US20230270443A1 - Device for atrial appendage exclusion - Google Patents
Device for atrial appendage exclusion Download PDFInfo
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- US20230270443A1 US20230270443A1 US18/309,607 US202318309607A US2023270443A1 US 20230270443 A1 US20230270443 A1 US 20230270443A1 US 202318309607 A US202318309607 A US 202318309607A US 2023270443 A1 US2023270443 A1 US 2023270443A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12122—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder within the heart
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/122—Clamps or clips, e.g. for the umbilical cord
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
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- A61B2017/2946—Locking means
Definitions
- the present disclosure pertains broadly to the field of fasteners and/or applicators. More specifically, the disclosure relates to surgical applicators of implants and/or fasteners, including but not limited to sterilized fasteners such as staples.
- Atrial fibrillation is a relatively common condition characterized by a very rapid heartbeat of the left and right atrium. While atrial fibrillation is not normally fatal itself, it has been associated with an increased risk of stroke. It is believed that the rapid heartbeat causes blood to pool in the left atrial appendage (LAA) which causes emboli that are released into the left atrium from where they can enter the cerebral vasculature, thus causing a stroke. In addition to stroke, the emboli can enter coronary circulation, potentially causing myocardial infarction, or can enter peripheral circulation, potentially causing peripheral vascular disease.
- LAA left atrial appendage
- the risk of stroke in patients suffering from atrial fibrillation can be reduced in a variety of ways.
- blood thinning drugs can be used to reduce the risk of clot formation.
- the use of blood thinners, however, is contraindicated in patients at risk of bleeding disorders.
- More aggressive treatment protocols have been proposed which involve closing the LAA. Closure and excision may be performed in open surgical procedures, typically requiring the patient to be placed on by-pass and the chest to be opened through the sternum.
- thoracoscopic and other less invasive procedures have been proposed. The tools are used to ablate or fuse the LAA from the inside using energy, adhesives, or the like.
- a compliant closure structure may be used for closing the LAA.
- Such compliant structure may have an elastomeric body having a pair of opposed legs which may be arranged in an oval or a U-shaped configuration to define an opening therebetween. By placing the opening between the legs over the LAA and aligning it with the base of the LAA, the compliant closure structure may be closed to provide the desired sealing of the LAA.
- a number of discrete, axially spaced-apart tissue penetrating fasteners are arranged along the lengths of each of the legs. By compressing the legs together to press-fit the closure devices, the compliant closure structure may be closed to provide a compliant seal which effectively isolates the LAA.
- the compliant closure structure is closed using a hand-operated delivery tool having jaws which can be inserted into the legs of the closure structure and actuated to close the jaws in the legs over the LAA.
- the jaws further include comb studs which engage and press fit the closure devices in order to hold the compliant closure structure in its closed, sealing configuration.
- the studs are intended to be retracted to allow the delivery tool to be removed.
- Existing delivery tools have certain shortcomings. For example, the actuation of the jaws and retraction of the comb studs can be performed out of order, increasing the risk that the delivery of the compliant structure will fail. Additionally, existing delivery tools do not allow for repeated “previewing” of the placement of the compliant closure structure on the LAA without closing the tissue penetrating fasteners. Moreover, positioning and orientation of the delivery tool can be difficult, particularly when the tool is introduced through an intercostal penetration to access the LAA.
- a surgical applicator for a fastener may include a handle, a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position, and a lockout mechanism movable relative to the trigger between a locked position and an unlocked position.
- the lockout mechanism may be operatively arranged to: lock the trigger in the intermediate position when the trigger is moved from the initial position toward the actuated position, and permit movement of the trigger from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position.
- the lockout mechanism may be further operatively arranged to permit movement of the trigger from the initial position to the actuated position when the lockout mechanism is moved from the locked position to the unlocked position prior to movement of the trigger from the initial position.
- the trigger may be movable relative to the handle from the initial position with application of a compressive force on the trigger in a direction toward the handle.
- the trigger may have a distal side opposite a proximal side facing the handle, and at least a portion of the lockout mechanism may be positioned on the distal side of the trigger.
- the lockout mechanism may have a release button connected to the trigger, the release button being movable between a first position and a second position relative to the trigger.
- the lockout mechanism may further have a trigger stop connected to the handle, the trigger stop being movable between a first position and a second position relative to the handle.
- the release button may be pivotally movable relative to the trigger, or linearly movable in a direction lateral relative to the trigger.
- the release button may be biased to the first position by a release button biasing member.
- the trigger stop may be biased to the first position by a trigger stop biasing member. Movement of the trigger from the initial position toward the actuated position may engage the trigger with the trigger stop to automatically lock the trigger in the intermediate position. Movement of the release button from the first position to the second position when the trigger is in the intermediate position may permit disengagement of the trigger from the trigger stop.
- a ratcheting mechanism may be provided to engage the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position.
- the ratcheting mechanism may disengage from the trigger when the trigger is moved to the actuated position.
- the ratcheting mechanism may have a ratchet rod and a ratchet that is engaged with the ratchet rod when the trigger is moved from the intermediate position toward the actuated position.
- the ratcheting mechanism may be actuated when the trigger is moved from the intermediate position toward the actuated position by a predetermined distance.
- the surgical applicator may further have a jaw assembly selectively movable between an open position and a closed position via movement of the trigger from the initial position to the actuated position.
- the jaw assembly may have a pair of jaws movably attached to one another, with each jaw having a pair of lateral sides with a plurality of lateral slots extending through each lateral side.
- An outer surface of at least one of the lateral sides of each jaw may have a recess that receives a cover element for enclosing at least a portion of the plurality of lateral slots.
- the cover element may be adhesively secured in the recess.
- the jaws may be pivotally attached to one another by a pin.
- the surgical application may further include a dampening mechanism operatively arranged with the trigger to dampen variations in a compressive force applied on the trigger during movement between the initial position and the actuated position.
- the dampening mechanism may have a spring and a damper.
- a surgical applicator for a fastener may have a handle, a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position, and a lockout mechanism.
- the lockout mechanism may include a release button connected to the trigger and a trigger stop connected to the handle. Movement of the trigger from the initial position toward the actuated position may engage the trigger stop with the trigger to lock the trigger in the intermediate position, and movement of the release button relative to the trigger when the trigger is in the intermediate position may disengage the trigger from the trigger stop to permit movement of the trigger from the intermediate position toward the initial position or the actuated position.
- the surgical applicator may further have a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position.
- the ratcheting mechanism may disengage from the trigger when the trigger is moved to the actuated position.
- a surgical applicator for a fastener may have a handle, a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position, and an elongate body extending distally from the handle.
- the elongate body may have a distal portion, a jaw assembly at the distal portion selectively movable between an open position, a closed position, and an intermediate position between the open position and the closed position via movement of the trigger.
- the surgical applicator may further have a lockout mechanism operatively arranged to lock the trigger and the jaw assembly in the intermediate position when the trigger is moved from the initial position toward the actuated position, and permit movement of the trigger from the intermediate position toward the initial position or the actuated position to move the jaw assembly from the intermediate position toward the open position or the closed position, respectively.
- a method of operating a fastener applicator may include moving a trigger of the fastener applicator from an initial position toward an actuated position by applying a compressive force on the trigger in a direction toward a handle of the fastener applicator, closing a jaw assembly of the fastener applicator from an open position toward a closed position via movement of the trigger, and locking the trigger and the jaw assembly in an intermediate position with a lockout mechanism.
- the method may further include moving the lockout mechanism from a locked position to an unlocked position, moving the trigger from the intermediate position toward the actuated position, and closing the jaw assembly from the intermediate position to the closed position via movement of the trigger. Closing the jaw assembly to the closed position may close a fastener from an unfixed position to a fixed position.
- the method may further include blocking the trigger via a ratcheting mechanism from movement toward the initial position after the trigger is moved from the intermediate position toward the actuated position.
- the jaw assembly may move from the closed position toward the open position when the trigger is moved to the actuated position, or after the trigger is moved to the actuated position.
- the method may further include unlocking the trigger when the trigger is moved to the actuated position.
- a surgical applicator for a fastener comprising:
- Clause 2 The surgical applicator of clause 1, wherein the lockout mechanism is further operatively arranged to permit movement of the trigger from the initial position to the actuated position when the lockout mechanism is moved from the locked position to the unlocked position prior to movement of the trigger from the initial position.
- Clause 3 The surgical applicator of clause 1 or clause 2, wherein the trigger is movable relative to the handle from the initial position with application of a compressive force on the trigger in a direction toward the handle.
- Clause 4 The surgical applicator of any of clauses 1-3, wherein the trigger has a distal side opposite a proximal side facing the handle, and wherein at least a portion of the lockout mechanism is positioned on the distal side of the trigger.
- Clause 6 The surgical applicator of clause 4, wherein the release button is pivotally movable relative to the trigger.
- Clause 7 The surgical applicator of clause 4, wherein the release button is linearly movable in a direction lateral relative to the trigger.
- Clause 8 The surgical applicator of clause 4, wherein the release button is biased to the first position by a release button biasing member.
- Clause 9 The surgical applicator of clause 4, wherein the trigger stop is biased to the first position by a trigger stop biasing member.
- Clause 10 The surgical applicator of clause 4, wherein movement of the trigger from the initial position toward the actuated position engages the trigger with the trigger stop to automatically lock the trigger in the intermediate position.
- Clause 11 The surgical applicator of clause 4, wherein movement of the release button from the first position to the second position when the trigger is in the intermediate position permits disengagement of the trigger from the trigger stop.
- Clause 12 The surgical applicator of any of clauses 1-11, further comprising a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position.
- Clause 13 The surgical applicator of clause 10, wherein the ratcheting mechanism disengages from the trigger when the trigger is moved to the actuated position.
- Clause 14 The surgical applicator of clause 10, wherein the ratcheting mechanism comprises a ratchet rod and a ratchet that is engaged with the ratchet rod when the trigger is moved from the intermediate position toward the actuated position.
- Clause 15 The surgical applicator of clause 10, wherein the ratcheting mechanism is actuated when the trigger is moved from the intermediate position toward the actuated position by a predetermined distance.
- Clause 16 The surgical applicator of any of clauses 1-15, further comprising a jaw assembly selectively movable between an open position and a closed position via movement of the trigger from the initial position to the actuated position.
- Clause 17 The surgical applicator of clause 16, wherein the jaw assembly comprises a pair of jaws movably attached to one another, each jaw having a pair of lateral sides with a plurality of lateral slots extending through each lateral side.
- Clause 18 The surgical applicator of clause 17, wherein an outer surface of at least one of the lateral sides of each jaw has a recess.
- Clause 19 The surgical applicator of clause 18, wherein the recess receives a cover element that encloses at least a portion of the plurality of lateral slots.
- Clause 20 The surgical applicator of clause 17, wherein the cover element is adhesively secured in the recess.
- Clause 21 The surgical applicator of clause 17, wherein the jaws are pivotally attached to one another by a pin.
- Clause 22 The surgical applicator of any of clauses 1-21, further comprising a dampening mechanism operatively arranged with the trigger to dampen variations in a compressive force applied on the trigger during movement between the initial position and the actuated position.
- Clause 23 The surgical applicator of clause 22, wherein the dampening mechanism comprises a spring and a damper.
- a surgical applicator for a fastener comprising:
- Clause 25 The surgical applicator of clause 24, further comprising a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position.
- Clause 26 The surgical applicator of clause 24 or clause 25, wherein the ratcheting mechanism disengages from the trigger when the trigger is moved to the actuated position.
- a surgical applicator for a fastener comprising:
- Clause 28 A method of operating a fastener applicator, the method comprising:
- Clause 29 The method of clause 28, wherein closing the jaw assembly to the closed position closes a fastener from an unfixed position to a fixed position.
- Clause 30 The method of clause 28 or clause 29, further comprising blocking the trigger via a ratcheting mechanism from movement toward the initial position after the trigger is moved from the intermediate position toward the actuated position.
- Clause 31 The method of any of clauses 28-30, wherein the jaw assembly moves from the closed position toward the open position when the trigger is moved to the actuated position, or after the trigger is moved to the actuated position.
- Clause 32 The method of any of clauses 28-31, further comprising unlocking the trigger when the trigger is moved to the actuated position.
- FIG. 1 is a side view of a fastener applicator constructed in accordance with an example of the present disclosure
- FIG. 2 is a perspective view of a tissue closure device in accordance with an example of the present disclosure
- FIG. 3 is an exploded perspective view of the fastener applicator shown in FIG. 1 ;
- FIG. 4 A is a perspective view of a pull rod assembly of the fastener applicator shown in FIG. 1 ;
- FIG. 4 B is an exploded perspective view of the pull rod assembly shown in FIG. 4 A ;
- FIG. 4 C is a top view of a shaft of a pull rod assembly
- FIG. 4 D is a top partial cross-sectional view of the shaft shown in FIG. 4 C ;
- FIG. 4 E is a cross-sectional view of the shaft shown in FIGS. 4 C- 4 D taken along line A-A;
- FIG. 5 is an exploded perspective view of a trigger assembly of the fastener applicator shown in FIG. 1 ;
- FIG. 6 A is a detailed perspective view of a trigger release button and trigger stop of a fastener applicator in accordance with an example of the present disclosure
- FIG. 6 B is a detailed perspective view of a trigger release button and trigger stop of a fastener applicator in accordance with another example of the present disclosure
- FIG. 7 A is a side view of the trigger assembly of the fastener applicator shown in FIG. 1 , showing a trigger in an initial position;
- FIG. 7 B is a side view of the trigger assembly of the fastener applicator shown in FIG. 1 , showing the trigger in a decision or intermediate position and a release button in a first position;
- FIG. 7 C is a side view of the trigger assembly of the fastener applicator shown in FIG. 1 , showing the trigger in a decision or intermediate position with the release button moved from the first position to a second position;
- FIG. 7 D is a side view of the trigger assembly of the fastener applicator shown in FIG. 1 , showing the trigger in a position between the intermediate position and the actuated position;
- FIG. 7 E is a side view of the trigger assembly of the fastener applicator shown in FIG. 1 , showing the trigger in a final or actuated position;
- FIGS. 8 A- 8 D illustrate the movement of a jaw assembly and engagement thereof with a tissue closure device according to an example of the present disclosure
- FIG. 9 illustrates use of the fastener applicator according to an example of the present disclosure, wherein the fastener applicator is used for closing a tissue closure device over a LAA;
- FIGS. 10 A- 10 C are schematic views of a trigger and a trigger sub lever illustrating the movement of the trigger between an initial position and an actuated position according to an example of the present disclosure
- FIG. 11 is a perspective view of a trigger release button in accordance with an example of the present disclosure.
- FIG. 12 A is a top, perspective view of a trigger stop in accordance with an example of the present disclosure.
- FIG. 12 B is a bottom, perspective view of a trigger stop in accordance with an example of the present disclosure.
- FIG. 13 A is a top, perspective view of a ratchet lever in accordance with an example of the present disclosure.
- FIG. 13 B is a bottom, perspective view of a ratchet lever in accordance with an example of the present disclosure.
- FIGS. 1 - 13 B like characters refer to the same components and elements, unless otherwise stated.
- proximal refers to a portion of the fastener applicator closest to a body of a user handling the fastener applicator during use of the fastener applicator.
- distal refers to a portion of the fastener applicator furthest away from a body of a user handling the fastener applicator during use of the fastener applicator.
- An exemplary tissue structure of a patient at risk of stroke or other adverse events resulting from emboli released into circulation from the LAA may include the LAA.
- a fastener applicator 10 (also referred to herein as “surgical applicator” or “applicator”) constructed in accordance with various examples of the present disclosure has a shaft 12 having a handle assembly 17 at its proximal end 13 , and a jaw assembly 16 at a distal end 15 , where individual jaws 18 , 20 are adapted to carry a fastener 22 (shown in FIG. 2 ).
- the handle assembly 17 has a trigger 32 movable relative to a handle 34 between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position.
- the trigger 32 is movable relative to the handle 34 from the initial position with application of a compressive force on the trigger 32 in a direction toward the handle 34 (arrow A in FIG. 1 ).
- the fastener applicator 10 is configured for introducing the fastener 22 over the tissue structure.
- the fastener 22 is shown in accordance with one non-limiting example of the present disclosure.
- the fastener 22 has a substantially U-shaped configuration for receiving the tissue structure, such as the LAA or other tissue structure, when the jaws 18 , 20 of the fastener applicator 10 are open.
- the fastener 22 has a compressible body 24 and a pair of parallel legs 26 having two opposed compliant tissue-engaging surfaces 28 .
- the legs 26 are movable between an open or unfixed position and a closed or fixed position.
- the legs 26 are each comprised of a soft biologically compatible material.
- the fastener 22 further has a plurality of tissue-penetrating fasteners 30 spaced-apart along the legs 26 and disposed to extend from a first one of the tissue-engaging surfaces 28 , through tissue at a puncture site, to a second one of the tissue-engaging surfaces 28 to close the tissue structure therebetween.
- the plurality of tissue-penetrating fasteners 30 apply a desired level of compression force, which is determined by both the softness of the compressible body 24 and the distance between the tissue-engaging surfaces 28 when they are fully connected to the tissue structure. When connected to the tissue structure, the fastener 22 is left in place in order to close and/or seal the tissue structure.
- a portion of the tissue structure extending beyond the fastener 22 may then be cut, excised, or otherwise removed, although this may be left to the physician's preference. More detailed description of various fasteners suitable for use with the fastener applicator 10 of the present disclosure are described in U.S. Pat. No. 7,992,757, the full disclosure of which is incorporated herein by reference.
- the handle assembly 17 has a housing 36 comprising a first housing portion 36 a and a second housing portion 36 b coupled to one another and defining an interior space for receiving the working components of the handle assembly 17 .
- the first housing portion 36 a and the second housing portion 36 b when assembled together, define the handle 34 that is grasped by the user when handling the fastener applicator 10 .
- the first and second portions 36 a , 36 b of the housing 36 are coupled using one or more handle fasteners 38 .
- first and second portions 36 a , 36 b of the housing 36 may be coupled using clips, grooves, adhesive, welding, or any other mechanical fastening arrangement.
- first and second portions 36 a , 36 b of the housing 36 may be removably or non-removably coupled to one another.
- the interior space of the housing 36 receives various components for actuating the surgical applicator 10 between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position.
- the housing 36 may receive various gears, linkages, springs, or the like to effect movement or actuation of the trigger 32 between the initial position, the actuated position, and the intermediate position between the initial position and the actuated position.
- the housing 36 receives at least a portion of the trigger 32 that is movable relative to the housing 36 in a pivoting motion about a trigger pivot pin 44 .
- the trigger 32 may be biased to the initial position by a trigger biasing member, such as a trigger spring 38 .
- the trigger spring 38 is compressible with movement of the trigger 32 from the initial position such that a restoring force is generated in the trigger spring 38 that restores the trigger 32 to the initial position when an urging force on the trigger 32 is removed or reduced to a magnitude that is lower than the restoring force of the trigger spring 38 .
- the trigger 32 has a trigger stop 40 pivotally connected to at least a portion of the housing 36 .
- the trigger stop 40 may be movable between a first position and a second position relative to the handle 34 .
- the trigger stop 40 is biased to the first position by a trigger stop biasing member, such as a trigger stop spring 50 .
- the housing 36 receives a ratcheting mechanism 46 having a ratchet rod 120 and a ratchet 128 , as discussed herein.
- the ratcheting mechanism 46 engages when the trigger 32 is moved from the intermediate position toward the actuated position to prevent movement of the trigger 32 toward the initial position. In some examples, the ratcheting mechanism 46 disengages when the trigger 32 reaches the actuated position such that the trigger 32 automatically moves toward the initial position when the ratcheting mechanism 46 is disengaged, or when the force applied to the trigger is relieved.
- a dampening mechanism 48 is received within the housing 36 and operatively arranged with the trigger 32 to dampen variations in a compressive force applied on the trigger 32 during movement between the initial position and the actuated position.
- the dampening mechanism 48 has a dampening spring 50 received within a damper plunger 52 and a damper 54 .
- the damper 54 may be a friction damper, an elastomeric damper, a magnetic damper, a viscous damper, or any combination thereof.
- FIG. 4 B is an exploded view of the jaw assembly 16 of FIG. 4 A .
- the jaw assembly 16 is movable between an open position (shown in FIGS. 4 A- 4 B ) and a closed position (shown in FIGS. 8 B- 8 C ) via movement of the trigger 32 from the initial position to the actuated position.
- the jaw assembly 16 comprises a pair of jaws 18 , 20 movably attached to one another.
- the jaws 18 , 20 are pivotally attached to one another with a hinge pin 56 and a washer 58 .
- the hinge pin 56 and the washer 58 may be welded together, such as using laser welding, ultrasonic welding, or other type of welding.
- the hinge pin 56 and the washer 58 are adhesively connected with each other, threadably connected with each other, or connected by way of any other removable or non-removable mechanical connection.
- each jaw 18 , 20 has a pair of lateral sides 60 , with each lateral side 60 having a plurality of lateral slots 62 extending therethrough.
- the lateral slots 62 define a channel for guiding the movement of jaw cam pins 64 .
- a single jaw cam pin 64 is received within each lateral slot 62 and is movable within the lateral slot 62 between a first position and a second position. In the first position, the jaw cam pins 64 in each jaw 18 , 20 are positioned relative to a stud comb 66 such that the comb 66 is in an extended or exposed position within the jaws 18 , 20 .
- the jaw cam pins 64 in each jaw 18 , 20 are positioned such that the jaw cam pins 64 urge the stud comb 66 in each jaw 18 , 20 to a retracted or concealed position, wherein the comb 66 acts on the tissue penetrating fasteners 30 of the fastener 22 .
- the jaws 18 , 20 are received within a clamp box 68 .
- the clamp box 68 has a pair of sides 68 a , 68 b defining a central opening 70 therebetween for receiving the jaws 18 , 20 .
- the sides 68 a , 68 b of the clamp box 68 may be removably or non-removably connected to one another, such as by one or more rivets 72 .
- the movement of the jaws 18 , 20 between the open and closed positions is guided by the interaction between the guide slots 63 on each of the jaws 18 , 20 and a corresponding guide pin 65 (shown in FIG. 4 B ) on the clamp box 68 .
- the clamp box 68 receives a distal end 74 of at least a portion of the shaft 14 , such as the distal end of the clamp tube 76 .
- the shaft 14 comprises the clamp tube 76 slidably received within an ejection tube 77 and an inner pull rod 78 slidably received within the clamp tube 76 such that the clamp tube, ejection tube 77 , and the inner pull rod 78 are coaxially disposed relative to one another.
- the clamp tube 76 may be rotatable about its longitudinal axis to rotate the clamp box 68 and the jaws 18 , 20 , thereby facilitating the orientation of the jaws 18 , 20 relative to the handle assembly 17 during use of the fastener applicator 10 .
- the shaft 14 is rotatable about its longitudinal axis with rotation of the positioning knob 88 (shown in FIG. 5 ).
- the pull rod 78 is axially movable relative to the clamp tube 76 with movement of the trigger 32 .
- the pull rod 78 may be movable in a direction extending between the proximal and distal ends of the shaft 14 and along a longitudinal axis thereof. Movement or closure of the trigger 32 from the initial position toward the actuated position draws the pull rod 78 proximally toward a proximal end 80 of the shaft 14 relative to the clamp tube 76 and the ejection tube 77 , which in turn closes the jaws 18 , 20 .
- the ejection tube 77 has at least one tendon 82 connected at its distal end. The at least one tendon 82 is operatively connected with the comb stud 66 such that movement of the trigger 32 to the activated position also pulls the at least one tendon 82 to cause the retraction of the comb stud 66 .
- an outer surface of at least one of the lateral sides 60 of each jaw 18 , 20 has a recess 84 .
- the recess 84 may be formed as a channel that extends into the body of each jaw 18 , 20 from the lateral sides 60 in a region surrounding the lateral slots 62 .
- the recess 84 receives a cover element 86 (also shown in FIG. 3 ) that encloses at least a portion of the plurality of lateral slots 62 .
- a thickness of the cover element 86 may be chosen such that an outer surface of the cover element 86 may be flush with the surface of the lateral side 60 .
- the thickness of the cover element 86 may be chosen such that its outer surface is recessed relative to the surface of the lateral side 60 , or such that the outer surface of the cover element 86 protrudes laterally from the surface of the lateral side 60 .
- the cover element 86 may be adhesively secured in the recess 84 .
- the cover element 86 may be transparent such that the lateral slots 62 and the jaw cam pins 64 can be seen through the cover element 86 .
- the cover element 86 When positioned in the recess 84 , the cover element 86 prevents contamination of the lateral slots 62 and the jaw cam pins 64 during use of the fastener applicator 10 which may cause the blockage of one or more lateral slots 62 and/or impede the movement of one or more jaw cam pins 64 through the lateral slots 62 .
- the trigger 32 comprises a first trigger portion 32 a and a second trigger portion 32 b coupled to one another.
- the first trigger portion 32 a and the second trigger portion 32 b when assembled together, define the trigger 32 that is grasped by the user when handling the fastener applicator 10 .
- the first and second trigger portions 32 a , 32 b are coupled using one or more trigger fasteners 90 .
- the first and second trigger portions 32 a , 32 b may be coupled using clips, grooves, adhesive, welding, press fit, or any other mechanical fastening arrangement.
- the first and second trigger portions 32 a , 32 b may be removably or non-removably coupled to one another.
- each trigger portion 32 a , 32 b has a first end 92 that is received within the housing 36 (shown in FIG. 3 ) and pivotally movable relative to the housing 36 .
- a second free end 94 extends opposite the first end 92 and protrudes outside the housing 36 .
- the second free end 94 of the trigger 32 is configured for being grasped by the user during movement of the trigger 32 between the initial position and the activated position.
- the trigger 32 further has a distal side 110 opposite a proximal side 108 facing the handle. As described herein, at least a portion of a lockout mechanism is positioned on the distal side 110 of the trigger 32 .
- the trigger 32 has a pivot pin opening 112 configured for receiving the trigger pivot pin 44 (shown in FIG. 3 ).
- the trigger 32 is pivotally movable about a longitudinal axis of the trigger pivot pin 44 which has its terminal ends secured to the housing 36 .
- a trigger slot 114 extends through the body at the first end 92 of the trigger 32 .
- the trigger slot 114 is configured to receive a closing trunnion 116 connected to the distal end of the pull rod 78 .
- the trigger slot 114 acts as a camming mechanism for controlling the movement of the pull rod 78 due to the movement of the closing trunnion 116 within the trigger slot 114 .
- the shape of the trigger slot 114 is configured to result in a linear movement of the pull rod 78 in a direction of a longitudinal axis 118 of the shaft 14 as a result of a pivoting movement of the trigger about the trigger pivot pin 44 .
- the closing trunnion 116 may contact or be positioned in near contact with a first end of the trigger slot 114 when the trigger 32 is in the initial position ( FIG. 7 A ).
- the closing trunnion 116 may contact or be positioned in near contact with a second end (opposite the first end) of the trigger slot 114 when the trigger 32 is in the actuated position ( FIG. 7 E ).
- the closing trunnion 116 may be positioned between the first end and the second end of the trigger slot 114 when the trigger 32 is in the intermediate position between the initial position and the actuated position. Lateral pins of an ejection trunnion 164 are received within an opening 123 extending through a first end of a trigger sub lever 122 (see, also, FIGS. 10 A- 10 C ) such that movement of the trigger 32 also causes a corresponding movement of the trigger sub lever 122 due to movement of the ejection trunnion 164 within the trigger slot 114 (see FIGS. 10 A- 10 C ).
- a second end of the trigger sub lever 122 has a pin 125 that is pivotally connected to the trigger 32 .
- the first end of the trigger sub lever 122 is slidably movable relative to the trigger slot 166 and the ejection trunnion 164
- the second end of the trigger sub lever 122 is pivotally movable relative to the trigger sub stop feature 172 on the handle 34 (see FIGS. 10 A- 10 C ).
- Amplification is determined by the ratio of the two distances L1 and L2 in FIG. 10 B .
- L1 is the distance between the trigger sub stop feature 172 and the trigger sub lever pin 125 while L2 is the distance between the trigger sub lever pin 125 and the ejection trunnion 164 .
- the trigger sub lever 122 effects the ejection trunnion 164 via the trigger sub lever slot 170 .
- a first (small) movement of the trigger 32 can have a second (greater) movement on the ejection trunnion 164 due to the ejection trunnion 164 being linked to the ejection tube 77 .
- the combs 66 can be retracted via the tendons 82 to release the fastener 22 (shown in FIG. 2 ).
- the fastener applicator 10 has a lockout mechanism 140 a movable relative to the trigger 32 between a locked position and an unlocked position.
- the lockout mechanism 140 a in FIG. 6 A is shown in accordance with one example of the present disclosure.
- the lockout mechanism 140 a is operatively arranged to lock the trigger 32 in the intermediate position ( FIG. 7 B ) when the trigger 32 is moved from the initial position toward the actuated position.
- the lockout mechanism 140 a is further operatively arranged to permit movement of the trigger 32 from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position ( FIG. 7 C ).
- the lockout mechanism 140 a is further operatively arranged to lock the trigger 32 in the initial position when a trigger release button 96 is moved from the first position to the second position prior to movement of the trigger 32 from the initial position.
- the lockout mechanism 140 a comprises the trigger release button 96 , the trigger stop 40 , and the ratcheting mechanism 46 .
- movement of the trigger 32 from the initial position toward the actuated position engages the trigger 32 with the trigger stop 40 and moves the trigger stop 40 to automatically lock the trigger 32 in the intermediate position.
- movement of the trigger release button 96 from the first position to the second position about the trigger release button pivot pin 100 when the trigger 32 is in the intermediate position permits disengagement of the trigger stop 40 from the trigger 32 .
- the trigger 32 can be retracted to the initial position due to a restoring force of the trigger spring 38 or moved to the actuated position to close the fastener 22 (shown in FIG. 2 ).
- the trigger release button 96 extends through an opening 98 on the trigger 32 between the first end 92 and the second free end 94 ( FIG. 5 ).
- the trigger release button 96 is positioned relative to the first and second ends 92 , 94 of the trigger 32 such that the trigger release button 96 may be operated using the user's index finger that contacts a pressing surface 97 of the trigger release button 96 .
- the trigger release button 96 is movable between a first position, wherein the trigger release button 96 protrudes from the opening 98 , and a second position, wherein at least a portion of the trigger release button 96 is moved into the opening 98 on the trigger.
- the trigger release button 96 may protrude from the opening 98 in the first position and the second position.
- the trigger release button 96 is pivotally movable relative to the trigger 32 between the first position and the second position about the first trigger release button pivot pin 100 .
- the trigger release button 96 may be linearly movable relative to the trigger 32 , such as by movement in a proximal/distal direction of the fastener applicator 10 , or in a lateral direction relative to the trigger 32 .
- a trigger release button slot 104 in the trigger release button 96 receives a second trigger release button pin 106 and may delimit a range of movement of the trigger release button 96 .
- the second trigger release button pin 106 may contact or be positioned in near contact with a first end of the trigger release button slot 104 when the trigger release button 96 is in the first position.
- the second trigger release button pin 106 may contact or be positioned in near contact with a second end (opposite the first end) of the trigger release button slot 104 when the trigger release button 96 is in the second position.
- the trigger release button 96 is biased to the first position by a release button biasing member, such as a trigger release button spring 102 .
- the trigger release button spring 102 is compressible with movement of the trigger release button 96 from the first position toward the second position such that a restoring force is generated in the trigger release button spring 102 that restores the trigger release button 96 to the first position when an urging force on the trigger release button 96 is removed and the trigger release button 96 is disconnected from the trigger stop 40 .
- the trigger release button 96 has a stop member 150 positioned at a second free end 95 of the trigger release button 96 and configured for engaging at least a portion of the trigger stop 40 to prevent movement of the trigger 32 from the initial position if the trigger release button 96 is pressed before the trigger 32 is moved to the intermediate position. In this manner, the trigger 32 can be moved from the initial position only if the trigger release button 96 is not pressed.
- the stop member 150 may be configured as a rounded tip at the second end of the trigger release button 96 .
- the trigger release button 96 has a trigger stop release member 152 positioned between the first trigger release button pivot pin 100 and the stop member 150 .
- the trigger stop release member 152 is configured for engaging at least a portion of the trigger stop 40 when the trigger 32 is positioned in the intermediate position between the initial position and the actuated position. Pressing the trigger release button 96 when the trigger 32 is in the intermediate position engages the trigger stop release member 152 with the trigger stop 40 to unlock the trigger stop 40 and permit movement of the trigger 32 from the intermediate position toward the actuated position or the initial position.
- the trigger stop release member 152 may be shaped as a rounded protrusion at a proximal portion of the trigger release button 96 between the first trigger release button pivot pin 100 and the stop member 150 .
- a non-limiting example embodiment of a trigger release button 96 a is shown in FIG. 11 .
- the embodiment of the trigger release button 96 a includes a pressing surface 97 a , a trigger release button slot 104 a , and a stop member 150 a .
- the pressing surface 97 a includes a raised cross pattern 197 , which provides a distinct surface for the user to locate the trigger release button and an increased grip to the user, thereby making the fastener applicator easier to use.
- This non-limiting example embodiment of trigger release button 96 a can be used in the embodiments of the fastener applicator of the present disclosure, including the embodiments of the fastener applicator shown in FIGS. 6 A, 6 B and 7 A- 7 E .
- the trigger stop 40 is connected to the handle 34 and is movable relative to the handle 34 between a first position ( FIG. 7 A ) and a second position ( FIG. 7 E ).
- the trigger stop 40 is biased to the first position by a trigger stop biasing member, such as the dampening spring 50 ( FIG. 3 ).
- the trigger stop 40 is pivotally movable relative to the handle 34 between the first position and the second position about a trigger stop pin 142 .
- the trigger stop 40 has a first end 144 that is pivotable about the trigger stop pin 142 and a second free end 146 opposite the first end 144 .
- At least a portion of the trigger stop 40 may be recessed within the housing 36 of the handle 34 when the trigger stop 40 is in the first position.
- the first end 144 and the second end 146 of the trigger stop 40 may be recessed within the housing 36 of the handle 34 when the trigger stop 40 is in the first position.
- at least a portion of the trigger stop 40 may extend from the housing 36 of the handle 34 when the trigger stop 40 is pivoted from the first position toward the second position.
- the first end 144 of the trigger stop 40 may be recessed within the interior of the housing 36 of the handle 34 while at least a portion of the second end 146 of the trigger stop 40 protrudes from the interior of the housing 36 when the trigger stop 40 is pivoted from the first position toward the second position.
- the trigger stop 40 has a dampening cam 148 configured for interacting with the dampening mechanism 48 when the trigger 32 is moved from the intermediate position toward the actuated position.
- the dampening cam 148 is positioned at the first end 144 of the trigger stop 40 and is shaped to vary the displacement of the dampening spring 50 (shown in FIG. 3 ) and the dampening plunger 52 during the stroke of the trigger 32 between the intermediate position toward the actuated position.
- the dampening plunger 52 engages the damper 54 (shown in FIG. 7 E ).
- the dampening cam 148 on the trigger stop 40 and the dampening mechanism 48 may be configured to require a persistant resistive force on the trigger 32 during movement of the trigger 32 from the intermediate position toward the final position regardless of the position of the trigger 32 during its stroke between the intermediate position and the final position. In this manner, the user does not need to vary the force input on the trigger 32 during activation of the fastener applicator 10 which may inadvertently change the position of the jaw assembly 16 (shown in FIG. 1 ) relative to the tissue structure.
- the second end 146 of the trigger stop 40 has a first stop member engagement surface 154 configured for engaging the stop member 150 of the trigger release button 96 if the trigger release button 96 is pressed while the trigger 32 is positioned in the initial position.
- Contact between the first stop member engagement surface 154 of the trigger stop 40 and the stop member 150 of the trigger release button 96 prevents movement of the trigger 32 from the initial position toward the actuated position if the trigger release button 96 is pressed before the trigger 32 is moved to the intermediate position. In this manner, the trigger 32 is locked in the initial position until the trigger release button 96 is released, thereby disengaging the first stop member engagement surface 154 of the trigger stop 40 from the stop member 150 of the trigger release button 96 .
- the first stop member engagement surface 154 of the trigger stop 40 may be configured as a recess at a terminal portion of the second end 146 of the trigger stop 40 .
- Movement of the trigger 32 to the intermediate position locks the trigger 32 relative to the handle 34 due to engagement of a trigger latch 156 on the trigger stop 40 with a trigger catch 158 on the trigger 32 .
- the trigger latch 156 on the trigger stop 40 is configured as at least one protrusion that extends laterally away from at least one lateral side of the trigger stop 40 .
- the trigger latch 156 is a pair of protrusions that extend laterally away from opposing lateral sides of the trigger stop 40 .
- the trigger catch 158 on the trigger 32 may be configured as a recess on a proximal side 108 of the trigger 32 that is shaped to receive at least a portion of the trigger latch 156 .
- the trigger latch 156 and the trigger catch 158 engage when the trigger 32 is moved to the intermediate position and prevent movement of the trigger 32 toward the initial position or the actuated position.
- the trigger latch 156 and the trigger catch 158 are disengaged by pressing the trigger release button 96 , whereby at least a portion of the trigger release button 96 contacts at least a portion of the trigger stop 40 to move the trigger stop 40 and displace the trigger latch 156 from contact with the trigger catch 158 on the trigger 32 .
- the stop member 150 of the trigger release button 96 engages a release surface 160 on the trigger stop 40 to move the trigger stop 40 and displace the trigger latch 156 from contact with the trigger catch 158 on the trigger 32 .
- the release surface 160 may be positioned at the second end 146 of the trigger stop 40 and proximally of the stop member 150 .
- the trigger stop 40 has a trigger actuation surface 162 positioned proximally of a second stop member engagement surface 155 and the release surface 160 .
- the trigger actuation surface 162 of the trigger stop 40 is configured for engaging the trigger stop release member 152 of the trigger release button 96 when the trigger 32 is moved from the intermediate position toward the actuated position while the trigger release button 96 is pressed. Pressing the trigger release button 96 when the trigger 32 is moved from the intermediate position toward the actuated position engages the trigger stop release member 152 with the trigger actuation surface 162 of the trigger stop 40 to unlock the trigger stop 40 and permit movement of the trigger 32 toward the actuated position.
- the trigger actuation surface 162 may be shaped as a ramp that engages the trigger stop release member 152 of the trigger release button 96 . In examples where the trigger actuation surface 162 is shaped as a slot, the trigger actuation surface 162 provides clearance for movement of the trigger stop release member 152 along the trigger actuation surface 162 .
- FIGS. 12 A and 12 B A non-limiting example embodiment of a trigger stop 40 a is shown in FIGS. 12 A and 12 B .
- the embodiment of the trigger stop 40 a includes a first end 144 a , a second end 146 a , a dampening cam 148 a , a first stop member engagement surface 154 a , a trigger latch 156 a , a release surface 160 a , and a trigger actuation surface 162 a .
- This non-limiting example embodiment of trigger stop 40 a can be used in the embodiments of the fastener applicator of the present disclosure, including the embodiments of the fastener applicator shown in FIGS. 6 A, 6 B and 7 A- 7 E .
- the lockout mechanism 140 a further comprises the ratcheting mechanism 46 that engages when the trigger 32 is moved from the intermediate position toward the actuated position.
- the ratcheting mechanism 46 is configured to prevent movement of the trigger 32 toward the initial position after the trigger 32 has been moved from the intermediate position toward the actuated position.
- the ratcheting mechanism 46 is actuated when the trigger 32 is moved from the intermediate position toward the actuated position by a predetermined distance.
- the ratcheting mechanism 46 is actuated when the trigger actuation surface 162 of the trigger stop 40 engages the trigger stop release member 152 of the trigger release button 96 as the trigger 32 is moved from the intermediate position toward the actuated position while the trigger release button 96 is pressed. In further examples, the ratcheting mechanism 46 is configured to automatically disengage when the trigger 32 reaches the actuated position to permit movement of the trigger 32 back toward to the initial position.
- the ratcheting mechanism 46 comprises a ratchet rod 120 that is selectively engagable with a ratchet lever 128 when the trigger 32 is moved from the intermediate position toward the actuated position.
- the ratchet rod 120 is movable axially in a distal-to-proximal direction as the trigger 32 is pivoted from the intermediate position ( FIG. 7 A ) toward the actuated position ( FIG. 7 E ).
- the ratchet rod 120 is linked to the trigger 32 via a coupler 131 (shown in FIG. 5 ).
- the ratchet rod 120 can pivot relative to the trigger 32 about the pins 168 (shown in FIG. 5 ).
- the ratchet lever 128 is movable between an initial position ( FIG.
- the ratchet lever 128 is pivotable about a ratchet pivot pin 132 .
- the ratchet lever 128 may be biased in a direction toward the initial position by a ratchet lever biasing mechanism, such as a ratchet lever spring 134 .
- a ratchet lever biasing mechanism such as a ratchet lever spring 134 .
- the proximal end of the ratchet rod 120 has one or more teeth 130 that interact with a ratchet lever 128 .
- Movement of the ratchet rod 120 in the proximal direction due to movement of the trigger 32 from the intermediate position toward the actuated position engages the proximal end of the ratchet rod 120 with the ratchet lever 128 .
- the initial contact between the proximal end of the ratchet rod 120 with the ratchet lever 128 displaces the ratchet lever 128 from the disengaged position toward the engaged position by pivoting the ratchet lever 128 against the ratchet lever spring 134 .
- the one or more teeth 130 of the ratchet rod 120 engage a locking tip 136 of the ratchet lever 128 when the trigger 32 is moved from the intermediate position toward the actuated position to prevent movement of the trigger 32 from the intermediate position toward the initial position.
- the ratchet rod 120 can include any number of teeth such that the trigger 32 can be progressively closed (i.e., brought into approximation of the handle 32 ) by more fully driving the ratchet rod 120 under the ratchet lever 128 in the direction of closure for the trigger 32 (e.g., from the configuration of FIG. 7 A to the configuration of FIG. 7 E ).
- the ratchet lever 128 may engage the ratchet rod 120 prior to the trigger 32 reaching the actuated position to prevent reverse movement of the trigger from the actuated position toward the initial position.
- the proximal end of the ratchet rod 120 can contact a ratchet lever engagement surface 138 at a proximal end of the ratchet lever 128 .
- the ratchet lever engagement surface 138 may be angled such that proximal movement of the ratchet rod 120 pivots the ratchet lever 128 .
- the ratchet lever 128 can be locked due to engagement of one or more locking tabs 139 on the ratchet lever 128 with at least a portion of the housing 36 .
- the one or more locking tabs 139 may be laterally deflectable between a first position, wherein the ratchet lever 128 can freely pivot about the ratchet pivot pin 132 , and a second position, wherein the ratchet lever 128 is locked relative to the housing 36 .
- the one or more locking tabs 139 may strike the housing 36 , thus causing a loud click to audibly alert the user that the trigger 32 has reached the actuated position and that jaws 18 , 20 have been closed. This audible confirmation indicates to the user that the fastener 22 has been closed and that the trigger 32 can be released.
- FIGS. 13 A and 13 B A non-limiting example embodiment of a ratchet lever 128 a is shown in FIGS. 13 A and 13 B , and ratchet lever 128 a includes a locking tip 136 a and two locking tabs 139 a .
- This non-limiting example embodiment of ratchet lever 128 a can be used in the embodiments of the fastener applicator of the present disclosure, including the embodiments of the fastener applicator shown in FIGS. 6 A, 6 B and 7 A- 7 E .
- the fastener applicator 10 is shown with a lockout mechanism 140 b in accordance with another example of the present disclosure.
- the components of the lockout mechanism 140 b shown in FIG. 6 B are substantially similar to the components of the lockout mechanism 140 a described herein with reference to FIG. 6 A .
- the previous discussion regarding the lockout mechanism 140 a generally shown in FIG. 6 A is applicable to the lockout mechanism 140 b shown in FIG. 6 B , only the relative differences between the two lockout mechanisms are discussed hereinafter.
- the trigger release button 96 has a stop member 150 positioned at a second free end 95 of the trigger release button 96 and configured for engaging at least a portion of the trigger stop 40 only when the trigger 32 is moved to the intermediate position.
- the trigger release button 96 and the trigger stop 40 of FIG. 6 B are configured to allow movement of the trigger 32 from the initial position even if the trigger release button 96 is pressed before the trigger 32 is moved from the initial position. In other words, if the trigger release button 96 is pressed and held, the trigger 32 can pass through the intermediate position without stopping and ultimately to the actuated position.
- the trigger stop release member 152 of the trigger release button 96 is configured for engaging at least a portion of the trigger stop 40 when the trigger 32 is positioned in the intermediate position between the initial position and the actuated position. Pressing the trigger release button 96 when the trigger 32 is in the intermediate position engages the trigger stop release member 152 with the trigger stop 40 to unlock the trigger stop 40 and permit movement of the trigger 32 from the intermediate position toward the actuated position. In some examples, pressing the trigger release button 96 when the trigger 32 is in the initial position engages the trigger stop release member 152 with the trigger stop 40 to unlock the trigger stop 40 and permit movement of the trigger 32 from the initial position toward the actuated position, thereby bypassing the locking of the trigger 32 in the intermediate position.
- the first stop member engagement surface 154 of the trigger stop 40 is configured as a substantially planar portion at a terminal portion of the second end 146 of the trigger stop 40 .
- the second stop member engagement surface 155 may be substantially planar, as opposed to the recessed configuration shown in FIG. 6 A . Pressing the trigger release button 96 prior to moving the trigger 32 from the intermediate position toward the actuated position engages the trigger stop release member 152 with the second stop member engagement surface 155 and the trigger actuation surface 162 of the trigger stop 40 to unlock the trigger stop 40 and permit movement of the trigger 32 toward the actuated position.
- FIGS. 7 A- 8 D and 10 A- 10 C a method of using the fastener applicator 10 to close the fastener 22 over the tissue structure will now be described with reference to FIGS. 7 A- 8 D and 10 A- 10 C .
- the fastener applicator 10 is shown in an initial or as-delivered configuration, wherein the trigger 32 is positioned in the initial position and the jaws 18 , 20 (shown in FIG. 8 A ) are in an open configuration to receive the fastener 22 therebetween.
- the jaws 18 , 20 are closed by manually moving the trigger 32 toward the handle 34 in the direction of arrow A in FIG. 7 B .
- the trigger 32 can be moved toward the handle 34 from the initial position ( FIG. 7 A ) by directing a proximally-directed force in the direction of arrow A on a distal side 110 of the trigger 32 .
- Closing the trigger 32 with respect to the handle 34 that is, pivoting about the trigger pivot pin 44 from the initial position of the trigger 32 (shown in FIG. 10 A or FIG. 7 A ), draws the pull rod 78 proximally toward a proximal end of the shaft 14 relative to the clamp tube 76 , which in turn closes the jaws 18 , 20 ( FIG. 8 B ).
- the trigger 32 can be moved in a proximal direction to close the jaws 18 , 20 or distally to open the jaws 18 , 20 during positioning of the fastener 22 relative to the tissue structure provided that the trigger 32 is not advanced past the intermediate position. This allows the user to carefully position the fastener 22 relative to the tissue structure without closing the fastener 22 .
- the trigger 32 is shown in the intermediate position, wherein the trigger 32 is temporarily locked relative to the handle 34 due to engagement of a trigger latch 156 on the trigger stop 40 with a trigger catch 158 on the trigger 32 .
- the trigger 32 is moved to the intermediate position and locked therein, further movement of the trigger 32 toward the initial position or the actuated position is prevented without further user input via the trigger release button 96 .
- the jaws 18 , 20 are closed in a “preview” position, wherein the legs 26 of the fastener 22 are brought toward one another to capture the tissue structure therebetween without engaging the tissue penetrating fasteners 30 ( FIG. 8 A ). This allows the user to preview the positioning of the fastener 22 relative to the tissue structure without closing the fastener 22 .
- the trigger 32 can be unlocked by pressing the trigger release button 96 to disengage the trigger latch 156 from the trigger catch 158 ( FIG. 7 C ).
- the trigger release button 96 By pressing the trigger release button 96 , at least a portion of the trigger release button 96 , such as the stop member 150 of the trigger release button 96 , contacts at least a portion of the trigger stop 40 , such as the release surface 160 on the trigger stop 40 , to move the trigger stop 40 and displace the trigger latch 156 from contact with the trigger catch 158 on the trigger 32 .
- the trigger 32 can then be moved distally relative to the handle 34 due to a restoring force of the trigger spring 42 (shown in FIG. 3 ). Movement of the trigger 32 toward the initial position and away from the handle 34 opens the jaws 18 , 20 to allow repositioning of the fastener 22 .
- the trigger 32 is unlocked from the intermediate position by pressing the trigger release button 96 to disengage the trigger latch 156 from the trigger catch 158 .
- the trigger 32 can then be advanced proximally toward the handle 34 by moving the trigger 32 in the direction of arrow A. Closing the trigger 32 with respect to the handle 34 moves the trigger stop 40 from a first position ( FIG. 7 C ) to a second position ( FIG. 7 E ) relative to the handle 34 to allow further proximal movement of the trigger 32 toward the actuated position.
- Closing the trigger 32 with respect to the handle 34 also proximally retracts the ratchet rod 120 which is linked to the trigger 32 .
- the trunnion 116 moves to a proximal end of the trigger slot 114 such that a center of the trunnion 116 , and therefore the opening 123 , is spaced apart proximally from a center of the trigger pivot pin 44 by a second predetermined distance X 2 that is larger than the first predetermined distance X 1 shown in FIG. 10 A .
- the trigger sub lever 122 is oriented such that its terminal end contacts the ratchet rod 120 and advances the ratchet rod 120 in a proximal direction. Proximal movement of the ratchet rod 120 due to movement of the trigger 32 past the intermediate position engages the teeth 130 of the ratchet rod 120 with the locking tip 136 of the locking lever 128 , thereby activating the ratcheting mechanism 46 . Once the ratcheting mechanism 46 is engaged, retraction of the trigger 32 in a direction toward the initial position ( FIG. 7 A ) is prevented. In this manner, the user is committed to closing the fastener 22 on the tissue structure by fully engaging the trigger 32 toward the actuated position.
- Closure of the trigger 32 from the intermediate position toward the actuated position further draws the pull rod 78 proximally toward a proximal end of the shaft 14 relative to the clamp tube 76 .
- the ejection tube 77 pulls at least one tendon 82 to retract the comb studs 66 .
- the jaws 18 , 20 are closed, the stud combs 66 engage the tissue penetrating fasteners 30 so that they engage and lock with each other, thus closing the two legs 26 of the fastener 22 , as shown in FIG. 8 C .
- the trigger stop 40 is deflected by the trigger 32 from the first position ( FIG. 7 A ) toward the second position ( FIG. 7 E ).
- the dampening cam 148 of the trigger stop 40 contacts the damper plunger 52 of the dampening mechanism 48 , thereby compressing the dampening spring 50 (shown in FIG. 3 ).
- the dampening plunger 52 engages the damper 54 (shown in FIG. 7 E ), which provides resistance to the compressive force directed to the trigger 32 in the direction of arrow A.
- the dampening cam 148 on the trigger stop 40 and the dampening mechanism 48 are configured such that the user feels a substantially constant reactive force from the trigger 32 during movement of the trigger 32 from the intermediate position toward the final position regardless of the position of the trigger 32 during its stroke between the intermediate position and the actuated position.
- the user may perceive a substantially constant reactive force from the trigger 32 while moving the trigger 32 toward the handle 34 in the direction of arrow A, thereby requiring a substantially constant compressive force on the trigger 32 during movement of the trigger 32 from the intermediate position toward the actuated position.
- the trigger 32 is moved to the actuated position to release the trigger 32 from the ratcheting mechanism 46 and allow retraction of the trigger 32 toward the initial position.
- the proximal end of the ratchet rod 120 contacts a ratchet lever disengagement surface 138 at a proximal end of the ratchet lever 128 , which lifts the ratchet lever 128 from the ratchet rod 120 and prevents reengagement with the ratchet rod 120 due to interaction of the one or more locking tabs 139 on the ratchet lever 128 with at least a portion of the housing 36 .
- the jaws 18 , 20 may be opened by releasing manual compression on the trigger 32 , thereby allowing the trigger spring 38 and the main spring 42 , which was compressed during closure of the trigger 32 to push the ratchet rod 120 distally forward, opening the jaws 18 , 20 and leaving the fastener 22 in place ( FIG. 8 D ).
- the fastener applicator 10 is used to deliver a fastener 22 over the base of a left atrial appendage LAA in an open chest, beating heart procedure.
- the sternum S is opened, spreading the ribs R to provide a working space over the heart H.
- the heart H may be lifted and turned, for example using a sheet of gauze or other material which is placed behind the heart, to expose the left atrial appendage LAA within the opening as shown in FIG. 9 .
- the jaws 18 , 20 of the fastener applicator 10 are placed around the base of the left atrial appendage LAA by manipulating the shaft 12 . Once the jaws 18 , 20 properly position the fastener 22 about the base of the left atrial appendage LAA, the jaws 18 , 20 are actuated and the fastener 22 is deployed as described previously.
Abstract
A surgical applicator for a fastener, the surgical applicator comprising: a handle; a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position; and a lockout mechanism movable relative to the trigger between a locked position and an unlocked position, the lockout mechanism operatively arranged to: lock the trigger in the intermediate position when the trigger is moved from the initial position toward the actuated position; and permit movement of the trigger from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position.
Description
- This application is a continuation of U.S. application Ser. No. 16/366,738, filed Mar. 27, 2019, and claims priority to U.S. provisional application No. 62/649,455, filed Mar. 28, 2018, both of which are incorporated herein by reference in their entireties.
- The present disclosure pertains broadly to the field of fasteners and/or applicators. More specifically, the disclosure relates to surgical applicators of implants and/or fasteners, including but not limited to sterilized fasteners such as staples.
- Atrial fibrillation is a relatively common condition characterized by a very rapid heartbeat of the left and right atrium. While atrial fibrillation is not normally fatal itself, it has been associated with an increased risk of stroke. It is believed that the rapid heartbeat causes blood to pool in the left atrial appendage (LAA) which causes emboli that are released into the left atrium from where they can enter the cerebral vasculature, thus causing a stroke. In addition to stroke, the emboli can enter coronary circulation, potentially causing myocardial infarction, or can enter peripheral circulation, potentially causing peripheral vascular disease.
- The risk of stroke in patients suffering from atrial fibrillation can be reduced in a variety of ways. For example, blood thinning drugs can be used to reduce the risk of clot formation. The use of blood thinners, however, is contraindicated in patients at risk of bleeding disorders. More aggressive treatment protocols have been proposed which involve closing the LAA. Closure and excision may be performed in open surgical procedures, typically requiring the patient to be placed on by-pass and the chest to be opened through the sternum. Alternatively, thoracoscopic and other less invasive procedures have been proposed. The tools are used to ablate or fuse the LAA from the inside using energy, adhesives, or the like.
- In some examples, a compliant closure structure may be used for closing the LAA. Such compliant structure may have an elastomeric body having a pair of opposed legs which may be arranged in an oval or a U-shaped configuration to define an opening therebetween. By placing the opening between the legs over the LAA and aligning it with the base of the LAA, the compliant closure structure may be closed to provide the desired sealing of the LAA. To hold the compliant closure structure closed, a number of discrete, axially spaced-apart tissue penetrating fasteners are arranged along the lengths of each of the legs. By compressing the legs together to press-fit the closure devices, the compliant closure structure may be closed to provide a compliant seal which effectively isolates the LAA.
- The compliant closure structure is closed using a hand-operated delivery tool having jaws which can be inserted into the legs of the closure structure and actuated to close the jaws in the legs over the LAA. The jaws further include comb studs which engage and press fit the closure devices in order to hold the compliant closure structure in its closed, sealing configuration. The studs are intended to be retracted to allow the delivery tool to be removed.
- Existing delivery tools have certain shortcomings. For example, the actuation of the jaws and retraction of the comb studs can be performed out of order, increasing the risk that the delivery of the compliant structure will fail. Additionally, existing delivery tools do not allow for repeated “previewing” of the placement of the compliant closure structure on the LAA without closing the tissue penetrating fasteners. Moreover, positioning and orientation of the delivery tool can be difficult, particularly when the tool is introduced through an intercostal penetration to access the LAA.
- For these reasons, it would be desirable to provide improved delivery tools for use with the compliant closure devices for sealing the LAA. It would be further desirable if the delivery tools and methods of their use were compatible with the delivery of other tissue closure devices and for procedures in addition to closure of the LAA.
- According to some non-limiting examples, a surgical applicator for a fastener may include a handle, a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position, and a lockout mechanism movable relative to the trigger between a locked position and an unlocked position. The lockout mechanism may be operatively arranged to: lock the trigger in the intermediate position when the trigger is moved from the initial position toward the actuated position, and permit movement of the trigger from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position.
- According to some non-limiting examples, the lockout mechanism may be further operatively arranged to permit movement of the trigger from the initial position to the actuated position when the lockout mechanism is moved from the locked position to the unlocked position prior to movement of the trigger from the initial position. The trigger may be movable relative to the handle from the initial position with application of a compressive force on the trigger in a direction toward the handle. The trigger may have a distal side opposite a proximal side facing the handle, and at least a portion of the lockout mechanism may be positioned on the distal side of the trigger.
- According to some non-limiting examples, the lockout mechanism may have a release button connected to the trigger, the release button being movable between a first position and a second position relative to the trigger. The lockout mechanism may further have a trigger stop connected to the handle, the trigger stop being movable between a first position and a second position relative to the handle. The release button may be pivotally movable relative to the trigger, or linearly movable in a direction lateral relative to the trigger. The release button may be biased to the first position by a release button biasing member. The trigger stop may be biased to the first position by a trigger stop biasing member. Movement of the trigger from the initial position toward the actuated position may engage the trigger with the trigger stop to automatically lock the trigger in the intermediate position. Movement of the release button from the first position to the second position when the trigger is in the intermediate position may permit disengagement of the trigger from the trigger stop.
- According to some non-limiting examples, a ratcheting mechanism may be provided to engage the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position. The ratcheting mechanism may disengage from the trigger when the trigger is moved to the actuated position. The ratcheting mechanism may have a ratchet rod and a ratchet that is engaged with the ratchet rod when the trigger is moved from the intermediate position toward the actuated position. The ratcheting mechanism may be actuated when the trigger is moved from the intermediate position toward the actuated position by a predetermined distance.
- According to some non-limiting examples, the surgical applicator may further have a jaw assembly selectively movable between an open position and a closed position via movement of the trigger from the initial position to the actuated position. The jaw assembly may have a pair of jaws movably attached to one another, with each jaw having a pair of lateral sides with a plurality of lateral slots extending through each lateral side. An outer surface of at least one of the lateral sides of each jaw may have a recess that receives a cover element for enclosing at least a portion of the plurality of lateral slots. The cover element may be adhesively secured in the recess. The jaws may be pivotally attached to one another by a pin. The surgical application may further include a dampening mechanism operatively arranged with the trigger to dampen variations in a compressive force applied on the trigger during movement between the initial position and the actuated position. The dampening mechanism may have a spring and a damper.
- According to some non-limiting examples, a surgical applicator for a fastener may have a handle, a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position, and a lockout mechanism. The lockout mechanism may include a release button connected to the trigger and a trigger stop connected to the handle. Movement of the trigger from the initial position toward the actuated position may engage the trigger stop with the trigger to lock the trigger in the intermediate position, and movement of the release button relative to the trigger when the trigger is in the intermediate position may disengage the trigger from the trigger stop to permit movement of the trigger from the intermediate position toward the initial position or the actuated position. The surgical applicator may further have a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position. The ratcheting mechanism may disengage from the trigger when the trigger is moved to the actuated position.
- According to some non-limiting examples, a surgical applicator for a fastener may have a handle, a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position, and an elongate body extending distally from the handle. The elongate body may have a distal portion, a jaw assembly at the distal portion selectively movable between an open position, a closed position, and an intermediate position between the open position and the closed position via movement of the trigger. The surgical applicator may further have a lockout mechanism operatively arranged to lock the trigger and the jaw assembly in the intermediate position when the trigger is moved from the initial position toward the actuated position, and permit movement of the trigger from the intermediate position toward the initial position or the actuated position to move the jaw assembly from the intermediate position toward the open position or the closed position, respectively.
- According to some non-limiting examples, a method of operating a fastener applicator may include moving a trigger of the fastener applicator from an initial position toward an actuated position by applying a compressive force on the trigger in a direction toward a handle of the fastener applicator, closing a jaw assembly of the fastener applicator from an open position toward a closed position via movement of the trigger, and locking the trigger and the jaw assembly in an intermediate position with a lockout mechanism. The method may further include moving the lockout mechanism from a locked position to an unlocked position, moving the trigger from the intermediate position toward the actuated position, and closing the jaw assembly from the intermediate position to the closed position via movement of the trigger. Closing the jaw assembly to the closed position may close a fastener from an unfixed position to a fixed position.
- According to some non-limiting examples, the method may further include blocking the trigger via a ratcheting mechanism from movement toward the initial position after the trigger is moved from the intermediate position toward the actuated position. The jaw assembly may move from the closed position toward the open position when the trigger is moved to the actuated position, or after the trigger is moved to the actuated position. The method may further include unlocking the trigger when the trigger is moved to the actuated position.
- Further examples of the present disclosure are set forth in the following numbered clauses.
- Clause 1: A surgical applicator for a fastener, the surgical applicator comprising:
-
- a handle;
- a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position; and
- a lockout mechanism movable relative to the trigger between a locked position and an unlocked position, the lockout mechanism operatively arranged to:
- lock the trigger in the intermediate position when the trigger is moved from the initial position toward the actuated position; and
- permit movement of the trigger from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position.
- lock the trigger in the intermediate position when the trigger is moved from the initial position toward the actuated position; and
- Clause 2: The surgical applicator of clause 1, wherein the lockout mechanism is further operatively arranged to permit movement of the trigger from the initial position to the actuated position when the lockout mechanism is moved from the locked position to the unlocked position prior to movement of the trigger from the initial position.
- Clause 3: The surgical applicator of clause 1 or clause 2, wherein the trigger is movable relative to the handle from the initial position with application of a compressive force on the trigger in a direction toward the handle.
- Clause 4: The surgical applicator of any of clauses 1-3, wherein the trigger has a distal side opposite a proximal side facing the handle, and wherein at least a portion of the lockout mechanism is positioned on the distal side of the trigger.
- Clause 5: The surgical applicator of any of clauses 1-4, wherein the lockout mechanism comprises:
-
- a release button connected to the trigger, the release button movable between a first position and a second position relative to the trigger, and
- a trigger stop connected to the handle, the trigger stop movable between a first position and a second position relative to the handle.
- Clause 6: The surgical applicator of clause 4, wherein the release button is pivotally movable relative to the trigger.
- Clause 7: The surgical applicator of clause 4, wherein the release button is linearly movable in a direction lateral relative to the trigger.
- Clause 8: The surgical applicator of clause 4, wherein the release button is biased to the first position by a release button biasing member.
- Clause 9: The surgical applicator of clause 4, wherein the trigger stop is biased to the first position by a trigger stop biasing member.
- Clause 10: The surgical applicator of clause 4, wherein movement of the trigger from the initial position toward the actuated position engages the trigger with the trigger stop to automatically lock the trigger in the intermediate position.
- Clause 11: The surgical applicator of clause 4, wherein movement of the release button from the first position to the second position when the trigger is in the intermediate position permits disengagement of the trigger from the trigger stop.
- Clause 12: The surgical applicator of any of clauses 1-11, further comprising a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position.
- Clause 13: The surgical applicator of
clause 10, wherein the ratcheting mechanism disengages from the trigger when the trigger is moved to the actuated position. - Clause 14: The surgical applicator of
clause 10, wherein the ratcheting mechanism comprises a ratchet rod and a ratchet that is engaged with the ratchet rod when the trigger is moved from the intermediate position toward the actuated position. - Clause 15: The surgical applicator of
clause 10, wherein the ratcheting mechanism is actuated when the trigger is moved from the intermediate position toward the actuated position by a predetermined distance. - Clause 16: The surgical applicator of any of clauses 1-15, further comprising a jaw assembly selectively movable between an open position and a closed position via movement of the trigger from the initial position to the actuated position.
- Clause 17: The surgical applicator of
clause 16, wherein the jaw assembly comprises a pair of jaws movably attached to one another, each jaw having a pair of lateral sides with a plurality of lateral slots extending through each lateral side. - Clause 18: The surgical applicator of
clause 17, wherein an outer surface of at least one of the lateral sides of each jaw has a recess. - Clause 19: The surgical applicator of
clause 18, wherein the recess receives a cover element that encloses at least a portion of the plurality of lateral slots. - Clause 20: The surgical applicator of
clause 17, wherein the cover element is adhesively secured in the recess. - Clause 21: The surgical applicator of
clause 17, wherein the jaws are pivotally attached to one another by a pin. - Clause 22: The surgical applicator of any of clauses 1-21, further comprising a dampening mechanism operatively arranged with the trigger to dampen variations in a compressive force applied on the trigger during movement between the initial position and the actuated position.
- Clause 23: The surgical applicator of
clause 22, wherein the dampening mechanism comprises a spring and a damper. - Clause 24: A surgical applicator for a fastener, the surgical applicator comprising:
-
- a handle;
- a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position; and
- a lockout mechanism comprising a release button connected to the trigger and a trigger stop connected to the handle,
- wherein movement of the trigger from the initial position toward the actuated position engages the trigger stop with the trigger to lock the trigger in the intermediate position, and
- wherein movement of the release button relative to the trigger when the trigger is in the intermediate position disengages the trigger from the trigger stop to permit movement of the trigger from the intermediate position toward the initial position or the actuated position.
- Clause 25: The surgical applicator of
clause 24, further comprising a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position. - Clause 26: The surgical applicator of
clause 24 or clause 25, wherein the ratcheting mechanism disengages from the trigger when the trigger is moved to the actuated position. - Clause 27: A surgical applicator for a fastener, the surgical applicator comprising:
-
- a handle;
- a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position;
- an elongate body extending distally from the handle, the elongate body having a distal portion;
- a jaw assembly at the distal portion of the elongate body, the jaw assembly selectively movable between an open position, a closed position, and an intermediate position between the open position and the closed position via movement of the trigger; and
- a lockout mechanism operatively arranged to:
- lock the trigger and the jaw assembly in the intermediate position when the trigger is moved from the initial position toward the actuated position; and
- permit movement of the trigger from the intermediate position toward the initial position or the actuated position to move the jaw assembly from the intermediate position toward the open position or the closed position, respectively.
- lock the trigger and the jaw assembly in the intermediate position when the trigger is moved from the initial position toward the actuated position; and
- Clause 28: A method of operating a fastener applicator, the method comprising:
-
- moving a trigger of the fastener applicator from an initial position toward an actuated position by applying a compressive force on the trigger in a direction toward a handle of the fastener applicator;
- closing a jaw assembly of the fastener applicator from an open position toward a closed position via movement of the trigger;
- locking the trigger and the jaw assembly in an intermediate position with a lockout mechanism;
- moving the lockout mechanism from a locked position to an unlocked position;
- moving the trigger from the intermediate position toward the actuated position; and
- closing the jaw assembly from the intermediate position to the closed position via movement of the trigger.
- Clause 29: The method of
clause 28, wherein closing the jaw assembly to the closed position closes a fastener from an unfixed position to a fixed position. - Clause 30: The method of
clause 28 or clause 29, further comprising blocking the trigger via a ratcheting mechanism from movement toward the initial position after the trigger is moved from the intermediate position toward the actuated position. - Clause 31: The method of any of clauses 28-30, wherein the jaw assembly moves from the closed position toward the open position when the trigger is moved to the actuated position, or after the trigger is moved to the actuated position.
- Clause 32: The method of any of clauses 28-31, further comprising unlocking the trigger when the trigger is moved to the actuated position.
- These and other features and characteristics of the present invention, as well as the methods of operation and functions of the related elements of structures and the combination of parts and economies of manufacture, will become more apparent upon consideration of the following description and the appended claims with reference to the accompanying drawings, all of which form a part of this specification, wherein like reference numerals designate corresponding parts in the various figures. It is to be expressly understood, however, that the drawings are for the purpose of illustration and description only and are not intended as a definition of the limits of the invention.
- Additional advantages and details of the invention are explained in greater detail below with reference to the exemplary examples that are illustrated in the accompanying schematic figures, in which:
-
FIG. 1 is a side view of a fastener applicator constructed in accordance with an example of the present disclosure; -
FIG. 2 is a perspective view of a tissue closure device in accordance with an example of the present disclosure; -
FIG. 3 is an exploded perspective view of the fastener applicator shown inFIG. 1 ; -
FIG. 4A is a perspective view of a pull rod assembly of the fastener applicator shown inFIG. 1 ; -
FIG. 4B is an exploded perspective view of the pull rod assembly shown inFIG. 4A ; -
FIG. 4C is a top view of a shaft of a pull rod assembly; -
FIG. 4D is a top partial cross-sectional view of the shaft shown inFIG. 4C ; -
FIG. 4E is a cross-sectional view of the shaft shown inFIGS. 4C-4D taken along line A-A; -
FIG. 5 is an exploded perspective view of a trigger assembly of the fastener applicator shown inFIG. 1 ; -
FIG. 6A is a detailed perspective view of a trigger release button and trigger stop of a fastener applicator in accordance with an example of the present disclosure; -
FIG. 6B is a detailed perspective view of a trigger release button and trigger stop of a fastener applicator in accordance with another example of the present disclosure; -
FIG. 7A is a side view of the trigger assembly of the fastener applicator shown inFIG. 1 , showing a trigger in an initial position; -
FIG. 7B is a side view of the trigger assembly of the fastener applicator shown inFIG. 1 , showing the trigger in a decision or intermediate position and a release button in a first position; -
FIG. 7C is a side view of the trigger assembly of the fastener applicator shown inFIG. 1 , showing the trigger in a decision or intermediate position with the release button moved from the first position to a second position; -
FIG. 7D is a side view of the trigger assembly of the fastener applicator shown inFIG. 1 , showing the trigger in a position between the intermediate position and the actuated position; -
FIG. 7E is a side view of the trigger assembly of the fastener applicator shown inFIG. 1 , showing the trigger in a final or actuated position; -
FIGS. 8A-8D illustrate the movement of a jaw assembly and engagement thereof with a tissue closure device according to an example of the present disclosure; -
FIG. 9 illustrates use of the fastener applicator according to an example of the present disclosure, wherein the fastener applicator is used for closing a tissue closure device over a LAA; -
FIGS. 10A-10C are schematic views of a trigger and a trigger sub lever illustrating the movement of the trigger between an initial position and an actuated position according to an example of the present disclosure; -
FIG. 11 is a perspective view of a trigger release button in accordance with an example of the present disclosure; -
FIG. 12A is a top, perspective view of a trigger stop in accordance with an example of the present disclosure; -
FIG. 12B is a bottom, perspective view of a trigger stop in accordance with an example of the present disclosure; -
FIG. 13A is a top, perspective view of a ratchet lever in accordance with an example of the present disclosure; and -
FIG. 13B is a bottom, perspective view of a ratchet lever in accordance with an example of the present disclosure. - In
FIGS. 1-13B , like characters refer to the same components and elements, unless otherwise stated. - Spatial or directional terms, such as “left”, “right”, “inner”, “outer”, “above”, “below”, and the like, are not to be considered as limiting as the invention can assume various alternative orientations. For purposes of the description hereinafter, the terms “end,” “upper,” “lower,” “right,” “left,” “vertical,” “horizontal,” “top,” “bottom,” “lateral,” “longitudinal,” and derivatives thereof shall relate to the invention as it is oriented in the drawing figures.
- As used in the specification and the claims, the singular form of “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise.
- All numbers used in the specification and claims are to be understood as being modified in all instances by the term “about”. By “about” is meant a range of plus or minus ten percent of the stated value.
- Unless otherwise indicated, all ranges or ratios disclosed herein are to be understood to encompass any and all subranges or subratios subsumed therein. For example, a stated range or ratio of “1 to 10” should be considered to include any and all subranges between (and inclusive of) the minimum value of 1 and the maximum value of 10; that is, all subranges or subratios beginning with a minimum value of 1 or more and ending with a maximum value of 10 or less, such as but not limited to, 1 to 6.1, 3.5 to 7.8, and 5.5 to 10.
- The terms “first”, “second”, and the like are not intended to refer to any particular order or chronology, but instead refer to different conditions, properties, or elements.
- By “at least” is meant “greater than or equal to”. By “not greater than” is meant “less than or equal to”.
- The term “includes” is synonymous with “comprises”.
- The terms “proximal” or “proximally”, when used in reference to any portion of the fastener applicator, refer to a portion of the fastener applicator closest to a body of a user handling the fastener applicator during use of the fastener applicator. Conversely, the terms “distal” or “distally”, when used in reference to any portion of the fastener applicator, refer to a portion of the fastener applicator furthest away from a body of a user handling the fastener applicator during use of the fastener applicator.
- It is to be understood that the specific devices and processes illustrated in the attached drawings, and described in the following specification, are simply exemplary examples or aspects of the invention. Hence, specific dimensions and other physical characteristics related to the examples or aspects disclosed herein are not to be considered as limiting.
- Various examples of the present disclosure provide alternative and improved devices, systems, and methods for deploying one or more closure devices or fasteners to tissue. An exemplary tissue structure of a patient at risk of stroke or other adverse events resulting from emboli released into circulation from the LAA, may include the LAA.
- Referring now to
FIG. 1 , a fastener applicator 10 (also referred to herein as “surgical applicator” or “applicator”) constructed in accordance with various examples of the present disclosure has ashaft 12 having ahandle assembly 17 at itsproximal end 13, and ajaw assembly 16 at adistal end 15, whereindividual jaws FIG. 2 ). Thehandle assembly 17 has atrigger 32 movable relative to ahandle 34 between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position. Thetrigger 32 is movable relative to thehandle 34 from the initial position with application of a compressive force on thetrigger 32 in a direction toward the handle 34 (arrow A inFIG. 1 ). In various examples of the present disclosure, thefastener applicator 10 is configured for introducing thefastener 22 over the tissue structure. - With reference to
FIG. 2 , thefastener 22 is shown in accordance with one non-limiting example of the present disclosure. Thefastener 22 has a substantially U-shaped configuration for receiving the tissue structure, such as the LAA or other tissue structure, when thejaws fastener applicator 10 are open. Thefastener 22 has acompressible body 24 and a pair ofparallel legs 26 having two opposed compliant tissue-engagingsurfaces 28. Thelegs 26 are movable between an open or unfixed position and a closed or fixed position. In some examples, thelegs 26 are each comprised of a soft biologically compatible material. Thefastener 22 further has a plurality of tissue-penetratingfasteners 30 spaced-apart along thelegs 26 and disposed to extend from a first one of the tissue-engagingsurfaces 28, through tissue at a puncture site, to a second one of the tissue-engagingsurfaces 28 to close the tissue structure therebetween. The plurality of tissue-penetratingfasteners 30 apply a desired level of compression force, which is determined by both the softness of thecompressible body 24 and the distance between the tissue-engagingsurfaces 28 when they are fully connected to the tissue structure. When connected to the tissue structure, thefastener 22 is left in place in order to close and/or seal the tissue structure. A portion of the tissue structure extending beyond thefastener 22 may then be cut, excised, or otherwise removed, although this may be left to the physician's preference. More detailed description of various fasteners suitable for use with thefastener applicator 10 of the present disclosure are described in U.S. Pat. No. 7,992,757, the full disclosure of which is incorporated herein by reference. - Referring now to
FIG. 3 , an exploded view of thefastener applicator 10 ofFIG. 1 is shown. Thehandle assembly 17 has ahousing 36 comprising afirst housing portion 36 a and asecond housing portion 36 b coupled to one another and defining an interior space for receiving the working components of thehandle assembly 17. Thefirst housing portion 36 a and thesecond housing portion 36 b, when assembled together, define thehandle 34 that is grasped by the user when handling thefastener applicator 10. In some examples, the first andsecond portions housing 36 are coupled using one ormore handle fasteners 38. In other examples, the first andsecond portions housing 36 may be coupled using clips, grooves, adhesive, welding, or any other mechanical fastening arrangement. In various examples, the first andsecond portions housing 36 may be removably or non-removably coupled to one another. - With continued reference to
FIG. 3 , the interior space of thehousing 36 receives various components for actuating thesurgical applicator 10 between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position. For example, thehousing 36 may receive various gears, linkages, springs, or the like to effect movement or actuation of thetrigger 32 between the initial position, the actuated position, and the intermediate position between the initial position and the actuated position. As discussed herein, thehousing 36 receives at least a portion of thetrigger 32 that is movable relative to thehousing 36 in a pivoting motion about atrigger pivot pin 44. Thetrigger 32 may be biased to the initial position by a trigger biasing member, such as atrigger spring 38. Thetrigger spring 38 is compressible with movement of thetrigger 32 from the initial position such that a restoring force is generated in thetrigger spring 38 that restores thetrigger 32 to the initial position when an urging force on thetrigger 32 is removed or reduced to a magnitude that is lower than the restoring force of thetrigger spring 38. In some examples, thetrigger 32 has atrigger stop 40 pivotally connected to at least a portion of thehousing 36. Thetrigger stop 40 may be movable between a first position and a second position relative to thehandle 34. Thetrigger stop 40 is biased to the first position by a trigger stop biasing member, such as atrigger stop spring 50. - With continued reference to
FIG. 3 , thehousing 36 receives aratcheting mechanism 46 having aratchet rod 120 and aratchet 128, as discussed herein. Theratcheting mechanism 46 engages when thetrigger 32 is moved from the intermediate position toward the actuated position to prevent movement of thetrigger 32 toward the initial position. In some examples, theratcheting mechanism 46 disengages when thetrigger 32 reaches the actuated position such that thetrigger 32 automatically moves toward the initial position when theratcheting mechanism 46 is disengaged, or when the force applied to the trigger is relieved. A dampeningmechanism 48 is received within thehousing 36 and operatively arranged with thetrigger 32 to dampen variations in a compressive force applied on thetrigger 32 during movement between the initial position and the actuated position. In some examples, the dampeningmechanism 48 has a dampeningspring 50 received within adamper plunger 52 and adamper 54. In various examples, thedamper 54 may be a friction damper, an elastomeric damper, a magnetic damper, a viscous damper, or any combination thereof. - With reference to
FIG. 4A , thejaw assembly 16 is illustrated separate from the remaining components of thefastener applicator 10.FIG. 4B is an exploded view of thejaw assembly 16 ofFIG. 4A . As described herein, thejaw assembly 16 is movable between an open position (shown inFIGS. 4A-4B ) and a closed position (shown inFIGS. 8B-8C ) via movement of thetrigger 32 from the initial position to the actuated position. Thejaw assembly 16 comprises a pair ofjaws jaws washer 58. In some examples, the hinge pin 56 and thewasher 58 may be welded together, such as using laser welding, ultrasonic welding, or other type of welding. In other examples, the hinge pin 56 and thewasher 58 are adhesively connected with each other, threadably connected with each other, or connected by way of any other removable or non-removable mechanical connection. - With continued reference to
FIGS. 4A-4B , eachjaw lateral slots 62 extending therethrough. Thelateral slots 62 define a channel for guiding the movement of jaw cam pins 64. A singlejaw cam pin 64 is received within eachlateral slot 62 and is movable within thelateral slot 62 between a first position and a second position. In the first position, the jaw cam pins 64 in eachjaw stud comb 66 such that thecomb 66 is in an extended or exposed position within thejaws jaw stud comb 66 in eachjaw comb 66 acts on thetissue penetrating fasteners 30 of thefastener 22. - With continued reference to
FIGS. 4A-4B , thejaws clamp box 68. In some examples, theclamp box 68 has a pair ofsides 68 a, 68 b defining acentral opening 70 therebetween for receiving thejaws sides 68 a, 68 b of theclamp box 68 may be removably or non-removably connected to one another, such as by one ormore rivets 72. The movement of thejaws guide slots 63 on each of thejaws FIG. 4B ) on theclamp box 68. - The
clamp box 68 receives adistal end 74 of at least a portion of theshaft 14, such as the distal end of theclamp tube 76. With reference toFIGS. 4C-4E , theshaft 14 comprises theclamp tube 76 slidably received within anejection tube 77 and aninner pull rod 78 slidably received within theclamp tube 76 such that the clamp tube,ejection tube 77, and theinner pull rod 78 are coaxially disposed relative to one another. Theclamp tube 76 may be rotatable about its longitudinal axis to rotate theclamp box 68 and thejaws jaws handle assembly 17 during use of thefastener applicator 10. In some examples, theshaft 14 is rotatable about its longitudinal axis with rotation of the positioning knob 88 (shown inFIG. 5 ). - The
pull rod 78 is axially movable relative to theclamp tube 76 with movement of thetrigger 32. For example, thepull rod 78 may be movable in a direction extending between the proximal and distal ends of theshaft 14 and along a longitudinal axis thereof. Movement or closure of thetrigger 32 from the initial position toward the actuated position draws thepull rod 78 proximally toward aproximal end 80 of theshaft 14 relative to theclamp tube 76 and theejection tube 77, which in turn closes thejaws ejection tube 77 has at least onetendon 82 connected at its distal end. The at least onetendon 82 is operatively connected with thecomb stud 66 such that movement of thetrigger 32 to the activated position also pulls the at least onetendon 82 to cause the retraction of thecomb stud 66. - With reference to
FIGS. 4A-4B , an outer surface of at least one of the lateral sides 60 of eachjaw recess 84. Therecess 84 may be formed as a channel that extends into the body of eachjaw lateral slots 62. In some examples, therecess 84 receives a cover element 86 (also shown inFIG. 3 ) that encloses at least a portion of the plurality oflateral slots 62. A thickness of thecover element 86 may be chosen such that an outer surface of thecover element 86 may be flush with the surface of the lateral side 60. In other examples, the thickness of thecover element 86 may be chosen such that its outer surface is recessed relative to the surface of the lateral side 60, or such that the outer surface of thecover element 86 protrudes laterally from the surface of the lateral side 60. In some examples, thecover element 86 may be adhesively secured in therecess 84. In further examples, thecover element 86 may be transparent such that thelateral slots 62 and the jaw cam pins 64 can be seen through thecover element 86. When positioned in therecess 84, thecover element 86 prevents contamination of thelateral slots 62 and the jaw cam pins 64 during use of thefastener applicator 10 which may cause the blockage of one or morelateral slots 62 and/or impede the movement of one or more jaw cam pins 64 through thelateral slots 62. - With reference to
FIG. 5 , thetrigger 32 comprises afirst trigger portion 32 a and a second trigger portion 32 b coupled to one another. Thefirst trigger portion 32 a and the second trigger portion 32 b, when assembled together, define thetrigger 32 that is grasped by the user when handling thefastener applicator 10. In some examples, the first andsecond trigger portions 32 a, 32 b are coupled using one ormore trigger fasteners 90. In other examples, the first andsecond trigger portions 32 a, 32 b may be coupled using clips, grooves, adhesive, welding, press fit, or any other mechanical fastening arrangement. In various examples, the first andsecond trigger portions 32 a, 32 b may be removably or non-removably coupled to one another. - With continued reference to
FIG. 5 , eachtrigger portion 32 a, 32 b has afirst end 92 that is received within the housing 36 (shown inFIG. 3 ) and pivotally movable relative to thehousing 36. A secondfree end 94 extends opposite thefirst end 92 and protrudes outside thehousing 36. The secondfree end 94 of thetrigger 32 is configured for being grasped by the user during movement of thetrigger 32 between the initial position and the activated position. Thetrigger 32 further has adistal side 110 opposite aproximal side 108 facing the handle. As described herein, at least a portion of a lockout mechanism is positioned on thedistal side 110 of thetrigger 32. - With continued reference to
FIG. 5 , thetrigger 32 has a pivot pin opening 112 configured for receiving the trigger pivot pin 44 (shown inFIG. 3 ). Thetrigger 32 is pivotally movable about a longitudinal axis of thetrigger pivot pin 44 which has its terminal ends secured to thehousing 36. Atrigger slot 114 extends through the body at thefirst end 92 of thetrigger 32. Thetrigger slot 114 is configured to receive aclosing trunnion 116 connected to the distal end of thepull rod 78. Thetrigger slot 114 acts as a camming mechanism for controlling the movement of thepull rod 78 due to the movement of the closingtrunnion 116 within thetrigger slot 114. In some examples, the shape of thetrigger slot 114 is configured to result in a linear movement of thepull rod 78 in a direction of alongitudinal axis 118 of theshaft 14 as a result of a pivoting movement of the trigger about thetrigger pivot pin 44. The closingtrunnion 116 may contact or be positioned in near contact with a first end of thetrigger slot 114 when thetrigger 32 is in the initial position (FIG. 7A ). Similarly, the closingtrunnion 116 may contact or be positioned in near contact with a second end (opposite the first end) of thetrigger slot 114 when thetrigger 32 is in the actuated position (FIG. 7E ). The closingtrunnion 116 may be positioned between the first end and the second end of thetrigger slot 114 when thetrigger 32 is in the intermediate position between the initial position and the actuated position. Lateral pins of anejection trunnion 164 are received within anopening 123 extending through a first end of a trigger sub lever 122 (see, also,FIGS. 10A-10C ) such that movement of thetrigger 32 also causes a corresponding movement of thetrigger sub lever 122 due to movement of theejection trunnion 164 within the trigger slot 114 (seeFIGS. 10A-10C ). - With continued reference to
FIG. 5 , a second end of thetrigger sub lever 122 has apin 125 that is pivotally connected to thetrigger 32. In this manner, the first end of thetrigger sub lever 122 is slidably movable relative to thetrigger slot 166 and theejection trunnion 164, while the second end of thetrigger sub lever 122 is pivotally movable relative to the triggersub stop feature 172 on the handle 34 (seeFIGS. 10A-10C ). When the second end oftrigger sub lever 122 strikes the triggersub stop feature 172 on thehandle 34, and thetrigger 32 continues moving proximally toward an actuated position, relative motion of the first end of thetrigger sub lever 122 is amplified by pivoting about apin 125. Amplification is determined by the ratio of the two distances L1 and L2 inFIG. 10B . L1 is the distance between the triggersub stop feature 172 and the triggersub lever pin 125 while L2 is the distance between the triggersub lever pin 125 and theejection trunnion 164. Thetrigger sub lever 122 effects theejection trunnion 164 via the triggersub lever slot 170. In this manner, a first (small) movement of thetrigger 32 can have a second (greater) movement on theejection trunnion 164 due to theejection trunnion 164 being linked to theejection tube 77. In this manner, thecombs 66 can be retracted via thetendons 82 to release the fastener 22 (shown inFIG. 2 ). - With reference to
FIG. 6A , thefastener applicator 10 has a lockout mechanism 140 a movable relative to thetrigger 32 between a locked position and an unlocked position. The lockout mechanism 140 a inFIG. 6A is shown in accordance with one example of the present disclosure. The lockout mechanism 140 a is operatively arranged to lock thetrigger 32 in the intermediate position (FIG. 7B ) when thetrigger 32 is moved from the initial position toward the actuated position. The lockout mechanism 140 a is further operatively arranged to permit movement of thetrigger 32 from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position (FIG. 7C ). The lockout mechanism 140 a is further operatively arranged to lock thetrigger 32 in the initial position when atrigger release button 96 is moved from the first position to the second position prior to movement of thetrigger 32 from the initial position. - With continued reference to
FIG. 6A , the lockout mechanism 140 a comprises thetrigger release button 96, thetrigger stop 40, and theratcheting mechanism 46. As described herein, movement of thetrigger 32 from the initial position toward the actuated position engages thetrigger 32 with thetrigger stop 40 and moves the trigger stop 40 to automatically lock thetrigger 32 in the intermediate position. To release thetrigger 32 from the intermediate position, movement of thetrigger release button 96 from the first position to the second position about the trigger releasebutton pivot pin 100 when thetrigger 32 is in the intermediate position permits disengagement of the trigger stop 40 from thetrigger 32. In this manner, thetrigger 32 can be retracted to the initial position due to a restoring force of thetrigger spring 38 or moved to the actuated position to close the fastener 22 (shown inFIG. 2 ). - The
trigger release button 96 extends through anopening 98 on thetrigger 32 between thefirst end 92 and the second free end 94 (FIG. 5 ). In various examples, thetrigger release button 96 is positioned relative to the first and second ends 92, 94 of thetrigger 32 such that thetrigger release button 96 may be operated using the user's index finger that contacts apressing surface 97 of thetrigger release button 96. Thetrigger release button 96 is movable between a first position, wherein thetrigger release button 96 protrudes from theopening 98, and a second position, wherein at least a portion of thetrigger release button 96 is moved into theopening 98 on the trigger. In some examples, thetrigger release button 96 may protrude from theopening 98 in the first position and the second position. - The
trigger release button 96 is pivotally movable relative to thetrigger 32 between the first position and the second position about the first trigger releasebutton pivot pin 100. In other examples, thetrigger release button 96 may be linearly movable relative to thetrigger 32, such as by movement in a proximal/distal direction of thefastener applicator 10, or in a lateral direction relative to thetrigger 32. A triggerrelease button slot 104 in thetrigger release button 96 receives a second triggerrelease button pin 106 and may delimit a range of movement of thetrigger release button 96. The second triggerrelease button pin 106 may contact or be positioned in near contact with a first end of the triggerrelease button slot 104 when thetrigger release button 96 is in the first position. Similarly, the second triggerrelease button pin 106 may contact or be positioned in near contact with a second end (opposite the first end) of the triggerrelease button slot 104 when thetrigger release button 96 is in the second position. - The
trigger release button 96 is biased to the first position by a release button biasing member, such as a triggerrelease button spring 102. The triggerrelease button spring 102 is compressible with movement of thetrigger release button 96 from the first position toward the second position such that a restoring force is generated in the triggerrelease button spring 102 that restores thetrigger release button 96 to the first position when an urging force on thetrigger release button 96 is removed and thetrigger release button 96 is disconnected from thetrigger stop 40. - With continued reference to
FIG. 6A , thetrigger release button 96 has astop member 150 positioned at a secondfree end 95 of thetrigger release button 96 and configured for engaging at least a portion of the trigger stop 40 to prevent movement of thetrigger 32 from the initial position if thetrigger release button 96 is pressed before thetrigger 32 is moved to the intermediate position. In this manner, thetrigger 32 can be moved from the initial position only if thetrigger release button 96 is not pressed. In some examples, thestop member 150 may be configured as a rounded tip at the second end of thetrigger release button 96. - With continued reference to
FIG. 6A , thetrigger release button 96 has a triggerstop release member 152 positioned between the first trigger releasebutton pivot pin 100 and thestop member 150. The triggerstop release member 152 is configured for engaging at least a portion of thetrigger stop 40 when thetrigger 32 is positioned in the intermediate position between the initial position and the actuated position. Pressing thetrigger release button 96 when thetrigger 32 is in the intermediate position engages the triggerstop release member 152 with the trigger stop 40 to unlock thetrigger stop 40 and permit movement of thetrigger 32 from the intermediate position toward the actuated position or the initial position. In some examples, the triggerstop release member 152 may be shaped as a rounded protrusion at a proximal portion of thetrigger release button 96 between the first trigger releasebutton pivot pin 100 and thestop member 150. - A non-limiting example embodiment of a trigger release button 96 a is shown in
FIG. 11 . The embodiment of the trigger release button 96 a includes a pressing surface 97 a, a trigger release button slot 104 a, and a stop member 150 a. In the embodiment of the trigger release button 96 a shown inFIG. 11 , the pressing surface 97 a includes a raisedcross pattern 197, which provides a distinct surface for the user to locate the trigger release button and an increased grip to the user, thereby making the fastener applicator easier to use. This non-limiting example embodiment of trigger release button 96 a can be used in the embodiments of the fastener applicator of the present disclosure, including the embodiments of the fastener applicator shown inFIGS. 6A, 6B and 7A-7E . - With continued reference to
FIG. 6A , thetrigger stop 40 is connected to thehandle 34 and is movable relative to thehandle 34 between a first position (FIG. 7A ) and a second position (FIG. 7E ). Thetrigger stop 40 is biased to the first position by a trigger stop biasing member, such as the dampening spring 50 (FIG. 3 ). In some examples, thetrigger stop 40 is pivotally movable relative to thehandle 34 between the first position and the second position about atrigger stop pin 142. Thetrigger stop 40 has afirst end 144 that is pivotable about thetrigger stop pin 142 and a secondfree end 146 opposite thefirst end 144. - At least a portion of the
trigger stop 40 may be recessed within thehousing 36 of thehandle 34 when thetrigger stop 40 is in the first position. For example, thefirst end 144 and thesecond end 146 of thetrigger stop 40 may be recessed within thehousing 36 of thehandle 34 when thetrigger stop 40 is in the first position. In some examples, at least a portion of thetrigger stop 40 may extend from thehousing 36 of thehandle 34 when thetrigger stop 40 is pivoted from the first position toward the second position. For example, thefirst end 144 of thetrigger stop 40 may be recessed within the interior of thehousing 36 of thehandle 34 while at least a portion of thesecond end 146 of the trigger stop 40 protrudes from the interior of thehousing 36 when thetrigger stop 40 is pivoted from the first position toward the second position. - With continued reference to
FIG. 6A , thetrigger stop 40 has a dampeningcam 148 configured for interacting with the dampeningmechanism 48 when thetrigger 32 is moved from the intermediate position toward the actuated position. The dampeningcam 148 is positioned at thefirst end 144 of thetrigger stop 40 and is shaped to vary the displacement of the dampening spring 50 (shown inFIG. 3 ) and the dampeningplunger 52 during the stroke of thetrigger 32 between the intermediate position toward the actuated position. As the dampeningplunger 52 is compressed against the restoring force of the dampeningspring 50, the dampeningplunger 52 engages the damper 54 (shown inFIG. 7E ). In some examples, the dampeningcam 148 on thetrigger stop 40 and the dampeningmechanism 48 may be configured to require a persistant resistive force on thetrigger 32 during movement of thetrigger 32 from the intermediate position toward the final position regardless of the position of thetrigger 32 during its stroke between the intermediate position and the final position. In this manner, the user does not need to vary the force input on thetrigger 32 during activation of thefastener applicator 10 which may inadvertently change the position of the jaw assembly 16 (shown inFIG. 1 ) relative to the tissue structure. - With continued reference to
FIG. 6A , thesecond end 146 of thetrigger stop 40 has a first stopmember engagement surface 154 configured for engaging thestop member 150 of thetrigger release button 96 if thetrigger release button 96 is pressed while thetrigger 32 is positioned in the initial position. Contact between the first stopmember engagement surface 154 of thetrigger stop 40 and thestop member 150 of thetrigger release button 96 prevents movement of thetrigger 32 from the initial position toward the actuated position if thetrigger release button 96 is pressed before thetrigger 32 is moved to the intermediate position. In this manner, thetrigger 32 is locked in the initial position until thetrigger release button 96 is released, thereby disengaging the first stopmember engagement surface 154 of the trigger stop 40 from thestop member 150 of thetrigger release button 96. In some examples, the first stopmember engagement surface 154 of thetrigger stop 40 may be configured as a recess at a terminal portion of thesecond end 146 of thetrigger stop 40. - Movement of the
trigger 32 to the intermediate position locks thetrigger 32 relative to thehandle 34 due to engagement of atrigger latch 156 on the trigger stop 40 with atrigger catch 158 on thetrigger 32. In some examples, thetrigger latch 156 on thetrigger stop 40 is configured as at least one protrusion that extends laterally away from at least one lateral side of thetrigger stop 40. In some examples, thetrigger latch 156 is a pair of protrusions that extend laterally away from opposing lateral sides of thetrigger stop 40. Thetrigger catch 158 on thetrigger 32 may be configured as a recess on aproximal side 108 of thetrigger 32 that is shaped to receive at least a portion of thetrigger latch 156. - The
trigger latch 156 and thetrigger catch 158 engage when thetrigger 32 is moved to the intermediate position and prevent movement of thetrigger 32 toward the initial position or the actuated position. Thetrigger latch 156 and thetrigger catch 158 are disengaged by pressing thetrigger release button 96, whereby at least a portion of thetrigger release button 96 contacts at least a portion of the trigger stop 40 to move thetrigger stop 40 and displace thetrigger latch 156 from contact with thetrigger catch 158 on thetrigger 32. In some examples, thestop member 150 of thetrigger release button 96 engages arelease surface 160 on the trigger stop 40 to move thetrigger stop 40 and displace thetrigger latch 156 from contact with thetrigger catch 158 on thetrigger 32. Therelease surface 160 may be positioned at thesecond end 146 of thetrigger stop 40 and proximally of thestop member 150. - With continued reference to
FIG. 6A , thetrigger stop 40 has atrigger actuation surface 162 positioned proximally of a second stopmember engagement surface 155 and therelease surface 160. Thetrigger actuation surface 162 of thetrigger stop 40 is configured for engaging the triggerstop release member 152 of thetrigger release button 96 when thetrigger 32 is moved from the intermediate position toward the actuated position while thetrigger release button 96 is pressed. Pressing thetrigger release button 96 when thetrigger 32 is moved from the intermediate position toward the actuated position engages the triggerstop release member 152 with thetrigger actuation surface 162 of the trigger stop 40 to unlock thetrigger stop 40 and permit movement of thetrigger 32 toward the actuated position. In some examples, thetrigger actuation surface 162 may be shaped as a ramp that engages the triggerstop release member 152 of thetrigger release button 96. In examples where thetrigger actuation surface 162 is shaped as a slot, thetrigger actuation surface 162 provides clearance for movement of the triggerstop release member 152 along thetrigger actuation surface 162. - A non-limiting example embodiment of a trigger stop 40 a is shown in
FIGS. 12A and 12B . The embodiment of the trigger stop 40 a includes a first end 144 a, a second end 146 a, a dampening cam 148 a, a first stop member engagement surface 154 a, a trigger latch 156 a, a release surface 160 a, and a trigger actuation surface 162 a. This non-limiting example embodiment of trigger stop 40 a can be used in the embodiments of the fastener applicator of the present disclosure, including the embodiments of the fastener applicator shown inFIGS. 6A, 6B and 7A-7E . - With continued reference to
FIG. 6A , the lockout mechanism 140 a further comprises theratcheting mechanism 46 that engages when thetrigger 32 is moved from the intermediate position toward the actuated position. Theratcheting mechanism 46 is configured to prevent movement of thetrigger 32 toward the initial position after thetrigger 32 has been moved from the intermediate position toward the actuated position. In some examples, theratcheting mechanism 46 is actuated when thetrigger 32 is moved from the intermediate position toward the actuated position by a predetermined distance. In further examples, theratcheting mechanism 46 is actuated when thetrigger actuation surface 162 of thetrigger stop 40 engages the triggerstop release member 152 of thetrigger release button 96 as thetrigger 32 is moved from the intermediate position toward the actuated position while thetrigger release button 96 is pressed. In further examples, theratcheting mechanism 46 is configured to automatically disengage when thetrigger 32 reaches the actuated position to permit movement of thetrigger 32 back toward to the initial position. - The
ratcheting mechanism 46 comprises aratchet rod 120 that is selectively engagable with aratchet lever 128 when thetrigger 32 is moved from the intermediate position toward the actuated position. Theratchet rod 120 is movable axially in a distal-to-proximal direction as thetrigger 32 is pivoted from the intermediate position (FIG. 7A ) toward the actuated position (FIG. 7E ). Theratchet rod 120 is linked to thetrigger 32 via a coupler 131 (shown inFIG. 5 ). Theratchet rod 120 can pivot relative to thetrigger 32 about the pins 168 (shown inFIG. 5 ). Theratchet lever 128 is movable between an initial position (FIG. 7A ) and an engaged position (FIGS. 7D-7E ). In some examples, theratchet lever 128 is pivotable about aratchet pivot pin 132. Theratchet lever 128 may be biased in a direction toward the initial position by a ratchet lever biasing mechanism, such as aratchet lever spring 134. Moving thetrigger 32 from the initial position (FIG. 7A ) toward the actuated position (FIG. 7E ) results in an axial movement of thepull rod 78 in a proximal direction of thelongitudinal axis 118 of theshaft 14 and an axial movement of theratchet rod 120 in the proximal direction. - With continued reference to
FIG. 6A , the proximal end of theratchet rod 120 has one ormore teeth 130 that interact with aratchet lever 128. Movement of theratchet rod 120 in the proximal direction due to movement of thetrigger 32 from the intermediate position toward the actuated position engages the proximal end of theratchet rod 120 with theratchet lever 128. The initial contact between the proximal end of theratchet rod 120 with theratchet lever 128 displaces theratchet lever 128 from the disengaged position toward the engaged position by pivoting theratchet lever 128 against theratchet lever spring 134. - The one or
more teeth 130 of theratchet rod 120 engage alocking tip 136 of theratchet lever 128 when thetrigger 32 is moved from the intermediate position toward the actuated position to prevent movement of thetrigger 32 from the intermediate position toward the initial position. Theratchet rod 120 can include any number of teeth such that thetrigger 32 can be progressively closed (i.e., brought into approximation of the handle 32) by more fully driving theratchet rod 120 under theratchet lever 128 in the direction of closure for the trigger 32 (e.g., from the configuration ofFIG. 7A to the configuration ofFIG. 7E ). - In some examples, the
ratchet lever 128 may engage theratchet rod 120 prior to thetrigger 32 reaching the actuated position to prevent reverse movement of the trigger from the actuated position toward the initial position. For example, the proximal end of theratchet rod 120 can contact a ratchetlever engagement surface 138 at a proximal end of theratchet lever 128. The ratchetlever engagement surface 138 may be angled such that proximal movement of theratchet rod 120 pivots theratchet lever 128. In some examples, theratchet lever 128 can be locked due to engagement of one ormore locking tabs 139 on theratchet lever 128 with at least a portion of thehousing 36. In some examples, the one ormore locking tabs 139 may be laterally deflectable between a first position, wherein theratchet lever 128 can freely pivot about theratchet pivot pin 132, and a second position, wherein theratchet lever 128 is locked relative to thehousing 36. The one ormore locking tabs 139 may strike thehousing 36, thus causing a loud click to audibly alert the user that thetrigger 32 has reached the actuated position and thatjaws fastener 22 has been closed and that thetrigger 32 can be released. Once the one ormore locking tabs 139 of theratchet lever 128 engage thehousing 36, theratchet lever 128 is locked in a disengaged state relative to theratchet rod 120. - A non-limiting example embodiment of a
ratchet lever 128 a is shown inFIGS. 13A and 13B , and ratchetlever 128 a includes a locking tip 136 a and two locking tabs 139 a. This non-limiting example embodiment ofratchet lever 128 a can be used in the embodiments of the fastener applicator of the present disclosure, including the embodiments of the fastener applicator shown inFIGS. 6A, 6B and 7A-7E . - With reference to
FIG. 6B , thefastener applicator 10 is shown with a lockout mechanism 140 b in accordance with another example of the present disclosure. The components of the lockout mechanism 140 b shown inFIG. 6B are substantially similar to the components of the lockout mechanism 140 a described herein with reference toFIG. 6A . As the previous discussion regarding the lockout mechanism 140 a generally shown inFIG. 6A is applicable to the lockout mechanism 140 b shown inFIG. 6B , only the relative differences between the two lockout mechanisms are discussed hereinafter. - With continued reference to
FIG. 6B , thetrigger release button 96 has astop member 150 positioned at a secondfree end 95 of thetrigger release button 96 and configured for engaging at least a portion of the trigger stop 40 only when thetrigger 32 is moved to the intermediate position. Unlike thetrigger release button 96 and the trigger stop 40 shown inFIG. 6A , thetrigger release button 96 and the trigger stop 40 ofFIG. 6B are configured to allow movement of thetrigger 32 from the initial position even if thetrigger release button 96 is pressed before thetrigger 32 is moved from the initial position. In other words, if thetrigger release button 96 is pressed and held, thetrigger 32 can pass through the intermediate position without stopping and ultimately to the actuated position. - With continued reference to
FIG. 6B , the triggerstop release member 152 of thetrigger release button 96 is configured for engaging at least a portion of thetrigger stop 40 when thetrigger 32 is positioned in the intermediate position between the initial position and the actuated position. Pressing thetrigger release button 96 when thetrigger 32 is in the intermediate position engages the triggerstop release member 152 with the trigger stop 40 to unlock thetrigger stop 40 and permit movement of thetrigger 32 from the intermediate position toward the actuated position. In some examples, pressing thetrigger release button 96 when thetrigger 32 is in the initial position engages the triggerstop release member 152 with the trigger stop 40 to unlock thetrigger stop 40 and permit movement of thetrigger 32 from the initial position toward the actuated position, thereby bypassing the locking of thetrigger 32 in the intermediate position. - With continued reference to
FIG. 6B , the first stopmember engagement surface 154 of thetrigger stop 40 is configured as a substantially planar portion at a terminal portion of thesecond end 146 of thetrigger stop 40. Similarly, the second stopmember engagement surface 155 may be substantially planar, as opposed to the recessed configuration shown inFIG. 6A . Pressing thetrigger release button 96 prior to moving thetrigger 32 from the intermediate position toward the actuated position engages the triggerstop release member 152 with the second stopmember engagement surface 155 and thetrigger actuation surface 162 of the trigger stop 40 to unlock thetrigger stop 40 and permit movement of thetrigger 32 toward the actuated position. - Having described the structure of the
fastener applicator 10, a method of using thefastener applicator 10 to close thefastener 22 over the tissue structure will now be described with reference toFIGS. 7A-8D and 10A-10C . With initial reference toFIG. 7A , thefastener applicator 10 is shown in an initial or as-delivered configuration, wherein thetrigger 32 is positioned in the initial position and thejaws 18, 20 (shown inFIG. 8A ) are in an open configuration to receive thefastener 22 therebetween. After thefastener 22 is advanced over the tissue structure, such as the LAA, thejaws trigger 32 toward thehandle 34 in the direction of arrow A inFIG. 7B . Thetrigger 32 can be moved toward thehandle 34 from the initial position (FIG. 7A ) by directing a proximally-directed force in the direction of arrow A on adistal side 110 of thetrigger 32. - Closing the
trigger 32 with respect to thehandle 34, that is, pivoting about thetrigger pivot pin 44 from the initial position of the trigger 32 (shown inFIG. 10A orFIG. 7A ), draws thepull rod 78 proximally toward a proximal end of theshaft 14 relative to theclamp tube 76, which in turn closes thejaws 18, 20 (FIG. 8B ). Thetrigger 32 can be moved in a proximal direction to close thejaws jaws fastener 22 relative to the tissue structure provided that thetrigger 32 is not advanced past the intermediate position. This allows the user to carefully position thefastener 22 relative to the tissue structure without closing thefastener 22. - With reference to
FIG. 7B , thetrigger 32 is shown in the intermediate position, wherein thetrigger 32 is temporarily locked relative to thehandle 34 due to engagement of atrigger latch 156 on the trigger stop 40 with atrigger catch 158 on thetrigger 32. When thetrigger 32 is moved to the intermediate position and locked therein, further movement of thetrigger 32 toward the initial position or the actuated position is prevented without further user input via thetrigger release button 96. With thetrigger 32 locked in the intermediate position, thejaws legs 26 of thefastener 22 are brought toward one another to capture the tissue structure therebetween without engaging the tissue penetrating fasteners 30 (FIG. 8A ). This allows the user to preview the positioning of thefastener 22 relative to the tissue structure without closing thefastener 22. - If repositioning of the
fastener 22 relative to the tissue structure is necessary, thetrigger 32 can be unlocked by pressing thetrigger release button 96 to disengage thetrigger latch 156 from the trigger catch 158 (FIG. 7C ). By pressing thetrigger release button 96, at least a portion of thetrigger release button 96, such as thestop member 150 of thetrigger release button 96, contacts at least a portion of thetrigger stop 40, such as therelease surface 160 on thetrigger stop 40, to move thetrigger stop 40 and displace thetrigger latch 156 from contact with thetrigger catch 158 on thetrigger 32. Thetrigger 32 can then be moved distally relative to thehandle 34 due to a restoring force of the trigger spring 42 (shown inFIG. 3 ). Movement of thetrigger 32 toward the initial position and away from thehandle 34 opens thejaws fastener 22. - Referring now to
FIG. 7D , if thefastener applicator 10 is oriented such that thefastener 22 is arranged at a desired position relative to the tissue structure, thetrigger 32 is unlocked from the intermediate position by pressing thetrigger release button 96 to disengage thetrigger latch 156 from thetrigger catch 158. Thetrigger 32 can then be advanced proximally toward thehandle 34 by moving thetrigger 32 in the direction of arrow A. Closing thetrigger 32 with respect to thehandle 34 moves the trigger stop 40 from a first position (FIG. 7C ) to a second position (FIG. 7E ) relative to thehandle 34 to allow further proximal movement of thetrigger 32 toward the actuated position. - Closing the
trigger 32 with respect to thehandle 34 also proximally retracts theratchet rod 120 which is linked to thetrigger 32. With reference toFIG. 10C , with thetrigger 32 positioned in the actuated position, thetrunnion 116 moves to a proximal end of thetrigger slot 114 such that a center of thetrunnion 116, and therefore theopening 123, is spaced apart proximally from a center of thetrigger pivot pin 44 by a second predetermined distance X2 that is larger than the first predetermined distance X1 shown inFIG. 10A . Thetrigger sub lever 122 is oriented such that its terminal end contacts theratchet rod 120 and advances theratchet rod 120 in a proximal direction. Proximal movement of theratchet rod 120 due to movement of thetrigger 32 past the intermediate position engages theteeth 130 of theratchet rod 120 with thelocking tip 136 of the lockinglever 128, thereby activating theratcheting mechanism 46. Once theratcheting mechanism 46 is engaged, retraction of thetrigger 32 in a direction toward the initial position (FIG. 7A ) is prevented. In this manner, the user is committed to closing thefastener 22 on the tissue structure by fully engaging thetrigger 32 toward the actuated position. - Closure of the
trigger 32 from the intermediate position toward the actuated position further draws thepull rod 78 proximally toward a proximal end of theshaft 14 relative to theclamp tube 76. Theejection tube 77 pulls at least onetendon 82 to retract thecomb studs 66. When thejaws tissue penetrating fasteners 30 so that they engage and lock with each other, thus closing the twolegs 26 of thefastener 22, as shown inFIG. 8C . - As the
trigger 32 is advanced from the intermediate position toward the actuated position, thetrigger stop 40 is deflected by thetrigger 32 from the first position (FIG. 7A ) toward the second position (FIG. 7E ). As the trigger stop 40 moves from the first position to the second position, the dampeningcam 148 of the trigger stop 40 contacts thedamper plunger 52 of the dampeningmechanism 48, thereby compressing the dampening spring 50 (shown inFIG. 3 ). As the dampeningplunger 52 is compressed against the restoring force of the dampeningspring 50, the dampeningplunger 52 engages the damper 54 (shown inFIG. 7E ), which provides resistance to the compressive force directed to thetrigger 32 in the direction of arrow A. As described herein, the dampeningcam 148 on thetrigger stop 40 and the dampeningmechanism 48 are configured such that the user feels a substantially constant reactive force from thetrigger 32 during movement of thetrigger 32 from the intermediate position toward the final position regardless of the position of thetrigger 32 during its stroke between the intermediate position and the actuated position. For example, the user may perceive a substantially constant reactive force from thetrigger 32 while moving thetrigger 32 toward thehandle 34 in the direction of arrow A, thereby requiring a substantially constant compressive force on thetrigger 32 during movement of thetrigger 32 from the intermediate position toward the actuated position. - Referring now to
FIG. 7E , thetrigger 32 is moved to the actuated position to release thetrigger 32 from theratcheting mechanism 46 and allow retraction of thetrigger 32 toward the initial position. As described herein, the proximal end of theratchet rod 120 contacts a ratchetlever disengagement surface 138 at a proximal end of theratchet lever 128, which lifts theratchet lever 128 from theratchet rod 120 and prevents reengagement with theratchet rod 120 due to interaction of the one ormore locking tabs 139 on theratchet lever 128 with at least a portion of thehousing 36. Thejaws trigger 32, thereby allowing thetrigger spring 38 and themain spring 42, which was compressed during closure of thetrigger 32 to push theratchet rod 120 distally forward, opening thejaws fastener 22 in place (FIG. 8D ). - Referring now to
FIG. 9 , one specific example of use is illustrated. In this example, thefastener applicator 10 is used to deliver afastener 22 over the base of a left atrial appendage LAA in an open chest, beating heart procedure. The sternum S is opened, spreading the ribs R to provide a working space over the heart H. After opening the pericardial sack, the heart H may be lifted and turned, for example using a sheet of gauze or other material which is placed behind the heart, to expose the left atrial appendage LAA within the opening as shown inFIG. 9 . After the left atrial appendage LAA is exposed, thejaws fastener applicator 10 are placed around the base of the left atrial appendage LAA by manipulating theshaft 12. Once thejaws fastener 22 about the base of the left atrial appendage LAA, thejaws fastener 22 is deployed as described previously. - Although the invention has been described in detail for the purpose of illustration based on what is currently considered to be the most practical and preferred examples, it is to be understood that such detail is solely for that purpose and that the invention is not limited to the disclosed examples, but, on the contrary, is intended to cover modifications and equivalent arrangements that are within the spirit and scope of the appended claims. For example, it is to be understood that the present invention contemplates that, to the extent possible, one or more features of any example can be combined with one or more features of any other example.
Claims (21)
1. A surgical applicator for a fastener, the surgical applicator comprising:
a handle;
a trigger movable relative to the handle between an initial position, an actuated position, and an intermediate position between the initial position and the actuated position; and
a lockout mechanism movable relative to the trigger between a locked position and an unlocked position, the lockout mechanism operatively arranged to:
lock the trigger in the intermediate position when the trigger is moved from the initial position toward the actuated position; and
permit movement of the trigger from the intermediate position toward the initial position or the actuated position when the lockout mechanism is moved from the locked position to the unlocked position.
2. The surgical applicator of claim 1 , wherein the lockout mechanism is further operatively arranged to permit movement of the trigger from the initial position to the actuated position when the lockout mechanism is moved from the locked position to the unlocked position prior to movement of the trigger from the initial position.
3. The surgical applicator of claim 1 , wherein the trigger is movable relative to the handle from the initial position with application of a compressive force on the trigger in a direction toward the handle.
4. The surgical applicator of claim 1 , wherein the trigger has a distal side opposite a proximal side facing the handle, and wherein at least a portion of the lockout mechanism is positioned on the distal side of the trigger.
5. The surgical applicator of claim 1 , wherein the lockout mechanism comprises:
a release button connected to the trigger, the release button movable between a first position and a second position relative to the trigger, and
a trigger stop connected to the handle, the trigger stop movable between a first position and a second position relative to the handle.
6. The surgical applicator of claim 4 , wherein the release button is pivotally movable relative to the trigger.
7. The surgical applicator of claim 4 , wherein the release button is linearly movable in a direction lateral relative to the trigger.
8. The surgical applicator of claim 4 , wherein the release button is biased to the first position by a release button biasing member.
9. The surgical applicator of claim 4 , wherein the trigger stop is biased to the first position by a trigger stop biasing member.
10. The surgical applicator of claim 4 , wherein movement of the trigger from the initial position toward the actuated position engages the trigger with the trigger stop to automatically lock the trigger in the intermediate position.
11. The surgical applicator of claim 4 , wherein movement of the release button from the first position to the second position when the trigger is in the intermediate position permits disengagement of the trigger from the trigger stop.
12. The surgical applicator of claim 1 , further comprising a ratcheting mechanism that engages the trigger when the trigger is moved from the intermediate position toward the actuated position to prevent movement of the trigger toward the initial position.
13. The surgical applicator of claim 12 , wherein the ratcheting mechanism disengages from the trigger when the trigger is moved to the actuated position.
14. The surgical applicator of claim 12 , wherein the ratcheting mechanism comprises a ratchet rod and a ratchet that is engaged with the ratchet rod when the trigger is moved from the intermediate position toward the actuated position.
15. The surgical applicator of claim 12 , wherein the ratcheting mechanism is actuated when the trigger is moved from the intermediate position toward the actuated position by a predetermined distance.
16. The surgical applicator of claim 1 , further comprising a jaw assembly selectively movable between an open position and a closed position via movement of the trigger from the initial position to the actuated position.
17. The surgical applicator of claim 16 , wherein the jaw assembly comprises a pair of jaws movably attached to one another, each jaw having a pair of lateral sides with a plurality of lateral slots extending through each lateral side.
18. The surgical applicator of claim 17 , wherein an outer surface of at least one of the lateral sides of each jaw has a recess.
19. The surgical applicator of claim 18 , wherein the recess receives a cover element that encloses at least a portion of the plurality of lateral slots.
20. The surgical applicator of claim 19 , wherein the cover element is adhesively secured in the recess.
21-32. (canceled)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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US18/309,607 US20230270443A1 (en) | 2018-03-28 | 2023-04-28 | Device for atrial appendage exclusion |
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Application Number | Priority Date | Filing Date | Title |
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US201862649455P | 2018-03-28 | 2018-03-28 | |
US16/366,738 US11653928B2 (en) | 2018-03-28 | 2019-03-27 | Device for atrial appendage exclusion |
US18/309,607 US20230270443A1 (en) | 2018-03-28 | 2023-04-28 | Device for atrial appendage exclusion |
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US16/366,738 Continuation US11653928B2 (en) | 2018-03-28 | 2019-03-27 | Device for atrial appendage exclusion |
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US20230270443A1 true US20230270443A1 (en) | 2023-08-31 |
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US18/309,607 Pending US20230270443A1 (en) | 2018-03-28 | 2023-04-28 | Device for atrial appendage exclusion |
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US16/366,738 Active 2040-12-03 US11653928B2 (en) | 2018-03-28 | 2019-03-27 | Device for atrial appendage exclusion |
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EP (1) | EP3773256A4 (en) |
JP (2) | JP7348199B2 (en) |
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Families Citing this family (112)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
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 |
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 |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
RU2493788C2 (en) | 2008-02-14 | 2013-09-27 | Этикон Эндо-Серджери, Инк. | Surgical cutting and fixing instrument, which has radio-frequency electrodes |
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 |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US9861361B2 (en) | 2010-09-30 | 2018-01-09 | Ethicon Llc | Releasable tissue thickness compensator and fastener cartridge having the same |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
BR112013027794B1 (en) | 2011-04-29 | 2020-12-15 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE SET |
RU2014143258A (en) | 2012-03-28 | 2016-05-20 | Этикон Эндо-Серджери, Инк. | FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS |
RU2639857C2 (en) | 2012-03-28 | 2017-12-22 | Этикон Эндо-Серджери, Инк. | Tissue thickness compensator containing capsule for medium with low pressure |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
BR112015021098B1 (en) | 2013-03-01 | 2022-02-15 | Ethicon Endo-Surgery, Inc | COVERAGE FOR A JOINT JOINT AND SURGICAL INSTRUMENT |
US9283054B2 (en) | 2013-08-23 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Interactive displays |
BR112016023698B1 (en) | 2014-04-16 | 2022-07-26 | Ethicon Endo-Surgery, Llc | FASTENER CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US20150297225A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
CN106456159B (en) | 2014-04-16 | 2019-03-08 | 伊西康内外科有限责任公司 | Fastener cartridge assembly and nail retainer lid arragement construction |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US10433844B2 (en) | 2015-03-31 | 2019-10-08 | Ethicon Llc | Surgical instrument with selectively disengageable threaded drive systems |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US20170086829A1 (en) | 2015-09-30 | 2017-03-30 | Ethicon Endo-Surgery, Llc | Compressible adjunct with intermediate supporting structures |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
US10675026B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Methods of stapling tissue |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US11000279B2 (en) | 2017-06-28 | 2021-05-11 | Ethicon Llc | Surgical instrument comprising an articulation system ratio |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10682134B2 (en) | 2017-12-21 | 2020-06-16 | Ethicon Llc | Continuous use self-propelled stapling instrument |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11903581B2 (en) | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US10925615B2 (en) * | 2019-05-03 | 2021-02-23 | Syntheon 2.0, LLC | Recapturable left atrial appendage clipping device and methods for recapturing a left atrial appendage clip |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11229437B2 (en) | 2019-06-28 | 2022-01-25 | Cilag Gmbh International | Method for authenticating the compatibility of a staple cartridge with a surgical instrument |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11864756B2 (en) | 2020-07-28 | 2024-01-09 | Cilag Gmbh International | Surgical instruments with flexible ball chain drive arrangements |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
US20220133300A1 (en) * | 2020-10-29 | 2022-05-05 | Ethicon Llc | Surgical instrument comprising a stowed closure actuator stop |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US20220378424A1 (en) | 2021-05-28 | 2022-12-01 | Cilag Gmbh International | Stapling instrument comprising a firing lockout |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Family Cites Families (779)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US729116A (en) | 1902-09-11 | 1903-05-26 | Robert P Barnstead | Automatic cut-off. |
US1756670A (en) | 1928-08-06 | 1930-04-29 | Lester A Treat | Vulva clamp |
US2659371A (en) | 1951-11-27 | 1953-11-17 | Charles F Schnee | Surgical clamp |
US3336133A (en) | 1962-06-01 | 1967-08-15 | Kao Corp | Process for the purification and concentration of cobalt and nickel |
US3139563A (en) | 1962-08-22 | 1964-06-30 | United States Steel Corp | Lift magnet for structural steel beams |
US3361133A (en) | 1965-07-22 | 1968-01-02 | Canadian Patents Dev | Vacuum artery clamp |
US3525340A (en) | 1967-10-31 | 1970-08-25 | Joseph G Gilbert | Surgical dressing with skin clips thereon |
US3746002A (en) | 1971-04-29 | 1973-07-17 | J Haller | Atraumatic surgical clamp |
US3993076A (en) | 1973-08-20 | 1976-11-23 | Fogarty Thomas J | Vessel occluding instrument |
GB1530282A (en) | 1975-07-22 | 1978-10-25 | Filshie G | Sexual sterilization devices |
US4060089A (en) | 1975-09-03 | 1977-11-29 | United States Surgical Corporation | Surgical fastening method and device therefor |
US4016883A (en) | 1975-11-11 | 1977-04-12 | Wright Jr Sanford J | Medical clamp for occluding intracranial blood vessels |
US4241861A (en) | 1977-12-20 | 1980-12-30 | Fleischer Harry N | Scissor-type surgical stapler |
US4257419A (en) | 1978-12-14 | 1981-03-24 | Mo Och Domsjo Aktiebolag | Suction-assisted hemorrhoid ligator |
US4390019A (en) | 1979-02-28 | 1983-06-28 | Leveen Harry H | Blood vessel clamp |
US4271828A (en) | 1979-09-13 | 1981-06-09 | Angelchik Jean P | Method for maintaining the reduction of a sliding esophageal hiatal hernia |
US4414721A (en) | 1980-11-07 | 1983-11-15 | Hufnagel Charles A | Occlusive clip and applicator for constricting flexible tubular members |
US4402445A (en) | 1981-10-09 | 1983-09-06 | United States Surgical Corporation | Surgical fastener and means for applying same |
US4489725A (en) | 1982-02-11 | 1984-12-25 | Simon Population Trust | Sexual sterilization devices |
US4548201A (en) | 1982-04-20 | 1985-10-22 | Inbae Yoon | Elastic ligating ring clip |
US4487205A (en) | 1982-04-26 | 1984-12-11 | Ethicon, Inc. | Non-metallic, bio-compatible hemostatic clips |
US4506670A (en) | 1983-03-30 | 1985-03-26 | United States Surgical Corporation | Two-part surgical fastener applying apparatus with frangible member |
US4506671A (en) | 1983-03-30 | 1985-03-26 | United States Surgical Corporation | Apparatus for applying two-part surgical fasteners |
GB2158539B (en) | 1983-10-04 | 1987-10-14 | United States Surgical Corp | Surgical fastener exhibiting improved hemostasis |
US4586503A (en) | 1983-12-01 | 1986-05-06 | University Of New Mexico | Surgical microclip |
IN165375B (en) | 1984-07-16 | 1989-10-07 | Ethicon Inc | |
US5127915A (en) | 1984-10-29 | 1992-07-07 | Mattson Philip D | Surgical instrument for severing and clamping an umbilical cord |
GB2177748B (en) | 1985-07-10 | 1988-11-16 | Femcare Ltd | Sexual sterilisation device |
US4702247A (en) | 1985-08-20 | 1987-10-27 | American Hospital Supply Corporation | Ligating clip |
US4610250A (en) | 1985-10-08 | 1986-09-09 | United States Surgical Corporation | Two-part surgical fastener for fascia wound approximation |
US4924864A (en) | 1985-11-15 | 1990-05-15 | Danzig Fred G | Apparatus and article for ligating blood vessels, nerves and other anatomical structures |
US4754758A (en) | 1986-04-14 | 1988-07-05 | American Cyanamid Company | Surgical closure device |
GB8611452D0 (en) | 1986-05-10 | 1986-06-18 | Femcare Ltd | Sexual sterilation device |
FR2598905B1 (en) | 1986-05-22 | 1993-08-13 | Chevalier Jean Michel | DEVICE FOR INTERRUPTING THE CIRCULATION OF A FLUID IN A FLEXIBLE WALL CONDUIT, IN PARTICULAR A HOLLOW VISCERE AND CLIP ASSEMBLY COMPRISING THIS DEVICE |
US4724839A (en) | 1986-09-18 | 1988-02-16 | Ethicon, Inc. | Surgical fastening systems made from polymeric materials |
US4822348A (en) | 1987-05-13 | 1989-04-18 | Donn Casey | Surgical clips |
US5366459A (en) | 1987-05-14 | 1994-11-22 | Inbae Yoon | Surgical clip and clip application procedures |
US4834096A (en) | 1987-10-26 | 1989-05-30 | Edward Weck Incorporated | Plastic ligating clips |
US4805617A (en) | 1987-11-05 | 1989-02-21 | Ethicon, Inc. | Surgical fastening systems made from polymeric materials |
GB2212201B (en) | 1987-11-10 | 1992-06-03 | Donn Casey | Surgical clip |
DE68910540T2 (en) | 1988-01-15 | 1994-04-21 | United States Surgical Corp | Device for attaching surgical clips. |
US4960420A (en) | 1988-08-23 | 1990-10-02 | Marlowe Goble E | Channel ligament clamp and system |
US5062846A (en) | 1989-03-28 | 1991-11-05 | Edward Weck Incorporated | Penetrating plastic ligating clip |
US4976722A (en) | 1989-05-22 | 1990-12-11 | Ethicon, Inc. | Surgical hemostatic clips |
US5040715B1 (en) | 1989-05-26 | 1994-04-05 | United States Surgical Corp | Apparatus and method for placing staples in laparoscopic or endoscopic procedures |
US5413268A (en) | 1989-05-26 | 1995-05-09 | United States Surgical Corporation | Apparatus and method for placing stables in laparoscopic or endoscopic procedures |
US4988355A (en) | 1990-01-16 | 1991-01-29 | Leveen Eric G | Arterial clamp |
GB9010696D0 (en) | 1990-05-12 | 1990-07-04 | Femcare Ltd | Sterilisation devices |
US5078731A (en) | 1990-06-05 | 1992-01-07 | Hayhurst John O | Suture clip |
US5268102A (en) | 1990-07-13 | 1993-12-07 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5160624A (en) | 1990-07-13 | 1992-11-03 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5653885A (en) | 1990-07-13 | 1997-08-05 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5614089A (en) | 1990-07-13 | 1997-03-25 | Isco, Inc. | Apparatus and method for supercritical fluid extraction or supercritical fluid chromatography |
US5250195A (en) | 1990-07-13 | 1993-10-05 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5635070A (en) | 1990-07-13 | 1997-06-03 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5094753A (en) | 1990-07-13 | 1992-03-10 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5173188A (en) | 1990-07-13 | 1992-12-22 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5601707A (en) | 1990-07-13 | 1997-02-11 | Isco, Inc. | Apparatus and method for supercritical fluid extraction or supercritical fluid chromatography |
US5132014A (en) | 1990-07-13 | 1992-07-21 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5932095A (en) | 1990-07-13 | 1999-08-03 | Isco, Inc. | Multi-chambered supercritical fluid extraction cartridge |
US5198197A (en) | 1990-07-13 | 1993-03-30 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5690828A (en) | 1990-07-13 | 1997-11-25 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5268103A (en) | 1990-07-13 | 1993-12-07 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5269930A (en) | 1990-07-13 | 1993-12-14 | Isco, Inc. | Apparatus and method for supercritical fluid extraction |
US5653373A (en) | 1990-09-17 | 1997-08-05 | United States Surgical Corporation | Arcuate apparatus for applying two-part surgical fasteners |
US5156315A (en) | 1990-09-17 | 1992-10-20 | United States Surgical Corporation | Arcuate apparatus for applying two-part surgical fasteners |
US5253793A (en) | 1990-09-17 | 1993-10-19 | United States Surgical Corporation | Apparatus for applying two-part surgical fasteners |
US5156614A (en) | 1990-09-17 | 1992-10-20 | United States Surgical Corporation | Apparatus for applying two-part surgical fasteners |
US5470009A (en) | 1990-12-06 | 1995-11-28 | United States Surgical Corporation | Surgical fastening apparatus with locking mechanism |
CA2055943C (en) | 1990-12-06 | 2003-09-23 | Daniel P. Rodak | Surgical fastening apparatus with locking mechanism |
US5366458A (en) | 1990-12-13 | 1994-11-22 | United States Surgical Corporation | Latchless surgical clip |
CA2055985A1 (en) | 1990-12-20 | 1992-06-21 | Daniel Shichman | Fascia clip |
US5312456A (en) | 1991-01-31 | 1994-05-17 | Carnegie Mellon University | Micromechanical barb and method for making the same |
US5336232A (en) | 1991-03-14 | 1994-08-09 | United States Surgical Corporation | Approximating apparatus for surgical jaw structure and method of using the same |
CA2061885A1 (en) | 1991-03-14 | 1992-09-15 | David T. Green | Approximating apparatus for surgical jaw structure |
US5171253A (en) | 1991-03-22 | 1992-12-15 | Klieman Charles H | Velcro-like closure system with absorbable suture materials for absorbable hemostatic clips and surgical strips |
US5171249A (en) | 1991-04-04 | 1992-12-15 | Ethicon, Inc. | Endoscopic multiple ligating clip applier |
US5171247A (en) | 1991-04-04 | 1992-12-15 | Ethicon, Inc. | Endoscopic multiple ligating clip applier with rotating shaft |
US5160339A (en) | 1991-06-18 | 1992-11-03 | Ethicon, Inc. | Endoscopic suture clip |
US5282812A (en) | 1991-07-10 | 1994-02-01 | Suarez Jr Luis | Clamp for use in vascular surgery |
US5307976A (en) | 1991-10-18 | 1994-05-03 | Ethicon, Inc. | Linear stapling mechanism with cutting means |
US5289963A (en) | 1991-10-18 | 1994-03-01 | United States Surgical Corporation | Apparatus and method for applying surgical staples to attach an object to body tissue |
CA2078794C (en) | 1991-10-18 | 1998-10-06 | Frank J. Viola | Locking device for an apparatus for applying surgical fasteners |
US5713896A (en) | 1991-11-01 | 1998-02-03 | Medical Scientific, Inc. | Impedance feedback electrosurgical system |
US5531744A (en) | 1991-11-01 | 1996-07-02 | Medical Scientific, Inc. | Alternative current pathways for bipolar surgical cutting tool |
US5207691A (en) | 1991-11-01 | 1993-05-04 | Medical Scientific, Inc. | Electrosurgical clip applicator |
US5665085A (en) | 1991-11-01 | 1997-09-09 | Medical Scientific, Inc. | Electrosurgical cutting tool |
US5893879A (en) | 1992-02-13 | 1999-04-13 | Medchem Products, Inc. | Apparatus for the closure of wide skin defects by stretching of skin |
JP3336540B2 (en) | 1992-03-24 | 2002-10-21 | 本田技研工業株式会社 | Power transmission device anti-vibration mechanism |
US5915615A (en) | 1992-03-26 | 1999-06-29 | Bauer; William | Tissue fastening device |
US5314424A (en) * | 1992-04-06 | 1994-05-24 | United States Surgical Corporation | Surgical instrument locking mechanism |
US5411481A (en) | 1992-04-08 | 1995-05-02 | American Cyanamid Co. | Surgical purse string suturing instrument and method |
CA2094463A1 (en) | 1992-04-28 | 1993-10-29 | Claude Vidal | Vessel clips |
US5658300A (en) | 1992-06-04 | 1997-08-19 | Olympus Optical Co., Ltd. | Tissue fixing surgical instrument, tissue-fixing device, and method of fixing tissues |
US5257999A (en) | 1992-06-04 | 1993-11-02 | Slanetz Jr Charles A | Self-oriented laparoscopic needle holder for curved needles |
US5246456A (en) | 1992-06-08 | 1993-09-21 | Wilkinson Lawrence H | Fenestrated gastric pouch |
DE69324608T2 (en) | 1992-06-30 | 1999-10-07 | American Cyanamid Co | Modular applicator for ligation clips |
US5258012A (en) | 1992-06-30 | 1993-11-02 | Ethicon, Inc. | Surgical fasteners |
US5330486A (en) | 1992-07-29 | 1994-07-19 | Wilk Peter J | Laparoscopic or endoscopic anastomosis technique and associated instruments |
US5342373A (en) | 1992-09-14 | 1994-08-30 | Ethicon, Inc. | Sterile clips and instrument for their placement |
CA2437773C (en) | 1992-09-21 | 2005-02-22 | United States Surgical Corporation | Device for applying a meniscal staple |
US5423471A (en) | 1992-10-02 | 1995-06-13 | United States Surgical Corporation | Apparatus for applying two-part surgical fasteners in laparoscopic or endoscopic procedures |
US5573169A (en) | 1992-10-02 | 1996-11-12 | United States Surgical Corporation | Apparatus for applying two-part surgical fasteners in laparoscopic or endoscopic procedures |
CA2107635C (en) | 1992-10-09 | 1999-08-17 | David T. Green | Surgical clip applier |
US5725538A (en) | 1992-10-09 | 1998-03-10 | United States Surgical Corporation | Surgical clip applier |
US5330442A (en) | 1992-10-09 | 1994-07-19 | United States Surgical Corporation | Suture retaining clip |
CA2133687C (en) | 1992-10-09 | 2007-03-27 | David T. Green | Surgical clip applier |
US6051003A (en) | 1992-10-09 | 2000-04-18 | Boston Scientific Corporation | Combined multiple ligating band dispenser and sclerotherapy needle instrument |
US5868761A (en) | 1992-10-09 | 1999-02-09 | United States Surgical Corporation | Surgical clip applier |
US5464416A (en) | 1992-11-10 | 1995-11-07 | Ethicon, Inc. | Ligating clip |
US5284488A (en) | 1992-12-23 | 1994-02-08 | Sideris Eleftherios B | Adjustable devices for the occlusion of cardiac defects |
WO1994015535A1 (en) | 1993-01-07 | 1994-07-21 | Hayhurst, John, O. | Clip for suture |
US5358510A (en) | 1993-01-26 | 1994-10-25 | Ethicon, Inc. | Two part surgical fastener |
US5425705A (en) | 1993-02-22 | 1995-06-20 | Stanford Surgical Technologies, Inc. | Thoracoscopic devices and methods for arresting the heart |
US5624453A (en) | 1993-02-23 | 1997-04-29 | Wilson-Cook Medical, Inc. | Endoscopic ligating instrument |
US5306234A (en) | 1993-03-23 | 1994-04-26 | Johnson W Dudley | Method for closing an atrial appendage |
CA2120828C (en) | 1993-04-16 | 1999-11-02 | Paul J. Phillips | Surgical hemostatic clip |
US6716232B1 (en) | 1993-04-30 | 2004-04-06 | United States Surgical Corporation | Surgical instrument having an articulated jaw structure and a detachable knife |
US5447265A (en) | 1993-04-30 | 1995-09-05 | Minnesota Mining And Manufacturing Company | Laparoscopic surgical instrument with a mechanism for preventing its entry into the abdominal cavity once it is depleted and removed from the abdominal cavity |
CA2159348A1 (en) | 1993-04-30 | 1994-11-10 | Claude A. Vidal | Surgical instrument having an articulated jaw structure and a detachable knife |
US5549621A (en) | 1993-05-14 | 1996-08-27 | Byron C. Sutherland | Apparatus and method for performing vertical banded gastroplasty |
US5368600A (en) | 1993-07-23 | 1994-11-29 | Ethicon, Inc. | Steerable bulldog clamp applier |
JP2958219B2 (en) | 1993-08-20 | 1999-10-06 | 住友ベークライト株式会社 | Endoscopic ligation kit |
DK110193A (en) | 1993-09-30 | 1995-03-31 | Per Baunsgaard | Terminal device |
RU2110221C1 (en) | 1993-10-01 | 1998-05-10 | Тофик Аскерович Султанов | Surgical suture appliance for endoscopic operations |
US5542594A (en) | 1993-10-06 | 1996-08-06 | United States Surgical Corporation | Surgical stapling apparatus with biocompatible surgical fabric |
US5607436A (en) | 1993-10-08 | 1997-03-04 | United States Surgical Corporation | Apparatus for applying surgical clips |
US5496333A (en) | 1993-10-20 | 1996-03-05 | Applied Medical Resources Corporation | Laparoscopic surgical clamp |
US5490856A (en) | 1993-12-14 | 1996-02-13 | Untied States Surgical Corporation | Purse string stapler |
GB9400739D0 (en) | 1994-01-15 | 1994-03-16 | Femcare Ltd | Medical clip |
US5465895A (en) | 1994-02-03 | 1995-11-14 | Ethicon Endo-Surgery, Inc. | Surgical stapler instrument |
US5597107A (en) | 1994-02-03 | 1997-01-28 | Ethicon Endo-Surgery, Inc. | Surgical stapler instrument |
US5833700A (en) | 1995-03-15 | 1998-11-10 | Ethicon Endo-Surgery, Inc. | Sterile occlusion fasteners and instrument and method for their placement |
CA2143560C (en) | 1994-03-02 | 2007-01-16 | Mark Fogelberg | Sterile occlusion fasteners and instrument and method for their placement |
CA2145723A1 (en) | 1994-03-30 | 1995-10-01 | Steven W. Hamblin | Surgical stapling instrument with remotely articulated stapling head assembly on rotatable support shaft |
US5715987A (en) | 1994-04-05 | 1998-02-10 | Tracor Incorporated | Constant width, adjustable grip, staple apparatus and method |
CA2144818C (en) | 1994-04-07 | 2006-07-11 | Henry Bolanos | Graduated anvil for surgical stapling instruments |
JPH10503387A (en) | 1994-04-21 | 1998-03-31 | メッドケム・プロダクツ・インコーポレーテッド | Single needle skin stretching device |
DE4415521C2 (en) | 1994-05-04 | 2003-01-30 | Storz Reling Sybill Gesamthand | Instrument for use in endoscopic procedures |
US5782749A (en) * | 1994-05-10 | 1998-07-21 | Riza; Erol D. | Laparoscopic surgical instrument with adjustable grip |
US5425740A (en) | 1994-05-17 | 1995-06-20 | Hutchinson, Jr.; William B. | Endoscopic hernia repair clip and method |
US5501693A (en) | 1994-07-06 | 1996-03-26 | United States Surgical Corporation | Surgical hemostatic clip |
US5833695A (en) | 1994-07-13 | 1998-11-10 | Yoon; Inbae | Surgical stapling system and method of applying staples from multiple staple cartridges |
US5551622A (en) | 1994-07-13 | 1996-09-03 | Yoon; Inbae | Surgical stapler |
US5462558A (en) | 1994-08-29 | 1995-10-31 | United States Surgical Corporation | Suture clip applier |
JPH08196538A (en) | 1994-09-26 | 1996-08-06 | Ethicon Inc | Tissue sticking apparatus for surgery with elastomer component and method of attaching mesh for surgery to said tissue |
DE4434864C2 (en) | 1994-09-29 | 1997-06-19 | United States Surgical Corp | Surgical staple applicator with interchangeable staple magazine |
US6142994A (en) | 1994-10-07 | 2000-11-07 | Ep Technologies, Inc. | Surgical method and apparatus for positioning a diagnostic a therapeutic element within the body |
US5487746A (en) | 1994-11-23 | 1996-01-30 | Yu; George W. | Surgical clip having a longitudinal opening through which clamped tissue protrudes |
US6206897B1 (en) | 1994-12-02 | 2001-03-27 | Ethicon, Inc. | Enhanced visualization of the latching mechanism of latching surgical devices |
RU2093201C1 (en) | 1994-12-19 | 1997-10-20 | Научный центр сердечно-сосудистой хирургии РАМН | Apparatus for closing heart's septal defects (alternatives) |
US5632432A (en) | 1994-12-19 | 1997-05-27 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
US5620452A (en) | 1994-12-22 | 1997-04-15 | Yoon; Inbae | Surgical clip with ductile tissue penetrating members |
US5976159A (en) | 1995-02-24 | 1999-11-02 | Heartport, Inc. | Surgical clips and methods for tissue approximation |
US5695505A (en) | 1995-03-09 | 1997-12-09 | Yoon; Inbae | Multifunctional spring clips and cartridges and applicators therefor |
WO1996029937A1 (en) | 1995-03-24 | 1996-10-03 | Organ, Inc. | Vessel and duct salvage device and method |
DE19520158C2 (en) | 1995-06-01 | 1998-10-15 | Aesculap Ag & Co Kg | Surgical clip |
US6132438A (en) | 1995-06-07 | 2000-10-17 | Ep Technologies, Inc. | Devices for installing stasis reducing means in body tissue |
US5706998A (en) | 1995-07-17 | 1998-01-13 | United States Surgical Corporation | Surgical stapler with alignment pin locking mechanism |
US5782396A (en) | 1995-08-28 | 1998-07-21 | United States Surgical Corporation | Surgical stapler |
US5676676A (en) | 1995-08-30 | 1997-10-14 | Porter; Wayne | Ligating clip having ramp-shaped vessel-clamping members |
US5713912A (en) | 1995-08-30 | 1998-02-03 | Stress Management, Inc. | Ligating clip having ramp-shaped vessel clamping members and tool for applying same |
DE19534320C1 (en) | 1995-09-15 | 1997-02-27 | Aesculap Ag | Instrument fitting and removing surgical clips |
DE19534322A1 (en) | 1995-09-15 | 1997-03-20 | Aesculap Ag | Surgical clip, especially a vascular clip |
DE19534323A1 (en) | 1995-09-15 | 1997-03-20 | Aesculap Ag | Clamping ring for a surgical clip |
DE19537299A1 (en) | 1995-10-06 | 1997-04-10 | Busse Design Ulm Gmbh | Applicator for surgical clips |
KR0166568B1 (en) | 1995-11-24 | 1999-01-15 | 박종덕 | Apparatus for clamping muscle |
US5797932A (en) | 1995-11-24 | 1998-08-25 | Jong-Deok Park | Muscle clamping device |
US5957977A (en) | 1996-01-02 | 1999-09-28 | University Of Cincinnati | Activation device for the natural heart including internal and external support structures |
US6015417A (en) | 1996-01-25 | 2000-01-18 | Reynolds, Jr.; Walker | Surgical fastener |
US5846255A (en) | 1996-01-31 | 1998-12-08 | Casey Medical Products Limited | Surgical clip |
US6852075B1 (en) | 1996-02-20 | 2005-02-08 | Cardiothoracic Systems, Inc. | Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery |
JP3776529B2 (en) | 1996-02-29 | 2006-05-17 | オリンパス株式会社 | Clip device |
US5772673A (en) | 1996-03-07 | 1998-06-30 | United States Surgical Corporation | Apparatus for applying surgical clips |
US5605272A (en) | 1996-03-12 | 1997-02-25 | Ethicon Endo-Surgery, Inc. | Trigger mechanism for surgical instruments |
US6139555A (en) | 1996-04-19 | 2000-10-31 | Applied Medical Resources Corporation | Grasping clip applier |
US5735874A (en) * | 1996-06-21 | 1998-04-07 | Ethicon Endo-Surgery, Inc. | Variable position handle locking mechanism |
DE19627992A1 (en) | 1996-07-11 | 1998-01-22 | Storz Karl Gmbh & Co | Instrument with two independent jaws |
US5833698A (en) | 1996-07-23 | 1998-11-10 | United States Surgical Corporation | Anastomosis instrument and method |
US6024748A (en) | 1996-07-23 | 2000-02-15 | United States Surgical Corporation | Singleshot anastomosis instrument with detachable loading unit and method |
US5730758A (en) | 1996-09-12 | 1998-03-24 | Allgeyer; Dean O. | Staple and staple applicator for use in skin fixation of catheters |
US20070167964A1 (en) | 1996-09-16 | 2007-07-19 | Willis Geoffrey H | Tubular anastomosis ring having alternating flexible and rigid sections |
US6811555B1 (en) | 1996-09-16 | 2004-11-02 | Origin Medsystems, Inc. | Method and apparatus for performing anastomosis with eversion of tissue edges and joining of exposed intima of the everted tissue |
US5722982A (en) | 1996-09-26 | 1998-03-03 | University Technology Corporation | Strabismus surgery apparatus and method |
US6036667A (en) | 1996-10-04 | 2000-03-14 | United States Surgical Corporation | Ultrasonic dissection and coagulation system |
US6050936A (en) | 1997-01-02 | 2000-04-18 | Myocor, Inc. | Heart wall tension reduction apparatus |
US6579304B1 (en) | 1997-02-03 | 2003-06-17 | Applied Medical Resources Corporation | Surgical clamp with improved traction |
US20030236537A1 (en) | 1999-08-09 | 2003-12-25 | Applied Medical Resources Corporation | Surgical instruments with improved traction |
JP3036686B2 (en) | 1997-02-27 | 2000-04-24 | 政夫 高橋 | Hemostatic holding device for vascular anastomosis used for coronary artery bypass surgery |
JP2001514563A (en) | 1997-03-10 | 2001-09-11 | アプライド メディカル リソーシーズ コーポレイション | Surgical clips and clamps |
GB9707204D0 (en) | 1997-04-09 | 1997-05-28 | Price Invena Aps | Clamping and cutting devices |
US5782901A (en) | 1997-04-16 | 1998-07-21 | Praeger; Peter I. | Sutureless electrode clip |
GB2324729B (en) | 1997-04-30 | 2002-01-02 | Bradford Hospitals Nhs Trust | Lung treatment device |
US5843101A (en) | 1997-05-02 | 1998-12-01 | Fry; William R. | Disposable clip for temporary vessel occulsion |
EP0930845B1 (en) | 1997-06-27 | 2009-10-14 | The Trustees Of Columbia University In The City Of New York | Apparatus for circulatory valve repair |
US5944750A (en) | 1997-06-30 | 1999-08-31 | Eva Corporation | Method and apparatus for the surgical repair of aneurysms |
DE19738306C2 (en) | 1997-09-03 | 2000-02-24 | Jens Ebbers | Vascular clamp |
DE29715758U1 (en) | 1997-09-03 | 1998-01-02 | Ebbers Jens | Vascular clamp |
US5928251A (en) | 1997-09-18 | 1999-07-27 | United States Surgical Corporation | Occlusion clamp and occlusion clamp applicator |
DE19741053C2 (en) | 1997-09-18 | 1999-08-12 | Aesculap Ag & Co Kg | Surgical tunneling instrument |
DE29716753U1 (en) | 1997-09-18 | 1997-10-30 | Aesculap Ag & Co Kg | Surgical tunneling instrument |
US5865361A (en) | 1997-09-23 | 1999-02-02 | United States Surgical Corporation | Surgical stapling apparatus |
US6139563A (en) | 1997-09-25 | 2000-10-31 | Allegiance Corporation | Surgical device with malleable shaft |
US20010034536A1 (en) | 1997-09-25 | 2001-10-25 | Looper Anthony M. | Surgical device with malleable shaft |
US6592600B1 (en) | 1997-10-08 | 2003-07-15 | Enrico Nicolo | Bowel clamp |
US5984934A (en) | 1997-10-10 | 1999-11-16 | Applied Medical Resources Corporation | Low-profile surgical clip |
GB9722203D0 (en) | 1997-10-21 | 1997-12-17 | Univ London | Surgical clip |
US6551328B2 (en) | 1997-11-03 | 2003-04-22 | Symbiosis Corporation | Surgical instrument for invagination and fundoplication |
US6042599A (en) | 1997-11-12 | 2000-03-28 | Bionix Development Corp. | Tissue approximation forceps |
US6007552A (en) | 1997-12-18 | 1999-12-28 | Minumys | Vascular clamps and surgical retractors with directional filaments for tissue engagement |
US6036706A (en) | 1998-03-13 | 2000-03-14 | Cardiothoracic Systems, Inc. | Vascular clamp and method for using the same |
US6241740B1 (en) | 1998-04-09 | 2001-06-05 | Origin Medsystems, Inc. | System and method of use for ligating and cutting tissue |
US6613059B2 (en) | 1999-03-01 | 2003-09-02 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6607541B1 (en) | 1998-06-03 | 2003-08-19 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6641593B1 (en) | 1998-06-03 | 2003-11-04 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
DE29811510U1 (en) | 1998-06-27 | 1998-10-08 | Tenckhoff Dirk | Device for handling clips, in particular for microsurgery |
DE19832739A1 (en) | 1998-07-21 | 2000-02-03 | Aesculap Ag & Co Kg | Surgical clip in U or V form for clamping hollow organs e.g. arteries |
US6099539A (en) | 1998-07-27 | 2000-08-08 | Thomas J. Fogarty | Surgical clamp pad with interdigitating teeth |
US7128073B1 (en) | 1998-11-06 | 2006-10-31 | Ev3 Endovascular, Inc. | Method and device for left atrial appendage occlusion |
US7044134B2 (en) | 1999-11-08 | 2006-05-16 | Ev3 Sunnyvale, Inc | Method of implanting a device in the left atrial appendage |
US6152144A (en) | 1998-11-06 | 2000-11-28 | Appriva Medical, Inc. | Method and device for left atrial appendage occlusion |
US7387634B2 (en) | 1998-11-23 | 2008-06-17 | Benderev Theodore V | System for securing sutures, grafts and soft tissue to bone and periosteum |
US6200330B1 (en) | 1998-11-23 | 2001-03-13 | Theodore V. Benderev | Systems for securing sutures, grafts and soft tissue to bone and periosteum |
WO2000032113A1 (en) | 1998-11-27 | 2000-06-08 | Anthony Lam | Artery clamp |
DE19858577C1 (en) | 1998-12-18 | 2000-09-07 | Aesculap Ag & Co Kg | Blood vessel clamping clip has a U-shape with rear extensions at the connecting link which lock in place when the legs are pressed together with easy distortion for positioning and a firm clamp in place |
DE29822558U1 (en) | 1998-12-18 | 1999-02-18 | Aesculap Ag & Co Kg | Vascular clip |
DE19860685A1 (en) | 1998-12-29 | 2000-07-06 | Pierre Nicolas Foss | Appliance for externally closing varicose veins consists of stapler, tacker or clamp with variously colored, shaped and sized staples |
US6193732B1 (en) | 1999-01-08 | 2001-02-27 | Cardiothoracic System | Surgical clips and apparatus and method for clip placement |
US6701929B2 (en) | 1999-03-03 | 2004-03-09 | Hany Hussein | Device and method for treatment of congestive heart failure |
WO2000054662A1 (en) | 1999-03-16 | 2000-09-21 | The University Of Sydney | Device for use in surgery |
US6582451B1 (en) | 1999-03-16 | 2003-06-24 | The University Of Sydney | Device for use in surgery |
US7666204B2 (en) | 1999-04-09 | 2010-02-23 | Evalve, Inc. | Multi-catheter steerable guiding system and methods of use |
US6488689B1 (en) | 1999-05-20 | 2002-12-03 | Aaron V. Kaplan | Methods and apparatus for transpericardial left atrial appendage closure |
US7273497B2 (en) | 1999-05-28 | 2007-09-25 | Anova Corp. | Methods for treating a defect in the annulus fibrosis |
US6716233B1 (en) | 1999-06-02 | 2004-04-06 | Power Medical Interventions, Inc. | Electromechanical driver and remote surgical instrument attachment having computer assisted control capabilities |
US8241322B2 (en) | 2005-07-27 | 2012-08-14 | Tyco Healthcare Group Lp | Surgical device |
IT1310919B1 (en) | 1999-06-10 | 2002-02-27 | Enrico Balbo | QUICK PLACING CLAMP FOR FLOW RATE ADJUSTMENT FLEXIBLE HOSES, IN PARTICULAR FOR MEDICAL USE. |
US6165204A (en) | 1999-06-11 | 2000-12-26 | Scion International, Inc. | Shaped suture clip, appliance and method therefor |
US6228104B1 (en) | 1999-06-18 | 2001-05-08 | Novare Surgical Systems, Inc. | Surgical clamp having replaceable pad |
US6821285B2 (en) | 1999-06-22 | 2004-11-23 | Ndo Surgical, Inc. | Tissue reconfiguration |
US6494888B1 (en) | 1999-06-22 | 2002-12-17 | Ndo Surgical, Inc. | Tissue reconfiguration |
US6626899B2 (en) | 1999-06-25 | 2003-09-30 | Nidus Medical, Llc | Apparatus and methods for treating tissue |
US20040122456A1 (en) | 2002-12-11 | 2004-06-24 | Saadat Vahid C. | Methods and apparatus for gastric reduction |
US6325810B1 (en) | 1999-06-30 | 2001-12-04 | Ethicon, Inc. | Foam buttress for stapling apparatus |
US7766924B1 (en) | 1999-07-28 | 2010-08-03 | Cardica, Inc. | System for performing anastomosis |
US7285131B1 (en) | 1999-07-28 | 2007-10-23 | Cardica, Inc. | System for performing anastomosis |
US7300444B1 (en) | 1999-07-28 | 2007-11-27 | Cardica, Inc. | Surgical system and method for connecting hollow tissue structures |
US6391038B2 (en) | 1999-07-28 | 2002-05-21 | Cardica, Inc. | Anastomosis system and method for controlling a tissue site |
DE29913246U1 (en) | 1999-07-29 | 1999-09-23 | Aesculap Ag & Co Kg | Surgical suture clip |
DE19935637A1 (en) | 1999-07-29 | 2001-02-22 | Aesculap Ag & Co Kg | Surgical suture clip |
DE19935904C1 (en) | 1999-07-30 | 2001-07-12 | Karlsruhe Forschzent | Applicator tip of a surgical applicator for placing clips / clips for the connection of tissue |
AU6178300A (en) | 1999-08-09 | 2001-03-05 | Salviac Limited | An occluder with anchor |
US6328689B1 (en) | 2000-03-23 | 2001-12-11 | Spiration, Inc., | Lung constriction apparatus and method |
US6231561B1 (en) | 1999-09-20 | 2001-05-15 | Appriva Medical, Inc. | Method and apparatus for closing a body lumen |
US6817972B2 (en) | 1999-10-01 | 2004-11-16 | Computer Motion, Inc. | Heart stabilizer |
CA2322061A1 (en) | 1999-10-05 | 2001-04-05 | Anil K. Nalagatla | Stapling instrument having two staple forming surfaces |
US6406485B1 (en) | 1999-10-08 | 2002-06-18 | Pilling Weck Incorporated | Surgical grasping device and components thereof |
US7004970B2 (en) | 1999-10-20 | 2006-02-28 | Anulex Technologies, Inc. | Methods and devices for spinal disc annulus reconstruction and repair |
US6626930B1 (en) | 1999-10-21 | 2003-09-30 | Edwards Lifesciences Corporation | Minimally invasive mitral valve repair method and apparatus |
US6689150B1 (en) | 1999-10-27 | 2004-02-10 | Atritech, Inc. | Filter apparatus for ostium of left atrial appendage |
US6551303B1 (en) | 1999-10-27 | 2003-04-22 | Atritech, Inc. | Barrier device for ostium of left atrial appendage |
US6652555B1 (en) | 1999-10-27 | 2003-11-25 | Atritech, Inc. | Barrier device for covering the ostium of left atrial appendage |
DE19951940C2 (en) | 1999-10-28 | 2001-11-29 | Karlsruhe Forschzent | Clamping device that can be used endoscopically |
IL132635A0 (en) | 1999-10-28 | 2001-03-19 | Niti Alloys Tech Ltd | Shape memory alloy clip and method of use thereof |
US6994092B2 (en) | 1999-11-08 | 2006-02-07 | Ev3 Sunnyvale, Inc. | Device for containing embolic material in the LAA having a plurality of tissue retention structures |
IL132913A (en) | 1999-11-14 | 2004-09-27 | Porat Michael | Device and method for clamping and cutting a flexible deformable tube |
GB9927040D0 (en) | 1999-11-17 | 2000-01-12 | Femcare Ltd | Medical clips |
US6911032B2 (en) | 1999-11-18 | 2005-06-28 | Scimed Life Systems, Inc. | Apparatus and method for compressing body tissue |
US6428548B1 (en) | 1999-11-18 | 2002-08-06 | Russell F. Durgin | Apparatus and method for compressing body tissue |
US20010041914A1 (en) | 1999-11-22 | 2001-11-15 | Frazier Andrew G.C. | Tissue patch deployment catheter |
US6932825B2 (en) | 1999-12-03 | 2005-08-23 | Applied Medical Resources Corporation | Vessel occlusion clamp |
WO2001043649A1 (en) | 1999-12-17 | 2001-06-21 | Fogarty Thomas J | Method and device for use in minimally invasive approximation of muscle and other tissue |
ATE302568T1 (en) | 2000-01-05 | 2005-09-15 | Integrated Vascular Sys Inc | DEVICE FOR CLOSING A PUNCTURE WOUND |
US6238414B1 (en) | 2000-01-20 | 2001-05-29 | Jerry R. Griffiths | Laparoscopic instrument with parallel actuated jaws |
MXPA02007506A (en) | 2000-02-04 | 2004-08-23 | Imagyn Medical Technologies Ca | Surgical clip applier. |
US7770773B2 (en) | 2005-07-27 | 2010-08-10 | Power Medical Interventions, Llc | Surgical device |
US8016855B2 (en) | 2002-01-08 | 2011-09-13 | Tyco Healthcare Group Lp | Surgical device |
US6273897B1 (en) | 2000-02-29 | 2001-08-14 | Ethicon, Inc. | Surgical bettress and surgical stapling apparatus |
US6648898B1 (en) | 2000-03-02 | 2003-11-18 | Cardiothoracic Systems, Inc. | Clip applying apparatuses and methods for vascular ligation |
US6926712B2 (en) | 2000-03-24 | 2005-08-09 | Boston Scientific Scimed, Inc. | Clamp having at least one malleable clamp member and surgical method employing the same |
US6419682B1 (en) | 2000-03-24 | 2002-07-16 | Timothy Appleby | Hemostatic clip cartridge |
US7374532B2 (en) | 2000-04-14 | 2008-05-20 | Attenuex Technologies, Inc. | High vapor pressure attenuation device |
US6908473B2 (en) | 2000-04-14 | 2005-06-21 | Jeffry B. Skiba | Tissue anchoring devices, biological vessel suspending devices and systems and methods utilizing same |
US6436108B1 (en) | 2000-04-19 | 2002-08-20 | Ensurg, Inc. | Movable ligating band dispenser |
US6546935B2 (en) | 2000-04-27 | 2003-04-15 | Atricure, Inc. | Method for transmural ablation |
US6932811B2 (en) | 2000-04-27 | 2005-08-23 | Atricure, Inc. | Transmural ablation device with integral EKG sensor |
US6592596B1 (en) | 2000-05-10 | 2003-07-15 | Scimed Life Systems, Inc. | Devices and related methods for securing a tissue fold |
DE10026683C2 (en) | 2000-05-30 | 2003-07-10 | Ethicon Endo Surgery Europe | Surgical stapling device |
US6840246B2 (en) | 2000-06-20 | 2005-01-11 | University Of Maryland, Baltimore | Apparatuses and methods for performing minimally invasive diagnostic and surgical procedures inside of a beating heart |
EP1330189B1 (en) | 2000-06-23 | 2007-12-19 | Viacor Incorporated | Automated annular plication for mitral valve repair |
US6746461B2 (en) | 2000-08-15 | 2004-06-08 | William R. Fry | Low-profile, shape-memory surgical occluder |
CN1447669A (en) | 2000-08-18 | 2003-10-08 | 阿特里泰克公司 | Expandable implant devices for filtering blood flow from atrial appendages |
EP1313406B1 (en) | 2000-08-29 | 2010-06-16 | KAPLAN, Aaron, V. | Methods and apparatus for transpericardial left atrial appendage closure |
WO2002017799A1 (en) | 2000-08-30 | 2002-03-07 | Cerebral Vascular Applications Inc. | Medical instrument |
US6755842B2 (en) | 2000-09-01 | 2004-06-29 | Angiolink Corporation | Advanced wound site management systems and methods |
US20040093024A1 (en) | 2000-09-01 | 2004-05-13 | James Lousararian | Advanced wound site management systems and methods |
ATE503423T1 (en) | 2000-09-08 | 2011-04-15 | Abbott Vascular Inc | SURGICAL BRACE |
US20020082621A1 (en) | 2000-09-22 | 2002-06-27 | Schurr Marc O. | Methods and devices for folding and securing tissue |
US6817508B1 (en) | 2000-10-13 | 2004-11-16 | Tyco Healthcare Group, Lp | Surgical stapling device |
US6776785B1 (en) | 2000-10-12 | 2004-08-17 | Cardica, Inc. | Implantable superelastic anastomosis device |
US7334717B2 (en) | 2001-10-05 | 2008-02-26 | Tyco Healthcare Group Lp | Surgical fastener applying apparatus |
US7407076B2 (en) | 2000-10-13 | 2008-08-05 | Tyco Healthcare Group Lp | Surgical stapling device |
ATE273660T1 (en) | 2000-10-17 | 2004-09-15 | Aesculap Ag & Co Kg | ANEURYSM CLAMP |
US20040267310A1 (en) | 2000-10-20 | 2004-12-30 | Racenet David C | Directionally biased staple and anvil assembly for forming the staple |
FR2815842B1 (en) | 2000-10-31 | 2003-05-09 | Assist Publ Hopitaux De Paris | MECHANICAL STAPLER FOR RECTUM SURGERY |
US20020138086A1 (en) | 2000-12-06 | 2002-09-26 | Robert Sixto | Surgical clips particularly useful in the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US6716226B2 (en) | 2001-06-25 | 2004-04-06 | Inscope Development, Llc | Surgical clip |
US7232445B2 (en) | 2000-12-06 | 2007-06-19 | Id, Llc | Apparatus for the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US20020068945A1 (en) | 2000-12-06 | 2002-06-06 | Robert Sixto | Surgical clips particularly useful in the endoluminal treatment of gastroesophageal reflux disease (GERD) |
US6719777B2 (en) | 2000-12-07 | 2004-04-13 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
EP1219247A1 (en) | 2000-12-26 | 2002-07-03 | Cardio Life Research S.P.R.L. | Clamp device for anatomic structure |
US6503259B2 (en) | 2000-12-27 | 2003-01-07 | Ethicon, Inc. | Expandable anastomotic device |
US7229453B2 (en) | 2001-01-23 | 2007-06-12 | Ams Research Corporation | Pelvic floor implant system and method of assembly |
ES2307723T3 (en) | 2001-01-24 | 2008-12-01 | Tyco Healthcare Group Lp | INSTRUMENT FOR ANASTOMOSIS AND METHOD TO CARRY IT OUT. |
JP2002224124A (en) | 2001-02-06 | 2002-08-13 | Olympus Optical Co Ltd | Ligating device |
US20020107531A1 (en) | 2001-02-06 | 2002-08-08 | Schreck Stefan G. | Method and system for tissue repair using dual catheters |
US6723109B2 (en) | 2001-02-07 | 2004-04-20 | Karl Storz Endoscopy-America, Inc. | Deployable surgical clamp with delivery/retrieval device and actuator |
US6575986B2 (en) | 2001-02-26 | 2003-06-10 | Ethicon, Inc. | Scaffold fixation device for use in articular cartilage repair |
US6890338B1 (en) | 2001-02-27 | 2005-05-10 | Origin Medsystems, Inc. | Method and apparatus for performing anastomosis using ring having tines with weak sections |
US8033983B2 (en) | 2001-03-09 | 2011-10-11 | Boston Scientific Scimed, Inc. | Medical implant |
JP4578708B2 (en) | 2001-03-26 | 2010-11-10 | オリンパス株式会社 | Biological tissue clip device |
WO2002078549A2 (en) | 2001-03-28 | 2002-10-10 | Vascular Control Systems, Inc. | Method and apparatus for the detection and ligation of uterine arteries |
US6638285B2 (en) | 2001-04-16 | 2003-10-28 | Shlomo Gabbay | Biological tissue strip and system and method to seal tissue |
US20110144661A1 (en) | 2001-04-24 | 2011-06-16 | Houser Russell A | Tissue closure devices, device and systems for delivery, kits and methods therefor |
WO2002087425A2 (en) | 2001-05-01 | 2002-11-07 | Coalescent Surgical, Inc. | Self-closing surgical clip for tissue |
DE10121305A1 (en) | 2001-05-02 | 2002-12-12 | Ethicon Endo Surgery Europe | Surgical instrument |
US6685715B2 (en) | 2001-05-02 | 2004-02-03 | Novare Surgical Systems | Clamp having bendable shaft |
US6592597B2 (en) | 2001-05-07 | 2003-07-15 | Ethicon Endo-Surgery, Inc. | Adhesive for attaching buttress material to a surgical fastening device |
US7427292B2 (en) | 2001-05-16 | 2008-09-23 | Michael Sachs | Maximal nasal internal support system |
US6916332B2 (en) | 2001-05-23 | 2005-07-12 | Scimed Life Systems, Inc. | Endoluminal fundoplication device and related method for installing tissue fastener |
US20020177863A1 (en) | 2001-05-24 | 2002-11-28 | Mandel Stanley R. | Surface treated ligating clip |
US7338514B2 (en) | 2001-06-01 | 2008-03-04 | St. Jude Medical, Cardiology Division, Inc. | Closure devices, related delivery methods and tools, and related methods of use |
WO2003007825A1 (en) | 2001-07-19 | 2003-01-30 | Atritech, Inc. | Individually customized device for covering the ostium of left atrial appendage |
AUPR668901A0 (en) | 2001-07-31 | 2001-08-23 | Research Surgical Pty Ltd | Surgical clamps |
US7338503B2 (en) | 2002-08-08 | 2008-03-04 | Interrad Medical, Inc. | Non-invasive surgical ligation clip system and method of using |
US6692507B2 (en) | 2001-08-23 | 2004-02-17 | Scimed Life Systems, Inc. | Impermanent biocompatible fastener |
US6629988B2 (en) | 2001-08-28 | 2003-10-07 | Ethicon, Inc. | Composite staple for completing an anastomosis |
US6755338B2 (en) | 2001-08-29 | 2004-06-29 | Cerebral Vascular Applications, Inc. | Medical instrument |
US6776784B2 (en) | 2001-09-06 | 2004-08-17 | Core Medical, Inc. | Clip apparatus for closing septal defects and methods of use |
ES2326361T3 (en) | 2001-09-20 | 2009-10-08 | Radi Medical Systems Ab | ADJUSTABLE COMPRESSOR OF RADIAL ARTERY. |
US8281973B2 (en) | 2001-10-05 | 2012-10-09 | Tyco Healthcare Group Lp | Surgical stapling device |
US20040199178A1 (en) | 2001-10-09 | 2004-10-07 | Small George H. | Umbilical cord clamp and methods of using same |
US6638282B2 (en) | 2001-10-16 | 2003-10-28 | Cetus, Lc | Umbilical cord cutting and clamping device |
CA2433040A1 (en) | 2001-10-24 | 2003-05-01 | John J. Damarati | Multiple hemoclip system for an endoscope |
MXJL01000028A (en) | 2001-11-15 | 2003-05-23 | Casta On Morales Jorge | Chirurgical pincer for pyloric trauma-mioplasty. |
RU2196530C1 (en) | 2001-11-20 | 2003-01-20 | Феденко Вадим Викторович | Clamp device for making implantation |
US20050177180A1 (en) | 2001-11-28 | 2005-08-11 | Aptus Endosystems, Inc. | Devices, systems, and methods for supporting tissue and/or structures within a hollow body organ |
US10098640B2 (en) | 2001-12-04 | 2018-10-16 | Atricure, Inc. | Left atrial appendage devices and methods |
US7749157B2 (en) | 2001-12-04 | 2010-07-06 | Estech, Inc. (Endoscopic Technologies, Inc.) | Methods and devices for minimally invasive cardiac surgery for atrial fibrillation |
US20050149069A1 (en) | 2001-12-04 | 2005-07-07 | Bertolero Arthur A. | Left atrial appendage devices and methods |
US20050277956A1 (en) | 2004-06-14 | 2005-12-15 | Francese Jose L | Clip storage for endoscopic clip applier |
WO2003053256A1 (en) | 2001-12-13 | 2003-07-03 | Sumitomo Bakelite Company Limited | Clip device for endoscope and clip for endoscope for use therein |
US6974462B2 (en) | 2001-12-19 | 2005-12-13 | Boston Scientific Scimed, Inc. | Surgical anchor implantation device |
WO2003059152A2 (en) | 2002-01-14 | 2003-07-24 | Nmt Medical, Inc. | Patent foramen ovale (pfo) closure method and device |
GB0203332D0 (en) | 2002-02-13 | 2002-03-27 | United Bristol Healthcare Nhs | Medical device |
EP1487353A4 (en) | 2002-03-25 | 2008-04-16 | Nmt Medical Inc | Patent foramen ovale (pfo) closure clips |
US7588585B2 (en) | 2002-03-26 | 2009-09-15 | Novare Surgical Systems, Inc. | Handleless clamping device |
US7007698B2 (en) | 2002-04-03 | 2006-03-07 | Boston Scientific Corporation | Body lumen closure |
WO2003086207A1 (en) | 2002-04-10 | 2003-10-23 | Tyco Healthcare Group, Lp | Surgical clip applier with high torque jaws |
US7070083B2 (en) | 2002-04-11 | 2006-07-04 | Tyco Healthcare Group Lp | Surgical stapling apparatus including an anvil and cartridge each having cooperating mating surfaces |
ES2622252T3 (en) | 2002-04-16 | 2017-07-06 | Covidien Lp | Surgical stapler and method |
US7896896B2 (en) | 2002-04-22 | 2011-03-01 | Tyco Healthcare Group Lp | Endoscopic surgical clip |
EP1496807B1 (en) | 2002-04-22 | 2017-01-04 | Covidien LP | Tack and tack applier |
US8241308B2 (en) | 2002-04-24 | 2012-08-14 | Boston Scientific Scimed, Inc. | Tissue fastening devices and processes that promote tissue adhesion |
WO2003092546A2 (en) | 2002-04-30 | 2003-11-13 | Cook Urological Inc. | Sling for supporting tissue |
WO2003096881A2 (en) | 2002-05-14 | 2003-11-27 | University Of Pittsburgh | Device and method of use for functional isolation of animal or human tissues |
US7060083B2 (en) | 2002-05-20 | 2006-06-13 | Boston Scientific Scimed, Inc. | Foldable vaso-occlusive member |
US20030225423A1 (en) | 2002-05-30 | 2003-12-04 | Huitema Thomas W. | Surgical clip |
US20040034375A1 (en) | 2002-05-31 | 2004-02-19 | Ruiz Larry R. | Fastening system incorporating washer for skull closure |
DE20208744U1 (en) | 2002-06-05 | 2003-01-23 | El Shazly Mohamed | End-to-side micro-surgical vascular clamp consists of a semi-circular vein-part clamp fixed to a transverse-lying member, also has a straight clamp freely fixed to the same transverse-lying member |
US20030233095A1 (en) | 2002-06-12 | 2003-12-18 | Urbanski Mark G. | Device and method for attaching soft tissue to bone |
DE60307637T2 (en) | 2002-06-17 | 2007-08-09 | Tyco Healthcare Group Lp, Norwalk | RINGTONE BRACKET STRUCTURE |
US6726705B2 (en) | 2002-06-25 | 2004-04-27 | Incisive Surgical, Inc. | Mechanical method and apparatus for bilateral tissue fastening |
US6773440B2 (en) | 2002-07-02 | 2004-08-10 | Satiety, Inc. | Method and device for use in tissue approximation and fixation |
US20040133219A1 (en) | 2002-07-29 | 2004-07-08 | Peter Forsell | Multi-material constriction device for forming stoma opening |
US7727247B2 (en) | 2002-08-21 | 2010-06-01 | Olympus Corporation | Living tissue ligation device |
EP2455013B1 (en) | 2002-08-21 | 2021-12-08 | Olympus Corporation | Clip unit case for ligating device for biological tissue |
DE20214068U1 (en) | 2002-09-05 | 2002-11-14 | Aesculap Ag & Co Kg | Two-part medical instrument |
WO2004023976A2 (en) | 2002-09-13 | 2004-03-25 | Damage Control Surgical Technologies, Inc. | Method and apparatus for vascular and visceral clipping |
US7153313B2 (en) | 2002-09-19 | 2006-12-26 | Whitton Daniel F | Auricular hematoma clamp |
US7678122B2 (en) | 2002-09-20 | 2010-03-16 | Id, Llc | Method of performing a treatment for gastroesophagheal reflux disease (GERD) |
US6863675B2 (en) | 2002-09-20 | 2005-03-08 | Pilling Weck Incorporated | Ligating clip with integral penetrating hook |
US7033378B2 (en) | 2002-09-20 | 2006-04-25 | Id, Llc | Surgical fastener, particularly for the endoluminal treatment of gastroesophageal reflux disease (GERD) |
DE60317909T2 (en) | 2002-09-23 | 2008-11-13 | NMT Medical, Inc., Boston | DEVICE FOR PUNCTING A SEPTUMS |
WO2004026113A2 (en) | 2002-09-23 | 2004-04-01 | Eva Corporation | Apparatus and method for reducing fluid loss during a surgical procedure |
EP1545335A1 (en) | 2002-10-04 | 2005-06-29 | Tyco Healthcare Group Lp | Angled surgical fastener apparatus |
JP4448449B2 (en) | 2002-10-04 | 2010-04-07 | タイコ ヘルスケア グループ エルピー | Tool assembly for a surgical stapling device |
ES2337248T3 (en) | 2002-10-04 | 2010-04-22 | Tyco Healthcare Group Lp | TOOL ASSEMBLY FOR A SURGICAL STAPLING DEVICE. |
EP2401969B1 (en) | 2002-10-04 | 2013-04-03 | Covidien LP | Pneumatic powered surgical stapling device |
US20040073241A1 (en) | 2002-10-11 | 2004-04-15 | Spiration, Inc. | Implantable tissue constriction device and method for suppressing leakage of fluid from resectioned body tissue |
EP1417933A1 (en) | 2002-11-11 | 2004-05-12 | Sergio Callegari | Transcatheter left atrial appendage occlusion prosthesis |
US7678125B2 (en) | 2002-11-12 | 2010-03-16 | Apollo Camera, L.L.C. | Surgical ligation clip |
US20040089312A1 (en) | 2002-11-12 | 2004-05-13 | Jordan James Lowell | Fertility plug |
US20040097979A1 (en) | 2002-11-14 | 2004-05-20 | Oleg Svanidze | Aortic valve implantation device |
CA2507967A1 (en) | 2002-12-17 | 2004-07-15 | Applied Medical Resources Corporation | Surgical staple-clip and applier |
US20040138683A1 (en) | 2003-01-09 | 2004-07-15 | Walter Shelton | Suture arrow device and method of using |
RU2245113C2 (en) | 2003-01-21 | 2005-01-27 | Курский государственный медицинский университет | Instrument for making operation on thyroid gland |
US6821284B2 (en) | 2003-01-22 | 2004-11-23 | Novare Surgical Systems, Inc. | Surgical clamp inserts with micro-tractive surfaces |
WO2004069023A2 (en) | 2003-02-10 | 2004-08-19 | Ramot At Tel Aviv University Ltd. | Vacuum holder for juxtaposing body tissues |
FR2851451B1 (en) | 2003-02-24 | 2005-05-20 | Sofradim Production | DEVICE FOR LIGATURING ANATOMICAL STRUCTURE |
GB0305976D0 (en) | 2003-03-14 | 2003-04-23 | Wild Andrew M | Surgical clip |
US20040193189A1 (en) | 2003-03-25 | 2004-09-30 | Kortenbach Juergen A. | Passive surgical clip |
US20040193188A1 (en) | 2003-03-25 | 2004-09-30 | Inscope Development, Llc | Laminated surgical clip |
US7597704B2 (en) | 2003-04-28 | 2009-10-06 | Atritech, Inc. | Left atrial appendage occlusion device with active expansion |
CN1859874A (en) | 2003-06-16 | 2006-11-08 | 伊西康内外科公司 | Surgical system with stapling instrument and retractor |
EP1635713B1 (en) | 2003-06-17 | 2012-04-11 | Tyco Healthcare Group LP | Surgical stapling device |
US6991637B2 (en) | 2003-06-18 | 2006-01-31 | Gore Enterprise Holdings, Inc. | Soft tissue defect repair device |
US7166116B2 (en) * | 2003-06-23 | 2007-01-23 | Ethicon, Inc. | Tissue grasper/suture passer instrument |
US7862571B2 (en) | 2003-07-25 | 2011-01-04 | Microline Surgical, Inc. | Occlusion clip and method of applying same |
WO2005016389A2 (en) | 2003-08-04 | 2005-02-24 | Kelly Jackson | Medical instruments and methods for using the same |
US7735493B2 (en) | 2003-08-15 | 2010-06-15 | Atritech, Inc. | System and method for delivering a left atrial appendage containment device |
ATE375754T1 (en) | 2003-09-12 | 2007-11-15 | Nmt Medical Inc | DEVICE FOR PREVENTING THROMB FORMATION IN THE LEFT ATRIAL APPENDIX |
US9089355B2 (en) | 2003-09-16 | 2015-07-28 | Vitalitec International, Inc. | Surgical clamp inserts with hooked traction elements |
JP5006041B2 (en) | 2003-09-16 | 2012-08-22 | バイタリテック インターナショナル,インコーポレイテッド | Surgical clamp insert with barbed traction element |
WO2005027753A1 (en) | 2003-09-19 | 2005-03-31 | St. Jude Medical, Inc. | Apparatus and methods for tissue gathering and securing |
US7494461B2 (en) | 2003-09-30 | 2009-02-24 | Boston Scientific Scimed, Inc. | Through the scope tension member release clip |
DE10347391A1 (en) | 2003-10-07 | 2005-05-12 | Gert Otten | Medical clamp for clamping organic tissue comprises two clamping bars that can be displaced from a starting position in which they are arranged a distance apart into an end position in which they are positioned closer together |
WO2005034802A2 (en) | 2003-10-09 | 2005-04-21 | Sentreheart, Inc. | Apparatus and method for the ligation of tissue |
US7296722B2 (en) | 2003-10-17 | 2007-11-20 | Tyco Healthcare Group Lp | Surgical fastener applying apparatus with controlled beam deflection |
US7473261B2 (en) | 2003-10-20 | 2009-01-06 | Henry Rennich | External incontinence clamp |
WO2005046489A1 (en) | 2003-11-07 | 2005-05-26 | Scimed Life Systems, Inc. | Endoscopic hemoscopic clipping apparatus |
WO2005046453A2 (en) | 2003-11-11 | 2005-05-26 | Endoscopic Technologies, Inc. | Left atrial appendage devices and methods |
SE526861C2 (en) | 2003-11-17 | 2005-11-15 | Syntach Ag | Tissue lesion creation device and a set of devices for the treatment of cardiac arrhythmia disorders |
US7566336B2 (en) | 2003-11-25 | 2009-07-28 | Cardia, Inc. | Left atrial appendage closure device |
EP3345577A1 (en) | 2003-12-04 | 2018-07-11 | Boston Scientific Scimed, Inc. | System for delivering a left atrail appendange containment device |
US20050149068A1 (en) | 2003-12-17 | 2005-07-07 | Mathew Williams | Left atrial appendage exclusion device |
CA2551531C (en) | 2003-12-26 | 2015-02-24 | Terumo Kabushiki Kaisha | Tissue closure and tissue closing device |
US7207472B2 (en) | 2003-12-30 | 2007-04-24 | Ethicon Endo-Surgery, Inc. | Cartridge with locking knife for a curved cutter stapler |
US7766207B2 (en) | 2003-12-30 | 2010-08-03 | Ethicon Endo-Surgery, Inc. | Articulating curved cutter stapler |
US20050149988A1 (en) | 2004-01-06 | 2005-07-07 | Sbc Knowledge Ventures, L.P. | Delivering interactive television components in real time for live broadcast events |
US7473384B2 (en) | 2004-01-06 | 2009-01-06 | Antonio Kanan | Method for making vinyl composition plank |
US20050149989A1 (en) | 2004-01-07 | 2005-07-07 | John Lupoi | Event management mechanism for athlete recruiting architecture |
WO2005069950A2 (en) | 2004-01-22 | 2005-08-04 | Eva Corporation | Surgical fastener |
US20110208233A1 (en) | 2004-01-22 | 2011-08-25 | Mcguckin Jr James F | Device for preventing clot migration from left atrial appendage |
US7326223B2 (en) | 2004-01-22 | 2008-02-05 | Teleflex Medical Incorporated | Ligating clip with integral cutting guide |
US7316696B2 (en) | 2004-01-22 | 2008-01-08 | Teleflex Medical Incorporated | Ligating clip with integral interlocking latch mechanism |
US20050165429A1 (en) | 2004-01-23 | 2005-07-28 | Peter Douglas | Surgical clamp possessing a combined parallel and scissor style clamp head |
US20050165423A1 (en) | 2004-01-23 | 2005-07-28 | Pilling Weck Incorporated | Ligating clip with integral tissue-securing mechanism |
US7001412B2 (en) | 2004-01-28 | 2006-02-21 | Pilling Weck Incorporated | Surgical clip with integral suture-securing mechanism |
US7585304B2 (en) | 2004-02-02 | 2009-09-08 | Teleflex Medical Incorporated | Endoscopic clip applying apparatus with improved aperture for clip release and related method |
US20050177176A1 (en) | 2004-02-05 | 2005-08-11 | Craig Gerbi | Single-fold system for tissue approximation and fixation |
US20050177224A1 (en) | 2004-02-11 | 2005-08-11 | Fogarty Thomas J. | Vascular fixation device and method |
ES2365547T3 (en) | 2004-02-17 | 2011-10-06 | Tyco Healthcare Group Lp | SURGICAL ENGRAVING DEVICE WITH LOCKING MECHANISM. |
US8523904B2 (en) | 2004-03-09 | 2013-09-03 | The Board Of Trustees Of The Leland Stanford Junior University | Methods and systems for constraint of spinous processes with attachment |
US7089515B2 (en) | 2004-03-09 | 2006-08-08 | International Business Machines Corporation | Threshold voltage roll-off compensation using back-gated MOSFET devices for system high-performance and low standby power |
US8100822B2 (en) | 2004-03-16 | 2012-01-24 | Macroplata Systems, Llc | Anoscope for treating hemorrhoids without the trauma of cutting or the use of an endoscope |
DE102004015223A1 (en) | 2004-03-24 | 2005-10-06 | Otten, Gert, Prof. Dr.med. | Surgical staple assembled of two elements and appropriate stapler in particular for joining outer ends of intestine segments |
US20050234543A1 (en) | 2004-03-30 | 2005-10-20 | Nmt Medical, Inc. | Plug for use in left atrial appendage |
US7578827B2 (en) | 2004-04-02 | 2009-08-25 | Applied Medical Resources Corporation | Suture clip with stop ribs and method for making same |
WO2005110243A2 (en) | 2004-05-03 | 2005-11-24 | Ams Research Corporation | Surgical implants and related methods |
NL1026102C2 (en) | 2004-05-03 | 2005-11-07 | Doorzand Guardian Angel B V | Blocking device for fallopian tubes and insertion device therefor. |
US8257389B2 (en) | 2004-05-07 | 2012-09-04 | W.L. Gore & Associates, Inc. | Catching mechanisms for tubular septal occluder |
EP3398522B1 (en) | 2004-05-14 | 2019-12-25 | Evalve, Inc. | Locking mechanisms for fixation devices |
US7645285B2 (en) | 2004-05-26 | 2010-01-12 | Idx Medical, Ltd | Apparatus and methods for occluding a hollow anatomical structure |
DE102004026617B4 (en) | 2004-06-01 | 2006-06-14 | Siemens Ag | Device for clamping tissue |
US20050273122A1 (en) | 2004-06-02 | 2005-12-08 | Microline, Inc. | Clip with enhanced gripping arrangement |
US7678117B2 (en) | 2004-06-07 | 2010-03-16 | Novare Surgical Systems, Inc. | Articulating mechanism with flex-hinged links |
US7699056B2 (en) | 2004-06-10 | 2010-04-20 | Conceptus, Inc. | Medical devices and methods of making and using such devices |
US8663245B2 (en) | 2004-06-18 | 2014-03-04 | Medtronic, Inc. | Device for occlusion of a left atrial appendage |
WO2006009729A2 (en) | 2004-06-18 | 2006-01-26 | Medtronic, Inc. | Methods and devices for occlusion of an atrial appendage |
US20060004388A1 (en) | 2004-06-18 | 2006-01-05 | Ablatrics, Inc. | System for tissue cavity closure |
US8926635B2 (en) | 2004-06-18 | 2015-01-06 | Medtronic, Inc. | Methods and devices for occlusion of an atrial appendage |
WO2006009545A1 (en) | 2004-06-22 | 2006-01-26 | Stilp Paul J | Ear clip |
BRMU8401529U (en) | 2004-07-02 | 2006-02-21 | Milton Tatsuo Tanaka | laparoscopic curved surgical clip |
US20060025812A1 (en) | 2004-07-28 | 2006-02-02 | Ethicon Endo-Surgery, Inc. | Surgical instrument incorporating an electrically actuated pivoting articulation mechanism |
US7410465B2 (en) | 2004-09-30 | 2008-08-12 | Laufer Michael D | Devices for counteracting hypotension |
US7819886B2 (en) | 2004-10-08 | 2010-10-26 | Tyco Healthcare Group Lp | Endoscopic surgical clip applier |
US8920438B2 (en) | 2004-10-08 | 2014-12-30 | Covidien Lp | Apparatus for applying surgical clips |
US8372094B2 (en) | 2004-10-15 | 2013-02-12 | Covidien Lp | Seal element for anastomosis |
US7717313B2 (en) | 2004-10-18 | 2010-05-18 | Tyco Healthcare Group Lp | Surgical apparatus and structure for applying sprayable wound treatment material |
US7938307B2 (en) | 2004-10-18 | 2011-05-10 | Tyco Healthcare Group Lp | Support structures and methods of using the same |
EP1809194B1 (en) | 2004-10-20 | 2012-04-25 | AtriCure Inc. | Surgical clamp |
RU2261057C1 (en) | 2004-11-12 | 2005-09-27 | Государственное образовательное учреждение высшего профессионального образования "Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова Министерства здравоохранения Российской Федерации" | Clamp for isolating of auticula atrii from left auricle and apparatus for placing the same |
US7641671B2 (en) | 2004-11-22 | 2010-01-05 | Design Standards Corporation | Closing assemblies for clamping device |
US7422783B2 (en) | 2004-11-24 | 2008-09-09 | Velcro Industries B.V. | Submerged hooks |
JP4758173B2 (en) | 2004-12-24 | 2011-08-24 | オリンパス株式会社 | Ligation device |
US7438208B2 (en) | 2005-01-25 | 2008-10-21 | Entrigue Surgical, Inc. | Septal stapler apparatus |
WO2006085389A1 (en) | 2005-02-09 | 2006-08-17 | Johnson & Johnson Kabushiki Kaisha | Stapling instrument |
US20060289602A1 (en) | 2005-06-23 | 2006-12-28 | Ethicon Endo-Surgery, Inc. | Surgical instrument with articulating shaft with double pivot closure and single pivot frame ground |
JP2008543354A (en) | 2005-03-24 | 2008-12-04 | テレフレックス・メディカル・インコーポレイテッド | Ligation clip with reduced closing force |
US20060217749A1 (en) | 2005-03-24 | 2006-09-28 | Pilling Weck Incorporated | Reduced closure force ligating clip |
DE202005005844U1 (en) | 2005-04-07 | 2005-06-09 | Schnorrenberg Chirurgiemechanik Gmbh | Surgical clamp in laparoscopy |
US7686820B2 (en) | 2005-04-14 | 2010-03-30 | Ethicon Endo-Surgery, Inc. | Surgical clip applier ratchet mechanism |
US7699860B2 (en) | 2005-04-14 | 2010-04-20 | Ethicon Endo-Surgery, Inc. | Surgical clip |
EP1874196B1 (en) | 2005-04-15 | 2010-03-31 | Satiety, Inc. | Single fold device for tissue fixation |
CA2603499A1 (en) | 2005-04-22 | 2006-11-02 | Rex Medical, L.P. | Closure device for left atrial appendage |
US7569064B1 (en) | 2005-05-13 | 2009-08-04 | Cardica, Inc. | Apparatus and method for closing an atrial appendage |
JP2006346445A (en) | 2005-05-17 | 2006-12-28 | Ethicon Endo Surgery Inc | Surgical stapler having aluminum head |
US7645286B2 (en) | 2005-05-20 | 2010-01-12 | Neotract, Inc. | Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures |
US20060264979A1 (en) | 2005-05-20 | 2006-11-23 | Shepard Rudolph C | Novel enhanced vascular surgical device |
US7896891B2 (en) | 2005-05-20 | 2011-03-01 | Neotract, Inc. | Apparatus and method for manipulating or retracting tissue and anatomical structure |
US7621866B2 (en) | 2005-05-31 | 2009-11-24 | Ethicon, Inc. | Method and device for deployment of a sub-pericardial sack |
US7717312B2 (en) | 2005-06-03 | 2010-05-18 | Tyco Healthcare Group Lp | Surgical instruments employing sensors |
US8945151B2 (en) | 2005-07-13 | 2015-02-03 | Atricure, Inc. | Surgical clip applicator and apparatus including the same |
US20090012545A1 (en) | 2005-07-14 | 2009-01-08 | Idx Medical, Ltd. | Apparatus and Methods for Occluding a Hallow Anatomical Structure |
US8298133B2 (en) | 2005-07-15 | 2012-10-30 | Ethicon Endo-Surgery, Inc. | Gastric band composed of different hardness materials |
RU2299023C2 (en) | 2005-07-18 | 2007-05-20 | Военно-медицинский институт Федеральной службы безопасности Российской Федерации (ВМИ ФСБ России) | Suturing apparatus |
WO2008005400A2 (en) | 2006-06-30 | 2008-01-10 | Cvdevices, Llc | Magnetic devices for hiatal hernia remodeling |
US20090163937A1 (en) | 2005-07-29 | 2009-06-25 | Cvdevices, Llc | Devices and methods for achieving magnetic stand-off of a tissue |
US20100114124A1 (en) | 2005-08-03 | 2010-05-06 | Brian Kelleher | Method and apparatus for partioning an organ within the body |
US7407075B2 (en) | 2005-08-15 | 2008-08-05 | Tyco Healthcare Group Lp | Staple cartridge having multiple staple sizes for a surgical stapling instrument |
US7398908B2 (en) | 2005-08-15 | 2008-07-15 | Tyco Healthcare Group Lp | Surgical stapling instruments including a cartridge having multiple staple sizes |
US7401721B2 (en) | 2005-08-15 | 2008-07-22 | Tyco Healthcare Group Lp | Surgical stapling instruments including a cartridge having multiple staple sizes |
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 |
US8506474B2 (en) | 2005-08-19 | 2013-08-13 | Bioventrix, Inc. | Method and device for treating dysfunctional cardiac tissue |
US8758397B2 (en) | 2005-08-24 | 2014-06-24 | Abbott Vascular Inc. | Vascular closure methods and apparatuses |
US20070060895A1 (en) | 2005-08-24 | 2007-03-15 | Sibbitt Wilmer L Jr | Vascular closure methods and apparatuses |
US20070049947A1 (en) | 2005-08-25 | 2007-03-01 | Microline Pentax Inc. | Cinch control device |
US20070049949A1 (en) | 2005-08-25 | 2007-03-01 | Microline Pentax Inc | Clip feeder mechanism for clip applying device |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070060951A1 (en) | 2005-09-15 | 2007-03-15 | Shannon Francis L | Atrial tissue fixation device |
US7972359B2 (en) | 2005-09-16 | 2011-07-05 | Atritech, Inc. | Intracardiac cage and method of delivering same |
US7451904B2 (en) | 2005-09-26 | 2008-11-18 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having end effector gripping surfaces |
US8096459B2 (en) | 2005-10-11 | 2012-01-17 | Ethicon Endo-Surgery, Inc. | Surgical stapler with an end effector support |
US20070083218A1 (en) | 2005-10-12 | 2007-04-12 | A Morris Steven | Coated ligating clip |
CA2563147C (en) | 2005-10-14 | 2014-09-23 | Tyco Healthcare Group Lp | Surgical stapling device |
AU2006228045B2 (en) | 2005-10-14 | 2011-11-24 | Covidien Lp | Apparatus for laparoscopic or endoscopic procedures |
US7901420B2 (en) | 2005-11-02 | 2011-03-08 | University Of Massachusetts | Tissue clamp |
US8052700B2 (en) | 2005-11-02 | 2011-11-08 | University Of Massachusetts | Tissue clamp |
US20070112365A1 (en) | 2005-11-15 | 2007-05-17 | Applied Medical Resources Corporation | Partial occlusion surgical guide clip |
US20070118161A1 (en) | 2005-11-22 | 2007-05-24 | Kennedy Daniel L | Non-snag polymer ligating clip |
US7896895B2 (en) | 2005-11-23 | 2011-03-01 | Ethicon Endo-Surgery, Inc. | Surgical clip and applier device and method of use |
US8142470B2 (en) | 2005-12-01 | 2012-03-27 | Atritech, Inc. | Method for accessing the left atrial appendage with a balloon-tipped transeptal sheath |
US20070135826A1 (en) | 2005-12-01 | 2007-06-14 | Steve Zaver | Method and apparatus for delivering an implant without bias to a left atrial appendage |
US9480480B2 (en) | 2005-12-22 | 2016-11-01 | Albert N. Santilli | Vascular and intestinal occlusion |
US9486225B2 (en) | 2005-12-22 | 2016-11-08 | Robert E. Michler | Exclusion of the left atrial appendage |
DE202006000329U1 (en) | 2006-01-11 | 2006-03-02 | Aesculap Ag & Co. Kg | Surgical ligature clip |
US20070173866A1 (en) | 2006-01-23 | 2007-07-26 | Tyco Healthcare Group, Lp | Surgical hemostatic clip |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US7628797B2 (en) | 2006-01-31 | 2009-12-08 | Edwards Lifesciences Corporation | System, apparatus, and method for fastening tissue |
EP1986581B1 (en) | 2006-01-31 | 2012-10-03 | Regents of the University of Minnesota | Surgical support structure |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
EP1981408A1 (en) | 2006-02-10 | 2008-10-22 | Sarkis Yeretsian | Surgical excision clamp comprising releasable medicaments |
US8292904B2 (en) | 2006-02-15 | 2012-10-23 | Ethicon Endo-Surgery, Inc. | Device, clip, endoscope and method for the intraluminal treatment of tissue, e.g. hemorrhoids |
US7749249B2 (en) | 2006-02-21 | 2010-07-06 | Kardium Inc. | Method and device for closing holes in tissue |
US20070203391A1 (en) | 2006-02-24 | 2007-08-30 | Medtronic Vascular, Inc. | System for Treating Mitral Valve Regurgitation |
US7727142B2 (en) | 2006-03-03 | 2010-06-01 | Acorn Cardiovascular, Inc. | Delivery tool for cardiac support device |
WO2007099448A2 (en) | 2006-03-03 | 2007-09-07 | Vayro Ltd. | A fastening device |
US7648514B1 (en) | 2006-03-08 | 2010-01-19 | Granit Medical Innovation, Llc | Deep endoscopic staple and stapler |
US7892244B2 (en) | 2006-03-09 | 2011-02-22 | Niti Surgical Solutions Ltd. | Surgical compression clips |
JP5175833B2 (en) | 2006-03-10 | 2013-04-03 | クック メディカル テクノロジーズ エルエルシー | Medical device capable of drawing target tissue into clip arm housing chamber |
RU2008141508A (en) | 2006-04-13 | 2010-05-20 | КейСиАй Лайсензинг, Инк. (US) | CLIP MEDICAL CLIP CLOSURE SYSTEM AND METHOD FOR CLOSING THE CROSS |
US8267849B2 (en) | 2006-04-18 | 2012-09-18 | Wazer David E | Radioactive therapeutic fastening instrument |
US20090131959A1 (en) | 2006-04-20 | 2009-05-21 | Liquidia Technologies Inc. | Biological Vessel Flow Control Devices and Methods |
US20070246505A1 (en) | 2006-04-24 | 2007-10-25 | Medical Ventures Inc. | Surgical buttress assemblies and methods of uses thereof |
DE102006036649A1 (en) | 2006-04-27 | 2007-10-31 | Biophan Europe Gmbh | Occluder for human or animal heart, has intermediate piece eccentrically connected with each closing body in edge area of bodies in closing condition, where occluder or its part forms electrical resonant oscillating circuit |
WO2007127664A1 (en) | 2006-04-28 | 2007-11-08 | Medtronic, Inc. | Methods and devices for occlusion of an atrial appendage |
US7666199B2 (en) | 2006-05-01 | 2010-02-23 | Boston Scientific Scimed, Inc. | Device and method for temporary vessel occlusion |
WO2007131110A2 (en) | 2006-05-03 | 2007-11-15 | Raptor Ridge, Llc | Systems and methods of tissue closure |
EP2018248B1 (en) | 2006-05-19 | 2015-11-04 | Applied Medical Resources Corporation | Surgical stapler |
US7846177B2 (en) * | 2006-06-26 | 2010-12-07 | Carefusion 2200, Inc. | Surgical device |
US8152823B2 (en) | 2006-06-30 | 2012-04-10 | Cvdevices, Llc | Devices for organ restriction |
WO2008010905A2 (en) | 2006-06-30 | 2008-01-24 | Cvdevices, Llc | Percutaneous intravascular access to cardiac tissue |
AU2007269655B2 (en) | 2006-07-01 | 2012-06-07 | Opus Ksd Inc. | Tissue fasteners and related insertion devices, mechanisms, and methods |
US20080021466A1 (en) | 2006-07-20 | 2008-01-24 | Shadduck John H | Spine treatment devices and methods |
DE102006035602A1 (en) | 2006-07-31 | 2008-02-07 | Plus Orthopedics Ag | Clamp for attaching surgical operating aids, actuator for such a clamp and an assembly comprising an actuator and a clamp |
US20080033241A1 (en) | 2006-08-01 | 2008-02-07 | Ruey-Feng Peh | Left atrial appendage closure |
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 |
US20080039743A1 (en) | 2006-08-09 | 2008-02-14 | Coherex Medical, Inc. | Methods for determining characteristics of an internal tissue opening |
US20080039879A1 (en) | 2006-08-09 | 2008-02-14 | Chin Albert K | Devices and methods for atrial appendage exclusion |
US20080046007A1 (en) | 2006-08-21 | 2008-02-21 | Ethicon Endo-Surgery, Inc. | Surgical fastener |
US20080046008A1 (en) | 2006-08-21 | 2008-02-21 | Ethicon Endo-Surgery, Inc. | Surgical fastener |
WO2008033558A2 (en) | 2006-09-15 | 2008-03-20 | Vascular Precision | Tissue closure, delivery device and method of use |
US7875053B2 (en) | 2006-09-15 | 2011-01-25 | Cardica, Inc. | Apparatus and method for closure of patent foramen ovale |
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 |
US7481348B2 (en) | 2006-10-06 | 2009-01-27 | Tyco Healthcare Group Lp | Surgical instrument with articulating tool assembly |
US7866525B2 (en) | 2006-10-06 | 2011-01-11 | Tyco Healthcare Group Lp | Surgical instrument having a plastic surface |
US8608043B2 (en) | 2006-10-06 | 2013-12-17 | Covidien Lp | Surgical instrument having a multi-layered drive beam |
US7967178B2 (en) | 2006-10-06 | 2011-06-28 | Tyco Healthcare Group Lp | Grasping jaw mechanism |
EP2314232B1 (en) | 2006-10-17 | 2015-03-25 | Covidien LP | Apparatus for applying surgical clips |
JP5327971B2 (en) | 2006-10-21 | 2013-10-30 | セロノヴァ・ステント・インコーポレーテッド | Deformable lumen support device and method of use thereof |
US7845533B2 (en) | 2007-06-22 | 2010-12-07 | Tyco Healthcare Group Lp | Detachable buttress material retention systems for use with a surgical stapling device |
WO2008057281A2 (en) | 2006-10-26 | 2008-05-15 | Tyco Healthcare Group Lp | Methods of using shape memory alloys for buttress attachment |
WO2008058056A2 (en) | 2006-11-03 | 2008-05-15 | William Pannell | Vasectomy devices and kit and method for use |
JP4716513B2 (en) | 2006-11-09 | 2011-07-06 | Hoya株式会社 | Endoscopic clip device |
US20080147083A1 (en) | 2006-11-09 | 2008-06-19 | Vold Steven D | Method and device for fixation of ophthalmic tissue |
US7780685B2 (en) | 2006-11-09 | 2010-08-24 | Ethicon Endo-Surgery, Inc. | Adhesive and mechanical fastener |
EP1982655B2 (en) | 2007-04-16 | 2022-12-07 | Occlutech Holding AG | Occluder to seal an atrial appendage and method of manufacture thereof |
US20080125796A1 (en) | 2006-11-28 | 2008-05-29 | Stryker Development Llc | Gastrotomy closure device |
US7758577B2 (en) | 2006-12-05 | 2010-07-20 | Ethicon Endo-Surgery, Inc. | Monopolar resection device and method of use |
US8114100B2 (en) | 2006-12-06 | 2012-02-14 | Ethicon Endo-Surgery, Inc. | Safety fastener for tissue apposition |
ATE529056T1 (en) | 2006-12-14 | 2011-11-15 | Ethicon Endo Surgery Inc | TISSUE CLAP FOR ENDOLUMINAL, LOCAL TISSUE EXCISION |
US9192471B2 (en) | 2007-01-08 | 2015-11-24 | Millipede, Inc. | Device for translumenal reshaping of a mitral valve annulus |
US20080177292A1 (en) | 2007-01-19 | 2008-07-24 | Moises Jacobs | Vertically oriented band for stomach |
US8480708B2 (en) | 2007-01-23 | 2013-07-09 | Cvdevices, Llc | Devices, systems, and methods for percutaneous trans-septal left atrial appendage occlusion |
US8647367B2 (en) | 2007-01-23 | 2014-02-11 | Cvdevices, Llc | Devices, systems, and methods for percutaneous trans-septal left atrial appendage occlusion |
US8591533B2 (en) | 2007-02-06 | 2013-11-26 | The Ohio State University Research Foundation | Endolumenal restriction method and apparatus |
US20080215090A1 (en) | 2007-02-14 | 2008-09-04 | Entrigue Surgical, Inc. | Method and System for Tissue Fastening |
US20080208324A1 (en) | 2007-02-23 | 2008-08-28 | Glithero Jason I | Method and apparatus for occluding an anatomical structure |
DE202007003398U1 (en) | 2007-02-28 | 2007-06-14 | Aesculap Ag & Co. Kg | Surgical instrument for endoscopic interference for treating body tissues, has deformation unit for simultaneous deformation of two clamping units with similar or same dimensions and/or deformation characteristics |
US7473258B2 (en) | 2007-03-08 | 2009-01-06 | Cardica, Inc. | Surgical stapler |
EP2120729A1 (en) | 2007-03-12 | 2009-11-25 | Applied Arthroscopy, Inc. | Anchor, system and method to attach a human tissue or suture material into a bone |
US7431188B1 (en) | 2007-03-15 | 2008-10-07 | Tyco Healthcare Group Lp | Surgical stapling apparatus with powered articulation |
US7735703B2 (en) | 2007-03-15 | 2010-06-15 | Ethicon Endo-Surgery, Inc. | Re-loadable surgical stapling instrument |
US7422136B1 (en) | 2007-03-15 | 2008-09-09 | Tyco Healthcare Group Lp | Powered surgical stapling device |
WO2008115922A1 (en) | 2007-03-19 | 2008-09-25 | Michael Brenzel | Methods and apparatus for occlusion of body lumens |
ES2627617T3 (en) | 2007-03-22 | 2017-07-28 | Covidien Lp | Apparatus for forming surgical closures of variable height |
JP2008229248A (en) | 2007-03-23 | 2008-10-02 | Toshiba Corp | Sleep controlling apparatus, method, and program |
US8056787B2 (en) | 2007-03-28 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling and cutting instrument with travel-indicating retraction member |
US7722628B2 (en) | 2007-04-04 | 2010-05-25 | Ethicon Endo-Surgery, Inc. | Device for plicating and fastening gastric tissue |
US8006885B2 (en) | 2007-04-09 | 2011-08-30 | Tyco Healthcare Group Lp | Surgical stapling apparatus with powered retraction |
US20100185219A1 (en) | 2007-04-25 | 2010-07-22 | Musculosketetal Transplant Foundation | Reinforced biological mesh for surgical reinforcement |
BRPI0701909A2 (en) | 2007-05-03 | 2008-12-16 | Fabio Cesar Atui | hemostatic clip, device for applying a hemostatic clip and its use |
US20090036923A1 (en) | 2007-05-04 | 2009-02-05 | Jabba Ronald J | Systems and methods for accommodating anatomical characteristics in the treatment of septal defects |
CA2685717C (en) | 2007-05-07 | 2015-08-11 | Tyco Healthcare Group Lp | Variable size-uniform compression staple assembly |
JP5331104B2 (en) | 2007-05-12 | 2013-10-30 | バロセンス、インク | Apparatus and method for gastric segmentation |
US20080287989A1 (en) | 2007-05-17 | 2008-11-20 | Arch Day Design, Llc | Tissue holding implants |
US8038045B2 (en) | 2007-05-25 | 2011-10-18 | Tyco Healthcare Group Lp | Staple buttress retention system |
US7549564B2 (en) * | 2007-06-22 | 2009-06-23 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulating end effector |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US8070779B2 (en) | 2007-06-04 | 2011-12-06 | K2M, Inc. | Percutaneous interspinous process device and method |
US7665646B2 (en) | 2007-06-18 | 2010-02-23 | Tyco Healthcare Group Lp | Interlocking buttress material retention system |
US7950561B2 (en) | 2007-06-18 | 2011-05-31 | Tyco Healthcare Group Lp | Structure for attachment of buttress material to anvils and cartridges of surgical staplers |
US7658311B2 (en) | 2007-06-22 | 2010-02-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with a geared return mechanism |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US7597229B2 (en) | 2007-06-22 | 2009-10-06 | Ethicon Endo-Surgery, Inc. | End effector closure system for a surgical stapling instrument |
EP2166966A1 (en) | 2007-07-03 | 2010-03-31 | Revolutionary Surgical Device, LLC | Methods and devices for continuous suture passing |
US8348972B2 (en) | 2007-07-11 | 2013-01-08 | Covidien Lp | Surgical staple with augmented compression area |
US20100228269A1 (en) | 2009-02-27 | 2010-09-09 | Garrison Michi E | Vessel closure clip device |
US7556185B2 (en) | 2007-08-15 | 2009-07-07 | Tyco Healthcare Group Lp | Surgical instrument with flexible drive mechanism |
US20090054916A1 (en) | 2007-08-23 | 2009-02-26 | Peter Meier | Clip-based method for treatment of uterine fibroids by obstruction of the uterine arteries |
US8061576B2 (en) | 2007-08-31 | 2011-11-22 | Tyco Healthcare Group Lp | Surgical instrument |
EP2233081B2 (en) | 2007-09-21 | 2018-03-28 | Covidien LP | Surgical device |
US7866523B1 (en) | 2007-09-21 | 2011-01-11 | Cardica, Inc. | Soft-tipped anvil |
CA2640345C (en) | 2007-10-05 | 2017-11-07 | Tyco Healthcare Group Lp | Surgical stapler having an articulation mechanism |
US8096460B2 (en) | 2007-10-05 | 2012-01-17 | Tyco Healthcare Group Lp | Surgical stapling apparatus |
US20090093826A1 (en) | 2007-10-05 | 2009-04-09 | Cardica, Inc. | Patent Foramen Ovale Closure System |
US8012170B2 (en) | 2009-04-27 | 2011-09-06 | Tyco Healthcare Group Lp | Device and method for controlling compression of tissue |
US8623034B2 (en) | 2007-10-19 | 2014-01-07 | Ethicon, Gmbh | Soft tissue repair implant |
US7942304B2 (en) | 2007-10-19 | 2011-05-17 | Tyco Healthcare Group Lp | Two piece anvil for surgical stapler |
WO2009052432A2 (en) | 2007-10-19 | 2009-04-23 | Coherex Medical, Inc. | Medical device for modification of left atrial appendange and related systems and methods |
US7954685B2 (en) | 2007-11-06 | 2011-06-07 | Tyco Healthcare Group Lp | Articulation and firing force mechanisms |
US20100234862A1 (en) | 2007-12-06 | 2010-09-16 | Manoj Patel | Surgical clamp and method of clamping an organ |
US20090171386A1 (en) | 2007-12-28 | 2009-07-02 | Aga Medical Corporation | Percutaneous catheter directed intravascular occlusion devices |
US9445820B2 (en) | 2007-12-31 | 2016-09-20 | Teleflex Medical Incorporated | Ligation clip with flexible clamping feature |
US20090182374A1 (en) | 2008-01-10 | 2009-07-16 | John Keith | Surgical staple |
US20090187198A1 (en) | 2008-01-22 | 2009-07-23 | Barry Weitzner | Resolution Clip |
US7905381B2 (en) | 2008-09-19 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with cutting member arrangement |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US7959051B2 (en) | 2008-02-15 | 2011-06-14 | Ethicon Endo-Surgery, Inc. | Closure systems for a surgical cutting and stapling instrument |
US20090209986A1 (en) | 2008-02-15 | 2009-08-20 | Stewart Michael C | Devices, Tools and Methods for Atrial Appendage Exclusion |
US8998933B2 (en) | 2008-02-28 | 2015-04-07 | Medtronic, Inc. | Surgical fastening clips, systems and methods for proximating tissue |
EP2098175B1 (en) | 2008-03-04 | 2011-08-17 | FUJIFILM Corporation | Clipping device |
US9138213B2 (en) | 2008-03-07 | 2015-09-22 | W.L. Gore & Associates, Inc. | Heart occlusion devices |
WO2009126298A1 (en) | 2008-04-11 | 2009-10-15 | Regents Of The University Of Minnesota | Fastener deployment system and method |
US20090255974A1 (en) | 2008-04-14 | 2009-10-15 | Tyco Healthcare Group Lp | Single loop surgical fastener apparatus for applying variable compression |
US8100310B2 (en) | 2008-04-14 | 2012-01-24 | Tyco Healthcare Group Lp | Variable compression surgical fastener apparatus |
US7926691B2 (en) | 2008-04-14 | 2011-04-19 | Tyco Healthcare Group, L.P. | Variable compression surgical fastener cartridge |
US8231040B2 (en) | 2008-04-14 | 2012-07-31 | Tyco Healthcare Group Lp | Variable compression surgical fastener cartridge |
ES2885755T3 (en) | 2008-04-16 | 2021-12-15 | Childrens Medical Center | Tissue clip |
US8028884B2 (en) | 2008-04-22 | 2011-10-04 | Tyco Healthcare Group Lp | Cartridge for applying varying amounts of tissue compression |
US20090275957A1 (en) | 2008-05-01 | 2009-11-05 | Harris Jason L | Clip and delivery assembly used in forming a tissue fold |
US8128642B2 (en) | 2008-05-02 | 2012-03-06 | Tyco Healthcare Group Lp | Fluid delivery system for surgical instruments |
CA2665017A1 (en) | 2008-05-05 | 2009-11-05 | Tyco Healthcare Group Lp | Surgical instrument with sequential clamping and cutting |
US20110054498A1 (en) | 2008-05-05 | 2011-03-03 | Niti Surgical Solutions Ltd. | Endoscopic compression clip and system and method for use thereof |
US7997468B2 (en) | 2008-05-05 | 2011-08-16 | Tyco Healthcare Group Lp | Surgical instrument with clamp |
US8186556B2 (en) | 2008-05-09 | 2012-05-29 | Tyco Healthcare Group Lp | Variable compression surgical fastener apparatus |
US8091756B2 (en) | 2008-05-09 | 2012-01-10 | Tyco Healthcare Group Lp | Varying tissue compression using take-up component |
US8967446B2 (en) | 2008-05-09 | 2015-03-03 | Covidien Lp | Variable compression surgical fastener cartridge |
US8424738B2 (en) | 2008-06-04 | 2013-04-23 | Covidien Lp | Attachable clamp for surgical stapler |
US8016176B2 (en) | 2008-06-04 | 2011-09-13 | Tyco Healthcare Group, Lp | Surgical stapling instrument with independent sequential firing |
US7942303B2 (en) | 2008-06-06 | 2011-05-17 | Tyco Healthcare Group Lp | Knife lockout mechanisms for surgical instrument |
US7789283B2 (en) | 2008-06-06 | 2010-09-07 | Tyco Healthcare Group Lp | Knife/firing rod connection for surgical instrument |
US7543730B1 (en) | 2008-06-24 | 2009-06-09 | Tyco Healthcare Group Lp | Segmented drive member for surgical instruments |
US8357170B2 (en) | 2008-07-09 | 2013-01-22 | Ethicon Endo-Surgery, Inc. | Devices and methods for placing occlusion fasteners |
WO2010006061A2 (en) | 2008-07-11 | 2010-01-14 | Mayo Foundation For Medical Education And Research | Left atrial appendage occlusion devices |
US8814778B2 (en) | 2009-06-23 | 2014-08-26 | Atricure, Inc. | Pericardial devices, systems and methods for occluding an atrial appendage |
WO2010011661A1 (en) | 2008-07-21 | 2010-01-28 | Atricure, Inc. | Apparatus and methods for occluding an anatomical structure |
US8801752B2 (en) | 2008-08-04 | 2014-08-12 | Covidien Lp | Articulating surgical device |
US8968355B2 (en) | 2008-08-04 | 2015-03-03 | Covidien Lp | Articulating surgical device |
US8056565B2 (en) | 2008-08-25 | 2011-11-15 | Tyco Healthcare Group Lp | Surgical clip applier and method of assembly |
CA2736836C (en) | 2008-08-29 | 2013-11-12 | Wilson-Cook Medical Inc. | Stapling device for closing perforations |
US8113405B2 (en) | 2008-09-03 | 2012-02-14 | Tyco Healthcare Group, Lp | Surgical instrument with indicator |
US9089415B2 (en) | 2008-09-05 | 2015-07-28 | Synovis Orthopedic And Woundcare, Inc. | Oblong cross-sectional tissue fixation peg |
US20100069924A1 (en) | 2008-09-11 | 2010-03-18 | Wilson-Cook Medical Inc. | Methods for achieving serosa-to-serosa closure of a bodily opening using one or more tacking devices |
US20100115739A1 (en) | 2008-09-16 | 2010-05-13 | Mathur Anant | Clip with hard and soft grips |
EP2344045A1 (en) | 2008-09-16 | 2011-07-20 | Ventralfix, Inc. | Method and apparatus for minimally invasive delivery, tensioned deployment and fixation of secondary material prosthetic devices in patient body tissue, including hernia repair within the patient's herniation site |
US8215532B2 (en) | 2008-09-23 | 2012-07-10 | Tyco Healthcare Group Lp | Tissue stop for surgical instrument |
US8070038B2 (en) | 2008-10-10 | 2011-12-06 | Tyco Healthcare Group, Lp | Surgical instrument with pivotable jaw member |
US20100125288A1 (en) | 2008-11-17 | 2010-05-20 | G&L Consulting, Llc | Method and apparatus for reducing renal blood pressure |
FR2938422A1 (en) | 2008-11-17 | 2010-05-21 | Pierre Sarradon | VASCULAR ANASTOMOSIS CLIPS AND METHOD OF APPLICATION |
WO2010080386A2 (en) | 2008-12-19 | 2010-07-15 | Wilson-Cook Medical Inc. | Clip devices and methods of delivery and deployment |
US8690911B2 (en) | 2009-01-08 | 2014-04-08 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage and related systems and methods |
US9393023B2 (en) | 2009-01-13 | 2016-07-19 | Atricure, Inc. | Apparatus and methods for deploying a clip to occlude an anatomical structure |
US8281974B2 (en) | 2009-01-14 | 2012-10-09 | Tyco Healthcare, Group LP | Surgical stapler with suture locator |
US8381961B2 (en) | 2009-01-14 | 2013-02-26 | Covidien Lp | Surgical stapling apparatus including staple with plate |
US8453905B2 (en) | 2009-01-26 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Surgical fastener for applying a large staple through a small delivery port |
US8142451B2 (en) | 2009-01-26 | 2012-03-27 | Microline Surgical, Inc. | Actuator and detachable connector of flexible clip applier |
AT507207B1 (en) | 2009-02-12 | 2010-03-15 | Johann Mag Klaffenboeck | SURGICAL CLAMMING DEVICE |
US10702275B2 (en) | 2009-02-18 | 2020-07-07 | St. Jude Medical Cardiology Division, Inc. | Medical device with stiffener wire for occluding vascular defects |
US8906037B2 (en) | 2009-03-18 | 2014-12-09 | Endogastric Solutions, Inc. | Methods and devices for forming a tissue fold |
US7988027B2 (en) | 2009-03-31 | 2011-08-02 | Tyco Healthcare Group Lp | Crimp and release of suture holding buttress material |
US8292154B2 (en) | 2009-04-16 | 2012-10-23 | Tyco Healthcare Group Lp | Surgical apparatus for applying tissue fasteners |
FR2944432B1 (en) | 2009-04-21 | 2011-07-15 | Cie Euro Etude Rech Paroscopie | SURGICAL RING WITH ASSEMBLED CONSTRUCTION |
DE102009018821A1 (en) | 2009-04-24 | 2010-10-28 | Aesculap Ag | Surgical instrument for applying ligature clips |
DE102009018819A1 (en) | 2009-04-24 | 2010-10-28 | Aesculap Ag | Surgical instrument for applying ligature clips |
US8728099B2 (en) * | 2009-05-12 | 2014-05-20 | Ethicon, Inc. | Surgical fasteners, applicator instruments, and methods for deploying surgical fasteners |
EP2429415B1 (en) | 2009-05-14 | 2013-03-27 | Cook Medical Technologies LLC | Systems for securing a graft member to tissue using one or more tacking devices |
US9023069B2 (en) | 2009-05-18 | 2015-05-05 | Covidien Lp | Attachable clamp for use with surgical instruments |
US8225980B1 (en) | 2009-06-02 | 2012-07-24 | Cardica, Inc. | True multi-fire surgical stapler with buttress strip |
EP2442728B1 (en) | 2009-06-17 | 2018-07-25 | Coherex Medical, Inc. | Medical device for modification of left atrial appendage |
US9463260B2 (en) | 2009-06-29 | 2016-10-11 | Covidien Lp | Self-sealing compositions |
US8276802B2 (en) | 2009-07-11 | 2012-10-02 | Tyco Healthcare Group Lp | Surgical instrument with double cartridge and anvil assemblies |
BRMU8901448U2 (en) | 2009-07-23 | 2010-10-05 | Fernando Cesar Tomazzi Lissa | constructive arrangement applied to surgical clip |
CA2769252C (en) | 2009-07-30 | 2016-01-12 | Evonik Roehm Gmbh | Powdery or granulated composition comprising a copolymer, a salt of a fatty monocarboxylic acid and a fatty monocarboxylic acid and/or a fatty alcohol |
US8647350B2 (en) | 2009-08-11 | 2014-02-11 | Raptor Ridge, Llc | Delivery device and method for compliant tissue fasteners |
US10349935B2 (en) * | 2009-08-11 | 2019-07-16 | Datascope Corp. | Delivery device and method for compliant tissue fasteners |
US8276801B2 (en) | 2011-02-01 | 2012-10-02 | Tyco Healthcare Group Lp | Surgical stapling apparatus |
US8342378B2 (en) | 2009-08-17 | 2013-01-01 | Covidien Lp | One handed stapler |
US9402757B2 (en) | 2009-08-24 | 2016-08-02 | Cvdevices, Llc | Devices, systems and methods for tissue restoration |
WO2011028196A2 (en) | 2009-08-24 | 2011-03-10 | Vitalitec International, Inc. | Method of manufacture of clip applying jaws |
US9089391B2 (en) | 2009-08-24 | 2015-07-28 | Cvdevices, Llc | Tissue restoration devices, systems, and methods |
US20110054515A1 (en) | 2009-08-25 | 2011-03-03 | John Bridgeman | Device and method for occluding the left atrial appendage |
US20110054494A1 (en) | 2009-08-27 | 2011-03-03 | Md-Art, Inc. | Clip and closure system |
US20110082495A1 (en) | 2009-10-02 | 2011-04-07 | Ruiz Carlos E | Apparatus And Methods For Excluding The Left Atrial Appendage |
US8152041B2 (en) | 2009-10-14 | 2012-04-10 | Tyco Healthcare Group Lp | Varying tissue compression aided by elastic members |
WO2011050658A1 (en) | 2009-10-26 | 2011-05-05 | 北京中法派尔特医疗设备有限公司 | Line stapler |
DE102009051408A1 (en) | 2009-10-30 | 2011-05-05 | Ovesco Endoscopy Ag | Medical instrument for setting tissue clips |
WO2011057282A2 (en) | 2009-11-09 | 2011-05-12 | Cardiovascular Technologies, Inc. | Tissue closure devices, device and systems for delivery, kits and methods therefor |
US8186558B2 (en) | 2009-11-10 | 2012-05-29 | Tyco Healthcare Group Lp | Locking mechanism for use with loading units |
US9682180B2 (en) | 2009-11-15 | 2017-06-20 | Thoratec Corporation | Attachment system, device and method |
US8235272B2 (en) | 2009-11-20 | 2012-08-07 | Tyco Healthcare Group Lp | Surgical stapling device with captive anvil |
WO2011066533A1 (en) | 2009-11-30 | 2011-06-03 | Clevex, Inc. | Clip assembly and method for approximating a wound in tissue |
DE102009059192A1 (en) | 2009-12-17 | 2011-06-22 | Aesculap AG, 78532 | Surgical instrument surgical system and method and method for connecting body tissue parts |
US20110152895A1 (en) | 2009-12-22 | 2011-06-23 | Colin Nyuli | Apparatus for clamping an organ during surgery |
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 |
JP5828147B2 (en) | 2010-01-20 | 2015-12-02 | マイクロ インターベンショナル デバイシズ,インコーポレイティド | Tissue repair implant, delivery device and delivery method |
EP2528512B1 (en) | 2010-01-29 | 2018-04-11 | Advanced Bariatric Technology, LLC | Surgical clamp |
US7845588B1 (en) * | 2010-03-02 | 2010-12-07 | Mark Trevis Goodick | Portable tool utilizing compound leveraged actuation to reduce medicine solids |
WO2011112577A1 (en) | 2010-03-09 | 2011-09-15 | Teleflex Medical Incorporated | Narrow profile surgical ligation clip |
US9597089B2 (en) | 2010-03-10 | 2017-03-21 | Conmed Corporation | Surgical clips for laparoscopic procedures |
US20110238094A1 (en) | 2010-03-25 | 2011-09-29 | Thomas Jonathan D | Hernia Patch |
RO126740A2 (en) * | 2010-04-02 | 2011-10-28 | Cătălin Eşanu | Endoscopic surgery instrument with detachable clamp, clamp-extractor and method for using the same |
US20110295290A1 (en) | 2010-05-28 | 2011-12-01 | Whitfield Kenneth H | Surgical hemostatic clip including work-hardened, movement-inhibiting structure and method of manufacturing same |
US20110295291A1 (en) | 2010-05-28 | 2011-12-01 | Dean Trivisani | Novel Vascular Clamp |
EP2392268A1 (en) | 2010-06-07 | 2011-12-07 | Top-Bound Enterprise Co. Ltd. | Improved vascular clamp structure |
US20110313437A1 (en) | 2010-06-16 | 2011-12-22 | Top-Bound Enterprise Co., Ltd. | Vascular clamp structure |
US20120130421A1 (en) | 2010-06-18 | 2012-05-24 | The Curators Of The University Of Missouri | Ratcheting staple for surgical applications |
US8828051B2 (en) | 2010-07-02 | 2014-09-09 | Pfm Medical Ag | Left atrial appendage occlusion device |
US8764778B2 (en) | 2010-07-08 | 2014-07-01 | Sarkis Yeretsian | Biodegradable suture clip for joining bodily soft tissue |
US20120012641A1 (en) | 2010-07-19 | 2012-01-19 | Milliman Keith L | Anvil assembly for surgical stapling device |
US8403946B2 (en) | 2010-07-28 | 2013-03-26 | Covidien Lp | Articulating clip applier cartridge |
US8827136B2 (en) | 2010-08-11 | 2014-09-09 | Covidien Lp | Endoscopic purse string surgical device |
US8733613B2 (en) | 2010-09-29 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
JP5917529B2 (en) | 2010-09-30 | 2016-05-18 | 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. | Surgical stapling instrument having a compatible staple cartridge configuration |
US8783542B2 (en) | 2010-09-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Fasteners supported by a fastener cartridge support |
US9232941B2 (en) | 2010-09-30 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a reservoir |
US20120248169A1 (en) | 2010-09-30 | 2012-10-04 | Ethicon Endo-Surgery, Inc. | Methods for forming tissue thickness compensator arrangements for surgical staplers |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US9168038B2 (en) | 2010-09-30 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising a tissue thickness compensator |
US10335157B2 (en) | 2010-10-02 | 2019-07-02 | Covidien Lp | Asymmetrical surgical clip with penetrating lock, non-slip clamping surface, severable hinge, hinge boss and pivoting applicator tip |
NZ609024A (en) | 2010-10-15 | 2015-03-27 | Surgiclamp Pty Ltd | Surgical clamping devices and tools for use therewith |
US9017349B2 (en) | 2010-10-27 | 2015-04-28 | Atricure, Inc. | Appendage clamp deployment assist device |
US9011464B2 (en) | 2010-11-02 | 2015-04-21 | Covidien Lp | Self-centering clip and jaw |
US8292150B2 (en) | 2010-11-02 | 2012-10-23 | Tyco Healthcare Group Lp | Adapter for powered surgical devices |
DE102010060322A1 (en) | 2010-11-03 | 2012-05-03 | Aesculap Ag | Surgical instrument comprises pair of receiving elements which are torque-proof connected by coupling element and arrest device that is set for locking retainer in fixed position |
DE202010008941U1 (en) | 2010-11-03 | 2010-12-23 | Aesculap Ag | Surgical instrument |
WO2012064643A1 (en) | 2010-11-09 | 2012-05-18 | Cook Medical Technologies Llc | Clip system having tether segments for closure |
US8308041B2 (en) | 2010-11-10 | 2012-11-13 | Tyco Healthcare Group Lp | Staple formed over the wire wound closure procedure |
US8636754B2 (en) | 2010-11-11 | 2014-01-28 | Atricure, Inc. | Clip applicator |
US9186152B2 (en) | 2010-11-12 | 2015-11-17 | W. L. Gore & Associates, Inc. | Left atrial appendage occlusive devices |
US8480703B2 (en) | 2010-11-19 | 2013-07-09 | Covidien Lp | Surgical device |
US8348130B2 (en) | 2010-12-10 | 2013-01-08 | Covidien Lp | Surgical apparatus including surgical buttress |
GB201100902D0 (en) | 2011-01-19 | 2011-03-02 | Univ Dundee | A surgical guide and tissue anchor |
US20120283585A1 (en) | 2011-02-10 | 2012-11-08 | Werneth Randell L | Atrial Appendage Occlusion and Arrhythmia Treatment |
US8479968B2 (en) | 2011-03-10 | 2013-07-09 | Covidien Lp | Surgical instrument buttress attachment |
US9044229B2 (en) | 2011-03-15 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical fastener instruments |
EP2688492A4 (en) | 2011-03-21 | 2015-07-08 | Univ Tulane | Multi-component detachable jaw tools and methods of using and making same |
WO2012173678A2 (en) | 2011-03-22 | 2012-12-20 | Nicholson William D Iv | System of fastening gastric sleeves |
DE202012001672U1 (en) | 2012-02-16 | 2012-03-30 | Anja Honnefelder | Surgical clip |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
US9888921B2 (en) | 2013-03-13 | 2018-02-13 | Covidien Lp | Surgical stapling apparatus |
US9700311B2 (en) * | 2013-11-08 | 2017-07-11 | Ethicon Llc | Tissue ingrowth materials and method of using the same |
US10485545B2 (en) | 2013-11-19 | 2019-11-26 | Datascope Corp. | Fastener applicator with interlock |
JP6396667B2 (en) * | 2014-03-31 | 2018-09-26 | オリンパス株式会社 | Auricular ligation system |
CN106344101A (en) * | 2015-07-07 | 2017-01-25 | 北京天钥医疗器械有限公司 | Clip applier for medical use and the safety device thereof |
-
2019
- 2019-03-27 JP JP2020551904A patent/JP7348199B2/en active Active
- 2019-03-27 AU AU2019243731A patent/AU2019243731A1/en active Pending
- 2019-03-27 US US16/366,738 patent/US11653928B2/en active Active
- 2019-03-27 CA CA3094709A patent/CA3094709A1/en active Pending
- 2019-03-27 CN CN201980029858.1A patent/CN112074240A/en active Pending
- 2019-03-27 WO PCT/US2019/024341 patent/WO2019191271A1/en unknown
- 2019-03-27 EP EP19777210.6A patent/EP3773256A4/en active Pending
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2023
- 2023-04-28 US US18/309,607 patent/US20230270443A1/en active Pending
- 2023-08-21 JP JP2023133920A patent/JP2023144125A/en active Pending
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JP7348199B2 (en) | 2023-09-20 |
EP3773256A1 (en) | 2021-02-17 |
EP3773256A4 (en) | 2021-12-15 |
AU2019243731A1 (en) | 2020-10-08 |
CN112074240A (en) | 2020-12-11 |
WO2019191271A1 (en) | 2019-10-03 |
JP2021519150A (en) | 2021-08-10 |
JP2023144125A (en) | 2023-10-06 |
CA3094709A1 (en) | 2019-10-03 |
US11653928B2 (en) | 2023-05-23 |
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