Abstract: Disclosed is an anastomosis catheter, for achieving a tissue to tissue or synthetic graft to tissue attachment. The catheter includes a plurality of deployable tissue anchors, which may be laterally deployed into surrounding tissue. The anchors may be used to achieve end to end or end to side anastomoses. Methods are also disclosed.

Abstract: A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein comprises a support device having a plurality of arms forming spaces therebetween and a plurality of piercing members slidably coupled to the arms. The support device piercing members have a retracted state and an extended state to support the first tubular structure thereon for placement within an opening in the second tubular structure to facilitate anastomosing the tubular structures together. The arms can be configured to urge the first tubular structure against the portion of the second tubular structure surrounding the opening to form a seal therebetween. According to one embodiment, a plurality of discrete fasteners are provided to pass through the support device spaces and the first and second tubular structures. In another embodiment, fasteners are integrated into the support device and releasably coupled thereto for delivery to the anastomosis site.

Abstract: The pyloric obesity valve includes a tubular valve body having proximal and distal ends. The valve body has an intermediate section which is between the proximal and distal ends. The proximal end is enlarged transversely relative to the intermediate section. The valve body has an inner surface and a lumen. The inner surface which is within the intermediate section has a cross-sectional area which is smaller than a cross-sectional area of the inner surface which coincides with the proximal end to resist a flow through the lumen of the valve body from the proximal end to the intermediate section.

Abstract: A pyloric valve is provided for inhibiting the flow of chyme through the pyloric region of the gastrointestinal tract. The pyloric valve includes a blocking portion having at least one axially-aligned annular flange defining a central opening and a support having a rim and a support surface. The support may be disposed in a nested position wherein the support surface is disposed within the central opening and an inverted position wherein the support surface is disposed away from the central opening. The pyloric valve may further include a sleeve that may have a beveled distal end. The pyloric valve may be constructed of silicon. Also provided are methods of inserting and removing the pyloric valve, which each include a step of manipulating the support between its inverted and nested positions. Insertion and removal systems are also provided for use with the pyloric valve.

Abstract: Described here are devices and methods for intussuscepting a portion of stomach tissue. Typically the intussusception is created at a position near, but distal to the gastroesophageal junction, and a pouch capable of storing a volume (from about 0 cc up to about 100 cc) is created proximal the intussuscepted tissue. In this way, the amount of food that may be ingested is reduced, helping to ameliorate GERD symptoms, and aiding in weight loss efforts. Some of the devices described here include an expandable member and at least one suction inlet. In these devices, the expandable member is expanded to create a proximal cavity into which the stomach tissue is pulled (e.g., using suction), thereby creating the intussusception.

Abstract: A method for treating morbid obesity in a body of a mammal having a gastrointestinal tract extending through a stomach and a pyloric sphincter and a wall forming the stomach and pyloric sphincter. At least one implant is formed in the wall in the vicinity of the pyloric sphincter to inhibit emptying of the stomach.

Abstract: 1. Instrumentation for carrying out a gastrointestinal bypass comprising: means (4, 6, 12) for creating a gastric sleeve (21, 22) from the lesser curvature (13) of the stomach (1), means for creating a gastrointestinal bypass involving said gastric sleeve (21, 22), in which said means for creating a gastrointestinal bypass include: means for creating a gastroenteroanastomosis (26) between two closely approximated gastric and intestinal tissue portions, maintaining the continuity of the intestinal duct after the creation of the gastroenteroanastomosis, means for creating an enteroenteroanastomosis (29) between two closely approximated tissue portions (27, 28) of the intestine, maintaining the continuity of the intestinal duct after the creation of the enteroenteroanastomosis (29), means for sectioning the intestine (20) between the gastroenteroanastomosis (26) and the enteroenteroanastomosis (29).

Abstract: Apparatus for reconfiguring tissue, the apparatus comprising a shaft having a distal end and a proximal end; at least one effector mechanism movably mounted to the distal end of the shaft, each effector mechanism comprising at least one gripping element for gripping tissue to that effector mechanism, the at least one effector mechanism being configured to capture the gripped tissue against said shaft, at least one actuating mechanism mounted to the proximal end of the shaft, and at least one connection mechanism connecting the at least one actuating mechanism to the at least one effector mechanism, whereby a user may utilize the at least one actuating mechanism to actuate the at least one effector mechanism so as to reconfigure tissue.

Abstract: A medical device for managing tissue in an organ, such as the stomach, for retracting or positioning tissue and related organs to allow certain regions of the stomach to be acquired for a gastroplasty procedure. The medical device includes an elongated body having a proximal end and a distal end, and a tissue treatment device attached to the distal end of the elongated body. The tissue treatment device includes a first jaw opposite a second jaw, and each jaw is adapted to acquire tissue. A retractor is disposed along the tissue treatment device and adapted to be moveable from a delivery position to a retraction position to move or manage the tissue of the stomach. The medical device also includes a collapsible barrier disposed between the first and second jaws of the tissue treatment device to direct tissue into the first and second jaws separately.

Abstract: A surgical instrument for creating an anastomosis includes a housing, a handle extending from the housing and a fastener support member extending distally from the housing. The fastener support member is configured and dimensioned to releasably support a plurality of surgical fasteners. The instrument further includes a tissue retaining mechanism which is selectively movable from a first position relative to the fastener support member to a second position in closer proximity with the fastener support member such that tissue disposed adjacent to the fastener support member is retained thereagainst. Upon actuation of the handle, a fastener firing mechanism simultaneously deforms the plurality of surgical fasteners to complete the anastomosis.

Abstract: A surgical device that includes an outer hollow body and an inner hollow body. The inner hollow body is slidably disposed within said outer hollow body and the inner hollow body includes at least two hollow arms located at the distal end of the inner hollow body. An inflatable member is rotatably attached to each hollow arm of the inner hollow body. At least a pair of suture rings are rotatably coupled to the outer hollow body wherein the suture rings are in parallel to each other and are coupled to each other by a plurality of suture clips.

Abstract: Devices and methods for acquiring and fastening tissues folds within an internal organ, such as the stomach, and for applying the methods and devices to producing reductions in organ volume or repair of bariatric procedures, are disclosed. An exemplary method for forming a continuous laterally extending tissue fold involves forming a succession of laterally extending folds having adjacent overlapping fold portions. One exemplary tissue-acquisition device has an open-end roller-and-arm structure that allows individual tissue folds to be formed and fastened, then advanced to an adjacent region within the stomach, for capture of a new fold that will form an extension of the existing fold(s).

Abstract: An intragastric anchor implant device is provided with a substantially rigid member having proximal and distal ends and atraumatic tips or features disposed near the proximal and distal ends. The atraumatic features prevent damage to the tissues of the stomach and the gastrointestinal track and may help to anchor the device in the stomach, while the substantially rigid member resists bending so as to engage a tissue of the stomach or the gastrointestinal tract to prevent passage through the stomach. The anchor implant device is coupled with a therapeutic device, typically a sleeve, such as an intestinal bypass sleeve. Ideally, the device includes a sliding seal to direct a flow of food particles from the stomach through the sleeve, so as to be useful in treating a disorder, including obesity and diabetes. Methods of deploying the anchor implant devices are also disclosed.

Abstract: A method is provided that involves endoscopically repairing or revising an anastomotic outlet previously formed in a portion of a patient's stomach as part of an earlier bariatric surgical procedure. The method may allow a surgeon to alter gastric functionality, such as gastric emptying or gastric dumping, by revising an existing anastomotic outlet. In this manner, the size of the outlet may be adjusted to change the rate at which contents pass from the stomach through the outlet. A surgical device may be inserted transorally through the patient's mouth, down through the esophagus and into the stomach or gastric pouch where it may be positioned in the vicinity of the anastomotic outlet. The surgical device may then be employed to revise the outlet to achieve a desired outlet configuration. The anastomotic outlet may be revised using an endoscopic fastening device that is configured to place a fastener in tissue.

Abstract: A shunt rivet for implementation in the aorta and inferior vena cava to treat chronic obstructive pulmonary disease, and a method of treating chronic obstructive pulmonary disease.

Abstract: The attenuation or isolation of environmental parameters on a gastric lumen is described herein. Once tissue plications are formed into a gastric lumen or sleeve within a stomach, the newly formed lumen is subjected to a multitude of fluctuating stresses or pressure from food or fluids passing therethrough, from naturally-occurring contractions, and/or from changes in pH levels from caustic stomach acids and hormones. The tissue interface between these plications can be isolated from such environmental fluctuations, or the fluctuations can be attenuated, by a number of methods. One example is to place a gastric stent or sleeve within the newly formed lumen. Another example is to utilize multiple rows of anchors, clips, or sutures along the interface. Alternatively, bio-adhesives can be dispensed to buttress the tissue interface. In another variation, the tissue can be approximated in different configurations which effectively reduce or isolate the adhered tissue region.

Abstract: Provided is an anastomosis device including a first head holding a first anastomosis ring, a second head holding a second anastomosis ring, a first guide bar connected to the first head and switching a release position and a standby position to each other, wherein the first guide bar includes a first rotation groove, a second guide bar connected to the second head and switching the release position and the standby position to each other, wherein the second guide bar includes a second rotation groove, and a rotation driver moving approximately in a parallel direction to the first and second guide bars and including a first guide protrusion and a second guide protrusion, which move along the first and second rotation grooves, respectively.

Abstract: Apparatus method for performing surgical anastomotic procedures are disclosed herein. The apparatus for performing the surgical anastomotic procedure includes a tubular sleeve defining an axial lumen therethrough, a positioning tube defining an axial lumen therethrough, an expansion assembly having a tubular body and an expandable tip operatively coupled to a distal end thereof, and an anchoring assembly. The positioning tube is preferably configured and adapted to be slidably received within the axial lumen of the tubular sleeve.

Abstract: Methods and devices for maintaining a space-occupying device in a fixed relationship relative to a patient's stomach by manipulation of the stomach. In one variation, two or more regions of the stomach wall are brought into approximation with one another and secured together in a manner that secures a space-occupying device within the stomach of the patient. In another variation, two or more regions of the stomach wall are wrapped around a space-occupying device to maintain the position of the space-occupying device relative to the stomach wall. In another variation, a system having a space-occupying member and a locking member capable holding the space-occupying member against the inner wall of the stomach are provided. In a further variation, a pouch is created within the stomach that receives and retains a space-occupying device.

Abstract: Methods and devices for maintaining a space-occupying device in a fixed relationship relative to a patient's stomach by manipulation of the stomach. In one variation, two or more regions of the stomach wall are brought into approximation with one another and secured together in a manner that secures a space-occupying device within the stomach of the patient. In another variation, two or more regions of the stomach wall are wrapped around a space-occupying device to maintain the position of the space-occupying device relative to the stomach wall. In another variation, a system having a space-occupying member and a locking member capable holding the space-occupying member against the inner wall of the stomach are provided. In a further variation, a pouch is created within the stomach that receives and retains a space-occupying device.

Abstract: Described here are devices and methods for intussuscepting a portion of stomach tissue. Typically the intussusception is created at a position near, but distal to the gastroesophageal junction, and a pouch capable of storing a volume (from about 0 cc up to about 100 cc) is created proximal the intussuscepted tissue. In this way, the amount of food that may be ingested is reduced, helping to ameliorate GERD symptoms, and aiding in weight loss efforts. Some of the devices described here include an expandable member and at least one suction inlet. In these devices, the expandable member is expanded to create a proximal cavity into which the stomach tissue is pulled (e.g., using suction), thereby creating the intussusception.

Abstract: A urological repair device includes a stent having a diameter that fits within a portion of a urological structure. The stent also has a length to bridge a distance between a first end of the urological structure and a second end of the urological structure. The stent includes at least one tapered end. The tapered end enables placement of the stent within the urological structure. A method of repairing a urological structure includes placing a first end of a substantially tubular urological structure over a first end of a tubular stent, and placing a second end of a substantially tubular urological structure over a second end of a stent, and attaching the first end of the substantially tubular urological structure, the second end of a substantially tubular urological structure, and the tubular stent to form a fluid passageway.

Abstract: An anastomosis surgical device comprising an elongate body having a drainage aperture at a distal end for communication with a proximal end of the elongate body, tissue approximating structure extendable from the elongate body and spaced proximally from the drainage aperture along the length of the elongate body. The device further includes an actuating mechanism extending from the proximal end of the elongate body and comprising at least one tissue approximating structure control mechanism, and a protective enclosure surrounding at least a portion of the actuating mechanism.

Abstract: Methods and devices for creating a seal in a vessel for performing multiple anastomoses. The device includes an expandable region at the shaft assembly distal end with a sealing membrane that spans the expandable region, and a corresponding clamping member moveable toward the expandable region. Once inserted into the vessel lumen the expandable region is deployed from a first low-profile position into a second expanded position, and positioned at the target site of the anastomoses. Movement of the distal end of the clamping member, which remains located outside the vessel, against the expanded region creates a seal at the target site allowing a blood-free, graft site area that is large enough to accommodate multiples anastomoses.

Abstract: Various obesity treatment tools and methods are described herein, as well as treatments for other gastric-related diseases, e.g., GERD. Treatment includes reducing the size of the stomach pouch to limit the caloric intake as well as to provide an earlier feeling of satiety. This may be done by creating a smaller gastric pouch within the stomach directly from the interior of the stomach itself. The smaller pouches may be made through the use of individual anchoring devices, rotating probes, or volume reduction devices. A pyloroplasty procedure may also be performed to render the pyloric sphincter incompetent. A gastric bypass procedure may additionally be performed using atraumatic magnetic anastomoses devices so that sugars and fats are passed directly to the bowel while bypassing the stomach. Many of these procedures may be done in a variety of combinations. Treatment may create enforced behavioral modifications by discouraging the ingestion of high-caloric foods.

Abstract: The present invention provides an anastomosis device which includes an elongate center pin having proximal and distal ends. The proximal end is configured to be graspable using a grasping tool. A grip mechanism is located at the distal end for crimping a suture. The device includes an outer sleeve having a passageway therethrough to receive therein the elongate center pin. A suture having a suture needle is attached to a first end of the center pin and a second end of the suture is formed into a pre-formed knot mounted on the sleeve. The device includes a suture release mechanism having a passageway extending therethrough to receive the outer sleeve therein. The suture release mechanism slides along the sleeve between a first position in which the suture release mechanism is spaced from the distal end and a second position such that movement of the suture release mechanism from the first position to the second position dislodges the pre-formed knot off the sleeve.

Abstract: Herein is provided an anastomosis device which includes a cylindrical support housing having a tapered section being formed of a plurality of compliant fingers integrally formed around the circumference of an end of the cylindrical section which can flex at their connection point to the cylindrical section. Each compliant finger holds a suture needle. The device includes a push rod having a cam head at one end of the rod section. The cam head is located adjacent to the tapered portion. In operation the anastomosis device is aligned with the anatomical tubular structure undergoing an anastomosis process. When a back end of the push rod is pushed towards the tapered section of the support housing, the cam head section bears against an inner surface causing each compliant finger to flex radially outwards forcing the suture needles to simultaneously pierce the wall of the anatomical tubular structure.

Abstract: Various obesity treatment tools and methods are described herein, as well as treatments for other gastric-related diseases, e.g., GERD. Treatment includes reducing the size of the stomach pouch to limit the caloric intake as well as to provide an earlier feeling of satiety. This may be done by creating a smaller gastric pouch within the stomach directly from the interior of the stomach itself. The smaller pouches may be made through the use of individual anchoring devices, rotating probes, or volume reduction devices. A pyloroplasty procedure may also be performed to render the pyloric sphincter incompetent. A gastric bypass procedure may additionally be performed using atraumatic magnetic anastomoses devices so that sugars and fats are passed directly to the bowel while bypassing the stomach. Many of these procedures may be done in a variety of combinations. Treatment may create enforced behavioral modifications by discouraging the ingestion of high-caloric foods.

Abstract: Methods and apparatus for creating an anastomosis or fistula between the gallbladder and an adjacent organ are disclosed. First, a parent magnet, typically a permanent magnet, is deployed in the stomach, small intestine, or another organ adjacent to the gallbladder, and a mating daughter material is deployed in the gallbladder in order to create a magnet-compression anastomosis. The gallbladder may then be ablated or otherwise functionally inactivated through the anastomosis. Another aspect of the invention relates to an all-in-one surgical kit that contains all the necessary specialized tools for a surgeon to perform the procedure.

Abstract: An anastomosis device including an actuation system adapted to control the deployment of the anastomosis device. The anastomosis device includes a watertight barrier for preventing bodily fluids from traversing an actuation wire lumen containing a plurality of actuation wires. The anastomosis device can include a lockout system on a mechanical actuator that prevents disengagement of a grasping assembly until healing from an anastomosis procedure is complete and the anastomosis device is removed.

Abstract: Methods and devices regulate the activation of ghrelin hormones within a stomach in order to treat weight disorders, to promote learning and memory functions, to treat stress-induced depression, and to control sleep duration. In one embodiment, a method for regulating activation of ghrelin hormones within a stomach comprises a means for isolating non-activated ghrelin hormones from food content and dietary lipids within the stomach. These means for isolating may take any number of forms and may comprise one or more of a surgical procedure, an implanted device, or an ingestible substance.

Abstract: A surgical device (1) for temporary protection of an anastomosis (5) in the colon (12, 13, 14), the rectum (11), or the anal passage (10), including: a) a semi-rigid hollow longitudinal temporary anchor element (2), a first wall of which includes a substantially cylindrical main portion (2a) with a substantially circular section having a length (L1) of at least 50 mm, preferably in the range 70 mm to 150 mm, said first wall having an outside diameter that may be varied in a controlled manner; and b) a flexible sheath (3) fixed to said anchor element (2) against, preferably around, said first wall and having a length (L3) downstream of said anchor element (2) of at least 50 cm, preferably at least 1 m, and an outside diameter when at rest in the range 20 mm to 40 mm, preferably in the range 25 mm to 33 mm, and said sheath is made from a biocompatible elastomer material having a wall thickness in the range 0.05 mm to 1 mm.

Abstract: An anastomosis device providing increased functionality, reliability and safety through the use of designs addressing potential puncture of an inflation balloon being used to hold and approximate tissue. The anastomosis device can include bladder retention structures configured to engage and retain tissue without pointed or sharpened surfaces that can rupture the inflation balloon. The anastomosis device can include a reinforced or otherwise protected inflation balloon to resist puncturing by a bladder retention structure. The anastomosis device can include a catheter wall profile selected to physically prevent bladder retention structures from being forcibly bent back so as to avoid potential contact with and puncture of the inflation balloon. The anastomosis device can include a catheter funnel with an internal spring for preventing kinking of the catheter lumen while providing for flexibility and stretch of the funnel to absorb pulling or shock force which can rupture the inflation balloon.

Abstract: A system for anastomosing a first tubular structure to a second tubular structure having an opening formed therein comprises a support device having a plurality of arms forming spaces therebetween. The support device is adapted to support the first tubular structure within an opening in the second tubular structure to facilitate anastomosing the tubular structures together. The arms can be configured to urge the first tubular structure against the portion of the second tubular structure surrounding the opening to form a seal therebetween. According to one embodiment, a plurality of discrete fasteners are provided to pass through the support device spaces and the first and second tubular structures.

Abstract: The invention relates to a connector (1), applicator and method for mechanically connecting hollow structures, in particular small blood vessels, in order to make an anastomosis. The connector incorporates various features to create a reliable engagement with the vessel walls to make a good connection thereof. The applicator may comprise knife members to make an arteriotomy and punch a hole in one of the vessel walls, comprises an expansion portion to cause a large expansion with a minimum profile, and comprises anvil members to reliably bring staple-like elements (5) of the connector to the joining position. The invention also includes auxiliary devices such as a punch and deforming instrument.

Abstract: An anastomosis device for avoiding stretching of a catheter body during an extending healing period while reducing scrap costs. The anastomosis device includes a catheter body defining a proximal end portion and a distal end portion, wherein a device body portion is operably attached at the proximal end portion. The device body portion includes a funnel shaped aperture connecting the device body portion to the proximal end portion. The device body portion provides access into the catheter body so as to allow for placement of a tension cable or flexible core tubing within the catheter body following inspection and verification of an overmold between the device body portion and catheter body. Placement of the tension cable or flexible core tubing subsequent to overmolding reduces scrap costs while eliminating stretching of the catheter body.

Abstract: A variable parietal/visceral pleural coupling may be utilized to create an air-tight seal in the pleural space between the parietal and visceral pleura. This coupling may be utilized to create a seal for other implantable devices.

Abstract: Intra-gastric fastening devices are disclosed herein. Expandable devices that are inserted into the stomach of the patient are maintained within by anchoring or otherwise fixing the expandable devices to the stomach walls. Such expandable devices, like inflatable balloons, have tethering regions for attachment to the one or more fasteners which can be configured to extend at least partially through one or several folds of the patient's stomach wall. The fasteners are thus affixed to the stomach walls by deploying the fasteners and manipulating the tissue walls entirely from the inside organ. Such fasteners can be formed in a variety of configurations, e.g., helical, elongate, ring, clamp, and they can be configured to be non-piercing. Alternatively, sutures can be used to wrap around or through a tissue fold for tethering the expandable devices. Non-piercing biased clamps can also be used to tether the device within the stomach.

Abstract: A medical method includes sliding two substantially straight unconnected arms over a fold of body tissue such that a first arm contacts a first portion of the fold and a second arm contacts a second portion. Then, each arm is bent completely through the fold such that both of the arms compress the portions of the fold into contact with each other. Another method includes releasably coupling first and second substantially linear arms to a bridge, each of the arms having a substantially straight sliding portion and a bendable piercing portion. The arms are slid over opposing sides of two body tissue layers, the first arm sliding over the first layer and the second over the second layer. While the sliding portions of the arms remain substantially straight, each piercing portion is bent completely through the adjacent layer and halfway through the other layer to compress the two layers together.

Abstract: Apparatus for performing a surgical anastomosis include a tubular body having an onion portion formed near the distal end of the tubular body. The apparatus includes a sleeve having a radius sized and dimensioned to slidably receive the tubular body therein. The apparatus includes a plunger assembly sized and dimensioned to be slidably received within the central lumen of the tubular body. The plunger assembly includes a distal end configured and adapted to deploy the onion portion.

Abstract: Apparatus for performing a surgical anastomosis include a tubular body having an expandable anchor operatively coupled near a distal end thereof. The apparatus further includes a sleeve slidably received about the tubular body. The sleeve has an expandable anchor operatively coupled near a distal end thereof. The expandable anchor of the tubular body has an annular ring concentric with a longitudinal axis defined by the tubular body.

Abstract: Methods and devices for providing a minimally-invasive placement of a mechanical structure for reducing the volume of a hollow body organ. Intragastric bands may be secured within the hollow body organ and then reduced in diameter to form a stricture within the hollow body organ. The strictures may be placed anywhere within the hollow body organ, and more than one stricture may be formed within the hollow body organ.

Abstract: Methods and devices are provided for reconfiguring a tissue within a hollow body organ using an entirely endoscopic approach in order to effectively reduce flow of fluid contents into a second hollow body organ in fluid communication with the first.

Abstract: A device for joining a first body vessel to a second body vessel including a cartridge having a distal end and defining a longitudinal axis, a radially expandable anchor disposed at the distal end of the cartridge for engaging the first body vessel, the expandable anchor having an initial condition and an expanded condition wherein the expandable anchor is radially larger than the expandable anchor in the initial condition, and a plurality of sutures disposed within the cartridge and being deployable therefrom so as to engage the second body vessel, the sutures being threaded through the expandable anchor.

Abstract: Apparatus for performing a surgical anastomosis include a tubular body having an onion portion formed near the distal end of the tubular body. The apparatus includes a sleeve having a radius sized and dimensioned to slidably receive the tubular body therein. The apparatus includes a plunger assembly sized and dimensioned to be slidably received within the central lumen of the tubular body. The plunger assembly includes a distal end configured and adapted to deploy the onion portion.

Abstract: Apparatus and methods for performing a surgical anastomotic procedure are disclosed herein. Apparatus according to the present disclosure include a tubular body having a distal end and a proximal end and defining a longitudinal axis, the tubular body including an expandable anchor provided near the distal end thereof and an expandable cuff provided near the distal end of the tubular body and proximal of the expandable anchor, and a joining member configured and adapted to be received about the expandable cuff of the tubular body, the joining member having an annular body portion including a pair of opposed terminal edges. The joining member has a retracted position in which the pair of opposed terminal edges overlap by a predetermined amount and an expanded position in which the pair of opposed terminal edges overlap by an amount less than the predetermined amount.

Abstract: A surgical instrument for applying a fastener to tissue. The instrument includes a shaft having a working end and a grip end, a first jaw pivotally mounted on the working end including a receiver for releasably holding a male component and a second jaw statically mounted on the working end including a receiver for releasably holding a female component. The first jaw is pivotally moveable between an open position in which the first jaw is sufficiently spaced from the second jaw so tissue can be received between a male component and a female component, and a closed position in which a protrusion of the male component is aligned with and received in a recess of the female component. The instrument includes a mechanism operatively connected to the first jaw for moving the first jaw between the open position and the closed position.

Abstract: A branch prosthesis configured for placement in a branch vessel includes an expandable tubular body portion, an expandable annular flange attached to a proximal end of the body portion, and a sealing sleeve proximally extending from the annular flange. The sealing sleeve is adapted to deform to a generally straight cylindrical hollow shape during implantation. When deployed, the sealing sleeve rolls up to a tightly-wound coil that bears against the annular flange. When used in conjunction with a main prosthesis having a side opening and deployed within in a main vessel, the annular flange of the branch prosthesis engages an outer surface of the main prosthesis around a perimeter of the side opening and the sealing sleeve engages an inner surface of the main prosthesis around the perimeter of the side opening to form a fluid-tight seal between the main prosthesis and the branch prosthesis.

Abstract: Viscerotomy closure devices and methods of use close a hole in a bodily organ, such as one created during a natural orifice transgastric surgery procedure. A mesh with a hole in its center and an attached loop of suture having a Roeder knot is mounted on the protruding rod of an end-to-end anastomosis stapler between the anvil and the staple carrying member. The mesh covers the staple receiving slots. When rotated when in contact with tissue, an augur-shaped blade attached to the anvil's exterior self-feeds the tissue through a notch in the anvil's base into the space between the anvil and the staple carrying member. After the stapler is fired to staple the mesh to the tissue and create a viscerotomy, a knot pusher cinches the loop of suture and subsequently tightens the Roeder knot to maintain the cinch.

Abstract: A vascular graft for anastomosis of blood vessels or ducts comprises piercing means (3) for engaging an end portion (8/8?) of a blood vessel or prosthesis and means (6, 6?) for precisely guiding one or more piercing elements (3) to pierce the wall of the vessel or prosthesis to a predetermined depth and in a predetermined direction.