Abstract: The present invention describes apparatus and methods for tying a filament across subcutaneous punctures. According to some embodiments, the apparatus and methods provide pre-tied knots that are inserted into a bodily lumen. Needles flanking the subcutaneous puncture are inserted into the lumen and grab the pre-tied knots. The pre-tied knots are pulled through tiny holes flanking the subcutaneous puncture by the needles, leaving an internal length of the filament across the subcutaneous puncture. The filament is then externally tied, closing the subcutaneous puncture.

Abstract: A loading unit for use with a surgical stapling apparatus is provided and includes a tool assembly having a cartridge assembly and an anvil assembly that are movable in relation to one another; a surgical buttress releasably secured to a tissue contacting surface of the anvil assembly and/or the cartridge assembly, wherein each surgical buttress is secured to the anvil assembly and/or the cartridge assembly by at least one anchor; a release assembly associated with the anvil assembly and/or the cartridge assembly; and a drive assembly slidably translatable through the tool assembly between proximal and distal positions, wherein the drive assembly actuates the release assembly to thereby release the anchor to free the surgical buttress from the anvil assembly and/or the cartridge assembly.

Abstract: A method and device for wound closure is provided. One advantage of wound closure devices and methods shown includes a simple and inexpensive modified suture with increased pullout resistance to close wounds in eyes and prevent leakage. Another advantage includes a visualization tool to aid in locating the wound on the eye.

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: The methods, devices, and systems are provided for performing endovascular repair of atrioventricular and other cardiac valves in the heart. Regurgitation of an atrioventricular valve, particularly a mitral valve, can be repaired by modifying a tissue structure selected from the valve leaflets, the valve annulus, the valve chordae, and the papillary muscles. These structures may be modified by suturing, stapling, snaring, or shortening, using interventional tools which are introduced to a heart chamber. Preferably, the tissue structures will be temporarily modified prior to permanent modification. For example, opposed valve leaflets may be temporarily grasped and held into position prior to permanent attachment.

Abstract: A method of fixing a suture to tissue of a patient includes placing an introducer onto a finger; attaching an anchor to the introducer; delivering the introducer into the patient's body with the finger; and driving the anchor with the finger into the tissue of the patient.

Abstract: A method and device provides features for the temporary “parking” of sutures with respect to a cannula. In the preferred embodiments the features are slots that maintain tension on, and orientation of, sutures placed therein. The slots or features may be integral with the cannula or part of a separate device which may be removably affixed to the external portion of a cannula. In addition, the opening(s) used for instrument-passing are off-center, thereby reducing if not elimination outward sprays during use. The invention eliminates the multiple steps inherent in current suture management techniques for arthroscopic procedures, particularly rotator cuff repair and assists in tensioning/advancement of tissue into its repair site.

Abstract: A suture trimmer having a shaft with a groove formed in the side thereof, a cutting member movably disposed within the shaft, and a suture retainer slidably disposed within the shaft. The suture trimmer may be used to position knots formed within a suture loop prior to trimming the free end(s) of the suture loop, and to deliver an agent near the location where the suture is severed.

Abstract: An adjustable, stand-alone tensioning system requires no additional fixturing, weights, or bone surface modification, and allows a single practitioner to provide an adjustable and repeatable tension to a soft tissue graft, and to install the final fixation implant. Its design facilitates introduction of the suture component of the graft into the tensioning process by simplifying retention of the suture. An even, regulated and reproducible tension is easily achieved without requiring the practitioner to manually pull on the suture strands to maintain graft tension.

Abstract: A solution is provided to push a knot and/or cut a suture using a housing having a tip, a first side and a second side, the first side and the second side having a recessed center. The housing further has at least one slit positioned at the tip, and a blade moveable between retracted and extended positions, and positioned within the housing such that the blade passes through the slit as it is moved from the retracted position to the extended position within the slit. A notch may be positioned at the tip to push the knot to a desired position.

Abstract: A surgical suturing apparatus includes a suture housing, a needle mounted within the suture housing for movement about an arcuate path, a drive assembly operably associated with the needle for controlling movement of the needle with a suture secured thereto about the arcuate path in a manner facilitating application of the suture to tissue, a handle, an elongated flexible member having a distal end attached to the suture housing and a proximal end attached to the handle, and a mechanism for releasing and reattaching the handle to the flexible member.

Abstract: The invention includes a needle loader that may be used with a suturing device. The needle loader includes a generally planar needle supporting surface, a hub configured and adapted for receiving a generally toroidally shaped suturing needle around the hub, and means for retaining a suturing needle in a fixed toroidal rotational position with respect to the hub about a center axis of needle rotation. Generally, a needle mounted around the hub is selectively disposable on and removable from the hub. In accordance with a further aspect, the loader may further include an opening for retaining suture material attached to a suturing needle. The opening may include a groove defined through the needle supporting surface. The needle loader may further include a guard for preventing access to the point of a suturing needle to protect the needle and/or to prevent accidental needle sticks.

Abstract: A surgical instrument of the present invention comprises an insertion unit; an operating unit provided on one end of the insertion unit; a treatment unit provided so as to protrude from the other end of the insertion unit; a first shaft member for transmitting turning force to the treatment unit in conjunction with the turning operation of a turning operation member provided on the operating unit; and a second shaft member for transmitting opening/closing force to the treatment unit in conjunction with the opening/closing operation of an opening/closing member provided on the operating unit.

Abstract: A method and apparatus for reattaching the opposed ends of a member, such as a tendon, ligament or bone, during preparing and healing of the member using a surgical repair device that can be securely attached to the member and then safely guided through tortuous anatomy for reattachment and repair. The repair device further includes structural means so as to secure opposed ends of the member against separation during healing. Devices for aiding in the positioning of the surgical repair device are provided.

Abstract: A suture knot can be tied during a medical procedure by use of a suture retainer ring in connection with a suturing instrument. The retainer ring allows a user to orient a suture about the instrument, such that a knot in the suture is automatically advanced and tightened by withdrawing the instrument from a surgical site after placing the suture. The retainer ring can be an integral part of the suturing instrument, or it can be removably coupled to the suturing instrument to facilitate use of the retainer ring with other suturing instruments.

Abstract: The invention provides devices and methods for performing closed-chest surgical intervention within an internal cavity of a patient's heart or great vessel. A scope extending through a percutaneous intercostal penetration in the patient's chest is used to view an internal portion of the patient's chest. An internal penetration is formed in a wall of the heart or great vessel using cutting means introduced through a percutaneous penetration in an intercostal space in the patient's chest. An interventional tool is inserted through the internal penetration to perform a surgical procedure under visualization using the scope. A cutting tool is introduced into the patient's left atrium from a right portion of the patient's chest to remove the patient's mitral valve. A replacement valve is then introduced through an intercostal space in the right portion of the chest and through the internal penetration in the heart, and the replacement valve is attached in the mitral valve position.

Abstract: A suture organizer to maintain a plurality of sutures attached to a patient during a surgical procedure or operation in position relative to each other during the surgical procedure or operation comprising a hemostat retainer including a hemostat retainer member having a plurality of grooves formed in the surface thereof to receive and retain the finger hole or thumb hole of a corresponding hemostat connected to a corresponding suture and a clasp including a pair of clasp members to cooperatively clamp a surgical drape or the like therebetween to hold the suture organizer in position during the surgical procedure or operation.

Abstract: A wound closure device for promoting hemostasis includes a polyhedral body comprising a proximal body end portion and a distal body end portion, including a suture channel horizontally extending through the proximal and distal body end portions, the suture channel containing proximal and distal suture channel openings. An actuator system includes a suture engagement member configured to selectively facilitate axial movement or release of one or more sutures through the channel in an open configuration, and to facilitate securement of suture(s) in the channel in a locked configuration. The proximal body end portion includes a face configured to contact a body surface, anchoring the body to the body surface when suture(s) are secured under tension by the engagement member in the locked position. Once the sutures are secured, the device lends itself to hands-free anchoring until hemostasis is achieved. The device and sutures may then be removed that same day, shortly thereafter.

Abstract: A surgical apparatus may include a guide apparatus to be used in an arthroscopic procedure and to interact with a passageway through a body portion formed by intersecting first and second holes that may lead into the body portion from different positions, e.g., from two different locations on a bone. The guide apparatus may include first and second guide members having first and second passages, respectively, that communicate with the first and second holes. The surgical apparatus may also include a suture retriever arranged to retrieve, from the second passage, a suture fed into the first passage. A method may include forming a passageway including first and second intersecting holes. First and second guide tubes may be positioned relative to the first and second holes, a suture or suture-like material may be provided into the first guide tube, and the suture or suture-like material may be retrieved from the second guide tube.

Abstract: A suturing device includes a body member having proximal and distal ends and a longitudinal axis and comprising a slide and trigger slide; a tip assembly attached to the distal end and comprising: a hollow sheath having a window at its distal end; a pushrod in the hollow sheath and in mechanical communication with the slide and moveable along the axis; and a heating element sheath containing a heating element and adjacent to the hollow sheath, the heating element in mechanical and electrical communication with the trigger slide and moveable within the heating element sheath along the axis and over the window; and circuitry in electrical communication between the trigger slide and the heating element. The trigger slide activates the circuitry to heat the heating element and moves the heating element along the axis and over the window to contact a suture and thereby create a bloom of suture material.

Abstract: Introducers for introducing a surgical circular stapler into a patient. Various embodiments comprise a hollow flexible sheath that has a distal end and an open proximal end that is sized to receive a stapling head portion of the circular stapler therein. A rigid cap assembly is attached to the distal end of the hollow flexible sheath. The rigid cap assembly may be configured to selectively move between a closed position wherein a distal face of the stapling head is covered when inserted therein and an open position wherein the cap assembly may be withdrawn from around the stapling head and elongated shaft. A release arrangement interfaces with the rigid cap assembly such that upon an application of a release motion thereto, the rigid cap is movable from the closed position to the open position.

Abstract: Techniques and reconstruction systems for knotless tissue fixation using a driver with a cannulated interference device or fixation device preloaded on the shaft of the driver. An eyelet, adjustable in size, is formed of a loading suture provided at the distal end of the driver shaft. A working suture attached to the tissue to be fixed is passed through the eyelet. The size of the eyelet is adjusted by the user once the working suture is passed through the eyelet, to capture the working suture with the eyelet. The cannulated interference device is then advanced down the shaft to secure the working suture in a bone socket.

Abstract: A transabdominal needle introducer for the repair of large ventral incisional hernias comprises a handle connected to a long tubular shaft and a disposable needle cartridge at its distal end. The handle has a round knob or head, and a needle pusher to extrude the needles out. The long tubular shaft contains two metal rods disposed inside thereof, one to change the angle of the cartridge, and the other one to extrude the needles. At the proximal end of the tubular shaft there is a rotatable cylindrical control provided with a spiral groove that moves a metal rod destined to pivot the needle cartridge. The second metal rod inside the shaft is assigned to extrude the needles and is connected to a flexible resilient wire that protrudes at the distal end of the tubular shaft and is provided at its distal end with an oval tip that engages a piston-type pusher inside the needle cartridge.

Abstract: A surgical device for guiding a needle during suturing of an incision comprising a body for insertion in the incision having a first passage to conduct an end of the needle below a location surrounding the incision, wherein a distal portion of the body comprises means for indicating the location to which the needle will be conducted. Methods for suturing an incision using the surgical device are also provided.

Abstract: A suture trimmer having a shaft, a cutting member, an actuating device, and a snare. The shaft has a first end and a second end and bounds a bore extending from the first end toward the second end. The shaft has an opening formed in a side adjacent the first end. The cutting member is slidably disposed within the bore of the shaft and can be moved between a first position and a second position, such that when disposed in the second position the cutting member closes the opening formed in the side of the shaft. The actuating device is in communication with the cutting member and is operable to move the cutting member from the first position to the second position. The snare extends through the opening and out of the bore at the first end of the shaft.

Abstract: A surgical instrument comprises an elongated body member having a distal end and a head extending from the distal end of the elongated body member, with the head comprising a remotely actuatable needle driver and a needle catch. A needle is adapted for receiving a suture and for being driven by the needle driver through a tissue into the needle catch, making a stitch. The instrument further comprises a remotely actuatable implement, such as a push bar, for moving the needle from a first position lodged in the needle catch to a second position dislodged from or able to be readily dislodged from the needle catch. The instrument may be used for placing multiple stitches without removing the instrument from the body. One particularly advantageous embodiment comprises a suturing device adapted for insertion in a body lumen, such as for attaching an endoluminal device to the lumen wall.

Abstract: Apparatuses for attaching tissue to bone are provided. In one exemplary embodiment, the apparatus includes an expandable body defining a bore, an expander pin having a shaft sized to be received in the bore of the expandable body, and an insertion shaft slidingly disposed in the bore of the expandable body and in a bore of the expander pin. The body is configured to expand laterally into and attach to bone when the expander pin is driven into the expandable body. The body includes a proximal main member having a distally extending threaded projection and a harder, distal tip member having a threaded recess in a proximal surface thereof such that the projection is threadedly interengageable with the recess. The expansion of the body by way of the pin can occur when the proximal main member and distal tip member are threadedly engaged. The insertion shaft is releasably secured to the expandable body and extends distally beyond the expandable body.

Abstract: A member of a rigid flexible elastic material, the member including a body portion and an aperture portion with the member adapted for delivery through an axial longitudinal channel of a percutaneous delivery subsystem, the aperture portion including an expanded mode having a lateral dimension greater than an inner diameter of the channel when the aperture portion extends outside the channel and a collapsed mode wherein the lateral dimension is not greater than the inner diameter of the channel when the aperture portion is within the channel, the channel including a first axial opening and a second axial opening with the aperture portion transitioning from the expanded mode to the collapsed mode when inserted into the openings and the aperture transitioning from the collapsed mode to the expanded mode when exiting from the openings.

Abstract: Methods and apparatus are provided for diagnosing and treating digestive or other organs (as well as other parts of the body) endoluminally and transluminally, via instruments passed into the GI tract per-orally and/or per-anally. The instruments may, for example, pass transluminally out of the stomach and/or the colon through a breach formed therein in order to conduct diagnostic or therapeutic procedures, such as gastroenterostomy.

Abstract: A method of fixing a suture to tissue of a patient includes placing an introducer onto a finger, the introducer including a zip line trailing from a proximal end of the introducer. The method additionally includes identifying a landmark with the finger, guiding a delivery device along the zip line toward the introducer, where the delivery device maintaining an anchor attached to a suture line, and ejecting the anchor from the delivery device and into the tissue of the patient.

Abstract: Methods and devices for treating female stress urinary incontinence are disclosed. The methods include transvaginally accessing the pelvic cavity and introducing a suburethral sling into the retropubic space. In some embodiments the ends of the sling are attached to an anatomical support structure. In other embodiments, the ends of the suburethral sling are not attached to an anatomical support structure. The devices include a surgical instrument for blunt dissection of the pelvic cavity which includes a curved shaft and a blunt distal end. A hook deployment device may optionally be attached to the surgical instrument.

Abstract: Described here are devices for closing one or more tissues, and handles for controlling these devices. Generally, the devices described here comprise a snare loop assembly, wherein the snare loop assembly comprises a snare and a suture loop, and a handle for controlling the snare loop assembly. In some variations the snare loop assembly may comprise a retention member that may releasably connect the suture loop to the snare. In other variations the devices comprise one or more force-reducing suture locks to help prevent the suture loop from inadvertently disengaging from the snare loop assembly. In still other variations, the excess-suture management features. The handles described here may be configured to remove excess suture from a suture loop, and may also be configured to release the suture loop from the snare loop assembly.

Abstract: A suture passer system and method are provided. The system includes a dual shaft suture passer. The suture passer is especially configured and contoured to aid in the retrieval of sutures during a flexor tendon repair procedures.

Abstract: A suture kit includes a plurality of flexible strands of suture, each of the strands of suture having one or more suture markings indicative of a suture orientation and a mesh material configured to enable the strands of suture to be passed therethrough, wherein at least one quadrant/section of the mesh material having one or more mesh markings indicative of a mesh material orientation. The one or more suture markings include visual indicators and the one or more mesh markings include visual indicators, the suture visual indicators corresponding to the mesh visual indicators for indicating correct orientation of the mesh material with respect to tissue of a subject.

Abstract: A suturing device includes a housing, a rod, a ferrule assembly, and a needle. The housing defines a guide lumen extending longitudinally therethrough. The rod is engaged with the housing and extends distally therefrom. The ferrule assembly is disposed at a distal end of the rod and is configured to releasably retain a ferrule therein. The ferrule is adapted to retain of a portion of a suture therein. The needle is configured for translation through the guide lumen defined within the housing. A distal end of the needle is configured to engage the ferrule within the ferrule assembly for removal of the ferrule from the ferrule assembly.

Abstract: A suture trimmer having a shaft with a groove formed in the side thereof, a cutting member movably disposed within the shaft, and a suture retainer slidably disposed within the shaft. The suture trimmer may be used to position knots formed within a suture loop prior to trimming the free end(s) of the suture loop, and to deliver an agent near the location where the suture is severed.

Abstract: A suture passer device includes a shaft, a handle, an end effector, and a suture capturing member. The shaft has a shaft proximal end and a shaft distal end. The handle assembly is coupled to the shaft proximal end. The end effector is coupled to the shaft distal end. The suture capturing member is within the end effector, is coupled to the handle assembly independently of the shaft, and is configured to capture a suture within the end effector.

Abstract: A gastric reduction apparatus that facilitates the creation of a transoral linear passageway through the stomach includes an elongated body including a proximal end and a distal end. The elongated body is generally sinusoidal shaped with at least one tissue engaging surface oriented such that a needle will pass therethrough. The elongated body also includes at least one needle passing channel respectively formed adjacent the at least one tissue engaging surface. The at least one needle passing channel generally passes through the center of the sinusoidal waveforms defined by the at least one tissue engaging surface such that a needle will pass entirely through stomach tissue contacting the tissue engaging surface of the elongated body. The elongated body further includes a suture passing channel.

Abstract: A manipulator includes a distal-end working unit having a rolling mechanism and an opening and closing mechanism. A forceps includes a gripper on a distal end thereof. A curved needle of a suture-needle assembly is inserted through an incision in a body cavity within a living body, while leaving a portion of a suture strand of the suture-needle assembly uninserted in the tissue. The gripper grips the curved needle. The suture strand is wound around the gripper a predetermined number of times by turning a proximal end portion of the curved needle with the rolling mechanism. The gripper grips the portion of the suture strand, which has not been inserted into the tissue. The gripper is then withdrawn through loops of the suture strand, which are wound around the gripper. The distal-end working unit and the gripper are moved relatively to each other in order to form a knot across the incision.

Abstract: A surgical suturing apparatus includes a suture housing, a needle having a proximal end and a distal end, the needle being mounted within the suture housing for movement about an arcuate path, a drive assembly operably associated with the needle for controlling movement of the needle with a suture secured thereto about the arcuate path in a manner facilitating application of the suture to tissue, and mechanism for determining the position of at least one of the distal end of the needle and the proximal end of the needle at all points along the arcuate path about which the needle moves.

Abstract: A surgical device for suturing vascular vessels is described, as well as methods for suturing tissue employing the surgical device. The device includes a distal member for insertion into a vascular vessel puncture wound. The distal member contains a suture and needle engaging fitting. At least one needle is advanced through tissue adjacent the puncture wound and into the needle engaging fitting to draw lengths of suture material which can then be used to close the puncture wound.

Abstract: A length of suture is provided, and a knot is partially tied in that suture around a tube. The partially-tied knot includes a noose portion connected to a loosely-tied barrel portion. The knot is tied by holding a standing end of the suture substantially stationary and pulling the running end of the suture through the noose. The knot locks upon tightening, making it suitable for surgical applications.

Abstract: A suture manipulating instrument, includes: first and second handles manually movable relative to each other to open and closed positions; an elongated shaft having a proximal end fixed to the first handle, and a distal end defining a first jaw engageable with a suture to be manipulated; a second jaw movably mounted to the distal end of the elongated shaft to open and closed positions with respect to the first jaw; and a coupling between the second handle and the second jaw for moving the second jaw to its open and closed positions with respect to the first jaw upon movement of the second handle to open and closed positions with respect to the first handle. The first and second jaws are formed with confronting surfaces configured to firmly grasp a suture between them in the closed position of the second jaw with respect to the first jaw.

Abstract: Disclosed is a suturing assembly for suturing in vivo tissue. The suturing assembly comprises a first suture thread positioned along a first surface of an in vivo tissue having a first surface and a second surface and at least one suture needle configured to pass through in vivo tissue. The suturing assembly additionally comprises a suture catch located on at least one side of the at least one suture needle, the suture catch configured to releasably catch the suture and draw the suture through the in vivo tissue during a first passage through the in vivo tissue such that the suture is formed into a first loop on a surface of the in vivo tissue.

Abstract: A trans-vascular surgical method includes forming an artificial opening in a blood vessel of a patient's vascular system at a substantially predetermined location and moving a distal end portion of a medical instrument through at least a section of the patient's vascular system and through the artificial opening. A surgical port device is disposed inside the blood vessel to inhibit blood from exiting the patient's vascular system through the artificial opening while permitting extension of the distal end portion of the medical instrument through the artificial opening. After moving the distal end portion of the medical instrument through the artificial opening, the medical instrument is operated to perform a medical procedure operation inside the patient.

Abstract: A tensioner for a tightening a surgical knot has a squeeze handle and a pair of jaw arms that pivot from a common point behind the handle. The jaw arms have a jaw clamp at the distal tip to clamp onto the suture material, and a release handle at the proximal or butt end. A spreader or distractor mechanism may be a pantographic arrangement of struts joined to anchor points on the jaw arms. This converts axial motion of an actuator rod into a lateral distractive force. A tension gauge in the handle indicates the amount of tension being applied to the suture material.

Abstract: An access apparatus includes an access member defining a longitudinal axis and having a longitudinal passage adapted to permit passage of a surgical suture utilized in performing a surgical procedure, a housing cap mountable with respect to the access member, and defining a cap opening in communication with the longitudinal passage of the access member to permit passage of the surgical suture and a suture trap mounted to the housing cap. The suture trap is pivotally movable, e.g., via a hinge, relative to the housing cap between a first position where a suture is positionable with respect to the housing cap, and a second position where the suture trap is secured relative to the housing cap and retains a suture segment of the suture in a predetermined relation. The housing cap may include a suture groove in communication with the cap opening and in general alignment with the suture trap. The suture groove is arranged to accommodate the surgical suture extending through the cap opening.

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 solution is provided to release a tissue cinching loop within a body having a first thread having a first end and a second end, and a second thread having a first half having a first tip, a second half having a second tip, a bottom half having a link, and a top half, wherein the first end is inserted through the link. A first knot is formed around the first thread with the top half thereby forming a loop where the diameter of the loop decreases as the knot is pushed into the body and the first thread is pulled out of the body and where the loop is released within the body when the first end is pulled out of the body.

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 is comprised of 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 is comprised of 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.