Abstract: A vaso-occlusive device delivery assembly includes a pusher assembly having proximal and distal ends, a conductive sacrificial link disposed at the distal end of the pusher assembly, and a vaso-occlusive device secured to the pusher assembly by the sacrificial link. The pusher assembly includes first and second conductors extending between the proximal and distal ends thereof. The sacrificial link is electrically coupled between the first and second conductors, such that the first conductor, sacrificial link and second conductor form an electrical circuit, and, when a disintegration current is applied through the sacrificial link through the first and second conductors, the sacrificial link thermally disintegrates, thereby releasing the attachment member and vaso-occlusive device from the pusher assembly.

Abstract: Devices are provided with an internal dimension that can be reduced and increased in vivo. In one example, an interatrial shunt for placement at an atrial septum of a patient's heart includes a body. The body includes first and second regions coupled in fluid communication by a neck region. The body includes a shape-memory material. The body defines a passageway through the neck region for blood to flow between a first atrium and a second atrium. The first and second regions are superelastic at body temperature, and the neck region is malleable at body temperature. A flow area of the passageway through the neck region may be adjusted in vivo.

Abstract: A surgical retractor includes a structure including a plurality of legs and a plurality of joints, each leg being connected to at least one second leg at a joint. The structure has a non-expanded state, and an expanded state in which the structure forms a three dimensional structure having an internal volume. The structure has first and second manipulator arms, each of the manipulator arms being connected to at least two joints of the structure. The manipulator arms may be manipulated by a hand of a user. The retractor also includes a connector that holds the first and second manipulator arms in a crossed position. The connector holds the first and second manipulator arms at a point of intersection. The connector allows a user to move the manipulator arms and cause an angle formed by the manipulator arms to change. Movement of the first and second manipulator arms causes the structure to move between the non-expanded state and the expanded state.

Abstract: An implantable adjunct for use with a surgical stapling instrument is provided. The implantable adjunct comprises means for allowing a clinician to determine the degree of skew, if any, that the adjunct may experience when implanted into a subject with a surgical stapling instrument. The implantable adjunct comprises one or more reference systems configured to be compared to the staples, the edges of the adjunct, and/or any other adjunct elements by a clinician once the adjunct has been implanted into the subject. The one or more reference systems comprise references that define one or more zones of the adjunct. A clinician can visually determine what zone, or zones, of the adjunct the staples have satisfactorily, and/or unsatisfactorily, purchased the adjunct.

Abstract: Provided is a medical device formed entirely from or formed partially from a polymer, e.g., a polysaccharide such as chitosan. In some embodiments, the medical device may be formed as a tubular member formed from a sheet of a chitosan material. This chitosan tube may be used to wrap around tissue, such as a nerve or tendon to help with the regeneration or healing process of the nerve or tendon, as applicable.

Abstract: A valve prosthesis and methods for implanting the prosthesis are provided. The prosthesis generally includes a self-expanding frame and two or more engagement arms. A valve prosthesis is sutured to the self-expanding frame. Each engagement arm corresponds to a native mitral valve leaflet. At least one engagement arm immobilizes the native leaflets, and holds the native leaflets close to the main frame. The prosthetic mitral valve frame also includes two or more anchor attachment points. Each anchor attachment point is attached to one or more anchors that help attach the valve prosthesis to the heart.

Abstract: The present disclosure pertains to medical devices. More particularly, the present disclosure pertains to tissue clip devices and related systems and methods. In an embodiment, a tissue clip may include a grasper including jaws at a first end, and a spring portion at a second end, and a longitudinal axis extending along a length of the grasper from the first end to the second end, wherein the spring portion is configured to bias the jaws toward each other. A wedge may be slidably disposed between the jaws such that an apex of the wedge is oriented toward the spring portion. A filament may be coupled to the wedge at a first end of the filament and may extend through a channel of the spring portion of the grasper to a second end of the filament.

Abstract: Devices for treating a cerebral aneurysm may include proximal and distal self-expanding resilient permeable shells each including a plurality of elongate resilient filaments having a braided structure. The distal permeable shell may include a first plurality of filaments gathered at least at the proximal end thereof. The proximal permeable shell may include a second plurality of filaments are gathered at least at the proximal end thereof. The expanded state of the distal permeable shell may have a convex shape at the distal end of the distal permeable shell and the expanded state of the proximal permeable shell may have a generally convex shape at the proximal end of the proximal permeable shell. The expanded states of the distal and proximal permeable shells may also define a toroidal cavity through which an elongate support member extends.

Abstract: A device includes a clip including a capsule and a pair of clip arms, proximal ends of which are slidably received within a channel of the capsule to move the clip arms between an open configuration and a closed configuration. The clip arms are aligned relative to one another via a pin received within openings extending through proximal ends of the clip arms. A proximal portion includes a flexible shaft extending from a proximal end to a distal end including a bushing releasably coupled to the capsule. A control member extends longitudinally through the flexible shaft from a proximal end to a distal end releasably coupled to the proximal ends of the clip arms, the distal end of the control member including a pair of holding jaws, each of which include a pair of fingers extending about the pin along opposing sides thereof to grip the pin therebetween.

Abstract: A sutureless implant for replacing damaged natural chordae tendineae of a human or possibly animal heart, the implant including a distal implant part, a proximal implant part, and an artificial chord. The distal implant part is configured to fit in a lumen of an implant delivery device and includes a self-spreading portion spreading radially outside when the distal implant part is released from the lumen, the self-spreading portion being capable of anchoring the distal implant part in human muscle tissue. The proximal implant part is configured to fit in the lumen of the implant delivery device and comprises a self-spreading portion spreading radially outside when the proximal implant part is released from the lumen, the self-spreading portion being capable of bearing on a tissue portion of leaflet tissue. The distal implant part and the proximal implant part are connected by the chord.

Abstract: The present invention relates to a device (10) for facilitating the implantation of a surgical mesh (1) having at least one barbed face (2), said device comprising: said surgical mesh (1), at least one biocompatible film (11, 11a, 11b) shaped and dimensioned to at least partially cover said barbed face (2), at least one cable (12) arranged to removably attach said film (11, 11a, 11b) to said barbed face (2) of said mesh (1).

Abstract: An endoscopic gastric plication device includes an assembly able to co-operate with a handle provided with a control mechanism for actuating the assembly for placing and securing a staple around a fold in a stomach wall. The device includes: a mechanism for gripping/pulling a portion of a stomach wall arranged at the end of a manipulation rod adapted to be connected to the control mechanism, which mechanism is capable of being actuated by the control mechanism so as to grip the stomach wall and pull it to form a fold; a mechanism for guiding a staple around the fold in the stomach wall; at least one staple and a mechanism for pushing the staple into the guide mechanism, the staple being designed to pass through and form a loop around the fold while being guided by the guide mechanism; and a mechanism for pulling the looped end of the staple.

Abstract: System, including methods and devices, for fixing bone. The system may include a bone plate having two or more plate members connected to one another with one or more movable joints. Each joint may permit the orientation of the plate members to be adjusted relative to one another in a single plane or two or more nonparallel planes. The joint may have a movable configuration and a fixed configuration. Methods of creating the bone plate are also provided.

Abstract: In a seal affixing system, adsorption pores are arranged plurally along a first direction and a second direction on an adsorption face, and the plurality of adsorption pores are sectioned into a first suction region, a second suction region, and a third suction region containing a plurality of adsorption pores from a downstream side to an upstream side along a movement direction, and a controller controls a suction power generator to individually suck the first suction region, the second suction region, and the third suction region. According to the seal affixing system, a turbulent spot will not be generated in the affixed seal.

Abstract: A method of using an occlusion clamp, the method comprising: (a) repositioning a tongs so that tissue interposes the tongs, the tongs comprising a first longitudinal segment operatively coupled proximally to a second longitudinal segment, the tongs including a first spring exerting a proximal bias tending to direct a proximal portion of each of the first and second longitudinal segments toward one another, where each of the first and second longitudinal segments includes a distal free end; (b) repositioning a second spring distally along each of the first and second longitudinal segments to exert a bias tending to direct a distal portion of each of the first and second longitudinal segments toward one another, where repositioning of the tongs so that tissue interposes the tongs precedes repositioning the second spring distally along each of the first and second longitudinal segments.

Abstract: The present disclosure provides collapsible medical devices that may be introduced via a delivery device into a pre-existing patent foramen ovale or trans-septal puncture hole and left in place to provide both a sealing function on the atrial wall and a septal-access function for additional procedures. The disclosed medical devices include a penetrable and re-sealable gasket material disposed in an open lumen in the medical device. This penetrable and re-sealable material allows catheters or other medical devices to pass therethough for providing additional therapy to an individual. By allowing the access point or portal to be opened by a guidewire or another medical tool, the medical devices as disclosed herein may be particularly suitable for a variety of cardiac procedures including, for example, atrial fibrillation, mitral valve replacement or repair, left atrial appendage closures, and the like.

Abstract: A method of applying a buttress to a surgical stapler end effector comprises positioning a buttress assembly between an anvil and a staple cartridge of the end effector. The buttress assembly comprises a buttress body and an adhesive material. The adhesive material faces either an underside of the anvil or a deck of the staple cartridge. The anvil is in an open position relative to the staple cartridge during the act of positioning the buttress assembly between the anvil and the staple cartridge. The method further comprises moving the anvil toward the staple cartridge then moving the anvil back to the open position. The buttress assembly is adhered to the underside of the anvil or the deck of the staple cartridge via the adhesive material with the anvil moved back to the open position. The adhesive material comprises a bioabsorbable polymer.

Abstract: The present disclosure provides description of applicators to implement modular magnetic anastomosis device. In one embodiment the delivery device is a laparoscopic instrument for MISS surgery, in another embodiment the delivery device is endoscopy or colonoscopy instrument for NOTES surgery.

Abstract: This application relates to methods, systems, and apparatus for replacing native heart valves with prosthetic heart valves and treating valvular insufficiency. In some implementations, a heart valve leaflet clipping mechanism includes a delivery apparatus and clipping arms. The clipping arms are coupled to the delivery apparatus. The clipping arms are movable between an open position and a closed position. The two clipping arms are biased to the closed position. The delivery apparatus is configured to hold the clipping arms in the open position. The delivery apparatus is configured to allow the clipping arms to move to the closed position to engage native heart valve leaflet tissue.

Abstract: A barbed rod device is provided for tissue closure and approximation. The device includes two or more subassemblies. Each subassembly includes a receiver having a central opening and centerline axis, a plurality of barbs extending radially outward from the receiver, and a linking rod extending from the receiver along the centerline axis of the receiver. The linking rod includes a locking end opposite the receiver. The locking end of a first subassembly is configured to engage the receiver of a second subassembly.

Abstract: A multi-laminar electrospun nanofiber scaffold for use in repairing a defect in a tissue substrate is provided. The scaffold includes a first layer formed by a first plurality of electrospun polymeric fibers, and a second layer formed by a second plurality of electrospun polymeric fibers. The second layer is combined with the first layer. A first portion of the scaffold includes a higher density of fibers than a second portion of the scaffold, and the first portion has a higher tensile strength than the second portion. The scaffold is configured to degrade via hydrolysis after at least one of a predetermined time or an environmental condition. The scaffold is configured to be applied to the tissue substrate containing the defect, and is sufficiently flexible to facilitate application of the scaffold to uneven surfaces of the tissue substrate, and to enable movement of the scaffold by the tissue substrate.

Abstract: A surgical suture provides a visual indication when the suture is subjected to excessive tension. The suture has an inner core at least partially covered by a segmented outer layer. The inner core is not visible when the suture is subjected to acceptable amounts of tension, but will become visible if the suture is subjected to unacceptable amounts of tension. The visibility of the inner core thus indicates to the surgeon or similar medical professional whether or not the suture is under acceptable tension.

Abstract: Drug delivery articles, resident articles, and retrieval systems e.g., for gram-level dosing, are generally provided. In some embodiments, the residence articles are configured for transesophageal administration, transesophageal retrieval, and/or gastric retention to/in a subject. In certain embodiments, the residence article includes dimensions configured for transesophageal administration with a gastric resident system. In some cases, the residence article may be configured to control drug release e.g., with zero-order drug kinetics with no potential for burst release for weeks to months. In some embodiments, the residence articles described herein comprise biocompatible materials and/or are safe for gastric retention. In certain embodiments, the residence article includes dimensions configured for transesophageal retrieval. In some cases, the residence articles described herein may comprise relatively large doses of drug (e.g., greater than or equal to 1 gram).

Abstract: An electromechanical surgical device includes an end effector configured to perform at least one function, the end effector including an input drive axle projecting therefrom; and a shaft assembly. The shaft assembly includes a rotatable drive shaft; a proximal neck housing supported at a distal end of an outer tube; a distal neck housing pivotally connected to the proximal neck housing; a pivot pin interconnecting the proximal neck housing and the distal neck housing; and a gear train supported in the proximal neck housing, on the pivot pin, and in the distal neck housing. The gear train includes a proximal gear; an intermediate gear; a distal gear; and a pair of output gears, wherein each output gear defines a coupling socket each configured to selectively receive the drive axle of the end effector.

Abstract: This document discusses, among other things, systems and methods for robotically assisted implantation of an implant in a patient. A system includes an implant-positioning unit configured to engage an elongate member of the implant, and a control console communicatively coupled to the positioning unit. The control console may have a user interface that enables a user to input motion control instructions. The control console may generate a motion control signal, according to a specific motion control instruction, to control the external positioning unit to propel the implant into a target implant site, path or shape. The system may be used to robotically control the delivery and positing of a neuromodulating implant during a spinal stimulator implantation or deep brain stimulator implantation surgery.

Abstract: A system for treating tissue includes an applicator including a catheter and a control member extending therethrough, the control member longitudinally movable relative to the catheter and including an abutment structure proximate a distal end thereof, and a clip assembly releasably coupleable to a distal end of the applicator, the clip assembly including a pair of clip arms, a proximal end of each of the clip arms slidably received within a channel of a capsule and configured to be releasably coupled to the distal end of the control member so that the clip arms are movable relative to the capsule between a tissue receiving configuration and a tissue clipping configuration, the capsule including proximal tabs movable between a biased non-engaging and an engaging configuration, in which the proximal tabs engage an engaging portion of the lumen of the catheter, when the abutment structure is received within the capsule.

Abstract: System for fixation of native leaflets of a heart valve including an implantable fixation device including a center portion defining a longitudinal axis. The implantable fixation device further includes a first distal assembly having a first distal strut pivotally-coupled with the center portion and a first distal element pivotally-coupled with the first distal strut. The first distal assembly is configured to move between a closed position and an extended position. The implantable fixation device further includes a second distal assembly having a second distal strut pivotally-coupled with the center portion and a second distal element pivotally-coupled with the second distal strut. The second distal assembly is configured to move between a closed position and an extended position. The implantable fixation device further includes a locking mechanism configured to lock the first distal assembly and second distal assembly in a selected locked position between the closed position and the extended position.

Abstract: A clip for gripping tissue can having a first arm with a first claw at a distal end of the first arm, and second arm, with a second claw at a distal end of the second arm, in which the first arm and second arm are configured to move in a direction toward each other to close the clip. The clips include one or more anchors on the arms of the clip which protrude in a direction other than the direction that the first arm and second arm are configured to move toward each other to close the clip. Such anchors can more readily attach to tissue of a patient upon contact than clips without an anchor.

Abstract: A system for treating tissue includes a clip assembly including clip arms movable relative to a channel of a capsule so that the clip arms are movable between a tissue receiving configuration and a tissue clipping configuration. Also, the system includes an applicator releasably coupleable to the clip assembly. The applicator includes a bushing and a control member extending therethrough. The bushing includes deflectable fingers, each of the fingers including an engaging feature at a distal end thereof to engage a corresponding engaging feature of the capsule of the clip assembly and assembled with a pusher element configured to push the fingers to a radially outward position. The pusher element includes a U-shaped portion curving into a channel of the bushing and a longitudinal portion extending distally therefrom. A cam washer is slidable over a length of the control member and positioned distally of the U-shaped portion.

Abstract: The present invention relates to tissue approximation and fixation, and surgical staples and staple placement devices for surgery. The present invention includes surgical staples having solid first and second legs for anchoring into respective tissue portions, and an elastically deformable bridge monolithically formed with the first leg and the second leg, the legs each forming respective angles greater than 90 degrees with respective portions of said elastically deformable bridge. The present invention also includes staple insertion device comprising a handle portion and substantially parallel insertion portions extending from the handle, the insertion portions each having an interior lateral channel, and each insertion portions having a terminal point.

Abstract: An implantable prosthesis and a method of attaching the prosthesis to a tissue structure disclosed. The prosthesis includes a body having a first side arranged to face the tissue structure having a defect and second side opposite the first side. One or more adhesive-filled pods are disposed on the first side of the body and selectively openable to supply an adhesive in between the tissue structure and the first side of the prosthesis body after the prosthesis body is positioned relative to the defect. The pods may be pierced, punctured, broken, and/or ruptured to supply the adhesive. A deployment device having a piercer may be used to puncture the pods.

Abstract: Novel compositions for treating wounds and promoting the healing thereof are described, including composition containing novel combinations of a carrier and recombinant platelet derived growth factor having fewer isoforms and enhanced biostability. Methods of treating wounds with novel therapeutic composition using doing procedures leading to effective results with a minimal number of treatment applications are also described.

Abstract: A tissue adhesive for contacting a tissue site, the tissue adhesive comprising: a mixture of natural polymers; and an activating agent enhancing the adhesive properties of the mixture of natural polymers. And a tissue adhesive for contacting a tissue site, the tissue adhesive comprising: a mixture of natural polymers; and an aqueous solution of a water soluble starch or a water soluble starch derivative which forms a gel with the addition of the mixture of natural polymers.

Abstract: A deployment device for positioning a soft tissue repair prosthesis includes a self-expanding support body releasably attachable to the prosthesis. The support body may be removably insertable into a pocket of the prosthesis. A handle coupled to the support body facilitates positioning the patch and/or removal of the support body from the pocket. The support body may substantially occupy the pocket in an expanded configuration. The handle may be arranged to direct a pulling force to the outer peripheral edge of the support body and/or cause a portion thereof to be pulled downward and below the body during withdrawal of the deployment device from the prosthesis. The support body may include support segments pivotally coupled together and foldable to collapse the support body for insertion into and removal from the pocket. One or more resilient support members may be provided for collapsing and expanding the support body and the prosthesis.

Abstract: The invention relates to a prosthetic porous knit based on a monofilament of a biocompatible polymer material, the pattern followed for the knitting of said monofilament on a warp knitting machine having two guide bars B1, B2 being the following, according to the ISO 11676 standard:—Bar B1: 1.2/4.5/4.3/4.5/4.3/1.0/1.2/1.0//—Bar B2: 1.3/1.0/1.2/1.0/1.2/4.5/4.3/4.5// The invention further relates to a method for producing such a knit and to a hernia prosthesis comprising such a knit.

Abstract: The invention is a device, system, and method for repairing heart valve function, which may include bisecting native valve leaflets for improved deployment of a prosthetic heart valve in the native valve annulus. The invention may include a catheter having a cutting element shaft with a cutting element configured to puncture a valve leaflet and/or make a controlled cut through the leaflet. The device may have an extendable foot configured to be positioned on an opposite side of the valve leaflet from the cutting element shaft. The device may include magnets to guide the cutting element and/or cutting element shaft in proper alignment with the extendable foot and to hold the elements in place during leaflet bisection.

Abstract: The present disclosure comprises micropatterned fabric, meshes, textiles, and implantable devices which may include having one substrate including a mesh, a second substrate having a microstructured surface, and a fibrous layer disposed therebetween. The fibrous layer comprises a plurality of randomly oriented fibers. The devices having the microstructured surface may include a plurality of first level microfeatures and a plurality of second level microfeatures wherein the plurality of second level microfeatures are disposed hierarchically the first level microfeatures. Also disclosed are methods for making such micropatterned fabric, meshes, textiles, and implantable devices.

Abstract: A device includes a capsule along with first and second clip arms, proximal ends of which are received within the channel so that the first and second clip arms are movable relative to one another between an open configuration and a closed configuration. A deployment mechanism includes a tension member connected to a proximal end of the first and second arms, a yoke releasably coupled to the tension member and longitudinally movable relative to the capsule to move the first and second arms between the open and closed configurations. The tension member and yoke are configured to separate from one another in response to a predetermined proximal force relative to the tension member. A locking mechanism is coupled to the deployment mechanism and is configured to engage the capsule to lock the one-piece clipping element in the closed configuration, when the yoke is separated from the tension member.

Abstract: The present invention relates to a surgical anti-adhesion barrier film comprising an oxidized collagen and a polyphosphate compound and to a surgical implant comprising a prosthetic fabric and such a film.

Abstract: Surgical stapling devices have a surgical buttress attached to an anvil jaw member, a cartridge jaw member, or both. In use, the surgical buttress reinforces a staple line formed upon application of staples from the surgical stapling device and minimizes leaks which may exude from the staple line and/or tissue being stapled by the surgical stapling device.

Abstract: A closure device includes a first ring structure having a first distal portion and a first medial portion and a second ring structure having a second distal portion and a second medial portion. The first and second distal portions are movable between an open position, where the first and second distal portions form an angle relative to one another for receiving target tissue therebetween, and a closed position, where the first and second distal portions are drawn toward one another for gripping the target tissue. The device also includes an anvil about which the first and second medial portions are formed. Either one of proximal motion of the anvil relative to the first and second rings or proximal motion of the medial portions relative to the anvil causes the first and second distal portions to move into either one of the open position or the closed position.

Abstract: Disclosed suture clips include a generally disk-shaped body having an annular outer body, first and second tabs extending radially inwardly from opposing sides of the annular outer body, first and second slots passing through a thickness of the suture clip and separating the annular outer body from lateral sides of the first and second tabs, and the first and second slots include stepped portions configured to align the suture clip on a rail of a clip deployment device. The stepped slots create bracketing surfaces that interface with the rail on which the clips are mounted, such that the bracketing surfaces prevent or limit the freedom of the clips from tilting or shifting relative to the rail. The disclosed clips can also include rounded edges on engagement surfaces of the tabs to minimize particulate formation.

Abstract: The invention relates to a prosthesis (1) comprising a textile (2) of elongate shape defining a longitudinal axis A, and a reinforcing element comprising at least one semi-rigid elongate structure (8) connected to said textile, said structure being substantially parallel to said longitudinal axis A and having a distal end provided with at least one fastening element (4) distinct from said textile and capable of cooperating with a part of a tool (10) that is able to pass through said trocar, in order to temporarily couple said prosthesis to said tool.

Abstract: The present disclosure describes kits for surgical repair of soft tissue defects, including hernias. The kits include any combination of components selected from an implantable sheet, a central tie, a delivery tool, a rolling device, and an insertion member. Packaging for the kits and/or components and methods of using the kits and/or components are also provided.

Abstract: An end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure can include an anvil, a cartridge, and a knife. The anvil includes a proximal end, a distal end, and a face that is positionable on a first side of the anatomical structure. The cartridge is configured to house a plurality of staples and includes a proximal end, a distal end, and a face that is positionable on a second side of the anatomical structure. The knife has a cutting edge, the knife being operably configured to move from a first position at about a distal end of the end effector to a second position at about a proximal end of the end effector. The distal end of the anvil is movably coupled to the distal end of the cartridge.

Abstract: A surgical staple cartridge is disclosed comprising a plurality of staples removably stored within the surgical staple cartridge. The staples comprise staple legs which extend from a staple base portion. The staple legs comprise staple tips configured to pierce tissue and contact a corresponding forming pocket of an anvil of surgical stapling instrument. The staples further comprise zones having different hardnesses.

Abstract: Exemplary embodiments provide an approach to predicting meal and/or exercise events for an insulin delivery system that otherwise does not otherwise identify such events. The insulin delivery system may use a model of glucose insulin interactions that projects estimated future glucose values based on a history of glucose values and insulin deliveries for a user. The predictions of meal events and/or exercise events may be based on residuals between actual glucose values and predicted glucose values. The exemplary embodiments may calculate a rate of change of the residuals over a period of time and compare the rate of change to thresholds to determine whether there likely has been a meal event or an exercise event. The insulin delivery system may then take measures to account for the meal event or the exercise event by the user.

Abstract: Intradiscal implants, systems, and methods thereof. The intradiscal system may include an expandable implant and one or more intradiscal implants. The intradiscal implants may be supplemental to or integrated with the expandable implant. The intradiscal implant may include one or more flexible anchors with a straight configuration and a curved configuration. The anchor may be bendable, for example, using a shape-memory material.

Abstract: The invention provides devices, systems and methods for tissue approximation and repair at treatment sites. The devices, systems and methods of the invention will find use in a variety of therapeutic procedures, including endovascular, minimally-invasive, and open surgical procedures, and can be used in various anatomical regions, including the abdomen, thorax, cardiovascular system, heart, intestinal tract, stomach, urinary tract, bladder, lung, and other organs, vessels, and tissues. The invention is particularly useful in those procedures requiring minimally-invasive or endovascular access to remote tissue locations, where the instruments utilized must negotiate long, narrow, and tortuous pathways to the treatment site. In addition, many of the devices and systems of the invention are adapted to be reversible and removable from the patient at any point without interference with or trauma to internal tissues.

Abstract: The invention comprises a method for fixating bones in the foot by aligning the bones in their desired position, inserting a screw in the aligned bones, inserting at least one transverse element near the head or tip of the screw, and tightening the screw to compress the bones. The screw comprises a shaft having first and second ends with spirally wound screw threads beginning near the first end and extending along the shaft. Advantageously, the screw is cannulated and screw threads are formed on an interior surface of the cannulation. Illustratively, the transverse elements may be staples, open-ended washers, or open-ended nuts. Reduction instruments and drill guides used in the invention are also disclosed.