Abstract: A gastrocutaneous closure device allows gastrocutaneous fistula closure from external abdominal access through the fistula site. Access through the fistula ensures accurate closure placement on the interior lumen wall of the stomach. A closure or clip has a plurality of prongs defined by a deformable material, such that the prongs extend radially from a central hub in an arcuate or curved, semicircular shape. The arcuate shape converges towards a central point or axis at a distal end, and the proximate end of the prongs attaches to the central hub such that the prongs radiate from the hub and the distal end curves back toward the axis through the hub. The deformable prongs may therefore radially compress or retract to define a larger or smaller diameter. The fistula lies on the axis such that the biased, inserted prongs pull the inner stomach wall closed around the healing fistula.

Abstract: A surgical instrument. The surgical instrument has a force delivery system which communicates a changing force to a user of the surgical instrument when a limit of a surgical function is reached. A sensor senses position of a moving element to communicate a signal to the force delivery system. In various embodiments, the system generates a vibratory force to signal the user.

Abstract: Vascular closure assembly embodiments may be used to provide hemostasis at vascular puncture sites or the like. Such vascular puncture or access sites may be created during a variety of percutaneous or minimally invasive medical procedures.

Abstract: The present disclosure includes a suturing device including: a fixed arm having a fixed jaw including a first grasping slot configured to receive a needle; a movable arm coupled to a movable jaw including a second grasping slot configured to receive the needle, the movable arm configured to pivot relative to the fixed arm to pivot the movable jaw relative to the fixed jaw until the needle is received in the first grasping slot and the second grasping slot; and a needle transfer mechanism configured to grasp the needle in the first grasping slot or the second grasping slot. In some aspects, the suturing device includes a safety member configured to control when the movable arm moves. The present disclosure includes a loading apparatus including a loading slot configured to receive a fixed jaw and a slider configured to move the needle towards into the fixed jaw.

Abstract: A catheter configured to dynamically compensate for the impact of internal and external forces that act upon the catheter during use is disclosed. The catheter may include sensors configured to measure received forces on control cables that extend within the catheter. A controller, coupled to the sensors, may record received force measurements associated with a working position of a distal end of the catheter. The controller may monitor subsequently received forces to identify force variances that may deflect the distal end of the catheter from its working position and may apply a driving force to one or more of the control cables to minimize the force variances. Monitoring received forces during use and applying compensating drive forces may reduce deflection of the distal end of the catheter, increasing the accuracy and precision of an annuloplasty procedure while minimizing potential damage to cardiac tissue.

Abstract: An improvement to devices and methods for suturing tissue in various applications, such as percutaneous closure of arterial and venous puncture sites and the like, providing a self-locking or self-securing suture that does not require manual knot-tying to hold in apposition the tissue of the vessel wall on opposite sides of the puncture.

Abstract: A suturing system including an elongate distal member and an elongate proximal member proximal the elongate distal member, the elongate proximal member having a lumen. A needle deployment actuator extends to the elongate distal member and is configured to initiate proximal movement of a needle toward an opening of the elongate proximal member. A guide is disposed within the elongate proximal member, a perimeter of the guide forming a plurality of needle receiving gaps that, when viewed in cross-section, are circumferentially spaced about the deployment actuator with a portion of the guide disposed between adjacent needle receiving gaps extending outwardly towards a wall of the lumen of the elongate proximal member.

Abstract: A mitral valve leaflet repair system may include a delivery catheter having at least one lumen extending proximally from a distal end of the delivery catheter, a plurality of anchor elements disposed within the at least one lumen, each of the plurality of anchor elements being configured to extend through one layer of mitral valve leaflet tissue, and a securing element configured to secure at least two of the plurality of anchor elements together on one side of the mitral valve leaflet tissue. The at least one lumen may include a suction lumen configured to grasp a mitral valve leaflet prior to extending the plurality of anchor elements through one layer of mitral valve leaflet tissue.

Abstract: A suturing device for minimally invasive surgery is disclosed. The suturing device has a head defining one or more ferrule holders and a tissue bite area. The device also has a first needle comprising a flywheel portion and one or more curved arms extending from the flywheel portion, each of the one or more curved arms comprising a ferrule engaging tip, wherein the first needle is pivotably coupled to the head. The suturing device further has a first actuator coupled to the first needle and configured to rotate it from a retracted position, where the ferrule engaging tip of each of the one or more curved arms starts away from the one or more ferrule holders, through the tissue bite area, and to an engaged position where the ferrule engaging tip of each of the one or more curved arms is operationally aligned with the one or more ferrule holders.

Abstract: A minimally invasive surgical method of approximating tissue includes coupling an adjustable loop of suture around an inserter. The loop can be coupled to the inserter by applying tension to a tail of the suture to collapse the loop around the inserter, then the inserter and loop are passed through a first location in tissue. The loop is decoupled from the inserter, the inserter is retracted from the first location, and reinserted into a second location in the tissue, after which the loop is recoupled to the inserter while the loop is distal of the tissue. The decoupling, retraction, and reinsertion can occur without withdrawing the inserter from the patient's body. The inserter and loop are then withdrawn together from the tissue through this second location and outside of the patient's body. The tails and loop can form a luggage knot to be reduced around the tissue.

Abstract: Devices for easily and quickly tying complex suture knots are disclosed. The knot tying accessories described herein provide a means for introducing a complex knot pattern into a bight of suture using a device body and a guide thread. The device body includes system for maintaining the guide thread and suture in a convoluted pathway, either with the use of channels, protrusions, or a combination of both within its interior, on its exterior, or both. The guide thread may include a coupler at one end for holding a suture end while the guide thread leads the suture through the convoluted path defined within the guide body. Pull tabs may also be included to aid with exchanging the guide thread for the suture ends.

Abstract: A surgical snare assembly is disclosed. The surgical snare assembly has a suture fastener having an entrance and an exit. The surgical snare assembly also has first and second suture engaging loops. The surgical snare assembly further has first and second handles configured such that: a) movement of the first handle a first distance away from the suture fastener causes the first suture engaging loop to move through the suture fastener from the exit to the entrance; and b) movement of the second handle a second distance away from the suture fastener causes the second suture engaging loop to move through the suture fastener from the entrance to the exit.

Abstract: The present disclosure includes a suturing device including: a fixed arm having a fixed jaw including a first grasping slot configured to receive a needle; a movable arm coupled to a movable jaw including a second grasping slot configured to receive the needle, the movable arm configured to pivot relative to the fixed arm to pivot the movable jaw relative to the fixed jaw until the needle is received in the first grasping slot and the second grasping slot; and a needle transfer mechanism configured to grasp the needle in the first grasping slot or the second grasping slot. In some aspects, the suturing device includes a safety member configured to control when the movable arm moves. The present disclosure includes a loading apparatus including a loading slot configured to receive a fixed jaw and a slider configured to move the needle towards into the fixed jaw.

Abstract: A set of devices and associated methodology for percutaneously closing a puncture through the wall of an artery. The method includes inserting a guide wire through a percutaneous entry and into the artery; using the guide wire to guide an insertion of an introducer catheter into the artery; inserting a balloon catheter through the introducer catheter and into the artery; obtaining a tube having a clamp configured to selectively clamp to the introducer catheter; loading the tube with a plurality of fasteners, each fastener individually tethered to a suture; clamping the tube loaded with fasteners onto the introducer catheter, thereby aligning the puncture with a distal working end of the tube; ejecting two or more of the fasteners from the tube to attach onto the artery; percutaneously tying together the tethered sutures of the attached fasteners to draw the attached fasteners together, closing the puncture.

Abstract: A surgical instrument includes an end effector having first and second jaws that cooperate to clamp in vivo material of a patient, and a first electrode that delivers an electrical signal to the in vivo material. The instrument further includes a second electrode that receives the electrical signal from the first electrode, and an electrical circuit housed within the end effector. The electrical circuit includes a microcontroller that controls delivery of the electrical signal to the first electrode, where the electrical signal passes through the in vivo material to the second electrode. The electrical circuit also determines an electrical impedance of the in vivo material and determines at least one of a presence or absence of tissue in the in vivo material, or a characteristic of tissue in the in vivo material.

Abstract: A surgical stapling assembly is disclosed. The surgical stapling assembly can include a first jaw, a second jaw, an articulation joint, a closure drive comprising a first flexible rotary drive extending through the articulation joint, and a firing drive comprising a second flexible rotary drive extending through the articulation joint and rotatable independent of the first flexible rotary drive. The surgical stapling assembly can further include a 3D-printed component.

Abstract: Surgical instruments and their methods of use are disclosed. In some embodiments, the surgical instrument may include a handle and an elongated shaft assembly extending distally from the handle. The surgical instrument may also include a fastener deployment system for deploying fasteners from the elongated shaft assembly including a reciprocating driveshaft disposed within the elongated shaft assembly. The driveshaft may include an internal channel and at least one guide surface shaped and arranged to maintain an orientation of at least one fastener in the channel of the driveshaft. In other embodiments, the fastener deployment system may include a follower disposed within the elongated shaft assembly for displacing one or more fasteners within the elongated shaft assembly towards a distal fastener deployment position.

Abstract: A first anchor is anchored inside a coronary sinus of a heart of a subject. A second anchor can be driven into a tricuspid annulus of the heart. A distal portion of the second anchor can be disposed adjacent and parallel to a center portion of the second anchor. The second anchor can be seated against a surface of the annulus, for example, such that (i) the distal portion is disposed perpendicular to the center portion, (ii) the center portion extends through the annulus, and (iii) a proximal portion of the second anchor is disposed in the atrium. A distance between the first and second anchors can be reduced by applying tension to a tensioning member coupled to the first anchor and the proximal portion of the second anchor. Other embodiments are also described.

Abstract: A method and apparatus for securing separate loops of suture with a coaxial mechanical fastener. Separate loops of suture extend from opposite ends of the mechanical fastener. A wire snare facilitates pulling the suture through the fastener. A suturing instrument provides for the infusion of pressurized physiologic solutions into the left ventricle so that the proper replacement suture length can be demonstrated real time prior to crimping the fastener. The instrument incorporates a slotted release site so that the fastener and suture can be released from the device tip once the fastener is secured. A method of securing suture coming from cardiac valve leaflets and or other structures like papillary muscles permits a more atraumatic orientation of the fastener coaxial with the suture strands.

Abstract: A buttress assembly is configured to temporarily adhere to a wet surgical stapler end effector. The buttress assembly includes a buttress body and a humidity tolerant adhesive material. The humidity tolerant adhesive material is applied to at least one side of the buttress body. The humidity tolerant adhesive material is configured to hold the buttress body to an underside of an anvil or a deck of a staple cartridge for at least five minutes in an environment of 100% relative humidity at approximately 37° C.

Abstract: A suturing system including a sheath, a handle assembly proximal the sheath, an elongate body disposed between the sheath and the handle, a plurality of needles disposed distal the elongate body in a pre-deployed configuration and movable into the elongate body in a deployed configuration, each of the plurality of needles including a needle tip, each needle tip being orientated proximally towards the elongate body in the pre-deployed configuration, and a needle capture assembly disposed between a distal end of the elongate body and the handle, the needle capture assembly including two needle engaging edges longitudinally spaced with respect to each other, with each being configured to interlock with at least one of the plurality of needles.

Abstract: A minimally invasively implanted anchor support for securing a medical prosthesis device with a tether to an implanted anchor. The anchor support includes a lock cap for connecting to the anchor, a tether swivel connected to the lock cap, a tock cone within the tether swivel and a tether collar on a proximal end of the tether swivel. An anchor support delivery system cooperates with the anchor support for securing to the lock cap.

Abstract: A surgical instrument module for powering a plurality of discrete surgical end effectors includes a motor, a planetary gear box, a high-torque/low-speed output operably coupled to the motor, and a high-speed/low-torque output operably coupled to the motor. The high-torque/low-speed is configured to be operably coupled to a driven member of a first type of surgical end effector, and the high-speed/low-torque output is configured to drive an operation of a second type of surgical end effector.

Abstract: The present subject matter provides improvements of endoscopic retrieving devices. In specific, the present subject matter provides a net element with an extra wide tail section. The present subject matter provides a new weaving pattern. The present subject matter provides a new shape of the loop. The present subject matter provides a net with a combination of net elements, such as combinations of different net geometries and/or different net materials. The present subject matter provides a new and inventive loop. The present subject matter provides an improved second end of the tubular member. The present subject matter provides a new and inventive arm.

Abstract: An apparatus for suturing includes an inner strut, a spiral suturing needle, a driving mechanism, a recovery mechanism, a suture-taking-up mechanism, and a suture-feeding mechanism. Grooves are distributed on periphery with respect to an axial direction of the inner strut, a path of the groove is consistent with a path of a metallic stent to be sutured, and a width of the groove matches an outer diameter of the spiral suturing needle; the spiral suturing needle is an elastic retractable structure and a length of the spiral suturing needle without deformation is longer than a length of the path of the groove, and a suturing needle tip is arranged on a head portion of the spiral suturing needle and a suture-piercing hole is arranged on a tail portion of the spiral suturing needle.

Abstract: A surgical stapling device (10) includes a reload assembly (300) having a cartridge assembly (100) and a shipping cap (200) releasably attached to the cartridge assembly (100). The cartridge assembly (100) includes an alignment pin assembly (140) having an alignment pin (144) defining a key hole slot (151) and is movable between a locked position and an unlocked position. The shipping cap (200) includes a locking pin (230) received through the key hole slot (151). When the alignment pin (144) is in the locked position, the alignment pin (144) prevents separation of the shipping cap (200) from the replaceable cartridge assembly (100) and when the alignment pin (144) is in the unlocked position, the alignment pin (144) permits separation of the shipping cap (200) from the replaceable cartridge assembly (100).

Abstract: In certain aspects, the present disclosure provides devices for loading a surgical bolster material. In accordance with some forms, the device includes a tray defining a guide channel for receipt of a bolster material. The guide channel may be configured to align and/or direct the device onto which the bolster material is to be loaded onto the bolster material.

Abstract: A knot tying device including a sheath configured for placement over a surgical instrument. The sheath includes a proximal end portion and a distal end portion. The distal end portion is elastically reconfigurable between a straightened configuration and a hook shaped configuration. Position of the sheath on the surgical instrument is adjustable between an extended position in which the sheath extends beyond a distal tip of the surgical instrument and a retracted position in which the sheath is pulled back from the distal tip of the surgical instrument. The distal end portion is in the hook shaped configuration when the sheath is in the extended position and the distal end portion is in the straightened configuration when the sheath is in the retracted position.

Abstract: Methods of tissue repair. At least one example method includes: pulling a tissue in place over a bone location; abutting a distal end of a guide tool against the tissue at a first location, and driving a first bone anchor through a delivery tube of the guide tool, through the tissue, and into the bone at the first location, the first bone anchor coupled to a first suture line; abutting the distal end of the guide tool against the tissue at a second location displaced from the first location, and then driving a second bone anchor through the delivery tube, through the tissue, and into the bone at the second location, the second bone anchor associated with the first suture line; withdrawing the guide tool away from the tissue; and tightening the first suture line to create a first suture over the tissue.

Abstract: A magnet-assisted suture grasper for grasping a magnetic suture is provided. The magnet-assisted suture grasper includes a suture retrieval needle, a retriever body, a grasper wire, a grasper arm, and a grasper magnet. Translation of the retriever body within a needle lumen of the suture retrieval needle in a first direction causes the grasper arm to move from a first position to a second position, thereby exposing the grasper magnet from the needle lumen and allowing contact between the grasper magnet and a magnetic suture attracted thereto. Translation of the retriever body within the needle lumen in a second direction opposite the first direction causes the grasper arm to move from the second position to the first position, thereby sequestering the grasper magnet and grasping the magnetic suture within the needle lumen.

Abstract: A handle assembly (12) of a hand-held surgical instrument (10) includes a handle housing (26), a motor (36), and a dual thread lead screw (46) operably coupled to the motor (36) and configured to move proximally and/or distally in response to an actuation of the motor (36). A first thread pitch of the lead screw (46) is suitable for effecting a closing of jaw members (20a, 20b) of an end effector (20), and a second thread pitch of the lead screw (46) is suitable for effecting a stapling function of the end effector (20).

Abstract: Apparatuses and methods for closing a transapical opening (9) in a wall of the heart include utilizing a suturing device (100) that is advanced through the transapical opening (9), extending suture arms (110) from a retracted position to an extended position within a ventricle of the heart, extending needles (120) from a retracted position to an extended position through the wall of the heart to engage a plurality of suture portions (52) held by the suture arms (110), retracting the needles through the wall of the heart to draw the suture portions through the wall of the heart, retracting the suture arms, withdrawing the suturing device from the transapical opening, and closing the transapical opening with the suture portions (52). The needles (120) can be deployed from within the transapical opening (9) at an angle to a longitudinal axis of the suturing device or through the exterior wall of the heart parallel to the longitudinal axis of the suturing device.

Abstract: Disclosed embodiments include apparatuses, systems, and methods for guiding a needle to facilitate suturing, such as in surgical anastomosis. In an illustrative embodiment, an apparatus includes at least one guide member configured to extend from a suturing mechanism that is configured to revolve a helically-shaped needle around an axis while the needle is advanced around an object to be sutured. A guide track is configured to be positioned around the object and to guide the suturing mechanism in an articulated path around the object. The guide track defines at least one guide channel configured to receive the guide member, where the at least one guide channel is configured to direct movement of the guide member to cause the suturing mechanism to pivot to realign the axis to be tangential to the curved guide track.

Abstract: An apparatus for deploying a tissue anchor is disclosed. The apparatus includes a catheter tube having a proximal end and a distal end defining the catheter's length, where the distal end has an anchor housing configured to hold a tissue anchor before deployment; and a pusher wire positioned within the catheter tube and extending through the length of the catheter tube. The apparatus is configured to provide a pushing force on the pusher wire from the proximal end of the catheter tube, thus displacing the pusher wire in a distal direction to the pusher wire's fully extended anchor deployment position which in turn deploys the tissue anchor from the anchor housing in the distal direction by pushing the tissue anchor in the distal direction.

Abstract: Described here are devices, systems and methods for closing the left atrial appendage. Some of the methods described here utilize one or more guide members having alignment members to aid in positioning of a closure device. In general, these methods include advancing a first guide having a first alignment member into the left atrial appendage, advancing a second guide, having a second alignment member, into the pericardial space, aligning the first and second alignment members, advancing a left atrial appendage closure device into the pericardial space and adjacent to the left atrial appendage, and closing the left atrial appendage with the closure device. In these variations, the closure device typically has an elongate body having a proximal end and a distal end, and a closure element at least partially housed within the elongate body. The closure element comprises a loop defining a continuous aperture therethrough.

Abstract: Catheter-based delivery systems for delivery and retrieval of a leadless pacemaker include features to facilitate improved manipulation of the catheter and improved capture and docking functionality of leadless pacemakers. Such functionality includes mechanisms directed to deflecting and locking a deflectable catheter, maintaining tension on a retrieval feature, protection from anti-rotation, and improved docking cap and drive gear assemblies.

Abstract: A surgical stapling device includes a cartridge assembly including a cartridge body, a staple pusher, a knife assembly, and a locking device. The locking device is configured to prevent readvancement of the knife assembly.

Abstract: Devices and methods for anchoring soft tissue, tissue grafts, and the like to a bone are provided. In one example, an assembly includes a suture anchor, suture, and inserter. In another example, a method provides for reattaching soft tissue to a bone.

Abstract: An apparatus for application of surgical clips to body tissue is provided and includes a handle assembly; a shaft assembly including a housing extending distally from the handle assembly and defining a longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; a jaw mounted adjacent a distal end portion of the shaft assembly, the jaw being movable between an open spaced-apart condition and a closed approximated condition; and a pusher bar reciprocally disposed within the housing of the shaft assembly and being detachably connectable to the housing of the shaft assembly, the pusher bar being configured to load a distal-most surgical clip into the jaws during distal movement and remain connected to the housing of the shaft assembly and in a distally advanced position during an approximation of the jaws.

Abstract: Systems, devices, and methods for transvascular ablation of target tissue. The devices and methods may, in some examples, be used for splanchnic nerve ablation to increase splanchnic venous blood capacitance to treat at least one of heart failure and hypertension. For example, the devices disclosed herein may be advanced endovascularly to a target vessel in the region of a thoracic splanchnic nerve (TSN), such as a greater splanchnic nerve (GSN) or a TSN nerve root. Also disclosed are methods of treating heart failure, such as HFpEF, by endovascularly ablating a thoracic splanchnic nerve to increase venous capacitance and reduce pulmonary blood pressure.

Abstract: An end effector for use with a surgical apparatus. The end effector comprising a staple cartridge having a tissue contacting surface defining a central longitudinal slot and an anvil plate having a tissue contacting surface defining a central longitudinal slot. A folded surgical buttress configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress having a first longitudinal portion, a second longitudinal portion, and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate.

Abstract: Suturing devices, systems, and methods used to suture biological structures. The suturing devices can be configured to place sutures into body tissue from one side of the tissue without requiring a component on an opposite side of the tissue and without requiring insertion of components into the body tissue beyond the needles and the suture.

Abstract: A knot delivery device for securing a suture comprises an elongated body having a proximal end and a distal end, a pre-configured knot disposed at the distal end of the elongated body, a suture snare having a snare configured to capture suture material, wherein the snare extends through the pre-configured knot and a suture locker secured to one end of material forming the pre-configured knot, wherein tension applied to the suture locker tightens the pre-configured knot.

Abstract: The disclosure relates to a surgical device configured to both strip and cut a tendon. The harvested tendon can be used in various orthopedic procedures, such as ACL, PCL, and UCL reconstructions.

Abstract: An endoscopic tissue fastening device may include a body having a first portion and a second portion arranged alongside the first portion. The second portion may extend distally of the first portion and may terminate in a distal end face of the body. The device may further include a tissue fastening assembly having a fastening head with a proximal end and a distal end. The fastening head may be deflectable at a location between the proximal end and the distal end of the fastening head. The tissue fastening assembly may be received within a lumen of the body. Further, the body may be moveable between an unarticulated configuration and an articulated configuration. In the articulated configuration, a central longitudinal axis of the second portion of the body may be substantially parallel with a central longitudinal axis of the tissue fastening assembly.

Abstract: An endoscopic resection assembly includes an adaptor configured to adapt to an endoscopic device. A pusher is disposed on the adaptor by inserting the adaptor into the central opening defined by the pusher. A cutting device includes a snare loop and a snare drive cable, and is removably coupled to the pusher. The cutting device is configured to resect a tissue when the snare loop is contracted by activation of the snare driver. A clip for engaging onto the tissue can be loaded onto the adaptor at a position distal to the pusher.

Abstract: System and method for dynamically managing message flow. According to the example embodiments, an intermediary network device or a client device dynamically manages the flow of messages received from an electronic exchange by analyzing the client device's capabilities, such as CPU utilization. Based on a percentage of total CPU utilization, the level of throttling is dynamically adjusted, such that if the percentage of CPU utilization, or load, increases, then throttling is increased from a lower level to a higher level. Similarly, if the percentage of CPU utilization decreases significantly enough, then throttling is decreased to a lower level.

Abstract: A device for positioning suture through tissue, the device including a proximal elongate member having a longitudinal axis, the proximal elongate member being configured to receive a needle, and a tissue locator disposed distal the proximal elongate member, the tissue locator being coupled to an elongate member extending through the proximal elongate member and including a leg with a needle receiving opening configured to accommodate the needle. Proximal movement of the elongate member compresses the tissue locator and folds the leg of the tissue locator, the leg transitioning from extending longitudinally to extending outwardly in relation to a position of the leg in a pre-compressed state.

Abstract: An endoscopic device, includes a clip assembly and a driving assembly. The clip assembly includes a first jaw, a second jaw, a pivot, a housing having an internal channel, and a release portion connecting to the first and second jaws. At least a portion of the first and second jaws is disposed within the internal channel, the first and second jaws selectively move along with the internal channel. The driving assembly includes an outer sheath, an inner tube, movably disposed within the outer sheath, and a driver, movably disposed within the inner tube, and removably received within the release portion. The driver is unbrokenly released from the release portion by a predetermined pull force. The housing and the outer sheath form a releasable handshake engagement. The inner tube extending into the housing prevents the handshake engagement from disengaging.

Abstract: Devices, systems and methods for passing a suture. In general, described herein are suturing devices, such as suture passers, as well as methods of suturing tissue. These suture passing devices may include dual deployment suture passers in which a first distal jaw member is moveable at an angle with respect to the longitudinal axis of the elongate body of the device and the second distal jaw member is retractable proximally to the distal end region of the elongate body and/or the first jaw member.