US20100331623A1 - System for endoscopic suturing - Google Patents

System for endoscopic suturing Download PDF

Info

Publication number
US20100331623A1
US20100331623A1 US12807259 US80725910A US2010331623A1 US 20100331623 A1 US20100331623 A1 US 20100331623A1 US 12807259 US12807259 US 12807259 US 80725910 A US80725910 A US 80725910A US 2010331623 A1 US2010331623 A1 US 2010331623A1
Authority
US
Grant status
Application
Patent type
Prior art keywords
suture
tube
instrument
end
distal end
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US12807259
Inventor
Jude S. Sauer
Michael W. Fitzsimmons
Mark A. Bovard
Original Assignee
Sauer Jude S
Fitzsimmons Michael W
Bovard Mark A
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131Accessories for endoscopes
    • A61B1/0014Fastening elements for attaching accessories to the outside of an endoscope shaft, e.g. clips, clamps or bands
    • 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
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • 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
    • A61B17/0467Instruments for cutting sutures
    • 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
    • A61B17/0482Needle or suture guides
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • 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
    • A61B2017/0496Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials for tensioning sutures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/30Surgical pincettes without pivotal connections
    • A61B2017/306Surgical pincettes without pivotal connections holding by means of suction

Abstract

A system for endoscopic suturing is provided having an endoscope, such as a gastroscope, with a distal end locatable in the body of a patient and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and a tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. A tissue suturing instrument is provided having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft. The tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue through an opening in the vacuum sleeve. Two needles are provided which extend through the shaft of the suturing instrument. Each needle is separately actuated into a gap in the instrument's tip, through tissue suctioned into the opening of the vacuum sleeve and into a ferrule at each end of a loop of suture. The system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft. After removal of the suturing instrument from the accessory tube, a loop of suture extends through the tissue and the accessory tube, the suture securing instrument receives the free ends of the loop of suture at its distal end through a sleeve member, and the suture securing instrument is then inserted through the accessory tube to the location of the suture in the tissue. The suture securing instrument crimps the sleeve member and cuts the free ends of the suture to secure the suture closed. The suturing instrument and suture securing instrument are passed through the accessory tube without removal of the endoscope from the patient. The endoscope provides viewing by an operator of the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.

Description

    FIELD OF THE INVENTION
  • The present invention relates to a system (and method) for endoscopic suturing, and in particular to a system for suturing through an accessory tube coupled to a flexible endoscope, which may be placed in the stomach through mouth and the esophagus of a patient utilizing a tissue suturing instrument and a suture securing instrument. The invention is suitable, for example, for applying at least one suture in the soft tissue lining of the stomach for different procedures such as gastroplasty, fundoplication, anterior gastropexy, or other procedures requiring suturing in the stomach, without the need for laparotomy or laparoscopy.
  • BACKGROUND OF THE INVENTION
  • Application of sutures in the gastrointestinal tract is required for several different types of medical procedures, for example, transoral endoscopic valvuloplasty for gastroesophageal reflux disease, gastroplasty, fundoplication, anterior gastropexy, suturing esophageal perforations, or closure of esophageal side of tracheo-esophageal fistula. Traditionally, these procedures were performed by physicians, such as gastroenterologist or surgeons, either by laparoscopy or open surgical techniques. Such procedures are invasive, as laparoscopy requires small access incision(s) made in the body of the patient through which a laparoscope and other surgical enabling tools are provided, while open surgical techniques are traditionally invasive and can have complications and long patient recovery periods.
  • The solution to these problems is to perform these medical procedures through the gastroesophageal tract via the mouth or other naturally occurring orifices. Already available flexible endoscopes, commonly called gastroscopes, can be provided through the gastroesophageal tract and enable illumination and visualization of tissue along the gastroesophageal tract on a video display for diagnostic purposes. Although gastroscopes often have a working channel to a port at the distal end of the gastroscope through which a biopsy tool may be provided to obtain tissue samples, they are not currently designed or typically large enough to be capable of applying sutures in tissue.
  • U.S. Pat. No. 5,792,153 describes a sewing device coupled to the distal end of an endoscope, which enables suturing in the gastroesophageal tract of a patient. The sewing device has a single hollow needle mounted in the biopsy channel of the endoscope, and a wire extending through the needle to a T-shaped tag having one end of a suture thread which extends outside of the patient. To apply a suture, suction is applied to a U-shaped opening of the sewing device via another channel of the endoscope to suck a layer (or fold) of tissue into the U-shaped opening, the needle in the biopsy channel is then pushed through the tissue, and then the wire is pushed and rotated to position the tag in a chamber along one side of the U-shaped opening. This rotates the tag into a position which captures the tag and the suture end in this chamber, and the needle and wire are retracted to the other side of the U-shaped opening. The endoscope and its coupled sewing device are removed from the patient, leaving a loop of suture through the tissue which must then be secured and closed. The patent also provides another sewing device at the end of an endoscope which enables multiple stitches in tissue with the same needle and suture thread. The sewing device of U.S. Pat. No. 5,792,153 to apply a single stitch is manufactured by Laboratories BARD S.A. of Voisinsle Bretonneux, France, and described in Kadirkamanathan et al., Gastrointestinal Endoscopy, August 1996, Vol. 44, No. 2, pp. 144-162.
  • Once the suture thread is placed through the tissue with the sewing device of U.S. Pat. No. 5,792,153, the suture thread must be secured and then cut close to the tissue. One device also manufactured by Laboratories BARD S.A., and described in U.S. Pat. No. 5,755,730, provides for securing and cutting suture using an endoscope. The device passes through the biopsy channel of the endoscope is order to push a knot made by a physician or surgeon, which ties the ends of a loop of suture thread together, down to the tissue, and then a cutting member cut the ends of the suture. Since the sewing device of U.S. Pat. No. 5,792,153 does not allow normal use of its biopsy channel of the endoscope upon which the sewing device is mounted, a second endoscope must be used to secure and cut the suture through its biopsy channel using the device described in U.S. Pat. No. 5,755,730. This results in multiple passes of endoscopes back and forth through the gastroesophageal tract, especially if single sutures are each applied and secured at multiple locations in tissue. To reduce possible damage to the esophageal tract and to facilitate multiple instrument insertions, an overtube is first placed in the esophageal tract and each endoscope is inserted and removed through the overtube. However, the overtube may be uncomfortable to patients, and can cause complications, such as mucosal tears in the esophagus. Accordingly, it would be desirable to provide a system for suturing which does not require different endoscopes for suture placement and suture securing, and moreover can apply and secure multiple single sutures in tissue with the single insertion of a flexible endoscope, i.e., gastroscope without requiring an overtube.
  • Other sewing devices or machines mounted on the end of an endoscope are described in U.S. Pat. Nos. 5,037,021 and 4,841,888. These sewing devices similarly utilize two channels of the endoscope, one to suction tissue into a slot of the device and the other to advance and retract a wire coupled to needle through the tissue. The needle has a suture loop at its tip such that when the needle is advanced through the slot it extends into a chamber where a hook or U-shaped member pivots to retain the suture loop when the needle retracts. A wire is coupled to the hook and extends through the same channel where suction is provided, such that movement of this wire pivot the hook to capture the suture thread. Removal of the sewing device then leaves a loop of suture through the tissue.
  • A further sewing device is described in U.S. Pat. No. 5,080,663 and also utilizes an operating device having tubes in a tubular sheath, such as endoscopic means, to provide suction to a slot in the device to capture a double fold of tissue and two wires extending through such tubes. One wire advances and retracts a needle having a tag with suture at its tip through tissue and the other wire controls capture of a tag at the other side of the opening. The patent provides for applying a sensor or transmitter in the body of a patient, such as the stomach. This sewing device is also described in Swaine et al., An endoscopically deliverable tissue-transfixing device for securing biosensors in the gastrointestinal tract, Gastrointestinal Endoscopy, November/December 1994, Vol. 40, No. 6, pp. 730-737.
  • Like the sewing devices of U.S. Pat. No. 5,792,153, those described in U.S. Pat. Nos. 5,037,021 4,841,888, and 5,080,663 have the same drawbacks as these devices are also mounted on an endoscope. Moreover, mounting on an endoscope limits the use of the endoscope for full visualization of tissue, as the sewing device partially obstructs the viewing area at the distal end of the endoscope. Further the use of the biopsy or working channel of an endoscope for needle placement does not allow use of the channel for other purposes, such as obtaining a biopsy. Accordingly, it would further be desirable to provide for suturing with a flexible endoscope which allows for more complete traditional use of the endoscope.
  • SUMMARY OF THE INVENTION
  • Accordingly, it is the principal object of the present invention to provide an improved system for endoscopic suturing that overcomes the drawbacks of the prior art.
  • It is another object of the present invention to provide an improved system for endoscopic suturing which allows single insertion of an endoscope and accessory tube assembly in the gastrointestinal tract of a patient through which multiple instruments for suturing and securing sutures can be used without removal of the endoscope between suturing and suture securing operations.
  • It is a further object of the present invention to provide an improved system for endoscopic suturing which provides a channel to sew through independent of an endoscope.
  • Yet a further object of the present invention is to provide an improved system for endoscopic suturing in which a suturing instrument separate from an endoscope can utilize suction to capture tissue to be sutured.
  • A still further object of the present invention is to provide an improved system for remote suturing in which can readily adapted to different types of flexible endoscopes to provide an external accessory tube through which medical or surgical instruments can pass.
  • A still further object of the present invention is to provide an improved system for endoscopic suturing which utilizes one or more instruments which each have a sufficient flexible shaft to pass through an external flexible accessory tube attached to a flexible endoscope.
  • A further object of the present invention is to provide an improved system for endoscopic suturing using instruments having shafts with enhanced flexibility.
  • And a still further object of the present invention is to provide an improved system for endoscopic suturing using flexible instruments with mechanical or hydraulic steerability.
  • Yet a further object of the present invention is to provide an improved system for endoscopic suturing in which remote viewing with an endoscope of suture and suture securing operations is provided in the stomach without hindering endoscope functionality.
  • Briefly described, a preferred embodiment of this system embodying the invention includes an endoscope, such as a gastroscope, having a distal end locatable in the body of a patient, such as in the gastrointestinal or gastroesophageal tract, and a flexible shaft extending to the distal end, a flexible accessory tube coupled to the endoscope to be movable relative to the endoscope's shaft, and an attachment tip coupled to the shaft of the endoscope having an opening through which one end of the accessory tube is received. The accessory tube is coupled to the shaft of the endoscope with multiple tube guides enabling the accessory tube to slide through the tube guides in response to bending of the endoscope's shaft. The accessory tube has a cannula through which an instrument may pass in the accessory tube. The system includes a tissue suturing instrument having a partially flexible shaft locatable through the accessory tube, and a tissue engaging end coupled to the shaft which is viewable by the endoscope at its distal end when the instrument is fully inserted through the accessory tube. The tissue engaging end has a vacuum sleeve enabling suction to be selectably applied at the tissue engaging end to capture tissue in a gap of a sew tip through an opening in the vacuum sleeve. Suction is applied via a vacuum connection assembly to a channel which extends down the shaft to the sew tip. A valve is provided to close one end of the suture carrying channel to enable such suction at the sew tip. Two needles are provided which extends through the shaft of the suturing instrument. Each needle is separately actuated into the gap of the sew tip through suctioned tissue to capture a ferrule having one end of a loop of suture. The system further includes a suture securing instrument having a partially flexible shaft locatable through the accessory tube, and a distal end coupled to the shaft which is viewable by the endoscope at its distal end when the instrument is fully inserted through the accessory tube. After removal of the suturing instrument from the accessory tube, a loop of suture extends through the tissue through the accessory tube, the suture securing instrument receives the free ends of the loop of suture at its distal end through a sleeve member, and the suture securing instrument is then inserted through the accessory tube to the location of the suture in the tissue. The suture securing instrument crimps the sleeve member and cuts the free ends of the suture to retain the suture closed. The endoscope enable an operator, such as a surgeon, gastroenterologist, or other skilled physician, to view the engaging end of the suturing instrument for selecting placement of the suture through tissue, and of the distal end of the suture securing instrument to secure the suture closed.
  • The suturing instrument in the system may further include a mechanism for steering the tissue engaging end of the instrument independent of steerability of the flexible endoscope.
  • A method embodying the present invention is also provided having the steps of: locating an endoscope, such as a gastroscope, coupled to an accessory tube through the gastrointestinal or gastroesophageal tract of a patient; inserting a suturing instrument through the accessory tube to place two ends of a loop of suture through tissue of the gastrointestinal or gastroesophageal tract; removing the suturing instrument to leave a loop of suture in the tissue having two free ends extending from the accessory tube; inserting a suture securing instrument having a distal end with a sleeve member through which the free ends of the suture loop are drawn to the suture in the tissue to crimp the sleeve member and cut the free ends of the suture; and removing the suture securing instrument from the accessory tube.
  • Optionally, the suturing instrument and suture securing instrument may be used without the accessory tube when an internal working of biopsy channel is provided in the endoscope that permits the passage of the shaft of the suturing instrument and suture securing instrument, respectively.
  • The following description referring to the endoscope as a gastroscope for purposes of illustration. Other types of endoscopes may be used in the system and method.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • The foregoing objects, features and advantages of the invention will become more apparent from a reading of the following description in connection with the accompanying drawings, in which:
  • FIG. 1 is a perspective view of the system in accordance with the present invention for application of a suture in tissue;
  • FIG. 1A is a partial view of endoscope shaft of FIGS. 1 and 2 showing the attachment of a tube guide to the endoscope while enabling the accessory tube to be slidable through the tube guide in response to flexing of the endoscope's shaft;
  • FIG. 1B is an expanded view of the distal end of the system of FIG. 1;
  • FIG. 2 is a perspective view of the system of FIG. 1 with the suture instrument of the system removed;
  • FIG. 2A is an expanded view of the distal end of the system of FIG. 2;
  • FIG. 3 is a perspective view of the accessory tube, cannula, attachment tip and tube guides of FIGS. 1 and 2;
  • FIG. 4 is a perspective view of the tube guide of FIG. 3;
  • FIG. 4A is a side view of the tube guide of FIG. 4;
  • FIGS. 5 and 5A are front and back perspective views, respectively, of the attachment tip of FIG. 3;
  • FIG. 6 is a perspective view of the cannula of FIG. 3;
  • FIG. 7 is cross-sectional view of the cannula along lines 7-7 of FIG. 6;
  • FIG. 8 is a perspective view of the suturing instrument of FIG. 1;
  • FIG. 9 is a side view of the suturing instrument of FIG. 1 in which the right cover of the housing of the instrument is removed;
  • FIG. 10 is an exploded view of the suturing instrument of FIG. 1 in which the right cover of the housing is removed;
  • FIG. 10A is a perspective view of the retainer member of the suturing instrument of FIGS. 9 and 10;
  • FIG. 10B is a side view of the cam member of the suturing instrument of FIGS. 9 and 10;
  • FIG. 11 is a partially exploded perspective view of the adapter, needle spreader, and gasket member of the suturing instrument of FIGS. 9 and 10;
  • FIG. 11A is a cross-sectional view through lines 11A-11A of FIG. 11 showing the gasket member of the suturing instrument of FIG. 11 without the suture tube or needles;
  • FIG. 11B is an end view of the gasket member of FIG. 11 without suture tube or needles;
  • FIG. 12 is a cross-sectional view along lines 12-12 of the suturing instrument of FIG. 9;
  • FIG. 13 is a cross-sectional view along lines 13-13 of the suturing instrument of FIG. 9;
  • FIG. 14 is a cross-sectional view along lines 14-14 of the suturing instrument of FIG. 9;
  • FIG. 15 is a cross-sectional view along lines 15-15 of the suturing instrument of FIG. 9;
  • FIG. 16 is a cross-sectional view along lines 16-16 of the suturing instrument of FIG. 9;
  • FIG. 17 is a cross-sectional view along lines 17-17 of the suturing instrument of FIG. 9;
  • FIG. 17A is an exploded view of the coupler member, sew tip, and the guide member between the coupler member and sew tip, of the suturing instrument of FIGS. 9 and 10;
  • FIG. 17B is a perspective view showing the connection of the coupler member, sew tip, and the guide member of FIG. 17A;
  • FIG. 17C is a cross-sectional view along lines 17C-17C of the FIG. 17B;
  • FIG. 18 is a perspective view of the vacuum connection assembly of the suturing instrument of FIGS. 9 and 10 for application of a vacuum or partial vacuum;
  • FIG. 18A is an exploded view of the vacuum connection assembly of FIG. 18;
  • FIG. 18B is a cross-sectional view of the vacuum connection assembly along lines 18B-18B of FIG. 18;
  • FIG. 18C is a cross-sectional view along lines 18C-18C of the suturing instrument of FIG. 9;
  • FIGS. 19A and 19B are perspective view of the valve seat and valve knob of the valve of the suturing instrument of FIGS. 9 and 10;
  • FIG. 19C is schematic diagram of an alternative valve for the suturing instrument of FIGS. 9 and 10;
  • FIGS. 20A, 20B, and 20C illustrate the valve seat in response to the rotation of the valve knob from an open state to a closed state to seal one end of the suture tube of the suturing instrument of FIGS. 9 and 10;
  • FIG. 21 is an exploded view of the distal end of the suturing instrument of FIG. 9;
  • FIG. 21A is an exploded view of the distal end of the FIG. 9 showing the sleeve into which the tissue engaging end of the suturing instrument is received;
  • FIG. 21B is a side view of the tissue engaging end of the suturing instrument with the sleeve of FIGS. 21 and 21A;
  • FIGS. 21C and 21D are perspective views showing assembly of the sleeve of FIGS. 21 and 21A;
  • FIGS. 22A-22H illustrates at the tissue engaging end of the suturing instrument the process of applying one end of a loop of suture through tissue with either one the two needles of the instrument;
  • FIG. 22I illustrates at the tissue engaging end of the suturing instrument after both of the needles of the instrument have applied the two ends of the suture loop in the tissue, such that removal of the instrument leaves the suture loop through the tissue;
  • FIG. 23 illustrates the operation of the tissue engaging end of the suturing instrument in accordance with another embodiment of the instrument without the outer sleeve of the tissue engaging end, where suction is not needed to capture tissue in applying a suture;
  • FIG. 24 is a perspective view of the suture securing instrument of the system in accordance with the present invention to retain close the suture applied by the suturing instrument;
  • FIG. 24A is a side view of the suture securing instrument of FIG. 24 in which the right cover of the housing of the instrument is removed;
  • FIG. 24B is an exploded view of the suture securing instrument of FIG. 24 in which the right cover of the housing is removed;
  • FIG. 24C is a cross-sectional view through lines 24C-24C of the suture securing instrument of FIG. 24A.
  • FIG. 24D is a cross-sectional view through lines 24D-24D of the suture securing instrument of FIG. 24A.
  • FIG. 24E is a cross-sectional view through lines 24E-24E of the suture securing instrument of FIG. 24A.
  • FIG. 24F is a cross-sectional view through lines 24F-24F of the suture securing instrument of FIG. 24A.
  • FIG. 24G is a cross-sectional view through lines 24G-24G of the suture securing instrument of FIG. 24A.
  • FIG. 25 is exploded view of the distal end of the suture securing instrument of FIG. 24;
  • FIGS. 25A and 25B illustrate the assembly of the distal end of the suture securing instrument of FIG. 24;
  • FIG. 25C is a cross-section of the distal end of the suture securing instrument along lines 25C-25C of FIG. 25B;
  • FIGS. 26A-26D illustrates the use of a loading device for placement of a sleeve member into the distal end of the suture securing instrument of FIG. 24, in which FIG. 26D further illustrates a guide wire loop for loading of suture in the instrument;
  • FIGS. 26E-26I illustrate use of the guide wire loop of FIG. 26D to load the suture through the sleeve member at the distal end of the suture securing instrument of FIG. 24;
  • FIGS. 27A-27I illustrates at the distal end of the suture securing instrument the process of fastening a sleeve member to retain the sutured tissue closed and cutting of the suture; FIGS. 28A-28M represent an example of the view through the endoscope for applying of a suture by the suturing instrument of the system of FIG. 1 and then secured in place by a suture securing instrument of the system;
  • FIG. 29A is an example of the system of the present invention positioned in the gastroesophageal tract of a patient before insertion of the suturing instrument;
  • FIG. 29B is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing insertion of the suturing instrument through the accessory tube of the system;
  • FIG. 29C is an example of the system of the present invention positioned in the gastroesophageal tract of a patient after placement of the suture thread and removal of the suturing instrument from the accessory tube of the system;
  • FIG. 29D is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing placement of the suture thread loop in the suture securing instrument;
  • FIG. 29E is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing insertion of the suture securing instrument through the accessory tube of the system;
  • FIG. 29F is an example of the system of the present invention positioned in the gastroesophageal tract of a patient showing the secured suture remaining after removal of the suture securing instrument;
  • FIG. 30 is a perspective view of another embodiment of the suturing instrument in the system of FIG. 1 having enhanced flexibility;
  • FIG. 31 is a schematic diagram of the needle assembly for each of the two needles in the embodiment of the suturing instrument of FIG. 30;
  • FIG. 32 is an exploded view of the coupler member, sew tip, and multi-lumen tube in the embodiment of the suturing instrument of FIG. 30 in which the needles are removed;
  • FIG. 32A is a partial perspective view of an example of the needles of FIG. 31 extending through one end of the multi-lumen tube of FIG. 32;
  • FIG. 33 is an exploded view of coupler member and sew tip of the embodiment of the suturing instrument of FIG. 30 in which the multi-lumen tube of FIG. 32 is replaced by two needle carrying tubes and one suture supply tube;
  • FIG. 34 is an exploded view similar to FIG. 33 showing in more detail the needle carrying tubes of FIG. 33; FIG. 35 is a schematic diagram of the needle assembly of FIG. 31 extending through one end of a needle carrying tube of FIG. 33;
  • FIG. 35A is a schematic diagram of alternative needle carrying tubes of FIGS. 33-35;
  • FIG. 35B shown in more detail one end of the needle carrying tube of FIG. 35A;
  • FIG. 36 is an exploded view of the tissue engaging end of a further embodiment of the suturing instrument of the system of FIG. 1 in which the vacuum connection assembly of the instrument is not required;
  • FIG. 36A is a side view of the tissue engaging end of the suturing instrument of FIG. 36 with the attachment tip partially broken away;
  • FIG. 37 is a perspective view of the tissue engaging end of the suturing instrument of the system of FIG. 1 without a sleeve to provide rotational locking of the tissue engaging end in the attachment tip of the accessory tube;
  • FIG. 38 is a side view of the attachment tip of the accessory tube to provide rotational locking with the tissue engaging end of the suturing instrument of FIG. 37, in which the interior of the attachment tip is partially broken away to show the slots into which the tissue engaging end can engage;
  • FIG. 39 is a cross-sectional view along lines 39-39 of FIG. 38;
  • FIGS. 40, 40A, 41, 42, 42A-42C, and 45A-45D are diagrams illustrating an optional hydraulic steering mechanism for the tissue engaging end of the suturing instrument of FIG. 1 using a cylinder of FIGS. 42 and 42A or folding piston of FIGS. 42B-C and 45A-45D; and
  • FIGS. 43, 43A, 44, and 44A are diagrams illustrating an optional mechanical steering mechanism for the tissue engaging end of the suturing instrument of FIG. 1.
  • DETAILED DESCRIPTION OF THE INVENTION
  • Referring to FIG. 1, a system 10 for suturing is shown including an accessory tube 12 and an endoscope 14, referred to herein after as a gastroscope, or other type of flexible endoscope having a shaft 14 a coupled to the accessory tube, and a suturing instrument 16. The suturing instrument 16 may be inserted in the accessory tube 12 as shown in FIG. 1, and is removable from the accessory tube 12 as shown in FIG. 2. The accessory tube 12 has access tubing 18 which is sufficiently flexible to be movable with the flexible shaft 14 a of the gastroscope. Tubing 18 is braid reinforced with a braid of stainless steel, nylon, or Kevlar, to maintain the integrity of the tubing's circular cross-sectional shape and avoid kinking as the shaft 14 a of the gastroscope bends when placed through the mouth into the gastrointestinal tract of a patient. The braiding may be located between two layers of tubing 18, which are integrated with the braiding during their extrusion forming tubing 18. For example, the outer diameter of tubing 18 may be 0.263 inches, while the internal diameter of tubing 18 may be 0.231 inches, and is such that a tissue engaging end 16 a coupled to shaft 16 b of suturing instrument 16 can pass through the tubing. Tubing 18 may be composed of pebax, polyurethane, or other flexible plastics of medical grade. The accessory tube 12 further has a cannula 20 attached to tubing 18 through which instruments, such as suturing instrument 16, may pass. Cannula 20 is describe is more detail later in connection with FIGS. 6 and 7. Accessory tube 12 is shown as a separate component in FIG. 2.
  • Multiple tube guides 22 couple tubing 18 to shaft 14 a of gastroscope 14. Each tube guide 22 has an opening 22 a extending through the tube guide and a curved surface 22 b along its length which abuts the outer curved surface of shaft 14 a, as shown in FIGS. 1A. FIGS. 4 and 4A show the tube guide 22 in more detail. Tube guides 22 may be attached to shaft 14 a by a band of tape 24 having an adhesive layer to fix the tube guide to shaft 14 a. Other attaching means are also be used, such as glue. The diameter of opening 22 a is slightly larger than the outer diameter of tubing 18 such that the tubing 18 is slidable through opening 22 a to enable the accessory tube 12 to move in concert with flexing, bending, rotation, or other movements of the gastroscope 14. Tube guides 22 maintain tubing 18 substantial coaxial with shaft 14 a of gastroscope 14. Preferably, four tube guides are provided as shown in FIGS. 1, 2, and 3, but other number of tube guides may be used.
  • At the distal end of accessory tube 12 is an attachment tip 26 having two openings 26 a and 26 b to receive one end of tubing 18, and the distal end 14 b of gastroscope 14, respectively. Attachment tip 26 is shown in more detail in FIG. 1B, and as a separate component in FIGS. 5 and 5A. Tubing 18 is attached to attachment tip 26, such as by glue or insert molding, while the gastroscope's distal end 14 a is held by friction and seats in a shelf or lip 26 c (FIG. 5) which forms a stop limiting forward movement of distal end 14 a. The attachment tip 26 may be made of urethane or other molded plastic material. The length of the accessory tube 12 from its cannula 20 to attachment tip 26 may be, for example, 30 inches, but also may be of other lengths. Gastroscope 14 may be any typical gastroscope, such as that manufactured by Olympus, Inc., Pendax, Inc., Vision-Sciences, or Welch Allyn. For purposes of illustration, gastroscope 14 has at its upper end 14 c a handle 27 a, two dials 27 b to steer the gastroscope, and various buttons/knobs to control typical gastroscope operation. The distal end 14 b of the gastroscope has elements for imaging optics 28 a, illumination 28 b, water for cleaning imaging optics 28 c, and a biopsy or working channel 28 d representing tubing in communication with a port 27 c at upper end 14 c. A video display system 193 (FIG. 29B) is coupled to upper end 14 a, via a cable 27 d, to allow viewing of tissue from its distal end 14 b on a display via optics 28 a. Although a gastroscope is referred to herein, any other flexible endoscope may similarly be used. FIGS. 2 and 2A illustrate the accessory tube 12 and gastroscope 14 when no instrument is located in the accessory tube.
  • Cannula 20 may be a typical type of cannula providing a sealable passage to tubing 18. For purposes of illustration, cannula 20 is shown in FIGS. 1-3, and in more detail in FIGS. 6 and 7. Cannula 20 has a housing 20 a and a cap 20 b which is received in housing 20 a. Two seals 20 c and 20 d are provided in cannula 20 along a passage 21 from an opening 21 a through which the shaft of an instrument may pass into tubing 18. Tubing 18 is received in an opening 20 f which extends into housing 20 a. Seal 20 c may be a duck-bill seal as illustrated in FIG. 7. An optional auxiliary port 20 e has a bore 20 f which opens to passage 21 through which water, air, or vacuum may be provided through tubing 18. Although a cannula with two seals is described, the cannula may alternatively have a single seal. Seal 20 d provides sealing about the shaft of an instrument, while seal 20 c provides sealing when no instrument is located in the accessory tube 12.
  • The assembly of the gastroscope 14 and accessory tube 12 when in the gastrointestinal or gastroesophageal tract of a patient provides the feature of enabling instruments, such as the suturing instrument, and the later to be described suture securing instrument, to be insertable and retractable about the distal end of the gastroscope, without requiring removal of the gastroscope. Further, normal functionality of the gastroscope in viewing is provided without any partial obstruction or loss of use of the working channel 28 d. An illustration of the system 10 in a patient's body is shown in FIGS. 29A-29F.
  • Referring to FIGS. 8-10, the suturing instrument 16 of system 10 is shown. Suturing instrument 16 represents the SEW-RIGHT® SR·5™ manufactured by LaserSurge, Inc. of Rochester, N.Y., which has been modified to have a longer and partially flexible shaft 16 b extending from a housing 30, and means for selectably establishing suction to capture tissue at its tissue engaging end 16 a. The tissue engaging end 16 a and needles thereto may be similar to that shown in U.S. Pat. Nos. 5,431,666, 5,766,183, or European Patent No. EP 0669101, filed Feb. 23, 1995 and granted Oct. 14, 1998, which are herein incorporated by reference The shaft 16 b represents an assembly of components 51-62 described below. Shaft 16 b is rigid along a first section 32 when it extends from opening 31 in housing 30 and then is flexible along a second section 33 until coupling to the tissue engaging end 16 a.
  • The housing 30 has a body shaped like a pistol having a handle portion 30 a, and may be made of a two-piece construction of molded plastic. A pair of needles 34 and 35 extends from housing 30 through the shaft 16 b into the tissue engaging end 16 a. Each needle 34 and 35 has a non-tissue engaging end in the housing having a spherical member 34 a and 35 a, such as a ball or bearing, respectively, attached thereto. Both needles 34 and 35 and spherical members 34 a and 35 a may be a made of metal, such as surgical stainless steel. The spherical member 34 a and 35 a may have a bore into which the non-tissue engaging ends of the needles 34 and 35, respectively, extend and joined thereto, such as by welding or brazing.
  • The suturing instrument 16 includes an actuator member 36 representing a lever having two pins 36 a extending into holes in the sides of housing 30 upon which the actuator member is pivotally mounted in the housing. Actuator member 36 has a portion which extends through an opening 30 b (FIG. 10) in housing 30 to enable pivotal movement about pin 36 a. An extension spring 38 is provided which hooks at one end in a notch 36 b of actuator member 36 and is wound at the other end around a pin 40 located in holes in the sides of housing 30, such that the actuator member 36 is spring biased to retain actuator member 36 normally in a forward position, as shown for example in FIG. 9. The body of housing 30 has a front portion 31 (FIG. 10) providing a stop that limits the pivotal movement of the actuator member 36. A notch 36 c is provided in the actuator member 36 which is shaped to received one of the non-engaging ends of needles 34 or 35, i.e., spherical members 34 a or 35 a, to be driven forward by an operator pulling actuator member 36 to pivot actuator member 36 towards handle portion 30 a. Two grooves 36 d (FIG. 10) are provided by three fingers 36 e into which the needle 34 or 35 near the spherical members 34 a or 35 a, respectively, may lie.
  • A retainer member 42 is fixed in housing 30 by two flanges 42 a above actuator member 36. As best shown in FIG. 10A, the retainer member 42 has a chamber 42 b having a lower opening 42 c to chamber 42 b and two grooves 42 d formed by fingers 42 e which allow the spherical members 34 a or 35 a of needles 34 or 35, respectively, to be received in chamber 42 b to restrict movement of the needle when held therein. The lower surface 42 f of retainer member 42 is curved and faces correspondingly curved upper surface 36 f of actuator member 36, such that the actuator member 36 is slidable along lower surface 42 f responsive to the operator pulling the actuator member.
  • To select which of the needles 34 and 35 is to be driven by actuator member 36, the instrument 16 has a needle selection mechanism having a selector lever (or arm) 44 which is rotationally coupled with a cam member 46. The cam member 46 and selector lever 44 is supported by an adapter 48 in housing 30. Adapter 48 is mounted in housing 30 by two flanges 48 a. The selector lever 44 is pivotally mounted by a pin 48 c extending upwards from adapter 48 at a hole 44 a through the lever. Selector lever 44 extends through an opening 30 c in housing 30 and has a downwardly protruding member 44 b which is received in a notch 46 a of cam member 46 to rotate cam member 46 in a pocket 48 b in the adapter 48 as the selector lever 44 is moved left or right. The cam member 46 may have a tapered surface 46 b to facilitate its rotation in pocket 48 b and two tapered apertures 46 c through which needles 34 and 35 respectively extend, as shown in FIG. 10B. To select needle 34 to be driven, the selector 44 is moved right which rotates the cam member 46 to position needle 34 down and needle 35 up, such that end 34 a is located in notch 36 c and end 35 a is located in chamber 42 b of retainer member 42. To select needle 35 to be driven, the selector 44 is moved left which rotates the cam member 46 to position needle 34 up and needle 35 down, such that end 35 a is located in notch 36 c and end 34 a is located in chamber 42 b of retainer member 42.
  • The needle selector 44 may further have another downwardly protruding member 44 c which rides in a slot 42 g on the upper surface of retainer member 42. The slot 42 g is contoured to have angled lower regions on either side of a raised region into which member 44 c can be located to releasably lock to retain the position of lever 44 left or right.
  • The adapter 48 has a bore extending there through in which a needle spreader 50 is located. Needle spreader 50 has two channels 50 b and 50 c into which needles 34 and 35 are respectively located to increase the distance between the needles 34 and 35 as they extend toward cam member 46, such that the needles are properly aligned to apertures 46 b in the cam member.
  • A suture routing tube 47 is provided for suture thread in housing 30. Suture routing tube 47 has one end received in a valve assembly 19, described later below, at the bottom of handle 30 a of housing 30 and then extends through notches 30 d (FIG. 10) along the interior of the left side of housing 30, and a groove 50 a along needle spreader 50 (FIGS. 10 and 11). A cross-section through needle spreader 50 and adapter 48 is shown in FIG. 12. The other end of the suture routing tube 47 is then mounted in a hole 51 a through gasket member 51. Gasket member 51 further has two holes 51 b and 51 c through which needles 34 and 35, respectively extend. A cross-section of shaft 16 b through gasket member 51 is shown in FIG. 13. The gasket member 51 may be made of medical grade rubber, such as Santoprene.
  • A longitudinal guide member 53 is provided multiple tracks along its length, including two needle tracks 53 a and 53 b for needles 34 and 35, respectively, and a suture track 53 c for suture thread extending from opening 51 a of gasket member 51. A cross-sectional view of shaft 16 b through guide member 53 is shown in FIG. 14. The guide member 53 may be made of extruded flexible material, such as Tecoflex®. A rigid tube 52 is provided which is D-shaped at one end 52 a is registered into a corresponding shaped opening in adapter 48, and a threaded nut 54 having an opening which extends over mounting tube 52 and screws onto the end of the adapter 48 to secure tube 52 to housing 30. With the gasket member 51 loaded first into rigid tube 53, guide member 53 extends from the gasket member 51 through the rigid tube. In this manner, tracks 53 a, 53 b, and 53 c each form a channel with the interior surface of rigid tube 52. Rigid tube 52 may be made of stainless steel, or other rigid material, and has for example, rigid tube 53 has an outside diameter of 0.205 inches. FIG. 11 shows the gasket member 51 prior to being positioned in abutment to needle spreader 50 and in end 52 a of rigid tube 52. For inside rigid tube 52, gasket member 51 has a ring 51 d which frictionally engages the interior surface of tube 52, hole 51 a of the gasket member is of a diameter such that the suture tube 47 tightly fits therein and provides a seal around suture tube 47. The suture tube 47 may be held in place in hole 51 a by friction, but adhesive may also be used. FIGS. 11A and 11B show gasket member 51 in more detail. Holes 51 b and 51 c are of a larger diameter than the needle, except for a small section of holes 51 b and 51 c where the diameter reduces to form flaps 51 e and 51 f, respectively of gasket material which seal around needles 34 and 35, respectively. This enables movement of the needles back and forth while maintaining a seal about each needle. One feature of the gasket member 51 is that it enables sealing the shaft 16 b, such that negative pressure, i.e., suction, may be selectively applied down the shaft via a vacuum connection assembly 64, as described later below.
  • At the other end 52 b of rigid tube 52, a coupler member 56 is mounted in which two tabs 56 a are received in two tracks 53 d along two opposing sides of guide member 53. Coupler member 56 joins the non-flexible section 32 of the shaft 16 b provided by rigid tube 52 with the flexible section 33 of the shaft 16 b (FIG. 8). Coupler member 56 may be composed of stainless steel. A cross-section of shaft 16 b through coupler member 56 is shown in FIG. 15. The coupler member has a track 56 b for suture, tracks 56 c and 56 d for needles 34 and 35, respectively, and a central hole 56 e. On the side of the coupler member 56 opposite guide member 53 is another longitudinal guide member 58 which extends through the flexible section of shaft 16 b to the tissue engaging end 16 a. Guide member 58, like guide member 53, is of an extruded flexible material, such as Tecoflex®. Guide member 58 has multiple tracks, including two needle tracks 58 a and 58 b for needles 34 and 35, respectively, and a suture track 58 c for suture thread extending from track 56 b of coupler member 56. A cross-sectional view of shaft 16 b through guide member 58 is shown in FIG. 16. Two tabs 56 f extend from the coupler member 56 into tracks 58 d of guide member 58. A wire 60 extends from the tissue engaging end 16 a through a central hole 58 e of guide member 58 and the central hole 56 e of coupler member 56, and then partly into a center hole 53 e (FIG. 14) extending into guide member 53. The wire 60 extends partly through central hole 53 e to facilitate registration of guide member 53 to coupler member 56 and guide member 58. The wire 60 is located in a central hole which extending into a sew tip 98 at the tissue engaging end 16 a and attached thereto, such as by welding or brazing, passed through guide member 58 via hole 58 e, and then extended through and in coupler member 56, where it is attached to the coupler member, via a tube coupler 57, such as by welding or brazing. This assembly is described in more detail below in connection with FIG. 17C. With the rigid tube 52, gasket 51, guide members 53 and 58 and central wire 60 in place, a plastic shrink wrap layer or tubing 62 is installed along shaft 16 b from the vacuum connection assembly 64 until the tissue engaging end 16 a, and shrunk in response to applied heat onto exposed surfaces of shaft 16 b. About guide member 58, tracks 58 a, 58 b, and 58 c each form a channel with the interior surface of shrink wrap layer 62.
  • The connection of coupler member 56, guide member 58 and a sew tip 98 of the tissue engaging end 16 a is best illustrated in FIGS. 17A and 17B in which tabs 56 f of coupler member 56 are received in tracks 58 d at one end of guide member 58, and tabs 100 from sew tip 98 are received in tracks 58 d at the other end of guide member 58. Wire 60 extends through coupler member 56, guide member 58 into a hole 98 h extends into the rear section 98 i of the sew tip 98 (FIG. 21B). The guide member 58 with the shrink wrap enables the flexible section 33 of shaft 16 b to bend and flex while maintaining the channels extending there through, while the wire 60 provide longitudinal support to the flexible section as it is attached to non-flexible section 30 at coupler member and the sew tip. Further, needles 34 and 35 are sufficiently flexible to bend without deformation within guide member 58. In order to translate rotational motion from the non-flexible section, tabs 56 a and 56 f of coupler member are registered into tracks 53 d and 58 d of guide members 53 and 58, respectively, and then tracks 58 d of guide member 58 into tabs 100 of sew tip 98. Thus rotation occurring at the non-flexible section, such as by rotation of housing 30, is translated to tissue engaging end 16 a.
  • FIG. 17C shows the attachment of wire 60, coupler member 56, and flexible section 33 of instrument 16 in more detail, such that possible damage to guide members from the heat of welding or brazing of metal components is avoided. The coupler member 56 has a recessed circular opening 56 h to central hole 56 e at the end 56 g of coupler member 56 into which one end 57 a of a wire coupler tube 57 is located. Wire coupler 57 represents a metal tube having an outer diameter sized to be received in recessed opening 56 h and an inner diameter sized to receive there through wire 60. Prior to attachment of coupler member 56 to guide member 53, wire coupler 57 is first attached to coupler member 56, such as by welding or brazing, about recessed opening 56 h prior to the assembly of the flexible section 33 components, i.e., sew tip 98, and guide member 58, to coupler member 56. Next, wire 60, which has not yet been passed through coupler member 56, is attached, such as by welding or brazing, into hole 98 h (FIG. 21B) of sew tip 98. Wire 60 is then slid through central hole 58 e of guide member 58 and hole 56 e of coupler member 56, and the sew tip 98 at two tabs 100 frictionally engages into two tracks 58 d of guide member 58 at one end of guide member 58. At the other end of guide member 58, tabs 56 e of coupler member 56 frictionally engages into tracks 58 d. With the coupler member 56 integrated with guide member 58, wire 60 is attached at end 57 b of wire coupler 57, such as by welding or brazing, which integrates the assembly of coupler member 56 with flexible section 33 of the instrument 16, as shown in FIG. 17B. Thereafter, the coupler member 56 at its tabs 56 f frictionally engages into tracks 53 d of guide member 53, such that wire 60 partly extends into central hole 53 e of guide member 53. The guide member 53 and coupler member 56 of the assembly are received into the rigid tube 52, such that guide member 53 abuts gasket 51, and coupler member is attached to rigid tube by mechanical fastening by forming small dents in the metal of the tube 52 with a press into recessed four pockets 56 i (FIG. 17A), i.e., two on each side of the coupler member 56.
  • Referring to FIGS. 18 and 18A-C, a vacuum connection assembly 64 for suturing instrument 16 is shown. Vacuum connection assembly 64 includes a front housing member 66 which has a circular opening 66 a to an interior chamber 66 b, and a rear housing member 68 having a circular opening 68 a extending there through. Rear housing member 68 has a first extension toward housing 30 providing a shaft 68 e having an annular flange 68 b and a second extension toward front housing member 66 providing a threaded shaft 68 c. Shaft 68 c is screwed in a threaded opening 66 c (FIG. 18B) to chamber 66 b of front housing member 66, whereby surface 68 d of the rear housing member tightly fits (mates) along surface 68 d of the front housing member 66. Circular opening 66 a is coaxial with circular opening 68 a through their respective housing members. A rubber O-ring 71 is provided in an annular groove in opening 66 a of the front housing member 66, while another O-ring 70 is provided in an annular groove in opening 68 a of rear housing member 68, as illustrated in FIG. 18B. A fitting member 72 is received in front member 66 in a recessed pocket 66 e to a threaded opening 66 f extending to chamber 66 b, such that a port 74 is provided having a bore 75 to chamber 66 b. Fitting member 72 is threaded along its surface 72 a to enable the fitting member to screw into threaded opening 66 f of front housing member 66. Except for O-rings 70 and 71, the components of vacuum connection assembly 64 may be made of stainless steel.
  • The vacuum connection assembly 64 is placed on rigid tube 52 so that the tube extends through openings 66 a and 68 a, O-rings 70 and 71, and chamber 66 b, and an opening 52 c in the rigid tube lies in chamber 66 b and faces bore 75 of the fitting member. The diameter of apertures 66 a and 68 b are slightly larger than the outer diameter of rigid tube 52 about opening 52 c. O-rings 70 and 71 engage the outer surface of rigid tube 52 to seal chamber 66 b, but for bore 75 and opening 52 c to suture track 53 c (FIG. 18C). Flange 68 b from rear housing member 68 is received in a pocket 37 (FIG. 9) formed when the left and right sides of housing 30 are mated to each other. A vacuum source may be applied via tubing (not shown) to port 74, such that negative air pressure is provided in chamber 66 b which may be communicated via an opening 52 c of rigid tube 52 along a suture channel formed by suture track 53 c of guide member 53 to suture track 58 d of guide member 58 through track 56 b of coupler member 56, down to the tissue engaging end 16 a. Vacuum connection assembly 64 may alternatively be coupled at port 74 to a source for air to provide positive air pressure along the same suture channel, i.e., to drive air down to the tissue engaging end 16 a.
  • A valve 19 is provided at the bottom of handle 30 a, as shown in FIGS. 9 and 10, having a valve seat 19 a and a valve controller 19 b, shown as separate components in FIGS. 19A and 19B. Valve seat 19 a is composed of medical grade rubber, such as Santoprene®, and has a hole 76 extending into an interior chamber 78. One side 79 of this chamber 78 has a lip 80 about an opening 81. Protruding into the chamber 78 facing opening 81 is a raised member 82 of the valve seat 19 a through which the hole 76 extends to an opening 84, which is recessed near a surface 82 a of the raised member 82. The recess of opening 84 forms the shape of an eye having two opposing corners 86 when valve 19 is open. Two opposing fingers 88 of the raised member 82 extend from the top and bottom of the eye of opening 84. A valve controller 19 b composed of molded plastic, or other rigid material, has a circular section 90 having an opening 92 to an interior surface forming a cam 94, and a recessed retainer ring 95. Circular section 90 is received through opening 81 such that retainer ring 90 is captured by lip 80 to retain valve controller 19 b in valve seat 19 a. Fingers 88 and corners 86 of the raised member 82 of the valve seat lie against the surface of cam 94 of the valve controller 19 b. The cam surface is wider along one dimension and narrower along a perpendicular dimension, such that when the fingers 88 lie along the narrower dimension, they compress the recess of opening 84 into a closet slit to close valve 19, and when fingers 88 lie along the wider dimension, the recess of opening 84 returns to its normal shape and the valve 19 is open. Adjusting the dimensions of the cam surface 94 a controls the amount of pressure applied to compress opening 84, and thus the integrity of the closed valve's seal. Another hole 76 b (FIG. 9) extends through opening 92 to the bottom 96 a of turn knob 96 of the valve controller. The suture routing tube 47 is received in hole 76 of valve seat 19 a, as shown in FIG. 9, such that suture material from the tube can pass through openings 76 and 84 of the valve seat and then through hole 76 b of the valve controller.
  • As shown in FIG. 20A, the valve 19 is open when the finger 88 align along surface 94 a and 94 b of the cam 94, and corners 86 are each received in corresponding detents 94 c and 94 d of cam 94. To close valve 19, a turn knob 96 of the valve controller 19 b is rotated as shown in FIG. 20B. This starts compressing fingers 88 against the surface of the cam 94 until the fingers 88 lie in detents 94 c and 94 d compressing opening 84 of the valve seat to close the valve, as shown in FIG. 20C. To open the valve 19, the turn knob 96 is again rotated until the corners 86 lie in detents 94 c and 94 d. The turn knob 96 may be rotated clockwise or counterclockwise to open and close valve 19. Valve 19 may be closed to seal the suture tube 47 when suction is applied via vacuum connection assembly 64, but allows suture to be drawn under slight tension through the valve.
  • Other types of valve 19 may alternatively be used, such as shown in FIG. 19D, which provides a seal, but enables the suture to be drawn under slight tension through the valve. In FIG. 19C, the bottom of handle 30 a is shown in which the suture tube 47 is received in a duck-bill valve 128 providing a chamber 128 a and two flaps 128 b extending into the chamber along the length of suture 105 which extends through suture tube 47 between flaps 128 b and through an opening 129 in housing 30. In response to negative air pressure in suture tube 47, the two flaps 128 b meet along edges 128 c providing a seal about the suture 105 in chamber 128 a. FIG. 19C illustrates the valve when closed, when open flaps 128 b at edges 128 c may separate from each other.
  • Referring to FIGS. 21, 21A and 21B, the tissue engaging end 16 a of the suturing instrument 16 is shown having the sew tip 98 which is mounted in a tip tube 102, such that the front section 98 a of the sew tip extends from tube 102. The mounting of the tip tube 102 to the sew tip 98 may be achieved by mechanical fastening by forming small dents in the metal of the tip tube 102 with a press into recessed four pockets 98 b, i.e., two on each side of the sew tip (FIG. 17A). The sew tip 98 has a gap 104 in a C-shaped jaw having two openings 98 c at one side of the gap through which each of needles 34 and 35 may extend to capture ferrules 103 having one end of suture material 105 located in openings 107 at the other side of gap 104, and after each needle captures a ferrule, the needle retracts back into their respective opening 98 c carrying the suture material on its tip. A channel 98 d is provided in the sew tip which aligns with suture track 58 c of guide member 58, as shown in FIG. 17B. The channel 98 d extends along the length of the sew tip and then fork into two channels, each leading to one of the two openings 107 having ferrules 103 to which the end of the suture thread is attached. Openings 107 retain ferrules 103 but are slotted to enable release of suture after a ferrule 103 is captured. The operation of sew tip 98 will be described in more detail below in connection with FIGS. 22A-22I. A vacuum sleeve 106 is provided having a tube 106 a, and a rounded cap 106 b which closes one end of tube 106. The cap 106 b has an edge 106 c which mates with the edge 106 d of tube 106 a and two extending flanges 110 which are received in tube 106 a to hold the cap in place (FIGS. 21C and 21D). Between flanges 110 the interior surface of the cap is angled to provide a ramp 112 (FIG. 21B). The sew tip 98 in tip tube 102 is received through the open end 106 f of tube 106 b, such that an opening 108 of tube 106 b is located over gap 104 of the sew tip. The two flanges 110 of cap 106 d register with the two sides of the forward part 98 g of the sew tip 98 to properly align sew tip 98 and tip tube 102 in the vacuum sleeve 106. The opening 108 represents a cut into tube 106 a to provide a oval shaped window 108 a and a forward slot 108 b which extend from window 108 a to the end of tube 106 a meeting cap 106 b, such that the forward (ferrule carrying) part 98 g of the sew tip 98 partially extends through slot 108 b (FIG. 21B). Cap 106 b has a notch 106 e located adjacent slot 108 b at edge 106 d of tube 106 a (FIG. 21D). The ramp 112 is negatively sloped at an angle towards slot 108 b, as shown in FIG. 21B, to facilitate the suturing process, as will be described later. Two fingers or prongs 103 extend from the sides of the tip tube 102 and are received in two corresponding openings 111 of the vacuum sleeve 106 to latch the sleeve in position over the sew tip. Guide member 58 extends into tip tube 102 as shown in FIG. 18B21B. Shrink wrap or tubing 114 is then applied over tube 106 a, such that openings 111 are sealed closed, to complete the assembly of the vacuum sleeve 106, as shown in FIG. 21A. A short metal ring 116 is placed over the end 102 a of the tip tube 102 and the edge of the shrink wrap 62 extending along shaft 18 b. In placing ring 116, shrink wrap 62 is first applied over shaft 18 b and tube 102, and then cut back to an edge 106 a of ring 116. Tubes 102 and 106 a are both made of metal, such as stainless steel, and cap 106 a may be made of molded plastic. A cross-section of tissue engaging end 16 a through the sew tip 98, tip tube 102, and vacuum sleeve 106, is shown in FIG. 17. This vacuum sleeve 106 enables a vacuum or partial vacuum to be applied to the path of the suture following gasket member 51, via the vacuum connection assembly 64, to channel 98 d of the sew tip 98, such that the upflow of air into the gap 104 of the sew tip through opening 108 of vacuum sleeve 106 can pull the tissue into the gap. The suction from the vacuum or partial vacuum is applied to gap 104 of the sew tip 98 via two openings 98 e in channel 98 d to two cavities 98 f each located on opposite sides of the sew tip in the space between the sides of sew tip 98 and vacuum sleeve 106 near gap 104 (FIG. 21). Although cap 106 b as described herein is preferred, cap 106 b may be provided by a metal cap 118, such as of stainless steel attached to the end of tube 106 a, and provides a small ramp 118 a.
  • The tissue engaging end of suturing instrument 16 may be as described in U.S. patent application Ser. No. 09/686,420, filed Oct. 11, 2000, which is herein incorporated by reference. This patent application describes the loading of a length of suture material, i.e., thread, whose ends are affixed to ferrules in the sew tip 98. Before such loading, the vacuum sleeve 106 is removed from tube tip 102 by pushing in fingers 103 to release them from openings 111 and then simultaneously pulling the vacuum sleeve 106 away from tube tip 102. After loading, the vacuum sleeve 106 is replaced and latched back (i.e., fingers 103 in openings 111) onto the tube tip 102 and the loop of suture extends from the ferrules through the suture tracks 53 a and 58 a of guide members 53 and 58 to suture routing tube 47, via track 56 b of the coupler member 56 and opening 51 a of the gasket member 51, out holes 76 and 76 a of valve 19. Proper orientation of the vacuum sleeve 106 over tube tip 102 and sew tip 98 is provided by flanges 111 of cap 106 b, as described earlier, and also by ramp 112 being angled such that it prevents upside down misalignment of the vacuum sleeve over the sew tip. The forward section 98 g of the sew tip will be stopped by ramp 112 before fingers 103 reach to the tube tip openings 111, preventing the vacuum sleeve 106 from latching. For example, the suture material may represent monofilament suture material or braided suture material.
  • Referring to FIGS. 22A-22I, the operation of the suturing instrument 16 at the tissue engaging end 16 a is shown after the suturing instrument is located, via accessory tube 12, near the tissue to be sutured. FIGS. 22A-22H show the process of applying one end of the suture through tissue 120 with needle 34, the same process is repeated for the other end of the suture for needle 35. Suturing with needles 34 and 35 may be provided in any order. In FIG. 22A, the tissue engaging end 16 a is shown with suture material 105 loaded in the sew tip 98, such that the two free ends of the loop of suture extend from the suture track 58 a of tube guide 58, via a passage 98 d of the sew tip 98, to two ferrules 103 coupled to the two suture ends in the sew tip 98. Opening 98 c at one end of gap 104 face ferrules 103 in openings 107 for respectively needles 34 and 35. The tissue engaging end 16 a is placed adjacent a first target area 121 in tissue 120 where the first end of the suture will be placed (FIG. 22B). Suction is then applied to pull the target area 121 of tissue 120 via gap 104 of the sew tip through opening 108 in the vacuum sleeve 106 to capture a fold 124 of tissue 120 at target area 121 (FIG. 22C). To apply suction, valve 19 is closed and a vacuum source, such as a vacuum pump 200 (FIG. 29B), provides suction to shaft 16 b, via tubing, to port 74 of the vacuum connection assembly 64. The vacuum is communicated into gap 104 via opening 52 c of rigid tube 52 to the suction channel in shaft 16 b formed by suture track 53 c of guide member 53, track 56 b of coupler member 56, and then suture track 58 d through coupler member 56 to channel 98 d and cavities 98 f of the sew tip 98. Principally, the suction is applied to cavities 98f, however the suction may occur elsewhere about gap 104, such as the space between the sew tip 98 and the interior surface of the vacuum sleeve 106, or via openings 107. With the suction maintained, and needle 34 selected by an operator using selector lever 44, and the actuator member 36 is pulled by the operator towards handle 30 a (FIG. 8), the needle passes through the tissue (FIG. 22D) and then into ferrule 103 (FIG. 22E), such that the tip 122 of the needle is captured in the ferrule. Although valve 19 is closed, the suture may be drawn through the valve seat 19 a. The actuator member 36 rotates against the bias of spring 38 until needle tip 122 engages ferrule 103. The amount of rotation of actuator member 36 depends on the distance the needle must transverse before engaging a ferrule, such distance may vary depending on the degree of flexing of shaft 16 b along its flexible section 33. The needle 34 is then retracted by the operator releasing actuator member 36, to pass the needle and captured ferrule 103 back through the tissue (FIG. 22F) and into opening 98 c (FIG. 22G). The suction generates negative air pressure near the tissue 120 sufficient to pull the tissue into gap 104 of the sew tip 98 without damaging the tissue. The suction is then discontinued, such as by turning off the vacuum source 200, and the valve 19 opened to release the tissue from gap 104 of the sew tip (FIG. 22H). The end of the suture thread extends from the captured ferrule on the needle tip through tissue 120 to channel 98 d. The suture releases through the slot extending along opening 108 b and the suture extends from captured ferrule through the tissue to channel 98 d. The process of FIGS. 22A-22H is then repeated at a second target area in the tissue with needle 35 selected to place the second end of the suture in the tissue. FIG. 22I shows the result after both suture ends are placed through tissue, where one suture end extends through tissue fold 124 and the other through fold 126. For example, the second target area may be located directly after placing the first suture end through the tissue by rotating the housing 30 of the instrument 180 degree to rotate the tissue engaging end 180 degrees. The entire operation is observed by the operator via the gastroscope, and in this manner, the first and second target located by the operator in the tissue. The operator may be a surgeon, gastroenterologist, or other skilled physician.
  • Alternatively, the suturing instrument may operate to apply a suture without suction if the target area of tissue can be sufficiently received in gap 104 of the sew tip 98. For example, the target area may represent a raised portion of tissue to be sutured. Further, the suturing instrument operating without section, may be used with the vacuum sleeve 106 removed from the tissue engaging end 16 a, such as shown for example in FIG. 23.
  • After two ends of the suture have been placed through the tissue, as illustrated in FIG. 22I, the suturing instrument 16 is removed from the accessory tube 12, which pulls the loop of suture, which extended from housing 30, down to tissue 120. As the suture passes through the tissue engaging end 16 a, the suture follows from channel 98 d of the sew tip over the ramp 112 and notch 106 e of cap 106 b. The suture may then be secure by a suture securing instrument 130 described below.
  • Referring to FIGS. 24, 24A, and 24B, the suture securing instrument 130 of the system is shown having a housing 132 similar to housing 30 of suturing instrument 16. Suture securing instrument 130 represents the Ti-KNOT® TK·5™ manufactured by LaserSurge, Inc. of Rochester, N.Y., except that its shaft 134 is longer and partially flexible, and means are provided for calibrating the length of a drive wire to the distal end 136 of the instrument 130. The distal end of instrument 130 may be similar to that described in U.S. Pat. Nos. 5,669,917, 5,643,289, 5,520,702, or European Patent Application No. 95102587.3, filed Feb. 23, 1995 and published Feb. 2, 1994 under Publication No. 0669103A1, which are herein incorporated by reference. The suture securing instrument 130 includes an actuator member 138 representing a lever having two pins 138 a extending into holes in the sides of housing 132 upon which the actuator member is pivotally mounted in the housing. Actuator member 138 has a portion which extends through an opening 132 a in housing 132 to enable pivotal movement about pin 138 a. A extension spring 140 is provided which hooks at one end in a notch 138 b of actuator member 138 and is wound at the other end around a pin 141 located in holes in the sides of housing 132, such that the actuator member 138 is spring biased to retain actuator member 138 normally in a forward position, as shown for example in FIG. 24A. The body of housing 132 has a front portion 132 b providing a stop that limits the pivotal movement of the actuator member 138. A pivot barrel 142 is coupled by a pin 144 which extends through an opening 142 a through the pivot barrel and two holes 143 between flanges 144 of actuator member 138. A turnbuckle 146 is provided representing a tubular member which has an interior surface right-hand threaded from one end and left-hand threaded from the other end. The turnbuckle 146 is attached to a threaded circular end 142 b of pivot barrel 142 and then to the threaded circular end 148 a of a ball connector 148. The ball connector has a ball 148 b having a hole 148 c there through. Drive tube 150 has one end 150 a into which ball 148 b is received and then coupled to the tube, via a pin 149, which extend through hole 148 c of the ball 148 b and two holes 150 c in drive tube 150. An adapter 152 is received in the other end 150 b of the driver tube 150 and has a hole partially extending there through in which is received and attached a drive wire 154. The adapter 152 is mounted in driver tube 150 for rotational movement about an annular groove 152 a of the adapter 152. Multiple detents (not shown) are formed in the tube 150, such as by deforming the metal by pressure, over the annular groove 152 a. The detents extend into the annular groove 152 a to form a track guide within which the adapter 152 may be rotated.
  • Another adapter 156 is provided which has flanges 156 a received in the two sides of housing 132. A rigid tube 158 having an end 158 a which is D-shaped is registered into a corresponding shaped opening in adapter 156, and a threaded nut 160 having an opening which extends over mounting tube 158 and screws onto the end of the adapter 156 to secure tube 158 to adapter 156. Rigid tube 158 extends from housing 132 via an opening 130 d in the housing. The assembly of components 142, 146, 148, 150, 152, and 154 described above are received in the adapter 156 and through rigid tube 158, as shown in FIG. 24A. A cross-section of the adapter 156 and rigid tube 158 at pin 149 is shown in FIG. 24C. Cross-section of shaft 134 through the rigid tube 158 at the drive tube is shown in FIG. 24D, and at the adapter 152 in FIG. 24E. The drive tube 150 is moveable through rigid tube 158. At the other end 158 b of the rigid tube 158 is another adapter 162 which is cylindrical and has a central hole 162 a extending there through. The adapter 162 is mounted in tube 158 by mechanical fastening in which small dents in the metal of the tip tube formed with a press into two slots 162 b on either side of the adapter 162. The drive wire 154 extends through hole 162 a of the adapter 162 and into an extension tube 164 which extends from the adapter 162 to the distal end 136 of instrument 130. Extension tube 164 is a stainless steel tube having for example, an inner diameter of 0.041 inches and an outer diameter of 0.059 inches, and is mounted in hole 162 a of adapter 162, such as by welding or brazing, while enabling movement of the drive wire through adapter 162 and extension tube 164. Drive wire 154 may be, for example, stainless steel music wire. A cross-section of shaft 134 b through extension tube 164 is shown in FIG. 24F. Pivot barrel 142, turnbuckle 146, ball connector 148, drive tube 150, adapter 152, rigid tube 158, and adapter 162 may be made of metal, such as stainless steel, while adapter 156 may be made of molded plastic.
  • The assembly of the distal end 136 is best shown in FIGS. 25, 25A, and 25B. A tip tube 166 is provided having an end 166 a into which is inserted a couple member 168 having an edge 168 a which mates along the edge 166 b of tip tube 166. The end 164 a of extension tube 164 is received into a central hole 168 b through coupler member 168 in which the drive wire 154 extends through the coupler member 168 and is received and attached in opening 171 (FIG. 25C) in a wedge tip section 170, where it is attached thereto, such as by welding or brazing. The wedge tip section 170 has a slot 170 a partially there through into which is received the hammer and anvil section 172, such that the hammer and anvil section is slidable in slot 170 a. Sections 170 and 172 are received in the tip tube 166. A pin 176 extends through two holes 166 d and an opening 172 a through hammer and anvil section 172 to retain section 172 in tube 166.
  • A chamber 173 is provided in the hammer and anvil section into which a securing sleeve member 174 (FIG. 25B) is located. The securing sleeve member 174 may be a Titanium Knot™ titanium tube manufactured by LaserSurge, Inc. of Rochester, N.Y. Cross-sections through the distal end 136 of the suture securing instrument are shown in FIGS. 24G and 25C. The wedge tip section has an upper member 170 b and a lower member 170 d having a knife 170 d when wedge tip section 170 is driven forward upper member 170 b abuts ramp 172 d of the hamper and anvil section 172 to first push hammer 172 b down to deform and crimp sleeve member 174 against anvil 172 c, and then knife 170 d cut sutures extending from sleeve member 174 near opening 166 e of tip tube 166. Thus, with ends of suture extending through the sleeve member 174 and exit the opening 166 e of the tube tip 166, wedge tip section 170 and the hammer and anvil section 172 provides for crimping the sleeve member to retain the suture and then cuts the suture in response to forward movement of the drive tube 150 and drive wire 154. Drive tube 150 and drive wire 154 are moved forward by an operator pulling actuator member 138 towards handle 132 c of housing 132, as will be described in more detail in connection with FIG. 27A-H. Rotation of adapter 152 in tube 150 facilitates freedom of wedge tip 170 to translate, or tilt, along its center axis, which extends in the direction of wire 154, as the wedge tip is driven forward against the ramped surface of hammer 172 b. Rotational movement of actuator member 138 is enabled by pivoting of the pivot barrel 142 about the axis defined by pin 144 in flanges 145.
  • Before attachment of the distal end 136 to extension tube 164 through which drive wire 154 extends, tube 164 is passes through a flexible plastic tubing 178, such as of Tygon. This tubing 178 extends from end 158 b of rigid tube 158, until distal end 136 when mounted to extension tube 164. The diameter of tubing 178 is substantially matched to the outside diameter of tube 158 and tip tube 166. A shrink wrap layer 180 is applied on the entire length of shaft 134 of instrument 130 until distal end 136.
  • The entire length of the instrument 130 is such that it can extend through accessory tube 12 in which its shaft 134 has a non-flexible section 134 a defined by the extend of rigid tube 158, and a flexible section defined by the extent of extension tube 164 in tubing 178. For example, the shaft 134 may be 31.5 inches in length, where its non-flexible section 134 a is 12.0 inches in length, and the flexible section 134 b is 19.5 inches in length.
  • Referring to FIGS. 26A-26D, the loading of sleeve member 174 into the distal end 136 of the suture securing instrument 130 is shown using a flexible holder 182 having a outer groove (not shown) around which a wire 184 is passed to forming a loop. This loading holder is commercially available as a Ti-KNOT® TK·5™ Quick Load™ unit from LaserSurge, Inc., Rochester, N.Y. Holder 182 may be made of molded rubber, and having an opening 182 a for the fingers of an operator. The ends of the wire loop 184 are attached to a C-shaped or curved handle 186, which may be composed of metal. A sleeve member 174 is slid along ring 186 until reaches the end of the ring at 186 a (FIG. 26A). The ring 186 is then passed through chamber 173 of the distal end 136 between the hammer 172 b and anvil 172 c of section 172 and then exits through opening 166 e of the tip tube 166 (FIG. 26B), until sleeve member 174 is located in chamber 173 (FIG. 26C). The flexible holder 184 may then be removed (FIG. 26D). Referring to FIGS. 26E-26I, the loading of the two ends of a loop of suture 105 through a loaded sleeve member 174 in the distal end 136 of the suture securing instrument 130 is shown. The two ends of suture 105 are passed through the wire loop 184 (FIG. 26E), as shown by arrow 188, and are captured by the wire loop as the C-shaped handle 186 is used to pull the wire loop through the sleeve member 174 (FIG. 26F) and opening 166 e of the tube tip 166, thereby pulling the two ends of the loop of suture through the sleeve member and opening 166 e in the direction indicated by arrows 190-192 (FIGS. 26G-26I).
  • FIGS. 27A-27H shows the operation of suture securing instrument 130 to secure and cut the suture. With the ends of the loop of suture 105 extending through the sleeve member 174 at the distal end 136 of the suture securing instrument 130, the instrument may be inserted into the accessory tube 12 down to the tissue through which the suture loop extends. The ends of the suture are pulled through the distal end 136, until sleeve member 174 is located adjacent the tissue (FIG. 27A). An operator then pulls the actuator member 138 towards handle 132 c, driving forward the wedge tip section 170 in which the motion is translated through shaft 134 via pivot barrel 142, turnbuckle 146, ball connection 148, through drive tube 150 and drive wire 154. In response, the upper member 170 b of the wedge tip section 170 slides forward against hammer 172 b deforming the sleeve member against anvil 170 c to retain the suture. FIGS. 27B-27E illustrates the downwards movement of the hammer deforming on the sleeve member as the wedge tip section 170 is driven forward. The knife 170 d at the lower member 170 c of the wedge tip section 170 is also driven forward against the suture (FIG. 27F), to cut the ends of the suture near the sleeve member 174 (FIG. 27G). The operator then releases the actuator member 138 which automatically retracts in response to the forward bias by spring 140, and the wedge tip section 170 retracts releasing the sleeve member 174 from between hammer 172 b and anvil 172 c (FIG. 27H). The distal end 136 of suture instrument 130 is then removed leaving the crimped sleeve member 174 a to retain the sutured tissue closed (FIG. 27I).
  • Referring to FIGS. 28A-28M and 29A-29F the overall operation of system 10 will now be described in which FIGS. 28A-28M illustrate examples of the images on a display 193 provided by the gastroscope 14, and FIGS. 29A-29F illustrate the relative position of the gastroscope 14, accessory tube 12, and instruments 16 and 130 during suturing and suture securing. With the patient 194 ready for the procedure, the gastroscope 14 and attached accessory tube 12 are inserted through the mouth 195 down the esophagus 196 and into the stomach 198 where the suturing will take place (FIG. 29A). The suturing instrument 16 with a loop of suture 105 loaded is then inserted into the accessory tube 12 via cannula 20, until the distal end 16 a passes through attachment tip 26 (FIGS. 28A and 29A). The tissue engaging end 16 a of the suturing instrument 16 is viewable to the operator on display 193 through the gastroscope (FIG. 28A). With the target area of the tissue located, the valve 19 is closed, and suction is applied to instrument via a vacuum source 200 and control (or regulator) 202 via tubing 201 to pull the tissue into gap 104 of sew tip 98, as described earlier (FIG. 28B). Control 202 may be integrated in vacuum source 200 or along tubing 201, and is used to selectably enable and disable suction to the sew tip 98 in vacuum sleeve 106. A first one of needles 34 or 35 is then extended and retracted by the operator, as described earlier, to locate the first end of the suture in the tissue. The suction is then disabled, valve 19 opened, and the sew tip is lifted leaving the suture extending through the tissue (FIGS. 28C, 28D, 28E, and 28F). The target area for the second end of the suture is then located, valve 19 closed, and vacuum again enabled to pull the tissue into the sew tip 98 (FIG. 28F). A second one of the needles 34 or 35 is extended and retracted to locate the second end of the suture in the tissue. The suction is then disabled, valve 19 opened, and the sew tip lifted leaving the suture extending through the tissue. FIG. 28G shows an image of the first and second ends of the suture in the tissue. The suturing instrument 16 is then removed from the accessory tube as shown in FIG. 29C, pulling a loop 105 a of suture 105 through the stomach tissue (FIGS. 28H-28J). The ends of the suture material are cut from the suturing instrument 16 and then loaded through the suture securing instrument 130 which has been loaded with a sleeve member 174, as shown in FIG. 29D. The suture securing instrument 130 is then inserted into the accessory tube 12 while gentle tension is applied to the free ends of the loop of suture (FIG. 28K). The distal end 136 of the suture securing instrument passes through the attachment tip 26 and is located near the suture loop extending from the tissue (FIG. 28L). The suture securing instrument 130 is positioned adjacent to the tissue, appropriate suture tension applied and the instrument is then actuated as described earlier to crimp and cut the sleeve member (FIG. 28M), and then the instrument 130 is removed leaving the crimped sleeve member 174 a to close the suture (FIG. 28N). FIG. 29F illustrates the patient after the suture is closed and the suture securing instrument is removed. The gastroscope 14 and attached accessory tube 12 remains in the patient during both the suturing and suture securing operations, and this procedure does not require the use of an overtube. If additional suturing is required, the suturing instrument 16 may be reloaded with another suture loop and above described procedure repeated with the suture securing instrument reloaded with another sleeve member to secure the suture closed. In this manner, multiple sutures may be made in the stomach tissue with a single insertion of the gastroscope 14. When suturing is completed, the gastroscope 14 and attached accessory tube 12 are removed from the patient.
  • Although the suturing instrument 16 and suture securing instrument 130 are described for use with gastroscope 14, instruments 16 and 130 may be used separately from the gastroscope 14 and accessory tube 12. Further, suturing instrument 16 and suture securing instrument 130 may pass through an internal channel 28 d (FIG. 1B), often called a working or biopsy channel, provided in gastroscope 14 to its distal end 14 a sized to receive the respective shaft of the instrument.
  • Referring to FIGS. 30-35, another embodiment of the suturing instrument 16 is shown to provide additional flexibility within section 33 of shaft 16 b of the instrument. This additional flexibility facilitate further freedom for section 33 to flex in the accessory tube 12 with the flexing of gastroscope shaft 14 a in positioning the distal end 14 b of the gastroscope. Suturing instrument 16 is the same in this embodiment except for the components in section 33 between coupler member 56 and sew tip 98. Needles 34 and 35 in this embodiment are illustrated in FIG. 31 as needle assembly 203. For illustration purposes, needle assembly 203 for needle 34 is shown, since needles 34 and 35 are identical. A needle driver 204 is coupled to ball 34 a by welding or braising into a hole in the ball. Needle driver 204 is a stainless steel wire or tube. A cable 206 is received in a hole 205 in one end 204 a of needle driver 204. A spring 207 is installed at one end 207 a over the cable 206 and attached, such as welded or crimped, to end 204 a of the needle driver 204. The other end of cable 206 is received in a hole 209 at end 208 a of needle 208, and the end 207 b of spring 207 is attached such as welded or crimped, to end 208 a of the needle. Cable 206 is a stainless steel wire or braided cable. Spring 207 is a stainless steel extension spring which is normally compressed, and has an inner diameter slightly larger than the outer diameter of cable 206. For example, inner diameter of spring 207 may be 0.020 inches, and the outer diameter of cable 206 may be 0.018 inches. The outside diameter of spring 207 may be matched to the outside diameters of needle driver 204 and needle 208. The length of needle driver 204, needle 208, and cable 206 in spring 207, is such that the tip 122 of the needle 208 lies in the sew tip 98 when the needle is fully retracted.
  • Needle assembly 203 for each of needles 34 and 35 extends through a multi-lumen tube 210 which is attached at end 210 a to coupler member 36 by tabs 56 f being received in corresponding pockets 212 at end 210 a, and is attached to sew tip 98 by tabs 100 of sew tip 98 in pocket 214 at end 210 b. For purposes of illustration, needles are not shown in FIG. 32. Multi-lumen tube 210 is made of flexible material, such as plastic, polyurethane, or pebex, and has two holes 216 through which needles 34 and 35, respectively, each extend, as best shown in FIG. 32A, where the spring 207 and needle 205 are shown through holes 216. The holes 216 have a diameter slightly larger than the outside diameter of the spring 207. The tube 210 is longitudinally reinforced, such that it cannot be substantially stretched or elongated. Such longitudinally reinforcement of the tube may be provided by a stainless steel kevlar, or nylon weave installed in the tube when it is extruded, or the weave may be adhesively bonded to the outer surface of tube 210. A suture hole 218 extends through tube 210 for passage of suture, and negative or positive air pressure, similar to hole 58 d of guide member 58. End 204 a of needle driver 204 and end 208 a of needle 208 are located in tube 210 for each needle in holes 216. Attachment of tip tube 102, ring 116, and sew tip 98 is the same as described earlier.
  • The operation of suturing instrument 16 in this embodiment is the same as described earlier, except that when actuator member 36 of instrument 16 is pulled by an operator for needle 34 or 35, forward movement is translated to needle 208 via needle driver 204 and spring 207, which compresses to assist in pushing forward needle 208 in sew tip 98. When actuator member 36 is retracted, the cable 206 and spring 207 assist in pulling needle 208 back.
  • Alternatively in this embodiment, the multi-lumen tube 210 may be replaced by needle carrying tubes 220 and suture supply tube 222. The needle assembly 203 for each of needles 34 and 35 extends through tubes 220, respectively, as shown in FIGS. 33 and 34, while the suture supply tube 222 provides a path for suture to sew tip 98, and also can provide negative (or positive) air pressure, as described earlier via vacuum connection assembly 64. Supply tube 222 extends from chamber 66 b of vacuum connection assembly 64 through hole 53 c of guide member 53, through suture track 56 b of coupler member 56, and then along flexible shaft section 35 to sew tip 98. Tubes 220 and 222 may be made of flexible stainless steel tubing or reinforced plastic, pebex, or polyurethane tubing, or nickel titanium tubing, such as nitnol. FIG. 35 shows needle assembly 203 at one end of tubing 220. In this embodiment, shrink wrap 62 (FIG. 10) covers multi-lumen tube 210, or tubes 220 and 222 if no multi-lumen tube is used, such as described earlier for guide member 58. Optionally, to enhance needle carrying tubes 220 flexibility, the tubes 220 may each represent a wound spring 234 with outer sheath 236, such heat shrink tubing, on the outside surface of the spring 234, as shown in FIGS. 35A and 35B. The interior diameter of the spring 234 is slightly greater than the outside diameter of needle assembly 203 extending there through. The outer sheath 236 is shrunk to the spring only at the ends 234 a and 234 b of the spring 234, such that elongation of spring 234 is restricted. The interior diameter of outer sheath 236 is larger than outside diameter of spring 234 to allow flexure of spring 234.
  • Referring to FIGS. 36 and 36A, a further embodiment of suturing instrument 16 is shown in which suction to the sew tip is provided without vacuum connection assembly 64. In this further embodiment, both the vacuum connection assembly 64 and opening 52 c to rigid tube 52 is removed, and an opening 224 is provided through the shrink wrap 62 to suture track 58 c of guide member 58. An additional ring seal 227 (FIG. 36A) is provided in the opening 26 b extending through attachment tip 26. Ring seal 227 is composed of the same material as attachment tip 26, and represents a ring extending from the interior surface of the opening 26 b having a diameter slightly smaller than the largest diameter of tissue engaging end 16 a. The tissue engaging end 16 a can pass through the seal 227, while ring seal 227 engages the outer diameter of the tissue engaging end. Suction may then be applied via cannula port 20 e (FIG. 6) of the accessory tube 12 and communicated through opening 224 to the suture channel, i.e., suture track 58 c and channel 98 d to cavities 98 f gap 104 of the sew tip 98, as described earlier, when instrument 16 is located through accessory tube 12. This suction may be provided from vacuum source 200 (FIG. 29B) through controller unit 202 and tubing 201 to port 20 e, rather than to the vacuum connection assembly 64.
  • Referring to FIGS. 37-39, system 10 may optionally have positional locking of tissue engaging end 16 a to lock the rotational position and to limit forward longitudinal travel of the tissue engaging end 16 a of the suturing instrument in attachment tip 26 of the accessory tube 12. Such locking is provided by adding one or more protrusion members 226 to ring 116 of tissue engaging end 16 a. For example, ring 116 may have two protrusion members located 180° apart along the outer circumference of ring 116. These protrusion members 226 may be made of stainless steel or molded from plastic, and attached, such as adhesively bonded, or if medal by welding or brazing, to the outer surface of ring 116. Protrusion members 226 are shaped to be received by slots 228 in opening 26 b extending through attachment tip 26. For example, eight slots 228 are provided at 30 degree increments about the interior surface of opening 26 b, such that two protrusion members 226 may be received in one of four opposing (180° apart) pairs of slots 228. Lesser or greater numbers of slots may also be provided. Each slot 228 extends from end 230 of attachment tip 26 partially into opening 26 b to provide a stop 231. The height of the protrusion member 226 from the outer surface of ring 116 is slightly less than the depth of the slots 228, and width of the protrusion members 226 is slightly less than the width of slots 228, such that protrusion members 226 can easily engage with an opposing pair of slots 228. Protrusion members 226 each have a forward round-shaped end 226 a that facilitates the alignment of the protrusion members 226 in slots 228 to limit instrument 16 rotation and forward travel.
  • In operation, when the tissue engaging end 16 a of the instrument 16 passes through accessory tube 12 and through the attachment tip 26, the distal end 14 a of the gastroscope 14 can view the vacuum sleeve, and partially the sew tip therein, prior to engagement of protrusion members 226 in a pair of opposing slots 228. The operator then can precisely locate the position of gap 104 of the sew tip with respect to a tissue target area 121 (FIG. 22B), as described earlier. With the target area located and sew tip gap 104 aligned to face the target area, and substantially parallel thereto, the operator slightly rotates the instrument at housing 30, such by handle 30 a, and pushes the instrument to locate and engage the protrusion member 226 of ring 116 of the tissue engaging end 16 a in the closest pair of opposing slots 228 in opening 26 b of the attachment tip 26 which corresponds to the desired aligned rotational position of the sew tip's gap 104 with respect to the tissue target area, until protrusion members' end 226 a abut stop 231. Once the tissue engaging end 16 a is so rotationally locked in position, the risk of rotational misalignment of the sew tip gap 104 when tissue is captured therein is reduced. To select another target area 126 (FIG. 22F), the operator rotationally unlocks tissue engaging end 16 a by pulling the instrument handle 30 slightly back which disengages the protrusion members 226 from slots 228.
  • Referring to FIGS. 40, 40A, 41, 42, and 42A, optionally the suturing instrument 16 may have a steering mechanism for flexing needle engaging end 16 a. This steering mechanism includes a control cylinder 238 having walls defining an interior chamber 240 having therein a plunger or piston 242 attached to the end of a threaded shaft 244 a, which is held in the chamber 240 by a threaded nut 246 (FIG. 40A). The threaded nut 246 is attached to the chamber 240 by insert molding. A thumb wheel 248 attached to the turn screw 244 enabled the shaft 244 a of the turn-screw to rotate along threaded nut 246 and control the position of the piston 242 in chamber 240. Piston 242 has a rubber ring seal 243 which engages the interior surface 240 b of chamber 240. An opening or outlet 248 at one wall of chamber 240 provides a flow path for the volume 241 of liquid 245 contained in the chamber 240, where this volume 241 is defined by the surface 242 a of the piston 242 facing opening 248 and the interior surface 240 b of the chamber 240.
  • As shown in FIG. 40, at least one exterior surface of a wall of control cylinder 238 is molded into housing 30, or the control cylinder 238 is applied by adhesive to the outer surface of housing 30. Shaft 244 a and nut 246 may be made of stainless steel, while walls of chamber 240, piston 242 and thumb wheel 248 may be made of plastic, such ABS. In housing 30, a flexible tube 250 is coupled at one end to outlet 248 and extends through an opening 252 located in the rigid tube 52 after gasket member 51 and before vacuum connection assembly 64, and then tune 250 follows a path along one of tracks 53 d of guide member 53 in rigid tube 52, and through a hole 254 of coupler member 56 extending through its tab 56 a and 56 d (as shown in dashed lines in FIG. 41). From coupler member 56, the tube 250 extends along one of tracks 58 d of guide member 58 to a cylinder 256 located in the track 58 d before sew tip 98 (FIG. 42). For example, tube 250 may be made of flexible plastic material. As shown in FIG. 42A, cylinder 256 has walls defining a interior chamber 256 a having an opening 256 b in one wall to this chamber which the other end of tube 250 is connected, such as by adhesive bonding. A piston or plunger 256 c in chamber 256 a is coupled to a rod 258 extending through an opening 256 d in a wall of the chamber. The surface 256 e of piston 256 c faces opening 256 b and is positionable in chamber 256 a to change the volume 257 of liquid 245 contained in the chamber, where volume 257 is defined by surface 256 e of the piston 256 c and the interior surface 256 f of cylinder 256.
  • Rod 258 has at its end 258 a a hole 258 b into which a flexure member 260 is attached, such as by welding or crimping. Flexure member 260 extends into a hole in one end of tabs 100 of sew tip 98, and is attached thereto by welding or crimping. Flexure coupler 260 allows for possible misalignment between rod 258 and tab 100 of the sew tip 98. Cylinder 256 is fixed in place in one of tracks 58 d, such as by frictionally engagement when shrink wrap tubing 62 is applied over guide member 58, or may be bonded by adhesive. For example, the components of cylinder 256 may be made of stainless steel, except piston 256 c which may be made of rubber.
  • To steer the sew tip, an operator of the suturing instrument 16 turns the thumb wheel 248 changing the volume of fluid 245 in chamber 240, and moving the fluid into or out of outlet 248 and tube 250. In response, the volume of fluid 245 in chamber 256 c of cylinder 256 changes, and piston 256 c and rod 258 moves in cylinder 238 causing the rod to extend or retract to flex tissue engaging end 16 a, via flexure coupler 260. For purposes of illustration, arrows 239 indicate flexure of the tissue engaging end 16 a of instrument 16. Fluid 245 may be, for example, water. This provide for a hydraulic steering mechanic which an operator of the instrument 16 can use to provide additional control in positioning the tissue engaging end during suturing, such positioning being independent of other steerability of the tissue engaging as may be provided by flexure of gastroscope's shaft 14 b.
  • Alternatively, cylinder 256 may be replaced by a folding piston 262, as shown in FIG. 42B and in more detail in FIG. 42C. Folding piston 262 has walls defining a cavity 262 a which can longitudinally expand or contract due to changes in volume 263 of liquid 245 contained in the cavity from movement of the fluid through an opening 262 b in one of the walls to which tube 250 is connected, such as by adhesive bonding. Rod 258 is attached to end 262 d of folding piston 262, by adhesive bonding or is molded to end 262 d. Folding piston 262 may be made of plastic, stainless steel, or of heat shrink tubing.
  • Folding piston 262 can be manufactured with a process using thin walled transparent or white heat shrink plastic tube 270 made from a non-elastic plastic, like polyester. FIG. 45A shows dark, light absorbing, lines 271 printed directly onto the tube 270 when it is collapsed flat. FIG. 45B shows the same tube 270 having plugs 273 with openings 262 b into the tube, and pressurized with a medium (not shown), such as water or air, through conduits to one or both openings 262 b. Water is a preferred pressurized medium, because it also acts as heat sink to ensure localized heating of the tube only at the desired, printed sites. An appropriate fluence of light, such as produced by a laser, for a specific duration to generate heat along such dark lines of the tube 270 provides controlled radial and axial shrinkage of the tube (FIG. 45C). Such changes to the tube shape permits longitudinal folding of tube 270, as indicated by arrow 272 (FIG. 45D). When the intraluminal pressure and volume are decreased and direct outside pressure is applied to either or both ends of the tube 270, such as via opening 262 b, the tube can collapse in length by folding in near the heat shrunk zones 274, and thus provide folding piston 262. By increasing pressure and volume within folding piston 262, the folded zones 274 will reexpand longitudinally to re-establish the length of the folding piston 262. By controlling volume and pressure within the folding piston 262, piston length is readily altered. Alternatively, light activated thermal modification of heat shrink tubing can be achieved by using a well controlled circumferential application of focused light, such as laser light, or by careful masking of the heat shrink tubing, or by placing a compliant marked mandrel or tube within a clear heat shrink tube and exposing to appropriate lighting conditions.
  • In a further alternative, a wire 263 may replace tube 250, such that a mechanical steering mechanism is provided. As shown in FIG. 44, wire 263 follows the same path as tube 250, except that a piston in no longer required in cylinder 238. Instead, the wire 263 is coupled in cylinder 238 to shaft 244 a to a ball 265, which is retained in a socket 267 formed at the end of the shaft 244 a. A cap 269 has a hole for wire 263 and is received and attached to the socket, such as by welding or brazing, to retain the ball onto the socket, but enable rotation of the ball so that the rotation of the shaft 244 a is not transferred to the wire 264. The wire passes through a tube 266, such as made of stainless steel extending between outlet 248 and opening 252 of the rigid tube 52 (FIG. 44). Tube 266 is attached to opening 252, such as by welding or brazing. The wire passes along one of tracks 53 d of guide member 53 extending with the guide member through rigid tube 52, and then through hole 254 of coupler member 56 through its tab 56 a and 56d, along one of tracks 58 d of guide member 58 to the sew tip 98 (FIG. 44A). Wire 262 is attached to a hole 268 extending into tab 100 of the sew tip 98, such as by welding or brazing.
  • From the foregoing description, it will be apparent that there has been provided an improved system and method for endoscopic suturing. Variations and modifications in the herein described system and method in accordance with the invention will undoubtedly suggest themselves to those skilled in the art. For example, the entire shaft 16 b or 134 of instruments 16 or 130, respectively, may be flexible along their length. Accordingly, the foregoing description should be taken as illustrative and not in a limiting sense.

Claims (19)

  1. 1-44. (canceled)
  2. 45. An instrument having a steerable distal end comprising:
    a proximal end;
    a distal end;
    an at least partially flexible shaft extending from said proximal end to said distal end;
    a housing coupled to said distal end having walls with folds capable of expanding or contracting said housing along a dimension to change the length of the housing along said dimension;
    a medium; and
    means for controlling one or more of volume and pressure of said medium within the housing to change length of said housing along said dimension to steer said distal end, in which said housing expands along said folds responsive to increase in one or more of volume and pressure of said medium in said housing, and said housing contracts along said folds response to decrease in one or more of pressure and volume of said medium in said housing.
  3. 46. The instrument according to claim 45 wherein said means for controlling comprises a conduit for passing said medium into and out of said housing.
  4. 47. The instrument according to claim 46 wherein said means for controlling is located at said proximal end.
  5. 48. The instrument according to claim 45 wherein said housing is longitudinally expandable or contractible along said folds.
  6. 49. The instrument according to claim 45 wherein said housing is cylindrical.
  7. 50. The instrument according to claim 45 wherein said medium is a liquid.
  8. 51. The instrument according to claim 45 wherein said means for controlling comprises a chamber, a positionable piston in said chamber to change the volume of said medium in said chamber, a first opening in said chamber, a tube coupled to said opening, and said tube extending along said shaft to pass said medium between said chamber and said housing responsive to said change in volume of said medium in said chamber.
  9. 52. The instrument according to claim 45 further comprising:
    a tissue engaging end coupled to said shaft at the distal end of the instrument; and
    one or more needles which extend through said shaft to said tissue engaging end.
  10. 53. The instrument according to claim 52 further comprising:
    means for carrying suture along said shaft to said tissue engaging end;
    said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and
    means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended.
  11. 54. An instrument having a remotely steerable distal end comprising
    a proximal end;
    a distal end;
    a shaft extending from said proximal end to said distal end;
    a chamber at or near said proximal end having a medium;
    a first piston in said chamber movable to change the volume of said medium in said chamber;
    an opening in said chamber; and
    a tube coupled to said opening extending along said shaft to said distal end; and
    a second piston coupled to said distal end said second piston having walls which are longitudinally expandable responsive to increase pressure and volume in said second piston when communicated through said tube from said first piston, and longitudinally contractible responsive to decease in pressure and volume of said medium in said second piston when communicated through said tube from said first piston, communicated through said tube to said piston to steer said distal end.
  12. 55. An instrument having a steerable distal end comprising:
    a flexible shaft having a distal end passable through a flexible internal or external conduit associated with an endoscope having a first steering means; and
    second means for steering said distal end of said shaft separately operative from said first steering means when the distal end of said shaft is passed through said flexible internal or external conduit associated with the endoscope.
  13. 56. The instrument according to claim 55 wherein said second steering means is mechanically actuated.
  14. 57. The instrument according to claim 55 wherein said second steering means is hydraulically actuated.
  15. 58. The instrument according to claim 57 wherein said second steering means comprises:
    a chamber at or near the proximal end of said instrument having a fluid and a piston in said chamber movable to change the volume of the fluid in said chamber, an opening to said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and
    a cylinder along said shaft having a piston coupled to said distal end movable responsive to changes in said volume of fluid in said chamber communicated through said tube to said cylinder to steer said distal end.
  16. 59. The instrument according to claim 57 wherein said second steering means comprises:
    a housing coupled to said distal end having walls with folds capable of expanding or contracting said housing along a dimension to change the length of the housing along said dimension;
    a medium; and
    means for controlling one or more of volume and pressure of said medium within the housing to change length of said housing along said dimension to steer said distal end, in which said housing expands along said folds responsive to increase in one or more of volume and pressure of said medium in said housing, and said housing contracts along said folds response to decrease in one or more of pressure and volume of said medium in said housing.
  17. 60. The instrument according to claim 57 wherein said second steering means comprises:
    a chamber at or near the proximal end of said instrument having a medium and a piston in said chamber movable to change the volume of said medium in said chamber, an opening in said chamber, and a tube coupled to said opening extending along said shaft to said distal end; and
    a folding housing coupled to said distal end expandable and retractable responsive to changes in said volume of said medium in said chamber communicated through said tube to said piston to steer said distal end.
  18. 61. The instrument according to claim 55 further comprising:
    a tissue engaging end coupled to said shaft at the distal end of the instrument; and
    one or more flexible needles which extend through said shaft to said tissue engaging end.
  19. 62. The instrument according to claim 61 further comprising:
    means for carrying suture along said shaft to said tissue engaging end;
    said tissue engaging end having an opening to a cavity through which said needles are extendable to each capture one end of the suture; and
    means for applying suction along said shaft to said cavity of said tissue engaging end to enable tissue to be pulled into said opening when said needles are extended.
US12807259 2001-02-02 2010-09-01 System for endoscopic suturing Abandoned US20100331623A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US09776431 US6997931B2 (en) 2001-02-02 2001-02-02 System for endoscopic suturing
US11085703 US20050165419A1 (en) 2001-02-02 2005-03-21 System for endoscopic suturing
US12807259 US20100331623A1 (en) 2001-02-02 2010-09-01 System for endoscopic suturing

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US12807259 US20100331623A1 (en) 2001-02-02 2010-09-01 System for endoscopic suturing

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
US11085703 Division US20050165419A1 (en) 2001-02-02 2005-03-21 System for endoscopic suturing

Publications (1)

Publication Number Publication Date
US20100331623A1 true true US20100331623A1 (en) 2010-12-30

Family

ID=25107357

Family Applications (3)

Application Number Title Priority Date Filing Date
US09776431 Active 2021-12-14 US6997931B2 (en) 2001-02-02 2001-02-02 System for endoscopic suturing
US11085703 Abandoned US20050165419A1 (en) 2001-02-02 2005-03-21 System for endoscopic suturing
US12807259 Abandoned US20100331623A1 (en) 2001-02-02 2010-09-01 System for endoscopic suturing

Family Applications Before (2)

Application Number Title Priority Date Filing Date
US09776431 Active 2021-12-14 US6997931B2 (en) 2001-02-02 2001-02-02 System for endoscopic suturing
US11085703 Abandoned US20050165419A1 (en) 2001-02-02 2005-03-21 System for endoscopic suturing

Country Status (3)

Country Link
US (3) US6997931B2 (en)
EP (1) EP1408809A4 (en)
WO (1) WO2002062200B1 (en)

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110046645A1 (en) * 2009-08-21 2011-02-24 Colophast A/S Suture assembly and system
US20120130403A1 (en) * 2010-11-22 2012-05-24 Brenner Jacob S Device and method for treatment of hemorrhoids
US20130023905A1 (en) * 2011-07-20 2013-01-24 Coloplast A/S Suture system with capsule eyelet providing multiple suture tissue fixation
US20130324905A1 (en) * 2012-05-31 2013-12-05 Valentx, Inc. Devices and methods for gastrointestinal bypass
US8882834B2 (en) 2011-07-08 2014-11-11 Smith & Nephew, Inc. Soft tissue repair
US9357997B2 (en) 2011-07-08 2016-06-07 Smith & Nephew, Inc. Suture passer and method
US9451960B2 (en) 2012-05-31 2016-09-27 Valentx, Inc. Devices and methods for gastrointestinal bypass
US20160287247A1 (en) * 2009-10-01 2016-10-06 Covidien Lp Wound closure device including direct-driven needle
US9561127B2 (en) 2002-11-01 2017-02-07 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US9662105B2 (en) 2011-07-08 2017-05-30 Smith & Nephew, Inc. Suture passer and method
US9675489B2 (en) 2012-05-31 2017-06-13 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9757264B2 (en) 2013-03-13 2017-09-12 Valentx, Inc. Devices and methods for gastrointestinal bypass

Families Citing this family (639)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5766183A (en) 1996-10-21 1998-06-16 Lasersurge, Inc. Vascular hole closure
US7435249B2 (en) 1997-11-12 2008-10-14 Covidien Ag Electrosurgical instruments which reduces collateral damage to adjacent tissue
US6726686B2 (en) 1997-11-12 2004-04-27 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US6228083B1 (en) 1997-11-14 2001-05-08 Sherwood Services Ag Laparoscopic bipolar electrosurgical instrument
US8414505B1 (en) * 2001-02-15 2013-04-09 Hansen Medical, Inc. Catheter driver system
US20030109875A1 (en) * 1999-10-22 2003-06-12 Tetzlaff Philip M. Open vessel sealing forceps with disposable electrodes
US7267677B2 (en) 1998-10-23 2007-09-11 Sherwood Services Ag Vessel sealing instrument
US7582087B2 (en) 1998-10-23 2009-09-01 Covidien Ag Vessel sealing instrument
US7744613B2 (en) 1999-06-25 2010-06-29 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US7955340B2 (en) 1999-06-25 2011-06-07 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US8574243B2 (en) 1999-06-25 2013-11-05 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US7364577B2 (en) 2002-02-11 2008-04-29 Sherwood Services Ag Vessel sealing system
ES2435094T3 (en) 2000-05-19 2013-12-18 C.R. Bard, Inc. Device and method for capturing and suture tissue
US7399304B2 (en) * 2000-03-03 2008-07-15 C.R. Bard, Inc. Endoscopic tissue apposition device with multiple suction ports
US6679264B1 (en) 2000-03-04 2004-01-20 Emphasys Medical, Inc. Methods and devices for use in performing pulmonary procedures
US6904909B2 (en) * 2000-03-04 2005-06-14 Emphasys Medical, Inc. Methods and devices for use in performing pulmonary procedures
US6719767B1 (en) * 2000-08-11 2004-04-13 Edwards Lifesciences Corporation Device and a method for treatment of atrioventricular regurgitation
WO2002013854A1 (en) * 2000-08-11 2002-02-21 Temple University Of The Commonwealth System Of Higher Education Obesity controlling method
US7737109B2 (en) 2000-08-11 2010-06-15 Temple University Of The Commonwealth System Of Higher Education Obesity controlling method
US6551330B1 (en) 2000-09-21 2003-04-22 Opus Medical, Inc. Linear suturing apparatus and methods
US7235086B2 (en) * 2001-02-02 2007-06-26 Lsi Solutions, Inc. Crimping instrument with motion limiting feature
US8313496B2 (en) * 2001-02-02 2012-11-20 Lsi Solutions, Inc. System for endoscopic suturing
DE10105592A1 (en) 2001-02-06 2002-08-08 Achim Goepferich Placeholder for drug release in the frontal sinus
US7118570B2 (en) 2001-04-06 2006-10-10 Sherwood Services Ag Vessel sealing forceps with disposable electrodes
EP1372506B1 (en) 2001-04-06 2006-06-28 Sherwood Services AG Electrosurgical instrument which reduces collateral damage to adjacent tissue
DE60139815D1 (en) 2001-04-06 2009-10-15 Covidien Ag An apparatus for sealing and dividing of a vessel with a non-conductive end stop
US6923819B2 (en) 2001-06-14 2005-08-02 Suturtek Incorporated Apparatus and method for surgical suturing with thread management
US20060199999A1 (en) * 2001-06-29 2006-09-07 Intuitive Surgical Inc. Cardiac tissue ablation instrument with flexible wrist
US6817974B2 (en) 2001-06-29 2004-11-16 Intuitive Surgical, Inc. Surgical tool having positively positionable tendon-actuated multi-disk wrist joint
US20060178556A1 (en) 2001-06-29 2006-08-10 Intuitive Surgical, Inc. Articulate and swapable endoscope for a surgical robot
US6605096B1 (en) * 2001-07-20 2003-08-12 Opus Medical Inc, Percutaneous suturing apparatus and method
US20030078601A1 (en) * 2001-10-22 2003-04-24 Oleg Shikhman Crimping and cutting device
US8142448B2 (en) * 2001-11-26 2012-03-27 Olympus Corporation Endoscopic instruments for suturing tissues in a body cavity
US6740030B2 (en) * 2002-01-04 2004-05-25 Vision Sciences, Inc. Endoscope assemblies having working channels with reduced bending and stretching resistance
WO2003105701A3 (en) * 2002-06-12 2004-04-15 Scimed Life Systems Inc Suturing instruments
US7753858B2 (en) * 2002-06-13 2010-07-13 Guided Delivery Systems, Inc. Delivery devices and methods for heart valve repair
US7883538B2 (en) * 2002-06-13 2011-02-08 Guided Delivery Systems Inc. Methods and devices for termination
US20060122633A1 (en) * 2002-06-13 2006-06-08 John To Methods and devices for termination
US9949829B2 (en) 2002-06-13 2018-04-24 Ancora Heart, Inc. Delivery devices and methods for heart valve repair
US7758637B2 (en) * 2003-02-06 2010-07-20 Guided Delivery Systems, Inc. Delivery devices and methods for heart valve repair
US7588582B2 (en) * 2002-06-13 2009-09-15 Guided Delivery Systems Inc. Methods for remodeling cardiac tissue
US20060241656A1 (en) * 2002-06-13 2006-10-26 Starksen Niel F Delivery devices and methods for heart valve repair
US6986775B2 (en) * 2002-06-13 2006-01-17 Guided Delivery Systems, Inc. Devices and methods for heart valve repair
US20050273138A1 (en) * 2003-12-19 2005-12-08 Guided Delivery Systems, Inc. Devices and methods for anchoring tissue
US7753924B2 (en) 2003-09-04 2010-07-13 Guided Delivery Systems, Inc. Delivery devices and methods for heart valve repair
US7666193B2 (en) 2002-06-13 2010-02-23 Guided Delivery Sytems, Inc. Delivery devices and methods for heart valve repair
US8641727B2 (en) 2002-06-13 2014-02-04 Guided Delivery Systems, Inc. Devices and methods for heart valve repair
US8287555B2 (en) * 2003-02-06 2012-10-16 Guided Delivery Systems, Inc. Devices and methods for heart valve repair
WO2003105674A3 (en) * 2002-06-18 2004-02-26 Andrew J Bilsbury Tissue removal device
US6770084B1 (en) * 2002-06-26 2004-08-03 Opus Medical, Inc. Suture capture device
US7083628B2 (en) 2002-09-03 2006-08-01 Edwards Lifesciences Corporation Single catheter mitral valve repair device and method for use
US20040158125A1 (en) * 2002-09-06 2004-08-12 Aznoian Harold M. Integrated endoscope and accessory treatment device
US8317816B2 (en) 2002-09-30 2012-11-27 Acclarent, Inc. Balloon catheters and methods for treating paranasal sinuses
US7276068B2 (en) 2002-10-04 2007-10-02 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7931649B2 (en) 2002-10-04 2011-04-26 Tyco Healthcare Group Lp Vessel sealing instrument with electrical cutting mechanism
US7270664B2 (en) 2002-10-04 2007-09-18 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US6899672B2 (en) * 2002-11-08 2005-05-31 Scimed Life Systems, Inc. Endoscopic imaging system including removable deflection device
US7799026B2 (en) * 2002-11-14 2010-09-21 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US9848938B2 (en) 2003-11-13 2017-12-26 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US20040199169A1 (en) * 2002-11-20 2004-10-07 Koons Kirk C. Cable clamp tool for surgical applications
US20050182298A1 (en) * 2002-12-06 2005-08-18 Intuitive Surgical Inc. Cardiac tissue ablation instrument with flexible wrist
KR101118049B1 (en) 2002-12-06 2012-02-24 인튜어티브 서지컬 인코포레이티드 Medical instrument
US20040122456A1 (en) * 2002-12-11 2004-06-24 Saadat Vahid C. Methods and apparatus for gastric reduction
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
US7618426B2 (en) 2002-12-11 2009-11-17 Usgi Medical, Inc. Apparatus and methods for forming gastrointestinal tissue approximations
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
US7637905B2 (en) 2003-01-15 2009-12-29 Usgi Medical, Inc. Endoluminal tool deployment system
US7833237B2 (en) * 2003-02-04 2010-11-16 Lsi Solutions, Inc. Instrument for assisting in the remote placement of tied surgical knots and trimming of suture away from the knot and method of use
US8016845B1 (en) 2003-02-04 2011-09-13 Lsi Solutions, Inc. Instrument for guiding the surgical cutting of tissue and method of use
US7481817B2 (en) 2003-02-13 2009-01-27 Lsi Soultions, Inc. Instrument for surgically cutting tissue and method of use
CA2518829C (en) 2003-03-13 2011-09-20 Sherwood Services Ag Bipolar concentric electrode assembly for soft tissue fusion
US7381210B2 (en) 2003-03-14 2008-06-03 Edwards Lifesciences Corporation Mitral valve repair system and method for use
US7753909B2 (en) 2003-05-01 2010-07-13 Covidien Ag Electrosurgical instrument which reduces thermal damage to adjacent tissue
US7160299B2 (en) * 2003-05-01 2007-01-09 Sherwood Services Ag Method of fusing biomaterials with radiofrequency energy
JP5137230B2 (en) 2003-05-15 2013-02-06 コヴィディエン・アクチェンゲゼルシャフト Method of sealing a tissue sealer and tissue with a non-conductive variable stop member
US7815565B2 (en) * 2003-05-16 2010-10-19 Ethicon Endo-Surgery, Inc. Endcap for use with an endoscope
US7431694B2 (en) * 2003-05-16 2008-10-07 Ethicon Endo-Surgery, Inc. Method of guiding medical devices
US20070203393A1 (en) * 2003-05-16 2007-08-30 David Stefanchik Apparatus for positioning a medical device
CA2525275C (en) 2003-05-16 2012-02-07 C.R. Bard, Inc. Single intubation, multi-stitch endoscopic suturing system
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
WO2004107990A9 (en) * 2003-06-06 2005-07-21 Abbott Lab Sizing and positioning adapter for medical instruments
US7150749B2 (en) 2003-06-13 2006-12-19 Sherwood Services Ag Vessel sealer and divider having elongated knife stroke and safety cutting mechanism
US7857812B2 (en) 2003-06-13 2010-12-28 Covidien Ag Vessel sealer and divider having elongated knife stroke and safety for cutting mechanism
US7156846B2 (en) 2003-06-13 2007-01-02 Sherwood Services Ag Vessel sealer and divider for use with small trocars and cannulas
US7534204B2 (en) * 2003-09-03 2009-05-19 Guided Delivery Systems, Inc. Cardiac visualization devices and methods
US7753922B2 (en) * 2003-09-04 2010-07-13 Guided Delivery Systems, Inc. Devices and methods for cardiac annulus stabilization and treatment
US8211142B2 (en) * 2003-09-30 2012-07-03 Ortiz Mark S Method for hybrid gastro-jejunostomy
US7452363B2 (en) * 2003-09-30 2008-11-18 Ethicon Endo-Surgery, Inc. Applier for fastener for single lumen access anastomosis
US7367976B2 (en) 2003-11-17 2008-05-06 Sherwood Services Ag Bipolar forceps having monopolar extension
US7131970B2 (en) 2003-11-19 2006-11-07 Sherwood Services Ag Open vessel sealing instrument with cutting mechanism
US7811283B2 (en) 2003-11-19 2010-10-12 Covidien Ag Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety
US7500975B2 (en) 2003-11-19 2009-03-10 Covidien Ag Spring loaded reciprocating tissue cutting mechanism in a forceps-style electrosurgical instrument
US7442193B2 (en) 2003-11-20 2008-10-28 Covidien Ag Electrically conductive/insulative over-shoe for tissue fusion
JP4594612B2 (en) * 2003-11-27 2010-12-08 オリンパス株式会社 The insertion aid
JP4643451B2 (en) * 2004-01-08 2011-03-02 オリンパス株式会社 Anastomotic device
US7211093B2 (en) * 2004-01-14 2007-05-01 Lsi Solutions, Inc. Sew-right running stitch instrument
US7780662B2 (en) 2004-03-02 2010-08-24 Covidien Ag Vessel sealing system using capacitive RF dielectric heating
US7703459B2 (en) 2004-03-09 2010-04-27 Usgi Medical, Inc. Apparatus and methods for mapping out endoluminal gastrointestinal surgery
JP4643328B2 (en) * 2004-04-07 2011-03-02 オリンパス株式会社 Ligature and suture device for medical application
JP4700384B2 (en) * 2004-04-07 2011-06-15 オリンパス株式会社 Ligature and suture device for medical application and medical ligation suture system
EP1740084A2 (en) * 2004-04-15 2007-01-10 Wilson-Cook Medical Inc. Endoscopic surgical access devices and methods of articulating an external accessory channel
US7410480B2 (en) * 2004-04-21 2008-08-12 Acclarent, Inc. Devices and methods for delivering therapeutic substances for the treatment of sinusitis and other disorders
US20070167682A1 (en) * 2004-04-21 2007-07-19 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US9351750B2 (en) 2004-04-21 2016-05-31 Acclarent, Inc. Devices and methods for treating maxillary sinus disease
US8747389B2 (en) 2004-04-21 2014-06-10 Acclarent, Inc. Systems for treating disorders of the ear, nose and throat
US8932276B1 (en) 2004-04-21 2015-01-13 Acclarent, Inc. Shapeable guide catheters and related methods
US8146400B2 (en) 2004-04-21 2012-04-03 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US9101384B2 (en) 2004-04-21 2015-08-11 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat
US9089258B2 (en) 2004-04-21 2015-07-28 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8894614B2 (en) 2004-04-21 2014-11-25 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US8864787B2 (en) 2004-04-21 2014-10-21 Acclarent, Inc. Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis
US7462175B2 (en) 2004-04-21 2008-12-09 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US7654997B2 (en) 2004-04-21 2010-02-02 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat
US8951225B2 (en) 2005-06-10 2015-02-10 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US9554691B2 (en) 2004-04-21 2017-01-31 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US9399121B2 (en) 2004-04-21 2016-07-26 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US8702626B1 (en) 2004-04-21 2014-04-22 Acclarent, Inc. Guidewires for performing image guided procedures
US7361168B2 (en) 2004-04-21 2008-04-22 Acclarent, Inc. Implantable device and methods for delivering drugs and other substances to treat sinusitis and other disorders
US8764729B2 (en) 2004-04-21 2014-07-01 Acclarent, Inc. Frontal sinus spacer
US20060004323A1 (en) 2004-04-21 2006-01-05 Exploramed Nc1, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US7419497B2 (en) 2004-04-21 2008-09-02 Acclarent, Inc. Methods for treating ethmoid disease
RU2506056C2 (en) 2008-09-18 2014-02-10 Аккларент, Инк. Methods and apparatus for treating ear, nose and throat diseases
US7803150B2 (en) 2004-04-21 2010-09-28 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US20060063973A1 (en) 2004-04-21 2006-03-23 Acclarent, Inc. Methods and apparatus for treating disorders of the ear, nose and throat
US8444657B2 (en) 2004-05-07 2013-05-21 Usgi Medical, Inc. Apparatus and methods for rapid deployment of tissue anchors
US7918869B2 (en) * 2004-05-07 2011-04-05 Usgi Medical, Inc. Methods and apparatus for performing endoluminal gastroplasty
US7347863B2 (en) 2004-05-07 2008-03-25 Usgi Medical, Inc. Apparatus and methods for manipulating and securing tissue
US8257394B2 (en) 2004-05-07 2012-09-04 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US7621925B2 (en) 2004-05-07 2009-11-24 Usgi Medical, Inc. Needle assembly for tissue manipulation
US8216252B2 (en) 2004-05-07 2012-07-10 Usgi Medical, Inc. Tissue manipulation and securement system
US8057511B2 (en) 2004-05-07 2011-11-15 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US7361180B2 (en) 2004-05-07 2008-04-22 Usgi Medical, Inc. Apparatus for manipulating and securing tissue
US7736374B2 (en) 2004-05-07 2010-06-15 Usgi Medical, Inc. Tissue manipulation and securement system
US7520884B2 (en) * 2004-05-07 2009-04-21 Usgi Medical Inc. Methods for performing gastroplasty
US8308765B2 (en) 2004-05-07 2012-11-13 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US20050251091A1 (en) * 2004-05-10 2005-11-10 Usgi Medical Inc. Apparatus and methods for transgastric tissue manipulation
US7758564B2 (en) 2004-05-14 2010-07-20 Ethicon Endo-Surgery, Inc. Medical instrument having a catheter and a medical guidewire
WO2005113051A3 (en) 2004-05-14 2007-07-12 Gregory J Bakos Medical instrument having a medical guidewire
US8206417B2 (en) 2004-06-09 2012-06-26 Usgi Medical Inc. Apparatus and methods for optimizing anchoring force
US7695493B2 (en) 2004-06-09 2010-04-13 Usgi Medical, Inc. System for optimizing anchoring force
US7736379B2 (en) 2004-06-09 2010-06-15 Usgi Medical, Inc. Compressible tissue anchor assemblies
US7678135B2 (en) 2004-06-09 2010-03-16 Usgi Medical, Inc. Compressible tissue anchor assemblies
US7931661B2 (en) 2004-06-14 2011-04-26 Usgi Medical, Inc. Apparatus and methods for performing transluminal gastrointestinal procedures
US8215531B2 (en) 2004-07-28 2012-07-10 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a medical substance dispenser
US8172857B2 (en) 2004-08-27 2012-05-08 Davol, Inc. Endoscopic tissue apposition device and method of use
US7195631B2 (en) 2004-09-09 2007-03-27 Sherwood Services Ag Forceps with spring loaded end effector assembly
EP1791476B1 (en) * 2004-09-20 2015-12-23 Endoevolution, Llc Apparatus for minimally invasive suturing
US8123764B2 (en) * 2004-09-20 2012-02-28 Endoevolution, Llc Apparatus and method for minimally invasive suturing
US7540872B2 (en) 2004-09-21 2009-06-02 Covidien Ag Articulating bipolar electrosurgical instrument
US7955332B2 (en) 2004-10-08 2011-06-07 Covidien Ag Mechanism for dividing tissue in a hemostat-style instrument
WO2006068970A3 (en) * 2004-12-21 2007-01-18 Mitchell Roslin Anastomotic outlet revision
US7686804B2 (en) 2005-01-14 2010-03-30 Covidien Ag Vessel sealer and divider with rotating sealer and cutter
US7909823B2 (en) 2005-01-14 2011-03-22 Covidien Ag Open vessel sealing instrument
US7857750B2 (en) * 2005-01-18 2010-12-28 The Regents Of The University Of California Endoscopic tube delivery system
US8465500B2 (en) * 2005-01-21 2013-06-18 Mayo Foundation For Medical Education And Research Thorascopic heart valve repair method and apparatus
US7491202B2 (en) 2005-03-31 2009-02-17 Covidien Ag Electrosurgical forceps with slow closure sealing plates and method of sealing tissue
US20060253126A1 (en) * 2005-05-04 2006-11-09 Bernard Medical, Llc Endoluminal suturing device and method
US7674271B2 (en) * 2005-05-04 2010-03-09 InTailor Surgical, Inc. Endoluminal gastric ring and method
US20060258904A1 (en) * 2005-05-13 2006-11-16 David Stefanchik Feeding tube and track
US7648457B2 (en) * 2005-05-13 2010-01-19 Ethicon Endo-Surgery, Inc. Method of positioning a device on an endoscope
US7615003B2 (en) * 2005-05-13 2009-11-10 Ethicon Endo-Surgery, Inc. Track for medical devices
US20060259010A1 (en) 2005-05-13 2006-11-16 David Stefanchik Feeding tube
US7857754B2 (en) 2005-05-13 2010-12-28 Ethicon Endo-Surgery, Inc. Apparatus useful for positioning a device on an endoscope
US7905830B2 (en) * 2005-05-13 2011-03-15 Ethicon Endo-Surgery, Inc. Sheath for use with an endoscope
US20060258903A1 (en) * 2005-05-13 2006-11-16 David Stefanchik Method of inserting a feeding tube
US8298291B2 (en) 2005-05-26 2012-10-30 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US8932208B2 (en) 2005-05-26 2015-01-13 Maquet Cardiovascular Llc Apparatus and methods for performing minimally-invasive surgical procedures
US9585651B2 (en) 2005-05-26 2017-03-07 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US7615060B2 (en) * 2005-06-13 2009-11-10 Ethicon-Endo Surgery, Inc. Endoscopic suturing device
US7766925B2 (en) * 2005-06-13 2010-08-03 Ethicon Endo-Surgery, Inc. Surgical suturing apparatus
US9545191B2 (en) * 2005-06-13 2017-01-17 Ethicon Endo-Surgery, Inc. Method for suture lacing
US8641728B2 (en) * 2005-06-13 2014-02-04 Ethicon Endo-Surgery, Inc. Attachment apparatus for coupling with an endoscope
US7846169B2 (en) * 2005-06-13 2010-12-07 Ethicon Endo-Surgery, Inc. Adjustable vacuum chamber for a surgical suturing apparatus
US7828812B2 (en) * 2005-06-13 2010-11-09 Ethicon Endo-Surgery, Inc. Surgical suturing apparatus with needle release system
US7628796B2 (en) * 2005-06-13 2009-12-08 Ethicon Endo-Surgery, Inc. Surgical suturing apparatus with anti-backup system
US8906040B2 (en) 2005-07-13 2014-12-09 Creighton University Systems and techniques for minimally invasive gastrointestinal procedures
US8641729B2 (en) 2005-07-13 2014-02-04 Creighton University Systems and techniques for minimally invasive gastrointestinal procedures
WO2007009115A3 (en) * 2005-07-14 2007-09-27 Bernard Medical Llc Endoluminal suturing device and method
US8029535B2 (en) * 2005-08-05 2011-10-04 Ethicon Endo-Surgery, Inc. Fasteners for use with gastric restriction
US8147506B2 (en) * 2005-08-05 2012-04-03 Ethicon Endo-Surgery, Inc. Method and clamp for gastric reduction surgery
US8715294B2 (en) * 2005-08-05 2014-05-06 Ethicon Endo-Surgery, Inc. Gastric instrument sleeve to prevent cross contamination of stomach content and provide fixation and repeatable path
US7896894B2 (en) * 2005-08-05 2011-03-01 Ethicon Endo-Surgery, Inc. Apparatus for single pass gastric restriction
US8029522B2 (en) * 2005-08-05 2011-10-04 Ethicon Endo-Surgery, Inc. Method and apparatus for sealing a gastric opening
US8252006B2 (en) * 2005-08-05 2012-08-28 Ethicon Endo-Surgery, Inc. Single pass gastric restriction with a corkscrew style wall anchor
US7779845B2 (en) * 2005-08-05 2010-08-24 Ethicon Endo-Surgery, Inc. Method and apparatus for endoscopically performing gastric reduction surgery
US7771440B2 (en) * 2005-08-18 2010-08-10 Ethicon Endo-Surgery, Inc. Method and apparatus for endoscopically performing gastric reduction surgery in a single pass
DE102005039601A1 (en) * 2005-08-19 2007-02-22 Karl Storz Gmbh & Co. Kg Endoscope, especially Duodenoscope for the mother-baby cholangioscopy
US8800838B2 (en) 2005-08-31 2014-08-12 Ethicon Endo-Surgery, Inc. Robotically-controlled cable-based surgical end effectors
US20130334284A1 (en) 2005-08-31 2013-12-19 Ethicon Endo-Surgery, Inc. Fastener cartridge assembly comprising a fixed anvil and different staple heights
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US7934630B2 (en) 2005-08-31 2011-05-03 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US20070194082A1 (en) 2005-08-31 2007-08-23 Morgan Jerome R Surgical stapling device with anvil having staple forming pockets of varying depths
US9237891B2 (en) 2005-08-31 2016-01-19 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US7896890B2 (en) * 2005-09-02 2011-03-01 Ethicon Endo-Surgery, Inc. Method and apparatus for endoscopically performing gastric reduction surgery in a single step
US8114113B2 (en) 2005-09-23 2012-02-14 Acclarent, Inc. Multi-conduit balloon catheter
US7879035B2 (en) 2005-09-30 2011-02-01 Covidien Ag Insulating boot for electrosurgical forceps
US7789878B2 (en) 2005-09-30 2010-09-07 Covidien Ag In-line vessel sealer and divider
US7922953B2 (en) 2005-09-30 2011-04-12 Covidien Ag Method for manufacturing an end effector assembly
EP1769765B1 (en) 2005-09-30 2012-03-21 Covidien AG Insulating boot for electrosurgical forceps
US7722607B2 (en) 2005-09-30 2010-05-25 Covidien Ag In-line vessel sealer and divider
CA2561034C (en) 2005-09-30 2014-12-09 Sherwood Services Ag Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue
US7798992B2 (en) * 2005-11-04 2010-09-21 Ethicon Endo-Surgery, Inc. Lumen traversing device
US20070106317A1 (en) 2005-11-09 2007-05-10 Shelton Frederick E Iv Hydraulically and electrically actuated articulation joints for surgical instruments
JP2009515598A (en) * 2005-11-10 2009-04-16 フェイズ ワン メディカル リミテッド ライアビリティ カンパニー Catheter device
US8007488B2 (en) * 2005-11-10 2011-08-30 Phase One Medical Llc Catheter device
US9192755B2 (en) 2005-11-10 2015-11-24 Phase One Medical, Llc Catheter device
US7651017B2 (en) * 2005-11-23 2010-01-26 Ethicon Endo-Surgery, Inc. Surgical stapler with a bendable end effector
US20070123917A1 (en) * 2005-11-29 2007-05-31 Ortiz Mark S Anastomotic device promoting tissue necrosis
EP1955643A4 (en) * 2005-12-01 2009-07-15 Olympus Medical Systems Corp Guiding long medical member and long medical device
US8882766B2 (en) 2006-01-24 2014-11-11 Covidien Ag Method and system for controlling delivery of energy to divide tissue
US8298232B2 (en) 2006-01-24 2012-10-30 Tyco Healthcare Group Lp Endoscopic vessel sealer and divider for large tissue structures
US8734443B2 (en) 2006-01-24 2014-05-27 Covidien Lp Vessel sealer and divider for large tissue structures
US8241282B2 (en) * 2006-01-24 2012-08-14 Tyco Healthcare Group Lp Vessel sealing cutting assemblies
WO2007089603A3 (en) 2006-01-27 2008-01-10 Suturtek Inc Apparatus and method for tissue closure
US8726909B2 (en) 2006-01-27 2014-05-20 Usgi Medical, Inc. Methods and apparatus for revision of obesity procedures
US8161977B2 (en) 2006-01-31 2012-04-24 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US20120292367A1 (en) 2006-01-31 2012-11-22 Ethicon Endo-Surgery, Inc. Robotically-controlled end effector
US9861359B2 (en) 2006-01-31 2018-01-09 Ethicon Llc Powered surgical instruments with firing system lockout arrangements
US8763879B2 (en) 2006-01-31 2014-07-01 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of surgical instrument
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US8820603B2 (en) 2006-01-31 2014-09-02 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US7575144B2 (en) * 2006-01-31 2009-08-18 Ethicon Endo-Surgery, Inc. Surgical fastener and cutter with single cable actuator
US20110295295A1 (en) 2006-01-31 2011-12-01 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical instrument having recording capabilities
US8708213B2 (en) 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US8221438B2 (en) * 2006-02-17 2012-07-17 Ethicon Endo-Surgery, Inc. Lumen reduction methods and devices
US7749249B2 (en) 2006-02-21 2010-07-06 Kardium Inc. Method and device for closing holes in tissue
US20070198032A1 (en) * 2006-02-22 2007-08-23 Ethicon Endo-Surgery, Inc. Methods and devices for fastener removal
US7771396B2 (en) 2006-03-22 2010-08-10 Ethicon Endo-Surgery, Inc. Intubation device for enteral feeding
US7803137B2 (en) 2006-03-22 2010-09-28 Ethicon Endo-Surgery, Inc. Intubation system for use with an endoscope
US20070225562A1 (en) * 2006-03-23 2007-09-27 Ethicon Endo-Surgery, Inc. Articulating endoscopic accessory channel
US8721630B2 (en) 2006-03-23 2014-05-13 Ethicon Endo-Surgery, Inc. Methods and devices for controlling articulation
US20070225556A1 (en) * 2006-03-23 2007-09-27 Ethicon Endo-Surgery, Inc. Disposable endoscope devices
US8992422B2 (en) 2006-03-23 2015-03-31 Ethicon Endo-Surgery, Inc. Robotically-controlled endoscopic accessory channel
US7615004B2 (en) 2006-03-30 2009-11-10 Ethicon Endo-Surgery, Inc. Endoscopic ancillary attachment devices
US20070239137A1 (en) * 2006-03-30 2007-10-11 Ethicon Endo-Surgery, Inc. Intubation device for colonic decompression
US20070239179A1 (en) * 2006-03-31 2007-10-11 Ethicon Endo-Surgery, Inc. Compliant Gastroplasty: Devices And Methods
US7686831B2 (en) * 2006-03-31 2010-03-30 Ethicon Endo-Surgery, Inc. Method for securing a suture
US20070239206A1 (en) * 2006-03-31 2007-10-11 Shelton Frederick E Iv Suture with adhesive/sealant delivery mechanism
US8118820B2 (en) * 2006-03-31 2012-02-21 Ethicon Endo-Surgery, Inc. Method for instrument insertion through a body orifice
US7763036B2 (en) * 2006-03-31 2010-07-27 Ethicon Endo-Surgery, Inc. Endoscopic instrument with secondary vacuum source
US7708747B2 (en) * 2006-04-12 2010-05-04 InTailor Surgical, Inc. Endoscopic suturing and implant system
US20070244494A1 (en) * 2006-04-18 2007-10-18 Downing Stephen W Methods and devices for treating atrial septal defects
US7731727B2 (en) * 2006-04-26 2010-06-08 Lsi Solutions, Inc. Medical instrument to place a pursestring suture, open a hole and pass a guidewire
US7846087B2 (en) * 2006-05-01 2010-12-07 Ethicon Endo-Surgery, Inc. Endoscopic rotation
US7862582B2 (en) 2006-05-02 2011-01-04 Ethicon Endo-Surgery, Inc. Suture management
US7927271B2 (en) * 2006-05-17 2011-04-19 C.R. Bard, Inc. Endoscope tool coupling
US8190389B2 (en) 2006-05-17 2012-05-29 Acclarent, Inc. Adapter for attaching electromagnetic image guidance components to a medical device
CN104887171B (en) * 2006-05-18 2018-03-20 智能医疗系统有限公司 Flexible endoscopic system and its functions
US8105355B2 (en) 2006-05-18 2012-01-31 C.R. Bard, Inc. Suture lock fastening device
US20070270688A1 (en) * 2006-05-19 2007-11-22 Daniel Gelbart Automatic atherectomy system
US7635373B2 (en) * 2006-05-25 2009-12-22 Ethicon Endo-Surgery, Inc. Absorbable gastric restriction devices and methods
US20070276409A1 (en) * 2006-05-25 2007-11-29 Ethicon Endo-Surgery, Inc. Endoscopic gastric restriction methods and devices
US8322455B2 (en) 2006-06-27 2012-12-04 Ethicon Endo-Surgery, Inc. Manually driven surgical cutting and fastening instrument
US8449605B2 (en) 2006-06-28 2013-05-28 Kardium Inc. Method for anchoring a mitral valve
US9119633B2 (en) 2006-06-28 2015-09-01 Kardium Inc. Apparatus and method for intra-cardiac mapping and ablation
US8920411B2 (en) 2006-06-28 2014-12-30 Kardium Inc. Apparatus and method for intra-cardiac mapping and ablation
US10028783B2 (en) 2006-06-28 2018-07-24 Kardium Inc. Apparatus and method for intra-cardiac mapping and ablation
US8109957B2 (en) 2006-06-30 2012-02-07 Depuy Spine, Inc. Disc nucleus removal devices and methods
US7776037B2 (en) 2006-07-07 2010-08-17 Covidien Ag System and method for controlling electrode gap during tissue sealing
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
US20100063358A1 (en) * 2006-07-07 2010-03-11 Fred Kessler Channeled flexible sleeve for medical articles
US7740159B2 (en) * 2006-08-02 2010-06-22 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist
US20080045863A1 (en) * 2006-08-17 2008-02-21 Ethicon Endo-Surgery, Inc. Guidewire structure including a medical guidewire
US8002714B2 (en) * 2006-08-17 2011-08-23 Ethicon Endo-Surgery, Inc. Guidewire structure including a medical guidewire and method for using a medical instrument
US20080072914A1 (en) * 2006-08-25 2008-03-27 Hendricksen Michael J Bronchial Isolation Devices for Placement in Short Lumens
US8597297B2 (en) 2006-08-29 2013-12-03 Covidien Ag Vessel sealing instrument with multiple electrode configurations
US20080097331A1 (en) * 2006-09-05 2008-04-24 Ethicon Endo-Surgery, Inc. Guidewire structure including a medical guidewire and method for using
US9820688B2 (en) 2006-09-15 2017-11-21 Acclarent, Inc. Sinus illumination lightwire device
US7559925B2 (en) 2006-09-15 2009-07-14 Acclarent Inc. Methods and devices for facilitating visualization in a surgical environment
US7665647B2 (en) 2006-09-29 2010-02-23 Ethicon Endo-Surgery, Inc. Surgical cutting and stapling device with closure apparatus for limiting maximum tissue compression force
US8070746B2 (en) 2006-10-03 2011-12-06 Tyco Healthcare Group Lp Radiofrequency fusion of cardiac tissue
US8795325B2 (en) * 2006-10-05 2014-08-05 Covidien Lp Handle assembly for articulated endoscopic instruments
US20080086147A1 (en) * 2006-10-05 2008-04-10 Knapp Thomas P Shape memory filament for suture management
US9072514B2 (en) 2006-10-05 2015-07-07 Thomas P. Knapp Shape memory filament for suture management
WO2008045353A3 (en) * 2006-10-05 2008-06-26 Tyco Healthcare Flexible endoscopic stitching devices
WO2008045376A3 (en) * 2006-10-05 2008-07-17 Tyco Healthcare Axial stitching device
US8475453B2 (en) * 2006-10-06 2013-07-02 Covidien Lp Endoscopic vessel sealer and divider having a flexible articulating shaft
EP3189807A1 (en) 2006-10-06 2017-07-12 Covidien LP Endoscopic vessel sealer and divider having a flexible articulating shaft
US9675285B2 (en) * 2006-10-16 2017-06-13 Given Imaging Ltd. Delivery device for implantable monitor
US8388680B2 (en) * 2006-10-18 2013-03-05 Guided Delivery Systems, Inc. Methods and devices for catheter advancement and delivery of substances therethrough
US8562629B2 (en) * 2006-10-24 2013-10-22 Arthrocare Corporation Suture device having selective needle actuation and related method
US8747304B2 (en) 2006-10-31 2014-06-10 Ethicon Endo-Surgery, Inc. Attachment apparatus for an endoscope
WO2008058005A3 (en) * 2006-11-03 2008-07-03 Penn State Res Found Endosurgery suturing device
US8551139B2 (en) 2006-11-30 2013-10-08 Cook Medical Technologies Llc Visceral anchors for purse-string closure of perforations
US7976458B2 (en) * 2006-12-05 2011-07-12 Ethicon Endo-Surgery, Inc. Independent articulating accessory channel
US8439687B1 (en) 2006-12-29 2013-05-14 Acclarent, Inc. Apparatus and method for simulated insertion and positioning of guidewares and other interventional devices
US8684253B2 (en) 2007-01-10 2014-04-01 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US8459520B2 (en) 2007-01-10 2013-06-11 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and remote sensor
US8652120B2 (en) 2007-01-10 2014-02-18 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US20080169332A1 (en) 2007-01-11 2008-07-17 Shelton Frederick E Surgical stapling device with a curved cutting member
US20080177380A1 (en) * 2007-01-19 2008-07-24 Starksen Niel F Methods and devices for heart tissue repair
US8007432B2 (en) * 2007-01-26 2011-08-30 Ethicon Endo-Surgery, Inc. Endoscopic accessory control mechanism
US20080200755A1 (en) * 2007-02-15 2008-08-21 Bakos Gregory J Method and device for retrieving suture tags
USD649249S1 (en) 2007-02-15 2011-11-22 Tyco Healthcare Group Lp End effectors of an elongated dissecting and dividing instrument
US7655004B2 (en) 2007-02-15 2010-02-02 Ethicon Endo-Surgery, Inc. Electroporation ablation apparatus, system, and method
US20080200933A1 (en) * 2007-02-15 2008-08-21 Bakos Gregory J Surgical devices and methods for forming an anastomosis between organs by gaining access thereto through a natural orifice in the body
US20080200911A1 (en) * 2007-02-15 2008-08-21 Long Gary L Electrical ablation apparatus, system, and method
US20080208223A1 (en) * 2007-02-26 2008-08-28 Paul Edward Kraemer Cable clamping device and method of its use
US7815662B2 (en) 2007-03-08 2010-10-19 Ethicon Endo-Surgery, Inc. Surgical suture anchors and deployment device
US7780691B2 (en) * 2007-03-21 2010-08-24 Ethicon Endo-Surgery, Inc. Endoscopic tissue resection device
US20100261962A1 (en) * 2007-03-21 2010-10-14 Friedberg Joseph S Natural orifice transluminal endoscopic surgery overtube and method of introducing multiple endoscopes
US7981124B2 (en) * 2007-04-04 2011-07-19 Misder, Llc Medical device for applying purse string sutures
US8267935B2 (en) * 2007-04-04 2012-09-18 Tyco Healthcare Group Lp Electrosurgical instrument reducing current densities at an insulator conductor junction
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
US8118757B2 (en) 2007-04-30 2012-02-21 Acclarent, Inc. Methods and devices for ostium measurement
US8753373B2 (en) * 2007-05-08 2014-06-17 Edwards Lifesciences Corporation Suture-fastening clip
US8485199B2 (en) 2007-05-08 2013-07-16 Acclarent, Inc. Methods and devices for protecting nasal turbinate during surgery
US8740937B2 (en) * 2007-05-31 2014-06-03 Cook Medical Technologies Llc Suture lock
US8534528B2 (en) 2007-06-04 2013-09-17 Ethicon Endo-Surgery, Inc. Surgical instrument having a multiple rate directional switching mechanism
US7905380B2 (en) 2007-06-04 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a multiple rate directional switching mechanism
US7832408B2 (en) 2007-06-04 2010-11-16 Ethicon Endo-Surgery, Inc. Surgical instrument having a directional switching mechanism
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
US7753245B2 (en) * 2007-06-22 2010-07-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments
US8408439B2 (en) * 2007-06-22 2013-04-02 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an articulatable end effector
US8590762B2 (en) 2007-06-29 2013-11-26 Ethicon Endo-Surgery, Inc. Staple cartridge cavity configurations
US9211119B2 (en) 2007-07-03 2015-12-15 Ceterix Orthopaedics, Inc. Suture passers and methods of passing suture
US20100130990A1 (en) * 2007-07-03 2010-05-27 Saliman Justin D Methods of suturing and repairing tissue using a continuous suture passer device
US8911456B2 (en) 2007-07-03 2014-12-16 Ceterix Orthopaedics, Inc. Methods and devices for preventing tissue bridging while suturing
US8663253B2 (en) * 2007-07-03 2014-03-04 Ceterix Orthopaedics, Inc. Methods of meniscus repair
US20110130773A1 (en) * 2007-07-03 2011-06-02 Saliman Justin D Methods for continuous suture passing
US9314234B2 (en) 2007-07-03 2016-04-19 Ceterix Orthopaedics, Inc. Pre-tied surgical knots for use with suture passers
US8702731B2 (en) 2007-07-03 2014-04-22 Ceterix Orthopaedics, Inc. Suturing and repairing tissue using in vivo suture loading
US20090012538A1 (en) * 2007-07-03 2009-01-08 Justin Saliman Methods and devices for continuous suture passing
US7879049B2 (en) * 2007-08-17 2011-02-01 Wilson-Cook Medical Inc. Device to open and close a bodily wall
US9005238B2 (en) 2007-08-23 2015-04-14 Covidien Lp Endoscopic surgical devices
US20090062795A1 (en) * 2007-08-31 2009-03-05 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
US8568410B2 (en) 2007-08-31 2013-10-29 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
US8157816B2 (en) * 2007-08-31 2012-04-17 Kimberly-Clark Worldwide, Inc. Gastropexy kit
US7867253B2 (en) * 2007-08-31 2011-01-11 Kimberly-Clark Worldwide, Inc. Suture retention hub
US20090062742A1 (en) 2007-08-31 2009-03-05 John Anthony Rotella Blunted Safety Needle
US20090082766A1 (en) * 2007-09-20 2009-03-26 Tyco Healthcare Group Lp Tissue Sealer and End Effector Assembly and Method of Manufacturing Same
CA2698571C (en) 2007-09-21 2016-12-20 Power Medical Interventions, Llc Surgical device
US8241283B2 (en) 2007-09-28 2012-08-14 Tyco Healthcare Group Lp Dual durometer insulating boot for electrosurgical forceps
US8235992B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot with mechanical reinforcement for electrosurgical forceps
US9023043B2 (en) 2007-09-28 2015-05-05 Covidien Lp Insulating mechanically-interfaced boot and jaws for electrosurgical forceps
US8221416B2 (en) 2007-09-28 2012-07-17 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with thermoplastic clevis
US8251996B2 (en) 2007-09-28 2012-08-28 Tyco Healthcare Group Lp Insulating sheath for electrosurgical forceps
US8267936B2 (en) * 2007-09-28 2012-09-18 Tyco Healthcare Group Lp Insulating mechanically-interfaced adhesive for electrosurgical forceps
US8235993B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with exohinged structure
US8236025B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Silicone insulated electrosurgical forceps
US9192374B2 (en) * 2007-10-18 2015-11-24 Neochord, Inc. Minimally invasive repair of a valve leaflet in a beating heart
US20090112059A1 (en) 2007-10-31 2009-04-30 Nobis Rudolph H Apparatus and methods for closing a gastrotomy
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
US7922063B2 (en) 2007-10-31 2011-04-12 Tyco Healthcare Group, Lp Powered surgical instrument
US8821518B2 (en) * 2007-11-05 2014-09-02 Ceterix Orthopaedics, Inc. Suture passing instrument and method
US8906011B2 (en) 2007-11-16 2014-12-09 Kardium Inc. Medical device for use in bodily lumens, for example an atrium
US8262655B2 (en) 2007-11-21 2012-09-11 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8579897B2 (en) 2007-11-21 2013-11-12 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8876701B2 (en) * 2008-01-03 2014-11-04 Cook Medical Technologies Llc Medical systems, devices and methods for endoscopically suturing perforations
US8287469B2 (en) * 2008-01-09 2012-10-16 Ethicon Endo-Surgery, Inc. Articulating surgical device and method of use
US8790367B2 (en) * 2008-02-06 2014-07-29 Guided Delivery Systems Inc. Multi-window guide tunnel
US8764748B2 (en) 2008-02-06 2014-07-01 Covidien Lp End effector assembly for electrosurgical device and method for making the same
US8453908B2 (en) * 2008-02-13 2013-06-04 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US7766209B2 (en) * 2008-02-13 2010-08-03 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US8561870B2 (en) 2008-02-13 2013-10-22 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
US8657174B2 (en) 2008-02-14 2014-02-25 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument having handle based power source
US8636736B2 (en) 2008-02-14 2014-01-28 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument
US8584919B2 (en) 2008-02-14 2013-11-19 Ethicon Endo-Sugery, Inc. Surgical stapling apparatus with load-sensitive firing mechanism
US8459525B2 (en) 2008-02-14 2013-06-11 Ethicon Endo-Sugery, Inc. Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device
US7819298B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with control features operable with one hand
US8752749B2 (en) 2008-02-14 2014-06-17 Ethicon Endo-Surgery, Inc. Robotically-controlled disposable motor-driven loading unit
US7866527B2 (en) 2008-02-14 2011-01-11 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with interlockable firing system
US8622274B2 (en) 2008-02-14 2014-01-07 Ethicon Endo-Surgery, Inc. Motorized cutting and fastening instrument having control circuit for optimizing battery usage
US7793812B2 (en) 2008-02-14 2010-09-14 Ethicon Endo-Surgery, Inc. Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US9179912B2 (en) 2008-02-14 2015-11-10 Ethicon Endo-Surgery, Inc. Robotically-controlled motorized surgical cutting and fastening instrument
US8758391B2 (en) 2008-02-14 2014-06-24 Ethicon Endo-Surgery, Inc. Interchangeable tools for surgical instruments
US9770245B2 (en) 2008-02-15 2017-09-26 Ethicon Llc Layer arrangements for surgical staple cartridges
US8623276B2 (en) 2008-02-15 2014-01-07 Covidien Lp Method and system for sterilizing an electrosurgical instrument
JP2011512958A (en) * 2008-02-27 2011-04-28 ザ リージェンツ オブ ザ ユニバーシティ オブ カリフォルニアThe Regents of The University of California Feeding tube system
US8262680B2 (en) 2008-03-10 2012-09-11 Ethicon Endo-Surgery, Inc. Anastomotic device
US8182432B2 (en) 2008-03-10 2012-05-22 Acclarent, Inc. Corewire design and construction for medical devices
US8864776B2 (en) * 2008-04-11 2014-10-21 Covidien Lp Deployment system for surgical suture
US7997468B2 (en) 2008-05-05 2011-08-16 Tyco Healthcare Group Lp Surgical instrument with clamp
US20090287304A1 (en) 2008-05-13 2009-11-19 Kardium Inc. Medical Device for Constricting Tissue or a Bodily Orifice, for example a mitral valve
US20090287236A1 (en) * 2008-05-16 2009-11-19 Ethicon Endo-Surgery, Inc. Endoscopic rotary access needle
US8771260B2 (en) 2008-05-30 2014-07-08 Ethicon Endo-Surgery, Inc. Actuating and articulating surgical device
US8652150B2 (en) 2008-05-30 2014-02-18 Ethicon Endo-Surgery, Inc. Multifunction surgical device
US8114072B2 (en) 2008-05-30 2012-02-14 Ethicon Endo-Surgery, Inc. Electrical ablation device
US8679003B2 (en) 2008-05-30 2014-03-25 Ethicon Endo-Surgery, Inc. Surgical device and endoscope including same
US8317806B2 (en) 2008-05-30 2012-11-27 Ethicon Endo-Surgery, Inc. Endoscopic suturing tension controlling and indication devices
US8070759B2 (en) 2008-05-30 2011-12-06 Ethicon Endo-Surgery, Inc. Surgical fastening 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
US8628545B2 (en) * 2008-06-13 2014-01-14 Covidien Lp Endoscopic stitching devices
USD708746S1 (en) 2009-06-10 2014-07-08 Covidien Lp Handle for surgical device
US20110040308A1 (en) * 2008-06-13 2011-02-17 Ramiro Cabrera Endoscopic Stitching Devices
US8287556B2 (en) * 2008-06-17 2012-10-16 Apollo Endosurgery, Inc. Endoscopic suturing system
US20120271327A1 (en) * 2008-06-17 2012-10-25 Stephen West Endoscopic Tissue Grasping Systems and Methods
US8679136B2 (en) 2008-06-17 2014-03-25 Apollo Endosurgery, Inc. Needle capture device
US8579921B2 (en) * 2008-06-18 2013-11-12 Covidien Lp Spring-type suture securing device
US8361112B2 (en) 2008-06-27 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical suture arrangement
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
US7976555B2 (en) * 2008-07-17 2011-07-12 Endoevolution, Llc Apparatus and method for minimally invasive suturing
US8469956B2 (en) * 2008-07-21 2013-06-25 Covidien Lp Variable resistor jaw
CA2732769A1 (en) 2008-07-30 2010-02-04 Acclarent, Inc. Paranasal ostium finder devices and methods
US8162973B2 (en) 2008-08-15 2012-04-24 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US8257387B2 (en) 2008-08-15 2012-09-04 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US8211125B2 (en) 2008-08-15 2012-07-03 Ethicon Endo-Surgery, Inc. Sterile appliance delivery device for endoscopic procedures
US20100042143A1 (en) * 2008-08-15 2010-02-18 Cunningham James S Method of Transferring Pressure in an Articulating Surgical Instrument
US9603652B2 (en) 2008-08-21 2017-03-28 Covidien Lp Electrosurgical instrument including a sensor
US8529563B2 (en) 2008-08-25 2013-09-10 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8795274B2 (en) 2008-08-28 2014-08-05 Covidien Lp Tissue fusion jaw angle improvement
US8784417B2 (en) 2008-08-28 2014-07-22 Covidien Lp Tissue fusion jaw angle improvement
US8317787B2 (en) 2008-08-28 2012-11-27 Covidien Lp Tissue fusion jaw angle improvement
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
US8303582B2 (en) * 2008-09-15 2012-11-06 Tyco Healthcare Group Lp Electrosurgical instrument having a coated electrode utilizing an atomic layer deposition technique
US20100069903A1 (en) * 2008-09-18 2010-03-18 Tyco Healthcare Group Lp Vessel Sealing Instrument With Cutting Mechanism
US7905381B2 (en) 2008-09-19 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with cutting member arrangement
US8540133B2 (en) * 2008-09-19 2013-09-24 Ethicon Endo-Surgery, Inc. Staple cartridge
US9386983B2 (en) 2008-09-23 2016-07-12 Ethicon Endo-Surgery, Llc Robotically-controlled motorized surgical instrument
US9005230B2 (en) 2008-09-23 2015-04-14 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US8210411B2 (en) 2008-09-23 2012-07-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument
US9050083B2 (en) 2008-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US8535312B2 (en) 2008-09-25 2013-09-17 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US9375254B2 (en) 2008-09-25 2016-06-28 Covidien Lp Seal and separate algorithm
US8968314B2 (en) 2008-09-25 2015-03-03 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
EP2341841A4 (en) * 2008-09-29 2015-01-28 Bard Inc C R Endoscopic suturing device
US8337394B2 (en) 2008-10-01 2012-12-25 Ethicon Endo-Surgery, Inc. Overtube with expandable tip
US8142473B2 (en) 2008-10-03 2012-03-27 Tyco Healthcare Group Lp Method of transferring rotational motion in an articulating surgical instrument
US8469957B2 (en) 2008-10-07 2013-06-25 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US8636761B2 (en) 2008-10-09 2014-01-28 Covidien Lp Apparatus, system, and method for performing an endoscopic electrosurgical procedure
US8016827B2 (en) 2008-10-09 2011-09-13 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
EP2349019A4 (en) 2008-10-10 2016-06-15 Guided Delivery Systems Inc Termination devices and related methods
US8795298B2 (en) 2008-10-10 2014-08-05 Guided Delivery Systems Inc. Tether tensioning devices and related methods
US8608045B2 (en) 2008-10-10 2013-12-17 Ethicon Endo-Sugery, Inc. Powered surgical cutting and stapling apparatus with manually retractable firing system
US8486107B2 (en) 2008-10-20 2013-07-16 Covidien Lp Method of sealing tissue using radiofrequency energy
EP2348950B1 (en) * 2008-10-29 2015-03-18 Cook Medical Technologies LLC Endoscope endcap for suturing tissue
US8157834B2 (en) 2008-11-25 2012-04-17 Ethicon Endo-Surgery, Inc. Rotational coupling device for surgical instrument with flexible actuators
US8197479B2 (en) 2008-12-10 2012-06-12 Tyco Healthcare Group Lp Vessel sealer and divider
US8172772B2 (en) 2008-12-11 2012-05-08 Ethicon Endo-Surgery, Inc. Specimen retrieval device
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
US8114122B2 (en) 2009-01-13 2012-02-14 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US20100198192A1 (en) 2009-01-20 2010-08-05 Eugene Serina Anchor deployment devices and related methods
WO2010085457A1 (en) * 2009-01-20 2010-07-29 Guided Delivery Systems Inc. Diagnostic catheters, guide catheters, visualization devices and chord manipulation devices, and related kits and methods
CN102292033A (en) * 2009-01-26 2011-12-21 斯恩蒂斯有限公司 Bidirectional suture passing device
US9226772B2 (en) 2009-01-30 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical device
US8252057B2 (en) 2009-01-30 2012-08-28 Ethicon Endo-Surgery, Inc. Surgical access device
US8037591B2 (en) 2009-02-02 2011-10-18 Ethicon Endo-Surgery, Inc. Surgical scissors
US8414577B2 (en) 2009-02-05 2013-04-09 Ethicon Endo-Surgery, Inc. Surgical instruments and components for use in sterile environments
US8397971B2 (en) 2009-02-05 2013-03-19 Ethicon Endo-Surgery, Inc. Sterilizable surgical instrument
US8444036B2 (en) 2009-02-06 2013-05-21 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
US20110006101A1 (en) 2009-02-06 2011-01-13 EthiconEndo-Surgery, Inc. Motor driven surgical fastener device with cutting member lockout arrangements
US8147505B2 (en) * 2009-03-23 2012-04-03 Arthrocare Corporation Surgical instrument for manipulating surgical suture and methods of use
US8435290B2 (en) 2009-03-31 2013-05-07 Acclarent, Inc. System and method for treatment of non-ventilating middle ear by providing a gas pathway through the nasopharynx
EP2413810B1 (en) 2009-04-03 2014-07-02 Cook Medical Technologies LLC Tissue anchors and medical devices for rapid deployment of tissue anchors
EP2429374B1 (en) * 2009-05-01 2013-09-25 Cook Medical Technologies LLC Medical device for suturing perforations
US8187273B2 (en) 2009-05-07 2012-05-29 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
CA2766379A1 (en) * 2009-06-24 2010-12-29 Creighton University Systems and techniques for performing gastrointestinal procedures
US8246618B2 (en) 2009-07-08 2012-08-21 Tyco Healthcare Group Lp Electrosurgical jaws with offset knife
DE102009037317A1 (en) * 2009-08-14 2011-02-17 Karl Storz Gmbh & Co. Kg Apparatus and method for centering of the inner and outer tube of an endoscope
US8133254B2 (en) 2009-09-18 2012-03-13 Tyco Healthcare Group Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US8112871B2 (en) 2009-09-28 2012-02-14 Tyco Healthcare Group Lp Method for manufacturing electrosurgical seal plates
JP5784613B2 (en) * 2009-10-01 2015-09-24 スミス アンド ネフュー インコーポレーテッド Surgical handpiece for endoscopic resection
WO2011041571A3 (en) 2009-10-01 2011-08-04 Kardium Inc. Medical device, kit and method for constricting tissue or a bodily orifice, for example, a mitral valve
US8490713B2 (en) * 2009-10-06 2013-07-23 Covidien Lp Handle assembly for endoscopic suturing device
US8141762B2 (en) * 2009-10-09 2012-03-27 Ethicon Endo-Surgery, Inc. Surgical stapler comprising a staple pocket
US8608652B2 (en) 2009-11-05 2013-12-17 Ethicon Endo-Surgery, Inc. Vaginal entry surgical devices, kit, system, and method
EP2498688B1 (en) 2009-11-09 2016-03-23 Ceterix Orthopedics, Inc. Devices, systems and methods for meniscus repair
US9011454B2 (en) 2009-11-09 2015-04-21 Ceterix Orthopaedics, Inc. Suture passer with radiused upper jaw
US9211118B2 (en) * 2009-11-16 2015-12-15 Arthrocare Corporation Suture passer
US8353438B2 (en) * 2009-11-19 2013-01-15 Ethicon Endo-Surgery, Inc. Circular stapler introducer with rigid cap assembly configured for easy removal
US8899466B2 (en) 2009-11-19 2014-12-02 Ethicon Endo-Surgery, Inc. Devices and methods for introducing a surgical circular stapling instrument into a patient
US8622275B2 (en) * 2009-11-19 2014-01-07 Ethicon Endo-Surgery, Inc. Circular stapler introducer with rigid distal end portion
US8353439B2 (en) 2009-11-19 2013-01-15 Ethicon Endo-Surgery, Inc. Circular stapler introducer with radially-openable distal end portion
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
US8851354B2 (en) 2009-12-24 2014-10-07 Ethicon Endo-Surgery, Inc. Surgical cutting instrument that analyzes tissue thickness
US8267300B2 (en) * 2009-12-30 2012-09-18 Ethicon Endo-Surgery, Inc. Dampening device for endoscopic surgical stapler
US20110160514A1 (en) * 2009-12-31 2011-06-30 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US9005198B2 (en) 2010-01-29 2015-04-14 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US8219171B2 (en) * 2010-03-16 2012-07-10 Given Imaging Ltd. Delivery device for implantable monitor
US7978742B1 (en) 2010-03-24 2011-07-12 Corning Incorporated Methods for operating diode lasers
WO2011140486A1 (en) * 2010-05-06 2011-11-10 Synthes Usa, Llc Soft tissue defect device and associated method
US8926640B2 (en) 2010-07-13 2015-01-06 Lsi Solutions, Inc. Method and apparatus for closing an opening in thick, moving tissue
FR2962896B1 (en) * 2010-07-26 2012-08-03 Gerald Blouin cleaning system Accessory for vision and set of corresponding cleaning
US8789740B2 (en) 2010-07-30 2014-07-29 Ethicon Endo-Surgery, Inc. Linear cutting and stapling device with selectively disengageable cutting member
US8783543B2 (en) 2010-07-30 2014-07-22 Ethicon Endo-Surgery, Inc. Tissue acquisition arrangements and methods for surgical stapling devices
WO2012031204A3 (en) 2010-09-03 2012-04-26 Guided Delivery Systems Inc. Devices and methods for anchoring tissue
US8360296B2 (en) 2010-09-09 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical stapling head assembly with firing lockout for a surgical stapler
US9877720B2 (en) 2010-09-24 2018-01-30 Ethicon Llc Control features for articulating surgical device
US9155492B2 (en) 2010-09-24 2015-10-13 Acclarent, Inc. Sinus illumination lightwire device
US9700317B2 (en) 2010-09-30 2017-07-11 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a releasable tissue thickness compensator
US8783542B2 (en) 2010-09-30 2014-07-22 Ethicon Endo-Surgery, Inc. Fasteners supported by a fastener cartridge support
US9629814B2 (en) 2010-09-30 2017-04-25 Ethicon Endo-Surgery, Llc Tissue thickness compensator configured to redistribute compressive forces
US8893949B2 (en) 2010-09-30 2014-11-25 Ethicon Endo-Surgery, Inc. Surgical stapler with floating anvil
US9220501B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensators
US9314246B2 (en) 2010-09-30 2016-04-19 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent
JP6224070B2 (en) 2012-03-28 2017-11-01 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. Retainer assembly including a tissue thickness compensator
US9364233B2 (en) 2010-09-30 2016-06-14 Ethicon Endo-Surgery, Llc Tissue thickness compensators for circular surgical staplers
RU2013119928A (en) 2010-09-30 2014-11-10 Этикон Эндо-Серджери, Инк. Crosslinking system comprising a retaining matrix and an alignment matrix
US9433419B2 (en) 2010-09-30 2016-09-06 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a plurality of layers
US9232941B2 (en) 2010-09-30 2016-01-12 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a reservoir
US9386988B2 (en) 2010-09-30 2016-07-12 Ethicon End-Surgery, LLC Retainer assembly including a tissue thickness compensator
US9615826B2 (en) 2010-09-30 2017-04-11 Ethicon Endo-Surgery, Llc Multiple thickness implantable layers for surgical stapling devices
US8940002B2 (en) 2010-09-30 2015-01-27 Kardium Inc. Tissue anchor system
US9016542B2 (en) 2010-09-30 2015-04-28 Ethicon Endo-Surgery, Inc. Staple cartridge comprising compressible distortion resistant components
US9414838B2 (en) 2012-03-28 2016-08-16 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprised of a plurality of materials
US9332974B2 (en) 2010-09-30 2016-05-10 Ethicon Endo-Surgery, Llc Layered tissue thickness compensator
RU2606493C2 (en) 2011-04-29 2017-01-10 Этикон Эндо-Серджери, Инк. Staple cartridge, containing staples, located inside its compressible part
US9386984B2 (en) 2013-02-08 2016-07-12 Ethicon Endo-Surgery, Llc Staple cartridge comprising a releasable cover
US9301753B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Expandable tissue thickness compensator
US9211120B2 (en) 2011-04-29 2015-12-15 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a plurality of medicaments
US20120080498A1 (en) 2010-09-30 2012-04-05 Ethicon Endo-Surgery, Inc. Curved end effector for a stapling instrument
US9775600B2 (en) 2010-10-01 2017-10-03 Endoevolution, Llc Devices and methods for minimally invasive suturing
US7993354B1 (en) 2010-10-01 2011-08-09 Endoevolution, Llc Devices and methods for minimally invasive suturing
WO2012141757A1 (en) 2010-12-29 2012-10-18 Neochord, Inc. Exchangeable system for minimally invasive beating heart repair of heart valve leaflets
US9913638B2 (en) 2011-01-10 2018-03-13 Ceterix Orthopaedics, Inc. Transosteal anchoring methods for tissue repair
US9848868B2 (en) 2011-01-10 2017-12-26 Ceterix Orthopaedics, Inc. Suture methods for forming locking loops stitches
US8500809B2 (en) 2011-01-10 2013-08-06 Ceterix Orthopaedics, Inc. Implant and method for repair of the anterior cruciate ligament
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
USD777926S1 (en) 2012-01-20 2017-01-31 Kardium Inc. Intra-cardiac procedure device
CA2764494A1 (en) 2011-01-21 2012-07-21 Kardium Inc. Enhanced medical device for use in bodily cavities, for example an atrium
US9452016B2 (en) 2011-01-21 2016-09-27 Kardium Inc. Catheter system
USD777925S1 (en) 2012-01-20 2017-01-31 Kardium Inc. Intra-cardiac procedure device
US9480525B2 (en) 2011-01-21 2016-11-01 Kardium, Inc. High-density electrode-based medical device system
US9095502B2 (en) * 2011-02-09 2015-08-04 Applied Medical Technology, Inc. Low profile G-J feeding tube
US8968340B2 (en) 2011-02-23 2015-03-03 Covidien Lp Single actuating jaw flexible endolumenal stitching device
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
US9254169B2 (en) 2011-02-28 2016-02-09 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
WO2012125785A1 (en) 2011-03-17 2012-09-20 Ethicon Endo-Surgery, Inc. Hand held surgical device for manipulating an internal magnet assembly within a patient
US9072511B2 (en) 2011-03-25 2015-07-07 Kardium Inc. Medical kit for constricting tissue or a bodily orifice, for example, a mitral valve
US20120265175A1 (en) * 2011-04-14 2012-10-18 Medtronic Xomed, Inc. Malleable instrument for laparoscopic procedures
US9198662B2 (en) 2012-03-28 2015-12-01 Ethicon Endo-Surgery, Inc. Tissue thickness compensator having improved visibility
US8795295B2 (en) 2011-05-04 2014-08-05 Lsi Solutions, Inc. Multiple loop device for passing suture tails through a surgical pledget
US9943303B2 (en) 2011-05-04 2018-04-17 Lsi Solutions, Inc. Method of passing suture tails through a surgical pledget
US8465505B2 (en) 2011-05-06 2013-06-18 Ceterix Orthopaedics, Inc. Suture passer devices and methods
WO2012154578A1 (en) * 2011-05-06 2012-11-15 The Trustees Of The University Of Pennsylvania Ped - endoscope image and diagnosis capture system
US9861354B2 (en) 2011-05-06 2018-01-09 Ceterix Orthopaedics, Inc. Meniscus repair
US9072535B2 (en) 2011-05-27 2015-07-07 Ethicon Endo-Surgery, Inc. Surgical stapling instruments with rotatable staple deployment arrangements
US8951263B2 (en) 2011-07-08 2015-02-10 Smith & Nephew, Inc. Orthopedic suture passer and method
US8801727B2 (en) 2011-07-08 2014-08-12 Smith & Nephew, Inc. Orthopedic suture passer and method
US8888849B2 (en) 2011-07-08 2014-11-18 Smith & Nephew, Inc. Soft tissue repair
US9107663B2 (en) 2011-09-06 2015-08-18 Ethicon Endo-Surgery, Inc. Stapling instrument comprising resettable staple drivers
US9050084B2 (en) 2011-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Staple cartridge including collapsible deck arrangement
US9060780B2 (en) 2011-09-29 2015-06-23 Covidien Lp Methods of manufacturing shafts for surgical instruments
US9173657B2 (en) 2011-12-15 2015-11-03 Ethicon Endo-Surgery, Inc. Devices and methods for endoluminal plication
US9113866B2 (en) 2011-12-15 2015-08-25 Ethicon Endo-Surgery, Inc. Devices and methods for endoluminal plication
US9888913B2 (en) 2012-05-31 2018-02-13 Via Surgical Ltd. Variable depth surgical fixation
US8535339B2 (en) * 2011-12-18 2013-09-17 Via Surgical Ltd. Apparatus and method for suturing
USD680220S1 (en) 2012-01-12 2013-04-16 Coviden IP Slider handle for laparoscopic device
US9044230B2 (en) 2012-02-13 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
US8986199B2 (en) 2012-02-17 2015-03-24 Ethicon Endo-Surgery, Inc. Apparatus and methods for cleaning the lens of an endoscope
US8992547B2 (en) 2012-03-21 2015-03-31 Ethicon Endo-Surgery, Inc. Methods and devices for creating tissue plications
RU2014143245A (en) 2012-03-28 2016-05-27 Этикон Эндо-Серджери, Инк. Compensator tissue thickness, comprising a capsule for a medium with a low pressure
US9307989B2 (en) 2012-03-28 2016-04-12 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorportating a hydrophobic agent
US9265514B2 (en) 2012-04-17 2016-02-23 Miteas Ltd. Manipulator for grasping tissue
US9364228B2 (en) * 2012-05-11 2016-06-14 Ethicon, Llc Applicator instruments having distal end caps for facilitating the accurate placement of surgical fasteners during open repair procedures
US9427255B2 (en) 2012-05-14 2016-08-30 Ethicon Endo-Surgery, Inc. Apparatus for introducing a steerable camera assembly into a patient
US9101358B2 (en) 2012-06-15 2015-08-11 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising a firing drive
US9408606B2 (en) 2012-06-28 2016-08-09 Ethicon Endo-Surgery, Llc Robotically powered surgical device with manually-actuatable reversing system
US9282974B2 (en) 2012-06-28 2016-03-15 Ethicon Endo-Surgery, Llc Empty clip cartridge lockout
US9289256B2 (en) 2012-06-28 2016-03-22 Ethicon Endo-Surgery, Llc Surgical end effectors having angled tissue-contacting surfaces
US9125662B2 (en) 2012-06-28 2015-09-08 Ethicon Endo-Surgery, Inc. Multi-axis articulating and rotating surgical tools
US9119657B2 (en) 2012-06-28 2015-09-01 Ethicon Endo-Surgery, Inc. Rotary actuatable closure arrangement for surgical end effector
US9364230B2 (en) 2012-06-28 2016-06-14 Ethicon Endo-Surgery, Llc Surgical stapling instruments with rotary joint assemblies
US9028494B2 (en) 2012-06-28 2015-05-12 Ethicon Endo-Surgery, Inc. Interchangeable end effector coupling arrangement
US9204879B2 (en) 2012-06-28 2015-12-08 Ethicon Endo-Surgery, Inc. Flexible drive member
US9072536B2 (en) 2012-06-28 2015-07-07 Ethicon Endo-Surgery, Inc. Differential locking arrangements for rotary powered surgical instruments
US9101385B2 (en) 2012-06-28 2015-08-11 Ethicon Endo-Surgery, Inc. Electrode connections for rotary driven surgical tools
US9226751B2 (en) 2012-06-28 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical instrument system including replaceable end effectors
US9561038B2 (en) 2012-06-28 2017-02-07 Ethicon Endo-Surgery, Llc Interchangeable clip applier
US8747238B2 (en) 2012-06-28 2014-06-10 Ethicon Endo-Surgery, Inc. Rotary drive shaft assemblies for surgical instruments with articulatable end effectors
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
US9572623B2 (en) 2012-08-02 2017-02-21 Ethicon Endo-Surgery, Inc. Reusable electrode and disposable sheath
US9277957B2 (en) 2012-08-15 2016-03-08 Ethicon Endo-Surgery, Inc. Electrosurgical devices and methods
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
US20140094822A1 (en) * 2012-09-21 2014-04-03 Atlas Spine, Inc. Minimally invasive spine surgery instruments: guide wire handle with a guide wire locking mechanism
US9307986B2 (en) 2013-03-01 2016-04-12 Ethicon Endo-Surgery, Llc Surgical instrument soft stop
EP2967562B1 (en) 2013-03-11 2018-05-16 Via Surgical Ltd. Surgical tacker with quantity indicator
US20140263552A1 (en) 2013-03-13 2014-09-18 Ethicon Endo-Surgery, Inc. Staple cartridge tissue thickness sensor system
US9687230B2 (en) 2013-03-14 2017-06-27 Ethicon Llc Articulatable surgical instrument comprising a firing drive
US9629629B2 (en) 2013-03-14 2017-04-25 Ethicon Endo-Surgey, LLC Control systems for surgical instruments
US20140263541A1 (en) 2013-03-14 2014-09-18 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising an articulation lock
US9433437B2 (en) 2013-03-15 2016-09-06 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US9629684B2 (en) 2013-03-15 2017-04-25 Acclarent, Inc. Apparatus and method for treatment of ethmoid sinusitis
US9492162B2 (en) 2013-12-16 2016-11-15 Ceterix Orthopaedics, Inc. Automatically reloading suture passer devices and methods
US9332984B2 (en) 2013-03-27 2016-05-10 Ethicon Endo-Surgery, Llc Fastener cartridge assemblies
US9795384B2 (en) 2013-03-27 2017-10-24 Ethicon Llc Fastener cartridge comprising a tissue thickness compensator and a gap setting element
US9572577B2 (en) 2013-03-27 2017-02-21 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a tissue thickness compensator including openings therein
US9801626B2 (en) 2013-04-16 2017-10-31 Ethicon Llc Modular motor driven surgical instruments with alignment features for aligning rotary drive shafts with surgical end effector shafts
US9844368B2 (en) 2013-04-16 2017-12-19 Ethicon Llc Surgical system comprising first and second drive systems
US9826976B2 (en) 2013-04-16 2017-11-28 Ethicon Llc Motor driven surgical instruments with lockable dual drive shafts
US9357984B2 (en) 2013-04-23 2016-06-07 Covidien Lp Constant value gap stabilizer for articulating links
US9574644B2 (en) 2013-05-30 2017-02-21 Ethicon Endo-Surgery, Llc Power module for use with a surgical instrument
US20160206178A1 (en) * 2013-08-20 2016-07-21 Scott & White Healthcare Surgical apparatuses for coupling elongated members to endoscopes, and related methods
US20150053737A1 (en) 2013-08-23 2015-02-26 Ethicon Endo-Surgery, Inc. End effector detection systems for surgical instruments
US9247935B2 (en) 2013-09-23 2016-02-02 Ceterix Orthopaedics, Inc. Arthroscopic knot pusher and suture cutter
US9918713B2 (en) 2013-12-09 2018-03-20 Covidien Lp Adapter assembly for interconnecting electromechanical surgical devices and surgical loading units, and surgical systems thereof
US9839424B2 (en) 2014-01-17 2017-12-12 Covidien Lp Electromechanical surgical assembly
US9554781B2 (en) 2014-01-23 2017-01-31 Lsi Solutions, Inc. Minimally invasive surgical suturing device and method
US9962161B2 (en) 2014-02-12 2018-05-08 Ethicon Llc Deliverable surgical instrument
US9693777B2 (en) 2014-02-24 2017-07-04 Ethicon Llc Implantable layers comprising a pressed region
US9913642B2 (en) 2014-03-26 2018-03-13 Ethicon Llc Surgical instrument comprising a sensor system
US9750499B2 (en) 2014-03-26 2017-09-05 Ethicon Llc Surgical stapling instrument system
US10004497B2 (en) 2014-03-26 2018-06-26 Ethicon Llc Interface systems for use with surgical instruments
US10013049B2 (en) 2014-03-26 2018-07-03 Ethicon Llc Power management through sleep options of segmented circuit and wake up control
JP2017513567A (en) 2014-03-26 2017-06-01 エシコン・エンド−サージェリィ・エルエルシーEthicon Endo−Surgery, LLC Power management with segmentation circuit and variable voltage protection
US20150297232A1 (en) 2014-04-16 2015-10-22 Ethicon Endo-Surgery, Inc. Fastener cartridge comprising non-uniform fasteners
US9468434B2 (en) 2014-06-03 2016-10-18 Covidien Lp Stitching end effector
US10045781B2 (en) 2014-06-13 2018-08-14 Ethicon Llc Closure lockout systems for surgical instruments
US9636103B2 (en) 2014-08-28 2017-05-02 Covidien Lp Surgical suturing instrument
WO2016035386A1 (en) * 2014-09-04 2016-03-10 オリンパス株式会社 Front end structure for endoscope
US10016199B2 (en) 2014-09-05 2018-07-10 Ethicon Llc Polarity of hall magnet to identify cartridge type
US9801627B2 (en) 2014-09-26 2017-10-31 Ethicon Llc Fastener cartridge for creating a flexible staple line
US9801628B2 (en) 2014-09-26 2017-10-31 Ethicon Llc Surgical staple and driver arrangements for staple cartridges
US9833233B2 (en) 2014-09-30 2017-12-05 Covidien Lp Methods and devices for tissue suturing
US9924944B2 (en) 2014-10-16 2018-03-27 Ethicon Llc Staple cartridge comprising an adjunct material
US9844376B2 (en) 2014-11-06 2017-12-19 Ethicon Llc Staple cartridge comprising a releasable adjunct material
US20160174972A1 (en) 2014-12-18 2016-06-23 Ethicon Endo-Surgery, Inc. Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge
US9844375B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Drive arrangements for articulatable surgical instruments
US9844374B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member
US9987000B2 (en) 2014-12-18 2018-06-05 Ethicon Llc Surgical instrument assembly comprising a flexible articulation system
US20160249916A1 (en) 2015-02-27 2016-09-01 Ethicon Endo-Surgery, Llc System for monitoring whether a surgical instrument needs to be serviced
US9993258B2 (en) 2015-02-27 2018-06-12 Ethicon Llc Adaptable surgical instrument handle
CA2978599A1 (en) 2015-03-05 2016-09-09 Ancora Heart, Inc. Devices and methods of visualizing and determining depth of penetration in cardiac tissue
US10045776B2 (en) 2015-03-06 2018-08-14 Ethicon Llc Control techniques and sub-processor contained within modular shaft with select control processing from handle
US9895148B2 (en) 2015-03-06 2018-02-20 Ethicon Endo-Surgery, Llc Monitoring speed control and precision incrementing of motor for powered surgical instruments
US9808246B2 (en) 2015-03-06 2017-11-07 Ethicon Endo-Surgery, Llc Method of operating a powered surgical instrument
US9993248B2 (en) 2015-03-06 2018-06-12 Ethicon Endo-Surgery, Llc Smart sensors with local signal processing
US9901342B2 (en) 2015-03-06 2018-02-27 Ethicon Endo-Surgery, Llc Signal and power communication system positioned on a rotatable shaft
US20160256071A1 (en) 2015-03-06 2016-09-08 Ethicon Endo-Surgery, Llc Overlaid multi sensor radio frequency (rf) electrode system to measure tissue compression
US9924961B2 (en) 2015-03-06 2018-03-27 Ethicon Endo-Surgery, Llc Interactive feedback system for powered surgical instruments
US20160310042A1 (en) * 2015-04-22 2016-10-27 Acclarent, Inc. System and method to map structures of nasal cavity
US20160367246A1 (en) 2015-06-18 2016-12-22 Ethicon Endo-Surgery, Llc Dual articulation drive system arrangements for articulatable surgical instruments
WO2017031493A1 (en) * 2015-08-20 2017-02-23 Lsi Solutions, Inc. Adjustable motion limiter for a minimally invasive surgical device
CN105361850B (en) * 2015-11-24 2017-11-24 深圳市技领科技有限公司 gastroscopy
CN105361849B (en) * 2015-11-24 2018-08-21 嵊州亿源投资管理有限公司 Having a control terminal endoscopy

Citations (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3773034A (en) * 1971-11-24 1973-11-20 Itt Research Institute Steerable catheter
US4403985A (en) * 1981-05-12 1983-09-13 The United States Of America As Represented By The Department Of Health And Human Services Jet controlled catheter
US4841888A (en) * 1984-09-11 1989-06-27 Mills Timothy N Sewing machine
US4890602A (en) * 1987-11-25 1990-01-02 Hake Lawrence W Endoscope construction with means for controlling rigidity and curvature of flexible endoscope tube
US5080663A (en) * 1990-09-26 1992-01-14 Univerity College London Sewing device
US5368601A (en) * 1992-04-30 1994-11-29 Lasersurge, Inc. Trocar wound closure device
US5431666A (en) * 1994-02-24 1995-07-11 Lasersurge, Inc. Surgical suture instrument
US5520702A (en) * 1994-02-24 1996-05-28 United States Surgical Corporation Method and apparatus for applying a cinch member to the ends of a suture
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
US5584861A (en) * 1992-09-04 1996-12-17 University College London Device for use in securing a thread
US5643289A (en) * 1994-02-24 1997-07-01 Lasersurge, Inc. Surgical crimping device and method of use
US5755730A (en) * 1994-03-23 1998-05-26 University College London Device for use in cutting threads
US5766183A (en) * 1996-10-21 1998-06-16 Lasersurge, Inc. Vascular hole closure
US5792153A (en) * 1994-03-23 1998-08-11 University College London Sewing device
US6562052B2 (en) * 1995-08-24 2003-05-13 Sutura, Inc. Suturing device and method

Family Cites Families (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3884222A (en) * 1974-03-11 1975-05-20 George Paul Moore Laryngoscope
US4960410A (en) * 1989-03-31 1990-10-02 Cordis Corporation Flexible tubular member for catheter construction
DE69023858T2 (en) * 1989-09-21 1996-08-22 Sgs Thomson Microelectronics An integrated circuit device having improved connections between the pins and the semiconductor material chip.
US5503616A (en) * 1991-06-10 1996-04-02 Endomedical Technologies, Inc. Collapsible access channel system
US5269763A (en) * 1991-07-18 1993-12-14 Vernay Laboratories, Inc. Self-sealing cannula cap
US5391173A (en) 1994-02-10 1995-02-21 Wilk; Peter J. Laparoscopic suturing technique and associated device
US5722990A (en) * 1995-11-08 1998-03-03 Sugar Surgical Technologies, Inc. Tissue grasping device
US5810805A (en) * 1996-02-09 1998-09-22 Conmed Corporation Bipolar surgical devices and surgical methods
US5817013A (en) * 1996-03-19 1998-10-06 Enable Medical Corporation Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like
US5910105A (en) * 1997-04-14 1999-06-08 C.R. Bard, Inc. Control handle for an endoscope
US5908429A (en) * 1997-05-01 1999-06-01 Yoon; Inbae Methods of anatomical tissue ligation
US5954731A (en) * 1997-07-29 1999-09-21 Yoon; Inbae Surgical instrument with multiple rotatably mounted spreadable end effectors
JP4121615B2 (en) * 1997-10-31 2008-07-23 オリンパス株式会社 Endoscope
US5947983A (en) * 1998-03-16 1999-09-07 Boston Scientific Corporation Tissue cutting and stitching device and method
US6042563A (en) * 1998-03-27 2000-03-28 Cardiothoracic Systems, Inc. Methods and apparatus for occluding a blood vessel
CA2289805C (en) * 1999-11-16 2006-10-17 Denis Courtemanche Snowmobile track with heat transfer clips

Patent Citations (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3773034A (en) * 1971-11-24 1973-11-20 Itt Research Institute Steerable catheter
US4403985A (en) * 1981-05-12 1983-09-13 The United States Of America As Represented By The Department Of Health And Human Services Jet controlled catheter
US5037021A (en) * 1984-07-11 1991-08-06 University College London Sewing machine
US4841888A (en) * 1984-09-11 1989-06-27 Mills Timothy N Sewing machine
US4890602A (en) * 1987-11-25 1990-01-02 Hake Lawrence W Endoscope construction with means for controlling rigidity and curvature of flexible endoscope tube
US5080663A (en) * 1990-09-26 1992-01-14 Univerity College London Sewing device
US5626588A (en) * 1992-04-30 1997-05-06 Lasersurge, Inc. Trocar wound closure device
US5368601A (en) * 1992-04-30 1994-11-29 Lasersurge, Inc. Trocar wound closure device
US5507757A (en) * 1992-04-30 1996-04-16 Lasersurge, Inc. Method of closing puncture wounds
US5584861A (en) * 1992-09-04 1996-12-17 University College London Device for use in securing a thread
US5431666A (en) * 1994-02-24 1995-07-11 Lasersurge, Inc. Surgical suture instrument
US5669917A (en) * 1994-02-24 1997-09-23 Lasersurge, Inc. Surgical crimping device and method of use
US5643289A (en) * 1994-02-24 1997-07-01 Lasersurge, Inc. Surgical crimping device and method of use
US5520702A (en) * 1994-02-24 1996-05-28 United States Surgical Corporation Method and apparatus for applying a cinch member to the ends of a suture
US5755730A (en) * 1994-03-23 1998-05-26 University College London Device for use in cutting threads
US5792153A (en) * 1994-03-23 1998-08-11 University College London Sewing device
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
US6562052B2 (en) * 1995-08-24 2003-05-13 Sutura, Inc. Suturing device and method
US5766183A (en) * 1996-10-21 1998-06-16 Lasersurge, Inc. Vascular hole closure

Cited By (26)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9839546B2 (en) 2002-11-01 2017-12-12 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US9561127B2 (en) 2002-11-01 2017-02-07 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US8920440B2 (en) 2009-08-21 2014-12-30 Coloplast A/S Suture assembly and system
US20110046642A1 (en) * 2009-08-21 2011-02-24 Coloplast A/S Suture assembly and system
US20110046645A1 (en) * 2009-08-21 2011-02-24 Colophast A/S Suture assembly and system
US20160287247A1 (en) * 2009-10-01 2016-10-06 Covidien Lp Wound closure device including direct-driven needle
US9980721B2 (en) * 2009-10-01 2018-05-29 Covidien Lp Wound closure device including direct-driven needle
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
US9357997B2 (en) 2011-07-08 2016-06-07 Smith & Nephew, Inc. Suture passer and method
US9662105B2 (en) 2011-07-08 2017-05-30 Smith & Nephew, Inc. Suture passer and method
US8882834B2 (en) 2011-07-08 2014-11-11 Smith & Nephew, Inc. Soft tissue repair
US8992550B2 (en) * 2011-07-20 2015-03-31 Coloplast A/S Suture system with capsule eyelet providing multiple suture tissue fixation
US8623033B2 (en) * 2011-07-20 2014-01-07 Coloplast A/S Suture system with capsule eyelet providing multiple suture tissue fixation
US20130023905A1 (en) * 2011-07-20 2013-01-24 Coloplast A/S Suture system with capsule eyelet providing multiple suture tissue fixation
US20130023906A1 (en) * 2011-07-20 2013-01-24 Coloplast A/S Suture system with capsule eyelet providing multiple suture tissue fixation
US9050168B2 (en) 2012-05-31 2015-06-09 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9039649B2 (en) 2012-05-31 2015-05-26 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9173759B2 (en) * 2012-05-31 2015-11-03 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9566181B2 (en) 2012-05-31 2017-02-14 Valentx, Inc. Devices and methods for gastrointestinal bypass
US8956318B2 (en) 2012-05-31 2015-02-17 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9675489B2 (en) 2012-05-31 2017-06-13 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9681975B2 (en) 2012-05-31 2017-06-20 Valentx, Inc. Devices and methods for gastrointestinal bypass
US20130324905A1 (en) * 2012-05-31 2013-12-05 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9451960B2 (en) 2012-05-31 2016-09-27 Valentx, Inc. Devices and methods for gastrointestinal bypass
US9757264B2 (en) 2013-03-13 2017-09-12 Valentx, Inc. Devices and methods for gastrointestinal bypass

Also Published As

Publication number Publication date Type
EP1408809A2 (en) 2004-04-21 application
US20020107530A1 (en) 2002-08-08 application
WO2002062200B1 (en) 2004-04-15 application
WO2002062200A2 (en) 2002-08-15 application
US6997931B2 (en) 2006-02-14 grant
EP1408809A4 (en) 2008-12-17 application
US20050165419A1 (en) 2005-07-28 application
WO2002062200A3 (en) 2004-02-19 application

Similar Documents

Publication Publication Date Title
US7771396B2 (en) Intubation device for enteral feeding
US7413543B2 (en) Endoscope with actively cooled illumination sources
US7559893B2 (en) Wound retractor device
US5431323A (en) Endoscopic surgical instrument with pivotable and rotatable staple cartridge
US7175648B2 (en) Deep endoscopic staple and stapler
US20110105850A1 (en) Vaginal entry surgical devices, kit, system, and method
US20090112062A1 (en) Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US20070073322A1 (en) Suturing method for penetrating hole
US20100280530A1 (en) Medical systems, devices and methods for suturing perforations
US20030220657A1 (en) Endoluminal fundoplication device and related method
US7273451B2 (en) Endoscopic treatment system and anastomotic method using this system
US6602262B2 (en) Medical device having linear to rotation control
US20040092960A1 (en) Resection and anastomosis devices and methods
US8500756B2 (en) Quick load mechanism for a surgical suturing apparatus
US20050145674A1 (en) Stapler for endoscopes
US7144401B2 (en) Suturing device for endoscope
US20070203474A1 (en) Deflectable tip access sheath
US7628796B2 (en) Surgical suturing apparatus with anti-backup system
US8641728B2 (en) Attachment apparatus for coupling with an endoscope
US20030176767A1 (en) Method for controlling position of medical instruments
US7306613B2 (en) Endoscopic instruments
US5897487A (en) Front end hood for endoscope
US7081097B2 (en) Endoscope sheath assemblies having an attached biopsy sampling device
US6261307B1 (en) Method of using surgical instrument with rotatably mounted offset end effector
US20090177031A1 (en) Medical systems, devices and methods for endoscopically suturing perforations