US20080287967A1 - Device and Methods for Suturing Tissue - Google Patents

Device and Methods for Suturing Tissue Download PDF

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Publication number
US20080287967A1
US20080287967A1 US12/182,836 US18283608A US2008287967A1 US 20080287967 A1 US20080287967 A1 US 20080287967A1 US 18283608 A US18283608 A US 18283608A US 2008287967 A1 US2008287967 A1 US 2008287967A1
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United States
Prior art keywords
suture
tissue
needle
opening
graft
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Abandoned
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US12/182,836
Inventor
Bernard H. Andreas
Michael Barrett
Mark J. Foley
Brian Gore
Lewis Isbell
Ronald Songer
James W. Vetter
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Abbott Laboratories
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Abbott Laboratories
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Filing date
Publication date
Priority claimed from US08/824,031 external-priority patent/US6036699A/en
Priority claimed from US08/883,246 external-priority patent/US6355050B1/en
Priority claimed from US10/033,689 external-priority patent/US20020095164A1/en
Application filed by Abbott Laboratories filed Critical Abbott Laboratories
Priority to US12/182,836 priority Critical patent/US20080287967A1/en
Publication of US20080287967A1 publication Critical patent/US20080287967A1/en
Abandoned legal-status Critical Current

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062Needle manipulators
    • A61B17/0625Needle manipulators the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • AHUMAN NECESSITIES
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    • A61B17/0482Needle or suture guides
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/06066Needles, e.g. needle tip configurations
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    • A61B2017/00637Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for sealing trocar wounds through abdominal wall
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    • A61B2017/00641Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closing fistulae, e.g. anorectal fistulae
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    • A61B2017/00646Type of implements
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    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0458Longitudinal through hole, e.g. suture blocked by a distal suture knot
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    • A61B2017/0464Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
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    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/047Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
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    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0472Multiple-needled, e.g. double-needled, instruments
    • AHUMAN NECESSITIES
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/0474Knot pushers
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B2017/06057Double-armed sutures, i.e. sutures having a needle attached to each end
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2002/30001Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30003Material related properties of the prosthesis or of a coating on the prosthesis
    • A61F2002/3006Properties of materials and coating materials
    • A61F2002/30092Properties of materials and coating materials using shape memory or superelastic materials, e.g. nitinol
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A61F2210/0019Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol operated at only one temperature whilst inside or touching the human body, e.g. constrained in a non-operative shape during surgery, another temperature only occurring before the operation
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S604/00Surgery
    • Y10S604/90Telltale showing entry of blood into body inserted conduit

Definitions

  • the present invention relates generally to devices and methods for the suturing of tissue in various applications such as closure of arterial and venous puncture sites, suturing a graft anastomosis to an aperture in a vessel wall or other types of tissue, and the like. More particularly, the inventive devices and methods provide for suturing the tissue of a vessel even though the vessel may be under physiological flow and while preferably maintaining hemostasis.
  • a number of diagnostic and interventional vascular procedures are now performed transluminally, where a catheter is introduced to the vascular system at a convenient access location and guided through the vascular system to a target location using established techniques.
  • Such procedures require vascular access which is usually established using the well known Seldinger technique, as described, for example, in William Grossman's “Cardiac Catheterization and Angiography,” 3rd Ed., Lea and Febiger, Philadelphia, 1986, incorporated herein by reference.
  • bioabsorbable fasteners to stop bleeding has been proposed by several groups.
  • these approaches rely on the placement of a thrombogenic and bioabsorbable material, such as collagen, at the superficial arterial wall over the puncture site. While potentially effective, this approach suffers from a number of problems. It can be difficult to properly locate the interface of the overlying tissue and the adventitial surface of the blood vessel, and locating the fastener too far from that surface can result in failure to provide hemostasis and subsequent hematoma and/or pseudo aneurism formation.
  • intravascular clots and/or collagen pieces with thrombus attached can form and embolize downstream causing vascular occlusion.
  • thrombus formation on the surface of a fastener protruding into the lumen can cause a stenosis which can obstruct normal blood flow.
  • Other possible complications include infection as well as adverse reactions to the collagen implant.
  • Catheters are also used to treat heart disease which is a major medical ailment wherein arteries become narrowed or blocked with a build-up of atherosclerotic plaque or clot which reduces flow to tissues downstream or “distal” to the blockage. When this flow reduction becomes significant, a patient's quality of life may be significantly reduced. In fact, heart disease patients often die when critical arteries, such as the coronary arteries, become significantly blocked.
  • balloon angioplasty has become a well accepted treatment wherein a balloon is inflated within the narrowed vessel to stretch or otherwise deform the blockage into a larger lumen.
  • the blockage can even be removed, such as in a procedure known as atherectomy.
  • these treatments use percutaneous catheters which are inserted into the patients' vessels at a peripheral artery or vein puncture site and guided to the internal blockage site via x-ray visualization.
  • the blockage is then treated remotely by use of hydraulic pressure in the case of balloon angioplasty, or by other actuating means to cause remote cutting or ablation of the blockage in the case of atherectomy.
  • CABG Coronary Artery Bypass Graft Surgery
  • CABG coronary artery bypass graft surgery
  • CABG surgery is generally initiated by directly exposing the heart to the surgeon. This is accomplished by opening the patient's chest using known sternotomy and retraction techniques that cut the sternum and spread the rib cage open. Then, one or both lungs are usually deflated and the patient is connected to a respiratory assist machine.
  • the patient is connected to a coronary bypass machine so that the blood supply circumvents the heart.
  • the heart is depressurized so that apertures can be cut into the walls of the vessels for surgical graft attachment.
  • the right atrium (or vena cava) and the aorta each is intubated with cannulas which are connected to an artificial pump and oxygenator. Once these major vessels are cannulated, cardioplegia is delivered to slow or stop the beating motion of the heart.
  • the aorta is then clamped proximally of the aortic bypass cannula, thereby isolating the proximal aortic root from the blood that is being circulated by the bypass machine.
  • bypass grafting is performed.
  • the required grafts are implanted to feed the coronary arteries distal to the blockage, the clamp is removed from the aorta, the lungs are restored, and the patient is then taken off of the bypass pump.
  • the bypass grafting is achieved between the aorta and one of the three major coronary arteries or their sub-branches, the left anterior descending artery (LAD), the circumflex artery (CIRC), or the right coronary artery (RCA).
  • LAD left anterior descending artery
  • CIRC circumflex artery
  • RCA right coronary artery
  • a saphenous vein is usually taken from the patient's leg and is transplanted as a “homograft” to connect these vessels in the same patient's chest.
  • Artificial grafts have also been disclosed as providing potential utility for this purpose and are herein collectively included in the general discussion of “saphenous veins” as used in CABG procedures.
  • An alternative CABG method uses the internal mammary artery (IMA) alone or in conjunction with the saphenous vein graft.
  • IMA internal mammary artery
  • the IMA is severed at a chosen location and is then connected to an aperture, in a coronary artery.
  • the proximal end of the graft is generally sutured or otherwise is affixed circumferentially to the tissue surrounding an aperture that is punched into the wall of the aorta.
  • the lumen of the graft communicates with the vessel through the aperture, wherein ideally the aperture approximates the inner diameter of the graft lumen.
  • the opposite, distal end of the graft is sutured to an aperture formed in the wall of the coronary vessel distal to the blockage.
  • proximal anastomoses and distal anastomoses are terms used when referring to grafting to the aorta and the coronary artery, respectively.
  • distal anastomosis is performed first, followed by the proximal anastomosis.
  • proximal anastomosis to the aorta is not required as it is in a saphenous vein graft procedure because the IMA's natural arterial blood flow feeds the heart.
  • an average CABG procedure involves approximately five anastomoses: two saphenous vein grafts, each with a proximal and a distal anastomosis, and one internal mammary artery having only one distal anastomosis. Therefore, the average time for graft suturing ranges from 35 minutes to 50 minutes—in any case a significant portion of the 60 minute critical threshold to patient morbidity. Closely related to the time spent on bypass is a second CABG success factor related to the extent and time of aortic cross-clamping. It is believed that the inherent crushing force from a cross-clamp across the bridge of the muscular aortic arch may be associated with a high degree of tissue trauma and structural damage. Additionally, hemostasis formed at or adjacent to the cross clamp, perhaps in conjunction with the tissue trauma of clamping, may also be a source of unwanted thrombogenesis.
  • the quality of interface between the graft and vessel is also believed to be an indicator of procedural success.
  • the accuracy, trauma, and repeatability of suturing, as well as the three-dimensional interface formed between the conduits at the anastomosis site, are significant variables in conventional manual surgical techniques. These variables are believed to significantly affect the short or long-term success of conventional CABG anastomosis procedures.
  • an aperture in an aortic wall during a saphenous vein graft procedure can only be made when that portion of the aorta is cross-clamped, bypassed, and depressurized. Otherwise, the high blood pressure and flow in the aorta would cause significant bleeding during the period from punching the aperture to forming the anastomosis. Because of this limitation in conventional surgical punches, the threshold 60 minute coronary bypass clock begins running before punching the aorta.
  • the prior art fails to disclose or fulfill the need which exists in the field of medical devices and methods for: suturing tissue by proximally drawing sutures through a tissue layer in the proximity of an aperture; suturing tissue by reversibly advancing needles from one side of a tissue layer to retrieve one or more sutures on the opposite side of the tissue layer; a medical device assembly and method that automatically and repeatably places suture thread through vessel wall tissue surrounding an aperture in the vessel wall in a suture pattern that is useful for anastomosing a tubular graft to the aperture; and a medical device assembly that deploys a suture with one end extending through the tissue that surrounds a aperture in a vessel wall and the opposite suture end extending radially through a tubular graft wall adjacent an open end of the graft, such that a vessel anastomosis may be rapidly and repeatably performed in a CABG procedure even while the vessel is under physiological flow.
  • the present invention provides a device for suturing a tissue layer having two sides which includes a suture and means for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer.
  • the device also includes means for retrieving the portion of the suture through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side.
  • a device for suturing at least one tissue layer wherein each tissue layer has two sides.
  • the device includes a fastener having at least a first and second portion.
  • the first and second portions have means for securing the first and second portions together.
  • the first and second portions have a base at one end to prevent the respective portion from passing completely through the tissue layer.
  • the device includes means for releasably retaining the first portion in a stationary position on one side of the tissue layer and means for driving the second portion through the tissue layer from the opposite side and securely engaging the securing means of the first and second portions whereby the base of the first portion abuts one side of the tissue layer and the base of the second portion abuts the opposite side of the tissue layer.
  • the present invention provides a device for suturing tissue in the proximity of an aperture in a tissue layer which include a shaft having a proximal and distal end and a foot attached to the distal end of the shaft. The foot is adapted for advancing through the aperture. At least one needle is carried above the distal end of the shaft. At least a portion of a suture is releasably retained on the foot in the proximity of the aperture.
  • the device also includes means for reversibly advancing the needle through the tissue to retrieve and draw at least a portion of the suture through the tissue.
  • the advancing means is integrally formed with the shaft.
  • a device for suturing the wall of a tubular graft having two sides is also provided by the present invention.
  • the device includes a suture, means for releasably retaining at least a portion of the suture on one side of the wall, and means for retrieving the portion of the length of suture through the wall of the graft to the opposite side of the wall.
  • a graft anastomosis assembly is also provided for suturing a tubular graft about an aperture in a tissue wall.
  • the assembly includes a suture, a tissue suturing and graft suturing devices.
  • the tissue suturing device includes means for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer and means for retrieving the portion of the suture through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side.
  • the graft suturing device includes means for releasably retaining at least a portion of the suture on one side of the graft and means for retrieving the portion of the length of suture through the wall of the graft to the opposite side of the graft.
  • a graft assembly for anastomosing a tubular graft and vessel is also disclosed herein.
  • the graft having a graft wall that defines a graft lumen with an open end.
  • the graft wall has a plurality of ports spaced in a predetermined pattern near the open end.
  • the assembly includes a plurality of sutures in the predetermined pattern. Each suture has a first suture portion extending through one of the plurality of ports in the graft wall.
  • Each suture has a second suture portion extending along at least a portion of the graft lumen.
  • a method for suturing a tissue layer having two sides is also provided by the present invention.
  • the steps of the method include: releasably retaining at least a portion of a suture in a stationary position on one side of the tissue layer; and retrieving at least a portion of the suture through the tissue layer to the opposite side.
  • Another method of the present invention sutures tissue in the proximity of an aperture in a tissue wall.
  • the steps of the method include: forming a port from the proximal side of the tissue wall; passing at least a portion of a suture from the distal side of the tissue wall proximally through the port in the tissue wall in the proximity of the aperture; and forming a loop with the remaining portion of the suture to secure the suture.
  • a further method for suturing an aperture in a vessel wall is provided herein.
  • the steps of the method include: reversibly advancing a plurality of needles through the vessel wall to form ports in the proximity of the aperture; passing at least a portion of a suture proximally through the ports in the vessel wall disposed on opposite sides of the aperture from the interior of the vessel with the remaining portion of the suture passing out of the vessel; and securing the ends of the suture to close the aperture.
  • Another method of the present invention sutures the wall of a tubular graft to define a graft lumen and an open graft end.
  • the steps of the method include: releasably retaining at least a portion of a suture within the graft lumen and adjacent the graft open end; puncturing the tubular graft wall with the plurality of needles to form a plurality of ports in a circumferential pattern; and drawing the portion of suture outwardly from the graft lumen and through each of the plurality of ports and external of the graft wall.
  • FIG. 1 is a perspective view of an embodiment of a suturing device constructed in accordance with the principles of the present invention
  • FIG. 2A is a detail view of the distal end of the guide body of the suturing device of FIG. 1 , shown with the needles retracted fully within the guide body;
  • FIG. 2B is a view similar to FIG. 2A , except that the needles have been partially drawn back into the guide body;
  • FIG. 3 is a cross-sectional view of the device of FIGS. 2A and 2B , taken along line 3 - 3 of FIG. 2B ;
  • FIGS. 4-7 illustrate the method of the present invention using the suturing device 30 of FIG. 1 ;
  • FIG. 8 illustrates the X-pattern of the tied suture applied by the suturing device
  • FIG. 9 is a perspective view of a tissue suturing device of the present invention inserted through a tissue layer
  • FIG. 10 is an isolated perspective view of the needle carrier and foot of the tissue suturing device in FIG. 9 ;
  • FIG. 11 is a top view of the foot of the tissue suturing device in FIG. 9 ;
  • FIG. 12 is a side view of the foot and shaft of the tissue suturing device in FIG. 9 inserted through a tissue layer;
  • FIG. 13 is an isolated perspective view of an alternate embodiment of the shaft and foot of the tissue suturing device
  • FIG. 14A is a cross-sectional view of the foot along the lines 14 A-D in FIG. 13 illustrating an example of one cross-sectional shape for the foot;
  • FIG. 14B is a cross-sectional view of the foot along the lines 14 A-D in FIG. 13 illustrating another example of one cross-sectional shape for the foot;
  • FIG. 14C is a cross-sectional view of the foot along the lines 14 A-D in FIG. 13 illustrating another example of one cross-sectional shape for the foot;
  • FIG. 14D is a cross-sectional view of the foot along the lines 14 A-D in FIG. 13 illustrating another example of one cross-sectional shape for the foot;
  • FIG. 15 is a side view isolating the engagement of a needle and suture of the tissue suturing device illustrated in FIG. 9 ;
  • FIG. 16 is a cross-sectional view of the needle and suture in FIG. 15 along the lines 16 - 16 with the needle and suture in an engaged position;
  • FIG. 17 is a top view of the needle and suture in FIG. 15 along the lines 17 - 17 with the needle and suture in an engaged position;
  • FIG. 18A is a side view of the suture end illustrating an example of a ball shape for the suture end
  • FIG. 18B is a side view of the suture end illustrating an example of a solid cuff shape for the suture end;
  • FIG. 18C is a side view of the suture end illustrating an example of a ring shape for the suture end
  • FIG. 18D is a side view of the suture end illustrating an example of a serrated cuff shape having slits for the suture end;
  • FIG. 18E is a side view of the suture end illustrating an example of a hook shape for the suture end
  • FIG. 19A is a side view of a serrated needle tip illustrating an example of a retrieving device of the present invention.
  • FIG. 19B is a side view of a needle tip and tubing assembly illustrating an example of another retrieving device of the present invention.
  • FIG. 19C is a side view of a needle tip with an indentation illustrating an example of another retrieving device of the present invention.
  • FIG. 19D is a side view of a hook-shaped needle tip illustrating an example of another retrieving device of the present invention.
  • FIG. 19E is a side view of a needle tip and tubing assembly illustrating an example of another retrieving device of the present invention.
  • FIG. 20 is a cross-sectional view of two tissue layers being joined by the present invention using a multi-piece fastener in a tissue suturing device;
  • FIG. 21 is a cross-sectional view of a tissue layer and suture being joined by the present invention using a multi-piece fastener in a tissue suturing device;
  • FIG. 22 is a cross-sectional view of a suture cuff attached to two lengths of a suture for use with the present invention
  • FIG. 23 is a top view of an isolated section of tissue layer having a suture pattern therein formed by a continuous suture used with the present invention
  • FIG. 24 is a top view of an isolated section of tissue layer having a purse-string suture pattern therein formed by a single suture used with the present invention
  • FIG. 25 is a perspective view of another embodiment of a tissue suturing device of the present invention.
  • FIG. 26 is an isolated top view of the foot of the tissue suturing device of FIG. 25 ;
  • FIG. 27 is a cross-sectional view of an alternate button embodiment for retrieving a suture loop in the foot of the present invention.
  • FIG. 28 is a top view of a tear shaped button embodiment for retrieving a suture loop in the foot of the present invention.
  • FIG. 29 is a cross-sectional view of the button embodiment in FIG. 27 for retrieving a suture loop in the foot of the present invention.
  • FIG. 30 is a diagrammatic side view of another embodiment of a tissue suturing device of the present invention utilizing a needle carrier and needle retrieval arrangement positioned at an obtuse angle to the longitudinal axis of the device;
  • FIG. 31 is a perspective view of an anastomoses assembly of the present invention.
  • FIG. 32 is an isolated perspective view of the graft suturing device from the assembly in FIG. 31 ;
  • FIG. 33 is another embodiment of a graft suturing device of the present invention which retrieves sutures inwardly through a graft wall;
  • FIG. 34 is another embodiment of a graft suturing device of the present invention which positions the graft through the needle carrier;
  • FIG. 35 is a perspective view of another embodiment of the graft suturing device of the present invention which retrieves the sutures in an axial direction;
  • FIG. 36 is a cross sectional view of a needle driving device for retrieving the sutures illustrated in FIG. 35 ;
  • FIG. 37 is a side view of an alternate arrangement for driving the needles as illustrated in FIG. 36 ;
  • FIG. 38 is a cross-sectional view of a vessel illustrating the insertion of a foot of the inventive tissue suturing device from a remote access site;
  • FIG. 39 is a cross-sectional view of a vessel illustrating the insertion of a foot of the inventive tissue suturing device from a remote access site.
  • FIG. 40 is a cross-sectional view of a vessel illustrating the insertion of another embodiment of a foot of the inventive tissue suturing device from a remote access site.
  • distal is generally defined as in the direction of the patient, or away from a user of a device, or in a downstream direction relative to a forward flow of blood.
  • distal herein refers to the interior or the lumen side of the vessel wall.
  • proximal generally means away from the patient, or toward the user, or in an upstream direction relative to a forward flow of blood.
  • proximal herein refers to the exterior or outer side of the vessel wall.
  • oval is herein intended to mean oval, elliptical, or otherwise having a generally rounded shape that is not perfectly circular.
  • the term describes the shape of a tubular graft end cut at an acute angle relative to the plane perpendicular to the tissue walls defining the graft.
  • hemostasis is herein used to mean the arrest of bleeding or substantially blocking flow of blood outwardly from a vessel lumen while the vessel lumen is pressurized or sustaining physiological blood flow. This amount of blockage or occlusion to flow is further defined such that the blood loss which is experienced is less than an amount which would affect procedural methods or outcomes according to a physician user of a device of ordinary skill in the art.
  • “hemostasis” is not intended to mean only “total hemostasis” such that there is a total lack of blood loss. Rather, the term is used to also mean “procedural hemostasis” as a relative term in its use among physicians of ordinary skill.
  • occlusion occlusion
  • occlude a procedurally relevant definition in the context of their use. For instance, an aperture is “occluded” although there is some measurable flow therethrough, but that flow is so low such that the intended procedural benefit of occlusion is at least partially achieved.
  • total effect definition, as well.
  • perfusion is herein used to mean the flow of blood or other unit of perfusate (the fluid used for perfusion) per unit volume of tissue.
  • Physiological perfusion refers to the amount of blood flow present when the body is functioning normally. For example, physiological perfusion usually prevents clinically significant ST elevations which is one of the most sensitive indicators of inadequate perfusion.
  • Adequate perfusion refers to the amount of blood flow that avoids the clinical requirement of transfusing the patient or that is needed to prevent tissue necrosis distal to the aperture in the blood vessel.
  • the term “suturing” is herein intended to include the process of joining two surfaces or edges together with a fasten r so as to close an aperture, opening, or wound or join tissues.
  • the fastener is usually a suture such as a thread of material (either polymeric or natural), gut, wire or the like.
  • the term fastener as used herein also includes clamps, studs, hasps, catches, hooks, rivets, staples, snaps, stitches, VELCROC, buttons, and other coupling members.
  • a suture applying device 400 which is suitable for suturing and sealing of percutaneous vascular puncture site, particularly those made to the femoral artery in a patient's groin, will be described. It will be appreciated, however, that the device of the present invention can be readily adapted for use with punctures made to other hollow body organs and lumens, although it may be necessary to modify the dimensions and other particular aspects of the device to accommodate the different usage environment.
  • the device 400 comprises a guide body 402 and a needle shaft 404 .
  • the guide body 402 includes a guide tip 406 at its distal end, which guide tip includes a plurality of guide channels 408 which receive the proximal ends of needles 410 .
  • An aligning arrow 403 is mounted on handle 405 located at the proximal end of the guide body 402 .
  • a marker lumen bubble 407 is located below the aligning arrow and serves to indicate when the distal end of the guide body has entered a blood vessel, as described in the embodiment below.
  • An indicator lumen 411 which permits the flow of blood to the marker lumen bubble 407 is illustrated in FIGS. 2A and 2B .
  • the needles 410 as illustrated comprise a sharpened tip section 412 and an elongate shank portion 414 , but may also be manufactured as an integral piece.
  • the shank portion 414 will be sufficiently long so that the needles may be pushed from their butt end by a support holster 428 fixedly attached to the needle shaft 404 in order to advance the needles through the tissue to be sutured and fully through the guide body 402 inserted together with support sheath 440 in the associated tract so that no capture mechanism will be required.
  • the guide body 402 further includes a plurality of needle lumens 420 which are axially aligned and spaced about the periphery of the guide body. As best seen in FIG. 2B , the needles 410 will enter the distal ends of the lumens 420 as the needles are advanced proximally relative to the guide body.
  • a flexible needle sheath 426 will be attached to the guide tip 406 of guide body 402 .
  • the central lumen of the needle sheath 426 receives a support holster 428 attached to the distal end of the needle shaft 404 , as well as the needles 410 .
  • the butts of the needles 410 are removably received within the support holster 428 .
  • the sheath 426 will be sufficiently long to permit the needles to extend at least 5 cm beyond the distal end of guide body 402 .
  • the suture applying device 400 will be in the configuration illustrated in FIGS. 1 and 2A . That is, the needle shaft 404 will be distally positioned within the guide body 402 and needle sheath 426 .
  • the tips of needles 412 will lie just at the guide tip 406 so that they may be easily advanced through the arterial tissue surrounding the arteriotomy. That is, the tips of the needles will be generally retracted within the guide tip 406 .
  • a length of suture 422 is attached to the proximal tips 412 of opposed pairs of needles 410 , with the connecting suture being stored in side lumens 427 extending axially along the exterior of the needle sheath 426 . As best observed in FIGS.
  • the suture 422 extending between one pair of opposed needles is received in a first of the side lumens 427
  • the suture extending between the other pair of opposed needles is received in the second of the side lumens. While it would be possible to store the suture 422 in the lumens 420 of the guide body 402 (and thus eliminate the need for side lumens 427 ), such storage is less preferred since it increases the risk that the suture will become entangled with the needles 410 as they are withdrawn proximally.
  • the use of side lumens 427 greatly simplifies feeding of the suture as the needles 410 are withdrawn.
  • the needles may then be drawn proximally forward through the tissue to be sutured by drawing proximally on handle 430 at the proximal end of needle shaft 404 .
  • the method of the present invention will now be described in more detail with reference to FIGS. 4-7 .
  • FIG. 4 The situation following an interventional or other vascular procedure, where the attending physician is satisfied that the puncture site may be sealed, is illustrated in FIG. 4 .
  • a conventional introducer sheath is in place with a guidewire passing into the femoral artery.
  • the conventional introducer sheath is withdrawn after assuring that an appropriate guidewire for the suturing process is in place.
  • the device 400 (including a support sheath 440 which initially covers the ports to the needle lumens 420 ) will then be introduced over the guidewire, as illustrated in FIG. 4 .
  • the needles 410 and sutures 422 mostly encased by flexible needle sheath 426 , will be fully advanced into the femoral artery FA past the arterial puncture site A.
  • Handle 441 on support sheath 440 is then partially withdrawn proximally to expose the needle lumens 420 (as shown in FIGS. 2A , 2 B, and 5 ).
  • Handle 430 will then be drawn proximally outward relative to the guide body 402 , causing the needles 410 to pass through the superficial wall of the femoral artery FA and into the needle lumens 420 , as illustrated in FIGS. 2B and 5 .
  • the handle 430 may continue to be drawn proximally (i.e., outward from the patient) in order to continue to pull the needle shaft 404 through the guide body 402 .
  • Such movement of the needle shaft 404 continues to draw the needles 410 outward through the lumens 420 of the guide body 402 until the tips of the needles are exposed.
  • the user may then grasp the needles and continue to draw them out until the suture is available to the user.
  • the guide body 402 may then be withdrawn from the support sheath 440 , leaving a portion of the needle sheath 426 still in the puncture site A to maintain hemostasis.
  • the suture can then be tied and the knot pushed back down through the support sheath 440 . The knot will then only be tightened when the needle sheath is finally withdrawn from the puncture site A.
  • the guide tip 406 deflects the needles radially outward so that the pattern of four needles engages the artery wall in an approximately square pattern about the arteriotomy A.
  • the resulting pattern of tied suture will appear as in FIG. 8 when viewed towards adventitial surface of the femoral artery FA surrounding the arteriotomy A.
  • Device 400 has certain advantages over the previous embodiments. Since it is not necessary to capture the needles using an internal capture mechanism, the needles need not have barbs. Such barbless needles will minimize trauma to the arterial tissue around the puncture site A and simplify the procedure.
  • the guide body 402 and guide tip 406 are designed as an integral structure to assure that needles 410 will be precisely centered around the puncture site A, and will very reliably enter the needle lumens 420 in guide body 402 . Also, tip 406 will occlude the arteriotomy puncture during the performance of the procedure, providing hemostasis. Moreover, the entire procedure is simplified, with fewer discrete steps being performed. The user need only introduce the device over-the-wire and thereafter draw out the needle shaft to carry the needles through the tissue to be sutured and outward through the guide body, where the suture becomes accessible and may be tied in a conventional manner.
  • the present invention also provides several devices which comprise a graft anastomosis assembly.
  • One of the preferred embodiments of the graft anastomosis assembly and component devices depicted in the drawings is inserted through an aperture or hole in a tissue wall, such as the wall of the distal artery, an aorta, or other vascular tissue.
  • the assembly mechanically places a predetermined pattern of sutures in the tissue wall.
  • the aperture can then be enlarged manually or, optionally, by the assembly itself, such that the suture pattern is in close proximity to the circumference of the aperture.
  • the assembly provides a graft to the tissue wall at the site of the aperture.
  • hemostasis is maintained during a substantial portion of the procedure.
  • the graft anastomosis assembly and devices can maintain perfusion beyond the area of the device introduction through the vascular tissue.
  • a preferred embodiment of one component for the graft anastomosis assembly is a tissue suturing device 10 shown in FIGS. 9-12 which reliably deploys a uniform suture pattern in a tissue wall 12 defining a blood vessel 14 .
  • the tissue suturing device 10 is useable separately for suturing any type of tissue, whether or not as part of an anastomoses procedure.
  • the tissue suturing device 10 can be used to deploy sutures in either, or both, the blood vessel and graft in an anastomosis procedure.
  • the tissue suturing device 10 can interlock with a graft suturing device, as will be discussed below, to provide alignment between the suture patterns in the tissue wall 12 and a graft wall.
  • the tissue suturing device 10 includes an elongated body 16 having a distal end 18 and proximal end 20 .
  • the tissue suturing device 10 includes a hand grip 22 partially nested within the elongated body 16 and externally accessible to an operator.
  • the device 10 also includes a needle carrier 24 , a foot 26 attached to a shaft 28 which extends proximally into the elongated body 16 , and an actuating mechanism referred to generally as 30 .
  • the actuating mechanism 30 attaches to the hand grip 22 as illustrated by the cut-away portion.
  • the actuating mechanism 30 includes a cam 32 which is rotatably secured to the elongated body 16 by a fastener 34 .
  • the cam 32 is integrally formed with the hand grip 22 and pivots in the directions indicated by arrows 36 using the fastener 34 as the pivot point.
  • the cam 32 includes a slot 38 located between the hand grip 22 and the fastener 34 and extending through the cam itself.
  • the cam 32 slidably connects to the proximal end 40 of the needle carrier 24 by engaging a peg 42 which is affixed to the needle carrier 24 and extends perpendicularly therefrom. Moving the hand grip 22 in the direction of the arrows 36 , pivots the cam 32 and slides the peg 42 along the slot 38 .
  • the needle carrier 24 travels along the shaft 28 within the elongated body 16 and reversibly moves the distal end 44 of the needle carrier toward the foot 26 .
  • the distal end 44 of the needle carrier includes an integrally formed cutting blade 46 mounted on a surface approximating the size of the circumference of the foot 26 .
  • One end 48 of the cutting blade is positioned near the shaft 28 so as to meet the circumference of an initial aperture 52 formed in the tissue wall (as shown in FIG. 9 ).
  • the cutting blade end 48 rides in a longitudinal groove 54 (as shown in FIG. 11 ) formed in the shaft 28 as the distal end 44 of the needle carrier and the foot 26 are squeezed together.
  • the opposite end 50 of the cutting blade is positioned to enlarge the initial aperture 52 in the direction extending away from the shaft 28 .
  • the cutting blade 46 preferably has a height profile which decreases from the one end 48 of the cutting blade near the shaft to the opposite end 50 to form a decreasing gradient or slant.
  • the decreasing gradient of the cutting blade 46 allows the end 48 of the cutting blade to first engage and cut the tissue wall 12 near the shaft 28 .
  • the cutting blade enlarges the incision toward the opposite end 50 as the distal end 44 of the needle carrier and foot 26 are squeezed progressively together.
  • the present invention also includes embodiments wherein the cutting blade 46 has a uniform height across its length or a gradient which is increasing from the cutting blade end 48 near the shaft to the opposite end 50 of the cutting blade.
  • the distal end 44 of the needle carrier includes a plurality of needles 56 attached thereto and extending in a generally perpendicular direction.
  • the needles 56 are arranged in a predetermined pattern which matches a desired corresponding suture pattern 58 (as seen in FIG. 12 ).
  • the needles 56 are positioned at approximately uniform intervals around the circumference of the initial aperture 52 which is enlarged to accommodate a graft (not shown).
  • the height of each of the needles 56 from the surface of the distal end 44 of the needle carrier to its tip is slightly higher than the height of the cutting blade 46 so that the needles 56 engage the tissue wall 12 just as, or slightly before, the cutting blade 46 engages the tissue wall 12 .
  • Having the needles 56 engage the tissue wall 12 before, or simultaneously with, the cutting blade 46 allows the tissue wall 12 to be captured and retained in position to form the desired suture pattern 58 even after the cutting blade 46 enlarges the initial aperture 52 .
  • the circumference of the enlarged aperture is retained in apposition as the cutting blade 46 completes the incision.
  • the foot 26 has a top surface 60 and an opposing bottom surface 62 as seen in FIG. 11 .
  • the top surface 60 faces the distal end 44 of the needle carrier and has a groove 64 which corresponds in position to the cutting blade 46 on the distal end 44 of the needle carrier.
  • the groove 64 is of sufficient size to accommodate a portion of the cutting blade 46 below the plane of the top surface 60 to facilitate the making of the incision.
  • the groove 64 has the same depth profile from one end 66 of the groove near the shaft 28 to the opposite end 68 as the height profile of the cutting blade 46 .
  • Located near the circumference 70 of the top surface 60 is a plurality of suture channels 72 extending through the depth of the foot 26 to the bottom surface 62 .
  • the pattern of the suture channels 72 on the top surface 60 corresponds to the pattern of needles 56 on the distal end 44 of the needle carrier (as seen in FIG. 10 ). As the distal end 44 of the needle carrier travels toward the top surface 60 of the foot, the needles 56 have sufficient height relative to the length of travel by the needle carrier 24 to slightly penetrate the suture channels 72 .
  • Each of the suture channels 72 in the foot are sized to releasably retain a suture 74 having a suture body or length 78 terminating at one end 76 .
  • the end 76 of the suture is releasably retained in one of the suture channels 72 .
  • a plurality of the sutures lengths 78 extend downward through a lumen 80 in the shaft 28 emerging through a distal shaft aperture 82 .
  • each suture length 78 emerges from the shaft, it is positioned within one of a plurality of suture grooves 84 within the bottom surface 62 of the foot.
  • Each suture groove 84 extends at least partially from the distal shaft aperture 82 to a respective suture channel 72 .
  • each suture groove 84 is sufficient to accommodate the width of the suture length 78 to provide a flush profile to the bottom surface 62 .
  • the end of each suture 76 extends to the respective channel 72 where it is releasably retained near the top surface 60 of the foot. Although it is preferred to position the suture end 76 approximately flush with the top surface 60 of the foot, it is suitable for the suture end 76 to be in any position where it can be retrieved or engaged by the corresponding needle 56 or other retrieving device or means when the actuating mechanism 30 squeezes the foot 26 and the distal end 44 of the needle carrier together.
  • the present invention also provides other embodiments.
  • a single needle or a subset of needles less than the number of suture channels can be used on the needle carrier.
  • the single needle or subset of needles engages a corresponding number of suture channels with a first stroke bringing the foot and needle carrier together.
  • the single needle or needle subset is rotated to a new position after each stroke bringing the foot and needle carrier together along the shaft 28 .
  • a multi-stroke successive deployment is used.
  • the suture lengths 78 extend toward the proximal end 20 of the elongated body.
  • the suture lengths 78 exit from the lumen 80 and pass through a longitudinal slot 86 (also illustrated in FIG. 10 ) which extends along the length of the shaft 28 and the distal end 44 of the needle carrier.
  • the suture lengths 78 extend from the longitudinal slot 86 to a guide 88 which organizes the sutures.
  • the guide 88 is located on the external surface of the elongated body near the distal end.
  • the suture lengths 78 extend through a second guide 90 to a suture holder 92 .
  • the second guide 90 is located near the proximal end 20 of the elongated body.
  • the suture holder 92 releasably retains the opposite ends 94 of the suture lengths so they may be individually identified as to their position in the suture pattern 58 and retrieved by the operator.
  • the longitudinal slot 86 allows the removal of the foot 26 from the aperture completed 52 in the tissue wall 12 and the subsequent removal of the suture lengths 78 so that each end, 76 and 94 , of the sutures can be fastened together.
  • the suture lengths 78 extend internally along the length of the elongated body 16 toward the proximal end 20 .
  • a seam 98 along the length of the elongated body 16 connects to the end of the longitudinal slot 86 so that the elongated body can be split open to remove the suture lengths 78 once the suture pattern 58 has been completed.
  • the longitudinal slot 86 itself can also be replaced with a seam to similarly split the shaft 28 , foot 26 , and needle carrier 24 to remove the suture lengths 78 from the lumen 80 .
  • the suture pattern 58 is a uniform distance from the perimeter of the completed aperture 52 in the tissue wall.
  • the initial aperture 52 is a simple longitudinal incision.
  • the present invention adjusts for the distance which the tissue wall 12 surrounding the shaft 28 is offset.
  • the foot 26 is partially defined by opposing side walls 100 and end walls which define a heel 102 and toe 104 for the foot.
  • the side walls 100 bulge slightly outward in the vicinity of the shaft 28 .
  • the distance between the circumference of the shaft and the side walls 100 is the same as the distance from the cutting blade groove 64 or longitudinal axis of the foot 26 to the side walls 100 along the remainder of the foot.
  • the suture channels in the vicinity of the bulge are located at the circumference of the side walls 100 which offsets suture channels 106 , 108 in the suture pattern 58 .
  • the offset suture channels 106 , 108 provide a uniform amount of tissue wall capture around the entire perimeter of the completed aperture 52 by adjusting the position of the suture pattern 58 for the offset of the tissue wall 12 on each side of the shaft 28 .
  • the tissue wall 12 is negligibly offset by the shaft 28 in the direction of the heel end wall 102 because the shaft is positioned toward or at the heel end wall 102 of the incision creating the initial aperture 52 .
  • the shaft have an oval shape to its cross-section as specifically illustrated in FIG. 11 .
  • the needles 56 on the surface of the distal end 44 of the needle carrier which correspond to the offset suture channels 106 , 108 on the foot are similarly offset.
  • the surface of the distal end 44 of the needle carrier in the vicinity of the shaft 28 is offset or bulges in a similar pattern as the opposing side walls 100 of the foot.
  • FIG. 12 illustrates a side view of the foot 26 upon insertion through the initial aperture 52 in the tissue wall 12 .
  • the toe end wall 104 is inserted first and moved forward.
  • the shaft has a cut-away portion 110 near its distal end to allow forward movement of the foot assisting the insertion of the heel end wall 102 through the tissue wall 12 .
  • the heel end wall 102 is then moved back slightly to abut one end of the initial aperture 52 .
  • the top surface 60 of the foot 26 abuts the distal side 112 of the tissue wall promoting uniform tissue capture when the needles engage the top surface 60 of the foot.
  • the dilated tissue around the aperture 52 usually responds elastically and compresses onto the shaft 28 , thereby maintaining hemostasis.
  • the top surface 60 of the foot lies adjacent the distal side 112 of the tissue wall, allowing adequate perfusion beneath the bottom surface 62 of the foot and the vessel wall intima 114 .
  • the perimeter of the shaft is preferably about equal to the perimeter of the incision.
  • using the tissue suturing device 10 to perform an anastomosis on the distal artery places the diameter of the shaft in a preferred range of about 1.5 mm to about 2 mm which is the generally accepted diameter of the distal artery.
  • the present invention includes an embodiment of the foot 26 which does not have an offset or bulge in the side walls 100 in the vicinity of the shaft 28 .
  • the same reference numerals are used for like components illustrated in the other figures.
  • FIG. 13 also illustrates the shaft 28 having a more round cross-section shape.
  • the foot 26 can be formed in many other shapes and sizes while employing the inventive concepts described herein to a particular surgical procedure, suture pattern, specific tissue, etc.
  • one preferred embodiment of the foot 26 has a rounded shape to the corners and edges of the top 60 and bottom 62 surfaces to provide for an atraumatic entry through the tissue wall and to guard against traumatizing the tissue wall intima opposite the aperture 52 upon advancing the foot 26 into the lumen of the blood vessel 14 as previously seen in FIG. 12 .
  • Another example illustrated in FIG. 14B emphasizes an even more rounded bottom surface 62 than FIG. 14A to guard against traumatizing the vessel wall intima 114 opposite the initial aperture 52 .
  • the foot 26 can also have several cross-sectional configurations as illustrated in FIGS. 14C and 14D for example, which provide a passageway 115 along the longitudinal axis of the foot for perfusion when the foot has been inserted through the tissue wall 12 into a vessel 14 (as seen in FIG. 12 ).
  • FIG. 14C provides the longitudinal passageway 115 along the length of the foot 26 from the heel end wall 102 to the toe end wall 104 .
  • FIG. 14D provides an example of a longitudinal passageway 115 to ensure perfusion being used in combination with a curved top surface 60 to the foot to minimize distortion of the proximal side of the tissue wall 12 .
  • a rounded bottom surface 62 prevents traumatizing the vessel wall intima 114 opposite the aperture 52 .
  • the suture channels 72 are positioned at an angle to the top surface 60 of the foot so that they are still perpendicular to the needles 56 on a corresponding needle carrier 24 (as seen in FIG. 10 ).
  • perfusion passageways include pathways which have a baffled or tortuous path.
  • a coiled path is another example of a non-straight perfusion passageway.
  • each of the sutures preferably terminates with a cuff 116 attached to the suture length 78 along a bottom exterior wall 118 .
  • the cuff 116 has a generally cup-shape interior space 120 defined by a side interior wall 122 and a bottom interior wall 124 .
  • the interior space 120 is sized to accommodate one of the needles 56 in a press-fit engagement.
  • the distal end 126 of each needle has an arrowhead shape with a tip 128 and one or more barbs 130 .
  • the arrowhead is mounted on a needle shaft 132 which has a tapered section 134 near the arrowhead.
  • the diameter of the arrowhead barb 130 is sized to be slightly larger than the interior diameter of the cuff interior space 120 .
  • the cuff side wall 122 deflects slightly as the arrowhead barb 130 is inserted into the interior space.
  • the deflected side wall 122 is biased against the barb 130 to provide a retaining force.
  • the tip 128 of the arrowhead continues until the interior side 124 of the bottom wall is engaged as a backstop to prevent further insertion of the arrowhead tip 128 . Penetration of the tip 128 into the interior bottom wall 124 is not required to provide an engaging force between the needle 56 and the suture 74 .
  • the preferred dimensions of the needle 56 are in a range of about a 0.01 inch to about a 0.02 inch needle shaft 132 diameter which decreases to a diameter of about 0.005 inch in a tapered section 134 .
  • the length of the tapered section 134 at the narrowest diameter is about 0.005 inch with an overall length of about 0.013 inch.
  • the diameter of the arrowhead barb 130 is in the range of about 0.007 to about 0.008 inch.
  • the height of the arrowhead barb 130 is in the range of about 0.010 inch to about 0.014 inch.
  • the height of the interior side of the side wall 122 is about 0.02 inch with the cuff 116 having an overall height of about 0.03 inch.
  • the diameter of the interior space 120 from the interior side of the side wall 122 is about 0.005 inch.
  • the thickness of the side wall 122 is about 0.0025 inch and the bottom wall 118 is about 0.01 inch.
  • the dimensions of each suture channel 72 in the foot 26 for this particular example have an interior diameter at the top surface 60 of the foot of about 0.011 inch.
  • the suture cuff 116 is preferably welded to the suture length 78 or molded as one-piece from polypropylene.
  • the cuff 116 can be made from other medical polymers or malleable metals with a preferred hardness to provide the retaining force by allowing the arrowhead barb 130 of a needle 56 to deflect and bias the side wall 122 of the cuff against itself and/or allow the barbs 130 of a needle to penetrate the side wall 122 of the cuff.
  • suture length 78 to the cuff 116 are also suitable for use in the present invention such as attaching the cuff to the suture length with a conventional adhesive like cyanoacrylate or by forming the cuff with an indentation in the exterior side 118 of the bottom wall and crimping the suture length therein.
  • the bottom wall 124 of the cuff can be made of the same, or different, polymer which exhibits a surface hardness sufficient to resist penetration of the tip 128 and provide a backstop preventing excessive penetration.
  • the cuff 116 may also be initially molded as a solid block and subsequently bore an interior space 120 into the solid block to complete the cuff.
  • the suture length 78 is a single strand or monofilament. Although a multi-stranded, covered, twisted, or braided suture length is also suitable for use with the present invention.
  • the cuff 116 is also preferably removable from the suture length 78 .
  • a suitable rupture strength of the cuff and suture length attachment is about 2 ounces to about 10 ounces so that the two may be separated with the application of a sharp tug.
  • FIGS. 18A-E are suture ends 76 which can be retrieved or fetched by a retrieving device.
  • the suture end 76 in FIG. 18A includes a suture length 78 having a ball-shaped end 136 which is made of a soft material.
  • the suture end 76 in FIG. 18B includes a suture length 78 attached to a solid cuff 138 made of a soft material.
  • the suture end 76 of FIG. 18C includes the suture length 78 attached in a perpendicular manner to one side of a ring 140 .
  • the ring 140 compresses in the suture channel (not shown) as the larger diameter arrowhead barb is inserted entirely through the hole 142 so that the ring is positioned above the barbs in the tapered section of the needle shaft. As the compressed material relaxes, the ring 140 is retained in the tapered section as the needle is withdrawn through the tissue wall.
  • One end 144 of the ring is preferably tapered to allow for easy passage through the tissue layer.
  • Another example of a retrieving device for use with the ring 140 is a hook as described further below.
  • the suture end 76 of FIG. 18D includes the suture length 78 attached to a cuff 146 defined by a serrated side-wall 148 providing slits 150 therein.
  • the barbs of the needle previously discussed easily deform the side wall 148 and at least partially fill into one or more of the slits 150 to provide a solid engagement therebetween.
  • the suture end 76 of FIG. 18E includes the suture length 78 which terminates in a hook-shaped end 152 made of a material sufficiently hard to resist flexing as it is pulled through the tissue layer.
  • Configurations of the suture end like the hook-shaped end 152 can be engaged by a retrieving device like, for example, a similarly shaped hook or by passing the hook-shaped end through the center of a retrieving device having a ring shape.
  • the retrieving device of the present invention generally includes means for forming a port in the tissue layer through which a suture, or other fastener, is retrieved or introduced.
  • the suture or fastener usually remains within the port.
  • FIG. 19A another configuration suitable for impaling the suture-end is illustrated in FIG. 19A as a serrated needle tip 154 effectively using a plurality of barbs like 156 , 158 at various positions and elevations along the shaft 132 of the needle to engage the suture end.
  • FIG. 19B retrieves the suture length 78 with a multiple piece assembly 160 having the needle shaft 132 with a tapered section 134 near the tip 128 .
  • a separate piece of tubing 162 in the tapered section 134 is initially retracted towards the upper portion 164 of the tapered section until the suture length 78 is biased into an indentation 166 in the bottom 168 of the tapered section.
  • the tubing 162 can further be configured to have an offset 170 at its bottom end to accommodate the thickness of the suture length 78 while simultaneously covering the portion of the suture resting in the indentation 166 .
  • the needle shaft 132 having the tapered section 134 can be used without the tubing 162 .
  • FIG. 19C shows the suture length 78 retained within an indentation 172 of the otherwise barbless needle shaft 132 with the aid of a suture loop 174 formed in the shape of a noose with a clasp 176 .
  • the noose can also be formed by tying a knot in the suture loop 174 .
  • FIG. 19D Another example of a retrieving device is illustrated in FIG. 19D with the needle shaft 132 having a hook-shaped end 178 with a tip 180 suitable for piercing the tissue layer.
  • the hook-shaped end 178 can further include an inwardly facing barb 182 for assistance in retaining the suture end within the bight of the hook-shaped end. Examples of a suture end suitable for use with the hook-shaped end 178 are shown in FIGS. 18C and 18E .
  • FIG. 19E illustrates another retrieving device having a cannula with a lumen or tube 184 with a removable piercing element such as a needle 186 located within the interior of the tube.
  • the needle 186 is initially used to form a port in the tissue layer to atraumatically introduce the tube 184 through the tissue within the proximity of the suture end.
  • the needle 186 is subsequently removed and the interior of the tube 184 is placed under a vacuum sufficient to draw the suture end to the end 188 of the tube.
  • the tube 184 engaged to the suture end is then drawn through the tissue layer. Examples of a suture end suitable for use with the tube 184 are shown in FIGS. 18A and 18B .
  • the present invention provides other means for engaging a portion of a fastener through a tissue layer from the side opposite means for retaining another portion of the fastener in a stationary position.
  • the present invention provides for using a variety of fasteners to form different types of suture patterns.
  • Other examples of the engaging means for a fastener are illustrated in FIGS. 20 and 21 .
  • a first tissue layer 200 and second tissue layer 202 are joined by releasably retaining a first portion of a fastener 204 in a stationary position on one side of the first tissue layer.
  • the first portion 204 can be releasably retained in the foot 26 of a tissue suturing device.
  • a second portion of the fastener 206 is releasably retained in the distal end 44 of the needle carrier of the tissue device.
  • the second portion 206 includes a needle tip 208 on a needle shaft 210 for piercing and forming a port 212 in the first and second tissue layers.
  • the second portion 206 also includes a base 214 for abutting the second tissue layer 202 and a barb 216 on the needle shaft for engaging and being retained in an indentation 218 formed in the first fastener portion 204 .
  • the first fastener portion 204 includes a face 220 for abutting the first tissue layer 200 .
  • FIG. 21 illustrates a tissue lay r 222 and a suture 224 are joined by releasably retaining a first portion of a fastener 204 in a stationary position on one side of the tissue layer 222 .
  • the first portion 204 can be releasably retained in the foot 26 of a tissue suturing device.
  • a second portion of the fastener 206 is releasably retained in the distal end 44 of the needle carrier of the tissue device.
  • the second portion 206 includes a needle tip 208 on a needle shaft 210 for piercing and forming a port 212 in the tissue layer 222 .
  • the second portion 206 also includes a base 214 for abutting the tissue layer 222 and a portion of the suture 224 .
  • a barb 216 on the needle shaft passes through an aperture 226 in the first fastener portion 204 and is retained therein.
  • the first fastener portion 204 includes a face 220 for abutting the opposite side of the tissue layer 222 .
  • the present invention is not limited to retrieving a suture only at its end.
  • another embodiment of the cuff 116 attaches directly to a suture length 78 and not the terminal end 76 of the suture forming two lengths 230 , 232 of the suture extending from the exterior bottom wall 118 of the cuff.
  • the cuff 116 can be integrally formed as one-piece with the suture length 78 , the cuff can be attached to the suture length with a conventional adhesive.
  • the suture length 78 can be one of a plurality of sutures that are deployed to form the suture pattern.
  • the suture length-cuff attachment illustrated in FIG. 22 can be used to form a suture pattern 58 in proximity to the aperture 52 in the tissue layer as illustrated in FIGS. 23 and 24 using either a single or a continuous suture.
  • suture cuffs 116 periodically attached along the length of a continuous suture 234 as described in FIG. 22 , the cuffs 116 are releasably retained in the suture channels 72 of the foot 26 as previously described.
  • the needles 56 penetrate the tissue wall 12 forming a port 236 to engage each cuff 116 , and pull each cuff through the tissue wall.
  • Each cuff 116 is removed from the attached two ends 230 , 232 of the suture length to form a suture loop 238 which proximally extends through and returns distally through the tissue wall at each port 236 .
  • Each suture loop 238 is exposed on the proximal side 240 of the tissue wall can be utilized in several ways such as by attaching one or more separate sutures like 242 , fasteners, or anchors on the proximal side 240 of the tissue wall in order to attach a graft (not shown) or to close the aperture 52 .
  • a corresponding plurality of separate sutures such as 242 attached at one end to a graft can be passed through each of the exposed suture loops 238 .
  • Each separate suture 242 can also accommodate an anchor therethrough so that as the lengths 230 and 232 of the suture are pulled to draw each of the suture loops 238 approximately flush with the proximal side 240 of the tissue wall.
  • the separate sutures 242 can also be tightened to bring the graft in apposition with the proximal side 240 of the tissue wall. The separate sutures 242 can then be tied off.
  • a purse-string suture pattern 246 in proximity to the aperture in the tissue layer uses a single suture 248 having free ends 250 .
  • a conventional anchor 244 is positioned underneath each suture loop 238 at each port 236 and pulling the free ends 250 of the suture to draw the pattern closed.
  • This suture pattern 246 would be useful, for example, to close a puncture site or aperture 52 .
  • FIGS. 25-26 Another embodiment of the inventive tissue suturing device 310 is shown in FIGS. 25-26 .
  • the tissue suturing device 310 includes an elongated body 316 having a distal 318 and proximal 320 end.
  • An actuating mechanism (not shown for clarity) operates a foot 326 in a reversible motion against the distal end 344 of a needle carrier 324 using a shaft 328 .
  • the distal end 344 of the needle carrier optionally includes integrally formed cutting blades like 346 on each side of the shaft mounted on a surface approximating the size of the circumference of the foot 326 .
  • the distal end 344 of the needle carrier includes a plurality of needles 356 attached thereto and extending in a generally perpendicular direction.
  • the needles 356 are arranged in a predetermined pattern which matches a corresponding suture pattern 358 .
  • the needles 356 are positioned at approximately uniform intervals around the circumference of the completed aperture which is being enlarged or slit to accommodate a graft (not shown).
  • the height of each of the needles 356 from the surface of the distal end 344 of the needle carrier to its tip is higher than the thickness of the tissue layer the needles 356 are anticipated to penetrate.
  • the foot 326 has a top surface 360 facing the distal end 344 of the needle carrier and an opposing bottom surface 362 .
  • Located on the top surface 360 is a plurality of suture channels 372 extending at least partially into the depth of the foot.
  • the pattern of the suture channels 372 on the top surface corresponds to the pattern of needles 356 on the distal end 344 of the needle carrier.
  • the needles 356 on the distal end have sufficient height relative to the length of travel by the needle carrier 324 to penetrate the suture channels 372 .
  • Each of the suture channels 372 in the foot are sized to allow insertion by the tip 380 of the needles.
  • the top surface 360 releasably retains the sutures, preferably loops 382 formed by one or more of the sutures.
  • a plurality of suture lengths 378 extend downward through grooves 384 in the shaft emerging along the top surface 360 of the foot to be positioned within one of a plurality of suture grooves 386 within the top surface of the foot.
  • Each suture groove 386 extends at least partially from the grooves on the shaft to a respective channel 372 . The depth of each suture groove 386 is sufficient to accommodate the width of the suture to provide an approximately flush profile to the top surface 360 .
  • Each suture length 378 extends to the respective channel 372 where it is releasably retained near the top surface 360 of the foot. Although it is preferred to position the suture length 378 approximately flush with the top surface 360 of the foot, it is suitable for the suture length 378 to be in any position where it can be retrieved by the corresponding needle 356 when the actuating mechanism squeezes the foot 326 and distal end 344 of the needle carrier together.
  • each suture length 378 extends from the groove 386 in the top surface of the foot and forms the suture loop 382 in a stationary position around the respective suture channel 372 .
  • the respective needle 356 travels in a perpendicular direction into the suture channel 372 .
  • the suture loop is tensioned or biased towards the needle 356 , preferably by being positioned to slightly overlap the path of travel expected for the needle 356 .
  • the suture loop 382 is positioned to engage the side of needle shaft 388 near the needle tip 380 .
  • the suture loop 382 is pushed slightly to one side until the needle 356 has been inserted sufficiently deep for the indentation 390 in the side of the needle shaft 388 to reach the suture loop 382 .
  • the tension on the suture loop 382 biases it toward the needle shaft 388 so the suture loop slides into the indentation 390 in the needle shaft given the opportunity for the suture loop to return to its initial position. It is not necessary to move the suture loop 382 toward the needle shaft 388 to engage the indentation 390 .
  • Proper position of the suture loop 382 relative to the side of the needle shaft 388 creates the desired bias to have the suture loop return to its starting position when the indentation 390 is adjacent the suture. Subsequently removing the needle 356 from the suture channel 372 back through the tissue layer pulls the suture loop along and passes it through the tissue layer.
  • FIGS. 27-29 Other embodiments of retaining the suture length 378 in the suture channel 372 are shown in FIGS. 27-29 .
  • the suture channel 372 in the top surface 360 of the foot retains a button 392 made of deformable material in a press-fit.
  • the button 392 is supported from the inside of the foot by an elastic tube or spring 394 which is positioned between the button and the bottom 362 of the foot.
  • the button 392 has a preferred tear-drop shape so that the suture loop 382 fits between the bottom and the edge of the suture channel 372 .
  • the suture loop 382 is tensioned or biased against the button 392 as previously discussed.
  • the button 392 includes an outer surface having an indentation 396 accessible to the needle 356 from the exterior side of the top surface 360 of the foot as seen in FIG. 27 .
  • the button 392 is not depressed by the needle 356 until the indentation 390 or barb of the needle shaft is about even with the outer surface of button to align the suture 382 with the barb or needle indentation 390 .
  • FIG. 28 the button 392 has a preferred tear-drop shape so that the suture loop 382 fits between the bottom and the edge of the suture channel 372 .
  • the suture loop 382 is tensioned or biased against the button 392 as previously discussed.
  • the button 392 includes an outer surface having an indentation 396 accessible to the needle 356 from the exterior side of the top surface 360
  • the needle 356 further depresses the button 392 which releases the suture loop 382 which slides into the barb or needle indentation 390 .
  • the needle 356 is withdrawn and pulls the suture loop 382 back through the suture channel 372 and, subsequently, through the tissue layer.
  • the needles 556 are positioned near the circumference of the distal end 544 of the needle carrier and extend downward toward the foot 526 and inward toward the shaft 528 forming an obtuse angle relative to the side surface of the elongated body 516 .
  • the foot 526 has a curved top surface 560 facing the distal end 544 of the needle carrier and a curved opposing bottom surface 562 .
  • Located on the top surface 560 is a plurality of suture channels 572 extending at least partially into the depth of the foot 526 .
  • the pattern of the suture channels 572 on the top surface 560 corresponds to the pattern of needles on the distal end 544 of the needle carrier.
  • the needles 556 on the distal end have sufficient height relative to the length of travel by the foot to penetrate the suture channels.
  • Each of the channels 572 in the foot are sized to allow insertion by the tip 580 of the needles.
  • a plurality of suture lengths 578 extend downward through grooves 584 in the shaft emerging along the top surface 560 of the foot to be positioned within one of a plurality of suture grooves within the top surface of the foot.
  • Each suture length 578 is positioned where it can be retrieved by the corresponding needle 556 when the actuating mechanism squeezes the foot and distal end of the elongate body together in the manner described above.
  • the actuating mechanism 630 includes a motor 682 secured to the elongated body 616 .
  • the motor 682 rotatably connects at one end to a worm gear 684 which connects to the proximal end 640 of the needle carrier.
  • the hand grip 622 includes a switch 686 connected to the motor 682 to control the direction and number of revolutions by the worm gear 684 . Activating the switch 686 energizes the motor 682 to turn the worm gear 684 and advance the needle carrier 624 along the shaft 628 within the elongated body 616 .
  • the motor 682 is stopped by manually deactivating the switch 686 or by using an automatic cut-off.
  • the switch 686 can then be activated to have the motor 682 turn the worm gear 684 in the opposite direction and reverse the travel of the needle carrier 624 to pass the sutures proximally through the tissue.
  • a power source 688 for the motor 682 is included within the elongated body 616 although an external power source can also be used.
  • FIG. 31 also illustrates a graft anastomoses assembly 700 which includes a graft suturing device 710 as a second component.
  • a graft suturing device 710 as a second component.
  • a preferred embodiment of the graft suturing device 710 is illustrated in FIGS. 31 and 32 .
  • the graft suturing device 710 reliably deploys a uniform graft suture pattern in a graft wall.
  • the graft suturing device 710 is useable separately for suturing any type of graft, whether or not as part of an anastomoses procedure.
  • the graft suturing device 710 can interlock with a tissue suturing device like 610 to provide alignment between the suture patterns in the tissue wall and a graft wall
  • the graft suturing device 710 includes a graft needle carrier 724 , a graft foot 726 attached to a shaft 728 which extends into the elongated body 616 of the tissue suturing device 610 , and the actuating mechanism 630 which can be the same as used by the tissue suturing device 610 .
  • the graft needle carrier 724 includes a distal end 744 having a mounting surface with an integral cutting blade 746 thereon.
  • the cutting blade 746 has a circular shape.
  • the distal end 744 of the needle carrier includes a plurality of graft needles 756 attached thereto and extending in a generally perpendicular direction.
  • the graft needles 756 are arranged in a predetermined pattern which matches a corresponding graft suture pattern 758 .
  • the graft needles 756 are positioned at approximately uniform intervals around the circumference of the wall of the graft end 782 (as seen in FIG. 32 ).
  • each of the graft needles 756 from the surface of the distal end 744 of the graft needle carrier to its tip 780 is slightly higher than the height of the graft cutting blade so that the needles engage the graft wall just as, or slightly before, the edge of the cutting blade 746 engages the wall near the graft end 782 . Having the needles 756 engage the wall near the graft end 782 before, or simultaneously with, the cutting blade 746 allows the wall of the graft end 782 to be captured and retained in position to form the desired suture pattern 758 even after the edge of the cutting blade 746 cuts the wall near the graft end 782 .
  • Another suitable embodiment of the cutting blade 746 preferably has a decreasing depth profile forming a decreasing gradient or slant from the one side of the graft needle carrier 724 .
  • the decreasing gradient allows the end of the cutting blade edge to engage and cut the graft end 782 in an oblong shape.
  • the edge of the cutting blade makes the cut as the distal end 744 and graft foot 726 are squeezed progressively together.
  • the present invention also includes embodiments wherein the cutting blade 746 has a uniform height across its length. An oblong shape or other desired shape can still be formed with a cutting blade 746 of uniform height by changing the circular shape of the cutting blade on the surface of the distal end 744 to the desired shape.
  • the graft foot 726 has a top surface 760 facing the distal end 744 of the graft needle carrier and an opposing bottom surface.
  • the top surface 760 has a graft groove which corresponds in position to the graft cutting blade on the distal end 744 of the graft needle carrier.
  • the graft groove is of sufficient size to accommodate a portion of the edge of the graft cutting blade below the plane of the top surface to facilitate the making of the cut.
  • Located near the circumference of the top surface is a plurality of suture channels 772 extending through the depth of the graft foot to the bottom surface.
  • the pattern of the suture channels 772 on the top surface corresponds to the pattern of graft needles on the distal end 744 of the graft needle carrier. As the distal end 744 of the graft needle carrier travels toward the top surface of the graft foot, the graft needles 756 have sufficient height relative to the length of travel by the graft needle carrier 724 to penetrate the channels 772 .
  • Each of the suture channels 772 in the graft foot are sized to releasably retain a suture length 778 , preferably the end 776 of the suture as previously described. Although it is preferred to position the suture end 776 approximately flush with the top surface of the foot, it is suitable for the suture end to be in any position where it can be retrieved or engaged by the corresponding graft needle 756 or other retrieving device or means when the actuating mechanism squeezes the foot and the needle carrier together.
  • the suture lengths 778 extend within a lumen 780 in the graft shaft 728 to the surface of the distal end 744 of the graft needle carrier where a slot in the cutting blade allows the suture lengths 778 to extend to the external side of the elongated body 616 as previously described with regard to the tissue suturing device 610 .
  • the graft shaft 728 extends to connect to the shaft 628 of the tissue suturing device or can be integrally made as a one-piece member.
  • the actuating mechanism 630 connects to the graft needle carrier 724 in the same manner as between the actuating mechanism and the needle carrier 624 of the tissue suturing device 610 in any of the embodiments previously described.
  • FIG. 31 illustrates one such embodiment wherein the actuating mechanism includes the motor 682 secured to the elongated body.
  • the motor 682 rotatably connects on the opposite end to a second worm gear 784 which connects to the proximal end 740 of the graft needle carrier.
  • the hand grip 622 includes a switch 686 connected to the motor to control the direction and number of revolutions by the worm gear. Activating the switch energizes the motor to turn the worm gear and advance the needle carrier along the shaft within the elongated body.
  • the motor is stopped by manually deactivating the switch or by using an automatic cut-off.
  • the switch 686 can then be activated to have the motor turn the second worm gear 784 in the opposite direction and reverse the travel of the needle carrier to pass the sutures proximally through the tissue.
  • FIGS. 33-34 Two other embodiments of a graft suturing devices 810 are shown in FIGS. 33-34 wherein the needles and suture channels are positioned on the opposite components of the device compared to the previously described embodiments.
  • the graft suturing devices 810 integrally mounts the foot 826 on the proximal end 820 of the elongated body 816 .
  • a shaft 828 extends from the proximal end 820 of the elongated body 816 to connect to the needle carrier 824 and to an actuating mechanism (not shown).
  • a graft 800 is pulled over the needle carrier 824 and extends toward the foot 826 .
  • the foot 826 includes suture channels 872 which releasably retain sutures 874 and are in alignment with needles 856 on the needle carrier. As previously described, the needles 856 move axially to engage the sutures 874 and retrieve the sutures through the graft 800 .
  • FIG. 33 ties one end 802 of the graft to the shaft 828 with a tie 804 .
  • a cutting blade 846 is located inwardly of the needles 856 toward the shaft 828 .
  • the graft 800 is positioned over the shaft 828 and pulled through the needles carrier 824 .
  • the graft 800 is further positioned over the top surface 860 of the foot to provide the cutting blade 846 with proper alignment to cut the graft in the proximity of the end 802 .
  • an indexing device 830 provides the proper alignment for the needles 856 to engage the sutures 874 and for the cutting blade 846 to cut the graft end 802 .
  • the needle carrier 824 may be detachable from the remainder of the graft suturing device 810 .
  • FIGS. 35-37 Another embodiment of a graft suturing device 910 is shown in FIGS. 35-37 which includes a graft needle carrier 924 , a graft foot 926 attached to a shaft 928 .
  • the graft shaft 928 may extend into the graft anastomosis assembly.
  • a graft 900 is positioned coaxially about the graft foot 926 and held in position with a tie 909 .
  • the graft foot 926 contains suture channels 972 for releasably retaining sutures 974 .
  • the sutures 974 extend from the graft foot through suture grooves 984 .
  • the suture channels 972 are positioned in an axial position relative to the longitudinal axis along the graft shaft 928 .
  • the needles 956 carried by the needle carrier 924 must also retrieve the sutures 972 in an axial position
  • the needles 956 are deployed radially inwardly through the graft 900 in a regularly spaced pattern of penetration sites or ports in the graft.
  • FIG. 36 specifically illustrates the details of the graft suturing device that permits an inward radial deployment of the needles 956 .
  • the graft suturing device 910 further includes an outer cam 902 which deploys as a sleeve around the needle carrier 924 and needles 956 .
  • the cam 902 includes ridges 904 and troughs 906 along a surface 908 of the interior circumference of the cam.
  • the cam 902 is rotated about the longitudinal axis along the graft shaft 928 in either a clockwise or counterclockwise direction as indicated by arrows 988 .
  • Each of the needles 956 includes a tail 990 which abuts and slides along the interior surface 908 .
  • the rotation of the cam 902 moves each of the needles 956 in either an inward or outward direction as the tail 990 encounters either the ridges 904 or troughs 906 respectively.
  • the needles 956 are driven inwardly through the graft 900 to engage the sutures 974 .
  • the direction of the needles' movement is reversed and the needles 956 move outwardly from the graft 900 with the sutures 974 in tow.
  • the return of the needles 956 to their initial position is assisted by a spring 992 coiled around the needles shaft.
  • the sutures 974 can be released from the needles 956 and the graft 900 can be removed from the cam 902 and graft foot 926 .
  • the needles 956 move simultaneously inward.
  • the needles can move inward successively by changing the position of the ridges 904 and troughs 906 relative to each one another.
  • FIG. 37 illustrates using a rail 994 to which the tail 990 of one of the needles is rotatably secured.
  • the needle 956 is moved inward and then is positively moved outward as the cam advanced.
  • the interior surface 908 can include the rail to which the tail 990 of the needle is slidably attached.
  • the tail 990 slides along the rail from trough 906 to ridge 904 and vice versa Since the tail 990 is positively attached to the interior surface 908 , the needle moves outward without the assistance of a spring-like member.
  • the graft suturing device 710 and the tissue suturing device 610 can be used solely independent (one without the other) or operating together simultaneously or successively.
  • the inventive tissue suturing device 610 and inventive graft suturing device 710 described herein can also be used solely independent with other devices or methods (conventional or not) to perform the other device's function in anastomosis assembly and method.
  • the graft suturing device 710 described in the related applications can be readily adapted to interlock with the tissue suturing device 610 herein.
  • the graft suturing device can be loaded with the graft prior to the insertion and operation of the tissue suturing device.
  • the two devices are then combined into one assembly to provide proper orientation of the graft to the deployed suture pattern in the vessel wall. This results in a two-stroke method being used wherein one needle passes the suture through the graft and a second needle passes the suture through the vessel wall.
  • a one-stroke method can be used with the present invention.
  • the needles can first pass the suture through the proximal side of the graft before they are attached to the distal Mend of the vessel suturing device. Then, as described above, the vessel suturing device is inserted through the vessel wall. The suture can then be passed through the distal side of the vessel wall to complete the loop.
  • the present invention also provides a tissue suturing device and an anastomosis assembly which inserts a portion of the tissue suturing device from a remote access site other than the site of the tissue suturing or anastomosis.
  • tissue suturing and/or graft anastomosis assembly which uses a remote access site are illustrated in FIGS. 38-40 .
  • FIGS. 38 and 40 illustrate a remote access site 1000 in the tissue wall 1012 of a blood vessel 1014 .
  • a remote foot 1026 is introduced into the blood vessel 1014 through the remote access site 1000 .
  • the remote foot 1026 is attached near its heel end wall 1002 to a guide wire 1004 which is controlled at the other end by an actuating mechanism 1030 .
  • the remote foot 1026 has a top surface 1060 with a groove 1064 thereon for facing the distal end of a needle carrier and corresponding to the position of a cutting blade as discussed herein.
  • Located near the circumference 1070 of the top surface 1060 is a plurality of suture channels 1072 extending into the foot 1026 .
  • the pattern of the suture channels 1072 on the top surface 1060 corresponds to the pattern of needles on the distal end of the needle carrier that will be attached to the remote foot 1026 at the site where the suture pattern is desired.
  • Each of the suture channels 1072 in the remote foot are sized to releasably retain a suture 1074 having a suture body or length 1078 terminating at one end 1076 .
  • the end 1076 of the suture is releasably retained in one of the suture channels 1072 .
  • the sutures lengths 1078 extend across the top surface 1060 of the remote foot and to terminate at the bottom of a plug 1006 .
  • the plug 1006 releasably retains the ends 1094 of the sutures 1074 opposite the suture ends 1076 retained in the suture channels 1072 so the suture ends 1094 may be individually identified as to their position in the suture pattern and retrieved by the operator.
  • the plug 1006 is detachable from the remote foot by the actuating mechanism 1030 .
  • the plug 1006 is released from the remote foot by the actuating mechanism 1030 and driven through the tissue wall 1012 of the blood vessel by a releasable connection to a second wire 1009 associated with the guide wires 1004 as seen in FIG. 39 .
  • a dilating blade 1008 is preferably mounted on the top surface of the plug.
  • the suture lengths 1078 have an excess amount of length sufficient to allow the plug 1006 to be pulled free of the blood vessel 1014 . The excess amount of length is coiled within the remote foot 1026 beneath the bottom surface of the plug 1006 before the plug is released. After the plug 1006 has passed through the tissue wall 1012 , the opposite suture ends 1094 can be released.
  • a depression 1098 corresponding to the shape of the plug is left in the top surface 1060 of the remote foot.
  • This depression is adapted to securely receive the distal end of a shaft of a tissue suturing device (not shown) as previously described herein.
  • the shaft is advanced through the initial aperture 1052 into the depression 1098 .
  • Attachment of the shaft of the tissue suturing device to the remote foot 1026 provides proper alignment of the needle carrier and needles of the tissue suturing device with the suture channels 1072 of the remote foot.
  • the plug 1006 can be another embodiment of the graft foot previously discussed herein.
  • the plug 1006 includes suture channels 1096 for releasably retaining the opposite suture ends 1094 .
  • the suture channels 1096 are illustrated in an axial position relative to the longitudinal axis.
  • the plug 1006 can then be attached to the shaft or other positioning device on a graft suturing device as previously described herein specifically with regard to FIG. 35 .
  • An alternate embodiment of the plug 1006 positions the suture channels 1096 along the longitudinal axis so that suture channels 1072 are flush with the top surface of the plug 1006 .
  • the plug can be attached to the shaft of a graft suturing device as previously described herein specifically with regard to FIG. 31 .
  • FIG. 40 Another embodiment of a tissue suturing device and an anastomosis assembly which inserts a portion of the tissue suturing device from a remote access site other than the site of the tissue suturing or anastomosis is illustrated in FIG. 40 .
  • the tissue suturing device 1110 in this embodiment uses a needle carrier 1124 , a shaft 1128 , and a remote foot 1126 as previously described with regard to the embodiments of the non-remote tissue suturing device.
  • the remote foot 1126 is attached to a rigid extension 1102 which connects at the other end to the shaft 1128 .
  • the needle carrier 1124 is attached to a rigid extension 1104 which connects at the other end to the shaft 1128 .
  • the extensions 1102 and 1104 allow the remote foot 1126 to be inserted through the tissue layer 1112 into a blood vessel 1114 at a remote access site 1100 .
  • the needle carrier 1124 has a shape corresponding to the remote foot 1126 so that the needles 1156 are aligned with the suture channels 1172 .
  • the suture channels 1172 releasably retain sutures 1174 at one of the ends 1176 while the suture lengths 1178 extend across the top surface 1160 of the remote foot through suture grooves 1184 near the perimeter of the remote foot.
  • the opposite ends 1194 of the sutures terminate in a plug 1106 which is releasably retained flush with the top surface 1160 of the remote foot.
  • One of the needles like 1157 on the needle carrier is aligned to retrieve the plug 1106 and draw it through the tissue layer 1112 . After the plug 1106 has been drawn through the tissue layer 1112 , the opposite ends 1194 of the sutures can be freed from the plug.
  • the tissue suturing device 1110 demonstrates that a suture pattern can be deployed at a deployment site 1108 other than the remote access site. Furthermore, the tissue suturing device 1110 does not need an initial aperture at the suture deployment site 1108 in order to deploy the suture pattern.
  • the alignment between the needles 1156 and the suture channels 1172 is provided by the extensions 1102 and 1104 without a shaft extending through an aperture at the deployment site 1108 .
  • a cutting blade 1146 can be mounted on the needle carrier 1124 and is positioned to make an incision at the deployment site 1108 to form an anastomosis site different from the remote access site 1100 and not simply enlarge an initial insertion site.
  • the cutting blade 1146 is preferably aligned with the groove 1164 on the top surface 1160 of the remote foot and avoids contact with the suture lengths 1178 . Rather than drawing the plug 1106 through a separate port in the tissue layer 1112 , the plug 1106 can be drawn through the incision made by the cutting blade 1146 .
  • alternate means of fastening the two ends of the suture body together are suitable.
  • the two ends of the suture body can be simply tied in a knot manually or, optionally, with a knot device as is described in copending application U.S. Ser. No. 08/552,211 filed Nov. 2, 1995.
  • the present invention is riot limited to any particular type of tissue.
  • the devices of the present invention can be used for suturing all types of tissue in many applications. More specifically, the present invention can close apertures in tissue or bind layers of tissue together such as in anastomoses.
  • the present invention can be used to close apertures in the septum of the heart such as with a atrial septal defect or a patent foramen ovale.
  • the present invention can deploy sutures around the annulus of a valve for the heart or other organs and around the proximity of a prosthesis.
  • the present invention can be used in anastomoses to provide a direct or indirect communication between two blood vessels, lymphatics, hollow viscera, or other tubular structures.
  • anastomoses between an aperture in a vessel wall and the end of a graft is specifically illustrated, the present invention can also be used to anastomose tubular structures in other configurations such end-to-end, end-to-side, in continuity, conjoined, or closed-end. Examples of specific applications include the CABG methods described herein using vessels and tubular grafts such as the aorta, veins, the internal mammary artery, or superficial temporal artery.
  • An example of an anastomosis involving an organ instead of a blood vessel is a Roux-en-Y operation which implants the distal end of the divided jejunum with the proximal end into the side of the jejunum at a suitable distance below the first to form a Y-shape pattern.
  • the suturing devices described herein can be used on grafts which do not have an open end.
  • the open end of a graft is closed off by a clamp or other closure means.
  • An incision is made in the graft to allow penetration of the foot of the tissue suturing device of the present invention into the side of the graft.
  • the tissue suturing device deploys the desired suture pattern and is withdrawn from the graft.
  • the suture pattern is available for attachment to a corresponding suture pattern or other fastener arrangement.
  • the corresponding suture pattern is deployed on the selected vessel,
  • the present invention can be used with catheter-based surgical techniques wherein one of the elements of the devices described herein is delivered to the suture site through a remote or alternate access location.
  • the vessel suturing device described herein can be introduced to the aorta through the femoral artery to the site where the sutures are deployed.
  • the present invention allows indirect visualization of the desired deployment site via marker ports, crystals or the like.

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Abstract

Systems for suturing a tissue layer having two sides with a suture be releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer. The portion of the suture is retrieved through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side. Systems for suturing the wall of a tubular graft having two sides is also provided using a suture by releasably retaining at least a portion of the suture on one side of the wall. the portion of the length of suture is retrieved through the wall of the graft to the opposite side of the wall.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • This application is a continuation of U.S. patent application Ser. No. 10/737,668, filed Dec. 16, 2003, which is a continuation of U.S. patent application Ser. No. 10/033,689, filed Dec. 28, 2001, which is a continuation of U.S. patent application Ser. No. 08/883,246, filed Jun. 26, 1997, now U.S. Pat. No. 6,355,050, which is a continuation-in-part of U.S. patent application Ser. No. 08/824,031, filed Mar. 26, 1997, now U.S. Pat. No. 6,036,699, which is a continuation-in-part of U.S. patent application Ser. No. 08/259,410, filed Jun. 14, 1994, now U.S. Pat. No. 5,779,719, which is a divisional and a continuation-in-part of U.S. application Ser. No. 07/989,611, filed Dec. 10, 1992, now U.S. Pat. No. 5,417,699. The disclosures of these prior applications are hereby incorporated by reference in their entirety.
  • FIELD OF THE INVENTION
  • The present invention relates generally to devices and methods for the suturing of tissue in various applications such as closure of arterial and venous puncture sites, suturing a graft anastomosis to an aperture in a vessel wall or other types of tissue, and the like. More particularly, the inventive devices and methods provide for suturing the tissue of a vessel even though the vessel may be under physiological flow and while preferably maintaining hemostasis.
  • BACKGROUND OF THE INVENTION
  • A number of diagnostic and interventional vascular procedures are now performed transluminally, where a catheter is introduced to the vascular system at a convenient access location and guided through the vascular system to a target location using established techniques. Such procedures require vascular access which is usually established using the well known Seldinger technique, as described, for example, in William Grossman's “Cardiac Catheterization and Angiography,” 3rd Ed., Lea and Febiger, Philadelphia, 1986, incorporated herein by reference.
  • When vascular access is no longer required, the introducer sheath must be removed and bleeding at the puncture site stopped. One common approach to attempt providing hemostasis (the cessation of bleeding) is to apply external force near and upstream from the puncture site, typically by manual or “digital” compression. This approach suffers from a number of disadvantages. It is time-consuming, frequently requiring one-half hour or more of compression before hemostasis is assured. This procedure is uncomfortable for the patient and frequently requires administering analgesics to be tolerable. Moreover, the application of excessive pressure can at times totally occlude the underlying blood vessel, resulting in ischemia and/or thrombosis. Following manual compression the patient is required to remain recumbent for at least six and at times as long as eighteen hours under close observation to assure continued hemostasis. During this time renewed bleeding may occur resulting in bleeding through the tract, hematoma and/or pseudoaneurism formation as well as arteriovenous fistula formation. These complications may require blood transfusion and/or surgical intervention. The incidence of these complications increases when the sheath size is increased and when the patient is anti-coagulated. It is clear that the standard technique for arterial closure can be risky, and is expensive and onerous to the patient. While the risk of such conditions can be reduced by using highly trained individuals, such use is both expensive and inefficient.
  • To overcome the problems associated with manual compression, the use of bioabsorbable fasteners to stop bleeding has been proposed by several groups. Generally, these approaches rely on the placement of a thrombogenic and bioabsorbable material, such as collagen, at the superficial arterial wall over the puncture site. While potentially effective, this approach suffers from a number of problems. It can be difficult to properly locate the interface of the overlying tissue and the adventitial surface of the blood vessel, and locating the fastener too far from that surface can result in failure to provide hemostasis and subsequent hematoma and/or pseudo aneurism formation. Conversely, if the fastener intrudes into the arterial lumen, intravascular clots and/or collagen pieces with thrombus attached can form and embolize downstream causing vascular occlusion. Also, thrombus formation on the surface of a fastener protruding into the lumen can cause a stenosis which can obstruct normal blood flow. Other possible complications include infection as well as adverse reactions to the collagen implant.
  • Catheters are also used to treat heart disease which is a major medical ailment wherein arteries become narrowed or blocked with a build-up of atherosclerotic plaque or clot which reduces flow to tissues downstream or “distal” to the blockage. When this flow reduction becomes significant, a patient's quality of life may be significantly reduced. In fact, heart disease patients often die when critical arteries, such as the coronary arteries, become significantly blocked.
  • However, technology has been developed to open some blocked arteries in the treatment of heart disease. For example, balloon angioplasty has become a well accepted treatment wherein a balloon is inflated within the narrowed vessel to stretch or otherwise deform the blockage into a larger lumen. Attentively, the blockage can even be removed, such as in a procedure known as atherectomy. In general, these treatments use percutaneous catheters which are inserted into the patients' vessels at a peripheral artery or vein puncture site and guided to the internal blockage site via x-ray visualization. The blockage is then treated remotely by use of hydraulic pressure in the case of balloon angioplasty, or by other actuating means to cause remote cutting or ablation of the blockage in the case of atherectomy.
  • Coronary Artery Bypass Graft Surgery (“CABG”)
  • In the alternative to using catheters to treat heart disease, or when such catheterizations are contraindicated, some blocked vessels can be treated with coronary artery bypass graft surgery (“CABG”). In conventional CABG techniques, a tubular graft is affixed to a port or aperture in an artery wall distally of the blockage. When the opposite end of the tube is in fluid communication with a pressurized arterial blood supply, such as the aorta, the tubular graft provides a conduit for flow into the vessel lumen distally of the blockage.
  • Conventional CABG surgery is generally initiated by directly exposing the heart to the surgeon. This is accomplished by opening the patient's chest using known sternotomy and retraction techniques that cut the sternum and spread the rib cage open. Then, one or both lungs are usually deflated and the patient is connected to a respiratory assist machine.
  • Once the heart is exposed, the patient is connected to a coronary bypass machine so that the blood supply circumvents the heart. In this way, the heart is depressurized so that apertures can be cut into the walls of the vessels for surgical graft attachment. The right atrium (or vena cava) and the aorta each is intubated with cannulas which are connected to an artificial pump and oxygenator. Once these major vessels are cannulated, cardioplegia is delivered to slow or stop the beating motion of the heart. The aorta is then clamped proximally of the aortic bypass cannula, thereby isolating the proximal aortic root from the blood that is being circulated by the bypass machine.
  • After the heart is isolated from blood pressure, conventional bypass grafting is performed. The required grafts are implanted to feed the coronary arteries distal to the blockage, the clamp is removed from the aorta, the lungs are restored, and the patient is then taken off of the bypass pump.
  • In one type of CABG method, the bypass grafting is achieved between the aorta and one of the three major coronary arteries or their sub-branches, the left anterior descending artery (LAD), the circumflex artery (CIRC), or the right coronary artery (RCA). In such a case, a saphenous vein is usually taken from the patient's leg and is transplanted as a “homograft” to connect these vessels in the same patient's chest. Artificial grafts have also been disclosed as providing potential utility for this purpose and are herein collectively included in the general discussion of “saphenous veins” as used in CABG procedures.
  • An alternative CABG method uses the internal mammary artery (IMA) alone or in conjunction with the saphenous vein graft. The IMA is severed at a chosen location and is then connected to an aperture, in a coronary artery.
  • In either case of using saphenous vein homografts or artificial grafts in CABG surgery, the proximal end of the graft is generally sutured or otherwise is affixed circumferentially to the tissue surrounding an aperture that is punched into the wall of the aorta. In this arrangement, the lumen of the graft communicates with the vessel through the aperture, wherein ideally the aperture approximates the inner diameter of the graft lumen. The opposite, distal end of the graft is sutured to an aperture formed in the wall of the coronary vessel distal to the blockage.
  • The fluid connections between a graft and a vessel are herein referred to as “anastomoses.” In the instance of CABG, “proximal anastomoses” and “distal anastomoses” are terms used when referring to grafting to the aorta and the coronary artery, respectively. In most CABG procedures using saphenous vein grafts, the distal anastomosis is performed first, followed by the proximal anastomosis.
  • For the CABG method using the IMA, only one distal anastomosis is formed distal to the arterial blockage. A proximal anastomosis to the aorta is not required as it is in a saphenous vein graft procedure because the IMA's natural arterial blood flow feeds the heart.
  • In conventional CABG surgery methods such as those just summarized, the timing and technique of the anastomosis procedures are critical factors to procedural success. In fact, it is believed that three critical determinants which affect outcomes of CABG surgery are: (1) time the patient spends on bypass, (2) time the patient spends with a clamped aorta, and (3) the quality of the anastomoses. It is generally believed that a CABG patient's operative and peri-operative morbidity are directly related to how long the patient must be on heart bypass. In fact, it is generally understood that the risk of patient morbidity is believed to rise significantly after a threshold time of one hour on bypass. Perhaps the most prevalent complication arising from prolonged cardiac bypass is the high risk of distal thrombus created by the artificial plumbing. For example, such thrombi can embolize into the neurovasculature and potentially can cause a stroke. In analyzing the timing of individual CABG steps against the backdrop of a patient's critical time on bypass, the time spent anastomosing the grafts to vessels emerges as a controlling factor. The average time for suturing one anastomosis is approximately 7-10 minutes. Furthermore, it is believed that an average CABG procedure involves approximately five anastomoses: two saphenous vein grafts, each with a proximal and a distal anastomosis, and one internal mammary artery having only one distal anastomosis. Therefore, the average time for graft suturing ranges from 35 minutes to 50 minutes—in any case a significant portion of the 60 minute critical threshold to patient morbidity. Closely related to the time spent on bypass is a second CABG success factor related to the extent and time of aortic cross-clamping. It is believed that the inherent crushing force from a cross-clamp across the bridge of the muscular aortic arch may be associated with a high degree of tissue trauma and structural damage. Additionally, hemostasis formed at or adjacent to the cross clamp, perhaps in conjunction with the tissue trauma of clamping, may also be a source of unwanted thrombogenesis.
  • In addition to the timing of anastomosing grafts and extent and duration of aortic cross-clamping, the quality of interface between the graft and vessel is also believed to be an indicator of procedural success. The accuracy, trauma, and repeatability of suturing, as well as the three-dimensional interface formed between the conduits at the anastomosis site, are significant variables in conventional manual surgical techniques. These variables are believed to significantly affect the short or long-term success of conventional CABG anastomosis procedures.
  • Limitations of Conventional CABG Devices & Methods
  • Both of the critical CABG success indicators summarized above—time on cardiac bypass and quality of anastomosis suturing—are directly affected by inherent limitations in the devices used in conventional CABG procedures. It is believed that improvements to these devices and related methods of use may provide for more rapid and reliable vessel-graft anastomosing. For example, conventional “surgical punches” are devices that cut or “punch” a plug in vessel wall tissue to form an aperture in the wall. In a CABG procedure, the tissue surrounding a punched-out aperture provides the substrate upon which a graft may be sutured to form an anastomosis. One procedural limitation in using conventional surgical punches is that hemostasis can not be maintained at a vessel wall after a plug of tissue is punched out and removed. Therefore, an aperture in an aortic wall during a saphenous vein graft procedure can only be made when that portion of the aorta is cross-clamped, bypassed, and depressurized. Otherwise, the high blood pressure and flow in the aorta would cause significant bleeding during the period from punching the aperture to forming the anastomosis. Because of this limitation in conventional surgical punches, the threshold 60 minute coronary bypass clock begins running before punching the aorta.
  • The prior art fails to disclose or fulfill the need which exists in the field of medical devices and methods for: suturing tissue by proximally drawing sutures through a tissue layer in the proximity of an aperture; suturing tissue by reversibly advancing needles from one side of a tissue layer to retrieve one or more sutures on the opposite side of the tissue layer; a medical device assembly and method that automatically and repeatably places suture thread through vessel wall tissue surrounding an aperture in the vessel wall in a suture pattern that is useful for anastomosing a tubular graft to the aperture; and a medical device assembly that deploys a suture with one end extending through the tissue that surrounds a aperture in a vessel wall and the opposite suture end extending radially through a tubular graft wall adjacent an open end of the graft, such that a vessel anastomosis may be rapidly and repeatably performed in a CABG procedure even while the vessel is under physiological flow.
  • SUMMARY OF THE INVENTION
  • The present invention provides a device for suturing a tissue layer having two sides which includes a suture and means for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer. The device also includes means for retrieving the portion of the suture through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side.
  • A device is also provided for suturing at least one tissue layer wherein each tissue layer has two sides. The device includes a fastener having at least a first and second portion. The first and second portions have means for securing the first and second portions together. The first and second portions have a base at one end to prevent the respective portion from passing completely through the tissue layer. The device includes means for releasably retaining the first portion in a stationary position on one side of the tissue layer and means for driving the second portion through the tissue layer from the opposite side and securely engaging the securing means of the first and second portions whereby the base of the first portion abuts one side of the tissue layer and the base of the second portion abuts the opposite side of the tissue layer.
  • The present invention provides a device for suturing tissue in the proximity of an aperture in a tissue layer which include a shaft having a proximal and distal end and a foot attached to the distal end of the shaft. The foot is adapted for advancing through the aperture. At least one needle is carried above the distal end of the shaft. At least a portion of a suture is releasably retained on the foot in the proximity of the aperture. The device also includes means for reversibly advancing the needle through the tissue to retrieve and draw at least a portion of the suture through the tissue. The advancing means is integrally formed with the shaft.
  • A device for suturing the wall of a tubular graft having two sides is also provided by the present invention. The device includes a suture, means for releasably retaining at least a portion of the suture on one side of the wall, and means for retrieving the portion of the length of suture through the wall of the graft to the opposite side of the wall.
  • A graft anastomosis assembly is also provided for suturing a tubular graft about an aperture in a tissue wall. The assembly includes a suture, a tissue suturing and graft suturing devices. The tissue suturing device includes means for releasably retaining at least a portion of the suture in a stationary position on one side of the tissue layer and means for retrieving the portion of the suture through the tissue layer from the opposite side whereby the suture is drawn from one side to the opposite side. The graft suturing device includes means for releasably retaining at least a portion of the suture on one side of the graft and means for retrieving the portion of the length of suture through the wall of the graft to the opposite side of the graft.
  • A graft assembly for anastomosing a tubular graft and vessel is also disclosed herein. The graft having a graft wall that defines a graft lumen with an open end. The graft wall has a plurality of ports spaced in a predetermined pattern near the open end. The assembly includes a plurality of sutures in the predetermined pattern. Each suture has a first suture portion extending through one of the plurality of ports in the graft wall. Each suture has a second suture portion extending along at least a portion of the graft lumen.
  • A method for suturing a tissue layer having two sides is also provided by the present invention. The steps of the method include: releasably retaining at least a portion of a suture in a stationary position on one side of the tissue layer; and retrieving at least a portion of the suture through the tissue layer to the opposite side.
  • Another method of the present invention sutures tissue in the proximity of an aperture in a tissue wall. The steps of the method include: forming a port from the proximal side of the tissue wall; passing at least a portion of a suture from the distal side of the tissue wall proximally through the port in the tissue wall in the proximity of the aperture; and forming a loop with the remaining portion of the suture to secure the suture.
  • A further method for suturing an aperture in a vessel wall is provided herein. The steps of the method include: reversibly advancing a plurality of needles through the vessel wall to form ports in the proximity of the aperture; passing at least a portion of a suture proximally through the ports in the vessel wall disposed on opposite sides of the aperture from the interior of the vessel with the remaining portion of the suture passing out of the vessel; and securing the ends of the suture to close the aperture.
  • Another method of the present invention sutures the wall of a tubular graft to define a graft lumen and an open graft end. The steps of the method include: releasably retaining at least a portion of a suture within the graft lumen and adjacent the graft open end; puncturing the tubular graft wall with the plurality of needles to form a plurality of ports in a circumferential pattern; and drawing the portion of suture outwardly from the graft lumen and through each of the plurality of ports and external of the graft wall.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • In the drawings, which comprise a portion of this disclosure but are not to scale:
  • FIG. 1 is a perspective view of an embodiment of a suturing device constructed in accordance with the principles of the present invention;
  • FIG. 2A is a detail view of the distal end of the guide body of the suturing device of FIG. 1, shown with the needles retracted fully within the guide body;
  • FIG. 2B is a view similar to FIG. 2A, except that the needles have been partially drawn back into the guide body;
  • FIG. 3 is a cross-sectional view of the device of FIGS. 2A and 2B, taken along line 3-3 of FIG. 2B;
  • FIGS. 4-7 illustrate the method of the present invention using the suturing device 30 of FIG. 1;
  • FIG. 8 illustrates the X-pattern of the tied suture applied by the suturing device;
  • FIG. 9 is a perspective view of a tissue suturing device of the present invention inserted through a tissue layer;
  • FIG. 10 is an isolated perspective view of the needle carrier and foot of the tissue suturing device in FIG. 9;
  • FIG. 11 is a top view of the foot of the tissue suturing device in FIG. 9;
  • FIG. 12 is a side view of the foot and shaft of the tissue suturing device in FIG. 9 inserted through a tissue layer;
  • FIG. 13 is an isolated perspective view of an alternate embodiment of the shaft and foot of the tissue suturing device;
  • FIG. 14A is a cross-sectional view of the foot along the lines 14A-D in FIG. 13 illustrating an example of one cross-sectional shape for the foot;
  • FIG. 14B is a cross-sectional view of the foot along the lines 14A-D in FIG. 13 illustrating another example of one cross-sectional shape for the foot;
  • FIG. 14C is a cross-sectional view of the foot along the lines 14A-D in FIG. 13 illustrating another example of one cross-sectional shape for the foot;
  • FIG. 14D is a cross-sectional view of the foot along the lines 14A-D in FIG. 13 illustrating another example of one cross-sectional shape for the foot;
  • FIG. 15 is a side view isolating the engagement of a needle and suture of the tissue suturing device illustrated in FIG. 9;
  • FIG. 16 is a cross-sectional view of the needle and suture in FIG. 15 along the lines 16-16 with the needle and suture in an engaged position;
  • FIG. 17 is a top view of the needle and suture in FIG. 15 along the lines 17-17 with the needle and suture in an engaged position;
  • FIG. 18A is a side view of the suture end illustrating an example of a ball shape for the suture end;
  • FIG. 18B is a side view of the suture end illustrating an example of a solid cuff shape for the suture end;
  • FIG. 18C is a side view of the suture end illustrating an example of a ring shape for the suture end;
  • FIG. 18D is a side view of the suture end illustrating an example of a serrated cuff shape having slits for the suture end;
  • FIG. 18E is a side view of the suture end illustrating an example of a hook shape for the suture end;
  • FIG. 19A is a side view of a serrated needle tip illustrating an example of a retrieving device of the present invention;
  • FIG. 19B is a side view of a needle tip and tubing assembly illustrating an example of another retrieving device of the present invention;
  • FIG. 19C is a side view of a needle tip with an indentation illustrating an example of another retrieving device of the present invention;
  • FIG. 19D is a side view of a hook-shaped needle tip illustrating an example of another retrieving device of the present invention;
  • FIG. 19E is a side view of a needle tip and tubing assembly illustrating an example of another retrieving device of the present invention;
  • FIG. 20 is a cross-sectional view of two tissue layers being joined by the present invention using a multi-piece fastener in a tissue suturing device;
  • FIG. 21 is a cross-sectional view of a tissue layer and suture being joined by the present invention using a multi-piece fastener in a tissue suturing device;
  • FIG. 22 is a cross-sectional view of a suture cuff attached to two lengths of a suture for use with the present invention;
  • FIG. 23 is a top view of an isolated section of tissue layer having a suture pattern therein formed by a continuous suture used with the present invention;
  • FIG. 24 is a top view of an isolated section of tissue layer having a purse-string suture pattern therein formed by a single suture used with the present invention;
  • FIG. 25 is a perspective view of another embodiment of a tissue suturing device of the present invention;
  • FIG. 26 is an isolated top view of the foot of the tissue suturing device of FIG. 25;
  • FIG. 27 is a cross-sectional view of an alternate button embodiment for retrieving a suture loop in the foot of the present invention;
  • FIG. 28 is a top view of a tear shaped button embodiment for retrieving a suture loop in the foot of the present invention;
  • FIG. 29 is a cross-sectional view of the button embodiment in FIG. 27 for retrieving a suture loop in the foot of the present invention;
  • FIG. 30 is a diagrammatic side view of another embodiment of a tissue suturing device of the present invention utilizing a needle carrier and needle retrieval arrangement positioned at an obtuse angle to the longitudinal axis of the device;
  • FIG. 31 is a perspective view of an anastomoses assembly of the present invention;
  • FIG. 32 is an isolated perspective view of the graft suturing device from the assembly in FIG. 31;
  • FIG. 33 is another embodiment of a graft suturing device of the present invention which retrieves sutures inwardly through a graft wall;
  • FIG. 34 is another embodiment of a graft suturing device of the present invention which positions the graft through the needle carrier;
  • FIG. 35 is a perspective view of another embodiment of the graft suturing device of the present invention which retrieves the sutures in an axial direction;
  • FIG. 36 is a cross sectional view of a needle driving device for retrieving the sutures illustrated in FIG. 35;
  • FIG. 37 is a side view of an alternate arrangement for driving the needles as illustrated in FIG. 36;
  • FIG. 38 is a cross-sectional view of a vessel illustrating the insertion of a foot of the inventive tissue suturing device from a remote access site;
  • FIG. 39 is a cross-sectional view of a vessel illustrating the insertion of a foot of the inventive tissue suturing device from a remote access site; and
  • FIG. 40 is a cross-sectional view of a vessel illustrating the insertion of another embodiment of a foot of the inventive tissue suturing device from a remote access site.
  • DETAILED DESCRIPTION
  • As used herein, the term “distal” is generally defined as in the direction of the patient, or away from a user of a device, or in a downstream direction relative to a forward flow of blood. In the context of a medical device intervention with or through a vessel wall, “distal” herein refers to the interior or the lumen side of the vessel wall.
  • Conversely, “proximal” generally means away from the patient, or toward the user, or in an upstream direction relative to a forward flow of blood. In the context of a medical device intervention with or through a vessel wall, “proximal” herein refers to the exterior or outer side of the vessel wall.
  • Additionally, “oblong” is herein intended to mean oval, elliptical, or otherwise having a generally rounded shape that is not perfectly circular. In particular, the term describes the shape of a tubular graft end cut at an acute angle relative to the plane perpendicular to the tissue walls defining the graft.
  • The term “hemostasis” is herein used to mean the arrest of bleeding or substantially blocking flow of blood outwardly from a vessel lumen while the vessel lumen is pressurized or sustaining physiological blood flow. This amount of blockage or occlusion to flow is further defined such that the blood loss which is experienced is less than an amount which would affect procedural methods or outcomes according to a physician user of a device of ordinary skill in the art. In other words, “hemostasis” is not intended to mean only “total hemostasis” such that there is a total lack of blood loss. Rather, the term is used to also mean “procedural hemostasis” as a relative term in its use among physicians of ordinary skill.
  • Similarly, “occlusion,” “occlude,” “blockage,” “block . . . plugging”, “block,” or variations thereof are all terms which are herein intended to have a procedurally relevant definition in the context of their use. For instance, an aperture is “occluded” although there is some measurable flow therethrough, but that flow is so low such that the intended procedural benefit of occlusion is at least partially achieved. Certainly, such terms also properly include within their scope a “total effect” definition, as well.
  • The term “perfusion” is herein used to mean the flow of blood or other unit of perfusate (the fluid used for perfusion) per unit volume of tissue. Physiological perfusion refers to the amount of blood flow present when the body is functioning normally. For example, physiological perfusion usually prevents clinically significant ST elevations which is one of the most sensitive indicators of inadequate perfusion. Adequate perfusion refers to the amount of blood flow that avoids the clinical requirement of transfusing the patient or that is needed to prevent tissue necrosis distal to the aperture in the blood vessel.
  • The term “suturing” is herein intended to include the process of joining two surfaces or edges together with a fasten r so as to close an aperture, opening, or wound or join tissues. The fastener is usually a suture such as a thread of material (either polymeric or natural), gut, wire or the like. The term fastener as used herein also includes clamps, studs, hasps, catches, hooks, rivets, staples, snaps, stitches, VELCROC, buttons, and other coupling members.
  • Referring to FIGS. 1-3, a suture applying device 400 which is suitable for suturing and sealing of percutaneous vascular puncture site, particularly those made to the femoral artery in a patient's groin, will be described. It will be appreciated, however, that the device of the present invention can be readily adapted for use with punctures made to other hollow body organs and lumens, although it may be necessary to modify the dimensions and other particular aspects of the device to accommodate the different usage environment.
  • The device 400 comprises a guide body 402 and a needle shaft 404. The guide body 402 includes a guide tip 406 at its distal end, which guide tip includes a plurality of guide channels 408 which receive the proximal ends of needles 410. An aligning arrow 403 is mounted on handle 405 located at the proximal end of the guide body 402. A marker lumen bubble 407 is located below the aligning arrow and serves to indicate when the distal end of the guide body has entered a blood vessel, as described in the embodiment below. An indicator lumen 411 which permits the flow of blood to the marker lumen bubble 407 is illustrated in FIGS. 2A and 2B.
  • The needles 410 as illustrated comprise a sharpened tip section 412 and an elongate shank portion 414, but may also be manufactured as an integral piece. The shank portion 414 will be sufficiently long so that the needles may be pushed from their butt end by a support holster 428 fixedly attached to the needle shaft 404 in order to advance the needles through the tissue to be sutured and fully through the guide body 402 inserted together with support sheath 440 in the associated tract so that no capture mechanism will be required.
  • The guide body 402 further includes a plurality of needle lumens 420 which are axially aligned and spaced about the periphery of the guide body. As best seen in FIG. 2B, the needles 410 will enter the distal ends of the lumens 420 as the needles are advanced proximally relative to the guide body.
  • A flexible needle sheath 426 will be attached to the guide tip 406 of guide body 402. The central lumen of the needle sheath 426 receives a support holster 428 attached to the distal end of the needle shaft 404, as well as the needles 410. As with previous embodiments, the butts of the needles 410 are removably received within the support holster 428. The sheath 426 will be sufficiently long to permit the needles to extend at least 5 cm beyond the distal end of guide body 402.
  • Prior to use, the suture applying device 400 will be in the configuration illustrated in FIGS. 1 and 2A. That is, the needle shaft 404 will be distally positioned within the guide body 402 and needle sheath 426. In particular, the tips of needles 412 will lie just at the guide tip 406 so that they may be easily advanced through the arterial tissue surrounding the arteriotomy. That is, the tips of the needles will be generally retracted within the guide tip 406. A length of suture 422 is attached to the proximal tips 412 of opposed pairs of needles 410, with the connecting suture being stored in side lumens 427 extending axially along the exterior of the needle sheath 426. As best observed in FIGS. 2A and 2B, the suture 422 extending between one pair of opposed needles is received in a first of the side lumens 427, while the suture extending between the other pair of opposed needles is received in the second of the side lumens. While it would be possible to store the suture 422 in the lumens 420 of the guide body 402 (and thus eliminate the need for side lumens 427), such storage is less preferred since it increases the risk that the suture will become entangled with the needles 410 as they are withdrawn proximally. The use of side lumens 427 greatly simplifies feeding of the suture as the needles 410 are withdrawn.
  • After the guide tip 406 has been passed through the puncture site to be sutured, the needles may then be drawn proximally forward through the tissue to be sutured by drawing proximally on handle 430 at the proximal end of needle shaft 404. The method of the present invention will now be described in more detail with reference to FIGS. 4-7.
  • The situation following an interventional or other vascular procedure, where the attending physician is satisfied that the puncture site may be sealed, is illustrated in FIG. 4. A conventional introducer sheath is in place with a guidewire passing into the femoral artery. The conventional introducer sheath is withdrawn after assuring that an appropriate guidewire for the suturing process is in place. The device 400 (including a support sheath 440 which initially covers the ports to the needle lumens 420) will then be introduced over the guidewire, as illustrated in FIG. 4. The needles 410 and sutures 422 mostly encased by flexible needle sheath 426, will be fully advanced into the femoral artery FA past the arterial puncture site A. Handle 441 on support sheath 440 is then partially withdrawn proximally to expose the needle lumens 420 (as shown in FIGS. 2A, 2B, and 5). Handle 430 will then be drawn proximally outward relative to the guide body 402, causing the needles 410 to pass through the superficial wall of the femoral artery FA and into the needle lumens 420, as illustrated in FIGS. 2B and 5. The handle 430 may continue to be drawn proximally (i.e., outward from the patient) in order to continue to pull the needle shaft 404 through the guide body 402. Such movement of the needle shaft 404, in turn, continues to draw the needles 410 outward through the lumens 420 of the guide body 402 until the tips of the needles are exposed. The user may then grasp the needles and continue to draw them out until the suture is available to the user. The guide body 402 may then be withdrawn from the support sheath 440, leaving a portion of the needle sheath 426 still in the puncture site A to maintain hemostasis. The suture can then be tied and the knot pushed back down through the support sheath 440. The knot will then only be tightened when the needle sheath is finally withdrawn from the puncture site A.
  • It can be seen that the guide tip 406 deflects the needles radially outward so that the pattern of four needles engages the artery wall in an approximately square pattern about the arteriotomy A. After the sutures are tied and the knots advanced back through the support sheath 440, the resulting pattern of tied suture will appear as in FIG. 8 when viewed towards adventitial surface of the femoral artery FA surrounding the arteriotomy A.
  • Device 400 has certain advantages over the previous embodiments. Since it is not necessary to capture the needles using an internal capture mechanism, the needles need not have barbs. Such barbless needles will minimize trauma to the arterial tissue around the puncture site A and simplify the procedure. The guide body 402 and guide tip 406 are designed as an integral structure to assure that needles 410 will be precisely centered around the puncture site A, and will very reliably enter the needle lumens 420 in guide body 402. Also, tip 406 will occlude the arteriotomy puncture during the performance of the procedure, providing hemostasis. Moreover, the entire procedure is simplified, with fewer discrete steps being performed. The user need only introduce the device over-the-wire and thereafter draw out the needle shaft to carry the needles through the tissue to be sutured and outward through the guide body, where the suture becomes accessible and may be tied in a conventional manner.
  • The present invention also provides several devices which comprise a graft anastomosis assembly. One of the preferred embodiments of the graft anastomosis assembly and component devices depicted in the drawings is inserted through an aperture or hole in a tissue wall, such as the wall of the distal artery, an aorta, or other vascular tissue. The assembly mechanically places a predetermined pattern of sutures in the tissue wall. The aperture can then be enlarged manually or, optionally, by the assembly itself, such that the suture pattern is in close proximity to the circumference of the aperture. The assembly provides a graft to the tissue wall at the site of the aperture. Preferably, hemostasis is maintained during a substantial portion of the procedure. Furthermore, the graft anastomosis assembly and devices can maintain perfusion beyond the area of the device introduction through the vascular tissue.
  • A preferred embodiment of one component for the graft anastomosis assembly is a tissue suturing device 10 shown in FIGS. 9-12 which reliably deploys a uniform suture pattern in a tissue wall 12 defining a blood vessel 14. The tissue suturing device 10 is useable separately for suturing any type of tissue, whether or not as part of an anastomoses procedure. On the other hand, the tissue suturing device 10 can be used to deploy sutures in either, or both, the blood vessel and graft in an anastomosis procedure. Optionally, the tissue suturing device 10 can interlock with a graft suturing device, as will be discussed below, to provide alignment between the suture patterns in the tissue wall 12 and a graft wall.
  • The tissue suturing device 10 includes an elongated body 16 having a distal end 18 and proximal end 20. Referring specifically to FIG. 9, the tissue suturing device 10 includes a hand grip 22 partially nested within the elongated body 16 and externally accessible to an operator. The device 10 also includes a needle carrier 24, a foot 26 attached to a shaft 28 which extends proximally into the elongated body 16, and an actuating mechanism referred to generally as 30. Supported within the elongated body 16, the actuating mechanism 30 attaches to the hand grip 22 as illustrated by the cut-away portion.
  • The actuating mechanism 30 includes a cam 32 which is rotatably secured to the elongated body 16 by a fastener 34. The cam 32 is integrally formed with the hand grip 22 and pivots in the directions indicated by arrows 36 using the fastener 34 as the pivot point. The cam 32 includes a slot 38 located between the hand grip 22 and the fastener 34 and extending through the cam itself. The cam 32 slidably connects to the proximal end 40 of the needle carrier 24 by engaging a peg 42 which is affixed to the needle carrier 24 and extends perpendicularly therefrom. Moving the hand grip 22 in the direction of the arrows 36, pivots the cam 32 and slides the peg 42 along the slot 38. As a result, the needle carrier 24 travels along the shaft 28 within the elongated body 16 and reversibly moves the distal end 44 of the needle carrier toward the foot 26.
  • As specifically illustrated in FIG. 10, the distal end 44 of the needle carrier includes an integrally formed cutting blade 46 mounted on a surface approximating the size of the circumference of the foot 26. One end 48 of the cutting blade is positioned near the shaft 28 so as to meet the circumference of an initial aperture 52 formed in the tissue wall (as shown in FIG. 9). Preferably, the cutting blade end 48 rides in a longitudinal groove 54 (as shown in FIG. 11) formed in the shaft 28 as the distal end 44 of the needle carrier and the foot 26 are squeezed together. The opposite end 50 of the cutting blade is positioned to enlarge the initial aperture 52 in the direction extending away from the shaft 28. The cutting blade 46 preferably has a height profile which decreases from the one end 48 of the cutting blade near the shaft to the opposite end 50 to form a decreasing gradient or slant. The decreasing gradient of the cutting blade 46 allows the end 48 of the cutting blade to first engage and cut the tissue wall 12 near the shaft 28. The cutting blade enlarges the incision toward the opposite end 50 as the distal end 44 of the needle carrier and foot 26 are squeezed progressively together. The present invention also includes embodiments wherein the cutting blade 46 has a uniform height across its length or a gradient which is increasing from the cutting blade end 48 near the shaft to the opposite end 50 of the cutting blade.
  • Although one embodiment of the cutting blade 46 and the actuating mechanism 30 is illustrated, alternative embodiments are suitable for use with the present invention as may be apparent to one of ordinary skill in the art. A variety of suitable punch/cutting devices, such as circular blades, anvils, and the like, as well as actuating mechanisms, are disclosed in the following prior documents which are hereby incorporated in their entirety by reference thereto: U.S. Pat. Nos. 3,104,666; 3,776,237; 4,018,228; 4,216,776; and 5,192,294 and U.S. Des. Pat. No. 372,310.
  • The distal end 44 of the needle carrier includes a plurality of needles 56 attached thereto and extending in a generally perpendicular direction. The needles 56 are arranged in a predetermined pattern which matches a desired corresponding suture pattern 58 (as seen in FIG. 12). The needles 56 are positioned at approximately uniform intervals around the circumference of the initial aperture 52 which is enlarged to accommodate a graft (not shown). The height of each of the needles 56 from the surface of the distal end 44 of the needle carrier to its tip is slightly higher than the height of the cutting blade 46 so that the needles 56 engage the tissue wall 12 just as, or slightly before, the cutting blade 46 engages the tissue wall 12. Having the needles 56 engage the tissue wall 12 before, or simultaneously with, the cutting blade 46, allows the tissue wall 12 to be captured and retained in position to form the desired suture pattern 58 even after the cutting blade 46 enlarges the initial aperture 52. The circumference of the enlarged aperture is retained in apposition as the cutting blade 46 completes the incision.
  • The foot 26 has a top surface 60 and an opposing bottom surface 62 as seen in FIG. 11. The top surface 60 faces the distal end 44 of the needle carrier and has a groove 64 which corresponds in position to the cutting blade 46 on the distal end 44 of the needle carrier. The groove 64 is of sufficient size to accommodate a portion of the cutting blade 46 below the plane of the top surface 60 to facilitate the making of the incision. The groove 64 has the same depth profile from one end 66 of the groove near the shaft 28 to the opposite end 68 as the height profile of the cutting blade 46. Located near the circumference 70 of the top surface 60 is a plurality of suture channels 72 extending through the depth of the foot 26 to the bottom surface 62. The pattern of the suture channels 72 on the top surface 60 corresponds to the pattern of needles 56 on the distal end 44 of the needle carrier (as seen in FIG. 10). As the distal end 44 of the needle carrier travels toward the top surface 60 of the foot, the needles 56 have sufficient height relative to the length of travel by the needle carrier 24 to slightly penetrate the suture channels 72.
  • Each of the suture channels 72 in the foot are sized to releasably retain a suture 74 having a suture body or length 78 terminating at one end 76. Preferably, the end 76 of the suture is releasably retained in one of the suture channels 72. As illustrated in FIG. 10, a plurality of the sutures lengths 78 extend downward through a lumen 80 in the shaft 28 emerging through a distal shaft aperture 82. As each suture length 78 emerges from the shaft, it is positioned within one of a plurality of suture grooves 84 within the bottom surface 62 of the foot. Each suture groove 84 extends at least partially from the distal shaft aperture 82 to a respective suture channel 72. The depth of each suture groove 84 is sufficient to accommodate the width of the suture length 78 to provide a flush profile to the bottom surface 62. The end of each suture 76 extends to the respective channel 72 where it is releasably retained near the top surface 60 of the foot. Although it is preferred to position the suture end 76 approximately flush with the top surface 60 of the foot, it is suitable for the suture end 76 to be in any position where it can be retrieved or engaged by the corresponding needle 56 or other retrieving device or means when the actuating mechanism 30 squeezes the foot 26 and the distal end 44 of the needle carrier together.
  • Although a plurality of needles 56 are illustrated on the needle carrier 24 in a one-to-one correspondence with the suture channels 72 on the foot 26, the present invention also provides other embodiments. For example, a single needle or a subset of needles less than the number of suture channels can be used on the needle carrier. The single needle or subset of needles engages a corresponding number of suture channels with a first stroke bringing the foot and needle carrier together. Upon retrieving a corresponding number of sutures, the single needle or needle subset is rotated to a new position after each stroke bringing the foot and needle carrier together along the shaft 28. Rather than having the needles deploy simultaneously with a single stroke, a multi-stroke, successive deployment is used.
  • Referring to FIG. 9, the suture lengths 78 extend toward the proximal end 20 of the elongated body. The suture lengths 78 exit from the lumen 80 and pass through a longitudinal slot 86 (also illustrated in FIG. 10) which extends along the length of the shaft 28 and the distal end 44 of the needle carrier. Optionally, the suture lengths 78 extend from the longitudinal slot 86 to a guide 88 which organizes the sutures. The guide 88 is located on the external surface of the elongated body near the distal end. The suture lengths 78 extend through a second guide 90 to a suture holder 92. The second guide 90 is located near the proximal end 20 of the elongated body. The suture holder 92 releasably retains the opposite ends 94 of the suture lengths so they may be individually identified as to their position in the suture pattern 58 and retrieved by the operator.
  • The longitudinal slot 86 allows the removal of the foot 26 from the aperture completed 52 in the tissue wall 12 and the subsequent removal of the suture lengths 78 so that each end, 76 and 94, of the sutures can be fastened together. In an alternate embodiment, the suture lengths 78 extend internally along the length of the elongated body 16 toward the proximal end 20. A seam 98 along the length of the elongated body 16 connects to the end of the longitudinal slot 86 so that the elongated body can be split open to remove the suture lengths 78 once the suture pattern 58 has been completed. The longitudinal slot 86 itself can also be replaced with a seam to similarly split the shaft 28, foot 26, and needle carrier 24 to remove the suture lengths 78 from the lumen 80.
  • Preferably, the suture pattern 58 is a uniform distance from the perimeter of the completed aperture 52 in the tissue wall. Usually, the initial aperture 52 is a simple longitudinal incision. Preferably, the present invention adjusts for the distance which the tissue wall 12 surrounding the shaft 28 is offset. As illustrated in FIGS. 10 and 11, the foot 26 is partially defined by opposing side walls 100 and end walls which define a heel 102 and toe 104 for the foot. The side walls 100 bulge slightly outward in the vicinity of the shaft 28. Specifically, the distance between the circumference of the shaft and the side walls 100 is the same as the distance from the cutting blade groove 64 or longitudinal axis of the foot 26 to the side walls 100 along the remainder of the foot. Like the remaining suture channels 72, the suture channels in the vicinity of the bulge, like 106 and 108, are located at the circumference of the side walls 100 which offsets suture channels 106, 108 in the suture pattern 58. The offset suture channels 106, 108 provide a uniform amount of tissue wall capture around the entire perimeter of the completed aperture 52 by adjusting the position of the suture pattern 58 for the offset of the tissue wall 12 on each side of the shaft 28. Usually, the tissue wall 12 is negligibly offset by the shaft 28 in the direction of the heel end wall 102 because the shaft is positioned toward or at the heel end wall 102 of the incision creating the initial aperture 52. To further minimize the offset of the tissue wall 12 caused by the shaft 28, it is preferred that the shaft have an oval shape to its cross-section as specifically illustrated in FIG. 11.
  • The needles 56 on the surface of the distal end 44 of the needle carrier which correspond to the offset suture channels 106, 108 on the foot are similarly offset. The surface of the distal end 44 of the needle carrier in the vicinity of the shaft 28 is offset or bulges in a similar pattern as the opposing side walls 100 of the foot.
  • FIG. 12 illustrates a side view of the foot 26 upon insertion through the initial aperture 52 in the tissue wall 12. Preferably, the toe end wall 104 is inserted first and moved forward. The shaft has a cut-away portion 110 near its distal end to allow forward movement of the foot assisting the insertion of the heel end wall 102 through the tissue wall 12. The heel end wall 102 is then moved back slightly to abut one end of the initial aperture 52. The top surface 60 of the foot 26 abuts the distal side 112 of the tissue wall promoting uniform tissue capture when the needles engage the top surface 60 of the foot. As the foot 26 passes through the tissue wall 12, the dilated tissue around the aperture 52 usually responds elastically and compresses onto the shaft 28, thereby maintaining hemostasis. Once in position, the top surface 60 of the foot lies adjacent the distal side 112 of the tissue wall, allowing adequate perfusion beneath the bottom surface 62 of the foot and the vessel wall intima 114. When the assembly is used on vascular tissue, the perimeter of the shaft is preferably about equal to the perimeter of the incision. For example, using the tissue suturing device 10 to perform an anastomosis on the distal artery places the diameter of the shaft in a preferred range of about 1.5 mm to about 2 mm which is the generally accepted diameter of the distal artery.
  • In those operations where the initial aperture 52 is formed by incising the tissue wall 12 or punching a hole of a size approximating the diameter of the shaft 28 in the tissue wall, there is significantly less offset of the tissue wall in the vicinity of the shaft. As a result, a nearly uniform suture pattern 58 is formed without the foot 26 having offset suture channels. As illustrated in FIG. 13, the present invention includes an embodiment of the foot 26 which does not have an offset or bulge in the side walls 100 in the vicinity of the shaft 28. The same reference numerals are used for like components illustrated in the other figures. FIG. 13 also illustrates the shaft 28 having a more round cross-section shape. The foot 26 can be formed in many other shapes and sizes while employing the inventive concepts described herein to a particular surgical procedure, suture pattern, specific tissue, etc.
  • As illustrated in FIG. 14A, one preferred embodiment of the foot 26 has a rounded shape to the corners and edges of the top 60 and bottom 62 surfaces to provide for an atraumatic entry through the tissue wall and to guard against traumatizing the tissue wall intima opposite the aperture 52 upon advancing the foot 26 into the lumen of the blood vessel 14 as previously seen in FIG. 12. Another example illustrated in FIG. 14B emphasizes an even more rounded bottom surface 62 than FIG. 14A to guard against traumatizing the vessel wall intima 114 opposite the initial aperture 52.
  • The foot 26 can also have several cross-sectional configurations as illustrated in FIGS. 14C and 14D for example, which provide a passageway 115 along the longitudinal axis of the foot for perfusion when the foot has been inserted through the tissue wall 12 into a vessel 14 (as seen in FIG. 12). FIG. 14C provides the longitudinal passageway 115 along the length of the foot 26 from the heel end wall 102 to the toe end wall 104. FIG. 14D provides an example of a longitudinal passageway 115 to ensure perfusion being used in combination with a curved top surface 60 to the foot to minimize distortion of the proximal side of the tissue wall 12. A rounded bottom surface 62 prevents traumatizing the vessel wall intima 114 opposite the aperture 52. The suture channels 72 are positioned at an angle to the top surface 60 of the foot so that they are still perpendicular to the needles 56 on a corresponding needle carrier 24 (as seen in FIG. 10).
  • Other examples of perfusion passageways include pathways which have a baffled or tortuous path. A coiled path is another example of a non-straight perfusion passageway.
  • Turning now to FIGS. 15-17, the relationship between the sutures 74 and needles 56 is described in more detail. One end 76 of each of the sutures preferably terminates with a cuff 116 attached to the suture length 78 along a bottom exterior wall 118. The cuff 116 has a generally cup-shape interior space 120 defined by a side interior wall 122 and a bottom interior wall 124. The interior space 120 is sized to accommodate one of the needles 56 in a press-fit engagement. The distal end 126 of each needle has an arrowhead shape with a tip 128 and one or more barbs 130. The arrowhead is mounted on a needle shaft 132 which has a tapered section 134 near the arrowhead.
  • As specifically illustrated by FIGS. 16 and 17, when the needle 56 engages the interior space 120 of the cuff, the diameter of the arrowhead barb 130 is sized to be slightly larger than the interior diameter of the cuff interior space 120. As a result, the cuff side wall 122 deflects slightly as the arrowhead barb 130 is inserted into the interior space. The deflected side wall 122 is biased against the barb 130 to provide a retaining force. The tip 128 of the arrowhead continues until the interior side 124 of the bottom wall is engaged as a backstop to prevent further insertion of the arrowhead tip 128. Penetration of the tip 128 into the interior bottom wall 124 is not required to provide an engaging force between the needle 56 and the suture 74.
  • For the sake of example, and not to be limited thereby, the preferred dimensions of the needle 56 are in a range of about a 0.01 inch to about a 0.02 inch needle shaft 132 diameter which decreases to a diameter of about 0.005 inch in a tapered section 134. The length of the tapered section 134 at the narrowest diameter is about 0.005 inch with an overall length of about 0.013 inch. The diameter of the arrowhead barb 130 is in the range of about 0.007 to about 0.008 inch. The height of the arrowhead barb 130 is in the range of about 0.010 inch to about 0.014 inch. The height of the interior side of the side wall 122 is about 0.02 inch with the cuff 116 having an overall height of about 0.03 inch. The diameter of the interior space 120 from the interior side of the side wall 122 is about 0.005 inch. The thickness of the side wall 122 is about 0.0025 inch and the bottom wall 118 is about 0.01 inch. The dimensions of each suture channel 72 in the foot 26 for this particular example have an interior diameter at the top surface 60 of the foot of about 0.011 inch.
  • The suture cuff 116 is preferably welded to the suture length 78 or molded as one-piece from polypropylene. The cuff 116 can be made from other medical polymers or malleable metals with a preferred hardness to provide the retaining force by allowing the arrowhead barb 130 of a needle 56 to deflect and bias the side wall 122 of the cuff against itself and/or allow the barbs 130 of a needle to penetrate the side wall 122 of the cuff.
  • Other means of attaching the suture length 78 to the cuff 116 are also suitable for use in the present invention such as attaching the cuff to the suture length with a conventional adhesive like cyanoacrylate or by forming the cuff with an indentation in the exterior side 118 of the bottom wall and crimping the suture length therein. In another embodiment, the bottom wall 124 of the cuff can be made of the same, or different, polymer which exhibits a surface hardness sufficient to resist penetration of the tip 128 and provide a backstop preventing excessive penetration. The cuff 116 may also be initially molded as a solid block and subsequently bore an interior space 120 into the solid block to complete the cuff.
  • Preferably, the suture length 78 is a single strand or monofilament. Although a multi-stranded, covered, twisted, or braided suture length is also suitable for use with the present invention. The cuff 116 is also preferably removable from the suture length 78. A suitable rupture strength of the cuff and suture length attachment is about 2 ounces to about 10 ounces so that the two may be separated with the application of a sharp tug.
  • The present invention provides other configurations for the suture end 76. Illustrated for the sake of example, and not for limitation, FIGS. 18A-E are suture ends 76 which can be retrieved or fetched by a retrieving device. The suture end 76 in FIG. 18A includes a suture length 78 having a ball-shaped end 136 which is made of a soft material. Similarly, the suture end 76 in FIG. 18B includes a suture length 78 attached to a solid cuff 138 made of a soft material.
  • The suture end 76 of FIG. 18C includes the suture length 78 attached in a perpendicular manner to one side of a ring 140. Made of deformable material, the ring 140 compresses in the suture channel (not shown) as the larger diameter arrowhead barb is inserted entirely through the hole 142 so that the ring is positioned above the barbs in the tapered section of the needle shaft. As the compressed material relaxes, the ring 140 is retained in the tapered section as the needle is withdrawn through the tissue wall. One end 144 of the ring is preferably tapered to allow for easy passage through the tissue layer. Another example of a retrieving device for use with the ring 140 is a hook as described further below.
  • The suture end 76 of FIG. 18D includes the suture length 78 attached to a cuff 146 defined by a serrated side-wall 148 providing slits 150 therein. The barbs of the needle previously discussed easily deform the side wall 148 and at least partially fill into one or more of the slits 150 to provide a solid engagement therebetween.
  • The suture end 76 of FIG. 18E includes the suture length 78 which terminates in a hook-shaped end 152 made of a material sufficiently hard to resist flexing as it is pulled through the tissue layer. Configurations of the suture end like the hook-shaped end 152 can be engaged by a retrieving device like, for example, a similarly shaped hook or by passing the hook-shaped end through the center of a retrieving device having a ring shape.
  • Other configurations of the retrieving device provided by the present invention are illustrated for example, and not limitation, in FIGS. 19A-E. Preferably, the retrieving device of the present invention generally includes means for forming a port in the tissue layer through which a suture, or other fastener, is retrieved or introduced. The suture or fastener usually remains within the port.
  • Specifically, another configuration suitable for impaling the suture-end is illustrated in FIG. 19A as a serrated needle tip 154 effectively using a plurality of barbs like 156, 158 at various positions and elevations along the shaft 132 of the needle to engage the suture end.
  • FIG. 19B retrieves the suture length 78 with a multiple piece assembly 160 having the needle shaft 132 with a tapered section 134 near the tip 128. A separate piece of tubing 162 in the tapered section 134 is initially retracted towards the upper portion 164 of the tapered section until the suture length 78 is biased into an indentation 166 in the bottom 168 of the tapered section. As the needle shaft 132 is withdrawn, the tubing 162 slides downward to the bottom 168 of the tapered section and over the suture length 78 to retain it in place. The tubing 162 can further be configured to have an offset 170 at its bottom end to accommodate the thickness of the suture length 78 while simultaneously covering the portion of the suture resting in the indentation 166. Optionally, the needle shaft 132 having the tapered section 134 can be used without the tubing 162.
  • FIG. 19C shows the suture length 78 retained within an indentation 172 of the otherwise barbless needle shaft 132 with the aid of a suture loop 174 formed in the shape of a noose with a clasp 176. In place of the clasp 176, the noose can also be formed by tying a knot in the suture loop 174.
  • Another example of a retrieving device is illustrated in FIG. 19D with the needle shaft 132 having a hook-shaped end 178 with a tip 180 suitable for piercing the tissue layer. Optionally, the hook-shaped end 178 can further include an inwardly facing barb 182 for assistance in retaining the suture end within the bight of the hook-shaped end. Examples of a suture end suitable for use with the hook-shaped end 178 are shown in FIGS. 18C and 18E.
  • FIG. 19E illustrates another retrieving device having a cannula with a lumen or tube 184 with a removable piercing element such as a needle 186 located within the interior of the tube. The needle 186 is initially used to form a port in the tissue layer to atraumatically introduce the tube 184 through the tissue within the proximity of the suture end. The needle 186 is subsequently removed and the interior of the tube 184 is placed under a vacuum sufficient to draw the suture end to the end 188 of the tube. The tube 184 engaged to the suture end is then drawn through the tissue layer. Examples of a suture end suitable for use with the tube 184 are shown in FIGS. 18A and 18B.
  • The present invention provides other means for engaging a portion of a fastener through a tissue layer from the side opposite means for retaining another portion of the fastener in a stationary position. The present invention provides for using a variety of fasteners to form different types of suture patterns. Other examples of the engaging means for a fastener are illustrated in FIGS. 20 and 21.
  • In FIG. 20 a first tissue layer 200 and second tissue layer 202 are joined by releasably retaining a first portion of a fastener 204 in a stationary position on one side of the first tissue layer. As previously described, the first portion 204 can be releasably retained in the foot 26 of a tissue suturing device. A second portion of the fastener 206 is releasably retained in the distal end 44 of the needle carrier of the tissue device. The second portion 206 includes a needle tip 208 on a needle shaft 210 for piercing and forming a port 212 in the first and second tissue layers. The second portion 206 also includes a base 214 for abutting the second tissue layer 202 and a barb 216 on the needle shaft for engaging and being retained in an indentation 218 formed in the first fastener portion 204. The first fastener portion 204 includes a face 220 for abutting the first tissue layer 200. As the distal end 44 of the needle carrier is squeezed toward the foot 26, the needle tip 208 engages the indentation 218 and the first and second portions of the fastener 204, 206 are retained together. As a result, the first and second tissue layers 200 and 202 are held in apposition.
  • FIG. 21 illustrates a tissue lay r 222 and a suture 224 are joined by releasably retaining a first portion of a fastener 204 in a stationary position on one side of the tissue layer 222. As previously described, the first portion 204 can be releasably retained in the foot 26 of a tissue suturing device. A second portion of the fastener 206 is releasably retained in the distal end 44 of the needle carrier of the tissue device. The second portion 206 includes a needle tip 208 on a needle shaft 210 for piercing and forming a port 212 in the tissue layer 222. The second portion 206 also includes a base 214 for abutting the tissue layer 222 and a portion of the suture 224. A barb 216 on the needle shaft passes through an aperture 226 in the first fastener portion 204 and is retained therein. The first fastener portion 204 includes a face 220 for abutting the opposite side of the tissue layer 222. As the distal end 44 of the needle carrier is squeezed toward the foot 26, the needle tip 208 passes through the aperture 226 and the first and second portions of the fastener 204, 206 are retained together. As a result, the first and second portions of the fastener secure the suture 224 therebetween.
  • The present invention is not limited to retrieving a suture only at its end. As illustrated in FIG. 22, another embodiment of the cuff 116 attaches directly to a suture length 78 and not the terminal end 76 of the suture forming two lengths 230, 232 of the suture extending from the exterior bottom wall 118 of the cuff. Although the cuff 116 can be integrally formed as one-piece with the suture length 78, the cuff can be attached to the suture length with a conventional adhesive. The suture length 78 can be one of a plurality of sutures that are deployed to form the suture pattern.
  • The suture length-cuff attachment illustrated in FIG. 22 can be used to form a suture pattern 58 in proximity to the aperture 52 in the tissue layer as illustrated in FIGS. 23 and 24 using either a single or a continuous suture. Using suture cuffs 116 periodically attached along the length of a continuous suture 234 as described in FIG. 22, the cuffs 116 are releasably retained in the suture channels 72 of the foot 26 as previously described. The needles 56 penetrate the tissue wall 12 forming a port 236 to engage each cuff 116, and pull each cuff through the tissue wall. Each cuff 116 is removed from the attached two ends 230, 232 of the suture length to form a suture loop 238 which proximally extends through and returns distally through the tissue wall at each port 236. Each suture loop 238 is exposed on the proximal side 240 of the tissue wall can be utilized in several ways such as by attaching one or more separate sutures like 242, fasteners, or anchors on the proximal side 240 of the tissue wall in order to attach a graft (not shown) or to close the aperture 52. For example, a corresponding plurality of separate sutures such as 242 attached at one end to a graft can be passed through each of the exposed suture loops 238. Each separate suture 242 can also accommodate an anchor therethrough so that as the lengths 230 and 232 of the suture are pulled to draw each of the suture loops 238 approximately flush with the proximal side 240 of the tissue wall. The separate sutures 242 can also be tightened to bring the graft in apposition with the proximal side 240 of the tissue wall. The separate sutures 242 can then be tied off.
  • As illustrated in FIG. 24, a purse-string suture pattern 246 in proximity to the aperture in the tissue layer uses a single suture 248 having free ends 250. To prevent drawing the suture loops 238 completely through the tissue layer, a conventional anchor 244 is positioned underneath each suture loop 238 at each port 236 and pulling the free ends 250 of the suture to draw the pattern closed. This suture pattern 246 would be useful, for example, to close a puncture site or aperture 52.
  • Another embodiment of the inventive tissue suturing device 310 is shown in FIGS. 25-26. The tissue suturing device 310 includes an elongated body 316 having a distal 318 and proximal 320 end. An actuating mechanism (not shown for clarity) operates a foot 326 in a reversible motion against the distal end 344 of a needle carrier 324 using a shaft 328. The distal end 344 of the needle carrier optionally includes integrally formed cutting blades like 346 on each side of the shaft mounted on a surface approximating the size of the circumference of the foot 326. The distal end 344 of the needle carrier includes a plurality of needles 356 attached thereto and extending in a generally perpendicular direction. The needles 356 are arranged in a predetermined pattern which matches a corresponding suture pattern 358. The needles 356 are positioned at approximately uniform intervals around the circumference of the completed aperture which is being enlarged or slit to accommodate a graft (not shown). The height of each of the needles 356 from the surface of the distal end 344 of the needle carrier to its tip is higher than the thickness of the tissue layer the needles 356 are anticipated to penetrate.
  • The foot 326 has a top surface 360 facing the distal end 344 of the needle carrier and an opposing bottom surface 362. Located on the top surface 360 is a plurality of suture channels 372 extending at least partially into the depth of the foot. The pattern of the suture channels 372 on the top surface corresponds to the pattern of needles 356 on the distal end 344 of the needle carrier. As the distal end 344 of the needle carrier slides along the shaft 328 towards the foot, the needles 356 on the distal end have sufficient height relative to the length of travel by the needle carrier 324 to penetrate the suture channels 372.
  • Each of the suture channels 372 in the foot are sized to allow insertion by the tip 380 of the needles. The top surface 360 releasably retains the sutures, preferably loops 382 formed by one or more of the sutures. A plurality of suture lengths 378 extend downward through grooves 384 in the shaft emerging along the top surface 360 of the foot to be positioned within one of a plurality of suture grooves 386 within the top surface of the foot. Each suture groove 386 extends at least partially from the grooves on the shaft to a respective channel 372. The depth of each suture groove 386 is sufficient to accommodate the width of the suture to provide an approximately flush profile to the top surface 360. Each suture length 378 extends to the respective channel 372 where it is releasably retained near the top surface 360 of the foot. Although it is preferred to position the suture length 378 approximately flush with the top surface 360 of the foot, it is suitable for the suture length 378 to be in any position where it can be retrieved by the corresponding needle 356 when the actuating mechanism squeezes the foot 326 and distal end 344 of the needle carrier together.
  • As specifically shown in FIG. 26, each suture length 378 extends from the groove 386 in the top surface of the foot and forms the suture loop 382 in a stationary position around the respective suture channel 372. The respective needle 356 travels in a perpendicular direction into the suture channel 372. The suture loop is tensioned or biased towards the needle 356, preferably by being positioned to slightly overlap the path of travel expected for the needle 356. As the needle 356 is inserted into the suture channel 372, the suture loop 382 is positioned to engage the side of needle shaft 388 near the needle tip 380. As the needle 356 continues its downward insertion, the suture loop 382 is pushed slightly to one side until the needle 356 has been inserted sufficiently deep for the indentation 390 in the side of the needle shaft 388 to reach the suture loop 382. The tension on the suture loop 382 biases it toward the needle shaft 388 so the suture loop slides into the indentation 390 in the needle shaft given the opportunity for the suture loop to return to its initial position. It is not necessary to move the suture loop 382 toward the needle shaft 388 to engage the indentation 390. Proper position of the suture loop 382 relative to the side of the needle shaft 388 creates the desired bias to have the suture loop return to its starting position when the indentation 390 is adjacent the suture. Subsequently removing the needle 356 from the suture channel 372 back through the tissue layer pulls the suture loop along and passes it through the tissue layer.
  • Other embodiments of retaining the suture length 378 in the suture channel 372 are shown in FIGS. 27-29. The suture channel 372 in the top surface 360 of the foot retains a button 392 made of deformable material in a press-fit. Alternately or in combination therewith, the button 392 is supported from the inside of the foot by an elastic tube or spring 394 which is positioned between the button and the bottom 362 of the foot.
  • As specifically shown in FIG. 28, the button 392 has a preferred tear-drop shape so that the suture loop 382 fits between the bottom and the edge of the suture channel 372. The suture loop 382 is tensioned or biased against the button 392 as previously discussed. The button 392 includes an outer surface having an indentation 396 accessible to the needle 356 from the exterior side of the top surface 360 of the foot as seen in FIG. 27. As the needle tip 380 is inserted into the outer surface indentation 396, the button 392 is not depressed by the needle 356 until the indentation 390 or barb of the needle shaft is about even with the outer surface of button to align the suture 382 with the barb or needle indentation 390. As seen in FIG. 29, the needle 356 further depresses the button 392 which releases the suture loop 382 which slides into the barb or needle indentation 390. The needle 356 is withdrawn and pulls the suture loop 382 back through the suture channel 372 and, subsequently, through the tissue layer.
  • Although the embodiments of the tissue suturing device discussed above show the needles 358 penetrating the tissue layer from a perpendicular direction into a foot having a flat or planar top surface 360, the present invention is not so limited. Another embodiment 510 of the inventive tissue suturing device is shown in FIG. 30. The tissue suturing device 510 includes an elongated body 516 having a distal end. An actuating mechanism (not shown for clarity) operates the foot 526 in a reversible motion against the distal end 544 of a needle carrier using the shaft 528. The distal end 544 of the needle carrier optionally includes integrally formed cutting blades 546. The distal end 544 of the needle carrier includes a plurality of needles 556 attached thereto. The needles 556 are positioned near the circumference of the distal end 544 of the needle carrier and extend downward toward the foot 526 and inward toward the shaft 528 forming an obtuse angle relative to the side surface of the elongated body 516.
  • The foot 526 has a curved top surface 560 facing the distal end 544 of the needle carrier and a curved opposing bottom surface 562. Located on the top surface 560 is a plurality of suture channels 572 extending at least partially into the depth of the foot 526. The pattern of the suture channels 572 on the top surface 560 corresponds to the pattern of needles on the distal end 544 of the needle carrier. As the distal end 544 of the needle carrier slides along the shaft 528 allowing the foot 526 to travel towards the distal end, the needles 556 on the distal end have sufficient height relative to the length of travel by the foot to penetrate the suture channels.
  • Each of the channels 572 in the foot are sized to allow insertion by the tip 580 of the needles. A plurality of suture lengths 578 extend downward through grooves 584 in the shaft emerging along the top surface 560 of the foot to be positioned within one of a plurality of suture grooves within the top surface of the foot. Each suture length 578 is positioned where it can be retrieved by the corresponding needle 556 when the actuating mechanism squeezes the foot and distal end of the elongate body together in the manner described above.
  • Another preferred embodiment of a tissue suturing device 610 is illustrated in FIG. 31. The actuating mechanism 630 includes a motor 682 secured to the elongated body 616. The motor 682 rotatably connects at one end to a worm gear 684 which connects to the proximal end 640 of the needle carrier. The hand grip 622 includes a switch 686 connected to the motor 682 to control the direction and number of revolutions by the worm gear 684. Activating the switch 686 energizes the motor 682 to turn the worm gear 684 and advance the needle carrier 624 along the shaft 628 within the elongated body 616. Once the needle carrier 624 has advanced to retrieve the sutures in the foot 626, the motor 682 is stopped by manually deactivating the switch 686 or by using an automatic cut-off. The switch 686 can then be activated to have the motor 682 turn the worm gear 684 in the opposite direction and reverse the travel of the needle carrier 624 to pass the sutures proximally through the tissue. A power source 688 for the motor 682 is included within the elongated body 616 although an external power source can also be used.
  • FIG. 31 also illustrates a graft anastomoses assembly 700 which includes a graft suturing device 710 as a second component. A preferred embodiment of the graft suturing device 710 is illustrated in FIGS. 31 and 32. The graft suturing device 710 reliably deploys a uniform graft suture pattern in a graft wall. The graft suturing device 710 is useable separately for suturing any type of graft, whether or not as part of an anastomoses procedure. Optionally, the graft suturing device 710 can interlock with a tissue suturing device like 610 to provide alignment between the suture patterns in the tissue wall and a graft wall The graft suturing device 710 includes a graft needle carrier 724, a graft foot 726 attached to a shaft 728 which extends into the elongated body 616 of the tissue suturing device 610, and the actuating mechanism 630 which can be the same as used by the tissue suturing device 610.
  • The graft needle carrier 724 includes a distal end 744 having a mounting surface with an integral cutting blade 746 thereon. The cutting blade 746 has a circular shape. The distal end 744 of the needle carrier includes a plurality of graft needles 756 attached thereto and extending in a generally perpendicular direction. The graft needles 756 are arranged in a predetermined pattern which matches a corresponding graft suture pattern 758. The graft needles 756 are positioned at approximately uniform intervals around the circumference of the wall of the graft end 782 (as seen in FIG. 32). The height of each of the graft needles 756 from the surface of the distal end 744 of the graft needle carrier to its tip 780 is slightly higher than the height of the graft cutting blade so that the needles engage the graft wall just as, or slightly before, the edge of the cutting blade 746 engages the wall near the graft end 782. Having the needles 756 engage the wall near the graft end 782 before, or simultaneously with, the cutting blade 746 allows the wall of the graft end 782 to be captured and retained in position to form the desired suture pattern 758 even after the edge of the cutting blade 746 cuts the wall near the graft end 782.
  • Another suitable embodiment of the cutting blade 746 preferably has a decreasing depth profile forming a decreasing gradient or slant from the one side of the graft needle carrier 724. The decreasing gradient allows the end of the cutting blade edge to engage and cut the graft end 782 in an oblong shape. The edge of the cutting blade makes the cut as the distal end 744 and graft foot 726 are squeezed progressively together. The present invention also includes embodiments wherein the cutting blade 746 has a uniform height across its length. An oblong shape or other desired shape can still be formed with a cutting blade 746 of uniform height by changing the circular shape of the cutting blade on the surface of the distal end 744 to the desired shape.
  • Referring specifically to FIG. 31, the graft foot 726 has a top surface 760 facing the distal end 744 of the graft needle carrier and an opposing bottom surface. The top surface 760 has a graft groove which corresponds in position to the graft cutting blade on the distal end 744 of the graft needle carrier. The graft groove is of sufficient size to accommodate a portion of the edge of the graft cutting blade below the plane of the top surface to facilitate the making of the cut. Located near the circumference of the top surface is a plurality of suture channels 772 extending through the depth of the graft foot to the bottom surface. The pattern of the suture channels 772 on the top surface corresponds to the pattern of graft needles on the distal end 744 of the graft needle carrier. As the distal end 744 of the graft needle carrier travels toward the top surface of the graft foot, the graft needles 756 have sufficient height relative to the length of travel by the graft needle carrier 724 to penetrate the channels 772.
  • Each of the suture channels 772 in the graft foot are sized to releasably retain a suture length 778, preferably the end 776 of the suture as previously described. Although it is preferred to position the suture end 776 approximately flush with the top surface of the foot, it is suitable for the suture end to be in any position where it can be retrieved or engaged by the corresponding graft needle 756 or other retrieving device or means when the actuating mechanism squeezes the foot and the needle carrier together. The suture lengths 778 extend within a lumen 780 in the graft shaft 728 to the surface of the distal end 744 of the graft needle carrier where a slot in the cutting blade allows the suture lengths 778 to extend to the external side of the elongated body 616 as previously described with regard to the tissue suturing device 610. The graft shaft 728 extends to connect to the shaft 628 of the tissue suturing device or can be integrally made as a one-piece member.
  • The actuating mechanism 630 connects to the graft needle carrier 724 in the same manner as between the actuating mechanism and the needle carrier 624 of the tissue suturing device 610 in any of the embodiments previously described. FIG. 31 illustrates one such embodiment wherein the actuating mechanism includes the motor 682 secured to the elongated body. The motor 682 rotatably connects on the opposite end to a second worm gear 784 which connects to the proximal end 740 of the graft needle carrier. The hand grip 622 includes a switch 686 connected to the motor to control the direction and number of revolutions by the worm gear. Activating the switch energizes the motor to turn the worm gear and advance the needle carrier along the shaft within the elongated body. Once the graft needle carrier 724 has advanced to retrieve the suture ends 776 in the foot 726, the motor is stopped by manually deactivating the switch or by using an automatic cut-off. The switch 686 can then be activated to have the motor turn the second worm gear 784 in the opposite direction and reverse the travel of the needle carrier to pass the sutures proximally through the tissue. Although one embodiment of the cutting blade and the actuating mechanism is illustrated, alternative embodiments are suitable for use with the present invention as may be apparent to one of ordinary skill in is the art.
  • Two other embodiments of a graft suturing devices 810 are shown in FIGS. 33-34 wherein the needles and suture channels are positioned on the opposite components of the device compared to the previously described embodiments. The graft suturing devices 810 integrally mounts the foot 826 on the proximal end 820 of the elongated body 816. A shaft 828 extends from the proximal end 820 of the elongated body 816 to connect to the needle carrier 824 and to an actuating mechanism (not shown). A graft 800 is pulled over the needle carrier 824 and extends toward the foot 826. The foot 826 includes suture channels 872 which releasably retain sutures 874 and are in alignment with needles 856 on the needle carrier. As previously described, the needles 856 move axially to engage the sutures 874 and retrieve the sutures through the graft 800.
  • Specifically, FIG. 33 ties one end 802 of the graft to the shaft 828 with a tie 804. A cutting blade 846 is located inwardly of the needles 856 toward the shaft 828. As a result, when the foot 826 and needle carrier 824 are drawn together, the sutures 874 will be drawn through the graft 800 from the external wall 806 to the internal wall 808. The sutures 874 can then be pulled out through the open end 802 of the graft once the graft is removed from the needle carrier 824.
  • In FIG. 34, the graft 800 is positioned over the shaft 828 and pulled through the needles carrier 824. The graft 800 is further positioned over the top surface 860 of the foot to provide the cutting blade 846 with proper alignment to cut the graft in the proximity of the end 802. Since the graft 800 extends through the needle carrier 824, an indexing device 830 provides the proper alignment for the needles 856 to engage the sutures 874 and for the cutting blade 846 to cut the graft end 802. Optionally, the needle carrier 824 may be detachable from the remainder of the graft suturing device 810.
  • Another embodiment of a graft suturing device 910 is shown in FIGS. 35-37 which includes a graft needle carrier 924, a graft foot 926 attached to a shaft 928. Optionally, the graft shaft 928 may extend into the graft anastomosis assembly. A graft 900 is positioned coaxially about the graft foot 926 and held in position with a tie 909. The graft foot 926 contains suture channels 972 for releasably retaining sutures 974. The sutures 974 extend from the graft foot through suture grooves 984. The suture channels 972 are positioned in an axial position relative to the longitudinal axis along the graft shaft 928. As a result, the needles 956 carried by the needle carrier 924 must also retrieve the sutures 972 in an axial position The needles 956 are deployed radially inwardly through the graft 900 in a regularly spaced pattern of penetration sites or ports in the graft.
  • FIG. 36 specifically illustrates the details of the graft suturing device that permits an inward radial deployment of the needles 956. The graft suturing device 910 further includes an outer cam 902 which deploys as a sleeve around the needle carrier 924 and needles 956. The cam 902 includes ridges 904 and troughs 906 along a surface 908 of the interior circumference of the cam. The cam 902 is rotated about the longitudinal axis along the graft shaft 928 in either a clockwise or counterclockwise direction as indicated by arrows 988. Each of the needles 956 includes a tail 990 which abuts and slides along the interior surface 908. The rotation of the cam 902 moves each of the needles 956 in either an inward or outward direction as the tail 990 encounters either the ridges 904 or troughs 906 respectively. The needles 956 are driven inwardly through the graft 900 to engage the sutures 974. Then the direction of the needles' movement is reversed and the needles 956 move outwardly from the graft 900 with the sutures 974 in tow. The return of the needles 956 to their initial position is assisted by a spring 992 coiled around the needles shaft. Subsequently, the sutures 974 can be released from the needles 956 and the graft 900 can be removed from the cam 902 and graft foot 926.
  • As illustrated in FIG. 36, the needles 956 move simultaneously inward. In another embodiment, the needles can move inward successively by changing the position of the ridges 904 and troughs 906 relative to each one another.
  • Other embodiments of the cam 902 provide means for moving the needles 956 outwardly without using a spring-like member. For example, FIG. 37 illustrates using a rail 994 to which the tail 990 of one of the needles is rotatably secured. As the cam 902 rotates in the direction of the arrows 988 and slides along the rail 994, the needle 956 is moved inward and then is positively moved outward as the cam advanced. In a similar example, the interior surface 908 can include the rail to which the tail 990 of the needle is slidably attached. As the cam 902 is rotated, the tail 990 slides along the rail from trough 906 to ridge 904 and vice versa Since the tail 990 is positively attached to the interior surface 908, the needle moves outward without the assistance of a spring-like member.
  • Referring to FIG. 31, the graft suturing device 710 and the tissue suturing device 610 can be used solely independent (one without the other) or operating together simultaneously or successively. The inventive tissue suturing device 610 and inventive graft suturing device 710 described herein can also be used solely independent with other devices or methods (conventional or not) to perform the other device's function in anastomosis assembly and method. For example, the graft suturing device 710 described in the related applications can be readily adapted to interlock with the tissue suturing device 610 herein.
  • Preferably, the graft suturing device can be loaded with the graft prior to the insertion and operation of the tissue suturing device. The two devices are then combined into one assembly to provide proper orientation of the graft to the deployed suture pattern in the vessel wall. This results in a two-stroke method being used wherein one needle passes the suture through the graft and a second needle passes the suture through the vessel wall.
  • In another embodiment, a one-stroke method can be used with the present invention. For example, using only the vessel suturing device, the needles can first pass the suture through the proximal side of the graft before they are attached to the distal Mend of the vessel suturing device. Then, as described above, the vessel suturing device is inserted through the vessel wall. The suture can then be passed through the distal side of the vessel wall to complete the loop.
  • The present invention also provides a tissue suturing device and an anastomosis assembly which inserts a portion of the tissue suturing device from a remote access site other than the site of the tissue suturing or anastomosis. Several embodiments of the tissue suturing and/or graft anastomosis assembly which uses a remote access site are illustrated in FIGS. 38-40.
  • FIGS. 38 and 40 illustrate a remote access site 1000 in the tissue wall 1012 of a blood vessel 1014. A remote foot 1026 is introduced into the blood vessel 1014 through the remote access site 1000. The remote foot 1026 is attached near its heel end wall 1002 to a guide wire 1004 which is controlled at the other end by an actuating mechanism 1030.
  • The remote foot 1026 has a top surface 1060 with a groove 1064 thereon for facing the distal end of a needle carrier and corresponding to the position of a cutting blade as discussed herein. Located near the circumference 1070 of the top surface 1060 is a plurality of suture channels 1072 extending into the foot 1026. The pattern of the suture channels 1072 on the top surface 1060 corresponds to the pattern of needles on the distal end of the needle carrier that will be attached to the remote foot 1026 at the site where the suture pattern is desired. Each of the suture channels 1072 in the remote foot are sized to releasably retain a suture 1074 having a suture body or length 1078 terminating at one end 1076. Preferably, the end 1076 of the suture is releasably retained in one of the suture channels 1072.
  • The sutures lengths 1078 extend across the top surface 1060 of the remote foot and to terminate at the bottom of a plug 1006. The plug 1006 releasably retains the ends 1094 of the sutures 1074 opposite the suture ends 1076 retained in the suture channels 1072 so the suture ends 1094 may be individually identified as to their position in the suture pattern and retrieved by the operator. The plug 1006 is detachable from the remote foot by the actuating mechanism 1030. Once the remote foot 1026 has been guided to the desired cite of the suture pattern, the plug 1006 is released from the remote foot by the actuating mechanism 1030 and driven through the tissue wall 1012 of the blood vessel by a releasable connection to a second wire 1009 associated with the guide wires 1004 as seen in FIG. 39. To assist in making an initial aperture 1052 through the tissue layer 1012 for the plug 1006 to pass through, a dilating blade 1008 is preferably mounted on the top surface of the plug. The suture lengths 1078 have an excess amount of length sufficient to allow the plug 1006 to be pulled free of the blood vessel 1014. The excess amount of length is coiled within the remote foot 1026 beneath the bottom surface of the plug 1006 before the plug is released. After the plug 1006 has passed through the tissue wall 1012, the opposite suture ends 1094 can be released.
  • With the release of the plug 1006, a depression 1098 corresponding to the shape of the plug is left in the top surface 1060 of the remote foot. This depression is adapted to securely receive the distal end of a shaft of a tissue suturing device (not shown) as previously described herein. The shaft is advanced through the initial aperture 1052 into the depression 1098. Attachment of the shaft of the tissue suturing device to the remote foot 1026 provides proper alignment of the needle carrier and needles of the tissue suturing device with the suture channels 1072 of the remote foot.
  • Optionally, the plug 1006 can be another embodiment of the graft foot previously discussed herein. Referring to FIG. 39, the plug 1006 includes suture channels 1096 for releasably retaining the opposite suture ends 1094. The suture channels 1096 are illustrated in an axial position relative to the longitudinal axis. The plug 1006 can then be attached to the shaft or other positioning device on a graft suturing device as previously described herein specifically with regard to FIG. 35.
  • An alternate embodiment of the plug 1006 positions the suture channels 1096 along the longitudinal axis so that suture channels 1072 are flush with the top surface of the plug 1006. With this configuration of suture channels 1072, the plug can be attached to the shaft of a graft suturing device as previously described herein specifically with regard to FIG. 31.
  • Another embodiment of a tissue suturing device and an anastomosis assembly which inserts a portion of the tissue suturing device from a remote access site other than the site of the tissue suturing or anastomosis is illustrated in FIG. 40. The tissue suturing device 1110 in this embodiment uses a needle carrier 1124, a shaft 1128, and a remote foot 1126 as previously described with regard to the embodiments of the non-remote tissue suturing device. The remote foot 1126, however, is attached to a rigid extension 1102 which connects at the other end to the shaft 1128. Similarly, the needle carrier 1124 is attached to a rigid extension 1104 which connects at the other end to the shaft 1128. The extensions 1102 and 1104 allow the remote foot 1126 to be inserted through the tissue layer 1112 into a blood vessel 1114 at a remote access site 1100. As previously described with regard to the various embodiments of the tissue suturing devices, the needle carrier 1124 has a shape corresponding to the remote foot 1126 so that the needles 1156 are aligned with the suture channels 1172.
  • The suture channels 1172 releasably retain sutures 1174 at one of the ends 1176 while the suture lengths 1178 extend across the top surface 1160 of the remote foot through suture grooves 1184 near the perimeter of the remote foot. The opposite ends 1194 of the sutures terminate in a plug 1106 which is releasably retained flush with the top surface 1160 of the remote foot. One of the needles like 1157 on the needle carrier is aligned to retrieve the plug 1106 and draw it through the tissue layer 1112. After the plug 1106 has been drawn through the tissue layer 1112, the opposite ends 1194 of the sutures can be freed from the plug.
  • The tissue suturing device 1110 demonstrates that a suture pattern can be deployed at a deployment site 1108 other than the remote access site. Furthermore, the tissue suturing device 1110 does not need an initial aperture at the suture deployment site 1108 in order to deploy the suture pattern. The alignment between the needles 1156 and the suture channels 1172 is provided by the extensions 1102 and 1104 without a shaft extending through an aperture at the deployment site 1108.
  • Optionally, a cutting blade 1146 can be mounted on the needle carrier 1124 and is positioned to make an incision at the deployment site 1108 to form an anastomosis site different from the remote access site 1100 and not simply enlarge an initial insertion site. The cutting blade 1146 is preferably aligned with the groove 1164 on the top surface 1160 of the remote foot and avoids contact with the suture lengths 1178. Rather than drawing the plug 1106 through a separate port in the tissue layer 1112, the plug 1106 can be drawn through the incision made by the cutting blade 1146.
  • With the various inventive embodiments, alternate means of fastening the two ends of the suture body together are suitable. For example and not for limitation, the two ends of the suture body can be simply tied in a knot manually or, optionally, with a knot device as is described in copending application U.S. Ser. No. 08/552,211 filed Nov. 2, 1995.
  • Even though the suture devices are illustrated herein with regard to vascular tissue, it should be understood that the present invention is riot limited to any particular type of tissue. Generally, the devices of the present invention can be used for suturing all types of tissue in many applications. More specifically, the present invention can close apertures in tissue or bind layers of tissue together such as in anastomoses. For example, and not for limitation, the present invention can be used to close apertures in the septum of the heart such as with a atrial septal defect or a patent foramen ovale. The present invention can deploy sutures around the annulus of a valve for the heart or other organs and around the proximity of a prosthesis.
  • The present invention can be used in anastomoses to provide a direct or indirect communication between two blood vessels, lymphatics, hollow viscera, or other tubular structures. Although the anastomoses between an aperture in a vessel wall and the end of a graft is specifically illustrated, the present invention can also be used to anastomose tubular structures in other configurations such end-to-end, end-to-side, in continuity, conjoined, or closed-end. Examples of specific applications include the CABG methods described herein using vessels and tubular grafts such as the aorta, veins, the internal mammary artery, or superficial temporal artery. An example of an anastomosis involving an organ instead of a blood vessel is a Roux-en-Y operation which implants the distal end of the divided jejunum with the proximal end into the side of the jejunum at a suitable distance below the first to form a Y-shape pattern.
  • The suturing devices described herein, particularly the tissue suturing devices, can be used on grafts which do not have an open end. In some instances, the open end of a graft is closed off by a clamp or other closure means. An incision is made in the graft to allow penetration of the foot of the tissue suturing device of the present invention into the side of the graft. The tissue suturing device deploys the desired suture pattern and is withdrawn from the graft. The suture pattern is available for attachment to a corresponding suture pattern or other fastener arrangement. In an anastomoses procedure, the corresponding suture pattern is deployed on the selected vessel,
  • The present invention can be used with catheter-based surgical techniques wherein one of the elements of the devices described herein is delivered to the suture site through a remote or alternate access location. For example, the vessel suturing device described herein can be introduced to the aorta through the femoral artery to the site where the sutures are deployed. The present invention allows indirect visualization of the desired deployment site via marker ports, crystals or the like.
  • While particular embodiments of the invention have been herein described in detail, it is to be appreciated that the present invention encompasses variations and combinations thereof, as may be apparent to one of ordinary skill from this disclosure. It is therefore to be understood that within the scope of the appended claims, the invention may be practiced otherwise than as specifically described herein.

Claims (25)

1. A device for closing an opening in tissue, the device comprising:
an elongated body having a proximal end and a distal end, a flexible sheath extending from the distal end of the elongated body and carrying a length of suture, with a cuff molded on an end of the length of suture, to close the opening in the tissue, the length of suture being deployable to penetrate the tissue wall, the elongated body being advanceable toward the opening along a guidewire to position the length of suture substantially adjacent the opening, and further comprising at least one needle advanceable through tissue surrounding the opening to deploy the length of suture through the tissue wall, the cuff having an inner space adapted to receive a tip of one needle of the at least one needle following advancement of the at least one needle through the tissue.
2. The device of claim 1, wherein the flexible sheath has a distal end, wherein the flexible sheath defines a guidewire entry port at or near the flexible sheath distal end, and wherein the flexible sheath defines a guidewire exit port situated along the flexible sheath at a location proximal to the guidewire entry port.
3. The device of claim 1, wherein the flexible sheath is sized to maintain hemostasis at the opening when the flexible sheath is positioned through the opening.
4. The device of claim 1, wherein the elongated body has a proximal end and a distal end, and further comprising a flexible sheath extending from the distal end of the elongated body, the flexible sheath defining a suture storage lumen.
5. The device of claim 1, wherein the needle has a barbed end for insertion through the cuff to attach the needle to the length of suture to deploy the suture through the tissue wall.
6. A device for closing an opening in tissue, the device comprising:
a shaft having a proximal end and a distal end;
a foot near the distal end of the shaft;
a length of suture having an end and a cuff molded on the end of the suture, the cuff being releasably retained in the foot; and
at least one needle arranged on the device to be advanceable through the tissue surrounding the opening, the needle having a barbed end for insertion through the cuff to attach the needle to the suture to draw the suture through the tissue, the cuff having an inner space adapted to receive a tip of one needle of the at least one needle following advancement of the at least one needle through the tissue.
7. The device of claim 6, wherein the cuff is molded as one piece from the suture material.
8. The device of claim 6, wherein the cuff is a ring and the length of suture is attached in a perpendicular manner to one side of the ring.
9. The device of claim 6, further comprising a flexible sheath extending from the distal end of the shaft, the flexible sheath defining a guidewire lumen.
10. The device of claim 9, wherein the sheath defines a suture storage lumen.
11. A method for closing an opening in tissue, the method comprising:
advancing an elongated body, the elongated body having a proximal end, a distal end, at least one needle, and a flexible sheath extending from the distal end of the elongated body and carrying a length of suture with a cuff molded on an end of the length of suture, along a guidewire to position the length of suture substantially adjacent the opening,
advancing the at least one needle through tissue surrounding the opening; and
deploying the length of suture through the tissue wall, the cuff having an inner space adapted to receive a tip of one needle of the at least one needle following advancement of the at least one needle through the tissue through the opening.
12. The method of claim 11, further comprising partially withdrawing the elongated body leaving a portion of the flexible sheath in the opening to maintain hemostasis.
13. The method of claim 11, further comprising advancing a needle through the tissue adjacent the opening to attach the needle to a length of suture.
14. The method of claim 13, further comprising advancing a barbed end of the needle through the cuff.
15. The method of claim 11, wherein the flexible sheath defines a guidewire lumen, and the method further comprises positioning a guidewire through the opening and loading the guidewire into the guidewire lumen to advance the flexible sheath through the opening.
16. A method for closing an opening in tissue, the method comprising:
providing a suturing device having a shaft, the shaft having a distal end;
advancing at least a portion the shaft through the opening;
positioning a length of suture on a distal side of the tissue, the suture having an end and a molded cuff on the end of the suture;
advancing a needle through the tissue adjacent the opening and through the cuff to attach the needle to the length of suture; and
withdrawing the needle and the suture through the tissue.
17. The method of claim 16, further comprising providing a flexible sheath on the distal end of the shaft.
18. The method of claim 17, further comprising partially withdrawing the suturing device leaving a portion of the flexible sheath in the opening to maintain hemostasis.
19. The method of claim 17, wherein the flexible sheath defines a guidewire lumen, and the method further comprises positioning a guidewire through the opening and loading the guidewire into the guidewire lumen to advance the suturing device through the opening.
20. The method of claim 16, further comprising tying a knot in the suture to close the opening.
21. A method for closing an opening in tissue, the method comprising:
inserting a guidewire through the opening in the tissue;
providing a closing device adapted to penetrate the tissue and permit closing of the opening carrying an implant with a cuff molded on an end of the implant;
using the guidewire to guide a portion of the closing device to a position substantially adjacent the opening; and
penetrating the tissue to at least partially close the opening.
22. The method of claim 21, wherein penetrating the tissue to at least partially close the opening includes deploying the implant.
23. The method of claim 22, wherein the implant is a length of suture.
24. The method of claim 22, further comprising providing a needle on the closing device and penetrating the tissue wall with the needle to advance the implant into the tissue wall.
25. The method of claim 24, further comprising:
positioning a portion of the suture on a distal side of the tissue, the molded cuff releasably retained on the closing device;
advancing the needle through the tissue adjacent the opening and through the cuff to attach the needle to the length of suture; and
withdrawing the needle and the suture through the tissue.
US12/182,836 1992-12-10 2008-07-30 Device and Methods for Suturing Tissue Abandoned US20080287967A1 (en)

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US07/989,611 US5417699A (en) 1992-12-10 1992-12-10 Device and method for the percutaneous suturing of a vascular puncture site
US08/259,410 US5779719A (en) 1992-12-10 1994-06-14 Device and method for the percutaneous suturing of a vascular puncture site
US08/824,031 US6036699A (en) 1992-12-10 1997-03-26 Device and method for suturing tissue
US08/883,246 US6355050B1 (en) 1992-12-10 1997-06-26 Device and method for suturing tissue
US10/033,689 US20020095164A1 (en) 1997-06-26 2001-12-28 Device and method for suturing tissue
US10/737,668 US7445626B2 (en) 1992-12-10 2003-12-16 Device and method for suturing tissue
US12/182,836 US20080287967A1 (en) 1992-12-10 2008-07-30 Device and Methods for Suturing Tissue

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US08/252,124 Expired - Lifetime US5613974A (en) 1992-12-10 1994-06-01 Apparatus and method for vascular closure
US08/259,410 Expired - Lifetime US5779719A (en) 1992-12-10 1994-06-14 Device and method for the percutaneous suturing of a vascular puncture site
US08/916,353 Expired - Lifetime US5860991A (en) 1992-12-10 1997-08-22 Method for the percutaneous suturing of a vascular puncture site
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US08/259,410 Expired - Lifetime US5779719A (en) 1992-12-10 1994-06-14 Device and method for the percutaneous suturing of a vascular puncture site
US08/916,353 Expired - Lifetime US5860991A (en) 1992-12-10 1997-08-22 Method for the percutaneous suturing of a vascular puncture site

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Cited By (56)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7842048B2 (en) 2006-08-18 2010-11-30 Abbott Laboratories Articulating suture device and method
US7846170B2 (en) 1999-03-04 2010-12-07 Abbott Laboratories Articulating suturing device and method
US7850701B2 (en) 1999-03-04 2010-12-14 Abbott Laboratories Articulating suturing device and method
US7883517B2 (en) 2005-08-08 2011-02-08 Abbott Laboratories Vascular suturing device
US7931669B2 (en) 2000-01-05 2011-04-26 Integrated Vascular Systems, Inc. Integrated vascular device with puncture site closure component and sealant and methods of use
US20110230899A1 (en) * 2009-10-23 2011-09-22 Medi-Globe Vascutec Gmbh Surgical device for feeding at least one suture thread through the edge area of a tissue opening of an individual and method for operating such a device
US8038688B2 (en) 1999-03-04 2011-10-18 Abbott Laboratories Articulating suturing device and method
US8048108B2 (en) 2005-08-24 2011-11-01 Abbott Vascular Inc. Vascular closure methods and apparatuses
US8083754B2 (en) 2005-08-08 2011-12-27 Abbott Laboratories Vascular suturing device with needle capture
US8128644B2 (en) 2000-12-07 2012-03-06 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8137364B2 (en) 2003-09-11 2012-03-20 Abbott Laboratories Articulating suturing device and method
US20120130403A1 (en) * 2010-11-22 2012-05-24 Brenner Jacob S Device and method for treatment of hemorrhoids
US8202281B2 (en) 2002-12-31 2012-06-19 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US8211122B2 (en) 2003-09-26 2012-07-03 Abbott Laboratories Device for suturing intracardiac defects
US8267947B2 (en) 2005-08-08 2012-09-18 Abbott Laboratories Vascular suturing device
US8313497B2 (en) 2005-07-01 2012-11-20 Abbott Laboratories Clip applier and methods of use
US8343089B2 (en) 2003-11-21 2013-01-01 Silk Road Medical, Inc. Method and apparatus for treating a carotid artery
US8419753B2 (en) 2003-12-23 2013-04-16 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US8574245B2 (en) 2008-08-13 2013-11-05 Silk Road Medical, Inc. Suture delivery device
US8574244B2 (en) 2007-06-25 2013-11-05 Abbott Laboratories System for closing a puncture in a vessel wall
US8579932B2 (en) 2002-02-21 2013-11-12 Integrated Vascular Systems, Inc. Sheath apparatus and methods for delivering a closure device
US8590760B2 (en) 2004-05-25 2013-11-26 Abbott Vascular Inc. Surgical stapler
US8603136B2 (en) 2000-12-07 2013-12-10 Integrated Vascular Systems, Inc. Apparatus and methods for providing tactile feedback while delivering a closure device
US8663252B2 (en) 2010-09-01 2014-03-04 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US8690910B2 (en) 2000-12-07 2014-04-08 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8740834B2 (en) 2007-07-18 2014-06-03 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US8758397B2 (en) 2005-08-24 2014-06-24 Abbott Vascular Inc. Vascular closure methods and apparatuses
US8758396B2 (en) 2000-01-05 2014-06-24 Integrated Vascular Systems, Inc. Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use
US8784447B2 (en) 2000-09-08 2014-07-22 Abbott Vascular Inc. Surgical stapler
US8808310B2 (en) 2006-04-20 2014-08-19 Integrated Vascular Systems, Inc. Resettable clip applier and reset tools
US8858490B2 (en) 2007-07-18 2014-10-14 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US8858573B2 (en) 2012-04-10 2014-10-14 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8864777B2 (en) 2011-01-28 2014-10-21 Anchor Orthopedics Xt Inc. Methods for facilitating tissue puncture
US8864778B2 (en) 2012-04-10 2014-10-21 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8893947B2 (en) 2007-12-17 2014-11-25 Abbott Laboratories Clip applier and methods of use
US8905937B2 (en) 2009-02-26 2014-12-09 Integrated Vascular Systems, Inc. Methods and apparatus for locating a surface of a body lumen
US8915933B2 (en) 2012-11-02 2014-12-23 Medtronic Vascular, Inc. Suturing device having a retractable distal tip and method for sealing an opening in a blood vessel or other biological structure
US8920442B2 (en) * 2005-08-24 2014-12-30 Abbott Vascular Inc. Vascular opening edge eversion methods and apparatuses
US8926633B2 (en) 2005-06-24 2015-01-06 Abbott Laboratories Apparatus and method for delivering a closure element
US9011467B2 (en) 2008-08-13 2015-04-21 Silk Road Medical, Inc. Suture delivery device
US9089674B2 (en) 2000-10-06 2015-07-28 Integrated Vascular Systems, Inc. Apparatus and methods for positioning a vascular sheath
US9149276B2 (en) 2011-03-21 2015-10-06 Abbott Cardiovascular Systems, Inc. Clip and deployment apparatus for tissue closure
US9241707B2 (en) 2012-05-31 2016-01-26 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US9301746B2 (en) 2013-10-11 2016-04-05 Abbott Cardiovascular Systems, Inc. Suture-based closure with hemostatic tract plug
US9370353B2 (en) 2010-09-01 2016-06-21 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US9414822B2 (en) 2011-05-19 2016-08-16 Abbott Cardiovascular Systems, Inc. Tissue eversion apparatus and tissue closure device and methods for use thereof
US9456811B2 (en) 2005-08-24 2016-10-04 Abbott Vascular Inc. Vascular closure methods and apparatuses
US9669191B2 (en) 2008-02-05 2017-06-06 Silk Road Medical, Inc. Interventional catheter system and methods
US10159479B2 (en) 2012-08-09 2018-12-25 Silk Road Medical, Inc. Suture delivery device
US10182801B2 (en) 2014-05-16 2019-01-22 Silk Road Medical, Inc. Vessel access and closure assist system and method
US10383620B2 (en) 2011-08-18 2019-08-20 Anchor Orthopedics Xt Inc. Suture passing instrumentation and methods of use thereof
US10426449B2 (en) 2017-02-16 2019-10-01 Abbott Cardiovascular Systems, Inc. Articulating suturing device with improved actuation and alignment mechanisms
US20210177269A1 (en) * 2018-08-24 2021-06-17 Canon Kabushiki Kaisha Image processing apparatus and image processing method and non-transitory computer-readable medium
US11439378B2 (en) 2009-01-09 2022-09-13 Abbott Cardiovascular Systems, Inc. Closure devices and methods
US11589856B2 (en) 2003-01-30 2023-02-28 Integrated Vascular Systems, Inc. Clip applier and methods of use
US11672518B2 (en) 2012-12-21 2023-06-13 Abbott Cardiovascular Systems, Inc. Articulating suturing device

Families Citing this family (998)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7060077B2 (en) 1992-09-04 2006-06-13 Boston Scientific Scimed, Inc. Suturing instruments and methods of use
US5713910A (en) * 1992-09-04 1998-02-03 Laurus Medical Corporation Needle guidance system for endoscopic suture device
US5540704A (en) * 1992-09-04 1996-07-30 Laurus Medical Corporation Endoscopic suture system
US5364408A (en) * 1992-09-04 1994-11-15 Laurus Medical Corporation Endoscopic suture system
US5578044A (en) * 1992-09-04 1996-11-26 Laurus Medical Corporation Endoscopic suture system
US6048351A (en) * 1992-09-04 2000-04-11 Scimed Life Systems, Inc. Transvaginal suturing system
US6036699A (en) * 1992-12-10 2000-03-14 Perclose, Inc. Device and method for suturing tissue
US20020095164A1 (en) * 1997-06-26 2002-07-18 Andreas Bernard H. Device and method for suturing tissue
US6355050B1 (en) 1992-12-10 2002-03-12 Abbott Laboratories Device and method for suturing tissue
US5799661A (en) * 1993-02-22 1998-09-01 Heartport, Inc. Devices and methods for port-access multivessel coronary artery bypass surgery
US6478029B1 (en) 1993-02-22 2002-11-12 Hearport, Inc. Devices and methods for port-access multivessel coronary artery bypass surgery
US6494211B1 (en) 1993-02-22 2002-12-17 Hearport, Inc. Device and methods for port-access multivessel coronary artery bypass surgery
US5797960A (en) * 1993-02-22 1998-08-25 Stevens; John H. Method and apparatus for thoracoscopic intracardiac procedures
US8795332B2 (en) 2002-09-30 2014-08-05 Ethicon, Inc. Barbed sutures
US6241747B1 (en) 1993-05-03 2001-06-05 Quill Medical, Inc. Barbed Bodily tissue connector
US5830125A (en) * 1993-08-12 1998-11-03 Scribner-Browne Medical Design Incorporated Catheter introducer with suture capability
US5527322A (en) * 1993-11-08 1996-06-18 Perclose, Inc. Device and method for suturing of internal puncture sites
US5545178A (en) * 1994-04-29 1996-08-13 Kensey Nash Corporation System for closing a percutaneous puncture formed by a trocar to prevent tissue at the puncture from herniating
US5531759A (en) * 1994-04-29 1996-07-02 Kensey Nash Corporation System for closing a percutaneous puncture formed by a trocar to prevent tissue at the puncture from herniating
WO1995032671A1 (en) * 1994-06-01 1995-12-07 Perclose, Inc. Method and device for providing vascular hemostasis
US5573540A (en) * 1994-07-18 1996-11-12 Yoon; Inbae Apparatus and method for suturing an opening in anatomical tissue
US5549633A (en) * 1994-08-24 1996-08-27 Kensey Nash Corporation Apparatus and methods of use for preventing blood seepage at a percutaneous puncture site
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
JP3729861B2 (en) * 1995-06-07 2005-12-21 メッドトロニック・インコーポレイテッド Wound closure device
US5902311A (en) * 1995-06-15 1999-05-11 Perclose, Inc. Low profile intraluminal suturing device and method
US5846253A (en) * 1995-07-14 1998-12-08 C. R. Bard, Inc. Wound closure apparatus and method
US5700273A (en) * 1995-07-14 1997-12-23 C.R. Bard, Inc. Wound closure apparatus and method
US5810846A (en) * 1995-08-03 1998-09-22 United States Surgical Corporation Vascular hole closure
US6117144A (en) * 1995-08-24 2000-09-12 Sutura, Inc. Suturing device and method for sealing an opening in a blood vessel or other biological structure
US6562052B2 (en) * 1995-08-24 2003-05-13 Sutura, Inc. Suturing device and method
US5653717A (en) * 1995-08-28 1997-08-05 Urohealth Systems, Inc. Wound closure device
US6183497B1 (en) * 1998-05-01 2001-02-06 Sub-Q, Inc. Absorbable sponge with contrasting agent
US6071300A (en) * 1995-09-15 2000-06-06 Sub-Q Inc. Apparatus and method for percutaneous sealing of blood vessel punctures
US5674231A (en) * 1995-10-20 1997-10-07 United States Surgical Corporation Apparatus and method for vascular hole closure
US6287322B1 (en) * 1995-12-07 2001-09-11 Loma Linda University Medical Center Tissue opening locator and everter and method
US6004341A (en) * 1996-12-05 1999-12-21 Loma Linda University Medical Center Vascular wound closure device
US6524326B1 (en) 1995-12-07 2003-02-25 Loma Linda University Medical Center Tissue opening locator and everter and method
US5814065A (en) * 1996-02-09 1998-09-29 Cordis Corporation Suture delivery tool
US5741276A (en) * 1996-03-28 1998-04-21 Innovative Surgical Instruments Apparatus for facilitating the performance of surgical procedures such as the placement of sutures, ligatures and the like
US6436109B1 (en) 1996-06-11 2002-08-20 X-Site, L.L.C. Device and method for suturing blood vessels and the like
US5855585A (en) * 1996-06-11 1999-01-05 X-Site, L.L.C. Device and method for suturing blood vessels and the like
US5728133A (en) * 1996-07-09 1998-03-17 Cardiologics, L.L.C. Anchoring device and method for sealing percutaneous punctures in vessels
US5718717A (en) 1996-08-19 1998-02-17 Bonutti; Peter M. Suture anchor
US6083244A (en) * 1996-09-13 2000-07-04 Tendon Technology, Ltd. Apparatus and method for tendon or ligament repair
US6984241B2 (en) * 1996-09-13 2006-01-10 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
US7611521B2 (en) * 1996-09-13 2009-11-03 Tendon Technology, Ltd. Apparatus and methods for tendon or ligament repair
US5766183A (en) * 1996-10-21 1998-06-16 Lasersurge, Inc. Vascular hole closure
US6261320B1 (en) 1996-11-21 2001-07-17 Radiance Medical Systems, Inc. Radioactive vascular liner
US6340359B1 (en) * 1996-12-20 2002-01-22 David G. Silverman Process for reversibly compressing prechannelled/preweakened diaphragms
US5782861A (en) * 1996-12-23 1998-07-21 Sub Q Inc. Percutaneous hemostasis device
US6491619B1 (en) 1997-01-31 2002-12-10 Endologix, Inc Radiation delivery catheters and dosimetry methods
US6458069B1 (en) 1998-02-19 2002-10-01 Endology, Inc. Multi layer radiation delivery balloon
US5782742A (en) 1997-01-31 1998-07-21 Cardiovascular Dynamics, Inc. Radiation delivery balloon
US5861005A (en) * 1997-02-11 1999-01-19 X-Site, L.L.C. Arterial stapling device
DE19706529C2 (en) * 1997-02-19 1999-02-25 Jobst Prof Dr Med Nitsch Percutaneous vascular occlusion system
US5876411A (en) * 1997-03-11 1999-03-02 X-Site L.L.C. Device and method for locating and sealing a blood vessel
US5931855A (en) 1997-05-21 1999-08-03 Frank Hoffman Surgical methods using one-way suture
US5810849A (en) * 1997-06-09 1998-09-22 Cardiologics, L.L.C. Device and method for suturing blood vessels and the like
US5954732A (en) * 1997-09-10 1999-09-21 Hart; Charles C. Suturing apparatus and method
US6059800A (en) * 1997-09-10 2000-05-09 Applied Medical Resources Corporation Suturing apparatus and method
FR2768324B1 (en) 1997-09-12 1999-12-10 Jacques Seguin SURGICAL INSTRUMENT FOR PERCUTANEOUSLY FIXING TWO AREAS OF SOFT TISSUE, NORMALLY MUTUALLY REMOTE, TO ONE ANOTHER
US5868762A (en) * 1997-09-25 1999-02-09 Sub-Q, Inc. Percutaneous hemostatic suturing device and method
US6171316B1 (en) 1997-10-10 2001-01-09 Origin Medsystems, Inc. Endoscopic surgical instrument for rotational manipulation
US6139556A (en) * 1997-10-29 2000-10-31 X-Site, L.L.C. Device and method for suturing blood vessels and the like
AU1923999A (en) 1998-01-30 1999-08-16 Vascular Science Inc. Medical graft connector or plug structures, and methods of making and installingsame
US6045551A (en) 1998-02-06 2000-04-04 Bonutti; Peter M. Bone suture
US5972005A (en) * 1998-02-17 1999-10-26 Advanced Cardiovascular Systems, Ind. Wound closure assembly and method of use
AU2687299A (en) 1998-02-19 1999-09-06 Radiance Medical Systems, Inc. Thin film radiation source
US6010514A (en) * 1998-03-17 2000-01-04 Burney; Bryan T. Suturing assembly and method of use
US6042601A (en) * 1998-03-18 2000-03-28 United States Surgical Corporation Apparatus for vascular hole closure
EP1067872B1 (en) 1998-03-20 2006-03-01 Boston Scientific Limited Endoscopic suture system
US7722667B1 (en) 1998-04-20 2010-05-25 St. Jude Medical, Inc. Two piece bioprosthetic heart valve with matching outer frame and inner valve
US6080167A (en) * 1998-04-28 2000-06-27 Lyell; Mark S. Anastomotic instrument
US7625352B1 (en) 1998-05-01 2009-12-01 Sub-Q, Inc. Depth and puncture control for system for hemostasis of blood vessel
US20010045575A1 (en) * 1998-05-01 2001-11-29 Mark Ashby Device and method for facilitating hemostasis of a biopsy tract
US6315753B1 (en) * 1998-05-01 2001-11-13 Sub-Q, Inc. System and method for facilitating hemostasis of blood vessel punctures with absorbable sponge
US5980539A (en) * 1998-05-06 1999-11-09 X-Site L.L.C. Device and method for suturing blood vessels and the like
US6077279A (en) * 1998-05-08 2000-06-20 X-Site L.L.C. Device and method employing adhesive for sealing blood vessels and the like
US6726704B1 (en) 1998-05-29 2004-04-27 By-Pass, Inc. Advanced closure device
US7060084B1 (en) 1998-05-29 2006-06-13 By-Pass, Inc. Vascular closure device
US20050283188A1 (en) * 1998-05-29 2005-12-22 By-Pass, Inc. Vascular closure device
AU4056499A (en) 1998-05-29 1999-12-20 By-Pass, Ltd. Vascular port device
US5910155A (en) * 1998-06-05 1999-06-08 United States Surgical Corporation Vascular wound closure system
US6048357A (en) * 1998-07-09 2000-04-11 X-Site, L.L.C. Anchoring device and method for sealing punctures in vessels
AU758665B2 (en) * 1998-07-22 2003-03-27 Angiolink Corporation Vascular suction cannula, dilator and surgical stapler
US6143004A (en) * 1998-08-18 2000-11-07 Atrion Medical Products, Inc. Suturing device
US7044134B2 (en) 1999-11-08 2006-05-16 Ev3 Sunnyvale, Inc Method of implanting a device in the left atrial appendage
US7713282B2 (en) 1998-11-06 2010-05-11 Atritech, Inc. Detachable atrial appendage occlusion balloon
US7128073B1 (en) 1998-11-06 2006-10-31 Ev3 Endovascular, Inc. Method and device for left atrial appendage occlusion
US7351249B2 (en) * 1998-11-06 2008-04-01 Neomend, Inc. Systems, methods, and compositions for achieving closure of suture sites
US6152144A (en) * 1998-11-06 2000-11-28 Appriva Medical, Inc. Method and device for left atrial appendage occlusion
US6080183A (en) * 1998-11-24 2000-06-27 Embol-X, Inc. Sutureless vessel plug and methods of use
US6110183A (en) * 1998-12-22 2000-08-29 Cook Incorporated Suture anchor device
US20050059925A1 (en) * 1999-01-15 2005-03-17 Maginot Thomas J. Catheter systems and associated methods
US20050096609A1 (en) * 1999-01-15 2005-05-05 Maginot Thomas J. Methods of performing medical procedures with catheter systems having movable member
JP2002536044A (en) * 1999-02-05 2002-10-29 イーバ コーポレイション Surgical guideline assembly and separator assembly for use during a surgical procedure
AU2759500A (en) * 1999-02-10 2000-08-29 Sub-Q Inc. Device and method for facilitating hemostasis of a biopsy tract
US20040092964A1 (en) * 1999-03-04 2004-05-13 Modesitt D. Bruce Articulating suturing device and method
US6136010A (en) 1999-03-04 2000-10-24 Perclose, Inc. Articulating suturing device and method
US20040044350A1 (en) 1999-04-09 2004-03-04 Evalve, Inc. Steerable access sheath and methods of use
US7811296B2 (en) 1999-04-09 2010-10-12 Evalve, Inc. Fixation devices for variation in engagement of tissue
DE60045096D1 (en) 1999-04-09 2010-11-25 Evalve Inc METHOD AND DEVICE FOR HEART LAPSE REPERATION
US8216256B2 (en) 1999-04-09 2012-07-10 Evalve, Inc. Detachment mechanism for implantable fixation devices
US7226467B2 (en) 1999-04-09 2007-06-05 Evalve, Inc. Fixation device delivery catheter, systems and methods of use
US10327743B2 (en) 1999-04-09 2019-06-25 Evalve, Inc. Device and methods for endoscopic annuloplasty
US6752813B2 (en) 1999-04-09 2004-06-22 Evalve, Inc. Methods and devices for capturing and fixing leaflets in valve repair
US6589279B1 (en) 1999-04-28 2003-07-08 St. Jude Medical, Inc. Efficient implantation of heart valve prostheses
US7273497B2 (en) * 1999-05-28 2007-09-25 Anova Corp. Methods for treating a defect in the annulus fibrosis
US20060247665A1 (en) * 1999-05-28 2006-11-02 Ferree Bret A Methods and apparatus for treating disc herniation and preventing the extrusion of interbody bone graft
US20070038231A1 (en) 1999-05-28 2007-02-15 Ferree Bret A Methods and apparatus for treating disc herniation and preventing the extrusion of interbody bone graft
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
US6991643B2 (en) 2000-12-20 2006-01-31 Usgi Medical Inc. Multi-barbed device for retaining tissue in apposition and methods of use
US6626899B2 (en) * 1999-06-25 2003-09-30 Nidus Medical, Llc Apparatus and methods for treating tissue
US8574243B2 (en) * 1999-06-25 2013-11-05 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US7637905B2 (en) 2003-01-15 2009-12-29 Usgi Medical, Inc. Endoluminal tool deployment system
US7618426B2 (en) 2002-12-11 2009-11-17 Usgi Medical, Inc. Apparatus and methods for forming gastrointestinal tissue approximations
ATE329531T1 (en) 1999-07-02 2006-07-15 Quickpass Inc SURGICAL SEWING DEVICE
FR2897259B1 (en) 2006-02-15 2008-05-09 Ldr Medical Soc Par Actions Si INTERSOMATIC TRANSFORAMINAL CAGE WITH INTERBREBAL FUSION GRAFT AND CAGE IMPLANTATION INSTRUMENT
US6447516B1 (en) 1999-08-09 2002-09-10 Peter M. Bonutti Method of securing tissue
US6368343B1 (en) 2000-03-13 2002-04-09 Peter M. Bonutti Method of using ultrasonic vibration to secure body tissue
US6425919B1 (en) 1999-08-18 2002-07-30 Intrinsic Orthopedics, Inc. Devices and methods of vertebral disc augmentation
US7507243B2 (en) * 1999-08-18 2009-03-24 Gregory Lambrecht Devices and method for augmenting a vertebral disc
US6936072B2 (en) * 1999-08-18 2005-08-30 Intrinsic Therapeutics, Inc. Encapsulated intervertebral disc prosthesis and methods of manufacture
US7094258B2 (en) * 1999-08-18 2006-08-22 Intrinsic Therapeutics, Inc. Methods of reinforcing an annulus fibrosis
WO2004100841A1 (en) * 1999-08-18 2004-11-25 Intrinsic Therapeutics, Inc. Devices and method for augmenting a vertebral disc nucleus
US7972337B2 (en) 2005-12-28 2011-07-05 Intrinsic Therapeutics, Inc. Devices and methods for bone anchoring
WO2009033100A1 (en) 2007-09-07 2009-03-12 Intrinsic Therapeutics, Inc. Bone anchoring systems
CA2425951C (en) 1999-08-18 2008-09-16 Intrinsic Therapeutics, Inc. Devices and method for nucleus pulposus augmentation and retention
US7717961B2 (en) 1999-08-18 2010-05-18 Intrinsic Therapeutics, Inc. Apparatus delivery in an intervertebral disc
US8323341B2 (en) 2007-09-07 2012-12-04 Intrinsic Therapeutics, Inc. Impaction grafting for vertebral fusion
US7998213B2 (en) * 1999-08-18 2011-08-16 Intrinsic Therapeutics, Inc. Intervertebral disc herniation repair
US7553329B2 (en) * 1999-08-18 2009-06-30 Intrinsic Therapeutics, Inc. Stabilized intervertebral disc barrier
WO2001015759A1 (en) * 1999-09-01 2001-03-08 Bacchus Vascular, Inc. Methods and apparatus for accessing and treating body lumens
DE19942951C1 (en) * 1999-09-08 2001-01-18 Gip Medizin Technik Gmbh Surgical device for closing opening in artery wall has rod-shaped thread guide with rotatable thread release/thread clamping section between its rear and front sections
US6358258B1 (en) 1999-09-14 2002-03-19 Abbott Laboratories Device and method for performing end-to-side anastomosis
US6190396B1 (en) 1999-09-14 2001-02-20 Perclose, Inc. Device and method for deploying and organizing sutures for anastomotic and other attachments
US6171317B1 (en) 1999-09-14 2001-01-09 Perclose, Inc. Knot tying device and method
US6231561B1 (en) 1999-09-20 2001-05-15 Appriva Medical, Inc. Method and apparatus for closing a body lumen
US6984219B2 (en) 1999-09-23 2006-01-10 Mark Ashby Depth and puncture control for blood vessel hemostasis system
US7695492B1 (en) 1999-09-23 2010-04-13 Boston Scientific Scimed, Inc. Enhanced bleed back system
US8632590B2 (en) 1999-10-20 2014-01-21 Anulex Technologies, Inc. Apparatus and methods for the treatment of the intervertebral disc
US7951201B2 (en) 1999-10-20 2011-05-31 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US7615076B2 (en) 1999-10-20 2009-11-10 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US20030153976A1 (en) * 1999-10-20 2003-08-14 Cauthen Joseph C. Spinal disc annulus reconstruction method and spinal disc annulus stent
US7004970B2 (en) 1999-10-20 2006-02-28 Anulex Technologies, Inc. Methods and devices for spinal disc annulus reconstruction and repair
US6592625B2 (en) * 1999-10-20 2003-07-15 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and spinal disc annulus stent
US8128698B2 (en) 1999-10-20 2012-03-06 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
US7935147B2 (en) 1999-10-20 2011-05-03 Anulex Technologies, Inc. Method and apparatus for enhanced delivery of treatment device to the intervertebral disc annulus
US7052516B2 (en) 1999-10-20 2006-05-30 Anulex Technologies, Inc. Spinal disc annulus reconstruction method and deformable spinal disc annulus stent
US20020123807A1 (en) * 1999-10-20 2002-09-05 Cauthen Joseph C. Spinal disc annulus reconstruction method and spinal disc annulus stent
US6551303B1 (en) 1999-10-27 2003-04-22 Atritech, Inc. Barrier device for ostium of left atrial appendage
US6652555B1 (en) * 1999-10-27 2003-11-25 Atritech, Inc. Barrier device for covering the ostium of left atrial appendage
US6689150B1 (en) 1999-10-27 2004-02-10 Atritech, Inc. Filter apparatus for ostium of left atrial appendage
US6994092B2 (en) * 1999-11-08 2006-02-07 Ev3 Sunnyvale, Inc. Device for containing embolic material in the LAA having a plurality of tissue retention structures
US6641592B1 (en) 1999-11-19 2003-11-04 Lsi Solutions, Inc. System for wound closure
US6203554B1 (en) 1999-11-23 2001-03-20 William Roberts Apparatus, kit and methods for puncture site closure
US6524317B1 (en) 1999-12-30 2003-02-25 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US9579091B2 (en) 2000-01-05 2017-02-28 Integrated Vascular Systems, Inc. Closure system and methods of use
US6197042B1 (en) * 2000-01-05 2001-03-06 Medical Technology Group, Inc. Vascular sheath with puncture site closure apparatus and methods of use
US6942674B2 (en) 2000-01-05 2005-09-13 Integrated Vascular Systems, Inc. Apparatus and methods for delivering a closure device
US8758400B2 (en) 2000-01-05 2014-06-24 Integrated Vascular Systems, Inc. Closure system and methods of use
US6635073B2 (en) 2000-05-03 2003-10-21 Peter M. Bonutti Method of securing body tissue
FR2804597B1 (en) * 2000-02-04 2002-04-26 Soprane Sa HYPER-ELASTIC NEEDLE
US7252666B2 (en) 2000-02-14 2007-08-07 Sherwood Services Ag Arterial hole closure apparatus
US7399304B2 (en) * 2000-03-03 2008-07-15 C.R. Bard, Inc. Endoscopic tissue apposition device with multiple suction ports
US7993368B2 (en) 2003-03-13 2011-08-09 C.R. Bard, Inc. Suture clips, delivery devices and methods
US8088060B2 (en) 2000-03-15 2012-01-03 Orbusneich Medical, Inc. Progenitor endothelial cell capturing with a drug eluting implantable medical device
US20160287708A9 (en) * 2000-03-15 2016-10-06 Orbusneich Medical, Inc. Progenitor Endothelial Cell Capturing with a Drug Eluting Implantable Medical Device
US9522217B2 (en) 2000-03-15 2016-12-20 Orbusneich Medical, Inc. Medical device with coating for capturing genetically-altered cells and methods for using same
US20050271701A1 (en) * 2000-03-15 2005-12-08 Orbus Medical Technologies, Inc. Progenitor endothelial cell capturing with a drug eluting implantable medical device
US6451031B1 (en) 2000-03-21 2002-09-17 X-Site, L.L.C. Blood vessel suturing device with single guide-wire/needle receiving lumen
US6805695B2 (en) 2000-04-04 2004-10-19 Spinalabs, Llc Devices and methods for annular repair of intervertebral discs
US6402750B1 (en) * 2000-04-04 2002-06-11 Spinlabs, Llc Devices and methods for the treatment of spinal disorders
US6533795B1 (en) 2000-04-11 2003-03-18 Opus Medical, Inc Dual function suturing apparatus and method
US6540735B1 (en) 2000-05-12 2003-04-01 Sub-Q, Inc. System and method for facilitating hemostasis of blood vessel punctures with absorbable sponge
US7220266B2 (en) * 2000-05-19 2007-05-22 C. R. Bard, Inc. Tissue capturing and suturing device and method
US8105351B2 (en) 2001-05-18 2012-01-31 C.R. Bard, Inc. Method of promoting tissue adhesion
EP1303218A1 (en) 2000-06-14 2003-04-23 Sterilis, Inc. Suturing method and apparatus
US6558399B1 (en) 2000-06-30 2003-05-06 Abbott Laboratories Devices and method for handling a plurality of suture elements during a suturing procedure
US6890342B2 (en) * 2000-08-02 2005-05-10 Loma Linda University Method and apparatus for closing vascular puncture using hemostatic material
US20020022860A1 (en) * 2000-08-18 2002-02-21 Borillo Thomas E. Expandable implant devices for filtering blood flow from atrial appendages
US6585730B1 (en) * 2000-08-30 2003-07-01 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US7074232B2 (en) * 2000-09-01 2006-07-11 Medtronic Angiolink, Inc. Advanced wound site management systems and methods
US6767356B2 (en) * 2000-09-01 2004-07-27 Angiolink Corporation Advanced wound site management systems and methods
US6755842B2 (en) 2000-09-01 2004-06-29 Angiolink Corporation Advanced wound site management systems and methods
US6533762B2 (en) * 2000-09-01 2003-03-18 Angiolink Corporation Advanced wound site management systems and methods
US7510572B2 (en) * 2000-09-12 2009-03-31 Shlomo Gabbay Implantation system for delivery of a heart valve prosthesis
WO2002024106A2 (en) 2000-09-21 2002-03-28 Atritech, Inc. Apparatus for implanting devices in atrial appendages
US6551330B1 (en) 2000-09-21 2003-04-22 Opus Medical, Inc. Linear suturing apparatus and methods
US7201725B1 (en) 2000-09-25 2007-04-10 Sub-Q, Inc. Device and method for determining a depth of an incision
US6652561B1 (en) * 2000-10-13 2003-11-25 Opus Medical, Inc Method and apparatus for attaching connective tissues to bone using a perforated suture anchoring device
DE50101835D1 (en) * 2000-10-31 2004-05-06 Medi Globe Gmbh Device for passing at least two sewing threads through a wall, in particular an artery
US6730102B1 (en) 2000-11-06 2004-05-04 Abbott Laboratories Systems, devices and methods for deploying needles
US7029481B1 (en) * 2000-11-06 2006-04-18 Abbott Laboratories Systems, devices and methods for suturing patient tissue
US20020055751A1 (en) * 2000-11-09 2002-05-09 Schraft Rolf Dieter Device and procedure for joining hollow organs
US6511487B1 (en) * 2000-11-28 2003-01-28 T. A. G. Medical Products Ltd. Suturing instrument and method
US7211101B2 (en) 2000-12-07 2007-05-01 Abbott Vascular Devices Methods for manufacturing a clip and clip
US6719777B2 (en) * 2000-12-07 2004-04-13 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US7806904B2 (en) 2000-12-07 2010-10-05 Integrated Vascular Systems, Inc. Closure device
US7905900B2 (en) 2003-01-30 2011-03-15 Integrated Vascular Systems, Inc. Clip applier and methods of use
US6632237B2 (en) 2001-01-11 2003-10-14 Bio-Seal Tech, Inc. Device and method for sealing a puncture in a blood vessel
US20020099410A1 (en) 2001-01-11 2002-07-25 Bio-Seal Tech Inc. Device and method for sealing a puncture in a blood vessel
US7285097B2 (en) * 2001-01-12 2007-10-23 Radi Medical System Ab Technique to confirm correct positioning with respect to arterial wall
DE60205780T2 (en) * 2001-01-12 2006-05-18 Radi Medical Systems Ab Arterial wall occlusion device provided with a position indicator
US7029480B2 (en) * 2001-01-24 2006-04-18 Abott Laboratories Device and method for suturing of internal puncture sites
US6770076B2 (en) 2001-02-12 2004-08-03 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US7083638B2 (en) * 2001-02-12 2006-08-01 Arthrocare Corporation Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US20030057156A1 (en) * 2001-03-08 2003-03-27 Dean Peterson Atrial filter implants
EP1406671A1 (en) * 2001-03-12 2004-04-14 Sub Q, Inc. Methods for sterilizing cross-linked gelatin compositions
US8187625B2 (en) 2001-03-12 2012-05-29 Boston Scientific Scimed, Inc. Cross-linked gelatin composition comprising a wetting agent
US8992567B1 (en) 2001-04-24 2015-03-31 Cardiovascular Technologies Inc. Compressible, deformable, or deflectable tissue closure devices and method of manufacture
US7025776B1 (en) 2001-04-24 2006-04-11 Advanced Catheter Engineering, Inc. Arteriotomy closure devices and techniques
US20080109030A1 (en) 2001-04-24 2008-05-08 Houser Russell A Arteriotomy closure devices and techniques
US8961541B2 (en) 2007-12-03 2015-02-24 Cardio Vascular Technologies Inc. Vascular closure devices, systems, and methods of use
FR2824253B1 (en) * 2001-05-04 2005-02-18 Francis Navarro INTRUMENT FOR CLOSING BY SUTURE SUBCUTANEOUS AN ORIFICE REALIZED IN THE ABDOMINAL WALL OF A PATIENT
FR2824261B1 (en) 2001-05-04 2004-05-28 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS AND IMPLEMENTATION METHOD AND TOOLS
US7029489B1 (en) 2001-05-18 2006-04-18 Sub-Q, Inc. System and method for delivering hemostasis promoting material to a blood vessel puncture site
US7008440B2 (en) 2001-11-08 2006-03-07 Sub-Q, Inc. System and method for delivering hemostasis promoting material to a blood vessel puncture site by fluid pressure
US6997932B2 (en) 2001-05-21 2006-02-14 Boston Scientific Scimed, Inc. Suture passer
US7338514B2 (en) * 2001-06-01 2008-03-04 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods and tools, and related methods of use
WO2002098282A2 (en) * 2001-06-04 2002-12-12 Albert Einstein Healthcare Network Cardiac stimulating apparatus having a blood clot filter and atrial pacer
US6547800B2 (en) * 2001-06-06 2003-04-15 Opus Medical, Inc. Method and apparatus for attaching connective tissues to bone using a cortical bone anchoring device
IES20010547A2 (en) 2001-06-07 2002-12-11 Christy Cummins Surgical Staple
WO2003000141A1 (en) 2001-06-25 2003-01-03 Abbott Laboratories Apparatus and methods for performing an anastomosis
US7056331B2 (en) 2001-06-29 2006-06-06 Quill Medical, Inc. Suture method
FR2827156B1 (en) 2001-07-13 2003-11-14 Ldr Medical VERTEBRAL CAGE DEVICE WITH MODULAR FASTENING
US7011671B2 (en) * 2001-07-18 2006-03-14 Atritech, Inc. Cardiac implant device tether system and method
US6605096B1 (en) * 2001-07-20 2003-08-12 Opus Medical Inc, Percutaneous suturing apparatus and method
US6848152B2 (en) 2001-08-31 2005-02-01 Quill Medical, Inc. Method of forming barbs on a suture and apparatus for performing same
US6776784B2 (en) 2001-09-06 2004-08-17 Core Medical, Inc. Clip apparatus for closing septal defects and methods of use
US20060052821A1 (en) 2001-09-06 2006-03-09 Ovalis, Inc. Systems and methods for treating septal defects
US6702835B2 (en) 2001-09-07 2004-03-09 Core Medical, Inc. Needle apparatus for closing septal defects and methods for using such apparatus
SE523902C2 (en) * 2001-09-07 2004-06-01 Jan Otto Solem Apparatus for closing a puncture in a body vessel
DE60239559D1 (en) * 2001-10-22 2011-05-05 Interventional Therapies Llc WUNDNÄHVORRICHTUNG
AU2002349994A1 (en) 2001-10-22 2003-05-06 Interventional Therapies, L.L.C. Removable sleeve
US20030078601A1 (en) * 2001-10-22 2003-04-24 Oleg Shikhman Crimping and cutting device
US7037323B2 (en) * 2001-11-08 2006-05-02 Sub-Q, Inc. Pledget-handling system and method for delivering hemostasis promoting material to a blood vessel puncture site by fluid pressure
US7037322B1 (en) 2001-11-08 2006-05-02 Sub-Q, Inc. System and method for delivering hemostasis promoting material to a blood vessel puncture with a staging tube
US7025748B2 (en) 2001-11-08 2006-04-11 Boston Scientific Scimed, Inc. Sheath based blood vessel puncture locator and depth indicator
US7192436B2 (en) * 2001-11-08 2007-03-20 Sub-Q, Inc. Pledget-handling system and method for delivering hemostasis promoting material to a blood vessel puncture site by fluid pressure
US6575971B2 (en) 2001-11-15 2003-06-10 Quantum Cor, Inc. Cardiac valve leaflet stapler device and methods thereof
US6719765B2 (en) 2001-12-03 2004-04-13 Bonutti 2003 Trust-A Magnetic suturing system and method
US6780198B1 (en) 2001-12-06 2004-08-24 Opus Medical, Inc. Bone anchor insertion device
US8211123B2 (en) 2001-12-21 2012-07-03 Abbott Laboratories Suture trimmer
US6746457B2 (en) 2001-12-07 2004-06-08 Abbott Laboratories Snared suture trimmer
US7094246B2 (en) * 2001-12-07 2006-08-22 Abbott Laboratories Suture trimmer
US7918867B2 (en) 2001-12-07 2011-04-05 Abbott Laboratories Suture trimmer
EP1467661A4 (en) 2001-12-19 2008-11-05 Nmt Medical Inc Septal occluder and associated methods
US7318833B2 (en) * 2001-12-19 2008-01-15 Nmt Medical, Inc. PFO closure device with flexible thrombogenic joint and improved dislodgement resistance
US7220265B2 (en) * 2002-01-14 2007-05-22 Nmt Medical, Inc. Patent foramen ovale (PFO) closure method and device
US20030181942A1 (en) 2002-01-25 2003-09-25 Sutton Gregg S. Atrial appendage blood filtration systems
US6855157B2 (en) 2002-02-04 2005-02-15 Arthrocare Corporation Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US6743242B2 (en) * 2002-02-13 2004-06-01 Qi-Zhao Guo Dual-use suturing device for suturing wound induced from celioscope surgery
US7402166B2 (en) * 2002-02-15 2008-07-22 A&P Feigl Family Limited Partnership Devices and methods for positioning sutures
US7048754B2 (en) 2002-03-01 2006-05-23 Evalve, Inc. Suture fasteners and methods of use
US6743241B2 (en) 2002-03-01 2004-06-01 Intellimed Surgical Solutions Llc Laparoscopic port site fascial closure device
US9155544B2 (en) 2002-03-20 2015-10-13 P Tech, Llc Robotic systems and methods
EP1487353A4 (en) 2002-03-25 2008-04-16 Nmt Medical Inc Patent foramen ovale (pfo) closure clips
WO2003090628A1 (en) * 2002-04-25 2003-11-06 Terumo Kabushiki Kaisha Organism tissue suturing apparatus
US7976564B2 (en) 2002-05-06 2011-07-12 St. Jude Medical, Cardiology Division, Inc. PFO closure devices and related methods of use
US6984237B2 (en) 2002-05-22 2006-01-10 Orthopaedic Biosystems Ltd., Inc. Suture passing surgical instrument
US20060089667A1 (en) * 2002-05-27 2006-04-27 Shlomo Ben-David Apparatus for sealing a puncture in a blood vessel
US20040098042A1 (en) * 2002-06-03 2004-05-20 Devellian Carol A. Device with biological tissue scaffold for percutaneous closure of an intracardiac defect and methods thereof
ATE417549T1 (en) 2002-06-04 2009-01-15 Abbott Vascular Inc SURGICAL CLAMP AND APPLICATION DEVICE FOR VESSEL WOUND CLOSURE
AU2003240549A1 (en) 2002-06-05 2003-12-22 Nmt Medical, Inc. Patent foramen ovale (pfo) closure device with radial and circumferential support
US7274876B2 (en) * 2002-06-06 2007-09-25 At&T Corp. Integrated electrical/optical hybrid communication system with revertive hitless switch
US7232447B2 (en) 2002-06-12 2007-06-19 Boston Scientific Scimed, Inc. Suturing instrument with deflectable head
JP4544991B2 (en) * 2002-06-14 2010-09-15 ローマ リンダ ユニヴァーシティ メディカル センター Apparatus and method for closing vascular wounds
US6770084B1 (en) * 2002-06-26 2004-08-03 Opus Medical, Inc. Suture capture device
US7041111B2 (en) 2002-08-02 2006-05-09 Boston Scientific Scimed, Inc. Placing sutures
US6773450B2 (en) 2002-08-09 2004-08-10 Quill Medical, Inc. Suture anchor and method
US7611454B2 (en) * 2002-08-29 2009-11-03 Universite De Liege Surgical procedure for the treatment of female urinary incontinence: tension-free inside-out transobturator urethral suspension
WO2004021872A2 (en) * 2002-09-06 2004-03-18 C.R. Bard, Inc. Tissue capturing devices
AU2003272289A1 (en) 2002-09-06 2004-03-29 C.R. Bard, Inc. Integrated endoscope and accessory treatment device
US8100940B2 (en) 2002-09-30 2012-01-24 Quill Medical, Inc. Barb configurations for barbed sutures
US20040088003A1 (en) 2002-09-30 2004-05-06 Leung Jeffrey C. Barbed suture in combination with surgical needle
US8574204B2 (en) 2002-10-21 2013-11-05 Angiodynamics, Inc. Implantable medical device for improved placement and adherence in the body
US20040102730A1 (en) * 2002-10-22 2004-05-27 Davis Thomas P. System and method for facilitating hemostasis of blood vessel punctures with absorbable sponge
US7766820B2 (en) 2002-10-25 2010-08-03 Nmt Medical, Inc. Expandable sheath tubing
US8317821B1 (en) 2002-11-04 2012-11-27 Boston Scientific Scimed, Inc. Release mechanism
US7455680B1 (en) 2002-11-04 2008-11-25 Boston Scientific Scimed, Inc. Apparatus and method for inhibiting blood loss
US7955353B1 (en) 2002-11-04 2011-06-07 Sub-Q, Inc. Dissolvable closure device
FR2846550B1 (en) 2002-11-05 2006-01-13 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
EP1560525B1 (en) * 2002-11-07 2009-01-14 NMT Medical, Inc. Patent foramen ovale (pfo) closure with magnetic force
US7090690B2 (en) * 2002-11-19 2006-08-15 Arthrocare Corporation Devices and methods for repairing soft tissue
US7108710B2 (en) 2002-11-26 2006-09-19 Abbott Laboratories Multi-element biased suture clip
DE10255344A1 (en) * 2002-11-27 2005-06-30 Siemens Ag Conveyor system for goods, in particular containers for luggage, and control system for the conveyor system
EP2399526B1 (en) 2002-12-09 2014-11-26 W.L. Gore & Associates, Inc. Septal closure devices
US7942884B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Methods for reduction of a gastric lumen
US7942898B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Delivery systems and methods for gastric reduction
US20040122451A1 (en) * 2002-12-23 2004-06-24 Wood Timothy J. Method and device for closing and fusing suture loops
US8821534B2 (en) 2010-12-06 2014-09-02 Integrated Vascular Systems, Inc. Clip applier having improved hemostasis and methods of use
US7857828B2 (en) 2003-01-30 2010-12-28 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8758398B2 (en) 2006-09-08 2014-06-24 Integrated Vascular Systems, Inc. Apparatus and method for delivering a closure element
US8202293B2 (en) 2003-01-30 2012-06-19 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8187288B2 (en) * 2003-03-10 2012-05-29 Boston Scientific Scimed, Inc. Re-shapeable medical device
US7658747B2 (en) 2003-03-12 2010-02-09 Nmt Medical, Inc. Medical device for manipulation of a medical implant
EP1605865B1 (en) * 2003-03-17 2008-12-10 ev3 Endovascular, Inc. Stent with thin film composite laminate
US20040267306A1 (en) 2003-04-11 2004-12-30 Velocimed, L.L.C. Closure devices, related delivery methods, and related methods of use
US8372112B2 (en) 2003-04-11 2013-02-12 St. Jude Medical, Cardiology Division, Inc. Closure devices, related delivery methods, and related methods of use
US7597704B2 (en) * 2003-04-28 2009-10-06 Atritech, Inc. Left atrial appendage occlusion device with active expansion
US7497864B2 (en) 2003-04-30 2009-03-03 Marctec, Llc. Tissue fastener and methods for using same
US7624487B2 (en) 2003-05-13 2009-12-01 Quill Medical, Inc. Apparatus and method for forming barbs on a suture
BRPI0410376B1 (en) 2003-05-16 2016-06-14 Bard Inc C R endoscopic suture system and single intubation
US10667823B2 (en) 2003-05-19 2020-06-02 Evalve, Inc. Fixation devices, systems and methods for engaging tissue
US7935128B2 (en) * 2003-05-21 2011-05-03 Boston Scientific Scimed, Inc. Remotely-reloadable suturing device
AU2004245108B2 (en) 2003-06-06 2010-03-11 Abbott Laboratories Sizing and positioning adapter for medical instruments
CA2527778C (en) 2003-06-13 2011-11-08 Tyco Healthcare Group Lp Multiple member interconnect for surgical instrument and absorbable screw fastener
US20040260300A1 (en) * 2003-06-20 2004-12-23 Bogomir Gorensek Method of delivering an implant through an annular defect in an intervertebral disc
WO2004112584A2 (en) * 2003-06-20 2004-12-29 Intrinsic Therapeutics, Inc. Implant for intervertebral disc annular defect
US7794471B1 (en) 2003-06-26 2010-09-14 Cardica, Inc. Compliant anastomosis system
US8574246B1 (en) 2004-06-25 2013-11-05 Cardica, Inc. Compliant anastomosis system utilizing suture
US7678123B2 (en) 2003-07-14 2010-03-16 Nmt Medical, Inc. Tubular patent foramen ovale (PFO) closure device with catch system
US9861346B2 (en) 2003-07-14 2018-01-09 W. L. Gore & Associates, Inc. Patent foramen ovale (PFO) closure device with linearly elongating petals
US8480706B2 (en) 2003-07-14 2013-07-09 W.L. Gore & Associates, Inc. Tubular patent foramen ovale (PFO) closure device with catch system
DE10335648A1 (en) 2003-07-30 2005-03-03 Eberhard-Karls-Universität Tübingen Closing plug for an opening in a wall of a vessel or hollow organ
US8216252B2 (en) 2004-05-07 2012-07-10 Usgi Medical, Inc. Tissue manipulation and securement system
US8308765B2 (en) 2004-05-07 2012-11-13 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
CA2535452C (en) 2003-08-14 2013-04-02 Loma Linda University Medical Center Vascular wound closure device
US7735493B2 (en) 2003-08-15 2010-06-15 Atritech, Inc. System and method for delivering a left atrial appendage containment device
CA2536368A1 (en) 2003-08-19 2005-03-03 Nmt Medical, Inc. Expandable sheath tubing
US8292943B2 (en) 2003-09-03 2012-10-23 Bolton Medical, Inc. Stent graft with longitudinal support member
US20080264102A1 (en) 2004-02-23 2008-10-30 Bolton Medical, Inc. Sheath Capture Device for Stent Graft Delivery System and Method for Operating Same
US7763063B2 (en) * 2003-09-03 2010-07-27 Bolton Medical, Inc. Self-aligning stent graft delivery system, kit, and method
US11596537B2 (en) 2003-09-03 2023-03-07 Bolton Medical, Inc. Delivery system and method for self-centering a proximal end of a stent graft
US9198786B2 (en) 2003-09-03 2015-12-01 Bolton Medical, Inc. Lumen repair device with capture structure
US20070198078A1 (en) * 2003-09-03 2007-08-23 Bolton Medical, Inc. Delivery system and method for self-centering a Proximal end of a stent graft
US11259945B2 (en) 2003-09-03 2022-03-01 Bolton Medical, Inc. Dual capture device for stent graft delivery system and method for capturing a stent graft
US8500792B2 (en) 2003-09-03 2013-08-06 Bolton Medical, Inc. Dual capture device for stent graft delivery system and method for capturing a stent graft
US7691112B2 (en) 2003-09-11 2010-04-06 Nmt Medical, Inc. Devices, systems, and methods for suturing tissue
US8100923B2 (en) 2003-09-15 2012-01-24 Abbott Laboratories Suture locking device and methods
US20050125032A1 (en) * 2003-10-10 2005-06-09 Whisenant Brian K. Patent foramen ovale (PFO) closure devices, delivery apparatus and related methods and systems
US20050192627A1 (en) * 2003-10-10 2005-09-01 Whisenant Brian K. Patent foramen ovale closure devices, delivery apparatus and related methods and systems
US7931670B2 (en) * 2003-10-15 2011-04-26 St. Jude Medical Puerto Rico Llc Tissue puncture closure device with automatic tamping
US20050085773A1 (en) * 2003-10-15 2005-04-21 Forsberg Andrew T. Method and apparatus for locating vascular punctures
US8007514B2 (en) * 2003-10-17 2011-08-30 St. Jude Medical Puerto Rico Llc Automatic suture locking device
US7419498B2 (en) * 2003-10-21 2008-09-02 Nmt Medical, Inc. Quick release knot attachment system
US7682374B2 (en) 2003-10-21 2010-03-23 Arthrocare Corporation Knotless suture lock and bone anchor implant method
US8292910B2 (en) 2003-11-06 2012-10-23 Pressure Products Medical Supplies, Inc. Transseptal puncture apparatus
JP4496223B2 (en) 2003-11-06 2010-07-07 エヌエムティー メディカル, インコーポレイティッド Septal penetration device
US20050107820A1 (en) * 2003-11-13 2005-05-19 Forsberg Andrew T. Vascular puncture depth locator
US8128652B2 (en) * 2003-11-13 2012-03-06 St. Jude Medical Puerto Rico Llc Method and apparatus for sealing an internal tissue puncture incorporating a block and tackle
US20050251203A1 (en) * 2003-11-14 2005-11-10 Oleg Shikhman Ferrule
US20050113868A1 (en) * 2003-11-20 2005-05-26 Devellian Carol A. Device, with electrospun fabric, for a percutaneous transluminal procedure, and methods thereof
US7597705B2 (en) * 2003-12-03 2009-10-06 St. Jude Medical Puerto Rico Llc Vascular puncture seal anchor nest
US7621937B2 (en) * 2003-12-03 2009-11-24 St. Jude Medical Puerto Rico LC Vascular sealing device with high surface area sealing plug
US7875043B1 (en) 2003-12-09 2011-01-25 Sub-Q, Inc. Cinching loop
US20050273119A1 (en) 2003-12-09 2005-12-08 Nmt Medical, Inc. Double spiral patent foramen ovale closure clamp
US7361180B2 (en) 2004-05-07 2008-04-22 Usgi Medical, Inc. Apparatus for manipulating and securing tissue
US7347863B2 (en) 2004-05-07 2008-03-25 Usgi Medical, Inc. Apparatus and methods for manipulating and securing tissue
US20050251189A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. Multi-position tissue manipulation assembly
US7390328B2 (en) * 2003-12-19 2008-06-24 Abbott Laboratories Device and method for suturing of internal puncture sites
US20070219586A1 (en) * 2004-01-23 2007-09-20 Chalam Mahadevan Suture Needle and Suture Assembly
US8262694B2 (en) * 2004-01-30 2012-09-11 W.L. Gore & Associates, Inc. Devices, systems, and methods for closure of cardiac openings
FR2865629B1 (en) 2004-02-04 2007-01-26 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
BRPI0507468A (en) 2004-02-04 2007-07-10 Ldr Medical intervertebral disc prosthesis
US6932824B1 (en) * 2004-03-02 2005-08-23 St. Jude Medical Puerto Rico B.V. Three-needle closure device
EP1737349A1 (en) 2004-03-03 2007-01-03 NMT Medical, Inc. Delivery/recovery system for septal occluder
US7976539B2 (en) 2004-03-05 2011-07-12 Hansen Medical, Inc. System and method for denaturing and fixing collagenous tissue
US7703459B2 (en) * 2004-03-09 2010-04-27 Usgi Medical, Inc. Apparatus and methods for mapping out endoluminal gastrointestinal surgery
US20050203488A1 (en) * 2004-03-09 2005-09-15 Usgi Medical Inc. Apparatus and methods for mapping out endoluminal gastrointestinal surgery
US20050234509A1 (en) * 2004-03-30 2005-10-20 Mmt Medical, Inc. Center joints for PFO occluders
US20050267524A1 (en) * 2004-04-09 2005-12-01 Nmt Medical, Inc. Split ends closure device
US7648493B2 (en) * 2004-04-20 2010-01-19 St. Jude Medical Puerto Rico Llc Method and apparatus for locating vascular punctures
US8361110B2 (en) 2004-04-26 2013-01-29 W.L. Gore & Associates, Inc. Heart-shaped PFO closure device
FR2869528B1 (en) 2004-04-28 2007-02-02 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US8801746B1 (en) 2004-05-04 2014-08-12 Covidien Lp System and method for delivering a left atrial appendage containment device
US7842053B2 (en) * 2004-05-06 2010-11-30 Nmt Medical, Inc. Double coil occluder
US8308760B2 (en) 2004-05-06 2012-11-13 W.L. Gore & Associates, Inc. Delivery systems and methods for PFO closure device with two anchors
US7736374B2 (en) 2004-05-07 2010-06-15 Usgi Medical, Inc. Tissue manipulation and securement system
US20050250986A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. Removable apparatus and methods for manipulating and securing tissue
US8444657B2 (en) 2004-05-07 2013-05-21 Usgi Medical, Inc. Apparatus and methods for rapid deployment of tissue anchors
US7520884B2 (en) * 2004-05-07 2009-04-21 Usgi Medical Inc. Methods for performing gastroplasty
US20060135971A1 (en) * 2004-05-07 2006-06-22 Usgi Medical Inc. System for treating gastroesophageal reflux disease
US8257389B2 (en) * 2004-05-07 2012-09-04 W.L. Gore & Associates, Inc. Catching mechanisms for tubular septal occluder
US20050251176A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. System for treating gastroesophageal reflux disease
US7390329B2 (en) * 2004-05-07 2008-06-24 Usgi Medical, Inc. Methods for grasping and cinching tissue anchors
US8257394B2 (en) * 2004-05-07 2012-09-04 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US7918869B2 (en) 2004-05-07 2011-04-05 Usgi Medical, Inc. Methods and apparatus for performing endoluminal gastroplasty
US20050251208A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. Linear anchors for anchoring to tissue
US7704268B2 (en) * 2004-05-07 2010-04-27 Nmt Medical, Inc. Closure device with hinges
US20050267520A1 (en) 2004-05-12 2005-12-01 Modesitt D B Access and closure device and method
US20050267521A1 (en) * 2004-05-13 2005-12-01 St. Jude Medical Puerto Rico B.V. Collagen sponge for arterial sealing
EP3398522B1 (en) 2004-05-14 2019-12-25 Evalve, Inc. Locking mechanisms for fixation devices
NZ598970A (en) 2004-05-14 2013-07-26 Ethicon Llc Suture device using an enlongated body with barbs and a needle at one end and an anchor to prevent pull-through at the other end
JP2008500125A (en) 2004-05-21 2008-01-10 ニートスティッチ リミティド Suture device
US8475476B2 (en) * 2004-06-01 2013-07-02 Cook Medical Technologies Llc System and method for accessing a body cavity
US7678135B2 (en) * 2004-06-09 2010-03-16 Usgi Medical, Inc. Compressible tissue anchor assemblies
US8206417B2 (en) * 2004-06-09 2012-06-26 Usgi Medical Inc. Apparatus and methods for optimizing anchoring force
US7736379B2 (en) * 2004-06-09 2010-06-15 Usgi Medical, Inc. Compressible tissue anchor assemblies
US7695493B2 (en) * 2004-06-09 2010-04-13 Usgi Medical, Inc. System for optimizing anchoring force
US7931661B2 (en) * 2004-06-14 2011-04-26 Usgi Medical, Inc. Apparatus and methods for performing transluminal gastrointestinal procedures
EP1755461B1 (en) 2004-06-16 2014-01-01 Smith & Nephew, Inc. Suture passing device
US7678133B2 (en) 2004-07-10 2010-03-16 Arstasis, Inc. Biological tissue closure device and method
US20060020276A1 (en) * 2004-07-23 2006-01-26 Usgi Medical Inc. Apparatus and methods for achieving prolonged maintenance of gastrointestinal tissue folds
CA2574977C (en) * 2004-07-29 2010-01-26 X-Sten, Corp. Spinal ligament modification devices
US8992549B2 (en) * 2004-08-05 2015-03-31 Teleflex Medical Incorporated Laparoscopic port site closure tool
US8123762B2 (en) 2004-08-19 2012-02-28 Boston Scientific Scimed, Inc. Suturing instrument
DE102004041936B3 (en) * 2004-08-30 2005-10-06 Medi-Globe Gmbh A surgical device for passing at least two sutures through the edge region of a tissue opening
US20060058844A1 (en) * 2004-09-13 2006-03-16 St. Jude Medical Puerto Rico B.V. Vascular sealing device with locking system
US8764848B2 (en) 2004-09-24 2014-07-01 W.L. Gore & Associates, Inc. Occluder device double securement system for delivery/recovery of such occluder device
US8052592B2 (en) 2005-09-27 2011-11-08 Evalve, Inc. Methods and devices for tissue grasping and assessment
EP1804677B1 (en) * 2004-09-27 2018-01-03 Nobles Medical Technologies, Inc. Handle for suturing apparatus
JP5124274B2 (en) 2004-09-27 2013-01-23 エヴァルヴ インコーポレイテッド Method and apparatus for grasping and evaluating tissue
US20090326578A1 (en) * 2004-09-30 2009-12-31 Usgi Medical, Inc. Interlocking tissue anchor apparatus and methods
US9463012B2 (en) * 2004-10-26 2016-10-11 P Tech, Llc Apparatus for guiding and positioning an implant
US7722629B2 (en) * 2004-10-29 2010-05-25 Jeffrey W. Chambers, M.D. System and method for catheter-based septal defect repair
US20060116602A1 (en) * 2004-12-01 2006-06-01 Alden Dana A Medical sensing device and system
FR2879436B1 (en) 2004-12-22 2007-03-09 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US20060142784A1 (en) * 2004-12-28 2006-06-29 Stavros Kontos Device and method for suturing internal structures puncture wounds
US7803142B2 (en) 2005-02-02 2010-09-28 Summit Access Llc Microtaper needle and method of use
US8050746B2 (en) 2005-02-02 2011-11-01 Voyage Medical, Inc. Tissue visualization device and method variations
US10064540B2 (en) * 2005-02-02 2018-09-04 Intuitive Surgical Operations, Inc. Visualization apparatus for transseptal access
US7860555B2 (en) * 2005-02-02 2010-12-28 Voyage Medical, Inc. Tissue visualization and manipulation system
US8078266B2 (en) 2005-10-25 2011-12-13 Voyage Medical, Inc. Flow reduction hood systems
US8137333B2 (en) 2005-10-25 2012-03-20 Voyage Medical, Inc. Delivery of biological compounds to ischemic and/or infarcted tissue
US20080015569A1 (en) 2005-02-02 2008-01-17 Voyage Medical, Inc. Methods and apparatus for treatment of atrial fibrillation
US7930016B1 (en) 2005-02-02 2011-04-19 Voyage Medical, Inc. Tissue closure system
US11478152B2 (en) 2005-02-02 2022-10-25 Intuitive Surgical Operations, Inc. Electrophysiology mapping and visualization system
US9510732B2 (en) 2005-10-25 2016-12-06 Intuitive Surgical Operations, Inc. Methods and apparatus for efficient purging
US7860556B2 (en) * 2005-02-02 2010-12-28 Voyage Medical, Inc. Tissue imaging and extraction systems
US7918787B2 (en) 2005-02-02 2011-04-05 Voyage Medical, Inc. Tissue visualization and manipulation systems
US8109945B2 (en) * 2005-02-04 2012-02-07 St. Jude Medical Puerto Rico Llc Percutaneous suture path tracking device with cutting blade
EP1855623B1 (en) 2005-02-07 2019-04-17 Evalve, Inc. Devices for cardiac valve repair
US8470028B2 (en) 2005-02-07 2013-06-25 Evalve, Inc. Methods, systems and devices for cardiac valve repair
WO2006102213A1 (en) 2005-03-18 2006-09-28 Nmt Medical, Inc. Catch member for pfo occluder
US7713283B2 (en) * 2005-04-11 2010-05-11 St. Jude Medical Puerto Rico, Llc Tissue puncture closure device with magazine fed tamping system
US7988706B2 (en) * 2005-04-11 2011-08-02 St. Jude Medical Puerto Rico Llc Tissue puncture closure device with automatic torque sensing tamping system
US7250057B2 (en) * 2005-04-11 2007-07-31 St. Jude Medical Puerto Rico B.V. Tissue puncture closure device with automatic torque sensing tamping system
US7618436B2 (en) * 2005-04-12 2009-11-17 St. Jude Medical Puerto Rico Llc Tissue puncture closure device with scroll gear transmission tamping system
US7622628B2 (en) * 2005-05-04 2009-11-24 Innovasa Corporation Hemostatic wire guided bandage and method of use
US20060276838A1 (en) * 2005-06-07 2006-12-07 Wensel Jeffrey P Vascular puncture sealing method, apparatus, and system
US20080015481A1 (en) * 2005-05-04 2008-01-17 Bergin Patrick J Hemostatic bandage and method of use
US20060276836A1 (en) * 2005-06-07 2006-12-07 Bergin Patrick J Hemostatic wire guided bandage and method of use
US8241325B2 (en) * 2005-05-12 2012-08-14 Arstasis, Inc. Access and closure device and method
US8038687B2 (en) * 2005-05-17 2011-10-18 St. Jude Medical Puerto Rico Llc Suture loop closure device
US8273094B2 (en) * 2005-05-17 2012-09-25 St. Jude Medical Puerto Rico Llc Puncture locating device
US7135377B1 (en) * 2005-05-20 2006-11-14 Phoenix Precision Technology Corporation Semiconductor package substrate with embedded resistors and method for fabricating same
US9585651B2 (en) 2005-05-26 2017-03-07 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US8298291B2 (en) 2005-05-26 2012-10-30 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
GB2441266B (en) 2005-06-01 2011-03-02 Arthrocare Corp Knotless suture anchoring device having deforming section to accommodate sutures of various diameters
AU2006262498B2 (en) 2005-06-20 2011-11-03 Nobles Medical Technologies, Inc. Method and apparatus for applying a knot to a suture
US20080312686A1 (en) * 2005-07-01 2008-12-18 Abbott Laboratories Antimicrobial closure element and closure element applier
US8579936B2 (en) 2005-07-05 2013-11-12 ProMed, Inc. Centering of delivery devices with respect to a septal defect
EP3228265A3 (en) 2005-07-29 2018-05-23 Vertos Medical, Inc. Percutaneous tissue excision devices
US7749247B2 (en) * 2005-08-04 2010-07-06 St. Jude Medical Puerto Rico, Llc Tissue puncture closure device with coiled automatic tamping system
US20070049952A1 (en) * 2005-08-30 2007-03-01 Weiss Steven J Apparatus and method for mitral valve repair without cardiopulmonary bypass, including transmural techniques
US7846179B2 (en) 2005-09-01 2010-12-07 Ovalis, Inc. Suture-based systems and methods for treating septal defects
US7972359B2 (en) 2005-09-16 2011-07-05 Atritech, Inc. Intracardiac cage and method of delivering same
FR2891135B1 (en) * 2005-09-23 2008-09-12 Ldr Medical Sarl INTERVERTEBRAL DISC PROSTHESIS
WO2007038336A2 (en) * 2005-09-23 2007-04-05 Ellipse Technologies, Inc. Method and apparatus for adjusting body lumens
US20070123934A1 (en) * 2005-09-26 2007-05-31 Whisenant Brian K Delivery system for patent foramen ovale closure device
US20070118176A1 (en) * 2005-10-24 2007-05-24 Opolski Steven W Radiopaque bioabsorbable occluder
US8221310B2 (en) * 2005-10-25 2012-07-17 Voyage Medical, Inc. Tissue visualization device and method variations
US20070123890A1 (en) * 2005-11-04 2007-05-31 X-Sten, Corp. Tissue retrieval devices and methods
US8764820B2 (en) * 2005-11-16 2014-07-01 Edwards Lifesciences Corporation Transapical heart valve delivery system and method
US7632308B2 (en) * 2005-11-23 2009-12-15 Didier Loulmet Methods, devices, and kits for treating mitral valve prolapse
FR2893838B1 (en) 2005-11-30 2008-08-08 Ldr Medical Soc Par Actions Si PROSTHESIS OF INTERVERTEBRAL DISC AND INSTRUMENTATION OF INSERTION OF THE PROSTHESIS BETWEEN VERTEBRATES
US20070135826A1 (en) 2005-12-01 2007-06-14 Steve Zaver Method and apparatus for delivering an implant without bias to a left atrial appendage
WO2007073566A1 (en) * 2005-12-22 2007-06-28 Nmt Medical, Inc. Catch members for occluder devices
US8382794B2 (en) * 2006-01-04 2013-02-26 St. Jude Medical Puerto Rico Llc Balloon insertion apparatus and method of sealing a tissue puncture
US20070167676A1 (en) * 2006-01-13 2007-07-19 Olympus Medical Systems Corp. Overtube and medical procedure via natural orifice using the same
US8728121B2 (en) * 2006-01-13 2014-05-20 Olympus Medical Systems Corp. Puncture needle and medical procedure using puncture needle that is performed via natural orifice
US20070167675A1 (en) * 2006-01-13 2007-07-19 Olympus Medical Systems Corp. Overtube and medical procedure via natural orifice using the same
US8721657B2 (en) * 2006-01-13 2014-05-13 Olympus Medical Systems Corp. Medical instrument
US20070219411A1 (en) * 2006-01-13 2007-09-20 Olympus Medical Systems Corp. Overtube and endoscopic treatment system
US20070213702A1 (en) * 2006-03-08 2007-09-13 Olympus Medical Systems Corp. Medical procedure carried out via a natural opening
US7785333B2 (en) * 2006-02-21 2010-08-31 Olympus Medical Systems Corp. Overtube and operative procedure via bodily orifice
US8241279B2 (en) * 2006-02-23 2012-08-14 Olympus Medical Systems Corp. Overtube and natural opening medical procedures using the same
US20080255422A1 (en) * 2006-01-13 2008-10-16 Olympus Medical Systems Corp. Medical device
US8726909B2 (en) 2006-01-27 2014-05-20 Usgi Medical, Inc. Methods and apparatus for revision of obesity procedures
US20080058839A1 (en) * 2006-02-07 2008-03-06 Nobles Anthony A Reverse tapered guidewire and method of use
US7824419B2 (en) * 2006-02-09 2010-11-02 Sreevathsa Boraiah Laparoscopic trocar and facial closure systems and methods
US7615061B2 (en) * 2006-02-28 2009-11-10 Arthrocare Corporation Bone anchor suture-loading system, method and apparatus
US20100137889A1 (en) * 2006-03-17 2010-06-03 T.A.G. Medical Products A Limited Partnership Surgical Instrument and Method for Attaching Soft Tissue to a Bone
JP2009532125A (en) 2006-03-31 2009-09-10 エヌエムティー メディカル, インコーポレイティッド Deformable flap catch mechanism for occluder equipment
US8870913B2 (en) 2006-03-31 2014-10-28 W.L. Gore & Associates, Inc. Catch system with locking cap for patent foramen ovale (PFO) occluder
US8551135B2 (en) * 2006-03-31 2013-10-08 W.L. Gore & Associates, Inc. Screw catch mechanism for PFO occluder and method of use
US9005220B2 (en) 2006-04-04 2015-04-14 C.R. Bard, Inc. Suturing devices and methods with energy emitting elements
US7942830B2 (en) * 2006-05-09 2011-05-17 Vertos Medical, Inc. Ipsilateral approach to minimally invasive ligament decompression procedure
US8105355B2 (en) 2006-05-18 2012-01-31 C.R. Bard, Inc. Suture lock fastening device
US8834496B2 (en) 2006-06-13 2014-09-16 Bret A. Ferree Soft tissue repair methods and apparatus
US8764835B2 (en) * 2006-06-13 2014-07-01 Bret A. Ferree Intervertebral disc treatment methods and apparatus
US9232938B2 (en) 2006-06-13 2016-01-12 Anova Corp. Method and apparatus for closing fissures in the annulus fibrosus
US8821549B2 (en) 2006-06-13 2014-09-02 Anova Corporation Methods and apparatus for anulus repair
US9055906B2 (en) * 2006-06-14 2015-06-16 Intuitive Surgical Operations, Inc. In-vivo visualization systems
US20070299459A1 (en) * 2006-06-26 2007-12-27 X-Sten Corp. Percutaneous Tissue Access Device
US8556930B2 (en) 2006-06-28 2013-10-15 Abbott Laboratories Vessel closure device
USD611144S1 (en) 2006-06-28 2010-03-02 Abbott Laboratories Apparatus for delivering a closure element
US8870916B2 (en) 2006-07-07 2014-10-28 USGI Medical, Inc Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use
USD620593S1 (en) 2006-07-31 2010-07-27 Vertos Medical, Inc. Tissue excision device
US20080033241A1 (en) * 2006-08-01 2008-02-07 Ruey-Feng Peh Left atrial appendage closure
US8133258B2 (en) 2006-08-03 2012-03-13 Arthrocare Corporation Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device
US20080097476A1 (en) 2006-09-01 2008-04-24 Voyage Medical, Inc. Precision control systems for tissue visualization and manipulation assemblies
WO2008028149A2 (en) 2006-09-01 2008-03-06 Voyage Medical, Inc. Electrophysiology mapping and visualization system
US10004388B2 (en) 2006-09-01 2018-06-26 Intuitive Surgical Operations, Inc. Coronary sinus cannulation
US7749248B2 (en) * 2006-09-18 2010-07-06 St. Jude Medical Puerto Rico Llc Flexible tamping device
US10335131B2 (en) 2006-10-23 2019-07-02 Intuitive Surgical Operations, Inc. Methods for preventing tissue migration
US8562629B2 (en) * 2006-10-24 2013-10-22 Arthrocare Corporation Suture device having selective needle actuation and related method
US20100070019A1 (en) * 2006-10-29 2010-03-18 Aneuwrap Ltd. extra-vascular wrapping for treating aneurysmatic aorta and methods thereof
EP2083706B1 (en) 2006-11-07 2012-02-01 Boston Scientific Limited Delivering sutures
WO2008067384A2 (en) 2006-11-30 2008-06-05 Wilson-Cook Medical, Inc. Visceral anchors for purse-string closure of perforations
US20080183036A1 (en) 2006-12-18 2008-07-31 Voyage Medical, Inc. Systems and methods for unobstructed visualization and ablation
US8131350B2 (en) * 2006-12-21 2012-03-06 Voyage Medical, Inc. Stabilization of visualization catheters
US9226648B2 (en) * 2006-12-21 2016-01-05 Intuitive Surgical Operations, Inc. Off-axis visualization systems
EP2114268A4 (en) * 2007-02-12 2010-03-03 Vertos Medical Inc Tissue excision devices and methods
US7655004B2 (en) 2007-02-15 2010-02-02 Ethicon Endo-Surgery, Inc. Electroporation ablation apparatus, system, and method
US8465546B2 (en) 2007-02-16 2013-06-18 Ldr Medical Intervertebral disc prosthesis insertion assemblies
WO2008107885A2 (en) 2007-03-05 2008-09-12 Alon Shalev Multi-component expandable supportive bifurcated endoluminal grafts and methods for using same
EP2134266A4 (en) 2007-03-29 2015-06-03 Nobles Medical Technologies Inc Suturing devices and methods for closing a patent foramen ovale
US9005242B2 (en) 2007-04-05 2015-04-14 W.L. Gore & Associates, Inc. Septal closure device with centering mechanism
WO2008124676A1 (en) * 2007-04-06 2008-10-16 Interventional Therapies Suturing, crimping and cutting device
US8915943B2 (en) 2007-04-13 2014-12-23 Ethicon, Inc. Self-retaining systems for surgical procedures
WO2008131167A1 (en) 2007-04-18 2008-10-30 Nmt Medical, Inc. Flexible catheter system
US8137381B2 (en) 2007-04-25 2012-03-20 Arthrocare Corporation Knotless suture anchor having discrete polymer components and related methods
US8075572B2 (en) * 2007-04-26 2011-12-13 Ethicon Endo-Surgery, Inc. Surgical suturing apparatus
US8100922B2 (en) 2007-04-27 2012-01-24 Ethicon Endo-Surgery, Inc. Curved needle suturing tool
EP2148608A4 (en) * 2007-04-27 2010-04-28 Voyage Medical Inc Complex shape steerable tissue visualization and manipulation catheter
US8657805B2 (en) 2007-05-08 2014-02-25 Intuitive Surgical Operations, Inc. Complex shape steerable tissue visualization and manipulation catheter
WO2008141238A1 (en) 2007-05-11 2008-11-20 Voyage Medical, Inc. Visual electrode ablation systems
US8740937B2 (en) * 2007-05-31 2014-06-03 Cook Medical Technologies Llc Suture lock
FR2916956B1 (en) 2007-06-08 2012-12-14 Ldr Medical INTERSOMATIC CAGE, INTERVERTEBRAL PROSTHESIS, ANCHORING DEVICE AND IMPLANTATION INSTRUMENTATION
US8226681B2 (en) 2007-06-25 2012-07-24 Abbott Laboratories Methods, devices, and apparatus for managing access through tissue
US20090030276A1 (en) * 2007-07-27 2009-01-29 Voyage Medical, Inc. Tissue visualization catheter with imaging systems integration
EP2182855A1 (en) * 2007-08-08 2010-05-12 Spirx Closure, LLC Methods and devices for delivering sutures in tissue
AU2008289259B2 (en) * 2007-08-17 2013-04-04 Cook Medical Technologies Llc Device to open and close a bodily wall
US8568445B2 (en) * 2007-08-21 2013-10-29 St. Jude Medical Puerto Rico Llc Extra-vascular sealing device and method
US8333787B2 (en) 2007-12-31 2012-12-18 St. Jude Medical Puerto Rico Llc Vascular closure device having a flowable sealing material
US8579897B2 (en) 2007-11-21 2013-11-12 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8262655B2 (en) 2007-11-21 2012-09-11 Ethicon Endo-Surgery, Inc. Bipolar forceps
US20090062790A1 (en) * 2007-08-31 2009-03-05 Voyage Medical, Inc. Direct visualization bipolar ablation systems
US8568410B2 (en) 2007-08-31 2013-10-29 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
US8235985B2 (en) * 2007-08-31 2012-08-07 Voyage Medical, Inc. Visualization and ablation system variations
US7963972B2 (en) 2007-09-12 2011-06-21 Arthrocare Corporation Implant and delivery system for soft tissue repair
ES2398779T3 (en) 2007-09-27 2013-03-21 Ethicon Llc Self-retaining sutures that include tissue retention elements with enhanced strength
US20090105744A1 (en) * 2007-10-17 2009-04-23 Modesitt D Bruce Methods for forming tracts in tissue
US8480657B2 (en) 2007-10-31 2013-07-09 Ethicon Endo-Surgery, Inc. Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US20090112059A1 (en) 2007-10-31 2009-04-30 Nobis Rudolph H Apparatus and methods for closing a gastrotomy
US20090118709A1 (en) * 2007-11-06 2009-05-07 Vertos Medical, Inc. A Delaware Corporation Tissue Excision Tool, Kits and Methods of Using the Same
US20090125022A1 (en) * 2007-11-12 2009-05-14 Voyage Medical, Inc. Tissue visualization and ablation systems
US20090143640A1 (en) * 2007-11-26 2009-06-04 Voyage Medical, Inc. Combination imaging and treatment assemblies
CA2709278A1 (en) 2007-12-15 2009-06-25 Endospan Ltd. Extra-vascular wrapping for treating aneurysmatic aorta in conjunction with endovascular stent-graft and methods thereof
US20090157101A1 (en) * 2007-12-17 2009-06-18 Abbott Laboratories Tissue closure system and methods of use
US7841502B2 (en) 2007-12-18 2010-11-30 Abbott Laboratories Modular clip applier
US8916077B1 (en) 2007-12-19 2014-12-23 Ethicon, Inc. Self-retaining sutures with retainers formed from molten material
BRPI0820129B8 (en) 2007-12-19 2021-06-22 Angiotech Pharm Inc process of formation of a self-retaining suture and self-retaining suture
US20090187215A1 (en) * 2007-12-19 2009-07-23 Abbott Laboratories Methods and apparatus to reduce a dimension of an implantable device in a smaller state
US8118834B1 (en) 2007-12-20 2012-02-21 Angiotech Pharmaceuticals, Inc. Composite self-retaining sutures and method
US9282953B2 (en) * 2007-12-31 2016-03-15 St. Jude Medical Puerto Rico Llc Systems and methods for locating and closing a tissue puncture
US8840640B2 (en) 2007-12-31 2014-09-23 St. Jude Medical Puerto Rico Llc Vascular closure device having an improved plug
JP5421927B2 (en) * 2008-01-03 2014-02-19 クック メディカル テクノロジーズ エルエルシー Medical device, instrument and method for suturing a hole using an endoscope
WO2009097556A2 (en) 2008-01-30 2009-08-06 Angiotech Pharmaceuticals, Inc. Appartaus and method for forming self-retaining sutures
US8615856B1 (en) 2008-01-30 2013-12-31 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
US8858609B2 (en) * 2008-02-07 2014-10-14 Intuitive Surgical Operations, Inc. Stent delivery under direct visualization
WO2009105663A2 (en) 2008-02-21 2009-08-27 Angiotech Pharmaceuticals, Inc. Method and apparatus for elevating retainers on self-retaining sutures
US8216273B1 (en) 2008-02-25 2012-07-10 Ethicon, Inc. Self-retainers with supporting structures on a suture
US8641732B1 (en) 2008-02-26 2014-02-04 Ethicon, Inc. Self-retaining suture with variable dimension filament and method
US8241324B2 (en) * 2008-03-03 2012-08-14 Eilaz Babaev Ultrasonic vascular closure device
US20090228002A1 (en) * 2008-03-04 2009-09-10 Rioux Robert F Electromagnetic energy assisted tissue penetration device and method
US20090223426A1 (en) * 2008-03-04 2009-09-10 Harry Shonteff Micro sewing device
US20130165967A1 (en) 2008-03-07 2013-06-27 W.L. Gore & Associates, Inc. Heart occlusion devices
US8262680B2 (en) 2008-03-10 2012-09-11 Ethicon Endo-Surgery, Inc. Anastomotic device
US8979828B2 (en) 2008-07-21 2015-03-17 The Spectranetics Corporation Tapered liquid light guide
US9421065B2 (en) 2008-04-02 2016-08-23 The Spectranetics Corporation Liquid light-guide catheter with optically diverging tip
JP5619726B2 (en) 2008-04-15 2014-11-05 エシコン・エルエルシーEthicon, LLC Self-retaining suture with bidirectional retainer or unidirectional retainer
EP2291125B1 (en) 2008-05-09 2021-04-21 Nobles Medical Technologies, Inc. Suturing devices for suturing an anatomic valve
US9282965B2 (en) 2008-05-16 2016-03-15 Abbott Laboratories Apparatus and methods for engaging tissue
US8679003B2 (en) 2008-05-30 2014-03-25 Ethicon Endo-Surgery, Inc. Surgical device and endoscope including same
US8070759B2 (en) 2008-05-30 2011-12-06 Ethicon Endo-Surgery, Inc. Surgical fastening device
US8652150B2 (en) 2008-05-30 2014-02-18 Ethicon Endo-Surgery, Inc. Multifunction surgical device
US8317806B2 (en) 2008-05-30 2012-11-27 Ethicon Endo-Surgery, Inc. Endoscopic suturing tension controlling and indication devices
US8771260B2 (en) 2008-05-30 2014-07-08 Ethicon Endo-Surgery, Inc. Actuating and articulating surgical device
US8114072B2 (en) 2008-05-30 2012-02-14 Ethicon Endo-Surgery, Inc. Electrical ablation device
US8906035B2 (en) 2008-06-04 2014-12-09 Ethicon Endo-Surgery, Inc. Endoscopic drop off bag
US8403926B2 (en) 2008-06-05 2013-03-26 Ethicon Endo-Surgery, Inc. Manually articulating devices
WO2009151815A1 (en) * 2008-06-11 2009-12-17 Boston Scientific Scimed, Inc. Suturing instrument and method for uterine preservation
US20090326572A1 (en) * 2008-06-27 2009-12-31 Ruey-Feng Peh Apparatus and methods for rapid tissue crossing
US8361112B2 (en) 2008-06-27 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical suture arrangement
AU2009269146B2 (en) 2008-06-30 2013-05-16 Bolton Medical, Inc. Abdominal aortic aneurysms: systems and methods of use
US8828029B2 (en) 2008-06-30 2014-09-09 Arthrocare Corporation Independent suture tensioning and snaring apparatus
US9101735B2 (en) 2008-07-07 2015-08-11 Intuitive Surgical Operations, Inc. Catheter control systems
JP5695564B2 (en) * 2008-07-07 2015-04-08 アピカ カーディオヴァスキュラー アイルランド リミテッド Tissue access site system and method
US8262563B2 (en) 2008-07-14 2012-09-11 Ethicon Endo-Surgery, Inc. Endoscopic translumenal articulatable steerable overtube
US8888792B2 (en) 2008-07-14 2014-11-18 Ethicon Endo-Surgery, Inc. Tissue apposition clip application devices and methods
US8562630B2 (en) * 2008-07-18 2013-10-22 Richard Campbell Suture instrument and method
CN102159127A (en) * 2008-07-21 2011-08-17 阿尔斯塔西斯公司 Devices and methods for forming tracts in tissue
WO2010011695A1 (en) 2008-07-21 2010-01-28 Arstasis, Inc. Devices, methods, and kits for forming tracts in tissue
WO2010011777A1 (en) * 2008-07-22 2010-01-28 Spirx Closure, Llc Methods and devices for delivering sutures in tissue
US8211125B2 (en) 2008-08-15 2012-07-03 Ethicon Endo-Surgery, Inc. Sterile appliance delivery device for endoscopic procedures
US8529563B2 (en) 2008-08-25 2013-09-10 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8241204B2 (en) 2008-08-29 2012-08-14 Ethicon Endo-Surgery, Inc. Articulating end cap
US8480689B2 (en) 2008-09-02 2013-07-09 Ethicon Endo-Surgery, Inc. Suturing device
US8409200B2 (en) 2008-09-03 2013-04-02 Ethicon Endo-Surgery, Inc. Surgical grasping device
US8114119B2 (en) 2008-09-09 2012-02-14 Ethicon Endo-Surgery, Inc. Surgical grasping device
CA2738426C (en) 2008-09-29 2016-03-15 C.R. Bard, Inc. Endoscopic suturing device
US8337394B2 (en) 2008-10-01 2012-12-25 Ethicon Endo-Surgery, Inc. Overtube with expandable tip
EP2537478B1 (en) * 2008-10-07 2014-01-29 Neurendo B.V. A minimal invasive neurosurgery assembly
US8894643B2 (en) 2008-10-10 2014-11-25 Intuitive Surgical Operations, Inc. Integral electrode placement and connection systems
US8333012B2 (en) 2008-10-10 2012-12-18 Voyage Medical, Inc. Method of forming electrode placement and connection systems
US8163022B2 (en) 2008-10-14 2012-04-24 Anulex Technologies, Inc. Method and apparatus for the treatment of the intervertebral disc annulus
EP2344050A1 (en) * 2008-10-20 2011-07-20 Keren Medical Ltd. Urethral anastomosis device and method of using the same
USD610259S1 (en) 2008-10-23 2010-02-16 Vertos Medical, Inc. Tissue modification device
USD621939S1 (en) 2008-10-23 2010-08-17 Vertos Medical, Inc. Tissue modification device
USD619252S1 (en) 2008-10-23 2010-07-06 Vertos Medical, Inc. Tissue modification device
USD611146S1 (en) 2008-10-23 2010-03-02 Vertos Medical, Inc. Tissue modification device
USD619253S1 (en) 2008-10-23 2010-07-06 Vertos Medical, Inc. Tissue modification device
USD635671S1 (en) 2008-10-23 2011-04-05 Vertos Medical, Inc. Tissue modification device
DE102008053809A1 (en) 2008-10-29 2010-05-12 Medi-Globe Gmbh Surgical thread positioning system for closing an opening within a tissue wall
US8398676B2 (en) 2008-10-30 2013-03-19 Abbott Vascular Inc. Closure device
MX339174B (en) 2008-11-03 2016-05-12 Ethicon Llc Length of self-retaining suture and method and device for using the same.
US9468364B2 (en) * 2008-11-14 2016-10-18 Intuitive Surgical Operations, Inc. Intravascular catheter with hood and image processing systems
US8157834B2 (en) 2008-11-25 2012-04-17 Ethicon Endo-Surgery, Inc. Rotational coupling device for surgical instrument with flexible actuators
US8172772B2 (en) 2008-12-11 2012-05-08 Ethicon Endo-Surgery, Inc. Specimen retrieval device
DE102008061933A1 (en) 2008-12-12 2010-06-17 Medi-Globe Gmbh Suturing device i.e. surgical suturing device, for suturing tissue opening at blood vessel wall of person, has expanding part pointing towards proximal end and movable between folded and expanded positions by traction and pressing rod
US20100152748A1 (en) * 2008-12-12 2010-06-17 E-Pacing, Inc. Devices, Systems, and Methods Providing Body Lumen Access
US8858594B2 (en) 2008-12-22 2014-10-14 Abbott Laboratories Curved closure device
US8323312B2 (en) 2008-12-22 2012-12-04 Abbott Laboratories Closure device
US20110011917A1 (en) * 2008-12-31 2011-01-20 Hansen Medical, Inc. Methods, devices, and kits for treating valve prolapse
US9173644B2 (en) 2009-01-09 2015-11-03 Abbott Vascular Inc. Closure devices, systems, and methods
US20100179589A1 (en) 2009-01-09 2010-07-15 Abbott Vascular Inc. Rapidly eroding anchor
US9414820B2 (en) 2009-01-09 2016-08-16 Abbott Vascular Inc. Closure devices, systems, and methods
US9089311B2 (en) 2009-01-09 2015-07-28 Abbott Vascular Inc. Vessel closure devices and methods
US8926639B2 (en) 2009-01-12 2015-01-06 Teleflex Medical Incorporated Apparatus and methods for tissue closure
US8828031B2 (en) 2009-01-12 2014-09-09 Ethicon Endo-Surgery, Inc. Apparatus for forming an anastomosis
US8361066B2 (en) 2009-01-12 2013-01-29 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8388349B2 (en) * 2009-01-14 2013-03-05 Ams Research Corporation Anastomosis deployment force training tool
US20100185234A1 (en) 2009-01-16 2010-07-22 Abbott Vascular Inc. Closure devices, systems, and methods
US20100191272A1 (en) * 2009-01-23 2010-07-29 Salviac Limited Distal access embolic protection system and methods of using the same
US8252057B2 (en) 2009-01-30 2012-08-28 Ethicon Endo-Surgery, Inc. Surgical access device
US9226772B2 (en) 2009-01-30 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical device
US8037591B2 (en) 2009-02-02 2011-10-18 Ethicon Endo-Surgery, Inc. Surgical scissors
US8529598B2 (en) * 2009-02-20 2013-09-10 Boston Scientific Scimed, Inc. Tissue puncture closure device
US8052914B2 (en) * 2009-02-20 2011-11-08 Boston Scientific Scimed, Inc. Modified plug for arteriotomy closure
US8317824B2 (en) 2009-02-20 2012-11-27 Boston Scientific Scimed, Inc. Tissue puncture closure device
US8375553B2 (en) * 2009-02-20 2013-02-19 Boston Scientific Scimed, Inc. Locking element for vascular closure device
US8292918B2 (en) 2009-02-20 2012-10-23 Boston Scientific Scimed, Inc. Composite plug for arteriotomy closure and method of use
US9913634B2 (en) 2009-02-20 2018-03-13 Boston Scientific Scimed, Inc. Locking element for vascular closure device
WO2010099437A1 (en) * 2009-02-27 2010-09-02 Silk Road Medical, Inc. Vessel closure clip device
WO2010105195A2 (en) 2009-03-13 2010-09-16 Bolton Medical, Inc. System and method for deploying an endoluminal prosthesis at a surgical site
US8147505B2 (en) * 2009-03-23 2012-04-03 Arthrocare Corporation Surgical instrument for manipulating surgical suture and methods of use
CA2757554A1 (en) 2009-04-03 2010-10-07 Cook Medical Technologies Llc Tissue anchors and medical devices for rapid deployment of tissue anchors
US20100256629A1 (en) * 2009-04-06 2010-10-07 Voyage Medical, Inc. Methods and devices for treatment of the ostium
AU2010233217A1 (en) 2009-04-09 2011-10-27 Cardiovascular Systems, Inc. Tissue closure devices, device and systems for delivery, kits and methods therefor
US8109943B2 (en) * 2009-04-10 2012-02-07 Gordian Surgical, LLC Systems and methods for suture anchor deployment
JP2012526640A (en) * 2009-05-15 2012-11-01 アルスタシス,インコーポレイテッド Apparatus, method and kit for forming pathways in tissue
US20100324597A1 (en) * 2009-06-19 2010-12-23 Oleg Shikhman Crimping and cutting device
US8956389B2 (en) 2009-06-22 2015-02-17 W. L. Gore & Associates, Inc. Sealing device and delivery system
US20120029556A1 (en) 2009-06-22 2012-02-02 Masters Steven J Sealing device and delivery system
CA2961767C (en) 2009-06-23 2018-08-14 Endospan Ltd. Vascular prostheses for treating aneurysms
US8597262B2 (en) 2009-07-09 2013-12-03 Ams Research Corporation Apparatus and methods of treatment of pathologic proliferative conditions uterine tissue
US8979892B2 (en) 2009-07-09 2015-03-17 Endospan Ltd. Apparatus for closure of a lumen and methods of using the same
US8439970B2 (en) 2009-07-14 2013-05-14 Edwards Lifesciences Corporation Transapical delivery system for heart valves
US8500757B2 (en) * 2009-07-28 2013-08-06 Edwards Lifesciences Corporation Surgical puncture cinch and closure system
US20110054492A1 (en) 2009-08-26 2011-03-03 Abbott Laboratories Medical device for repairing a fistula
EP2477555B1 (en) 2009-09-15 2013-12-25 Evalve, Inc. Device for cardiac valve repair
KR101805935B1 (en) 2009-09-17 2017-12-06 엘디알 홀딩 코포레이션 Intervertebral implant having extendable bone fixation members
WO2011038026A1 (en) * 2009-09-22 2011-03-31 Arstasis, Inc. Devices, methods, and kits for forming tracts in tissue
US8845682B2 (en) 2009-10-13 2014-09-30 E-Pacing, Inc. Vasculature closure devices and methods
US20110098704A1 (en) 2009-10-28 2011-04-28 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8608652B2 (en) 2009-11-05 2013-12-17 Ethicon Endo-Surgery, Inc. Vaginal entry surgical devices, kit, system, and method
US9211118B2 (en) * 2009-11-16 2015-12-15 Arthrocare Corporation Suture passer
CN105361976B (en) 2009-11-30 2017-08-18 恩多斯潘有限公司 For implantation into the multi-part overlay film frame system in the blood vessel with multiple branches
EP2509535B1 (en) 2009-12-08 2016-12-07 Endospan Ltd Endovascular stent-graft system with fenestrated and crossing stent-grafts
US8496574B2 (en) 2009-12-17 2013-07-30 Ethicon Endo-Surgery, Inc. Selectively positionable camera for surgical guide tube assembly
US8353487B2 (en) 2009-12-17 2013-01-15 Ethicon Endo-Surgery, Inc. User interface support devices for endoscopic surgical instruments
US8506564B2 (en) 2009-12-18 2013-08-13 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US9028483B2 (en) 2009-12-18 2015-05-12 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
WO2011090628A2 (en) 2009-12-29 2011-07-28 Angiotech Pharmaceuticals, Inc. Bidirectional self-retaining sutures with laser-marked and/or non-laser marked indicia and methods
WO2011080738A1 (en) 2009-12-31 2011-07-07 Endospan Ltd. Endovascular flow direction indicator
ES2662009T3 (en) 2009-12-31 2018-04-05 Ldr Medical Intervertebral system comprising an anchoring device
US8460319B2 (en) 2010-01-11 2013-06-11 Anulex Technologies, Inc. Intervertebral disc annulus repair system and method
US10743854B2 (en) 2010-01-20 2020-08-18 Micro Interventional Devices, Inc. Tissue closure device and method
US10959840B2 (en) 2010-01-20 2021-03-30 Micro Interventional Devices, Inc. Systems and methods for affixing a prosthesis to tissue
JP5828147B2 (en) 2010-01-20 2015-12-02 マイクロ インターベンショナル デバイシズ,インコーポレイティド Tissue repair implant, delivery device and delivery method
US10058314B2 (en) 2010-01-20 2018-08-28 Micro Interventional Devices, Inc. Tissue closure device and method
US9980708B2 (en) 2010-01-20 2018-05-29 Micro Interventional Devices, Inc. Tissue closure device and method
US9005198B2 (en) 2010-01-29 2015-04-14 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
CA2789304C (en) 2010-02-08 2018-01-02 Endospan Ltd. Thermal energy application for prevention and management of endoleaks in stent-grafts
EP2533698B1 (en) * 2010-02-11 2018-03-28 Boston Scientific Scimed, Inc. Automatic vascular closure deployment devices
US8694071B2 (en) 2010-02-12 2014-04-08 Intuitive Surgical Operations, Inc. Image stabilization techniques and methods
US20110218191A1 (en) * 2010-03-03 2011-09-08 Boehringer Ingelheim Vetmedica Gmbh Use of meloxicam for the long term-treatment of kidney disorders in cats
US8303624B2 (en) 2010-03-15 2012-11-06 Abbott Cardiovascular Systems, Inc. Bioabsorbable plug
US9814522B2 (en) 2010-04-06 2017-11-14 Intuitive Surgical Operations, Inc. Apparatus and methods for ablation efficacy
KR101019222B1 (en) * 2010-04-14 2011-03-04 정경진 Trocar assembly for laparoscopic surgery
NZ705330A (en) 2010-05-04 2016-12-23 Ethicon Llc Laser cutting system and methods for creating self-retaining sutures
EP2579786B1 (en) 2010-06-09 2017-11-01 C.R. Bard Inc. Instruments for delivering transfascial sutures and transfascial suture assemblies
AU2011265232B2 (en) 2010-06-11 2015-01-22 Ethicon Llc Suture delivery tools for endoscopic and robot-assisted surgery and methods
US8758399B2 (en) 2010-08-02 2014-06-24 Abbott Cardiovascular Systems, Inc. Expandable bioabsorbable plug apparatus and method
US8603116B2 (en) 2010-08-04 2013-12-10 Abbott Cardiovascular Systems, Inc. Closure device with long tines
US8597340B2 (en) 2010-09-17 2013-12-03 Boston Scientific Scimed, Inc. Torque mechanism actuated bioabsorbable vascular closure device
US8603137B2 (en) 2010-11-01 2013-12-10 Abbott Cardiovascular Systems, Inc. Methods and systems for establishing hemostasis relative to a puncture
RU2608237C2 (en) 2010-11-03 2017-01-17 ЭТИКОН ЭлЭлСи Self-fastening suturing materials releasing drugs and related methods
EP3138506B1 (en) 2010-11-09 2020-08-26 Ethicon, LLC Emergency self-retaining sutures
EP2455001B1 (en) 2010-11-17 2020-07-22 Arthrex, Inc. Adjustable suture-button constructs for ligament reconstruction
EP2462876B1 (en) 2010-12-09 2015-10-14 Arthrex, Inc. Suture button construct with dog-bone shaped button for acromioclavicular joint fixation
US8758402B2 (en) 2010-12-17 2014-06-24 Boston Scientific Scimed, Inc. Tissue puncture closure device
US10092291B2 (en) 2011-01-25 2018-10-09 Ethicon Endo-Surgery, Inc. Surgical instrument with selectively rigidizable features
US9526638B2 (en) 2011-02-03 2016-12-27 Endospan Ltd. Implantable medical devices constructed of shape memory material
US8685047B2 (en) 2011-02-07 2014-04-01 Abbott Vascular, Inc. Scaffold device for preventing tissue trauma
US8556916B2 (en) 2011-02-14 2013-10-15 Smith & Nephew, Inc. Method and device for suture manipulation
US8617184B2 (en) 2011-02-15 2013-12-31 Abbott Cardiovascular Systems, Inc. Vessel closure system
US9855046B2 (en) 2011-02-17 2018-01-02 Endospan Ltd. Vascular bands and delivery systems therefor
US9149265B2 (en) 2011-02-26 2015-10-06 Abbott Cardiovascular Systems, Inc. Hinged tissue support device
US9254169B2 (en) 2011-02-28 2016-02-09 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9314620B2 (en) 2011-02-28 2016-04-19 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9233241B2 (en) 2011-02-28 2016-01-12 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
WO2012117395A1 (en) 2011-03-02 2012-09-07 Endospan Ltd. Reduced-strain extra- vascular ring for treating aortic aneurysm
WO2012121877A1 (en) 2011-03-10 2012-09-13 Boston Scientific Scimed, Inc. Flexible suturing instrument
US9049987B2 (en) 2011-03-17 2015-06-09 Ethicon Endo-Surgery, Inc. Hand held surgical device for manipulating an internal magnet assembly within a patient
US10492780B2 (en) 2011-03-23 2019-12-03 Ethicon, Inc. Self-retaining variable loop sutures
US9162038B2 (en) 2011-04-11 2015-10-20 The Spectranetics Corporation Needle and guidewire holder
US11083870B2 (en) 2011-04-11 2021-08-10 The Spectranetics Corporation Hypotube based support catheter
CN110882021A (en) 2011-04-15 2020-03-17 心脏缝合有限公司 Suturing device and method for suturing an anatomical valve
US9381082B2 (en) 2011-04-22 2016-07-05 Edwards Lifesciences Corporation Devices, systems and methods for accurate positioning of a prosthetic valve
US8556932B2 (en) 2011-05-19 2013-10-15 Abbott Cardiovascular Systems, Inc. Collapsible plug for tissue closure
US8753357B2 (en) * 2011-05-19 2014-06-17 Abbott Cardiovascular Systems, Inc. Devices and methods for suturing tissue
US20130172931A1 (en) 2011-06-06 2013-07-04 Jeffrey M. Gross Methods and devices for soft palate tissue elevation procedures
US9241708B2 (en) 2011-06-07 2016-01-26 St. Jude Medical Puerto Rico, Llc Large bore closure device and methods
US8574287B2 (en) 2011-06-14 2013-11-05 Endospan Ltd. Stents incorporating a plurality of strain-distribution locations
EP2579811B1 (en) 2011-06-21 2016-03-16 Endospan Ltd Endovascular system with circumferentially-overlapping stent-grafts
EP2729095B1 (en) 2011-07-07 2016-10-26 Endospan Ltd. Stent fixation with reduced plastic deformation
US9770232B2 (en) 2011-08-12 2017-09-26 W. L. Gore & Associates, Inc. Heart occlusion devices
US9055932B2 (en) 2011-08-26 2015-06-16 Abbott Cardiovascular Systems, Inc. Suture fastener combination device
US9839510B2 (en) 2011-08-28 2017-12-12 Endospan Ltd. Stent-grafts with post-deployment variable radial displacement
US9636101B2 (en) 2011-09-01 2017-05-02 Arthrocare Corporation Bone anchor having an integrated stress isolator
US8945177B2 (en) 2011-09-13 2015-02-03 Abbott Cardiovascular Systems Inc. Gripper pusher mechanism for tissue apposition systems
WO2013049370A1 (en) * 2011-09-27 2013-04-04 Regents Of The University Of Minnesota Systems for closure of openings in organs and tissue and related methods
WO2013065040A1 (en) 2011-10-30 2013-05-10 Endospan Ltd. Triple-collar stent-graft
CN103987325B (en) 2011-11-08 2017-03-29 波士顿科学国际有限公司 For the Handleset of left atrial appendage occlusion device
WO2013074490A1 (en) 2011-11-16 2013-05-23 St. Jude Medical Puerto Rico Llc Large bore vascular closure device with inner and outer seals
WO2013074488A1 (en) 2011-11-16 2013-05-23 St. Jude Medical Puerto Rico Llc Vascular closure system
WO2013081905A1 (en) 2011-11-28 2013-06-06 St. Jude Medical Puerto Rico Llc Anchor device for large bore vascular closure
US9332976B2 (en) 2011-11-30 2016-05-10 Abbott Cardiovascular Systems, Inc. Tissue closure device
US9597204B2 (en) 2011-12-04 2017-03-21 Endospan Ltd. Branched stent-graft system
WO2013103682A2 (en) 2012-01-04 2013-07-11 Teleflex Medical Incorporated Apparatus and methods for tissue closure
US9226742B2 (en) 2012-01-27 2016-01-05 Arthrocare Corporation Restricted wedge suture anchor and method for soft tissue repair
US9034014B2 (en) 2012-01-27 2015-05-19 Arthrocare Corporation Free floating wedge suture anchor for soft tissue repair
US9198649B2 (en) 2012-01-27 2015-12-01 Arthrocare Corporation Rotating locking member suture anchor and method for soft tissue repair
US9364210B2 (en) 2012-01-27 2016-06-14 Arthrocare Corporation Biased wedge suture anchor and method for soft tissue repair
US9023083B2 (en) 2012-01-27 2015-05-05 Arthrocare Corporation Method for soft tissue repair with free floating suture locking member
US10265062B2 (en) 2012-02-07 2019-04-23 Arthrocare Corporation Surgical instrument for manipulating and passing suture
US9351721B2 (en) 2012-02-16 2016-05-31 Coopersurgical, Inc. Suture passers and related methods
US8986199B2 (en) 2012-02-17 2015-03-24 Ethicon Endo-Surgery, Inc. Apparatus and methods for cleaning the lens of an endoscope
FR2987256B1 (en) 2012-02-24 2014-08-08 Ldr Medical ANCHORING DEVICE FOR INTERVERTEBRAL IMPLANT, INTERVERTEBRAL IMPLANT AND IMPLANTATION INSTRUMENTATION
US9138214B2 (en) 2012-03-02 2015-09-22 Abbott Cardiovascular Systems, Inc. Suture securing systems, devices and methods
KR101282789B1 (en) 2012-03-06 2013-07-05 연세대학교 산학협력단 Blood vessel sealing apparatus of reverse type
US9358077B2 (en) 2012-03-14 2016-06-07 St. Jude Medical Puerto Rico Llc Markers for tissue tract depth indication and methods
US9821145B2 (en) 2012-03-23 2017-11-21 Pressure Products Medical Supplies Inc. Transseptal puncture apparatus and method for using the same
US9707339B2 (en) 2012-03-28 2017-07-18 Angiodynamics, Inc. High flow rate dual reservoir port system
US9713704B2 (en) 2012-03-29 2017-07-25 Bradley D. Chartrand Port reservoir cleaning system and method
US9855028B2 (en) 2012-04-06 2018-01-02 Arthrocare Corporation Multi-suture knotless anchor for attaching tissue to bone and related method
CN104363862B (en) 2012-04-12 2016-10-05 波顿医疗公司 Blood vessel prosthesis conveyer device and using method
US9265514B2 (en) 2012-04-17 2016-02-23 Miteas Ltd. Manipulator for grasping tissue
EP3597115A1 (en) 2012-05-11 2020-01-22 Heartstitch, Inc. Suturing devices for suturing an anatomic structure
US9427255B2 (en) 2012-05-14 2016-08-30 Ethicon Endo-Surgery, Inc. Apparatus for introducing a steerable camera assembly into a patient
US9770350B2 (en) 2012-05-15 2017-09-26 Endospan Ltd. Stent-graft with fixation elements that are radially confined for delivery
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US20130317438A1 (en) 2012-05-25 2013-11-28 Arstasis, Inc. Vascular access configuration
US20130317481A1 (en) 2012-05-25 2013-11-28 Arstasis, Inc. Vascular access configuration
JP5963559B2 (en) 2012-06-18 2016-08-03 日本コヴィディエン株式会社 Medical suture tool
US9078662B2 (en) 2012-07-03 2015-07-14 Ethicon Endo-Surgery, Inc. Endoscopic cap electrode and method for using the same
US9545290B2 (en) 2012-07-30 2017-01-17 Ethicon Endo-Surgery, Inc. Needle probe guide
US10314649B2 (en) 2012-08-02 2019-06-11 Ethicon Endo-Surgery, Inc. Flexible expandable electrode and method of intraluminal delivery of pulsed power
US9572623B2 (en) 2012-08-02 2017-02-21 Ethicon Endo-Surgery, Inc. Reusable electrode and disposable sheath
WO2014021937A1 (en) 2012-08-03 2014-02-06 St. Jude Medical Puerto Rico Llc Large bore introducer with improved seal
US9277957B2 (en) 2012-08-15 2016-03-08 Ethicon Endo-Surgery, Inc. Electrosurgical devices and methods
US10182811B2 (en) * 2012-08-21 2019-01-22 Harry Shonteff Micro sewing device
WO2014031147A1 (en) 2012-08-24 2014-02-27 St. Jude Medical Puerto Rico Llc Balloon bailout and bioadhesive delivery device for suture based closure and methods
US9345475B2 (en) 2012-09-11 2016-05-24 Abbott Cardiovascular Systems, Inc. Needle harvesting devices, systems and methods
US9345474B2 (en) 2012-09-11 2016-05-24 Abbott Cardiovascular Systems, Inc. Needle removal devices, systems, and methods
US20140074126A1 (en) * 2012-09-11 2014-03-13 Abbott Cardiovascular Systems, Inc. Removing needles from a suturing device
US9750595B2 (en) 2012-09-28 2017-09-05 Covidien Lp Implantable medical devices which include grip-members and methods of use thereof
CN107456297A (en) 2013-01-08 2017-12-12 恩多斯潘有限公司 The minimum of Stent Graft Migration during implantation
US9486132B2 (en) 2013-01-17 2016-11-08 Abbott Cardiovascular Systems, Inc. Access device for accessing tissue
US10828019B2 (en) 2013-01-18 2020-11-10 W.L. Gore & Associates, Inc. Sealing device and delivery system
WO2014117107A1 (en) 2013-01-28 2014-07-31 Cartiva, Inc. Systems and methods for orthopedic repair
US9737294B2 (en) 2013-01-28 2017-08-22 Cartiva, Inc. Method and system for orthopedic repair
US9610076B2 (en) 2013-02-15 2017-04-04 Cook Medical Technologies Llc Wound closure device
KR102346230B1 (en) * 2013-02-22 2022-01-04 메데온 바이오디자인, 인코포레이티드 Systems for percutaneous suture delivery
US10098527B2 (en) 2013-02-27 2018-10-16 Ethidcon Endo-Surgery, Inc. System for performing a minimally invasive surgical procedure
US10136885B2 (en) 2013-03-11 2018-11-27 St. Jude Medical Puerto Rico Llc Three suture large bore closure device and methods
WO2014141232A1 (en) 2013-03-11 2014-09-18 Endospan Ltd. Multi-component stent-graft system for aortic dissections
US9055933B2 (en) 2013-03-12 2015-06-16 St. Jude Medical Puerto Rico Llc Large bore closure secondary hemostasis bioadhesive delivery systems and methods
US9439751B2 (en) 2013-03-15 2016-09-13 Bolton Medical, Inc. Hemostasis valve and delivery systems
US10149757B2 (en) 2013-03-15 2018-12-11 Edwards Lifesciences Corporation System and method for transaortic delivery of a prosthetic heart valve
WO2014169215A2 (en) 2013-04-11 2014-10-16 University Of Utah Research Foundation Self-closing laparoscopic port
US10828022B2 (en) 2013-07-02 2020-11-10 Med-Venture Investments, Llc Suturing devices and methods for suturing an anatomic structure
US10085731B2 (en) 2013-07-15 2018-10-02 E-Pacing, Inc. Vasculature closure devices and methods
US10070851B2 (en) 2013-08-02 2018-09-11 Covidien Lp Devices, systems, and methods for wound closure
US9918712B2 (en) 2013-08-02 2018-03-20 Covidien Lp Devices, systems, and methods for providing surgical access and facilitating closure of surgical access openings
US9681868B2 (en) 2013-08-02 2017-06-20 Covidien Lp Devices, systems, and methods for wound closure
WO2015040617A1 (en) 2013-09-17 2015-03-26 Gordian Surgical Ltd. Trocar and wound closure device
US10603197B2 (en) 2013-11-19 2020-03-31 Endospan Ltd. Stent system with radial-expansion locking
EP3079602B1 (en) 2013-12-06 2020-01-22 Med-venture Investments, LLC Suturing apparatuses
US10166321B2 (en) 2014-01-09 2019-01-01 Angiodynamics, Inc. High-flow port and infusion needle systems
US9730701B2 (en) 2014-01-16 2017-08-15 Boston Scientific Scimed, Inc. Retrieval wire centering device
US20170086997A1 (en) * 2014-03-07 2017-03-30 Maquet Holding B.V. & Co. Kg Catheter device for fenestrating a stentgraft
US9572666B2 (en) 2014-03-17 2017-02-21 Evalve, Inc. Mitral valve fixation device removal devices and methods
US10390943B2 (en) 2014-03-17 2019-08-27 Evalve, Inc. Double orifice device for transcatheter mitral valve replacement
WO2015164819A1 (en) 2014-04-24 2015-10-29 Smith & Nephew, Inc. Suture passer
EP3134033B1 (en) 2014-05-29 2018-04-04 Edwards Lifesciences CardiAQ LLC Prosthesis and delivery device
EP3251605B1 (en) * 2014-06-02 2021-03-31 Terumo Medical Corporation Systems for suture delivery
US9808230B2 (en) 2014-06-06 2017-11-07 W. L. Gore & Associates, Inc. Sealing device and delivery system
US11246583B2 (en) 2014-06-18 2022-02-15 Boston Scientific Scimed, Inc. Insertion devices, anchors, and methods for securing an implant
US10178993B2 (en) 2014-07-11 2019-01-15 Cardio Medical Solutions, Inc. Device and method for assisting end-to-side anastomosis
US9936943B1 (en) 2014-08-07 2018-04-10 Nicholas MANCINI Suture passing surgical device with atraumatic grasper preventing accidental perforations
US11504192B2 (en) 2014-10-30 2022-11-22 Cilag Gmbh International Method of hub communication with surgical instrument systems
WO2016098113A1 (en) 2014-12-18 2016-06-23 Endospan Ltd. Endovascular stent-graft with fatigue-resistant lateral tube
US10188392B2 (en) 2014-12-19 2019-01-29 Abbott Cardiovascular Systems, Inc. Grasping for tissue repair
CN113520498A (en) * 2015-02-10 2021-10-22 丽多斯医疗有限公司 Device for communicably coupling a first organ body and a second organ body
US10524912B2 (en) 2015-04-02 2020-01-07 Abbott Cardiovascular Systems, Inc. Tissue fixation devices and methods
US11076849B2 (en) * 2015-06-01 2021-08-03 Terumo Medical Corporation Suture delivery with asynchronous needle capture
US10376673B2 (en) 2015-06-19 2019-08-13 Evalve, Inc. Catheter guiding system and methods
US10238494B2 (en) 2015-06-29 2019-03-26 Evalve, Inc. Self-aligning radiopaque ring
US10667815B2 (en) 2015-07-21 2020-06-02 Evalve, Inc. Tissue grasping devices and related methods
US10271838B2 (en) * 2015-07-21 2019-04-30 Artisan Medical Supply Corporation Laparoscopic suturing guide
US10413408B2 (en) 2015-08-06 2019-09-17 Evalve, Inc. Delivery catheter systems, methods, and devices
US10639020B2 (en) 2015-09-28 2020-05-05 M-V Arterica AB Vascular closure device
US10238495B2 (en) 2015-10-09 2019-03-26 Evalve, Inc. Delivery catheter handle and methods of use
US10058393B2 (en) 2015-10-21 2018-08-28 P Tech, Llc Systems and methods for navigation and visualization
EP3373829A1 (en) 2015-11-13 2018-09-19 Cardiac Pacemakers, Inc. Bioabsorbable left atrial appendage closure with endothelialization promoting surface
US20170164942A1 (en) * 2015-12-15 2017-06-15 Heartstitch, Inc. Holding Block For Multiple Catheter Needles
US10219803B2 (en) 2016-03-01 2019-03-05 Ryan Grant Surgical instrument
EP3442437B1 (en) 2016-04-11 2020-11-11 Nobles Medical Technologies II, Inc. Tissue suturing device with suture spool
US10736632B2 (en) 2016-07-06 2020-08-11 Evalve, Inc. Methods and devices for valve clip excision
PL3509506T3 (en) 2016-09-07 2021-10-25 Vertos Medical, Inc. Percutaneous lateral recess resection instruments
US11071564B2 (en) 2016-10-05 2021-07-27 Evalve, Inc. Cardiac valve cutting device
EP3531931A1 (en) 2016-10-31 2019-09-04 Smith & Nephew, Inc Suture passer and grasper instrument and method
US10363138B2 (en) 2016-11-09 2019-07-30 Evalve, Inc. Devices for adjusting the curvature of cardiac valve structures
US10398553B2 (en) 2016-11-11 2019-09-03 Evalve, Inc. Opposing disk device for grasping cardiac valve tissue
US10426616B2 (en) 2016-11-17 2019-10-01 Evalve, Inc. Cardiac implant delivery system
US10779837B2 (en) 2016-12-08 2020-09-22 Evalve, Inc. Adjustable arm device for grasping tissues
US10314586B2 (en) 2016-12-13 2019-06-11 Evalve, Inc. Rotatable device and method for fixing tricuspid valve tissue
CN110831520B (en) 2017-04-27 2022-11-15 波士顿科学国际有限公司 Occlusive medical devices with fabric retention barbs
EP3621529A1 (en) 2017-05-12 2020-03-18 Evalve, Inc. Long arm valve repair clip
CN107149493B (en) * 2017-06-06 2023-11-14 张金霞 Blunt needle puncture measuring instrument
EP3641660A1 (en) 2017-06-19 2020-04-29 Heartstitch, Inc. Suturing devices and methods for suturing an opening in the apex of the heart
EP4115818A3 (en) 2017-06-19 2023-04-05 Heartstitch, Inc. Suturing systems and methods for suturing body tissue
WO2019035095A1 (en) 2017-08-18 2019-02-21 Nobles Medical Technologies Ii, Inc. Apparatus for applying a knot to a suture
WO2019055779A1 (en) * 2017-09-14 2019-03-21 Access Closure, Inc. Arteriotomy positioning device and method of use therefor
US10736616B2 (en) 2017-10-30 2020-08-11 Ethicon Llc Surgical instrument with remote release
US11311342B2 (en) 2017-10-30 2022-04-26 Cilag Gmbh International Method for communicating with surgical instrument systems
US11564756B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
JP7289834B2 (en) * 2017-10-30 2023-06-12 エシコン エルエルシー Modular Surgical Instrument Control System Configuration
US11291510B2 (en) 2017-10-30 2022-04-05 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11510741B2 (en) 2017-10-30 2022-11-29 Cilag Gmbh International Method for producing a surgical instrument comprising a smart electrical system
US11129634B2 (en) 2017-10-30 2021-09-28 Cilag Gmbh International Surgical instrument with rotary drive selectively actuating multiple end effector functions
EP3476302A3 (en) * 2017-10-30 2019-07-31 Ethicon LLC Surgical suturing instrument comprising a non-circular needle
US11026687B2 (en) 2017-10-30 2021-06-08 Cilag Gmbh International Clip applier comprising clip advancing systems
US11229436B2 (en) 2017-10-30 2022-01-25 Cilag Gmbh International Surgical system comprising a surgical tool and a surgical hub
US11317919B2 (en) 2017-10-30 2022-05-03 Cilag Gmbh International Clip applier comprising a clip crimping system
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
US10959744B2 (en) 2017-10-30 2021-03-30 Ethicon Llc Surgical dissectors and manufacturing techniques
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US10932804B2 (en) 2017-10-30 2021-03-02 Ethicon Llc Surgical instrument with sensor and/or control systems
WO2019098921A1 (en) 2017-11-16 2019-05-23 M-V Arterica AB Vascular closure device, a hemostasis device comprising collapsible tubes adjacent anchors, and methods for using the devices.
EP3727164B1 (en) 2017-12-18 2024-03-13 Boston Scientific Scimed, Inc. Occlusive device with expandable member
US11666331B2 (en) 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11589888B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Method for controlling smart energy devices
US11234756B2 (en) 2017-12-28 2022-02-01 Cilag Gmbh International Powered surgical tool with predefined adjustable control algorithm for controlling end effector parameter
US10943454B2 (en) 2017-12-28 2021-03-09 Ethicon Llc Detection and escalation of security responses of surgical instruments to increasing severity threats
US11132462B2 (en) 2017-12-28 2021-09-28 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US10987178B2 (en) 2017-12-28 2021-04-27 Ethicon Llc Surgical hub control arrangements
US11998193B2 (en) 2017-12-28 2024-06-04 Cilag Gmbh International Method for usage of the shroud as an aspect of sensing or controlling a powered surgical device, and a control algorithm to adjust its default operation
US12062442B2 (en) 2017-12-28 2024-08-13 Cilag Gmbh International Method for operating surgical instrument systems
US11304763B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Image capturing of the areas outside the abdomen to improve placement and control of a surgical device in use
US11419630B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Surgical system distributed processing
US11160605B2 (en) 2017-12-28 2021-11-02 Cilag Gmbh International Surgical evacuation sensing and motor control
US11058498B2 (en) 2017-12-28 2021-07-13 Cilag Gmbh International Cooperative surgical actions for robot-assisted surgical platforms
US10932872B2 (en) 2017-12-28 2021-03-02 Ethicon Llc Cloud-based medical analytics for linking of local usage trends with the resource acquisition behaviors of larger data set
US11291495B2 (en) 2017-12-28 2022-04-05 Cilag Gmbh International Interruption of energy due to inadvertent capacitive coupling
US11464535B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Detection of end effector emersion in liquid
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11376002B2 (en) 2017-12-28 2022-07-05 Cilag Gmbh International Surgical instrument cartridge sensor assemblies
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US20190206569A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Method of cloud based data analytics for use with the hub
US10755813B2 (en) 2017-12-28 2020-08-25 Ethicon Llc Communication of smoke evacuation system parameters to hub or cloud in smoke evacuation module for interactive surgical platform
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US11559308B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method for smart energy device infrastructure
US11419667B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11278281B2 (en) 2017-12-28 2022-03-22 Cilag Gmbh International Interactive surgical system
US11284936B2 (en) 2017-12-28 2022-03-29 Cilag Gmbh International Surgical instrument having a flexible electrode
US10849697B2 (en) 2017-12-28 2020-12-01 Ethicon Llc Cloud interface for coupled surgical devices
US11672605B2 (en) 2017-12-28 2023-06-13 Cilag Gmbh International Sterile field interactive control displays
US11096693B2 (en) 2017-12-28 2021-08-24 Cilag Gmbh International Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing
US10892995B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11266468B2 (en) 2017-12-28 2022-03-08 Cilag Gmbh International Cooperative utilization of data derived from secondary sources by intelligent surgical hubs
US11432885B2 (en) 2017-12-28 2022-09-06 Cilag Gmbh International Sensing arrangements for robot-assisted surgical platforms
US10758310B2 (en) 2017-12-28 2020-09-01 Ethicon Llc Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US11273001B2 (en) 2017-12-28 2022-03-15 Cilag Gmbh International Surgical hub and modular device response adjustment based on situational awareness
US11056244B2 (en) 2017-12-28 2021-07-06 Cilag Gmbh International Automated data scaling, alignment, and organizing based on predefined parameters within surgical networks
US11969216B2 (en) 2017-12-28 2024-04-30 Cilag Gmbh International Surgical network recommendations from real time analysis of procedure variables against a baseline highlighting differences from the optimal solution
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11576677B2 (en) 2017-12-28 2023-02-14 Cilag Gmbh International Method of hub communication, processing, display, and cloud analytics
US11571234B2 (en) 2017-12-28 2023-02-07 Cilag Gmbh International Temperature control of ultrasonic end effector and control system therefor
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11423007B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Adjustment of device control programs based on stratified contextual data in addition to the data
US11659023B2 (en) 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11308075B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical network, instrument, and cloud responses based on validation of received dataset and authentication of its source and integrity
US11076921B2 (en) 2017-12-28 2021-08-03 Cilag Gmbh International Adaptive control program updates for surgical hubs
US11364075B2 (en) 2017-12-28 2022-06-21 Cilag Gmbh International Radio frequency energy device for delivering combined electrical signals
US11304745B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical evacuation sensing and display
US11257589B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Real-time analysis of comprehensive cost of all instrumentation used in surgery utilizing data fluidity to track instruments through stocking and in-house processes
US11100631B2 (en) 2017-12-28 2021-08-24 Cilag Gmbh International Use of laser light and red-green-blue coloration to determine properties of back scattered light
US11202570B2 (en) 2017-12-28 2021-12-21 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US11179208B2 (en) 2017-12-28 2021-11-23 Cilag Gmbh International Cloud-based medical analytics for security and authentication trends and reactive measures
US11410259B2 (en) 2017-12-28 2022-08-09 Cilag Gmbh International Adaptive control program updates for surgical devices
US20190201146A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Safety systems for smart powered surgical stapling
US11253315B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Increasing radio frequency to create pad-less monopolar loop
US10892899B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Self describing data packets generated at an issuing instrument
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11324557B2 (en) 2017-12-28 2022-05-10 Cilag Gmbh International Surgical instrument with a sensing array
US10695081B2 (en) 2017-12-28 2020-06-30 Ethicon Llc Controlling a surgical instrument according to sensed closure parameters
US11529187B2 (en) 2017-12-28 2022-12-20 Cilag Gmbh International Surgical evacuation sensor arrangements
US10944728B2 (en) 2017-12-28 2021-03-09 Ethicon Llc Interactive surgical systems with encrypted communication capabilities
US10966791B2 (en) 2017-12-28 2021-04-06 Ethicon Llc Cloud-based medical analytics for medical facility segmented individualization of instrument function
US11109866B2 (en) 2017-12-28 2021-09-07 Cilag Gmbh International Method for circular stapler control algorithm adjustment based on situational awareness
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11304699B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US10898622B2 (en) 2017-12-28 2021-01-26 Ethicon Llc Surgical evacuation system with a communication circuit for communication between a filter and a smoke evacuation device
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11540855B2 (en) 2017-12-28 2023-01-03 Cilag Gmbh International Controlling activation of an ultrasonic surgical instrument according to the presence of tissue
US11937769B2 (en) 2017-12-28 2024-03-26 Cilag Gmbh International Method of hub communication, processing, storage and display
US11612408B2 (en) 2017-12-28 2023-03-28 Cilag Gmbh International Determining tissue composition via an ultrasonic system
US11069012B2 (en) 2017-12-28 2021-07-20 Cilag Gmbh International Interactive surgical systems with condition handling of devices and data capabilities
US20190201139A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Communication arrangements for robot-assisted surgical platforms
US11602393B2 (en) 2017-12-28 2023-03-14 Cilag Gmbh International Surgical evacuation sensing and generator control
US11147607B2 (en) 2017-12-28 2021-10-19 Cilag Gmbh International Bipolar combination device that automatically adjusts pressure based on energy modality
US11969142B2 (en) 2017-12-28 2024-04-30 Cilag Gmbh International Method of compressing tissue within a stapling device and simultaneously displaying the location of the tissue within the jaws
US11389164B2 (en) 2017-12-28 2022-07-19 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11633237B2 (en) 2017-12-28 2023-04-25 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11464559B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Estimating state of ultrasonic end effector and control system therefor
US11844579B2 (en) 2017-12-28 2023-12-19 Cilag Gmbh International Adjustments based on airborne particle properties
US20190201039A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Situational awareness of electrosurgical systems
US11317937B2 (en) 2018-03-08 2022-05-03 Cilag Gmbh International Determining the state of an ultrasonic end effector
US12096916B2 (en) 2017-12-28 2024-09-24 Cilag Gmbh International Method of sensing particulate from smoke evacuated from a patient, adjusting the pump speed based on the sensed information, and communicating the functional parameters of the system to the hub
US11051876B2 (en) 2017-12-28 2021-07-06 Cilag Gmbh International Surgical evacuation flow paths
US11424027B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Method for operating surgical instrument systems
US11832840B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical instrument having a flexible circuit
US11311306B2 (en) 2017-12-28 2022-04-26 Cilag Gmbh International Surgical systems for detecting end effector tissue distribution irregularities
US11559307B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method of robotic hub communication, detection, and control
US11166772B2 (en) 2017-12-28 2021-11-09 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US11446052B2 (en) 2017-12-28 2022-09-20 Cilag Gmbh International Variation of radio frequency and ultrasonic power level in cooperation with varying clamp arm pressure to achieve predefined heat flux or power applied to tissue
US11304720B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Activation of energy devices
IL256954A (en) 2018-01-16 2018-03-29 Daas Kamal Anastomosis assembly
US11413048B2 (en) 2018-01-19 2022-08-16 Boston Scientific Scimed, Inc. Occlusive medical device with delivery system
US10772621B2 (en) 2018-02-02 2020-09-15 Abbott Cardiovascular Systems, Inc. Suture management devices, methods, and systems
US11399858B2 (en) 2018-03-08 2022-08-02 Cilag Gmbh International Application of smart blade technology
US11337746B2 (en) 2018-03-08 2022-05-24 Cilag Gmbh International Smart blade and power pulsing
US11259830B2 (en) 2018-03-08 2022-03-01 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
US11096688B2 (en) 2018-03-28 2021-08-24 Cilag Gmbh International Rotary driven firing members with different anvil and channel engagement features
US11259806B2 (en) 2018-03-28 2022-03-01 Cilag Gmbh International Surgical stapling devices with features for blocking advancement of a camming assembly of an incompatible cartridge installed therein
US11278280B2 (en) 2018-03-28 2022-03-22 Cilag Gmbh International Surgical instrument comprising a jaw closure lockout
US11471156B2 (en) 2018-03-28 2022-10-18 Cilag Gmbh International Surgical stapling devices with improved rotary driven closure systems
US11197668B2 (en) 2018-03-28 2021-12-14 Cilag Gmbh International Surgical stapling assembly comprising a lockout and an exterior access orifice to permit artificial unlocking of the lockout
US10973520B2 (en) 2018-03-28 2021-04-13 Ethicon Llc Surgical staple cartridge with firing member driven camming assembly that has an onboard tissue cutting feature
US11219453B2 (en) 2018-03-28 2022-01-11 Cilag Gmbh International Surgical stapling devices with cartridge compatible closure and firing lockout arrangements
US11090047B2 (en) 2018-03-28 2021-08-17 Cilag Gmbh International Surgical instrument comprising an adaptive control system
US11207067B2 (en) 2018-03-28 2021-12-28 Cilag Gmbh International Surgical stapling device with separate rotary driven closure and firing systems and firing member that engages both jaws while firing
US11129609B2 (en) 2018-04-24 2021-09-28 Covidien Lp Devices, systems, and methods for providing surgical access and facilitating closure of surgical access openings
US11331104B2 (en) 2018-05-02 2022-05-17 Boston Scientific Scimed, Inc. Occlusive sealing sensor system
US11234690B2 (en) 2018-05-02 2022-02-01 Covidien Lp Method and device for closing a port site incision
US11213288B2 (en) 2018-05-02 2022-01-04 Covidien Lp Port site closure instrument
CN112312841A (en) 2018-05-15 2021-02-02 波士顿科学医学有限公司 Closed medical device with charged polymer coating
WO2019237004A1 (en) 2018-06-08 2019-12-12 Boston Scientific Scimed, Inc. Medical device with occlusive member
US11123079B2 (en) 2018-06-08 2021-09-21 Boston Scientific Scimed, Inc. Occlusive device with actuatable fixation members
CN112566566A (en) 2018-07-06 2021-03-26 波士顿科学医学有限公司 Closed medical device
US11596533B2 (en) 2018-08-21 2023-03-07 Boston Scientific Scimed, Inc. Projecting member with barb for cardiovascular devices
US12102531B2 (en) 2018-10-22 2024-10-01 Evalve, Inc. Tissue cutting systems, devices and methods
EP3870076A4 (en) 2018-10-24 2022-08-10 Arterica Inc. Self-expanding hemostatic devices and methods for fascia and vessel passages
US10271837B1 (en) * 2018-11-19 2019-04-30 Mohammad Reza Rajebi Arteriotomy closure device
MX2021009291A (en) * 2019-01-31 2022-01-04 Terumo Medical Corp Suture delivery with asynchronous needle capture.
IL264561A (en) 2019-01-31 2020-08-31 Lydus Medical Ltd Anastomosis device
US11369377B2 (en) 2019-02-19 2022-06-28 Cilag Gmbh International Surgical stapling assembly with cartridge based retainer configured to unlock a firing lockout
US11298129B2 (en) 2019-02-19 2022-04-12 Cilag Gmbh International Method for providing an authentication lockout in a surgical stapler with a replaceable cartridge
US11357503B2 (en) 2019-02-19 2022-06-14 Cilag Gmbh International Staple cartridge retainers with frangible retention features and methods of using same
US11317915B2 (en) 2019-02-19 2022-05-03 Cilag Gmbh International Universal cartridge based key feature that unlocks multiple lockout arrangements in different surgical staplers
US11751872B2 (en) 2019-02-19 2023-09-12 Cilag Gmbh International Insertable deactivator element for surgical stapler lockouts
USD950728S1 (en) 2019-06-25 2022-05-03 Cilag Gmbh International Surgical staple cartridge
USD964564S1 (en) 2019-06-25 2022-09-20 Cilag Gmbh International Surgical staple cartridge retainer with a closure system authentication key
USD952144S1 (en) 2019-06-25 2022-05-17 Cilag Gmbh International Surgical staple cartridge retainer with firing system authentication key
WO2021011653A1 (en) 2019-07-15 2021-01-21 Evalve, Inc. Independent proximal element actuation methods
EP4403118A3 (en) 2019-07-17 2024-10-09 Boston Scientific Scimed, Inc. Left atrial appendage implant with continuous covering
US11439383B2 (en) 2019-08-20 2022-09-13 Abbott Cardiovascular Systems, Inc. Self locking suture and self locking suture mediated closure device
CN114340516A (en) 2019-08-30 2022-04-12 波士顿科学医学有限公司 Left atrial appendage implant with sealing disk
WO2021102044A1 (en) 2019-11-19 2021-05-27 Arterica Inc. Vascular closure devices and methods
EP4125634A1 (en) 2020-03-24 2023-02-08 Boston Scientific Scimed Inc. Medical system for treating a left atrial appendage
US12048448B2 (en) 2020-05-06 2024-07-30 Evalve, Inc. Leaflet grasping and cutting device
US12048818B2 (en) 2020-07-05 2024-07-30 New Wave Endo-Surgical Corp. Handheld elongate medical device advancer and related systems, devices and methods
JP7564370B2 (en) 2020-12-18 2024-10-08 ボストン サイエンティフィック サイムド,インコーポレイテッド Occlusive medical device with sensing function
USD1029259S1 (en) 2021-08-31 2024-05-28 New Wave Endo-Surgical Corp. Portion of a medical device
USD1002009S1 (en) 2021-08-31 2023-10-17 New Wave Endo-Surgical Corp. Medical device
WO2023126843A2 (en) * 2021-12-31 2023-07-06 Pylon Medical Ltd. A closure device
IL296164A (en) 2022-09-04 2024-04-01 Lydus Medical Ltd Anastomosis Device
US11678874B1 (en) * 2022-10-26 2023-06-20 King Faisal University Double “J” laparoscopic fascial closure device

Citations (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4069825A (en) * 1976-01-28 1978-01-24 Taichiro Akiyama Surgical thread and cutting apparatus for the same
US4782954A (en) * 1987-06-11 1988-11-08 Reynolds Jack M Mending kit
US5169041A (en) * 1991-10-18 1992-12-08 Deje E-Z Enterprises, Inc. Portable sewing kit
US5417684A (en) * 1993-03-11 1995-05-23 Wilson Greatbatch Ltd. Laparoscopic surgical grasper with a loop with gripping formations
US5474568A (en) * 1993-10-08 1995-12-12 United States Surgical Corporation Instrument for closing trocar puncture wounds
US5540703A (en) * 1993-01-06 1996-07-30 Smith & Nephew Richards Inc. Knotted cable attachment apparatus formed of braided polymeric fibers
US5601572A (en) * 1989-08-16 1997-02-11 Raychem Corporation Device or apparatus for manipulating matter having a elastic ring clip
US5814069A (en) * 1997-04-08 1998-09-29 Ethicon Endo-Surgery, Inc. Load assist device for a suture cartridge
US6165183A (en) * 1998-07-15 2000-12-26 St. Jude Medical, Inc. Mitral and tricuspid valve repair
US6245079B1 (en) * 1995-08-24 2001-06-12 Sutura, Inc. Suturing device and method for sealing an opening in a blood vessel or other biological structure
US7108710B2 (en) * 2002-11-26 2006-09-19 Abbott Laboratories Multi-element biased suture clip
US7224198B2 (en) * 2004-09-15 2007-05-29 Samsung Electronics Co., Ltd. Input and output circuit and method of operation thereof
US7753923B2 (en) * 1999-04-09 2010-07-13 Evalve, Inc. Leaflet suturing
US20120053600A1 (en) * 2010-09-01 2012-03-01 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US20120150201A1 (en) * 2005-08-08 2012-06-14 Abbott Laboratories Vascular suturing device with needle capture
US8211122B2 (en) * 2003-09-26 2012-07-03 Abbott Laboratories Device for suturing intracardiac defects
US20120316579A1 (en) * 2006-08-18 2012-12-13 Abbott Laboratories Articulating suturing device and method
US20130006277A1 (en) * 2003-12-23 2013-01-03 Abbott Laboratories Suturing device with split arm and method of suturing tissue

Family Cites Families (63)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US312408A (en) * 1885-02-17 Surgical needle
US659422A (en) * 1900-06-12 1900-10-09 George W Shidler Surgical instrument.
US2397823A (en) * 1941-02-12 1946-04-02 Carl W Walter Forceps
US2646045A (en) * 1951-05-01 1953-07-21 Bruno S Priestley Mechanical suturing device
US2959172A (en) * 1957-08-27 1960-11-08 American Cystoscope Makers Inc Self-threading suturing instrument
US3470875A (en) * 1966-10-06 1969-10-07 Alfred A Johnson Surgical clamping and suturing instrument
US3665926A (en) * 1970-04-08 1972-05-30 Bard Inc C R Ligature and applicator therefor
DE2300840C3 (en) * 1973-01-09 1975-08-28 Richard Wolf Gmbh, 7134 Knittlingen Device for preparing ligatures of the fallopian tubes
US3939820A (en) * 1974-10-29 1976-02-24 Datascope Corporation Single-chamber, multi-section balloon for cardiac assistance
US3926194A (en) * 1974-11-20 1975-12-16 Ethicon Inc Sutures with reduced diameter at suture tip
US4168073A (en) * 1978-03-01 1979-09-18 Owens-Illinois, Inc. Glass article handling chuck
US4161951A (en) * 1978-04-27 1979-07-24 Scanlan International, Inc. Needle driver
US4235177A (en) * 1979-02-23 1980-11-25 Raymond C. Kelder Suturing device
JPS55151956A (en) * 1979-05-17 1980-11-26 Janome Sewing Machine Co Ltd Sewing machine for medical treatment
US4317445A (en) * 1980-03-31 1982-03-02 Baxter Travenol Laboratories, Inc. Catheter insertion unit with separate flashback indication for the cannula
SU993922A1 (en) * 1981-07-20 1983-02-07 за вители Device for guiding ligature material
US4493323A (en) * 1982-12-13 1985-01-15 University Of Iowa Research Foundation Suturing device and method for using same
SU1093329A1 (en) * 1983-04-07 1984-05-23 Калининский Государственный Медицинский Институт Suture appliance for soft tissue
EP0140557A3 (en) * 1983-09-12 1986-09-03 Edward Lee Blackwood Surgical instrument
US4553543A (en) * 1984-03-05 1985-11-19 Amarasinghe Disamodha C Suturing assembly and method
SU1174036A1 (en) * 1984-03-11 1985-08-23 Омский Государственный Ордена Трудового Красного Знамени Медицинский Институт Им.М.И.Калинина Instrument for placing sutures
JPS60234671A (en) * 1984-05-09 1985-11-21 テルモ株式会社 Catheter inserter
IL73081A (en) * 1984-09-26 1988-12-30 Istec Ind & Technologies Ltd Suturing implement particularly useful in surgical operations for the attachment of a prosthetic valve
US4587969A (en) * 1985-01-28 1986-05-13 Rolando Gillis Support assembly for a blood vessel or like organ
US4852568A (en) * 1987-02-17 1989-08-01 Kensey Nash Corporation Method and apparatus for sealing an opening in tissue of a living being
US4744364A (en) * 1987-02-17 1988-05-17 Intravascular Surgical Instruments, Inc. Device for sealing percutaneous puncture in a vessel
US4890612A (en) * 1987-02-17 1990-01-02 Kensey Nash Corporation Device for sealing percutaneous puncture in a vessel
US4957498A (en) * 1987-11-05 1990-09-18 Concept, Inc. Suturing instrument
US4926860A (en) * 1988-02-05 1990-05-22 Flexmedics Corporation ARthroscopic instrumentation and method
US4836205A (en) * 1988-03-21 1989-06-06 Barrett Gene R Grasper-stitcher device for arthroscopic anterior cruciate ligament repair
US5100419A (en) * 1990-04-17 1992-03-31 Ehlers Robert L Device for removing diverticula in the colon
US4984581A (en) * 1988-10-12 1991-01-15 Flexmedics Corporation Flexible guide having two-way shape memory alloy
US4929246A (en) * 1988-10-27 1990-05-29 C. R. Bard, Inc. Method for closing and sealing an artery after removing a catheter
SU1648400A1 (en) * 1989-05-03 1991-05-15 Одесский Облздравотдел Device for applying ligature
US4935027A (en) * 1989-08-21 1990-06-19 Inbae Yoon Surgical suture instrument with remotely controllable suture material advancement
US5059201A (en) * 1989-11-03 1991-10-22 Asnis Stanley E Suture threading, stitching and wrapping device for use in open and closed surgical procedures
US5061274A (en) * 1989-12-04 1991-10-29 Kensey Nash Corporation Plug device for sealing openings and method of use
WO1993007813A1 (en) * 1989-12-04 1993-04-29 Kensey Nash Corporation Plug device for sealing openings and method of use
US5002563A (en) * 1990-02-22 1991-03-26 Raychem Corporation Sutures utilizing shape memory alloys
WO1991015155A1 (en) * 1990-04-02 1991-10-17 Kanji Inoue Device for closing shunt opening by nonoperative method
US5021059A (en) * 1990-05-07 1991-06-04 Kensey Nash Corporation Plug device with pulley for sealing punctures in tissue and methods of use
US5037433A (en) * 1990-05-17 1991-08-06 Wilk Peter J Endoscopic suturing device and related method and suture
US5047039A (en) * 1990-09-14 1991-09-10 Odis Lynn Avant Method and apparatus for effecting dorsal vein ligation and tubular anastomosis and laparoscopic prostatectomy
US5053043A (en) * 1990-09-28 1991-10-01 Vance Products Incorporated Suture guide and method of placing sutures through a severed duct
DK166600B1 (en) * 1991-01-17 1993-06-21 Therkel Bisgaard TOOL USE TOUCH BY SUTURING IN DEEP OPERATING OPENINGS OR BODY SPACES
US5160339A (en) * 1991-06-18 1992-11-03 Ethicon, Inc. Endoscopic suture clip
US5109780A (en) * 1991-07-15 1992-05-05 Slouf James W Embroidery tool
US5219358A (en) * 1991-08-29 1993-06-15 Ethicon, Inc. Shape memory effect surgical needles
US5222974A (en) * 1991-11-08 1993-06-29 Kensey Nash Corporation Hemostatic puncture closure system and method of use
DE4137218C1 (en) * 1991-11-13 1993-02-11 Heidmueller, Harald, 5000 Koeln, De
US5171251A (en) * 1992-03-02 1992-12-15 Ethicon, Inc. Surgical clip having hole therein and method of anchoring suture
DE4210724C1 (en) * 1992-04-01 1993-07-22 Rema-Medizintechnik Gmbh, 7201 Duerbheim, De Surgical instrument with expander in shaft portion - has expanding member mounting eccentrical on pinion meshing with central gear on shaft passing through stem
US5411481A (en) * 1992-04-08 1995-05-02 American Cyanamid Co. Surgical purse string suturing instrument and method
US5368601A (en) * 1992-04-30 1994-11-29 Lasersurge, Inc. Trocar wound closure device
US5336231A (en) * 1992-05-01 1994-08-09 Adair Edwin Lloyd Parallel channel fixation, repair and ligation suture device
US5250053A (en) * 1992-05-29 1993-10-05 Linvatec Corporation Suture shuttle device
US5254126A (en) * 1992-06-24 1993-10-19 Ethicon, Inc. Endoscopic suture punch
US5364408A (en) * 1992-09-04 1994-11-15 Laurus Medical Corporation Endoscopic suture system
US5342369A (en) * 1992-09-11 1994-08-30 The Board Of Regents Of The University Of Washington System for repair of bankart lesions
CA2106127A1 (en) * 1992-09-23 1994-03-24 Peter W.J. Hinchliffe Instrument for closing trocar puncture wounds
US5306254A (en) * 1992-10-01 1994-04-26 Kensey Nash Corporation Vessel position locating device and method of use
US5304184A (en) * 1992-10-19 1994-04-19 Indiana University Foundation Apparatus and method for positive closure of an internal tissue membrane opening
US5374275A (en) * 1993-03-25 1994-12-20 Synvasive Technology, Inc. Surgical suturing device and method of use

Patent Citations (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4069825A (en) * 1976-01-28 1978-01-24 Taichiro Akiyama Surgical thread and cutting apparatus for the same
US4782954A (en) * 1987-06-11 1988-11-08 Reynolds Jack M Mending kit
US5601572A (en) * 1989-08-16 1997-02-11 Raychem Corporation Device or apparatus for manipulating matter having a elastic ring clip
US5169041A (en) * 1991-10-18 1992-12-08 Deje E-Z Enterprises, Inc. Portable sewing kit
US5540703A (en) * 1993-01-06 1996-07-30 Smith & Nephew Richards Inc. Knotted cable attachment apparatus formed of braided polymeric fibers
US5417684A (en) * 1993-03-11 1995-05-23 Wilson Greatbatch Ltd. Laparoscopic surgical grasper with a loop with gripping formations
US5474568A (en) * 1993-10-08 1995-12-12 United States Surgical Corporation Instrument for closing trocar puncture wounds
US6245079B1 (en) * 1995-08-24 2001-06-12 Sutura, Inc. Suturing device and method for sealing an opening in a blood vessel or other biological structure
US5814069A (en) * 1997-04-08 1998-09-29 Ethicon Endo-Surgery, Inc. Load assist device for a suture cartridge
US6165183A (en) * 1998-07-15 2000-12-26 St. Jude Medical, Inc. Mitral and tricuspid valve repair
US7753923B2 (en) * 1999-04-09 2010-07-13 Evalve, Inc. Leaflet suturing
US7108710B2 (en) * 2002-11-26 2006-09-19 Abbott Laboratories Multi-element biased suture clip
US8211122B2 (en) * 2003-09-26 2012-07-03 Abbott Laboratories Device for suturing intracardiac defects
US20130006277A1 (en) * 2003-12-23 2013-01-03 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US7224198B2 (en) * 2004-09-15 2007-05-29 Samsung Electronics Co., Ltd. Input and output circuit and method of operation thereof
US20120150201A1 (en) * 2005-08-08 2012-06-14 Abbott Laboratories Vascular suturing device with needle capture
US20120316579A1 (en) * 2006-08-18 2012-12-13 Abbott Laboratories Articulating suturing device and method
US20120053600A1 (en) * 2010-09-01 2012-03-01 Abbott Cardiovascular Systems, Inc. Suturing devices and methods

Cited By (122)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8172860B2 (en) 1999-03-04 2012-05-08 Abbott Laboratories Articulating suturing device and method
US7846170B2 (en) 1999-03-04 2010-12-07 Abbott Laboratories Articulating suturing device and method
US7850701B2 (en) 1999-03-04 2010-12-14 Abbott Laboratories Articulating suturing device and method
US9993237B2 (en) 1999-03-04 2018-06-12 Abbott Laboratories Articulating suturing device and method
US8323298B2 (en) 1999-03-04 2012-12-04 Abbott Laboratories Articulating suturing device and method
US8663248B2 (en) 1999-03-04 2014-03-04 Abbott Laboratories Articulating suturing device and method
US8038688B2 (en) 1999-03-04 2011-10-18 Abbott Laboratories Articulating suturing device and method
US9301747B2 (en) 1999-03-04 2016-04-05 Abbott Laboratories Articulating suturing device and method
US8048092B2 (en) 1999-03-04 2011-11-01 Abbott Laboratories Articulating suturing device and method
US8057491B2 (en) 1999-03-04 2011-11-15 Abbott Laboratories Articulating suturing device and method
US9282960B2 (en) 1999-03-04 2016-03-15 Abbott Laboratories Articulating suturing device and method
US7931669B2 (en) 2000-01-05 2011-04-26 Integrated Vascular Systems, Inc. Integrated vascular device with puncture site closure component and sealant and methods of use
US9050087B2 (en) 2000-01-05 2015-06-09 Integrated Vascular Systems, Inc. Integrated vascular device with puncture site closure component and sealant and methods of use
US8758396B2 (en) 2000-01-05 2014-06-24 Integrated Vascular Systems, Inc. Vascular sheath with bioabsorbable puncture site closure apparatus and methods of use
US9060769B2 (en) 2000-09-08 2015-06-23 Abbott Vascular Inc. Surgical stapler
US8784447B2 (en) 2000-09-08 2014-07-22 Abbott Vascular Inc. Surgical stapler
US9402625B2 (en) 2000-09-08 2016-08-02 Abbott Vascular Inc. Surgical stapler
US9089674B2 (en) 2000-10-06 2015-07-28 Integrated Vascular Systems, Inc. Apparatus and methods for positioning a vascular sheath
US8486092B2 (en) 2000-12-07 2013-07-16 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8128644B2 (en) 2000-12-07 2012-03-06 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8690910B2 (en) 2000-12-07 2014-04-08 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8236026B2 (en) 2000-12-07 2012-08-07 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8603136B2 (en) 2000-12-07 2013-12-10 Integrated Vascular Systems, Inc. Apparatus and methods for providing tactile feedback while delivering a closure device
US8486108B2 (en) 2000-12-07 2013-07-16 Integrated Vascular Systems, Inc. Closure device and methods for making and using them
US8579932B2 (en) 2002-02-21 2013-11-12 Integrated Vascular Systems, Inc. Sheath apparatus and methods for delivering a closure device
US8998932B2 (en) 2002-12-31 2015-04-07 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US8202281B2 (en) 2002-12-31 2012-06-19 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US9889276B2 (en) 2002-12-31 2018-02-13 Abbott Laboratories Systems for anchoring a medical device in a body lumen
US11589856B2 (en) 2003-01-30 2023-02-28 Integrated Vascular Systems, Inc. Clip applier and methods of use
US8137364B2 (en) 2003-09-11 2012-03-20 Abbott Laboratories Articulating suturing device and method
US9155535B2 (en) 2003-09-26 2015-10-13 Abbott Laboratories Device and method for suturing intracardiac defects
US10245022B2 (en) 2003-09-26 2019-04-02 Abbott Laboratories Device and method for suturing intracardiac defects
US8257368B2 (en) 2003-09-26 2012-09-04 Abbott Laboratories Device for suturing intracardiac defects
US8211122B2 (en) 2003-09-26 2012-07-03 Abbott Laboratories Device for suturing intracardiac defects
US8361088B2 (en) 2003-09-26 2013-01-29 Abbott Laboratories Device and method for suturing intracardiac defects
US8343089B2 (en) 2003-11-21 2013-01-01 Silk Road Medical, Inc. Method and apparatus for treating a carotid artery
US8414516B2 (en) 2003-11-21 2013-04-09 Silk Road Medical, Inc. Method and apparatus for treating a carotid artery
US9375211B2 (en) 2003-12-23 2016-06-28 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US10413288B2 (en) 2003-12-23 2019-09-17 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US8419753B2 (en) 2003-12-23 2013-04-16 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US8597309B2 (en) 2003-12-23 2013-12-03 Abbott Laboratories Suturing device with split arm and method of suturing tissue
US8590760B2 (en) 2004-05-25 2013-11-26 Abbott Vascular Inc. Surgical stapler
US8926633B2 (en) 2005-06-24 2015-01-06 Abbott Laboratories Apparatus and method for delivering a closure element
US12070214B2 (en) 2005-07-01 2024-08-27 Abbott Laboratories Clip applier and methods of use
US8313497B2 (en) 2005-07-01 2012-11-20 Abbott Laboratories Clip applier and methods of use
US11344304B2 (en) 2005-07-01 2022-05-31 Abbott Laboratories Clip applier and methods of use
US9592038B2 (en) 2005-08-08 2017-03-14 Abbott Laboratories Vascular suturing device
US8083754B2 (en) 2005-08-08 2011-12-27 Abbott Laboratories Vascular suturing device with needle capture
US7883517B2 (en) 2005-08-08 2011-02-08 Abbott Laboratories Vascular suturing device
US8267947B2 (en) 2005-08-08 2012-09-18 Abbott Laboratories Vascular suturing device
US8313498B2 (en) 2005-08-08 2012-11-20 Abbott Laboratories Vascular suturing device
US9456811B2 (en) 2005-08-24 2016-10-04 Abbott Vascular Inc. Vascular closure methods and apparatuses
US8758397B2 (en) 2005-08-24 2014-06-24 Abbott Vascular Inc. Vascular closure methods and apparatuses
US8048108B2 (en) 2005-08-24 2011-11-01 Abbott Vascular Inc. Vascular closure methods and apparatuses
US8920442B2 (en) * 2005-08-24 2014-12-30 Abbott Vascular Inc. Vascular opening edge eversion methods and apparatuses
US8932324B2 (en) 2005-08-24 2015-01-13 Abbott Vascular Inc. Redundant tissue closure methods and apparatuses
US8808310B2 (en) 2006-04-20 2014-08-19 Integrated Vascular Systems, Inc. Resettable clip applier and reset tools
US8430893B2 (en) 2006-08-18 2013-04-30 Abbott Laboratories Articulating suturing device and method
US7842048B2 (en) 2006-08-18 2010-11-30 Abbott Laboratories Articulating suture device and method
US8252008B2 (en) 2006-08-18 2012-08-28 Abbott Laboratories Articulating suturing device and method
US8574244B2 (en) 2007-06-25 2013-11-05 Abbott Laboratories System for closing a puncture in a vessel wall
US9259215B2 (en) 2007-07-18 2016-02-16 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US10952882B2 (en) 2007-07-18 2021-03-23 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US10485917B2 (en) 2007-07-18 2019-11-26 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US11364332B2 (en) 2007-07-18 2022-06-21 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10085864B2 (en) 2007-07-18 2018-10-02 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US12042593B2 (en) 2007-07-18 2024-07-23 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10543307B2 (en) 2007-07-18 2020-01-28 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9789242B2 (en) 2007-07-18 2017-10-17 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10286139B2 (en) 2007-07-18 2019-05-14 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10426885B2 (en) 2007-07-18 2019-10-01 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US10709832B2 (en) 2007-07-18 2020-07-14 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9833555B2 (en) 2007-07-18 2017-12-05 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US8740834B2 (en) 2007-07-18 2014-06-03 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9011364B2 (en) 2007-07-18 2015-04-21 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US8858490B2 (en) 2007-07-18 2014-10-14 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US8784355B2 (en) 2007-07-18 2014-07-22 Silk Road Medical, Inc. Methods and systems for establishing retrograde carotid arterial blood flow
US9655755B2 (en) 2007-07-18 2017-05-23 Silk Road Medical, Inc. Systems and methods for treating a carotid artery
US8893947B2 (en) 2007-12-17 2014-11-25 Abbott Laboratories Clip applier and methods of use
US9669191B2 (en) 2008-02-05 2017-06-06 Silk Road Medical, Inc. Interventional catheter system and methods
US11364369B2 (en) 2008-02-05 2022-06-21 Silk Road Medical, Inc. Interventional catheter system and methods
US10226598B2 (en) 2008-02-05 2019-03-12 Silk Road Medical, Inc. Interventional catheter system and methods
US8574245B2 (en) 2008-08-13 2013-11-05 Silk Road Medical, Inc. Suture delivery device
US9179909B2 (en) 2008-08-13 2015-11-10 Silk Road Medical, Inc. Suture delivery device
US11389155B2 (en) 2008-08-13 2022-07-19 Silk Road Medical, Inc. Suture delivery device
US10357242B2 (en) 2008-08-13 2019-07-23 Silk Road Medical, Inc. Suture delivery device
US9011467B2 (en) 2008-08-13 2015-04-21 Silk Road Medical, Inc. Suture delivery device
US11439378B2 (en) 2009-01-09 2022-09-13 Abbott Cardiovascular Systems, Inc. Closure devices and methods
US8905937B2 (en) 2009-02-26 2014-12-09 Integrated Vascular Systems, Inc. Methods and apparatus for locating a surface of a body lumen
US20110230899A1 (en) * 2009-10-23 2011-09-22 Medi-Globe Vascutec Gmbh Surgical device for feeding at least one suture thread through the edge area of a tissue opening of an individual and method for operating such a device
US9370353B2 (en) 2010-09-01 2016-06-21 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US8663252B2 (en) 2010-09-01 2014-03-04 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US10463353B2 (en) 2010-09-01 2019-11-05 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US11647997B2 (en) 2010-09-01 2023-05-16 Abbott Cardiovascular Systems, Inc. Suturing devices and methods
US20120130403A1 (en) * 2010-11-22 2012-05-24 Brenner Jacob S Device and method for treatment of hemorrhoids
US9149271B2 (en) * 2010-11-22 2015-10-06 The Board Of Trustees Of The Leland Stanford, Jr. University Device and method for treatment of hemorrhoids
US8864777B2 (en) 2011-01-28 2014-10-21 Anchor Orthopedics Xt Inc. Methods for facilitating tissue puncture
US9149276B2 (en) 2011-03-21 2015-10-06 Abbott Cardiovascular Systems, Inc. Clip and deployment apparatus for tissue closure
US9414822B2 (en) 2011-05-19 2016-08-16 Abbott Cardiovascular Systems, Inc. Tissue eversion apparatus and tissue closure device and methods for use thereof
US10383620B2 (en) 2011-08-18 2019-08-20 Anchor Orthopedics Xt Inc. Suture passing instrumentation and methods of use thereof
US11154293B2 (en) 2012-04-10 2021-10-26 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8864778B2 (en) 2012-04-10 2014-10-21 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US8858573B2 (en) 2012-04-10 2014-10-14 Abbott Cardiovascular Systems, Inc. Apparatus and method for suturing body lumens
US10111653B2 (en) 2012-05-31 2018-10-30 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US10980531B2 (en) 2012-05-31 2021-04-20 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US9241707B2 (en) 2012-05-31 2016-01-26 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US11839351B2 (en) 2012-05-31 2023-12-12 Abbott Cardiovascular Systems, Inc. Systems, methods, and devices for closing holes in body lumens
US11839372B2 (en) 2012-08-09 2023-12-12 Silk Road Medical, Inc. Suture delivery device
US10159479B2 (en) 2012-08-09 2018-12-25 Silk Road Medical, Inc. Suture delivery device
US10881393B2 (en) 2012-08-09 2021-01-05 Silk Road Medical, Inc. Suture delivery device
US8915933B2 (en) 2012-11-02 2014-12-23 Medtronic Vascular, Inc. Suturing device having a retractable distal tip and method for sealing an opening in a blood vessel or other biological structure
US11672518B2 (en) 2012-12-21 2023-06-13 Abbott Cardiovascular Systems, Inc. Articulating suturing device
US11666315B2 (en) 2013-10-11 2023-06-06 Abbott Cardiovascular Systems, Inc. Suture-based closure with hemostatic tract plug
US10806439B2 (en) 2013-10-11 2020-10-20 Abbott Cardiovascular Systems, Inc. Suture-based closure with hemostatic tract plug
US9301746B2 (en) 2013-10-11 2016-04-05 Abbott Cardiovascular Systems, Inc. Suture-based closure with hemostatic tract plug
US9757108B2 (en) 2013-10-11 2017-09-12 Abbott Cardiovascular Systems, Inc. Suture-based closure with hemostatic tract plug
US10182801B2 (en) 2014-05-16 2019-01-22 Silk Road Medical, Inc. Vessel access and closure assist system and method
US10973502B2 (en) 2014-05-16 2021-04-13 Silk Road Medical, Inc. Vessel access and closure assist system and method
US12029404B2 (en) 2014-05-16 2024-07-09 Silk Road Medical, Inc. Vessel access and closure assist system and method
US10426449B2 (en) 2017-02-16 2019-10-01 Abbott Cardiovascular Systems, Inc. Articulating suturing device with improved actuation and alignment mechanisms
US20210177269A1 (en) * 2018-08-24 2021-06-17 Canon Kabushiki Kaisha Image processing apparatus and image processing method and non-transitory computer-readable medium
US12114961B2 (en) * 2018-08-24 2024-10-15 Canon Kabushiki Kaisha Image processing apparatus and image processing method and non-transitory computer-readable medium

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EP1236437B1 (en) 2006-05-17
US5860991A (en) 1999-01-19
EP0673228A4 (en) 1996-08-14
EP0673228B1 (en) 2002-09-04
WO1994013211A1 (en) 1994-06-23
DE69332272D1 (en) 2002-10-10
AU5742194A (en) 1994-07-04
DE69334017T2 (en) 2007-01-25
DE69334017D1 (en) 2006-06-22
EP1236437A1 (en) 2002-09-04
US5779719A (en) 1998-07-14
JP3440099B2 (en) 2003-08-25
EP0673228A1 (en) 1995-09-27
DE69332272T2 (en) 2003-01-02
JPH08506973A (en) 1996-07-30
US5613974A (en) 1997-03-25
US5417699A (en) 1995-05-23

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