a threaded portion that matches threads formed in a torque transmitter element fixed within the sleeve. Linear movement of the shaft through the torque transmitter element causes the shaft to rotate. The medical instrument may also include a pivot connector for reducing torque build-up of the shaft and/or a clutch assembly for restricting controlled rotation of the snare loop to only one direction.

Abstract: Various apparatus and methods for excising tissue are described therein. In certain variations, a method of excising a target tissue mass from a subject, may include advancing an elongate instrument having an opening at its distal end into a subject. A cutting element, e.g., a snare or loop, may be advanced from the distal end of the elongate instrument, wherein the cutting element may be configured to cut tissue. The cutting element may be positioned near the target tissue mass. The cutting element may be actuated, e.g., expanded or deployed, and may perform energy based or mechanical cutting of a section of tissue encapsulating the target tissue mass. The cut section of tissue and the target tissue mass encapsulated therein may be removed from the subject.

Abstract: Processes of preventing tumor cell mestastases induced by surgical procedures such as resection or biopsy are provided. Some embodiments include applying a tissue adhesive to a structure that is then adhered to tissue providing a tensioning surface for exposing normal tissue for cutting thereby preventing contact of a surgical instrument with tumor tissue. Methods of preventing tumor cell metastasis during or following biopsy are also provided whereby an adhesive alone or optionally along with a structure occupy a track left by a biopsy needle and provide a physical barrier between tumor tissue and normal tissue. The inventive processes improve patient outcome by reducing surgically induced tumor cell metastases.

Abstract: A medical device having a member with a lumen extending from a proximal end to a distal end of the member is disclosed. The lumen has a device portion defined by at least one curved walled portion and at least one anchoring portion. An endoscopic device, such as a needle, is attached to an actuator inserted into the device portion of the lumen. A housing or stop is inserted into the distal end of the lumen.

Abstract: The invention is directed to an endoscopic retrieval instrument for receiving and retrieving one or more objects from the human body, the instrument comprising an insertion instrument, a retrieval container, and a coupling mechanism configured to selectively disconnect the retrieval container from the insertion instrument.

Abstract: A snare device and methods of making and using the same. The snare device may include a sheath having a proximal end region, a distal end region, and a shaft slidably disposed therein. A handle may be coupled to the shaft and disposed adjacent the proximal end region. The snare device may also include a swivel disposed adjacent the distal end region of the sheath and coupled to the shaft and to a snare loop.

Abstract: A surgical instrument can be used to capture and retrieve tissue, or other specimens, from within the body of a patient through a single trocar port. The surgical instrument can include a grasper, wherein the grasper can be configured to capture a specimen, and a specimen retrieval bag, wherein the specimen retrieval bag can be configured to at least partially surround, or encapsulate, the captured specimen when the specimen retrieval bag is in a deployed position. In certain embodiments, the retrieval bag can be inverted as it is moved between undeployed and deployed positions. In various embodiments, the surgical instrument can further include a snare operably engaged with the specimen retrieval bag, wherein the snare can be configured to at least partially close the bag. A vacuum can be placed in communication with the bag to reduce the size of the bag before it is removed from the surgical site.

Abstract: A surgical instrument includes a hollow member having a sidewall provided with a window and a closure member movably connected to the hollow member for alternately covering and uncovering the window. The hollow member has a first clamping surface along an edge of the window, while the closure member has a second clamping surface opposing the first clamping surface and disposable substantially adjacent thereto in a clamping or closure configuration of the instrument. The instrument additionally comprises a tissue occlusion component mounted to at least one of the hollow member and the closure member for acting on tissues gripped between the first clamping surface and the second clamping surface, to couple the tissues to each other.

Abstract: A fistula cleaning and repairing device comprises a device for cleaning a fistula and a device for repairing a fistula. Some versions of the device for cleaning a fistula comprise a rotary device with ah head configured to debride a fistula. Some versions of the device for cleaning comprise an abrasive catheter. Some versions of the device for cleaning comprise a plurality of abrasive beads. Some versions of the device for repairing a fistula comprise an implantable stent. Some versions of the device for repairing a fistula comprise an implantable mesh. Some versions of the device for repairing a fistula comprise a swab configured to deliver a medical fluid.

Abstract: Various embodiments of a surgical device that combines tissue cutting and spraying in a single device and related methods of use are disclosed. The device may include an elongated member having a proximal end and a distal end, an end effector proximate the distal end of the elongated member, and a nozzle member configured to substantially seal the distal end of the elongated member. The nozzle member may define a flow path in fluid communication between inside and outside of the elongated member when the distal end of the elongated member is sealed with the nozzle member.

Abstract: A medical instrument captures and removes very large intraocular foreign bodies. The foreign bodies may have an irregular shape, a low coefficient of friction, and be made of non-magnetic materials. A fixed position hollow rod is mounted to a leading end of an elongate base and a lid is mounted to the distal end of the hollow rod. A control rod is slideably received within the hollow rod and a control knob slideably mounted on the elongate base is connected to the control rod to control extension and retraction of the control rod. A silicone basket depends from a rim formed at the distal end of the control rod. A silicone wire interconnects the hollow rod and a bottom of the basket so that the basket is drawn parallel to the control rod when the control rod is extended. The lid covers the basket when the control rod is retracted.

Abstract: A surgical instrument and method are provided for positioning an osteochondral plug within a bone defect site. The instrument includes an elongate shaft, a ribbon, an elongate sleeve and a locking mechanism. The shaft has proximal and distal ends, with the distal end being shaped to contact the osteochondral plug. The ribbon extends along two sides of the shaft and around the distal end, forming a loop that is used to secure the osteochondral plug to the distal end. The sleeve is movably mounted to the shaft for reciprocating relative thereto between retracted and extended positions. The sleeve includes a slot that allows for visualization and cutting of the ribbon. The locking mechanism locks the ribbon in place and thereby controls the size and tension of the loop that surrounds the osteochondral plug, securing it to the distal end of the shaft.