Abstract: A staple for attaching a sheet-like implant to tissue or bone may include first and second arms, and first and second flukes. In some embodiments, the first arm has a proximal end and a distal end, and the second arm has a proximal end and a distal end. A bridge extends from the proximal end of the first arm to the proximal end of the second arm. The first fluke has a proximal end abutting the distal end of the first arm, and the first fluke extends distally from the first arm. The first fluke has a lateral extent larger than a lateral extent of the first arm and is mounted eccentrically thereto. The first fluke includes a proximal surface projecting at an outward angle in a proximal direction away from the distal end of the first arm to engage the tissue or bone when inserted therein. The second fluke has similar features. This arrangement causes the first and second flukes to rotate in response to a pullout force on the bridge.

Abstract: A surgical stapling apparatus includes a staple cartridge and an anvil member. The staple cartridge includes a plurality of surgical fasteners disposed in rows of retention slots. The staple cartridge may have an annular or linear configuration of retention slots. The tissue contacting surface of the staple cartridge may be tapered or stepped. The anvil member has a tissue contacting surface that includes a number of pockets arranged for substantially aligning with the retention slots. In addition, the tissue contacting surface of the anvil member may complement the tissue contacting surface of the staple cartridge.

Abstract: A method and system for operating a surgical instrument. A surgical instrument can operate in an initial operating state and a secondary operating state. The secondary operating state can be one of a warned operating state or a modified operating state. After receiving feedback from the surgical instrument, an operator of the surgical instrument can decide whether to proceed to the warned operating state or the modified operating state.

Abstract: The present disclosure provides medical devices possessing reactants thereon, which further promote adherence of the device to tissue in vivo and/or release of bioactive agents from the device.

Abstract: A staple delivery applicator for delivering radioactive staples during brachytherapy medical treatment has an actuating device for attaching source staples located distally thereform. The actuating device is removably attachable to an actuator arm on a proximal end. A staple applicator cartridge holder is attached to the actuator arm on a distal end. The staple applicator cartridge is mountable in the holder and has slots for mounting of radioactive source staples therein. An anvil therein crimps the staples. The staple applicator cartridge holder is removably mountable in a connector and the connector is also removably mounted to a surgical staple holder. A trigger device has a control for closing the anvil of the cartridge holder and for firing of the source staples in the cartridge therein to cause the staples to crimp, and a control for opening the anvil and releasing the trigger device from the actuator arm.

Abstract: An endoscopic surgical stapler for applying a suture to tissue including an elongated tubular member, a first jaw positioned at the distal end portion of the tubular member and having a longitudinal axis, and a second jaw disposed in substantially parallel relation to the first jaw at the distal end portion of the tubular member. The second jaw is movable in a direction substantially perpendicular to its longitudinal axis toward the first jaw, while maintaining the substantially parallel relation between the first and second jaws. A stapling assembly is disposed in each of the first and second jaws and configured to apply surgical staples to the tissue such that a suture, in combination with the surgical staples, forms a purse string with the tissue when the surgical stapler is activated.

Abstract: The present disclosure relates to compositions comprising a copolymer that includes a first monomer and a second monomer that is different from the first monomer, wherein both the first and second monomer are selected from the group consisting of 3-sulfopropyl acrylate potassium salt, sodium acrylate, N-(tris(hydroxyl methyl)methyl)acrylamide, and 2-acrylamideo-2-methyl-1-propane sulfonic acid. The present disclosure further relates to methods for preparing the copolymer compositions and shaped articles comprising the copolymers.

Abstract: An apparatus for placement into an opening formed in a wall of a body lumen to deploy a closure element. The apparatus comprising a housing having a handle portion formed at a distal end, the handle portion configured to be engaged by a user when advancing the housing to deploy the closure element. A triggering element deploys the closure device and can at least be partially formed in the housing. A throw reducing mechanism can slide relative to the housing and reduce the distance a user must stretch a hand to move a triggering system within the housing. The housing can include, or be connected to, a handle member having one or more expansion members which expand to provide a stable base for manipulating the apparatus.

Abstract: A medical instrument includes a first grasping member and a second grasping member that approach and separate from each other, a rotating body that is rotatably installed on a rotation shaft fixed to the first grasping member, an open-close link whose first end is rotatably connected to a first rotation shaft provided on the second grasping member and whose second end is rotatably connected to a second rotation shaft provided on the rotating body at a distance from the rotation shaft, and a manipulating member rotating the rotating body. When the rotating body is rotated in a predetermined direction, the first grasping member and the second grasping member approach each other while the second rotation shaft approaches an imaginary straight line connecting axes of the rotation shaft and the first rotation shaft.

Abstract: A staple for attaching a sheet-like implant to tissue or bone may include first and second arms, and first and second flukes. In some embodiments, the first arm has a proximal end and a distal end, and the second arm has a proximal end and a distal end. A bridge extends from the proximal end of the first arm to the proximal end of the second arm. The first fluke has a proximal end abutting the distal end of the first arm, and the first fluke extends distally from the first arm. The first fluke has a lateral extent larger than a lateral extent of the first arm and is mounted eccentrically thereto. The first fluke includes a proximal surface projecting at an outward angle in a proximal direction away from the distal end of the first arm to engage the tissue or bone when inserted therein. The second fluke has similar features. This arrangement causes the first and second flukes to rotate in response to a pullout force on the bridge.

Abstract: A device for attaching a sheet-like implant to a target tissue includes a pilot member and a staple push rod. In some embodiments, the pilot member has a distal end and at least a pair of prongs extending from the distal end. The prongs are configured to form pilot holes when the distal end of the pilot member is pressed against the target tissue. The staple push rod is disposed within at least a portion of the pilot member and slidable relative thereto. The staple push rod includes at least a pair of stakes. Each stake is dimensioned to engage a surface of a staple to apply pushing forces thereto. Each stake is positioned relative to a prong along an inner surface of the pilot member so that the stakes advance into the pilot holes when the stakes are moved in a distal direction. Methods for attaching a sheet-like implant to a target tissue are also disclosed.

Abstract: Implantable tissue structure modification devices are provided. Aspects of the tissue structure modification devices include first and second tissue securers separated by a contraction region, wherein the device is configured to be implanted at a cardiac location and assume a first constrained length that is longer than a second relaxed length. Also provided are methods of using the devices for tissue structure modification, as well as delivery systems and kits that find use in the methods. The devices and methods of the invention find use in a variety of different applications, including valve (e.g., mitral valve) structure modification.

Abstract: A surgical instrument includes a handle portion, a shaft housing a firing bar, an end effector comprising an anvil, a lower jaw, and a stapling and severing assembly responsive to a longitudinal closing motion produced by the handle portion and the shaft. The lower jaw is configured to receive a cartridge when in an open position. The cartridge includes a housing, a plurality of staples disposed in the housing, and a deck disposed over the plurality of staples. The deck defines apertures, with each aperture being substantially disposed over each staple. The cartridge further receives a matrix including glue beads suspended in the matrix. The staples are driven through the matrix to secure the matrix to tissue. The glue beads are activated when the matrix is secured to the tissue, such that the activated adhesive further secures the staple line in the tissue.

Abstract: An anvil assembly comprising an anvil shaft and an anvil head, the anvil head having anvil depressions for forming surgical staples. The anvil head is mounted to the anvil shaft and the anvil shaft has a longitudinal axis and first and second spaced apart elongated projections attached to the anvil shaft and extending therefrom. The projections are configured and dimensioned to retain a purse string suture.

Abstract: A staple having a crown, a deformable leg extending from the crown, and a spring extending from the crown configured to compress tissue between the spring and the deformable member. Owing to the flexibility of the spring, the staple can accommodate a wide range of tissue thicknesses while still compressing the tissue captured therein. As a result, a single staple design can be used in a wide variety of surgical procedures thereby reducing the amount of staple designs that must be provided to the surgeon. In at least one embodiment, the staple includes a crushable member. This crushable member can include a plastically deformable first portion and an elastically deformable second portion. The present invention can also include, in various embodiments, a crown, a first deformable member extending from the crown, and means for compressing the tissue against the first deformable member.

Abstract: A staple clip for providing an attachment function in a surgical procedure is described. A center hub has a center hub aperture. The center hub defines a lateral hub plane. A plurality of joining legs each has an inner leg end attached to the center hub and an outer foot defining a lateral foot plane. The inner leg end and outer foot are separated along the leg by an elongate leg body extending laterally outward and longitudinally downward from the center hub. A plurality of lobe pads are attached to the center hub and lie substantially within the lateral hub plane. The inner leg ends and lobe pads alternate with each other around a periphery of the center hub.

Abstract: Surgical instruments and procedures for performing a circular anastomosis of a tubular organ. The surgical instruments may include selectively deployable tissue acquisition members configured to puncture through a portion of the tubular organ and position the portion of the organ adjacent to a fastener face of a staple cartridge supported in the instrument. At least one cutting member may be radially deployed and rotated to sever the positioned portion of organ from a distal portion of the organ. An anvil may be employed to draw another portion of the organ adjacent to the portion of organ positioned adjacent to the fastener face of the staple cartridge. The staples may then be deployed through the adjacent portions of organ and an annular knife may be advanced through the adjacent organ portions to complete the anastomosis.

Abstract: Surgical instruments are disclosed. Various non-limiting embodiments may include an elongated shaft that has a distal end portion that is configured to operably support a circular staple cartridge therein. A tissue acquisition shaft may be rotatably supported within said elongated shaft and have a distal portion that protrudes distally beyond the distal end portion of the elongated shaft. At least one tissue acquisition member may be pivotally attached to the distal end portion of the tissue acquisition shaft such that the tissue acquisition members are selectively pivotable from a retracted position to deployed positions upon application of a deployment motion thereto. A rotatable cutting member may be operably supported adjacent to the tissue acquisition member and being selectively rotatable about the central axis upon application of a cutting actuation motion thereto.

Abstract: A non-surgical gastric bander device and process is described. The non-surgical gastric bander device includes a staple device, an elongated articulated shaft, an operations handle and a cable connecting the operations handle to the staple device. The staple device includes a housing having an interior housing channel for receiving a slidable tube. The slidable tube includes at least one suction port, a constriction band surrounding the exterior surface of the slidable tube and a plurality of staples removably positioned adjacent the exterior surface of the slidable tube and held in place by the constriction band. The gastric bander device further includes an elongated, articulated shaft connecting the staple device to an operations handle.

Abstract: A method of deploying a surgical fastener using the steps of introducing a fastener into a body of a patient while the fastener is in a first shape forming a first loop. Moving end segments of the fastener away from each other substantially along an entire length thereof. And forming the fastener into a second loop having a width greater than a width of the first loop.

Abstract: According to an aspect of the present disclosure, a surgical instrument for operating on tissue is provided. The surgical instrument includes an end effector including a first tissue engaging member and a second tissue engaging member in juxtaposed relation to the first tissue engaging member; a gap determination element operatively associated with each of the first tissue engaging member and the second tissue engaging member for measuring a gap distance between the first tissue engaging member and the second tissue engaging member; and a tissue contact determining element operatively associated with a respective tissue contacting surface of at least one of the first tissue engaging member and the second tissue engaging member. The present disclosure also relates to methods of using the surgical instrument.

Abstract: A surgical instrument including a housing, an endoscopic portion, a drive motor, a drive tube, a firing rod and an end effector is disclosed. The endoscopic portion extends distally from the housing and defines a first longitudinal axis. The drive motor is disposed at least partially within the housing. The drive tube is disposed in mechanical cooperation with the drive motor and is rotatable about a drive tube axis extending through the drive tube. The firing rod is disposed in mechanical cooperation with the drive tube and at least a portion of the firing rod is translatable with respect to the drive tube. The end effector is disposed adjacent a distal portion of the endoscopic portion and is in mechanical cooperation with the firing rod so that the firing rod drives a surgical function of the end effector.

Abstract: A surgical staple for connecting two tubular tissue structures may include a substantially rectangular base having a first edge and a second edge substantially parallel to one another, and a third edge substantially perpendicular to the first and said second edges; and may also include at least three deformable tines extending from the first and second edges of said base; where no tine that extends from the first edge may be positioned at substantially the same distance from the third edge as any said tine that extends from the second edge; and where deformation of the tines secures the tubular tissue structures together.

Abstract: The present disclosure relates to a two-piece implant. The implant includes a first piece having at least two prongs and a protrusion located between the prongs and a second piece coupled to the first piece, wherein the second piece is configured to rotate relative to the first piece. A method of tissue repair is also disclosed.

Abstract: An exemplary surgical method of treating tissue may include possessing a surgical tool that has at least one movable feeder belt that includes staples frangibly connected thereto, where at least one staple is oriented relative to the feeder belt in a direction angled relative to the transverse direction; placing the surgical tool adjacent to tissue; deforming at least one staple into tissue; frangibly separating at least one deformed staple from the feeder belt; advancing the feeder belt; and repeating the placing, deploying and separating. Another exemplary surgical method of treating tissue of a patient may include holding a cartridgeless surgical tool that includes staples; stapling tissue with staples in response to a single actuation of the surgical tool; and repeating the stapling at least once.

Abstract: A stapling element is provided, operative to pierce and penetrate a tissue by a first end, and close around the tissue. Three factors help prevent local necrosis: 1. The self-closing feature of the staple does not lead to tissue crushing. 2. Edge seams are applied generally perpendicular to the tissue edge, allowing for blood supply to the tissue edge. 3. Excess tissue is cut off at the seam, minimizing the amount of tissue that may undergo local necrosis. A physical feature prevents the staple from rotating, when in an application shaft, to maintain a predetermined closing direction. The stapling element may be formed of an alloy, a pure metal, a polymer, or a composite of at least two materials. Additionally, staplers, anastomosis devices, and methods for their applications are described.

Abstract: A surgical severing and stapling instrument, suitable for laparoscopic and endoscopic clinical procedures, clamps tissue within an end effector of an elongate channel pivotally opposed by an anvil. Various embodiments are configured to be operably attached to a robotic system to receive actuation/control motions therefrom.

Abstract: Embodiments of a clamping instrument are disclosed. In some embodiments, a clamping device with calibrated parameters and a calibration process for the clamping device is presented. A method of calibrating a clamping instrument can include acquiring a data set of clamping torque as a function of tip deflection data for the clamping instrument; determining a torque limit from the data set; and storing the torque limit in the clamping instrument.

Abstract: Surgical fasteners, including tacks are disclosed for fastening a surgical mesh to underlying tissue during surgical procedures to repair body tissue, such as in hernia repair. Such tacks can include a head, a elongated body portion having a distal end and a proximal end, and an anchoring element on an outer surface of the body portion for inhibiting the removal of the tack from the mesh and body tissue.

Abstract: A fastener cartridge can comprise a support portion, a tissue thickness compensator positioned relative to the support portion, and a plurality of fasteners positioned within the support portion and/or the tissue thickness compensator which can be utilized to fasten tissue. In use, the fastener cartridge can be positioned in a first jaw of a surgical fastening device, wherein a second jaw, or anvil, can be positioned opposite the first jaw. To deploy the fasteners, a staple-deploying member is advanced through the fastener cartridge to move the fasteners toward the anvil. As the fasteners are deployed, the fasteners can capture at least a portion of the tissue thickness compensator therein along with at least a portion of the tissue being fastened.

Abstract: A fastener suitable for anastomosis procedures may include a base, at least two sharp tines extending from the base, and at least one blunt wing extending from the base. The base may have a perimeter, and the tines and the wings may be arranged in alternating sequence along that perimeter. A method for performing anastomosis between a graft vessel and a target vessel, may include stapling the end of the graft vessel to the side of the target vessel, and deploying at least one fastener into tissue at least at one end of the anastomosis, wherein the fastener includes a plurality of tines and at least one wing, wherein each wing compresses the wall of the graft vessel against the outer surface of the target vessel without penetrating either of the graft vessel and the target vessel.

Abstract: A staple for attaching a sheet-like implant to tissue or bone may include first and second arms, and first and second flukes. In some embodiments, the first arm has a proximal end and a distal end, and the second arm has a proximal end and a distal end. A bridge extends from the proximal end of the first arm to the proximal end of the second arm. The first fluke has a proximal end abutting the distal end of the first arm, and the first fluke extends distally from the first arm. The first fluke has a lateral extent larger than a lateral extent of the first arm and is mounted eccentrically thereto. The first fluke includes a proximal surface projecting at an outward angle in a proximal direction away from the distal end of the first arm to engage the tissue or bone when inserted therein. The second fluke has similar features. This arrangement causes the first and second flukes to rotate in response to a pullout force on the bridge.

Abstract: A cartridge assembly is disclosed. The cartridge assembly comprises a cartridge housing and a cartridge. The cartridge housing has a plurality of biasing members thereon. The cartridge is configured for reception at least partially within the cartridge housing. The cartridge includes a plurality of fasteners at least partially therein. The cartridge has a plurality of pockets. Each fastener is ejectable from a corresponding pocket. The cartridge has a plurality of chambers, and each chamber is adjacent a pocket and configured to store at least one fastener at least partially therein. At least one fastener is movable from the chamber to the pocket. The cartridge includes a plurality of pushers, where each pusher is configured to engage at least one corresponding fastener. At least one pusher includes at least one cam surface thereon. Each biasing member urges at least one corresponding fastener toward the corresponding pocket.

Abstract: Medical devices and systems for easily and reliably closing a perforation in tissue. One embodiment of a medical device for use with a scope includes a tubular member having a distal end, an exterior surface and an interior space. A carrier element extends along the exterior surface and around the distal end of the tubular member. An elastic band is positioned on the carrier element around the exterior surface of the tubular member. A staple is positioned within the interior space of a tubular member and includes first and second prongs which are spaced apart and translatable relative to one another. The carrier element is structured to deliver the elastic band beyond the distal end of the tubular member where upon the elastic band contracts and engages the staple to translate the first and second prongs towards each other.

Abstract: The present invention provides devices for safely closing an opening in tissue. In one embodiment, the medical device includes a delivery tube, a control member and a staple. The delivery tube is elongated and extends from a proximal end to a distal end to define a longitudinal axis. The delivery tube defines a tube lumen, while the control member is elongated and extends through the tube lumen. The staple is releasably attached to the control member adjacent the distal end of the delivery tube. The staple formed of a resilient material having a C-shape, the C-shape including free ends defining first and second tines. The resilient material of the staple is elastically deformable such that the staple may flex to change a distance between the first and second tines. The free ends are spaced apart a first distance in an unbiased state of the staple.

Abstract: A surgical staple having at least one projection formed thereon. In various embodiments, the projection is formed on a crown of the surgical staple. In one various embodiment, the projection surrounds, or is positioned adjacent to, at least one deformable member of the surgical staple. In one embodiment, the projection can apply an increased compressive force or pressure to soft tissue surrounding the deformable member prior to the deformable members puncturing a hole in the soft tissue. As a result of the increased compressive force or pressure on the tissue, after staple deployment, blood flow proximate deformable member puncture holes can be reduced.

Abstract: Improved tissue fasteners are disclosed that can be inserted into (and optionally through) tissue structures underlying a tissue surface for affixing overlapping tissues and tissue planes together, and the like. In some embodiments, an elongate anvil body may protrude distally and/or laterally from a fastener support disposed along the base. The anvil body may have a sharpened end and be configured to penetrate into the tissue, with the elongate anvil body optionally having a bend from a more distal orientation adjacent the clip support to a more lateral orientation adjacent the sharpened end during at least a portion of the deployment. The first leg can be driven through a desired location on the surface of the first tissue and against a receptacle of the anvil body so as to deform the fastener and affix it to the first tissue.

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: Apparatus and methods are provided for use in sealing a vascular puncture site. The invention comprises an introducer sheath with an integrated closure component. The closure component includes a fastener and an advanceable, deformable clip having a delivery configuration in which opposing sides do not contact one another, and a deployed configuration, in which the fastener causes opposing sides of the deformable clip to close towards one another. The clip is advanced along the sheath until it pierces opposing sides of a vessel wall at a puncture site. The clip is then deformed with the fastener to draw opposing sides of the puncture together, and the sheath is withdrawn to seal the wound. The clip and fastener preferably are bioabsorbable.

Abstract: A surgical fastener system can comprise a plurality of fasteners which can be connected to each other by, one, a retention matrix which is assembled to the fasteners in order to capture tissue within the fasteners and, two, an alignment matrix configured to hold the fasteners together before the retention matrix is assembled thereto. In various embodiments, the retention matrix and the alignment matrix can each comprise a tissue-contacting surface configured to compress tissue therebetween.

Abstract: A vascular closure device comprising a retrievable sheath-delivered contractible, clip device with structural radial or terminal members with terminal and non-terminal hooks that engage the vessel wall. Unlike other vascular closure clips, this device is delivered on the outside rather than the inside of sheath. Closure of the tissue opening can be effected by the feet of the clip engaging the puncture, aperture, or wound edges and memory characteristics of the device cause a contraction of the members, bringing the members into apposition and the wound edges together, permitting immediate vascular closure and healing of the blood vessel. The device can be delivered and recovered by an intravascular sheath.

Abstract: The present disclosure relates to surgical fasteners and more particularly to surgical fasteners coated with wound treatment materials. According to an aspect of the present disclosure, a surgical fastener for use in combination with a surgical fastener applying apparatus is provided. The surgical fastener includes a pair of legs; a crown interconnecting the pair of legs; and a wound treatment material coating at least a portion of the legs and crown.

Abstract: A surgical instrument including a handle assembly, an elongated body portion, a head portion and an elongated channel. The elongated body portion extends distally from the handle assembly. The head portion is disposed adjacent a distal end of the elongated body portion and includes an anvil assembly and a shell assembly. The elongated channel includes a proximal opening and a distal opening. The proximal opening is disposed distally of a proximalmost end of the handle assembly and proximally of the shell assembly. The distal opening is disposed on the shell assembly.

Abstract: An anvil assembly comprising an anvil shaft and an anvil head, the anvil head having anvil depressions for farming surgical staples. The anvil head is mounted to the anvil shaft and the anvil shaft has a longitudinal axis and first and second spaced apart elongated projections attached to the anvil shaft and extending therefrom. The projections are configured and dimensioned to retain a purse string suture.

Abstract: A process and system are disclosed for downloading sensor data, stored in a memory device of a surgical cutting and fastening instrument, to an external or remote computer device. The process may involve storing data from one or more sensors of a surgical cutting and fastening instrument in a memory device of a control unit of the surgical cutting and fastening instrument during a surgical procedure involving the surgical cutting and fastening instrument. Next, after the surgical procedure, a data link between the control unit and the remote computer device is established. Then, the sensor data can be downloaded from the control unit to the remote computer device.

Abstract: A surgical stapling device comprises a first jaw, a second jaw having an open position and a closed position with respect to the first jaw, a carriage, a driver, and an actuator configured to reciprocate the driver at a high rate with respect to the first and second jaws to translate the carriage with respect to the first and second jaws.

Abstract: A surgical device is described herein that can be used to fire different types and sizes of disposable loading units. In a preferred embodiment, the device applies parallel rows of surgical fasteners to body tissue and concomitantly forms an incision between the rows of staples during an endoscopic or laparoscopic surgical procedure. The device can be utilized with disposable loading units configured to apply linear rows of staples measuring from about 15 mm in length to about 60 mm in length and can be used to fire disposable loading units containing surgical clips and individual staples.

Abstract: A method for applying and maintaining compression with a staple includes piercing a material with deformable ends of staple legs. The legs enter the material until the material applies a pre-set compressive force within a pre-defined compression range to a compression device disposed at least partly between the legs. The compression device has a compression resistor connected to a compression surface. The compression surface is movably disposed with respect to the bridge. Movement of the compression surface towards the bridge is resisted with a force imparted by the compression resistor. The legs are deformed to maintain at least some of the compressive force between the material and the compression device. Forces greater than the pre-set force are absorbed with the compression resistor. The pre-set compressive force to the material is maintained within the pre-defined compression range throughout a state change of the material.

Abstract: A substantially U-shaped staple has a bridge, legs, and an internally disposed compression device with a bias portion having a compression surface movably disposed between the legs and a compression resistor connected to the bridge and to the compression surface and is formed to resist movement of the compression surface towards the bridge with a force.

Abstract: An instrument for fastening tissue within a body includes an elongated tube having a proximal end for extending outside of the body and a distal end for positioning proximate the tissue; and a distal member configured to fold the tissue together. The distal member includes a first member having a proximal end coupled to the distal end of the tube; and a second member pivotably coupled to the distal end of the first member. The first and second members are configured to install at least one fastener. A grasper is coupled to at least one of the first member and the second member. The second member is pivotable between an open position for receiving tissue and a closed position for folding tissue therebetween. The grasper is configured to project outward from at least one of the first member and the second member when in the open position.