Abstract: A vessel access and closure device places a running suture in the wall of a blood vessel using a rotating helical suture needle that carries the suture along a helical path passing through the vessel wall, then reverses rotation to release a suture anchor attached to the distal end of the suture. A loose helical coil of suture is left behind as the helical suture needle withdraws. The device is withdrawn and replaced with a vessel dilator and an introducer sheath that opens up a larger access opening into the blood vessel and creates a pathway that passes though the helical coil of suture for introducing an interventional device into the blood vessel. After the interventional procedure is completed, the interventional device and the introducer sheath are withdrawn and the running suture is tightened and secured with a suture lock to close the access opening into the vessel.

Abstract: A system is disclosed including a first expandable anchor and a second expandable anchors. The anchors may be delivered to opposing sides of a fascial opening and expanding to a predetermined size to secure the anchor at the site of delivery. A strap, designed to pull the anchors together, may extend from the first anchor to the second anchor. Upon deployment, a tension force may be exerted on the strap in order to pull the anchors toward one another and close the fascial opening. Methods and apparatus for closing the fascial opening are also disclosed.

Abstract: A system for suture passage through a tissue according to embodiments of the present invention includes a suture snare, the suture snare comprising a resilient anchor element and a suture capture element, a substantially rigid passer tube, an actuator rod, a snare enclosure formed by the passer tube and actuator rod, the actuator rod movable to move the snare enclosure between a closed configuration which completely captures a portion of the suture snare and an open configuration which does not completely capture the portion of the suture snare, and a piercing tip configured to form a hole through the tissue, wherein at least one dimension of the resilient anchor element in an undeformed state is larger than a largest dimension of the hole, and the anchor element deforms during insertion of the resilient anchor element through the hole and substantially resumes its prior shape after passing through the hole.

Abstract: A surgical suture material and a method to the use thereof are represented by different needles and surgical threads. The main embodiments comprises a needle (6), consisting of two needles (7, 8) jointed by a temporary connection having a tetrahedral, diamond or another shape in such a way that a single needle point (9) is formed, and a surgical thread (10) provided with shaped design projections embodied on the thread surface in the form of notches. The shaped design of the notches has a very important significance since it makes it possible to provide a reliable linkage with soft tissues and to forcedly holding the soft tissues when force actions are applied thereto. The method consists in introducing, during a surgical intervention, the twin needle in one puncture at a small depth, wherein the needle is divided into two needles, and in leading each needle along a required contour. The surgical suture material can be extensively used for surgical and cosmetic interventions.

Abstract: An arthroscopic suture cutting device according to embodiments of the invention includes an outer tube; an inner rod including an outer surface and an aperture, a distalmost edge of a second distal opening located distally of a distalmost edge of a first distal opening, the inner rod can receive a suture extending through both distal openings; in a loading position, the inner rod extends distally of the outer tube to receive the suture; in an intermediate position, the distal openings are closer to the outer tube, such that the suture is permitted to slide through the aperture without release; and in a cut position, the distalmost edges of the distal openings are within the outer tube. Moving from intermediate position to cut position draws the suture between outer tube and inner rod, urging the inner rod radially toward the second distal opening, cutting the suture between the outer tube and the distalmost edge of the second distal opening.

Abstract: An endoscopic surgical instrument for passing a suture through tissue includes a first jaw member, a needle, and a capture feature actuable to grip and retain the suture after the suture has been passed through a tissue body. An actuation mechanism can both move the needle between retracted and extended positions, and move the capture feature between open and closed configurations, via a single actuation. The capture feature may be a trap door which is axially translatable relative to the first jaw member to overlap a portion of the first jaw member and trap a portion of the suture between the trap door and the overlapped portion. The first jaw member may be movable relative to a second jaw member to grasp a tissue body. The instrument can grasp a tissue body, pass the suture through the tissue, capture and retain the suture without being repositioned relative to the tissue.

Abstract: A method for positioning a guide element in a patient and a kit for use in the method. In one embodiment, the method involves transorally inserting an endoscope into a patient's stomach. An incision site is externally indicated by transilluminating the stomach and abdominal walls of the patient from within the stomach. Next, a scalpel incision is made at the indicated incision site, and an access needle is inserted into the incision, the proximal end of the access needle remaining external to the patient and the distal end of the access needle extending into the patient's stomach. The stylet of the access needle is then removed from the patient while keeping the cannula in place. Next, the distal end of a grasping tool is inserted through the cannula and into the patient's stomach. The looped leading end of a pullwire is then inserted through the endoscope and into the stomach. The tool is then manipulated until a distal hook on the tool catches the looped leading end.

Abstract: Methods and devices are disclosed for minimally invasive procedures in the heart. In one application, a catheter is advanced from the left atrium through the mitral valve and along the left ventricular outflow tract to orient and stabilize the catheter and enable a procedure such as a “bow tie” repair of the mitral valve. Right heart procedures are also disclosed.

Abstract: A method for closing an opening in tissue using a suturing device includes inserting at least a portion of a suture through a tissue tract and through a tissue wall. Following inserting at least a portion of the suture, the method includes advancing a first end of the suture through a bight of the suture, the bight pre-formed about a periphery of a knot tube of the suturing device. Once the first end is advanced, the method includes tensioning the first end of the suture and a second end of the suture adjacent the bight to form a knot affixing a loop of suture across the puncture.

Abstract: Medical devices for cutting and suturing biological tissue generally include a shaft and first and second guide members each including a first portion coupled to the shaft at a first location and a second portion coupled to the shaft at a second location. The first portions are movable along the shaft relative to the second portions, and the first and second guide members define an arcuate profile and are configured to flex in response to such movement. When used to cut tissue, the medical device may further include a blade positioned between the first and second guide members. When used to suture tissue, one or more suture guides may be provided on the first guide member for directing a suture needle through tissue proximate the first guide member. Methods of repairing and replacing a meniscus using the medical devices are also provided.

Abstract: A surgical knot setter includes an elongated shaft having a long axis and proximal and distal portions. A tip is provided at the distal end of the shaft. The tip has a loop with an interior loop opening and a gate opening for permitting ingress and egress of a suture into the loop opening. The loop is laterally offset from the long axis and distal to the distal end of the shaft, such that the loop is laterally and longitudinally offset from the distal end of the shaft. A closure is provided for selectively opening and closing the gate opening between open and closed positions to selectively permit or prevent the suture from passing through the gate opening. An actuator moves the closure between the open and closed positions. A method for tying suture knots is also disclosed.

Abstract: A suture device is configured to guide a suture thread. The device includes a sleeve that defines an opening, and a plunger to which a suture thread can be attached. The plunger can be inserted into the opening of the sleeve, and movable between a retracted position and an advanced position. When the plunger is in the retracted position, a distal portion of the suture thread is located proximal with respect to the distal end of the suture device. When the plunger is in the advanced position, the distal portion of the suture thread is driven out the distal end of the suture device.

Abstract: The integrated medical apparatus includes an operator handle end and a multi-prong grasping member positioned within and movable relative to a grasper lumen that extends from the handle end, wherein the grasping prongs are moved between an open and closed position by relative axial movement between the prongs of the grasping member and the grasper lumen. The medical apparatus includes a contractible snare and a plurality of axially moveable snare pushing arms. At least two of the snare pushing arms include a snare holding and release mechanism, wherein the snare pushing arms are configured to advance the snare in an open, encircling position to a final deployed position where the snare can be released through the activation of the holding and release mechanism of the pushing arms, and finally tightened in a conventional fashion, such as pulling on an end of the snare at the handle end.

Abstract: A minimally invasive surgical instrument having an elongate stem extending between a proximal end which in use is located externally of an operating space and a distal end which in use is located within an operating space. At least a portion of the stem is malleable to facilitate manipulation of the stem in the operating space and then to maintain the stem in the manipulated position and/or orientation within the operating space. The instrument has an end effector at the distal end of the stem, the end effector having a proximal main body and distal operating means, such as graspers or cutters. The instrument has at least one joint for independent movement of the end effector main body in at least one direction relative to the distal end of the stem for enhanced degrees of freedom of the instrument.

Abstract: The present disclosure relates to a seal assembly for a cannula. The cannula includes a housing having a proximal portion and a distal portion. The seal assembly is located in the proximal portion of the housing and includes a first seal including a first tri-slit, a second seal disposed co-axially and proximal to the first seal and including a second tri-slit, and a third seal disposed co-axially to the first seal and the second seal and including a central opening. A cap is coupled to the proximal portion of the housing and adjacent the third seal and includes a plurality of suture retaining features, such as tabs, for management of sutures during surgery. Fluid leakage out of the cannula, during surgery, is substantially reduced due to the leakage being limited to a channel defined by the first tri-slit, the second tri-slit, and the central opening.

Abstract: The present disclosure relates to a seal assembly for a cannula. The cannula includes a housing having a proximal portion and a distal portion. The seal assembly is located in the proximal portion of the housing and includes a first seal including a first tri-slit, a second seal disposed co-axially and proximal to the first seal and including a second tri-slit, and a third seal disposed co-axially to the first seal and the second seal and including a central opening. A cap is coupled to the proximal portion of the housing and adjacent the third seal and includes a plurality of suture retaining features, such as tabs, for management of sutures during surgery. Fluid leakage out of the cannula, during surgery, is substantially reduced due to the leakage being limited to a channel defined by the first tri-slit, the second tri-slit, and the central opening.

Abstract: A surgical incision suturing device particularly suited for minimally invasive surgical procedures comprising a suturing mechanism built into a trocar stem that enables a surgeon to stitch a patient by utilizing controls on the exposed top portion of the trocar.

Abstract: A lattice stitch and stitching method for closing wounds are characterized by the use of a tension limiting device. First and second anchor stitches are arranged in a tissue layer spaced from and generally parallel to the wound, with the first and second anchor stitches being on opposite sides of the wound. A closing stitch is looped around the fist and second anchor stitches and tied to draw the wound to a closed condition. The tension limiting device is used during stitching of the anchor stitches. The device is arranged between the anchor stitches and the tissue layer adjacent to the wound to prevent over-tightening of the anchor stitches and lend support to the closure. The tension limiting device can be used in any soft tissue surgical application to displace and disperse suture tension at the surface of the underlying soft tissue, to fasten a dressing to the surface of a wound, and to bolster skin graft repairs of wounds.

Abstract: A system for installing a vertebral stabilization system. The system includes an installation tool including a handle portion and a shaft extending distally from the handle portion. The shaft includes a conduit and a staple mechanism. The system also includes a flexible implant member extending along the conduit configured to be advanced out from a distal end of the shaft, and a staple housed in the staple mechanism. The staple is configured to secure the flexible implant member to a vertebra. The handle portion is configured to selectively advance the flexible implant member from the shaft and to selectively actuate the staple mechanism.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot near a distal end of a shaft is inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot carries suturing attachment cuffs, and needles are advanced from the shaft through the vessel wall outside of the penetration and into engagement with the needle cuffs after the foot has been drawn proximally up against the endothelial surface of the blood vessel. The cross-section of the shaft within the tissue tract can be minimized by laterally deflecting the needles as they leave the shaft, while tapered depressions within the foot can guide the advancing needles into engagement with the cuffs. The cuffs lockingly engage the needles and can be withdrawn proximally along the needle paths and through the tissue tract so as to form a loop of suture across the puncture.

Abstract: A closure device is provided for clamping sutures when closing an opening in tissue. The closure device includes an inner part and an outer part. Sutures drawn through the inner part and the outer part are clamped and held in place when the inner part is pressed together with the outer part.

Abstract: A system for repairing a meniscus includes a suture that includes a first anchor, a second anchor, and a flexible portion connecting the first anchor and the second anchor. The flexible portion includes a self-locking slide knot between the first anchor and the second anchor. The system also includes a needle having a longitudinal extending bore and an open end. The bore is configured to receive the first anchor and the second anchor. The system further includes a body portion operatively connected to the needle at a distal end of the body portion. The body portion has a lumen. The system also includes a pusher configured to rotate and slide within the lumen of the body portion and the longitudinal extending bore of the needle. The pusher has first and second stop surfaces, each of which is constructed and arranged to engage a proximal end of the body portion.

Abstract: A device for closing an aperture in a vessel wall comprising a covering member having a longitudinal axis and positionable inside the vessel against the internal opening of the aperture and a first spherical retainer positionable external of the vessel. The covering member has a dimension to prevent egress of fluid through the aperture.

Abstract: A method for inserting an instrument through a natural orifice. The instrument has a low profile orientation and a deployed orientation which is larger than the size of the natural orifice through which it is to be inserted. The method is achieved by coupling the instrument to an endoscope and placing the instrument in its low profile orientation, inserting the endoscope and the instrument through a natural orifice to a target position within a body while the instrument is in its low profile orientation, actuating the instrument to it is deployed orientation, and returning the instrument to its low profile orientation and withdrawing the instrument from the body through the natural orifice.

Abstract: A novel bridge clip tissue connector includes two clips separated by a bridge portion. The clips allow for the connecting of tissue at two positions that are maintained by the bridge portion. The connector can be used for performing a wide variety of surgical procedures, including anastomosis and a horizontal mattress suture-like connection.

Abstract: The invention relates to a surgical instrument, e.g. forceps, and method to be used for suturing tissue, the surgical instrument comprising a first arm and a second arm that are spring-connected at a proximal end, while at a distal end the first arm and the second arm can be moved towards each other, and wherein at least the first arm and/or the second arm can be provided with a bullet that is suitable for receiving and affixing a surgical needle, wherein the bullet is designed for being positioned at the distal end, at an inside and/or lower side of the end of an arm.

Abstract: A device for automatically providing needles to a sealing apparatus for sealing a puncture in an anatomical structure, the sealing apparatus including a needle insertion lumen and a needle pusher channel having a needle pusher disposed therein. The device may include a housing coupled to the sealing apparatus and a cartridge disposed in the housing. The cartridge has a first and a second needle slot extending from a distal end of the cartridge to a proximal end of the cartridge. The first and second needle slots have first and second needles disposed, e.g., pre-loaded, therein, respectively. The cartridge is moveable, such as by a biasing element, relative to the housing between a first position in which the first needle slot is aligned with the needle insertion lumen and the needle pushing channel, and a second position in which the second needle slot is aligned with the needle insertion lumen and the needle pushing channel.

Abstract: The present invention is directed to methods and apparatus for cutting filaments percutaneously. The methods and systems may be used in conjunction with sealing a puncture percutaneously in tissue separating two internal portions of the body of a living being with an anchor, a sealing plug and a filament connecting the anchor and sealing plug. The present invention provides for safe filament cutting below the skin and may reduce the risk of cutting the filament distal of any knots.

Abstract: The present invention relates to devices and methods for securing a pair of suture lengths together or for using a single strand of suture to secure tissue(s) together at an operative site in a patient without necessarily tying a knot. The suture lock device may include a suturing securing device having an outer body member having a lumen extending therethrough, the lumen defining a suture path through the outer body, an inner wedge member axially insertable into the outer body member to secure a portion of a suture between the wedge and the interior surface of the lock member, an outer tube carrying the outer body member at the distal end of the outer tube, the outer tube carrying the wedge proximal to the outer body member, and a pusher member slidable within the outer tube to push the wedge into the lock member.

Abstract: An apparatus for tissue repair includes first and second fixation members configured to secure tissue together, a flexible coupling member coupling the first and second fixation members, the flexible coupling member having two terminal ends, one of the two terminal ends terminating adjacent one of the first and second fixation members, the flexible coupling member slidably coupled to at least one of the first and second fixation members such that when the other of the two terminal ends of the flexible coupling member is pulled, a length of the flexible coupling member between the first and second fixation members is shortened, and a closed loop of flexible material, the flexible coupling member being slidably received through the closed loop of flexible material.

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

Abstract: Devices and treatments for various joint conditions include a resilient elongate orthopedic device inserted into a joint space using a suture. The suture is passed through the joint space and used to pull the orthopedic device into the joint space. The suture may be using a percutaneously inserted needle or other type of needle-based delivery instrument. The resilient elongate orthopedic device may be restrained to a reduced profile that permits minimally invasive implantation, but assume an enlarged profile when positioned at an implantation site.

Abstract: A surgical suture instrument including a shank (2) on whose distal end a forceps jaw (4) is formed. The surgical suture instrument comprises a needle guide (30) through the forceps jaw (4). A receiver (40) for the releasable fastening of a needle holder (42) is formed on the shank (2), connected to the needle guide (30) on the proximal side of the needle guide (30).

Abstract: A suture system includes a plurality of double-stranded needles connected in sequence with a single-stranded needle at each end. The double-stranded suture needles incorporates two suture strands into a single needle. The suture system of the present invention facilitates the implantation of valve prostheses.

Abstract: A device for straightening sutures or pre-packaged suture-needle combinations. The device has a body formed of substantially resilient material flexible enough to be penetrated by a pointed end of a needle along with a suture inserted into it or to obtain a substantial gap when a slit is cut or molded into it. The device may be held securely in a position for subsequent grasping by a user for drawing a suture through it or attached to an OEM suture packaging. A means of engagement such as adhesive provides means for temporary or permanent attachment to the suture packaging.

Abstract: A tensioning device is provided comprising a locking device. The locking device comprises a locking enclosure comprising a groove and a locking pin comprising teeth. The tensioning device further comprises a suture comprising first and second portions. The first and second portions of the suture and the locking pin are positioned within the groove of the locking enclosure and the locking pin is movable within the groove between a first, outer position in which the teeth are disengaged from the suture so that the locking device is movable along the first and second portions of the suture and a second, inner position in which the teeth are engaged with the suture so that the locking device is not movable along the suture. Methods for treating mitral valve regurgitation are also provided.

Abstract: A surgical knot pusher device allows a prepared knot to be pushed down a length of suture without deforming or collapsing the knot. The surgical knot pusher device includes a handle portion and an elongate body extending from the handle portion. The elongate body has a curved tip that is tapered and has a groove along a length of the tip. The tip also includes a central channel extending from the groove to a distal end of the tip.

Abstract: A surgical device and method used to assist in the surgical repair and rehabilitation of damaged and/or severed tendons. In one embodiment of the present invention, the device includes a hollow member, preferably shaped as a partial funnel and/or cone, having an inner and outer surface, a flared mouth, a shaft, and an apical end. In another embodiment, the device includes a hollow member, preferably shaped as funnel or barrel cut in half along its longitudinal axis, having an inner and outer surface, two flared mouths, and a shaft. The device may further include a thin, elongated handle for ease of manipulation, and can be implantable or non-implantable.

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: An auxiliary device for a puncture needle allowing an easier manipulation of puncture needles as well as being capable of improving the suture stability. The auxiliary device for a puncture needle comprises a plate-shaped auxiliary device main body on the surface of which parallel guide grooves were formed, and a plate-shaped rotating-sliding contact part rotatably attached to one of the edge parts of the auxiliary device main body. Moreover, a stabilization plate was provided at the lower end part of the auxiliary device main body. And, a window part for confirming an insertion-puncture needle-outer needle and a pullout-puncture needle were provided at the lower part side portion of the auxiliary device main body. Moreover, a projecting edge part was formed at the upper end part of the auxiliary device main body, and an opening side width of a portion located at the projecting edge part of the guide grooves was made wider than the width of the other portion of the guide grooves.

Abstract: The invention, in various embodiments, provides systems, devices, and methods for treating urinary incontinence. The invention also provides a driver and methods for advancing needles, cannulas, and other medical devices through the pubic bone. The driver may be used in connection with a driver frame assembly for proper positioning and stabilization of the driver, and with other devices for creating a cavity in the urethral floor and for positioning medical devices therein. The invention also provides simple connections for attaching a suture to a device within the cavity in the urethral floor or in the vagina, and also for attaching sutures to the pubic bone.

Abstract: A suture pushing device includes a handle, a shaft extending from the handle, and a suturing head at the distal end of the shaft. The suturing head includes a first jaw and a second jaw. The first jaw and/or the second jaw have a tissue cutting edge adapted to cut an opening in a tissue. A blunt suture pushing member advances from within the shaft, through the suturing head, and through the cut opening in the tissue to place a suture.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot near a distal end of a shaft is inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot carries suturing attachment cuffs, and needles are advanced from the shaft through the vessel wall outside of the penetration and into engagement with the needle cuffs after the foot has been drawn proximally up against the endothelial surface of the blood vessel. The cross-section of the shaft within the tissue tract can be minimized by laterally deflecting the needles as they leave the shaft, while tapered depressions within the foot can guide the advancing needles into engagement with the cuffs. The cuffs lockingly engage the needles and can be withdrawn proximally along the needle paths and through the tissue tract so as to form a loop of suture across the puncture.

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: Described is a surgical suture positioning system for closing an opening inside an intracorporeal tissue wall, comprising an elongated shaft, which has a distal shaft region, on which a means is provided, which is made at least partially of an elastomer material and which can be reversibly transferred from a position that is flush with the shaft into a position radially protruding over the shaft, and a needle guide unit, which is provided on the shaft and in which at least one needle arranged movably along the shaft is guided, which needle can be reversibly transferred from a retracted position into an advanced distal position, in which the needle penetrates the means located in the position radially protruding over the shaft, wherein a suture carried along by the means remains in the means by retracting the needle into the retracted position.

Abstract: A tissue retractor for displacing body tissue during surgery includes a tissue piercing member such as a surgical needle, a wire-like filament such as a suture line affixed to the surgical needle, a fixed element such as an anchoring port being associated with a stable surgical platform such as a sternum retractor and a movable element such as an anchoring plug cooperating with anchoring port to engage a portion of suture line after the suture line is threaded through the body tissue with the surgical needle and after the suture wire is tensioned to effect a predetermined displacement of the body tissue. The predetermined displacement of body tissue is maintained by retention of the engaged portion of suture line by the fixed anchoring port and the movable anchoring plug.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot is inserted through a penetration and actuated extend the foot carrying suturing attachment cuffs. Needles are advanced from the shaft through the vessel wall outside of the penetration and into engagement with the needle cuffs after the foot has been drawn proximally up against the endothelial surface of the blood vessel. The cuffs lockingly engage the needles and can be withdrawn along the needle paths and through the tissue tract to form a loop of suture across the puncture. The articulating foot may be realigned with the shaft and withdrawn proximally through the tissue tract without dilating the tissue tract.

Abstract: Devices, systems, and methods for suturing of body lumens allow the suturing of vascular puncture sites located at the distal end of a percutaneous tissue tract. An elongated articulated foot near a distal end of a shaft is inserted through the penetration and actuated so that the foot extends along the lumenal axis. The foot carries suturing attachment cuffs, and needles are advanced from the shaft through the vessel wall outside of the penetration and into engagement with the needle cuffs after the foot has been drawn proximally up against the endothelial surface of the blood vessel. The cross-section of the shaft within the tissue tract can be minimized by laterally deflecting the needles as they leave the shaft, while tapered depressions within the foot can guide the advancing needles into engagement with the cuffs. The cuffs lockingly engage the needles and can be withdrawn proximally along the needle paths and through the tissue tract so as to form a loop of suture across the puncture.

Abstract: A manipulator includes a composite input unit that is manually operable by the fingers, a connector shaft extending from an operating unit, and a working unit mounted on the distal end of the connector shaft. The working unit comprises a rolling mechanism, a tilting mechanism, and an opening and closing mechanism. The composite input unit includes a shuttle ring for actuating the rolling mechanism. The manipulator also includes a gripper for gripping a curved needle. The gripper is placed near a DVC, whereupon the rolling mechanism is actuated to roll the gripper and to pierce a living body with the curved needle, until the point of the curved needle projects outside of the living body.

Abstract: A surgical stapling instrument is provided having systems for securing buttress material to the anvil and staple containing cartridge associated with the surgical instrument. The system includes a retainer configured to engage the anvil or the staple containing cartridge and capture the buttress material between the retainer and the anvil or staple containing cartridge. The disclose retainer engages the anvil or staple containing cartridge in snap fit or friction fit fashion. The buttress material includes a circumferential perforation line enabling the center of the buttress material to be stapled to tissue while the remainder of the buttress material remains with the anvil or staple containing cartridge.