Abstract: Knotless surgical constructs and methods of tissue repairs. A surgical construct can offer both repair and shuttling capabilities to allow for a single pass to load multiple sutures at once. A surgical construct can pass or shuttle multiple repair sutures while making a single pass through or around soft tissue.

Abstract: An endoscopic surgical instrument deploys a hemostatic clip during endoscopic submucosal resection. The hemostatic clip has an elongated collar configured to be detachably coupled to a shaft of the surgical instrument, a pair of jaws received in the collar, and a magnet coupled to the jaws.

Abstract: Devices are provided for a suturing device used during laparoscopic surgical procedures. A suturing needle includes a shaft forming a rod axis; a curved body having a piercing tip at a first end and a base at a second end; and an arm extending from the shaft to the base of the curved body such that the curved body is rotatable about the shaft. The suturing device includes a housing, a suturing needle, one or more sutures, a suture magazine configured to hold the one or more sutures, and a drive system, whereby the drive system may actuate the suturing needle to rotate, allowing the suturing needle to drive into and out of tissue to apply a suture.

Abstract: A suture placement system is disclosed. The suture placement system has a plate defining a first opening spaced from a second opening. The suture placement system also has a first lumen having proximal and distal ends, wherein the distal end of the first lumen is coupled to the first opening. The suture placement system further has a second lumen having proximal and distal ends, wherein the distal end of the second lumen is coupled to the second opening. The suture placement system also has a guide coupled to the plate. A method of minimally invasive suture placement is also disclosed.

Abstract: An example anchor-manipulation tool includes (i) at a distal portion of the tool, an anchor-engaging element and an actuator, (ii) at an extracorporeal proximal portion of the tool, a controller, and (iii) a flexible longitudinal member extending between the proximal portion and the distal portion. The distal portion of the tool can be transluminally advanced to an anchor that is intracorporeally implanted in a subject. Subsequently, the anchor-engaging element can be engaged with an eyelet defined by a head of the anchor. Subsequently, the controller can be used to transition the tool into an articulatably-coupled state in which: (i) the eyelet at least in part inhibits movement of the anchor-engaging element away from the anchor, and (ii) the distal portion of the anchor-manipulation tool is deflectable with respect to the anchor. Subsequently, the anchor can be de-anchored by using the anchor-manipulation tool to apply a de-anchoring force to the eyelet.

Abstract: A benign prostatic hyperplasia treatment device. The benign prostatic hyperplasia treatment device includes: an anchor assembly including a pair of first and second anchors arranged at upper and lower portions of the outer surface of the prostate gland, and a ligature connecting the first and second anchors with each other so that the first and second anchors continuously compress the prostatic tissues to secure the opening of the prostatic urethra; a sheath inserted into the urethra and having a needle, which guides the anchor assembly to be deployed at the prostate gland; a needle manipulation part for manipulating movement of the needle so that the needle is deployed through an end portion of the sheath.

Abstract: A delivery device includes a central elongate structure, a sheath, a plurality of tethers extending through the central elongate structure configured to hold a cardiac valve, a cutting mechanism, a handle, and a control. The sheath is configured to slide over the central elongate structure. The cutting mechanism is configured to cut the tethers upon activation to release the cardiac valve. The handle is connected to the central elongate structure. The control on the handle is configured to activate the cutting mechanism.

Abstract: A surgical stapling instrument comprising an elongate shaft assembly that defines a shaft axis and includes a surgical end effector that is operably coupled thereto by an articulation joint. The surgical instrument includes a longitudinally movable flexible firing beam that is configured to flexibly traverse the articulation joint and be selectively axially movable from a starting position to an ending position. A middle support member is movably coupled to the elongate shaft assembly and a portion of the surgical end effector. A proximal support link is located proximal to the middle support member and is configured to provide lateral support to a proximal portion of the flexible firing beam traversing the articulation joint. A distal support link is located distal to the middle support member and is configured to provide lateral support to a distal portion of the flexible support beam traversing the articulation joint.

Abstract: A surgical loading unit includes an elongate body, an end effector pivotably coupled to the elongate body, and a flexible knife bar extending through a distal portion of the elongate body and a proximal portion of the end effector. Articulation of the end effector relative to the elongate body in a first direction moves a first segment of the knife bar in the first direction and moves a second segment of the knife bar in a second direction, opposite the first direction.

Abstract: Apparatus and methods are provided for closing a tubular structure within a patient's body. The apparatus includes a needle including a proximal end including a hub, a distal end including a sharpened distal tip, a lumen having an oblong cross-section extending proximally from the distal end, and defining a longitudinal axis between the proximal and distal ends, and a clip deliverable from the lumen. The clip is compressible between a relaxed state in which a plurality of tines of the clip are shaped to engage and close a tubular structure within a patient's body, and a stressed state in which the tines are compressed to allow the clip to be loaded into the. The apparatus may also include a pusher member for deploying the clip from the distal tip of the needle such that the tines engage and close a tubular structure through which the tubular member is directed.

Abstract: Surgical tools and kits for performing methods include a grommet with cylindrical shaft, cutting tip, annular flange with suture retaining anchoring fixture; a grommet jig for extending between adjacent grommets and guiding a needle therebetween; a family of needles with single and double pointed ends, reinforced eyelets, stops to limit inadvertent exiting, double shaft construction with a longitudinal gap and sharpened, slicing ends, including a “J” shape embodiment; a bone anchor with ring to secure sutures about a patient's clavicle; a tissue dissector having radially extending cones to nick taut connecting tissues; a tissue rasp having a series of crisscrossing grooves along an end; a tissue mesher comprising one or more blocks having a matrix of holes for clamping a plurality of needles and a supporting framework; and a kit device and a method of surgically inserting an internal mesh brassiere under the breast skin.

Abstract: A system for repairing a tricuspid valve and positioned at a distal end of a catheter having a proximal end and a distal end and a bore extending between the proximal end and the distal end. The system comprises an activation element extending along the bore, the activation element including a first push element and a first pull element; a second push element and a second pull element; a third push element and a third pull element; wherein the first push element, the second push element, and the third push element are independently slideable in relation to each other; a first lower jaw being pin connected to the first pull element; a second lower jaw being pin connected to the second pull element; a third lower jaw being pin connected to the third pull element.

Abstract: A tissue-fastening tool indwelling system includes: a sheath; a needle tube disposed in the sheath; a tissue-fastening tool including a wire having a coil region disposable in the needle tube in a stretched state and restorable to a coil shape with the same winding diameter outside the needle tube; a stylet connected to the wire; and a manipulation part for manipulating the stylet to advance the wire and rotate the sheath in a first direction. In a state where a distal end of the needle tube is proximal of the distal end of the sheath, the manipulation part is designed to operate such that the wire is delivered from the sheath by a length of one winding of the coil region per rotation of the sheath by less than one turn, and the protruding coil region biased to have a diameter larger than the winding diameter.

Abstract: A clip applier includes an outer tube, an actuation member, and an end effector. The actuation member has a distal portion including a cam member. The end effector includes a first jaw and a second jaw. Each of the first and second jaws includes a proximal portion that defines a cam slot. The cam member of the actuation member is operatively engaged with the cam slots of the first and second jaws such that movement of the actuation member from the first position to the second position causes movement of the end effector from an intermediate position to the open position and subsequently to the clamped position.

Abstract: An apparatus for transferring mechanical energy in a handle to a cartridge to manipulate tissue or anatomical structures within the body of a human or animal subject for the purpose of treating diseases or disorders. The handle and cartridge contain safety interlocks.

Abstract: Surgical access devices having wound closure features incorporated as part of the device are provided. The devices allow suture to be inserted directly into the device and operated to close an opening through which the device is disposed as or shortly after the device is removed from the surgical site. Further, the wound closure features allow for various orientations of wound closure to be achieved by adjusting an angle at which the suture enters tissue surrounding the opening to be closed. Some of the wound closure features provided for include openings formed in both the housing and cannula of the surgical access device, multiple openings formed in one or both the housing and cannula, locations of the openings being adjustable or otherwise movable, and various flexible seals. Other features, as well as methods of closing an opening through which the surgical access device was disposed, are also provided.

Abstract: An apparatus comprises a body, a shaft assembly, an end effector, a cartridge, and a staple driver actuator. The end effector is operable to manipulate tissue. The end effector comprises a lower jaw, a pivotable anvil, and a translating cutter. The translating cutter is operable to translate relative to the lower jaw and the anvil when the anvil is pivoted toward the lower jaw to manipulate tissue. The cartridge is insertable into the lower jaw and includes a plurality of staples. The staple driver actuator is disposed within the cartridge. The staple driver actuator comprises a secondary cutting element. The translating cutter of the end effector is operable to drive the staple driver actuator distally to staple and cut tissue substantially simultaneously.

Abstract: A surgical instrument comprising an end effector is disclosed. The end effector comprises a staple cartridge including a cartridge body comprising an annular array of staple cavities, staples removably stored in the staple cavities, a firing drive configured to eject the staples from the staple cavities, and a cutting member circumscribed by the staple cavities. The end effector further comprises an anvil including a tissue compression surface, forming surfaces configured to deform the staples and a tissue block for controlling the flow of tissue. The anvil is movable toward the cartridge body to compress tissue between the cartridge body and the tissue block during a closure stroke and the cutting member is configured to incise the tissue and the tissue block during a cutting stroke of the cutting member. The tissue block holds the tissue in position while it is being incised.

Abstract: A suture assembly may include a needle having a cylindrical body with a sharp point on at least one end, a lumen extending transverse to a longitudinal axis of the cylindrical body, and a recess in communication with an opening to the lumen. A suture extends through the lumen and is secured within the recess of the needle by a sleeve extending over the needle.

Abstract: A surgical system comprises an end effector including an ultrasonic blade and a capturing arm, wherein the capturing arm is movable to capture tissue against the ultrasonic blade. In addition, the surgical system includes a transducer configured to generate ultrasonic energy for transmission to the ultrasonic blade and a clamping member removably coupled to the end effector, the clamping member configured to clamp the captured tissue.

Abstract: An automated suturing adapter is disclosed. The automated suturing adapter has a target and a snare loop supported by the target. The automated suturing adapter also has a ferrule and a snare extension between the snare loop and the ferrule. An assembly is also disclosed. The assembly includes a cassette. The cassette has a housing defining a suturing gap. The cassette also has a needle stored in the housing proximal to the suturing gap. The cassette further has a ferrule holder distal to the suturing gap. The assembly also includes a target and a snare loop supported by the target. The assembly further includes a ferrule held in the ferrule holder and a snare extension between the snare loop and the ferrule.

Abstract: Cartridges and methods for ligation or dissection and ligation of tubular tissue structures are described. The cartridges and methods provide a means for efficient dissection and application of one or more ligatures by a single user using a single cartridge resulting in effective closure of a vessel or other tubular tissue structure by placement of a ligature at the desired location resulting in the desired tissue margin or stump.

Abstract: Various embodiments for a stent delivery device that utilizes a first mode of actuation for slow retraction of an outer sheath and a second mode of actuation for fast retraction of the outer sheath during delivery of a self-expanding implantable device such as a stent or stent graft.

Abstract: Embodiments of a knot pusher and methods of use thereof are disclosed, that are usable for pushing a knot formed from a suture, two limbs of the suture extending from the knot. The knot pusher comprises a distal head defining top and bottom walls terminating in a distal knot pushing surface. The distal head includes at least two side grooves defined between the top and bottom walls that extend proximally from the knot pushing surface. Each of these side grooves is operable to receive one of the limbs of suture. The distal head additionally comprises at least one suture guide coupled to the top and bottom walls for guiding the one of the limbs of suture into one of the side grooves.

Abstract: A surgical access apparatus is presented including a cannula having a housing and a cannula shaft, the cannula shaft defining an internal lumen and a slot in communication with the internal lumen and an obturator insertable through the internal lumen of the cannula. The obturator includes an obturator shaft having a proximal end and a distal end and a tip member disposed at the distal end of the obturator shaft, the tip member configured to form an incision through tissue. An outer surface of the obturator shaft and the tip member defines a channel for receiving and directing insufflation fluid into a body cavity, a portion of the same channel also configured to guide a surgical instrument, such as a suture passer/grasper for closing an incision, towards and through the slot. In this way, the cannula and obturator can be employed both for forming an incision at the beginning of a surgical procedure and for closing the same incision at the conclusion of the surgical procedure.

Abstract: An implantable prosthetic device includes a coaption portion, paddles, and clasps. The paddles are moveable from a closed position to an open position. The clasps are also moveable from an open position to a closed position. The implantable prosthetic device can be used to repair a native valve, such as a native mitral valve. Other embodiments are also described.

Abstract: A surgical device comprising a first jaw member, a second jaw member, a clamping member and a clamp apparatus is disclosed. The clamping member is slidably positioned to translate at least partially through the first jaw member. The clamping member engages the first jaw member and the second jaw member, and has a knife blade for cutting tissue. A flange of the clamping member is configured to engage a cam surface to pivot the second jaw member with respect to the first jaw member from an open position toward an approximated position. The clamp apparatus is movable from a retracted position to an advanced position for preventing a gap between proximal portions of the first jaw member and the second jaw member from exceeding a predetermined distance. The clamping member and the clamp apparatus are separately movable.

Abstract: A device for securing an article to a tissue may include a body, transitionable from a deployment state to a securing state, having a first portion, a second portion, and a medial portion therebetween. The first portion and the second portion may each have an end configured to pierce the tissue. The device in the deployment state may have a linearly extended or a U-shaped structure. In the securing state, the first portion may be embedded in the tissue and the medial portion may contact the article. A system for securing the article to the tissue may releasably engage the device while in the deployment state. A method for securing the article may include contacting the article with a tissue surface and releasing the device from the system so that the device, in the securing state, may anchor the article to the tissue.

Abstract: A surgical device comprising a first jaw member, a second jaw member, a clamping member and a clamp apparatus is disclosed. The clamping member is slidably positioned to translate at least partially through the first jaw member. The clamping member engages the first jaw member and the second jaw member, and has a knife blade for cutting tissue. A flange of the clamping member is configured to engage a cam surface to pivot the second jaw member with respect to the first jaw member from an open position toward an approximated position. The clamp apparatus is movable from a retracted position to an advanced position for preventing a gap between proximal portions of the first jaw member and the second jaw member from exceeding a predetermined distance. The clamping member and the clamp apparatus are separately movable.

Abstract: An end effector assembly (114) includes a first jaw member (114a) having a first tissue contact surface (122) and a second jaw member (114b) having a second tissue contact surface (122). The second jaw member (114b) is pivotally coupled to the first jaw member (114a). The tissue contact surfaces (122) may include raised steps (122b) that define an exhaust channel (124). A longitudinally extending knife slot (214) may be defined in one or both of the tissue contact surfaces (122). One or more exhaust slots (216), which may be defined in one or both of the tissue contact surfaces (122), are in communication with the knife slot (214). The exhaust channel (124) and the exhaust slots (216) direct fluid away from the jaw members (114a, 114b) to minimize thermal damage risks associated with tissue sealing.

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: Embodiments of systems and methods for fixing soft tissue are disclosed herein. In some embodiments, soft tissue may be fixed to an attachment surface (such as bone, other soft tissue, other implants, or allograft or xenograft materials) by providing a helical suture in the soft tissue, wherein the soft tissue has a longitudinal axis along which the soft tissue undergoes tension under normal physiological conditions, and wherein a longitudinal axis of the helical suture in the soft tissue is oriented parallel to the longitudinal axis of the soft tissue; and securing the helical suture to an attachment surface.

Abstract: A dural repair device operable with a single hand. The device comprises a handle and an outer arm having an end opening and a mechanism for holding a needle within the outer arm. The device also comprises an inner arm including a heel, a platform, an end opening, and a mechanism for catching a needle. The handle is activatable such that the inner and outer arms couple, the needle is caught by the mechanism for catching a needle within the inner arm, and when the inner and outer arms are uncoupled, the needle is transferred from the outer arm to the inner arm.

Abstract: A cassette is disclosed for use in a prosthetic suturing device. The cassette has a base. The base has a pair of pivots, a pair of alignment tabs, and at least one retention latch. The cassette also has a cover coupled to the base. The cover has at least one retention latch. The cover also defines one or more ferrule holders. The cassette further has one or more needles guided by the base and the cover. A surgical suturing device is also disclosed for use with a cassette. The suturing device has a cassette receiver and one or more needle drivers, each needle driver having a needle receiver positioned within the cassette receiver.

Abstract: A valve repair device for repairing a native heart valve of a patient includes a pair of clasps, where each clasp is configured to attach to native valve leaflet. The ends of the pair of clasps can move away from one another to a partially open position when the native valve leaflets open during a diastolic phase of a cardiac cycle, and the ends of the pair of clasps can move toward one another when the native valve leaflets close during a systolic phase of a cardiac cycle.

Abstract: An adjunct material for use with an end effector for a surgical instrument is provided that has different types of features for mating with the end effector. The adjunct is configured to be releasably retained on a jaw, such as a cartridge or anvil, using a plurality of female features formed thereon. Each female feature is configured to encompass a corresponding at least one of male features formed on the jaw in a clearance fit such that the adjunct is able to move with respect to the jaw at least in a first plane parallel to the tissue-facing surface. The male and female features mate such that the adjunct is not retained in a second plane that is perpendicular to the first plane. The adjunct also includes at least one attachment feature configured to releasably retain the adjunct on the jaw.

Abstract: A suturing device, in particular for suturing lacerations of the meniscus, comprising: a needle provided with a longitudinal cavity extending along a main direction; at least a first and a second member slidably inserted in the cavity and arranged in succession along the main direction; a surgical thread slidably inserted in the cavity and connected to the first and second member, wherein the first and second member each comprise at least one pair of bodies connected together by means of a junction. Other aspects may be disclosed and claimed.

Abstract: An end effector of a surgical stapling instrument is disclosed. The end effector comprises a staple cartridge and an anvil jaw comprising a tissue compression surface. The staple cartridge jaw comprises a deck, staple cavities, and staples stored in the staple cavities. The deck comprises first and second deck portions. A first tissue gap is defined between the first deck portion and the tissue compression surface when the end effector is in a closed configuration. A second tissue gap is defined between the second deck portion and the tissue compression surface when the end effector is in the closed configuration. The second tissue qap is larger than the first tissue gap. The second deck portion at least partially surrounds the staple cavities and is positioned vertically below the first deck portion. A distinct gap is defined between the first and second deck portions.

Abstract: A method for manufacturing a surgical instrument to have a manual release, which comprises mechanically coupling a manual release to a transmission of a surgical instrument having a self-contained power source disposed within a handle thereof, the transmission mechanically connecting an electrically-powered motor inside the handle to a movable part of a surgical end effector connected to the handle such that the transmission is operable to displace the movable part to a starting position, an actuated position, and at least one point between the starting position and the actuated position when the motor is operated; and wherein the manual release is operable to interrupt the transmission from operation of the motor and, during interruption, displace the movable part towards the starting position irrespective of the position of the movable part and independent of operation of the motor.

Abstract: A surgical instrument is disclosed. The surgical instrument comprises an elongate shaft comprising a distal end including a concave surface, an end effector assembly comprising a proximal end including a convex surface, wherein the convex surface is received by the concave surface of the elongate shaft, and wherein the convex surface comprises a first slot and a second slot defined therein, and an articulation assembly. The articulation assembly comprises a first articulation driver comprising a distal end including a first ball, wherein the first ball is received by the first slot and a second articulation driver comprising a distal end including a second ball, wherein the second ball is received by the second slot, and wherein the end effector assembly is rotated in a plane with respect to the elongate shaft when at least one of the first articulation driver and the second articulation driver are driven longitudinally.

Abstract: Disclosed herein are various embodiments of suture adjustment mechanisms for anchors configured to be inserted into a heart wall of a patient to anchor a suture as an artificial chordae under an appropriate tension for proper valve function. Suture adjustment mechanisms can be configured to retain suture ends extending from the leaflet to the anchor with sufficient force to prevent natural movement of the leaflet from adjusting a length of the suture between the anchor and the leaflet. Free ends of the suture can extend from the anchor external to the body as tensioning strands. A surgeon can supply sufficient force on the tensioning strands from external the body to adjust a length and tension of the suture between the anchor and the leaflet.

Abstract: A system for piercing through biological tissue and providing access to internal structures; particularly, intra-abdominal structures, and closing an opening in the tissue. The system includes a suture guide sub-system having a tissue positioning sub-system for engaging segments of tissue disposed proximate the tissue opening and a suture passer sub-system that slideably engages the suture guide sub-system. The suture passer sub-system includes suture deployment and capture means that is configured to removably secure a suture thereto and deliver the suture to the segments of tissue disposed proximate the tissue opening.

Abstract: A device is provided to assist in closing an incision through body tissue that comprises a tubular body sized for introduction through the incision and carrying a plurality of stabilizer elements at the distal end thereof. The stabilizer elements are configured to be deployed within the body cavity to engage the lowermost tissue layer. In one method, the device is pulled with the stabilizer elements deployed to retract the body tissue away from adjacent body structure. In another method, a plurality of needle tips carrying sutures are guided through the body tissue to a retention device at the ends of the stabilizer elements. With the needle tips captured in the retention devices, the device is withdrawn from the incision so that the sutures form ligatures that can be tied off to close the incision.

Abstract: An exemplary valve repair device for repairing a native valve of a patient includes: a strip of material; a coaption element formed from the strip of material; a pair of paddles formed from the strip of material and connected to the coaption element; a cap attached to the paddles; and a pair of extension members connected to the cap and the paddles via attachment portions. The paddles are movable between an open position and a closed position and are configured to attach to the native valve of the patient. Movement of the cap toward the coaption element causes the pair of paddles to move to the closed position, and movement of the cap away from the coaption element causes the pair of paddles to move to the open position. The extension members extend to end portions attached to the strip material. The end portions extend beyond the strip of material.

Abstract: Features are disclosed for an end effector for automated identification and handling of an object. The end effector includes an entangling structure that can be positioned over an entanglement point of an overpackage in which a desired object is location using sensors. Using the location information, the end effector can identify a path to the entanglement location and detect whether the overpackage is engaged by detecting environmental changes at the end effector.

Abstract: Devices and methods for securing a tissue anchor in tissue of a patient, in particular to ensure proper deployment of a cardiac tissue anchor by regulating the force or pressure of a deployment tool against the tissue. One way to ensure proper deployment force is to visualize the distal end of the tissue anchoring catheter from outside the body using a display for an imaging sensor, where the distal end of the catheter changes configuration when it is pressed against the tissue. Another method involves automatically regulating the pressure applied to the tissue prior to deployment of the tissue anchor, which may also be used in conjunction with visualization. Several safety locks to prevent deployment of the tissue anchor prior to establishment of the proper pressure are disclosed, which again may be used with visualization and/or an automated pressure regulator.

Abstract: An endoscopic treatment tool includes a sheath; a treatment portion; and a manipulation main body which includes a distal end-fixing portion capable of being fixed to a proximal end side-opening portion, an intermediate portion connected to a proximal end of the sheath and advances and retracts in a longitudinal axis direction of the sheath, a proximal end-manipulating unit which slides with respect to the intermediate portion, a fixing member, and a support member. One of the distal end-fixing portion and the intermediate portion is inserted and connected to the other thereof to partially overlap each other in the longitudinal axis direction, the support member is rotatably engaged with a member disposed on an outer side among the distal end-fixing portion and the intermediate portion, and the support member is configured to be able to fix the fixing member at an arbitrary-position of the manipulation main body in the circumferential direction.

Abstract: Apparatus for controlling motion of an invasive probe relative to a sheath enclosing the probe. The apparatus includes an outer casing, configured for connection to the sheath. The apparatus further includes a drive mechanism, fixedly connected to the outer casing. The drive mechanism has a first set of components, configured to translate the probe along a direction parallel to an axis of the probe, in order to advance and retract the probe with respect to the sheath in a translational stepwise manner. The drive mechanism also includes a second set of components, configured to rotate the probe around the axis of the probe, in order to rotate the probe clockwise and counter-clockwise, with respect to the sheath, in a rotational stepwise manner.

Abstract: A suturing system including an elongate distal member, an elongate proximal member proximal the elongate distal member, and a needle guide disposed between the elongate distal member and the elongate proximal member. A plurality of needles with a needle tip of each needle of the plurality of needles are orientated generally proximally toward a single opening in a distal end of the elongate proximal member. When the needle tip of each of the plurality of needles is at least partially disposed within the single opening, a portion of each needle of the plurality of needles, proximal a distal end of the needle guide, being radially separated by a distance less than a diameter of the elongated proximal member.

Abstract: A surgical suturing device has a guide tip defining cuff receiving and tissue bite areas. The guide tip has at least one needle guide configured to guide at least one needle through the cuff receiving area and the tissue bite area. Another surgical suturing device has a guide tip defining cuff receiving and tissue bite areas. The guide tip has at least one pair of needle guides configured to guide both the needles of at least one pair of needles through the cuff receiving area and the tissue bite area. The guide tip also has at least one pair of ferrule receiving apertures. The cuff receiving area and the tissue bite area are oriented to avoid cross-over of a suture passed by the at least one pair of needles through tissue in the tissue bite area and a replacement anatomical device sewing cuff in the cuff receiving area.