Abstract: A holder for an annuloplasty ring is disclosed. It comprises a plurality of linked-together suture platforms, wherein said holder comprises an upper face, a lower face, and a closed peripheral edge with means for accommodating and supporting said suture platforms of said annuloplasty ring.

Abstract: A suture tensioning apparatus for tightening the suture used to tie a tissue of a patient to the bone of the patient so that the tissue will cinch to the bone. A lever is mounted on a stub shaft that is supported to a base member and is movable in a lateral position. A pair of spaced spools are mounted on the lever and the reach of the suture is wrapped around each of the spools. Means, including a coil spring wrapped around the stub shaft is connected to the lever and a rotatable dome. The movement of the lever causes the lower portion of the coils to unwrap around the stub shaft, and rotation of the dome causes the upper portion of the coils to unwrap whereby the movement of the coil spring forces the lever to return to its original position. The tensioning apparatus can be incorporated into an existing suture gun or can be made integral therewith.

Abstract: Various exemplary methods and devices are provided for tensioning suture. The methods and devices are particularly useful in surgical suturing applications in which it is desirable to maintain tension on suture being delivered, yet to allow the tension to be released as desired without retracting the suture. Thus, when tension is released, a length of suture extended from the device can remain extended without any tension being applied thereto. Tension is only applied to any additional length of suture that is extended from the device. The tension applied to the suture is proportional to the length of the suture extended from the device until the tension is released and reset.

Abstract: An implantable port with an integral attachment mechanism. The implantable port includes one or more suture needles enclosed within a port body, the suture needle(s) coupled to a movable member such that movement of the movable member results in movement of the suture needle(s) out of the port body and into the tissue of a body into which it is implanted. The movable member can be a cam or tensioning member that rotates about a central port axis. The movable member can be coupled to a gear to permit movement of the movable member following implantation of the port within a subcutaneous pocket.

Abstract: A suture anchor loader comprises a housing with a port. A channel extends into the housing from the port, the channel being dimensioned to receive a surgical needle. A suture anchor is preloaded in the channel with a length of suture connected to the suture anchor and stored in the housing. A push rod is slideably positioned in the channel such that the suture anchor is intermediate the push rod and the port. An actuator is operatively connected to push rod to selectively deploy the anchor into the needle.

Abstract: Methods and devices are provided for deploying and applying a suture anchor. In one embodiment, a surgical device is provided having a shaft configured to be introduced into a body and to deliver a suture anchor with a coil of suture attached thereto to tissue. The shaft can be configured to deploy the suture anchor through tissue and to deliver the coil of suture into a body cavity such that the suture extending from the coil extends through the tissue to allow the anchor to engage the tissue. The coil can remain in the body cavity for subsequent use.

Abstract: A filament-guiding device directs a filament to spool over a rotating device within tissue. The filament-guiding device has both closed and open positions. In the closed position, the filament-guiding device is resiliently straightened for delivering into tissue. Within tissue, the filament-guiding device resumes a curved configuration in the open position to orient the filament perpendicular to the rotating device for spooling. The spooled filament is deployed by withdrawing the rotating device and filament-guiding device to bulk and repair the tissue.

Abstract: A suture needle instrument having improved connection means enabling a hollow suture needled to be attached to a handle in a variety of orientations. The suture needle is provided with user accessible suture channels and suture advancing wheels to facilitate cleaning and repair.

Abstract: A medical instrument which allows ligation in a living body to be efficiently carried out in safety by only one operator, or one operator and an assistant is provided.

Abstract: A device (10) is used for moving a thread of a surgical sewing instrument (60). The device comprises a clamp (18) for detachably clipping said device (10) on the surgical sewing instrument (60). The device has an arm (24) having a first end connected to said clamp (18). A freely rotatable roller (50) being arranged at a second end of said arm (24), said roller (50) resting on the thread of the surgical instrument (60) having clipped on the device (10).

Abstract: A suture anchor loader comprises a housing with a port. A channel extends into the housing from the port, the channel being dimensioned to receive a surgical needle. A suture anchor is preloaded in the channel with a length of suture connected to the suture anchor and stored in the housing. A push rod is slideably positioned in the channel such that the suture anchor is intermediate the push rod and the port. An actuator is operatively connected to push rod to selectively deploy the anchor into the needle.

Abstract: A tissue closing device for closing an opening penetrating a tissue membrane in a living body includes a closure configured to close the opening and a device configured to deploy the closure. The closure includes a seal portion and a deformation portion for covering the opening and tissue membrane surrounding the opening from opposite sides, and a connecting portion connecting the seal portion and the deformation portion. The arrangement device includes a storing member for storing the deformation portion and supporting the connecting member, and a hand-operated portion on the proximal side of the storing member. The storing member includes a take-out port which is openable from a closed state. The deformation portion is discharged exterior of the storing member by opening the take-out port.

Abstract: A ligature and suture device for medical application includes a distal end insertion portion, a needle body, a ligature tool, and an operation section. The operation section includes a housing that is provided in a base end portion of the distal end insertion portion, a puncture handle that is provided in the housing so as to be able to move freely backwards and forwards and that drives the needle body, a pressing handle that is provided in the housing so as to be able to move freely backwards and forwards and that drives a pressing member, a ligature tool operation unit that is provided in the housing so as to be able to move freely backwards and forwards and that drives a ligature sheath, and a ligature handle that is provided in the ligature tool operation unit so as to be able to move freely backwards and forwards and that drives an engaging portion.

Abstract: The surgical suturing instrument incorporates a pressurized fluid suture feed system for passing a suture through the instrument and the tissues to be joined thereby. A fluid jet in communication with a suture feed conduit selectively entrains a suture in a stream of pressurized fluid, which carries the suture through the instrument's hollow tissue penetrating needle. The tissue penetrating needle may be shaped to direct the suture's free end to a point external the body cavity. Alternatively, a suture return conduit may be provided to engage the hollow tissue penetrating needle to receive and carry the suture's leading end to a point external the body cavity. External or internal pressurized fluid sources are utilized. A surface irregularity proximal the suture's leading end enhances the entrainment of the suture with the fluid stream. Individual, cartridge and spool fed sutures may all be utilized.

Abstract: A device is disclosed for passing a flexible elongated element through a portion of a subject. In an embodiment, the device includes structure for retaining said flexible elongated element; and advancement structure for longitudinally advancing the flexible elongated element from a proximal end of the device toward a distal end of the device with sufficient force to pass the flexible elongated element through the portion of the subject. The advancement structure includes at least one drive wheel for contacting the flexible elongated element, and further wherein the at least one drive wheel contains a peripheral groove therein for receiving the flexible elongated element so as to provide increased contact area between the at least one drive wheel and the flexible elongated element.

Abstract: A surgical instrument for applying sutures to tissue includes a needle deployment mechanism and a catch mechanism. In some embodiments, the needle deployment mechanism employs a linear path. Alternatively, it can employ a curved needle. The surgical instrument may include a rotatable head, a bend, and/or a malleable elongated body member formable into various shapes.

Abstract: Devices for dispensing suture threads and/or suture threads with needles attached to them that are particularly useful for inserting surgical implants, such as suture anchors, that make use of sutures. The devices use a novel spool design to safely and neatly hold the suture thread and/or needles until the surgeon wishes to dispense them.

Abstract: A device is disclosed for introducing a flexible elongated element through at least two portions of a subject. In an embodiment, the device includes a proximal end and a distal end, as well as an advancement unit for longitudinally advancing the flexible elongated element toward the distal end such that a proximal end of the elongated element may pass from the distal end of said device with sufficient force to pass through the portions of the subject. The device also includes a securing unit for variably adjusting a securing force applied by the flexible elongated element to secure together the portions of the subject.

Abstract: A catheter includes a steering system for manipulating the distal-end region of a sheath having a plurality of electrodes into direct contact with difficult-to-reach areas of the human body. The steering system includes a core base, a core distal tip, a stylet, a steering tendon, and a lever. Movement of the lever applies tension to the steering tendon causing the distal end of the sheath to deflect. A positioning mechanism, including a slidable controller, adjusts the position of the steering system relative to the catheter sheath to thereby provide multiple steering profiles.

Abstract: Devices for dispensing suture threads and/or suture threads with needles attached to them that are particularly useful for inserting surgical implants, such as suture anchors, that make use of sutures. The devices use a novel spool design to safely and neatly hold the suture thread and/or needles until the surgeon wishes to dispense them.

Abstract: A surgical instrument for applying sutures to tissue includes a needle deployment mechanism and a catch mechanism. In some embodiments, the needle deployment mechanism employs a linear path. Alternatively, it can employ a curved needle. The surgical instrument may include a rotatable head, a bend, and/or a malleable elongated body member formable into various shapes.

Abstract: A surgical instrument for applying sutures to tissue includes a needle deployment mechanism and a catch mechanism. In some embodiments, the needle deployment mechanism employs a linear path. Alternatively, it can employ a curved needle. The surgical instrument may include a rotatable head, a bend, and/or a malleable elongated body member formable into various shapes.

Abstract: An apparatus and method for delivering or installing a surgical suture or suture-like implant into soft tissue, such as the meniscus of the knee, for example, for reattachment or repair of that tissue. The apparatus and method facilitate ease of placement of the suture or implant by the surgeon, protect surrounding tissue and nerves from damage during use, and permit suturing to occur through a single body portal. An injury to soft tissue, such as a tear in the meniscus of the knee joint or detachment of soft tissue from bone, is repaired through a single body portal by installing a surgical suture across the injury, tear, or detachment and passing that suture back through the body portal so that the suture can be joined and the injury, tear, or detachment can be reapproximated by the surgeon while working through the single body portal.

Abstract: A suture passer comprises a longitudinally extending hollow cannula having a central passage slidingly receivable of a surgical suture; a manually graspable handle connected to the hollow cannula for manipulation thereof, the handle having an upper surface; first guide means, connected to the upper surface of the handle, proximate a proximal end of the handle for releasably, guidingly, holding the surgical suture; second guide means, connected to the upper surface of the handle, distal to the first guide means, for releasably, guidingly, holding the surgical suture. The suture passer can be provided in a kit, for use in the suturing of internal tissue, along with a cannula bender, various hollow surgical needles and surgical suture material. The suture passer finds particular use in the suturing of internal tissues which are at least partially accessible through a body cavity, e.g., arthroscopic surgery.

Abstract: A procedure wherein an elongate, at least partially flexible tie member is partially wound about tissues to be closed at a surgical site. Opposite ends of the flexible tie element are entrained by a twisting instrument which has a distal end juxtaposed to the surgical site. The twisting instrument extends out of the patient so that a proximal end of the instrument is manipulable by a surgeon. The surgeon rotates the instrument about a longitudinal axis, thereby twisting the tie member multiple turns about itself. Where the tie member is a wire, the twisting effectively locks the tie member at the surgical site. The tie member may then be severed by a cutters so that the tissues are closed.

Abstract: A surgical suturing apparatus includes a needle, a needle holder which also serves as a support for suturing material, and an elongate handle. The needle defines a passageway through which the suturing material extends. The passageway has an outlet at the distal end of the needle.

Abstract: A suture container having a spool rotatably mounted therein. A length of suture material is wound on the spool is wrapped in an outer bacterial-proof envelope.

Abstract: In a packaging (1) for surgical suture material (6), a thread duct which runs spiral-like is formed in a base (2) and opens at its first end to form a thread removal zone in the periphery area of the base (2). The base (2) is provided with a cover (4). An edge segment (3) of the base (2) can be folded down about a fold line provided in the region of the underside of the base (2) for access to the thread removal zone.

Abstract: A surgical instrument for applying sutures to tissue includes a needle deployment mechanism and a catch mechanism. In some embodiments, the needle deployment mechanism employs a linear path. Alternatively, it can employ a curved needle. The surgical instrument may include a rotatable head, a bend, and/or a malleable elongated body member formable into various shapes.

Abstract: A combined tissue clamping and suturing instrument includes a pair of opposed jaws selectively actuated by operation of a handle portion, a hollow suture needle mounted on a first of the jaws and provided with a slot, and a length of suture material extending through the hollow needle. A groove is preferably formed on a peripheral side wall of the first jaw so that a portion of the suture material can be disposed within the groove and, when provided, the groove preferably communicates with a first open end of the hollow suture needle. The slot and groove each have a width to prevent the suture material from inadvertently falling out while permitting deliberate removal of the suture material via the slot or groove by application of force so that suturing of anatomical tissue can be performed with tissue held between jaws of the instrument.

Abstract: A surgical instrument includes a pair of pivotally connected arms defining a pair of opposed jaws, a hollow suture needle mounted on a first of the jaws and provided with a slot, and a length of suture material extending through the hollow needle. The hollow needle has a first open end mounted on the first jaw and a second open end defining a tissue penetrating point, the first and second open ends being connected by the slot. A groove is preferably formed along an outer surface of the first jaw so that a portion of the suture material can be disposed within the groove and, when provided, the groove preferably communicates with the first open end of the hollow suture needle. The slot and groove each have a width to prevent the suture material from inadvertently falling out while permitting deliberate removal of the suture material via the slot or groove by application of force so that suturing of anatomical tissue can be performed with tissue held between jaws of the instrument.

Abstract: A ligating instrument for forming ligatures at an internal operative site in the body includes an instrument body having a distal end for positioning at the operative site, a proximal end for positioning externally of the body and a lumen between the distal and proximal ends. A ligature supply including a plurality of preformed, contractible ligature loops of filamentous ligature material is disposed in the lumen. Each of the ligature loops has a fixed knotting element and a movement permitting knotting element permitting movement of the ligature material relative thereto to reduce the size of the ligature loops around anatomical structure. The ligature supply is movable distally relative to the instrument body to move a ligature loop through the distal end to deploy the ligature loop externally of the instrument body for positioning around anatomical structure.

Abstract: A surgical instrument an outer hollow member having a passageway extending therethrough. A handle is disposed near its proximal end to enable manipulation of the outer member. An inner movable assembly reciprocates through the passageway. A distal end of the inner assembly is drivable distally through the passageway from a retracted position to an extended position protruding distally beyond the distal end of the outer member. The distal end of the inner assembly terminates in at least first and second grasper members for traveling past and on either side of a portion of a surgical filament in the extended position and for encircling the filament portion in the retracted position to manipulate the filament within the patient.

Abstract: The invention described herein is a device for tying knots intracorporeally during laparoscopic surgery. It is intended to simplify the process of tying intracorporeal knots to the point that the average laparoscopist can quickly learn to suture laparoscopically with confidence. The unique features of this invention include: a driven shuttle; integral grasper or needle driver; the system is reloadable; and the system may have a detachable end effector. The system also may have a multi function handle, and incorporates an integral needle driver mechanism.

Abstract: Methods and apparatus for suturing in physically confined and visually restricted areas are disclosed. Suturing instruments are described that serve to deliver suture material through biological tissue by extending and retracting the distal portion of the instrument through the tissue. Suture needles are described that include structure for piercing through biological tissue to a position on the opposite side of the anastomotic site structure for delivering suture material through the tissue. In this way, a stitch is formed as the suture needle retracts. In one embodiment, the suture needle includes a notch located on the needle surface which can receive a loop of suture material. Upon passing the suture needle through the tissue, the suture material can be seated within the notch so that the suture material is drawn through the tissue as the needle is retracted. The needle can include a coupling mechanism that mounts the needle for pivoting action in response to a linear actuating motion of a rod.

Abstract: A device and method are provided for the surgical suturing of narrow incisions that penetrate through a plurality of tissue layers. An elongated, "J"-shaped needle, through which suture material is threaded, is inserted into the wound, bringing the tip through one or more layers of tissue on one side of the wound and pulling suture material up through the wound. After repeating these steps on the other side of the wound, the suture material is knotted. A slidable locking member serves the dual purpose of covering the tip of the suture needle when not in use and also of maintaining pneumoperitoneum.

Abstract: The invention described herein is a device for tying knots intracorporeally during laparoscopic surgery. It is intended to simplify the process of tying intracorporeal knots to the point that the average laparoscopist can quickly learn to suture laparoscopically with confidence. The unique features of this invention include: a driven shuttle; integral grasper; the system is reloadable; and the system may have a detachable end effector. The system also may have a multi function handle.

Abstract: A moldable and/or extrudable polymer which is useful for the manufacture of surgical devices such as sutures, staples, clips, etc., possesses structural units derived from a cyclic amide monomer containing oxygen, sulfur or nitrogen in the ring.

Abstract: Surgical suturing apparatus comprises upper and lower jaw elements selectively movable relative to one another between open and closed position. Each jaw element is provided with a respective recess arranged to receive a portion of an elongate incision member or length of surgical thread and securing means is provided arranged to selectively secure the surgical incision member or length of surgical thread in a respective recess. The jaw elements are typically provided at an end of an elongate positioning and operating arm making the device particularly useful for use in laparoscopic surgery.

Abstract: A device and method are provided for the surgical suturing of narrow incisions that penetrate through a plurality of tissue layers. The device comprises a hollow needle through which suture material is threaded, the needle having the shape of an elongated "J." The method entails inserting the needle into the wound, bringing the tip through one or more layers of tissue, and pulling suture material up through the wound; these steps are repeated for the other side of the wound to form a single stitch, which may then be knotted. In this way one or more subcutaneous layers of tissue may be sutured without involving the skin, which may be sutured using conventional means to complete the closure.

Abstract: An instrument (602), particularly suited for endoscopic use, has an elongate body, including a base (604) and an elongate spindle (630) rotatably mounted to the base. A removable end-effector assembly (612), mounted at the distal end of the spindle (630), includes end-effector elements (608, 610), such as a pair of jaws, actuated by finger and thumb rings (616, 618) mounted to the base. A rotary actuator trigger (78) is slidably mounted to the base. The spindle (630) has a spiral groove (632) engaged by a cam pin (82) extending from the trigger so that axial movement of the trigger causes rotary motion of the spindle and the end-effector assembly therewith. The spindle and end-effector assembly are sheathed by a nonrotating sleeve (688) with an unbroken outer surface. The sleeve can be releasably translated axially to release or engage an end-effector assembly, allowing use of alternate end-effector assemblies.

Abstract: A needle manipulator (2), particularly suited for endoscopic use, has an elongate body (4) including a base (6) and an elongate tip carrier tube (8) rotatably mounted to the base. A removable tip assembly (10), mounted at the distal end of the tip carrier tube, includes jaws (26,28) actuated by finger and thumb loops (16,18) mounted to the base. A rotary actuator trigger (78) is slidably mounted to the base. The tip carrier tube has a spiral groove (90) engaged by a cam pin (82) extending from the trigger so that axial movement of the trigger causes rotary motion of the tip carrier tube and the tip assembly therewith. Suture material (93) is supplied through the carrier tube and to a needle (118) held by the jaws.

Abstract: An endoscopic suture punch for use in endosurgical procedures, especially an anti-reflux procedure. This suture punch has an elongate frame and a handle mounted to one end of the frame. A pair of opposed jaws having tissue punches is mounted to the other end of the frame. One jaw is rigidly mounted to the frame while the other jaw is movably mounted to the frame, although both jaws can be movably mounted. An actuation handle is mounted to the frame for actuating the jaws. The suture punch has a suture pathway through the frame, the punches and the jaws for receiving the suture. There is a suture drive mechanism mounted to the frame for moving the suture through the suture pathway. The endoscopic suture punch is used with an invaginator for performing an anti-reflux procedure. The endoscopic suture punch may typically be used for suturing and other endoscopic procedures.

Abstract: An endoscopic suture tool is provided to minimize extra-corporeal exposure of the suture to bacteria and to minimize the possibility of suture entanglement with external trocars and other instruments. The suture tool has a holder with a protrubing hub for accepting a standard suture reel and an orifice through which the suture feeds into and through the lumen of an extension member releasably carried by the holder. Adjacent the distal end of the extension member, a slot is located in the extension member for captively and releasably holding the free end of the suture.

Abstract: An endoscopic surgical instrument is designed for axial elongation by incorporating a manually operated mechanism which elongates the instrument upon manual rotation. The manually operated mechanism is joined to an internal rod and tube, which are likewise extended and which support a functional element at the tip of the instrument. Operation of the functional element at the distal tip of the instrument is achieved by manipulations at the proximal end of the instrument, and is not impaired by the extension.

Abstract: A surgical instrument for threading a loop of suture material through a piece of tissue to be stitched or removed as part of a surgical procedure and for wrapping a loop of suture around a piece of tissue. The instrument includes an extractor shaft assembly which is slidably disposed inside an inner tube. The latter is slidably disposed inside an outer tube. The extractor assembly has a pointed front end and a hook directly behind the front end. A tissue clamping bracket is secured to the front end of the outer tube, both of which are sized to fit inside a conventional cannula of the sort used in closed surgeries. The outer tube is secured to a handle assembly which includes a movable member for causing the inner tube to reciprocate inside the outer tube so as to coact with the clamping bracket to clamp a piece of tissue therein.

Abstract: A suturing instrument for use in arthroscopic surgery includes a hollow needle for penetrating tissue to be sutured within the body while the tissue is clamped between relatively movable jaws, and a suture feed mechanism for feeding suture material through the hollow needle such that the jaws can be opened and the suturing instrument withdrawn from the body pulling the free end segment of the suture material with the instrument. A knot can be tied in the suture material externally of the body and the knot moved back into the body at a position adjacent the tissue.

Abstract: The invention relates to surgical instruments and methods for effecting suturing of tissue that can be controlled from a position remote from the suture site. The invention provides for the continuous feed of suture material through opposed forcep jaw members between which the tissue segments are interposed to expedite the suturing process and enable suturing to be accomplished at remote internal sites of the body incident to various endoscopic procedures.

Abstract: A method of suturing tissue in the body particularly useful in arthroscopic surgery requiring only small incisions or portals for insertion of diagnostic and surgical instruments includes the steps of inserting an instrument in the body having a distal end carrying relatively movable jaws with openings therein, manipulating the jaws to penetrate the tissue to be sutured and to move the jaws to positions adjacent each other with the openings therein aligned, feeding suture material through the openings in the jaws, securing ends of the suture material to form a knot and moving the knot to a position adjacent the tissue.

Abstract: A suturing implement particularly useful in surgical operations for suturing a member, such as a prosthetic valve, to tissue at the suture site by a plurality of sutures each including a needle attached to at least one end. The implement comprises a manually grippable handle; pledget gripping members carried by the handle for gripping a plurality of pledgets each in a position to be pierced by a suture needle; and a releasing device carried by the handle for actuating the pledget gripping means to release the pledgets and the sutures applied thereto from the handle.