Abstract: A multi-frequency ultrasound therapy apparatus is configured to operate at its center frequency and at the higher harmonic of its center frequency. The center frequency can be for the entire apparatus or for each ultrasound source element. At least one source element can generate ultrasound energy at its center frequency while, simultaneously, at least another source element can generate ultrasound energy at the higher harmonic of its center frequency. In addition, the same source element can generate ultrasound energy at its center frequency and the higher harmonic of its center frequency, respectively, but at different times. A data storage unit that stores encrypted and encoded data is disposed on the apparatus. The encoded data includes a unique identification code of the apparatus, the condition of use of the apparatus, the center frequency of each source element, the ultrasound efficiency of each source element, and/or other parameters relating to the apparatus.

Abstract: An improved multifunction cable for use in an operating room avoids the usual tangle of wires and tubes can be a significant hazard. The cable comes pre-sterilized with a number of wires and tubes pre-installed in a protective housing making it easy to conduct myriad wires and tubes from one region of the operating room to another without any possibility of tangling or violation of sterility. At the sterile end of the cable a special terminus acts as a holder to keep the various operating instrument organized. The terminus is designed to accept a special smoke evacuating monopolar electrosurgery instrument.

Abstract: Method and devices for delivering pulsed RF ablation energy to enable the creation of lesions in tissue are disclosed. The delivery of RF energy is controlled such that the generator power setting remains sufficiently high to form adequate lesions while mitigating against overheating of tissue. An ablation catheter tip having high-thermal-sensitivity comprises a thermally-insulative ablation tip insert supporting at least one temperature sensor and encapsulated, or essentially encapsulated, by a conductive shell. A system for delivering pulsed RF energy to a catheter during catheter ablation comprises an RF generator and a pulse control box operatively connected to the generator and configured to control delivery of pulsatile RF energy to an ablation catheter comprising at least one temperature sensor mounted in its tip. Also disclose is a method of controlling the temperature of an ablation catheter tip while creating a desired lesion using pulsatile delivery of RF energy.

Abstract: An implant or endoprosthesis suitable to be implanted in human or animal tissue includes two (or more than two) parts to be joined in situ. Each one of the parts includes a joining location, the two joining locations facing each other when the device parts are positioned for being joined together, wherein one of the joining locations includes a material which is liquefiable by mechanical vibration and the other one of the joining locations includes a material which is not liquefiable by mechanical vibration and a structure (e.g. undercut cavities or protrusions) suitable for forming a positive fit connection with the liquefiable material. The joining process is effected by pressing the two device parts against each other and by applying ultrasonic vibration to one of the device parts when the two parts are positioned relative to each other such that the two joining locations are in contact with each other.

Abstract: A surgical system includes a surgical instrument having a body, a shaft extending distally from the body, an ultrasonic transducer supported by the body, and an end effector at a distal end of the shaft. The end effector includes an ultrasonic blade configured to be driven by the ultrasonic transducer with ultrasonic energy, and an RF electrode operable to seal tissue with RF energy. A generator is operatively coupled with the surgical instrument and is operable to generate a combined drive signal having an ultrasonic energy component and an RF energy component. Filter circuitry arranged externally of the body of the surgical instrument is operable to convert the combined drive signal to an ultrasonic drive signal configured to energize the ultrasonic transducer to drive the ultrasonic blade with ultrasonic energy, and an RF drive signal configured to energize the RF electrode with RF energy sufficient to seal tissue.

Abstract: Disclosed herein are systems, devices, and methods for treating heart failure. In some variations, a catheter for forming an anastomosis in a heart may comprise a first catheter comprising an electrode. A second catheter may be slidably disposed within the first catheter. The second catheter may comprise a barb and a dilator comprising a mating surface configured to engage the electrode.

Abstract: An instrument and method for applying thermal energy to targeted tissue. An instrument and method for tissue thermotherapy. In one embodiment, a method includes providing a vapor source comprising a pump configured for providing a flow of liquid media from a liquid media source into a vaporization chamber having a heating mechanism, actuating the pump to provide the liquid into the vaporization chamber, applying energy from the heating mechanism to convert a substantially water liquid media into a minimum water vapor level for causing an intended effect in tissue. For examples such levels can comprise at least 60% water vapor, at least 70% water vapor, at least 80% water vapor or at least 90% water vapor for causing an intended effect in tissue.

Abstract: A medical device includes a catheter, which includes a first lumen for injection of a first volume of a treatment solution, the first lumen opening out at the distal end of the catheter; and a junction element extending the first lumen at the end of the catheter including a diameter at the distal end thereof less than the diameter of the catheter.

Abstract: Catheterization is carried out by bringing an electrode that is disposed on a distal portion of a catheter into contact with tissue, wherein the electrode has an area that falls within a range of 0.01-25 mm2. A power generator delivers pulses of radiofrequency power through the electrode to the tissue. While applying the pulses temperatures at the distal portion of the catheter are recorded. A rate of change of the temperatures is calculated and tissue thickness estimated based on the rate of change.

Abstract: Embodiments of the disclosure are drawn to a medical device delivery system. The system may include a shaft having a proximal end and a distal end. The device may also include a visualization system at a distal region of the shaft. The system may further include at least one latching structure configured to extend beyond the distal end of the shaft and retract within the distal region of the shaft and at least one advancement mechanism configured to extend beyond the distal end of the shaft to pull the shaft in a distal direction.

Abstract: Apparatus and methods for ocular treatment are provided. The apparatus can comprise a microcannula having a proximal end, a distal end, a cavity, and a central longitudinal axis. The apparatus can include a handle coupled to the proximal end of the microcannula. The apparatus can include multiple orifices extending circumferentially about the microcannula distal end, each of the orifices defining a channel extending transverse to the central longitudinal axis, and one or more grooves about a circumference of the microcannula.

Abstract: A medical device includes a hand piece, a heating power supply, and a therapy power supply. The hand piece includes a first electrode including a heater. The heating power supply selectively provides heating power to the heater. The therapy power supply selectively provides therapeutic power to the first electrode. The medical device is changeable between operating a first electrosurgical configuration and a second electrosurgical configuration. In the first electrosurgical configuration, the heating power supply provides the heating power to the heater to heat the first electrode and the therapy power supply provides the therapeutic power to the first electrode. A single conductor line carries the heating power to the heater and the therapeutic power to the first electrode.

Abstract: The invention can selectively heat a diseased area in the lung while minimizing heating to the healthy area and surrounding tissue. This is done by exposing the lung to an electromagnetic field causing dielectric or eddy current heating. The invention is particularly useful for treating emphysema as the diseased areas have reduced blood flow. The diseased area will heat up rapidly while the healthy tissue will be cooled by the blood flow. This is particularly effective for treating emphysema because of the low mass of the lungs and the high blood flow. To avoid heating of surrounding organs the direction of the electromagnetic energy is switched in a way it always passes through lungs but only intermittently passes through adjacent organs. If heat activated drugs are present in the lungs, they are selectively released in the heated tissue.

Abstract: A bipolar forceps includes a mechanical forceps including first and second shafts each having a jaw member extending from a distal end thereof and a handle disposed at a proximal end thereof for effecting movement of the jaw members relative to one another about a pivot. A disposable housing is configured to releasably couple to at least one of the shafts and an electrode assembly has electrodes releasably coupleable to the jaw members and adapted to connect to a source of electrosurgical energy to allow selective conduction of electrosurgical energy through tissue held therebetween to effect a tissue seal. An electrically conductive cutting element is disposed on at least one of the electrodes and is adapted to connect to the source of electrosurgical energy to allow selective conduction of electrosurgical energy through tissue held between the electrodes to effect a tissue cut.

Abstract: Various exemplary methods, systems, and devices for controlling electrosurgical tools are provided. In exemplary embodiments of methods, systems, and devices provided herein, a control system can be configured to monitor an electrical parameter during end effector closure, e.g., as jaws of an end effector of an electrosurgical tool move from an open position to a closed position. In response to the electrical parameter dropping to a predetermined minimum parameter threshold, the control system can be configured to cause the end effector to open.

Abstract: An occlusive medical device system may include a microcatheter, an elongate shaft, an occlusive medical device, wherein a release wire is configured to releasably attach the medical device to the distal end of the shaft at a release mechanism, and an RF generator. In a first electrical state current is not flowing and in a second electrical state current is flowing to the medical device. The shaft is slidable between a first position wherein the medical device is disposed within the microcatheter, a second position wherein at least a portion of the medical device is disposed outside of the microcatheter and the release mechanism is disposed within the microcatheter, and a third position wherein the release mechanism is disposed outside of the microcatheter. The medical device system is configured to be in the second electrical state when the elongate shaft is in the second position.

Abstract: A grasping treatment unit includes a first jaw, and a second jaw openable and closable relative to the first jaw. In the first jaw, a heating wire continues without branching from a first extending end to a second extending end, and generates heat over an entire length from the first extending end to the second extending end when an electric current flows therethrough. A heating portion is lower in calorific value per unit area in a distal portion than in a proximal portion in the first jaw in a state where the heat is generated from the heating wire.

Abstract: A medical system for repairing a mitral valve comprising a catheter (5) with a temporary valve (10), a commissure locator device (20), wherein the commissure locator device and the temporary valve are connected, and an annuloplasty implant (30).

Abstract: A portable surgical training device is provided. The trainer includes a top cover spaced apart from a base to form a simulated body cavity for locating model organs that are substantially obscured from the field of view of the user. The top cover includes a video display, fixed insertion ports and interchangeable inserts containing simulated tissue layers. The training device has open sides for demonstrating and training lateral surgical techniques including a simulated or live tissue colon attached to a support leg for simulating transanal minimally invasive surgery. A training endoscope with an adjustable focal length for use with the trainer and, in particular, with optical trocars is disclosed. The surgical trainer can be angled and is well suited for training laparoscopic surgery techniques and demonstrating surgical instruments.

Abstract: Apparatus and methods for ocular treatment are provided. The apparatus can comprise a microcannula having a proximal end, a distal end, a cavity, and a central longitudinal axis. The apparatus can include a handle coupled to the proximal end of the microcannula. The apparatus can include multiple orifices extending circumferentially about the microcannula distal end, each of the orifices defining a channel extending transverse to the central longitudinal axis, and one or more grooves about a circumference of the microcannula.

Abstract: A surgical instrument includes a body portion, a shaft, and an end effector that is operable to compress, staple, and cut tissue. The end effector includes and anvil and a staple cartridge. The anvil has a body and a modular releasable curved tip that connects with the body. The curved tip may be elastically deformable. The curved anvil tip and the tip of the cartridge include cooperating features that assist in gripping tissue during clamping. A separate cartridge may be provided that retains a replacement anvil tip and a replacement staple cartridge, where the replacement anvil tip and staple cartridge include the cooperating features. The separate cartridge may also include anvil tip and staple cartridge removal features to assist in removal of previously installed anvil tips and staple cartridges.

Abstract: Cryogenic tissue ablation instruments for treating body tissue include an elongate flexible body with a proximal supply port for coupling with a pressurized coolant (e.g., liquid N2O), a supply lumen in fluid communication with the proximal supply port, and an expandable cryogenic balloon carried on a distal portion of the elongate body, the balloon having a wall defining an interior of the balloon.

Abstract: A device for reducing pressure within a lumen includes a reservoir structured for holding a fluid therein, an injection port in fluid communication with the reservoir, a compliant body structured to expand and contract upon changes in pressure, and a conduit extending between and fluidly coupling the reservoir and the compliant body. The fluid may be a compressible or a noncompressible fluid.

Abstract: Apparatus and methods for ocular treatment are provided. The apparatus can comprise a microcannula having a proximal end, a distal end, a cavity, and a central longitudinal axis. The apparatus can include a handle coupled to the proximal end of the microcannula. The apparatus can include multiple offices extending circumferentially about the microcannula distal end, each of the orifices defining a channel extending transverse to the central longitudinal axis, and one or more grooves about a circumference of the microcannula.

Abstract: Two minimally invasive therapeutic procedures, particularly for patients with congestive heart failure, may be performed separately or together. One procedure involves providing a valved passageway through the patient's left ventricular wall at the apex of the patient's heart and advancing instruments through the valved passageway to connect the valve leaflets of the patient's heart valve, e.g. the mitral valve. The second procedure involves advancing a pacing lead and a pacing lead implanting device through a trocar in the patient's chest and implanting the pacing lead on an exposed epicardial region of the patient's heart wall. The pacing lead has a penetrating electrode which is secured within the heart wall. Improved devices for these procedures include a minimally invasive grasping device for heart leaflets, a leaflet connector with artificial cordae tendenae and a pacing lead implant instrument.

Abstract: A coating and devices using the coating are provided. The coating is applied in liquid form and dried or otherwise cured to form a durable adherent coating resistant to high temperatures and having optional hydrophobic properties. The coating formulation contains an aqueous formulation of silica, one or more fillers, and sufficient base, (e.g., potassium hydroxide), to have a pH exceeding about 10.5 during at least part of the formulation process. The formulation may contain a compound(s) that affects surface free energy, energy to make the cured coating hydrophobic. Such compounds include silanes containing halogens (e.g., fluorine or chlorine) and in particular silanes containing one or more hydrolyzable groups attached to at least one silicon atom and a group containing one or more halogens (e.g., chlorine or fluorine). A medical instrument (e.g., electrosurgical instrument) may be at least partially covered by a coating using the formulation.

Abstract: An energy output section outputs first electric energy so that a high-frequency current flows between electrodes through a treated target, and outputs second electric energy so that heat occurs in an end effector. A controller outputs the first electric energy at the same time as the second electric energy in at least a part of a period during which the heat is continuously denaturing the treated target from an output start of the second electric energy. The controller makes, based on judging that the treated target entered a predetermined state, an electric power of the first electric energy increased.

Abstract: A treatment apparatus for treating a body tissue, the treatment apparatus having a drive circuit, an electric resistance pattern, a heat transfer plate, a temperature acquisition circuit, and a controller. The controller controlling the drive circuit to supply power to the electric resistance pattern based on a target temperature of the heat transfer plate and a temperature of the electric resistance pattern acquired by the temperature acquisition circuit.

Abstract: A hysteroscopy system includes a scope having an internal channel, a sheath removably coupled to the scope, and an outflow channel. The sheath has a distal flange extending internally towards an outer surface of the scope. The outflow channel is formed between an inner surface of the sheath and an outer surface of the scope. The distal flange forms a distal end of the outflow channel and is generally located between the scope and the sheath.

Abstract: A microwave ablation system and method is disclosed comprising a balloon catheter apparatus and a control system. The balloon catheter apparatus comprises a catheter configured to house a coaxial cable and one or more coolant channels, an inflatable balloon located at the distal end of the catheter, and an antenna positioned in the inflatable balloon and in communication with the coaxial cable. The control system comprises a fluid pump configured to introduce fluid into a proximal end of the catheter, a power amplifier capable of generating microwave energy for delivery to the target tissue zone for at least one energy application cycle ranging from 60 seconds to 600 seconds at a frequency ranging from 2.4 GHz to 2.5 GHz, and a computer system configured to monitor and/or regulate the delivery of microwave energy to the target tissue, the fluid pump, at least one sensor, and antenna reflected power.

Abstract: An implant includes first thermoplastic material portions, and second thermoplastic material portions liquefiable by mechanical vibrations and being in contact with the first thermoplastic material portions, wherein the second thermoplastic material portions preferably constitute at least a part of a surface of the implant, and wherein the first thermoplastic material portions have a glass transition temperature above an implantation temperature (about 20° C. to 40° C.), and wherein the second thermoplastic material portions either have a glass transition temperature below the implantation temperature or are able to transform non-mechanical energy into heat.

Abstract: Catheter apparatuses, systems, and methods for cryogenically modulating neural structures of the renal plexus by intravascular access are disclosed herein. One aspect of the present application, for example, is directed to apparatuses, systems, and methods that incorporate a catheter treatment device comprising an elongated shaft. The elongated shaft is sized and configured to deliver a cryo-applicator to a renal artery via an intravascular path. Cryogenic renal neuromodulation may be achieved via application of cryogenic temperatures to modulate neural fibers that contribute to renal function, or of vascular structures that feed or perfuse the neural fibers.

Abstract: Surgical systems and methods are disclosed for creating a 3D model of a patient's affected area using an imaging device, using the model to determine an implant orientation and position, creating patient-matched instrumentation, placing the patient-matched instrumentation on the patient's anatomy, registering a computer-assisted surgical tool, and acquiring registration information. The methods and systems also include associating the surgical tool with a computer to perform a computer assisted surgery. Also disclosed are embodiments of patient-matched instrumentation to acquire registration information.

Abstract: A medical treatment apparatus includes a heat transfer portion, a heating chip, a temperature measurement unit and a control unit. The heat transfer portion comes into contact with a living tissue and transfers heat to the living tissue. The heating chip includes a heating region, is joined to the heat transfer portion, and heats the heat transfer portion by inputting energy to the heating region. The temperature measurement unit acquires a temperature of the heating region. The control unit controls a temperature of the heat transfer portion to a target temperature by controlling the temperature of the heating region to a temperature differing from the target temperature by an offset value which changes in accordance with an amount of the energy.

Abstract: A catheterization system that includes an electrophysiologic (EP) catheter which has a lumen receiving an electrically conductive fluid delivered by a hydraulic line that is acted upon by a peristaltic pump advantageously avoids noise in intracardiac ECG signal recordings by using an electrical connection to short triboelectrical charge carried by the conductive fluid in the hydraulic line to an existing analog ground in the system. In one embodiment, the electrical connection includes an electrically conductive wire housed in the control handle and configured to provide electrical connection between the fluid and a pin on a printed circuit board housed in the control handle that is electrically connected to the analog ground. In another embodiment, the electrical connection shorts the electrically conductive fluid proximal of the control handle of the catheter.

Abstract: Apparatus and methods for segmental treatment of hollow anatomical structures using an optical fiber are disclosed. An elongate energy application device can absorb, scatter and/or reflect laser energy over a length of the elongate energy application device to thereby treat the hollow anatomical structure along one or more lengthened treatment segments.

Abstract: Systems and methods for transcutaneously implanting medical devices, such as in vivo analyte sensors, are provided. The systems and methods involve the use of introducers or inserters made of shape memory alloy (SMA) materials which are transitionable from one operative state or configuration to another operative state or configuration, wherein the transition from state to state enables the transcutaneous implantation and/or transcutaneous explantation of the medical device.

Abstract: Apparatus comprises: (A) a housing (248), percutaneously deliverable to a heart of a subject, slidable along a guidewire (242), and shaped to define at least one opening (249); (B) a guide member (250), percutaneously deliverable to the heart, percutaneously removable from the subject, couplable to the housing, and having: (i) a distal portion, comprising a chord-engaging element (252), configured to be percutaneously slidably coupled to and decouplable from at least one chordae tendineae (244), and (ii) a proximal portion, comprising a longitudinal element (251); and (C) a deployment tool, configured (i) to be reversibly coupled to a tissue anchor (50,280), (ii) to be slidably coupled to the longitudinal element of the guide member, and (iii) to anchor the tissue anchor to a papillary muscle (254) of the subject. Other embodiments are also described.

Abstract: Cardiac ablation catheters and methods of use. Catheters that include an expandable membrane, an imaging member disposed within the expandable membrane, the imaging member having a field of view, a light source disposed within the expandable member adapted to deliver light towards the field of view of the imaging member, and an electrode comprising an outer conductive layer and inner light absorbing layer disposed between the electrode and the expandable membrane, the inner light absorbing layer adapted to absorb light from the light source and thereby reduce reflection of the light from the outer conductive electrode.

Abstract: A handling device for handling an augmentation implant is proposed, comprising an elongated housing having an axial through-bore for accommodating a sonotrode of an ultrasound applicator, and a lateral opening for inserting a pin magazine with an augmentation pin, wherein the axial through-bore and the lateral opening are connected to each other. The handling device further comprises a distal implant portion for fastening a proximal end of the augmentation implant at the housing, and a proximal tool portion for driving and/or augmenting the augmentation implant.

Abstract: The invention relates to devices, systems, and methods for heating tissue, including ablating a tumor, using the catalyzed heat of decomposition of hydrogen peroxide solutions. A hydrogen peroxide solution is contacted with a catalyst to decompose the hydrogen peroxide and heat the distal tip of a catheter to a temperature effective to ablate a target tissue.

Abstract: Various embodiments are directed to articulatable surgical instruments. Some embodiments comprise an end effector to treat tissue, where the end effector comprises an ultrasonic blade. A hollow shaft may extend proximally from the end effector along a longitudinal axis. A waveguide may extend through the shaft and may be acoustically coupled to the ultrasonic blade. The waveguide may comprise a distally positioned flange positioned within the hollow shaft proximally from the blade and may be held stationary at a first pivot point positioned within the hollow shaft proximally from the flange. A reciprocating wedge may be positioned within the hollow shaft such that distal motion of the wedge pushes the wedge between the flange and the hollow shaft, causing the ultrasonic blade to pivot about the first pivot point in a first direction.

Abstract: The stirring efficiency of a heating liquid which is supplied to the balloon of a balloon-equipped ablation catheter is increased to quickly uniformize the surface temperature of the balloon, and air is prevented from remaining in the balloon-equipped ablation catheter to enhance the safety of treatment which uses the balloon-equipped ablation catheter. A shaft for a balloon-equipped ablation catheter, consisting of a single pipe, wherein the shaft has two lumens which communicate from the distal end to the proximal end of the shaft, a first lumen being a guide wire passage lumen which is provided in order to allow a guide wire to pass therethrough, the second lumen being a liquid supply lumen which is provided in order to supply liquid to the inside of the balloon of the balloon-equipped ablation catheter.

Abstract: A method of making a stent delivery system is provided in which a delivery catheter has a balloon that extends non-uniformly into interstices of a stent. In accordance with the method a balloon/stent/crimping tube assembly is placed in a crimping tool, the balloon is inflated, and the crimping tool is actuated to compress the stent on the outside of the balloon without application of heat or chemicals, thereby causing creases of the balloon to extend non-uniformly into the interstices of the stent. Optionally, pillows may be formed in the balloon to prevent longitudinal movement of the stent with respect to the balloon during intravascular delivery. One or more secondary crimpings also may be performed to achieve a smoother delivery profile.

Abstract: An electromagnetic radiation treatment regime includes identifying a target area of a patient. An electromagnetic radiation source, for example, a low frequency and/or radio frequency electromagnetic radiation source, is selected, along with treatment session parameters, such as, pulse frequency, pulse duration, electrical current, magnetic flux density, and/or treatment session exposure time. An amount of electromagnetic radiation is applied to the target area, and a response to the electromagnetic radiation in the target area is measured. Based on an evaluation of the measured response, the treatment parameters may be modified for one or more subsequent electromagnetic radiation treatment session.

Abstract: Devices and methods are disclosed for the delivery of a compressible implant into a bodily lumen. The delivery device includes an enlarged section that is configured to house the implant during delivery thereof into a patient. In certain embodiments, the implant is kept within the delivery device in a substantially uncompressed configuration prior to the delivery thereof.

Abstract: Regions of tissue having reduced electrical propagation are created in a bladder to affect its electrical or mechanical properties. To create these tissue regions, a tubular device is advanced through the urethra leading to the interior of the bladder, a distal expandable structure of the device is expanded to contact the inner wall of the bladder, and electrodes or other active energy delivery elements of the device are activated to deliver ablation energy. The electrodes or other active energy delivery elements are disposed over the expandable structure which is shaped to conform to the interior of the bladder. The inner wall of the organ is ablated in a predetermined pattern. The same or other electrodes disposed over the expandable structure can used to electrically map the bladder. This map of electrical activity can be used to create the predetermined pattern.

Abstract: Systems, methods, and apparatus for providing a fluid and reduced-toxicity optical media with optical analysis and therapeutic energy delivery. An aspect of the invention provides an aqueous solution of increased-salinity of between about 1% and 35%. An increasing salinity in accordance with the invention provides improved transmissive efficiency at many wavelengths and less toxicity than many existing systems and methods. A catheter having integrated fibers for probing or treating internal lumens or other tissues can include a liquid-inflatable balloon or flushing mechanism using the solution for displacing blood or other obstructions in an optical path between the fiber and targeted tissue. Methods including spectroscopy can be employed with the solution for diagnosing medical conditions associated with diseased vessels or other tissues while reducing the risk of permanent damage resulting from the diagnosis.

Abstract: A communication apparatus notifies existence of content data in a recording medium of an image processing apparatus to an external apparatus according to a request from the external apparatus. When the content data in the recording medium includes the content data having a first format, the communication apparatus notifies existence of the content data having the second format corresponding to the content data having the first format.

Abstract: An apparatus includes a body, a shaft, an ultrasonic element, and an annular clamp pad. The shaft extends distally from the body. The ultrasonic element is located at the distal end of the shaft. The ultrasonic element includes a distally presented annular face. The clamp pad is movable toward the distally presented annular face of the ultrasonic element. When tissue is compressed between the clamp pad and the distally presented annular face of the ultrasonic element, the ultrasonic element may be activated with ultrasonic energy. The resulting ultrasonic vibrations may sever and seal the tissue captured between the distally presented annular face and the clamp pad, resulting in an anastomosis. The apparatus may thus be used to join two hollow tubular tissue structures, such as portions of a gastrointestinal tract.