Abstract: Methods and apparatus for closing a left atrial appendage are described. The methods rely on introducing a closure tool from a location beneath the rib cage, over an epicardial surface, and to the exterior of the left atrial appendage. The closure device may then be used to close the left atrial appendage, preferably at its base, by any one of a variety of techniques. A specific technique using graspers and a closing loop is illustrated.

Abstract: A tissue closure device including a tissue eversion apparatus, and a first and a second, redundant closure element that are placed on the external surface of a tissue puncture wound to enhance the efficacy of closure. The first closure element and the second closure element are left resident on the external surface of or in proximity to the tissue puncture wound in order to provide redundancy of closure.

Abstract: According to an aspect of the present disclosure, a surgical instrument for operating on tissue is provided. The surgical instrument includes an end effector including a first tissue engaging member and a second tissue engaging member in juxtaposed relation to the first tissue engaging member; a gap determination element operatively associated with each of the first tissue engaging member and the second tissue engaging member for measuring a gap distance between the first tissue engaging member and the second tissue engaging member; and a tissue contact determining element operatively associated with a respective tissue contacting surface of at least one of the first tissue engaging member and the second tissue engaging member. The present disclosure also relates to methods of using the surgical instrument.

Abstract: An endoscopic stitching device includes a tool assembly having a pair of juxtaposed jaws pivotally associated with one another, each jaw defining a needle receiving recess formed in a tissue contacting surface thereof; a drive assembly including a pair of concentric, individually rotatably and translatably supported barrels, each barrel defining a central lumen therethrough; and a pair of axially translatable needle engaging blades slidably supported, one each, in a respective jaw. The stitching device further includes a center rod slidably and rotatably disposed through the lumen of the barrels, a distal end of the center rod being operatively engaged with the pair of jaws.

Abstract: An apparatus includes an elongate member having a distal end portion and a proximal end portion. The elongate member defines a longitudinal axis. The distal end portion of the elongate member defines a notch having a face defining an axis. The axis of the face and the longitudinal axis define an acute angle with respect to a first direction along the longitudinal axis. The notch is configured to retain a loop of a suture when the elongate member is moved through a tissue of a patient in the first direction along the longitudinal axis. The notch is configured to release the loop of the suture when the elongate member is moved through the tissue of the patient in a second direction different than the first direction. The suture has at least one tissue anchor configured to be disposed within the tissue of the patient.

Abstract: An apparatus for joining two hollow organ sections with an annular array of surgical staples includes a staple cartridge component, an anvil component, a buttress component and a fastening member. The staple cartridge component includes a plurality of surgical staples arranged in an annular array. The anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp the organ sections between the staple cartridge and anvil components. The buttress components are configured and dimensioned to be positioned on a distal surface of the staple cartridge component and the proximal surface of the anvil component. In particular, the buttress component includes a buttress member and a plurality of circumferentially arranged tabs extending proximally from the buttress member.

Abstract: A tissue anchoring system includes a tissue anchor member that is suitable for anchoring against tissue. The system also includes a tensioning member operatively connected to the anchor member such that the anchor member can slide relative to the tensioning member, the tensioning member capable of being pulled to cause the anchor member to move relative to the tensioning member into a position seated against the tissue. A hand operated deployment catheter is operable to extend and deploy the anchor member therefrom. The deployment catheter includes a rotatable member about which the tensioning member is routed and a clutch assembly for limiting tension within the tensioning member to prevent the deployed anchor from being pulled through the tissue.

Abstract: Systems and methods for repairing tears in soft tissue, e.g., meniscal tissue, by employing cinch stitching. More specifically, the present invention provides apparatus and methods for meniscal repair using a suture implant construct. The suture implant construct includes a first and second implant which are connected to each other via a length of suture. The implants are designed to be loaded on external surfaces of the first and second trocars.

Abstract: A tissue fastener assembly delivers a fastener for deployment. The assembly includes a fastener including a first member, a second member, the first and second members having first and second ends, and a flexible connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members. The first member has a longitudinal axis and a through channel along the axis. The assembly further includes a deployment wire slidingly received within the through channel of the first member that pierces into the tissue and guides the first member through the tissue, a guide structure defining a lumen that receives the fastener and deployment wire and guides the deployment wire and fastener to the tissue, and a fastener configuration structure that orientates the second member in a predetermined position relative to the first member within the lumen for dependable deployment.

Abstract: A system, device, device and method for implanting a food restrictor in a patient's stomach, by coupling the restrictor to a plurality of tissue-plication anchors already placed in the stomach, are disclosed. The device includes an elongate shaft assembly for accessing the stomach transorally, and on which the restrictor can be carried, and a plurality of cable members mounted on the shaft assembly. The cable members are disposed on the shaft assembly along a distal section thereof, and releasably attached to the shaft assembly's distal end. After a cable member engages a tissue-plication anchor, retracting the cable is operable to first release the member from a holder at the distal end of the shaft assembly, then pull a portion of the anchor through an aperture in the restrictor. This process is repeated for each anchor in the stomach for attaching the restrictor to the stomach.

Abstract: The invention provides a surgical fastening or suturing device. The device of the invention has a slender shaft and an actuating mechanism configured to eject a surgical fastener from the distal end of the shaft or configured to perform suturing at the distal end of the shaft. The device also has an attachment arrangement for attaching a piece of surgical mesh material onto an external lateral surface of the shaft and around the distal end of the shaft.

Abstract: A threading device assembly for use in plastic surgery that includes a first elongated rod having first and second opposite ends, a second elongated rod having first and second opposite ends, and a suture having first and second opposite ends. The first end of the suture is secured to the first elongated rod at a location that is approximately halfway between the first and second ends, and the second end of the suture is secured to the second elongated rod at a location that is approximately halfway between the first and second ends.

Abstract: A device 10 for gathering tissue of a heart valve leaflet 2 may include an outer tube 16 extending in an elongation direction, a capture tool 22 moveable in the outer tube between a contained position and a use position, and a tissue securing component 32 disposed at a distal end 17 of the outer tube and adapted to be applied to tissue 8 captured by the capture tool to hold the captured tissue in a gathered configuration. The capture tool may include a first element 20 and a second element 22 that are moveable relative to one another in the elongation direction. The first and second elements 20, 22 may be operable to capture tissue 8 of the heart valve leaflet 2 therebetween and to draw the captured tissue into the outer tube 16 in the gathered configuration.

Abstract: A surgical instrument with a tissue-clamping end effector, where actuation of the instrument is locked out when the thickness of the tissue clamped in the end effector is not within a specified thickness range. The end effector may comprise a tissue thickness module that senses the thickness of the tissue clamped in the end effector. The surgical instrument also comprises a control circuit in communication with the tissue thickness module. The control circuit prevents actuation of a working portion of the end effector when the thickness of the tissue clamped in the end effector is not within the specified thickness range.

Abstract: Apparatus and methods for delivering a surgical clip to a patient during a minimally invasive surgical procedure are disclosed herein. An exemplary apparatus for isolating an atrial appendage of a patient includes a surgical clip that locks onto the atrial appendage of the patient, and a surgical clip applicator that releasably engages the surgical clip. The surgical clip can include a top portion and a bottom portion. The surgical clip applicator can include a first flexible flap and a second flexible flap. The first and second flexible flaps can be sufficiently rigid to prevent the surgical clip from falling off of the surgical clip applicator when the surgical clip is engaged to the surgical applicator and the surgical clip applicator is in a relaxed state, and sufficiently flexible to facilitate separation of the surgical clip from the surgical clip applicator when the surgical clip is locked onto the atrial appendage.

Abstract: A single trigger system and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device configured to deploy and implant anchor devices for such purposes.

Abstract: A suture retention device includes a stack of suture engaging members which can be provided by coils or other segments of a spring. A suture engages with the stack so as to permit travel of the retention device along the suture in one direction more facilely than travel along the suture in the other direction. The retention device can include a housing that encloses the spring or other stack structure, and the suture can pass from a first hole in the housing, through the suture engaging members, and to a second hole in the housing. A suture anchor can be attached to the suture, and the resulting assembly can be combined with a needle designed to introduce the anchor and suture into patient tissue, e.g. in the conduct of a gastropexy procedure.

Abstract: A surgical fastener is disclosed, and includes a head section and a tissue snaring section. The head section includes an engagement member pivotably disposed on an outer surface of the head section. The tissue snaring section defines a longitudinal axis and extends away from the head section. At least one helical thread defined along an outer surface of the tissue snaring section. The tissue snaring section is configured to rotate about the longitudinal axis in a first radial direction, and the engagement member is configured pivot outwardly from the head section in the first radial direction.

Abstract: A biological tissue is sutured or ligatured, a suture and ligature member such as a ligature wire is cut, and then a holding member is reliably recovered from the body. In a holding member of a medical ligature tool, a protrusion is disposed between distal lateral holes, and proximal lateral holes, so that it protrudes outward in a diameter direction thereof. On the other hand, a concave portion is formed in the inner periphery of a cutting member. When the cutting member is extended to cut a ligature wire, the concave portion is fitted to the protrusion to allow the holding member to engage the cutting member.

Abstract: A system and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device configured to deploy and implant anchor devices for such purposes.

Abstract: A surgical instrument for surgically joining tissue is disclosed. The surgical instrument includes a handle portion, an endoscopic portion, a pair of jaw members and at least one flexible member attachment structure. The endoscopic portion extends distally from the handle portion and defines a first longitudinal axis. The pair of jaw members is disposed adjacent a distal end of the endoscopic portion and extends generally distally therefrom. At least one of the jaw members is movable with respect to the other between an open position and an approximated position for engaging body tissue therebetween. The flexible member attachment structure is disposed in mechanical cooperation with at least one jaw member and is configured to facilitate the attachment of a flexible member thereto.

Abstract: A surgical stapling device particularly suited for endoscopic procedures is described. The device includes a handle assembly and an elongated body extending distally from the handle assembly. The distal end of the elongated body is adapted to engage a disposable loading unit. A control rod having a proximal end operatively connected to the handle assembly includes a distal end extending through the elongated body. A control rod locking member is provided to prevent movement of the control rod until the disposable loading unit is fully secured to the elongated body of the stapling device.

Abstract: Methods and devices are provided for closing a puncture wound. In one exemplary embodiment, a puncture closure device is provided having an elongate tubular body that is disposable through a puncture in tissue and that includes proximal and distal portions. The proximal portion can be adapted to expand to form proximal wings upon rotation of the elongate tubular body, preferably in a first direction. The distal portion can be adapted to expand to form distal wings upon rotation of the elongate tubular body, preferably in a second, opposite direction. The proximal and distal portions can also be adapted to be moved toward one another as they expand upon rotation. As a result, the proximal and distal wings can engage tissue therebetween.

Abstract: Integrated systems and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device configured to deploy and implant anchoring devices for such purposes.

Abstract: There are disclosed various embodiments of surgical tacks for use in surgical procedures. The tacks generally include a head and a barrel portion extending distally from the head. Preferably, the head and the barrel portion define a throughbore for receipt of a drive instrument. A thread on the head is provided to engage threads in the installation tool. A tissue thread is provided on the barrel portion to engage tissue. Distal and proximal surfaces of the tissue thread may be oriented at various angles relative to the barrel portion. There is also disclosed an insertion instrument to insert one or more tacks as well as a method of use. There is further disclosed a model device for use in explaining the operation of the instrument.

Abstract: The present invention is a device having a rigidly linked jaw that is decoupled from an articulating wrist. The device provides for articulating motion as well as actuation that may be used in grasping, cutting, suturing or the like.

Abstract: A cartridge assembly is disclosed. The cartridge assembly comprises a cartridge housing and a cartridge. The cartridge housing has a plurality of biasing members thereon. The cartridge is configured for reception at least partially within the cartridge housing. The cartridge includes a plurality of fasteners at least partially therein. The cartridge has a plurality of pockets. Each fastener is ejectable from a corresponding pocket. The cartridge has a plurality of chambers, and each chamber is adjacent a pocket and configured to store at least one fastener at least partially therein. At least one fastener is movable from the chamber to the pocket. The cartridge includes a plurality of pushers, where each pusher is configured to engage at least one corresponding fastener. At least one pusher includes at least one cam surface thereon. Each biasing member urges at least one corresponding fastener toward the corresponding pocket.

Abstract: A vascular graft for anastomosis of blood vessels or ducts comprises piercing means (3) for engaging an end portion (8/8?) of a blood vessel or prosthesis and means (6, 6?) for precisely guiding one or more piercing elements (3) to pierce the wall of the vessel or prosthesis to a predetermined depth and in a predetermined direction.

Abstract: A tissue fastening apparatus related to the present invention includes; a tissue fastening tool formed of a wire wound into a coil shape provided with a first tissue fixing section which is hooked onto a first biological tissue and a second tissue fixing section which is hooked onto a second biological tissue; a tubular puncturing tool which extends a tissue fastening tool and accommodates the stretched tissue fastening tool inside of the puncturing tool; a fastening tool pusher in which the distal end thereof is inserted into the puncturing tool and dispenses the tissue fastening tool inserted into the puncturing tool from a distal end of the puncturing tool when the fastening tool pusher advances; and a rotating mechanism to rotate the puncturing tool when the fastening tool pusher advances.

Abstract: Apparatus and methods for manipulating and securing tissue are described herein. In creating tissue folds within the body of a patient, a tissue manipulation assembly may generally have an elongate tubular member, an engagement member slidably disposed through the tubular member and a distal end adapted to engage tissue via a helical member, tissue stabilizing members positioned at the tubular member distal end which are adapted to stabilize tissue therebetween, and a delivery tube pivotable about the tissue stabilizer. The stabilizing members can be adapted to become angled relative to a longitudinal axis of the elongate tubular member. Moreover, one or all the articulation controls and functions can be integrated into a singular handle assembly connectable to the tissue manipulation assembly via a rigid or flexible tubular body.

Abstract: An apparatus for delivering and deploying a closure element to an opening formed in a body lumen, including a delivery assembly positionable through the tissue and into the opening. The delivery assembly includes a distal locator portion and a carrier portion oriented proximal to the distal locator portion. The distal locator portion is configured to selectably engage the body lumen adjacent to the opening, and the carrier portion is configured to carry and support the closure element in a substantially tubular configuration. The carrier portion is further configured to urge the closure element toward an expanded cross-sectional dimension for deployment thereof, such that the closure element is oriented to engage the tissue when deployed and, when released, to return to the natural, substantially planar configuration and the natural cross-section dimension wherein the engaged tissue is drawn substantially closed.

Abstract: A novel occluder application and clip device for treatment of embolic stroke caused by atrial fibrillation uses multiple sutures in a non directional handle to affix the occlusion device to the applicator and manipulate the occluder from an open and receiving position to a closed and occluding position. The occluder is retained in place by a clamping means related to locks retainers, resilient material or otherwise. An actuator mechanism is used to manipulate the occluder to a locked or occluding position. The applicator with the occluder attached has a low profile and remote manipulations to allow the occluder to be delivered to the clamping location within a patient through a small incision or delivery port such as a trocar cannula or the like.

Abstract: In some embodiments, an apparatus includes a handle and an elongate member coupled to the handle. The elongate member has a first portion, a second portion and a third portion. The first portion of the elongate member extends from the handle and defines a first longitudinal axis. The second portion of the elongate member extends from the first portion and defines a second longitudinal axis. The first longitudinal axis and the second longitudinal axis define a first angle and a first plane. The third portion of the elongate member extends from the second portion of the elongate member and defines a third longitudinal axis. The third longitudinal axis and the second longitudinal axis define a second angle and a second plane. The second plane is non-parallel with the first plane.

Abstract: A surgical stapling apparatus includes a staple cartridge and an anvil member. The staple cartridge includes a plurality of surgical fasteners disposed in rows of retention slots. The staple cartridge may have an annular or linear configuration of retention slots. The tissue contacting surface of the staple cartridge may be tapered or stepped. The anvil member has a tissue contacting surface that includes a number of pockets arranged for substantially aligning with the retention slots. In addition, the tissue contacting surface of the anvil member may complement the tissue contacting surface of the staple cartridge.

Abstract: An end effector includes an anvil and a staple cartridge. The staple cartridge includes a first deck surface, a second deck surface, a plurality of first staple cavities arranged in a first row extending along the first deck surface, a plurality of second staple cavities arranged in a second row extending along the second deck surface, a plurality of third staple cavities arranged in a third row, a driven element, and a plurality of staples engaged with the driven element and deployed into the tissue. The plurality of staples include a first staple removably stored in the first row, a second staple removably stored in the second row, and a third staple removably stored in the third row.

Abstract: An apparatus for suturing tissue includes first and second needles. A first structure associated with the first needle is adapted and configured to pass a leading portion of the suture from a near side of a tissue to a far side of the tissue. A second structure cooperates with the second needle to capture and secure the suture. Proximal movement of the apparatus after the suture is captured moves the suture from the far side of the tissue to the near side of the tissue.

Abstract: A surgical stapling apparatus includes a staple cartridge and an anvil member. The staple cartridge includes a plurality of surgical fasteners disposed in rows of retention slots. The staple cartridge may have an annular or linear configuration of retention slots. The tissue contacting surface of the staple cartridge may be tapered or stepped. The anvil member has a tissue contacting surface that includes a number of pockets arranged for substantially aligning with the retention slots. In addition, the tissue contacting surface of the anvil member may complement the tissue contacting surface of the staple cartridge.

Abstract: A surgical instrument including a handle assembly, a first endoscopic portion, a motor, and a first end effector is disclosed. The first endoscopic portion is selectively connectable to a distal portion of the handle assembly and defines a longitudinal axis. The first endoscopic portion includes a housing adjacent its proximal portion and includes an actuation member. The motor is disposed in mechanical cooperation with the housing of the first endoscopic portion and is operatively connected to the actuation member for moving the actuation member substantially along the longitudinal axis. The first end effector is selectively connectable to a distal portion of the first endoscopic portion and is configured to perform a first stapling function.

Abstract: According to an aspect of the present disclosure, an endoscopic surgical device is provided. The surgical device includes a handle assembly including a drive mechanism actuatable by a trigger; and an endoscopic assembly including a proximal end portion extending from the handle assembly; a distal end portion pivotably connected to the proximal end portion of the endoscopic assembly; and a rotatable inner actuation shaft extending from the handle assembly and into the distal end portion of the endoscopic assembly, the inner actuation shaft including a flexible portion extending across the pivot connection. The surgical device includes an end effector selectively connectable to the distal end portion of the endoscopic assembly and to a distal portion of the rotatable inner actuation shaft. The end effector includes a splined inner tube rotatably supported in an outer tube; and a plurality of surgical anchors loaded in the inner tube of the end effector.

Abstract: According to an aspect of the present disclosure, an endoscopic surgical device is provided. The surgical device includes a handle assembly including a drive mechanism actuatable by a trigger; and an endoscopic assembly including a proximal end portion extending from the handle assembly; a distal end portion pivotably connected to the proximal end portion of the endoscopic assembly; and a rotatable inner actuation shaft extending from the handle assembly and into the distal end portion of the endoscopic assembly, the inner actuation shaft including a flexible portion extending across the pivot connection. The surgical device includes an end effector selectively connectable to the distal end portion of the endoscopic assembly and to a distal portion of the rotatable inner actuation shaft. The end effector includes a splined inner tube rotatably supported in an outer tube; and a plurality of surgical anchors loaded in the inner tube of the end effector.

Abstract: A system for performing multi-tool minimally invasive medical procedures through a single instrument port into a body cavity includes a rigid tube carried by a mount. Cannulas having instrument channels and steerable distal ends extend distally from the rigid tube. During a procedure using the system, the mount is supported by an operating room fixture, and instruments are advanced through the steerable instrument channels. Manipulation of the instrument handles engages actuators positioned on the mount, which steer the distal ends of the cannulas through the action of pull cables. The distal ends of the instruments may thus be steered within the body by the distal ends of the steerable cannulas.

Abstract: An endoscopic tissue anchor deployment device includes a handle, an elongated shaft defining an internal lumen, and an end effector attached to the distal end of the elongated shaft. A tissue anchor catheter is removably inserted through the lumen of the elongated shaft, the catheter having a tissue anchor assembly that is deployable from its distal end. The handle may include a pin and track assembly that define a series of handle actuation steps corresponding to deployment steps for the deployment device end effector and the tissue anchor catheter. In some embodiments, the handle includes a catheter stop member that prevents movement of the tissue anchor catheter under certain circumstances, and a handle stop member that prevents actuation of the handle under certain circumstances.

Abstract: Apparatus is provided that can be delivered through a catheter to a remote location in a patient's body. The apparatus may include a first structure that can be positioned in all dimensions in a controlled manner and stabilized in that desired position, a second structure that can then position a lumen axis at a desired angle relative to the first structure, and a third member that can pass through the lumen and approach and engage with force (e.g., penetrate) a desired location on the anatomy without compromising maintaining the desired position. The apparatus effectively separates the forces needed for positioning and the forces needed for tissue engagement (e.g., penetration).

Abstract: Tissue eversion apparatuses and methods suitable for use, as examples, with vascular closure devices. The tissue eversion apparatuses comprise a tissue engaging element, disposed within a delivery sheath. The delivery sheath protects the tissue engaging element and the surrounding tissue during use. The tissue engaging element can extend from the sheath and engage the tissue near an aperture in a tissue wall. Motion of the tissue engaging element away from the tissue can urge the tissue wall near the aperture to evert from the tissue wall, allowing, as examples, aperture closure apparatuses and methods to be conveniently employed.

Abstract: A method for operating a surgical end effector of a medical device includes the steps of operably associating a passive articulation joint with a surgical end effector to allow articulation of the end effector, retaining the passive articulation joint in a still position with an articulation lock, releasing the articulation lock to free the passive articulation joint from its still position thereby permitting the end effector to articulate through the passive articulation joint dependent upon forces that are external to the device and are applied to the end effector, and passively articulating the end effector into a desired articulated position by pressing a portion of the end effector against a feature of the environment.

Abstract: The disclosure provides a needle-electrode anchor system having a needle and an optional electrode with one or more anchors. The system can provide an electrical cutting current to the needle-electrode to create an opening in a tissue portion. An anchor coupled to the needle-electrode can be pushed through the opening with a pusher and pulled into position to set the anchor on a distal surface of the opening. If the tissue portion is to be approximated to another tissue portion, the system can be relocated to another tissue portion and another opening created with the cutting current with another anchor pushed through the opening and secured on a distal surface. Lines coupled to the anchors can be pulled together, approximating the tissue portions. If the tissue portion is to be retracted, an anchor line can be grasped to retract the tissue portion from an adjacent tissue portion.

Abstract: The present invention involves new interventional methods and devices for reconfiguring a portion of the gastrointestinal tract. The procedures are generally performed laparoscopically and may generally be described as laparoscopic plication gastroplasty (LPG) in which, after obtaining abdominal access, spaced apart sites on a gastric wall are engaged, approximated and fastened to create one or more tissue folds forming one or more plications projecting into the gastrointestinal space. The serosal tissue may optionally be treated during the procedure to promote the formation of a strong serosa-to-serosa bond that ensures the long-term stability of the tissue plication. These procedures are preferably carried out entirely extragastrically (i.e. without penetrating through the gastrointestinal wall), thereby minimizing the risks of serious complications.

Abstract: A method of securing a prosthetic device to tissue includes providing an applicator instrument including a housing, a shaft, surgical fasteners, a firing rod for dispensing the surgical fasteners from the shaft, a trigger, and an energy storing element. The method includes positioning a prosthetic device over tissue, juxtaposing a distal end of the shaft with the prosthetic device, and compressing the trigger for piloting the firing rod toward the distal end of the elongated shaft at a first rate of speed. The method includes preventing the firing rod from moving distally while building up energy in the energy storing element, and further compressing the trigger for releasing the firing rod for distal movement and transferring the built up energy for moving the firing rod toward the distal end of the elongated shaft at a second rate of speed that is greater than the first rate of speed.

Abstract: A suture fixation system includes a suture assembly having an anchor, an introducer, and a delivery device. The introducer is attachable to a finger of a person and includes a platform attached to an exterior of the introducer and a zip line attached to the platform. The delivery device is movable along the zip line and configured to removably retain the anchor. The introducer allows the finger to identify a target landmark within a patient and the delivery device is movable along the zip line and attachable to the platform to position the anchor for insertion to the target landmark.

Abstract: Implant delivery systems are disclosed. In general overview, an exemplary system includes any number of the following: a delivery device, a sling assembly, guide members, and connectors that interconnect the above. Embodiments of all the above components and their combinations are disclosed. Methods of using the above system in suprapubic, prepubic, transvaginal, trans-obturator and other approaches are also disclosed.